An Ecological Study and Disparities Analysis of Stunting and Its Predictors  in Indonesia Based on SSGI 2024

Niken Agus Tianingrum; Reny Mareta Sari

doi:10.36590/jika.v8i1.1952

Authors

Niken Agus Tianingrum Program Studi Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Muhammadiyah Kalimantan Timur, Samarinda, Indonesia
Reny Mareta Sari Program Studi Kesehatan Masyarakat, Universitas Strada Indonesia, Kediri, Indonesia

DOI:

https://doi.org/10.36590/jika.v8i1.1952

Keywords:

child nutrition, ecological study, regional disparities, stunting

Abstract

Stunting still remains a public health problem in Indonesia. Based on Indonesian Nutritional Status Survey (SSGI) 2024, the prevalence of stunting has declined over the past decade but remains high and varies considerably across the 36 provinces. This study aimed to describe ecological patterns and regional disparities in stunting prevalence and its predictors in Indonesia. This ecological study used secondary data from the SSGI 2024, with provinces as the unit of analysis. The dependent variable was provincial stunting prevalence, while independent variables included maternal knowledge, complete basic immunization, standard growth monitoring, iron supplementation, and access to safe drinking water. Bivariate analysis was conducted using scatter plots, and Spearman correlation tests were applied to assess associations. The results revealed clear disparities in stunting prevalence between western and eastern Indonesia, particularly across Sumatra, Java, and Bali. Provinces with higher coverage of complete basic immunization and better access to safe drinking water tended to have lower stunting prevalence. Conversely, higher coverage of growth monitoring was associated with higher stunting prevalence. Three variables were significantly associated with stunting prevalence: complete basic immunization (p-value = 0.03), standard growth monitoring (p-value = 0.007), and access to safe drinking water (p-value = 0.0002). The findings suggest that strengthening basic immunization, growth monitoring, and access to safe drinking water, particularly through optimizing POSYANDU as an integrated maternal and child health service may help reduce stunting prevalence in Indonesia.

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Author Biographies

Niken Agus Tianingrum, Program Studi Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Muhammadiyah Kalimantan Timur, Samarinda, Indonesia

Program Studi Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Muhammadiyah Kalimantan Timur, Samarinda, Indonesia

https://scholar.google.com

Reny Mareta Sari, Program Studi Kesehatan Masyarakat, Universitas Strada Indonesia, Kediri, Indonesia

Program Studi Kesehatan Masyarakat, Universitas Strada Indonesia, Kediri, Indonesia

https://scholar.google.com

References

Adam, N., Fitrianingsih, J., Basir, M., 2024. The Role of Knowledge in Improving Attitudes and Behaviors of Stunting Prevention in Pregnant Women. Jurnal Ilmiah Kesehatan Sandi Husada 13(2), 403–410. https://jurnal.edi.or.id/index.php/jiksh/article/view/364

Anwar, F., Khomsan, A., Sukandar, D., Riyadi, H., Mudjajanto, E.S., 2010. High Participation in The Posyandu Nutrition Program Improved Children Nutritional Status. Nutrition Research and Practice 4(3), 208-214. Https://Doi.Org/10.4162/Nrp.2010.4.3.208

Aprilina, H.D., Nurkhasanah, S., Hisbulloh, L., 2021. Mothers’s Nutritional Knowledge and Behavior to Stunting Prevalence Among Children Under Two Years Old: Case-Control. Bali Medical Journal 10(3), 1211–1215.

[BAPPENAS, UNICEF] Badan Perencanaan Pembangunan Nasional., United Nations Children's Fund., 2017. SDG Baseline Report on Children in Indonesia [WWW Document]. Https://Www.Unicef.Org/Indonesia/Reports/Sdg-Baseline-Report-Children-Indonesia. [Accessed January 2026].

Berendsen, M.L.T., Smits, J., Netea, M.G., Ven, A.V., 2016. Non-Specific Effects of Vaccines and Stunting: Timing May Be Essential. Ebiomedicine 8, 341–348. Https://Doi.Org/10.1016/J.Ebiom.2016.05.010

Flanagan, K.L., Van Crevel, R., Curtis, N., Shann, F., Levy, O., 2013. Heterologous (“Nonspecific”) and Sex-Differential Effects of Vaccines: Epidemiology, Clinical Trials, and Emerging Immunologic Mechanisms. Clinical Infectious Diseases 57(2), 283–289. Https://Doi.Org/10.1093/Cid/Cit209

Hahn, R.A., 2021. What is A Social Determinant of Health? Back to Basics. Journal of Public Health Research 10(4), 1-6. Https://Doi.Org/10.4081/Jphr.2021.2324

Haider, B.A., Olofin, I., Wang, M., Spiegelman, D., Ezzati, M., Fawzi, W.W., 2013. Anaemia, Prenatal Iron Use, and Risk of Adverse Pregnancy Outcomes: Systematic Review and Meta-Analysis. BMJ 346, F3443–F3443. Https://Doi.Org/10.1136/Bmj.F3443

Hall, C., Bennett, C., Crookston, B., Dearden, K., Hasan, M., Linehan, M., Syafiq, A., West, S., West, J., 2018. Maternal Knowledge of Stunting in Rural Indonesia. International Journal of Child Health and Nutrition 7(4), 139–145. Https://Doi.Org/10.6000/1929-4247.2018.07.04.2

Johnson, S., 2024. Pediatric Nutrition Plays an Important Role in Growth, Development and Overall Well Being of Infants, Children under fives and Children The Significance of Early Nutrition Maternal and Pediatric Nutrition Perspective Correspondence to. Matern Pediatr Nutr 9(1), 1000217–1000218

[Kemenkes] Kementerian Kesehatan., 2025. Survey Status Gizi Indonesia dalam Angka. Kementerian Kesehatan RI, Jakarta.

Kusrini, I., Laksono, A.D., 2020. Regional Disparities of Stunted Children under five in Indonesia. Indian Journal of Forensic Medicine & Toxicology 14(3), 1952-1956. Https://Doi.Org/10.37506/Ijfmt.V14i3.10706

Kwami, C.S., Godfrey, S., Gavilan, H., Lakhanpaul, M., Parikh, P., 2019. Water, Sanitation, and Hygiene: Linkages with Stunting in Rural Ethiopia. International Journal of Environmental Research and Public Health 16(20), 1-21. Https://Doi.Org/10.3390/Ijerph16203793

Laksono, A.D., Kusrini, I., 2020. Ecological Analysis of Stunted Children under five in Indonesia. Indian Journal of Forensic Medicine and Toxicology 14(3), 1733-1739. Https://Doi.Org/10.37506/Ijfmt.V14i3.10666

Laksono, A.D., Rukmini, R., Wulandari, R.D., 2020. Regional Disparities in Antenatal Care Utilization in Indonesia. PLOS ONE 15(2), 1-13. Https://Doi.Org/10.1371/Journal.Pone.0224006

Liu, Q., Taylor, M., Nabwera, H., Long, Q., 2023. The Impact of Growth Monitoring and Promotion on Health Indicators in Children Under Five Years of Age in Low- and Middle-Income Countries. Cochrane Database of Systematic Reviews, 1-22. Https://Doi.Org/10.1002/14651858.CD014785

Maida, M., 2025. Social Science Approach Theory in Public Health. Journal Health of Indonesian 3(02), 86–96. Https://Doi.Org/10.58471/Health.V3i02.192

Masriawan, J., Ariadi, Z., 2025. Assessing The Effectiveness of The Posyandu Program on Maternal and Child Health Outcomes in Kekalik Jaya and Child Health. Media of Health Research 3(2), 71–79. Https://Doi.Org/10.70716/Mohr.V3i2.246

Novianti, S., Huriyati, E., Padmawati, R.S., 2023. Safe Drinking Water, Sanitation and Mothers’s Hygiene Practice as Stunting Risk Factors: A Case Control Study in A Rural Area of Ciawi Sub-District, Tasikmalaya District, West Java, Indonesia. Ethiopian Journal of Health Sciences 33(6), 935-944. Https://Doi.Org/10.4314/Ejhs.V33i6.3

Nurrizka, R.H., Wahyono, T.Y.M., 2018. Disparitas Kematian Maternal di Indonesia: Studi Ekologi dengan Analisis Spasial. Media Kesehatan Masyarakat Indonesia 14(2), 119-127. Https://Doi.Org/10.30597/Mkmi.V14i2.3630

Nutbeam, D., Lloyd, J.E., 2021. Understanding and Responding to Health Literacy As A Social Determinant of Health. Annual Review of Public Health 42(1), 159–173. Https://Doi.Org/10.1146/Annurev-Publhealth-090419-102529

Prendergast, A.J., 2015. Malnutrition and Vaccination in Developing Countries. Philosophical Transactions of The Royal Society B: Biological Sciences 370(1671), 1-8. Https://Doi.Org/10.1098/Rstb.2014.0141

Purwanti, E.D., Masitoh, S., Ronoatmodjo, S., 2025. Association Between Basic Immunization Status and Stunting in Children under fives Aged 12-59 Months in Indonesia. Journal of Preventive Medicine and Public Health 58(3), 298–306. Https://Doi.Org/10.3961/Jpmph.24.230

Raharini, H., Yuniarti, E., 2023. Relationship Between Water Quality and Stunting in Indonesia: Literature Review. Jurnal Penelitian Pendidikan IPA 9(9), 664–670. Https://Doi.Org/10.29303/Jppipa.V9i9.4513

Sari, A.M., Simbolon, D., Wahyu, T., 2021. Hubungan Cakupan Imunisasi Dasar dan ASI Eksklusif dengan Status Gizi Balita di Indonesia (Analisis Data Riskesdas 2018). Journal of Nutrition College 10(4), 335–342. Https://Doi.Org/10.14710/Jnc.V10i4.31699

Theresia, G.N., Sudarma, V., 2022. Immunization Status Lowers The Incidence of Stunting in Children 1-5 Years. World Nutrition Journal 6(1), 9–15. Https://Doi.Org/10.25220/WNJ.V06.I1.0003

Traore, S.S., Bo, Y., Kou, G., Lyu, Q., 2023. Iron Supplementation and Deworming During Pregnancy Reduces The Risk of Anemia and Stunting in Infants Less Than 2 Years of Age: A Study from Sub-Saharan Africa. BMC Pregnancy and Childbirth 23(63), 1-8. Https://Doi.Org/10.1186/S12884-023-05399-7

[UNICEF, WHO, The World Bank] United Nations Children's Fund., World Health Organization., The World Bank., 2025. Joint Child Malnutrition Estimates (JME) Levels and Trends 2025 Edition [WWW Document]. https://data.unicef.org/resources/jme/. [Accessed January 2026].

Wahyuni, F.C., Karomah, U., Basrowi, R.W., Sitorus, N.L., Lestari, L.A., 2024. Hubungan Literasi Gizi dan Pengetahuan Gizi terhadap Kejadian Stunting: A Scoping Review. Amerta Nutrition 7(3SP), 71–85. Https://Doi.Org/10.20473/Amnt.V7i3sp.2023.71-85

Wang, W., Yan, H., Zeng, L., Cheng, Y., Wang, D., Li, Q., 2012. No Effect of Maternal Micronutrient Supplementation on Early Childhood Growth in Rural Western China: 30 Month Follow-Up Evaluation of A Double Blind, Cluster Randomized Controlled Trial. European Journal of Clinical Nutrition 66(2), 261–268. Https://Doi.Org/10.1038/Ejcn.2011.190

[WHO]. World Health Organization., 2015. Stunting in A Nutshell [WWW Document]. Https://Www.Who.Int/News/Item/19-11-2015-Stunting-In-A-Nutshell. [Accessed January 2026].

[WHO] World Health Organization., 2025. Joint Child Malnutrition Estimates. World Health Organization, Geneva.