Determinants of stunting in children under five years old in South Sulawesi and West Sulawesi Province: 2013 and 2018 Indonesian Basic Health Survey

BACKGROUND: The prevalence of stunting in South Sulawesi and West Sulawesi Province is relatively high. Studies reveal various household, parental, and child factors are associated with stunting. This paper aimed to determine the determinants of stunting among children under five in South and West Sulawesi Province using the 2013 and 2018 Indonesia Basic Health Survey. METHODS: This study was a secondary data analysis using the 2013 and 2018 Indonesian Basic Health Surveys. The unit of analysis was children under five years, and the study obtained 3641 and 4423 children in South Sulawesi Province from the 2013 and 2018 Indonesia Basic Health Survey, respectively, and 804 and 1059 children from the 2013 and 2018 Indonesia Basic Health Survey in West Sulawesi Province, respectively. The multivariable poisson regression model was conducted to determine the determinants of stunting. RESULTS: The results showed that the mean age of children in South Sulawesi and West Sulawesi Province was 31.1 months and 30.8 months, respectively, on 2013 survey compare to 29.6 months and 29.1 months on the 2018 survey. The determinants of stunting in children under five in South Sulawesi Province in 2013 survey were household with two children under five (APR:1.24; 95% CI: 1.1-1.3; p-value = 0.006), maternal BMI (APR: 1.1; 95% CI: 1.03-1.1; p-value = <0.001), maternal weight (APR: 0.9; 95% CI: 0.94-0.97; p-value = <0.001), children aged 12-23 months (APR: 2.2; 95% CI: 1.7-2.7; p-value = <0.001), children aged 24-59 months (APR: 2.2; 95% CI: 1.8-2.7; p-value = <0.001), birthweight (APR: 1.9; 95% CI: 1.5-2.5; p-value = <0.001). In the 2018 survey, the determinants were maternal weight (APR: 0.9; 95% CI: 0.98-0.99; p-value = 0.005), mothers with no education or with education in primary school (APR: 1.5; 95% CI: 1.3-1.9; p-value = <0.001), mothers with education in middle school (APR: 1.3; 95% CI: 1.1-1.6; p-value = 0.014), mothers with a height less than 151 cm (APR: 1.3; 95% CI: 1.5-3.1; p-value = <0.001), mothers with a height of 151-160 cm (APR: 1.3; 95% CI: 1.1-1.6; p-value = 0.014), children aged 12-23 months (APR: 2.2; 95% CI: 1.7-2.8; p-value = <0.001), children aged 24-59 months (APR: 2.5; 95% CI: 2.0-3.2; p-value = <0.001)., birthweight (APR: 1.5; 95% CI: 1.2-1.9; p-value = <0.001). The determinants of stunting in children under five in West Sulawesi Province in 2013 survey were children under five years living in poor households (APR: 1.9; 95% CI: 1.1-3.3; p-value = 0.021), children under five who lived in a household with three or more children under five (APR:1.8; 95% CI: 1.2-2.7; p-value = 0.002), children aged 12-23 months (APR: 1.8; 95% CI: 1.2-2.6; p-value = 0.006), children aged 24-59 months (APR: 1.9; 95% CI: 1.3-2.7; p-value = 0.001). On the 2018 survey, the determinants were maternal BMI (APR: 1.02; 95% CI: 1.01-1.03; p-value = 0.004), maternal weight (APR: 0.9; 95% CI: 0.95-0.98; p-value = <0.001), mothers with no education or with education in primary school (APR: 1.9; 95% CI: 1.3-2.7; p-value = 0.001), mothers with education in middle school (APR: 1.9; 95% CI: 1.3-2.7; p-value = 0.001), mothers with education in high school (APR: 1.8; 95% CI: 1.2-2.6; p-value = 0.004), children aged 12-23 months (APR: 2.1; 95% CI: 1.4-3.0; p-value = <0.001), children aged 24-59 months (APR: 2.6; 95% CI: 1.9-3.6; p-value = <0.001), male (APR: 1.2; 95% CI: 1.01-1.4; p-value = 0.035), and acute respiratory infection (ARI) (APR: 1.6; 95% CI: 1.04-2.5; p-value = 0.030). CONCLUSIONS: The determinants of stunting in children under five in South Sulawesi Province are number of children under five in the household, maternal education, maternal weight, maternal height, maternal BMI, child's age, and birthweight. Meanwhile, the determinants of stunting in children under five in West Sulawesi were wealth, maternal education, maternal weight, maternal BMI,, child's age, child's sex, and history of acute respiratory infection. Hence, intervention on household and child levels as well as maternal sociodemographic factors need to be addressed.