Development, Validation, and Concurrent Performance of the Multidimensional Index of Child Growth (MICG) for Identifying Stunting in Primary Health Care

Abstract

Background: Height-for-age anthropometry is the backbone of stunting detection in Indonesian primary health care, yet it does not describe the feeding, health, developmental, caregiving, and service-access conditions that shape child growth.
Purpose: To develop a multidimensional child growth instrument, evaluate its psychometric properties, and examine how well its composite index identifies concurrent stunting status.
Methods: This cross-sectional validation study enrolled 180 caregiver–child pairs (children aged 6–59 months) from four stunting-priority sub-districts of an Indonesian city through cluster random sampling. The 80-item, six-dimension Indonesian MICG was tested for content validity, item–total correlation, factor structure, and internal consistency. An equal-weighted index (0–100) was compared with concurrent height-for-age status using Spearman correlation, receiver operating characteristic analysis, and logistic regression.
Results: All items achieved an item-level content validity index of 1.00. Cronbach’s alpha ranged from 0.35 (Physical Health) to 0.88 (Child Development). The mean index score was 80.16 (SD 8.83). The index correlated weakly with continuous height-for-age z-scores (rho = 0.17; p = 0.027) but not with height-for-age category (rho = −0.13; p = 0.084). The area under the curve was 0.57 (95% CI 0.48–0.66) for both outcome definitions, and the six-dimension logistic model was not significant (p = 0.115).
Conclusion: The current equal-weighted MICG Index cannot distinguish children who are stunted or at risk from those growing normally and should not replace or supplement anthropometric screening. Its use for holistic growth profiling remains a proposal requiring feasibility and utility evaluation.