Faktor Risiko Stunting, Anemia, dan Koeksistensinya pada Anak Usia Sekolah (6-9 Tahun) di Perdesaan, Perkotaan, dan Indonesia
Date
2022Author
Utami, Mia Mustika Hutria
Kustiyah, Lilik
Dwiriani, Cesilia Meti
Metadata
Show full item recordAbstract
Stunting dan anemia merupakan masalah kesehatan masyarakat di Indonesia.
Stunting, anemia, dan Koeksistensi Stunting dan Anemia (KSA) dapat berpengaruh
terhadap terhambatnya perkembangan psikomotor, sosio-emosional, serta performa
akademik yang kurang baik pada anak. Usia 6-9 tahun merupakan periode anak usia
sekolah yang tepat untuk mengidentifikasi faktor risiko stunting, anemia, dan KSA
karena anak belum mengalami second growth spurt atau puncak pertumbuhan
sebelum tinggi badan akhir tercapai, serta perempuan belum menarche. Tujuan
penelitian adalah menganalisis faktor risiko stunting, anemia, dan koeksistensinya
pada anak usia sekolah (6-9 tahun) di wilayah perdesaan, perkotaan, dan Indonesia.
Penelitian cross-sectional ini menggunakan data sekunder Indonesian Family
Life Survey (IFLS) gelombang 5 tahun 2014-2015 dari RAND Corporation, United
States dengan unit analisis nasional. Penelitian ini dilaksanakan sejak Oktober
2021-Februari 2022. Subjek penelitian berjumlah 1986 anak berusia 6-9 tahun yang
berasal dari 13 provinsi di Indonesia, terdiri dari 858 subjek di perdesaan dan 1128
subjek di perkotaan. Variabel penelitian adalah karakteristik subjek (usia, jenis
kelamin), status gizi subjek (nilai z TB/U dan status anemia), karakteristik orang
tua (usia, status merokok, lama sekolah, pekerjaan, status perkawinan, tinggi
badan), karakteristik keluarga (besar keluarga, kepala keluarga, wilayah tinggal,
skor sanitasi lingkungan, akses listrik, dan Wealth Index/WI), kebiasaan (frekuensi
konsumsi pangan) dan kualitas konsumsi pangan subjek (Individual Dietary
Diversity Score/IDDS), dan status gizi orang tua (IMT dan status anemia). Analisis
data yang digunakan meliputi analisis univariat (uji deskriptif), analisis bivariat (uji
beda menggunakan Independent t-test, Mann-Whitney test dan Chi-squared test (ꭓ2
)
dan uji korelasi menggunakan Pearson test, Spearman test, dan Chi-squared test
(ꭓ2
)), serta analisis multivariat menggunakan uji regresi logistik). Pengolahan data
status gizi subjek menggunakan WHO AnthroPlus version 1.04, dan untuk variabel
lainnya menggunakan Microsoft Excel 2010 dan STATA version 16.0. Analisis
data menggunakan IBM SPSS version 23.0.
Rata-rata nilai z TB/U, IDDS subjek, frekuensi konsumsi telur, daging, susu,
pisang, pepaya, wortel, fast food, dan makanan manis subjek signifikan lebih rendah
di perdesaan dibandingkan perkotaan. Sebaliknya, rata-rata frekuensi konsumsi
ikan, sayuran hijau, dan sambal signifikan lebih tinggi di perdesaan dibandingkan
perkotaan. Meskipun demikian, rata-rata usia, kadar Hb, proporsi jenis kelamin
subjek, frekuensi konsumsi nasi, ubi, mangga, mie instan, minuman soda, dan
gorengan subjek tidak berbeda signifikan antar wilayah tinggal. Rata-rata usia, lama
sekolah, tinggi badan, dan IMT orang tua; WI; skor sanitasi lingkungan; dan
proporsi ibu bekerja; signifikan lebih rendah di perdesaan dibandingkan perkotaan.
Sebaliknya, proporsi ayah perokok aktif dan rumah tangga yang tidak memiliki
akses listrik signifikan lebih tinggi di perdesaan dibandingkan perkotaan. Meskipun
demikian, rata-rata kadar Hb orang tua, besar keluarga, proporsi ayah bekerja, ibu
bukan sebagai perokok aktif, kepala keluarga, dan status perkawinan orang tua tidak
berbeda signifikan antar wilayah tinggal.
Prevalensi stunting di perdesaan, perkotaan, dan nasional berturut-turut
adalah 31,8%, 19,5%, dan 24,8%. Prevalensi anemia di perdesaan, perkotaan, dan
nasional berturut-turut adalah 32,1%, 29,3%, dan 30,5%. Prevalensi KSA di
perdesaan, perkotaan, dan nasional berturut-turut adalah 10,4%, 7,5%, dan 8,8%.
Prevalensi stunting dan KSA signifikan lebih tinggi di perdesaan dibandingkan
perkotaan. Namun, prevalensi anemia tidak berbeda signifikan antar wilayah
tinggal, hanya cenderung lebih tinggi di perdesaan dibandingkan perkotaan.
Faktor risiko stunting di perdesaan adalah ayah dan ibu pendek (OR=2,05,
OR=2,23), skor sanitasi lingkungan rendah (OR=2,27), dan besar keluarga sedang
(OR=1,42). Faktor risiko stunting di perkotaan adalah ayah dan ibu pendek
(OR=2,00, OR=2,81), IDDS tergolong tidak beragam (OR=1,64), subjek anemia
(OR=1,81), lama sekolah ibu <12 tahun dan 12 tahun (OR=1,90, OR=1,83), skor
sanitasi lingkungan sedang (OR=2,15), dan ayah underweight (OR=1,81). Faktor
risiko stunting di Indonesia adalah ayah dan ibu pendek (OR=2,00, OR=2,49),
IDDS tergolong tidak beragam (OR=1,30), subjek anemia (OR=1,35), lama sekolah
ibu <12 tahun (OR=1,73), skor sanitasi lingkungan rendah dan sedang (OR=2,36,
OR=1,36), ayah underweight (OR=1,59).
Faktor risiko anemia di perdesaan adalah usia subjek lebih muda (6-7 tahun)
(OR=2,01), ayah dan ibu anemia (OR=1,92, OR=2,61). Faktor risiko anemia di
perkotaan adalah usia subjek 6-7 tahun (OR=1,85), ayah dan ibu anemia (OR=1,51,
OR=1,61), dan subjek stunting (OR=1,69). Faktor risiko anemia di Indonesia
adalah usia subjek 6-7 tahun (OR=2,01), ayah dan ibu anemia (OR=1,69,
OR=1,97), dan subjek stunting (OR=1,32). Faktor risiko KSA di perdesaan adalah
usia subjek 6-7 tahun (OR=2,02), ayah dan ibu pendek (OR=1,89, OR=1,84), dan
ibu anemia (OR=1,66). Faktor risiko KSA di perkotaan adalah usia subjek 6-7 tahun
(OR=1,80), dan ibu pendek (OR=2,04). Faktor risiko KSA di Indonesia adalah usia
subjek 6-7 tahun (OR=1,96), serta ayah dan ibu pendek (OR=1,64, OR=1,89).
Karakteristik subjek dan keluarga secara umum tidak berbeda signifikan antar
wilayah tinggal. Di perdesaan, konsumsi pangan lebih tidak beragam, sanitasi
lingkungan dan status ekonomi lebih buruk dibandingkan perkotaan. Prevalensi
stunting, anemia, dan KSA lebih tinggi di perdesaan dibandingkan perkotaan.
Berbagai faktor meningkatkan risiko satu atau kedua malnutrisi. Faktor risiko
utama stunting di perdesaan adalah skor sanitasi lingkungan rendah. Faktor risiko
utama stunting di perkotaan dan nasional, dan KSA di perkotaan adalah ibu pendek.
Faktor risiko utama anemia di perdesaan dan nasional adalah ibu anemia. Faktor
risiko utama anemia di perkotaan dan KSA di perdesaan dan nasional adalah usia
subjek 6-7 tahun.
Oleh karena itu, keragaman konsumsi subjek yang sudah baik perlu
dipertahankan. Pemerintah perlu melanjutkan program wajib belajar 12 tahun,
melakukan perbaikan fasilitas air bersih dan sanitasi, dan melaksanakan pendidikan
gizi terkait sanitasi lingkungan. Berdasarkan faktor risiko teridentifikasi, kebijakan
untuk mengatasi stunting, anemia, maupun KSA tidak dapat digeneralisasi antar
wilayah tinggal karena memiliki faktor risiko yang bervariasi. Penelitian
selanjutnya disarankan menganalisis perbedaan faktor risiko stunting, anemia, dan
KSA antara usia sebelum dan setelah menarche pada Anak Usia Sekolah (AUS). Stunting and anemia are become a public health problem in Indonesia.
Stunting, anemia, and coexistence of stunting and anemia (CSA) could affect the
retardation of psychomotor, socio-emotional, and poor academic performance
among children. Age 6-9 years is an appropriate period for school-aged children to
identify risk factors of stunting, anemia, and CSA because the children have not
experienced a growth spurt or peak growth before the final height is reached, and
girls have not menarched. It provides a chance to catch-up and improve nutrition
just before the adolescence period (the second window opportunity). The objective
of this study is to analyze risk factors of stunting, anemia, and CSA among schoolaged children (6-9 years) in rural, urban, and Indonesia.
This cross-sectional study using the secondary dataset of the Indonesian
Family Life Survey (IFLS) wave 5 in 2014-2015 from RAND Corporation, United
States, with national unit analysis. This study was obtained from October 2021-
February 2022. The number of subjects were 1986 children aged 6-9 years from 13
provinces in Indonesia, consisting of 858 subjects in rural areas and 1128 subjects
in urban areas. Variables being studied were subject characteristics (age, gender);
subject’s nutritional status (HAZ, anemic status); parent characteristics (age,
smoking status, length of study, occupation, marital status, height); household
characteristics (family size, household head, living area, environmental sanitation
score, electricity access and Wealth Index/WI); subject’s food habits (consumption
frequency) and diet quality (Individual Dietary Diversity Score/IDDS); and parental
nutritional status (BMI, anemic status). Data analysis used included univariate
analysis (descriptive test), bivariate analysis (different test using Independent t-test;
Mann-Whitney test; and Chi-squared test (ꭓ
2
), and correlation test using Pearson
test; Spearman test; and Chi-squared test (ꭓ
2
)), and multivariate analysis using
logistic regression test. Data processing of subject’s nutritional status using WHO
AnthroPlus version 1.04, and other variables using Ms. Excel 2010 and STATA
version 16.0. Data analysis using IBM SPSS version 23.0.
The average subject’s HAZ, IDDS, consumption frequencies of egg, meat,
dairy, bananas, papaya, carrots, fast food, and sweet foods were significantly lower
in rural than urban areas. In contrast, the average consumption frequencies of fish
green leafy vegetables, and chili sauce were significantly higher in rural than urban
areas. Nevertheless, the average subject’s age, Hb level, gender proportion, and the
average consumption frequencies of rice, tuber, mango, instant noodles, coke, and
fried foods were not significantly different between living areas. The average
parental age, length of study, height, and BMI; WI; environmental sanitation score;
and the proportion of working parents were significantly lower in rural than urban
areas. In contrast, the proportions of active smoker father and household who
doesn’t have electricity access were significantly higher in rural than urban areas.
Nevertheless, the average parental hemoglobin level, family size, proportions of
non-active smoker mother, household head, and parent’s marital status were not
significantly different between living areas.
The prevalence of stunting in rural, urban, and national areas were 31,8%,
19,5%, and 24,8%, respectively. The prevalence of anemia in rural, urban, and
national were 32,1%, 29,3%, and 30,5%, respectively. The prevalence of CSA in
rural, urban, and national were 10,4%, 7,5%, and 8,8%, respectively. The
prevalence of stunting and CSA were significantly higher in rural than urban areas.
Nevertheless, the prevalence of anemia was not significantly different between
living areas. It tended to be higher in rural than urban areas.
Risk factors of stunting in rural areas were paternal and maternal short stature
(OR=2,05, OR=2,23), low environmental sanitation score (OR=2,27), and medium
family size (OR=1,42). Risk factors of stunting in urban area were paternal and
maternal short stature (OR=2,00, OR=2,81), IDDS classified as not diverse
(OR=1,64), anemic subject (OR=1,81), maternal length of study <12 years and 12
years (OR=1,90, OR=1,83), medium environmental sanitation score (OR=2,15),
and paternal underweight (OR=1,81). Risk factors of stunting in Indonesia were
paternal and maternal short stature (OR=2,00, OR=2,49), IDDS classified as not
diverse (OR=1,30), anemic subjects (OR=1,35), maternal length of study <12 years
(OR=1,73), low and moderate environmental sanitation score (OR=2,36,
OR=1,36), underweight father (OR=1,59).
Risk factors of anemia in rural areas were younger subjects (aged 6-7 years)
(OR=2,01), paternal and maternal anemia (OR=1,92, OR=2,61). Risk factors of
anemia in urban areas were subjects aged 6-7 years (OR=1,85), paternal and
maternal anemia (OR=1,51, OR=1,61), and stunted subjects (OR=1,69). Risk
factors of anemia in Indonesia were subjects aged 6-7 years (OR=2,01), paternal
and maternal anemia (OR=1,69, OR=1,97), stunted subjects (OR=1,32). Risk
factors of CSA in rural areas were subjects aged 6-7 years (OR=2,02), paternal and
maternal short stature (OR=1,89, OR=1,84), and maternal anemia (OR=1,66). Risk
factors of CSA in urban areas were subjects aged 6-7 years (OR=1,80) and maternal
anemia (OR=2,04). Risk factors of CSA in Indonesia were subjects aged 6-7 years
(OR=1,96), and paternal and maternal short stature (OR=1,64, OR=1,89).
Subject’s, parental, and household characteristics generally were not
significantly different between living areas. In the rural areas, food consumption
was less diverse. Environmental sanitation and economic status were also worse in
rural than urban areas. The prevalence of stunting, anemia, and CSA were higher in
rural than urban areas. Various factors increase the risk of one or both malnutrition.
The main risk factor of stunting in rural areas was a low environmental sanitation
score. The main risk factor of stunting in urban and national, and CSA in urban
areas was maternal short stature. The main risk factor of anemia in urban, and CSA
in rural and national areas was subjects aged 6-7 years.
Therefore, a good variety of food consumption needs to be maintained. It is
also necessary to continue with the 12 years compulsory education program,
improvement of clean water and sanitation facilities, as well as nutrition education
related to environmental sanitation. Based on the identified risk factors, policies to
overcome stunting, anemia, or KSA cannot be generalized between living area
because they have varied risk factors. Further research is recommended to analyze
the differences in the risk factors of stunting, anemia, and CSA between age before
and after menarche among School-Aged Children (SAC).
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