Beware of Stunting in Urban Areas

Despite having adequate economic conditions and health access, urban and suburban areas still have a high prevalence of stunting.

KOMPAS/SEKAR GANDHAWANGI

A child aged 3 years and 11 months with "stunting" or long-term health was measured for his height and weight at RW 09 Cakung Barat Subdistrict, Cakung District, East Jakarta on Saturday (8/4/2023).

JAKARTA, KOMPAS – There is still a large number of stunted children in urban areas, even though urban residents have access to knowledge, economic resources and health services. Poverty, limited immunization coverage, lack of knowledge and a polluted environment are among the triggers of stunting in urban areas.

Luis, a boy of 4 years and 10 months, in Wonokromo village, Surabaya, East Java, has not yet overcome stunting. He weighs less than 12 kilograms and is less than 100 centimeters tall. A 5-year-old boy should typically weigh 14.1 kg to 24.2 kg and be 100.7 cm to 119.2 cm tall. This remains a challenge amid the Surabaya municipality administration’s success in reducing the stunting prevalence from 28.9 percent in 2021 to 4.8 percent in 2022.

“Luis likes to drink milk but eats very little. He only eats once a day, like someone who is fasting,” said Luis’ aunt, who did not want to be named, on Saturday (8/4/2023).

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While both his parents work, Luis’s aunt looks after him and his younger brother. Attempts to stimulate Luis’ appetite have not been successful.

Farida, a nutritionist at the Wonokromo community health center (puskesmas) who accompanied Luis, said the child had been breastfeeding until he was 2 years old, had complete immunizations and did not suffer from any metabolic disorders.

Nur, a child of 2 years and 2 months in Banda Aceh, Aceh, went through something different. Nur only weighs 8.2 kg and is 74 cm tall. A child of Nur’s age should typically weigh 11.5 kg to 13.9 kg and have a height of 80 cm to 101.7 cm. According to her mother, Anita, 35, Nur had not yet been vaccinated as she was often sick since birth.

KOMPAS/ZULKARNAINI

Nur and her mother in front of their house in Beurawe Village, Kuta Alam District, Banda Aceh City, Aceh Province, Wednesday (5/4/2023). Nur experienced slow growth due to unbalanced nutritional intake.

Anita only found out that she was pregnant with Nur after six months. From the womb to birth, Nur did not get enough nutrition due to her family’s limited financial condition. This family with four children are beneficiaries of the Family Hope Program and depend on the income of Nur’s father as a motorized pedicab driver, which usually amounts to Rp 50,000-100,000 per day.

Bilqis, the 10^th of 11 children of Asnawi, 49, and Nurlaelah, 39, residents of Cibarusahjaya village, Bekasi regency, West Java, is also stunted. At the age of 2 years and 5 months, she only weighs 8.1 kg and is 76.2 cm tall. Her ideal weight and height is the same as Nur’s.

Bilqis lives in a suburban area, close to an industrial area in Cikarang. The family lives in a small wooden house with two bedrooms and a living room. Asnawi and Nurlaelah live here with their children. Three of the couple’s children have died.

I wanted to join the family planning program but my father did not allow it.

Issues with eating triggered Bilqis’ stunting.

“She has difficulty eating, especially since she is allergic to eggs. So I give her noodles, instant porridge, tofu and tempeh,” said Nurlaelah. While she was pregnant with Bilqis, Nurlaelah, who had given birth 11 times, did not consume animal protein and only drank milk twice as she has allergies.

Bilqis has also never been taken to a community health post (posyandu) for routine weighing, as it is located far away. Once a post was set up in front of their house in August 2022, Bilqis was taken there and has gained a lot of weight since. None of Asnawi and Nurlaelah’s children have been vaccinated.

“I wanted to join the family planning program but my father did not allow it. Pamali [taboo],” she said.

AGUSTINUS YOGA PRIMANTORO

Nurlaelah (39) hugs Bilqis, her 10th child, on the terrace of her house in Cibarusahjaya Village, Cibarusah District, Bekasi Regency, West Java, Friday (7/4/2023).

Multiple variables

Stunting in urban areas needs serious attention. Out of the 32 provincial capital cities, the prevalence of stunting has increased in 10 from 2021 to 2022.

The highest increase was observed in Manokwari, West Papua, which increased by 7.3 percent, followed by Pekanbaru, Riau, with 5.4 percent and Samarinda, East Kalimantan, with 3.7 percent. This is concerning as these spikes occurred in cities known to be rich and have high Human Development Index levels.

National Population and Family Planning Agency (BKKBN) head Hasto Wardoyo said stunting in children in urban and suburban areas was triggered by a lack of adequate nutrition, sub-optimal health conditions and unsupportive parenting styles. There are also many cases of tuberculosis in children in urban areas, generally those living in the slums.

Unhealthy settlements also make it easy for stunting to be prevalent in almost all cities and suburbs. South Kalimantan BKKBN representative head Ramlan said most stunted children in Banjarmasin lived in the slums by the river. They used floating latrines and consumed polluted river water.

“About 70 percent of stunting is determined by physical factors or infrastructure. Nutrition and immunization only make up about 30 percent,” he said.

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> Strengthen Collaboration to Overcome Stunting

University of Indonesia public health professor Budi Haryanto said there were different variables that caused stunting in each region. It was not sufficient to curb stunting by simply providing nutritious food for children and mothers. Something had also to be done to address the polluted environment.

Hasto added that parents in urban areas were also busier, so their children were usually cared for by caregivers or their grandmothers. As a result, nutrition was not monitored enough and parenting was lacking. So even though there might be access to health facilities and families were economically viable, children in urban areas still would not be free from stunting.

Health Ministry public health director general Maria Endang Sumiwi added that mothers in urban areas who were busy working prevented optimal exclusive breastfeeding.

(BRO/ETA/AIN/FRI/TAN/AIK/Z08/MZW)

This article was translated by Kesya Adhalia.