The coexistence of both undernutrition and overweight/obesity, a phenomenon called double burden of malnutrition, is a global public health challenge existing at all levels from the individual to the population, especially in low-to middle-income countries.
Research on malnutrition in Indonesia found that about 20 percent of households exhibit double burden of malnutrition. In his doctoral dissertation, Umeå University researcher Masoud Vaezghasemi emphasizes the importance of social and contextual determinants in fighting against both forms of malnutrition.
“In many ways, Indonesia is a prime example to study these phenomena,” said Masoud Vaezghasemi. “As the fourth most populous country in the world, Indonesia is undergoing very fast transitions – economically, demographically, health-wise and also nutrition-wise. The Indonesian diet transformed very fast from its traditional diets high in cereal and fibre towards Western pattern diets high in sugars, fat, and animal-source foods. This caused a swift increase in the prevalence of overweight and obesity while undernutrition remains a great public health concern.”
The researchers started off with exploring the distributions of body mass index (BMI) across different socioeconomic groups in Indonesia using the Indonesian Family Life Survey (IFLS) dataset, which stands out as one of the biggest longitudinal health surveys outside the OECD. According to the results:
- Difference in BMI among people from different socioeconomic groups became smaller while people within the same socioeconomic group became more differentiated over time.
- Households were identified as a context having a great effect on the variation of BMI.
- About 20 percent of all Indonesian households exhibited a double burden of malnutrition.
- Households with a higher socioeconomic status had higher odds of double burden of malnutrition with the exception of women-headed households and communities with high social capital.
“At the contextual level, recognition of increased variation among households is important for creating strategies that respond to different needs of individuals within the same household,” said Masoud Vaezghasemi.
In a subsequent sub-study, Masoud Vaezghasemi picked up on the findings in regards to gender relations and households’ nutritional status. He conducted a qualitative study over two months in 2013 which included focus group discussions among rural and urban community members. The study was done in Indonesia’s capital Jakarta, which is the place where the researchers had identified the highest percentage of dual burden of malnutrition, and in Central Java, where said share was the lowest.
The overall results captured the significance of gendered power relations, generational relations, and the emerging obesogenic environment. According to Masoud Vaezghasemi, the findings have three main implications:
- Future intervention strategies in Indonesia must recognize that there are often different needs within the same household. When both underweight and overweight individuals live in the same household, interventions must be tailored to that or otherwise will create harm.
- Since women-headed households across different socioeconomic groups and communities with high social capital had lower rates of malnutrition, women’s empowerment and community social capital should be promoted to reduce inequalities in the double burden of malnutrition.
- Community health and nutrition programmes need to address gender empowerment and engage men in the fight against the emerging obesogenic environment and increased malnutrition, especially among children.
The first three sub-studies in Masoud Vaezghasemi doctoral thesis were based on the IFLS dataset. The IFLS is conducted by the RAND Corporation in collaboration with other international and Indonesian partners such as Gadjah Mada University. Two of those sub-studies were conducted in collaboration with Professor SV Subramanian from the Harvard T.H. Chen School of Public Health in Boston, where Masoud spent one semester as a researcher.
"Ukosefu wa lishe na uzito kupita kiasi, jambo linaloitwa ""mzigo maradufu wa utapiamlo,"" ni changamoto ya afya ya umma ulimwenguni kote, kuanzia kwa mtu binafsi hadi kwa idadi ya watu, hasa katika nchi zenye mapato ya chini hadi ya kati." Utafiti wa malnutrition nchini Indonesia umegundua kuwa asilimia 20 ya familia zinaonyesha mzigo mara mbili wa malnutrition. Katika dissertation yake ya udaktari, utafiti Umeå Chuo Kikuu Masoud Vaezghasemi inasisitiza umuhimu wa kijamii na contextual determinants katika kupambana na aina zote mbili za utapiamlo. "Kwa njia nyingi, Indonesia ni mfano bora wa kusoma matukio haya", alisema Masoud Vaezghasemi. "Kama nchi ya nne yenye idadi kubwa ya watu ulimwenguni, Indonesia inapitia mabadiliko ya haraka sana kiuchumi, idadi ya watu, afya na pia lishe.""" Chakula cha Indonesia kilibadilika haraka sana kutoka kwa vyakula vyake vya jadi vyenye nafaka nyingi na nyuzi kuelekea vyakula vya mtindo wa Magharibi vyenye sukari nyingi, mafuta, na vyakula vya asili ya wanyama. "Hii ilisababisha ongezeko la haraka la kuenea kwa uzito wa ziada na unene wa kupita kiasi wakati utapiamlo unabaki kuwa wasiwasi mkubwa wa afya ya umma. ""Watafiti walianza na kuchunguza usambazaji wa index ya wingi wa mwili (BMI) katika vikundi tofauti vya kijamii na kiuchumi nchini Indonesia kwa kutumia seti ya data ya Uchunguzi wa Maisha ya Familia ya Indonesia (IFLS), ambayo inasimama kama moja ya uchunguzi mkubwa wa afya ya urefu nje ya OECD." Kwa mujibu wa matokeo: - Tofauti katika BMI kati ya watu kutoka makundi tofauti ya kijamii na kiuchumi ikawa ndogo wakati watu ndani ya kundi moja la kijamii na kiuchumi ikawa tofauti zaidi kwa muda. - Nyumba zilitambuliwa kama mazingira yenye athari kubwa juu ya tofauti ya BMI. Karibu asilimia 20 ya familia zote za Indonesia zilikuwa na tatizo la utapiamlo. - Nyumba zenye hali ya juu ya kijamii na kiuchumi zilikuwa na uwezekano mkubwa wa mzigo maradufu wa utapiamlo isipokuwa nyumba zilizoongozwa na wanawake na jamii zilizo na mtaji wa juu wa kijamii. "Katika ngazi ya muktadha, utambuzi wa kuongezeka kwa tofauti kati ya kaya ni muhimu kwa kuunda mikakati ambayo inakabiliana na mahitaji tofauti ya watu ndani ya nyumba moja", alisema Masoud Vaezghasemi. Katika utafiti uliofuata, Masoud Vaezghasemi alichukua matokeo kuhusiana na mahusiano ya jinsia na hali ya lishe ya kaya. Katika utafiti wa mwaka wa 2013, utafiti wa kina ulifanywa na washiriki wa kikundi cha kuzingatia katika vijiji vya vijijini na mijini. Utafiti huo ulifanyika katika mji mkuu wa Indonesia, Jakarta, ambapo watafiti walipata asilimia kubwa ya mzigo wa chini ya lishe, na katika Java ya Kati, ambapo sehemu hiyo ilikuwa ya chini zaidi. Matokeo ya jumla yalionyesha umuhimu wa mahusiano ya nguvu ya kijinsia, mahusiano ya vizazi, na mazingira yanayotokea ya obesogenic. Kulingana na Masoud Vaezghasemi, matokeo yana athari kuu tatu: - Mikakati ya baadaye ya uingiliaji nchini Indonesia lazima itambue kwamba mara nyingi kuna mahitaji tofauti ndani ya kaya moja. Wakati wote chini ya uzito na overweight watu kuishi katika nyumba moja, hatua lazima kuwa tailored kwa kwamba au vinginevyo itazalisha madhara. - Kwa kuwa familia zinazoongozwa na wanawake katika vikundi tofauti vya kijamii na kiuchumi na jamii zenye mtaji wa kijamii wa juu zina viwango vya chini vya utapiamlo, nguvu za wanawake na mtaji wa kijamii wa jamii zinapaswa kuendelezwa ili kupunguza ukosefu wa usawa katika mzigo wa mara mbili wa utapiamlo. - Programu za afya na lishe za jamii zinahitaji kushughulikia kuwezesha jinsia na kuhusisha wanaume katika kupambana na mazingira yanayotokea ya uzalishaji wa mafuta na kuongezeka kwa utapiamlo, haswa kati ya watoto. Mafunzo matatu ya kwanza ya Masoud Vaezghasemi ya udaktari yalitegemea seti ya data ya IFLS. IFLS ni utafiti uliofanywa na RAND Corporation kwa kushirikiana na washirika wengine wa kimataifa na wa Indonesia kama vile Chuo Kikuu cha Gadjah Mada. Utafiti huo ulifanywa na Profesa S.V. Subramanian wa Chuo Kikuu cha Harvard. Chen Shule ya Afya ya Umma katika Boston, ambapo Masoud alitumia muhula mmoja kama mtafiti.