PAPER: A review of child stunting determinants in Indonesia. In Maternal and Child Nutrition

 

Beal, T., Tumilowicz, A., Sutrisna, A., Izwardy, D., & Neufeld, L. M. (2018). A review of child stunting determinants in Indonesia. In Maternal and Child Nutrition (Vol. 14, Issue 4). https://doi.org/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.

Keywords: Indonesia; child stunting; conceptual framework; determinants; height for age; linear growth.

The World Health Organization conceptual framework on childhood stunting: Proximate causes and contextual determinants. Bold text represents determinants that have been addressed in the literature. Normal styled text represents determinants not addressed in the literature. Italicized text represents determinants that were not explicitly stated in the framework but identified in the literature. Modified from Stewart et al., 2013

CONCLUSION

          The evidence in Indonesia aligns with common proximate causes of child stunting identified in the broader literature: maternal height and education, premature birth and birth length, exclusive breastfeeding for 6 months, and household socio-economic status. Unsurprisingly, clean drinking water is especially important for household with unimproved latrines. SQ-LNS have pontential to considerably reduce child stunting incidence, particularly in rural Indoensia, likely due to the provision of both micronutrients and macronutrients during the initial critical grwoth period when compelementary foods are first introduced. Several proximate determinants identified in the WHO framework have not been assessed for their impact on child stunting in Indonesia, and studies addressing these knowledge gaps in Indonesia re needed. Community and societal factors are also vital-especially addressing health and health care-but more research is needed to address the pathways between the political economy, education, society and culture, agriculture and food system, and water, sanitation and the environment and child stunting, which likely play an important role in Indonesia.

           In addition to mothers of short stature and poor education, children born prematurely, and poor households, children from poor urban and especially rural communities are particularly vulnerable to stunting. Boys are far more likely than girls to be stunted throughout Indonesia' the biological factors, living conditions, and differences in maternal feeding