Development Of Stunted Toddlers Aged 24-59 Months Using Prescreening Developmental Questionnaire (PDQ) In Air Dingin Public Health Center, Padang 2019: An Overview

Received: January, 24, 2020 Revised: April, 17, 2020 Available online: February, 2021 Stunting is a chronic malnutrition problem that resulted from an insufficient nutritional intake for a long time. This problem can develop during pregnancy, infancy, childhood, and throughout the life cycle due to feeding that does not accommodate the nutritional needs. Stunting correlates with disorders of fine motor, gross motor, language, and personal social skills. This study aims to perceive an overview of stunted toddlers aged 24-59 months using the Prescreening Developmental Questionnaire (PDQ). The authors carried out this research in Air Dingin public health center, Padang, from April to September 2019. This research was descriptive that included 40 toddlers aged 24-59 months diagnosed with stunting. The data presentation was a frequency distribution table and percentage. This study obtained that 22 toddlers (55.0%) were girls, seven toddlers (17.5%) experienced a developmental deviation, and 26 toddlers (65%) had suspected developmental deviation. In short, there were several cases of stunted toddlers who underwent a developmental deviation.


INTRODUCTION
The WHO Child Growth Standard defines stunting by using the index of length-for-age or height-for-age compared to a limit (Z-Score) of less than -2 SD. (De Onis, 2015) In 2016, WHO published data that 22.9% of children under five years old are a stunted child. This report revealed a 56% stunting prevalence in Asia, 34.1% in South Asia, 25.8% in Southeast Asia, and 38% in Africa. (WHO, 2016).
Basic Health Research (Riskesdas) 2018 reported stunting data of the children in Indonesia. This data showed that the proportion of children under five years who were moderate and severe stunting was 30.8%, and children under five who were underweight and severe underweight was 10.2% (RISKESDAS, 2018).
The Ministry of Health published a Nutrition Monitoring Pocket Book in 2017. This report obtained data in West Sumatra that the cases of malnutrition and nutrition deficiency of the children under five were 3.4%. Other data revealed that children aged 0-59 months who suffered from malnutrition were 3.3%.
Another report found 30.6% stunting children; in detail, children aged 0-59 months with moderate and severe stunting were 21.3% and 9.3%, respectively. These figures increased from the previous year - reported that there were 3,269 (20.04%) stunted children (Kemenkes RI, 2018).
Stunting is one of the health problems caused by chronic malnutrition. The disproportion of feeding with the amount of nutritional need since pregnancy, infancy, and childhood can lead to a lack of nutritional intake. (Kementerian Kesehatan Republik Indonesia, 2018). There are direct causesexclusive breastfeeding history, infectious disease history, inadequate food intake, and low birth weightand indirect causes of stuntingparents' education level, parents' occupations, and the family's economic status. Stunted children may experience obstacles in their physical and mental development. Small children have a risk of decreased intellectual and an increased risk of degenerative diseases in the future (Danaei et al., 2016).
Stunted children can experience disturbances in motor and mental development in childhood, a higher risk of experiencing communicable and non-communicable diseases, an increased risk of overweight and obesity, worsening achievement in school, and low education level that affect the future income. Stunting in children can become a factor that can predict the human resources' quality of a country. Stunting can cause long-term losses to the national economy (Crookston et al., 2011). The stunting impact becomes the authors' background in conducting observational research on "The development of stunted toddlers aged 24-59 months using the Prescreening Developmental Questionnaire (PDQ) in the Air Dingin public health center Padang, 2019".

METHOD
This research was carried out in the Air Dingin public health in Padang from April to October 2019. This descriptive categorical research used the total sampling method, including all children aged 24-59 months who had previously been diagnosed with stunting and registered at Air Dingin public health center. The obtained sample size was 40 toddlers. Data collection on child development by an interview with mothers or child caregivers using the Prescreening Developmental Questionnaire (DPQ) (Dhamayanti, 2016). Data presentation were in terms of frequency and percentage.

RESULTS
In this study, table 1 below describes the frequency distribution of the respondents by gender: This study obtained data on the frequency distribution of respondents' development in table 2 as follows:  (Hafid and Nasrul, 2016;Hanani and Syauqi, 2016).
For a toddler, the first 1,000 days of life is a critical period. When a toddler obtains nutritional intake deficiency in the early 1000 days of life and experiences stunting, the toddler can have difficulties catching up with age-appropriate growth. For this reason, fulfilling the toddler's nutritional intake in the first 1000 days needs serious attention (Kemenkes RI, 2014;Husnah, 2017).
When stunting occurs before five years old, developmental disorders can happen in motoric, cognitive, language, and social skills. The development of all brain parts that affect motoric, cognitive, and socioemotional development is complete at five years (Vazir and Boindala, 2016;Arini, Mayasari, and Rustam, 2019).
The disturbance in the motoric area -experienced by stunted childrenresults from an obstacle in the muscle maturation process. That disturbance affects the mechanical ability of the muscles. Lack of nutrients for an extended period, especially the intake of energy, fat, and protein, will inhibit muscle tissue formation and maturation (Pantaleon, Hadi, and Gamayanti, 2016 conditions will experience susceptibility to suffering from infectious diseases, both acute and chronic. The child becomes weak due to infection, less exploring the environment, and further influences the personal and social development of the child (Nahar et al., 2012;Casale, Desmond, and Richter, 2014).
Developmental disorders in the cognitive and language areas can occur in stunted children because children aged 0 to five are still at the pre-operational stage of development, a developmental stage of children who are not ready to engage in activities requiring logical thinking. They can understand symbols, self-identity, the cause and effect of an event, and numbers and gather in a group. At this age, the child's language development process by carrying out a systematic mapping process in the brain also happens. When there is a long-term shortage of nutrients, there will be an obstacle in brain cells' development process (Gunawan, Fadlyana, and Rusmil, 2016;Hartanto et al., 2016).

CONCLUSIONS
Based on the overview of the development of stunted children in Air Dingin Public health center in Padang in 2019, this study concludes that most stunted children are girls and experience suspected developmental deviation.