TREND OF STUNTING
3.1. TREND OF STUNTING AMONG CHILDREN UNDERFIVE
The National Institute of Health Research and Development of the Ministry of Health has done 5 national large surveys measuring the nutritional status of children, namely HHS 2001 and 2004, as well as Riskesdas in 2007, 2010 and 2013. The number of samples used for each survey do not equally represent the territory, so it should be take into caution in interpreting the results. Survey in 2001 and 2004 could represent the national and regional (Java- Bali, Sumatra and East indonesia) level, Riskesdas 2010 represents national and provincial level, while Riskesdas 2007 and 2013 are using the largest sample so they represent the national, provincial and district level. For the national level there is a decrement of the prevalence of stunting among underfive, in 2001 is at 29.5%
(CI 27.9 to 30.1) to 28.5% (CI27.2 to 28.8) in 2004. The prevalence of stunting in underfive showed an increment from 2004 to 2007 (36.8%:CI 35.8 to 36.2), and then there was a slight decrease in 2010 (35.6%; CI 34.7 to 35.3) and increased again in 2013 to 37.2%
(CI 36.7 to 37.3). In general, boys tend to have higher prevalence than girls (see figure 6 below)
Figure 6. Trend ofstunted prevalence among children under five, 2001 – 2013
Trends of stunting prevalence among children under five in the last 6 years can be seen from the results of Riskesdas 2007, 2010 and 2013 (Figure 7). For the prevalence of severe stunting, tends to have decreased from 18.8% (Riskesdas 2007) to 18.0%
(Riskesdas 2013), but for stunting occured a slight increment from 18.0% (Riskesdas 2007) slightly fell to 17.1% (Riskesdas 2010) but then to 19.2% (Riskesdas 2013).
Figure 7. The trend of severe and moderate stuntedprevalence of children under five: 2007-2013
TREND OF STUNTING Dynamics of changes in the prevalence of stunting between provinces can be seen in Figure 8 that combines the prevalence of stunting from Riskesdas (2007, 2010 and 2013) below.
Figure 8. The trend of stunted prevalence among children under five by province, 2007-2013
Compared to 2007, the prevalence of stunting was relatively stagnant, some provinces showed progress with a decrease in the prevalence of stunting among underfive (Kaltim, Babel, Banten, South Sumatra, Maluku). Some provinces showed deterioration due to increased prevalence of stunting (Sulawesi, West Papua and Aceh, NTT). According to Riskesdas in 2013, the provinces with the highest prevalence of stunting are East Nusa Tenggara, West Sulawesi and West Nusa Tenggara.
Public health problems of stunting are considered as severe when its stunting prevalence is of 30-39 percent and the prevalence of severe stunting ≥ 40 percent (WHO 2010). A total of 14 provinces are considered as having severe category, and as many as 15 provinces are categorised as very severe . The 15 provinces are: (1)
Sulawesi, (6) Central Kalimantan, (7) Aceh, (8) North Sumatra , (9) Southeast Sulawesi, (10) Lampung, (11). South Kalimantan, (12).
West Papua, (13). Nusa Tenggara Barat, (14). West Sulawesi and (15) East Nusa Tenggara.
The results of further review of the height/length of children under five in Indonesia based on gender as compared to WHO reference 2005 can be seen in Figure 9 below. It appears that with increasing of the age, there was a widening gap compared to the standard/reference, both for boys and girls. In 2010 the average height of childrenunderfive when reaching the age of 5 years, for boys there is a difference of 6.7 cm and 7.3 cm forgirls compared to WHO standards.
Figure 9. The difference of mean height of Indonesian Children under five (Riskesdas 2010) compared to WHO’s Reference
While based on the results of Riskesdas 2013 at the same age, for boys there is a difference of 6.4 cm and 6.7 cm in girls compared to the standard. Height improvement occurred within the last 3 years. Compared to the standard, the gap decreased by 0.3 cm in boys and 0.6 cm in girls.
TREND OF STUNTING Trends of stunting using a national research data from 2001 through 2013 can be concluded based on the year of birth.
Assumed that the child was born in 2001 (0 years old), in 2004 he will be 3 years old, and for a child that were born in 2004, in 2007 will be 3 years old, and so the children that born in 2010, in 2013 will be 3 years old. The situation looks like in figure 10, which seems to be that the children of Indonesia were deteriorated.
The proportion of children that were born short in 2001 at 23 percent, had dropped to 18.6 percent in 2004, but rose again in 2007 to 27.9 per cent, and in 2010 to 29.3 per cent. From that, the child who was born in 2001, will be 3 years old in 2004, with the proportion of stunting of 29.4 percent, and so on, who was born in 2004 will be 3 years old in 2007, with the proportion of stunting to 44.8 percent. And so on, who was born in 2010, will be 3 years old in 2013 with the proportion of stunting dropped to 39.6 percent.
Figure 10. Trends of stunted prevalence at the aged 0 and 3 years according to the child's year of birth
By comparing the prevalence between children aged 0 to 3 years, it appears that the prevalence of stunting at the age of 3 years is always higher than at birth. It shows during the growing age of (0-
3) years, there is an increase in the prevalence of stunting, which means there is a worsening of the nutritional status, particularly on stunting.
Figure 11 presents the trend for the prevalence of the combined nutritional status indicators of height for age and weight for height nationwide. The underfive children that have normal height and normal weight nutritional status were less than 50 percent.
Additionally there is a trend of increment in the prevalence of normal-overweight at 3.9 percent (2007) to 5.1 percent (2013).
This situation shows that the double burden of malnutrition problem has been existing since the age of five.
Figure 11. Trends in the proportion of combined nutritional status(Height for Age and Weight for height) of children under fivebased on Riskesdas
2007, 2010, and 2013