Challenges for stunting prevention in an Indonesia-Malaysia border community: health cadres’ knowledge of breastfeeding and complementary feeding practices

Abstract Background Stunting remains a major public health problem in Indonesia, particularly in remote border areas with limited healthcare access and food distribution systems. Community health workers (cadres) play an important role in promoting breastfeeding and complementary feeding, yet evidence on cadres’ knowledge and complementary feeding within cross-border food environments remains limited. This study assessed cadres’ knowledge of stunting, breastfeeding, and complementary feeding, and explored complementary feeding practices, local food utilization and participants’ reported experiences of food access in Jagoi Babang, an Indonesia–Malaysia border area. Methods A sequential explanatory mixed-methods study was conducted among 13 cadres in Jagoi Babang Village, Bengkayang Regency, West Kalimantan, Indonesia. Quantitative data were first collected using researcher-developed questionnaires assessing knowledge of stunting, breastfeeding, and complementary feeding. Knowledge scores were categorized using modified Bloom’s cut-offs, and association were explored using Kendall’s Tau-b correlation. This was followed by non-participant observation, in-depth interviews, and field documentation with the same participants to explain the quantitative findings. Qualitative data were analyzed using thematic analysis. Results Most cadres had moderate to high knowledge of stunting (61.5% moderate; 30.8% high) and high knowledge of breastfeeding/complementary feeding (69.2%). Misconceptions remained regarding the definition and assessment of stunting, sanitation-related stunting factors, and the recommended timing of complementary feeding introduction. An exploratory Kendall’s Tau-b analysis showed a positive but not-significant correlation between stunting knowledge and breastfeeding/complementary feeding knowledge (τ = 0.375, p = 0.115). Thematic analysis identified five themes: limited formal training, local food utilization, cross-border food access, economic constraints, and challenges in translating knowledge into complementary food preparation. Participants reported using both local foods and selected foods from Malaysia markets because they were perceived to be readily available, affordable and of good quality. Conclusions Cadres demonstrated moderate to high knowledge, but qualitative findings suggested challenges in practical complementary food preparation despite favourable knowledge scores. Participants identified limited training, household economic constraints, and local and cross-border food access as factors shaping their reported practices. These findings provide context-specific evidence from one border community and warrant further research involving caregivers, children’s diet, and nutritional outcomes.