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

Objectives: The objectives of this study were to determine the prevalence of malnutrition among five-year-olds and factors associated with unsuccessful outcome of a Food Basket Programme (FBP) in a rural district of Kelantan, Malaysia.Design: Administrative health records from selected health clinics were reviewed. Study sample includes indigenous population or Orang Asli of Malaysia. Unsuccessful outcome was defined according to failure to complete the programme according to growth gain and on-time. Multiple logistics regression was used to assess the associated factors of unsuccessful outcome of FBP.Results: This study showed that the prevalence rates of malnutrition among children below five years old were 34.2% underweight, 16.4% thinness, 32.5% stunting and 3.0% overweight, with Orang Asli children faring the worse. Orang Asli children were also five times more likely to be unsuccessful in the FBP (p < .001).Conclusion: Malnutrition is still prevalent among children below five years old in this rural setting and Orang Asli children are vulnerable to have an unsuccessful outcome from the Food Basket Programme. Further research is necessary to further explain this association to inform policy, specifically for Orang Asli children.

Maternal obesity and its determinants: A neglected issue?

Maternal obesity is a global public health concern that affects every aspect of maternity care. It affects the short-term and long-term health of the mother and her offspring. Obese pregnant mothers are at an increased risk of developing complications during antenatal, intrapartum, and postnatal periods. Maternal complications include gestational diabetes mellitus, hypertensive disorder in pregnancy, pre-eclampsia and eclampsia, increased rate of cesarean delivery, pulmonary embolism, and maternal mortality; fetal complications include congenital malformation, stillbirth, and macrosomia. Moreover, both mother and infant are at an increased risk of developing subsequent non-communicable diseases and cardiovascular problems later in life. Several factors are associated with the likelihood of maternal obesity, including sociodemographic characteristics, obstetric characteristics, knowledge, and perception of health-promoting behavior. Gaining a sound understanding of these factors is vital to reaching the targets of Sustainable Developmental Goal 3-to reduce global maternal mortality and end preventable deaths of children under 5 years of age-by 2030. It is essential to identify pregnant women who are at risk of maternal obesity in order to plan and implement effective and timely interventions for optimal pregnancy outcomes. Importantly, maternal obesity as a significant pregnancy risk factor is largely modifiable.

Substituting white rice with brown and black rice as an alternative to prevent diabetes mellitus type 2: a case-study among young adults in Yogyakarta, Indonesia.

PURPOSE: The purpose of this study is to explore the preference and acceptance of white rice substitution with brown and black rice among young adults in Indonesia to prevent diabetes. METHODS: This study used a qualitative design. Rice preference deeply explored using focus group discussion as a case-study. 85 informants with an average of ages 20 years old were divided into several groups. Several topics to discuss include the reasons to accept or reject brown and black rice, knowledge, attitude, motivation, and potency to substitute white rice. RESULTS: Price was the main barrier to substitute white rice to brown and black rice. The participants have known brown rice from parents, mass media, and friends. Most of them were still unfamiliar with black rice. Culture also affected the preferences of the participants. To motivate people to change their white rice diet, creative packaging and segmentation of the sale were recommended. CONCLUSION: Substituting white to brown and black rice is still a challenge for young adults in Indonesia. Several barriers such as culture, accessibility, and affordability need to be considered. Further efforts are important to manage a program to increase brown and black rice consumption.

Associations of pre-pregnancy body mass index, middle-upper arm circumference, and gestational weight gain.

OBJECTIVES: An optimal gestational weight gain is essential for maternal health and to reduce adverse birth outcomes. Current guidelines to monitor gestational weight gain are based on pre-pregnancy body mass index (BMI). However, middle-upper arm circumference (MUAC) is increasingly used as an alternative nutritional status measure for pregnant women. Hence, this study aimed to determine associations of MUAC and pre-pregnancy BMI with gestational weight gain rate among Malaysian pregnant women. STUDY DESIGN: A cross-sectional study was conducted among 444 pregnant women (≥20 weeks gestation). MAIN OUTCOMES MEASURES: Women completed questionnaires on sociodemographic data, maternal characteristics and pre-pregnancy weight. Height, current weight and MUAC were measured at study visit (from 1st February 2016 to 31st January 2017). RESULTS: About a third (34.24%) of pregnant women were overweight or obese prior to pregnancy. MUAC was inversely associated with an inadequate rate of gestational weight gain (OR = 0.77; 95% CI: 0.68, 0.87) as compared to normal gestational weight gain. In contrast, a higher MUAC was associated with a higher odds ratio (OR = 1.28; 95% CI: 1.11, 1.49) of having excessive rate of gestational weight. No associations were found for pre-pregnancy BMI categories for gestational weight gain rate. CONCLUSION: Our findings revealed that women with low MUAC were more likely to have an inadequate gestational weight gain rate during pregnancy whereas higher MUAC was associated with an excessive gestational weight gain rate. MUAC may be a useful indicator of nutritional status associated with GWG. Routine measurement of MUAC in pregnant women may help health professionals, particularly in middle-income countries, to counsel women about gestational weight gain.

The coexistence of dual form of malnutrition in a sample of rural malaysia.

BACKGROUND: The coexistence of under and over nutrition might be influenced by a marked shift in dietary and lifestyle practices of people in developing countries. This study aims to identify factors associated with the occurrence of dual form of malnutrition in the same households in a rural district in Peninsular Malaysia. METHODS: A cross sectional study was conducted on a 223 mother-child pairs based on several inclusion criteria such as; non-pregnant, non lactating mothers and having youngest children aged from 2 to 12 years old. Anthropometric indices of Weight-for-age Z score (WAZ) ≤ 1SD was used to classify underweight status in children and body mass index (BMI) ≥25kg/m(2) was used to measure overweight status among mothers. A pre-tested questionnaire was used to collect socio-demographic data, whereas food frequency questionnaire was used to assess the diet diversity. RESULTS: The results showed that the prevalence of overweight mother/underweight child (OWM/UWC) pairs was 29.6%, whereas the prevalence of normal weight mother/normal weight child (NWM/NWC) pairs was 15.2%. Out of mother-child pairs measured, 61.0% of the children were underweight and 61.4% were stunted, whereas the prevalence of overweight and obesity in women were 35.0% and 17.0%, respectively. The study did not report any association between the dual burden of malnutrition and household size, number of children, educational level of the mother, total income, income per capita, and food expenditure, except with household type (OR:5.01;95% CI:1.63,15.34; P = 0.005). In general, the total diet diversity score of both types of mother-child pairs was low. CONCLUSIONS: Dual forms of malnutrition in the same household exists in Malaysian households. This phenomenon will be a big challenge especially for food intervention programs to be implemented in the future.

Nutritional outcomes related to household food insecurity among mothers in rural Malaysia.

During the past two decades, the rates of food insecurity and obesity have risen. Although a relationship between these two seemingly-paradoxical states has not been repeatedly seen in men, research suggests that a correlation between them exists in women. This study examines nutritional outcomes of household food insecurity among mothers in rural Malaysia. A cross-sectional survey of low-income households was conducted, and 223 households with mothers aged 18-55 years, who were non-lactating, non-pregnant, and had at least one child aged 2-12 years, were purposively selected. A questionnaire was administered that included the Radimer/Cornell Scale, items about sociodemographic characteristics, and anthropometric measurements. Of the households, 16.1% were food-secure whereas 83.9% experienced some kind of food insecurity: 29.6% of households were food-insecure, 19.3% contained individuals who were food-insecure, and 35.0% fell into the 'child hunger' category. The result reported that household-size, total monthly income, income per capita, and food expenditure were significant risk factors of household food insecurity. Although there was a high prevalence of overweight and obese mothers (52%) and 47.1% had at-risk waist-circumference (> or = 80 cm), no significant association was found between food insecurity, body mass index, and waist-circumference. In conclusion, the rates of household food insecurity and overweight and obesity were high in the study population, although they are looking paradoxical. Longitudinal studies with larger sample-sizes are recommended to further examine the relationship between food insecurity and obesity.

Perceptions and practice of exclusive breastfeeding among Malay women in Kelantan, Malaysia: a qualitative approach.

INTRODUCTION: Despite evidence from various studies on exclusive breastfeeding (EBF) being best for infants, many women do not or are unable to practise EBF. This study aimed to examine perceptions on EBF and its influencing factors among a sample of Malay women in rural and urban areas in Kelantan, Malaysia. METHODS: A qualitative study using in-depth interviews was conducted to examine respondents' views about EBF including their beliefs, experiences and feelings. The interviews were audio-recorded and transcribed verbatim, followed by discussion and identification of emergent concepts. RESULTS: Data saturation was achieved after interviewing a total of 30 women. The mean age of the women was about 30 years with most having at least secondary level schooling; the majority were working women. Thirteen of the 30 women practised EBF. They believed breastfeeding allowed them to fulfill their reproductive role and regarded it as a gift from God. The practice required sacrifice, and was therefore associated with a combination of positive and negative feelings. Differing opinions surfaced with regard to belief in the superiority of breastfeeding and feasibility of practice. Many women accepted breastfeeding practice but found it challenging to practise EBF especially when confronted with low milk production, perceived low nutritional quality breast milk, and work commitments. CONCLUSION: Women should be educated on the importance of EBF with regard to the nutritional adequacy of breast milk and long-term benefits for mother and children.