Double-burden of malnutrition among the indigenous peoples (Orang Asli) of Peninsular Malaysia

BACKGROUND

Double-burden of malnutrition (DBM) is an emerging public health concern among the Orang Asli (indigenous peoples) of Peninsular Malaysia. This study aimed to identify the presence of DBM at the community and household levels in Orang Asli population and its associated demographic and socio-economic factors.

METHODS

This cross-sectional study was conducted in 11 Orang Asli villages surrounding the Krau Wildlife Reserve, Peninsular of Malaysia from October 2011 to January 2012. Of 438 households, a total of 981 adults and 304 children who met the study criteria agreed to participate. About 160 households were further selected with pairs of children aged 3-59 months and non-pregnant mothers aged 15-55 years. Demographic and socio-economic data were obtained using interviewer-administered questionnaire while weight and height were measured using standard procedures. Double-burden of malnutrition was defined as overweight/obese mother-underweight child (OWOBM/UWC), overweight/obese mother-stunted child (OWOBM/STC) or overweight/obese mother-underweight or/and stunted child (OWOBM/UWSTC). Binary logistic regression identified the demographic and socio-economic factors associated with double-burden households.

RESULTS

About 26 % of overweight and obese adults coexisting with high proportions of underweight (49%) and stunted (64%) children in these Orang Asli villages. There was a higher prevalence of households with OWOBM/UWSTC (20%) and OWOBM/STC (19.4%) than households with OWOBM/UWC (12.5%). Boys (P < 0.05), older age mothers (P < 0.05), mothers with higher education (P < 0.05) and households with income per capita less than USD 29.01 (RM 97.00) (P < 0.01) were associated with higher odds of OWOBM/STC. Jah Hut (P < 0.05) and higher number of children (P < 0.05) were significantly associated with lower odds of OWOBM/UWC.

CONCLUSIONS

The occurrence of double-burden of malnutrition in Orang Asli population deserves attention. Poverty reduction, access to quality diet and improved health and nutrition literacy are among strategies that could address the coexistence of DBM in this population.

Dietary diversity is associated with nutritional status of Orang Asli children in Krau Wildlife Reserve, Pahang

INTRODUCTION

It is known that dietary diversity improves diet quality and nutritional status of young children. This study aimed to determine the relationship between dietary diversity and nutritional status of Orang Asli children in Krau Wildlife Reserve.

METHODS

A total of 216 children from three Orang Asli sub-tribes (Jah Hut, Temuan and Che Wong) aged 1 to 6 years from 162 households in 16 villages participated in this cross-sectional study. Children and mothers were measured for body weight and height. Mothers were interviewed for household socio-demographic information and diet diversity of children in the last 7 days. Diet diversity score (DDS) was calculated based on 15 food groups.

RESULTS

There was a high prevalence of underweight (50.9%) and stunting (61.6%) in Orang Asli children. For mothers, 11.1%, 27.8% and 7.4% were underweight, overweight and obese, respectively. Mean DDS of children was 6.38 [95% CI-6.10, 6.65] of the possible 15. Higher DDS of children was significantly related to older age (p < 0.05), the non Jahut sub-tribe (p < 0.01) and longer maternal years of schooling (p < 0.05). DDS was also positively related to weight-for-age z-scores (p < 0.001) and height-for-age z-scores (p < 0.05).

CONCLUSION

Undernutrition remains a major nutrition problem among Orang Asli children living within the forest reserve. Efforts to promote dietary diversity should emphasise traditional and nutritious foods that could improve health and nutritional status of the Orang Asli children.

A Qualitative Study on Coping Strategies among Women from Food Insecurity Households in Selangor and Negeri Sembilan

Understanding the experiences of household food insecurity is essential for better measurement and assessment of its nutritional, physical and psychological consequences. This qualitative study explored coping strategies and their perceived severity in relation to household food insecurity. Women (n=57; 20-50 years old) from rural and urban areas in Selangor and Negeri Sembilan participated in this study. These women were interviewed using a semi-structured questionnaire. The questionnaire was divided into two parts, that is, demographic and socio-economic information and women's experiences of coping with household food insecurity. Women were chosen since they were primarily responsible for food acquisition and preparation for the all household members. Thematic analysis was utilized in data analysis. Thematic analysis is a method for identifying, analysing and reporting patterns and themes of the qualitative data. Themes capture something important related to the study objectives and describe an integrating as well as relational idea from the data. Results showed that households displayed a variety of non-food related coping strategies and food-related coping strategies. Women's descriptions of non-food related coping strategies to food insecurity were categorised into five themes i.e. cloth purchasing behaviors, reduce school-going children's expenditure, delay the payment of bills, adjust lifestyle and increase cash and income earning. Food related coping strategies were categorised into four themes i.e. food stretching, food rationing, food seeking and food anxiety. Food stretching is a strategy of food insecurity that affects the quality of diet. Food rationing comprises coping strategies of food insecurity related to the quantity of food available for household's consumption. Food seeking is a strategy of acquiring food through socially unacceptable ways and food anxiety is a strategy that indicates households allocating money to buy staple food in order to prevent food insecurity. Each coping strategy showed a different level of perceived severity, that is, less severe, quite severe, severe and very severe. In conclusion, the qualitative data provide valuable information for understanding the experiences of food insecurity that can be used as a basis to develop direct indicators that can capture the core behaviours and their level of severity to measure household food insecurity.