Determinants of multidimensional child health outcomes among infants in an urban poor setting in Makassar, Indonesia
Abstract
Child malnutrition remains a major public health challenge in Indonesia. However, the factors associated with multidimensional child health outcomes (MCHO), defined as the coexistence of anthropometric failure and infectious morbidity, remain poorly understood. Examining these conditions jointly is important because undernutrition and infection are biologically interconnected, frequently coexist, and together impose a greater burden on child health than either condition alone. This study examined maternal and child determinants of MCHO in a cross-sectional analysis nested within an ongoing birth cohort of 142 mother–child pairs (children aged 6–13 months) participating in an ongoing birth cohort in an urban poor setting in Makassar, Indonesia. Nutritional status was assessed using World Health Organization anthropometric indicators, and associations were estimated using Firth penalised-likelihood logistic regression with sensitivity analyses based on modified Poisson regression and E-values. MCHO affected 14.79% of children, while stunting, wasting, underweight, and recent infectious morbidity affected 23.94%, 19.72%, 11.97%, and 30.99%, respectively. Caesarean delivery was independently associated with MCHO, though estimated from a model with a modest events-per-variable ratio (AOR 3.09, 95% CI 1.18–8.10, p = 0.022; adjusted prevalence ratio [aPR] 2.60, 95% CI 1.17–5.77; E-value 5.63). Recent infectious morbidity was independently associated with wasting (AOR 2.57, 95% CI 1.07–6.16, p = 0.034; aPR 2.01, 95% CI 1.03–3.93; E-value 4.58). Unimproved drinking water showed consistent positive associations with MCHO, stunting, and wasting (all p < 0.10). These findings highlight the associations of maternal, infectious, and environmental factors with child health and underscore the need for integrated interventions that address nutrition, infection prevention, maternal and child health, and household environmental conditions simultaneously.