The Relationship of the Green Lawrence Theory of Exclusive Assessment and Stunting Events in Busungbiu Puskesmas I Buleleng District of Bali

Stunting is a chronic condition that describes stunted growth due to long-term malnutrition, indicated by a TB / U z-score of less than -2 SD. Stunting data at the Pusung Busungbiu in 2019 was 51.25% so research on the factors causing stunting was needed. Method: This study was an observational analytic study with a case control approach. The total sample of 200 people included mothers and toddlers aged 24 59 months according to inclusion criteria. Sampling is done by using cluster random sampling to select groups of samples and simple random sampling to select samples. The independent variables of this study were maternal height, sex of the toddler, age of the toddler, family income, parent's education, mother's married age, history of maternal KEK status, history of birth weight, long history of birth, history of exclusive breastfeeding and history of time of giving MP ASI. The collected data was tested using Chi Square and multiple logistic regression to find out the significant level at the significance level a = 0.05. Results: The results of multivariate analysis showed that birth length <48 cm had (P = 0.00; OR 14.1) and the age group 24-36 months had (P = 0.01; OR 1.6) while maternal height, toddler sex, family income, parent's education, mother's married age, history of maternal KEK status, history of birth weight, history of exclusive breastfeeding and history of time of giving ASI MP are not factors causing stunting. Conclusion: Birth length <48 cm and age groups 24-36 months were the most dominant causes of stunting. So it is necessary to get interventions, assistance and monitoring of growth and development that is good to improve the quality of life in the future.


INTRODUCTION
,5 Almost half of toddlers who came and studied were toddlers with a range of 24-36 months of age that were 97 people (48.5%) while 37-48 months of age were 53 people (26.5%) and ages 49 -59 months were 50 people ( 25%). In addition, the most sexes are 103 men (51.5%) and 97 fewer women (48.5%). 3,5 Based on table 2, which reviews the characteristics of mothers, almost all of the mother's height <155 cm is 162 people (81%). Nearly half of the mothers were elementary school graduates, 84 people (42%), 52 junior high school graduates (26%), 57 senior high school graduates (28.5%) and PT graduates with the least number of 7 people (3.5%)   Mother's milk is not coming out  21  22,1  Sick  6  6,3  Work  6  6,3  Children cry all the time  23  24,2  Etc  39  41,1  3  Type of Food / Beverage  Formula milk  61  64,2  Tea  1  1,1  Water  10  10,5  Honey  3  3,2  Etc  20 21,1 Table 4 shows that most children under five have a history of exclusive breastfeeding with 105 people (52.5%), partial breastfeeding with 70 people (35%) and not exclusive breastfeeding with 25 people (12.5%). Of the 95 respondents who have a history of not exclusive breastfeeding, they have a reason because the mother's milk does not come out as many as 21 people (22.1%), sick women 6 people (6.3%), working mothers 6 people (6.3%), children crying continuously 23 people (24.2%) and other reasons with almost half of them, 39 people (41.1%). The types of drinks mostly given were formula milk as many as 61 people (64.2%). Based on table 17, the variables of birth length and toddler age significantly have an influence on the incidence of stunting. Variable history of birth length has an OR value of 14.1, which means that birth length <48 cm has a risk of 14.1 times the incidence of stunting. The toddler age variable has an OR value of 1.6 which means that the 24-36 month age group has a 1.6 times risk of stunting. Between the two variables, short birth length (<48 cm) had the greatest influence as a cause of stunting in infants aged 24 -59 months in the Puskesmas Busungbiu I

DISCUSSION
The results of this statistical tests show that there is no relationship between maternal height and the incidence of toddler stunting. This contradicts research in East Semarang (2012) about risk factors for stunting in toddlers aged 24-36 which shows that children born to mothers or short fathers are very at risk of becoming stunting. If one or both parents have a short body due to physical conditions (such as growth hormone deficiency) have inheritance genes in chromosomes that can carry short traits so that the child has the opportunity to inherit the gene so the child grows into stunting. If, short parents are caused by lack of nutritional needs or illness, it is likely that the child can grow to normal height as long as the child is not exposed to other risk factors (Nasikhah, 2012). The results of statistical tests in this study indicate that there is no relationship between the sex of children under five with the incidence of stunting. The treatment of parents between toddlers, male and female genders is the same, that is, they both receive good food. This research is also in line with the research of Izzati (2016) at Tugurejo District Public Hospital Semarang which states that there is no significant difference between the sexes and the incidence of stunting between male and female toddlers. The results of these statistical tests indicate a relationship between toddler age and the incidence of toddler stunting. Children over the age of 24 months are four times more likely to become stunted than children under 24 months (AOR = 3.97 [95% CI, 1.30-12.11] (Beruk et al, 2016). By the second year there is a gradual decrease in calorie intake toddlers weight unity (Behrman et al., 1996) Because the age range of 2-3 years which tends to experience growth slowing so the chances of catching up to grow lower than the age of 0-2 years (Kusuma, 2013). According to Leroy et al ( 2014) at the age of 2 to 5 years increases the risk of stunting as much as 30% if there is a growth and development disorder in 1000 days of life and increases the risk of obesity and chronic diseases in the future at the age of 2-3 years who have a small birth history Multivariate analysis test results using multiple logistic regression tests in the last step showed no relationship between family income and the incidence of stunting under five.
This study is not in line with research conducted in Banda Aceh City by Rahayu (2019), where the level of family income is one of the factors that has a significant relationship with the incidence of stunting in infants.
The results of statistical tests in this study indicate that there is no relationship between mother's education and father's education with the incidence of toddler stunting The results of this study are in line with research conducted by Anisa (2012) which states that mothers with low education have a risk of 10,818 times their stunting compared to mothers with higher education. In addition, research conducted by Rahayu and Khairiyati (2014) states that mothers who have low education are 5.1 times more at risk of having stunting children compared to mothers who have higher education.
The results of statistical tests in this study indicate that there is no relationship between the age of married mothers and the incidence of stunting of toddlers. This is in line with research conducted by Agustini (2016) Statistically concluded there is no relationship between maternal age with the incidence of stunting in children aged 24-59 months in the working area of Wonosari I Puskesmas and maternal age is not a risk factor for stunting, besides that the results of this study are also in line with research conducted by Astuti (2016) which states that there is no relationship between maternal age and stunting, this is because maternal age is considered to play a more psychological role as maternal factors such as the acceptance of child pregnancy so that it affects the parenting patterns children, in this case parenting giving food. The results of these statistical tests show that there is no relationship between the history of the KEK status of the mother during pregnancy and the incidence of toddler stunting. When pregnant, the mother requires sufficient protein and complete amino acid content because during pregnancy there is an increased need for protein for fetal growth and development (Almatsier, 2006). Animal food is food that is difficult to reach for some low-income people because of the high price. The results of the study of Fitrah et al (2013) revealed that the average protein intake of subjects during pregnancy was less than 60 percent of the RDA. The quality of the protein is determined by the type and proportion of amino acids it contains. Animal protein, except gelatin, is a complete protein that contains all kinds of essential amino acids in proportions suitable for growth needs. So that even though the average KEK status of the respondent is good, if the intake of protein and other nutrients is not fulfilled, it will still have a risk of stunting. Statistical test results in this study indicate that there is no relationship between the history of Birth Weight with the incidence of stunting of toddlers. Child birth weight in this study is grouped into two categories, namely low birth weight babies (LBW) and low birth weight (LBW). Birth weight is categorized as LBW if 0.05) thus it can be concluded that there is no significant relationship between birth weight and the risk of stunting in children in the Lendah II Health Center area of Kulon Progo Regency. Based on the OR (Odd Ratio) value obtained 0.544, this indicates that children with low birth weight do not have the risk of being stunted as well as children who have normal birth weight. Multivariate analysis test results using multiple logistic regression test at the last step, the p value obtained for a long history of birth weight is 0.00 and the p value for toddler age is 0.01 which indicates that there is a relationship between the long history of birth weight and toddler age with the cause stunting in toddlers aged 24 -59 months. With an odd ratio value of 14.1 and 1.6 which means that toddlers who have a long birth history <48 cm are 14.1 times more likely to experience stunting and toddlers in the age group 24-36 months more risk 1.6 times to experience stunting. Because the OR value> 1 which means a long history of birth weight and age of the toddler is a risk factor for stunting. Body length that is far below the average birth rate is due to growth retardation while in the womb. Growth retardation while still in the womb shows the lack of nutritional status and health of the mother during pregnancy, causing the child to be born with less body length (Ni'mah, 2015). Nurillah's research results (2016) showed that the length of the body born was significantly related to the growth and development of children. It was seen that children with short birth length with abnormal growth and development had a greater percentage (66.7%) than those with normal birth length (33.8%).
The results of the statistical test show that there is no relationship between the history of exclusive breastfeeding and the incidence of toddler stunting. The results of this research are not in line with research by Kartiningrum (2015) in his research stating that a history of exclusive breastfeeding is a risk factor for stunting in infants. Of the 20 cases used, 13 (68.4%) were not exclusively breastfed and stunted. This is also the same as what researchers found where 55 people (75%) of respondents did not exclusively breastfeed (Kartiningrum, 2015). The results of the statistical test show that there is no relationship between the history of the ASI MP and the incidence of stunting among children. According to the results of Widyaswari's research (2011), infants who were given MP-ASI 6 months had more normal nutritional status than those aged 0-3 months or 4-5 months. Poor nutritional status in infants can be due to the introduction of MP-ASI less than 6 months. Supporting Research Results Rohmani (2010).

CONCLUSION
1. Characteristics of mothers and fathers entirely are Malay Deutro race and most have an elementary school education. 2. Most mothers of children under five have height> 145 in the 78% case group and 87% control group and there is no relationship between maternal height and the incidence of stunting. 3. Most stunting toddlers are female at 51% and there is no relationship between sex and the incidence of stunting. 4. Most stunting toddlers are in the age range 24-36 months which is 57% and there is a relationship between toddler age and the incidence of stunting. 5. The majority of family income is below the minimum wage, in the 80% case group and 77% control group and there is no relationship between family income and the incidence of stunting. 6. Most stunting toddlers have a father with low education that is 71% and also most of the low maternal education that is 66% and there is no relationship between father and mother education with the incidence of stunting. 7. Most age of marriage of mothers ≥ 18 years do not have stunting toddlers as much as 71% and there is no relationship between the age of married mothers with stunting. 8. Most stunting toddlers are born by mothers who have a history of Non-SEZ by 85% and there is no relationship between the history of the status of SEZs during pregnancy with stunting. 9. Most toddlers are born with normal birth weight ie in the 92% case group while the control group is 91% and there is no relationship between birth weight history with the incidence of stunting. 10. Almost all stunting toddlers are born with a short body length of 83% and there is a relationship between the length of the body born with the incidence of stunting. 11. Most stunting toddlers get exclusive breastfeeding which is 57% and there is no relationship between the history of exclusive breastfeeding with the incidence of stunting. 12. Most stunting toddlers get breast milk MP <6 months which is 72% and there is no relationship between the history of breast milk MP with stunting. 13. Factors that cause stunting and have a significant relationship are toddler age and a long history of birth weight. The results of multivariate analysis, birth length <48 cm and the age group of toddlers 24-36 months are at risk of causing stunting.