skip to main content

AIR, SANITASI, DAN STUNTING DI INDONESIA : NARRATIVE REVIEW

1Departemen Ilmu Gizi, Fakultas Kedokteran, Universitas Diponegoro, Semarang, Jawa Tengah, Indonesia

2Fakultas Kesehatan Masyarakat, Universitas Diponegoro, Semarang, Jawa Tengah, Indonesia

3Departemen Ilmu Kedokteran, Fakultas Kedokteran, Universitas Diponegoro, Tembalang, Semarang, Jawa Tengah, Indonesia

Received: 6 May 2025; Revised: 8 Jul 2026; Accepted: 13 Jul 2026; Available online: 27 Jul 2026; Published: 27 Jul 2026.

Citation Format:
Abstract

ABSTRACT

Background: Stunting is a condition of growth failure in toddlers (under 5 years) due to chronic nutritional problems that cause children to be short for their age. Globally, WHO (2022) estimates that as many as 148.1 million (22.3%) toddlers experience stunting, most of whom are in Asian (52%) and African (43%) countries, one of which is Indonesia. Poor water and sanitation conditions are often found in areas with a high prevalence of stunting. So far, a lot of research has been conducted on stunting in Indonesia, but it only focuses on nutrition/ food. Water and sanitation factors have not been researched much or have not receive much attention, even though their influence is quite large.

Objectives: This study aims to analyze the association between water and sanitation factors and the incidence of stunting in Indonesia.

Methods: The method used in writing this article is a narrative review. A search for several electronic databases was conducted between January - March 2025 using Scopus, Science Direct, and PubMed published between 2020-2025. The search keywords used included “Water “AND” Sanitation “AND” Stunting.

Results: A review of 22 articles found that water factors (source of clean water, quality of clean water, source of drinking water, access to drinking water, drinking water treatment) and sanitation (use of toilets, healthy toilets, ownership of toilets, open defecation behavior and improper disposal of toddler feces) were all associated with stunting in children under five years of age.

Conclusion: Inadequate water and sanitation factors are associated with stunting in toddlers in Indonesia

Keywords : Water; Sanitation;Toddlers; Stunting; Indonesia

 

ABSTRAK

Latar belakang: Stunting mencerminkan kondisi gagal tumbuh pada anak balita (bawah 5 tahun) akibat masalah gizi kronis yang menyebabkan anak menjadi pendek untuk usianya. Secara global, WHO (2022) memperkirakan sebanyak 148.1 juta (22.3%) anak balita mengalami stunting, sebagian besar berada di negara-negara Asia (52%) dan Afrika (43%), salah satunya Indonesia. Kondisi air dan sanitasi yang buruk, sering ditemukan di daerah dengan prevalensi stunting yang tinggi. Selama ini penelitian terkait stunting di Indonesia sudah banyak dilakukan namun hanya berfokus pada gizi/ makanan, faktor air dan sanitasi masih belum banyak di teliti atau tidak terlalu diperhatikan padahal pengaruhnya cukup besar

Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan faktor air dan sanitasi dengan kejadian stunting di Indonesia.

Metode: Metode yang digunakan dalam penulisan artikel ini adalah narrative review. Pencarian beberapa electronic database dilakukan pada bulan Januari – Maret 2025 melalui Scopus, Science Direct, dan PubMed yang terbit pada 2020-2025. Keywords pencarian yang digunakan meliputi “Water “AND” Sanitation “AND” Stunting.  

Hasil: Tinjauan terhadap 22 artikel menemukan bahwa faktor air (sumber air bersih, kualitas air bersih, sumber air minum, akses terhadap air minum, pengolahan air minum) dan sanitasi (penggunaan jamban, jamban sehat, kepemilikan jamban, perilaku buang air besar sembarangan dan pembuangan kotoran balita tidak tepat) berhubungan dengan stunting pada anak di bawah usia lima tahun.

Simpulan: Faktor air dan sanitasi yang tidak memadai berhubungan dengan kejadian stunting pada anak balita di Indonesia

Kata Kunci : Air; Sanitasi; Balita; Stunting;  Indonesia


Keywords: Air; Sanitasi; Balita; Stunting; Indonesia

Article Metrics:

Article Info
Section: Articles
Language : ID
  1. Leroy J., Frongillo E. Perspective: What Does Stunting Really Mean? A Critical Review of the Evidence. Adv Nutr. 2019;10(2):196-204. doi: https://doi.org/10.1093/advances/nmy101
  2. Mezmur H, Tefera M, Roba AA, Basdas O. Multi-Level Mixed-Effects Analysis of Stunting Among 6 to 59 Months Children in Ethiopia: Evidenced from Analysis of Health and Demographic Survey, 2000 to 2019. Glob Pediatr Heal. 2024;11. doi: https://doi.org/10.1177/2333794X241239226
  3. Supadmi S, Laksono AD, Kusumawardani HD, et al. Factor related to stunting of children under two years with working mothers in Indonesia. Clin Epidemiol Glob Heal. 2024;26:101538. doi: 10.1016/j.cegh.2024.101538
  4. Beal T, Tumilowicz A, Sutrisna A, Izwardy D, Neufeld LM. A review of child stunting determinants in Indonesia. Matern Child Nutr. 2018;14(4):1-10. doi: 10.1111/mcn.12617
  5. Kementerian Dalam Negeri, Bappenas dan TNP2K. Strategi Nasional Percepatan Pencegahan Anak Kerdil (Stunting) Periode 2018-2024. Published online 2018
  6. Beal T, Tumilowicz A, Sutrisna A, Izwardy D, Neufeld L. A Review of Child Stunting Determinants in Indonesia. Matern Child Nutr. 2018;14(4):1-10
  7. Woldesenbet B, Tolcha A, Tsegaye B. Water, hygiene and sanitation practices are associated with stunting among children of age 24-59 months in Lemo district, South Ethiopia, in 2021: community based cross sectional study. BMC Nutr. 2023;9(1):1-9. doi: 10.1186/s40795-023-00677-1
  8. World Health Organization. Global Database on Child Growth and Malnutrition 2017. Published online 2017. http://www.who.int/nutgrowthdb/about/introduction/en/index6.html
  9. Lestari E, Siregar A, Hidayat AK, Yusuf AA. Stunting and its association with education and cognitive outcomes in adulthood: A longitudinal study in Indonesia. PLoS One. 2024;19(5):1-18. doi: 10.1371/journal.pone.0295380
  10. UNICEF, World Health Organization, World Bank Group. Levels and Trends inChild Malnutrition. 2023 Edition. UNICEF, World Health Organization, World Bank Group; 2023
  11. Kemenkes. Hasil Survei Status Gizi Indonesia (SSGI) 2022. Kemenkes. Published online 2022:1-7
  12. Kementrian, PPN/ Bappenas Indonesia. Rencana Pembangunan Menengah Nasional 2020–2024. Published online 2020
  13. Sari DP, Yusuf S, Andid R, Darussalam D, Amna EY. Water , sanitation , and hygiene ( WASH ) factors associated with stunting among under-fives : A hospital-based cross-sectional study in Banda Aceh , Indonesia Faktor-faktor air , sanitasi , dan kebersihan yang berhubungan dengan stunting pada anak balita. 2024;9(3):614-622
  14. Batool M, Saleem J, Zakar R, et al. Relationship of stunting with water , sanitation , and hygiene ( WASH ) practices among children under the age of five : a cross- sectional study in Southern Punjab , Pakistan. Published online 2023:1-7
  15. Siti N, Novianti S, Huriyati E, Padmawati RS. Safe Drinking Water , Sanitation and Mother ’ s Hygiene Practice as Stunting Risk Factors : A Case Control Study in a Rural Area of Ciawi Sub-district , Tasikmalaya District , West Java , Indonesia. Published online 2025
  16. Ademas A, Adane M, Keleb A, Berihun G, Tesfaw G. Water, sanitation, and hygiene as a priority intervention for stunting in under-five children in northwest Ethiopia: a community-based cross-sectional study. Ital J Pediatr. 2021;47(1):1-11. doi: 10.1186/s13052-021-01128-y
  17. Marlinae L, Arifin S, Husaini, et al. The Relationship Between Drinking Water Treatment and Clean Water Sources on The Incidence Of Stunting. River Stud. 2024;2(2):232-242. doi: 1061848/rst.v2i2-81
  18. Ramli, Agho KE, Inder KJ, Bowe SJ, Jacobs J, Dibley MJ. Prevalence and risk factors for stunting and severe stunting among under-fives in North Maluku province of Indonesia. BMC Pediatr. 2009;9:64. doi: 10.1186/1471-2431-9-64
  19. Menteri Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 21 Tahun 2020 tentang Rencana Strategis Kementerian Kesehatan Tahun 2020-2024. Kemenkes Republik Indones. Published online 2020:1-337
  20. Sapriansyah E, Aramico B, Azwar E. The Relationship Between Environmental Sanitation and Clean Water with Stunting Incidence in Toddlers in Panteraja. Media Publ Promosi Kesehat Indones. 2024;7(8):2235-2240. doi: https://doi.org/10.56338/mppki.v7i8.5980
  21. Soe TK, Laohasiriwong W, Sornlorm K, Mahato RK. Safely managed sanitation practice and childhood stunting among under five years old children in Myanmar. PLoS One. 2023;18(11 November):1-14. doi: 10.1371/journal.pone.0290600
  22. Heriana C, Heryanto ML, Herwandar FR, Latifa NN. Environmental Risk Determinants Associated With Stunting in ChildreninTasikmalaya,Indonesia:APublicHealthSurveillancebased Retrospective Studies. Malaysian J Med Heal Sci. 2024;20(2018):150-154. doi: 10.47836/mjmhs.20.s9.24
  23. Purnamasari NA, Raharjo M, Hanani Y. Environmental Sanitation and PBHS Analysis of Stunting Incidents in Toddler in Paser District. Media Publ Promosi Kesehat Indones. 2024;7(8):2092-2097. doi: https://doi.org/10.56338/mppki.v7i8.5721ResearchArticles2092
  24. Budiastutik I, Pranaka RN, Amaliyah N, Hediyanti G, Trisnawati E. The Relation of Infectious Diseases , Water Access , Hygiene Practice , and Sanitation with the Stunting : A Case-Control Study in Sambas Regency Hubungan Penyakit Menular , Sumber Air Bersih , Praktik Kebersihan , dan. Amerta Nutr. 2024;8(1):70-75. doi: 10.20473/amnt.v8i1SP.2024.70
  25. Haq W, Abbas F. A Multilevel Analysis of Factors Associated With Stunting in Children Less Than 2 years Using Multiple Indicator Cluster Survey (MICS) 2017–18 of Punjab, Pakistan. SAGE Open. Published online 2022:1-12. doi: 10.1177/21582440221096127
  26. Suarayasa K, Wandira BA, Yani A. Relationship between Basic Sanitation Facilities and Stunting Incidence in Toddlers Aged 6-59 Months in Palu City, Central Sulawesi. Media Publ Promosi Kesehat Indones. 2022;5(12):1665-1669. doi: 10.56338/mppki.v5i12.3547
  27. Ryadinency R, Izhak, Uly N, Zamli, Kinanti RA. Relationship between Family Environmental Sanitation and Stunting Incidents in Toddlers in Pararra Village, Sabbang District in 2021. Media Publ Promosi Kesehat Indones. 2022;5(8):1010-1014
  28. Octaria Y, Ernawati F, Khomsan A, Wardani Z. Determinants of Stunting in 6-59-Month-Old Children from Rural Agricultural Households in Cianjur, Indonesia. Malaysian J Med Heal Sci. 2020;16:29-30
  29. Id AD, Haszard JJ, Sari SYI, et al. Determination of modifiable risk factors for length-for-age z-scores among resource-poor Indonesian infants. 2021;16(2):1-20. doi: 10.1371/journal.pone.0247247
  30. Wicaksono RA, Arto KS, Mutiara E, Deliana M, Lubis M, Batubara JRL. Risk factors of stunting in indonesian children aged 1 to 60 months. Paediatr Indones Indones. 2021;61(1):12-19. doi: 10.14238/pi61.1.2021.12-9
  31. Mulyaningsih T, Mohanty I, Widyaningsih V, Gebremedhin TA, Miranti R, Wiyono VH. Beyond personal factors: Multilevel determinants of childhood stunting in Indonesia. PLoS One. 2021;16(11 November):1-19. doi: 10.1371/journal.pone.0260265
  32. Purba IG, Sunarsih E, Trisnaini I, Sitorus RJ. Environmental Sanitation and Incidence of Stunting in Children Aged 12-59 Months in Ogan Ilir Regency. J Kesehat Lingkung. 2020;12(3):189-199. doi: 10.20473/jkl.v12i3.2020.189-199
  33. Rah JH, Badgaiyan N, Cronin AA, Torlesse H. Improved sanitation is associated with reduced child stunting amongst Indonesian children under 3 years of age. 2020;16(October 2018):1-8. doi: 10.1111/mcn.12741
  34. Hasanudin, Djaafar T, Saharudin, Bungawati A. Factors related to the incidence of stunting in Nupabomba and Guntarano Villages, Tanantovea District, Donggala Regency. IOP Conf Ser Earth Environ Sci. 2021;755(1):1-8. doi: 10.1088/1755-1315/755/1/012035
  35. Gani AA, Widasari L, Otoluwa AS, et al. Risk factors for stunting among children in Banggai Regency , Indonesia. Enfermería Clínica. 2020;30:149-152. doi: 10.1016/j.enfcli.2019.10.058
  36. Asefa A, Girma D, Kaso AW, Ferede A, Agero G, Beyen TK. Prevalence of stunting and associated factors among under-five children in Robe Woreda, Arsi zone, Ethiopia. Int J Africa Nurs Sci. 2024;21(September):100782. doi: 10.1016/j.ijans.2024.100782
  37. Yunitasari E, Lee BO, Krisnana I, Lugina R, Solikhah FK. Determining the Factors That Influence Stunting during Pandemic in Rural Indonesia : A Mixed Method. Published online 2022:1-16
  38. Permatasari TAE, Chadirin Y, Ernirita EF, Putri BA. The association of sociodemographic, nutrition, and sanitation on stunting in children under five in rural area of West Java Province in Indonesia. J Public health Res. 2023;12(3). doi: 10.1177/22799036231197169
  39. Ministry of Health Indonesia. Indonesia Demographic and Health Survey 2017. Bps. Published online 2018:588. https://dhsprogram.com/pubs/pdf/FR342/FR342.pdf
  40. Richard SA, Black RE, Gilman RH, et al. Diarrhea in early childhood: Short-Term association with weight and long-Term association with length. Am J Epidemiol. 2013;178(7):1129-1138. doi: 10.1093/aje/kwt094
  41. BAPPENAS. Pedoman Pengukuran Capaian Pembangunan Perumahan dan Pemukiman Berbasis Hasil (Outcome). Published online 2019
  42. Menteri Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Nomor 2 Tahun 2023 Tentang Peraturan Pemerintah Nomor 66 Tahun 2014 Tentang Kesehatan Lingkungan. Menteri Kesehat Republik Indones. Published online 2023:1-179
  43. Rinanda T, Riani C, Artarini A, Sasongko L. Correlation between gut microbiota composition, enteric infections and linear growth impairment: a case–control study in childhood stunting in Pidie, Aceh, Indonesia. Gut Pathog. 2023;15(54):1-14. doi: 10.1186/s13099-023-00581-w
  44. National Institute of Population Research and Training (NIPORT); ICF International. Bangladesh Demographic and Health Survey 2017-18. Dhaka, Bangladesh, Rockville, Maryland, USA NIPORT ICF. Published online 2019:1-511
  45. Bangladesh Bureau of Statistics (BBS) and UNICEF Bangladesh. Progotir Pathey Bangladesh, Multiple Indicator Cluster Survey 2019, Survey Findings Report.; 2019. https://www.unicef.org/bangladesh/media/3281/file/Bangladesh 2019 MICS Report_English.pdf
  46. UNICEF W. Joint Monitoring Program. https://washdata.org/monitoring
  47. Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 3 Tahun 2014. Published online 2014:1-203
  48. Njuguna J. Effect of eliminating open defecation on diarrhoeal morbidity : an ecological study of. BMC Public Health. Published online 2016:2-7. doi: 10.1186/s12889-016-3421-2
  49. Sahiledengle B, Petrucka P, Kumie A, et al. Association between water, sanitation and hygiene (WASH) and child undernutrition in Ethiopia : a hierarchical approach. BMC Public Health. 2022;22(1943):1-20. doi: 10.1186/s12889-022-14309-z
  50. Gizaw Z, Yalew AW, Bitew BD, Lee J, Bisesi M. Stunting among children aged 24–59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural northwest Ethiopia. Sci Rep. 2022;12(1):1-11. doi: 10.1038/s41598-022-23981-5

Last update:

No citation recorded.

Last update:

No citation recorded.