HOUSEHOLD SOCIAL CONTEXT AND HEALTH BEHAVIORS INFLUENCING CHILD STUNTING: INSIGHTS FROM NORTH SUMATRA, INDONESIA

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, equityoriented
public health strategies that consider both behavioral practices and the underlying
social vulnerabilities shaping child health outcomes in decentralized contexts like North
Sumatra.