Combat stunting in Indonesia: Quo vadis?

Stunting, a chronic malnutrition condition featured by impaired growth and development in children, remains a global public health concern.Children are classified as stunting if their body height or length is <-2 standard deviations from the World Health Organization (WHO) standard growth.Stunting is not merely about suboptimal height, but beyond that, it has profound impacts on human quality in future adulthood.It hinders neurocognitive development, decreases the immune system, and increases the risk of cardiometabolic disease. 1 The Sustainable Development Goals (SDGs) aim to eliminate all forms of malnutrition worldwide, with a specific target of reducing stunting prevalence.The global stunting rate shows a remarkable decline from 2000-2012.However, this reduction continues to be slower in the next decade, with nearly all living in lower-middle-income countries (LMICs), particularly in Africa and Asia.If this decrease continues to slope, there is a potential missed gap between the SDGs target and recent achievement according to the projected trend in 2030. 2 To address this issue, a comprehensive understanding of the conceptual framework outlining the context, causes, and consequences of childhood stunting is fundamental.This causative model, developed by WHO based on a review of global data, highlights numerous factors that are linked to stunted growth and development.First, at the top level, the framework demonstrates the consequences of stunting, consisting of short and long-term consequences of stunting.Second, the causes include specific conditions that closely hinder growth during the crucial first 1,000 days of life -a pivotal period from conception to a child's second birthday for cognitive and physical development.The causes encompass four key elements: household and family factors, breastfeeding practices, infections, and insufficient complementary feeding. 3t the baseline level of the framework, the contextual factors-spanning community and societal aspects-represent the situational background, including political economy, healthcare, education, cultural and societal norms, agriculture and food systems, as well as water, sanitation, and environmental conditions, all of which influence the underlying drivers of childhood stunting 3 .This conceptual framework has been globally adopted as a guideline to analyze to what extent the achievement and constraints in stunting reduction across the countries. 3,4ndonesia, as one of the largest LMICs, reflects this global challenge by setting combating stunting as one of its top national priorities.Tackling those obstacles, Indonesia introduced the National Strategy to Accelerate Stunting Prevention (StraNas Stunting) in 2017 as an initiative to bring together multisectoral efforts, healthcare, economy, education, and infrastructure, with emphasis the critical phase "first 1,000-day of life" or "seribu hari pertama kehidupan (SHPK)".By 2023, Indonesia successfully demonstrates significant improvement but fall short of the annual reductions necessary to achieve the 2024 target. 5hese situations suggest that works for stunting should be one step ahead.Stunting is not something that suddenly happened but started by a long-term slower growth.In LMICs, lots of