Forecasting the impact of maternal undernutrition on child health outcomes in Indonesia

Abstract

Maternal nutrition influences a child’s birthweight, which affects the child’s growth and subsequent survival. However, the broad consequences of maternal undernutrition and the outcomes of interventions to improve maternal nutrition take years to manifest. To examine the long-term health outcomes of low birthweight infants in response to a maternal nutritional supplementation intervention without this obstacle, we developed the Forecasting Population Progress (FPOP) microsimulation model. The intervention we assessed was based on the findings of a published clinical trial outcome that reduced the incidence of low birthweight, a known cause of stunting. We implemented the “before intervention” and “after intervention” simulations and generated the difference in outcomes, using a spatially explicit synthetic baseline population of Indonesia generated from a microdata sample of the Indonesian 2010 census. We focused specifically on two provinces—Yogyakarta and Bali—which represent different levels of fertility and mortality but both exhibit significant underweight birth. The baseline scenario represented the current nutritional status of pregnant women in the two Indonesian provinces and projected that implementing a multiple nutrition supplementation intervention would, after 30 years, avert 8 per 1,000 low birthweight births, 3.8 per 1,000 stunted children younger than 5 years of age, and 0.25 infant deaths per 1,000 births. As our model results demonstrate, improvement in maternal nutrition would reduce infant mortality, but an even greater impact could be the reduction in growth stunting.