Sun, Feb 23, 2025
[Archive]
Volume 10, Issue 1 (Feb 2025)
JNFS 2025, 10(1): 50-56 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rusnaeni R, Howay R, Gunawan E, Pratiwi R D, Napitupulu D, Sianturi E I. Factors Associated with Stunting in Posyandu in an Underdeveloped Area of Indonesia: A Cross-Sectional Study in Papua. JNFS 2025; 10 (1) :50-56
URL: http://jnfs.ssu.ac.ir/article-1-827-en.html
URL: http://jnfs.ssu.ac.ir/article-1-827-en.html
Rusnaeni Rusnaeni 
, Rosdiana Howay , Elsey Gunawan , Rani Dewi Pratiwi , Daniel Napitupulu , Elfride Irawati Sianturi *
, Rosdiana Howay , Elsey Gunawan , Rani Dewi Pratiwi , Daniel Napitupulu , Elfride Irawati Sianturi *
Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Cenderawasih, Indonesia
Full-Text [PDF 333 kb]
(131 Downloads)
| Abstract (HTML) (1505 Views)
Introduction
Table 2 shows that the mean age of mothers was 30.42 years (SD = 6.40). The majority of mothers (86.5 %) were unpaid, and consumed Fe supplements during pregnancy (98.2%). More than half of mothers graduated from high school
(59.5 %).
Full-Text: (27 Views)
Factors Associated with Stunting in Posyandu in an Underdeveloped Area of Indonesia: A Cross-Sectional Study in Papua
Rusnaeni Rusnaeni; MSc1, Rosdiana Howay; BSc1, Elsey Gunawan; MSc1, Rani Dewi Pratiwi; MSc1,
Daniel Napitupulu; MSc2 & Elfride Irawati Sianturi; MSc*1
Rusnaeni Rusnaeni; MSc1, Rosdiana Howay; BSc1, Elsey Gunawan; MSc1, Rani Dewi Pratiwi; MSc1,
Daniel Napitupulu; MSc2 & Elfride Irawati Sianturi; MSc*1
1 Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Cenderawasih, Indonesia; 2 Geophysical Engineering Study Program, Department of Physics, Universitas Cenderawasih.
| ARTICLE INFO | ABSTRACT | |
| ORIGINAL ARTICLE | Background: Studies have shown that numerous variables were significantly associated with stunting including knowledge of mothers and level of education. However, the study on nutrition knowledge and nutrition benefits among mothers was limited in Papua. This study aims to explore the prevalence of stunted children in this area and to determine whether the knowledge on healthy nutrition and taking iron supplements are associated with stunted children among mothers who have children under 5 years. Methods: This study as a cross-sectional study was done in 2022. It involved mothers who brought their children under 5 years old to integrated health posts and signed informed consent. Data on balanced nutrition and nutritional benefits for children were collected through a questionnaire consisting of 26 questions with true/false answers. While mothers completed questionnaires on nutrition knowledge, nutrition benefits, and sociodemographic data, height and weight of their children were measured. Results: A total of 496 mothers participated in this study, the mean age of mothers was 30.42±6.40 years. Based on mothers’ characteristics, the majority of mothers went to high school, were unpaid, and consumed iron supplements during pregnancy (98.2%). There was a 10% stunting incidence in this study. After adjusting for potential confounding factors, having children aged 1 to 20 months old (odds ratio (OR)=0.11; 95% confidence interval (CI)=0.03–0.64) and knowledge of nutritional benefits (OR=0.62; 95% CI=0.40–0.95) decreased the odds of stunting. Conclusion: A comprehensive program about nutrition should be available, particularly for mothers. This study also suggests that interventions to increase nutrition knowledge among mothers with children aged under 2 years should be prioritized. | |
| Article history: Received: 7 Feb 2023 Revised: 16 Jul 2023 Accepted:21 Aug 2023 |
||
| *Corresponding author: ira_sianturi@yahoo.co.id Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Cenderawasih, Indonesia. Postal code: 99582 Tel: +62 85770654294 |
||
| Keywords: Stunting; Nutrition status; Dietary supplement; Poverty area; Indonesia. |
Introduction
High prevalence of stunted children has been reported in 40% of children worldwide (Saleh et al., 2021). This may be slightly less common in Indonesia compared to the worldwide occurrence (Beal et al., 2018). Some wealthy regions in Indonesia were reported to have reduced the number of stunting cases, while Papua may be one of the regions still coping with it (Anonim, 2021). Stunting is a health problem that can be seen as the condition of being underweight based on weight for age, short or very short based on height for age, and thin or wasting based on weight according to height (Rinawan et al., 2022) . This condition increases the risk of illness, irreversible body damage, the risk of sub-optimal brain development and affects cognitive ability and mortality in children (Grantham-McGregor et al., 2007) particularly children aged under 5 years. The latest study on effective stunting prevention showed that improvement in nutrition knowledge among mothers was effective to reduce the number of stunted children (Wulandari et al., 2022).
Some studies have found that complex factors have affected stunting prevalence (Danaei et al., 2016). In addition to socioeconomic factors, parental education level can affect the probability of stunting among children. Moreover, some variables related to stunted children were sufficient knowledge of feeding children with nutritious food (Saleh et al., 2021), and taking iron (Fe) and folic acid supplements (Nisar et al., 2020). In addition, multiple micronutrient supplements on childhood growth will add effects on child development. For example, Fe supplements may help with the formation of bones, teeth, joints, muscles, and skin. Hence, Fe deficiency can cause short stature in children (Prendergast et al., 2019).
Indonesia launched Posyandu, abbreviated from Pos Pelayanan Terpadu or integrated service posts as a mother-child health (MCH) community program in mid 1980s (Rinawan et al., 2022). The programs are run by Public Health Centers in every village in Indonesia. Nurses and midwives come monthly to examine child development. Children who attend Posyandu will be weighed by nurses and midwives and regularly provided with supplementary feeding.
According to a prior study, Papua has a higher stunting rate than stunting rate in Indonesia (Wulandari et al., 2022). However, there is limited evidence to support the idea that knowledge of mothers on nutrition is related to the prevalence of stunted children. This study aimed to explore the prevalence of stunted children and to determine whether the knowledge on healthy nutrition and taking Fe supplements are associated with stunted children among mothers who have children aged under 5 years.
Materials and Methods
Study design
This was a cross-sectional study using questionnaires to assess sociodemographic factors, knowledge of mothers on nutrition, and stunted children. The participants were recruited from multi-integrated health posts in rural areas of Papua Province, Indonesia. Inclusion criteria were female subjects, at least 18 years old, mothers who brought their children aged under 5 years for developmental screenings, and subjects who signed informed consent. Those women who brought the children with relationships as caregivers were excluded. The researchers explained the aim of the study while women were having their children checked at Posyandu in Jayapura. The researchers consisted of one pharmacist, one nurse, and an undergraduate pharmacy student. After signing the informed consent, the questionnaire was distributed and completed by the subjects. Data collection was conducted between September and December 2022.
Instruments
The selected questionnaire to assess the knowledge of mothers consisted of 26 questions in 2 domains, balanced nutrition and nutrition benefits for children (Herlianawati, 2017). Balanced nutrition domain has 17 items and 9 items were included to benefits of the nutrition domain. The response was binary (false/true), with correct answers scoring 1 and incorrect answers scoring 0. A total score for each domain score was calculated as the sum of all items.
Data collection
During attending Posyandu, researchers distributed paper-based questionnaires and the questionnaires consisted of women sociodemographic information (age, education level, employment status, whether having Fe supplements during pregnancy, and balanced nutrition and nutrition benefits knowledge and children information (age and gender). Data on balanced nutrition and nutritional benefits for children were collected through a questionnaire consisting of 26 questions with true/false answers. They completed the questionnaires during attending Posyandu while their children were weighing. The z-score values for height-for-age and BMI-for-age were calculated using the World Health Organization (WHO) anthropometrics. The limit for the nutritional status category according to the height index/age is (Characteristics of Mother as Predictors of Stunting in Toddler) (Laksono et al., 2019):
- Stunted: <−3.0 SD to −2.0 SD
- Normal: ≥−2.0 SD.
The results were dichotomized into stunting and normal growth. Data were collected between November and December 2021.
Ethical considerations
The study was approved by the Ethics Commission, Universitas Muhammadiyah Magelang, Indonesia (number: 116/KEPK-FIKES/II.3.AU/F/2022).
Data analysis
The sociodemographic variables were analyzed using descriptive statistics. The outcome variable was binary coded as stunting and normal category. The Chi-square test and Mann-Whitney U test were used to analyze the association between independent variables and stunted children. Independent variabels included age of children, gender, education level, employment status, consuming Fe supplements during pregnancy, and knowledge on nutrition.
All independent variables with a P-value of < 0.20 in the descriptive analysis were included in the multivariate logistic regression analysis (Bursac et al., 2008). In the multivariate logistic regression analysis, all independent variables were significant with a P-value of ≤0.05. Finally, the odds ratios of independent variables and their 95% confidence interval were presented. All analyses were done using two-tailed tests at a significance level of 0.05. The statistical analyses were performed using the Statistical Program for Social Sciences (SPSS) version 24.0 for Windows.
Results
Sociodemographic characteristics of participants: This study involved 496 women who brought their children aged under 5 years to Posyandu and signed informed consent. Table 1 shows that more than half of the children (55.4%) were 1-20 months and were boys (55.4%). In addition, the prevalence of stunted children was 10.3%.
Some studies have found that complex factors have affected stunting prevalence (Danaei et al., 2016). In addition to socioeconomic factors, parental education level can affect the probability of stunting among children. Moreover, some variables related to stunted children were sufficient knowledge of feeding children with nutritious food (Saleh et al., 2021), and taking iron (Fe) and folic acid supplements (Nisar et al., 2020). In addition, multiple micronutrient supplements on childhood growth will add effects on child development. For example, Fe supplements may help with the formation of bones, teeth, joints, muscles, and skin. Hence, Fe deficiency can cause short stature in children (Prendergast et al., 2019).
Indonesia launched Posyandu, abbreviated from Pos Pelayanan Terpadu or integrated service posts as a mother-child health (MCH) community program in mid 1980s (Rinawan et al., 2022). The programs are run by Public Health Centers in every village in Indonesia. Nurses and midwives come monthly to examine child development. Children who attend Posyandu will be weighed by nurses and midwives and regularly provided with supplementary feeding.
According to a prior study, Papua has a higher stunting rate than stunting rate in Indonesia (Wulandari et al., 2022). However, there is limited evidence to support the idea that knowledge of mothers on nutrition is related to the prevalence of stunted children. This study aimed to explore the prevalence of stunted children and to determine whether the knowledge on healthy nutrition and taking Fe supplements are associated with stunted children among mothers who have children aged under 5 years.
Materials and Methods
Study design
This was a cross-sectional study using questionnaires to assess sociodemographic factors, knowledge of mothers on nutrition, and stunted children. The participants were recruited from multi-integrated health posts in rural areas of Papua Province, Indonesia. Inclusion criteria were female subjects, at least 18 years old, mothers who brought their children aged under 5 years for developmental screenings, and subjects who signed informed consent. Those women who brought the children with relationships as caregivers were excluded. The researchers explained the aim of the study while women were having their children checked at Posyandu in Jayapura. The researchers consisted of one pharmacist, one nurse, and an undergraduate pharmacy student. After signing the informed consent, the questionnaire was distributed and completed by the subjects. Data collection was conducted between September and December 2022.
Instruments
The selected questionnaire to assess the knowledge of mothers consisted of 26 questions in 2 domains, balanced nutrition and nutrition benefits for children (Herlianawati, 2017). Balanced nutrition domain has 17 items and 9 items were included to benefits of the nutrition domain. The response was binary (false/true), with correct answers scoring 1 and incorrect answers scoring 0. A total score for each domain score was calculated as the sum of all items.
Data collection
During attending Posyandu, researchers distributed paper-based questionnaires and the questionnaires consisted of women sociodemographic information (age, education level, employment status, whether having Fe supplements during pregnancy, and balanced nutrition and nutrition benefits knowledge and children information (age and gender). Data on balanced nutrition and nutritional benefits for children were collected through a questionnaire consisting of 26 questions with true/false answers. They completed the questionnaires during attending Posyandu while their children were weighing. The z-score values for height-for-age and BMI-for-age were calculated using the World Health Organization (WHO) anthropometrics. The limit for the nutritional status category according to the height index/age is (Characteristics of Mother as Predictors of Stunting in Toddler) (Laksono et al., 2019):
- Stunted: <−3.0 SD to −2.0 SD
- Normal: ≥−2.0 SD.
The results were dichotomized into stunting and normal growth. Data were collected between November and December 2021.
Ethical considerations
The study was approved by the Ethics Commission, Universitas Muhammadiyah Magelang, Indonesia (number: 116/KEPK-FIKES/II.3.AU/F/2022).
Data analysis
The sociodemographic variables were analyzed using descriptive statistics. The outcome variable was binary coded as stunting and normal category. The Chi-square test and Mann-Whitney U test were used to analyze the association between independent variables and stunted children. Independent variabels included age of children, gender, education level, employment status, consuming Fe supplements during pregnancy, and knowledge on nutrition.
All independent variables with a P-value of < 0.20 in the descriptive analysis were included in the multivariate logistic regression analysis (Bursac et al., 2008). In the multivariate logistic regression analysis, all independent variables were significant with a P-value of ≤0.05. Finally, the odds ratios of independent variables and their 95% confidence interval were presented. All analyses were done using two-tailed tests at a significance level of 0.05. The statistical analyses were performed using the Statistical Program for Social Sciences (SPSS) version 24.0 for Windows.
Results
Sociodemographic characteristics of participants: This study involved 496 women who brought their children aged under 5 years to Posyandu and signed informed consent. Table 1 shows that more than half of the children (55.4%) were 1-20 months and were boys (55.4%). In addition, the prevalence of stunted children was 10.3%.
| Table 1. Socio-demographic characteristics of children based on age, gender, and stunting status. | ||
| Variables | n | % |
| Age (months) 1-20 |
275 |
55.40 |
| 21-40 | 144 | 29.00 |
| 41-60 | 77 | 15.50 |
| Sex Boy |
275 |
55.40 |
| Girl | 221 | 44.60 |
| Status of stunting Yes |
51 |
10.30 |
| No | 445 | 89.70 |
Table 2 shows that the mean age of mothers was 30.42 years (SD = 6.40). The majority of mothers (86.5 %) were unpaid, and consumed Fe supplements during pregnancy (98.2%). More than half of mothers graduated from high school
(59.5 %).
| Table 2. Socio-demographic characteristics of women based on age, education, occupation, and iron supplement consumption. | ||
Variables |
Mean±SD | |
| Age of mother (y) |
30.42 ±6.40 |
|
|
Knowledge score
Balanced nutrition domain |
12.73±1.11 |
|
Nutritional benefit domain |
3.85±0.723 |
|
Education levelBasic education |
n |
% |
146 |
29.40 |
|
High school |
294 |
59.30 |
University |
56 |
11.30 |
EmploymentUnpaid |
429 |
86.50 |
Paid |
67 |
13.50 |
Iron supplementationYes |
487 |
98.20 |
No |
9 |
1.80 |
Table 3 shows there is a significant difference between the age of mothers and children,
and balanced nutrition domain compared to stunting.
Multivariate logistic regression: Having children aged 1 to 20 months (odds ratio (OR)=0.11; 95% confidence interval (CI)=0.03–0.64), and having knowledge on nutritional benefits (OR=0.62; 95% CI=0.40–0.95) decreased the odds of being stunting. These factors were protective factors (Table 4).
and balanced nutrition domain compared to stunting.
Multivariate logistic regression: Having children aged 1 to 20 months (odds ratio (OR)=0.11; 95% confidence interval (CI)=0.03–0.64), and having knowledge on nutritional benefits (OR=0.62; 95% CI=0.40–0.95) decreased the odds of being stunting. These factors were protective factors (Table 4).
| Table 3. Result of correlation characteristic test based on children and women with stunting . | |||
| Variables | Stunting (n=51) | Normal (n=445) | P-valuea |
| Age of mothers (y) | 29.00±6.30b | 30.58±6.39 | 0.08 |
| Knowledge score Balanced nutrition domain |
12.76±1.07 |
12.72±1.12 |
0.04 |
| Nutritional benefit domain | 4.06±0.65 | 3.88±0.73 | 0.51 |
| Education level Nine years education |
12 (23.50)c |
134 (30.10) |
0.02 |
| High school | 38 (74.50) | 256 (57.50) | |
| Universities | 1 (2.00) | 55 (12.40) | |
| Working status Unpaid |
44 (86.30) |
385 (86.50) |
0.56 |
| Paid | 7 (13.70) | 60 (13.50) | |
| Iron supplementation Yes |
51 (10.50) |
436 (89.50) |
0.37 |
| No | 0 (0.00) | 9 (100) | |
| Sex Girl |
27 (12.20) |
194 (87.80) |
0.13 |
| Boy | 24 (8.70) | 251 (91.30) | |
| Age of children (months) 1-20 |
28 (10.20) |
247 (89.80) |
0.02 |
| 21-40 | 21(14.60) | 123 (85.40) | |
| 41-60 | 2 (2.60) | 75 (97.40) | |
| a: Independent t-test used for quantitative and Chi-square for categorical variables; b: Mean± SD; c: n (%). | |||
| Table 4. Univariate and multivariate analyses on the association of variables with stunting. | ||||
| Variables | Univariate OR (95% CI) | P-value | Multivariate OR (95% CI) | P-value |
| Sex Girl |
Ref |
0.13 | ||
| Boy | 0.67 (0.38-1.22) | |||
| Age of children (months) 1-20 |
Ref |
0.00 | 0.11 (0.03-0.64) |
0.02 |
| 21-40 | 0.23 (0.05-1.01) | 0.25 (0.05-1.08) | ||
| 41-60 | 0.15 (0.03-0.68) | Ref | ||
| Education level of mothers Nine years education |
Ref |
0.00 | Ref |
0.10 |
| High school | 0.20 (0.02-1.59) | 0.687 (0.33-1.39) | ||
| Bachelor | 0.12 (0.01-0.91) | 5.09 (0.63-40.59) | ||
| Knowledge score Knowledge of balanced nutrition |
Ref |
Ref |
||
| Knowledge of nutritional benefits | 0.63 (0.41-0.96) | 0.06 | 0.62 (0.40-0.95) | 0.03 |
| Age of mothers (y | 1.04 (0.99-1.09) | 0.08 | ||
Discussion
This study showed that based on self-reporting, more than ten percent of children brought to Posyandu were stunted. This was lower than the results of a prior study that used secondary data (Laksono and Kusrini, 2020), but it is difficult to compare the results because of differences in methods and instruments used. The results showed that having children aged 1 to 20 months, and the knowledge of nutritional benefits decreased the odds of stunting, whichwere protective factors.
In line with a prior study, growth disorders may occur from the moment the baby was born until the age of two (Nasrul et al., 2015) and stunting that occurred in the first 36 months will be usually accompanied by long-term effects (Wahdah et al., 2015). It may be related to the weaning phase and a period of high activity when children explore their surrounding environment (Fadzila and Tertiyus, 2019). In addition, this time relates to the period of gross motor skills development for children. At this stage, some children will face several possible circumstances that cause malnutrition, namely decreased appetite, low nutritional intake, decreased sleep hours, and susceptibility to infection when mothers/caregivers pay less attention to hygiene and sanitation. It may occur particularly for women who are still classified as teenagers when they got pregnant. Relatively young maternal age was closely related to growth failure in infants and the age of a mother had a significant relationship with the occurrence of stunting (Yu et al., 2016). Mothers who were too young were likely to have stunted offspring compared to mothers who were from 20 to 35 years old (Manggala et al., 2018). In addition, there is a need to provide nutrition counseling for mothers of those ages. However, there is a need to adjust the implementation of the counselling based on local culture to receive more acceptance among mothers in this area (Sianturi et al., 2022).
Knowledge of nutritional benefits was significantly associated with stunting. A previous study showed that mothers play a substantial role in taking care of feeding children (Wanjihia et al., 2021). Mothers with low knowledge will encounter higher risks of having stunted children since they may not be able to measure their children nutritional needs and to decide which food should be given to children (Rashid et al., 2020). The socio-cultural belief and practices of feeding may relate to how mother commonly feed their children. Mothers usually erroneously provide complimentary food to their children. The existence of negative views also prohibits immunization and exclusive breastfeeding. This is contrary to secondary data that have been used in another study. In their study, education level was insignificant with behavior pattern of mothers in preparing and providing nutritious food for children was related to their educational background (Grantham-McGregor et al., 2007)
The reduction of stunting requires the continuation of current efforts while engaging with macro policy. The government need to engage not only health care providers but also the community. The presence of policies that focus on stunting prevention by improving nutrition and sanitation among mothers and families and collaboration between government and all stakeholders including health sectors and the community is recommended.
This was the first study to examine the prevalence of stunted children and the knowledge of nutrition benefits and taking Fe supplements associated with stunted children in Papua area as one of underdeveloped provinces in Indonesia
and where data is scarce. The study had limitations that may affect its generalizability and representativeness, since the study area was one location in a district closest to the capital. It may be more developed with better health and other social demographic infrastructure. Moreover, results from other areas with narrow health facility gaps between urban and rural areas within Papua may be different.
Conclusion
The prevalence of stunting in this study was lower than other areas, but certain improvements were noted. Mothers play a significant role in preventing stunting in children. A comprehensive program about nutrition should be available, particularly for mothers. This study also suggests that interventions to increase nutrition knowledge among mothers whose children were under 2 years should be prioritized by regular counselling. The intervention should also acknowledge cultural practices to increase acceptance among mothers.
Acknowledgements
The authors would like to express their gratitude to the mothers who participated in this study.
Authors’ contributions
Conceived and designed the study: R Rusnaeni, R Howay, EI Sianturi. Analyzed the data: EI Sianturi, R Rusnaeni, R Howay, D Napitupulu. Wrote the paper: EI Sianturi, R Howay, R Rusnaeni, E Gunawan, RD Pratiwi, D Napitupulu All authors read and approved the final manuscript.
Conflict of Interest
The authors have indicated that they have no competing interests.
Funding
The authors did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References
Anonim 2021. Index Khusus Penanganan Stunting. (ed. B. P. S. Indonesia).
Beal T, Tumilowicz A, Sutrisna A, Izwardy D & Neufeld LM 2018. A review of child stunting determinants in Indonesia. Maternal child nutrition. 14 (4): e12617.
Bursac Z, Gauss CH, Williams DK & Hosmer DW 2008. Purposeful selection of variables in logistic regression. Source code for biology and medicine. 3 (17): 1-8.
Danaei G, et al. 2016. Risk factors for childhood stunting in 137 developing countries: a comparative risk assessment analysis at global, regional, and country levels. PLoS medicine. 13 (11): e1002164.
Fadzila DN & Tertiyus EP 2019. Ketahanan Pangan Rumah Tangga Anak Stunting Usia 6-23 Bulan di Wilangan, Kabupaten Nganjuk Household Food Security of Stunted Children Aged 6-23 Months in Wilangan, Nganjuk District. Nganjuk District. 152: 18-23.
Grantham-McGregor S, et al. 2007. Developmental potential in the first 5 years for children in developing countries. Lancet. 369 (9555): 60-70.
Herlianawati S 2017. Tingkat Pengetahuan Ibu Tentang Pemenuhan Gizi Pada Balita Di Dusun Tegalsari Posyandu Kuncup Mekar GunungKidul. Sekolah Tinggi Ilmu Kesehatan Jenderal Achmad Yani: Yogyakarta.
Laksono A, Ibad M, Mursita A, Kusrini I & Wulandari R 2019. Characteristics of Mother as Predictors of Stunting in Toddler. Pakistan journal of nutrition. 18 (12): 1101-1106.
Laksono AD & Kusrini I 2020. Ecological Analysis of Stunted Toddler in Indonesia. Indian journal of forensic medicine & toxicology. 14 (3): 1733-1739.
Manggala A, Kenwa W, Kenwa M, Jaya A & Sawitri A 2018. Risk factors of stunting in children aged 24-59 months. Paediatrica Indonesiana. 58 (5): 205-212.
Nasrul N, Hafid F, Thaha A & Suriah S 2015. Faktor Risiko Stunting Usia 6-23 Bulan di Kecamatan Bontoramba Kabupaten Jeneponto. Media Kesehatan Masyarakat Indonesia. 11 (3): 139-146.
Nisar YB, Aguayo VM, Billah SM & Dibley MJ 2020. Antenatal iron-folic acid supplementation is associated with improved linear growth and reduced risk of stunting or severe stunting in South Asian children less than two years of age: a pooled analysis from seven countries. Nutrients. 12 (9): 2632.
Prendergast AJ, et al. 2019. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on stunting and anaemia among HIV-exposed children in rural Zimbabwe: a cluster-randomised controlled trial. Lancet child adolesc Hhalth. 3 (2): 77-90.
Rashid M, Parvin S, Alam M & Ullah B 2020. Prevalence of Malnutrition and Contributory Factor among Under Two Years Children in Central Bangladesh. Journal of nutrition and food security. 5 (4): 316-322.
Rinawan FR, et al. 2022. Posyandu Application for Monitoring Children Under-Five: A 3-Year Data Quality Map in Indonesia. International journal of geo-information. 11 (7): 399.
Saleh A, Syahrul S, Hadju V, Andriani I & Restika I 2021. Role of maternal in preventing stunting: a systematic review. Gaceta Sanitaria. 35: S576-S582.
Sianturi EI, et al. 2022. Understanding Reasons for Lack of Acceptance of HIV Programs Among indigenous Papuans: a qualitative study in Indonesia. Sexual Health. 19 (4).
Wahdah S, Juffrie M & Huriyati M 2015. Risk factors for stunting in children aged 6–36 months in the hinterland of Silat Hulu District, Upper Kapuas, West Kalimantan. Indonesian journal of nutrition and dietetics. 3 (2): 119-130.
Wanjihia VW, et al. 2021. The Association between Nutritional Knowledge, SocioEconomic Status of Caregivers and Stunting of Children Under 5 Years in Kwale County of Kenya: A Baseline Survey. Austin journal of nutrition & metabolism. 8 (2): 1-7.
Wulandari RD, Laksono AD, Kusrini I & Tahangnacca M 2022. The Targets for Stunting Prevention Policies in Papua, Indonesia: What Mothers’ Characteristics Matter? Nutrients. 14 (3): 549.
Yu SH, Mason J, Crum J, Cappa C & Hotchkiss DR 2016. Differential effects of young maternal age on child growth. Global health action. 9 (1): 31171.
This study showed that based on self-reporting, more than ten percent of children brought to Posyandu were stunted. This was lower than the results of a prior study that used secondary data (Laksono and Kusrini, 2020), but it is difficult to compare the results because of differences in methods and instruments used. The results showed that having children aged 1 to 20 months, and the knowledge of nutritional benefits decreased the odds of stunting, whichwere protective factors.
In line with a prior study, growth disorders may occur from the moment the baby was born until the age of two (Nasrul et al., 2015) and stunting that occurred in the first 36 months will be usually accompanied by long-term effects (Wahdah et al., 2015). It may be related to the weaning phase and a period of high activity when children explore their surrounding environment (Fadzila and Tertiyus, 2019). In addition, this time relates to the period of gross motor skills development for children. At this stage, some children will face several possible circumstances that cause malnutrition, namely decreased appetite, low nutritional intake, decreased sleep hours, and susceptibility to infection when mothers/caregivers pay less attention to hygiene and sanitation. It may occur particularly for women who are still classified as teenagers when they got pregnant. Relatively young maternal age was closely related to growth failure in infants and the age of a mother had a significant relationship with the occurrence of stunting (Yu et al., 2016). Mothers who were too young were likely to have stunted offspring compared to mothers who were from 20 to 35 years old (Manggala et al., 2018). In addition, there is a need to provide nutrition counseling for mothers of those ages. However, there is a need to adjust the implementation of the counselling based on local culture to receive more acceptance among mothers in this area (Sianturi et al., 2022).
Knowledge of nutritional benefits was significantly associated with stunting. A previous study showed that mothers play a substantial role in taking care of feeding children (Wanjihia et al., 2021). Mothers with low knowledge will encounter higher risks of having stunted children since they may not be able to measure their children nutritional needs and to decide which food should be given to children (Rashid et al., 2020). The socio-cultural belief and practices of feeding may relate to how mother commonly feed their children. Mothers usually erroneously provide complimentary food to their children. The existence of negative views also prohibits immunization and exclusive breastfeeding. This is contrary to secondary data that have been used in another study. In their study, education level was insignificant with behavior pattern of mothers in preparing and providing nutritious food for children was related to their educational background (Grantham-McGregor et al., 2007)
The reduction of stunting requires the continuation of current efforts while engaging with macro policy. The government need to engage not only health care providers but also the community. The presence of policies that focus on stunting prevention by improving nutrition and sanitation among mothers and families and collaboration between government and all stakeholders including health sectors and the community is recommended.
This was the first study to examine the prevalence of stunted children and the knowledge of nutrition benefits and taking Fe supplements associated with stunted children in Papua area as one of underdeveloped provinces in Indonesia
and where data is scarce. The study had limitations that may affect its generalizability and representativeness, since the study area was one location in a district closest to the capital. It may be more developed with better health and other social demographic infrastructure. Moreover, results from other areas with narrow health facility gaps between urban and rural areas within Papua may be different.
Conclusion
The prevalence of stunting in this study was lower than other areas, but certain improvements were noted. Mothers play a significant role in preventing stunting in children. A comprehensive program about nutrition should be available, particularly for mothers. This study also suggests that interventions to increase nutrition knowledge among mothers whose children were under 2 years should be prioritized by regular counselling. The intervention should also acknowledge cultural practices to increase acceptance among mothers.
Acknowledgements
The authors would like to express their gratitude to the mothers who participated in this study.
Authors’ contributions
Conceived and designed the study: R Rusnaeni, R Howay, EI Sianturi. Analyzed the data: EI Sianturi, R Rusnaeni, R Howay, D Napitupulu. Wrote the paper: EI Sianturi, R Howay, R Rusnaeni, E Gunawan, RD Pratiwi, D Napitupulu All authors read and approved the final manuscript.
Conflict of Interest
The authors have indicated that they have no competing interests.
Funding
The authors did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References
Anonim 2021. Index Khusus Penanganan Stunting. (ed. B. P. S. Indonesia).
Beal T, Tumilowicz A, Sutrisna A, Izwardy D & Neufeld LM 2018. A review of child stunting determinants in Indonesia. Maternal child nutrition. 14 (4): e12617.
Bursac Z, Gauss CH, Williams DK & Hosmer DW 2008. Purposeful selection of variables in logistic regression. Source code for biology and medicine. 3 (17): 1-8.
Danaei G, et al. 2016. Risk factors for childhood stunting in 137 developing countries: a comparative risk assessment analysis at global, regional, and country levels. PLoS medicine. 13 (11): e1002164.
Fadzila DN & Tertiyus EP 2019. Ketahanan Pangan Rumah Tangga Anak Stunting Usia 6-23 Bulan di Wilangan, Kabupaten Nganjuk Household Food Security of Stunted Children Aged 6-23 Months in Wilangan, Nganjuk District. Nganjuk District. 152: 18-23.
Grantham-McGregor S, et al. 2007. Developmental potential in the first 5 years for children in developing countries. Lancet. 369 (9555): 60-70.
Herlianawati S 2017. Tingkat Pengetahuan Ibu Tentang Pemenuhan Gizi Pada Balita Di Dusun Tegalsari Posyandu Kuncup Mekar GunungKidul. Sekolah Tinggi Ilmu Kesehatan Jenderal Achmad Yani: Yogyakarta.
Laksono A, Ibad M, Mursita A, Kusrini I & Wulandari R 2019. Characteristics of Mother as Predictors of Stunting in Toddler. Pakistan journal of nutrition. 18 (12): 1101-1106.
Laksono AD & Kusrini I 2020. Ecological Analysis of Stunted Toddler in Indonesia. Indian journal of forensic medicine & toxicology. 14 (3): 1733-1739.
Manggala A, Kenwa W, Kenwa M, Jaya A & Sawitri A 2018. Risk factors of stunting in children aged 24-59 months. Paediatrica Indonesiana. 58 (5): 205-212.
Nasrul N, Hafid F, Thaha A & Suriah S 2015. Faktor Risiko Stunting Usia 6-23 Bulan di Kecamatan Bontoramba Kabupaten Jeneponto. Media Kesehatan Masyarakat Indonesia. 11 (3): 139-146.
Nisar YB, Aguayo VM, Billah SM & Dibley MJ 2020. Antenatal iron-folic acid supplementation is associated with improved linear growth and reduced risk of stunting or severe stunting in South Asian children less than two years of age: a pooled analysis from seven countries. Nutrients. 12 (9): 2632.
Prendergast AJ, et al. 2019. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on stunting and anaemia among HIV-exposed children in rural Zimbabwe: a cluster-randomised controlled trial. Lancet child adolesc Hhalth. 3 (2): 77-90.
Rashid M, Parvin S, Alam M & Ullah B 2020. Prevalence of Malnutrition and Contributory Factor among Under Two Years Children in Central Bangladesh. Journal of nutrition and food security. 5 (4): 316-322.
Rinawan FR, et al. 2022. Posyandu Application for Monitoring Children Under-Five: A 3-Year Data Quality Map in Indonesia. International journal of geo-information. 11 (7): 399.
Saleh A, Syahrul S, Hadju V, Andriani I & Restika I 2021. Role of maternal in preventing stunting: a systematic review. Gaceta Sanitaria. 35: S576-S582.
Sianturi EI, et al. 2022. Understanding Reasons for Lack of Acceptance of HIV Programs Among indigenous Papuans: a qualitative study in Indonesia. Sexual Health. 19 (4).
Wahdah S, Juffrie M & Huriyati M 2015. Risk factors for stunting in children aged 6–36 months in the hinterland of Silat Hulu District, Upper Kapuas, West Kalimantan. Indonesian journal of nutrition and dietetics. 3 (2): 119-130.
Wanjihia VW, et al. 2021. The Association between Nutritional Knowledge, SocioEconomic Status of Caregivers and Stunting of Children Under 5 Years in Kwale County of Kenya: A Baseline Survey. Austin journal of nutrition & metabolism. 8 (2): 1-7.
Wulandari RD, Laksono AD, Kusrini I & Tahangnacca M 2022. The Targets for Stunting Prevention Policies in Papua, Indonesia: What Mothers’ Characteristics Matter? Nutrients. 14 (3): 549.
Yu SH, Mason J, Crum J, Cappa C & Hotchkiss DR 2016. Differential effects of young maternal age on child growth. Global health action. 9 (1): 31171.
Type of article: orginal article |
Subject:
public specific
Received: 2023/02/7 | Published: 2025/02/4 | ePublished: 2025/02/4
Received: 2023/02/7 | Published: 2025/02/4 | ePublished: 2025/02/4
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
