Health Promotion Model for Improvement of the Nutritional Status of Children Under Five Years

Objective: Nutrition problems in Indonesia are multidimensional problems that are influenced by several factors including economic, education, social culture, agriculture, and health. Nutrition problems reflect economic, political, and social crises as the root causes of malnutrition. This study formulates a health promotion model to improve the nutritional status of children under five years old. Method: This type of research is quantitative with survey design and cross-sectional approach. Result: This study produced a risk of children under five yearsexperiencing poor nutritional status with a history of illness.The risk of children under five yearsexperiencing undernourished nutritional status with strong health workers-cadre-family partnerships and strong family support. The risk of children under five years experiencing wasting nutritional status increases with a history of diarrheal disease. The risk of children under five yearsexperiencing wasting nutritional status decreases with strong health workers-cadre-family partnerships and strong family support. The risk of a child under five yearsexperiencing a stunting nutritional status increases with a history of diarrheal disease. The risk of children under five years old experiencing stunting nutritional status decreases with strong health workers-cadre-family partnerships and strong family support. Conclusion: Nutritional status of children under five years (malnutrition, wasting and stunting) is affected directly and indirectly through the variables of family income, mother's knowledge, attitudes towards nutrition problems, environmental sanitation, social capital, health workers-cadre-family partnerships, family support, history of diarrhea disease and mother'seducation.


Introduction
Public health problems as general in developing countries including in Indonesia are micronutrient deficiencies, especially for infants and children in the first two years of life (Eichler, Wieser, Ruthemann et al., 2012). Nutrition issues which are the main concern of the world today are stunting in children under five years old.
Health Research and Development Agency of the Ministry of Health Republic Indonesia (2013) reported a prevalence of stunting at children under five years old of 37.4% meaning that 3 -4 out of 10 children under five years old in Indonesia experience short posture. Age of the first 1,000 days of life inchildren under five years old with stunting is not caused by heredity but generally by malnutrition and/or experience pain in a relatively long time. In stunting children under five years old can occur low endurance, low intelligence, and low productivity as adults. To cope with stunting in children under five years old need to be improved nutrition from the fetus in the womb, exclusive breastfeeding until the age of 6 months, and the provision of appropriate complementary food from the age of 6 months.
According to Achadi's study (2012), children who are under five years' experience a short body or stunting having lower cognitive levels, poor learning, and psychosocial achievement. Indonesia is among 17 countries out of 117 countries reviewed by the Word Nutrition Report experiencing stunting, wasting, and overweight in children under five years. The Ministry of Health (2014) and the Food Security Council (2015) report that the percentage of malnutrition problems in children under five years short (stunting 37.2%), thin (12% wasting), and overweight (11.9% overweight).
The nutritional problem is faced by all groups of people, both low economic groups and those who have a higher economic capacity. Nutritional problems are disturbances to individuals or the community caused by the unmet need for nutrients obtained from food. The problem of macro nutrition, especially the problem of lack of protein-energy, is a problem that dominates the world's attention. At the age of 15 months, nearly one-third of children in developing countries who are malnourished, namely children under five years old with stunting, children under five years thin (wasting), and malnutrition. Obstacles to growth in the womb in the first five years of life. Morbidity from nutrition in the first five years of life affects 200 million children and includes impaired cognitive function and physical capacity. One of the nutritional problems that occur in Indonesia is children under five years with stunting (S. E. Whaley, Koleilat, M. Whaley et al., 2012).
The impact of stunting in children under five years is not only felt by parents and individuals who experience it but also affects the economy and nation's development, this is because the resources of children under five years old have lower quality than human resources normal (Oktarina & Sudiarti, 2013).
Nutrition problems reflect economic, political, and social crises as the root causes of malnutrition. While the direct cause of malnutrition is the imbalance between food intake related to infectious diseases. Lack of food intake makes the immune system is very weak, makes it easy to be infected by infectious diseases due to tropical climate, poor environmental sanitation, so that it becomes malnourished (UNICEF, 1998).

Research Methods
This type of research is quantitative with survey design andcross-sectional approach.The main purposeof this study is to formulate a health promotion model for improvement of the nutritional status of children under five years. This research was conducted at the Public Health Centre in the Municipality of Yogyakarta, Yogyakarta Special Province, Indonesia, in December 2018 -February2019.
The target population in this study were children under five years (12-60 months) who were in eight Public Health Center in Yogyakarta Municipality area with 8,902 children under five years old (Yogyakarta City Health Office, 2016). The source population in this study is mothers who have children under five years (12-60 months) who are in eight Public Health Centre in the Municipality ofYogyakarta.
The number of samples in this study was calculated using cluster sampling technique by determining the total population of children under five years (12-60 months) in Public Health Centre in the Municipality of Yogyakarta, the determination of the population is based on geographical area and data from high nutritional status figures in eight Public Health Centre in Yogyakarta Municipality in 2016. The sample was 383 children under five years old living in the working area of Public Health Centre in Yogyakarta Municipality.
The variables of this study are endogenous: family income (Y 1 ), mother's knowledge (Y 2 ), attitudes towards nutrition issues (Y 3 ), environmental sanitation (Y 4 ), family support (Y 5 ), diarrheal disease (Y 6 ) health workerscadre-family partnerships (Y 7 ) nutritional status of children under five years old (malnutrition, wasting, stunting) (Y 8 ) and exogenous variables: mother's education (X 1 ) and social capital (X 2 ). Data Analysis in this study uses path analysis in Stata 13. Path analysis is an applied form of multi-regression analysis. Path analysis uses path diagrams to help conceptualize problems or test complex hypotheses. For prediction or forecasting and estimating the value of endogenous variables based on the values of exogenous variables, the right relationship pattern is with the structural model. Direct and indirect effects can be reflected in the path coefficients which have been standardized are the regressioncoefficients.
The hypotheses in this study are: There is a direct influence on the history of diarrhea disease,health workers-cadre-family partnerships, family support for the nutritional status of children under five years old (malnutrition, wasting,and stunting). There is an indirect effect of family support through a history of diarrhea disease and environmental sanitation on the nutritional status of children under five years old (malnutrition, wasting, and stunting).
There is an indirect effect of environmental sanitation through a history of diarrhea diseases on the nutritional status of children under five years old (malnutrition, wasting, and stunting). There is an indirect effect of the health workers-cadre-family partnerships through environmental sanitation, a history of diarrhea disease, and familysupport for the nutritional status of children under five years old (malnutrition, wasting, and stunting). There is an indirect effect of family income through family support on the nutritional status of children under five years old (malnutrition, wasting, and stunting). There is an indirect effect of mother's knowledge through family support, attitudes towards nutrition problems, and family support for the nutritional status of children under five years old (malnutrition, wasting, and stunting). There is an indirect effect of social capital through family support and health workers-cadre-family partnerships on the nutritional status of children under five years old (malnutrition, wasting, and stunting). There is an indirect effect of attitudes on nutrition through family support for the nutritional status of children under five years old (malnutrition, wasting, and stunting). There is an indirect effect of mother's education through family income, mother's knowledge, and family support for the nutritional status of children under five years old (malnutrition, wasting, andstunting). The results of the analysis related to the mother's knowledge indicators have a score range of 1-10. The questionnaire to find out the mother's knowledge consists of ten questions, with the description of the answer giving a cross (x) on one of the appropriate alternatives in the questionnaire with the correct answer was given a value of 1 and the wrong answer given a value of 0. Of the ten existing statements, which have a score the lowest is item number 2, which is "processing vegetables daily (washed-peeled-cut)". Vegetables are one source of vitamins and minerals that function to help the absorption of nutrients in the body. Vitamins B and C are water-soluble vitamins because vitamins B and C are water-soluble vitamins so these vitamins are very soluble in water. If vegetables are cut first and then washed, the water-soluble vitamins (Vitamins B and C) can easily dissolve in water, compared to vegetables that are washed before being peeled and cut. This shows the importance of processing vegetables with (washed-peeled-cut) so as not to lose and the benefits of vitamins B and C in the body. This shows the low processing of vegetables every day bythemother.

Results
Most respondents with strong social capital are 271 people (70.76%) and some respondents with weak social capital are 112 people (29.24%). The results of the analysis related to social capital indicators have a score range of 0-18. The questionnaire to find out social capital consists of nine statements, with the answer yes (2), sometimes (1) and, no (0). Of the nine statements available, the one with the lowest score is item number 2, which is "the village community generally trusts the seriousness of health workers in helping to overcome residents' health problems". This shows the low trust of citizens in health workers.
Most respondents with weak health workers-cadre-family partnerships are 212 people (55.35%) and some respondents with strong health workers-cadre-family partnerships, are 171 people (44.65%). The results of the analysis related to indicators of health workers-cadre-family partnerships have a score range of 1-40. The questionnaire to find out the health workers-cadre-family partnerships consists of eight statements, with the answer information never (1), rarely (2), sometimes (3), often (4) and, always (5). Of the eight statements available, the one with the lowest score is item 4, "Health cadres provide health assistance on training in feeding children and toddlers". This shows the low level of assistance "Health cadres in the family about providing food to children and toddlers." Most respondents based on attitudes toward negative nutrition problems are 225 people (58.75%) and some respondents with attitudes toward positive nutrition problems are 158 people (41.25%). The results of the analysis related to indicators of attitudes toward nutritional problems have a score range of 1-45. The questionnaire to determine attitudes toward nutritional problems consists of nine statements, with the answer score five (5) for answers strongly agree, score four (4) for answers agree, score three (3) for answers somewhat agree, score two (2) for answers disagree and scores one (1) for answers strongly disagree. Of the nine statements available, the one with the lowest score was item 1, "attitude toward high iron intake from breast milk". This shows the low attitude towards nutritional problems regarding the high iron intake found in breast milk.
Most respondents based on high family support are 214 people (55.87%). The results of the analysis related to family support indicators have a score range of 1-60. The questionnaire to find out family support consists of twelve statements, with the description of the answer score answers never (1), rarely (2), sometimes (3), often (4) and, always (5). Of the twelve statements available, the one with the lowest score is item 8, "What kind of Instrumental Support does the husband/family provide loans when the mother needs a loan to buy staples?" This shows the low level of family support regarding instrumental support formothers.
Most respondents based on good environmental sanitation are 315 people (82.25%) and some respondents with poor environmental sanitation are 68 people (17.75%). The analysis results related to environmental sanitation indicators have a score range of 0-7. The questionnaire to find out environmental sanitation consists of seven statements, with the answer giving a cross (x) on one of the appropriate alternatives in the questionnaire with the correct answer was given a value of 1 and the wrong answer given a value of 0. Of the seven statements that have, which have thelowest score is item number 2, which is "Mother and family defecate in the toilet". This shows the still low environmental sanitation of mothers and families defecating in addition to the toilet.
Most respondents were based on not having diarrhea are 296 people (77.28%) and some respondents with the diarrhea disease are 87 people (22.72%). The results of the analysis related to indicators of the history of the diarrheal disease have a score range of 0-10. The questionnaire to determine the history of the diarrheal disease consists of ten statements, with a description of the answer yes (2), sometimes (1) and, no (0). Of the ten statements available, the one with the lowest score is item number 1, which is "children under five years old within 1 month suffer from diarrhea". This shows that within 1 month there is still a history of diarrheal disease in children under five years old ". people (13.32%). Figure 1 shows that path analysis with the help of the STATA 13 program shows that there is an influence of nutritional status (malnutrition, wasting, stunting) and risk factors. The results of the coefficient on each variable in each path that there is a positive influence: mother's education of your knowledge is 1.20, there is a positive effect of your education on family income that is equal to 0.62, there is a positive influence of mother's knowledge of attitudes towards nutrition problems that is equal to 1.80, there is a positive influence attitudes toward nutrition problems towards family support that is equal to 0.69, there is a positive influence of social capital on partnerships that is equal to 0.74, there is a positive influence of social capitalon family support that is equal to 0.62, there is a positive influence of your knowledge of family support that is equal to 0.61, there is a positive influence of income family to family support that is equal to 1.80, there is a positive influence of health workers-cadre-family partnerships to family support that is equal to 0.52, there is a positive effect of health workers-cadre-family partnershipsto environmental sanitation that is equal to 0.65, there is a positive influence of family support on environmental sanitation that is equal to 0.75. There is a negative influence of environmental sanitation on the history of diarrheal disease that is equal to -0.72, there is a negative influence on family support of the history of diarrheal disease that is equal to -1.50, there is a positive influence between the history of diarrheal disease on nutritional status (stunting) that is equal to 0.66, there is a negative influence of health workers-cadre-family partnershipson nutritional status (stunting) that is equal to -0.67, there is a negative influence of family support on nutritional status (stunting) that is equal to -0.99. There is a positive influence of a history of diarrheal disease on nutritional status (malnutrition) in the amount of 1.20, there is a negative influence on health workers-cadre-family partnerships on nutritional status (malnutrition) in the amount of -0.95, there is a negative influence on family support towards nutritional status (nutrition less) that is equal to -0.48, there is a positive influence on the history of diarrheal disease on nutritional status (wasting) that is equal to 0.75, gjhs.ccsenet.org Global Journal of Health Science Vol. 12, No.8;2020 there is a negative influence of health workers-cadre-family partnerships on nutritional status (wasting) that is equal to -0.69, there is a negative influence on family support towards nutritional status (wasting) that is-0.86.  The The indirect effect of mother's education on family income: mother's education increases the likelihood of children under five years to get family income. Children under five years with high mother's education, have the possibility (logodd) to have family income 0.62 higher than children under five years of age who have low mother's education (b = 0.62; 95% CI = 0.17 to 1.06; p = 0.006). The indirect effect of mother's education on mother's knowledge: mother's education increases the likelihood of children under five years to have a mother's knowledge. Children under five years with high mother's education have the possibility (logodd) to have 1.20 knowledge higher than children under five years who have low mother's education (b = 1.20; 95% CI = 0.66 to 1.64; p <0.001).

a. The direct influence of diarrhea history on the nutritional status of children under five years (malnutrition, wasting andstunting)
The path analysis results show that there is a positive influence on the history of diarrhea on the nutritional status of children under five years (malnutrition, wasting, and stunting) with a positive correlation coefficient. Children under five years who have underweight nutritional status have a 38% higher risk of experiencing diarrheathan children under five who have normal/good nutritional status, the nutritional status shows a low effect on the incidence of diarrhea with OR 1.38, P = 0.427 (Oketcho, Cornelio, Nyaruhucha et al., 2012).

b.
The direct influence of family support on nutritional status of children under five years (malnutrition, wasting, and stunting).
The path analysis results show that there is a positive influence of family support on the nutritional status of children under five years old (malnutrition, wasting, and stunting) with a negative coefficient value. Social support networks include a combination of actions that are primarily aimed at maintaining the physical and psychological health of individuals. Actions in social support can be in the form of emotional, material, collaborative, and information support. Social support can be carried out by family, friends, neighbors, or others. When pregnancy is in a teenager, family support becomes more important because adolescents have a high risk of pregnancy weight gain and low birth weight. Family support has a positive influence on pregnancy in adolescencewhen family support is given by female families such as mothers or sisters. (Samano, Rojano, Barba et al., 2019).

c.
The direct influence of the health workers-cadre-family partnershipon the nutritional status of children under five years (malnutrition, wasting, and stunting).
The results of the path analysis show that there is a positive influence of health workers-cadre-family partnership on the nutritional status of children under five years old (malnutrition, wasting, and stunting) with a negative coefficient value. Human relations are very meaningful in social life. Human relations form a social group and close collaboration between individuals and families. Partnerships facilitate knowledge transfer. Knowledge transfer is built on a comprehensive understanding and is developed through trust, commitment, interdependence, togetherness, and balanced power (He, Gallear, Ghonadian et al., 2011).

d.
The indirect effect of family support through diarrheal history variables on the nutritional status of children under five years (malnutrition, wasting, andstunting).
The path analysis results show that there is a positive influence of family support through diarrheal history variables on the nutritional status of children under five years (malnutrition, wasting, and stunting) with negative coefficient values. Mothers who have strong family support are 55.87% and Mothers who have weak family support are those who have children under five years of age with nutritional status (malnutrition, wasting, and stunting) as many as 38, 66%. Potter (2009) states that family support is a form of providing support to family members who experience problems. Form of family support by providing maintenance support, emotional to achieve the welfare of family members, especially a mother.

e. The indirect effect of environmental sanitation through diarrheal disease history variables on the nutritional status of children under five years (malnutrition, wasting, andstunting).
The path analysis results show that there is a positive influence of environmental sanitation through a diarrheal history variable on the nutritional status of children under five years (malnutrition, wasting, and stunting) with a negative coefficient value. The incidence of diarrhea is often associated with diet and the environment. Healthy environmental sanitation will reduce the incidence of diarrhea in children under five years. The cause of diarrhea in children under five years is the healthy living habits of each family member. Healthy living habits include breastfeeding, complementary feeding, use of sufficiently clean water, use of hand washing, using latrines and properly disposing of baby's stool. Diarrhea and malnutrition are the main causes of morbidity and mortality in children under five years in areas with poor access to clean water, lack of improved sanitation, and low socioeconomic status (Araya, Tsehaye, & Mekonen, 2018).

f.
The indirect effect of family support through environmental sanitation variables on the nutritional status of children under five years (malnutrition, wasting, andstunting).
The path analysis results show that there is a positive influence of family support through family environment sanitation variables on the nutritional status of children under five years (malnutrition, wasting, and stunting) with a positive coefficient. Mothers who have strong family support are expected to have good environmental sanitation. Family support is one form of social support, where the existence of family support will create a level of success in good environmental sanitation and nutritional health status of children under five years to be good.

g. The indirect effect of the health workers-cadre-family partnershipthrough environmental sanitation variables and the history of diarrheal disease on the nutritional status of children under five years (malnutrition, wasting, and stunting).
The results of the path analysis show that there is an effect of the health workers-cadre-family partnershipthrough environmental sanitation variables and diarrheal disease history of the nutritional status of children under five years (malnutrition, wasting, and stunting) with positive coefficient values. Health with the family, in this case, is the mother will have a positive impact on the health workers-cadre-family partnership.The existence of a psychologist in the structure of the first-level health service (Puskesmas) is felt to be very important to achieve the health condition of the community perfectly. One ofpart can work together with the psychologist Puskesmas is a Posyandu's cadre because Posyandu's cadres come from the same area as the fostered area and interact daily with the community environment (Sari, 2016).

h.
The indirect effect of the cadre-health-family partnership through family support variables on the nutritional status of children under five years (malnutrition, wasting, and stunting).
The results of the path analysis show that there is a positive influence on health workers-cadre-family partnershipthrough family support variables on the nutritional status of children under five years old (malnutrition, wasting, and stunting) with a positive coefficient. Cadres play the role of actors in a health system. Cadres provide various services at Posyandu. The services provided by the cadres include the height and weight measurements of children under five years old, filling cards for health (KMS), providing counseling/dissemination of health information, mobilizing mothers who have children under five years to attend and participate in activities Integrated Healthcare Center. The partnership between health workers and cadres and family is very important in Posyandu activities. Cadres must be fostered and enhanced their knowledge and skills through the guidance of health workers in this case the Puskesmas as a Trustee (Nilasari & Farich, 2012).
i. The indirect effect of family income through family support variables on the nutritional status of children under five years (malnutrition, wasting, and stunting).
The path analysis results show that there is a positive influence on family income through the variable of family support on the nutritional status of children under five years (malnutrition, wasting, and stunting) with a positivecoefficient. The results of the study with the variable family income obtained results of family income with a high income of 51.44%, UMK income in Yogyakarta amounting to Rp 1,700,000. Increased family income in the household will be followed by improvements in food quality for family members. Low income affects the amount of food consumed by families and increases the likelihood of contracting infectious diseases so that the nutritional status of children under five years is low. If the income is low, the food consumed does not consider nutritional value, but the value of the material is more considered (Kusumaningrum, 2003).

j.
The indirect effect of mother's knowledge through family support variables on the nutritional status of children under five years (malnutrition, wasting, andstunting).
The path analysis results show that there is a positive influence of mother's knowledge through family support variables on the nutritional status of children under five years (malnutrition, wasting, and stunting) with a positive coefficient. Family support is important in the realization of high knowledge and positive attitudes. Family support views that someone supportive is always ready to provide help and assistance if needed. Help will be provided by the extended family and extended family as a support system for family members. Family support is given in the form of emotional, instrumental, informative, and appreciation support (Friedman, 2003).

k.
The indirect effect of social capital through family support variables on the nutritional status of children under five years (malnutrition, wasting, and stunting).
The path analysis results show that there is a positive influence of social capital through family support variables on the nutritional status of children under five years (malnutrition, wasting, and stunting) with a positive coefficient. Social capital is one important factor that determines the economic growth of society, without the existence of harmony and synergy that will increasingly complicate the economic development of a society. To build social capital the role of groups in society is very important starting from the core group, namely the family to the community in general (Ancok, 2003).

l.
The indirect effect of attitudes on nutritional problems through family support variables on the nutritional status of children under five years (malnutrition, wasting, andstunting).
The results of the path analysis show that there is a positive influence of attitudes on nutritional problems through family support variables of the nutritional status of children under five years (malnutrition, wasting, and stunting) with a positive coefficient. A mother's attitude toward positive nutrition is a factor that influences the nutritional status of children under five years. The attitude becomes a willingness which is intended to react positively or negatively to certain objects (Sarnoff, 2007).

m.
The indirect effect of mother's knowledge through attitude variables towards nutritional problems on the nutritional status of children under five (malnutrition, wasting, andstunting).
The path analysis results show that there is a positive influence of mother's knowledge through the attitude variable towards nutritional problems on the nutritional status of children under five years (malnutrition, wasting, and stunting) with a positive coefficient value. Mothers who have attitudes towards negative nutrition problems with poor nutritional status are 48%, while Mothers who have attitudes towards positive nutrition problems with good/normal nutritional status are 86.71%. Education is a factor that influences a mother's nutritional knowledge. The more the education level a mother has, the higher one's ability to capture information can increase her knowledge (Khomsan, 2000).

n.
The indirect effect of social capital through the health workers-cadre-family partnership variable on the nutritional status of children under five years (malnutrition, wasting, andstunting).
The path analysis results show that there is a positive influence of social capital through the health workers-cadre-family partnership variable on the nutritional status of children under five years (malnutrition, wasting, and stunting) with a positive coefficient. The concept of social capital arises from the thinking that members of the community cannot individually overcome the various problems encountered. Good togetherness and cooperation from all members of the community are needed to overcome the existing problems. The basic principle of social capital which emphasizes the importance of maintaining good relations and trust between fellow citizens and with the aid providers. In this case the aid provider through a cadre of health-family-health workers (Syahra, 2003).

o.
The indirect effect of mother's education through family income variables on the nutritional status of children under five years (malnutrition, wasting, and stunting).
The path analysis results show that there is a positive influence of mother's education through family income variables on the nutritional status of children under five years (malnutrition, wasting, and stunting) with a positive coefficient. The results of this study indicate that the mother's high education (Senior High School/ Vocational High School) is 30.29%. The education of a mother has an important role to educate children in the family. Education isobtained using formal education but allows a mother to get an informal education. Higher education obtained by a mother makes a child shape his character and personality for the better. Research results on the study of the relationship of education level and family income towards attitudes in household waste management (case study in the village of Condongcatur, Depok, Sleman, Yogyakarta, there is a high-income family has high attitude participation towards waste management that is equal to 64.37%. Low income has participation low attitudes towards waste management that are equal to 90.91% Higher education and high family income have a positive effect on family attitudes towards waste management (Putra, Taufiq, & Juliani, 2013).

p.
The indirect effect of your education through your knowledge variables on the nutritional status of children under five years (malnutrition, wasting, and stunting).
The path analysis results show that there is a positive influence on your education through the variable of your knowledge on the nutritional status of children under five years (malnutrition, wasting, and stunting) with a positive coefficient. The results of this study showed a low mother's education <senior high school by 69.7% and high mother's education ≥ senior high school by 30.29%. Education and knowledge are the main things to change one's perception. Higher education and good knowledge of a mother can increase her knowledge about nutrition in children under five years. Nigeria in the population has limited access to formal education with a stunting prevalence in children under five years with a low education of 45% with a wasting prevalence in children under five years with a low education of 18%. Mother's knowledge with low education on the prevalence of stunting in children under five yearsis 46% and mother's knowledge with low education on the prevalence of wasting in children under five years is 28%. A high level of education in mothers has a positive and significant relationship to the HAZ and WHZ index in children. Anthropometric measurements in the form of percentiles and Z-scores (standard deviations). Recommendations from the results of this study are to obtain good knowledge in a mother with low education, the State of Nigeria established a health promotion program with health education through counseling (communication) for adult women. It is hoped that with this counseling adult women in Nigeria will gain knowledge and practice on nutrition, to change behavior, and reach poor women and low education in Nigeria to obtain optimal nutritional status results in children (Fadare, Amare, Mavrotas et al., 2019).

Conclusion
The risk of children under five years old experiencing malnourished nutritional status increases with a history of diarrhea. The risk of children under five years experiencing malnourished nutritional status decreases with strong health workers-cadre-family partnership and strong family support. The risk of children under five years experiencing wasting nutritional status increases with a history of diarrhea. The risk of children under five years experiencing wasting nutritional status decreases with strong cadre-health-family partnerships and strong family support. The risk of a child under five experiencing a stunting nutritional status increases with a history of diarrheal disease. The risk of children under the age of five experiencing stunting nutritional status decreases with strong health workers-cadre-family partnership and strong family support. The nutritional status of children under five years (malnutrition, wasting, and stunting) is affected indirectly through the variables of family income, mother's knowledge, attitudes towards nutrition problems, environmental sanitation, social capital, and mother'seducation.

Research Limitations
Limitations in this study related to the design that used, which is survey design with a cross-sectional approach, this can limit the ability to explore the causal relationship between variables. If making a comprehensive observation of the improvement of nutritional status in children under five years requires quite a long time. In this study, only questionnaires were given to the research subjects and anthropometric measurements in children under five years.