Abstract

This study developed a system dynamics model to simulate stunting reduction in West Sumatra Province, Indonesia, by integrating infant and toddler health, maternal health, and environmental determinants. Secondary data from 2020–2024 on low birth weight, immunization, malnutrition, exclusive breastfeeding, maternal chronic energy deficiency, iron and folic acid supplement distribution, sanitation, and safe drinking water access were compiled from West Sumatra Provincial Health Office and Statistics Indonesia, and validated through consultation with five stakeholder institutions. Causal Loop Diagrams mapped feedback relationships among determinants and were translated into Stock Flow Diagrams using Powersim Studio 10. The model was validated through structural verification, extreme-condition testing, and historical-fit testing. Baseline and intervention scenarios were simulated over 25- to 100-year horizons. Enhanced immunization and breastfeeding increased immunized toddlers from 180,000 to over 240,000 (33% improvement) and reduced malnutrition cases by approximately 25% relative to baseline. In the integrated multisectoral scenario combining maternal nutrition, breastfeeding, immunization, and sanitation improvements, projected stunted toddlers decreased from 164,321 under baseline conditions to 72,143 over 25 years, a 56% reduction, despite the toddler population nearly doubling to 150,473. These findings indicate that coordinated, multisectoral interventions addressing environmental, maternal, and child health determinants can substantially reduce stunting despite population growth and support integrated policies to accelerate SDG 2 achievement in West Sumatra Province and comparable regions.

References

1. United Nations. Sustainable Development Goals Report 2024. New York: United Nations Publications; 2024.

2. World Health Organization. SDG Target 2.2 Malnutrition: Key Facts and Data. Geneva: World Health Organization; 2023.

3. Health Development Policy Agency. SSGI 2024 Achievements Reveal Positive Trends. Jakarta: the Indonesian Ministry of Health; 2025.

4. Darmin D, Noris M, Khatimah NH, et al. Spatial determinants of childhood stunting in Lambitu, Bima: A GIS-based multilevel analysis. Med Health Res. 2026; 4 (2): 53-66. DOI: 10.70716/mohr.v4i2.434.

5. Yusriadi Y, Sugiharti S, Ginting YM, et al. Preventing stunting in rural Indonesia: A community-based perspective. Afr J Food Agric Nutr Dev. 2024; 24 (9): 24470-24491. DOI: 10.22004/AG.ECON.348069.

6. Biro Komunikasi dan Informasi Publik. SSGI 2024: Prevalensi Stunting Nasional Turun Menjadi 19,8%SSGI 2024: Prevalensi Stunting Nasional Turun Menjadi 19,8%. Jakarta: Kementerian Kesehatan Republik Indonesia; 2025.

7. Masthalina H, Doloksaribu TH. Household social context and health behaviors influencing child stunting: Insights from North Sumatra, Indonesia. Afr J Food Agric Nutr Dev. 2025; 25 (6): 27122-27141. DOI: 10.18697/ajfand.143.25825.

8. Rahut, DB, Mishra R, Bera S. Geospatial and environmental determinants of stunting, wasting, and underweight: Empirical evidence from rural South and Southeast Asia. Nutr. 2024; 120: 112346. DOI: 10.1016/j.nut.2023.112346.

9. Gizaw Z, Yalew AW, Bitew BD, et al. Stunting among children aged 24–59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural northwest Ethiopia. Sci Rep. 2022; 12: 19293. DOI: 10.1038/s41598-022-23981-5.

10. Beal T, Tumilowicz A, Sutrisna A, et al. Review of determinants of stunting in children in Indonesia. Matern Child Nutr. 2018; 14 (4): e12617. DOI: 10.1111/mcn.12617.

11. Baugh Littlejohns L, Hill C, Neudorf C. Diverse approaches to creating and using causal loop diagrams in public health research: Recommendations from a scoping review. Public Health Rev. 2021; 42: 1604352. DOI: 10.3389/phrs.2021.1604352.

12. Currie DJ, Smith C, Jagals P. The application of system dynamics modelling to environmental health decision-making and policy: A scoping review. BMC Public Health. 2018; 18: 402. DOI: 10.1186/s12889-018-5318-8.

13. Li M, Yu W, Tian W, et al. System dynamics modeling of public health services provided by China CDC to control infectious and endemic diseases in China. Infect Drug Resist. 2019: 613-625. DOI: 10.2147/IDR.S185177.

14. Sharif SV, Moshfegh PH, Morshedi MA, et al. Modeling the impact of mitigation policies in a pandemic: A system dynamics approach. International J Dis Risk Reduct. 2022; 82: 103327. DOI: 10.1016/j.ijdrr.2022.103327.

15. Chandra D, Barlian E, Heldi H, et al. Traffic noise level modeling and population exposure estimation in Padang City. AIP Conf Proceed. 2024; 3001: 080015. DOI: 10.1063/5.0184146.

16. Yuniarti E, Dewata I, Heldi. Waste management and its impact on healthy living behavior: A literature review. Multidis Rev. 2024; 7 (3): e2024046. DOI: 10.31893/multirev.2024046.

17. Yuniarti E, Raharini H. The relationship between healthy behavior and environmental sanitation with water quality in the stunting incident work area of Sikabu Padang Pariaman Health Center. IOP Conf Series Earth Environ Sci. 2024; 1317: 012020. DOI: 10.1088/1755-1315/1317/1/012020.

18. Azzahra N, Yuniarti E, Syah N, et al. Bibliometric analysis of research stunting 2010–2023. Multidis Rev. 2024; 8 (6): e2025160. DOI: 10.31893/multirev.2025160.

19. Tim Percepatan Penurunan Stunting. RAKORNAS 2023: Pastikan Prevalensi Stunting Turun Menjadi 14% pada Tahun 2024. Jakarta: Kementerian Sekretariat Negara Republik Indonesia; 2023.

20. Dinas Kesehatan Provinsi Sumatera Barat. Profil Kesehatan Sumatera Barat 2020-2024. Padang: Dinas Kesehatan Provinsi Sumatera Barat; 2021-2025.

21. Badan Pusat Statistik Provinsi Sumatera Barat. Profil Kesehatan Provinsi Sumatera Barat 2020-2022. Padang: Badan Pusat Statistik Provinsi Sumatera Barat; 2021-2023.

22. Badan Pusat Statistik Provinsi Sumatera Barat. Profil Statistik Kesehatan Provinsi Sumatera Barat 2023. Padang: Badan Pusat Statistik Provinsi Sumatera Barat; 2024.

23. Badan Pusat Statistik Provinsi Sumatera Barat. Profil Statistik Kesehatan Provinsi Sumatera Barat 2024. Padang: Badan Pusat Statistik Provinsi Sumatera Barat; 2025.

24. Morecroft JDW. Strategic modelling and business dynamics: a feedback systems approach. Hoboken, NJ: John Wiley & Sons; 2015.

25. Pham Y, Wozniak TM. Systems thinking to understand the complexity of antimicrobial resistance across One Health: A systematic review of current approaches. One Health. 2025; 20: 101081. DOI: 10.1016/j.onehlt.2025.101081.

26. Umar I, Dewata I. Systems approach: In social, engineering, and environmental sciences. Padang: UNP Press; 2017.

27. Dolifah D, Setiadi DK, Rahmat DY, et al. Providing education for a mother in stunting prevention: A collaborative study through action research. Univers J Public Health. 2021; 9 (2): 88-93. DOI: 10.13189/ujph.2021.090207.

28. Joe W, Prakash A, Yaqoob Azimi SM, et al. Levels, severity, and determinants of stunting in children 0–59 months in Afghanistan: Secondary analysis of Multiple Indicator Cluster Survey, 2022–23. PLOS Glob Public Health. 2025; 5 (4): e0004423. DOI: 10.1371/journal.pgph.0004423.

29. Mulyaningsih T, Mohanty I, Widyaningsih V, et al. Beyond personal factors: Multilevel determinants of childhood stunting in Indonesia. PLOS One. 2021; 16 (11): e0260265. DOI: 10.1371/journal.pone.0260265.

30. Danaei G, Andrews KG, Sudfeld CR, et al. Risk factors for stunting in children in 137 developing countries: A comparative risk assessment analysis at the global, regional, and country levels. PLOS Med. 2016; 13 (11): e1002164. DOI: 10.1371/journal.pmed.1002164.

31. Kustanto A, Rachmat O, Setyadi S. The prevalence of stunting in Indonesia: An examination of the health, socioeconomic status, and environmental determinants. J Iran Med Council. 2025; 8 (1): 67-79. DOI: 10.18502/jimc.v8i1.17062.

32. World Health Organization. Global Nutrition Targets 2025: Stunting policy brief. Geneva: World Health Organization; 2025.

33. Rahman MS, Howlader T, Masud MS, et al. Association of low birth weight with malnutrition in children under five in Bangladesh: Do maternal education, socioeconomic status, and birth spacing influence? PLOS One. 2016; 11 (6): e0157814. DOI: 10.1371/journal.pone.0157814.

34. Bakri RT, Setyono J, Kusuma MNH, et al. Determinants of stunting severity among under-fives: Comparison of agricultural and nonagricultural households in South Lampung Regency, Indonesia. Adv Public Health. 2025; 7443296. DOI: 10.1155/adph/7443296.

35. World Health Organization, United Nations Children’s Fund. The WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene. Geneva: World Health Organizationl 2023.

36. Arifuddin A, Prihatni Y, Setiawan A, et al. Epidemiological model of stunting determinants in Indonesia. Healthy Tadulako J. 2023; 9 (2): 155-164. DOI: 10.22487/htj.v9i2.928.

37. Syah Putri MS, Syahmarani A, Nasution PK, et al. Modeling the CART method on the factors that cause stunting. Int J Adv Sci Eng Inform Technol. 2025; 15 (2): 524-529. DOI: 10.18517/ijaseit.15.2.20453.

38. Wang Y, Hu B, Zhao Y, et al. Applications of system dynamics models in chronic disease prevention: A systematic review. Prev Chronic Dis. 2021; 18: 210175. DOI: 10.5888/pcd18.210175.

39. Brown AD, Bolton KA, Clarke B, et al. System dynamics modeling to engage community stakeholders in addressing water and sugar-sweetened beverage consumption. Int J Behav Nutr Phys Act. 2022; 19: 118. DOI: 10.1186/s12966-022-01363-4.

40. Headen IE, Eaton TM, Kumanyika SK. Using system dynamics mapping to explore synergy in an equity-focused obesity prevention framework. Front Public Health. 2025; 13: 1525224. DOI: 10.3389/fpubh.2025.1525224.

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