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Ensuring pregnant women, children are well nourished
The Micronutrient Initiative, the Ministry of Health (MoH) and Governments of Australia and Canada have joined forces to tackle micronutrient deficiencies facing pregnant women and children under five in East Java and East Nusa Tenggara (NTT) amid an ever-changing environment
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he Micronutrient Initiative, the Ministry of Health (MoH) and Governments of Australia and Canada have joined forces to tackle micronutrient deficiencies facing pregnant women and children under five in East Java and East Nusa Tenggara (NTT) amid an ever-changing environment.
Witnessing pregnant women taking iron tablets and young children drinking mineral supplements will surely please those concerned about women's and children's health. Sufficient nutrition is of particular benefit to women, infants and young children.
But the reality has yet to reflect expectations.
Health officials and trained volunteers at a community health center (Puskesmas) and an integrated health service post (Posyandu), acknowledged the challenges facing them in persuading pregnant women and children under five to take the vitamins and minerals that their bodies need.
'Iron tablets are available for free for pregnant women. It turns out, however, that asking them to take them is not that easy,' said A. Heru Nugroho, head of the Nutrition Division at Provincial Health Office of East Java in Surabaya following the recent launch of the Integrated Program of Micronutrient Supplementation for Reducing Mortality and Morbidity in Indonesia (MITRA).
Tastelessness and lack of awareness of its benefits are the reason behind their reluctance to take the tablets, he added.
'Many pregnant women prefer consuming jamu [herbal medicine] which tastes better than an iron tablet,' he said.
A similar micronutrient-taking reluctance-related challenge is also facing Puskesmas staff in NTT.
'Once our staff at Puskesmas gave Oralit [oral rehydration therapy] and zinc tablets to diarrhea-infected children, but the tablets remained untouched because they did not like them,' said Joyce Tibuludji, head of the disease elimination and prevention division at the NTT Provincial Health Office. 'Many parents still underestimate diarrhea.'
Trained volunteers at the Posyandu in Kuanheum village, about half an hour from Kupang, NTT, also share the same challenges, especially in regard to inviting pregnant women or mothers with newborns to visit a nearby health post where they are supposed to receive iron tablets, Vitamin A, zinc and other vitamins and minerals.
'We need extra efforts to persuade pregnant women to visit the Posyandu and take iron tablets,' said trained volunteer Yosintip, 33.
Micronutrients, including iron, are vital for pregnant women and children under five, especially in the first 1,000 days of a child's life. 'Iron-deficiency anemia during pregnancy is associated with preterm delivery, low birth weight and infant mortality,' said an expert.
A lack of these important vitamins and minerals puts children at increased risk of illness, which unless tackled properly, will affect their development and growth.
Many pregnant women lack awareness about the importance of consuming such micronutrients, which partly contributes to the increased rate of stunting among children.
The World Bank said in its latest report that 37.2 percent of Indonesian children under the age of five ' 8.4 million children ' were stunted (meaning excessively small for their age) and suffered from chronic malnutrition.
'As such, Indonesia has the fifth-highest level of stunting in the world,' it said.
The report also stated that 19.6 percent of Indonesian children under five years old (approximately 4.4 million) were underweight as a result of malnutrition.
This explains why the Canada-based Micronutrient Initiative (MI) and the governments of Indonesia, Australia and Canada launched recently a new nutrition program, called MITRA dedicated to improving the health and productivity of pregnant women and children below the age of five in East Java and NTT provinces under the MITRA initiative.
The expected three-year program that targets 20 districts in the respective provinces will ensure that pregnant women and young children get the right start in life, paving the way for a new generation of healthy and productive Indonesians, which ultimately will contribute to building a stronger and more resilient society.
Under the program, MI is collaborating with the MoH to increase healthcare workers' capacity to promote the distribution and consumption of iron and folic acid (IFA) tablets to pregnant women to prevent complications related to anemia during pregnancy and avoid neural tube defects like spina bifida in newborns. It also aims to help 770,000 children in the two provinces receive annual doses of Vitamin A.
The 20 districts are expected to serve as a mode l for improved performance in pregnant women's and young children's micronutrient consumption, to which other districts can refer when seeking solutions to micronutrient issues.
Hidden hunger
The salvation of the first 1,000 day of a child's life ' from the nine month-pregnancy through to a child's second birthday ' is under the government's framework of boosting people's nutrition, according to Doddy Izwardi, Director of Community Nutrition at the MoH.
To enhance people's nutrition, the ministry continues to promote a balanced diet to replace an old campaign titled '4 Sehat 5 Sempurna' (Four Healthy, Five Perfect).
The balanced diet guidelines have four principles: Food variation, a clean lifestyle, active lifestyle and routine control of body weight.
An imbalanced diet will lead to hidden hunger. 'Unconsciously people need vitamins and minerals, however small the amount, but it is not that easy to maintain it. For example, even though a child may eat a plateful of rice, he can suffer from a lack of Vitamin A because rice only contains small amounts of Vitamin A,' Doddy said.
He added that today, educating mothers about nutrition was a tough challenge due to the ever-changing environment, especially with the rapid growth of the food industry.
'We have now more choices in terms of foods but pregnant women should be aware of the importance of keeping their baby healthy by ensuring the first 1,000 days of their child's life,' he says.
Starting from having a proper micronutrient intake, embracing a healthy lifestyle and routine check-ups at a health facility, the issue of pregnant women's health should be tackled comprehensively, he said.
Underscoring the importance of collaboration with all relevant stakeholders, Doddy said the government should retain its strong principles regarding the handling of the first 1,000 days of a child's life, which deals with preventive, promotional and curative programs and involves non-health sectors, such as the public works office and the ministries of agriculture, trade and industry.
To comply with Presidential Decree No. 2/2015 requiring the MoH to focus on lowering the rate of stunting among children, the ministry and its related offices have to combat stunting, with the first 1,000 days in a child's life becoming a priority.
'Under the collaboration program with MI, micronutrients are included in pregnant women's routine checks, which showcases a new point in the program,' said Doddy.
Filling the gap
Meanwhile, Dr. Elvina Karyadi, Country Director of MI Indonesia, said the program was an integration of several programs, including Vitamin A for children under five, IFA for pregnant women, zinc and ORS for childhood diarrhea.
'The integrated program calls for collaboration across sectors and programs. The concept, introduced for the first time, is in line with the MoH's existing nutrition-related program,' she said.
Principally, the collaboration allows MI to lend a hand in the existing initiatives in the government's system instead of running a new program. 'We give something that the government is lacking, which we term 'filling the gap' ['¦] that's the principle. That's why we have a good partnership with the government,' she said.
The government, including provincial and district administrations, then develops a sense of ownership of the initiative, which will ensure sustainability of the program. 'We meet the government's needs,' she said.
To ensure a sustainable program in terms of funding, the East Java administration has designed a Budget Plan for Regional Nutrition and Food Action (RADPG-Rencana Aksi Daerah Pangan dan Gizi) so that when donors cease to give financial assistance in 2018, the program will continue, according to Heru.
Apart from rampant micronutrient deficiency, NTT is prone to diarrhea-related issues due to a lack of access to clean water resulting from long drought and geographical challenges, according to Joyce.
She said that villages located in remote areas had difficulties with access. 'For those living in remote areas, a healthy and clean lifestyle has yet to become a culture,' she said. 'Many still like to drink un-boiled water,' she added.
More trained staff are expected to be deployed in NTT so the program will reach its targets, including people living in hard-to-reach areas.
Despite the program targeting 20 districts, it will also be expanded in terms of coverage. 'The prototype of the books can be copied and distributed to other districts in the two provinces and trainers [from MI] are welcome to provide capacity building training at other districts in the two provinces,' Doddy said.
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