Mapping Human Development Index and Nutritional Status: Identifying Factors Associated with Malnutrition in Indonesia

Background: Indonesia, as an upper-middle-income country, is undergoing a nutrition transition. The persistent problem of undernutrition is now accompanied by rising overnutrition, creating a double burden of malnutrition. The Human Development Index (HDI) that measures socio-economic development, has shown steady improvements in Indonesia, yet nutritional disparities remain across provinces with varying HDI levels. Objective: This study aims to map the relationship between HDI and nutritional status by analyzing the prevalence of stunting, wasting, underweight, and overweight across different HDI categories and provinces in Indonesia. Additionally, this study explores the determinants of malnutrition to provide a deeper understanding of the factors influencing child nutrition status. Methods: This ecological study utilizes data from 2023 Indonesian Nutrition Status Study, Central Bureau of Statistics and Indonesian Demographic and Health Survey and creates provincial level dataset with malnutrition prevalence, HDI, and other health indicators. The analysis employs spatial relationship, descriptive statistics, and correlation analysis to assess the determinants of malnutrition. This ecological study used 2023 provincial-level data from the Indonesian Health Survey (SKI) and the Human Development Index (HDI) published by the Central Bureau of Statistics. Nutritional indicators (stunting, underweight, wasting, and overweight) were analyzed in relation to HDI and other determinants. Spearmans correlation and Mann-Whitney U tests were used for statistical analysis. Spatial patterns were visualized through GIS mapping to explore geographic relationships between HDI levels and nutritional status. Results: Provinces with high to very high HDI had significantly lower prevalence of stunting (21.36% vs. 31.80%), underweight (16.60% vs. 21.89%), and wasting (9.49% vs. 13.00%) compared to those with low to medium HDI (p < 0.05). No significant difference was found for overweight. Significant negative correlations were observed between stunting, underweight, and wasting with several key determinants, including exclusive breastfeeding, proper infant and young child feeding practices, adequate vitamin A intake, proper handwashing and sanitation practices, parental education, immunization coverage, and HDI. However, no significant correlations were found between these determinants and overweight. Conclusion: This study highlights the complex relationship between HDI and nutritional status, emphasizing the need for region-specific interventions. While improving HDI can help to reduce undernutrition, rising overweight prevalence requires targeted public health strategies. These findings offer valuable insights for policymakers to design holistic, multi-dimensional approaches to combat malnutrition in Indonesia. Keywords: Human Development Index, Nutritional Status, Spatial Analysis, Malnutrition, Indonesia