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
indanah@umkudus.ac.id ratnadewi@gmail.com

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

Copyright © 2020 The Authors. Published by Atlantis Press B.V.

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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 milk school education (47.8, 3%)
up to 50%. This figure indicates that only a few Indonesian
children receive adequate nutrition from breast milk. Whereas TABEL 1 TODDLER RESPONDENTS CHARACTERISTICS
BASED ON AGE, BW, WL (N:90)
breastfeeding plays an important role in the process of
Variable Mean SD Min-Max 95% CI
physical and mental development of children with long-term
impacts [3]
Age 30,52 12,868 13 - 60 27,83 – 33,22
Inadequate nutritional intake of children can lead to (month)
disruption of growth and development in children, even if the BW (gram) 2910 567,152 2200 - 3900 2791,04 –
condition is not handled properly, the risk of illness and death 3028,83
of children will increase. Parents who will feed their children BL (cm) 48,09 2,612 43 - 52 47,54 – 48,64
are related to parents' knowledge and parental education, this
is due to the level of understanding and acceptance of Diagram 1 explains that based on PBL and BBL, out of 90
information that parents will absorb about nutrition that will infants there are 42 (47%) respondents who have Low BBL
be given to their children. Parental education is closely related and 43 (48%) have a body length that is less than normal. The
to the nutritional status of children because parents, especially results of the history of breastfeeding and breastfeeding
mothers who directly care for children, including preparing history shows that 9 (10%) respondents did not get complete
and providing food to children. Septikasari, (2018) [7] states immunizations and 48 (53%) were not given breast milk
that the higher the level of one's education, the easier it is to exclusively. Eating patterns and Parental Knowledge are
be given an understanding of information, and the easier it is explained in Diagram 1 with the results that 45 (50%) toddlers
to implement knowledge in behavior, especially in terms of get good eating patterns and 52 (58%) parents of toddlers have
health and nutrition. good knowledge about stunting
Regarding parents' feeding patterns to their children, the B. Bivariate Analysis
results of the study Nurbaiti et al, (2014) say that the customs
and culture that have taken root greatly influence their The results of the bivariate analysis of factors related to
behavior and living habits, including eating habits and daily stunting can be explained in Table 2. In Table 2 it can be
eating patterns. The types of food ingredients and menus explained that all factors are related to the incidence of
consumed, meal times, frequency of meals, food destination, stunting in infants. This can be seen from the p value = 0.0000
to the types of food items taboo by the community are strongly (α <0.05). Based on the Odd Ratio for each variable, the
influenced by their customs and culture. The same thing variable pattern of parental feeding among toddlers shows a
applies to children in the first 1,000 days of their lives. [8] high number that is 462 which means that for toddlers who get
poor diet, 462 times will be at risk of stunting.
II. METHOD There is a relationship between birth weight and the
This research is a quantitative study using analytic incidence of stunting. Birth weight is the most important
descriptions with a case control research design with a anthropometric measure and is most often used in newborns
retrospective approach. The study was conducted for 2 (neonates). Birth weight (BW) is used to diagnose normal or
months, namely March and April 2019. The population in this Low Birth Weight (LBW) babies. For example babies born
study were parents who had stunting and not stunting toddlers with low birth weight can be at risk of experiencing growth
in the Kudus District Health Center area of 100 people. The failure that can cause stunting. Mothers who have poor
sampling technique in this study uses Stratified random nutritional status, age of mothers who are too old and too
sampling technique for toddlers who are not stunted. The young, maternal education, and diseases suffered by pregnant
overall sample in this study was 90 parents of toddlers with women such as anemia, asthma, hypertension, HIV / AIDS
details of 45 toddlers experiencing stunting and 45 toddlers not etc., are likely to give birth to babies with low birth weight
experiencing stunting. This study uses a questionnaire that has (LBW) and premature is also greater. Low birth weight is a
been tested for validity and reliability to assess the variables multi-picture picture of public health problems including
of knowledge, feeding patterns and history of breastfeeding. mothers with long-term malnutrition, poor health, hard work
As for the LBL, LBW, Immunization History variables using and poor health care and pregnancy. Individually, LBW is an
the results recorded in the Children's KIA Handbook. For important predictor in the health and survival of newborns and
stunting criteria use Nutrition measurements from NCHS. The is associated with high risk in children. The proportion of
data in this study were analyzed using a computer program. stunting toddlers is higher in toddlers with a history of low
Data were analyzed using univariate, and bivariate analysis. birth weight (Diagram 1). Babies born with Low Birth Weight
Using chi square analysis. (<2500 grams) have the opportunity to experience stunting 16
times compared with babies born with normal weight.
III. RESULT AND DISCUSSION Based on univariate analysis in Diagram 1, it can be
A. Characteritics of Respondents concluded from 90 respondents that most respondents who
Respondents in this study were mothers and toddlers in the had normal birth length were 47 respondents (52.2%), while
District Health Center X Kudus District. Of the 90 respondents respondents who had low birth length (LBL) were 43
in the intervention group, the average toddler with an average respondents (47.8%) . Based on the results of calculations with
age of 2.5 years and male sex (57.8%). The average mother is the chi square test obtained a significant level of p = 0,000
<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 it
Low birth length indicates that the child in the womb is can be a protection for babies from various infectious diseases
experiencing a lack of nutritional intake so that the impact on such as bacteria, viruses, and fungi. Children who are not
the growth of children is not optimal but if after the child is breastfed for 6 months are counted after birth, the child is
born the child does not get adequate nutritional intake in a long susceptible to infection. The relationship of history of
time so that one of the impacts is the nutritional status of breastfeeding with the incidence of stunting shows that
children is based on height and low age, which makes toddlers children who are not exclusively breastfed have 37 times the
at risk of stunting. chance to experience stunting. The proportion of stunting
toddlers is higher in toddlers who are not exclusively breastfed
(Table 1).
DIAGRAM 1 CHARACTERISTICS OF RESPONDENTS TABLE 2
BASED ON INDEPENDENT VARIABLES (N = 90) CHARACTERISTICS OF RESPONDENTS BASED ON FACTORS
RELATED TO STUNTING (N = 90
100
80 No Variable OR P value
60 1 Birth Weight ( BW) 16 0,000
(5,349 – 147,858)
40
20 2 Birth Length (BL) 16,188 0,000
0 (5,732 – 45,717)
Poor
Complete
Normal

Incomplete

Exclusive

Good

Good
Not Exclusive

Poor
Normal

Low

Low

3 Basic Immunization 0,444 0,000

(0,348 – 0,567)

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

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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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