Prevalence and risk factors for stunting and severe stunting among under-fives in North Maluku province of Indonesia

BMC Pediatrics Prevalence and risk factors for stunting and severe stunting among under-fives in North Maluku province of Indonesia Ramli 2 Kingsley E Agho 1 Kerry J Inder 2 Steven J Bowe 2 Jennifer Jacobs 1 Michael J Dibley 0 0 School of Public Health, the University of Sydney , NSW , Australia 1 School of Medicine, the University of Western Sydney , NSW , Australia 2 Centre for Clinical Epidemiology and Biostatistics, the University of Newcastle , NSW , Australia Background: Adequate nutrition is needed to ensure optimum growth and development of infants and young children. Understanding of the risk factors for stunting and severe stunting among children aged less than five years in North Maluku province is important to guide Indonesian government public health planners to develop nutrition programs and interventions in a post conflict area. The purpose of the current study was to assess the prevalence of and the risk factors associated with stunting and severe stunting among children aged less than five years in North Maluku province of Indonesia. Methods: The health and nutritional status of children aged less than five years was assessed in North Maluku province of Indonesia in 2004 using a cross-sectional multi-stage survey conducted on 750 households from each of the four island groups in North Maluku province. A total of 2168 children aged 0-59 months were used in the analysis. Results: Prevalence of stunting and severe stunting were 29% (95%CI: 26.0-32.2) and 14.1% (95%CI: 11.7-17.0) for children aged 0-23 months and 38.4% (95%CI: 35.9-41.0) and 18.4% (95%CI: 16.1-20.9) for children aged 0-59 months, respectively. After controlling for potential confounders, multivariate analysis revealed that the risk factors for stunted children were child's age in months, male sex and number of family meals per day (2 times), for children aged 0-23 months, and income (poorest and middle-class family), child's age in months and male sex for children aged 0-59 months. The risk factors for severe stunting in children aged 0-23 months were income (poorest family), male sex and child's age in months and for children aged 0-59 months were income (poorest family), father's occupation (not working), male sex and child's age in months. Conclusion: Programmes aimed at improving stunting in North Maluku province of Indonesia should focus on children under two years of age, of male sex and from families of low socioeconomic status. - Background The optimal growth and development of infants and young children are fundamental for their future [1]. Stunting, a deficit in height or length relative to a child's age is a major health problem in South Asia where half of children aged less than five years are stunted [2]. In Indonesia, 37% of children aged less than five years are stunted [3]. Promoting better eating habits in an effort to improve nutrition is one of the most challenging tasks in Indonesia as malnutrition remains one of the most important public health problems facing almost every district [4]. In Indonesia, like many developing countries, the most common nutritional problems in infancy and early childhood are stunting, wasting; iron-deficiency anaemia, poverty and low birth weight [5,6]. Malnutrition during the first 2 years of life can lead to mortality and morbidity in childhood [7,8] and is one of the most preventable risk factors for mortality [9]. Past studies have also shown that lower intelligence quotient (IQ), mother's height, male sex, mother and father level of education, poverty, socioeconomic status, residence, child care behaviour (inadequate complimentary feeding and breastfeeding), cultural beliefs, access to health care and environmental ecosystems [10,11] are factors associated with stunting in children aged less than five years. Despite the persistently high prevalence of stunted children in Indonesia, there is a lack of information about the prevalence and risk factors associated with stunted and severely stunted children in the North Maluku province of Indonesia using the new Growth reference from the World Health Organisation [12]. This province is an area in Indonesia that in 2004 had recently emerged from a period of prolonged civil conflict. This paper assesses the prevalence and risk factors associated with stunting and severe stunting in children aged 0-59 months old in North Maluku province of Indonesia. Methods Study location The study covered all areas in the North Maluku province of Indonesia (see Figure 1) [13] with a total population of about 920,000 people in 2006 [14,15], divided into four island groups The first island group consists of the districts of Ternate and Tidore with a total population of about 241,000 people. The second island group consists of the districts of Central Halmahera and East Halmahera with a total population of about 95,000 people. The third island group consists of the districts of West Halmahera and North Halmahera with a total population of about 276,000 people. The forth island group consists of the districts of South Halmahera and Sula-Isles with a total population of about 308,000 people [15]. FMiagpuorefI1ndonesia showing North Maluku Province Map of Indonesia showing North Maluku Province. (Source: Wikipedia, 2008) Study design A cross-sectional survey was conducted in 2004 on 3000 households from the four island groups in North Maluku province. A multistage cluster sampling technique was used for selecting the study sample in which North Maluku province was grouped into four island groups with eight districts in total. Selection of subjects The four island groups within North Maluku province were used to select the study areas. In the first stage, two districts were randomly selected based on probability proportional to size from each island group [15]. In the second stage, subdistricts (referred to as clusters) were randomly selected from each district. In the third stage, Puskesmas (Community Public Health Services) were selected randomly from each subdistrict and finally, the villages were randomly selected from Puskesmas. Household selection in each cluster was randomly taken by using the sampling frame of every 10th household with the nearest household from the village health service (Pustu) as the starting point. Comprehensive details of the study districts and selection criteria have been reported elsewhere [16]. In total, 50 households were selected in each cluster and 15 clusters in each island group, yielding a total of 750 households from each island group. Stunting (Height-for-age) The nutritional status of children less than five years of age was measured anthropometrically. Length was measured for children aged less than two years old and height for those two years of age and older. Length was measured using a wooden stadiometer to the nearest 0.1 cm and height was measured using Microtoice tape to the nearest 0.1 cm [17]. The height-for-age measurement status was expressed in (...truncated)