Multilevel Determinants Associated with Childhood Stunting in Southeast Asia: A Systematic Review
TL;DR
The findings support integrated, multilevel strategies addressing child, maternal, household, environmental, and health-system factors in Southeast Asia and further longitudinal and multilevel research is needed to clarify interactions among these determinants.
Abstract
Childhood stunting remains a major public health challenge in Southeast Asia, including Indonesia, Cambodia, the Philippines, Vietnam, and Malaysia, and is influenced by interconnected determinants operating at multiple levels. However, evidence integrating these determinants among children under five years remains fragmented. This systematic review aimed to synthesize evidence on multilevel determinants associated with childhood stunting among children aged 0–59 months in Southeast Asia. A systematic literature review following PRISMA guidelines was conducted. PubMed and Sciencedirect was searched for analytical observational studies published from 2020 to 2026. Eligible studies examined stunting or linear growth and at least one determinant among children aged 0–59 months in Southeast Asia. Determinants were organized into five levels: child, maternal, household, environmental/community, and health-system. Methodological quality was assessed using design-specific Joanna Briggs Institute critical appraisal tools. Findings were synthesized narratively. The search identified 456 records, of which 35 reports met the eligibility criteria and underwent quality appraisal. Child-level determinants were examined most frequently (30; 76.9%), followed by household (23; 58.9%) and maternal determinants (24; 61.5%). Environmental/community determinants were examined in 18 reports (46.2%), while health-system determinants were examined in 8 (20.5%). Reported associations included birth characteristics, dietary and infection-related factors, maternal height and education, socioeconomic conditions, water, sanitation and hygiene, and selected health services. Childhood stunting in Southeast Asia is associated with determinants across multiple levels. The findings support integrated, multilevel strategies addressing child, maternal, household, environmental, and health-system factors. Further longitudinal and multilevel research is needed to clarify interactions among these determinants.