Exploring the effects of universal health coverage on stunting in West Java: an ecological study

Abstract

ABSTRAK

Latar Belakang: Stunting merupakan indikator penting yang mencerminkan ketimpangan kesehatan anak yang disebabkan oleh berbagai faktor seperti malnutrisi, penyakit infeksi, dan kurangnya stimulasi sosial. Selain itu, faktor sosial ekonomi juga berperan penting dalam memengaruhi status gizi anak.

Tujuan: Penelitian ini bertujuan untuk menentukan faktor risiko stunting di Provinsi Jawa Barat pada tahun 2022.

Metode: Desain penelitian yang digunakan adalah studi ekologi dengan unit sampel analisis menggunakan 27 kabupaten/kota di Provinsi Jawa Barat. Data diperoleh dari laporan Survei Status Gizi Indonesia (SSGI) tahun 2022 dan Badan Pusat Statistik (BPS) Jawa Barat. Analisis bivariat menggunakan korelasi Pearson diterapkan untuk data berdistribusi normal, sedangkan korelasi Spearman digunakan untuk data tidak normal. Hubungan dianggap signifikan jika nilai p-value <0,05. Analisis regresi logistik digunakan untuk menentukan Odds Ratio (OR) guna mengidentifikasi faktor risiko stunting.

Hasil: Hasil penelitian menunjukkan bahwa prevalensi stunting di Jawa Barat mencapai 20.2% dengan 16 wilayah memiliki prevalensi stunting tinggi (>19.2%). Analisis korelasi menunjukkan adanya hubungan signifikan antara kemiskinan dan prevalensi stunting (r=0,423, p=0,028), asuransi kesehatan dan stunting (r=-0,570, p=0,002), partisipasi keluarga berencana dan stunting (r=-0,589, p=0,001), pernikahan dini dan stunting (r=0,528, p=0,005), serta prevalensi diare dan stunting (r=0,647, p=0,001). Asuransi kesehatan berperan sebagai faktor protektif terhadap stunting, wilayah yang memiliki jaminan kesehatan memiliki penurunan risiko terkena stunting sebesar 38,2% dibandingkan dengan wilayah yang tidak memiliki jaminan kesehatan. Sementara wilayah dengan diare memiliki risiko 1,84 kali lebih tinggi untuk mengalami stunting dibandingkan dengan wilayah tanpa diare.

Kesimpulan: Prevalensi stunting di Jawa Barat menunjukkan pola distribusi yang tidak merata, dengan konsentrasi tinggi di wilayah barat, timur, dan tenggara. Wilayah barat dan timur menghadapi kendala spesifik terkait kemiskinan, pernikahan dini, diare, serta cakupan asuransi kesehatan. Strategi penurunan prevalensi stunting harus melibatkan peningkatan kesejahteraan ekonomi, perluasan cakupan asuransi kesehatan, serta akses ke sanitasi untuk mengendalikan diare. Intervensi komprehensif dan terintegrasi diperlukan untuk mengurangi prevalensi stunting di Jawa Barat.

KATA KUNCI: cakupan kesehatan universal; diare; kemiskinan; pernikahan dini; pneunomia; stunting

ABSTRACT

Background: Stunting is an important indicator reflecting children’s health disparities, caused by various factors such as malnutrition, infectious diseases, and a lack of social stimulation. Additionally, socioeconomic factors play a crucial role in influencing the nutritional status of children.

Objectives This study aims to determine the risk factors of stunting in West Java Province in 2022.

Methods: The study design was an ecological study using data from 27 districts/cities in West Java Province. The data were obtained from the 2022 Indonesian Nutrition Status Survey (SSGI) report and the Statistics of West Java Province. Bivariat analysis with Pearson correlation is applied for normally distributed data, while Spearman correlation is used for non-normal data. Variables are considered significantly related if the p-value is <0.05. Logistic regression analysis determines Odds Ratios (OR) to identify risk factors for stunting.

Results: The results revealed that stunting prevalence in West Java reached 20.2% with 16 regions showing a high prevalence of stunting (>19.2%). Correlation analysis showed significant association between poverty and stunting prevalence (r= 0.423, p=0.028), health insurance and stunting prevalence (r = -0.570, p = 0.002), family planning and stunting prevalence (r = -0.589, p = 0.001), early marriage and stunting (r= 0.528, p= 0.005), diarrhea prevalence and stunting (r= 0.647, p=0.001). Health insurance as a protective factor of stunting. Regions with health insurance have 38.2% lower risk of stunting compared to regions without health insurance (OR = 0.618, 95% CI: 0.369–0.535). Diarrhea as a risk factor of stunting, regions with diarrhea had 1,84 times higher risk of stunting than regions without diarrhea (OR = 1.841, 95% CI: 1.091–3.106).

Conclusions: Prevalence of stunting in West Java shows a widespread distribution pattern with high concentrations in the eastern, western, and southeastern regions of West Java. The western and eastern regions have specific obstacles related to poverty, early marriage, diarrhea and having health insurance. Strategies to reduce the prevalence of stunting must involve increasing economic prosperity, expanding health insurance coverage, and increasing access to sanitation to control diarrhea. Comprehensive and integrated interventions are needed to reduce prevalence of stunting.

KEYWORD: diarrhea; early marriage; pneumonia; poverty; stunting; universal health coverage

Received: 14 Mar 2025; Revised: 28 Nov 2024; Accepted: 18 Mar 2025; Available online: 30 May 2025; Published: 31 Mar 2025.