Division of International Health (Public Health), Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Faculty of Public Health, Universitas Islam Negeri Sumatera Utara, Medan, Indonesia.
J Prev Med Public Health. 2024 Sep;57(5):461-470. doi: 10.3961/jpmph.24.246. Epub 2024 Aug 2.
This study aimed to map the incidence of acute respiratory infections (ARIs) among under-5 children in Indonesia, address the triple burden of malnutrition, and analyze the impact of malnutrition on ARIs, taking into account the environmental and wealth disparities in Indonesia.
This study utilized an ecological design, analyzing aggregate data from the Indonesia Nutrition Survey, 2022. It encompassed 33 provinces and 486 districts/cities, involving a total of 334 878 children under 5 years of age. Partial least squares structural equation modeling was employed to investigate the relationships among wealth, environment, malnutrition (stunting, wasting, and underweight), and ARIs.
The proportion of ARI cases in Indonesia was generally concentrated in central Sumatra, the western and eastern parts of Java, and eastern Papua. In contrast, the northern part of Sumatra, central Kalimantan, central Sulawesi, and central Papua had a higher proportion of malnutrition cases compared to other regions. Negative associations were found between malnutrition and ARIs (path coefficient =-0.072; p<0.01) and between wealth and environment (path coefficient =-0.633; p<0.001), malnutrition (path coefficient=-0.399; p<0.001), and ARIs (path coefficient=-0.918; p<0.001).
An increasing wealth index is expected to contribute to reducing ARIs, malnutrition and environmental burdens in the future. This study emphasizes the necessity for focused strategies that address both immediate health challenges and the underlying socioeconomic determinants to improve child health outcomes in the Indonesian context.
本研究旨在绘制印度尼西亚五岁以下儿童急性呼吸道感染（ARI）的发病率，探讨营养不良的三重负担，并分析营养不良对 ARI 的影响，同时考虑印度尼西亚的环境和财富差异。
本研究采用生态设计，分析了 2022 年印度尼西亚营养调查的汇总数据。该研究涵盖了印度尼西亚的 33 个省和 486 个区/市，共有 334878 名 5 岁以下儿童。采用偏最小二乘结构方程模型来研究财富、环境、营养不良（发育迟缓、消瘦和体重不足）和 ARI 之间的关系。
印度尼西亚 ARI 病例的比例主要集中在苏门答腊中部、爪哇岛西部和东部以及巴布亚东部。相比之下，苏门答腊北部、中加里曼丹、中苏拉威西和中巴布亚的营养不良病例比例高于其他地区。营养不良与 ARI（路径系数=-0.072；p<0.01）和财富与环境（路径系数=-0.633；p<0.001）、营养不良（路径系数=-0.399；p<0.001）和 ARI（路径系数=-0.918；p<0.001）之间存在负相关关系。
预计财富指数的增加将有助于减少未来的 ARI、营养不良和环境负担。本研究强调了在印度尼西亚，需要制定有针对性的策略，既要解决当前的健康挑战，又要解决潜在的社会经济决定因素，以改善儿童的健康结果。
