EDUCATION ON THE IMPORTANCE OF THE FIRST 1000 DAYS OF LIFE IN AN EFFORT TO IMPROVE THE NUTRITIONAL STATUS OF CHILDREN IN THE WORKING AREA OF PUSKESMAS KARTINI, PEMATANG SIANTAR CITY

Community service activities carried out in the form of education on the importance of the First 1000 Days of Life in improving the health and nutritional status of children in the Working Area of the Kartini Health Center, Pematang Siantar City. The partner in this activity is the Kartini Health Center with the target being pregnant women and mothers with toddlers who come to the Posyandu in the Working Area of the Kartini Health Center in Pematang Siantar City. The choice of location for the activity was because the Kartini Health Center is one of the Health Centers in the city center of Pematang Siantar. Nutritional and health problems, especially in toddlers, can be prevented through educational activities provided through Posyandu activities. The solution in community service activities is to provide education on the First 1000 Days of Life for parents of toddlers, specifically mothers who come to visit the Posyandu. The purpose of this service activity is to increase the knowledge of parents of toddlers about the First 1000 Days of Life and changes in good nutritional behavior so that they can improve the health and nutritional status of children. The benefit of this activity is that parents, especially pregnant women and mothers of toddlers, know the importance of the First 1000 Days of Life to prevent nutritional problems in toddlers and improve children's health and nutritional status. The purpose of this service activity is to increase the knowledge of parents of toddlers about the First 1000 Days of Life and changes in good nutritional behavior so that they can improve the health and nutritional status of children. The benefit of this activity is that parents, especially pregnant women and mothers of toddlers, know the importance of the First 1000 Days of Life to prevent nutritional problems in toddlers and improve children's health and nutritional status. The purpose of this service activity is to increase the knowledge of parents of toddlers about the First 1000 Days of Life and changes in good nutritional behavior so that they can improve the health and nutritional status of children. The benefit of this activity is that parents, especially pregnant women and mothers of toddlers, know the importance of the First 1000 Days of Life to prevent nutritional problems in toddlers and improve children's health and nutritional status. The expected output of community service activities is in the form of articles published in community service journals and leaflets.


INTRODUCTION
Health problems related to nutritional status in children are still a problem in the world, especially in developing countries. Indonesia is a developing country that has a relatively high nutritional status problem. Efforts to improve nutritional status must be started as early as possible, starting from the time of fetal life. In Indonesia this effort is called the First 1000 Days of Life Movement, abbreviated as 1000 HPK. (Ministry of Health RI, 2018) The 1000 HPK period is the early period of life when you are still in the womb for up to the first 2 years of life. This early period of life is also known as the Golden Period. 1000 HPK is very important because it greatly influences the conditions for growth and development of children very rapidly, so that it will have an impact on the future. (Sudargo, 2018).
The focus of handling nutrition in the 1000 HPK is to prevent malnutrition which is a major health problem in toddlers because it can hinder the process of growth and development and contribute to child morbidity and mortality. In general, malnutrition in children is divided into stunting (underweight for age), wasting (underweight for height), and malnutrition (underweight for age). These nutritional problems will occur if the nutrients are not fulfilled in the 1000 HPK period. (Black & et al, 2013).
stuntis a chronic nutritional problem due to non-fulfillment of nutritional intake within the 1000 HPK period resulting in growth disturbances in children. A child is considered stunted if the child's height is lower or shorter (dwarf) than the standard age. The state of stunting is indicated by the z-score value for height for age (index height/age) <-2 SD based on WHO standards (Azrimaidaliza, Nursal, Rahmy, & Asri, 2019;Lamid, 2018;WHO, 2010). Wasting is an acute nutritional problem caused by a lack of nutritional intake in a short period of time. Wasting can impair the body's immunity, thereby increasing the severity, duration, and susceptibility to infectious diseases. In addition, wasting 1000 HPK can lead to impaired cognitive development and learning abilities, reduced lean body mass, short adult stature, impaired glucose metabolism, and low productivity. The state of wasting is indicated by the z-score value of body weight for height (index weight/height) < -2 SD based on WHO standards. (Azrimaidaliza, et al., 2019;Dewey, 2013;Lamid, 2018;Pem, 2015;WHO, 2010).
Malnutrition is a condition where children under five experience malnutrition or malnutrition. Malnutrition is a nutritional disorder that can be fatal to the health of toddlers. If this situation is not resolved it will have a bad impact on toddlers. Malnutrition will have an impact on obstacles to children's growth. A child is called malnourished if the z-score for weight for age (W/A) is between -3 SD to -2 SD and severe malnutrition ≤ 3SD. (Black & et al, 2013;Wahyudi, Sriyono, & Indarwati, 2015).
The results of the Basic Health Research (RISKESDAS) of the Republic of Indonesia in 2018 showed the percentage of stunting was 30.8%, the percentage of wasting was 10.2% and the percentage of malnutrition was 17.7%. (Ministry of Health RI, 2018) In West Sumatra Province in 2018 the prevalence of stunting under five was 9.58%, wasting was 2.87% and malnutrition was 3.51%. cases (6.7%), this result increased from 2018 (1.04%). The coverage of stunting toddlers (TB/U) was 4,266 cases (9.6%). The results of this screening also increased from 2018 (7.65%) and wasting (BB/TB) of 1,947 cases (4.4%) which was also far increased from 2018 (0.55%). (Pematang Siantar City Health Office, 2019) Kartini Health Center is one of the health centers in Pematang Siantar City with high incidence of stunting, wasting and malnutrition. There were 5.2% cases of stunting, 3.3% wasting and 6.5% of malnutrition. The direct factors that affect nutritional status are infectious diseases and the lack of food absorbed by the body during pregnancy until after birth. While other factors that are indirect are the lack of access to health services, lack of access to clean water and sanitation. (A. Azrimaidaliza, Nurmy, & Edison, 2012;Rahmayana, Ibrahim, & Damayanti, 2014) nutritional status by improving diet, parenting and sanitation. (Azrimaidaliza, Asri, Handesti, & Lisnayenti, 2017). The nutritional status of 1000 HPK will affect the quality of health, intellectuality and productivity of toddlers in the future. Mothers and babies need adequate and quality nutrition to ensure nutritional status and health status (motor, social and cognitive abilities). learning ability and productivity of toddlers. The results of Humaira's research (2016) showed that there was a significant relationship between nutritional status and psychomotor development of toddlers in the working area of the Kartini Health Center. (Humaira, Jurnalis, & Edison, 2016;USAID, 2014) Various nutrition education activities have been carried out in several working areas of the Puskesmas in Pematang Siantar City, but incidental activities have not been carried out routinely in collaboration with the Puskesmas in order to assist health workers or nutrition workers in preventing and overcoming nutritional problems. Furthermore, this community service activity is not only carried out directly to the work area of the Puskesmas but in the future it can be carried out continuously using social media. Therefore it is necessary to carry out routine service activities through the collaboration of health education institutions and health institutions, one of which aims to increase mother's knowledge about 1000 HPK, fulfill the nutritional needs of mothers and toddlers, and balanced nutrition and change in good nutritional behavior.
Puskesmas Kartini is a health center located in the city center of Pematang Siantar, which is close to health facilities in terms of access. From the data from the Pematang Siantar City Health Office in 2019, information was obtained that there was a trend of increasing incidence rates related to nutritional status (stunting, wasting and malnutrition) from 2018. The conditions of the COVID-19 pandemic have contributed to the possibility of increasing nutritional problems and efforts to overcome these nutritional problems . Based on this, community service activities were carried out with the topic "Education on the importance of the First 1000 Days of Life in improving the health and nutritional status of children in the Work Area of the Kartini Health Center, Pematang Siantar City".

METHODS
The leaflet media is used and it is planned to continue this activity through WhatsApp social media. Activities carried out with the following stages; 1. Pre-test activities, tests are carried out to find out the description of the knowledge and attitudes of mothers who have children under five regarding 1000 HPK. This activity was carried out by asking mothers to fill out a questionnaire containing 10 questions related to the material to be delivered. 2. Data collection on the nutritional status of children under five is known from the results of measurements carried out by health workers. Besides that, it also collects data on the contact numbers of mothers of toddlers which will later be useful in further educational activities using social media. 3. The delivery of material on 1000 HPKs in improving the health and nutritional status of children was carried out by the Head of Service as an educator assisted by a health promotion tool in the form of a leaflet containing information on the material provided.
After the material was delivered by the educator, then the respondent was given the opportunity to ask questions about the material that had been presented (question and answer). 4. Post-test activities, tested how much increase in knowledge and attitudes of respondents to the material that has been delivered. 5. Monitoring and evaluation activities are carried out after the nutrition promotion activities are carried out. This activity aims to determine changes in mother's behavior in caring for toddlers through a questionnaire. This activity was carried out by the cadres of each sub-district in the working area of the Kartini Health Center, Pematang Siantar City. 6. Educational activities are continued through WhatsApp (WA) media. This activity began with forming a special WA group for mothers who were in the working area of the Kartini Health Center and in forming a group RESULTS AND DISCUSSION Classification of hypertension patients based on gender is used to determine whether gender is a factor that influences the occurrence of hypertension in a person. Bagget (2004) states that blood pressure increases with age, but in general women have higher blood pressure than men of the same age. The results of this study as well Community service activities that will be carried out are one of the community service activities within the Faculty of Public Health (FKM) Efarina University. Community service activities are routinely carried out by teaching staff every year by raising topics according to the scientific fields of each lecturer and the problems being faced by the community. This activity involved FKM Unefa students, especially students from the Nutrition Study Program so that it not only provided the main benefits for the community in the form of efforts to overcome health problems but also became one of the learning media for students in increasing experience in communicating with the community.
According to data from the Pematang Siantar City Health Office in 2017, the Kartini Health Center is one of the health centers in Pematang Siantar City with a high percentage of stunting, wasting and malnutrition. There were 5.2% stunting cases, 3.3% wasting and 6.5% malnutrition. (Health Office of Pematang Siantar City, 2017, 2019; Health Office of West Sumatra Province, 2017) Solutions to the problems offered in an effort to improve the health and nutritional status of toddlers will provide nutritional information or education to parents, especially mothers who have toddlers through Posyandu activities about 1000 HPK, meeting the nutritional needs of mothers and toddlers, and balanced nutrition.

CLOSING Conclusion
The result of the expected solution in this activity is the implementation of educational activities regarding 1000 HPK in improving the health and nutritional status of children delivered through leaflet promotional media. Then knowledge of activity objectives is expected to increase the positive attitude and awareness of mothers in applying the information obtained in everyday life.
Educational activities regarding 1000 HPK in improving children's health and nutrition status were carried out directly, then continued through the WhatsApp group so that the intensity of communication was better between educators and activity targets. The promotional media used in this activity was a leaflet entitled "The First 1000 Days of Life".