Abstract
The prevalence of stunting in young Indonesian children is the highest among countries belonging to the Association of Southeast Asian Nations (ASEAN). Breastfed children are reported to grow better than non-breastfed. The present study examined the protective effect of exclusive breastfeeding against stunting in children under two years old (CU2) and its interaction with monthly household expenditure. Secondary analyses were conducted based on a 2012 cross-sectional study including 408 children aged 6–24 months and their caregivers from 14 villages in rural Eastern Indonesia. Data on breastfeeding history, childcare, and household expenditures were collected using structured questionnaires. Focus Group Discussions (FGDs) were conducted in each village (n = 14). Nearly two-thirds (61%) of caregivers who identified as the biological mother exclusively breastfed their child at 6 months. Exclusively-breastfed CU2 from poorer households were 20% less likely to be stunted than their non-exclusively-breastfed peers. Further, exclusively-breastfed CU2 from wealthier households were 50% less likely to be stunted than non-exclusively-breastfed CU2 from poorer households. FGDs revealed that some mothers were unaware of the importance of recommended breastfeeding practices. Exclusive breastfeeding may protect low-income children against stunting. Health promotion to improve caregiver motivation to exclusively breastfeed is critical in the present setting and beyond.
Highlights
Child undernutrition, especially stunting, remains a global public health challenge in the 21st century [1]
The use of formula feeding is not recommended in low- and middle-income country (LMIC) settings due to poor sanitation and the subsequent risk of contamination of the water with microbes and toxins used for the preparation of formula [13]
We found no significant direct relationship between exclusive breastfeeding and stunting in this sample, but we found a significant relationship between monthly household expenditures and exclusive breastfeeding (Table 3) Further analyses were conducted to explore the relationship between stunting prevalence, exclusive breastfeeding, and monthly household expenditures
Summary
Especially stunting, remains a global public health challenge in the 21st century [1]. The prevalence of stunting is concerningly high in Indonesia and East. Based on the Basic Health Research report in 2018, the prevalence of stunting among children under 5 years of age in Indonesia is 30.8%, while in NTT Province, the prevalence is 42.6% [2]. Stunting is defined as having a height-for-age below two standard deviations of the WHO Child Growth Standards median [3] and is a consequence of inadequate nutrition and/or recurrent infections or chronic diseases which cause poor nutrient intake, absorption, and utilization [4]. To reduce stunting prevalence more effectively, rigorous prevention strategies need to be defined and implemented properly. Exclusive breastfeeding has been reported to be effective for maintaining optimal growth of young children [6]. The impact of exclusive breastfeeding in protecting young children from stunting in remote, diverse economic environments requires further investigation and promotion
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