Malnutrition takes its toll on children

Malnutrition takes its toll on children

Tantri Yuliandini, The Jakarta Post, Jakarta

The hall is noisy, filled with the chatter of concerned
mothers and the crying of small children. Pediatrician Alinda
Rubiati tries to make herself heard so that the mother she is
speaking to could understand her.

"Your child is too small for his age, go to that table there,
they will help. Meanwhile I will give a prescription for his
fever," she said to the young mother. The woman smiled, thanked
the doctor and moved on to the indicated table where a volunteer
took her family data and photograph.

It was a health screening day for the underprivileged of the
Cilandak area in South Jakarta and volunteer doctors from the
Care for the Malnourished Kids Foundation (YPAM-IDI) have taken a
break from their busy schedules to pay extra attention to the
needy.

Some 350 children under five years of age had been screened
that day and most were found to be undernourished or
malnourished. About 100 of these children will be given Rp 2,000
a day from the sponsors to improve their nutrition status.

It is a sobering sight to watch all those pallid-faced, thin
children being weighed and measured, and one of ironies being
that not very far away other children are put on special diets
due to obesity.

Malnutrition is one of Indonesia's worst problems caused
mainly by poverty which had deepened with the economic crisis in
1998 and has not let up since.

According to the Indonesian Society of Pediatricians, last
year some 6.8 million babies out of a total of 85 million babies
and children in Indonesia were classified as malnourished.

Out of the total some 1.8 million were poorly nourished, while
the other five million were lacking in the intake of good
nutritious food.

"What with the recent floods washing away people's homes, this
number has undoubtedly increased," YPAM-IDI head Yudanarso Daud
said.

Malnourished children have a lower resistance to infection;
they are more likely to die from common childhood ailments like
gastric diseases and respiratory infections. For those who
survive, frequent illness saps their strength and depreciates
their nutritional status, locking them into a vicious cycle of
recurring sickness and faltering growth.

"Malnutrition retards both the physical and mental growth of
children," Yudanarso said.

According to the World Health Organization (WHO), some 6.6
million out of 12.2 million deaths among children under five in
the world in 1998 were associated with malnutrition.

Besides poverty, low levels of education and poor access to
health services are major contributors to childhood malnutrition.

For example, many mothers in Indonesia are unaware of the
value of breast-feeding, substituting breast milk instead with
bottled milk and foods and unconsciously depriving infants of
vital nutrition.

The United Nations Children's Fund (Unicef) estimates that in
Indonesia, 63 percent of infants are exclusively breast-fed
during the first month of life. This percentage steadily
decreases as the child grows older, where only 6 percent of
infants are breast-fed at the age of six months.

Malnutrition is recognized by a standard deviation (SD) of the
median of the international reference population, recognized by
WHO. It is calculated using the child's weight, height, and age.

A child is considered moderately underweight when the median
weight-for-age falls below minus-2 SD, and severely underweight
when it falls below minus-3 SD. The child suffers from stunted
growth when the median height-for-age falls below minus-2 and
minus-3, and wasting when the median weight-for-height falls
below minus-2 and minus-3 SD.

Severe cases of malnutrition can cause a condition called
marasmus, kwashiorkor, and a combination of both. Marasmus is
usually caused by a diet deficient in calories and proteins,
while kwashiorkor by a diet excessively high in carbohydrates and
extremely low in protein.

A child with indications of marasmus:
* Unusually thin
* Looks older than his age
* Cranky and troublesome
* Protruding ribs
* Concave stomach
* Wrinkly skin, fatty tissue almost non-existent
* Chronic diarrhea or constipation
* Low blood pressure, slower heart-beat and breathing frequency

A child with indications of kwashiorkor:
* Edema particularly in the legs
* Rounded and swollen face
* Muscle shrinkage
* Cranky, troublesome and sometimes apathetic
* Little or no appetite for food
* Swollen liver
* Often followed by infection, anemia, and diarrhea
* Hair without luster and easily uprooted
* Red spots on the skin that quickly spread and become blackish

For more information contact YPAM-IDI at IDI South Jakarta,
Fatmawati Hospital, Jl. RS Fatmawati, Cilandak Barat, Jakarta
12430, phone and fax : 75902544, hotline : 0811-100034.