What explains stunting among children living in a rice urplus area in Central Java, Indonesia?

Demak district is part of the province of Central Java, one of the national rice stock areas in Indonesia. In 2013, in Central Java the districts ranked sixth in rice productivity, but, at the same time, seventh in chronic child malnutrition. This paradox triggered an interest in the correlations between food accessibility and utilisation of households in Demak and the prevalence of stunting among children under five years old. During December 2014-February 2015, this issue was investigated in three sub-districts in Demak that had the highest rice production and poorest nutritional status of children under five. The oldest breastfed children aged 6 to 60 months from farmer families were selected for food intake and nutritional status measurement. Data were obtained on household socio-economic status, general characteristics, anthropometry, and food intake of the children. Nearly one-third (31.9%) of the 335 children in the study was stunted. Remarkably, food accessibility was similar between households with and without stunted children. However, diet quality regarding energy, calcium and iron intake was significantly better in households without stunted children. Unhealthy snacking habits of the children were found to contribute to an inadequate food intake as well. Improvement of complementary foods and family diet, including healthy homemade snacks based on locally available foods from animal and plant sources should be promoted.