Contributing factors to underweight among children under five: A cross-sectional study at Belawan Primary Health Center

Endang Sihaloho* -  Department of Midwifery, Faculty of Health and Technology, Universitas Wirahusada Medan, Indonesia, Indonesia
Antonij Edimarta Sitanggang -  Universitas Sari Mutiara Indonesia, Indonesia
Underweight in toddlers is a significant public health concern in Indonesia, where the 2022 National Nutrition Status Survey reported a prevalence of 17,1% among children under five years of age, reflecting persistent nutritional challenges. This study aimed to analyze the incidence of underweight in toddlers in the Belawan Primary Health Center (PHC) and its contributing factors. This research applied a descriptive-analytical design with a cross-sectional approach, conducted in January 2025, in Belawan, Medan City, North Sumatra. A total of 41 toddlers were selected using a total sampling method. Data were collected using structured questionnaires and secondary records, and ethical approval was obtained from the Institutional Review Board. The sample size was determined based on the population of underweight toddlers recorded at the health center. Data were analyzed using chi-square tests and logistic regression. The results indicated significant associations between exclusive breastfeeding (p=0,032), inappropriate complementary feeding (p=0,041), and maternal education (p=0,021) and underweight incidence. Logistic regression showed that low maternal education was the most dominant factor (OR=7,26). In conclusion, the role of mothers is very important in child feeding practices. Interventions to reduce underweight should prioritize maternal education and community-based nutrition programs by strengthening the roles of health workers and Integrated Health Post cadres.

Keywords : Complementary feeding, exclusive breastfeeding, nutritional status, underweight

  1. Abolurin, O., Oyelami, O., Oseni, S., Akinlosotu, M., Sodeinde, K., & Adekoya, A. (2021). Relationship between breastfeeding practices and nutritional status of children aged 6–24 months in South-West Nigeria. Annals of Health Research, 7(2), 179–189. https://doi.org/10.30442/ahr.0702-09-128
  2. Ahmad, A., Madanijah, S., Dwiriani, C. M., & Kolopaking, R. (2018). Complementary feeding practices and nutritional status of children 6–23 months old: Formative study in Aceh, Indonesia. Nutrition Research and Practice, 12(6), 512–520. https://doi.org/10.4162/nrp.2018.12.6.512
  3. Ahmed, R., Sultana, P., Al-Fuad, S., & Islam, A. (2017). Association between breastfeeding practices and nutritional status of children aged 6–24 months in Jessore, Bangladesh. [Conference abstract/grey literature]. Retrieved from https://consensus.app/papers/association-between-breastfeeding-practices-and-islam-ahmed/da905ff415d25ad4be0202f321820bd7/
  4. Al Rahmad, A. H. (2023). Scoping Review: The Role of Micronutrients (Fe, Zn, Iodine, Retinol, Folate) During Pregnancy. Jurnal Kesehatan Manarang, 9(1), 1–13. https://doi.org/https://doi.org/10.33490/jkm.v9i1.812
  5. Ashok, A., Shwetha, J. H., & Mahesh, T. K. (2018). A comparative study of impact of breastfeeding practices on the nutritional status of the infants among the working and non-working women. International Journal of Contemporary Pediatrics, 5(5), 1759–1764. https://doi.org/10.18203/2349-3291.ijcp20182999
  6. Boy, E., Hasibuan, R. I., Rasyid, A. M. A., Ilhamsyah, N., Shafira, C. S. D., Hendewi, A. F., Pranata, R. H., & Harun, P. M. A. (2023). The impact of exclusive breastfeeding and timely complementary feeding on the nutritional status of toddlers. Jurnal Kedokteran dan Kesehatan Indonesia, 14(2), 172–177. https://doi.org/10.20885/JKKI.Vol14.Iss2.art8
  7. Bras, H., & Mandemakers, J. (2022). Maternal education and sibling inequalities in child nutritional status in Ethiopia. SSM – Population Health, 17, 101041. https://doi.org/10.1016/j.ssmph.2022.101041
  8. Bresnahan, K. A., & Tanumihardjo, S. A. (2014). Undernutrition, the acute phase response to infection, and its effects on micronutrient status indicators. Advances in Nutrition, 5(6), 702–711. https://doi.org/10.3945/an.114.006361
  9. Budiono, I., Fauzi, L., & Rochmayani, D. S. (2024). Exploration of positive deviance in prevention of underweight in the under-five: A qualitative study on low-income urban families. Kesmas: National Public Health Journal, 19(3), 180–188. https://doi.org/10.21109/kesmas.v19i3.2019
  10. Carvalho, M. C. da C., Ribeiro, S. A., de Sousa, L. S., Lima, A. Â. M., & Maciel, B. L. L. (2025). Undernutrition and intestinal infections in children: A narrative review. Nutrients, 17(9), 1479. https://doi.org/10.3390/nu17091479
  11. Chowdhury, T. R., Chakrabarty, S., Rakib, M., Saltmarsh, S., & Davis, K. A. (2018). Socio-economic risk factors for early childhood underweight in Bangladesh. Globalization and Health, 14(1), 54. https://doi.org/10.1186/s12992-018-0372-7
  12. Cockerham, W. C. (2022). Theoretical approaches to research on the social determinants of obesity. American Journal of Preventive Medicine, 63(1, Suppl.), S8–S17. https://doi.org/10.1016/j.amepre.2022.01.030
  13. Edwards, B., Schaefer, E. W., Murray-Kolb, L. E., & Daymont, C. (2023). Evaluation of income and food insecurity as risk factors for failure to thrive: An analysis of national survey data. Clinical Pediatrics, 62(8), 862–870. https://doi.org/10.1177/00099228221150705
  14. Emerson, E., Savage, A., & Llewellyn, G. (2020). Prevalence of underweight, wasting and stunting among young children with a significant cognitive delay in 47 low‐income and middle‐income countries. Journal of Intellectual Disability Research, 64(2), 93–102. https://doi.org/10.1111/jir.12698
  15. Fadare, O., Amare, M., Mavrotas, G., Akerele, D., & Ogunniyi, A. (2019). Mother’s nutrition-related knowledge and child nutrition outcomes: Empirical evidence from Nigeria. PLOS ONE, 14(2), e0212775. https://doi.org/10.1371/journal.pone.0212775
  16. Fairuz, S. M. W. A., & Fadilah, T. F. (2025). Maternal knowledge of exclusive breastfeeding and nutritional status of children under two years during the COVID-19 pandemic. Journal of Society Medicine, 4(1), 1–7. https://doi.org/10.71197/jsocmed.v4i1.189
  17. Febrianti, R., Tarigan, R. B., Gulo, R., Silalahi, M. I., Simangunsong, P. M. J., & Pane, P. Y. (2025). Characteristics of stunted toddlers in Medan Belawan. Buletin Kedokteran & Kesehatan Prima, 4(2), 271–276.
  18. Firza, D. (2022). Hubungan keaktifan ibu dalam posyandu dengan status gizi balita di Desa Sei Rotan. Jurnal Kesehatan Masyarakat Indonesia, 17(1), 45–51. https://doi.org/10.26714/jkmi.17.1.2022.45-51
  19. Frost, M. B., Forste, R., & Haas, D. W. (2005). Maternal education and child nutritional status in Bolivia: Finding the links. Social Science & Medicine, 60(2), 395–407. https://doi.org/10.1016/j.socscimed.2004.05.010
  20. Hanandita, W., & Tampubolon, G. (2015). The double burden of malnutrition in Indonesia: Social determinants and geographical variations. SSM – Population Health, 1, 16–25. https://doi.org/10.1016/j.ssmph.2015.10.002
  21. Iftikhar, A., Bari, A., Bano, I., & Masood, Q. (2017). Impact of maternal education, employment and family size on nutritional status of children. Pakistan Journal of Medical Sciences, 33(6), 1401–1405. https://doi.org/10.12669/pjms.336.13689
  22. Irawan, I. R., Sudikno, S., Julianti, E. D., Nurhidayati, N., Rachmawati, R., Sari, Y. D., & Herianti, H. (2022). Risk factors for underweight in toddlers in urban and rural areas in Indonesia [Data analysis of the 2019 Indonesian Toddler Nutritional Status Study]. Penelitian Gizi dan Makanan (The Journal of Nutrition and Food Research), 45(1), 47–58. https://doi.org/10.22435/pgm.v45i1.6041
  23. Khan, S., Zaheer, S., & Safdar, N. F. (2019). Determinants of stunting, underweight and wasting among children < 5 years of age: Evidence from 2012–2013 Pakistan demographic and health survey. BMC Public Health, 19(1), 358. https://doi.org/10.1186/s12889-019-6688-2
  24. Kurnianingtyas, S., Sartika, R. A. D., & Ningsih, W. M. (2021). Underweight in child aged 24–59 months in North Sumatra: The 2014 Indonesia Family Life Survey data. Indonesian Journal of Public Health Nutrition, 1(2), 25–33.
  25. Makoka, D. (2013). The impact of maternal education on child nutrition: Evidence from Malawi, Tanzania, and Zimbabwe. [Conference abstract/grey literature]. Retrieved from https://consensus.app/papers/the-impact-of-maternal-education-on-child-nutrition-makoka/625b2a12d3195644b25bad300fef25b9/
  26. Marbun, W. M., Iskandar, W., Ayunda, H. M., & Khairunnas, K. (2024). Pengaruh pengetahuan gizi ibu dan asupan balita terhadap status gizi balita di Desa Ranto Panyang. Polyscopia, 1(4), 236–241. https://doi.org/10.57251/polyscopia.v1i4.1440
  27. Masuke, R., Msuya, S. E., Mahande, J. M., Diarz, E. J., Stray-Pedersen, B., Jahanpour, O., & Mgongo, M. (2021). Effect of inappropriate complementary feeding practices on the nutritional status of children aged 6–24 months in urban Moshi, Northern Tanzania: Cohort study. PLOS ONE, 16(5), e0250562. https://doi.org/10.1371/journal.pone.0250562
  28. Miko, A., & Al-Rahmad, A. H. (2017). Hubungan berat dan tinggi badan orang tua dengan status gizi balita di Kabupaten Aceh Besar. Gizi Indonesia, 40(1), 21. https://doi.org/10.36457/gizindo.v40i1.222
  29. Nasution, R. S., Mouliza, N., & Pratiwi, D. (2024). Positive deviance in nutritional practices for two-year-olds in poor fisherman families in the Belawan Health Center Area, 2022. International Journal of Public Health Excellence, 4(1), 238–243. https://doi.org/10.55299/ijphe.v4i1.1110
  30. Oktarina, M. D., Sekartini, R., Wasito, E., & Kartjito, M. S. (2023). Immunity as key factors that influence cognitive development on children. World Nutrition Journal, 6(Suppl. 2), 23–29. https://doi.org/10.25220/WNJ.V06.S2.0003
  31. Rachmi, C. N., Agho, K. E., Li, M., & Baur, L. A. (2016). Stunting, underweight and overweight in children aged 2.0–4.9 years in Indonesia: Prevalence trends and associated risk factors. PLOS ONE, 11(5), e0154756. https://doi.org/10.1371/journal.pone.0154756
  32. Rahman, M. S., Howlader, T., Masud, M. S., & Rahman, M. L. (2016). Association of low-birth weight with malnutrition in children under five years in Bangladesh: Do mother’s education, socio-economic status, and birth interval matter? PLOS ONE, 11(6), e0157814. https://doi.org/10.1371/journal.pone.0157814
  33. Rezaeizadeh, G., Mansournia, M. A., Keshtkar, A., Farahani, Z., Zarepour, F., Sharafkhah, M., Kelishadi, R., & Poustchi, H. (2024). Maternal education and its influence on child growth and nutritional status during the first two years of life: A systematic review and meta-analysis. EClinicalMedicine, 71, 102574. https://doi.org/10.1016/j.eclinm.2024.102574
  34. Saidu, S. F., & Danielson, R. A. (2024). Social determinants of health associated with increased prevalence of childhood malnutrition in Africa. Frontiers in Nutrition, 11, 1456089. https://doi.org/10.3389/fnut.2024.1456089
  35. Shrestha, M. L., Perry, K. E., Thapa, B., Adhikari, R. P., & Weissman, A. (2022). Malnutrition matters: Association of stunting and underweight with early childhood development indicators in Nepal. Maternal & Child Nutrition, 18(2), e13321. https://doi.org/10.1111/mcn.13321
  36. Siddiqa, M., Shah, G. H., Mayo-Gamble, T. L., & Zubair, A. (2023). Determinants of child stunting, wasting, and underweight: Evidence from 2017 to 2018 Pakistan Demographic and Health Survey. Journal of Nutrition and Metabolism, 2023, 2845133. https://doi.org/10.1155/2023/2845133
  37. Silitonga, A. I., Nabila, Z. A., Lubis, C. R. Z., Safitri, N., & Haryadi, H. (2024). Klasterisasi gizi buruk dan stunting di Provinsi Sumatera Utara menggunakan K-means clustering. Methodika: Jurnal Teknik Informatika dan Sistem Informasi, 10(2), 13–18. https://doi.org/10.46880/mtk.v10i2.3147
  38. South, C. A., Keown-Stoneman, C. D. G., Birken, C. S., Malik, V., Zlotkin, S. H., & Maguire, J. L. (2024). Underweight in the first 2 years of life and nutrition risk in later childhood: A prospective cohort study. Journal of Human Nutrition and Dietetics, 37(2), 474–483. https://doi.org/10.1111/jhn.13269
  39. Suharto, A. (2022). Mother’s behavior on knowledge and attitudes toward child nutritional status in Magetan Regency, East Java, Indonesia. Open Access Macedonian Journal of Medical Sciences, 10(E), 555–559. https://doi.org/10.3889/oamjms.2022.8369
  40. Suryawan, A., Jalaludin, M. Y., Poh, B. K., Sanusi, R., Tan, V. M. H., Geurts, J. M., & Muhardi, L. (2022). Malnutrition in early life and its neurodevelopmental and cognitive consequences: A scoping review. Nutrition Research Reviews, 35(1), 136–149. https://doi.org/10.1017/S0954422421000159
  41. Tamir, T. T., Zegeye, A. F., Workneh, B. S., & Mekonen, E. G. (2024). Underweight and associated factors among children under age of five in low and lower-middle income African countries: Hierarchical analysis of demographic and health survey data. Frontiers in Public Health, 12, 1423603. https://doi.org/10.3389/fpubh.2024.1423603
  42. Toma, T. M., Andargie, K. T., Alula, R. A., Kebede, B. M., Temesgen, K., & Guyo, T. G. (2024). Underweight and predictors among children aged 6–59 months in South Ethiopia. International Journal of Public Health, 69, 1606837. https://doi.org/10.3389/ijph.2024.1606837
  43. White, P. A., Awad, Y. A., Gauvin, L., Spencer, N. J., McGrath, J. J., Clifford, S. A., Nikiema, B., Yang-Huang, J., Goldhaber-Fiebert, J. D., Markham, W., Mensah, F. K., van Grieken, A., Raat, H., Jaddoe, V. W. V., Ludvigsson, J., Faresjö, T., Séguin, L., … Raat, H. (2022). Household income and maternal education in early childhood and risk of overweight and obesity in late childhood: Findings from seven birth cohort studies in six high-income countries. International Journal of Obesity, 46(9), 1703–1711. https://doi.org/10.1038/s41366-022-01171-7
  44. Zhang, L., Liu, H.-J., Li, P., Liu, Y., Zhang, T., Zhu, J.-Y., Zhu, H.-M., Zhou, Y.-P., Wang, H.-J., & Li, Y. (2024). Association of early-term birth and breastfeeding practices with nutritional outcomes in singleton term infants: A multicenter cross-sectional study. International Breastfeeding Journal, 19(1), 46. https://doi.org/10.1186/s13006-024-00653-w

Open Access Copyright (c) 2025 Endang Sihaloho, Antonij Edimarta Sitanggang
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