Socio-Economic Barriers to The Adoption of Hygiene Behaviors for Stunting Prevention in Developing Countries: A Systematic Review

Authors

  • Ruth Rize Paas Megahati S Universitas Nahdlatul Ulama Sumatera Barat, Padang, Indonesia
  • Liza Yuliana Universitas Nahdlatul Ulama Sumatera Barat, Padang, Indonesia

DOI:

https://doi.org/10.56778/rjhs.v3i4.675

Keywords:

Stunting, socio-economic barriers, hygiene behavior, developing country

Abstract

Objective: This systematic review aims to identify and analyze the various socio-economic barriers that hinder the adoption of hygiene behaviors for stunting prevention. It specifically examines how economic factors, infrastructure limitations, and social norms influence the effectiveness of environmental health interventions in developing nations.

Methods: A Systematic Literature Review (SLR) was conducted following the PRISMA protocol. Data were sourced from three primary databases: Scopus, Web of Science, and Google Scholar, covering the period from 2016 to 2024. A total of 24 research articles focusing on stunting dynamics and environmental factors in developing regions, including Indonesia, were selected for in-depth synthesis and analysis. Results: The findings reveal that systemic poverty, limited access to affordable clean water, and high operational expenses are the primary obstacles to hygiene practice. Additionally, the study identifies that maternal education level and household gender roles are significant determinants of the sustainability of these behaviors. The results underscore that hygiene education campaigns alone have a limited impact if the underlying economic and structural barriers remain unaddressed.

Conclusion: Stunting prevention requires a multi-sectoral strategy that transcends purely medical and nutritional interventions. To be effective, policies must integrate household economic empowerment with the development of inclusive sanitation infrastructure. This study provides a critical perspective for policymakers to design interventions that are sensitive to the socio-economic constraints of communities in developing nations.

References

Achyar, K. A., Surasta, W., Lestari, A. S., Wiardani, N. K., Ribek, N & Wigati. (2024). Addressing Stunting Through Local Strategies: A Study of Social Phenomena in Various Regions of Indonesia. Evolutionary Studies In Imaginative Culture, 8(12), 508–524. https://doi.org/10.70082/esiculture.vi.707

Agustin, I., & Ar, H. (2024). Strategi Strategi Pengembangan Sumber Daya Manusia Dalam Mengatasi Stunting. Publik: Jurnal Manajemen Sumber Daya Manusia, Administrasi Dan Pelayanan Publik, 11(3), 1118–1128. https://doi.org/10.37606/publik.v11i3.1507

AL-qurashi, M., Almuhaydib, M., Alfaqih, A., Albalawi, D., Alshehri, A., Qattan, K., & Alfaqih, A. (2024). Environmental risk factors associated with stunting in pediatric. International Journal of Medicine in Developing Countries, 8(9),2492–2498. https://doi.org/10.24911/IJMDC.51-1724783737

Arifuddin, A., Fauzan, A., Hakim, R. B. F., & Nur, A. F. (2025). Spatial Pattern Analysis and Determinants of Stunting Prevalence in Central Sulawesi, Indonesia: Using Linear Regression, Local Moran’s I, and Random Forest Approaches. Healthy Tadulako Journal (Jurnal Kesehatan Tadulako), 11(3), 504–516. https://doi.org/10.22487/htj.v11i3.1863

Beal, T., Le, D. T., Trinh, T. H., Burra, D. D., Huynh, T., Duong, T. T., Truong, T. M., Nguyen, D. S., Nguyen, K. T., De Haan, S., & Jones, A. D. (2019). Child stunting is associated with child, maternal, and environmental factors in Vietnam. Maternal & Child Nutrition, 15(4), e12826. https://doi.org/10.1111/mcn.12826

Budge, S., Parker, A. H., Hutchings, P. T., & Garbutt, C. (2019). Environmental enteric Dysfunction And Child Stunting. Nutrition Reviews, 77(4), 240–253. https://doi.org/10.1093/nutrit/nuy068

Cameron, L., Chase, C., Haque, S., Joseph, G., Pinto, R., & Wang, Q. (2021). Childhood stunting and cognitive effects of water and sanitation in Indonesia. Economics & Human Biology, 40, 100944. https://doi.org/10.1016/j.ehb.2020.100944

Da Silva, I. D., Auxiliadora Menezes Da Silva, D., Maria Ximenes, H., Jesus Vaz Cabral, T. D., & Santos Ximenes, H. D. (2024). Literature Review: Health Promotion Strategies Stunting Prevention in Timor-Leste. KESANS: International Journal of Health and Science, 3(11), 532–540. https://doi.org/10.54543/kesans.v3i11.309

Fadilla, U. S., & Choiriyah, I. U. (2024). Enhancing Maternal Engagement for Effective Stunting Prevention Strategies. Indonesian Journal of Cultural and Community Development, 15(3), 247-256. https://doi.org/10.21070/ijccd.v15i3.1102

Fregonese, F., Siekmans, K., Kouanda, S., Druetz, T., Ly, A., Diabaté, S., & Haddad, S. (2017). Impact of contaminated household environment on stunting in children aged 12–59 months in Burkina Faso. Journal of Epidemiology and Community Health, 71(4), 356–363. https://doi.org/10.1136/jech-2016-207423

Gleason, K. M., Valeri, L., Shankar, A. H., Obrycki, J. F., Ibne Hasan, M. O. S., Mostofa, G., Quamruzzaman, Q., Wright, R. O., Christiani, D. C., Bellinger, D. C., & Mazumdar, M. (2020). Stunting and lead: Using causal mediation analysis to better understand how environmental lead exposure affects cognitive outcomes in children. Journal of Neurodevelopmental Disorders, 12(1), 39-47. https://doi.org/10.1186/s11689-020-09346-x

Gusnedi, G., Nindrea, R. D., Idral Purnakarya, Hermita Bus Umar, Andrafikar, Syafrawati, Asrawati, Andi Susilowati, Novianti, Masrul, & Nur Indrawaty Lipoeto. (2023). Risk factors associated with childhood stunting in Indonesia: A systematic review and meta-analysis. Asia Pacific Journal of Clinical Nutrition, 32(2), 184-195 https://doi.org/10.6133/apjcn.202306_32(2).0001

Haddaway, N. R., Page, M. J., Pritchard, C. C., & McGuinness, L. A. (2022). PRISMA2020: An R package and Shiny app for producing PRISMA 2020‐compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Systematic Reviews, 18(2), e1230. https://doi.org/10.1002/cl2.1230

Halimah, H., Santoso, I., Rahmawati, R., & Erminawati, E. (2022). Analysis Of Household Environmental Sanitation On Stunting In Toddlers. Jurnal Kesehatan Lingkungan: Jurnal Dan Aplikasi Teknik Kesehatan Lingkungan, 19(2), 227–230. https://doi.org/10.31964/jkl.v19i2.359

Hasanah, I., & Susanti, H. (2018). Does water and sanitation effects on children’s physical development? Evidence from Indonesia Family life Survey (IFLS) 2014. E3S Web of Conferences, 74, 09007. https://doi.org/10.1051/e3sconf/20187409007

Kustriyanti, D., Hastuti, W., Boediarsih, B., Kusyati, E., & Pratiwi, N. (2024). Is Environmental Sanitation as A Trigger Factor Leading to Stunting? Jendela Nursing Journal, 8(1), 36–44. https://doi.org/10.31983/jnj.v8i1.9377

Kwami, C. S., Godfrey, S., Gavilan, H., Lakhanpaul, M., & Parikh, P. (2019). Water, Sanitation, and Hygiene: Linkages with Stunting in Rural Ethiopia. International Journal of Environmental Research and Public Health, 16(20), 3793. https://doi.org/10.3390/ijerph16203793

Lee, C., Lakhanpaul, M., Stern, B. M., Sarkar, K., & Parikh, P. (2021). Associations between the household environment and stunted child growth in rural India: A cross-sectional analysis. UCL Open Environment, 2. 6(8), 1-13. https://doi.org/10.14324/111.444/ucloe.000014

Lestari, S., Arlinda, S., Mukhlis, M., Lindawati, L., & Alhamda, S. (2024). GSEM analysis of environmental factors as the risk of increasing infectious diseases in under-fives to stunting incidence in Solok district. MOJ Public Health, 13(1), 32–36. https://doi.org/10.15406/mojph.2024.13.00434

Nurjazuli, N., Budiyono, B., Raharjo, M., & Wahyuningsih, N. E. (2023). Environmental factors related to children diagnosed with stunting 3 years ago in Salatiga City, Central Java, Indonesia. Toxicologie Analytique et Clinique, 35(3), 198–205. https://doi.org/10.1016/j.toxac.2023.01.003

Christopher, O. E. (2024). Investigating the Barriers Against Water, Sanitation and Hygiene (WASH) Adoption in Non-Household Settings (NHHS) in Nsukka Zone, Enugu State, Nigeria: A Cultural and Political Ecology (CAPE) Approach [PhD, Glasgow Caledonian University]. https://doi.org/10.59019/WOXU8041

Olo, A., Mediani, H. S., & Rakhmawati, W. (2020). Hubungan Faktor Air dan Sanitasi dengan Kejadian Stunting pada Balita di Indonesia. Jurnal Obsesi : Jurnal Pendidikan Anak Usia Dini, 5(2), 1113–1126. https://doi.org/10.31004/obsesi.v5i2.788

Owino, V., Ahmed, T., Freemark, M., Kelly, P., Loy, A., Manary, M., & Loechl, C. (2016). Environmental Enteric Dysfunction and Growth Failure/Stunting in Global Child Health. Pediatrics, 138(6), e20160641. https://doi.org/10.1542/peds.2016-0641

Rahut, D. B., Mishra, R., & Bera, S. (2024). Geospatial and environmental determinants of stunting, wasting, and underweight: Empirical evidence from rural South and Southeast Asia. Nutrition, 120, 112346. https://doi.org/10.1016/j.nut.2023.112346

Raiten, D. J., & Bremer, A. A. (2020). Exploring the Nutritional Ecology of Stunting: New Approaches to an Old Problem. Nutrients, 12(2), 371. https://doi.org/10.3390/nu12020371

Regassa, R., Belachew, T., Duguma, M., & Tamiru, D. (2024). Factors associated with stunting in under-five children with environmental enteropathy in slum areas of Jimma town, Ethiopia. Frontiers in Nutrition, 11, 1335961. https://doi.org/10.3389/fnut.2024.1335961

Santoso, P., & Pujianto, T. (2024). The Analysis of Factors that Influence Stunting. Jurnal Ners Dan Kebidanan (Journal of Ners and Midwifery), 11(2), 200–208. https://doi.org/10.26699/jnk.v11i2.ART.p200-208

Sentika, R., Setiawan, T., Kusnadi, K., Rattu, D. J., Yunita, I., Masita, B. M., & Basrowi, R. W. (2024). The Importance of Interprofessional Collaboration (IPC) Guidelines in Stunting Management in Indonesia: A Systematic Review. Healthcare, 12(22), 2226. https://doi.org/10.3390/healthcare12222226

Syahroni, A., & Nugroho, T. A. (2023). Technology as A Determinant of Mother’s Knowledge About Stunting In Toddlers Aged 1-5 Years Old Tanjung Sari Natar Village Selatan. Radinka Journal of Health Science, 1(1), 39–46. https://doi.org/10.56778/rjhs.v1i1.138

Syahroni, A., Yessiana Lutfia Bahri, & Suci Kurnia Sarri. (2023). Risk Factors of Stunting in Toddlers in The Village of Gunung Batin Udik, Lampung Tengah. Radinka Journal of Health Science, 1(2), 57–66. https://doi.org/10.56778/rjhs.v1i2.205

Yusriadi, Y., Sugiharti, S., Ginting, Y., Sandra, G., Sudirman, A., Zarina, A. (2024). Preventing stunting in rural Indonesia: A community-based perspective. African Journal of Food, Agriculture, Nutrition and Development, 24(9), 24470–24491. https://doi.org/10.18697/ajfand.134.24820

Vico, N. (2024). Quo Vadis Sanitasi Aman dalam Strategi Nasional Stunting menuju Net Zero Stunting. Pahlawan Jurnal Pendidikan-Sosial-Budaya, 20(1), 145–155. https://doi.org/10.57216/pah.v20i1.758

Wardani, E. K., & Rofika, L. D. (2022). Characteristic of Environmental Sanitation in Family With Stunting Children Under Five Years Of Age. Jurnal Kebidanan Kestra (JKK), 4(2), 93–100. https://doi.org/10.35451/jkk.v4i2.1043

Wasono, W., & Sukmana, H. (2024). Navigating Implementation Challenges of Stunting Solutions in Indonesia’s Health Programs. Indonesian Journal of Cultural and Community Development, 15(3), 273-284. https://doi.org/10.21070/ijccd.v15i3.1106

Woldesenbet, B., Tolcha, A., & Tsegaye, B. (2023). Water, hygiene and sanitation practices are associated with stunting among children of age 24-59 months in Lemo district, South Ethiopia, in 2021: Community based cross sectional study. BMC Nutrition, 9(1), 17. https://doi.org/10.1186/s40795-023-00677-1

Zahtamal, Z., Restila, R., Sundari, S., & Palupi, R. (2024). The Influence of Environmental Sanitation on Stunting. Jurnal Kesehatan Lingkungan, 16(1), 59–67. https://doi.org/10.20473/jkl.v16i1.2024.59-67

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Published

2026-05-31

How to Cite

Megahati S, R. R. P., & Yuliana, L. (2026). Socio-Economic Barriers to The Adoption of Hygiene Behaviors for Stunting Prevention in Developing Countries: A Systematic Review. RADINKA JOURNAL OF HEALTH SCIENCE, 3(4), 668–681. https://doi.org/10.56778/rjhs.v3i4.675