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 Epidemiology and Society Health Review| ESHR 
Vol. 5, No. 1, 2023, pp. 51-59 ISSN 2656-6052 (online) | 2656-1107 (print) 
      http://journal2.uad.ac.id/index.php/eshr/index                                                eshr@ikm.uad.ac.id 

 

 

10.26555/eshr.v5i1.7229 

 
 

51 

 
 

 

Review Article   
 
The relationship between household good security and 
incidence of stunting in toddlers during the new normal:  
A systematic review 
 
Dwi Syaputri Yanti1*, Sumardiyono2, Kusnandar3  

1 Department of Human Nutrition, Universitas Sebelas Maret, Surakarta, Indonesia 
2 Department of Occupational Safety and Health Vocational School, Universitas Sebelas 

Maret, Surakarta, Indonesia 
3 Department of Agribusiness, Faculty of Agriculture, Universitas Sebelas Maret, Surakarta, 
  Indonesia 

 
* Correspondence: dwisyaputriy@gmail.com. Phone: +6282387047115 
 
Received 09 January 2023; Accepted 13 March 2023; Published 13 March 2023 
 

ABSTRACT 

Background: Stunting is a growth disorder and malnutrition problem experienced by 
toddlers worldwide and affects the quality of human resources that have an essential role 
in developing a nation. Households experiencing food insecurity led to a lack of nutritional 
intake and stunting. This work aimed to analyze the relationship between household food 
security with the incidence of stunting in toddlers during the new normal era. 
Method: This was a systematic review design conducted by searching relevant articles from 
some databases: Google Scholar, PubMed, and Science Direct using the keywords 
(“Household Food Security” OR “Food Security Families”) AND (“Stunting” OR “Stunted” 
“Nutritional Status”) AND (“Toddlers” OR “Children”) AND (“New Normal” OR “Adaptation 
of “new habits”) in Bahasa Indonesia and English. This work was performed following 
PRISMA guidelines. Articles were selected based on inclusion criteria: publication date from 
2017 to 2022, food security with stunting incidence and factors affecting stunting, full text, 
open access, and academic journals. Articles were analyzed using a matrix table. 
Results: Based on the search results for articles that match the keywords, there are 333 
articles. Of these, ten articles come from Indonesia, Iran, and Rwanda. The analyzed 
articles were selected from 10 articles.  
Conclusion: This study concludes that there is a relationship between household food 
security and the incidence of stunting in toddlers during the new normal. 

Keywords: Household Food Security; Stunting; Toddlers; New Normal  

 



 
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INTRODUCTION 

Human Resources (HR) quality is critical to a country's development. Indonesia 2020 has a 
Human Resources Index of 0.54 and is ranked 87th out of 174 countries.1 As a developing 
country, Indonesia's low human resource index is a serious issue, with stunted children being 
one of the causes. This situation demonstrates that Indonesia is likely to lose its future 
economic potential. 

New normal is a term that refers to a new situation or condition that arises after significant 
changes occur in society during the COVID-19 pandemic. In the context of the COVID-19 
pandemic, stunting can become a severe problem due to the pandemic's impact on food and 
nutrition available for the population, primarily related to the ability to provide sufficient 
nutrients. For some low-income families who are affected economically and struggle to meet 
their children's nutritional needs, thus pandemic could be a horrible situation. Accordingly, 
efforts are needed to address the potential increase of stunting in the new normal condition. 
This must be a collective concern and the responsibility of the entire community to prevent 
young children from stunting. 

Stunting is one of the effects of hunger on toddlers worldwide. In 2017, approximately 150.8 
million (22.2 %) children under five were stunted. According to the World Health Organization, 
Indonesia ranks third in the Southeast Asia/South-East Asia Regional (SEAR) region for 
stunting prevalence, with 36.4 percent (WHO).2 Furthermore, according to the Riskesdas 
findings from 2018, Indonesia has a stunting rate of 30.8 percent.3 In 2019, the prevalence of 
stunting in children under five years old, based on the Studi Status Gizi Indonesia (SSGI) 
results, was 27.67 percent4 and decreased to 24.4 percent in 2021.5 Although the prevalence 
of stunting has decreased, the prevalence is still very high. It is considered a public health 
problem because the target for reducing the prevalence of stunting is less than 20%.2 One of 
the public health issues associated with stunting is an increased risk of disease, death, and 
cognitive and motor development challenges that will limit their productivity as adults.6 

Problems with food security, education, access to clean water, poverty, social issues, and 
other issues, in addition to health issues, influence the high stunting rate.7 The COVID-19 
pandemic has significantly impacted people's lives in the health and economic sectors, 
particularly on the elements that affect stunting. Children's nutritional status will undoubtedly 
be influenced by the fact that approximately 3 million people have lost their jobs or means of 
support, children no longer have access to programs that deliver nutritious food to schools, 
and some families are struggling to buy the food they usually eat.8 Previous research has 
found that households with low socioeconomic status are 1.67 times more likely to experience 
stunting than households with higher socioeconomic status.9 

This study aims to determine whether household food security and the prevalence of stunting 
in toddlers during the new normal era are related based on the information provided. 
According to Unicef (2013), one factor that influences stunting is household food security.10 

Food insecurity in households can be caused by insufficient availability and access, resulting 
in inadequate food intake or nutrition.11 According to Safitri, children under five from food-
insecure families have a 21.4 percent higher risk of stunting.12 Adelina claimed that children 
under five from non-food insecure homes are 3,059 times more likely to suffer from stunting.13 



 
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In the new normal era, it is necessary to make adjustments and adaptations to the new way 
of life after experiencing many changes in social and economic aspects during the COVID-19 
pandemic that have affected or worsened the stunting condition. In the new normal era, it is 
essential to continue consuming healthy and nutritious foods and maintaining hygiene and 
health by adhering to health protocols. Therefore, this research contributes to determining 
policies for preventing and reducing the stunting rate. 

METHOD 

Strategies for searching for relevant articles in Indonesian and English, the age of the children 
who are respondents under five years old, and research articles published online between 
2017 and 2022 using three databases: Google scholar databases, PubMed and Science 
Direct. In the research, the authors used the Boolean operators “AND” and “OR,” wildcards, 
and truncation to expand the search for various tenses. The keyword used for the search were 
(“Household Food Security” OR “Food Security Families”) AND (“Stunting” OR “Stunted” 
“Nutritional Status”) AND (“Toddlers” OR Children”) AND (“New Normal” OR “Adaptation of 
new habits”). A matrix table was used to analyze the literature review. 

This review included studies with cross-sectional designs. Studies were excluded if they were 
not linked to stunting, the child was not under five, and the subject was drawn from an 
unhealthy population. The inclusion criteria for this study were articles with titles and content 
relevant to the objectives that were published in full text in English or Indonesian. 

Articles found were screened by title and abstract according to the inclusion and exclusion 
criteria—literature search strategies using the PICO approach (Table 1). 

Table 1. PICO approach used in this research 
PICO Search Terms 

Patient or problem Stunting and toddler 
Intervention New normal, household food security 
Comparison - 

Outcome 
Household food security is good, so there are no stunting 
toddlers 

 
The flow of the article review using the PRISMA guideline is presented in Figure 1. Based on 
search results on Google Scholar, Pubmed, and Science Direct, we found 6,101 articles that 
match those keywords. As many as 2,232 report found according to the research title are then 
screened, namely looking at the article list that matches the inclusion criteria; after being 
traced there, are:1,899 articles were excluded because they did not meet the inclusion criteria. 
By going back and re-excluding up to 324 articles that were duplicated and did not fulfill the 
inclusion criteria, 10 articles that did meet the inclusion criteria were obtained for evaluation, 
allowing for the assessment of eligibility against 333 full-text articles. 
 
 
 



 
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Figure 1. Flowchart of the study course 

 

RESULTS 

The reviewed articles have shown a correlation between household food security and 
the occurrence of stunting in toddlers. To examine this relationship, relevant and 
recent studies were tracked and compiled in Table 3. Each study presented in the 
table includes information on the author, title, purpose, methodology, and results of 
the research 

 

 

 

Google Scholar: 1,310 
PubMed: 3,669 
Science Direct: 1,122 
Total: 6,101 

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2,232 screening articles 

3,869 articles were excluded 
due to did not match the 

keyword 

1,899 full text articles were 
excluded due to duplication 

and did not match the 
inclusion criteria 

333articles open access 
and full text were eligible 

for analysis 

10 articles were reviewed 

• Subjects age >5 years 
• Subjects were recruited from 

an unhealthy population 
• Article has no relation 



 
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Table 3. Article Review Result 
 

No Title, Author Study aims Method Result 
1. Relationship between 

Food Security and 
Diarrhea Disease with 
Stunting in Toddlers 13-48 
Months in Manyar 
Sabrangan Village, 
Surabaya 
 
Safitri et al., (2020)12 

To analyze the relationship 
between household food 
security and diarrheal 
diseases with stunting in 
children under five. 

Cross-
sectional 
study 

There is a relationship between 
household food security and 
stunting with a p-value<0.050.  

2. The Relationship between 
Household Food Security 
with Toddler Nutritional 
Status (Study in Palasari 
Village and Community 
Health Center in Legok 
District, Tangerang 
Regency) 
 
Arlius A et al., (2017) 14 

This study aims to 
examine the relationship 
between food security and 
the nutritional status of 
children under five and 
various efforts to improve 
food security in preventing 
under-five malnutrition in 
the working area of the 
Legok Health Center, 
Legok District, Tangerang 
Regency. 

Cross-
sectional 
study 

There is a relationship between 
household food security and the 
nutritional status of children under five 

3. Household Food 
Insecurity as a Predictor of 
Stunted Children dan 
Overweight/ Obese 
Mothers 
(SCOWT) in Urban 
Indonesia 
 
MahmudionoT  et al., 
(2018) 15 

To determine the 
relationship between 
household food security 
with the incidence of 
stunting and obesity 
(SCOWT) 

Cross-
sectional 
study 

There is a relationship between 
household food insecurity with 
stunting children and SCOWT 

4. Household Food Security 
with Stunting and non-
stunting in children aged 6-
23 months in Wilangan 
sub-district, Nganjuk 
Regency 
 
Fadzila D et al., (2019)11 

Analyzing the condition of 
household food security 
with stunting and non-
stunting in children aged 6-
23 months in Wilangan 
sub-district, Nganjuk 
Regency. 

Case-
control 

There is a relationship between the 
age of children under two years (p = 
0.02) and food security (p = 0.041) with 
stunting. 

5. Analysis of Factors 
Affecting the Prevalence 
of Stunting in Children 
Under Five Years 
 
Rahayuwati L et al., 
(2020)16 

To analyze the factors that 
affect the prevalence of 
stunting in children in the 
West Java region, 
including socio-
demographics of mothers, 
children, and children's 
health status. 

Cross-
sectional 

There is a relationship between 
mother's work, childbirth 
complications, completeness of 
immunization distribution, schedule of 
immunizations, exclusive 
breastfeeding, and medical records of 
children with stunting. 

6. A Community-Based 
Survey of Household Food 
Insecurity and Associated 
Socio demographic 
Factors among 2-6 Years 
Old Children in the 
Southeast of Iran 
 
Sotoudeh M et al., 
(2021)17 

To find out the status of 
household food insecurity 
and influencing 
sociodemographic factors 
in children aged in urban 
areas of Iran 

Cross-
sectional 

There is an influence of household 
food insecurity and sociodemographic 
factors, including weight and height, 
mother's education level, and 
sanitation in children 2-6 years old. 



 
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No Title, Author Study aims Method Result 
7. Analysis of Household 

Food Security and 
Household Characteristics 
with the Incidence of 
Stunting 
 
Sihite N et al., (2021)18 

To analyze the relationship 
between household food 
security and household 
social factors with the 
incidence of stunting. 

Cross-
sectional 

A significant relationship exists 
between household food security (p= 
0.031) and stunting incidence. 
Household food security is  
directly related to the incidence of 
stunting; families in households who 
are not food insecure tend to have 
children under five who are classified 
as stunting; this is due to the lack of 
nutritional intake received both in 
terms of quantity and quality and did 
not meet the nutritional adequacy 
standard for stunting toddlers. 

8. Food Insecurity in 
Household Level with 
Stunting During the Covid-
19 Pandemic 
 
Imansari A et al., (2022)19 

To analyze the relationship 
between food insecurity at 
the household level and 
stunting during the  
Covid-19 pandemic 

Cross-
sectional 

There is no significant relationship 
between the level of household food 
insecurity with the incidence of 
stunting in toddlers 

9. Analysis of Food 
Expenditure, Food 
Security, and Nutrient 
Intake of Under Two Years 
Old as Stunting Risk 
Factors 
 
Aritonang E et al., (2020)20 

To analyze the proportion of 
food expenditure, 
household food security, 
and food intake as a risk 
factor for stunting children 
aged 6-24 month 

Case-
Control 

There is a relationship between 
household food security and the 
incidence of stunting (p = 0.018), and 
household food insecurity has a 6.9 
times greater risk of experiencing 
stunting. 

10. Moderate and Severe 
Household Food 
Insecurity Predicts 
Stunting and Severe 
Stunting Among Rwanda 
Children 6-59 Months 
Residing in Gicumbi 
District 
 
Agho et al., (2018)21 

To examine the association 
between household food 
insecurity and stunting and 
severe stunting among 
Rwandan children aged 6-
59 months residing in the 
Gicumbi district. 

Cross-
sectional 

There is a correlation between 
moderate and severe household food 
insecurity with stunting and severe 
stunting. 
The odds of moderate and severe HFI 
were significantly higher among 
stunted children aged 6-59 months 
than those not. Children from 
households with moderate food 
insecurity were 2.47 times more likely 
to be severely stunted. Those from 
families with severe food insecurity 
were more likely to be severely stunted 
(AOR = 1.82) compared with children 
aged 6-59 months from households 
with food security.  

DISCUSSION  

The high prevalence of stunting is not only related to health problems but also influenced by 
other issues that indirectly affect health, such as food security, education, availability of clean 
water, poverty, social factors, and others.2 According to UNICEF (United Nations Children's 
Fund), household food security is one-factor affecting stunting.10 Food insecurity in 
households can be caused by insufficient availability and access to food, resulting in 
inadequate food or nutrient intake.11 

Toddlers classified as stunted are more common in families with inadequate access to 
nutritious food. Children in households tend to experience a lack of nutritional intake needed 
for optimal growth and development. This can cause stunting in children, impacting physical 



 
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and mental health, and a high risk of developing chronic diseases in the future.18 A lack of food 
supply and poor nutrition, especially in terms of providing a balanced diet for the household, 
are further variables that contribute to food insecurity in families.12 In addition, food security is 
impacted by socioeconomic status, which affects children who experience stunting.23 Food 
security is when all households have physical and economic access to sufficient and nutritious 
food for all family members. Poverty and lack of income can lead to a lack of ability for families 
to provide adequate and healthy food for all family members, resulting in food insecurity, which 
can impact the nutritional status of children.20 

Based on ten reviewed studies, household food security is directly related to the incidence of 
stunting. In a study by Sihite et al.,18 there was a significant association between household 
food security and the incidence of stunting in children. Adelina et al.13 also stated that there is 
a relationship between household food security and the incidence of stunting, with an OR 
value of 3.059. This is further supported by the study by Aritonang,20 which found that the risk 
of stunting is 6.9 times higher in children from households that are not food-secure, as stunting 
results from the long-term effects of nutrient deficiencies. Therefore, children who live in food-
insecure homes for years will experience stunting.24 

Household food security and stunting are related because the household's inability to meet 
sufficient and balanced food needs can affect the child's nutritional intake. Insufficient nutrient 
intake during early growth and development can lead to stunting. Children who experience 
stunting tend to have a higher risk of ongoing health problems. Therefore, efforts to improve 
household food security and ensure sufficient and balanced nutrient intake for children are 
crucial in preventing and addressing stunting. 

In the new normal era, household food security still closely correlates with the incidence of 
stunting in children. Although there have been changes in eating habits and dietary patterns 
in the new normal era, the risk of inadequate nutrient intake in children still exists, especially 
in families experiencing economic difficulties or being affected by the COVID-19 pandemic.25 
The new normal era can also worsen household food security due to economic and social 
restrictions affecting access to nutritious food.26 Therefore, efforts to improve household food 
security must continue to be increased in the new normal era by providing access to quality 
food, increasing education on healthy and nutritious eating patterns, and providing support 
and assistance to families experiencing economic difficulties. This can help prevent stunting 
in children and improve the quality of life for communities in the new normal era. 

CONCLUSION 

This review concludes that stunting was still a global health issue that needs to be addressed 
in the new normal era. There was a relationship between household food security and the 
incidence of stunting in toddlers. Toddlers from food-insecure households have a higher risk 
of experiencing stunting compared to toddlers from food-secure families. Using backyard 
gardens can be an alternative solution for household food security. Therefore, the community 
needs to be informed about the importance of nutrition and health, educated on how to utilize 
backyard land effectively, and receive support from the local government to increase access 
to food or meet the needs of simple gardening activities in their backyard land. 



 
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Declarations 

Authors' contribution 

S and K Designed the study. DSY Writing the manuscript and conducted a literature search. 
DSY was writing the result. S and K contributed to reviewing and evaluating this manuscript 
for publication. 

Funding Statement 

 This research has not received external funding. 

Conflict of interest 

There is no conflict of interest in this research.  

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