The double burden of malnutrition in Indonesia

Abstract

Introduction The double burden of malnutrition (DBM) is characterised by overlapping conditions of under- and over-nutrition within one population, household, or even individual. Indonesia faces this situation. The overall aim of this thesis was to provide a better understanding of DBM in Indonesian children. Methods This thesis used a mixed methods approach, combining a secondary data analysis from the Indonesian Family Life Survey (IFLS) and a qualitative study. Prevalence data for DBM, from Indonesian children aged 2.0-4.9 years at four different time points -1993, 1997, 2000, and 2007 - were calculated. In addition I undertook a longitudinal analysis of children aged 2.0 to 4.9 years at baseline (1993 and 2000) and their weight and blood pressure status 7 (2000 and 2007) and 14 years (2007) later. In the qualitative study I explored the perceptions of Indonesian mothers and grandmothers of under-five and elementary school-aged children towards child obesity and food choices. I conducted twelve focus group discussions in West Java with 94 carers from three different socioeconomic status groups. Results DBM occurs in Indonesian children, with decreasing secular trends in stunting and underweight; and increasing trends in overweight/obesity. I found an inconsistent trend in the prevalence of concurrent stunting and overweight across 1993 to 2007. Although the cross sectional data showed that stunted children are more likely to be overweight/ obese, my longitudinal evidence showed the opposite. I found no association between stunting in early childhood and thinness, overweight/ obesity, or high blood pressure in the later years. In the qualitative study, primary carers still define overweight subjectively. The “chubbier is healthier” concept may be a contributing factor, and even though some mothers realize that their children are overweight/ obese, denial of the effect of overweight/ obesity on their children’s physical ability is still apparent. There are complex reasons behind primary carers’ decision-making processes around their children’s food choices that may additionally contribute to the increased prevalence of overweight/ obesity. Conclusion These results provide a better understanding of DBM in Indonesia. Such information is likely to reveal potential strategies to tackle this issue both in Indonesia, and potentially in other low- and middle-income countries.