Investigating the Impact of Drinking Water on Urban Stunting in Indonesia

In Indonesia, stunting remains a health issue among children aged < 5 years, with a prevalence of 36.8% in 2021, the highest prevalence of malnutrition in the said age group, and the quality of drinking water consumed being one of the main causes. This study aimed to identify the quality of drinking water and determine the risk factors for stunting.

This study was conducted at four Primary Health Care work areas in an urban city between July and October 2022 using a cross-sectional study design with 172 under-fives, 106 of whom had drinking water-related stunting. The sampling methods employed were two-stage, including cluster and purposive sampling. Data collection included anthropometric measurements, interviews, and collecting drinking water samples. This study used the logistic regression test for multivariate analysis.

The results showed that 93.6% of the drinking water was positive for microbiological agents, whereas analysis of heavy metals in drinking water revealed concentrations within acceptable limits as defined by standard drinking water quality regulations. Multivariate analysis showed that exposure to microbiologically contaminated drinking water was significantly associated with a higher risk of stunting. Children exposed to contaminated drinking water had a 3.3 times higher risk of stunting (OR 3.328; 95% CI 1.681-6.587). Additional confounding factors such as children over 23 months of age, history of infectious disease, low birth weight, and poor hygiene practices also contributed to increased stunting risk.

This study highlights the significant role of drinking water quality in the incidence of stunting among children under five. The high prevalence of microbiological contamination in household drinking water was strongly associated with increased stunting risk. Children exposed to contaminated water were over three times more likely to experience stunting. While concentrations of heavy metals remained within safe limits, additional confounding factors including child age, history of infectious disease, low birth weight, and poor hygiene practices further exacerbated the risk. These findings underscore the urgent need for integrated public health interventions focusing on water safety, hygiene education, and early childhood care to effectively reduce stunting prevalence in urban communities.