Journal of Epidemiology and Public Health (2020), 05(03): 372-383 Research

Masters Program in Public Health, Universitas Sebelas Maret

Multilevel Analysis Association of Soil Transmitted

Helminths and Stunting in Children Aged 6-12 Years Old
in Pinrang District, South Sulawesi
Putri Andini Muslimah1), Harsono Salimo2), Yulia Lanti Retno Dewi3)
1)MastersProgram in Public Health, Universitas Sebelas Maret
2)Department of Pediatrics, Dr. Moewardi Hospital, Surakarta
3)Faculty of Medicine, Universitas Sebelas Maret

ABSTRACT

Background: Stunting in children is often 0.001), short maternal height (b= 1.03; 95%
associated with infectious diseases, one of CI= 0.10 to 1.96; p= 0.030), LBW (b= 1.45;
which is Soil Transmitted Helminths (STH). 95% CI= 0.38 to 2.51; p= 0.007), short birth
Worms in children affect the intake, digestion, length (b= 1.91; 95% CI= 0.95 to 2.87; p<
absorption and metabolism of food which has 0.001), and inappropriate complementary feed-
an impact on reducing the supply of nutrients ing (b= 1.11; 95% CI= 0.21 to 2.11; p= 0.029).
to the body. This study aimed to determine the The risk of stunting decreased with exclusive
relationship between STH and the incidence of breastfeeding (b= 0.96; 95% CI= 0.23 to 1.91;
stunting in children aged 6-12 years in Pinrang, p= 0.045). Village had negligible contextual
South Sulawesi. effect on the stunting with ICC= 8.2%.
Subjects and Method: This was an analytic Conclusion: The risk of stunting increases
observational with cross sectional design. The with worms, low maternal education, low
study was conducted in Pinrang Regency, South income, number of family, short maternal
Sulawesi, from January to March 2020. A sam- height, LBW, short birth length, and inappro-
ple of 200 children aged 6-12 years was selected priate complementary feeding. The risk of stun-
by random sampling. The dependent variable ting decreases with exclusive breastfeeding.
was stunting. The independent variables were Village has negligible contextual effect on the
worm disease, maternal education, family stunting.
income, number of family members, maternal
body height, low birth weight, length of birth, Keywords: stunting, soil transmitted
exclusive breastfeeding, and complementary helminths
feeding. The data were collected by question-
naire and analyzed by a multiple multilevel Correspondence:
logistic regression run on STATA13. Putri Andini Muslimah. Masters Program in
Results: The risk of stunting increased with Public Health, Universitas Sebelas Maret, Jl. Ir.
worms (b= 2.11; 95% CI= 1.11 to 3.10; p Sutami 36A, Surakarta 57126, Central Java.
<0.001), low maternal education (b= 1.08; 95% Email: [email protected]. Mobile: +6285-
CI= 0.13 to 2.03; p= 0.025), low income (b= 331663133.
1.03; 95% CI= 0.05 to 2.02; p= 0.039), number
of family (b= 2.13; 95% CI= 1.13 to 3.13; p<

Cite this as:

Muslimah PA, Salimo H, Dewi YLR (2020). Multilevel Analysis Association of Soil Transmitted Helminths
and Stunting in Children Aged 6-12 Years Old in Pinrang District, South Sulawesi. J Epidemiol Public
Health. 05(03): 372-383. https://doi.org/10.26911/jepublichealth.2020.05.03.11.
Journal of Epidemiology and Public Healthis licensed under a Creative Commons
Attribution-NonCommercial-ShareAlike 4.0 International License.

BACKGROUND tion in children in developing countries

Stunting is a measure of chronic malnutri- (Hagos et al. 2017). The prevalence of
tion as the most common form of malnutri- stunting according to UNICEF/WHO/-

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Muslimah et al./ Soil Transmitted Helminths and Stunting in Children Aged 6-12 Years Old

World Bank Group (2019) affects around quantity as well as health care for all family
21.9% or 149 million toddlers worldwide. members (Andriani M, 2014). Families who
There are approximately 9 million children have a large number of children or family
aged 0-59 months old with the condition of members, especially those with less econo-
continuing stunting until 6-18 years old. mic conditions are the cause of stunting,
This condition is more clear for Indo- this is due to the inability to fulfill food
nesia, which shows a trend (tendency) for needs and the inability to pay attention to
non-communicable disease to increase all children or family members they have
from 2007 to 2013, where it is estimated (Candra, 2011). Height is a form of genetic
that 70 million adult people (>18 years old) expression and is a factor passed on to
suffer from non-communicable disease children and is associated with the inci-
(Ministry of Health of the Republic of Indo- dence of stunting (Ibrahim et al. 2019).
nesia, 2018). In 2018, there was an increase In addition, babies born with low
from the previous year to 30.8% which birth weight (LBW) will experience obsta-
made Indonesia got the the fourth rank in cles in their growth and development
the world (Ministry of Health of the Repu- (Azriful et al. 2018), birth length (Swathma
blic of Indonesia, 2018b). The incidence of et al. 2016), history of exclusive breastfeed-
stunting in South Sulawesi also in the ing (Kusumawardhani, 2017), History pro-
fourth rank in all of Indonesia. The preva- vision of complementary foods (Parama-
lence of stunting in Pinrang Regency was shanti et al. 2016) also has a direct relation-
43.6% in 2017, this makes Pinrang Regency ship with the incidence of stunting which, if
as the fifth largest stunting rate in South not improved, nutritional intake in the
Sulawesi (South Sulawesi Provincial Health early stages of growth will lead to various
Office, 2018). kinds of diseases that are detrimental to
The incidence of stunting in children children.
is influenced by various factors, one of Therefore, researchers are interested
them is infectious diseases, such as the inci- in conducting study on "multilevel analysis
dence of worm infections. Worms can make of the relationship of soil transmitted
children experience digestive disorders and helminths (sth) and the incidence of stunt-
protein absorption so that children expe- ing in children aged 6-12 years in Pinrang
rience growth problems and acute anemia Regency".
due to malnutrition. Infectious disease has
a significant relationship (p <0.05) with the SUBJECTS AND METHOD
incidence of stunting (Fitria, 2017). 1. Study Design
Another factor related to the inci- This was an analytic observational study
dence of stunting is maternal education, the with a cross-sectional design. The study
level of mother's education will influence was conducted in Pinrang Regency from
the mother's attitude and mindset in paying January to March 2020.
attention to food intake so that it will affect 2. Population and Sample
the choice of food that will determine the The source population in this study were
nutritional status of the child (Rozali, 2016) children aged 6-12 years in 25 sub-districts
Family income is also related to the inci- in Pinrang Regency. A sample of 200
dence of stunting, high family income can children aged 6-12 years was selected by
be a factor in fulfilling food needs, nutritio- simple random sampling.
nal needs both in terms of quality and

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Muslimah et al./ Soil Transmitted Helminths and Stunting in Children Aged 6-12 Years Old

3. Study Variable Health of the Republic of Indonesia, 2013).

The dependent variable was stunting. The Categorical data scale. Code 0: Body length
independent variables were worm disease, at birth ≥48 cm, 1: body length at birth <48
maternal education, family income, cm.
number of family members, height of the Exclusive breastfeeding is a history of
mother, low birth weight, length of birth, breastfeeding from 0-6 months old without
exclusive breastfeeding, complementary other food or drink. Categorical data scale.
feeding, and village level. Code 0: exclusive breastfeeding, 1: non-
4. Definition of Operational Variable exclusive breastfeeding.
Worms is the finding of intestinal nema- Complementary feeding is a history of
tode eggs or larvae in children 6-12 years complementary feeding starting from 6
based on the results of examination of stool months old. Categorical data scale. Code 0:
samples. Categorical data scale. Code 0: no Getting complementary food, 1: Not getting
worms, 1: worms. complementary food.
Maternal education is the last type of Sub-district is the strata or level of the
formal education completed by mothers. village with the topography in Pinrang
Categorical data scale. Code 0: high school Regency. Categorical data scale. Code 1:
education to college, 1: elementary to junior Altitude 0-100 masl, 2: altitude 100-400
high school. masl, 3: altitude 400-1,000 masl, 4: alti-
Family income is the average income tude> 1,000 masl.
obtained in one family, adjusted to the MW 5. Study Instrument
Pinrang Regency (Rp. 2,860,000). Conti- The study instrument used for data collec-
nous data scale, converted to categorical tion was a questionnaire that had been
during data analysis. Code 0: ≥Minimum tested for validity and reliability, medical
wage, 1: <Minimum wage. records (KIA book), laboratory tests. The
Number of family is the number many questionnaire was used to measure mater-
family members in one household. Conti- nal education, family income, number of
nous data scale, converted to categorical family members, maternal height, exclusive
during data analysis. Code 0: number of breastfeeding, complementary feeding.
family members ≥4, 1: number of family Medical records were used to measure
members> 4. LBW, birth length. Laboratory tests were
Maternal height is the mother's current used to measure the incidence of worms.
height as measured at the time of data 6. Data Analysis
collection. Measured using microtoise. Univariate analysis to find out the frequ-
Continous data scale, converted to catego- ency distribution and percentage of charac-
rical during data analysis. Code 0: Height teristics of study subjects. Bivariate analysis
≥150 cm, 1: Height <150 cm. to determine the relationship between the
Low birth weight is the weight of the dependent variable and the independent
child at birth <2,500 grams (Ministry of variable using the chi-square test. Multi-
Health of the Republic of Indonesia, 2013). variate analysis using logistic regression
Categorical data scale. Code 0: No LBW, analysis through a multilevel approach with
code 1: LBW Stata13 program to determine the
Birth length is the length of the child's effect of level 2 (sub-district) on child
body at birth, the standard size of the development.
child's birth length is 48 cm (Ministry of

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Muslimah et al./ Soil Transmitted Helminths and Stunting in Children Aged 6-12 Years Old

7. Study Ethic Multilevel analysis explained the

Ethical clearance in this study was obtained effect of more than one independent vari-
from the Health Research Ethics Commis- able (worm disease, gender, maternal edu-
sion of the Moewardi Hospital, Surakarta cation, family income, number of family
City with number 1,284/XII/HREC/2019 members, maternal height, LBW, birth
which was published on December 3, 2019. length, exclusive breastfeeding and comple-
mentary feeding) with the dependent vari-
RESULTS able (stunting). The results of multivariate
1. Sample Characteristics analysis of the incidence of stunting using
The characteristics studied included worm multiple logistic regression with a multi-
infection status, maternal education, family level approach can be seen in Table 4.
income, number of family members, mater- Table 4 shows that:
nal height, age, low birth weight, birth 1. The Effect of Worms Infection
length, exclusive breastfeeding, comple- Status on Stunting
mentary feeding and sub-districts. These Based on Table 4, it can be seen that there
characteristics can be shown in Table 1 and was an effect of infection status of worms
Table 2. on the incidence of stunting in children
2. Bivariate Analysis aged 6-12 years. Children with worms had a
Bivariate analysis using the chi-square test. logodd probability of experiencing stunting
Bivariate analysis based on the results of by 2.11 units greater than children without
this study can be seen in table 3. worms. (b= 2.11; CI 95% = 1.11 to 3.10; p=
3. Multilevel Analysis <0.001
Table 1. The Characteristics of Study Subjects (Continous Data)
Variables N Mean SD Min. Max.
Income (rupiah) 200 3,116,500 4392247 0 54,000,000
Number of family 200 4.635 1.435996 3 11
Maternal body height (cm) 200 153.24 7.061994 132 169
Age (years old) 200 8.99 2.319158 6 12
LBW (gram) 200 2.777 .4348754 2.1 4.3
Birth length (cm) 200 47.72 2.319158 39 53
Z-score (bh/a) 200 -1.67245 1.2778 -3.96 3.52
2. The effect of maternal education had logodd of experiencing stunting by 1.03
on stunting units greater than children with high-
There was an effect of maternal education income families (b= 1.03; 95% CI= 0.05 to
on the incidence of stunting in children 2.02; p= 0.039).
aged 6-12 years. Children with low-edu- 4. The effect of number of family on
cated mothers had logodd of experiencing stunting
stunting by 1.08 units higher than children There was an effect of the number of family
with highly educated mothers (b= 1.08; members on the incidence of stunting in
95% CI= 0.13 to 2.03; p= 0.025). children aged 6-12 years. Children who
3. The effect of family income on have a number of family members ≥5 were
stunting more likely (logodd) to experience stunting
There was an effect of family income on the by 2.13 units than children who have a
incidence of stunting in children aged 6-12 number of family members of <5 (b= 2.13;
years. Children with low income families 95% CI= 1.13 to 3.13; p<0.001).

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Muslimah et al./ Soil Transmitted Helminths and Stunting in Children Aged 6-12 Years Old

Table 2. The Characteristics of Study Subjects (Dichotomy Data)

Variables Category n %
Stunting Normal 107 53.3
Stunting 93 46.5
Worm infection status No 118 59.0
Yes 82 41.0
Gender Male 99 49.5
Female 101 50.5
Maternal education <Senior high school 86 43.0
≥ Senior high school 114 57.0
Family income <Minimum wage 109 54.4
≥ Minimum wage 91 45.5
Number of family member <5 127 63.5
≥5 73 36.5
Maternal height <150 cm 70 35.0
≥150 cm 130 65.0
Low birth weight Not LBW 144 72.0
LBW 56 28.0
Birth length <48 cm 75 37.5
≥48 cm 125 62.5
Exclusive breastfeeding Not exclusive breastfeeding 73 36.5
Exclusive breastfeeding 127 63.5
Complementary feeding Not in time 77 38.5
In time 123 61.5

Table 3. Bivariate Analysis

Stunting
Independent Variables Normal Stunting OR p
n % n %
Worm infection status
No 79 67.0 39 33.0 7.55 <0.001
Yes 28 34.1 54 65.9
Maternal education
< HS 37 43.1 49 56.9 2.73 0.026
≥HS 70 61.4 44 38.6
Family income
<MW 40 36.7 69 63.3 2.73 0.038
≥MW 67 73.6 24 26.4
Number of family member
<5 82 64.6 45 35.4 7.88 <0.001
≥5 25 34.2 48 65.8
Maternal height
<150 cm 23 32.9 47 67.1 2.66 0.030
≥150 cm 84 64.6 46 35.4
Low birth weight
Not LBW 92 63.9 52 36.1 3.75 0.008
LBW 15 26.8 41 73.2
Birth length
<48 cm 20 26.7 55 73.3 6.28 <0.001
≥48 cm 87 69.6 38 30.4
Breastfeeding
Not exclusive breastfeeding 28 38.4 45 61.6 2.57 0.041
Exclusive breastfeeding 79 62.2 48 37.8
Complementary feeding
Not in time 27 35.1 50 64.9 3.02 0.024
In time 80 65.0 43 35.0

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Muslimah et al./ Soil Transmitted Helminths and Stunting in Children Aged 6-12 Years Old

5. The effect of maternal height on 1.91 units higher than children who had a
stunting history of ≥48 cm (b= 1.91; 95% CI= 0.94 to
There was an effect of maternal height on 2.87; p<0.001).
the incidence of stunting in children aged 8. The effect of exclusive breastfeed-
6-12 years. Children with mothers who have ing on stunting
a height <150 cm were more likely (logodd) There was an effect of exclusive breast-
to experience stunting by 1.03 units than feeding on stunting in aged children 6-12
children with maternal height of ≥150 cm years. Children who had a history of not
(b= 1.03; 95% CI= 0.10 to 1.96; p= 0.030). being exclusively breastfed were more likely
6. The effect of LBW on stunting (logodd) to experience stunting by 0.96
There was an effect of LBW on stunting in units than children who had a history of
children aged 6-12 years. Children who exclusive breastfeeding (b= 0.96; 95% CI=
have a history of LBW, the likelihood (log- 0.23 to 1.90; p= 0.045).
odd) of experiencing stunting was 1.45 9. The effect of complementary feed-
units higher than children with normal ing on stunting
birth weight (b= 1.45; 95% CI= 0.38 to 2.51; There was an effect of complementary feed-
p= 0.007). ing on stunting in children aged 6-12 years.
7. The effect of birth length on Children with inappropriate complemen-
stunting tary feeding were more likely (logodd) to
There was an effect of body length at birth experience stunting by 1.11 higher than
on the incidence of stunting in children those with appropriate complementary
aged 6-12 years. Children who had a history feeding (b= 1.11; 95% CI= 0.12 to 2.11; p=
of body length at birth <48 cm were more 0.029).
likely (logodd) to experience stunting by
Table 4. Multiple logistic regression analysis with a multilevel approach Associa-
tion of Soil Transmitted Helminths and Stunting in Children Aged 6-12 Years Old
Regression 95% CI
Independent Variables Coefficient Lower Upper p
(b) Limit Limit
Fixed effect
Worms infection status (yes) 2.11 1.11 3.10 <0.001
Education (low) 1.08 0.13 2.03 0.025
Income (low) 1.03 0.05 2.02 0.039
Number of family member (≥5) 2.13 1.13 3.13 <0.001
Maternal height (≥150 cm) 1.03 0.10 1.96 0.030
LBW (yes) 1.45 0.38 2.51 0.007
Birth length (≥48 cm) 1.91 0.94 2.87 <0.001
Exclusive breastfeeding (yes) 0.96 0.23 1.90 0.045
Complementary feeding (yes) 1.11 0.12 2.11 0.029
Constants -5.16 -6.76 -3.56 <0.001
Random Effect
Var (Constants) 0.294
N observation= 200
N group= 25
Log Likelihood= -74.19
Min= 8, max= 8
p= <0.001
ICC= 8.2%

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10. The effect of village on stunting cation on the incidence of stunting, mater-
Village had a contextual effect on stunting nal education affects protein intake and
(ICC= 8.2%). The variation in the incidence energy intake which indirectly affects stunt-
of stunting was 8.2% influenced by the sub- ing status. The majority of mothers have
district. The ICC value in this study was in tertiary education, namely high school and
accordance with the rule of thumb (8-10%), tertiary education, but mothers with higher
so the contextual influence in this study was education levels are not always knowledge-
important. able, because knowledge is not only obtain-
ed from formal education but also from
DISCUSSION non-formal education (Senbanjo et al.
1. The relationship between worms 2011).
and stunting 3. The relationship between family
The results in this study indicated that income and stunting
worms had a relationship with the inci- The results in this study indicated that
dence of stunting. In this study, it is known family income has a relationship with the
that children aged 6-12 years who have incidence of stunting. In this study, it is
worms can cause stunting. known that children aged 6-12 years with
According to Susilowati and Quyumi, low-income families can cause stunting.
in 2017, infectious diseases that can cause Families with sufficient or high
malnutrition or stunting are worm infec- income are able to buy food that is better in
tions. Worms can cause a decrease in child- quality and quantity so that the family's
ren's appetite which results in loss of carbo- nutritional needs can be fulfilled, this is a
hydrates, protein and loss of blood and reflection of good nutritional behavior.
other nutrients needed by the body, thereby According to Handini (2013), income and
reducing the quality of human resources nutritional status have a significant
(Onis and Branca, 2016). In the long term, relationship.
this can affect children's learning achieve- 4. The relationship between number
ment, because the child's motor, cognitive of family member and stunting
and verbal development is impaired. Child- The results in this study indicated that the
ren with disabilities who are stunted may number of family members has a relation-
experience interference with the matura- ship with the incidence of stunting. In this
tion process of brain neurons and changes study, it is known that children aged 6-12
in brain structure and function (Yadika et years with a number of family members ≥5
al. 2019). can cause stunting.
2. The relationship between maternal There is an effect of the number of
education and stunting family members (≥4 family members) on
The results in this study indicate that the incidence of stunting (Sugiyanto et al.
maternal education has a relationship with 2019). Having a large number of family
the incidence of stunting. In this study, it is members (≥5 family members) and low
known that children aged 6-12 years with economic status can make family members
mothers with low education cause the have limitations and competition in terms
incidence of stunting. of providing and getting food that is
This is in line with research conducted nutritionally balanced.
by Utami et al. (2017) which showed that The large number of children in
there is an indirect effect of maternal edu- families with sufficient and stable economic

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Muslimah et al./ Soil Transmitted Helminths and Stunting in Children Aged 6-12 Years Old

status can cause reduced love and attention of birth length <48 cm caused the incidence
from mothers to child development, but it of stunting.
is not absolutely a risk factor for the inci- The results of a study conducted in
dence of stunting, it is necessary to pay Pinrang Regency are in line with the results
attention to various other risk factors of research conducted by Ilma, Salimo and
(Suciningtyas et al. 2019). Pamungkasari (2019) in Kupang, which
5. The relationship between maternal stated that children with a long history of
height and stunting normal birth weight reduce the risk of
The results in this study indicated that stunting. Child birth length significantly
maternal height has a relationship with the increases the risk of stunting by up to 2
incidence of stunting. In this study, it is years in an early life, which can increase the
known that children aged 6-12 years with risk of various chronic diseases.
mothers who are <150 cm can cause 8. The relationship between exclusive
stunting. breastfeeding and stunting
Maternal height is a predictor factor The results in this study indicated that
in reducing the prevalence of stunting. exclusive breastfeeding has a relationship
Children with mothers who have a height of with the incidence of stunting. In this study
≥154 cm have a prevalence of 78% lower it is known that children aged 6-12 years
than children whose mothers have a height who do not have a history of exclusive
of <154 cm (Dekker et al. 2010). breastfeeding can cause stunting.
6. The relationship between LBW and Akombi et al. (2017) found that there
stunting was a relationship between the length of
The results in this study indicated that LBW breastfeeding and the incidence of stunting.
has a relationship with the incidence of Children who were exclusively breastfed for
stunting. In this study, it is known that more than 12 months were more likely to be
children aged 6-12 years with a history of stunted than children who were exclusively
LBW can cause stunting. breastfed for 6 months.
Ntenda (2019) stated that compared Breastmilk given to children early in
to children with normal birth weight, child- life can provide immediate and long-term
ren who experience LBW have a higher protection against infection. The content of
chance of experiencing stunting in Malawi. breast milk in the form of various immu-
Likewise what happened in Bangladesh, nity, anti-microbial, anti-inflammatory and
research done by Rahman et al. (2016) nutritional properties can protect children
stated that there is a positive relationship from diseases that can be carried by fluids
between LBW and malnutrition in children, or other foods contaminated by infectious
the percentage of malnourished children agents (Nigatu et al. 2019).
born with LBW is greater than children 9. The relationship between comple-
born with normal weight, although other mentary feeding and stunting
variables have been controlled. The results in this study indicate that com-
7. The relationship between birth plementary foods have a relationship with
length and stunting the incidence of stunting. In this study, it is
The results in this study indicated that birth known that children aged 6-12 years who
body length has a relationship with the inci- do not have a history of complementary
dence of stunting. In this study it was found foods can cause stunting.
that children aged 6-12 years with a history

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Muslimah et al./ Soil Transmitted Helminths and Stunting in Children Aged 6-12 Years Old

Hijra et al. (2016) stated that there is place of residence as a child's domicile has a
a relationship between complementary significant relationship with the opportu-
feeding and the incidence of stunting, child- nity for the incidence of stunting. Access to
ren who do not get complementary foods health facilities is one of the causes of the
have an increased risk of stunting by 8.26 incidence of stunting under five, while the
times than children who get complemen- affordability of access to health services in
tary foods on time. the regions is one of the targets for stunting
Impaired growth in children is caused management interventions.
by malnutrition experienced since they
were in the womb, inappropriate timing of AUTHOR CONTRIBUTION
complementary feeding, inadequate com- Putri Andini Muslimah as the main author
plementary solids and inappropriate com- has the role in collecting data, formulating
plementary patterns according to the child's data, designing study, conducting question-
age. The provision of solid foods must fulfill naire reliability test and analyzing data.
the requirements for quantity, time, tex- Harsono Salimo advised discussion of study
ture, variety of food, method of administra- and writing techniques. Yulia Lanti Retno
tion and adequate hygiene principles Dewi examined the data, provided input on
(Rakhmahayu et al. 2019). study discussions and writing techniques.
10. The contextual effect of village on
stunting CONFLICT OF INTEREST
The results in this study indicated that the There was no conflict of interest in this
context of the sub-district has a relation- study.
ship with the incidence of stunting. The
value of the contextual influence of the sub- FUNDING AND SPONSORSHIP
district with the regional topographic strata This study used personal funds of the main
at the second level is shown by the ICC researcher.
value of 8.2%.
A study Leo et al. (2018) stated that ACKNOWLEDGEMENT
the risk factors for stunting in the highlands The researchers expresses their gratitude to
and lowlands areas have differences and all Heads of villages in Pinrang Regency
this indirectly affects the incidence of stunt- who have allowed this study to be carried
ing, while differences in risk factors in each out. Thank you to all the children aged 6-12
region include the level of energy suffi- years who have been willing and coope-
ciency and the level of protein adequacy rative to be the study subjects.
and a history of exclusive breastfeeding.
Children who live in the lowlands have a REFERENCE
tendency to consume more carbohydrates, Akombi BJ, Agho KE, Hall JJ, Merom D,
foods that contain carbohydrates are mostly Astell-Burt T, Renzaho MN (2017).
obtained from large portions of rice and Stunting and severe stunting among
regular meals at all times. In addition, most children under-5 years in Nigeria: A
children who live in the lowlands also eat multilevel analysis. BMC Pediatr,
snacks such as sponge cakes and various 17(1): 1–16. doi: 10.1186/s12887-016-
other snacks (Rahma et al., 2018). 0770-z.
This is in line with Indrastuty and Andriani M (2014). Peranan gizi dalam
Pujiyanto (2019), which showed that the siklus kehidupan. (The role of nutri-

www.jepublichealth.com 380
Muslimah et al./ Soil Transmitted Helminths and Stunting in Children Aged 6-12 Years Old

tion in the cycle of life.) Jakarta: Ken- Makassar.

cana Prenadamedia Group. Hagos S, Hailemariam D, Woldehanna T,
Azriful, Bujawati E, Habibi, Aeni S, Yusda- Lindtjørn B (2017). Spatial heteroge-
rif (2018). Determinan kejadian stun- neity and risk factors for stunting
ting pada balita usia 24-59 bulan di among children under age five in
Kelurahan Rangas Kecamatan Bang- Ethiopia: A Bayesian geo-statistical
gae Kabupaten Majene (Determinants model. PLoS ONE, 12(2):1–18. doi:
of stunting incidence in children age 10.1371/journal.pone.0170785.
24-59 months in Rangas Village, Handini D, Ichsan B, Nirlawati DD (2013).
Banggae District, Majene Regency). Hubungan tingkat pendapatan kelu-
Al-sihah: The Public Health Science arga dengan status gizi balita di Wila-
Journal. 10(2): 192–203. doi: 10.242- yah Kerja Puskesmas Kalijambe (The
52/as.v10i2.6874. relationship between family income
Candra A (2011). Hubungan underlying level and nutritional status of children
factor dengan kejadian stunting pada under five in the working area of
anak 1-2 tahun (The relationship Kalijambe Health Center). Biomedika,
between underlying factor and stunt- 5(2). doi: 10.23917/biomedika.v5i2.-
ing in children aged 1-2 years). J Nutr 263.
Health. doi: 10.4324/9781315082417- Hijra H, Muis FS, Kartasurya MI (2016).
24. Inappropriate complementary feeding
Dekker LH, Mora-Plazas M, Marin C, Bay- practice increases risk of stunting in
lin A, Villamor E (2010). Stunting children aged 12-24 months. Univ-
associated with poor socioeconomic med, 35(3): 146. doi: 10.18051/univ-
and maternal nutrition status and med.2016.v35.146-155.
respiratory morbidity in Colombian Ibrahim IA, Bujawati E, Syahrir S, Adha AS,
schoolchildren. Food Nutr Bull, 31(2): Mujahida (2019). Analisis determinan
242–250. doi: 10.1177/15648265100- kejadian growth failure (stunting)
3100207. pada anak balita usia 12-36 bulan di
Dinas Kesehatan Provinsi Sulawesi Selatan Wilayah Pegunungan Desa Bontongan
(2018). Data stunting Provinsi Sula- Kecamatan Baraka Kabupaten Enre-
wesi Selatan (South Sulawesi Province kang (Determinant analysis of the
stunting data). Dinas Kesehatan Pro- incidence of growth failure (stunting)
vinsi Sulawesi Selatan. Makassar. in children aged 12-36 months in the
Fitria N (2017). Hubungan faktor asupan mountainous area of Bontongan
makanan dan kondisi penyakit Village, Baraka District, Enrekang
dengan kejadian stunting pada anak Regency). Al-sihah: The Public Health
balita di wilayah kerja puskesmas Science Journal, 11(1): 50–64. doi:
Barombong Kota Makassar (The rela- 10.24252/as.v11i1.9418.
tionship between food intake factors Ilma NN, Salimo H, Pamungkasari EP
and disease conditions with the inci- (2019). Prevalence and path analysis
dence of stunting in children under on the effects of diarrhea and life
five in the working area of the Barom- course determinants on stunting in
bong Community Health Center, children under two years of age in
Makassar City). Skripsi. Makassar: Kupang, East Nusa Tenggara. Matern
Universitas Islam Negeri Alauddin Child Health J, 4(4): 230–241. doi:

www.jepublichealth.com 381
Muslimah et al./ Soil Transmitted Helminths and Stunting in Children Aged 6-12 Years Old

10.26911/thejmch.2019.04.04.02. dirman, 2(1): 51. doi: 10.20884/1.jgp-

Indrastuty D, Pujiyanto P (2019). Determi- s.2018.2.1.512.
nan sosial ekonomi rumah tangga dari Susilowati E, Quyumi ER (2019). Pening-
balita stunting di Indonesia: Analisis katan status gizi dan penurunan
Data Indonesia Family Life Survey infeksi cacing pada anak toddler
(IFLS) 2014 (Household socio-econo- dengan penerapan dinamika kelom-
mic determinants of childhood stunt- pok sosial (Increasing nutritional sta-
ing in Indonesia: Data Analysis of the tus and decreasing worm infection in
2014 Indonesia Family Life Survey toddlers by application of social group
(IFLS)). Jurnal Ekonomi Kesehatan dynamics). J Chem Inf Model, 53(9):
Indonesia, 3(2). doi: 10.7454/eki.v3- 1689–1699. doi: 10.1017/CBO978110-
i2.3004. 7415324.004.
Kementerian Kesehatan Republik Indone- Nigatu D, Azage M, Motbainor A (2019).
sia (2013). Buku saku pelayanan Effect of exclusive breastfeeding ces-
kesehatan neonatal esensi (Neonatal sation time on childhood morbidity
health service essential pocket book). and adverse nutritional outcomes in
Kementerian Kesehatan Republik Ethiopia: Analysis of the demographic
Indonesia. Jakarta. and health surveys. PLoS ONE, 14
Kementerian Kesehatan Republik Indone- (10):1–12. doi: 10.1371/journal.pone.-
sia (2018a). Buletin Stunting (Stunt- 0223379.
ing Bulletin). Kementerian Kesehatan Ntenda PAM (2019). Association of low
Republik Indonesia. Jakarta. birth weight with undernutrition in
Kementerian Kesehatan Republik Indone- preschool-aged children in Malawi.
sia (2018b). RISKESDAS 2018: Exe- Nutrition Journal, 18(1): 1–15. doi:
cutive Summary. Kementerian Kese- 10.1186/s12937-019-0477-8.
hatan Republik Indonesia. Jakarta. Onis MD, Branca F (2016). Childhood stun-
Kusumawardhani I (2017). ASI eksklusif, ting: A global perspective. Matern
panjang badan lahir, berat badan Child Nutr, (12): 12–26. doi: 10.1111/-
lahir rendah sebagai faktor risiko mcn.12231.
terjadinya stunting pada anak usia 6- Paramashanti BA, Hadi H, Gunawan IMA
24 bulan di Puskesmas Lendah II (2016). Pemberian ASI eksklusif tidak
Kulon Progo (Exclusive breastfeeding, berhubungan dengan stunting pada
birth length, low birth weight as risk anak usia 6–23 bulan di Indonesia
factors for stunting in children aged (Exclusive breastfeeding is not asso-
6-24 months at Puskesmas Lendah II ciated with stunting in children aged
Kulon Progo). Skripsi. Yogyakarta: 6–23 months in Indonesia). IJND,
Politeknik Kesehatan Kementerian 3(3): 162. doi: 10.21927/ijnd.2015.3-
Kesehatan Yogyakarta. (3).162-174.
Leo AR, Subagyo HW, Kartasurya MI Rahma N, Hasanah, Nurfadilah (2018).
(2018). Faktor risiko stunting pada Perbedaan tingkat kecukupan energi,
anak usia 2-5 tahun di wilayah protein dan status gizi anak sekolah
gunung dan pesisir pantai (Risk dasar negeri daerah pantai dan dae-
factors for stunting in children aged rah pengunungan Kecamatan Sindue
2-5 years in mountain and coastal (The difference in the level of energy,
areas). Jurnal Gizi dan Pangan Soe- protein and nutritional status of

www.jepublichealth.com 382
Muslimah et al./ Soil Transmitted Helminths and Stunting in Children Aged 6-12 Years Old

public elementary school children in Swathma D, Lestari H, Ardiansyah RT

coastal areas and mountainous areas (2016). Analisis faktor risiko BBLR,
of Sindue District). Jurnal Kesehatan, panjang badan bayi saat lahir dan
3(6): 48–60. riwayat imunisasi dasar terhadap
Rahman MS, Howlade T, Masud MS, kejadian stunting pada balita usia 12-
Rahman ML (2016). Association of 36 bulan di Wilayah Kerja Puskesmas
low-birth weight with malnutrition in Kandai Kota Kendari Tahun 2016
children under five years in Bang- (Analysis of LBW risk factors, baby
ladesh: Do mother’s education, socio- body length at birth and history of
economic status, and birth interval basic immunization against the inci-
matter. PLoS ONE. 11(6): 1–16. doi: dence of stunting in toddlers aged 12-
10.1371/journal.pone.0157814. 36 months in the Work Area of the
Rakhmahayu A, Dewi YLR, Murti B (2019). Kandai Health Center, Kendari City,
Logistic regression analysis on the 2016). E-Journal Unsyiah, 1(3): 1–10.
determinants of stunting among UNICEF/WHO/World Bank Group (2019).
children aged 6-24 months in Purwo- Levels and trends in child malnutri-
rejo Regency, Central Java. Matern. tion: key findings of the 2019 Edition
Child Health J, 4(3): 158–169. doi: of the Joint Child Malnutrition Esti-
10.26911/thejmch.2019.04.03.03. mate. 1–15. Available at: https://-
Suciningtyas PD, Triharini M, Rachmawati www.who.int/nutgrowthdb/jme-20-
PD (2019). Hubungan data demografi 19-key-findings.pdf?ua=1%.
keluarga dalam pemberian ASI esklu- Utami AD, Indarto D, Dewi YLR (2017).
sif anak balita stunting (Relationship The effect of nutrient intake and
of family demographic data in exclu- socioeconomic factor toward stunting
sive breastfeeding for stunting in incidence among primary school
children). Pediomaternal Nursing students in Surakarta. J Epidemiol
Journal, 5(1): 132. doi: 10.20473/pm- Public Health, 2(1): 1–10. https://-
nj.v5i1.13133. doi.org/jepublichealth.2017.02.01.01.
Sugiyanto J, Raharjo SS, Dewi YLR (2019). Yadika ADN, Berawi KN, Nasution SH
The effects of exclusive breastfeeding (2019). Pengaruh stunting terhadap
and contextual factor of village on perkembangan kognitif dan prestasi
stunting in Bontang, East Kalimantan, belajar (The effect of stunting on cog-
Indonesia. J Epidemiol Public Health. nitive development and learning
4(3): 222–233. doi: 10.26911/jepub- achievement). Jurnal Majority, 8(2):
lichealth.2019.04.03.10. 273–282.

www.jepublichealth.com 383