Reversing the Ravages of Child Malnutrition in Indonesia

Alfredon, who will turn 1 next month, cries as a community health worker slips a measuring band around his upper arm at his home in Magepanda subdistrict, East Nusa Tenggara.

The health worker does not pay much attention to the toddler's tears. She is pleased with the reading of 12.5 centimeters, which shows that the circumference of Alfredon's arm is 2.5 centimeters longer than two months ago when he was classified as severely malnourished.

Long-term consequences

Child malnutrition affects 37 percent of Indonesian children whose growth has been stunted by ill health and a lack of vital micronutrients in their diet. While Alfredon has recovered from his acute malnutrition, there is a good chance that the chronic, long-term lack of nutrients has impaired his growth and development, which unfortunately cannot be reversed.

Stunting, one of the outcomes of child malnutrition, is linked to a decrease in cognitive functioning and IQ and negatively impacts on both educational achievement and employment prospects. Studies suggest those who have been stunted earn 20 percent less over the course of their lives than those from similar backgrounds who receive adequate nutrition. Most worryingly for Indonesia's booming economy, it has been predicted that stunting costs developing countries 2 percent to 3 percent of their gross domestic product.

With 240 million people, about 32 percent of Indonesia's population is under 18, with 9 percent below the age of 5.

So how can Indonesia do better for these children? Health experts have identified a number of simple, low-cost solutions that dramatically reduce the incidence of stunting in young children and could save the lives of 36,000 children under the age of 5 in Indonesia each year. These strategies target children from conception until they are 2 years old, when the damage caused by malnourishment is largely irreversible.

One of these solutions is to give pregnant mothers and children supplements in iron and vitamin A as well as zinc for children suffering from diarrhea. A yearly supply of capsules containing these micronutrients typically costs between $1-$2 per person.

Other solutions to reverse the malnutrition rate involve behavioral changes, including exclusive breastfeeding for the first six months of an infant's life, followed by complementary feeding of frequent, quality food to supplement breast milk intake until the age of 23 months. The World Bank estimates that educating households on these practices costs $7.50 per child.

The reality of the situation

While these solutions are not complex or expensive, implementing them often is. Government health worker Anastasia, who works in the Sikka district, says that she is only able to screen for malnutrition in children who visit the village health posts. However, more than a quarter of children do not attend or complete the program, which may take as long as 10 weeks. According to Anastasia, "A lot of people, they come for four weeks, see their child is better and then stop coming."

One of these mothers, Susana Beni, explains that she did not continue to take her 16-month-old son Riomundus back to the clinic after he was identified as malnourished by a local health worker in March because he caught tuberculosis and was in hospital for two weeks.

After Riomundus became sick, Susana stopped focusing on her son's nutrition and assumed the hospital would have given him any treatment she needed. When asked whether child malnutrition and its causes had been explained to her, Susana said that this had not taken place.

On a field trip sponsored by the UN Children's Fund, Dorothy Foote, a program specialist at Unicef, said that these types of stories indicate that even in areas where there is extensive coverage of communities by health services addressing malnutrition, the quality of care may not be adequate.

"Quality can be a real issue. One solution is to make sure that health workers and counselors are trained properly so that they pass on the right information, but also so that they are engaging with the mothers in the community, that they are having a conversation with them and listening to their situation, not just giving them a lecture," she said.

As part of Unicef and the European Union's joint action on Improving Nutrition Security in Asia, Unicef has targeted three districts in which to focus its efforts to support and train health clinics, workers and community volunteers. The Klaten district in Central Java, Jayawijaya in Papua and Sikka, where Alfredon lives, were chosen by Unicef due to both the high rates of stunting and the strong leadership present in these areas.

Evidence of this can be seen in Makendetung, a village in Sikka, where the community has banded together to ensure their children are better nourished. Under the leadership of their chief, Ibu Maria Feligonda, village members took part in a Participatory Action and Learning (PLA) exercise facilitated by Unicef in July 2011.

This three-day process allowed the village to identify how many children were stunted or at risk of malnourishment and the likely causes.

As well as paying more attention to breastfeeding, clean water and sanitation, the village has set up a nutrition post to ensure that its 130 children under the age of 5 are regularly monitored. Any child identified as underweight is fed on a diet supervised by the nutrition post for 12 consecutive weeks.

The bigger picture

With Indonesia's economic growth surging, the government has begun to recognize the investment that is represented by ensuring every child in the country reaches his or her full potential. In 2010, the government announced its commitment to the Scaling Up Nutrition project, a global movement that pushes for action on maternal and child nutrition. The Ministry of Health claims that it allocates Rp 700 billion ($77.7 million) annually to combat child malnutrition.

Indonesia now boasts a 2.6 percent reduction in its stunting rate each year on average, putting it among the top 15 nations making the fastest gains against malnutrition. But the country also contains the fourth highest number of children under 5 who are stunted globally.

Even accounting for Indonesia's status as a highly populous developing country, this is a poor figure. Indonesia falls well below the level expected of a country with its $3,500 GDP per capita, which should put its stunting rate at one in five children, rather than the more than one in three children.

Alfredon's mother Maria agrees that nutrition needs to be a priority not only for the government, but also for parents.

"I don't know why mothers don't take their children to the health post enough, but if I see any of them, I will tell them to go," she said.

"Alfredon is better now. Before, all he would do was sleep. Now he plays all the time."

(sumber : Thejakartaglobe.com)