Double-burden of malnutrition among the indigenous peoples (Orang Asli) of Peninsular Malaysia

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Abstract

Background

Double-burden of malnutrition (DBM) is an emerging public health concern among the Orang Asli (indigenous peoples) of Peninsular Malaysia. This study aimed to identify the presence of DBM at the community and household levels in Orang Asli population and its associated demographic and socio-economic factors.

Methods

This cross-sectional study was conducted in 11 Orang Asli villages surrounding the Krau Wildlife Reserve, Peninsular of Malaysia from October 2011 to January 2012. Of 438 households, a total of 981 adults and 304 children who met the study criteria agreed to participate. About 160 households were further selected with pairs of children aged 3–59 months and non-pregnant mothers aged 15–55 years. Demographic and socio-economic data were obtained using interviewer-administered questionnaire while weight and height were measured using standard procedures. Double-burden of malnutrition was defined as overweight/obese mother-underweight child (OWOBM/UWC), overweight/obese mother-stunted child (OWOBM/STC) or overweight/obese mother-underweight or/and stunted child (OWOBM/UWSTC). Binary logistic regression identified the demographic and socio-economic factors associated with double-burden households.

Results

About 26 % of overweight and obese adults coexisting with high proportions of underweight (49 %) and stunted (64 %) children in these Orang Asli villages. There was a higher prevalence of households with OWOBM/UWSTC (20 %) and OWOBM/STC (19.4 %) than households with OWOBM/UWC (12.5 %). Boys ( P < 0.05), older age mothers ( P < 0.05), mothers with higher education ( P < 0.05) and households with income per capita less than USD 29.01 (RM 97.00) ( P < 0.01) were associated with higher odds of OWOBM/STC. Jah Hut ( P < 0.05) and higher number of children ( P < 0.05) were significantly associated with lower odds of OWOBM/UWC.

Conclusions

The occurrence of double-burden of malnutrition in Orang Asli population deserves attention. Poverty reduction, access to quality diet and improved health and nutrition literacy are among strategies that could address the coexistence of DBM in this population.

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Boys are more stunted than girls in Sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys

Henry Wamani, Anne Astrom, Stefan Peterson … (2007)

Background Many studies in sub-Saharan Africa have occasionally reported a higher prevalence of stunting in male children compared to female children. This study examined whether there are systematic sex differences in stunting rates in children under-five years of age, and how the sex differences in stunting rates vary with household socio-economic status. Methods Data from the most recent 16 demographic and health surveys (DHS) in 10 sub-Saharan countries were analysed. Two separate variables for household socio-economic status (SES) were created for each country based on asset ownership and mothers' education. Quintiles of SES were constructed using principal component analysis. Sex differentials with stunting were assessed using Student's t-test, chi square test and binary logistic regressions. Results The prevalence and the mean z-scores of stunting were consistently lower amongst females than amongst males in all studies, with differences statistically significant in 11 and 12, respectively, out of the 16 studies. The pooled estimates for mean z-scores were -1.59 for boys and -1.46 for girls with the difference statistically significant (p < 0.001). The stunting prevalence was also higher in boys (40%) than in girls (36%) in pooled data analysis; crude odds ratio 1.16 (95% CI 1.12–1.20); child age and individual survey adjusted odds ratio 1.18 (95% CI 1.14–1.22). Male children in households of the poorest 40% were more likely to be stunted compared to females in the same group, but the pattern was not consistent in all studies, and evaluation of the SES/sex interaction term in relation to stunting was not significant for the surveys. Conclusion In sub-Saharan Africa, male children under five years of age are more likely to become stunted than females, which might suggest that boys are more vulnerable to health inequalities than their female counterparts in the same age groups. In several of the surveys, sex differences in stunting were more pronounced in the lowest SES groups.

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A nutrition paradox--underweight and obesity in developing countries.

Benjamin Caballero (2005)

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Do nutrition knowledge and beliefs modify the association of socio-economic factors and diet quality among US adults?

May Beydoun, Youfa Wang (2008)

We examined effects of socio-economic status (SES) factors on diet quality and fruits and vegetables intake among US adults and effect modification by nutrition knowledge and beliefs. We used national cross-sectional data (Continuing Survey of Food Intake by Individuals) on 4356 US adults, aged 20-65 years, collected in 1994-1996. Socio-economic factors considered were education and poverty income ratio. Nutrition knowledge and belief score was measured by principal components analysis of 11 question responses. We considered three binary and two continuous outcomes related to United States Department of Agriculture recommended intake of fruits and vegetables and overall diet quality through Healthy Eating Index and alternate Mediterranean Diet Score. Multivariate analyses indicated that better SES independently improved likelihood of adequate fruits and vegetables intake and overall diet quality. In several cases, nutrition knowledge and beliefs acted as an effect modifier. In particular, education showed no association with diet quality among subjects in the lowest nutrition knowledge and belief tertile, while the association was consistently stronger in the highest tertile (Education x Nutrition knowledge and beliefs interaction term P<0.10 for Healthy Eating Index and both fruits and vegetables guidelines). A similar interaction was noted for poverty income ratio. For improvement in overall diet quality, socio-economic interventions must be coupled with health education programs targeting all segments of the US population.

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Author and article information

Contributors

C. Y. Wong: w_swallow11@yahoo.com

M. S. Zalilah: +60389472472 , zalilahms@upm.edu.my

E. Y. Chua: eeyinchua@gmail.com

S. Norhasmah: norhasmah@upm.edu.my

Y. S. Chin: chinys@upm.edu.my

A. Siti Nur’Asyura: sa_asyura@upm.edu.my

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 21 July 2015

Publication date PMC-release: 21 July 2015

Publication date Collection: 2015

Volume: 15

Electronic Location Identifier: 680

Affiliations

Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan Malaysia

Article

Publisher ID: 2058

DOI: 10.1186/s12889-015-2058-x

PMC ID: 4508822

PubMed ID: 26194643

SO-VID: f90a8b61-148a-4b3c-8df5-f14854fe19c4

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 14 April 2015

Date accepted : 14 July 2015

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ScienceOpen disciplines: Public health

Keywords: double-burden of malnutrition,demographics and socio-economics,indigenous peoples,orang asli

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ScienceOpen disciplines: Public health

Keywords: double-burden of malnutrition, demographics and socio-economics, indigenous peoples, orang asli

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Double-burden of malnutrition among the indigenous peoples ( Orang Asli) of Peninsular Malaysia

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Chinese Journal of School Health

Most cited references 42

Boys are more stunted than girls in Sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys

A nutrition paradox--underweight and obesity in developing countries.

Do nutrition knowledge and beliefs modify the association of socio-economic factors and diet quality among US adults?

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