Life-Course and Multisectoral Determinants of Childhood Stunting in Low- and  Middle-Income Settings

Muhammad Muhibbi

Authors

Muhammad Muhibbi

Keywords:

childhood stunting, life course approach, malnutrition, multisectoral intervention, under five children

Abstract

Background: Childhood stunting remains a major public health and human development challenge in low- and middle
income countries, including Indonesia. Stunting reflects cumulative growth impairment resulting from interconnected
nutritional, biological, maternal, environmental, socioeconomic, and health-system conditions. This review aimed to
synthesize recent evidence on the determinants of childhood stunting and identify implications for integrated prevention
across the life course. Method: A narrative review was conducted using literature published primarily between 2021 and
2026 from PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, ProQuest Dissertations and Theses, and
PubMed Central, complemented by reports from WHO, UNICEF, the World Bank, and the Indonesian Ministry of Health.
The review was informed by PRISMA 2020 principles and employed thematic synthesis using life-course and
socioecological perspectives. Results: Evidence indicates that stunting results from interacting determinants rather than a
single causal pathway. Important factors included low birth weight, prematurity, inadequate maternal nutrition and antenatal
care, suboptimal breastfeeding and complementary feeding, recurrent infections, household food insecurity, poverty, low
maternal education, inadequate water, sanitation and hygiene, and limited access to preventive health services. Stunting
was also associated with wasting, underweight, impaired cognitive development, reduced school readiness, and adverse
long-term human capital outcomes. Conclusion: Stunting prevention requires integrated and multisectoral interventions
beginning before conception and extending through the first 1,000 days and early childhood. Priorities include maternal
and child nutrition, optimal infant feeding, WASH, infection prevention, growth monitoring, food security, social
protection, and responsive caregiving to reduce health inequities and improve child growth and development.

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