The Determinant of Stunting in 24-59 Month-Old Children in Kulon Progo

District 2019

Determinan Anak Stunting Usia 24-59 Bulan di Kabupaten Kulon Progo

2019

Chatrine Aprilia Hendraswari1*, Yuliasti Eka Purnamaningrum1, Tri Maryani1, Yani

Widyastuti1 & Sakinah Harith2

1
Poltekkes Kemenkes Yogyakarta Faculty of Midwifery, Mangkuyudan street, MJ III/304,
Yogyakarta 55143, Indonesia
2
Faculty of Health Sciences, Universiti Sultan Zainal Abidin, 21300 Kuala Nerus,
Terengganu, Malaysia

*Chatrine Aprilia Hendraswari, Poltekkes Kemenkes Yogyakarta Faculty of Midwifery, E-

mail: chatrineaprilia6@gmail.com, Phone: 085727763335

ABSTRACT

Stunting is toddlers with z-score of <-2SD and <-3SD. The results of the preliminary study
showed 22.6% as the highest prevalence of stunting in Kulon Progo, which belongs to Temon
II Health Center. The aim is to determinants of stunting toddler aged 24-59 months. The
research was conducted in September 2018-Mei 2019. The type of the research is
observational analytic with the design of case control. Sample was toddlers aged 24-59
months with 60 toddlers. The sampling method utilizes proportional sampling whereas data
analysis applies the chi-square and logistic regression. The analysis of statistical tests shows
that there was a significant correlation to stunting toddler is energy intake factor (p-value =
0.030; α= 0.05; CI= 95%). Risk factors are energy intake, protein intake, suffering URI,
suffering diarrhea. Non-risk factors are immunization status. Protective factors are access to
clean water, history of exclusive breastfeeding. The most influencing factor for stunting
toddler aged 24-59 months in the working area of Temon II Health Center is energy intake.
Keywords: stunting, energy intake, determinant.

ABSTRAK

Stunting menurut Kemenkes adalah balita dengan nilai z-scorenya <-2SD dan <-3SD.
Kabupaten Kulon Progo di urutan ke-43 Lokus 100 Kabupaten/Kota utama untuk intervensi
stunting sebesar 20,30%. Hasil studi pendahuluan menunjukkan prevalensi stunting tertinggi
di Kulon Progo sebesar 22,6% adalah Puskesmas Temon II. Tujuan penelitian adalah untuk
mengetahui determinan anak stunting usia 24 - 59 bulan di wilayah kerja Puskesmas Temon

1
II Kabupaten Kulon Progo. Jenis penelitian adalah analitik observasional dengan desain case
control yang dilaksanakan pada bulan September 2018-Mei 2019. Sampel adalah balita usia
24-59 bulan yang memenuhi kriteria inklusi berjumlah 60 balita. Metode pengambilan
sampling menggunakan proporsional sampling. Analisis data menggunakan chi-square dan
regresi logistik. Analisis uji statistik menunjukkan yang berhubungan dengan anak stunting
adalah asupan energi (p-value = 0,017; OR = 6,00). Faktor risiko adalah asupan protein,
asupan energi, diare, ISPA. Bukan faktor risiko adalah status imunisasi, jamban. Faktor
protektif adalah akses air bersih, riwayat ASI Eksklusif. Faktor yang paling mempengaruhi
anak stunting adalah asupan energi.
Kata Kunci : stunting, asupan energi, determinan.

Intoduction
Stunting is one of nutrient issue that concerned the world in developed countries
especially.1 Stunting, or being too short for one’s age, is defined as a height that is more than
two standard deviations below the World Health Organization (WHO) Child Growth
Standards median.2 Malnutrition happens during the pregnancy time and the newborn time.
Toddler that considered as stunted and severely stunted if the body length and the
height based on the age range are less than WHO-MGRS median standart. 3 Whereas
Indonesia Ministry of Health considers that stunted toddler with the value of z-score less
than -2SD/ deviation standart and severely stunted toddler with the value less than -3SD. 4 In
while, wasting in children is a symptom of acute undernutrition, usually as a consequence of
insufficient food intake or a high incidence of infectious diseases, weight for height < –2 SD
of the WHO Child Growth Standards median.5
Children who suffer from growth retardation as a result of poor diets or recurrent
infections tend to be at greater risk for illness and death. Stunting is the result of long-term
nutritional deprivation and often results in delayed mental development, poor school
performance and reduced intellectual capacity. This in turn affects economic productivity at
national level. Women of short stature are at greater risk for obstetric complications because
of a smaller pelvis. Small women are at greater risk of delivering an infant with low birth
weight, contributing to the intergenerational cycle of malnutrition, as infants of low birth
weight or retarded intrauterine growth tend be smaller as adults.5
According to the national research The Basic Health Research (Riskesdas) shows that
there is an increase in the prevalence of stunting in Indonesia from 37,2% in 2013 decreased
to 30,8% in 2018.6 Stunting percentage according to PSG (Monitoring Nutritional Status) in
2014 is 28,9%, in 2015 is 29%, in 2016 is 27,5% and in 2017 is 29,6%.
The prevalence of stunting in DIY in 2017 is 13.86% and this number drops to 12.37 in
2018.6

Based of Rahmayana's study found that findings from Bangladesh, India and Pakistan
where children aged 24-59 months were found to be at greater risk of obstruction. Efforts to
handle the incidence of stunting must be known the factors that cause it. Whereas the causes
of stunting are reducing food intake, the presence of infectious diseases, lack of mother's
knowledge, wrong parenting, poor sanitation, and low health services .1,7 However, according

2
to UNICEF it is said that the factors that influence the nutritional status of toddler and the
causes of malnutrition are divided into two: direct and indirect causes. Foods and disease
could directly cause the low nutrient, while there are three indirect causes of low nutrient
which are food security, child care patterns, health and environmental services. Based on
those problems and still high prevalence of stunting in toddler , further investigation is
needed on what determinants cause stunting.8 The aim of the study was to determine the
determinants of stunting toddler aged 24-59 months.
Method
This study was an observational analytic study with a case control design. The study
was conducted between September 2018-May 2019 in Temon II Public Health Center, Kulon
Progo Regency. The population were all toddlers aged 24-59 months, as the sample of case
were 30 stunted, and control sample was 30 not stunted. Respondent are mother of cases and
controls toddlers. Sampling in this study is proportional sampling, taken from seven villages
in Temon II Health Center. Toddlers in each village carried out according to inclusion and
exclusion criteria. The inclusion is toddlers with an age range of 24-59 months who reside in
the study area, has z-score limit of ≥-2 SD sampai dengan 2 SD, and are willing to follow the
research by signing a inform consent. Then randomly taken in accordance with the
proportional distribution that has been determined by each village, so that each village can be
represented.
History of exclusive breastfeeding in accordance with the respondent's
acknowledgment of breastfeeding for 0-6 months. Energy intake is in accordance with the
total energy sourced from food and beverages consumed by respondents inputted in the
NutriSurvey 2007. It is said to be low if <80%, and sufficient ≥80%. Protein intake is taken
from total protein sourced from animal and vegetable proteins and inputted in the
Nutrisurvey 2007 with a low category <80% and sufficient ≥80%. Immunization status is
taken from the MCH book in accordance with the basic immunization requirements obtained
according to his age and the government policy of the Immunization Development Program.
Suffering from URI is obtained from the respondent's recognition of the frequency of sick
toddlers affected by URI (TB, cough, colds and other respiratory diseases) in the past year
with frequent categories (≥6 times a year) and rarely (<6 times a year). Suffered from
diarrhea obtained from the respondent's recognition of the frequency of sick toddlers affected
by diarrhea in the past year with a frequent category (≥3 times a year) and rarely (<3 times a
year). Access to clean water is obtained from the respondent's acknowledgment, and
inspection of the availability of clean water in the respondent's house.
Data are obtained from interview with questionnaire. Data of respondents' food intake
obtained from interviews using a 24-hour food recall questionnaire was analyzed by
NutriSurvey 2007 software to obtain the percentage of energy intake and protein intake then
compared with the nutritional adequacy rate (AKG). Data on infectious diseases (suffered
from diarrhea and Upper Respiratory Tract Infection in September 2018 to May 2019) were
collected from the respondent's confession and the Health Center register book within the
past year of 2018. Basic immunization data is collected from the MCH handbook and register
of Temon II Health Center immunization. Environmental sanitation is based on the use of

3
toilets and
access to clean water.
The collector is a researcher who works closely with the nutrition team (two nutrition
experts and three applied nutrition students). Initial preparation is to take data at the Health
Center, then select respondents using the inclusion and exclusion criteria. The researcher
briefed the nutrition team, Health Center staff and framework to collect data. Researchers
educate and supervise framework in measuring toddler height. Researchers select
respondents. If the respondent matches the inclusion, then an interview is conducted using a
questionnaire. The researcher writes the immunization status in the questionnaire as
secondary data from the MCH book. Then the nutrition team conducted a direct interview to
fill in a 24-hour food recall. Interviews with the 24 hour food recall method were conducted
twice in one week with an interval of two days. So the researchers made another time
contract by visiting the respondent's house.
Data analysis included univariate, bivariate and multivariate. Univariate by
conducting a frequency distribution test. Bivariate analysis used Chi-square test with
significance level (p value = 0.05) and CI 95%. Interpretation of OR values is used to
determine the risk of each factors and the most influential factors. To see the most dominant
factors, a multivariate logistic regression analysis was performed on the variable results of
bivariate analysis that had a value of p <0.25. This research has been approved by Health
Research Ethics Committee (KEPK) Health Ministry of Health Polytechnic Yogyakarta No.
LB.01.01/KE-01/VII/249/2019.

Result
Gender can affect the level of stunting of toddler , it is known that toddlers who
experience stunting are more in male (53.3%) than female toddlers. While those who did not
stunting were found to be more in female by (53.3%) than male toddlers. Mother's work can
also affect the level of toddler 's stunting, it is known that stunting and non-stunting toddler
have unemployed mothers higher than employed mothers respectively (66.7%) and (63.3%).
Maternal education can also influence the level of stunting of toddler , it is known that
toddlers who are stunting and not stunting have mothers with secondary education higher
than mothers who have a low education and enough respectively (80%) and (83.3%).
Table 1. Distribution of Frequency of Stunting Toddlers Based on Characteristics in the
Work Area of Temon II Public Health Center in Kulon Progo Regency
Variables that Influence Toddlers Aged Stunting Not Stunting
24-59 Months n % N %
Gender
1. Male 16 53,3 14 46,7
2. Female 14 46,7 16 53,3
Total 30 100 30 100
Mother's Work Status
1. Employed 10 33,3 11 36,7
2. Unemployed 20 66,7 19 63,3
Total 30 100 30 100
Mother’s Education Level
1. Lower 4 13,3 3 10
24 80 25 83,3

4
 2. Secondary 2 6,7 2 6,7
3. Tertiary 30 100 30 100
Total

Table 2. Relationship of Some Risk Factors of Stunting Toddler Age 24-59 Months in
Temon II Public Health Center in Kulon Progo Regency
Variables that Influence Stunting Not Stunting P OR 95%CI
Toddlers Aged 24-59 Value
Months N % N %
Exclusive Breastfeeding History
1. Exclusive 9 30 12 40 0,588 0,643 0,221 – 1,873
Breastfeeding 21 70 18 60
2. Not Exclusive 30 100 30 100
Breastfeeding
Jumlah
Energy Intake
1. Low 12 40 3 10 0,017 6,000 0,047 – 0,782
2. Sufficient 18 60 27 90
Total 30 100 30 100
Protein Intake
1. Low 3 10 1 3,3 0,605 3,222 0,030 – 3,168
2. Sufficient 27 90 29 96,7
Total 30 100 30 100

Immunization Status
1. Complete 29 96,7 29 96,7 1,000 1,000 0,060 – 16,763
2. Incomplete 1 3,3 1 3,3
Jumlah 30 100 30 100
Suffer from Diarrhea
1. Often 4 13,3 3 10 1,000 1,385 0,282 – 6,796
2. Rare 26 86,7 27 90
Total 30 100 30 100
Suffer from URI
1. Often 9 30 4 13,3 0,210 2,786 0,751 – 10,331
2. Rare 21 70 26 86,7
Total 30 100 30 100
Access to Clean Water
1. Yes 17 56,7 21 70 0,422 0,560 0,193 – 1,623
2. No 13 43,3 9 30
Total 30 100 30 100
Toilet
3. Yes 29 96,7 29 96,7 1,000 1,000 0,060 – 16,763
4. No 1 3,3 1 3,3
Total 30 100 30 100
Description: * means p-value <0.05
Based on Table 2, the history of exclusive breastfeeding according to the statistical test
results showed that there was no relationship between exclusive breastfeeding history and
stunting toddler (p-value = 0.588; α = 0 , 05; CI = 95%). Toddler who are not given
exclusive breastfeeding have a risk of 0.64 times stunting when compared to toddler who are
given exclusive breastfeeding, meaning exclusive breastfeeding is a protection factor
although it is not statistically significant.

5
 The factor of energy intake from the statistical test results showed that there were
differences in stunting toddler (p-value = 0.017; α = 0.05; CI = 95%). Toddler with low
energy intake have 6 times the chance to experience stunting when compared to toddler who
have enough energy intake. According to these results, it means that low energy intake is a
risk factor for stunting toddler. In the factor of protein intake from the results of the statistical
test there is no correlation between protein intake and stunting toddler (p-value = 0.605; α =
0.05; CI = 95%). Toddler who have low protein intake have a chance of 3.22 times to
experience stunting when compared to toddler who have enough protein intake. It means that
low protein intake is a risk factor for stunting toddler .
Immunization factors have no significant relationship with stunting toddler (p-value =
1.00; α = 0.05; CI = 95%). But toddler who do not have complete basic immunizations have
a chance of 1.00 stunting than toddler who have complete basic immunizations. According to
a statistical test analysis, complete basic immunization is not a risk factor for stunting.
Based on the results of statistical tests it was found that there was no relationship
between stunting toddler who often suffer from URI with toddler who rarely suffer from
URI (p-value = 0.210; α = 0.05; CI = 95%). Toddler who often suffer from URI have a
chance of 2.78 times higher to having stunting than toddler who rarely suffer from URI.
Means the factor of the frequency of toddler suffering from URI have a high risk factor for
the occurrence of stunting toddler . Toddler who often and rarely suffer from diarrhea have
no difference with toddler who are stunting and not stunting (p-value = 1.00; α = 0.05; CI =
95%). However, toddler who often suffer from diarrhea have a chance of 1.38 times slightly
higher to experience stunting than toddler who rarely suffer from diarrhea. This means that
toddler who often suffer from diarrhea have risk factors for stunting.
Access to clean water factor, based on the results of statistical tests, found that there
was no difference in access to clean water that consumed by stunting toddler and those who
did not have stunting or there was no significant relationship between access to clean water
toward stunting toddler (p-value = 0.422; α = 0.05; CI = 95%). Toddler who consume
unsanitized water have a chance of 0.56 times higher to experience stunting when compared
to toddler who consume sanitized water. It means that access to clean water is a protective
factor or a preventive factor for stunting.
Based on Table 2, from the toilet factor it was found that there was no difference in
stunting toddler who did not have good toilets and good toilets (p-value = 1.00; α = 0.05; CI
= 95%). Toddler who do not use good toilets have a chance of 1.00 times stunting than
toddler who use good toilets. Judging from the odds ratio, that toilet is not a risk factor for
stunting.
Table 3. Results of the Analysis of Factors that Most Affect Stunting Toddler Aged 24-59
Months in the Temon II Working Area of Kulon Progo Regency
Variables that Influence B Wald df Sig. Exp 95% CI for Exp
Toddlers Aged 24-59 (B) (B)
Months Lower Upper
Energy Intake -1,637 0,740 1 0,027 0,195 0,046 0,830
Suffered from URI -0,537 0,534 1 0,465 0,584 0,138 2,467
Description: * p-value <0.25

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 Based on Table 3, the variable energy intake (p-value = 0.027) is a factor that is
significantly associated with stunting toddler aged 24-59 months, after being controlled with
a history of exclusive breastfeeding, energy intake, protein intake, immunization status,
suffered from diarrhea and URI, and toilet. Means that energy intake factors are protective or
preventive factors to stunting in 24-59 month old.

Discussion
The factors examined in this study were feeding factors including exclusive
breastfeeding, energy intake and protein intake. Health care factors include immunization
status and infectious diseases, namely suffering from URI and suffered from diarrhea.
Environmental sanitation factors consist of access to clean water and toilets.
The results of the study showed that toddlers who were not given exclusive
breastfeeding during the first 6 months had a greater risk of the incidence of stunting. Based
on Table 2. the results of this study stated that there was no association of giving exclusive
breastfeeding history to stunting toddler aged 24-59 months in the working area of Temon II
Public Health Center in Kulon Progo Regency. Exclusive breastfeeding factors are protective
factors or preventive factors for stunting toddler . This research is in line with the research in
Tariku, et al. In Ethiopia, exclusive breastfeeding is not related to stunting. 9 This can be
caused by the condition of stunting not determined by factors of exclusive breastfeeding
status, but also influenced by other factors such as: complementary food quality, adequate
nutritional intake given to the child every day, as well as the health status of the baby.10

The results of this study indicate that there is a relationship between energy intake and
stunting. Inadequate nutritional intake especially from total energy is directly related to
physical growth deficits in toddler . The low energy consumption is a major factor as a cause
of toddler stunting in Indonesia.11 According to Astari, et al., In Annisa Pramitha's study that
the low energy consumption in the toddler stunting group is probably caused by several other
factors including frequency and amount of feeding, low energy density, dietary bulk, reduced
appetite and infectious diseases.
This study revealed that there was no relationship between protein intake for stunting
toddler aged 24-59 months in the working area of Temon II Public Health Center in Kulon
Progo Regency, but statistically protein intake was a risk factor for stunting.
These results indicate that there is a significant relationship between protein
consumption and the incidence of stunting in infants. The study findings showed that most
toddlers had sufficient levels of protein intake, but statistically no association was found
between the level of protein intake and stunting toddler aged 24-59 months. Some of the
reasons for not finding the relationship are thought to be caused by several factors. Stunting
occurs in a long period of time, so the level of protein intake that occurs now is not one of the
causes of stunting. Protein intake is not the only factor that affects stunting.
Immunization is an attempt to actively raise or enhance one's immunity against a
disease, so that if one day is exposed to the disease it will not get sick or only experience mild
illness.12 Immunization status in toddler is one indicator of contact with health services.

7
Because it is hoped that contact with health services will help improve nutritional problems.
Immunization status is also expected to have a positive effect on long-term nutritional status.
This is in line with the results of this study which was analyzed statistically that there
was no relationship between immunization status and stunting toddler aged 24-59 months.
According to statistical tests immunization factors are not a risk factor for stunting. Paramitha
Annisa's research states that there is no meaningful immunization status with the incidence of
stunting. In contrast to this study, one of the studies conducted by Neldawati showed that
immunization status had a significant relationship to the nutritional status index TB / U.45
Toddler who were not given complete basic immunization did not immediately suffer from
infectious diseases. Toddler 's immunity is influenced by other factors such as nutritional
status and the presence of pathogens. There are terms of herd immunity or immunity in
immunization, ie individuals who do not get an immunization program are protected because
most of the other individuals in the group are immune to the disease after receiving
immunization.10

Infection is a factor that directly affects nutritional status in addition to adequate

nutrition. Infection decreases food intake, interferes with nutrient absorption, causes direct
loss of nutrients, increases metabolic requirements or catabolic loss of nutrients and interferes
with nutrient transport to target tissues. This includes food intake. One infectious disease
including diarrhea is actually a symptom of gastrointestinal disease or other diseases outside
the digestive tract.
The study was not in line with the results of this study that there was no association
between diarrheal infections in stunting toddler aged 24-59 months. However, in Table 3.
that toddler who often suffer from diarrhea have a risk of 1.38 times stunting, meaning
diarrheal infections are a risk factor for stunting. The absence of a meaningful relationship in
this study was due to the direct impact of diarrhea, that is weight loss compared to stunting.
Toddler who experience diarrhea are usually accompanied by anorexia and dehydration, if
not properly treated will have an impact on weight loss which is a sign of acute malnutrition,
while stunting signifies repeated chronic malnutrition. This can also be caused by the
duration of the infection experienced.10

URI as well as diarrhea is one of the infectious diseases that is vulnerable to toddler
under the age of five. The age of toddlers is a vulnerable age for the occurrence of health
problems, especially URI, because toddler under five have a low immune system. Acute
Respiratory Infections or URIs are acute inflammation of the upper and lower respiratory
tract caused by bacterial, viral, or rickets infections, both with or without inflammation of
pulmonary parenchyma. 13

The results of this study that there is no significant relationship between URI infectious
disease and stunting toddler aged 24-59 months. But the factor of infectious disease is a risk
factor for stunting. The results of this study are in accordance with the research conducted by
Nasikhah in East Semarang Subdistrict which shows that the history of infectious diseases in
this case of acute upper respiratory tract infection is a non-significant risk factor for
stunting.14 Unlike the Agrina study that there is a significant influence between nutritional

8
status toddler with URI.11 This is due to stunting not only being affected by the frequency of
infectious diseases, but also by the duration of the disease and nutrient intake during the
episode of infectious disease.15

Access to clean water and sanitation is the 6th target of SDGs. Without clean water and
adequate sanitation a decrease in the prevalence of stunting will not be achieved. 16 Poor
exposure to the environment and hygiene can be the result of stunting due to malnutrition
absorption and the ability of the intestines to function less as a disease barrier. 17 This is not in
line with this research that there is no relationship between access to clean water and stunting
toddler aged 24-59 months in the Temon II Health Center work area, but it is a protective
factor or a preventive factor for the occurrence of stunting.
Van der Hoek's research, states that toddler from families that have clean water
facilities have a lower prevalence of diarrhea and stunting than toddler from families without
clean water and toilet facilities. The indicators for the short-term number of toddler are due
to the lack of availability of clean and decent drinking water. As many as 47% of the
population of Indonesia drink water containing germs even though the water has been cooked
and 340 toddler die from diarrhea every week in Indonesia. 11 There is no relationship
between access to clean water as a source of drink.
Exposure to environment and cleanliness is in line with basic sanitation factors.
According to Yulestari's research, the results of the study showed that stunting toddlers were
more prevalent in families with poor basic sanitation. Households with poor sanitation are 1.3
times at risk of having stunting toddlers compared to households with good basic sanitation.
In this study, there was no relationship between toilet ownership and stunting toddler aged
24-59 months and this toilet factor was not a risk factor for stunting. Although, the fact
according to this study result the proportion of respondents with good toilet and clean water
source (sanitation) are bigger than poor sanitation group.
The logistic regression test results as in Table 3. shows that energy intake is the dominant
factor associated with stunting toddler aged 24-59 months in the Temon II Health Center
work area. In Yensasnidar's research, there is a significant relationship between energy intake
and the incidence of stunting in these students. This research is the same as conducted by
Citaningrum Wiyogowati in 2012, the title of stunting in children under five years (0-59
months) in the province of West Papua in 2010 with the results (54.9%) of children whose
low energy consumption was stunting nutritional status.18 Maria Nova's research results show
that the incidence of stunting in toddlers is more found mostly in energy intake less than
toddlers with intake enough energy. Toddlers with energy intake less risk 1.2 times
experienced stunting from toddlers with energy intake enough.19 Based on the theoretical and
factual results, researchers assume that low energy intake gets the highest percentage as a
factor in stunting because total energy is directly related to physical growth deficits in toddler
.
This particular effort can be in the form of creating food creations that can make toddler
interested in eating it. Infectious diseases that occur in the stunting toddler result in a lack of
appetite so that consumption of food in toddler becomes reduced. 11 Coaching families to
improve the nutritional status of children. Development of health promotion media related to

9
toddler nutrition and counseling to families with malnutrition problems in toddlers to be
adjusted to the characteristics of the family. extension media and material must be adjusted to
the level of family education so that the effectiveness of the delivery of information runs
optimally for example with a flip sheet with sentence selection that is easy to understand.
besides that, it needs refreshment for cadres in providing health education, especially
nutrition for toddlers.

Conclusion
Respondents characteristics in Temon II Health Center, Kulon Progo according to
gender, stunting toddler were more in male while toddler who were not stunting were
female. Employed mothers contributes to stunting rather than unemployed mothers with
secondary education. Energy intake factor has a significant relationship to stunting toddler
aged 24-59 months, while feeding factors (Exclusive breastfeeding history, and protein
intake), immunization status, infectious diseases (suffered from diarrhea and URI) and toilet s
are not associated with stunting toddler aged 24-59 months.
Risk factors in stunting toddler aged 24-59 months inof Temon II Public Health Center
working area in Kulon Progo Regency are feeding factors (energy intake and protein intake),
infectious diseases (suffered from diarrhea and URI). Non-risk factors are immunization and
toilet status while the protective factor is the history of exclusive breastfeeding and access to
clean water. The most influential factor of stunting in Temon II Public Health Center working
area in Kulon Progo Regency is energy intake.

Recommendation
Increase the revitalization efforts about nutrition conscious families to increase the
importance of balanced nutritional needs for toddler to prevent stunting. Then, increasing
information dissemination to the community regarding stunting, for example through media
booklets or counseling and making policies for the First 1,000 Days of Child Life in order to
improve the nutritional status of pregnant women, nursing mothers, and toddler under five.
For practitioner are providing information and education counseling about fulfilling balanced
nutritional needs for toddler under five to prevent stunting. Then give education for mothers
with toddler under five, including prevention since pregnancy, which in turn encourages
mothers with toddler under five to actively participate in Maternal and Child Health Services
so that toddler 's growth and development can be monitored to support stunting prevention
efforts. Improve the ability of Maternal and Child Health Services cadres through guidance
and training on monitoring the growth and development of toddler under five, so that they
are not too dependent on the Maternal and Child Health Services officers.
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