MATERNAL CHARACTERISTICS AS PREDICTORS FOR STUNTING IN RURAL AGRICULTURAL HOUSEHOLDS IN INDONESIA
This study aimed to analyze the associations of maternal characteristics and nutritional status of primary caregivers with the occurrence of stunting in children aged 6 – 59 months from rural agricultural households in Indonesia. This study used a sequential explanatory mixed method design. It started with a cross-sectional survey, followed by a qualitative study to explore community perceptions related to findings from the quantitative analysis. The survey involved 200 mother and child dyads. multiple logistic regression was carried out with the dependent variable being the incidence of stunting in children, and maternal characteristics as independent variables. Data analysis showed that WDDS and the maternal length of education in years were significant predictors for the incidence of stunting in children. The adjusted odds ratio (AOR) for WDDS was 0.78 (95% CI 0.63 - 0.98), while for the length of education of mothers was 1.22 (95% CI 1.01 - 1.48). We also conducted a qualitative study to explore food distribution and utilization within the household. Qualitative data analysis showed that, except for pregnant mothers, “good food” was prioritized the least for mothers. The persistent barriers for utilization of quality and diverse food are access to such food rather than knowledge of what is considered “good food for health”. Increasing access and consumption of diverse foods for all mothers beyond pregnancies is an important factor for preventing stunting in Indonesian children from rural agricultural households.
Ministry of Health RI;Kementerian Kesehatan RI Badan Penelitian dan Pengembangan Kesehatan. Laporan Nasional RISKESDAS 2018; Jakarta, MoH RI, 2019.
TNP2K. 100 Kabupaten/Kota Prioritas Untuk Intervensi Anak Kerdil (Stunting) 100 Kabupaten/Kota Prioritas Untuk Intervensi / 100 districts as stunting priority intervention sites ; Jakarta, TNP2K, 2017.
BPS Cianjur. Kabupaten Cianjur Dalam Angka 2016/ Cianjur District in Numbers 2016, Cianjur, BPS CIanjur/Statistics Indonesia Cianjur, Published online 2017.
Smith LC, Haddad L. Reducing Child Undernutrition: Past Drivers and Priorities for the Post-MDG Era. World Dev. 2015;68(1):180-204. doi:10.1016/j.worlddev.2014.11.014 https://www.sciencedirect.com/science/article/pii/S0305750X14003726
Galiè A, Jiggins J, Struik PC. Women’s identity as farmers: A case study from ten households in Syria. NJAS - Wageningen J Life Sci. 2013;64-65:25-33. doi:10.1016/j.njas.2012.10.001 https://www.sciencedirect.com/science/article/pii/S1573521412000541
Dessie ZB, Fentie M, Abebe Z, Ayele TA, Muchie KF. Maternal characteristics and nutritional status among 6-59 months of children in Ethiopia: Further analysis of demographic and health survey. BMC Pediatr. 2019;19(1):1-10. doi:10.1186/s12887-019-1459-x
Beal T, Le DT, Trinh TH, et al. Child stunting is associated with child, maternal, and environmental factors in Vietnam. Matern Child Nutr. 2019;15(4). doi:10.1111/mcn.12826
Zheng M. Conceptualization of cross-sectional mixed methods studies in health science: a methodological review. Int J Quant Qual Res Methods. 2015;3(2):66-87.
Food and Agriculture Organization. Guidelines for Measuring Household and Individual Dietary Diversity. FAO; 2011. Accessed from: http://www.fao.org/publications/card/en/c/5aacbe39-068f-513b-b17d-1d92959654ea/
World Health Organization. Nutrition Landscape Information System (NLIS) COUNTRY PROFILE INDICATORS Interpretation Guide. Vol 20.; 2015. doi:10.1159/000362780.Interpretation Accessed from:https://www.who.int/nutrition/nlis_interpretationguide_isbn9789241599955/en/
Corbel MJ, Tolari F, Yadava VK, WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications. Lancet. 2004;363(9403):157-163. doi:10.1016/S0140-6736(03)15268-3 https://pubmed.ncbi.nlm.nih.gov/14726171/
Özaltin E, Hill K, Subramanian S V. Association of maternal stature with offspring mortality, underweight, and stunting in low- to middle-income countries. JAMA - J Am Med Assoc. 2010;303(15):1507-1516. doi:10.1001/jama.2010.450 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100588/
BPS Cianjur. Kecamatan Campaka Mulya Dalam Angka 2019/ Campaka Mulya Sub-district in numbers 2019; Cianjur, BPS CIanjur/Statistics Indonesia Cianjur, Published online 2020.
Hailu BA, Bogale GG, Beyene J. Spatial heterogeneity and factors influencing stunting and severe stunting among under-5 children in Ethiopia: spatial and multilevel analysis. Sci Rep. 2020;10(1):1-10. doi:10.1038/s41598-020-73572-5 https://www.nature.com/articles/s41598-020-73572-5
Nkurunziza S, Meessen B, Van geertruyden JP, Korachais C. Determinants of stunting and severe stunting among Burundian children aged 6-23 months: Evidence from a national cross-sectional household survey, 2014. BMC Pediatr. 2017;17(1):1-14. doi:10.1186/s12887-017-0929-2 https://pubmed.ncbi.nlm.nih.gov/28743238/
Gupta AK, Santhya KG. Proximal and contextual correlates of childhood stunting in India: A geo-spatial analysis. PLoS One. 2020;15(8 August):1-12. doi:10.1371/journal.pone.0237661 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237661
Li Z, Kim R, Vollmer S, Subramanian S V. Factors Associated with Child Stunting, Wasting, and Underweight in 35 Low- And Middle-Income Countries. JAMA Netw Open. 2020;3(4):1-18. doi:10.1001/jamanetworkopen.2020.3386 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2764662
Amaha ND, Woldeamanuel BT. Maternal factors associated with moderate and severe stunting in Ethiopian children: analysis of some environmental factors based on 2016 demographic health survey. Nutr J. 2021;20(1):1-9. doi:10.1186/s12937-021-00677-6 https://nutritionj.biomedcentral.com/articles/10.1186/s12937-021-00677-6
Mistry SK, Hossain MB, Khanam F, et al. Individual, maternal- and household-level factors associated with stunting among children aged 0-23 months in Bangladesh. Public Health Nutr. 2019;22(1):85-94. doi:10.1017/S1368980018002926 https://pubmed.ncbi.nlm.nih.gov/30404673/
Fadare O, Amare M, Mavrotas G, Akerele D, Ogunniyi A. Mother’s nutrition-related knowledge and child nutrition outcomes: Empirical evidence from Nigeria. PLoS One. 2019;14(2):1-17. doi:10.1371/journal.pone.0212775 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212775
Danaei G, Andrews KG, Sudfeld CR, et al. Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels. PLoS Med. 2016;13(11):1-18. doi:10.1371/journal.pmed.1002164 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002164
Hasan M, Islam MM, Mubarak E, Haque MA, Choudhury N, Ahmed T. Mother’s dietary diversity and association with stunting among children <2 years old in a low socio-economic environment: A case–control study in an urban care setting in Dhaka, Bangladesh. Matern Child Nutr. 2019;15(2):1-8. doi:10.1111/mcn.12665 https://pubmed.ncbi.nlm.nih.gov/30216672/
Rao S, Yajnik CS, Kanade A, et al. Intake of micronutrient-rich foods in rural Indian mothers is associated with the size of their babies at birth: Pune maternal nutrition study. J Nutr. 2001;131(4):1217-1224. doi:10.1093/jn/131.4.1217 https://pubmed.ncbi.nlm.nih.gov/11285330/
Dhaded SM, Hambidge KM, Ali SA, et al. Preconception nutrition intervention improved birth length and reduced stunting and wasting in newborns in South Asia: The Women First Randomized Controlled Trial. PLoS One. 2020;15(1):1-15. doi:10.1371/journal.pone.0218960 https://pubmed.ncbi.nlm.nih.gov/31995570/
Young MF, Nguyen PH, Gonzalez Casanova I, Addo OY, Tran LM, Nguyen S, et al. (2018) Role of maternal preconception nutrition on offspring growth and risk of stunting across the first 1000 days in Vietnam: A prospective cohort study. PLoS ONE 13(8): e0203201. https://doi.org/ 10.1371/journal.pone.0203201
Harris-Fry H, Azad K, Kuddus A, et al. Socio-economic determinants of household food security and women’s dietary diversity in rural Bangladesh: A cross-sectional study. J Heal Popul Nutr. 2015;33(1):1-12. doi:10.1186/s41043-015-0022-0 https://pubmed.ncbi.nlm.nih.gov/26825273/
Harris-Fry H, Shrestha N, Costello A, Saville NM. Determinants of intra-household food allocation between adults in South Asia - A systematic review. Int J Equity Health. 2017;16(1):1-21. doi:10.1186/s12939-017-0603-1 https://pubmed.ncbi.nlm.nih.gov/28637477/
Panjwani A, Heidkamp R. Complementary feeding interventions have a small but significant impact on linear and ponderal growth of children in low- and middle-income countries: A systematic review and meta-analysis. J Nutr. 2017;147(11):2169S-2178S. doi:10.3945/jn.116.243857 https://pubmed.ncbi.nlm.nih.gov/28904113/
Koppmair S, Kassie M, Qaim M. Farm production, market access and dietary diversity in Malawi. Public Health Nutr. 2017;20(2):325-335. doi:10.1017/S1368980016002135 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244442/
Hirvonen K, Hoddinott J, Minten B, Stifel D. Children’s Diets, Nutrition Knowledge, and Access to Markets. World Dev. 2017;95:303-315. doi:10.1016/j.worlddev.2017.02.031 https://www.sciencedirect.com/science/article/pii/S0305750X17300682