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© 2008 American Society for Nutrition J. Nutr. 138:2244-2249, November 2008

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

Ashley A. Campbell2,3, Andrew Thorne-Lyman3, Kai Sun2, Saskia de Pee3, Klaus Kraemer4, Regina Moench-Pfanner5, Mayang Sari6, Nasima Akhter7, Martin W. Bloem3 and Richard D. Semba2,*

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.


   ABSTRACT
TOP
 ABSTRACT
Introduction
 Subjects and Methods
 Results
 Discussion
 LITERATURE CITED
 
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.


   Introduction
TOP
 ABSTRACT
 Introduction
Subjects and Methods
 Results
 Discussion
 LITERATURE CITED
 
Multiple micronutrient deficiencies and chronic malnutrition are common among preschool children in southeast Asia, where the diet is primarily rice based and there is relatively low intake of animal source and other nongrain foods such as fruits and dark green leafy vegetables. Child malnutrition is a major underlying cause of mortality worldwide, accounting for an estimated 2.2 million under-5 child deaths annually (1). The Millennium Development Goal 4 calls for a reduction in under-5 child mortality by two-thirds between 1990 and 2015 (2). Policies and programs aimed at reducing child malnutrition will be critically important in reaching this goal.

Many poor households in developing countries lack the resources to grow or purchase sufficient and nutritious foods to meet their dietary needs, and thus, their diets are often deficient in energy and micronutrients. Long-term chronic consumption of a low-quality diet results in child stunting, which affects one-third to one-half of preschool children in southeast Asia (3). Dietary diversity (4) and animal source foods (5) are recognized as key components of high quality diets. Previous studies have shown that greater consumption of animal source foods is associated with better growth (6,7) and cognitive development (7,8). Animal foods are important sources of micronutrients such as vitamin A, vitamin B-12, riboflavin, calcium, iron, and zinc (5). Household food insecurity is often reflected by decreased expenditures on food in general, but especially animal source foods and fruits and vegetables (9).

Recent studies from Bangladesh and Indonesia showed a strong relationship between household rice expenditures and child malnutrition, childhood anemia, maternal night-blindness, and maternal thinness (10,11). We sought to expand these investigations to the relationships between household food expenditures and under-5 child mortality. Although a dietary pattern of high consumption of fruits and vegetables has been linked with reduced mortality in older adults (12), the relationship between the consumption of plant source foods and under-5 child mortality has not been well characterized. We hypothesized that a history of under-5 child mortality would be greater in households with lower expenditures on animal source foods and higher expenditures on grain foods. To address this hypothesis, we studied the relationships between household food expenditures and history of under-5 child mortality in rural families in Indonesia.


   Subjects and Methods
TOP
 ABSTRACT
 Introduction
 Subjects and Methods
Results
 Discussion
 LITERATURE CITED
 
The study subjects consisted of households that participated in the Nutrition and Health Surveillance System (NSS) in Indonesia that was established by the Ministry of Health, the Government of Indonesia, and Helen Keller International in 1995 (13). The NSS was conducted in the provinces of Lampung, Banten, West Java, Central Java, East Java, Lombok, and South Sulawesi. The households included in this analysis were surveyed between December 6, 2000 and September 27, 2003. The NSS was based upon UNICEF's conceptual framework on the causes of malnutrition (14) with the underlying principle to monitor public health problems and guide policy decisions (15). The NSS was based upon stratified multistage cluster sampling of households in ecological zones of provinces of the country (13). In each zone, villages were selected by probability-proportional-to-size sampling. The NSS in Indonesia involved the collection of data from ~40,000 randomly selected rural households every quarter. A different sample of households was drawn every round. Data were collected by 2-person field teams. A structured coded questionnaire was used to record data for children aged 0–59 mo, including anthropometric measurements, date of birth, and sex. Anthropometric measurements included maternal height and weight. The mother of the child or other adult member of the household was asked to provide information on the household composition, maternal age, parental education, and weekly household expenditures, along with other socioeconomic, environmental sanitation, and health indicators.

In the interview, the mother was asked whether any of her children had died and if yes, what was the age of the child. The participation rate of families in the surveillance system was >97% and the main reason for nonresponse was that the family had moved out of the area or was absent at the time the interviews were conducted. Nonresponse because of refusal to participate in the surveillance system was very low (<1%).

The interviewee was asked to provide a sample of salt that was used in the household and the interviewer tested the sample for the presence of iodine using a UNICEF rapid test kit (PT Kimia Farma). The kit was used to distinguish between salt with ≥30 mg/L (adequate) or ≤30 mg/L (inadequate) iodine. The kit provided for possible outcomes of no color to light purple color that is lighter than the reference color (<30 ppm) or purple color same as or darker than the reference color (≥30 mg/L). In this article, the term adequately iodized salt is used to refer to salt that tested positive for ≥30 mg/L iodine (16).

The NSS included questions on weekly expenditures on food and other commodities. In each household, data were gathered regarding the expenditures in the previous week on rice, other staple foods (cassava, sago, etc.), eggs, vegetables, and other plant sources of food (bean curd, tempeh), fruits, cooking oil, beef, chicken, fish, sugar, instant noodles, milk, snacks, clothes, housing, education, cigarettes, savings, social activities, medicine, production activities, recreation, transportation, pocket money, water, and other (gasoline, electricity, telephone, soap, seasonings, etc.). Food expenditures were divided into 4 categories: 1) plant foods, consisting of fruits, vegetables, and other plant sources (bean curd, tempeh); 2) animal foods, consisting of beef, goat, chicken, horse, fish, milk, and eggs; 3) other nongrain foods, consisting of snacks, noodles (commonly consumed as a snack), sugar, cooking oil; and 4) grain food expenditures, consisting of rice, corn, sago, cassava, and wheat flour. The category of total nongrain foods consisted of the total of the first 3 food categories. The NSS also included questions regarding household consumption of vegetables, but not consumption of fruits, in the last 3 d.

The study protocol complied with the principles enunciated in the Helsinki Declaration (17). The field teams were instructed to explain the purpose of the NSS and data collection to each child's mother or caretaker, and, if present, the father and/or household head; data collection proceeded only after written informed consent. Participation was voluntary and all subjects were free to withdraw at any stage of the interview. The protocol was approved by the Medical Ethical Committee of the Ministry of Health, Government of Indonesia, and the plan for secondary data analysis was approved by the Institutional Review Board of the Johns Hopkins School of Medicine.

Categorical variables were compared using chi-square tests. Multivariate logistic regression models were used to examine the relationship between food expenditure and under-5 child mortality. Separate multivariate models were used to examine the relationships between food categories and under-5 child mortality. Variables that were significantly associated with under-5 child mortality in univariate analyses were included in the final multivariate models. Population-based weighting was used to account for differences in population size of the various provinces. The level of significance in this study was P < 0.05.


   Results
TOP
 ABSTRACT
 Introduction
 Subjects and Methods
 Results
Discussion
 LITERATURE CITED
 
Of 292,894 households, 32,777 (11.2%) reported a history of under-5 child mortality. The demographic characteristics and food expenditure categories are shown for households with and without under-5 child mortality (Table 1). In this table, we report plant food, animal food, other nongrain food, total nongrain food, and grain food expenditures as a percentage of total weekly food expenditure per capita. Households with mothers who were older, less educated, and underweight, that have >4 household members sharing the same kitchen, have a father who smoked, use adequately iodized salt less often, and had lower weekly household expenditure per capita were more likely to have under-5 child mortality. Households that spent less money on plant and animal foods and spent more money on other nongrain foods and on grain foods had more under-5 child mortality. Total nongrain food expenditures were lower in households with under-5 child mortality. Under-5 child mortality was highest in Lombok, West Sumatra, and Banten, and lowest in Central Java and West Java.


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  		TABLE 1 Characteristics of families with and without a history of under-5 child mortality in rural Indonesia

 
Separate multivariate models were performed to examine the relation between plant food, animal food, other food, and total nongrain food expenditures and under-5 child mortality (Table 2). As in Table 1, all expenditures are reported as a percentage of total weekly food expenditure per capita. Families in the higher quintiles of plant food expenditures had significantly lower odds of having under-5 child mortality in a multivariable model adjusting for maternal age, maternal education, maternal BMI, paternal smoking, use of adequately iodized salt, weekly per capita household expenditure, and location. The relationship between animal food expenditures and odds of having under-5 child mortality in the household was not significant and not consistent across higher quintiles of expenditure. The relationship between other nongrain food expenditures and odds of having under-5 child mortality in the household was also not significant and not consistent across higher quintiles of expenditure. Families in the higher quintiles of total nongrain food expenditures had significantly lower odds of having under-5 child mortality. Families in the higher quintiles of grain food expenditures had significantly higher odds of having under-5 child mortality.


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  		TABLE 2 Separate multivariate models for percent of weekly food expenditures on plant food, animal food, other food, and total nongrain food and odds of under-5 child mortality among families in rural Indonesia1

 
Given the strong and significant relationship between the percent expenditure on plant foods and under-5 child mortality, additional analyses were conducted to determine whether absolute weekly expenditure (i.e. actual amount spent) on plant foods and total weekly food expenditure (nongrain plus grain foods) were related to under-5 child mortality. The relationships between absolute weekly plant food expenditures per capita and total weekly food expenditures per capita and under-5 child mortality were examined in separate multivariate logistic regression models (Table 3). Compared with the lowest quintile of absolute weekly plant food expenditures, households in the higher quintiles of weekly plant food expenditure per capita had significantly lower odds of under-5 child mortality. In comparison, quintiles of total weekly food expenditures per capita were not significantly associated with under-5 child mortality.


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  		TABLE 3 Separate multivariate models for absolute weekly plant food expenditures and absolute total weekly food expenditures and odds of under-5 child mortality among families in rural Indonesia1

 
The percentage of weekly per capita household expenditure on plant foods, animal foods, grain foods, and other nongrain foods is shown in families with and without a history of under-5 child mortality (Fig. 1). The households were stratified into quintile of weekly per capita household expenditure. Within each quintile, expenditures on plant foods were lower and expenditures on grain foods were higher in households with under-5 child mortality.


Figure 1
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  		FIGURE 1  Percent of weekly household expenditure on plant foods, animal foods, other foods, and nongrain foods in households with (n = 32,777) and without (n = 260,117) under-5 child mortality, stratified by quintile of weekly per capita household expenditure.

 
The relationships between absolute plant food expenditures and under-5 child mortality were further explored in families within the 5 quintiles of total weekly household expenditure (Table 4). Among households within each quintile of total weekly household expenditure, compared with the lowest quintile of expenditure on plant foods, higher expenditure on plant foods was associated with lower odds of under-5 child mortality. In general, within each quintile of total weekly household expenditure, greater weekly expenditure on plant foods was associated with lower odds of under-5 child mortality.


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  		TABLE 4 Separate multivariate models of the relationship of absolute weekly plant food expenditures with under-5 child mortality among families within 5 quintiles of total weekly household expenditure per capita in rural Indonesia1

 
The relationship between plant food expenditures and under-5 child mortality was further explored by a round of data collection to determine whether the relationship was consistent over time, because commodity prices fluctuated during the study period. The odds ratios (OR) for under-5 child mortality are shown for households in the highest quintile compared with the lowest quintile of plant food expenditures by round of data collection from 2000 to 2003 (Fig. 2). Households in the highest quintile of plant food expenditures had significantly lower odds of under-5 child mortality at each round of data collection through the entire study period.


Figure 2
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  		FIGURE 2  OR for history of under-5 child mortality among families in the highest quintile of plant food expenditures (n = 58,470) compared with the lowest quintile (n = 58,491), by round of data collection from 2000 to 2003. Separate multivariate logistic regression models were analyzed for each round of data collection and adjusted for maternal age, maternal education, maternal BMI, paternal smoking, use of adequately iodized salt, weekly per capita household expenditure, and location. Upper and lower lines indicate 95% CI.

 
Given the relationship between plant food expenditures and under-5 child mortality, the relationship between household food consumption of vegetables in the last 3 d and under-5 child mortality was explored, where under-5 child mortality was the dependent variable. Households in the higher quintile of per capita vegetable consumption, from the 5th to the 2nd quintile, respectively, compared with the lowest quintile, had lower odds of under-5 child mortality in a multivariate logistic regression model adjusting for maternal age, maternal education, maternal BMI, paternal smoking, use of adequately iodized salt, expenditure on grain foods, weekly per capita household expenditure, and location (Table 5).


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  		TABLE 5 Multivariate logistic regression model for per capita household food consumption of vegetables in the last 3 d and odds of under-5 child mortality among families in rural Indonesia1

 

   Discussion
TOP
 ABSTRACT
 Introduction
 Subjects and Methods
 Results
 Discussion
LITERATURE CITED
 
This study shows that households that spend a greater proportion on plant foods have lower under-5 child mortality in rural Indonesia. Contrary to our original hypothesis, there was not a consistent and strong relationship between expenditures on animal source foods and a history of under-5 child mortality even though previous studies would lead one to expect a significant relationship (6–8). In contrast, the relationship between higher expenditure on plant foods and lower odds of under-5 child mortality was strong and consistent, whether plant foods were considered as percentage of total weekly per capita household expenditure, as absolute weekly per capita expenditure, or among households within each quintile of total weekly household expenditure. Thus, even after controlling for the well-documented tendency of wealthier households to diversify their diets, expenditures of plant source foods remained an important predictor of child mortality risk (18,4).

Fruits and vegetables are important sources of dietary polyphenols, provitamin A carotenoids, folate, and vitamin C, but whether these nutrients can explain the association between greater expenditures on plants foods and lower under-5 child mortality is not clear. In the Sudan, greater consumption of tomatoes was associated with a lower risk of child morbidity and mortality (19). Lower intake of fruits and vegetables was associated with greater respiratory symptoms in a study of >20,000 children in 6 European countries (20).

Household rice expenditure has previously been associated with child underweight in Bangladesh (10). This study extends these findings and suggests that households that spend a greater percentage of weekly food expenditures on grain foods (primarily rice) have higher under-5 child mortality, even after adjusting for weekly household expenditures and other potential confounders. In this study, the poorest households spent a larger proportion of weekly food expenditure on rice and a smaller proportion on plant foods and animal foods.

The analyses in the present study adjusted for other factors that are known to be associated with greater under-5 child mortality, including lower maternal education (21), maternal BMI, paternal smoking (22), and use of adequately iodized salt (16). Under-5 child mortality was highest in Lombok, West Sumatra, and Banten, which are the 3 poorest provinces of the 8 included in the NSS.

The study has some limitations. The data from the NSS are cross-sectional and there could be unmeasured changes over time between food expenditures at the time the data were collected in relation to the time of an under-5 child death in the family. Changes in the prices of foods could affect the pattern of household food expenditures (10). However, data from the NSS show that the relationship between plant food expenditures and under-5 child mortality was consistent over time, even when food prices, such as rice, were fluctuating in the period following the Asian economic crisis. The data from the NSS did not measure what specific foods were purchased or how food was distributed within the family. It is possible that the reason a strong association was not found between expenditures on animal source foods and under-5 child mortality was due to uneven distribution of animal source foods within the family. Although Indonesia is fairly representative of a rice-based rural food economy in southeast Asia, the findings from this study cannot necessarily be extrapolated to other countries. Further studies are needed to corroborate these findings in other settings in developing countries.

Future studies are needed to determine whether food insecurity, as measured by various assessment tools, is associated with under-5 child mortality. Whether consumption of animal source foods are or are not associated with under-5 child mortality needs to be explored in other settings.


   FOOTNOTES
 
1 Author disclosures: A. A. Campbell, A. Thorne-Lyman, K. Sun, S. de Pee, K. Kraemer, R. Moench-Pfanner, M. Sari, N. Akhter, M. W. Bloem, and R. D. Semba, no conflicts of interest. Back

Manuscript received 8 May 2008. Initial review completed 7 June 2008. Revision accepted 3 August 2008.


   LITERATURE CITED
TOP
 ABSTRACT
 Introduction
 Subjects and Methods
 Results
 Discussion
 LITERATURE CITED
 

1. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371:243–60.[Medline]

2. Murray CJL, Laakso T, Shibuya K, Hill K, Lopez AD. Can we achieve Millennium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015. Lancet. 2007;370:1040–54.[Medline]

3. Semba RD, de Pee S, Sun K, Sari M, Akhter N, Bloem MW. Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study. Lancet. 2008;371:322–8.[Medline]

4. Ruel MT. Operationalizing dietary diversity: a review of measurement issues and research priorities. J Nutr. 2003;133:S3911–26.[Abstract/Free Full Text]

5. Murphy SP, Allen LH. Nutritional importance of animal source foods. J Nutr. 2003;133:S3932–5.[Abstract/Free Full Text]

6. Grillenberger M, Neumann CG, Murphy SP, Bwibo NO, Weiss RE, Jiang L, Hautvast JGAJ, West CE. Intake of micronutrients high in animal-source foods is associated with better growth in rural Kenyan school children. Br J Nutr. 2006;95:379–90.[Medline]

7. Neumann CG, Murphy SP, Gewa C, Grillenberger M, Bwibo NO. Meat supplementation improves growth, cognitive, and behavioral outcomes in Kenyan children. J Nutr. 2007;137:1119–23.[Abstract/Free Full Text]

8. Whaley SE, Sigman M, Neumann C, Bwibo N, Guthrie D, Weiss RE, Alber S, Murphy SP. The impact of dietary intervention on the cognitive development of Kenyan school children. J Nutr. 2003;133:S3965–71.[Abstract/Free Full Text]

9. Melgar-Quinonez HR, Zubieta AC, MkNelly B, Nteziyaremye A, Gerardo MFD, Dunford C. Household food insecurity and food expenditure in Bolivia, Burkina Faso, and the Philippines. J Nutr. 2006;136:S1431–7.[Abstract/Free Full Text]

10. Torlesse H, Kiess L, Bloem MW. Association of household rice expenditure with child nutritional status indicates a role for macroeconomic food policy in combating malnutrition. J Nutr. 2003;133:1320–5.[Abstract/Free Full Text]

11. Bloem MW, de Pee S, Darton-Hill I. Micronutrient deficiencies and maternal thinness: first chain in the sequence of nutrition and health events in economic crises. In: Bendich A, Deckelbaum RJ, editors. Preventive nutrition: the comprehensive guide for health professionals. 3rd ed. Totowa (NJ): Humana Press; 2005.

12. Nöthlings U, Schulze MB, Weikert C, Boeing H, van der Schouw YT, Bamia C, Benetou V, Lagiou P, Krogh V, et al. Intake of vegetables, legumes, and fruit, and risk for all-cause, cardiovascular, and cancer mortality in a European diabetic population. J Nutr. 2008;138:775–81.[Abstract/Free Full Text]

13. de Pee S, Bloem MW, Sari M, Kiess L, Yip R, Kosen S. High prevalence of low hemoglobin concentration among Indonesian infants aged 3–5 months is related to maternal anemia. J Nutr. 2002;132:2215–21.[Abstract/Free Full Text]

14. de Pee S, Bloem MW. Assessing and communicating impact of nutrition and health programs. In: Semba RD, Bloem MW, eds. Nutrition and health in developing countries. Totowa (NJ): Humana Press; 2001. p. 483–506.

15. Mason JB, Habicht JP, Tabatabai H, Valverde V. Nutritional surveillance. Geneva: WHO; 1984.

16. Semba RD, de Pee S, Hess SY, Sun K, Sari M, Bloem MW. Child malnutrition and mortality among families not utilizing adequately iodized salt in Indonesia. Am J Clin Nutr. 2008;87:438–44.[Abstract/Free Full Text]

17. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79:373–4.[Medline]

18. Hoddinott J, Yohannes Y. Dietary diversity as a household food security indicator. Washington, DC: Food and Nutrition Technical Assistance: 2002.

19. Fawzi W, Herrera MG, Nestel P. Tomato intake in relation to mortality and morbidity among Sudanese children. J Nutr. 2000;130:2537–42.[Abstract/Free Full Text]

20. Antova T, Pattenden S, Nikiforov B, Leonardi GS, Boeva B, Fletcher T, Rudnai P, Slachtova H, Tabak C, et al. Nutrition and respiratory health in children in six Central and Eastern European countries. Thorax. 2003;58:231–6.[Abstract/Free Full Text]

21. Houweling TAJ, Jayasinghe S, Chandola T. The social determinants of childhood mortality in Sri Lanka: time-trends and comparisons across South Asia. Indian J Med Res. 2007;126:239–48.[Medline]

22. Semba RD, de Pee S, Sun K, Best C, Sari Y, Bloem MW. Paternal smoking and increased risk of infant and under-five child mortality in Indonesia. Am J Public Health.





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