Infectious Disease and Maternal Factors Associated with Stunting among Children in Mimika, Central Papua: A Case–Control Study
DOI:
https://doi.org/10.32382/medkes.v21i1.2186Keywords:
Stunting, infectious disease, low birth weight, maternal health, socioeconomic factors, PapuaAbstract
Child stunting persists as a critical nutritional challenge in Indonesia, with a disproportionately high burden in its eastern provinces, where infectious diseases are endemic. This study aimed to identify the determinants of stunting among children aged 24–59 months in Mimika District, Papua Tengah. A retrospective case–control study was carried out in the service area of the Pasar Sentral Primary Health Center. The analysis included 330 children aged 24–59 months, including 110 stunted cases and 220 controls, who were recruited from the same community health posts; controls were selected using simple random sampling with a 1:2 case-to-control ratio Information was obtained through structured interviews with caregivers and the verification of health records, including maternal and child health books and the electronic community-based nutrition recording system (e-PPGM). The associations between potential risk factors and stunting were evaluated using chi-square tests, followed by multivariable logistic regression analysis. A history of infectious disease had the strongest association (aOR 4.81; 95% CI 2.69–8.58). Additional factors associated with stunting were household income below the provincial minimum wage (aOR 3.52; 95% CI 1.98–6.26), low maternal education (aOR 2.92; 95% CI 1.63–5.23), low birth weight (aOR 2.78; 95% CI 1.37–5.64), incomplete immunization (aOR 2.21; 95% CI 1.24–3.94), lack of exclusive breastfeeding (aOR 2.32; 95% CI 1.29–4.16), incomplete antenatal care visits (aOR 1.96; 95% CI 1.10–3.49), and maternal anemia during pregnancy (aOR 1.85; 95% CI 1.04–3.30). Integrated strategies focusing on infection prevention, maternal and child health services, and household living conditions are needed to reduce stunting in malaria-endemic areas.
References
UNICEF, World Health Organization, World Bank Group. Levels and trends in child malnutrition: Key findings of the 2023 edition of the Joint Malnutrition Estimates. Geneva: 2023.
2. Kementerian Kesehatan Republik Indonesia. Survei Kesehatan Indonesia (SKI) 2023. Jakarta: Kementerian Kesehatan Republik Indonesia, 2024.
3. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. The lancet. 2013;382(9890):427-51.
4. Kementerian Kesehatan Republik Indonesia. Hasil survei status gizi Indonesia (SSGI) 2024. Jakarta: Kementerian Kesehatan Republik Indonesia, 2025.
5. Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia 2023. Jakarta: Kementerian Kesehatan Republik Indonesia,, 2024.
6. Karyana M, Devine A, Kenangalem E, Burdarm L, Poespoprodjo JR, Vemuri R, et al. Treatment-seeking behaviour and associated costs for malaria in Papua, Indonesia. Malaria journal. 2016;15(1):536.
7. Masrif, Ngardita IR, Sahiddin M, Pramestiyani M, Mashar H, Annah I. Paparan malaria maternal dan bayi berat lahir rendah: studi kasus-kontrol di daerah endemik malaria Papua, Indonesia: Maternal malaria exposure and low birth weight: a case-control study in malaria-endemic Papua, Indonesia. JURNAL KEPERAWATAN TROPIS PAPUA. 2025;8(1):1-7.
8. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. The lancet. 2008;371(9609):340-57.
9. Das D, Grais RF, Okiro EA, Stepniewska K, Mansoor R, van der Kam S, et al. Complex interactions between malaria and malnutrition: a systematic literature review. BMC Med. 2018;16(1):186.
10. Gari T, Loha E, Deressa W, Solomon T, Lindtjørn B. Malaria increased the risk of stunting and wasting among young children in Ethiopia: results of a cohort study. PloS one. 2018;13(1):e0190983.
11. Kang H, Kreuels B, Adjei O, Krumkamp R, May J, Small DS. The causal effect of malaria on stunting: a Mendelian randomization and matching approach. International journal of epidemiology. 2013;42(5):1390-8.
12. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. The Lancet Global Health. 2013;1(1):e16-e25.
13. Vollmer S, Bommer C, Krishna A, Harttgen K, Subramanian S. The association of parental education with childhood undernutrition in low-and middle-income countries: comparing the role of paternal and maternal education. International journal of epidemiology. 2017;46(1):312-23.
14. Hadi H, Fatimatasari F, Irwanti W, Kusuma C, Alfiana RD, Asshiddiqi MIN, et al. Exclusive breastfeeding protects young children from stunting in a low-income population: a study from Eastern Indonesia. Nutrients. 2021;13(12):4264.
15. Kementerian Kesehatan Republik Indonesia. Pedoman praktis manajemen program imunisasi puskesmas. Jakarta: Direktorat Jenderal Pencegahan dan Pengendalian Penyakit, Kementerian Kesehatan Republik Indonesia; 2023.
16. Tarigan N, Simanjuntak RR, Nainggolan O. Maternal age at birth and low birth weight (LBW) in Indonesia (Analysis of Riskesdas 2018). Gizi Indonesia. 2023;46(1):1-10.
17. Felle Z, Sahiddin M. Unraveling Potential Confounding Variables in the Association Between Maternal Malaria and Child Stunting in Papua: A Case-Control Study with Mantel-Haenszel Analysis. Public Health of Indonesia. 2024;10(1):33-42.
18. Sahiddin M, Ishak H, Arsin AA, Pramestiyani M. Impact of early-life malaria exposure on childhood stunting: A case-control study in high endemic malaria area, Papua, Indonesia. Narra J. 2024;4(3):e1451.
19. Amriviana MP, Khairunnisa C, Sasongko TH. Parental stature as a risk factor for stunting in Indonesia: A systematic review and meta-analysis. Narra J. 2023;3(2):e144.
20. Jokhu LA, Syauqy A, Lin L-Y, Dieny FF, Rahadiyanti A. Determinants of stunting among children 6–23 months: a population-based study in Indonesia. Nutrition & Food Science. 2024;54(8):1369-82.
21. Prendergast AJ, Humphrey JH. The stunting syndrome in developing countries. Paediatrics and International Child Health. 2014;34(4):250-65.
22. Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, Morris SS, et al. Multi-country analysis of the effects of diarrhoea on childhood stunting. International Journal of Epidemiology. 2008;37(4):816-30.
23. Richard SA, Black RE, Gilman RH, Guerrant RL, Kang G, Lanata CF, et al. Diarrhea in Early Childhood: Short-term Association With Weight and Long-term Association With Length. American Journal of Epidemiology. 2013;178(7):1129-38.
24. Heriana C, Heryanto ML, Herwandar FR, Latifa NN. Environmental Risk Determinants Associated With Stunting in Children in Tasikmalaya, Indonesia: A Public Health Surveillancebased Retrospective Studies. Malaysian Journal of Medicine & Health Sciences. 2024;20.
25. Danaei G, Andrews KG, Sudfeld CR, Fink G, McCoy DC, Peet E, et al. Risk factors for childhood stunting in 137 developing countries: a comparative risk assessment analysis at global, regional, and country levels. PLoS medicine. 2016;13(11):e1002164.
26. Kustanto A, Rachmat O, Setyadi S. The prevalence of stunting in Indonesia: An examination of the health, socioeconomic status, and environmental determinants. Journal of Iranian Medical Council. 2024;8(1).
27. Torlesse H, Cronin AA, Sebayang SK, Nandy R. Determinants of stunting in Indonesian children: evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction. BMC Public Health. 2016;16(1):669.
28. Beal T, Tumilowicz A, Sutrisna A, Izwardy D, Neufeld LM. A review of child stunting determinants in Indonesia. Maternal & child nutrition. 2018;14(4):e12617.
29. Lubis Z, Bukit J. Determinants of stunting in Indonesia: investigating key factors influencing child growth. J Ecohuman. 2024;3(7):249-59.
30. Vats H, Walia GK, Saxena R, Sachdeva MP, Gupta V. Association of low birth weight with the risk of childhood stunting in low-and middle-income countries: A systematic review and meta-analysis. Neonatology. 2024;121(2):244-57.
31. Rijken MJ, De Livera AM, Lee SJ, Boel ME, Rungwilailaekhiri S, Wiladphaingern J, et al. Quantifying low birth weight, preterm birth and small-for-gestational-age effects of malaria in pregnancy: a population cohort study. PloS one. 2014;9(7):e100247.
32. Mal-Ed Network Investigators. Childhood stunting in relation to the pre-and postnatal environment during the first 2 years of life: the MAL-ED longitudinal birth cohort study. PLoS medicine. 2017;14(10):e1002408.
33. Zheng Y, Correa-Silva S, Palmeira P, Carneiro-Sampaio M. Maternal vaccination as an additional approach to improve the protection of the nursling: Anti-infective properties of breast milk. Clinics (Sao Paulo, Brazil). 2022;77:100093.
34. Georgieff MK. Iron deficiency in pregnancy. American journal of obstetrics and gynecology. 2020;223(4):516-24.
35. Martin S, Mutuku F, Sessions J, Lee J, Mukoko D, Malhotra I, et al. Factors associated with early childhood stunted growth in a 2012–2015 birth cohort monitored in the rural Msambweni area of coastal Kenya: a cross-sectional study. BMC Pediatrics. 2020;20(1):208.
