The Jakarta Post
The future generation of Indonesia is facing a dark future ahead in terms of their competitiveness and quality of life due to malnutrition, a recent discussion and data show.
The government's Basic Health Research (Riskesdas) data show that in 2013, the prevalence of anemia in toddlers aged 12 months to 59 months reached 28.1 percent. This means that one out of every four toddlers in the country suffers from anemia.
In addition, the same data showed that one out of three toddlers in Indonesia suffers from stunting.
The World Bank, in its recent report titled 'The Double Burden of Malnutrition in Indonesia', said that many Indonesians were still unaware about the severity of malnutrition among the newborn generation, especially surrounding the issue of stunting.
According to the World Bank, traditionally Indonesia has paid more attention to severely underweight children as a way to determine the country's state of nutrition. By this measure alone, nutritional issues appear largely resolved, as the prevalence of severely underweight children is just 5.4 percent among children under five years of age.
However, the fact that 8.4 million children or 37.2 percent of children under five are stunted should be of greater concern, given the lifelong consequences. Between 2010 and 2013, incidences of stunting increased from 35.6 to 37.2 percent.
'One of the main challenges in overcoming stunting in Indonesia is that shortness is often considered normal, due to hereditary reasons,' a nutrition expert from the University of Indonesia (UI), Endang L. Achadi, said in the report.
'Shortness is not the real problem,' she added. 'When it comes to stunting, other processes in the body are also stunted, such as brain development, which affects intelligence.'
The World Bank said that when children were stunted at an early age, they had the risk of reduced productivity over time. They might also receive poor education, which will result in jobs with low earnings. If followed by accelerated weight gain when older, they risk suffering obesity and other diet-related non-communicable diseases. Stunting is basically the double burden of malnutrition.
The World Bank estimated in its report that losses due to stunting and malnutrition were between 2 and 3 percent of Indonesia's gross domestic product.
'More cases of non-communicable diseases in Indonesia have caused higher expenditure for the government, particularly for national health insurance,' said Doddy Izwardy, director of nutrition at the Health Ministry, in the report.
'The highest costs for national health insurance are for treating stroke, diabetes and kidney failure.'
Non-communicable diseases account for around 60 percent of deaths, according to the World Bank. Stunting will also hamper the potential gain from Indonesia's demographic transition, where the ratio of the non-working age to the working age is shrinking.
Meanwhile, Nestle Research Center Public Nutrition Department head JÃ¶rg Spieldenner said in a recent discussion in Jakarta that children who suffered from stunting would also have an IQ that is five to 10 points lower than the average during their teen and adult life.
Spieldenner said that in a sense, people who did not have proper nutrition intake during their younger years would lack competitiveness, and if this happened to a significant number of people in a country, then the society in general would suffer a great economic cost.
Spieldenner, in one of his latest studies, calculated the potential economic cost suffered by a country due to malnutrition. His recent study, published last year, shows the total cost of the lack of iron, vitamin A and zinc in children aged six months to five years in the Philippines: 'The results showed that the medical costs of a lack of iron, zinc and vitamin A in the Philippines reached US$30 million or about Rp 390 billion per [...] generation,' Spieldenner said.
'But truly worrying is the loss of work productivity due to reduced lifetime earnings. In Indonesia, this could account for up to more than a billion dollars for anemia alone. Micronutrient deficiencies are detrimental to the quality of life and very costly to society and should therefore be prevented.'
One of the solutions to prevent micronutrient deficiencies is through food fortification, according to Spieldenner.
Food fortification, by definition, is an effort to improve the nutritional quality of foods by adding one or more specific micronutrients into them.
Spieldenner said 60 studies on fortification trials conducted on children in various low- and middle-income countries in Asia, Europe, Australia and America show that consumption of iron-fortified foods increases hemoglobin concentration and reduces the risks of anemia and iron deficiency.
Proper complementary feeding should also be conducted by parents since the first 1,000 days of a child's life is the most important period for growth and development to prevent malnutrition and macronutrient deficiencies.
The World Health Organization (WHO) recommends that exclusive breastfeeding should only be done during the first six months of a baby's life and afterwards, parents should introduce complementary feeding.
A proper provision of complementary feeding must come with the right quantity, type and quality, according to Trevino.
Otherwise, children can suffer from long-term inadequate micronutrient intake and this will lead to a deficiency in micronutrients and clinical symptoms, such as anemia. If parents fail to recognize this threat, the anemia, in the long run, will have negative impacts on the children, such as a cognitive decline and higher risks to infection.
Trevino A. Pakasi, a doctor and a nutritionist from the Community Medicine department of UI's School of Medicine, said during the discussion that despite the importance of food fortification and complementary feeding for babies, most parents in Indonesia still did not know much about the issue.
'Generally, the practice of complementary feeding for children has not been optimal,' Trevino said.
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