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Community and International Nutrition

Greater Household Expenditures on Fruits and Vegetables but Not Animal Source Foods Are Associated with Decreased Risk of Under-Five Child Mortality among Families in Rural Indonesia¹

² Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205; ³ Nutrition Service, Policy, Strategy and Programme Support Division, World Food Programme, 00148 Rome, Italy; ⁴ Sight and Life, DSM, 4002 Basel, Switzerland; ⁵ Global Alliance for Improved Nutrition, 1202 Geneva, Switzerland; ⁶ Helen Keller International, New York, NY 10006; and ⁷ Helen Keller International Asia Pacific, Dhaka, Bangladesh

^* To whom correspondence should be addressed. E-mail: rdsemba{at}jhmi.edu.

The specific aims of this study were to examine the relationships between household food expenditures and under-5 child mortality among families in rural Indonesia. Data collected between 2000 and 2003 in the Indonesia Nutrition and Health Surveillance System, a population-based surveillance system conducted in 7 rural provinces, were utilized for the analysis. Food expenditures were divided into 4 major categories: plant foods (fruits and vegetables), animal foods, other nongrain foods, and grain foods (primarily rice) and expressed as quintiles of proportional food expenditure. Of 292,894 households, 32,777 (11.2%) households reported a history of under-5 child mortality. Plant food expenditures were associated with reduced odds of under-5 child mortality [odds ratio (OR), 0.70; 95% CI, 0.67–0.73; P < 0.0001) among families in the highest quintile compared with the lowest quintile, adjusting for potential confounders. Grain food expenditures were associated with increased odds of under-5 child mortality (OR, 1.25; 95% CI, 1.20–1.30; P < 0.0001) among families in the highest quintile compared with the lowest quintile, adjusting for potential confounders. Animal food expenditures were not consistently and significantly associated with under-5 child mortality across quintiles of expenditures. These findings suggest that lower under-5 child mortality is found in households that spend a greater proportion of income on plant foods and less on grain foods in rural Indonesia.