Chronic Energy Deficiency, High Parity, and Child Stunting: An Urban–Rural Analysis Using Indonesia’s 2024 Nutritional Status Survey

Authors

  • Ummi Khairun Niswah Faculty of Public Health, Universitas Islam Negeri Sumatera Utara, Indonesia
  • Khelian Ni Syevira Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
  • Sevrima Anggraini Faculty of Health Science, Universitas Ibn Khaldun Bogor, Bogor, West Java, Indonesia
  • Muhammad Nuzul Azhim Ash Siddiq Faculty of Public Health, Universitas Mulawarman, Samarinda, Kalimantan Timur, Indonesia

DOI:

https://doi.org/10.26911/jepublichealth.2026.11.04.08

Abstract

Background: Stunting remains a major public health problem in Indonesia, affecting nearly one-fifth of children under five, with maternal chronic energy deficiency (CED) and high parity considered important contributing factors at the maternal–child interface. This study examined the association between maternal CED, parity, diarrheal morbidity, and residence with stunting among children under five, using nationally representative data from the 2024 Indonesian Nutritional Status Survey.

Subjects and Methods: This cross-sectional study used data on children aged 0–59 months selected through two-stage stratified sampling. After excluding children with incomplete data on all study variables, the final analytic sample comprised 261,819 children. The dependent variable was stunting status (stunted versus not stunted) among children aged 0–59 months, defined as height-for-age z-score (HAZ < -2 SD). Independent variables were child diarrheal history, maternal parity, CED, maternal BMI, and place of residence. Multivariate logistic regression was performed to obtain adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results: Grand multiparity (aOR = 2.11; 95% CI= 1.97 to 2.26; p < 0.001), rural residence (aOR = 1.30; 95% CI= 1.26 to 1.35; p < 0.001), maternal CED (aOR = 1.49; 95% CI= 1.40 to 1.60; p < 0.001), and maternal underweight (aOR = 1.26; 95% CI= 1.17 to 1.35; p < 0.001) were associated with higher odds of stunting. Diarrhea lasting more than two weeks increased risk of stunting (aOR = 1.28; 95% CI= 1.04 to 1.57; p = 0.019).

Conclusion: Maternal parity, chronic energy deficiency, BMI, diarrheal history, and rural residence were associated with childhood stunting. Practical strategies such as family planning counseling for high-parity mothers, supplementary feeding programs for underweight women, and community-based sanitation initiatives in rural areas may help reduce this burden.

Keywords:

stunting, chronic energy deficiency, parity, diarrhea, rural

Published

2026-10-16

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Issue

Vol. 11 No. 4 (2026)

Section

Articles

How to Cite

Chronic Energy Deficiency, High Parity, and Child Stunting: An Urban–Rural Analysis Using Indonesia’s 2024 Nutritional Status Survey. (2026). Journal of Epidemiology and Public Health, 11(4), 486-497. https://doi.org/10.26911/jepublichealth.2026.11.04.08

References

Ayuningtyas D, Hapsari D, Rachmalina R, Amir V, Rachmawati R, Kusuma D. (2022). Geographic and Socioeconomic Disparity in Child Undernutrition across 514 Districts in Indonesia. Nutrients. 14(4):843. https://doi.org/10.3390/nu14040843.

Beal T, Tumilowicz A, Sutrisna A, Izwardy D, Neufeld LM. (2018). A review of child stunting determinants in Indonesia. Matern Child Nutr. 14(4):e12617. https://doi.org/10.1111/mcn.12617.

Budge S, Parker AH, Hutchings PT, Garbutt C. (2019). Environmental enteric dysfunction and child stunting. Nutr Rev. 77(4):240–253. https://doi.org/10.1093/nutrit/nuy068.

Choiroh ZM, Windari EN, Proborini A. (2020). Hubungan antara Frekuensi dan Durasi Diare dengan Kejadian Stunting pada Balita Usia 24-36 Bulan di Desa Kedungrejo Kecamatan Pakis. J Issues Midwifery. 4(3):131–141. https://doi.org/10.21776/ub.JOIM.2020.004.03.4.

Chowdhury R, Nitika, Choudhary TS, Dhabhai N, Mittal P, Dewan R, Kaur J, et al. (2022). Gestational weight gain and pregnancy outcomes: Findings from North Indian pregnancy cohort. Matern Child Nutr. 18(1):e13238. https://doi.org/10.1111/mcn.13238.

Da Silva NP, De O Mercês R, Magalhães ES, Oliveira CA, De O Campos R, Santos MP, Dos Santos DB, et al. (2025). Association Between Iron, Folate, and Zinc Deficiencies During Pregnancy and Low Birth Weight: Systematic Review of Cohort Studies. Nutr Rev. 83(7):e1647–e1659. https://doi.org/10.1093/NUTRIT/NUAE102.

Danaei G, Andrews KG, Sudfeld CR, Fink G, McCoy DC, Peet E, Sania A, et al. (2016). Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels. PLOS Med. 13(11):e1002164. https://doi.org/10.1371/journal.pmed.1002164.

Gernand AD, Schulze KJ, Stewart CP, West KP, Christian P. (2016). Micronutrient deficiencies in pregnancy worldwide: health effects and prevention. Nat Rev Endocrinol. 12(5):274. https://doi.org/10.1038/NRENDO.2016.37.

Harper KM, Mutasa M, Prendergast AJ, Humphrey J, Manges AR. (2018). Environmental enteric dysfunction pathways and child stunting: A systematic review. PLOS Negl Trop Dis. 12(1):e0006205. https://doi.org/10.1371/journal.pntd.0006205.

Headey D, Hoddinott J, Park S. (2017). Accounting for nutritional changes in six success stories: A regression-decomposition approach. Glob Food Secur. 13(8):12–20. https://doi.org/10.1016/j.gfs.2017.02.003.

Health Development Policy Agency. (2023). Survei Kesehatan Indonesia (SKI) 2023 Dalam Angka Data Akurat Kebijakan Tepat (Indonesian Health Survey (SKI) 2023 in Figures: Accurate Data, Appropriate Policies). Retrieved from https://www.badankebijakan.kemkes.go.id/ski-2023-dalam-angka/.

Health Development Policy Agency, Ministry of Health of the Republic of Indonesia. (2025). SSGI 2024: Prevalensi Stunting Nasional Turun Menjadi 19,8% (Indonesian Nutritional Status Survey 2024: National stunting prevalence declines to 19.8%). Retrieved from https://kemkes.go.id/id/ssgi-2024-prevalensi-stunting-nasional-turun-menjadi-198.

Howell EM, Holla N, Waidmann T. (2016). Being the younger child in a large African Family: a study of birth order as a risk factor for poor health using the demographic and health surveys for 18 countries. BMC Nutr. 2:61. https://doi.org/10.1186/s40795-016-0100-8.

Kwami CS, Godfrey S, Gavilan H, Lakhanpaul M, Parikh P. (2019). Water, Sanitation, and Hygiene: Linkages with Stunting in Rural Ethiopia. Int J Environ Res Public Health. 16(20):3793. https://doi.org/10.3390/IJERPH16203793.

Meiyetriani E, Utomo B. (2025). Improved sanitation and co-occurrence of anemia and stunting in Indonesian children: A retrospective cohort study. Narra J. 5(1):e2070. https://doi.org/10.52225/narra.v5i1.2070.

Ministry of Health of the Republic of Indonesia. (2025). Peraturan Menteri Kesehatan Republik Indonesia Nomor 12 Tahun 2025 tentang Rencana Strategis Kementerian Kesehatan Tahun 2025-2029 (Regulation of the Minister of Health of the Republic of Indonesia Number 12 of 2025 concerning the Strategic Plan of the Ministry of Health for 2025–2029). Retrieved from: https://www.kemkes.go.id/id/permenkes-ri-no-12-tahun-2025-tentang-rencana-strategis-kementerian-kesehatan-tahun-2025-2029

Ministry of Health of the Republic of Indonesia. (2025). Survey Status Gizi Indonesia (SSGI) 2024 Dalam Angka (Indonesian Nutrition Status Survey (SSGI) 2024: Statistics in Figures). Retrieved from https://www.badankebijakan.kemkes.go.id/survei-status-gizi-indonesia-ssgi-2024/.

Molitoris J, Barclay K, Kolk M. (2019). When and Where Birth Spacing Matters for Child Survival: An International Comparison Using the DHS. Demography. 56(4):1349–1370. https://doi.org/10.1007/s13524-019-00798-y.

Mulyaningsih T, Mohanty I, Widyaningsih V, Gebremedhin TA, Miranti R, Wiyono VH. (2021). Beyond personal factors: Multilevel determinants of childhood stunting in Indonesia. PLoS ONE. 16(11):e0260265. https://doi.org/10.1371/JOURNAL.PONE.0260265.

Owino V, Ahmed T, Freemark M, Kelly P, Loy A, Manary M, Loechl C. (2016). Environmental Enteric Dysfunction and Growth Failure/Stunting in Global Child Health. Pediatr. 138(6). https://doi.org/10.1542/peds.2016-0641.

Picauly I, Adi AAAM, Meiyetriani E, Mading M, Weraman P, Nashriyah SF, Boeky DLA, et al. (2024). Determinants of child stunting in the dryland area of East Nusa Tenggara Province, Indonesia: insights from a national-level survey. J Med Life. 17(2):147–156. https://doi.org/10.25122/jml-2023-0313.

Sari K, Sartika RAD. (2021). The Effect of the Physical Factors of Parents and Children on Stunting at Birth Among Newborns in Indonesia. J Prev Med Public Health. 54(5): 309. https://doi.org/10.3961/JPMPH.21.120.

Samsuddin NA, Isaura ER, Sumarmi S. (2021). Relationship of Former History of Diarrhea and Sanitation with The Prevalence of Stunting Among Children Aged 1–5 Years in Sidotopo Wetan, Surabaya. Media Gizi Indonesia. 16(3): 248–255. https://doi.org/10.20473/mgi.v16i3.248-255.

Saputra YA, Lisa M, Hikmi N, Irawati S, Azhari AR, Muharramah DH. (2025). Association of inadequate WaSH, housing, and infectious diseases with undernutrition hotspots among children under five: findings from a national survey in Indonesia. Clin Epidemiol Glob Health. 36(1):102211. https://doi.org/10.1016/j.cegh.2025.102211.

Sentika R, Setiawan T, Kusnadi, Rattu DJ, Yunita I, Basrowi RW, Masita BM, Makrufardi F. (2024). Expert Consensus on Interprofessional Collaboration (IPC) Guidelines on Stunting Management in Indonesian Primary Healthcare (Puskesmas). Open Public Health J. 17: e18749445352608. https://doi.org/10.2174/0118749445352608241119164446.

Simbolon D, Suryani D, Yorita E. (2019). Prediction Model and Scoring System in Prevention and Control of Stunting Problems in Under Five-Year-Olds in Indonesia. Kemas: Jurnal Kesehatan Masyarakat. 15(2): 160–170. https://doi.org/10.15294/kemas.v15i2.13415.

Soliman A, De Sanctis V, Alaaraj N, Ahmed S, Alyafei F, Hamed N, Soliman N. (2021). Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood. Acta Biomed. 92(1): e2021168. https://doi.org/10.23750/abm.v92i1.11346.

Tasnim T. (2018). Determinants of Malnutrition in Children Under Five Years in Developing Countries: A Systematic Review. Indian J Public Health Res Dev. 9(6):333–338. https://doi.org/10.5958/0976-5506.2018.00574.0.

Taufiqoh S, Suryantoro P, Kurniawati HF. (2017). Maternal parity and exclusive breastfeeding history are significantly associated with stunting in children aged 12-59 months. Majalah Obstetri & Ginekologi. 25:66–70. https://doi.org/10.20473/mog.V25I22017.66-70.

Titaley CR, Ariawan I, Hapsari D, Muasyaroh A, Dibley MJ. (2019). Determinants of the stunting of children under two years old in Indonesia: A multilevel analysis of the 2013 Indonesia basic health survey. Nutrients. 11(5):1106. https://doi.org/10.3390/nu11051106.

Torlesse H, Cronin AA, Sebayang SK, Nandy R. (2016). Determinants of stunting in Indonesian children: evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction. BMC Public Health. 16:669-. https://doi.org/10.1186/s12889-016-3339-8.

UNICEF-WHO-The World Bank. (2025). Levels and trends in child malnutrition: Joint child malnutrition estimates (2025 edition). Retrieved from: https://data.unicef.org/resources/jme/.

Victora CG, Christian P, Vidaletti LP, Gatica-Domínguez G, Menon P, Black RE. (2021). Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda. Lancet. 397(10282): 1388–1399. https://doi.org/10.1016/S0140-6736(21)00394-9.

Widyaningsih V, Mulyaningsih T, Rahmawati FN, Adhitya D. (2022). Determinants of socioeconomic and rural-urban disparities in stunting: evidence from Indonesia. Rural Remote Health. 22(1): 1–9. https://doi.org/10.22605/RRH7082.

Yuliastanti T, Ambarwati WN, Sulastri S, Rahmawati A. (2023). History of Chronic Energy Deficiency (CED) of Pregnant Women and Stunting in Toddlers. Int J Nurs Inf. 2(2): 7–12. https://doi.org/10.58418/ijni.v2i2.45.