Stunting Among Wealthy Indonesian Families: A Cross-Sectional Study of Children Under the Age of Two
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Abstract
Previous studies globally report that poverty was a determinant of stunting. However, studies also showed that stunting can be found in wealthy families. To analyze factors related to stunting among wealthy families, we examined the 2021 Indonesian National Nutritional Status Survey. This cross-sectional study included 23,957 children under the age of two years old. In addition to stature, the study analyzed eight independent variables (e.g., residence, maternal age, marital, education, employment, children's age, gender, and early initiation breastfeeding). By employing a binary logistic regression test in the last analysis, this study found that children in rural areas were 1.160 times more likely to be stunted than those in urban areas (95% CI [1.152, 1.168], p < .001). The characteristics of mothers were also found to be related to stunting, including age, marital status, education, and employment. Additionally, 12–13-month-old children were 3.033 times more likely to be stunted than < 12 months (95% CI [3.011, 3.055], p < .001). Boys were 1.320 times more likely to be stunted than girls (95% CI [1.311, 1.328], p < .001). Children with early breastfeeding initiation were 1.025 times more likely to be stunted than those without (95% CI [1.018, 1.031], p < .001). Lastly, eight significant factors related to stunting among wealthy families in Indonesia were found: residence, maternal age, marital, education, employment, children's age, gender, and early breastfeeding initiation. The government must focus on the specific targets produced in this study to accelerate reducing the prevalence of stunting in wealthy Indonesian families.
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References
• Agency for Health Research and Development. (2019). Laporan Nasional Riskesdas 2018 [Riskesdas National Report 2018]. https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/
• Ahmed, M., Zepre, K., Lentero, K., Gebremariam, T., Jemal, Z., Wondimu, A., Bedewi, J., Melis, T., & Gebremeskel, A. (2022). The relationship between maternal employment and stunting among 6–59 months old children in Gurage Zone Southern Nation Nationality People’s region, Ethiopia: A comparative cross-sectional study. Frontiers in Nutrition, 9, Article 964124. https://doi.org/10.3389/fnut.2022.964124
• Aryastami, N. K., Shankar, A., Kusumawardani, N., Besral, B., Jahari, A. B., & Achadi, E. (2017). Low birth weight was the most dominant predictor associated with stunting among children aged 12–23 months in Indonesia. BMC Nutrition, 3(1), Article 16. https://doi.org/10.1186/s40795-017-0130-x
• Ayelign, A., & Zerfu, T. (2021). Household, dietary and healthcare factors predicting childhood stunting in Ethiopia. Heliyon, 7(4), Article e06733. https://doi.org/10.1016/j.heliyon.2021.e06733
• Beal, T., Tumilowicz, A., Sutrisna, A., Izwardy, D., & Neufeld, L. M. (2018). A review of child stunting determinants in Indonesia. Maternal and Child Nutrition, 18(4), Article e12617. https://doi.org/10.1111/mcn.12617
• Budhathoki, S. S., Bhandari, A., Gurung, R., Gurung, A., & Kc, A. (2020). Stunting among under 5-year-olds in Nepal: Trends and risk factors. Maternal and Child Health Journal, 24(s1), 39–47. https://doi.org/10.1007/s10995-019-02817-1
• Budiarto, W., Wulandari, R. D., Rohmah, N., & Laksono, A. D. (2021). Ecological relationship between poverty and nutritional status of toddler in Indonesia in 2018. Indian Journal of Forensic Medicine and Toxicology, 15(4), 2863–2869. https://doi.org/10.37506/ijfmt.v15i4.17135
• Castro-Bedriñana, J., Chirinos-Peinado, D., & De La Cruz-Calderón, G. (2021). Predictive model of stunting in the Central Andean region of Peru based on socioeconomic and agri-food determinants. Public Health in Practice, 2(21), Article 100112. https://doi.org/10.1016/j.puhip.2021.100112
• Castro-Bedriñana, J., Chirinos-Peinado, D., & Ríos, E. R. (2020). Socioeconomic and productive disparity in child stunting in the central Andes of Peru, taking as a model the community of Tunanmarca, Jauja. Advances in Science, Technology and Engineering Systems, 5(3), 135–141. https://doi.org/0.25046/aj050318
• Chowdhury, T. R., Chakrabarty, S., Rakib, M., Afrin, S., Saltmarsh, S., & Winn, S. (2020). Factors associated with stunting and wasting in children under 2 years in Bangladesh. Heliyon, 6(9), Article e04849. https://doi.org/10.1016/j.heliyon.2020.e04849
• Derso, T., Tariku, A., Biks, G. A., & Wassie, M. M. (2017). Stunting, wasting and associated factors among children aged 6-24 months in Dabat health and demographic surveillance system site: A community based cross-sectional study in Ethiopia. BMC Pediatrics, 17(1), Article 96. https://doi.org/10.1186/S12887-017-0848-2
• Development Initiatives. (2021). 2021 Global Nutrition Report: The state of global nutrition. Development Initiatives Poverty Research Ltd. https://globalnutritionreport.org/documents/851/2021_Global_Nutrition_Report_aUfTRv0.pdf
• Galasso, E., & Wagstaff, A. (2016, October). The economic costs of stunting and how to reduce them. World Bank Group. https://documents1.worldbank.org/curated/en/099350307142324151/pdf/IDU0e883e26805fcd047b109a050c6013ce72703.pdf
• Gibson, R. S., Rahmannia, S., Diana, A., Leong, C., Haszard, J. J., Hampel, D., Reid, M., Erhardt, J., Suryanto, A. H., Sofiah, W. N., Fathonah, A., Shahab-Ferdows, S., Allen, L. H., & Houghton, L. A. (2020). Association of maternal diet, micronutrient status, and milk volume with milk micronutrient concentrations in Indonesian mothers at 2 and 5 months postpartum. American Journal of Clinical Nutrition, 112(4), 1039–1050. https://doi.org/10.1093/ajcn/nqaa200
• Health Development Policy Agency (BKPK). (2021, December 21). Buku Saku Hasil Survei Status Gizi Indonesia Tingkat Nasional, Provinsi, dan Kabupaten/Kota Tahun 2021 [Pocket Book of the Indonesian Nutrition Status Survey at the National, Provincial and District/City Levels in 2021]. Ministry of Health. https://www.badankebijakan.kemkes.go.id/buku-saku-hasil-studi-status-gizi-indonesia-ssgi-tahun-2021/
• Ipa, M., Yuliasih, Y., Astuti, E. P., Laksono, A. D., & Ridwan, W. (2023). Stakeholders’ role in the implementation of stunting management policies in Garut Regency. Indonesian Journal of Health Administration, 11(1), 26–35. https://doi.org/10.20473/jaki.v11i1.2023.26-35
• Januarti, L. F., & Hidayathillah, A. P. (2020). Parenting culture on the role of father in prevention of stunting in toddler. Babali Nursing Research, 1(2), 81–90. https://doi.org/https://doi.org/10.37363/bnr.2020.1211 Original
• Kartasurya, M. I., Syauqy, A., Suyatno, S., Dewantiningrum, J., Nuryanto, N., Sunarto, S., Isnawati, M., Nurcahyani, Y. D., & Wati, E. K. (2023). Determinants of length for age Z scores among children aged–months in Central Java, Indonesia: A path analysis. Frontiers in Nutrition, 10, Article 1031835. https://doi.org/10.3389/fnut.2023.1031835
• Ketema, B., Bosha, T., & Feleke, F. W. (2022). Effect of maternal employment on child nutritional status in Bale Robe Town, Ethiopia: A comparative cross-sectional analysis. Journal of Nutritional Science, 11, Article E28. https://doi.org/10.1017/jns.2022.26
• Kusrini, I., Ipa, M., & Laksono, A. D. (2019). “Is It true that the child is king?”: Qualitative study of factors related to nutritional status of children in West Lombok, Indonesia. Indian Journal of Public Health Research and Development, 10(12), 1729–1733. https://doi.org/10.37506/v10/i12/2019/ijphrd/192113
• Kusrini, I., & Laksono, A. D. (2020). Regional disparities of stunted toddler in Indonesia. Indian Journal of Forensic Medicine and Toxicology, 14(3), 1685–1691. https://doi.org/10.37506/ijfmt.v14i3.10706
• Laksono, A. D., Sukoco, N. E. W., Rachmawati, T., & Wulandari, R. D. (2022). Factors related to stunting incidence in toddlers with working mothers in Indonesia. International Journal of Environmental Research and Public Health, 19(17), Article 10654. https://doi.org/10.3390/ijerph191710654
• Laksono, A. D., & Wulandari, R. D. (2019). “Children are assets”: Meta-synthesis of ‘the value of children’ in the Lani and Acehnese Tribes. Journal of Reproductive Health, 10(1), 11–20. https://doi.org/10.22435/kespro.v10i1.933.11-20
• Laksono, A. D., Wulandari, R. D., & Kusrini, I. (2020). Regional disparities of stunted toddler in Madura Island, Indonesia. Journal of Critical Reviews, 7(19), 6115–6121. https://doi.org/10.31838/jcr.07.19.708
• Laksono, A. D., Wulandari, R. D., Kusrini, I., & Ibad, M. (2021). The effects of mother’s education on achieving exclusive breastfeeding in Indonesia. BMC Public Health, 21(1), Article 14. https://doi.org/10.1186/s12889-020-10018-7
• Laksono, A. D., Wulandari, R. D., Wisnuwardani, R. W., & Amaliah, N. (2022). Stunting among children under two years in Indonesia: Does maternal education matter? PLOS ONE, 17(7), Article e0271509. https://doi.org/10.1371/journal.pone.0271509
• Maghfiroh, M. S., & Laksono, A. D. (2020). Diberi air gula… awalnya nangis menjadi diam, karena kenyang, gak lemas, daya tahan tubuhnya meningkat” [“Given sugar water ... at first the cry became silent, because it was full, not limp, its endurance increased”; Study of patterns of infant intake]. Amerta Nutrition, 4(2), 116–122. https://doi.org/10.20473/amnt.v4i2.2020.116-122
• Muldiasman, M., Kusharisupeni, K., Laksminingsih, E., & Besral, B. (2018). Can early initiation to breastfeeding prevent stunting in 6–59 months old children? Journal of Health Research, 32(5), 334–341. https://doi.org/10.1108/JHR-08-2018-038
• Mutasa, K., Tome, J., Rukobo, S., Govha, M., Mushayanembwa, P., Matimba, F. S., Chiorera, C. K., Majo, F. D., Tavengwa, N. V, Mutasa, B., Chasekwa, B., Humphrey, J. H., Ntozini, R., Prendergast, A. J., & Bourke, C. D. (2022). Stunting status and exposure to infection and inflammation in early life shape antibacterial immune cell function among Zimbabwean children. Frontiers in Immunology, 13, Article 899296. https://doi.org/10.3389/fimmu.2022.899296
• Nankinga, O., Kwagala, B., & Walakira, E. J. (2019). Maternal employment and child nutritional status in Uganda. PLOS ONE, 14(12), Article e0226720. https://doi.org/10.1371/journal.pone.0226720
• National Team for the Acceleration of Poverty Reduction. (2017, August). 100 Kabupaten Kota prioritas untuk Intervensi Anak Kerdil (Stunting): Volume I [100 Priority Regencies/Cities for Stunting Intervention (Stunting): Volume 1]. https://www.tnp2k.go.id/images/uploads/downloads/Binder_Volume1.pdf
• Ngandu, C. B., Momberg, D., Magan, A., Chola, L., Norris, S. A., & Said-Mohamed, R. (2020). The association between household socio-economic status, maternal socio-demographic characteristics and adverse birth and infant growth outcomes in sub-Saharan Africa: A systematic review. Journal of Developmental Origins of Health and Disease, 11(4), 317–334. https://doi.org/10.1017/S2040174419000680
• Nsereko, E., Mukabutera, A., Iyakaremye, D., Umwungerimwiza, Y. D., Mbarushimana, V., & Nzayirambaho, M. (2018). Early feeding practices and stunting in Rwandan children: A cross-sectional study from the 2010 Rwanda demographic and health survey. Pan African Medical Journal, 29, Article 157. https://doi.org/10.11604/pamj.2018.29.157.10151
• Nshimyiryo, A., Hedt-Gauthier, B., Mutaganzwa, C., Kirk, C. M., Beck, K., Ndayisaba, A., Mubiligi, J., Kateera, F., & El-Khatib, Z. (2019). Risk factors for stunting among children under five years: A cross-sectional population-based study in Rwanda using the 2015 Demographic and Health Survey. BMC Public Health, 19(1), Article 175. https://doi.org/10.1186/s12889-019-6504-z
• Ntoimo, L. F. C., & Odimegwu, C. O. (2014). Health effects of single motherhood on children in sub-Saharan Africa: A cross-sectional study. BMC Public Health, 14(1), Article 1145. https://doi.org/10.1186/1471-2458-14-1145
• Paramita, A., Izza, N., Tjandrarini, D. H., & Laksono, A. D. (2022). Does the proximity of the area affect in incidence of stunting?: Study on densely populated provinces in Indonesia. Indian Journal of Forensic Medicine and Toxicology, 16(3), 131–140. https://doi.org/10.37506/ijfmt.v16i3.18257
• Pratita, I., & Laksono, A. D. (2020). “Anak ini kalau makan, ya apapun yang diminta…”: Eksplorasi Nilai Anak dan Pola Pengasuhan Anak pada Suku Jawa di Desa Besowo, Kediri, Jawa Timur [“If this child eats, whatever she/he is asked ...”: Exploration of value of children and parenting patterns in Javanese in the Besowo village, Kediri, East Java]. Amerta Nutrition, 4(2), 147–154. https://doi.org/10.20473/amnt.v4i2.2020.147-154
• Purwita, E., Kesehatan Kementerian Kesehatan, P., Soekarno -Hatta, J., Darul Imarah, K., & Aceh Besar, K. (2022). Determinants of stunting in children under five in rural areas. Science Midwifery, 10(4), 2858–2865. https://doi.org/10.35335/midwifery.v10i4.729
• Raj, E., Calvo-Urbano, B., Heffernan, C., Halder, J., & Webster, J. P. (2022). Systematic review to evaluate a potential association between helminth infection and physical stunting in children. Parasites and Vectors, 15(1), Article 135. https://doi.org/10.1186/s13071-022-05235-5
• Ridwanah, A. A., Megatsari, H., Laksono, A. D., & Ibad, M. (2021). Factors related to stunted in East Java Province in 2019: An ecological analysis. Medico-Legal Update, 21(2), 230–235. https://doi.org/10.37506/mlu.v21i2.2678
• Simanjuntak, B. Y., Haya, M., Suryani, D., & Ahmad, C. A. (2018). Inisiasi menyusui dini dan suplementasi vitamin A dengan status gizi anak usia 6-59 bulan [Early inititation of breastfeeding and vitamin A supplementation with nutritional status of children aged 6-59 months]. Kesmas: National Public Health Journal, 12(3), 107–113. http://dx.doi.org/10.21109/kesmas.v12i3
• Situmeang, N. S. D., Sudaryati, E., & Jumirah. (2020). Correlation of parenting and nutrient intake with stunting in children 24-59 months. Britain International of Exact Sciences (BIoEx) Journal, 2(1), 280–285. https://doi.org/10.33258/bioex.v2i1.147
• Suratri, M. A. L., Putro, G., Rachmat, B., Nurhayati, Ristrini, Pracoyo, N. E., Yulianto, A., Suryatma, A., Samsudin, M., & Raharni. (2023). Risk factors for stunting among children under five years in the province of East Nusa Tenggara (NTT), Indonesia. International Journal of Environmental Research and Public Health, 20(2), Article 1640. https://doi.org/10.3390/ijerph20021640
• Susyani, S., Febry, F., Margarhety, I., Sadiq, A., Sartono, S., Sari, I. P., & Ni’mah, T. (2022). Maternal risk factor on incidence of stunting in South Sumatera. Open Access Macedonian Journal of Medical Sciences (OAMJMS), 10(E), 1599–1604. https://doi.org/10.3889/OAMJMS.2022.10761
• Talukder, A., Razu, S. R., & Hossain, M. Z. (2018). Factors affecting stunting among children under five years of age in Bangladesh. Family Medicine and Primary Care Review, 20(4), 356–362. https://doi.org/10.5114/fmpcr.2018.79348
• Tariku, A., Biks, G. A., Derso, T., Wassie, M. M., & Abebe, S. M. (2017). Stunting and its determinant factors among children aged 6-59 months in Ethiopia. Italian Journal of Pediatrics, 43(1), Article 112. https://doi.org/10.1186/s13052-017-0433-1
• Thurstans, S., Opondo, C., Seal, A., Wells, J., Khara, T., Dolan, C., Briend, A., Myatt, M., Garenne, M., Sear, R., & Kerac, M. (2020). Boys are more likely to be undernourished than girls: a systematic review and meta-analysis of sex differences in undernutrition. BMJ Global Health, 5(12), Article e004030. https://doi.org/10.1136/BMJGH-2020-004030
• Titaley, C. R., Ariawan, I., Hapsari, D., Muasyaroh, A., & Dibley, M. J. (2019). Determinants of the stunting of children under two years old in Indonesia: A multilevel analysis of the 2013 Indonesia Basic Health Survey. Nutrients, 11(5), Article 1106. https://doi.org/10.3390/nu11051106
• Utami, R. A., Setiawan, A., & Fitriyani, P. (2019). Identifying causal risk factors for stunting in children under five years of age in South Jakarta, Indonesia. Enfermeria Clinica, 29, 606–611. https://doi.org/10.1016/j.enfcli.2019.04.093
• Wali, N., Agho, K. E., & Renzaho, A. M. N. (2020). Factors associated with stunting among children under 5 years in five south asian countries (2014–2018): Analysis of demographic health surveys. Nutrients, 12(12), Article 3875. https://doi.org/10.3390/nu12123875
• World Health Organization (WHO). (2014, December 30). Global nutrition targets 2025: Stunting policy brief. https://www.who.int/publications/i/item/WHO-NMH-NHD-14.3
• World Health Organization (WHO). (2015, November 19). Stunting in a nutshell. https://www.who.int/news/item/19-11-2015-stunting-in-a-nutshell
• Wulandari, R. D., & Laksono, A. D. (2023). Factors related to stunted toddlers in Eastern Indonesia. Jurnal Keperawatan Indonesia Timur (East Indonesian Nursing Journal), 3(1), 1–10. https://doi.org/ 10.32695/JKIT.V3I1.451
• Wulandari, R. D., Laksono, A. D., Kusrini, I., & Tahangnacca, M. (2022). The targets for stunting prevention policies in Papua, Indonesia: What mothers’ characteristics matter? Nutrients, 14(3), Article 549. https://doi.org/10.3390/nu14030549
• Wulandari, R. D., Laksono, A. D., Prasetyo, Y. B., & Nandini, N. (2022). Socioeconomic disparities in hospital utilization among female workers in Indonesia: A cross-sectional study. Journal of Primary Care & Community Health, 13(2), 1–7. https://doi.org/10.1177/21501319211072679
• Yoto, M., Hadi, M. I., Pratita, I., Syahriyatul, M., Maghfiroh, Multazam, A. Z., Tyastirin, E., Media, A., Ridwanah, A. A., Sarweni, K. P., Husnia, Z., Esvanti, M., Nugraheni, R., Megatsari, H., & Laksono, A. D. (2020). Determinan sosial penanggulangan stunting: Riset aksi partisipatif desa sehat berdaya fokus penanggulangan stunting [Social determinants of stunting countermeasures: Participatory action research in healthy villages empowered by stunting countermeasures]. Health Advocacy.
• Zewdu, D., & Halala Handiso, Y. (2020). Under-nutrition of 2–5 years old children and associated factor among employed and unemployed women: Comparative cross-sectional study. Cogent Food & Agriculture, 6(1), Article 1801215. https://doi.org/10.1080/23311932.2020.1801215
• Zhang, N., Bécares, L., & Chandola, T. (2016). Patterns and determinants of double-burden of malnutrition among rural children: Evidence from China. PLOS One, 11(7), Article e0158119. https://doi.org/10.1371/journal.pone.0158119