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RELATIONSHIP BETWEEN LOW BIRTH WEIGHT AND INFECTIOUS DISEASES
WITH STUNTING IN CHILDREN AGED 4 TO 5 YEARS
Nur Linawati
RS Citra Sari Husada, Indonesia
email : nurlinawati_girl@yahoo.com
ARTICLE INFO
ABSTRACT
Date received : 29 Mei 2022
Revision date : 11 Juni 2022
Date received : 18 Juni 2022
Stunting is a nutritional problem that has a high prevalence in
Indonesia. Stunting is directly affected by birth weight and
infectious diseases. This study aims to analyze the relationship
between low birth weight and infectious diseases with the
incidence of stunting in children under two. This type of
research uses a case-control design. Sampling was done by
purposive sampling technique. The sample size is 105 children
(35 stunted children and 70 non-stunting children). In
collecting data, researchers used instruments in the form of
questionnaires, interviews and height measurement tools.
Questionnaires are used to determine birth weight which has
been tested for validity and reliability. The collection of data on
infectious diseases of children was carried out by structured
interviews with the children's parents and medical records from
the puskesmas doctors. Then the height measurement tool
used is a stature meter SH - 2° with an accuracy of 0.1. To
determine stunting using the z-score using the NCHS standard
value. The results of this study on the birth weight variable
obtained the RE (Risk Estimtae) value of 7.667 (95% CI: 3.718
- 15.807). Then the infectious disease variable obtained RE
(Risk Estimate) value of 0.521 (95% CI: 0.418 – 0.649). The
conclusion of this study is that there is a relationship between
low birth weight and infectious diseases with the incidence of
stunting in children aged 4 to 5 years.
Keywords: Low birth
weight; Infectious Diseases;
Stunting.
Indonesian Journal of Multidisciplinary Science © 2022 by International Journal Labs is licensed
under CC BY-SA 4.0
INTRODUCTION
Stunting is a chronic malnutrition problem in toddlers that causes linear growth
disorders (RPL). According to the World Health Organization Child Growth Standards,
stunting is based on measuring height or height using z-score constraints and using an
index of length to age (PB/U) or height to age (TB/U). < -2 SD. Minister of Health Decree
No. 1995/MENKES/SK/XII/2010 concerning anthropometric standards for assessing
Relationship Between Low Birth Weight and Infectious Diseases With Stunting In
Children Aged 4 To 5 Years
Indonesian Journal of Multidisciplinary Science, Vol 1 (9), Juni 2022
1021
children's nutritional status is divided into 2, namely stunted (short / z score < -2SD) and
severely stunted (very short / z score < -3S (Saadah, 2020).Health
The Research in 2013 study found that the national prevalence of stunting reached
37.2%, an increase from 2010 (35.6%) and 2007 (36.8%). Or one of three Indonesian
children. Indonesia has a higher prevalence of stunting than other Southeast Asian
countries, such as Myanmar (35%), Vietnam (23%) and Thailand (16%). Indonesia has
the fifth-highest number of stunted children in the world. More than a third of children
under five in Indonesia are below average height (Surono, Widiyanti, Kusumo, & Venema,
2021).
One of the risk factors for growth retardation in children under 5 years of age is a
birth history of low birth weight (LBW). According to Proverawati and Ismawati (2010)
LBW babies grow and develop more slowly because LBW babies experience intrauterine
growth retardation since birth and will continue until the next birth age, i.e. grow and
develop more slowly than birth babies. Normal and often not keeping up with the growth
rate he should have achieved after birth. Babies with low birth weight also suffer from
digestive disorders because the digestive tract does not function, such as when B. can
absorb fat without digesting protein, resulting in a lack of nutrient reserves in the body.
As a result, if this pattern of undernutrition, high infection rates, and poor health care
persists, growth and development of LBW babies can be stunted, resulting in stunted
children (Proverawati & Ismawati, 2010).
Developmental delay is generally caused by a number of interrelated factors. The
consumption of nutrients such as energy, protein, and zinc, as well as a history of
infectious diseases, are factors that directly affect the growth process of children.
Inadequate nutritional intake in children leads to increased numbers of children with
stunting (growth disorders) (Millward, 2017). In addition, the frequency of children
experiencing infections will also have an impact on their growth patterns. Infection has a
contribution to a decrease in appetite and if it persists it will interfere with the child's
linear growth (Millward, 2017).
The infectious disease status of children under five years of age is also a factor
that affects the incidence of stunting in children under five years of age. The majority of
the stunted infant population had higher disease levels, implying a significant association
between disease prevalence and nutritional status in stunted infants (Welasasih &
Wirjatmadi, 2012). Based on the exposure of the factors causing stunting based on
infectious diseases into clinical and subclinical infections, with examples of infectious
diseases as follows: enteric infections, diarrheal diseases, environmental enteropathy,
worms, respiratory infections, malaria, decreased appetite due to infection, and
inflammation (Dewey & Mayers , 2011).
Relationship Between Low Birth Weight and Infectious Diseases With Stunting In
Children Aged 4 To 5 Years
Indonesian Journal of Multidisciplinary Science, Vol 1 (9), Juni 2022
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This study aimed to analyze the association of low birth weight and infectious
diseases with growth retardation in children based on exposure to cases of stunting
caused by birth weight and infectious diseases aged 4 to 5 years.
METHOD
The type of research used is cross sectional. This research was conducted in Curug
Village, Klari District, Karawang Regency, which was carried out in January-February
2022. The total population was 150 children and the sample size was 105 children, the
sample size was adjusted to the sample table from Isaac and Michael with a significance
of 5%. Samples were taken from 8 Posyandu in Curug Village, Klari District, Karawang
Regency. Sampling was done by purposive sampling technique. The sampling was based
on the criteria for the child's age, namely 4-5 years and parents were willing to have their
children become respondents by signing the consent form.
In collecting data, researchers used instruments in the form of questionnaires,
interviews and height measurement tools. Questionnaires were used to determine birth
weight which had been tested for validity and reliability. The collection of infectious
disease data for children was carried out by structured interviews with the child's parents
and medical records from the puskesmas doctor. Then the height measurement tool used
is a stature meter SH - 2° with an accuracy of 0.1. To determine stunting using the z-
score using the NCHS standard value.
The data analysis technique is univariate and bivariate analysis. Data analysis
performed using SPSS 25 software was used to determine the risk of each interrelated
variable.
RESULT AND DISCUSSION
A. Univariate Analysis
1. Gender of Respondents
Characteristics of respondents in this study based on gender are presented in table
1 below:
Table 1. Gender of Respondents
Frequency
Percent
Valid Percent
Cumulative Percent
Valid
Male
47
44.8
44.8
44.8
Female
58
55.2
55.2
100.0
Total
105
100.0
100.0
Relationship Between Low Birth Weight and Infectious Diseases With Stunting In
Children Aged 4 To 5 Years
Indonesian Journal of Multidisciplinary Science, Vol 1 (9), Juni 2022
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Based on the table of respondents' gender, it can be seen that the respondents in
this study were dominated by girls, namely 58 respondents or 55.2%. While the male
respondents were 47 respondents or 44.8%.
2. Respondent's Birth Weight
The characteristics of respondents in this study based on birth weight are
presented in table 2 below:
Table 2. Respondents Birth Weight
Frequency
Percent
Valid Percent
Cumulative Percent
Valid
Normal
69
65.7
65.7
65.7
Low
36
34.3
34.3
100.0
Total
105
100.0
100.0
Based on the table of respondents' birth weight, out of 105 respondents were
obtained. There are 69 respondents belonging to normal birth weight children, namely
65.7%. Then there were 36 children with low birth weight, namely 34.3%.
3. Respondents' Infectious Diseases
Characteristics of respondents in this study based on infectious diseases are
presented in table 3 below:
Table 3. Respondents' Infectious Diseases
Frequency
Percent
Valid
Percent
Cumulative
Percent
Valid
Chickenpox
7
6,7
6,7
6,7
Worms
9
8.6
8.6
15.2
Measles
4
3.8
3.8
19.0
Dengue
Fever
9
8.6
8.6
27.6
Diarrhea
19
18.1
18.1
45.7
Influenza
20
19.0
19.0
64.8
Relationship Between Low Birth Weight and Infectious Diseases With Stunting In
Children Aged 4 To 5 Years
Indonesian Journal of Multidisciplinary Science, Vol 1 (9), Juni 2022
1024
Based on the respondent's infectious disease table, from 105 respondents, it was
obtained. There are 32 respondents who are classified as children without infectious
disease (normal). Then the respondents who were classified as children with influenza
infection were 20 children, namely 19% as the first highest infectious disease and 19
children with diarrheal infection, namely 18.1% as the second highest infectious
disease.
4. Respondents Stunting
Characteristics of respondents in this study based on stunting are presented in
table 4 below:
Table 4. Stunting Respondents
Frequency
Percent
Valid Percent
Cumulative Percent
Valid
Normal
70
66.7
66.7
66.7
Stunting
35
33.3
33.3
100.0
Total
105
100.0
100.0
Based on the respondent's stunting table, respondents with normal height
category are 70 respondents or 66.7%. Meanwhile, respondents with stunting category
were 35 respondents or 33.3%.
B. Bivariate Analysis
Table 5. Chi-Square Tests Birth Weight
Value
df
Asymptotic
Significance (2-
sided)
Exact Sig.
(2-sided)
Exact
Sig.-
sided)
Pearson Chi-
Square
48,696
a
1
1,000
Normal
32
30.5
30.5
95.2
Pneumonia
5
4.8
4.8
100.0
Total
105
100
0.0
100.0
Relationship Between Low Birth Weight and Infectious Diseases With Stunting In
Children Aged 4 To 5 Years
Indonesian Journal of Multidisciplinary Science, Vol 1 (9), Juni 2022
1025
Continuity
Correction
b
45,700
1
,000
Likelihood
50,230
Ratio
1,000
Fisher's Exact
Test
,000
,000
Linear-by-Linear
Association
48,232
1
,000
N of Valid Cases
105
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is
12.00.
b. Computed only for a 2x2 table
Table 6. Risk Estimate of Birth Weight
Value
95% Confidence
Interval
Lower
Upper
Odds Ratio for Birth Weight_New
(Low / Normal)
31,000
10,235
93,896
For cohort Stunting_New =
Stunting
7,667
3,718
15,807
For cohort Stunting_New = Normal
,247
,134
,458
N of Valid Cases
105
1. Birth Weight
Based on tables 5 and 6, it is known that the results of the
chi-square
show that
there is a relationship between birth weight and
stunting
with a p
value
of p = 48.696
which means that there is a relationship between low birth weight in
stunted
and
non-
stunted.
Then the RE (
Risk Estimtae
) value was obtained at 7.667 (95% CI: 3.718 –
Relationship Between Low Birth Weight and Infectious Diseases With Stunting In
Children Aged 4 To 5 Years
Indonesian Journal of Multidisciplinary Science, Vol 1 (9), Juni 2022
1026
15.807). The RE (
Risk Estimate
) value means that children aged 4-5 years who have a
history of low birth weight are 7.667 times more likely to experience
stunting
thanwith
children aged 4-5 years who do not experience low birth weight.
Table 7. Chi-Square Tests for Infectious Diseases
Value
df
Asymptotic
Significance (2-
sided)
Exact Sig.
(2-sided)
Exact
Sig.-
sided)
Pearson Chi-
Square
23,014
a
1
1,000
Continuity
Correction
b
20,907
1
,000
Ratio
32,592
1,000
Likelihood
Fisher's Exact
Test
,000
,000
Linear-by-Linear
Association
22,795
1
,000
N of Valid Cases
105
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is
10.67.
b. Computed only for a 2x2 table
2. Infectious Diseases
Statistical test
chi-square
indicate that there is a relationship between infectious
diseases and
stunting
with a p
value
of p = 23,014 which means that there is a
relationship between infectious diseases in
stunted
and
non-stunted children.
Then the
RE (
Risk Estimate
) value was obtained of 0.521 (95% CI: 0.418 – 0.649), the RE (
Risk
Estimate
) value means that children aged 4-5 years who have a history of infectious
diseases are 0.521 times greater at risk of
stunting
compared to children 4-5 years old
who do not have an infectious disease.
Relationship Between Low Birth Weight and Infectious Diseases With Stunting In
Children Aged 4 To 5 Years
Indonesian Journal of Multidisciplinary Science, Vol 1 (9), Juni 2022
1027
DISCUSSION
Results of the analysis showed an association between low birth weight and
stunting in children aged 4-5, with children with a history of low birth weight having a
7,667-fold higher risk of stunting compared to children with normal birth weight. This
condition can occur because babies born with low birth weight Babies who have
experienced intrauterine growth retardation in utero and will continue into the next
postpartum age grow and develop more slowly than normally born babies and often
cannot keep up with the growth rate. reached after birth (Proverawati & Ismawati, 2010).
Growth inhibition that occurs is related to brain maturity, namely before 20 weeks of
gestation, brain growth inhibition occurs, such as somatic growth (Moog et al., 2017).
Research has found that small low birth weight babies during pregnancy, after 2
months of age, experiencegrowth falthering (Trihono et al., 2015). Failure to thrive at an
early age (2 months) indicates a risk for failure to thrive in the next period. At the age of
12 months, infants with low birth weight during pregnancy did not reach the body length
achieved by normal children, although normal children did not grow optimally, in other
words,catch up growthwas inadequate. Catch-up growth in children born with low birth
weight lasts until the age of two (Negrato & Gomes, 2013). Failure to thrive and
inadequate pursuit of growth is a pathological condition that causes stunting in toddlers
(Kyle, Shekerdemian, & Coss‐ Bu, 2015).
In addition to low birth weight, a history of childhood infectious diseases is one of
the causes of stunting. The results of the analysis show that there is a relationship
between infectious diseases and the incidence of stunting in children aged 4-5 years,
which is 0.521 times more risky for stunting in children with a history of infectious
diseases than children born without infectious diseases. Similar results were obtained
from the research by Picauly & Toy (2013) which showed that children who had a history
Table 8. Risk Estimate of Infectious Diseases
Value
95% Confidence Interval
Lower
Upper
For cohort Stunting_New = Normal
,521
,418
,649
N of Valid Cases
105
Relationship Between Low Birth Weight and Infectious Diseases With Stunting In
Children Aged 4 To 5 Years
Indonesian Journal of Multidisciplinary Science, Vol 1 (9), Juni 2022
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of infectious diseases would be followed by an increase in the incidence of stunting by
2,332 times (Picauly & Toy, 2013).
Children in the stunting group had more history of infectious diseases than children
in the normal group. The frequency of children experiencing infectious diseases for a long
time not only affects their weight but also has an impact on linear growth. Infections also
contribute to deficiencies in energy, protein, and other nutrients due to decreased
appetite so that food intake is reduced (Dwi & Wirjatmadi, 2012).
The effect of infection on children's linear growth is obtained through a mechanism
by first affecting the child's nutritional status which then affects the child's linear growth
(Ahsan, Arifeen, Al-Mamun, Khan, & Chakraborty, 2017). Infection can reduce food
intake, interfere with nutrient absorption, cause direct loss of nutrients, increase
metabolic needs or decrease catabolic processes of nutrients so that it will affect
consumption patterns which in turn will affect the nutritional status of toddlers. If this
condition lasts for a long time it will affect the child's linear growth (Martorell & Zongrone,
2012).
CONCLUSION
The results showed that low birth weight Infectious diseases are factors that cause
stunting in children aged 4 to 5 years. Statistical analysis showed an association between
low birth weight and stunting in children aged 4-5 years, with children with a history of
low birth weight having a 7,667 times higher risk of stunting than normal weight children.
Along with low birth weight, children with a history of infectious diseases were One of
the reasons for stunted growth. The results of statistical analysis showed that there was
a correlation between infectious diseases and the incidence of stunting in children aged
4-5 years. Children with a history of infectious diseases were 0.521 times more likely to
develop stunting than children born without infectious diseases. It is recommended that
children who have low birth weight problems and infectious diseases are given special
attention by the posyandu and it is necessary to carry out regular development related
reviews so that developmental disorders that may occur can be immediately recognized
and treated.
Relationship Between Low Birth Weight and Infectious Diseases With Stunting In
Children Aged 4 To 5 Years
Indonesian Journal of Multidisciplinary Science, Vol 1 (9), Juni 2022
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First publication right :
Indonesian Journal of Multidisciplinary Science
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