Analysis of biological, behavioural and environmental determinants of malnutrition: a study of malnourished chidlren in Tumpat, Kelantan, Malaysia.
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Date
2010
Authors
Whye Lian, Cheah
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Abstract
Many studies have shown that poor growth in children is associated with malnutrition.
The contributing factors are diverse, multi-sectoral and interrelated, including biological,
social, cultural and economical factors. As poor growth is one of the most serious health
issues in the world, it is important for policymakers to understand the determinants, in
order to design more concise and effective public health intervention programmes. The
purpose of this cross-sectional study is to examine the relationships between biological,
behavioural and environmental factors, and malnutrition in children aged five years and
below. The instrument used in this study is based on a previously described conceptual
framework for malnutrition in children (Sastry 1996) and was tested for its psychometric
component, using both qualitative and_ quantitative methods. In addition the use of a
questionnaire, anthropometric and dietary data were collected from 295 children who
were randomly selected from clinics in Tumpat, Kelantan, Malaysia. The proposed
model was tested and modified using Structural Equation Modeling. The modified model
was adequately fitted with the data. The results demonstrate that the environmental
construct with its factors (i.e. total household income ~=0.68, p<O.Ol ; total expenditure
~=0.67, p<O.Ol ; number of rooms in house ~=0.46, p<O.Ol ; socio-economic status
~=0.71, p<O.Ol), had a significant effect on malnutrition. None of the biological and
behavioural constructs showed any significant effects. These findings provide useful
insights into the importance of focusing on environmental factors as the main target in
designing intervention programmes, patiicularly in the area that can promote economic
growth. The adoption of 'pro-poor growth', establishment of social and physical
infrastructure, and execution of public policy that directly helps the poorest groups
should be continued to the main agendas of the government in eradicating malnutrition
among children. Nevertheless, the existing health intervention on behavioral change and
infrastructure support should be continued to maintain the current nutritional status of the
childen. Moderate malnutritio~ among children 5 years and below in rural communities
is still an area of importance. The findings also have implications for the use of multiple
techniques in anthropometry for screening the nutritional status of children. Future efforts
should focus on promoting public awareness on poverty and child malnutrition among the
rural communities ; partnership between private sectors, non-governmental agencies with
government in eradicating poverty and child malnutrition, empowering communities in
the implementation of intervention programmes, and capacity building among the
communities to take care of themselves.
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Keywords
Environmental determinants , Malnourished