Nutrition-specific and nutrition-sensitive factors associated with childhood stunting: A case-control study in rural West Kalimantan, Indonesia

Abstract

Stunting remains a major public health problem in Indonesia, and Kubu Raya Regency in West Kalimantan has persistently recorded stunting prevalence above provincial and national levels. The aim of this study was to identify nutrition-specific and nutrition-sensitive factors associated with stunting among children under five in this high-burden rural setting. A 1:1 matched case-control study was conducted in three villages within the catchment area of Sungai Ambawang Public Health Center from August to December 2022. Sixty-seven stunted children and 67 non-stunted children aged 0–59 months were matched by sex and age. Exposures were ascertained by structured caregiver interviews, anthropometric measurements, and record reviews; household food insecurity was measured using the Household Food Insecurity Access Scale. Data were analyzed using unconditional multivariable logistic regression with the matching variables retained as covariates, and Firth penalized logistic regression was used in a sensitivity analysis to assess potential sparse-data bias. Exclusive breastfeeding (Firth-adjusted odds ratio (aOR): 0.06; 95% confidence interval (CI): 0.02–0.25) and at least six antenatal care visits (aOR: 0.18; 95%CI: 0.06–0.54) were independently associated with lower odds of stunting. In contrast, acute infection (Firth aOR: 27.47; 95%CI: 5.22–144.50), moderate (aOR: 5.84; 95%CI: 1.19–28.76) and severe (aOR: 11.11; 95%CI: 2.31–53.37) household food insecurity were associated with higher odds of stunting. Stunting was associated with infant feeding practices, antenatal care, reported infection, and household food insecurity. These findings may inform local priorities within the national stunting strategy, although the observational design precludes causal inference.