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      A review of child stunting determinants in Indonesia

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          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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          Most cited references33

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          Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development.

          The low micronutrient content of complementary foods is associated with growth faltering in many populations. A potential low-cost solution is the home fortification of complementary foods with Sprinkles (SP) powder, crushable Nutritabs (NT) tablets, or energy-dense (108 kcal/d), fat-based Nutributter (NB). The objective was to test the hypothesis that multiple micronutrients added to home-prepared complementary foods would increase growth and that the effect would be greatest in the presence of added energy from fat. We randomly assigned 313 Ghanaian infants to receive SP, NT, or NB containing 6, 16, and 19 vitamins and minerals, respectively, daily from 6 to 12 mo of age. We assessed anthropometric status at 6, 9, and 12 mo; micronutrient status at 6 and 12 mo; motor development at 12 mo; and morbidity weekly. Infants (n = 96) not randomly selected for the intervention (nonintervention; NI) were assessed at 12 mo. The groups did not differ significantly at baseline, except that the NB group had a higher proportion of boys and weighed slightly more. The dropout rate (15/313) was low. At 12 mo, after control for initial size, the NB group had a significantly greater weight-for-age z score (WAZ) (-0.49 +/- 0.54) and length-for-age z score (LAZ) (-0.20 +/- 0.54) than did the NT group (WAZ: -0.67 +/- 0.54; LAZ: -0.39 +/- 0.54) and the NT and SP groups combined (WAZ: -0.65 +/- 0.54; LAZ: -0.38 +/- 0.54); the difference with the NI group (WAZ: -0.74 +/- 1.1; LAZ: -0.40 +/- 1.0) was not significant. A lower percentage of the NI infants (25%) than of the intervention groups (SP: 39%; NT: 36%; NB: 49%) could walk independently by 12 mo. All 3 supplements had positive effects on motor milestone acquisition by 12 mo compared with no intervention, but only NB affected growth.
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            Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study.

            Child stunting is associated with poor child development and increased mortality. Our aim was to determine the effect of length of maternal and paternal education on stunting in children under the age of 5 years. Data for indicators of child growth and of parental education and socioeconomic status were gathered from 590,570 families in Indonesia and 395,122 families in Bangladesh as part of major nutritional surveillance programmes. The prevalence of stunting in families in Indonesia was 33.2%, while that in Bangladesh was 50.7%. In Indonesia, greater maternal formal education led to a decrease of between 4.4% and 5% in the odds of child stunting (odds ratio per year 0.950, 95% CI 0.946-0.954 in rural settings; 0.956, 0.950-0.961 in urban settings); greater paternal formal education led to a decrease of 3% in the odds of child stunting (0.970, 0.967-0.974). In Bangladesh, greater maternal formal education led to a 4.6% decrease in the odds of child stunting (0.954, 0.951-0.957), while greater paternal formal education led to a decrease of between 2.9% and 5.4% in the odds of child stunting (0.971, 0.969-0.974 in rural settings; 0.946, 0.941-0.951 in urban settings). In Indonesia, high levels of maternal and paternal education were both associated with protective caregiving behaviours, including vitamin A capsule receipt, complete childhood immunisations, better sanitation, and use of iodised salt (all p<0.0001). Both maternal and paternal education are strong determinants of child stunting in families in Indonesia and Bangladesh.
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              Socioeconomic gradients in child development in very young children: evidence from India, Indonesia, Peru, and Senegal.

              Gradients across socio-economic position exist for many measures of children's health and development in higher-income countries. These associations may not be consistent, however, among the millions of children living in lower- and middle-income countries. Our objective was to examine child development and growth in young children across socio-economic position in four developing countries. We used cross-sectional surveys, child development assessments, measures of length (LAZ), and home stimulation (Family Care Index) of children in India, Indonesia, Peru, and Senegal. The Extended Ages and Stages Questionnaire (EASQ) was administered to parents of all children ages 3-23 mo in the household (n =8,727), and length measurements were taken for all children 0-23 mo (n = 11,102). Household wealth and maternal education contributed significantly and independently to the variance in EASQ and LAZ scores in all countries, while controlling for child's age and sex, mother's age and marital status, and household size. Being in the fifth wealth quintile in comparison with the first quintile was associated with significantly higher EASQ scores (0.27 to 0.48 of a standardized score) and higher LAZ scores (0.37 to 0.65 of a standardized score) in each country, while controlling for maternal education and covariates. Wealth and education gradients increased over the first two years in most countries for both EASQ and LAZ scores, with larger gradients seen in 16-23-mo-olds than in 0-7 mo-olds. Mediation analyses revealed that parental home stimulation activities and LAZ were significant mediating variables and explained up to 50% of the wealth effects on the EASQ.
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                Author and article information

                Contributors
                atumilowicz@gainhealth.org
                Journal
                Matern Child Nutr
                Matern Child Nutr
                10.1111/(ISSN)1740-8709
                MCN
                Maternal & Child Nutrition
                John Wiley and Sons Inc. (Hoboken )
                1740-8695
                1740-8709
                17 May 2018
                October 2018
                : 14
                : 4 ( doiID: 10.1111/mcn.2018.14.issue-4 )
                : e12617
                Affiliations
                [ 1 ] Department of Environmental Science and Policy, Program in International and Community Nutrition University of California, Davis Davis California USA
                [ 2 ] Global Alliance for Improved Nutrition (GAIN) Geneva Switzerland
                [ 3 ] Consultant for Global Alliance for Improved Nutrition (GAIN) Jakarta Indonesia
                [ 4 ] Direktorat Gizi Masyarakat‐Kementerian Kesehatan RI Jakarta Indonesia
                Author notes
                [*] [* ] Correspondence

                Alison Tumilowicz, Global Alliance for Improved Nutrition (GAIN), 7 Rue de Varembé 7, 1202 Geneva, Switzerland.

                Email: atumilowicz@ 123456gainhealth.org

                Author information
                http://orcid.org/0000-0002-0398-9825
                http://orcid.org/0000-0002-8955-1479
                http://orcid.org/0000-0003-0506-556X
                http://orcid.org/0000-0003-2652-9108
                Article
                MCN12617 MCN-10-17-RA-2847.R2
                10.1111/mcn.12617
                6175423
                29770565
                70d14fe7-9fc3-43ec-af68-2acae6a996cb
                © 2018 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 October 2017
                : 03 March 2018
                : 15 March 2018
                Page count
                Figures: 3, Tables: 0, Pages: 10, Words: 6827
                Funding
                Funded by: National Science Foundation Graduate Research Fellowship Program
                Award ID: 1650042
                Funded by: The Ministry of Foreign Affairs of the Netherlands
                Award ID: 24530
                Categories
                Review Article
                Review Articles
                Custom metadata
                2.0
                mcn12617
                October 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.0 mode:remove_FC converted:08.10.2018

                child stunting,conceptual framework,determinants,height for age,indonesia,linear growth

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