Insidens kasus tuberkulosis (TBC) anak di Indonesia diperkirakan mencapai 11,7% dari total kasus TB. Tidak semua individu terpapar TBC akan menjadi sakit, namun kemungkinan reaktivasi lebih tinggi pada anak , terutama pada anak di bawah lima tahun. Kontak serumah lebih berisiko. Nutrisi baik makro maupun mikro mempengaruhi kejadian TBC pada anak. Studi menyatakan Vitamin D dan Seng berperan dalam peningkatan imunitas. Namun penelitian tentang pemberian suplementasi vitamin D dan Seng serta upaya perbaikan nutrisi dalam pencegahan infeksi TBC pada balita belum dilakukan. Penelitian ini bertujuan untuk mengetahui efek pemberian suplementasi dan konseling diet dalam pencegahan infeksi TBC pada balita kontakserumah TBC paru terkonfirmasi bakteriologis di DKI Jakarta. Kami melakukan penelitian quasi eksperimen pada balita kontak serumah TBC paru bakteriologis di 25 kecamatan di DKI Jakarta. Kelompok intervensi diberikan vitamin D 400-600 IU/hari dan Seng 10-20mg/hari tergantung usia selama 3 bulan serta konseling diet pada orang tua. Balita yang masuk dalam sampel adalah balita yang tidak terinfeksi dan atau sakit TBC, tidak gizi buruk, HIV negative dan tidak menderita penyakit kronis lain. Setiap bulan  dilakukan recall diet 24 jam untuk mengukur nutrisi dan status gizi. Setelah 3 bulan akan dihitung balita yang terinfeksi dan tidak dengan menggunakan tes tuberculin. Analisa multivariat dilakukan dengan GEE. Berdasarkan hasil penelitian, insidenss kumulatif infeksi TBC pada kelompok intervensi 5% sedangkan pada kelompok kontrol 23%. Pemberian intervensi meningkatkan konsumsi vitamin D pada balita yakni dari 3 mcg menjadi 14,9 mcg dan Seng 3.8 mg menjadi 18.2 mg. Pada balita terinfeksi, konsumsi  vitamin D dan Seng lebih rendah. Besarnya risiko kejadian infeksi TBC dengan pemberian intervensi adalah 0.22 kali ( 95% CI 0.08-0.57 p. value 0.002). Pemberian suplementasi vitamin D dan Seng serta konseling diet  menurunkan kejadian infeksi TBC pada balita kontak serumah hingga 78%. Kata Kunci : Infeksi TBC pada balita kontak serumah, suplementasi vitamin D dan Seng, quasi eksperimen, tes tuberculin

The incidence of childhood tuberculosis (TB) in Indonesia is estimated to be 11.7% of total TB cases. Not all individuals exposed to TB will become ill, but the likelihood of reactivation is higher in children, especially children under five years old. Household contacts are more at risk. Both macro and mikro nutriens influence the incidence of TB in children. Studies suggest that vitamin D and zinc play a role in boosting immunity. However, research on vitamin D and zinc supplementation and nutritional improvement efforts in preventing tuberculosis infection in children under five years of age has not been conducted. This study aims to determine the effect of supplementation and dietary counseling in preventing TB infection in young children with bacteriologically confirmed pulmonary TB in DKI Jakarta. We conducted a quasi-experimental study among infants with bacteriologically confirmed pulmonary TB home contacts in 25 subdistricts in DKI Jakarta. The intervention group received vitamin D 400-600 IU/day and Zinc 10-20mg/day depending on age for 3 months, as well as nutritional counseling for parents. Included in the sample were infants who were not infected and/or sick with TB, not malnourished, HIV negative, and not suffering from any other chronic diseases. A 24-hour dietary recall to measure diet and nutritional status was conducted every month. After 3 months, infected and uninfected children were counted using the tuberculin test. Multivariate analysis was performed using GEE. Based on the results of the study, the cumulative incidence of TB infection was 5% in the intervention group and 23% in the control group. The intervention increased vitamin D consumption in toddlers from 3 mcg to 14.9 mcg and zinc from 3.8 mg to 18.2 mg. Vitamin D and zinc intake was lower among infected infants. The risk of TB infection with the intervention was 0.22 times (95% CI 0.08-0.57 p. value 0.002). Provision of vitamin D and zinc supplementation and dietary advice reduced the risk of TB infection. Keywords: Infection of TB in Household contact children under five years age, Tuberculin Test, Suplementation of vitamin D and zinc, Quasi experimental studies

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.