The Jakarta Post
Collaboration: Volunteer health workers take part in a training session to learn about stunting. (Courtesy of 1000 Days Fund/-)
It starts with a simple sticker, stuck to the wall of the main room in the family home by a volunteer with one goal: ending stunting in Indonesia.
Stunting is when a child does not grow properly and fails to meet height averages that match their age, resulting in brain damage that causes issues such as low IQ and illness later in life.
Currently, it affects one in three Indonesian children, or 35 percent of children under the age of five, according to the World Bank.
“In the places we’ve been to, food has never been the problem […] the problem is always insufficient micronutrients and hygiene,” says Valerie Krisni, an outreach coordinator at the 1,000 Days Fund, a group that is battling stunting with a promising pilot program.
Measure up: A child is measured using one of the in-home height charts developed by the 1000 Days Fund. (Courtesy of 1000 Days Fund/-)
She also said that there was a strong correlation between homes that did not have a toilet and severe stunting.
The main causes are a lack of safe water and toilet access, low breast-feeding rates, low immunization rates, malnutrition and wealth inequality; although these often affect one another and not every child is affected by all causes.
The organization says that on average, stunted children lose between six to 10 IQ points and miss approximately a year of school over their education as the result of sickness.
Children experience more sicknesses such as pneumonia and diarrhea from extended malnutrition, as well as being more likely to die of severe illness from a weakened immune system.
Later in life, affected children are more likely to suffer from chronic diseases such as hypertension. They also earn lower wages, earning around one fifth less than their non-stunted peers.
However, organizations like the 1,000 Days Fund are tackling the problem from the start.
The organization is named for the critical first 1,000 days from conception to age two, after which brain damage and other ill effects of stunted growth cannot be reversed.
Smart blanket: A mother holds up the smart blanket which is designed to measure infant children who cannot stand. (Courtesy of 1000 Days Fund/-)
They distribute height charts and smart blankets, which are blanket height charts for babies and for children, alongside delivering training to volunteers at an integrated health service post (Posyandu).
“We work through the established health system,” 1,000 Days Fund founder Zack Petersen says.
The organization recently received a US$25,000 grant from the World Bank to develop and deliver a combined height chart and education pilot program in three villages in East Nusa Tenggara in 2019, which had a stunting rate of 43 percent.
The program was highlighted on television program Kick Andy in June 2019, which resulted in some Rp 100 million ($7,317) in donations to the 1,000 Days Fund from state-owned airport operator Angkasa Pura.
According to research conducted by the 1,000 Days Fund, the national average of stunting is 30.8 percent, higher that some areas of sub-Saharan Africa.
The organization eventually arrived on a simple plan of attack.
First, all the volunteer healthcare workers and professionals in the area gather for a group training session.
Next, two members of the 1,000 Days Fund team and one local volunteer healthcare worker go to every house, explaining the height chart and training the parents in how to prevent stunting in their children.
By the end of the day, the volunteer is trained in delivering and maintaining the program in their village, which includes promoting proper nutrition and hygiene practices.
The village also develops an action plan to prevent and reduce stunting in the future.
Education first: Caregivers take part in an in-home training session to learn about the importance of nutrition and sanitation. (Courtesy of 1000 Days Fund/-)
Simon Flint, chair of the 1,000 Days Fund, says it works closely with local communities, especially women.
“We asked the mothers what they thought of the posters and they’d say ‘Oh, we love the posters, but we have to wait until our child can stand up before we can use them’ so what we did is we went away and developed the smart blanket,” he said.
He also described how educating the community is very important, as it allows for the information to sink in and be practiced reliably in the community.
Flint said a study that took place in Zambia that used similar posters in the home reduced stunting in children by 22 percent, an idea that formed the basis for the pilot program.
Indonesia already experiences stunting rates that are on par with countries such as Zambia and Ethiopia.
A study that accompanied the program showed promising results.
In January 2019, only 4 percent of caregivers could identify and explain stunting, while 65 percent could do so after the program ended.
“We almost doubled the number of women who not just said they breastfed, but were able to explain why it was good for their child. This rose from about three in 10 to six in 10” Simon said of nutritional education that formed part of the program for mothers.
To date, the 1,000 Days Fund has distributed 12,000 height charts across 22 islands in Indonesia.
In the future, it hopes to increase its efforts to give out 20,000 height charts this year as well as expanding the implementation of their program to more villages.
Before the election of President Joko “Jokowi” Widodo, Flint said “the government was either unaware or did not prioritize it”, praising the current government for recognizing the impact, although it has not outlined a formal plan to address the issue.
“It’s a disproportionately large problem with a disproportionately small amount of focus,” Simon says.
For now, organizations like the 1,000 Days Fund have made steps toward reducing the effects on child stunting in Indonesia, with a goal to eliminate it by 2030. (ste)
-- Isabelle Harris traveled to Jakarta with the assistance of the ACICIS Study Indonesia program.
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