The impact of food affordability and essential services on child stunting in Kalimantan

Abstract

Background: Child stunting remains a major public health issue in Indonesia, particularly in Kalimantan, where high food prices, poverty, and limited access to water, sanitation, and hygiene (WASH) intersect. This study investigates how the affordability of nutrient-rich foods, income inequality, and environmental health affect child growth outcomes. Methods: A quantitative cross-sectional analysis was conducted using 2024 provincial data from 5 provinces of Kalimantan. Key variables included stunting prevalence, food prices, affordability indices, poverty rate, Gini ratio, and WASH access. Nutritional affordability was assessed using the Cost of Nutrient Adequacy (CoNA) framework, calculated as the cost per 1,000 kilocalories and per 10 grams of protein. Statistical analyses were applied using STATA 18 included Spearman’s correlation and robust Ordinary Least Squares (OLS) regression with HC3 standard errors and 1,000 bootstrap resamples. Findings: Results showed that affordability and improved WASH access are associated with reduced stunting, while higher poverty and inequality are linked to increased stunting. The interaction between affordability and inequality diminished the protective effect of affordability (β = +2.83, p = 0.03), accounting for 78% of the variance. These results demonstrate that both economic and infrastructural equity are critical determinants of child nutrition outcomes. Conclusion: This study presents a provincial application of the CoNA framework in Indonesia, integrating affordability, inequality, and WASH indicators within a unified econometric model to elucidate regional disparities in stunting. Novelty/Originality of this article: This study applying the Cost of Nutrient Adequacy (CoNA) framework at the provincial level in Indonesia and integrating food affordability, economic inequality, and WASH access within a unified econometric model to identify multidimensional determinants of stunting and inform evidence-based, equity-oriented public health strategies for vulnerable populations.