Risk Factors Associated with Underweight Children Under the Age of Five in Putrajaya, Malaysia: A Case-Control Study

Ruhaya Salleh, Mohamad Hasnan Ahmad, Cheong Siew Man, Norazizah Ibrahim Wong, Syafinaz Mohd Sallehuddin, Lalitha Palaniveloo, Norsyamlina Che Abdul Rahim, Azli Baharudin, Hazizi Abu Saad, Mohd Azahadi Omar, Noor Ani Ahmad


The study aimed to determine the associated factors for underweight among children under five years old in Putrajaya, Malaysia. This was a case-control study with a one-to-one ratio matched by sex as well as by three age categories (6‒11 months, 12‒35 months, dan 36‒59 months) between underweight and normal-weight children. There were 364 underweight children and 364 children with normal weight recruited from four government clinics and 118 preschools in Putrajaya. Both groups were assessed via face-to-face interviews; anthropometric measurements; haemoglobin level through finger prick blood sample; and a self-administered 3-day food diary. Underweight is defined as a weight-for-age z score less than -2SD based on World Health Organization (WHO) 2006 Growth Chart. The logistic regression’s final model revealed that various factors were significantly associated with underweight among children under five in Putrajaya. These factors included father being employed as a non-government servant [aOR:1.45 (95% CI:1.04‒2.02) compared to government servant], children from B40 group with a monthly household income less than <RM 7,380 (USD 1727.33) [aOR:2.17 (95% CI:1.01‒4.66) compared to T20], monthly expenditure for childcare less than RM 1,000 (USD 234.06), [aOR:1.77 (95% CI:1.01‒3.10) compared to ≥RM 2,000], underweight mother during prepregnancy [aOR:1.89 (95% CI:1.10‒3.26)] compared to normal weight, anemic children [aOR:1.57 (95% CI:1.15‒2.16)] compared to normal children, children using pacifiers [aOR:1.75 (95% CI:1.21‒2.73)] compared to not using pacifiers and children staying with unregistered babysitters [aOR:2.33 (85% CI:1.52‒3.59)] compared to those attending kindergarten. The above findings suggest several factors are significantly associated with underweight among children under five years old. Therefore, it highlights on the importance of improving household socioeconomic status, maternal nutritional status, and infant and young child feeding practices to prevent underweight issues in this population.


Ahmad NA, Awaluddin SM, Samad R, Kasim NM, Yusof M, Razak M, Sahril N. 2015. Validity of point-of-care testing mission plus in detecting anemia. Int J 96 J. Gizi Pangan, Volume 18, Number 2, July 2023 Biomed 5:91‒4. https://doi.org/10.21103/Article5(2)_MME1
Ahmad MH, Zaki NAM, Othman F, Baharudin A, Salleh R, Man CS, Arifien AHMZ, Kamal NIA, Ahmad NA, Saad HA, Koon PB. 2021. Malnutrition and its associated factors among children under 5 years old in Putrajaya: A study protocol. Malays J Nutr 27(1):141‒151. https://doi.org/10.31246/mjn-2020-0075
Akombi BJ, Agho KE, Merom D, RenzahoAM, Hall JJ 2017. Child malnutrition in sub-Saharan Africa: A meta-analysis of demographic and health surveys (2006‒2016). Plos One 12(5):e0177338. h t t p s : / / d o i . o rg / 1 0 . 1 3 7 1 / j o u r n a l .pone.0177338
Amin NA, Julia M. 2016. Faktor sosiodemografi dan tinggi badan orang tua serta hubungannya dengan kejadian stunting pada balita usia 6‒23 bulan. Jurnal Gizi dan Dietetik Indonesia 2(3):170‒177. https://doi.org/10.21927/ijnd.2014.2(3).170-177
Baharudin A, Ahmad MH, Naidu BM, Hamzah NR, Zaki NAM, Zainuddin AA, Nor NSM, 2017. Reliability, technical error of measurement and validity of height measurement using portable stadiometer. Pertanika J Sci Technol 25(3).
Berglund SK, Kriström B, Björn M, Lindberg J, Westrup B, Norman M, Domellöf M. 2016. Marginally low birthweight increases the risk of underweight and short stature at three and a half years of age. Acta Paediatr 105(6):610‒617. https://doi.org/10.1111/apa.13356
Bursac Z, Gauss CH, Williams DK, Hosmer DW. 2008. Purposeful selection of variables in logistic regression. Source Code Biol Med 3(1):1‒8. https://doi.org/10.1186/1751-0473-3-17
Campos MPDMS, Valença PADM, Silva GMD, Lima MDC, Jamelli SR, Góes PSAD. 2018. Influence of head and linear growth on the development of malocclusion at six years of age: a cohort study. Braz Oral Res 32. https://doi.org/10.1590/1807-3107bor-2018.vol32.0098
Department of Social Welfare. 2020. Care Centres Act 1993 (ACT 506). http://www.jkm.gov.my/jkm/index.php?r=portal/left&id=T21VOVlra1haV3p4SUp5RVJadEREUT09 [Accessed 5th January 2022].
Duggal P, Petri Jr WA. 2018. Does malnutrition have a genetic component? Annu Rev Genom Hum Genet 19:247‒262. h t t p s : / /d o i . o rg/10.1146/annurevgenom-083117-021340
Fagbamigbe AF, Kandala NB, Uthman OA. 2020. Severe acute malnutrition among under-5 children in low-and middleincome countries: A hierarchical analysis of associated risk factors. Nutr 75:110768. https://doi.org/10.1016/j.nut.2020.110768
Garza C, Borghi E, Onyango AW, de Onis M, WHO Multicentre Growth Reference Study Group. 2013. Parental height and child growth from birth to 2 years in the WHO M ulticentre G rowth R eference Study. Maternal Child Nutr 9:58‒68. https://doi.org/10.1111/mcn.12085
Gul R, Iqbal S, Anwar Z, Ahdi SG, Ali SH, Pirzada S. 2020. Pre-pregnancy maternal BMI as predictor of neonatal birth weight. Plos One 15(10):e0240748. https://doi.org/10.1371/journal.pone.0240748
Guyatt H, Muiruri F, Mburu P, Robins A. 2020. Prevalence and predictors of underweight and stunting among children under 2 years of age in Eastern Kenya. Public Health Nutr 23(9):1599‒1608. https://doi.org/10.1017/S1368980019003793
Hossain FB, Shawon MSR, Al-Abid MSU, Mahmood S, Adhikary G, Bulbul MMI. 2020. Double burden of malnutrition in children aged 24 to 59 months by ocioeconomic status in five South Asian countries: Evidence from demographic and health surveys. BMJ Open 10(3):e032866. https://doi.org/10.1136/bmjopen-2019-032866
[IPH] Institute for Public Health. 2016. National Health and Morbidity Survey (NHMS) 2016: Maternal and Child Health. Vol. II: Maternal and Child Health Findings. Malaysia (KL): Institute for Public Health, Ministry of Health Malaysia.
Kanjilal B, Mazumdar PG, Mukherjee M, Rahman MH. 2010. Nutritional status of children in India: household socioeconomic condition as the contextual determinant. Int J Equity Health 9(1):1‒13. https://doi.org/10.1186/1475-9276-9-19
Kaur R, Mathew S, Kaur M. 2017. A comparative study to assess nutritional assessment of working and non-working parents having children 0‒3 years of age at selected area, Ludhiana, Punjab. Clin Pract
14(3):184‒196. https://doi.org/10.4172/ clinical-practice.1000112
Kimani-Murage EW. 2013. Exploring the paradox: Double burden of malnutrition in rural South Africa. Glob Health Action 6(1):19249. https://doi.org/10.3402/gha.v6i0.19249
Kurnianingtyas S, Sartika RAD, Ningsih WM. 2021. Underweight in Child Aged 24‒59 Months in North Sumatra: The 2014 Indonesia family life survey data. Indonesian Journal of Public Health Nutr 1(2). https://doi.org/10.7454/ijphn.v1i2.4808
Li C, Zhu N, Zeng L, Dang S, Zhou J, Pei L, Watson V, Chen T, Wang D, Yan H. 2018. Effect of maternal pre-pregnancy underweight and average gestational weight gain on physical growth and intellectual development of early schoolaged children. Sci Rep 8(1):1‒9. https://doi.org/10.1038/s41598-018-30514-6
Li Z, Kim R, Vollmer S, Subramanian SV. 2020. Factors associated with child stunting, wasting, and underweight in 35 low-and middle-income countries. JAMA Network Open 3(4):e203386-e203386. https://doi.org/10.1001/jamanetworkopen.2020.3386
[MoHM] Ministry of Health Malaysia. 2016. National Plan of Action for Nutrition of Malaysia III 2016‒2025. Malaysia (KL): National Coordinating Committee on Food and Nutrition (NCCFN).
[MoHM] Ministry of Health Malaysia. 2018. Training Module for Food Preparation in Nurseries, Kindergartens and Preschools. First edition. Malaysia (KL): Ministry of Health Malaysia.
Mgongo M, Chotta NA, Hashim TH, Uriyo JG, Damian DJ, Stray-Pedersen B, Msuya SE, Wandel M, Vangen S. 2017. Underweight, stunting and wasting among children in Kilimanjaro region, Tanzania: A population-based cross-sectional study. Int J Environ Res Public Health 14(5):509. https://doi.org/10.3390/ijerph14050509
Motbainor A, Worku A, Kumie A. 2015. Stunting is associated with food diversity while wasting with food insecurity among underfive children in East and West Gojjam Zones of Amhara Region, Ethiopia. Plos One 10(8):e0133542. https://doi.org/10.1371/journal.pone.0133542
Mousa U. 2018. Work patterns of mothers influence the weights of their children. Turk J Endocrinol Metab 22(2). https://doi.org/10.25179/tjem.2017-59385
Mumbare SS, Maindarkar G, Darade R, Yenge S, Tolani MK, Patole K. 2012. Maternal risk factors associated with term low birth weight neonates: A matched-pair case control study. Indian Pediatr 49(1):25‒28. https://doi.org/10.1007/s13312-012-0010-z
Nackers LM, Appelhans BM. 2013. Food insecurity is linked to a food environment promoting obesity in households with children. J Nutr Educ Behav 45(6):780‒784. https://doi.org/10.1016/j.jneb.2013.08.001
Ntenda PAM. 2019. Association of low birth weight with undernutrition in preschoolaged children in Malawi. Nutr J 18(1):1‒15. https://doi.org/10.1186/s12937-019-0477-8
Roba KT, O'Connor TP, Belachew T, O'Brien NM. 2016. Anemia and undernutrition among children aged 6‒23 months in two agroecological zones of rural Ethiopia. Pediatric Health Med Ther 7:131‒140. https://doi.org/10.2147/PHMT.S109574
Suh SB, Kim HS. 2020. Influences of socioeconomic status on short stature in childhood. Kosin Med J 35(1):15‒25. https://doi.org/10.7180/kmj.2020.35.1.15
Tigga PL, Sen J. 2016. Maternal body mass index is strongly associated with childrenscores for height and BMI. Journal of Anthropology 2016:1‒10. https://doi.org/10.1155/2016/6538235
[UNICEF] United Nations Children's Fund. 2019. The State of the World's Children 2019. Children, Food and Nutrition: Growing well in a Changing World. New York (USA): UNICEF.
[U.N] United Nations. 2015. Transforming our wolrd: The 2030 agenda for sustainble development. Resolution adopted by the general assembly on 25 September 2015. https://www.un.org/en/development/desa/population/migration/generalassembly/docs/globalcompact/A_RES_70_1_E.pdf [Accessed 22nd November 2022].
Utami NH, Rachmalina R, Irawati A, Sari K, Rosha BC, Amaliah N. 2018. Short birth length, low birth weight and maternal short stature are dominant risks of stunting among children aged 0-23 months: evidence from Bogor Longitudinal Study on Child Growth and Development, Indonesia. Malaysian Journal of Nutrition 24(1).
Veena SR, Gale CR, Krishnaveni GV, Kehoe SH, Srinivasan K, Fall CH. 2016. Association between maternal nutritional status in pregnancy and offspring cognitive function during childhood and adolescence: A systematic review. BMC Pregnancy and Childbirth 16(1):1‒24. https://doi.org/10.1186/s12884-016-1011-z
Wells JC. 2019. Body composition of children with moderate and severe undernutritionm and after treatment: A narrative review. BMC Medicine 17:1‒9. https://doi.org/10.1186/s12916-019-1465-8
[WHO] World Health Organization. 2007. Indicators for Assessing Infant and Young Child Feeding Practises. Part 1 Definitions. Washington DC (USA): WHO.
[WHO] World Health Organization. 2011. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. https://apps.who.int/iris/bitstream/handle/10665/85839/WHO_NMH_NHD_MNM_11.1_eng.pdf?sequence=22&isAllowed=y [Accessed 31st December 2021].
[WHO] World Helath Organization. World health statistics 2017: Monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2017. [Accessed 14th June 2023]
Yang W, Li X, Li Y, Zhang S, Liu L, Wang X, Li W. 2012. Anemia, malnutrition and their correlations with socio-demographic characteristics and feeding practices among infants aged 0‒18 months in rural areas of Shaanxi province in northwestern China: A cross-sectional study. BMC Public Health 12(1):1‒7. https://doi.org/10.1186/1471-2458-12-1127
Yu Z, Han S, Zhu J, Sun X, Ji C, Guo X. 2013. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: A systematic review and meta-analysis. Plos One 8(4):e61627. h t t p s : / / d o i .o rg / 1 0 . 1 3 7 1 / j o u r n a l .pone.0061627


Ruhaya Salleh
ruhaya.s@moh.gov.my (Primary Contact)
Mohamad Hasnan Ahmad
Cheong Siew Man
Norazizah Ibrahim Wong
Syafinaz Mohd Sallehuddin
Lalitha Palaniveloo
Norsyamlina Che Abdul Rahim
Azli Baharudin
Hazizi Abu Saad
Mohd Azahadi Omar
Noor Ani Ahmad
SallehR., AhmadM. H., Man C. S., WongN. I., SallehuddinS. M., PalanivelooL., Che Abdul RahimN., BaharudinA., Abu SaadH., OmarM. A., & AhmadN. A. (2023). Risk Factors Associated with Underweight Children Under the Age of Five in Putrajaya, Malaysia: A Case-Control Study. Jurnal Gizi Dan Pangan, 18(2), 89-98. https://doi.org/10.25182/jgp.2023.18.2.89-98

Article Details