CURRICULUM VITAE

Nama

: Moehammad Al Ghazali Loebis

Tempat / tanggal lahir

: Medan/ 22 12 - 1993

Pekerjaan

: Mahasiswa

Agama

: Islam

Alamat

: Komp. Tasbih Blok B No.17 A

Nomor Telepon

: 089627537141

Orang Tua

: Prof. Dr. H. M. Nawawi Loebis M phil.Ph-D (Ayah)

Hj. Pristiwani Mei Hilda (Ibu)

Riwayat Pendidikan

: SD YP Shafiyyatul Amaliah Medan (1998 2004)

SMP YP Shafiyyatul Amaliah Medan (2004 2007)
SMA YP Shafiyyatul Amaliah Medan (2007 2010)
Fakultas Kedokteran USU (2010 sekarang)

Kegiatan

: Melakukan proposal penelitian untuk mengetahui

faktor fakor penyebab kurang gizi pada siswa - siswi
SD Juara Medan

Universitas Sumatera Utara

KUESIONER
FAKTOR YANG BERHUBUNGAN DENGAN STATUS GIZI SISWA/I SD
JUARA MEDAN

Alamat Responden :
Identitas Responden

Nama :

Umur :

Pekerjaan :

Pendapatan per bulan :

Pendidikan :
a. Tidak Sekolah/tidak tamat SD
b. Tamat SD
c. Tamat SLTP
d. Tamat SLTA
e. Tamat Akademi
f. Sarjana

Jumlah anak :

Identitas Anak

Nama :

Umur :

Jenis kelamin :

Pola Makan
1. Apakah pola makan teratur (3 kali sehari) ?
a. Ya
b. Tidak

Universitas Sumatera Utara

2. Apakah Anda memasak sendiri makanan yang dihidangkan kepada anak

Anda?
a. Ya
b. Tidak ( Sebutkan cara anda mendapatkan makanan tersebut
)

3. Apakah Anda memperhatikan kebersihan makanan yang dihidangkan

kepada anak anda?
a. Ya
b. Tidak

4. Apakah makanan yang dihidangkan mengikuti kaidah 4 Sehat 5

sempurna?
a. Ya
b. Tidak

Faktor Lingkungan
1. Sumber air minum keluarga
a. Sumur gali
b. PAM/Sumur bor
c. Air kemasan

2. Kebiasaan minum keluarga

a. Tidak di masak
b. Kadang-kandang di masak
c. Di masak sampai mendidih

3. Kondisi air minum

a.Keruh, berasa dan bebau
b. Bening, tidak berasa dan berbau
c. beninig, tidak berasa dan berbau

Universitas Sumatera Utara

4. Tipe jamban
a. Cemplung
b. Jamban leher angsa
c. Closet

5. Keadaan jamban
a. Tidak terawat sama sekali
b. Jarang dibersihkan
c. Terawat dan bersih

6. Jenis tempat pembuangan sampah

a. Tidak ada
b. Lubang tanah galian
c. Tong sampah

7. Cara pengolahan sampah

a. Tidak diolah dan dibiarkan berserakan
b. Dibakar
c. Diangkut petugas kebersihan

Universitas Sumatera Utara

polamakan1 * imt Crosstabulation

imt
Gemuk
polamakan1

Count
% of Total

Total

Total

19

112

137

3.9%

12.4%

73.2%

89.5%

13

16

.7%

1.3%

8.5%

10.5%

21

125

153

4.6%

13.7%

81.7%

100.0%

Count
% of Total

Normal

Count
% of Total

Kurus

polamakan2 * imt Crosstabulation

imt
Gemuk
polamakan2

Count
% of Total

Count
% of Total

Total

Count
% of Total

Kurus

Normal

Total

20

112

139

4.6%

13.1%

73.2%

90.8%

13

14

.0%

.7%

8.5%

9.2%

21

125

153

4.6%

13.7%

81.7%

100.0%

polamakan3 * imt Crosstabulation

imt
Gemuk
polamakan3

Count
% of Total

Total

Count
% of Total

Kurus

Normal

Total

21

125

153

4.6%

13.7%

81.7%

100.0%

21

125

153

4.6%

13.7%

81.7%

100.0%

Universitas Sumatera Utara

polamakan4 * imt Crosstabulation

imt
Gemuk
polamakan4

Count
% of Total

Total

Total

11

92

108

3.3%

7.2%

60.1%

70.6%

10

33

45

1.3%

6.5%

21.6%

29.4%

21

125

153

4.6%

13.7%

81.7%

100.0%

Count
% of Total

Normal

Count
% of Total

Kurus

lingkungan1 * imt Crosstabulation

imt
Gemuk
lingkungan1

Count
% of Total

Total

.0%

.0%

3.3%

3.3%

13

55

70

1.3%

8.5%

35.9%

45.8%

65

78

3.3%

5.2%

42.5%

51.0%

21

125

153

4.6%

13.7%

81.7%

100.0%

Count
% of Total

Total

Count
% of Total

Normal

Count
% of Total

Kurus

lingkungan2 * imt Crosstabulation

imt
Gemuk
lingkungan2

Count
% of Total

Count
% of Total

Count
% of Total

Total

Count
% of Total

Kurus

Normal

Total

31

36

.7%

2.6%

20.3%

23.5%

26

30

2.0%

.7%

17.0%

19.6%

16

68

87

2.0%

10.5%

44.4%

56.9%

21

125

153

4.6%

13.7%

81.7%

100.0%

Universitas Sumatera Utara

lingkungan3 * imt Crosstabulation

imt
Gemuk
lingkungan3

Count
% of Total

Total

Total

.0%

.0%

2.0%

2.0%

21

122

150

4.6%

13.7%

79.7%

98.0%

21

125

153

4.6%

13.7%

81.7%

100.0%

Count
% of Total

Normal

Count
% of Total

Kurus

lingkungan4 * imt Crosstabulation

imt
Gemuk
lingkungan4

Count
% of Total

Total

Total

.0%

.0%

5.9%

5.9%

21

116

144

4.6%

13.7%

75.8%

94.1%

21

125

153

4.6%

13.7%

81.7%

100.0%

Count
% of Total

Normal

Count
% of Total

Kurus

lingkungan5 * imt Crosstabulation

imt
Gemuk
lingkungan5

Count
% of Total

Count
% of Total

Total

Count
% of Total

Kurus

Normal

Total

15

16

.0%

.7%

9.8%

10.5%

20

110

137

4.6%

13.1%

71.9%

89.5%

21

125

153

4.6%

13.7%

81.7%

100.0%

Universitas Sumatera Utara

lingkungan6 * imt Crosstabulation

imt
Gemuk
lingkungan6

Count
% of Total

Total

11

.0%

1.3%

5.9%

7.2%

12

2.0%

1.3%

4.6%

7.8%

17

109

130

2.6%

11.1%

71.2%

85.0%

21

125

153

4.6%

13.7%

81.7%

100.0%

Count
% of Total

Total

Count
% of Total

Normal

Count
% of Total

Kurus

lingkungan7 * imt Crosstabulation

imt
Gemuk
lingkungan7

Count
% of Total

Count
% of Total

Count
% of Total

Total

Count
% of Total

Kurus

Normal

Total

.0%

1.3%

.0%

1.3%

41

55

3.3%

5.9%

26.8%

35.9%

10

84

96

1.3%

6.5%

54.9%

62.7%

21

125

153

4.6%

13.7%

81.7%

100.0%

pendidikan
Frequency
Valid

Percent

Valid Percent

Cumulative Percent

d3

5.2

5.2

5.2

s1

18

11.8

11.8

17.0

sd

1.3

1.3

18.3

slta

95

62.1

62.1

80.4

sltp

29

19.0

19.0

99.3

.7

.7

100.0

153

100.0

100.0

tidak se
Total

Universitas Sumatera Utara

penyakit
Frequency
Valid

Percent

Valid Percent

Cumulative Percent

1.3

1.3

1.3

.7

.7

2.0

.7

.7

2.6

149

97.4

97.4

100.0

Total

153

100.0

100.0

Pekerjaan
Cumulative
Frequency
Valid

Percent

Valid Percent

Percent

buruh tetap

25

16.3

16.3

16.3

buruh lepas

34

22.2

22.2

38.6

ibu rumah tangga

94

61.4

61.4

100.0

153

100.0

100.0

Total

imt
Frequency
Valid

Gemuk

Percent

Valid Percent

Cumulative Percent

4.6

4.6

4.6

21

13.7

13.7

18.3

Normal

125

81.7

81.7

100.0

Total

153

100.0

100.0

Kurus

Universitas Sumatera Utara

imt * pendidikan Crosstabulation

pendidikan
d3
imt

Gemuk

Count

Normal

slta

sltp

tidak se

Total

% within imt

14.3%

.0%

.0%

57.1%

28.6%

.0%

100.0%

% within pendidikan

12.5%

.0%

.0%

4.2%

6.9%

.0%

4.6%

.7%

.0%

.0%

2.6%

1.3%

.0%

4.6%

12

21

% within imt

.0%

4.8%

4.8%

57.1%

33.3%

.0%

100.0%

% within pendidikan

.0%

5.6%

50.0%

12.6%

24.1%

.0%

13.7%

% of Total

.0%

.7%

.7%

7.8%

4.6%

.0%

13.7%

17

79

20

125

5.6%

13.6%

.8%

63.2%

16.0%

.8%

100.0%

87.5%

94.4%

50.0%

83.2%

69.0%

100.0%

81.7%

4.6%

11.1%

.7%

51.6%

13.1%

.7%

81.7%

18

95

29

153

5.2%

11.8%

1.3%

62.1%

19.0%

.7%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

5.2%

11.8%

1.3%

62.1%

19.0%

.7%

100.0%

Count

Count
% within imt
% within pendidikan
% of Total

Total

sd

% of Total
Kurus

s1

Count
% within imt
% within pendidikan
% of Total

Chi-Square Tests
Asymp. Sig. (2Value
Pearson Chi-Square
Likelihood Ratio
N of Valid Cases

df

sided)

10.108a

10

.431

11.004

10

.357

153

a. 13 cells (72.2%) have expected count less than 5. The minimum expected count is
.05.

Universitas Sumatera Utara

imt * Pekerjaan Crosstabulation

Pekerjaan
buruh tetap
imt

Gemuk

Kurus

Normal

Total

Count

buruh lepas

ibu rumah tangga

Total

% within imt

.0%

42.9%

57.1%

100.0%

% within Pekerjaan

.0%

8.8%

4.3%

4.6%

% of Total

.0%

2.0%

2.6%

4.6%

13

21

% within imt

9.5%

28.6%

61.9%

100.0%

% within Pekerjaan

8.0%

17.6%

13.8%

13.7%

% of Total

1.3%

3.9%

8.5%

13.7%

23

25

77

125

% within imt

18.4%

20.0%

61.6%

100.0%

% within Pekerjaan

92.0%

73.5%

81.9%

81.7%

% of Total

15.0%

16.3%

50.3%

81.7%

25

34

94

153

16.3%

22.2%

61.4%

100.0%

100.0%

100.0%

100.0%

100.0%

16.3%

22.2%

61.4%

100.0%

Count

Count

Count
% within imt
% within Pekerjaan
% of Total

Chi-Square Tests
Asymp. Sig. (2Value
Pearson Chi-Square
Likelihood Ratio
N of Valid Cases

df

sided)

4.088a

.394

5.014

.286

153

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is
1.14.

Universitas Sumatera Utara

imt * jumlahanak Crosstabulation

jumlahanak
1
imt

Gemuk

Kurus

Count

Total

% within imt

.0%

28.6%

28.6%

28.6%

14.3%

.0%

100.0%

% within jumlahanak

.0%

4.8%

4.5%

4.2%

9.1%

.0%

4.6%

% of Total

.0%

1.3%

1.3%

1.3%

.7%

.0%

4.6%

21

4.8%

23.8%

28.6%

23.8%

19.0%

.0%

100.0%

16.7%

11.9%

13.6%

10.4%

36.4%

.0%

13.7%

.7%

3.3%

3.9%

3.3%

2.6%

.0%

13.7%

35

36

41

125

4.0%

28.0%

28.8%

32.8%

4.8%

1.6%

100.0%

83.3%

83.3%

81.8%

85.4%

54.5%

100.0%

81.7%

3.3%

22.9%

23.5%

26.8%

3.9%

1.3%

81.7%

42

44

48

11

153

3.9%

27.5%

28.8%

31.4%

7.2%

1.3%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

3.9%

27.5%

28.8%

31.4%

7.2%

1.3%

100.0%

Count

% within jumlahanak
% of Total
Count
% within imt
% within jumlahanak
% of Total
Total

% within imt

Normal

Count
% within imt
% within jumlahanak
% of Total

Chi-Square Tests
Asymp. Sig. (2Value
Pearson Chi-Square
Likelihood Ratio
N of Valid Cases

df

sided)

10

.730

6.354

10

.785

6.953

153

a. 11 cells (61.1%) have expected count less than 5. The minimum expected count is
.09.

Universitas Sumatera Utara

imt * polamakan1 Crosstabulation

polamakan1
a
imt

Gemuk

Count

Normal

Total

Total

85.7%

14.3%

100.0%

% within polamakan1

4.4%

6.3%

4.6%

% of Total

3.9%

.7%

4.6%

19

21

% within imt

90.5%

9.5%

100.0%

% within polamakan1

13.9%

12.5%

13.7%

% of Total

12.4%

1.3%

13.7%

112

13

125

% within imt

89.6%

10.4%

100.0%

% within polamakan1

81.8%

81.3%

81.7%

% of Total

73.2%

8.5%

81.7%

137

16

153

89.5%

10.5%

100.0%

100.0%

100.0%

100.0%

89.5%

10.5%

100.0%

% within imt

Kurus

Count

Count

Count
% within imt
% within polamakan1
% of Total

Chi-Square Tests
Asymp. Sig. (2Value

df

sided)

.937

Likelihood Ratio

.120

.942

N of Valid Cases

153

Pearson Chi-Square

.130

a. 2 cells (33.3%) have expected count less than 5. The minimum expected count is
.73.

Universitas Sumatera Utara