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Structural Analysis of Environmental, Socio-Demographic Determinants of Malnutrition

Cheah WL
Universiti Malaysia Sarawak
[email protected]

Wang YC
Universiti Malaysia Sarawak

Zabidi-Hussin ZAMH, Manan WMW
Universiti Sains Malaysia

Malnutrition is the direct result of inadequate dietary intake, the presence of disease, or the interaction of these two factors (WHO, 1995).

In Malaysia, the percentage of children with moderate to severe malnutrition in 2000 is still high (19.1%) (Ministry of Health, 2000). This is in spite of the government’s efforts in providing food baskets and various other agencies /NGO’s efforts (Public Health Department, 2000). A total of RM6.1 million has been spent to help 5186 children suffering from malnutrition across Malaysia (Ministry of Health, 2000).

For the past 50 years, many studies from all over the world have showed that most of the nutritional problems are caused mainly by the same factors (Kikafunda et al., 1998). Most of these factors are inter-related, diverse in nature, multi-sectoral and involved different aspects ranging from biological, social, cultural to economical. The influences of these factors can originate and manifest from different levels of the child environment – family, household, community and national levels (Griffiths et al., 2003). Therefore, to plan and deliver an effective preventive intervention programme, the groups at risk must be identified and causes of malnutrition must be clearly understood. Otherwise, efforts in eradicating malnutrition would be redundant and wasteful (Tharakan & Suchindran, 1999).

There are various studies on causes of malnutrition. Many studies have proven that child health outcomes are affected by factors operating both at the individual level and within the compositional and contextual situation in which the child reside (UNICEF, 1990; Fotso & Kuate-Defo, 2005; Pande, 2003; Christiaensen & Alderman, 2001; Kikafunda et al., 1998; Nakwe, 1995). One of the framework proposed by Sastry (1996 & 1997) emphasized the effect of different levels of clustering cases within families and communities on child survival. This study has adapted the framework for the study of malnutrition determinants among children.

The development of multi-level modeling techniques has facilitated the identification of community effects on health, leading to various studies regarding the impact of community-level factors (such as environmental factors) on health outcomes (Griffiths et al., 2004; Tharakan & Suchindran, 1999; Sastry, 1996; Heaton & Forste, 2003). Understanding the

relative contribution of individual, household and community, predictions of health outcomes is important for policymakers in order to design target public health intervention.

However, many of these studies did not investigate inter-relationships among all components simultaneously. By using a comprehensive analytical method such as Structural Equation Modeling, researchers can evaluate theoretical models that are measured by multiple variables or measurement instruments -known as indicator or observed variables. (Connell et al., 1999). By using this multi-level models, one can provide a framework for analysis which is not only technically stronger but also has a much greater capacity for generality than traditional single-level statistical methods.

Conceptual Framework
Framework for interpreting community, family and individual effects on malnutrition among children under 5 years of age (Sastry, 1997):

Level of operation Biological Behavioral Environmental
Community – various levels of community (kampong/district)  
  • Health & diet
  • feeding practices
  • Shared preference for food
  • Location
  • Economic
  • Development
  • Community
  • Infrastructure
  • Health services
  • Education facilities
Household Siblings shared
  • Childcare practice
  • Health practices
  • Feeding practices
  • Maternal factors
  • Status of children in the household
  • Family food preference
  • Birth intervals
  • Household socioeconomic status
  • Sanitation
  • Food availability
  • Disease
  • Environment
  • Intra-household resource allocation
Individual
  • Siblings shared
  • Gender
  • Age
  • birthweight
  • food preferences
  • co-operation in feeding
  • Breastfeeding/Weaning
  • Prolonged breast feeding

Figure 1 : Conceptual Framework for Malnutrition (Sastry, 1997)

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