**2. Stunting cases in Indonesia**

In 2020, there will be 149.2 million stunted, 45.4 million wasting, and 38.9 million overweight children worldwide. Except for Africa, all areas are seeing a decrease in the number of children with stunting. Asia as a whole is home to more than threequarters of all children with severe wasting, and more than half of all children affected by wasting live there. At the national level, the stunting target is where countries are making the most success, with over two-thirds of them observing at least some improvement. In contrast, the majority of nations have either made little progress or worsened when it comes to the obesity [8].

As shown in **Figure 1**, globally, there has been improvement in the rates of chronic undernourishment and linear growth stunting in children under the age of five; however, these rates are still high in many areas. The growth and development of children may be enhanced by policies, programs, and interventions that support maternal and child health and nutrition. Data from the Indonesian Ministry of Health, one in three of the country's nine million children were stunted in 2018 [9, 10]. The Delivery of Additional Food program is then used nationwide to carry out the government's objective to combat stunting. This program delivers healthy biscuits to toddlers and pregnant women, with a special emphasis on undernourished toddlers.

**Figure 1.** *Global overview of stunting [9].*

In underdeveloped nations, stunting in toddlers is closely linked to hunger because chronic malnutrition affects the prevalence of stunting. Height and body weight can be used to assess growth and development, which can have an impact on both physical and psychological growth and development in toddlers [11]. To prevent stunting in children, dietary supplementation is, therefore, crucial during the toddler years.

By 2025, Indonesia aims to achieve its Sustainable Development Goal of a 40% reduction in stunting. Analyzing the dietary intake of children under the age of five hence requires more investigation. A critical time for a child's growth and development is when they are newborns and young infants to toddlers. The growth of the child's body and mind will be stunted by stunting situations [12, 13]. Stunting is typically brought on by children's inadequate nutritional intake, which is linked to diet and infection [14, 15]. One of the research-based risk factors for stunting indicates that environmental sanitation outcomes, such as the accessibility of latrines and the quality of drinking water, carry a higher risk [16, 17]. Lead exposure is linked to a number of nutritional deficiencies, which ultimately stunts children's neurodevelopment [18]. Children who consume contaminated food and are exposed to environmental toxins like metals are, especially susceptible to poor nutrition absorption. Stunted growth is one common sign of a nutritional deficiency and happens when a child's height (or length) for that age falls below the 5th percentile [17].

The previous research showed that stunted conditions (22%) with a z score of 3 to 2 standard deviations (SD), followed by severely stunted circumstances (8%) with a z score of 3 SD, dominated the evaluation of the stunting status of children under five in 2021. The study showed that the condition of stunting was not caused by environmental causes. However, it was thought that drinking boiled water increased the risk of stunting. Additionally, our data demonstrated a correlation between the state of stunting and exclusive breastfeeding, which supplied a protective factor for stunting in toddlers [19].

Ambitious international nutrition goals have been established during the current Sustainable Development Goals era. The World Health Assembly set the goal of reducing stunting in children under the age of five by 40% by 2025 as one of its objectives. According to the World Health Organization, stunting is the decreased growth and development of children as a result of inadequate nutrition, frequent infections, and insufficient psychosocial stimulation. If a child's height for age is less than −2 standard deviations from the WHO Child Growth reference, they are considered stunted. Though the overall number of stunted children has reduced, there are still 150 million of them in the globe under the age of five. This figure represents a tiny portion of the kids whose linear growth is being slowed down for a variety of reasons. The main focus is on supporting breastfeeding, complementary feeding, and antiinfection measures for kids. All of these are crucial for a child's health and survival, yet they have little to no impact on stunting. Adolescent females' health and nutrition must be promoted through action. Often, the first pregnancy occurs too early.

As shown in **Figure 2**, The Sustainable Development Goals Report 2022 provides a global overview of progress on implementation of the Agenda for Sustainable Development, using the latest available data and estimates. Prenatal nutrition is required in cases of food insecurity, along with other prenatal or early pregnancy interventions. "Reducing the burden of stunting requires a paradigm shift from interventions focusing solely on children and infants to those that reach mothers and families and improve their living environment and nutrition," the authors of the Danaei research write in their conclusion.

Indonesia's COVID-19 epidemic has had an effect on a number of areas, including the economy, education, and other facets of communal life, such as health issues.

*Social and Behavior Change Communication Framework DOI: http://dx.doi.org/10.5772/intechopen.112744*

#### **Figure 2.**

*The sustainable development goals report 2022 [20].*

Despite being quite a heavy burden on the health sector, the government's various efforts to foresee the effects of the COVID-19 pandemic, particularly for vulnerable populations like pregnant women and young children, have produced quite encouraging results as the issue of stunting in Indonesia has decreased over the past two years. This evaluation of toddler nutrition status is also strongly related to the key objectives of the Healthy Indonesia Program in the 2020–2024 National Medium-Term Development Plan (NMTDP), namely enhancing the nutritional and health status of Indonesian children.

The national stunting rate has reduced by 1.6% every year, from 27.7% in 2019 to 24.4% in 2021, according to the findings of the 2021 SSGI [21]. Only 5 of the 34 provinces show a rise from 2019 while the majority of them show a fall. This demonstrates that the government's efforts to reduce stunting in Indonesia have shown some promising results. The Health Research and Development Agency of the Ministry of Health's SSGI 2021 study not only gives an overview of toddlers' nutritional status, but it can also be used as a tool for tracking and assessing the success of sensitive interventions and specific intervention indicators that have been implemented at the national and district/city levels starting in 2019 and lasting until 2024. At the moment, stunting is more common in Indonesia than in Myanmar (35%), although it is still more common than in Vietnam (23%), Malaysia (17%), Thailand (16%), and Singapore (4%).

Over the previous 10 years, Indonesia has maintained a high frequency of child stunting, which currently stands at about 37% nationwide. Uncertainty exists over the alignment of Indonesia's current child stunting prevention strategies with the available scientific data. We examine the available literature using the World Health Organization conceptual framework on child stunting to determine what has been examined, what can be said about the causes of child stunting in Indonesia, and where data gaps still exist [1]. Consistent evidence indicates that factors contributing to child stunting in Indonesia include nonexclusive breastfeeding for the first six months, low household socioeconomic position, early birth, short birth length, and low maternal height and education.

**Figure 3** shows that the prevalence of stunting in children aged 0–59 months who live in homes with unimproved restrooms and untreated water are also more at risk throughout one decade. Child stunting has frequently been linked to neighborhood and socioeconomic problems, specifically a lack of access to health care and living in rural areas. There are not many published research on how education, society, culture, food production, water, sanitation, and the environment affect child growth. This thorough review of the research on the factors that influence child stunting in Indonesia identifies at-risk groups, effective interventions, and areas in which additional study is required to close knowledge gaps. According to the WHO framework, household and family factors, inadequate complementary feeding (poor quality foods, inadequate practices, and food and water safety), breastfeeding (inadequate practices), and infection (clinical and subclinical infection) are the main factors that contribute to child stunting. It classifies comparable contextual variables into the following subelements: political economics; health and health care; education; society and culture; agricultural and food systems; and water, sanitation, and environment. It also classifies contextual components into the general category of community and societal factors.

Stunting-risk family-based interventions are developed as a result of the accelerated program to reduce stunting, with an emphasis on preparing for parenthood, ensuring a healthy diet, improving parenting, expanding access to and improving the quality of health services, and expanding access to drinking water and sanitation. Monitoring and evaluation, the fifth pillar of the National Strategy for Stunting, is seen as critical and crucial in the quest to understand the effects of interventions on stunting prevention and control. This is anticipated to help lessen the issue of stunting in Indonesia in general and in priority districts/cities in particular [21]. Although the prevalence rate is currently below 20% in some places, it still falls short of the 14% target set by the NMTDP for 2024. Even though 14% has been met, stunting still exists in Indonesia. The next goal is to lower the stunting rate to a low category or below 2.5%.

**Figure 3.** *Prevalence of stunting (%) in children 0–59 months by district in 2013.*
