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Abstract

Background:

Stunting in children has adverse consequences such as a decrease in cognition, language, and academic performance. Most of the children in Indonesia were diagnosed with stunting. The aim of this study was to measure factors affecting behavior in fulfilling nutritional needs among children under the age of 5 years with stunting.

Design and method:

This study used a cross-sectional design. Data were collected from mothers who had children under the age of 5 years (6–48 months) in Talang village, Pamekasan Regency, Madura using a self-report questionnaire. The total sample in this study was 120, selected using a random sampling technique. The independent variables were maternal characteristics, culture, family support, and mother’s knowledge, while the dependent variable was the behavior in fulfilling nutritional needs among children. We used a self-report questionnaire to measure variables. Logistic regression was used to analyze factors affecting the behavior of fulfilling nutrition interventions. We used a statistical significance p < 0.05.

Results:

Culture, family support, and knowledge were factors that affecting behavior of fulfilling nutritional needs among children under the age of 5 years with stunting, 0.279 (OR = 0.279, 95% CI: 0.084-0.920, p = 0.036); (OR = 2.435, 95% CI: 1.270-4.667, p = 0.007; OR = 4.860, 95% CI: 1.548-15.261, p = 0.724), respectively.

Conclusion:

Behavioral in Fulfilling nutritional needs determines the health status of children. Therefore, the awareness of parents, knowledge, and multisectoral is needed to prevent stunting among children.

Keywords

Children stunting culture knowledge family

Introduction

Stunting is poor nutrition among children and presented using height-for-age is more than two standard deviations below the WHO Child Growth Standards median.¹ Stunting in children has adverse consequences such as a decrease in cognition, language, and academic performance. Furthermore, children with stunting have an increased risk of serious chronic diseases related to nutrition.^2–4

The data showed, that 149.2 million children in 2020 were diagnosed with stunting, and more than half are from Asia.⁵ Indonesia is a country with high levels of stunting, data from Basic health research showed that there were 30.8% of children under 5 years of age with stunting.⁶ Stunting in Indonesia is higher than in other ASEAN countries.⁷ It was showed that close to 3 in 10 children in Indonesia were stunted.⁸ East Java is one of the provinces in Indonesia that has a high number of stunting, especially on Madura Island. In addition, the number has increased since 2013.⁹

Factors that influence the nutritional status of children were direct factors and indirect factors.¹⁰ Direct factors consist of nutrient intake and infectious diseases, while indirect factors include culture, family support, and knowledge.^11,12 Culture has an effect on the nutritional status of children,¹³ such as people who lived in coastal areas. They have different socio-cultural conditions from other areas, especially how they feed their children. Also, their geographic condition had an effect on access to food, hygiene, as well as access to water, and sanitation.^14,15 The family also plays an important role, such as in food selection and food preparation.¹⁶ Different parenting styles will influence the nutritional status of children.¹⁷ Knowledge is an important step in decreasing stunting, especially in educating mothers. Educated mothers have good knowledge regarding the causes and risks of stunting.^18,19

This study addresses to measure factors that affect behavior in fulfilling nutritional needs among children underthe age of 5-year-old with stunting, especially culture, family support, and mother’s knowledge.

Methods

Research design

The aim of this study was to measure factors affecting behavior in fulfilling nutritional needs among children under the age of 5 years with stunting. This study used a cross-sectional design. The independent variables were maternal characteristics, cultural, family support, and mother’s knowledge, while the dependent variable is the behavior in fulfilling nutritional needs among children.

Participants

Data were collected from mothers who had children under the age of 5 years (6–48 months) in Talang village, Pamekasan Regency, Madura. The total sample in this study was 120, selected using a random sampling technique.

Data collection

Data were collected using a self-report questionnaire. We collected the data after obtaining permission from the National Unity and Political Agency of Pamekasan City in 2021. Respondents who agreed to join this study signed the informed consent. Afterward, the questionnaires were delivered to participants.

Instruments

We used self-report questionnaire to measure the variables. Culture had eight items, with yes and no answer. The total score less than 8 was interpreted by absent and total score more than 9 was present. Family supports had eight items with yes and no answer. Total score between 1–6 was poor, 7–12 was moderate, and 13–16 was good. Mother’s knowledge had six items with yes or no answer. Score between 1 and 7 was poor knowledge, and more than 7 was good. Behavior in fulfilling nutritional needs had seven items, with yes or no answer. Total score between 1–6 was good and 7–14 was poor. All of these questionnaires were developed from health promotion model.^20,21

Data analyzed

All data were entered in SPSS version 23. A descriptive analysis was used to measure the distribution and percentage of variables. Logistic regression was used to analyze factors affecting the behavior of in fulfilling nutrition interventions. Furthermore, we used statistical significance (p < 0.05).

Ethical clearance

This research has received approval from the ethics committee of Universitas Muhammadiyah of Surabaya number 21/KEPK/2021.

Results

Table 1 showed the characteristic of respondents. Most of the respondents were housewife (52.3%), around 39.1 % of participants had junior high school degrees, and only 4.1% of respondents have university degrees.

Table 1.

Characteristic of respondents.

Characteristic	Frequency (N)	Percentage (%)
Age of mother (year)
20–23	20	16.6%
24–27	30	25.0%
28–31	42	35.0%
32–35	8	6.6%
36–39	13	10.8%
40–43	7	5.8%
Age of children (months)
06–12	29	24.16%
13–19	25	20.8%
20–26	21	17.5%
27–33	15	12.5%
34–40	17	14.16%
41–47	13	10.8%
Employment
Housewife	63	52.3
Self-employee	51	42.5
Civil servant	3	2.5
Education degree
University	5	4.1
Senior high school	26	21.6
Junior high school	47	39.1
Elementary school	25	20.8
Not in school	17	14.2

Table 2 showed the frequency distribution of culture, family support, knowledge, that fulfilling nutritional needs among family who have children with stunting. There were 54.2% with low fulfilling nutritional needs has specific culture. There were 40.8 % of participants who had low family support tend to have low in fulfilling nutritional needs among their children. There were 55% of participants who had poor knowledge tend to have low in fulfilling nutritional needs.

Table 2.

Frequency distribution of culture, family support, knowledge, that fulfilling nutritional needs.

Culture	Behavior of fulfilling nutritional needs				Total
	Poor		Good		Total
	n	%	n	%	N	%
Absent	10	8.3	25	20.9	35	29.2
Present	65	54.2	20	16.7	85	70.8
Family support
Poor	49	40.8	16	13.3	65	54.2
Moderate	21	17.5	12	10	33	27.5
Good	5	4.2	17	14.2	22	18.3
Knowledge
Good	9	7.5	29	24.1	38	31.7
Poor	66	55	16	13.3	62	51.7

Table 3 showed that culture, family support and mother’s knowledge were factors that affecting behavior of fulfilling nutritional needs among children under the age of 5 years with stunting, 0.279 (OR = 0.279, 95% CI: 0.084-0.920, p = 0.036); (OR = 2.435, 95% CI: 1.270-4.667, p = 0.007); (OR = 4.860, 95% CI: 1.548-15.261, p = 0.724), respectively. Based on the data above, families who have good family support have a risk of 2.435 in fulfilling good nutritional needs, good knowledge has a chance of implementing in fulfilling good nutritional needs of 4.860, and culture has an opportunity to provide less nutrition intervention 0.276 times than those who are not influenced by culture.

Table 3.

Factors affecting behavior in fulfilling nutritional needs among children under the age of 5 years with stunting.

Variables	B	Sig	Exp (B)	95% CI
Variables	B	Sig	Exp (B)	Lower	Upper
Culture	−1.278	0.036	0.279	0.084	0.920
Family support	0.890	0.007	2.435	1.270	4.667
Knowledge (1)	1.581	0.007	4.860	1.548	15.261
Constant	−0.406	0.724	0.666

Discussion

Stunting is the public health issue in Indonesia as well as in other developing countries. Our study showed that culture, family support, and knowledge were factors that affecting in fulfilling nutritional needs among children under the age of 5 years with stunting. Our study revealed that culture, poor family support, and poor knowledge tend to be low in fulfilling of nutritional needs among children with stunting. This study is in line with the previous study which mentioned that culture is related to beliefs and norms, social support, and caregiver and it has an effect on behavior in fulfilling nutrition among children,²² this study also mentioned that culture is related to knowledge and it also had an effect on behavior in fulfilling nutrition among children.²² Another study mentioned that family support, especially instrumental and emotional support from the father was related to stunting Indonesia.²³

The culture of the local community will greatly affect behavior in fulfilling nutrition among children with stunting. In this study, most of the respondents mostly only follow the orders of the parents or the existing culture of the family. This study is in line with previous studies which mentioned that parenting and family nutritional climate can predict food parenting practices and contribute to BMI scores in children.^24–26 Culture is a society’s habits related to daily behavior.²⁷ It is necessary to increase programs that are focused on behavioral changes that have positive values in fulfilling nutritional needs among children with stunting. Government policies is needed when behavior was fail.²⁸

Our study revealed that family support is factor that affecting in fulfilling nutritional needs among children under the age of 5 years with stunting. Fulfilling nutritional needs among children is needed the family support^29–31 especially related to exclusive breastfeeding.³² Family support is defined as assistance from the closest people such as husbands and parents. In Indonesia, paternalistic family have rule, that was mother has responsible for taking care of the baby.³³ So, it is necessary to empower women or counseling regarding appropriate nutrition for their children, and it must be supported by the family.

Knowledge is factor that influence in fulfilling nutritional needs among children under the age of 5 years with stunting. Knowledge about nutrition was supported by adequate education.³⁴ Mothers who have adequate knowledge about nutrition can choose and feed their children better, especially related to breastfeeding.³⁵ Adequate maternal education will support the readiness of mothers in caring for children.³⁶ It must be supported by the family’s ability to meet daily needs as well as household income.³⁷

Based on the results of the study culture, family support, and knowledge in fulfilling nutritional needs for children under the age of 5-year-old with stunting. Fulfilling nutritional needs determines the health status of children. Therefore, the awareness of parents who have children under the age of 5-year-old with stunning is needed to improve their knowledge, and family support as well as multisectoral. The limitation of this study was considered, this study is a cross-sectional study, therefore the association between variables must be interpreted carefully. Further research is needed regarding longitudinal study and nutrition interventions for children with stunting is needed that go in hand with local policies as well as regional culture.

Conclusion

There were influence of culture, family support, and mother’s knowledge on behavior in fulfilling nutritional needs for children under the age of 5-year-old with stunting especially in coastal areas. Mother’s behavior in fulfilling nutrition needs to be supported by regional policies with a multi-disciplinary approach so that the incidence of nutritional disorders can be minimized.

Footnotes

Acknowledgements

We would like to thank all the respondents, Kedaireka Kementerian Pendidikan, Kebudayaan, Riset, dan Teknologi. Republik Indonesia, and, Universitas Muhammadiyah Surabaya, for their support of this study.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors received financial support from Kedaireka Kementerian Pendidikan, Kebudayaan, Riset, dan Teknologi. Republik Indonesia for the research, authorship, and/or publication of this article.

Ethical approval

This research has received approval from the ethics committee of Universitas Muhammadiyah of Surabaya number 21/KEPK/2021.

Significance of public health

Stunting is the consequences of malnutrition and it has negative effect on neurocognitive development among children. Therefore, stunting is public health issue, because it was related to mortality and morbidity. Indonesia is country with high prevalence of stunting. Knowing well factors related to stunting among children under 5-year-old age is needed for developing strategy to prevent stunting.

ORCID iD

Pipit Festi Wiliyanarti

References

WHO. Stunting in a nutshell, https://www.who.int/news/item/19-11-2015-stunting-in-a-nutshell (2015, accessed 15 November 2022).

Nahar

Hossain

Mahfuz

, et al Early childhood development and stunting: findings from the MAL-ED birth cohort study in Bangladesh. Matern Child Nutr 2020; 16(1): e12864.

Wolde

Belachew

Chronic undernutrition (stunting) is detrimental to academic performance among primary schools of adolescent children: a randomized cross sectional survey in Southern Ethiopia. BMC Res Notes 2019; 12(1): 1-6.

Cordoba Gamboa

Vazquez Salas

Cantoral

, et al, eds. Lead exposure, stunting and language development in Mexico: a first national study. In: ISEE conference abstracts, New York, 23–26 August 2021. ISEE.

WHO. The State of Food Security and Nutrition in the World 2021: Transforming food systems for food security, improved nutrition and affordable healthy diets for all. Food & Agriculture Organization; 2021.

Kemenkes

Laporan hasil riset kesehatan dasar (riskesdas) Indonesia tahun 2018. Riset Kesehatan Dasar 2018; 2018: 182–183.

Soekatri

Sandjaja

Syauqy

Stunting was associated with reported morbidity, parental education and socioeconomic status in 0.5–12-year-old Indonesian children. Int J Environ Res Public Health 2020; 17(17): 6204.

UNICEF. Nutrition , https://www.unicef.org/indonesia/nutrition (2014, accessed 15 November 2022).

UNICEF. Profil singkat provinsi: Jawa Timur: UNICEF; 2013.

10.

Kim

Vollmer

, et al Factors associated with child stunting, wasting, and underweight in 35 low-and middle-income countries. JAMA Netw Open 2020; 3(4): e203386.

11.

Januarti

Hidayathillah

AP.

Parenting Culture of Father in Prevention of Stunting in Toddlers. Babali Nurs Res 2020; 1(2): 81–90.

12.

Santosa

Arif

Ghoni

DA.

Effect of maternal and child factors on stunting: partial least squares structural equation modeling. Clin Exp Pediatr 2022; 65(2): 90.

13.

Ratna

DPS

Winda

. Qualitative study of local cultural wisdom and health services on stunting events. IJMA 2030; 3(1): 1–7.

14.

Chowdhury

Chakrabarty

Rakib

, et al Factors associated with stunting and wasting in children under 2 years in Bangladesh. Heliyon 2020; 6(9): e04849.

15.

Jonah

Sambu

May

JD.

A comparative analysis of socioeconomic inequities in stunting: a case of three middle-income African countries. Arch Public Health 2018; 76(1): 1–15.

16.

Romani

Grappi

Bagozzi

, et al Domestic food practices: a study of food management behaviors and the role of food preparation planning in reducing waste. Appetite 2018; 121: 215–227.

17.

Shloim

Edelson

Martin

, et al Parenting styles, feeding styles, feeding practices, and weight status in 4–12 year-old children: a systematic review of the literature. Front Psychol 2015; 6: 1849.

18.

Permatasari

TAE

Rizqiya

Kusumaningati

, et al The effect of nutrition and reproductive health education of pregnant women in Indonesia using quasi experimental study. BMC Pregnancy Childbirth 2021; 21(1): 1–15.

19.

Hall

Bennett

Crookston

, et al Maternal knowledge of stunting in rural Indonesia. Int J Child Health Nutr 2018; 7(4): 139–145.

20.

Christensen

The health-promoting family: a conceptual framework for future research. Soc Sci Med 2004; 59(2): 377–387.

21.

Seeman

TE.

Health promoting effects of friends and family on health outcomes in older adults. Am J Health Promot 2000; 14(6): 362–370.

22.

Beal

Tumilowicz

Sutrisna

, et al A review of child stunting determinants in Indonesia. Mater Child Nutr 2018; 14(4): e12617.

23.

Krisnana

Suryawan

Muftiyaturrohmah

Analysis of fathers? Support based on maternal perceptions through stunting incidence in toddler at coastal areas. Syst Rev Pharm 2020; 11(5): 761–767.

24.

Peters

Dollman

Petkov

, et al Associations between parenting styles and nutrition knowledge and 2–5-year-old children’s fruit, vegetable and non-core food consumption. Public Health Nutr 2013; 16(11): 1979–1987.

25.

Gerards

Kremers

The role of food parenting skills and the home food environment in children’s weight gain and obesity. Curr Obesity Rep 2015; 4(1): 30–36.

26.

Hughes

Power

O’Connor

, et al Maternal feeding styles and food parenting practices as predictors of longitudinal changes in weight status in Hispanic preschoolers from low-income families. J Obesity 2016; 2016: 7201082.

27.

Church

Katigbak

Reyes

JAS

, et al Prediction and cross-situational consistency of daily behavior across cultures: Testing trait and cultural psychology perspectives. J Res Pers 2008; 42(5): 1199–1215.

28.

Kinzig

Ehrlich

Alston

, et al Social norms and global environmental challenges: the complex interaction of behaviors, values, and policy. BioScience 2013; 63(3): 164–175.

29.

Sari

andSuhardin

Family determinants of stunting in Indonesia: a systematic review. Int J Psychosoc Rehabil 2020; 24(9): 815–822.

30.

Susanto

Rasni

Susumaningrum

LA.

Prevalence of malnutrition and stunting among under-five children: a cross-sectional study family of quality of life in agricultural areas of Indonesia. Mediterr J Nutr Metab 2021; 14(2): 147–161.

31.

Wilianarti

Wulandari

Ghufron

, et al Stunting prevention in coastal family with health-promoting family approach. Open Access Maced J Med Sci 2022; 10(G): 290–296.

32.

Maleki-Saghooni

Amel Barez

Karimi

FZ.

Investigation of the relationship between social support and breastfeeding self-efficacy in primiparous breastfeeding mothers. J Matern Fetal Neonatal Med 2020; 33(18): 3097–3102.

33.

Chin

GV.

State Ibuism and one happy family: Polygamy and the “good” woman in contemporary Indonesian narratives. In: Chin

Mohd Daud

(eds) The Southeast Asian woman writes back. Singapore: Springer; 2018. pp.89–106.

34.

Hamulka

Wadolowska

Hoffmann

, et al Effect of an education program on nutrition knowledge, attitudes toward nutrition, diet quality, lifestyle, and body composition in Polish teenagers. The ABC of healthy eating project: design, protocol, and methodology. Nutrients 2018; 10(10): 1439.

35.

Dukuzumuremyi

JPC

Acheampong

Abesig

, et al Knowledge, attitude, and practice of exclusive breastfeeding among mothers in East Africa: a systematic review. Int Breastfeed J 2020; 15(1): 1–17.

36.

Mensch

Chuang

Melnikas

, et al Evidence for causal links between education and maternal and child health: systematic review. Trop Med Int Health 2019; 24(5): 504–522.

37.

Utami

Setiawan

Fitriyani

Identifying causal risk factors for stunting in children under five years of age in South Jakarta, Indonesia. Enferm Clin 2019; 29: 606–611.

Behavior in fulfilling nutritional needs for Indonesian children with stunting: Related culture,family support,and mother’s knowledge