Background
Undernutrition in children under five years of age is a problem in many countries. In Asia, 49.9% of children under five experience growth failure (i.e. are stunted, wasted or overweight) [
1]. Likewise in Indonesia, as one of the countries in Southeast Asia, there is a high prevalence of stunting. In 2018, the prevalence of stunting in Indonesia (30.8%) was the second-highest in Southeast Asia, after that of Cambodia [
2]. This figure signifies a challenge for the Indonesian government, which is aiming for a 14% reduction in the prevalence of stunting by 2024 [
3]. Based on the results of the 2018 Basic Health Research (Riskesdas), the prevalence of stunting in Indonesia showed a decline of 6.4% over five years, from 37.2% (2013) to 30.8% (2018). However, due to some other nutritional problems, as many as 17.7% were underweight and 10.2% were wasting. This malnutrition problem occurs evenly across various provinces. In West Java Province, there is 31.1% stunting, 13.2% underweight and 8.4% wasting. This serious problem can affect a child’s health, making them more susceptible to disease and infection, and impairing their mental and physical development [
4,
5]. Furthermore, this nutritional problem can hinder economic growth and reduce labor market productivity, contributing to widening inequality and causing poverty across generations [
6,
7].
Efforts to deal with nutritional problems in Indonesia have been inititated since the early 1980s, through observation at the village level using integrated weighing and child health in integrated post services (Posyandu) [
8]. This commitment is strengthened through Presidential Regulation number 72 of 2021, which concerns the Acceleration of Stunting Reduction [
3]. This effort is in line with one of the 2030 Sustainable Development Goals (SDGs), namely, eliminating all forms of malnutrition, including reducing the prevalence of stunting and wasting for those under the age of five by 2025. Undernutrition is a global problem: One in three children under the age of five suffers from stunting, wasting, overweight and in some cases suffer a combination of the two forms of malnutrition [
1].
In the population, indicators of undernutrition in children can be identified by anthropometric measurements. This method is used to assess the size, proportion and composition of the human body. Anthropometry can be used to evaluate the general health status, nutritional adequacy and growth and development patterns of children [
9,
10]. The World Health Organization (WHO) report presents the first set of WHO Child Growth Standards using the conventional indices of weight-for-age, length/height-for-age, weight-for-length/height and BMI-for-age [
11,
12]. In Indonesia, assessing a child’s nutritional status is stipulated in Regulation of the Minister of Health of the Republic of Indonesia Number 2 of 2020 concerning Child Anthropometry Standards. There are four conventional indices: weight-for-age, height/length-for-age, weight-for-height/length (for children aged 0–60 months) and BMI-for-age (for children aged 0–60 months and children aged 5–18 years) [
13].
The weight-for-age index indicates general nutritional problems and represents a child’s current nutritional status. This index is used to assess children who are underweight or severely underweight. The height/length-for-age index indicates chronic malnutrition. This index can identify children who have suffered from frequent illness or malnutrition for a long time; it is categorized into short (stunted) or very short (severely stunted). This nutritional problem is associated with high poverty, unhealthy living behaviour, parenting patterns, failure to give exclusive breastfeeding, early breastfeeding, complementary foods and low balanced nutrition practices [
14‐
16]. It is also related to infectious diseases such as diarrhea, Acute Respiratory Infections (ARI) and tuberculosis [
14,
17‐
19]. The high prevalence of infectious diseases is also poor environmental sanitation and lack of hygiene practices [
20]. The weight-for-height/length index describes a recent (acute) or prolonged (chronic) condition of poor nutrition. It is categorized into undernutrition (wasted), severe undernutrition (severely wasted) and possible risk of overweight. BMI-for-age is used for assessments in accord with the categories of poor nutrition, poor nutrition, good nutrition, risk of overnutrition and obesity. This index is more sensitive when screening for overweight and obese children. However, the four conventional indices cannot determine the overall prevalence of malnutrition in the population. Researchers are forced to choose one category of anthropometric failure to represent the nutritional status of the target population while foregoing information on the other nutritional indices [
13].
The Composite Index of Anthropometric Failure (CIAF) method was developed to overcome multiple nutritional failures and to report the prevalence of accurate data. This method identifies children with single or multiple anthropometric failures [
21]. The CIAF is an anthropometric index that combines the three indices of weight-for-age, height/length-for-age and weight-for-height/length, so as to determine the nutritional status of children under five years of age [
22]. The combined index method of the Svedberg model divides malnourished children into six categories: A) without anthropometric failure; B) wasting only; C) wasting and underweight; D) wasting, underweight and stunting; E) underweight and stunting; F) stunting only. Furthermore, Nandy et al. added category Y), which is underweight only [
23]. The CIAF is right in emphasising the importance of child feeding practices, family planning practices, appropriate mothers’ parenting patterns and mothers’ knowledge in preventing the prevalence of undernutrition in children under five years. This measurement model can accelerate the reduction in child mortality by expanding preventive and curative interventions that are more effective in addressing the significant causes of undernutrition. The CIAF also describes a comprehensive measure and can detect children with multiple anthropometric failures [
24]. In light of this, Svedberg added three categories to the existing conventional indicators: C) wasting and underweight; D) wasting, underweight and stunting; E) underweight and stunting [
25].
In Indonesia, the CIAF is frequently applied to identify nutritional problems; the results show that the prevalence of under-fives who experience anthropometric failure is still high [
26,
27]. Until now, however, the measurement of the nutritional status of children under five at the national level has still used the conventional anthropometric index, which only assesses one type of undernutrition. The results of measuring nutritional status using the conventional index are still high. If the measurement of nutritional status only uses one indicator of nutritional status, it is possible to lose information on other malnutrition problems. This will affect the response effort, because the reference information used does not represent the actual problem. That is why the prevalence of undernutrition is still quite high; efforts to tackle nutrition problems have not been comprehensively carried out. Therefore, the measurement of nutritional status using the CIAF constitutes a solution, as it enables the prevention of undernutrition to be more appropriately based on the type of undernutrition experienced by children under five [
28].
Previous studies have shown that the prevalence of undernutrition in children under five years is still high. Porwal et al. (2021) reported that, in India, 48.2% of children experienced anthropometric failure. The causes of this anthropometric failure are low household income and residence in urban areas. Moreover, according to the CIAF, a high risk obtains for children of mothers who are underweight and have many children [
29]. A similar study in Ethiopia on anthropometric measurements using the CIAF method showed that the child’s age, previous birth spacing, mother’s educational status, wealth status and region were independent factors related to the nutritional status of children in rural Ethiopia [
30]. Another study showed that the risk of anthropometric failure was higher among older children who had low birth weight, had mothers with low BMI, resided in rural areas, had mothers and fathers without formal education [
31]. A study conducted by Das et al. in Bangladesh also reported that differences in demographic characteristics such as age, gender and type of residence were significantly related to the occurrence of various types of undernutrition including wasting, underweight and stunting, with the prevalence of all forms of undernutrition showing an increasing trend in both rural and urban areas [
32]. In addition, the occurrence of various types of undernutrition is also associated with the impact of environmental exposure. Poor environmental sanitation conditions and unfavorable temperature exposure can increase the risk of undernutrition in children under five [
33]. The availability of clean water for drinking and for household needs, as well as sanitation and hygiene conditions, are positively related to the occurrence of undernutrition and infectious diseases of the digestive tract [
34]. Therefore, the assessment of undernutrition using the CIAF is necessary for overcoming the problem of malnutrition, especially in Indonesia.
Results
Table
3 presented that the prevalence of anthropometric failure – that is, overall prevalence of undernutrition based on the CIAF – in children under five years old was 42.1%. This figure accounts for wasting only (2.4%), wasting and underweight (5.8%), wasting, underweight and stunting (2.1%), underweight and stunting (16.4%), stunting only (11.5%) and underweight only (3.9%). In contrast, the prevalence of other forms of undernutrition based on conventional anthropometrix indices, namely underweight, stunting and wasting were 27.8, 29.7 and 10.6%, respectively. Also, Table
3 illustrated that the percentage of children under five who experienced anthropometric failure, underweight and stunting among children aged 25–59 months was 53.8, 37.4 and 43.8%, respectively. This was higher than the corresponding values for children aged 0–24 months – that is, 29.6, 17.6 and 14.4%, respectively. The percentage of anthopometric failure (43.9%), underweight (29.3%) and stunting (32.4%) in boys is higher than in girls (40.4, 26.5, 27.1%, respectively). On the other hand, the proportion of children in the age range of 0–24 months who experience wasting (15.1%) is higher compared to children aged 25–59 months (6.4%); in addition, the proportion of girls who are wasting (11.4%) is higher than the proportion of boys (9.7%).
Table 3
Classification of nutritional status in children under five years old
Nutritional Status based on Composite Index of Anthropometric (Failure) CIAF) |
No failure (A) | 112 | 70.4 | 79 | 46.2 | 92 | 56.1 | 99 | 59.6 | 191 | 57.9 |
Wasting only (B) | 8 | 5.0 | 0 | 0.0 | 5 | 3.0 | 3 | 1.8 | 8 | 2.4 |
Wasting & underweight (C) | 13 | 8.2 | 6 | 3.5 | 7 | 4.3 | 12 | 7.2 | 19 | 5.8 |
Wasting, underweight & stunting (D) | 2 | 1.3 | 5 | 2.9 | 4 | 2.4 | 3 | 1.8 | 7 | 2.1 |
Stunting and underweight (E) | 12 | 7.5 | 42 | 24.6 | 30 | 18.3 | 24 | 14.6 | 54 | 16.4 |
Stunting only (F) | 10 | 6.3 | 28 | 16.4 | 19 | 11.6 | 19 | 11.4 | 38 | 11.5 |
Underweight only (Y) | 2 | 1.3 | 11 | 6.4 | 7 | 4.3 | 6 | 3.6 | 13 | 3.9 |
Anthropometric Failure (B + C + D + E + F + Y) | 47 | 29.6 | 92 | 53.8 | 72 | 43.9 | 67 | 40.4 | 139 | 42.1 |
Nutritional Status based on Conventional (Single) Anthropometric Index |
Weight-for-Age |
Severely underweight (< −3 SD) | 4 | 2.5 | 11 | 6.4 | 8 | 4.9 | 7 | 4.2 | 15 | 4.5 |
Underweight (− 3 SD to < −2 SD) | 24 | 15.1 | 53 | 31.0 | 40 | 24.4 | 37 | 22.3 | 77 | 23.3 |
Normal weight (−2 SD to + 1 SD) | 103 | 64.8 | 97 | 56.7 | 94 | 57.3 | 106 | 63.9 | 200 | 60.6 |
Risk of overweight (> + 1 SD) | 28 | 17.6 | 10 | 5.9 | 22 | 13.4 | 16 | 9.6 | 38 | 11.6 |
Length/Height-for-Age |
Severely stunted (< −3 SD) | 4 | 2.5 | 31 | 18.1 | 21 | 12.9 | 14 | 8.4 | 35 | 10.6 |
Stunted (−3 SD to < −2 SD) | 19 | 11.9 | 44 | 25.7 | 32 | 19.5 | 31 | 18.7 | 63 | 19.1 |
Normal −2 SD to + 3 SD | 130 | 81.8 | 96 | 56.2 | 107 | 65.2 | 119 | 71.7 | 226 | 68.5 |
Tall (> + 3 SD) | 6 | 3.8 | 0 | 0.0 | 4 | 2.4 | 2 | 1.2 | 6 | 1.8 |
Weight-for-length/height |
Severely wasted (< −3 SD) | 8 | 5.0 | 5 | 2.9 | 5 | 3.0 | 8 | 4.8 | 13 | 3.9 |
Wasted (−3 SD to < −2 SD) | 16 | 10.1 | 6 | 3.5 | 11 | 6.7 | 11 | 6.6 | 22 | 6.7 |
Normal (−2 SD to + 1 SD) | 119 | 74.9 | 147 | 86.0 | 129 | 78.8 | 137 | 82.6 | 266 | 80.6 |
Possible risk of overweight (> + 1 SD to + 2 SD) | 8 | 5.0 | 10 | 5.8 | 11 | 6.7 | 7 | 4.2 | 18 | 5.5 |
Overweight (> + 2 SD to + 3 SD) | 3 | 1.9 | 0 | 0.0 | 3 | 1.8 | 0 | 0.0 | 3 | 0.9 |
Obese (> + 3 SD) | 5 | 3.1 | 3 | 1.8 | 5 | 3.0 | 3 | 1.8 | 8 | 2.4 |
Table
4 shown that the percentage (80.4%) of anthropometric failure (overall prevalence of undernutrition based on the CIAF) is higher for mothers of 25 years or older. Similarly, the percentage for underweight (75.5%), stunting (82.9%) and wasting (77.7%) in children under five is higher for mothers of 25 years or older than for mothers younger than 25. The percentage of children under five who experienced anthropometric failure (57.6%), underweight (59.8%) and stunting (64.3%) was higher for short mothers (height below 150 cm) than tall mothers (height is equal to or more than 150 cm). Meanwhile, the percentage of wasting children was higher for tall mothers (57.1%) than for short mothers (42.9%). The percentage of children under five who suffer anthropometric failure (71.2%), underweight (71.7%), stunting (75.5%) or wasting (65.7%) was higher for mothers with low education than for mothers with higher education. The percentage of children under five suffering from anthropometric failure (77.0%), underweight (78.3%), stunting (71.4%) or wasting (85.7%) was higher for mothers who did not work (housewives) than for employed mothers. The percentage of children under five suffering from anthropometric failure (55.6%), underweight (70.6%), stunting (56.0%) or wasting (60.0%) was higher in families with low income levels (below the regional minimum wage) than for families with high income levels. The percentage of children under five who experienced anthropometric failure (66.9%), underweight (67.4%), stunting (66.3%) or wasting (71.4%) was higher for mothers who were grand multiparity than for mothers who were prirmiparity and grand multiparity. The percentage of children under five who experienced anthropometric failure (74.1%), underweight (73.9%), stunting (73.5%) or wasting (80.0%) was higher for mothers with low nutritional knowledge than for mothers with high nutritional knowledge. The percentage of children under five who experienced anthropometric failure (51.8%), underweight (52.2%) or stunting (54.1%) was higher in boys than girls. However, under five wasting was more prevalent for girls (54.3%) than for boys (45.7%). The percentage of children under five who experienced anthropometric failure (66.2%), underweight (69.6%) or stunting (76.5%) was higher among children aged 25–59 months than among children aged 0–24 months. On the other hand, the percentage of wasting toddlers was higher in toddlers aged 0–24 months (68.6%) than toddlers aged 25–59 months (31.4%). In this study, it can be seen that the percentage of children under five who experienced anthropometric failure (66.2%), underweight (64.1%), stunting (66.3%) or wasting (71.4%) was higher among children under five who had a history of infectious diseases than among children under five who had no history of infectious disease. The percentage of children under five who experienced the four nutritional problems was also more common among children under five who were not fully immunized, i.e. 49.6, 50.0, 49.0 and 48.6%, than children under five who were completely immunized.
Table 4
Maternal and child characteristic based on anthropometric failure (overall prevalence of undernutrition using CIAF) and other undernutrition (n = 330)
Maternal Characteristics |
Age |
< 25 years | 31 (22.3) | 18 (19.6) | 24 (24.5) | 6 (71.1) |
≥ 25 years | 108 (77.7) | 74 (80.4) | 74 (75.5) | 29 (82.9) |
Height |
Short (< 150 cm) | 80 (57.6) | 55 (59.8) | 63 (64.3) | 15 (42.9) |
Tall (≥ 150 cm) | 59 (42.4) | 37 (40.2) | 35 (35.7) | 20 (57.1) |
Education |
Low | 99 (71.2) | 66 (71.7) | 74 (75.5) | 23 (65.7) |
High | 40 (28.8) | 26 (28.3) | 24 (24.5) | 12 (34.3) |
Working Status |
Unemployed | 107 (77.0) | 72 (78.3) | 70 (71.4) | 30 (85.7) |
Employed | 32 (23.0) | 20 (21.7) | 28 (28.6) | 5 (14.3) |
Family Income |
Low (below the regional minimum wage) | 15 (55.6) | 14 (56.0) | 3 (60.0) | 15 (55.6) |
High (equal or more than the regional minimum wage) | 12 (44.4) | 11 (44.0) | 2 (40.0) | 12 (44.4) |
Parity |
Primiparity | 28 (20.1) | 19 (20.7) | 20 (20.4) | 7 (20.0) |
Multiparity | 93 (66.9) | 62 (67.4) | 65 (66.3) | 25 (71.4) |
Grand multiparity | 18 (12.9) | 11 (12.0) | 13 (13.3) | 3 (8.6) |
Nutrition knowledge |
Not good | 103 (74.1) | 68 (73.9) | 72 (73.5) | 28 (80.0) |
Good | 36 (25.9) | 24 (26.1) | 26 (26.5) | 7 (20.0) |
Parenting |
Other | 16 (11.5) | 11 (12.0) | 15 (15.3) | 2 (5.7) |
Mother | 123 (88.5) | 81 (88.0) | 83 (4.7) | 33 (94.3) |
Child Characteristics |
Sex |
Male | 72 (51.8) | 48 (52.2) | 53 (54.1) | 16 (45.7) |
Female | 67 (48.2) | 44 (47.8) | 45 (45.9) | 19 (54.3) |
Age |
0–24 months | 47 (33.8) | 28 (30.4) | 23 (35.5) | 24 (68.6) |
25–59 months | 92 (66.2) | 64 (69.6) | 75 (76.5) | 11 (31.4) |
History of Infectious Diseases |
Yes | 92 (66.2) | 59 (64.1) | 65 (66.3) | 25 (71.4) |
No | 47 (33.8) | 33 (35.9) | 33 (33.7) | 10 (28.6) |
History of Immunization |
Ungiven | 14 (10.1) | 8 (8.7) | 7 (7.1) | 5 (14.3) |
Incomplete | 69 (49.6) | 46 (50.0) | 48 (49.0) | 17 (48.6) |
Complete | 56 (40.3) | 38 (41.3) | 43 (43.9) | 13 (37.1) |
Early Initiation of Breastfeeding |
No | 101 (72.7) | 66 (71.7) | 73 (74.5) | 25 (71.4) |
Yes | 38 (27.3) | 26 (28.3) | 25 (25.5) | 10 (28.6) |
Frequency consumption of energy sources |
Low (< 3x/day) | 10 (7.4) | 7 (7.8) | 2 (2.1) | 3 (9.1) |
High (≥ 3x/day) | 125 (92.6) | 83 (92.2) | 94 (97.9) | 30 (90.9) |
Frequency consumption of protein sources |
Low (< 3x/day) | 27 (20.6) | 15 (17.2) | 16 (17.2) | 10 (31.3) |
High (≥ 3x/day) | 104 (79.4) | 72 (82.8) | 77 (82.8) | 22 (68.8) |
Environment sanitation and clean living behaviour |
Ambient room temperature |
Uncomfortable (< 20.5 °C and > 27.2 °C) | 62 (78.5) | 44 (81.5) | 46 (79.3) | 12 (75.0 |
Comfortable (20.5 °C–27.2 °C) | 17 (21.5) | 10 (18.5) | 12 (20.7) | 4 (25.0) |
Home’s Relative Humidity |
Uncomfortable (< 40% and > 70%) | 65 (86.7) | 41 (82.0) | 46 (85.2) | 16 (100.0) |
Comfortable (40–70%) | 10 (13.3) | 9 (18.0) | 8 (14.8) | 0 (0.0) |
Cooking water source |
Unprotected springs | 5 (3.6) | 4 (4.3) | 4 (4.1) | 0 (0.0) |
Protected springs | 134 (96.4) | 88 (95.7) | 94 (95.9) | 35 (100.0) |
Handwashing habit |
Not good | 70 (50.4) | 43 (46.7) | 53 (54.1) | 16 (45.7) |
Good | 69 (49.6) | 49 (53.3) | 45 (45.9) | 19 (54.3) |
Defecation habit |
Open place | 3 (2.2) | 3 (3.3) | 2 (2.0) | 0 (0.0) |
Toilet | 136 (97.8) | 89 (96.7) | 96 (98.0) | 35 (100.0) |
In Table
5, it can also be seen that the percentage of children under five who experienced anthropometric failure (72.7%), underweight (71.7%), stunting (74.5%) or wasting (71.4%) was higher among children who were not given EIB than among children under five who were given EIB. In this study, it is also known that children under five who experience anthropometric failure and other types of undernutrition are higher in children under five who consume protein and energy sources of food equal or more than three times a day compared to children under five who consume protein and energy sources below three times a day. In addition, the percentage of children under five who experienced anthropometric failure (78.5%), underweight (81.5%), stunting (79.3%) or wasting (75.0%) was higher for children under five who lived at home with uncomfortable ambient room temperature (< 20.5 °C and > 27.2 °C) than for children under five who lived in a house with a comfortable ambient room temperature (20.5 °C–27.2 °C). Likewise, the percentage of toddlers who experience anthropometric failure (86.7%), underweight (82.0%), stunting (85.2%) or wasting (100%) is also higher for children under five who live at home with uncomfortable relative humadity (< 40% or > 70%) than children under five who live in a house with comfortable relative humidity (40–70%). Almost all children under five (95–100%) who experienced undernutrition in this study came from families that used cooking water sources from protected springs. The percentage of children under five who experience anthropometric failure is not significantly different between children under five who lack good hand-washing habits (50.4%) and children under five who have good hand washing-habits (49.6%). Children under five who experience anthropometric failure and other undernutrition (underweight, stunting and wasting) are almost all in the habit of defecating in the toilet. Table
5 shown that, based on bivariate analysis, there are factors associated with anthropometric failure (overall prevalence of undernutrition based on the CIAF), underweight, stunting and wasting. The results of this study indicate that there are four factors associated with the occurrence of underweright in children under five years, namely, mother’s height (
p = 0.028), family income (
p = 0.043), child’s age (
p < 0.001) and frequency of consumption of protein sources (
p = 0.015). Meanwhile, other factors showed no significant relationship (
p > 0.05) with underweight in children under five. There are eight variables related to stunting, including mother’s height (
p = 0.001), mother’s education (
p = 0.018), mother’s occupation (
p = 0.013), parenting (
p = 0.029), child’s age (
p < 0.001), EIB (
p = 0.034), frequency of consumption of energy sources (
p = 0.001) and protein (
p = 0.010). Other factors were not significantly related (
p > 0.05) with the incidence of stunting in children under five. In this study, it is also known that there is only one variable that is significantly related to wasting, namely, the child’s age (
p = 0.018). Other variables showed no significant relationship (
p > 0.05) on the incidence of wasting. There are six factors that are significantly related to the occurrence of anthropometric failure, namely, mother’s height (
p = 0.017), child’s age (
p < 0.001), history of infectious disease (
p = 0.034), EIB (
p = 0.026), frequency of consumption of energy sources (
p = 0.047) and frequency of consumption of protein sources (
p = 0.024). Other factors showed no significant relationship (
p > 0.05) to anthropometric failure.
Table 5
Factors associated with undernutrition (underweight, stunting, wasting and anthropometric failure) in children under five years old
A. Mother Characteristics |
Age | 0.189 | 0.64 (0.35–1.16) | 0.967 | 0.95 (0.55–1.64) | 0.343 | 0.59 (0.23–1.46) | 0.374 | 0.77 (0.46–1.28) |
Height | 0.028 | 1.78 (1.09–2.90) | 0.001 | 2.36 (1.45–3.85) | 0.510 | 0.74 (0.36–1.50) | 0.017 | 1.75 (1.13–2.73) |
Education | 0.173 | 1.49 (0.88–2.52) | 0.018 | 1.65 (1.15–3.32) | 1.000 | 1.01 (0.48–2.12) | 0.078 | 1.56 (0.98–2.50) |
Working Status | 0.670 | 0.84 (0.46–1.52) | 0.013 | 0.47 (0.27–0.83) | 0.531 | 1.53 (0.57–4.12) | 0.248 | 0.70 (0.40–1.20) |
Family Income | 0.043 | 4.11 (1.19–14.13) | 0.362 | 1.91 (0.65–5.60) | 0.898 | 1.76 (0.27–11.47) | 0.348 | 1.93 (0.66–5.65) |
Parity | 0.617 | – | 0.620 | – | 0.551 | – | 0.379 | – |
Nutrition knowledge | 0.871 | 1.09 (0.63–1.87) | 0.951 | 1.05 (0.62–1.80) | 0.412 | 1.57 (0.66–3.72) | 0.724 | 1.13 (0.67–1.85) |
Parenting | 0.434 | 1.48 (0.68–3.22) | 0.029 | 2.44 (1.15–5.15) | 0.629 | 0.56 (0.13–2.44) | 0.351 | 1.53 (0.73–3.20) |
B. Child Characteristics |
Sex | 0.662 | 1.15 (0.71–1.86) | 0.360 | 1.28 (0.80–2.06) | 0.749 | 0.84 (0.41–1.69) | 0.589 | 1.16 (0.75–1.80) |
Age | < 0.001 | 0.36 (0.21–0.60) | < 0.001 | 0.22 (0.13–0.37) | 0.018 | 2.59 (1.22–5.47) | < 0.001 | 0.36 (0.23–0.57) |
History of Infectious Diseases | 0.302 | 1.34 (0.81–2.20) | 0.106 | 1.54 (0.94–2.53) | 0.165 | 1.84 (0.85–3.97) | 0.034 | 1.67 (106–2.63) |
History of Immunization | 0.821 | – | 0.450 | – | 0.426 | – | 0.526 | – |
Early Initiation of Breastfeeding | 0.173 | 0.67 (0.40–1.13) | 0.034 | 0.55 (0.32–0.93) | 0.550 | 0.73 (0.34–1.59) | 0.026 | 0.57 (0.35–0.91) |
Frequency consumption of energy sources | 0.218 | 0.53 (0.22–1.28) | 0.001 | 0.11 (0.02–0.45) | 0.820 | 0.72 (0.21–2.51) | 0.047 | 0.43 (0.20–0.94) |
Frequency consumption of protein sources | 0.015 | 0.44 (0.24–0.83) | 0.010 | 0.43 (0.23–0.80) | 0.765 | 1.23 (0.55–2.73) | 0.024 | 0.52 (0.30–0.90) |
Environment Sanitation and Clean Living Behaviour |
Room temperature | 0.618 | 1.32 (0.60–2.93) | 0.955 | 1.10 (0.52–2.34) | 0.477 | 0.82 (0.25–2.70) | 1.000 | 1.03 (0.51–2.08) |
Humidity | 0.284 | 0.54 (0.22–1.35) | 0.756 | 0.77 (0.31–1.94) | 0.103 | – | 1.000 | 0.91 (0.38–2.20) |
Cooking water source | 0.098 | 3.56 (0.78–16.23) | 0.120 | 3.25 (0.71–14.80) | 0.764 | – | 0.230 | 3.53 (0.67–18.45) |
Hand washing habit | 0.218 | 0.71 (0.44–1.16) | 0.842 | 1.08 (0.67–1.73) | 0.484 | 0.73 (0.36–1.47) | 0.533 | 0.85 (0.55–1.31) |
Defecation habit | 0.394 | 1.57 (0.37–6.71) | 0.559 | 0.78 (0.16–3.95) | 0.404 | – | 0.545 | 0.82 (0.19–3.50) |
Table
6 presented are binary logistic regression analysis shows that family income is the dominant factor influencing anthropometric failure (overall prevalence of undernutrition using the CIAF) is mother’s height (
p = 0.008, AOR = 1.95, 95% CI: 1.19–3.19). From these results, it can be concluded that short mothers are 1.95 times more likely that tall mothers to have children who experience anthropometric failure. In addition, anthropometric failure is also influenced by the child’s age (
p = 0.046, AOR = 0.57, 95% CI: 0.32–1.00). The dominant factor associated with underweight is family income (
p = 0.018, OR: 5.44, 95% CI: 1.34–22.11). It can be concluded that families with low income levels are 5.4 times more likely to have underweight children than families with high income. Another factor that causes underweight is a child’s age (
p = 0.026, AOR = 0.07, 95% CI: 0.006–0.72). The dominant factors associated with stunting are mother’s height (
p < 0.001; AOR: 3.29, 95% CI: 1.83–5.91). From this study, it can be seen that short mothers are at 3.29 times higher risk than tall mothers of having children who experience stunting. Moreover, a child’s age (
p = 0.002, AOR = 0.34, 95% CI: 0.17–0.66) and the frequency of consumption of energy sources (
p = 0.003, AOR = 0.09, 95% CI: 0.02–0.46) are also associated with stunting. The dominant factor related to wasting is a child’s age child (
p = 0.013, AOR: 2.59, 95% CI: 1.22–5.47). Children aged 25–59 months had a 2.4 higher risk of suffering from wasting than children aged 0–24 months.
Table 6
Binary logistic regression analysis of factors associated with undernutrition (CIAF, underweight, stunting and wasting) in children under five years old
Composite Index of Anthropometric Failure (CIAF) |
Anthropometric failure | Mother’s height | 0.008 | 1.95 | 1.19–3.19 |
Child’s age | 0.046 | 0.57 | 0.32–1.00 |
Conventional Anthropometric Index |
Underweight | Family income | 0.018 | 5.44 | 1.34–22.11 |
Child’s age | 0.026 | 0.07 | 0.006–0.72 |
Stunting | Mother’s height | < 0.001 | 3.29 | 1.83–5.91 |
Child’s age | 0.002 | 0.34 | 0.17–0.66 |
Frequency consumption of energy sources | 0.003 | 0.09 | 0.02–0.46 |
Wasting | Child’s age | 0.013 | 2.59 | 1.22–5.47 |
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