Krisis ekonomi yang terjadi di Indonesia sejak tahun 1997 dan dampak kekeringan yang berkepanjangan telah membawa masalah baru berupa penurunan daya beli dan penurunan konsumsi pangan terutama pada keluarga miskin sehingga mempengaruhi kesehatan dan status gizi masyarakat. Anak usia dibawah lima tahun (balita) adalah golongan usia yang rentan terhadap masalah kesehatan dan gizi, terutama masalah Kurang Energi Protein (KEP) dan hal ini merupakan salah satu masalah gizi utama di Indonesia yang perlu ditanggulangi karena dapat mempengaruhi kecerdasan melalui kerusakan otak yang akan bersifat permanen. Ibu kota propinsi Riau adalah kota Pekanbaru, memiliki 8 kecamatan dan merupakan pusat aktivitas perekonomian, pemerintahan maupun sosial kemasyarakatan. dimana berdasarkan hasil pemantauan status gizi (PSG) balita tahun 2001 didapatkan 5 (lima) kecamatan masih memiliki prevalensi gizi buruk lebih dari atau lama dengan 1% (>1%), sehingga untuk menghindari agar status gizi balita tidak jatuh kepada keadaan yang lebih buruk, dilakukan penelitian terhadap sistem tata laksana kurang energi protein (KEP) balita. Penelitian dilakukan di kota Pekanbaru terhadap kecamatan yang memiliki balita dengan status gizi sedang dimana berdasarkan batasan kritis kesehatan masyarakat dengan berat badan menurut umur (BB/U)adalah lebih dari 15% (<-2SD). Penelitian dilakukan dengan menggunakan metode kualitatif, yang dilaksanakan pada bulan februari 2003. Pengumpulan data dilaksanakan dengan menggunakan teknik wawancara mendalam (in depth Interview), observasi dan telaah dokumen terhadap variabel pengetahuan petugas, dana, sarana dan prasarana, metode, perencanaan, pengorganisasian. penggerakan, pengawasan, cakupan program dan tindak lanjut penanganan masalah. Informan dalam penelitian ini adalah pejabat pengambil keputusan, penanggung jawab operasional program gizi dan masyarakat pengguna dalam hal ini kader dan ibu balita dengan status gizi sedang. Berdasarkan hasil penelilian terhadap penemuan Kurang Energi Protein menunjukkan bahwa kurang lengkapnya pengetahuan petugas lapangan, masih rendahnva kemampuan advokasi Dinas Kesehatan Kota kepada pihak pemerintah Kota dalam hal penyediaan dana bagi penemuan Kurang Energi Protein balita, lemahnya sistim pencatatan dan pelaporan dalam ketersediaan sarana, belum dilaksanakannya penggunaan metode penanggulangan Kurang Energi Protein balita secara optimal, masih lemahnya data dan informasi dalam penyusunan perencanaan dan evaluasi, tidak aktifnya koordinasi lintas sektoral, belum berjalannya fungsi penggerakan secara maksimal di tingkat puskesmas, belum dilaksanakannya fungsi pengawasan secara menyeluruh meliputi komponen input, proses, dan out put, dan belum terkoordinasinya sistim rujukan antara Rumah sakit dan puskesmas maka manajemen penemuan Kurang Energi Protein (KEP) di Dinas Kesehatan Kota Pekanbaru perlu diperkuat. Dalam upaya penemuan Kurang Energi Protein (KEP) di Dinas kesehatan kota Pekanbaru disarankan agar pihak Dinas kesehatan bekerja sama dengan Puskesmas lebih meningkatkan perhatiannva pada kegiatan peningkatan pengetahuan petugas lapangan, advokasi yang efektif kepada pemerintah kota dan DPRD, peningkatan hubungan kerja sama lintas sektoral, peningkatan sistem manajemen data dan informasi terutama pencatatan, pelaporan dan pengolahan data, serta meningkatkan fungsi pengawasan meliputi komponen input, proses dan out put.

An Analysis of Protein Energy Malnutrition (PEM) Management System for Children Under-Five in District Health Office of Pekanbaru in 2002Economic crisis, which has started since 1997, and the effect of long dry season in Indonesia have brought about some new problems, such as the decrease of public purchasing power and food consumption especially for the poverty family. This decrease may influence public health and nutritional status. The group of children under five is susceptible to health and nutritional problems, especially to the problem of Protein Energy Malnutrition (PEM), and this is a main nutrient problem in Indonesia that is necessary to prevent due to its bad effect to one's intelligence through permanent brain decay. The capital city of Riau Province is Pekanbaru. It is a center of economic activities, government administration and social activities and has 8 sub districts. Data of Nutritional Assessment (NA) of children under five in 2001 show that 5 (five) sub districts remained to have bad nutrient prevalence, which is more or equivalent to 1% (> 1%). To prevent the bad nutritional status of children under five is not becoming worse, it is necessary to carry out a research about Protein Energy Malnutrition (PEM) management system for children under five. This research was conducted in Pekanbaru City in five sub districts that have medium nutritional status, vbere its public health critical limit to the body mass based on age is more than 15% (< -2SD). The research was conducted by using qualitative method, which is conducted in February 2003. The data were collected by using in-depth interview, observation and documents review for the variables of personnel's knowledge, fund, structure and super-structure, methods, planning, organization, movement, supervision, program coverage, and follow up of problem treatment. The informants of the research were policy makers, operational coordinator of nutritional program, and communities: mother candidates or mothers of children under five with medium nutritional status. According to the result the study of finding management system of protein energy malnutrition, there are less completeness of field personnel?s' knowledge, lack ness of City of Health Office's advocacy ability to the City Government to provide sufficient fund for protein energy malnutrition for children under five, weaknesses in recording and reporting system due to facilities availability: not optimum of using protein malnutrition energy finding method, weaknesses of data and information in plan arrangement and evaluation, inactiveness of cross sectoral coordination, not maximum of moving function in the level of Public health center, not carrying out of overall supervision function, which consists input, process, and output component, and no coordination of reference system between Hospital and Public Health Center. Therefore, Protein Energy Malnutrition (PEM) management system for children under five in the Health Office of Pekanbaru is necessary to be strengthened. In the effort of Protein Energy Malnutrition (PEM) management system in City Health Office of Pekanbaru, it is suggested to Health Office to work together with Public Health Centers to increase their attention to the programs of field personnel's' knowledge development, to make effective advocacy to the City Government and Local House Representative, to increase cross-sectoral coordination, to improve data and information systems especially in recording, reporting, and data processing, also to increase supervision function, which consists input, process, and output component.

Studi tentang pertumbuhan fisik telah menunjukkan bahwa pertumbuhan anak usia 13 -15 tahun merupakan pertumbuhan fisik yang cepat. Pada anak perempuan, hal tersebut berhubungan dengan kematangan seksual yang merupakan ciri-ciri pubertas, ditandai haid pertama dan berkaitan dengan keadaan gizi dan psikhisnya. Studi pengantar di Tanjungsari mengenai kematangan seksual, ditemukan data Cohort WHO, dari 3500 anak terdapat 1550 anak perempuan dengan tiugkat maturasi seksual 28 anak (1,8%). Usia menarchenya 12 tahun, dan ditemukan 11 responden (0,70 %) atau (39,28%) dad data kematangan seksual, telah menikah. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang berhubungan dan faktor apa yang dominan berhubungan dengan kematangan seksual. Desain penelitian merupakan survey dengan pendekatan Cross Sectional, lokasi di Kecamatan Tanjungsari Kabupaten Sumedang Jawa Barat, dilaksanakan pada bulan April sampai bulan Juni tahun 2003. Jumlah sampel 150 anak perempuan usia 13 sampai 15 tahun. Vaniabel babas yang diduga berhubungan idalah Indeks Masa Tubuh, Status anemia, Kadar lemak tubuh, Perilaku sosial, Umur, Pendidikan, Pendidikan Ayah, Pendapatan Orangtua dan Kebiasaan keluarga. Data merupakan data primer yang dikumpulkan dari anak perempuan dengan menghitung Indeks Masa Tubuh dari pengukuran berat badan dalam kilogram dibagi ukuran tinggi badan dalam meter kuadrat dan Status Anemia. Ban pengambilan sampel darah anak kemudian dianalisa hasilnya dalam ukuran gram %. Prosentase lemak tubuh, dilakukan setelah diketahui ukuran tinggi badan, berat badan, umur dan jenis kelaniin,masukkan dalam BIA, hasilnya berupa prosentase. Data kematangan seksual diperoleh dari pemeriksaan fisik tanda kematangan seksual sekunder, sedangkan data mengenai perilaku sosial, umur, pendidikan, pendidikan ayah, pendapatan orangtua, serta kebiasaan keluarga diperoleh melalui kuesioner. Pengolahan data dilakukan manual, dan bantuan komputer, data yang terkumpul dimasukan pada program. Hasil analisa Univariat dari 150 Responder, melalui pengukuran Indeks Masa Tubuh, diperoleh status gizi kurang sebanyak 35 responden (23,3%), 15 responden (10%) mengalami Anemia, melalui lemak tubuh didapatkan data Gizi kurang 78 responden (52,0%). Sebanyak 33 responden (22,0%) mengalami kematangan seksual lambat, 117 responden (78,0 %) mengalami kematangan seksual cepat. Hasil analisa Bivariat menggunakan Chi-Square ditemukan 2 variabel yang berhubungan dengan kematangan seksual yaitu Lemak tubuh dengan p value = 0,005, dan kebiasaan keluarga p value = 0,004. Faktor-faktor lainnya yaitu, Indeks Masa Tubuh, Status Anemia, umur, Sikap perilaku sosial, pendidikan anak, pendidikan ayah dan pendapatan orangtua tidak berhubungan dengan kematangan seksual. Analisa multivariat yang mempunyai p value terkecil adalah kebiasaan keluarga dengan p Value = 0,004, dan ini merupakan faktor yang paling dominan berhubungan dengan kematangan seksual secara bermakna. Sebagai saran, Puskesmas dan Instansi pusat terkait perlu meningkatkan program pelayanan kesehatan reproduksi remaja di daerah ini. Untuk peminat dan peneliti lain perlu meneliti lebih lanjut mengenai masalah reproduksi remaja, terutama bila anak akan menghadapi masa berkeluarga.

A study about physical growth has found that the children's growth spurt is occur at the age of 13 to 15 year old. On a girl, this episode is related to her sexual maturity, which usually called as puberty. It is usually characterized by the onset of menarche, her first menstruation, and related to her state of nutrition and of psychology. An introductory study at Tanjungsari on sexual maturity, using WHO's cohort data, has found that among 3,500 children there are 1,550 girls. And among those girls there were 28 (1.8%) girls who already have their sexual maturation, with details information that their age of menarche are 12 years old, and found that 11 of them (39.28%) were married. Study will be carried out, and have a purpose on finding out what factors related and which factor that have a greatest role in determining the sexual maturity. The design of the study is a survey with a cross-sectional approach, will be held in Kecamatan Tanjungsari Kabupaten Sumedang,West Java, on April to June 2003. The number of the sample is 150 young girls with have an age range. between 13 to 15 years old. The independent variables assumed to have relationship with sexual maturity are: body mass index, the state of anemia, percentage of body fat, social behavior, age, education, father's education, parent's income and family's customs. A primary data will be collected from young girls by calculating the body mass index, which measured the body weight in kilograms divided by the height in Meter Square and the state of anemia is also observed by examining the blood sample and analyzed those samples to obtain the measurement for the state of anemia in gram-percent. The percentage of body fat can be calculated after data on height, weight, age and sex have been accomplished to Hand Bio Electric Impedance Analyzer. Meanwhile, data on sexual maturity were obtained from performing the physical examination on secondary sexual maturity signs, and data on social behavior, age, education, parents' education and income, and family customs are gathered using a questionnaire. Data were being organized manually, followed by using the computer when data are being entered to a statistical program. From the univariate analysis upon 150 respondents, it can be known from calculation on body mass index that 35 respondents or 23.3% have a poor nutrition status and 15 respondents or 10% have anemia. From the percent of body fat, it has found that respondents with mild of poor nutrition state are 78 people (52,0%). Severe poor of nutrition state are 33 respondents (22%). As little as 33 girls (22,0%) have found in the state of late (slow) sexual maturity, 117 girls (78,0%) are in the state of fast sexual maturity. Result from bivariate analysis, using chi-square, has found that2 variables are related to the sexual maturity, which are: percentage of body fat with p-value 0.05;, and family customs (p-value 0.004). Other factors that are: Body Mass Index, anemia, age, social attitude and behavior, education, father's education and family income, are not related with sexual maturity. When those variables are analyzed by multivariate analysis, it is found that variable which has the least p-value is family customs (p-value 0.004). This represent that family customs is significantly to be the most dominant factor related to sexual maturity. Based on those findings, it is suggested that Community Health Center (Puskesmas) and other central institution should be concern to the problem of health reproduction on a young girls, and should evaluate every matters related to adolescent in this region. For the other researchers it is suggested to explore a research on other issues on Adolescent Health reproduction, especially to those girls who will be engaged in a marriage in a little while.