Food resources management and multilevel determinants of stunting: Insights from a national socio-ecological analysis in Indonesia

Introduction: Factors influencing stunting are multifaceted, particularly at individual, household, and institutional levels. However, Indonesia’s significant research gap regarding integrating these ecological levels in stunting prevention efforts remains. Therefore, the present study analysed individual (children and mothers), household, and healthcare service factors contributing to stunting. Methods: The study design was an ecological study using secondary data from 2023 Indonesian Health Survey in Numbers report (response rate: 98.74%). The dataset consisted of 38 units of analysis representing Indonesia’s provinces. This study applied the socio-ecological model (SEM), which illustrates United Nations Children’s Fund (UNICEF) Conceptual Framework on Maternal and Child Nutrition. The analysis employed Pearson’s correlation tests, followed by linear regression, with a 95% significance level (α=0.050). Results: Results showed that stunting in Indonesia remained above the 14% national target for 2024, with a prevalence of 21.5% in 2023. Preventing stunting requires minimising risks within food resource management and public health services. The model explained 99.2% of stunting determinants, aligning with UNICEF’s Conceptual Framework, using SEM to analyse direct, indirect, and fundamental causes. Furthermore, food consumption and infection status were direct causes shaped by regional food ecosystems, while environmental health and public health services were crucial indirect factors. Socio-economic disparities also contributed to better healthcare and economic conditions in Western Indonesia, while stunting prevalence remained higher in Eastern Indonesia. Conclusion: Strengthening cross-sectoral programme synergies targeting children, mothers, households, and institutions is essential for a comprehensive and sustainable approach to stunting reduction.