Crowded Housing and Urban Residence as Risk Factors for Under-Five Children’s Pneumonia in Indonesia: Analysis of SSGI 2024 Data

Jurnal Keselamatan Kesehatan Kerja dan Lingkungan (JK3L) e-ISSN: 2776-4133. Volume 07 (2) 2026 http://jk3l.fkm.unand.ac.id/index.php/jk3l/index Crowded Housing and Urban Residence as Risk Factors for Under-Five Children’s Pneumonia in Indonesia: Analysis of SSGI 2024 Data Kepadatan Hunian dan Wilayah Perkotaan sebagai Faktor Risiko Pneumonia pada Balita di Indonesia: Analisis Data SSGI 2024 Fadilah Yuma Zahara1, Defriman Djafri2*, Aria Gusti2 1. Master’s Program in Epidemiology, Faculty of Public Health, Universitas Andalas, Padang, West Sumatra, Indonesia 2. Department of Public Health, Faculty of Public Health, Universitas Andalas, Padang, West Sumatra, Indonesia *Corresponding Author: Defriman Djafri Email : , ABSTRACT Pneumonia remains the leading cause of morbidity and mortality among under-five children in Indonesia, with cases tending to increase each year. This study aimed to examine the association between crowded housing, cooking fuel type, nutritional status, sex, and classification of residence with the incidence of under-five children under five years old in Indonesia. This study used a cross-sectional design with secondary data from the 2024 Indonesian Nutritional Status Survey. The sample included 201,017 children aged 12-59 months. Bivariate analysis was performed using the chi-square test. The bivariate analysis of five variables showed that crowded housing (p=0.008; POR=1.273) and urban residence (p<0.001; POR=1.918) were significant risk factors for under-five children’s pneumonia. Meanwhile, sex (p=0.412), nutritional status (p=0.216), and cooking fuel type (p=0.290) did not show statistically significant associations. Crowded housing conditions and living in urban areas are significant risk factors for pneumonia in children under five in Indonesia. Public health interventions should prioritize improving household ventilation, reducing indoor crowding, and developing targeted pneumonia prevention programs in urban areas. Keywords: pneumonia, under-five children, crowded housing, urban residence, SSGI 2024 ABSTRAK Pneumonia masih menjadi penyebab utama morbiditas dan mortalitas pada balita di Indonesia dengan kasus yang cenderung meningkat setiap tahunnya. Penelitian ini bertujuan untuk melihat hubungan antara kepadatan hunian, bahan bakar memasak, status gizi, jenis kelamin, serta klasifikasi tempat tinggal dengan kejadian pneumonia pada balita di Indonesia. Penelitian ini menggunakan desain cross sectional dengan data sekunder dari Survei Status Gizi Indonesia (SSGI) 2024. Sampel mencakup 201.017 balita usia 12-59 bulan. Analisis data dilakukan secara bivariat dengan menggunakan uji chisquare. Hasil analisis bivariat dari lima variabel menunjukkan bahwa kepadatan hunian (p=0,008; POR=1,273) dan klasifikasi tempat tinggal di wilayah urban (p<0,001; POR=1,918) merupakan faktor risiko signifikan terhadap kejadian pneumonia pada balita. Sementara itu, jenis kelamin (p=0,412), status gizi (p=0,216), dan penggunaan bahan bakar memasak (p=0,290) tidak menunjukkan hubungan yang bermakna secara statistik. Hunian yang padat dan tinggal di wilayah perkotaan terbukti meningkatkan risiko pneumonia pada balita di Indonesia. Untuk itu, upaya pencegahan pneumonia perlu difokuskan pada pengurangan kepadatan hunian dan pengembangan program yang lebih terarah khususnya di daerah perkotaan. Kata Kunci : Pneumonia, balita, kepadatan hunian, wilayah perkotaan, SSGI 2024 116 Zahara et al, Crowded Housing and Urban Residence as Risk Factors for Under-Five Children INTRODUCTION Pneumonia is an acute respiratory infection that affects the alveoli and the distal bronchial tree of the lungs. It is caused by various agents, including bacteria, viruses, parasites, and fungi, although bacterial and viral infections are the most common causes according to the Centers for Disease Control and Prevention.1,2 Infection leads to inflammation and fluid accumulation in the lungs, causing breathing difficulties and potentially death, making pneumonia the leading infectious cause of mortality among children worldwide.3 Globally, pneumonia remains the leading cause of death among children compared to other infectious diseases. It is estimated that over 700,000 children under five die annually, or about 2,000 deaths per day, with around 610,000 deaths reported in 2023 based on the Global Burden of Disease study.4 Reports from UNICEF and the International Vaccine Access Center (IVAC) in 2024 indicate that more than 70% of under-five deaths are due to pneumonia and diarrhea.5 The decline in pneumonia-related mortality has been slower than that of other infectious diseases, highlighting its ongoing public health importance. In Indonesia, the burden of under-five children’s pneumonia has increased significantly over the past five years. Data from the Indonesian Health Profile 2020–2024 show a decline from 309,838 cases in 2020 to 278,261 cases in 2021, likely due to pandemicrelated changes in healthcare access and mobility. However, cases rose again in 2022, reaching 386,724, 416,435 in 2023, and 530,641 in 2024.6 Overall, this represents an increase of more than 70%, indicating that pneumonia remains a major challenge for the national health system. Several studies have identified factors associated with under-five children’s pneumonia, particularly environmental conditions such as crowded housing. High housing density increases the risk of droplet transmission due to poor ventilation and close contact. A study by Sa’diyah et al. (2022) in Semarang found a significant association between crowded housing and pneumonia (OR=3.889; p=0.014).7 Additionally, residence classification (urban–rural) also plays a role, with a study by Dharel et al. (2023) in Nepal reporting higher pneumonia risk among children in urban areas (p<0.001).8 Other contributing factors include sex, nutritional status, and type of cooking fuel. Ananda & Budyanra (2024) found that male children had a 1.14 times higher risk of pneumonia, while undernourished children had 1.23 times higher odds.9 Furthermore, Kurniawati and Wulandari (2025) reported that the use of unclean cooking fuel (firewood) increased the risk of pneumonia by 6.61 times (p=0.019).10 Based on this background, this study utilizes data from the 2024 Indonesian Nutritional Status Survey (SSGI), the most recent nationally representative dataset. The novelty of this study lies in examining key risk factors, especially crowded housing and residence classification, along with supporting factors such as sex, nutritional status, and cooking fuel type. Therefore, this study aims to analyze their association with the incidence of under-five children’s pneumonia in Indonesia in 2024. METHOD This study employed a cross-sectional design using secondary data from the 2024 Indonesian Nutritional Status Survey (SSGI). The target population was all children aged 12– 59 months living in Indonesia in 2024. The study sample included 201,017 children who met the followin (...truncated)