Rural child malnutrition and unsuccessful outcome of food basket programme: does ethnicity matter?

Stunting and Its Associated Factors among Children Below 5 Years Old on the East Coast of Peninsular Malaysia: Evidence from the National Health and Morbidity Survey

Background

Child malnutrition problems still occur in Malaysia, particularly stunting. This study aimed to determine the proportion of stunting among children below 5 years old and investigate the factors associated with stunting on the East Coast of Peninsular Malaysia.

Methods

This study utilised data from the 2016 National Health and Morbidity Survey (NHMS). Multiple logistic regression was used to determine the factors associated with malnutrition among non-stunted and stunted children.

Results

The proportion of stunting among children below 5 years old in this East Coast region was 26.2%. When divided by state, Kelantan had the highest proportion of stunting, followed by Pahang and Terengganu, at 28.8%, 26.2% and 23.4%, respectively. In this study, the factors associated with stunting were children aged 24 months old-59 months old (adjusted odds ratio [aOR]: 1.52; 95% CI: 1.26, 1.83; P < 0.001), male children (aOR: 1.47; 95% CI: 1.23, 1.76; P < 0.001), Orang Asli children (aOR: 2.84; 95% CI: 1.86, 4.32; P < 0.001), children with low birth weight from 1,500 g to 2,499 g (aOR: 1.86; 95% CI: 1.36, 2.55; P < 0.001) and children from households that practice unsanitary waste disposal (aOR: 1.42; 95% CI: 1.16, 1.74; P = 0.001).

Conclusion

Stunting among children under the age of 5 years old on the East Coast of Peninsular Malaysia remains a public health problem. To reduce the prevalence of stunting in this region, intervention programmes should be intensified. Emphasis should be placed on public health programmes that target the associated factors, such as dietary habits, Orang Asli children, low birth weight and unsanitary waste disposal.

High prevalence of malnutrition and vitamin A deficiency among schoolchildren of rural areas in Malaysia using a multi-school assessment approach

Childhood malnutrition is known as a public health concern globally. The present study aims to assess the anthropometry and blood biochemical status of rural primary schoolchildren in Malaysia. A total of 776 children (7-11 years old) from ten rural primary schools from five states were included in this study. Nutritional outcomes were assessed based on sex, age group and school categories among the children (median age: 9 years (P25:8, P75:10)). The overall prevalence of malnutrition was 53·4 %. Vitamin A deficiency (VAD) was recorded at 20·6 and 39·8 % based on retinol and retinol-binding protein (RBP) levels, respectively. Anaemia, iron deficiency (ID), iron-deficiency anaemia (IDA) and elevated inflammation were found at 14·9, 17·9, 9·1 and 11·5 %, respectively. Malnutrition, VAD, anaemia, ID, IDA and elevated inflammation were more prevalent among Orang Asli (OA) schoolchildren compared with Non-Orang Asli schoolchildren. Higher occurrences of VAD and anaemia were also found among children aged <10 years. Retinol, RBP, α-carotene, ferritin and haemoglobin levels were lower among undernourished children. Besides, overweight/obese children exhibited a higher level of high-sensitivity C-reactive protein. Multivariate analysis demonstrated that OA school children (adjusted OR (AOR): 6·1; 95 % CI 4·1, 9·0) and IDA (AOR: 3·6; 95 % CI 1·9, 6·6) were associated with stunting among this population. The present study revealed that malnutrition, micronutrient deficiencies and anaemia are prevalent among rural primary schoolchildren in Malaysia, especially those from OA schools and younger age children (<10 years). Hence, more appropriate and targeted measures are needed to improve the nutritional status of these children.

The challenges in managing the growth of indigenous children in Perak State, Malaysia: A qualitative study

Indigenous peoples in Peninsular Malaysia, known as Orang Asli, have been associated with the problem of malnutrition. Approximately 40% of their children are underweight. Indigenous peoples' distinct social, cultural, and economic traits, which differ from those of the dominant communities in which they live, may pose significant challenges for health care providers (HCPs) in addressing the malnutrition issue. This study explores challenges encountered by HCPs, with at least six months of experience in monitoring the growth parameters of Orang Asli children residing in Perak State in Peninsular Malaysia. A cross-sectional study was conducted between December 2020 and June 2021, involving three focus group discussions and three in-depth interviews. Thematic analysis was used. A total of 19 participants (6 nurses, 5 nursing managers, 4 medical officers, 2 nutritionists, a family medicine specialist, and a paediatrician) took part in this study. The challenges were summarized into four themes: (I) accessibility to nutrition, (II) accessibility to healthcare services, (II) skills of HCPs, and (IV) challenges of implementing nutrition programs. The inability of the Orang Asli children to access nutritious food was due to poverty, different perceptions of life priorities, and the practice of food taboos among the communities. Inadequate infrastructure and transportation discourage parents from bringing their children to healthcare facilities. The belief in and preference for traditional healing, the practice of semi-nomadic lifestyles, and fear of HCPs and their timid nature were factors that prevented Orang Asli children from accessing healthcare services. HCPs need to equip themselves with cross-cultural communication and interaction skills and adapt their skills to environmental challenges to overcome unexpected encounters in mobile clinics. The non-exposed food items, the risk of food basket sharing with other family members, and community feeding programs' coordination were the challenges to be addressed when implementing nutrition programmes for Orang Asli children. The challenges of HCPs are multifactorial and require a multifaceted approach. There is a need for joint efforts of stakeholders, from communities and non-governmental organisations (NGOs) to the health authorities, to address the challenges of HCPs.

Determinants of Household Food Insecurity and Its Association with Child Malnutrition in Sub-Saharan Africa: A Review of the Literature

Food insecurity is a global public health challenge. Household food insecurity is the leading risk factor of malnutrition, claiming approximately 300,000 deaths each year. Whether directly or indirectly, due to inadequate food consumption and poor diet quality, it is also accountable for over half of all deaths among children in Sub-Saharan Africa. It is estimated that the prevalence of food-insecure individuals in the area will reach 17 million by the year 2021. Inadequate nutrition may result in low immunity, impaired physical and mental development and reduced productivity among children under five years and throughout the life course. This review article attempts to discuss the various household food insecurity determinants and their association with child malnutrition in a Sub-Saharan Africa context. The purposes of this article are to inform governments, policymakers and service providers regarding the importance of household food security and its determinants on child malnutrition, and to plan strategies to improve the household food security status in Sub-Saharan Africa.