An Analysis of Stunting Determinants in North Tapanuli Regency
DOI:
https://doi.org/10.30829/contagion.v8i1.27890Abstract
There has been a decline in stunting prevalence nationally in the last two years, requiring a more specific analysis of local determinants to optimize interventions at the regional level, especially in areas with geographical characteristics such as North Tapanuli Regency. This study aims to analyze the effect of nutritional intake, environmental sanitation, immunization status, and medical history on the incidence of stunting in toddlers. This quantitative study with a cross-sectional design involved 71 stunted toddler respondents in four working areas of the Community Health Center in North Tapanuli Regency. The data were analyzed using the Chi-Square test for bivariate analysis and Path Analysis to see the direct and indirect effects. The path analysis results showed that nutritional intake (0.365), sanitation (0.146), and immunization status (0.141) had a significant direct effect on stunting. Nutritional intake was the most dominant determining factor (p=0.010). Conversely, medical history (p=0.485) did not show a significant relationship and did not play a strong mediating role in this model. Nutritional intake is a key factor in determining the severity of stunting. Intervention strategies should focus on meeting the specific nutritional needs of toddlers in addition to improving sanitation and basic immunization coverageKeywords: Stunting, Nutritional Intake, Infectious Diseases, Sanitation, ImmunizationReferences
Angelica, S., Aisiyah, N., & Aprilawati, D. (2020). The Role of Animal Protein in Preventing Stunting in Children : A Literature Review. International Journal of Research Publications, 139(1), 174–183. https://doi.org/10.47119/10.47119/IJRP10013911220235819
Aprihatin, Y., Barlian, E., Fatimah, S., Yanti, E., & Author, C. (2020). Impact Of Environmental Sanitation And Infection Disease As A Determining Stunting Factor For Children. Sumatra Journal of Disaster, 4(2), 209–211. https://doi.org/http://sjdgge.ppj.unp.ac.id/index.php/Sjdgge
Batool, M., Saleem, J., Zakar, R., Butt, M. S., Iqbal, S., Haider, S., & Fischer, F. (2023). Relationship of stunting with water , sanitation , and hygiene ( WASH ) practices among children under the age of five : a cross- sectional study in Southern Punjab , Pakistan. BMC Public Health, 23(2153), 1–7. https://doi.org/https://doi.org/10.1186/s12889-023-17135-z
Dadras, O., Suwanbamrung, C., Jafari, M., & Stanikzai, M. H. (2024). Prevalence of stunting and its correlates among children under 5 in Afghanistan : the potential impact of basic and full vaccination. BMC Pediatrics, 24(436), 1–10. https://doi.org/https://doi.org/10.1186/s12887-024-04913-w
Das, S., Fahim, S. M., Alam, A., Mahfuz, M., Bessong, P., Mduma, E., Kosek, M., Shrestha, S. K., & Ahmed, T. (2020). Not water , sanitation and hygiene practice , but timing of stunting is associated with recovery from stunting at 24 months : results from a multi-country birth cohort study. Public Health Nutrition, 24(6), 1428–1437. https://doi.org/10.1017/S136898002000004X
Dwi, A., Febriani, B., Daud, D., Rauf, S., Nawing, H. D., Ganda, I. J., & Salekede, S. B. (2020). Risk Factors and Nutritional Profiles Associated with Stunting in Children. Pediatr Gastroenterol Hepatol Nutr, 23(5), 457–463. https://doi.org/https://doi.org/10.5223/pghn.2020.23.5.457
Gado, P., Oparah, O. S., Ezeh, F. E., Gbaraba, S. V., & Adeleke, A. S. (2020). Framework for Developing Data-Driven Nutrition Interventions Targeting High-Risk Low-Income Communities Nationwide. International Journal of Multidisciplinary Research and Growth Evaluation, 1(3), 244–271. https://doi.org/https://doi.org/10.54660/.IJMRGE.2020.1.3.244-271
H, M., AM, L., & Doloksaribu, T. (2025). Household Social Context And Health Behaviors Influencing Child Stunting: Insights From North Sumatra, Indonesia. Afr. J. Food Agric. Nutr. Dev, 25(6), 27122–27141. https://doi.org/https://doi.org/10.18697/ajfand.143.25825
Harahap, H., Syam, A., Palutturi, S., Syafar, M., Hadi, A. J., Sani, H. A., Mallongi, A., Syafar, M., Anto, J., Ahmad, H., Sani, A., & Mallongi, A. (2024). Stunting and Family Socio-Cultural Determinant Factors : A Systematic Review. Pharmacognosy Journal, 16(1), 268–275. https://doi.org/10.5530/pj.2024.16.39
Ismawati, R., Dewi, R., Fatkhur, I., & Dwijayanti, I. (2020). Nutrition intake and causative factor of stunting among children aged under-5 years in Lamongan city ଝ. Enfermería Clínica, 30(August 2018), 71–74. https://doi.org/10.1016/j.enfcli.2019.10.043
Kemenkes RI. (2022). Survei Status Gizi SSGI 2022. In BKPK Kemenkes RI.
Khan, J., & Mohanty, S. K. (2025). Immunization attributable burden of stunting among under-five children in India , 2005 –. BMC Pediatrics, 25(851), 1–20. https://doi.org/https://doi.org/10.1186/s12887-025-06139-w
Ludwig, D. S., Editor, S., Leroy, F., Barnard, N. D., & Leroy, M. A. (2020). Great Debates in Nutrition Children and adults should avoid consuming animal products to reduce risk for chronic disease : NO. The American Journal of Clinical Nutrition, 112(4), 931–936. https://doi.org/https://doi.org/10.1093/ajcn/nqaa236
Mulyani, A. T., Khairinisa, M. A., & Khatib, A. (2025). Understanding Stunting : Impact , Causes , and Strategy to Accelerate Stunting Reduction — A Narrative Review. Nutrients, 17(9), 1–29. https://doi.org/https://doi.org/10.3390/nu17091493
Pakpahan, L., Manurung, K., Sitorus, M. E., Ketaren, O., & Lina, F. (2025). Factors Influencing the Incidence of Stunting at the Lumban Sinaga Community Health Center , Pangaribuan District , North Tapanuli Regency in 2023 Faktor-Faktor Yang Mempengaruhi Kejadian Stunting Di UPT Puskesmas Lumban Sinaga Kecamatan. Journal of Pharmaceutical and Sciences, 8(1), 536–549. https://doi.org/https://doi.org/10.36490/journal-jps.com.v8i1.784
Purba, I. G., Sunarsih, E., Trisnaini, I., & Sitorus, R. J. (2020). Environmental Sanitation And Incidence Of Stunting In Children Aged 12-59 Months. Jurnal Kesehatan Lingkungan, 12(3), 189–199. https://doi.org/10.20473/jkl.v12i3.2020.189-199
Purwanti, E. D., Masitoh, S., & Ronoatmodjo, S. (2025). Association Between Basic Immunization Status and Stunting in Toddlers Aged 12-59 Months in Indonesia. Journal of Preventive Medicine & Public Health, 58, 298–306. https://doi.org/https://doi.org/10.3961/jpmph.24.230
Rah, J. H., Badgaiyan, N., Cronin, A. A., & Torlesse, H. (2020). Improved sanitation is associated with reduced child stunting amongst Indonesian children under 3 years of age. Matern Child Nutr, 16(S2), 1–8. https://doi.org/https://doi.org/10.1111/mcn.12741
Regassa, R., Tamiru, D., Duguma, M., & Belachew, T. (2023). Environmental enteropathy and its association with water sanitation and hygiene in slum areas of Jimma Town Ethiopia. PLoS ONE, 18(6), 1–18. https://doi.org/10.1371/journal.pone.0286866
Rizaldi, M. A., Ali, K., Mega, S., Rara, H., Sri, B., & Panjaitan, R. (2025). Water, Sanitation and Hygiene (WASH) and its Association with Stunting in Developing Countries in Asia: A Systematic Review. Svāsthya: Trends in General Medicine and Public Health, 2(2), 1–15. https://doi.org/https://doi.org/10.70347/svsthya.v2i2.81
Saavedra, J. M., & Prentice, A. M. (2022). Nutrition in school-age children : a rationale for revisiting priorities. Nutrition Reviews, 81(7), 823–843. https://doi.org/https://doi.org/10.1093/nutrit/nuac089
Sabir, G., & Bernet, T. (2022). Empowering rural service providers to improve nutrition in mountain regions. Frontiers in Sustainable Food Systems, 7(April), 1–10. https://doi.org/10.3389/fsufs.2023.1121995
Silva, J. R. M., Vieira, L. L., Abreu, A. R. M., Fernandes, E. D. S., Moreira, T. R., Dias, G., & Cotta, R. M. M. (2023). Water , sanitation , and hygiene vulnerability in child stunting in developing countries : a systematic review with meta-analysis. Public Health, 219, 117–123. https://doi.org/10.1016/j.puhe.2023.03.024
Silva, P., Araque-padilla, R. A., & Montero-simo, M. J. (2025). The importance of socio-demographic factors on food literacy in disadvantaged communities. Frontiers in Sustainable Food Systems, 9(April), 1–11. https://doi.org/10.3389/fsufs.2025.1441694
Situmeang, N. S., Sudaryati, E., & Jumirah. (2020). Correlation of Parenting and Nutrient Intake with Stunting in Children 24-59 Months. Britain International of Exact Sciences (BIoEx) Journal, 2(1), 280–285. https://doi.org/https://doi.org/10.33258/bioex.v2i1.147
Syukur, S. B., & Harismayanti, H. (2020). Stunting Problems in Pregnant Women and Children Within 1000 Days of Early Life. International Journal Papier Advance and Scientific Review, 1(1), 47–52. https://doi.org/https://doi.org/10.47667/ijpasr.v1i2.45
Theresia, G. N., & Sudarma, V. (2022). Immunization status lowers the incidence of stunting in children 1-5 years. World Nutrition Journal, 6(1), 9–15. https://doi.org/10.25220/WNJ.V06.i1.0003
UNICEF, WHO, & World Bank. (2020). Levels and trends in child malnutrition: Key findings of the 2020 Edition of the Joint Child Malnutrition Estimates. Geneva: WHO, 24(2), 1–16.
Wahyuni, W., Wakhidah, L. N., Fatmawati, S., & Widayati, R. S. (2021). The Relation of Stunting with Immunization Status and the History of Low Birth Weight in the Work Area of Public Health Center at Gilingan. Education and Humanities Research, 535, 468–471.
Wanda, Y. D., Elba, F., Susanti, A. I., Rinawan, F. R., Masyarakat, I. K., Kedokteran, F., & Padjadjaran, U. (2021). Riwayat Status Imunisasi Dasar Berhubungan Dengan Kejadian Balita Stunting. JKM (Jurnal Kebidanan Malahayati)Malahayati), 7(4), 851–856. https://doi.org/10.33024, http://ejurnalmalahayati.ac.id/index.php/kebidanan
Wells, J. C. (2022). The double burden of malnutrition : aetiological pathways and consequences for health. Lancet, 395(10217), 75–88. https://doi.org/10.1016/S0140-6736(19)32472-9.The
WHO. (2020). Levels and Trends in Child Malnutrition 2020 Edition. World Health Organization, 1–15.
Wijaya, M. I. (2024). Social Ecological Approach to Combating Stunting in Kintamani , Bali , Indonesia. Universal Journal of Public Health, 12(5), 799–810. https://doi.org/10.13189/ujph.2024.120502
Zahtamal, Restila, R., Sundari, & Palupi, R. (2024). The Influence Of Environmental Sanitation On Stunting. Journal of Environmental Health, 16(1), 59–67. https://doi.org/10.20473/jkl.v16i1.2024.59-67
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