Stunting is currently seen as a serious health problem in the community as the prevalence of children with stunting is more than 40%. Globally the world's stunting presentation is relatively high at 24%, in which the highest were Papua New Guinea and East Timor (50% each), followed by Pakistan (45%), Mozambique (43%), Zambia (40%), India (39%), Nepal (37%), Indonesia (36%), Myanmar (35%), and United Republic of Tanzania (35%), and based on continental coverage, south Asia ranked highest stunting presentation in the world at 37%, followed by sub-Saharan Africa (36%), eastern and southern Africa (36%), west, and central Africa (35%), and East Asia and Pacific (11%), and the lowest are Latin America, Caribbean, and Russian Federation (10%).1 The global prevalence of stunting in children under five is 141.3 million, and by 2025 WHO predicts that stunting incidence in children under five years old is 128.3 million, and it will decrease to 116.5 million by 2030. 2

Even though it has decreased, this number is still the largest number of cases globally, so efforts to prevent and minimize stunting must still be optimized because this cannot be separated from the short-term and long-term effects of stunting. Short-term consequences are impaired brain development, cognitive development, physical growth disorders, and metabolic disorders in the body. Long-term consequences are decreased cognitive abilities and learning achievement, a low immune system so that children are susceptible to disease, high risk for diabetes, obesity, heart and blood vessel function disorders, cancer, stroke, and disabilities in the old phase.3

These consequences are in line with stunting experienced in infancy and early childhood resulting in long-term harms such as increased morbidity, poor cognition and educational performance in childhood, an increased risk of perinatal death and premature death for women, lower productivity, reduced income in adults and if accompanied by excessive weight gain in childhood, resulting in an increased risk of chronic disease. 4 In other side, The prevalence rates of underweight and overweight among the children were 14.5% and 20.4%, respectively. Underweight was more prevalent in boys. Factors such as mother's level of education, having an underweight father, and playing outdoors on weekends for more than 2h were significantly associated with underweight children. By contrast, mothers with high levels of education, overweight parents, sleeping for less than 9h, and playing outdoors on weekends for less than 1h were significantly associated with overweight children. 5 Other study found that there was a significant relationship between food intake and nutritional status of children under five years. 6

The various roles of mothers are a key factor in preventing stunting. Mother is the only source of nutrition for a developing child during the critical 1000 days period, in the first six months of life when the breastfeeding period is exclusive.7 Mother plays a crucial role in shaping their children's food intake through their food intake and the food they provide for the child.8 Besides, the mother is also the primary person responsible for meal planning and food preparation, so it is evident that the mother's role is vital in fulfilling child nutrition to prevent stunting. 9 The long-term health impacts of malnutrition in childhood show that it is crucial to overcome its beginnings before a critical stage of childhood development is achieved that it is in desperate need of an early maternal role to prevent stunting. 10

However, a comprehensive review of the mother's role in preventing stunting does not yet exist. A review is needed to explore a mother's various roles as a key factor in stunting prevention. Therefore, this study aimed to provide a synthesis of evidence from the exploration of three important phases, called the golden phase, regarding the role of mother in child growth and development to prevent stunting.

This study used a systematic review method with a narrative synthesis that discusses the mother's role in preventing stunting. This review is based on PRISMA guidelines on writing a systemic review report. 11 The process used to perform systemic reviews is for reviewers to search for several journal articles published through electronic databases. The electronic databases used include PubMed, ProQuest, ScienceDirect, and Google Scholar with a period of January 1, 2010, to July 1, 2020. The keywords included in the search terms were “stunting,” “role of maternal,” and “prevent stunting.”

The reviewed study selection process consisted of six steps shown in Figure 1, then further excluded, and in the end, the study that had been input will be synthesized. For this study, data extraction tools were designed to guide information from records according to study objectives. The data were extracted from each study that had inclusion criteria: author, year, country, population, and setting, study design, objectives, methods, instruments, and results (Table 1). This systemic review used guidelines to analyze the quality of literature among selected studies. The guideline used were the Critical Appraisal Skills Program tools (CASP) and Quality Assessment to assess the risk of bias from the selected study.12

Figure 1.

PRISMA Flow diagram.

(0.16MB).

This study is a part of our original study that examine the role of maternal in preventing stunting. The study has been approved by the Ethical Committee for Medicine and Health Research of Hasanuddin University number 493/UN4.6.4.5.31/PP36/2020.

The mother's role in child development is vital, starting from the preconception phase, prenatal phase, and baby-toddler phase. This role is important because failure to grow up can affect the life of the baby in adulthood. Besides, nutritional status is a factor in the child's development that is influenced by eating habits.13 Healthy eating habits are mandatory for children who need to grow up and address acute dietary problems in children.37 In a cohorts study examining five prospective birth groups (Brazil, Guatemala, India, the Philippines, and South Africa), short women (<150.1cm) were three times more likely to have dwarf children26 by the age of 2.16

Optimization of the mother's role can be realized from strengthening aspects of maternal knowledge and skills. This aspect is strengthened by a study that proves that the attitude score and understanding of the mother's diet is positively related to the diet scores of toddlers38 and mothers with good nutritional knowledge prefer to prepare food for their family in comparison to buying finished foods that cannot be certain of their nutritional content and hygiene.13 This contributes significantly to efforts to prevent stunting in children through optimal nutritional fulfillment. This effort is in line with what is stated, many mothers who have higher levels of nutritional practice have average-weight children.38

The pattern of foster care is also a contributor to stunting events in children.18,19 Therefore, it is necessary to improve education for mothers-to-be, especially young women, and increased knowledge of pregnant women who have low education about parenting patterns in toddlers following aspects of good and correct parenting patterns.19 The quality of baby growth at critical times is influenced both by genetic and environmental factors. One environmental factor is the role of the mother, who optimizes the innate potential of a child through care giving and stimulation, the effectiveness of mother empowerment in the care of babies through the provision of health education with a modeling approach showed an increase in baby anthropometric status.33. Mother's level of education was significantly associated with underweight children.8 For that reason, it is necessary to increase knowledge about positive parenting patterns for toddlers targeted by pregnant women through regular socialization conducted with village midwives and community health cadres. This effort is expected to improve the optimal parenting pattern in toddlers from before birth to later life, not to experience stunting.19

Strengthening the economic aspect must also be done, which is the mother and the family's responsibility. Research in India shows that children from low-income groups have high levels of difficulty buying food. This finding suggests that poverty is not the only contributing factor to malnutrition, but lack of food intake, poor hygienic habits, and low environmental and educational levels can also contribute to child malnutrition in low-income groups. 27 However, optimizing the local food which is more accessible and cheaper as local-food based complementary could be affordable for family.39

Some strategies applied, both prenatal and post-natal, can positively impact a child's growth, but the results are mixed, and growth responses are not always observed. There is no risk of producing the expected impact on nutritional interventions if the target population is frequently infected clinically and subclinically.21 The role of health workers to degrade and prevent stunting is also needed, growing evidence that improving the accessibility and quality of nutritional education through health services can improve maternal knowledge and child food intake, both of which can lower the prevalence of stunting. 40

The mother's important role in preventing stunting in the child lies in three phases: the preconception phase, prenatal phase, and baby phase – toddlerhood. The mother's role in these three phases becomes a key factor in preventing stunting events in the child. Although the conception period is not yet a fetus, maternal nutrition's early strengthening must be done. The mother's body is ready in the prenatal phase for fetal development, continuing in the baby phase – toddlerhood until adolescence.

Considering the mother's role as a key factor in the effort to combat stunting, it is vital to be involved in health workers and family support to empower mothers in strengthening aspects of knowledge and skills in self-management to prepare for pregnancy and child development.

The authors declare no conflict of interest.