Spatial analysis of stunting determinants in 514 Indonesian districts/cities: Implications for intervention and setting of priority

Submitted: 18 November 2021
Accepted: 5 March 2022
Published: 17 May 2022
Abstract Views: 2409
PDF: 1443
HTML: 67
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

While the national prevalence of stunting in Indonesia has decreased, the level remains high in many districts/cities and there is significant variation. This ecological study employed aggregated data from the Basic Health Research Report and the District/City Poverty Data from 2018. We investigated the determinants of stunting prevalence at the district/city level, including autocorrelation applying the spatial autoregressive (SAR) model. The analyses revealed stunting prevalence above the national average in 282 districts/cities (54.9%), i.e. ≥30% in 297 districts/cities (57.8%) and ≥40% in 91 districts/cities (17.7%). Autocorrelation was found between Sumatra, Java, Sulawesi as well as Bali, East Nusa Tenggara and West Nusa Tenggara (Bali NTT NTB). The SAR modelling revealed the following variables with significant impact on the stunting prevalence in various parts of the country: closet defecation, hand washing, at least four antenatal care visits during pregnancy, poverty, immunisation and supplementary food for children under 5 years.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Aguayo VM, Menon P, 2016. Stop stunting: Improving child feeding, women’s nutrition and household sanitation in South Asia. Matern Child Nutr 12:3-11. DOI: https://doi.org/10.1111/mcn.12283
Anselin L, 2005. Exploring spatial data with GeoDa: A workbook. Geogr 244.
Badriyah L, Syafiq A, 2017. The association between sanitation, hygiene, and stunting in children under two-years (an analysis of Indonesia’s Basic Health Research, 2013). Makara J Health Res 21:35-41. DOI: https://doi.org/10.7454/msk.v21i2.6002
Bauza V, Guest JS, 2017. The effect of young children’s faeces disposal practices on child growth: evidence from 34 countries. Trop Med Int Health 22:1233-48. DOI: https://doi.org/10.1111/tmi.12930
Bhunia GS, Shit PK, 2019. Geospatial Analysis of Public Health, Springer Nature Switzerland, Switzerland. DOI: https://doi.org/10.1007/978-3-030-01680-7
Di Cesare M, Bhatti Z, Soofi SB, Fortunato L, Ezzati M, Bhutta ZA, 2015. Geographical and socioeconomic inequalities in women and children’s nutritional status in Pakistan in 2011: An analysis of data from a nationally representative survey. Lancet Glob. Health 3:229-39. DOI: https://doi.org/10.1016/S2214-109X(15)70001-X
Di Cesare M, Sabates R, 2013. Access to antenatal care and children’s cognitive development: A comparative analysis in Ethiopia, Peru, Vietnam and India. Int J Public Health 58:459-67. DOI: https://doi.org/10.1007/s00038-012-0418-1
Development Initiatives, 2018. Global nutrition report 2018: shining a light to spur action on nutrition.https://globalnutritionreport.org/reports/global-nutrition-report-2018/ Accessed: January 2020.
Fotheringham S, Rogerson PA, 2009. The SAGE Handbook of Spatial Analysis. Sage Publications, London, UK. DOI: https://doi.org/10.4135/9780857020130
Grekousis G. 2020. Spatial analysis methods and practice: describe, explore, explain through GIS. Cambridge University Press, Cambridge, UK. DOI: https://doi.org/10.1017/9781108614528
Gupta A, 2017. Assessing stunting and predisposing factors among children. Asian J Pharm Clin Res 10:364-71. DOI: https://doi.org/10.22159/ajpcr.2017.v10i10.21116
Hagos S, Hailemariam D, Wolde Hanna T, Lindtjørn B, 2017. Spatial heterogeneity and risk factors for stunting among children under age five in Ethiopia: a Bayesian geo-statistical model. PLoS One 12:1-18. DOI: https://doi.org/10.1371/journal.pone.0170785
Haile D, Azage M, Mola T, Rainey R, 2016. Exploring spatial variations and factors associated with childhood stunting in Ethiopia: Spatial and multilevel analysis. BMC Pediatr 16:49. DOI: https://doi.org/10.1186/s12887-016-0587-9
Hernández-Vásquez A, Tapia-López E, 2017.Desnutricióncrónicaenmenores de cincoañosen Perú: análisisespacial de información [Chronic Malnutrition among Children under Five in Peru: A Spatial Analysis of Nutritional Data, 2010-2016]. Rev Esp Salud Publica, pii: e201705035.
Huicho L, Huayanay-Espinoza CA, Herrera-Perez E, Segura ER, Niño de Guzman J, Rivera-Ch M, Barros AJD, 2017. Factors behind the success story of under-five stunting in Peru: a district ecological multilevel analysis. BMC Pediatr 17:29. DOI: https://doi.org/10.1186/s12887-017-0790-3
Jonah CMP, Sambu WC, May JD, 2018. A comparative analysis of socioeconomic inequities in stunting: a case of three middle-income African countries. Arch Public Health 76:1-15. DOI: https://doi.org/10.1186/s13690-018-0320-2
Kandala N-B, Madungu TP, Emina JB, Nzita KP, Cappuccio FP, 2011. Malnutrition among children under the age of five in the Democratic Republic of Congo (DRC): does geographic location matter? BMC Public Health 11:261. DOI: https://doi.org/10.1186/1471-2458-11-261
Leroy JL, Frongillo EA, 2019. Perspective: what does stunting really mean? A critical review of the evidence. Adv Nutr 10:196-204. DOI: https://doi.org/10.1093/advances/nmy101
Menon P, Headey D, Avula R, Nguyen PH, 2018. Understanding the geographical burden of stunting in India: a regression-decomposition analysis of district-level data from 2015-16. Matern Child Nutr 14:1-10. DOI: https://doi.org/10.1111/mcn.12620
Myers RH, 2000. Classical and modern regression with applications. Second Edition. Duxbury Press, United States.
Ministry of Health, 2015. Report of Indonesia Nutrition Status Monitoring 2015. Jakarta.
Ministry of Health,2016. Report of Indonesia Nutrition Status Monitoring 2016. Jakarta.
Ministry of Health,2017. Report of Indonesia Nutrition Status Monitoring 2017. Jakarta.
Ministry of Health,2018. National Report of Basic Health Research Indonesia 2018.
Monteiro CA, Benicio MHDA, Conde WL, Konno S, Lovadino AL, Barros AJD, Victora CG, 2010. Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974-2007. Bull World Health Organ 88:305-11. DOI: https://doi.org/10.2471/BLT.09.069195
National Team for Poverty Reducation Acceleration Indonesia, 2017. Gerakan Nasional Pencegahan Stunting dan Kerjasama Kemitraan Multisektor [National Movement for Stunting Prevention and Multisectoral Partnerships]: 1-42, Jakarta.
Pfeiffer D, Robinson T, Stevenson M, Stevens K, Rogers D, Clements A, 2008. Spatial analysis in epidemiology. Oxford University Press, New York, NY, USA. DOI: https://doi.org/10.1093/acprof:oso/9780198509882.001.0001
Rah JH, Cronin AA, Badgaiyan B, Aguayo V, Coates S, Ahmed S, 2015. Household sanitation and personal hygiene practices are associated with child stunting in rural India: A cross-sectional analysis of surveys. BMJ Open 5:e005180. DOI: https://doi.org/10.1136/bmjopen-2014-005180
Rahmawati AI, Umbul C, 2014. Faktor yang mempengaruhi kelengkapan imunisasi dasar di Kelurahan Krembangan Utara [Factors influenced the complete of primary immunization in Krembangan Utara Village]. Jurnal Berkala Epidemiologi 2:59-70. DOI: https://doi.org/10.20473/jbe.v2i1.2014.59-70
Ramirez N, Gamboa L, Bedi A, 2012. Child malnutrition and antenatal care: Evidence from three Latin American countries, Work. Pap (536).
Saxton J, Rath S, Nair N, Gope R, Mahapatra R, Tripathy P, Prost A, 2016. Handwashing, sanitation and family planning practices are the strongest underlying determinants of child stunting in rural indigenous communities of Jharkhand and Odisha, Eastern India: a cross-sectional study. Matern Child Nutr 12:869-84. DOI: https://doi.org/10.1111/mcn.12323
Schmidt C, 2014. Beyond malnutrition: the role of sanitation in stunted growth. Environ Health Perspect 122:298-303. DOI: https://doi.org/10.1289/ehp.122-A298
Souris M, 2019. Epidemiology and geography. John Wiley & Sons, London, UK. DOI: https://doi.org/10.1002/9781119528203
Spears D, Ghosh A, Cumming O, 2013. Open defecation and childhood stunting in India: an ecological analysis of new data from 112 districts. PLoS One 8:1-10. DOI: https://doi.org/10.1371/annotation/9ffcb740-f394-41af-bbbc-800c7cc25ea8
Sugiharto M, Budisuari MA, 2017. Review of implementation of complete basic immunisation performed by midwives in Bangkalan District, 2015. J Kesehat Reprod 8:187-202.
Sujendran S, Senarath U, Joseph J, 2015. Prevalence of stunting among children aged 6 to 36 months, in the Eastern Province of Sri Lanka. J Nutr Disord Ther 5:1-3. DOI: https://doi.org/10.4172/2161-0509.1000154
Sulistiyani P, Shaluhiyah Z, Cahyo K, 2017. Gambaran Penolakan Masyarakat Terhadap Imunisasi Dasar Lengkap Bagi Balita (Studyin Sendangmulyo Village, Semarang City) [Overview of Public Rejection of Complete Basic Immunizations for Toddlers]. Jurnal Kesehatan Masyarakat 5:1081-91.
Talukder A, Razu SR, Hossain MZ, 2018. Factors affecting stunting among children under five years of age in Bangladesh. Fam Med Prim Care Rev 20:356-62. DOI: https://doi.org/10.5114/fmpcr.2018.79348
Tariku A, Biks GA, Derso T, Wassie MM, Abebe SM, 2017. Stunting and its determinant factors among children aged 6-59 months in Ethiopia. Ital J Pediatr 43:112. DOI: https://doi.org/10.1186/s13052-017-0433-1
Tessema M, Belachew T, Ersino G, 2013. Feeding patterns and stunting during early childhood in rural communities of Sidama South Ethiopia. Pan Afr Med J 14:1-12.
Titaley CR, Ariawan I, Hapsari D, Muasyaroh A, Dibley MJ, 2019. Determinants of the stunting of children under two years old in Indonesia: a multilevel analysis of the 2013 Indonesia basic health survey. Nutrients 11:1106. DOI: https://doi.org/10.3390/nu11051106
Torlesse H, Cronin AA, Sebayang SK, Nandy R, 2016. 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 16:669. DOI: https://doi.org/10.1186/s12889-016-3339-8
UNICEF, 1991. Strategy for improved nutrition of children and women in developing countries. UNICEF, New York, USA.
UNICEF, 1998. The State of The World’s Children 1998. UNICEF, New York, USA.
WHO, 2013. Childhood stunting: context, causes and consequences. WHO conceptual framework. World Health Organization, Geneva, Switzerland.
WHO, 2014. Global nutrition targets 2025 stunting policy brief. World Health Organization, Geneva, Switzerland.
Waller LA, Gotway CA, 2004. Applied spatial statistics for Public Health Data. John Wiley & Sons, USA. DOI: https://doi.org/10.1002/0471662682
Wirth JP, Rohner F, Petry N, Onyango AW, Matji J, Bailes A, de Onis M, Woodruff BA, 2017. Assessment of the WHO stunting framework using Ethiopia as a case study. Matern Child Nutr 13:1-16. DOI: https://doi.org/10.1111/mcn.12310

How to Cite

Eryando, T., Sipahutar, T., Budhiharsana, M. P., Siregar, K. N., Nur Aidi, M. ., Minarto, D., Utari, D. M., Rahmaniati, M., & Hendarwan, H. . (2022). Spatial analysis of stunting determinants in 514 Indonesian districts/cities: Implications for intervention and setting of priority. Geospatial Health, 17(1). https://doi.org/10.4081/gh.2022.1055

Similar Articles

You may also start an advanced similarity search for this article.