Predictors of the double burden of malnutrition in mother and child pairs in the Special Region of Yogyakarta, Indonesia

The double burden of malnutrition in mother and child pairs has been observed mainly in countries with rapid nutrition transition. Studies investigating factors for the double burden of malnutrition have a number of limitations. Many have been restricted to less and non-modifiable determinants, such as economic status and food insecurity. More recent research has investigated factors directly related to nutrition status, but not used validated instruments relevant to the setting. This thesis investigated modifiable and proximal factors for the double burden of malnutrition among three settings in Yogyakarta, Indonesia. The first study was conducted to validate three measures, parental child feeding practice, child eating behaviour and maternal eating behaviour, by adapting instruments developed and tested in high-income countries in the west. Following a qualitative study for content validation and cultural adaptation, a cross-sectional survey was conducted with 238 mother–child pairs to test the psychometric properties of the three instruments. All three adapted instruments showed sound factorial validity and acceptable reliability. The second study was designed to test three predictive models: factors related to maternal overweight; factors related to child’s thinness; and factors related to the double burden of malnutrition. In addition to the three validated measures, data were collected on food consumption of mother and child, using a three-day 24-hour dietary recall and anthropometric measurement of mother and child. The cross-sectional survey of 379 mother and child pairs was conducted to test the hypotheses on the determinants of maternal and child nutritional status and the double burden of malnutrition status. Multivariate logistic regressions were used to test the prediction models. The first two models identified factors predictive of overweight in the mother and thinness in the child. The final model found the significant modifiable predictors of the double burden of malnutrition were maternal cognitive restraint, maternal dietary diversity, perceived parental weight, perceived child weight, pressure to eat, and child’s protein intake. Further research is needed to validate these findings in other settings and to test interventions in Indonesia based on these findings