Searching for answers to malnutrition

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)