•  
  •  
 

Abstract

Stunting is a problem in Indonesia. In 2022, Kedaung Wetan and Selapajang Villages in Neglasari sub-district, Tangerang City, were identified as a priority. This study aimed to identify factors associated with stunting among children (6 – 59 months) in these villages. A matched case-control study consisting of 214 children (107 cases and 107 controls) was conducted, with individual matching based on age, sex, and prematurity at birth. Cases were children with height-for-age (H/A) measurement less than -2SD (according to WHO standard), while controls were children with H/A equal to or greater than -2SD. Conditional logistic regression was used for the multivariable analysis. No statistically significant associations were identified between the factors analyzed and the risk of stunting. However, higher maternal education was associated with higher odds of stunting compared to lower maternal education (OR 4.04, 95% CI 0.96 – 16.95), and among children with low birth weight (LBW) compared to non-LBW (OR 4.02, 95% CI 0.38 – 42.25) Nevertheless, the wide confidence intervals indicate statistical uncertainty. Conversely, lower odds of stunting were found among children not exclusively breastfed compared to those exclusively breastfed (OR 0.39, 95% CI 0.07 – 2.17) and among those with low birth length compared to normal length (OR 0.66, 95% CI 0.43 – 1.01), although none reached statistical significance. The only related variable was clean water (OR 1.06, 95% CI 0.03 – 0.75). In conclusion, several factors were explored as potential determinants, although no statistically associations. Future study procedures should be improved to minimize flaws and improve reliability.


Keywords: Birth length, Breastfeeding, Exposure to smoke, Maternal education, Stunting

References

  1. de Onis M, Branca F. Childhood stunting: a global perspective. Matern Child Nutr. 2016; 12 Suppl 1(Suppl 1):12–26. DOI: 10.1111/mcn.12231.
  2. Permenkes Stunting. Peraturan Presiden (Perpres) Nomor 72 Tahun 2021 tentang Percepatan Penurunan Stunting. 2021
  3. Soliman A, De Sanctis V, Alaaraj N, et al. Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood. Acta Bio Medica Atenei Parm. 2021; 92 (1): e2021168. DOI: 10.23750/abm.v92i1.11346.
  4. Mustakim MRD, Irwanto, Irawan R, et al. Impact of Stunting on Development of Children between 1–3 Years of Age. Ethiop J Health Sci. 2022; 32 (3): 569–78. DOI: 10.4314/ejhs.v32i3.13.
  5. Vaivada T, Akseer N, Akseer S, Somaskandan A, Stefopulos M, Bhutta ZA. Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline. Am J Clin Nutr. 2020 Sep;112(Suppl 2):777S–791S. doi:10.1093/ajcn/nqaa159. DOI: 10.1093/ajcn/nqaa159.
  6. Tadesse SE, Mekonnen TC, Dewau R, et al. Urban-rural disparity in stunting among Ethiopian children aged 6–59 months old: A multivariate decomposition analysis of 2019 Mini-EDHS. PLOS ONE. 2023; 18 (4): e0284382. DOI: 10.1371/journal.pone.0284382.
  7. Tang X, Zhao Y, Liu Q, et al. The Effect of Risk Accumulation on Childhood Stunting: A Matched Case-Control Study in China. Front Pediatr.  2022; 10: 816870. DOI: 10.3389/fped.2022.816870. Available from:
  8. Logistic Regression Analysis on the Determinants of Stunting among Children Aged 6-24 Months in Purworejo Regency, Central Java. Journal of Maternal and Child Health. 2019;
  9. AL-Rahmad AH, Miko A, Hadi A. Kajian Stunting pada Anak Balita Ditinjau Dari Pemberian ASI Ekslusif, MP-ASI, Status Imunisasi dan Karakteristik Keluarga Di Kota Banda Aceh. Poltekkes Kemenkes Aceh; 2013.
  10. Wulandari E, Fitri HN. Kajian Stunting Pada Anak Balita Ditinjau Dari Pemberian Asi Eksklusif, Mpasi Dan Status Imunisasi Di Kelurahan Alak Kota Kupang. J Matern Kebidanan. 2023; 8 (2): 103–12. DOI: 10.34012/jumkep.v8i2.4247.
  11. Soesanti F, Uiterwaal CSPM, Grobbee DE, et al. Antenatal exposure to secondhand smoke of non-smoking mothers and growth rate of their infants. PloS One. 2019; 14 (6): e0218577. DOI: 10.1371/journal.pone.0218577.
  12. Beal T, Tumilowicz A, Sutrisna A, et al. A review of child stunting determinants in Indonesia. Matern Child Nutr. 2018; 14 (4): e12617. DOI: 10.1111/mcn.12617.
  13. Saleh A, Syahrul S, Hadju V, et al. Role of Maternal in Preventing Stunting: a Systematic Review. Gac Sanit.  2021; 35: S576–82. DOI: 10.1016/j.gaceta.2021.10.087.
  14. Scherbaum V, Srour ML. The Role of Breastfeeding in the Prevention of Childhood Malnutrition. World Rev Nutr Diet. 2016; 115: 82–97. DOI: 10.1159/000442075.
  15. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology. 1996;49(12):1373–1379.
  16. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology. 1996;49(12):1373–1379.
  17. Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic regression. American Journal of Epidemiology. 2007;165(6):710–718.
  18. Hadi H, Fatimatasari F, Irwanti W, et al. Exclusive Breastfeeding Protects Young Children from Stunting in a Low-Income Population: A Study from Eastern Indonesia. Nutrients. 2021; 13 (12). DOI: 10.3390/nu13124264.
  19. Tello B, Rivadeneira MF, Moncayo AL, et al. Breastfeeding, feeding practices and stunting in indigenous Ecuadorians under 2 years of age. Int Breastfeed J. 2022; 17 (1): 19. DOI: 10.1186/s13006-022-00461-0.
  20. Formula I of M (US) C on the E of the A of IN to I. Comparing Infant Formulas with Human Milk. Dalam: Infant Formula: Evaluating the Safety of New Ingredients. National Academies Press (US); 2004.
  21. Mothers need more support amid decline in Indonesia’s breastfeeding rates. 2023.
  22. Nanishi K, Green J, Shibanuma A, et al. Challenging the utility of 24-hour recall of exclusive breast feeding in Japan. BMJ Glob Health. 2023; 8 (12): e013737. DOI: 10.1136/bmjgh-2023-013737.
  23. Laksono AD, Wulandari RD, Ibad M, Kusrini I. The effects of mother’s education on achieving exclusive breastfeeding in Indonesia. BMC Public Health. 2021; 21 (1): 14. DOI: 10.1186/s12889-020-10018-7.  
  24. Azizah AM, Nurmala I, Devy SR. Meta Analisis: Pengaruh Tingkat Pendidikan Ibu Terhadap Kejadian Stunting Pada Anak Balita. Amerta Nutr. 2022; 6 (4): 369–75. DOI:10.20473/amnt.v7i4.2022.369-375.
  25. Le K, Nguyen M. Shedding light on maternal education and child health in developing countries. World Dev. 2020; 133: 105005. DOI: 10.1016/j.worlddev.2020.105005.
  26. Laksono AD, Wulandari RD, Amaliah N, Wisnuwardani RW. Stunting among children under two years in Indonesia: Does maternal education matter? PLOS ONE. 2022; 17 (7): e0271509. DOI: 10.1371/journal.pone.0271509.
  27. UNICEF Indonesia. Pendidikan dan Remaja.
  28. Statista. Indonesia: education completion rate by education level and gender 2023. 2024.
  29. Database Peraturan.  JDIH BPK. Permendikbud No. 9 Tahun 2018. 2018.
  30. Semba RD, de Pee S, Sun K, Sari M, Akhter N, Bloem MW. Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study. Lancet. 2008 Jan 26;371(9609):322–328. doi:10.1016/S0140-6736(08)60169-5..
  31. Halli SS, Biradar RA, Prasad JB. Low Birth Weight, the Differentiating Risk Factor for Stunting among Preschool Children in India. Int J Environ Res Public Health. 2022; 19 (7): 3751. DOI: 10.3390/ijerph19073751.
  32. Sharma D, Shastri S, Sharma P. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med Insights Pediatr. 2016; 10: 67–83. DOI: 10.4137/CMPed.S40070
  33. Santosa A, Novanda Arif E, Abdul Ghoni D. Effect of maternal and child factors on stunting: partial least squares structural equation modeling. Clin Exp Pediatr. 2022; 65 (2): 90–7. DOI: 10.3345/cep.2021.00094.
  34. World Health Organization. Low birth weight. 2024.
  35. Gusnedi G, Nindrea RD, Purnakarya I, et al. Risk factors associated with childhood stunting in Indonesia: A systematic review and meta-analysis. Asia Pac J Clin Nutr. 2023; 32 (2): 184–95.
  36. Arabzadeh H, Doosti-Irani A, Kamkari S, et al. The maternal factors associated with infant low birth weight: an umbrella review. BMC Pregnancy Childbirth. 2024; 24 (1): 316.
  37. Gage TB, Fang F, O’Neill E, Dirienzo G. Maternal education, birth weight, and infant mortality in the United States. Demography. 2013; 50 (2): 615–35. DOI: 10.1007/s13524-012-0148-2.
  38. Silvestrin S, Silva CH da, Hirakata VN, et al. Maternal education level and low birth weight: a meta-analysis. J Pediatr (Rio J). 2013; 89 (4): 339–45. DOI: 10.1016/j.jped.2013.01.003.
  39. Günther V, Alkatout I, Vollmer C, et al. Impact of nicotine and maternal BMI on fetal birth weight. BMC Pregnancy Childbirth. 2021; 21: 127.
  40. Nadhiroh SR, Djokosujono K, Utari DM. The association between secondhand smoke exposure and growth outcomes of children: A systematic literature review. 2020. DOI: 10.18332/tid/117958.
  41. Muchlis N, Yusuf RA, Rusydi AR, et al. Cigarette Smoke Exposure and Stunting Among Under-five Children in Rural and Poor Families in Indonesia. Environ Health Insights. 2023; 17: 11786302231185210. DOI:10.1177/11786302231185210.
  42. Mau G, Netter P. Die Auswirkungen des väterlichen Zigarettenkonsums auf die perinatale Sterblichkeit und die Mißbildungshäufigkeit. DMW - Dtsch Med Wochenschr. 2009; 99: 1113–8. DOI: DOI: 10.1055/s-0028-1107900.
  43. Windham, Eaton, Hopkin. Evidence for an association between environmental tobacco smoke exposure and birthweight: a meta-analysis and new data. Paediatr Perinat Epidemiol. 1999; 13 (1): 35–57. DOI: 10.1046/j.1365-3016.1999.00150.x.
  44. Krebs NF, Hambidge KM, Westcott JL, et al. Birth length is the strongest predictor of linear growth status and stunting in the first 2 years of life after a preconception maternal nutrition intervention: the children of the Women First trial. Am J Clin Nutr. 2022; 116 (1): 86–96. DOI: 10.1093/ajcn/nqac051.
  45. World Health Organization. Length/height-for-age. 2024.
  46. Lukman TNE, Anwar F, Riyadi H, et al. Birth Weightand Length Associated with Stunting among Children Under-Five in Indonesia. J Gizi Pangan. 2021; 16 (Supp.1): 99-108.

Bahasa Abstract

Stunting merupakan masalah di Indonesia. Pada tahun 2022, Desa Kedaung Wetan dan Selapajang di Kecamatan Neglasari, Kota Tangerang, diidentifikasi sebagai daerah prioritas. Studi ini bertujuan untuk mengidentifikasi faktor-faktor yang berhubungan dengan stunting pada anak (usia 6-59 bulan) di desa-desa tersebut. Studi kasus-kontrol berpasangan yang terdiri dari 214 anak (107 kasus dan 107 kontrol) dilakukan, dengan pencocokan individu berdasarkan usia, jenis kelamin, dan prematuritas saat lahir. Kasus adalah anak-anak dengan pengukuran tinggi badan menurut usia kurang dari -2SD (menurut standar WHO), sedangkan kontrol adalah anak-anak dengan sama dengan atau lebih besar dari -2SD. Regresi logistik bersyarat digunakan untuk analisis multivariabel. Tidak ditemukan hubungan yang signifikan secara statistik antara faktor-faktor yang dianalisis dengan risiko stunting. Namun, penelitian ini menemukan peningkatan kemungkinan stunting pada anak yang ibunya memiliki tingkat pendidikan yang tinggi dibandingkan dengan ibu yang memiliki pendidikan rendah (OR 4,04, 95% CI 0,96 – 16,95), dan pada anak dengan berat badan lahir rendah dibandingkan dengan yang tidak (OR 4,02, 95% CI 0,38 – 42,25). Namun, interval kepercayaan yang lebar menunjukkan ketidakpastian statistik. Sebaliknya, kemungkinan stunting yang lebih rendah ditemukan pada anak yang tidak diberi ASI eksklusif dibandingkan dengan yang diberi ASI eksklusif (OR 0,39, 95% CI 0,07 – 2,17) dan pada anak dengan panjang lahir rendah dibandingkan dengan panjang normal (OR 0,66, 95% CI 0,43 – 1,01), meskipun tidak ada yang mencapai signifikansi statistik. Satu-satunya variabel yang terkait adalah air bersih (OR 1,06, 95% CI 0,03 – 0,75). Kesimpulannya, beberapa faktor dieksplorasi sebagai penentu potensial, meskipun tidak ditemukan hubungan secara statistik. Prosedur penelitian di masa mendatang perlu ditingkatkan untuk meminimalkan kekurangan dan meningkatkan keandalan.

Kata Kunci: ASI, Panjang Badan Lahir, Paparan Asap Rokok, Pendidikan Ibu, Stunting

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.