Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia.
Master of Public Health Study Program, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia.
BMC Public Health. 2023 Sep 21;23(1):1836. doi: 10.1186/s12889-023-16728-y.
Although child malnutrition has been reducing, the coexistence in mothers and children of various forms of malnutrition has continued to rise around the world. In the Indonesian context, a knowledge gap exists on the coexistence of multiple malnutrition burdens. This study examines trends in the coexistence of the triple burden of malnutrition (TBM) among mother-child pairs living in the same house and explores multilevel (individual, household, and community) factors associated with TBM in Indonesia.
We used data from the 2013 and 2018 Indonesia Basic Health Research, the nationally representative survey of the Indonesian population, as repeated cross-sectional surveys. Study samples were mothers and children (0-59 months old), who resided in the same household and indicated by the same identifier number. The anthropometric measurements of the mothers and children, and the hemoglobin levels of the children were collected. We employed a multilevel mixed-effects model to consider the hierarchical data structure. The model captured the role of cluster, district, provincial differences, and the individual, household, community-level, and TBM status characteristics.
Of 3,891 mother-child pairs analyzed, 24.9% experienced TBM. Girls had 63% higher odds than boys of TBM (aOR: 1.63; 95% CI: 1.30 to 2.03). Significantly lower odds were found in children of mothers who had a gestational age lower than 37 weeks (aOR: 0.72; 95% CI: 0.55 to 0.94). At the household level, children with a father who had a high-school, primary-school, or no school education had significantly higher odds of TBM than children of fathers who had graduated from academy. Children of mothers who visited Antenatal Care (ANC) no more than 6 times had significantly lower odds (aOR: 0.65; 95% CI: 0.47 to 0.88). Children of mothers who consumed Iron and Folic Acid (IFA) supplements had significantly lower odds.
TBM is related to characteristics at not just the individual level but also the family and community levels. To achieve significant outcomes, integrated nutrition interventions in Indonesia should also consider family and community factors.
尽管儿童营养不良问题一直在减少，但世界各地母亲和儿童中各种形式营养不良的共存现象仍在持续上升。在印度尼西亚，人们对多种营养不良负担共存的问题知之甚少。本研究旨在探讨居住在同一家庭的母婴对子中三重营养不良负担（TBM）共存的趋势，并探讨与印度尼西亚 TBM 相关的多层次（个体、家庭和社区）因素。
我们使用了来自 2013 年和 2018 年印度尼西亚基本卫生研究的数据，这是一项对印度尼西亚人口的全国代表性调查，作为重复的横断面研究。研究样本为居住在同一家庭并由相同标识符编号标识的母亲和儿童（0-59 个月大）。收集了母亲和儿童的人体测量数据以及儿童的血红蛋白水平。我们采用多水平混合效应模型来考虑分层数据结构。该模型捕捉了聚类、区、省差异以及个体、家庭、社区层面和 TBM 状况特征的作用。
在分析的 3891 对母婴对子中，有 24.9%的母婴对子存在 TBM。女孩发生 TBM 的可能性比男孩高 63%（优势比：1.63；95%置信区间：1.30 至 2.03）。发现胎龄低于 37 周的母亲所生的儿童发生 TBM 的可能性显著降低（优势比：0.72；95%置信区间：0.55 至 0.94）。在家庭层面上，父亲受过高中、小学或没有学校教育的儿童发生 TBM 的可能性显著高于父亲毕业于学院的儿童。母亲接受产前护理（ANC）次数不超过 6 次的儿童发生 TBM 的可能性显著降低（优势比：0.65；95%置信区间：0.47 至 0.88）。母亲食用铁和叶酸（IFA）补充剂的儿童发生 TBM 的可能性显著降低。
TBM 不仅与个体层面的特征有关，还与家庭和社区层面的特征有关。为了取得显著成果，印度尼西亚的综合营养干预措施还应考虑家庭和社区因素。
