Early introduction of complementary food and childhood stunting were linked among children aged 6-23 months


Bunga Astria Paramashanti(1*), Stella Benita(2)

(1) Department of Nutrition, Faculty of Health Sciences, Universitas Alma Ata, Yogyakarta
(2) Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
(*) Corresponding Author


Background: Indonesia’s national stunting prevalence remains high. The transition from exclusive breastfeeding to poor complementary feeding practices may put infants at higher risk of becoming stunting.

Objective: This study aimed to analyze the relationship between the early introduction of complementary food and stunting among young children aged 6-23 months in Kebumen Regency.

Methods: A cross-sectional study design was conducted among 307 young children in Kebumen Regency, Central Java Province, Indonesia, by using multistage cluster sampling. Our primary outcome was stunting or height-for-age z-score <-2, whereas independent variables were child, maternal, and household factors. Univariate and multivariate logistic regression were performed to assess significant determinants at the level of significance 0.05.

Results: Timely introduction of complementary food was a protective factor against stunting (AOR= 0.54; 95%CI: 0.31-0.94). Female children were less likely to be associated with stunting (AOR= 0.54; 95%CI: 0.32-0.93). Conversely, variables which significantly increased the risk of becoming stunting included older children aged 12-17 months (AOR= 2.01; 95%CI: 1.05-3.84) and 18-23 months (AOR= 4.17; 95%CI: 2.15-8.08) and maternal occupation in agricultural sectors (AOR= 3.77; 95%CI: 1.17-12.1).

Conclusions: Child factors associated with stunting was the first timing of complementary feeding, child sex, and child age. The maternal factor linked to stunting was the mother's occupation in the agricultural sector. This study indicated that child and maternal factors play essential roles in childhood stunting.


factors associated; infants and young children; stunting; timing of complementary food introduction

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  1. World Bank Group. Aiming high: Indonesia's ambition to reduce stunting. Washington: World Bank; 2018.
  2. Laporan Nasional Riskesdas 2018. National Institute of Health and Research Development (Balitbangkes). [series online] 2019 [cited September 27 2019]. Available from: URL: http://labdata.litbang.kemkes.go.id/images/download/laporan/RKD/2018/Laporan_Nasional_RKD2018_FINAL.pdf
  3. Victora CG, De Onis M, Hallal PC, Blössner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics. 2010;125(3):e473-80. doi: 10.1542/peds.2009-1519
  4. Stewart CP, Iannotti L, Dewey KG, Michaelsen KF, Onyango AW. Contextualising complementary feeding in a broader framework for stunting prevention. Matern Child Nutr. 2013;9(S2):27-45. doi: 10.1111/mcn.12088
  5. Prendergast AJ, Humphrey JH. The stunting syndrome in developing countries. Paediatr Int Child Health. 2014;34(4):250-65. doi: 10.1179/2046905514Y.0000000158
  6. Titaley CR, Ariawan I, Hapsari D, Muasyaroh A, Dibley MJ. Determinants of the stunting of children under two years old in Indonesia: a multilevel analysis of the 2013 Indonesia Basic Health Survey. Nutrients. 2019;11(5):1106. doi: 10.3390/nu11051106
  7. Paramashanti BA, Hadi H, Gunawan IMA. Pemberian ASI eksklusif tidak berhubungan dengan stunting pada anak usia 6–23 bulan di Indonesia. Jurnal Gizi dan Dietetik Indonesia. 2015;3(3):162-74. doi: 10.21927/ijnd.2015.3(3).162-174
  8. Lestari EF, Dwihestie LK. ASI eksklusif berhubungan dengan kejadian stunting pada balita. Jurnal Ilmiah Permas. 2020;10(2):129-36.
  9. Handayani S, Kapota WN, Oktavianto E. Hubungan status ASI eksklusif dengan kejadian stunting pada batita usia 24-36 bulan di Desa Watugajah, Kabupaten Gunungkidul. Jurnal Medika Respati. 2019;14(4):287-300. doi: 10.35842/mr.v14i4.226
  10. Dewi S, Mu'minah I. Pemberian MP-ASI tidak berhubungan dengan kejadian stunting pada anak usia 1-3 tahun di wilayah kerja Puskesmas Sumbang I Kabupaten Banyumas. Jurnal INFOKES. 2020;10(1):5-10.
  11. Najamuddin N, Rahmadani R, Suriany. Faktor yang mempengaruhi kejadian stunting pada balita usia 12-59 bulan di wilayah kerja Puskesmas Campalagian. Bina Generasi: Jurnal Kesehatan. 2020;11(2):75-83. doi: 10.35907/bgjk.v11i2.152
  12. Khasanah DP, Hadi H, Paramashanti BA. Waktu pemberian makanan pendamping ASI (MP-ASI) berhubungan dengan kejadian stunting anak usia 6-23 bulan di Kecamatan Sedayu. Jurnal Gizi dan Dietetik Indonesia. 2016;4(2):105-11. doi: 10.21927/ijnd.2016.4(2).105-111
  13. Prihutama NY, Rahmadi FA, Hardaningsih G. Pemberian makanan pendamping ASI dini sebagai faktor risiko stunting pada anak usia 2-3 tahun. Jurnal Kedokteran Diponegoro. 2018;7(2):1419-30.
  14. Tessema M, Belachew T, Ersino G. Feeding patterns and stunting during early childhood in rural communities of Sidama, South Ethiopia. Pan Afr Med J. 2013;14:75. doi: 10.11604/pamj.2013.14.75.1630
  15. WHO. Resolution WHA65.6. Maternal, infant and young child nutrition. Geneva: World Health Organization; 2012.
  16. National Team for the Acceleration of Poverty Reduction (TNP2K). 100 priority districts/cities for child stunting intervention. Jakarta: National Team for the Acceleration of Poverty Reduction (TNP2K); 2017.
  17. Health Promotion Center. Ayo ke posyandu. Jakarta: Ministry of Health of Indonesia; 2012.
  18. World Health Organization. WHO Child Growth Standards: length/heightfor-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. [series online] 2006 [cited September 3 2019]. Available from: URL: https://apps.who.int/iris/handle/10665/43413.
  19. WHO/UNICEF. Global strategy for infant and young child feeding. Geneva, Switzerland: World Health Organization; 2003.
  20. Kementrian Kesehatan RI. Angka kecukupan gizi yang dianjurkan bagi bangsa Indonesia. Jakarta: Kementrian Kesehatan RI; 2013.
  21. FAO. Transforming food and agriculture to achieve the SDGs: 20 interconnected actions to guide decision-makers. Rome: Food and Agriculture Organization (FAO) of the United Nations; 2018.
  22. de Onis M, Borghi E, Arimond M, Webb P, Croft T, Saha K, et al. Prevalence thresholds for wasting, overweight and stunting in children under 5 years. Public Health Nutr. 2019;22(1):175-9. doi: 10.1017/S1368980018002434
  23. Pelletier DL, Frongillo EA, Gervais S, Hoey L, Menon P, Ngo T, et al. Nutrition agenda setting, policy formulation and implementation: lessons from the Mainstreaming Nutrition Initiative. Health Policy Plan. 2012;27(1):19-31. doi: 10.1093/heapol/czr011
  24. Paramashanti BA, Paratmanitya Y, Marsiswati. Individual dietary diversity is strongly associated with stunting in infants and young children. Jurnal Gizi Klinik Indonesia. 2017;14(1):19-26. doi: 10.22146/ijcn.15989
  25. Jackson KM, Nazar AM. Breastfeeding, the immune response, and long-term health. J Am Osteopath Assoc. 2006;106(4):203-7.
  26. Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-90. doi: 10.1016/S0140-6736(15)01024-7
  27. Nigatu D, Azage M, Motbainor A. Effect of exclusive breastfeeding cessation time on childhood morbidity and adverse nutritional outcomes in Ethiopia: analysis of the demographic and health surveys. PLoS One. 2019;14(10):e0223379. doi: 10.1371/journal.pone.0223379
  28. Dewey KG, Mayers DR. Early child growth: how do nutrition and infection interact?. Matern Child Nutr. 2011;7(Supp 3):129-42. doi: 10.1111/j.1740-8709.2011.00357.x
  29. Roche ML, Gyorkos TW, Blouin B, Marquis GS, Sarsoza J, Kuhnlein HV. Infant and young child feeding practices and stunting in two highland provinces in Ecuador. Matern Child Nutr. 2017;13(2):e12324. doi: 10.1111/mcn.12324
  30. Nkurunziza S, Meessen B, Van geertruyden JP, Korachais C. Determinants of stunting and severe stunting among Burundian children aged 6-23 months: evidence from a national cross-sectional household survey, 2014. BMC Pediatrics. 2017;17:176. doi: 10.1186/s12887-017-0929-2
  31. de Onis M, Branca F. Childhood stunting: a global perspective. Matern Child Nutr. 2016;12(Suppl 1):12-26. doi: 10.1111 / mcn.12231
  32. Przyrembel H. Timing of introduction of complementary food: short- and long-term health consequences. Ann Nutr Metab. 2012;60 Suppl 2:8-20. doi: 10.1159/000336287
  33. Mallard SR, Houghton LA, Filteau S, Chisenga M, Siame J, Kasonka L, et al. Micronutrient adequacy and dietary diversity exert positive and distinct effects on linear growth in urban Zambian infants. J Nutr. 2016;146(10):2093-101. doi: 10.3945/jn.116.233890
  34. Slemming W, Kagura J, Saloojee H, Richter LM. Early life risk exposure and stunting in urban South African 2-year old children. J Dev Orig Health Dis. 2017;8(3):301-10. doi: 10.1017/S2040174417000034
  35. Bork KA, Diallo A. Boys are more stunted than girls from early infancy to 3 years of age in rural Senegal. J Nutr. 2017;147(5):940-7. doi: 10.3945/jn.116.243246
  36. Komatsu H, Malapit HJL, Theis S. Does women's time in domestic work and agriculture affect women's and children's dietary diversity? evidence from Bangladesh, Nepal, Cambodia, Ghana, and Mozambique. Food Policy. 2018;79:256-70. doi: 10.1016/j.foodpol.2018.07.002
  37. Jones AD, Shrinivas A, Bezner-Kerr R. Farm production diversity is associated with greater household dietary diversity in Malawi: findings from nationally representative data. Food Policy. 2014;46:1-12. doi: 10.1016/j.foodpol.2014.02.001
  38. Rehman AM, Gladstone BP, Verghese VP, Muliyil J, Jaffar S, Kang G. Chronic growth faltering amongst a birth cohort of Indian children begins prior to weaning and is highly prevalent at three years of age. Nutr J. 2009;8:44. doi: 10.1186/1475-2891-8-44
  39. Rutstein SO, Johnson K. The DHS wealth index. Calverton, Maryland: ORC Macro; 2004.

DOI: https://doi.org/10.22146/ijcn.53788

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