The Existence of Double-Burden of Malnutrition in the Same Households in Eastern Indonesia: Analysis Using Global Vs. Alternative Asian BMI Cut-off Points

The study utilizes the data from the first round of Indonesian Family Life Survey conducted in the eastern part of the country (IFLS East) during 2012 to identify child-mother pairs which experience the Double Burden of Malnutrition (DBM) - a situation where overnutrition of the mother and undernutrition of the child coexist within the same household. The analyisis is done using several cross tabulations and comparisons to determine outcomes for the two separate Body Mass Index (BMI) measurement classifications; the Global-Cut off and the Asian Cut-off. The study also explores the difference in household characteristic as factors contributing to DBM. The results showed that the prevalence of child undernourishment within the IFLS East is considerably high, especially for the stunting prevalence (44%). The results also showed that the use of the Asian-Cut off for classification of BMI raises the prevalence of mothers in the categories of overweight and obese from 32% to 46%, consequently raising the prevalence of DBM child-mother pairs by 6 percentage points. The study was able to detect a significant risk factor for DBM of maternal short stature, but was not able to detect other significant factors leading to the presence of the DBM child-mother pair. The paper argues that more research is required into the special characteristics of the women in between the two cut-off classifications, as well as their children. Findings of the additional research may lead to a determination of the appropriateness of the Asian Cut-off as more accurately capturing the severity and prevalence of double burden of malnutrition amongst the population. Several policy recommendations for the further monitoring and analysis of DBM and obesity amongst women of child bearing age are provided

Toward a Sustainable Food System in West Papua, Indonesia: Exploring the Links Between Dietary Transition, Food Security, and Forests

Natural tropical forests cover 89% of the land area of West Papua Province, Indonesia. Forests have traditionally been an important part of local food systems for Indigenous Papuans. Despite the contribution of forests to food security, West Papua has been ranked as one of the most food-insecure provinces in Indonesia, with high rates of both under-and-overnutrition. This paper aims to discuss the dietary transition taking place in West Papua and uses local perspectives to explore the link between changes in diets, food security, and forests. We used mixed methods with a triangulation design to corroborate the quantitative data that we present from two rounds of the National Socioeconomic Survey (SUSENAS) on food consumption for West Papua from 2008 and 2017, with information from four focus group discussions with institutional and local stakeholders. The quantitative analysis showed that West Papua is experiencing a dietary transition, moving away from the consumption of traditional foods, such as sago, tubers, wild meat, and fresh legumes, toward diets with more rice, chicken, tofu, and tempeh. The consumption of processed and ultra-processed food (UPF) has increased while the consumption of fresh food has decreased. The qualitative analysis confirmed these findings. The institutional stakeholders expressed a desire for Papuans to return to eating traditional diets for better food security, whereas the local stakeholders worried about their children's high consumption of UPFs. We also found a disconnect between how food security is measured by the national Food Security Index (FSI) and the point of view of the institutional stakeholders. While the FSI indicators are more infrastructure-related measures, the institutional stakeholders link food security with the availability, accessibility, stability, and sustainability of the food sources in their surrounding environment, especially the forests. The institutional stakeholders support the commitment of the provincial government to maintain at least 70% of the forest cover in West Papua, as stated in the Manokwari Declaration although they expressed the need for more clarity on how this will impact their food security. The Indonesian government and the international community should support this initiative and carry it out with substantial input from local Papuan stakeholders

Global Burden of Double Malnutrition: Has Anyone Seen It?

Background. Low- to middle-income countries (LMICs) are believed to be characterized by the coexistence of underweight and overweight. It has also been posited that such coexistence is appearing among the low socioeconomic status (SES) groups. Methods. We conducted a cross-sectional analysis of nationally representative samples of 451321 women aged 20–49 years drawn from 57 Demographic and Health Surveys conducted between 1994 and 2008. Body Mass Index (BMI in $kg/m^2$), was used to define underweight and overweight following conventional cut-points. Covariates included age, household wealth, education, and residence. We estimated multinomial multilevel models to assess the extent to which underweight $(BMI<18.5 kg/m^2)$ and overweight $(BMI≥25.0 kg/m^2)$ correlate at the country-level, and at the neighborhood-level within each country. Results. In age-adjusted models, there was a strong negative correlation between likelihood of being underweight and overweight at country- (r = −0.79, p<0.001), and at the neighborhood-level within countries (r = −0.51, P<0.001). Negative correlations ranging from −0.11 to −0.90 were observed in 46 of the 57 countries at the neighborhood-level and 29/57 were statistically significant $(p\leq 0.05)$. Similar negative correlations were observed in analyses restricted to low SES groups. Finally, the negative correlations across countries, and within-countries, appeared to be stable over time in a sub-set of 36 countries. Conclusion. The explicitly negative correlations between prevalence of underweight and overweight at the country-level and at neighborhood-level suggest that the hypothesized coexistence of underweight and overweight has not yet occurred in a substantial manner in a majority of LMICs

Internal validity of a household food security scale is consistent among diverse populations participating in a food supplement program in Colombia

Objective: We assessed the validity of a locally adapted Colombian Household Food Security Scale (CHFSS) used as a part of the 2006 evaluation of the food supplement component of the Plan for Improving Food and Nutrition in Antioquia, Colombia (MANA – Plan Departamental de Seguridad Alimentaria y Nutricional de Antioquia). Methods: Subjects included low-income families with pre-school age children in MANA that responded affirmatively to at least one CHFSS item (n = 1,319). Rasch Modeling was used to evaluate the psychometric characteristics of the items through measure and INFIT values. Differences in CHFSS performance were assessed by area of residency, socioeconomic status and number of children enrolled in MANA. Unidimensionality of a scale by group was further assessed using Differential Item Functioning (DIF). Results: Most CHFSS items presented good fitness with most INFIT values within the adequate range of 0.8 to 1.2. Consistency in item measure values between groups was found for all but two items in the comparison by area of residency. Only two adult items exhibited DIF between urban and rural households. Conclusion: The results indicate that the adapted CHFSS is a valid tool to assess the household food security of participants in food assistance programs like MANA