Althea Medical Journal. 2015;2(3)

395

Undernutrition Affects the Occurrence of Acute Respiratory Infections 
in Children under Five Years Old in Cipacing, Jatinangor Subdictrict, 

West Java from October to November 2012

Windi Elsanita,1 Deni Kurniadi S,2 Diah Asri Wulandari,3 Elsa Pudji Setiawati4
1Faculty of Medicine Universitas Padjadjaran, 2Department of Public Health Faculty of Medicine 

Universitas Padjadjaran, 3Department of Child Health, Faculty of Medicine Universitas 
Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung

Abstract

Background: Millennium Development Goals’ (MDGs) aims to decrease mortality in children will be 
achieved if the cause ofmortality include acute respiratory infections (ARIs) is eliminated. Acute respiratory 
infections are influenced by some factorssuch as nutritional status. The objective of this study was to analyze 
the correlation between nutritional status andthe occurrence of ARIs in children.
Methods: This study used retrospective cohort approach during October─November 2012. One hundred 
and ten mothers with children under five years old with different nutritional status were randomly selected 
and then asked about their history of respiratory symptoms. Data were analyzed using chi square test.
Results: About 66 under five children (60%) with good nutrition status had ARIs occurrence of <7 times 
and 5 children (4.5%) had ARIs≥7 times. In children with undernutrition, about 30 children (27.3%) had 
ARIs<7 times and 9 children (8.2%) had ARIs≥7 times. Bivariate analysis result showed that there was a 
correlation between nutritional status with the occurrence of ARIs in under five children (p<0.05).
Conclusions: Acute respiratory tract infections are often experienced by undernutrition children. 
This study strengthens the essential to correct nutritional status to prevent the infections in children. 
[AMJ.2015;2(3):395–97]

Keywords: Acute respiratory infections, children under five, nutritional status

Correspondence: Windi Elsanita, Faculty of Medicine, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang Km.21, 
Jatinangor, Sumedang, Indonesia, Phone: +6285275577025 Email: windielsanita@gmail.com

Introduction
 
Acute respiratory infections (ARIs) are 
common in under-five children   and spread 
through direct contact with the etiologic 
organisms   through the air.1 Acute respiratory 
infections are caused by microorganisms into 
the length of the respiratory tract starting 
from the nose to the alveoli and takes place 
for a period up to 14 days.2 Acute respiratory 
infections-causing microorganisms are 
rhinovirus, coronavirus, influenza virus, 
parainfluenza virus, adenovirus, and group A 
beta hemolytic streptococcus.3 According to 
the Indonesian Ministry of Health, the average 
child gets ARIs  3─6 times per year.4

The symptoms of ARIs are listed based 
on the classification such as cough, runny 
nose, fever, sneezing, nasal congestion, and 
sore throat. Severe respiratory infection may 
develop bluish fingernails and lips (cyanosis), 

and tension in the chest wall breath sounds 
rough and dry.3 Factors which influence the 
occurrence of ARIs are nutritional status, 
socio-economic, socio-cultural, environmental, 
treatment-seeking behavior, readiness and 
preparedness of health workers as an effort 
to provide the best services for the treatment 
and prevention of the disease.4 

Nutritional status is a balance of a person's 
food intake in the form of specific variables.  
Factors  which affect the nutritional status 
are the biological environment, the physical 
environment, psychosocial factors and 
family factors.5 Anthropometric assessment 
of nutritional status uses an index based on 
weight for age (W/A) according to the WHO 
2005.6

In this case, nutrition in children determines 
the tendency to be affected by ARIs in children. 
Good nutrition will form a good endurance in 
children against the environment. Conversely, 
children with poor nutrition do not develop 



Althea Medical Journal. 2015;2(3)

396     AMJ September, 2015

strong endurance so that these children are 
more likely to have the diseases, especially 
infections.7

Arsyad8 stated that nutritional status, 
immunization, home environment, and socio-
economic factors influence the occurrence of 
ARIs in under-five children in Bantimurung 
subdistrict. A similar study shows that there is 
a relationship between nutritional status with 
the occurrence of ARIs in Soetomo Hospital 
Surabaya.9 A previous study shows that there 
is a correlation between nutritional status with 
the incidence ARIs in which undernourished 
children tend to experience the recurrent 
ARIs.10

This study calculated the frequency of 
ARIs in the past year experienced by children. 
The objective of this study was to analyze the 
correlation between nutritional status and the 
occurrence of ARIs in children.

Methods

This qualitative study was conducted in 
Cipacing during the period October─November 
2012 to 110 mothers who have under-five 
children with different nutritional status were 
randomly selected and then asked about their 
history of respiratory symptoms. This study 
used retrospective cohort approach.

Informed consent was signed by the 
mothers for approval and respondents who 

did not agree were not included in the study. 
Respondents were asked about symptoms 
of respiratory infections that occurred in 
children. Respiratory symptoms asked were 
cough, fever, runny nose, wheezing, pain or 
discharge from the ears, bluish lips or pale 
skin, snoring, shortness of breath and husky. 
The frequency of ARIs in the previous year, 
was classified into <7 times and ≥7 times.  It 
was based on the average number of children 
getting ARIs for 3─6 times in a year.4 

The nutritional status of children was 
assessed by the WHO anthropometric standard 
2005 after the categories of nutritional 
status were classified by the ministry of 
health. Assessment of nutritional status by 
index weight for age (W/A) were performed 
according to WHO 2005. The Z value for 
each level of nutritional status were severe 
undernourished <-3SD, undernourished -3 
SD to <-2 SD, good nutrition -2 SD to 2 SD, 
and obese >2 SD. Children with incomplete 
measurement W/A data were not included in 
the study.6

Data were analyzed statistically using 
nonparametric chi-square test. The study 
variables were bivariate and the distribution 
of data was abnormal.  

 
Results

Children with good nutrition were more than 

Table 1 Description Nutritional Status in Children 

Nutritional Status Frequency Percentage (%)

Good nutrition 71 64.5
Undernourished 39 35.5

Table 2 Description of ARIs in Children 

ARIs Frequency Percentage (%)

<7 times 96 87.3
≥7 times 14 12.7

Table 3 ARIs Distribution Based on The Nutritional Status

Nutritional Status
ARIs

Frequency Percentage (%)

Good nutrition 66 (60) 5 (4.5)
Undernouris 30 (27.3) 9 (8.2)



Althea Medical Journal. 2015;2(3)

397

the undernourished ones (Table 1). Children 
who had ARIs <7 times were more than those 
with ARIs ≥7 times (Table 2).

Children with good nutritional status 
tended to have less ARIs <7 times while 
undernourished children suffered more ARIs 
≥7 times (Table 3). The results of the analysis 
found that the chi square test for the variable 
nutritional status with the occurrence of 
ARIs shows a significant p value of p = 0.016 
(p<0.05).  P <0.05 mean that there was a 
relationship between nutritional status with 
the occurrence of ARIs in children under five 
years old.

Discussion 

Nutritional status is a balance of one food 
intake expresses in the form of specific 
variables.  Nutritional status describes the 
adequacy or inadequacy of nutrients in a 
person as undernourished, good nutrition, 
and obese.5

Nutrition plays a role in our bodies in form 
antibodies as a defense against infections 
or diseases that comes from environment. 
Children with good nutrition will form 
adequate antibodies and are more rarely 
infected than undernourished ones.7

The result of this study showed that there 
was a correlation between nutritional status 
with the occurrence of ARIs. Children with good 
nutrition were less likely to get a respiratory 
infection than undernourished children who 
had a tendency to get infected. Therefore, it 
is important to improve nutritional status 
in children to prevent infection in the 
environment. 

Acute respiratory infections are influenced 
by many factors such as nutritional status, 
socio-economic, socio-cultural, environmental, 
treatment-seeking behavior, readiness and 
preparedness of health workers as an effort to 
provide the best service for the treatment and 
prevention of the disease. This study only used 
two variables and could not compare more 
significant factors influencing the occurrence 
of ARIs in children. Biased recall might occur 
because the symptoms of ARIs  asked were 
from the previous  year . 

It was mentioned that many factors can 
affect the nutritional status of children such 
as biological factors, physical environment, 
psychosocial factors and family factors. As a 
conclusion, improvement in these factors will 
improve the nutritional status in children.5

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Windi Elsanita, Deni Kurniadi S, Diah Asri Wulandari, Elsa Pudji Setiawati: Undernutrition Affects the Occurrence of 
Acute Respiratory Infections in Children under Five Years Old in Cipacing, Jatinangor Subdictrict, West Java from October to 

November 2012