2nd International Symposium on Public Health Aceh-Taiwan

August 23-24, 2016

Child Malnutrition Issue

Marisa, MD., M.Sc (Clin. Nutrition)
Nutrition Department Faculty of Medicine
Syiah Kuala University

 Preface
Existing Conditions
Possible Research Collaboration

Preface
Malnutrition is a serious condition that occurs when a persons diet
doesnt contain the right amounts of nutrients.
Poor nutrition
Undernutrition
Overnutrition

Preface
Nearly half of all deaths in children under 5 are attributable to undernutrition.
This translates into the unnecessary loss of about 3 million young lives a year.
Undernutrition puts children at greater risk of dying from common infections,
increases the frequency and severity of such infections, and contributes to
delayed recovery.
In addition, the interaction between undernutrition and infection can create a
potentially lethal cycle of worsening illness and deteriorating nutritional status.
Poor nutrition in the first 1,000 days of a childs life can also lead to stunted
growth, which is irreversible and associated with impaired cognitive ability and
reduced school and work performance.

Global Data

Global Stunting Prevalence (1990-2014)

Global Underweight Prevalence (1990-2014)

Global Overweight Prevalence (1990-2014)

Indonesia

Malnutrition Facts in Indonesia

Despite economic growth, 87 million Indonesians remain vulnerable to
food insecurity
Malnutrition cost Indonesia more than USD 5 billion annually due to
lost productivity as the result of poor education standard and
dimishing physical capability
Children suffer frequent episodes of diarrhoea, which accelerates
undernutrition. In 2012, 14% of all children in Indonesia had suffered
an episode of diarrhoea in the previous two weeks.
Double burden of malnutrition. Undernutrition in one side, and
overnutrition in the oher side.

Malnutrition Facts in Indonesia (2)

Almost two out of every three children under two years of age, or
57 %, in rural areas in Indonesia are anaemic.
Only 42% of children aged less than six months are exclusively
breastfed, and only 36% of children consume appropiate
complementary food
About 10% of adolescent girls aged 15-19 years of age are already
mothers or pregnant with their first child. Therefor, poses a major
risk to the nutritional status both for mother and child

Malnutrition Facts in Indonesia (3)

There has been no progress in reducing stunting between 2007
(36.8%) and 2013 (37.2%)
Indonesia has the fifth highest number of stunted children in the
world. More than one out every three children in Indonesia are
stunted (9.5 millions children under five are malnourished)
More than three million or 12% of children under five years of age
in Indonesia suffer from wasting

Under 5 Child Malnutrition Prevalence

32
40.1

39.2
36.4

15

19.6
14.8
12.3
6.8

5.4

13.5

12.3

11.2

18.6

19.9

11.5

6.7

Severe Wasting

Wasting

Overweight
2007

2010

Stunting
2013

Underweight

Underweight prevalence

Stunting prevalence

Wasting prevalence

Aceh

5.101.473 people

565.567 (2015)

23 district

Under 5 population:

Underfive Children Malnutrition Case in Aceh

2014

2015

70

59

60

50

47

40

28

30

27

26

24
19

20

10

15

13

11
8

14
9

6
3

19

21

19
15

18
1312
65

16

1112

10
67

6
2

5
1

1312

Underfive Children Malnutrition Case in Aceh

366

212

Total Cases
2014

2015

Causes

Target by 2019

Strategies
Key strategies
1. Enhance the coverage and quality of a package of integrated health and
nutrition services to address undernutrition and overnutrition.
2. Promote appropriate health, nutrition, sanitary, hygiene and parenting
behaviours.

Strategies (2)
3. Strengthen competencies of nutritionists and health workers providing
nutrition services.
The Ministry of Health should work closely with university and education institutes
to ensure that course curricula and competencies reflect the focus on nutritional
status during the first 1000 days of life as well as the double burden of
malnutrition

4. Strengthen the design, implementation and monitoring of laws, regulations

and standards for nutrition.

 PHC as a firstlayer in identificate, preventing, and promoting

health issue related malnutrition

Possible Research Areas

Researchs doing by Medicine Faculty Students

(Undergraduate study program)
Determinant factors affecting nutritional status in underfive
children
Asssociation between mother nutritional status and knowledge
with under five child nutritional status
Influenced of Social Economic factors to Breastfeeding Practice in
Primary Health Care
Mother education level and succesfull complementary feeding

 Students ongoing research:

Association between dietary fiber intake and physical activity with senior
high school students obesity
Analysis of dietary fat intake, physical activity, and body composition in
overweight undergraduate students.
Effect of local organic rice and non organic rice intake on glycemic
response in overweight.

Research focus area

Peer Group
Nutrition, Microbiology, Immunology,
Daily Five Servings of Fruit and Vegetables Influence on Gut Microbiota
Composition in Type 2 Diabetes Mellitus Patients
RSUDZA Hospital, Banda Aceh
Aceh:

Gut Microbiota consider as a factor contributing to NCD, T2DM

There is a lack informations about gut microbiota in NCD, T2DM (Indonesia, Aceh)
High prevalence of DM, obesity
98% didnt meet the WHO recommendation on vegetables and fruit intake

Aims:
Define the gut microbiota composition
Promote dietary fiber intake
Suggest a recommendation: is 5 portions is enough to modulate gut microbiota thus promoting
good metabolic profile, esp. In Aceh population

 Methods:

Experimental
One group: ask to have 5 portions vegetables and fruit for 6 weeks,
Other group: take their diet as usually they have
Collect feces sample to identify Bifidobacterium spp and Akkermansia
muciniphila, bacterial counts conducted by realtime PCR

marisa@unsyiah.ac.id
Thank You