Malnutrition takes its toll on children<\/p>\n
Tantri Yuliandini, The Jakarta Post, Jakarta<\/p>\n
The hall is noisy, filled with the chatter of concerned
\nmothers and the crying of small children. Pediatrician Alinda
\nRubiati tries to make herself heard so that the mother she is
\nspeaking to could understand her.<\/p>\n
\"Your child is too small for his age, go to that table there,
\nthey will help. Meanwhile I will give a prescription for his
\nfever,\" she said to the young mother. The woman smiled, thanked
\nthe doctor and moved on to the indicated table where a volunteer
\ntook her family data and photograph.<\/p>\n
It was a health screening day for the underprivileged of the
\nCilandak area in South Jakarta and volunteer doctors from the
\nCare for the Malnourished Kids Foundation (YPAM-IDI) have taken a
\nbreak from their busy schedules to pay extra attention to the
\nneedy.<\/p>\n
Some 350 children under five years of age had been screened
\nthat day and most were found to be undernourished or
\nmalnourished. About 100 of these children will be given Rp 2,000
\na day from the sponsors to improve their nutrition status.<\/p>\n
It is a sobering sight to watch all those pallid-faced, thin
\nchildren being weighed and measured, and one of ironies being
\nthat not very far away other children are put on special diets
\ndue to obesity.<\/p>\n
Malnutrition is one of Indonesia's worst problems caused
\nmainly by poverty which had deepened with the economic crisis in
\n1998 and has not let up since.<\/p>\n
According to the Indonesian Society of Pediatricians, last
\nyear some 6.8 million babies out of a total of 85 million babies
\nand children in Indonesia were classified as malnourished.<\/p>\n
Out of the total some 1.8 million were poorly nourished, while
\nthe other five million were lacking in the intake of good
\nnutritious food.<\/p>\n
\"What with the recent floods washing away people's homes, this
\nnumber has undoubtedly increased,\" YPAM-IDI head Yudanarso Daud
\nsaid.<\/p>\n
Malnourished children have a lower resistance to infection;
\nthey are more likely to die from common childhood ailments like
\ngastric diseases and respiratory infections. For those who
\nsurvive, frequent illness saps their strength and depreciates
\ntheir nutritional status, locking them into a vicious cycle of
\nrecurring sickness and faltering growth.<\/p>\n
\"Malnutrition retards both the physical and mental growth of
\nchildren,\" Yudanarso said.<\/p>\n
According to the World Health Organization (WHO), some 6.6
\nmillion out of 12.2 million deaths among children under five in
\nthe world in 1998 were associated with malnutrition.<\/p>\n
Besides poverty, low levels of education and poor access to
\nhealth services are major contributors to childhood malnutrition.<\/p>\n
For example, many mothers in Indonesia are unaware of the
\nvalue of breast-feeding, substituting breast milk instead with
\nbottled milk and foods and unconsciously depriving infants of
\nvital nutrition.<\/p>\n
The United Nations Children's Fund (Unicef) estimates that in
\nIndonesia, 63 percent of infants are exclusively breast-fed
\nduring the first month of life. This percentage steadily
\ndecreases as the child grows older, where only 6 percent of
\ninfants are breast-fed at the age of six months.<\/p>\n
Malnutrition is recognized by a standard deviation (SD) of the
\nmedian of the international reference population, recognized by
\nWHO. It is calculated using the child's weight, height, and age.<\/p>\n
A child is considered moderately underweight when the median
\nweight-for-age falls below minus-2 SD, and severely underweight
\nwhen it falls below minus-3 SD. The child suffers from stunted
\ngrowth when the median height-for-age falls below minus-2 and
\nminus-3, and wasting when the median weight-for-height falls
\nbelow minus-2 and minus-3 SD.<\/p>\n
Severe cases of malnutrition can cause a condition called
\nmarasmus, kwashiorkor, and a combination of both. Marasmus is
\nusually caused by a diet deficient in calories and proteins,
\nwhile kwashiorkor by a diet excessively high in carbohydrates and
\nextremely low in protein.<\/p>\n
A child with indications of marasmus:
\n * Unusually thin
\n * Looks older than his age
\n * Cranky and troublesome
\n * Protruding ribs
\n * Concave stomach
\n * Wrinkly skin, fatty tissue almost non-existent
\n * Chronic diarrhea or constipation
\n * Low blood pressure, slower heart-beat and breathing frequency<\/p>\n
A child with indications of kwashiorkor:
\n * Edema particularly in the legs
\n * Rounded and swollen face
\n * Muscle shrinkage
\n * Cranky, troublesome and sometimes apathetic
\n * Little or no appetite for food
\n * Swollen liver
\n * Often followed by infection, anemia, and diarrhea
\n * Hair without luster and easily uprooted
\n * Red spots on the skin that quickly spread and become blackish<\/p>\n
For more information contact YPAM-IDI at IDI South Jakarta,
\nFatmawati Hospital, Jl. RS Fatmawati, Cilandak Barat, Jakarta
\n12430, phone and fax : 75902544, hotline : 0811-100034.<\/p>",
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