FACTORS AFFECTING NUTRITIONAL STATUS IN CHILDREN IN COT PEURADI VILLAGE, SUKA MAKMUE DISTRICT NAGAN RAYA DISTRICT

The nutritional status of Suka Makmue District in 2019 has a nutritional status rate of 27.8%, the number of cases of wasting reaches 9.1%, and cases of underweight with a rate of 13.1% (50%). (Puskemas Cot Kuta, Suka Makmue District, Nagan Raya Regency 2019). In 2020 in Suka Makmue District, cases of nutrition were at 30%, cases of wasting were 8.90%, and underweight were at 12.85%. 2021 nutritional status reaches 20% while toddlers who experience malnutrition are 8.88%. 2022 states that data on the nutritional status of toddlers has decreased by 2.8% to 21.6%. carried out in this problem of nutritional status. determine the factors that cause nutritional status problems that cause nutritional status events in the working area of Posyandu Cot Peuradi, Nagan Raya Regency. Method: this study uses a quantitative method with a Cross Sectional Study approach. The population in this study were all toddlers in the Posyandu Cot Peuradi data and the sample used was 30 toddlers, using the sampling method of sampling. The results showed that there was a significant influence between knowledge and cases of malnutrition (p-value = 0.07), patterns of feeding children (p-value = 0.000), or family income (p-value = 0.013). Because it is not a problem in the health sector that can easily be cured and requires willingness from the start at the prevention stage, this case starts with the prospective mother and father. Because childhood, which is composed in the first 1000 days of life, greatly influences what events can happen to children.


INTRODUCTION
Nutritional problems are a problem that is experienced in every country, be it developed countries, developing countries, or even poor countries. Nutritional problems that often receive attention from the state are underweight, stunting, wasting, and micronutrient deficiencies. (Maulina, 2021). Problems are caused by multimedia factors and not only caused by malnutrition factor experienced by children under five. The most decisive intervention to be able to reduce the prevalence of nutritional problems, for that it needs to be done on the 1000 day HPK of children under five. Some of the factors that cause nutritional problems can be illustrated by the lack of knowledge of mothers regarding health and nutrition before and during pregnancy and after giving birth. Other factors such as cases are still limited health services for children and mothers during pregnancy. And family income that is unable to meet or meet food needs along with nutritional intake during the pre-conceptional age, during pregnancy, and also during the baby's growth period (Munir, et al. 2021).
According to WHO in 2019 there were 146 million or 22.2% of children under five in the world suffering from nutritional status problems. More than 55% come from Asia while 39% are in Africa (WHO, 2019;Indonesian Ministry of Health, 2019). Based on the results of the 2020 Basic Health Research (Riskesdas), the prevalence of nutritional status is at 30.8% and the Soft Launching of the results of the Indonesian Toddler Nutrition Status Survey SSGBI (Indonesian Toddler Nutrition Status Survey) 2020 nutritional status figures of 27.67% is the basis for the target to reduce prevalence nutritional status. And in 2020 the nutritional status figure will be 26.92%. Thus, almost a quarter of toddlers in the country experience nutritional status problems. The target for reducing the nutritional status rate for 2024 is 14%. It is known that the percentage indicator for the nutritional status of children under five is a set case. This condition illustrates that the achievement of this year's percentage is on track (Ministry of Health RI, 2020 Indonesia has a prevalence rate of 25.87% nutritional status, cases of wasting with a rate of 7.25%, and cases of underweight as much as 16.90%. (SSGI, 2020).Based on SSGBI data for 2021, regarding the Prevalence of National Under-five Nutritional Status, the nutritional status rate in Indonesia reaches 24.4% (23.9-24.9) or around 5.33 million children under five. The wasted rate in Indonesia reached 7.1% (6.8-7.3), and for the Underweight rate it was at 17. 0% (16.6-17.4). This is still above the standard set by WHO, which is 20%. Based on the report on the Indonesian Nutritional Status Study (SSGI), (Ministry of Health RI, 2021).
Based on SSGI 2019 data, the prevalence of under five nutritional status in Aceh province is 34.18%. Cases of wasting have a prevalence rate of 11.8%, and for underweight it is at 24.16%. (Aceh Ministry of Health, 2019). In 2020 the nutritional status rate reached 34.87%, cases of wasting with a rate of 10.87%, and underweight were at 23.90%. (SSGI, 2020) Based on SSGI data for 2021, the prevalence of nutritional status for toddlers in Aceh Province, namely for cases of nutritional status, is at 33.2%. Wasted cases in Aceh province are at 10.7%. Underweight cases in the province of Aceh are in sixth place with a rate of 23.8%. (Aceh Ministry of Health, 2021).
From data from Nagan Raya Regency, nutritional status is at 26.46%, cases of malnutrition are at 12.0%. Cases with a rate of 20.1% in 2019. Data for 2020 for a nutritional status rate of 31.21%, cases of wasting with a rate of 11.6%, and cases of underweight with a rate of 19.67%. (Nagan Raya Health Office 2020). Based on the 2021 Nagan Raya Regency report, the prevalence of Toddler Nutritional Status, namely the case of nutritional status in Nagan Raya Regency, is at 32.5%. Underweight wasting cases are in seventh place, with a rate of 10.1%. Underweight cases in Nagan Raya Regency are in 16th place with a prevalence rate of 19.9%. (Nagan Raya Health Office, 2021).
The SSGI 2022 nutritional status report states that data on the nutritional status of Indonesian toddlers experiencing nutritional problems has decreased by 2.8% to 21.6%. Wasting toddler data is 7.7%, Underweight toddler data is 17.1% and Overweight toddler data is 3.5%. And in Aceh province it is recorded that toddlers with nutritional status problems are at 31.2%, the prevalence of Wasting toddlers in Aceh province is at 11.3%, Underweight toddlers are in 3rd position with a rate of 24.2%, and for Overweight toddlers is at 1.9%. Data at the district level, namely in Nagan Raya Regency, toddlers with nutritional status problems are at 28.8%, Wasting toddlers are at 8.6%, toddlers with Underweight status are 22.6%, toddlers with Overweight status are at number 3 .2% (SSGI, 2022).
According to the initial survey that the researchers conducted on 5 mothers whose children had malnutrition, one of them stated that because the mother did not know about how to fulfill child nutrition, the other mother said there was a lack of family income and the other mother said that the mother did not pay enough attention to the nutritious child's diet. . Based on the problems found in the initial survey above, it is necessary to conduct research on the factors that influence the nutritional status of children under five that cause stunting in Cot Peuradi Village, SukaMakmue District, Nagan Raya Regency.

RESEARCH METHODS
This type of research is a quantitative method looking at the factors that affect the nutritional status of children under five in Cot Peuradi Village, Nagan Raya Regency. With a cross-sectional approach. This research was conducted by Posyandu in Cot Peuradi Village, SukaMakmue District, Nagan Raya Regency. The population in this study were 30 toddlers in Cot Peuradi Village. The sample in this study was taken using the total sampling technique. This research was conducted in January 2023. Data collection was obtained in two ways, namely primary data and secondary questionnaire data. Analysis of the data obtained was carried out using Univariate and Bivariate methods.  Based on Table 1, it can be seen that of the 30 toddlers who were sampled in this study, most were in the age range of 24-59 months, namely 20 toddlers (67%) while toddlers who were in the age range 0-23 months, namely 10 toddlers (33 %). The sex of the toddlers was mostly female, namely 18 toddlers (60%) while the male types amounted to 12 toddlers (40%). Mothers who have good knowledge are 15 people (50%) while mothers who have poor knowledge are 15 people (50%). In the feeding patterns section, it is known that there are 15 toddlers (50%) with good feeding patterns and 15 toddlers (50%) with poor feeding patterns. There are 22 families (73%) with high income families and 8 families with low income. (27%). And underfives with less nutritional status were 10 underfives (33%) while those with normal nutritional status were as many as 20 underfives (67%).  Table 2 shows that cases of nutritional problems were more common in the group of mothers with poor knowledge, namely 9 toddlers (60%) compared to toddlers with good maternal knowledge, namely 1 toddler (7%). Statistical analysis test with Chi-square obtained p-value = 0.07 less than 1/20 = (0.05), based on these results it can be concluded that Ho is rejected and Ha is accepted, which means that mother's knowledge is one of the factors that causes cases of nutritional status problems.  Table 3 shows that cases of nutritional problems are more common in the group of mothers who are not good at feeding patterns for toddlers, namely as many as 10 toddlers (67%) compared to mothers with normal child nutritional status, the mothers carry out appropriate feeding patterns and correct with the normal toddler category of 15 toddlers. Statistical analysis test with chi-square obtained p-value = 0.000 less than (0.05), based on these results it can be seen that the pattern of feeding toddlers is also a factor that affects the nutritional status of toddlers.   Table 4 explains that many cases of nutritional problems occur in the low family income category, namely 6 families (75%) compared to cases of nutritional status problems in families with high income categories, namely 4 families (18%). Based on the Fisher statistical analysis test, the result is p-value = 0.013 which is less than 1/20 = (0.05) which means that income or status is also a factor that causes nutritional status problems.

DISCUSSION
The problem of nutrition is essentially a public health problem, the solution of which cannot be done by approaching medical services and health services for nutrition problems, so it must involve various related sectors. The problem of nutritional status also arises due to food security problems at the household level, malnutrition is generally caused by poverty, lack of public knowledge about balanced nutrition and the health of toddlers is one of the groups or groups of the population that is prone to malnutrition, nutrition is still dominated by malnutrition. such as iron anemia, disorders due to lack of iodine, lack of vitamin A and lack of protein energy. (WHO,2019) Mother's knowledge of under-five nutrition as children get older, the food provided must be more diverse, nutritious and balanced to support the growth and development and nutritional status of under-fives. Mothers play an important role in determining the type of food that will be consumed by children, therefore knowledge is very important about children's nutrition. A good toddler feeding pattern consists of consuming good and quality food, namely healthy and varied food. Consuming enough food and implementing the right behavior will result in normal nutritional status. Malnutrition is not only caused by the amount consumed but also the pattern of feeding. of the whole is insufficient and unbalanced, it is called malnutrition. The opinion of the family also influences the nutrition of toddlers, especially in the poor, which affects the nutrition of toddlers. Families with less income certainly cannot afford to provide nutritious food and later can result in undernourished status and families with high incomes can provide adequate nutrition for children, so meeting nutritional needs is sufficient good.(Jomis, 2020)

The effect of mother's knowledge on the nutritional status of children under five
The results of the statistical test using Chi-square showed that the result of p-value = 0.07 was greater than 0.05 which stated that there was a significant influence between the problem of nutritional status and the level of knowledge of the mother. This research is in line with research conducted by (Marniati, M (2016,December). Which states that there is a relationship between mother's knowledge and nutritional status in which the research obtained a p-value = 0.02, where mother's knowledge can affect the health and growth and development and well-being of children.  shows that mother's knowledge of the incidence of nutritional status problems is one of the things for toddlers, namely the level of family knowledge regarding nutritional intake and the level of education of parents that influence mindsets. However, this research is not in line with the results of research conducted by Daming (2019)  Mother's knowledge plays an important role in the nutritional status of toddlers because mothers must pay close attention to children's nutritional intake, mothers really determine how to provide healthy food, selection and good food occurs when the mother provides enough food by the body. mother's knowledge is good because mothers have to know and understand how to provide food to children besides that this can also be caused by the many sources of information that can be obtained by mothers such as counseling, television and radio so that mothers can follow about toddler nutrition provided by health officer.
Natoatmojo's theory, 2003 that knowledge can form an attitude and cause a behavior in everyday life. A high level of knowledge about nutrition can form a positive attitude towards growth in the health sector. Nutritional status as a result of food consumption and the use of nutrients in these conditions can be divided into poor, good and more nutritional status. Nutritional problems in toddlers are still a major public health problem in Indonesia. Various efforts to address nutritional problems have been carried out through business programs to improve toddler nutrition. Good nutrition is influenced by the amount of nutrient intake consumed.
This research is in line with research conducted by Hasnawati, et al (2021) which states that there is a relationship between mother's knowledge and nutritional status and mother's level of knowledge. In Mugianti's research (2018) it shows that mother's knowledge of the incidence of nutritional status problems is one of the things for toddlers, namely the level of family knowledge and parental education regarding nutritional intake and parental education level. Meanwhile, research conducted by Daming (2019) where there is no significant relationship between mother's knowledge and nutritional status problems.

Effect of feeding patterns on nutritional status in children under five
In this study, the results of the statistical test with Chi-square showed the result of p-value = 0.000 which indicated that the result was greater than (0.05) which stated that there was an influence between the incidence of nutritional status problems and the pattern  Roess,et al (2018) who said that the pattern of feeding children including balanced nutritional portions and sufficient vitamins for children affects the incidence of nutritional status. This research is not significant with research conducted by kaloko,I.,et al (2022) which states that there is no there is a relationship between the level of adherence to parenting given to children which is one of the factors for the occurrence of nutritional status in toddlers. And this is also not in line with the research conducted by I Kadek, et al (2021) which stated that there is no relationship between the attitude of mothers feeding their children and the nutritional status problems experienced by toddlers.
Researchers on feeding patterns in children must really pay attention to the needs of children. Feeding patterns are behaviors that can affect nutritional status so that nutritional intake is sufficient for children so that the amount of nutrition fulfilled is sufficient for the body. Feeding patterns are efforts and ways of mothers to provide food to toddlers with the aim that the nutritional needs of toddlers are met. Feeding patterns are a way or efforts of mothers to arrange good food and maintain health to prevent and help children from disease to meet children's nutritional and protein needs. for good nutritional status.
Theory (Sulistyaningsih, 2019). Feeding pattern is a way to regulate the type or amount of food according to the proportion of body needs to maintain health, nutritional needs and prevent disease, feeding patterns can also be defined as characteristics or characteristics of feeding activity, nutritional adequacy numbers such as carbohydrates,fat protein or minerals. A good diet consists of consuming a variety of foods that are sufficient in terms of quality by applying the right eating behavior if this can be applied it will produce good nutrition.
This research is in line with Intan 2022 which states that the pattern of feeding children includes balanced nutritional portions and sufficient vitamins for children are sufficient for children. Research conducted by Astuti (2018) which states that there is no relationship between the level of adherence to parenting given to children is a factor in the occurrence of nutritional status. And this is not in line with research conducted by I Kadek, et al (2021) which states that there is no relationship between the attitude of mothers feeding their children and the nutritional status problems experienced by toddlers.

The effect of family income on the nutritional status of children under five
The results of the statistical tests that have been carried out show that the p-value = 0.013 is less than (0.05) which gives the result that the amount of income in the family can affect the causes of nutritional status in children under five, we can also relate this to the adequacy of food that can obtained if the income situation in the family is insufficient to meet the nutritional needs of children under five and all existing family members. This research is in line with research conducted by Nursyamsiah (2021) which says that there is a very significant relationship between family income and the incidence of malnutrition in toddlers with a p-value = 0.000. Parents with sufficient family income can meet the needs of food and basic needs which are highly guaranteed and have quality which is very helpful to meet the nutritional needs of their family members, by Marniati,M., et al (2020). This research contradicts research conducted by Yuanti, et al (2021). It is known that in the income condition of bivariate analysis, the p-value = 0.06 in this analysis it is known that income conditions are not related to the incidence of nutritional status in toddlers.
The opinion of researchers is that family income must be in accordance with shared needs, especially in toddler nutrition so that the nutritional needs of toddlers are met and sufficient because family income has a large effect on food, if low family income can affect the nutritional status of toddlers. family income if someone has sufficient income then the family can meet all the nutritional needs of children both through good food intake and being able to improve good nutrition, and if families with low incomes then these families cannot meet the child's nutrition then there will be a risk of malnourished children.
Theory (Suparyanto, 2019). Family income is the total income of all household members that is used to meet the needs of both and someone in the household, families with less income are certainly unable to provide nutritious food and can later result in undernourished status. Increasing the age of the child, the food provided must be more supportive for growth and development and the nutritional status of toddlers will increase the nutritional adequacy of the level of nutritional adequacy obtained is one that can affect the nutritional status of toddlers.
This research is in line with research conducted by Nursyamsiah (2019) which says that there is a very significant relationship between family income and the incidence of malnutrition in. This research is also in line with Kusumawati et al (2018) that sufficient family income can meet basic needs that are highly guaranteed and have quality that is very helpful in meeting the nutritional needs of family members. This research contradicts research conducted by Yuanti, et al (2021) it is known that income conditions are not related to the incidence of toddler nutritional status.

CONCLUSION
The results obtained from toddler data in the Posyandu area of Cot Peuradi Village, SukaMakmue District, Nagan Raya Regency, namely: Mother's knowledge has an influence on cases of nutritional problems that cause nutritional status events that occur in children under five at the posyandu of Cot Peuradi Village, SukaMakmue District, Nagan Raya Regency (p-value = 0.07). The pattern of feeding is a nutritional problem that causes the incidence of malnutrition that occurs in children under five which is also stated to affect the pattern of feeding carried out by the mother (p-value = 0.000). The monthly income received by the family has a significant value in cases of nutritional problems that cause malnutrition (p-value = 0.013). The results of what has been obtained and what has been concluded are certainly expected from any government sector by midwives and other village officials that the factors that cause nutritional status come from within the family itself. Both in terms of knowledge, feeding patterns and monthly family income. However, the problem of nutritional status cases must be addressed immediately with all efforts that can be made. Because it is not a problem in the health sector that can easily be cured. Requires willingness from the start at the prevention stage of this case, starting with the prospective mother and the prospective father.Because childhood, which is arranged in the first 1000 days of life, greatly influences what events can happen to the child.

SUGGESTION
Requires cooperation with village officials to prevent nutritional status problems to achieve nutritional well-being for toddlers and increase efforts to provide healthy food for toddlers in Cot Peuradi Village to reduce the number of undernourished children in Cot Peuradi Village.
1. Knowledge of family mothers or parents should pay more attention to the variety of knowledge about fulfilling the nutritional status of children. from childhood within the first 1000 days of life. Because if parents do not have good knowledge of the child's nutrition, the child will be at risk of experiencing health problems during the growth period. 2. The pattern of feeding a mother must be able to understand about patterns of feeding that are good for children. either in the type of food or vitamins in the right amount and time to be given to children. Because all nutritional intake for children must be fulfilled and everything that enters the child's body affects the growth and health of children. 3. Family income is expected to be more adequate to provide sufficient nutritional intake for families, especially for children. the government must also help by opening more jobs and of course to increase family income so that they can meet their nutritional needs, especially for toddlers.