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 Epidemiology and Society Health Review| ESHR 
Vol. 4, No. 1, 2022, pp. 12-20 ISSN 2656-6052 (online) | 2656-1107 (print) 
 
 

      10.26555/eshr.v4i1.4039  

12  
 

  
 

Research Article 
 
Stunting Determinants in Kulonprogo District, Yogyakarta 
Year 2019 
 
Desi Nurfita1* Annisa Parisudha1, Sugiarto Sugiarto2 
1 Public Health Faculty, Universitas Ahmad Dahlan, Yogyakarta, Indonesia  
2 Kulonprogo Health Office, Yogyakarta, Indonesia 
 
* Correspondence:desi.nurfita@ikm.uad.ac.id. Phone: 62821-9135-0472 
 
Received 30 April 2021; Accepted 02 August 2021; Published 23 January 2022 
 

ABSTRACT 

Background: UNICEF stated that in 2014, about 66% of children aged less than five years 
in lower-middle-income countries were stunted. Stunting is a predictor of poor quality of 
human resources and reduces a nation's productivity in the future. Stunting control in the 
Kulonprogo District is one of the priority districts in Indonesia. This study aimed to analyze 
the determinants of stunting in the Kulonprogo District. 
Methods: This research was conducted in Kuponprogo District. The population was 
children under five in Kulonprogo District. Analysis was done through a descriptive 
approach. Descriptive quantitative research was used by employing secondary data from 
the year 2013. 
Results: The prevalence of stunting among children under five in the Kulonprogo District 
was 11.12%, spread across all primary health centers (Puskesmas) in the Kulonprogo 
District. The three puskesmas with the highest prevalence rate were Puskesmas Girimulyo 
2, Puskesmas Samigaluh 2, and Puskesmas Kalibawang. The analysis found that low-
income families, maternal education, age at pregnancy, chronic energy deficiency during 
pregnancy, anemia during pregnancy, early initiation of breastfeeding, exclusive 
breastfeeding, and parenting mode are the determinant factors of stunting in the Kulonprogo 
District in 2019. 
Conclusion: Several determinants of stunting were found, namely low-income families, 
maternal education, age at pregnancy, chronic energy deficiency during pregnancy, anemia 
during pregnancy, early initiation of breastfeeding, exclusive breastfeeding, and parenting 
mode. 

Keywords: Stunting; Determinants; Malnutrition; Under-five children 

INTRODUCTION 

Stunting is a chronic undernutrition status during growth and development since early life. This 
situation is indicated by the z-score of height for age (height-for-age) less than-2 standard 
deviations (SD) based on growth standards according to WHO (1). (2)Nutritional problems, 



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especially stunting in toddlers, can hinder child development, with negative impacts in the next 
life, such as intellectual decline, vulnerability to non-communicable diseases, decreased 
productivity that causes poverty, and risk factors for delivering low birth weight baby (3). 
Stunting is the point of the six global nutrition targets in 2025 and one indicator of the post-
2015 development agenda (2). 

Family socioeconomic status such as family income, parental education, mother's knowledge 
of nutrition, and the number of family members can indirectly relate to stunting (4). Research 
in South Ethiopia states that the number of family members is a risk factor for stunting in 
toddlers aged 24-36 months (6). The incidence of stunting in children under five is influenced 
by low income and parental education (5). Families with high incomes will have easier access 
to education and health to improve children's nutritional status (6).(7) 

The direct causes of stunting are infectious diseases and nutrient intake (8)(9). The intake of 
nutrients that significantly affect the linear growth of children is a protein (10), zinc (11), iron 
(12) as well as vitamin A (13). Theoretically, differences in topography and geographical 
location give their characteristics to people's eating patterns and impact food availability in 
certain areas (14). 

The selection of 100 priority districts/cities for stunting interventions in Indonesia is based on 
the criteria for the number and prevalence of stunted under-fives, taking into account the 
district/city poverty level (14). Kulon Progo is the only district in the Special Region of 
Yogyakarta that is included in the 100 priority districts for stunting intervention in Indonesia. 
The prevalence of stunting under five in Kulon Progo in 2013 was 26,31%. The incidence of 
stunting decreased in 2018 to 12,66%. (15)Stunting in Kulon Progo is almost spread in every 
village. Based on data from the Kuloprogo District Health Office in 2019, Kulonprogo District 
has 10 Stunting Prevention Priority Villages. Priority villages consist of Nomporejo, Tuksono, 
Karangsari, Mediumsari, Donomulyo, Sidoharjo, Gerbosari, Ngargosari, Pagerharjo, and 
Kebonharjo.  

Stunting is an exciting topic to study, considering that stunting has a profound impact in shor-
tem and long-term. The short-term impact would be closely connected with morbidity and 
mortality on the baby or under five-year-old children, the midterm effect relating to low 
cognitive skills, and the long term relating to human resource quality and degenerative illness 
in the adult period (16). Accordingly, the researcher is attracted to analyze the determinants 
of stunting in the Kulonprogo District. This research contributes to informing policymaker about 
the factors associated with stunting in this region. It is essential to explore because the COVID-
19 pandemic that occurred at the beginning of 2020 could exacerbate the situation of 
nutritional fulfillment in the marginal group.  

METHOD 

The design of this study was descriptive quantitative research that attempts to collect 
quantifiable information for statistical analysis of the population sample. We used secondary 
data from the Kulonprogo health office Data for Stunting Toddlers in Kulonprogo District Year 
2019. Those data-based on community data surveys with the population of children under five 
in this area. We analyzed using frequency distribution.  



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RESULTS 

Based on the data from the Kulonprogo District Office, in 2019, there were 2.740 toddlers out 
of a total of 24,644 toddlers. We figure out the number of toddlers based on the number of 
toddlers of their body weight in Posyandu. This measurement is one indicator of posyandu 
achievement in each health center. Figure 1 shows the comparison between the number of 
children under five and the number under five that measure their body weight in Kulonprogo 
during 2019. 

 
 

Figure 1. Comparative Analysis of Toddlers who Came and Weighed in Kulonprogo  District 
in 2019 

 
Based on Figure 2, it is known that most of the Puskesmas in Kulonprogo  District are not 
achieving 100% of toddlers coming and being weighed yet. The highest achievement was 
reached by Puskesmas Kalibawang with more than 95%, and the lowest achievement was 
Puskesmas Temon 2 with about 83%. 
 

Stunting in Kulonprogo District 

Figure 3 shows the proportion of stunted children under five by Puskesmas in the Kulonprogo 
District. It is known that the highest proportion of stunting toddlers under five is in Puskesmas 
Girimulyo 2, followed by Puskesmas Samigaluh 2 and Kalibawang Health Center. While the 
lowest stunting toddler under five is in Puskesmas Nanggulan. 

 
 



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Figure 2. The proportion of Toddlers Who Come and Weighed by Health Center in 
Kulonprogo  District in 2019 

 

 
 

Figure 3. The proportion of Stunting Toddlers per Health Center in Kulonprogo  District in 
2019 

 



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Regarding the gender of the toddler who was getting stunting, it was known that mostly 
stunting children were dominated by a male toddler (53%). However, it seems the proportion 
was not significant (Figure 4).   
 

 
Figure 4. Stunting Toddlers by Gender in Kulonprogo District in 2019 

 
Determinants of Stunting in Kulonprogo  District 

Table 1. Frequency distribution analysis the determinants of stunting in Kulonprogo District 

Indicator Number Percentage (%) 
Family Status   

Poor 1475 56 
Wealthy 1146 44 

Mother's education   
Primary school 123 6 
Junior high school 406 22 
Senior high school 1250 52 
Diploma/University 105 6 

Age when pregnant (year)   
15 – 20 96 5 
20 – 30 938 47 
30 – 35 727 37 
>35 216 11 

Chronic energy deficiency 
during pregnancy 

  

Yes 767 30 
No 1817 70 

Anemia status   
Yes 370 25 
No 1108 75 

Early initiation of breastfeeding 
status 

  

Yes 1750 70 
No 743 30 

Exclusive breastfeeding status   
Yes 1710 66 
No  893 34 

Parenting mode   
By themselves 1757           77 
Helped by others 106            5 
Mix      418               18 

 

53%

47%

MaleFemale



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Based on Table 1, as many as 44% of children under five with stunting come from low-income 
families. About 52% of mothers with stunting toddlers have a high school education. There 
are still mothers who give birth at an age that has a high risk, namely 5% at the age of 15-20 
years and 11% at the age of >35 years. There are still risk factors for insufficient total energy 
intake, which is 30% of pregnant women. There are still risk factors for anemia, which is 25% 
of pregnant women. The majority of mothers with toddler stunting have done early 
breastfeeding initiation (70%). Most mothers with stunting children conducted exclusive 
breastfeeding (66%). Most toddlers are cared for by their mothers (77%).  
 
According to our data, the determinants of stunting in Kulonprogo during 2019 were low-
income families, mother's education, age during pregnancy, chronic energy deficiency during 
pregnancy, anemia during pregnancy, early initiation of breastfeeding, exclusive 
breastfeeding, and parenting mode. 

DISCUSSION  

Kulonprogo District is an area that is included in the 100 priority districts/cities for stunting 
intervention and is also the only district in the Special Region of Yogyakarta that is suffering 
from stunting problems. Unbalanced nutrient intake or inadequate complementary feeding is 
one factor that directly affects stunting. Nutrient intake is influenced by the quality of the food, 
especially macronutrient and micronutrients, and the eating behavior of the families, especially 
mothers and children, which will impact the rule of feeding practice. Changes in behavior can 
occur when mothers have sufficient knowledge about balanced nutrition and understand 
nutritional problems at risk for stunting in children (17).  

The quality and quantity of a person's food depend on the nutritional content of the food, the 
presence or absence of other food in the family, the purchasing power of the family, and the 
mother's characteristics regarding food and health. Nutritional status is determined by two 
aspects: the food eaten and the state of health. The state of health is also related to the 
mother's characteristics of food and health, the family's purchasing power, the presence or 
absence of infectious diseases, and the reach of health services. 

Stunting is caused by multi-dimensional factors and not only caused by poor nutrition 
experienced by pregnant women and children under five (18). Therefore, interventions that 
will be very decisive in reducing stunting prevalence need to be carried out in the first 1,000 
Days of Life. Poor maternal education is related to the incidence of stunting in children. Lack 
of maternal education and knowledge about nutrition is associated with stunting in toddlers 
aged 6-59 months (19). Stunting is also related to food and animal source food expenditure in 
families of children under five (household-level food security) (20). Family income is also 
reported as one of the determinants of stunting. Several studies have stated that children from 
low economic levels tend to be at risk of stunting(19,21–23). Research reports that toddlers 
living in families with low incomes are at 6.24 times greater risk of experiencing stunting than 
toddlers with families with sufficient income, which is the main factor of stunting in toddlers 
(23). Another determinant factor of stunting in Indonesia is related to gender. The male sex is 
the dominant gender that suffers stunting than the female sex.  



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Many studies related to the history of insufficiency total energy intake in pregnant women with 
stunting have been carried out. The research conducted by Dewi et al. (2020) found that 
mothers with a history of chronic energy deficiency were associated with stunting (24). 
However, another study conducted by Prabandari et al. (2016) obtained an inversely 
proportional result. There was no significant relationship between the history of poor nutrition 
during pregnancy and the incidence of stunting in toddlers (25). 

Based on research conducted by Febrina (2017), it was found that there is a significant 
relationship between anemia in pregnant women and the incidence of stunting (26). However, 
another study conducted by Warsini et al. (2016) obtained different results (27). Another study 
conducted by Prabandari et al. (2016) in Boyolali District also showed that a history of maternal 
anemia did not significantly correlate with the incidence of stunting in children under five. 

Toddlers under two years who experience stunting will have a lower level of intelligence, 
making children more susceptible to disease and, in the future, maybe at risk of decreasing 
productivity levels. In the end, stunting will broadly inhibit economic growth, increase poverty, 
and widen inequality (15). Therefore, stunting prevention needs to be carried out to develop a 
healthier generation. 

CONCLUSION 

In conclusion, several determinants of stunting under-five children were identified in 
Kulonprogo District: low-income families, mother's education, age during pregnancy, chronic 
energy deficiency during pregnancy, anemia during pregnancy, early initiation of 
breastfeeding status, exclusive breastfeeding for six months, and parenting mode. 

Authors' contribution 

DN contributed to data collection, analysis, report writing, and manuscript publication. AP 
contributed to the data collection and report writing. SS contributed to the data collection and 
licensing. 

Funding 

This research has not received external funding 

Conflict of interest 

There is no conflict of interest in this research.  

 

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