Dr. Dini Latief MSc., SpGK.

INTERNATIONAL CONFERENCE ON CSR AND COMBATING MALNUTRITION:

OBTAINING MILLENNIUM DEVELOPMENT GOALS (MDGs) IN INDONESIA

Grand Sahid Jaya Hotel, 13 – 14 December 2010

Session 1: Prevention & Intervention in Improving The National Nutrition Status in Indonesia

Dr. Dini Latief MSc., SpGK.

Maternal and Child Nutrition for Preventing and Improving the Nation’s Nutritional Status

Indonesia’s Experience

Dr Dini Latief, MSc, SpGK

Dr Dini Latief, MSc, SpGK

Nutritional Status of Children Under-5 (RISKESDAS, 2010)

17,9

35,6

13,3 14,2

0

5

10

15

20

25

30

35

40

GIZI KURANG PENDEK KURUS GEMUK

Pre

vale

nsi

(%)

3

Prevalence of Stunting by ProvinceRiskesdas, 2010

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

NA

D

Sum

ut

Sum

Ba

r

Ria

u

Jam

bi

Sum

Sel

Be

ng

kulu

Lam

pu

ng

Ba

Be

l

Ke

pR

i

Jaka

rta

Jab

ar

Jate

ng

DI Y

og

ya

Jati

m

Ba

nte

n

Ba

li

NT

B

NT

T

Ka

lBa

r

Ka

lTim

Ka

lSe

l

Ka

lTim

SulU

t

SulT

en

g

SulS

el

SulT

era

Go

ron

talo

SulB

ar

Ma

luku

Ma

lUt

Pa

pB

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Pa

pu

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IND

ON

ESI

A

2007

2010

Prevalence of Underweight by Province2007 and 2010 (Riskesdas)

Mapping of severe underweight (gizi buruk )Riskedas, 2010

MGDs target 2015 ≤ 3.5 %

≤ 3.5 %

3.6-7.0 %

> 7.0 %

Percentage of Population with Energy Intake <1400 Kkal/cap/day, by Province

Susenas, 2009

Child growth

failure

Low birthweight

baby

Low weight &

height in teenagersEarly pregnancy

Small adult

woman

Small adult man

The intergenerational transmission of growth failure:

When to intervene in the life cycle?(ACC/SCN, 1992)

Critical Period of Child’s Growth

Abas, 200910

Critical Period of Child’s Growth(Indonesia’s data)

Window of Opportunity

• Maternal and birth outcomes

• Newborn babies

• Infants and children under two years old

The Womb.Your Mother.

Yourself.

What makes the way we are?

1. Our genes: the DNA we inherited at conception

2. Our childhood experiences: how we were treated and what we took in, especially the first three years

3. Our health and well-being stem from the lifestyle choices: kind of diet and how much exercise

4. Powerful source of influence:

Our life as a fetus(David Baker et al, 1990)

a) The kind and quantity of nutrition received in the womb

b) The pollutants, drugs and infections exposed to during gestation

c) The mother’s health, stress level and state of mind while she was pregnant

Sufficient evidence of interventionsthat affect maternal and child undernutrition

in Indonesia

1. Maternal and birth outcomes: Ante-natal care incl. iron-folate/calcium supplementation and TT immunization, consumption of iodized salt, reduce tobacco consumption and indoor air pollution, maternal supplement of balanced energy and protein, insecticide-treated bednets.

2. Newborn babies: Promotion of breastfeeding (individual and group counseling) and immunization.

Sufficient evidence of interventionsthat affect maternal and child undernutrition

3. Infant and children: Promotion of breastfeeding, Behavior change communication for improved complementary feeding, completed immunization, Zn in management of diarrhea, Iron-Vitamin A fortification and supplementation, Universal iodized salt, hand washing or hygiene interventions, treatment of severe malnutrition, insecticide-treated bednets.

INDONESIANational Plan of Actions on

Food and Nutrition

Policy on Food and Nutrition

1. Strengthen poverty reduction for increased impact on child and maternal undernutrition.

2. Focusing key nutrition interventions targeted at vulnerable group of pre-pregnant, pregnant and lactating women and children under two years of age.

3. Improve food security at local level and increase accessibility of the poor to adequate nutritious and safe food.

4. Healthy and Clean Life-style behaviour

5. Strengthen Food and Nutrition Institution at all level

Strategy of Plan of Actions for Food and Nutrition

1. New initiatives for more effective interventions at selected Provinces/Districts (prevalence of underweight > 15.5%, stunting >32% and daily energy intake <2000 Kkal/cap/day).

2. Gold standard of infant feeding incl. promotion of breastfeeding and complementary feeding

3. Hygiene and sanitation

4. Identify deployment gaps and competencies of human resources for health and nutrition.

Target:Universal Access to Food and Nutrition

in 2015

All Kabupaten/Kota:

1. Prevalence of underweight of children under five years of age: <15.5%

2. Prevalence of stunting of children under five years of age: <32%

3. Energy intake <2000Kkal/cap/day: 35.32% of population

Terima Kasih