Peer-reviewed article

Household social context and health behaviors influencing child stunting: insights from North Sumatra, Indonesia

Poltekkes Kemenkes Medan, Herta Masthalina, Alfons Maryono Letelay, Tetty Herta Doloksaribu · 30 Jul 2025

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This study examined stunting among 7,973 children aged 6–23 months in North Sumatra, Indonesia, where stunting rates remained above national targets at 21.1%. Using cross-sectional survey data, researchers identified key risk factors including non-diverse diet, male sex, low household income, rural residence, and diseases like diarrhea and tuberculosis. Vitamin A supplementation was protective against stunting. The findings show that stunting is driven by both health behaviors and deeper socioeconomic inequalities, particularly affecting children in early complementary feeding stages and disadvantaged populations.

Key points

Non-diverse diet, low household income, rural residence, and male sex significantly increased stunting likelihood
Diarrhea (OR: 1.48) and tuberculosis (OR: 11.53) showed strong associations with stunted growth
Vitamin A supplementation demonstrated protective effect (OR: 0.70)
Children aged 6–11 months had elevated stunting risk during early complementary feeding stages
Maternal unemployment increased stunting risk (OR: 1.31), reflecting reduced income and caregiving capacity

Limitations

As a cross-sectional study, this research cannot establish causation—only associations between variables. The study cannot determine whether observed health vulnerabilities like diarrhea cause stunting or result from it.

Abstract

This study examines how household social context and health behaviors influence child stunting in North Sumatra, Indonesia, where the stunting rate among children under two years reached 21.1% in 2022—still above the national target. Drawing on cross-sectional data from 7,973 children aged 6–23-months collected in the 2022 Indonesian Nutritional Status Study (SSGI), this research explores the relationships between stunting and various structural, behavioral, and health-related variables using multivariate logistic regression. The analysis reveals that non-diverse diet (OR: 1.21; 95% CI: 1.10-1.37), male sex (OR: 1.38; 95% CI: 1.23 - 2.56), low household income (OR: 1.64; 95% CI: 1.45 - 1.87), and rural residence (OR: 1.24 ; 95% CI: 1.09 - 1.40) significantly increase the likelihood of stunting. Health vulnerabilities, such as diarrhea (OR: 1.48; 95% CI: 1.23-1.84) and tuberculosis (OR: 11.53;95% CI: 4.15 - 32.03) (OR: 11.53), also show strong associations with stunted growth. Conversely, vitamin A supplementation (OR: 0.70; 95% CI: 0.63 - 0.79) demonstrates a protective effect, reinforcing the importance of micronutrient interventions. Children aged 6 -11 - months were found to have elevated risk compared to older age groups, highlighting the vulnerability during early complementary feeding stages. Socioeconomic disparities emerged as key determinants. Maternal unemployment (OR: 1.31; 95% CI: 1.15 - 1.47) was associated with increased risk of stunting, likely reflecting reduced income and limited caregiving capacity. Moreover, parental education levels correlated with child nutrition, although maternal education lost statistical significance in the final multivariate model. The findings further demonstrate that dietary diversity, although behaviourally driven, is deeply embedded within socioeconomic structures and access to resources. These results underscore the multifactorial nature of stunting in Indonesia, emphasizing the interdependence between social determinants and health practices. Addressing stunting thus requires multisectoral approaches that integrate nutrition, healthcare, education, and economic empowerment, particularly for disadvantaged populations in rural and low-income settings. Strengthening early childhood health programs, enhancing maternal education, improving sanitation, and ensuring access to affordable nutritious food are essential to reducing stunting prevalence. This study provides actionable evidence for policymakers to design more targeted, equity-oriented public health strategies that consider both behavioral practices and the underlying social vulnerabilities shaping child health outcomes in decentralized contexts like North Sumatra. Key words: stunting, social determinants, dietary diversity, child nutrition, health behaviour