Masalah malnutrisi balita masih menjadi tantangan global, dengan 45 juta anak mengalami wasting pada 2022. Di Indonesia, prevalensi wasting dan underweight masing-masing mencapai 8,5% dan 15,9%, termasuk di Jakarta Timur yang mencatat angka wasting 9,3% dan memiliki jumlah balita terbanyak di DKI Jakarta. Untuk mengatasi hal ini, pemerintah mengimplementasikan program Pemberian Makanan Tambahan (PMT) Pemulihan yang didanai melalui APBD maupun Corporate Social Responsibility (CSR).
Penelitian bertujuan untuk mengevaluasi efektivitas Program PMT berbahan pangan lokal yang didanai oleh APBD dan CSR terhadap perubahan status gizi anak usia 6–59 bulan di Jakarta Timur tahun 2024. Menggunakan desain mixed methods sequential explanatory, yang menggabungkan analisis kuantitatif terhadap 2.183 anak (APBD: 1.812; CSR: 371) dan analisis kualitatif melalui wawancara mendalam dengan pengelola program. Analisis dilakukan untuk mengevaluasi perubahan status gizi anak sebelum dan sesudah intervensi PMT berdasarkan sumber pendanaan (APBD dan CSR). Analisis statistik meliputi independent sampel t-test, oneway ANOVA, dan regresi linier dengan menggunakan indikator perubahan Δ z-score BB/U dan BB/TB.
Hasil penelitian menunjukkan adanya peningkatan status gizi BB/U (APBD naik 6,4%; CSR naik 10%) dan BB/TB (APBD naik 1%; CSR naik 2,4%). Ditemukan hubungan yang bermakna antara status gizi awal dengan perubahan z-score BB/U (APBD p=0,000; CSR p=0,033) dan BB/TB (APBD p=0,000). Regresi linier multivariat menunjukkan bahwa status gizi awal, frekuensi, dan jenis PMT merupakan faktor signifikan dalam perubahan z-score (p<0,05), sedangkan sumber pendanaan tidak menunjukkan pengaruh signifikan setelah dikontrol variabel lain. Temuan kualitatif menyoroti perbedaan dalam pelaksanaan dan pemantauan antara skema APBD dan CSR, namun keberhasilan program lebih dipengaruhi oleh ketepatan sasaran dan kualitas implementasi.
Studi ini menyimpulkan keduanya pendanaan memiliki potensi yang setara dalam mendukung perbaikan status gizi anak. Tidak ditemukan perbedaan efektivitas antara PMT berbasis APBD dan CSR, di mana keberhasilan program lebih dipengaruhi oleh ketepatan sasaran dan pelaksanaannya. Penguatan monitoring serta kolaborasi lintas sektor diperlukan untuk meningkatkan dampak intervensi gizi pada anak. Temuan penelitian ini menjadi rujukan bagi pengambil kebijakan dalam pengembangan intervensi gizi anak berbasis kebutuhan lokal.

Child malnutrition remains a global challenge, with an estimated 45 million children experiencing wasting in 2022. In Indonesia, the prevalence of wasting and underweight among children under five remains high at 8.5% and 15.9%, respectively. East Jakarta, which has the largest number of under-five children in the capital, reported a wasting prevalence of 9.3%. To address this issue, the government has implemented the Supplementary Feeding Program (PMT Pemulihan), funded through both local government budgets (APBD) and Corporate Social Responsibility (CSR) schemes. This study aimed to evaluate the effectiveness of locally sourced PMT programs funded by APBD and CSR on the nutritional status improvement of children aged 6–59 months in East Jakarta in 2024. A sequential explanatory mixed-methods design was used, combining quantitative analysis of 2,183 children (APBD: 1,812; CSR: 371) and qualitative analysis through in-depth interviews with program implementers. The analysis assessed changes in nutritional status before and after PMT interventions, based on funding sources. Statistical methods included independent sample t-tests, one-way ANOVA, and linear regression using changes in weight-for-age (Δ z-score W/A) and weight-for-height (Δ z-score W/H) as indicators. The results showed improvements in W/A (6.4% in APBD; 10% in CSR) and W/H (1% in APBD; 2.4% in CSR). Significant associations were found between baseline nutritional status and z-score changes for both W/A (APBD p = 0.000; CSR p = 0.033) and W/H (APBD p = 0.000). Multivariate regression indicated that initial nutritional status, feeding frequency, and PMT type were significant factors affecting z-score changes (p < 0.05), while funding source was not significant after adjusting for other variables. Qualitative findings highlighted differences in implementation and monitoring between APBD and CSR programs, but emphasized that program success was more influenced by targeting accuracy and quality of implementation. The study concludes that both funding schemes have comparable potential in improving child nutritional status. No significant difference in effectiveness was found between APBD- and CSR-based PMT. Success was driven more by precise targeting and proper implementation. Strengthening monitoring systems and cross-sectoral collaboration is essential to maximize the impact of nutrition interventions. These findings provide evidence-based guidance for policymakers in developing locally tailored child nutrition strategies.

Periode seribu hari pertama kehidupan (1000 HPK) merupakan masa yang sangat rentan terjadinya berbagai masalah gizi yang berdampak terhadap pertumbuhan dan perkembangan anak. Salah satu bentuk gangguan pertumbuhan yang sering muncul pada periode ini adalah stunting. Kelahiran risiko tinggi, khususnya kelahiran “4 TERLALU” (terlalu muda, terlalu tua, terlalu dekat, terlalu banyak) berperan penting dalam meningkatkan risiko morbiditas pada ibu dan anak. Sejumlah studi mengaitkan kelahiran “4 TERLALU” terhadap stunting, namun demikian temuan mengenai hal ini masih terbatas, tidak konsisten, dan umumnya hanya mencakup anak usia balita. Penelitian ini menggunakan data longitudinal Indonesia Family Life Survey (IFLS) tahun 2000, 2007, dan 2014 di 13 provinsi dengan 1.401 anak usia 0–59 bulan yang diikuti hingga usia remaja untuk menilai pengaruh kelahiran 4 TERLALU terhadap status stunting dan perubahan status stunting. Status stunting ditentukan dengan z skor PB/U atau TB/U berdasarkan standar WHO 2007, dan perubahan status dikelompokkan menjadi remained normal, height faltering, catch-up growth, dan remained stunted. Analisis dilakukan menggunakan Generalized Estimating Equation (GEE) untuk menilai dampak kelahiran “4 TERLALU” terhadap status stunting dan multinomial regresi logistik untuk menilai dampak kelahiran “4 TERLALU” terhadap perubahan status stunting di usia sekolah dan usia remaja. Hasil penelitian menunjukkan prevalensi stunting tertinggi pada usia balita (39%), menurun pada usia sekolah (35%), dan mencapai 25% pada remaja. Proporsi kelahiran terlalu muda sebesar 12,7%, terlalu tua 9,6%, terlalu dekat 6,8%, terlalu banyak 16,2%, dengan kelahiran risiko tinggi ≥1 sebesar 36,1% dan ≥2 sebesar 8,7%. Kelahiran terlalu dekat (<24 bulan) secara konsisten meningkatkan risiko stunting sejak balita hingga remaja, sedangkan kelahiran terlalu muda, terlalu tua, dan terlalu banyak tidak menunjukkan hubungan signifikan. Faktor lain yang berpengaruh antara lain usia anak pada saat baseline, berat badan lahir rendah, pendidikan ibu rendah, tinggi badan ibu ≤150 cm, tinggi badan ayah ≤161,9 cm, serta kondisi sosioekonomi dan lingkungan, di mana anak dari keluarga kuintil aset 3 memiliki risiko 21% lebih rendah dibanding kuintil 1. Analisis perubahan status stunting menunjukkan bahwa jarak kelahiran terlalu dekat meningkatkan risiko anak menjadi stunted (height faltering) dan remained stunted. Temuan ini menegaskan bahwa stunting bersifat dinamis dan kelahiran terlalu dekat berkontribusi besar pada gangguan pertumbuhan linier jangka panjang, sehingga diperlukan intervensi gizi, kesehatan reproduksi, dan pemantauan pertumbuhan yang berkesinambungan sejak masa sebelum konsepsi hingga masa remaja.

The first 1,000 days of life (1,000 HPK/Hari Pertama Kehidupan) represents a critical window during which children are highly vulnerable to various nutritional problems that can adversely affect their growth and development. Stunting is one of the most common forms of growth faltering that occurs during this period. Births with high-risk factors, particularly those related to the "4 Too's" (maternal age being too young or too old, a short birth interval, and numerous previous births), greatly increase the likelihood of illness among mothers and their children. Although several studies have linked the "4 Too's" birth characteristics to stunting, the evidence remains limited, inconsistent, and is generally confined to children under five years of age. This study used longitudinal data from the Indonesia Family Life Survey (IFLS) conducted in 2000, 2007, and 2014 across 13 provinces. A cohort of 1,401 children aged 0-59 months was followed through adolescence to assess the influence of the "4 Too's" birth characteristics on stunting status and its longitudinal changes. Stunting status was determined using height-for-age z-scores (HAZ) based on the 2007 WHO standards. Stunting status changes were classified as normal, height faltering, catch-up growth, and stunted persistence. Generalized Estimating Equations (GEE) were used to examine the impact of the 'Four Too' birth factors on stunting, while multinomial logistic regression was employed to investigate their effect on changes in stunting during school age and adolescence. The findings showed that stunting prevalence was most common among 5- year-olds (39%), decreased to 35% during school age, and dropped to 25% in adolescence. The proportions of high-risk births were as follows: 12.7% to mothers who were too young, 9.6% to mothers who were too old, 6.8% with a short birth interval, and 16.2% with high parity. The prevalence of births with at least one risk factor was 36.1%, while 8.7% had two or more risk factors. A birth interval of less than 24 months was constantly linked to an elevated risk of stunting from early childhood through adolescence, while no noteworthy correlation was found between births to mothers of young or older age and those of high parities. The other significant risk factors were the child's age at baseline, low birth weight, low levels of maternal education, maternal height of 150 cm or less, and paternal height of 161.9 cm or less. Socioeconomic factors also played a role, with children from the third asset quintile having a 21% lower risk of stunting than those from the first quintile. Analysis of the changes in stunting status revealed that short birth intervals increased the risk of a child experiencing height faltering or remaining stunted. These findings affirm the dynamic nature of stunting and highlight that a short birth interval is a major contributor to long-term linear growth faltering. Consequently, sustained nutritional and reproductive health interventions, along with continuous growth monitoring, are imperative from the pre-conception period through adolescence to break the intergenerational cycle of stunting.