User

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

Abstract

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: nabilahnurul86@gmail.com. Mobile: +6287838555468.

Journal of Maternal and Child Health, 2019, 4(4): 230-241
https://doi.org/10.26911/thejmch.2019.04.04.02

Full Text:

PDF

References


Abebe Z, Desse G, Baye K (2017).Child feeding style is associated with food intake and linear growth in rural Ethiopia. Appetite. 116:132-138. doi: 10.1016/j.appet.2017.04.033  Crossref  PubMed  Google Scholar 


Abeway, Gebremichael B, Murugan R, Assefa M, Adinew YM (2018). Stunting and its determinants among children aged 6-59 months in Northern Ethiopia: A crosssectional study Shiferaw. Hindawi Journal of Nutrition and Metabolism. 2018: 1-8. doi: 10.1155/2018/1078480  Crossref  PubMed  Google Scholar 


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(1). doi: 10.1186/s40795-017-0130-x  Crossref  Google Scholar 


Ayuningrum IY, Salimo H, Dewi YLR. (2017). Path analysis on gestational socio economic determinants of nutritional status in children under five in Purworejo Regency, Central Java. Journal of Maternal and Child Health. 2(1): 30-41. doi: 10.26911/thejmch.2017.02.01.04  Crossref  Google Scholar 


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): e01-89106. doi: 10.1371/journal.pone.0189106  Crossref  PubMed  Google Scholar 


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. 140(1): 153S-161S. doi: 10.3945/jn.109.110767  Crossref  PubMed  Google Scholar 


Budhathoki SS, Bhattachan M, Yadav AK, Upadhyaya P, Pokharel PK (2016). Eco-Social and behavioural determinants of diarrhoea in under five children of Nepal: a framework analysis of the existing literature. Tropical Medicine and Health. 44(1). doi: 10.1186/s41182-016-0006-9  Crossref  PubMed  Google Scholar 


Cahyono F (2016). Faktor penentu stunting anak balita pada berbagai zona ekosistem di Kabupaten Kupang. Jurnal Gizi Pangan. Google Scholar 


Cumming O and 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  Crossref  PubMed  Google Scholar 


De Onis M, Branca F (2016). Childhood stunting: a global perspective. Maternal and Child Nutrion. doi: 10.1111/mcn.12231  Crossref  PubMed  Google Scholar 


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. 1(3): 243-251. doi: 10.20473/amnt.v1i3.2017.243-25110.20473/amnt.v1i3.2017.243-251  Crossref  Google Scholar 


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  Crossref  PubMed  Google Scholar 


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. Google Scholar 


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: 10.1093/ije/dyr102  Crossref  PubMed  Google Scholar 


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 randomised trial. Lancet Glob Health. 7(1): e132-e147. doi: 10.1016/S2214-109X(18)30374-7  Crossref  PubMed  Google Scholar 


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. doi: 10.26911/thejmch.2018.03.02.07  Crossref  Google Scholar 


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). Google Scholar 


Kavosi E, Rostami ZH, Kavosi Z, Nasihatkon A, Moghadami M, Heidari M (2014). Prevalence and determinants of under nutrition among children under six: a crosssectional survey in Fars province, Iran. International Jo-urnal of Health Policy and Management. 3(2): 71-76. doi: 10.15171/ijhpm.2014.63  Crossref  PubMed  Google Scholar 


Ministry of Health (2013). Riset kesehatan dasar. Jakarta: Kemenkes RI. Website


Ministry of Health (2016). Infodatin: Pusat Data dan Informasi. Jakarta: Kemenkes RI. Website


Ministry of Health (2018). Riset Kesehatan Dasar. Jakarta: Kemenkes RI. Website


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). Google Scholar 


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): 2169S-2178S. doi: 10.3945/jn.116.243857  Crossref  PubMed  Google Scholar 


Prendergast AJ, Humphrey JH (2014). The stunting syndrome in developing countries. Paediatrics and International Child Health. 34(4): 250–265. doi: 10.1179/2046905514Y.0000000158  Crossref  PubMed  Google Scholar 


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 crosssectional analysis of surveys. BMJ Journals. 5(2):e005180-e005180 doi: 10.1136/bmjopen-2014-005180  Crossref  PubMed  Google Scholar 


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). Website


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


Torlesse H, Cronin AA, Sebayang SK, Nandy R (2016). Determinants of stunting in Indonesian children: evidence from a crosssectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction. BMC Public Health. 16(1):1-11. doi: 10.1186/s12889-016-3339-8  Crossref  PubMed  Google Scholar 


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


WHO (2014). Global nutrition target 2025 Stunting Policy Brief. Website


World Bank (2018). Joint child malnutrition estimates 2018 (UNICEF-WHO-WB). Website


Ministry of Health Kupang (2018). Profil Kesehatan Kota Kupang. Kota Kupang.


Ministry of Health NTT (2018). Profil kesehatan Nusa Tenggara Timur. Kupang.

Refbacks

  • There are currently no refbacks.