Comparison of Growth Diagrams Of Indonesian Children to 2006 World Health Organization Growth Standards in diagnosing stunting

Abstract

Background Stunting represents a linear growth disturbance due to chronic malnutrition, recurrent infection, and inadequate psychosocial stimulation. The 2006 World Health Organization (WHO) Growth Standards are utilized as a modality in monitoring children’s growth, but to date, there has been no recommendation on use of the Growth Diagrams of Indonesian Children to monitor the growth of Indonesian children.
 Objective To determine the proportion of stunting, the sensitivity and specificity of Growth Diagrams of Indonesian Children for diagnosing stunting. In addition, we aimed to compare proportions of stunting using the 2006 WHO Growth Standards and Growth Diagrams of Indonesian Children.
 Method A cross-sectional study was conducted in Lawe Alas District, Southeast Aceh, Indonesia, from December 2017 to May 2018. Subjects were children aged 1-59 months who fulfilled the inclusion criteria. Subjects were obtained using a consecutive sampling method. Weight and height measurements were plotted on the Growth Diagrams of Indonesian Children and on the 2006 WHO Growth Standards to determine the stature o subjects. Stunting was defined as the index Z-score for HAZ of less than -2 SD for the 2006 WHO Growth Standards, and an HAZ index of below the 10th percentile (p10th) for the Growth Diagrams of Indonesian Children.
 Results Of 141 subjects, 66 (46.8%) had stunting based on the 2006 WHO Growth Standards and 51 (34.8%) had stunting based on Growth Diagrams of Indonesian Children. The sensitivity and specificity of the Growth Diagrams of Indonesian Children were 75.5% and 98.66%, respectively. Significantly more children were considered to be stunted using the 2006 WHO Growth Standards than using the Growth Diagrams of Indonesian Children.
 Conclusion Stunting prevalence is high in Southeast Aceh. The Growth Diagrams of Indonesian Children is a spesific and sensitive tool to diagnosed stunting in accordance with Indonesian children’s growth patterns.

Risk factors of stunting in Indonesian children aged 1 to 60 months

“…A previous study found that the proportion of stunting was significantly lower using the Growth Diagrams of Indonesian Children compared to the 2006 WHO Growth Standards (36.2% to 46.8%, respectively; P<0.001). 9 Furthermore, a study reported that Indonesian boys (SD 1.47) and girls (SD 1.43) were lower in height compared to American children. 6 The Growth Diagrams of Indonesian Children had good specificity (98.66%) for diagnosing stunting in the Indonesian pediatric population.…”

“…6 The Growth Diagrams of Indonesian Children had good specificity (98.66%) for diagnosing stunting in the Indonesian pediatric population. 9 Nutritional status in the first 1,000 days of life affects future quality of life. Intrauterine growth retardation (IUGR) is a reflection of maternal malnutrition.…”

“…Anthropometric data were plotted in Growth Diagrams of Indonesian Children to determine subjects' stunting status. 6,9 To identify risk factors of stunting, we first conducted a bivariate analysis between potential risk factors and proportion of stunting. Chi-square test was used to analyze for a possible correlation between risk factors and proportion of stunting in each group Variables with P value <0.25 were included in multivariate analysis with double logistic regression model.…”

“…7 The prevalences of stunting in Southeast Aceh District from our previous study were 36.2% by the Growth Diagrams of Indonesian Children and 46.8% by the 2006 WHO Growth Standards. 9 Stunting in Indonesian children requires preventive strategies, such as early intervention on risk factors. Thus, identification of risk factors is needed for better interventional strategies.…”

Effectiveness, Efficiency of Spending and Health Office Strategy in Overcoming Stunting in Maluku

“…Provinsi Acehmenempati peringkat ketiga prevalensi stunting tertinggi nasional dan pada anak balita merupakan yang tertinggi, yaitu sebesar 37,9% (Kemenkes 2018). Pada penelitian sebelumnya mencatat prevalensi stunting yang dilakukan pengukuran antropometri dengan kurva pertumbuhan anak Indonesia di Kabupaten Aceh Tenggara dari 141 anak berusia 1-60 bulan adalah sebesar 36,2%, lebih rendah dibandingkan dengan pengukuran menggunakan WHO Growth Standards 2006, yaitu sebesar 46,8% (Wicaksono et al 2020). Hal ini merupakan masalah kesehatan masyarakat yang berat dimana prevalensi stunting disuatu daerah adalah sebesar 30-39% dan masalah yang serius apabila prevalensi stunting = 40% (World Health Organization, 2010).…”