Peer-reviewed article
Ecological study on child nutrition in Indonesia: National urban–rural patterns and local-level variation
Intan Qanita, Nuril Farid Abshori, Derren David Christian Homenta Rampengan, Roy Novri Ramadhan, Arga Setyo Adji et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined patterns of child malnutrition across Indonesia using national survey data, comparing urban and rural areas and analyzing variation within provinces. Urban children had lower rates of underweight and stunting but higher rates of overweight and unhealthy food consumption compared to rural children. Significant differences in child nutrition outcomes were found not just between urban and rural areas, but also among districts within the same province, suggesting that city size and health service access matter more than simple urban-rural classification.
Key points
- Urban children had 22-23% lower odds of underweight and stunting but 35% higher odds of being at risk of overweight compared to rural children
- Rural areas showed poorer dietary diversity and lower coverage of antenatal care
- Smaller cities with better health service access (like Magelang Municipality) had better child nutrition outcomes than larger cities
- Intra-provincial analyses revealed marked contrasts in child nutrition outcomes among districts within Central Java and South Sulawesi
- Indonesia faces a double burden of malnutrition with persistent undernutrition and growing overweight prevalence among children
Limitations
This is an ecological analysis using aggregated data, which cannot establish individual-level relationships or determine causality. The study does not evaluate an intervention but rather describes patterns and disparities in existing data.
Abstract
Indonesia continues to face a double burden of malnutrition, characterized by persistent undernutrition and a growing prevalence of overweight among children. Although urban children typically show lower rates of stunting and underweight, emerging evidence indicates rising obesity due to unhealthy behavior. At the same time, national indicators may mask substantial heterogeneity at the provincial and district levels. This study aimed to compare urban–rural disparities in child nutrition and maternal care at the national level and examines intra-provincial variation that may be obscured by aggregated statistics. An ecological analysis was conducted using data from the 2024 Indonesian Nutritional Status Survey. Urban–rural differences were evaluated using odds ratios (OR) and Chi-square tests. Sub-provincial analyses were undertaken in selected districts of Central Java and South Sulawesi to assess patterns of variation across smaller administrative units. At the national level, urban children exhibited lower odds of severe underweight (OR: 0.78; 95%CI: 0.75–0.81), underweight (OR: 0.82; 95%CI: 0.80–0.84), and stunting (OR: 0.77; 95%CI: 0.75–0.78). In contrast, they had higher odds of being at risk of overweight (OR: 1.35; 95%CI: 1.31–1.40) and of consuming unhealthy foods (OR: 1.22; 95%CI: 1.19–1.25). Rural areas showed poorer dietary diversity and lower coverage of antenatal care. District-level analyses revealed marked contrasts, where in Central Java, Magelang Municipality had lower odds of severe underweight than Surakarta and Tegal Municipalities. Meanwhile, in South Sulawesi, Makassar Municipality performed better than Pare-pare Municipality but still lagged behind Tana Toraja. These intra-provincial patterns suggest that urban residence does not uniformly confer nutritional advantage. Significant inequities persist not only between urban and rural populations but also across districts within the same province. Smaller cities with stronger health service access, such as Magelang Municipality, tend to show better child nutrition outcomes.