Stunted children will have normal cognitive ability if nutrition is improved. The rapid brain growth in the first 1,000 days of life means that children should not be malnourished. Stunting is generally caused by a lack of macronutrients (carbohydrates, protein, and fat) and micronutrients (calcium and zinc). The mobile application called stunting child nutrition (GiAS) has features that can detect stunting, monitor toddler growth, recommend daily menus for toddlers, nutritional adequacy rate (RDA) in 2019, and others. The purpose of this study was to make it easier to distinguish macronutrients, zinc, and calcium from stunting and non-stunting children aged 12–24 months using the GiAS android application. It is conducted at the Citeureup Community Health Center, Cimahi city, for June–July 2020. The sampling technique was a simple random sampling of 88 respondents. This type of research is an observational analytic with a statistical test is a cross-sectional design. The results of the study using the Mann-Whitney test showed differences in carbohydrates (84.99±26.31 vs 151.16±68.43, p=0.001), protein (30.81±11.03 vs 60.55±38.43, p=0.001), fat (32.80±15.39 vs 64.84±47.81, p=0.001), and calcium (0.55±0.40 vs 1.43±1.16, p=0.001) and there is similarity of zinc (0.005±0.004 vs 0.010±0.016, p=0.084) after 7 days of using the GiAS application between stunting and non-stunting children. The probability value <0.05 means that the application can compare macronutrients, zinc, and calcium between stunted and non-stunted children on the 7th day. Chi-square analysis showed an increase in children's weight and height under five at two weeks and one month (p=0.001). In conclusion, the comparison of macronutrients, zinc, calcium in stunting and non-stunting children aged 12–24 months can be differentiated using the GiAS application. APLIKASI GIZI ANAK STUNTING (GIAS) BERBASIS ANDROID UNTUK MENILAI ZAT GIZI MAKRO, ZINC, DAN KALSIUM PADA ANAK STUNTING DAN NON-STUNTINGAnak stunting akan memiliki kognitif yang normal jika dilakukan perbaikan gizi yang optimal. Pertumbuhan otak yang pesat di 1.000 hari pertama kehidupan menjadikan anak tidak boleh kekurangan nutrisi. Stunting umumnya kekurangan zat gizi makro (karbohidrat, protein, dan lemak) serta zat gizi mikro (kalsium dan zinc). Aplikasi mobile bernama gizi anak stunting (GiAS) memiliki fitur yang dapat mendeteksi stunting, memantau pertumbuhan balita, merekomendasikan menu harian untuk balita, angka kecukupan gizi (AKG) tahun 2019, dan lainnya. Tujuan penelitian ini adalah kemudahan membedakan zat gizi makro, zinc, dan kalsium anak stunting dengan non-stunting usia 12–24 bulan menggunakan aplikasi android GiAS di Puskesmas Citeureup Kota Cimahi periode Juni–Juli 2020. Teknik pengambilan sampel adalah simpel random sampling sebanyak 88 responden. Jenis penelitian ini adalah analitik observasional dengan uji statistik adalah desain cross-sectional (α=0,05). Hasil penelitian menggunakan Uji Mann-Whitney terdapat perbedaan karbohidrat (84,99±26,31 vs 151,16±68,43; p=0,001), protein (30,81±11,03 vs 60,55±38,43; p=0,001), lemak (32,80±15,39 vs 64,84±47,81; p=0,001), dan kalsium (0,55±0,40 vs 1,43±1,16; p=0,001) serta ada persamaan zinc (0,005±0,004 vs 0,010±0,016; p=0,084) sesudah 7 hari penggunaan aplikasi GiAS antara anak stunting dan non-stunting. Nilai probabilitas <0,05 berarti aplikasi dapat membandingkan zat gizi makro, zinc, dan kalsium antara anak stunting dan non-stunting pada hari ke-7. Analisis chi-square terlihat peningkatan berat badan dan tinggi badan balita pada 2 minggu dan 1 bulan (p=0,001). Simpulan, komparasi zat gizi makro, zinc, kalsium anak stunting dan non-stunting usia 12–24 bulan dapat dibedakan menggunakan aplikasi GiAS.
Fajarini Putri Hidayat, Ma'mun Sutisna, Roni Rowawi et al.
ABSTRACT Despite socio‐economic progress, prevalence of childhood stunting remains high in South Asia—a phenomenon often referred to as the “Asian Enigma.” This paradox stems from suppressed women's empowerment, poor water, sanitation, and hygiene (WaSH) conditions and inadequate child‐feeding. Evidence shows that women's empowerment improves these underlying factors associated with improved stunting. We examined how domains of women's empowerment relate to the risk of childhood stunting in South Asia directly and indirectly in interaction with household improved WaSH facility and age‐appropriate food consumption. Using recent Demographic and Health Survey data from Bangladesh, India, Nepal, and Pakistan, we analyzed a sample of 37,620 married women, aged 15–49 years, currently cohabiting with husbands and having an under‐five child. We constructed three domains of survey‐based women's empowerment index‐global: social independence, intrinsic agency, and instrumental agency, by confirmatory factor analysis, using generalized structural equation modelling. We developed three different models by using generalized linear mixed‐effects models with robust error variance to estimate the relative risk (RR) of stunting with 95% confidence interval (CI). We found social independence [RR: 0.86, 95% CI: 0.83, 0.90], intrinsic agency [0.98 (0.97, 0.99)] and instrumental agency [0.99 (0.98, 0.99)] were associated with reduced risk of stunting in South Asia. Though interaction between social independence and WaSH was associated with reduced risk [0.92 (0.86, 0.99)], interaction between social independence [1.12 (1.07, 1.17)] and instrumental agency [1.03 (1.01, 1.05)] and food consumption increased risk of stunting in South Asia. Interactions between women's empowerment and WaSH and food consumption reveal complex effects including both synergy and trade‐offs, highlighting the need for integrated strategies combining women's empowerment, WaSH improvements, and targeted nutrition specific interventions in South Asia.
Saira Parveen Jolly, Regien Biesma, Robert Lensink et al.
AbstractGrowing evidence suggests that household sanitation is associated with child nutritional status in low‐ and middle‐income countries. This paper examined whether household access to improved sanitation facilities and sources of drinking water was associated with stunting and anaemia amongst children aged 6–35 months of age in Indonesia. The sample for the analysis comprised 1,450 children aged 6–35 months who participated in the end‐line survey of the maternal and young child nutrition security project in Asia, conducted in three selected districts in Indonesia. Logistic regression models were used to determine the association between household sanitation and water source, and stunting and anaemia. Approximately 26% and 56% of children 6–35 months of age were stunted and anaemic, respectively. Children living in a household with improved sanitation facilities had 29% reduced odds of being stunted compared with those in a household with unimproved sanitation facilities, after adjusting for potential confounders including child's age and gender, maternal education, and iron–folic acid supplementation, as well as household wealth status and source of drinking water (OR = 0.68, 95% CI:0.48–0.96). No association between household sanitation and childhood anaemia was observed. Source of drinking water was not associated with stunting or anaemia amongst children. There were no synergistic effects of household sanitation and water supply on stunting and anaemia. This suggests that efforts to improve household sanitation condition may need to be considered an essential, integral part of the programmatic responses by governments and development partners for the prevention of childhood nutritional status. Further randomised research is necessary to determine the causal link.
<em>The purpose of this research is to describe the Regent Regulation No. 77 of 2021 Implementation of the Stunting ReductionProgram Policy in Ayula Tilango Village, Bone Bolango Regency. Based on the following indicators; (a) Policy Standards and Targets, (b) Resources, (c) Inter – Agency Communication, (d) Implementer Characteristics, (e) Economic, Social, and Political Environment, and (f) Implementer Attitudes. This study utilized a qualitative research method with a case study approach. Data was collected through in – depth interviews with various stakeholders, observation, and analysis of policy documents related to stunting program, The research results indicated that the implementation of the stunting program in Ayula Tilango Village faces several challenges, such as budget misalignment and difficulties in creating land for a clean water source. Despite these challenges, the program has achieved some positive impacts, including increased awareness of importance of balanced nutrition, improved acces to healthcare services, and healthier eating habits. However. These impacts still need further enchancement to address stunting issue in Ayula Tilango Village effectively. In conclusion, this research finds that the implementation of the stunting program in Ayula Tilango Village has encountered various obstacles affecting its effectiveness, therefore, greater efforts are needed to improve human resources and allocate budget moe effectively</em>
Mohamad Rifki Dimas, Fenti Prihatini Dance Tui, Sri Yulianti Mozin
AbstractStunting is the core measure of child health inequalities as it reveals multiple dimensions of child health and development status. The main focus of this study is to show the procedure of selecting the most appropriate logistic regression model for stunting by developing and comparing several plausible models, which ultimately helps to identify the predictors of childhood stunting in Bangladesh. This study utilizes child anthropometric data collected in the 2014 Bangladesh Demographic and Health Survey. Valid height‐for‐age anthropometric indices were available for a total of 6,931 children aged 0–59 months, of which about 36% were stunted. Ordinary logistic, survey logistic, marginal logistic, and random intercept logistic regression models were developed assuming independence, sampling design, cluster effect, and hierarchy of the data. Based on a number of model selection criteria, random intercept logistic model is found the most appropriate for the studied children. A number of child, mother, household, regional, and community‐level variables were included in the model specification. The factors that increased the odds of stunting are children older than 11 months, short birth interval, recent morbidity of children, lower maternal education, young maternity, lower maternal body mass index, poor household wealth, urban residential place, and living in Sylhet division. Findings of this study recommend to utilize an appropriate logistic model considering the issues relevant to the data, particularly sampling design and clustering for determining the risk factors of childhood stunting in Bangladesh.
Abstract The study describes the patterns of concurrent wasting and stunting (WaSt) among children age 6–59 months living in the 1980s in Niakhar, a rural area of Senegal under demographic surveillance. Wasting and stunting were defined by z scores lower than −2 in weight for height and height for age. Both conditions were found to be highly prevalent, wasting more so before age 30 months, stunting more so after age 30 months. As a result, concurrent WaSt peaked around age 18 months and its prevalence (6.2%) was primarily the product of the two conditions, with an interaction term of 1.57 ( p < 10 −6 ). The interaction was due to the correlation between both conditions (more stunting if wasted, more wasting if stunted). Before age 30 months, boys were more likely to be concurrently wasted and stunted than girls (RR = 1.61), but the sex difference disappeared after 30 months of age. The excess susceptibility of younger boys could not be explained by muscle mass or fat mass measured by arm or muscle circumference, triceps, or subscapular skinfold. Concurrent WaSt was a strong risk factor for child mortality, and its effect was the product of the independent effect of each component, with no significant interaction.
Abstract Gender disparities in child undernutrition and mortality in India have been a topic of interest for a long time, but little is known on trends or geographic variability in recent periods. We examined the degree to which historic patterns in gender disparities in child undernutrition and mortality in India have persisted given recent progress in health and nutrition. Using two nationally representative datasets from India between 2006 and 2016, we estimated mortality rates and stunting by gender and by birth order among children under 5 years old. We then tested for differences between boys and girls within each survey round for both national and state levels using bootstrapped standard errors, controlling for cluster and sampling weights. We found striking progress in child mortality and stunting in India between 2006 and 2016 for both boys and girls. Boys were more likely to die than girls during the first year of life. Girls had a higher risk of mortality between age 1 and 5 years than boys in 2006, but the improvements in survival eliminated this gender gap in 2016. For stunting, we found no gender difference in 2006, but girls had higher height‐for‐age Z ‐scores (HAZ) and lower stunting than boys in 2016. Trends in gender gaps in mortality and stunting vary substantially by birth order and between states. Our findings indicate that improvements in mortality and nutritional status among girls have started to close gender disparities. Policy efforts to close gaps must stay the course in states that have made progress and be accelerated in states where disparities are still prominent.
Harold Alderman, Phuong Hong Nguyen, Lan Mai Tran et al.
AbstractChild stunting prevalence is primarily used as an indicator of impeded physical growth due to undernutrition and infections, which also increases the risk of mortality, morbidity and cognitive problems, particularly when occurring during the 1000 days from conception to age 2 years. This paper estimated the relationship between stunting prevalence and age for children 0–59 months old in 94 low‐ and middle‐income countries. The overall stunting prevalence was 32%. We found higher stunting prevalence among older children until around 28 months of age—presumably from longer exposure times and accumulation of adverse exposures to undernutrition and infections. In most countries, the stunting prevalence was lower for older children after around 28 months—presumably mostly due to further adverse exposures being less detrimental for older children, and catch‐up growth. The age for which stunting prevalence was the highest was fairly consistent across countries. Stunting prevalence and gradient of the rise in stunting prevalence by age varied across world regions, countries, living standards and sex. Poorer countries and households had a higher prevalence at all ages and a sharper positive age gradient before age 2. Boys had higher stunting prevalence but had peak stunting prevalence at lower ages than girls. Stunting prevalence was similar for boys and girls after around age 45 months. These results suggest that programmes to prevent undernutrition and infections should focus on younger children to optimise impact in reducing stunting prevalence. Importantly, however, since some catch‐up growth may be achieved after age 2, screening around this time can be beneficial.
Omar Karlsson, Rockli Kim, Grainne M. Moloney et al.
AbstractMicronutrient supplementation is widely used to prevent stunting in children under 5 years in low‐ and middle‐income countries (LMIC), but the impact of treatment has been disappointing, possibly due to non‐compliance. Our aim was to deliver long‐term micronutrient supplementation via a novel, culturally acceptable liquid food to improve linear growth in a high stunting prevalence region.In a randomised control trial, 971 children aged 6–72 months received either ‘Chispuditos®’ (n = 681), a hot drink (atole) fortified with micronutrients (atole + MN) (9 mg/zinc, 12.5 mg/iron), or lactose‐free milk (n = 290) for 18 months. Primary outcomes were changes in length/height‐for‐age (HAZ) score and the prevalence of stunting at 18‐month follow‐up. Adherence was monitored monthly, and 73% children in atole + MN group consumed at least half their daily zinc and iron requirement. At 18 months, there was no difference between the treatments in growth [mean change in HAZ −0.02 (95% CI −0.12, 0.08)] or stunting [atole + MN 41%, milk 41%; RR 0.99 (95% CI 0.84, 1.19)]. There were no differences in haemoglobin (HB), ferritin or zinc. No children had iron deficiency anaemia (IDA) at outcome, but zinc deficiency remained equally prevalent in both groups: atole + MN 35%, milk 35% [RR 1.02 (95% CI 0.83, 1.24)]. There was no difference in morbidity between the groups, and micronutrient status was unrelated to HAZ. Long‐term micronutrient supplementation via a culturally acceptable food had no impact on stunting or morbidity, raising the question of whether large‐scale micronutrient supplementation is worthwhile.
Victor Alfonso Mayén, Abimbola Ogunlusi, Charlotte Margaret Wright et al.
ABSTRACT Child stunting affects 38.3% of children under five in Ethiopia as of 2016. Women's empowerment, defined through both fundamental capabilities and household decision‐making authority, has emerged as a critical determinant of child nutritional outcomes. Drawing on Sen's capability approach and Kabeer's empowerment framework, we examined the associations between two distinct dimensions of women's empowerment and child stunting across Ethiopia's diverse regions. We analyzed 18,466 mother–child pairs from the 2011 and 2016 Ethiopia Demographic and Health Surveys. Validated empowerment indices were constructed using factor analysis. We employed hierarchical multilevel models as our primary specification to examine the associations between women's empowerment and child stunting across Ethiopia's 11 administrative regions. Between 2011 and 2016, stunting declined from 42.3% to 36.4%. Women's decision‐making authority increased (mean score: 0.70–0.78), while capabilities remained stable (0.17– 0.16). Higher capabilities were significantly associated with lower odds of stunting ( β = −0.141, aOR = 0.87, 95% CI: 0.83, 0.91), whereas decision‐making showed no association ( β = 0.013, aOR = 1.01, 95% CI: 0.98, 1.05). A significant interaction between capabilities and decision‐making was observed ( β = 0.050, aOR = 1.05, 95% CI: 1.01, 1.09). Regional heterogeneity was substantial: Amhara maintained high stunting rates despite empowerment gains, while Somali saw improvements with low capabilities but increased decision‐making. The study findings suggest that interventions should prioritize capability development through region‐specific strategies reflecting diverse pastoral, agrarian, and urban contexts; promote multi‐sectoral programs linking education and nutrition services; and develop monitoring frameworks to track both dimensions of empowerment at the regional level.
Seyoum Teffera Mengesha, Eva Berde, Amare Zerihun Yohannes et al.
