Toddler’s Nutritional Status: the effect of infection rate as a mediating factor
DOI:
https://doi.org/10.56294/saludcyt20251812Keywords:
Nutritional Status, Infection, Mother Knowledge, Feeding Practice, Socioeconomic, ToddlersAbstract
This article examines how infection rate, as a mediating factor, affects toddlers' nutritional status in developing regions. A comprehensive cross-sectional study was conducted on 302 pairs of mothers and toddlers in four districts of West Sumatra, Indonesia. The research collected extensive data on socioeconomic factors including household income, maternal nutritional knowledge, feeding practices, toddlers' nutritional status mediated by infection rate, and the relationship between maternal knowledge and feeding practice. The findings support three of the four proposed hypotheses, providing valuable insights into child health determinants in resource-limited settings. The collected data was analyzed using SPSS 21 with descriptive statistics and partial least squares structural equation modeling (PLS-SEM) to ensure statistical rigor. Statistical analysis demonstrated significant relationships between variables. The findings reveal several important relationships: 1) there is a positive effect of income on nutritional status mediated by infection, highlighting socioeconomic influences; 2) there is a positive effect of maternal knowledge on nutritional status mediated by infection, emphasizing educational components; 3) there is no indirect effect of feeding practices on nutritional status mediated by infection, contrary to initial expectations; and 4) there is a direct relationship between maternal knowledge and feeding practice, confirming educational impact on care behaviors. Nutritional status and infection are strongly interrelated in a synergistic relationship, where each factor impacts the other. The infection rate serves as a critical mediating factor affecting toddlers' nutritional status in developing regions. These results support further longitudinal studies to investigate specific infection factors affecting toddlers across different developmental stages and socio-economic contexts.
References
1 Abate HK, Kidane SZ, Feyessa YM, Gebrehawariat EG. Mortality in children with severe acute malnutrition. Clin Nutr ESPEN. 2019 Oct;33:98-104. doi: 10.1016/j.clnesp.2019.07.001. Epub 2019 Jul 19. PMID: 31451282.
2 Ewusie JE, Beyene J, Ahiadeke C, Hamid JS. Malnutrition in Pre-school Children across Different Geographic Areas and Socio-Demographic Groups in Ghana. Matern Child Health J. 2017 Apr;21(4):797-808. doi: 10.1007/s10995-016-2173-z. PMID: 27520556.
3 World Health Organization, United Nations Children’s Fund (Unicef), World Bank. Levels And Trends In Child Malnutrition: Unicef / Who / The World Bank Group Joint Child Malnutrition Estimates: Key Findings Of The 2021 Edition. 2021.
4 Zhang YQ, Li H, Wu HH, Zong XN. Stunting, wasting, overweight and their coexistence among children under 7 years in the context of the social rapidly developing: Findings from a population-based survey in nine cities of China in 2016. PLoS One. 2021 Jan 14;16(1):e0245455. doi: 10.1371/journal.pone.0245455. PMID: 33444425; PMCID: PMC7808628.
5 Sablah M. Causes And Impacts Of Undernutrition Over The Life Course. In: Nutrition. Unicef; 2019.
6 Krawinkel MB. Interaction of nutrition and infections globally: an overview. Ann Nutr Metab. 2012;61 Suppl 1:39-45. doi: 10.1159/000345162. Epub 2013 Jan 21. PMID: 23343946.
7 Schaible UE, Kaufmann SH. Malnutrition and infection: complex mechanisms and global impacts. PLoS Med. 2007 May;4(5):e115. doi: 10.1371/journal.pmed.0040115. PMID: 17472433; PMCID: PMC1858706.
8 Macallan D. Infection And Malnutrition. Medicine (Baltimore). 2009;37(10):525–8. https://doi.org/10.1016/j.mpmed.2009.07.005
9 Suminar, Ervi & Wibowo, Ach. (2021). The Correlation Between Infection Diseases History and Nutritional Status in Toddler. Fundamental and Management Nursing Journal. 4. 18. 10.20473/fmnj.v4i1.21587.
10 Katona P, Katona-Apte J. The interaction between nutrition and infection. Clin Infect Dis. 2008 May 15;46(10):1582-8. doi: 10.1086/587658. PMID: 18419494.
11 Nuño, N., Mäusezahl, D., Hattendorf, J. et al. Effectiveness of a home-environmental intervention package and an early child development intervention on child health and development in high-altitude rural communities in the Peruvian Andes: a cluster-randomised controlled trial. Infect Dis Poverty 11, 66 (2022). https://doi.org/10.1186/s40249-022-00985-x.
12 He, P., Baiocchi, G., Hubacek, K. et al. The environmental impacts of rapidly changing diets and their nutritional quality in China. Nat Sustain 1, 122–127 (2018). https://doi.org/10.1038/s41893-018-0035-y.
13 Panda, B. K., Mohanty, S. K., Nayak, I., Shastri, V. D., & Subramanian, S. V. (2020). Malnutrition and poverty in India: does the use of public distribution system matter?. BMC nutrition, 6, 41. https://doi.org/10.1186/s40795-020-00369-0.
14 Krasevec, J., An, X., Kumapley, R., Bégin, F., & Frongillo, E. A. (2017). Diet quality and risk of stunting among infants and young children in low- and middle-income countries. Maternal & child nutrition, 13 Suppl 2(Suppl 2), e12430. https://doi.org/10.1111/mcn.12430.
15 Irarrázaval, B., Barja, S., Bustos, E., Doirsaint, R., Senethmm, G., Guzmán, M. P., & Uauy, R. (2018). Influence of Feeding Practices on Malnutrition in Haitian Infants and Young Children. Nutrients, 10(3), 382. https://doi.org/10.3390/nu10030382.
16 Dony Novaliendry, Tegar Wibowo, Noper Ardi, Tiolina Evi, & Dwi Admojo. (2023). Optimizing Patient Medical Records Grouping through Data Mining and K-Means Clustering Algorithm: A Case Study at RSUD Mohammad Natsir Solok. International Journal of Online and Biomedical Engineering (iJOE), 19(12), pp. 144–155. https://doi.org/10.3991/ijoe.v19i12.42147.
17 Nurcan, Yabanci & Kisac, Ibrahim & Karakuş, Suzan. (2014). The Effects of Mother's Nutritional Knowledge on Attitudes and Behaviors of Children about Nutrition. Procedia - Social and Behavioral Sciences. 116. 10.1016/j.sbspro.2014.01.970.
18 Novaliendry, D., Septiawan Saltriadi, K., Mahyuddin, N., Sriwahyuni, T., & Ardi, N. (2022). Development of Interactive Media Based on Augmented Reality for Early Childhood Learning Around the Home. International Journal of Interactive Mobile Technologies (iJIM), 16(24), pp. 4–20. https://doi.org/10.3991/ijim.v16i24.34501.
19 Nakamori, M., Nguyen, X. N., Nguyen, C. K., Cao, T. H., Nguyen, A. T., Le, B. M., Vu, T. T., Bui, T. N., Nakano, T., Yoshiike, N., Kusama, K., & Yamamoto, S. (2010). Nutritional status, feeding practice and incidence of infectious diseases among children aged 6 to 18 months in northern mountainous Vietnam. The journal of medical investigation : JMI, 57(1-2), 45–53. https://doi.org/10.2152/jmi.57.45.
20 Jemide Jo, Nkechi Ene-Obong H, Effiong Edet E, Emmanuel Udoh E, Julie Omaghomi Jemide C. Association Of Maternal Nutrition Knowledge And Child Feeding Practices With Nutritional Status Of Children In Calabar South Local Government Area, Cross River State, Nigeria. Int J Home Sci [Internet]. 2016;2(1):293–8. Available From: Https://Www.Researchgate.Net/Publication/326207982.
21 Yunianto, Andi & Khomsan, Ali & Dwiriani, Cesilia & Nurdin, Naufal. (2015). Association Between Nutrition Knowledge and Nutritional Status with Blood Glucose Status in Rural Areas. Pakistan Journal of Nutrition. 14. 603-610. 10.3923/pjn.2015.603.610.
22 Sanlier, N., & Unusan, N. (2009). Infant feeding practices in Central Anatolia, Turkey. Early Child Development and Care, 179(1), 17–25. https://doi.org/10.1080/03004430600870389.
23 Sarstedt, M., Cheah, JH. Partial least squares structural equation modeling using SmartPLS: a software review. J Market Anal 7, 196–202 (2019). https://doi.org/10.1057/s41270-019-00058-3.
24 C. Thirumalai, M. Vignesh and R. Balaji, "Data analysis using box and whisker plot for lung cancer," 2017 Innovations in Power and Advanced Computing Technologies (i-PACT), Vellore, India, 2017, pp. 1-6, doi: 10.1109/IPACT.2017.8245071.
25 Dony Novaliendry, M. Fadilah Putra Pratama, Khairi Budayawan, Yasdinul Huda, & Wan Mohd Yusof Rahiman. (2023). Design and Development of Sign Language Learning Application for Special Needs Students Based on Android Using Flutter. International Journal of Online and Biomedical Engineering (iJOE),19(16), pp. 76–92. https://doi.org/10.3991/ijoe.v19i16.44669.
26 Rinaldy Simbolon, J., Suparman, Y., & Septiani Pontoh, R. (2022). Linier Mixed Model Dalam Mengevaluasi Efektifitas Eye Movement Desensitization Pada Pasien Posttraumatic Stress Disorder. BIAStatistics Journal of Statistics Theory and Aplication, 2022(1), Stat4. https://doi.org/10.1234/bias.v2022i1.148
27 Αntoniadou, M., & Varzakas, T. (2021). Breaking the vicious circle of diet, malnutrition and oral health for the independent elderly. Critical reviews in food science and nutrition, 61(19), 3233–3255. https://doi.org/10.1080/10408398.2020.1793729.
28 Dony Novaliendry, Khairi Budayawan, Rogi Auvi, Bayu Ramadhani Fajri, & Yasdinul Huda. (2023). Design of Sign Language Learning Media Based on Virtual Reality . International Journal of Online and Biomedical Engineering (iJOE), 19(16), pp. 111–126. https://doi.org/10.3991/ijoe.v19i16.44671.
29 Cunningham-Rundles, S., McNeeley, D. F., & Moon, A. (2005). Mechanisms of nutrient modulation of the immune response. The Journal of allergy and clinical immunology, 115(6), 1119–1129. https://doi.org/10.1016/j.jaci.2005.04.036
30 Scrimshaw Ns, Taylor Ce, Gordon Je, World Health Organization. Interactions Of Nutrition And Infection. World Heal. Geneva, Switzerland; 1968.
31 Gorse, G. J., Messner, R. L., & Stephens, N. D. (1989). Association of malnutrition with nosocomial infection. Infection control and hospital epidemiology, 10(5), 194–203. https://doi.org/10.1086/646002.
32 Qureshi Mo, Chughtai Aa, Seale H. Recommendations Related To Occupational Infection Prevention And Control Training To Protect Healthcare Workers From Infectious Diseases: A Scoping Review Of Infection Prevention And Control Guidelines. Bmc Health Serv Res [Internet]. 2022;22(1):1–11. Available From: Https://Doi.Org/10.1186/S12913-022-07673-4.
33 Baker, R. E., Mahmud, A. S., Miller, I. F., Rajeev, M., Rasambainarivo, F., Rice, B. L., Takahashi, S., Tatem, A. J., Wagner, C. E., Wang, L. F., Wesolowski, A., & Metcalf, C. J. E. (2022). Infectious disease in an era of global change. Nature reviews. Microbiology, 20(4), 193–205. https://doi.org/10.1038/s41579-021-00639-z.
34 Zelner, J., Masters, N. B., Naraharisetti, R., Mojola, S. A., Chowkwanyun, M., & Malosh, R. (2022). There are no equal opportunity infectors: Epidemiological modelers must rethink our approach to inequality in infection risk. PLoS computational biology, 18(2), e1009795. https://doi.org/10.1371/journal.pcbi.1009795.
35 Novaliendry, Dony, and Nazifa D. Putri. "Design and Build A Photo Studio Marketplace Using the Codeigniter Framework." Jurnal Teknologi Informasi dan Pendidikan, vol. 14, no. 1, 2021, pp. 18-26, doi:10.24036/tip.v14i1.401.
36 Sari, E. N., Tinambunan, E. S. L., Prameswari, G., Kartika, L., & Tahapary, P. A. (2021). The Relationship between Parents’ Knowledge and Behaviors with The Acute Respiratory Infection Incidence of Children Under Five in Tangerang. STRADA : Jurnal Ilmiah Kesehatan, 10(1), 1403–1411. https://doi.org/10.30994/sjik.v10i1.815.
37 Rattan, S. I. S., & Kaur, G. (2022). Nutrition, Food and Diet in Health and Longevity: We Eat What We Are. Nutrients, 14(24), 5376. https://doi.org/10.3390/nu14245376.
38 Nkoka, O., Chuang, T. W., & Chen, Y. H. (2021). Influence of Maternal Exposure to Malaria Social and Behavioral Change Messages and Effectiveness of Communication Media on Bed Net Use and Malaria Infection in Malawi. Health education & behavior : the official publication of the Society for Public Health Education, 48(2), 179–189. https://doi.org/10.1177/1090198120964201.
39 Leone, M., Kuja-Halkola, R., Leval, A., D'Onofrio, B. M., Larsson, H., Lichtenstein, P., & Bergen, S. E. (2022). Association of severe childhood infections with depression and intentional self-harm in adolescents and young adults. Brain, behavior, and immunity, 99, 247–255. https://doi.org/10.1016/j.bbi.2021.10.004.
40 Lutpiatina, L., Sulistyorini, L., Notobroto, H. B., Raya, R. P., Utama, R. D., & Thuraidah, A. (2022). Multilevel Analysis of Lifestyle and Household Environment for Toddlers With Symptoms of Acute Respiratory Infection (ARI) in Indonesia in 2007, 2012, and 2017. Global pediatric health, 9, 2333794X221078700. https://doi.org/10.1177/2333794X221078700.
41 Farhad, Jafari & Malihe, Aminzadeh & Fatemeh, Azami & Mahmood, Samadpour. (2014). The Knowledge, Attitude and Practice of Mothers Regarding Acute Respiratory Tract Infection in Children. Biosciences Biotechnology Research Asia. 11. 343-348. 10.13005/bbra/1279.
42 Mazza, M., Morseth, M., & Torheim, L. E. (2022). Association between parental feeding practices and children's dietary intake: a cross-sectional study in the Gardermoen Region, Norway. Food & nutrition research, 66, 10.29219/fnr.v66.8050. https://doi.org/10.29219/fnr.v66.8050.
43 Gray, H. L., Buro, A. W., & Sinha, S. (2023). Associations Among Parents' Eating Behaviors, Feeding Practices, and Children's Eating Behaviors. Maternal and child health journal, 27(2), 202–209. https://doi.org/10.1007/s10995-022-03572-6.
44 Grummer-Strawn, L. M., Scanlon, K. S., & Fein, S. B. (2008). Infant feeding and feeding transitions during the first year of life. Pediatrics, 122 Suppl 2, S36–S42. https://doi.org/10.1542/peds.2008-1315d.
45 Asoba, G. N., Sumbele, I. U. N., Anchang-Kimbi, J. K., Metuge, S., & Teh, R. N. (2019). Influence of infant feeding practices on the occurrence of malnutrition, malaria and anaemia in children ≤5 years in the Mount Cameroon area: A cross sectional study. PloS one, 14(7), e0219386. https://doi.org/10.1371/journal.pone.0219386.
46 Bimpong, Kingsley & Cheyuo, Ernest & abdul-mumin, Alhassan & Ayanore, Martin & Kubuga, Clement & Mogre, Victor. (2020). Mothers’ knowledge and attitudes regarding child feeding recommendations, complementary feeding practices and determinants of adequate diet. 10.21203/rs.3.rs-25288/v3.
47 Jemide, Julie & Ene-Obong, Henrietta & Effiong, Emmanuel & Udoh, Ekerette & Correspondence, Julie & Jemide, & Edet, Emmanuel & Udoh, Emmanuel. (2016). Association of maternal nutrition knowledge and child feeding practices with nutritional status of children in Calabar South Local Government Area, Cross River State, Nigeria.
48 Organization Wh. Indicators For Assessing Infant And Young Child Feeding Practices: Part 2: Measurement. 2010.
49 Saaka, M., Larbi, A., Mutaru, S. et al. Magnitude and factors associated with appropriate complementary feeding among children 6–23 months in Northern Ghana. BMC Nutr 2, 2 (2016). https://doi.org/10.1186/s40795-015-0037-3.
50 Mulat, Efram & Alem, Girma & Woyraw, Wubetu & Temesgen, Habtamu. (2019). Uptake of minimum acceptable diet among children aged 6–23 months in orthodox religion followers during fasting season in rural area, DEMBECHA, north West Ethiopia. BMC Nutrition. 5. 10.1186/s40795-019-0274-y.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Yuliana, Afifah Nur Hasanah, Violintikha Harmawan, Nabila Tasrif , Mentari Larashinda, Cheng-Hong Yang, Dony Novaliendry (Author)

This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.