Assessment of undernutrition using the composite index of anthropometric failure (CIAF) and its determinants: A cross-sectional study in the rural area of the Bogor District in Indonesia

Abstract

Background The Composite Index of Anthropometric Failure (CIAF) can comprehensively identify undernutrition by combining several indicators of nutritional status – namely, weight-for-age, length/height-for-age and weight-for-length/height – to determine the nutritional status of children under five years of age. This study aims to assess undernutrition using the CIAF and its determinants on children under five years of age in the Bogor District, Indonesia. Methods A cross-sectional study was conducted during February–May 2019 among 330 mother-children pairs (with children under five), selected by systematic random sampling from four villages as undernutrition pockets in the rural area of Bogor District, Indonesia. The nutritional status of the children was assessed by measuring weight and length/height. Z-score was calculated using WHO Anthro software and was categorized based on conventional indices, including weight-for-age (WAZ), length/height-for-age (HAZ) and weight-for-length/height (WHZ). The CIAF is measured based on a combination of conventional index measurements. In addition, mothers’ and childrens’ characteristics and clean living behaviour are assessed via structured questionnaires. Environmental sanitation is assessed using the environment meter. Binary logistic regression analysis with SPSS version 22.0 is used to analyse the dominant factors associated with undernutrition. Results Among children under five, 42.1% experienced anthropometric failure (overall prevalence of undernutrition based on the CIAF), 2.4% experienced wasting only, 5.8% were classified as both wasting and underweight, 2.1% as wasting, underweight and stunting, 16.4% as underweight and stunting, 11.5% as stunting only, and 3.9% as underweight only. Assessment of nutritional status using a conventional anthropometric index shows that respective prevalences of underweight, stunted and wasted were 27.8, 29.7, and 10.6%. The mother’s height is the most dominant factor associated with anthropometric failure [p = 0.008; AOR = 1.95; 95% CI: 2.19–3.19]. The most dominant factors associated with the conventional undernutrition indices of underweight, stunted and wasted are, respectively, family income [p = 0.018; AOR = 5.44; 95% CI: 1.34–22.11], mother’s height [p = < 0.001; AOR = 3.29; 95% CI:1.83–5.91] and child’s age [p = 0.013; AOR = 2.59; 95% CI: 1.22–5.47]. Conclusion Nearly half of children under five experience anthropometric failure. Specific nutrition improvement interventions and specific nutrition interventions during pregnancy and lactation are needed, especially for malnourished mothers, to prevent malnutrition in infant.

The association of sociodemographic, nutrition, and sanitation on stunting in children under five in rural area of West Java Province in Indonesia

“…42 Another similar study involving 330 toddlers in rural areas in West Java Province in Indonesia reported similar results, namely the prevalence of stunting in older toddlers (25-59 months) was higher (37.4%) compared to younger toddlers (0-24 months) that is as much as 17.6%. 16 condensed milk is a significant contributor to malnutrition in children. Therefore, this study also reported that sanitation facilities, water treatment, and clean living behavior are determined by stunting.…”

Child undernutrition and its association with household environmental conditions in Bangladesh

“…As a secondary outcome of the study, the Composite Index of Anthropometric Failure (CIAF) was used to summarize multiple indicators of child nutritional status. It combines measures of stunting, wasting, and underweight into a single index [22,31]. We further categorized them into seven groups, each representing a speci c combination of nutritional failures, such as no failure, wasted only, stunted only, underweight only, wasted with underweight, stunted with underweight, and stunted, wasted and underweight.…”

“…Other variables included in this study were identi ed through literature searches and determined based on existing evidence from LMICs and Bangladesh [7,8,21,22,24,25,31]. The covariates we included were child's age (continuous), child's sex (male or female), religion (Muslim or non-Muslim), sex of the household head (male or female), education level of the child's mother (no formal education, primary, secondary or higher), education level of the child's father (no formal education, primary, secondary or higher), employment status of the child's mother (unemployed or employed), household size (1-5 members, 6-10 members or 10 + members), place of residence (urban or rural) and administrative divisions (Barishal, Chattogram, Dhaka, Mymensingh, Khulna, Rajshahi, Rangpur or Sylhet).…”

Prevalence of Composite Indicator Anthropometric Failures and Associated Factors among 6-59 Month Children Living In Mojo Town, Oromia, Ethiopia

“…Accordingly, the odds of developing CIAFs were 75% higher among children living in families that had ve or more family members [AOR = 1.75, 95% CI: Bogor city, Indonesia (42.1%) [9], other areas of India, west Bengal (50.2%) [27], Nagpur (58.6%) [28], Anganwadi (51.8%) [29], rural areas of Bengal (32.7%) [30] and Yemen (70.1%) [31], in Tanzania (38.2%) [11] and Malawi (50.6%) [15].…”

“…Furthermore, according to the study conducted in 34 low and middle-income countries (LMICs) in 2019, about 36% of under-ve children had CIAFs, of which 13.7% had double growth failures (12.0% stunted and underweight, 1.7% wasted and underweight), and 1.5% had triple growth failures [ 8]. Likewise, the prevalence of CIAFs was in Indonesia [9], 62% in India [10], 38.5% in Tanzania [11], and 50.6% in Malawi [12].…”