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.