Determinants of Stunting in Children Under Five
Abstract
Introduction: Stunting in children under five years old remains a major global health concern, affecting approximately 22.3% of children worldwide. It contributes to impairments in physical and cognitive development, reduced academic performance, lower economic productivity, and increased susceptibility to non-communicable diseases. This study aims to synthesize comprehensive evidence regarding the determinants associated with stunting in children under five.
Methods: A systematic review and meta-analysis were conducted using data from 22 eligible studies retrieved from international databases (Scopus, PubMed, ScienceDirect, and Springer). Heterogeneity was assessed using the I² statistic, and a random-effects model was applied to estimate the odds ratio (OR) and 95% confidence interval (CI). Publication bias was evaluated using funnel plot visualization and Egger’s test.
Results: Meta-analysis findings demonstrate that several determinants significantly increase the risk of stunting, including low maternal education (OR = 1.63; 95% CI: 1.11–2.41; I² = 84.64%), low paternal education (OR = 1.66; 95% CI: 1.05-2.61; I² = 55.64%), maternal occupation (OR = 1.59; 95% CI: 1.09-2.32; I² = 71.16%), low household income (OR = 1.83; 95% CI: 1.30-2.58; I² = 73.72%), and households with two or more young children (OR = 2.34; 95% CI: 1.65-3.30; I² = 23.89%). Additional factors such as inadequate antenatal care (OR = 1.62; 95% CI: 1.07-2.47; I² = 41.71%), non-exclusive breastfeeding (OR = 1.21; 95% CI: 1.60-3.03; I² = 80.25%), incomplete immunization (OR = 2.77; 95% CI: 1.48-5.19; I² = 63.58%), low birth weight (OR = 2.72; 95% CI: 1.61-4.66; I² = 65.71%), and a history of infectious diseases (OR = 1.96; 95% CI: 1.36-2.82; I² = 64.06%) were also strongly associated with stunting. No substantial publication bias was indicated by Egger’s test (p > 0.05).
Conclusion:Stunting is influenced by a combination of sociodemographic factors and maternal-child health services, such as parental education, household income, and exclusive breastfeeding. Reducing the prevalence of stunting requires integrated policies that encompass education, health, and family economic empowerment.
References
WHO. Joint child malnutrition estimates. World Health Organization [Internet]. 2022 [cited 2025 Feb 20]; Available from: https://www.who.int/data/gho/data/themes/topics/joint-child-malnutrition-estimates-unicef-who-wb?utm_source=chatgpt
Sari NIY, Maringga EG. Determinant of Maternal and Hair Zinc Level on Stunting and Developmental Disorders in Under Five Aged Children: A Path Analysis. In: Childhood Stunting, Wasting, and Obesity, as the Critical Global Health Issues: Forging Cross-Sectoral Solutions [Internet]. In The International Conference on Public Health Proceeding; 2020 [cited 2025 Feb 14]. Available from: https://theicph.com/index.php/icph/article/view/1588
Mulaw GF, Adem OS, Belachew AB. Determinants of Stunting among Children Aged 6-23 Months of Age in Pastoral Community, Afar Region, Ethiopia: Unmatched Case-Control Study. Int J Child Health Nutr. 2020 Nov 25;9(4):191–201.
Tahangnacca M, Amiruddin R, Ansariadi, Syam A. Model of stunting determinants: A systematic review. Enferm Clin. 2020 Jun;30:241–5.
Fidyah Aminin, Melly Damayanti, Nurul Aini Suria Saputri, Darwitri D. Determinants Of Stunting: A Systematic Review. International Journal of Social Science. 2022 Apr 1;1(6):1065–76.
Mudadu Silva JR, Vieira LL, Murta Abreu AR, de Souza Fernandes E, Moreira TR, Dias da Costa G, et al. Water, sanitation, and hygiene vulnerability in child stunting in developing countries: a systematic review with meta-analysis. Public Health. 2023 Jun;219:117–23.
Hafid F, Nasrul N, Adhyanti A, Bohari B. Social and Health Determinants of the Families of Children Under Two Years of Age with Stunting in Sigi District. Poltekita : Jurnal Ilmu Kesehatan. 2023 May 31;17(1):137–46.
Islam MS, Zafar Ullah AN, Mainali S, Imam MdA, Hasan MI. Determinants of stunting during the first 1,000 days of life in Bangladesh: A review. Food Sci Nutr. 2020 Sep 20;8(9):4685–95.
Kassaw A, Kassie YT, Kefale D, Azmeraw M, Arage G, Asferi WN, et al. Pooled prevalence and its determinants of stunting among children during their critical period in Ethiopia: A systematic review and meta-analysis. PLoS One. 2023 Nov 29;18(11):e0294689.
Hailegebriel T. Prevalence and Determinants of Stunting and Thinness/Wasting Among Schoolchildren of Ethiopia: A Systematic Review and Meta-Analysis. Food Nutr Bull. 2020 Dec 15;41(4):474–93.
Tan PY, Chan CL, Som SV, Dye L, Moore JB, Caton S, et al. Prevalence and key determinants of the triple burden of childhood malnutrition in Southeast Asian countries: a systematic review and meta-analysis within an adapted socio-ecological framework. Crit Rev Food Sci Nutr. 2024 Oct 23;1–15.
Dessie G, Li J, Nghiem S, Doan T. Prevalence and Determinants of Stunting-Anemia and Wasting-Anemia Comorbidities and Micronutrient Deficiencies in Children Under 5 in the Least-Developed Countries: A Systematic Review and Meta-analysis. Nutr Rev. 2025 Feb 1;83(2):e178–94.
Maulina R, Sri Purwanti A, Maria Veronika R, Maulina R. A Systematic Review and Meta-Analysis of Multilevel Analysis of Risk Factors for Stunting Among Under Five-Year-Old Children in Indonesia. Helios Multidisciplinary. 2024 Oct 25;1(1).
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Intern Med. 2009 Aug 18;151(4):264–9.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;n71.
Kassaw A, Kassie YT, Kefale D, Azmeraw M, Arage G, Asferi WN, et al. Pooled prevalence and its determinants of stunting among children during their critical period in Ethiopia: A systematic review and meta-analysis. PLoS One. 2023 Nov 29;18(11):e0294689.
DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials. 2015 Nov;45:139–45.
Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta?analysis. Stat Med. 2002 Jun 15;21(11):1539–58.
Irwig L, Macaskill P, Berry G, Glasziou P. Bias in meta-analysis detected by a simple, graphical test. Graphical test is itself biased. BMJ. 1998 Feb 7;316(7129):470; author reply 470-1.
Mutiarasari D, Miranti M, Fitriana Y, Pakaya D, Sari P, Bohari B, et al. A Determinant Analysis of Stunting Prevalence on Under 5-Year-Old Children to Establish Stunting Management Policy. Open Access Maced J Med Sci. 2021 Jan 19;9(B):79–84.
Tafesse T, Yoseph A, Mayiso K, Gari T. Factors associated with stunting among children aged 6–59 months in Bensa District, Sidama Region, South Ethiopia: unmatched case-control study. BMC Pediatr. 2021 Dec 6;21(1):551.
Ara G, Fawad B, Shabbir S. Malnutrition in children under five years in a squatter settlement of Karachi: a case-control study. BMC Public Health. 2024 Mar 19;24(1):848.
Hasan M, Islam MM, Mubarak E, Haque MdA, Choudhury N, Ahmed T. Mother’s dietary diversity and association with stunting among children <2 years old in a low socio?economic environment: A case–control study in an urban care setting in Dhaka, Bangladesh. Matern Child Nutr. 2019 Apr 14;15(2).
Gudeta HT, Nagari SL, Dadi DG, Abdulahi T, Abose S. Predictors of Stunting among 6–35 Months Old Children in Assosa Zone, Northwest Ethiopia: Unmatched Case–Control Study. Adv Public Health. 2023 Nov 13;2023:1–12.
Marume A, Archary M, Mahomed S. Predictors of stunting among children aged 6–59 months, Zimbabwe. Public Health Nutr. 2023 Apr 9;26(4):820–33.
Eshete Tadesse S, Chane Mekonnen T, Adane M. Priorities for intervention of childhood stunting in northeastern Ethiopia: A matched case-control study. PLoS One. 2020 Sep 24;15(9):e0239255.
Hayuningsih A, Kartasurya MI, Suhartono S, Sutiningsih D, Adi MS. Faktor Maternal, Keragaman Pangan dan Kelengkapan Imunisasi sebagai Determinan Stunting Baduta di Kecamatan Kalinyamatan Kabupaten Jepara. Amerta Nutrition. 2024 Aug 30;8(1SP):45–54.
Derso T, Tariku A, Biks GA, Wassie MM. Stunting, wasting and associated factors among children aged 6–24 months in Dabat health and demographic surveillance system site: A community based cross-sectional study in Ethiopia. BMC Pediatr. 2017 Dec 4;17(1):96.
Dranesia A, Wanda D, Hayati H. Pressure to eat is the most determinant factor of stunting in children under 5 years of age in Kerinci region, Indonesia. Enferm Clin. 2019 Sep;29:81–6.
Astuti Y, Paek SC, Meemon N, Marohabutr T. Analysis of traditional feeding practices and stunting among children aged 6 to 59 months in Karanganyar District, Central Java Province, Indonesia. BMC Pediatr. 2024 Jan 8;24(1):29.
Hadi H, Fatimatasari F, Irwanti W, Kusuma C, Alfiana RD, Asshiddiqi MIN, et al. Exclusive Breastfeeding Protects Young Children from Stunting in a Low-Income Population: A Study from Eastern Indonesia. Nutrients. 2021 Nov 26;13(12):4264.
Yuliastini S, Sudiarti T, Sartika RAD. Factors Related to Stunting among Children Age 6-59 Months in Babakan Madang Sub-District, West Java, Indonesia. Current Research in Nutrition and Food Science Journal. 2020 Aug 30;454–61.
Batiro B, Demissie T, Halala Y, Anjulo AA. Determinants of stunting among children aged 6-59 months at Kindo Didaye woreda, Wolaita Zone, Southern Ethiopia: Unmatched case control study. PLoS One. 2017 Dec 20;12(12):e0189106.
Shaka MF, Woldie YB, Lola HM, Olkamo KY, Anbasse AT. Determinants of undernutrition among children under-five years old in southern Ethiopia: does pregnancy intention matter? A community-based unmatched case-control study. BMC Pediatr. 2020 Dec 3;20(1):101.
Fikadu T, Assegid S, Dube L. Factors associated with stunting among children of age 24 to 59 months in Meskan district, Gurage Zone, South Ethiopia: a case-control study. BMC Public Health. 2014 Dec 7;14(1):800.
Agussalim, Zulkifli A, Noor NN, Ansariadi, Stang, Riskiyani S. Risk Factor Analysis of Stunting in Children Aged 6-23 Months in Tanralili District, Maros Regency, Indonesia. National Journal of Community Medicine. 2024 Jul 1;15(07):559–65.
Atamou L, Rahmadiyah DC, Hassan H, Setiawan A. Analysis of the Determinants of Stunting among Children Aged below Five Years in Stunting Locus Villages in Indonesia. Healthcare. 2023 Mar 9;11(6):810.
Gebreayohanes M, Dessie A. Prevalence of stunting and its associated factors among children 6–59 months of age in pastoralist community, Northeast Ethiopia: A community-based cross-sectional study. PLoS One. 2022 Feb 3;17(2):e0256722.
Usman S, Salma WO, Asriati A. Determinants of Stunting Incidence in Children Under Five Years of Age at the Rumbia Health Center, Indonesia. Journal of Client-centered Nursing Care. 2021 Nov 1;7(4):295–302.
Nurhayati E, Paramashanti BA, Astiti D, Aji AS. Dietary diversity, vitamin D intake and childhood stunting: a case-control study in Bantul, Indonesia. Malays J Nutr. 2020 Aug 5;26(2):273–87.
Laksono AD, Wulandari RD, Amaliah N, Wisnuwardani RW. Stunting among children under two years in Indonesia: Does maternal education matter? PLoS One. 2022 Jul 25;17(7):e0271509.
Hasan MT, Soares Magalhaes RJ, Williams GM, Mamun AA. The role of maternal education in the 15?year trajectory of malnutrition in children under 5 years of age in B angladesh. Matern Child Nutr. 2016 Oct 26;12(4):929–39.
Makoka D, Masibo PK. Is there a threshold level of maternal education sufficient to reduce child undernutrition? Evidence from Malawi, Tanzania and Zimbabwe. BMC Pediatr. 2015 Dec 22;15(1):96.
Sumon IH, Akter S, Sujon MdSH, Alam MK, Yasmin S, Yeasmin S, et al. Determinants of stunting among under?five children: Evidence from Cambodian Demographic and Health Survey 2021–2022. Child Care Health Dev. 2024 Jul 19;50(4).
Yuni Y, Budiastutik I, Trisnawati E, Marlenywati M. The The Effect of “PENTING” Education on Improving Father’s Parenting Role. Miracle Journal of Public Health. 2024 Dec 30;7(2):155–66.
Ahmed M, Zepre K, Lentero K, Gebremariam T, Jemal Z, Wondimu A, et al. The relationship between maternal employment and stunting among 6–59 months old children in Gurage Zone Southern Nation Nationality People’s region, Ethiopia: A comparative cross-sectional study. Front Nutr. 2022 Oct 6;9.
Gadanya AM, Auwal M, Abubakar SM, Mudassir L. Effect of Maternal Age and Occupation on Feeding Habits and Nutritional Status of under Five Children in Kibiya and Dala Local Government Areas, Kano Nigeria. Asian Journal of Biochemistry, Genetics and Molecular Biology. 2020 Dec 29;1–13.
Fitriani FD, Sunarsih T, Yulaikhah L. The Association of Occupation and Income with The Incidence of Stunting. EMBRIO. 2024 Dec 31;16(2):147–54.
Seko M, Mosha I. Fathers’ Involvement in Child Care Practices to Improve Stunting among Under-five Children in Sumbawanga Rural District, Rukwa Tanzania. eajahme. 2024 Dec 31;7(3).
Utami RA, Setiawan A, Fitriyani P. Identifying causal risk factors for stunting in children under five years of age in South Jakarta, Indonesia. Enferm Clin. 2019 Sep;29:606–11.
Bigirimana JB. Stunting among Under Five Years Old Children in Rwanda: Influences of Family Planning Status and Household Size and Composition. Rwanda Journal of Medicine and Health Sciences. 2021 Apr 8;4(1):112–30.
Mengesha A, Hailu S, Birhane M, Belay MM. The Prevalence of Stunting and Associated Factors among Children Under Five years of age in Southern Ethiopia: Community Based Cross-Sectional Study. Ann Glob Health. 2021 Nov 17;87(1).
Kuhnt J, Vollmer S. Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries. BMJ Open. 2017 Nov 15;7(11):e017122.
Kurniawati A, Kusuma FV, Paryono H. Effect of Exclusive Breastfeeding on Stunting in Children Under Five at Pedan Health Center, Klaten, Central Java, Indonesia. In: Developing a Global Pandemic Exit Strategy and Framework for Global Health Security. Masters Program in Public Health, Universitas Sebelas Maret; 2021. p. 168.
Izzah R, Ahmad A, Junita D, Rafiqi Arifin S. Exclusive breastfeeding and low birth weight as risk factors of stunting in under-five children: A case-control study in Darul Imarah Sub-District, Aceh Besar, Indonesia. JAND: Journal of Applied Nutrition and Dietetic. 2022 Jun 11;1(1):34–42.
Purwanti E, Masitoh S, Ronoatmodjo S. Association Between Basic Immunization Status and Stunting in Toddlers Aged 12 to 59 Months in Indonesia. Journal of Preventive Medicine and Public Health. 2025 Jan 30;
Theresia GN, Sudarma V. Immunization status lowers the incidence of stunting in children 1-5 years. World Nutrition Journal. 2022 Aug 26;6(1):9–15.
Putri TA, Salsabilla DA, Saputra RK. The Effect of Low Birth Weight on Stunting in Children Under Five: A Meta Analysis. Journal of Maternal and Child Health. 2021 Jul 16;6(4):496–506.
Rasmaniar R, Sapitri A, Leksono P, Petrus P, Fathurrahman T, Rai sudarsono I made, et al. The Relationship of Infectious Disease ,Nutritional Knowledge of Mothers and Eating Patterns with the Incidence of Stunting in Under Five Children in the Area Health Center Kapoiala Konawe Southeast Sulawesi. Jurnal Stunting Pesisir dan Aplikasinya. 2023 Jul 2;2(2).
Elsa Octa Aditia N, Mitra M, Rienarti Abidin A, Priwahyuni Y, Vita Gloria Purba C. Factors Associated with Stunting in Children Under Five Years. Jurnal Kesehatan Komunitas. 2023 Apr 9;9(1):122–31.
Copyright (c) 2025 Media Publikasi Promosi Kesehatan Indonesia (MPPKI)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Media Publikasi Promosi Kesehatan Indonesia retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:
-
Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.
-
Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Media Publikasi Promosi Kesehatan Indonesia.
-
License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.
