Keywords
Ecology
Infectious Diseases
River Communities
Sanitation
Stunting
How to Cite
Abstract
Stunting continues to pose a significant public health concern in riverine and ecologically vulnerable communities, where environmental, socio-cultural, and health system factors converge. Populations residing in floating dwellings along the Kahayan River face challenges such as inadequate sanitation, exposure to unsafe water sources, and limited access to essential services, all of which may contribute to an elevated risk of stunting. Accordingly, a comprehensive analytical model is warranted to clarify both direct and indirect ecological pathways influencing stunting among children under five in floating-house settlements. This mixed method cross-sectional study was carried out among children aged 0–59 months residing in floating-house communities along the Kahayan River. A purposive sampling technique was employed to select a total of 193 research participants. Quantitative data were gathered through structured questionnaires and anthropometric assessments, and subsequently analyzed using Structural Equation Modeling Partial Least Squares (SEM-PLS). Qualitative data were collected via in-depth interviews and focus group discussions with mothers, community leaders, healthcare professionals, and local stakeholders. Ecological determinants of stunting encompass individual-level factors such as dietary intake (β = 0.615, t = 12.871) and infectious diseases (β = 0.121, t = 2.370), both of which demonstrate direct impacts on stunting. Conversely, environmental sanitation (β = -0.096, t = 1.985) and cultural factors (β = -0.082, t = 1.665) are found to have indirect effects on stunting. Stunting among riverine floating communities is linked to ecological health factors. To prevent it effectively, a comprehensive approach is needed, including improved sanitation, culturally sensitive nutrition education, infection control, and strengthened community health services. The ecology-based model developed offers a tailored framework for sustainably reducing stunting in disadvantaged river settlements.
References
Adzura, M., Yulia, Y., & Fathmawati, F. (2021). Hubungan Sanitasi, Air Bersih dan Mencuci Tangan dengan Kejadian Stunting pada Balita di Indonesia. Sulolipu: Media Komunikasi Sivitas Akademika Dan Masyarakat, 21(1), 79. https://doi.org/10.32382/sulolipu.v21i1.2098
Akbar, M. R. A., Herawati, H., & Santi, E. (2025). Hubungan Sanitasi Lingkungan di Daerah Pinggiran Sungai dengan Stunting pada Balita (Studi di Wilayah Kerja UPTD Puskesmas Martapura Barat Kabupaten Banjar). Jurnal Kesehatan Lingkungan Indonesia, 24(2), 145–153. https://doi.org/10.14710/jkli.67777
Akinbode, S. O., Dipeolu, A. O., Bolarinwa, T. M., & Olukowi, O. B. (2021). Effect of health outcome on economic growth in sub-Saharan Africa: a system generalized method of moment approach. Journal of Economics and Development, 23(3), 254–266. https://doi.org/10.1108/JED-06-2020-0078
Angelica, S., Aisiyah Widjaja, N., & Aprilawati, D. (2023). The Role of Animal Protein in Preventing Stunting in Children: A Literature Review. International Journal of Research Publications, 139(1). https://doi.org/10.47119/IJRP10013911220235819
Ari Setyawati, Glendy Ariando Salomon, Nordianiwati Nordianiwati, Risna Ayu Rahmadani, & Herlina Herlina. (2023). Meningkatkan Kapasitas Kader Posyandu dalam Upaya Pencegahan dan Penanganan Stunting. Abdimas Polsaka, 82–88. https://doi.org/10.35816/abdimaspolsaka.v2i1.43
Arief, Y. S., Yunita, F. C., Efendi, F., Murti, F. A. K., Pradipta, R. O., & McKenna, L. (2025). Social and Environmental Determinants of Childhood Stunting in Indonesia: National Cross-Sectional Study. JMIR Pediatrics and Parenting, 8, e68918–e68918. https://doi.org/10.2196/68918
Arisjulyanto, D., & Suweni, K. (2024). Pengaruh Penyuluhan Terhadap Tingkat Pengetahuan Masyarakat Tentang Malaria Di Kabupaten Kepulauan Yapen. JURNAL KESEHATAN TROPIS INDONESIA, 2(1), 1–8. https://doi.org/10.63265/jkti.v2i1.51
Ariskawati, D., Prihayati, & Ismarina. (2024). Determinants Analysis of Increasing Incidents of Stunting among Toddlers Aged 6-59 Months. Nursing and Health Sciences Journal (NHSJ), 4(3), 323–331. https://doi.org/10.53713/nhsj.v4i3.406
Aryastami, N. K., & Mubasyiroh, R. (2021). Traditional practices influencing the use of maternal health care services in Indonesia. PLOS ONE, 16(9), e0257032. https://doi.org/10.1371/journal.pone.0257032
Asiah, A., Yogisutanti, G., & Purnawan, A. I. (2020). Asupan Mikronutrien dan Riwayat Penyakit Infeksi pada Balita Stunting di UPTD Puskesmas Limbangan Kecamatan Sukaraja Kabupaten Sukabumi. Journal of Nutrition College, 9(1), 6–11. https://doi.org/10.14710/jnc.v9i1.24647
Badan Pusat Statistik Indonesia. (2024). Persentase Bayi Usia Kurang Dari 6 Bulan Yang Mendapatkan Asi Eksklusif Menurut Provinsi, 2021-2023. https://www.bps.go.id/id/statistics-table/2/MTM0MCMy/persentase-bayi-usia-kurang-dari-6-bulan-yang-mendapatkan-asi-eksklusif-menurut-provinsi.html
Bakara, S. M. (2023). Analisis Spasial Sanitasi Total Berbasis Masyarakat dan Kejadian Stunting di Kabupaten Cianjur Tahun 2017. Preventif : Jurnal Kesehatan Masyarakat, 14(2). https://doi.org/10.22487/preventif.v14i2.722
Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., de Onis, M., Ezzati, M., Grantham-McGregor, S., Katz, J., Martorell, R., & Uauy, R. (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 382(9890), 427–451. https://doi.org/10.1016/S0140-6736(13)60937-X
Das, S., Fahim, S. M., Alam, M. A., Mahfuz, M., Bessong, P., Mduma, E., Kosek, M., Shrestha, S. K., & Ahmed, T. (2021). Not water, sanitation and hygiene practice, but timing of stunting is associated with recovery from stunting at 24 months: results from a multi-country birth cohort study. Public Health Nutrition, 24(6), 1428–1437. https://doi.org/10.1017/S136898002000004X
De Glanville, W. A., Thomas, L. F., Cook, E. A. J., Bronsvoort, B. M. de C., Wamae, N. C., Kariuki, S., & Fèvre, E. M. (2019). Household socio-economic position and individual infectious disease risk in rural Kenya. Scientific Reports, 9(1), 2972. https://doi.org/10.1038/s41598-019-39375-z
Fanny Dewi, T. I. A., Wirawan, N. N., & Muslihah, N. (2025). Determinants of stunting in urban and rural areas of Indonesia: A systematic review. AcTion: Aceh Nutrition Journal, 10(3), 860. https://doi.org/10.30867/action.v10i3.2690
Fazila, L., Fitri Siregar, S. M., Reynaldi, F., & Husna, A. (2022). Strategies for Handling Stunting in Nagan Raya Districts. J-Kesmas: Jurnal Fakultas Kesehatan Masyarakat (The Indonesian Journal of Public Health), 9(1), 1. https://doi.org/10.35308/j-kesmas.v9i1.4707
Febria, D., Hardianti, S., & Indrawati, I. (2023). Hubungan Sanitasi Lingkungan Rumah Tangga dengan Kejadian Stunting pada Anak Balita di Wilayah Kerja Puskesmas Kampar Kiri. Jurnal Kesehatan Tambusai, 4(4), 4562–4566. https://doi.org/10.31004/jkt.v4i4.18891
Febriyani, E. (2025). Faktor Kebertahanan Rumah Lanting di Kelurahan Kapuas Kanan Hilir. Jurnal Ilmiah Membangun Desa Dan Pertanian, 10(3), 323–332. https://doi.org/10.37149/jimdp.v10i3.2021
Food and Agriculture Organization of the United Nations. (2025). Fish and human nutrition. https://www.fao.org/fileadmin/user_upload/newsroom/docs/BlueGrowthNutritionRev2.pdf
Frenquelli, R., Ratcliff, M., Villar de Onis, J., Fernandes, M., Barros, F. C., Hirst, J. E., Papageorghiou, A. T., Kennedy, S. H., & Villar, J. (2022). Complex Perinatal Syndromes Affecting Early Human Growth and Development: Issues to Consider to Understand Their Aetiology and Postnatal Effects. Frontiers in Neuroscience, 16. https://doi.org/10.3389/fnins.2022.856886
Gowder, S. J. T. (2024). Social Aspects of Food and Nutrition: An Overview. Journal of Ecohumanism, 3(7), 2953–2961. https://doi.org/10.62754/joe.v3i7.4431
Gunawan, A. S., & Prameswari, G. N. (2022). Evaluasi Program Intervensi Gizi Spesifik Penanggulangan Stunting pada Baduta. Indonesian Journal of Public Health and Nutrition, 2(3), 251–259. https://doi.org/10.15294/ijphn.v2i3.55253
Huriah, T., & Nurjannah, N. (2020). Risk Factors of Stunting in Developing Countries: A Scoping Review. Open Access Macedonian Journal of Medical Sciences, 8(F), 155–160. https://doi.org/10.3889/oamjms.2020.4466
Iskandar Munir. (2024). Pelatihan Intensif Kader Kesehatan Sebagai Upaya Pencegahan Stunting Yang Efektif. Jurnal Ilmu Kesehatan Dan Gizi, 2(3), 42–48. https://doi.org/10.55606/jig.v2i3.3034
Islam, M. R., Rahman, M. S., Rahman, M. M., Nomura, S., de Silva, A., Lanerolle, P., Jung, J., & Rahman, M. M. (2020). Reducing childhood malnutrition in Bangladesh: the importance of addressing socio-economic inequalities. Public Health Nutrition, 23(1), 72–82. https://doi.org/10.1017/S136898001900140X
Jr., A. M. G., & Salvador, M. N. (2020). Nutritional Status and Infant and Young Child Feeding (IYCF) Practices among Buhid Mangyan Tribe, Occidental Mindoro Philippines. International Journal of Child Health and Nutrition, 9(2), 47–54. https://doi.org/10.6000/1929-4247.2020.09.02.1
Juliandar, M., Rohmat, D., Setiawan, I., & Nandi, N. (2023). The Impact of Citarum Harum Project on Ecoliteracy Among Upper Citarum Residents. Geosfera Indonesia, 8(3), 316. https://doi.org/10.19184/geosi.v8i3.40131
Jumu, L., Tukayo, I. J. H., Sukatemin, S., & Hardy, S. (2022). Maintaining The Sustainable Engagement of Adolescent in Family Team of Stunting Prevention Program. Jurnal Aisyah : Jurnal Ilmu Kesehatan, 7(S1), 307–312. https://doi.org/10.30604/jika.v7iS1.1296
Kemenkes RI. (2022). Kejar Target Stunting Turun Hingga 14%, Kemenkes Lakukan Pendekatan Gizi Spesifik. https://kemkes.go.id/id/ kejar-target-stunting-turun-hingga-14-kemenkes-lakukan-pendekatan-gizi-spesifik
Kementerian Sekeretarian Negara RI. (2026). Stunting Dalam Angka Provinsi Kalimantan Tengah. https://stunting.go.id/stunting-dalam-angka-provinsi-kalimantan-tengah/
Kwami, C. S., Godfrey, S., Gavilan, H., Lakhanpaul, M., & Parikh, P. (2019). Water, Sanitation, and Hygiene: Linkages with Stunting in Rural Ethiopia. International Journal of Environmental Research and Public Health, 16(20), 3793. https://doi.org/10.3390/ijerph16203793
Lisdeni, R., & Hartono, B. (2023). Faktor Risiko Sanitasi Lingkungan terhadap Kejadian Stunting pada Balita di Indonesia : Literatur Review. Jurnal Sehat Mandiri, 18(1), 153–167. https://doi.org/10.33761/jsm.v18i1.979
Loihala, M., Indar, I., Syam, A., Syafar, M., Abdullah, M. T., & Muis, M. (2023). Food consumption, culture, and living environment’s impact on stunting cases: A systematic review. Science, Engineering and Health Studies, 23050021. https://doi.org/10.69598/sehs.17.23050021
Makori, N., Kassim, N., Matemu, A., & Kinabo, J. (2018). Factors associated with stunting in Dodoma region, Tanzania. African Journal of Food, Agriculture, Nutrition and Development, 18(03), 13842–13861. https://doi.org/10.18697/ajfand.83.17000
Maya Puspitasari, F., Viprindrartin, S., & Zainuri, Z. (2024). Strategy Analysis for Reducing Stunting in Acceleration of Achievement of Sustainable Development Goals Case Study in Jember District, East Java. International Journal of Regional Innovation, 4(3). https://doi.org/10.52000/ijori.v4i3.119
Mulyasari, I., Puji Afiatna, Moneca Diah Listiyaningsih, & Anisa Puspitasari. (2024). Peningkatan Kapasitas Tim Pendamping Keluarga (TPK) dalam Melakukan Surveilan pada Program Percepatan Penurunan Stunting di Kabupaten Sragen. INDONESIAN JOURNAL OF COMMUNITY EMPOWERMENT (IJCE), 6(1), 112–117. https://doi.org/10.35473/ijce.v6i1.3189
Nasution, I. S., & Susilawati, S. (2023). Faktor Water, Sanitation, dan Hygiene (WASH) dengan Kejadian Stunting pada Balita di Kawasan Pesisir. Health Information : Jurnal Penelitian, 15(1 SE-Journal Supplement). https://myjurnal.poltekkes-kdi.ac.id/index.php/hijp/article/view/934
Nurfikri, A., & Nurhasanah, N. (2022). Infection Control Risk Assessment Pelayanan Kebidanan di Klinik Pratama Kota dan Kabupaten Cirebon. Jurnal Kesehatan Vokasional, 7(3), 148. https://doi.org/10.22146/jkesvo.72014
Olo, A., Mediani, H. S., & Rakhmawati, W. (2020). Hubungan Faktor Air dan Sanitasi dengan Kejadian Stunting pada Balita di Indonesia. Jurnal Obsesi : Jurnal Pendidikan Anak Usia Dini, 5(2), 1113–1126. https://doi.org/10.31004/obsesi.v5i2.788
Puspitasari, A., Abdullah, N., & Alimuddin, H. (2024). Sanitasi Lingkungan dan Tingkat Asupan Protein Hewani Terhadap Kejadian Stunting Pada Balita di Desa Pucak Kabupaten Maros. An Idea Health Journal, 4(02), 45–50. https://doi.org/10.53690/ihj.v4i02.239
Renaldo Tegar Prasetyo, Ananta Fittonia Benvenuto, Suci Nirmala, & Sahrun. (2023). Hubungan Status Gizi dengan Kejadian Pneumonia pada Anak di Kabupaten Lombok Utara Provinsi Nusa Tenggara Barat (NTB). Nusantara Hasana Journal, 2(12), 54–62. https://doi.org/10.59003/nhj.v2i12.848
Rismawati, R., Alfianti, S. A., Hasanah, I., Riskiyono, S., Wardhana, D. I., & Setyowati, T. (2024). Pelatihan Pemberian Makanan Tambahan dalam Pencegahan Stunting melalui Edukasi Cara Produksi Pangan Olahan yang Baik (CPPOB). Journal of Community Development, 4(3), 344–352. https://doi.org/10.47134/comdev.v4i3.163
Rizky, A., & Marlenywati, M. (2023). Determinan Stunting Balita Usia 24-59 Bulan Di Daerah Tepian Sungai Kapuas Kota Pontianak. JUMANTIK, 9(2), 80. https://doi.org/10.29406/jjum.v9i2.4904
Ruel, M. T., & Alderman, H. (2013). Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? The Lancet, 382(9891), 536–551. https://doi.org/10.1016/S0140-6736(13)60843-0
Seis, W., Veldhuis, M.-C. Ten, Rouault, P., Steffelbauer, D., & Medema, G. (2024). A new Bayesian approach for managing bathing water quality at river bathing locations vulnerable to short-term pollution. Water Research, 252, 121186. https://doi.org/10.1016/j.watres.2024.121186
Simbolon, D., Suryani, D., Dayanti, H., Setia, A., & Hasan, T. (2024). Infant and Young Child Feeding (IYCF) Practices in Rural and Urban Regions of Indonesia. Advances in Public Health, 2024, 1–12. https://doi.org/10.1155/2024/6658959
Siramaneerat, I., Astutik, E., Agushybana, F., Bhumkittipich, P., & Lamprom, W. (2024). Examining determinants of stunting in Urban and Rural Indonesian: a multilevel analysis using the population-based Indonesian family life survey (IFLS). BMC Public Health, 24(1), 1371. https://doi.org/10.1186/s12889-024-18824-z
Slodia, M. R., Ningrum, P. T., & Sulistiyani, S. (2022). Analisis Hubungan Antara Sanitasi Lingkungan dengan Kejadian Stunting di Kecamatan Cepu, Kabupaten Blora, Jawa Tengah. Jurnal Kesehatan Lingkungan Indonesia, 21(1), 59–64. https://doi.org/10.14710/jkli.21.1.59-64
Sorgho, R., Quiñonez, C. A. M., Louis, V. R., Winkler, V., Dambach, P., Sauerborn, R., & Horstick, O. (2021). Addendum: Sorgho, R., et al. Climate Change Policies in 16 West African Countries: A Systematic Review of Adaptation with a Focus on Agriculture, Food Security, and Nutrition. Int. J. Environ. Res. Public Health 2020, 17, 8897. International Journal of Environmental Research and Public Health, 18(3), 945. https://doi.org/10.3390/ijerph18030945
Sutarto, S., Indriyani, R., Puspita Sari, R. D., Surya, J., & Oktarlina, R. Z. (2021). Hubungan Kebersihan diri, Sanitasi, dan Riwayat Penyakit Infeksi Enterik (diare) dengan Kejadian Stunting pada balita usia 24-60 bulan. JURNAL DUNIA KESMAS, 10(1), 56–65. https://doi.org/10.33024/jdk.v10i1.3415
UNICEF. (2021). Laporan Tahunan 2021 (p. 42). https://www.unicef.org/indonesia/id/laporan/laporan-tahunan-2021
UNICEF. (2024). The State of Food Security and Nutrition in the World 2024. FAO; IFAD; UNICEF; WFP; WHO; https://doi.org/10.4060/cd1254en
UNICEF. (2025). Child Malnutrition. https://www.unicef.org/media/174086/file
Wardani, A. K., Hikmah, D. N., Pratiwi, S. S., Hikmareza, Y. A., & Nurmalasari, S. F. (2023). Quality improvement of posyandu cadres in optimizing stunting prevention in toddlers and adolescent women. Community Empowerment, 8(3), 401–406. https://doi.org/10.31603/ce.8768
Wardita, Y., Kurniyati, E. M., & Permatasari, D. (2025). Integrated Stunting Reduction Model through Supplementary Feeding and Deworming: A Cross-Sectional SEM-PLS Study among Toddlers. International Journal of Health Concord, 1(2), 85–98. https://doi.org/10.55018/ihc.v12.22
Woldesenbet, B., Tolcha, A., & Tsegaye, B. (2023). 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 Nutrition, 9(1), 17. https://doi.org/10.1186/s40795-023-00677-1
Wolf, J., Hubbard, S., Brauer, M., Ambelu, A., Arnold, B. F., Bain, R., Bauza, V., Brown, J., Caruso, B. A., Clasen, T., Colford, J. M., Freeman, M. C., Gordon, B., Johnston, R. B., Mertens, A., Prüss-Ustün, A., Ross, I., Stanaway, J., Zhao, J. T., … Boisson, S. (2022). Effectiveness of interventions to improve drinking water, sanitation, and handwashing with soap on risk of diarrhoeal disease in children in low-income and middle-income settings: a systematic review and meta-analysis. The Lancet, 400(10345), 48–59. https://doi.org/10.1016/S0140-6736(22)00937-0
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2026 Mars Khendra Kusfriyadi, I Nyoman Sudyana, Liswara Neneng, Trilianty Lestarisa