Stunting among children under two years in Indonesia: Does maternal education matter?

Risk factors associated with stunting incidence in under five children in Southeast Asia: a scoping review

INTRODUCTION

Stunting or growth failure is a health problem faced by the world today, especially in developing countries, including Southeast Asia. The Southeast Asian region accounts for more than a quarter of the number of children experiencing stunting worldwide. In addition to impacting children's growth and development, mortality and morbidity rates will also affect the economies and productivity of countries in the future.

RESEARCH OBJECTIVES

This scoping review aimed to systematically map the research that has been conducted in this area and identify existing gaps in knowledge related to risk factors for stunting in the Southeast Asian region.

METHODE

A scoping review was conducted using three databases: Scopus, PubMed, Embase, and one academic publisher, Taylor & Francis. The keywords used were "Children," "Risk Factors," "Stunting.". The inclusion criteria were as follows: (1) studies with a population of children under five years of age, (2) studies addressing risk factors for stunting, (3) studies conducted in countries in the Southeast Asian region, (4) studies of all research types, and (5) articles published in English. Of the 2252 articles, 54 met the inclusion criteria.

RESULT

In this review, the risk factors associated with stunting in children under five years of age in Southeast Asia were categorized into direct, underlying, and basic factors. Direct factors include parental and child characteristics, food intake, and health. Underlying factors include the practice of providing food and access to health services and care. The basic factors causing stunting are environmental, household health, and socioeconomic factors.

CONCLUSIONS

This scoping review determined the risk factors for childhood stunting in Southeast Asia, such as attributes of the child, traits of the parent, the amount of food the child consumes, the health of the child, feeding habits, access to health services, household and environmental health, and socioeconomic status. These factors are interrelated and affect each other. Therefore, it is necessary to pay attention to these factors to reduce the risk of stunting among underfives in Southeast Asia.

Detecting Age Prone to Growth Retardation in Children Through a Bi-Response Nonparametric Regression Model with a Penalized Spline Estimator

Background

The growth of children aged 0-60 months can impact their subsequent growth and development. This study aims to identify the vulnerable age for boys and girls, who experience growth retardation within this age range.

Methods

The study design used was a cross-sectional approach in which each child's measurement data was only taken once. The data were obtained from weighing results at the Health Integrated Service Post in South Sulawesi Province in 2022. The number of data analyzed was 698 children, namely 369 boys and 329 girls by considering the factors of age, weight, and height. We used a nonparametric bi-response regression model estimated using a penalized spline. The knots used are 12, 24, 36, and 48 on each model.

Results

The value of the penalized spline regression coefficient in the model indicates that the child's growth is slowed down and is not within normal limits. This can be seen in the weight and height of boys from the age of reaching 12 months to 24 months, only increasing by about 0.3 kg and 0.3 cm. For girls, the problem occurs from the age of 24 to 36 months, namely their weight increases by about 0.6 kg, and their height increases by about 1 cm.

Conclusions

The analysis results show that boys' growth slows down at 2 years of age and continues until 5 years of age. In the case of girls, their growth begins to slow when they are 3 years old until they reach 5 years old.

Maternal knowledge on nutritional-focused nurturing care and associated factors among women with stunted children aged 6-23 months in Yogyakarta, Indonesia: A cross-sectional study

Background

Childhood stunting poses serious long-term risks to cognitive development, education, and adult productivity. While research has explored stunting's causes and effects, there is a lack of focus on maternal knowledge of nutrition-focused nurturing care for stunted children. This gap limits the ability to design effective interventions that target improved caregiving practices.

Objective

This study aimed to assess maternal knowledge of nutrition-focused nurturing care and explore associated factors, including child gender, maternal age, education, income, and prior exposure to nurturing care information, among mothers of stunted children aged 6-23 months in Indonesia.

Methods

A cross-sectional study was conducted with 73 mothers in Kulon Progo, Yogyakarta. Data were collected from February to March 2024 using a validated self-assessment questionnaire covering four domains: responsive caregiving, early learning opportunities, safety and security, and supportive caregiver well-being. Statistical analyses, including t-tests and one-way ANOVA, were performed.

Results

Overall maternal knowledge of nurturing care was high, with a mean score of 25.15 (SD = 4.72). Factors significantly associated with higher knowledge included having male children (p = 0.017), being aged 30-34 years (p = 0.035), possessing higher education levels (p = 0.002), and prior exposure to nurturing care information (p <0.001). Family income significantly influenced knowledge in the domain of early learning opportunities (p = 0.006), though not in other areas.

Conclusion

Maternal knowledge of nutrition-focused nurturing care was influenced by child gender, maternal age, education, income, and prior exposure to nurturing care information. These findings emphasize the importance of focused educational interventions in nursing practice to enhance maternal knowledge. Addressing these factors can help align nursing strategies better to support the healthy growth and development of children.

Buccal DNA global methylation and cognitive performance in stunted children under 5 years of age

The prevalence of stunting in Indonesian children under five years of age is about 20%. Chronic maternal malnutrition contributes to the risk of stunting by affecting global DNA methylation. In the present study, we aimed to evaluate the levels of 5-methyl-cytosine (5mC), as a surrogate marker of global DNA methylation, in buccal swabs and its potential association with risk of stunting and cognitive performance. The levels of 5mC were measured using the enzyme-linked immunosorbent assay. The Wechsler Preschool and Primary Scale of Intelligence was used to measure cognitive functions. Buccal swab DNA samples and anthropometric data were collected from a total of 231 children aged zero to five years. In this cross-sectional cohort, the prevalence of stunting was 37% in 138 children aged zero to two years and 30% in 93 children aged > two years. The univariable analysis revealed that the levels of 5mC in buccal swab DNA were significantly lower in severely stunted children (median, 2.84; interquartile range [IQR], 2.39-4.62; P-value, 0.0314) and in children of a younger age (median, 2.81; IQR 2.53-4.62, P-value, 0.0001) than in normal (median, 3.75; IQR, 2.80-4.74) and older children (median, 4.01, IQR, 3.39-4.87), respectively. We also found that the average cognitive scores tended to be low in boys and stunted children, although the differences were not statistically significant. Furthermore, levels of 5mC found in buccal and mouthwash DNA were not associated with cognitive scores.

Examining determinants of stunting in Urban and Rural Indonesian: a multilevel analysis using the population-based Indonesian family life survey (IFLS)

BACKGROUND

In Indonesia, chronic malnutrition leading to stunted growth in children represents a significant issue within the public health domain. The prevalence of stunting varies between urban and rural areas, reflecting disparities in access to nutrition, healthcare, and other socioeconomic factors. Understanding these disparities is crucial for developing targeted interventions to address the issue.

METHODS

The study used data from the fifth wave of the Indonesian Family Life Survey (IFLS), which is a national cross-sectional population-based survey conducted across approximately 13 provinces in Indonesia in 2014-2015. Multivariate and Multilevel logistic regression models were utilized in the analysis to determine the factors associated with the prevalence of stunting in Indonesian children.

RESULTS

The multivariate logistic regression analysis indicated that among children aged 24-59 months in Indonesia, stunting was associated with the age of the child, birth weight, maternal nutritional status, and residence. Subsequently, the multilevel logistic regression analysis revealed that in rural areas, the age of the child and birth weight exhibited significant associations with stunting. Conversely, in urban areas, stunted children were influenced by 7 factors, including the child's age (months), age of weaning, birth weight (kg), mother and father's age, place of birth, and maternal nutritional status.

CONCLUSIONS

Variations in childhood stunting between urban and rural regions in Indonesia were observed, indicating a differential prevalence. The study's findings suggests the importance of age-appropriate nutritional support, healthcare interventions, and growth monitoring. Focused interventions are vital, potentially encompassing initiatives such as improving access to maternal and child healthcare services, promoting adequate nutrition during pregnancy and infancy, and facilitate greater parental engagement in childcare responsibilities.

An overview of the nutritional status of childbearing age women, children and adolescents living in a rural area of Madagascar: preliminary results of the Tany Vao project

OBJECTIVE

To describe the food consumption, nutrition knowledge and nutritional assessment of childbearing age women and their children, living in rural villages in Madagascar. The results presented are related to the Tany Vao research study.

DESIGN

A cross-sectional pilot study.

SETTING

The study was carried out in Ampanitosoha village on Nosy Mitsio island in Madagascar.

PARTICIPANTS

32 women (14-49 years) and 36 children and adolescents (2-17 years).

RESULTS

70 % of the women lacked nutrition knowledge and did not reach the Minimum Dietary Diversity Index for Women cut-off. The median BMI was 21·1 kg/m2 but 55·2 % of the women exceeded the cut-off for waist-to-hip ratio, 51·7 % for waist-to-height ratio and 81·2 % for mid-upper arm circumference (MUAC). Almost all had adequate intake of energy, protein and carbohydrates, while 27·6 % had excessive fat intake and 75·9 % of added sugars. Over half of the women did not meet the micronutrients Reference Daily Intake (RDI). For children, the MUAC z-score was lower for boys than for girls (P-value = 0·041).

CONCLUSIONS

These results underline the importance of increasing women's nutritional knowledge to promote healthy pregnancy and lactation. Moreover, it is fundamental to provide people living in rural areas with sustainable tools to improve dietary diversity and support long-term health.

Analysis of traditional feeding practices and stunting among children aged 6 to 59 months in Karanganyar District, Central Java Province, Indonesia

BACKGROUND

Traditional feeding practices are widespread in Indonesia. Therefore, using traditional feeding practices commonly used among mothers, this study examined the association between these practices and stunting along with other relevant factors (i.e., sociodemographic factors, feeding practices, vaccination status, and place of residence).

METHODS

This cross-sectional study was conducted in Karanganyar District, Central Java Province. Data from a total of 706 children aged 6 to 59 months (352 children with stunting and 354 children without stunting) were obtained from the medical records of 10 primary health care units (PHCUs) in 9 subdistricts. Descriptive analysis and binary logistic regression (BLR) were performed to explore the association between the dependent (stunting) and independent variables.

RESULTS

The BLR results from children 6 to 59 months indicated that children of mothers with food restrictions during pregnancy (AOR = 5.87, 95% CI: 3.03, 11.38), children with prelacteal feeding (AOR = 4.27, 95% CI: 2.16, 8.41) and children with food restrictions (AOR = 7.74, 95% CI: 1.22, 49.16) were more likely to experience stunting. Those from children 6 to 23 months revealed that food restrictions during pregnancy (AOR = 17.55, 95% CI: 2.86, 107.80) and prelacteal feeding (AOR = 10.58, 95% CI: 2.06, 54.41) were related to stunting. The reasons for traditional feeding practices were related to cultural beliefs. For example, mothers believed that red meat could cause high blood pressure; thus, the consumption of red meat could trigger miscarriage or bleeding during delivery. In addition, this study showed that low sociodemographic status, inappropriate feeding practices, incomplete vaccination, and residence in rural areas were related to stunting.

CONCLUSIONS

The findings reflect the importance of education for mothers to correct misconceptions of traditional feeding practices. The government should strengthen counseling services in PHCUs to improve mothers' knowledge of and attitudes toward appropriate feeding practices. Additionally, public relations practices through the mass media should continue for family members, especially senior members, as they influence mothers' autonomy in decision-making regarding feeding practices in Indonesia.

The intergenerational effect of tuition-free lower-secondary education on children's nutritional outcomes in Africa

One in five child deaths under age 5 are a result of severe wasting. Malnutrition at early ages is linked to lifelong consequences, such as reduced cognitive skills, reduced earnings in adulthood and chronic health conditions. Countries worldwide have committed to addressing child undernutrition, and ending hunger is foundational to the Millennium Development Goals. In this paper, we study the intergenerational effect of providing free tuition in secondary school on future children's nutrition. We combined a novel longitudinal dataset that captures educational policies for 40 African countries from 1990 to 2019 with the Demographic and Health Survey (DHS). We identified three countries that introduced free secondary education several years after implementing free primary education. Exploiting this variation in timing we estimate the additional impact of providing free secondary education over free primary education. Using a difference-in-difference approach, we find that introducing free secondary education significantly reduced wasting. Cohorts exposed to free secondary had an 18% relative decrease in wasting. The impact on cohorts exposed only to free primary was smaller and not statistically significant. Expanding free secondary education has long-term, intergenerational benefits and is an effective path to reducing malnutrition. Results are robust to different specifications.

Outcome and factors associated with undernutrition among children with congenital heart disease

BACKGROUND

Congenital heart disease (CHD) is associated with high morbidity and mortality, especially among those with undernutrition. Evaluating risk factors associated with undernutrition is important to improve clinical outcomes. We aimed to evaluate the outcome and factors associated with undernutrition among children with CHD.

MATERIAL AND METHODS

A prospective cohort study was conducted among children with CHD at Dr. Sardjito Hospital, Yogyakarta, Indonesia during February 2016 to June 2018. Clinical and demographic data were collected at the time of diagnosis. Multivariate logistic regression analysis was used to identify independent factors associated with undernutrition using odds ratio (OR) and 95% confidence interval (CI). Significance was set as p<0.05.

RESULTS

We recruited 1,149 children with CHD, of those, 563 (49%) were underweight, 549 (47.8%) were stunting, and 361 (31.4%) were wasting. In the multivariate analysis, cyanotic CHD, delayed diagnosis, congestive heart failure, pulmonary hypertension, syndrome, young maternal age, history of low birth weight, and being first child were independently associated with undernutrition. Underweight and stunting were significantly associated with increased mortality with OR of 3.54 (95% CI: 1.62-7.74), p<0.001 and OR 3.31 (95% CI: 1.65-6.64), p<0.001, respectively.

CONCLUSIONS

About half of the children with CHD were categorized with undernutrition. An increased risk of undernutrition was associated with cyanotic CHD, delayed diagnosis, congestive heart failure, pulmonary hypertension, syndrome, low birth weight, and being first child. Underweight and stunting were significantly associated with increased risk of death.

Factors Related to Stunting Incidence in Toddlers with Working Mothers in Indonesia

Previous studies have suggested that a toddler stunting is closely related to maternal characteristics. Working mothers, as a group, are vulnerable to having a stunted toddler. The present research aimed to analyze factors related to stunting incidence in toddlers with working mothers in Indonesia. The study sampled 44,071 toddlers with working mothers. The final stage used a multinomial logistic regression test. The study found that working mothers living in rural areas have a higher probability of having stunted or severely stunted toddlers. Maternal age partially affects the incidence of stunted toddlers in Indonesia. Mothers in the ≤19 age group are 1.461 (95% CI 1.140-1.872) times more likely than those in the ≥45 group to have a severely stunted toddler. Those who were never married were 1.433 (95% CI 1.006-2.043) times more likely than those who were divorced/widowed to have a severely stunted toddler. A married mother was 0.734 (95% CI 0.617-0.872) times less likely to have a severely stunted toddler than a divorced/widowed mother. Better education is protective against working mothers having stunted toddlers. Moreover, the present study found that the toddler's age determined the incidence of stunted toddlers. This study concluded that there are five variables related to stunting incidence in toddlers with working mothers in Indonesia: residence, age, marital status, education, and toddler age.