A review of child stunting determinants in Indonesia

Seasonal Variation of Household Food Insecurity and Household Dietary Diversity on Wasting and Stunting among Young Children in A Drought Prone Area in South Ethiopia: A Cohort Study

This study was conducted to evaluate seasonal patterns of household food insecurity, dietary diversity, and household characteristics on wasting and stunting among children in households followed for 1 year in the drought-prone areas of Sidama, Ethiopia. A cohort study design was employed. Data were collected on the pre-harvest season (March and June) and post-harvest season (September and December) of 2017. We studied 935 children aged 6 to 47 months. At four seasons over a year, we had 3,449 observations from 897 households and 82% (2,816) (95% CI: 80.3-82.9) were food in-secured households. Severe food insecurity was higher in the pre-harvest (March; food scarcity season) which was 69% as compared to 50% of September (P < .001). From 3,488 observations, 44% (1,533) (95% CI: 42.3-45.6) of children were stunted. Stunting showed seasonal variations with 38% (95% CI: 34.7-41.0) in March and 49% (95% CI: 45.8-52.5) in December. Six percent (95% CI: 5.0-6.6) of children were wasted, with higher prevalence in March (8%) as compared to 3% of September (P < .001). Moreover, household characteristics such as poverty level, education, occupation and the household food insecurity and dietary diversity were associated with subsequent wasting and stunting.

An interpersonal nutrition campaign and maternal knowledge and childhood feeding practices: a case study from mothers in rural Indonesia

Background

The purpose of this study was to examine the extent to which a national nutrition communication campaign (NNCC) intervention providing interpersonal communication (IPC) was associated with improved knowledge and behaviors related to feeding practices among mothers with children under two years of age in rural Indonesia.

Methods

Data came from a follow-up, cross-sectional survey of 1734 mothers. Key outcomes of interest were minimum meal frequency, minimum dietary diversity and minimum acceptable diet, as defined by the World Health Organization. Associations between exposure to the NNCC intervention and infant and young child feeding (IYCF) knowledge and behaviors were analyzed using adjusted linear and logistic regression, controlling for age, education, and income.

Results

A total of 525 mothers reported exposure to IPC interventions (30.3%). Participation in IPC was associated with increased knowledge of feeding practices (p < .0001). Separately, knowledge of feeding practices was related to achieving recommended behavioral practices of minimum meal frequency (p = 0.019), dietary diversity (p = 0.013), adequate diet (p < .001).

Conclusion

These findings underscore the value of increasing maternal knowledge of IYCF practices through IPC interventions as a way to improve behavioral practices and address stunting in rural Indonesia.

Determinan Balita Stunting di Jawa Timur: Analisis Data Pemantauan Status Gizi 2017

Background: Stunting in early life will have adverse functional consequences, including poor cognition and low levels of education. The study aimed to determine the determinants of stunting toddlers in East Java.Methods: The study uses secondary data from the 2017 PSG. Using the multi-stage cluster random sampling method, a sample of 10,814 toddlers aged 0-59 months was taken. The analyzed variables consisted of the dependent variable nutritional status of toddlers, 7 independent variables: residence, toddler age, mother's age, marital status of mothers, mother's education level, and working status of mothers. Determination of determinants using the Binary Logistic Regression test.Results: Toddlers living in urban areas were 0.855 times more at risk of stunting compared to toddlers living in rural areas (OR 0.885; 95% CI 0.798-0.980). Toddlers who have mothers with elementary education and below 2.206 times have more risk of stunting compared to toddlers who have mothers with college education (OR 2.206; 95% CI 1,835-12,651). Toddlers who have mothers with junior high school education were 1,676 times more likely to have stunting risk compared to toddlers who have mothers with tertiary education (OR 1.676; 95% CI 1.395-2.015). toddlers who have mothers with high school education are 1,266 times more likely to have stunting risk compared to toddlers who have mothers with tertiary education (OR 1,266; 95% CI 1,058-1,514).Conclusion: There were 4 variables that have proven to be significant as determinants of stunting in East Java Province, namely residence, age of toddler, age of toddler mother, and mother's level of educationABSTRAK Latar Belakang: Stunting dalam kehidupan awal akan mempunyai konsekuensi fungsional yang merugikan, termasuk kognisi yang buruk dan tingkat pendidikan yang rendah. Variabel ini perlu diperhatikan karena menurut Unicef, ada faktor sosial budaya yang berperan dalam terjadinya permasalahan stunting. Penelitian ditujukan untuk menentukan determinan balita stunting di Jawa Timur.Metode: Penelitian menggunakan data sekunder survei Pemantauan Status Gizi tahun 2017 (PSG 2017). Dengan metode multi-stage cluster random sampling, diambil sampel 10.814 balita berusia 0-59 bulan. Varibel yang dianalisis terdiri dari variabel dependen status gizi balita, 7 variabel independen: tempat tinggal, umur balita, umur ibu balita, status perkawinan ibu balita, tingkat pendidikan ibu balita, dan status bekerja ibu balita. Penentuan determinan dengan menggunakan uji Regresi Logistik Biner.Hasil: Balita yang tinggal di daerah perkotaan 0,855 kali lebih memiliki risiko stunting dibandingkan dengan balita yang tinggal di daerah pedesaan (OR 0,885; 95% CI 0,798-0,980). Balita yang memiliki ibu dengan pendidikan SD ke bawah 2,206 kali lebih memiliki risiko stunting dibandingkan dengan balita yang memiliki ibu dengan pendidikan perguruan tinggi (OR 2,206; 95% CI 1,835-12,651). Balita yang memiliki ibu dengan pendidikan SLTP 1,676 kali lebih memiliki risiko stunting dibandingkan dengan balita yang memiliki ibu dengan pendidikan perguruan tinggi (OR 1,676; 95% CI 1,395-2,015). balita yang memiliki ibu dengan pendidikan SLTA 1,266 kali lebih memiliki risiko stunting dibandingkan dengan balita yang memiliki ibu dengan pendidikan perguruan tinggi (OR 1,266; 95% CI 1,058-1,514).Kesimpulan: Ada 4 variabel yang terbukti signifikan sebagai determinan kejadian stunting di Provinsi Jawa Timur, yaitu tempat tinggal, umur balita, umur ibu balita, dan tingkat pendidikan ibu balita. 

Hubungan antara Perilaku Gizi dan Perilaku Hidup Bersih dan Sehat (PHBS) dengan Status Gizi Baduta Di Kabupaten Cirebon

Background: Cirebon Regency is one of the priority areas that becomes the locus in efforts to accelerate the reduction of stunting in 2018.Objective: This study aims to analyze the relationship between feeding parenting pattern with nutrient intake of under two-years infants and the relationship between nutritional behavior and clean and healthy lifestyle behavior (CHLB) with nutritional status of under two-years infants in Cirebon Regency.Methods: This study used a cross-sectional study design using secondary data from previous studies conducted at the same two locations in Cirebon Regency. The data processing was carried out in November to December 2019. The subjects involved were 70 mothers who had infants aged 0-24 months. Analysis of the relationship between variables using the Rank Spearman test.Results: The results of the correlation test showed that there was no significant relationship (p> 0.05) between feeding parenting pattern with nutritional intake. In addition, maternal nutritional behavior also did not have a significant relationship (p> 0.05) with nutritional status. This study found that there was a significant relationship between clean and healthy living behavior on the indicators of a smoke-free home environment with the nutritional status using HAZ index.Conclusion: Imbalance between knowledge and socio-economic factors of income can lead to inequality in the application of feeding parenting pattern, nutritional behavior, and CHLB to the nutritional status of under two years. Therefore, a continuous monitoring and evaluation system is needed to ensure that the stunting acceleration program runs effectively and efficiently.ABSTRAK Latar belakang: Kabupaten Cirebon merupakan salah satu daerah prioritas yang menjadi lokus dalam upaya percepatan penurunan stunting pada tahun 2018.Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan antara pola asuh makan dengan asupan zat gizi baduta serta hubungan antara perilaku gizi dan perilaku hidup bersih dan sehat dengan status gizi baduta di Kabupaten Cirebon.Metode: Penelitian ini menggunakan desain studi cross-sectional dengan menggunakan data sekunder dari penelitian sebelumnya yang dilakukan pada dua lokasi yang sama di Kabupaten Cirebon. Proses pengolahan data dilakukan pada bulan November hingga Desember 2019. Subjek yang terlibat adalah 70 orang ibu baduta yang memiliki bayi berusia 0-24 bulan. Analisis hubungan antar variabel menggunakan uji Rank Spearman.Hasil: Hasil uji korelasi menunjukkan bahwa tidak terdapat hubungan yang signifikan (p >0,05) antara pola asuh makan dengan asupan zat gizi. Selain itu, perilaku gizi ibu juga tidak memilki hubungan yang signifikan (p>0,05) dengan status gizi. Penelitian ini menemukan bahwa terdapat hubungan yang signifikan antara perilaku hidup bersih dan sehat pada indikator lingkungan rumah bebas asap rokok terhadap status gizi baduta.Kesimpulan: Ketidakseimbangan antara pengetahuan dengan faktor sosio-ekonomi penghasilan dapat mengakibatkan terjadinya ketimpangan dalam penerapan pola asuh makan, perilaku gizi, dan PHBS terhadap status gizi baduta. Oleh karena itu, diperlukan sistem monitoring dan evaluasi secara kontinu untuk memastikan bahwa program percepatan stunting berjalan secara efektif dan efisien.

Nutrition education in Southeast Sulawesi Province, Indonesia: A cluster randomized controlled study

This study evaluated the impact of a nutrition education intervention on child feeding practices and children's nutritional status. Using a randomized controlled trial, we conducted an intervention for 6 months among caregivers with children aged 6-17 months in two subdistricts of Kendari, SE Sulawesi Province, Indonesia. In all, 22 integrated health posts were randomly assigned to an educational intervention or control group with 266 participants in both groups. Participants in the intervention group attended four nutrition classes and received a monthly home visit by cadres (community volunteers), whereas participants in the control group only received standard monthly health care at the health post. The primary study outcome was children's dietary diversity scores (DDSs). Mixed model analysis was conducted to examine the intervention effects on DDS and children's growth adjusting for clustering within subvillages. The study showed the educational intervention had a significant effect on children's DDS. Children in the intervention group had a larger DDS compared with children in the control group (Beta [mean difference] = 0.34, 95% CI: 0.02 to 0.66, P = 0.038). The intervention effect on height-for-age z-score (HAZ) could not be shown (Beta = 0.24, 95% CI: -0.06 to 0.56, P = 0.112). However, stunting prevalence remained stable in the intervention group but increased in the control group. These results indicated nutrition education delivered through nutrition classes combined with regular home visits by cadres as influencers provided a great potential to be adopted to complement other nutrition programmes in community health centres.

Comparison of WHO growth standard and national Indonesian growth reference in determining prevalence and determinants of stunting and underweight in children under five: a cross-sectional study from Musi sub-district

Background: Determination of stunting and wasting always uses the WHO growth standard in Indonesia. However, it is believed that Indonesian children are “below” the global standard, thus the WHO standard is not reliable to present the actual prevalence. This study aims to compare the prevalence and determinants of stunting and underweight using WHO growth standard and national Indonesian growth reference.

Methods: This was a cross-sectional study carried out in Musi sub-district, East Nusa Tenggara province in July 2019. East Nusa Tenggara province had the highest prevalence of stunting and underweight in Indonesia. The study population were children under five, and total sampling method was used for this study. Length/height-for-age and weight-for-age were plotted using WHO standard and national Indonesian reference. Univariate and multivariate binomial logistic regression were used for statistical analysis.

Results: The prevalence of stunting and underweight were higher for the WHO standard than the national reference (53.9% vs 10.7% and 29.17% vs 17.7%; all p < 0.001). After adjusted for confounding factors, when the WHO standard was used, determinants of stunting were maternal mid-upper arm circumference below 23.5cm and maternal height below 150cm; determinants of underweight were intrauterine growth restriction, young maternal age during pregnancy, and multiple parities. When the national reference was used, no determinants was found for stunting; the determinants of underweight were intrauterine growth restriction and maternal education.

Conclusions: The WHO standard is not suitable for representing child growth in Musi sub-district. Future studies should be done to re-evaluate the prevalence and determinants of stunting and underweight nationwide using the national Indonesian reference.

Current Status of Malnutrition and Stunting in Pakistani Children: What Needs to Be Done?

Malnutrition is one of the greatest health challenges that affects about 2 billion people globally. Multiple factors including poverty, food insecurity, maternal health and nutritional status, mother's age at marriage and educational status, low birthweight or small for gestational age (SGA), premature births, suboptimal breastfeeding practices, unhealthy dietary and lifestyle patterns, health and immunization status of children, socioeconomic status of family, environmental and household conditions, together with cultural practices and myths, play vital role in affecting the growth of children at early age. Although child stunting has declined in Pakistan, the reduction rate is only 0.5%, which is very low. This may be due to ineffective or inappropriate intervention programs as they are mostly addressing only one issue at a time and don't use the multi-sector approach to address numerous determinants of stunting. It is therefore important to initiate cost-effective multi-tiered intervention approaches to be implemented at pre-conception, pregnancy and early postpartum stages to prevent the problems of malnutrition and stunting in Pakistani children. This review discusses the etiology of child malnutrition and stunting in Pakistan, role of various determinants of stunting and what type of intervention strategies and approaches should be developed and implemented to deal with these problems. Key teaching pointsMalnutrition is one of the greatest global health challenges.Poverty, food insecurity, socioeconomic status, unhealthy dietary patterns, maternal health and nutritional status, low birthweight, suboptimal breast feeding, environmental conditions, cultural practices and myths, are the main factors for child malnutrition and stunting in Pakistan.The slow reduction rate in child stunting may be due to inappropriate intervention programs.Cost-effective multi-tiered intervention approaches must be implemented at pre-conception, pregnancy and early postpartum stages to prevent child malnutrition and stunting in Pakistan.A holistic approach comprising nutrition and WASH interventions, together with strategies to improve the socioeconomic status be developed and implemented to resolve this dilemma.

High proportions of children under 3 years of age consume commercially produced snack foods and sugar-sweetened beverages in Bandung City, Indonesia

Child undernutrition continues to be a national concern in Indonesia, whereas childhood overweight/obesity rises. Economic development has led to wide availability of highly processed foods and beverages, with growing evidence that children are consuming commercial snack products during the critical complementary feeding period. This study assessed the prevalence and patterns of consumption of commercially produced snack foods and sugar‐sweetened beverages among Indonesian children. A cross‐sectional survey was conducted with 495 mothers of children aged 6–35 months living in Bandung City, Indonesia. Among all children, 81.6% consumed a commercial snack food and 40.0% consumed a sugar‐sweetened beverage in the day preceding the interview. At 6–11 months, 46.5% of children consumed a snack food and 2.0% consumed a sugar‐sweetened beverage. Snack foods were consumed 3 or more times a day by 60.0% of children 24–35 months of age. Sweet biscuits and savory snacks were the most commonly consumed snack foods; sweetened milks and sweetened teas were the most common beverages. Maternal education, child age, and consumption of a commercially produced complementary food were associated with snack food consumption. Factors associated with sugar‐sweetened beverage consumption were child age and consumption of a commercially produced complementary food or breastmilk substitute. These findings reflect a high presence of processed, high‐sugar/salt commercial snack products in the diets of children 6–35 months. National attention should focus on interventions to reduce reliance on processed snack products and increase consumption of nutrient‐rich, locally available foods during the complementary feeding period.

Reducing Anemia Among School-Aged Children in China by Eliminating the Geographic Disparity and Ameliorating Stunting: Evidence From a National Survey

Background: The aim of this study was to assess the geographic disparity in anemia and whether stunting was associated with anemia in different geographic groups among school-aged children in China. Methods: 71,129 Han children aged 7, 9, 12, and 14 years old were extracted from the 2014 cycle of Chinese National Surveys on Children Constitution and Health. Anemia, anemia severity, and stunting were defined according to WHO definitions. Binary logistic regression models were used to estimate the association between anemia and stunting in different geographic groups. Results: The prevalence of anemia was significantly higher in girls (10.8%) than boys (7.0%). The highest anemia prevalence was in Group VII (lower class/rural, 12.0%). A moderate/severe prevalence of anemia was concentrated in Group VII and Group VIII (western/lower class/rural) for both sexes. The prevalence of anemia was higher in stunting boys than non-stunting boys in Group IV (lower class/city, χ² = 12.78, P = 0.002) and Group VII (χ² = 6.21, P = 0.018), while for girls, it was higher in stunting girls than their non-stunting peers only in Group II (upper class/large city, χ² = 4.57, P = 0.046). Logistic regression showed that the stunting children have 30% higher risk of anemia than non-stunting children after adjustment for age, sex and school (OR = 1.30, 95% CI: 1.05-1.60). Conclusion: A significant geographic disparity and an association between anemia and stunting among specific groups of school-aged children in China was demonstrated. Consequently, eliminating the geographic disparity and ameliorating stunting might contribute to the improvement of Chinese children's anemia. Specific guidelines and interventions are needed, especially for adolescent girls and the groups with serious anemia burden.

Explaining the fall of socioeconomic inequality in childhood stunting in Indonesia

In spite of the enormous economic progress and development witnessed in Indonesia in the last few decades, still more than 30% of Indonesian children under the age of five suffer from stunting, or low height for age. This concern is exacerbated by the fact that stunting remains more concentrated among the poorer households, leading to further intergenerational transmission of poverty and ill health. We examine recent trends in the evolution of the prevalence of childhood stunting and severe stunting, its socioeconomic inequality and the factors that appear to have contributed to these developments. Using the two most recent waves of the Indonesia Family Life Survey (IFLS), we study the changes in the prevalence of (severe) stunting between 2007 and 2014 for children aged 0-59 months and their socioeconomic-inequality using the Erreygers Concentration Index (EI) and its regression-based decomposition. We find a significant drop in the rate of severe stunting but not in stunting, as well as a significant reduction in the degree of absolute inequality of stunting. A decomposition analysis shows that household wealth, maternal education, institutional delivery, and availability of adequate sanitation contribute most to socioeconomic inequality in under-five stunting. Further analysis of the change in inequality over time indicates that the reduction in the association of wealth with stunting and a substantial improvement of health care access of the poor (as proxied by immunizations and institutional deliveries) play the most important role in narrowing the stunting gap between richer and poorer kids. General economic growth, poverty reduction, and implementation of pro-poor health and social programs during the studied period such as the expansion of health insurance coverage for the poor (Jamkesmas) and Conditional Cash Transfer program (Program Keluarga Harapan, PKH) are some plausible explanations of the observed result.

Nutritional status of children with cerebral palsy in remote Sumba Island of Indonesia: a community-based key informants study

AIM

To assess the burden and underlying factors of malnutrition among children with cerebral palsy (CP) in the remote Sumba Island, Indonesia.

METHODS

This is a community-based key informant (KI) method survey of children with CP in the southwest regency of Sumba Island, Indonesia (child population∼152 471). Children with suspected CP identified by trained community volunteers (KIs) underwent a detailed neurodevelopmental assessment by a multidisciplinary medical assessment team to confirm diagnosis of CP. Anthropometric measurements were taken, z scores were calculated, and nutritional status was determined following the World Health Organization guideline. Descriptive analyses were performed, multivariable linear regression model was fitted to identify potential predictors of malnutrition.

RESULTS

One hundred and thirty children with CP aged <18 years were included in the study. The majority were severely underweight (78.8%) and severely stunted (85.9%). Severe malnutrition was overrepresented among young children, children who had spastic tri/quadriplegia, Gross Motor Function Classification System levels III-V, had at least one associated impairment, speech impairment and/or swallowing difficulties. Age and presence of visual impairment were found to be significantly associated with weight-for-age z score (i.e., underweight) whereas, epilepsy was significantly associated with the height-for-age z score (i.e., stunting) when adjusted for other covariates.

CONCLUSIONS

The substantial-high burden of malnutrition among children with CP in remote Sumba Island highlights their vulnerability to poor health-related outcomes. There is an urgent need for nutritional rehabilitation services to avert such consequences among children with CP in low and middle-income countries like Indonesia.Implications for rehabilitationMalnutrition among children with cerebral palsy (CP) is alarmingly high in the remote Sumba island of Indonesia.Children with severe gross motor function limitations or spastic tri/quadriplegia had the most severe malnutrition.There is an urgent need for rehabilitation services including nutrition and feeding interventions for children with CP in low and middle-income countries like Indonesia.

Ethnic Variations in Nutritional Status among Preschool Children in Northern Vietnam: A Cross-Sectional Study

(1) Background: Vietnam is a multiethnic country undergoing rapid economic development, the improvement in nutritional status in preschool children is not equally shared by all ethnic groups; (2) Methods: A cross-sectional study was performed from September-December 2018 on 16,177 children aged 24-60 months representing Kinh (n = 14421), Muong (n = 1307) and Tay (n = 449) ethnic groups. Prevalence of malnutrition, overweight, obesity and anthropometric indices were compared across ethnic groups, using WHO 2006 child growth standards; (3) Results: The prevalence of malnutrition among children of Kinh, Muong and Tay origins was 14.7%, 34.3% and 43.2%, respectively. The corresponding data for overweight was 5.5%, 2.7%, 2.2% and for obesity 2.8%, 0.8% and 0.4%, respectively. The prevalence of stunting remained the highest in three subtypes of malnutrition in all ethnic groups. Kinh children were heavier and taller than the other groups, while Muong children were taller than Tay children (p-value < 0.001); and (4) Conclusions: Malnutrition remains a major public health issue among children of minor ethnicities while overweight and obesity is an emerging challenge for the Kinh ethnic group. The results imply that a community-based intervention should be specific to ethnicity to reduce the gap in nutritional status between ethnic groups in Vietnam.

Faktor Risiko Stunting pada anak di Negara Berkembang

Background: The problem of stunting occurs in developing countries including Indonesia. In Indonesia the prevalence of child stunting is 30.8%, still above the world prevalence, which is 22.2%. The prevalence of stunting in sub-Saharan Africa is 34.5%, in Ethiopia is 52.4%, and the prevalence of stunting in Congo is 40%. While WHO stipulates that nutrition problems should not exceed 20%. Stunting could inhibit linear growth, development and degenerative diseases later in adulthood.Objective: This review discussed the risk factors of child stunting in developing countries.Discusion: One of the causes of increased stunting in children was due to inadequate nutritional intake in a long period. Stunting was often not realized by parents and only visible after the age of 2 due to low stature. Based on the results of the literature review the likelihood of stunting in developing country were: 16.43 times morelikely due to low birth length, 3.27 times higher due to maternal education, 2.45 times higher if the children were living in rural area, 4.5 times higher due to low birth weight, no risk Antenatal Care increase the risk 3.4 times, 6.38 times higher due to no immunization, and no exclusive breastfeeding increase the risk of stunting 4.0 times.Conclusion: The risk factor for child stunting in developing countries are exclusive breastfeeding, socioeconomic, low birth weight, length of birth, low maternal education, infectious disease.ABSTRAKLatar Belakang: Masalah stunting (stunting) yang terjadi di Negara Berkembang seperti Indonesia masih tinggi yaitu 30,8% masih  di atas dunia yaitu 22,2%.  Stunting di sub sahara Afrika 34,5%, di Ethiopia  52,4%, prevalensi stunting di Congo 40%. Word Health Organization sudah menentukan bahwa terjadinya masalah gizi suatu negara sebaiknya kurang dari 20%. Stunting memiliki risiko gangguan pertumbuhan, perkembangan dan penyakit degeneratif pada usia dewasa nanti.Tujuan: Review ini bertujuan untuk mengidentifikasi faktor risikos apa saja yang dapat menentukan terjadinya stunting anak di Negara berkembang.Ulasan: Berdasarkan dari beberapa hasil penelitian menyebutkan bahwa salah satu penyebab stunting pada anak adalah karena tidak terpenuhinya gizi yang baik pada kurun waktu yang panjang dan sering kali tidak disadari oleh orang tuanya sehingga setelah anak usia di atas 2 tahun baru terlihat bahwa anaknya mengalami stunting. Berdasarkan hasil literatur review menunjukkan bahwa faktor risiko terjadinya stunting adalah panjang lahir berisiko 16,43 kali, pendidikan ibu yang rendah berisiko 3,27 kali, serta anak yang tinggal di desa berisiko 2,45 kali,  BBLR berisiko 4,5 kali, tidak ANC berisiko 3,4 kali, tidak imunisasi berisiko 6,38 kali, dan tidak ASI Eksklusif berisiko 4,0 kali  adalah merupakan faktor risiko  stunting anak di negara berkembang.Kesimpulan: Hasil sintesis ini secara konsisten yang menjadi faktor risikos terjadinya stunting pada anak di negara berkembang adalah tidak diberikan ASI eksklusif, sosial ekonomi, berat bayi lahir rendah, panjang lahir, pendidikan ibu rendah, penyakit infeksi.

Promotions of breastmilk substitutes, commercial complementary foods and commercial snack products commonly fed to young children are frequently found in points-of-sale in Bandung City, Indonesia

Few studies have documented the marketing of commercial foods and beverages for infants and young children in West Java, Indonesia. To assess the prevalence of promotions at points-of-sale for commercially produced products commonly fed to young children in Bandung City, 43 small and large stores were visited in 2017. Promotions for breastmilk substitutes (BMS), commercially produced complementary foods (CPCF), and select types of commercial snack products were photographed and information recorded on promotion characteristics. There were 402 and 206 promotions observed with BMS and CPCF products, respectively. Sixteen promotions with BMS products for infants under 12 months were found in 42.9% of stores selling BMS, violating national regulations. Almost all BMS promotions (98.3%) included BMS products for ages 1 year and above ("growing-up milks"). Of all BMS products available for sale, half of all infant/follow-up formula and 77.2% of growing-up milks were promoted. CPCF were found in 97.7% of stores, and 81.0% of these stores had promotions; 70.5% of all available CPCF products were promoted. Of the 2,451 promotions observed for commercial snack products, 17.3% used promotional techniques targeting young children or caregivers. Joint-promotions were common, with BMS and CPCF marketed in combination with commercial snack products; 49.0% of BMS promotions were joint BMS-snack promotions, and 80.0% or more of infant/follow-up formula promotions included a commercial snack. Revising and enforcing infant food and beverage marketing regulations to ensure consistency with global standards are necessary to protect and promote optimal infant and young child feeding in Indonesia.

Commercially produced complementary foods in Bandung City, Indonesia, are often reported to be iron fortified but with less than recommended amounts or suboptimal forms of iron

Commercially produced complementary foods (CPCF) that are iron fortified can help improve iron status of young children. We conducted a review of 217 CPCF sold in 42 stores in Bandung, Indonesia, in 2017. There were 95 (44%) infant cereals, 71 (33%) snacks or finger foods (biscuits or cookies, puffs, and noodles or crackers), 35 (16%) purees, and 16 (7%) other foods for which we obtained label information. Nearly 70% of CPCF reported iron content on their labels, but only 58% of products were reported to be fortified with iron according to ingredient lists. Among iron-fortified products, only one fifth indicated a specific type of iron used as the fortificant, but all of these were recommended by the World Health Organization for fortifying complementary foods. Infant cereal was more likely to contain added iron (81%) compared with snacks or finger food (58%) and purees (14%) and had higher iron content per median serving size (cereal = 3.8 mg, snacks or finger food = 1.3 mg, mixed meals = 2.7 mg, and purees = 0.9 mg). Infant cereal was most likely to meet the recommended daily intakes for iron (41% for infants 6-12 months of age and 66% for children 12-36 months) compared with snacks or finger food (infants = 14%, children = 22%), mixed meals (infants = 28%, children = 46%), or purees (infants = 9%, children = 15%). Regulations on fortification of complementary foods need to specify minimum levels and forms of iron and require reporting in relation to requirements by child age and serving size. Monitoring and enforcement of regulations will be essential to ensure compliance.

Child stunting is associated with child, maternal, and environmental factors in Vietnam

Child stunting in Vietnam has reduced substantially since the turn of the century but has remained relatively high for several years. We analysed data on children 6-59 months (n = 85,932) from the Vietnam Nutritional Surveillance System, a nationally representative cross-sectional survey. Multivariable Poisson regression models were used to estimate relative risk (RR) of stunting, stratified by child age and ecological region. Covariates at the child, maternal, household, and environmental levels were included based on available data and the World Health Organization conceptual framework on child stunting. Among children 6-23 months, the strongest associations with child stunting were child age in years (RR: 2.49; 95% CI [2.26, 2.73]), maternal height < 145 cm compared with ≥150 cm (RR: 2.04; 95% CI [1.85, 2.26]), living in the Northeast compared with the Southeast (RR: 2.01; 95% CI [1.69, 2.39]), no maternal education compared with a graduate education (RR: 1.77; 95% CI, [1.44, 2.16]), and birthweight < 2,500 g (RR: 1.75; 95% CI [1.55, 1.98]). For children 24-59 months, the strongest associations with child stunting were no maternal education compared with a graduate education (RR: 2.07; 95% CI [1.79, 2.40]), living in the Northeast compared with the Southeast (RR: 1.94; 95% CI [1.74, 2.16]), and maternal height < 145 cm compared with ≥150 cm (RR: 1.81; 95% CI [1.69, 1.94]). Targeted approaches that address the strongest stunting determinants among vulnerable populations are needed and discussed. Multifaceted approaches outside the health sector are also needed to reduce inequalities in socioeconomic status.

A review of child stunting determinants in Indonesia

Child stunting reduction is the first of 6 goals in the Global Nutrition Targets for 2025 and a key indicator in the second Sustainable Development Goal of Zero Hunger. The prevalence of child stunting in Indonesia has remained high over the past decade, and at the national level is approximately 37%. It is unclear whether current approaches to reduce child stunting align with the scientific evidence in Indonesia. We use the World Health Organization conceptual framework on child stunting to review the available literature and identify what has been studied and can be concluded about the determinants of child stunting in Indonesia and where data gaps remain. Consistent evidence suggests nonexclusive breastfeeding for the first 6 months, low household socio-economic status, premature birth, short birth length, and low maternal height and education are particularly important child stunting determinants in Indonesia. Children from households with both unimproved latrines and untreated drinking water are also at increased risk. Community and societal factors-particularly, poor access to health care and living in rural areas-have been repeatedly associated with child stunting. Published studies are lacking on how education; society and culture; agriculture and food systems; and water, sanitation, and the environment contribute to child stunting. This comprehensive synthesis of the available evidence on child stunting determinants in Indonesia outlines who are the most vulnerable to stunting, which interventions have been most successful, and what new research is needed to fill knowledge gaps.