AROMATHERAPY MASSAGE OF
LEMONGRASS, KAFFIR LIME, AND LEMON
TO INCREASE APPETITE, IGF-1 (Insulin-like Growth Factor 1) LEVELS, BODY
WEIGHT, AND HEIGHT IN STUNTED TODDLER
Risa Yuliatri, Melyana
Nurul Widyawati, Ari Suwondo, Walin
KEMENKES POLTEKKES Semarang, Indonesia
Email: [email protected]
|
KEYWORDS Stunting; aromatherapy massage; appetite; IGF-1 levels; weight; height |
ABSTRACT Stunting is a chronic nutritional
problem caused by malnutrition over a long period of time, resulting in
children becoming short. Stunting is not only a problem of impaired physical
growth, but also causes children to become easily sick, impaired brain
development and intelligence, so stunting is a major threat to the quality of
human resources in Indonesia. Indonesia's stunting prevalence is 24.4% in
2021, based on the results of the Indonesian Nutritional Status Survey (SSGI)
by the Ministry of Health. This figure is quite high and still above the
standard tolerated by WHO, which is below 20%. For this reason, efforts are
needed to reduce stunting rates with aromatherapy footing. The study aims to
analyze the effect of aromatherapy massage on appetite, IGF-1 levels, body
weight, and height in stunted toddlers. The research design used was pretest-postest with control group design. The number of
samples in this study was 32 subjects, which were divided into two groups, 16
subjects in the intervention group were given aromatherapy massage 3 times a
week with a duration of 15 minutes for 8 weeks and the control group was
given standard care for stunting toddlers given PMT biscuits. The probability sampling technique is simple
random sampling. The data studied were appetite, IGF-1 levels, body weight, and
height of stunted toddlers. Data analysis using Wilcoxon Test, Man Wihtney Test, Paired T-test, and Independent T-test. The
results show there were differences between before and after aromatherapy
massage in the intervention group on appetite (P = 0.001), IGF-1 levels (P =
0.000), body weight (P = 0.000), and height (P = 0.000). Aromatherapy massage
3 times a week for a duration of 15 minutes for 8 weeks is effective in
increasing appetite, IGF-1 levels, weight, and height of stunted toddlers. |
INTRODUCTION
The toddler years (under five years) are an important
age, where children's growth and development develops
rapidly. Nutritional intake that suits their needs is needed at this age. The
state of adequate nutrition has a significant impact on the sustainable health
of toddlers into the future. During this period, children are vulnerable to
experiencing nutritional problems. One of the nutritional problems experienced
by toddlers is stunting (Uce, 2018).
The
incidence of short toddlers or stunting is a situation where the child's height
is shorter or lower when viewed from age standards. Stunting is a chronic
nutritional problem caused by inadequate nutritional intake over a long period
of time, resulting in children being short (Israini Suriati, 2016). Stunting is not only a problem of impaired physical
growth, but also causes children to become sick easily, impaired brain and
intelligence development, so stunting is a major threat to the quality of human
resources in Indonesia (Indonesian Ministry of Health, 2018a)
World Health Organization (WHO) Child Growth Standards determine stunting from the anthropometric
index of body length compared to age (PB/U) or height compared to age (TB/U)
with a limit (z-score) below the standard deviation (<-2 SD) (Black et al., 2013)(Budiastutik & Nugraheni, 2018). The prevalence of stunting in 2017 among toddlers in
the world was 22.2% or approximately 150.8 million, more than half of stunted
toddlers came from Asia (55%) and more than a third (39%) lived in Africa. Of
the total 83.6 million stunted children under five in Asia, the largest
contributor comes from South Asia (58.7%) and the lowest proportion in Central
Asia (0.9%) (Indonesian Ministry of Health, 2018b)In 2020, Indonesia itself had the second highest prevalence of editing
in the Southeast Asia region after Timor Leste with a prevalence rate of 31.8% (Databooks, 2021).
Indonesia's stunting prevalence is
24.4% in 2021, based on the results of the Indonesian Nutrition Status Survey
(SSGI) by the Ministry of Health. This figure is quite high and still above the
WHO tolerated standard, namely below 20%. National level findings from the 2021
Indonesian Nutrition Status Survey (SSGI), Provinces, and Districts/Cities,
from 35 Provinces in Indonesia, the prevalence of stunting in West Sumatra is
at 23.3%, which is still far from the national target in the 2024 RPJM, namely
14%.
West Sumatra consists of 12 districts
and 7 cities. Of the total 19 regencies and cities in West Suatra
Province, the lowest prevalence of stunting is in Solok City at 18.5%, however
this figure is still below the 2024 RPJM target (Indonesian Ministry of
Health, 2022) In 2024, the
government hopes that the stunting rate in Indonesia will only be 14%. Efforts
are needed to reduce the stunting rate of children under five years of age by
2.7% per year to achieve this goal (Coordinating Ministry for Human Development and
Culture of the Republic of Indonesia, 2022).
Nutritional
factors are related to stunting, and other conditions such as genetics,
hormones, as well as psychosocial environmental factors can contribute to
growth disorders (Almaitser S, 2017). According to the Ministry of Villages, Development of Disadvantaged
Regions and Transmigration, stunting in children under five is included in
chronic malnutrition caused by several factors, including socio-economic
conditions, nutrition of pregnant women, infant morbidity rates, and inadequate
nutritional intake of infants (Remarks et al., n.d.).
In line with Aditiawati's
statement that child development is a process of various factors, including
hormonal, psychosocial and environmental factors, especially nutrition,
interacting with each other (Aditiawati, 2019). The impact of stunting is closely related to appetite and growth
disorders. Appetite is the desire to eat and choose food according to what is
desired. During the toddler period, the child's appetite begins to be erratic
and difficult to predict, resulting in the child's appetite decreasing (Almaitser, 2017).
Lack of food intake such as protein can damage bone
mineral by inhibiting Insulin-like Growth Factor 1 (IGF-1), besides reduced
plasma insulin caused by energy imbalance resulting in decreased synthesis of
IGF-1 in the liver, disrupting the performance of IGF binding protein-1 ,
thyroid hormone, and other systemic factors involved in Fibroblast Growth
Factor 1 (FGF-1) all contribute to linear growth (Gat-Yablonski & Phillip, 2015). The effects of growth hormone Growth Hormone (GH) are mediated by
Insulin-like Growth Factor 1, which also regulates somatic growth and organ
development, including brain development (Arifiyah & Purwanti, 2017). Despite its much stronger growth-stimulating
effects, IGF-1 is a GH delivery protein with a structure and function similar
to insulin (Putri & Natsir, 2021).
Using pharmacological and non-pharmacological methods
can overcome difficulty eating or lack of appetite. The administration of
multivitamins and other micronutrients is combined in pharmacological treatment
efforts. On the other hand, there are non-pharmacological treatments such as
herbal medicine, massage and acupuncture (View of The
Effect of Tui Na Massage on Appetite in Toddlers: Literature Review, nd). The World Health
Organization (WHO) states that traditional medicine must be adopted and
developed in every country. To maintain, improve and maintain their level of health,
the global community is currently using traditional health services with the
understanding of returning to nature, one of which is massage (Indonesian Ministry of Health, 2015).
Massage is a form of touch therapy that functions as a
treatment technique. Touch and gentle stimulation are basic needs for babies that can stimulate
and stimulate the baby's appetite. So with baby massage it will cause an
increase in appetite which will ultimately increase the baby's weight (Malikhah et al., 2019; Suharta & Anggrianti,
2021).
Research conducted by Happy Marthalena at the Baawang Palangkaraya
Community Health Center in 2019 on 15 babies showed that there was a
significant effect of tuina massage on increasing difficulty in feeding
toddlers before and after massage, where 15 respondents (100%) experienced
difficulty in breastfeeding. Another study by Halimatus Sa'diah and Rahma
Kusuma Dewi on toddlers aged 12-59 months with 32 respondents having difficulty
eating, 16 respondents were given massage and 16 respondents were given
lemongrass oil aromatherapy, showing that both massage and lemongrass
aromatherapy had an influence in overcoming children's eating difficulties.
toddler. However, massage is more effective in overcoming feeding difficulties
in toddlers than giving lemongrass aromatherapy (Saidah & Dewi, 2020).
Journal of Pediatric Nursing (2016) in one of their publications mentioned the
efficacy and safety of using oil in massage to increase baby growth. Research
shows that massage using oil can increase a baby's weight, body length and head
circumference. In conclusion, massage using oil effectively increases the
physical growth of babies (Li et al., 2016)
Aromatherapy
can be given by inhaling, compressing, applying to the skin, spraying, or
mixing it with water to soak the whole body or certain parts of the body.
Massaging will make it work better (Permenkes No. 8 of 2014 concerning SPA
Health Services [JDIH BPK RI], nd). In the massage process with aromatherapy,
aromatherapy stimulates the central nervous system through the distribution of
molecules that spread aroma, so it is useful for treatment and relaxation (Kasmiatun, 2017; Nirnasari, 2018).
Based on this explanation, researchers are interested
in conducting research on the effectiveness of aromatherapy massage, which in
this study uses lemongrass, kaffir lime and lemon aromatherapy oils in the form
of Increased Appetite Massage Oil on increasing appetite and IGF-1
(Insulin-like Growth Factor 1) levels), body weight and height in stunted
toddlers.
"Based on the background description above, this
research aims to find out whether lemongrass, kaffir lime and lemon
aromatherapy massage has an effect on increasing appetite, IGF-1 levels, body
weight and height in stunted toddlers?"
RESEARCH
METHOD
Research
Hypothesis
Major Hypothesis
Aromatherapy massage has an effect on increasing
appetite, IGF-1 levels, body weight and height in stunted toddlers
Minor Hypothesis
1) Aromatherapy massage has an effect on increasing the
appetite of stunted toddlers.
2) Aromatherapy massage has an effect on increasing IGF-1
levels in stunted toddlers.
3) Aromatherapy massage has an effect on increasing the
weight of stunted toddlers.
4) Aromatherapy massage has an effect on increasing the
height of stunted toddlers.
Types and Research
Design
This type of research is experimental research with a true
experimental design. The research design used was a pretest-posttest with
control group design. This research involved a control group and a treatment
group. The
description of this research design is:
|
|
Pre-Test |
Treatment |
Post-Test |
|
|
|
K1 |
01 |
X1 |
02 |
|
K2 |
03 |
X2 |
04 |
Figure 1. Research Design
Information
:
R :Randomization
K1 :
Aromatherapy massage intervention group
K2 :
Control group given PMT biscuits
O1&O3 :Initial data measurements in
the intervention group and control group were for the variables appetite, IGF-1
levels, weight and TB
O2&O4 : Final group data measurementintervention and control groups after being given treatment on the
variables of appetite, IGF-1 levels, BW and TB
X1 :Aromatherapy massage treatment in the intervention group
X2 :
Treatmentgiving PMT biscuits to the control group
Population and
Sample
Population
The
population in this study were all stunted toddlers in wworking area of the Tanjung Paku Community Health Center, Solok City,
West Sumatra Province.
Sample
The sampling technique in this
research is probability sampling, namely simple random sampling. Based on the
formula calculation above by estimating the proportion of respondents who
dropped out, the total sample size for this study, including the number of drop
out samples, was 32 respondents, consisting of 16 people in the intervention
group and 16 people in the control group.
Data Processing and Analysis Techniques
Data
Processing Techniques
Data processing in research is carried out in the following stages:
1) Editing
Editing is an effort to re-check the correctness of the data
obtained. If there is incomplete information, the researcher asks respondents
to complete the data.
2) Coding
Provide codes according to respondents' answers to
facilitate data analysis and processing
3) Tabulating
Tabulatingis the process of arranging it into table form. At this
stage the data is considered to have been processed so that it is arranged into
a format that has been designed to make it easier for researchers to read the
data that has been collected.
4) Cleaning
This stage aims to provide data from several possible data
that do not meet the requirements with the help of software.
5) Processing
Researchers process data using computer programs.
Data
analysis
1) Univariate Analysis
Univariate
analysis was analyzed by calculating the frequency of the research data
results. Based on each variable, it produces descriptive distributions and
percentages. The purpose of this data analysis is to describe the
characteristics of each variable studied and the data displayed in the analysis
is the frequency distribution of data in each group. Then, a characteristic
homogeneity analysis was carried out before the intervention to assess whether
there were differences in the variance of each group.
2) Bivariate
Analysis
Before carrying
out bivariate analysis, a data normality test was first carried out as a
monitor for bivariate parameters using the Kolmogorov Smirnov test (samples
> 50) and Shapiro Wilk (samples < 50). Foranalyze the effectiveness of
providing interventions, if data is normally distributed then statistical
analysis is done using the parametric Paired T-test. If you get data that is
not normally distributed, statistical analysis uses the Wilcoxon test.
RESULTS AND
DISCUSSION
Data analysis
Univariate
Analysis
Variable Analysis
Table
1. Characteristics of Respondents and Research Subjects
|
Variable |
Intervention
Group |
Control Group |
p-Value |
||||
|
|
N |
% |
Mean±SD |
N |
% |
Mean±SD |
|
|
Mother's Age |
|
|
|
|
|
|
0.711 |
|
Reproductive |
13 |
81.3 |
|
12 |
75.0 |
|
|
|
Risky |
3 |
18.8 |
|
4 |
25.0 |
|
|
|
Mother's Education |
|
|
|
|
|
|
0.606 |
|
SENIOR
HIGH SCHOOL |
5 |
31.3 |
|
6 |
37.5 |
|
|
|
D3 |
5 |
31.3 |
|
4 |
25.0 |
|
|
|
S1 |
5 |
31.3 |
|
6 |
37.5 |
|
|
|
S2 |
1 |
6 |
|
0 |
0 |
|
|
|
Mother's Job |
|
3 |
|
|
|
|
0.124 |
|
IRT |
5 |
31.3 |
|
7 |
43.8 |
|
|
|
Trade |
4 |
25.0 |
|
1 |
6.3 |
|
|
|
Honour |
1 |
6.3 |
|
4 |
25.0 |
|
|
|
Private |
4 |
25.0 |
|
3 |
18.8 |
|
|
|
Civil
servants |
2 |
12.5 |
|
1 |
6.3 |
|
|
|
Gender Subject |
|
|
|
|
|
|
0.660 |
|
Man |
8 |
50.0 |
|
8 |
50.0 |
|
|
|
Woman |
8 |
50.0 |
|
8 |
50.0 |
|
|
|
Exclusive breastfeeding |
|
|
|
|
|
|
0.200 |
|
Yes |
11 |
68.8 |
|
7 |
43.8 |
|
|
|
No |
5 |
31.3 |
|
9 |
56.3 |
|
|
|
BB Born |
|
|
|
|
|
|
0.891 |
|
<2.5kg |
2 |
12.5 |
|
2 |
|
|
|
|
2.5-4kg |
13 |
81.3 |
|
14 |
12.5 |
|
|
|
>4
kg |
1 |
6.3 |
|
0 |
87.5 |
|
|
|
Appetite |
|
|
70,937±16,453 |
|
|
72.175±17.56 |
|
|
IGF-1 |
|
|
41,539±12,538 |
|
|
26,973±6,316 |
0,000 |
The characteristics of the respondents and research
subjects can be seen from the table above. For confounding variables, subject characteristics
in this study include characteristics based on history of exclusive
breastfeeding and birth weight which can be seen in table 2.
Table 2. Frequency
Distribution of Confounding Variables for Research Subjects in the Intervention
Group and Control Group
|
Characteristics |
Group |
P-value |
|
|||
|
Intervention |
Control |
|
||||
|
n |
% |
n |
% |
|
||
|
Exclusive
breastfeeding |
|
|
|
|
|
|
|
Yes |
11 |
68.8 |
7 |
43.8 |
0.377* |
|
|
No |
5 |
31.3 |
9 |
56.3 |
|
|
|
Birth
Weight |
|
|
|
|
|
|
|
<2.5kg 2.5-4 kg |
1 14 |
6.3 87.5 |
2 13 |
12.5 81.3 |
0.107* |
|
|
>4 kg |
1 |
6.3 |
1 |
6.3 |
|
|
*Chi-Square
Test
Based on table 2, it is shown that the characteristics
of respondents based on exclusive breastfeeding show that from the intervention
group there were 11 respondents who were given exclusive breast milk (68.8%)
while those who were not given exclusive breast milk were 5 people (31.3%),
while for the control group there were 7 people. respondents (43.8%) who
received exclusive breastfeeding and 9 respondents (56.3%) who did not receive
exclusive breastfeeding. From the results of the characteristic homogeneity
test based on exclusive breastfeeding, the P-value was 0.377 (P>0.05), which
means that there was no difference between the intervention group and the
control group. From the characteristics based on birth weight in both groups,
the average respondent had a birth weight of 2.5-4 kg, 14 respondents (87.5%)
in the intervention and control groups, 13 respondents (81.3%).
From the test results obtained, the P-value was
>0.05, indicating that there was no significant difference between the
exclusive breastfeeding variable and the baby's birth weight, as the
confounding variable was homogeneous so it had no effect on the analysis
results.
Normality test
The data normality test used in this research was the Shapiro Wilk test
because the number of samples in the study was <50 respondents. Data is
considered to be normally distributed if a p-value > 0.05 is obtained,
conversely if the p-value is < 0.05 then the data is considered not to be
normally distributed. The results of the normality test determine the type of
research test that will be used next. The results of the normality test can be
seen from the table
Table 3.
Results of Appetite Normality Test, IGF-1, BB, TB
Intervention
Group and Control Group
|
Variable |
Group |
P–value |
Information |
|
Appetite |
|
|
|
|
Pretest |
Intervention |
0.004 |
Abnormal |
|
|
Control |
0.004 |
Abnormal |
|
Posttest |
Intervention |
0,000 |
Abnormal |
|
|
Control |
0.046 |
Abnormal |
|
IGF-1 |
|
|
|
|
Pretest |
Intervention |
0.076 |
Normal |
|
|
Control |
0.079 |
Normal |
|
Posttest |
Intervention |
0.644 |
Normal |
|
|
Control |
0.218 |
Normal |
|
BB |
|
|
|
|
Pretest |
Intervention |
0.407 |
Normal |
|
|
Control |
0.510 |
Normal |
|
Posttest |
Intervention |
0.236 |
Normal |
|
|
Control |
0.170 |
Normal |
|
TB |
|
|
|
|
Pretest |
Intervention |
0.756 |
Normal |
|
|
Control |
0.816 |
Normal |
|
Posttest |
Intervention |
0.531 |
Normal |
|
|
Control |
0.877 |
Normal |
The
results of statistical tests using the Shapiro Wilk test in table 3 show the
pretest and posttest appetite variables in the control and intervention groups
obtained a p-value <0.05, which means the data is not normally distributed
so the next test that will be used is the non-parametric Wilcoxon test and Mann
Whitney. For the IGF-1, BB and TB level variables in the intervention group and
control group, both pretest and posttest, the P-value was >0.05, meaning the
data was normally distributed, so the next parametric test was Paired T-test
and Independent T-test. test.
Bivariate
Analysis
Bivariate
analysis was carried out to test the differences between two variables, where
in the previous stage a data normality test was carried out first and then
further tests were carried out for paired and unpaired variables.
1) Differences
in Appetite Before and After Treatment in the Intervention Group and Control
Group
|
Variable |
|
Group |
P-value |
|
|
Data |
Intervention |
Control |
||
|
|
Mean±SD |
Mean±SD |
||
|
Appetite |
Pretest |
70.94 ± 16.45 |
73.75±16.48 |
0.669** |
|
|
Posttest |
12.50±15.81 |
60.31 ± 23.05 |
0,000** |
|
|
ΔMean |
-58.4 |
-13.44 |
|
|
P-value |
|
0.001* |
0.100* |
0.001* |
aWilcoxon
sign rank, *level of significance sig <0.05
bMann-Whitney,
**level of significance sig <0.05
Based on
table 4, it shows the average remaining meal in the pretest intervention group
was 70.94 and posttest 12.50. The explanation of this figure is that in the intervention
group before being given treatment (pretest) the average remaining food was
70.94 and after being given treatment (posttest) the remaining food decreased
to an average of 12.50. In the sense that less food is left over, in other
words, more food is used up after being given treatment. In the control group,
the average remaining food was 73.75 at pretest and in the posttest the average
remaining food was 60.31.
The
Wilcoxon test was carried out to determine the difference in pre and post
averages in the intervention group and control group. Based on the statistical
test output, it is known that Asymp. The sign
(2-tailed) for the intervention group is 0.001, because the value 0.001 is
smaller than <0.05, it can be concluded that the hypothesis is accepted.
This means that in the intervention group there was a difference between the
appetite of the pre-test and post-test groups. Meanwhile, the control group
showed the Asymp value. Sign (2-tailed) 0.100>0.05
which means that there is no significant difference in the control group before
and after being given treatment.
The
Mann-Whitney test was carried out to determine whether there was a difference
in the average appetite between the intervention group and the control group
after being given treatment. Based on the statistical test output, it was found
that Asymp. Sign (2-tailed) is 0.000 (<0.05). It
can be concluded that there is a difference in appetite between the
intervention group and the control group. Because there is a significant
difference, it can be said that there is an influence of aromatherapy massage
treatment on appetite in stunted toddlers.
Meanwhile,
the difference in average appetite in the intervention group and the control
group before treatment was found to be Asymp. Sign
(2-tailed) is 0.669 (>0.05). It can be concluded that there was no
difference in appetite between the intervention group and the control group
before being given aromatherapy massage treatment.
2) Differences
in Insulin-like Growth Factor 1 (IGF-1) Levels Before and After Treatment in
the Intervention Group and Control Group
Table 5.
Differences in Insulin-like Growth Factor 1 (IGF-1) Levels Before and After
Treatment in the Intervention Group and Control Group
|
Variable |
|
Group |
P-value |
|
|
Data |
Intervention |
Control |
||
|
|
Mean±SD |
Mean±SD |
||
|
IGF-1 |
Pretest |
41.54±12.53 |
26.97±6.316 |
0,000** |
|
|
Posttest |
67.43±9.680 |
27.33±6.271 |
0,000** |
|
|
ΔMean |
25.89 |
0.36 |
|
|
P-value |
|
0,000* |
0.074* |
0.001* |
aPaired T-test, *level of
significance sig <0.05
bIndependent T-test, **level
of significance sig <0.05
Paired
Samples T-test which was carried out to determine the pre and post differences
between the intervention group and the control group is known in the table with
the Sig value. (2-tailed) in the intervention group was 0.000 (<0.05), then
we can conclude that there is a real difference between IGF-1 levels in the
pretest and posttest in the intervention group. In the control group with Sig.
(2-tailed) 0.074 which means >0.05, so it can be concluded that there is no
difference in IGF-1 levels between the pretest and posttest control group.
Based on
table 5, it shows that the results of the pretest measurements showed that the
average IGF-1 level in the intervention group was 41.54 and for posttest
measurements the average was 67.43, while in the control group the average
IGF-1 pretest result was 26.97. and for the posttest, namely 27.33. The
difference in mean IGF-1 in the control and intervention groups can be seen in
the graph below:
Figure 2. Changes in Mean
IGF-1 Pretest and Posttest in the Intervention Group and Control Group
Figure
2 shows that in the intervention group there was an increase in the average
IGF-1 before and after treatment, while in the control group the average IGF-1
also increased, before and after treatment, but not as much as the increase in
the intervention group.
The
results of the Independent T-test were carried out to determine whether there
was a difference in the average between the intervention group and the control
group after being given treatment. The statistical test results in table 4.4
show the value of Syg. (2-tailed) of 0.000
(<0.05), which means there is a significant difference between IGF-1 levels
between the intervention group and the control group both before and after
treatment.
3) Differences
in Body Weight (BW) Before and After Treatment in the Intervention Group and
Control Group
Table 6. Differences
in Body Weight (BW) Before and After Treatment in the Intervention Group and
Control Group
|
Variable |
|
Group |
P-value |
|
|
Data |
Intervention |
Control |
||
|
|
Mean±SD |
Mean±SD |
||
|
BB |
Pretest |
9.65±1.36 |
9.08±1.41 |
0.255** |
|
|
Posttest |
9.87±1.39 |
9.22 ± 1.31 |
0.183** |
|
|
ΔMean |
0.22 |
0.14 |
|
|
P-value |
|
0,000* |
0.062* |
0.001* |
aPaired T-test, *level of
significance sig <0.05
bIndependent T-test, **level
of significance sig <0.05
Based on
the measurement results in table 6 above, the intervention group shows an
average pretest weight of 9.65 and an average posttest of 9.87. In the control
group, the average pretest BB result was 9.08 and for the posttest it was 9.22.
Paired Samples T-test which was carried out to determine the pre and post
differences between the intervention group and the control group is known in
the table with the Sig value. (2-tailed) in the intervention group was 0.000
(<0.05), so we can conclude that there is a real difference between BB in
the pretest and posttest in the intervention group. In the control group with
Sig. (2-tailed) 0.062 which means >0.05, so it can be concluded that there
is no difference in BW between the pretest and posttest control group.
The results
of the Independent T-test were carried out to determine whether there was a
difference in the average between the intervention group and the control group
after being given treatment. It can be seen from the statistical test results
in table 6 that the Syg. (2-tailed) in the
intervention group was 0.255 and the control group was 0.183 which means
<0.05. It can be said that there is no significant difference in body weight
between the intervention group and the control group, either before being given
treatment or after being given treatment.
4) Differences
in Body Height (TB) Before and After Treatment in the Intervention Group and
Control Group
Table 7. Differences in Height (TB) Before and After Treatment in the
Intervention Group and Control Group
|
Variable |
|
Group |
P-value |
|
|
Data |
Intervention |
Control |
||
|
|
Mean±SD |
Mean±SD |
||
|
TB |
Pretest |
77.73±4.91 |
77.02 ± 4.57 |
0.677** |
|
|
Posttest |
79.55±5.10 |
77.53±4.46 |
0.234** |
|
|
ΔMean |
1.82 |
0.51 |
|
|
P-value |
|
0,000* |
0,000* |
0.001* |
aPaired T-test, *level of
significance sig <0.05
bIndependent T-test, **level
of significance sig <0.05
The table
above shows the results in the TB intervention group with a pretest average of
77.73 and a posttest average of 79.55. For the control group, the average TB
pretest result was 77.02 and for the posttest it was 77.53. Paired Samples
T-test which was carried out to determine the pre and post differences between
the intervention group and the control group, can be seen in the table with the
Sig value. (2-tailed) in the intervention group and control group is 0.000
(<0.05), so we can conclude that there is a real difference between TB in
the pretest and posttest in the intervention group and control group.
The results
of the Independent T-test were carried out to determine whether there was a
difference in the average between the intervention group and the control group
after being given treatment. It can be seen from the statistical test results
in table 7 that the Syg. (2-tailed) in the
intervention group was 0.677 and the control group was 0.243 which means
<0.05. It can be said that there is no significant difference in TB between
the intervention group and the control group, either before being given
treatment or after being given treatment.
5) Effectiveness
of Giving Aromatherapy MassageLemongrass, Kaffir
Lime, and Lemon on Increased Appetite, IGF-1, BB, and TB in Stunting
Toddlers
The
intervention group was the group that received aromatherapy massage treatment 3
times a week with a massage duration of 15 minutes for 8 weeks. Apart from
that, the intervention group also received standard treatment for stunting
toddlers, namely giving PMT biscuits. Meanwhile, the control group only
received PMT biscuits.
In this
case, we can see the effectiveness of giving aromatherapy massage in increasing
appetite, IGF-1 levels, body weight and height in stunted toddlers compared to
edited toddlers who only received standard treatment, namely PMT biscuits. We
can know this from comparing the means of the intervention group and the
control group after being given treatment, using the effectiveness formula
below.
x
100%
Table 8. Effectiveness of Providing Aromatherapy
Massage Compared to Standard Care for Stunting Toddlers Providing PMT Biscuits
|
Variable |
Posttest Mean Intervention |
Posttest Mean Control |
Effectiveness (%) |
|
Appetite |
12.50 |
60.31 |
4.78 |
|
IGF-1 |
67.43 |
27.33 |
4,010 |
|
Weight |
9.87 |
9.22 |
65 |
|
Height |
79.55 |
77.53 |
200 |
From table 8
above which measures the effectiveness of giving aromatherapy massage in
increasing appetite, IGF-1 levels, body weight and height in stunted toddlers
compared to edited toddlers who only received standard treatment, namely giving
PMT biscuits, it can be seen that giving aromatherapy massage is proven.
statistically effective compared to standard care for pregnant toddlers in the
form of giving PMT bisuits.
DISCUSSION
Influenceof Providing Lemongrass, Kaffir Lime, and Lemon
Aromatherapy Massage to Increase Appetite in Stunting Toddlers Before and After
Treatment
Based on
the results of data analysis,The
average appetite in the pretest intervention group was 70.94 and posttest
12.50, while in the control group the average appetite was 73.75 at pretest and
posttest 60.31. The results of the difference test using the Wilcoxon test in
the intervention group showed a P-value of 0.001<0.05, which means that
there was a significant difference in the intervention group regarding the
increase in appetite before and after being given treatment.So it can be concluded that there is an influence of
aromatherapy massage treatment on appetite in stunted toddlers.Meanwhile, the control group showed a P-value of 0.100>0.05, which
means that there was no significant difference in the control group before and
after being given treatment.
Based on the test results using Mann-Whitney on the appetite pretest,
a p-value of 0.622 (>0.05) was obtained, which means that there was no
significant difference in appetite between the intervention group and the
control group before treatment was given. In the posttest data, a P-value of
0.000<0.05 was obtained, which means there was a significant difference in
the intervention group and the control group after being given treatment.
Stunting isthe problem of chronic malnutrition due to a lack of nutritional
intake over a long period of time. Stunting must be considered by treating it
as early as possible because it has an impact on the level of intelligence,
productivity and body immunity to disease, which in turn can hamper economic
growth thereby increasing poverty and inequality which have long-term effects
on sufferers, their families and the country (Rahmah et al., 2023).
The Ministry of Health defines stunting as a
height index for age (TB/U) of less than minus two standard deviations (-2SD) or
below the existing standard average and severe stunting is defined as less than
-3SD. Multidimensional factors are thought to be factors that influence the
incidence of stunting. Apart from that, poor nutrition experienced by pregnant
women and toddlers also contributes to stunting in toddlers. Poor parenting
practices, lack of maternal knowledge regarding health and nutrition, limited
health services including pregnancy check-up/ANC services, lack of
household/family access to nutritious food and lack of access to clean water
and sanitation (Nurhidayati et al., 2020).
A good appetite needs to be developed from an
early age so that eating disorders do not arise later in life. Toddlers whose
eating patterns are disturbed have an impact on their health, making them
susceptible to disease. One way to prevent this is by giving massage to
toddlers. Massage is a direct contact touch therapy with the body that can
provide a feeling of safety and comfort. If massage is done regularly, it will
increase catecholamine hormones (epinephrine and norepinephrine) which can
stimulate growth and development because they can increase appetite, increase
body weight, and stimulate the development of brain structure and function (Simanungkalit, 2020).
The
results of Simanungkalit's research on 15 children aged 1 year showed thatThere is a significant influence on the level of difficulty in eating
toddlers before and after massage. After the massage, 13 respondents (86.7%)
had no difficulty eating and only 2 respondents (13.3%) still had difficulty
eating. This shows that there is an effect of massage on increasing the
appetite of toddlers aged 1 year (Simanungkalit, 2020).
Giving
PMT biscuits to the control group did not have a significant effect on
children's appetite. This is supported by research by Ibrahim, et al. Giving
additional food (PMT) biscuits is not able to change the nutritional status of
toddlers as shown byThe average Zscore
value is still at <-2 SD, indicating that children under five are still in
the malnourished category because children under five in both the intervention
group and the control group prefer outside snacks and do not finish the
biscuits given because their appetite has decreased.
Influence of Providing Lemongrass,
Kaffir Lime, and Lemon Aromatherapy Massage to Increase IGF-1 Levels in
Stunting Toddlers Before and After Treatment
Based on the results of data analysis, the
results of the pretest measurements showed that the average IGF-1 level in the
intervention group was 41.54 and for posttest measurements the average was
67.43. Meanwhile, in the control group, the average IGF-1 pretest result was
26.97 and for the posttest it was 27.33. The results of data analysis showed
that in the intervention group there was an increase in the average IGF-1
before and after treatment, while in the control group the average IGF-1 also
increased, before and after treatment, but not as much as the increase in the
intervention group.
The results of the test for the influence of paired variable data
using the Paired T Test statistical test on the IGF-1 level variable show that
the p-value in the experimental group and control groupin the intervention group, a p-value of 0.000 was obtained, which
means that there was a significant difference before and after being given
treatment. Meanwhile, in the control group, a p-value was obtained of 0.074,
which means that there was no significant difference before and after being
given treatment.
The results of the Independent T Test in the pretest showed a P-value
of 0.160 (<0.05), which means there was no significant difference in the
increase in IGF-1 between the intervention group and the control group.
Meanwhile, the P-value in the posttest data is 0.000 <0.05, which means that
there is a significant difference in the intervention group and the control
group after being given treatment.
IGF-1 is a hormone produced by the liver and
other tissues in response to stimulation from GH which functions to influence
the growth and development of bones and skeletal muscles. The effects of GH on
growth depend on the interaction between growth hormone and IGF-1. The IGF-1
hormone plays a role in regulating postnatal growth in babies from late infancy
onwards (Sinaga et al., 2018). Massage is
a therapy that can increase IGF-1 levels. The mechanism of massage is that it
can increase insulin and IGF-1. Insulin promotes the conversion of glucose to
short-term (glucogen) and long-term (lipid) storage, and IGF-1 plays an
important role in promoting growth by stimulating cell growth and
multiplication as well as inhibiting apoptosis (Yuyun, 2021). The
hormone insulin (IGF-1) plays a regulatory role and overall cell metabolism in
the human body. IGF-1 is produced by the liver under growth hormone stimulation
and has systemic growth effects.
Based on the results of research by Sudarmi,
et al on 48 babies aged 6-12 months, it showed that there was a significant
difference in IGF-1 levels between the intervention and control groups. The
average IGF value in the intervention group before the intervention was 1.377
and after it was 2.573, there was an increase in the average IGF-1 value of
1.19, the results of statistical analysis using the paired t test showed a
significant increase of p=0.003 (p<0.05 ), whereas in the control group
before it was 1.74 and after 4.29 there was an increase of 2.55 indicating a
significant increase of p<0.001 (p<0.05). The intervention group and
control group showed significant differences indicating that infant massage
could increase IGF-1 levels (Sudarmi et al., 2020).
The intervention group received massage, which
showed that baby massage could increase IGF-1 levels. Massage can stimulate the
vagal nerve (one of 12 cranial nerves in the brain) which causes increased
vagal activity and increases gastric motility (movement of the digestive tract)
and the release of insulin (food absorption hormone) and IGF-1 which play an
important role in stimulating growth (Sudarmi et al., 2020).
Lemongrassis a type of spice
plant, usually used as a cooking spice and medicine. This plant has a shape
resembling grass, in many clumps, with very deep and strong roots. The main
ingredients of lemongrass essential oil are citronellal, citronellol and
geraniol. The citronellol content has biological effects such as analgesic,
calming/sedative, hypotensive properties, reduces inflammation, infection, as
an antioxidant, stomokic, antipyretic, and stimulates relaxation reactions in
the body (Selvita, 2020).
Traditionally the fruit, leaves and bark of Citrus hystrix are the
parts most commonly used to reduce the severity of certain diseases. The fruit
is used to treat stomach aches by the tribes of hilly Tripura in North East
India (Md Othman et
al., 2016). While the leaves and fruit are both used to steam baths for
postpartum mothers, to relieve headaches, rheumatism, fever and to treat
diabetes mellitus, used to improve sexual performance and to treat
hypertension, heart disease and diarrhea (Das et al.,
2009; Siti et al., 2022). The fruit is used in
hair shampoo to reduce dandruff and increase hair growth (Silalahi,
2018).
Lemon essential oil, extracted from lemons, has been used to treat
various pathological diseases, such as diabetes, inflammation, cardiovascular
disease, depression, and hepatobiliary dysfunction. Several randomized,
double-blind, placebo-controlled trials have also revealed anxiolytic-like
effects in humans with lemon extract. Its health-related biological activities
are not only related to Vitamin C but are also related to flavonoids with
anti-allergic, antioxidant, anti-inflammatory, anti-cancer and anti-carcinogenic
actions. Recent pharmacological studies also reveal that members of the genus
typically express several monoterpenes that impart a "lemon" taste
and odor notably, linalool, limonene, pinene, myrcene, eriodictyol and their
derivatives, as well as some of the more typical monoterpenes expressed by
related genera. Monoterpene factors may have some effects directly related to
brain function, including: cholinesterase inhibitory activity by essential
oils. Monoterpenes exert emotional influencing activity by directly acting on
the olfactory nerves and the central nervous system (Ben Hsouna et
al., 2017; EM Mustafa, 2015).
Journal of Pediatric Nursing (2016)
in one of their publications mentioned the efficacy and safety of using oil in
massage to increase baby growth. Research shows that massage using oil can
increase a baby's weight, body length and head circumference. In conclusion,
massage using oil effectively increases the baby's physical growth (Saidah &
Dewi, 2020).
Aromatherapy can be given by inhaling, compressing, applying to the
skin, spraying, or mixing it with water to soak the whole body or certain parts
of the body. Massaging will make it work better (Li et al.,
2016). In the massage
process with aromatherapy, aromatherapy stimulates the central nervous system
through the distribution of molecules that spread aroma, so it is useful for
treatment and relaxation (Nirnasari,
2021; Minister of Health Regulation No. 8 of 2014 concerning SPA Health
Services [JDIH BPK RI], 2014).
Nutritional factors are related to stunting, and other conditions such
as genetics, hormones, as well as psychosocial environmental factors can
contribute to growth disorders (Almaitser,
2017). According to the Ministry of Villages, Development of Disadvantaged
Regions and Transmigration, stunting in children under five is included in
chronic malnutrition caused by several factors, including socio-economic
conditions, nutrition of pregnant women, infant morbidity rates, and inadequate
nutritional intake of infants (Remarks et
al., n.d.).
In line with Aditiawati's statement that child development is a
process in which various factors, including hormonal, psychosocial and environmental
factors, especially nutrition, interact with each other (Aditiawati,
2019). The impact of stunting is closely related to impaired appetite and
growth. Appetite is the desire to eat and choose food according to what is
desired. During the toddler period, the child's appetite begins to be erratic
and difficult to predict, resulting in the child's appetite decreasing (Almaitser,
2017).
Influence of Providing Lemongrass,
Kaffir Lime, and Lemon Aromatherapy Massage on Increased Body Weight (BB) in Stunting
Toddlers Before and After Treatment
Based on the results of data analysis, the
pretest measurement results obtained in the intervention group were 9.65 and
for the posttest measurements the mean was 9.87 with a P-value of 0.000.
Meanwhile, in the control group, the average pretest BB result was 9.08 and for
the posttest it was 9.22 with a P-value of 0.062. The results of data analysis
showed that in the intervention group there was an increase in mean body weight
before and after treatment, whereas in the control group there was no
difference in mean weight between before and after treatment.
The results of the test for the
influence of paired variable data using the Paired T-test statistical test on
the weight variable show that the P-value in the experimental group and control
groupin the intervention group, the P-value was
0.000, which means that there was a real difference between body weight before
and after treatment. Meanwhile, in the control group, a p-value was obtained of
0.062, which means that there was no real difference before and after being
given treatment.
The results of the Independent T-test in the intervention group showed
a P-value of 0.255 (<0.05), while the P-value in the posttest data was 0.183
(<0.05), which means there was no significant difference in weight between
the intervention group and control group.
One of the
factors that influences a child's growth and development is stimulation, one of
which is touch in the form of massage. Massage can have positive physical
effects, including increasing growth and influencing body weight. Children who
are massaged well and regularly can grow healthier and develop better. This is
because beta endorphin influences the growth mechanism. Babies who are massaged
experience an increase in vagus nerve tone which will cause an increase in
enzyme levels for better food absorption (Maharani et al., 2017).
Weight gain is of course greatly
influenced by ongoing massage. Basically, toddlers who are massaged will
experience an increase in the levels of absorption enzymes and insulin so that
the absorption of food essence becomes better. As a result, toddlers become
hungry quickly and increase their appetite (Massage et al., 2022).
There are several factors that can
influence the increase in weight of toddlers, including child psychology,
mother's knowledge about nutrition, health status, as well as personal factors
and preferences. Socioeconomic status and food culture have a big responsibility
for the health status of children under five. In particular, this research
proves that giving massage to toddlers can help optimize toddler growth by
increasing the toddler's weight (Kamariah & Damayanti, 2023).
This research is supported by research
conducted by Laska et al (2022) which states that there is an effect of giving
massage on weight gain in stunted toddlers. Massage for toddlers will improve
the function of the digestive system, especially in the absorption of food
essences so that body weight will increase as expected (Knowledge et al., 2022).
In line with research conducted by Freya Nazera Iskandar on premature babies, it was stated that
stimulation in the form of touch, known as kinesthetic tactile, then given 2
times a day for 3 days with a duration of 15 minutes, was effective in
increasing the weight of premature babies (Iskandar et al., 2019). As we know, massage
is a form of stimulation using the touch method. This research is also
supported by research conducted by Agrystina Ryma Melati who examined the
effect of spa on baby's weight, where in spa there are 2 components, namely
swimming and massage, stating that giving spa 2 times a week significantly
increases baby's weight (Agrystina, 2017).
Influence of Giving Lemongrass,
Kaffir Lime, and Lemon Aromatherapy Massage to Increase Height (TB) in Stunting
Toddlers Before and After Treatment
Based on the results of data analysis, the results of the pretest
measurements showed that the average height in the intervention group was 77.73
and for the posttest measurements the average was 79.55. In the control group,
the average height for the pretest was 77.05 and for the posttest it was 77.53.
The results of data analysis showed that in the intervention group there was an
increase in the average height before and after treatment and in the control
group the average height also increased before and after treatment, but not as
much as the increase in the intervention group.
The results of the test for the influence of paired
variable data using the Paired T-test statistical test on the height variable
show the P-value in the groupsThe
pretest and posttest interventions obtained a P-value of 0.000, which means
that there was a significant difference before and after the treatment was
given. In the pretest and posttest control groups, a P-value of 0.000 was
obtained, which means that there was a significant difference before and after
being given treatment.
The results of the Independent T-test on the pretest showed a P-value
of 0.000 (<0.05), which means there was a significant difference in the
increase in height between the intervention group and the control group.
Meanwhile, the P-value in the posttest data is 0.000 <0.05, which means that
there is a significant difference in the intervention group and the control
group after being given treatment.
Height is one part of a child's growth. Growth is an increase in a
person's physical size that can be observed and lasts from birth to adulthood.
To find out a child's growth, you need to measure your height every month. At
infant age, children's growth rate is very rapid, but this does not happen to
stunted children. The average length of a baby at 1 year old is 1.5 times the
length at birth, if it does not meet the standards the child is categorized as
stunting.
The impact of stunting also affects body height. To increase the
height of stunted babies, of course, therapeutic efforts such as baby massage
are needed. Baby massage will improve the function of the digestive system,
especially in the absorption of food essences so that height will increase
along with weight gain. This is in line with research by Prastiwi and
Alindawati in 2022 which stated that baby massage has an effect on increasing
weight and height, although the results are different from giving baby spa.
Effectiveness of
Giving Aromatherapy MassageLemongrass,
Kaffir Lime, and Lemon on Increased
Appetite, IGF-1, BB, and TB in Stunting Toddlers
Based on the results
of calculations assessing the effectiveness of aromatherapy massage treatment 3
times a week for 15 minutes for 8 weeks in stunted toddlers compared to
standard care for stunted toddlers in the form of giving PMT biscuits, in
increasing appetite, IGF-1 levels, body weight and height, it was found that
massage Aromatherapy is effective in increasing appetite, IGF-1 levels, body
weight and height in stunted toddlers compared to just giving PMT biscuits
alone.
The effectiveness of
aromatherapy massage in increasing appetite was found to be 4.78% more
effective than standard care of giving PMT biscuits. For IGF-1 levels the
effectiveness was 4,010%, for the weight variable the treatment effectiveness
was 65%, and for the height variable the effectiveness of aromatherapy massage
was 200% compared to standard care for stunting toddlers in the form of giving
PMT biscuits.
Stunting
is a child's growth that is disturbed, namely the child's height is
lower/shorter than his age and stunting that occurs in toddlers is an indicator
of chronic malnutrition. 27 Stunting is a serious condition when children do
not receive good nutritious food in the right amount and for a long time.The impact of stunting is closely related to appetite and growth
disorders.
One important clinical disorder that is often
experienced by children but is often ignored is appetite disorders. When the
desire to eat is less strong than before or is caused by a certain condition,
disease or other disorder, this is called decreased appetite. It is believed
that decreased appetite is the main cause of malnutrition and can affect weight
loss (Hermina &
Prihatini, 2016).
Massage is a
traditional childcare practice that has survived to this day because its
efficacy has been proven. Our ancestors were accustomed to massaging babies
when there were health problems indicated by symptoms of fussiness, flatulence
and not wanting to eat (Massage et al., 2022).
Aromatherapy is an
alternative therapy known as complementary therapy and is a legacy from ancient
times. Aroma therapyIt is claimed to be
able to improve the psychological and physical well-being of babies. Several
types of aroma therapy that can be used to increase appetite, IGF-1, BB and TB
are lemongrass, kaffir lime and lemon. This type of aromatherapy provides a
calming/sedative effect and stimulates a relaxation reaction in the body.
Aromatherapy can be given by inhaling,
compressing, applying to the skin, spraying, or mixing it with water to soak
the whole body or certain parts of the body. Massaging will make it work better (Li et al.,
2016). In the aromatherapy
massage process, aromatherapy stimulates the central nervous system through the
distribution of molecules that spread aroma, so it is useful for treatment and
relaxation.
Massage using oil can increase the baby's
weight, body length and head circumference. In conclusion, massage using oil
effectively increases the baby's physical growth (Saidah & Dewi, 2020). This is in line with this research, where a significant difference was
found in the increase in toddlers' appetite before and after being given
Lemongrass, Kaffir Lime and Lemon aromatherapy massage.
Massage will increase the mechanism of food
absorption by the vagus nerve so that the child's appetite will increase and
can directly increase the child's weight and height. Based on research by
researchers and previous research, it was found that massage therapy using
aromatherapy can have an influence on appetite, IGF-1, weight and height of
toddlers.
CONCLUSION
As
a result of the analysis and discussion that has been described, the conclusion
of this research is that there is an influence of the intervention of providing
lemongrass, kaffir lime and lemon aromatherapy massage on increasing appetite
and IGF-1 levels in stunted toddlers, so the conclusion can be described as
follows:
1.
Lemongrass,
kaffir lime and lemon aromatherapy massage had an effect on increasing appetite
in stunted toddlers compared to the control group, proven statistically and
significant with a P-value of 0.000.
2.
Lemongrass,
kaffir lime and lemon aromatherapy massage had an effect on increasing IGF-1
levels in stunted toddlers compared to the control group. This was proven
statistically and significant with a P-value of 0.000.
3.
Lemongrass,
kaffir lime and lemon aromatherapy massage showed that the P-value of appetite
in the intervention group using the Wilcoxon test showed a P-value of 0.001
< 0.05, which means that there was a significant difference in the intervention
group in terms of increasing appetite before and after it was given. treatment.
4.
Lemongrass,
kaffir lime and lemon aromatherapy massage showed that the average IGF-1 level
in the pretest intervention group was 41.54 and for posttest measurements the average
was 67.43. The test results using the Paired T-test in the intervention group
showed a P-value of 0.000, which means that there was a significant difference
in IGF-1 levels before and after treatment.
5.
Lemongrass,
kaffir lime and lemon aromatherapy massage using the Paired T-test statistical
test showed that the average body weight in the pretest intervention group was
9.65 and for the posttest measurement the average was 9.87. The test results
using the Paired T-test in the intervention group obtained a P-value of 0.000,
it can be concluded that there was a significant difference before and after
being given treatment.
6.
Lemongrass,
kaffir lime and lemon aromatherapy massage showed that the average height in
the pretest intervention group was 77.73 and for the posttest measurement the
average was 79.55. In the control group the pretest average was 77.02 and
posttest 77.53. The test results used the Paired T test, in the intervention
group and control group, a P-value of 0.000 was obtained, which means that
there was a significant difference before and after being given treatment in
the intervention group and also in the control group.
7.
Aromatherapy
massage of lemongrass, kaffir lime, and lemon through the posttest
effectiveness test (after treatment) in the intervention group with the control
seen from the mean difference, it was found that aromatherapy massage compared
to standard care for stunted toddlers, namely giving PMT biscuits, was
effective in increasing appetite, IGF-1 levels, body weight and height with
effectiveness of 4.78%, 4,010%, 65% and 200% respectively.
REFERENCES
Aditiawati, S. S.
(2019). Pertumbuhan dan Perawakan Pendek. Prosiding Ilmiah Dies Natalis
Fakultas Kedokteran Universitas Sriwijaya, 57.
Agrystina, R. M., & Kuntjoro, T. C. (2017). Effect of
Solus Per Aqua (SPA) on Iinfant Weight. Belitung Nursing Journal, 3(4),
438–443. https://doi.org/https://doi.org/10.33546/bnj.154
Almaitser, S. (2017). Gizi
Seimbang Dalam Daur Kehidupan (S. Almatsier (Ed.)). PT. Gramedia Pustaka.
Arifiyah, A., & Purwanti, A.
(2017). Hubungan antara Insulin-like Growth Factor-1 dengan Pertumbuhan dan
Perkembangan Anak Sindrom Down. Sari Pediatri,
18(5), 350–356. https://doi.org/10.14238/SP18.5.2017.350-6
Ben Hsouna, A., Ben Halima, N.,
Smaoui, S., & Hamdi, N. (2017). Citrus lemon essential oil: Chemical composition, antioxidant and
antimicrobial activities with its preservative effect against Listeria
monocytogenes inoculated in minced beef meat. Lipids in Health and Disease,
16, 1–11.
Black, R. E., Victora, C. G., Walker,
S. P., Bhutta, Z. A., Christian, P., De Onis, M., Ezzati, M.,
Grantham-Mcgregor, S., Katz, J., Martorell, R., & Uauy, R. (2013). Maternal
and child undernutrition and overweight in low-income and middle-income
countries. The Lancet, 382(9890), 427–451.
https://doi.org/10.1016/S0140-6736(13)60937-X
Budiastutik, I., & Nugraheni, S.
A. (2018). Determinants of stunting in Indonesia: A review article. International
Journal Of Healtcare Research, 1(2), 43–49.
Das, S. C., Prakash, J., Deb, A. K.,
& Biswas, T. (2009). Medicinal value of underutilized fruits in hilly
Tripura. II International Symposium on Medicinal and Nutraceutical Plants
972, 135–141.
Databooks. (2021). Prevalensi
Stunting Balita Indonesia Tertinggi ke-2 di Asia Tenggara. Layanan Konsumen
& Kesehatan.
EM Mustafa, N. (2015). Citrus
essential oils: current and prospective uses in the food industry. Recent
Patents on Food, Nutrition & Agriculture, 7(2), 115–127.
Gat-Yablonski, G., & Phillip, M.
(2015). Nutritionally-Induced Catch-Up Growth. Nutrients, 7(1),
517. https://doi.org/10.3390/NU7010517
Hermina, H., & Prihatini, S.
(2016). Gambaran konsumsi sayur dan buah penduduk Indonesia dalam konteks gizi
seimbang: analisis lanjut survei konsumsi makanan individu (SKMI) 2014. Indonesian
Bulletin of Health Research, 44(3), 205–218.
Iskandar, F. N., Suwondo, A., &
Santoso, B. (2019). Tactile-kinesthetic stimulation to gain weight and reduce
the length of stay care for premature baby at public hospitals of Semarang,
Indonesia. GHMJ (Global Health Management Journal), 3(1), 25–30.
https://doi.org/10.35898/GHMJ-31553
Israini, S. (2016). Jurnal Kebidanan.
Jurnal Kebidanan, 10(1), 103–108.
Kamariah, K., & Damayanti, D. F.
(2023). Baby Massage to Improve Baby’s Sleep Quality. Indonesian Midwifery
and Nursing Scientific Journal, 2(1), 11–18.
https://doi.org/10.56435/IMANSION.V2I1.21
Kasmiatun, S. (2017). Pengaruh Pijat
Bayi Dengan Terapi Bunga Lavender Terhadap Pemenuhan Kebutuhan Tidur Neonatus
Di Posyandu Melati Mojoroto Kediri. Jurnal Ilmu Kesehatan, 3(1),
41. https://doi.org/10.32831/jik.v3i1.44
Kementerian Kesehatan RI. (2015). Website
Direktorat Jenderal Kesehatan Masyarakat.
Kementerian Kesehatan RI. (2018a).
Buletin Jendela Data dan Informasi Kesehatan: Situasi Balita Pendek (Stunting)
di Indonesia. Kementerian Kesehatan RI, 20.
Kementerian Kesehatan RI. (2018b). Situasi Balita Pendek di
Indonesia. Buletin Jendela Data dan Informasi Kemenerian Kesehatan RI.
Pusat Data Dan Informasi - Kementerian Kesehatan Republik Indonesia.
Kementerian Kesehatan RI. (2022). Buku
Saku Hasil Studi Status Gizi Indonesia (SSGI) Tahun 2021 | Badan Kebijakan
Pembangunan Penelitian. Humas
BKPK.
Kementerian Koordinator Bidang
Pembangunan Manusia dan Kebudayaan Republik Indonesia. (2022). Kejar Target!
Per Tahun Prevalensi Stunting Harus Turun 3 Persen. Siaran Pers Nomor:
16/HUMAS PMK/I/2022.
Li, X., Zhong, Q., & Tang, L.
(2016). A Meta-Analysis of the Efficacy and Safety of Using Oil Massage to
Promote Infant Growth. Journal of Pediatric Nursing, 31(5),
e313–e322. https://doi.org/10.1016/j.pedn.2016.04.003
Maharani, Y., Suwondo, A., Hardjanti,
T. S., Hadisaputro, S., Fatmasari, D., & Mashoedi, I. D. (2017). The Impact
of Gentle Human Touch in Iincreasing Baby Weight, Body Temperature and Pulse
Stability on Preterm Baby. Belitung Nursing Journal, 3(4),
307–315. https://doi.org/10.33546/bnj.153
Malikhah, F., Widyawati, M. N.,
Sutarmi, S., Kistimbar, S., & Kusmini, T. (2019). The Effect of Loving
Touch Stimulation Therapy for Infant’s Weight Gain. Proceedings of the
International Conference on Applied Science and Health, 4, 503–508.
Md Othman, S. N. A., Hassan, M. A.,
Nahar, L., Basar, N., Jamil, S., & Sarker, S. D. (2016). Essential oils
from the Malaysian Citrus (Rutaceae) medicinal plants. Medicines, 3(2),
13.
Nirnasari, M. (2018). Efektifitas
Pijat Bayi Pada Peningkatan Berat Badan Neonatus. Jurnal Keperawatan, 8(1),
819–826.
Nirnasari, M. (2021). Efektifitas
Pijat Bayi pada Peningkatan Berat Badan Neonatus. Jurnal Keperawatan, 11(1),
7–13.
Nurhidayati, T., Rosiana, H., &
Rozikhan. (2020). Usia Ibu Saat Hamil Dan Kejadian Stunting Pada Anak Usia 1-3
Tahun. Midwifery Care Journal, 1.
Pengetahuan, G., Kader, D. S.,
Terapi, T., Dalam, P., Berat, M., Pada, B., Stunting, B., Kelurahan, D., Riau,
T., Batam, K., Laska, Y., Putri, H., & Mastikana, I. (2022). Gambaran
Pengetahuan Dan Sikap Kader Terhadap Terapi Pijat Dalam Meningkatkan Berat Badan
Pada Balita Stunting Di Kelurahan Tanjung Riau Kota Batam. MEDICAL JURNAL OF
AL-QODIRI, 7(2), 96–102.
Permenkes No. 8 Tahun 2014 tentang
Pelayanan Kesehatan SPA [JDIH BPK RI]. (n.d.).
Permenkes No. 8 Tahun 2014 tentang
Pelayanan Kesehatan SPA [JDIH BPK RI]. (2014).
https://peraturan.bpk.go.id/Home/Details/117302/permenkes-no-8-tahun-2014
Pijat, P., Terhadap, B., Berat, K.,
Bayi, B., Klinik, D., Care, Z., Desi, P. :, Amru, E., Haryati, S. D., Aziz, H.,
Kesehatan, I., & Bunda, M. (2022). Pengaruh Pijat Bayi Terhadap Kenaikan
Berat Badan Bayi di Klinik Zada Care. Healthcaring:
Jurnal Ilmiah Kesehatan, 1(1), 61–68.
https://doi.org/10.47709/HEALTHCARING.V1I1.1342
Putri, D., & Natsir, P. (2021). Analisis
Kadar Insuli-like Growth Factor-1 (IGF-1) Pada Anak Dengan Perawakan Pendek.
Universitas Hasanuddin.
Rahmah, G. Z., Kurniasari, R.,
Kesehatan, F. I., & Karawang, U. S. (2023). The Influence Of Nutrition
Education Media forms On Increasing Mother’s Knowledge To Prevent Stunting In
Children. Jurnal Gizi Kesehatan, 15(1), 131–139.
Saidah, H., & Dewi, R. K. (2020).
Differences In The Effectiveness Of Massage Tuina And Grant Aromatherapy Oil
Lemongrass (Cymbopogonnardus) In Overcoming Difficulties Eating In Children In
The Work Area Health Balowerti Kediri City. STRADA Jurnal Ilmiah Kesehatan, 9(2), 1309–1322.
https://doi.org/10.30994/sjik.v9i2.467
Sambutan, K., Desa, M., Tertinggal,
D., & Transmigrasi, D. (n.d.). Buku Saku Desa dalam Penanganan Stunting
i.
Selvita, B. D. (2020). Pengaruh
Aromaterapi Chamomile Terhadap Tingkat Kecemasan Lansia Di Desa Wonokerso.
Universitas Kusuma Husada Surakarta.
Silalahi, M. (2018). An
ethnobotanical study of traditional steam-bathing by the Batak people of North
Sumatra, Indonesia. Pacific Conservation Biology, 25(3), 266–282.
Simanungkalit, H. M. (2020). Pengaruh
Pijat Terhadap Tingkat Kesulitan Makan Balita Usia 1 Tahun. Media Informasi, 15(2), 96–100.
https://doi.org/10.37160/bmi.v15i2.360
Sinaga, D., Yantri, E., &
Yusrawati, Y. (2018). Kadar
insulin-like growth factor-1, ghrelin ASI, dan peningkatan berat badan bayi
pada ibu menyusui obesitas dan normal. Jurnal Gizi Klinik Indonesia, 15(1).
https://doi.org/10.22146/IJCN.34939
Siti, H. N., Mohamed, S., &
Kamisah, Y. (2022). Potential therapeutic effects of Citrus hystrix DC and its
bioactive compounds on metabolic disorders. Pharmaceuticals, 15(2), 167.
Sudarmi, Sukrama, I. D. M.,
Sutirtayasa, I. W. P., Weta, I. W., & Irianto. (2020). Influence of baby massage stimulation on the
improvement of nutritional status, IGF-1, and cortisol level on undernourished
infant. Bali Medical Journal, 9(1), 36–40.
https://doi.org/10.15562/bmj.v9i1.1688
Suharta, & Anggrianti, D. M.
(2021). Pijat Bayi Sebagai Alternatif Intervensi Untuk Meningkatkan berat Bdan.
Medical Journal of Al-Qodiri Jurnal Keperawatan Dan Kebidanan, 6(1),
17–25.
Uce, L. (2018). Pengaruh Asupan
Makanan Terhadap Kualitas Pertumbuhan dan Perkembangan Anak Usia Dini. Bunayya:
Jurnal Pendidikan Anak, 4(2), 79–92.
Yuyun, Y. (2021). Pengaruh Pijat Bblr
Terhadap Berat Badan Pada Bayi Dengan Bblr Di Ruang Perinatologi Rsu Provinsi
Jampang Kulon Kabupaten Sukabumi. Jurnal Health Society, 10 No. 2(2),
54–65.
Copyright holders:
Risa Yuliatri,
Melyana Nurul Widyawati,
Ari Suwondo, Walin (2023)
First publication right:
Devotion - Journal of Research and Community
Service
This
article is licensed under a Creative
Commons Attribution-ShareAlike 4.0 International