Abstract
The presence of simultaneous under- and over-nutrition has been widely documented in low- and middle-income countries, but global nutritional research has seen only a few large-scale population studies from Indonesia. We investigate the social determinants as well as the geographical variations of under- and over-nutrition in Indonesia using the largest public health study ever conducted in the country, the National Basic Health Research 2007 (N=645,032). Multilevel multinomial logistic regression and quantile regression models are fitted to estimate the association between nutritional status and a number of socio-economic indicators at both the individual and district levels. We find that: (1) education and income reduce the odds of being underweight by 10–30% but at the same time increase those of overweight by 10–40%; (2) independent from the compositional effect of poverty, income inequality is detrimental to population health: a 0.1 increase in the Gini coefficient is associated with an 8–12% increase in the odds of an individual׳s being both under- and overweight; and (3) the effects that these determinants have upon nutritional status are not necessarily homogeneous along the continuum of body mass index. Equally important, our analysis reveals that there is substantial spatial clustering of areas with elevated risk of under- or over-nutrition across the 17,000-island archipelago. As of 2007, under-nutrition in Indonesia remains a ‘disease of poverty’, while over-nutrition is one of affluence. The income inequality accompanying Indonesia׳s economic growth may aggravate the dual burden of under- and over-nutrition. A more equitable economic policy and a policy that improves living standards may be effective for addressing the double burden.
Highlights
The presence of simultaneous under- and over-nutrition has been widely documented in low- and middle-income countries, but global nutritional research has seen only a few large-scale population studies from Indonesia
Little is known about the double burden of malnutrition in Indonesia, despite the fact that it is in a state of rapid economic and epidemiologic transition where industrialisation, urbanisation and political decentralisation are met with rising income inequality, widening regional disparities and a diminishing rate of poverty reduction (World Bank, 2014)
These clearly show that, in 2007, one in three Indonesian adults was potentially suffering from nutritional problems and that the double burden of malnutrition in the country consisted relatively of both extremes of nutritional status
Summary
The presence of simultaneous under- and over-nutrition has been widely documented in low- and middle-income countries, but global nutritional research has seen only a few large-scale population studies from Indonesia. A large-scale population study covering the entire 17,000-island archipelago is, to our knowledge, non-existent as ‘there is little awareness of the double burden of malnutrition issues, be it in the government, the public or professional circles’ (Shrimpton & Rokx, 2013: 6; see WHO, 2010). We are interested in understanding (1) the pattern of association between an individual's socio-economic position and his or her nutritional status; (2) the influence of contextual factors at the district level on one's probability of being under- or overweight; and (3) the geographical distribution of the risk of malnutrition within the archipelago after accounting for the effects of observable sociodemographic determinants. Because understanding who gets the diseases and where the diseases strike is imperative for tackling the double burden (UNSCN, 2006: 7), insights gained from this analysis are of high relevance for the formulation of evidence- or need-based intervention measures—especially for policy targeting in Indonesia as well as in other parts of the developing world
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call