In e na ional Jou nal o Cu en Science Resea ch and Re iew
ISSN: 2581-8341
Volume 08 Issue 11 No embe 2025
DOI: 10.47191/ijcs /V8-i11-25, Impac Fac o : 8.048
IJCSRR @ 2025
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Fac o s Causing Was ing in Toddle s: A Li e a u e Re iew
Dyah Su ya Agus ine Sesunan1, Dian Is i Ang aini2, Bayu Anggileo P amesona3,
Dyah Wulan Sumeka Rengganis Wa dani4, Reni Zu aida5
1,2,3,4,5Mas e o Public Heal h P og am, Facul y o Medicine Uni e si as Lampung, Jl. P o . D . I . Suman i B ojonego o No.1,
Gedong Meneng, Rajabasa, Banda Lampung, Lampung 35145, Indonesia
ABSTRACT:
Backg ound: Was ing is one o he acu e nu i ional p oblems in oddle s, e lec ing a weigh ha is oo low o hei heigh . This
condi ion can inc ease he isk o mo ali y and long- e m de elopmen al diso de s. The p e alence o was ing in Indonesia in 2022
eached 7.7%, wi h Banda Lampung Ci y a 8.4%, exceeding he p o incial a e age.
Objec i e: This s udy aims o e iew esea ch a icles o jou nals on he ac o s causing was ing in oddle s.
Me hods: The me hod used in his s udy is a li e a u e e iew sou ced om he Google Schola and PubMed da abases wi hin he
pe iod o 2020-2025. Li e a u e selec ion was conduc ed based on inclusion and exclusion c i e ia de e mined by he esea che .
This e iew s age includes iden i ying he esea ch p oblem, sea ching o li e a u e, p esen ing da a, and e alua ing he da a.
Resul s: Based on he li e a u e e iew collec ed, he causes o was ing can be ca ego ized in o di ec and indi ec ac o s. Di ec
ac o s include inadequa e ood in ake and in ec ious diseases like dia hea. Indi ec ac o s include exclusi e b eas eeding, eeding
p ac ices, and access o heal hca e se ices. The main unde lying ac o s a e po e y, amily cha ac e is ics, ood dis ibu ion
pa e ns, he mo he 's educa ion le el, employmen s a us, and household income le el.
Conclusion: Was ing in young child en is caused by a complex in e ac ion be ween di ec , indi ec , and p ima y ac o s. P e en ion
and managemen e o s o was ing mus be designed comp ehensi ely, conside ing all con ibu ing ac o s, especially imp o ed
nu i ional in ake, managemen o in ec ious diseases, inc eased ma e nal knowledge, and imp o emen o amily socioeconomic
condi ions.
KEYWORDS: Acu e malnu i ion Causal ac o s, Malnu i ion, Toddle s, Was ing.
INTRODUCTION
Was ing is a o m o malnu i ion ha e lec s a child's weigh being oo low o hei heigh , cha ac e ized by a weigh -
o -heigh z-sco e o less han -2 SD o was ing and a weigh - o -heigh z-sco e o less han -3 SD o se e e was ing (Minis y o
Heal h o he Republic o Indonesia, 2020). Was ing in child en esul s om apid weigh loss o an inabili y o gain weigh
(UNICEF, WHO, The Wo ld Bank, 2019). This condi ion pu s oddle s a isk o long- e m g ow h e a da ion, dec eased immune
sys em unc ion, inc eased se e i y and suscep ibili y o in ec ious diseases, and an inc eased isk o dea h, especially o oddle s
wi h se e e was ing.
Acco ding o he WHO, he public heal h p oblem is classi ied as se ious i i eaches 10.0% o 14.0% and c i ical i i
exceeds 15% (JGMI, 2022). The incidence o was ing in Indonesia has shown a luc ua ing end ecen ly, eaching 7.4% in 2019,
7.1% in 2021, and hen ising o 7.7% in 2022 (Minis y o Heal h o he Republic o Indonesia, 2023). Al hough he incidence o
was ing in Indonesia is dec easing, he was ing a e in Banda Lampung Ci y, acco ding o he 2023 Indonesian Heal h Su ey,
s ands a 8.4% and is ea ed o con inue o inc ease annually (Minis y o Heal h o he Republic o Indonesia, 2023).
The impac o was ing is g a e o child en's heal h and de elopmen . Was ed child en, especially hose wi h malnu i ion,
ha e weakened immune sys ems, making hem suscep ible o in ec ious diseases such as dia hea, colds, and pneumonia (Ali e al.,
2022). Fu he mo e, was ed child en a e a isk o impai ed physical g ow h, including s un ed g ow h, which can de elop in o
s un ing (De Onis & Blössne , 1997). Inadequa e nu i ion in was ed child en also poses isks o op imal b ain de elopmen , lea ning
abili y, and u u e wo k p oduc i i y (Galle e al., 2021). O all o ms o childhood nu i ional p oblems, was ing, pa icula ly
se e e malnu i ion, ca ies he highes isk o dea h, nea ly 12 imes highe han ha o well-nou ished child en (Caul ield e al.,
2004).
In e na ional Jou nal o Cu en Science Resea ch and Re iew
ISSN: 2581-8341
Volume 08 Issue 11 No embe 2025
DOI: 10.47191/ijcs /V8-i11-25, Impac Fac o : 8.048
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UNICEF (1998) asse s ha bo h di ec and indi ec ac o s in luence nu i ional s a us. Di ec ac o s a ec ing nu i ional
s a us include ood in ake and in ec ious diseases. Indi ec ac o s a ec ing nu i ional s a us include access o ood, child and
ma e nal ca e, and sani a ion o heal h se ices. The main causes o nu i ional p oblems a e po e y, lack o knowledge and skills,
and beha io . P e ious esea ch has shown ha ac o s such as amily income, ma e nal educa ion, ma e nal occupa ion, exclusi e
b eas eeding, and in ec ious diseases a e signi ican ly associa ed wi h was ing (Muse e al., 2025; Luzingu e al., 2022; Rahu e
al., 2024).
Based on his backg ound, a ious complex and in e ac ing ac o s con ibu e o was ing in oddle s. The e o e, esea che s
conduc ed a li e a u e e iew o o e an in-dep h analysis o he ac o s causing was ing in oddle s. Unde s anding hese ac o s is
expec ed o lead o app op ia e policy ecommenda ions and s a egies o p e en ing and managing was ing in oddle s in Indonesia,
pa icula ly in Banda Lampung Ci y.
METHODS
This esea ch is a li e a u e e iew. Da a sou ces we e ob ained om Google Schola and PubMed da abases o he 2020-
2025 pe iod. The sea ch e ms used in Google Schola we e "causes o was ing," " isk ac o s o was ing in oddle s," and
"de e minan s o was ing." The PubMed da abase used keywo ds such as "de e minan s o was ing," " isk ac o s o was ing in
child en," and "causes o acu e malnu i ion."
Li e a u e selec ion was conduc ed by e iewing i les and abs ac s and hei ele ance o he opic o "causes o was ing
in oddle s." A icles we e selec ed i hey me he inclusion c i e ia: ele ance o he opic o was ing, ull- ex a ailabili y, ee o
cha ge, using a quan i a i e c oss-sec ional o coho design, and ha ing oddle s aged 0-59 mon hs as subjec s. Exclusion c i e ia
included li e a u e e iews, a icles ela ed o he COVID-19 pandemic, s udies wi h quali a i e da a, and a icles wi h inaccessible
con en . The COVID-19 pandemic was excluded due o la ge-scale es ic ions ha limi ed pa ien s' abili y o p o ide eedback on
heal hca e se ices, as well as abno mal condi ions in pa en ing pa e ns and ood access. Quali a i e esea ch can yield di e en
in e p e a ions, pa icula ly when using obse a ion and in e iew me hods, making i di icul o syn hesize sys ema ically.
The selec ion o esea ch a icles based on sea ches o Google Schola and PubMed da abases in ol ed se e al s ages:
a icle iden i ica ion, sc eening based on i le and abs ac , assessing eligibili y based on ull ex , and inally, inclusion o a icles
mee ing he c i e ia in he li e a u e e iew. This selec ion p ocess adhe ed o he PRISMA (P e e ed Repo ing I ems o Sys ema ic
Re iews and Me a-Analyses) guidelines.
RESULTS
The li e a u e sea ch yielded se e al a icles ele an o he causes o was ing in oddle s. These a icles we e hen analyzed
o iden i y causal ac o s ha consis en ly eme ged ac oss a ious s udies. The ollowing ables p esen he esul s o he li e a u e
e iew.
Li e a u e Re iew Based on Resea ch Cha ac e is ics
Table 1. Li e a u e e iew based on au ho , yea , loca ion, esea ch design, and sample
No
Fi s au ho , Yea
Coun y
Resea ch Design
Sample
Sampling Technique
1
Muse e al., 2025
E hiopia
C oss-sec ional
384 child en
Simple andom sampling
2
Mulu e al., 2021
E hiopia
C oss-sec ional
385 child en
Sys ema ic andom sampling
3
Ali e al., 2022
E hiopia
C oss-sec ional
754 child en
Simple andom sampling
4
Mu a ka e al., 2020
India
C oss-sec ional
3.671 oddle s
Mul is age sampling
5
Luzingu e al., 2022
Democ a ic Republic
o he Congo
C oss-sec ional
3.911 child en
Clus e sampling
6
Zhang e al., 2022
China
C oss-sec ional
2.547 child en
Mul is age sampling
7
Vijay e al., 2024
Nepal
C oss-sec ional
2.076 child en
Seconda y da a analysis
8
Nguedjo e al., 2024
Came oon
C oss-sec ional
200 child en
Pu posi e sampling
In e na ional Jou nal o Cu en Science Resea ch and Re iew
ISSN: 2581-8341
Volume 08 Issue 11 No embe 2025
DOI: 10.47191/ijcs /V8-i11-25, Impac Fac o : 8.048
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No
Fi s au ho , Yea
Coun y
Resea ch Design
Sample
Sampling Technique
9
Islam e al., 2024
Pakis an
C oss-sec ional
29.887 child en
Mul is age sampling
10
Rahu e al., 2024
Sou h Asia & Sou h
Eas Asia
C oss-sec ional
Demog aphics
Heal h Su ey
Seconda y da a analysis
Li e a u e Re iew Based on Fac o s Causing Was ing
Table 2. Li e a u e e iew based on ac o s ha cause was ing in oddle s
Causa i e ac o
Au ho s (Yea )
Resul s
p- alue
Di ec Fac o s
Inadequa e ood in ake
Zhang e al. (2022)
Insu icien ene gy and p o ein in ake inc eases he isk o was ing
< 0,05
Ali e al. (2022)
Snacking less han wice a day is associa ed wi h was ing
0,032
In ec ious disease (dia hea)
Mu a ka e al. (2020)
Acu e dia hea is signi ican ly associa ed wi h was ing
< 0,001
Mulu e al. (2021)
Illness in he las 2 weeks inc eases he isk o was ing
0,018
Islam e al. (2024)
The p e alence o dia hea is nega i ely ela ed o g ow h
< 0,01
Indi ec Fac o s
Exclusi e b eas eeding
Mu a ka e al. (2020)
Exclusi e b eas eeding is signi ican ly associa ed wi h
p e en ing was ing
< 0,001
Luzingu e al. (2022)
Combining b eas milk wi h d inking wa e inc eases he isk o
was ing
0,024
Pa en ing eeding pa e ns
Zhang e al. (2022)
The igh iming o gi ing supplemen a y ood educes he isk o
was ing
0,015
Nguedjo e al. (2024)
Limi ed ood consump ion inc eases he isk
0,008
Access o heal h se ices
Muse e al. (2025)
Lack o access o oile s is associa ed wi h was ing
0,003
Rahu e al. (2024)
Unsa e d inking wa e inc eases he isk o malnu i ion
< 0,001
Main Fac o s
Po e y/Family income
Muse e al. (2025)
Low amily income is signi ican ly associa ed wi h was ing
0,001
Vijay e al. (2024)
Poo households
< 0,05
Ali e al. (2022)
No ha ing a ehicle is ela ed o was ing
0,028
Mo he 's educa ion
Luzingu e al. (2022)
Low ma e nal educa ion inc eases he isk o was ing
0,012
Rahu e al. (2024)
Ma e nal illi e acy is posi i ely associa ed wi h malnu i ion
< 0,001
Zhang e al. (2022)
High a he 's educa ion educes he isk o was ing
0,021
Mo he 's job
Luzingu e al. (2022)
Mo he s wo king in he las 12 mon hs inc eases he isk o
was ing
0,036
Nguedjo e al. (2024)
Low economic s a us inc eases he isk o was ing
0,015
Family cha ac e is ics
Vijay e al. (2024)
Ha ing 3-4 child en inc eases he isk o s un ing and was ing
< 0,05
Islam e al. (2024)
High pa i y is nega i ely associa ed wi h g ow h
< 0,01
Luzingu e al. (2022)
Ma e nal age 35-49 yea s inc eases he isk o was ing
0,042
En i onmen al ac o s
Rahu e al. (2024)
Di y cooking uel inc eases he isk o was ing
< 0,001
Islam e al. (2024)
Inc eased empe a u e and ain all a e nega i ely associa ed wi h
was ing
< 0,01
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DISCUSSION
1. Di ec Fac o s
A. Food In ake
Food in ake is he mos undamen al di ec ac o in was ing. Toddle s need o ea enough ood, including ene gy and
p o ein, while hey a e g owing (Ali e al., 2022; Hall e al., 2020; Mohammed e al., 2019). Resea ch by Zhang e al. (2022) shows
ha child en wi h insu icien ene gy and p o ein in ake a e a highe isk o was ing compa ed o child en wi h adequa e in ake.
These esul s align wi h esea ch by Ali e al (2022), which ound ha snacking less han wice daily is signi ican ly associa ed wi h
malnu i ion in child en.
Nu i ional de iciencies in ea ly li e impac la e li e. Malnu i ion in oddle s no only impac s physical g ow h bu also
impac s he quali y o in elligence and u u e de elopmen . The e o e, he ole o nu i ious oods is c ucial, such as oods con aining
ene gy, p o ein (especially animal p o ein), i amins such as i amin B complex, i amin C, and i amin A, and mine als such as
calcium, i on, iodine, phospho us, and zinc.
B. In ec ious Diseases
In ec ious diseases a e ano he di ec ac o con ibu ing o was ing. Resea ch by Mu a ka e al. (2020) in India showed
ha acu e dia hea was signi ican ly associa ed wi h was ing in oddle s. Simila indings we e epo ed by Mulu e al. (2021) in
E hiopia, who ound ha child en who we e ill in he pas wo weeks inc eased he isk o was ing.
Child en in de eloping coun ies, especially in he i s yea s o li e, equen ly su e om in ec ious diseases. In ec ions
con ibu e o de iciencies in ene gy, p o ein, and o he nu ien s by educing appe i e and hus educing ood in ake. In ac ,
malnu i ion and in ec ious diseases o en occu simul aneously. Malnu i ion can inc ease he isk o in ec ion, while in ec ion can
cause malnu i ion, leading o a icious cycle o in ec ious malnu i ion (Rahu e al., 2024; Wandji Nguedjo e al., 2024). Islam e
al (2024), in hei s udy in Pakis an, ound ha dia hea p e alence was nega i ely associa ed wi h child en's linea g ow h, wi h
inc easing dia hea incidence associa ed wi h dec eased g ow h and an inc eased isk o was ing. Dia hea is a disease ha is
ansmi ed h ough wa e and is gene ally accompanied by omi ing and dia hea, which has an impac on child en's g ow h.
2. Indi ec Fac o s
A. Exclusi e B eas eeding
Exclusi e b eas eeding is a p o ec i e ac o agains was ing. Resea ch by Mu a ka e al. (2020) showed ha exclusi e
b eas eeding was signi ican ly associa ed wi h was ing p e en ion in u al India. Exclusi e b eas eeding is de ined as b eas milk
gi en o in an s om bi h o six mon hs wi hou adding o eplacing i wi h o he oods o d inks (Indonesian Go e nmen
Regula ion Numbe 17 o 2023). Con e sely, esea ch by Luzingu e al. (2022) ound ha child en who we e b eas ed and d ank
wa e had a highe isk o was ing. This demons a es he impo ance o exclusi e b eas eeding wi hou addi ional luids du ing he
i s six mon hs o li e. Resea ch in Bangladesh also shows ha exclusi e b eas eeding un il oddle s each six mon hs o age
signi ican ly con ibu es o imp o ing child en's nu i ional s a us (Chowdhu y e al., 2020).
B. Feeding Pa en ing Pa e ns
Feeding pa en ing pa e ns play a c ucial ole in p e en ing was ing. Resea ch by Zhang e al. (2022) showed ha app op ia e
iming o complemen a y eeding and sepa a e p epa a ion o complemen a y oods we e signi ican ly associa ed wi h a lowe isk
o malnu i ion. Pa en ing pa e ns include he ways ha mo he s o ca egi e s hink and ac abou eeding hei child en e e y day,
such as b eas eeding, complemen a y eeding, and amily meals.
Nguedjo e al. (2024), in hei s udy in Came oon, ound ha limi ed ma e nal ood consump ion inc eased he isk o a ious
malnu i ion pheno ypes, including was ing, in child en. This sugges s ha ood a ailabili y a he household le el and ood
dis ibu ion pa e ns wi hin he amily also in luence child en's nu i ional s a us.
C. Access and U iliza ion o Heal h Se ices
Access o heal h se ices and sa is ac o y sani a ion a e c ucial ac o s in p e en ing was ing. Resea ch by Muse e al.
(2025) shows ha lack o access o la ines is signi ican ly associa ed wi h he incidence o acu e malnu i ion. Poo sani a ion
inc eases he isk o in ec ious diseases, especially dia hea, which is a di ec cause o was ing. Rahu e al. (2024) disco e ed in a
mul i-coun y s udy in Sou h and Sou heas Asia ha unsa e d inking wa e and con amina ed cooking uels ele a e he isk o
malnu i ion in child en. These en i onmen al ac o s a e associa ed wi h exposu e o pa hogens and pollu ion, which can a ec
child en's heal h and nu i ional s a us. Adequa e access o heal h se ices, including in eg a ed heal h pos s (Posyandu), communi y
heal h cen e s (Puskesmas), and go e nmen nu i ion p og ams, can acili a e ea ly de ec ion and ea men o was ing.
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3. Main Fac o s
A. Po e y and Family Income
Po e y is a majo unde lying ac o in a ious nu i ional p oblems, including was ing. Muse e al.'s (2025) esea ch iden i ies
low a e age amily income as a de e minan o acu e malnu i ion. Po e y leads o limi ed access o ood, heal h se ices, and
educa ion, all o which con ibu e o was ing.
Vijay e al. (2024), in hei s udy in Nepal, ound ha child en om middle- and weal hie households had a 49% and 47%
lowe isk o was ing compa ed o child en om he poo es households, espec i ely. These esul s s eng hen e idence ha amily
socioeconomic s a us signi ican ly in luences child en's nu i ional s a us. Ali e al. (2022) also ound ha lacking a amily ehicle,
an indica o o po e y, was signi ican ly associa ed wi h child malnu i ion. Pa en s' abili y o pu chase nu i ious ood and access
heal h se ices depends hea ily on amily income.
B. Mo he 's Educa ion Le el
Ma e nal educa ion is a ac o consis en ly associa ed wi h was ing in a ious s udies. Luzingu e al. (2022) ound ha low
ma e nal educa ion inc eases he isk o was ing in child en. The highe a pe son's educa ion, he easie i is o unde s and
in o ma ion and implemen his knowledge in o beha io , pa icula ly ega ding heal h and nu i ion. Rahu e al. (2024) epo ed
ha ma e nal illi e acy is posi i ely associa ed wi h child malnu i ion in Sou h and Sou heas Asia. Mo he s wi h mo e educa ion
a e mo e likely o lis en o nu i ion in o ma ion and use wha hey lea n o ca e o and eed hei child en. Zhang e al. (2022) also
ound ha highe pa e nal educa ion is associa ed wi h a lowe isk o malnu i ion, demons a ing he ole o bo h pa en s in
de e mining a child's nu i ional s a us. Pa en al educa ion in luences childca e, as highe educa ion helps pa en s unde s and he
impo ance o hei ole in child de elopmen . Fu he mo e, a highe educa ion is hough o enhance nu i ional knowledge, enabling
hem o apply i o hei eeding and childca e p ac ices.
C. Mo he 's Employmen S a us
Ma e nal employmen s a us has been shown o signi ican ly in luence was ing incidence. Luzingu e al. (2022) ound ha
mo he s who wo ked in he 12 mon hs p io o he su ey inc eased hei child's isk o was ing. Wo king mo he s may ha e less
ime o ca e o and moni o hei child's nu i ional in ake.
Nguedjo e al. (2024) also epo ed ha low socioeconomic s a us, o en associa ed wi h in o mal employmen o
unemploymen , inc eases he isk o a ious malnu i ion pheno ypes. Howe e , employmen s a us mus be iewed in a b oade
con ex , as employed mo he s wi h su icien incomes may be able o p o ide be e nu i ion despi e limi ed ca egi ing ime. A
s udy in Pakis an by Siddiqa e al. (2023) ound ha he p opo ion o was ed child en was highe among employed mo he s han
among unemployed mo he s. This indica es he impo ance o balancing wo k and childca e, as well as he need o amily and
social suppo o wo king mo he s.
D. Family Cha ac e is ics
Family cha ac e is ics, including he numbe o amily membe s and bi h o de , in luence he incidence o was ing. Vijay e
al. (2024) ound ha he odds o s un ing and was ing we e 1.6 imes highe in child en wi h 3-4 siblings compa ed o child en wi h
1-2 siblings. Islam e al. (2024), in hei s udy in Pakis an, ound ha high ma e nal pa i y was nega i ely associa ed wi h child en's
linea g ow h and inc eased he p e alence o was ing. Families, especially hose in ex eme po e y, ind i easie o mee hei
ood needs i hey ha e ewe child en o eed. The ood a ailable o a la ge amily may be su icien o a amily hal ha size,
bu i may no be enough o p e en malnu i ion in ha la ge amily.
Luzingu e al. (2022) also ound ha olde ma e nal age, be ween 35 and 49, inc eases he isk o was ing in child en. Ma e nal
heal h condi ions, high pa i y, and exhaus ion om ca ing o child en may con ibu e o his. Child en g owing up in poo amilies
wi h la ge numbe s o membe s a e mos ulne able o malnu i ion, and he younges child en a e usually he mos a ec ed by ood
sho ages.
E. En i onmen al and Ecological Fac o s
An o en-o e looked en i onmen al ac o ha has a signi ican impac is he physical and ecological condi ions o he
en i onmen . In a geospa ial s udy in Sou h and Sou heas Asia, Rahu e al. (2024) ound ha di y cooking uels like i ewood and
cha coal inc ease he isk o malnu i ion in child en. Exposu e o indoo ai pollu ion om he combus ion o hese uels can a ec
child en's espi a o y heal h and inc ease he isk o in ec ion. Islam e al. (2024) epo ed in iguing indings indica ing a nega i e
co ela ion be ween clima e ac o s like inc easing su ace empe a u e and ain all a iabili y and child en's linea g ow h.
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Inc easing empe a u e and e a ic ain all a e associa ed wi h educed g ow h and an inc eased p e alence o dia hea, ul ima ely
inc easing he isk o was ing. These ecological ac o s sugges ha clima e change may pose a new h ea o child en's nu i ional
s a us, pa icula ly in de eloping coun ies wi h limi ed adap a ion o en i onmen al changes.
Household densi y is also an in luen ial en i onmen al ac o . High-densi y housing inc eases he isk o in ec ious disease
ansmission be ween amily membe s, which can wo sen child en's nu i ional s a us. Poo en i onmen al sani a ion, limi ed access
o clean wa e , and open de eca ion p ac ices, as epo ed by Mulu e al. (2021), a e ac o s ela ed o was ing.
F. Food Dis ibu ion Pa e ns in he Family
Food dis ibu ion pa e ns wi hin he amily a e an impo an aspec ha is o en o e looked in nu i ion s udies. In some
socie ies, ood is dis ibu ed acco ding o a amily hie a chy, wi h he a he o head o he amily ecei ing he p ima y po ion,
ollowed by sons, hen daugh e s, and hen young child en. This pa ia chal pa e n can lead o malnu i ion in ce ain g oups wi hin
he amily, pa icula ly women and child en. Unequal dis ibu ion pa e ns can esul in young child en no ecei ing su icien
nu i ious ood. As amily size inc eases, ood o each child dec eases, and many pa en s ail o ealize ha e y young child en
equi e ela i ely mo e ood han olde child en. Consequen ly, young child en may no be adequa ely ed.
App op ia e ood dis ibu ion among amily membe s is c ucial o achie ing sa is ac o y nu i ion. Food should be
dis ibu ed o mee he nu i ional needs o e e yone in he amily. Child en, p egnan women, and b eas eeding women should
ecei e a subs an ial po ion o p o ein- ich ood. All amily membe s, based on hei indi idual needs, should ecei e su icien
ene gy, p o ein, and o he nu ien s each day o mee hei needs.
4. In e ac ion be ween ac o s
I is impo an o unde s and ha he ac o s causing was ing do no ope a e in isola ion bu in e ac wi h each o he in
complex pa e ns. UNICEF's (1998) concep ual model explains how hese ac o s a e hie a chically ela ed, wi h p ima y ac o s
such as po e y and sociopoli ical s uc u e in luencing p ima y ac o s such as educa ion and amily income, which in u n in luence
indi ec ac o s such as access o ood and heal h se ices, and ul ima ely impac di ec ac o s such as die a y in ake and in ec ious
diseases. Fo example, po e y can lead o limi ed access o nu i ious ood, esul ing in inadequa e ene gy and p o ein in ake.
Po e y also limi s access o sani a ion and clean wa e , inc easing he isk o in ec ious diseases. These wo di ec ac o s
(inadequa e in ake and in ec ions) hen ein o ce each o he in a icious cycle ha wo sens a child's nu i ional s a us.
Low ma e nal educa ion, o en associa ed wi h po e y, a ec s nu i ional knowledge, eeding p ac ices, and access o
heal h se ices. Low-educa ed mo he s may no unde s and he impo ance o exclusi e b eas eeding, he app op ia e iming o
complemen a y eeding, o how o ca e o a sick child, all o which con ibu e o was ing.
Ma e nal employmen s a us also in e ac s wi h o he ac o s. Wo king mo he s wi h low incomes may lack he ime and esou ces
o p o ide nu i ious ood and op imal ca e. Meanwhile, unemployed mo he s wi h low amily incomes also ace limi ed access o
nu i ious ood.
5. Implica ions o P og ams and Policies
Being amilia wi h he ac o s causing was ing has impo an implica ions o he design o p e en ion and ea men
p og ams and policies. App oaches ha ocus solely on one aspec , such as supplemen a y eeding, wi hou conside ing o he
ac o s, a e likely o be ine ec i e in he long e m. Was ing p e en ion and ea men p og ams mus be designed in a mul isec o al
manne , in ol ing he heal h, ag icul u e, educa ion, and socioeconomic sec o s. Supplemen al eeding p og ams should be
accompanied by nu i ion educa ion o mo he s, imp o emen s in en i onmen al sani a ion, inc eased access o clean wa e , and
po e y alle ia ion p og ams. Nu i ion-speci ic in e en ions, such as p omo ing exclusi e b eas eeding, p o iding imely and
high-quali y complemen a y oods, and managing in ec ious diseases, need o be s eng hened. Howe e , we also need o in eg a e
nu i ion-sensi i e in e en ions ha ackle oo causes like po e y, educa ion, and access o basic se ices.
Rou ine nu i ional moni o ing and su eillance a he in eg a ed heal h pos (Posyandu) and communi y heal h cen e
(Puskesmas) le els need o be imp o ed o ea ly de ec ion o was ing cases. An e ec i e e e al sys em om Posyandu o
Puskesmas and hospi als o se e e was ing cases mus also be s eng hened. Empowe ing heal h cad es and inc easing he capaci y
o heal h wo ke s in was ing managemen a e essen ial componen s o p e en ion p og ams. S ong poli ical commi men and
adequa e budge alloca ion o nu i ion p og ams a e necessa y a he policy le el. Policies ha suppo adequa e ma e ni y lea e
o wo king mo he s, access o a o dable heal h and nu i ion se ices, and social secu i y o low-income amilies can help educe
he isk ac o s o was ing.
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6. Limi a ions o he S udy
This li e a u e e iew has se e al limi a ions. Fi s , he a icles e iewed mos ly o igina e om de eloping coun ies in
A ica and Asia, wi h socioeconomic con ex s ha may di e om condi ions in Indonesia, pa icula ly Banda Lampung Ci y.
Second, he majo i y o s udies employed c oss-sec ional designs, which a e inadequa e o elucida ing he causal ela ionship
be ween causal ac o s and he incidence o was ing. Thi d, a ia ions in ope a ional de ini ions and measu emen me hods o isk
ac o s be ween s udies may a ec he compa abili y o esul s. Fou h, his e iew did no conduc a sys ema ic me hodological
quali y assessmen o he a icles e iewed. Fi h, ce ain ac o s, such as ood dis ibu ion pa e ns wi hin amilies and local cul u al
aspec s, ha e no been ex ensi ely s udied in he e iewed li e a u e; hus, unde s anding o hese ac o s emains limi ed.
CONCLUSION
Based on he esul s o he li e a u e e iew, i can be concluded ha was ing in oddle s is caused by a complex in e ac ion
be ween a ious di ec , indi ec , and unde lying ac o s. Di ec causal ac o s include inadequa e die a y in ake, pa icula ly ene gy
and p o ein, and in ec ious diseases, pa icula ly dia hea. These wo ac o s ein o ce each o he in a icious cycle ha wo sens a
child's nu i ional s a us.
Indi ec ac o s include exclusi e b eas eeding, pa en ing p ac ices, and access o heal h se ices and en i onmen al
sani a ion. Exclusi e b eas eeding du ing he i s six mon hs o li e has been shown o be a p o ec i e ac o agains was ing, while
inapp op ia e eeding p ac ices and poo sani a ion inc ease he isk. The main ac o s unde lying was ing a e po e y and low
amily income, low ma e nal educa ion, ma e nal employmen s a us, amily cha ac e is ics such as numbe o child en and pa i y,
ood dis ibu ion pa e ns wi hin he amily, and en i onmen al and ecological ac o s, including exposu e o pollu ion and clima e
change.
E o s o p e en and add ess was ing mus be designed comp ehensi ely and mul isec o ally, aking in o accoun all
causal ac o s. Nu i ion-speci ic in e en ions need o be combined wi h nu i ion-sensi i e in e en ions ha add ess oo causes
such as po e y, educa ion, and access o basic se ices. An e ec i e p og am equi es s ong poli ical commi men , adequa e budge
alloca ion, and in e sec o al coo dina ion.
In he con ex o Banda Lampung Ci y, wi h a was ing p e alence o 8.4%, u he esea ch using a coho o case-con ol
design is needed o iden i y speci ic isk ac o s in he egion. To unde s and local cul u al aspec s ha in luence pa en ing and
eeding p ac ices o oddle s, quali a i e esea ch is also necessa y. Regula e alua ion o exis ing nu i ion p og ams is necessa y
o ensu e e ec i eness and con inuous imp o emen .
REFERENCES
1. Ali, M. A., Yi e , H., & Bekele, A. (2022). De e minan s o unde nu i ion among p i a e and public p ima y school
child en: A compa a i e c oss-sec ional s udy owa d nu i ional ansi ion in no hwes E hiopia. Jou nal o Nu i ion and
Me abolism, 2022, 1-12.
2. Caul ield, L. E., de Onis, M., Blössne , M., & Black, R. E. (2004). Unde nu i ion as an unde lying cause o child dea hs
associa ed wi h dia hea, pneumonia, mala ia, and measles. The Ame ican Jou nal o Clinical Nu i ion, 80(1), 193-198.
3. Chowdhu y, T. R., Chak aba y, S., Rakib, M., A in, S., Sal ma sh, S., & Winn, S. (2020). Fac o s associa ed wi h ma e nal
malnu i ion in Bangladesh: A s udy on 15-49 yea s old women. BMC Women's Heal h, 20, 1-10.
4. De Onis, M., & Blössne , M. (1997). WHO Global Da abase on Child G ow h and Malnu i ion. WHO, Gene a.
5. Galle , J. R., B ingas-Vega, M. L., Tang, Q., Rabinowi z, A. G., Musa, K. I., Chai, W. J., ... & Valdés-Sosa, P. A. (2021).
Neu ode elopmen al e ec s o childhood malnu i ion: A neu oimaging pe spec i e. Neu oImage, 231, 117828.
6. Hall, J. A., Seeda , Y. K., & Chikob u, P. (2020). P e alence and p edic o s o was ing among child en aged 6-59 mon hs
in Limpopo P o ince, Sou h A ica. Sou h A ican Jou nal o Clinical Nu i ion, 33(4), 93-99.
7. Islam, M., Ahmed, T., Choudhu y, N., & Hossain, M. I. (2024). D i e s o s un ing and was ing ac oss se ial c oss-sec ional
household su eys o child en unde 2 yea s o age in Pakis an: Po en ial con ibu ion o ecological ac o s. Ma e nal &
Child Nu i ion, 20(1), e13435.
8. Minis y o Heal h o he Republic o Indonesia. (2020). Pe a u an Men e i Keseha an Republik Indonesia Nomo 2 Tahun
2020 en ang S anda An opome i Anak. Jaka a: Kemenkes RI.
In e na ional Jou nal o Cu en Science Resea ch and Re iew
ISSN: 2581-8341
Volume 08 Issue 11 No embe 2025
DOI: 10.47191/ijcs /V8-i11-25, Impac Fac o : 8.048
IJCSRR @ 2025
www.ijcs .o g
5692 *Co esponding Au ho : Dyah Su ya Agus ine Sesunan Volume 08 Issue 11 No embe 2025
A ailable a : www.ijcs .o g
Page No. 5685-5692
9. Minis y o Heal h o he Republic o Indonesia. (2023). Hasil Su ei S a us Gizi Indonesia (SSGI) 2022. Jaka a: Kemenkes
RI.
10. Minis y o Heal h o he Republic o Indonesia. (2023). Su ei Keseha an Indonesia (SKI) 2023. Jaka a: Kemenkes RI.
11. Luzingu, J. K., S oupe, N., Alao e, H., Jacin o, E., & Ta en, D. (2022). Risk ac o s associa ed wi h unde - i e: S un ing,
was ing, and unde weigh in ou p o inces o he Democ a ic Republic o Congo: Analysis o he ASSP p ojec baseline
da a. Nu ien s, 14(14), 2931.
12. Mohammed, S. H., La ijani, B., & Esmaillzadeh, A. (2019). Concu en anemia and s un ing in young child en: P e alence,
die a y and non-die a y associa ed ac o s. Nu i ion Jou nal, 18(1), 10.
13. Mulu, N., Kahssay, M., Geb emedhin, T., & Des a, K. (2021). De e minan s o s un ing and was ing in s ee child en in
No hwes E hiopia: A communi y-based s udy. BMC Nu i ion, 7(1), 67.
14. Mu a ka , S., Go hanka , J., Doke, P., Po e, P., Lalwani, S., Dhumale, G., ... & Pa il, R. (2020). P e alence and de e minan s
o unde nu i ion among unde - i e child en esiding in u ban slums and u al a ea, Maha ash a, India: A communi y-based
c oss-sec ional s udy. BMC Public Heal h, 20(1), 1559.
15. Muse, A. I., Yusu , H., Guled, A. A., Ahmed, A. A., Abdullahi, A. A., & Roble, A. K. (2025). De e minan s o acu e
malnu i ion among 6 o 59 mon hs child en in public heal h acili ies o Mogadishu, Somalia. Jou nal o Heal h, Popula ion
and Nu i ion, 44(1), 1-12.
16. Nguedjo, M. W., Djié o-Lo don, C., & Ndomou, M. (2024). The pheno ypes o double bu den o malnu i ion in pai s o
mo he s and hei child en aged 0-59 mon hs a a u al dis ic in wes egion, Came oon: A c oss-sec ional s udy. BMC
Nu i ion, 10(1), 15.
17. Pe a u an Peme in ah Republik Indonesia Nomo 17 Tahun 2023 en ang Keseha an.
18. Rahu , D. B., Debela, B. L., Kassie, G. T., Songse msawas, T., Demons henes, M., & Rahu , R. (2024). Geospa ial and
en i onmen al de e minan s o s un ing, was ing, and unde weigh : Empi ical e idence om u al Sou h and Sou heas Asia.
Food Policy, 123, 102598.
19. Siddiqa, A., Memon, Z. A., Na ejo, N., & Talpu , A. A. (2023). Ma e nal employmen and child nu i ional s a us in
Pakis an. Pakis an Jou nal o Medical Sciences, 39(2), 456-461.
20. UNICEF. (1998). The S a e o he Wo ld's Child en 1998: Focus on Nu i ion. New Yo k: UNICEF.
21. UNICEF, WHO, The Wo ld Bank. (2019). Le els and T ends in Child Malnu i ion: Key Findings o he 2019 Edi ion.
Gene a: WHO.
22. UNICEF. (2021). P og amming Guidance on he Managemen o Was ing and Nu i ional Oedema (Acu e Malnu i ion) in
In an s unde 6 Mon hs o Age. New Yo k: UNICEF.
23. Vijay, J., Pa el, K. K., & Kuma , R. (2024). Malnu i ion among unde - i e child en in Nepal: A ocus on socioeconomic
s a us and ma e nal BMI. Child en, 11(2), 156.
24. Wandji Nguedjo, M., Djié o-Lo don, C., & Ndomou, M. (2024). Assessmen o nu i ional s a us and associa ed ac o s
among child en aged 0-59 mon hs in u al Came oon. A ican Jou nal o Food, Ag icul u e, Nu i ion and De elopmen ,
24(1), 23654-23672.
25. Zhang, M., Li, X., Wang, L., Yang, Y., & Zhao, L. (2022). P e alence o malnu i ion and associa ed ac o s among child en
aged 6-24 mon hs unde po e y alle ia ion policy in Shanxi p o ince, China: A c oss-sec ional s udy. BMC Public Heal h,
22(1), 2217.
Ci e his A icle: Agus ine Sesunan, D.S., Ang aini, D.I., P amesona, B.A., Rengganis Wa dani, D.W.S., Zu aida, R. (2025).
Fac o s Causing Was ing in Toddle s: A Li e a u e Re iew. In e na ional Jou nal o Cu en Science Resea ch and Re iew,
8(11), pp. 5685-5692. DOI: h ps://doi.o g/10.47191/ijcs /V8-i11-25
