<![CDATA[Stunting is a multidimensional development problem that reflects the interaction of biological, social, economic, and environmental factors. In East Nusa Tenggara Province (NTT), archipelago characteristics, hilly topography, water limitations, and scattered settlement patterns pose challenges for the provision of sanitation infrastructure. This study aims to analyze the development and distribution of stunting prevalence in NTT, examine the role of proper sanitation as a determinant of sensitive nutrition, and develop an Infrastructure–Health Outcome Framework that places sanitation infrastructure as an engineering variable in the stunting system. The study uses a quantitative paradigm with an analytical descriptive approach and cross-sectional observational design based on SSGI 2022 and 2024 secondary data. The analysis includes prevalence distribution, sanitation status comparison, risk ratio calculation, and technical interpretation based on infrastructure systems. The results of the study show that the prevalence of stunting in NTT in 2024 is around 37.0% and there is a disparity between districts/cities. The distribution used in the analysis showed a stunting prevalence of 42% in the unsuitable sanitation group and 35% in the decent sanitation group, so that a risk ratio of around 1.20 was obtained. The findings showed that the risk of stunting was about 20% higher in the unsuitable sanitation group. In the perspective of Civil Engineering, sanitation is positioned as an infrastructure system whose performance is determined by the quality of design, construction, waste treatment, distance to water sources, and suitability with geological and hydrological conditions. The developed framework connects sanitation infrastructure, environmental quality, exposure to pathogens, recurrent infections, impaired nutrient absorption, and stunting.]]>
