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Asian Journal of Healthy and Science

p-ISSN: 2980-4302

e-ISSN: 2980-4310

Vol. 3 No. 1 January 2024

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1,2,3,4

RSUD Kefamenanu, Indonesia

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Universitas Brawijaya, Indonesia

Email: maryampermataa@gmail.com, josegiovanny110@gmail.com,

Awliya@alumni.ui.ac.id, drlelytan@gmail.com, iwa_obg@yahoo.com

Abstract

Stunting, defined as height-for-age more than two standard deviations below the

WHO’s child growth standards median has many long-term consequences. With a

test and multivariate analysis using multiple logistic regression methods. Of the 103

children who attended Posyandu in Kelurahan Sasi, 28,1% of children exhibited

stunting, with statistically significant risk factors namely low maternal education, low

knowledge about stunting, low household wealth index, gestational age, and short

maternal height. Maternal education emerged as the primary risk factor for stunting

in Sasi Community Health Center (OR 6.0; 95% CI 2,3 to 4.5; P=0.0029). Maternal

education emerged as the primary risk factor on stunting in Sasi Community Health

Center, as indicated by both bivariate and multivariate analysis. Furthermore, low

household index and short maternal height were linked to a higher likelihood of

stunting, emphasizing the influence of economic factors. Maternal age and iron

Keywords: Stunting, maternal education, household wealth index, gestational

age, gestational age

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two standard deviations below the World Health Organization's child growth

standards median, is a significant public health issue, particularly in developing

countries (De Onis & Branca, 2016). Epidemiologically, stunting is not merely a

reflection of poor nutrition, but also a marker of persistent socio-economic problems

(Ssentongo et al., 2021). It is closely linked to maternal health factors, including

implications, including increased susceptibility to chronic diseases and impaired

cognitive development (Prendergast & Humphrey, 2014). From a socio-economic

perspective, stunting perpetuates a cycle of poverty and poor health, with stunted

children often facing reduced productivity and earning potential in adulthood (Rizal

& van Doorslaer, 2019).

Indonesia ranks 108th out of 132 countries, with the second-highest prevalence of

stunting in the Southeast Asia region, following Cambodia (World Health

Organization, 2020). According to Studi Status Gizi Indonesia (SSGI) in 2019, the

predicted prevalence of stunting in Indonesia is 27,7%, 26,9%, and 24,4% for the year

five years old) in February 2023, and in August 2023, it was 10% (32 children under-

five) years old. Considering our high prevalence of stunting and its long-term

consequences, we aim to investigate whether the maternal risk factors identified in

the current literature align with those prevalent in our area (Hanjahanja-Phiri, 2018)

(Bago et al., 2022).

Health Center which aims to determine the impact of maternal factors on the

incidence of stunting in children aged 6 to 59 months. Sasi Community Health

Center was chosen due to its location in the capital, and thus serves as a benchmark

for other health centers in Timor Tengah Utara regency. This study is an

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child health outcomes in Timor Tengah Utara Regency and beyond.

The inclusion criteria in this study includes children aged 6 to 59 months, both

experiencing stunting and those who are not, participating in the Posyandu, and

receiving the questionnaire. The sample size was determined using the minimal

sample size formula for case-control studies, resulting in a total sample of 103

children, consisting of 29 case samples (stunting) and 74 control samples (non-

stunting). The determination of nutritional status (stunted/non-stunted) in

materials on stunting to the Posyandu’s participants, followed by a brief discussion,

and lastly, the administration of questionnaires through individual interviews with

the parents.

questionnaires. The filled questionnaires will be summarized and processed for

comparative analysis, which are bivariate with chi-square test, and multivariate with

multiple logistic regression method, using the SPSS 27 application. In this study,

seven variables were identified as maternal risk factors to be assessed for their impact

on the occurrence of stunting in our working area, namely maternal education,

household wealth index, stunting knowledge, maternal height, gestational age,

identified as having low birth weight, defined as being below 2500 grams. The mean

age of the participants' mothers at their initial childbirth ranged from 20 to 35 years.

Additionally, an assessment of the household wealth index for each child was

classified as delineated in Table 1. Comprehensive baseline characteristics of the

subjects and their parents are shown in Table 1.

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the data from the Public Health Office.

Maternal Education and Knowledge about Stunting

equivalent to junior high school (SMP) (Badan Pusat Statistik, 2023). Therefore,

maternal education below junior high school level is considered low, and vice versa.

The result of our study suggests an association between low maternal education and

an increased likelihood of stunting, as evidenced by both the bivariate analysis (OR

2.1; 95% CI 1.22 to 5.68; P=0.001) and multivariate analysis. From the multivariate

analysis, maternal education emerged as the primary risk factor for stunting among

all variables (P=0.002). This finding was consistent with existing research, conducted

services, therefore have more positive caregiving behaviors and effective feeding

practices, foster optimal child growth, improve socioeconomic status and overall

well-being (Akombi et al., 2017; Emamian et al., 2014; Wachs, 2008).

knowledge about stunting among parents and the probability of stunting (OR 6.0;

95% CI 2,3 to 4.5; P=0.0029). This finding aligns with the preceding paragraph

regarding mother’s education level. Additionally, it may be associated with the lack

of awareness of stunting and appropriate feeding practices. Mothers may encounter

issues such as inadequate child appetite, a preference for outside snacks over home-

some uneducated parents may choose not to insist on their children's food intake to

avoid crying and resistance (Candra, 2020).

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purchasing power, resulting in typically reduced variety and quantity in food choices,

infrequent provision of eggs, meat, fish on a daily basis, thus leading to insufficient

intake of crucial nutrients, such as protein, vitamins, and minerals (Candra, 2020;

Marsaoly et al., 2021).

conscious about their children’s nutritional needs and health are typically associated

with wealthier households (Tiwari et al., 2014). Previous studies in Peruvian,

Cambodian, Bangladeshi children also identified household wealth index as a key

predictor for stunting in children under five years of age (Ikeda et al., 2013; Urke et

al., 2011).

was classified as 'at risk' when it fell below 150 cm (Kemenkes RI, 2015). Numerous

studies have investigated the immediate connection between maternal height and the

size of the child at birth and during specific postnatal stages. However, there is limited

information regarding the correlation between maternal height and the long-term

growth trajectory of offspring. Specifically, there is a gap in research exploring the

link between maternal height and linear growth in offspring during specific and

potentially crucial developmental periods postnatally (Addo et al., 2013).

results from a combination of genetic factors and maternal environmental influences.

Shorter mothers often possess lower protein and energy reserves, smaller

give birth to stunted children (Utami et al., 2018).

were statisctically significant associated with stunting. Our findings align with the

outcomes of a study done by Qurani et al. indicating a notable correlation between

genetic factors, represented by the mother's height, and stunting in the children,

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occurrence of stunting. (Amin & Julia, 2016) Another study by Utami et al. similarly,

found that children between 0-23 months old, born to mothers with a height less than

150 cm, are 1.4 times more prone to developing stunting compared to those with

mothers who are 150 cm or taller. Addo et al. indicated that mothers with a height

below 150.1 cm were more prone to having a child who experienced stunting at 2

years (prevalence ratio = 3.20 (95% CI: 2.80-3.60) and as an adult (prevalence ratio

among the majority of short mothers in the study. Consequently, stunting did not

Gestational Age

weeks), term (37-42 weeks), and post-term (>42 weeks). Preterm birth and

intrauterine growth restriction (IUGR) are the two fundamental biological factors

that contribute to low birth weight (LBW). Infants experiencing intrauterine growth

restriction (IUGR) during fetal development are essentially born malnourished. The

growth deficits observed from birth appear to significantly elevate the likelihood of

stunting up to the age of 2, contributing to short stature and an increased risk of

developing chronic diseases in later life (Sartika et al., 2021).

significant association between gestational age at delivery and the incidence of

stunting (p = 0.338). This aligns with the findings of other studies conducted by

Manggala et al. and Warsini et al.

Maternal Age

maternal age at childbirth correlates with an increased risk of intrauterine growth

restriction (IUGR), preterm birth, and undernutrition. Generally, younger mothers

exhibit lower nutritional statuses than their older counterparts, owing to their own

mother and fetus, thereby limiting adequate nutritional intake for the child

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advanced maternal age poses its own set of pregnancy risks, including increased

occurrences of preterm birth, IUGR, and various maternal health conditions that can

affect offspring (Fall D et al., 2015).

not emerge as a significant contributing factor to stunting. Surprisingly, mothers

categorized as low-risk in terms of maternal age exhibited a higher likelihood of

socioeconomic, psychological, and educational factors, which in turn, influence the

Iron Supplementation

imperative in mitigating the occurrences of anemia, puerperal sepsis, low birth

weight, and stunting (Sari Kencana, 2023). Research indicates a notable threefold

increase in the likelihood of stunting among offspring born to mothers who did not

receive iron supplementation during pregnancy compared to those whose mothers

received such supplementation (Sari Kencana, 2023). In a retrospective cohort study

spanning seven South Asian countries, antenatal iron supplementation exhibited an

8% reduction in stunting risk, whereas the consumption of 120 iron supplementation

tablets demonstrated a 14% reduction (Nisar Y Bin, 2016).

link between iron supplementation and stunting, proactive measures should be

undertaken to minimize associated risks.

Therefore the Health Department including the Community Health Center and The

Public Health Office need to pay more attention not only to cases of stunting but also

to maternal factors that can influence the incidence of stunting in the future.