A review of child stunting determinants in Indonesia.

Ty Beal,Alison Tumilowicz,Aang Sutrisna,Doddy Izwardy,Lynnette M Neufeld

doi:10.1111/mcn.12617

Abstract

Child stunting reduction is the first of 6 goals in the Global Nutrition Targets for 2025 and a key indicator in the second Sustainable Development Goal of Zero Hunger. The prevalence of child stunting in Indonesia has remained high over the past decade, and at the national level is approximately 37%. It is unclear whether current approaches to reduce child stunting align with the scientific evidence in Indonesia. We use the World Health Organization conceptual framework on child stunting to review the available literature and identify what has been studied and can be concluded about the determinants of child stunting in Indonesia and where data gaps remain. Consistent evidence suggests nonexclusive breastfeeding for the first 6 months, low household socio‐economic status, premature birth, short birth length, and low maternal height and education are particularly important child stunting determinants in Indonesia. Children from households with both unimproved latrines and untreated drinking water are also at increased risk. Community and societal factors—particularly, poor access to health care and living in rural areas—have been repeatedly associated with child stunting. Published studies are lacking on how education; society and culture; agriculture and food systems; and water, sanitation, and the environment contribute to child stunting. This comprehensive synthesis of the available evidence on child stunting determinants in Indonesia outlines who are the most vulnerable to stunting, which interventions have been most successful, and what new research is needed to fill knowledge gaps.

Highlights

Under‐five child stunting represents poor linear growth during a critical period and is diagnosed as a height for age less than −2 standard deviations from the World Health Organization (WHO) child growth standards median (WHO, 2006)
Our results demonstrate there is strong and consistent evidence from randomized controlled trials (RCTs) and observational studies that household and family factors—short maternal stature, premature birth, short birth length, low maternal education, and low household wealth—are important proximate determinants of child stunting in Indonesia
We found that community and societal factors have been shown to play an important role in child stunting in Indonesia— access to health care, health infrastructure, and qualified health providers

Summary

Introduction

Under‐five child stunting represents poor linear growth during a critical period and is diagnosed as a height for age less than −2 standard deviations from the World Health Organization (WHO) child growth standards median (WHO, 2006). There are large disparities subnationally (Figure 1), ranging by province from 26% in Riau Islands to 52% in East Nusa Tenggara (NHRD, MOH, 2013). This indicates the variation in the population's exposure to determinants of child stunting and the need to target and tailor interventions to the most vulnerable. There are numerous potential causes of stunting in Indonesia, including proximate factors such as maternal nutritional status, breastfeeding practices, complementary feeding practices, and exposure to infection as well as related distal determinants such as education, food systems, health care, and water and sanitation infrastructure and services. We use the WHO child stunting framework (Stewart et al, 2013) to organize studies with an outcome of under‐five child stunting or linear growth into the appropriate determinant categories and identify knowledge gaps (Figure 2)

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Discussion

Conclusion