Malnutrition remains a major public health concern in Indonesia and the double burden of malnutrition refers to the presence of under- and over-nutrition in the same population. This study aimed to determine the prevalence of under-nutrition (stunting, thinness) and over-nutrition (overweight, obesity) in Indonesian children.
We analysed a merged dataset of children <5 years old in 1993, and followed them up in the 1997, 2000, and 2007 waves of the Indonesian Family Life Survey (IFLS). IFLS is a longitudinal, nationally representative survey of a stratified random sample of households involving both questionnaires and anthropometric measurements. The survey included 7,224 households and 22,000 individuals in 1993, with a re-contact rate of more than 90% in each wave. Height/length and body mass index (BMI) were expressed as z-scores with reference to WHO Standard (2006; <5 years) or WHO Reference (2007; 5-19 years) charts. Children with height-for-age-z-scores <-2SD were categorised as stunted. Children with BMI-z-scores <-2SD, >+2SD, >+3SD in WHO 2006 and <-2SD, >+1SD, >+2SD in WHO 2007 were categorised as thin, overweight or obese, respectively.
1742 children had complete anthropometry in all four waves. The mean (95% CI) age at each wave was 2.1 (2.0-2.2), 6.1 (6.0-6.2), 8.9 (8.8-8.9) and 16.3 (16.2-16.3) years. The prevalence of stunting in each wave was 22.5% (CI: 20.8-24.3%), 28.9% (CI: 25.6-31.1%), 28.7% (CI: 26.9-30.7%), and 27.1% (CI: 25.1-29.2%), respectively. The prevalence of thinness increased from 1993-2000 (8.3%, 9.4%, and 11.1%), but decreased in 2007 (8.0%). The trends in prevalence of overweight and obesity showed the opposite pattern, decreasing from 1993 (6.7% and 5.3%) to 1997 (2.2% and 1.5%) then increasing in the two recent waves (4.1% and 1.9%) in 2000 and (6.4% and 2.3%) in 2007.
ConclusionThere is strong evidence that the Double Burden of Malnutrition occurs in Indonesian children. A coordinated approach to overcome chronic malnutrition and over-nutrition is required.