Risk factors associated with childhood stunting in Indonesia: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: In Indonesia, stunting is one of the most public health concerns. This study aims to systematically review and meta-analyze childhood stunting risk factors in the country. METHODS AND STUDY DESIGN: We did a systematic review and meta-analysis of observational (cross-sectional and longitudi-nal) studies on stunting risk factors published between 2010 and 2021 based on available publications in online databases of PubMed, ProQuest, EBSCO, and google scholar. The quality of the publications was evaluated using the Newcastle-Ottawa Quality Assessment Scale and organized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Publication bias was examined using Egger's and Begg's tests. RESULTS: A total of 17 studies from the literature search satisfied the inclusion criteria, with 642,596 subjects. The pooled stunting prevalence was 30.9% (95% CI 25.0%-36.8%). Children born with low birth weight (POR 2.39, 2.07-2.76), female (POR 1.05, 1.03-1.08), and did not get the deworming program (1.10, 1.07-1.12) are the primary child characteristics that contributed to stunting. Meanwhile, maternal age ≥ 30 years (POR 2.33, 2.23-2.44), preterm birth (POR 2.12, 2.15-2.19), and antenatal care <4 times (POR 1.25, 1.11-1.41) were among mother characteristics consistently associated with stunting. The primary household and community risk factors for stunting were food insecurity (POR 2.00, 1.37-2.92), unimproved drinking water (POR 1.42, 1.26-1.60), rural residence (POR 1.31, 1.20-1.42), and unimproved sanitation (POR 1.27, 1.12-1.44). CONCLUSIONS: A diverse range of risk factors associated with childhood stunting in In-donesia demonstrates the need to emphasize nutrition programs by scaling up to more on these determinants.

Effectiveness of optimized food-based recommendation promotion to improve nutritional status and lipid profiles among Minangkabau women with dyslipidemia: A cluster-randomized trial.

BACKGROUND: In women of Minangkabau ethnicity, a high prevalence of dyslipidemia, overweight, and obesity is thought to be closely related to poor dietary practices. Promotion of local specific food-based recommendations (FBRs) was previously found to be effective in improving dietary practice and nutrient intakes related to dyslipidemia. This study aimed to describe the effects of the FBR promotion on the nutritional status and lipid profiles of Minangkabau women with dyslipidemia. METHODS: We used a cluster-randomized design with a total subject of 123 Minangkabau women of reproductive age with dyslipidemia. They were recruited from 16 sub-villages and assigned to either the FBR group (n = 61) or the non-FBR group (n = 62). Data on body weight, height, waist circumference, and lipid profiles were collected at the baseline and the end of the trial. Linear mixed model analysis was used to analyze the effect of the intervention on nutritional status and lipid profiles. RESULTS: The mean effect (95% confidence interval) of the intervention on body weight, body mass index, and waist circumference for the FBR group versus the non-FBR group were -1.1 (-1.8; -0.39) kg, -0.43(-0.76; -0.11) kg/m2 and -2.1(-3.7;-0.46) mm respectively (p <0.05). The Castelli's index in the FBR group improved, but there was no significant between-group difference in the change of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides at the end of the intervention. CONCLUSION: The promotion of the FBRs positively impact the nutritional status but did not significantly affect the blood lipid profile of Minangkabau women with dyslipidemia. TRIAL REGISTRATION: The trial was retrospectively registered at ClinicalTrials.gov Protocol Registration and Result System (PRS) as NCT04085874, in September 2019.

Factors driving and inhibiting stunting reduction acceleration programs at district level: A qualitative study in West Sumatra.

Stunting prevalence varies significantly across Indonesian provinces and districts/municipalities, including West Sumatra. This research aims to identify the driving and inhibiting factors for implementing the stunting reduction acceleration program at the district level in West Sumatra. The research was conducted in 2022 with a qualitative study design and a case study approach. Data were collected through (i) group interviews with key informants involving policymakers and program managers at the provincial, district, sub-district, and village levels and (ii) in-depth interviews with mothers of stunted children. Two districts were selected as research sites. One district represents an area that has yet to be developed (District A or failed district). The other district has seen a significant reduction in the prevalence of stunting (District B or successful district). We found several driving and inhibiting factors that affect the reduced prevalence of stunting, such as the need for the relevant agency to play a strong role as the leading and responsible sector for stunting convergence actions. Another important factor is paying close attention to improving the quality of stunting data and providing adequate funding support. High commitment from Public Health Centers to maternal health through classes for pregnant women, infants, and children under the age of five can also have an impact. Furthermore, properly performing duties by assigned actors in specific and sensitive programs and integrated monitoring and evaluation of program implementation and outcomes can influence stunting prevalence. Recommendations for accelerating stunting reduction include improving communication and coordination, establishing stunting prevalence reduction as a performance indicator among the related district government and its various agencies, and assisting the village administration with planning and budgeting to support stunting prevention.