Acceleration of stunting reduction: Advancing social and environmental well-being through policy, education, and environmental management
DOI:
https://doi.org/10.61511/jssew.v2i2.2025.1496Keywords:
drinking water, East Nusa Tenggara, environmental, sanitation, stuntingAbstract
Background: Stunting is a serious public health problem in Indonesia, especially in East Nusa Tenggara/Nusa Tenggara Timur (NTT) Province, which has a high prevalence. Based on the 2021 Indonesian Nutritional Status Survey (SSGI), there are 15 districts in NTT with stunting rates of more than 30%, even in South Central Timor and North Central Timor Regencies, the prevalence reaches more than 46%. The main factors contributing to stunting include malnutrition, poor sanitation, and consanguineous marriage practices. Methods: This study uses a literature review approach by applying the Social Ecological Model (SEM) to analyze risk factors and intervention strategies. The data used include empirical studies and policies related to stunting in NTT. Findings: The analysis shows that poor sanitation, such as access to clean drinking water which only reaches 86.79% and access to proper sanitation of 73.7%, is correlated with high stunting rates. Data also show that low milk consumption, with an average consumption of only 30 kilocalories per capita per day in Southeast Asia, contributes to the high prevalence of stunting of 31%. In addition, maternal education levels and the practice of washing hands with soap after feeding children are significantly associated with stunting. Social assistance programs such as the Family Hope Program/Program Keluarga Harapan (PKH) have reached 64% of beneficiaries but have not been effective in reducing stunting rates because there is still inaccuracy in targeting recipients. Conclusion: Accelerating stunting reduction in NTT requires a multi-sectoral approach involving improving sanitation infrastructure, increasing access to nutrition, health education, and optimizing social assistance programs. Monitoring and evaluation of policy implementation need to be improved to ensure the effectiveness of the interventions carried out. Novelty/Originality of this article: This study highlights the relationship between environmental factors, cultural practices, and policy effectiveness in accelerating stunting reduction in NTT. The SEM approach used offers a holistic perspective in understanding the complexity of the problem and designing more effective intervention strategies.
References
[BPS NTT] Badan Pusat Statistik Provinsi Nusa Tenggara Timur/ Central Statistics Agency of East Nusa Tenggara Province. (2023). Infografis Indeks Pembangunan Manusia Provinsi Nusa Tenggara Timur. Badan Pusat Statistik Provinsi Nusa Tenggara Timur. https://ntt.bps.go.id/indicator/26/46/1/-metode-baru-indeks-pembangunan-manusia-ipm-menurut-kabupaten-kota.html
Akbar, D. D. (2023). Pollution and stunting (Case study at DKI Jakarta). Jurnal Pendidikan Bahasa, 10(2), Oktober 2023. https://doi.org/10.36232/jurnalpendidikanbahasa.v10i2.4899
Akram, R., Sultana, M., Ali, N., Sheikh, N., Sarker, A.R. (2018). Prevalence and Determinants of Stunting Among Preschool Children and Its Urban–Rural Disparities in Bangladesh. Food and Nutrition Bulletin, 39(4), 521-535. https://doi.org/10.1177/0379572118794770
Aprihatin, Y., Barlian, E., Fatimah, S., Yanti, E., & Amaita. (2020). Impact of Environmental Sanitation and Infection Disease as a Determining Stunting Factor for Children. Jurnal Kebencanaan, Geografi dan Pendidikan Geografi Sumatera, 4(2), 209–211. http://sjdgge.ppj.unp.ac.id/index.php/Sjdgge/article/view/336
Apriliana, T., Keliat, B.A., Mustikasari, Primasari, Y. (2022). A contributing factor to maternal pregnancy depression is the occurrence of stunting in toddlers. Journal of Public Health Research, 11, 2738. https://doi.org/10.4081/jphr.2021.2738
Armand, A., & Carneiro, P. (2018). Impact evaluation of the conditional cash transfer program for secondary school attendance in Macedonia. Impact Evaluation Report (Report No. 69). International Initiative for Impact Evaluation (3ie). https://3ieimpact.org
Attanasio, O., Cattan, S., Meghir, C. (2021) Early Childhood Development, Human Capital, and poverty. Annual Rev Econ. 14. https://doi.org/10.1146/annurev-economics092821-053234
Barth‑Jaeggi, T., Speich, T., Havugimana, C., Bayisenge, F., Kimenju, S., Omondi, W., Pasha, S.F., Islam, S., van Zutphen‑Küffer, K.G., van den Berg, S., Barjolle, D., Pannatier, M., Prytherch, H. (2023). Nutrition transition, the double burden of malnutrition, and urbanization patterns in secondary cities of Bangladesh, Kenya, and Rwanda. BMC Nutrition, 9, 125. https://doi.org/10.1186/s40795-023-00782-1
Berhanu, A., Garoma, S., Arero, G., Mosisa, G. (2022). Stunting and associated factors among school-age children (5–14 years) in Mulo district, Oromia region, Ethiopia. Sage Open Medicine. https://doi.org/10.1177/20503121221127880
Carter, B., Roelen, K., Enfield, S., & Avis, W. (2019). Social protection topic guide. The Institute of Development Studies and Partner Organisations. https://hdl.handle.net/20.500.12413/14885
Chowdhury, M.H., Aktar, M.F., Islam, M.A., Khan, N.M. (2023). Factors associated with stunting status among under-5 years children in Bangladesh: Quantile regression modeling approach. Children and Youth Services Review. 155, 107199. https://doi.org/10.1016/j.childyouth.2023.107199
de Beer, H., 2012. Dairy products and physical stature: a systematic review and meta-analysis of controlled trials. Economics & Human Biology 10, 299-309. https://doi.org/10.1016/j.ehb.2011.08.003
Dieleman, J.L. (2020). Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3. Lancet, 396, 693–724. https://doi.org/10.1016/S0140-6736(20)30608-5
Dimitrova, A., Marois, G., Kiesewetter, G., Rafaj, P., Pachauri, S., KC, S., Olmos, S., Rasella, D., & Tonne, C. (2022). Memproyeksikan dampak polusi udara terhadap stunting pada anak di India—sinergi dan keseimbangan antara mitigasi perubahan iklim, pengendalian kualitas udara sekitar, dan akses memasak bersih. Surat Penelitian Lingkungan, 17(10). https://doi.org/10.1088/1748-9326/ac8e89
Dorsten, L. E., Hotchkiss, L., & King, T. M. (1999). The effect of inbreeding on early childhood mortality: Twelve generations of an Amish settlement. Demography, 36, 263–271.
Dror, D.K., Allen, L.H., 2011. The Importance of Milk and Other Animal-Source Foods for Children in Low-Income Countries. Food Nutr. Bull, 32(3), 227–243. https://doi.org/10.1177/156482651103200307
Dror, D.K., Allen, L.H., 2014. Dairy product intake in children and adolescents in developed countries: trends, nutritional contribution, and a review of association with health outcomes. Nutrition Reviews, 72(2), 68–81. https://doi.org/10.1111/nure.12078
Esen E, Çelik, Keçili, M. (2021). Economic growth and health expenditure analysis for Turkey: evidence from time series. Journal of the Knowledge Economy, 13, 1786-1800. https://doi.org/10.1007/s13132-021-00789-8
Fanzo, J., & Davis, C. (2021). The multiple burdens of malnutrition. In Global food systems, diets, and nutrition (Palgrave Studies in Agricultural Economics and Food Policy). Palgrave Macmillan. https://doi.org/10.1007/978-3-030-72763-5_5
Gayawan, E., Egbon, O.A. (2023). Spatio-temporal mapping of stunting and wasting in Nigerian children: A bivariate mixture modeling. Spatial Statistics. 58. https://doi.org/10.1016/j.spasta.2023.100785
Gizaw, Z., Yalew, AW, Bitew, BD, Lee, J., & Bisesi, M. (2022). Stunting pada anak usia 24–59 bulan dan kaitannya dengan sanitasi, infeksi usus, dan disfungsi usus lingkungan di pedesaan barat laut Ethiopia. Laporan Ilmiah, 12(1), 1–11. https://doi.org/10.1038/s41598-022-23981-5
Haile, B., & Headey, D. (2023). Growth in milk consumption and reductions in child stunting: Historical evidence from cross-country panel data. Food Policy, 118, 102485. https://doi.org/10.1016/j.foodpol.2023.102485
Halkos, G., Gkampoura, E.C. (2021). Where do we stand on the 17 Sustainable Development Goals? An overview of progress. Economic Analysis and Policy, 70, 94–122. https://doi.org/10.1016/j.eap.2021.02.001
Headey, D., Hirvonen, K., Hoddinott, J., 2018. Animal Sourced Foods and Child Stunting. American Journal of Agricultural Economics, 100(5), 1302–1319. https://doi.org/10.1093/ajae/aay053
Headey, D., Hoddinot, J., Park S. (2016). Drivers of nutritional change in four South Asian countries: a dynamic observational analysis. Maternal & Child Nutrition, 12(S1), 210–218. https://doi.org/10.1111/mcn.12274
Headey, D., Palloni, G., 2019. Water, Sanitation, and Child Health: Evidence From Subnational Panel Data in 59 Countries. Demography, 56, 729–752. https://doi.org/10.1007/s13524-019-00760-y
Hermawan, D., Kurniasari, D., Sandayanti, V., Sari, N., Listyaningsih, E. (2023). Relationships of deworming drug consumption and animal protein intake with stunting. Parasite Epidemiology and Control, 23. https://doi.org/10.1016/j.parepi.2023.e00326
Iannotti, L., Muehlhoff, E., Mcmahon, D., 2013. Review of milk and dairy programs affecting nutrition. Journal of Development Effectiveness, 5(1), 82–115. https://doi.org/10.1080/19439342.2012.758165
Jolly, S.P., Chowdhury, T.R., Sarker, T.T., Afsana, K. (2023). Water, sanitation, and hygiene (WASH) practices and deworming improve the nutritional status and anemia of unmarried adolescent girls in rural Bangladesh. Journal of Health, Population and Nutrition, 42, 127. https://doi.org/10.1186/s41043-023-00453-8
Kaiser, J. (2016). When DNA and culture clash. Science, 354, 1217–1221. https://doi.org/10.1126/science.354.6317.1217
Lapak, M.M.M.M., Sendratari, L.P., Wirawan, I. G. M. A. S. (2021). Eksistensi Budaya Kawin Tungku Di Kalangan Pemuda Manggarai Kecamatan Cibal Nusa Tenggara Timur Sebagai Sumber Belajar Sosiologi Di SMA. Journal Pendidikan Sosiologi, 3(3), https://doi.org/10.1016/s2542-5196(19)30144-5
Lloyd, S., Bangalore, M., Chalabi, Z., Kovats, RS, Hallegatte, S., Ronberg, J., & Valin, H. (2019). Potensi dampak perubahan iklim terhadap stunting pada anak melalui pendapatan dan harga pangan pada tahun 2030: model tingkat global. Kesehatan Planet Lancet, 3(S1). https://doi.org/10.1016/s2542-5196(19)30144-5
Matingwina T. (2018). Health, academic achievement, and school-based interventions. Intech. https://dx.doi.org/10.5722/intechopen.764331
Ministry of Environment and Forestry. (2022). Indonesian Environmental Status https://ppkl.menlhk.go.id
Ministry of Health. (2022). Indonesian Nutrition Status Survei. https://layanandata.kemkes.go.id/katalog-data/ssgi/ketersediaan-data/ssgi-2022
Nadhiroh, S. R., Micheala, F., Tung, S. E. H., & Kustiawan, T. C. (2023). Association between maternal anemia and stunting in infants and children aged 0–60 months: A systematic literature review. Nutrition, 115, 112094. https://doi.org/10.1016/j.nut.2023.112094
Nefiodow L. (2014). Health: The economic growth engine of the 21st century. ICU Manage Pract, 14(4), 1–6. https://healthmanagement.org/c/icu/issuearticle/health-the-economic-growth-engine-of-the-21st-century-1
Oginawati, K., Yapfrine, S.J., Fahimah, N., Salami, I.R.S., Susetyo, S.H. (2023). The associations of heavy metals exposure in water sources to the risk of stunting cases. Emerging Contaminants, 9. https://doi.org/10.1016/j.emcon.2023.100247
Perkins, J.M., Kim, R., Krishna, A., McGovern, M., Aguayo, V.M., Subramanian, S.V. (2017). Understanding the association between stunting and child development in low- and middle-income countries: Next steps for research and intervention. Social Science and Medicine, 193. https://doi.org/10.1016/j.socscimed.2017.09.039
Popkin, B.M., Corvalan, C., Grummer-Strawn, L.M. (2020). Dynamics of the Double Burden of Malnutrition and the Changing Nutrition Reality. The Lancet, 395(10217), 65–74. https://doi.org/10.1016/S0140-6736(19)32497-3
Pradhan, I., Pradhan, J., Kandapan, B. (2023). Caste-based analysis of multidimensional early childhood poverty in India: Patterns and determinants. Children and Youth Services Review, 155, 107220. https://doi.org/10.1016/j.childyouth.2023.107220
Raja, S., Sweeney, E., Mui, Y., Frimpong–Boamah, E. (2021). Local Government Planning for Community Food Systems—Opportunity, Innovation, and Equity in Low- and Middle-Income Countries. FAO.
Rekha, S., Shirisha, P., Muraleedharan, V.R., Vaidyanathan, G., Dash, U. (2023). Wealth inequalities in nutritional status among the tribal under-5 children in India: A temporal trend analysis using NFHS data of Jharkhand and Odisha states - 2006-21. Dialogues in Health, 2. http://dx.doi.org/10.1016/j.dialog.2023.100135
Ruel, M.T., Quisumbing, A.R., Balagamwala, M., 2018. Nutrition-sensitive agriculture: What have we learned so far? Global Food Security, 17, 128–153. https://doi.org/10.1016/j.gfs.2018.01.002
Rukiko, M.D., Mwakalobo, A.B.S., Mmasa, J.J. (2023). The impact of the Conditional Cash Transfer program on stunting in under five years poor children. Public Health in Practice, 6. https://doi.org/10.1016/j.puhip.3.100437
Saggar, A. K., & Bittles, A. H. (2008). Consanguinity and child health. Paediatrics and Child Health, 18, 244–249. https://doi.org/10.1016/j.paed.2008.02.008
Saif, S., & Anwar, S. (2023). Unraveling the South Asian enigma: concurrent manifestations of child anthropometric failures and their determinants in selected South Asian countries. BMC Nutrition, 9(120). https://doi.org/10.1186/s40795-023-00771-4
Sangalang, S.O., Prado, N.O., Lemence, A.L.G., Cayetano, M.G., Lu, J.L.D.P, Valencia, J.C., Kistemann, T., Borgemeister, C. (2022). Diarrhea, malnutrition, and dehydration associated with school water, sanitation, and hygiene in Metro Manila, Philippines: A cross-sectional study. Science of the Total Environment, 838, 155882. http://dx.doi.org/10.1016/j.scitotenv.2022.155882
Sharma, N., Shastri, S., Shastri, S. (2023). Does urbanization level and types of urban settlements matter for child stunting prevalence in India? Empirical evidence based on nighttime light data. Cities, 140. https://doi.org/10.1016/j.cities.2023.104388
Spears, D., (2018). Exposure to open defecation can account for the Indian enigma of child height. Journal of Development Economics, 146. https://doi.org/10.1016/j.jdeveco.2018.08.003
Speich, C., Barth-Jaeggi, T., Musard, C., Havugimana, C., Nwokoro, C., Gakuba, E., Zamil, F., Sécula, F., Thönnissen, C., Six, J., Kraemer, K., van Zutphen, K.G., Sonnevelt, M., Tshering, P.P., Erismann, S., van den Berg, S., Winter, S., Johnson-Chadwick, V., Pannatier, M., Gavin-Smith, B., Barjolle, D., Prytherch, H. (2023). Nutrition in City Ecosystems (NICE): Protocol of a multi-sectoral development project to improve food and nutrition security of secondary city populations in Bangladesh, Kenya, and Rwanda. Front Public Health 11. https://doi.org/10.3389/fpubh.2023.1081535
Vishwakarma, D. Sharma, S.K, Puri, P. (2021). Linkages between consanguineous marriages and childhood stunting: Evidence from a cross-sectional study in India. Children and Youth Services Review, 122. https://doi.org/10.1016/j.childyouth.2021.105922
Williyanarti, P.F., Wulandari, Y., Nasrullah, D. (2022). Behavior in fulfilling nutritional needs for Indonesian children with stunting: Related culture, family support, and mother’s knowledge. Journal of Public Health Research. 11(4), 1–5. https://doi.org/10.1177/22799036221139938
Woldesenbet, B., Tolcha, A., & Tsegaye, B. (2023). Water, hygiene and sanitation practices are associated with stunting among children of age 24-59 months in Lemo district, South Ethiopia, in 2021: Community-based cross-sectional study. BMC Nutrition, 9(1), 17. https://doi.org/10.1186/s40795-023-00677-1
Yudono, A., Purnomo, J., & Damayanti, R. (2021). Regresi Tertimbang Geografis Faktor Risiko Stunting di Kabupaten Malang, Indonesia. Forum Geografi, 35(1), 1–13. https://doi.org/10.23917/forgeo.v35i1.12273
Zaba, T., Conkle, J., Nyawo, M., Foote, D., Myatt, M., (2022). Concurrent wasting and stunting among children 6–59 months: an analysis using district-level survey data in Mozambique. BMC Nutrition, 8(1), 15. https://doi.org/10.1186/s40795-022-00508-9
Downloads
Published
How to Cite
Issue
Section
Citation Check
License
Copyright (c) 2025 Samuel Evan Firdaus, Precious Douglas Maulana
This work is licensed under a Creative Commons Attribution 4.0 International License.
