Logistic Regression Analysis on the Determinants of Stunting among Children Aged 6-24 Months in Purworejo Regency, Central Java
Abstract
Background: Stunting is a representation of the state of chronic malnutrition in the first 1000 days of life that occurred in the world at an incidence of 22.2% in 2017. Stunting in children has impact on morbidity and mortality, resulting in a long-term decline socio-economic productivity of the community. The purpose of this study was to analyze the determinants of stunting in children aged 6-24 months in Purworejo, Central Java.
Subjects and Method: This was an analytic observational study with a case control design. It was conducted in 25 integrated community health posts (posyandu) in Purworejo, from October to December 2018. A sample 200 children under five was selected using by simple random sampling. The dependent variable was stunting. The independent variables were maternal mid-upper arm circumference (MUAC) at pregnancy, maternal education, paternal education, family income, family food allocation, infant birth weight, exclusive breastfeeding, complementary feeding (CF), posyandu strata, stunting monitoring at posyandu, and posyandu stunting intervention. The data was collected by questionnaire and analyzed by a multiple logistic regression.
Results: Maternal MUAC at pregnancy ?23.5 cm (b= -1.56; 95% CI= 0.06 to 0.67; p = 0.009), high maternal education (b= -1.70; CI95% = 0.06 to 0.57; p = 0.003), high paternal education (b= -1.90; 95% CI= 0.05 to 0.51; p= 0.002), high family income (b= -1.85; 95% CI= 0.05 to 0.50; p = 0.002), family food allocation (b= -2.26; 95% CI= 0.03 to 0.37; p<0.001), birth weight ?2,500 g (b= -1.39; 95% CI= 0.08 to 0.83; p= 0.024), exclusive breastfeeding (b = -2.04; 95% CI= 0.04 to 0.48; p= 0.002), and adequate complementary feeding (b= -1.61; 95% CI= 0.06 to 0.65; p= 0.007) reduced the risk of stunting in children aged 6-24 months.
Conclusions: Maternal MUAC at pregnancy ?23.5 cm, high maternal education, high paternal education, high family income, family food allocation, birth weight ?2,500 g, exclusive breastfeeding, and adequate complementary feeding reduce the risk of stunting in children aged 6-24 months.
Keywords: stunting, determinants, children aged 6-24 months
Correspondence:
References
Abera L, Dejene T, Laelago T (2018). Magnitude of stunting and its determinants in children aged 6
Abuya BA, Ciera J, Murage EK (2012). Effect of mother
Aldorman H, Headey DD (2017). How important is parental education for child nutrition?. World Development. 94: 448
Arifin DZ, Irdasari SY, Sukandar H (2012). Analisis sebaran dan faktor risiko stunting pada baduta di Kabupaten Purwakarta. Bandung: Universitas Padjajaran. http://pustaka.unpad.ac.id/wpcontent/uploads/2013/07/pustaka_unpad_analisis_sebaran_dan_faktor_risiko_stunting.pdf.
Aryastami NA, Shankar N, Kusumawardani B, Besral AB, Jahari, Achadi E (2017). Low birth weight was the most dominant predictor associated with Stunting among children aged 12
Atsu BK, Guure C, Laar AK (2017). Determinants of overweight with concurrent stunting among Ghanaian children. BMC Pediatric 17:177. doi 10.1186/s1288701709283.
Custodio E, Descalzo MA, Roche J, Molina L, Sanchez I, Lwanga M, Torres AM, FernandezZincke E, Bernis C, Villamor E, Baylin A (2010). The economic and nutrition transition in equatorial guinea coincided with a double burden of over and under nutrition. Economics and Human Biology 8(1): 80
Dhungana GP (2017). Nutritional status and the associated factors in under five years children of Lamjung, Gorkha and Tanahun Districts of Nepal. Nepalese Journal of Statistics 1(15-28): 17. Doi: https://doiorg/10.3126/njs.v1i0.18814.
Dinas Kesehatan Kabupaten Purworejo (2016). Profil Kesehatan Kabupaten Purworejo. Purworejo: Pemerintah Kabupaten Purworejo. http://www.depkes.go.id/resources/download /profil/PROFIL_KAB_KOTA_2015/ 3306_Jateng_Kab_Purworejo_2015.pdf.
Haile D, Azage M, Tegegn M, Rainey R (2016). Exploring spatial variations and factors associated with childhood stunting in Ethiopia: Spatial and multilevel analysis. BMC Pediatr. 16-49. doi: 10.1186/s1288701605879.
Hossain M, Choudhury M, Abdullah KAB, Mondal P, Jackson AA, Walson J, Ahmed T (2017). Evidencebased approaches to childhood stunting in low and middle income countries: A systematic review. Archives of Disease in Childhood. 102(10): 9039 doi: 10.1136/archdischild2016311050.
Kementerian Kesehatan Republik Indonesia (2015). Stunting di Indonesia, masalah, dan solusinya. Jakarta: Badan Penelitian dan Pengembangan Kesehatan. http://pdgmi.org/wpcontent/uploads/2016/08/StuntingdiIndonesiaA5rev7.pdf.
Kementerian Kesehatan Republik Indonesia (2016). Situasi balita pendek. Jakarta: Pusat Data dan Informasi Kementerian Kesehatan RI. http://www.depkes.go.id/resources/download/pusdatin/infodatin/situasibalitapendek2016.pdf.
Khasanah DP, Hadi H, Paramashanti BA (2016). Waktu pemberian makanan pendamping ASI (MP-ASI) berhubungan dengan kejadian stunting anak usia 6-23 bulan di Kecamatan Sedayu. Jurnal Gizi Dan Dietetik Indonesia. 4(2): 10511. Doi: http://dx.doi.org/10.21927/ijnd.2016.4(2).105-111.
Kismul H, Acharya P, Mapatano MA, Hatloy A (2018). Determinants of childhood stunting in the Democratic Republic of Congo: Further Analysis of Demographic and Health Survey 2013
Kuchenbecker J, Jordan I, Reinbott A, Herrmann J, Jeremias T, Kennedy G, Muehlhoff E, Mtimuni B, Krawinkel MB (2015). Exclusive breastfeeding and its effect on growth of Malawian Infants: Results from a Cross-Sectional study. Paediatrics and International Child Health. 35(1): 14-23. doi: 10.1179/2046905514Y.0000000134.
Kusumawati W, Rahardjo S, Sari HP (2015). Model pengendalian faktor risiko stunting pada anak usia di bawah tiga tahun. Jurnal Kesehatan Masyarakat Nasional. 9(3): 249-56. https://media.neliti.com/media/publications/39896IDmodelpengendalianfaktorrisikostuntingpadaanakbawahtigatahun.pdf.
Masrin, Paratmanitya Y, Aprilia V (2014). Ketahanan pangan rumah tangga berhubungan dengan stunting pada anak usia 6-23 bulan. Jurnal Gizi dan Dietetik Indonesia. 2(3): 103-15. https://ejournal.almaata.ac.id/index.php/IJND/article/download/296/268.
Najnin N, Bennett CM, Luby SP (2011). Inequalities in care-seeking for febrile illness of under-five children in Urban Dhaka, Bangladesh. J Health Popul Nutr. 29(5): 523
Nkurunziza S, Meessen B, Geetruyden JPV, Korachais C (2017). Determinants of stunting and severe stunting among Burundian children aged 6-23 months: Evidence from a National Cross-Sectional Household Survey, 2014. BMC Pediatr. doi: 10.1186/s1288701709292.
Prendergast AJ, Humphrey JH (2014). The stunting syndrome in developing countries. Paediatrics and International Child Health. 34(4): 257 doi: 10.1179/2046905514Y.00000000158.
Rahayu A, Khairiyati L (2014). Risiko pendidikan ibu terhadap kejadian stunting pada anak 6-23 bulan. Penel Gizi Makan. 37(2). http://ejournal.litbang.depkes.go.id/index.php/pgm/article/view/4016/3833.
Rahayu A, Yulidasari F, Putri AO, Rahman F (2015). Riwayat berat badan lahir dengan kejadian stunting pada anak usia bawah dua tahun. Jurnal Kesehatan Masyarakat Nasional. 10(2): 67-73. Doi: http://dx.doi.org/10.21109/kesmas.v10i2.882.
Rahayu RM, Pamungkasari EP, Wekadigunawan CSP (2018). The biopsychosocial determinants of stunting and wasting in children aged 12-48 months. Journal of Maternal and Child Health. 3(2): 105-18. https://doi.org/10.26911/thejmch.2018.03.02.03.
Rosha BC, Hardinsyah, Baliwati YF (2012). Analisis determinan stunting anak 0-23 bulan pada daerah miskin di Jawa Tengah dan Jawa Timur. Penel Gizi Makan, 35(1). http://ejournal.litbang.depkes.go.id/index.php/pgm/article/view/3081.
Sarma H, Khan JR, Asaduzzaman M, Uddin F, Tarannum S, Hasan M, Rahman AS, Ahmed T (2017). Factors influencing the prevalence of stunting among children aged below five years in Bangladesh. Food and Nutrition Bulletin. 38(3): 291-301. doi: 10.1177/0379572117710103.
Sukmawati, Hendrayati, Chaerunnimah, & Nurhumaira (2018). Status gizi ibu saat hamil, berat badan lahir bayi dengan stunting pada balita. Media Gizi Pangan. 25(1): 18-24. https://media.neliti.com/media/publications/65332statusgiziibusaat-hamilberatbadanl8054 beb3.pdf.
Sumarmi MS (2016). Maternal short sta-ture and neonatal stunting: an intergenerational cycle of malnutrition. International conference on health and well-being (ICHWB). 265-72. https://publikasiilmiah.ums.ac.id/bitstream/handle/11617/7411/32%20%20Sri%20Sumarmi.pdf?sequence=1
Torlesse H, Cronin AA, Sebayang SK, Nandy R (2016). 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. doi: 10.1186/s1288901633398.
UNICEF (2018). Malnutrition rates remain alarming: stunting is declining too slowly while wasting still impacts the lives of far too many young children, https://data.unicef.org/topic/nutrition/malnutrition/.
UNICEF (2013). Improving child nutrition: the achievable imperative for global progress. United Nations Publications Sales. https://www.unicef.org/ gambia/Improving_Child_Nutrition_the_achievable_imperative_for_global_progress.pdf.
Utami NH, Sisca DKP (2015). Resiko terjadinya kegemukan pada anak usia 3-5 tahun dengan status gizi pendek di Indonesia. Jurnal Ekologi Kesehatan. 14(3): 273-83. https://media.neliti.com/media/publications/82080IDresikoterjadinyaegemukanpadaanakus.pdf.
Uwiringiyimana V, Ocke MC, Amer S, Veldkamp A (2018). Predictors of Stunting with Particular Focus on Complementary Feeding Practices: A Cross-Sectional Study in the Northern Province of Rwanda. Nutrition, 1-28. doi: 10.1016/j.nut.2018.07.016.
Vollmer S, Bommer C, Krishna A, Harttgen K, Subramanian SV (2017). The association of parental education with childhood undernutrition in low and middle income countries: comparing the role of paternal and maternal education. International Journal of Epidemiology. 46(1): 312
WHO (2014). Nutrition landscape information system (NLIS) country profile indicators: Interpretation guide. https://www.who.int/nutrition/nlis_interpretationguide_isbn978924159-9955/en/.
