This book was preceded by a task assigned by the Directorate of Local Nutrition, Directorate General of Nutrition, Maternal and Child Health of the Ministry of Health to create a book review on stunting. Results: The high prevalence of stunting nationally in under-fives to school-age children has not improved.
CONTENTS
METHOD ___________________________ 8 2.1. Data Sources _____________________________ 8
ACRONYMS ABBREVIATIONS
SMA: SMA SMP: SMP SMP: SMP SMA: SMA Sulawesi Utara: Sulawesi Utara Sulawesi Tengah: Sulawesi Tengah Sultra: Sulawesi Tenggara Sulbar: Sulawesi Barat Sulawesi Selatan: Sulawesi Selatan Sumatera Barat : Sumatera Barat Sumatera Selatan: Sumatera Selatan Sumatera Utara: Sumatera Utara SUN: Peningkatan Gizi Survei Kesehatan Nasional: Survei Kesehatan Nasional.
INTRODUCTION
- BACKGROUND
- PROBLEMS
- OBJECTIVE
- General Objective
- Specific Objectives
- BENEFITS
- METHOD
- DATA SOURCES
- CONCEPTUAL FRAMEWORK
- DATA ANALYSIS
- OPERATIONAL DEFINITION
- STUDY LIMITATION
To provide information on the future burden of stunting in Indonesia, both short-term and long-term burden. Logical framework of stunting in Indonesia, modified from "Logical framework of nutritional problems" Unicef, 2013.
TREND OF STUNTING
TREND OF STUNTING AMONG CHILDREN UNDERFIVE
Trends in the prevalence of stunting among children under five years old in the last 6 years can be seen from the results of Riskesdas and 2013 (Figure 7). Some provinces showed deterioration due to increased prevalence of stunting (Sulawesi, West Papua and Aceh, NTT).
TRENDS OF STUNTING AMONG SCHOOL-AGED CHILDREN
The analysis of the growth of school-age children from 2001 to 2013 by gender can be seen in the figure below. There appear to have been improvements in the growth rates of school-age children for boys and girls gradually, though not particularly significantly.
TRENDS OF STUNTING AMONG ADULTS AGED
The condition that a third of girls suffered from retarded growth is very alarming, because this will later affect the condition of the fetus. This condition can be dangerous because there can be stunted growth over generations if no intervention has an impact.
This can be attributed as a result of the economic crisis, where the majority of children in this age group are born. There appears to be an improvement in nutrition in adulthood indicated by a decrease in prevalence.
THE MAGNITUDE OF STUNTING PREVALENCE
STUNTING AMONG INFANTS Birth weight and birth length
Nationally, the percentage of children under five with short birth length and low birth weight was 4.3. THE GOVERNMENT OF STUNTING PREVALENCE The percentage of children under five years of age with a history of low birth weight and short birth length by their characteristics is described in Figure 23. The percentage of children with a history of low birth weight and short birth length tends to decrease as its parent. 'seduction level increases.
THE SIZE OF STUNNING PREVALENCE The percentage of birth length for children under five years of age by characteristics is explained in Table 3.
STUNTING AMONG CHILDREN UNDER FIVE YEARS OLD
The number and proportion of children under two years of age based on their nutritional status (height for age) in Indonesia is shown in Table 5. THE SCOPE OF STUNTING PREVALENCE The proportion of samples of the Riskesdas 2013 for children under two years of age, disaggregated by combination of nutritional status Table 6 shows that 8.5% of children under the age of two in Indonesia were small and overweight. The highest percentage of small children and children under two years of age who were overweight was in Lampung (13.5%).
Number of children under two years of age (0-23 months) by combination of nutritional status across provinces, Indonesia 2013 provinces.
STUNTING AMONG SCHOOL-AGED CHILDREN
- Age 5–12 years
- Age 13 -15 years
- Age 16–18 years
Proportion of children aged 5-12 years based on their nutritional status (height/age) by demographic characteristics, Indonesia 2013. Detailed information on the proportion of youth aged 13-15 years based on their nutritional status (height-for-age) by province are listed in Table 10 and by characteristics in Table 11. Proportion of youth aged 13-15 based on their nutritional status (height for age) by province, Indonesia 2013 provinces.
SIZE OF INFIDELITY OUTBREAK Based on demographic characteristics, the prevalence of inhibition among young people aged 16-18 years is detailed in Table 13.
NUTRITIONAL STATUS AMONG ADULTS 1. Stunting among adults (age 18-65 years)
- Pregnant women with high risk
- Women in reproductive age with chronic energy deficiency (CED)
The lowest prevalence of high-risk pregnant women was found in Bali (12.1%), while the highest was found in West Sumatera (39.8%). The lowest and the highest prevalence of CED risk were found in Bali (10.1%) and East Nusa Tenggara (45.5%), respectively. Nationally, the prevalence of CED risk in women of reproductive age was as high as 20.8 percent.
Prevalence of chronic energy deficiency (CED) risk among women of childbearing age 15–49 years by province, Indonesia 2013.
THE GAP OF STUNTING PREVALENCE
- Gaps by residence
- Gaps by household’s wealth level
- Gaps by educational level
- Gaps across provinces
- Gaps across provinces for all age group
- The gaps across districts within province
- Pattern of the gaps across provinces in 2007 – 2013
The size of the gap in the prevalence of stunting between urban and rural areas from all age groups is shown in Figure 30. The next figure (Figure 32) shows the gaps in the prevalence of stunting for each age group, related to the educational level of the head of the household. Gaps in the prevalence of stunting for all age groups by province can be seen in the following figure.
It is interesting to observe the pattern of differences in the prevalence of stunting in 2007, compared to that in 2013.
THE BURDEN IN THE FUTURE AS A RESULT OF STUNTING TODAY
CHILD DEVELOPMENT
A cohort study of child growth and development in Bogor has successfully followed the growth process of 220 infants, with some information on the child's development as follows. It showed that babies born short, with body length <50 cm, will have a developmental disorder. A study of pre-school education in three provinces (West Sumatra, South Sulawesi and East Java) in 2009 clearly showed the link between inhibition and delay in children's development.
The comparison of child development in disabled and normal children in different areas of child development.
MORBIDITY
NON COMMUNICABLE DISEASES
Analysis of the relationship between stunting and diabetes mellitus was performed using data from Riskesdas 2007/08. Stunting is a risk factor for diabetes mellitus in adults who were lean and normal (BMI <23) and had a 1.5-fold increased risk of diabetes mellitus. Those who were short and non-obese (BMI <23) had a 1.5-fold increased risk of developing diabetes, while those who were short and obese had a 3.4-fold increased risk of developing diabetes compared to those who were not short and fat.
A similar study, using Riskesdas data from 2007, also measured the relationship between stunting and high blood pressure.
SOCIAL FACTORS OF STUNTING DETERMINANT
THE FRAMEWORK FOR HANDLING STUNTING PROBLEM
THE CAUSE OF STUNTING ON INFANT
Pregnant women with pre-pregnancy weight <45 kg had significantly lower weight gain compared to the standard. Meanwhile, pregnant women with pre-pregnancy weight ≥45 kg had closer weight gain compared to the standard. Pregnant women with normal pre-pregnancy BMI had near-normal pregnancy weight gain.
It could be seen that pregnant women with CED had far from standard weight gain during pregnancy.
THE CAUSE OF STUNTING IN CHILDREN UNDER FIVE
This can be a factor that weakens their nutritional status, affects their growth performance, and therefore increases the incidence of stunting. In the poorest group, the prevalence of retarded children of smoking parents was 33.7 percent compared to 13.7 percent whose parents did not smoke. It is clearly shown that poverty factors have greatly influenced the prevalence of stunting and the number is exacerbated with smokers' parents.
The predominance of the occurrence of disabled children in the population is probably due to the famine that occurred in a long time.
THE CAUSE OF STUNTING IN SCHOOL AGE CHIDLREN
Percentage of school-age children who were sick last month and average days sick. As an illustration, the percentage of children aged 5-18 suffering from diarrhea in the past month by province can be seen in the figure below. The percentage of diarrhea in the previous month for children aged 5-18 years is slightly higher in rural areas than in urban areas.
The prevalence of ARI in people aged 5-18 years in the last month by economic status, 2013.
OTHER DETERMINANT FACTORS
- Environmental Factors
- Healthcare Factors
- Behavioral factors
- Reproductive Health Factors
- PHDI 2013
- Economic status
- Educational status
These environmental health conditions have a significant association with nutritional status, especially as the prevalence of stunting among children under five years of age and among children aged 5 to 18 years is decreasing. The same analysis was carried out using a scatter plot for all 497 districts between the prevalence of stunted children under five years and children aged 5 to 18 years and their healthcare index. The analysis for the scatterplot was also carried out using the value of PHDI 2013, where the result of a composition of seven sub-indexes includes 30 indicators with the prevalence of stunting in children under five years of age and in children aged 5 to 18 years (see table 30 for list of 30 indicators).
The higher the percentage of people with higher education in the district/city, the lower the prevalence of pregnancy for children under five years old as well as for children aged 5-18 years.
RECOMMENDED NUTRITION INTERVENTION PROGRAM IN
FRAMEWORK FOR STUNTING REDUCTION
The nutrition-specific intervention carried out by the health sector was therefore considered a downstream effort, which may not have a large impact if the upstream sector is not adequately addressed. Many experts have mentioned that nutrition intervention is the kind of intervention that will lead to intergenerational benefit. It has been shown that nutrition intervention can break the vicious cycle of poverty and increase the country's gross domestic product by 2-3 percentage points annually.
A $1 investment in nutrition intervention can lead to a $30 profit in the health sector and productive economic education.
RECOMMENDED INTERVENTION PROGRAM IN INDONESIA
RECOMMENDED NUTRITION INTERVENTION PROGRAM IN INDONESIA The next section will describe specific and sensitive intervention during different life cycle periods.
PREGNANT WOMEN
- Interventions during the first 1000 days of life
- Universal health coverage
- High calorie, protein and micornutrient food Supplementation
- Quality of Ante Natal Care (ANC) Services
- Health personnel assisted delivery in health facility
- Early detection of communicable and non- communicable diseases
- Reproductive health education for pregnant women
- Early initiation of breastfeeding and exclusive breasfeeding
- Family Planning
- Deworming program
Study on Jampersal (Tety Rachmawaty, 2013) also showed that for pregnant women, Jampersal shifted the place of delivery from the home to the health facility. The limited implementation of the education program can be seen, for example, from the use of MCH book as a means of counseling for pregnant women. The figure shows that only 40.4% of pregnant women had and could show the KIA/MCH book.
In conclusion, various models and media for counseling and health education among pregnant women have been designed and implemented, but the implementation still needs to be strengthened and scaled up.
CHILDREN UNDER FIVE YEARS
- Growth monitoring among under five children
- Food supplementation for underfive children
- Early stimulation for child development
- Universal health coverage through JKN
- Optimal health care services
Considering the growth curve of Indonesian children, which was increasingly deviating from the standard growth curve, the development of nutritional supplements for children under five years of age seemed necessary. The program for the stimulation of early childhood for the age under five years should be integrated into the activities of the integrated health center. If this is addressed, the country will have the benefit of the demographic bonus.
One of the indicators for coverage of child health services for children is immunization and the coverage can be seen in Figure 97.
SCHOOL AGE CHILDREN: 6-12 YEARS
- Prolonged compulsory education from 9 years to 12 years
- School days become 5 days/week, 7 hours/day
- Nutrition improvement progrm at school
- Moral and religious education
- Clean and healthy behaviour education
- Provision of safe drinking water and hand washing facilities at school
- Provision of adequate sanitary toilet facilities
- Provision of sanitary disposal and sewerage facilities
- Health education (intra dan extra curriculair)
- School as non smoking areas
- School free of drug abuse
- Health services at school
- Bullying free environment at school
- Cooperation with the National Social Insurance System for health sector
- School health program become compulsory health services of the primary health care center
Compulsory education for 12 years enabled all children to reach secondary school and thus allowed children to be in school until the age of 18. In order to ensure a clean and healthy behavior among children, environments must be provided in the school. Which component of health education should be given in school should be evaluated by the health sector.
Health assessment should not only be carried out for screening purposes, but can be followed up by programs to improve children's health.
ADOLESCENT PERIOD, AGED 13-15 YEARS
Focusing the school health program on this age group can also prepare children's nutritional status before they enter adolescence. The expected impact of the school health program was to improve the overall health status of school students, which could lead to reduced absenteeism. Furthermore, healthy children will be able to acquire knowledge better than unhealthy ones, so that they are prepared to be great human beings in the future and enable the country to benefit from them.
RECOMMENDED NUTRITION INTERVENTION PROGRAM IN INDONESIA is increasing and becoming one of the causes of death.
ADOLESCENT PERIOD, AGED 16-18 YEARS
Therefore, safe traffic awareness should be introduced so that the youth start driving carefully and obeying traffic signs, rules and regulations. Balanced nutrition education, eating a lot of fruits and vegetables, maintaining ideal body weight are the important messages that needed to be emphasized. Safe road behavior, both for users of public transport or as drivers, was also an important message to convey because the highest cause of death in this age group was road accidents.
The age limit for legal marriage should be raised from 16 to 20 for women and from 19 to 20 for men.
PRODUCTIVE AGE
