Abstract

Malnutrisi pada balita masih merupakan permasalahan di Indonesia termasuk di Daerah Istimewa Yogyakarta. Berdasarkan indikator berat badan menurut tinggi badan, 2,6% balita mengalami malnutrisi akut berat. Pada beberapa dekade terakhir, telah terjadi pergeseran paradigma dalam penanganan balita malnutrisi, yang sebelumnya berbasis pendekatan fasilitas kesehatan bergeser menjadi pendekatan berbasis komunitas. Tujuan penelitian ini adalah untuk menganalisis pengaruh program home care terhadap peningkatan status gizi balita malnutrisi pada anak usia 6-60 bulan. Penelitian menggunakan desain kuasi eksperimen dengan pretest dan posttest control group melalui tiga tahap pendampingan yaitu intensif, mandiri, dan penguatan dengan pendekatan asuhan keperawatan. Sampel adalah 56 balita malnutrisi akut di dua wilayah, yaitu 33 balita di Kota Yogyakarta (eksperimen) dan 23 balita di Kabupaten Sleman (kontrol) dengan teknik pengambilan sampel yaitu purposive sampling. Intervensi home care diberikan selama tiga 3 bulan (Januari sampai Maret 2013). Hasil penelitian menunjukkan setelah program home care, terjadi peningkatan yang signifikan pada status gizi balita (p < 0,05). Pada akhir intervensi, terjadi penurunan kejadian malnutrisi akut berat dari 100% menjadi 56,7% (p < 0,05). Children undernutrition is still an issue in Indonesia, including in the Special Region of Yogyakarta. Based on weight for height indicator, 2.6% children experience severe acute malnutrition. In the last few decades, there has been a paradigm shift in the management of acute malnutrition from a facility- based to community-centered approach. The purpose of this study was to analyze the effect of home care intervention on the improvement of nutritional status of severe acute malnutrition children aged 6-60 months. This study was designed with quasi-experimental and pretest-posttest control group design, conducted in three phases; intensive, strengthening and independent with nursing approach (January until March 2013). Samples were 56 children with severe and moderate acute malnutrition for both study sites, 33 children in Yogyakarta city (experiment) and 23 children in Sleman district (control), selected using purposive sampling. Home care intervention is given for three months (January until March 2014). Results findings show there were significant increase in nutritional status (p < 0.05) after home care intervention. At end line evaluation, the proportion of severe acute malnutrition in the experimental groups reduced significantly from 100% to 56,7% (p < 0.05).

References

1. Magdalena J, Nyirenda LZ, Annakarin J, Birgitta L. Perceptions of Malawian nurses about nursing interventions for malnourished children and their parents. Journal Health, Population and Nutrition. 2011 Dec; 29(6): 612-8.

2. Menezes FS, Leite HP, Nogueira Paulo CK. Malnutrition as an independent predictor of clinical outcome in critically in children. Nutrition. 2012; 28 : 267-70

3. Walton E, Stephen A. Malnutrition in developing countries. Pediatrics and Child Health. 2011; 21: 9

4. Schoones A, Lombard M, Musekiwa A, Nel E, Volmink J. Ready-to-use therapeutic food for home-based treatment of severe acute malnutristion in children from six months to five years of age. Cochrane Database of Systematic Review. 2013; 6.

5. Lenters LM, Wazny K, Webb Pa, Ahmed T, Bhutta ZA. Treatment of severe and moderate acute malnutrition in low- and middle-income settings: a systematic review, meta-analysis and Delphi process. BMC Public Health, 2013; 13 (Suppl 3): S23

6. Talbert A, Thuo N, Karisa J, Chesaro C, Ohuma E, Ignas J, et al., Diarrhoea complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome. PLoS ONE. 2012; 7(6); e38321: 1-9

7. Vygen SB, Roberfroid D, Captier V, Kolsteren P. 2013, Treatment of severe acute malnutrition in infants aged < 6 months in Niger. The Journal of Pediatrics. 2013; 162: 515-21

8. BAPPENAS/Kementerian Perencanaan Pembangunan Nasional. Rencana Aksi Nasional Pangan dan Gizi 2011-2015. Jakarta: Kementerian Perencanaan Pembangunan Nasional; 2011.

9. Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia 2010. Jakarta: Kementerian Kesehatan Republik Indonesia; 2011.

10. Urquijo, Ibane, Maza. Assessment of the intervention in a therapeutic feeding center for children in Nicaragua. Nutrition Hospital. 2011; 26(6): 1345-9

11. Teferi E, Lera M, Sita S, Bogale Z, Datiko D, Yassin M. Treatment outcome of children with severe acute malnutriion admitted to therapeutic feeding centers in Southern Region of Ethiopia. Ethiopian Journal of Health Development. 2010; 24 : 234-8.

12. Bachmann. Cost effectiveness of community based treatment of severe acute malnutrition in children. Expert Reviews of Pharmacoeconomics and Outcomes Research. 2010; 10 (5): 605-12.

13. AFC. Community-based management of acute malnutrition [online]. 2012 [cited 2013 Jun 25]. Available from: http://www.actioncontrlafaim.ca/index.php?option=com_content&view =article&id=1166&Itemid=500&lang=en.

14. Leggo M, Banks M, Isenring E, Stewart L, Tweeddale M. A quality improvement nutrition screening and intervention program available to home and community care eligible clients. Nutrition and Dietetics. 2008; 65: 162-7.

15. Shi L, Zhang J, Wang Y, Caufield LE, Guyer B. Effectiveness of an educational intervention on complementary feeding practices and growth in rural China : a cluster randomised controlled trial. Public Health Nutrition. 2009: 13 (4); 556-65.

16. McCabe B, Potash D, Omohundro E, Taylor CR. Seven-month pilot of an integrated, continous evaluation, and quality improvement system for a state-based home-visiting program. Maternal Child Health Journal. 2012; 16: 1401-12.

17. Shafiq Y, Saleem A. Lassi ZS, Zaidi AKM. Community-based versus health facilty based management of acute malnutrition for reducing the prevalence of severe acute malnutrition in children 6 to 59 months of age in low and middle-income countries (Protocol). The Cochrane Library. 2013; 6: 1-14.

18. Saias T, Lemer E, Greacen T, Vernier ES, Emer A, Pintaux E, et al. Evaluating fidelity in home-visiting programs a qualitative analysis of 1058 home visit case notes from 105 families. PloS ONE. May 2012; 7 (5): 1-10.

19. Long WE, Cabral HJ, Garg A. Are components of the medical home differentially associated with child health care utilization, health, and health promoting behavior outcomes? Clinical Pediatrics. 2013; 52 (5): 423–32.

20. Schaffer MA, Goodhue A, Stennes K, Lanigan C. Evaluation of a public health nurse visiting program for pregnant and parenting teens. Public Health Nursing. 2012; 29 (3): 218-31.

21. Roche ML. A community-based positive deviance/hearth intervention to improve infant and young child nutrition in the Ecuadorian Andes [thesis]. Canada: McGill University; 2011.

22. Bhutta Z, Das JK, Rizvi A, Gaffey M, Walker N, Horton S. et al., Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013; 382: 452- 77.

23. Connor NE & Manary MJ. Monitoring the adequacy of catch-up growth among moderately malnourished children receiving home-based therapy using mid-upper arm circumference in Southern Malawi. Maternal and Child Health Journal. 2011; 15: 980-4.

24. Contreras AG, Ganbay EMV, Velarde ER, Gutierrez AI, Sanroman RT, Montes IES. Intensive nutritional support improves the nutritional status and body composition in severely malnourished children with cerebral palsy. Nutricion Hospitalaria. 2014; 29 (4): 838-43.

25. Yebyo HG, Kendall C, Nigusse D, Lemma W. Outpatient the rapeutic feeding program outcomes and determinants in treatment of severe acute malnutrition in Tigary, Nothern Ethiopia : a retrospective cohort study. PLoS ONE. 2013; 8 (6): e65840 : 1-9

26. Bisits BPA. The positive deviance/hearth approach to reducing child malnutrition: systemic review. Tropical Medicine and International Health. 2011; 16 (11): 1354-66.

27. Iversen PO, Marais D, du Plessis L, Herselman M. Assesing nutrition intervention programmes that addresed malnutrition among young children in South Africa between 1994-2010. AJFAND online. 2012; 12 (2): 5928-45.

Download

Share

COinS