Effects of Social Economy, Exclusive Breastfeeding, Complementary Feeding, and Physical Environment on the Stunted Children’s Development


  • Rahmi Windhy Astari Master’s Program in Public Health, Universitas Sebelas Maret
  • Eti Poncorini Pamungkasari Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret
  • Bhisma Murti Master's Program in Public Health, Universitas Sebelas Maret




Background: Maternal and infant morbidity and mortality continue to be a challenge today. Most maternal and newborn deaths occur during the early postnatal period. This condition can be caused by low utilization of postnatal care services. This study aims to analyze and estimate the influence of determining factors on the utilization of postnatal care services.

Subject and Methods: Meta-analysis was conducted using PRISMA guidelines and PICO format. Population: Postpartum Mothers. Intervention: high antenatal care, high maternal education, high family income and delivery in hospital. Comparison: low antenatal care, low maternal education, low family income, home birth. Outcome: postnatal care services. Cross-sectional study articles were collected from Google Scholar, PubMed, and Science Direct databases. The search strategy used the keywords: "Determinant Postnatal Care" AND "Maternal Health Service" AND "Cross-Sectional". The inclusion criteria for this study were full-text, cross-sectional studies published from 2014 to 2023. Data from articles were extracted with RevMan 5.3.

Result: The meta-analysis included 16 cross-sectional studies from Ethiopia, Ghana, Kenya, and Malawi. The total sample was 29,165 postpartum mothers. Postnatal mothers with high antenatal care visits (aOR= 2.64; 95% CI= 1.87 to 3.71; p = 0.001), high education (aOR= 2.09; 95% CI= 1.67 to 2.63; p = 0.001), high family income ( aOR= 1.63; 95% CI= 1.25 to 2.11; p = 0.002), and hospital delivery (aOR= 1.58; 95% CI= 1.15 to 2.97; p = 0.010) allow the utilization of postnatal care services and these results were statistically significant.

Conclusion: The results of this study reveal that high antenatal care, high maternal education, high family income and delivery in hospital have a positive effect on the utilization of postnatal care services.


antenatal care, health institutional, maternal education, family income, postnatal care


Abeway S, Gebremichael B, Murugan R, Assefa M, Adinew YM (2018). Stunting and its determinants among children aged 6-59 months in Northern Ethiopia: A cross-sectional study. J Nutr Metab. https://doi.org/10.1155/2018/1078480.

Ananditha AC (2017). Factors associated with gross motor development in toddlers. Muhammadiyah Journal of Nursing. 2(1). https://doi.org/10.30651/jkm.v2i1.924.

Central Statistical Authority (2014). Retrieved November 29, 2023. Ethiopian mini demographic health survey (EDHS), Addis Ababa, Ethiopia.

Chowdhury MRK, Rahman MS, Khan MMH, Mondal MNI, Rahman MM, Billah B (2016). Risk factors for child malnutrition in Bangladesh: A multilevel analysis of a nationwide population-based survey. J Pediatr. 172: 194–201.e1. https://doi.org/10.1016/j.jpeds.2016.01.023.

Dahl GB, Lochner L (2017). The impact of family income on child achievement: Evidence from the earned income tax credit. Am Econ Rev. 107(2): 623–628. https://doi.org/10.1257/aer.20150988.

De Onis M, Branca F (2016). Childhood stunting: a global perspective. Matern Child Nutr. 12: 12–26. https://Doi.Org/10.1111/Mcn.12231.

Desalegn BB, Kinfe E, Kidist F, Bosha T (2016). Stunting and its associated factors in under five years old children: the case of Hawassa University Technology villages, Southern Ethiopia. J Environ Sci Toxicol Food Technol. 10(11): 25–31. https://doi.org/10.9790/24021011022531.

Dinkel D, Snyder K (2020). Exploring gender differences in infant motor development related to parent’s promotion of play. Infant Behav Dev. 59. 101440. https://doi.org/10.1016/j.infbeh.2020.101440.

Gao Y, Zhang L, Kc A, Wang Y, Zou S, Chen C, Zhou H (2021). Housing environment and early childhood development in sub-Saharan Africa: A cross-sectional analysis. PLoS Med. 18(4): 1–18. https://doi.org/101371/journal.pmed.1003578.

Indonesian Pediatrician Association. Retrieved December 07, 2023. From nutritional value of breast milk: https://www.idai.or.id/artikel/klinik/asi/nilai-nutrisi-air-susu-ibu

Ministry of Health of the Republic of Indonesia (2018). Retrieved December 08, 2023. From Directorate of Health Promotion and Community Empowerment: https:// promkes.kemkes.go.id/?p=8929

Koh K (2017). Maternal breastfeeding and children’s cognitive development. Soc. sci. med. 187: 101–108. https://doi.org/10.1016/j.socscimed.2017.06.012

Kuewa Y, Sattu M, Otoluwa A (2021). The relationship between environmental sanitation and the incidence of stunting in toddlers in Jayabakti village in 2021. J Public Health. 12(2): 117. Retrieved from https://journal.fkmuntika.ac.id/index.php/phj

Liben ML, Abuhay T, HaileY (2016). Determinants of child malnutrition among agro pastorals in northeastern Ethiopia: a cross-sectional study. Health Sci J. 10(4): 1–10.

Luengo MH, Álvarez BC, Pozuelo CDP, Berlanga MC, Martínez VV, Notario PB (2019). Relationship between breast feeding and motor development in children: Protocol for a systematic review and meta-analysis. BMJ Open. 9(9): 1–6. https://doi.org/10.1136/bmjopen-2019-029063.

Matanda DJ, Mittelmark MB, Kigaru DMD (2014). Child undernutrition in Kenya: Trend analyses from 1993 to 2008-09. BMC Pediatrics. 14(1). https://doi.org/10.1186/14712431145.

Mgongo M, Chotta NAS, Hashim TH, Uriyo JG, Damian DJ, Stray-Pedersen B, Vangen S (2017). Underweight, stunting and wasting among children in Kilimanjaro region, Tanzania; a population-based cross-sectional study. Int. J. Environ. Res. Public Health. 14(5): 1–12. https://doi.org/10.3390/ijerph14050509

Murti B (2019). Application of path analysis and structural equation model with stata. Surakarta: UNS Postgraduate IKM Study Program.

Ngaisyah RD (2015). Socio-economic relationship with the incidence of stunting in toddlers in Kanigoro Village, Saptosari Gunung Kidul. Journal of Medical Respati. 10(4): 65–70.

Ngura ET, Ita E, Laksana DNL, Natal YR (2021). Stunting and its effects in early childhood development. Journal of Smart Paud. 4(2): 174–182.

Nurbawena H, Utomo MT, Yunitasari E (2021). The relationship between a history of illness and the incidence of stunting in toddlers. Indonesian Midwifery and Health Sciences Journal. 3(3): 213–225. https://Doi.Org/10.20473/Imhsj.V3i3.2019.213-225

NMN Daughter, Widnyana M, IPYP Son, Saraswati NLPGK (2023). Exclusive breastfeeding affects the motor development of infants aged 3-6 months at puskesmas II West Denpasar. Indonesian Physiotherapy Scientific Magazine. 11(2): 118–122.

Rosyidah M, Dewi YLR, Qadrijati I (2021). effects of stunting on child development: a meta-analysis. J of Matern and Child Health. 6(1): 25–34. https://doi.org/10.26911/thejmch.2021.06.01.03.

Sartika AN, Khoirunnisa M, Meiyetriani E, Ermayani E, Pramesthi IL, Nur Ananda AJ (2021). Prenatal and postnatal determinants of stunting at age 0–11 months: a cross-sectional study in indonesia. Plos One. 16(7): 1–14. https://Doi.Org/10.1371/Journal. Pone.0254662.

Sahitarani AS, Paramashanti BA, Sulistiyawati S (2020). The relationship between stunting and the duration of infectious diseases in children aged 24-59 months in Sedayu District, KabuPaten Bantul. J Of Nutr Coll. 9(3): 202–207. https://Doi.Org/10.14710/Jnc.V9i3.26952.

Sclar GD, Garn JV, Penakalapati G, Alexander KT, Krauss J, Freeman MC, Clasen, T (2017). Effects of sanitation on cognitive development and school absence: A systematic review. Int J Hyg Environ Health. 220(6): 917–927.

Sterling FA, Coll CG, Lamarre M (2012). Sexing the baby: Part 1 - What do we really know about sex differentiation in the first three years of life? Soc. sci. med. 74(11): 1684–1692.https://doi.org/10.1016/j.socscimed.2011.05.051.

Sutarto S, Azqinar TC, Puspita Sari RD (2020). The relationship between maternal education level and family income with the incidence of stunting in toddlers in the working area of Puskesmas Way Urang, South Lampung Regency. World Journal of Public Health. 9(2): 256–263. https://doi.org/10.33024/Jdk.V9i2.2380.

Suryaputri IY, Rosha BC, Anggraeni D (2014). Determinants of Motor Skills of Children Aged 2-5 Years: A Case Study in Kebon Kalapa Village, Bogor. Penel Nutrition Meal, 37(1): 43–50.

Tiwari R, Ausman LM, Agho KE (2014). Determinants of stunting and severe stunting among under-fives: evidence from the 2011 nepal demographic and health survey. BMC Pediatr. 14(1): 1–15. https://doi.org/10.1186/1471243114239.

Veldman MP, Maurits NM, Nijland MAM, Wolters NE, Mizelle JC, Hortobágyi T (2018). Spectral and temporal electroencephalography measures reveal distinct neural networks for the acquisition, consolidation, and interlimb transfer of motor skills in healthy young adults. Clin. Neurophysiol. 129(2): 419–430. https://doi.org/10.1016/j.clinph.2017.12.003.

Wiyani (2016). Consep Dasar PAUD. Yogyakarta: Gava Media

World Health Organization (2014). Retrieved Juli 18, 2023. From global nutrition targets 2025: stunting policy brief: https://www.Who.Int/Publications/I/Item/WHO-NMH-NHD-14.3

World Health Organization (2021). Retrieved Agustus 29, 2023. From Levels and trends in child malnutrition unicef/who/world bank group joint child malnutrition estimates key findings of the 2021 edition: https://www.Who.Int/Publications/I/Item/9789240025257

Zhang J, Guo S, Li Y, Wei Q, Zhang C, Wang X, Scherpbier RW (2018). Factors influencing developmental delay among young children in poor rural china: a latent variable approach. BMJ Open. 8(8): 1–9. https://doi.org/10.1136/Bmjopen-2018-02162.




How to Cite

Astari, R. W., Pamungkasari, E. P., & Murti, B. (2024). Effects of Social Economy, Exclusive Breastfeeding, Complementary Feeding, and Physical Environment on the Stunted Children’s Development . Journal of Maternal and Child Health, 9(2), 201–216. https://doi.org/10.26911/thejmch.2024.09.02.07