How to cite:
Susanti br Perangin-Angin. (2022). The Effect of Risk Factors on
Stunting Events the Titi Papan Puskesmas, Mabar Hilir Kelurahan,
Medan Deli District Medan City, 2021. Journal of Eduvest. Vol 2 (9):
Page 1712-1727
E-ISSN:
2775-3727
Published by:
https://greenpublisher.id/
Eduvest – Journal of Universal Studies
Volume 2 Number 9, September, 2022
p- ISSN 2775-3735 - e-ISSN 2775-3727
THE EFFECT OF RISK FACTORS ON STUNTING EVENTS THE
TITI PAPAN PUSKESMAS, MABAR HILIR KELURAHAN, MEDAN
DELI DISTRICT MEDAN CITY, 2021
Susanti br Perangin-Angin
Lecturer of Poltekkes Kemenkes Medan, Indonesia
Email: [email protected]
ABSTRACT
The World Health Organization (WHO) collected stunting
data showing that Indonesia is one of the three countries with
the highest prevalence in the South-East Asia Region (SEAR).
Health problems that affect infants are stunting or short
stature due to chronic malnutrition where malnutrition is a
global problem, including in Indonesia. This research is an
analytic observational study with a case control study. The
design was carried out at the Titi Papan Health Center,
Mabar Hilir District, Medan Deli Regency in 2021 to analyze
the influence of risk factors on stunting events with a sample
of 88 children under five, 44 cases and 44 controls, sampling
was carried out purposively where cases and controls were
taken in one population. Data were obtained from
Puskesmas, Medan City Health Office, observations, direct
interviews with respondents using questionnaires. The results
of the study concluded that the most influential variable on
the incidence of stunting was family income (p = 0.000, Exp(B)
= 9.208). Factors that significantly influence the incidence of
stunting are birth weight (p = 0.001, OR = 2.375), education
(p = 0.001, OR = 6.923), family income (p = 0.000, OR =
15.857), availability of clean water facilities . (p = 0.000, OR =
9.643), family latrine facilities (p = 0.001, OR = 2.333),
sewerage ownership (p = 0.000), OR = 0.405. The need for
intensive counseling by health workers regarding factors
related to stunting, to increase public awareness to change
bad habits that are contrary to health and can cause stunting
in toddlers.
Eduvest – Journal of Universal Studies
Volume , Number , Month, Year
The Effect of Risk Factors on Stunting Events the Titi Papan Puskesmas, Mabar
Hilir Kelurahan, Medan Deli District Medan City, 2021
1713
KEYWORDS
toddler stunting, risk factor analysis
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International
INTRODUCTION
There are 4 factors that influence the degree of human health, namely
behavior, health services and heredity as well as environmental factors that play a
major role in this. From the environmental aspect, the problem of ownership of
healthy latrines and the provision of clean water still needs to be considered
(Aksoy, 2017).
One of the health problems that affect infants is stunting or short stature
due to chronic malnutrition where malnutrition is a global problem, including in
Indonesia. Fulfillment of nutrition that has not been fulfilled both from the womb
until the baby is born can cause various health problems that affect the mother and
baby (Ananda, 2022)(Ati, n.d.)(Awa, Ojiabo, & Emecheta, 2015).
Environmental sanitation problems need to be monitored on environmental
factors because they affect human health(Ayandibu & Houghton, 2017).
Activities that can be done in this case are cleaning the house and yard regularly,
cleaning bathrooms and toilets, cleaning drains and using clean water (Belch &
Belch, 2004) (Chege & Wang, 2020)
Some of the scopes of environmental sanitation are the existence of
healthy latrines and the availability of clean water (Pinontoan and Sumampouw,
2019). Environmental sanitation is an indirect factor causing stunting and the
other is insufficient access to food, maternal care and health services (Etuk, Etuk,
& Michael, 2014)(Fanida, Niswah, Megawati, & Rahaju, 2020)(Gunawan &
Sulaeman, 2020).
Based on data on stunting toddlers collected by the World Health
Organization (WHO) shows that Indonesia is one of the three countries with the
highest prevalence in the Southeast Asia region / South-East Asia Regional
(SEAR). The average prevalence of stunting under five in Indonesia from 2005 to
2017 was 36.4 % . In 2017 as many as 22.2% or around 150.8 million children
under five in the world experienced stunting of which more than half of stunted
children in the world came from Asia (55%) and a third lived in Africa (39%). Of
the 86.3 million stunted children under five in Asia, the largest proportion came
from South Asia (58.7%) and the least came from Central Asia (0.9%). When
compared with the stunting rate in 2000 of 32.6%, it can be said that there has
been a decline in stunting because the stunting rate in 2017 was 22.2%. (Ministry
of Health RI, 2018).
Data from Unicef about 1 in 4 toddlers is stunted (UNICEF, 2013), the
prevalence of short toddlers becomes a public health problem if the prevalence is
20% or more because the percentage of stunted toddlers in Indonesia is still high
and is a health problem that must be addressed compared to some neighboring
countries. short toddlers (16%) and Singapore (4%) (UNSD, 2014). The 2014
Global Nutrition Report shows that Indonesia is included in 17 countries, among
117 countries, which have three nutritional problems, namely stunting , wasting
and overweight in children under five. Reducing stunting or short stature is an
Susanti br Perangin-Angin
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international target for 2025 and is one of the health outputs of the Sustainable
Development Goals (SDGs), which is a continuation program of the Millennium
Development Goals (MDGs).
Several other impacts that occur due to stunting where children have less
intelligence which affect learning achievement are not optimal and productivity
decreases. If this continues, it will hinder the development of a nation's
productivity in the future. Stunting problems that occur in childhood have an
impact on morbidity, mortality, impaired physical growth, impaired mental
development, cognitive and motor development disorders. Disorders that occur
tend to be irreversible and affect subsequent developments which can increase the
risk of degenerative diseases as adults(Juwita, Arsyad, & Alfando, 2020)(Putra,
Nugroho, Julendra, & Fahmi, n.d.)(Kahrilas et al., 1986).
Stunting occurs due to basic causes associated with education, poverty,
socio-culture, government policies and politics. The causes of stunting consist of
many factors that influence each other and the causes are different in each region
(Kwami et al, 2019; Saputri & Tumangger, 2019). Direct causes of stunting
include inadequate nutritional intake and infectious diseases and indirectly
stunting can be caused by factors of family food security, parenting, health
services and inadequate environmental health including water and sanitation.
(Sulistyanto, Dwinarko, Syafrizal, & Mujab, 2021)(Katyal & Xaviour,
2015)(Keskġn, Ġentürk, Sungur, & Kġrġġ, 2010)
Several factors of poor environmental sanitation including inadequate
access to clean water, use of unhealthy latrine facilities and poor hand washing
hygiene behavior contribute to an increase in infectious diseases such as diarrhea,
Environmental Enteric Dysfunction ( EED ), intestinal worms. This can cause
linear growth disorders and can increase mortality in children under five (Kwami
et al., 2019; Headey & Palloni, 2019; Cumming & Cairncross, 2016; BAPPENAS
& UNICEF, 2017)
Several studies related to the problem of stunting related to complex
causes were carried out in various countries, especially in low and middle income
countries. The research conducted not only focuses on nutritional problems and
infectious diseases as the cause of stunting , but also on other supporting factors
such as the nutritional adequacy of parents, socioeconomic status of the family.
One of the factors that are closely related to stunting is water, sanitation and
hygiene (Kotler, 2012)(Mutula & van Brakel, 2006)(Setiawati, Purba, Imran,
Kusumasari, & Murtadi, 2019)(Mukhtar, Putri, Suseno, Wibowo, & Wardana,
2020)
The prevalence of stunting or the level of malnutrition in children under
five in North Sumatra is still relatively high, which is obtained from the results of
the Basic Health Research (Riskesdas). In 2019, the prevalence of stunting in
North Sumatra reached 30.11% and previously 32.4% in 2018. And there are 15
areas in North Sumatra that are priority stunting prevention. The 15 areas are
Medan, Deli Serdang, Langkat, Simalungun, Dairi, Pakpak Bharat, Central
Tapanuli, Mandailing Natal, Padang Lawas, North Padang Lawas, Nias, South
Nias, West Nias, North Nias, and Gunung Sitoli.
Eduvest – Journal of Universal Studies
Volume , Number , Month, Year
The Effect of Risk Factors on Stunting Events the Titi Papan Puskesmas, Mabar
Hilir Kelurahan, Medan Deli District Medan City, 2021
1715
Based on the data above, the author is very interested in conducting
research on the determinants of stunting at the Titi Papan Health Center, Mabar
Hilir Village, Medan Deli District in 2021.
RESEARCH METHOD
There are 4 factors that influence the degree of human health, namely
behavior, health services and heredity as well as environmental factors that play a
major role in this. From the environmental aspect, the problem of ownership of
healthy latrines and the provision of clean water still needs to be considered
(North & Smallbone, 2000)(Nwachukwu & Ogbo, 2012)(Setiawati et al.,
2019)(Putra et al., n.d.)(Mukhtar et al., 2020).
One of the health problems that affect infants is stunting or short stature
due to chronic malnutrition where malnutrition is a global problem, including in
Indonesia. Fulfillment of nutrition that has not been fulfilled both from the womb
until the baby is born can cause various health problems that affect the mother and
baby. (Ministry of Health, 2018).
Environmental sanitation problems need to be monitored on environmental
factors because they affect human health (Surahman & Poetra, 2022). Activities
that can be done in this case are cleaning the house and yard regularly, cleaning
bathrooms and toilets, cleaning drains and using clean water (Rahatmawati,
Istanto, Wijaya, & Hayati, 2020)(Setiawati et al., 2019)(Sulistyanto et al., 2021)
Some of the scopes of environmental sanitation are the existence of
healthy latrines and the availability of clean water (Pinontoan and Sumampouw,
2019). Environmental sanitation is an indirect factor causing stunting and the
other is insufficient access to food, maternal care and health services (Unicef,
1998; Helmyati, 2019).
Based on data on stunting toddlers collected by the World Health
Organization (WHO) shows that Indonesia is one of the three countries with the
highest prevalence in the Southeast Asia region / South-East Asia Regional
(SEAR). The average prevalence of stunting under five in Indonesia from 2005 to
2017 was 36.4 % . In 2017 as many as 22.2% or around 150.8 million children
under five in the world experienced stunting of which more than half of stunted
children in the world came from Asia (55%) and a third lived in Africa (39%). Of
the 86.3 million stunted children under five in Asia, the largest proportion came
from South Asia (58.7%) and the least came from Central Asia (0.9%). When
compared with the stunting rate in 2000 of 32.6%, it can be said that there has
been a decline in stunting because the stunting rate in 2017 was 22.2%. (Ministry
of Health RI, 2018).
Data from Unicef about 1 in 4 toddlers is stunted (UNICEF, 2013), the
prevalence of short toddlers becomes a public health problem if the prevalence is
20% or more because the percentage of stunted toddlers in Indonesia is still high
and is a health problem that must be addressed compared to some neighboring
countries. short toddlers (16%) and Singapore (4%) (UNSD, 2014). The 2014
Global Nutrition Report shows that Indonesia is included in 17 countries, among
117 countries, which have three nutritional problems, namely stunting , wasting
and overweight in children under five. Reducing stunting or short stature is an
Susanti br Perangin-Angin
1716
http://eduvest.greenvest.co.id
international target for 2025 and is one of the health outputs of the Sustainable
Development Goals (SDGs), which is a continuation program of the Millennium
Development Goals (MDGs).
Several other impacts that occur due to stunting where children have less
intelligence which affect learning achievement are not optimal and productivity
decreases. If this continues, it will hinder the development of a nation's
productivity in the future. Stunting problems that occur in childhood have an
impact on morbidity, mortality, impaired physical growth, impaired mental
development, cognitive and motor development disorders. Disorders that occur
tend to be irreversible and affect subsequent developments which can increase the
risk of degenerative diseases as adults (Surya et al., 2021)(Syahza, Savitri, Asmit,
& Meiwanda, 2021)(Tambunan, 2008)
Stunting occurs due to basic causes associated with education, poverty,
socio-culture, government policies and politics. The causes of stunting consist of
many factors that influence each other and the causes are different in each region
(Kwami et al, 2019; Saputri & Tumangger, 2019). Direct causes of stunting
include inadequate nutritional intake and infectious diseases and indirectly
stunting can be caused by factors of family food security, parenting, health
services and inadequate environmental health including water and sanitation.
(UNICEF, 2013 in Trihono et al, 2015; Ministry of Health, 2018; Fenske et al,
2013; WHO, 2014).
Several factors of poor environmental sanitation including inadequate
access to clean water, use of unhealthy latrine facilities and poor hand washing
hygiene behavior contribute to an increase in infectious diseases such as diarrhea,
Environmental Enteric Dysfunction ( EED ), intestinal worms. This can cause
linear growth disorders and can increase mortality in children under five (Kwami
et al., 2019; Headey & Palloni, 2019; Cumming & Cairncross, 2016; BAPPENAS
& UNICEF, 2017)
Several studies related to the problem of stunting related to complex
causes were carried out in various countries, especially in low and middle income
countries. The research conducted not only focuses on nutritional problems and
infectious diseases as the cause of stunting , but also on other supporting factors
such as the nutritional adequacy of parents, socioeconomic status of the family.
One of the factors that are closely related to stunting is water, sanitation and
hygiene (Vrgovic, Vidicki, Glassman, & Walton, 2012)
The prevalence of stunting or the level of malnutrition in children under
five in North Sumatra is still relatively high, which is obtained from the results of
the Basic Health Research (Riskesdas). In 2019, the prevalence of stunting in
North Sumatra reached 30.11% and previously 32.4% in 2018. And there are 15
areas in North Sumatra that are priority stunting prevention. The 15 areas are
Medan, Deli Serdang, Langkat, Simalungun, Dairi, Pakpak Bharat, Central
Tapanuli, Mandailing Natal, Padang Lawas, North Padang Lawas, Nias, South
Nias, West Nias, North Nias, and Gunung Sitoli.
Based on the data above, the author is very interested in conducting
research on the determinants of stunting at the Titi Papan Health Center, Mabar
Hilir Village, Medan Deli District in 2021.
Eduvest – Journal of Universal Studies
Volume , Number , Month, Year
The Effect of Risk Factors on Stunting Events the Titi Papan Puskesmas, Mabar
Hilir Kelurahan, Medan Deli District Medan City, 2021
1717
RESULTS AND DISCUSSION
A. Overview of Research Sites
Titi Papan Health Center is one of the health centers that provides outpatient
services. For the community, the Puskesmas is the only health facility or place for
treatment provided by the nearest government and at an affordable cost. One of
them is the Titi Papan Health Center which is located in the District of Medan
Deli, Jalan Platina No. 04, Medan City.
The population under the guidance of the Titi Papan Health Center is 33,065 people,
consisting of 16,325 male residents and 16,740 female residents. Titi Papan Health Center
has a working area of 1 kelurahan with an area of ± 400.0 H with 16 neighborhoods and
7,989 families which are the working area of Titi Papan Health Center
B. Univariate Analysis
Table 4.1 Distribution of Proportion of Respondents by Gender, Birth Weight,
Maternal Age During Pregnancy, Education, Occupation, Family Income, Mother's
Height, Availability of Clean Water Facilities, Family Toilet Facilities, Availability of
Garbage Disposal Sites and Ownership of Sewerage Channels at Titi Health Center
Medan Deli District Board, Medan Municipality in 2021.
No.
Independent Variable
k case
C control
F
%
f
%
1.
2.
Gender
Woman
Man
22
22
50
50
20
24
45.5
54.5
Amount
44
100
44
100
1.
2.
Birth Weight
at risk
No Risk
12
32
27.3
72.7
0
44
0
100
Amount
44
100
60
100
1.
2.
Mother's Age When
Pregnant
at risk
No Risk
2
42
4.5
95.5
4
40
9.1
90.9
Amount
44
100
44
100
1
2.
Education
Low
Tall
18
26
40.9
59.1
4
40
9.1
90.9
Amount
44
100
60
100
1.
2.
Work
Doesn't work
B work
36
8
81.8
18.2
31
13
70.5
29.5
Amount
44
100
44
100
1.
2.
Family Income
< MSE
MSE
37
7
84.1
15.9
11
33
25
75
Amount
44
100
44
100
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1.
2.
Mother's Height
at risk
No Risk
7
37
15.9
84.1
1
43
9.1
90.9
Amount
44
100
44
100
1.
2.
Availability of Clean Water
Facilities
Not eligible
Qualify
30
14
68.2
31.8
8
36
8
.2
81.8
Amount
44
100
44
100
1.
2.
Family latrine facilities
Not eligible
Qualify
11
33
25
75
0
44
0
100
Amount
44
100
44
100
1.
2.
Availability of Garbage
Disposal
Not eligible
Qualify
42
2
95.5
4.5
44
0
100
0
0
Amount
44
100
44
100
1.
2.
Sewerage Ownership
Not eligible
Qualify
30
14
68.2
31.8
44
0
1
00
0
Amount
44
100
44
100
Based on the results of research on the sex of the respondents that the case and
control groups were each as many as 22 people (50%), while in the control group most of
the sexes were male, namely as many as 24 people (54.5%).
Birth weight in the case group was mostly not at risk as many as 32 people
(72.7%), while in the control group all were not at risk, namely 2.5-4 kg as many as 44
people (100%).
The age of the mother during pregnancy in the case group was mostly between
the ages of 20-35 years, as many as 42 people (95.5%), while in the control group most
were also aged 20-35 years, as many as 40 people (90.9%).
Eduvest – Journal of Universal Studies
Volume , Number , Month, Year
The Effect of Risk Factors on Stunting Events the Titi Papan Puskesmas, Mabar
Hilir Kelurahan, Medan Deli District Medan City, 2021
1719
The nutritional status of children under five in the case group was mostly normal,
as many as 27 people (91.7%), while in the control group, most of them were normal, as
many as 52 people (86.7%).
Mother's education in the case group was mostly highly educated , namely > high
school and above as many as 26 people (59.1%), while in the control group most of them
were also highly educated, namely 40 people (90.9%).
Most of the mothers under five in the case group did not work as many as 36
people (81.8%), while in the control group most of them also did not work, as many as 31
people (70.5%).
Family income in the case group was mostly below the minimum wage for North
Sumatra, namely < Rp.3.222,556, namely 37 people (84.1%), while in the control group
mostly Rp.3.222,556, namely 33 people (75%) .
mother's height in the case group was mostly > 150 cm as many as 37 people
(84.1%), while in the control group most were also > 150 cm as many as 43 people
(97.7%).
clean water sources in the case group mostly did not meet the requirements,
namely 30 people (68.2%), while in the control group most of them met the requirements,
namely 50 people (56.8%).
Family latrine facilities in the case group mostly met the requirements, namely 33
people (75%), while in the control group, most of them also met the requirements, namely
44 people (100%).
The availability of waste disposal sites in the case group mostly did not meet the
requirements, namely 42 people (95.5%), while in the control group, most of them also
did not meet the requirements, namely 44 people (100%).
Availability of Wastewater Sewerage in the case group mostly did not meet the
requirements, namely 30 people (68.2%), while in the control group most of them also
did not meet the requirements, namely 44 people (100%).
C. Univariate Analysis
Table 4.2 Cross-tabulation of the Influence of Gender, Birth Weight, Maternal
Age During Pregnancy, Education, Occupation, Family Income, Mother's Height,
Availability of Clean Water Facilities, Family Toilet Facilities, Availability of Garbage
Disposal Sites and Ownership of Sewerage Channels in Stunting Incidents at Titi Papan
Health Center, Medan Deli District, Medan Municipality in 2021
Risk Factor
Stunting Incident
p.value
_
1.1 OR
(95% CI)
k case
C control
f
%
f
%
Gender
Woman
Man
22
22
50
50
20
24
45.5
54.5
0.831
1,200
(0.519-
2.773)
Amount
44
100
44
100
Birth Weight
at risk
No Risk
12
32
27.3
72.7
0
44
0
100
0.001
2,375
(1.825-
3.091)
Amount
44
100
60
100
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Mother's Age
When Pregnant
at risk
No Risk
2
42
4,595.5
4
40
9.1
0.9
0
.672
0.476
(0.083-
2.745)
Amount
44
100
44
100
Education
Low
Tall
18
26
40.9
59.1
4
40
9.1
0.9
0.001
6,923
(2.105-
22.771)
Amount
44
100
60
100
Work
Doesn't work
B work
36
8
81.8
18.2
31
13
70.5
29.5
0.317
1,887
(0.692-
5,146)
Amount
44
100
44
100
Family Income
< UMR
UMR
37
7
84.1
15.9
11
33
25
75
0.000
15,857
(5,508-
45,654)
Amount
44
100
44
100
Mother's Height
at risk
No Risk
7
37
15.9
84.1
1
43
9.1
0.9
0.064
8.135
(0.956-
69.205)
Amount
44
100
44
00
The Presence of
Clean Water
Sources
Not eligible
Qualify
30
14
68.2
31.8
8
36
1
8.2
81.8
0.000
9,643
(3,566-
26,072)
Amount
44
100
44
100
Family latrine
facilities
Not eligible
Qualify
11
33
25
75
0
44
0
100
0.001
2,333
(1,803-
3,020)
Amount
44
100
44
1
00
Availability of
Garbage Disposal
Not eligible
Qualify
42
2
95.5
4.5
44
0
1
00 0
0.474
0.488
(0.393-
0.606)
Amount
44
100
44
00
Eduvest – Journal of Universal Studies
Volume , Number , Month, Year
The Effect of Risk Factors on Stunting Events the Titi Papan Puskesmas, Mabar
Hilir Kelurahan, Medan Deli District Medan City, 2021
1721
Sewerage
Ownership
Not eligible
Qualify
30
14
68.2
31.8
44
0
1
00
0
,000
0.405
(0.308-
0.534)
Amount
44
100
44
00
D. Table 4.3 Results of the First Stage of Double Logistics Regression Test that will
enter In Model
No
Variable
pValue
Description
1
Gender
0.670
Not Candidate
2
Birth Weight
0.999
Not Candidate
3
Mother's Age When Pregnant
0.406
Not Candidate
4
Education
0.001
Candidate
5
Work
0.215
Candidate
6
Family Income
0.000
Candidate
7
Mother's Height
0.055
Not Candidate
8
Availability of clean water
facilities
0.000
Candidate
9
Family latrine facilities
0.999
Not Candidate
10
Availability of Garbage
Disposal
0.999
Not Candidate
11
Ownership of Sewerage
0.998
Not Candidate
Based on the final stage modeling, to see the most dominant variable on the
incidence of stunting with the largest OR is the family income variable where the OR is
9.208 and the confounding variable is Education and Work because p value > 0.05
DISCUSSION
Gender has no effect on the incidence of stunting with a probability value ( p) =
0.831. The Odds Ratio (OR) value is 1,200 (95% CI; 0,519-2,773) meaning that toddlers
suffer from stunting 1,200 times greater for female than male.
Boys get sick more often than girls but it's not clear why this is. In traditional
societies, girls clearly have a lower status than boys so that infant mortality and
malnutrition are still high in women (Soetjiningsih in Fitri, 2012). According to the
Cohort Study in Ethiopia, male infants have a double risk of becoming stunted compared
to female infants at the age of 6-12 months (Medhin in Anisa 2012). The results of
research from Bosvh, Baqui & Ginneken, (2008) are that the probability of stunting in
adolescence for girls is about 0.4 times the probability for boys, which means that girls in
adolescence are slightly more stunted than boys. man. Girls enter puberty two years
earlier than boys, their growth stops at least two years earlier than boys, and two years is
also the difference in peak speed between the two sexes (Fitri, 2012) . Based on the
results of Nadiyah's research (2014) Gender, boys are more likely to experience stunting
(35.7%) than girls (31.6%). According to Adriana (2012) in general, men need more
energy than women.
The prevalence of LBW at the population level is an indicator of public health
problems which include long-term maternal nutrition problems, illness, heavy workload
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and inadequate prenatal care. Although until now there is no limit for the prevalence of
LBW at the population level, LBW is still a public health problem in many countries,
because it is considered to be one of the factors causing infant mortality. Populations with
a high percentage of LBW often have a high IMR (Wilcox , 2001).
Birth weight in the case group was mostly not at risk as many as 32 people
(72.7%), while in the control group all were not at risk, namely 2.5-4 kg as many as 44
people (100%).
Toddler birth weight has an effect on the incidence of stunting with a probability
value ( p) = 0.001. The Odds Ratio (OR) value is 2.375 (95% CI; 1.825-3.091), meaning
that toddlers suffer from stunting 2.375 times greater with body weight < 2.5 kg years
compared to body weight 2.5-4 kg.
Maternal age has no effect on the incidence of stunting with a probability value (
p) = 0.672. The Odds Ratio (OR) value is 0.476 (95% CI; 0.083-2.745) meaning that
toddlers suffer from stunting 0.476 times greater with maternal age <20 and > 35 years
compared to maternal age 20-35 years.
Age is one of the factors used to predict differences in terms of diseases,
conditions and health events (Widyastuti , 2005 ).
This study is in line with the findings of Astuti (2016) that there is no relationship
between maternal age and the incidence of stunting , this is because maternal age is
considered more of a role as a psychological factor for mothers such as acceptance of
child pregnancy so that it affects child care patterns, in this case feeding parenting. . This
is in line with Candra in Astuti (2016) which states that the physiological factors of
maternal age affect fetal growth but the intake of balanced food that is digested by the
mother can have a positive impact.
Mother's education has an effect on the incidence of stunting with a probability
value ( p) = 0.001. The value of the Odds Ratio (OR) is 6.923 (95% CI; 2.105-22.771),
meaning that toddlers suffer from stunting 6.923 times greater with low maternal
education compared to high maternal education.
Mother's education is a very important factor. Mother's level of education is
closely related to the level of knowledge of health care, pregnancy and postpartum, as
well as awareness of the health and nutrition of children and their families. And can
determine whether or not someone easily absorbs and understands the nutritional
knowledge that has been obtained (Daming et al., 2019)
Respondents with the characteristics of low income, low education and low level
of knowledge in meeting the nutritional needs of children are the enabling factors
for stunting . Low maternal knowledge coupled with low family income is the dominant
factor in the incidence of stunting . The incidence of stunting by these factors causes the
main family of the mother to pay less attention to the nutritional needs of the child, as a
result the nutritional needs are not met, resulting in growth failure of the toddler and
stunting occurs.
The work of the mother under five has no effect on the incidence of stunting with
a probability value ( p) = 0.317. The value of the Odds Ratio (OR) is 1.887 (95% CI;
0.692-5.146) meaning that toddlers suffer from stunting 1.887 times greater with mothers
who do not work compared to working mothers.
The results of this study are in line with research by Anisa (2012) where it is said
that mother's work is not related to the incidence of stunting in toddlers. This can be
because working mothers can help in terms of the economy so as to increase purchasing
power for children's nutritional intake. Although the time to care for children is less than
mothers who do not work. When researchers went to the field, it was found that working
mothers left their children with their parents and the parents did not provide enough care
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for their grandchildren and added to the very poor sanitation conditions due to the
condition of the house, dirty bathrooms, lots of garbage behind the house and the house
on the road. which is very risky to breathe dirty air because of the many passing vehicles.
Toddler family income has an effect on the incidence of stunting with a
probability value ( p) = 0.000. The Odds Ratio (OR) value is 15,857 (95% CI; 05,508-
45,654), meaning that children under five suffer from stunting 15,875 times greater with
income below the UMK (Rp. < 3,222.556) compared to family income UMK.
The socioeconomic status of the family can be seen from the income of a family.
Respondents who have stunting toddlers mostly earn income in the low category, so some
respondents assume that the income they get is still very less to be able to meet their daily
needs. Mothers prefer cheap food products to give to their toddlers. They also do not care
about the nutritional content contained in every food product they buy so that the food
consumed does not have sufficient nutrition for the growth and development of their
children (Daming et al ., 2019).
In another study, stunting was also found in families with prosperous
socioeconomic status. This is in line with the study by Nurmayasanti (2019); Fikrina
(2017); Ngaisyah (2019) which states that apart from low-income families, stunting is
also found in high-income families, but the proportion is lower than low-income families.
This study said that the socioeconomic status of stunting families was found .
Most of the studies revealed that the economic status of the families of stunting toddlers
was in the low category. The characteristics of parents of toddlers who mostly have low
education (Nurmayasanti, 2019; Fikrina, 2017; Wahyuni & Fitrayuna, 2020; Ngaisyah,
2015 Divine, 2017; Dalimunte, 2015; Winasis, 2018) have an impact on working
conditions, most of whom work in the private sector. as casual daily laborers and mothers
who only work as housewives (Wahyuni & Fitrayuna, 2020; Ngaisyah, 2015) are
enabling factors for the low family income of these stunting toddlers.
Low socioeconomic status is a risk factor for stunting in children under five.
Family income is related to the ability of the household to meet the needs of life, both
primary, secondary, and tertiary. High family income makes it easier to meet the
necessities of life, on the contrary, low family income understands the difficulties in
meeting the necessities of life. Low income will affect the quality and quantity of food
consumed by the family. The food obtained will usually be less varied and in small
quantities, especially in foods that function for the growth of children, sources of protein,
vitamins, and minerals, thereby increasing the risk of malnutrition.
Mother's height has no effect on the incidence of stunting with a probability value
( p) = 0.064. The Odds Ratio (OR) value is 8.135 (95% CI; 0.956-69.205) meaning that
toddlers suffer from stunting 8.135 times greater with a height less than or equal to 150
cm compared to a mother's height of more than 150 cm.
The finding that the child's height has a significant relationship with the mother's
height (Hartati, 2011). The finding that height is closely related to productivity and final
height is determined by nutrition from conception to age two. Lack of height as an adult
is the result of childhood stunting which is associated with a loss of productivity of 1.4%
(Nadiyah, 2014). About the 2013 Nutrition Adequacy Rate (RDA) Stunting children from
mothers whose height is <155 cm are more than stunting children from mothers whose
height is 155 cm (Hafid, 2016). Research from Hanum (2014) which says that stunting
children (74.5 % ) have more short mothers than normal children (60.5%). The findings
from Lestari (2014) state that children born to short mothers have an 11.13 times risk of
becoming stunted compared to children born to parents of normal height. This study is
not in line with the results stated by other researchers that having a short mother is a risk
factor for stunting. Stunting tends to be inherited, so it is thought to have a genetic cause.
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Family members not only share genes, but also lack of food intake that can encourage
stunting. (Adriani, 2012). Children become short mostly because children get a lack of
parenting in terms of feeding practices (Lestari, 2014)
The existence of good and proper drinking water sources is protected drinking
water including tap water (taps), public hydrants, public taps, terminal PAH water, or
protected springs and wells, drilled wells or pumps, with a minimum distance of 10
meters from sewage disposal, waste collection and waste disposal. This does not include
bottled water, water sold through tanks, water from mobile vendors, well water and
unprotected springs (Kemenkes RI, 2018b).
The existence of clean water sources affects the incidence of stunting with a
probability value ( p) = 0.000. The Odds Ratio (OR) value is 9.643 (95% CI; 3.566-
26.072), meaning that toddlers suffer from stunting 9.643 times greater with the presence
of clean water sources that do not meet the requirements compared to the presence of
clean water sources that meet the requirements.
This is in line with research which states that there is a significant relationship
between the availability of clean water sources and the incidence of stunting . Families
that do not have access to clean water are at a significantly higher risk of 3 times
suffering from stunting when compared to families who have access to clean water
(Ahmad & Indah, 2019).
Research conducted by several studies, namely the evidence found in Indonesia,
has similarities with findings from abroad which reveal that unimproved water increases
the incidence of stunting in children under five. One of the Ethiopian findings revealed
that drinking water sources are associated with stunting in children under five ( Kwami.,
et al, 2019).
We know that latrines that do not meet standards will trigger infectious diseases
due to poor hygiene and sanitation so that they can inhibit the absorption of nutrients in
the digestive tract (Kemenkes RI, 2018b)
Family latrine facilities affect the incidence of stunting with a probability value (
p) = 0.001. The value of the Odds Ratio (OR) is 2,333 (95% CI; 1,803-3,020) meaning
that toddlers suffer from stunting 2,333 times greater with family latrine facilities that do
not meet the requirements compared to family latrine facilities that meet the
requirements.
This result is in line with the results of Nasrul's research (2018) which states that
there is a significant relationship between improper latrine ownership and the incidence
of stunting . Toddlers with inadequate latrine ownership are at risk of stunting 7,398
times higher than toddlers with proper latrine ownership.
Several studies, namely most of the findings in Rural Indonesia related to
sanitation using latrine facilities ranging from latrine ownership, types of latrines, latrines
not using septic tanks, latrine hygiene, Open defecation behavior and disposal of under-
five feces not in latrines were associated with an increase in stunting in children under
five in Indonesia. Indonesia (Ahmadi et al., 2020; Badriyah & Syafiq, 2017; Choirunnisa
et al., 2020; Dwipayanti et al., 2020; Fikru & Doorslaer, 2019; Hasanah & Susanti., 2018;
; Hafid., et al., 2017 ; Hasan & Kadarusman., 2018; Herawati et al., 2020; Nasrul, 2018;
Otsuka et al., 2019; Rahayu et al., 2017; Rahayu et al., 2018; Lobo et al, 2020; Siswati,
2018; Torlesse et al., 2016; Wiyono et al., 2019; Cahyono et al., 2016; Rahayu and
Darmawan, 2019; Zairinayati & Purnama, 2019).
The results of this study are in line with the research of Fregonese et al., (2016),
which states that children living in an environment contaminated with inadequate
sanitation have a 40% risk of stunting and are significantly higher in rural and suburban
areas (43% vs 27%). compared to those living in urban areas (5%). An analysis in India
Eduvest – Journal of Universal Studies
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Hilir Kelurahan, Medan Deli District Medan City, 2021
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proves that the incidence of stunting is highest in children living in rural areas because
most people still practice open defecation (Chakravarty et al, 2017).
availability of waste disposal sites has no effect on the incidence of stunting with
a probability value ( p) = 0.474. The Odds Ratio (OR) value is 0.488 (95% CI; 0.393-
0.606) meaning that toddlers suffer from stunting 0.488 times greater with the availability
of waste disposal sites that do not meet the requirements compared to the availability of
eligible waste disposal.
Garbage is a source of disease and a breeding ground for disease vectors such as
flies, mosquitoes, rats, cockroaches etc. In addition, garbage can pollute the soil and
cause comfort and aesthetic disturbances such as unpleasant odors and unsightly views.
The existence of sources of infection that can cause waste disposal facilities,
namely through insects or flies that land on open food can be prevented because most of
the people in the Titi Papan Health Center, Mabar Hilir Subdistrict, Medan Deli District
cover their food with a serving hood, so in this study it is said not to be there is a
significant relationship between waste disposal facilities and the incidence of stunting in
children under two.
Based on the observations of researchers that the average community does not
have a garbage collection place at home that meets the requirements where the waste is
first stockpiled and then disposed of in a temporary waste disposal site and transported
regularly by janitors and some are dumped in a garbage pit, and some burn garbage and
there are also those who throw garbage into the ditch so that in the ditch there are flies
and other vectors of disease in the form of mosquitoes.
The availability of sewerage affects the incidence of stunting with a probability
value ( p) = 0.000. The Odds Ratio (OR) value is 0.405 (95% CI; 0.308-0.534 ) meaning
that toddlers suffer from stunting 0.405 times greater with Availability of sewers that do
not meet the requirements compared to Availability of sewers that meet the requirements.
finding is in line with research conducted in the work area of the Cibeureum
Health Center, Tasikmalaya City which showed that there was a significant relationship
between the availability of household wastewater disposal sanitation facilities and the
incidence of stunting in children under five, households that had household wastewater
disposal sanitation facilities that did not meet the requirements. 3,124 times more risky
than household sanitation facilities that meet the requirements
.
(Ramadan, 2019 ). Bad
sewerage can be a breeding ground for disease because animals such as insects can live in
dirty places where there is standing water, so that they can pollute the environment and
trigger various environmental-based diseases, one of which is stunting.
Disposal Facilities have an effect on the incidence of stunting with a probability
value ( p) = 0.027. The value of the Odds Ratio (OR) is 2.286 (95% CI; 1.092-4.783),
meaning that toddlers suffer from diarrhea 2.286 times greater than those with waste
water disposal facilities that do not meet the requirements.
Based on the observations of researchers that the waste water disposal facilities
are still very lacking, there are still many residents who do not have waste disposal
facilities and if there is a waste water disposal channel, the average wastewater disposal
channel is open and the water is stagnant and in the ditch there is a lot of garbage so that
if it rains it often results in as a result of flooding but some also have a closed sewer t.
CONCLUSION
The factors that significantly influence _ Significantly the incidence of
stunting was birth weight ( p = 0.001, OR = 2.375), education ( p = 0.001, OR =
6.923), family income ( p = 0.000, OR = 15.857), availability of clean water
facilities ( p = 0.000, OR = 9.643), family latrine facilities ( p = 0.001, OR =
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2.333), ownership of sewerage ( p = 0.000, OR = 0.405) AND the results of the
Multivariate Test found that one variable that had the most influence on the
incidence of stunting was family income ( p = 0,000, Exp (B) = 9,208. where low
income or low family income will affect the quality and quantity of food
consumed by the family. The food obtained will usually be less varied and in
small quantity, especially in foodstuffs that function for the growth of children.
protein, vitamins, and minerals, thereby increasing the risk of malnutrition.
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