Stunting DR Aman
Stunting DR Aman
Stunting DR Aman
9
SUSTAINABLE
ANO COMMUNITIES
CTOS
THE GLOBAL GOALS
Jfe (5 40 RESPONSIBLE l£
CONSUMPTIOI
CONSUMPTION AND
PRODUCTION
For Sustainable Development
M
UTE BELOW
1R llFE PUCE AND JUSTICE STRONG
INSTITUTIONS
FOR THE GOALS
IU ONU
WATER
Pada tahun 2030, mengakhiri semua bentuk malnutrisi, termasuk mencapai, pada
tahun 2025, target yang disepakati secara internasional tentang stunting dan
wasting pada anak di bawah usia 5 tahun, dan mengatasi kebutuhan gizi remaja
perempuan, wanita hamil, dan menyusui dan orang yang lebih tua.
Growth: Normal and
Abnormal
Short stature or stunting
• Pertumbuhan normal jatuh antara persentil ke-3 dan ke-97 dari semua
anak -> 3% terpendek dan tertinggi jatuh di luar batas perawakan
"normal"
Normal Distribution/Standard
Deviation Scores/Percentiles
Standard Normal Curve
Sportsmen in 1900 were put in line
according to height:
Short ones on the right
Tall ones on the left
p80 p20
SD
Some children CHANGE
IN POSITION, because
they grow faster than
others.
Most however do not.
p50
p60 p40 Most children keep their
position.
Some children CHANGE IN
POSITION, because they
grow faster than others.
• Pubertas
• Ditandai dengan percepatan pertumbuhan 8 hingga 14 cm/tahun
(3,2 hingga 5,5 in/tahun) karena efek sinergis dari peningkatan
steroid gonad dan sekresi hormon pertumbuhan
Phases of Normal Growth (cont)
(1+2 + 3)
Age (years)
Adapted from Kariberg J. Acta Paediatr Scand Suppl. 1989;350:70-94.
Normal Growth Rates During Childhood
Age (y)
Best practices for anthropometric measurements
• NCHS, CDC
Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2010;59(No. RR-9):1-15.
Growth Chart
Btrth to 24 months: Boys NAME_ 2 to 20 years: Boys
l *ngth-f or-age and Welght-for-ago percentiles 3ECC«> • Stature-tor-age and Wetght-lor-age percentiles
Target HT
Predicted HT
STiia
Growth Charts: Take-Home Points
• CDC curves overdiagnose failure-to-thrive (underweight) in US infants
• Use of the WHO curves should lead to fewer referrals for further
evaluation of ''underweight" infants
Growth Failure and Short Stature: Definitions
• Definitions
• Short stature: height more than 2.0 SD below the mean for age and
gender; strictly statistical convention
• Growth failure: decline in rate of linear growth (cross channels)
• Slowly growing children are usually short
10to19per cent 20 to 29
4
30 n
BOS ins
H H 1 II
»«K« Olttff MS 2110
1
INFANT AND YOUNG CHILD FEEDING
IMS 2000 2001 2007 20 IS Other
MICS Otlwr NS Other MS Other NS NS
in*
Breewied and^
waa*ed ■ Br9U«tr*d
(not breastfed) B>**itf and pain Mater only
ed and sdidi'sami solid ■ Excluovety
toads Breewied and breastfed
other miRitormuU
The SEANUTS study
Key words: Nutritional status: t hi Id growth: Micron utrient deficiencies: l-ood intakes: Indonesian children
35
30
io>
25
£o>
® 20
15
10
50-59 6 0-69 7 0-79 80-89 90-9-9
Age (years)
Fig. 3. Mrxvn woryht ol boys agod 50 99 yonrs—, WHO , urtxm; - - , rural
Age (years) (A colour vorslon ol this hguo can bo found onlmo at hop //www pumuts
Fig. 1. Moan wa(?*al boys agod 0-5 49 years—.WHO; , urban:rural aimbndgo.org/bfn)
(A colour worsen ol tss hguro can bo lound orlno at httpy/wwwjournals
Cambridge orgbyi)
Age (years) Age (years)
Fig. 5. Moan bcmf* at boys agod 05 49 ynars—.WHO: . urban; - - , rival Fig. 7. Moan height of boys agod 5 0 9 9 years. —. WHO; . urban; - - . rural
(A colour version ol tvs figure can be found odne at http 7/www journals (A colour version of Ihfc figure can be found ontne at htfp;/www|(Xjrnais
cambndgc orgfbjn) Cambridge orgbjn).
35
10---■---■-
50-5-9 60-6-9 70-7-9 8-0-69 90-9-9
Age (years) Age (years)
Fig. 2. Moan wcr^il al gals aged 0-5 4-9 years—.WHO, , urban;rural. Fig. 4. Mean weight of girls aged 50-9-9 years. —. WHO; . urban; - - , naal
(A colour version d this figure can be found online at http/Avww journals. (A colour version of tvs figure can be found ontoo at hrtp/rwww journals
Cambridge orgbjn) Cambridge onytajn)
170 r
120
160
Ago (years)
Age (years) Fig. (. Moon hor^rt of gate agod 50 9 9
Fig. 6. Moan hon7« ol gris agod as 49 years —, WHO; , urtMn; - - , rural yoars—.WHO; . urban;rural
(A odour version ol Itvs tiguc can bo found ootnc at hOpV/www loumals (A colour vemon ol Ihrs Irguro can bo found
Cambridge orgta)n) orAne at Imp/Awnrvir founds cambndgc
orytyi)
RISET KESEHATAN DASAR
RISKESDAS 2013
1 S
■ Sangatpendek Pendek Gambar 3.14 7
Prevalensi pendek anak umur 5-12 tahun menurut provinsi. Indonesia 2013
National stunting prevalence : 37,2% (18.0% severely stunting and 19.2% stunting) Highest
prevalence in boys is at 13 years of age (40.2%) while in girls is at 11 years of age (35.8%)
14 provinces have severe stunting problem (prevalence : 30-39%) and 15 provinces have
serious stunting problem (prevalence more than 40%)
70.0
400
Gambar 3 14 4
□ Pendek-kurus ■ Pendek-Normal □ Pendek-Gemuk
Kecenderungan prevalent gia kurang. pendek. kurus, dan gemuk pada bakta Indonesia
20072010 dan 2013 □ Normal-kurus □ Normal-normal □ Normal-gemuk
Gambar 3.14.5
Kecenderungan prevalensi status guu balita menurut gabungan mdikator
TBAJ dan BB/TB. Indonesia 2007 2010, dan 2013
Assessment of linear growth of children in low-
and middle income countries (LMIC)
Jan M. Wit, John H. Himes , Stef van Buuren, Donna M. Denno, Parminder S. Suchdev
Pattern of Linear Growth in LMICs
The window of opportunity for preventing linear growth faltering ends at 2 years of age
The best way to analyze growth may be different for the various age periods
Presumed causes of growth faltering in the first two years
• Anthropometric measurement
• Evaluate further if:
• HAZ < -3SD
• Growth velocity is under 25 th percentile or <5cm/year
• Projected adult height below potential height
• Growth faltering
• Laboratory work for short stature evaluation
:
• Complete blood count
• Thyroid hormone level
• Bone age
• Karyotipe
• Growth hormone and IGF-1 level
Algorithm for diagnostic
approach in short
stature children
Definition IUGR:
and/or
Catch up growth: