Preventing Stunting by Identifying the Influence of Predictive Factors on Indonesian Toddler Development
Nurunnisa Umaira1 , Yumna Maida Rinangku2
Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Negeri Semarang
ABSTRACT
Stunting in Indonesia is a nutrition problem that is still a priority, this is because nutrition problems have an impact on the quality of human resources (HR). At 8.9 million Indonesian children or 1 in 3 children are stunted. Stunting is a condition of growth failure in children under five years old due to chronic malnutrition so that children are too short for their age.
This study uses a systematic literature review (SLR) by using the method of reviewing journal results from several keywords that represent related research titles and there are 4 main keywords which are further specified into 7 derivative keywords related to the title, looking at the publication time range 2015 - 2022. This literature review explains the prevention efforts made by looking at the influence of predictors of stunting on the development of children under five, based on ten research results. It is known that stunting is 27.9%, more common in children aged <3 years, female gender and more frequent ARI than diarrhoea. The factors that can influence the occurrence of stunting are in the included studies showed that there are several main predictors of stunting in children: child factors (low birth weight, premature birth); maternal factors (short stature of parents, parental education, maternal age, food parenting); infection, and exclusive breastfeeding which is one of the significant factors in influencing stunting in children under five. Nutritional status, child health problems, instant food habits, and maternal height are associated with stunting in children under five. The multiple factors that contribute, to varying degrees, to stunting suggest that it is important to consider how these predictors interact with nutrition, integrated health promotion and interventions by health care providers to prevent the impact of stunting on cognitive motor development in children under five.
Keywords: Stunting Factors, Stunting, Toddlers, Cognitive Development, Motor Development, Prevention.
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INTRODUCTION
Stunting is a condition where children are too short for their age due to growth failure caused by poor nutrition and health before and after birth. Stunting is defined as height-for- age below -2 standard deviations on the growth curve. Stunting is considered a failure of linear growth in children due to prolonged periods of poor nutrition. Stunting is still a major problem in developing countries such as Indonesia due to its high prevalence.
Stunting in Indonesia is a nutrition problem that is still a priority, this is because nutrition problems have an impact on the quality of human resources (HR). The prevalence of stunting from the Basic Health Research in 2013 was 37.2%, while the results of the recording of nutritional status in 2016 were 27.5%, much greater than the WHO limit of
<20%. This means that there is a problem of stunted growth in 8.9 million Indonesian children or 1 in 3 children experiencing stunting. Stunting is a condition where a person's height is shorter than the general age (Kemendesa, 2017). Some characteristics of stunting are measured by height above minus two median standard deviations of child growth standards from World Health Organisation (WHO) standards. WHO announced a policy brief on reducing stunting cases among children under five years of age by 40% by 2025. According to UNICEF in 2018, three in 10 children under five suffer from stunting, and one in 10 suffer from wasting. The prevalence of incident stunting among children under five was 37.2%
nationally in 2013. Meanwhile, it decreased by 3.1% to 27.67% in 2018. The 2019 Indonesian Health Profile noted that the proportion of stunting (height/age) in children under five was 27.67% in eastern Indonesia Nusa Tenggara, West Sulawesi, and West Nusa Tenggara dominated the incidence of stunting. Meanwhile, Riau Islands, Bangka Belitung Islands, and Jakarta have the lowest proportion of stunting in children under five.
According to WHO, a public health problem can be considered chronic if the prevalence of stunting is more than 20 per cent. This means that nationally, the stunting problem in Indonesia is considered chronic, especially in 14 provinces where the prevalence exceeds the national figure. Children who experience stunting have stunted growth and are irreversible. The impact of stunting can last a lifetime and affect the next generation. The impact of disorders in infancy and childhood, especially stunting, can lead to impaired motor and cognitive development and an increased risk of disease.
infection and further death. Stunting is also associated with school performance and, to a lesser extent, reduced productivity in adulthood.
Stunting is caused by problems with nutritional intake during pregnancy and toddlerhood. Lack of maternal knowledge about health and nutrition before pregnancy, as well as the postpartum period, limited health services such as antenatal care, post natal care and low access to nutritious food, low access to sanitation and clean water are also causes of stunting.
Stunting also reflects impaired growth as a result of poor nutritional and health status in the pre- and post-natal periods. The UNICEF framework describes the factors that cause malnutrition. The two direct causes of stunting are disease and nutrient intake. These two factors are related to parenting, access to food, access to health services and environmental sanitation. However, the underlying causes of these are at the individual and household level, such as education level, household income. Many cross-sectional studies have found a strong association between maternal education level and child nutritional status.
Southeast Asian countries have agreed to reduce stunting by increasing food diversification, providing fortified foods to pregnant and lactating mothers and children aged 6-23 months. The government cannot rely on the results of one study to implement a programme.
Therefore, a review of similar research is needed if there are already many studies on stunting prevention. This review will be useful for policy makers to obtain a more appropriate and efficient stunting prevention programme. This review aims to review the current evidence in determining what has been studied and can be concluded as a determinant of stunting in children in Indonesia and gain an understanding of the relationship between these factors and their impact so that later this article can be a reference in determining steps to prevent stunting in children under five years of age (toddlers) to obtain data on the efficacy of macronutrients or micronutrients to prevent stunting in infants and toddlers. The success of stunting prevention efforts depends on the research design, the ingredients and dosage of the intervention, and the duration of the intervention.
LITERATURE REVIEW 1. Definition of Stunting
Stunting is a condition of growth failure in children under five due to chronic malnutrition so that children are too short for their age. Malnutrition occurs since the baby is in the womb and in the early period after the baby is born, stunting conditions are only seen after the baby is 2 years old.3 Stunting according to the Decree of the Minister of Health in 2010 is a nutritional status based on the index of body length according to age (PB / U) or height according to age (TB / U) in the standard assessment of children's nutritional status, with measurement results that are at standard values or z-score < -2 SD to -3 SD for stunted and stunted.
< -3 SD for severely stunted.
According to the Minister of Health Decree No. 1995/MENKES/SK/XII/ 2010 on Anthropometric Standards for Child Nutrition Status Assessment, a toddler is said to be stunted if the threshold value (z-score) is -3SD to less than -2SD and is categorised as very short if the z-score value is less than -3SD from the body length index or height for age.
2. Impact of Stunting
`Stunting can have devastating effects, both in the short and long term. In the short term, stunting can cause growth failure, cognitive & motor development barriers that affect brain development and educational success, and suboptimal physical body size and metabolic disorders. Stunting is a form of growth disturbance in the body, when this happens, one of the organs that is quickly at risk is the brain. In the brain there are nerve cells that are closely related to children's responses including in seeing, hearing, and thinking during the learning process.16 The long-term impacts of stunting are decreased intellectual capacity, impaired structure and function of nerves and brain cells that are permanent and cause a decrease in the ability to absorb lessons at school age which will affect productivity as an adult, and increase the risk of non-communicable diseases such as diabetes mellitus, hypertension, coronary heart disease and stroke. Children experiencing stunting have the potential for incomplete growth and development, low motor skills and productivity, and have a higher risk of suffering from non-communicable diseases. Stunting in children under five has an impact on potential economic losses
due to decreased labour productivity and maintenance costs. All of which will reduce the quality of human resources, productivity and competitiveness of the nation.
3. Stunting Assessment and Classification
A very commonly used assessment of the nutritional status of children under five is anthropometric assessment. Anthropometry deals with various measurements of body dimensions and body composition of various ages and nutritional levels. Various types of body measurements include weight, height, upper arm circumference and fat thickness under the skin. Height is an anthropometry that describes the state of skeletal growth. Under normal circumstances, height grows with age. The effect of nutritional deficiencies on height will appear in a relatively long time. Some anthropometric indices that are often used are BB/U, TB/U and BB/TB. For monitoring nutritional status over a long period of time (2 years or more) the main choice is to use the TB/U index. This index is sensitive enough to measure long-term changes in nutritional status. In addition to providing an overview of past nutritional status, the TB/U index is also more closely related to socio-economics. When assessing nutritional status in Indonesia, each anthropometric index used has a reference standard. The reference standard used in Indonesia is the WHO 2005 reference standard. The 2005 WHO standard classifies nutritional status using a z-score or z (median value), which is a number one of which is TB against its standard deviation, according to age and sex.
4. Factors Causing Stunting
Stunting is influenced by many factors and these factors are interrelated with one another. UNICEF (1998) describes the factors associated with nutritional status including stunting. First, the direct causes of stunting are nutritional intake and infectious diseases.8 Nutritional intake is unbalanced, not meeting the amount and composition of nutrients that meet balanced nutritional requirements such as diverse, appropriate, clean and safe food, for example infants do not get exclusive breastfeeding.20 Second, indirect causes, namely household-level food availability, behaviour or care of mothers and children, and health services and the environment. The availability of food at the household level, especially food for infants 0-6 months, namely exclusive breastfeeding and infants aged 6-23 months, namely MP- ASI, and nutritionally balanced food, especially for pregnant women. All of these are related to the quality of parenting. Household-level food availability, maternal and child behaviour or care, and health and environmental services are influenced by the key issues of poverty, low education, food availability, and employment opportunities. The totality of
The causes of the above nutritional problems are influenced by basic problems, namely the political and economic crisis. Soetjiningsih states that there are two factors that influence child development, namely genetic factors and environmental factors. Genetic factors are the basic capital in achieving the final result of the child's growth and development process.
Through the genetic instructions contained in the fertilised egg, the quality and quantity of growth can be determined. Characterised by the intensity and speed of division, the degree of tissue sensitivity to stimuli, the age of puberty and the cessation of bone growth. Genetic factors include various normal and pathological congenital factors, gender, ethnicity or nation. Growth disorders in developed countries are more often caused by genetic factors, while in developing countries, growth disorders are not only caused by genetic factors, but also environmental factors that are inadequate for optimal child development.
Environmental factors are factors that determine whether or not innate potential is achieved. A good enough environment will allow the achievement of innate potential, while a poor one will hinder it. These environmental factors are broadly divided into prenatal and postnatal environmental factors. Prenatal environmental factors are environmental factors that affect children while still in the womb. Prenatal environmental factors that affect fetal growth and development from conception to birth include maternal nutrition during pregnancy, mechanical, toxins or chemicals, endocrine, radiation, infection, stress, immunity and embryonic anoxia. Post-natal environmental factors are environmental factors that affect the growth and development of children after birth. In general, post-natal environmental factors can be classified into biological environment, physical factors, psychosocial factors, and family factors and customs. Family factors such as parental education can be a contributing factor to the stunting problem. Parental education is one of the important factors in child development. Good parental education can make it easier to receive all information from outside, especially about how to care for children, how to maintain children's health, and so on.
5. Child development
Development is the increase in abilities in more complex body structures and functions in a regular pattern as a result of the maturation process. Development is the process of differentiation of body cells, tissues, organs and systems.
The child's organs develop optimally and can fulfil their respective functions, including in the development of emotions, intellect, and behaviour of children which is the result of interactions with the surrounding environment (Ardiana, 2011). Development is different from growth, development is a qualitative change where this change is emphasised in functional terms, changes are also progressive, directed and integrated or coherent, this means that children's development has a certain direction and tends to continue to progress, while directed and integrated indicate that there is a definite relationship between what is happening at this time, before and after (Soetjiningsih, & Ranuh, 2016).
b. Aspects of Child Development
Development in children can be seen from various aspects including the following:
1) Aspects of Physical Development
The human physique or body is a very complex and amazing organ. All human organs begin to grow since they are in the womb. Kuhlen and Thomshon (1956) suggest that physical development in humans includes 4 aspects, namely, the nervous system that affects individual intelligence and emotions, muscles that affect motor abilities, endocrine glands that cause the emergence of new behaviours, physical structure or body which includes height and weight. Physical development is also closely related to gross motor and fine motor skills.
Human physical development at least includes aspects of anatomical and physiological development. Anatomical development relates to changes that are quantitative or measurable such as bone structure, in infancy the bone structure is 270 which is still flexible porous and the joints are still loose, height and weight at the time of infancy the range of height and weight is 50 - 60 cm and 2 - 4 kg while in childhood height and weight ranges from 90-120 cm and 12-15 kg, the proportion of height to and body has a ratio of 1: 4. Physiological development is related to quantitative, qualitative and functional changes in the body's organ work system, such as muscle contractions, blood circulation, respiratory system, innervation system, and digestive system.
2) Aspects of Cognitive Development
Cognitive development is a process of thinking, namely the child's ability to connect, assess, and consider. Cognitive development is closely related to the child's intellect in thinking and making decisions to generate ideas in learning and solving existing problems.
Cognitive development in children
This includes the development of general knowledge, science, concepts of shapes, numbers, letters, and symbols. 3) Aspects of Language Development Many people still confuse the use of the term speech with language. Language is a system used to communicate, using certain symbols to convey messages from individuals to other individuals. Symbols used for communication can be writing, speaking, symbolic language, facial expressions, gestures, pantonyms, and art. Grouping language development into 3 major groups, namely, biological aspects, psychological aspects and culture. Biological aspects, muscles and nerves in the speaking apparatus are well developed since the child is born. Newborn children can already make sounds such as "a", "e". Psychological aspects, at first children speak by reacting with their own voice, and repeated by others, then children will learn new sounds and imitate others speaking. Cultural aspects, to open the child's social horizons in social life is the solution. children will better understand that language is very important to interact and make friends in a group. This requires children to be able to learn more and digest every language that is issued in the community to interact with one another.
RESEARCH METHODS
This research uses a systematic literature review (SLR) by using the method of reviewing journal results from several keywords that represent related research titles.
Literature searches were conducted by accessing electronic databases online from Google Scholar. At the beginning of the database search using journals and articles related to the title refers to the processed database keywords (keywords) and there are 4 main keywords which are further specified into 7 derivative keywords related to the title, looking at the publication time range 2015 - 2022. The first stage is to select several recent journals from several many journal results related to the search for one keyword such as the 4 main keywords, namely Stunting, Factors, Development and Prevention. The selected research results include 10 studies from 10 different journals, namely with each grouping, namely 1 journal discussing the overview and specifications of stunting, 2 journals discussing prevention or prevention, 1 journal discussing the relationship with cognitive development only and 1 other discussing cognitive and motor development in stunted toddlers, 5 journals discussing the factors of stunting including
4 journals related to predictor factors and 1 journal discussed risk factors. This literature review explains the influence of the determinants (predictors) of stunting on the development of children under five in Indonesia based on ten research results from journals, which can be seen in the following table.
RESEARCH RESULTS
This literature review describes prevention efforts that are carried out by looking at the influence of the determinants (predictors) of the occurrence of circumcision on the development of toddlers, based on ten research results, which can be seen in the following table.
Article Review Author, Title and Year
Destination Methods Conclusion Factors Predicting
Stunting in Toddlers in East Tanjung Jabung Regency Riris Diana
Rachmayanti, Zulfa Kevaladandra, Faisal Ibnu, Nur Khamidah 2022
To identify the impact of exclusive breastfeeding on the incidence of stunting in children under five.
This study used a systematic
literature review using the PRISMA method. Literature searches were conducted by accessing online electronic databases from Pubmed and Google Scholar from 2012-2022.
Overall, exclusive breastfeeding was
significantly associated with (p < 0.05) with the incidence of stunting in children under five. Exclusive breastfeeding is protective against stunting because breast milk contains nutrients that boost immunity, prevent infection, and
nutrients for optimal growth and protection from the risk of chronic diseases. Exclusive Breast milk is one of the significant factors affecting stunting in children under five.
Predictors of Stunting Among Children Under Five Year of Age in Indonesia: A Scoping Review
Henny Suzana Median
To identify the current literature and collate predictors that have been associated with stunting in Indonesia and in other
countries.
This research uses a systematic literature review using the
PRISMA method.
The results of this study show that there is a diversity of predictors of stunting in children under five in Indonesia. The current evidence in Indonesia is mainly in line with the common factors found such as
low birth weight,
2020
where data gaps still exist
Literature searches were conducted by accessing online electronic databases from Pubmed and Google Scholar from 2012-2022.
Preterm birth, parental short stature, parental education, were significantly associated with childhood stunting.
Literature Review:
The Relationship of Stunting with
Children's Motor and Cognitive
Development Annisa Rahmidini, S.ST., M.Keb 2020
To determine the relationship between stunting nutritional status and children's motor and cognitive development.
This study used a systematic
literature review using the PRISMA method. Literature searches were conducted by accessing online electronic databases from Pubmed and Google Scholar from 2012-2022.
The results of the study state that stunted children have an 11.98 times greater chance of having below-average motor development. The moderate stunting category with suspect or delayed cognitive development can result in 15-20 per cent less brain cells, so that later in life they will become humans with brain quality around 80-85 per cent.
The Problem of Stunting and Interventions to Prevent Stunting
LPPM STIKes Huang Tuah Pekan baru 2015
To assess the policies to reduce stunting and the interventions of these policies.
This study used a systematic
literature review using the PRISMA method. Literature searches were conducted by accessing online electronic databases from Pubmed and Google Scholar from 2012-2022.
Stunting is a form of growth faltering due to the
accumulation of nutritional inadequacies that lasts from pregnancy to 24 months of age. In Indonesia, based on Riskesdas 2013, there was an increase in stunted children from 36.8% in 2010 to 37.2%.
in 2013. Over the past 20 years, tackling stunting has been very slow. Globally, the percentage of children who stunted growth
declined by only 0.6 per cent per year since 1990.
Factors Affecting Stunting in
Toddlers in Grobogan District
Yuwanti, Festy Mahanani
Mulyaningrum, Meity Mulya Susanti.
2021
To find out the factors that influence the incidence of stunting among under-fives in Grobogan Regency.
This study is a correlation study with a cross sectional approach.
The study was conducted in Grobogan Regency, with a population of stunted toddlers aged 0 - 59 months.
The number of samples in this study was 90 people. Bivariate data analysis using Chi Square and multivariate data analysis using logistic regression.
The results showed that nutritional status, health problems in children, eating habits of instant food, and maternal height were associated with stunting in toddlers with a p value <0.05.
Abstinence from food, history of iron tablet consumption, history of antenatal care, history of comorbidities in pregnancy, history of
exclusive breastfeeding, clean water sanitation, smoking environment and economic conditions are not associated with the incidence of stunting in toddlers with p value =>
0.05. Nutritional status, health problems in children, eating habits of instant food, and height were not associated with the incidence of stunting in toddlers with p value = 0.05.
mothers in relation to stunting in toddlers Stunting, Risk Factors
and Prevention Sutarto, Diana Mayasari, Reni Indriyani 2018
To know the factors, risks, and prevention of
incidence of stunting
This study used a systematic
literature review using the PRISMA method. Literature searches were conducted by accessing online electronic databases from Pubmed and Google Scholar from 2012-2022.
Indonesia has a severe nutritional problem
characterised by many cases of undernutrition. The prevalence of stunting in Indonesia is higher than other countries in Southeast Asia, such as Myanmar (35%), Vietnam (23%), and Thailand (16%) and ranked fifth in the world.
Stunting is caused by multi- dimensional factors and is not only caused by poor nutrition experienced by the mother.
pregnant women and children under five.
Systematic Literature Review: Negative Effects of Stunting on
To analyse the relationship between
This research uses Based on the results of the review, it was found that stunting has implications
Child Cognitive Development
Aprilia Daracantika, Ainin, Besral
2021
stunting on cognitive development child.
systematic literature review using the PRISMA method. Literature searches were conducted by accessing online electronic databases from Pubmed and Google Scholar from 2012-2022.
biological impact on brain and neurological development which translates into cognitive impairment. Severe stunting with a Z-score <-3SD of the child's length-for-age or height-for-age index has a negative impact on child development.
In addition, children who experience stunting in the first 2 years of life are likely to have a non-verbal IQ below 89 and an IQ lower by 4.57 times than the IQ of children who are not stunted.
It was concluded that stunting has a negative influence on children's cognitive abilities which impact on
lack of learning achievement
Efforts to Prevent and Combat Toddler Stunting: A
Systematic Review
Yuniar Rosmalina, Erna Luciasari, Aditianti, Fitrah Ernawati
2018
To obtain data on the efficacy of macronutrients or micronutrients to prevent stunting in infants and toddlers.
This study used a systematic
literature review using the PRISMA method. Literature searches were conducted by accessing online electronic databases from Pubmed and Google Scholar from 2012-2022.
There are four types of interventions to reduce stunting in toddlers: single nutrients, a combination of 2- 3 nutrients, multi-
micronutrients, and nutrients plus additional energy (macronutrients).
Infant interventions
providing a single nutrient, a combination of 2-3 nutrients or a multi-nutrient-micro- nutrient have inconclusive results on increasing infant length or growth or
child.
Factors Influencing the Incidence of Stunting in Children.
To find out what factors
Case control analytical survey research with the
Based on the results of data collection for toddlers, the data for
Toddlers in Malang District
I Dewa Nyoman Supariasa, Heni Purwaningsih 2019
influences the incidence of stunting in Malang District with 3 (three) locations that have different regional
characteristics, namely
mountainous, near urban and near coastal locations.
retrospective. The sampling technique in this study used Cluster Random Sampling because the population in this study, namely toddlers in Malang Regency, was considered heterogeneous.
The most influential variables on stunting were income (p = 0.002), breastfeeding (p = 0.25), family size (p = 0.029).
The main variables are income, family size, father's education and father's occupation.
Meanwhile, breastfeeding is a protective factor for the main factors, so that if the
protective factors are carried out, income, father's education and father's work are not the main factors causing stunting in toddlers.
in Malang District.
Factors Predicting Stunting in Toddlers in East Tanjung Jabung Regency Novia Susianti, Weni Lestari
2020
To analyse the factors associated with the incidence of stunting and the predictive factors of stunting in Tanjung Jabung Timur Regency.
The type of research is quantitative research with a cross-sectional design and part of the research on the determinants of stunting in areas with heavy
prevalence in Jambi Province.
Determination of the location and research sample was carried out by purposive sampling.
The results showed that the prevalence of stunting was 27.9%, more prevalent in children aged <3 years, female gender and more frequent ARI than diarrhoea. Factors
associated with the incidence of stunting were found to be maternal age, maternal height, parenting (age of MP
breastfeeding), parenting (hand washing behaviour and weighing toddlers at the posyandu) and sanitation (SPAL, family latrines and water availability).
clean).
DISCUSSION
According to Rachmayanti, 2022. Exclusive breastfeeding is one of the significant factors affecting stunting in children under five. The eight articles selected as a whole showed that exclusive breastfeeding was significantly associated with the incidence of stunting in children under five. Exclusive breastfeeding is a protection against stunting because breast milk contains nutrients that can increase body immunity, prevent infection, and nutrients for optimal growth and development and protection from the risk of chronic diseases.
A study conducted by Mediani, 2020 showed that there are several key predictors of child stunting: child factors (low birth weight, preterm birth); maternal factors (parental short stature, parental education); infections, and breastfeeding. The multiple factors that contribute, to varying degrees, to stunting suggest the importance of considering how these predictors interact with nutrition. Integrated health promotion, prevention and intervention by health care providers,
Rahmidini, 2020 states that stunted children have an 11.98 times greater chance of having motor development below average. As well as the mild stunting category with suspect cognitive development there is a delay in toddler children, namely not being able to mention the type of colour, distinguish the size of objects, mention gender, pair known images. While the moderate stunting category with suspect cognitive development or experiencing delays can result in reduced brain cells of 15-20 percent, so that later in life they will become humans with brain quality of around 80-85 percent. Toddler children who experience severe stunting with suspect cognitive development are characterised by slow maturity of nerve cells, slow motor movements, lack of intelligence and slow social response.
Hang Tuah, 2015 in reviewing policies in tackling the incidence of stunting and interventions carried out from a global policy called Scaling UP Nutrition (SUN) and in Indonesia it is called the National Movement for Nutrition Awareness in the Context of Accelerating Nutrition Improvement in the First 1000 Days of Life. The interventions carried out consist of specific interventions (short term) and sensitive interventions (long term).
Yuwanti, 2021 in examining the factors that can affect the occurrence of stunting, namely mentioning that nutritional status, health problems in children, eating habits
Instant food, and maternal height were associated with stunting in children under five with a p value <0.05. Abstinence from food, history of iron tablet consumption, history of antenatal care, history of comorbidities in pregnancy, history of exclusive breastfeeding, clean water sanitation, smoking environment and economic conditions are not associated with the incidence of stunting in toddlers with p value => 0.05. Nutritional status, maternal height, and the habit of eating instant food together as risk factors for stunting in toddlers. The conclusion of this study is that nutritional status, health problems in children, the habit of eating instant food, and maternal height are associated with stunting in toddlers.
Sutarto, 2018 explained that stunting is caused by multi-dimensional factors and is not only caused by malnutrition experienced by pregnant women and children under five. The most decisive intervention to reduce the prevalence of stunting therefore needs to be done in the First 1,000 Days of Life (HPK) of children under five. Prevention of stunting can be done, among others, by fulfilling the nutritional needs of pregnant women. 2.Exclusive breastfeeding until 6 months of age and after 6 months of age given complementary foods (MPASI) that are sufficient in quantity and quality. 3.Monitoring the growth of children under five at the posyandu. 4.Improving access to clean water and sanitation facilities, and maintaining environmental hygiene.
Daracantika, 2021 found that stunting has biological implications for brain and neurological development which translates into decreased cognitive scores. Severe stunting with a Z-score <-3SD of the child's length-for-age or height-for-age index has a negative impact on child development. In addition, children who are stunted in the first 2 years of life are likely to have a non-verbal IQ below 89 and an IQ 4.57 times lower than the IQ of children who are not stunted. It is concluded that stunting has a negative influence on children's cognitive abilities which have an impact on learning achievement.
Rosmalina, 2017 mentioned that the results of a review of 8 intervention articles using a single nutrient (Vitamin A, Fe, Zn or DHA) and a combination of nutrients showed different results, there were 3 articles that showed the provision of a single nutrient provided a significant increase in body length. In the case of multi-micronutrient feeding, 2 articles showed positive results on changes in body length. The addition of carbohydrate sources to solid foods, rice porridge, maize in combination with breastfeeding or zinc mineral or multivitamins was not found to be positive.
had an effect on linear growth in infants after 6 months of intervention. It was concluded that interventions in infants to overcome the problem of stunting by providing a single nutrient, a combination of 2-3 nutrients (multi-nutrient-micro-nutrient) have been widely carried out and the impact is not conclusive to prevent toddlers from becoming stunted.
Supariasa, 2019 states that the causes of stunting are based on the most influential factors in order, namely: family income, exclusive breastfeeding, family size, toddler father's education, toddler father's occupation, toddler mother's nutritional knowledge, family food security, toddler mother's education, toddler carbohydrate consumption level, accuracy of complementary feeding, toddler fat consumption level, toddler infectious disease history, socio-culture, toddler protein consumption level, toddler mother's occupation, kadarzi behaviour, toddler energy consumption level, and toddler immunisation completeness.
Susianti, 2020 showed that the prevalence of stunting was 27.9%, more prevalent in children aged <3 years, female gender and more often experienced ARI than diarrhoea.
Factors associated with stunting were found to be maternal age, maternal height, parenting (age of breastfeeding), parenting (handwashing behaviour and weighing toddlers at the posyandu) and sanitation (SPAL, family latrines and availability of clean water).
CONCLUSIONS
From all the literature that has been reviewed, it can be concluded that in determining preventive measures to minimise the occurrence of stunting in Indonesia, it is necessary to know the various indicators of causes or determinants (predictors) that can cause stunting both in internal and external factors.
It is known that stunting is 27.9%, more prevalent in <3 years old, female gender and more frequent ARI than diarrhoea. Factors that can affect the occurrence of stunting are in the included studies showed that there are several main predictors of stunting in children: child factors (low birth weight, premature birth); maternal factors (short stature of parents, parental education, maternal age, food parenting); infection, and exclusive breastfeeding which is one of the significant factors in influencing stunting in children under five. Nutritional status, child health problems, instant food habits, and maternal height are associated with stunting in children under five. Multiple contributing factors are, to varying degrees, associated with stunting in children under five.
with stunting, suggesting the importance of considering how these predictors interact with nutrition, integrated health promotion and interventions by health care providers as a preventative measure in causing the impact of stunting on cognitive motor development in children under five years of age.
LITERATURE
Daracantika, A., Ainin, A., & Besral, B. (2021). The Negative Effect of Stunting on Children's Cognitive Development. Journal of Biostatistics, Population, and Health Informatics, 1(2), 124-134.
Mediani, H. S. (2020). Predictors of stunting among children under five years of age in Indonesia: a scoping review. Global Journal of Health Science, 12(8), 83.
Mitra, M. (2015). The Problem of Stunting and Interventions to Prevent Stunting (A Literature Review). Journal of Community Health, 2(6), 254-261.
Rachmayanti, R. D., Kevaladandra, Z., Ibnu, F., & Khamidah, N. Systematic Review:
Protective Factors from the Risks of Stunting in Breastfeeding Period. Indonesian Journal of Health Promotion, 17(2), 72-78.
Rahmidini, A., ST, S., & Keb, M. (2020, April). Stunting Literature Review: The Relationship of Stunting with Children's Motor and Cognitive Development. In Journal of National Seminar (Vol. 2, No. 01, Pp. 90-104).
Rosmalina, Y., Luciasari, E., Aditianti, A., & Ernawati, F. (2018). Prevention and control of stunted toddlers: a systematic review. Nutrition Indonesia, 41(1), 1-14.
Supariasa, I. D. N., & Purwaningsih, H. (2019). Factors influencing the incidence of stunting among under-fives in Malang district. Journal of Regional Innovation and Development, 1(2), 76-85.
Susianti, N., & Lestari, W. (2020). PREDICTIVE FACTORS OF STUNTING IN THE DISTRICT
Journal of Intellectual Khazanah, 4(2), 729-757.
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