Identifying factors associated with childhood stunting in West Java, Indonesia: an explanatory sequential mixed-methods study

Abstract

Abstract Objective Stunting impairs child development and long-term economic productivity. In Indonesia, prevalence has declined substantially but progress has slowed. We aim to understand the contextual factors of childhood stunting in two rural communities in the Sumedang district, West Java, which is prioritised by health authorities due to its high stunting prevalence. Methods We used an explanatory sequential mixed-methods design. A cross-sectional household survey (172 children under 5 years of age) informed the adaptation of interview guides for a qualitative phase consisting of 34 in-depth interviews with caregivers and community key informants, which were analysed inductively and integrated with the survey findings in a joint display. Results Measured stunting prevalence was similar in the two communities (20.5% and 29.8%) and higher than the routine district estimates. Exploratory models showed common associations such as with household wealth, consistent with the wider literature. The interviews uncovered important resources and risks. These included informal nutrition education networks, delegated caregiver arrangements, coping with food insecurity through borrowing, credit, subsistence farming and fishing and health-worker accompaniment and village-funded social assistance programmes as buffers. Conclusions Stunting in these communities was high and socially patterned. Sustained reductions will require ongoing intergenerational policies that address structural socioeconomic disadvantage and strengthen caregiving environments, rather than stand-alone nutrition or health interventions.