Siti Aisah, Kemal Nazarudin Siregar


Background: Stunting or being too short affects one-third of children under five years old in developing countries. Stunting has long-term effects on cognitive development, school performance and economic productivity in adulthood. Early detection of cognitive impairment caused by stunting offers rapid strategies for reducing stunting by examine the consequence on cognitive development. Reliable assessment tools are necessary to properly track cognitive development caused by stunting. This study identifies that the use of appropriate cognitive assessment tools assists in early detection of the impact of stunting in children under five years old in developing countries.

Methods: Systematic literature review using PRISMA-P guidelines were applied for this study. Studies were identified from 4 electronic sources (Scopus, Science Direct, EBSCO and Google Scholar) from 2015 to 2018 using relevant keywords. All studies were conducted on children under five years old in developing countries. The used studies for this review are limited to full-text in English and Bahasa Indonesia. Studies conducted from 19 April to 11 May 2018.

Results: From 492 studies that have been extracted, there are 10 studies reported the cognitive impairment assessment tools for under five years old children used in developing countries. The satisfying assessment tools in eligibility criteria are Bayley Scales of Infant Development (BSID III), the Indonesian child development pre-screening questionnaire (Kuesioner Pra-Skrining Perkembangan/KPSP ) and Denver Developmental Screening Test (DDST II). They appear promising to be used in identifying and monitoring cognitive development of children in developing countries. Conclusions: In the context of stunting in children under five years old, rapid assessment of cognitive ability is feasible for routine clinical use. The BSID III, KPSP and DDST II are the most common used in developing countries and they have moderately good accuracy to detect the cognitive impairment. 

Full Text:



United Nations Development Programme. 2016 Human Development Report.

Kemenkes RI. 2010. Indeks Pembangunan Kesehatan Masyarakat (IPKM). ISBN 978-979-8270-82-6.

UNICEF. Stunting reflects chronic undernutrition during the most critical periods of growth and development in early


WHO. 2010. Nutrition Landscape Information System (NLIS) Country Profile Indicators: Interpretation Guide. Switzerland :

WHO. ISBN: 978 92 4 159995 5.

de Onis M and Branca F. Childhood stunting: a global perspective. Matern Child Nutr. 2016 May; 12(Suppl Suppl 1): 12–

doi: 10.1111/mcn.12231.

UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates. 2017. Levels and trends in child malnutrition. Key findings

of the 2017 edition.

United Nations Children’s Fund, the World Health Organization and World Bank Group. 2017. Levels and Trends in Child


Kementerian Kesehatan Republik Indonesia. 2013. Riset Kesehatan Dasar.

UNICEF. 2016. Regional Report on Nutrition Security in ASEAN. V olume 2. olume_2%29.pdf

Yasmin G, Kustiyah L and Dwiriani CM. 2014. Risk Factors of Stunting among School-Aged Children and Eight Provinces in Indonesia. Pakistan Journal of Nutrition, 13: 557-566.

Mahmudiono T, Sumarmi S, Rosenkranz RR. Household dietary diversity and child stunting in East Java, Indonesia. Asia Pacific Journal of Clinical Nutrition. Asia Pac J Clin Nutr 2017;26(2):317-325.

UNICEF. 2016. Regional Report on Nutrition Security in ASEAN. V olume 2. olume_2%29.pdf

Garna H, Nataprawira HM 2014. Pedoman Diagnosis Dan Terapi Ilmu Kesehatan Anak. Edisi ke-5. Departemen/SMF Ilmy Kesehatan Anak Fakultas Kedokteran Padjajaran/RSUP Dr. Hasan Sadikin. Bandung.

Webb KE, Horton NJ, Katz DL. 2005. Parental IQ and cognitive development of malnourished Indonesian children. European Journal of Clinical Nutrition 59(4), pp. 618-620.

Pelletier DL. The relationship between child anthropometry and mortality in developing countries: implications for policy, programs and future research. J Nutr. 1994;124:2047S–2081S.

Carulla LS, Reed GM, Vaez-Azizi LM, Cooper SA, Leal RM, Bertelli M et al. Intellectual developmental disorders: towards a new name, definition and framework for “mental retardation/intellectual disability” in ICD-11. World Psychiatry v. 10(3); 2011 Oct; 175-180 PMC3188762.

Nessim AA. Correlation of mild pre-school developmental delay and subsequent learning abilities: a health and education perspective. Public Health. 1994;108:195–201. doi: 10.1016/S0033-3506(94)80117-7.

Centers for Disease Control and Prevention (CDC). 2018. Developmental Monitoring and Screening.

Centers for Disease Control and Prevention (CDC). 2017. Important Milestones: Your Child By Five Years.

Moodie S, Daneri P , Goldhagen S, Halle T, Green K & LaMonte L. 2014. Early childhood developmental screening: A compendium of measures for children ages birth to five (OPRE Report 2014 11). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Viridula EY, Murti B , Suryani N. Path Analysis on the Effect of Biopsychosocial and Economic Factors during Gestational Period on the Risk of Stunting and Development in Children under Five, in Nganjuk, East Java. Journal of Health Promotion and Behavior (2016), 1(3): 180-189

Manandhar SR, Dulal S, Manandhar DS, Saville N,Prost A. Acceptability and Reliability of the Bayley Scales of Infant Development III Cognitive and Motor Scales among Children in Makwanpur. J Nepal Health Res Counc 2016 Jan - Apr;14(32):47- 50.

Jeong SU, Kim GC, Jeong HJ, Kim DY, Hong YR, Kim HD et al. 2017. The Validity of the Bayley-III and DDST-II in Preterm Infants With Neurodevelopmental Impairment: A Pilot Study. Ann Rehabil Med. 2017 Oct; 41(5): 851–857. doi: 10.5535/arm.2017.41.5.851

Spencer-Smith MM, Spittle AJ, Lee KJ, Doyle LW, Anderson PJ. 2015. Bayley-III Cognitive and Language Scales in Preterm Children. Pediatrics V olume 135, number 5, May 2015. DOI: 10.1542/peds.2014-3039.

Simangunsong SW, Machfudz S, Sitaresmi MN. 2012. Accuracy of the Indonesian child development pre-screening questionnaire. Paediatr Indones, Vol. 52, No. 1, January 2012.

Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B. Developmental potential in the first 5 years for children in developing countries. Lancet 2006; 369: 60–70.

Walker SP, Wachs TD, Grantham-McGregor S, Black MM, Nelson CA, Huffman SL et al. Inequality in early childhood: risk and protective factors for early child development. Lancet 2011; 378: 1325-1338.

UNICEF, 2013. Improving Child Nutritition. The achievable imperative for global progress. ISBN: 978-92-806-4686-3.

Chilton M, Chyatte M, Breaux J. The negative effects of poverty and food insecurity on child development. Indian J Med

Res. 2007;126:262–72. [PubMed]

Kemenkes RI. 2016. Pedoman Pelaksanaan Stimulasi, Deteksi dan lntervensi Dini Tumbuh Kembang Anak di Tingkat Pelayanan


Green field PM. You can't take it with you: why ability assessments don't cross cultures. Am Psychol. 1997;52:1115–24.

Abubakar A, Holding P, Van Baa A, Newtoon CRJC, Van de Vijver FJR. Monitoring psychomotor development in a resource-

limited setting: an evaluation of the Kilifi Developmental Inventory. An of Trop Paediatr. 2008;28:217–26.


  • There are currently no refbacks.