Sociodemographic and Household Environmental Determinants of Stunting at Birth: Evidence of Regional Disparities in Indonesia

Abstract Background: Stunting at birth reflects impaired fetal growth and increases the risk of adverse health outcomes throughout the life course. Evidence on regional variations in determinants of stunting at birth in Indonesia remains limited. This study identified sociodemographic, and household environmental determinants of stunting at birth at both the national and regional levels. Methods: This cross-sectional study analyzed data from the 2024 Indonesian Nutritional Status Survey (SSGI), including 28,982 children aged 0-23 months. Bivariate and multivariable logistic regression analyses were conducted nationally and across seven regions: Sumatra, Java-Bali, Nusa Tenggara, Kalimantan, Sulawesi, Maluku, and Papua. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. Results: The prevalence of stunting at birth was 5.53%, with the highest prevalence in Sulawesi (8.02%). Nationally, household crowding was the only factor significantly associated with stunting at birth after adjustment. Regional analyses revealed considerable variation in associated factors. In Sumatra, urban residence was associated with lower odds of stunting at birth (aOR: 0.73; 95% CI: 0.55-0.97), while children from the lowest wealth quintile had higher odds (aOR: 1.78; 95% CI: 1.03-3.06). In Java-Bali, low maternal nutritional knowledge was associated with increased odds of stunting at birth (aOR: 1.65; 95% CI: 1.02-2.66). In Nusa Tenggara, limited drinking water services (aOR: 2.35; 95% CI: 1.09-5.07) and limited sanitation services (aOR: 2.34; 95% CI: 1.28-4.26) were associated with higher odds of stunting at birth. Conclusions: Determinants of stunting at birth differed across Indonesian regions. While household crowding emerged as a national determinant, socioeconomic factors were more important in Sumatra, maternal nutritional knowledge in Java-Bali, and environmental conditions in Nusa Tenggara. These findings highlight the need for region-specific strategies to prevent stunting from the prenatal period.