Modeling Stunting Reduction Policies Through PLS-SEM Using Socioeconomic Factors In East Kalimantan
DOI:
https://doi.org/10.70260/nij.v4i2.93Keywords:
Stunting Reduction, Socioeconomic Factors, PLS-SEM, Human Development Index, Public PolicyAbstract
Objective: Stunting remains a critical public health and development issue, particularly in developing regions where socioeconomic disparities persist. Despite significant economic growth, East Kalimantan Province continues to experience relatively high and uneven stunting rates across its regencies and cities. This condition indicates that stunting is not merely a nutritional problem but a multidimensional issue influenced by broader socioeconomic factors. The main problem addressed in this study is the limited understanding of how regional socioeconomic determinants interact structurally to influence stunting reduction. Therefore, this study aims to develop a comprehensive policy model for reducing stunting based on community socioeconomic factors using a structural approach.
Design/Methods/Approach: This research employs a quantitative design using secondary data from the Central Statistics Agency (BPS) and related institutions for 2020–2025. The unit of analysis consists of regencies and cities in East Kalimantan. Partial Least Squares Structural Equation Modeling (PLS-SEM) is applied to analyze both direct and indirect relationships among variables, including regional health expenditure, maternal education, sanitation, Human Development Index (HDI), and stunting reduction.
Findings: The results indicate that all proposed hypotheses are supported. Regional health expenditure, maternal education, and sanitation have positive and significant effects on HDI, with maternal education emerging as the strongest determinant. Furthermore, HDI has a significant negative effect on stunting, confirming its mediating role in translating socioeconomic improvements into better child health outcomes.
Originality/Value: The model demonstrates strong explanatory power for HDI but more limited capacity in explaining stunting reduction directly. In general, the findings imply that effective stunting reduction policies must adopt an integrated, multisectoral approach focusing on improving quality of life.
Practical/Policy implication: Policy priorities should emphasize strengthening maternal education, enhancing preventive health spending, and expanding access to sanitation. These strategies are essential for accelerating sustainable stunting reduction at the regional level.
References
Acharya, S., Thapa, B., Kansakar, R., Shakya, H., Dhakal, A. K., & Divya, K. C. (2023). Stunting among Children Aged 6 to 59 Months Visiting the Outpatient Department of Pediatrics in a Tertiary Care Centre. Journal of the Nepal Medical Association, 61(264), 654–657. https://doi.org/10.31729/jnma.8249
Akseer, N., Tasic, H., Nnachebe Onah, M., Wigle, J., Rajakumar, R., Sanchez-Hernandez, D., Akuoku, J., Black, R. E., Horta, B. L., Nwuneli, N., Shine, R., Wazny, K., Japra, N., Shekar, M., & Hoddinott, J. (2022). Economic costs of childhood stunting to the private sector in low- and middle-income countries. EClinicalMedicine, 45. https://doi.org/10.1016/j.eclinm.2022.101320
Alao, J. O., Otorkpa, O. J., Ayejoto, D. A., & Saqr, A. M. (2025). Assessing the community knowledge on waste management practices, drinking water source systems, and the possible implications on public health systems. Cleaner Waste Systems, 11, 100295. https://doi.org/10.1016/J.CLWAS.2025.100295
Alristina, A. D., Laili, R. D., Nagy, É., & Feith, H. J. (2025). The Importance of Socioeconomic Factors Associated with Maternal Nutrition Knowledge and Undernutrition Among Children Under Five. Nutrients, 17(21). https://doi.org/10.3390/nu17213355
Alum, E. U., Obeagu, E. I., & Ugwu, O. P. C. (2024). Enhancing quality water, good sanitation, and proper hygiene is the panacea to diarrhea control and the attainment of some related sustainable development goals A review. Medicine (United States), 103(38), e39578. https://doi.org/10.1097/MD.0000000000039578
Amorocho-Daza, H., van der Zaag, P., & Sušnik, J. (2023). Access to Water-Related Services Strongly Modulates Human Development. Earth’s Future, 11(4). https://doi.org/10.1029/2022EF003364
Antara News Kaltim. (2025, November 19). Wagub Kaltim: Perlu penguatan intervensi penanganan stunting di daerah - ANTARA News Kalimantan Timur. https://kaltim.antaranews.com/berita/251145/wagub-kaltim-perlu-penguatan-intervensi-penanganan-stunting-di-daerah
Bommer, C., Vollmer, S., & Subramanian, S. V. (2019). How socioeconomic status moderates the stunting-age relationship in low-income and middle-income countries. BMJ Global Health, 4(1). https://doi.org/10.1136/bmjgh-2018-001175
Cepeda, G., Roldán, J. L., Sabol, M., Hair, J., & Chong, A. Y. L. (2024). Emerging opportunities for information systems researchers to expand their PLS-SEM analytical toolbox. Industrial Management and Data Systems, 124(6), 2230–2250. https://doi.org/10.1108/IMDS-08-2023-0580
Costa-Font, J., & Moscone, F. (2008). The impact of decentralization and inter-territorial interactions on Spanish health expenditure. Empirical Economics, 34(1), 167–184. https://doi.org/10.1007/s00181-007-0166-x
Cuartas, J. (2022). The Effect of Maternal Education on Parenting and Early Childhood Development: An Instrumental Variables Approach. Journal of Family Psychology, 36(2), 280–290. https://doi.org/10.1037/fam0000886
Dasic, B., Devic, Z., Denic, N., Zlatkovic, D., Ilic, I. D., Cao, Y., Jermsittiparsert, K., & Le, H. V. (2020). Human development index in a context of human development: Review on the western Balkans countries. Brain and Behavior, 10(9). https://doi.org/10.1002/brb3.1755
De Jongh, J., Mncayi, P., & Mdluli, P. (2019). Analysing the impact of water access and sanitation on local economic development (LED) in the Sedibeng District Municipality, South Africa. International Journal of Innovation, Creativity and Change, 5(2), 551–572.
de Onis, M., & Branca, F. (2016). Childhood stunting: A global perspective. Maternal and Child Nutrition, 12, 12–26. https://doi.org/10.1111/mcn.12231
Deliktas Demirci, A., Ahmedova, P., & Kabukcuoglu, K. (2024). Maternal experiences of women who had received salutary childbirth education: A descriptive qualitative study. Journal of Advanced Nursing. https://doi.org/10.1111/jan.16359
Dewey, K. G., & Begum, K. (2011). Long-term consequences of stunting in early life. Maternal and Child Nutrition, 7(SUPPL. 3), 5–18. https://doi.org/10.1111/j.1740-8709.2011.00349.x
Ding, X., & Song, Y. (2025). Maternal education and early childhood outcomes in China. Economics of Education Review, 107. https://doi.org/10.1016/j.econedurev.2025.102660
Dwivedi, R., & Pradhan, J. (2017). Does equity in healthcare spending exist among Indian states? Explaining regional variations from national sample survey data. International Journal for Equity in Health, 16(1). https://doi.org/10.1186/s12939-017-0517-y
Eidan, A. T., & Shawq, A. H. (2024). Effect of a Nutritional Education Program on Mother Knowledge Regarding Their Children Nutritional Status. Journal of Obstetrics, Gynecology and Cancer Research, 9(5), 522–531. https://doi.org/10.30699/jogcr.9.5.522
Elba, F., Hassan, H. C., Umar, N. S., & Hilmanto, D. (2024). The Effect of Stunting on Nutrition and Fine Motor Development in Children: A Literature Review. Malaysian Journal of Medicine and Health Sciences, 20, 215–219.
Firdaus, N. A., Mulyana, R. R., Munthalib, M. A. M., Winarni, S., & Tantular, B. (2024). Negative Binomial Regression Analysis of Stunting Determinants in Toddlers: Achieving Optimal Nutrition in West Java, Indonesia. Communications in Mathematical Biology and Neuroscience, 2024. https://doi.org/10.28919/cmbn/8929
Firdaus, N., & Adnan, A. H. M. (2021). Correlation Between Environmental Factors and The Human Development Index in East Java in 2019. Jurnal Biometrika Dan Kependudukan, 10(2), 122–129. https://doi.org/10.20473/jbk.v10i2.2021.122-129
García-Searcy, V., Villada-Canela, M., & Muñoz-Pizza, D. M. (2025). Sanitation in Ensenada, Baja California, Mexico: bridging the gap between human rights and practice. Frontiers in Water, 7. https://doi.org/10.3389/frwa.2025.1627694
Garcia-Tizon Larroca, S., Arevalo-Serrano, J., Duran Vila, A., Pintado Recarte, M. P., Cueto Hernandez, I., Solis Pierna, A., Lizarraga Bonelli, S., & De Leon-Luis, J. (2017). Human Development Index (HDI) of the maternal country of origin as a predictor of perinatal outcomes - a longitudinal study conducted in Spain. BMC Pregnancy and Childbirth, 17(1). https://doi.org/10.1186/s12884-017-1515-1
Ghasemi, I., Roshandel, A., Samadpour, T., & Sadeghzadeh, V. (2012). Investigation the effect of maternal education on nutritional status of children aged 2 to 5 years in Zanjan, Iran. Life Science Journal, 9(3), 2495–2500.
Hair, J. F., Astrachan, C. B., Moisescu, O. I., Radomir, L., Sarstedt, M., Vaithilingam, S., & Ringle, C. M. (2021). Executing and interpreting applications of PLS-SEM: Updates for family business researchers. Journal of Family Business Strategy, 12(3). https://doi.org/10.1016/j.jfbs.2020.100392
Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31(1), 2–24. https://doi.org/10.1108/EBR-11-2018-0203
Haniarti, H., Sabriani, S., Nurlinda, N., & Umar, F. (2025). Socio-Cultural Influences on Stunting Children Aged 24-59 Months: A Cross-Sectional Study in the Bugis Community of Indonesia. Media Publikasi Promosi Kesehatan Indonesia, 8(8), 818–830. https://doi.org/10.56338/mppki.v8i8.7946
Hauff, S., Richter, N. F., Sarstedt, M., & Ringle, C. M. (2024). Importance and performance in PLS-SEM and NCA: Introducing the combined importance-performance map analysis (cIPMA). Journal of Retailing and Consumer Services, 78. https://doi.org/10.1016/j.jretconser.2024.103723
Hilmers, D. C., & Abrams, S. A. (2014). Role of nutrition in human health and disease. In Nutrition-Infection Interactions and Impacts on Human Health (pp. 1–16). CRC Press. https://doi.org/10.1201/b17311
Hoang, V.-N., Nghiem, S., & Vu, X.-B. (2019). Stunting and academic achievement among Vietnamese children: new evidence from the young lives survey. Applied Economics, 51(18), 2001–2009. https://doi.org/10.1080/00036846.2018.1537476
Huang, Y. C. (2022). Middle-aged and Elderly Adult Wellbeing: Connections to Travel Motivation and Restorative Servicescapes. Family and Consumer Sciences Research Journal, 51(1), 20–34. https://doi.org/10.1111/fcsr.12451
Hung, N. T., & Thanh, S. D. (2022). Fiscal decentralization, economic growth, and human development: Empirical evidence. Cogent Economics & Finance, 10(1). https://doi.org/10.1080/23322039.2022.2109279
Kansal, M. L., & Cole, P. C. I. (2019). Water, sanitation, and hygiene (WASH) sustainability assessment and its impact on the human Development index (HDI) in Kailahun district of Sierra Leone. In G. F. Scott & W. Hamilton (Eds.), World Environmental and Water Resources Congress 2019: Emerging and Innovative Technologies and International Perspectives - Selected Papers from the World Environmental and Water Resources Congress 2019 (pp. 25–39). American Society of Civil Engineers (ASCE). https://doi.org/10.1061/9780784482322.003
Kemenkes RI. (2025, May 26). SSGI 2024: Prevalensi Stunting Nasional Turun Menjadi 19,8%. https://kemkes.go.id/id/ssgi-2024-prevalensi-stunting-nasional-turun-menjadi-198
Khaled, M. A. (2012). Malnutrition and inflammation: Implications on human digestive systems. In Human Malnutrition: Twin Burdens of Undernutrition and Overnutrition (pp. 121–132). Nova Science Publishers, Inc.
Kim, R., Mejía-Guevara, I., Corsi, D. J., Aguayo, V. M., & Subramanian, S. V. (2017). Relative importance of 13 correlates of child stunting in South Asia: Insights from nationally representative data from Afghanistan, Bangladesh, India, Nepal, and Pakistan. Social Science and Medicine, 187, 144–154. https://doi.org/10.1016/j.socscimed.2017.06.017
Komarulzaman, A., Andoyo, R., Anna, Z., Ghina, A. A., Halim, P. R., Napitupulu, H., Karunia, M. R., & Andriani, A. (2023). Achieving Zero Stunting: A Sustainable Development Goal Interlinkage Approach at District Level. Sustainability (Switzerland), 15(11). https://doi.org/10.3390/su15118890
Kuznetsova, M. V, & Ivashina, N. S. (2020). Methodological approaches to the inclusion of environmental factors in human development index. In D. B. Solovev (Ed.), Smart Innovation, Systems and Technologies (Vol. 138, pp. 232–242). Springer Science and Business Media Deutschland GmbH. https://doi.org/10.1007/978-3-030-15577-3_23
Magnuson, K. A., Sexton, H. R., Davis-Kean, P. E., & Huston, A. C. (2009). Increases in maternal education and young children’s language skills. Merrill-Palmer Quarterly, 55(3), 319–350. https://doi.org/10.1353/mpq.0.0024
Maitra, C., Sethi, V., Unisa, S., & Shankar, S. (2019). Household Food Insecurity and Maternal and Child Nutritional Status: Evidence from Maharashtra. Review of Income and Wealth, 65(S1), S63–S101. https://doi.org/10.1111/roiw.12436
Makbul, I. A. A., Yeo, G. S., Sharif, R., Lim, S. M., Mediani, A., Geurts, J., & Poh, B. K. (2025). Determinants of Stunting Among Children Aged 0.5 to 12 Years in Peninsular Malaysia: Findings from the SEANUTS II Study. Nutrients, 17(14). https://doi.org/10.3390/nu17142348
Manley, S. C., Hair, J. F., Williams, R. I., & McDowell, W. C. (2021). Essential new PLS-SEM analysis methods for your entrepreneurship analytical toolbox. International Entrepreneurship and Management Journal, 17(4), 1805–1825. https://doi.org/10.1007/s11365-020-00687-6
Marshan, J., & Pritadrajati, D. (2025). Maternal Education and Childrenʼs Well-Being: Evidence From Four Pacific Countries. Asia and the Pacific Policy Studies, 12(3), e70044.
Maulina, R., Qomaruddin, M. B., Prasetyo, B., Indawati, R., & Alfitri, R. (2023). The Effect of Stunting on the Cognitive Development in Children: A Systematic Review and Meta-analysis. Studies on Ethno-Medicine, 17(1–2), 19–27. https://doi.org/10.31901/24566772.2023/17.1-2.661
Memon, M. A., Ramayah, T., Cheah, J.-H., Ting, H., Chuah, F., & Cham, T. H. (2021). PLS-SEM STATISTICAL PROGRAMS: A REVIEW. Journal of Applied Structural Equation Modeling, 5(1), i–xiv. https://doi.org/10.47263/JASEM.5(1)06
Moestue, H., & Huttly, S. (2008). Adult education and child nutrition: The role of family and community. Journal of Epidemiology and Community Health, 62(2), 153–159. https://doi.org/10.1136/jech.2006.058578
Mohamud, K. M., Warei, S. Y., & Abubakr, A. H. A. (2026). Burden or benefit? Unveiling the impact of out-of-pocket health expenditures in Somalia’s healthcare system. Health Economics Review, 16(1). https://doi.org/10.1186/s13561-025-00703-x
Mostafa Kamal, S. M. (2011). Socio-economic determinants of severe and moderate stunting among under-five children of rural Bangladesh. Malaysian Journal of Nutrition, 17(1), 105–118.
Mulyani, A. T., Khairinisa, M. A., Khatib, A., & Chaerunisaa, A. Y. (2025). Understanding Stunting: Impact, Causes, and Strategy to Accelerate Stunting Reduction—A Narrative Review. Nutrients, 17(9). https://doi.org/10.3390/nu17091493
Ndaguba, E. A., & Hlotywa, A. (2021). Public health expenditure and economic development: The case of South Africa between 1996 and 2016. Cogent Economics and Finance, 9(1). https://doi.org/10.1080/23322039.2021.1905932
Odjegba, E. E., Bankole, A. O., Layi-Adigun, B. O., & Dada, V. O. (2021). Water, sanitation, and hygiene in healthcare centres: Appraisal in a pandemic. Journal of Water Sanitation and Hygiene for Development, 11(6), 926–936. https://doi.org/10.2166/washdev.2021.075
Paudel, A., Bhandari, T. R., & Dangi, N. B. (2021). Household Food Security and Nutritional Status of Under-Five-Year Children: A Case Study of Nepal. Journal of Nutrition and Food Security, 6(2), 179–184. https://doi.org/10.18502/jnfs.v6i2.6073
Pedrosa, E. N., & Teixeira, E. C. (2021). Efeito Da Escolaridade Dos Pais Sobre O Estado Nutricional Dos Filhos No Brasil. Economia Aplicada, 25(4), 581–608. https://doi.org/10.11606/1980-5330/ea163386
Pemerintah Provinsi Kalimantan Timur. (2025, November 24). Pemprov Kaltim Targetkan Penurunan Stunting Signifikan dalam Setahun. https://www.kaltimprov.go.id/detailberita/pemprov-kaltim-targetkan-penurunan-stunting-signifikan-dalam-setahun
Perkins, J. M., Kim, R., Krishna, A., McGovern, M., Aguayo, V. M., & Subramanian, S. V. (2017). Understanding the association between stunting and child development in low- and middle-income countries: Next steps for research and intervention. Social Science and Medicine, 193, 101–109. https://doi.org/10.1016/j.socscimed.2017.09.039
Prendergast, A. J., & Humphrey, J. H. (2014). The stunting syndrome in developing countries. Paediatrics and International Child Health, 34(4), 250–265. https://doi.org/10.1179/2046905514Y.0000000158
Ramadan, M., AlGhamdi, S., & Alsiary, R. (2025). Analyzing the cancer mortality-to-incidence ratios and health expenditures in the aging population: a 20-year comparative study across high-income countries. Frontiers in Aging, 6. https://doi.org/10.3389/fragi.2025.1506897
Ramadhan, S. A., Widayani, S. T., Mahmudiono, T., Rakhmad, A. F. O., Hargiyanto, E. D., Permatasari, F. I., Azzahra, C. N., Sahila, N., Atmaka, D. R., Febrianto, E. C., Astuti, R. D. P., Mulia, S. A., Pratiwi, D. A., Nadhiroh, S. R., Simangunsong, T. T., Prameswari, A. A., Ismail, W. I., Noor, M. A. B. M., Shariff, M. H. B. M., … Yasin, A. B. M. (2024). The Effect of Nutritional Education on Parental Knowledge of Balanced Nutrition in Children at Yayasan An-Nusyur Aeng Panas, Sumenep Madura. Media Gizi Indonesia, 19(3), 322–329. https://doi.org/10.20473/mgi.v19i3.322-329
Ramlan, P., Sukri, P., Abdullah, M. T., Ibrahim, M. A., & Cahyani, A. (2025). Poverty and Stunting: A Socioeconomic Analysis of Vulnerable Communities; a Systematic Literature Review. IOP Conference Series: Earth and Environmental Science, 1475(1). https://doi.org/10.1088/1755-1315/1475/1/012026
Roy, C., Sati, V. P., Biswas, A., & Kumar, S. (2023). Status of drinking water, sanitation facilities, and hygiene in West Bengal: Evidence from the National Family Health Survey of India (NFHS), 2019-2021. Journal of Water Sanitation and Hygiene for Development, 13(1), 50–62. https://doi.org/10.2166/washdev.2023.228
Sabol, M., Hair, J., Cepeda, G., Roldán, J. L., & Chong, A. Y. L. (2023). PLS-SEM in information systems: seizing the opportunity and marching ahead full speed to adopt methodological updates. Industrial Management and Data Systems, 123(12), 2997–3017. https://doi.org/10.1108/IMDS-07-2023-0429
Saidu, S. F., & Danielson, R. A. (2024). Social determinants of health associated with increased prevalence of childhood malnutrition in Africa. Frontiers in Nutrition, 11. https://doi.org/10.3389/fnut.2024.1456089
Saputra, D. A., & Setiawan, D. (2026). Regional Revenues and Human Development Index: An Empirical Evidence From Indonesia. Revista Brasileira de Gestao e Desenvolvimento Regional, 22(1), 7–29. https://doi.org/10.54399/rbgdr.v22i1.7446
Shahzad, M., Ahmad, H. A., Ghani, M., & Al Nabhani, Z. (2025). Animal models for understanding the mechanisms of malnutrition: a literature review. Frontiers in Nutrition, 12. https://doi.org/10.3389/fnut.2025.1655811
Singh, S., Srivastava, S., & Upadhyay, A. K. (2019). Socio-economic inequality in malnutrition among children in India: An analysis of 640 districts from National Family Health Survey (2015-16). International Journal for Equity in Health, 18(1). https://doi.org/10.1186/s12939-019-1093-0
Telias, A., Narea, M., & Abufhele, A. (2022). A mediation analysis to disentangle relations between maternal education and early child development. International Journal of Behavioral Development, 46(6), 568–575. https://doi.org/10.1177/01650254221108143
Tsai Tan, A. H. (2021). Is the Human Development Index Still Appropriate for the Assessment of Quality of Life? Quality of Life: An Interdisciplinary Perspective, 1–17.
Tunçalp, O., Souza, J. P., Hindin, M. J., Santos, C. A., Oliveira, T. H., Vogel, J. P., Togoobaatar, G., Ha, D. Q., Say, L., & Gülmezoglu, A. M. (2014). Education and severe maternal outcomes in developing countries: a multicountry cross-sectional survey. BJOG : An International Journal of Obstetrics and Gynaecology, 121 Suppl 1, 57–65. https://doi.org/10.1111/1471-0528.12634
UNICEF. (2025, July). Malnutrition in Children - UNICEF DATA. https://data.unicef.org/topic/nutrition/malnutrition/
Werku, B. C., & Woldeamanuel, A. A. (2025). Assessing Rural Communities in Central and East Africa: How to Provide Clean Water and Sanitation by 2030. Environmental Health Insights, 19. https://doi.org/10.1177/11786302251335130
Wicaksono, R. A., Arto, K. S., Saragih, R. A. C., Deliana, M., Lubis, M., & Batubara, J. R. L. (2020). Comparison of growth diagrams of Indonesian children to 2006 world health organization growth standards in diagnosing stunting. Paediatrica Indonesiana(Paediatrica Indonesiana), 60(2), 95–100. https://doi.org/10.14238/pi60.2.2020.95-100
Winkler, I. (2016). Te human right to sanitation. University of Pennsylvania Journal of International Law, 37(4), 1331–1406.
Wirth, J. P., Rohner, F., Petry, N., Onyango, A. W., Matji, J., Bailes, A., de Onis, M., & Woodruff, B. A. (2017). Assessment of the WHO Stunting Framework using Ethiopia as a case study. Maternal and Child Nutrition, 13(2). https://doi.org/10.1111/mcn.12310
Yang, S., Wang, D., Xu, L., Wang, C., Yang, X., & Lo, K. (2021). Private healthcare expenditure in china: A regional comparative analysis. Healthcare (Switzerland), 9(10). https://doi.org/10.3390/healthcare9101374
Zahroh, S., & Pontoh, R. S. (2021). Education as an important aspect to determine human development index by province in Indonesia. Journal of Physics: Conference Series (Vol. 1722, Number 1). IOP Publishing Ltd. https://doi.org/10.1088/1742-6596/1722/1/012106
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Muhammad Alfarizi, Suci Megawati

This work is licensed under a Creative Commons Attribution 4.0 International License.


