Structural Model of the Impact of Sanitation Facilities and Maternal Factors on Stunting among Under-Five Children in the Morosi Mining Area in Southeast Sulawesi Region, Indonesia

Abstract

This study aimed to analyze the direct relationships of WASH components and maternal factors with stunting and to explore the pathways through which these factors influence stunting among children under five in the Morosi mining area of Southeast Sulawesi, Indonesia. A quantitative case–control study was conducted involving 150 mothers, consisting of 75 mothers with stunted children and 75 mothers with normal children. Data were analyzed using Partial Least Squares–Structural Equation Modeling (PLS-SEM). The results showed that the model explained 31.5% of the variance in stunting (R^² = 0.315). Access to clean water was significantly associated with stunting (β = −0.148, p = 0.028) and had a strong relationship with toilet facilities (β = 0.723, p < 0.001) and handwashing facilities (β = 0.196, p = 0.011). Toilet facilities showed the strongest association with stunting (β = 0.523, p < 0.001), followed by handwashing facilities (β = 0.260, p = 0.001). Indirect effect analysis revealed that clean water was significantly associated with stunting through toilet facilities (β = 0.378, p < 0.001) and handwashing facilities (β = 0.051, p = 0.038). These findings suggest that access to clean water contributes to improved sanitation practices, which are associated with lower stunting risk among children. Strengthening integrated Water, Sanitation, and Hygiene (WASH) interventions, particularly improvements in household water access, sanitation, and handwashing facilities, is essential to support stunting reduction in mining communities.