Background: Stunting is based on the index of PB/U or TB/U with a threshold (z-score) ≤ -2 SD. Stunting is not only caused by one factor but is caused by many factors that are interconnected with each other. This study aims to determine the relationship between parenting and maternal knowledge about nutrition with the incidence of stunting in children aged 7-24 months at the Sawah Lebar Health Center in Bengkulu in 2023.

Method: The research design used in this study was Descriptive Analytic with Cross Sectional approach and ampelous wasselected by accidental sampling technique with a sample of 52 people. This study used the Chi Square test with a confidence level of 95%.

Results: Based on univariate analysis, the results showed that most of the mother's parenting style was good parenting (76,9%), while mother's knowledge about nutrition was mostly good knowledge (78,8%) and children were stunted, namely (15,4%). The results of bivariate analysis showed that there was a association between parenting style and the incidence of stunting with p-value (0,017) and there was a association between nutritional knowledge of mother and the incidence of stunting with p-value (0,001).

Conclusion: There is an association between parenting style and nutritional knowledge of mother with the incidence of stunting aged 7-24 months in Sawah Lebar Health Center in Bengkulu City in 2023

Suggestion: Suggestions for mothers are expected to pay attention to the nutritional status of children, especiallypuskesmas to provide counseling to mothers who have children and toddlers about stunting, so that further research is expected on parenting and knowledge Mothers about nutrition by considering other factors that can affect the incidence of stunting such as child intake and infectious diseases.

Keywords: parenting style, nutritional knowledge of mothers, stunting

UNICEF, united nations children’s fund; WHO, world health organization

The nutritional status in children is an important thing that every parent must know who needs attention for their growth and development.¹ The nutritional status of children is dependent on their age, weight, and height. Several factors, including the appropriateness of BB/U, the suitability of PB/U or TB/U, and the suitability of BB/TB, affect a child's nutritional health.² The first 1000 days of a child's life, from the mother's pregnancy to the age of two, sometimes known as the "Golden Age" are crucial because nutritional issues are more likely to emerge in young infants under the age of two. Linear growth retardation can occur due to the failure of the development process resulting from low health conditions and lack of nutritional intake.³

One of the problems of child nutritional status which has become a national problem is the problem of stunting. This is because stunting has a negative impact on human resources in the future. Studies show that stunting has long term and short term effects, including health problems, poor academic performance, substandard labor force, low household income, and increased risk of cardiovascular disease in adulthood. Short term nutritional problems (stunting) are problems that need to be addressed quickly. A kid that is stunting has a height or length that is below average for their age. Stunting is determined by the indices (PB/U) or (TB/U) at the threshold (z-score) of -2 SD. Stunting accounts for 15 to 17 percent of all child deaths worldwide because stunting children have a low immune system and make children susceptible to disease.⁴

Worldwide prevalence of stunting in children under five at 2020 is 149,2 million. Toddlers affected by stunting are more than 50% living on the Asian continent. The goal is to bring the number of stunting children under five to 104 million in 2025 and to 87 million in 2030.⁵ According to data on stunting from the 2019 SSGI, the incidence of stunting in Indonesia is 27,7%. The frequency of stunting has decreased to 24,4% according to the 2021 SSGI. In SSGI 2022 it decreased to 21,6%. Based on the age group, the incidence of stunting when 6-11 months was 13,7% and when 12-23 months it increased 1,6 times to 22,4% so that children between the ages of 7 and 24 months were the subjects of research studies.⁶

According to SSGI in 2019, In Bengkulu Province, the stunting rate in children under five reaches 26.9%. The 2021 SSGI shows a decrease in the prevalence of stunting to 22.1%. In SSGI in 2022 it decreased to 19,8%. All recorded data still does not meet the target of RPJMN objective stipulates that the target for stunting in 2024 is 14%. In SSGI 2022 the prevalence of stunting under five from 10 Regencies/Cities, Bengkulu is in the order of 9 out of 10 Regencies/Cities with a stunting percentage of 12,8%.⁶ The Bengkulu Provincial Government continues to conduct socialization and targets stunting cases to fall to 12,55 percent in 2024. The results of ePPGBM data entry conducted in Bengkulu in 2022 were 20 public health center including 16 public health center s with stunting toddlers in Bengkulu with a target of 11.700 toddlers toddler. One of the public health center that has stunting is the Sawah Lebar Health Center with a total of 1091 children under five and there are 18 children who are stunting, with a stunting percentage of 1,65%.⁷

Factors causing stunting are grouped into direct and indirect. The direct factors are nutritional intake and Infectious illnesses. Indirect factors are the availability and consumption patterns of households, parenting patterns in feeding practices, parenting habits, use of healthcare services, knowledge of mothers, as well as health and environmental hygiene service. The prevalence of child stunting is influenced by a variety of variables, but this study focuses on parenting style and nutritional knowledge of mother. Stunting is produced by a variety of variables that are interrelated with one another, not just one and toddlers children still depend on their parents.⁴

According to the study of Noftalina et al.⁸ indicates that there is a significant relationship between parenthood and the incidence of stunting. Parenting practices are practiced in the household and achieved through the availability of food and health care and other resources for the survival, growth, and development of children. Aspects assessed in this study included 3 aspects: dietary practices, parenting habits and use of health services. Parenthood plays a role in stunting rates in toddlers because food intake in toddlers is completely regulated by the mother. Mothers who raise children well tend to have children with better nutritional status than mothers who raise children poorly.⁹

According to the study by Olsa et al.⁴ it was shown that maternal knowledge has an effect on the prevalence of stunting malnutrition. To get a good nutrition, parents need to have good nutritional knowledge to make a balanced menu choice. Maternal nutritional knowledge plays an important role in preventing stunting. Mothers with inadequate knowledge and attitudes about nutrition will greatly affect the nutritional status of children and make it difficult to choose nutritious foods for children and the whole family. The results of the initial survey were carried out by several integrated service post in Sawah Lebar Health Center in Bengkulu, out of 10 respondents there were 3 children (30%) out of 10 toddlers experiencing stunting, 4 mothers (40%) out of 10 mothers had poor parenting patterns and 3 mothers (20%) out of 10 mothers have poor knowledge about nutrition. According to the above description, the researchers were curious to discover the association between parenting style and nutritional knowledge of mothers with the incidence of stunting children aged 7-24 months in Bengkulu Province, specifically at Sawah Lebar Health Center.

The research design of this study is descriptive-analytic in nature and uses a cross-sectional methodology. The study was conducted to determine the relationship between parenting style and nutritional knowledge of mothers with the incidence of stunting. The place and time of this research was at the Sawah Lebar Bengkulu Health Center which was carried out in May 2023. Children aged 7 to 24 months from the Sawah Lebar Health Center in Bengkulu served as the study samples. Sampling using accidental sampling technique as many of 52 respondents. In this study, the bivariate analysis used was the chi-square test with a 95% confidence level, to see a significant relationship between the independent and dependent variables. The ethics committee of the Bengkulu Ministry of Health Polytechnic has approved this research with number No. KEPK.BKL/200/05/2023 on May 14, 2023.

Univariate analysis

This study involved 52 children aged 7-24 months from the Sawah Lebar Health Center in Bengkulu. Table 1 shows the distribution and frequency characteristics related to nutritional status by index (TB/U) in children aged 7 to 24 months. Based on Table 1, the incidence of stunting in children aged 7-24 months (84,6%) in Bengkulu Sawah Lebar Health Center in 2023 was assessed as not stunting. At the Sawah Lebar Health Center the stunting rate in children aged 7 to 24 months was (15,4) percent, namely 8 children.

The results of the research on the distribution of maternal parenting patterns are shown in Table 1. There were also mothers (23,1%) who did not have good parenting styles. Therefore, in 2023, the number of mothers with good parenting styles for their children aged 7-24 months in Bengkulu Sawah Lebar Health Center will be (76,9%). Based on the research results, the distribution of maternal nutritional knowledge for children aged 7-24 months in Bengkulu Sawah Lebar Health Center in 2023 is illustrated in Table 1. Some mothers (21.2%) do not have sufficient knowledge about nutrition. Thus, in 2023 the number of mothers (78.8%) who have sufficient knowledge about nutrition for their children aged 7-24 months at the Sawah Lebar Health Center in Bengkulu City will increase.

Bivariate analysis

Statistical test results in Table 2. Some 12 mothers do not have appropriate parenting patterns, and 11 mothers do not have adequate nutrition knowledge. Based on Table 2, it was determined that among the 8 stunting kids, most of them had not good parenting (38,4%) and of the 44 children who were not stunting, most of them had good parenting (92,3%). The statistical analysis revealed a p-value 0,017. This demonstrates there is association between parenting style and stunting incidence (p-value <0,05) so the Ha Hypothesis is accepted that there is a association between parenting style and the incidence of stunting in Sawah Lebar Health Center, Bengkulu. The OR value (95% CT) shows that children with not good parenting styles are 7,5 times more at risk of stunting than children with good parenting styles.

Through the research results, out of 8 children showing stunted growth, the majority of mothers did not have good knowledge about nutrition (54,5%) and out of 44 children showed no signs of growth retardation. number of mothers with good knowledge of nutrition (95,1%). A statistical test gave a p-value = 0,001. This shows the association between nutritional knowledge and stunting prevalence in Sawah lebar medical center in Bengkulu, its value (p value 0,05) indicates the acceptance of hypothesis Ha. The OR (95% CT) scale showed that mothers with poor nutrition knowledge were 23,4 times more likely to have a stunted child than mothers with good nutrition knowledge.

Description of the incidence of stunting children aged 7-24 months at the sawah lebar health center Bengkulu

The results showed that most of the children under 7-24 months old had nutritional status of normal height/age, up to 44 children (84.6%) and 8 children (15.4%) under 2 years of age were impaired. stunting nutrition of Sawah Lebar Medical Center. bengkulu. A stunted child is a child whose nutritional status is based on TB/U. This condition is measured as height standard deviation ≤ -2 from the WHO standard median for growth in children. Stunting malnutrition occurs when a child's growth and development is disrupted due to health problems and suboptimal nutrition.⁴ Many factors cause stunting in children. Factors causing stunting can be caused by direct or indirect factors. Some of the factors that affect growth and development are poor health, nutritional status of the mother, inadequate food intake, and infectious diseases. Stunting also affects productivity and economic growth. Feeding the quality and quantity of food makes a major contribution to the incidence of stunting stunting is not only caused by one factor but caused by many factors that are interconnected with one another.¹⁰

Description of the Mother parenting style of children aged 7-24 months at the sawah lebar health center Bengkulu

Based on the results of research that has been conducted on mothers who have children aged 7-24 in Sawah Lebar Health Center in Bengkulu City, it shows that most of the mothers' parenting styles are good parenting by 40 people (76,9%) and poor parenting by 12 people (23.1%). The results of this study are in line with research conducted by Meliasari¹¹ in Paud Al Fitrah Sei Rempah District, Serdang Bedagai Regency, said that the application of parenting style in toddlers is mostly in the good category, which is as much as (56,2%). In the study, the parenting measure was divided into 3, which are eating habits, parenting habits and health service usage habits. According to the research results, the lowest rate is the parents' eating habits (27%). Eating habits indicate what foods a child eats other than breast milk from what age, the type of food the mother feeds, the circumstances in which the child eats, and whether the child always consumes food. According to Bella et al.¹² Eating healthy, eating well and adjusting the consumption portion will improve the nutritional status of children. Good nutrition for infants and young children needs to meet the requirements of adequate energy and nutrition according to age, a balanced menu with available food ingredients, the child's habits and tastes, the form of food and the diet is suitable for the child's condition, paying attention to personal hygiene and the environment. 

According to the research results on parents' habits of using health services, specifically (35%). The routine of health services is the number of times the child has weighed in the past 6 months, if the child is sick, what has the mother done, what medicine has been given to the child, vaccinations and vitamin A tablets given to the child. According to Apriyanto et al.¹³, habits in efforts to access health services include ways for mothers to access health services for their children by fully vaccinating, treating diseases and supporting them professional support to maintain the health of the child. This is important to improve the nutritional status of children as mothers strive to take advantage of existing health services to obtain accurate health information. Efforts to increase the use of health services to increase the provision of health information to mothers with diverse activities such as nutrition counseling, health and nutrition counseling for mothers with young children have nutritional problems. 

In the part of parenting in parenting habits, the research results show that the highest percentage is parenting in parenting habits (38%). Parents' habits such as the age of child care, napping habits, the number of times the child's nails are cut, the number of baths the child takes, and whether the mother washes her hands with soap before feeding the child children. According to Syahida et al.¹⁴ good parenting habits are promoted by the mother herself with the maximum amount of time that the mother has to spend with the toddler on a daily basis. Families with poor parenting habits were nine times more likely to have poor nutrition. Parental role models are very important in the growth and development of children. One of the factors affecting the growth and development of children is the presence of psychosocial factors including important factors in children's lives, namely the importance of stimulation in parenting. A good parent is an image of a child's positive interaction with a primary caregiver, who plays a role in the child's emotional and psychological development to induce normal growth and development.

Some factors that affect parenting according to Edward in Christiana et al.¹⁵ are age, education, economic status, and work. The age of parents greatly affects parenting. Younger parents are more likely to communicate with their children than older parents. And older parents tend to be harsher in parenting and more dominant in their children's decision-making and education. The level of education and knowledge of parents and their experience are very influential in parenting.¹⁵ A mother's education and parenting experience influence her willingness to be the right parent, but knowledge is not always gained in formal education alone, it can be from the media. Parents with high economies tend to facilitate their children more, and these facilities will affect the child's personality. While parents with low economic status tend to be harsher to children and want to teach children to be grateful for the limited facilities available Currently, many mothers work to increase their family's financial income, and work makes them have less time to care for their babies.¹⁵

Description of the nutritional knowledge of mother children aged 7-24 months at the sawah lebar health center Bengkulu

Based on the results of research that has been conducted on mothers who have children aged 7-24 in Sawah Lebar Health Center in Bengkulu City, it shows that most of the mothers' knowledge about nutrition most mothers have good knowledge of 41 people (78,8%) and poor knowledge of 11 people (21,2%). The results of this study are in line with research conducted by Salman et al.¹⁶ Buhu Village, Talaga Jaya District, Gorontalo Regency, stating that maternal knowledge about nutrition in children is mostly in the good category, which is as much as (66,7%).

The questions given to mothers were 10 knowledge questions about nutrition. Of the 10 questions given, the question that many mothers do not know the answer to is question number 6, which is a question about what are the types of nutrients. The question on this questionnaire cannot be answered by the mother because the mother never gets an explanation or read about various types of nutrients, the mother only knows several types of nutrients, namely carbohydrates, proteins and fats. Some mothers do not know if vitamins and minerals are included in the type of nutrition, most mothers cannot answer the questions given correctly so that the food given by the mother does not meet the requirements of balanced nutrition and causes the child to be stunted.English translation.  Mother's nutritional knowledge is one of the factors that determine a person's food intake. People with good nutrition knowledge will be able to apply their nutritional knowledge in choosing and preparing food so that it is safer to eat, while using household income distribution to choose choose good foods, while also taking care of good nutrition for children and their families.¹⁶

Maternal poor nutrition knowledge is influenced by many factors including education and maternal lack of interest or understanding about nutrition which will affect the growth and development of the child, children will have growth disorders such as stunting. Good nutritional knowledge in mothers is to provide the right type and the right amount of food according to the child's developmental age needs so that the child develops optimally and does not have problems during the growth period.¹⁷

Discussion of the association between parenting style with the incidence of stunting children aged 7-24 months at the sawah lebar health center Bengkulu

The results of the statistical tests conducted showed that there is a statistically significant relationship between parenting style and the prevalence of stunting in children 7-24 months old at Sawah Lebar Bengkulu Medical Center, with a p-value of 0,017 and an OR of 7,5, meaning that children with poor parenting have a 7,5 times higher risk of stunting than children with good parenting. One of the factors that influence the prevalence of stunting is the parenting culture that exists in family in the form of feeding habits, parenting habits and habits in trying to get health services when a family member is sick. Mother's parenting style for children is closely related to the mother's condition, especially health, education, knowledge and skills in children. Therefore caring for toddlers is very important because it will affect the child's growth and development process.¹⁸ Based on the results of research conducted in Sawah Lebar Health Center Bengkulu 2023, the incidence of stunting was found to be more in poor parenting (38,4%), this condition occurs because parenting style directly influences nutritional intake and the incidence of infection in children. According to Rizyana et al. Nutritional status is directly affected by nutritional intake and infectious diseases that children may suffer from. These two direct causes are closely related to the parenting style provided by the mother/caregiver. And the indirect causes are food security in the family, parenting patterns as well as health and environmental health services.¹⁹

In this study, there were still unfavorable maternal parenting styles and as many as (61,6%) children were not stunted. This could happen because mothers can support the selection of foods with high nutritional value so that children get good food consumption. According to Handayani et al.²⁰ in terms of fulfilling good nutrition for children food is not always expensive but it depends on a mother in terms of utilizing existing natural products and choosing cheap but high nutritional food ingredients. Therefore, at the household level, mothers have an important role in determining the food in the household.²⁰ In this study, most of the parenting styles of mothers had good nutritional status, not stunting (92,3%). This is because the mother's role as executor of parenting has gone very well in implementing diet, parenting habits and health services. According to Noorhasanah et al.²¹ Parenting habits that have been implemented properly and correctly are common in toddlers with normal height or who are not stunted. Parenting plays an important role in the occurrence of growth disorders in children, parental care for children affects the growth and development of children through the adequacy of food and health conditions.²¹ In this study there were still children who were stunted even though the mother had done good parenting as much (7,7%). This happened because the children had a habit of having difficulty eating and only choosing certain foods they liked and possibly caused by several other factors that could lead to stunting in children. According to Hermawan et al.²² Factors that need to be considered in relation to stunting are mothers who have short stature, mothers who have had nutritional problems during pregnancy, a history of breastfeeding, any infectious diseases the child has experienced. So even though the mother's upbringing is good, these other factors can increase the occurrence of stunting.²²

The results of this study are consistent with the study of Noorhasanth et al.²¹ at Cempaka Banjarbaru Medical Center, which obtained a p-value of 0.01, so there is a relationship between motherhood and status. underdeveloped. Mothers with good parenting methods will always care about their children's health, to take measures to prevent stunting problems early. On the contrary, bad parenting will also have a negative impact on the growth and development of children, especially the nutritional status of children. Most stunted children have poor or bad upbringing, so mothers are likely to overlook important questions regarding the causes of nutritional problems.²¹ This study is also consistent with the study done by Fauziyah et al.²³ in the village of Sukamulya, which obtained a p-value of 0.043, indicating that there is a relationship between parenting style and proportion developmental delay in toddlers. This condition arises because parenting style directly affects nutritional intake and infection rates in toddlers. Providing adequate nutrients and minimizing the incidence of infections will improve the nutritional status of children under the age of 5 so that they do not become malnourished. Parents with good parenting practices optimally improve their children's nutritional status compared to parents with poor parenting practices.²³

The results of this study are not in line with the research of Ni mah et al.²⁴ in Balen District, Bojonegoro Regency, with a p-value of 0,928 which indicates that there is no relationship between maternal parenting and stunting. Mothers with good parenting styles do not necessarily have toddlers with fewer stunting problems than mothers with poor parenting styles. This can happen because in poor families there are limitations to meet their daily needs, so the mother's parenting style does not contribute to the emergence of stunting problems.²⁴ Parenting pattern is the way parents take care of, care for, educate young children. Parenting that is very closely related to the growth and development of toddlers aged 6-59 months is a period when children still need a sufficient supply of food and nutrition. Therefore health and food care in the first year of life is very important for toddler development.²³

Discussion of nutritional knowledge of mother with the incidence of stunting children aged 7-24 months at the sawah lebar health center Bengkulu

Based on statistical tests it can be concluded that there is a significant relationship between maternal knowledge related to nutrition and the incidence of stunting in children aged 7-24 months at the Sawah Lebar Bengkulu Health Center in 2023 with a p-value of 0,001 and OR 23,4, which means that children with a pattern Poor parenting has a 23,4 times greater risk of experiencing stunting compared to children who have good parenting.

Mother's knowledge about nutrition is the mother's ability to understand all information related to food ingredients that contain nutrients for toddlers. Knowledge of feeding children can influence the behavior of mothers in feeding their children because the process of forming behavior is the development of knowledge that can shape attitudes and then can influence the emergence of behavior. Knowledge of good nutrition in mothers is expected to be able to provide food with the right type and amount according to the needs of the child's growth age so that children can grow optimally and not experience problems during their growth period.¹⁷

Based on the results of research conducted in Sawah Lebar Health Center Bengkulu 2023, stunting was found to be more stunted children with poor maternal knowledge of nutrition (54.5%), this condition occurs because maternal knowledge of nutrition directly affects nutritional intake in children and mothers do not know the kinds of nutrients and food ingredients. According to Titisari et al.²⁵ the lack of knowledge of mothers about nutrition can make the mother's behavior in paying attention to the nutrition of her toddler less than optimal. The majority of respondents who are less knowledgeable and have toddlers with undernourished status, they are not good at preparing menus for their toddlers. Most provide the same food menu for their toddlers. In addition, respondents did not know the principles of balanced nutrition for toddlers which became the basis for fulfilling toddler nutrition.²⁶ In this study, there was still mother's knowledge about poor nutrition and her child was not stunted as much (45,5%), this is because mother's parenting style and experience can affect the health of toddlers, such as the type of food given, the frequency of eating toddlers, and the amount of food given, so that mothers who lack knowledge can also have children who are not stunted. This is in line with Lailatul explaining that a high level of knowledge does not guarantee having a toddler with normal nutritional status or not stunting.²⁴

In this study, most of the parenting styles of mothers had good nutritional status, not stunting (95,1%), this was because mothers understood nutritional knowledge in the practice of selecting types and variations of food every day so that mothers were able to serve good menus or nutrition to their children. and well-nourished children. This is in line with the research of Salman et al.¹⁶ Mothers with good nutritional skills can apply their nutritional knowledge to food selection and processing, thus using household income sharing to make quality food choices and take care of proper nutrition for their children and their children. and can expect safer food intake for family.¹⁶ In this study there were still children who were stunted even though mothers had good nutrition knowledge (4,9%) this was because some mothers only knew about balanced nutrition but did not apply it in their daily lives due to several other factors that could lead to stunting in children. According to Karisidiana et al.²⁶ even though mothers' knowledge about nutrition is good, these other factors can increase the incidence of stunting.²⁶

The results of this study are in agreement with Wardanu et al.²⁷ of Simpang Hilir District, Kayong Utara Regency, who obtained a p-value of 0.000, indicating that there is a significant association between knowledge on maternal nutritional status and morbidity. of stunting. A child's nutritional intake is influenced by the mother's nutritional knowledge, especially regarding food choices and the variety of foods the child eats, because the mother is solely responsible for the child's nutrition family nutrition.²⁷ This study is also consistent with the study carried out by Adelina et al.²⁸ at Duren Community Health Center, Semarang Regency, with a p value of 0.017 indicating that there is a significant relationship between ant Maternal nutrition and growth retardation. The mother's level of knowledge is the key to household management, it will influence the mother's attitude in the selection of food ingredients to be consumed in the family. Mothers with good nutrition knowledge will understand the importance of good nutrition for health and well-being.²⁸

The results of this study were not in line with Salman et al.¹⁶ in Buhu Village, Talaga Jaya District, Gorontalo District, a p-value of 0,877 was obtained which indicated that there was no relationship between maternal nutritional knowledge and the incidence of stunting in toddlers.¹⁶ Mother's poor nutritional knowledge does not always affect the incidence of stunting in children/toddlers, but there are other factors such as nutrient intake for children, feeding patterns for children, and family economic status. Low levels of nutritional knowledge, or an inability to apply nutritional knowledge in choosing everyday food types and variations, can lead to nutritional problems. Because of that. Knowledge is a very important aspect and influences the formation of human behavior. In this case, it is the mother's knowledge of the diet. Therefore, the mother's understanding and knowledge of nutrition is one of the factors leading to the high rate of stunted children.²⁷

Study on the incidence of stunting at the Sawah Lebar Health Center in Bengkulu in 2023 found that (15.4%) of children are stunted, (76.9%) of mothers have appropriate parenting practices, and (78.8%) of mothers have a strong understanding of nutrition. The findings of statistical research at the Sawah Lebar Community Health Center in Bengkulu in 2023 revealed a strong associationbetween parenting style and mother's nutrition awareness and the prevalence of stunting in children aged 7 to 24 months.

None.

Authors declare that there is no conflict of interest.

None.

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