Under-five Nutritional Status and its Relationship with Household Dietary Diversity and Food Security Among the Dayak Communities in Sarawak, Malaysia

Background: Malnutrition among under-five children is one of the paramount public health concerns in the country. Objectives: This study aimed to determine the relationship between under-five nutritional status and household dietary diversity (HDD) and household food security (HFS). Methods: In this cross-sectional study analysed 808 under-five children’s data from 50 villages in five divisions of Sarawak using a multistage cluster sampling technique. Data were collected by face-to-face interview using interviewer-administered questionnaires. WHO Anthro version 3.2.2 was used for anthropometric, and IBM SPSS version 22.0 was used for multivariate data analysis. Results: Multivariate analysis showed that children with low HDD were 1.68 times more likely to be stunted than those with high HDD. Children from households with food insecurity but without hunger were 3.86 times and with hunger were 4.02 times likely to be wasted in the last three months and were almost six times more likely to stunted at the same time. The likelihood of being underweight was 2.86 times more likely to occur in households with food insecurity without hunger and 4.89 times in food insecurity with hunger households. In the past 12 months, children from households with food insecurity with hunger were 8.56 times and four times more likely to be stunted with food insecurity without hunger. Underweight children had twice the odds of occurring in households with food insecurity without hunger compared with food secured households. HFS in the last three months had a significant association with wasting, stunting and underweight of the children, while HFS in the last 12 months was associated with stunting and underweight children. Conclusion: Low HDD had resulted in stunting, and food insecurity had resulted in wasting, stunting and underweight in under-five Dayak children in rural areas of Sarawak. A food-based intervention programme should be undertaken for malnourished children

Prevalence and factors associated with undernutrition among Dayak children in rural areas of Sarawak, Malaysia

Background: Undernutrition among children has become a major public health issue due to the high risk of morbidity and mortality involving this vulnerable age group. This study focused on the rural population, especially among the Dayak children in Sarawak, Malaysia. Methodology: This community-based cross-sectional study was conducted in Sarawak’s rural areas using a multistage stratified cluster sampling technique. Data were collected through face-to-face interviews using an interviewer-guided questionnaire. The nutritional status of the under-five children was measured according to the World Health Organization guidelines. The nutritional indicators were calculated as z-scores. Multivariate logistic regression analyses were performed using SPSS to identify the factors associated with nutritional status. Results: The prevalence of undernutrition among the under-five Dayak children in the rural areas of Sarawak was 39.6%. The analysis suggested that wasting was predominantly associated with parental education levels of primary and below, poor wealth index, environmental and sanitation issues, children with history of low birth weight, shorter duration of exclusive breastfeeding, and poor appetite. Stunting was high within the age group of <3 years old and was associated with parents’ occupation and household wealth index. Low parental education, poor wealth index, environmental and sanitation issues, poor appetite, and the children’s recent illness predicted underweight. Conclusion: These findings imply that a multi-sectoral and multi-dimensional approach is essential to address undernutrition in rural settings. Improvement on households’ socioeconomy, environment and sanitation should be emphasised to reduce undernutrition among the children