THE ROLE OF HEALTH WORKERS IN PREVENTING STUNTING IN CHILDREN

The goal of this study was to find out what health workers can do to stop children from being too short for their age in villages. The method in this study is a qualitative research method with a type of literature study. The library research steps to be carried out in this study include: a) preparing equipment; b) compiling a work bibliography; c) managing time; d) reading and making research notes. In this study, data sources were obtained from relevant literature, such as books, journals, or scientific articles related to the selected topic. The data collection technique used in this library research is to find data about things or variables in the form of notes, books, papers or articles, journals, and so on. The research instrument used by researchers is a check-list list of research material classifications based on the focus of the study, writing schemes and maps, and research note formats. The data analysis technique used in content analysis research The results of this study show that the role of health workers in preventing stunting in the village has a very strategic role, in which these roles include: a. increasing awareness and education about the importance of balanced nutrition in children and families; b. identifying children who are at risk of experiencing stunting; c. providing a growth and nutrition monitoring program; d. providing appropriate nutritional supplements; and e. providing support and counseling for pregnant and lactating women. In addition, the role of health workers is to provide counseling on health and nutrition in the community, assist UKS in schools, and optimize community health centers (PUSKESMAS) by improving administration and providing medical equipment.


INTRODUCTION
Health workers are a group of professionals in the health sector who play an important role in providing health services to the community. This group of medical workers includes doctors, nurses, midwives, nutritionists, pharmacists, radiographers, and many others with different jobs.Please note that the role of medical personnel is very important in the health system because they play a direct role in providing health services to patients. Medical personnel are responsible for ensuring that patients receive the best care according to their health needs (Koswara, 2018).
In addition, health workers also play an important role in educating the public about how to maintain health and prevent disease (Christina dkk., 2022). They also play a role in conducting research and development in the health sector to improve the quality of health services. During the COVID-19 pandemic, the role of health workers is increasingly in the spotlight. Because they are at the forefront of treating COVID-19 patients, providing health services, and carrying out medical procedures in accordance with applicable health (Ardiansyah & Anggraeni, 2022).
In a global setting, the role of health workers in improving a country's health system is becoming more and more important.Countries need qualified and skilled health workers to give more people access to good health care that is also affordable.So, one of the most important things to do to improve the quality of the health system is to train more doctors and nurses.In this case, it is important for the government and health education institutions to make sure that the health workers who are trained have enough knowledge and skills to give the best care to the community.
Health workers have a very important role in providing health services to people in the village. The presence of medical personnel in villages can increase the accessibility and quality of health services for the community, especially for those who live in remote or difficult-to-reach areas.
The following are some of the roles of medical staff in the village: a. Providing integrated and comprehensive health services to rural communities. Medical personnel in the village are responsible for providing basic health services such as routine health checks, simple medication, immunization, health counseling, and health education. Medical personnel in the village play a role in carrying out promotional and preventive activities, such as immunization campaigns, health education, environmental health monitoring, and maternal and child health programs. c. They identify and handle disease cases found in the village. Medical personnel in the village are responsible for identifying and treating disease cases, as well as referring patients to more specialist health facilities if needed; establishing cooperation with related parties, such as government agencies, NGOs, and village communities, to improve the quality and accessibility of health services; and providing psychological and social support to patients and their families. Medical personnel in the village also act as facilitators in providing psychological and social support to patients and their families, especially in dealing with difficult situations such as death or serious illness (Prasanti & Fuady, 2018).
One of the duties of health workers in the village is to ensure that children in the village are not stunted. Stunting in children in rural areas is a serious health problem and affects their growth and developmentnted. Stunting in children in rural areas is a serious health problem and affects their growth and development. Stunting is a condition of failure to thrive in children who experience chronic malnutrition in the long term and can cause delays in physical and cognitive growth, as well as increase the risk of chronic diseases in later life. Some of the factors that cause stunting in children in villages include: a. malnutrition in pregnant women and babies; b. lack of nutritional intake during pregnancy and during the child's early growth period can cause stunting in children; c. poor sanitation and environment. Poor environmental conditions, such as inadequate sanitation, limited access to clean water, and poor waste handling, can affect children's health and cause stunting. d. Lack of accessibility and quality of health services. e. Lack of accessibility and quality of health services, such as lack of knowledge and access to health services, as well as the lack of availability of adequate health facilities, can increase the risk of stunting in children (Afifa, 2019).

METHOD
The method used in this research is a qualitative research method with a type of literature study. Research Literature studies are related to theoretical studies and several references that cannot be separated from scientific literature es and several references that cannot be separated from scientific literature (Adlini dkk., 2022). The library research steps to be carried out in this study include: a) preparing equipment; b) compiling a work bibliography; c) managing time; d) reading and making research notes. In this study, data sources were obtained from relevant literature, such as books, journals, or scientific articles related to the selected topic. The data collection technique used in this library research is to find data about things or variables in the form of notes, books, papers or articles, journals, and so on. The research instrument used by researchers is a checklist list of research material classifications based on the focus of the study, writing schemes and maps, and research note formats. Data analysis techniques are used in content analysis research (content analysis) (Nasution, 2020). In order to maintain the immutability of the review process and prevent and overcome misinformation (human misunderstandings that can occur due to a lack of knowledge of researchers or a lack of literature writers), checking is carried out between pieces of literature and re-reading the literature. This research is structured on the principles of simplicity and convenience. This principle was chosen considering the limited abilities of researchers who have not been able to conduct an in-depth and more detailed literature review. In addition, the purpose of using the principles of simplicity and convenience is to make it easier for readers to understand the core content regarding the role of health workers in preventing stunting in children.

RESULTS AND DISCUSSION
Medical workers play a big part in making sure kids don't grow too short or don't get enough food.Stunting is a condition of failure to thrive in children caused by chronic malnutrition, especially protein and iron (Pratiwi & Pratiwi, 2022). Stunting can cause disturbances in physical growth and brain development, which can affect children's learning abilities, health, and productivity in the future (Ramadhan dkk., 2022).
One solution to preventing or dealing with stunting in the village is by optimizing the role of the posyandu. The role of the posyandu is to provide nutritional health counseling and education. Although this role is still not optimal in the field, This can be caused by the number of health workers in each village.
In general, stunting is due to a lack of understanding about health sciences, especially nutrition for children. For this reason, the role of health workers, one of which is counseling and nutritional health counseling, is important because the delivery of information is not comprehensive to all levels of society and is not well understood, and the educational levels of mothers with children under five are of course different. will affect the level of absorption of information. As for the posyandu side, what usually happens in the field is that posyandu cadres lack adequate knowledge and skills. The knowledge in question is knowledge about materials related to maternal and child health, nutritional health, exclusive breastfeeding, and various other health topics that will be conveyed to mothers and children at the Posyandu. As for the skills in question, they are skills such as taking anthropometric measurements, namely weighing the body, measuring length or height, and measuring the head circumference, which is good and right, and how to fill out the right health card (KMS).
The causes of stunting include a lack of protein in children. Protein has a unique function that cannot be replaced by other nutrients, namely building, maintaining cells and tissues, and promoting growth. According to Achmadi, protein has the function of forming new tissue during the growth and development period of the body and repairing, maintaining, and replacing dead or damaged tissue. Protein also plays a role in providing amino acids for digestion and body metabolism. Children belong to the growth period, so they need an increase in the amount of protein in the body. The amount of protein needed by children is greater than that needed by adults who have stopped their growth. Children who have inadequate protein consumption for a long time will inhibit their height growth even though their energy consumption is sufficient. The height of children who lack protein will grow slower than that of children who consume enough protein.
According to Prentice and Bates (Maulidah et al., 2019), protein provides amino acids that are used to build bone matrix and influence bone growth because protein has the function of modifying the secretion and action of the osteotropic hormone IGF1. Therefore, protein can modulate the genetic potential for achieving peak bone mass. According to Fanzo, food sources of animal protein have complete essential amino acids to meet the body's protein needs. If the amino acids in the body are obtained from incomplete food consumption, it can result in growth disorders.
The next cause of stunting is zinc deficiency. A child who has sufficient levels of zinc consumption can reduce the risk of stunting. There is a significant relationship between zinc consumption and the incidence of stunting in children. According to Salgueiro, zinc has an important role in growth. Zinc has a role in more than 300 enzymes, both as part of their structure and in their catalytic and regulatory action. Zinc is a structural ion in biological membranes and is involved in protein synthesis. Zinc also interacts with important hormones involved in bone growth, such as somatomedin-C, osteocalcin, thyroid hormone, testosterone, and insulin. Zinc has an important role in bone metabolism, so it has a positive role in growth. Zinc has an important role in strengthening the bone matrix and facilitating the effects of vitamin D on bone metabolism, which is carried out through simulating DNA synthesis in bone cells. Backeljauw stated that zinc can increase the plasma concentration of insulinlike growth factor 1 (IGF 1), which can trigger growth. Insulin-like growth factor 1 acts as a growth hormone mediator that functions as a growth-promoting factor in the growth process. The concentration of IGF-1 in circulation is low, so growth hormone will be low, and conversely, if the concentration of IGF-1 is high, growth hormone will be high. Low consumption of zinc in toddlers can reduce the concentration of IGF-1, which will affect growth hormone, so that low zinc consumption can inhibit the growth of toddlers (Ernawati, 2020). When compared to children who don't get enough calcium, children who do get enough calcium are less likely to be short for their age.Low calcium consumption can affect linear growth if the calcium content in the bones is less than 50% of the normal content. According to Khairy et al., the demands on mineralization during the growth period are very high. Low consumption of calcium can lead to hypocalcemia, which can lead to low mineralization of the matrix of new bone deposits and osteoblast dysfunction. Therefore, a deficiency in calcium consumption in children who are experiencing growth can cause disturbances in the formation of bone mass. Bones will experience continuous formation and strengthening during growth. The process of calcium metabolism involves various types of hormones, including calcitriol, calcitonin, and PTH. This hormone has the function of maintaining calcium balance. If the amount of calcium absorbed is less than the requirement, the hormone will take up calcium reserves in the bones. If calcium consumption is continuously lacking for a long period of time, it will result in the bone formation process not being optimal (Prasanti & Fuady, 2018).
Chronic disease is also a cause of stunting in children. So it can be stated that children who do not have a history of chronic infectious diseases have a reduced risk of stunting compared to children who do have a history of chronic infectious diseases. According to Stephen, the presence of chronic infectious diseases in children can lead to malnutrition. The presence of infection will cause decreased food consumption, impaired absorption of nutrients, direct loss of micronutrients, increased metabolism and increased catabolism, and even impaired transportation of nutrients to body tissues. Chronic infections in children can cause malnutrition. This can be caused by the transfer of energy functions so that the energy needed for growth is diverted to the body's resistance to infection. Pathogenic bacteria that cause chronic infectious diseases can cause inflammation of the intestinal mucosa. This results in a failure of the barrier function that allows translocation of pathogens, resulting in a systemic inflammatory response that inhibits bone growth hormone. In addition, malabsorption of nutrients will exacerbate malnutrition and contribute to the inhibition of growth hormone, which can inhibit bone growth.
Therefore, the importance of health workers in the village to reduce stunting has a very strategic role; the following are some of the roles of medical staff in preventing stunting: a. Increase awareness and education about the importance of balanced nutrition in children and families. Medical personnel can provide information about the importance of adequate nutritional intake for children as well as how to prepare a healthy and balanced diet. b. Identify children who are at risk of experiencing stunting. Medical personnel can carry out periodic health checks on children to identify those who are at risk of experiencing stunting. For example, children who are underweight or not growing normally can be identified for more care and attention. c. Provide growth and nutrition monitoring programs. Medical personnel can provide growth and nutrition monitoring programs for children by carrying out regular check-ups to ensure that children are getting adequate nutrition and growing normally; d. provide appropriate nutritional supplements. Medical personnel can provide appropriate nutritional supplements to children who need them, such as additional vitamins or minerals or complementary foods (MP-ASI) that are rich in nutrients. e. Provide support and counseling for pregnant and lactating women. Medical personnel can provide support and counseling to pregnant and breastfeeding women to help them meet the nutritional needs of themselves and their babies, as well as provide information on healthy feeding practices.
Besides that, the role of health workers in efforts to prevent stunting in villages is to optimize the Puskesmas. Puskesmas is the technical implementation unit of the District/City Health Service, which is responsible for implementing health development in one or part of the subdistrict area. Puskesmas plays a role in providing quality public services to the community by making various efforts to fulfill all expectations, desires, and needs, and is able to provide satisfaction for the community. Puskesmas, as the first strata of health service efforts, include individual health services and community health services. As for the mandatory health efforts of the Community Health Center, namely efforts to check and provide basic treatment to patients, Based on the results of the study, it was found that the role of medical personnel at the auxiliary health center in examining and treating patients at the Linggang Amer auxiliary health center was quite good, namely based on the standard operating procedures (SOP) that apply at the health center by prioritizing the flow of services that provide convenience and certainty for the stages of service to the community. According to the Indonesian Ministry of Health (2007), the examination and treatment of patients at the Puskesmas are based on the flow of service. Service flow, namely the ease and certainty of the stages of service provided to the community, The service flows that must exist are the health center service flow, delivery room  (2007), standard operating procedures (SOP) are a standardized set of instructions to complete a certain routine work process by providing the correct and best steps based on shared consensus to carry out various activities and service functions to help reduce errors and substandard service. The quality of health services refers to their level of perfection, which on the one hand can lead to satisfaction for each patient in accordance with the level of satisfaction of the average population, and on the other hand, the procedures for administering them are in accordance with the code of ethics and professional service standards that have been established.
Another effort to prevent stunting is by fostering the health of school-age children, which is a strategic step in preparing quality human resources for the future. This effort can be carried out through the School Health Business (UKS) program. The main activities of the UKS program, known as the UKS Trias, include health services in schools, counseling or health education in schools, and fostering a healthy school environment. UKS activities must be carried out at all levels of education, starting from kindergarten, elementary school, junior high school, and general and vocational high schools. The activities carried out include coaching the procurement of UKS, which refers to the UKS Trias guidelines, conducting health checks in the form of eye and ear examinations, measuring students' height and weight, which is carried out twice a year, implementing measles immunization in grade 1 and grade 2 students in the context of School Children Immunization Month (BIAS), and a mass toothbrush program. According to Soenarjo, school health efforts are community health efforts carried out in schools, targeting schoolchildren and their environment. Efforts to foster and develop healthy living habits are carried out in an integrated manner, both through educational programs in schools through physical, sports, and health education subjects that can be carried out in curricular activities (intra-curricular and extracurricular) as well as through efforts made in the context of coaching and maintaining public health (Nurhayati, 2016). Environmental health coaching in schools is an activity that is encouraged by UKS teachers under the supervision of Puskesmas staff and aims to increase awareness, opportunity, willingness, and ability of students to improve their health status for the better through UKS programs. One of the important factors in coaching is the participation of UKS teachers. The ability of UKS teachers is influenced by the planning, training, and supervision that are set in place to achieve the UKS target of fostering environmental health in schools. It is hoped that increased behavior will be able to influence community development activities in elementary schools.
Besides that, health workers need to provide counseling to the community. Counseling is a process of changing behavior among the community so that they know, want, and are able to make changes in order to achieve increased production, income, or profits, and improve their welfare. Health counseling is an educational activity that is carried out by spreading messages and instilling beliefs so that people are not only aware, know, and understand but are also willing and able to carry out recommendations related to their health. Health education or health counseling are all activities to provide or improve the knowledge, attitudes, and practices of the community in maintaining and improving their own health. Health education is a combination of various activities and opportunities based on learning principles to achieve a situation where individuals, families, groups, or society as a whole wants to live healthily, knows how to do it, does what can be done, individually or in groups, and asks for help. Public health education, also known as health promotion, is an effort to empower individuals, groups, and communities to maintain, improve, and protect health through increasing knowledge, willingness, and ability, and developing a supportive climate that is carried out by and for the community according to sociocultural and local conditions. Counseling is also carried out if there are cases of KLB (extraordinary events) in the area. According to the Ministry of Health of the Republic of Indonesia (2004), health counseling is the addition of one's knowledge and abilities through learning practice techniques or instructions with the aim of changing or influencing human behavior individually, in groups, and in society so that they can be more independent in achieving healthy living goals. Effendy also stated that health education is a combination of various activities and opportunities based on the principles of learning to achieve a situation where individuals, families, groups, or society as a whole want to live healthy, know how, and do what can be done, individually or in groups, by asking for help (Nurhayati, 2016). CONCLUSION Based on the results of the research and discussion above, it can be concluded that the role of health workers in preventing stunting in the village has a very strategic role, in which these roles include: a. increasing awareness and education about the importance of balanced nutrition in children and families; b. identifying