Faktor Determinan Penyebab Tren Stunting pada Balita di Indonesia 2019 – 2022

Abstract

Stunting masih menjadi permasalahan gizi utama di Indonesia meskipun prevalensinya menunjukkan tren penurunan. Berdasarkan Studi Status Gizi Indonesia (SSGI), prevalensi stunting menurun dari 27,7% (2019) menjadi 21,6% (2022), namun masih berada di atas cut-off WHO (>20%) dan belum mencapai target nasional RPJMN 2020–2024 sebesar 14%. Stunting berdampak pada kesehatan, perkembangan kognitif, produktivitas ekonomi, serta berpotensi memperkuat siklus kemiskinan antargenerasi. Hingga saat ini, penelitian yang menganalisis determinan penyebab tren stunting secara komprehensif dengan pendekatan ekologis dan data lintas waktu pada tingkat provinsi masih terbatas. Oleh karena itu, penelitian ini bertujuan menganalisis karakteristik, hubungan, serta faktor determinan penyebab tren stunting pada balita di Indonesia dengan pendekatan multidimensi, guna memberikan rekomendasi strategi penanggulangan yang lebih efektif dan berkelanjutan. Penelitian ini menggunakan desain ecological study, di mana variabel exposure dan outcome dianalisis pada tingkat agregat provinsi (bukan individu). Unit analisis mencakup 34 provinsi dengan menggunakan data sekunder yang bersumber dari berbagai laporan publik resmi pada tahun 2019, 2021, dan 2022, berdasarkan ketersediaan data. Pemilihan periode tersebut memungkinkan analisis perubahan prevalensi stunting dan faktor-faktor yang berhubungan dengannya pada fase sebelum, selama, dan setelah pandemi COVID-19, yang merupakan periode dengan perubahan pada sistem kesehatan, kondisi perekonomian, dan ketahanan pangan rumah tangga. Variabel yang dianalisis mencakup status kesehatan (riwayat BBLR dan penyakit infeksi), asupan makanan (TKE, TKP, dan PPH), faktor sosial ekonomi (ibu remaja, tingkat kemiskinan, jenis kelamin kepala keluarga, kepemilikan akta kelahiran, RLS dan pengeluaran per kapita), serta program intervensi yang dikelompokkan menjadi intervensi pada konsumsi gizi (PMT ibu hamil KEK dan balita gizi kurang, suplementasi TTD ibu hamil dan remaja putri, serta ASI eksklusif), intervensi pada kesehatan dan lingkungan (akses fasilitas kesehatan, persalinan yang ditolong tenaga kesehatan, kunjungan ANC K4, imunisasi dasar lengkap, KB pascapersalinan, kepemilikan JKN-PBI, serta akses air minum dan sanitasi layak) dan intervensi pada pangan dan sosial (BPNT dan PKH). Analisis data dilakukan secara bertahap melalui analisis univariat untuk mendeskripsikan karakteristik dan laju perkembangan variabel. Selanjutnya, analisis perbedaan antarvariabel menggunakan uji ANOVA/Kruskal-Wallis, analisis hubungan menggunakan uji Pearson/Spearman, serta analisis multivariat dengan regresi linier berganda (backward elimination) untuk menentukan faktor determinan penyebab tren stunting. Hasil analisis menunjukkan bahwa prevalensi stunting secara nasional mengalami penurunan signifikan, dengan rata-rata laju perkembangan negatif sebesar 8,91% (p=0,05). Namun, capaian tersebut belum merata di seluruh wilayah, dengan penurunan terbesar terjadi di Provinsi Bali dengan laju perkembangan negatif sebesar 25,46%, sedangkan Provinsi Papua Barat mengalami peningkatan prevalensi tertinggi, yaitu sebesar 10,50%. Hal ini menunjukkan bahwa kemajuan penurunan stunting masih belum merata serta mencerminkan adanya kesenjangan pembangunan kesehatan dan efektivitas pelaksanaan intervensi antarprovinsi. Karakteristik asupan gizi, status kesehatan, layanan kesehatan, kondisi sosial ekonomi, serta cakupan program intervensi mengalami perkembangan dan perbedaan signifikan antarperiode. Analisis hubungan menunjukkan bahwa variabel yang memiliki hubungan signifikan dengan prevalensi stunting antarperiode meliputi status kesehatan, asupan gizi, kondisi sosial ekonomi, dan cakupan program intervensi. Analisis multivariat mengidentifikasi enam faktor determinan yang secara bersama-sama menjelaskan 75,9% variasi tren stunting (AdjR²=0,759). Faktor yang berkontribusi terhadap penurunan tren stunting adalah laju perkembangan diare (r= -0,719; p<0,001), ASI eksklusif (r= -0,963; p<0,001), dan KB pascapersalinan (r= -0,097; p=0,002). Sebaliknya, laju perkembangan kepala keluarga perempuan (r= 0,368; p=0,011), pengeluaran pangan (r= 2,156; p<0,001), dan PMT ibu hamil KEK (r= 0,269; p=0,005) berhubungan dengan peningkatan tren stunting. Peningkatan laju perkembangan diare justru cenderung menunjukkan penurunan tren stunting, yang diduga mencerminkan adanya perbaikan intervensi kesehatan dan sanitasi di wilayah yang mengalami peningkatan kasus diare, sehingga dampak diare terhadap stunting dapat diminimalkan. Sebaliknya, peningkatan proporsi kepala keluarga perempuan dan laju pengeluaran pangan berhubungan positif dengan tren stunting, menunjukkan kerentanan ekonomi dan sosial dapat meningkatkan risiko stunting, terutama terkait ketahanan pangan dan kesejahteraan keluarga. Program PMT bagi ibu hamil KEK menunjukkan hubungan positif dengan tren stunting, yang diduga berkaitan dengan prioritas pelaksanaan program di wilayah dengan prevalensi stunting yang tinggi, sehingga hubungan yang terbentuk belum sepenuhnya mencerminkan efektivitas program dalam menurunkan stunting. Sementara itu, peningkatan cakupan ASI eksklusif dan penggunaan KB pascapersalinan berhubungan dengan penurunan tren stunting melalui perbaikan status gizi bayi dan pengaturan jarak kelahiran yang lebih optimal sebagai strategi utama pencegahan stunting. Secara keseluruhan, penelitian ini menyimpulkan bahwa tren stunting pada balita di Indonesia tidak hanya ditentukan oleh faktor gizi secara langsung, tetapi juga dipengaruhi oleh faktor struktural dan multisektoral. Oleh karena itu, upaya penanggulangan stunting memerlukan pendekatan multisektoral yang terintegrasi dan berkelanjutan, dengan menitikberatkan pada peningkatan kualitas asupan gizi, perbaikan status kesehatan dan sanitasi, penguatan pelayanan kesehatan, peningkatan ketahanan ekonomi rumah tangga, serta optimalisasi efektivitas program intervensi secara merata antarwilayah guna mempercepat penurunan stunting secara berkelanjutan.

Stunting remains a significant nutritional problem in Indonesia, despite a recent decline. According to the Indonesian Nutrition Status Study (SSGI), the prevalence of stunting decreased from 27.7% in 2019 to 21.6% in 2022; however, it still exceeds the WHO threshold for public health concern (>20%) and has not yet reached the national target of 14% under the 2020–2024 National Medium-Term Development Plan (RPJMN). Stunting has significant consequences for children's health, cognitive development, adult economic productivity, and the perpetuation of intergenerational poverty cycles. Until now, research that comprehensively analyzes the determinants of stunting trends using an ecological approach and longitudinal data at the provincial level has been limited. Therefore, this study aims to analyze the characteristics, associations, and determinants of the trend in stunting among children under five in Indonesia using a multidimensional approach, drawing on the latest longitudinal data to provide recommendations for more effective and sustainable coping strategies. This research employed an ecological study design, in which exposure and outcome variables were analyzed at the aggregate provincial level rather than at the individual level. The unit of analysis comprised 34 provinces, using secondary data from various official public reports for the years 2019, 2021, and 2022, based on data availability. The selection of these periods enabled analysis of changes in stunting prevalence and associated factors across three distinct phases: before, during, and after the COVID-19 pandemic, a period characterized by major shifts in the health system, economic conditions, and household food security. The variables analyzed included health status (history of low birth weight and infectious diseases), nutritional intake (TKE, TKP, and PPH), socioeconomic factors (adolescent mothers, poverty level, gender of the household head, ownership of birth certificates, average years of education and per capita expenditure), and stunting intervention programs(supplementary feeding, iron supplementation, exclusive breastfeeding, access to basic health facilities, births assisted by health workers, and antenatal care visits, complete basic immunization, postpartum family planning, access to drinking water and sanitation, ownership of JKN-PBI, non-cash food assistance and PKH). Data analysis was conducted in stages: univariate analysis to describe variable characteristics and development rates; between-group difference testing using ANOVA/Kruskal-Wallis; association analysis using Pearson/Spearman tests; and multivariate analysis using multiple linear regression (backward elimination) to identify the determinants of the trends of stunting. The analysis indicated that the national stunting prevalence declined significantly, with an average development rate of -8.91% (p=0.05). However, this progress was unevenly distributed across provinces. The greatest decline was recorded in Bali Province (development rate: -25.46%), while West Papua Province experienced the highest increase in prevalence (+10.50%). These findings reflect persistent disparities in health development and the varying effectiveness of intervention implementation across provinces. The characteristics of health status, nutritional intake, socioeconomic conditions, nd intervention program coverage showed significant differences and development across the study periods. Association analysis revealed that variables significantly associated with stunting prevalence across periods included health status, dietary intake, socioeconomic conditions, and intervention program coverage. Multivariate analysis identified six determinant factors that together explained 75.9% of the variation in the stunting trend (AdjR²=0.759). Factors contributing to the decrease in the stunting trend were the rate of diarrhea development (r= -0.719; p<0.001), exclusive breastfeeding (r= -0.963; p<0.001), and postpartum family planning (r= -0.097; p=0.002). Conversely, the rate of development of female-headed households (r= 0.368; p=0.011), food expenditure (r= 2.156; p<0.001), and supplementary feeding for pregnant women with chronic energy deficiency (PMT KEK) (r= 0.269; p=0.005) were associated with an increase in the trend of stunting. The increase in the diarrhea development rate was paradoxically associated with a declining stunting trend, which is presumed to reflect improvements in health and sanitation interventions in areas experiencing rising diarrhea cases minimized the impact of diarrhea on stunting. Conversely, the increase in the proportion of female-headed households and the rate of food expenditure growth were positively associated with the stunting trend, indicating that economic and social vulnerability can elevate the risk of stunting, particularly in terms of food security and family welfare. The supplementary feeding program for pregnant women with CED showed a positive association with the trend of stunting, which is likely attributable to the program's prioritization in areas with high stunting prevalence, meaning that the observed association does not fully reflect the program's effectiveness in reducing stunting. Meanwhile, increased coverage of exclusive breastfeeding and postpartum family planning was associated with a declining stunting trend through improvements in infant nutritional status and optimal birth spacing, respectively, serving as key prevention strategies. Overall, this research concludes that the trend of stunting among children under five in Indonesia is not only determined by direct nutritional factors, but also influenced by structural and multisectoral factors. Therefore, efforts to combat stunting require an integrated, sustainable, multisectoral approach that emphasizes improving the quality of nutritional intake, enhancing health and sanitation, strengthening health services, increasing household economic resilience, and optimizing the effectiveness of intervention programs across regions to accelerate sustainable stunting reduction.