Factors Associated with Stunting Prevalence in Indonesia: A Multilevel Analysis of Island Disparities

Introduction: Stunting among children under the age of five is a major public health challenge in Indonesia. Several factors have been identified as influencing stunting; however, Indonesia has several islands with unique characteristics that may impact them. Objectives: This study aims to investigate factors that are associated to the district's stunting prevalence in Indonesia that extend island-level variation. Methods: This study utilised data mainly from the 2020 Food Security and Vulnerability Atlas (data indicator of 2019) of the Indonesian Ministry of Agriculture. The independent variables are classified into two levels: the district level (514 districts) and the island level (eight major islands). The analysis was done using multilevel linear regression. Results: Most districts (473 out of 514) have a high or very high prevalence of stunting. The results of the multilevel analysis suggest that 5 out of 6 variables at the district level and 1 out of 3 variables at the island level correlate with stunting prevalence in Indonesia. Poverty, households with food expenditures greater than 65%, households without water, and women's education were all positively related with stunting at the district level, but health personnel coverage was adversely associated. At the island level, Gross Regional Domestic Products (GRDP) were found to be negatively linked with stunting. Conclusion: Poverty and lack of basic infrastructure continue to be major contributors to stunting. Given Indonesia's breadth and number of islands, stunting-reduction initiatives are customised to regional challenges, with a focus on regions where stunting is more prevalent.