ISGH4

KnE Medicine
The 4th International Seminar on Global Health
Volume 2022

Research article

Factors Affecting Stunting in Saguling

Community Health Centers, West Bandung
Rika Nurhasanah*, and Indria Astuti
Midwifery Program, The University of Jenderal Ahmad Yani

Abstract.
Stunting is one of the most common nutritional problems experienced by toddlers
around the world. When exclusive breastfeeding is not given for six months the
risk of stunting in toddlers may be higher because breast milk is important in the
baby’s growth period. The knowledge of mothers about nutrition affects the mother’s
behavior in providing the right food to support the growth and development of
children. Pregnant women who have suffered from chronic energy deficiency (CED)
are more likely to have babies born with a low weight, affecting their health. If
they cannot grow properly, low birthweight (LBW) babies will most likely suffer from
stunting. This study was conducted to determine the factors that affect stunting in
toddlers aged 24-36 months in Saguling community health centers in West Bandung.
Corresponding Author: Rika
Observational methods were used with a cross sectional approach. The sample
Nurhasanah; email:
rika_dot@[Link]
consisted of 82 mothers who had toddlers aged 24-36 months. The Chi-square test
was used to analyze the data. Bivariate results showed that exclusive breastfeeding
Published: 3 June 2022 was a factor that influenced the occurrence of stunting (p < 0.001, PR = 2.353), as was
LBW (p = 0.001, PR = 1.760). Other factors related to the incidence of stunting were a
Publishing services provided by
Knowledge E
history of CED (p = 0.007, PR = 1.657) and the mother’s knowledge (p = 0.005, PR = 1.679).

Rika Nurhasanah, and Indria Keywords: stunting, exclusive breastfeeding, LBW, CED, mother’s knowledge
Astuti. This article is distributed
under the terms of the Creative
Commons Attribution License,
which permits unrestricted use
and redistribution provided that
1. Introduction
the original author and source
are credited.
Stunting is one of the nutritional problems experienced by toddlers in the world. Glob-
Selection and Peer-review under ally, in 2019 there were around 21.9% or 149 million children under five in the world
the responsibility of the ISGH4
experiencing stunting. This figure has decreased when compared to the stunting rate
Conference Committee.
in 2017 which was around 150.8 million or 22.2% of children under five. However,
according to WHO, if the stunting problem is above 20%, it becomes a public health
problem [1].
WHO states that the prevalence of stunting under five in Indonesia (36.4%) is included
in the third country with the highest prevalence in the Southeast Asia Region after Timor
Leste (38.4%) and India (38.4%) [2].
This stunting problem is experienced by 1 in 3 Indonesian children. More than 1/3
of children under 5 years old in Indonesia are below the average height. Based on

How to cite this article: Rika Nurhasanah*, and Indria Astuti, (2022), “Factors Affecting Stunting in Saguling Community Health Centers, West
Bandung ” in The 4th International Seminar on Global Health, KnE Medicine, pages 117–126. DOI 10.18502/kme.v2i2.11074
Page 117
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the results of the Integrated Toddler Nutrition Status (SSGBI) survey by the Indonesian
Ministry of Health’s Balitbangkes in 2019, it is known that the proportion of stunting in
Indonesia is 27.67. The highest proportion of stunting was found in NTT, West Sulawesi,
and NTB. For the province of West Java, it is below the average proportion of Indonesia,
which is 26.21 [3]. In 2018, the percentage of very short and short toddlers aged 0-59
months in Indonesia was 11.5% and 19.3%, respectively. This condition increased from
the previous year, namely 9.8% and 19.8%. West Java Province occupies stunting rates
with a percentage incidence of 13.2% very short toddlers and 15.9% short toddlers. West
Bandung Regency is one of the districts with a fairly high incidence of stunting, namely
10,487 stunting events [3].
Stunting is a chronic condition that describes stunted growth due to long-term mal-
nutrition. Stunting according to the WHO Child Growth Standard is based on an index
of body length compared to age (PB/U) or height compared to age (TB/U) with a limit
(z-score) of less than -2 SD [4]. Stunting is caused by two factors, namely directly and
indirectly. Directly, namely exclusive breastfeeding, infectious diseases, food intake, and
birth weight. And which is an indirect factor of parental education, parental occupation,
and family economic status.
Growth and development in infancy requires a balanced and relatively large intake
of nutrients. However, a baby’s ability to eat is limited by the state of his digestive tract
which is still in the maturation stage. The only food that suits the condition of the baby’s
digestive tract and meets the needs for the first months is breast milk [5]. One of the
causes of stunting in toddlers is unbalanced foof intake. Unbalanced food intake is
included in exclusive breastfeeding that is not given for 6 months. Children who do
not get exclusive breastfeeding are at higher risk for lack of nutrients needed for the
growth process. Impaired growth will result in the occurrence of stunting in children [6].
According to Fitri’s research, there has been a significant correlation between exclusive
breast milk and the stunting of toddlers in Lima Puluh Community Health Center, in
which 41.8% of those not exclusively breast-milk children stunting [7].
Pregnant women during pregnancy need special attention at this important period.
Pregnant women are one of the groups that are vulnerable to nutrition. Nutritional intake
of pregnant women is very influential on fetal growth. Good nutritional status in pregnant
women can prevent the occurrence of low birth weight (LBW) and stunting (short).The
high rate of malnutrition in pregnant women has contributed to the high number of LBW
in Indonesia which is estimated to reach 350,000 babies every year. Malnutrition that
occurs in first trimester pregnant women can cause the fetus to die and the baby to be
born prematurely. If malnutrition occurs in the second and third trimesters, the fetus can

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be stunted and do not develop according to the gestational age of the mother. Poor fetal
growth of pregnant women with CED will produce babies with low birth weight (LBW). A
pregnant woman will give birth to a healthy baby if the level of health and nutrition is in
good condition [8]. According to Fitri’s research, there has been a significant correlation
between LBW and the stunting, in which 72,7% of LBW have stunting [7]. Pregnant
women with malnutrition cause the fulfillment of nutrition to the fetus to be reduced so
that children born can be at risk of stunting. Ruaida & Soumokil’s research showed that
mothers with a history of 57.89% CED resulted in stunting in children and were 4.85
times more likely to cause stunting in children compared to mothers who did not [8].
Another factor that affect of stunting is mother’s knowledge. Based on the results
of Septamarini’s research in the Journal of Nutrition College in 2019 said that mothers
with low knowledge had a 10.2 times greater risk of children experiencing stunting
compared to mothers with sufficient knowledge. Knowledge is the result of ”knowing”
and this occurs after people have sensed a certain object. Sensing occurs through the
five human senses, namely the senses of sight, hearing, smell, taste, and touch. Most
of human knowledge is obtained through the eyes and ears [9].
Based on the description above, it showed that the factors for stunting are not
giving exclusive breastfeeding, low birth weight, mothers with a history of CED, and
mother’s knowledge. Therefore, in an effort to find out and understand how these
factors affect stunting, the researchers are interested in conducting research on the
relationship between exclusive breastfeeding, low birth weight, history of CED, and
mother’s knowledge with the incidence of stunting in toddlers. The aim of the study
was to determine the factors that affect the incidence of stunting in toddlers aged
24-36 months at the Saguling Community Health Center, West Bandung.

2. Methods
2.1. Study design

The design of this study is a survey method with a cross sectional approach which was
carried out at the Saguling Community Health Centers in March-August 2021.
Sample
The sample used in this study were 82 respondents, namely mothers who have
toddlers aged 24-36 months. Inclusion criteria were children with stunting, aged 24-36
months, born at term, mothers were willing to be respondents. The sampling technique
used is purposive sampling.

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2.2. Instrument

Toddlers with exclusive breastfeeding are seen from exclusive breastfeeding for 6
months. Toddlers with LBW are seen from birth weight less than 2500 g.
Data collection procedure
Samples were obtained from mothers with stunting toddlers who came to the
puskesmas, were willing to become respondents by filling out the questionnaire given.
Respondents are guaranteed the confidentiality of their data.

2.3. Data analysis

Univariate data analysis to see the description of respondent characteristics and fre-
quency distribution, the magnitude of the proportion of each variable. Data is normally
distributed. Bivariate analysis using chi square to see the relationship between exclusive
breastfeeding, low birth weight, history of CED, and mother’s knowledge with the
incidence of stunting. Data were analyzed using SPSS.

3. Results
3.1. Univariate Analysis

Based on table 1 above, it can be seen that the toddlers based on gender in this study
were mostly female as many as 49 toddlers (59.8%) and toddlers with male sex as many
as 33 toddlers (40.2%). The characteristics of the work of most of the mothers are not
working as many as 47 people (57.3%) and working mothers as many as 35 people
(42.7%).
The frequency distribution of children under five who were not exclusively breastfed
(64.6%) was higher than that of children who were given exclusive breastfeeding (35.4%).
The distribution of the frequency of toddlers who are not LBW (64.6%) is more than that
of toddlers who are LBW (35.4%). The frequency distribution of mothers with CED
(56.1%) was higher than mothers without CED (43.9%). The frequency distribution of
low maternal knowledge (53.7%) is more than high maternal knowledge (46.3%). The
distribution of the frequency of stunting (64.6%) was higher than that of non-stunted
(35.4%).

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Table 1: Frequency Distribution of Respondents’ Characteristics and Research Variables.

No Variable f %
1 Toddler Gender
Male 33 40.2
Female 49 59.8
2 Mother's Job
Work 35 42.7
Does not work 47 57.3
3 Exclusive Breastfeeding
No Exclusive Breastfeeding 53 64.6
Exclusive breastfeeding 29 35.4
4 LBW
LBW 29 35.4
Non LBW 53 64.6
5 CED history
CED 46 56.1
Non CED 36 43.9
6 Mother's Knowledge
Low 44 53.7
High 38 46.3
7 Stunting
Stunting 53 64.6
Non Stunting 29 35.4

3.2. Bivariate Analysis

Table 2: The Relationship between Exclusive Breastfeeding and Stunting.

Exclusive Stunting Total P-value PR

breastfeeding
Stunting Non Stunting
f % f % f %
No Exclusive 43 52.4 10 12.2 53 64.6 0.000 2,353
Breastfeeding
Exclusive 10 12.2 19 23.2 29 35.4
breastfeeding
Total 53 64.6 29 35.4 82 100

Based on table 2 above, it can be seen that toddlers who experience stunting are
more common in toddlers who are not given exclusive breastfeeding, which is 52.4%
compared to toddlers who are given exclusive breastfeeding (12.2%) with a p-value of
0.000 and a PR of 2.353. This shows that exclusive breastfeeding has an effect on
the incidence of stunting. Toddlers who were not given exclusive breastfeeding were

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2,353 times more likely to experience stunting compared to toddlers who were given
exclusive breastfeeding.

Table 3: The Relationship between LBW and Stunting.

LBW Stunting Total P-value PR

Stunting Non Stunting
f % f % f %
LBW 26 31.7 3 3.7 29 35.4 0.001 1,760
Non LBW 27 32.9 26 31.7 53 64.6
Total 53 64.6 29 35.4 82 100

Based on table 3 above, it can be seen that toddlers who experience stunting are
more common in toddlers who are not LBW, which is 32.9% compared to toddlers who
are LBW (31.7%) with a p-value of 0.001 and a PR of 1.760. These results indicate that
children with low birth weight have an effect on the incidence of stunting. Toddlers with
LBW are 1,760 times more likely to experience stunting than toddlers who are not LBW.

Table 4: The Relationship between CED History and Stunting.

CED history Stunting Total P-value PR

Stunting Non Stunting
f % f % f %
CED 36 43.9 10 12.2 46 56.1 0.007 1,657
Non CED 17 20.7 19 23.2 36 43.9
Total 53 64.6 29 35.4 82 100

Based on table 4 above, it can be seen that children under five who experience
stunting are more common in mothers with a history of CED, which is 43.9% compared
to mothers with no history of CED (20.7%) with a p-value of 0.007 and a PR of 1.657.
These results indicate that mothers with a history of CED have an effect on the incidence
of stunting. Mothers with CED during pregnancy were 1,657 times more likely to have
children with stunting than mothers who did not.

Table 5: The Relationship between Mother’s Knowledge and Stunting.

Mother's Stunting Amount P-value PR

Knowledge
Stunting Non Stunting
f % f % f %
Low 35 42.7 9 11 44 53.7 0.005 1,679
High 18 22 20 24.3 38 46.3
Total 53 64.6 29 35.4 82 100

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Based on table 5 above, it can be seen that under-fives who experience stunting
are more common in mothers with low knowledge, namely 42.7% compared to mothers
with high knowledge (22%) with p-value of 0.005 and PR 1.679. These results indicate
that mothers who have low knowledge have an effect on the incidence of stunting.
Toddlers with mothers with low knowledge are 1,679 times more likely to experience
stunting than mothers with high knowledge.

4. Discussion

The results of this study indicate that there is a relationship between exclusive breast-
feeding and the incidence of stunting in toddlers. This result is in accordance with
research conducted by Lestari which stated that there is an effect of exclusive breast-
feeding on the incidence of stunting with a p value of 0.000 with an OR of 3.375 which
means that toddlers who not given exclusive breastfeeding has a 3.375 times greater
risk of experiencing stunting [10]. This study is also the same as the research conducted
by Rilyani which stated that exclusive breastfeeding had an effect on stunting with a
p-value of 0.001 OR 3.375 [11]. Breast milk is the best food for babies immediately after
birth. According to WHO, exclusive breastfeeding is breastfeeding only for infants up to
the age of 6 months without additional fluids or other foods. Breast milk can be given
until the baby is 2 years old.
The results showed that LBW affected the occurrence of stunting in toddlers, this
was in line with research conducted by Fitri which showed that 72.7% of LBW toddlers
experienced stunting. And there is a significant relationship between LBW and the
incidence of stunting where p-value 0.000 <0.05 [7]. Other studies also show that
children with LBW have a 29.4 times greater chance of experiencing stunting compared
to children who are not LBW [8]. Poor nutritional status of mothers during pregnancy
can cause toddlers to be born with low birth weight (LBW). Babies born with LBW often
have difficulty catching up with their growth (inadequate catch up growth). The risk of
growth restriction will be exacerbated if the incidence of malnutrition in the fetus is
followed by inadequate food intake in the first two years of life. The period in the womb
and the first two years of life is very decisive for the incidence of stunting in adulthood
[12].
The results showed that mothers who had a history of CED had an effect on the
incidence of stunting in toddlers, this is in line with the another research which showed
that mothers with a history of CED 57.89% resulted in stunting in children and were
4.85 times more likely resulted in stunting in children compared to mothers who did not

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have CED [8]. Other studies also show that CED has a significant relationship with the
incidence of stunting with a p-value of 0.03 and a 2 times greater risk of increasing the
incidence of stunting compared to non-CED [13]. Chronic Energy Deficiency (CED) is a
condition where the mother suffers from a chronic (chronic) lack of food which results
in health problems for the mother. CED is the nutritional status of mothers in the past
who experienced chronic malnutrition which can cause toddlers to grow up with a short
body (stunting) or thin (wasting) as adults [2]. CED is formed due to the failure of the
mother to gain weight during pregnancy. Maternal weight gain during the 1st trimester of
pregnancy has a very important role, because during this period the fetus and placenta
are formed, but failure to gain maternal weight in the 2nd and 3rd trimesters will increase
the baby with low birth weight (LBW). This is what causes CED which results in a small
placental size and a lack of food supply to the fetus. Malnutrition in the mother that is
prolonged and sustained during pregnancy will have a worse impact on the fetus than
acute malnutrition [14].
The results showed that mothers who had low knowledge had a relationship with the
incidence of stunting in toddlers, this is in line with Hapsari’s research which states that
Mother’s knowledge of low nutrition is a risk factor for stunting in toddlers with a risk
of 3,801 [15]. Other studies also show that there is a relationship between attitudes and
knowledge of mothers on the incidence of stunting in children who have just entered
elementary school with p value 0.000 <0.05. Mothers who have children aged 1-2
years show as many as 60% of mothers with sufficient knowledge, 30% of mothers
with less knowledge, and 10% of mothers with less knowledge [16]. Knowledge is very
closely related to education, where it can be assumed that with higher education,
people will have wider knowledge. Mother’s knowledge about nutrition is the initial
process in changing behavior to increase nutrition, so knowledge is an internal factor
that influences behavior change. Mother’s knowledge about nutrition will determine the
mother’s behavior in providing the right food to support the growth and development
of children.
In this study, there are limitations that can be taken into consideration, not all factors
that influence stunting are studied such as genetics, parenting patterns, environmental
sanitation, household income. The data are only examined in a limited time and only to
prove the conditions that occurred at the time of the study and changes that may have
occurred and will not occur can not be observed.

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5. Conclusions

Factors that influence stunting are exclusive breastfeeding, low birth weight, history
of CED, and mother’s knowledge. It is recommended for health workers to provide
counseling to the community, especially pregnant women about knowledge related to
stunting, exclusive breastfeeding for children, prevention of CED which can lead to
low birth weight babies through improving nutritional status by consuming balanced
nutrition. Families are expected to provide balanced nutritional intake for children and
well-applied parenting patterns to prevent stunting.

Acknowledgment

We thank our study staff and participants from the Saguling Community Health Centers
who have toddlers aged 24-36 months.

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