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      Stunting Among Children Under Two Years in the Islands Areas: A Cross-sectional Study of the Maluku Region in Indonesia, 2021

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          Abstract

          Background: The Maluku region encompasses thousands of islands. The study analyzed factors related to stunting among children under two years old in the Maluku Region of Indonesia.

          Study Design: A cross-sectional study.

          Methods: This cross-sectional study examined 4764 children under two years. In addition to nutritional status (stature), the study analyzed ten independent variables (province, residence, maternal age, marital status, maternal education, employment, wealth, children’s age, gender, and early initiation of breastfeeding [EIBF]). Finally, the contribution of various factors to stunting was examined using logistic regression.

          Results: Children in Maluku province were 1.13 times more likely than those in North Maluku province to become stunted. In addition, children aged 12-13 months were 4.09 times more likely than<12 months, and boys were 1.87 times more likely than girls to have the patterns of stunting. Children in rural areas were 1.10 times more likely to become stunted than those in urban areas (95% confidence interval: 1.06, 1.14). Divorced/widowed mothers were 1.88 times more likely than married mothers. Mothers of all education levels were more likely than those without formal education, and unemployed mothers were 1.07 times more likely than employed mothers to have stunted children. The possibility of becoming stunted was lower when the children were wealthier.

          Conclusion: Nine variables were related to stunted incidence, including province, residence, maternal age, marital status, maternal education, employment, wealth, children’s age, and gender.

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          A review of child stunting determinants in Indonesia

          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.
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            Determinants of the Stunting of Children Under Two Years Old in Indonesia: A Multilevel Analysis of the 2013 Indonesia Basic Health Survey

            Indonesia is ranked fifth among countries with the highest burden of stunting in children under five. This study aims to examine the determinants of stunting in children aged 0–2 years in Indonesia using data derived from the 2013 Indonesia Basic Health Survey. Twenty potential predictors of stunting, categorized into household and housing characteristics; maternal and paternal characteristics; antenatal care services and child characteristics were analyzed. Multilevel analyses were performed to examine the role of cluster/district/provincial differences, as well as individual/household level characteristics and stunting status. Of 24,657 children analyzed, 33.7% (95%CI: 32.8%–34.7%) were stunted. The odds of stunting increased significantly among children living in households with three or more children under five-years-old (aOR = 1.33, 95%CI: 1.03–1.72), households with five to seven household members (aOR =1.11; 95%CI: 1.03–1.20), children whose mothers during pregnancy attended less than four antenatal care services (aOR = 1.22, 95%CI: 1.08–1.39), boys (aOR = 1.33, 95%CI: 1.22–1.45), children aged 12–23 months (aOR = 1.89; 95%CI: 1.54–2.32), and children who weighed <2500 g at birth (aOR = 2.55; 95%CI: 2.05–3.15). The odds also increased significantly with the reduction of household wealth index. Integrated interventions to address environment, an individual level associated with stunting in Indonesia, from the environment- to individual-level factors are important.
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              Boys Are More Stunted than Girls from Early Infancy to 3 Years of Age in Rural Senegal.

              Background: Girls tend to have a lower risk of stunting than boys do in low-income countries.Objective: We evaluated differences in height status and complementary food (CF) intake between sexes from ages 2 to 39 mo in Senegal.Methods: Length and weight measurements were taken at ages 2-3, 4-5, 6-8, and 9-10 mo (n = 7319). Qualitative 24-h and 7-d food recalls were conducted in a subgroup (n = 2512). A smaller subsample was followed up to age 39 mo (n = 512). Height was measured, and intake of CF was noted. Boys and girls were compared in terms of height-for-age z score (HAZ) of WHO standards and National Center for Health Statistics growth reference, height-for-age difference, stunting, and consumption of CF by using chi-square tests, general linear models, and mixed-effects linear models (MLMs).Results: By using WHO standards, the mean HAZ was lower for boys than for girls in infancy, i.e., at 2-3 mo of age (-0.65 compared with -0.57; P = 0.002) and beyond, i.e., at 24-29 mo of age (-2.01 compared with -1.65; P < 0.001). Overall risk of stunting was 24.5% and 19.4% for boys and girls, respectively, during infancy (P < 0.001) compared with 59.2% and 47.9%, respectively, at 12-39 mo (P = 0.010). In MLMs from ages 2 to 39 mo, boys had a lower mean HAZ than girls had at age 2 mo (β0 = -0.19; P = 0.035), and sex differences increased with increasing age (β1 = -0.007 z scores/mo; P < 0.001). At 2-3 mo of age, boys were more likely to have been fed CF every day during the past week (15.8% compared with 11.2% for girls; P = 0.005) and to have eaten ≥2 meals in the past 24 h (13.4% compared with 8.2% for girls; P < 0.001).Conclusions: In Senegalese infants, CF intake differed by sex, with boys more likely to consume CF. Boys had lower HAZs than girls had during infancy, and sex differences increased up to age 39 mo. The importance of sex in complementary feeding and growth warrants further attention in low-income countries.
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                Author and article information

                Journal
                J Res Health Sci
                J Res Health Sci
                J Res Health Sci
                JRHS
                Journal of Research in Health Sciences
                Hamadan University of Medical Sciences
                2228-7795
                2228-7809
                Fall 2023
                29 December 2023
                : 23
                : 4
                : e00597
                Affiliations
                1National Research and Innovation Agency, Republic of Indonesia, Jakarta, Indonesia
                Author notes
                [* ] Corresponding author: Hastin Dyah Kusumawardani, Email: hastin.dyah.kusumawardani@ 123456brin.go.id
                Author information
                https://orcid.org/0000-0002-0888-6067
                Article
                10.34172/jrhs.2023.132
                10843314
                38315912
                abcdf3fa-4531-41a6-b3d4-8a4397bf7a7e
                © 2023 The Author(s); Published by Hamadan University of Medical Sciences.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 August 2023
                : 28 October 2023
                : 03 December 2023
                Categories
                Original Article

                stunting,children,maluku region,nutritional status
                stunting, children, maluku region, nutritional status

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