Risk Factors of Stunting Among School-aged Children
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Date
2014Author
Yasmin, Ghaida
Kustiyah, Lilik
Dwiriani, Cesilia Meti
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Based on the results of Indonesian Basic Health Research in 2010, the national prevalence of stunting among school aged children (6-12 years old) was 35.6%. Stunting is a major public-health problem in low and middle-income countries because of its association with increased risk of mortality during childhood. Stunting also leads to significant physical and functional deficits among survivors (The Lancet 2008). Stunting affects the development of cognitive processes during school-aged period (Kar et al. 2008). Several studies have shown that during school-aged period, children was less experienced catchup growth or remain stable even experienced stunting (Friedman et al. 2005). Health Research and Development Agency of the Indonesian Ministry of Health has conducted a Basic Health Research at national scale in 2010 that could potentially be analyzed to determine the risk factors for stunting in school-aged children. Therefore, the objective of this study was to analyze risk factors of stunting among school-aged children. Specifically, objective of this study as follows: (1) identify the characteristics of the children and families of stunted and normal children, (2) identify health and environmental sanitation in stunted and normal children, (3) identifying the incidence of infectious diseases (malaria) in stunted and normal children, (4) analyzing the quantity and quality of food consumption in stunted and normal children and (5) analyze factors that influence the incidence of stunting in the children. This study used secondary data from Basic Health Research by Health Research and Development Agency of the Indonesian Ministry of Health in 2010 with a cross-sectional study design. The data analyzed in this study were from eight Provinces which selected according category of prevalence of stunting (WHO 1997), were very high (≥ 40%) in East Nusa Tenggara and North Sumatra, high (30-39%) in West Nusa Tenggara and West Java, moderate (20-29%) in Bangka Belitung, Jakarta and Yogyakarta, and low (<20%) in Bali. Processing and data analysis was conducted in June-October 2013. Subjects of this research are boys and girls aged 6-12 years from eight provinces. Number of subjects contained in the electronic files was 11335 children. After a cleaning process, the number of children analyzed was 8710. Analysis data used Microsoft Excel 2007 and SPSS for Windows version 17.0. The t test and oneway ANOVA was used to determine mean difference of variable with data continues and mean HAZ. Chisquare test was used to determine relationship between independent variable with stunting. Multivariate analyzes were performed using logistic regression with Backward Wald method with statistical significance criteria of p<0.05, and the value of the confidence interval (CI) of 95%. Prevalence of stunting in eight provinces was 28.11 % and 11.38% were categorized as severe stunting. Stunted children were higher in older children (10- 12 years), male, mother with short stature (<145 cm), parents with low education levels (≤ primary school), father who smoking, mother with a low BMI and father 6 with normal BMI, children with ≥ 8 family member, low household expenditure (quintiles 1 and 2), and living in rural areas. There were significant relationship between children with older age (10-12 years), male children, low maternal height (<145 cm), paternal smoking habits, parental BMI <18.5 kg/m2, large family (≥8 member), low household expenditure (quintiles 1 and 2) and living in rural areas with stunting in children. There was at least one health care facility in living environment of children and have used it in 76.41% children. There was a significant relationship between the availability and utilization of health care facilities with stunting in the children. A total of 50.46% children have moderate of environmental sanitation scores and only 32.57% were classified as good. There was a significant relationship between environmental sanitation scores with stunting in children. There was 2.26% children had diagnosed with malaria during the last 1 year. There is no significant relationship between malaria and stunting in children. Mean energy and nutrients adequacy level of stunted children significantly lower than normal children, except for vitamin A and C. Mean vitamin A and C adequacy level were higher in stunted children than normal children, but only vitamin C which significantly different between stunted and normal children (p<0.05). Percentage of energy from carbohydrate, fat and protein is significantly lower in stunted children compared to normal children (p<0.05). Energy and nutrients adequacy level significantly associated with stunting in school-aged children (p<0.05), except for vitamin A adequacy level. There was a significant relationship between the percentage of energy from carbohydrate, fat and protein with stunting in school-aged children (p<0.05). There were 65.03% of children who have poor quality food consumption and only 20 (0.23%) children have good quality food consumption. There was a significant relationship between categories of HEI score with stunting in school-aged children (p<0.05). Based on logistic regression analysis, risk factors of stunting in schoolaged children were low household expenditure (quintile 1 and 2), low Healthy Eating Index score (<50), low maternal height (<145 cm), low maternal education (middle-high school and ≤ elementary school), higher family member (≥8 member), low energy and protein adequacy level (<70%), older age (age 10-12 years), living in rural area, male sex, and low sanitation score (<60%). In the process of overcoming the problem of stunting, particularly in school-aged children, there should be an effort to improve the socio-economic status and mother education. Family planning also needs to be encouraged in order to create a family with ideal number. Health care facilities and environmental sanitation conditions need to be improved, especially in provinces with very high stunting prevalence category. School-based nutrition, health and hygiene practice education, should also be done in order to direct school-aged children as the primary targets.
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