<span lang="EN">Environmental health conditions associated with childhood <span lang="EN">stunting during the first ۱۰۰۰ days of life

BACKGROUND AND OBJECTIVES: Child stunting is increasingly recognized not only as a nutritional disorder but also as a complex environmental health issue. Household environmental conditions, especially access to safe drinking water and improved sanitation, play a fundamental role in reducing children's exposure to environmental health risks that impair linear growth. Using the transtheoretical model as a behavioral framework, the study objectives were to examine how household environmental conditions, including access to improved drinking water and sanitation, together with maternal environmental health-related behaviors, are associated with child stunting during the first ۱,۰۰۰ days of life in Indonesia. METHODS: This cross-sectional study used nationally representative data from the fifth wave of the Indonesian Family Life Survey. Maternal behaviors related to nutrition, healthcare utilization, and environmental conditions were operationalized as proxies for advanced stages of behavioral change. Child stunting was defined using height-for-age z-scores based on the World Health Organization Child Growth Standards. Binary logistic regression was applied to estimate the associations between maternal behaviors, socio-demographic and environmental factors, and the risk of child stunting.FINDINGS: The prevalence of stunting among children aged ۰ to ۲۳ months was ۳۰.۳۲ percent. Low birth weight and higher birth order significantly increased the odds of stunting. Maternal behaviors reflecting progression to the action and maintenance stages were protective, including routine antenatal care attendance, with an odds ratio of ۰.۶۴۲, and delivery assisted by a skilled birth attendant, with an odds ratio of ۰.۷۰۷. Higher maternal education and access to improved drinking water and sanitation were also associated with lower odds of stunting, while underweight maternal nutritional status increased the odds by ۲۶.۵ percent.CONCLUSION: Household environmental conditions constitute fundamental determinants of child stunting during the first ۱,۰۰۰ days of life. Maternal progression toward advanced stages of stunting prevention behavior, reinforced by adequate health services and enabling environments, plays a critical role in reducing stunting during the first ۱,۰۰۰ days of life. The study demonstrates the usefulness of the transtheoretical model as a theoretical framework to stunting prevention by integrating maternal behavioral readiness with health service utilization and environmental conditions, offering a stage-sensitive and contextually grounded perspective on early childhood growth.

کلیدواژه ها:

Environmental health ، Environmental perspectives ، First ۱ ، ۰۰۰ days of life ، Maternal behavior ، Stunting.