5 Ranks of Disease/Health Problem in Pre School Children

Arranged to Fill the Assignment of School-Based Health Problem Epidemiology Subject

Lecturer :
dr. Rr. Sri Ratna Ratna Rahayu, M.Kes., Ph.D

Group Members :
1. Luluk Fadhoh Sakinah (6411416017)
2. Dhinda Trimadyaningsih (6411416103)
3. Farida Nurjanati Hardanis (6411416134)
4. Wulan Istri Hastari (6411417099)

PUBLIC HEALTH DEPARTMENT

FACULTY OF SPORT SCIENCE
UNVERSITAS NEGERI SEMARANG
2019
 CHAPTER I
INTRODUCTION

Preschool are children who are in 3-4 years old and no longer baby but are not yet
enough to go to school are sometimes reffrered to as preschoolers.
Preschool are the most at risk to get infectious disease because their lack of immunity.
The immunity from the mother are just last for about 2 years. Infections are caused by viruses,
bacteria, and parasites and your child will get an infection if they come into contact with
someone who has the infection and if they are not already immune.
Some infections, such as Impetigo (School Sores) and Varicella (Chickenpox) are
spread from direct contact with the infection site.
Other infections are spread by respiratory droplets from an infected persons lungs, nose
or mouth to another person. The droplets can spread through the air directly onto another child,
or may land on a surface, which is then touched by another child. Infections spread by
respiratory droplets include the common cold, flu, and Whopping Cough (Pertussis).
According to the WHO (World Health Organization) mortality rate toddlers in 2013
were still high at 6.3 million. The highest dead number of children under five in developing
countries is 92% or 29,000 toddlers / day (Rahman et al., 2014). Most infant mortality caused
by infectious diseases such as pneumonia (15%), diarrhea (9%), and malaria (7%) (WHO,
2013).

Based on the reports of health service facilities, in 2017 the number of infant deaths in
Semarang City was 197 out of 26,052 births life, so that the Infant Mortality Rate (IMR) is
7.56 per 1,000 KH. Based on the causes, the most under-five mortality was 52% due to illness.
Other causes include diarrhea, ARI and DHF by 16%.
 CHAPTER II
CONTENT

A. Pneumonia
Pneumonia is an acute infection that affects lung tissue (alveoli). Infection can be
caused by bacteria, viruses or fungi. Pneumonia can also occur due to accidents due to
inhalation of liquids or chemicals. Populations prone to Pneumonia are children less than 2
years old, more than 65 years old, or people who have health problems (malnutrition,
immunological disorders). (Profil Kesehatan Jawa Tengah, 2017)
This infection begins with disrupting our upper respiratory system (nose and throat).
Then the infection will move towards the lungs, which then inhibits the movement of air in the
lungs, so you will increasingly experience difficulty in breathing. Most pneumonia can be
treated until healed within one to two weeks (pneumonia due to viruses generally takes longer).
But our condition will certainly be worse if we experience pneumonia coupled with the
presence of other diseases in our body.
Somewhat different from pneumonia in general, pneumonia in children in some cases
is not marked by an increase in the tempo of breathing, especially if the pneumonia attacks the
lower lung. Symptoms that occur are generally just fever, vomiting and pain in the lower
abdomen.
Some other symptoms that indicate your child is attacked by pneumonia include:
• Fever,
• Cough, which may be dry and may also phlegm followed by mucus or mucus in green
or yellow.
• Breathing in a high tone,
• Difficulty breathing. Generally your child will still feel difficulty breathing even when
he is resting.
• Throws up,
• Pain in the chest.
• Abdominal pain that can occur because your child's efforts are too hard to breathe
normally.
• Decreased activity.
• Loss of appetite.
• In more severe conditions your child's lips and nails will turn blue.
• Sweating

At the age of children, pneumonia can be prevented by routinely getting a vaccine that
will usually be given since he was about two months old. But as mentioned above, pneumonia
will have a worse impact when the attack comes along with other diseases. Especially if
comorbidities are chronic diseases that come with relapses such as heart disease or asthma.
Although pneumonia is not an infectious disease, the microorganisms that cause this
disease can spread through droplets of water when sneezing or coughing. So that the child
should:
• Close the mouth every time someone with cough pneumonia or sneezing nearby
• Wash hands with soap, to prevent the spread of any bacteria or viruses.
 Pneumonia is an infectious disease which is the leading cause of death in infants in the
world. Basic Health Research (Riskesdas) in 2007 reported that under-five mortality in
Indonesia reached 15.5%. Until now, pneumonia is the leading cause of infant mortality in the
world. It is estimated that there are 1.8 million or 20% of child deaths caused by pneumonia,
exceeding deaths from AIDS, malaria and tuberculosis. 1 In Indonesia, pneumonia is also the
second cause of death in children under five after diarrhea. Basic Health Research (Riskesdas)
reported that the incidence of pneumonia in the last month (period prevalence) increased in
2007 by 2.1 ‰ to 2.7 ‰ in 2013. By definition, pneumonia is an infection of the lung tissue
(alveoli) that is I. The causes are bacteria, viruses, fungi, exposure to chemicals or physical
damage from the lungs, as well as indirect effects from other diseases. The bacteria that
commonly cause pneumonia are Streptococcus and Mycoplasma pneumonia, while the viruses
that cause pneumonia are adenoviruses, rhinoviruses, viral influenza, respiratory syncytial
virus (RSV) and the influenza virus. (Anwar. All., 2014)
The occurrence of pneumonia is characterized by symptoms of coughing and / or
breathing difficulties such as rapid breathing, and the pulling of the lower chest wall inward.
In general, pneumonia is categorized as an infectious disease transmitted through air, with the
source of transmission is pneumonia patients who spread germs in the form of droplets to air
when coughing or sneezing. Henceforth, germs that cause pneumonia enter the respiratory tract
through inhalation (inhaled air), or by means of direct transmission, ie splashes of droplets
released by patients when coughing, sneezing, and talking directly inhaled by people around
the sufferer, or holding and use objects that have been affected by respiratory secretions of
sufferers.
Many factors can influence the increasing incidence of pneumonia in infants, both from
the individual aspects of the child, the behavior of parents (mother), and the environment. The
physical environment of a house that does not meet health requirements and fuel use behavior
can increase the risk of various diseases such as TB, cataracts and pneumonia.7-9 Dense
housing, indoor air pollution due to the use of solid fuel (fuel wood / charcoal ), and smoking
behavior from parents is an environmental factor that can increase the susceptibility of toddlers
to pneumonia.
The proportion of the population in Indonesia who live in homes that meet the
requirements of a healthy home is still low, namely 24.9% .10 According to the 2013 Riskesdas
report, residents who live in homes with ceiling roofs are only 59.4%, walls made of walls are
only 69, 6%, and non-land floors 93.1% .3 Behavior that can pose a risk of indoor air pollution,
such as the use of unsafe fuels (kerosene, fuel wood, charcoal, coal) and smoking habits in the
home, the proportion still quite high. As many as 64.2% of households in rural areas still use
charcoal and firewood for cooking and 76.6% (of 28.2% smokers) smoke inside the house
when together with other family members.
There were 1,229 people (1.5%) had been diagnosed by health workers and 2,091
people (2.5%) had symptoms of pneumonia in the last 12 months from the interview (Table 1).
81,205 people were never diagnosed (98.2%) and 232 people did not know (0.3%). A total of
79,233 people (95.8%) did not experience symptoms of pneumonia and 115 people (0.1%) said
they did not know. The incidence of pneumonia in children under five is based on a diagnosis
by health workers and perceived / observed symptoms, amounting to 3,320 people (4.0%).
 Based on sociodemographic characteristics, the characteristics of individuals with the
incidence of pneumonia in sex between men and women were almost the same, men as many
as 41,925 were only slightly more contentious than women, which was as many as 40,695.
Toddlers' homes are mostly in rural areas compared to urban areas, education for mothers of
children under five is generally junior high school and above. Mother of a toddler who does
not work more nearly half of working mothers. The economic level of under-five households
measured by the ownership index quintile, is mostly in the middle to upper levels (middle to
upper) compared to the lower middle (lower and lower middle).
The incidence of pneumonia in children under five based on a diagnosis by a health
worker or perceived / observed symptoms is 4%. Based on the results of multivariate analysis,
the factors that influence pneumonia in children under five are gender, type of residence,
maternal education, economic level / quintile of ownership index, kitchen location, presence /
habit of opening bedroom windows and ventilation. This means that social, demographic,
economic and home environment factors together contribute to the incidence of pneumonia in
infants in Indonesia.
The discovery and treatment of pneumonia sufferers in toddlers in Central Java in 2017
amounted to 50.5 percent, decreasing compared to the 2016 achievement of 54.3 percent. An
overview of the trends in the discovery and treatment of pneumonia sufferers in infants can be
seen in the figure. 3.1

Figure 3.1 Discovery of Handling Pneumonia Patients in Toddlers in Central Java

Province 2013-2017

Figure 3.2. Severe Pneumonia & Pneumonia Cases by Age Group 2013-2017
 The number of cases of pneumonia and severe pneumonia based on the age of the sufferer has
increased in 2017.

Figure 3.3 Semarang Pneumonia Underfive Cases in 2017 According to Gender

In 2017 toddlers pneumonia cases mostly occur in the age group 1 – 5 year, a total of 6,830
cases (20%), in the <1 year age group there were 2,756 cases (51%), the remaining 29% around
3,882 cases occurred in the age group> 5 years. According to gender cases of Pneumonia
Toddlers in Semarang City in 2017 appear to be the case Toddler pneumonia in women (46%)
is less than pneumonia cases toddlers in boys (54%).

Morbidity (IR = Incidence Rate) pneumonia is the number of sufferers toddler pneumonia
per number of toddlers times 10,000. IR pneumonia in 2017 is as big as 542 per 10,000 toddlers
increased compared to 2016. Increased IR pneumonia shows the number of people with
pneumonia and severe pneumonia found more a lot, this is influenced by the active
participation of the community to want to bring it the recipients went to the Puskesmas earlier
when they were sick, as well as the active role of the Puskesmas officers and health cadres
provide counseling in the community so that knowledge about the prevention of pneumonia
increases.

Coverage of patient discovery is the number of people with pneumonia and pneumonia the
weight found is divided by the number of targets. Coverage of patient discovery severe
pneumonia and pneumonia who went to the Puskesmas in 2017 by 150% increased compared
to 2016 (111%). The mortality rate (CFR) due to pneumonia and severe pneumonia in the city
of Semarang based on data from RS in 2017 of 0.06%, in 2016 amounted to 0.02% while in
puskesmas there were no cases of pneumonia or severe pneumonia that died (CFR0%), this
indicates that the referral system has been implemented properly.

B. Diarrhea
Based on Riskesdas 2013, the incident rate of diarrhea in children under 5 years old is
7%. Based on Profil Kesehatan RI 2017, in 2017 there are 21 times outbreaks of diarrhea in 12
provinces, 17 districts / cities. Polewali Mandar, Pohuwato, Central Lampung and Merauke
districts each occur 2 times outbreaks. The number of sufferers is 1,725 people and the death
of 34 people (CFR 1.97%).
 Diarrhea is a major cause of morbidity and mortality among children less than 5 years.
Globally there is an increased incidence of diarrhea and death due to diarrhea in infants from
2015-2017. In 2015, diarrhea caused around 688million sick people and 499,000 deaths
worldwide occur in children under 5 years. Based on WHO (2017), nearly 1.7 billion cases of
diarrhea occur in children with a mortality rate of around 525,000 in children under five each
year.

Diarrheal disease is the second leading cause of death in children under five years old,
and is responsible for killing around 525 000 children every year. Diarrhea can last several
days, and can leave the body without the water and salts that are necessary for survival. In the
past, for most people, severe dehydration and fluid loss were the main causes of diarrhea deaths.
Now, other causes such as septic bacterial infections are likely to account for an increasing
proportion of all diarrhea-associated deaths. Children who are malnourished or have impaired
immunity as well as people living with HIV are most at risk of life-threatening diarrhea.
 Diarrhea is defined as the passage of three or more loose or liquid stools per day (or
more frequent passage than is normal for the individual). Frequent passing of formed stools is
not diarrhea, nor is the passing of loose, "pasty" stools by breastfed babies.
Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be
caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through
contaminated food or drinking-water, or from person-to-person as a result of poor hygiene.
Interventions to prevent diarrhea, including safe drinking-water, use of improved
sanitation and hand washing with soap can reduce disease risk. Diarrhea should be treated with
oral rehydration solution (ORS), a solution of clean water, sugar and salt. In addition, a 10-14
day supplemental treatment course of dispersible 20 mg zinc tablets shortens diarrhea duration
and improves outcomes.
There are three clinical types of diarrhea:
1. acute watery diarrhea – lasts several hours or days, and includes cholera;
2. acute bloody diarrhea – also called dysentery; and
3. persistent diarrhea – lasts 14 days or longer.
Causes of diarrhea are :
1. Infection: Diarrhoea is a symptom of infections caused by a host of bacterial, viral and
parasitic organisms, most of which are spread by faeces-contaminated water. Infection is
more common when there is a shortage of adequate sanitation and hygiene and safe water
for drinking, cooking and cleaning. Rotavirus and Escherichia coli, are the two most
common etiological agents of moderate-to-severe diarrhoea in low-income countries.
Other pathogens such as cryptosporidium and shigella species may also be important.
Location-specific etiologic patterns also need to be considered.
2. Malnutrition: Children who die from diarrhoea often suffer from underlying malnutrition,
which makes them more vulnerable to diarrhoea. Each diarrhoeal episode, in turn, makes
their malnutrition even worse. Diarrhoea is a leading cause of malnutrition in children
under five years old.
3. Source: Water contaminated with human faeces, for example, from sewage, septic tanks
and latrines, is of particular concern. Animal faeces also contain microorganisms that can
cause diarrhoea.
4. Other causes: Diarrhoeal disease can also spread from person-to-person, aggravated by
poor personal hygiene. Food is another major cause of diarrhea when it is prepared or
stored in unhygienic conditions.Unsafe domestic water storage and handling is also an
important risk factor. Fish and seafood from polluted water may also contribute to the
disease.

Way to prevent diarrhea in Children are :

1. Water, sanitation and hygiene

Improving access to safe drinking water and adequate sanitation, as well as promoting
good hygiene, are key components in preventing diarrhoea. Yet a recent WHO/UNICEF
report indicated that, in 2006 (the latest year for which data are available), an estimated 2.5
billion people were lacking improved sanitation facilities. Moreover, nearly 1 in 4 people
in developing countries were practising indiscriminate or open defecation. To further
 compound the problem, children’s faeces are often unsafely disposed of in many
developing countries. Children’s stools tend to carry a higher pathogen load than adults,
and many children play in areas in which stools are found. Safely disposing of them is
therefore critical for reducing the number of diarrhoea cases.
2. Adequate nutrition
Undernourished children are more likely to suffer from diarrhoea and its consequences,
which, in turn, increases their chances of worsening nutritional status. Today, 129 million
children under the age of five in the developing world are underweight for their age.
Together, Africa and South Asia account for more than 80 per cent of total underweight
children (25 per cent and 57 per cent, respectively) (Figure 9). About 40 per cent of
children under five years of age are stunted in Africa, and nearly half in South Asia.
3. Breastfeeding
Over the past decade, there has been some progress in exclusive breastfeeding rates
among infants in the first six months of life across the developing world, and particularly
in Africa. Despite these advances, overall levels remain low, and only 37 per cent of infants
in developing countries are exclusively breastfed for the first six months of life.
4. Micronutrient supplementation
Vitamin A supplementation rates have increased significantly in recent years. Coverage
of children aged 6-59 months with at least one dose of vitamin A per year has increased
by nearly 50 per cent since 1999. Moreover, between 1999 and 2007, coverage of children
considered fully protected by vitamin A – that is, receiving two doses per year – increased
nearly fourfold in developing countries (Figure 11). Progress was made possible through
innovative strategies that included combined delivery with other high-impact interventions
for health and nutrition. Reaching the poorest children and those living in rural areas, who
are most at risk of vitamin A deficiency, remains the greatest challenge.
Zinc is important for normal growth and development and for reducing childhood
diarrhoea cases. Yet data on improving children’s zinc status as a key prevention measure
are not available.
5. Immunization
Only a few, mostly high- and middle-income countries include rotavirus vaccine in
their routine immunization schedules. WHO recently recommended introduction of the
vaccine in all routine schedules, and data to monitor its coverage in many countries are
expected to follow implementation.

C. Malaria
The population who has a high risk of contracting malaria is 9 in the age group 1-5
years. Death of children under five years due to malaria in ASEAN was 1% in 2010 and 10
ranked second after Africa. Based on WHO (2013), between 2000 and 2012 malaria deaths
were 45% in all age groups and 1151 % in children under five years. About three million (90%)
deaths from malaria in 2001 to 2012 came from children under five years. In 2015, it was
estimated that there was a 63% reduction in mortality from malaria in children under five years
of age.
 Indonesia got the third rank in the worst rank in ASEAN after Timor Leste and
Cambodia with malaria cases in 2010 amounting to 229,819 cases and the percentage of deaths
of children under five due to malaria tended to increase from 1% in 2000 to 2% in 2010.
Based on the Indonesian Health Demographic Survey (SDKI) conducted from 2008-
2012 shows the Infant Mortality Rate (IMR) of 34 / 1,000,000 live births. The presence of an
infectious disease infection can affect AKB, one of which is infection with Plasmodium which
causes malaria.
Malaria is a life-threatening disease. Malaria parasites spread by successively infecting
two types of hosts: humans and female Anopheles mosquitoes. It’s typically transmitted
through the bite of an infected Anopheles mosquito. Infected mosquitoes carry
the Plasmodium parasite. Four species of malaria parasite can infect humans under natural
conditions: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium
malariae. The first two cause the most infections worldwide. In humans, the parasites grow
and multiply first in the liver cells and then in the erythrocytes. Blood‐stage parasites are
responsible for causing the symptoms of malaria, and the disease is diagnosed by its symptoms
and the microscopic examination of blood. Malaria is completely curable but the emergence of
drug‐resistance in P.falciparum is a major obstacle to the control of the disease. Insecticide
resistance in disease‐transmitting mosquitoes makes it vital to understand the molecular
background of the pathogenesis of malaria in order to facilitate the development of novel
approaches to combat the disease.
When this mosquito bites, the parasite is released into the bloodstream.Once the
parasites are inside the body, they travel to the liver, where they mature. After several days, the
mature parasites enter the bloodstream and begin to infect red blood cells.Within 48 to 72
hours, the parasites inside the red blood cells multiply, causing the infected cells to burst
open.The parasites continue to infect red blood cells, resulting in symptoms that occur in cycles
that last two to three days at a time.Malaria is typically found in tropical and subtropical
climates where the parasites can live. The World Health Organization (WHO) states that, in
2016, there were an estimated 216 million cases of malaria in 91 countries.In the United States,
the Centers for Disease Control and Prevention (CDC) report 1,700 casesof malaria annually.
Most cases of malaria develop in people who travel to countries where malaria is more
common.
The symptoms of malaria typically develop within 10 days to 4 weeks following the
infection. In some cases, symptoms may not develop for several months. Some malarial
parasites can enter the body but will be dormant for long periods of time. Common symptoms
of malaria include:
 shaking chills that can range from moderate to severe
 high fever
 profuse sweating
 headache
 nausea
 vomiting
 abdominal pain
 diarrhea
 anemia
 muscle pain
 convulsions
 coma
 bloody stools

Risk Factors of Malaria :

 Rain and increased water bodies are appropriate for mosquito breeding and disease
transmission.
 Young children and infants.
 Pregnant women.
 People with weak immunity are more susceptible to the risk of malaria.
 People travelling to malaria infected areas.
 Poverty and lack of health awareness and education contributes to spreading the disease and
increasing mortality rate around the world.

How to prevent Malaria :

 Using mosquito repellent.
 Using mosquito repellent paint on exposed skin, or by spraying insecticide to kill mosquito
specially at sleeping areas. Do not use the paint on young children or infants of less than two
months.
 Concentration of the pesticide depends on the hours of protection, a high concentration of 50%
gives longer hours of protection, while the pesticide which its concentration reaches only 10%
provides protection of only 2 hours.
 Wearing protective clothing during activity times of mosquito, usually between dusk and dawn,
like trousers and shirts with long sleeves, putting repellent paint on clothes and shoes before
traveling, you may also buy treated clothes and using caps to protect face and neck.
 Using long-lasting insecticidal nets (LLINs), if the place you stayed in has no air conditioning
or mosquito repellent, and you must sleep under treated mosquito nets.
 Filling ponds and getting rid of mosquito breeding sites contributes to prevention of malaria
and limit its spread.

D. Stunting
Stunting is a condition of failure to thrive in children under five (infants under five
years) due to chronic malnutrition so children are too short for their age. Malnutrition
occurs since the baby is in the womb and in the early days after the baby is born, however,
the stunting condition appears only after the baby is 2 years old. Toddlers are short
(stunted) and very short (severely stunted) are toddlers with body length (PB / U) or height
(TB / U) according to their age compared to the standard WHO-MGRS (Multicentre
Growth Reference Study) 2006. While the definition of stunting according to the Ministry
of Health (Kemenkes) are children under five with z-score values less than -2SD / standard
deviation (stunted) and less than - 3SD (severely stunted).
 In Indonesia, around 37% (almost 9 million) of children under five are stunting
(Basic Health Research / Riskesdas 2013) and throughout the world, Indonesia is the
country with the fifth largest prevalence of stunting. Toddlers / Baduta (Infants under the
age of Two Years) who experience stunting will have a level of intelligence that is not
optimal, making children more vulnerable to disease and in the future can be at risk of
declining levels of productivity. In the end broadly stunting will be able to hamper
economic growth, increase poverty and widen inequality.
Dwarf children that occur in Indonesia are actually not only experienced by poor /
disadvantaged households / families, because stunting is also experienced by households /
families that are not poor / who are above the 40% level of social and economic welfare.
As illustrated in the graph below, the condition of stunting children is also experienced by
non-poor families / households. Stunting is caused by multi-dimensional factors and is not
only caused by malnutrition factors experienced by pregnant women and children under
five.
The most decisive intervention
in order to reduce stunting prevalence, it is therefore necessary to do 1,000 First Days of
Life (HPK) of children under five. In more detail, several factors that are the causes of
stunting can be described as follows:
6. Poor parenting practices, including a lack of maternal knowledge about health
and nutrition before and during pregnancy, as well as after the mother gives
birth. Some facts and information show that 60% of children aged 0-6 months
do not get breast milk exclusively, and 2 out of 3 children aged 0-24 months do
not receive MP-ASI. MP-ASI is given / introduced when toddlers are over 6
months old. In addition to functioning to introduce new types of food to babies,
MP-ASI can also fulfill the nutritional needs of the baby's body which can no
longer be supported by breast milk, and form the immune system and
development of the child's immunological system for food and drink.
7. Limited health services including ANC-Ante Natal Care services (health
services for mothers during pregnancy) Post Natal Care and quality early
learning. Information gathered from Ministry of Health publications and the
World Bank stated that the attendance rate of children at Posyandu declined
from 79% in 2007 to 64% in 2013 and children did not have adequate access to
immunization services. Another fact is that 2 out of 3 pregnant women have not
consumed adequate iron supplements and there is still limited access to quality
early learning services (only 1 out of 3 children aged 3-6 years has not been
enrolled in Early Childhood Education / Early Childhood Education services)
8. Still lack of household / family access to nutritious food. This is because the
price of nutritious food in Indonesia is still relatively expensive. According to
several sources (2013 RISKESDAS, 2012 IDHS, SUSENAS), food
commodities in Jakarta are 94% more expensive than in New Delhi, India.
Prices of fruits and vegetables in Indonesia are more expensive than in
Singapore. Limited access to nutritious food in Indonesia has also been noted to
have contributed to 1 in 3 pregnant women who have anemia.
 9. Lack of access to clean water and sanitation. Data obtained in the field shows
that 1 in 5 households in Indonesia still defecate in open spaces, and 1 in 3
households do not yet have access to clean drinking water.

Short prevalence (stunting) in children under five in Central Java Province compared
to National. In 2014, based on the results of Nutritional Status Monitoring in 496 Districts /
Cities involving 165,000 Toddlers as the sample, the stunting rate decreased to 29% compared
to 2013 at 37.2%. This result is also reinforced by data from UNICEF which intervened for
three years from 2011-2014 in three districts in Indonesia (Sikka, Jayawijaya, Klaten) and
succeeded in reducing the stunting rate by 6%. The condition of the prevalence of stunting in
children under five in Central Java based on Nutritional Status Monitoring (PSG) data of the
Central Java Provincial Health Office is 22.57% of the number of toddlers in Central Java in
2014 or 2,460 people. This condition shows that when compared to the average National 2014
amounted to 29.0%, conditions in Central Java were still better.

Short Prevalence (Stunting) in Toddlers Per District / City in Central Java Province Overall
the prevalence of stunting / shortage of toddlers in Central Java Province based on 2014 Central
Java Provincial Health PSG data of 22.57% was below the MDG target of 32% (Figure 2.17 )
Districts / cities with unfavorable conditions or the highest short and very short prevalence
rates, namely in Pati Regency, amounting to 37.14% due to the lack of knowledge about
diverse, nutritious, healthy and safe balanced food patterns, among others, the low average
energy consumption rate. While the lowest short and very short prevalence in the city of
Magelang was 4.33%. The problem of stunting toddlers is integrated in nutrition improvement
activities during pregnancy, the application of exclusive breastfeeding and the provision of
complementary feeding for infants.
 E. Tuberculosis
Tuberculosis is a disease caused by Mycobacterium tuberculosis that most often affect
the lungs with main symptoms like cough, fever, night sweats, and weight loss that may be
mild for many months (WHO, 2018). Case in Semarang City 791 (Semarang City Health
Profile 2017). In Central Java 4461 (Central Java Health Profile 2017). The prevalence of TB
in Indonesia ages 1-4 years old is 0.4 (Health Data and Information in Indonesia Health Profile
2016)
Children are easy to get TB because :
1. Tuberculosis is easy to spread
Tuberculosis is a well-known disease that can be spread easily through air. The
bacteria germs that contain in the droplet can spread easily in the air and inhaled by the
children. Basically, the children can be infected from their parents, family, close relative
or even other infected people whose contact with them.
2. Tuberculosis has strong relation with other disease
Tuberculosis is a disease that usually accompanied by other disease for example
HIV, diabetes, etc. Those disease exampled could weaken the immune system defense
indirectly. This condition will make the bacteria infect the children body easier compare
to normal condition. Besides, the low nutritional status such as stunting or other
nutritional problem could lead to the increasing of infection.
3. Tuberculosis has strong relation with environment
Tuberculosis is a disease that can’t be disparate with environment. The environment
condition mentioned are includes inadequate air ventilation, inadequate lights, the lack
of humidity, the smoked-room (relatives who are smoking) and whose population
density are below the standard. This kind of conditions are easy to be found in the urban
society.
4. Tuberculosis has strong relation with socio-economy factor
 The low income family with low economy level could lead to tuberculosis indirectly
because it will affect the food intake consumption of the children. Continuously, it will
affect the nutritional status itself. Later on, the external factor such low knowledge and
awareness of the people around the children could increase the possibility of the
children to become infected.
Symptoms can occur a bit differently in each child, and they depend on the child's
age. The most common symptoms of active TB in younger children include:
1. Fever
2. Weight loss
3. Poor growth
4. Cough
5. Swollen glands
6. Chills
The most common symptoms of active TB in adolescents include:
1. Cough that lasts longer than 3 weeks
2. Pain in the chest
3. Blood in sputum
4. Weakness
5. Tiredness
6. Swollen glands
7. Weight loss
8. Decrease in appetite
9. Fever
10. Sweating at night
11. Chills
The symptoms of TB can be like other health conditions.

Treatment may include a short-term hospital stay to be treated with medicine. For latent
TB, the child is given a 6- to 12-month course of the medicine isoniazid. Or the child may get
a shorter course of another medicine. For active TB, a child may take 3 to 4 medicines for 6
months or more. This is to make sure that the medicine is working.

Children usually start to get better within a few weeks of starting treatment. After 2
weeks of treatment with medicine, a child is usually not contagious. Treatment must be fully
finished as prescribed. It is important that your child take all of the medicines for the entire
time period.

Talk with your child’s healthcare provider about the risks, benefits, and possible side effects
of all medicines. TB can be prevented by lowering the child’s risk for the diseas
 CHAPTER III
CONCLUSION

Children cared for at daycare or in preschool education exhibit a two to three times
greater risk of acquiring infections, which impacts both on individual health and on the
dissemination of diseases through the community. Among other factors, the risk is associated
with the characteristics of daycare centers, and simple preventative measures are effective for
reducing transmission of diseases. Recommended measures include: appropriate hand washing
after exposure; employment of standard precautions; standardized routines for changing and
disposal of used diapers, location and cleanliness of changing area, cleaning and disinfection
of contaminated areas; use of disposable tissues for blowing noses; separate workers and area
for handling foods; notification of infectious diseases; training of workers and guidance for
parents.
In the face of growing utilization of daycare and preschool education and their
association with increased risk of acquired infections, control measures are indispensable to
the prevention and control of infectious diseases.
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