UNDERWEIGHT CHILDREN AS ONE OF TRIPLE BURDEN IN INDONESIA

INTRODUCTION

Malnutrition becomes one of problems faced by many countries over the world. Underweight, overweight, and hidden hunger (deficiency in micronutrients) are ‘the triple burden’ malnutrition that mostly happened not only in adult age but also children age. Those nutrition problems usually happened in middle and lower country, including Indonesia.

Indonesia faces serious nutrition problem especially in children age. Underweight becomes the biggest problem that should be taken into consideration. According to 2020 data of UNICEF, Indonesia ranks fifth highest for stunting in the world. It becomes a big challenge that should be solved in this country. As we know that the biggest asset of the country is the human resources itself and children are the next generation for the future. Children nowadays are expected to become good quality of human resources for the next future. Therefore, children should be paid attention especially in malnutrition case.

Malnutrition in children has short-term and long-term effect. It is related to a decrease in physical, brain, and mental development. Those are will affect the decrease in body immunity and cognitive function. Besides, it will increase the risk of metabolic diseases and increase morbidity and mortality. Hence, those will cause a decrease in the quality of human resources in the future.

However, many factors that affected malnutrition case including underweight. Economical factors and educational factors may become the most significant factor associate with malnutrition. Gap between urban and rural areas also becomes the factor of malnutrition in Indonesia because in rural areas, they still lack of sanitation facilities, poor housing, health services, and even unregistered births.

 

DISCUSSION

Many studies that investigated underweight case in children in Indonesia. A study from Kurnianingtyas et al., (2021) tried to find and determine factors related to children underweight aged 24-59 months lived in North Sumatera based on child characteristics, maternal characteristics and parenting characteristics. The samples of the study were 280 children at 24-59 months. The result of the study showed that the proportion of underweight in North Sumatera is high according to World Health Organization (WHO). Child gender, maternal body mass index and cigarette expenditure become the significant determinants of underweight for children under-five in North Sumatera.

Other study comes from Yunitasari et al., (2020) who tried to identify the factors related to underweight for children at 24-59 months in urban and rural areas of Indonesia. The samples of the study were 5165 children at 24-59 months who distinguished by rural and urban areas. The result showed that underweight of children in rural areas is higher than urban areas. The significant factors of the underweight in rural and urban areas were affected by father’s education level which higher in urban areas compared to rural areas, mother’s education level which higher in urban areas than rural areas, the total members of the family, and energy adequacy level. While significant factors of the underweight in rural areas only affected by children’s age and the total number of children in a family.

Rachmi et al., (2016) conducted a study that aimed to determine temporal trends in the prevalence of underweight, stunting, and at risk of overweight/ overweight or obesity in Indonesian children aged 2.0–4.9 years and examine associated risk factors. This study used a secondary data analysis of waves 1, 2, 3, and 4 (1993, 1997, 2000, and 2007) of the Indonesian Family Life Survey, which includes 13 out of 27 provinces in Indonesia. The results showed that there were 938, 913, 939, and 1311 separate children respectively in the 4 waves. The prevalence of stunting and underweight decreased significantly, while the prevalence of obesity was increased. The study showed that stunting and underweight were related to lower birth weight, having parents who also underweight or had short body, and the mothers who never attend formal education. The result also found that stunting was higher in rural areas.

Moreover, Syahrul et al., (2016) conducted a study that aimed to determine factors associated with underweight and overweight in school-aged children in Indonesia. The participants of the study were 877 children aged 6-13 years and their parents. The results showed that the prevalence rates of underweight and overweight respectively were 14.5% and 20.4%. Underweight was found more in boys. The factors that significantly associated with underweight were having father who underweight, mother’s level education, and also playing in outdoor for more than two hours on the weekend. On the other hand, overweight parents, mothers with high level of education, and playing in outdoor for less than an hour on the weekend significantly associated with the obesity.

Based on the previous studies above, it showed that many factors that associated with underweight children in Indonesia. Lifestyle, food intake, economical factor, child feeding practices, health services, and sociodemographic factors such as education, income, and parental work becomes the factors that causes underweight children. As mentioned before, that underweight children in rural areas in Indonesia is higher that in urban areas. The factor comes from the education level of the parents that affected the income of the family. Higher education can create higher opportunity in the work field with the good salary to fulfil household needs.

Moreover, people in rural areas were having high risk in underweight children if the total number of the children in a family was more than one. Many parents also have low education about balance nutritional food for body. Total energy intake will determine nutritional status. Unfortunately, people tend to spend money only high in carbohydrate but rarely eat protein, dairy products, and fibre. The impact was not only about how mothers fed their children but also about mothers’ body themselves who underweight that later can affect children underweight.

Those problems above become a big challenge to Indonesia government until nowadays. Indonesia government should pay attention seriously to solve this problem by educating the parents about how to feed a child well, and how to live with a good lifestyle. Developing the facilities of health services, and creating an environment that supporting nutritional life evenly. Giving help to children and women who had malnutrition problems also important.

 

CONCLUSION

Underweight as “the triple burden” malnutrition in Indonesia was still a serious problem that should be solved because children are nation’s asset for the next future. The good quality of children growth can create a good quality of human resources later.  However, studies showed that there were many children underweight found in Indonesia especially in rural areas. Many factors affected children underweight such as economical aspect, educational aspects, lack of health services and sanitation, and low environment which supporting healthy lifestyle. By those factors, Indonesia government should pay attention to solve the malnutrition case by educating parents about how to fulfil nutrition during the pregnancy. Educating the society about how to feed the children with balance nutrition and giving a help also very important. Besides, provide health services, education facilities, good sanitation, and vaccination program evenly are also needed to decrease underweight children in Indonesia and remove the gap between children who lived in rural areas and urban areas.

 

REFERENCES

Kemenpppa. (2020). Pandemi Covid-19, Stunting Masih Menjadi Tantangan Besar Bangsa, retrieved on October 9, 2021 from https://www.kemenpppa.go.id/index.php/page/read/29/2929/pandemi-covid-19-stunting-masih-menjadi-tantangan-besar-bangsa

Kurnianingtyas, S., Sartika, R.A.D & Ningsih, W.M. (2021). Underweight in Child Aged 24-59 Months in North Sumatra: the 2014 Indonesia Family Life Survey Date. Indonesian Journal of Public Health Nutrition, 1(2), 40 – 49.

Rachmi, C.N., Agho, K.E., Muli & Baur, L..A.(2021). Stunting, Underweight and Overweight in Children Aged 2.0–4.9 Years in Indonesia: Prevalence Trends and Associated Risk Factors. PLOS ONE. DOI:10.1371/journal.pone.0154756

Syahrul, et al. (2016). Prevalence of underweight and overweight among school-aged children and it's association with children's sociodemographic and lifestyle in Indonesia. International Journal of Nursing Science 3, 169-177.

UNICEF. (2020). The State of Children in Indonesia, UNICEF: Bangkok.

Yunitasari, et al. (2020). Household Factors Associated with Underweight in Children 24-59 Month in Urban and Rural in Indonesia. Media Kesehatan Masyarakat Indonesia, 16(1). DOI : http://dx.doi.org/10.30597/mkmi.v16i1.9105