EurAsian Journal of BioSciences Eurasia J Biosci 14, 6725-6735 (2020)
Analysis of factors affecting the prevalence of stunting on children under five years
Laili Rahayuwati 1*, Ikeu Nurhidayah 2, Nur Oktavia Hidayati 3, Sri Hendrawati 2, Habsyah Saparidah Agustina 3, Rindang Ekawati 4, Alette Suzy Setiawan 5 1 Department of Community Nursing, Faculty of Nursing Universitas Padjadjaran, INDONESIA 2 Department of Pediatric Nursing, Faculty of Nursing Universitas Padjadjaran, INDONESIA 3 Department of Psychiatric Nursing, Faculty of Nursing Universitas Padjadjaran, INDONESIA 4 National Population and Family Planning Board (BKKBN), Bandung, INDONESIA 5 Department of Dentistry, Faculty of Dentistry Universitas Padjadjaran, INDONESIA *Corresponding author: [email protected]
Abstract Introduction: Stunting is a latent problem indicating a chronic malnutrition status during the child’s growth since birth. The prevalence of stunting is caused by multiple factors. This research aims at analyzing the factors affecting the prevalence of stunting on children in the area of West Java Province, including the demographic social of the mother, the child, and the child’s health status. Method: The research applies quantitative method. The number of respondents is 810. The research took place in 6 regencies/cities whose villages support family planning (Kampung Keluarga Berencana) such as Bandung City, Bandung Regency, West Bandung Regency, Subang Regency, Sumedang Regency, and Garut Regency. The quantitative analysis consists of a univariate using frequency percentage and distribution, as well as bivariate analysis using correlation test. Result: The result of this research shows that nearly all toddlers have a normal body height as much as 73.1%, while 23.8% others fall into the category of “short” or “very short.” Based on the factor analysis, there exists a relevance in such factors as mother’s occupation (p = 0.010; OR = 0,532), delivery complications (p = 0,010; OR = 2,072), completeness of immunization distribution (p = 0,000; OR = 3,111), immunization schedule (p = 0,000; OR = 3,289), exclusive ASI (ASI) provision (p = 0,041; OR = 1,486), and child medical records (p = 0,044; OR = 1,649), while other factors are considered irrelevant. Conclusion: The suggestion for this research is that it requires cross-sectoral cooperation and improvement of the role of healthcare staff in educating mothers regarding complete immunization distribution on schedule, exclusive breastfeeding distribution, and prevention of contagious illness to children. Originality of the study is firstly observation on the stunting related to the prevalence and management in several regency/city in West Java Province.
Keywords: children, prevalence, quality of life, stunting
Rahayuwati L, Nurhidayah I, Hidayati NO, Hendrawati S, Agustina HS, Ekawati R. Setiawan AS (2020) Analysis of factors affecting the prevalence of stunting on children under five years. Eurasia J Biosci 14: 6725-6735.
© 2020 Rahayuwati et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License.
INTRODUCTION Nadhiroh, 2015). This condition is represented by a high z-score of the body height based on age (TB/U) with less The setback of low-quality population is indicated by than -2 of SD and on growth standards according to the prevalence of nutrition and stunting that will affect WHO (WHO, 2010). WHO (2011), in 2010, claimed that the quality of human resource. This results in youth 171 million children worldwide were suffering from degeneration and in the condition of future economy stunting, 167 millions of whom lived in underdeveloped (Fauzi, 2012). WHO has articulated SDGs with countries. Basic Health Research (Riset Kesehatan eradicating starvation as one of its objectives, and 2025 Dasar/Riskesdas) 2013 shared similar point of view, is the year expected where issues such as malnutrition lamenting the national prevalence of stunting in 2013 is and stunting are thoroughly overcome. In 2017, the 37.2% or nearly 9 million toddlers suffer from stunting. In Ministry of Health Republic of Indonesia (Kementerian Kesehatan Republik Indonesia/Kemenkes) stipulated the number of stunting cases in Indonesia, overlapping the limit set forth by WHO. Received: September 2019 Accepted: March 2020 Stunting is a latent problem. It depicts a chronic Printed: December 2020 malnutrition during a child’s growth since birth (Ni’mah &
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2010, Riskesdas reported that Indonesia contributed to causes needed to reduce stunting further. This requires the 5th biggest stunting sufferers worldwide. diets diversity, which is influenced by several factors. In 2013, Indonesia National Planning Board (Badan The factors affected the stunting are economic Perencanaan Nasional/Bappenas) reported that the development, urbanization, providing access to a occurrence of stunting in toddlers is pertinent to the greater variety of foods, including processed and issue of body weight reaching up to <2500 grams enriched foods, parental education, and modernizing the (BBLR) at birth. The period of child under two years old, food system. Richer consumers are increasingly able to including their heyday (the first 1000 days of life) is a access more nutritious food, while poorer consumers highly environment-sensitive period; thus, attention to need support to improve access, and should be optimize bigger proportion of attention to nutrition level is dire the hygiene and sanitation (Shively, Sununtnasuk, & (Kurniasih, 2010). Issues such as stunting today may Brown, 2015). hamper the child’s growth, with negative impacts looming, such as intellectual breakdown, prone to METHOD degenerative and non-contagious illness, productivity Researcher applied quantitative method. The decline, causing poverty and the risk of having a low- population in this research included fertile couples, with weighted baby (UNICEF, 2012; WHO, 2010). Therefore, the criteria such as pregnant mother (first to third prevention during heyday is crucial and fundamental. trimester) and/or mother with toddlers. Both categories Stunting status during heydays may affect the quality were taken from 6 regencies and cities in West Java of health, intellect, and productivity in the future (USAID, Province, collected using questionnaire technique. 2014; Kemenkes, 2013). Mothers and children need The call on which regency/city to be taken as sufficient and quality nutrition to ensure the most optimal samples is based on the highest number of stunting amount and results; motoric, social, and cognitive occurrence in West Java (Bappenas, 2017), including abilities; learning skills and future productivity. Bandung Regency, Bandung City, Garut Regency, West Considering the urgency of nutrition during heydays, a Bandung Regency, Subang Regency, and Sumedang prevention and intervention of stunting is to be put top Regency, totalling up to 534.652 respondents. The priority to improve the life quality for future generations minimal number of samples is based on the number of (Bappenas, 2012). population according to the Isaac and Michael sample- Prevention and countermeasures of stunting must be determining table with significance rate as much as 1% aligned with the collateral factors There are 5 main for ±550.000 population. Therefore, the minimal number factors of stunting according to Kemenkes in Riskesdas thereof falls within a range of 665 to 810 respondents. (2013), including poverty, social and culture, increase on The final samples used in this research are 810 exposure of contagious illness, less nutritious food respondents. susceptibility and limited access to health care service. Sampling technique in this research uses cluster The collateral factors of stunting on children in rural and sampling from 6 regencies/cities consisting of 6 villages urban areas are strengthened by research from that have KB village, each represented by a 135- Aridiyan, Rohmawati, and Ririanty (2015), including respondent sample per village. 810 respondents of 6 KB mother’s education level, family income, mother’s villages in 6 regencies/cities in West Java. 735 of them knowledge about nutrition, exclusive ASI distribution, the include toddlers and mom with toddlers (89.3%), age during which solid food given to a child before 6 pregnant women (8.2%) or 67 people, and pregnant months old (MP-ASI) is distributed, level of zinc and iron women with toddlers (2.5%) or around 20 respondents. adequacy, medical records. The aim of this research is Data collecting is done through questionnaires to analyze the collateral factors of stunting on children, consisting of questions to measure: individual factor measured from the mother’s socio-demographic factor, (mother’s pregnancy history and medical records), the child’s socio-demographic factor, and the child’s socio-demographic factors (gender, age, educational health status. background, occupation, family income, health insurance, healthcare service access), and behavior LITERATURE REVIEW (knowledge and family action on health defense, Bloem, at al (2013) study about the relationship nutritional adequacy fulfillment for pregnant women, between different causes of stunting and stunting antenatal check-up, and secure delivery process, prevalence over time in Southeast Asia. The results of exclusive breastfeeding distribution, nutritional this study that between 1990-2011, mortality rates adequacy fulfillment for toddlers, immunization among children under five declined from 69/1,000 to distribution, growth and development, as well as healthy 29/1,000 live births. Despite the reduction in disease, life behavior in family. Apart from that, data collecting is one of the two direct causes of stunting has played an also done through looking at medical records with Child important role that must be maintained, namely an Identity Card (Kartu Ibu dan Anak/KIA) as the main increase in meeting nutritional needs, and other direct reference; this is to observe the health status of the
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Table 1. Nutrition Status of Toddlers Based on Body Height Nutrition Status Frequency (f) Percentage (%) Nutrition Status Based on Body Heights: Very Short 37 5,0 Short 138 18,8 Normal 537 73,1 Tall 23 3,1
Table 2. Stunting Prevalence on Toddlers Based on Distribution per Regency/City Bandung West Bandung Sumedang Nutrition Status Bandung City Subang Regency Garut Regency Regency Regency Regency Indicator f % f % f % f % f % f % Based on body heights: Very Short 4 3,1 6 4,7 3 2,4 9 7,3 8 7,0 7 6,0 Short 23 18,0 39 30,2 37 30,1 17 13,7 12 10,4 10 8,7 Normal 101 78,9 83 64,3 82 66,7 92 74,2 85 73,9 94 81,0 Tall 0 0 1 0,8 1 0,8 6 4,8 10 8,7 5 4,3
mother and the child (stunting, pregnant mom’s anemia, 20%, specifically Bandung City 21.1%, Bandung risky pregnancy). Physical observation with Regency 34.9%, West Bandung Regency 32,5%, anthropometry to observe the condition of stunting on Subang Regency 21%, while Garut Regency 14.7%. If toddlers. put chronologically, it is indicated that the highest Data analysis done in this research applies that of prevalence of stunted toddlers occur in Bandung Chi square and Spearman to analyze factors affecting Regency as much as 34.9%, West Bandung Regency the occurrence of stunting on children. Research 32.5%, Subang Regency 30%, Bandung City 21.1%, relevant to human resources must be carried out Sumedang Regency 17.0%, while the least is Garut according to ethical principles. According to Polit and Regency 14.7%. Beck (2008), it is obligatory that researcher secure the The distribution of nutrition status of toddlers per rights of the individuals involved in nursing research. regency and mother’s characteristics can be seen on the Therefore, this research has been ethically consented Table 2 and Table 3. by the Ethical Committee of Research Universitas Table 3 shows the mother’s age in this research is Padjadjaran, with letter number: various. As much as 47.2% mothers are in their late 1206/UN6/KEP/EC/2018. The implementation of this teens (17 - 25 years old), 40.9% middle-school research took 3 months, specifically from October to graduates, 80.8% unemployed and thus take care of December 2018. their child on their own. Father’s occupation are also various, but mostly are private employees at 49.5% with RESULTS average income under 1.500.000 rupiahs. The average Based on the table above, seen from the body height of family spending is unparalleled with that of income. indicator, nearly all toddlers have a normal body height 41.5% family spending is bigger than the income, that is (73.1%) and the percentage for very short body and 1.500.000 - 2.500.000 rupiah. Around 64.8% families short reaches up to 23.8%. have health insurances and 92.6% claim that access to Out of all stunting data per regency city, it was health care service is easy. 81.8% mothers have applied indicated that Bandung City, Bandung Regency, and KB and 67.2% more apply injection-form KB, while 9.6% West Bandung Regency have the highest number of get information on KB from the healthcare staff. The stunting occurrence compared to that in Subang mother’s nutrition health status is obtained variously. Regency, Sumedang Regency, and Garut Regency. In 47.3% mothers have normal nutrition status, and 3.1% Bandung City, there are 23 short children (18.0%) and 4 others are very skinny. Moreover, around 89.3% are not very short children (3.1%). Meanwhile, Bandung pregnant, 97.3% do not have history of contagious Regency has 39 short children (30.2%) and 6 very short illness, and 95.9% do not have history of chronic children (4.7%). diseases. Based on Table 2, indicated by the body height Table 4 shows that the mother’s socio-demographic indicator, the nutrition status of nearly all toddlers in 6 factor pertinent to the occurrence of stunting is the regency/cities fall in normal category, in Bandung City mother’s occupation and record of delivery as much as 78.9%, Bandung Regency 64.3%, West complications (p value < 0.05), while other factors are Bandung Regency 66.7%, Subang Regency 74.2%, considered irrelevant. Based on the OR value, it is Sumedang Regency 73.9%, and Garut Regency 81%. figured that working mothers have higher risk of stunted Besides, the issue of short and very short toddlers toddlers as much as 0.532 compared to those who are remains apparent in the table above. Out of 6 unemployed. Meanwhile, mothers who have history of regencies/cities, nearly all regencies/cities have the delivery complications, have higher risk of stunted prevalence of short and very short toddlers more than
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Table 3. Mother’s Socio-Demographic Factor toddlers as much as 2.072 compared to those who do Factor Frequency (f) Percentage (%) not. Mother’s Age Early teens 12-16 years old 276 34,5 On Table 5, the number of male children are 386 Late teens 17-25 years old 378 47,2 (52.5%). Nearly all children are toddlers (99.7%). Based Early adult 26-35 years old 141 17,6 on the immunization status, nearly all children get Late adult 36-45 years old 6 0,7 Early teens 12-16 years old 276 34,5 complete immunization (83.8%), and 81.6% get on-time Mother’s Educational Background immunization. Apart from that, 75.5% children get Elementary School 236 29,5 Middle School 328 40,9 exclusive ASI, while 71.3% others get MPASI after the High School 200 25,1 child is 6 months old. On the other hand, based on the Diploma 10 1,2 child’s health status, 84.9% children have never been Bachelor (Graduate) 26 3,2 Master (Postgraduate) 1 0,1 hospitalized, and 88.4% do not have history of Mother’s Occupation contagious illness. Unemployed 647 80,8 Farmer 62 7,7 The demography factor and child’s health status, it is Private employee 48 6,0 found out that the completeness and punctuality of Self-employed 31 3,9 immunization, exclusive breastfeeding, and medical Civil servant 3 0,4 Others 10 1,2 history, have a significant relation with the occurrence of Father’s Occupation stunting on toddlers (p < 0.05). Partial immunizations Unemployed 10 1,2 carry the risk of stunting on toddlers 3.111 times bigger Farmer 90 11,2 Private employee 208 26,0 than those who get complete immunization. Mis- Self-employed 396 49,5 scheduled immunizations also have the risk of stunting Civil servant 40 5,0 Others 57 7,1 on toddlers 3.289 times bigger than those who get on- Family Income time immunization. Babies who do not get exclusive
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Table 4. Relation between the Mother’s Socio-Demographic Factor and Stunting Stunting Status P value OR Stunting Not Stunting 118 395 Middle school and under 23.0% 77.0% Education level 0.435 0.865 57 165 High school and under 25.7% 74.3% 56 174 >34 years old 24.3% 75.7% Age 0.817 1.044 119 386 ≤ 34 years old 23.6% 76.4% 45 110 >2 children 29.0% 71.0% Number of children 0.087 1.416 130 450 ≤ 2 children 22.4% 77.6% 23 124 Employed 15.6% 84.4% Occupation 0.010 0.532 152 436 Unemployed 25.9% 74.1% 85 250 ≤ 1.500.000 25.4% 74.6% Income 0.363 1.171 90 310 >1.500.000 22.5% 77.5% 68 213 ≤ 1.500.000 24.2% 75.8% Spending 0.845 1.035 107 347 >1.500.000 23.6% 76.4% 70 191 None 26.8% 73.2% Health Insurance 0.156 1.288 105 369 Available 22.2% 77.8% 12 47 Difficult 20.3% 79.7% Access to Healthcare Service 0.515 0.804 163 513 Easy 24.1% 75.9% 19 74 No Family Planning/Keluarga 20.4% 79.6% 0.414 0.800 Berencana Acceptor 156 486 Yes 24.3% 75.7% 96 295 Not Normal 24.6% 75.4% Mother’s Nutrition Status 0.614 1.092 79 265 Normal 23.0% 77.0% 38 66 Positive 36.5% 63.5% Delivery Complications 0.01 2.072 137 493 Negative 21.7% 78.3% 9 45 Non Healthcare Staff 16.7% 83.3% Delivery Service 0.214 0.602 166 515 Healthcare Staff 24.4% 75.6% 24 55 Special Delivery 30.4% 69.6% Delivery Process 0.149 1.459 151 505 Normal Delivery 23.0% 77.0% 6 17 Positive 26.1% 73.9% History of Contagious Illness 0.795 1.134 169 543 Negative 23.7% 76.3% 5 28 Positive 15.2% 84.8% History of Chronic Illness 0.238 0.559 170 532 Negative 24.2% 75.8%
along with its negative impacts on their future life. These from the increase of risk of contagious illness and death impacts include intellectual decline, susceptibility to that may hamper grow and mental development. The degenerative and non-contagious illness, productivity consequence of such deficiency during childhood is downturn, ultimately resulting in poverty and the risk of grave. Deficiency of pure protein on advanced stage giving birth to unconventionally low-weighted baby may cause kwashiorkor and marasmus during the (UNICEF, 2012; WHO, 2010). Other impact of child’s adolescence. malnutrition is often associated with lack of specific Table 3 shows the mother’s age in this research is minerals, vitamins, or micronutrients. Previous research various. As much as 47.2% mothers are in their late have shown the impact of micronutrients deficiency, teens (17 - 25 years old), 40.9% middle-school
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EurAsian Journal of BioSciences 14: 6725-6735 (2020) Rahayuwati et al. graduates, 80.8% unemployed and thus take care of development inside womb, resulting in low body weight their child on their own. Father’s occupation are also at birth (BBLR) and in stunting (Karima & Achadi, 2012). various, but mostly are private employees at 49.5% with One of the direct causes that contribute to the average income under 1.500.000 rupiah. The average of occurrence of stunting is contagious illness. This factor family spending is unparalleled with that of income. is much pertinent to basic healthcare service such as 41.5% family spending is bigger than the income; that is, immunization. The result of this research shows that 1.500.000 - 2.500.000 rupiah. Family economic status most toddlers (83.8%) get basic complete immunization and mother’s education level affects the occurrence of and 81.6% get on-time immunization. The coverage of stunting on children, according to Assefa (2013). The this type of immunization has not yet reached the targets mother’s relatively low level of knowledge may also in West Java; that is, 90%. In West Java alone, basic cause stunting on children. complete immunization has reached 93.4%. However, in In this research, as much as 64.8% family has health this research the number of the coverage is lower than insurance and 92.6% get easy access to healthcare that of West Java. service. Most mothers use injection family planning (KB) Both immunized toddlers and unimmunized toddlers as much as 9.6%; they have the KB information from have a good nutrition status. On the other hand, based healthcare staff. The mother’s nutrition status is varying. on the result of height measurement, unimmunized While 47.3% fall into normal category, 31% others into children are twice as likely to experience stunting very skinny. Around 89.3% mothers are not pregnant, compared to those who are immunized. This is similar to 97.3% have history of contagious illness and 95.9% do the research done by Rahmad and Miko (2016), not. This status is highly affective to the occurrence of showing that children who do not get basic complete stunting on children; therefore, the mother’s condition is immunization have the risk of stunting 4 times bigger healthy during pre-conception and pregnancy, even compared to those who do. It has important role in before, specifically during school age and adolescence, building child immune system. If toddlers are not forcing the mother’s condition to be in a normal immune to illness, it will result in decrease in appetite, condition. faster energy loss and lower nutrition level (Girma & The relation between the mother’s factor and the Genebo, 2007). child’s nutrition status (Table 4) can be seen from p Immunization is highly related to the stunting value on the table. If p value shows > 0.05, it means condition in this research. It is the means to actively there is no relation between variables on the mother’s provide immune to someone against contagious virus factor and the child’s nutrition status. On the other hand, (Ranuh, 2001). It is the means to improve one’s health if p value shows < 0.05, it shows there is a relation. On who has been ill (Mansjoer, 2000). It is the effort to that table, the mother’s factor relevant to the occurrence protect babies, children, and adults from infection of stunting consists of mother’s occupation and history (Riyadi, 2001). It is a reaction between antigen and of delivery complications. antibodies, or toxins in the field of immunology. The aim Table 4 shows that mother’s factor having p value < of immunization is to lower the number of illness, 0.05 is her occupation and her history of delivery disability, and death from illness curable with complications. This shows that there is a significant immunization. The result of the research in Kupang relation between that variable and the occurrence of shows that children who do not have history of stunting on children. Based on OR value, it is found out immunization has a bigger chance of suffering from that the working mothers carry the risk of having a stunting than those who do not, with 1.983 times bigger. stunted baby 0.532 times bigger than those who do not. Other research also mention the completeness of This is similar to theory of Sunardi (2008) in Khotimah immunization has significant impact on stunting. It is and Kuswandid (2014), claiming that a fairly good necessary for early ages being the age most vulnerable occupation will result in good income, sufficing the need to illness. Unimmunized or partially immunized children of food and health. However, in this research, it is seen are more susceptible to illness, impacting on the that the mother’s occupation, working mothers carry the occurrence of stunting. Stunting itself is a condition of risk of having stunted babies 0.532 times bigger than chronic malnutrition prone to ill-driven toddlers. those who do not. This is of course supported by a large The result of this research shows that the proportion number of family members, resulting to lack of food of stunted toddlers is more commonly found in toddlers provision to all. Moreover, the mothers who do not work with history of basic partial immunization than those with will spend more time with their children, affecting the history of basic complete immunization. This research is child’s nutrition quality. parallel with Dandara, et. al., (2016) claiming that there On the other hand, mothers who have history of exists a strong relation between basic immunization and delivery complications carry the risk of having stunted stunting prevalence on toddlers in West Papua baby 2.072 times bigger than those who do not. The Province. It further claims that the children without complications include anemia, hypertension, and immunization history has 1.983 bigger chance to suffer hyperemesis. These will hamper the fetus’s growth and from stunting than those who do not.
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Table 5. Factor of the Child’s Demography and Health children aged 0 - 23 months old (Nadiyah, Briawan, & Status Martianto, 2014). Food provision beside exclusive milk Factor Frequency(f) Percentage (%) Gender have a negative systemic effect such as contagion- Male 386 52,5 prone digestive system, and disturbed growth (Tan, Female 349 47,5 2011). Age Toddler 733 99,7 The low frequency of exclusive milk becomes one of Children 2 0,3 the triggers of malnutrition on toddlers caused by past Immunization Fulfillment experiences and has impact to their future. A good ASI Non-immunized 17 2,3 Partial Immunization 102 13,9 provision from the mother will keep the balance of the Complete Immunization 616 83,8 child’s nutrition level, reaching to a normal level of their Immunization Schedule Non-immunized 17 2,3 growth. Children who have been given exclusive ASI Mis-scheduled Immunization 118 16,1 and solid food according to their needs can reduce the On-time Immunization 600 81,6 risk of malnutrition. This is because, during the age of 0 Exclusive 0-6 month ASI status ASI and MPASI 59 8,0 to 6 months old, babies can build immune system so that ASI and Formula Milk 117 16,0 they are protected from contagious illness. After 6 ASI 555 75,5 months, they are given solid food in a certain amount Formula milk 4 0,5 Exclusive 6 month - 2 year breastfeeding status and frequency so their nutritional necessity can be ASI, Formula Milk, MPASI (no) 150 20,4 fulfilled. The less frequent the milk provision, the higher Formula Milk and MPASI (no) 61 8,3 ASI and MPASI (yes) 524 71,3 the risk of malnutrition and slow growth. Starting Age of additional food Regarding the child’s demography factor and health 0 Month 2 0,3 status, it is found out that the completeness and 1 Month 3 0,4 2 Month 4 0,5 schedule of immunization, exclusive ASI, and medical 3 Month 8 1,1 records, have significant relation to the occurrence of 4 Month 19 2,6 stunting on toddlers (p < 0.005). Partial immunization 5 Month 12 1,6 6 Month (Suitable) 643 87,6 carries the risk of stunting at 3.111 times bigger than 7 Month 33 4,5 those who get complete immunization. Mis-scheduled 8 Month 8 1,1 9 Month 1 0,1 immunizations also carry the risk of stunting on toddlers 10 Month 1 0,1 at 3.289 times bigger than those who were given 12 Month 1 0,1 immunizations on-time. The result of this research History of Hospitalization Negative 624 84,9 shows that partial immunization have significant relation Positive 111 15,1 to the occurrence of stunting on toddlers (Ramli et. al, Child Medical Records Negative 649 88,4 2009). Complete immunizations may prevent the child TBC 18 2,4 from an illness. Several factors causing the benefit and ISPA/Pneumonia 45 6,1 effectivity of immunization provision include vaccine Other Illnesses 23 3,1 quality and punctuality of the provision. Therefore, a toddler with complete immunization have less chance to Besides, one of the factors directly causing the suffer from stunting. The complete immunization nutrition status of toddlers is food intake. On babies at 0 provision must be supported with the punctuality of - 6 months old, exclusive ASI becomes a vital factor for immunization provision, so that the result can be optimal their growth. The result of this research shows that to improve the child’s immune system. Basic 75.5% toddlers get exclusive ASI, and 24.4% others do immunization is crucial for the child’s immune system, not. The latter does not get the milk because they are as stipulated by national objectives, saying that basic already provided with enough food. The table above complete immunization must achieve a 100% target. shows that 30% of these toddlers will suffer from This is because children without complete immunization stunting. will have immune complications such as susceptibility to In this research, children who get exclusive ASI, contagious illness, knowing that the production of have better nutrition status than those who do not. antibody slows down. This means access to dangerous Similarly, those who do not get exclusive milk have the viruses that may hamper the production of various higher risk of suffering from stunting, although no enzymes for digestion (Al-Rahmad, Miko, & Hadi, 2013). significant difference is indicated. The relation between The status of exclusive breastfeeding provision also exclusive ASI with stunting occurrence is parallel with is impactful to stunting. Babies who don’t get exclusive the research from Paramashanti, Hadi, and Gunawan breastfeeding will carry the risk of stunting 1.146 times (2016) to 6.956 Indonesian toddlers, showing that bigger than those who do. It is also the factor on the exclusive milk is protective to the stunting occurrence on occurrence of stunting (Fitri, 2010). The low amount of toddlers but does not indicate significant impact. Food exclusive ASI also becomes one of the triggers of provision or non-milk on babies before 6 months old, can stunting, strengthened by past experiences and result in be a significant risk factor to stunting occurrence on
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EurAsian Journal of BioSciences 14: 6725-6735 (2020) Rahayuwati et al. their future. On the other hand, a good milk provision CONCLUSION from the mother will help keep their nutrition balanced. In general, this research concludes that there are Toddlers who are given exclusive breastfeeding and 23.8% toddlers are stunted. That number is relatively solid food according to their needs are less likely to lower than that of national, 30.8% (Riskesdas, 2018) but suffer from stunting. This is because the milk given at higher than the national target to lower the number of the age of 0 to 6 months may prevent the baby from stunted children under 20%. Based on the factor contagious illness. After 6 months, solid food is given in analysis, there is a relation between mother’s a certain amount and frequency so that the nutrition level occupation (p = 0.010; OR = 0.532), delivery is adequate. The low amount of milk given is one trigger complications (p = 0.010; OR = 2.072), completeness of of stunting due to past experiences and is impactful to immunization provision (p = 0.000; OR = 3.111), the child’s future. On the other hand, a good provision of immunization schedule (p = 0.000; OR = 3.289), milk will keep the child’s nutrition balanced. ASI is crucial exclusive breastfeeding provision (p = 0.041; OR = during the baby’s growth. Therefore, it is obligatory that 1.486), and child’s medical record (p = 0.044; OR = the mother provide milk exclusively until 6 months and 1.649). Other factors are considered irrelevant. Children keep milking the baby for the next 2 years (Al-Rahmad, who get basic complete immunization have bigger risk Miko, & Hadi, 2013). of suffering from stunting than those who get partial Medical history also contributes to the occurrence of immunization. Besides, those who don’t get exclusive stunting. Toddlers who have medical records are at risk breastfeeding tend to suffer from stunting more, 1.649 times bigger than those who do not. The analysis although no significant difference is indicated. Medical result shows there is a relation between history of records also contribute to the occurrence of stunting. contagious illness and stunting occurrence, both in rural Those who have medical record have the risk of stunting and urban areas. This goes hand in hand with previous bigger than those who do not. Therefore, it is necessary research done in Karangasem, showing that contagious to cooperate from all sectors and improve the role of illness hampers linear growth by first impacting the healthcare staff in educating the mother regarding child’s nutrition status. This is because contagious complete immunization provision on-time, exclusive illness may pass down food intake, disrupt the breastfeeding provision, and prevention of contagious absorption of nutrients, and cause direct nutrition loss, illness on children. improve metabolic needs (Suiraoka, Kusumajaya, & Larasati, 2014). There lies a reciprocal interaction ACKNOWLEDGEMENT between nutrition status and contagious illness. Malnutrition may increase the risk of contagion, while the This finalization of this study conducted by financial contagion itself may cause malnutrition, both going on a support from Indonesia Population Board, and Ministry vicious circle. This condition must not be overlooked. of Research, Technology and Higher Education. I would like to thank to the community leaders and the community itself in all Regencies and Cities in West Java Province who are involved in this study.
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