Averting 'lost generation' through nutrition plan
JAKARTA (JP): The country's economic crisis has caused fears of a food crisis that could retard the physical and mental growth of the coming generation.
The steep depreciation of the rupiah against the greenback has caused prices to soar, and the increasing cost of living makes basic commodities less and less affordable for many poor pregnant women and children.
Data from the United Nation Children's Fund (Unicef) shows that 32 million of the country's 210 million people are currently living below the poverty line.
A professor with the state-run Bogor Agricultural Institute (IPB), Darwin Karyadi, said the poor lived in unhygienic conditions, exposing them, especially children, to diseases like diarrhea and respiratory infections.
"The children will likely have intelligent quotients that are 10 to 50 points lower," Darwin said during a recent seminar on preventing a "lost generation". The seminar was held by baby food manufacturer PT Gizindo Primanusantara, a subsidiary of PT Indofood Sukses Makmur Tbk.
The United Nations Development Program (UNDP) identifies three factors that determine a country's Human Development Index (HDI): education, health and economy -- all are related to the country's nutrition status.
According to UNDP's 2000 report, Indonesia ranks 109 among 174 countries in terms of HDI. Among other ASEAN countries, the Philippines is at 77, Thailand 67, Malaysia 56, Brunei 25 and Singapore 22.
Endang S. Sunaryo from PT Indofood Sukses Makmur said the undernutrition-related mortality rate in Indonesia was relatively high. World Health Organization's data shows 390 maternal deaths per 100,000 births and 48 neonatal deaths per 1,000 live births.
"An adequate nutritional intake is very important before and during pregnancy, and this should be maintained until babies reach their second year," she said.
Pregnant women require extra nutrition -- energy, protein, vitamins, minerals and micronutrients, for themselves and to allow the fetuses to grow.
Pregnant women who are undernourished are liable to fatal infectious diseases. Not only that, they are also likely to have underweight babies and low-quality breast milk.
"Research has proved that adequate nutrition is imperative during pregnancy and this condition should continue until the baby reaches two years. This period is critical for the baby's physical and mental development," Endang said.
Undernourished children who lack protein are classified as kwashiorkor and those with severe carbohydrate and protein deficiencies are classified as marasmus.
A kwashiorkor infant has pale skin, loses hair, lacks appetite, suffers edema and has a swollen liver. He/she is underweight, too. If pressed, his/her skin will remain dented.
The marasmus baby shows signs of heavy dehydration, has a weak pulse, hollow eyes, hollow occipital and inelastic skin. It is too weak to even sit.
These children are prone to degenerative diseases like diabetes, hypertension and cardiovascular as they grow.
"Babies born with a weight of less than 2.5 kilograms and remain below standard after a year are prone to degenerative diseases later in life," Darwis said.
Breast feeding
Darwis stressed the importance of breast feeding for babies under the age of six months, and weaning food for the next six months to introduce babies to solid food.
"Breast milk is no longer sufficient for babies older than six months. That's why nutritious weaning food should be given to ensure adequate nutritional intake during their critical growth period and for their brain development," he said.
Another speaker from IPB at the seminar, F.G. Winarno, said community health centers should play a more active role in disseminating information about the importance of adequate nutrition for pregnant women and nutritious weaning food for babies.
"Hygiene plays an important role because failure to maintain hygiene leads to infection and diarrhea, which would deprive the babies of the important nutrition they need," he said.
Besides such foods as eggs, meat, milk and other dairy products, Winarno also recommended popular and inexpensive nutritious food such as pulses, nuts, cassava, sweet potatoes and other tubers, grains, fruits and vegetables, saying a balanced and varied diet was highly recommended.
Pediatrician Soehartati Safiun from the Jakarta chapter of the Indonesian Pediatricians Association said that weaning food should be easily ingested by babies. This food should meet certain requirements, such as: * Containing adequate nutrition, carbohydrate, protein, vitamins, minerals and fibers. * Can be easily swallowed and ingested by babies. * Types of food and feeding should be in compliance with healthy and hygienic eating standards. * Uncontaminated * Balanced composition of different food groups. * Easily obtained and acceptable to the baby.
When babies reach the age of four months their digestive systems start working. Physiologically, the digestive system is a chain process of ingestion, secretion of digestive enzymes to break down food, absorption of nutrients and the removal of undigestible material to the rectum.
The early swallowing process is started by a voluntary movement -- the food is pushed by the tongue to the pharynx and the baby closes his mouth. In the pharynx the involuntary movement starts, enabling only mashed food that can enter the posterior pharynx. A soft palate closes off the post nasal cavity to prevent food from entering, while the epiglottis temporarily closes off the trachea as food enters the opening of the esophagus with the pressure of the pharingeus constrictor muscle.
"Babies need some time to master this skill. At first babies may do it incorrectly, and the food will fall out of their mouths," she said, adding that many parents misinterpret this experience and think that their babies are refusing to eat, when they are actually learning to swallow.
She said that there were possible danger during the feeding of weaning foods, and recommended that parents gradually introduce weaning foods to allow babies to become accustomed to them.
"This can be done by introducing liquid weaning foods with thicker consistencies. Never feed them with too much food in a short time. Give them one thing at a time to see if the baby likes it. But don't force them to eat as this will only make them lose their appetite," she cautioned.
Mothers can purchase various kinds of baby food, which is more practical, hygienic and nutritious, or prepare multimixed weaning foods that include four food components: * Primary food: grains, tubers or roots * High protein food from animal and from plants * Sources of vitamins and minerals: vegetables and fruits * Sources of energy: fat, oil and sugar.
"A six-month-old baby may be given filtered multimixes while a nine-month-old baby can be given unfiltered (multimixes)," she said.
Parents may give finicky babies nutritious snacks, such as cooked vegetables, soft fruits, unsalted crackers, mashed bananas and other foods.
Soehartati advised parents to feed their babies fruits and vegetables to prevent constipation.
She also has a list of food unsuitable for babies: * Food that can choke babies: peanuts, potato chips, seeded fruits, corn, scaled fish, small and rough fish. * Less nutritious food: candy, soft drinks, cake, cookies and other artificially flavored drinks. * Food that is not easily digested: sausages, high-fat food, fried food and spicy food. * Honey should not be given to babies under the age of one as it contains the spora Clostridium botulinum, which can trigger Type B infant botulism, characterized by muscle weakness, paralysis and disturbances of vision. * Food that can trigger allergic reactions: cow milk and its derivatives, egg whites, peanuts, chocolate and fish. (lup)