Relationship between Low Birth Weight (LBW), Birth Length,

and Basic Immunization History with Stunting in Children

Age 9 - 60 Months in Kabupaten Purwakarta

July Ivone

, Stella T. Hasianna

, Victor Yohanes S.

and Vilia Ruthy W.

Department of Public Health, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia

Department of Physiology, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia

Keywords: Stunting, Factors, Relationship, Children.

Abstract: Childhood stunting has considerable human and economic costs. Three main factors that cause stunting are

birth weight, birth length, caregiving methods including infant immunization. There are three sub-districts in

Purwakarta have > 20% prevalence of under-five stunting; Bungursari (20.9%), Sukasari (24.1%), and

Darangdan (23.6%). The study aims to discover the relationship between Low Birth Weight (LBW), birth

length, basic immunization history, and stunting in children age 9 - 60 Months in Depok Village, Kecamatan

Darangdan, Kabupaten Purwakarta. This is a community-based cross-sectional study established in Kabupaten

Purwakarta from April to May 2019. Data was collected by interviewing 54 mothers of 9 to 60 months children

in Depok Village, Kecamatan Darangdan, Kabupaten Purwakarta, followed by measurement of length/height.

Data were analyzed using the Chi-Square test with α = 0.05 using SPSS. Bivariate analysis showed that low

birth weight (OR=3.178; p value=0.042), birth length (OR=3.067; p=0.050), and history of immunization

(OR=0.25; p value=0.042) are associated with the incidence of stunting in Depok Village, Kecamatan

Darangdan, Kabupaten Purwakarta (p <0.05). Conclusion: There was a relationship between low birth weight,

birth length, and basic immunization history and stunting in Kabupaten Purwakarta.

1 INTRODUCTION

Stunting is a condition in which children have less

length or height compared to age. This condition is

measured by a length or height that is below minus

two standard deviations from the WHO median

growth standard for children. (WHO, 2019). Stunting

results from the exposure of the fetus and/or young

child to nutritional deficiency and infectious disease.

Maternal undernutrition results in fetal growth

restriction, whereas infectious disease in pregnancy

can result in preterm delivery. Both of these

conditions are important contributors to early

childhood stunting. Stunting is a form of malnutrition

that makes a major global public health concern. An

estimated 155 million children under 5 years of age

are stunted around the world. Three regions had very

high rates of stunting with approximately one-third of

children affected: (1) South Asia; (2) Eastern and

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Southern Africa; and (3) West and Central Africa. Of

the 83.6 million stunted children under five in Asia,

the highest proportion came from South Asia (58.7%)

and the lowest proportion was in Central Asia (0.9%).

(Badan Pusat Statistik, 2018) The prevalence of

stunting has increased from 27.5% (2016) to 29.6%

(2017). T

here are 3 sub-districts in Purwakarta that

have a prevalence of under-five stunting > 20%;

Bungursari 20.9%, Sukasari 24.1%, and Darangdan

23.6%. (Arifin DZ, Irdasari SY & Sukandar H,

2012).

Stunting has its origins from conception to the

first 2 years of life, referred to as the 1000 days. It is

called the windows critical period because the brain

or intelligence grows rapidly during that time. As the

consequence, inadequate nutritional intake

(breastfeeding or complementary feeding) during the

first 2 years of life can lead to stunting. Failure of

growth due to undernutrition during this golden

period will cause a long-term permanent effect on the

Ivone, J., Hasianna, S., S., V. and W., V.

Relationship between Low Birth Weight (LBW), Birth Length, and Basic Immunization History with Stunting in Children Age 9 - 60 Months in Kabupaten Purwakarta.

DOI: 10.5220/0010748700003113

In Proceedings of the 1st International Conference on Emerging Issues in Technology, Engineering and Science (ICE-TES 2021), pages 245-249

ISBN: 978-989-758-601-9

245

individual growth.

The WHO conceptual framework on child

stunting classified the causes of stunting in terms of

several factors. Household and family factors,

inadequate complementary feeding, breastfeeding,

and infection are all factors related to stunting in

children (Beal et al., 2018). Those factors can be the

potential causes of stunting in Indonesia. Nutritional

status at birth (weight and length of birth) is the

dominant risk factor that affects stunting. Chronic

energy and micronutrient deficiency in pregnancy will

increase the risk of low-birth-weight babies (Svefors

et al., 2016). Mothers with this kind of condition may

have reduced protein and energy stores, a smaller

reproductive organ system, and limited room for fetal

development (Addo et al.,2013). Mothers with

chronic energy and micronutrient deficiency may not

provide sufficient breast milk to their baby which may

further affect the child's growth. (Utami, 2018).

Another factor that increases the risk of stunting in

children under five is immunization. Recurrent

infection in children can affect their growth and

development, which can lead to stunting. Disease

gives negative feedback to the nutritional status and

if it happens over a long time, it can increase the risk

of stunting (Permatasari, 2018). Children with

incomplete immunization status are 1.78 more times

at risk of stunting than children with complete

immunization status. Vaccinations have a role in

reducing child mortality and children who receive

vaccination have a lower risk. Early vaccination can

reduce the odds of stunting in children, while delayed

vaccination can increase the odds of stunting

(Berendsen, 2016).

The number of cases of stunting patients in the

Depok Village at Puskesmas Darangdan was still

high, hence the researchers were interested in

conducting a study on the relationship between LBW,

birth length, and basic Immunization history with

stunting in children age 9 - 60 months in Kabupaten

Purwakarta.

2 METHODS

This research was conducted with a descriptive-

analytic research type and a cross-sectional research

design. Camry scales and stature meters (microtoise)

were used to measure the weight and height of the

subjects. Data were collected through interviews with

54 mothers with children aged 9 to 60 months in

Depok Village, Kecamatan Darangdan, Kabupaten

Purwakarta using the incidental sampling technique.

The research was conducted on 23 April - 7 May

2019, at the Posyandu in Depok Village, Kecamatan

Darangdan, Kabupaten Purwakarta.

Data were analyzed using the Chi-Square test

with α = 0.05 and the calculations were done using

SPSS.

The research ethics included informed consent,

anonymity, confidentiality, and ethical clearance. The

ethical clearance in this study was obtained from the

Research Ethics Committee Maranatha Christian

University Number 010/KEP/II/2019.

3 RESULTS AND DISCUSSION

It Table 1 can be seen that of the 32 respondents who

have children with stunting, 22 (68.8%) of

respondents have children with LBW, and 10 (31.1%)

respondents

have children with normal birth

weight. Chi-square test for birth weight showed a p-

value of 0.042.

Table 1: The relationship between low birth weight with

stunting.

Stunting Status

Total OR p

Birth

Weight(g)

Stunting

(

)

Not

Stunting (%)

< 2500

22 9

(68.8) (40.9)

3.178

0.042

≥250

10 13

(31.1) (59.1)

32 22 54

According to WHO, low birth weight is defined

as birth weight < 2500 g. Birth weight is determined

by the pregnancy age and the growth rate of the fetus.

(Fitri, 2012) Birth weight has a vital role in

determining newborns' survival in vulnerable

conditions. Low birth weight is associated with fetal

and neonatal morbidity and mortality, impairment of

growth and development and also chronic disease

later in life (Lake, 2018).

Based on the analysis of the risk of LBW on the

incidence of stunting, an OR of 3.178 was obtained;

that means respondents who had children with low

birth weight had a 3.178 times greater risk of

experiencing stunting compared to respondents who

had children with normal birth weight (p-value =

0.042). This is in line with previous research in Aceh

which also showed that infants with LBW had a risk

of stunting up to 3.26 times greater than infants

without a history of LBW. (Lestari, Margawati, &

Rahfiludin, 2014). Research in 2015 showed that

stunted children were associated with a history of

ICE-TES 2021 - International Conference on Emerging Issues in Technology, Engineering, and Science

246

LBW (p-value = 0.015; OR = 1.555), which means

that children who had a history of LBW had a risk of

stunting 1.555 times compared to children who did

not experience LBW. (Rahayu, Yulidasari, Putri, &

Rahman, 2015). Another study stated that a baby's

weight at birth affected the growth of the baby

(Fekadu et al., (2015). Toddlers with a history of low

birth weight were more likely to experience stunting.

Babies who were born with LBW experience

difficulties in early growth. The problem of growth

could lead to stunting.

Table 2: Relationship between birth length with stunting.

Stunting Status

Total

Birth

length(cm)

Stunting

(%)

ot Stuntin

(%)

< 48

23 10

(71.9) (45.5)

3.067 0.005

≥ 48

9 14

(28.1) (54.5)

32 22 54

Table 2 showed that of 32 respondents who had

children with stunting, 23 (71.9%) respondents had

children with low birth length, and 9 (28.1%)

respondents had children with normal birth length.

The results of statistical tests with Chi-square for the

variable history of birth length showed a probability

value p-value = 0.050, so a significant difference was

found.

The length of the baby's body at birth describes

the linear growth of the baby during pregnancy. A

low linear measure usually indicates a state of

undernutrition due to a lack of energy and protein

suffered in the past which begins with a slowdown or

retardation of fetal growth (Lukman, Anwar, Riyadi,

Harjomidjojo, & Martianto, 2021). Inadequate

maternal nutritional intake before pregnancy causes

growth problems in the fetus, which can cause babies

to be born with low birth lengths (KEMENKES,

2020).

Based on the results the risk of birth length on the

incidence of stunting, an OR of 3.067 was obtained,

meaning that respondents who had children with a

low birth length had a risk of being stunted 3.067

times greater than those who had children with

normal birth length with a p-value = 0.005.

According to De Onis and Branca (2016), birth length

was one of the main factors affecting the incidence of

stunting. Stunting started from the first 1000 days of

life due to in-uterine growth disorder. Short birth

length reflects the history of protein-energy

malnutrition during pregnancy, causing fetal growth

retardation (FGR). This is in line with Khoirun and

Siti Rahayu's research in 2015 in Surabaya which

stated that low birth length has a higher risk of

stunting among children. (Khoirun, 2015). This is

also in line with the research conducted by Dandara

in Kediri, which said that the results of a large risk

analysis of the length of a baby at birth to the

incidence of stunting, obtained an OR of 4.078 with a

p-value of 0.000 (Swathma, Hariati, & Ardiansyah,

2016). This study was in accordance with a study by

Ayuningrum, Salimo, and Dewi (2017) which was

done in Purworejo, Central Java, Indonesia. It stated

that there was a meaningful relationship between

birth length and the incidence of stunting in toddlers.

Table 3: Relationship between basic immunization history

with stunting.

Stunting Status

Total OR p

Basic

mmunizatio

Stun ting

(%)

ot Stuntin

(%)

Complete

(87.5)

(63.6)

Incomplete 4

(

12.5

)

8 (36.4)

0.25 0.042

It can be seen in table 3 that of the 32 respondents

who experienced stunting, 28 (87.5%) of respondents

received complete basic immunization and 4 (12.5%)

respondents did not get complete basic

immunization.

Stunting directly affected by infectious diseases

and immunizations is a way to boost a person's

immunity so as not to get the disease. It has been

recognized for decades and highlighted by UNICEF

that infectious diseases contribute to child

undernutrition. An infectious disease can cause: (i)

reduced dietary intake (e.g. appetite loss, reduced

feeding by parents as an attempt to end diarrhea); (ii)

increased nutrient loss (e.g. vomiting, malabsorption)

and (iii) elevated nutrient requirements caused by

increases in metabolism such as those due to fever.

(Anekwe & Kumar, 2012)

Based on the results of a large analysis of the risk

of basic immunization history on the incidence of

stunting, an OR of 0.250 was obtained, meaning that

respondents who had children with incomplete basic

immunization had a risk of stunting 0.250 times

Relationship between Low Birth Weight (LBW), Birth Length, and Basic Immunization History with Stunting in Children Age 9 - 60

Months in Kabupaten Purwakarta

247

greater than respondents who had children with

complete basic immunization with p-value = 0.042.

This is also in line with research conducted by

Fajariah (2020), which shows that immunization

status has a significant relationship with the

nutritional status index of TB/U. (Fajariyah &

Hidajah, 2020). Swathma (2016) states that

immunization status is the underlying factor in the

incidence of stunting in children. (Swathma, 2016).

Another study from Chandra Dewi & Tresna Adhi

(2016) states that toddlers who have a history of

infection are more at risk for stunting. Infected

toddlers (Acute Respiratory Infection or diarrhea)

have a 5.41 times greater risk of experiencing stunting

(Chandra Dewi & Tresna Adhi, 2016). Vaccination is

the most effective public health intervention against

vaccine-preventable disease and has saved millions of

children’s lives.

4 CONCLUSIONS

There is a relationship between LBW with

stunting

There is a relationship between birth length with

stunting

There is a relationship between basic

immunization history with stunting

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Months in Kabupaten Purwakarta

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