Determinants of Wasting Among Children Under Five in Sragen Regency, Central Java, Indonesia
DOI:
https://doi.org/10.26911/thejmch.2026.11.05.05Abstract
Background: Wasting remains a public health concern in Sragen Regency despite its agricultural potential. This study examined associations with childhood wasting and pathways involving household food insecurity, dietary diversity, and attendance at community-based integrated health posts (Posyandu).
Subjects and Method: This cross-sectional study recruited 204 children aged 6–59 months through consecutive sampling at Posyandu from an accessible population of 5,781 in Sragen Regency. Sample size planning considered the anticipated complexity of GSEM. The recruitment target was 200 participants, and 204 were enrolled. Wasting was the dependent variable; independent variables included maternal education, household economic status, household size, number of children, social capital, maternal mental health, food security, dietary diversity, and Posyandu attendance. Data were collected using anthropometry and questionnaires (SRQ-20, HFIAS, DDS) and analyzed using chi-square tests, multivariable logistic regression, and GSEM comprising four structural equations with 16 regression paths.
Results: Low maternal education (aOR=4.21; 95% CI=2.05 to 8.63; p<0.001), low economic status (aOR=6.67; 95% CI=3.09 to 14.40; p<0.001), large household size (aOR=2.83; 95% CI=1.22 to 6.55; p=0.015), low dietary diversity (aOR=3.65; 95% CI=1.73 to 7.72; p=0.001), and irregular Posyandu attendance (aOR=3.08; 95% CI=1.40 to 6.77; p=0.005) were associated with higher odds of wasting. GSEM showed positive associations of large household size (b=0.99; 95% CI=0.21 to 1.77; p=0.013) and more children (b=0.95; 95% CI=0.24 to 1.67; p=0.009) with food insecurity, low maternal education with low dietary diversity (b=0.71; 95% CI=0.14 to 1.28; p=0.015), and maternal psychological distress with irregular attendance (b=0.92; 95% CI=0.31 to 1.53; p=0.003). Other examined intermediate associations were nonsignificant.
Conclusion: Low maternal education, low household economic status, larger household size, inadequate dietary diversity, and irregular Posyandu attendance were associated with higher odds of wasting. GSEM identified additional associations involving household food insecurity, dietary diversity, and Posyandu attendance, although the overall indirect effects were not formally tested.
Keywords:
wasting, children under five, nutritional status, maternal factorsHow to Cite
References
Bai Z, Yang J, Wang Z, Cao W, Cao C, Hu Z, Chen R. (2022). Association between social capital and self-rated health among community-dwelling older adults. Front Public Health. 10: 916485. https://doi.org/10.3389/fpubh.2022.916485.
Becquey E, Touré M, Djoufouna AD, Affenou A, Barba F, Diatta AD, Dione M, et al. (2023). Community Volunteers Deliver Integrated Prevention and Treatment Services to Reduce Child Wasting in Chad. Project note. Washington, DC: International Food Policy Research Institute. https://hdl.handle.net/10568/138983.
Chen M. (2022). Engel's law in China: Some new evidence. Rev Dev Econ. 26(3): 1640–1662. https://doi.org/10.1111/rode.12887.
Craig A, Hutton C, Lewis LA, Musa FB, Sheffield J (2023). Linking household access to food and social capital typologies in Phalombe District, Malawi. Sustain Sci. 18:1721–1737. https://doi.org/10.1007/s11625-023-01329-w.
Dassie GA, Chala Fantaye T, Charkos TG, Sento Erba M, Balcha Tolosa F. (2024). Factors influencing concurrent wasting, stunting, and underweight among children under five who suffered from severe acute malnutrition in low- and middle-income countries: a systematic review. Front Nutr. 11:1452963. https://doi.org/10.3389/fnut.2024.1452963.
Grootaert C, Narayan D, Jones VN, Woolcock M (2003). Measuring Social Capital: An Integrated Questionnaire. Washington DC: The International Bank for Reconstruction and Development/The World Bank. Retrieved from https://documents1.worldbank.org/curated/en/515261468740392133/pdf/281100PAPER0Measuring0social0capital.pdf.
Habtamu E, Chilo D, Desalegn D. (2022). Determinants of wasting among children aged 6-59 months in Wonago woreda, south Ethiopia. A facility-based unmatched case-control study. PloS one. 17(6):e0269380. https://doi.org/10.1371/journal.pone.0269380.
Hossain MI, Huq S, Islam MM, Mahfuz M, Sari M, Khan GM, Sharmin F, et al. (2024). Risk or associated factors of wasting among under-five children in Bangladesh: A systematic review. Asia Pac J Clin Nutr. 33(4):457–480. https://doi.org/10.6133/apjcn.202412_33(4).0001.
Ismail NA, Rahim NS, Hamid SB. (2025). Association of Household Food Security Status and Dietary Diversity among Children during COVID-19. Jurnal Gizi dan Pangan. 20(1): 89–98. https://doi.org/10.25182/jgp.2025.20.Supp.1.89-98.
Jokhu LA, Syauqy A. (2024). Determinants of concurrent wasting and stunting among children 6 to 23 mo in Indonesia. Nutrition. 122:112390. https://doi.org/10.1016/j.nut.2024.112390.
Kassaw A, Kefale D, Baye FD, Agimas MC, Awoke G, Zeleke S, Aytenew TM, et al. (2024). Wasting and its associated factors among under-two years children in Ethiopia: a systematic review and meta-analysis. BMC Public Health. 24(1):2547. https://doi.org/10.1186/s12889-024-20063-1.
Katoch OR. (2022). Determinants of malnutrition among children: A systematic review. Nutrition. 96:111565. https://doi.org/10.1016/j.nut.2021.111565.
Ministry of Health of Indonesia (2023). Petunjuk Teknis Integrasi Pelayanan Kesehatan Primer (Technical Guidelines for the Integration of Primary Healthcare Services). Retrieved from https://kesprimkom.kemkes.go.id/konten/126/176/0/nomor-hk-01-07-menkes-2015-2023.
Ministry of Health of Indonesia (2024). Peraturan Menteri Kesehatan Republik Indonesia Nomor 6 Tahun 2024 tentang Standar Teknis Pemenuhan Standar Pelayanan Minimal Kesehatan (Regulation of the Minister of Health of the Republic of Indonesia Number 6 of 2024 concerning Technical Standards for Fulfilling Minimum Health Service Standards). Retrieved from https://jdih.kemkes.go.id/documents/peraturan-menteri-kesehatan-nomor-6-tahun-2024.
Ministry of Health of Indonesia (2025). Survei Status Gizi Indonesia 2024 Dalam Angka (Indonesian Nutrition Status Survey 2024: Statistical Yearbook). Retrieved from https://repository.kemkes.go.id/book/1357.
Khan AM. (2022). Maternal mental health and child nutritional status in an urban slum in Bangladesh: A cross-sectional study. PLOS Glob Public Health. 2(10):e0000871. https://doi.org/10.1371/journal.pgph.0000871.
Kline RB (2016). Principles and Practice of Structural Equation Modeling, 4th ed. New York: The Guilford Press. Retrieved from https://psycnet.apa.org/record/2015-56948-000.
Kudu SR, Dewi YLR, Raharjo SS. (2021). The associations of clean and healthy behavior, social capital, and nutritional status in children under five in Waingapu Health Center. J Health Promot Behav. 6(1):57–66. https://doi.org/10.26911/thejhpb.2021.06.01.06.
Mahmudiono T, Nindya TS, Andrias DR, Megatsari H, Rosenkranz RR. (2018). Household Food Insecurity as a Predictor of Stunted Children and Overweight/Obese Mothers (SCOWT) in Urban Indonesia. Nutrients. 10(5):535. https://doi.org/10.3390/nu10050535.
Maulida NR, Fitriyani R, Fitriani A. (2023). Household food insecurity access scale as the indicator of dietary diversity scores into nutritional status aged 12-59 months. ARGIPA (Arsip Gizi dan Pangan). 8(1):19–30. https://doi.org/10.22236/argipa.v8i1.11893.
Mengesha EW, Alene GD, Amare D, Assefa Y, Tessema GA. (2021). Social capital and maternal and child health services uptake in low- and middle-income countries: mixed methods systematic review. BMC Health Serv Res. 21(1):1142. https://doi.org/10.1186/s12913-021-07129-1.
Nahar MZ, Zahangir MS. (2024). The role of parental education and occupation on undernutrition among children under five in Bangladesh: A rural-urban comparison. PloS one. 19(8):e0307257. https://doi.org/10.1371/journal.pone.0307257.
Prasetio C, Triwahyuni A, Prathama A. (2022). Psychometric Properties of Self-Report Questionnaire-20 (SRQ-20) Indonesian Version. Jurnal Psikologi. 49(1):69-86. http://dx.doi.org/10.22146/jpsi.69782.
Purwanti R, Ginting IAB, Aulia NP, Nuryanto N, Dieny FF. (2024). Karakteristik Keluarga, Ketahanan Pangan, Pengeluaran Pangan, dan Keanekaragaman Pangan Keluarga dengan dan tanpa WaSt (Wasting-Stunting) pada Anak di Kota Semarang (Family Characteristics, Food Security, Expenditure, and Dietary Diversity among Families with and without Concurrently Wasted and Stunted Children in Semarang). Amerta Nutr. 8(3):228–239. https://doi.org/10.20473/amnt.v8i3SP.2024.228-239.
Russell J, Lechner A, Hanich Q, Delisle A, Campbell B, Charlton K. (2018). Assessing food security using household consumption expenditure surveys (HCES): a scoping literature review. Public Health Nutr. 21(12):2200–2210. https://doi.org/10.1017/S136898001800068X.
Sragen Regency Health Office (2025). Rekapitulasi data gizi Dinas Kesehatan Kabupaten Sragen (Nutritional Data Recapitulation of the Sragen District Health Office). [Unpublished report].
Sutrisno R, Fatmawati ID, Laksono AD, Rahmawati W, Wirawan NN, Handayani D. (2026). The role of household food insecurity in malnutrition among Indonesian children under 5 years of age: a systematic review and meta-analysis (2015-2025). Public Health Nutr. 29(1):e86. https://doi.org/10.1017/S1368980026102365.
UNICEF (2020). UNICEF conceptual framework for the determinants of maternal and child nutrition. Retrieved from https://www.unicef.org/documents/conceptual-framework-nutrition.
WHO (2008). Indicators for Assessing Infant and Young Child Feeding Practices: Part 1 Definitions. Geneva. Retrieved from https://www.who.int/publications/i/item/9789241596664.
Yadav SS, Matela H, Panchal P, Menon K. (2024). Household food insecurity, dietary diversity with undernutrition among children younger than five years in Indian subcontinent-a narrative review. The Lancet Regional Health - Southeast Asia. 26:100426. https://doi.org/10.1016/j.lansea.2024.100426.
