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Nutrient intake and iron status of urban and rural poor without access to rice fields are affected by the emerging economic crisis: the case of pregnant Indonesian women
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
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2003 (English)In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 57, no 5, 654-666 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: We evaluated the adequacy of nutrient intake in comparison with the Indonesian Estimated Average Requirement (EARs) among pregnant Indonesian women and explain the short-term effect of economic crisis on nutrient intake and iron status. DESIGN: Cross-sectional study. SETTING: Purworejo District, Central Java, located 60 km west of Yogyakarta Province, Indonesia. SUBJECTS: During the period from 1996 to 1998, up to six 24 h recalls were performed during the second trimester of pregnancy among 450 women. Nutrient intake and iron status was evaluated in relation to date of data collection relative to the economic crisis that emerged in August 1997. A computer program (Inafood) was developed to calculate nutrient intake. RESULTS:: Forty percent of the pregnant women were at risk of inadequate intake of energy and protein, and 70% were at risk of inadequate intake of vitamin A, calcium and iron even before the crisis. Our results also demonstrate an effect of short-term economic crisis on nutrient intake and iron status. When the crisis emerged, urban poor experienced a decrease in intake of most nutrients. During the crisis, rich women experienced a significant decrease in fat (P<0.05). Negative changes in fat density during crisis were experienced by the rich and the rural, poor, and access to rice field subgroups (P<0.01). A significant increase in carbohydrate densities was seen for the rich and rural, poor, and access to rice fields groups (P<0.05). Urban poor experienced decreased serum ferritin concentration (P<0.05), whereas rich women experienced a significant increase (P<0.05). CONCLUSIONS: Urban poor and rural poor landless women were most directly affected by the emerging economic crisis.

Place, publisher, year, edition, pages
2003. Vol. 57, no 5, 654-666 p.
Keyword [en]
nutrient intake, iron status, pregnancy, economic crisis, Indonesia
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-3791DOI: 10.1038/sj.ejcn.1601595PubMedID: 12771966OAI: oai:DiVA.org:umu-3791DiVA: diva2:142664
Available from: 2004-03-15 Created: 2004-03-15 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Food habits, dietary intake and nutritional status during economic crisis among pregnant women in Central Java, Indonesia
Open this publication in new window or tab >>Food habits, dietary intake and nutritional status during economic crisis among pregnant women in Central Java, Indonesia
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

FOOD HABITS, DIETARY INTAKE AND NUTRITIONAL STATUS DURING ECONOMIC CRISIS AMONG PREGNANT WOMEN IN CENTRAL JAVA, INDONESIA

Th. Ninuk Sri Hartini, Epidemiology and Public Health Sciences, Dept. of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Community Health and Nutrition Research Laboratories, Gadjah Mada University, Jogjakarta, Indonesia; Nutrition Academy, Ministry of Health, Jogjakarta, Indonesia

ABSTRACT

Objectives: The overall objective of this thesis was to study the effect of the economic crisis on food habits, dietary intake and nutritional status among pregnant women in Purworejo District, Central Java, Indonesia.

Subjects and methods: Since 1994, the Community Health and Nutrition Research Laboratories (CHN-RL), Gadjah Mada University, Jogjakarta, Indonesia have operated a surveillance system in Purworejo District, Central Java, Indonesia. Between 1996 and 1998, a monthly monitoring of new pregnancies took place within the surveillance system. This project included a detailed evaluation of dietary intake during pregnancy. Each trimester six repeated 24-hour recalls were conducted on 450 pregnant women. Weight and mid-upper arm circumference (MUAC) were measured monthly, height and serum ferritin concentration was measured once. Here, the dietary intake and nutritional status of the women during the second trimester are evaluated in relation to the emergence of the economic crisis, that started in 1997. Women were classified into four socio-economic groups. A computer program (Inafood) was developed to calculate nutrient intake. To support the quantitative results, a qualitative study was carried out between January and June 1999. Focus group discussions were held with four groups of women, in-depth interviews with 16 women, three traditional birth attendants and four midwives, and observations were carried out with four women. Here, food habits and coping strategies in relation to the economic crisis were explored.

Results: Before the crisis, more than 80% of the pregnant women had inadequate energy and 40% had inadequate protein and vitamin A intake. All women had inadequate calcium and iron intake. The food intake consisted of rice, nuts and pulses and vegetables, meaning that it was mainly plant-based food. Rice behaved as a strongly inferior good in economic term, meaning that its consumption increased in spite of its price increase. Rice remained an important supplier of energy, protein and carbohydrates also during the crisis. Especially, rural, poor women with access to rice fields increased their rice intake and decreased their intake of non-rice staple foods. Reasons for the continued rice intake included the women had been accustomed to eating rice since they were born and that cooking methods for non-rice staple foods were difficult. The intake of animal food was low initially and decreased further during the economic crisis. Rich women decreased their intake of fat. The intake of nuts and pulses and vegetables increased for most groups. Nuts and pulses were an important supplier of calcium and iron, and vegetables were an important supplier of vitamin A. The rural, poor women with access to rice fields kept their food taboos also during the crisis. Rich women were able to maintain a good nutrient intake during the crisis, although fat intake decreased. Also, urban poor and rural, poor, landless women had an increased intake “during crisis” because relatives and neighbour provided some foods and perhaps also because of the government support programme.

Conclusion: Before the crisis, energy and nutrient intake of pregnant women were inadequate. The food pattern of the women was predominately plant-based. Rich women were able to maintain a good nutrient intake during the crisis, although fat intake decreased. Rural poor women with access to rice fields had a higher rice intake than other groups throughout the crisis. Urban poor and rural poor, landless women experienced a decreased intake of most nutrients in the transition period but an increased intake during the crisis, reflecting government intervention and support from relatives and neighbours. The latter, however, is not sustainable. Thus, vulnerable groups are at risk of developing nutritional deficiencies without food support programmes.

Key words: Food intake, nutrient intake, nutritional status, food pattern, pregnancy, food habits, coping strategies, economic crisis, Indonesia.

Publisher
80 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 885
Keyword
Public health, Folkhälsomedicin
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-212 (URN)91-7305-590-5 (ISBN)
Public defence
2004-03-26, D, Tandläkarhögskolan, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
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Supervisors
Available from: 2004-03-15 Created: 2004-03-15 Last updated: 2010-01-22Bibliographically approved

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