Relationship between household expenditures on

strategic foods and prevalence of undernutrition

among children 0 to 23 months of age in Indonesia

Anna Vipta Resti Mauludyani, Umi Fahmida, and Otte Santika

Abstract
Background. The global economic crisis in 2007/08
resulted in higher food prices, which increased household
food expenditures while worsening the quantity and
quality of food consumed, potentially leading to child
undernutrition.
Objective. To characterize the relationship of the mean
proportions of household expenditures on strategic foods
with the prevalence of undernutrition (high stunting,
wasting, and underweight) among children under 2 years
of age in Indonesia.
Methods. The study used data from 437 districts from
two nationally representative surveys conducted in 2007,
the National Socioeconomic Survey (Susenas) and the
Basic Health Research (Riskesdas).
Results. A higher mean proportion of household
expenditure on soybeans was significantly associated
with lower odds (3rd vs. 1st tertile) of prevalence of
high wasting (OR, 0.51; 95% CI, 0.28 to 0.94; p = .031)
and high underweight (OR, 0.09; 95% CI, 0.03 to 0.28;
p < .0001). A lower mean proportion of household
expenditure on sugar and cooking oil was significantly
associated with lower odds of prevalence of high wasting (OR, 2.41; 95% CI, 1.37 to 4.23; p = .002) and high
underweight (2nd vs. 1st tertile) (OR, 2.38; 95% CI, 1.05
to 5.41; p = .039).
Conclusions. Among all strategic foods, a higher
proportion of household expenditure on soybeans and
a lower proportion of household expenditure on sugar
and cooking oil are associated with lower odds of high
Anna Vipta Resti Mauludyani, Umi Fahmida, and Otte
Santika are affiliated with the Southeast Asian Ministers
of Education Organization, Regional Center for Food and
Nutrition, University of Indonesia, Jakarta; Anna Vipta Resti
Mauludyani is also affiliated with Bogor Agricultural University, Bogor, Indonesia.
Please direct queries to the corresponding author: Anna
Vipta Resti Mauludyani, Department of Community Nutrition, Faculty of Human Ecology, Bogor Agricultural University, Jl. Lingkar Akademik, Kampus IPB Dramaga Bogor
16680, Indonesia; e-mail: vipta11@yahoo.com.

440

wasting and underweight prevalence among children 0

to 23 months of age. The results indicate the need for
promotion of consumption of fermented soybeans and
education aiming at decreasing expenditure on sugar
and cooking oil to increase consumption of more nutritious foods.

Key words: Children 023 months old, soybean,

strategic food expenditure, undernutrition

Introduction
The global economic crisis in 2007/08, which included
food, fuel, and financial crises, resulted in higher
global food prices. Between 2000 and 2008, the Food
and Agriculture Organization (FAO) food price index
more than doubled, while the cereal price index more
than tripled [1]. Food prices also increased in Indonesia [2]. Higher food prices increased household
food expenditures while worsening the quantity and
quality of food consumed, potentially leading to child
undernutrition [3, 4].
Undernutrition is more likely to occur in the first 2
years of life and can have irreversible consequences,
such as growth failure and damage to brain and organ
development [5]. These consequences can be related to
numerous outcomes during adulthood, including short
stature, lower income, lower economic productivity,
poor intellectual ability, poor reproductive performance, high glucose concentrations, high blood pressure, and metabolic and cardiovascular diseases [6, 7].
Therefore, the first 2 years of life is a critical window of
opportunity for intervention to prevent undernutrition
and to support optimal growth and development [8, 9].
Previous studies conducted in several countries
found that higher proportions of expenditures on
nonstaple foods are associated with a lower risk of
undernutrition [1012]. A recent study in Bangladesh
using Nutrition Surveillance Project data from 2000 to
2005 showed that expenditure on rice was positively

Food and Nutrition Bulletin, vol. 35, no. 4 2014, The Nevin Scrimshaw International Nutrition Foundation.

Expenditures on strategic foods and prevalence of undernutrition

441

correlated (r = 0.91, p = .001) with the prevalence of

underweight among children 6 to 59 months old [12].
Using the same dataset, it was found that expenditure
on rice was associated with an increase in stunting
among children aged 6 to 11, 12 to 23, and 24 to 59
months (OR, 1.11; 95% CI, 1.02 to 1.20; p = .01; OR,
1.09; 95% CI, 1.04 to 1.13; p < .0001; OR, 1.13; 95% CI,
1.08 to 1.18; p < .0001, respectively) [10]. In Indonesia, children under 5 years of age in households with
higher proportions of expenditure on total nongrain
(OR, 0.85; 95% CI, 0.83 to 0.87; p < .0001 in rural areas
and OR, 0.88; 95% CI, 0.85 to 0.92; p < .0001 in urban
poor areas) and lower proportions of expenditure on
grain (OR, 1.21; 95% CI, 1.18 to 1.24; p < .0001 in rural
areas and OR, 1.09; 95% CI, 1.04 to 1.13; p < .0001 in
urban poor areas) had a lower risk of stunting. For
expenditures on total nongrain, the risk of stunting was
lowered by a similar amount by increasing expenditures
on animal-source foods (OR, 0.87; 95% CI, 0.85 to 0.90;
p < .0001 in rural areas and OR, 0.78; 95% CI, 0.74 to
0.81; p < .0001 in urban poor areas) and plant-source
foods (OR, 0.86; 95% CI, 0.84 to 0.88; p < .0001 in rural
areas) [11].
Country-level analysis should be done with the district as the unit of analysis because the districts have
local autonomy in the area of public works, including
public health (Law No. 22 of 1999 on Local Government) [13, 14]. Secondly, analysis conducted on districts can provide broader ideas for local governments
to gain a better understanding of the problems and
the potential solutions to create effective and efficient
policy [15]. Last, the nature of the problem and the
potential solution may be district specific. For instance,
the Food Security and Vulnerability Atlas of Indonesia
showed that strategies for food security are different
at the district level, since the malnutrition problem as
part of food security is different in each district [16].
Nonetheless, the relationships between undernutrition (stunting, wasting, and underweight) among
children under 2 years of age and various types of food
expenditure are not well characterized. This study aims
to characterize the relationship of mean proportion of
household food expenditure on rice, nonrice staples,
soybeans, animal protein, sugar and cooking oil, formula milk, and manufactured complementary foods
with the prevalence of undernutrition (high stunting,
wasting, and underweight) among children under 2
years old in Indonesia using the district as the unit of
analysis. We hypothesized that districts with higher
mean proportion of household expenditures on rice,
nonrice staples, and sugar and cooking oil, which are
considered less nutritious foods, and lower mean proportion of household expenditures on soybeans, animal
protein, formula milk, and manufactured complementary foods have higher odds of child undernutrition. In
order to address this hypothesis, we analyzed data from

two national surveys in Indonesia. This study describes

in more detail which household expenditures are associated with undernutrition, so that the expenditures
can taken into account in supporting the efficacy and
efficiency of the potential interventions.

Methods
Data sources

Data were collected from two nationally representative surveys: the National Socioeconomic Survey
(Susenas) and the National Basic Health Research
(Riskesdas). Both surveys were conducted in 2007 by
Statistics Indonesia and the National Institute of Health
Research and Development of Ministry of Health,
respectively. Susenas was a household survey that collected socioeconomic data from a district representative sample with a national scope, using a multistage
cluster sampling design [1719]. Clustering occurred
within census blocks that are a part of a village, having
a clear natural or created (subhamlet, hamlet, etc.)
boundary, and are located in one region. The number
of census blocks per district was proportional to the
number of households in each district (probability
proportional to size). If the number of households in a
census block was more than 150, a subcensus block was
created. Afterwards, 16 households were selected by
simple random sampling from all households in each
census block. The survey collected data on education,
demographics, housing and environment, social and
cultural activities, household expenditures, domestic
travel, and community perception of their own welfare.
The variables were classified into two categories: core,
containing general characteristics of the households,
and module, which contains data on expenditures.
The module collected data on food expenditures (215
items) and nonfood expenditures (104 items). The time
frame of expenditure on food was 1 week prior to the
interview. Data were collected in February and March
2007 by interviews using structured questionnaires
with the mother or other household members who
had knowledge of the household conditions. The total
numbers of households in the core and the module of
Susenas 2007 were 274,184 and 64,880, respectively.
The study used data from 14,767 households in the
module with children less than 2 years of age from 437
districts in 33 provinces [19].
Riskesdas was also a national survey with a district
representative sample employing a sampling design
similar to that of Susenas [20]. Riskesdas collected data
on health and nutrition, such as anthropometry, mortality, morbidity, and food consumption, by interviews
using structured questionnaires. Data were collected
in two stages, from July 2007 to January 2008 for 28

442

provinces and during August and September 2008

for 5 provinces (NTT, Maluku, North Maluku, Papua,
and West Papua). Anthropometric data from children
under 2 years of age were obtained by measuring the
childs length (to the nearest 0.1 cm) without shoes
using a length board and by measuring the childs body
weight wearing light clothing to the nearest 0.1 kg
with a digital scale. Riskesdas also conducted a single
24-hour recall to obtain data on individual intakes
of children under 2 years of age in the households.
Riskesdas collected data from 258,366 households
from 440 districts in 33 provinces, which included
31,569 children under 2 years of age. Since the unit of
analysis in this study is the district, three districts from
Riskesdas were taken out to match the districts sampled
in Susenas, resulting in 31,435 children. Finally, 25,922
children from 437 districts were used in the analyses
after exclusion based on the validity of the anthropometric measurements. We merged and linked data
from Susenas and Riskesdas by using unique identification numbers for districts.
Variables

We used monthly household expenditure (Indonesian

rupiahs [IDR]/person/month) as a proxy for household
income [10, 21, 22]. To calculate household monthly
food expenditure, existing figures on weekly food
expenditure in Susenas were divided by 7 and multiplied by 30. This study used mean household income
per district in the analysis. Among all food items, this
study used data on monthly household expenditures
on rice (rice, glutinous rice, rice meal, rice noodles),
corn (fresh corn with husk, dry shelled corn, corn
meal), cassava (cassava, dried cassava, dried cassava
flour, cassava flour), sweet potatoes, wheat flour (wheat
flour, instant noodles, wheat noodles), soybeans (soybeans, tofu, tempeh, soybean paste, soy sauce), beef,
eggs (broiler eggs, local chicken eggs, duck eggs, quail
eggs), chicken (broiler meat, local chicken meat), milk
(fresh milk, preserved milk, sweet canned liquid milk,
canned powdered milk, cheese, milk products), fish
(fresh fish, fresh shrimp, canned fish, canned shrimps),
sugar (cane sugar), cooking oil (coconut oil, corn
oil, palm oil), formula milk (baby powdered milk),
and manufactured complementary food (porridge in
package). Subsequently, we grouped these household
expenditures into seven categories: rice, nonrice (the
sum of expenditures on corn, cassava, sweet potatoes,
and wheat flour), soybeans, animal protein (the sum
of expenditures on beef, eggs, chicken, milk, and fish),
sugar and cooking oil, formula milk, and manufactured complementary food. Foods in these categories
are considered strategic foods, a term commonly
used by the Ministry of Agriculture of the Republic of
Indonesia.

A. V. R. Mauludyani et al.

Strategic foods

Strategic foods are foods that are considered important

to a large part of the community in economic, political, social, and cultural terms [23]. The proportion
of household expenditure for a strategic food was
obtained by dividing the expenditure for the food by
total household food expenditure. This study used the
mean proportions of household expenditures on strategic food for the districts. The mean household income
and mean proportion of expenditure on strategic food
are presented in tertiles.
Data from 24-hour recall in Riskesdas were represented in the form of consumption of energy (kcal),
protein (g), iron (mg), and zinc (g) in a day. Since the
data on breastmilk intake among children under 2
years of age were not available in Riskesdas, the nutrient intake for each child was compared with nutrient
requirements from complementary foods, assuming
average breastmilk intake for developing countries [24,
25]. The nutrient adequacy then was categorized as
inadequate when the percentage of the Recommended
Dietary Allowance (RDA) was less than 77%. The value
of 77% of RDA was used arbitrarily to estimate the
Estimated Average Requirement (EAR), assuming a
coefficient of variance for the nutrient of 15% about the
EAR [26]. The proportions of children with inadequate
nutrient intakes were calculated for each district. Data
on health status were obtained from the prevalence
of acute respiratory infection and diarrhea for each
district. This study also used data on the proportion of
mothers with low education, defined as having graduated from elementary school or with less education.
Data on the weight, height, age, and sex of children
under 2 years old were obtained from Riskesdas. Variables on length and weight were presented in the form
of three anthropometric indicators: length/heightfor-age z-score (HAZ), weight-for-height z-score
(WHZ), and weight-for-age z-score (WAZ). Stunting,
wasting, and underweight were determined by using a
cutoff < 2 for HAZ, WHZ, and WAZ [27]. To ensure
the quality of anthropometric data, z-scores that fell
outside the 2006 World Health Organization (WHO)
Child Growth Standard (HAZ 6 and +6, WHZ 5 and
+5, WAZ 6 and +5) were excluded [2729]. Data on
individuals were transformed into prevalence rates of
stunting, wasting, and underweight for each district.
To create district-level indicators of undernutrition,
districts were categorized as having or not having high
prevalence rates of stunting, wasting, and underweight
using predetermined cutoffs modified from the WHO
Classification for Assessing Severity of Malnutrition
by Prevalence Ranges among Children Under 5 Years
of Age [30]. High prevalence rates of stunting, wasting, and underweight among children under 2 years
old were defined as 30%, 15%, and 20% or greater,
respectively.

443

Expenditures on strategic foods and prevalence of undernutrition

Statistical analysis

Bivariate logistic regression tests were used to examine

the relationship between undernutrition (prevalence
of high stunting, wasting, and underweight) and its
covariates (mean proportion of household expenditures
on strategic foods, proportion of children with inadequate nutrient intake, prevalence of acute respiratory
infection and diarrhea, proportion of mothers with low
education, and mean household income). The mean
proportion of household expenditures on strategic
foods was entered in all multivariate logistic regression
models together with variables that were significantly
associated with undernutrition in the previous tests.
The covariates of high stunting prevalence were mean
household income and the proportion of mothers
with low education, while the multivariate model of
high wasting prevalence included the proportion of
children with inadequate energy intake. The covariate
of high underweight prevalence was the proportion of
mothers with low education. The level of significance
used in this study was p < .05. All data analyses were
conducted with SPSS, version 16.
Ethical approval

The use of the dataset for the analysis was approved by

the Indonesian Center for Agriculture Socio Economic
and Policy Studies of the Ministry of Agriculture and
the National Institute of Health Research and Development of the Ministry of Health.

Results
Household expenditure in the 437 districts ranged
between 170,000 IDR/person/month (US$18) and
332,000 IDR/person/month (US$35). Based on the
IDR to US$ conversion rate for the year 2007, the
mean household expenditure was 230,125 IDR/person/
month (US$24). Among all strategic foods, the mean
proportion of household expenditure on rice was the
highest (22.6%), followed by animal protein (12.7%).
The mean proportion of mothers with low education
was 46.9%. Nutrient intake among children under 2
years old was poor. The mean proportions of children
with inadequate intakes of energy, protein, iron, and
zinc were 33.3%, 11.1%, 81.8%, and 55.6%, respectively. The prevalence of high stunting, high wasting,
and high underweight were 46.9%, 59.5%, and 17.2%,
respectively (table 1).
A lower mean proportion of household expenditures
on animal protein was significantly associated with
lower odds (3rd vs. 1st tertile) of a high prevalence of
stunting compared with the districts in the lowest tertile (OR, 2.08; 95% CI, 1.13 to 3.82; p = .019) (table 2).
A higher mean proportion of household expenditures

TABLE 1. Characteristics of districts included in the sample

(n = 437)
Characteristic

Value

Mean household expenditureIDR(US$)/ 230,125 (24)

person/mo
Mean household income by income
tertileIDR(US$)/person/mo
1
2
3

170,000 (18)
231,000 (24)
332,000 (35)

Mean proportion of household expenditures on strategic foods (%)

Rice
Nonrice staple
Manufactured complementary food
Formula milk
Soybean
Animal protein
Sugar and cooking oil

22.6
3.7
0.1
1.5
1.7
12.7
5.53

Mean proportion of children under 2 yr

with inadequate nutrient intake (%)
Energy
Protein
Iron
Zinc

33.3
11.1
81.8
55.6

Mean proportion of mothers with low

education (%)a

46.9

High prevalence of stunting among

children under 2 yr (%)b

46.9

High prevalence of wasting among

children under 2 yr (%)c

59.5

High prevalence of underweight among

children under 2 yr (%)d

17.2

IDR, Indonesian rupiahs

a. Elementary school (graduated) or below.
b. Stunting is defined as length/height-for-age z-score (HAZ) < 2.
High stunting prevalence is defined as 30%.
c. Wasting is defined as weight-for-height z-score (WHZ) < 2. High
wasting prevalence is defined as 15%.
d. Underweight is defined as weight-for-age z-score (WAZ) < 2.
High underweight prevalence is defined as 20%.

on soybeans was associated with lower odds (3rd vs.

1st tertile) of high prevalence of wasting (OR, 0.51;
95% CI, 0.28 to 0.94; p = .031). In contrast, lower mean
proportions of household expenditures on manufactured complementary foods (OR, 1.90; 95% CI, 1.06
to 3.41; p = .032) and sugar and cooking oil (OR, 2.41;
95% CI, 1.37 to 4.23; p = .002) were also significantly
associated with lower odds (3rd vs. 1st tertile) of high
prevalence of wasting (table 3). Similar to the result
from high prevalence of wasting, this study also found
that a higher mean proportion of household expenditure on soybeans was significantly associated with
lower odds (3rd vs. 1st tertile) of high prevalence of
underweight (OR, 0.09; 95% CI, 0.03 to 0.28; p < .0001).

444

A. V. R. Mauludyani et al.

A lower mean proportion of household expenditure on

sugar and cooking oil was also significantly associated
with lower odds (2nd vs. 1st tertile) of high prevalence
of underweight (OR, 2.38; 95% CI, 1.05 to 5.41; p =
.039) (table 4).

Discussion
This study aimed to characterize the relationship of
mean proportion of household expenditure on strategic foods with the prevalence of undernutrition. The
study found that a lower mean proportion of household
expenditure on soybeans and higher mean proportions
of household expenditures on animal protein, manufactured complementary food, and sugar and cooking
oil were associated with undernutrition.
A higher proportion of household expenditure on
soybeans was associated with lower odds of prevalence
of high wasting and underweight. Protein is the primary nutrient in the body, with a role in tissue repair
and growth. Proteins also serve as hormones and other

components critical to child development [31]. Therefore, the protein content of soybeans may be associated
with reductions in wasting and underweight of children. The phytic acid contained in soybeans reduces
iron and zinc absorption [32]. However, the types
of soybean reported in this study are mostly tempeh
(soybean cake) and soybean paste, which are fermented
products. Fermentation is the best way to reduce phytic
acid, and therefore this process minimizes the reduction in iron and zinc absorption [33].
A lower mean proportion of household expenditure
on manufactured complementary food was associated with lower odds of a high prevalence of wasting.
Manufactured complementary food is one of the best
solutions to deficient nutrient intake among children,
since conventional complementary food is lacking
in key nutrients, particularly iron and zinc, so that
it is unlikely to meet the nutrient requirements for
children [34]. Manufactured complementary food is
fortified with micronutrients to meet the nutritional
requirements of children, especially those aged 6 to
24 months [35]. Iron and zinc are critical for growth

TABLE 2. Association of proportion of household expenditure on strategic foods

with high stunting prevalence among children 0 to 23 months olda
Expenditure
(tertile)

OR

95% CI

Rice

1
2
3

1.00
1.02
1.81

1.00
0.571.84
0.913.58

.939
.089

Nonrice staplesb

1
2
3

1.00
1.43
1.25

1.00
0.852.42
0.712.20

.179
.440

Manufactured complementary foods

1.00

1.00

2
3

0.90
0.66

0.511.58
0.381.16

.711
.152

Formula milk

1
2
3

1.00
0.74
1.10

1.00
0.451.22
0.602.04

.240
.759

Soybeans

1
2
3

1.00
1.14
0.86

1.00
0.671.95
0.471.56

.631
.615

Animal proteinc

1
2
3

1.00
1.63
2.08

1.00
0.942.81
1.133.82

.080
.019*

Sugar and cooking oil

1
2
3

1.00
1.37
1.32

1.00
0.812.31
0.742.34

.241
.348

Food

a. Stunting is defined as length/height-for-age z-score (HAZ) < 2. High stunting prevalence is defined as 30%. The multivariate model is adjusted for household income and
proportion of mothers with low education.
b. Nonrice staples consist of corn, cassava, sweet potatoes, and wheat flour.
c. Animal protein consists of beef, egg, chicken, and fish.
*Logistic regression, p < .05.

Expenditures on strategic foods and prevalence of undernutrition

445

during infancy and childhood, when rapid growth

occurs. Insufficient intake of these minerals may cause
retarded growth and development and impairment of
cognitive functions [36]. For example, in periurban
areas of Indonesia, even when the best combination of
iron-dense foods is recommended for complementary
feeding, the diet provides only 63% of iron requirements [37]. However, a study found that the iron
and zinc contents in 57 cereal-based manufactured
complementary foods purchased in five countries in
Africa and Asia were less than the fortification claim.
Only about 4% and 2% of the complementary foods
met the WHO estimated needs for breastfed infants
aged 9 to 11 months for iron and zinc, respectively
[38]. We also analyzed the relationship between the
mean proportion of household expenditure on manufactured complementary food and other covariates
of high wasting prevalence. We found that the mean
proportion of household expenditure on manufactured
complementary food was negatively associated with

expenditure on rice but positively associated with mean

household income. Households with high income
prefer manufactured complementary foods. The most
preferred manufactured complementary food in Indonesia is instant cereal porridge that only needs to be
mixed with hot water for preparation. The porridge is
available in various flavors and brands. High-income
households spend less time in food preparation than
low-income household [39]. As the staple food of
Indonesian people, rice is commonly consumed by
all age groups, including children under two years of
age. However, since the manufactured complementary
food is considered as food that can fulfil the nutrient
requirement of the child, households do not give their
children rice. Therefore, this poor nutrient intake may
associate with undernutrition, since the manufactured
complementary food is not able to meet the needs [38].
A higher proportion of expenditure on sugar and
cooking oil was associated with higher odds of high
prevalence rates of wasting and underweight. This

TABLE 3. Association of proportion of household expenditure on strategic foods

with high wasting prevalence among children 0 to 23 months olda
Expenditure
(tertile)

OR

95% CI

Rice

1
2
3

1.00
0.77
0.75

1.00
0.451.32
0.411.38

.346
.358

Nonrice staplesb

1
2
3

1.00
0.63
0.89

1.00
0.381.05
0.511.54

.076
.672

Manufactured complementary foods

1.00

1.00

2
3

1.76
1.90

0.983.17
1.063.41

.060
.032*

Formula milk

1
2
3

1.00
0.78
0.61

1.00
0.471.32
0.321.14

.358
.118

Soybeans

1
2
3

1.00
0.88
0.51

1.00
0.501.52
0.280.94

.634
.031*

Animal proteinc

1
2
3

1.00
1.32
1.24

1.00
0.782.24
0.682.25

.309
.485

Sugar and cooking oil

1
2
3

1.00
1.70
2.41

1.00
1.022.85
1.374.23

.042*
.002*

Food

a. Wasting is defined as weight-for-height z-score (WHZ) < 2. High wasting prevalence

is defined as 15%. The multivariate model is adjusted for proportion of children with
inadequate energy intake.
b. Nonrice staples consist of corn, cassava, sweet potatoes, and wheat flour.
c. Animal protein consists of beef, egg, chicken, and fish.
*Logistic regression, p < .05.

446

A. V. R. Mauludyani et al.

study also found that the mean proportion of household expenditure on sugar and cooking oil was negatively correlated with mean household income and
proportion of expenditure on manufactured complementary foods, formula milk, and soybeans. Manufactured complementary foods, formula milk, and
soybeans are nutrient-dense foods, while sugar and
cooking oil are energy-dense foods with less nutritional
value [35, 40, 41]. Fried food is widely preferred by
Indonesians, especially by poor people. It is cheap and
can be purchased in many places, including from street
vendors [42]. The poor nutritional value of sugar and
cooking oil is associated with undernutrition.
A lower mean proportion of household expenditure
on animal protein was significantly associated with
lower odds of a high prevalence of stunting. This
finding is not in line with the previous study [11].
Animal-source foods are good sources of bioavailable,
high-quality protein and important micronutrients
needed for growth because they are rich in micronutrients such as iron, zinc, vitamin A, and iodine [43]. Our
study also tried to relate expenditure on animal protein

with other covariates for high stunting prevalence. The

results showed that expenditure on animal protein
was positively associated with household income but
negatively associated with the proportion of mothers
with low education. It is possible that the high-income
but low-educated households allocate high proportion
of their expenditure on animal protein.
This study has limitations. Because expenditure is
made up of two different elements, prices and quantities, it cannot reflect actual consumption by the
household. However, we strongly believe that the use of
expenditure in this study provides a better description
of the position of the respective food among others,
since all are in terms of IDR/person/month.
We conclude that among all strategic foods, a higher
proportion of household expenditure on soybeans and
a lower proportion of household expenditure on sugar
and cooking oil are associated with lower odds of high
wasting and underweight prevalence among children 0
to 23 months of age. Based on these findings, we make
the following recommendations. First, since soy protein
is the only widely available plant-based protein [44]

TABLE 4. Association of proportion of household expenditure on strategic

foods with high underweight prevalence among children 0 to 23 months olda
Expenditure
(tertile)

OR

95% CI

Rice

1
2
3

1.00
1.28
0.91

1.00
0.602.72
0.421.96

.519
.801

Nonrice staplesb

1
2
3

1.00
1.02
0.64

1.00
0.482.17
0.301.41

.967
.269

Manufactured complementary foods

1.00

1.00

2
3

0.90
0.76

0.411.96
0.361.62

.780
.481

Formula milk

1
2
3

1.00
1.05
0.93

1.00
0.542.02
0.372.35

.887
.882

Soybeans

1
2
3

1.00
0.47
0.09

1.00
0.240.93
0.030.28

.030*
< .0001*

Animal proteinc

1
2
3

1.00
0.92
1.40

1.00
0.412.06
0.623.15

.829
.422

Sugar and cooking oil

1
2
3

1.00
2.38
2.23

1.00
1.055.41
0.965.20

.039*
.063

Food

a. Underweight is defined as weight-for-age z-score (WAZ) < 2. High underweight

prevalence is defined as 20%. The multivariate model is adjusted for the proportion
of mothers with low education.
b. Nonrice staples consist of corn, cassava, sweet potatoes, and wheat flour.
c. Animal protein consists of beef, egg, chicken, and fish.
*Logistic regression, p < .05.

Expenditures on strategic foods and prevalence of undernutrition

447

consumed by the majority (80%) of the households, but

still in relatively small amounts (5.4 kg/person/year),
we suggest the need for promotion of consumption of
fermented soybeans. Second, education should aim at
decreasing expenditure on sugar and cooking oil. This
could lead to increased consumption of other foods
that are more nutritious. Further study needs to be
conducted on the relationship between expenditures
on strategic foods and undernutrition as well as micronutrient deficiencies. The findings of this study may be
useful in other countries with similar characteristics.

Anna Vipta Resti Mauludyani received a scholarship to attend a course and workshop at the Harvard
School of Public Health entitled Analysis of Health
and Nutrition Data from Low-Income Countries and
also received support for manuscript preparation and
data analysis from the Higher Education Network
Ring Initiative (HENRI) Program, a partnership supported by a grant from the US Agency for International
Development-Indonesia (Cooperative Agreement
AID-497-A-11-00002) to the Harvard School of Public
Health in partnership with, and with in-kind contributions from, the SEAMEO Regional Centre for Food
and Nutrition, the University of Mataram, Andalas
University, the Summit Institute of Development, and
Helen Keller International, with additional contributions from the Rajawali Foundation and the Harvard
Kennedy School Indonesia Program. The funding
sources had no involvement in the study design, writing of the report, or in the decision to submit the paper
for publication.

Acknowledgments
Anna Vipta Resti Mauludyani received Susenas and
Riskesdas data from the Indonesian Center for Agriculture Socio Economic and Policy Studies of Ministry of
Agriculture and National Institute of Health Research
and Development of Ministry of Health, respectively.

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