STUNTING AND SEVERE STUNTING AMONG

INFANTS IN INDIA: THE ROLE OF DELAYED

INTRODUCTION OF COMPLEMENTARY
FOODS AND COMMUNITY AND HOUSEHOLD
FACTORS
M A N S I V I J AY B H A I D H A M I A , F E L I X A K P O J E N E O G B O A , B , U C H E C H U K W U L . O S U A G W U C , Z I N O
UGBOMAD AND KINGSLEY E. AGHO A,E

ABDI DWIYANTO PUTRA SAMOSIR

DIVISI NUTRISI DAN PENYAKIT METABOLIK
 ABSTRACT

• Background:
Delayed introduction of solid, semi-solid or soft foods (complementary feeding) and
associated factors are related to stunting and severe stunting among children in many
low- and middle-income countries. In India, however, there is limited evidence on
the relationship between delayed complementary feeding and associated factors with
stunting and severe stunting to advocate for policy interventions.
• Objectives:
The present study investigated the relationship between delayed complementary
feeding and associated factors with stunting and severe stunting among infants aged
6 - 8 months in India.
Methods:
Survey data on 13,548 infants aged 6–8 months were obtained
from the 2015–16 National Family Health Survey in India.
Logistic regression (Generalized Linear Latent and Mixed
Models [GLLAMM] with a logit link and binomial family)
models that adjusted for clustering and sampling weights were
used to investigate the relationship between delayed
complementary feeding and associated factors (community,
household, maternal, child and health service factors) with
stunting and severe stunting among infants aged 6–8 months in
India.
Results:
The prevalence of stunting and severe stunting was 22.0%
(95% CI: 21.0–23.7%) and 10.0% (95% CI: 9.0–11.0%) among
infants aged 6–8 months who received no complementary
foods, respectively. Delayed introduction of solid, semi-solid or
soft foods was associated with stunting (adjusted Odd ratios
[aOR] = 1.24, 95% CI: 1.09–1.41) and severe stunting (aOR =
1.21, 95% CI: 1.01–1.45) among infants aged 6–8 months.
High maternal education (secondary or higher education) and
household wealth (middle, richer and richest) were protective
against stunting and severe stunting.
Conclusion:
Delayed introduction of complementary foods and
associated factors were related to stunting and
severe stunting among infants aged 6–8 months in
India. Reducing the proportion of infants who are
stunted in India would require comprehensive
national nutrition policy actions that target the sub-
population of mothers with no schooling and
limited resources.
 BACKGROUND

• Stunting, defined as height-for-age less than minus two standard

deviations of the WHO Child Growth Standards median, is prevalent in
many low- and middle-income countries (LMICs), including India.
• In India, evidence from discrete subnational studies suggested that
stunting was associated with an array of factors. These factors included
delayed initiation of breastfeeding, colostrum deprivation, delayed
introduction of complementary foods, female gender, maternal
underweight, a lack or fewer than recommended antenatal visit, higher
birth order, lower socioeconomic, status, a lack or lower maternal
education, and a lack of potable water and poor hygiene, as well as
household food competition.
 BACKGROUND

• The present study aimed to investigate the

relationship between the delayed introduction of
solid, semisolid or soft foods and stunting and
severe stunting among infants aged 6–8 months in
India.
 The primary outcome variables were
stunting and
severe stunting, consistent with
previously published
studies

Method
s

The study used data from the

In this study, we used STATA/MP
2015–16 National Family version 14 (Stata
Health Survey (NFHS–4) Corp, College Station, TX, USA) to
conducted by InternationalInstitute conduct all statistical
for Population Sciences, Mumbai, analyses
India
RESULTS
RESULTS
RESULTS
 DISCUSSION

• The present study suggested that 22.0% and 10.0% of

infants aged 6–8 months who had delayed
complementary foods were stunted and severely stunted,
respectively
• Delayed introduction of solid, semisolid or soft foods
was associated with stunting and severe stunting among
infants aged 6–8 months in India.
 DISCUSSION

• Factors associated with a reduced risk of stunting included:

 higher maternal education,
belonging to wealthier households, and perceived size
(average or large) of the baby at birth.
Female sex, higher household wealth,
perceived size (large and average) of the baby at birth
caesarean births were associated with a reduced risk of severe
stunting in India.
 DISCUSSION

Globally, an estimated 3 This finding is consistent

million deaths among with studies from regional
children Our study suggested that
delayed introduction of India, which indicated that
younger than five years were children whose
due to malnutrition solid, semi-solid or soft foods
was associated with stunting mothers delayed the
in 2018, reflecting the burden introduction of
of stunting, wasting and severe stunting in infants complementary
aged 6–8 months.
and underweight among foods were more likely to be
young children. stunted.
 CONCLUSION

The study indicated that delayed introduction of complementary foods

was associated with stunting and severe stunting among Indian infants
aged 6–8 months. Other modifiable factors associated with stunting
and severe stunting included a lack of maternal education and lower
household wealth. National nutrition efforts need to be context-specific
in India to improve the introduction of complementary foods among
infants (particularly those aged 6–8 months), while also considering
the modifiable maternal vulnerabilities such as poor household wealth
and no maternal schooling.
 T E L AA H K RI T I S J U R NA L BE R B A SI S E VI DE N S U NT UK M E N I L A I
VIA
( VA L I DI T Y, I M P O R TA N T, A P L I C A BI L I T Y )

STUNTING AND SEVERE STUNTING AMONG

INFANTS IN INDIA: THE ROLE OF DELAYED
INTRODUCTION OF COMPLEMENTARY
FOODS AND COMMUNITY ANDHOUSEHOLD
FACTORS
MANSI VIJAYBHAI DHAMI, FELIX AKPOJENE OGBO, UCHECHUKWU L. OSUAGWU, ZINO UGBOMA &
KINGSLEY E. AGHO
 MENILAI BUKTI KLINIS EBM JURNAL INI :

VALIDITY UNTUK MENILAI KESAHIHAN STUDI :

1.Apakah definisi awal penelitian jelas? Ya, jelas

2.Apakah desain penelitian jelas? Ya, Cohorts study
3.Apakah identifikasi kelompok pembanding jelas ? Ya, dibagi 2 kelompok, yaitu kelompok
dengan Stunting dan Severe stunting
4.Apakah outcome dinilai dengan kriteria obyektif? Ya, mengetahui prevalensi stunting dan severe
stunting di India berdasarkan keterlambatan pemberian makanan padat, semi padat dan lunak.
5.Overall study lengkap

• KESIMPULAN: PENELITIAN INI VALID

 IMPORTANT- MENENTUKAN PENTINGNYA STUDI
INI DI RSWS

1. Apakah hasil penelitian dengan uji statistic dan nilai P? Ya,

Dapat dilihat pada Tabel 2, bahwa hasil karakteristik indeks kekayaan rumah tangga memiliki
hubungan yang bermakna pada kriteria rumah tangga yang memiliki kekayaan mengenah dan
kekayaan sangat kaya secara signifikan mengalami stunting disbanding mereka yang lahir dari
tingkat kekayaan miskin (untuk kriteria terkaya, lebih kaya, serta menengah dengan nilai p-Value <
0,001 dan untuk rumah tangga miskin dengan nilai P-Velue 0,029)

2. Seberapa besarkah hasil efektivitas terapi dengan OR dan CI 95%?

Dapat dilihat pada Tabel 2, bahwa hasil karakteristik indeks kekayaan rumah tangga memiliki
hubungan yang bermakna pada kriteria rumah tangga yang memiliki kekayaan mengenah dan
kekayaan sangat kaya secara signifikan mengalami stunting disbanding mereka yang lahir dari
tingkat kekayaan miskin (AOR = 0,46 95% CI: 0,36-0,61 untuk terkaya, AOR = 0,54 95% CI : 0,43
– 0,68 untuk lebih kaya, AOR = 0,66, 95% CI : 0,54 – 0,80 untuk menengah dengan nilai p-Value <
0,001 dan AOR = 0,83, 95% CI : 0,70-0,98 untuk rumah tangga miskin dengan nilai P-Velue 0,029)
 APLICABILITY

1.Apakah pasien kita serupa dengan subyek penelitian? Ya

• 2. Apakah bukti klinis ini mempengaruhi pencegahan pasien ?

Ya,

• KESIMPULAN: Keterlambatan pemberian makanan padat, semi

padat dan lunak dapat dijumpai pada pasien Stunted di RSWS
 LEVEL OF EVIDENCE DAN
RECOMMENDATION GRADES:
Level of evidence
Level 1: Systematic review/meta-analysis.
Level 2: At least 1 randomized controlled
trial (RCT).
Level 3: A non-RCT.
Level 4: An analytical epidemiologic study
(cohort study or case-control study) or single-
arm intervention study (no controls).
Level 5: A descriptive study(case report or
case series).
Level 6: Opinion of an expert committee or
an individual expert, which is not based on
patient data.
Recommendation Grades
Grade A : Strongly recommended
because the scientific basis is strong.
Grade B : Recommended because
there is some scientific basis.
Grade C1 : Recommended despite
having only a weak scientific basis.
Grade C2 : Not recommended because
there is only a weak scientific basis.
Grade D: Not recommended because
scientific evidence shows
treatment to be ineffective or
harmful.
 HASIL TELAAH KRITIS JURNAL :

• Level of evidence : 4 An analytical epidemiologic study

• Recommendation Grades: B because there is some scientific basis.

• KESIMPULAN:
Stunting and severe stunting among infants in India: the role of delayed
introduction of complementary foods and community and household
factors
( level of evidence 4, derajat rekomendasi B)
THANKYOU