THE DIFFERENCE BETWEEN HEMOGLOBIN COUNTS ON STUNTING AND NON-

STUNTING 6-59 MONTH BABIES AT MATARAM ILIR VILLAGE OF SEPUTIH

SURABAYA SUBDISTRICT OF LAMPUNG TENGAH REGENCY IN 2019

ABSTRACT

Background: Stunting or diminutiveness is a retard growth condition on infant (0-11 months)

and toddler (12-59 months) due to chronic nutrition deficit in the first 1,000 days of life so that
the babies is too short compared with the normal ones (PERSAGI, 2018). Shortness on baby can
be identified by comparing the height of a baby with the standard height on normal population
having identical age and gender. A baby is identified as stunting when his height below -2 SD
based on WHO standard (WHO, 2014). Objective: the current research was to identify The
difference between hemoglobin counts on stunting and non-stunting 6-59 month babies at
Mataram Ilir Village of Seputih Surabaya Subdistrict of Lampung Tengah Regency in 2019.
Method: the design was observational analytic with case control. The samples were 6-59 month
stunting and non—stunting babies at Mataram Ilir Village of Seputih Surabaya Subdistrict of
Lampung Tengah Regency in 2019 amounting to 57 babies in each group. The statistical analysis
was conducted by having Mann Whitney U Test with significance p < 0.05. Result: the
calculation found that the Z score was 7.550 with 0.000 probability. Conclusion: there was
significant difference between hemoglobin counts on stunting and non-stunting babies at
Mataram Ilir Village in 2019 where the stunting babies exhibited lower hemoglobin count.
Keywords: hemoglobin, stunting

Introduction problem, particularly stunting, can impede

Stunting or diminutiveness refers to retard of
growth on infant (0-11 months) and toddler
(12-59 months) due to chronic malnutrition
which mainly in the first 1000 days of living
that causes shortness in the age (PERSAGI,
2018). Shortness on baby can be identified
by comparing the height of a baby with the
standard height on normal population having
identical age and gender. A baby is
identified as stunting when his height below
-2 SD based on WHO standard (WHO,
2014).
Baby age is a period that is sensitive with
environment so that sufficient nutrition and
more attention are required. Nutrition
baby development which affects negative
impact on the future life such as intellectual
degradation, susceptibility of noninfectious
diseases, deprivation of productivity leading
to poverty, and risk of delivering low weight
baby (UNICEF, 2012); WHO, 2010).
Nutrition problem, especially
diminutiveness on baby, hampers his
development which negative impact could
last in the future life. Researches revealed
that stunting relates to bad academic
achievement, lower education span, and
lower income in the adult time. Stunting
baby may face bigger opportunity to live as
adult with low education background,
poverty, bad healthy history, and susceptible
to noninfectious diseases. Therefore, the
stunting baby is the predictor of widely bad
human resource which affects lower
productivity of a nation (UNICEF, 2012).
Based on Oktarina and Sudiarti (2013), there
are factors of stunting on babies. The factors
are financial condition of the family, number
of family members, clean water access,
health service, and nutritional intake. As
addition, parenting pattern becomes one of
the factors. The baby raised with improper
parenting usually receives insufficient
nutrition for the age which influences the
baby linear growth.
Globally, one out of four babies suffers
stunting (UNICEF, 2013). In Indonesia,
based on basic health research (Riskesdas)
in 2013, there were 37.2% babies got
stunting. It was known that 19.2% babies
got shortness and 18.0% was very short. The
prevalence of the stunting was higher
compared with the Riskesdas data in 2010
which was amounting to 35.6%. Particularly
in Lampung Province, based on Riskesdas
2013, there were 42.64% babies were short
and very short, higher than the national
average. In 2014, the health minister
released derivational data of Riskesdas 2013
namely Indeks Pembangunan Kesehatan
Masyarakat/Index of Public Health
Development (IPKM). The IPKM 2014
elaborated Riskesdas 2013 data on the level
of Regency and Municipality for prevalence
of short and very short toddlers. The results
of the elaboration were 52.68% in Lampung
Tengah Regency, 50.81% in Pesawaran
Regency, 47.34% in Metro Municipality,
44.59% in Bandar Lampung Municipality,
43.43% in Mesuji Regency, 43.17% in
Lampung Timur Regency, 43.01% in
Lampung Selatan Regency, 40.99% in
Tulang Bawang Regency, 40.08% in Tulang
Bawang Barat Regency, 39.66% in
Tanggamus Regency, 36.99% in Pringsewu
Regency, 34.60% in Lampung Barat
Regency, 32.44% in Lampung Utara
Regency, and 29.80% in Way Kanan
Regency (IPKM, 2014).
Based on data from Health Agency of
Lampung Tengah, there were ten stunting
locations in 2017. The villages which
belonged to the ten stunting locations were
Bandar Putih (13.54%), Gedung Ratu
(16.80%), Riau Pariangan (15.83%), Tulung
Kakan (21.92%), Tanjung Rejo (23.23%),
Cabang (24.37%), Gn Batin Udik (25.00%),
Mataram Udik (29.96%), Mataram Ilir
(38.1%), and Buyut Udik (56.10%).
Stunting incidences are related to macro
nutritional intakes such as energy, protein
and fat. However, macro minerals intake
like iron and zinc must be maintained. The
low iron intake can cause cognitive function
hamper and retard growth. As addition, iron
is very useful for baby’s immunity that
avoids suffering some diseases. Zinc
consumption should be conserved as well.
Low zinc intake may cause impede growth
hormone metabolism which decreases
synthesis and secretion of IGF-1 (Insulin
Like Growth Factor 1). The decrease
becomes the reason of stunting (Damayanti
et al, 2011).
Result

Univariate Analysis independent variables. The data was

presented on the following table:
The analysis was conducted on each variable
of the result, both dependent and
Table 4.1 the Mean of Hemoglobin Count on Stunting Babies at Mataram Ilir Village in 2019

Variabel Mean Std Min Max

deviation
Hemoglobin Count 9.698 1.3282 7.3 14.2

The 4.1 table showed that investigation deviation amounting to 1.3282. the
result of hemoglobin count on stunting minimum hemoglobin was 7.3 g/dL and the
babies at Mataram Ilir Village in 2019 with maximum hemoglobin was 14.2 g/dL.
the average score 9.698 g/dL and standard

Table 4.2 the Mean of Hemoglobin Count on non-stunting babies at Mataram Ilir Village in
2019

Variable Mean Std Min Max

deviation
Hemoglobin 11.879 1.0894 8.7 15.0
Count

The 4.2 table indicated that the mean of hemoglobin investigation on Non-stunting babies at
Mataram Ilir Village in 2019 was 11.879 g/dL and the standard deviation was 1.0894. The
minimum hemoglobin was 8.7 g/dL and the maximum was 15.0.

Bivariate Analysis stunting at Mataram Ilir Village in 2019.

The bivariate analysis was performed by
The bivariate analysis was run to examine using statistical test namely Mann Whitney
whether there was difference between U Test. The result was presented on the
hemoglobin counts on stunting and non- following table.
Table 4.3 The Result of Mann Whitney U Test to Differ Hemoglobin Count among Babies

Groups N Mean Rank U Z p

Stunting 57 34.14
293.000 -7,550 .000
Non-Stunting 57 80.86

The table 4.3 displayed the nonparametric
bivariate analysis with Mann Whitney U
Test. The Z score was -7.550 with
probability value 0.000. Because 0.000 <
Discussion
The Difference Between Hemoglobin
Counts on Stunting and Non-Stunting
Babies
Based on bivariate analysis, p value was
0.000 (p<0.05) meaning that H0 was
rejected. It can be inferred that there was a
difference between hemoglobin counts on
stunting and non-stunting babies (6 to 59
months) at Mataram Ilir Village of Seputih
Surabaya Subdistrict of Lampung Tengah in
2019.
The factors were various that included
inadequate nutrition in the long run and
worsened by suffering the continuous
infectious diseases. The linear growth
impede was caused by the body adaptation
towards low nutrition intake together with
inadequate nutrition sufficiency that
hampered body metabolism process that
retard the growth of cell and tissue
production (Damayanti et al, 2016).
Iron (Fe) is an essential micro nutrition for
human body. This substance is needed to
form hemoglobin molecule (Hb). In the
human body, Fe is conjugated with protein
the form of ferro or ferri. If the iron is plenty
stored, the red blood cell production in the
lumbar cord will be enough. However, if the
iron is not sufficient and the source from the
food intake is inadequate, it will cause
imbalance iron count in the body. Iron has
0.05, the H0 was rejected to sign that there
was a significant difference between
hemoglobin count on stunting and non-
stunting babies at Mataram Ilir Village in
2019.
some vital functions in human body such as
for energy metabolism, immunity, learning
ability, growth and development, and drug
dissolubility. Iron has significant function in
human immunity (Achmadi, 2013).
Babies are susceptible to have iron deficit.
This condition is caused by the increase of
iron need in the developing phase, reduced
iron reserve, and low iron food intake. The
iron insufficiency on babies can retard the
growth which is in the long term leads to
stunting (Sundari and Nuryanto, 2016).
In the early age, toddler with iron
inadequacy becomes a reason of cognitive
and physical hampers and raise the risk of
mortality. This is because the iron
essentially regulates oxygen in the tissues.
Low oxygenation in the baby’s body may
lead to minimum bone growth. Having this,
it can be concluded that the baby with
insufficiency of macro and micro nutrition
intake will have impeded growth namely
stunting (Petry et al, 2016).
The other common cause is known that the
abnormality of digestive track in the form of
malabsorption (imperfect absorption of food
material by the small intestine) or digestive
enzyme system interference that causes
inadequate nutrition intake. The iron
malabsoprtion in the babies is a reason of
low hemoglobin count (Anggraeni, 2012).
Iron intake is stored in the tendon and spinal
cord. The stunting babies had iron
malabsorption that caused iron insufficiency.
Therefore, the iron stock in the spinal cord is
unable to produce enough hemoglobin (Hb).
Hb functions to regulate oxygen from lung
to all human body. When the Hb is
decreased, free erythrocyte protoporphyrin
will increase that causes low heme synthesis
and smaller erythrocyte size (erythrocyte
microcytic), this condition is known as iron
anemia (Zhang et al, 2011).
If the iron insufficiency happens constantly
it can cause empty iron supply. The low
source of iron for erythropoiesis can cause
a hinder on the form of erythrocyte but
anemia has not clinically happened yet. This
condition is called iron deficient
erythropoiesis. In this phase the initial
detected abnormality is the increase of free
protophorphyrin or zinc protophorphyrin
count in erythrocyte. The saturation of
transferrin is declining while Total Iron
Binding Capacity (TIBC) is rising. Recently,
the specific parameter is indicated by the
increase of transferrin receptor in the serum.
If the iron receptor is reducing constantly,
the erythropoiesis process is hindered that
causes falling hemoglobin count (Setiati et
al, 2014).
The current research is in line with the
research conducted by Losong and Adriani
in 2017 at Surabaya entitled the difference
between hemoglobin, iron and zinc intake on
stunting babies compared with non stunting
ones revealed that there was significant
difference between hemoglobin count on
stunting and non-stunting babies which is in
line with the finding at Tambak Wedi
Village of Kenjeran Subdistrict of Surabaya
City on 12-24 month toddlers with 42
samples that resulted p value 0.009 < 0.05
for indication of significant difference
(Losong and Adriani, 2017).
The research above was in accordance with
a study conducted by Ayoya et al in 2013 in
Haiti entitled prevalence and risk factors of
anemia on 6-59 month babies in Haiti. The
study revealed that there was a significant
relation between stunting babies and anemia
incidences. Anemia and stunting may occur
simultaneously because anybody may have
complex nutritional problem. Stunting
babies tend to get anemia 2.3 times higher
than normal height babies. The low
hemoglobin cound is caused by some factors
likely low iron intake, bleeding, recurring
infection, low iron supply in the body
(Ayoya et al, 2013).
WHO (2011) stated that insufficient
nutritional food intake can cause inadequate
iron supply in the body to synthesize
hemoglobin (Hb). In the constant incidence,
the Hb count will decrease and cause other
related nutritional problems like iron anemia
and stunting. Thus, it can be concluded that
the low intake of food on babies may cause
stunting followed with iron deficit that leads
to declining iron supply in the body
contributing low hemoglobin count.
Conclusions
1. The mean of hemoglobin on stunting
6-59 month babies at Mataram Ilir
Village of Seputih Surabaya
 Subdistrict of Lampung Tengah
Regency was 9.698 g/dL.
2. The mean of hemoglobin on non-
stunting 6-59 month babies at
Mataram Ilir Village of Seputih
Surabaya Subdistrict of Lampung
Tengah Regency was 11.879 g/dL.
3. There were significant difference
between hemoglobin counts on
stunting and non-stunting 6-59
month babies at Mataram Ilir Village
of Seputih Surabaya Subdistrict of
Lampung Tengah Regency in 2019
amounting to 46.72 with p value =
0.000 (<0.05).
Suggestions
For Future Researchers
The next researchers are suggested to give
questionnaires to the mother of the babies in
order to investigate the history of infectious
diseases on the babies. The observation
should be conducted or a survey about
surrounding environment like neighborhood
and schools.
For Health Institutions
The current result could contribute
promotion and prevention to society about
hemoglobin on stunting and non-stunting
babies such as
1. Monitoring nutrition sufficiency and
fetal development routinely on
pregnant women during Antenatal
Care (ANC).
2. Strict supervision on stunting babies
by maintaining adequate nutrition
supply.
3. Communication with the villagers
about the bad impact of stunting and
giving counseling on family with
stunting babies.
4. Cooperate with the society to
maintain hygiene and healthy living.
For Educational Institutions
The result of this study is expected to be a
reference about the difference between
hemoglobin counts on stunting and non-
stunting babies at the villages by doing:
1. Community service on the stunting
population.
2. Literacy prevention by providing
sources about stunting.
For Community
The preventions must be done as follow:
1. The community should understand
the impact of stunting in order to
trigger awareness on the healthy and
nutritional food intake for pregnant
women and babies.
2. The healthy and hygienic
environment must be maintain by the
community by making cooperation
among them.
3. The community should be more
diligent to monitor health of pregnant
women and babies to avoid
nutritional deficit.
4. The community should learn the
importance of breastfeeding and it
additional food to prevent stunting.