WHO’s Recommendation for stunting reduction · Suplemen yodium bagi ibu hamil • Pengobatan kekurangan gizi 1. ... • Development of a guideline to support subnational evidence-based

WHO’s Recommendation for stunting reduction

Presented bySugeng Eko Irianto

11th National Workshop on Food and Nutrition Jakarta, 3 – 4 July 2018

Background• Childhood stunting remains one of the world’s most fundamental

challenges for improved human development;• Currently, 162 million children are stunted worldwide, of whom 56 %

live in Asia and 36 % in Africa;• Several countries in the WHO European Region still present 20-30%

stunting prevalence rates;• Current progress is insufficient, and further investment and action are

needed to reach the target of reducing the number of stunted children to 100 million by 2025;

• If reduction rates observed between 1990 and 2010 were maintained, a projected 127 million children U5 would be stunted in 2025, representing a reduction of only 26%;

• Nearly a quarter of all children under five years of age today are stunted, with diminished physical and capacities.

Background• Stunting is a well-established risk marker for poor child development;• Specifically, stunting before age two predicts poorer cognitive and

educational outcome in later childhood and adolescent outcomes in later childhood and adolescence and has important education and economic consequence at the individual, household and community level;

• Recent longitudinal studies of children from Brazil, Guatemala, India, Philippines, South Africa associated stunting with grade failure and a reduction in schooling, where adult who at age two years were stunted completed nearly one year less of schooling compared to non-stunted individuals;

• Similarly, a study of Guatemalan adults found that those who were stunted as children has less total schooling, lower test performance, lower household per capita expenditure and a greater likelihood of living in poverty.

Map of global prevalence of stunting of children less than 5 years of age

CHILDHOOD STUNTING: CONTEXT, CAUSES AND CONSEQUENCES (WHO Conceptual Framework)

PENGALAMAN BEBERAPA NEGARA DALAM MENGATASI STUNTING

PENGALAMAN SINEGAL

PENGALAMAN PERU: Memprioritaskan daerah2 dengan insiden stunting yang lebih parah

PENGALAMAN THAILAND

PENGALAMAN BRAZIL

PENGALAMAN BANGLADESH

PENGALAMAN NEPAL

PENGALAMAN VIETNAM

PENGALAMAN MAHARASTRA

PENGALAMAN MEXICO

KEBIJAKAN YANG DILAKUKAN INDONESIA

INTERVENSI YANG PERLU DITINGKATKAN

REKOMENDASI LANCET 2015 UNTUK PENURUNAN STUNTING • Praktek gizi yang baik

1. Dukungan pemberian ASI2. Dukungan pemberian makanan pendamping3. Dukungan cuci tangan dengan sabun dan perilaku hidup sehat

• Mikronutrien1. Pemberian obat cacing2. Pemberian suplemen Vitamin A 3. Bubuk mikronutrien4. Suplemen zat besi-folat bagi ibu hamil5. Fortifikasi makanan dengan zat besi6. Iodisasi garam7. Suplemen yodium bagi ibu hamil

• Pengobatan kekurangan gizi1. Pencegahan dan pengobatan anak kurang gizi sedang yang berusia

antara 6 sampai 23 bulan2. Suplemen zinc terapeutik3. Pengobatan gizi buruk akut

Framework for action• Macronutrient supplementation of at-risk women, more specifically,

balanced energy-protein supplements provided in the third semester appears to improve fetal growth and birth weight;

• Early initiation and exclusive breastfeeding for six months provides protection against gastrointestinal infections, and is a key source of nutrients during infection by this means it minimizes growth faltering since repeated diarrhoeal infections contribute directly to stunting;

• Similarly, continued breastfeeding in the second year contributes importantly to intake of key nutrients that are undersupplied by typically low-quality complementary diets in poor settings;

• Among the most effectiveness interventions for improving linear growth and preventing stunting the complementary feeding period in improving the quality of children’s diets.

Framework for action• Specifically, evidence suggest that greater dietary diversity and the

consumption animal source foods associated with improved linear growth.

• Consumption of fortified complementary foods was part of the intervention packages that improved linear growth in Bolivia and Mexico;

• The safety of complementary foods is an important intervention are for preventing microbial contamination due to poor hygiene from poor food handling and storage;

• Similarly, availability of high-quality foods (food supply) and affordability of nutrient-rich foods (socioeconomic status) will affect a family’s ability to provide a healthy diet and thus prevent child stunting;

Six steps to identify policy actions to achieve healthy diet

WHO recommended action for stunting reduction1. Enact policies and/or strengthen intervention to improve maternal

nutrition and health, beginning with adolescent girls, pregnancy and maternity polices for pre and postnatal care;

2. Protect and promote exclusive breastfeeding in the first six months to promote “secure” nutrition;

3. Promote consumption of healthy diet, diversified diets including high-quality, nutrient-rich foods in the complementary feeding period of 6 –23 months;

4. Improve micronutrient intake through food fortification, including complementary foods, and use of supplements when where needed;

5. Foster safe food storage and handling practices to avoid infections from microbial contamination;

6. Strengthen community-based interventions to protect children from infections, intestinal worms and environmental health through improved water, sanitation and hygiene (WASH);

Key Recommendations7. Incorporate linear growth assessment in child health; 8. Integrate nutrition in health promotion strategies and

strengthen service delivery capacity in primary heath systems and community-based care for prevention of stunting;

9. Strong and committed coordinating committee for food control;

10. Development of a consistent risk based national approach that includes coherent planning followed by national accountability and reporting;

11. National and sub-national level have access to information management systems and data collection to support the risk basis of the food control system including risk analysis. 23

WHO support to the government• Promotion of dietary guidelines among teachers;• Capacity building on application of optifood linear programming

at local food environment for food-based recommendations and nutrient intake to reduce maternal anaemia among pregnant women;

• Reproductive health education and services among adolescent and pre-marriage women;

• Development health curriculum for school children;• Development guidelines for mother class;• Development National Health Action Plan for mother and new

born; neonates; school age children and adolescent.

• Development of a guideline to support for undergoing into a subnational evidence-based and multi-sectoral consultative process to review and strengthen implementation of local activities in prevention and control of stunting in Indonesia;

• Training of trainer the implementation of Standardized Nutrition Care for the health center;

• Development of a guideline to support subnational evidence-based and multi-sectoral consultative process in prevention and control of stunting;

• Training of trainer the implementation of Standardized Nutrition Care for the health center;

• Work with FAO to assist Government of Indonesia to strengthen the FCSthrough strategic outcomes of the food control system that identifies keyactions and priorities in developing a multi year strategic plan;

• Technical expert in national risk profiling and risk categorization.

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WHO support to the government

TERIMA KASIH