Determinants of socioeconomic and rural–urban disparities in stunting: evidence from Indonesia

Early Abstract:

Introduction: Stunting is still a prominent health problem in Indonesia. Stunting prevalence is higher in children from poor families or living in rural areas, however, there was lack of information on predictors of stunting disparities and stunting risk factors by socioeconomic status and area of residence. This study aims to examine the factors associated with stunting by socioeconomic status and area of residence, and 2) assess determinants of stunting disparities by socioeconomic status and area of residence in Indonesia.
Methods: This study analyzed data from the Indonesian Family and Life Survey (IFLS) wave 5 conducted in 2014. Data from 3887 children 0-59 months which includes individual, family, and community level variables were analyzed. Stratified logistic regression was conducted to assess differences in determinants of stunting by households’ consumption level and area of residence. Oaxaca-Blinder decomposition method was used to assess determinants of stunting disparities by households’ consumption level and area of residence.
Results: The analyses showed differences in factors associated with stunting among children in rural-urban areas, or children in poor and non-poor households. Mother’s short stature and low educational level increased the odds of stunting across all groups. However, in children from higher households’ consumption level, unhealthy snacks were a significant predictor of stunting (adjusted Odds Ratio(aOR) 1.23, 95% Confidence Interval (CI) 1.04-1.47). This finding was not found in other groups. Access to sanitation significantly reduced stunting in children from higher households’ consumption level and children from urban communities. Nutritional services significantly associated with stunting in poor children, and children from urban areas. The decomposition analyses showed that differences in characteristics explained 55.35% stunting disparity by households’ consumption. Meanwhile, rural-urban disparity was mostly explained by differences in responses (56.20%), with low birth weight and unexplained variables as predominant contributors.
Conclusions: There were slight differences in stunting determinants by households’ consumption level and area of residence in Indonesia. Stunting disparities were attributed by differences in characteristics and responses between the less and more advantaged populations. To improve the effectiveness of stunting reduction programs, specific intervention tailored to address the differences between the more and less advantaged population is needed.