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
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
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
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
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
Fink G, G
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
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
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
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.