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DEVELOPMENT OF NON-CONTACT DETECTION OF CHILD STUNTING USING

ULTRASONIC SENSORS YUNI KUSMIYATI LUCKY HERAWATI

Article · August 2023

DOI: 10.17605/OSF.IO/6GFAP

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Jilin Daxue Xuebao (Gongxueban)/Journal of Jilin University (Engineering and Technology Edition)
ISSN：1671-5497
E-Publication: Online Open Access
Vol: 42 Issue: 08-2023
DOI 10.17605/OSF.IO/6GFAP

DEVELOPMENT OF NON-CONTACT DETECTION OF CHILD

STUNTING USING ULTRASONIC SENSORS

TRI SISWATI*
Associate Professor, Department of Nutrition, Politeknik Kesehatan Kemenkes Yogyakarta, Indonesia.
Center of Excellence in Health Science and Research for Applied Technology Innovation in The Field of
Public Health (PUI_Novakesmas), Politeknik Kesehatan Kemenkes Yogyakarta, Indonesia.
Corresponding Author Email: [email protected]
YUNI KUSMIYATI
Associate Professor, Department of Midwifery, Politeknik Kesehatan Kemenkes Yogyakarta, Indonesia.
Email: [email protected]
LUCKY HERAWATI
Professor, Department of Health Environment, Politeknik Kesehatan Kemenkes Yogyakarta, Indonesia.
Email: [email protected]
YULIASTI EKA PURNAMANINGRUM
Lecturer, Department of Midwifery, Politeknik Kesehatan Kemenkes Yogyakarta, Indonesia.
Email: [email protected]
BUNGA ASTRIA PARAMASHANTI
Department of Nutrition, Faculty of Health Sciences, Universitas Alma Ata. Yogyakarta, Indonesia.
Sydney School of Public Health, The University of Sydney, New South Wales 2006, Australia.
Email: [email protected]
MUHAMMAD PRIMIAJI RIALIHANTO
Lecturer, Department of Nutrition, Politeknik Kesehatan Kemenkes Yogyakarta, Indonesia.
Email: [email protected]

Abstract
Childhood stunting remains public health issue globally and in Indonesia. Thus, providing safe, affordable,
and precise measurements of height or length is one important aspect of stunting detection in children.
This study aims to develop an anthropometric tool using ultrasonic technology with the output of height or
length, z-score, and stunting status of the children. We developed a comprehensive height/length
measurement tool that generates measurement results in centimeter’s, z scores, and nutritional status for
toddlers. The Z-score calculation followed The Indonesian Ministry of Health Regulation Number 2 in
2020 about Child Growth Standards. The materials included HC-SR04 ultrasonic sensors, ESP32
microcontrollers, OLED 128x64 pixels, and fiber. To achieve a steady measuring value, we conducted
measurement trials by observing the free area of the measure. The Ultrasonic HC-SR04 sensor was used
in this tool to measure height, which was then processed by the ESP32 microprocessor to determine the
measured height classification. The classification findings were then shown on a 128x64 pixel OLED
display. The measurement results indicated that the ultrasonic sensor had a transmitting angle of 15 o. As
conclusion this non-contact anthropometric measurement tool has the potential to be utilized through
community empowerment since it is simple to use, easy to carry, and portable.
Keywords: Stunting, Ultrasonic, Sensor, Non-Contact Measurement, Anthropometry, Growth, Height,
Length

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Jilin Daxue Xuebao (Gongxueban)/Journal of Jilin University (Engineering and Technology Edition)
ISSN：1671-5497
E-Publication: Online Open Access
Vol: 42 Issue: 08-2023
DOI 10.17605/OSF.IO/6GFAP

1. INTRODUCTION
Stunting is a condition where a child's height is lower than standard [1]. Stunting is a
form of malnutrition caused by repeated infections and long-term malnutrition. In
addition, stunting under five reflects the social, sanitation, and economic problems of
the region [2], [3]. Currently, stunting is still a major health problem in low- and middle-
income countries, including Indonesia [3], [4]. Based on the 2022 Indonesian Nutritional
Status Survey, the country is currently in the moderate stunting category [5] as many as
21,6% [6]. In fact, stunting greatly interferes with human quality and productivity and
even increases the risk of morbidity and death [7]–[10].
Concerning the COVID-19 pandemic, amid efforts made to reduce stunting, the COVID-
19 pandemic also increases the risk of decreasing the nutritional quality of vulnerable
groups, including toddlers [11]–[14]. To prevent the pandemic, service activities at
Posyandu (an integrated health post for child growth monitoring) stopped due to
restrictions on mobilization and avoiding human contact. Restrictions and population
mobilization also disrupt health services for pregnant women and other vulnerable
groups in need of health services [11], [15], [16].
Several efforts have been made to reduce the risk of stunting under five and its severity
including safe, inexpensive height or length measurements, and providing precise
measurement results [17]. In toddlers, body mass measurements can provide
information on the health status and well-being of toddlers, as well as detection of
nutritional adequacy, impaired growth and development and health and well-being of
toddlers [17], [18].
There are several kinds of toddler height measurement tools in the community such as
microtoise, infantometer [19], measuring tape [20], growth mat (or tikar pertumbuhan in
Bahasa Indonesia) [21] and growth sticker [22]. All of these tools are measuring
instruments used with contact between the measured and the measuring so that the
accuracy of the measuring data is very dependent on the knowledge, skills and
motivation of the meter as well as good cooperation between the mother of the toddler
and surveyor [23]–[25]. One way of measurement with the manual method is that it
takes quite a lot of time, a lot of manpower/human resources involved and complex
procedures [23], and suboptimal validity of measurement results [26]. The results
showed that there was a difference between anthropometric measurements carried out
by cadres with the results of meaningful statistical analysis, so the measurement results
needed to be validated [27].
Non-contact height measurement with ultrasonic sensor technology is one of the efforts
to reduce disease transmission, such as during the current COVID-19 pandemic [28].
Technology also facilitates measurement, improves data accuracy, saves resources
and supports stunting intervention programs [29][26]. Previous research reported that
the use of sensors can provide accurate anthropometric measurement results of up to
95%[30]. Thus, this study aims to develop anthropometric tools using ultrasonic
technology with the output of height or length, z-score and the state of toddlers whether
stunting or normal.

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Jilin Daxue Xuebao (Gongxueban)/Journal of Jilin University (Engineering and Technology Edition)
ISSN：1671-5497
E-Publication: Online Open Access
Vol: 42 Issue: 08-2023
DOI 10.17605/OSF.IO/6GFAP

2. METHODS
2.1 System Block Diagram
At this stage, we developed a comprehensive height/length measurement tool to
produce output in the form of measurement results in centimetres, z score, and
children's nutritional status.
2.2 Design
The input of anthropometric tools developed included the date of birth of toddlers,
measurement dates, sex, and measuring positions. In this tool, anthropometric
standards were included based on the 2005 WHO Anthropometry. The measurement
data were categorized based on the Z-score as per The Indonesian Ministry of Health
Regulation Number 2 in 2020 about Child Growth Standards. Toddlers were
categorized as severe stunting if the Z-score was <-3 standard deviations, stunting if the
Z-score was < -2 standard deviations, normal if -2 to 3 standard deviations, and >3
standard deviations were high [31].
2.3 Materials
The materials used were 4 AAA batteries, buttons, HC-SR04 Ultrasonic sensors,
ESP32 microcontrollers, OLED 128x64 pixels and fiber for the case.
2.4 Measurement Trials
Measurement trials were carried out to determine the measurement results. This test
was carried out by observing the free area of the measure to produce a stable
measuring value.

3. RESULTS
3.1 Prototype
This tool used the Ultrasonic HC-SR04 sensor to measure height which later was
processed by the ESP32 microcontroller to determine the measured height
classification. Then, the tool displayed the classification results on a 128x64 pixel OLED
display. Figure 1 describes how the tool works.

Figure 1: Prototype and how the tool works

This tool was divided into three parts, namely electronic, mechanical, and program. The
electronic part included microcontrollers, PCBs, and some components. The
mechanical part included the casing design of this tool. Meanwhile, the program part
was code embedded in the microcontroller using the Arduino language. Figure 2
describes parts of this tool.

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Jilin Daxue Xuebao (Gongxueban)/Journal of Jilin University (Engineering and Technology Edition)
ISSN：1671-5497
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Vol: 42 Issue: 08-2023
DOI 10.17605/OSF.IO/6GFAP

No Design Figure

1. Preview PCB

2. 3D Preview PCB

3. PCB results

4. Wiring diagram

Figure 2: Electronic parts of the tool

The mechanical part included the creation of the casing design for this tool. The
prototype casing of this tool was made with PLA material using 3D Print. Figure 3
describes the design of the case.

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Jilin Daxue Xuebao (Gongxueban)/Journal of Jilin University (Engineering and Technology Edition)
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Vol: 42 Issue: 08-2023
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No. Parts Figure

1. Size preview

2. Front-top view

3. Front-down view

4. Back-top view

Figure 3: Mechanical parts of the tool

The following is the program (code) section containing commands poured on the
microcontroller. This program used Arduino language and used Arduino IDE software.
The detailed flowchart of the program is shown in Figure 4.

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Figure 4: Program Flow Diagram

The calculations were carried out by the ESP32 microcontroller, including calculating
the child’s age. The child’s age in months was obtained. by calculating the number of
days from the input date of birth and the current date, then the result is divided by
30.4375. In addition, another process that occurs is to get the median value and Z-score
reference based on age and measurement method. Finally, the calculation of the Z-
score with the following formula:

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ISSN：1671-5497
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Vol: 42 Issue: 08-2023
DOI 10.17605/OSF.IO/6GFAP

This value was then classified based on the Indonesian Ministry of Health Regulation
No. 2 in 2020 about the Child Anthropometric Standard. The categorization was severe
stunting (if Z-score <-3 SD), stunting (if Z-score <-2 SD), normal (if -2 to +3 SD), and tall
(if >3 SD) [31]
3.2 Measurement trials
Measurement trials were carried out to determine the sensitivity of the tool by placing
objects around the tool. The measurement results indicated that the ultrasonic sensor
had a transmitting angle of 15o. This sensor utilized objects as ultrasonic sound
reflectors in reading the distance to the object so that the area was the reading area of
the tool. To produce a valid measuring value, the area should be free as shown in
Figure 5.

Figure 5: Tool reading area using an ultrasonic sensor

4. DISCUSSION
Changes in height are very important parameters to determine nutritional adequacy,
especially nutritional adequacy in the long term [32]. Toddler height also reflects general
social conditions including household economic conditions, sanitation, education,
parental knowledge, policies and other social factors [3], [33], [34]. Children who are
stunted often experience developmental disorders [9][7], obesity, morbidity, mortality
and other non-communicable diseases [35]–[38]. The main way to detect stunting is to
measure height or length correctly and regularly, especially at toddler age [17].
Measuring height or length by automatic methods is an easy way to do and save
resources [29], [39]–[43]. The use of sensors also has sufficient accuracy [44], [45][30].
In previous research, the development of automatic and non-contact height measuring
instruments with ultrasonic sensor technology has been successfully developed, but the
measurement output is centimeters [30]. Meanwhile, for the benefit of the intervention,
the nutritional status of toddlers determined through measuring height or length in
centimeters is still being processed through calculations by comparing the

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Vol: 42 Issue: 08-2023
DOI 10.17605/OSF.IO/6GFAP

measurement results with WHO anthropometric standards of 2005[46] and then

categorized into normal growth or stunting.
In this study, we have succeeded in developing a height/length measurement tool with a
centimeter, z-score and toddler status whether stunting or normal growth. This tool is
one of the technological innovations that support health transformation pillar 1, namely
primary health services with a priority to overcome stunting under five and pillar 6,
namely health technology transformation. This tool has the advantage of being easy to
use, with a reading area with an angle of 15%. This measuring tool is useful for stunting
prevention programs, and preventing disease transmission such as during the COVID-
19 pandemic and other special conditions.

5. CONCLUSION
The design of a non-contact height/length measurement instrument has been
successfully made, because the sensor reads objects by reflecting ultrasonic sounds, to
have optimal measurement results, a free area with an angle of 15 o of its. The use of
this non-contact anthropometric measurement tool can detect stunting early, easy to
use, easy to carry or portable so it has the potential to be used by ordinary people
through community empowerment at Posyandu.

6. AUTHORS’ CONTRIBUTIONS
This work was carried out in collaboration among all authors. All authors read and approved the final
manuscript.
7. CONSENT
Not applicable.
8. ETHICAL APPROVAL
Not applicable.
9. COMPETING INTERESTS
We don’t have any competing interests.
10. ACKNOWLEDGEMENT
We thank to Zulvan Kheidir 'Aliy Nurwigantara which develop this tool.

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Vol: 42 Issue: 08-2023
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