The Role of Household Food Insecurity in Malnutrition Among Indonesian Children Under Five: A Systematic Review and Meta-Analysis (2015–2025)

Objective: To synthesize and quantify the association between household food insecurity (HFI) and various forms of malnutrition that includes stunting, wasting, underweight, overnutrition, and anaemia among Indonesian children under five years of age. Design: Systematic review and meta-analysis conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The study included literature search, screening, data extraction, quality assessment using Joanna Briggs Institute (JBI) tools, and meta-analysis using Review Manager 5.4. Setting: Studies conducted in Indonesia, covering urban, rural, and mixed settings across multiple provinces. Participants: Children under five years of age residing in Indonesia, from households assessed for food insecurity using validated tools. Results: A total of 32 studies met the inclusion criteria, of which 26 were eligible for meta-analysis. HFI was significantly associated with higher odds of stunting (case-control: OR = 4.66; 95% CI: 3.39–6.40; P < 0.001; cross-sectional: OR = 4.61; 95% CI: 4.17–5.11; P < 0.001;), wasting (OR = 1.92; 95% CI: 1.60–2.32; P < 0.001), underweight (OR = 5.26; 95% CI: 2.12–13.04; P < 0.001), and overnutrition (OR = 1.66; 95% CI: 1.49–1.85; P < 0.001). Children in food-secure households had significantly lower odds of anaemia (OR = 0.41; 95% CI: 0.30–0.58; P < 0.001). Conclusions: Household food insecurity is strongly associated with multiple forms of malnutrition among Indonesian children under five. These findings highlight the urgent need for integrated, nutrition-sensitive strategies that address food security to improve child health and reduce malnutrition in Indonesia.