Determinants of Stunting among Children under Five in a High-Tourism Setting: A Multidistrict Case–Control Study from Bali, Indonesia

Stunting remains a persistent public health problem in Indonesia, including in Bali, a province characterized by relatively strong health infrastructure and socioeconomic development. This study aimed to identify determinants of stunting among children under five years of age in a high-tourism, middle-income setting. A matched case–control study was conducted between August and December 2025 across all nine districts of Bali Province, involving 1,377 children aged 6–59 months (459 stunted cases and 918 non-stunted controls) matched by age group and district. Data on maternal characteristics, birth outcomes, infant feeding practices, healthcare utilization, and household environmental conditions were collected through structured caregiver interviews and verified health records. Multivariate logistic regression analysis showed that low birth weight was the strongest determinant of stunting. Maternal education and maternal knowledge of stunting were consistently associated with increased odds of stunting, highlighting the importance of caregiving capacity and health literacy. Feeding practices, limited antenatal care attendance, and incomplete immunization demonstrated moderate but significant associations. Environmental factors, including unsafe drinking water and poor household sanitation, were also independently associated with stunting, although overall prevalence was relatively low. These findings indicate that stunting in Bali arises from the accumulation of moderate risks rather than extreme deprivation, underscoring the need for targeted, proportionate interventions focused on vulnerable households.