Stunting Detection and Education Training Course for Kindergarten Teachers

. Indonesia has the third highest prevalence of stunting among children under five in Southeast Asia, which in 2018 reached 30.8%. The incidence of stunting in the Sleman Regency of Yogyakarta has increased significantly, from 7.20% in 2020 to 16.0% in 2021. Preschool-aged children are one group of children who are at high risk of stunting. One strategy for addressing nutrition issues is for teachers to become more knowledgeable about the importance of health screening for students. Community services were carried out in 11 ABA Kindergartens in Mlati District from February to March 2022. The targets were 35 teachers and 120 students. All kindergarten teachers in the Mlati District received training in stunting detection and education. The stunting detection card was also tested at IIUM Educare SDN BHD, Malaysia. The procedure for the community service activities is divided into several stages: coordination with the Head of the Aisyiyah Mlati Branch Office and the Chairperson of the ABA Kindergarten Teachers Association; training for the teachers in detecting stunting; and providing stunting education to all ABA Kindergarten teachers in the Mlati District. The results of the community service show that kindergarten teachers' knowledge of stunting prevention has increased, as have skills in stunting screening .


Introduction
One of the nutritional problems experienced by toddlers around the world is stunting.Stunting is a chronic malnutrition condition caused by a prolonged lack of nutrients.The child is shorter or dwarfed than the average age [1].Stunting is a major threat to human quality because it can impact the next life's sustainability, such as developmental delays, intellectual decline, and decreased productivity, resulting in poverty [1,2].In 2017, the global stunting rate for children under the age of five was 22.2% or approximately 150.8 million children [3].There are 83.6 million stunted children under five in Asia, with South Asia having the highest proportion (58.7%) and Central Asia having the lowest (0.9%) [1].According to the World Health Organization (WHO), Indonesia has the third highest prevalence of stunting among children under five in the Southeast Asia/South-East Asia Regional region.The number of stunting incidents in Indonesia in 2018 reached 30.8%, indicating that the stunting rate in Indonesia in 2021 was quite high [4,5].
Yogyakarta Special Region is one of the provinces in Indonesia that still has a stunting problem.The prevalence of stunting in children under five in Kulonprogo is 11.30%, Bantul District is 9.70%, Gunung Kidul is 17.40%, Sleman is 7.20%, and Yogyakarta City is 14.30%.According to the Indonesian Ministry of Health, the stunting rate will be 17.3% in 2021.Gunung Kidul comes in first with 20.6%, followed by Bantul at 19.1%, Yogyakarta at 17.1%, Kulon Progo at 14.9%, and Sleman at 16.0%.Stunting increased significantly in Sleman, rising from 7.20% in 2020 to 16.0% in 2021 6 .Mlati is one of the sub-districts in the Sleman Regency, where the incidence of stunting reaches 9% (Figure 1)  2019) [7], preschool-age children are one group of children who are at high risk of stunting.Stunting in preschool children impacts the learning process at school, such as not being able to put up pictures, distinguish colors, determine gender, distinguish objects given, be easily emotional, and also leads to some social consequences.Anxiety, self-doubt, and feelings of unhappiness can all be the symptoms of emotional problems [8].
One strategy for addressing nutrition issues in Sleman Regency is for teachers to become more knowledgeable about the importance of health screening for students.Kindergarten/PAUD teachers can be targeted for a prevention effort because they play a role in anticipating and reducing stunting rates in children under five [9,10].To train teachers about stunting detection, education cards can be used to prevent and reduce stunting in preschoolers.The health approach is to improve the knowledge and skills of kindergarten teachers or caregivers.This approach is consistent with one of the government's programs to support the 2025 Global Nutrition Target.
According to previous research, counseling activities can produce skilled teachers for measuring growth.Sefrina and Elvandari (2020) stated counseling activities improve teachers' knowledge of assessing students' nutritional status [11].Furthermore, there is a link between knowledge and the accuracy of early detection of stunting.He is implying that the greater PAUD teachers' knowledge, the more accurate the results of early detection of stunting [11].

Methodology
The first activity in this community service was the improvement of the stunting detection and education card in collaboration with International Islamic University Malaysia service members (Dr Siti Hazariah Binti Abdul Hamid).The development of a stunting detection card was adapted for preschool-aged children in Southeast Asia so that the stunting detection and education card will become a reference and be used in Southeast Asian countries, particularly Indonesia and Malaysia.
The community service activities were carried out in all 11 ABA Kindergartens in Mlati District (TK ABA Blunyah Gede, TK ABA Jongke, TK ABA Kusumajati, TK ABA Kutu Asem, TK ABA Mulungan, TK ABA Sendanghadi, TK ABA Sinduadi, TK ABA Sono, TK ABA Sumberadi, TK ABA Tlogoadi II, TK ABA Tlogoadi Nyamplungan) and IIUM Educare SDN BHD, Malaysia during February to March 2022.The participants were 35 teachers and 120 students.All kindergarten teachers in the Mlati District received training in stunting detection and education.The stunting detection card was also tested at IIUM Educare SDN BHD, Malaysia.
The procedure for community service activities was divided into several stages, the first was coordination with the Head of the Aisyiyah Mlati Branch Office, the Chairperson of the ABA Kindergarten Teachers Association (IGABA), and the Chairperson of IIUM Educare SDN BHD, Malaysia.The next stage was teacher training in detecting stunting using a stunting detection card in preschool-aged children.The last stage was providing stunting education to all ABA Kindergarten teachers in the Mlati District.
The data was gathered through a series of measurements.Before beginning the activity, the community service team administered a pretest to ABA kindergarten teachers to assess their knowledge, attitudes, and behavior toward stunting prevention.Teachers are trained in the use of the stunting detection card.The next activity was stunting education for both kindergarten teachers and the student's parents.Following the completion of all activities, a posttest was administered to assess the teacher's knowledge, attitude, and psychomotor skills.

Results and Discussion
TK ABA is one of the kindergarten in Mlati, Sleman.The activities in TK ABA start from Monday to Saturday at 07.30 -11.00 WIB.The health programs in school are the measurement of body height, weight, arm circle, and head circle which are done once a month.Additionally, there is also supplementary feeding each week or when there is no supplementary feeding, the students bring nutritious food from home.By January 2023, the number of teachers teaching at TK ABA Kabupaten Sleman was 48 teachers.Training activities of TK ABA teachers were attended by 36 teachers coming from 11 TK ABA in the district of Mlati Sleman Yogyakarta.Activities were held at ABA TK Sinduadi Mlati Sleman DIY on Tuesday, December 13, 2022, from 08.00 to 15.00.The material provided was stunting prevention and how to detect stunting in students using stunting detection cards.

Figure 2. Training activities for TK ABA Teachers
The teachers who attended the training totaled 36 people but those who completed the pretest and posttest were only 30 people.This happened because six teachers asked for permission not to attend some remaining sessions of the training activities.The characteristics of the teachers can be seen in Table 1.  1 shows the average age of respondents who work as teachers is 46 years.Most of the respondents come from ABA Sinduadi Kindergarten, with undergraduate education and an average length of working as a teacher is 18.17 years.Training and follow-up of training were held from December to January 2023 and the training materials provided were in accordance with the training plan that had been prepared.Follow-up trainings were in the form of monitoring and evaluating teachers' abilities in conducting stunting education for parents and stunting detection for students.Teachers at ABA Blunyah Gede Kindergarten and ABA Sinduadi Kindergarten have conducted education about stunting at parents' meetings in their kindergartens.The media used were stunting detection and education cards developed by the community service team.In addition to conducting education, teachers were also trained to measure students' height and nutritional status (Figure 4).Table 2 shows that the majority of teachers rate the material used during the stunting education and stunting detection training as excellent and good.3 shows that there is an increase in knowledge following the training, but no change in attitudes.
The teacher's knowledge of stunting prevention improved as a result of the community service.This corresponds to the respondents' educational level, the majority of whom are S1.The reception of information is influenced by a person's level of education.Someone with a higher level of education will be able to receive information more easily than someone with a lower level of education.The educational level of a person influences their knowledge of the parenting style, whereas inappropriate parenting can lead to an increase in stunting [12].The higher the education taken, the wider the knowledge possessed by the teacher.Greater ability and knowledge possessed by the teachers allow them to increase their ability and knowledge as teaching staff to help growing children prevent stunting [13,14].
According to the findings of this study, the teacher's attitude toward preventing stunting before receiving an intervention was in the good, sufficient, and lacking categories.This corresponds to the respondents' educational level, the majority of whom are S1.The level of education has a significant impact on a person's critical thinking when it comes to searching and processing information.The knowledge a person possesses influences his/her attitude.Knowledge is a critical factor in the formation of one's actions.Understandingbased knowledge will foster a positive attitude in efforts to prevent stunting [15,16].

Conclusion
The results of the community service showed that ABA Kindergarten teachers who participated in stunting detection and education training had an increased knowledge about stunting detection and education.Speaker and infrastructure evaluations were also very positive.

Figure 1 .
Figure 1.Prevalence of stunting (short and very short) in Sleman Regency According to De Onis et al. (2019)[7], preschool-age children are one group of children who are at high risk of stunting.Stunting in preschool children impacts the learning process at school, such as not being able to put up pictures, distinguish colors, determine gender, distinguish objects given, be easily emotional, and also leads to some social consequences.Anxiety, self-doubt, and feelings of unhappiness can all be the symptoms of emotional problems[8].One strategy for addressing nutrition issues in Sleman Regency is for teachers to become more knowledgeable about the importance of health screening for students.Kindergarten/PAUD teachers can be targeted for a prevention effort because they play a role in anticipating and reducing stunting rates in children under five[9,10].To train teachers about stunting detection, education cards can be used to prevent and reduce stunting in preschoolers.The health approach is to improve the knowledge and skills of kindergarten teachers or caregivers.This approach is consistent with one of the government's programs to support the 2025 Global Nutrition Target.According to previous research, counseling activities can produce skilled teachers for measuring growth.Sefrina and Elvandari (2020) stated counseling activities improve teachers' knowledge of assessing students' nutritional status[11].Furthermore, there is a link between knowledge and the accuracy of early detection of stunting.He is implying that the greater PAUD teachers' knowledge, the more accurate the results of early detection of stunting[11].

Figure 3 .
Figure 3. Stunting education for teachers from TK ABA Blunyah Gede and TK ABA Sinduadi

Figure 4 .
Figure 4. Stunting detection by teachers from TK ABA Blunyah Gede dan TK ABA Kutu AsemThe Kirkpatrick method was used to evaluate the training program.The total number of teachers who attended the training was 36, but only 30 completed the pre and posttest questionnaires.There were two types of training evaluation: reaction evaluation and learning evaluation.