Interconnected Maternal and Child Determinants of Under-Five Morbidity in Indonesia: A Cross-Sectional Study for a Holistic Care Model to Achieve SDG 3
Abstract Background High childhood morbidity from infectious diseases in Indonesia remains a significant barrier to achieving Sustainable Development Goal (SDG) 3, Target 3.2. A holistic maternal-child care approach that integrates physical, psychological, social, and spiritual dimensions is essential. However, current care models are often fragmented, failing to address the complex interplay of risk factors across the continuum from pregnancy through early childhood. Methods This cross-sectional study was conducted in Sleman Regency, Indonesia, involving 450 children aged 12–59 months selected via multistage cluster sampling. Guided by the Holistic Maternal and Child Health Continuum of Care Model, data on maternal factors (anemia, pre-eclampsia, ANC utilization) and child factors (immunization status, stunting, developmental delay) were extracted from health records, including Maternal and Child Health (KIA) books and integrated service posts records. Multivariate logistic regression was used to assess predictors of childhood illness, controlling for socioeconomic confounders (p < 0.05). Results Maternal anemia (48.3% prevalence) significantly increased disease risk (aOR = 2.15; 95% CI: 1.38–3.35). Inadequate ANC (< 6 visits) was associated with a 1.78-fold increased risk (aOR = 1.78; 95% CI: 1.15–2.75). Child factors emerged as the strongest predictors: stunting was the most significant (aOR = 2.45; 95% CI: 1.58–3.80), with stunted children showing over five times the odds of illness (crude OR = 5.20; 95% CI: 3.44–7.86). Incomplete immunization (aOR = 2.28; 95% CI: 1.48–3.51) and developmental delay (aOR = 1.92; 95% CI: 1.05–3.51) were also significant independent predictors. The model explained 42% of the variance in childhood illness (Nagelkerke R²=0.42). Conclusion To reduce childhood illness and advance SDG 3 targets, a nurse/midwife-coordinated holistic care model is critical. This model must address interconnected physical, psychological, social, and spiritual determinants. Practical implementation requires integrated maternal-child health records, family-centered care, and continuity from preconception through early childhood. Such a model offers a pathway to improve child health outcomes and accelerate progress toward SDG 3 in Indonesia and similar settings.