Integrated Healthy-Economic Household Model for Stunting Prevention in Rural Indonesia
Keywords:
Stunting, Household sanitation, Local food system, Economic empowermentAbstract
Background: Stunting in rural Indonesia remains a multidimensional challenge driven by poverty, inadequate sanitation, limited parenting knowledge, and constrained household access to nutritious foods, particularly animal protein. Effective prevention therefore requires integrated interventions that address health, behavioral, environmental, and economic determinants simultaneously.
Aims: This study presents and evaluates the Integrated Healthy-Economic House Model implemented in Pekangkungan Village, East Java, Indonesia, to examine whether a household-centered approach combining stunting prevention, clean and healthy living behavior (PHBS), household sanitation, and local food-based economic empowerment improves nutrition, sanitation, and livelihood-related outcomes.
Methods: The program employed Participatory Action Research (PAR) and Asset-Based Community Development (ABCD) approaches involving 40 at-risk households, including eight households with confirmed stunting cases. Interventions included nutrition and parenting education, budikdamber (catfish-in-bucket aquaculture) training, productive home garden development, local protein-based food processing, and household sanitation mentoring delivered through posyandu cadres and PKK networks. Program effectiveness was assessed using a pre–post evaluation design across seven key indicators.
Results: Nutrition knowledge rose by 46 percentage points (38% to 84%); consistent PHBS practice increased by 43 points (29% to 72%); 80% of households established active budikdamber units; and animal protein consumption of at least four times per week rose by 39 points (22% to 61%). Asset mapping identified community social capital, particularly PKK networks and trained posyandu cadres, as the most decisive enabler of sustainable outcomes.
Conclusions: The model offers a realistic, replicable pathway to reduce stunting by transforming households into healthy and economically productive units, with implications for intersectoral budget integration in village governance.
References
Abdullah, Y. A., & Pratama, E. F. (2024). Penerapan sanitasi masyarakat kepulauan dengan pembuatan jamban sehat sebagai upaya peningkatan kesehatan masyarakat dan lingkungan. Jurnal Pengabdian Kesehatan Masyarakat, 5(2), 75–82. https://doi.org/10.37905/jpkm.v5i2.27405
Addae, H. Y., Sulemana, M., Yakubu, T., Atosona, A., Tahiru, R., & Azupogo, F. (2024). Low birth weight, household socio-economic status, water and sanitation are associated with stunting and wasting among children aged 6–23 months: Results from a national survey in Ghana. PLOS ONE, 19(3), e0297698. https://doi.org/10.1371/journal.pone.0297698
Azis, R., Akmal, A., Rahayu, I., Masriadi, M., Alif, A. B., & Samsidarwati, B. (2025). Parenting behaviour and stunting prevention in south sulawesi province, indonesia. Jurnal Biometrika Dan Kependudukan, 14(1), 66–77. https://doi.org/10.20473/jbk.v14i1.2025.66-77
Azriani, D., Masita, Qinthara, N. S., Yulita, I. N., Agustian, D., Zuhairini, Y., & Dhamayanti, M. (2024). Risk factors associated with stunting incidence in under five children in Southeast Asia: A scoping review. Journal of Health, Population and Nutrition, 43(1), 174. https://doi.org/10.1186/s41043-024-00656-7
Alamri, A. R., Nurwati, R. N., Rusyidi, B., & Hermanto, B. (2025). Asset-based Community Development (ABCD): In conversation with John McKnight about the heritage of ABCD and its place in the world today (3rd edition). Community Development Journal, 60(3), 606–609. https://doi.org/10.1093/cdj/bsae064
Beatty, A., Borkum, E., Leith, W., Null, C., & Suriastini, W. (2024). A cluster randomized controlled trial of a community-based initiative to reduce stunting in rural Indonesia. Maternal & Child Nutrition, 20(1), e13593. https://doi.org/10.1111/mcn.13593
Budiastutik, I., Pranaka, R. N., Amaliyah, N., Hediyanti, G., & Trisnawati, E. (2024). The Relation of Infectious Diseases, Water Access, Hygiene Practice, and Sanitation with the Stunting: A Case-Control Study in Sambas Regency: Hubungan Penyakit Menular, Sumber Air Bersih, Praktik Kebersihan, dan Sanitasi dengan Kejadian Stunting: Studi Kasus Kontrol di Kabupaten Sambas. Amerta Nutrition, 8(1SP), 70–75. https://doi.org/10.20473/amnt.v8i1SP.2024.70-75
Chao, K. (2024). Family farming in climate change: Strategies for resilient and sustainable food systems. Heliyon, 10(7), e28599. https://doi.org/10.1016/j.heliyon.2024.e28599
Dahir, H. M., Korse, A. H., & Mohamed, F. I. (2026). Water, sanitation, and hygiene and their association with child undernutrition: A hierarchical analysis of the 2020 Somaliland demographic health survey. Frontiers in Public Health, 13, 1734101. https://doi.org/10.3389/fpubh.2025.1734101
Dominguez-Salas, P., Waddington, H. S., Grace, D., Bosire, C., Moodley, A., Kulkarni, B., Dasi, T., Banjara, S. K., Kumar, R. N., Fahmida, U., Htet, M. K., Sudibya, A. R. P., Faye, B., Tine, R. C., Heffernan, C., Saxena, D., Dreibelbis, R., & Häsler, B. (2024). Understanding the role of household hygiene practices and foodborne disease risks in child stunting: A UKRI GCRF Action Against Stunting Hub protocol paper. BMJ Paediatrics Open, 8(Suppl 1), e001695. https://doi.org/10.1136/bmjpo-2022-001695
Dubey, S. K., Padiyar, A., Chadag, V. M., Shenoy, N., Gaikwad, A. B., Ratha, B. C., & Belton, B. (2024). Scaling community-based aquaculture for enhanced nutrition and women’s empowerment: Lessons from Odisha, India. Frontiers in Sustainable Food Systems, 8, 1412686. https://doi.org/10.3389/fsufs.2024.1412686
Escher, N. A., Andrade, G. C., Ghosh-Jerath, S., Millett, P. C., & Seferidi, P. (2024). The effect of nutrition-specific and nutrition-sensitive interventions on the double burden of malnutrition in low-income and middle-income countries: A systematic review. The Lancet Global Health, 12(3), e419–e432. https://doi.org/10.1016/S2214-109X(23)00562-4
Guja, H., Belgiu, M., Baye, K., & Stein, A. (2025). Prevalence and determinants of stunting and anaemia in children aged 6–23 months: A multilevel analysis from rural Ethiopia. Maternal & Child Nutrition, 21(1), e13736. https://doi.org/10.1111/mcn.13736
Harianingsih, H., Sulistyawan, V. N., Widiarti, N., Putra, M. R. F., & Sokmawan, M. R. H. (2024). The aquaponic cultivation of catfish in barrels (Budikdamber) on Internet of Things (IoT) and fish pellets from water hyacinth as a food security strategy for the Tugu Village community, Sayung District, Demak. Journal of Community Empowerment, 4(2), 82–87. https://doi.org/10.15294/jce.v4i2.13346
Heni, D. A., Anwar, M. S., Falasifah, N., Arida, V., & Chairiyah, U. (2021). Budikdamber (fish farming in buckets) as a food security solution in Simomulyo Baru Sukomanunggal Surabaya. Proceedings of International Conference on Da'wa and Communication, 3(1), 215–226. https://doi.org/10.15642/icondac.v3i1.517
Kalinda, C., Qambayot, M. A., Ishimwe, S. M. C., Regnier, D., Bazimya, D., Uwizeyimana, T., Desie, S., Rudert, C., Gebremariam, A., Brennan, E., Karumba, S., Wong, R., & Bekele, A. (2024). Leveraging multisectoral approach to understand the determinants of childhood stunting in Rwanda: A systematic review and meta-analysis. Systematic Reviews, 13(1), 16. https://doi.org/10.1186/s13643-023-02438-4
Juniarti, N., Alsharaydeh, E., Sari, C. W. M., Yani, D. I., & Hutton, A. (2025). Determinant factors influencing stunting prevention behaviors among working mothers in rural Indonesia. BMC Public Health, 25(1), 891. https://doi.org/10.1186/s12889-025-20988-2
Kaminski, A. M., Cole, S. M., Johnson, J., Thilsted, S. H., Lundeba, M., Genschick, S., & Little, D. C. (2024). Smallholder aquaculture diversifies livelihoods and diets thus improving food security status: Evidence from northern Zambia. Agriculture & Food Security, 13(1), 1. https://doi.org/10.1186/s40066-023-00452-2
Keats, E. C., Das, J. K., Salam, R. A., Lassi, Z. S., Imdad, A., Black, R. E., & Bhutta, Z. A. (2021). Effective interventions to address maternal and child malnutrition: An update of the evidence. The Lancet Child & Adolescent Health, 5(5), 367–384. https://doi.org/10.1016/S2352-4642(20)30274-1
Kusumawati, I., Puspitasari, H. P., Soesilawati, P., Izzah, Z., Fitria, A. L., Ramadhani, F. A., Rullyansyah, S., Pratama, Y. A., Pattymahu, C. V. P., & Gamar, F. H. I. (2025). Participatory health innovation for stunting prevention: A multi-strategy community based approach in rural East Java, Indonesia. World Journal of Advanced Research and Reviews, 28(1), 1–12. https://doi.org/10.30574/wjarr.2025.28.1.3466
Mirza, M. U., Richter, A., van Nes, E. H., & Scheffer, M. (2025). Modeling environmental interactions and collaborative interventions for childhood stunting: A case from Indonesia. Environmental Modelling & Software, 186, Article 100036. https://doi.org/10.1016/j.envsoft.2025.100036
Mulyani, A. T., Khairinisa, M. A., Khatib, A., & Chaerunisaa, A. Y. (2025). Understanding Stunting: Impact, Causes, and Strategy to Accelerate Stunting Reduction—A Narrative Review. Nutrients, 17(9), 1493. https://doi.org/10.3390/nu17091493
Nasution, S. W. R., Harahap, R. A., & Suraya, R. (2024). Pengaruh promosi kesehatan melalui media poster terhadap perilaku hidup bersih dan sehat pada siswa SD. Jurnal Vokasi Kesehatan, 10(2). https://doi.org/10.30602/jvk.v10i2.1502
Noviana, U., Ekawati, H., Hasinuddin, M., Haris, M., & Mufarika, M. (2024). Stunting prevention behavior among children under two years based on integrated behavior: A model development. Pediomaternal Nursing Journal, 10(1), 7–13. https://doi.org/10.20473/pmnj.v10i1.47366
Permatasari, T. A. E., Chadirin, Y., Ernirita, E., Syafitri, A. N., & Fadhilah, D. A. (2025). The accuracy of a novel stunting risk detection application based on nutrition and sanitation indicators in children aged under five years. BMC Nutrition, 11(1), 93. https://doi.org/10.1186/s40795-025-01074-6
Prasetyo, A. A., & Susanna, D. (2025). Hygiene and Sanitation Towards the Incidence of Stunting in Children Under Five Years Old in Bidara Cina Villege, East Jakarta in 2024. International Journal of Advancement in Life Sciences Research, 08(02), 129–142. https://doi.org/10.31632/ijalsr.2025.v08i02.010
Quattrochi, J. P., Croke, K., Dohou, C., Ghib, L. S., Lokaya, Y., Coville, A., & Mvukiyehe, E. (2025). Effects of a community-driven water, sanitation, and hygiene intervention on diarrhea, child growth, and local institutions: A cluster-randomized controlled trial in rural Democratic Republic of Congo. PLOS Medicine, 22(3), e1004524. https://doi.org/10.1371/journal.pmed.1004524
Ricci, H., Schmid, D., Kruger, S., Terzoni, S., & Ricci, C. (2026). Factors Associated With Childhood Undernutrition in Sub‐Saharan Africa: A Systematic Review and Meta‐Analysis. Maternal & Child Nutrition, 22(1), e70083. https://doi.org/10.1111/mcn.70083
Roy, S., Gourav, Sharma, R., & Basu, S. (2026). Impact of water, sanitation and hygiene (WASH) on child stunting and wasting in India: A propensity score matching analysis from the National Family Health Survey. Biodemography and Social Biology, 1–17. https://doi.org/10.1080/19485565.2026.2627002
Sharma, V. (2024). Empowering local food security: A systematic review of community grain banks. Journal of Agriculture, Food Systems, and Community Development, 1–23. https://doi.org/10.5304/jafscd.2024.141.006
Siboro, V. A., Rochadi, K., Sinaga, J., Manurung, K., & Bancin, D. (2025). The Relationship of Knowledge, Parenting Patterns, Feeding, and Environmental Sanitation to the Incidence of Stunting in Toddler Ages 24-59 Months in the Working Area of the Buhit Puskesmas, Samosir District, 2025. Journal of Pharmaceutical and Sciences, 2107–2117. https://doi.org/10.36490/journal-jps.com.v8i3.1084
Sinharoy, S., Reese, H., Clasen, T., & Sinharoy, S. S. (2026). Applying machine learning to predict stunting in children under 5 years old based on water, sanitation and hygiene behaviors and infrastructure. PLOS One, 21(3), e0343796. https://doi.org/10.1371/journal.pone.0343796
Syitra, S. M. L. P., Tiara, A., & Tarigan, A. A. (2025). Effectiveness of community-based nutrition interventions in preventing stunting and malnutrition in toddlers: A literature review. International Journal of Health Science, 5(2), 78–88. https://doi.org/10.55606/ijhs.v5i2.5252
South, J., Coan, S., Woodward, J., Bagnall, A.-M., & Rippon, S. (2024). Asset based community development: Co-designing an asset-based evaluation study for community research. SAGE Open, 14(2). https://doi.org/10.1177/21582440241240836
Suharto, A., Wildan, M., & Handayani, T. E. (2020). Development of stunting prevention behavior model based on health promotion model and social capital in the Magetan District. Health Notions, 4(2), 48–56. https://doi.org/10.33846/hn40204
Sunarsih, T., Kharisma, K., Viyani, A. O., Suyitno, S., Saputra, M. H., Wibawanti, J. M. W., Astuti, E. P., & Shanti, E. F. A. (2026). Activating community-based change pathways for stunting prevention: Integrating appropriate technology and primary health cadre capacity in rural Indonesia. Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 9(4), 693–715. https://doi.org/10.56338/mppki.v9i4.9400
Ward, S. (2023). Using theory-based evaluation to understand what works in asset-based community development. Community Development Journal, 58(2), 206–224. https://doi.org/10.1093/cdj/bsac035
World Health Organization. (2024). Reducing stunting in children: Equity considerations for achieving the Global Nutrition Targets 2025. WHO Press.
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