Analysis of Risk Factors for Stunting in Toddlers
Abstract
Stunting has been a significant public health burden in Indonesia, reflecting chronic malnutrition during the critical first 1,000 days of life. Despite a national decline, local prevalence in rural areas, such as in Langkat District, remains a challenge. This study aims to analyze interrelated risk factors: maternal knowledge, antenatal care (ANC) visits, iron supplementation, exclusive breastfeeding, and complementary feeding, that contribute to stunting in toddlers. A cross-sectional study was conducted in the working area of the Secanggang Community Health Center, Langkat. A total of 162 toddlers participated in this study. Data were collected through interviews with mothers and anthropometric measurements. Bivariate analysis was performed using the Chi-square test to determine the relationship between variables. The prevalence of stunting was 40.7% (n=66). Statistical analysis showed that all factors studied were significantly associated with stunting (p < 0.05). Mothers' knowledge about stunting was generally low (70.4%). The highest risk was found in infants who did not receive exclusive breastfeeding, where 25.9% experienced stunting compared to those who received exclusive breastfeeding. Inadequate ANC visits (p < 0.05) and poor adherence to iron (Fe) tablets (p < 0.05) also significantly increased the risk of growth failure. Stunting in this population is triggered by the interaction between low maternal literacy and suboptimal antenatal and postnatal care. These findings indicate an urgent need for maternal education programs and breastfeeding support integrated into the primary health care (Puskesmas) framework to reduce long-term growth disorders.
Keywords: Maternal Knowledge, Antenatal Care, Exclusive Breastfeeding, Stunting, Toddlers
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Abri, N. (2022). Identification of Socio-Demographic Factors with the Incidence of Stunting in Elementary School Children in Rural Enrekang. Journal of Health and Nutrition Research, 1(2), 88–94. https://doi.org/https://doi.org/10.56303/jhnresearch.v1i1.20
Adilah, H., Syafiq, A., & Sukoso. (2023). Correlation Of Anemia In Pregnant Women With Stunting Incidence : A Review. Indonesian Journal of Multidisciplinary Science, 2(9), 3155–3169.
Aisyah, N., Putri, S., Adiwinoto, R. P., Arundani, P., & Nugraheni, P. A. (2024). The Relationship Between Feeding Patterns and Maternal Knowledge about Nutrition with the Incidence of Stunting in Children Age 0-5 Years in the Working Area of the Gedongan Health Center , Mojokerto City. AgriHealth: Journal of Agri-Food, Nutrition and Public Health, 5(1), 21–28. https://doi.org/http://dx.doi.org/10.20961/agrihealth.v5i1.83808
Ali, A. (2023). Brain and Stunting : Integrative Clinical and Community Stunting Prevention Perspectives in Disorders of Brain Development. International Journal Papier Public Review, 4(1), 60–69. https://doi.org/https://doi.org/10.47667/ijppr.v4i1.216
Anyanwu, O., Ghosh, S., Kershaw, M., Cherinet, A., & Kennedy, E. (2022). Dietary Outcomes, Nutritional Status, and Household Water, Sanitation, and Hygiene (WASH) Practices. Current Developments in Nutrition, 6(4). https://doi.org/https://doi.org/10.1093/cdn/nzac020
Aprilina, H. D., Nurkhasanah, S., & Hisbulloh, L. (2021). Mother ’s nutritional knowledge and behavior to stunting prevalence among children under two years old : case-control. Bali Medical Journal (Bali MedJ), 10(3), 1211–1215. https://doi.org/10.15562/bmj.v10i3.2868
Astuti, A., Muyassaroh, Y., & Ani, M. (2020). The Relationship Between Mother’s Pregnancy History and Baby’s Birth to the incidence of stunting in infants. Journal of Midwifery Science : Basic and Applied Research, 2(1), 1–5. https://doi.org/http://ejournal.poltekkes-smg.ac.id/ojs/index.php/JOMISBAR/manager
Aswi, A., Rahardiantoro, S., Kurnia, A., Sartono, B., Handayani, D., Nurwan, & Cramb, S. (2024). Childhood stunting in Indonesia: assessing the performance of Bayesian spatial conditional autoregressive models. Geospatial Health, 19(2). https://doi.org/10.4081/gh.2024.1321
Beal, T., Tumilowicz, A., Sutrisna, A., Izwardy, D., & Neufeld, L. M. (2018). A review of child stunting determinants in Indonesia. Maternal and Child Nutrition, 14(4), 1–10. https://doi.org/10.1111/mcn.12617
Cerf, M. E. (2023). Maternal and Child Health , Non-Communicable Diseases and Metabolites. Metabolites, 13(6), 1–20. https://doi.org/https://doi.org/10.3390/metabo13060756
Clara, M., Ribeiro, S. A., Sousa, L. S. De, Aldo, Â., Lima, M., Leal, B., & Maciel, L. (2025). Undernutrition and Intestinal Infections in Children : A Narrative Review. Nutrients, 17(9), 1–32. https://doi.org/https://doi.org/10.3390/nu17091479
Fatmah, M., Yantina, Y., & Nurliyani. (2023). The Relationship Between The Mother Factor. JKM (Jurnal Kebidanan Malahayati), 9(2), 307–311. https://doi.org/10.33024
Gabain, I. L., Ramsteijn, A. S., & Webster, J. P. (2023). Parasites and childhood stunting – a mechanistic interplay with nutrition, anaemia, gut health, microbiota, and epigenetics. Trends in Parasitology, 39(3), 167–180. https://doi.org/10.1016/j.pt.2022.12.004
Hadi, H., Fatimatasari, F., Irwanti, W., Kusuma, C., Alfiana, R. D., Asshiddiqi, M. I. N., Nugroho, S., Lewis, E. C., & Gittelsohn, J. (2021). Exclusive Breastfeeding Protects Young Children from Stunting in a Low-Income Population : A Study from Eastern Indonesia. Nutrients, 13, 1–14. https://doi.org/https://doi.org/10.3390/nu13124264
Hadi, M. (2023). Association Between Exclusive Breastfeeding and Stunting in Children : A Systematic Review. Journal of Advance Research in Medical & Health Science, 9(6), 90–94. https://doi.org/https://doi.org/10.53555/nnmhs.v9i6.1740
Harumi, A. M., Wardani, N. E. K., & Sholikah, S. M. (2025). Relationship Between Antenatal Care History and Parenting Patterns with the Incidence of Stunting in Toddlers. Journal La Medihealtico, 06(01), 10–19. https://doi.org/10.37899/journallamedihealtico.v6i1.1709
Hasni, D., Anugrah, N. S., Asri, Z. Al, Jelmila, S. N., & Baiturrahmah, U. (2023). The Relationship Between Exclusive Breastfeeding and. Nusantara Hasana Journal, 3(7), 161–173. https://doi.org/https://doi.org/10.59003/nhj.v3i7.1081
Hidayati, T., & Pratiwi, R. C. D. (2022). The Correlation Between Feeding Patterns and The Incidence of Stunting in Children Aged 0-59 Months. Journal of Health Science, 15(2), 126–131. https://doi.org/https://doi.org/10.33086/jhs.v15i02.2732
Joe, W., Prakash, A., Azimi, S. M. Y., Galvin, M., & Murira, Z. (2025). Levels , severity , and determinants of stunting in children 0 – 59 months in Afghanistan : Secondary analysis of Multiple Indicator Cluster Survey , 2022-23. PLOS Glob Public Health, 5(4), 1–18. https://doi.org/10.1371/journal.pgph.0004423
Limardi, S., Hasanah, D. M., Made, N., & Utami, D. (2022). Dietary intake and stunting in children aged 6-23 months in rural Sumba, Indonesia. Pediatric Nutrition & Metabolic Disease, 62(5), 341–356. https://doi.org/https://doi.org/10.14238/pi62.5.2022.341-56
Malonda, N. S. H., Warouw, F., Kawatu, P. A. T., & Sanggelorang, Y. (2020). History of Exclusive Breastfeeding and Complementary Feeding as a Risk Factor of Stunting in Children Age 36-59 Months in Coastal Areas. Journal of Health, Medicine and Nursing, 70, 52–57. https://doi.org/http://www.iiste.org/
Marita, Z., Okinarum, G. Y., Huda, M. H., & Dwihestie, L. K. (2023). Analysis of Stunting Incidents Based on Mother ’ s Knowledge. International Journal of Nursing Information (IJNI), 2(2), 1–6. https://doi.org/10.58418/Ijni.V2i2.54
Masuke, R., Msuya, S. E., Mahande, J. M., Diarz, E. J., Stray-, B., Jahanpour, O., & Mgongo, M. (2021). Effect of inappropriate complementary feeding practices on the nutritional status of children aged 6-24 months in urban Moshi , Northern Tanzania : Cohort study. PLoS ONE, 16(5), 1–16. https://doi.org/10.1371/journal.pone.0250562
Ministry of Health of Indonesia. (2020). Buletin Jendela Data dan Informasi Kesehatan: Situasi Balita Pendek (Stunting) di Indonesia. Jakarta : Ministry of Health of Indonesia.
Ministry of Health of Indonesia. (2024). Hasil Survei Status Gizi Indonesia (SSGI) 2024. Jakarta : Ministry of Health of Indonesia.
Montenegro, C. R., Dvoretskiy, S., Gomez, G., Dewitt, T., Hincapie, O., Gracia, D., & Misas, J. D. (2022). The pediatric global burden of stunting : Focus on Latin America. Lifestyle Medicine, 3(June), 1–11. https://doi.org/https://doi.org/10.1002/lim2.67
Muslimatun, S., Ade, L., & Wiradnyani, A. (2016). Dietary diversity , animal source food consumption and linear growth among children aged 1 – 5 years in Bandung , Indonesia : a longitudinal observational study. 116. https://doi.org/10.1017/S0007114515005395
Nisar, Y. Bin, Aguayo, V. M., Billah, S. M., & Dibley, M. J. (2020). Antenatal Iron-Folic Acid Supplementation Is Associated with Improved Linear Growth and Reduced Risk of Stunting or Severe Stunting in South Asian Children Less than Two Years of Age : A Pooled Analysis from Seven Countries. Nutrients, 12, 1–19. https://doi.org/http://dx.doi.org/10.3390/nu12092632
Oktarina, C., Dilantika, C., Sitorus, N. L., & Basrowi, R. W. (2024). Relationship Between Iron Deficiency Anemia and Stunting in Pediatric Populations in Developing Countries : A Systematic Review and Meta-Analysis. Children, 11, 1–14. https://doi.org/https://doi.org/10.3390/children11101268
Qomah, I., Takziah, M., & Rahmayanti, R. (2024). The Relationship between mother’s knowledge and the incidence of stunting in toddlers in polindes, mundar village, south labuan amas district, hulu sungai tengah regency in 2024. Journal of Health Management and Pharmacy Exploration, 2(2), 33–42. https://doi.org/https://shmpublisher.com/index.php/johmpe/article/view/383
Ramadhan, M. F., Dimiati, H., Hidayaturrahmi, & Indah, R. (2024). The Correlation between Stunting, Maternal Knowledge, and Nutritional Care in Aceh, Indonesia. Amerta Nutrition, 8(4), 513–518. https://doi.org/10.20473/amnt.v8i4.2024.513-518
Renn, O., Laubichler, M., Lucas, K., Kröger, W., Schanze, J., Scholz, R. W., & Schweizer, P. (2022). Systemic Risks from Different Perspectives. Risk Analysis, 42(9), 1902–1920. https://doi.org/https://doi.org/10.1111/risa.13657
Saavedra, J. M., & Prentice, A. M. (2022). Nutrition in school-age children : a rationale for revisiting priorities. Nutrition Reviews, 81(7), 823–843. https://doi.org/https://doi.org/10.1093/nutrit/nuac089
Santoso, C. A., & Sodik, M. A. (2025). The Relationship Between Pregnant Women ’ s Participation in Pregnant Women ’ s Classes and Integrated ANC ( Ante Natal Care ) With the Incidence of Stunting in Toddlers in The Work Area of Pesantren I Public Health Center Kediri City. Indonesian Journal of Nutritional Epidemiology and Reproductive, 8(2), 49–53. https://doi.org/https://doi.org/10.30994/ijner.v8i2.334
Sari, K., & Sartika, R. A. D. (2023). The Impact of Iron Supplementation During Pregnancy and Change of Consumption among Stunting Children Aged 6 ‑ 24 Months During the COVID ‑ 19 Pandemic in Indonesia. International Journal of Preventive Medicine, 14(18), 1–7. https://doi.org/10.4103/ijpvm.ijpvm
Sari, N., Randell, M., Sari, N., Manjorang, M., & Randell, M. (2021). Exclusive Breastfeeding History Risk Factor Associated with Stunting of Children Aged 12 – 23 Months Exclusive Breastfeeding History Risk Factor Associated with Stunting of Children Aged 12 – 23 Months. Kesmas, 16(1), 28–32. https://doi.org/10.21109/kesmas.v16i1.3291
Scheffler, C., Hermanussen, M., Bogin, B., Liana, D. S., Taolin, F., Cempaka, P. M. V. P., & Irawan, M. (2020). Stunting is not a synonym of malnutrition. European Journal of Clinical Nutrition, 74, 377–386. https://doi.org/10.1038/s41430-019-0439-4
Setyowati, E., Musfiroh, M., Arief, I., Samsuddin, & Sari, A. L. (2022). Exclusive Breastfeeding as an Effort to Prevent Stunting in Toddlers. NeuroQuantology, 20(5), 3668–3675. https://doi.org/10.14704/nq.2022.20.5.NQ22664
Simbolon, D., Adevianti, D., Setianingsih, L., & Andriani, L. (2021). The Relationship Between Maternal And Child Health Services With The Prevalence Of Stunting Based On The Basic Health Research In Indonesia. The Indonesian Journal of Public Health, 16(2), 177–187. https://doi.org/10.20473/ijph.vl16il.2021.177-187
Siregar, R. J., Harahap, M. L., & Suryani, E. (2024). Determinants of Stunting Among Children Under Five Years in Indonesia : Evidence from the 2021-2022 Demographic and Health Survey. International Journal of Public Health Excellence (IJPHE), 3(2), 666–676. https://doi.org/10.55299/ijphe.v3i2.794
Soesanti, I., Saptandari, P., Adiningsih, & Qomaruddin, M. B. (2020). The practice of complementary feeding among stunted children under the age of two. Infectious Disease Reports, 12(1), 29–32. https://doi.org/10.4081/idr.2020
Soliman, N., Soliman, A., Alyafei, F., Elsiddig, S., Alaaraj, N., Hamed, N., Ahmed, S., & Itani, M. (2024). Persistent Global Burden of Stunting Among. European Journal of Medical and Health Sciences, 6(2), 15–20. https://doi.org/https://doi.org/10.24018/ejmed.2024.6.2.2080
Sudarianti, Susanti, R., & Sari, R. A. (2022). Mother ’s Behavior and Knowledge in Preventing Stunting Through Breastfeeding Complementary Feeding to Children Aged 6-24 Months. Science Midwifery, 10(4), 3156–3163. https://doi.org/https://doi.org/10.35335/midwifery.v10i4.782
Suryani, E. (2025). The Relationship Between Nutritional Care Patterns and ANC Frequency with Stunting Incidence in Newborns : A Prospective Cohort Study in North Sumatra. Journal of Public Health Sciences, 4(03), 298–324. https://doi.org/10.56741/IISTR.jphs.001102
Tello, B., Rivadeneira, M. F., Moncayo, A. L., Buitrón, J., Astudillo, F., Estrella, A., & Torres, A. L. (2022). Breastfeeding , feeding practices and stunting in indigenous Ecuadorians under 2 years of age. International Breastfeeding Journal, 17(19), 1–15. https://doi.org/https://doi.org/10.1186/s13006-022-00461-0
Traore, S. S., Bo, Y., Kou, G., & Lyu, Q. (2023). Iron supplementation and deworming during pregnancy reduces the risk of anemia and stunting in infants less than 2 years of age : a study from Sub ‑ Saharan Africa. BMC Pregnancy and Childbirth, 1–8. https://doi.org/10.1186/s12884-023-05399-7
Triana, N. Y., Faculty, H., Java, C., Haniyah, S., Faculty, H., & Java, C. (2020). Relationship of Exclusive Breastfeeding , Complementary Feeding and Nutritional Intake with Stunting in Children in Karanglewas Health Center. Advances in Health Sciences Research, 20, 74–78. https://doi.org/https://doi.org/10.2991/ahsr.k.200204.017
Umiyah, A., & Hamidiyah, A. (2020). Exclusive Breastfeeding With Stunting. STRADA Jurnal Ilmiah Kesehatan, 9(2), 471–477. https://doi.org/10.30994/sjik.v9i2.454
Virginia, A., Maryanto, S., & Anugrah, R. M. (2020). The Correlation Between Complementary Feeding And First Complementary Feeding Time With Stunting In Children Of 6-24 Months In Leyangan Village, East Ungaran, Semarang Regency. Jurnal Gizi Dan Kesehatan, 12(27), 29–39.
Wahyuni, F. C., Karomah, U., Basrowi, R. W., Sitorus, N. L., & Lestari, L. A. (2023). The Relationship between Nutrition Literacy and Nutrition Knowledge with the Incidence of Stunting : A Scoping Review Hubungan Literasi Gizi dan Pengetahuan Gizi terhadap Kejadian Stunting : A Scoping Review. Amerta Nutrition, 7(3), 71–85. https://doi.org/10.20473/amnt.v7i3SP.2023.71-85
DOI: http://dx.doi.org/10.30829/contagion.v8i1.25622
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