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Mother’s Working Status and Nutritional Status of Children

Under the Age of 5 in Urban Low-income Community,
Surabaya, Indonesia

by N. Toyama,a S. Wakai,a Y. Nakamura,b and Andryansyah Arifinc

a
Department of International Community Health, Graduate School of Medicine, the University of Tokyo, Japan
b
Faculty of Human Sciences, Osaka University, Japan
c
Health Service and Developing Center, National Institute of Health Research and Development, Ministry of Health, Republic
of Indonesia

Summary
A cross-sectional anthropometrics survey was carried out in a low-income community of Surabaya,
Indonesia, to examine the association between mother’s employment and the child’s nutritional
status for identifying a group at risk of having malnourished children. Subjects were 274 children
under the age of 5. The children of non-working mothers had significantly higher height-for-age z-
score (HAZ) (p < 0.05) than those of working mothers. When mother’s work was divided into
‘formal’ and ‘informal’, HAZ and weight-for-age z-score (WAZ) of children of the informal worker’s
group were significantly lower than those of the non-working mother and the formal worker’s group
(p < 0.05). Mother’s education and income of the formal worker’s group were significantly higher
than those of the informal worker’s group (p < 0.01). Our study identified a group at risk of malnu-
trition, i.e., children of mothers working in informal sectors. The programs to provide childcare for
working mothers should target this particular group of poor households.

Introduction
As the economic situation in many parts of develop-
ing countries becomes more difficult, the number of
women engaged in wage earning has increased.1 In
developing countries, the effects of mother’s work on
their children’s health are not well understood.
Previous studies have shown conflicting results:
positive2,3 and also negative effects4,5 on children’s
nutritional status have been reported. This study was
thus conducted to explore the association between
mother’s employment and the child’s nutritional
status in taking several confounding factors into
account and to find a group at risk of having
malnourished children.
Acknowledgements
We are grateful to all the staff who supported us in this study and all
respondents and participants who willingly gave their time to this
study in Surabaya. Thanks also go to Ms Yoshiko Sato, Former
Chief advisor of JICA MCH Handbook project and Drs Fumie
Takagi and Junko Okumura.
Correspondence: Susumu Wakai, Department of International
Community Health, Graduate School of Medicine, The University
of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. Tel 81
3 5841 3696; Fax 81 3 5841 3422. E-mail <swakai@m.u-tokyo.ac.jp>.
Methods
Surabaya city, the capital of east Java province, was
selected as a study area being a typical urban area in
Indonesia with a population of approximately 2.8
million in 1997. There are some low-income villages
in the city. The government defined the low-income
villages according to the socioeconomic and environ-
mental status of the inhabitants.6 Of these low-
income villages, Kalijudan village was chosen for this
study. Six of the nine Posyandus (Integrated health
post) were selected randomly in this village. The
total population of these six study areas was 5599.
The subjects were children under the age of 5 and
their families. All children living in the area were
invited to participate in the study. Of the 342
children, 274 (80 per cent) participated. The data
were collected between mid-September and October
1999. Structured interviews were performed in local
language by eight health center staff, including a
medical doctor, one nurse, two midwives and three
nutritionists under supervision of two researchers.
Three sets of data were collected.
1. Weight-for-age z-score (WAZ), height-for-age
z-score (HAZ), and weight-for-height z score
(WHZ) based on the growth reference curves
developed by National Center for Health
Statistics (NCHS) and Center for Disease
Control and Prevention (CDC).

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BRIEF REPORTS

2. Socioeconomic characteristics of the respon-
dents, including child’s and mother’s age,
mother’s education, working status of mothers,
monthly household income, food shortage
during the last 1 month in the household, and
living with extended family.
3. Working status of mothers: non-working and
working. Working mothers were further catego-
rized into working in formal and informal
sectors.
SPSS software (Version 9.0) was used for statistical
analysis.
Results
The three indicators of 274 children’s growth were as
follows: HAZ was –0.38 (SD ± 1.81), WAZ was –1.01
(SD ± 1.32), and WHZ was –0.95 (SD ± 1.38). Nearly
one-quarter of the children (24 per cent) were below
–2.0 SD of WAZ, 16 per cent were below –2.0 SD of
HAZ, and 18 per cent were below –2.0 SD of WHZ.
Multiple linear regression analysis revealed that
HAZ of working mother’s children was significantly
lower than that of non-working mother’s children
when the child’s age and the mother’s education and
income, and the likelihood of living with extended
family were controlled (p < 0.05, R2 = 0.15). Sixty-
four (23 per cent) children’s mothers carried out paid
work. The children of non-working mothers had
significantly higher HAZ than those of working
mothers (p < 0.05). There was no significant differ-
ence in education or likelihood of living in an
extended family. The mean income of working
mother’s household was significantly higher than
those of non-working mothers (p < 0.01). Food
shortage in the working mother’s group, however,
was significantly higher than that of the non-working
mother’s group (p < 0.05). Among 64 children of
working mothers, 35 (55 per cent) had formal work
as a government employee or factory worker, while
29 (44 per cent) had informal work such as a tailor,
maid, street vendor or other.
As Table 1 shows, all nutritional indicators were
the best in the formal worker’s group. Both HAZ
and WAZ of children of the informal worker’s group
were significantly lower than those of the non-
working mother’s and the formal worker’s groups (p
< 0.05). Mother’s education and income of the formal
worker’s group were significantly higher than those

TABLE 1
Association between socioeconomic and nutritional status of 274 children by mother’s working status

Nutritional indicators Non-working mother Working mother

(n = 210) ––––––––––––––––––––––––––––––––––––––––––––––––
Formal work Informal work
(n = 35) (n = 29)

Mean (SD) Mean (SD) Mean (SD)

**
**
Height-for-age z-score (HAZ) –0.26 (1.79) –0.14 (1.62) –1.56 (1.83)
*
**
Weight-for-age z-score (WAZ) –0.96 (1.24) –0.67 (1.72) –1.75 (1.09)

Weight-for-height z-score (WHZ) –0.97 (1.40) –0.68 (1.64) –1.10 (0.75)

*
Child’s age (months) 25 (16.6) 29 (17.5) 37 (16.4)

Mother’s age (years) 28 (5.0) 29 (5.5) 29 (6.7)

** **
Mother’s education (years) 8.9 (3.3) 10.9 (2.6) 7.9 (3.3)
** **
Income per month per household (1000Rp) 319 (139) 545 (318) 341 (240)
*
a
Food shortage 0.15 (0.36) 0.20 (0.41) 0.34 (0.48)

Living with extended familyb 0.27 (0.45) 0.46 (0.51) 0.28 (0.45)

*p < 0.05, **p < 0.01 (Bonfferoni was used as post-hoc analysis).
a
0 = household which suffered from food shortage, 1 = household which did not suffer from food shortage
b
0 = household which did not live with extended family, 1 = household which lived with extended family.
US$ 1 = 7300Rp

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BRIEF REPORTS

of the non-working mother’s group and the informal
worker’s group (p < 0.01). Mother’s education and
income were not significantly different between the
non-working mothers and the informal worker’s
group.
Discussion
This study revealed that children of working mothers
had significantly lower HAZ than that of non-
working mothers. There are several studies in other
countries supporting our findings.4,5 Previous studies
showed four main factors related to mother’s
working and children’s nutritional status: food
intake, care arrangement, mother’s working
condition, and income.3,5,7–9 Our study identified a
group at risk of malnutrition: children of mothers
who had informal work. Our findings and those of
others10,11 on the relationship between mother’s
work and children’s nutritional status, indicate that
the type of work should be considered in predicting
the association of mother’s work and children’s nutri-
tional status to clarify conflicting findings among
differently designed studies.
In our study the households of working mothers
were, in general, not poorer than those of non-
working mothers, but food shortage was higher in the
working mother’s group. A study in Latin America
reported that in families with both husband and wife
present, women’s work was associated with a higher
standard of living.12 Informal workers are likely to be
‘poverty-avoiders’, and formal workers to be
‘income-enhancers’.12 We thus divided our subjects
into two groups according to socioeconomic
conditions: formal and informal workers. Workers of
informal sectors lived in significantly poorer house-
holds than workers of formal sectors. The amount of
income was less than the poverty line,13 they were
less educated, they suffered from shortage of food
and lived in a nuclear family. Policy makers should
focus more on these ‘poverty-avoiders’ to improve
children’s health and welfare.
References
1. UNDP. Human Development Report. Oxford University Press,
New York, 1997; 54.
2. Tripp RB. Farmers and traders: Some economic determinants of
nutritional status in Northern Ghana. J Trop Pediatr 1981; 27:
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3. Lamontagne JF, Engle PL. Maternal employment, child care,
and nutritional status of 12–18 month old children in Managua,
Nicaragua. Soc Sci Med 1998; 46: 403–14.
4. Powell CA, Grantham-McGregor S. The ecology of nutritional
status and development in young children in Kingston, Jamaica.
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5. Popkin BM. Time allocation of the mother and child nutrition.
Ecol Food Nutr 1980; 9: 1–14.
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Ministry of Health Indonesia, Jakarta, 1994.
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PhD Thesis, Ithaca, NY, Cornell University, 1983.
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10. Engle PL, Pedersen ME. Maternal work for earnings and
children’s nutritional status in urban Guatemala. Ecol Food
Nutr 1989; 22: 211–23.
11. Wolf BL, Behrman JR. Determinants of child mortality, health
and nutrition in a developing country. J Develop Econ 1982; 11:
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12. Rosenberg JT. Employment and family formation among
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Evaluation of Serum Cholesterol and Triglyceride Levels in

1–6-year-old Saudi Children

by Mohsen A. F. El-Hazmi and Arjumand S. Warsy

a
Department of Medical Biochemistry and bDepartment of Biochemistry, King Saud University, Riyadh, Saudi Arabia

Summary
Estimations of cholesterol and triglyceride in serum are frequently requested tests due to the close
association between elevated levels of these parameters and the risk of arteriosclerosis later leading
to cardiovascular disease. Since lipid levels in children show considerable variations in different
populations, this study was conducted with the aim of investigating levels of cholesterol and triglyc-
erides in Saudi children less than 6 years old. The study group comprised 582 children with ages
ranging from 1 to 6 years, randomly selected during a household screening programme. Fasting
blood was used for the estimation of cholesterol and triglyceride using an autoanalyser. The overall

Journal of Tropical Pediatrics Vol. 47 June 2001 181