Spatial Association of Acute Respiratory Infection, Diarrhea, and Low Birth Weight with Stunting Prevalence in Indonesia, 2024

Authors

• Dian Rosadi, Lambung Mangkurat University, BanjarbaruFollow
• Husaini Husaini, Lambung Mangkurat University, BanjarbaruFollow
• Triawanti Triawanti, Lambung Mangkurat University, BanjarbaruFollow
• Musafaah Musafaah, Lambung Mangkurat University, BanjarbaruFollow

Abstract

Stunting remains unevenly distributed across Indonesia, but national evidence integrating spatial analysis and spatial regression is limited. This study examined the spatial distribution of stunting and its associations with acute respiratory infection (ARI), diarrhea, and low birth weight (LBW) across Indonesian provinces. An ecological cross-sectional study used data from the 2024 Indonesian Nutritional Status Survey. Stunting-only analyses included all 38 provinces, whereas analyses involving ARI, diarrhea, and LBW included 37 provinces with complete data. Spatial analyses used a row-standardized symmetric four-nearest-neighbor spatial weights matrix and included Global Moran’s I, bivariate spatial analysis, Local Indicators of Spatial Association, ordinary least squares, and spatial regression. Stunting showed positive spatial autocorrelation (Moran’s I = 0.368; pseudo p-value = 0.002). Global bivariate Moran’s I showed negative spatial associations between stunting and neighboring ARI (I = −0.296; pseudo p-value = 0.001) and stunting and diarrhea prevalence (I = −0.292; pseudo p-value = 0.001), whereas LBW was not associated. In the final spatial error model, LBW was positively associated with stunting (B = 1.455; p-value = 0.008), whereas ARI and diarrhea were not associated. No significant residual spatial autocorrelation remained. These findings indicate that stunting prevalence in Indonesia is spatially clustered and that LBW remains an important province-level correlate of stunting after accounting for spatial dependence.

References

1. Indanah I, Wanda D, Nurhaeni N. Empowerment of parents with stunting children. J Aisyah J Ilmu Kesehat. 2022; 7 (4): 1013–1022. DOI: 10.30604/jika.v7i4.1183.

2. Kementerian Kesehatan Republik Indonesia. Survei Status Gizi Indonesia 2024 dalam Angka. Jakarta: Kementerian Kesehatan Republik Indonesia; 2025.

3. Badan Kebijakan Pembangunan Kesehatan. Survei Kesehatan Indonesia (SKI) 2023 dalam angka. Jakarta: Badan Kebijakan Pembangunan Kesehatan, Kementerian Kesehatan Republik Indonesia; 2024.

4. Badan Kependudukan dan Keluarga Berencana Nasional. Peraturan Badan Kependudukan dan Keluarga Berencana Nasional Nomor 12 Tahun 2021 Tentang Rencana Aksi Nasional Percepatan Penurunan Angka Stunting Indonesia Tahun 2021–2024. Jakarta: Badan Kependudukan dan Keluarga Berencana Nasional; 2021.

5. Eryando T, Sipahutar T, Budhiharsana MP, et al. Spatial analysis of stunting determinants in 514 Indonesian districts/cities: Implications for intervention and setting of priority. Geospat Health. 2022; 17 (1): 1055. DOI: 10.4081/gh.2022.1055.

6. Sipahutar T, Eryando T, Budhiharsana MP. Spatial analysis of seven islands in Indonesia to determine stunting hotspots. Kesmas. 2022; 17 (3): 228–234. DOI: 10.21109/kesmas.v17i3.6201.

7. World Health Organization, United Nations Children’s Fund, World Bank Group. The UNICEF-WHO-World Bank joint child malnutrition estimates standard methodology: Tracking progress on SDG indicators 2.2.1 on stunting, 2.2.2 (1) on overweight and 2.2.2 (2) on wasting. Geneva: World Health Organization; 2024.

8. Trihono T, Atmarita A, Tjandrarini DH, et al. Pendek (stunting) di Indonesia: Masalah dan solusinya. Jakarta: Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan; 2015.

9. Arini D, Nursalam N, Mahmudah M, et al. The incidence of stunting, the frequency/duration of diarrhea and acute respiratory infection in toddlers. J Public Health Res. 2020; 9 (2): 117–120. DOI: 10.4081/jphr.2020.1816.

10. Noeris ZR, Onasis A, Sugriarta E, et al. Analisis Spasial Faktor Risiko Lingkungan pada Balita Stunting di Kecamatan Payung Sekaki Kabupaten Solok Tahun 2023. J Kesehat Lingkung Mandiri. 2023; 2 (1): 39–49 DOI: 10.33761/jklm.v2i2.1112.

11. Wicaksono F, Harsanti T. Determinants of stunted children in Indonesia: A multilevel analysis at the individual, household, and community levels. Kesmas. 2020; 15 (1): 48–53. DOI: 10.21109/kesmas.v15i1.2771.

12. Yassar GC, Yuliawati Y, Puspitaningrum EM. Faktor-faktor yang berhubungan dengan stunting pada balita di Puskesmas Yosomulyo Metro Pusat. J Ilmu Kesehat. 2024; 13 (1): 74–80. DOI: 10.32831/jik.v13i1.716.

13. Sakti ES, Makful MR, Dewi R. Analisis spasial prioritas penanganan stunting di Provinsi Aceh tahun 2021. J Mutiara Kesehat Masy. 2023; 8 (1): 10–23. DOI: 10.51544/jmkm.v8i1.3856.

14. Musni, Malka S, Fatimah S, et al. Birth length, diarrheal and acute respiratory infection risk of stunting in toddlers. J Medihealtico. 2024; 5 (1): 15–21. DOI: 10.37899/journallamedihealtico.v5i1.947.

15. Wangge YFP, Hinga IAT, Sir AB, et al . Analisis faktor risiko kejadian stunting pada balita di wilayah kerja Puskesmas Ngalupolo Kabupaten Ende. J Bid Ilmu Kesehat. 2025; 15 (1): 28–43. DOI: 10.52643/jbik.v15i1.5499.

16. United Nations Children’s Fund, World Health Organization, World Bank Group. Levels and trends in child malnutrition: UNICEF/WHO/World Bank Group joint child malnutrition estimates: Key findings of the 2025 edition. Geneva: World Health Organization; 2025.

17. Anselin L. Local indicators of spatial association—LISA. Geogr Anal. 1995; 27 (2): 93–115. DOI: 10.1111/j.1538-4632.1995.tb00338.x.

18. Anselin L. Global spatial autocorrelation (1). Chicago: GeoDa Center for Geospatial Analysis and Computation; 2020.

19. Ariawan I, Jusril H, Afifa ZI, et al. Intervention Levers for Stunting Reduction in Indonesia: Evidence from the 2023 Indonesian Health Survey Data. Kesmas. 2026; 21 (2): 125–134. DOI: 10.7454/kesmas.v21i2.2686.

20. Ayuningtyas D, Hapsari D, Rachmalina R, et al. Geographic and socioeconomic disparity in child undernutrition across 514 districts in Indonesia. Nutrients. 2022; 14 (4): 843. DOI: 10.3390/nu14040843.

21. Kusumawardani HD, Laksono AD, Hidayat T, et al. Stunting among children under two years in the islands areas: A cross-sectional study of the Maluku Region in Indonesia, 2021. J Res Health Sci. 2023; 23 (4): e00597. DOI: 10.34172/jrhs.2023.132.

22. Aswi A, Rahardiantoro S, Kurnia A, et al. Childhood stunting in Indonesia: Assessing the performance of Bayesian spatial conditional autoregressive models. Geospat Health. 2024; 19 (2): 1321. DOI: 10.4081/gh.2024.1321.

23. Rahardiantoro S, Juhanda ARN, Kurnia A, et al. Spatio-temporal modeling to identify factors associated with stunting in Indonesia using a modified generalized lasso. Spat Spatiotemporal Epidemiol. 2024; 51: 100694. DOI: 10.1016/j.sste.2024.100694.

24. Sartika AN, Khoirunnisa M, Meiyetriani E, et al. Prenatal and postnatal determinants of stunting at age 0–11 months: A cross-sectional study in Indonesia. PLoS One. 2024; 19 (12): e0315015. DOI: 10.1371/journal.pone.0254662.

25. Suratri MAL, Indriasih E, Warouw TS, et al. The relationship between infectious diseases and stunting among toddlers in Indonesia. Iran J Nurs Midwifery Res. 2025; 30 (6): 936–940. DOI: 10.4103/ijnmr.ijnmr_87_24.

26. Purnama TB, Wagatsuma K, Saito R. Prevalence and risk factors of acute respiratory infection and diarrhea among children under 5 years old in low-middle wealth household, Indonesia. Infect Dis Poverty. 2025; 14 (1): 13. DOI: 10.1186/s40249-025-01286-9.

27. Rahmadiani I, Fibriana AI, Nisa AA, et al. Impact of low birth weight and other determinants on stunting in children under-five years old: Evidence from Indonesia’s Nutrition Status Survey. Int J Prev Med. 2025; 16: 76. DOI: 10.4103/ijpvm.ijpvm_242_24.

28. Mariyami T, Sanjaya R. Hubungan BBLR dan status pemberian ASI dengan kejadian stunting pada baduta. J Curr Health Sci. 2022; 2 (1): 13–18. DOI: 10.47679/jchs.202231.

29. Azis AA, Aswi A. Spatial clustering of stunting cases in Indonesia: A Bayesian approach. Commun Math Biol Neurosci. 2023; 2023: 28. DOI: 10.28919/cmbn/7898.

30. Aswi A, Rahardiantoro S, Kurnia A, et al. Bayesian spatio-temporal conditional autoregressive localized modeling techniques for socioeconomic factors and stunting in Indonesia. MethodsX. 2025; 15: 103464. DOI: 10.1016/j.mex.2025.103464.

31. Wahyuni IS, Gustina I, Makful MR, et al. Spatial Durbin model on the utilization of delivery at health facilities: A 2017 Indonesian Demographic and Health Survey analysis. Kesmas. 2024; 19 (2): 74–80. DOI: 10.21109/kesmas.v19i2.1279.

32. Sagita D, Oktarizal H, Pramawati A, et al. Hubungan faktor lingkungan dan riwayat penyakit diare pada kejadian balita stunting di Pulau Setokok Kecamatan Bulang Kota Batam tahun 2023. J Kesehat Ibnu Sina. 2024; 5 (1): 62–81. DOI: 10.36352/j-kis.v5i1.636.

33. Huntoyungo Y, Kuswari H, Firnaherera VA, et al. Moran’s I index and KKN-based LISA: Spatial analysis of toddler stunting in Indonesia 2024. J Bina Praja. 2025; 17 (2). DOI: 10.21787/jbp.17.2025-2888.

Recommended Citation

Rosadi D , Husaini H , Triawanti T , et al. Spatial Association of Acute Respiratory Infection, Diarrhea, and Low Birth Weight with Stunting Prevalence in Indonesia, 2024. Kesmas. 2026; 21(3): 195-204
DOI: 10.7454/kesmas.v21i3.2790
Available at: https://scholarhub.ui.ac.id/kesmas/vol21/iss3/6