A National SKI-Based Child Stunting Risk Index for Concurrent Vulnerability Screening of Child Nutritional Risk in Indonesia

Abstract

Indonesia has made progress in reducing child stunting, but current policy and surveillance systems largely identify children only after anthropometric growth deficits have occurred. This approach overlooks the accumulation of biological, infection, nutritional, and caregiving risks that precede measurable stunting. This study develops a Child Stunting Risk Index (CSRI) using the 2023 Indonesian Health Survey to support early and preventive risk prioritization among children aged 0–59 months. The CSRI is designed as a concurrent vulnerability screening tool rather than a diagnostic measure or an estimator of stunting prevalence. The formative index combines age-eligible proximal indicators within two dimensions: biological/infection risks and nutrition/care risks. Indicators are aggregated using nested equal weighting, subject to minimum data-coverage requirements. Risk categories are determined using a sample-relative traffic-light classification and assessed through leave-one-out known-group validation against established child growth risk markers. Among 82,678 children with valid scores, the weighted mean CSRI was 0.126 (12.56 on a 0–100 scale), with mean indicator coverage of 96.45%. Overall, 25.64% of children were classified as having high or very high risk. Risk was highest among children aged 6–23 months and in Maluku-Papua, Sumatra, and Sulawesi. Higher scores were consistently observed among children exposed to low birth weight, prematurity, incomplete immunization, inadequate dietary diversity, limited growth monitoring, and suboptimal breastfeeding and feeding practices. Theoretically, the study extends stunting assessment from outcome-based measurement to a multidimensional vulnerability framework. Practically, the CSRI provides a scalable tool for targeting preventive interventions before growth failure becomes observable.