Distribution Pattern of Stunting Incidence at Gedong Tataan

Community Health Center Pesawaran District

Sutarto

1,* a

, Ratna Derwi Puspita Sari

and Winda Trijayanti Utama

Medical Education Study Program, Faculty of Medicine, University of Lampung, Bandar Lampung, 35145, Indonesia

Medical Professional Study Program, Faculty of Medicine, University of Lampung, Bandar Lampung, 35145, Indonesia

Keywords: Stunting, Ratio of Nearest Neighbors, Cluster, Pattern, Spread.

Abstract: Introduction: According to the 2022 Indonesian Nutrition Status Survey (SSGI), stunting in Indonesia is

21.6%, down from 24.4% in the previous year, with a target of 14% in 2024. The situation in Lampung

Province is highest in Pesawaran Regency (25.1%) and the most in Gedong Tataan were 175 stunted children.

Factors that influence the prevalence of stunting are influenced by regional and geographical factors. The aim

of this research is to determine and explain the distribution pattern of stunting in the work area of the Gedong

Tataan Community Health Center, Pesawaran Regency. Method: Quantitative analysis to describe using

Nearest Neighbor Analysis. Nearest Neighbor Analysis is an analysis method used to examine stunting

distribution patterns. Results: The indicator values in the Nearest Neighbor Ratio analysis illustrate that the

incidence of stunting is spread geographically. An NNR that is lower than 1 (0.567095) means that the

incidence of stunting at the Gedong Tataan Community Health Center has a tendency towards a concentration

or clustering pattern. Conclusion: The incidence of stunting at the Gedong Tataan Community Health Center

has a cluster pattern, although the incidence of stunting is very low, and the difference is very statistically

significant compared to the expected average.

1 INTRODUCTION

Reducing child stunting is an important goal of the 6

goals in the Global Nutrition Targets by 2025 and is a

key indicator in the second Sustainable Development.

Consistent evidence shows that non-exclusive

breastfeeding in the first 6 months, low household

socioeconomic status, premature birth, short birth

length, and low maternal height and education are

determinants of stunting in children in Indonesia.

Stunting results in decreased motor and (Beal et al.,

2018; Yuda et al., 2023) cognitive development,

impaired immunity and low educational attainment. In

adulthood, stunting leads to a decrease in economic

productivity, an increased risk of chronic diseases and

weight loss born in spring (Murti, 2020;

Uwiringiyimana et al., 2019).

Stunting is influenced by maternal factors (short

maternal height, low education, short birth spacing,

poor health before conception), and by household and

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life characteristics (low income, inadequate water and

sanitation, and low access to health services) (Islami

& Khouroh, 2021). In implementing stunting

reduction programs, there are many obstacles, when

the implementation of the program lacks human

resources and workload in the health office

district/city. Gedong Tataan Community Health

Center is one of the sub-districts in Pesawaran

Regency with the highest number of stunting children

and spread across 10 villages. Stunting prevention and

control services by the health service network in the

Gedong Tataan Community Health Center work area

have been carried out in auxiliary puskesmas units and

posyandu units. The health services provided affect

the pattern of distribution of stunting events, because

the services in the Gedong Tataan Community Health

Center area are served by Auxiliary Health Center and

Posyandu.

The government has created a medium-term

program of the National Strategy for the Acceleration

Sutarto, , Sari, R. D. P. and Utama, W. T.

Distribution Pattern of Stunting Incidence at Gedong Tataan Community Health Center Pesawaran Distr ict.

DOI: 10.5220/0013219800003873

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Medical Science and Health (ICOMESH 2023), pages 38-44

ISBN: 978-989-758-740-5

of Stunting Prevention 2018-2024, in the form of

stunting acceleration that prioritizes and focuses

targets on pregnant women, breastfeeding mothers,

children 0-23 years old, children aged 24-59 months,

women of childbearing age and adolescent girls, in its

implementation in 1,000 focus villages in 100 priority

(Yuda et al., 2023). Districts / cities Stunting is a major

global public health problem and has spatial variations

that change contextual variables from one region to

another, suggesting that geography is an important

component in the development of stunting reduction

and prevention strategies. After adjusting for

demographic and socioeconomic factors, altitude of

residence and being served by rural markets was also

significantly associated with the incidence of stunting

in children (Tamir et al., 2022; Uwiringiyimana et al.,

2019). The spatial distribution rate of stunting using

the latest data is very important in planning and

implementing geographically targeted and optimized

nutrition interventions in the Gedong Tataan

Community Health Center area. Interventions are

carried out by health service units in healthcare center.

Auxiliary community health center and Posyandu, so

it is necessary to buffer health services in stunting

prevention.

This study aims to assess the spatial distribution

pattern and buffer of stunting prevention health

services in children under five in the work area of

Gedong Tataan Community Health Center.

2 METHOD

The study design used population-based cross-

sectional study analysis and explored geographic

variation and identified patterns of distribution and

buffering of health services, factors influencing child

stunting and stunting. The research was conducted at

Gedong Tataan Community Health Center.

The analysis uses spatial analysis and nearest

neighbors to describe the phenomenon of distribution

patterns and buffering of health services. Data source.

This research data was taken from a survey by a

student enumerator majoring in Geography, Faculty

of Teacher Training and Education, University of

Lampung. To provide timely and reliable data on

health and demographic outcomes, standardized GPS

measuring instruments are used.

3 RESULTS

Pesawaran Regency is one of the regencies in

Lampung Province, Indonesia. Geographically,

Pesawaran Regency is located between 1040-05014'

East Longitude and 507'-5048' South Latitude. This

regency was inaugurated on November 2, 2007 based

on Law Number 33 of 2007 concerning the

Establishment of Pesawaran Regency. Initially this

regency was part of South Lampung Regency. The

total area of Pesawaran Regency is 1,173.77 km2 or

117,377 Ha with Padang Cermin District as the

largest district, which is 31,763 Ha. Pesawaran

Regency consists of 37 islands. The three largest

islands are Legundi Island, Pahawang Island, and

Kelagian Island.

Figure 1, administratively seen Pesawaran

Regency has the following boundaries.

• The northern part is bordered by Kalirejo District,

Bangunrejo District, Bumi Ratu Nuban District,

Trimurjo District, Central Lampung Regency

• The eastern part is bordered by Natar District,

South Lampung Regency, Kemiling District, and

Teluk Betung Barat District, Bandar Lampung

City

• The southern part is bordered by Lampung Bay,

Kelumbayan District, and Cukuh Balak District,

Tanggamus Regency

• The west is bordered by Adiluwih, Sukoharjo,

Gadingrejo, and Pardasuka Districts, Pringsewu

Regency.

Figure 1: Pesawaran District Administration Map (Primary

data collection results, 2023

Throughout 2023, there will be 175 cases of

stunting. The pattern of distribution of stunting cases

from the Average Nearest Neighbor (ANN) analysis,

provides an overview of the phenomenon of the spread

of stunting to form a pattern. Spatial statistics that have

been carried out describe geographical objects /

changes in events at a location, in addition to

describing spatial patterns formed by three types of

spatial patterns, clustered, dispersed, and random.

Distribution Pattern of Stunting Incidence at Gedong Tataan Community Health Center Pesawaran District

Figure 2 explains the clustering pattern of stunting

incidence in health services in 2 (two) auxiliary

community health center units located in the Gedong

Tataan Community Health Center work area. Each

auxiliary community health center unit is realized as

an independent health service center that provides

high-quality services to the local community. The

clustering pattern of stunting events based on the

service coverage of 2 (two) auxiliary health center

seems to have reached all stunting incidents so that the

role of health services is needed by the auxiliary

auxiliary health center as a network in the work area

of the Gedong Tataan Community Health Center. The

efficiency and effectiveness of health services in these

2 (two) auxiliary community health center units are

divided into certain groups based on the health service

needs of stunting locations that have the

characteristics of local residents in getting good health

services.

The clustering pattern of stunting incidence in

health services in 2 (two) auxiliary community health

centers, and the basis for improving children's health

services in this region. Collaboration between

auxiliary community health center and joint efforts in

overcoming stunting problems are expected to be

increased in response to the findings of this study. In

addition, the accuracy of the location and placement

of auxiliary community health center units in the

clustering pattern of stunting events also allows for

more even distribution of health resources. This helps

maximize the accessibility of stunted toddlers to

health services, reduces transportation burdens, and

increases responsibility towards local health needs.

Figure 2: Clustering Pattern of Stunting Incidence in Health

Services in 2 (two) auxiliary Puskesmas units in the Gedong

Tataan Health Center Work Area (Primary data collection

results, 2023)

Figure 2 shows the pattern of clustering services

in two auxiliary health center units in the Gedong

Tataan community health center work area creating a

coordinated and structured system, optimizing

community health services with a holistic approach

and based on local needs. This cluster is formed in 3

(three) central locations, centered on health services,

north to northeast and south to southwest.

Posyandu is a form of community-sourced health

efforts carried out by, from, and with the community,

to provide convenience for the community in

obtaining health services for mothers, babies, and

children under five. The skills of each posyandu

cadre in carrying out anthropometric measurements

are very necessary, for the detection of child growth

and development. Posyandu cadres are community

members who are willing, able, and have the time to

organize posyandu activities voluntarily. Early

detection of toddler growth disorders is one of the

best ways to reduce stunting prevalence, involving

posyandu cadres is a role in the implementation of the

3 (three) pillars stunting program in Indonesia,

empowering the community in stunting prevention

(Julianti & Elni, 2022; Sanjaya et al., 2022; Tri Astuti,

2022).

Figure 3 Clustering Pattern of Stunting Incidence in 10 (ten)

health services in Posyandu units in the Gedong Tataan

Health Center Work Area (Primary data collection results,

2023

Figure 3 reflects the exploration of certain patterns

in the incidence of stunting related to the quality of

health services provided by Posyandu in the Gedong

Tataan Community Health Center area. Identifying

risk factors that influence the incidence of stunting, as

well as mapping this clustering pattern between

Posyandu locations can be associated with differences

in health services. Factors such as diet, accessibility of

maternal and child health services, and socioeconomic

variables help detail specific aspects that need

attention. Assessing the existence of specific

geographical patterns in the incidence of stunting to

ICOMESH 2023 - INTERNATIONAL CONFERENCE ON MEDICAL SCIENCE AND HEALTH

understand the spatial distribution of stunting cases

across the working area of Gedong Tataan community

health center. This setting can provide a more holistic

view of the health challenges in each Posyandu and

assist in designing more targeted intervention

strategies.

The clustering pattern in health services is

contained in 10 (ten) Posyandu units in the Gedong

Tataan community health center working area, with a

planned layout, each Posyandu is organized in such a

way as to provide holistic and coordinated health

services to the local community. This clustering

pattern was designed by taking into account the

diversity and health needs of the community around

the Gedong Tataan community health center work

area. Each Posyandu focuses on preventive,

promotive and curative health services that are

specific to the public health profile in their

environment. With strategic placement, this clustering

pattern in Posyandu health services allows efficient

and optimal utilization of resources. People can easily

access quality healthcare without having to travel far.

In addition, collaboration between 10 Posyandu units

enables effective information exchange and

coordination in addressing various health issues at the

community level for stunting prevention.

The importance of clustering stunting events in

health service Posyandu can be seen in an effort to

improve the welfare of the community as a whole.

With a focus on disease prevention and health

promotion, this system contributes positively in

improving the quality of health and quality of life of

residents in the Gedong Tataan community health

center work area.

Community health center can manage and

implement all work programs and other health efforts

continuously well, so that community health center

must be able to prepare activity plans and budgeting

based on health development policies and the results

of situation analysis, not only that community health

center also needs to supervise and control activities

that have been running. Figure 4 explains that the

distribution pattern of stunting events can still be

reached by the Gedong Tataan community health

center office with the closest service distance of 5 kilo

meters and the farthest 10 kilo meters. Figure 4 also

shows clusters of stunting events in the south to

southwest, closest to health services in the nearest sub-

district (Kota Dalam sub-district by Kota Dalam

Health Center) (Al Hikami et al., 2022; Pratiwi Yunus

et al., 2021).

Grouping distance, travel time and availability of

transportation to access health services including

community health center is an access variable, the

longer the distance to the puskesmas will reduce the

frequency of visits to community health center,

indirectly can affect the incidence of stunting (Son &;

Suariyani, 2021).

The distance between the patient's home and the

health facility (more than 10 kilo meters) reduces

visits and adherence to treatment. Patients stop

visiting treatment because the distance from home to

the community health center is too far requires

transportation costs and time, even though the person

concerned has understood and understood the impact

of non-compliance in undergoing treatment (Riki

Yudiana et al., 2022).

Nutrition-sensitive interventions have an effect on

reducing the incidence of stunting through various

improvements in health services both in the primary

target of toddlers, pregnant women, as well as

secondary targets of adolescent girls and community

leaders. To realize this, the government established

Guidelines for the Implementation of the Healthy

Indonesia Program with a Family Approach, through

efforts to provide services for Pregnant and Maternity

Women through Intervention in the first 1,000 days of

life; integrated antenatal care (ANC) quality

assurance; childbirth in a health facility; high-calorie,

protein, and micronutrient feeding programs, early

detection of diseases (infectious and non-

communicable); eradication of worms; transformation

of Kartu Menuju Sehat (KMS) into MCH Book; Early

Breastfeeding Initiation Counseling, exclusive

breastfeeding; and monitoring toddler growth by

organizing supplementary food activities for toddlers

at posyandu (Maesaroh &; Sulistyorini, 2021;

Sugianti &; Devianti Putri, 2022).

Figure 4: Clustering Pattern of Stunting Incidence

according to the Gedong Tataan Community Health Center

(Primary data collection results, 2023)

Specific interventions carried out by all

community health center in Indonesia are in

Distribution Pattern of Stunting Incidence at Gedong Tataan Community Health Center Pesawaran District

accordance with applicable guidelines, each with

different targets. In target adolescent girls, two

specific interventions were carried out, namely

anaemia screening and consumption of blood-

boosting tablets. Anaemia screening activities that

can be carried out include Haemoglobin (Hb)

Examination activities for junior and senior high

school students, adolescent female anaemia

education, anaemia screening training, female student

training on measuring height, weight, upper arm

circumference and clinical signs of anaemia,

distribution of iron tablets that must be taken for 12

weeks (1 tablet/week). The target of pregnant women

is three activities, namely antenatal care (ANC),

consumption of iron tablets for pregnant women,

supplementary feeding for pregnant women with

chronic energy deficiency. The toddler target is

carried out with five specific activities, namely

monitoring toddler growth, exclusive breastfeeding,

giving food rich in animal protein for under two years

old children, managing nutritional problems,

increasing immunization coverage (Pratiwi, 2023)

In Figure 5 and Table 1, the context of stunting

events in the working area of Gedong Tataan

community health center, the results of Average

Nearest Neighbor (ANN) analysis with important

information, the average distance observed was

278.7904 meters, reflecting the average distance

between each stunting case and other nearby stunting

cases in the Gedong Tataan community health center

work area. The Nearest Neighbor Ratio value of

0.567095 shows the relationship between the

observed mean distance and the expected average

distance of each randomly distributed stunting case.

If this value is less than 1, it indicates a tendency to

form clusters. The Z-score of -6.573460 is used to

measure the distance of the observation value from

the randomly distributed expectation value, and a

negative value indicates that the distribution of

stunting cases is not random (distributed cluster). A

very small P value (0.000000001) indicates that the

difference between the observed and expected

distributions is significantly randomly distributed.

The results obtained from these values show patterns

or clusters in the distribution of stunting events in the

work area of the Gedong Tataan community health

center.

Based on these results, there are factors that can

cause cluster patterns, namely health service factors

that have been carried out by posyandu, auxiliary

community health centers and elderly health centers.

Health services carried out by these health facilities

are anaemia screening and consumption of iron

tablets for adolescent girls, distribution of iron tablets

for pregnant women, antenatal care (ANC),

supplementary feeding for pregnant women who are

chronically deficient in energy and for toddler targets

in the form of monitoring toddler growth, exclusive

breastfeeding, providing complementary foods,

managing nutritional problems, increased

immunization coverage and others (Pratiwi, 2023).

Figure 5: Neighboar Nearest Average Test Results Analysis

of Stuntitng Incidence in Gedong Tataan Health Center

Working Area (Primary data collection results, 2023)

Table 1: Analysis of the Average Closest Distance to the

Incidence of Stunting in the Working Area of Gedong

Tataan Community Health Center

Average observed distance 278.7904 meters

The ratio of nearest neighbors 0.567095

Z-Score -6.573460

p-value 0.000000

Source: primary data processing results, 2023

Table 1 shows that the average distance between

stunting toddlers is 278 meters, this distance shows

the density and very close between stunting toddlers,

the close distance between stunting toddlers is

possible because of the similarity in the receipt of

health services provided by health facilities related to

the average distance from stunting toddlers' homes to

health facilities. The distance between health

facilities has an impact on the utilization rate of these

facilities, if health facilities are located far away or

difficult to access, people may not want or have

difficulty in utilizing available health services (Muin

& Radaya, 2023). In this analysis of the distribution

of stunting toddlers, distribution patterns that tend to

form clusters around health facilities, mean that

stunted toddlers tend to be localized or gather in areas

close to health facilities. These results illustrate the

possible influence or relationship between the

incidence of stunting in toddlers and the location of

health facilities. This pattern of group distribution has

important implications for strategic planning and

ICOMESH 2023 - INTERNATIONAL CONFERENCE ON MEDICAL SCIENCE AND HEALTH

implementation of health interventions in the regions,

focusing on areas that show higher stunting rates and

adjacent to health facilities.

The proximity of health facilities, taking into

account the distance of the house from the facility,

can provide information on the grouping of health

service recipients around the location of health

facilities, so that this condition can be a solution by

ensuring optimal health services for the community

so that stunting events can be prevented and

overcome.

4 CONCLUSIONS

The incidence of stunting in the working area of the

Gedong Tataan community health center

determination of the results of the analysis The

Average Nearest Neighbor formed a cluster with an

average distance of 278.7904 meters, reflecting the

average distance between stunting cases so close that

it formed a cluster pattern. Nearest Neighbor Ratio

with a value of 0.567095 indicates that the

distribution of points or objects observed tends to be

more collected or form groups. There is a tendency to

approach each other in space, an indication of

collected spatial patterns or clusters. The condition of

this observed spatial pattern is not due to chance, but

is caused by certain factors or processes that affect the

distribution pattern. Distribution patterns tend to form

clusters around health facilities, illustrating the

possible influence or relationship between the

incidence of stunting in toddlers and the location of

health facilities. This cluster distribution pattern has

important implications for strategic planning and

implementation of health interventions for stunting

prevention and control with a focus on areas adjacent

to health facilities.

ACKNOWLEDGEMENTS

We would like to express our gratitude to the Faculty

of Medicine, University of Lampung, which has

provided enthusiastic support and funding.

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