EXCLUSIVE BREASTFEEDING, COMPLEMENTARY FEEDING, LOW BIRTHWEIGHT, AND WASTING IN CHILDREN UNDER-FIVE: A PATH ANALYSIS EVIDENCE FROM INDONESIA

Abstract

Objective: Studies using life course perspective, longitudinal data, and path analysis on the relationships between exclusive breastfeeding (EBF), complementary feeding (CF), low birthweight (LBW), and wasting are lacking. This study aimed to investigate the relationships between EBF, CF, LBW, and wasting, while controlling for some confounding factors.Methods: This was a case–control study conducted in Purworejo, Central Java, Indonesia. A total sample of 160 children 2–5 years of age were selected by fixed disease sampling, consisting of 28 wasted and 132 normal weight children. The dependent variable was wasting. The independent variables were EBF, CF, LBW, maternal middle upper-arm circumference at pregnancy, and family income at pregnancy. Sources of data were maternal and child health record and pre-tested questionnaire. The data were analyzed by path analysis using Stata 13.Results: A path model was created based on life course perspective and longitudinal sample data. Wasting was directly and significantly affected by CF (b=−3.65; 95% CI=−5.72 – −1.59; p<0.001). The direct association between wasting and EBF was not significant (b=0.37; 95% CI=−0.76–1.49; p=0.521), while the indirect association between wasting and EBF through CF was significant (b=2.17; 95% CI=1.42–2.93; p<0.001). Wasting was directly and significantly associated with LBW (b=1.49; 95% 0.39–2.58; p=0.008). Family income at pregnancy indirectly and significantly affected the risk of wasting both through LBW and middle upper-arm circumference at pregnancy.Conclusion: EBF and CF jointly predict the risk of wasting. Only if EBF is followed by CF, it can reduce the risk of wasting in children under five. LBW is a significant predictor of wasting.