Nia Junia Puteri, Laila Fitria

Access to Sanitation and Its Impact on Stunting in Toddlers in EastNusa Tenggara, Indonesia

Introduction

Access to sanitation and its impact on stunting in toddlers in eastnusa tenggara, indonesia. Examines the impact of sanitation access on stunting in toddlers (0-59 months) in East Nusa Tenggara, Indonesia. Inadequate sanitation raises stunting risk by 1.56 times. Recommends improved sanitation in rural areas.

Abstract

Background: Stunting is still one of the focuses of health problems in the world.Stunting is caused by many factors, including access to sanitation. Inadequate access to sanitation can cause infectious diseases that impair nutritional absorption intoddlers during digestion, leading to stunting. Objective: This study examines theconnection between sanitation access and stunting in East Nusa Tenggara Provincealong with its confounding variables consisting of access to drinking water, toddlerage, gender, and residence. Method: The study design was cross-sectional with asample size of 4,224 children aged 0-59 months analyzed from the 2023 Indonesian Health Survey (IHS) data. Data were analyzed using univariate, bivariate (ChiSquare test), and multivariate (multiple logistic regression analyses with a risk factormodel). Results: Studies showed households with inadequate sanitation access canincrease the risk of stunting by 1.56 compared to those with adequate sanitation access. Other factors significantly associated with stunting included toddler age, gender, and residence. The problem of access to sanitation is related to residence anddefecation behavior. Conclusion: Increasing indiscriminate defecation behavior canincrease exposure to pathogens from feces which can cause diseases such as diarrhea, resulting in malnutrition and stunted growth. To reduce stunting in East NusaTenggara Province, the government is suggested to enhance programs to expandaccess to sanitation, especially in rural areas.

Review

This study provides a highly relevant and timely examination of the critical link between access to sanitation and stunting among toddlers in East Nusa Tenggara, Indonesia. A significant strength lies in its robust methodology, drawing upon a substantial sample size of 4,224 children from the 2023 Indonesian Health Survey data. The application of appropriate statistical analyses, including multivariate logistic regression, enhances the credibility of the findings. The core result, demonstrating that inadequate sanitation access increases the risk of stunting by 1.56 times, offers a clear and impactful contribution to the public health discourse on child malnutrition. The identification of other significant factors like toddler age, gender, and residence further enriches the understanding of stunting's multifaceted etiology in the region. While the study's objective and primary findings are clear and impactful, the abstract could be strengthened by offering a more explicit definition of "inadequate sanitation access." Clarifying whether this refers to unimproved facilities, shared facilities, or specifically open defecation behavior would provide greater precision for readers and policymakers. Additionally, the conclusion introduces "indiscriminate defecation behavior" as a key factor contributing to pathogen exposure; however, its specific measurement or direct link to the reported sanitation access variable was not explicitly detailed in the methods or results summary within the abstract, creating a slight interpretational gap. Finally, while "access to drinking water" was listed as a confounding variable, its association with stunting was not reported in the results summary, which could have provided a more complete picture of environmental health factors. Despite these minor points, this research offers invaluable insights into a persistent public health challenge. The study effectively underscores the critical role of environmental health interventions, particularly improved sanitation, in addressing stunting. Its findings provide a strong evidence base for the concluding recommendation, urging the government to enhance programs for expanding sanitation access, especially in rural areas, to mitigate the burden of stunting in East Nusa Tenggara. This paper serves as an important call to action, guiding public health efforts and resource allocation towards comprehensive strategies that integrate sanitation improvements with nutritional interventions.

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