Comparison of WHO and Indonesian growth standards in determining prevalence and determinants of stunting and underweight in children under five: a cross-sectional study from Musi sub-district

Abstract

Background: Undernutrition among children under five continues to be a critical global public health challenge, especially in developing countries. However, it is believed that Indonesian children are “below” the global standard, thus the WHO standard is not reliable to present the actual prevalence. This study aims to compare the difference between WHO and Indonesian growth standards regarding prevalence of stunting and underweight and its determinants. Methods: This is a cross-sectional study carried out in Musi sub-district, East Nusa Tenggara province in July 2019. East Nusa Tenggara province had the highest prevalence of stunting and underweight in Indonesia. The study population were children under five, and total sampling method was used for this study. Length/height-for-age and weight-for-age were plotted using WHO and national standards. Univariate and multivariate binomial logistic regression were used for statistical analysis. Results: The prevalence of stunting and underweight were higher for the WHO than the national standard (53.9% vs 10.7% and 29.17% vs 17.7%; all p < 0.001). Determinants of stunting were maternal mid-upper arm circumference below 23.5cm and maternal height below 150cm when the WHO standard was used, and no determinant was found when the national standard was used. Determinants of underweight were intrauterine growth restriction, young maternal age during pregnancy, and multiple parities when the WHO standard was used. When the national standard was used, the determinants of underweight were intrauterine growth restriction and maternal education. Conclusions: The WHO standard over-diagnosed stunting and underweight in Musi sub-district. Future studies should be done to re-evaluate the prevalence and determinants of stunting and underweight nationwide using the Indonesian standard.