PENGARUH INTERVENSI PRAKTIK PEMBERIAN MP-ASI KOMPREHENSIF TERHADAP SELF-EFFICACY IBU, PRAKTIK PEMBERIAN MP-ASI, DIETARY DIVERSITY, ASUPAN MAKANAN DAN PERTUMBUHAN BALITA USIA 6 - 12 BULAN

HENI HENDRIYANI, Dr. Toto Sudargo S.K.M., M.Kes.; Dr. Siti Helmyati D.C.N., M.Kes.; Dr. Susetyowati D.C.N., M.Kes.

2020 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Status kesehatan dan gizi anak terutama malnutrisi, masih menjadi isu penting yang harus ditangani di Indonesia. Data Riskesdas 2018 menunjukkan proporsi kurang gizi, stunting dan wasting usia 6-23 bulan 11.4%, 30% and 11.7% dan prevalensi stunting di pedesaan lebih tinggi (32,8%) dari perkotaan (27,4%). Tujuaan penelitian untuk mengetahui pengaruh intervensi praktik pemberian MP-ASI komprehensif terhadap peningkatan self-efficacy ibu, praktik pemberian MP-ASI, minimum dietary diversity (MDD), asupan makanan dan pertumbuhan Balita usia 6 - 12 bulan. Disain penelitian kuasi eksperimen dengan kelompok perlakuan dan kontrol yang diukur bersamaan saat sebelum dan sesudah perlakuan. Kelompok perlakuan sejumlah 83 orang dan kontrol 82 orang ibu dan Balitanya usia 6-12 bulan di Kulon Progo Yogyakarta. Dilakukan kunjungan rumah setiap dua minggu selama tiga bulan oleh enumerator. Data dikumpulkan dengan kuesioner, recall 24 jam penimbangan dan pengukuran panjang badan. Analisis data dengan uji Saphiro Wilk, Mann Whitney, chi square dan Independent t-test dilakukan pula uji sequence equation model (SEM) dengan SmartPLS. Hasil analisis linear programming menunjukkan seng dan zat besi merupakan absolute problem nutrients. Terdapat perbedaan bermakna pada kelompok intervensi dan kontrol setelah intervensi pada skor complementary feeding self-efficacy (CFSE), skor praktik MP-ASI, asupan energi, karbohidrat, protein, lemak, zat besi dan seng (p = 0,000; p = 0,000; p = 0,000, p = 0,013, p =0,000; p = 0,001; p = 0,011 dan p = 0,000) serta pada selisih skor CFSE, selisih asupan protein dan seng (nilai p = 0,047, p = 0,033 dan p = 0,028). Tidak ada perbedaan bermakna pada MDD, selisih MDD, asupan vitamin A dan selisih vitamin A (p = 0,935; p = 0, 526; p = 0,065 dan p = 0,080). Demikian juga selisih skor praktik MP-ASI, asupan energi, karbohidrat, lemak, zat besi dan vitamin A (p = 0,162; p=0,060; p = 0,309, p = 0,105, p = 0,137). Selisih berat dan panjang badan menunjukkan perbedaan bermakna (p = 0,007 dan p = 0,040), selisih z skor BB/U, PB/U dan BB/PB tidak ada perbedaan bermakna (p = 0,813, p = 0,448 dan p = 0,335). Hasil analisis SEM usia ibu berhubungan dengan praktik (r=-0,321; p = 0,002); CFSE dengan praktik (r =0,262; p = 0,011); praktik MP-ASI dengan asupan gizi (energi, protein, zat besi, seng dan vitamin A) (r = 0,304; p = 0,001) dan asupan gizi dengan selisih berat badan dan panjang badan (r = 0,268; p = 0,007). Intervensi praktik pemberian MP-ASI komprehensif melalui penyuluhan dan konseling dengan pesan spesifik hasil linear programming dan media yang efektif meningkatkan CFSE ibu, asupan makanan terutama protein dan seng serta kenaikan berat dan panjang badan anak Balita.

Health and nutritional status of children especially malnutrition is still important issues to be tackled in Indonesia. Basic Health Research Data 2018 revealed that the proportion of under nutrition, stunting and wasting in this age group were 11.4%, 30% and 11.7% respectively and the prevalence of stunting was higher in rural areas (32.8%) than urban areas (27.4%). Aims of the study were to determined effect of comprehensive complementary feeding intervention on the increase of complementary feeding self-efficacy, feeding practices, minimum dietary diversity (MDD), nutrient intake and growth children aged 6-12 months. The study used quasi experimental research design with intervention and control group measured before and after intervention. Intervention group consisted of 83 and control 82 mothers and her infant aged 6-12 months in Kulon Progo Yogyakarta There were home visit fortnightly for three months by enumerator. Data were collected through questionnaire, recall 24 hr, weighing and measuring length. Data were analyzed using Saphiro Wilk, Mann Whitney, chi square dan Independent t-test and sequence equation model (SEM) with SmartPLS. Linear programming results revealed that zinc and iron were the absolute problem nutrients. There were significant differences in two groups on complementary feeding self-efficacy (CFSE) score, feeding practices score, intake of energy, carbohydrate, protein, fat, iron and zinc (p = 0,000; p = 0,000; p= 0,000, p = 0,013, p = 0,000; p = 0,001; 0,011 dan 0,000) as well as on CFSE score delta, protein and zinc intake delta with p = 0,047, p = 0,033 and p = 0,028 respectively. There were no significant differences on vitamin A intake and MDD score and delta (p = 0,065, p = 0,080 p = 0,935 and p = 0,526), feeding practices score delta, energy, carbohydrate, fat, and iron intake delta (p = 0,162; p = 0,060; p = 0,309, p = 0,105, p = 0,137). Meanwhile, there were significant differences on weight and height gain between two groups (p = 0,007 and p = 0,040). While there were no significant differences on WAZ, HAZ and WHZ z score delta with p = 0,813, p = 0,448 and p = 0,335. Sequence equation model analysis showed mothers age relate with feeding practices (r =- 0,321; p = 0,002), CFSE with feeding practices (r = 0,262; p = 0,011), feeding practices with nutrients intake (energy, protein, iron, zinc and vitamin A) (r = 0,304; p = 0,001) and nutrient intake with weight and height gain (r = 0,268; p = 0,007). Comprehensive complementary feeding intervention through nutrition education and counseling based on linear programming using effective media increase complementary feeding self-efficacy of mothers, nutrient intake especially protein and zinc intake as well as weight and height gain among infant

Kata Kunci : MP-ASI, efikasi diri ibu, praktik MP-ASI, linear programming, Optifood, asupan gizi.; complementary feeding, feeding self-efficacy, linear programming, Optifood, nutrient intake