Examining the Different Pathways to Stunting Among Children Under Five Years Old in a Low-Middle Income Country

Stunting is a multi-cause growth failure affecting the growth and development of children. The Government of Indonesia is implementing a National Strategy to Accelerate Stunting Prevention in order to ensure that it targets all individuals including those in the critical period of "the first 1000 days of life" —those with pregnant women or children under the age of two —can access the full package program of services essential to stunting prevention. Indonesia has successfully reduced stunting prevalence, by about 6.4% during 5 years between 2013 and 2018. The present study focused on analyzing the pathway of possible factors affecting stunting, among children under five based on national data from the 2013 and 2018 Indonesia Basic Health Surveys (IBHS). The partial least squares structural equation modeling (PLS-SEM) was used to identify the different pathways affecting stunting in the two data sets. This study found the different pathway within the data from the 2013 and 2018 IBHS. Stunting was significantly affected by birth size (T value=9.78) (low weight and length birth), as well as, the disease factors (T=2.48) in 2013, but only birth size (T=8.75) in 2018. In 2013, socio-economic factors affected stunting indirectly (T=1.497) through maternal factors (T=13.86) that influence disease (T=5.235) via exclusive breastfeeding (T=3.531). This study found that, Low Birth Weight (LBW) babies were two to three times more likely to be stunted children. Click or tap here to enter text. Overall, the stunting prevalence across regions in Indonesia demonstrated a decreasing trend from 2013 (38.4%) and reached lower in 2018 (33.9%). The 2013 IBHS showed an indirect effect of socioeconomic factors on stunting through the pathways of maternal factors, breastfeeding practices, and disease. This indirect effect was not found in the 2018 IBHS. There were different pathways of factors affecting stunting between the two datasets of the 2013 and 2018 basic health survey, but the consistent factor is the birth size (birth weight and length). Birth size is the most important determinant of stunting in Indonesia and must be prioritized and addressed immediately.