Association Between Birth Weight, Birth Length, and Stunting: A Case Analysis at Lempake Public Health Center, East Kalimantan, Indonesia

Stunting remains a significant public health concern in Indonesia, as it affects early childhood growth and development, leading to long-term health and cognitive impairments. Birth length and birth weight are critical predictors of stunting, as inadequate growth parameters at birth may contribute to poor nutritional status and delayed development. Toddlers, particularly those in low-resource settings, are among the most vulnerable age groups to dietary deficiencies, making early identification of risk factors essential for prevention efforts. This study aimed to assess the association between birth weight, birth length, and the incidence of stunting among children at Lempake Community Health Center in Samarinda, Indonesia. A quantitative analytic observational study with a case-control design was conducted to evaluate the relationship between these perinatal factors and stunting risk. The findings revealed that stunting was more prevalent among male infants (51.1%) aged 0–11 months. A statistically significant association was observed between birth weight and stunting (p = 0.00), with an odds ratio of 0.414 (95% CI: 0.23–0.72), indicating that children born with a birth weight of <2500 grams had a higher likelihood of experiencing stunting. Similarly, birth length was significantly associated with stunting (p =0.02), with an odds ratio of 0.264 (95% CI: 0.13–0.50), suggesting that infants with a birth length of <48 cm were at an increased risk. These findings underscore the importance of monitoring birth weight and length as early indicators for stunting prevention strategies in Indonesia.

INTRODUCTION

Toddlers are among the age groups most susceptible to nutritional deficiencies. One of the main concerns of dietary problems in toddlers is stunting, which remains a significant health issue in Indonesia. Addressing stunting globally is one of the objectives of the Sustainable Development Goals (SDGs). Even though it has steadily declined since 2000, we need faster progress, especially in Asia and Africa. Because 52% of children under 5 years old are affected by stunting, and 70% of all children affected by wasting live in Asia¹¹. If current trends continue, an estimated 128.5 million children (19.5%) will be stunted in 2030. Indonesia is one of Asia’s low- and middle-income countries (LMICs), with a stunting proportion of around 26.8%, higher than the global proportion²². Moreover, the prevalence of stunting in East Kalimantan Province in 2021 is 22.8%³³. Stunting is defined as a condition of the nutritional status of toddlers with a length or height classified as less than their age. Birth length and weight have the potential as predictors of stunting. Predictors are crucial for prevention, early detection, and getting faster treatment. The pathogenesis underlying growth flattering or linear growth is poorly understood⁴⁴. Measurements are carried out using child growth standards from WHO, namely with the interpretation of stunting if it is more than minus two median standard deviations. Many factors, such as socioeconomic conditions, maternal nutrition during pregnancy, infant pain, and inadequate nutritional intake in infants, can cause toddler stunting. These contributing factors typically persist over an extended period⁵⁵.

The causes of stunting include growth retardation in the womb, insufficient nutrient intake during infancy and childhood, frequent exposure to infectious diseases, low birth length, and weight, and inappropriate feeding practices and food consistency for the child’s age.

Children born with low birth weight (LBW) are often the result of insufficient maternal nutrient intake during pregnancy, which inhibits growth and increases susceptibility to infectious diseases⁶⁶. Moreover, socioeconomic disadvantage, poverty, and food insecurity were widespread problems in LMICs, including Indonesia. It caused higher maternal mortality, low weight gain, and inadequate fetal nutrition⁷⁷.

The short-term impacts of stunting include increased incidence of morbidity and mortality, suboptimal cognitive, motor, and verbal development in children, and higher health costs. The long-term effects of stunting include a body posture not appropriate for age, increased risk of obesity and other diseases, decreased reproductive health, reduced learning capacity and suboptimal school performance, and lower productivity and work capacity⁸⁸.

Babies with a history of low birth weight can be affected in their development, as can be seen from anthropometry. Birth weight is usually strongly associated with infant and child morbidity and subsequent growth and development. Birth length is a significant risk factor for stunting in toddlers and is one of the determinants of the delay in growth and development⁵⁵.

The main objective of this article is to analyze the odds ratio of birth weight and birth length regarding stunting outcomes in children at the Lempake Community Health Center in Samarinda, Indonesia.

MATERIALS AND METHODS

This research is a quantitative analytic observational design with a case-control approach. The population consisted of children aged 0 to 60 months who were recorded in the working area of the Lempake Community Health Center and visited between January 2022 and April 2023, excluding those who did not meet the inclusion criteria, such as incomplete medical records or toddlers with chronic diseases (e.g., tuberculosis, congenital heart disease. The sample for this research was selected using simple random sampling, resulting in 280 children divided into two groups. 1) case group, group that consist of children who stunted, and 2) control group, children who were not stunted. The study included independent variables of gender, age, birth length, and birth weight. The dependent variable was the stunting cases. The data were analysed using the chi-square test. The Spearman Rank was used for the variables of children’s age, while the Pearson correlation was utilized to examine the relationship between birth length, birth weight, and stunting status. Furthermore, logistic regression analysis was performed to identify the most substantial factors associated with stunting, with a significance cutoff set at p<0.05.

The research protocol has been approved by the Medical Research Ethics Committee of Fakultas Kedokteran Universitas Mulawarman (Approval number: 184/KEPK-FK/VII/2023, Date: July 27th, 2023)

RESULTS

Characteristic

Table 1.Sample Distribution Characteristics

Stunting condition
	Stunted		Not Stunted
	N	%	N	%
Gender
Male	42	29.4%	101	70.6%
Female	29	21.2%	108	78.8%
Age (month)
0 – 11	12	13.8%	75	86,2%
12 – 23	13	23.6%	42	76.4%
24 – 35	25	50%	25	50%
36 – 47	19	38%	31	62%
48 – 60	2	5.3%	36	94.7%
Total	71	25.4%	209

Table 1 showed that 143 (51.1%) were male, and 137 (48.9%) were female. Forty-two male toddlers (29.4%) and 29 female toddlers (21.2%) were stunted. Most respondents (n=143, 51.1%) were male, and most (n=87, 31.1%) were aged 0-11 months at the time of measurement. Interestingly, at the age group 24–35 months, the percentages of toddlers stunted and not stunted are equal.

Table 2 showed that the majority of respondents (n=223, 83.2%) had a birth weight >2500 grams, while 16.8% (n=47) had a birth weight ≤2500 grams. Using the chi-square test revealed a significant association between birth weight and stunting (p=0.00), with an odds