Prevalence and Path Analysis on the Effects of Diarrhea and Life Course Determinants on Stunting in Children Under Two Years of Age in Kupang, East Nusa Tenggara

Nabilah Nurul Ilma, Harsono Salimo, Eti Poncorini Pamungkasari


Background: The interaction between infections and malnutrition has been recognized as a vicious cycle. Repeated diarrhoeal illnesses as well as other common childhood infections progressively altered the normal growth trajectories of children. This study aimed to analyze the effects of diarrhea and lifelong determinants on the incidence of stunting in children under two years in Kupang.

Subjects and Method: This was a case-control study conducted in 25 integrated health posts in Alak and Oebobo Subdistricts, in Kupang, East Nusa Tenggara, from November December 2018. A sample of 200 children under two years was selected by multi-stage random sampling. The dependent variable was stunting. The independent variables were diarrhea, birth length, parental income, maternal education, exclusive breastfeeding, maternal height, maternal mid-upper arm circumference (MUAC), complementary feeding, maternal hygiene practice, and sanitation. The data were collected by questionnaire and analyzed by path analysis.

Results: Stunting prevalence in Kupang was 30.5%. The risk of stunting was directly decreased by appropriate complementary feeding (b= -1.97; 95% CI= -3.55 to -0.39; p= 0.014), good hygiene practice (b= -4.38; 95% CI= - 6.63 to -2.12; p<0.001), good sanitation (b= -2.32; 95% CI= -4.00 to -0.64; p= 0.007), and birth length ≥48 cm (b= -2.22; 95% CI= -3.74 to -0.69; p= 0.004). The risk of stunting was directly increased by diarrhea (b= 2.55; 95% CI= 1.01 to 4.09; p= 0.001). It was indirectly affected by parental income, maternal education, exclusive breastfeeding, maternal height, and maternal MUAC at pregnancy.

Conclusion: The risk of stunting is directly decreased by appropriate complementary feeding, good hygiene practice, good sanitation, and birth length ≥48 cm. The risk of stunting is directly increased by diarrhea. It is indirectly affected by parental income, maternal education, exclusive breastfeeding, maternal height, and maternal MUAC at pregnancy.

Keywords: stunting, determinants, prevalence, diarrhea

Correspondence: Nabilah Nurul Ilma. Masters Program in Public Health. Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: Mobile: +6287838555468.

Journal of Maternal and Child Health, 2019, 4(4): 230-241

Full Text:



Abebe Z, Desse G, Baye K (2017).Child feeding style is associated with food intake and linear growth in rural Ethiopia. Appetite. S01956663(16) 304986. Doi: 10.1016/j.appet.2017.04.033

Abeway, Gebremichael B, Murugan R, Assefa M, Adinew YM (2018). Research article stunting and its determinants among children aged 6–59 months in Northern Ethiopia: A cross-sectional study Shiferaw. Hindawi Journal of Nutrition and Metabolism. Doi:

Aguayo VM, Menon P (2016). Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications. Matern Child Nutr. 12(1): 91–105. doi: 10.1111/mcn.12258

Aryastami NK, Shankar A, Kusumawardani N, Besral B, Jahari AB, Achadi E (2017). Low birth weight was the most dominant predictor associated with stunting among children aged 12–23 months in Indonesia. BMC Nutrition, 3:16. Doi:10.1186/s407950170130x

Ayuningrum IY, Salimo H, Dewi YLR. (2017). Path analysis on gestational socioeconomic determinants of nutritional status in children under five in Purworejo Regency, Central Java. Journal of Maternal and Child Health. 2(1): 30-41.

Batiro B, Demissie T, Halala Y, Anjulo A (2017). Determinants of stunting among children aged 6-59 months at KindoDidayeworeda, Wolaita Zone, Southern Ethiopia: Unmatched case control study. PLoS ONE 12(12): e0189106. DOI:

Brinkman HJ, Pee SD, Sanogo I, Subran L, Bloem MW (2009). High food prices and the global financial crisis have reduced access to nutritious food and worsened nutritional status and health. American Society for Nutrition (2010). Doi: 10.3945/jn.109.110767

Budhathoki SS, Bhattachan M, Yadav AK, Upadhyaya P, Pokharel PK (2016). Ecosocial and behavioural determinants of diarrhoea in underfive children of Nepal: a framework analysis of the existing literature. Tropical Medicine and Health. 44:7. Doi: 10.1186/s4118201600069.

Cahyono F (2016). Faktor penentu stunting anak balita pada berbagai zona ekosistem di Kabupaten Kupang. Jurnal Gizi Pangan. ISSN 19781059. 11(1):9-18.

Cumming O, Cairncross S (2016). Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications. Matern Child Nutr. 12(1): 91–105. Doi: 10.1111/mcn.12258.

deOnis M, Branca F (2016). Childhood stunting: a global perspective. Maternal and Child Nutrion. 12(1): 12–26. Doi: 10.1111/mcn.12231.

Desyanti C, Nindya TS (2017). Hubungan riwayat penyakit diare dan praktik higiene dengan kejadian stunting pada balita usia 24-59 bulan di wilayah kerja Puskesmas Simolawang, Surabaya. Amerta Nutrition. 243-251. doi: 10.2473/amnt.v1i3.2017.243-251

Dewey KG (2016). Reducing stunting by improving maternal, infant and young child nutrition in regions such as South Asia: evidence, challenges and opportunities. Matern Child Nutr. 12(1): 27–38. doi: 10.1111/mcn.12282.

Dewi IAKC, Adhi KT (2014). Pengaruh konsumsi protein dan seng serta riwayat penyakit infeksi terhadap kejadian stunting pada anak balita umur 24-59 bulan di wilayah kerja Puskesmas Nusa Penida III. Archive of Community Health. 3(1): 36–46.

Dinas Kesehatan NTT (2018). Profil kesehatan Nusa Tenggara Timur. Kupang.

Dinas Kesehatan Kota Kupang (2018). Profil Kesehatan Kota Kupang. Kota Kupang.

Fink G, Günther I, Hill K (2011). The effect of water and sanitation on child health: evidence from the demographic and health surveys 1986–2007. International Journal of Epidemiology. 40(5): 1196–1204. Doi:

Humphrey JH, Mbuya MNN, Ntozini R, Moulton LH, et al. (2018). Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster randomized trial. Lancet Glob Health. 7(1): e132e147. Doi: 10.1016/S2214109X(18)303747.

Indriyani E (2018). Biopsychosocial determinants of stunting in children under five: A path analysis evidence from the Border Area West Kalimantan. Journal of Maternal and Child Health 3(2): 146-155.

Jamro B, Junejo AA, LalS, Bouk GR, Jamro S (2012). Risk factors for severe acute malnutrition in children under the age of five year in Sukkur. Pakistan Journal of Medical Research. 51(4).

Kavosi E, Rostami ZH, Kavosi Z, Nasihatkon A, Moghadami M, Heidari M (2014). Prevalence and determinants of undernutrition among children under six: a cross-sectional survey in Fars province, Iran. International Journal of Health Policy and Management. 3(2): 71.

Kementerian Kesehatan RI (2013). Riset kesehatan dasar. Jakarta: Kemenkes RI.

_____ (2016). Infodatin: Pusat Data dan Informasi. Jakarta: Kemenkes RI.

_____ (2018). Riset Kesehatan Dasar. Jakarta: Kemenkes RI.

Niga DM, Purnomo W (2016). Hubungan antara praktik pemberian makan, perawatan kesehatan, dan kebersihan anak dengan kejadian stunting pada anak usia 1-2 tahun di wilayah kerja Puskesmas Oebobo Kota Kupang. Jurnal Wiyata. 3(2).

Panjwani A, Heidkamp R (2017). Complementary feeding interventions have a small but significant impact on linear and ponderal growth of children in low and middle income countries: A Systematic Review and Meta Analysis. The Journal of Nutrition. 147(11): 2169S2178S. doi: 10.3945/jn.116.243857.

Prendergast AJ, Humphrey JH (2014). The stunting syndrome in developing countries. Paediatr Int Child Health. 34(4): 250–265. Doi: 10.1179/2046905514Y.0000000158.

Rah JH, Cronin AA, Aguayo VM, Coates S, Ahmed S (2015). Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys. BMJ Journals. Doi:

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. 16: 669. DOI:

Rahman HF, Widoyo S, Siswanto H, Biantoro (2016). Faktor-faktor yang berhubungan dengan kejadian diare di Desa Solor Kecamatan Cermee Bondowoso. Nurse Line Journal. 1(1).

Sulaiman AA, Bushara SO, Elmadhoun WM et al. (2018). Prevalence and determinants of undernutrition among children under 5-year-old in rural areas: A cross-sectional survey in North Sudan. J Family Med Prim Care. 7(1): 104–110. Doi: 10.4103/jfmpc.jfmpc_73_17.

UNICEF (2013). Improving Child Nutrition The achievable imperative for global progress. New York,United Nations Children’s Fund (UNICEF).

WHO (2014). Global nutrition target 2025 Stunting Policy Brief. WHO/NMH/ NHD/14.3. stunting/en/.

World Bank (2018). Joint child malnutrition estimates 2018 (UNICEFWHOWB). malnutrition.


  • There are currently no refbacks.