Counselling on Stunting in Children and How to Prevent it in Bengkok Village, Mahendra-Cibaliung, Pandeglang Regency

The main purpose of this counseling is to provide clear information to mothers in Bengkok Village regarding what stunting is and how to prevent stunting in toddlers. Stunting disease is a physical growth disorder of toddlers characterized by a decrease in growth speed and impacts nutritional imbalances. Stunting illness can usually be seen from the condition of the toddler's height which is less when compared to his friends his age. Lack of nutritional intake in children is a picture of stunted toddlers. Socio-economic factors influence the high prevalence of stunting, including parents' economic status, family food security, parental education and knowledge, number of family members, sanitation, and environmental hygiene. Counseling on stunting and how to prevent it was carried out in Bengkok Village, Pandeglang in August 2022.


Introduction
Stunting disease is a physical growth disorder of toddlers characterized by a decrease in growth speed and impacts nutritional imbalances. Stunting illness can usually be seen from the condition of the toddler's height which is less when compared to his friends his age. In addition to size, stunting in toddlers can impact decreasing productivity and intellectual development of toddlers and, in the future, will experience difficulties in achieving optimal physical and cognitive development (Sekretariat Wakil Presiden RI, 2021). Based on the report of the Ministry of Health of the Republic of Indonesia (2018;2021), stunting in children under five is measured by height for age which is more than minus two standard deviations from the median growth standard based on WHO. Stunting is formed by inadequate growth faltering and catch-up growth, which reflects the inability to achieve optimal growth. It reveals that groups of toddlers born with normal weight can experience stunting if the fulfillment of further needs is not met correctly (Kementerian Kesehatan RI, 2018;Rahmadhita, 2020;WHO, 2017).
Stunting is used as an indicator of chronic malnutrition, describing the long-term history of malnutrition in children under five. Stunting disease in toddlers is one of the most common nutritional problems experienced by toddlers in all countries, including Indonesia. Based on the results of the Indonesian Nutrition Status Survey (SSGI) conducted by the Indonesian Ministry of Health in 2021, the stunting prevalence rate in Indonesia is 24.4%. This figure has decreased, which in 2018 was reported to have a prevalence rate of 30.8%. Until now, it is targeted to decrease to 14% by 2024 (Sekretariat Wakil Presiden Republik Indonesia, 2017)(Sekretariat Wakil Presiden Republik Indonesia, 2017).
Lack of nutritional intake in children is a picture of stunted toddlers. Socioeconomic factors are one of the factors that influence the high prevalence of stunting, including the economic status of parents, family food security, parental education and knowledge, number of family members, environmental sanitation and hygiene as well as access to buy food and to the nearest health service (Asri Dewi & Primadewi, 2021;Budiastutik & Nugraheni, 2018;Saadah, 2020).
Economic status can be seen in parents' income from various aspects such as work, sales, or other things. A research result conducted by Ruswati et al. (2021) shows that low-income parents with short toddler heights get 41 toddlers (87.2%). The category of low parent income with very short toddler heights gets 6 toddlers (12 ,8%), while the category of high income parents with short toddler height was not found. The type of high-income parents with very short toddler height obtained two toddlers (100%). So that the results of the continuity between the economic status of parents and the incidence of stunting are obtained were with sufficient income, the food purchased is of the best quality and with enough quantity so that it will reduce the stunting rate that occurs (Kementerian Kesehatan RI, 2018;Teja, 2019).
Parental education, especially for mothers, will influence choosing nutritious food, a daily meal for pregnant women and toddlers, or Complementary Foods for Mother's Milk (MP-ASI). Mother's knowledge will be needed to apply nutritional information to daily food.
According to Beal, Tumilowicz, Sutrisna, Izwardy, & Neufeld (2018) dan Ruswati et al. (2021), maternal knowledge that is less related to the incidence of stunting in toddlers aged 6-36 months with a p-value of 0.008 has a 3.27 times risk of experiencing stunting under five. And also mothers who still hold fast to the opinions of previous people about what can and cannot be given to toddlers. Brilliant mothers https://equatorscience.com/index.php/move can undoubtedly apply their knowledge of 4 healthy five perfect in their daily lives for themselves and their children.
Environmental cleanliness is also a significant thing to pay attention to. A dirty and unguarded environment will become a breeding ground for disease and cause many infections (Sekretariat Wakil Presiden Republik Indonesia, 2017). Clean water sources have not yet reached areas far from reach, such as in Bengkok Village. Public access to buy food and the nearest health service also needs to be considered.
Many areas in Indonesia are very far from shopping centers such as markets, so people in these areas can only buy food from traders. Roads in Indonesia, especially for areas located in the interior, need to be improved so that access from outside and inside can be achieved to meet the needs of daily life. Adequate health services are also required in each area. Starting from facilities, child immunization, checking pregnant women, etc. So that people understand more, it is easier to get health aspects and reduce stunting in the area (Kementerian Kesehatan RI, 2018;Ruswati et al., 2021).
Based on the introduction that has been stated, the formulation of the problem from this research is how to prevent stunting in Bengkok Village, Mahendra Village, Cibaliung District, Pandeglang Regency. At the same time, the main purpose of this counseling is to provide clear information to mothers in Bengkok Village regarding what stunting is and how to prevent stunting in toddlers.

Implementation Method
The counseling activity was held in conjunction with the monthly routine posyandu in Bengkok Village in August 2022. The counseling was delivered directly by the Village Midwife, namely Midwife Tresna and Midwife Ikah. The targets of this counseling are pregnant women and mothers who have toddlers in Bengkok Village, one of the villages in Mahendra Village, which is very far to reach or is in the forest's interior. The target for the success of counseling is that local mothers understand stunting and how to prevent it.

Result and Discussion
Based on the factors described in the introduction, the first is related to the local community's economy. Most of the livelihoods of the Bengkok Village community are farmers and fishermen whose income does not even reach the Regional Minimum Wage (Sekretariat Wakil Presiden Republik Indonesia, 2017).
However, not a few are unable to find work, so their income is not fulfilled. The local government can try to discuss job creation with the community and village officials. Judging from the geographical location of Mahendra Village in the mountains, it opens up opportunities for the construction of tourist attractions so that they can open new jobs and incomes that are suitable or even higher than the minimum wage.
Furthermore, related to food, the sources of protein and fiber found in Mahendra Village are less diverse. And there are some vegetables whose prices cannot be reached by people with low incomes. Mother's knowledge is also vital regarding the food chosen to be a source of daily food nutrition. As explained in the introduction, the women in Bengkok Village, Mahendra Village, still firmly adhere to the opinions of previous people, such as toddlers who can only consume rice with salt. This makes the child's nutrition significantly less.
Therefore, the village midwife gave directions again regarding four healthy five perfect per the instructions from Kementerian Kesehatan RI (2018) dan World Health Organization (2021). According to sources, not all nutritious food is expensive. For https://equatorscience.com/index.php/move example, a protein source from puffer fish can still be purchased at affordable prices by the surrounding community. The women of Bengkok Village were also advised to pay more attention to nutrition than taste.
Furthermore, environmental hygiene, sanitation, and clean water are essential to prevent stunting. In Bengkok Village, there is no waste sorting, and it is still far from pure, local people pile garbage in wells or burn it. And because of that, the well that was supposed to be a place to get clean water was turned into a garbage dump.
The local government needs to pay attention to how the community will dispose of waste, select waste, and maximize clean water. The village midwife also conveyed to the mothers that proper waste sorting affects children's health.
Road access is also something that needs to be considered in Bengkok Village, located in the forest's interior. The road to Kampung Bengkok is also very far from good words. The road is full of stones and dirt and goes up and down sharply. Difficulty in access means that local people can only rely on traveling merchants who pass by, and this is very rare because access is so complicated that it is rare for itinerant traders to pass through Kampung Bengkok. The local government can pay attention to road access for the Bengkok Village community so that food or other things can be spread evenly throughout the village.
The last time there were inadequate health services, the posyandu in Bengkok Village was very small. So it can not fit many activities there. The Cibaliung District Health Center has facilitated the necessary vitamins and tools to check pregnant women. However, it is also expected to pay attention to the facilities so that local people are more comfortable visiting the posyandu for health checks. Before the posyandu activity begins, there is a photo documentation session with pregnant women and mothers of toddlers next to the posyandu. The action started at 08.00 WIB with posyandu first. Our team helps midwives to prepare the necessary tools, such as tools to check pregnant women, then immunizations for toddlers. We also recorded children under five and pregnant women in the Bengkok Village.
The immunization and check-up activities for pregnant women lasted until 10.00 WIB. Then it was continued with stunting counseling which was held in a saung near the posyandu and attended by approximately 20 women from Bengkok Village. Midwife Tresna opened the counseling and explained the definition of stunting and what causes stunting.

Conclusion
Counseling on stunting and prevention occurred in Bengkok Village, Mahendra Village, Cibaliung District, Pandeglang Regency in August 2022. Counseling was delivered directly by the Village Midwife, namely Midwife Tresna, who conveyed the understanding and causes of stunting in toddlers, and then Midwife Ikah who explained how to prevent stunting. There were approximately 20 mothers who took part in this counseling activity, and all were enthusiastic about participating, which could be seen from the questions posed to the village midwife as a resource person.