Determinants of environmental health factors associated with the risk of stunting among children under five in North Aceh District
Stunting among children under five years of age remains a major public health concern and reflects long-term nutritional deficiencies, often linked to poor environmental health conditions. The North Aceh District reports a stunting prevalence higher than the provincial and national averages, indicating a critical research gap regarding the environmental determinants contributing to this burden in the region. This study aimed to analyze the association between environmental health factors and the risk of stunting among children under five years of age in North Aceh District. This quantitative cross-sectional study was conducted from April to August 2025 in the working areas of the Simpang Keramat and Kuta Makmur Public Health Centers. A total of 90 children under five were selected through purposive sampling. Data were collected using structured questionnaires and through direct observations. Instrument validity and reliability were assessed prior to data collection. Statistical analyses were performed using the chi-square test. The prevalence of stunting among children under five years of age was 54.4%. Significant associations were found between stunting and clean water availability (OR = 4.8; p < 0.001), latrine availability (OR = 5.1; p = 0.002), waste management practices (OR = 8.5; p < 0.001), household waste disposal (OR = 4.9; p < 0.001), and the presence of helminth eggs in feces (OR = 5.0; p = 0.001). Overall, inadequate household waste management was the strongest environmental determinant of child stunting. In conclusion, environmental sanitation conditions, particularly household waste management, play a substantial role in the risk of stunting in children under five years of age. Strengthening community-based sanitation interventions and improving household waste management practices may effectively reduce infection-related risks and lower the prevalence of stunting in North Aceh District.
Keywords : Environmental Health, Growth Disorders, Child, Preschool, Sanitation, Risk Factors
- Aceh Provincial Health Office. (2023). Aceh health profile 2023. https://dinkes.acehprov.go.id/
- Agho, K., Mukabutera, C., Mukazi, M., Ntambara, M., Mbugua, I., Dowling, M., & Kamara, J. K. (2019). Moderate and severe household food insecurity predicts stunting and severe stunting among Rwanda children aged 6–59 months residing in Gicumbi district. Maternal and Child Nutrition, 15(3), e12767. https://doi.org/10.1111/mcn.12767
- Agustina, K. K., Wirawan, I. M. A., Sudarmaja, I. M., Subrata, M., & Dharmawan, N. S. (2022). The first report on the prevalence of soil-transmitted helminth infections and associated risk factors among traditional pig farmers in Bali Province, Indonesia. Veterinary World, 15(5), 1154–1162. https://doi.org/10.14202/vetworld.2022.1154-1162
- Al Rahmad, A. H., Miko, A., Labatjo, R., Fajriansyah, F., Fitri, Y., & Suryana, S. (2020). Malnutrition prevalence among toddlers based on family characteristics: A cross-sectional study in the rural and urban areas of Aceh, Indonesia. Sri Lanka Journal of Child Health, 49(3), 263. https://doi.org/10.4038/sljch.v49i3.9145
- Al Rahmad, A. H., Junaidi, J., Muliyani, N. S., & Emilda, E. (2023). The impact of integrating the ISO/IEC 25010 standard into the “PSG Balita” on the quality of the toddler nutritional status report data. AcTion: Aceh Nutrition Journal, 8(4), 653–659. https://doi.org/10.30867/action.v8i4.754
- Al Rahmad, A. H., Sofyan, H., Usman, S., & Mudatsir. (2024). The accuracy data of the toddlers’ nutritional status using the “PSG Balita” app. In T. Tahlil & P. Ardia (Eds.), The 6th Aceh International Nursing Conference (pp. 82–86). Journal of Liaquat University of Medical and Health Sciences. https://doi.org/10.22442/jlumhs.2024.01130
- Anastasia, H., Hadju, V., Hartono, R., Samarang, Manjilala, Sirajuddin, Salam, A., & Atmarita. (2023). Determinants of stunting in children under five years old in South Sulawesi and West Sulawesi Province: 2013 and 2018 Indonesian Basic Health Survey. PLOS ONE, 18(5), e0281962. https://doi.org/10.1371/journal.pone.0281962
- Arbiana, A., Tsaralatifah, R., & Nuraeni, N. (2020). Management of expired liquid chemicals in Gunung Batu’s chemistry laboratory of Health Polytechnic of the Ministry of Health Bandung in 2018. Jurnal Kesehatan Lingkungan, 12(4), 270–275. https://doi.org/10.20473/jkl.v12i4.2020.270-275
- Blankenship, J., Gwavuya, S., Palaniappan, U., Alfred, J., DeBrum, F., & Erasmus, W. (2020). High double burden of child stunting and maternal overweight in the Republic of the Marshall Islands. Maternal and Child Nutrition, 16(2), e12832. https://doi.org/10.1111/mcn.12832
- Butzin-Dozier, Z., Ji, Y., Coyle, J., Malenica, I., Rogawski McQuade, E. T., Grembi, J. A., Platts-Mills, J. A., Houpt, E. R., Graham, J. P., Ali, S., Rahman, M. Z., Alauddin, M., Famida, S. L., Akther, S., Hossen, M. S., Mutsuddi, P., Shoab, A. K., Rahman, M., Islam, M. O., … Lin, A. (2025). Treatment heterogeneity of water, sanitation, hygiene, and nutrition interventions on child growth by environmental enteric dysfunction and pathogen status for young children in Bangladesh. PLOS Neglected Tropical Diseases, 19(2), e0012881. https://doi.org/10.1371/journal.pntd.0012881
- Ciptanurani, C., & Chen, H. (2021). Household structure and concurrent stunting and overweight among young children in Indonesia. Public Health Nutrition, 24(9), 2629–2639. https://doi.org/10.1017/S1368980021001385
- Cumming, O., & Cairncross, S. (2016). Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications. Maternal & Child Nutrition, 12(S1), 91–105. https://doi.org/10.1111/mcn.12258
- Fauziah, N., Ar-Rizqi, M. A., Hana, S., Patahuddin, N. M., & Diptyanusa, A. (2022). Stunting as a risk factor of soil-transmitted helminthiasis in children: A literature review. Interdisciplinary Perspectives on Infectious Diseases, 2022, 1–14. https://doi.org/10.1155/2022/8929025
- Fufa, D. A. (2022). Determinants of stunting in children under five years in Dibate district of Ethiopia: A case-control study. Human Nutrition & Metabolism, 30, 200162. https://doi.org/10.1016/j.hnm.2022.200162
- Garcia, L. S., & Procop, G. W. (2016). Diagnostic medical parasitology. In Manual of commercial methods in clinical microbiology: International edition (pp. 284–308). [data tidak tersedia penerbit]. https://doi.org/10.1002/9781119021872.ch15
- Gassara, G., Lin, Q., Deng, J., Zhang, Y., Wei, J., & Chen, J. (2023). Dietary diversity, household food insecurity and stunting among children aged 12 to 59 months in N’Djamena—Chad. Nutrients, 15(3), 573. https://doi.org/10.3390/nu15030573
- Hasyim, H., Kusuma Aerosta, D., Budiastuti, A., Razak, R., Yeni, Y., Misnaniarti, M., Alam Fajar, N., Febry, F., Etrawati, F., Lionita, W., Rahmawaty, A., Amin Arigo Saci, M., Yuliana, I., Indah Fajar Ningsih, W., Pratiwi, L., Yasyfi Nur Alfaini, N., Putri, N., Wahyuni, N., Murniati, N., … Fadhilah Eka Maharani. (2025). Environmental factors’ determinant of childhood stunting in Indonesia: A systematic review and meta-analysis. Malaysian Journal of Public Health Medicine, 25(2), 11–19. https://www.mjphm.org/index.php/mjphm/article/view/2538
- Humphrey, J. H., Jones, A. D., Manges, A. R., Mangwadu, G., Maluccio, J. A., Mbuya, M. N. N., Moulton, L. H., Ntozini, R., Prendergast, A. J., Stoltzfus, R. J., Tielsch, J. M., Chasokela, C., Chigumira, A., Heylar, W., Hwena, P., Kembo, G., Majo, F. D., Mutasa, B., Mutasa, K., … Makoni, T. (2019). Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: A cluster-randomised trial. The Lancet Global Health, 7(1), e132–e147. https://doi.org/10.1016/S2214-109X(18)30374-7
- Junita, D., Al Rahmad, A. H., & Fajarna, F. (2024). Health status of adolescence girls based on nutritional status assessment and cardiorespiratory endurance (VO2max). National Nutrition Journal/Media Gizi Indonesia, 19(3), 275–281. https://doi.org/10.20473/mgi.v19i3.275–281
- Kemenkes RI. (2023). Survei Kesehatan Indonesia (SKI) 2023. https://www.badankebijakan.kemkes.go.id/ski-2023-dalam-angka/
- Kemenkes RI. (2024). Survei Status Gizi Indonesia (SSGI) 2024: Hasil utama nasional dan provinsi. https://www.badankebijakan.kemkes.go.id/survei-status-gizi-indonesia-ssgi-2024/
- Khan, S., Zaheer, S., & Safdar, N. F. (2019). Determinants of stunting, underweight and wasting among children < 5 years of age: Evidence from 2012–2013 Pakistan Demographic and Health Survey. BMC Public Health, 19(1), 358. https://doi.org/10.1186/s12889-019-6688-2
- Morales, S., Bowers, M. E., Shuffrey, L. C., Ziegler, K., Troller‐Renfree, S. V., Hernández, A., Leach, S. C., McGrath, M., Ola, C., Leve, L. D., Nozadi, S. S., Swingler, M. M., Lai, J., Schweitzer, J. B., Fifer, W. P., Camargo, C. A., Hershey, G. K. K., Shapiro, A., Keating, D. P., … Elliott, A. J. (2024). Maternal education prospectively predicts child neurocognitive function: An environmental influences on child health outcomes study. Developmental Psychology, 60(6), 1028–1040. https://doi.org/10.1037/dev0001642
- Nkhoma, B., Ng’ambi, W., Chipimo, P. J., & Zambwe, M. (2021). Determinants of stunting among children < 5 years of age: Evidence from 2018–2019 Zambia Demographic and Health Survey. [data tidak tersedia nama jurnal/preprint server]. https://doi.org/10.1101/2021.05.19.21257389
- Ntshebe, O., Channon, A. A., & Hosegood, V. (2019). Household composition and child health in Botswana. BMC Public Health, 19(1), 1621. https://doi.org/10.1186/s12889-019-7963-y
- Nuraini, I., Iswati, R. S., & Aisyah, A. (2022). Intervention of stunting aged 0–59 months reviewing from nutrition. Journal of Pharmaceutical Negative Results, 13(4), 700–705. https://doi.org/10.47750/pnr.2022.13.04.094
- Palmer, S., Burton-Obanla, A., Goon, S., Allison, T., Bogdonas, K., Fombelle, M., Hoffman, A., Smith, J., McCaffrey, J., & Prescott, M. P. (2024). Policy, systems, and environmental changes in child nutrition programs: A systematic literature review. Advances in Nutrition, 15(1), 100116. https://doi.org/10.1016/j.advnut.2023.09.004
- Prüss‐Üstün, A., Wolf, J., Bartram, J., Clasen, T., Cumming, O., Freeman, M. C., Gordon, B., Hunter, P., Medlicott, K., & Johnston, R. B. (2019). Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries. International Journal of Hygiene and Environmental Health, 222(5), 765–777. https://doi.org/10.1016/j.ijheh.2019.05.004
- Pun, V. C., Dowling, R., & Mehta, S. (2021). Ambient and household air pollution on early-life determinants of stunting: A systematic review and meta-analysis. Environmental Science and Pollution Research, 28(21), 26404–26412. https://doi.org/10.1007/s11356-021-13719-7
- Rah, J. H., Cronin, A. A., Badgaiyan, B., Aguayo, V. M., Coates, S., & Ahmed, S. (2015). Household sanitation and personal hygiene practices are associated with child stunting in rural India: A cross-sectional analysis of surveys. BMJ Open, 5(2), e005180. https://doi.org/10.1136/bmjopen-2014-005180
- Raj, E., Calvo-Urbano, B., Heffernan, C., Halder, J. B., & Webster, J. P. (2022). Systematic review to evaluate a potential association between helminth infection and physical stunting in children. Parasites & Vectors, 15(1), 135. https://doi.org/10.1186/s13071-022-05235-5
- Saaka, M., Saapiire, F. N., & Dogoli, R. N. (2021). Independent and joint contribution of inappropriate complementary feeding and poor water, sanitation and hygiene (WASH) practices to stunted child growth. Journal of Nutritional Science, 10, e109. https://doi.org/10.1017/jns.2021.103
- Sahiledengle, B., Petrucka, P., Kumie, A., Mwanri, L., Beressa, G., Atlaw, D., Tekalegn, Y., Zenbaba, D., Desta, F., & Agho, K. (2022). Association between water, sanitation and hygiene (WASH) and child undernutrition in Ethiopia: A hierarchical approach. BMC Public Health, 22(1), 1943. https://doi.org/10.1186/s12889-022-14309-z
- Sari, I. P., Ningsih, W. I. F., & Sari, D. M. (2023). The correlation between the household food security and the incidence of stunting in toddlers 6–59 months in Seberang Ulu I Palembang. Jurnal Ilmu Kesehatan Masyarakat, 14(2), 198–209. https://doi.org/10.26553/jikm.2023.14.2.198-209
- Shrestha, A., Six, J., Dahal, D., Marks, S., & Meierhofer, R. (2020). Association of nutrition, water, sanitation and hygiene practices with children’s nutritional status, intestinal parasitic infections and diarrhoea in rural Nepal: A cross. BMC Public Health, 20(1), 1241. https://doi.org/10.1186/s12889-020-09302-3
- Siramaneerat, I., Astutik, E., Agushybana, F., Bhumkittipich, P., & Lamprom, W. (2024). Examining determinants of stunting in urban and rural Indonesian: A multilevel analysis using the population-based Indonesian Family Life Survey (IFLS). BMC Public Health, 24(1), 1371. https://doi.org/10.1186/s12889-024-18824-z
- Striessnig, E., & Bora, J. K. (2020). Under-five child growth and nutrition status: Spatial clustering of Indian districts. Spatial Demography, 8(1), 63–84. https://doi.org/10.1007/s40980-020-00058-3
- Thurstans, S., Opondo, C., Seal, A., Wells, J., Khara, T., Dolan, C., Briend, A., Myatt, M., Garenne, M., Sear, R., & Kerac, M. (2020). Boys are more likely to be undernourished than girls: A systematic review and meta-analysis of sex differences in undernutrition. BMJ Global Health, 5(12), e004030. https://doi.org/10.1136/bmjgh-2020-004030
- UNICEF. (2023). The state of the world’s children 2023. https://www.unicef.org/reports/state-worlds-children-2023
- UNICEF/WHO/World Bank. (2023). Levels and trends in child malnutrition: 2023 edition. World Health Organization. https://www.who.int/publications/i/item/9789240073791
- Utami, W. S., Armiyanti, Y., & Amrina, A. P. Y. (2024). Analysis of determinants of tuberculosis in stunted toddlers in Rambipuji, Jember. Journal of Agromedicine and Medical Sciences, 10(1), 34–40. https://doi.org/10.19184/ams.v10i1.46500
- Vilcins, D., Sly, P. D., & Jagals, P. (2018). Environmental risk factors associated with child stunting: A systematic review of the literature. Annals of Global Health, 84(4), 551–562. https://doi.org/10.9204/aogh.2361
- WHO. (2023). Global tuberculosis report 2023. https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2023
- Yani, D. I., Rahayuwati, L., Sari, C. W. M., Komariah, M., & Fauziah, S. R. (2023). Family household characteristics and stunting: An update scoping review. Nutrients, 15(1), 233. https://doi.org/10.3390/nu15010233
- Zhu, W., Zhu, S., Sunguya, B., & Huang, J. (2021). Urban–rural disparities in the magnitude and determinants of stunting among children under five in Tanzania: Based on Tanzania Demographic and Health Surveys 1991–2016. International Journal of Environmental Research and Public Health, 18(10), 5184. https://doi.org/10.3390/ijerph18105184
Copyright (c) 2025 Ibrahim, Safwan, Safridha Kemala Putri, T. Khairul Fadjri

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.