Nutritional Status and Tuberculosis among Children under Five in Indonesia: A Systematic Review and Meta-Analysis
Keywords:
Body Mass Index, Children under five, Tuberculosis, Meta-analysis, Stunting
Abstract
Background: According to the Indonesian Health Survey (SKISurvei Kesehatan Indonesia), the national prevalence of stunting is. In contrast, the prevalence of tuberculosis (TB) among infants has been reported to reach up to in certain regions. Stunted children are particularly vulnerable to TB infection due to their compromised immune function.
Methods: The study used five popular and credible electronic database sources, such as Crossref, Google Scholar, ScienceDirect, Scopus, and Semantic Scholar, to ensure broad and accurate coverage of information. The studies or scientific articles searched were limited to the last ten years, from to . Included studies were
observational, conducted in Indonesia, involved infants, and investigated the relationship between nutritional status (underweight, stunting, wasting) and TB.
Results: Eight studies were selected because they met the inclusion criteria. All studies had observational designs, namely cross-sectional (observations at one time) and case-control (comparing groups with
and without tuberculosis). The sample sizes of the studies varied widely, from small with only participants to very large with up to participants. In general, the majority of studies found that poor nutrition or stunting was positively associated with tuberculosis, meaning that people with nutritional problems were more likely to develop TB. The meta-analysis showed a pooled odds ratio (OR) of confidence interval: ), with a high degree of heterogeneity among the studies .
Conclusion: Malnutrition, particularly stunting, substantially elevates the risk of tuberculosis among infants in Indonesia. Therefore, effective TB prevention strategies must incorporate comprehensive nutritional
interventions as a core component.
References
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30. Manillaturrochmah M, Fatmaningrum W, Setyoningrum RA, Utomo B. Relationship of Nutritional Status with Tuberculosis Lungs of Children Aged 0-5 Years in Surabaya. Asian Journal of Social and Humanities [Internet]. 2023 Jan 12;1(04):154–61. Available from: https://ajosh.org/index.php/jsh/article/view/15
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34. Martinez L, Cords O, Horsburgh CR, Andrews JR, Acuna-Villaorduna C, Desai Ahuja S, et al. The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis. The Lancet [Internet]. 2020 Mar 21 [cited 2025 Jun 14];395(10228):973–84. Available from: https://pubmed.ncbi.nlm.nih.gov/32199484/
35. Faisal DR, Noveyani AE, Purwatiningsih Y, Lestyoningrum SD, Putro WG, Mikrajab MA, et al. Prevalence and Associated Factors of Children Tuberculosis in Southeast Asia Countries: A Systematic Review. Malaysian Journal of Medical Sciences [Internet]. 2024 [cited 2025 Jun 14];31(6):112–25. Available from: https://pubmed.ncbi.nlm.nih.gov/39830107/
36. Ockenga J, Fuhse K, Chatterjee S, Malykh R, Rippin H, Pirlich M, et al. Tuberculosis and malnutrition: the European perspective. Clinical Nutrition. 2023;42(4):486–92.
37. Lönnroth K, Williams BG, Cegielski P, Dye C. A consistent log-linear relationship between tuberculosis incidence and body mass index. Int J Epidemiol. 2010;39(1):149–55.
38. Basu Roy R, Whittaker E, Seddon JA, Kampmann B. Children and Mycobacterium tuberculosis: a review of susceptibility and protection. Lancet Infect Dis [Internet]. 2018 Mar 1 [cited 2025 Jun 14];19(3):e96. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6464092/
39. Sacramento LA, Gonzalez-Lombana C, Id PS. Malnutrition disrupts adaptive immunity during visceral leishmaniasis by enhancing IL-10 production. Kima PE, editor. PLoS Pathog [Internet]. 2024 Nov 11 [cited 2025 Jun 14];20(11):e1012716. Available from: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1012716
40. Chandrasekaran P, Saravanan N, Bethunaickan R, Tripathy S. Malnutrition: Modulator of Immune Responses in Tuberculosis. Front Immunol [Internet]. 2017 Oct 18 [cited 2025 Jun 14];8(OCT):1316. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5651251/
2. Roy RB, Whittaker E, Seddon JA, Kampmann B. Children and Mycobacterium tuberculosis: a review of susceptibility and protection. Lancet Infect Dis. 2018;19(3):e96.
3. Patterson B, Wood R. Is cough really necessary for TB transmission? Tuberculosis. 2019;117:31–5.
4. Haerana BsT, Prihartono NA, Riono P, Djuwita R, Syarif S, Hadi EN, et al. Prevalence of tuberculosis infection and its relationship to stunting in children (under five years) household contact with new tuberculosis cases. Indian Journal of Tuberculosis [Internet]. 2021 Jul 1;68(3):350–5. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0019570720302080
5. Vonasek BJ, Radtke KK, Vaz P, Buck WC, Chabala C, McCollum ED, et al. Tuberculosis in children with severe acute malnutrition. Expert Rev Respir Med. 2022;16(3):273–84.
6. Liang Y, Wang J, Yang J, Liu J, He XF. Global burden and trend of tuberculosis in children and adolescents (under 15 years old) from 1990 to 2021, with projections to 2040. Front Public Health. 2021;13:1578658.
7. Ministry of Health RI. Tuberculosis Data Dashboard in Indonesia Data Updated May 5, 2025 [Internet]. Indonesian Ministry of Health. 2025. Available from: https://www.tbindonesia.or.id/pustaka-tbc/data-kondisi-tbc/
8. Ministry of Health RI. The 2024 Indonesian Nutritional Status Survey [Internet]. Ministry of Health RI. 2025 [cited 2025 Jun 13]. Available from: https://stunting.go.id/ssgi-2024-prevalensi-stunting-nasional-turun-jadi-198-capai-angka-di-bawah-proyeksi-bappenas/
9. Nataprawira HM, Cesilia C, Tirtosudiro MA, Rinawan FR, Wulandari DA, Sudarwati S, et al. Tuberculosis (TB) Status in Under-Five Children with Stunting in Bandung. Glob Pediatr Health. 2024;11:2333794X241304375.
10. Farid MdS, prince GD, Raquib OI, Nath SK, Sultana S, BM S, et al. Nutritional Status among Tuberculosis Patients at the End of Initial Phase of Treatment. International Journal of Pharmaceutical and Bio Medical Science [Internet]. 2025 Feb 17 [cited 2025 Jun 13];5(2):125–30. Available from: https://ijpbms.com/index.php/ijpbms/article/view/702
11. Muse AI, Osman MO, Ibrahim AM, Wedajo GT, Daud FI, Abate KH. Undernutrition and Associated Factors Among Adult Tuberculosis Patients in Jigjiga Public Health Facilities, Somali Region, East, Ethiopia. Res Rep Trop Med [Internet]. 2021 Jun [cited 2025 Jun 13];Volume 12:123–33. Available from: https://www.dovepress.com/undernutrition-and-associated-factors-among-adult-tuberculosis-patient-peer-reviewed-fulltext-article-RRTM
12. Ozer NT, Gundogan K. The Vicious Cycle of Malnutrition and Tuberculosis: A Narrative Review. J CLIN PRACT RES Official Journal of Erciyes University Faculty of Medicine Narrative Review J Clin Pract Res [Internet]. 2024 [cited 2025 Jun 13];46(5):444–8. Available from: www.jcpres.com
13. Gupta K, Gupta R, Atreja A, Verma M, Vishvkarma S. Tuberculosis and nutrition. Lung India [Internet]. 2009 Jan 1 [cited 2025 Jun 13];26(1):9. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2813110/
14. Martinez L, Gray DM, Botha M, Nel M, Chaya S, Jacobs C, et al. The Long-Term Impact of Early-Life Tuberculosis Disease on Child Health: A Prospective Birth Cohort Study. Am J Respir Crit Care Med [Internet]. 2023 Apr 15 [cited 2025 Jun 13];207(8):1080–8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10112440/
15. Dwilow R, Hui C, Kakkar F, Kitai I. Chapter 9: Pediatric tuberculosis. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine [Internet]. 2022 [cited 2025 Jun 13];6(S1):129–48. Available from: https://www.tandfonline.com/doi/pdf/10.1080/24745332.2022.2043055
16. Nkereuwem E, Ageiwaa Owusu S, Fabian Edem V, Kampmann B, Togun T. Post-tuberculosis lung disease in children and adolescents: A scoping review of definitions, measuring tools, and research gaps. Paediatr Respir Rev [Internet]. 2025 Mar 1 [cited 2025 Jun 13];53:55–63. Available from: https://www.sciencedirect.com/science/article/pii/S1526054224000551
17. Romanowski K, Chiang SS, Land SA, van der Zalm MM, Campbell JR. Tuberculosis-associated respiratory impairment and disability in children and adolescents: a systematic review. EClinicalMedicine. 2025;81.
18. WHO. Tuberculosis in children - Implementing the WHO Stop TB Strategy [Internet]. NCBI Bookshelf. 2008 [cited 2025 Jun 13]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310766/
19. Moore BK, Graham SM, Nandakumar S, Doyle J, Maloney SA. Pediatric Tuberculosis: A Review of Evidence-Based Best Practices for Clinicians and Health Care Providers. Pathogens 2024, Vol 13, Page 467 [Internet]. 2024 Jun 1 [cited 2025 Jun 13];13(6):467. Available from: https://www.mdpi.com/2076-0817/13/6/467/htm
20. UNICEF. Desk Review: Pediatric Tuberculosis with a Focus on Indonesia i Pediatric Tuberculosis with a Focus on Indonesia Desk revIew. UNICEF. 2022.
21. Téllez-Navarrete NA, Ramón-Luing LA, Muñoz-Torrico M, Osuna-Padilla IA, Chávez-Galán L. Malnutrition and tuberculosis: the gap between basic research and clinical trials. The Journal of Infection in Developing Countries. 2021;15(03):310–9.
22. McMurray DN, Bartow RA, Mintzer CL, Hernandez-Frontera E. Micronutrient status and immune function in tuberculosis. Ann N Y Acad Sci [Internet]. 1990 [cited 2025 Jun 13];587:59–69. Available from: https://pubmed.ncbi.nlm.nih.gov/2113788/
23. WHO. Inclusion for every child: reaching every child affected by tuberculosis [Internet]. WHO. 2024 [cited 2025 Jun 13]. Available from: https://www.who.int/news/item/20-11-2024-inclusion-for-every-child--reaching-every-child-affected-by-tuberculosis
24. Ministry of Health RI. Indonesia’s Movement to End TB [Internet]. Ministry of Health RI. 2025 [cited 2025 Jun 13]. Available from: https://kemkes.go.id/eng/indonesias-movement-to-end-tb
25. Graham SM, Dwihardiani B, Felisia F, Koesoemadinata RC, Putri ND, Alisjahbana B, et al. Challenges and opportunities to improve tuberculosis care for Indonesian children. Paediatr Indones. 2025;65(1):1–9.
26. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar;372:n71.
27. Setyoningrum RA, Maharani RA, Hapsari R, Chafid APP. Risk factors of tuberculosis in children with adult household tuberculosis contact. Paediatr Indones [Internet]. 2024 Aug 2;64(4):287–92. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/3396
28. Jahiroh N, Prihartono N. The Relationship Between Nutritional Stunting and Tuberculosis Among Children Under Five Years. The Indonesian Journal of Infectious Diseases [Internet]. 2017 Nov 5;1(2):6–13. Available from: https://www.ijid-rspisuliantisaroso.co.id/index.php/ijid/article/view/7
29. Farsida F, Febrianti R, Lutfy N, Rahmini R, Syahniar R. Relationship between Nutritional Status and Living Conditions with the Risk of Tuberculosis in Children. Jurnal Kesehatan Masyarakat [Internet]. 2023 Jan 20;18(3):341–8. Available from: https://journal.unnes.ac.id/nju/kemas/article/view/35343
30. Manillaturrochmah M, Fatmaningrum W, Setyoningrum RA, Utomo B. Relationship of Nutritional Status with Tuberculosis Lungs of Children Aged 0-5 Years in Surabaya. Asian Journal of Social and Humanities [Internet]. 2023 Jan 12;1(04):154–61. Available from: https://ajosh.org/index.php/jsh/article/view/15
31. Purnamasari RD, Sartika RAD, Sudarti T. Current Intake and Infection Status were not Good Predictive Factors of Stunting among Children Aged 6-59 Months in Babakan Madang Sub-District, Bogor District, West Java, Indonesia. Indonesian Journal of Public Health Nutrition [Internet]. 2022 Apr 30;2(2). Available from: https://scholarhub.ui.ac.id/ijphn/vol2/iss2/5/
32. Li A, Yuan SY, Li QG, Li JX, Yin XY, Liu NN. Prevalence and risk factors of malnutrition in patients with pulmonary tuberculosis: a systematic review and meta-analysis. Front Med (Lausanne). 2023 Aug 10;10:1173619.
33. Sinha P, Davis J, Saag L, Wanke C, Salgame P, Mesick J, et al. Undernutrition and Tuberculosis: Public Health Implications. J Infect Dis [Internet]. 2018 Apr 16 [cited 2025 Jun 13];219(9):1356. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6941617/
34. Martinez L, Cords O, Horsburgh CR, Andrews JR, Acuna-Villaorduna C, Desai Ahuja S, et al. The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis. The Lancet [Internet]. 2020 Mar 21 [cited 2025 Jun 14];395(10228):973–84. Available from: https://pubmed.ncbi.nlm.nih.gov/32199484/
35. Faisal DR, Noveyani AE, Purwatiningsih Y, Lestyoningrum SD, Putro WG, Mikrajab MA, et al. Prevalence and Associated Factors of Children Tuberculosis in Southeast Asia Countries: A Systematic Review. Malaysian Journal of Medical Sciences [Internet]. 2024 [cited 2025 Jun 14];31(6):112–25. Available from: https://pubmed.ncbi.nlm.nih.gov/39830107/
36. Ockenga J, Fuhse K, Chatterjee S, Malykh R, Rippin H, Pirlich M, et al. Tuberculosis and malnutrition: the European perspective. Clinical Nutrition. 2023;42(4):486–92.
37. Lönnroth K, Williams BG, Cegielski P, Dye C. A consistent log-linear relationship between tuberculosis incidence and body mass index. Int J Epidemiol. 2010;39(1):149–55.
38. Basu Roy R, Whittaker E, Seddon JA, Kampmann B. Children and Mycobacterium tuberculosis: a review of susceptibility and protection. Lancet Infect Dis [Internet]. 2018 Mar 1 [cited 2025 Jun 14];19(3):e96. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6464092/
39. Sacramento LA, Gonzalez-Lombana C, Id PS. Malnutrition disrupts adaptive immunity during visceral leishmaniasis by enhancing IL-10 production. Kima PE, editor. PLoS Pathog [Internet]. 2024 Nov 11 [cited 2025 Jun 14];20(11):e1012716. Available from: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1012716
40. Chandrasekaran P, Saravanan N, Bethunaickan R, Tripathy S. Malnutrition: Modulator of Immune Responses in Tuberculosis. Front Immunol [Internet]. 2017 Oct 18 [cited 2025 Jun 14];8(OCT):1316. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5651251/
Published
2025-12-31
Section
Research Article
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