ISSN: ISSN: 0974-5823 Vol. 7 No.

2 February, 2022
International Journal of Mechanical Engineering

Impact Of The Covid-19 Pandemic On The

Convergence Effort Of Stunting Prevention And
Treatment In East Java Province
Diadjeng Setya W 1), Rismaina Putri 2), Miftahul Jannah 3)
Medicine Faculty, Universitas Brawijaya, Malang, Indonesia 1,2,3)
Correspondence address: Diadjeng Setya Wardani

ABSTRACT
Background : Stunting occurs as a result of chronic nutritional deficiency. Malnutrition that occurs results in children not being
able to reach their maximum growth potential. The benchmark for the success of the program can be seen from the achievements of
the program indicator (monitoring nutritional status, exclusive breastfeeding, Vitamin A, Supplementary Feeding (PMT), Infant and
Child Feeding, and visit at health facilities. During the Covid-19 pandemic, public health centre activities did not normally (has an
impact on the number of visits to health care facilities with an average of 65% per month).
Aims: To analyze the factors causing the decline in visits and the effect of visits during the Covid-19 pandemic on stunting
prevention efforts.
Method : Observational analytic with cross-sectional approach. The research subjects were 70 mothers with toddlers and 21 officers
in seven health offices in the province of East Java. Data analysis used Fisher's exact test and calculated the prevalence ratio to find
out the most dominant role that influenced the decrease in visits.
Results: The results showed that knowledge related to covid-19 (p-value 0.033, positive attitude (p-value 0.023), and education of
health workers (0.045) had an effect on visits, while family support (p-value 0.007) had no effect on visits. , The prevalence ratio
of each component is education of health workers (PR = 0.714) followed by knowledge support (0.667), family support (PR = 0.333)
and positive attitude (PR = 0.600). Next is the effect of decreasing visits on stunting prevention efforts. (p-value = 0.043).
Conclusion: There is a significant role that most influences maternal visits, namely the education of health workers regarding health
protocols in preventing the transmission of covid-19, and there is an effect of decreasing visits on stunting prevention efforts.

Keywords : Visit, public health centre, Stunting, Decrease

BACKGROUND
According to the World Health Organization in 2018 in the Ministry of Health (2018), stunting is a growth problem in Indonesia,
which is currently still high. The prevalence of stunting in 2018 reached 30.8% while the 2019 National Medium-Term Development
Plan (RPJMN) target was 28%[1]. Stunting is a condition of failure to thrive in children under five as a result of chronic malnutrition
so that the child is too short for his age. Malnutrition occurs since the baby is in the womb and in the early days after the baby is
born, stunting is only seen after the baby is 2 years old [2].
Stunting is a condition of failure to thrive in children under five as a result of chronic malnutrition so that the child is too short for
his age. Malnutrition occurs since the baby is in the womb and in the early days after the baby is born, stunting is only seen after
the baby is 2 years old [3]. Stunting occurs as a result of chronic nutritional deficiencies, especially in the first 1000 days of a child's
life. Malnutrition that occurs during this period results in irreversible growth and development of children, so they cannot reach
their maximum growth potential [4].
Stunting or often called disproportionately short is a condition of failure to thrive in children under five years old (toddlers) due to
chronic malnutrition and repeated infections, especially in the first 1,000 days of life (HPK), from fetus to child aged 23 months [5].
The short-term impacts on children who experience stunting are impaired body growth, metabolic disorders, impaired brain
development, and affect children's intelligence [6]. The results of the study found that in the long term it will result in children who
are short in stature who will have a great opportunity to earn lower amounts of income as adults [7]. Therefore, stunting is a
nutritional problem that must be addressed or prevented as early as possible.
Efforts to accelerate stunting prevention will be more effective if specific nutrition intervention programs and sensitive nutrition
interventions are carried out convergently [8]. Convergence of service delivery requires an integrated process of planning, budgeting,
and monitoring of government programs/activities across sectors to ensure the availability of each specific nutrition intervention
service to priority target families and sensitive nutrition interventions for all community groups, especially the poor[9]. In other
words, convergence is defined as an intervention approach that is carried out in a coordinated, integrated, and jointly targeted manner
in geographic areas and priority households to prevent stunting [10].
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1943
Stunting in East Java reached 10%. Stunting or short is a big hidden problem. Stunting occurs as a result of chronic nutritional
deficiency, especially in the first 1000 days of a child's life [11]. Malnutrition that occurs during this period results in irreversible
growth and development of children, so they cannot reach their maximum growth potential. The problem of stunting is currently a
threat to nutritional problems in the world, because there are 165 million children under five years of age who are stunted, and 90%
of stunted children are in Africa and Asia[12].
The results of Riskesdas in 2018 showed a decrease in the prevalence of stunting in children aged under five years compared to the
results of Riskesdas in 2013 (from 37.2% in 2013 to 30.8% in 2018)11. Over five years the prevalence decreased by almost 7%.
However, this figure is still relatively high. Moreover, if referring to the global target of the World Health Assembly in 2012 in
reducing stunting by 40% by 2025, the achievement is still far away.
The stunting interventions launched by the Indonesian government include specific nutrition interventions and sensitive nutrition
interventions. Specific nutrition interventions are interventions carried out by the health sector in the First Thousand Days of Life
(1000 HPK), this intervention is expected to reduce the prevalence of stunting by 30%. Meanwhile, sensitive interventions are
carried out by institutions outside the health sector through several programs that can contribute to the stunting reduction rate of up
to 70%13.
The benchmark for the success of a program can be seen by the achievement of indicators of an activity. There is a Maternal and
Child Health (KIA) program, which consists of 6 indicators for reducing stunting efforts, namely Monitoring of Nutritional Status
at Posyandu, Exclusive Breastfeeding, Toddlers receiving Vitamin A, Toddlers receiving PMT, PMBA Activities, and Integrated
Management of Sick Toddlers (MTBS). in East Java Province. The existence of Covid-19 has caused the East Java Provincial
Government to have implemented WFH (Work From Home) regulations, but at this time daily activities have taken place as usual
while still implementing health protocols. During the Covid-19 outbreak, Posyandu activities no longer run normally in all regions,
but are adjusted to the zone where the pandemic occurs.
The impact of the Covid-19 pandemic also has an impact on the number of patient visits to health care facilities, where the average
monthly patient visits to the Puskesmas in 2019 reached 105,236 people. Meanwhile, in 2020 until July the average patient visits
per month were 37,454 people. Indicators of the success of a program can be measured from the achievement of targets in each
activity14. The division of zones, namely the green zone, means that the posyandu will remain open but in accordance with health
protocols. Then for the yellow to red zones, posyandu are closed and do not receive services. However, currently, some posyandu
have been opened while still implementing health protocols.
Government programs that have been well structured as an effort to prevent and control stunting in 2020 cannot be carried out
optimally. Therefore, researchers want to analyze the impact of the COVID-19 pandemic on the program stunting prevention and
control strategies in 1000 HPK in East Java province.

METHOD
This research is a quantitative research using an analytical observational approach. The subjects of this study were 70 mothers with
toddlers and 21 health workers at the Health Service in 7 districts in East Java. The research method uses observational analytic
with a cross-sectional approach. Data analysis used Fisher's exact test and calculated the prevalence ratio to determine the most
dominant causal factor influencing visits to health facilities during the COVID-19 pandemic.

RESULT
Table 1. Frequency Distribution of Characteristics of Mothers Having Toddlers

Responden Mother has Health workers

Characteristics Toddler

n % n %
Age
21-30 years old 48 68,57 9 42,85
31-40 years old 22 31,42 11 52,38
41-50 years old 0 0 1 4,76
Total 70 100 21 100
Education
Senior High 43 61.42 0 0
School
Diploma and 25 35.71 19 90,47
bachelor

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 Post Graduate 2 2,85 2 9,52
Total 70 100 21 100
Occupational
Civil servant 8 11,42 18 85,71
Non Civil servant 22 31,42 3 14,28
Housewife 40 57,14 0 0
Total 70 100 21 100
Sallary
< 1 million 4 5,71 0 0
1-2 million 6 8,57 0 0
2-5 million 48 68,57 14 66,66
> 5 million 12 17,14 7 33,4
Total 70 100 21 100

Table 1 shows that the age of mothers who have the most children under five is 21-30 years old, which is 68.57%, while most of
the health workers (52.38%) are 31-40 years old. The last education category, for mothers with toddlers, shows that most (61.42%)
have high school education, while for health workers, it also shows that most (90.47%) have diploma and bachelor degrees.
For the occupational category, some mothers do not work (57.14%) and 85.71% of health workers are civil servants. The last
category is income, showing that the income of mothers who have toddlers is mostly (68.57%) 2-5 million and health workers
66.67% earns 2-5 million.
Table 2 Factors Causing Low Visits

Parameter Good Not good Total

n % n %

Knowledge about covid-19 40 57,14 30 42,85 70 (100%)

Health worker education 21 30 49 70 70 (100%)

Family support 22 31,42 48 68,57 70 (100%)
Positive attitude 34 48,57 36 51,42 70 (100%)

Based on table 2 above, it shows that the mother's knowledge regarding covid-19 is good (57.14%). From the table it can also
be seen that the education of health workers, family support and a positive attitude showed bad results.

Table 3 Effect of Causative Factors with Low Visits

Influence between p-value PR
Variables Exact

Knowledge about covid-19  Visit 0,033 0,667

Health worker education  Visit 0,048 0,714
Family support  visit 0,007 0,333
Positive attitude  visit 0,023 0,600

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Based on table 3 above, it shows that knowledge related to covid-19, education of health workers, and positive attitudes affect visits
to health facilities ( <0.05). From the calculation of the prevalence ratio, it shows that the factors that have the most significant
influence on health facility visits are education of health workers (PR = 0.714), knowledge about covid-19 (PR = 0.667), and positive
attitudes (PR = 0.600).

Table 4 Achievements of the Stunting Reduction Program during the Covid-19 Pandemic in 2020
Indicator Program 2019 2020 Trend

Nutritional Status Monitoring 88,76 28,4 60,36

Exclusive breastfeeding 90,12 38,5 51,62
Giving Vitamin A 95 46 49
Supplementary Feeding (PMT) 93,46 44 49,46
Infant and Child Feeding 89,43 35 54,43
Integrated Management of Sick Toddlers (MTBS) 94 28,7 65,3

Based on table 4 above, it shows that all program indicators implemented by the government in an effort to reduce the incidence of
stunting have decreased in trend. This is because during the pandemic there was a decrease in visits at the integrated service post
(Posyandu) and community health center (Puskesmas)

Table 5. The Effect of Decreasing Visits on Stunting Convergence Efforts

Influence between variables p-value

Exact Sig..(2-sided)
Nutritional Status Monitoring  Stunting convergence efforts 0,012
Exclusive breastfeeding  Stunting convergence efforts 0,022
Giving Vit A  Stunting convergence efforts 0,001
Supplementary Feeding  Stunting convergence efforts 0,002
Infant and Child Feeding  Stunting convergence efforts 0,002
Integrated Management of Sick Toddlers (MTBS) Stunting 0,014
convergence efforts

Based on table 5 above, it shows that there is a significant influence of each program indicator on the convergence efforts that have
been launched by the government, this can be seen from the results of all indicators p-vvalue <0.05.

DISCUSSION
From the results of the study, it can be seen that mothers who have good knowledge are 57.14%, this states that public knowledge
is good about Covid-19. reluctant to visit health facilities. People still doubt the effectiveness of using masks so that the behavior of
using masks is still not optimal. It is known that face masks reduce the spread of infection through the nose and mouth and control
the spread of Covid-19 by reducing the amount of infected saliva and respiratory droplets released into the air from individuals with
Covid-19.
Factors that affect knowledge are education, age, occupation and other external factors15. Age affects knowledge, age affects a
person's perception and mindset16. With increasing age, a person's ability to capture and thought patterns is developed so that the
knowledge gained is increasing as well. Knowledge is a result of curiosity through sensory processes, especially in the eyes and ears
of certain objects. Knowledge is an important domain in the formation of open behavior. The results of this study indicate that most
of the respondents are 21-30 years old. Anne (2018), reveals that knowledge is getting better because of the perception and mindset
that is growing with the increasing age of a person[19]. According to the researcher's assumptions, mothers who have toddlers have
good knowledge because respondents are very active on social media. They always update knowledge related to COVID-19 by
accessing Facebook, Instagram and YouTube. Age can affect a person's knowledge, where increasing age means more experience
is gained so that knowledge is getting better, but the ability or remembering knowledge will decrease towards old age.

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Based on the results of this study, the respondents with the highest recent education characteristics were mostly at the senior high
school graduates and the smallest was at the mster level. Apart from formal education, it can be obtained through other people and
mass media, including magazines, television, newspapers, and radio. Someone with low education does not mean absolutely have
low knowledge as well [20]. However, another opinion says that with higher education, a person will be easier to receive information
so that the knowledge he has will also increase. In the opinion of the researcher, the results of this study are in accordance with the
opinion of Notoatmodjo (2012) where knowledge can be obtained apart from formal education in schools but can also be obtained
from non-formal education outside of school and through experience16. Even though the respondents are in the majority with low
education, it does not mean that they have absolutely low knowledge. Education does not affect their knowledge because respondents
with good knowledge can obtain information from experience or other people as well as the mass media [21]. A person's education
about health will affect health behavior, this is because the education obtained will gain knowledge and will create efforts to prevent
a disease. The higher a person's level of education will make it easier for him to absorb knowledge, thus his insight will be wider
[16].
Researchers assume that knowledge determines each individual so that it will affect behavior in everyday life. Because the higher a
person's level of knowledge, the easier it is to determine what to choose and what to do in his life. In line with what Prihantana,
(2016) said that knowledge has a close relationship with the decisions to be taken, because with knowledge a person has a basis for
making choices [22].
Other studies that are in line with the results of this study are research conducted by Clements JM (2020) which shows that the
people of the United States have good knowledge and behavior and Zhonng BL (2020) which examines Chinese society as the initial
place for the discovery of this corona virus. good and positive knowledge and behavior [23] . This is also related to the experience
of the Chinese community in dealing with the SARS outbreak in the 2000s [24].
Therefore, public knowledge about COVID-19 is a very important aspect in the current pandemic. Someone who has good
knowledge regarding healthy behavior has a tendency to behave well. This, however, eventually caused anxiety for mothers to go
to health care facilities for fear of contracting COVID-19.
Many factors influence the efforts to improve one's health. These factors can be a basis in determining strategies in providing health
education. In this study, the characteristics of the respondents affect the acceptance of the education delivered. A well-delivered
education will have an impact on a person's cognitive perception in seeing the importance of health. In the end they will then believe
and realize that health is a personal need for everyone. This can encourage the respondent to be cognitively easy to catch what is
conveyed from the educator who then accepts and does the ways given to improve health and prevent a disease that has an impact
on health [25].
Cognitive perception and acceptance of education about Coronavirus (covid-19) in respondents can also be motivated by a history
of the disease that is being suffered. This is an impetus to comply with the health protocols submitted to prevent the spread of Covid-
19. Corona virus is a newly discovered infectious disease, this also encourages respondents to hear well about the new information
they receive [26].
Age maturity also helps respondents to be able to capture messages according to educational goals and objectives because they
relate to factors that can prevent disease and improve health status. In this study, the majority of respondents entered early and late
adulthood, which are mature ages in capturing informative and useful messages for their health [27]. The function of analysis and
memory can also be due to the respondent's knowledge factor. But seen as a whole, it can be concluded that education affects the
increase in respondents' knowledge in general [28].
Education is a planned effort to influence other people, either individuals, groups or communities so that they do what is expected
by educators. There are various media for delivering education, using visual media such as printed media (booklets, leaflets,
flipcharts, posters and writings), electronic media (television and slides) and media boards or billboards [16]. However, after the
emergence of Covid-19 which then caused a global pandemic, the strategy for providing education experienced a shift in terms of
delivery and educational methods.
According to the results of the study, most respondents said that the education of health workers about covid-19 was not good
because they said that socialization related to the use of health facilities was very low. Many respondents said they did not know
how to use these health facilities at the peak of the COVID-19 pandemic at that time. There are also many Integrated Healthcare
Center (posyandu) organizers who do not open weighing due to fear and uncertainty about how to implement this Integrated
Healthcare Center (posyandu).
Family support is a form of interpersonal relationship that protects a person from the effects of bad stress, or a form of interpersonal
relationship that includes attitudes, actions and acceptance of family members, so that family members feel that someone is paying
attention to them. Family social support is a process that occurs throughout life, the nature and types of social support vary in various
stages of the life cycle. However, at all stages of the life cycle, family social support enables the family to function in a variety of
ways and intelligences. As a result, it improves family health and adaptation [29]..
Wills (1985) in Friedman (1998), concluded that both buffer effects (social support counteracts the negative effects of stress on
health) and primary effects (social support directly affects health outcomes) were found. Indeed, the main and buffering effects of
social support on health and well-being may function in tandem [30].
Family as a safe and peaceful place for rest and recovery and helps control emotions. Families provide expressions of love, care,
respect, and sympathy, and create a sense of trust, listening, and being heard. Aspects of emotional support include the form of
family assistance, the form of attention given by the family in supporting mothers to make visits to health facilities.
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Support or motivation is something that causes and supports someone's actions or behavior. Support refers to the drive and effort to
satisfy a need or a goal. Support is a reason for a person to act in order to meet his life needs [31, 32].
The husband or family must help and accompany the mother in making the decision so that the mother does not feel alone because
the mother's continued anxiety will cause the mother not to take her toddler to a health facility. The results showed that there was
more family support regarding their child's examination in the good category. This can happen, one of which is the husband's
knowledge about the importance of checking and weighing toddlers and the easy access to information received by the husband
regarding the completeness of the pregnancy examination and the husband's desire to improve the health status of the family [33].
Aspects of emotional support include support that is manifested in the form of affection, trust, attention, listening and being heard.
According to Julianto, emotional support consists of verbal and non-verbal information or advice, real help or actions provided by
social intimacy. According to Saefudin Azwar, attitude is one of the personality elements that a person must have to determine his
actions and behave towards an object accompanied by positive and negative feelings. Then the psychologists dysfunction attitude
is a form of evaluation or feeling reaction. And the attitude formulation is associated as positive affect and negative affect which is
associated with a psychological object [34]. So the attitude is related to one's feelings towards objects not actions, where feelings
are sometimes positive and sometimes negative.
The definition looks at attitudes from an evaluation point of view. Thus, attitude is a positive or negative evaluation system, namely
a tendency to approve or reject. A positive attitude will be formed when the stimulus that comes to someone gives a pleasant
experience. On the other hand, a negative attitude will arise if the stimulus that comes gives an unpleasant experience. Differences
in attitudes are related to the degree of a person's liking or disliking of the object at hand, or in other words attitudes regarding the
individual's readiness to react to certain objects based on the concept of positive-negative evaluation {35}. Therefore, attitude is an
evaluative statement, both favorable and unfavorable. about objects, people or events.
The mother's attitude in making decisions depends on the mother's own knowledge because knowledge is the basis for improving
maternal health. Attitude is an action in the form of a person's reaction or response. Attitude is an important determinant of behavior
[36]. Mothers who have a positive attitude can give a positive response in taking attitudes or decisions. A positive attitude will
encourage mothers to always be active, increase the frequency of their activities including visiting posyandu in an effort to find out
the condition of their children, so that it is beneficial for children's health. In this study, mothers who always had a positive attitude
had higher morale by 42 percent compared to mothers who always had a negative attitude.
New values that are believed to be true, good, beautiful, and so on, will ultimately affect the emotions or affective components of
individual attitudes [37]. Therefore, the affective component can be said as a feeling (emotion) of the individual towards the object
or subject, which is in line with the results of the assessment. While the component of the tendency to act is related to the individual's
desire to perform actions in accordance with his beliefs and desires. A person's attitude towards an object or subject can be positive
or negative. Manifest attitude can be seen from a person's response whether he accepts or rejects, agrees or disagrees with the object
or subject [38].

CONCLUSION
The most significant role that affects maternal visits is the education of health workers regarding the Health protocol in preventing
the transmission of covid-19 (PR=0.714), and there is an effect of decreasing visits on stunting prevention efforts (p-v-value
<0.05).

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