Beyond personal factors: Multilevel determinants of childhood stunting in Indonesia.

Tri Mulyaningsih,Vitri Widyaningsih,Riyana Miranti,Tesfaye Alemayehu Gebremedhin,Vincent Hadi Wiyono,Itismita Mohanty,Ammal Mokhtar Metwally

doi:10.1371/journal.pone.0260265

Tri Mulyaningsih, Vitri Widyaningsih + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0260265

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Journal: PloS one	Publication Date: Nov 19, 2021
Citations: 20	License type: CC BY 4.0

Affiliation: Sebelas Maret University, University of Canberra

Abstract

Stunting is still a major public health problem in low- and middle-income countries, including Indonesia. Previous studies have reported the complexities associated with understanding the determinants of stunting. This study aimed to examine the household-, subdistrict- and province-level determinants of stunting in Indonesia using a multilevel hierarchical mixed effects model. We analyzed data for 8045 children taken from the 2007 and 2014 waves of the Indonesian Family and Life Surveys (IFLS). We included individual-, family-/household- and community-level variables in the analyses. A multilevel mixed effects model was employed to take into account the hierarchical structure of the data. Moreover, the model captured the effect of unobserved household-, subdistrict- and province-level characteristics on the probability of children being stunted. Our findings showed that the odds of childhood stunting vary significantly not only by individual child- and household-level characteristics but also by province- and subdistrict-level characteristics. Among the child-level covariates included in our model, dietary habits, neonatal weight, a history of infection, and sex significantly affected the risk of stunting. Household wealth status and parental education are significant household-level covariates associated with a higher risk of stunting. Finally, the risk of stunting is higher for children living in communities without access to water, sanitation and hygiene. Stunting is associated with not only child-level characteristics but also family- and community-level characteristics. Hence, interventions to reduce stunting should also take into account family and community characteristics to achieve effective outcomes.

Highlights

Stunting is an ongoing issue in many low- and middle-income countries
This paper addresses two main research questions: Do variations at the province, subdistrict, household and individual levels explain childhood stunting in Indonesia? What are the multilevel determinants of childhood stunting in Indonesia? The remaining parts of the paper are organized as follows
We considered the subdistrict as the third level in our model, as service provision and quality of care in primary health centers (PHCs) or puskesmas are determined at the subdistrict level

Summary

Introduction

Stunting is an ongoing issue in many low- and middle-income countries. The proportion of stunted children is concentrated in low-income (16%) and lower-middle-income (47%) countries compared to upper-middle-income (27%) and high-income (10%) countries [1]. Indonesia is one of the countries with a high burden of malnutrition, including stunting [1]. Data published by the Ministry of Health show that the incidence of stunting among children aged five years and below remains high at 30.8% [3]. The World Bank (2020) [4] noted that Indonesia has underperformed in terms of reducing the level of stunting compared to other upper-middle-income countries and other countries in the region. Stunting is still a major public health problem in low- and middle-income countries, including Indonesia.

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