Searching for answers to malnutrition

JAKARTA (JP): Entering the 21st century, Indonesia will have a "lost generation".

The term lost generation is commonly used for children who miss out on adequate nutrition and health care between the crucial ages of six and 24 months of age.

Between the ages of six and 24 months, a child's physical development requires adequate nutrition through breastfeeding and other nutritious foods.

Children who do not receive such nutrition are at risk of long-term adverse effects to their cognitive ability and immunocompetence, as well as facing a higher risk of death and degenerative diseases.

The medical director of Helen Keller International's branch office in Indonesia, Roy Tjiong, said these frightening facts were based on comprehensive studies conducted jointly by local and foreign institutions in those areas in Jakarta, West Java, Central Java, East Java, West Nusa Tenggara and South Sulawesi which have been hardest hit by the economic crisis over the past three years.

Helen Keller International, in cooperation with the Ministry of Health, Diponegoro University in Semarang, Central Java, Hasanudin University in Ujungpandang, South Sulawesi, and the National Institute for Health Research and Development, has been carrying out a Nutritional Surveillance System (NSS) in Indonesia.

The project, jointly funded by the United Nations Children's Fund, the United States Agency for International Development and the Asian Development Bank, is aimed at monitoring and assessing the impact of the crisis on the nutritional and health status of the population, and the effectiveness of crisis-related social safety net programs.

The study has revealed the economic crisis is causing a serious deterioration in the quality of people's diets and the country's health services.

"Due to the crisis, people's purchasing power has dramatically dropped and it has affected their spending on food," he said.

Millions of children and mothers in Central Java and West Nusa Tenggara, for example, do not consume enough milk, eggs and meat (from animal sources which are rich in micronutrients) because the prices of such foods have increased enormously.

"We have conducted the study since l996. Therefore, we have sufficient data to compare people's health and nutritional status before and after the crisis," he said.

The NSS collects data on a wide-range of nutrition, health, socioeconomic and environmental indicators at the household level on a trimonthly basis.

"Even before the crisis, many Indonesian children and pregnant and lactating mothers did not receive adequate and nutritious food," he said.

The number of malnutrition cases has increased sharply, and now 450 children die of malnutrition each day.

Roy said local government and health officials used to hide the problem. During the crisis, however, reports of severely malnourished children are all too common.

"In the era of reform, all the facts are uncovered. The implementation of the social safety net program for health issues has also encouraged people to reveal the truth," he said.

With the disbursement of social safety net funds, all interested parties are now busy locating malnourished children who need help.

"Public health centers and provincial hospitals are willing to treat these children because their costs are easily reimbursed from the safety net fund," he said.

The treatment of severely malnourished children is urgently needed, but there is a more serious problem facing millions of Indonesian babies born into families that cannot afford micronutrient-rich foods because of the crisis.

"We are actually ignoring the real threat of a rocketing number of children with micronutrient deficiencies, which is a leading cause of anemia," Roy said.

More than 50 percent of Indonesian infants have anemia by six months of age because of poor diets.

The impact of anemia on young children is debilitating. A mild-case of anemia can impair intellectual development. Anemia during infancy can lower a child's IQ by between 10 and 15 points. Anemia among women and children also has a major impact on maternal and childhood mortality rates.

The studies also revealed that the condition of children living in urban slums and industrial areas like Jakarta, Semarang, Surabaya and Ujungpandang was far worse than children living in rural villages.

In rural areas, the benefit of the harvest is a significant crisis-coping mechanism not available to the urban poor.

Living in urban slums with no close relatives -- usually regarded as primary source of help -- with fewer job opportunities and less food available, has prevented parents from providing enough food for their children. Poor sanitation has further worsened these children's health.

These children will most likely suffer stunted growth, will be less productive and lack cognitive potencies.

"This is a disaster for a nation because these children are the future leaders," he said.

Many parties, including the government and donor institutions, have not yet emphasized the danger of malnutrition, especially the potential long-term impacts.

The World Bank released a report earlier this year titled Social Impacts of the Indonesian Crisis: New Data and Policy Implications. The report suggested the impact of the economic crisis, particularly on health and nutrition, was not as dramatic as had been previously reported.

"We do not agree with the report. The crisis' impact is so austere that it might ruin the future of our young generation," Roy said.

The World Bank and other institutions can conduct studies on the condition of Indonesians during the crisis, particularly women and children, but they should not cover up the real facts for certain purposes, Roy said.(raw)