Maternal perception of sickness as a risk factor 


156

*Division of Nutrition,
Faculty of Medicine,
Diponegoro University, Semarang
**Department of Pediatrics,
Faculty of Medicine,
Diponegoro University/
Dr.Kariadi Central General Hospital,
Semarang
***Program in Nutrition,
Muhamadiyah University, Semarang

Correspondence:
Maria Fatima Dete Dellu
Division of Nutrition,
Faculty of Medicine,
Diponegoro University, Semarang.
Jl. Dr. Soetomo No. 18
(Komplek Zona Pendidikan RSUP
Dr. Kariadi, Gd. Dekanat
FK Undip Lt.2)
Email: mariafatimadellu@gmail.com

Univ Med 2016;35:156-64
DOI: 10.18051/UnivMed.2016.v35.156-164
pISSN: 1907-3062 / eISSN: 2407-2230

This open access article is distributed under
a Creative Commons Attribution-Non
Commercial-Share Alike 4.0 International
License

ABSTRACT

UNIVERSA MEDICINA
September-December, 2016September-December, 2016September-December, 2016September-December, 2016September-December, 2016                          Vol.35 - No.3                         Vol.35 - No.3                         Vol.35 - No.3                         Vol.35 - No.3                         Vol.35 - No.3

Maternal perception of sickness as a risk factor
of stunting in children aged 2-5 years

Maria Fatima Dete Dellu*, Maria Mexitalia**, and Ali Rosidi***

BACKGROUND
Stunting in children is caused by past nutritional problems, adversely
affects the physical and mental characteristics of children and is a well-
established child-health indicator of chronic malnutrition. Socio-cultural
factors can affect parenting, thereby indirectly affecting child growth.
The objective of this study was to determine socio-cultural factors and
parental short stature as risk factors of stunting in children aged 2 to 5
years.

METHODS
The study used a quantitative approach with case control design and a
qualitative approach with in-depth interview. The study subjects were
children aged 2-5 years, consisting of 45 cases of stunting and 45 controls
(normal subjects). Socio-cultural data were obtained through interviews
with the mothers, while height was measured with a stadiometer. Data
were analyzed using chi square and logistic regression tests to calculate
the odds ratio (OR).

RESULTS
The logistic regression test showed that maternal perception of sickness
as a curse (OR=7.43; 95% CI: 2.37-23.21), stopping breastfeeding at
<24 months (OR=6.01;95% CI: 1.83-19.69) and low household
expenditure for food (OR=5.78;95% CI: 1.28-26.01) were risk factors of
stunting incidence with a probability of 73.8%. The most dominant risk
factor of stunting was maternal perception of sickness (OR=7.43 95%
CI: 2.37-23.21).

CONCLUSION
Maternal perception of sickness was the most dominant risk factor of
stunting in children 2-5 years of age. A multidisciplinary approach is
needed to address the range of raised issues and so combat stunting in
children.

Keywords: Stunting, socio-cultural, parental short stature, children aged
2-5 years

DOI: http://dx.doi.org/10.18051/UnivMed.2016.v35.156-164



157

INTRODUCTION

Stunting or short stature is the condition in
which the height-for-age index is less than -2
standard deviations (SD). A child with stunting
will be shorter than a normal child of the same
age.(1) The condition of stunting in children shows
the presence of nutritional deficiencies and disease
that occurred in their growth and development
early in life.(2)

The global prevalence of stunting to date is
still relatively high, since in several countries more
than half of children under 5 years of age are
recorded as having retarded growth.(2) Data from
the Indonesian Basic Health Research (Riskesdas)
for the year 2013 showed that up to 37.2% of
Indonesian underfives suffered from stunting. The
highest prevalence of stunting of 58% was found
in the province of East Nusa Tenggara (Nusa
Tenggara Timur, NTT).(3) In this province, South
Central Timor (Timor Tengah Selatan, TTS)
district has in recent years had the highest
prevalence of stunting among the underfives. The
Riskesdas for 2007 showed that the prevalence
of stunting in the underfives in TTS district was
57%, increasing up to 70.5% in 2013, with
Amanuban subdistrict as one of the subdistricts
with the highest prevalence of stunting, i.e.
66.25%.(4)

Previous studies have concluded that the
prevalence of stunting in children is caused by
various factors. The study of Nabuasa et al.(5) in
children aged 24-59 months found a significant
association between culture and the prevalence
of stunting. This differs from a study in the Medan
Area district, which found no relationship between
family tradition/beliefs and nutritional status in
children.(6)

Parental genetics, in this case parental
height, is also of influence on the problem of
stunting in children. Parental height and growth
pattern are the key to the growth pattern of their
children. Mothers with a height of <145 cm are
at higher risk of having children with stunting
compared with mothers with a height of >145
cm.(7) The study by Solihin et al.(8) stated that

maternal height is significantly associated with
nutritional status (height-for-age index) of the
underfives. However, this differs from the study
by Hanum (9) and Kusuma (10) who found that
maternal height is not associated with the
nutritional status of the children.

The present study focuses on the socio-
cultural variables of the local community and
parental short stature, in this case the height of
both parents. Previous studies investigating the
influence of socio-economic and socio-cultural
variables on the nutritional status of the children,
focused only on maternal height in relation to the
prevalence of stunting in children. On the other
hand, the present study used the height of both
parents in relation to the prevalence of stunting,
with the aim to determine socio-cultural factors
and parental short stature as risk factors for the
prevalence of stunting in children aged 2-5 years.

METHODS

Design of the study
The study design used a quantitative

approach with an analytic-observational
unmatched case-control design and a qualitative
approach with in-depth interview and focus group
disscusion (FGD). The study location was
Amanuban Selatan subdistrict, Timor Tengah
Selatan district, Nusa Tenggara Timur province.
The study was conducted from February to April
2016.

Study subjects
The subjects of this study were 90 children

aged 2-5 years, consisting of 45 cases of stunting
and 45 normal controls. The required sample size
was calculated using the formula for analytic
unmatched case-control studies with categorical
variables. Recruitment of the study subjects was
by the simple random type of probability
sampling. The subjects were selected from the
intended study population of 415 children, who
were then stratified into cases and controls, in
accordance with the exclusion and inclusion
criteria that had been decided upon. The inclusion

Univ Med                                                                                                                                                                     Vol. 35 No.3



158

criteria in this study were children with stunting
and normal children, living with their own parents,
having a record of their birth weight, born at term
with a weight of >2500 grams, and their parents
agreeing for their children to be included in the
study sample. Categorization into children with
stunting and normal children was based on the
children’s height-for-age index expressed as z-
scores. The children were considered to have
stunting if the height-for-age z-score was ≤-2
standard deviations (SD) and not to have stunting
(or to be of normal height) if the height-for-age z-
score was >-2 SD.(4)

Anthropometric measurements
Measurement of height was performed in the

children who were the subjects of this study and
in both of their parents, using a stadiometer with
an accuracy of 0.1 cm. The measurement
procedure was as follows: the subjects without
footwear and headgear stood upright in contact
with the measuring device and looked straight
ahead, with the eyes parallel to the vertex. The
operator moved the paddle of the measuring device
downwards so that it rested lightly on the subject’s
head, then read the result off the device.

The evaluation of parental short stature was
performed by measuring the height of both
parents, then using the formula of midparental
height (MPH) to project the development of the
height of their children based on the genetics of
both parents. The calculated result was then
plotted on a curve generated by the WHO Anthro
program.(11)

Data collection
Data on community socio-cultural

characteristics were obtained by in-depth
interviews with the respondents, i.e. the mothers
of the subjects. Data on individual perception
about sickness and the customs for pregnant
mothers were obtained by interviews using
questionnaires. The investigators asked whether
the parents, in this case the mothers of the subjects,
believed that the sickness suffered by their children
was or was not a curse, through a number of

questions. Maternal perception about sickness was
categorized as perception of sickness as a curse
and perception of sickness not as a curse.

On the custom of food taboos for pregnant
mothers, the investigators asked the mothers about
their dietary habits during pregnancy, such as
whether they did or did not observe taboos on
certain foods or dishes that are forbidden by
culture. The dietary habit of the pregnant mothers
was categorized as observing food taboos and not
observing food taboos.

With regard to the custom of stopping
breastfeeding, the investigators asked the mothers
whether they believed or not that breastfeeding
the children until the age of 24 months will
interfere with the growth of the children. The
custom of stopping breastfeeding was categorized
as stopping breastfeeding at <24 months and
stopping breastfeeding at ≥24 months.

The question posed to the mothers about the
custom of administering food to the newborn was
whether or not there were certain foods that
according to culture must be given to newborn
infants. Administration of foods to newborn
infants was categorized as administering the foods
and not administering the foods.

Data on the maternal educational level were
obtained by asking the mothers about their level
of formal education up to the time of interview.
The educational level was categorized as low if
the respondents did not have any education or
received education up to primary school or junior
high school, and as high if the respondents went
from senior high school to tertiary education,
either at diploma level or higher.

As to household expenditure, the parents
were asked about their weekly expenditure for
food for consumption by all family members. The
weekly expenditure was then multiplied by four
to obtain the total monthly expenditure. The cut-
off point was determined on the basis of the mean
total expenditure. The level of household
expenditure was categorized as low
(<Rp.921.250) and high (≥Rp.921.250).

Data on maternal outdoor activity were also
obtained by interviews using questionnaires. The

Dellu, Mexitalia, Rosidi                                                                                           Maternal perception of sickness and stunting



159

investigators asked the mothers whether they were
involved in certain activities so that they had less
time to care for their children. Maternal outdoor
activity was categorized as present and absent.

Statistical analysis
Bivariate analysis was performed using the

chi square test with 95% confidence interval (95%
CI) (p<0.05) to find the p value and the odds ratio
(OR). Multivariate analysis was by means of the
logistic regression test.

Ethical clearance
This study obtained ethical clearance

No.008/EC/FK-RSDK/2016 from the Ethics
Commission.

RESULTS

The proportions of males in the group of
cases and controls were 68.9% and 51.1%),

respectively. There were more farmers among the
subjects’ fathers in the group of cases (91.1%)
than in the group of controls (86.7%). The number
of mothers who were housewifes or unemployed
was greater in the group of cases (73.3%) than in
the group of controls (51.1%). There was no
difference in paternal height between the group
of cases and the group of controls, with mean
heights of 160.1 cm and 160.8 cm, respectively.
On the other hand, there was a difference in
maternal height between the group of cases and
controls, with mean heights of 149.2 cm and 152.4
cm, respectively.

The results of the analysis showed that the
risk factors for the prevalence of stunting in
children were maternal perception about sickness,
with sickness being considered a curse
(OR=8.94;95% CI 3.26-24.46), the custom of
stopping breastfeeding at <24 months (OR=6.20;
95% CI 2.29-16.80), and low level of expenditure
(OR=6.22;95% CI 1.89-20.46) (Table 1).

Univ Med                                                                                                                                                                     Vol. 35 No.3

*Significant (p<0.05)

Table 1. Relationship between several risk variables and incidence of stunting



160

Table 2. Results of logistic regression of factors influencing incidence of stunting
in children aged 2-5 years

*Significant (p<0.05), R2=0.49=49%

On the basis of the results of bivariate
analysis, the variables included in the multivariate
analysis were individual perception, i.e. maternal
perception about sickness, custom of stopping
breastfeeding at <24 months, low level of
household expenditure, and maternal outdoor
activity (p<0.25).

The results of the multivariate analysis
showed that maternal perception about sickness,
custom of stopping breastfeeding and level of
household expenditure were risk factors for the
prevalence of stunting. The variable of maternal
outdoor activity was not a risk factor for the
prevalence of stunting. The variable with the
greatest influence or the dominant variable for
the prevalence of stunting with highest OR value
w a s  m a t e r n a l  p e r c e p t i o n  a b o u t  s i c k n e s s
(OR=7.43;95% CI 2.37-23.21). This signifies
that children whose mothers perceive sickness
as a curse have a 7.43-fold greater probability
to experience stunting than do children whose
mothers do not perceive sickness as a curse
(Table 2).

DISCUSSION

Maternal perception about sickness is the
most dominant risk factor for the prevalence of
stunting in children. The results of this study are
in line with a study on underfives among the
Dawan clan in TTS district, in which it was found
that family beliefs in traditional ceremonies are a
risk factor for the prevalence of short stature in
children.(3) This study is also in line with the study
of Nabuasa who demonstrated a significant
relationship between culture and the prevalence
of stunting.(5) However, a study conducted in

Medan Area district found no relationship between
family traditions/beliefs and nutritional status of
the children.(6)

The perception of the community about the
causes of a disease differred between regions,
depending on the culture prevailing and
developing in the community in question. The
community of the TTS district in general still
believes in various traditional ceremonies, such
as the ceremony of confession of sins, called
naketi in the local language, which is a ceremony
for the healing of sick persons. It is usually
performed by the parents of sick children in the
hope that after performing the ceremony, the
children will recover. The results of the present
study are supported by the results of in-depth
interviews with principal informants and
triangulation informants. These informants said
that the care of sick children consists in bringing
them to a doctor or healthcare facility, but if they
do not recover, the cause of the sickness is sought
on the basis of local beliefs, i.e. through the naketi
ceremony. However, the children are frequently
not brought to a hospital or medical facility, since
the community is of the opinion that bringing the
children to a medical facility is useless, because
this will not heal the children, but on the other
hand will worsen their sickness. Sickness is caused
not only by a disease but is according to them is
also attributable to bad winds or parental
obstruction.

The custom of food taboos for pregnant
mothers is not a risk factor for the prevalence of
stunting. Food taboo is the prohibition of
consuming certain types of food, since their
consumption will endanger the consumer. Initially
food taboos were meant to protect the health of

Dellu, Mexitalia, Rosidi                                                                                           Maternal perception of sickness and stunting



161

the children and their mothers, but may actually
become detrimental to the children’s health and
nutrition, since the food taboos usually concern
foods that are sources of essential nutrients for
both the mothers and the children. The absence of
a relationship between the custom of food taboos
for pregnant mothers and the prevalence of
stunting is caused by the higher total proportion
of mothers in the group of cases and controls who
did observe the food taboos when pregnant, in
comparison with those who did not. These results
show the occurrence of behavioral changes
associated with food taboos.

The custom of administering food to
newborn infants is not a risk factor for the
prevalence of stunting. This study agrees with that
of Aguayo et al.(12) who state that administering
food to newborn infants had a significant but
negative association with the prevalence of
stunting. The custom of administering food to
newborn infants is in principle associated with
exclusive breastfeeding. The period of exclusive
breastfeeding recommended by the WHO is the
first 6 months. This recommendation was issued
based on the results of a study revealing that
exclusive breastfeeding up to 6 months has several
benefits, such as a decrease in gastrointestinal and
respiratory infections, that does not occur in
exclusive breastfeeding up to 3 or 4 months.(13)

The present study did not agree with the studies
conducted by Nadiyah and by Muchina, who
showed that children with prelacteal feeding were
more at risk of stunting.(14,15) The absence of such
a relationship in our study was caused by the
greater total proportion (60.0%) of respondents
who administered food to their newborn infants,
both in the group of cases and the group of
controls, in comparison with those who did not
(40.0%). This signifies that among the subjects
in the groups of cases and controls, there were
still many who had received food as newborns or
under the age of 6 months.

The custom of stopping breastfeeding before
the children are 2 years old (<24 months) is a risk
factor for the prevalence of stunting in children.
The present study is in agreement with previous

studies stating that children who were breastfed
for less than 24 months were more at risk for
stunting, as compared to children who were
breastfed for at least 24 months.(16,17) However,
the present study is not in line with the study by
Kamal which showed that breastfeeding for less
than 24 months is not a risk factor for the
prevalence of stunting.(18)

Weaning is a term used to refer to the
transition period in which infants still receive
liquid food, either breast milk or formula milk,
but are also gradually introduced to solid food.
In England, the term weaning signifies the
introduction of solid food along with milk (breast
or formula milk), and not the process of separating
the infants from their mother’s breasts.(19) The
weaning process in children may start at different
times. The WHO and UNICEF recommend that
infants be breastfed up to the age of two years. In
Indonesia, there are certain cultural communities
that wean the children before the age of 6 months
or even after the age of 2 years. Between the
experts’ concept of weaning and weaning as
understood by the community in TTS district,
there is a difference in definition. The community
of TTS district understands by weaning the
definitive cessation of breastfeeding. When the
children are able to consume the family foods or
foods other than breast milk, they are not breastfed
any longer and this weaning is called sole in the
local language. In this process the infants are
clearly separated from their mothers’ breasts. This
is supported by in-depth interviews with the
informants, who stated that if the children are able
to consume family foods, they are not breastfed
anymore, since this will impair their appetite. In
addition, according to the informants, the longer
the children are breastfed, the more dumb they
become and the larger their buttocks. The custom
of sole is one of the cultural traditions of the local
community that up to the present time are still
adhered to. The lack of breastfeeding or even the
absence of breastfeeding up to 24 months has a
profound impact, such as increased prevalence
of diarrhea from unhygienic complementary foods
or formula milk, poor nutrient adequacy for

Univ Med                                                                                                                                                                     Vol. 35 No.3



162

children under the age of two years (baduta),
allergic reactions in some of the children as a result
of administration of formula milk or
complementary feeding that is not suited to the
condition of the children, and the increased
household expenditure resulting from the purchase
of formula milk. All these factors increase the
probability of stunting in the children.

Maternal educational level is not a risk factor
for the prevalence of stunting in children. This
study is in line with the study of Nasikah and
Margawati (20) who found that maternal
educational level was not significantly associated
with the prevalence of stunting. However, our
study is not in line with previous studies showing
that mothers with a low educational level are at
risk for stunting in their children.(7,20) In fact, a
higher maternal educational level will contribute
to total family income and better social status,
and will ultimately influence the nutritional
status.(1)

The level of household expenditure for food
may be used to determine economic status. The
results of this study showed that a low level of
household expenditure for food is a risk factor
for stunting in children. This study is in line with
the study by Yasmin, who state that lower
household expenditure increases the risk of
stunting.(7) Households with low socio-economic
status are more susceptible to food shortages
because of their low food consumption and their
limited access to food.(22)

Materrnal outdoor activity is associated
with the length of time the mothers spend with
their children, thereby providing good parenting
for their children. Our study showed that
maternal outdoor activity is not a risk factor for
the prevalence of stunting in children. This is in
line with the study by Lestari who found that
maternal employment status had no significant
relationship with the prevalence of stunting in
children.(23) Maternal outdoor activity may
influence parenting pattern, either because the
mothers are busy earning a living or are involved
in time-consuming social activities. Among
mothers with an occupation, the probability of

stunting in children is greater than among those
without occupation.(20)

Parental short stature is not a risk factor for
the prevalence of stunting in children. The results
of this study is in line with the study of Hanum(9)

who found no relationship between parental height
and prevalence of stunting. Parental short stature,
in this case parental height and growth pattern,
was not a determinant of stunting in their children.
Parents of short stature do not automatically have
children of short stature and vice versa. According
to the Hardy-Weinberg law of equilibrium,(24)

height is hereditary and is transmitted continously
from one generation to the next. However, this
herediatry trait may also be influenced by changes
in diverse environmental factors such as socio-
economic status, dietary pattern and physical
activity of the children. The absence in this
analysis of a relationship between the stature of
parents and stunting in their children was caused
by the almost identical parental growth patterns
in the group of cases as well as the controls, so
that in the analysis no association was found.

According to the WHO, the prevalence of
stunting in children is the result of a complex
interaction of various factors, among others
household condition, environmental influence,
socio-economics and culture.(25) The risk factors
that were investigated in this study were only
socio-cultural factors, namely factors that only
indirectly cause stunting. On the other hand, there
are still many other factors with a direct influence
on stunting, such as dietary intake and infectious
disease. In this study no in-depth investigation was
carried out on parental short stature in relation to
genetic factors. Determination of parental stature
was based only on measurement of parental height
during the study, while no research was done on
the height of the preceding generations.

The occurrence of a relationship between
maternal perception about sickness and the
prevalence of stunting in children aged 2–5 years,
show the need for intensive education to improve
culture-related community concepts that tend to
be detrimental to the community, particularly the
underfives. Further in-depth studies should be

Dellu, Mexitalia, Rosidi                                                                                           Maternal perception of sickness and stunting



163

conducted on the relation of parental genetic
factors with the prevalence of stunting in children,
since height is the product of interaction between
genetic and environmental factors.

CONCLUSION

Maternal perception of sickness was the most
dominant risk factor of stunting in children 2-5
years of age. A multidisciplinary approach is
needed to address the range of raised issues and
so combat stunting in children.

CONFLICT OF INTEREST

There were no conflicts of interest in this
study , which was entirly self-financed.

ACKNOWLEDGMENTS

The authors wish to express their utmost
gratitude to the study subjects and respondents
who agreed to participate in this study. The
authors also thank the supervisors and
examinators who provided helpful advice for
writing the study report.

REFERENCES

1. Senbanjo IO, Oshikoya KA, Odusanya OO, et
al. Prevalence and risk factors for stunting among
school children and adolescents in Abeokuta,
Southwest Nigeria. J Health Pop Nutr 2011;2:
364-70.

2. United Nations Children’s Fund (UNICEF).
Tracking progress on child and maternal
nutrition: a survival and development priority.
New York: United Nations Children’s Fund
(UNICEF);2009.

3. Kusumaningrum R. Studi epidemiologi sosial
kejadian stunting anak balita suku Dawan di
kabupaten Timor Tengah Selatan (TTS) (Tesis).
Kupang: Universitas Nusa Cendana;2014.

4. Kementerian Kesehatan Republik Indonesia
(Kemenkes RI). Riset Kesehatan Dasar
(Riskesdas) tahun 2013. Jakarta: Kementerian
Kesehatan Republik Indonesia (Kemenkes RI);
2013.

5. Nabuasa CD, Juffrie M, Huriyati E. Riwayat pola
asuh, pola makan, asupan zat gizi berhubungan

dengan kejadian stunting pada anak usia 24-59
bulan di Kecamatan Biboki Utara, Kabupaten
Timor Tengah Utara Provinsi Nusa Tenggara
Timur. Jurnal Gizi Dietetik Indonesia 2013;1:31-
43.

6. Yudi H. Hubungan faktor sosial budaya dengan
status gizi anak usia 6-24 bulan di Kecamatan
Medan Area, Kota Medan (Tesis). Medan:
Universitas Sumatera Utara; 2008.

7. Yasmin G, Lilik K, Cesilla MD. Risk factors of
stunting among school-children from eight
provinces in Indonesia. Pakistan J Nutr 2014;13:
557-66.

8. Solihin RDM, Anwar F, Sukandar D. Kaitan
antara status gizi, perkembangan kognitif, dan
perkembangan motorik pada anak usia
presekolah. Jurnal Penelitian Gizi Makanan
2013;36:62-72.

9. Hanum F. Hubungan asupan dan tinggi badan
ibu dengan status gizi anak balita. Jurnal Gizi
Pangan 2014;9:78-1059.

10. Kusuma KE, Nuryanto. Faktor risiko kejadian
stunting pada anak usia 2-3 tahun (studi di
Kecamatan Semarang Timur). J Nutr Coll 2013;
2:523-30.

11. Barstow C, Rerucha C. Evaluation of short and
tall stature in children. Am Fam Physician 2015;
92:43-50.

12. Aguayo VM, Nair R, Badgaiyan N, et al.
Determinants of stunting and poor linear growth
in children under 2 years of age in India: an in-
depth analysis of Maharashtra’s comperhensive
nutrition survey. Matern Child Nutr 2016;12:
121-40.

13. Cahyani NWW, Widarsa IKT. Penerapan analisis
jalur dalam analisis faktor determinan
eksklusivitas pemberian ASI di wilayah kerja
Puskesmas Payangan, Gianyar. J Comm Health
2014;2:96-106.

14. Nadiyah, Briawan D, Martianto D. Faktor risiko
stunting pada anak usia 0-23 bulan di Provinsi
Bali, Jawa Barat, dan Nusa Tenggara Timur.
Jurnal Gizi Pangan 2014;9:125-32.

15. Muchina EN, Waithaka PM. Relationship
between breastfeeding practices and nutritional
status of children aged 0–24 months in Nairobi,
Kenya. African J Food Agric Nutr Dev 2010;10:
1-14.

16. Teshome B, Kogi-Makau W, Getahun Z, et al.
Magnitude and determinants of stunting in
children under-five years of age in food surplus
region of Ethiopia: The case of West Gojam
Zone. Ethiop J Health Dev 2009;23:98-106

17. Fikadu T, Assegid S, Dube L. Factors associated
with stunting among children af age 24 to 59
months in Meskan district, Gurage zone, South

Univ Med                                                                                                                                                                     Vol. 35 No.3



164

Dellu, Mexitalia, Rosidi                                                                                           Maternal perception of sickness and stunting

Ethiophia: a case-control study. BMC Public
Health 2014:14;1-7.

18. Kamal M. Socio-economic determinants of
severe and moderate stunting among under five
children of rural Bangladesh. Mal J Nutr 2011;
17:105–18.

19. More J. Gizi bayi, anak dan remaja. Yogyakarta.
Pustaka Belajar; 2014.

20. Picauly I, Sarci MT. Analisis determinan dan
pengaruh stuntingterhadap prestasi belajar anak
sekolah di Kupang dan Sumba Timur, NTT.
Jurnal Pangan Gizi 2012;8:55-62.

21. Nasikhah R, Margawati A. Faktor resiko
kejadian stunting pada balita usia 24-36 bulan
di Kecamatan Semarang Timur. J Nutr Coll
2012;1:176-84.

22. Dekker LH, Mora-Plazas M, Marin C, et al.
Stunting associated with poor socioeconomic and
maternal nutrition status and respiratory
morbidity in Colombian school children. Food
Nutr Bull 2010;31:242-50.

23. Lestari W, Margawati A, Rahfiludin ZM. Faktor
risiko stunting pada anak umur 6-24 bulan di
kecamatan Penanggalan kota Subulussalam
Provinsi Aceh. Jurnal Gizi Indonesia 2014;3:
126-34.

24. Nature Education. Hardy-Weinberg equilibrium;
2014. Available at: http://www.nature.com/
scitable/definition/hardy-weinberg-equilibrium-
122. Accessed September 2, 2016.

25. Stewart CP, Iannotti L, Dewey KG, et al.
Contextualizing complementary feeding in a
broader framework for stunting prevention.
Maternal Child Nutrition 2013;9:27-45.