Faktor Risiko Kejadian Stunting Pada Anak Usia 2-3 Tahun di Kecamatan Genuk Semarang

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Kesehatan Ibu dan Anak 2017 ABSTRAK Santy Sundari Faktor Risiko Kejadian Stunting Pada Anak Usia 2-3 Tahun di Kecamatan Genuk Semarang xvii + 101 halaman + 32 tabel + 3 gambar + 17 lampiran Stunting merupakan keadaan tubuh yang pendek sebagai akibat pertumbuhan linier yang terhambat, ditandai dengan z-score panjang badan menurut umur kurang dari -2 SD. Prevalensi stunting di jawa tengah mencapai 25%. Prevalensi kejadian stunting tertinggi di Semarang di Kecamatan Genuk (20,93%). Penelitian ini bertujuan untuk menganalisis faktor risiko kejadian stunting pada anak usia 2-3 tahun di wilayah kerja kecamatan Genuk, Semarang. Jenis penelitian observasional dengan rancangan kasus kontrol. Sampel dipilih dengan teknik consecutive sampling dengan jumlah sampel 61 subjek untuk masing-masing kelompok. Stunting diukur berdasarkan z-score tinggi badan menurut umur (TB/U) dianalisis dengan software WHO Anthro 2005. Data identitas subjek dan responden diperoleh melalui wawancara dengan kuesioner. Data tinggi badan anak dan tinggi badan orang tua diukur dengan menggunakan stadiometer. Data asupan makanan diperoleh menggunakan kuesioner frekuensi makanan semi kuantitatif. Analisis bivariat menggunakan Chi-Square dan continuity correction. Analisis multivariat menggunakan uji regresi logistik ganda. Hasil analisis multivariat menunjukkan bahwa faktor risiko stunting pada anak usia 2-3 tahun adalah tinggi badan ayah <162 cm (p=0,004, OR=11,147), pemberian ASI yang tidak eksklusif (p=0,004, OR=9,347), riwayat ISPA (p=0,032, OR=5,939), dan asupan energi kurang (p=0,000 , OR=43,411. Faktor risiko yang tidak terbukti mempengaruhi kejadian stunting adalah tinggi badan ibu, pemberian MP-ASI, riwayat diare, riwayat campak, status imunisasi, asupan protein, asupan kalsium dan asupan zat besi. Disimpulkan bahwa tinggi badan ayah yang pendek, pemberian ASI yang tidak eksklusif, riwayat ISPA, dan asupan energi yang kurang merupakan faktor risiko yang berpengaruh terhadap kejadian stunting pada anak usia 2-3 tahun. Kata kunci : Stunting, Faktor Risiko Kepustakaan : 95 (1988-2015)Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Maternal and Child Health 2017 ABSTRACT Santy Sundari Risk Factors for Stunting on Children aged 2-3 Years Old at Genuk Subdistrict in Semarang xvii + 101 pages + 32 tables + 3 figures + 17 appendices Stunting is a problem of linear growth retardation shown by a condition of very low height for age signed by an index of z score of height for age below -2 Standard Deviation. A prevalence of stunting in Central Java was 25%. Genuk Subdistrict was the highest prevalence of stunting in Semarang (20.93%). This study aimed at analysing risk factors for stunting on children aged 2-3 years old at Genuk Subdistrict in Semarang. This was an observational study using case-control approach. Samples were selected using a technique of consecutive sampling with number of samples for each group were 61 children. Stunting was measured based on an index of z score of height for age (H/A) analysed using software of WHO Anthro 2005. Data of subjects’ identities and respondents were collected by conducting interview using a questionnaire. Height of children and their parents were measured using stadiometer. Data of food intake were collected using a semi-quantitative food frequency questionnaire. Bivariate analyses used Chi-Square and Continuity Correction tests. Multivariate analysis used a Multiple Logistic Regression test. The results of multivariate analysis showed that risk factors for stunting on children aged 2-3 years old were father’s height <162 cm (p=0.004; OR=11.147), providing non-exclusive breastfeeding (p=0.004; OR=9.347), a history of acute respiratory tract infection (ARTI)(p=0.032; OR=5.939), and a lack of energy intake (p=0.000; OR=43.411). In contrast, risk factors that were not significant were mother’s height, providing complementary foods of breastfeeding, a history of diarrhea, a history of measles, status of immunisation, protein intake, calcium intake, and iron intake. To sum up, a short father, non-exclusive breastfeeding, a history of ARTI, and the lack of energy intake were the risk factors for stunting on children aged 2-3 years old. Keywords: Stunting, Risk Factor Bibliography: 95 (1988-2015

The Association Between Sanitation, Hygiene, and Stunting in Children Under Two-Years (an Analysis of Indonesia's Basic Health Research, 2013)

Background: This study aims to identify the relationship between sanitation, hygiene, and stunting in children under two-years in Indonesia. Methods: This was a cross-sectional study that examined 9,688 children under the age of two. We obtained data from Indonesia's Basic Health Research paper that was released in 2013 and applied multiple logistic regression analysis. The prevalence of stunting amongst children under two-years in 2013 was 33.3%. Results: Our analysis showed that stunting is closely related to low birth weight, age, gender, exclusive breastfeeding, socioeconomic status, garbage removal, and waste management. Appropriate sanitation and hygiene had a significant impact on stunting amongst children under two-years in Indonesia, with waste management and low birth weight being the most important indicators. Conclusions: Nutrition, socioeconomic status, and a healthy environment are key to ensure children under two-years meet the recommended growth standards

Biomarkers of systemic inflammation and growth in early infancy are associated with stunting in young Tanzanian children

Stunting can afflict up to one-third of children in resource-constrained countries. We hypothesized that low-grade systemic inflammation (defined as elevations in serum C-reactive protein or alpha-1-acid glycoprotein) in infancy suppresses the growth hormone–insulin-like growth factor (IGF) axis and is associated with subsequent stunting. Blood samples of 590 children from periurban Dar es Salaam, Tanzania, were obtained at 6 weeks and 6 months of age as part of a randomized controlled trial. Primary outcomes were stunting, underweight, and wasting (defined as length-for-age, weight-for-age and weight-for-length z-scores < −2) between randomization and endline (18 months after randomization). Cox proportional hazards models were constructed to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of time to first stunting, underweight, and wasting as outcomes, with measures of systemic inflammation, insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) as exposures, adjusting for numerous demographic and clinical variables. The incidences of subsequent stunting, underweight, and wasting were 26%, 20%, and 18%, respectively. In multivariate analyses, systemic inflammation at 6 weeks of age was significantly associated with stunting (HR: 2.14, 95% CI: 1.23, 3.72; p = 0.002). Children with higher levels of IGF-1 at 6 weeks were less likely to become stunted (HR: 0.58, 95% CI: 0.37, 0.93; p for trend = 0.019); a similar trend was noted in children with higher levels of IGF-1 at 6 months of age (HR: 0.50, 95% CI: 0.22, 1.12; p for trend = 0.07). Systemic inflammation occurs as early as 6 weeks of age and is associated with the risk of future stunting among Tanzanian children.This research was funded by the National Institutes of Health (R01 HD048969, 2P30 DK040561, K24 DK104676-Dr. Duggan) and the Bill and Melinda Gates Foundation (OPP1066203-Dr. Duggan). (R01 HD048969 - National Institutes of Health; 2P30 DK040561 - National Institutes of Health; K24 DK104676 - National Institutes of Health; OPP1066203 - Bill and Melinda Gates Foundation)Accepted manuscrip

Maternal Human Capital and Childhood Stunting In Nepal: A Multi-Level Modeling Approach

Childhood stunting among preschool-age children stands as a serious public health problem to be addressed in Nepal. Applying the multi-level modeling approach to nationally representative data, in the overall, we provide evidence that the negative influence of maternal own education to childhood stunting occurs especially for mother's higher level of education, but there exists substantial residential variations. Most interestingly, we provide new evidence of a strong negative community externality of maternal education on childhood stunting, even if mothers of children are uneducated. We also find mother's height is negatively related to childhood stunting, regardless of mother's educational attainment and place of residence, providing evidence of intergenerational transmission of maternal health.Health Economics and Policy, Labor and Human Capital,

Elucidating the sustained decline in under‐three child linear growth faltering in Nepal, 1996-2016

Childhood linear growth faltering remains a major public health concern in Nepal. Nevertheless, over the past 20 years, Nepal sustained one of the most rapid reductions in the prevalence of stunting worldwide. First, our study analysed the trends in height-for-age z-score (HAZ), stunting prevalence, and available nutrition-sensitive and nutrition-specific determinants of linear growth faltering in under-three children across Nepal's Family Health Survey 1996 and Nepal's Demographic and Health Surveys 2001, 2006, 2001, and 2016. Second, we constructed pooled multivariable linear regression models and decomposed the contributions of our time-variant determinants on the predicted changes in HAZ and stunting over the past two decades. Our findings indicate substantial improvements in HAZ (38.5%) and reductions in stunting (-42.6%) and severe stunting prevalence (-63.9%) in Nepalese children aged 0-35 months. We also report that the increment in HAZ, across the 1996-2016 period, was significantly associated (confounder-adjustedp< .05) with household asset index, maternal and paternal years of education, maternal body mass index and height, basic child vaccinations, preceding birth interval, childbirth in a medical facility, and prenatal doctor visits. Furthermore, our quantitative decomposition of HAZ identified advances in utilisation of health care and related services (31.7% of predicted change), household wealth accumulation (25%), parental education (21.7%), and maternal nutrition (8.3%) as key drivers of the long-term and sustained progress against child linear growth deficits. Our research reiterates the multifactorial nature of chronic child undernutrition and the need for coherent multisectoral nutrition-sensitive and nutrition-specific strategies at national scale to further improve linear growth in Nepal

Persistence of Natural Disasters on Children's Health: Evidence from the Great Kanto Earthquake of 1923

This study uses a catastrophic earthquake in 1923 to analyze the long-term effects of a one-off disaster on children's health. I find that fetal exposure to Japan's Great Kanto Earthquake had stunting effects on girls in the devastated area. Disaster relief spending helped remediate stunting among boys by late primary school ages, whereas it did not ameliorate girls' stunting, suggesting a biased remediation mechanism before birth and compensating investment after birth. While the maternal mental stress via strong vibrations played a role in the adverse health effects, the maternal nutritional stress via physical disruption also enhanced those effects

Household food (in)security and nutritional status of urban poor children aged 6 to 23 months in Kenya

Background Millions of people in low and low middle income countries suffer from extreme hunger and malnutrition. Research on the effect of food insecurity on child nutrition is concentrated in high income settings and has produced mixed results. Moreover, the existing evidence on food security and nutrition in children in low and middle income countries is either cross-sectional and/or is based primarily on rural populations. In this paper, we examine the effect of household food security status and its interaction with household wealth status on stunting among children aged between 6 and 23 months in resource-poor urban setting in Kenya. Methods We use longitudinal data collected between 2006 and 2012 from two informal settlements in Nairobi, Kenya. Mothers and their new-borns were recruited into the study at birth and followed prospectively. The analytical sample comprised 6858 children from 6552 households. Household food security was measured as a latent variable derived from a set of questions capturing the main domains of access, availability and affordability. A composite measure of wealth was calculated using asset ownership and amenities. Nutritional status was measured using Height-for-Age (HFA) z-scores. Children whose HFA z-scores were below −2 standard deviation were categorized as stunted. We used Cox regression to analyse the data. Results The prevalence of stunting was 49 %. The risk of stunting increased by 12 % among children from food insecure households. When the joint effect of food security and wealth status was assessed, the risk of stunting increased significantly by 19 and 22 % among children from moderately food insecure and severely food insecure households and ranked in the middle poor wealth status. Among the poorest and least poor households, food security was not statistically associated with stunting. Conclusion Our results shed light on the joint effect of food security and wealth status on stunting. Study findings underscore the need for social protection policies to reduce the high rates of child malnutrition in the urban informal settlements

The relationship of ethnicity, socio-economic factors and malnutrition in primary school children in North of Iran: A cross-sectional study

related factors based on three ethnic groups among primary school children in north of Iran in 2010. Methods: This cross-sectional study was carried out through multistage cluster random sampling on 5698 subjects (2505 Fars-native, 2154 Turkman, and 1039 Sistani) in 112 schools. Well-trained staffs completed the questionnaire and measured students' weight and height. Malnutrition estimated the Z-score less than -2SD for underweight, stunting and wasting were calculated using the cutoffs from WHO references. Results: Generally, malnutrition was observed in 3.20%, 4.93% and 5.13% based on underweight, stunting and wasting respectively. It was more common in girls than in boys and in Sistani than in other ethnic groups. The correlation between malnutrition based on underweight and stunting and ethnicity was statisti-cally significant (P=0.001). Results of logistic regression analyses showed that the risk of malnutrition was in rural area 1.34 times more than urban area, in girls 1.17 times more than boys, in Sistani ethnic group 1.82 times more than Fars-native ethnic group, in low economic families 2.01 times more than high economic families. Conclusion: Underweight, stunting and wasting are the health problems in primary school children in north of Iran with a higher prevalence in girls, in rural areas, and in Sistani ethnic group