Paediatrica Indonesiana
Paediatrica Indonesiana
Paediatrica Indonesiana
Original Article
G
Abstract rowth and development from conception
Background Growth and developmental delays are com- to adolescence is characteristic of
mon among children under the age of five years (under-five the childhood phase.1 Growth can be
children), especially in slum areas. Early detection and
intervention may give better prognoses. monitored through increments of weight,
Objective To detect growth and developmental delays and height, and head circumference, while development is
related risk factors among under-five children living in an marked by increases in individual abilities, such as gross
inner-city slum area of the Indonesian capital. and fine motor skills, hearing, vision, communication,
Methods This cross-sectional study was conducted from
October to November 2018 in Tanah Tinggi, Johar Baru social-emotion, independence, intelligence, and
District, an inner-city slum area in Central Jakarta. Subjects moral.2 Rapid growth and development occur in the
were healthy children aged 3-60 months. Socioeconomic first five years of life, therefore, close monitoring and
profile was obtained through questionnaires, anthropo- early detection of delays during this critical period is
metric data through measurements, and developmental
status through the Kuesioner Pra Skrining Perkembangan crucial.1,3
(KPSP) instrument. Development was considered to be Close monitoring of children’s development can
delayed for KPSP scores <9. Data were analyzed using be done using questionnaires. A practical and widely-
Chi-square test. used questionnaire in Indonesia is the Kuesioner Pra
Results Of 211 subjects, prevalence of underweight,
stunting, and wasting were 35.1%, 28.0%, and 20.9%, Skrining Perkembangan (KPSP). This KPSP is the
respectively, meanwhile low maternal education, and low Indonesian version of the Prescreening Developmental
family income were 57.9% and 75%. The prevalence of Questionnaire (PDQ), modified by the Republic of
developmental delay was 10%, while suspected develop- Indonesia Ministry of Health in 1996 and revised
mental delay was 26.1%. The prevalence increased from
age 21 months and peaked at 36 months. Associated risk in 2005.1 With sensitivity of 60% and specificity
factors were low maternal education, low family income, of 92%,3 KPSP is recommended for use in primary
underweight weight-for-age, stunted height-for-age, and healthcare services as an early detection method for
microcephalic head circumference-for-age.
Conclusion Low education and low income were significant
risk factors for growth and developmental delay. [Paediatr
Indones. 2019;59:276-83; doi: http://dx.doi.org/10.14238/
pi59.5.2019.276-83 ]. From Department of Child Health, Universitas Indonesia Medical School/
Dr.Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
performed. In our study, KPSP results were categorized Maternal working status
Working 17 (12.6) 12 (15.8)
as normal (total score ≥9) or abnormal (score <9). Non-working 118 (87.4) 64 (84.2)
Data are presented in tables with frequency Family income
and percentage for each category. Differences in High 53 (39.3) 19 (25.0)
proportions of anthropometric results based on Low 82 (60.7) 57 (75.0)
socioeconomic profiles and KPSP results were Weight-for-age (WFA)
Severely underweight 5 (3.7) 11 (14.5)
analyzed using Chi-square test with SPSS version 20.0
Underweight 32 (23.7) 26 (34.2)
software. Results with P values <0.05 were considered Normal weight 91 (67.4) 35 (46.1)
to be statistically significant. Risk of overweight 7 (5.2) 4 (5.3)
Length/height-for-age
(LFA/HFA)
Severely stunted 9 (6.7) 3 (3.9)
Results Stunted 22 (16.3) 25 (32.9)
Normal height 104 (77.0) 48 (63.2)
We examined 290 children during the study period Weight-for-length (WFL)
(October 2018 until November 2018), of whom Severely wasted 1 (0.7) 5 (6.6)
Wasted 23 (17.0) 15 (19.7)
5 children were excluded, 52 dropped out due Good nutritional status 106 (78.5) 52 (68.4)
to incomplete data, and 22 dropped out due to Overweight 5 (3.7) 4 (5.3)
uncooperativeness during examination (refused, slept, Head circumference for
or cried). Thus, 211 children aged 3-60 months were age (HCA)
Microcephalic 15 (11.1) 21 (27.6)
included in this study. The median age of subjects was Normocephalic 120 (88.9) 55 (72.4)
Table 3. Associations between developmental delay (abnormal KPSP scores) and socioeconomic factors as well as
anthropometric results
Variables OR (95%CI) P value
Gender 1.23 (0.70-2.16) 0.466
Total number of children in family 1.22 (0.66-2.26) 0.521
Maternal education 2.34 (1.32-4.15) 0.003†
Maternal working status 1.30 (0.59-2.89) 0.517
Family income 1.94 (1.04-3.62) 0.036†
WFA* 2.51 (1.40-4.52) 0.002†
LFA/HFA** 1.96 (1.06-3.62) 0.031†
WFL*** 1.65 (0.84-3.24) 0.143
HCA**** 3.06 (1.46-6.37) 0.002†
* Categories used for analysis were underweight (underweight and severely underweight) and normal weight (normal and risk of
overweight).
** Categories used for analysis were stunted (stunted and severely stunted) and normal height (normal).
*** Categories used for analysis were wasted (wasted and severely wasted) and good nutritional status (good and overweight).
**** Categories used for analysis were microcephalic and normocephalic.
† P< 0.05.
results requiring referral had global developmental another Indonesian study conducted in children aged
delay (GDD), which was delay in 2 or more domains 2 to 4.9 years reported that maternal education to
of development. Sixteen children were delayed in middle school and below was significantly associated
gross motor skills, 19 children in fine motor skills, with nutritional status of a child. The study finds
14 children in language skills, and 15 children in that maternal education to middle school and
personal-social skills. One mother (primary caregiver) below were associated with weight-for-age Z score
of a child with GDD suffered hearing loss and a speech <-2 (underweight) and height-for-age Z score <-2
disorder. (stunted).14 We noted that maternal education to
senior high school was significantly associated with
children’s improved nutritional status. Mothers
Discussion with higher education are better placed to receive
information about childhood nutrition and are
Growth disturbances among under-five children more responsive in facing acute conditions, such as
living in inner-city slum areas are reflected in the fever and diarrhea,13 such that weight loss may be
prevalences of underweight (WFA <-2SD) and prevented. Therefore, one of the strategies for solving
wasted (WFL <-2SD), which were higher in our nutritional problems in children is strengthening the
study than in the national data from the Indonesian education sector, especially for girls, by completing
Basic Health Research Report 2018 (underweight: their senior high school education, as recommended
35.1% vs. 10.2%, respectively; wasted: 20.9% vs. by the national, 12-year, compulsory education
17.7%, respectively).11 However, the prevalence of program.15
stunted (LFA/HFA <-2SD) in our study population A study reported that in children aged 1-3 years
was lower compared to the national data (28.0% vs. old in Sidoarjo, East of Java, weight-for-age was a
30.8%, respectively), yet higher than the local DKI significantly related variable to family income, but not
Jakarta province prevalence, which was 17.7%.11 to maternal working status.16 Sufficient family income
Growth problems in under-five children living in provides the means to better meeting the nutritional
urban slum areas can be caused by inappropriate requirements of children.
feeding practices, diseases occurring due to poor There was no significant difference in
sanitation, inappropriate parenting, and lack of access socioeconomic factors between stunting and normal
and coordination of public health services.12 height in our study. This finding might have been due
In our study, low maternal educational level to the limited sample size. In addition, several factors
was associated with weight-for-length (wasted). This associated with height-for-age were not studied, such
finding was in agreement with a study by Makoka,13 as history of intrauterine growth restriction, premature
which showed that children’s nutritional status birth, poor sanitation, infectious disease, as well as
increased with maternal education. In addition, energy and protein intake.17,18 These factors may play