Vulnerability to Food Insecurity Map of NTT Province
CHAPTER 4 FOOD UTILIZATION
4.6 HEALTH OUTCOME
Life expectancy is an outcome of health and nutrition status. In NTT province, the average of life expectancy was 66 years. The highest life expectancy was reported in Sikka district (68.4) and the lowest was in Sumba Timur district (61.6) (Table 4.5). At the sub-district level, 74 out of 280 sub-districts had the life expectancy of 70 years or more (Annex 4.1 and Map 4.5).
Table 4.4: Percentage of Underweight and Stunted Under Five Years Children
District
Children (< 5 yrs) Stunting 49,10
Source: Riskesdas 2007, MoH
Table 4.5: Life Expectancy
District
No Life Expectancy (year)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Sumba Barat Sumba Timur Kupang T T S T T U Belu Alor Lembata Flores Timur Sikka Ende Ngada Manggarai Rote Ndao Manggarai Barat Sumba Barat Daya Sumba Tengah Nagekeo Manggarai Timur Sabu Raijua Total NTT Total Indonesia
64.48 61.62 65.02 66.60 67.71 65.30 66.25 66.34 67.51 68.40 64.41 66.93 66.89 67.22 65.99 63.11 62.42 63.27 66.89 65.02 65.57 68.16 Source: SUSENAS CORE 2007-2009, PODES 2008, BPS
Strategies for improving health and nutirion status of nutritionally vulnerable groups Chronic malnutrition (stunting) remains at very high level in NTT province. Chronic malnutrition is resulted from poor fetal growth and reduced growth in the first two years of life, mainly due to a combination of inadequate nutrient intake, high disease exposure and poor caring practices. It causes irreversible damages, leads to substantial increases of under-five mortality and the overall disease burden.
Early undernutrition, especially stunting, leads to reduced physical and mental development during young ages, which subsequently affects school performance and attendance. Undernourished children are more likely to start school later and drop out earlier. This devastating impact on early development adversely affects their income earning potential for life, making it very difficult to rise out of poverty. In addition, undernourished children who put on weight rapidly at later stages of childhood and adolescence are more likely to develop chronic diseases (diabetes, hypertension and coronary heart disease) related to nutrition. The long-term damage caused by early childhood undernutrition also includes shorter adult height and low birth weight babies born to women, which perpetuates the problem in the next generation.
To reduce high rates of stunting, nutrition interventions should be planned and implemented urgently and more effectively at all levels, from household to provincial and national levels. To effectively prevent and treat different forms of undernutrition, it is important that nutritionally vulnerable groups are prioritized, underlying multi-dimensional causes are understood, appropriate and effective interventions to address identified causes are selected, and commitment and investment in nutrition is increased.
Food Security and Vulnerability Atlas of NTT
The following nutrition strategies are recommended:
1. Focus on nutritionally vulnerable groups, including:
a. Children younger than two years of age. The first two years of life which are most critical are know as “window of opportunity” because preventing undernutrition at this age benefits children and society throughout the rest of their life. Although most damage is done and should be prevented from conception (i.e. 9 months) to 24 months of age, children’s vulnerability to diseases and risk of death remains high during first five years. That’s why many health and nutrition interventions focus on all under-fives. Health and nutrition interventions should prioritize under two years children, and if resources permit, under five years children.
b. Moderately malnourished children. They have a higher risk of dying due to increased susceptibility to infections. The detected moderately malnourished children should be properly treated to prevent from becoming severely malnourished.
c. Pregnant and lactating women because they have greater nutritional needs for fetal growth and development, and for producing breast milk for their infants.
d. Micronutrient deficiencies among people of all age groups, especially young children, pregnant and lactating women. Micronutrient deficiencies are assumed to be widespread in the population due to heavily carbohydrate-based diets, low intake of proteins (animals, vegetables, and fruits) and fortified foods. In this context, stunting is usually widely prevalent.
2. Plan and implement multi-sectoral interventions to address THREE underlying causes (food, health and care related) of undernutrition.
A single sector alone (health or education or agriculture) cannot effectively address multi-faceted causes of the problem.
a. Direct interventions with direct benefits for nutrition (mostly through Health Sector):
• Improving maternal nutrition and care, especially during the second half of pregnancy:
frequent, diversified and nutritious meals; daily taking iron tablets or multiple micronutrient powder (Sprinkle); and at least 4 ante-natal care check-ups during a pregnancy.
• Promoting breastfeeding during 0-24 months: initiation of breastfeeding as soon as after birth;
exclusive breastfeeding up to first six months; continued breastfeeding up to 24 months; and continued breastfeeding during child’s sickness.
• Improving complementary feeding of 6-24 months children: start complementary feeding from 7th month; frequent small, diversified and nutritious meals (animal foods, eggs, bean, peas, peanuts, vegetables, fruits, oil); and avoiding unhealthy snacks.
• Regular monitoring weight and height of 0-24 months or 0-59 months children, if resources permit, early detected malnutrition for timely intervention. Enhance communication with families on child’s weight, ways to prevent and correct weight and height failure.
• Facility-based and community-based management of acute malnutrition among under-five children according to WHO/UNICEF and MoH guidelines.
• Improving micronutrient intake: promoting iodized salt; diversified diet; fortified foods; iron tablets for pregnant women; semi-annual vitamin A supplementation for 6-24 months children (or 6-59 months if resources permit), and lactating mothers within 1st month after birth; and de-worming.
• Intensifying health and nutrition information-education-communication (IEC) on these direct and indirect interventions, by using various channels (mass media, village loudspeakers, village
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events, etc.) to address not only mothers and caregivers, but also village and religius leaders, husbands and other family members, adolescents, teachers, extension workers and community service providers.
b. Indirect intervention with indirect benefits for nutrition (mostly through non-health sectors)
• Promoting homestead agriculture: home gardening of vegetables, fruits, beans, peanuts; small animal husbandry (chicken, ducks); and fish pond.
• Mobilizing community-based leaderships of village head, religion leaders, women’s association, farmers’ association, etc. in nutrition interventions, particularly in hygiene and nutrition education.
• Improving drinking water: increasing access to improved water sources at households and schools; promoting the drinking of boiled water instead of raw water; constructing water tanks to collect water during rainy seasons; and encouraging students to bring drinking water to school to prevent thirst.
• Improving hygiene and sanitation: hand washing before meals and after toilets; improving sewage system; and proper waste/excretion disposal.
• Improving women’s status: increasing female education, improving knowledge/skills on child care and feeding; enhancing shared responsibility of husbands and other family members in child care and feeding.
• Strengthening capacities of the related provincial and district officials in planning, implementing, monitoring and evaluating nutrition interventions.
It should be emphasized that the indirect interventions are complementary to, but should not substitute for direct nutrition interventions.
3. Prioritize and increase investment in nutrition and commitment to solve nutrition problems
The economic costs of child undernutrition are very high. Child undernutrition leads to losses in adult productivity and high health care and education cost. There are various forms of childhood malnutrition that cause productivity losses in adulthood associated with lower cognitive ability. Protein-energy malnutrition is associated with a 10% loss, iron deficiency anemia with a 4% loss, and iodine deficiency with a 10% loss in adult productivity. Childhood malnutrition also leads to productivity losses in manual labor.
Investments in nutrition are among the most cost-effective development interventions, because very high benefit-to-cost ratios, not only for individuals, but also for sustainable growth of countries, because they protect health, prevent disability, boost economic productivity and save lives.
Regional Mid Term Development Plan (RPJMD) of NTT Province 2009–2013. The RPJMD includes a programme related to education, health development and women empowerment, which consists of the following aspects:
a. Education:
1. Completion of compulsory 9 years basic education; and 2. Non-formal education.
b. Health:
1. Community nutrition rehabilitation programme;
2. Disease prevention and eradication programme;
3. Health promotion and community empowerment programme;
4. Healthy environment programme; and 5. Health education programme.
Food Security and Vulnerability Atlas of NTT
c. Empowerment of women, children and youngsters
1. Programme for policy synchronization focusing on increasing the quality of life of children and women;
2. Programme to improve the quality of life and protection of women; and 3. Programme to increase the role of rural women.
The expected outcomes of the above programmes are:
• Reduction of illiteracy rate from 11.5% (2007) to 5% (2013);
• Reduction of severe malnutrition rates from 6.7% to 4.1% and moderate malnutrition rates from 30.1% to 25.8%; and
• Increase of life expectancy from 65 years to 68.5 years.