SOCIAL FACTORS OF STUNTING DETERMINANT
6.3. THE CAUSE OF STUNTING IN CHILDREN UNDER FIVE
SOCIAL FACTORS OF STUNTING DETERMINANT 4. Nutrition improvement programme in schools. The school
day is changed to 5 days (Monday to Friday) a week, study hours increased from 7 to 16. Lunch and snacks are used for nutrition improvement program in schools. During the day and before going home, there should beobligatory prayers in congregation, as well as moral and cultural development of the nation. Therefore the intensity of children and parents interaction could be longer, 2 days (Saturday-Sunday) in a week.
5. UKS (School Health Program) becaming a Health center should be mandatory, with coverage throughout the primary, secondary, and high school.
6.3. THE CAUSE OF STUNTING IN CHILDREN UNDER
Associated with the growth rate of WHO standard, as shown in Figure 9 in the previous chapter, it appears that thegap of growth of children both for male and female is widening, and also shows the slowdown in the growth start from age 12-23 months. Many factors are causing this, but because they are very dependent on the mother/family, therefore the family and environmental conditions that affect the family will have an impact on nutritional status.
Reduction of the nutritional status occurs due to poor nutritional intake and frequent infections. Therefore environmental factors, and health behavior of the families who facilitate/triggering the infection, affects the nutritional status of children. Adequacy of energy and protein per day per capita of Indonesian child seems very lacking when compared to Recommended Dietary Allowance (RDA ), both for normal children or stunted children ( Figure 73).
It is very interesting that the energy and protein intake did not differ significantly between children who are classified as stunted nor normal. Generally assumed, that consumption obtained for all children (stunted or normal ) is in the same condition, which is less than the RDA. If it lasts for years then a chronic problem occurs.
SOCIAL FACTORS OF STUNTING DETERMINANT
Source : Riskesdas 2010.
Figure 73. Average intake of energy and protein per day per capita by age in under five children.
The incidence of infection in the past month can be seen from the Susenas data in the following table. It appears that in average,children under five get sick (in average) 3-4 days in a month. This could bea factor that makes their nutritional status deteriorated, influencing their growth performance, and thus the prevalence of stunting increased.
Table 25. Proportion of children <5 sick last month and average days of affected by age groups and gender, Susenas 2012
Age (month) Health complaints last month Average days of sick Boys Girls Boys+ Girls
0-11 38.5 35.7 37.1 4.2
12-23 49.0 49.6 49.3 4.1
24-35 43.9 44.0 44.0 4.0
36-47 39.3 38.8 39.0 3.8
48-59 37.1 36.4 36.8 3.8
Source : Atmarita, 2014
Significant factors that worsened the problem of nutrition is clearly shown in Figure 74. The influence of parents who smoke both at the level of the lowest economic status (quintile 1) to the top (quintile 5), underlines the magnitude of stunting problem more than doubled. In the poorest group, the prevalence of stunted children of smoking parents was at 33.7 percent compared to 13.7 percent whose parents do not smoke. The prevalence of stunfed children for the richest group also differ significantly in smoking parents or non-smoking parents (18.1% versus 9.9%). It is clearly shown that poverty factors greatly affected the prevalence of stunting and the number is worsened with smoker’s parents. Overall, a smoker parent causes about 16% increase (OR: 1.156, 95CI: 1,154 - 1,159) in the incidence of stunting compared withnon-smokers parents.
(Atmarita, 2012)
Source: Riskesdas 2010
Picture 74. The proportion of stunted children in families of smokers and non-smokers based on economic status
One study of environmental pollution which have an impact on public health is the contamination of pesticides that is widely used in agriculture. At one areas with a high pesticide usage, a significant difference is found in the proportion of patients with hypothyroidism (based on the level of TSHs/Thyroid Stimulating hormons) between pesticides exposed and non exposed areas,
SOCIAL FACTORS OF STUNTING DETERMINANT as shown in the following figure. If the exposure to the pesticides happen continuously, the growth of the children will be impaired and lead to the more incidence of stunting. Although the coverage area of this study is not very wide, but the impact of environmental contamination must continually be put into concern.
Source: Study of pesticides environmental pollution, Balitbangkes 2012
Figure 75. The proportion of patients with hypothyroidism based on TSHs levels by pesticide exposure areas 2012
The dominance of stunted children incidence in the population is likely as a result of the famine that occurred in a long time. One of the fundamental causes is poverty. Clear differences are shown in Figure 76, where the prevalence of stunted in population groups with the lowest spending level (quintile 1) is almost at 20 percent of population with the highest expenditure level (quintile 5).
Source : Riskesdas 2010.
Figure 76. The stunted prevalence among children 0-59 months by Parent’s Expenditure level
A significant difference in prevalence between population quintile groups 1 to 4 with quintile 5 is clearly shown by the difference of average expenditure per capita which are<Rp700,000 versus>Rp 1,500,000. The figure of this economic status is actually an interaction of malnutrition that causes poverty, and vice versa poverty causes chronic malnutrition. In adulthood, the people with malnutrition will potentially not have optimal productivity, and generally, this condition is followed by imperfect intelligence (Atmarita , 2012).