DEPARTEMEN ILMU KESEHATAN ANAK FAKULTAS KEDOKTERAN UNHAS

Stunting diagnostic and awareness: impact assessment study

of sociodemographic factors of stunting among school-going
children of Pakistan
Mahvish Ponum, Saadia Khan, Osman Hasan, et al. 2020

Oleh:
Nama: Nur Aisyah
NIM: C105202005

Pembimbing:
Dr.dr. Aidah Juliaty A. Baso, Sp.A(K), Sp.GK
dr. Destya Maulani, Sp.A
 Background
A child is defined as stunted if his
Poor nutrition  Ruins children height-for-age is below − 2 standard
cognition and destroys their all deviations (SD) from the median of
World Health Organization (WHO)
working abilities Child Growth Standards

Stunting
• 149 million children 2018, 55% of
stunted children reside in Asia
Ruinous result of poor nutrition in • In 2000, global stunting was recorded
early childhood of children. Stunting with 32.6 percentage in children under 5
affected children age
- Gain impaired growth and • The rate of stunting is declined to 21.9%
development, in 2018
- Experience poor cognition
- Spread of repeated infection
 Background
The Problem Solution

Maternal education is We focused on maternal education, maternal and

distinctive factor that affects the child nutrition awareness and offering mHealth
stunting stunting diagnostic and education tool

To the best of our knowledge,

very little attempt is made Stunting Diagnostic and Education
through programs to educate mHealth app
mothers about stunting,
maternal and This app provides the easy diagnostic of stunting based on
child nutrition, in Pakistan symptoms, stunting prevention, nutritional practices for infants
and young children, and nutritional video guidelines by the
nutritionists and child experts
 Method
Questioner Data
Design Collection
Methods Questionnaire design 1420 school going children
Questionnaire was designed by 3 1 were collected
Nutritionist to get the data about height,
weight, age, BMI, anthropometric
measurements, physical activities,
demographic characteristics and diet to The children with age 4 to 18 years
analyze the prevalence of stunting and 2 participated in this study
effects of factors on stunting. After
development, all questions in
questionnaire were analyzed by 3
Pediatrician to validate the data asked Nutritionists calculated height for age,
in questionnaire. 3 obtained the stunted children from
the lists and noted mild, moderate
and severe stunted children
 Method

App
Development
The Stunting Diagnostic and
Education app compasses 4
modules:
• Stunting Diagnostic,
• Stunting Prevention,
• Dietary Practices,
• Stunting Guidelines
 Method
Stunting
Diagnostic
This module facilitates the caregiver to
diagnose mild, moderate and severe
stunting. The symptoms in the form of
virtual patients are shown to caregivers for
better understanding of signs of stunting.
The module spots the stunting by querying
simple questions from caregivers by
showing them images of ill children. As, a
mother starts the app, diagnostic appears
promptly and provides easy navigation to
caregiver. Interface itself guides the
caregiver to navigate through the app
 Method

Stunting
Prevention
This module guides the
caregivers to prevent mild,
moderate and severe stunting. It
focuses on prevention of
infections through improved
water, sanitation and hygiene,
supplements of nutrient-rich
foods and improving the quality
of children’s diet to prevent
stunting.
 Method

Dietary Practice
This module focuses on efficient diet
during pregnancy, breastfeeding,
continued breastfeeding,
complementary feeding to infants
and young children, consumption of
vitamins and minerals (i.e. zinc, iron,
calcium and vitamin A), usage of
plant source foods (i.e. vegetables,
fruits etc.) and consumption of
animal source food (i.e. meat, eggs
etc.) according to the ages of The Growth Nutrients

children.
 Method

Stunting Guidelines
This module consist of videos tutorials of
stunted children to explain all question
including what is stunting, what are causes
of stunting, how to treat stunted children,
how to look after a stunted child at home,
what kind of nutrition, caregiver should
provide to stunted child, which things should
be avoided to give to stunted child and it
provides the video guidelines on dos and
don’ts of stunting.
Result

1
Various
sociodemographic
factors of school
going children,
determined in
questionnaire
Result

2
Prevalence of
stunting

3
Distribution of
stunting according to
different age groups
Result

4
Dietary Patterns of non-
stunted and stunted
participants

5
Distribution of dietary
patterns of stunted children
calculated with respect to
Rural and Urban areas
 Result
1 The usability should have at least 10 participants

2 The app was installed in all mothers’ (15 participants) cell phones

3 All mothers were asked to start the stunting diagnostic and education app

As they tapped the icon of app, the diagnostic test was appeared on the
4 interface of cell phone and question related to stunting were asked to mothers

5 The mothers diagnosed mild and moderate stunting the most in their children
using app

After diagnosis, app instructed to explore prevention of stunting and to explore

nutrition for healthy diet
 Result
How the app’s usability?

Simplicity and ease of

Easy navigation Very user-friendly access of all features

What part do you like the most?

Mothers said that they liked its diagnostic test feature, nutrition feature and video guidelines the
most

The mothers suggested to publish it over Google play store and to make its access free all over
the Pakistan. They further suggested to spread it among all health agencies of Pakistan, so that
each caregiver can get benefit from this app
 Conclusion
To prevent stunting, the
Stunting Diagnostic and
Education app was developed
to teach mothers

It is simply an education tool

The app proved to be very useful for mothers to better
and mothers liked its all features. understand about stunting and
its prevention

This app would be made

available to all mothers over
Google play store in the future
 THANKYOU

Stunting diagnostic and awareness: impact assessment study of

sociodemographic factors of stunting among school-going children
of Pakistan
 Telaah Kritis Umum
No HAL YANG DINILAI CHECK LIST PENILAIAN YA TIDAK

1 Judul Makalah a.Tidak terlalu panjang atau tidak terlalu pendek V  

b.Menggambarkan isi utama penelitian V  
c. Cukup menarik V  
d.Tanpa singkatan, selain yang baku V  
 

2 Abstrak a.Abstrak terstruktur V  

b.Mencakup komponen IMRAC (Introduction, methods, Results, V  
Conclusion)    
c. Secara keseluruhan abstrak informatif V
d.Tanpa singkatan, selain yang baku V  
e.Kurang dari 250 kata   V
  (401 kata)
 Telaah Kritis Umum
No HAL YANG DINILAI CHECK LIST PENILAIAN YA TIDAK

3 Pendahuluan a. Ringkas terdiri dari 2 – 3 paragraf V (7 paragraf) 

V
b. Paragraf pertama mengemukakan alasan dilakukannya penelitian  
V
c. Paragraf berikut menyatakan hipotesis atau tujuan penelitian  
V
d. Didukung oleh pustaka yang kuat & relevan  
V
e. Kurang dari 1 halaman  

4 Metode a. Disebutkan design, tempat dan waktu penelitian V  

b. Disebutkan populasi sumber (populasi terjangkau) V  
c. Dijelaskan kriteria pemilihan subyek (inklus i& eksklusi) V  
d. Disebutkan cara pemilihan subjek (teknik sampling) V
e. Disebutkan perkiraan besar sampel & alasannya   V
f. Perkiraan besar sampel dihitung dengan rumus yang sesuai V
g. Observasi, pengukuran serta intervensi dirinci sehingga orang lain V 
dapat mengulanginya
 Telaah Kritis Umum
No HAL YANG DINILAI CHECK LIST PENILAIAN YA TIDAK

4 Metode h. Ditulis rujukan bila teknik pengukuran tidak dirinci V

i. Pengukuran dilakukan secara tersamar V
V
j. Definisi istilah & variable penting dikemukakan  
V
k. Ethical clearance diperoleh
V
l. Disebutkan rencana analisis, batas kemaknaan & power penelitian  
 

5 Hasil a. Disertakan tabel karakteristik subjek penelitian V  

b. Karakteristik subjek yang penting (data awal) dibandingkan V
kesetaraannya  
c. Dilakukan uji hipotesis (statistik) untuk kesetaraannya  V
d. Disebutkan jumlah subjek yang diteliti V
e. Dijelaskan subyek yang dropout dengan alasannya V
f. Ketepatan numerik dinyatakan dengan benar V
g. Penuisan tabel dilakukan dengan tepat V
h. Semua hasil di dalam tabel disebutkan dalam naskah V
 Telaah Kritis Umum
No HAL YANG DINILAI CHECK LIST PENILAIAN YA TIDAK

5 Hasil i. Semua outcome yang penting disebutkan dalam hasil V

V
j. Subyek yang drop out diikutkan dalam analisis
 
k. Analisis dilakukan dengan uji statistik yang sesuai V
l. Ditulis hasil uji statistik, derajat kebebasan (degree of freedom), dan V
nilai p
 V
m. Disertakan interval kepercayaan
 
n. Dalam hasil disertakan komentar & pendapat V

6 Diskusi a. Semua hal yang relevan dibahas V

b. Tidak sering diulang hal yang dikemukakan pada hasil V
V
c. Dibahas keterbatasan penelitian, dan dampaknya terhadap hasil
V
d. Disebutkan penyimpangan protokol, dan dampaknya terhadap hasil
 
e. Diskusi dihubungkan dengan pertanyaan penelitian V
V
f. Dibahas hubungan hasil dengan teori/hasil penelitian terdahulu
g. Dibahas hubungan hasil dengan praktek klinis V
V
h. Efek samping dikemukakan dan dibahas
 Telaah Kritis Umum

No HAL YANG DINILAI CHECK LIST PENILAIAN YA TIDAK

6 Diskusi i. Disebutkan hasil tambahan selama diobservasi V

j. Disertakan simpulan utama penelitian V
k. Simpulan didasarkan pada data penelitian V
l. Disebutkan generalisasi hasil penelitian V
m. Disertakan saran penelitian selanjutnya V
 CRITICAL APPRAISAL
PENILAIAN VALIDITAS PENELITIAN HUBUNGAN KAUSAL/KOMPARATIF/KESERASIAN

1. Apakah Awal Penelitian Didefinisikan dengan Jelas?

Ya, untuk menganalisis faktor risiko (meliputi distribusi karakteristik sosiodemografi, pendidikan orang tua, status
pekerjaan ibu, pola makan anak sekolah dan prevalensi stunting pada anak sekolah) yang terkait dengan Stunting pada anak di
bawah dan di atas usia 5 tahun

2. Apakah Desain Penelitian Jelas?

Ya, dengan Studi potong lintang (Cross Sectional study)

3. Apakah Pembanding Kelompok Jelas?

Tidak ada kelompok pembanding dalam peneltian ini

4. Apakah Faktor Kausal Dikemukakan?

Ya, faktro resiko stunting pada Penelitian ini disebutkan secara jelas yaitu distribusi karakteristik sosiodemografi, pendidikan
orang tua, status pekerjaan ibu, pola makan anak sekolah.

Singh, N., Kamble, D. & Mahantshetti, N.S. Effect of Vitamin D Supplementation in the Prevention of Recurrent Pneumonia in Under-Five Children. Indian J Pediatr 86, 1105–1111 (2019). https://doi.org/10.1007/s12098-019-
 CRITICAL APPRAISAL
PENILAIAN VALIDITAS PENELITIAN HUBUNGAN KAUSAL/KOMPARATIF/KESERASIAN

5. Apakah Kelompok-kelompok yang Dibandingkan Sebanding pada Tahap Awal atau

Karakteristik Kelompok yang Dibandingkan ?
Tidak ada pembanding dalam penelitian ini

6. Apakah Follow-up Dilakukan Secara Memadai?

Tidak dilakukan follow up panjang pada penelitian karena penelitian ini memakai metode cross sectional
study..

Singh, N., Kamble, D. & Mahantshetti, N.S. Effect of Vitamin D Supplementation in the Prevention of Recurrent Pneumonia in Under-Five Children. Indian J Pediatr 86, 1105–1111 (2019). https://doi.org/10.1007/s12098-019-
 Uraian unsur PICO
P = Pasien, Populasi
▹ Anak sekolah usia 4-18 tahun di Multan, Pakistan

I = Intervensi
▹ Intervensi berupa penggunaan aplikasi Stunting Diagnostic and Education

C = Comparison (pembanding)
▹ Tidak ada pembanding

O = Outcome (Luaran)
▹ Dapat meningkatkan pemahaman ibu mengenai stunting dan pencegahannya
 CRITICAL APPRAISAL

PENILAIAN PENTINGNYA HASIL PENELITIAN HUBUNGAN KAUSAL /

KOMPARATIF / KESERASIAN

1. Apakah Hasil Penelitian ini Dipaparkan dengan Uji Statistik dan Nilai P?
Ya, dengan statistik yang dilakukan dengan IBM SPSS Statistics.dengan nilai p kurang dari 0,05 dianggap
signifikan secara statistik.

2. Seberapa Besarkah Estimasi Hasil dengan Nilai OR,RR,PR dengan Nilai Korelasi 95% CI?
Pada penelitian ini tidak memaparkan nilai OR, RR dan PR dari hasil penelitian yang dilakukan.

Singh, N., Kamble, D. & Mahantshetti, N.S. Effect of Vitamin D Supplementation in the Prevention of Recurrent Pneumonia in Under-Five Children. Indian J Pediatr 86, 1105–1111 (2019). https://doi.org/10.1007/s12098-019-
 CRITICAL APPRAISAL

PENILAIAN KEMAMPUTERAPAN HASIL PENELITIAN HUBUNGAN

KAUSAL / KOMPARATIF / KESERASIAN
1. Apakah Karakteristik Pasien Kita Mirip dengan Subjek yang Diteliti?
Ya, Serupa.

2. Apakah Bukti ini akan Mempunyai Pengaruh yang Penting Secara Klinis terhadap Kesembuhan Pasien Kita Tentang
Apa yang Telah Diberikan Kepada Pasien Kita?
Tidak secara langsung namun hasil pemaparan dari karakteristik dan faktor resiko stunting pada penelitian ini dapat
memberikan petunjuk pada kita untuk dapat mencegah terjadinya stunting sejak dini.

3. Apakah Simpulan Tentang Hasil Studi tersebut Berguna Bagi Pasien Dalam Tatalaksana Secara Keseluruhan?
Ya, berguna untuk meberikan gambaran faktor-faktor resiko serta karakteristik stunting sehingga kita dapat mengurangi
kejadian stunting dengan memberikan edukasi mengenai faktor resiko tersebut.

Singh, N., Kamble, D. & Mahantshetti, N.S. Effect of Vitamin D Supplementation in the Prevention of Recurrent Pneumonia in Under-Five Children. Indian J Pediatr 86, 1105–1111 (2019). https://doi.org/10.1007/s12098-019-
CRITICAL APPRAISAL

LEVEL OF EVIDENCE
Grade A: Strongly because the
scientific basis is strong

Grade C: Recommended
despite having only a weak
scientific basis
 CRITICAL APPRAISAL

Stunting diagnostic and awareness: impact assessment study of

sociodemographic factors of stunting among school-going children
of Pakistan
Mahvish Ponum, Saadia Khan, Osman Hasan, et al. 2020

FINAL CONCLUSION:
(Level of evidence 5, Recommendation Grade B)
 PROGRAM PENDIDIKAN DOKTER SPESIALIS-1
ILMU KESEHATAN ANAK
FAKULTAS KEDOKTERAN UNIVERSITAS
HASANUDDIN
MAKASSAR 2021

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