Determinants of stunting and prevention strategies in remote villages of West Aceh, Indonesia: A case–control study

Fitriani Fitriani, Teungku N. Farisni, Yarmaliza Yarmaliza, Zakiyuddin Zakiyuddin, Fitrah Reynaldi, Safrizal Safrizal, Veni N. Syahputri, Denis O. Handika

Abstract

This study examined determinants of stunting among children aged 24–59 months in remote rural areas of West Aceh, Indonesia, and proposed context-specific prevention strategies. A case–control study was conducted in the Kaway XVI sub-district between March and June 2022, involving 33 stunted and 33 non-stunted children selected from the same communities. Data were collected through maternal interviews, anthropometric measurements, and health records, assessing nutritional care practices, household sanitation, food availability, infectious disease history, maternal knowledge, and breastfeeding practices. Multivariate logistic regression showed that inadequate household sanitation (aOR = 26.41), poor nutritional care practices (aOR = 17.43), limited household food availability (aOR = 8.96), and frequent infectious diseases (aOR = 8.45) were independently associated with stunting. These findings demonstrate the relative strength of caregiving, environmental, and food access determinants in a highly resource-limited setting. A multilevel prevention model guided by the MATCH framework is proposed to inform integrated, community-based stunting prevention strategies in remote rural areas. 

Full Text:

PDF

References

Taslim NA, Farradisya S, Gunawan W Ben, Alfatihah A, Barus RIB, Ratri LK, Arnamalia A, Barazani H, Samtiya M, Mayulu N, Kim B, Hardinsyah H, Surya E, Nurkolis F. The interlink between chrono-nutrition and stunting: current insights and future perspectives. Front Nutr 2023; 10. doi: 10.3389/fnut.2023.1303969.

Torlesse H, Cronin AA, Sebayang SK, Nandy R. Determinants of stunting in Indonesian children: evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction. BMC Public Health 2016; 16(1): 669. doi: 10.1186/s12889-016-3339-8.

Vir SC. Improving women’s nutrition imperative for rapid reduction of childhood stunting in South Asia: coupling of nutrition specific interventions with nutrition sensitive measures essential. Matern Child Nutr 2016; 12(S1): 72–90. doi: 10.1111/mcn.12255.

Wit JM, Himes JH, van Buuren S, Denno DM, and Suchdev PS. Practical Application of Linear Growth Measurements in Clinical Research in Low- and Middle-Income Countries. Horm Res Paediatr 2017; 88(1): 79–90. doi: 10.1159/000456007.

Mulyani AT, Khairinisa MA, Khatib A, Chaerunisaa AY. Understanding Stunting: Impact, Causes, and Strategy to Accelerate Stunting Reduction—A Narrative Review. Nutrients 2025; 17(9): 1493. doi: 10.3390/nu17091493.

Kim HY, Cho GJ, Ahn KH, Hong S-C, Oh M-J, Kim H-J. Short-term neonatal and long-term neurodevelopmental outcome of children born term low birth weight. Sci Rep 2024; 14(1): 2274. doi: 10.1038/s41598-024-52154-9.

Ministry of Health of the Republic of Indonesia. Indonesian Nutrition Status Survey (SSGI) 2024 in Numbers. Jakarta, 2025.

World Health Organization. World health statistics 2024: monitoring health for the SDGs, sustainable development goals. Geneva, 2024.

Government of Indonesia. Presidential Regulation No. 12 of 2025 on the National Medium-Term Development Plan 2025–2029. Indonesia, 2025.

Indra J, Khoirunurrofik K. Understanding the role of village fund and administrative capacity in stunting reduction: Empirical evidence from Indonesia. PLoS One 2022; 17(1): e0262743. doi: 10.1371/journal.pone.0262743.

Komang Ayu Henny Achyar, Wayan Surasta, Agus Sri Lestari, Ni Komang Wiardani, Nyoman Ribek, Wigati. Addressing Stunting Through Local Strategies: A Study of Social Phenomena in Various Regions of Indonesia. Evol Stud Imaginative Cult 2024; : 508–524. doi: 10.70082/esiculture.vi.707.

Chabibah IFA, Agustina R. Exploration of the role of posyandu cadres in achieving community health center programs to reduce stunting incidence. Amerta Nutr 2023; 7(2SP): 65–72. doi: 10.20473/amnt.v7i2SP.2023.65-72.

Aceh Provincial Health Office. Aceh health profile 2019. Aceh, 2019.

Fatwa R, Srinita S, Abrar M. The Effect of the Agriculture Sector on Poverty in Aceh Province. Int J Quant Res Model 2022; 3(2): 77–86. doi: 10.46336/ijqrm.v3i2.275.

Julita N, Silvia Putri E. The Effectiveness of Nutrition Education on Stunting Prevention Behavior In Pregnant Women in Kaway Xvi District, Aceh Barat Regency. MORFAI J 2022; 2(1): 81–88. doi: 10.54443/morfai.v2i1.202.

Ramadhan MF, Dimiati H, Hidayaturrahmi H, Indah R. The Correlation between Stunting, Maternal Knowledge, and Nutritional Care in Aceh, Indonesia. Amerta Nutr 2024; 8(4): 513–518. doi: 10.20473/amnt.v8i4.2024.513-518.

Ministry of Health of the Republic of Indonesia. Regulation of the Minister of Health of the Republic of Indonesia No. 3 of 2014 on Community-Based Total Sanitation. Indonesia, 2014.

Ministry of Health of the Republic of Indonesia. Maternal and Child Health (MCH) Handbook: A Comprehensive Guide to Promoting Maternal and Child Health. Jakarta, 2024.

UNICEF. UNICEF Conceptual Framework on Maternal and Child Nutrition. UNICEF: New York, 2021.

World Health Organization & The United Nations Children’s Fund (UNICEF). Indicators for assessing infant and young child feeding practices: definitions and measurement methods. World Health Organization and the United Nations Children’s Fund (UNICEF): Geneva, 2021.

World Health Organization. WHO Child Growth Standards: Growth velocity based on weight, length and head circumference: Methods and development. Geneva, 2009.

UNICEF. UNICEF Conceptual Framework on Maternal and Child Nutrition. 2021; : 2–3.

Houghton LA, McIntosh DR, Trilok-Kumar G, Haszard JJ, Gibson RS. Suboptimal feeding and caring practices among young Indian children ages 12 to 24 mo living in the slums of New Delhi. Nutrition 2020; 69: 110553. doi: 10.1016/j.nut.2019.110553.

Kubeka Z, Modjadji P. Association of Stunting with Socio-Demographic Factors and Feeding Practices among Children under Two Years in Informal Settlements in Gauteng, South Africa. Children 2023; 10(8): 1280. doi: 10.3390/children10081280.

Samosir OB, Radjiman DS, Aninditya F. Food consumption diversity and nutritional status among children aged 6–23 months in Indonesia: The analysis of the results of the 2018 Basic Health Research. PLoS One 2023; 18(3): e0281426. doi: 10.1371/journal.pone.0281426.

Verhoef J, van Kessel K, and Snippe H. Immune Response in Human Pathology: Infections Caused by Bacteria, Viruses, Fungi, and Parasites. In: Nijkamp and Parnham’s Principles of Immunopharmacology. Springer International Publishing: Cham, 2019, pp 165–178 doi: 10.1007/978-3-030-10811-3_10.

Arini D, Nursalam N, Mahmudah M, Faradilah I. The incidence of stunting, the frequency/duration of diarrhea and Acute Respiratory Infection in children. J Public health Res 2020; 9(2): 117–120. doi: 10.4081/jphr.2020.1816.

Audiena NP, Siagian ML. Association between Infectious Disease and Hygiene Practice on Stunting Children Aged 24-59 Months. Amerta Nutr 2021; 5(2): 149. doi: 10.20473/amnt.v5i2.2021.149-157.

Yani DI, Rahayuwati L, Sari CWM, Komariah M, Fauziah SR. Family Household Characteristics and Stunting: An Update Scoping Review. Nutrients 2023; 15(1): 233. doi: 10.3390/nu15010233.

Loopstra R. An overview of food insecurity in Europe and what works and what doesn’t work to tackle food insecurity. Eur J Public Health 2020; 30(Supplement_5): doi: 10.1093/eurpub/ckaa165.521.

Tsegaye AT, Tariku A, Worku AG, Abebe SM, Yitayal M, Awoke T, Alemu K, Biks GA. Reducing amount and frequency of meal as a major coping strategy for food insecurity. Arch Public Heal 2018; 76(1): 56. doi: 10.1186/s13690-018-0303-3.

Delisle H. Maternal education is essential but may not be sufficient to prevent child stunting: a commentary. Public Health Nutr 2021; 24(12): 3753–3755. doi: 10.1017/S1368980020003754.

Nankinga O, Kwagala B, and Walakira EJ. Maternal employment and child nutritional status in Uganda. PLoS One 2019; 14(12): e0226720. doi: 10.1371/journal.pone.0226720.

Trofholz AC, Schulte AK, Berge JM. A qualitative investigation of how mothers from low income households perceive their role during family meals. Appetite 2018; 126: 121–127. doi: 10.1016/j.appet.2018.03.017.

Shrestha A, Six J, Dahal D, Marks S, Meierhofer R. Association of nutrition, water,sanitation and hygiene practices with children’s nutritional status, intestinal parasitic infections and diarrhoea in rural Nepal: a cross-sectional study. BMC Public Health 2020; 20(1): 1241. doi: 10.1186/s12889-020-09302-3.

Has EMM, Krisnana I, Efendi F. Enhancing Maternal Caregiving Capabilities Model to Prevent Childhood Stunting: A UNICEF-Inspired Model. SAGE Open Nurs 2024; 10. doi: 10.1177/23779608231226061.

Skoufias E, Vinha K, Sato R. Reducing Stunting through Multisectoral Efforts in Sub-Saharan Africa. J Afr Econ 2021; 30(4): 324–348. doi: 10.1093/jae/ejaa016.

Aminah S, Mahmudiono T, Nadhiroh SR. Policy, intervention, and management in addressing stunting in children: A systematic review. Afr J Reprod Health 2024; 28(10s): 348–357. doi: 10.29063/ajrh2024/v28i10s.37.

Khan AM, Carducci B, Muralidharan O, Bhutta ZA. Evidence on Strategies for Integrating Nutrition Interventions with Health and Immunization Systems in Conflict-affected Areas of Low- and Lower-middle-income Settings—A Systematic Review. Nutr Rev 2025; 83(8): 1475–1493. doi: 10.1093/nutrit/nuaf031.

Setiawan A, Christiani Y. Integrated Health Post for Child Health (Posyandu) As A Community-Based Program in Indonesia: An Exploratory Study. J Keperawatan Indones 2018; 21(3): 150–158. doi: 10.7454/jki.v21i3.600.

Refbacks

  • There are currently no refbacks.