Stunting among under-five children in remote indonesia: associations with feeding practices, immunization adherence, and safe water use

Authors

  • Hendra Ruru Department of Public Health, Universitas Tamalatea Makassar, South Sulawesi, Indonesia, Indonesia

DOI:

https://doi.org/10.61099/jih.v2i4.557

Keywords:

child nutrition, immunization, stunting, water supply

Abstract

Introduction: Childhood stunting remains a major public health concern, particularly in remote areas where nutritional inadequacy, limited access to preventive health services, and unsafe household water may occur simultaneously. This study examined the associations of feeding practices, immunization adherence, and clean water use with stunting among under-five children in the Arimop Public Health Center area, Boven Digoel Regency, Indonesia.

Research Methodology: An observational analytic study with a cross-sectional design was conducted in July 2026. The study population comprised 296 registered under-five children, from whom 75 children were selected using purposive sampling. Data were obtained through questionnaires and anthropometric measurements. Descriptive and bivariate analyses were performed to examine associations between the independent variables and stunting.

Results: Of the participating children, 53.3% had suboptimal feeding practices, 44.0% had incomplete or non-adherent immunization, and 30.7% used household water that did not meet health requirements. Stunting was identified in 34.7% of children. Feeding practices, immunization adherence, and clean water use were each significantly associated with stunting (all p<0.001).

Conclusion: Stunting among under-five children was associated with nutritional practices, preventive healthcare adherence, and household water conditions. Integrated prevention should therefore strengthen appropriate child feeding, completion of routine immunization, and access to safe household water, particularly in remote communities.

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References

1. Agadjanian V, Prata N. Civil war and child health: regional and ethnic dimensions of child immunization and malnutrition in Angola. Soc Sci Med. 2003;56(12):2515-2527. doi:https://doi.org/10.1016/S0277-9536(02)00286-1

2. Asefa A, Girma D, Kaso AW, Ferede A, Agero G, Beyen TK. Prevalence of stunting and associated factors among under-five children in Robe Woreda, Arsi zone, Ethiopia. Int J Africa Nurs Sci. 2024;21:100782. doi:10.1016/j.ijans.2024.100782

3. Batani J, Maharaj MS. Harnessing emerging technologies for sustainable child health: Rethinking strategies for advancing SDG 3.2 in resource-constrained environments. Women Child Nurs. 2024;2(4):75-83. doi:10.1016/j.wcn.2024.09.001

4. Boba HI, Belayneh SB, Melaku FG, Hayelom DH, Bamboro SA. Prevalence and determinants of stunting among children aged 6–59 months in drought-affected pastoralist communities of teltele district, Borena Zone, Oromia Region, Ethiopia: A Cross-Sectional Study. Glob Pediatr. 2026;17:100347. doi:10.1016/j.gpeds.2026.100347

5. Caraka RE, Supardi K, Gio PU, et al. Bayesian Network analysis of spatial disparities in child nutrition status and health determinants across Indonesia. Int J Appl Earth Obs Geoinf. 2025;144(1):104936. doi:10.1016/j.jag.2025.104936

6. Fatima M, Ünsal Ö. Geospatial analysis of diarrhoea determinants among children under five in Pakistan using Multiscale Geographically Weighted Regression (MGWR). Appl Geogr. 2024;172:103434. doi:10.1016/j.apgeog.2024.103434

7. Fuchs GJ. Global Child Nutrition. Gastroenterol Clin North Am. 2025;54(4):681-697. doi:10.1016/j.gtc.2025.08.008

8. Fufa DA. Determinants of stunting in children under five years in dibate district of Ethiopia: A case-control study. Hum Nutr Metab. 2022;30:200162. doi:10.1016/j.hnm.2022.200162

9. Gune S, Alderman H, Nguyen PH, Chakrabarti S. Does Local System Strengthening Improve Nutrition Program Coverage and Child Growth: Evidence from a Large-Scale Program Initiative in India. J Nutr. Published online June 2026:101641. doi:10.1016/j.tjnut.2026.101641

10. Jokhu LA, Syauqy A. Determinants of concurrent wasting and stunting among children 6 to 23 mo in Indonesia. Nutrition. 2024;122:112390. doi:10.1016/j.nut.2024.112390

11. Lewis JI, Mbabazi J, Mutumba R, et al. Correlates of Body Composition in Children with Stunting: A Cross-sectional Study in Uganda. J Nutr. 2024;154(10):3105-3115. doi:10.1016/j.tjnut.2024.08.001

12. Li J. Less stunted? The impact of Chinese health aid on child nutrition. Soc Sci Med. 2024;342:116559. doi:10.1016/j.socscimed.2024.116559

13. Nandi A, Kumar S, Shet A, Bloom DE, Laxminarayan R. Childhood vaccinations and adult schooling attainment: Long-term evidence from India’s Universal Immunization Programme. Soc Sci Med. 2020;250:112885. doi:10.1016/j.socscimed.2020.112885

14. Milman A, Frongillo EA, de Onis M, Hwang J-Y. Differential Improvement among Countries in Child Stunting Is Associated with Long-Term Development and Specific Interventions. J Nutr. 2005;135(6):1415-1422. doi:10.1093/jn/135.6.1415

15. Nadhiroh SR, Micheala F, Tung SEH, Kustiawan TC. Association between maternal anemia and stunting in infants and children aged 0–60 months: A systematic literature review. Nutrition. 2023;115:112094. doi:10.1016/j.nut.2023.112094

16. Oginawati K, Yapfrine SJ, Fahimah N, Salami IRS, Susetyo SH. The associations of heavy metals exposure in water sources to the risk of stunting cases. Emerg Contam. 2023;9(4):100247. doi:10.1016/j.emcon.2023.100247

17. Orimadegun AE, Jegede AS, Gaffey MF, et al. A mixed-methods study of the drivers of stunting reduction among children under five in Nigeria, 2008–2018. Am J Clin Nutr. 2025;121:S86-S94. doi:10.1016/j.ajcnut.2025.02.022

18. Otoo GE, Gaffey MF, Confreda E, et al. A mixed-methods study of the drivers of stunting reduction among children under-5 in Ghana, 2003–2017. Am J Clin Nutr. 2025;121:S95-S105. doi:10.1016/j.ajcnut.2025.02.011

19. Parashar S. Moving beyond the mother-child dyad: Women’s education, child immunization, and the importance of context in rural India. Soc Sci Med. 2005;61(5):989-1000. doi:10.1016/j.socscimed.2004.12.023

20. Pasha M, Shimul MMH, Hossain R, Khandker S, Khan S, Mehriban N. Nutritional status and determinants of malnutrition among under-five children in a specialized hospital in Bangladesh during the COVID-19 pandemic. Clin Nutr Open Sci. 2025;64:192-202. doi:10.1016/j.nutos.2025.10.008

21. Prayitno G, Zuhriyah L, Efendi A, et al. Community-powered environmental pathways to reduce stunting: Food security, social capital, and open innovation in semi-urban Indonesia. Environ Challenges. 2025;21:101350. doi:10.1016/j.envc.2025.101350

22. Wendt A, Hellwig F, Saad GE, et al. Are children in female-headed households at a disadvantage? An analysis of immunization coverage and stunting prevalence: in 95 low- and middle-income countries. SSM - Popul Heal. 2021;15:100888. doi:10.1016/j.ssmph.2021.100888

23. Putri NA, Purwanti R, Panunggal B, Wijayanti L. Determinants of wasting among children aged 6–23 months from low-income households in Indonesia: an analysis of the SSGI 2022. Nutr Food Sci. 2026;56(4):740-753. doi:10.1108/NFS-11-2025-0395

24. Sharma D, Vijin PP, Goyal R, ul Hadi S, Kumar R. Unveiling subgroup trends of stunting and wasting in Indian children: a serial cross-sectional analysis from National Family Health Surveys 3–5. Am J Clin Nutr. 2025;121(5):1077-1089. doi:10.1016/j.ajcnut.2025.01.027

25. Suprapto. Stunting Policy Implementation in Indonesia: A Primary Health Care Perspective. J Ilm Kesehat Sandi Husada. 2026;15(1):347-361. doi:10.35816/jiksh.v15i1.302

26. Wand H, Moodley J, Reddy T, Naidoo S. Geospatial correlations and variations in child mortality and stunting in South Africa: Evaluating distal vs structural determinants. Spat Spatiotemporal Epidemiol. 2024;50:100653. doi:10.1016/j.sste.2024.100653

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Published

2026-11-01

How to Cite

Hendra Ruru. (2026). Stunting among under-five children in remote indonesia: associations with feeding practices, immunization adherence, and safe water use. Journal Interdisciplinary Health, 2(4), 216–227. https://doi.org/10.61099/jih.v2i4.557

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