Sanitation and Systemic Inflammation Shape Maternal Nutrition in Coastal South Sulawesi, Indonesia

Chronic Energy Deficiency (CED) and anemia in pregnancy are global health concerns with severe consequences for maternal survival and fetal development. In coastal settings, these conditions are further exacerbated by poor sanitation and systemic inflammation. This study aimed to examine the association between household waste sanitation and systemic inflammation, measured by the neutrophil-to-lymphocyte ratio (NLR), with the occurrence of CED and anemia among pregnant women in Takalar District, South Sulawesi, Indonesia. A cross-sectional study was conducted among 293 pregnant women. Data collection included structured interviews, mid-upper arm circumference (MUAC) measurements, digital hemoglobin testing, and complete blood counts for NLR calculation. Bivariate associations were analyzed using chi-square tests, and multivariate logistic regression was applied to identify dominant predictors. The prevalence of CED, anemia, and systemic inflammation (high NLR) were 17.7%, 14.0%, and 46.4%, respectively. Poor household waste sanitation was significantly associated with CED (P=0.002), anemia (P=0.016), and systemic inflammation (P=0.004). Multivariate analysis identified high NLR as the strongest predictor of both CED (OR=16.3; 95% CI: 5.3–50.1) and anemia (OR=2.2; 95% CI: 1.1–4.5). Maternal undernutrition in coastal Takalar was strongly associated with poor household waste sanitation and systemic inflammation, underscoring the need for integrated strategies that combine nutritional interventions, environmental sanitation, and strengthened antenatal care.