Comparison of high and low stunting reduction groups using IFE-EFE matrix analysis in Central Java Province, Indonesia.

Background: The results of the 2021 Indonesian Nutritional Status Study (Studi Status Gizi Indonesia, SSGI) showed a 6.8% declining prevalence of stunting in Central Java from 2019 to 2021. However, the prevalence decreases in the regency level of Central Java varied from 0.1 to 20.3%. This study aimed to analyze the external and internal factors that influenced the stunting reduction prevalence in Central Java Province, Indonesia. Methods: This qualitative study was conducted over 2 months, from April to May 2022. In-depth interviews were used to explore the supporting factors (external, internal, and strategies) and the challenges (internal, external, and solutions) in implementing stunting reduction acceleration programs. The supporting factors and challenges were compared between the groups with high Gro, Sra, Kla, and Pek (GSKP) and low Sur, Mag, Teg, and Pat (SMTP) reduction prevalence. Data were analyzed using internal factor evaluation (IFE) and external factor evaluation (EFE). Results: In quadrant II, the high-reduction group (GSKP) had IFE and EFE scores of 2.61 and 2.76, respectively. In quadrant IV, the low-reduction group (SMTP) had IFE and EFE scores of 1.86 and 1.62, respectively. The high-reduction group (GSKP) was better than the low-reduction group (SMTP) in using external opportunities and internal strengths by avoiding external threats and minimizing the weakness in the stunting reduction acceleration program in each area. The existence of superior programs and innovations were the strengths that differentiated the high and low groups. Conversely, the low-stunting reduction group struggled to overcome major challenges, especially lacking leadership capacity. From the outside, lack of program sustainability at the village level and budget restraint were the threats found in both groups. Conclusion: Compared with the low-stunting reduction group, the high group could maximize their strengths and use the opportunities to implement stunting reduction programs.

Determinants of length for age Z scores among children aged 6-23 months in Central Java, Indonesia: a path analysis.

Introduction: Length for Age Z (LAZ) score determinants are complex and vary among different areas, but it is important for designing effective and efficient strategies to decrease stunting prevalence among children under 2 years. This study aimed to investigate the determinants of LAZ scores among children under 2 years in Central Java, Indonesia. Methods: This study was conducted on the 2021 Indonesian Nutritional Status Study (INSS) dataset, which was a cross-sectional survey. Data on 3,430 children aged 6-23 months from Central Java province were derived from the 2021 INSS data. After missing data elimination, 3,238 subjects were included in the analysis. Determinant factors included direct and indirect factors. Direct factors were the mother's age, birth weight Z score (BWZ), birth length Z score (BLZ), exclusively breastfed history, dietary diversity scores (DDS), empty calorie drink consumption, unhealthy snacks consumption, and infections. Indirect factors were early initiation of breastfeeding (EIBF) and posyandu (integrated health post) utilization. Underlying factors were socioeconomic status (SES) and the mother's education. Bivariate analyses and multiple linear regressions were conducted. A path analysis with a hypothesized model based on the UNICEF conceptual framework was also performed. Results: Stunting, wasting and underweight proportions among the subjects were 19.1%, 7.6% and 12.3%, respectively. The mean LAZ scores were -0.95 ± 1.22; the mother's age was 29.7 ± 5.95 years; BWZ was -0.47 ± 0.97; BLZ was -0.55 ± 1.05; and DDS was 4.45 ± 1.51. The infection proportion among the subjects was 28%. BWZ and BLZ were positively correlated to LAZ scores, with r = 0.267 (p < 0.01) and r = 0.260 (p < 0.01), respectively. The mother's age was negatively correlated to LAZ scores with r = -0.041 (p < 0.05). Maternal education was positively correlated to SES but had no direct effect on LAZ scores. LAZ score determinants of BLZ (p < 0.001) and SES (p < 0.001) showed positive direct associations with LAZ scores, but the mother's age (p = 0.039), exclusively breastfed history (p < 0.001), and empty calorie drinks consumption (p < 0.001) had negative associations with LAZ scores. Conclusion: To prevent stunting among children aged 6-23 months in Central Java, Indonesia, intervention programs to increase the nutritional status of women at child-bearing age and nutrition education on child feeding practices should be conducted more efficiently and effectively.