Jurnal Kesehatan Vol. No. December 2025, pp. p-ISSN: 1979-7621, e-ISSN: 2620-7761. DOI: 10. 23917/jk. Risk Factors for Stunting in Toddlers of Fishermen Families in the Coastal Area of Mojo Pemalang Ayu Dwi Indah Lestari1*. Irwan Budiono2 1 Nutrition Study Program. Faculty of Medicine. Semarang State University 2 Nutrition Study Program. Faculty of Medicine. Semarang State University How to Cite: Lestari. , & Budiono. Risk Factors for Stunting in Toddlers of Fishermen Families in the Coastal Area of Mojo Pemalang. Jurnal Kesehatan, 18. , 326Ae342. https://doi. org/10. 23917/jk. Article Information Article History: Submission: 29 September Revision: 31 October 2023 Reception: 07 November 2023 Keywords: Toddlers. Factors. Fishermen. Stunting ABSTRACT Introduction: Stunting is a condition of growth failure caused by the accumulation of inadequate nutritional intake during pregnancy until the baby reaches 24 months of age. The incidence of stunting in Indonesia is still a dominant nutritional problem, especially in coastal areas. This study aims to determine the factors that influence the incidence of stunting in toddlers of fishermen families. Methods: This study was conducted from May to June 2023. The type of research is quantitative observational analytic with case control design. The number of samples in the study were 60 toddlers of fishing families aged 24 - 59 months. The technique of determining the sample with purposive sampling. The research instruments were microtoise, interview with questionnaire. SQ-FFQ (Semi Quantitative Food Frequency Questionnair. sheet, and observation sheet. Analysis was done by univariate analysis, chi-square test and multiple logistic regression test. Results: There is a relationship between exclusive breastfeeding history, energy adequacy level, protein adequacy level, father's occupation, family income, fishermen's work group, and access to clean water with the incidence of stunting in toddlers of fishermen families. The results showed that the level of protein adequacy had the strongest influence with an OR value of Conclusion: This study suggests that people in coastal areas are advised to consume food intake with balanced nutrition, consume foods with protein sources such as fish, create a clean and healthy environment, and improve the health status of toddlers. Corresponding Authors: (*) Nutrition Study Program. Faculty of Medicine. Semarang State University. Semarang. Jl. Kelud Utara i No. Petompon. Semarang 50237. Indonesia Email: adlindahh123@students. INTRODUCTION Toddler age is an age that requires more attention in growth and development because toddlers are one of the vulnerable groups in experiencing nutritional problems with irreversible nature (Cameron et al. , 2. One of the nutritional problems that are prone to occur in toddlers is stunting. Stunting is a condition of growth faltering caused Journal Page: https://journals2. id/index. php/jk Jurnal Kesehatan p-ISSN: 1979-7621, e-ISSN: 2620-7761 by the accumulation of inadequate nutritional intake from pregnancy until the baby reaches 24 months of age (Ramdaniati & Nastiti, 2. In the anthropometric standard for assessing the nutritional status of children, stunting nutritional status is based on the PB/U or TB/U index (Indonesian Ministry of Health, 2. The United Nations Children's Fund (UNICEF). World Health Organization (WHO) and The World Bank . noted that globally, 144 million . %) children under the age of 5 are stunted. Stunting is a nutritional problem that is the focus of the Indonesian government's health development program. Reducing the prevalence of stunting in children under five years old is a key target of the National Medium-Term Development Plan 2020 to 2024. Based on the Indonesian Nutrition Status Study . , 1 in 4 Indonesian toddlers experience stunting nutrition problems with an average national percentage of The prevalence of stunting in Central Java. SSGI recorded 20. 80% while Pemalang Regency's prevalence rate was below the Central Java percentage of 19. The incidence of stunting in the coastal area of Pemalang is still quite high, one of which is in the Mojo Health Center area. Based on preliminary studies conducted at the Mojo Health Center, the number of toddlers in Mojo Village in February 2023 was 678 toddlers with 326 toddlers aged 24 to 59 months and 139 of them came from fishing Data from the Mojo Health Center in 2023, the prevalence of stunting in fishing families in this area is 17. According to research, 32. 14% of the 16. 42 million coastal communities are still below the poverty line with incomes that are still below the average monthly (Rusmil et al. , 2. Low family income results in poor childcare practices, resulting in a high risk of obstacles in the growth and development of children under five. The fishermen's working group is a grouping of fishermen based on the number of people at sea. The fishermen working group can be divided into individual fishermen, joint business group fishermen, and company fishermen (Sabihaini et al. , 2. The fishermen's work group affects the frequency of income Based on research, families with an average income below the minimum wage have a higher risk of having stunted children. Many previous stunting studies have shown that stunting is not only caused by one factor but is caused by several interrelated factors (UNICEF, 2. Factors that affect stunting are divided into 2, namely direct causes and indirect causes (Bappenas. Direct causes have a direct impact on the incidence of under-five stunting such as LBW, gender, non-optimal nutritional intake, not obtaining exclusive breastfeeding, and health status related to diarrhea and ARI infections. While indirect causes are related to the availability and affordability of nutritious food, social environment . ducation and employment of parent. , family income, health environment such as access to health services, residential environment . nvironmental sanitation and access to clean wate. (Bappenas, 2. (Mugianti et al. , 2. (Nirmalasari, 2. (Rosha et al. (UNICEF/WHO/WORLD BANK, 2. Inadequate macronutrient intake will increase the risk of stunting, which will affect the slow growth and cognitive development of toddlers. In coastal areas, the dominant risk factor is related to protein intake. In fact, coastal communities have a great opportunity to consume fish as a food ingredient that has protein and fat content that can reduce the risk of stunting (Femidio & Muniroh, 2. Based on research, toddlers have a 4 times greater risk of stunting if the level of protein adequacy is low (Yuliantini et al. , 2. Environmental conditions also play an important role in the incidence of stunting (Rahayu & Darmawan, 2. Poor environmental conditions such as unhealthy latrines and difficult access to clean water are risk factors for stunting. Risk Factors for Stunting in Toddlers of Fishermen Families in the Coastal Area of Mojo Pemalang (Ayu Dwi Indah Lestari & Irwan Budion. A p-ISSN: 1979-7621, e-ISSN: 2620-7761 Improper family latrines are caused by not burying fecal waste which can invite rats and flies which will affect environmental health (Utama et al. , 2. Meanwhile, unfit/contaminated water is certainly at risk of causing various diseases such as typhoid, hepatitis, diarrhea, and so on (Ramdaniati & Nastiti, 2. Based on the description above, the current situation that occurs is the lack of data on factors that affect the incidence of stunting in fishermen's families. Therefore, it is necessary to conduct a study related to this problem. This study aims to analyze the Risk Factors for the Occurrence of Stunting in Toddlers of Fishermen Families in the Coastal Area of Mojo Pemalang. LITERATURE REVIEW Studies say that stunting is a nutritional deficiency over a long period of time, starting during the life of the fetus in the womb. In the "Social Action Plan to Reduce Stunting", stunting occurs due to several factors such as direct causes related to nutritional intake, exclusive breastfeeding, health status, while indirect causes are related to environmental factors . ccess to clean water, environmental sanitation, health services . ccess to health service. ) (Bappenas, 2. The problem of stunting also occurs in fishing families. Studies say that fishermen are people who are generally below the poverty line with less income and traditional behavior in terms of skills, psychology and mentality. This results in poor parenting patterns and causes nutritional problems such as stunting (Ahmad Rizal et al. , 2. Another factor that affects stunting in fishermen's families is the level of protein adequacy. Research conducted by Syabandini . , the results showed that the majority of toddlers from fishermen's families did not like to eat fish and other side dishes, causing low protein Meanwhile, in Wilda's research . at the Soropia Sulawesi Health Center, protein intake did not have a significant relationship with the incidence of stunting. Toddlers in the Soropia Health Center area have adequate protein intake because they like to eat high-protein foods such as fish and eggs. Malnutrition in children not only creates the problem of stunting but also creates obstacles in children's intelligence, the risk of non-communicable diseases and reduced productivity (Nelson, 2. The short-term impact of stunting causes failure of growth and development of cognitive, motor and metabolic disorders. The long-term impact for stunted children is to permanently reduce neural growth, thus affecting their productivity as adults (Jakub et al. , 2. METHOD This research used an analytic observational method with a case control research study design. This research was conducted in the Coastal Area of Mojo Pemalang. The population in this study was 139 toddlers. The subjects in this study were 60 toddlers who were calculated using the Lameshow formula. Sampling technique with purposive The sample consists of two groups, namely the case group and the control group. The case group consisted of 30 toddlers aged 24 to 59 months with a z-score value for the TB / U index < -2 SD . and the control group consisted of 30 toddlers aged 24 to 59 months with a z-score value for the TB / U index > -2 SD . based on the WHO Child Growth Standard with different inclusion and exclusion criteria between groups. The independent variables in this study were low birth weight (LBW), fishermen status, family income, exclusive breastfeeding history, energy adequacy level, protein adequacy level, history of ARI disease, history of diarrhea disease, access to clean water, and fishermen Jurnal Kesehatan. Vol. No. December 2025: 326 Ae 342 Jurnal Kesehatan p-ISSN: 1979-7621, e-ISSN: 2620-7761 work group. While the dependent variable is the incidence of stunting. The types of data in this study are primary data and secondary data. The instruments in this study were microtoise, interview with questionnaire. SQ-FFQ (Semi Quantitative Food Frequency Questionnar. sheet, and observation Height measurements were taken using a microtoise with an accuracy of 0. 1 cm. The data obtained were then processed using statistical test applications with univariate analysis, bivariate and multivariate analysis. Bivariate analysis was used to see the relationship between variables and the magnitude of risk (Odd Rati. using the Chisquare test with a 95% confidence level or = 0. 05 and the Fisher Exact Test as an Multivariate analysis used multiple logistic regression test. This study has received ethical approval with code number 321/KEPK/EC/2023. RESULTS AND DISCUSSION Mojo Pemalang Coastal Area Mojo is a village in Ulujami sub-district. Pemalang. Central Java. It is located on the north coast. Mojo village consists of 4 hamlets, namely Mojo . outhern area or government cente. Sigedang. Karangsambung, and Perumnas. Based on the data from the univariate analysis of toddler characteristics, it shows that there are 30 toddlers . %) experiencing stunting, while toddlers who do not experience stunting are 30 toddlers . %). The gender of toddlers is dominated by women with a total of 36 toddlers . %) and men as many as 24 toddlers . %). The subjects of this study were toddlers aged 24 - 59 months. Based on the results of univariate analysis, the number of toddlers aged 24 - 35 months was 18 toddlers . %), toddlers aged 36 - 47 months with a total of 24 toddlers . %), and the number of toddlers aged 48 - 59 months was 18 toddlers . %) (Table . Table 1. Frequency Distribution of Research Subject Characteristics Variables Incidence of Stunting Category Frequency . Percentage (%) Stunting Not Stunting Gender Female Male Age 24 - 35 months 36 - 47 months 48 - 59 months LBW < 2500 grams Ou 2500 grams Exclusive breastfeeding Not exclusively breastfed Exclusive breastfeeding History of URI disease Never suffered from URI Have ever suffered from URI History of diarrhea Never had diarrhea Have ever suffered from diarrhea Birth Weight (LBW) in toddlers of fishermen families is mostly born with normal birth weight (Ou 2500 gram. with a total of 58 toddlers . 7%) while babies with low birth weight (< 2500 gram. only amounted to 2 toddlers . 3%). In the exclusive breastfeeding history variable showed that as many as 26 toddlers . 3%) did not get exclusive breastfeeding and there were 34 toddlers . 7%) getting exclusive breastfeeding. Furthermore, the history of ARI disease is dominated by toddlers who have never Risk Factors for Stunting in Toddlers of Fishermen Families in the Coastal Area of Mojo Pemalang (Ayu Dwi Indah Lestari & Irwan Budion. A p-ISSN: 1979-7621, e-ISSN: 2620-7761 experienced Acute Respiratory Infection (ARI), totaling 59 toddlers . 3%) while there are 1 toddler . 7%) who have suffered from Acute Respiratory Infection (ARI). In the variable history of diarrhea disease, there were 55 toddlers . 7%) never suffered from diarrhea disease, and there were 5 toddlers . 3%) had suffered from diarrhea disease (Table . The results of the univariate test analysis in Table 2. the frequency distribution of risk factors associated with the incidence of stunting in toddlers shows that, in the variable level of energy adequacy, in the category of insufficient adequacy there are 29 toddlers . 3%), while in the category of sufficient adequacy, there are 31 toddlers . 7%). In the protein adequacy level variable, the results showed that at the insufficient level there were 22 toddlers . 7%) and at the adequate level there were 38 toddlers . 3%). Furthermore, in the fishermen status variable in the fishermen laborer profession group, there were 31 toddlers . 7%) and in the owner fishermen profession group there were 29 toddlers . 3%). Table 2. Frequency Distribution based on Research Variables Variables Energy Adequacy Level Protein Sufficiency Level Fisherman Status Family Income Fishermen Working Group Clean Water Access Category Less Simply Less Simply Fisherman Labor Owner Fisherman Low High Individual Group Not Eligible Eligible Frequency . Percentage (%) In the family income variable, there were 25 children under five . 7%) at the low-income level and 37 children under five . 3%) at the high-income level. In the fishermen work group variable, there are 22 toddlers . 7%) in the form of individuals and 38 toddlers . 3%) in the form of groups. In the clean water access variable, there are 26 toddlers . 3%) who do not get clean water while there are 34 toddlers . who get access to clean water. Low Birth-Weight Low Birth Weight Infants (LBW) are babies who have a birth weight of less than 5 kilograms. Based on table 3. the results of the bivariate test analysis, it was found that the p value of the test results using the Chi Square test for the Low Birth Weight variable was 0. -value> 0. In this study, only 2 out of 30 stunted toddlers had low birth weight, so there was no significant relationship between LBW and the incidence of stunting in toddlers of fishing families in the Mojo Pemalang Coastal Area. In this study, the birth weight of babies was categorized into two, namely babies with birth weight <2. 5 kilograms . and Ou2. 5 kilograms . Infants with low birth weight have digestive tracts that are not yet functioning properly, so digestive disorders arise and result in the body not being able to absorb nutrients properly (Windasari et al. , 2. In addition, babies will be susceptible to infection so that there is a delay in growth and development compared to normal born babies. Jurnal Kesehatan. Vol. No. December 2025: 326 Ae 342 Jurnal Kesehatan A p-ISSN: 1979-7621, e-ISSN: 2620-7761 This study is in line with research conducted by Windasari, . resulting in a chi- square test, a p value of 0. 172 so that the history of LBW has no relationship with the incidence of stunting in toddlers in the Talamate Health Center working area. Another study showed the same thing, namely research conducted at the Gabus II Health Center on toddlers aged 24-59 months with the results of LBW . = 0. OR = 1. had no relationship with the incidence of stunting (Astutik, 2. Table 3. Bivariate Test Analysis Results Stunting Variables LBW < 2500 grams Ou 2500 grams Exclusive breastfeeding history Not exclusively breastfed Exclusive breastfeeding History of ARI Never suffered from URI Have ever suffered from URI History of Diarrhea Disease Never had diarrhea Have ever suffered from diarrhea Energy Adequacy Level Less Simply Protein Sufficiency Level Less Simply Fisherman Status Fisherman Labor Owner Fisherman Family Income Low High Fishermen Working Group Individual Group Clean Water Access Not Eligible Eligible Stunting Total Not Stunting P-value OR 95% CI 738 Ae Based on the results of the multivariate test analysis with multiple logistic regression test, it was found that the most dominant risk factor was the level of protein Toddlers in fishing families who have a low level of protein adequacy have a 167 times greater risk of stunting compared to toddlers in fishing families with sufficient protein adequacy. Risk Factors for Stunting in Toddlers of Fishermen Families in the Coastal Area of Mojo Pemalang (Ayu Dwi Indah Lestari & Irwan Budion. A p-ISSN: 1979-7621, e-ISSN: 2620-7761 Table 1. Results of Multivariate Test Analysis Variabel Exclusive Breastfeeding History Father's work Fishermen working group Family income Access to clean water Energy sufficiency level Protein adequacy rate p-value Wald CI . Lower Upper Table 2. Results of the Multivariate Analysis Test Step 5 p-value Variabel Wald CI . Lower Upper Exclusive Breastfeeding History Energy sufficiency level Protein adequacy rate Exclusive breastfeeding Exclusive breastfeeding is understood as the provision of breast milk for 6 months without additional liquids such as formula, water, tea and solid foods such as porridge, bananas, and biscuits (Sampe Sr et al. , 2. Based on the bivariate test results in the table, the chi-square test results show a p-value of 0. -value <0. which can be concluded that there is a significant relationship between exclusive breastfeeding and the incidence of stunting in toddlers of fishing families in the Mojo Pemalang Coastal Area. The odds ratio value on this variable is 17. 875 which indicates that toddlers from fishermen families who are not exclusively breastfed have a risk of stunting by 17. 875 times compared to toddlers from fishermen families who are exclusively breastfed. The same research was conducted in Jadi Village. Semanding-Tuban District, based on the results of chi-square, the p value = 0. 000, which means that there is a relationship between exclusive breastfeeding and the incidence of stunting in toddlers. (Eka Wijayanti. A total of 22 out of 30 stunted toddlers have a history of not being exclusively breastfed by the mother. The number of mothers who do not provide exclusive breastfeeding to their toddlers is due to a lack of knowledge and also a hereditary culture that is still practiced, such as giving porridge or mashed bananas when the baby is not yet 6 months old. Babies who do not get exclusive breastfeeding have less intake, which can cause nutritional problems such as stunting. This is inversely proportional to babies who are exclusively breastfed. Babies tend to have a higher height according to the growth curve compared to babies who are given formula milk (Windasari et al. , 2. History of ARI ARI infection is a disease that is often suffered by toddlers due to pathogenic infections that will stimulate the immune response (Maineny et al. , 2. ARI disease disrupts the absorption of nutrients in the intestine, reduces appetite and increases catabolism so that nutrient reserves are not sufficient to support the formation of body tissues during growth. (Usman S. Salma WO, 2. Based on the results of the research that has been done, there are 1 out of 60 toddlers who have suffered from Acute Respiratory Infection (ARI). The p value of the chi-square Jurnal Kesehatan. Vol. No. December 2025: 326 Ae 342 Jurnal Kesehatan p-ISSN: 1979-7621, e-ISSN: 2620-7761 test results on the ARI disease history variable is 1. -value> 0. , so it can be concluded that there is no significant relationship between the history of ARI disease and the incidence of stunting in toddlers of fishing families in the Mojo Pemalang Coastal Area. The results of the study are in line with the findings conducted in Sedayu District. Bantul which states that there is no significant relationship between ARI disease and the incidence of stunting . -value = 0. (Sahitarani et al. , 2. The difference in results occurred in a study conducted by Himawati . , toddlers with a history of ARI disease had a 3 times higher risk of stunting compared to toddlers who had never suffered from ARI disease. This difference is due to the possibility that infectious diseases have been handled properly so that they do not affect nutrient intake and stunting status in toddlers (Sahitarani et al. , 2. History of Diarrheal Diseases Based on the results of the research that has been conducted, the p-value of the chisquare test results was obtained with a p-value of 0. -value>0. , so it can be concluded that there is no significant relationship between the history of diarrhea and the incidence of stunting in toddlers of fishing families in the Coastal Area of Mojo Pemalang. The result is an odds ratio (OR) value of 2,800. This shows that toddlers from fishing families who have suffered from diarrhea have a 2,800 times higher risk of stunting than toddlers from fishing families who have never suffered from diarrhea. Stunting toddlers who suffered from diarrhea in this study occurred less than 3 times within one month and did not occur Based on the interviews conducted, when toddlers suffer from diarrhea, the mother will give oral fluids or herbal medicines. If the toddler does not recover, the mother of the toddler will check her child to the nearest midwife or health service center. This research is in line with Angraini, 2021 with the results of the research p-value 237 stating that there was no association between the incidence of diarrhea and stunting in the working area of the Rule Mupo Health Center. Central Bengkulu. Diarrhea is not the only factor in the cause of its occurrence stunting. There are other factors such as nutrient Diarrhea is a short-term metabolic infectious disease while stunting is malnutrition from the impact over a long period of time that occurs continuously (Purwanti & Ratnasari. Rapid diarrhea prevention, infrequent diarrhea frequency, and short duration cause diarrhea to not affect stunting in toddlers (Angraini et al. , 2. Energy Sufficiency Level Based on the results of the bivariate test in the table, the results of the chi-square test showed a p-value of 0. -value<0. , indicating that there was a significant relationship between the level of energy adequacy and the incidence of stunting under five in fishing families in the Mojo Coastal Area of Pemalang. The categorization of energy adequacy levels is divided into 2, namely less (TKE < 80% based on AKG) and sufficient (TKE Ou 80% based on AKG). The odds ratio for this variable is 32,500, indicating that toddlers in fishing families with low energy sufficiency have a 32,500 times greater risk of stunting compared to toddlers from fishing families who have sufficient energy levels. Based on the research conducted, stunted toddlers tend to have a poor appetite and prefer snacks compared to eating Ae the main food. These results are in line with research conducted by Yuliantini, 2022 with the results of p-value = 0. 006 which indicates that toddlers with low levels of energy sufficiency have a 5 times greater risk of experiencing stunting compared to toddlers who have sufficient energy adequacy. Low energy intake in toddlers is caused by a lack of appetite and a lack of feeding leads to an energy imbalance that causes nutritional problems (Yuliantini et al. Risk Factors for Stunting in Toddlers of Fishermen Families in the Coastal Area of Mojo Pemalang (Ayu Dwi Indah Lestari & Irwan Budion. A p-ISSN: 1979-7621, e-ISSN: 2620-7761 Energy from food can be obtained from macronutrients such as carbohydrates, proteins, and fats. Energy functions as a support in the growth process and metabolism of the body, if toddlers have a low level of energy intake, it will result in obstacles in the growth and cognitive development of toddlers (Diniyyah & Nindya, 2. Protein Adequacy Rate Based on the results of the research that has been carried out, the test results chisquare Shows value p-value by 0. -value < 0. which can be concluded that there is a significant relationship between protein adequacy and incidence stunting to toddlers fishing families in the Mojo Coastal Area. Pemalang. The categorization of protein adequacy levels is divided into 2, namely less (< 80% based on AKG) and sufficient (Ou 80% based on AKG). Value odds ratio This variable of 28,000 indicates that toddlers from fishing families who have a low level of protein adequacy have a 28,000 times greater risk of developing stunting compared to toddlers from fishing families who have sufficient levels of protein adequacy. Although this research was conducted in coastal areas with the majority of the population being fishermen, the level of fish consumption is still relatively Toddlers often consume chicken or only vegetable sauce and rice without side dishes. This happens because of the mother's lack of knowledge related to nutrients in food, so the mother gives food that only her toddler wants to eat. If this continues, it will have a negative effect on the growth rate of toddlers because protein plays an important role in building and maintaining body tissues (Syabandini isninda Prisca. Fatima Pradigdo. Suatno. This is supported by previous research that states that low levels of protein intake have a 4 times greater risk of developing stunting compared to toddlers with a high level of protein adequacy (Syabandini isninda Prisca. Fatima Pradigdo. Suatno, 2. Another research conducted in line by Verawati, 2021 with the results of p-value= 0,0001 yang prove that there is a significant relationship between protein adequacy and incidence stunting in Pulau Jambu Village (Verawati et al. , 2. Father's Work Based on the results of the bivariate test, the results of the chi-square test showed a p-value of 0. -value < 0. which can be concluded that there is a meaningful relationship between father's work and the incidence of stunting in toddlers of fishing families in the Coastal Area of Mojo Pemalang. The odds ratio value in this variable of 9. shows that toddlers with fathers who work as fishermen have a risk of 9. 036 times experiencing stunting compared to toddlers with father's work as fishermen owners. The research conducted is in line with the research conducted by Lemaking . , with the results that there is a meaningful relationship between the father's work and the incidence stunting in Central Kupang. Fishermen are people who sell labor for work in fishing activities at sea, while fishermen owners are people who have a fishing business with rights to boats or fishing gear used to catch fish at sea (Lemaking et al. , 2. Father's work has a big role in nutrition problems because it is related to income and purchasing power for family needs. Toddlers with fathers who work as fishermen have a higher risk of experiencing stunting compared to toddlers with their father as a fisherman who owns the Family Income Based on the results of the research that has been conducted, the results of the chisquare test produced a p-value of 0. -value < 0. which can be concluded that there is a meaningful relationship between family income and stunting incidence in the Mojo Jurnal Kesehatan. Vol. No. December 2025: 326 Ae 342 Jurnal Kesehatan p-ISSN: 1979-7621, e-ISSN: 2620-7761 Coastal Area of Pemalang. Income is categorized based on the regional minimum wage from Pemalang Regency, namely the low (