Abstract

This study aimed to examine the risk factors of childhood undernutrition in Indonesia. Determinants of childhood stunting were examined by using the 2013 Indonesia Basic Health Research Survey dataset. A total of 76,165 children aged under 5 years were included in this study. The analysis used multivariate multilevel logistic regression to determine adjusted odds ratios (aORs). The prevalence of stunting in the sample population was 36.7%. The odds of stunting increased significantly among the under-five boys, children living in slum area, and the increase of household member (aOR = 1.11, 95 %CI: 1.06–1.15; 1.09, 95%CI: 1.04–1.15; and 1.03, 95%CI: 1.02–1.04 respectively). The odds of stunting decreased significantly among children whose parents more educated (aOR = 0.87, 95 %CI: 0.83–0.91 and 0.87, 95%CI: 0.83–0.9, respectively), who live in urban area, in a province with higher Gross Domestic Product (GDP) per capita, and in a province with higher ratio of professional health worker per 1,000 population aged 0-4 years (aOR = 0.85, 95%CI: 0.81–0.89; 0.89; 95%CI: 0.79–1.00; and 0.99; 95%CI: 0.99–1.00, respectively). The study found that stunting was resulted from a complex interaction of factors, not only at the individual level, but also at household and community levels. The study findings indicate that interventions should implement multi-level approaches to address various factors from the community to the individual level.

References

1. International Food Policy Research Institute. Global nutrition report 2016: from promise to impact: ending malnutrition by 2030. Washington, DC; 2016.

2. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013; 382(9890): 396.

3. Martins VJB, Toledo Florêncio TMM, Grillo LP, Do Carmo P. Franco M, Martins PA, Clemente APG, et al. Long-lasting effects of undernutrition. International Journal of Environmental Research and Public Health. 2011; 8 (6): 1817–46.

4. Stewart CP, Iannotti L, Dewey KG, Michaelsen KF, Onyango AW. Contextualising complementary feeding in a broader framework for stunting prevention. Maternal and Child Nutrition. 2013; (9): 27–45.

5. World Health Organization. Maternal, infant, and young child nutrition. The sixty‐fifth world health assembly WHA65.6. Geneva, Switzerland: 2012.

6. Sustainable Development Goals Knowledge Platform [homepage on the Internet]. Sustainable Development Goal 2.

7. Tim Nasional Percepatan Penanggulangan Kemiskinan. 100 Kabupaten/Kota prioritas untuk intervensi anak kerdil (Stunting). Jakarta; 2017.

8. United Nations Children's Fund. Improving child nutrition: the achievable imperative for global progress. UNICEF: New York; 2013.

9. United Nations Children's Fund. UNICEF’s approach to scaling up nutrition for mothers and their children. New York: Discussion paper. Programme Division, UNICEF; 2015.

10. Kimani-Murage EW, Muthuri SK, Oti SO, Mutua MK, van de Vijver S, Kyobutungi C. Evidence of a double burden of malnutrition in urban poor settings in Nairobi, Kenya. Nugent RA, editor. PLoS One. 2015; 10 (6): e0129943.

11. Asfaw M, Wondaferash M, Taha M, Dube L. Prevalence of undernutrition and associated factors among children aged between six to fifty nine months in Bule Hora district, South Ethiopia. BMC Public Health. 2015; 15 (1): 41.

12. Magadi MA. Household and community HIV/AIDS status and child malnutrition in Sub-Saharan Africa: evidence from the demographic and health surveys. Social Science & Medicine. 2011; 73 (3): 436–46.

13. Ntenda PAM, Chuang YC. Analysis of individual-level and community-level effects on childhood undernutrition in Malawi. Pediatrics and Neonatology. 2018; 59 (4): 380-9.

14. Handayani F, Siagian A, Aritonang EY. Mother’s education as a determinant of stunting among children of age 24 to 59 months in North Sumatera Province of Indonesia. IOSR Journal Of Humanities and Social Science. 2017; 22 (9): 58–64.

15. Kusumawati E, Rahardjo S, Sari HS. Model of stunting risk factor control among children under three years old. Kesmas: Jurnal Kesehatan Masyarakat Nasional. 2015; 9 (3): 249–56.

16. Torlesse H, Cronin AA, Sebayang SK, Nandy R. Determinants of stunting in Indonesian children: evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction. BMC Public Health. 2016; 16 (1): 1–11.

17. Gebru KF, Haileselassie WM, Tomesgen AH, Seid AO, Mulugeta BA. Determinants of stunting among under-five children in Ethiopia: a multilevel mixed-effects analysis of 2016 Ethiopian demographic and health survey data. BMC Pediatrics. 2019; 19: 176.

18. Casanovas MC, Lutter C, Mangasaryan N, Mwadime R, Hajeebhoy N, Aguilar AM et al. Multi-sectoral interventions for healthy growth. Maternal & Child Nutrition. 2013; 9: 46-57.

19. Hox JJ. Quantitative methodology series. Multilevel analysis: techniques and applications. 2nd edition. Routledge/Taylor & Francis Group; 2010.

20. Goldstein H. Multilevel statistical models. 4th edition. Wiley, London; 2010.

21. Ministry of Health and National Institute of Health Research and Development. National report on basic health research, Riskesdas, 2013. Jakarta: NIHRD; 2014.

22. Perumal M, Bassani BG, Roth DE. Use and misuse of stunting as a measure of child health. The Journal of Nutrition. 2018; 148 (3): 311- 15.

23. Akombi BJ, Agho KE, Hall JJ, Merom D, Astell-Burt T, Renzaho AMN. Stunting and severe stunting among children under-5 years in Nigeria: a multilevel analysis. BMC Pediatrics. 2017; 17 (1): 1–16.

24. Chirande L, Charwe D, Mbwana H, Victor R, Kimboka S, Issaka AI, et al. Determinants of stunting and severe stunting among under-fives in Tanzania: evidence from the 2010 cross-sectional household survey. BMC Pediatrics. 2015; 15: 165.

25. Alderman H, Headey DD. How important is parental education for child nutrition? World Development. 2017; 94: 448–64.

26. Burchi F. Child nutrition in Mozambique in 2003: The role of mother's schooling and nutrition knowledge. Economics and Human Biology. 2010; 8: 331–45.

27. Shieh SJ, Chen HL, Liu FC, Liou CC, Lin YI, Tseng HI et al. The effectiveness of structured discharge education on maternal confidence, caring knowledge and growth of premature newborns. Journal of Clinical Nursing. 2010; 19: 3307–13.

28. Rosiyati E, Pratiwi EAD, Poristinawati I, Rahmawati E, Nurbayani R, Lestari S, et al. Determinants of stunting children (0-59 months) in some countries in Southeast Asia. Journal of Community Health. 2018; 4 (3): 88-94.

29. Budge S, Parker AH, Hutchings PT, Garbutt C. Environmental enteric dysfunction and child stunting. Nutrition Reviews. 2019; 77 (4): 240– 253.

30. Biadgilign S, Shumetie A, Yesigat H. Does economic growth reduce childhood undernutrition in Ethiopia? PLoS One. 2016; 11(8).

31. Mary S. How much does economic growth contribute to child stunting reductions?. Economies. 2018; 6 (4): 55.

32. Perez F, Ba H, Dastagire SG, Altmann M. The role of community health workers in improving child health programmes in Mali. BMC International Health and Human Rights. 2009; 9: 28.

Share

COinS