Socio-demographic and Maternal Determinants of Knowledge, Attitudes, and Practices Related to Infant and Young Child Nutrition among Mothers of Stunted Children in Penang, Malaysia

Childhood stunting remains a major public health concern and continues to affect a substantial proportion of children under five years of age in Malaysia. Maternal knowledge, attitudes, and practices (KAP) related to infant and young child nutrition are widely recognised as important factors influencing child growth and nutritional status. However, evidence on the factors associated with maternal KAP among mothers of stunted children remains limited in the Malaysian context. This study aimed to examine the associations between maternal socio-demographic characteristics, obstetric factors, child characteristics, anthropometric measurements, and maternal KAP related to nutrition, growth monitoring, breastfeeding, and child feeding practices.
A cross-sectional correlational study was conducted among 66 mothers of stunted children attending selected Maternal and Child Health Clinics in Penang, Malaysia. Data were collected using a structured questionnaire comprising socio-demographic information and validated KAP instruments. Descriptive statistics and Spearman’s rank correlation were used to analyse the data.
Maternal income and education were significantly associated with several KAP domains, particularly breastfeeding and growth monitoring. Higher maternal income was associated with better breastfeeding knowledge (ρ = 0.703, p = .005), breastfeeding practice (ρ = 0.500, p = .001), and growth-monitoring knowledge (ρ = 0.495, p = .001). Higher maternal education was associated with better breastfeeding knowledge (ρ = 0.492, p = .002) and breastfeeding practice (ρ = 0.362, p = .040), but with lower child-feeding knowledge (ρ = −0.348, p = .045). Other significant associations involved maternal age, number of children, which child was stunted, gestational age, maternal height and weight. Overall, the findings varied across the different KAP domains.
The study highlights the importance of considering maternal socioeconomic and family characteristics when planning nutrition education and maternal and child health programmes. Tailoring interventions to the needs of mothers from different backgrounds may enhance the relevance of nutrition education, promote appropriate infant and young child feeding practices, and strengthen ongoing efforts to address childhood stunting in Malaysia.

Childhood stunting, Maternal knowledge, attitudes, and practices, Socio-demographic factors

1. Abu-Saad, K., & Fraser, D. (2010). Maternal nutrition and birth outcomes. Epidemiologic Reviews, 32(1), 5–25. https://doi.org/10.1093/epirev/mxq001 [Google Scholar] [Crossref]

2. Addo, O. Y., Stein, A. D., Fall, C. H., Gigante, D. P., Guntupalli, A. M., Horta, B. L., Kuzawa, C. W., Lee, N., Norris, S. A., Prabhakaran, P., Richter, L. M., Sachdev, H. S., & Martorell, R. (2013). Maternal height and child growth patterns. The Journal of Pediatrics, 163(2), 549–553. https://doi.org/10.1016/j.jpeds.2013.02.002 [Google Scholar] [Crossref]

3. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall. [Google Scholar] [Crossref]

4. Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., de Onis, M., Ezzati, M., Grantham-McGregor, S., Katz, J., Martorell, R., & Uauy, R. (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 382(9890), 427–451. https://doi.org/10.1016/S0140-6736(13)60937-X [Google Scholar] [Crossref]

5. de Onis, M., & Branca, F. (2016). Childhood stunting: A global perspective. Maternal & Child Nutrition, 12(Suppl. 1), 12–26. https://doi.org/10.1111/mcn.12231 [Google Scholar] [Crossref]

6. Department of Statistics Malaysia. (2022). National Health and Morbidity Survey (NHMS) 2022: Maternal and child health. Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia. [Google Scholar] [Crossref]

7. Galasso, E., & Wagstaff, A. (2018). The aggregate income losses from childhood stunting and the returns to a nutrition intervention aimed at reducing stunting (Policy Research Working Paper No. 8536). World Bank Group. [Google Scholar] [Crossref]

8. Haron, M. Z., Rohana, A. J., Hamid, N. A. A., Omar, M. A., & Abdullah, N. H. (2023). Stunting and its associated factors among children below 5 years old on the East Coast of Peninsular Malaysia: Evidence from the National Health and Morbidity Survey. Malaysian Journal of Medical Sciences, 30(5), 155. https://doi.org/10.21315/mjms2023.30.5.13 [Google Scholar] [Crossref]

9. How, E. T. C., Shahar, S., Robinson, F., Manah, A. M., Ibrahim, M. Y., Jeffree, M. S., Rahim, S. S. S. A., & Yusuff, A. S. M. (2020). Risk factors for undernutrition in children under five years of age in Tenom, Sabah, Malaysia. Malaysian Journal of Public Health Medicine, 20(1), 71–81. [Google Scholar] [Crossref]

10. Institute for Public Health. (2016). National Health and Morbidity Survey 2016: Maternal and child health (Volume 2: Maternal and child health findings). Ministry of Health Malaysia. [Google Scholar] [Crossref]

11. Institute for Public Health. (2020). National Health and Morbidity Survey (NHMS) 2019: Non-communicable diseases, healthcare demand, and health literacy—Key findings. Ministry of Health Malaysia. [Google Scholar] [Crossref]

12. Institute for Public Health. (2023). National Health and Morbidity Survey (NHMS) 2022: Maternal and child health. Ministry of Health Malaysia. [Google Scholar] [Crossref]

13. Jai, A. N., Kassim, A. B. M., Samad, A. A., Baharuddin, A., Rosman, A., Naidu, B. M., Ying, C. Y., Man, C. S., Siew, C. Y., Paiwai, F., Bakar, F. A., Othman, F., Hamid, H. A. A., Gua, H. T., & Zulkifli, Z. A. (2016). National Health and Morbidity Survey 2016: Maternal and child health (MCH). Kementerian Kesihatan Malaysia. [Google Scholar] [Crossref]

14. Kamaruzaman, N. A., Musa, N., Pasi, H., & Osman, I. F. (2024). Stunting and its association with feeding problem among under-five children: A case-control study in Kuantan District, Malaysia. Medical Journal of Malaysia, 79(4), 514–520. [Google Scholar] [Crossref]

15. Lee, W. S., Jalaludin, M. Y., Khoh, K. M., Kok, J. L., Nadarajaw, T., Soosai, A. P., ... & Cheang, H. K. (2022). Prevalence of undernutrition and associated factors in young children in Malaysia: A nationwide survey. Frontiers in Pediatrics, 10, 913850. https://doi.org/10.3389/fped.2022.913850 [Google Scholar] [Crossref]

16. Manchala, S. (2018). Influence of maternal short stature on the stunting levels of infants and toddlers: A case study of urban slums in Chennai. Review of Development and Change, 23(1), 151–180. https://doi.org/10.1177/0972266120180107 [Google Scholar] [Crossref]

17. Mitra, M., Lita, L., Mardeni, M., & Nurlisis, N. (2023). Evaluation of the effectiveness of the Stunting Education and Anticipation System on improving knowledge, attitudes, and practice about the stunting of Pekanbaru City mothers. Health Education and Health Promotion, 11(2), 195–201. [Google Scholar] [Crossref]

18. Mugyia, A. S. N., Tanya, A. N. K., Njotang, P. N., & Ndombo, P. K. (2016). Knowledge and attitudes of pregnant mothers towards maternal dietary practices during pregnancy at the Etoug-Ebe Baptist Hospital, Yaounde. Health Sciences and Disease, 17(2), 24–29. [Google Scholar] [Crossref]

19. National Coordinating Committee on Food and Nutrition. (2016). Recommended nutrient intakes for Malaysia: A report of the Technical Working Group on Nutritional Guidelines. Ministry of Health Malaysia. [Google Scholar] [Crossref]

20. Penang Institute. (2024). Penang’s progress towards the sustainable development goals by 2030 (Monograph). Penang Institute. https://penanginstitute.org/wp-content/uploads/2024/02/Penangs-Progress-towards-the-Sustainable-Development-Goals-by-2030.pdf [Google Scholar] [Crossref]

21. Turyashemererwa, F. M., Kikafunda, J. K., & Agaba, E. (2009). Prevalence of early childhood malnutrition and influencing factors in peri-urban areas of Kabarole District, western Uganda. African Journal of Food, Agriculture, Nutrition and Development, 9(4). [Google Scholar] [Crossref]

22. United Nations Children's Fund, World Health Organization, & World Bank. (2023). Levels and trends in child malnutrition: UNICEF/WHO/World Bank Group joint child malnutrition estimates—Key findings of the 2023 edition. World Health Organization. [Google Scholar] [Crossref]

23. Victora, C. G., Christian, P., Vidaletti, L. P., Gatica-Domínguez, G., Menon, P., & Black, R. E. (2021). Revisiting maternal and child undernutrition in low-income and middle-income countries: Variable progress towards an unfinished agenda. The Lancet, 397(10282), 1388–1399. [Google Scholar] [Crossref]

24. Wan Muda, W. M., Sundaram, J. K., & Tan, Z. G. (2019). Addressing malnutrition in Malaysia. Khazanah Research Institute. [Google Scholar] [Crossref]

25. World Health Organization, & United Nations Children's Fund. (2018). Baby-friendly hospital initiative: Ten steps to successful breastfeeding. World Health Organization. https://www.who.int/activities/promoting-baby-friendly-hospitals/ten-steps-to-successful-breastfeeding [Google Scholar] [Crossref]

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