Abstract
Background: Composite Index of Anthropometric Failure (CIAF) can assess anthropometric failure by combining the three conventional index measurements of weight-for-age, length/height-for-age, and weight-for-length/height to determine the nutritional status of children under five years. This study aims to assess undernutrition using the CIAF and its determinants on children under five years in the rural area of Bogor District, in Indonesia.Methods: A cross-sectional study was conducted during February-May 2019 among 330 pairs of mother-children (under five years). Sample selected by systematic random sampling from four villages as undernutrition pockets in the rural area of Bogor District, Indonesia. The nutritional status of children was assessed by measuring weight and length/height. Then, Z-score was calculated using WHO Anthro software and categorized based on conventional indices that included weight-for-age (WAZ), length/height-for-age (HAZ), weight-for-length/height (WHZ). CIAF is measured based on a combination of conventional index measurements. In addition, the characteristics of mother’s and child, and clean living behavior measured by structured questionnaires. Meanwhile, environmental sanitation is assessed by the environment meter. Binary logistic regression analysis with SPSS version 22.0 was used to analyze the dominant factors associated with undernutrition.Results: The prevalence underweight, stunted, and wasted was 27.8%, 29.7%, and 10.6% respectively. Children who are undernutrition are 42.1% according to the CIAF of which about a quarter (17.8%) of undernutrition children experience a single anthropometric failure, about half (22.2%) had dual failure, and 2.1% had multiple failures. The most dominant factor associated with underweight, stunted, and wasted is family income [p-value=0.018; AOR=5.44; 95% CI: 1.34-22.11], mother's height [p-value=<0.001; AOR=3.29; 95% CI:1.83-5.91], and child's age [p-value=0.013; AOR=2.59; 95% CI: 1.22-5.47] respectively. Mother's height is the most dominant factor associated with anthropometric failure (CIAF) [p-value=0.008; AOR=1.95; 95% CI: 2.19-3.19].Conclusion: CIAF is worthwhile in preventing undernutrition in children under five years. The CIAF can identify more malnourished children than the conventional index. CIAF can use more widely in various regions in Indonesia and other developing countries. Furthermore, improvements in improving nutrition for mother’s in the child since the First 1000 days of life period are needed to determine optimal nutritional status as an indicator of growth success.