nhms_2019.pdf

Non-Communicable Diseases: Risk Factors and other Health Problems 203 Table 14.9: Mean Weight by BMI Category Among Adults Aged 18 Years and Above in Malaysia (n=9,811) BMI Category Count Estimated Population Mean (kg) 95% CI Lower Upper MALAYSIA 9,935 20,173,950 66.7 66.10 67.24 Underweight 543 1,315,829 45.2 44.45 45.97 Normal 3,889 8,664,943 57.6 57.17 58.01 Overweight 3,280 6,103,730 70.8 70.39 71.21 Obesity 2,164 3,973,474 87.5 86.47 88.45

National Health and Morbidity Survey 2019 Technical Report − Volume I 204 This page has been intentionally left blank.

Non-Communicable Diseases: Risk Factors and other Health Problems 205 Nutritional Status of Children

National Health and Morbidity Survey 2019 Technical Report − Volume I 206 Nutritional Status of Children 15.1 Nutritional Status of Children Below 5 Years Old Contributors to this section: Ruhaya Salleh,Nur Shahida Abdul Aziz, Mohamad Hasnan Ahmad, Nursyamlina Che Abd Rahim, Azli Baharudin, Suhaila Abd. Ghaffar, Junidah Raib, Rusidah Selamat, Hamid Jan Jan Mohamad Introduction Nutritional status is an important indicator of an overall health of the population. Thus, poor maternal nutrition may lead to poor birth outcome such as low birth weight which subsequently increased the risk of the children to be malnourished [1]. The global prevalence of stunting, wasting and overweight among the children was 21.9%, 7.3% and 5.9% respectively [2][3]. According to report on other countries such as Thailand, their prevalence of stunting was 10.5%, wasting 5.4% and overweight was 8.2%, while in China 4.4% children was stunted, 3.6% wasting and 2.6% was overweight [3-5]. For children below 5 years, it indicates the food adequacy for fetus starting from the womb. Poor maternal nutrition may lead to poor birth outcome. Inappropriate food intake and environment may further affect the growth of the child after birth. The detrimental effect of nutrition and environment on child growth can be measured using appropriate anthropometric indicators such as height and weight. This information can be applied to define nutrition status of children such as underweight, overweight, wasted and stunted using a universally reference standard. Objectives General objective To determine the nutritional status of children below 5 years of age in Malaysia. Specific Objectives

1. To determine the prevalence of underweight among children below 5 years in Malaysia
2. To determine the prevalence of stunting among children below 5 years in Malaysia
3. To determine the prevalence of wasting among children below 5 years in Malaysia
4. To determine the prevalence of overweight and obese among children below 5 years in Malaysia Methods Classification of nutritional status was made according to recommendation by World Health Organization (2006). The anthropometric measurements for this survey were done by trained researchers according to the standard protocol. The nutritional status of under five children was defined using the World Health Organization Growth Standard 2006 (WHO 2006). These four indices were: • Weight for Age -z-score (for children below 5 years old) • Height-for-Age z-score (for children below 5 years old) • Weight for Height z-score (for children below 5 years old) • BMI-for-Age z-score (for children below 5 years old) Findings Underweight The national prevalence of underweight (Weight for Age < -2SD) was 14.1% (95% CI: 11.39, 17.37). By strata, children from rural areas had higher prevalence of underweight [15.6% (95% CI: 12.12, 19.93)]. Compared by sex, the prevalence of underweight was higher among males [15.5% (95% CI: 11.43, 20.70)] than females [12.6% (95% CI: 9.79, 16.20)]. By household income, the highest prevalence was noted among those from B40 income group [14.1% (95% CI: 11.23, 17.45)]. Stunting

Non-Communicable Diseases: Risk Factors and other Health Problems 207 The national prevalence of stunting (Height for Age < -2SD) among children was 21.8% (95% CI: 18.42, 25.63). Children from rural areas showed higher prevalence of stunting [22.2% (95% CI: 18.72, 26.12)] than those from urban areas [21.7% (95% CI: 17.35, 26.72)]. By sex, females showed a higher prevalence of stunting [23.5% (95% CI: 18.90, 28.77)] than males [20.2% (95% CI: 15.52, 25.89)]. Children of Bumiputera Sarawak ethnicity [41.5% (95% CI: 26.09, 58.71)] had higher prevalence of stunting. Based on the household income group, those from B40 income group had the highest prevalence of stunting [22.4% (95% CI: 18.47, 26.84)]. Wasting The national prevalence of wasting (Weight for Height < -2SD) among children was 9.7% (95% CI: 7.57, 12.25). Children from urban areas showed a higher prevalence of wasting [10.1% (95% CI: 7.47, 13.43)] than children from rural areas [8.5% (95% CI: 5.96, 12.02)]. Males showed a higher prevalence of wasting [11.3% (95% CI: 8.36, 15.21)] than females [7.9% (95% CI: 5.49, 11.16)]. Children of Malay ethnicity [11.7% (95% CI: 9.03, 15.05)] were found to have a higher prevalence of wasting. Overweight and Obese The national prevalence of overweight and obese (BMI for Age > +2SD) among children was 5.6% (95% CI: 4.13, 7.55). Children from urban areas showed a higher prevalence of overweight and obese [6.0% (95% CI: 4.19, 8.54)] than children from rural areas [4.4% (95% CI: 2.65, 7.31)]. Males showed a higher prevalence of overweight and obese [6.7% (95% CI: 4.60, 9.70)] than females [4.4% (95% CI: 2.62, 7.35)]. Based on the household income group, those in the B40 income group noted the highest prevalence of overweight and obese [6.0% (95% CI: 4.03, 8.75)]. Conclusion In conclusion, this survey showed that the prevalence of under nutrition has shown increment with underweight 14.1%, stunting 21.8% and wasting 9.1% as compared with previous survey (NHMS 2015) which found underweight was 12.4%, stunting 17.7% and wasting 8.1%. Prevalence of underweight and stunting were predominantly in rural areas and those in the B40 income group. The prevalence of over nutrition showed decreasing trends compared to the previous survey. These findings should help in future planning of programs for healthy children growth, while taking into consideration the factors that contributed to the problem of malnutrition. Recommendations

1. Focus on the first 1000 days of life with intensification and strengthening of the maternal nutrition programmed before and during pregnancy.
2. To further strengthen nutrition knowledge and practices of mothers and caregivers and increase capacity of health care personnel on monitoring and management of the nutritional status of children under 5 years of age. Table 15.1: Nutritional Status (Children Under 5 Years of Age) Trend in Malaysia 2011 2015 2019 Underweight 11.6 12.4 14.1 Stunting 16.6 17.7 21.8 Wasting 12.4 8.1 9.4 References

S.L. Loy, M. Marhazlina & J.M. Hamid Jan (2012). Association between Maternal Food Group Intake and Birth Size., Sains Malaysiana. 2012; 42(11):1633-8. 2. de Onis, Mercedes, et al., ‘Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics/WHO International Growth Reference: Implications for child health programmes’, Public Health Nutrition, vol. 9, no. 7, 2006, pp. 942– 947 3. UNICEF, Progress for Children Beyond Averages: Learning from the MDGs, New York, 2015 4. UNICEF, Division of Data Research and Policy (2018), Global UNICEF Global Databases: Infant and Young Child Feeding, New York, May 2018. 5. de Onis, Mercedes, et al., ‘Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics/WHO International Growth Reference: Implications for child health programmes’, Public Health Nutrition, vol. 9, no. 7, 2006, pp. 942– 947. 15.2 Nutritional Status Among Children 5 To 17 Years Old Contributors to this section: Nur Shahida Abdul Aziz, Ruhaya Salleh, Syafinaz Mohd Sallehuddin, Munawarah Pardi, Nursyamlina Che Abd Rahim, Azli Baharudin, Mohamad Hasnan Ahmad, Junidah Raib, Norlida Zulkafly, Rusidah Selamat, Hamid Jan Jan Mohamad Introduction The nutritional status of children is a measure of the extent to which the physiological needs of the nutrients are met. It is the balance between the intake of nutrients and the use or need of nutrients in individuals. Report from Global Database on child growth and malnutrition revealed that prevalence of overweight among girls in 2016 was 5.6% while boys 7.8%. However, there was high prevalence of overweight in India, 11.6% and lower in Chinatown Ethiopia, 1.4%, regardless of gender. Monitoring child growth in school should be emphasized to achieve the global target of having zero increment of overweight and obese prevalence among children [1][2].

National Health and Morbidity Survey 2019 Technical Report − Volume I 208 Nutritional anthropometry as measured by body weight and height can be used to reflect an individual’s past and present nutritional status. When considered in combination, anthropometric indices can be used to identify stunting (low stature), wasting (thinness), and underweight and overweight. Objectives General objective To determine the nutritional status of children and adolescents aged 5 to 17 years old in Malaysia. Specific Objectives

1. To determine the prevalence of underweight, normal weight and overweight among children and adolescent aged (5 - <10 years old) by sociodemographic in Malaysia
2. To determine the prevalence of stunting, normal, tall and very tall among children and adolescents (5 to 17 years old) by sociodemographic in Malaysia
3. To determine the prevalence of thinness, normal, overweight and obese among children and adolescents (5 to 17 years old) by sociodemographic in Malaysia Methods Classification of nutritional status was made according to recommendation by World Health Organization (2007). The anthropometric measurements for this survey were done by trained researchers according to the standard protocol. The nutritional status of adolescents was identified based on the World Health Organization Growth Reference 2007 (WHO 2007). The major indices referred to were: • Weight for age -z-score (for adolescents between 5 and 10 years old) • Height-for-Age z-score (for adolescents between 5 and 17 years old) • BMI-for-Age z-score (for adolescents between 5 and 17 years old) Findings Underweight The national prevalence of underweight (Weight for Age < -2SD) was [15.4% (95% CI: 12.78, 18.52)]. By strata, children from urban areas had higher prevalence of underweight [15.8% (95% CI: 12.58, 19.75)]. Compared to sex, the prevalence of underweight was higher among females [16.1% (95%CI: 12.39, 20.71)] than males [14.8% (95% CI: 11.72, 18.54)]. The lowest prevalence was noted among Chinese ethnicity [6.2% (95% CI: 2.55, 14.16)]. Stunting The finding of the survey shows that 85.2% (95% CI: 83.15, 87.02) of children age 5 to 17 years old had normal height- for-age status (HAZ: ≥ -2SD) with 12.7% (95% CI: 10.96, 14.70) stunting among children age 5 to 17 years old in Malaysia. Rural areas had higher prevalence of stunting [17.1% (95% CI: 13.39, 21.48)] compared to urban areas [11.3% (95% CI: 9.36, 13.47)]. Chinese had the lowest prevalence of stunting [6.7% (95% CI: 3.44, 12.78)]. Children from household with income less than RM1,000 had the highest prevalence of stunting at 18.0% (95% CI: 11.82, 26.38). Overweight and Obese The findings of this survey showed that 15.0% (95% CI: 13.31, 16.82) of adolescents were overweight and 14.8% (95% CI: 13.06, 16.70) were obese, based on their BMI-for-Age status. A total of 15.4% (95% CI: 13.34, 17.71) of children were in urban areas and 13.7% (95% CI: 11.40, 16.44) in urban areas were overweight. Males had a higher prevalence [15.7% (95% CI: 13.25, 18.50)] compared to females [14.2% (95% CI: 12.12, 16.65)]. By ethnic groups, Chinese showed the highest prevalence of overweight [18.8% (95% CI: 13.45, 25.54)] and based on household income group, children in B40 was the higher prevalence [15.4% (95% CI: 13.24, 17.76)] compared than other income groups. Among obese children, 15.3% (95% CI: 13.16, 17.78) children were in urban area and 13.2% (95% CI: 11.11, 15.61) in rural areas. Based on sex, males had a higher prevalence [17.5% (95% CI: 15.03, 20.21)] compared than female [12.0% (95% CI: 10.01, 14.36)]. According to ethnic groups, Indians show the highest prevalence of obese at 16.8% (95% CI: 10.59, 25.48) and based on household income group, children in T20 was the higher prevalence [17.8% (95% CI: 12.42, 24.91)] compared than other income groups. Conclusion The NHMS 2019 showed that the national prevalence of under nutrition children, underweight, wasting, stunting and underweight were increased by 1.7%, 4.1% and 1.6% respectively as compared with finding of NHMS 2015. However, prevalence of obesity showed increment trend which 11.9% increased to 14.8%. Prevalence of obesity was predominantly in urban area and among T20 household income group.