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ORIGINAL ARTICLE
Year : 2022  |  Volume : 12  |  Issue : 2  |  Page : 75-84

Food Consumption among Under-five Children in Agats, Asmat District, Papua Province


1 Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta; Human Nutrition Research Centre-Indonesia Medical Education and Research Institute (HNRC IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
2 Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
3 Gunadarma University, Depok, Indonesia

Date of Submission02-Dec-2021
Date of Decision18-Jan-2022
Date of Acceptance30-Jan-2022
Date of Web Publication10-May-2022

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnpnd.ijnpnd_75_21

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   Abstract 


Context: Malnutrition outbreak in 2018 caused increased morbidity and mortality of Asmat children. Many studies indicated that malnourished children should receive adequate nutrients. Aim: The study aims to analyze food consumption among under-five children in Asmat. Settings and design: The cross-sectional study was conducted in Agats subdistrict, Asmat district, and Papua province, in July 2018 and included 62 under-five children. Children were selected using purposive sampling from five villages. Materials and methods: The primary data were collected by interview, direct measurement, questionnaire fulfillment consisting of general, anthropometric, and food consumption data. Statistical analysis used: descriptive data, composed of the characteristics of children, children’s nutritional status, and food consumption. Results: The average energy intake was 561.7 ± 335.3 kcal/day. The mean carbohydrate and protein were 93.3 ± 52.9 and 18.2 ± 11.2 g, respectively. The median fat intake was 7.53 (2.6, 16.9) g and fiber was 1.63 (1.0, 2.9) g/day. The median iron and zinc were 1.5 (0.8, 2.6) g and 1.5 (0.8, 2.3) g. The average folic acid intake was 36.4 ± 25.2 g. Conclusion: Compared to the Indonesian Recommended Dietary Allowance (RDA), the percentage of children’s energy (93.5%), protein (75.8%), fat (96.8%), carbohydrate (83.9%), fiber (91.9%), iron (88.7%), folic acid (98.4%), and zinc (88.7%) intakes was included as below of Indonesian RDA category. These results can be used to make appropriate dietary recommendations, which will be used as a substantial improvement in community service programs.

Keywords: Asmat, dietary recall, food consumption, rural, under-five


How to cite this article:
Prafiantini E, Sari O, Hanisa N, Andayani D, Anugrapaksi E, Octavia L. Food Consumption among Under-five Children in Agats, Asmat District, Papua Province. Int J Nutr Pharmacol Neurol Dis 2022;12:75-84

How to cite this URL:
Prafiantini E, Sari O, Hanisa N, Andayani D, Anugrapaksi E, Octavia L. Food Consumption among Under-five Children in Agats, Asmat District, Papua Province. Int J Nutr Pharmacol Neurol Dis [serial online] 2022 [cited 2022 Sep 25];12:75-84. Available from: https://www.ijnpnd.com/text.asp?2022/12/2/75/345018


   Introduction Top


Malnutrition in all its forms remains severe across all regions of the world. Globally, approximately 151 million children under-five suffer from stunting, nearly 51 million were wasted, and 16 million were severely wasted. Furthermore, about 20 million newborn babies are estimated to have low birth weight, whereas 38.3 million children under-five are overweight. [1,2] Although stunting and wasting were presented as two different conditions, both conditions affected each other conditions, as children who are wasted are more likely to become stunted, and children who are stunted are more likely to become wasted.[3] Both forms of malnutrition require immediate public health interventions.

Another study showed that malnutrition has short-term implications, such as improper growth and functioning of the immune system, and long-term implications, such as slow body growth and slow cognitive development.[4] It is reported that children suffering from stunting may never reach their full possible height and cognitive potential of their brain development. Other consequences of stunting include diminished ability to learn, lower school achievement, and reduced lifelong productivity. Moreover, children suffering from wasting may have weakened immunity. Thus, they are more likely to be susceptible to long-term developmental delays and have a greater risk of death. [2,5] Malnutrition is also associated with increased mortality, proven by the condition that malnourished children have a higher risk from other diseases and infections compared to healthy children.[3],[6],[7],[8],[9]

In early 2018, Asmat children’s mortality rate spiked due to malnutrition outbreak. About 800 children, with as many as 100 toddlers, have been diagnosed by a measles-and-malnutrition outbreak in Indonesia’s remote Papua province. Between September 2017 and January 2018, malnutrition and measles outbreaks caused more than 550 people to be infected. At least 175 were hospitalized, and at least 73 villagers, with most children under-five, died in the Asmat district. This data led to many deaths and the quick spreading of measles among children. Despite the Ministry of Health’s first warnings and reports in September 2017 on low immunization coverage and malnutrition to the central, provincial, or local government in Papua province, no supportive action was taken before January 2018. [10,11]

In Papua province and Asmat district, central and local governments had not established an effective early warning system through vaccination campaigns to prevent further measles outbreaks and overcome chronic food insecurity. In Agats subdistrict, people could not find proper health care and the low awareness of the patients with measles and malnutrition, which did not have the urgency to seek medical attention in the public hospital. Unfortunately, until February 2018, the malnutrition crisis in the Asmat district had not changed.[10]

Communication and Community Service Ministry of Health reported that in February 2018, patients who suffered from measles and malnutrition and were treated at the Agats Hospital in Asmat district, Papua province, underwent a recovery period. It is proven by decreasing patients’ complaints, increasing food and drink intake, and achieving weight gain. The Ministry of Health also improved nutrition by accelerating food and calories intake to pursue normal body growth. Family factors also influenced this improvement.[12]

Though many factors caused measles and malnutrition, such as inadequate eating patterns and unhealthy living and cleanliness behaviors, the role of family eating patterns and behavior have been one of the critical points on children’s health and food intake. Lack of access to clean drinking water contributes to malnutrition by disrupting the absorption of food and nutrients. Families with hospitalized children who undergo a recovery period should still be cautious. If they do not ensure proper maintenance and sustainable monitoring of their children’s condition, a similar problem will recur. It is recommended that trained health cadres have good knowledge and practice monitoring the family. Therefore, a health service center’s intervention program in Asmat is needed as a food and nutritional strategy to overcome this problem.[12],[13],[14]

In July 2018, the Department of Nutrition, Faculty of Medicine Universitas Indonesia (FMUI) assessed Agats children’s food intake to assess the postmalnutrition outbreak in Asmat. We expected this evaluation to serve as an essential guide for developing nutrition education. The provision of nutrition education can be used as a community service program to improve children’s nutrition status. Another study supports nutrition knowledge of caregivers and households that are needed in rural communities. Therefore, they can provide children with dietary diversity and adequacy, impacting their growth and health.[15]

In the current study, we analyzed the food consumption among under-five children in Asmat. The result can evaluate the improvements or stable condition of their food consumption after malnutrition outbreak. This result can also be used as the primary data for preparing the nutrition education materials given to the caregiver.


   Subjects and methods Top


The team from Department Nutrition, FMUI conducted a cross-sectional study in Agats subdistrict, Asmat district, and Papua province, in July 2018. The target population in this study consisted of people who lived in Asmat district, whereas the accessible population was Agats subdistrict’s people. Nevertheless, subjects were chosen using a purposive sampling procedure from five selected villages: Bis Agats, Mbait, Aswetsy, Syuru, and Kaye. The inclusion criteria consisted of under-five children whose caretaker was willing to participate in the study. The subject was domiciled in Agats subdistrict and was not categorized as a disabled person both physically and mentally. The exclusion criteria were subjects who were moved to another area, refused to continue the study, or were classified as disabled persons both physically and mentally. Finally, a total of 62 children were selected for this study.

Primary data were collected using interviews, direct measurement, and questionnaire fulfillment consisting of general, anthropometric, and food consumption data. We used a structured questionnaire to collect the general data. For anthropometric data, we used (SECA 877® is IDS Medical Systems Indonesia) to measure body weight and (Shorrboard® is from PT GeneCraft Labs) to measure body height. The food consumption data were assessed using a single-day 24-hour dietary recall. The 24-hour dietary recall is used to characterize the mean intakes of an individual.[16] Children’s mothers or caregivers were interviewed for general and children’s food consumption.

We classified the result of anthropometric data according to z-scores into three categories, namely underweight (weight for age z-score, WAZ), stunting (height for age z-score, HAZ), and wasting (weight for height z-score, WHZ). We analyze the nutritional status using the WHO Anthro software (version 3.2.2). We defined those categories into similar cutoff points: −2.00 to 2.00 as normal, −2.01 to −3.00 as moderate, and <−3.00 as severe.[17]

We used (Nutrisurvey software 2007, The main NutriSurvey software 2007 program is the english translation of a commercial german software (EBISpro)) to analyze food consumption. Using a single day 24-hour dietary recall, we determined the actual intake level of the subject. Then, we used the Indonesian RDA as a standard value in evaluating the adequacy of nutrient intakes consisting of energy, protein, fat, carbohydrate, fiber, vitamin (folic acid), and minerals (iron and zinc) to conclude whether the intakes have met the adequate requirements. The Indonesian RDA value,[18] according to the respective age, is described in [Table 1].
Table 1 Indonesian recommendation dietary allowance for under-give children

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This study has been approved by the Ethical Committee of Health Research, FMUI No 0690/UN2.F1/ETIK/2018. Before the study started, mothers or caregivers received detailed information about the study. Then if they agree to participate, they would sign the informed consent.

We used SPSS software (version 23.0, is developed from IBM) to conduct the data analysis. In this recent study, we analyze the descriptive data, consisting of characteristics of children, children’s nutritional status, and food consumption per day.

General data

After mothers or caregivers agreed to participate and signed the informed consent, they were asked about general information of children consisting of name, age, and gender.

Anthropometric measurement

Anthropometric measurements using weight and height, or length, were assessed to determine the nutritional status of the children. The weight was measured by digital scales, SECA 877®, nearest 0.1 kg. Each child was weighed without footwear and wearing minimal clothing. Shorrboard® measured the height or length to the closest accuracy of 0.1 cm. Children under 2 years were measured lying down, and older children stood up.

Food consumption data

The team and trained enumerators obtained children’s food consumption data. Mothers or caregivers were asked what children ate at home and what food they consumed outside their homes over the past 24 hours. We used a single-day 24-hour dietary recall to assess the mean actual individual intakes. The 24-hour dietary recall is a retrospective assessment method to obtain quantitative information of food eaten on the past 24 hours, listed in chronological order of consumption, from morning to evening. Whether the foods were purchased outside or cooked at home, brands of purchased foods were also recorded. The team interviewed mothers or caregivers directly, with additional aids to estimate the portion size using food photographs and household measures.

The team then converted the portion size to the gram amount of each dietary consumption. Then, data were input into the Nutrisurvey software 2007. From this software, we obtained the nutrient content from each food. The calculation of total nutrient intakes was determined by calculating each nutrient intake.


   Results Top


Characteristics of under-five children

The findings of the characteristics of the children are presented in [Table 2]. Most of the children were in the age group between 1 and 3 years old (74.2%), with the median age of children being 19.5 months. The proportion of boys was higher than girls, which was 53.2%. We assessed the weight and height of the children, and we found that the mean weight was 10.1 kg, and the mean height was 81.2 cm.

Nutritional status of under-five children

It was found that 32.3% were stunted, whereas 24.2% were wasted, and 14.5% of children were underweight. The proportion of severely wasted children was higher (11.3%) than stunted and underweight children [Table 3].

Food consumption of under-five children

[Table 4] presents the mean food consumption among under-five children per day in Agats subdistrict. After assessing children’s food consumption using a single day 24-hour dietary recall, the mean energy intake of children was 561.7 ± 335.3 kcal/day. For macronutrient intake, it was found that the mean daily carbohydrate and protein intakes were 93.3 ± 52.9 and 18.2 ± 11.2 g, respectively. The median fat intake was 7.53 (2.6, 16.9) g/day and the median fiber intake was 1.63 (1.0, 2.9) g/day. Micronutrient intake represented iron, zinc, and folic acid intake. The iron and zinc intake median was 1.5 (0.8, 2.6) and 1.5 (0.8, 2.3) g. In addition, the average daily folic acid intake was 36.4 ± 25.2 μg.


   Discussion Top


Characteristics of under-five children

The age group 6 to 23 months is a critical phase for child development, and any irreversible damages due to nutritional deficiencies can occur, and the impact will be severe.[19] Based on the previous study, the male gender was one of the predictors of stunting.[19] The current study result is similar to the previous study. Not only about children’s age but also children’s gender plays a significant role in their nutritional status. The mean weight was slightly smaller than the National Synthetic Growth Reference Charts for Indonesian children for 2 years old, 11.22 kg for boys and 10.86 kg for girls.

Nutritional status of under-five children

The same result was found in the mean height. Children in the present study were shorter than the national reference, 83.97 cm for boys and 82.12 cm for girls. Relevant to the more remote areas of Indonesia, a previous study also presented one separate height chart, which was mainly provided for children of Papua. The findings in this study on mean height were slightly shorter for both gender, 82.32 cm for boys and 81.43 cm for girls.[20]

Poor fetal growth or stunting in 2 years of life leads to irreversible damage, including shorter adult height, lower attained schooling, reduced adult income, and decreased offspring birth weight.[21] The current study uses weight for height (wasting), height for age (stunting), and weight for age (underweight) z-score to indicate children’s nutritional status.

Based on the Indonesian Basic Health Survey 2018, 33.1% stunted and 15.3% severely stunted prevalence of Papua province, higher than the current study’s prevalence.[22] Even though the present study found a smaller proportion, the prevalence of stunted children in the Agats subdistrict was considered a high public health problem.[23]

More than 50% of children had a normal nutritional status in all anthropometric indicators. On the other hand, this study also found that around 6.5% of children were overweight, whereas only 3.2% and 1.6% of children were tall and overnutrition. From this study, we can determine whether children in Agats subdistrict improved nutritional status or not due to the past malnutrition outbreak in early 2017. This study showed that most children had a normal nutritional status; nevertheless, the malnutrition outbreak in Agats subdistrict occurred in February 2017. However, in February 2018, children who had suffered from measles and malnutrition already had been treated. They were in a healthy recovery period. We can conclude that children’s nutritional status had been improved during the last recovery period to this current data collection.

Food consumption of under-five children

Overall, compared to the Indonesian Recommended Dietary Allowance (RDA),[18] more than 50% of children’s nutrients intake were included as category “below of Indonesian RDA,„ such as energy (93.5%), protein (75.8%), fat (96.8%), carbohydrate (83.9%), fiber (91.9%), iron (88.7%), folic acid (98.4%), and zinc (88.7%). Children’s food consumption was compared to their age group, 0 to 6 months, 7 to 11 months, 1 to 3 years, and 4 to 6 years.

We already knew that most of the children in this study had normal nutritional status; however, they were still had an inadequate nutrient intake. This result was proven by the food consumption data in Agats subdistrict that was still below Indonesian RDA. If this condition is not improved, the children are at risk of returning to the previous malnutrition problem and the malnutrition outbreak in early 2017. Another study showed that children might exhibit sustained vulnerability even after achieving nutritional cure, including heightened mortality and morbidity risk and persistent stunting.[24]

Limitation and delimitation of the study

The present study was conducted in one district, Agats; thus, this study’s findings may not represent a wider area. Additionally, the cross-sectional nature of this data does not allow us to examine causality in the relationship between malnutrition and various risk factors because the study’s objective aimed to improve the knowledge of the caregiver.

The season of data collection should be given special attention, as the area was malaria endemic. A longitudinal study would be recommended to ensure the food pattern and disease in the area.[25]

Accordingly, we are sure that this limitation of the study does not make a difference in our general conclusions.


   Conclusion Top


This study conducted by the Nutrition Department, FMUI, was the first study that evaluated the nutritional status, consisting of anthropometric and food consumption data in Agats subdistrict, Asmat district, and Papua province, Indonesia after the malnutrition outbreak occurred. This study showed that regular monitoring of the nutritional status of children after a malnutrition outbreak has a meaningful impact on preventing malnutrition. The monitoring could be identified by the anthropometric measurement and multiple days of food consumption assessment.

Most children in Agats subdistrict have nutrient intake below the recommendation. This result can be used as a basis to make appropriate dietary recommendations. Furthermore, these recommendations could be used as materials for nutrition education in community services programs. We can conclude that those materials for nutrition education were based on prior science-based research findings. Nutrition education was one of the strategies to promote sustained behavior changes to prevent malnutrition by improving dietary quality.

Acknowledgment

The authors appreciate and acknowledge the children and mothers or caretakers who participated in this study and the Local Government, District Health Office, Public Health Center, and cadre who supported the team during the study.

The study was funded by the Directorate of Research and Community Services Universitas Indonesia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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