Relationship Between Responsive Feeding Behavior And The Incidence Of Stunting In Toddlers 6 - 36 Months
A Study in the Working Area of Saptosari Public Health Center, Gunungkidul, Indonesia
Keywords:
Stunting, Responsive Feeding, Child NutritionAbstract
Purpose: Stunting is still a serious health problem in Indonesia with a prevalence in Gunungkidul of 23.5%. Responsive feeding is an important part of complementary feeding and reduces risk stunting because children receive food in appropriate quantity and quality.
Method: This study employed an observational design with a case-control approach and was conducted in February 2025 in the working area of Saptosari Public Health Center. The study population consisted of 494 children aged 6–36 months. A purposive sampling technique was used to select 82 participants, divided into case and control groups. The research instrument used was the Responsive Feeding Practices Assessment Tool (RFPAT). Data analysis included univariate and bivariate analyses using the chi-square statistical test.
Finding: The majority of respondents in this study were categorized as non-low birth weight (84.1%) and were mothers who were not employed (85.4%). Most mothers had a secondary level of education (70.7%) and came from families with an income below the regional minimum wage (58.5%). There is a significant relationship to behavior responsive feeding with the incident stunting (p=0.009). On external variables, there is a relationship between birth weight (p=0.034) and mother's last education (p=0,039) with incidence stunting. Employment status and family income were not related to the incident stunting.
Novelty: There is a significant association between responsive feeding behavior and stunting in children aged 6–36 months in the working area of Saptosari Public Health Center.
References
Ejigu H, Tafese Z. Stunting at birth: linear growth failure at an early age among newborns in Hawassa city public health hospitals, Sidama region, Ethiopia: a facility-based cross-sectional study. J Nutr Sci [Internet]. 2023 May 30;12(9):e63. Available from: https://www.cambridge.org/core/product/identifier/S2048679023000460/type/journal_article
UNICEF, WHO, WORLD BANK. Level and trend in child malnutrition. World Heal Organ [Internet]. 2023;4. Available from: https://www.who.int/publications/i/item/9789240073791
Kementrian Kesehatan. Profil Kesehatan Indonesia 2023. 2024. 100 p.
Dinkes. Profil Kesehatan Kabupaten GunungKidul 2023. Dinas Kabupaten Gunungkidul. 2023;3–4.
Alam MA, Richard SA, Fahim SM, Mahfuz M, Nahar B, Das S, et al. Erratum: Impact of early-onset persistent stunting on cognitive development at 5 years of age: Results from a multi-country cohort study (PLoS One (2020) 15:1 (e0227839) DOI: 10.1371/journal.pone.0227839). PLoS One. 2020;15(2):1–16.
Aurora WID, Sitorus RJ, Flora R. Effect of Stunting on Intelligence Quotient (IQ) of School-Age Children. Proc 3rd Green Dev Int Conf (GDIC 2020). 2021;205(Gdic 2020):176–80.
Ahmad R, Akter F, Haque M. Editorial: Diet and nutrition for non-communicable diseases in low and middle-income countries. Front Nutr [Internet]. 2023 Mar 28;10(8). Available from: https://www.frontiersin.org/articles/10.3389/fnut.2023.1179640/full
Fang Y, Luo J, Boele M, Windhorst D, van Grieken A, Raat H. Parent, child, and situational factors associated with parenting stress: a systematic review. Eur Child Adolesc Psychiatry [Internet]. 2024;33(6):1687–705. Available from: https://doi.org/10.1007/s00787-022-02027-1
Büttner N, Heemann M, De Neve JW, Verguet S, Vollmer S, Harttgen K. Economic Growth and Childhood Malnutrition in Low- and Middle-Income Countries. JAMA Netw Open [Internet]. 2023 Nov 9;6(11):e2342654. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2811562
Milwan, Sunarya A. Stunting Reduction in Indonesia: Challenges and Opportunities. Int J Sustain Dev Plan. 2023;18(7):2223–31.
Saminan, Rabbany N, Aini Z, Zulkarnain, Murzalina C. Implementation of Stunting Prevention Program in Indonesia: Literature Review. Media Publ Promosi Kesehat Indones. 2024;2(1):56–61.
Pratiwi D, Yulian V. Peran Posyandu terhadap Pencegahan Stunting di Indonesia: Sebuah Studi Literatur. Pros Semin Nas. 2023;5(2):51–8.
Rikayoni R, Rahmi D. Hubungan Status Gizi Ibu Selama Hamil Dengan Kejadian Stunting Pada Bayi Usia 0-36 Bulan Di Wilayah Kerja Puskesmas Sijunjung Tahun 2022. Menara Ilmu. 2023;17(1):97–106.
Prijono M, Andarwulan N, Palupi NS. Perbedaan Konsumsi Pangan dan Asupan Gizi pada Balita Stunting dan Normal di Lima Provinsi di Indonesia. J Mutu Pangan Indones J Food Qual. 2020;7(2):73–9.
Sarkar P, Rifat MA, Bakshi P, Talukdar IH, Pechtl SML, Lindström Battle T, et al. How is parental education associated with infant and young child feeding in Bangladesh? a systematic literature review. Vol. 23, BMC Public Health. 2023. 1–46 p.
Khoirun Nisa DM, Sukesi TW. Hubungan Antara Kesehatan Lingkungan dengan Kejadian Stunting di Wilayah Puskesmas Kalasan Kabupaten Sleman. J Kesehat Lingkung Indones. 2022;21(2):219–24.
Zullaiha S, Purnamaningrum YE, Santi MY. Factors affecting incident of stunting in children under five years. J Kesehat Ibu dan Anak. 2021;15(2):139–47.
Himawati EH, Fitria L. Hubungan Infeksi Saluran Pernapasan Atas dengan Kejadian Stunting pada Anak Usia di Bawah 5 Tahun di Sampang. J Kesehat Masy Indones [Internet]. 2020 May 27;15(1):1. Available from: https://jurnal.unimus.ac.id/index.php/jkmi/article/view/5819
Putri MG, Irawan R, Mukono IS. Hubungan Suplementasi Vitamin A, Pemberian Imunisasi, dan Riwayat Penyakit Infeksi Terhadap Kejadian Stunting Anak Usia 24-59 Bulan di Puskesmas Mulyorejo, Surabaya. Public Heal Nutr Media [Internet]. 2021;10(1):72. Available from: https://e-journal.unair.ac.id/MGK/article/view/24946
Latifah U, Prastiwi RS, Baroroh U. The Responsive Feeding Behavior and Stunting Incident on Toddlers. J Kebidanan. 2020;10(2):143–8.
Andayani K, Kuswati, Hayatullah MM. Hubungan Pengetahuan, Sikap dan Perilaku Ibu terhadap Pemberian Makanan Pendamping ASI Usia 6-24 Bulan di PMB “M” Kecamatan Bojonggede Kabupaten Bogor Provinsi Jawa Barat Tahun 2023. JMSWH J Midwifery Sci Women’s Heal. 2023;3(2):71–7.
Chowdhury R, Manapurath R, Sandøy IF, Upadhyay RP, Dhabhai N, Shaikh S, et al. Impact of an integrated health, nutrition, and early child stimulation and responsive care intervention package delivered to preterm or term small for gestational age babies during infancy on growth and neurodevelopment: study protocol of an individually . Trials [Internet]. 2024;25(1):1–14. Available from: https://doi.org/10.1186/s13063-024-07942-z
UNICEF. Nurturing young children through responsive feeding is key for a child ’ s. Nuturing Care Early Child Dev [Internet]. 2022;1–16. Available from: https://nurturing-care.org/wp-content/uploads/2023/06/NTCTRF.pdf
Killion KE, Corcoran A, Romo-Palafox MJ, Harris JL, Kagan I, Gilbert L, et al. Responsive Feeding Practices to Promote Healthy Diets: A Mixed Method Study among Low-Income Caregivers with Toddlers. Nutrients. 2024;16(6).
Larasati AQ, Sudargo T, Susetyowati S. Responsive feeding ibu dan asupan makan anak stunting usia 2-5 tahun. J Gizi Klin Indones. 2022;18(4):164.
Scott N, Delport D, Hainsworth S, Pearson R, Morgan C, Huang S, et al. Ending malnutrition in all its forms requires scaling up proven nutrition interventions and much more: a 129-country analysis. BMC Med. 2020;18(1):1–19.
Aurima J, Susaldi S, Agustina N, Masturoh A, Rahmawati R, Tresiana Monika Madhe M. Faktor-Faktor yang Berhubungan dengan Kejadian Stunting pada Balita di Indonesia. Open Access Jakarta J Heal Sci. 2021;1(2):43–8.
Fernanda L. Reformulasi Hubungan Warga Dan Pemerintah Dalam Penanganan Stunting Di Kabupaten Kulon Progo. J Soc Bridg [Internet]. 2024;2:103–17. Available from: https://www.bk3s.org/ojs/jsb/article/view/42%0Ahttps://www.bk3s.org/ojs/jsb/article/download/42/38
Pohan HM, Harahap FS, Elisa, Pardede N, Harahap HJ. Kontribusi kuliah kerja nyata terhadap pencegahan stunting pada balita. J Olahraga dan Kesehat Indones [Internet]. 2023;3(2):109–14. Available from: https://jurnal.stokbinaguna.ac.id/index.php/jok
Esha D, Mubin A, Hakim F. Mengenal Lebih Dalam Ciri – ciri Stunting , Cara Pencegahannya , dan Perilaku Hidup Sehat dan Bersih. J Chem Inf Model. 2023;2(6):24–8.
Tadele TT, Gebremedhin CC, Markos MU, Fitsum EL. Stunting and associated factors among 6–23 month old children in drought vulnerable kebeles of Demba Gofa district, southern Ethiopia. BMC Nutr [Internet]. 2022;8(1):1–11. Available from: https://doi.org/10.1186/s40795-022-00501-2
Halli SS, Biradar RA, Prasad JB. Low Birth Weight, the Differentiating Risk Factor for Stunting among Preschool Children in India. Int J Environ Res Public Health. 2022;19(7).
Rahmatul A, Suhartini T, Supriyadi B. Hubungan Berat Badan Lahir Rendah (Bblr) Dengan Kejadian Stunting Pada Anak Usia 1-3 Tahun. Nutr J. 2019;3(1):36.
Lestari ES. Hubungan ASI Eksklusif dan BBLR dalam Pertumbuhan Bayi Usia 1-2 Tahun. Syntax Idea. 2021;3(1):80–97.
Savita R, Amelia F. Hubungan Pekerjaan Ibu, Jenis Kelamin, dan Pemberian Asi Eklusif Terhadap Kejadian Stunting Pada Balita 6-59 Bulan di Bangka Selatan. J Kesehat Poltekkes Kemenkes Ri Pangkalpinang. 2020;8(1):1.
Amalia RA, Rasyida AU, Buana AW, Adam OM. Hubungan Antara Pendapatan Keluarga, Pola Pemberian Makan, dan Pengetahuan Ibu tentang Gizi dengan Kejadian Stunting di Wilayah Kerja Puskesmas Bangkingan. Surabaya Biomed J. 2023;
Ainul D, Mikawati, Rizky P. Hubungan Inisiasi Menyusui Dini, ASI Eksklusif, dan Pemantauan Tumbuh Kembang dengan Kejadian Stunting dan Wasting. Bul Ilmu Kebidanan dan Keperawatan. 2024;3(03):5–8.
Lefebo BK, Kassa DH, Tarekegn BG. Factors associated with stunting: gut inflammation and child and maternal-related contributors among under-five children in Hawassa City, Sidama Region, Ethiopia. BMC Nutr. 2023;9(1):1–8.
Setiawati E. Hubungan Pendidikan Ibu Balita dengan Kejadian Stunting di Puskesmas Marusu Kabupaten Maros. J Aafiyah Heal Res. 2025;6(1):27–33.
Hendraswari CA, Purnamaningrum YE, Maryani T, Widyastuti Y, Harith S. The determinants of stunting for children aged 24-59 months in Kulon Progo District 2019. Kesmas. 2021;16(2):71–7.
Natalia V, Hertati D. Analisis Faktor-faktor yang Mempengaruhi Kejadian Stunting di Kalimantan Tengah Berdasarkan Literature Review. J Surya Med. 2023;9(3):181–9.
Indriyani O, Rahardjo N. Edukasi Pentingnya MP-ASI Sebagai Upaya Pencegahan Stunting Pada Masa Golden Anak. J Midwifery Community [Internet]. 2023;1(1):22–8. Available from: https://jurnal.uns.ac.id/jmc/article/view/71551
Morales F, Montserrat-de la Paz S, Leon MJ, Rivero-Pino F. Effects of Malnutrition on the Immune System and Infection and the Role of Nutritional Strategies Regarding Improvements in Children’s Health Status: A Literature Review. Nutrients. 2024;16(1):1–16.
Daracantika A, Ainin A, Besral B. Pengaruh Negatif Stunting terhadap Perkembangan Kognitif Anak. J Biostat Kependudukan, dan Inform Kesehat. 2021;1(2):113.
Yani DI, Rahayuwati L, Sari CWM, Komariah M, Fauziah SR. Family Household Characteristics and Stunting: An Update Scoping Review. Nutrients. 2023;15(1):1–17.
Kusuma L, Aulia V, Hadhikul M. Risks of Stunting and Interventions to prevent Stunting. J Community Engagem Heal. 2023;6(2):241–5.
Ekholuenetale M, Barrow A, Ekholuenetale CE, Tudeme G. Impact of stunting on early childhood cognitive development in Benin: evidence from Demographic and Health Survey. Egypt Pediatr Assoc Gaz. 2020;68(1).
Kalinda C, Qambayot MA, Ishimwe SMC, Regnier D, Bazimya D, Uwizeyimana T, et al. Leveraging multisectoral approach to understand the determinants of childhood stunting in Rwanda: a systematic review and meta-analysis. BMC Public Health. 2024;13(1):1–12.
Syafrawati S, Lipoeto NI, Masrul M, Novianti N, Gusnedi G, Susilowati A, et al. Factors driving and inhibiting stunting reduction acceleration programs at district level: A qualitative study in West Sumatra. PLoS One [Internet]. 2023;18(3 MARCH):1–21. Available from: http://dx.doi.org/10.1371/journal.pone.0283739
Notoadmodjo S. Promosi Kesehatan & Prilaku Kesehatan. Jakarta: EGC. 2012.
Mahendra D, Jaya IMM, Lumban AMR. Buku Ajar Promosi Kesehatan. Progr Stud Diploma Tiga Keperawatan Fak Vokasi UKI. 2019;1–107.
Nurfitri M. Hubungan Pengetahuan Responsive Feeding Ibu Dengan Kejadian Stunting Pada Anak Usia 12-24 Bulan. Semin Nas Keperawatan “Strategi Optim Status Kesehat Ment Masy dengan Perawatan Paliat di Era Pandemi Covid 19” Tahun 2021. 2021;99–104.
Azwar A, Tane R, Sartika MS D. Responsive Feeding dan Stunting Pada Anak : Literature Review. J Nurs Innov. 2023;2(3):73–80.
Mugode RH, Puoane T, Michelo C, Steyn NP. “Feeding a child slowly:” a responsive feeding behavior component likely to reduce stunting: Population-based observations from rural Zambia. J Hunger Environ Nutr [Internet]. 2020;13(4):455–69. Available from: https://doi.org/10.1080/19320248.2017.1403409
Dayuningsih, Permatasari Endah Astika Tria SN. Pengaruh Pola Asuh Pemberian Makan Terhadap Kejadian Stunting Pada Balita 0-59 Bulan. J Kesehat Masy Andalas [Internet]. 2021;14(2):3–11. Available from: http://jurnal.fkm.unand.ac.id/index.php/jkma/
Siringoringo ET, Syauqy A, Panunggal B, Purwanti R, Widyastuti N. Karakteristik Keluarga Dan Tingkat Kecukupan Asupan Zat Gizi Sebagai Faktor Risiko Kejadian Stunting Pada Baduta. J Nutr Coll. 2020;9(1):54–62.
Arintasari F. Analisis Stunting 1000 Hari Pertama Kehidupan (Hpk) dengan Perilaku Responsive Feeding dan Pemberian Therapy Massage Eating Difficulties untuk Menunjang Tumbuh Kembang. J TSCNers. 2022;16(1):1–23.
Item I, Munawaroh M, Astuti RP. Hubungan Pola Makan, Status Gizi Dan Peran Nakes Terhadap Pencegahan Stunting Di Wilayah Puskesmas Simpang Rimba Kab Bangka Selatan Tahun 2022. SENTRI J Ris Ilm. 2023;2(9):3466–75.
Yogiisworo N, Wahyurianto I, Yasin, P R, Teresia. Faktor Dominan Responsive Feeding Pada Ibu Dengan Anak Stunting Di Desa Penambangan Wilayah Kerja Puskesmas Semanding Kabupaten Tuban. J Multidisiplin Indones. 2023;2(9):2621–31.
Rezaeizadeh G, Mansournia MA, Keshtkar A, Farahani Z, Zarepour F, Sharafkhah M, et al. Maternal education and its influence on child growth and nutritional status during the first two years of life: a systematic review and meta-analysis. eClinicalMedicine [Internet]. 2024;71(April):102574. Available from: https://doi.org/10.1016/j.eclinm.2024.102574
Haidar M., Sharaf N., Al-Dankali MM. UNUSUAL PRESENTATION OF ACUTE INTESTINAL OBSTRUCTION DUE TO TRANSVERSE COLON VOLVULUS IN LATE PREGNANCY. J Syst Softw. 2020;
Djogo H. Hubungan Pekerjaan Ibu Dan Praktik Asi Ekslusif Dengan Kejadian Stunting Pada Balita Di Kabupaten Timor Tengah Selatan. J Kesehat. 2021;8(2):89–97.
Nurdiantami Y, Shabriyyah NF, Riyanti FD, Muhammad RF, Muhayati DA. Hubungan Karakteristik Ibu dengan Sikap Responsif Anak. J Epidemiol Kesehat Indones. 2022;6(1):45–52.
Putrihapsari R, Fauziah PY. Manajemen Pengasuhan Anak Usia Dini Pada Ibu Yang Bekerja: Sebuah Studi Literatur. JIV-Jurnal Ilm Visi. 2020;15(2):127–36.
Millah NW, Bahrodin A. Pengaruh Dukungan Sosial Dan Pola Asuh Orang Tua Terhadap Perkembangan Psikososial. Al-Adawat J Pendidik Guru Madrasah Ibtidaiyah. 2022;1(02):151–66.
Husna A, Willis R, Rahmi N, Fahkrina D. Hubungan Pendapatan Keluarga dan Pemberian ASI Eksklusif dengan Kejadian Stunting pada Balita Usia 24-36 Bulan di Wilayah Kerja Puskesmas Sukajaya Kota Sabang. J Healthc Technol Med. 2023;9(1):583.
Atsbha MK. Effect of food texture and responsive feeding on food intake of infants aged 9–11 months, West Gojjam, Ethiopia. Cogent Food Agric [Internet]. 2021;7(1). Available from: https://doi.org/10.1080/23311932.2021.1924431
Ayalew CA, Belachew T. Effect of complementary feeding behaviour change communication delivered through community-level actors on infant growth and morbidity in rural communities of West Gojjam Zone, Northwest Ethiopia: A cluster-randomized controlled trial. Matern Child Nutr. 2021;17(3):1–13.
Black MM, Tofail F, Hodges EA, Bann CM, Hamadani JD, Aktar S, et al. Rethinking Responsive Feeding: Insights from Bangladesh. Nutrients. 2022;14(15):1–13.
Aubuchon-Endsley NL, Swann-Thomsen HE, Douthit N. Maternal prenatal cortisol and breastfeeding predict infant growth. Int J Environ Res Public Health. 2020;17(21):1–13.
