Study of Stunting Determinants in the Highest-Prevalence Area of Southeast Sulawesi, Indonesia
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Abstract
While national interventions like the Free Nutritious Meal Program and breastfeeding promotion have shown regional success in Southeast Sulawesi, Buton District experiences a paradoxical rise in stunting. This study aimed to analyze the determinants of stunting in this high-prevalence area. A case-control study was conducted in the 6 subdistricts of Buton District from July to September 2025, involving 106 mothers of children aged 6–59 months (53 stunted and 53 non-stunted). Bivariate and multivariate logistic regression were used to identify factors associated with stunting. Multivariate analysis showed that younger age (aOR = 0.92; 95% CI: 0.87–0.97; p = 0.002), primigravida status (aOR = 0.07; 95% CI: 0.00–0.78; p = 0.031), higher maternal education (aOR = 0.01; 95% CI: 0.00–0.26; p = 0.004), and higher household income (high: aOR = 0.01; 95% CI: 0.00–0.13; p = 0.001; medium: aOR = 0.05; 95% CI: 0.00–0.92; p = 0.044) were protective against stunting. Other variables, including exclusive breastfeeding, maternal history of chronic energy deficiency, iron supplementation, drinking water treatment, and household size, were not significant. The model demonstrated good explanatory power (Nagelkerke R² = 0.665) and fit (Hosmer–Lemeshow = 0.830).Maternal education and household income are key determinants of stunting in Buton District. Interventions should target maternal knowledge, economic empowerment, and support for multigravida mothers to reduce stunting in high-risk areas.
References
[BPS] Badan Pusat Statistik., 2019. Indeks Pembangunan Manusia Kabupaten Buton. Badan Pusat Statistik, Buton.
Casale, D., Espi, G., Norris, S.A., 2018. Estimating The Pathways through Which Maternal Education Affects Stunting: Evidence from An Urban Cohort in South Africa. Public Health Nutrition 21(10), 1810–1818. Https://Doi.Org/10.1017/S1368980018000125
Cendana, P., Kim, S.Y., 2025. Maternal Factors and Breastfeeding Practices Associated with Stunting Among Indonesian Children Aged 6 to 23 Months. Asia Pacific Journal of Public Health 37(4), 402–410. Https://Doi.Org/10.1177/10105395251337970
Danaei, G., Andrews, K.G., Sudfeld, C.R., Fink, G., Mccoy, D.C., Peet, E., Sania, A., Smith Fawzi, M.C., Ezzati, M. And Fawzi, W.W., 2016. Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels. PLOS Medicine 13(11), 1-12. Https://Doi.Org/10.1371/Journal.Pmed.1002164
Duke, T., Albuhairan, F.S., Agarwal, K., Arora, N.K., Arulkumaran, S., Bhutta, Z.A., Binka, F., Castro, A., Claeson, M., Dao, B., Darmstadt, G.L., English, M., Jardali, F., Merson, M., Ferrand, R.A., Golden, A., Golden, M.H., Homer, C., Jehan, F., Kabiru, C.W., Kirkwood, B., Lawn, J.E., Li, S., Patton, G.C., Ruel, M., Sandall, J., Sachdev, H.S., Tomlinson, M., Waiswa, P., Walker, D., Zlotkin, S., 2022. World Health Organization and Knowledge Translation in Maternal, Newborn, Child and Adolescent Health and Nutrition. Archives of Disease in Childhood 107(7), 644–649. Https://Doi.Org/10.1136/Archdischild-2021-323102
Fadhlurrahman, I., 2023. Prevalensi Ketidakcukupan Konsumsi Pangan di Buton Tengah Capai 17,56% pada 2023 [WWW Document]. https://databoks.katadata.co.id/demografi/statistik/97339bbed519090/prevalensi-ketidakcukupan-konsumsi-pangan-di-buton-tengah-capai-1756-pada-2023. [Diakses Mei 2026].
Fink, G., Günther, I., Hill, K., 2011. The Effect of Water and Sanitation on Child Health: Evidence from The Demographic and Health Surveys 1986–2007. International Journal of Epidemiology 40(5), 1196–1204. Https://Doi.Org/10.1093/Ije/Dyr102
Finlay, J.E., Norton, M.K., Guevara, I.M., 2017. Adolescent Fertility and Child Health: The Interaction of Maternal Age, Parity and Birth Intervals in Determining Child Health Outcomes. International Journal of Child Health and Nutrition 6(1), 16–33. Https://Doi.Org/10.6000/1929-4247.2017.06.01.2
Fitriani, H., Setya, A., Nurdiana, P., 2020. Risk Factors of Maternal Nutrition Status During Pregnancy to Stunting in Toddlers Aged 12-59 Months. Jurnal Keperawatan Padjadjaran 8(2), 175–183. Https://Doi.Org/10.24198/Jkp.V8i2.1305
Flocke, S.A., Ohri-Vachispati, P., Shon, E.J., Trapl, E.S., Borawski, E., Matlack, K., Freedman, D.A., 2017. Developing Multidimensional Measures of Healthy Food Access Among Low-Income Adults in Cleveland, Ohio, Usa. Public Health Nutrition 20(16), 2859–2868. Https://Doi.Org/10.1017/S1368980017002002
Gayawan, E., Orunmoluyi, O.S., Adegboye, O.A., 2022. Geostatistical Patterns of Comorbidity of Diarrhea, Acute Respiratory Infection, and Stunting Among Under-Five Children in Nigeria. Mathematical Population Studies 29(2), 58–72. Https://Doi.Org/10.1080/08898480.2021.1942654
Girotra, S., Malik, M., Roy, S., Basu, S., 2023. Utilization and Determinants of Adequate Quality Antenatal Care Services in India: Evidence from The National Family Health Survey. BMC Pregnancy and Childbirth 23(800), 1-12. Https://Doi.Org/10.1186/S12884-023-06117-Z
Haryanti, F., Hartini, S., Akhmadi, A., Andarwati, F., Risnawati, H., Pratiwi, A.N., Kusumawati, A.S., Cahyani, R.D., Lusmilasari, L., 2024. Maternal Knowledge on Nutritional-Focused Nurturing Care and Associated Factors Among Women with Stunted Children Aged 6-23 Months in Yogyakarta, Indonesia: A Cross-Sectional Study. Belitung Nursing Journal 10(4), 472–480. Https://Doi.Org/10.33546/Bnj.3481
[Kemenkes] Kementerian Kesehatan., 2023. Indonesian Health Survey 2023 in Numbers. Kementerian Kesehatan RI, Jakarta
[Kemenkeu] Kementerian Keuangan., 2024. Laporan Kinerja Anggaran dan Pembangunan Program Pencegahan dan Penurunan Stunting melalui Belanja Kementrian/Lembaga. Kementerian Keuangan RI, Jakarta.
Khotimah, H., Lintang, S.S., Azkiya, F., 2023. The Influence of Socio-Economy and Local Food Diversity on Stunting in Toddlers. Journal of Health Science and Policy 1(3), 147–160. Https://Doi.Org/10.56855/Jhsp.V1i3.524
Laltanpuii, L., Roy, V., Lukima S., Lalthanthuami, H., 2024. Relationship of Maternal Characteristics and Stunting Among Children. Indian Journal of Public Health Research and Development 15(4), 197–203. Https://Doi.Org/10.37506/S2j1p268
Leroy, J.L., Habicht, J.P., González De Cossío, T., Ruel, M.T., 2014. Maternal Education Mitigates The Negative Effects of Higher Income on The Double Burden of Child Stunting and Maternal Overweight in Rural Mexico. The Journal of Nutrition 144(5), 765–770. Https://Doi.Org/10.3945/Jn.113.188474
Mbuma, V., Lissner, L., Hunsberger, M., 2021. Parental Investment Can Moderate The Negative Effects of Low Socioeconomic Status on Children’s Health: An Analysis of Kenyan National Data. Journal of Global Health Reports 5, 1-7. Https://Doi.Org/10.29392/001c.29462
Monroe-Lord, L., Ardekani, A., Weitman, C., 2024. The Impact of Covid-19 on Food Security Across Income Levels. Journal of Nutrition Education and Behavior 56(8), 1-22. Https://Doi.Org/10.1016/J.Jneb.2024.05.086
Nasrin, D., Liang, Y., Verani, J.R., Powell, H., Sow, S.O., Omore, R., Hossain, M.J., Doh, S., Zaman, S.M.A., Jones, J.C.M., Awuor, A.O., Kasumba, I.N., Tennant, S.M., Ramakrishnan, U., Kotloff, K.L., 2023. Stunting Following Moderate-To-Severe Diarrhea Among Children Aged <5 Years in Africa Before and After Rotavirus Vaccine Introduction: A Comparison of The Global Enteric Multicenter Study and The Vaccine Impact on Diarrhea in Africa (VIDA) Study. Clinical Infectious Diseases 76(S1), S49–S57. Https://Doi.Org/10.1093/Cid/Ciac948
Neupane, S., Scott, S., Nguyen, P., Menon, P., 2021. Both Quantity and Quality of Antenatal Care Matter for Child Birthweight: An Analysis of Nationally Representative Data from Bangladesh, India, Nepal, and Pakistan. Current Developments in Nutrition 7(5), 1-22. Https://Doi.Org/10.1093/Cdn/Nzab046_091
Nisa, T.I.Z., Adriani, B.B., Murti, B., 2022. Effect of Early Initiation of Breastfeeding on Exclusive Breastfeeding and Stunting: A Meta-Analysis. Journal of Maternal and Child Health 7(6), 685–698. https://thejmch.com/index.php/thejmch/article/view/867
Ohonba, A., Ngepah, N., Simo-Kengne, B., 2019. Maternal Education and Child Health Outcomes in South Africa: A Panel Data Analysis. Development Southern Africa 36(1), 33–49. Https://Doi.Org/10.1080/0376835x.2018.1456908
Orunmoluyi, O., Gayawan, E., Manda, S., 2022. Spatial Co-Morbidity of Childhood Acute Respiratory Infection, Diarrhoea and Stunting in Nigeria. International Journal of Environmental Research and Public Health 19(3), 1-16. Https://Doi.Org/10.3390/Ijerph19031838
[PEMKAB] Pemerintah Kabupaten., 2024. Publikasikan Hasil Pengukuran Prevalensi Stunting E-PPGBM. Pemerintah Kabupaten Buton.
Popkin, B.M., Corvalan, C., Grummer-Strawn, L.M., 2020. Dynamics of The Double Burden of Malnutrition and The Changing Nutrition Reality. The Lancet 395(10217), 65–74. Https://Doi.Org/10.1016/S0140-6736(19)32497-3
Rahayu, E.P., Yastirin, P.A., Sehmawati, S., 2023. Studi Korelasi Karakteristik dan Status Gizi Ibu Hamil terhadap Prevalensi Stunting pada Balita. Jurnal Inovasi Riset Ilmu Kesehatan 1(3), 298–314. Https://Doi.Org/10.55606/Detector.V1i3.2479
Rahmat, A., Indrasuri, W.O.V., Wigati, R.S., 2021. Profil Anak Kabupaten Buton 2021. Dinas Pemberdayaan Perempuan dan Perlindungan Anak, Buton.
Ramlan, P., Sukri, P., Abdullah, Muh. T., Ibrahim, M.A., Hardianti., Cahyani, A., 2025. Poverty and Stunting: A Socioeconomic Analysis of Vulnerable Communities; A Systematic Literature Review. Earth and Environmental Science 1475(1), 1-9. Https://Doi.Org/10.1088/1755-1315/1475/1/012026
Septiani, W., Harahap, E.S., Ismainar, H., Zaman, M.K., Alamsyah, A., Maharani, R., 2020. Maternal Factors on Stunting in Pekanbaru Local Health Center, Indonesia. Academia Open 2, 1-12. Https://Doi.Org/10.21070/Acopen.2.2020.488
Victora, C.G., De Onis, M., Hallal, P.C., Blössner, M. Shrimpton, R., 2010. Worldwide Timing of Growth Faltering: Revisiting Implications for Interventions. Pediatrics 125(3), E473–E480. Https://Doi.Org/10.1542/Peds.2009-1519
Vikram, K., Vanneman, R., 2020. Maternal Education and The Multidimensionality of Child Health Outcomes in India. Journal of Biosocial Science 52(1), 57–77. Https://Doi.Org/10.1017/S0021932019000245
[WHO] World Health Organization., 2015. Stunting in A Nutshell.
Zhao, J., Huang, J., Nie, F., 2022. The Income Elasticities of Food, Calories, and Nutrients in China: A Meta-Analysis. Nutrients 14(22), 1-24. Https://Doi.Org/10.3390/Nu14224711