Holistic-comprehensive approaches to improve nutritional status of children under five years
Background: Malnutrition has been identified as the leading cause of illness and death in almost half of children under 5 years. Hence, to prevent the impact of malnutrition on physical and psychological development, family physicians need to explore new approaches in the health care delivery models that go beyond the scope of practice. A holistic-comprehensive approach will help the physicians develop a more thorough assessment of nutritional status. This study aims to determine factors associated with the nutritional status of children under five years using holistic-comprehensive approaches.
Design and Methods: A case–control design was implemented, with emphasis on the identification of cases and control groups; 48 children confirmed malnutrition cases and 48 control without malnutrition were recruited from a Community Integrated Health Center in East Java, Indonesia. The characteristics of agent, host and environment between groups were compared and analyzed using correlation coefficients, odds ratio, logistic regression analysis, and Structural Equation Modeling-Partial Least Square (SEM-PLS).
Results: The SEM-PLS results showed that environmental factors have a greater influence on nutritional status (t-value >1.96), compared to the host factors. Furthermore, environmental factors having significant associations with nutritional status were poor socioeconomic status, low maternal educational level and not having exclusive breastfeeding. Also, the results of correlation coefficients and OR showed that birth weight (p=0.000, OR=33) and socioeconomic status (p=0.000, OR=22.3) had strong correlations with nutritional status.
Conclusion: Holistic-comprehensive approaches can be used as new ways to determine factors that may be associated with nutritional status of children under 5 years of age.
WHO. Children: improving survival and well-being. Geneva: World Health Organization; 2020 [cited 2020 Oct 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality
India State-Level Disease Burden Initiative Malnutrition Collaborators. The burden of child and maternal malnutrition and trends in its indicators in the states of India: the Global Burden of Disease Study 1990–2017. Lancet Child Adolesc Health 2019;3:855-70.
UNICEF, WHO, International Bank for Reconstruction and Development/The World Bank. Levels and trends in child malnutrition: Key Findings of the 2020 Edition of the joint child malnutrition estimates. Geneva: World Health Organization; 2020.
Titaley CR, Ariawan I, Hapsari D, et al. Determinants of the stunting of children under two years old in Indonesia: A multilevel analysis of the 2013 Indonesia Basic Health Survey. Nutrients 2019;11:1106. DOI: https://doi.org/10.3390/nu11051106
Rahman MS, Howlader T, Masud MS, et al. Association of low-birth weight with malnutrition in children under five years in Bangladesh: Do mother's education, socio-economic status, and birth interval matter? PLoS One 2016;11:e0157814. DOI: https://doi.org/10.1371/journal.pone.0157814
Anwar S, Nasreen S, Batool Z, et al. Maternal education and child nutritional status in Bangladesh: Evidence from demographic and health survey data. Pak J Life Soc Sci 2013;11:77-84.
Abuya BA, Ciera J, Kimani-Murage E. Effect of mother's education on child's nutritional status in the slums of Nairobi. BMC Pediatr 2012;12:80. DOI: https://doi.org/10.1186/1471-2431-12-80
Abdulahi A, Shab-Bidar S, Rezaei S, et al. Nutritional status of under five children in Ethiopia: A systematic review and meta-analysis. Ethiop J Health Sci 2017;27:175-88. DOI: https://doi.org/10.4314/ejhs.v27i2.10
Hubschman LE. Malnutrition in congenital heart disease. ICAN Infant Child Adolesc Nutrn 2013;5:170-6. DOI: https://doi.org/10.1177/1941406413485906
Farhadi S, Ovchinnikov RS. The relationship between nutrition and infectious diseases: A review. Biomed Biotechnol Res J 2018;2:168-72. DOI: https://doi.org/10.4103/bbrj.bbrj_69_18
Khan S, Zaheer S, Safdar NF. Determinants of stunting, underweight and wasting among children <5 years of age: evidence from 2012-2013 Pakistan demographic and health survey. BMC Public Health 2019;19:358. DOI: https://doi.org/10.1186/s12889-019-6688-2
Prendergast AJ. Malnutrition and vaccination in developing countries. Philos Trans R Soc Lond B Biol Sc. 2015;370:20140141. DOI: https://doi.org/10.1098/rstb.2014.0141
Johnson-Walker YJ, Kaneene JB. Epidemiology: Science as a tool to inform one health policy. In Herrmann JA, Johnson-Walker YJ, editors. Beyond one health: From recognition to results. Hoboken: Wiley; 2018. p. 3-30. DOI: https://doi.org/10.1002/9781119194521.ch1
Dea P, Chattopadhyay N. Effects of malnutrition on child development: Evidence from a backward district of India. Clin Epidemiol Glob Health 2019;7:439-445. DOI: https://doi.org/10.1016/j.cegh.2019.01.014
Hanandita W, Tampubolon G. The double burden of malnutrition in Indonesia: Social determinants and geographical variations. SSM Popul Health 2015;1:16–25. DOI: https://doi.org/10.1016/j.ssmph.2015.10.002
Supriyanto S, Ernawaty E, Setyawan FEB, et al. Enhancing family medicine practice in developing countries through a holistic-comprehensive care model: A review. Indian J Public Health Res Dev 2020;11:774-8.
Setyawan FEB, Supriyanto S, Ernawaty E, et al. Developing a holistic-comprehensive assessment model: Factors contributing to personal protective equipment compliance among Indonesian cement workers. Indian J Occup Environ Med 2020;24:19-24. DOI: https://doi.org/10.4103/ijoem.IJOEM_115_19
Setyawan FEB, Widiadi CE. The effect of holistic comprehensive health service approach through family functions on optimizing the nutrition status of junior high school students. Jurnal Saintika Medika 2020;16:1-13. DOI: https://doi.org/10.22219/sm.Vol16.SMUMM1.12687
Aryastami NK, Shankar A, Kusumawardani N, et al. Low birth weight was the most dominant predictor associated with stunting among children aged 12-23 months in Indonesia. BMC Nutrition 2017;3:16. DOI: https://doi.org/10.1186/s40795-017-0130-x
Solomons NW, Vossenaar M. Towards appropriate feeding to prevent malnutrition in infants and toddlers. Eur J Clin Nutr 2018;72:1274-81. DOI: https://doi.org/10.1038/s41430-018-0266-z
Urke HB, Bull T, Mittelmark MB. Socioeconomic status and chronic child malnutrition: wealth and maternal education matter more in the Peruvian Andes than nationally. Nutr Res 2011;31:741-7. DOI: https://doi.org/10.1016/j.nutres.2011.09.007
Akombi BJ, Agho KE, Renzaho AM, et al. Trends in socioeconomic inequalities in child undernutrition: Evidence from Nigeria Demographic and Health Survey (2003-2013). PLoS One 2019;14:e0211883. DOI: https://doi.org/10.1371/journal.pone.0211883
Dekker LH, Mora-Plazas M, Marín C, et al. Stunting associated with poor socioeconomic and maternal nutrition status and respiratory morbidity in Colombian schoolchildren. Food Nutr Bull 2010;31:242-50. DOI: https://doi.org/10.1177/156482651003100207
Mohseni M, Aryankhesal A, Kalantari N. Prevalence of malnutrition among Iran’s under five-year-old children and the related factors: A systematic review and meta-analysis. Iran J Pediatr 2018;28:e9189. DOI: https://doi.org/10.5812/ijp.9189
Krol KM, Grossmann T. Psychological effects of breastfeeding on children and mothers. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018;61:977-85. DOI: https://doi.org/10.1007/s00103-018-2769-0
Webb HJ. Maternal self-rated health and psychological distress predict early feeding difficulties: Results from the longitudinal study of Australian children. Int J Eat Disord 2018;51:1312-21. DOI: https://doi.org/10.1002/eat.22971
Nguyen PH, Sanghvi T, Kim SS, et al. Factors influencing maternal nutrition practices in a large scale maternal, newborn and child health program in Bangladesh. PLoS One 2017;12:e0179873. DOI: https://doi.org/10.1371/journal.pone.0179873
Dessie ZB, Fentie M, Abebe Z, et al. Maternal characteristics and nutritional status among 6-59 months of children in Ethiopia: further analysis of demographic and health survey. BMC Pediatrics 2019;19:83. DOI: https://doi.org/10.1186/s12887-019-1459-x
Javid N, Pu C. Maternal stature, maternal education and child growth in Pakistan: a cross-sectional study. AIMS Public Health 2020;7:380-92. DOI: https://doi.org/10.3934/publichealth.2020032
Ghosh S. Factors responsible for childhood malnutrition: A review of the literature. Curr Res Nutr Food Sci 2020;8:360-70. DOI: https://doi.org/10.12944/CRNFSJ.8.2.01
Zhang P, Wu J, Xun N. Role of maternal nutrition in the health outcomes of mothers and their children: A retrospective analysis. Med Sci Monit 2019;25:4430-7. DOI: https://doi.org/10.12659/MSM.914679
Workicho A, Belachew T, Argaw A, et al. Maternal nutritional status mediates the association between maternal age and birth outcomes. Maternal Child Nutr 2020;16:e13015. DOI: https://doi.org/10.1111/mcn.13015
Huynh G, Huynh QHN, Nguyen NHT, et al. Malnutrition among 6–59-month-old children at District 2 Hospital, Ho Chi Minh City, Vietnam: Prevalence and associated factors. BioMed Res Int 2019;2019:6921312. DOI: https://doi.org/10.1155/2019/6921312
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