Forecasting the impact of maternal undernutrition on child health outcomes in Indonesia

By Phillip Cooley, Christine Poulos, Jay Rineer, Susan Rogers, Matthew Scruggs, Diane Wagener, William D Wheaton, Bruce Lee

Maternal nutrition influences a child’s birthweight, which affects the child’s growth and subsequent survival. However, the broad consequences of maternal undernutrition and the outcomes of interventions to improve maternal nutrition take years to manifest. To examine the long-term health outcomes of low birthweight infants in response to a maternal nutritional supplementation intervention without this obstacle, we developed the Forecasting Population Progress (FPOP) microsimulation model. The intervention we assessed was based on the findings of a published clinical trial outcome that reduced the incidence of low birthweight, a known cause of stunting. We implemented the “before intervention” and “after intervention” simulations and generated the difference in outcomes, using a spatially explicit synthetic baseline population of Indonesia generated from a microdata sample of the Indonesian 2010 census. We focused specifically on two provinces—Yogyakarta and Bali—which represent different levels of fertility and mortality but both exhibit significant underweight birth. The baseline scenario represented the current nutritional status of pregnant women in the two Indonesian provinces and projected that implementing a multiple nutrition supplementation intervention would, after 30 years, avert 8 per 1,000 low birthweight births, 3.8 per 1,000 stunted children younger than 5 years of age, and 0.25 infant deaths per 1,000 births. As our model results demonstrate, improvement in maternal nutrition would reduce infant mortality, but an even greater impact could be the reduction in growth stunting.


Cooley, P., Poulos, C., Rineer, J., Rogers, S., Scruggs, M., Wagener, D., ... Lee, B. (2016). Forecasting the impact of maternal undernutrition on child health outcomes in Indonesia. (RTI Press Publication No. RR-0028-1612). Research Triangle Park, NC: RTI Press.

© 2019 RTI International. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.


Phillip CooleyPhilip C. Cooley, MSc, is currently a senior fellow at RTI International in computational biology and high performance computing. He has more than 42 years of experience in developing computer models used in the study of environmental health and disease transmission scenarios. He has developed models to study the transmission of a number of diseases including malaria, tuberculosis, HIV/AIDS, and influenza.

Christine PoulosChristine Poulos, PhD, is a senior research economist in RTI Health Solutions. Dr. Poulos has more than 15 years of academic, government, donor, and commercial experience in health and environmental economics. Her area of expertise is survey research to support the assessment of preferences, willingness to pay and demand for products and services, cost-benefit analyses, and impact evaluation studies to support health policy decision making.

Jay RineerJames I. Rineer, MS, is a senior research geospatial scientist in RTI’s Geospatial Science and Technology Program. He has 15 years of experience as a civil/environmental engineer and geospatial application and model developer. His current focus is developing projection models for the study of a wide range of social phenomena linked to the spread of infectious and chronic disease.

Susan RogersSusan M. Rogers, PhD, is a demographer with more than 25 years of experience in the design and execution of population-based research studies. She was employed by RTI from 1993 to 2015. Her research interests focus on public health and infectious diseases.

Matthew ScruggsMatthew D. Scruggs, BS, is a software engineer for Bronto Software Incorporated. Previously, he worked at RTI International as a programmer analyst where he designed, programmed, and tested software to support a variety of environmental science studies that required expertise in computer programming and data management.

Diane WagenerDiane K. Wagener, PhD, a former senior epidemiologist at RTI International, has 37 years of experience in academia, government, and consulting studying the causes, genetics, and social impact on a number of diseases.

William D WheatonWilliam D. Wheaton, MA, is a senior research geographer and director of RTI’s Geospatial Science and Technology program. He has 30 years of experience developing and applying geospatial tools and technologies to environmental and social policy research. Mr. Wheaton is an expert on the development and use of large, geospatial, statistically accurate synthetic household populations.

Bruce LeeBruce Y. Lee, MD, MBA, is the director of operations research at the International Vaccine Access Center (IVAC), director of the Global Obesity Prevention Center (GOPC) at Johns Hopkins, and associate professor of International Health at the Johns Hopkins Bloomberg School of Public Health. Previously, he was associate professor at the University of Pittsburgh, where he founded and directs the Public Health Computational and Operations Research (PHICOR) group, which specializes in designing economic and operational computer models that help decision makers tackle a variety of global health issues.

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