Globally, 149.2 million children are stunted, and 45.4 million children are wasting in 2020 [1]. The prevalence of stunting in Indonesia is higher than in other countries ASEAN, especially in remote areas. Based on the Indonesian nutritional status study in 2021, the prevalence of stunting by 24,4% decreased from 2019 by 27,7% [2]. However, it exceeds of WHO standard of 20%. The prevalence of stunting in Indonesia is still higher than in Vietnam (22,3%), Malaysia (20,9%), Thailand (12,3%), and Singapore (2,8%) [3]. More efforts are still needed from various ministries and institutions through specific and sensitive nutrition interventions to achieve targets of reducing stunting by 3.0% per year or 14% in 2024 [4].
The quality of human resources country can be reflected in the magnitude of the stunting problem because stunting has a very detrimental impact in the short and long term. Recent studies revealed stunting correlates with increased morbidity, mortality, and decreased quality of life [5–9]. Stunting increases the risk of low cognitive ability, suboptimal height, lost productivity, poor educational performance, several infectious diseases, and a greater risk of degenerative diseases in adulthood [10–14]. In addition, stunting can affect economic growth [15]. One of the key indicators of a well-functioning health system is equitable access to health services. Indonesia has a large geographic and socio-economic disparity in child undernutrition. For example, Papua Region (Eastern Indonesia region) has a higher prevalence of malnutrition than the Java-Bali Region [16].
The factors causing stunting include household social-economic status, inadequate complementary feeding, not breastfeeding practice, and a sick history. The present study shows that stunting in Indonesia is influenced by many factors, both individuals, families, and the environment [17, 18]. Another study also found that the factors related to stunting were a history of premature birth, health facilities of delivery, parents' education level, food security status, urban or rural residence, having a toilet at home, inadequate utilization of prenatal care, poor nutritional status during pregnancy and infectious dis-ease history [19–26]. In addition, poor sanitation, lack of access to health services, and use of contraception influence the incidence of stunting in toddlers [27].
Several studies have shown that the prevalence of stunting in remote and rural areas is higher than in non-remote areas or urban [28, 29]. Although the prevalence of stunting in remote areas is higher, a study in Bangladesh which is also a developing country like Indonesia shows that the prevalence of stunting in remote and non-remote areas is not too different, namely 38.1% and 31.2% respectively [30]. In remote or urban areas, health facilities are widely available and evenly distributed, but people who live in non-remote areas also have poor people who have low levels of education and socioeconomic status.
Based on data from the Indonesian Central Bureau of Statistics, the number of poor people in Indonesia in 2022 is 26.16 million, of which 11.82 million people live in urban areas or non-remote areas [31]. Most of the people who are classified as poor in Indonesia have a low level of education or have never received an education, do not have a steady job, so they have a low level of economic and welfare, and do not have a decent place to live [32]. The low level of education of parents will affect their ability to obtain more health information and can also affect the type and amount of food that will be given to their children [33]. In fact, a higher level of education will also increase the socio-economic level of the community so that their welfare also increases [33]. This can cause them to not have awareness of and access to good health care facilities, which can cause their children to also be at risk of experiencing stunting, even though they live in urban or non-remote areas.
Unfortunately, there is still limited information regarding predisposing factors related to stunting based on the characteristics of regions in Indonesia. The study aims is to determine whether the existence of adequate health facilities followed by low levels of education and economy in non-remote areas will affect to prevent the incidence of stunting on children in Indonesia.