Advances in Health Sciences Research, volume 27

Proceedings of the 1st International Conference on Science, Health, Economics,

Education and Technology (ICoSHEET 2019)

Factors Related to Stunting in Toddlers

1st Indanah
2nd Ratna Dewi J
D3 Nursing Program
S1 Nursing Program
Muhammadiyah University of Kudus
Muhammadiyah University of Kudus
Kudus, Indonesia
Kudus, Indonesia
[email protected]
[email protected]

Abstract—Stunting is a state of failure to thrive, occurring and how to assess nutritional status using the Zscore rules
in children under 5 years of age. Stunting is a chronic listed in the Decree of the Minister of Health of the Republic
malnutrition. The incidence of stunting according to the World of Indonesia Number:1995/MENKES/SK/XII/2010 About
Health Organization (WHO, 2012) is estimated that there are
Antopometry Standards for Assessment of Child Nutritional
162 million children under 5 year-old. The prevalence of
stunting is a public health problem. The percentage of stunting Stantus. This stunting can be caused by direct or indirect
in Indonesia is still categorized high and is a health problem factors. One of the direct causes of stunting is nutrition
that must be overcome. Many factors can cause stunting. The intake [4].
purpose of this study was to determine what factors are Stunting toddlers increase the risk of decreased intellectual
associated with the incidence of stunting in infants in the X ability, inhibits motor skills, productivity, and increases the
health center area of Kudus Regency. This study uses a case risk of degenerative diseases in the future. This is because
control design with a retrospective approach. Sampling using stunting children tend to be more prone to becoming obese,
stratified random sampling technique with a sample of 90 because people with short bodies should ideally also have a
toddlers. The results showed that there was a significant
low body weight. just a few pounds can make a person's
relationship between education, parental knowledge, history of
immunization, history of breastfeeding, birth length, birth Body Mass Index (BMI) rise above normal limits.
weight and eating patterns with the incidence of stunting (p Factors of parental education, behavior and genetics,
value: 0.0000) socioeconomic conditions, breastfeeding, low birth length
(LBL) and low birth weight (LBW) are factors related to
Keywords—stunting, toddlers stunting. One of the risk factors that influence the incidence
of stunting in children under five is low birth weight (LBW)
I. INTRODUCTION
and low birth length (LBL). LBW and LBL will result in
Stunted growth that reflects stunted growth due to disruption of the growth of the baby, if this situation
malnutrition. Stunting is characterized by an index of body continues and the provision of food that can not meet the
length compared to age (L / U) or height compared to age (H needs of the baby, often infected with infectious diseases
/ U) with a z-score limit of less than -2 SD [1]. According to can cause toddlers to become stunted [5].
WHO (2010) [1], Stunting reflects the nutritional status of Factors that cause stunting include incomplete basic
less than chronic during growth and development since early immunization coverage and exclusive breastfeeding [1].
life. Stunting is a form of growth failure (shaky growth) Immunization provides an immune effect against humans,
accumulated inadequate nutrition that lasts a long time. needed especially at an early age which is an age vulnerable
The problem of short children (stunting) is one of the to disease [6]. In Indonesia, the coverage of complete basic
nutritional problems faced in the world, especially in poor immunization (CBI) in 2016 has not reached the target. The
and developing countries [2]. Stunting is a problem because government is targeting cbi coverage of 91.5%, but until the
it is associated with an increased risk of morbidity and end of the year only 82.1% has been achieved. This figure is
death, suboptimal brain development so that motor equivalent to 3,589,226 babies born throughout 2016.
development is delayed and stunted mental growth [2]. The Achievements in 2016 are different from 2015, which
prevalence of stunting in several countries in Southeast exceeded the target. CBI coverage reached 80%, which is
Asia, such as Myanmar by 35%, Vietnam by 23%, and greater than the target of 75%, the figure is equivalent to
Thailand by 16%. The prevalence of stunting in Indonesia 4,139,903 babies born a year ago. Giving immunization to
According to the 2013 Basic Health Research was 37.2%, an children follows the existing schedule. By providing
increase from the year 2010 of 35.6% and in 2007 of 36.8%. immunizations according to a predetermined schedule
This means that the maximum growth is suffered by around provides optimal immune formation results (antibodies) so
8 million children in Indonesia, or one in three children in as to protect children from exposure to disease.
Indonesia. The prevalence of stunting in Central Java is WHO(world health organization) states that only 40% of
relatively high at 33.6% with details of 17% of short children babies in the world get exclusive breastfeeding while 60% of
and 16.9% of very short children [3]. The prevalence of other babies have actually received non-exclusive
stunting is even higher compared to nutritional problems in breastfeeding when they are less than 6 months old. This
other toddlers such as malnutrition (19.6%), thinness illustrates that exclusive breastfeeding is still low while the
(6.8%), and fat (11.9%), (Millennium Challenge Account practice of non-exclusive breastfeeding in various countries
Indonesia 2015). is still high. Data in Indonesia shows that exclusive
The tool to determine whether a child is stunted or not is
a WHO table based on the WHO-NCHS Reference
Standard
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 Advances in Health Sciences Research, volume

breastfeeding coverage is only 42%. This figure is clearly 25 years old, most (77.8%) as housewives, and have high
below the WHO target which requires coverage of breast school education (47.8, 3%)
milk up to 50%. This figure indicates that only a few
Indonesian children receive adequate nutrition from breast TABEL 1 TODDLER RESPONDENTS CHARACTERISTICS
milk. Whereas breastfeeding plays an important role in the BASED ON AGE, BW, WL (N:90)
process of physical and mental development of children with Variable Mean SD Min-Max 95% CI
long-term impacts [3]
Inadequate nutritional intake of children can lead to Age 30,52 12,868 13 - 60 27,83 – 33,22
(month)
disruption of growth and development in children, even if BW (gram) 2910 567,152 2200 - 3900 2791,04 –
the condition is not handled properly, the risk of illness and 3028,83
death of children will increase. Parents who will feed their BL (cm) 48,09 2,612 43 - 52 47,54 – 48,64
children are related to parents' knowledge and parental
education, this is due to the level of understanding and Diagram 1 explains that based on PBL and BBL, out of
acceptance of information that parents will absorb about 90 infants there are 42 (47%) respondents who have Low
nutrition that will be given to their children. Parental BBL and 43 (48%) have a body length that is less than
education is closely related to the nutritional status of normal. The results of the history of breastfeeding and
children because parents, especially mothers who directly breastfeeding history shows that 9 (10%) respondents did
care for children, including preparing and providing food to not get complete immunizations and 48 (53%) were not
children. Septikasari, (2018) [7] states that the higher the given breast milk exclusively. Eating patterns and Parental
level of one's education, the easier it is to be given an Knowledge are explained in Diagram 1 with the results that
understanding of information, and the easier it is to 45 (50%) toddlers get good eating patterns and 52 (58%)
implement knowledge in behavior, especially in terms of parents of toddlers have good knowledge about stunting
health and nutrition.
B. Bivariate Analysis
Regarding parents' feeding patterns to their children, the
results of the study Nurbaiti et al, (2014) say that the The results of the bivariate analysis of factors related to
customs and culture that have taken root greatly influence stunting can be explained in Table 2. In Table 2 it can be
their behavior and living habits, including eating habits and explained that all factors are related to the incidence of
daily eating patterns. The types of food ingredients and stunting in infants. This can be seen from the p value =
menus consumed, meal times, frequency of meals, food 0.0000 (α <0.05). Based on the Odd Ratio for each
destination, to the types of food items taboo by the variable, the variable pattern of parental feeding among
community are strongly influenced by their customs and toddlers shows a high number that is 462 which means that
culture. The same thing applies to children in the first 1,000 for toddlers who get poor diet, 462 times will be at risk of
days of their lives. [8] stunting.
There is a relationship between birth weight and the
II. METHOD incidence of stunting. Birth weight is the most important
This research is a quantitative study using analytic anthropometric measure and is most often used in newborns
descriptions with a case control research design with a (neonates). Birth weight (BW) is used to diagnose normal or
retrospective approach. The study was conducted for 2 Low Birth Weight (LBW) babies. For example babies born
months, namely March and April 2019. The population in with low birth weight can be at risk of experiencing growth
this study were parents who had stunting and not stunting failure that can cause stunting. Mothers who have poor
toddlers in the Kudus District Health Center area of 100 nutritional status, age of mothers who are too old and too
people. The sampling technique in this study uses Stratified young, maternal education, and diseases suffered by
random sampling technique for toddlers who are not stunted. pregnant women such as anemia, asthma, hypertension, HIV
The overall sample in this study was 90 parents of toddlers / AIDS etc., are likely to give birth to babies with low birth
with details of 45 toddlers experiencing stunting and 45 weight (LBW) and premature is also greater. Low birth
toddlers not experiencing stunting. This study uses a weight is a multi-picture picture of public health problems
questionnaire that has been tested for validity and reliability including mothers with long-term malnutrition, poor health,
to assess the variables of knowledge, feeding patterns and hard work and poor health care and pregnancy. Individually,
history of breastfeeding. As for the LBL, LBW, LBW is an important predictor in the health and survival of
Immunization History variables using the results recorded in newborns and is associated with high risk in children. The
the Children's KIA Handbook. For stunting criteria use proportion of stunting toddlers is higher in toddlers with a
Nutrition measurements from NCHS. The data in this study history of low birth weight (Diagram 1). Babies born with
were analyzed using a computer program. Data were Low Birth Weight (<2500 grams) have the opportunity to
analyzed using univariate, and bivariate analysis. Using chi experience stunting 16 times compared with babies born
square analysis. with normal weight.
Based on univariate analysis in Diagram 1, it can be
III. RESULT AND DISCUSSION concluded from 90 respondents that most respondents who
A. Characteritics of Respondents had normal birth length were 47 respondents (52.2%), while
Respondents in this study were mothers and toddlers in respondents who had low birth length (LBL) were 43
the District Health Center X Kudus District. Of the 90 respondents (47.8%) . Based on the results of calculations
respondents in the intervention group, the average toddler with the chi square test obtained a significant level of p =
with an average age of 2.5 years and male sex (57.8%). The 0,000
average mother is <0.005. Thus it can be concluded that there is a relationship

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between the length of the body born with the incidence of This gap can only be eliminated or reduced by breastfeeding.
stunting in Puskesmas X Kudus District. Mother's milk contains immunity or immune system so that
Low birth length indicates that the child in the womb is it can be a protection for babies from various infectious
experiencing a lack of nutritional intake so that the impact diseases such as bacteria, viruses, and fungi. Children who
on the growth of children is not optimal but if after the child are not breastfed for 6 months are counted after birth, the
is born the child does not get adequate nutritional intake in a child is susceptible to infection. The relationship of history
long time so that one of the impacts is the nutritional status of breastfeeding with the incidence of stunting shows that
of children is based on height and low age, which makes children who are not exclusively breastfed have 37 times the
toddlers at risk of stunting. chance to experience stunting. The proportion of stunting
toddlers is higher in toddlers who are not exclusively breastfed
(Table 1).
TABLE 2
DIAGRAM 1 CHARACTERISTICS OF RESPONDENTS CHARACTERISTICS OF RESPONDENTS BASED ON FACTORS
BASED ON INDEPENDENT VARIABLES (N = 90) RELATED TO STUNTING (N = 90

100
No Variable OR P value
80 1 Birth Weight ( BW) 16 0,000
60 (5,349 – 147,858)
40
20 2 Birth Length (BL) 16,188 0,000
0 (5,732 – 45,717)
Exclus
Compl

Incompl

P
L

Nor

P
Nor

3 Basic Immunization 0,444 0,000

(0,348 – 0,567)
Not

4 Breastfeed 37 0,000
Birth WeightB(irBtWh L) engtBhas(iBcLI)mmunizatBiorenastfeedDietary habitKnowledge (11,106 –123,271)
5 Dietary habit 462,250 0,000
Low birth length indicates that the child in the womb is (62,245 –
experiencing a lack of nutritional intake so that the impact 3432,803)
on the growth of children is not optimal but if after the child
is born the child does not get adequate nutritional intake in a 6 Knowledge 86 0,000
(17,452 – 423,780)
long time so that one of the impacts is the nutritional status
of children is based on height and low age, which makes
toddlers at risk of stunting.
The poor and unequal status of the mother obtained by The relationship of immunization history with the
the mother during pregnancy, causing the child to be born incidence of stunting shows that children who do not have a
with a nutritional state that is lacking. There is a relationship complete history of immunization have a greater chance of
between the length of the body born with the incidence of experiencing stunting, which is 0.4 times compared to children
stunting in infants in the working area of Health Center X who have a history of complete immunization
Kudus Regency in 2019. The proportion of toddlers with There was a significant relationship between feeding
stunting is more in infants with a history of less birth length. patterns and the incidence of stunting among children at
Toddlers with a long history of low birth weight are 16 times Puskesmas X Kudus District in 2019 (p value 0,000; α
stunted. <0.005). As children age, the food they provide must be
History of immunization is to provide immunity against more diverse and nutritious and balanced in order to support
a particular disease. Children are immune or resistant to one the nutritional status and growth and development of
disease but not necessarily immune to other diseases. children. The mother plays an important role in determining
Immunization is an effort to actively raise / increase a the types of food that will be consumed by children.
person's immunity to a disease, so that if one day exposed to Provision of adequate eating patterns associated with good
the disease it will not hurt or only experience mild illness. quality food consumption of children which will ultimately
For children who get complete basic immunization can increase the adequacy of nutrients as well. The level of
prevent suffering or pain caused by diseases that are likely to nutrient adequacy is one of the factors that can affect the
cause disability or death. Benefits for the family and the nutritional status of children under five. Toddlers who are
country can improve the level of health and be able to create not good in feeding patterns will have the opportunity to
a strong and sensible nation to continue the country's experience stunting 462 times (table 1). The proportion of
development. stunting toddlers is more in toddlers who are less good in
The relationship of immunization history with the their feeding patterns. Inadequate nutritional intake of
incidence of stunting shows that children who do not have a children can lead to disruption of growth and development in
complete history of immunization have a greater chance of children, even if the condition is not handled properly, the
experiencing stunting, which is 0.4 times compared to children risk of illness and death of children will increase.
who have a history of complete immunization Parents who will feed their children are related to
Exclusive breastfeeding is full breastfeeding for the first parental knowledge and parental education, this is due to the
six months without giving food or other drinks to the baby. level of understanding and acceptance of information that
For newborn babies scientifically get immunoglobulin (immune parents will absorb about nutrition to be given to their
or immune substances) through the placenta, but the levels children. The level
of these substances will quickly decrease immediately after
birth.

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of maternal knowledge about nutrition is one of the factors that

can influence the occurrence of stunting in children under five,
both in rural and urban areas. Knowledge about nutrition is
the initial process in changing behavior to improve
nutritional status, so knowledge is an internal factor that
influences behavior change. The mother's knowledge about
nutrition will determine the mother's behavior in providing
food for her child. Mothers with good nutritional knowledge
can provide food with the right type and amount to support
the growth and development of children under five. There is
a relationship between parents' knowledge about nutrition with
the incidence of stunting. Parental knowledge about poor
nutrition will provide an opportunity 86 times for toddlers to
experience stunting. The proportion of toddlers with stunting
is more for mothers of toddlers who have less knowledge
about toddler nutrition.
IV. CONCLUSION
The main conclusion of this study is that there is a
significant relationship between independent variables (PBL,
BBL, Immunization History, History of Breastfeeding,
Feeding Patterns and Parental Knowledge) with stunting
events in Puskesmas X Kudus District in 2019 with a p
value
< 0,000 ( α:0.05). Toddlers who are not good in feeding
patterns have 462 chances of experiencing stunting.
ACKNOWLEDGMENT
I wish to express my deep thanks to all the members of
the Department of Nursing, Muhammadiyah University of
Kudus for their kindness and helps to my articles.
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