Structural determinants of stunting among children aged 0–59 months: A PLS-SEM analysis of family, environmental, and health factors in Banten, Indonesia

Adam Sugiharto -  Department Faculty of Human Ecology, Bogor Agricultural University, West Java, and Ministry of Population and Family Development/National Population and Family Planning Agency, Indonesia
Megawati Simanjuntak* -  Faculty of Human Ecology, Bogor Agricultural University, West Java, Indonesia
Yulina Eva Riany -  Faculty of Human Ecology, Bogor Agricultural University, West Java, Indonesia
Muhammad Rizal Martua Damanik -  Faculty of Human Ecology, Bogor Agricultural University, West Java, Indonesia
Diah Krisnatuti -  Faculty of Human Ecology, Bogor Agricultural University, West Java, Indonesia
DOI : 10.30867/action.v11i2.3202

Stunting remains a major public health problem among children under five years of age in Indonesia, particularly among socioeconomically vulnerable families. Previous studies have mostly examined stunting determinants separately and rarely analyzed their structural relationships. This study aimed to analyze the structural relationships between family economic pressure, access to health facilities, feeding practices, and child nutritional status using Partial Least Squares Structural Equation Modeling (PLS-SEM). A cross-sectional study was conducted from July to September 2025 in Sumur District, Banten Province, Indonesia, involving 402 mothers with children aged 0–59 months from families at risk of stunting. Data were collected through structured interviews, anthropometric measurements and standardized questionnaires. Data were analyzed using SPSS 23 and SmartPLS 3.0. PLS-SEM analysis showed that family economic pressure significantly influenced feeding practices (β = 0.321; p < 0.001), and access to health facilities positively affected feeding practices (β = 0.130; p = 0.024). However, feeding practices did not significantly influence HAZ (β = 0.015; p = 0.768). Birth weight was associated with the nutritional status of the child. In conclusion, these findings highlight the importance of strengthening economic resilience and improving access to supportive health services in family based stunting prevention strategies.

Keywords : Economic pressure, feeding practices, nutritional status, PLS-SEM, stunting

  1. Ahmad, A. (2024). Factors associated with stunting among children 0–23 months in Aceh: A cross-sectional study using SSGI 2021. AcTion: Aceh Nutrition Journal, 9(3), 539. https://doi.org/10.30867/action.v9i3.1824
  2. Aleru, E. O., Bodunde, I. O., Deniran, I. A., Ajani, O. N., Aleru, O. O., & Fawole, A. O. (2023). WASH practices increased the prevalence of malnutrition among under-five children (6–59 months) in an urban slum area in Ibadan, Nigeria. Journal of Water, Sanitation and Hygiene for Development, 13(11), 910–920. https://doi.org/10.2166/washdev.2023.186
  3. Almaatani, D., Zurbau, A., Khoshnevisan, F., Bandsma, R. H. J., Khan, T. A., Sievenpiper, J. L., & van den Heuvel, M. (2023). The association between parents’ stress and parental feeding practices and feeding styles: Systematic review and meta-analysis of observational studies. Maternal & Child Nutrition, 19(1), e13448. https://doi.org/10.1111/mcn.13448
  4. Apriliani, A. (2025). Utilization of primary healthcare services and stunting among children aged 0–59 months in Indonesia: a national cross-sectional study. Contagion: Scientific Periodical Journal of Public Health and Coastal Health, 7(1), 404-414. https://doi.org/http://dx.doi.org/10.30829/contagion.v7i1.25425
  5. Ariyanti, R., Saefurrohim, M. Z., & Rahayu, E. P. (2025). Pengaruh water, sanitation, and hygiene (WASH) terhadap kejadian stunting pada balita di Indonesia: A systematic review. Jurnal Keperawatan Malang, 10(1), 18–30. https://doi.org/10.36916/jkm.v10i1.357
  6. Badan Pusat Statistik Provinsi Banten. (2024). Provinsi Banten dalam angka 2024. Badan Pusat Statistik Provinsi Banten.
  7. Beal, T., Tumilowicz, A., Sutrisna, A., Izwardy, D., & Neufeld, L. M. (2018). A review of child stunting determinants in Indonesia. Maternal & Child Nutrition, 14(4), e12617. https://doi.org/10.1111/mcn.12617
  8. Darmawan, A., Reski, R., & Andriani, R. (2022). Kunjungan ANC, posyandu dan imunisasi dengan kejadian stunting pada balita di Kabupaten Buton Tengah. AcTion: Aceh Nutrition Journal, 7(1), 33. https://doi.org/10.30867/action.v7i1.469
  9. de Onis, M., & Branca, F. (2016). Childhood stunting: A global perspective. Maternal & Child Nutrition, 12(S1), 12–26. https://doi.org/10.1111/mcn.12231
  10. Fitri, R., Khomsan, A., & Dwiriani, C. M. (2024). The dominant factors associated with stunting among two years children in five provinces in Indonesia. AcTion: Aceh Nutrition Journal, 9(1), 100–109. https://doi.org/10.30867/action.v9i1.1527
  11. Gaffan, N., Kpozehouen, A., Degbey, C., Ahanhanzo, Y. G., & Paraïso, M. N. (2023). Effects of the level of household access to water, sanitation and hygiene on the nutritional status of children under five, Benin. BMC Nutrition, 9(1). https://doi.org/10.1186/s40795-023-00751-8
  12. Heryanda, M. F., & Khoiriyah, N. (2024). Effects of healthy eating patterns based nutrition education and providing structured supplementary feeding on improving the nutritional status of stunted children. AcTion: Aceh Nutrition Journal, 9(3), 512. https://doi.org/10.30867/action.v9i3.1749
  13. Inbaraj, L. R., Khaja, S., George, C. E., & Norman, G. (2020). Paternal involvement in feeding and its association with nutritional status of children in an urban slum in a low resource setting: A cross-sectional study. Nutrition, 74, 110735. https://doi.org/10.1016/j.nut.2020.110735
  14. Kementerian Kesehatan Republik Indonesia. (2025). Survei Status Gizi Indonesia 2024. Kementerian Kesehatan Republik Indonesia.
  15. Kurniawan, R., Widyastuti, L., Alimoeso, S., Fathonah, S., Diaini, M., Kodir, M., Fine, W., Prawiti, O. A., & Fadhilah, H. F. (2025). Families at risk of stunting and the prevalence of stunting in Indonesia: An ecological study. KEMAS, 21(1), 225–236. https://doi.org/10.15294/kemas.v21i1.20978
  16. Kusdalinah, K., & Suryani, D. (2021). Asupan zat gizi makro dan mikro pada anak sekolah dasar yang stunting di Kota Bengkulu. AcTion: Aceh Nutrition Journal, 6(1), 93. https://doi.org/10.30867/action.v6i1.385
  17. Makasi, R. R., & Humphrey, J. H. (2020). Summarizing the child growth and diarrhea findings of the Water, Sanitation, and Hygiene Benefits and Sanitation Hygiene Infant Nutrition Efficacy trials. Nestlé Nutrition Institute Workshop Series, 93, 153–166. https://doi.org/10.1159/000503350
  18. Maqfira, N., Setiawan, B., & Dwiriani, C. M. (2024). Faktor determinan stunting pada balita dan positive deviance ibu di Desa Lokus Stunting Kabupaten Barru. AcTion: Aceh Nutrition Journal, 9(3), 433. https://doi.org/10.30867/action.v9i3.1700
  19. Muluye, S. D., Lemma, T. B., & Diddana, T. Z. (2020). Effects of nutrition education on improving knowledge and practice of complementary feeding of mothers with 6- to 23-month-old children in daycare centers in Hawassa Town, Southern Ethiopia: An institution-based randomized control trial. Journal of Nutrition and Metabolism, 2020, 6571583. https://doi.org/10.1155/2020/6571583
  20. Mustikaningrum, A. C., Subagio, H. W., & Margawati, A. (2016). Determinan kejadian stunting pada bayi usia 6 bulan di Kota Semarang. Jurnal Gizi Indonesia, 4(2), 82–88. https://doi.org/10.14710/jgi.4.2.82-88
  21. Nasrul Z, N. Z., Usman, S., & Alfridsyah, A. (2022). Prevalensi dan faktor determinan kejadian stunting pada siswa sekolah dasar di Kota Subulussalam, Provinsi Aceh 2021. AcTion: Aceh Nutrition Journal, 7(1), 104. https://doi.org/10.30867/action.v7i1.833
  22. Novitasari, P. D., & Wanda, D. (2020). Maternal feeding practice and its relationship with stunting in children. Pediatric Reports, 12(1), 1–4. https://doi.org/10.4081/pr.2020.8698
  23. Sachdev, H. S., & Borghi, E. (2024). Should a single growth standard be used to judge the nutritional status of children under age 5 years globally? No. The American Journal of Clinical Nutrition, 120(4), 759–763. https://doi.org/10.1016/j.ajcnut.2024.04.014
  24. Schmiedeberg, C., & Bozoyan, C. (2021). Do economic hardship and pressure really influence parenting? European Sociological Review, 37(2), 287–304. https://doi.org/10.1093/esr/jcaa051
  25. Schneider, W., & Schenck-Fontaine, A. (2022). Growing up unequal: Objective and subjective economic disparities and authoritarian parenting. Child Abuse & Neglect, 130, 105332. https://doi.org/10.1016/j.chiabu.2021.105332
  26. Story, W. T., & Carpiano, R. M. (2017). Household social capital and socioeconomic inequalities in child undernutrition in rural India. Social Science & Medicine, 181, 112–121. https://doi.org/10.1016/j.socscimed.2017.03.043
  27. Sugiharto, A., & Riany, Y. E. (2024). Comparative review of stunting prevalence rates in Banten Province, causal factors and preventive-curative measures. Journal of Family Sciences, 99–116. https://doi.org/10.29244/jfs.vi.50748
  28. Sugiharto, A., & Riany, Y. E. (2024a). Family characteristics, family functions and socio-economic status among families of contributory assistance recipient in Indonesia. Journal of Family Sciences, 9(1). https://doi.org/10.29244/jfs.v9i1.43941
  29. Sugiharto, A., & Riany, Y. E. (2024b). Comparative review of stunting prevalence rates in Banten Province, causal factors and preventive-curative measures. Journal of Family Sciences, 99–116. https://doi.org/10.29244/jfs.vi.50748
  30. Sugiharto, A., Simanjuntak, M., Riany, Y. E., Damanik, M. R. M., & Krisnatuti, D. (2026). Exploring husband’s contribution to toddler nutritional sufficiency: A socio-economic study from coastal and agromaritime communities. BIO Web of Conferences, 234, 04008. https://doi.org/10.1051/bioconf/202623404008
  31. UNICEF, World Health Organization, & World Bank Group. (2023). Levels and trends in child malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates: Key findings of the 2023 edition. UNICEF, World Health Organization, & World Bank Group.
  32. Vaivada, T., Akseer, N., Akseer, S., Somaskandan, A., Stefopulos, M., & Bhutta, Z. A. (2020). Stunting in childhood: An overview of global burden, trends, determinants, and drivers of decline. The American Journal of Clinical Nutrition, 112(Supplement 2), 777S–791S. https://doi.org/10.1093/ajcn/nqaa159
  33. Victora, C. G., Christian, P., Vidaletti, L. P., Gatica-Domínguez, G., Menon, P., & Black, R. E. (2021). Revisiting maternal and child undernutrition in low-income and middle-income countries: Variable progress towards an unfinished agenda. The Lancet, 397(10282), 1388–1399. https://doi.org/10.1016/S0140-6736(21)00394-9
  34. World Health Organization & United Nations Children’s Fund. (2025). Global nutrition targets 2030: Stunting brief. World Health Organization. https://doi.org/10.2471/B09383
  35. Yuliantini, E., Kamsiah, K., Maigoda, T. C., & Ahmad, A. (2022). Asupan makanan dengan kejadian stunting pada keluarga nelayan di Kota Bengkulu. AcTion: Aceh Nutrition Journal, 7(1), 79. https://doi.org/10.30867/action.v7i1.579

Open Access Copyright (c) 2026 Adam Sugiharto, Megawati Simanjuntak, Yulina Eva Riany, Muhammad Rizal Martua Damanik, Diah Krisnatuti
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AcTion: Aceh Nutrition Journal
Published by: Department of Nutrition at the Health Polytechnic of Aceh, Ministry of Health.
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