Abstract

Background: Low birth weight (LBW) is defined as a birth weight of less than 2500 g (up to and including 2499 g).  LBW generally experience an unfavorable future life, babies born with low birth weight are mostly born to mothers with low nutritional status during pregnancy who are at risk of becoming stunted.

Aim: To determine the relationship between low birth weight and the incidence of stunting in children aged 6-24 months in the Working Area of ​​the Air Dingin Health Center, Padang City.

Method: The research was conducted in the Working Area of ​​the Air Dingin Health Center in Padang, from May 2019 – January 2020. This is a correlative analytic study with a cross-sectional research design. The affordable population is part of the target population of children aged 6-24 months in the Air Dingin Health Center Padang with 65 samples using stratified random sampling technique.  The analysis data using chi-square test SPSS version 24.0.

Results:Based on the results of the study, the most gender was male, 21 people (53.8%), the most age was 12 - <24 months, 38 people (97.4%), experienced stunting as many as 39 people (60%), experienced LBW as many as 27 people (41.5%) and there is a relationship between low birth weight and the incidence of stunting in children aged 6-24 months in the Working Area of ​​the Air Dingin Health Center, Padang ( p=0.027 < 0.05)

Conclusion: There is a relationship between low birth weight and the incidence of stunting in children aged 6-24 months in the Working Area of ​​the Air Dingin Health Center in Padang.

Preliminary

Indonesia is a developing country that has complex problems, especially in nutritional problems. Today, stunting as a part of malnutrition chronic in childrens has an emergency problem. Stunting can be at risk of disease and death, children who survive tend to have poor performance in school. But not many parents are aware that their child is suffering from stunting.^1,2

WHO in 2018 showed that 149 million children under five, 22% were stunted. Africa and Asia are the two continents with the highest incidence of stunting under five in the world with percentages of 39% and 55% respectively. Indonesia is included in the top 10 countries with the highest prevalence of stunting under five in Southeast Asia along with other countries, namely Timor Leste, Nepal, India, Bangladesh and Myanmar.^3,4

Improvements in nutritional problems are also stated in the 2015-2019 National Medium Term Development Plan (RPJMN) target with a stunting prevalence target of 28%.5 However, in reality the results of the Basic Health Research (Riskesdas) show an increase in stunting prevalence of 1.6%, from 35 .6% in 2010 to 37.2% in 2013.⁶ Meanwhile, in 2018 showed a decrease in the incidence of stunting by 30.8%.⁷ Although there has been a decline in the incidence of stunting in Indonesia, the prevalence of stunting is still high, which means children's problems Short nutrition is still a big problem in Indonesia and requires attention from various parties to overcome it.

The prevalence of stunting under five in West Sumatra in 2016 was 25.6%.8 Monitoring the Nutritional Status (PSG) of children under five, this incident increased in 2017 by 30.6%, which was categorized as short 21.3% and very short 9.3 %.⁷ Padang City Health Office annual report from 2013 to 2018 there was a decline in stunting prevalence. In 2013 the prevalence of stunting was recorded at 28.3%.⁹ This was a significant decrease in 2018 by 11.2%. The Air Dingin Health Center area is one of the areas with the highest incidence of stunting in the city of Padang at 17.5% in children aged 6-24 months.¹⁰

Factors that affect stunting include low birth weight (LBW), lack of protein energy, chronic disease, poor food intake, poverty factors and inadequate child care.¹¹ The process of stunting starts from 6 months and appears mainly in the first two years of life or also known as the First 1000 Days of Life. This period is an important period in determining the quality of life of children.¹² Infants with low birth weight (LBW) are predictors of the strongest incidence of stunting.¹³ Babies born with low birth weight are mostly born to mothers with low nutritional status during pregnancy who later are at risk of becoming stunted.¹⁴

Low birth weight is a baby born weighing less than 2500 grams. LBW generally experience an unfavorable future life.¹⁵ The incidence of LBW in Padang City 2016 was 2.10%, and decrease in 2017 was 1.5%.¹⁶

Research conducted by El Taquri, Adel et al in Libya also showed that LBW had a 1.8 times risk of becoming stunted.¹⁷ This is in line with research in South India conducted by Andrea M Rehman et.al which showed that children with low birth weight has a 3.6 times risk of becoming stunted at the age of 3 years.¹⁸ Nasution's research, children with a history of LBW have a 5.6 times risk of experiencing stunting compared to children born with normal weight.¹⁹

The results of the initial survey data on the incidence of stunting in the Air Dingin Health Center area at the age of 0-24 months there were 98 children. Researchers want to take data on children aged 6-24 months because according to the title, the relationship between LBW children and stunting can be seen at the age of 6-24 months, because if it is more than 24 months there are many other factors that can cause stunting. In the area of ​​the Air Dingin Health Center, there are 3 villages, namely Aia Pacah Village, Lubuk Minturun Village, and Balai Gadang Village.

Research Methods

The scope of this research is Pediatrics. The research was conducted in the Working Area of ​​the Air Dingin Health Center, Padang.

The research sample is children aged 6-24 months who visited the Air Dingin Health Center Work Area. We measure the child's height using the length board. The measurement results are entered into the Z score chart for body length/age. Data analysis was carried out univariate and bivariate using chi-square test. The value used to see whether there is a relationship between the two variables is p (probability), then it is said to be significant if p <0.05.

Research result

This study aims to determine the relationship between low birth weight and the incidence of stunting in children aged 6-24 months in the working area of ​​the Air Dingin Health Center. There were 65 research samples that met the inclusion and exclusion criteria. Based on the results of the collection and analysis of the data that has been obtained, the authors can conclude the results of the research in the exposure below:

Based on the characteristics of the respondents, the age and sex of children. The results showed that the frequency of respondents' characteristics according to gender in the Working Area of ​​the Air Dingin Health Center in Padang can be described as follows:

According to Gender in the Working Area of ​​the Air Dingin Health Center Padang. Based on table 1, it was obtained from 39 stunting children, the most gender was male, 21 people (53.8%).

Based on table 1, it was obtained from 39 stunting children, the most gender was male, 21 people (53.8%).

Based on table 5.2, the results were obtained from 39 stunted children, the most ages were 12 - <24 months, namely 38 people (97.4%).

1. Characteristics of Respondents
2. Univariate Analysis

In the following, an analysis of each variable is presented, namely low birth weight with the incidence of stunting in children aged 6-24 months in the working area of ​​the Air Dingin Health Center in Padang with a table description as follows:

The results of the study found that the frequency of stunting in children in the Air Dingin Health Center's Padang can be described as follows:

65 children, experienced stunting as many as 39 people (60%).

1. Stunting
2. LBW

The results of the study found that the frequency of LBW in the Air Dingin Health Center's Padang working area can be described as follows:

Based on table 4, the results obtained from 65 children, experiencing LBW as many as 27 people (41.5%)

Bivariate Analysis

In the following, the results of research on the relationship between low birth weight and the incidence of stunting in children aged 6-24 months are presented in the Working Area of ​​the Air Dingin Health Center in Padang City in the table below:

Based on table 5 shows that of the 27 children who experienced LBW, the most experienced stunting, 21 people (77.8%) while out of 38 children who did not experience LBW, there were 18 people (47.4%). The results of the statistical test (chi-square) obtained a value of p = 0.027 (p <0.05), it can be concluded that there is a relationship between low birth weight and the incidence of stunting in children aged 6-24 months in the Air Dingin Health Center in Padang City.

Area, the results showed that the highest number of stunting occurred in girls. that is 54.84%.32Baby girls can survive in large numbers than baby boys in most developing countries including Indonesia.22 Boys have more muscle tissue and less fat tissue than girls. Metabolically, muscle requires more energy than fat. Thus, men and Women with the same height, weight and age have different body compositions, so their energy and nutritional needs will also be different.23

In the first year of life, male are more susceptible to malnutrition than females. This is due to the large size of the male body so that if food intake is not met and this condition occurs for a long period of time it can increase growth disorders (stunting).24 However, in the second year of life, girls are more at risk of becoming stunted. This is related to women having less physical activity so that growth is not optimal and the parenting pattern of parents in feeding their children.25 Both men and women have a probability of becoming stunted. However, with good parenting, stunting can actually be prevented. In the Working Area of ​​the Padang City Air Dingin Health Center, although the number of men is more than the number of women, the proportion of children under five who experience stunting is almost the same, namely 53.8%. This may be due to the lack of parenting for children for both boys and girls

Based on the research, the results obtained from 65 children who experienced stunting, namely 39 children, the most age was 12 - <24 months, namely 38 people, 97.4% in children aged 6-24 months in the Working Area of ​​the Air Dingin Health Center in Padang City. This research is supported by previous research conducted by Putra's research in 2015 on children aged 12-60 months in the Pauh Health Center Work Area, the results obtained were the most stunting at the age of 12-24 months, namely 35.48% and also research conducted by Dewi in 2018 for baduta in Maron Kidul Village, Maron District, Probolinggo Regency, the results obtained were the most stunting events at the age of 19-23 months, namely 50%.32.26

This is because the age of 12-24 months is a time when toddlers are undergoing a transition. At this age, many changes occur, including changes in eating patterns from breast milk to solid foods, some toddlers begin to have difficulty eating. If care is not taken care of, then toddlers more often get diseases, especially infectious diseases. The incidence of recurrent infectious diseases not only loses weight or will appear in the low value of the weight indicator for age, but also the indicator for height for age. This situation is in accordance with research by Welassih who found that the incidence of stunting was more common in children aged 12-24 months.27

Stunting

Based on the research, the results obtained from 65 children experienced stunting as many as 39 people (60%) in children aged 6-24 months in the Working Area of ​​the Air Dingin Health Center in Padang City. In line with previous research conducted by Dalimunthe in 2015 on toddlers aged 24-59 months in West Nusa Tenggara, the results showed that the most toddlers experienced stunting, namely 56.36% and also research conducted by Sundari in 2018 on children under five at Sangkrah Health Center Surakarta City obtained results (50%) under two years are stunting.20,28

The risk for growth faltering is greater in infants who have experienced previous falters, namely conditions during pregnancy and prematurity. That is, a body length that is far below the birth average due to having experienced growth retardation while still in the womb indicates a lack of nutritional status and maternal health during pregnancy causing children to be born with less body length so that they are at risk of stunting.29

The impact of stunting is an increase in the incidence of morbidity and mortality, suboptimal cognitive, motor, and verbal development in children, increased health costs, suboptimal body posture as adults (shorter than in general), increased risk of obesity and other diseases, decreased reproductive health, learning capacity and less than optimal performance during school years, as well as suboptimal productivity and work capacity.12

Complications of stunting can hinder children's physical and mental development, risk of illness and death, stunted growth of motor and mental abilities, decreased intellectual ability, productivity, and increased risk of degenerative diseases in the future.30

Based on the research, the results obtained from 65 children experienced LBW as many as 27 people (41.5%) in children aged 6-24 months in the Working Area of ​​the Air Dingin Health Center in Padang City. The results of this study are in line with previous research conducted by Hidayat in 2019 on toddlers in the Upt Work Area of ​​the Kramatwatu Public Health Center, Serang Regency. the result of baduta experiencing LBW as much as (40%).31,20

Low birth weight, i.e. birth weight less than 2500 grams, will carry a risk of death, impaired growth and development of children, including the risk of becoming short if not handled properly.12 This condition can occur because in babies born with low birth weight, since in the womb has experienced growth retardation due to poor maternal nutrition, low maternal body mass index, low maternal height, and weight gain during pregnancy is not optimal and will continue until the next age after birth, namely experiencing slower growth and development than babies born normally and often fails to keep up with the growth rate that should be attained at postnatal age.32

Low birth weight is a picture of multiple public health problems including long-term malnutrition, poor health, hard work and poor health care and pregnancy.33 Malnourished mothers will experience a decrease in blood volume, which will cause inadequate cardiac output so that Blood flow to the placenta decreases and the placenta becomes small and nutrients from the mother to the fetus through the placenta are reduced resulting in growth retardation. Growth retardation since in the womb is at risk of giving birth to a child with an abnormal birth weight

1. Age
2. LBW
3. Connection LBW with Stunting

Based on table 5.3 shows that of the 27 children who experienced LBW, the most experienced stunting, namely 21 people (77.8%) while out of 38 children who did not experience LBW, there were 18 people (47.4%).The results of the statistical test (chi-square) obtained a value of p = 0.027 (p <0.05), it can be concluded that there is a relationship between low birth weight and the incidence of stunting in children aged 6-24 months in the Air Dingin Health Center in Padang City. This happens because, since in the womb, the child has experienced growth retardation in the womb and will continue in the future.

The results of this study are in line with previous research conducted in Nepal conducted by Paudel in 2012 which showed that there was a relationship between a history of low birth weight and the incidence of stunting. Low birth weight had a stunting risk of 4.47 times greater than under five with low birth weight. normal and also research by Sundari in 2018 on children under two at Sangkrah Health Center Surakarta City, the results showed that there was a relationship between low birth weight and stunting in children under two years old at Sangkrah Health Center Surakarta City. p=0.032.20.38

Nasution's 2014 research in the city of Yogyakarta stated that of 121 cases of children suffering from stunting, there were 31 (25.6%) with a history of LBW. Children born with LBW have a 5.6 times risk of becoming stunted at the age of 6-24 months than babies born with normal birth weight.19 In addition to the research in Jenoponto, LBW is the most dominant risk factor associated with stunting. Children under two years old (baduta) who are born with low birth weight are 4 times more at risk of stunting compared to children who are born with normal weight.35 In contrast to the results of Rahmadi's study in Lampung, which stated that there was no relationship between low birth weight and stunting. with p = 0.966,

Babies with LBW also experience digestive tract disorders because the digestive tract is not functioning properly, cannot absorb fat and digest protein which can result in a lack of nutrient reserves in the body. This causes the growth of LBW babies to be disrupted, then if this continues with inadequate feeding, the babies often experience infections, as well as poor health care, which can cause children to experience stunting.19

A child born with LBW will grow up to be stunted, the impact of which is in the form of health problems and less productivity. At school age, if there is no improvement in adequate nutrition and good health services, it will continue at the next age, namely short adolescents. A study in China found that adolescents born with a low birth weight <2500 grams will experience delays in physical growth, cognitive capacity and academic ability compared to adolescents born with a weight >2500 grams.37

Conclusion

Based on the results, it can be concluded that there is a relationship between low birth weight and the incidence of stunting in children aged 6-24 months in the Air Dingin Health Center, Padang City.

Bibliography

1. UNICEF Indonesia. Summary of Maternal and Child Nutrition Studies. Jakarta: Center for Promotion of the Indonesian Ministry of Health; 2012.
2. Oktarina, Z., & Sudiarti, T. Risk Factors for Stunting in Toddlers (24-59 Months) in Sumatra. Journal of Nutrition and Food.2014;8(3).p.177.
3. UNICEF. WHO. and The World bank: Joint Child Malnutrition Estimates – levels and trends – 2019 edition. UNICEF DATA [cited 2019 March 20] Retrieved from https://data.unicef.org/resources/jme/
4. World Health Statistics data visualizations dashboard | Child stunting. (2019). [cited 2019 March 20] Retrieved from http://apps.who.int/gho/data/node.sdg.2-2-viz-1?lang=en
5. National Development Planning Agency. Presidential Regulation of the Republic of Indonesia Number 5 of 2010 concerning the National Medium Term Development Plan (RPJMN) 2010-2014. Jakarta; 2014.
6. Indonesian Ministry of Health. Profile and Health of Indonesia. the Ministry of Health of the Republic of Indonesia; 2013.
7. Riskesdas. National Report on Basic Health Research [internet]. Basic Health Research. 2018. [Quoted March 20, 2019]. Downloaded from: http://www.depkes.go.id.
8. Indonesian Ministry of Health. Basic Health Research (RISKESDAS) 2017. Health Research and Development Agency of the Indonesian Ministry of Health. Jakarta; 2017.
9. Padang City Health Office. Padang City Health Profile. Padang: Padang City Health Office; 2013
10. Padang City Health Office. Padang City Health Profile. Padang: Padang City Health Office; 2018
11. United Nations Children's Fund (UNICEF). Tracking progress on child and maternal nutrition: a survival and development priority [internet]. New York. United Nations Children's Fund (UNICEF); 2009 [cited 2019 March 20]. from: https://www.unicef.org/publications/files/Tracking_Progress_on_Child_and_Maternal_Nutrition_EN_110309.pdf
12. Indonesian Ministry of Health. Center for Data and Information on the Situation of Short Children. 2016. Data and Information Center of the Indonesian Ministry of Health. Jakarta; 2016. [accessed March 20, 2019] http://www.depkes.go.id/resources/download/pusdatin/infodatin/situasi-anak- short-2016.pdf
13. Aryastami NK. A. Shankar., N. Kusumawardhani., Bersal., AB Jahari., E. Achadi. Low Birth Weight Was The Most Dominant Predictor Associated With Stunting Among Children Aged 12-23 Months In Indonesia. BMC Nutrition.2017;3(16)
14. Kusharisupeni. The Role of Birth Status on Infant Stunting: A Retrospective Study. Trisakti Medical Journal. 2002; 23:73-80
15. Department of Nutrition and Public Health FKM UI. Nutrition and Public Health. Jakarta: Rajawali Press; 2011
16. Padang City Health Office. Padang City Health Profile. Padang: Padang City Health Office; 2017
17. El Taquri A, Betilmal Ibrahim, Murad Mahmud Salah, Goulet Oliver, Hercberg Serge, et, al. Risk factors for stunting among under-fives in Libya. Public Health Nutrition. 2008;12(8): 1141-9
18. Rahman Azizur, Chowdhury Soma, Hossain Delwar. Acute Malnutrition in Bangladeshi Children: levels and Determinants. Australia: National Center for Social and Economic Modeling (NATSEM); 2009.
19. Nasution D, Nurdiati DS. The relationship between low birth weight (LBW) and the incidence of stunting in children aged 6-24 months in the city of Yogyakarta. Thesis. Gadjah Mada University; 2014
20. Sundari, Rina Murdaningsihand , Susi Dyah Puspowati, M.Sc. Relationship between Low Birth Weight (LBW) and Exclusive Breastfeeding Behavior with Baduta Stunting Incidence at Sangkrah Health Center Surakarta City; 2018 Thesis thesis, University of Muhammadiyah Surakarta.
21. Mugianti, Sri, et al. Factors causing stunting in children aged 25-60 months in Sukorejo District, Balitar City; 2018 Journal of Nurses and Midwifery Poltekkes, Ministry of Health Malang (P-ISSN:2355052X). http://jnk.phb.ac.id/index.php/jnk
22. Ramli, et al. Prevalence and Risk Factors For Stunting And Severe Stunting Among Under-Fives In North Maluku Province Of Indonesia; 2009. BMC Pediatrics 9:64. Accessed December 20, 2019 from www.biomedcentral.com
23. Almatsier, Sunita. Basic principles of nutrition. Jakarta : PT. Gramedia Main Library; 2001
24. Gershwin M, et al. Handbook of Nutrition and Immunity. New Jersey. Humana Press. P71-85; 2004
25. Sari Dian Febrida, Oktacia Reski. Overview of Risk Factors for Stunting in Toddlers in the Work Area of ​​the Nangalo Health Center, Padang City. Padang city; 2018
26. Dewi Novianti Tysmala, Widari Dhenok. Relationship between Low Birth Weight and Infectious Diseases with Stunting Incidence in Baduta in Maron Kidul Village, Maron District, Probolinggo Regency. p 373-381; 2018
27. Welasasih, BD and Wirjatmadi, RB 'Several Factors Associated with the Nutritional Status of Stunting Toddlers', Ministry of Health Nutrition, 8, pp. 99–104; 2012
28. Dalimunthe, SM Overview of Stunting Incidence Factors in Toddlers Age 24-59 Months in NTB Province in 2010. Syarif Hidayatullah State Islamic University Jakarta.;2015
29. Ni'mah, K. and Nadhiroh, SR'Factors Associated with Stunting Incidents in Toddlers'; 2015
30. Ningrum, Ema Wahyu & Utami, Tin. The relationship between stunting nutritional status and the development of toddlers aged 12-59 months. STIKes Harapan Bangsa Purwokerto.; 2015
31. Hidayat Annisa Nurhayati, Ismawati. Factors in the Incidence of Stunting in Toddlers in the Work Area of ​​the UPT Puskesmas KramaTwatu Serang Regency. Volume 3; 2019
32. Prendergast, AJ, JH Humphrey. The Stunting Syndrome in Developing Countries. Paediatrics and International Child Health, ISSN: 2046-9047 (Print) 2046-9055; 2014 http://www.tandfonline.com/loi/ypch20 Accessed December 20, 2019
33. Maryanto S, Anugrah RM. The relationship between pulmonary tuberculosis (pulmonary TB) and LBW with the incidence of stunting in grade 1 students at Sambek public elementary school, Wonososbo district; 2015
34. Soetjiningsih., IG. NG Ranuh. Child Development Edition 2. EGC. Jakarta; 2015
35. Hafid, F & Nasrul, N. Risk Factors for Stunting in Children aged 6-23 Months in Jeneponto Regency, Indonesian Journal of Human Nutrition, 3(1); 2016
36. Rahmadi Antun, Sumardilah. Risk of stunting in children under the age of 7-24 months. Vol 10, p 93-104; 2019
37. Peng, YM Huang, B. Biro, F. & Slap, G. Outcome of Low Birthweight in China: A 16-year longitudinal study.;2015
38. Paudel Rajan, Pradhan Bandana, Wagle RR, Pahari Prasada Durga, Onta SR. et al. Risk Factors For Stunting Among Children: A Community Based Case Control Study In Nepal. Kathmandu University Med J. 2012; 10 (39): 18-24