The Effect of Concurrent Anemia and Stunting on Cognitive Ability : A Longitudinal Study of Children in Indonesia

Background and objectives: Anemia and stunting are nutritional problems that affect the cognitive abilities of school aged children in Indonesia. Concurrent anemia and stunting conditions can occur due to the characteristics of the child, mother and family environment. This study aims to asses the impact of concurrent anemia and stunting on children's cognitive ability. Methods: We use two wave (2000-2007) longitudinal data from Indonesia Family Life Survey (IFLS). The subject of the study were 568 children aged 3-5 years old in 2000. Anthropometric data and hemoglobin level were collected for children at 3-5 years of age. Cognitive ability was measured with Raven Progressive Matrices, collected for children at 10-12 years of age. We used one-way annova to measured the frequency and correlation of cognitive ability with concurrent anemia and stunting. We also build linear regression models for multivariate analysis. Results: Cognitive ability score of children with concurrent anemia and stunting was 11.72±3.30 (95% CI=11.12-12.31). The prevalence of concurrent anemia and stunting in this study was 21.65%. Concurrent anemia and stunting in early childhood were associated with head circumference, animal protein consumption, maternal education, father and mother's occupation and region of residence. Based on multivariate analysis, children with concurrent anemia and stunting have the lowest cognitive abilities compared to other groups and were statistically signitificant (p=0.031) after adjusted with children, parents and household factors. Conclusions: Concurrent anemia and stunting at 3-5 years of age will increase the risk of low cognitive ability at 10-12 years of age. Therefore, nutritional and public health intervention to prevent low cognitive abilities and concurrent anemia and stunting not only focus on 1000 days of life but include children up to 5 years or more.