Comparative Analysis of Risk Factors for Wasting among Under-Five Children in Urban and Rural Areas of East Nusa Tenggara
Keywords:
wasting, risk factors, Urban-rural disparities, undernutrition, east nusa tenggara.Abstract
Introduction: Wasting, including wasted and severely wasted based on the weight-for-height index, remains a major public health concern in Indonesia. East Nusa Tenggara Province recorded the highest prevalence nationwide (15.9%) in 2024, highlighting persistent challenges in preventing child undernutrition. This study examined setting-specific factors associated with wasting among children aged 0–59 months in urban and rural areas of East Nusa Tenggara.
Methods: A cross-sectional study was conducted using secondary data from the 2024 Indonesian Nutrition Status Survey (INSS), including 11,372 children aged 0–59 months. Wasting was defined as a Weight-for-Height z-score (WHZ) < −2 SD based on World Health Organization standards. Independent variables included child characteristics, infant and young child feeding practices, health status and healthcare access, parental characteristics, and household factors. Modified Poisson regression was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs).
Results: Wasting prevalence was identical in urban and rural areas (15.5%). Low birth weight and short birth length were consistently associated with wasting in both settings. In urban areas, children aged 0–5 months had a lower prevalence of wasting (aPR= 0.43; 95% CI: 0.20–0.90), whereas low birth weight (aPR= 1.63; 95% CI: 1.15–2.30), short birth length (aPR= 1.35; 95% CI: 1.04–1.76), and low paternal education (aPR= 1.68; 95% CI: 1.20–2.35) increased the prevalence. In rural areas, wasting was associated with low birth weight (aPR= 1.64; 95% CI: 1.35–1.98), short birth length (aPR = 1.32; 95% CI: 1.11–1.57), male sex (aPR= 1.34; 95% CI: 1.18–1.53), and medium and low maternal education (aPR= 1.30 and 1.33, respectively).
Conclusion: Although wasting prevalence was similar across settings, associated factors differed between urban and rural areas. Strengthening interventions to prevent adverse birth outcomes, while addressing setting-specific educational and socioeconomic determinants, may improve strategies to reduce wasting in East Nusa Tenggara.
References
Al Rahmad, A. H., Miko, A., Labatjo, R., Fajriansyah, F., Fitri, Y., & Suryana, S. (2020). Malnutrition prevalence among toddlers based on family characteristics: A cross-sectional study in the rural and urban areas of Aceh, Indonesia. Sri Lanka Journal of Child Health, 49(3), 263–268. https://doi.org/10.4038/sljch.v49i3.9145
Atok, Y. S., Nuhan, M. V., Sormin, R. E. M., & Palalangan, D. (2023). Multivariable Analysis of Wasting Incidents in Children Under the Age of 5 in Kupang Regency. Contagion: Scientific Periodical Journal of Public Health and Coastal Health, 5(1), 12. https://doi.org/10.30829/contagion.v5i1.14919
Ayuningtyas, D., Hapsari, D., Rachmalina, R., Amir, V., Rachmawati, R., & Kusuma, D. (2022). Geographic and Socioeconomic Disparity in Child Undernutrition across 514 Districts in Indonesia. Nutrients, 14(4). https://doi.org/10.3390/nu14040843
Dong, Y., & Peng, C.-Y. J. (2013). Principled missing data methods for researchers. SpringerPlus, 2(1), 222. https://doi.org/10.1186/2193-1801-2-222
Gebresilassie, Y. H., Nyatanga, P., & Teka, A. M. (2024). Determinants of rural urban child malnutrition disparities in Ethiopia. Food Research, 8(5), 385–396. https://doi.org/10.26656/fr.2017.8(5).013
Hosmer, D. W. ., Lemeshow, Stanley., & Sturdivant, R. X. . (2013). Applied logistic regression. Wiley.
Ijaiya, M. A., Anjorin, S., & Uthman, O. A. (2024). Navigating the nutritional paradox: The impact of sustainable development targets on childhood wasting and overweight prevalence. PLOS Global Public Health, 4(6), e0003335. https://doi.org/10.1371/journal.pgph.0003335
Joseph, J., & Sendhil, R. (2026). Nutritional status of children in rural and urban India based on National Family Health Surveys. Discover Public Health, 23(1), 220. https://doi.org/10.1186/s12982-026-01467-3
Kemenkes RI. (2017). Peraturan Menteri Kesehatan Republik Indonesia Nomor 12 Tahun 2017 tentang Penyelenggaraan Imunisasi. In Sekretariat Jenderal Kementerian Kesehatan (12).
Kemenkes RI. (2020). Peraturan Menteri Kesehatan RI Nomor 1 Tahun 2020 tentang Standar Antropometri Anak.
Kementerian Kesehatan RI. (2024). SSGI 2024 DALAM ANGKA.
Kirk, C. M., Uwamungu, J. C., Wilson, K., Hedt-Gauthier, B. L., Tapela, N., Niyigena, P., Rusangwa, C., Nyishime, M., Nahimana, E., Nkikabahizi, F., Mutaganzwa, C., Ngabireyimana, E., Mutabazi, F., & Magge, H. (2017). Health, nutrition, and development of children born preterm and low birth weight in rural Rwanda: a cross-sectional study. BMC Pediatrics, 17(1), 191. https://doi.org/10.1186/s12887-017-0946-1
Koritelu, R. T. E., Syauqy, A., & Margawati, A. (2024). Determinants of Wasting Among Children Aged 6–23 Months in Indonesia. Media Kesehatan Masyarakat Indonesia, 20(4), 184–195. https://doi.org/10.30597/mkmi.v20i4.35531
Lacagnina, S. (2020). The Developmental Origins of Health and Disease (DOHaD). American Journal of Lifestyle Medicine, 14(1), 47–50. https://doi.org/10.1177/1559827619879694
Makoka, D., & Masibo, P. K. (2015). Is there a threshold level of maternal education sufficient to reduce child undernutrition? Evidence from Malawi, Tanzania and Zimbabwe. BMC Pediatrics, 15(1), 96. https://doi.org/10.1186/s12887-015-0406-8
Malhotra, A., Allison, B. J., Castillo-Melendez, M., Jenkin, G., Polglase, G. R., & Miller, S. L. (2019). Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact. Frontiers in Endocrinology, 10. https://doi.org/10.3389/fendo.2019.00055
Meiandayati, R., Wulansari, R., Hanifah, L., & Achadi, E. L. (2018). Wasting and associated factors among infants aged 0-23 months in 13 provinces in Indonesia: Evidence from Indonesia Family Life Surveys (IFLS) 2000, 2007 and 2014. In Mal J Nutr (Vol. 24, Number 3).
Mertens, A., Benjamin-Chung, J., Colford, J. M., Hubbard, A. E., van der Laan, M. J., Coyle, J., Sofrygin, O., Cai, W., Jilek, W., Rosete, S., Nguyen, A., Pokpongkiat, N. N., Djajadi, S., Seth, A., Jung, E., Chung, E. O., Malenica, I., Hejazi, N., Li, H., … Yori, P. P. (2023). Child wasting and concurrent stunting in low- and middle-income countries. Nature, 621(7979), 558–567. https://doi.org/10.1038/s41586-023-06480-z
Miller, J., Ritchie, B., Tran, C., Beggs, S., Lada, C. O., & Whetter, K. (2013). Seasonal variation in the nutritional status of children aged 6 to 60 months in a resettlement village in West Timor. Asia Pacific Journal of Clinical Nutrition, 22(3), 449–456. https://doi.org/10.6133/apjcn.2013.22.3.10
Motbainor, A., Worku, A., & Kumie, A. (2015). Stunting is associated with food diversity while wasting with food insecurity among underfive children in East and West Gojjam Zones of Amhara Region, Ethiopia. PLoS ONE, 10(8). https://doi.org/10.1371/journal.pone.0133542
Murarkar, S., Gothankar, J., Doke, P., Pore, P., Lalwani, S., Dhumale, G., Quraishi, S., Patil, R., Waghachavare, V., Dhobale, R., Rasote, K., Palkar, S., & Malshe, N. (2020). Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09642-0
Okwaraji, Y. B., Krasevec, J., Bradley, E., Conkle, J., Stevens, G. A., Gatica-Domínguez, G., Ohuma, E. O., Coffey, C., Estevez Fernandez, D. G., Blencowe, H., Kimathi, B., Moller, A.-B., Lewin, A., Hussain-Alkhateeb, L., Dalmiya, N., Lawn, J. E., Borghi, E., & Hayashi, C. (2024). National, regional, and global estimates of low birthweight in 2020, with trends from 2000: a systematic analysis. The Lancet, 403(10431), 1071–1080. https://doi.org/10.1016/S0140-6736(23)01198-4
Pemerintah Pusat Indonesia. (2003). Undang-Undang Republik Indonesia Nomor 20 Tahun 2003 tentang Sistem Pendidikan Nasional.
Purwadi, H. N., Nurrika, D., Wulandari, M., Novrinda, H., & Febriyanti, H. (2023). Determinants of Wasted Among Age 6-59 Months: The Indonesia Family Life Survey 2014. Amerta Nutrition, 7(1SP), 17–24. https://doi.org/10.20473/amnt.v7i1SP.2023.17-24
Qanita, I., Abshori, N. F., Rampengan, D. DCH., Ramadhan, R., Adji, A. S., Nurkolis, F., Al-Abdullah, H. B., & Al-Dubai, S. A. (2025). Ecological study on child nutrition in Indonesia: National urban–rural patterns and local-level variation. Narra X, 3(3), e235. https://doi.org/10.52225/narrax.v3i3.235
Rezaeizadeh, G., Mansournia, M. A., Keshtkar, A., Farahani, Z., Zarepour, F., Sharafkhah, M., Kelishadi, R., & Poustchi, H. (2024). Maternal education and its influence on child growth and nutritional status during the first two years of life: a systematic review and meta-analysis. EClinicalMedicine, 71, 102574. https://doi.org/10.1016/j.eclinm.2024.102574
Roba, K. T., O’Connor, T. P., O’Brien, N. M., Aweke, C. S., Kahsay, Z. A., Chisholm, N., & Lahiff, E. (2019). Seasonal variations in household food insecurity and dietary diversity and their association with maternal and child nutritional status in rural Ethiopia. Food Security, 11(3), 651–664. https://doi.org/10.1007/s12571-019-00920-3
Shagti, I., Khomsan, A., Dewi, M., & Latifah, M. (2025). Risk factors for wasting in toddlers in East Nusa Tenggara. BIO Web of Conferences, 153. https://doi.org/10.1051/bioconf/202515302001
Sperandei, S. (2014). Understanding logistic regression analysis. Biochemia Medica, 24(1), 12–18. https://doi.org/10.11613/BM.2014.003
Tamir, T. T., Tekeba, B., Aemro, A., Wassie, M., & Mekonen, E. G. (2025). Prevalence, spatial distribution, and determinants of wasting among children under five in Senegal: spatial and multilevel analyses of the 2023 Senegal Demographic and Health Survey. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1543945
Thurstans, S., Opondo, C., Seal, A., Wells, J. C., Khara, T., Dolan, C., Briend, A., Myatt, M., Garenne, M., Mertens, A., Sear, R., & Kerac, M. (2022). Understanding Sex Differences in Childhood Undernutrition: A Narrative Review. Nutrients, 14(5), 948. https://doi.org/10.3390/nu14050948
Thurstans, S., Opondo, C., Seal, A., Wells, J., Khara, T., Dolan, C., Briend, A., Myatt, M., Garenne, M., Sear, R., & Kerac, M. (2020). Boys are more likely to be undernourished than girls: a systematic review and meta-analysis of sex differences in undernutrition. BMJ Global Health, 5(12), e004030. https://doi.org/10.1136/bmjgh-2020-004030
UNICEF. (2022). Severe Wasting: An overlooked child survival emergency-UNICEF Child Alert.
Vaezghasemi, M., Öhman, A., Ng, N., Hakimi, M., & Eriksson, M. (2020). Concerned and Conscious, but DefenselessThe intersection of gender and generation in child malnutrition in Indonesia: a qualitative grounded theory study. Glob. Health Action, 13(1), 1744214.
Vollmer, S., Bommer, C., Krishna, A., Harttgen, K., & Subramanian, S. (2016). The association of parental education with childhood undernutrition in low- and middle-income countries: comparing the role of paternal and maternal education. International Journal of Epidemiology, dyw133. https://doi.org/10.1093/ije/dyw133
WHO. (n.d.-a). Low birth weight. Nutrition Landscape Information System (NLiS). World Health Organization. Retrieved February 10, 2026, from https://www.who.int/data/nutrition/nlis/info/low-birth-weight?
WHO. (n.d.-b). Preterm Birth. WHO . Retrieved February 10, 2026, from https://www.who.int/news-room/fact-sheets/detail/preterm-birth
WHO. (2006). WHO Child Growth Standards - Length/Height-for-age, Weight-for-age, Weight-for-length, Weight-for-height and Body Mass Index-for age : Methods and Development. World Health Organization.
WHO. (2021). Indicators for assessing infant and young child feeding practices Definitions and measurement methods.
WHO, UNICEF, & World Bank Group. (2025). Joint Child Malnutrition Estimates 2025 edition: Levels and trends in child malnutrition.
World Health Organization. (2023). Expanded Programme on Immunization (EPI) – Factsheet 2023: Indonesia. http://apps.who.
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