THE ROLE OF THE HEALTH SERVICE IN HEALTH PROMOTION TO MANAGE STUNTING PREVALENCE IN KERAMAT MUFAKAT VILLAGE, CENTRAL ACEH DISTRICT

The background of this research is that the number of toddlers affected by cases of malnutrition (stunting) in the village of Keramat Mufakat is as many as 17 toddlers affected by malnutrition (stunting) out of the 100 toddlers, including those in Bebesen District with details of 17 toddlers found in the village of Keramat Mufakat . Research Methods Researchers used a type of qualitative population research and the samples taken were claimed to be informants. The expected informant criteria include: standards of knowledge and standards of behavior towards nutritious food that is far from the risk of stunting. This research was conducted in Keramat Mufakat Village, Bebesen District, Central Aceh District. This research was conducted in the village of Keramat Mufakat, Bebesen sub-district, Central aceh district on September 25, 2022. Research results Based on the results of this study, it was found that most children received exclusive breastfeeding. This is because the majority of mothers have employment status as housewives or do not have a job which can make it difficult for mothers of toddlers to exclusively breastfeed. In addition, there are problems regarding the lack of breastfeeding for mothers, and regarding the problem of income for parents who are unable to meet family needs so that most toddlers are not given or assisted with formula milk, but are only given breast milk and continue until the age of 2 years. Conclusion In the study in the village of Keramat Mufakat there were 17 toddlers who experienced malnutrition (stunting). Significant risk factors for stunting were history of

incidence of stuntingin toddlers in Indonesia in 2017-2018 there was an increase of 1.8% and became a serious public health problem because the prevalence of stunting in Indonesia ranged from 30-39% (Ministry of Health RI, 2019). Whereas in West Java Province in 2018, toddlers who experienced very short stunting were 11.70% and short ones were 19.40% and in 2017 toddlers who experienced very short stunting were 8.40% and short ones were 20.80% (West, 2018).
According to data from the Basic Health Research of the Indonesian Ministry of Health (Riskesdas) in 2018, the prevalence rate of stunting in Indonesia is 8.7 million or 30.7% of infants under five years old (toddlers), in this case the figure is still above the target set by the Health Agency. World (WHO) by 20%. The Government of Indonesia is very concerned about tackling the problem of stunting, we can see that in the 2020-2024 Medium Term Development Plan (RPJMN), the government is targeting a reduction in the stunting rate to a maximum of 19% in 2024. This condition illustrates the difficult task that still needs to be completed regarding stunting prevention in Indonesia. Failure to resolve the stunting problem has a very serious impact because it can result in not achieving national development targets. and the risk of a large burden to be borne by the state due to the very low quality of human resources (HR) which are not competitive. Indonesia's target to take advantage of the projected demographic bonus in 2030 and the realization of Superior Indonesia in 2045 will not be achieved if we fail to address the stunting problem.
Growth in a human starts from the time of conception to adulthood, moreover the growth experienced by children will definitely increase very quickly every year, in the growth process there is an addition to the structure of the number of cells, cell size and growth in each child will vary so there will be differences in growth from one child to another, in the growth of children there are factors that influence, namely internal factors consisting of genetics in the sense of inheritance from genes owned by parents and hormones in the sense of substances formed by certain body parts in small quantities and carried to the tissues other bodies in the child's body while environmental factors such as prenatal factors which include nutrition and birth factors (Astuti, 2013: 3).
In line with this, according to Saraswati (2013: 21) there are 2 factors that influence growth, namely internal and external factors. Internal factors, namely from the deepest scope of the child there are genetic factors passed down by their parents, aspects of intelligence or intelligence, hormone aspects that have a major influence on growth, namely gonadotropins (development of sex organs), somatotropin (stimulates brain cell growth), thyroid (cell growth and organs in children), then external factors which include prenatal factors that enter, one of which is nutrition and childbirth factors.
Toddlers are a critical age for growth and development. At that time the brain growth point was very fast because in this period the formation of nerve cells was formed so that nutritional intake was very important for parents to pay attention to, for this reason parents needed attention regarding good and proper nutrition starting from childhood. in the womb until the child is born in the world and parents can be selective in choosing the right food for the child (Mursid, 2015: 143).
It is known that toddlers are a group of people who are vulnerable to the nutritional intake they eat. In this group growth cycles and nutritional intake are very important, but sometimes health problems are often experienced by toddlers, resulting in disruption of the intelligence experienced by toddlers and can hinder the performance of the brain which should control body performance (Mursid, 2015: 138). The nutritional status in toddlers is a benchmark that can affect several aspects of both growth and development in children, so that the nutritional intake needed for toddlers must be fulfilled correctly and appropriately so that their growth and development can be optimal (Rahim, 2014).
Stunting is a condition of toddlers who have less length or height when compared to their age peers (Ministry of Health, Republic of Indonesia, 2018). Chronic nutritional problems are a cause of stunting which is influenced by various factors including economic conditions, maternal nutrition during pregnancy, illness in infants and lack of nutritional intake in infants so that in the future they may experience difficulties achieving optimal physical and cognitive development (Kementian Kesehatan RI, 2018 ).
The Ministry of Health stated that chronic malnutrition that occurs in stunted toddlers is caused by bad parenting practices, limited health services, lack of access to nutritious food, and lack of access to clean water. And according to the Ministry of National Development Planning/Bappenas, the causes of stunting are classified into 2 (two), namely direct causes, direct causes related to nutrition and health nutritional status, while indirect causes are related to other factors outside of health such as food security, social environment, environment health, and the residential environment.
Law Number 36 of 2009 Article 1 Paragraph 3 concerning Health states that "Health Efforts are any activities or series of activities carried out in an integrated, integrated and sustainable manner to maintain and improve the degree of public health in the form of disease prevention, health improvement, disease treatment, and restoration of health by the government and/or the community". The law regulates the implementation of efforts to improve community nutrition including: directions, goals, and strategies to improve community nutrition. The aim of improving nutrition is to improve the nutritional quality of individuals and communities. There are four strategies to improve community nutrition, namely: 1) Improvement of food consumption patterns in accordance with balanced nutrition; 2) Improving nutrition awareness, physical activity and health behavior; 3) Increasing access to and quality of nutrition services in accordance with advances in science and technology; and 4) Improving the food and nutrition alert system (Law No. 36 of 2009).
According to the World Health Organization (WHO), stunting is a developmental disorder in children caused by poor nutrition, repeated infections, and inadequate psychosocial simulation. The problem of stunting in Indonesia is a serious threat that requires proper handling, based on data from the Indonesian Toddler Nutrition Status Survey (SSGBI) in 2019, the prevalence of stunting in Indonesia has reached 27.7%. This means that around one in four children under five (more than eight million children) in Indonesia are stunted. This figure is still very high when compared to the threshold set by WHO, which is 20%.
The Health Office is one of the government implementing agencies in the health sector and is led by a service head who is under and responsible to the regional head through the regional secretary. The Health Office has the duties, functions and responsibilities to carry out some regional affairs in the health sector to support the achievement of public welfare in the health sector and carry out co-administration tasks in accordance with their respective fields.
The achievement of prevalence in toddlers in Central Aceh district from 2017 to 2021 shows a positive trend, from 38% in 2017 to 34.3% in 2021. Although it still exceeds the Aceh provincial average of only 33.4%, this achievement has shifting the position of Central Aceh District to seventh with the highest stunting in Aceh, which in the last ten years has always been ranked in the top three. In an effort to reduce the prevalence of stunting, the Central Aceh District Government continues to strengthen and evaluate the necessary efforts to accelerate stunting reduction in Central Aceh District.
From year to year there are definitely cases of malnutrition (stunting) in Aceh with different levels of ratios because cases of malnutrition (stunting) often occur in several regions. Judging from the available data according to the Aceh Provincial Health Office, Central Aceh District is included in the area with toddlers with cases of malnutrition (stunting), in 2021 according to data from the Central Aceh District Health Office, 2021 The number of toddlers found to be suffering from malnutrition (stunting) ) there are 12 toddlers in 2021 and there are 17 toddlers experiencing malnutrition (stunting) in 2022, so the total data on toddlers in Keramat Village agrees that there are cases of malnutrition (stunting). Of these cases, including the village of Keramat Mufakat, Bebesen District, there has been an increase from year to year, toddlers experiencing cases of malnutrition (stunting) with details of 17 toddlers found in the village of Keramat Mufakat, Bebesen District and no toddlers affected by malnutrition (stunting) in the village of Tan Saril,

668
Multidiciplinary Output Research For Actual and International Issues |MORFAI JOURNAL E-ISSN: 2808-6635 |https://radjapublika.com/index.php/MORFAI Bebesen District. This year, 100% of toddlers affected by malnutrition have received treatment with details of 2 toddlers experiencing wasting accompanied by malnutrition and 9 experiencing malnutrition (stunting). The problem of malnutrition was not resolved in 2021, in the following year, namely in 2022, toddlers who experienced cases of malnutrition were found again, from the data from the Central Aceh Health Service for 2022 it stated that in that year in Bebesen District, in the village of Keramat Mufakat experienced the most cases of malnutrition according to data (Central Aceh Health Office, 2022) Bebesen sub-district and no toddlers were found affected by malnutrition (stunting) in Tan Saril village, Bebesen sub-district. This year, 100% of toddlers affected by malnutrition have received treatment with details of 2 toddlers experiencing wasting accompanied by malnutrition and 9 experiencing malnutrition (stunting). The problem of malnutrition was not resolved in 2021, in the following year, namely in 2022, toddlers who experienced cases of malnutrition were found again, from the data from the Central Aceh Health Service for 2022 it stated that in that year in Bebesen District, in the village of Keramat Mufakat experienced the most cases of malnutrition according to data (Central Aceh Health Office, 2022) Bebesen sub-district and no toddlers were found affected by malnutrition (stunting) in Tan Saril village, Bebesen sub-district. This year, 100% of toddlers affected by malnutrition have received treatment with details of 2 toddlers experiencing wasting accompanied by malnutrition and 9 experiencing malnutrition (stunting). The problem of malnutrition was not resolved in 2021, in the following year, namely in 2022, toddlers who experienced cases of malnutrition were found again, from the data from the Central Aceh Health Service for 2022 it stated that in that year in Bebesen District, in the village of Keramat Mufakat experienced the most cases of malnutrition according to data (Central Aceh Health Office, 2022) This year, 100% of toddlers affected by malnutrition have received treatment with details of 2 toddlers experiencing wasting accompanied by malnutrition and 9 experiencing malnutrition (stunting). The problem of malnutrition was not resolved in 2021, in the following year, namely in 2022, toddlers who experienced cases of malnutrition were found again, from the data from the Central Aceh Health Service for 2022 it stated that in that year in Bebesen District, in the village of Keramat Mufakat experienced the most cases of malnutrition according to data (Central Aceh Health Office, 2022) This year, 100% of toddlers affected by malnutrition have received treatment with details of 2 toddlers experiencing wasting accompanied by malnutrition and 9 experiencing malnutrition (stunting). The problem of malnutrition was not resolved in 2021, in the following year, namely in 2022, toddlers who experienced cases of malnutrition were found again, from the data from the Central Aceh Health Service for 2022 it stated that in that year in Bebesen District, in the village of Keramat Mufakat experienced the most cases of malnutrition according to data (Central Aceh Health Office, 2022) In 2022 according to (Central Aceh Health Office, 2022) that Bebesen District is still listed as a district affected by cases of malnutrition (stunting) in toddlers, the ratio for toddlers affected by cases of malnutrition by looking at indicators of weight according to height in toddlers. For all cases of malnutrition experienced by toddlers in the Bebesen sub-district, 100 toddlers who experienced malnutrition cases where the most cases of malnutrition (stunting) were in Keramat Mufakat Village, Bebesen District. Cases of malnutrition in 2022 have increased compared to the previous year in 2021, in the following year in 2022 the same case occurred in toddlers regarding malnutrition where in December 2021, Researchers also conducted interviews on September 25, saying that the number of toddlers affected by cases of malnutrition (stunting) in Keramat Mufakat village was 17 out of 100 toddlers affected by malnutrition, including those in Bebesen District with details of 17 toddlers found in the village of Keramat Mufakat.

RESEARCH METHOD
In this study, researchers used a type of qualitative research. According to Sukandaramudi, qualitative research is a way of analyzing research data which is carried out by compiling in depth and systematically, factually and accurately regarding facts and events based on a particular symptom. Describes an object that is examined in a systematic way with the rules that apply.

Research Approach
This research is a descriptive qualitative research. Qualitative research is research that is natural, research that does not use statistical mathematical models or personal computers (Kurniawan, 2012, p.22). Descriptive research is designed using descriptive, systematic, factual and accurate descriptions or drawings about information facts, characteristics and correlations between the phenomena investigated (Nazir, 2003, p.54). The type of data in this study is qualitative data. Qualitative data means data that comes from natural research, research that does not use mathematical, statistical or personal computer models (Kurniawan, 2012, p.22). The qualitative data used in this study came from information from the puskesmas, the source of the data in this study used primary data.

2.2.Population and Sample
In this qualitative research, the population and samples taken are claimed to be informants. Research informants are people who really know or actors who are directly involved with research problems. Including efforts to find, create, test the reality of information that is equipped with inspection techniques that are characterized as a logical method for obtaining information with explicit goals and uses. The expected informant criteria include: standards of knowledge and standards of behavior towards nutritious food that is far from the risk of stunting. This research was conducted in Keramat Mufakat Village, Bebesen District, Central Aceh District. This research was conducted in the village of Keramat Mufakat, Bebesen sub-district, Central aceh district on September 25 2022.

2.3.Type and Source
In this examination, the researchers used field research procedures in which the researcher directly approached the informant to ask for information related to the topic of discussion that the author planned. The researcher directly went to the location of the field object and met the research subject in order to obtain valid information and be able to support this research process regarding the prevalence of stunting in Keramat Mufakat village. maturely. This step intends to explore the status of a collection of people, objects, sets of conditions or arrangements of thought. Naturally, in this study there was an interaction between the researcher and the source of the data he had obtained for himself who went into the field. Researchers will go directly to the village of Keramat Mufakat to find data from real conditions in the village. In qualitative research, the instrument users are flexible, meaning that in a qualitative study, researchers can use more than one instrument that is tailored to the needs of researchers. For example, in a research study, researchers use interviews and observations at the same time with the aim of obtaining more in-depth data and for strengthening the validity and reliability of the data.

2.4.Data Collection Techniques
In obtaining data from informants who have been determined there are several ways that can be done, including: (1) Research writing, especially research led by utilizing reading and concentrating on related books, (2) Observational exploration, namely collecting specific information that is carried out automatically. methodically by paying attention to and recording the

THE ROLE OF THE HEALTH SERVICE IN HEALTH PROMOTION TO MANAGE STUNTING PREVALENCE IN KERAMAT MUFAKAT VILLAGE, CENTRAL ACEH DISTRICT Hafizah Nur, Jun Musnadi Is
side effects explored, (3) Interviews, especially the question and answer process to direct informants in field research.

2.5.Analysis
Data analysis was carried out by comparing research results from various journals and literature that discussed the influence of mother's knowledge and behavior.

RESULTS AND DISCUSSION
Stunting is a condition of growth and development in children under five who fail due to chronic malnutrition, especially in the first 1000 Days of Life (HPK) (Ministry of National Development Planning/Bappenas, 2018). The World Health Organization (WHO) in 2018 reported that data on the prevalence of toddlers experiencing growth and development disorders was 28.7% and Indonesia was included in the third country with the highest prevalence in the Southeast Asia / South-East Asia Regional (SEAR).
Aceh Province is ranked 3rd out of 34 provinces in Indonesia with a prevalence of stunting in toddlers, namely 37.1%. So based on WHO criteria the prevalence of stunting in the province of Aceh is included in the very high and high categories, namely areas with a prevalence of stunting between 30-39.9% (Aceh Provincial Health Office, 2018). Data from the Central Aceh District Health Office in 2021 up to December show that the Bebesen Health Center, Bebesen District, is the work area with the highest number of stunting at the Health Center in Central Aceh (Central Aceh District Health Office, 2021).
After conducting research in the village of Keramat Mufakat, there were 17 toddlers who experienced malnutrition (stunting). Significant risk factors for stunting were history of complementary feeding, history of infectious diseases, mother's knowledge about toddler nutrition and family economic factors. Meanwhile, risk factors that were not significant for the incidence of stunting were a history of exclusive breastfeeding, toddler immunization, mother's height (genetic factor) and mother's education.
The results of the study were obtained when the researchers interviewed the informants, there were several habits of the informants in taking care of the children which were quite lacking, starting from the habits of breastfeeding and also the habits of caring for children, many babies in the village did not get breast milk from their mothers because the mothers experienced a lack of water ASI and the mother also carry out daily activities in the garden so the child can be forgotten when the child needs breast milk from the mother, and there are also economic factors that make children over 2 years old do not get good MP-ASI from the family so that the child suffers from malnutrition ( stunting).
Based on the results of this study it was found that most children get exclusive breastfeeding. This is because the majority of mothers have employment status as housewives or do not have a job which can make it difficult for mothers of toddlers to exclusively breastfeed. In addition, there are problems regarding the lack of breastfeeding for mothers, and regarding the problem of income for parents who are unable to meet family needs so that most toddlers are not given or assisted with formula milk, but are only given breast milk and continue until the age of 2 years.
Giving Mother's Milk (ASI) is an intake of nutrients that are suitable for the needs of babies and will help the growth and development of toddlers, especially in the golden age period. Carbohydrates in breast milk are in the form of lactose, whose fat content is in the form of polyunsaturated fatty acids (polyunsaturated fatty acids). The main protein is lactalbumin which is easily digested and contains high vitamins and minerals. In addition, breast milk also contains antiinfective substances. Breast milk contains sIgA which functions as the predominant antibody, besides that IgM and IgG are also found in breast milk (Larasati, Nindya and Arief, 2018).
Mother's milk (ASI) which is released by the mother at the beginning of birth or called colostrum also has a very high IgA, IgM and IgG content. Another content of breast milk that functions as an antibody is lactoferrin, namelyiron-binding glycoproteinbelonging to the transferrin group. This compound has the benefit of fighting bacteria, viruses and fungi. Another glycoprotein that functions as an antibody is lactadherin which is found in milk fat. Lactadherin moves from breast milk to the baby's stomach and prevents infection by rotaviral in newborns (Larasati, Nindya and Arief, 2018).

CONCLUSION
Stunting is a growth and development condition in children under five who fail due to chronic malnutrition, especially in the first 1000 days of life (HPK). In the study in the village of Keramat Mufakat, there were 17 toddlers who experienced malnutrition (stunting). Significant risk factors for stunting were history of complementary feeding, history of infectious diseases, mother's knowledge about toddler nutrition and family economic factors. Meanwhile, risk factors that were not significant for the incidence of stunting were a history of exclusive breastfeeding, toddler immunization, mother's height (genetic factor) and mother's education. It was found that most children get exclusive breastfeeding. This is because the majority of mothers have employment status as housewives or do not have a job which can make it difficult for mothers of toddlers to exclusively breastfeed. Besides that,