Environmental Determinants of Stunting: The Role of Wash and Housing Conditions in a High-Burden District in Indonesia

Abstract

Introduction: Stunting remains a major health issue in Banjar Regency, South Kalimantan, with prevalence rising from 30.6% (2023) to 32.3% (2024). This study aims to analyze the relationship between WASH practices, hygiene behaviors, and housing conditions and stunting among toddlers in the region. Methods: A cross-sectional study was conducted among 110 mothers of children under five years of age who were selected through proportional stratified random sampling from ten villages. Data were collected using structured questionnaires and direct observations in households. The independent variables included healthy lifestyle behaviors, housing conditions, and stunting status based on the WHO Child Growth Standards. Data were analyzed using the chi-square test and multivariate logistic regression. Results and Discussion: Bivariate analysis showed significant associations between sanitation hygiene (p = 0.049) and housing conditions (p = 0.018) with stunting, whereas water variables and hygiene behavior were not significantly associated. In the multivariable model, only inadequate housing conditions remained significantly associated with stunting (AOR = 5.33; 95% CI: 1.33–21.44; p = 0.018), indicating that children living in inadequate housing had more than five times higher odds of being stunted than those living in adequate housing. Conclusion: Housing quality appears to be more strongly associated with stunting than WASH indicators in this high-prevalence setting. Stunting prevention programs should therefore integrate housing improvement with nutrition-specific, WASH, and socioeconomic interventions.