The Relationships Breastfeeding, Weight, Sanitation to Stunting

Event in Age 2-12 Years in Medan Tuntungan, Indonesia

Arlinda Sari Wahyuni

1,*

, Dwi Rita Anggraini

, Tri Widyawati

Sake Juli Martina

Department of Public Health/Community Medicine Faculty of Medicine,Universitas Sumatera Utara Indonesia

Department of Anatomy Faculty of Medicine Universitas Sumatera Utara, Indonesia

Department Pharmacology & Therapeutic Faculty of Medicine Universitas Sumatera Utara

Departement of Pharmacology and Therapeutic of Medicine Universitas Sumatera Utara

and Universitas Sumatera Utara Hospital

Keywords: Stunting, Duration Breastfeeding, Weight, Sanitation

Abstract: Background: Stunting is a problem that occur in the world. Based on Riskesdas(Basic Health Research)

Indonesia 2013 data, the incidence of stunting in Indonesia in children under five was 37.2% (18% very short

and 19.2% short). This is a matter of concern because the impact of stunting can cause various physical and

psychological disorders for the children. Therefore, the purpose of this study is to determine the factors that

influence the occurrence of stunting, especially in children aged 2 to 12 years, in The area of Puskesmas

Tuntungan Medan. Methodology: This research is an analytical descriptive with cross sectional approach

done in Tuntungan Medan Health Center area. The sample size is 92 children selected by total sampling. The

datas used are primary data of height, weight, education and parental awareness and sanitation status obtained

from questionnaire. Results: The result of this study indicates that the prevalence of stunting children is 33.7%

(31 children). From the bivariate analysis of breastfeeding variable and sanitation variable, the obtained p

value was 0,002 and 0,019. From the multivariate analysis, the variable that influence the incidence of stunting

the most is the duration of breastfeeding (exclusive breastfeeding) with p value 0,007. The largest OR value

obtained was 4.781. Conclusion: It can be concluded that from all the variables that cause stunting, which

are duration of breastfeeding, birth weight, sanitation, education and income of the elderly, the breastfeeding

variable is the most significant variable

1 INTRODUCTION

Stunting is a problem that is facing in this world.

According to WHO 2012 data, there are 162 million

children under 5 years old (toddlers) globally

experience stunting (WHO, 2012). A person is said to

be stunting if his height is based on age below the 5th

percentile based on the Center for Disease Control

and Prevention (CDC) curve (CDC, 2000)

Based on data from Global Nutrition Report

(GNR) 2014, some countries that have been reported

to have stunting incidents account for 40% such as

Bangladesh, Cambodia, Ethiopia, Nepal, Yemen and

Zambia. India is also one of the countries with high

rates of stunting that is 38.8% (Data Rapid Survey Of

Children [RSOC] in 2013 - 2014) (Hadad, et al, 2015)

Basic Health Research (Riskesdas) divides the

classification of Height/Age indicators from WHO to

3, such as very short (Zscore <-3.0), short (-3.0 ≤

Zscore <-2.0) and normal (Zscore ≥ -2.0). Based on

Riskesdas 2013 data, the incidence of stunting in

Indonesia in children under five is 37.2% (18% very

short and 19.2% short). Children aged 5-12 years are

30.7%, (very short 12.3% and 18.4% short). Children

aged 13- 15 years are 35.1% (13.8% very short and

21.3% short). Children ages 15-18 are 31.4 percent

(7.5% very short and 23.9% short). North Sumatra is

one of the 15 provinces with a very short prevalence

of children ages 5 - 12 over the national prevalence,

with a short rate of about 18% and a very short 19%

(Riskesdas/Annualy Report, 2013)

Stunting in children is caused by lack of nutrition

in pregnant women and less intake in infants and

young children. Stunting can lead to short-term

clinical manifestations of health in the form of

increased mortality and morbidity, in the field of child

development in the form of decreased cognitive,

motor and language development, and also in the

economy can increase spending on health costs.

Wahyuni, A., Anggraini, D., Widyawati, T. and Martina, S.

The Relationships Breastfeeding, Weight, Sanitation to Stunting Event in Age 2-12 Years in Medan Tuntungan, Indonesia.

DOI: 10.5220/0010038800920096

In Proceedings of the 3rd International Conference of Computer, Environment, Agriculture, Social Science, Health Science, Engineering and Technology (ICEST 2018), pages 92-96

ISBN: 978-989-758-496-1

Long-term clinical manifestations of health in the

form of short stature, increased obesity, and

decreased reproductive health, in the field of child

development in the form of decreased learning

capacity, and in the economic field can lead to

decreased work ability and productivity (WHO,

2013)

Based on the background that has been described

above and still not much research on stunting done in

Indonesia in primary school age children, researchers

want to do this research.

2 METHOD

The type of this research is descriptive research with

cross sectional research design approach. This study

was conducted on June 5, 2017 until June 22, 2017 in

the neighborhood around Medan Tuntungan health

center, Medan Tuntungan sub-district, Medan city. In

this study the affordable population is the 2-12 year

old people who live around puskesmas Medan

Tuntungan, Medan Tuntungan district, Medan city.

In this research, the sampling is done by

interviewing the parents or guardian and measuring

the height and weight of the children aged 24 months

to 12 years who live around the work area of Medan

Tuntungan health center, Medan Tuntungan sub-

district, Medan. The sample of the study was 100

people aged 2-12 years and willing to be the

respondent in this research

This study used a questionnaire consisting of 24

questions measuring the knowledge of respondents

who have been validated.

Data is processed using statistical methods with

computer program and then presented in frequency

distribution table.

3 RESULTS AND DISCUSSION

3.1 Univariate Analysis

Characteristics of respondents in this study were

gender, occupation, last education, and income. The

distribution of respondents based on these

characteristics can be seen in Table 1 below

Table 1: Respondent Characteristic Distribution

Variable n %

Last Education

Primary School

Junior High School

Senior High School

College

16,2

34,8

37,0

12,0

Gender

Male

Female

59,8

40,2

Occupation

Midwife

Laborers

Cleaning Service

Teacher

Housewife

Employee

Merchant

Teaching Religion

Farmer

Entrepreneu

1,1

5,4

1,1

2,2

46,7

1,1

22,8

1,1

17,4

Income

< Rp.500.000

Rp. 500.000-

Rp.1.000.000

Rp 1.000.000-Rp.

1.500.000

>Rp 2.000.000

9,8

33,7

34,8

21,7

Table 2: Characteristic Respondent According to the

Duration of Breastfeeding, Weight, Sanitation, and

Height/Age Status

Variabel n %

Duration

Breastfeeding

< 6 month

> 6 month

27,2

72,8

Birth

Weight

< 2,5 kg

≥ 2,5 kg

Sanitation

Bad

Goo

54,3

45,7

Height/Age

Status

Stunting

No Stunting

33,7

66,3

Total 92 100

Characteristics of respondents who most often in

terms of senior high school followed by junior high

school, elementary and college. From the

characteristics of the sex of most children of male

with mother as a housewife with income Rp.

1,000,000-Rp. 1.500.000.

This study showed that from 92 samples there

were 25 children (27,2%) with breastfeeding time

The Relationships Breastfeeding, Weight, Sanitation to Stunting Event in Age 2-12 Years in Medan Tuntungan, Indonesia

under 6 months and 67 child (72,8%) with

breastfeeding time above 6 months.

This study showed that of 92 samples there were

11 children (12%) with birth weight below 2.5 kg and

as many as 81 children (88%) with birth weight equal

to or above 2.5 kg.

This study shows that from 92 samples there are

50 children (54,3%) with poor sanitation status and

42 children (45,7%) with good sanitation status.

Table 5 results show that out of 92 samples there

were 31 children (33.7%) with short stature for the

age with Height/Age <5

percentile and 61 children

(66.3%) with normal body height with Height/Age ≥

percentile.

3.2 Bivariate Analysis

Bivariate results based on the research conducted are

as follows.

Table 3. Cross Distribution Between Stunting and

Breastfeeding Time

Breastfeeding

Time

bulan

Total p

Value

Stuntin

15 16 31 0,002

o Stuntin

10 51 61

Total 25 67 92

Table 4. Cross Distribution Between Stunting and Birth

Weight

Birth Weight <2,5

≥2,5

Total p

Value

Stuntin

5 25 31 0,289

o Stuntin

656 61

Total 11 81 92

Table 5. Cross Distribution Between Stunting and

Sanitation

Sanitation Bad Good Total p Value

Stuntin

22 9 31 0,01

o Stuntin

28 33 61

Total 50 42 92

Table 6. Cross Distribution Between Stunting and

Education Category

Education Low High Total p

Value

Stunting 16 15 31

0,559

Tidak

Stunting

31 30 61

Total 47 45 92

Table 7. Cross Distribution Between Stunting and Income

Category

Income Low High Total p Value

Stunting 26 5 31 0,257

No Stunting 46 15 61

Total 72 20 92

This study states that there is a relationship

between the duration of breastfeeding and the

incidence of stunting. This has been in accordance

with pre-existing theory and research. According to

previous study, the risk of stunting is 3.7 times higher

in children who are not exclusively breastfed (ASI <6

months) compared to children exclusively breastfed

(≥ 6 months) (Arifin, et al, 2015). This is because in

infants with breastfed <6 months get less immune that

is the content of breast milk and early exposure to

complementary foods (Cruz, 2017). Besides immune

also breast milk contains nutrients needed by children

for growth. It is advisable to breastfeed for 6 months

(Scherbaum, et al, 2016)

This study states that there is no relationship

between birth weight with stunting events. This is not

in accordance with the theory that has been there

before. This study contradictive to previous study that

20% of stunting events stem from periods of growth

during the intra-uterine period (Christian, et al, 2013)

The relationship of low birth weight with the

incidence of stunting is due to the low levels of

nutrients needed for growth, such as vitamin A, zinc,

and iron. Breast milk consist of that nutrient (Cruz, et

al, 2017). Low birth weight is closely related to the

low body mass index of the mother. Therefore, not

only pay attention to child nutrition but also maternal

nutrition should be noted (Akombi, et al, 2017). This

may be due to the small number of samples compared

with pre-existing studies and aims to determine the

relationship between birth weight and stunting events.

This study states that there is a sanitation

relationship with the stunting event. This has been in

accordance with pre-existing theory and research.

Food hygiene effect on stunting. Families who do not

control food hygiene experience a stunting event 4.26

times higher than that of families who control food

hygiene (Paudel, 2012) Poor food sanitation

contributes to stunting events because poor sanitation

can lead to an increase in infection cases. These

infections will cause a decrease in nutrients for

growth (Fregonese, 2016). Environmental sanitation

also significantly affects the incidence of stunting in

children. It is explained that the cause is due to poor

sanitation causing the reduction of nutrients needed

ICEST 2018 - 3rd International Conference of Computer, Environment, Agriculture, Social Science, Health Science, Engineering and

Technology

for growth (Larsen, 2017). Therefore, it takes a

preventive effort in the form of improvement of food

and environmental sanitation in reducing the

incidence of stunting (Fregonese, 2016)

This study states that there is no relationship

between education status and stunting events. This is

not in accordance with previous research that children

of illiterate mothers are more likely to suffer stunting

than a mother who can read. As many as 56, 2% of

children suffering from stunting have illiterate

mothers while 43, 8% of children suffering from

stunting can read (Fikadu, et al, 2014). A good

mother's education level has a large protective effect

on the incidence of malnutrition in children. Not only

maternal education, but the knowledge level of father

is also influential. High education mother and father

will automatically pay attention to health and family

intake (Akombi, 2017).

This study states that there is no relationship

between family income and stunting events. The

results obtained in this study in accordance with

previous studies which states that there is no

relationship between the mother's work on stunting a

events (Cruz, 2017). Previous research examined that

mothers who work as traders and farmers are more

likely to stunting than mothers who do not work

(Housewife) (Fikadu, et al, 2014). The presence or

absence of work and how much income affects the

purchasing power of quality foods that can reduce the

incidence of stunting (Akombi, 2017).

3.3 Multivariate Analysis

Table 8. Multivariate Result With Multiple Logistic

Regression

Variable Si

Income Cate

0,356

Education Cate

0,943

Breastfeeding Time 0,002

Birth Wei

0,384

Sanitation 0,025

Table 9. Multivariate Analysis Result With Multiple

Logistic Regression

Subvariable B Wald Sig OR CI 95%

Breastfeeding

time

1,381 7,222 0,007 4,781 1,799-12,709

Sanitation 0,776 2,424 0,119 2,881 1,143-7,263

The multivariate analysis concluded that of all

independent variables suspected to influence the most

influential stunting incidence is the duration of

breastfeeding (receiving exclusive breastfeeding)

with p value 0,007. The largest OR value obtained

was 4,781, meaning that the duration of breastfeeding

(receiving exclusive breastfeeding <6 months) had a

4.781 chance of occurring stunting events. This is in

accordance with pre-existing data and theory.

According to Arifin, the risk of stunting is 3.7 times

higher in children who are not exclusively breastfed

(breastfed <6 months) than children exclusively

breastfed (≥6 months) (Arifin, 2015) Research

conducted in Kota Banda Aceh states that the

incidence of stunting is caused by low family income,

non-exclusive breastfeeding, poor MP-ASI,

incomplete immunization with the most dominant

factor influencing is non-exclusive breastfeeding

(Dinas Kesehatan Propinsi Sumatera Utara, 2014).

4 CONCLUSIONS AND

RECOMMENDATIONS

Based on the results of this study, it was found that

from 5 (five) variables studied were breastfeeding,

birth weight, sanitation, education and income of

parents, the variable length of breastfeeding was more

significant cause stunting. Where is obtained odds

ratio 4,781. This means that children who have a long

history of breastfeeding (exclusive breastfeeding)

less than 6 months tend to suffer stunting 5 times

greater than those who get exclusive breastfeeding is

about 6 months.

When viewed from the results of this study,

parents are expected to pay more attention to the

duration of exclusive breastfeeding for the baby to

prevent the occurrence of stunting in children. As for

health centers and health offices to further improve

the program to increase knowledge of mother about

stunting and the factors that influence it.

Researchers can further develop the results of this

future research related to stunting with additional

anemia variables, and learning achievement of

children.

ACKNOWLEDGEMENTS

Data for this study was collect by Dedi Kurniawan

Nst, Primadona Yani Gultom, Yose Natasa, Paska

Ria Angela, and Ruth Manullang.

The Relationships Breastfeeding, Weight, Sanitation to Stunting Event in Age 2-12 Years in Medan Tuntungan, Indonesia

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