Examining determinants of stunting in Urban and Rural Indonesian: a multilevel analysis using the population-based Indonesian family life survey (IFLS).

BACKGROUND: In Indonesia, chronic malnutrition leading to stunted growth in children represents a significant issue within the public health domain. The prevalence of stunting varies between urban and rural areas, reflecting disparities in access to nutrition, healthcare, and other socioeconomic factors. Understanding these disparities is crucial for developing targeted interventions to address the issue. METHODS: The study used data from the fifth wave of the Indonesian Family Life Survey (IFLS), which is a national cross-sectional population-based survey conducted across approximately 13 provinces in Indonesia in 2014-2015. Multivariate and Multilevel logistic regression models were utilized in the analysis to determine the factors associated with the prevalence of stunting in Indonesian children. RESULTS: The multivariate logistic regression analysis indicated that among children aged 24-59 months in Indonesia, stunting was associated with the age of the child, birth weight, maternal nutritional status, and residence. Subsequently, the multilevel logistic regression analysis revealed that in rural areas, the age of the child and birth weight exhibited significant associations with stunting. Conversely, in urban areas, stunted children were influenced by 7 factors, including the child's age (months), age of weaning, birth weight (kg), mother and father's age, place of birth, and maternal nutritional status. CONCLUSIONS: Variations in childhood stunting between urban and rural regions in Indonesia were observed, indicating a differential prevalence. The study's findings suggests the importance of age-appropriate nutritional support, healthcare interventions, and growth monitoring. Focused interventions are vital, potentially encompassing initiatives such as improving access to maternal and child healthcare services, promoting adequate nutrition during pregnancy and infancy, and facilitate greater parental engagement in childcare responsibilities.

Inequalities in immunization coverage in Indonesia: a multilevel analysis.

INTRODUCTION: Immunization is one of the most cost-effective methods for reducing mortality and morbidity rates in children. Children being fully vaccinated helps prevent diseases that would have great societal costs otherwise. Incomplete vaccination poses public health risks and challenges. This study examines the issue of incomplete vaccination in Indonesia. The objectives were to quantify the association between child level, parent level and community level determinants and child immunization coverage in Indonesia. METHODS: Data were from the 2017 Indonesian Demographic Health Survey; this study included 4753 children aged 12-24 months. The survey implemented multistage random sampling. The data were examined using descriptive statistics and multilevel logistic regression analysis. RESULTS: The survey found that in Indonesia, country-wide, 58.22% of children were fully vaccinated. A multilevel logistic regression model after adjusting for household wealth and proportion of public healthcare centers (PHCs) showed that children of first birth order had significantly lower likelihood of being fully immunized than children of second order and higher. The parent level factors, such as age of mother at delivery, mother's education, father's occupation, antenatal care (ANC) and region, significantly influenced the completeness of child immunization. At the community level, the presence of a PHC significantly improved immunization coverage. CONCLUSION: The findings indicate that there is a wide range of inequality in immunization throughout the region due to socioeconomic and demographic factors. Findings revealed that complete immunization status was significantly associated with birth order, age of mother at delivery, mother's education, father's occupation, ANC, region, and proportion of PHCs. This study emphasizes the need to increase healthcare centers in each community with the objective to reduce disparities in maternal and child health services.