Health Education-The Higher Infant Mortality Rate more than Maternal Mortality

Health Education-The infant mortality rate during childbirth in Jember higher than maternal mortality. Warranty labor is expected to reduce this figure.

According to Health Department data Jember, maternal mortality rate (MMR) alone, there were 52 cases. Lower than the infant mortality rate (IMR), ie 360 ​​cases. There are several factors causing higher infant mortality.

Health Education-PR Health Jember Jumarlis said, the factors that delayed the handling of labor, so the baby is difficult to be saved. With jampersal program, is expected to increase the number of pregnant women are routinely checked its contents. "Required by jampersal, that at least pregnant women perform at least three times to the midwife," she said.

Health Education-With the number of couples of childbearing age reached 18 thousand people and pregnant women 36 thousand per year, jampersal it is possible to reduce maternal and infant mortality. The government provides package delivery Rp420 thousand pregnant women. It's destined antenatal, normal delivery, and service.

Health Education-However, this can not be implemented jampersal medical centers and private midwives. Jember health office has not established a memorandum of understanding with the non-government medical services. DHO prepare health personnel in health centers, and have coordinated with three regional hospitals in Jember.

Health Education-There are a number of health centers with the status BEONC (Obsetry Neonatal Emergency Inspection Association), the Health Center Levee, Kencong, Puger, Gumukmas, Mayang, Sumberjambe, Jenggawah Ambulu and Health Center. PHC is designated to serve birth in the area around the district.

Health Highlights: May 2011

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:

U.S. Insurers Told to Justify Rate Hikes Over 10 Percent

The Obama Administration on Thursday told the health insurance industry that insurers must now justify any increases in rates that exceed 10 percent, in an effort to hold back soaring premium rates, The New York Times reported.

In a period where many Americans are putting off care due to faltering finances, insurers are reaping the benefit in higher profits, said Kathleen Sebelius, secretary of Health and Human Services.

"Health insurance companies have recently reported some of their highest profits in years and are holding record reserves," she said. "Insurers are seeing lower medical costs as people put off care and treatment in a recovering economy, but many insurance companies continue to raise their rates. Often, these increases come without any explanation or justification."

The 10 percent threshold was first proposed in December, but the insurance industry criticized it as arbitrary, the Times said. The administration rejected that notion, and on Thursday upheld the 10 percent threshold.

Workers in some states experienced health insurance premium hikes of 20 percent to 40 percent in 2011, the Times said, even as coverage shrinks and deductibles rise.

Federal officials do not have the authority to block rate increases over 10 percent that are found to be unjustified, but many states do have that capability. The administration is therefore providing $250 million in aid to states to help them fight increases deemed to be unreasonable, the Times said.

The new rule has its critics and admirers. "If we believe health care costs are crushing the economy, we ought to have a debate about how to bring costs under control," Karen M. Ignagni, president of America's Health Insurance Plans, a trade group, told the Times. "Focusing on premiums diverts attention from that debate."

But a consumer advocate supported the new move. "The days of insurance companies running roughshod over consumers and jacking up rates whenever they want are over," Ethan S. Rome, executive director of Health Care for America Now, which represents labor unions and civil rights groups, told the Times.

-----

FBI Investigating 'Unabomber' Kaczynski for 1980s Tylenol Deaths

Theodore Kaczynski, the so-called "Unabomber" in prison for life for three killings, said that the Federal Bureau of Investigation is seeking to procure his DNA to see if he was also behind the rash of tainted-Tylenol killings in 1982, Bloomberg News reported.

Those killings, still unsolved, had Americans on edge as seven people in the Chicago area died and 31 million bottles of the nonprescription painkiller were taken off pharmacy shelves.

Kaczynski's disclosure comes in an effort to block an auction of his belongings, currently ongoing, Bloomberg reported. In one handwritten court document, the 68-year-old former mathematics professor said that the FBI "wanted a sample of my DNA to compare with the partial DNA profiles connected with a 1982 event in which someone put potassium cyanide in Tylenol." According to Kaczynski, "I have never even possessed any potassium cyanide."

FBI spokeswoman Kathy Wright declined to comment, Bloomberg said.

-----

Most U.S. Women Have Complications During Pregnancy: Report

More than 9 out of every 10 American women who give birth experience some form of complication, according to a study conducted in 2008 by the Agency for Healthcare Research and Quality (AHRQ).

Overall, 94 percent of women hospitalized for their pregnancy/delivery experienced a complication such as abnormal fetal heart rate, advanced maternal age (over 35 years), anemia, bleeding, diabetes, eclampsia (sudden rise in maternal blood pressure), hypertension, laceration during delivery of the area between vagina and anus, premature labor, urinary infection or vomiting.

Complications seem tied to longer hospital stay: an average of 2.9 days for pregnancies with complications vs. 1.9 days for those without, the AHRQ said in their News and Numbers.

Costs also rose, from an average of $2,600 for pregnancies without complications to $4,100 when health issues arose. Overall, pregnancy/delivery-linked complications totaled $17.4 billion in hospital costs in 2008, the report found.

Stages of Childhood Development (0-59 months) and Pre-School Children (60-72 months)

Parents, caregivers and educators need to know the developmental stages of children (students), whether normal or there is ongoing development of irregularities. When educators suspect that their students have grown deviation or late development compared with age, it can tell parents to immediately check their children to health facilities that can be addressed early.

Some things to know about the process of development of the child which is a process of growth and development of children take place regularly, interrelated and continuous. In general, the characteristics of development of the child are:

    Growth and development occur simultaneously and correlated. For example: the growth of brain and nerve fibers of the child will be accompanied by changes in the function of the development intelegensianya.
    The development has a regular pattern and sequence. Growth and development at an early stage will determine the next stage of growth and development. For example: before the child can walk, he should be able to stand up first.
    The development of organ function has a fixed pattern, namely: development first occurred in the head area and then headed toward the lower (caudal), development occurs on the ability of coarse motion first, then followed by fine motor skills.
    The development is the result of the process of maturation and learning. Maturity is a process from within (intrinsic) that occur on its own according to their talents and potential of children. While the learning process will sharpen the ability of the child so the child has the ability to use the resources and potential inherited in children.
    The development can be foreseen. There is a common pattern of development for all children from the general ketahapan specific stages that occur regularly and continuously. Thus a child's developmental stages can be predicted.
Stages of development of children aged 0-72 months as follows:
Age 0-3 months:

    Lifting his head as high as 45 °
    Moving the head from left / right to the middle
    Seeing your face and stare
    Babble babble spontaneously or react with
    Like laughing out loud
    Reacting surprised to loud noise
    Replying to a smile when asked to talk / smile.
    Know Your mother by sight, smell, hearing, and contacts
Age 3-6 months:

1.     Turning from tummy to his back
2.     Lifting his head as high as 90 °
3.     Maintaining the position of the head remains upright and stable
4.     Hold the pencil
5.     Reaching objects within range
6.     Holding his own hand
7.     Trying to broaden outlook
8.     Directing her eyes on small objects
9.     Removing the high-pitched excited voice or yell
10.     Smiled when he saw the toys / interesting pictures when playing alone

Age 6-9 months:

1.     Sitting alone (in the cross-legged stance)
2.     Learning to stand, his feet rested in part weight
3.     Crawl and reach a toy or approached a person
4.     Moving objects from one hand to the other
5.     Picked up two bodies, each hand holding an object at the same time
6.     Picked up the object of beans scooped by
7.     Talking with no meaning such as: mamama, bababa, dadada, tatata
8.     Looking for toys / objects being dropped
9.     Playing applause /-a-boo
10.     Rejoice with throwing objects
11.     Eat the cake itself

Age 9-12 months:

1.     Lifting his body to a standing position
2.     Learning to stand for 30 seconds or holding onto a chair
3.     Can walk with guided
4.     Extended arm / body to achieve the desired toy
5.     Mengenggam tight pencil
6.     Inserting objects into the mouth
7.     Repeating imitating the sound is heard
8.     2-3 mention the same syllable without meaning
9.     Exploring around, curious, wanting to touch anything
10.     Reacting to a whisper (slowly)
11.     Glad to be invited to play "peekaboo"
12.     Getting to know family members, fear in people who have not known

Age 12-18 months:

1.     Stand alone without holding
2.     Bending over to pick up a toy and then stand back
3.     Walking back 5 steps
4.     Calling dad with the word "papa", calling the mother with the word "mama".
5.     Stacking two cubes
6.     Enter the cube in the box
7.     Referring to what he wants without crying / whining, children can spend a fun or interesting sounds mother's hand
8.     Jealousy show / compete

Age 18-24 months:

1.     Stand alone without holding for 30 seconds
2.     Walk without stumbling
3.     Clapping, waving
4.     Four stacked cubes
5.     Picking up small objects with thumb and forefinger
6.     Rolling the ball towards the target
7.     Call 3-6 words that have meaning
8.     Assist / imitate housework
9.     Hold the cup itself, learning to eat-drink alone

Age 24-36 months:

1.     The road up the stairs alone
2.     Can play and kick a small ball
3.     Pencil scribble on paper
4.     Speak well, using two words
5.     May appoint one or more parts of his body when asked
6.     Viewing pictures and can be called correctly name two or more objects
7.     Helping pick up his toys alone or help bring an object if requested
8.     Eat rice without a lot of spill
9.     Releasing his own clothes

Age 36-48 months:

1.     Standing on one foot for 2 seconds
2.     Jumping with both legs lifted
3.     Pedal a tricycle
4.     Draw a straight line
5.     Accumulate 8 pieces cube
6.     Know 2-4 colors
7.     Name, age, place.
8.     Understand the meaning of words above, below, in front of
9.     Listening to stories
10.     Wash and dry own hands
11.     Playing together ternan, follow the rules of the game
12.     Wearing their own shoes
13.     Dressed in slacks, shirt, clothes

Age 48-60 months:

1.     Standing on one foot for 6 seconds
2.     Jumping with both legs lifted
3.     Pedal a tricycle
4.     Draw a straight line
5.     Accumulate 8 pieces cube
6.     Know 2-4 colors
7.     Name, age, place
8.     Understand the meaning of words above, below, in front of
9.     Listening to stories
10.     Wash and dry own hands
11.     Playing with friends, follow the rules of the game
12.     Wearing their own shoes
13.     Dressed in slacks, shirt, clothes

Age 60-72 months:

1.     Walking straight
2.     Standing with one leg for 11 seconds
3.     Drawing 6 parts of the body, draw a complete person
4.     Catch a small ball with both hands
5.     Draw a rectangle
6.     Understand the meaning of the opposite
7.     Understand conversations using 7 words or more
8.     Answering questions about what objects are made of and its usefulness
9.     Know the numbers, can count the number 5 -10
10.     Know Your colorful
11.     Expressing sympathy
12.     Following the rules of the game
13.     Dress himself without assistance

SourceDepartment of Health, 2006, Guidelines for Stimulation, Detection and Early Intervention Growth in Primary Health Care Level.Posted by ARVIEN Farrell

Early Stimulation in Infants and Young Children to Develop Multiple Intelligences and Creativity

What is multiple intelligence?Multiple intelligences (multiple intelligences) are different types of intelligence that can be developed in children, such as verbal-linguistic (ability to describe the thoughts in sentences, presentations, speeches, discussions, writings), logical-mathematical (the ability to use logic in solving mathematical various issues), visual spatial (three-dimensional thinking skills), bodily-kinesthetic (movement skills, dance, sports), musicals (sensitivity and ability of expression by sound, tone, melody, rhythm), intrapersonal (the ability to understand and control myself) , interpersonal (the ability to understand and adjust to other people), naturalists (the ability to understand and utilize the environment).
What factors that affect the quality of intelligence?Multiple Intelligences influenced two major interrelated factors are heredity (congenital, genetic) and environmental factors. A child can develop a variety of intelligence if you have hereditary factors and stimulated by the environment continuously.
Parents who are intelligent children tend to be intelligent if environmental factors also support the development kecerdasaannnya since in the womb, infancy and toddler. Although both parents smart but if the environment is not providing basic necessities for the development of intelligence, then the potential intelligence of the child will not develop optimally. While parents who happened to have no chance to follow higher education (not necessarily they are not smart, probably because there is no opportunity or economic constraints) can be intelligent if it satisfied his need for the development of intelligence since in the womb up to school age and adolescence.
What basic need to develop intelligence?Three basic need to develop intelligence, among others, is the need PHYSICAL-BIOLOGICAL (particularly for brain growth, sensory and motor systems), EMOTIONS-AFFECTION (influence of emotional intelligence, inter and intrapersonal) and early stimulation (stimulating other intelligence-intelligence).
PHYSICAL-BIOLOGICAL needs good nutrition, especially since in the womb to teens, especially for brain development, prevention and treatment of diseases that can affect the development of intelligence, and physical skills to perform everyday activities.
EMOTION-AFFECTION needs: primarily with protecting, creating a sense of security and comfort, attention and respect of children, do not give priority to punishment with anger but more to give examples and lovingly. Needs stimulation involves the continuous stimulation with a variety of ways to stimulate all the sensory and motor systems.
The three basic needs must be given at the same time since the fetus inside the womb because it will affect each other. If the requirement is not fulfilled biophysical, affects less, often ill, then no optimal brain development. When the need for emotion and affection are not fulfilled then the inter-and inter-personal intelligence is also low. When stimulation in daily interactions is less varied then the development of intelligence is also less variable.
What's that early stimulation? What are the benefits?Early stimulation is the stimulation performed since the newborn (even better since 6 month fetus in the womb) is done every day, to stimulate all the senses (hearing, seeing, touching, pembauan, taste). In addition it should also stimulate the movement of rough and smooth legs, hands and fingers, encouraging communication, and stimulate pleasant feelings and thoughts of infants and toddlers. Stimulation performed at birth, continuous, varied, with the air play and compassion, will spur the various aspects of children's intelligence (multiple intelligences), namely intelligence: logiko-mathematical, emotional, communication, language (linguistic), musical intelligence, movement (kinesthetic) , visuo-spatial, visual art etc.
How do the early stimulationStimulation should be done every time there is a chance to interact with infants / toddlers. for example when bathing, changing diapers, feeding, feeding, holding, take a walk, play, watch TV, in the vehicle, before bed.
Stimulation for infants 0-3 months with a way: seeking a sense of comfortable, safe and fun, hugging, holding, gazing at the baby's eyes, inviting smile, speak, sounds a different sound or music alternately, hang brightly colored and moving objects (circles or boxes black-white), things sounded, baby mengulingkan right-left, stomach, back, stimulated to reach out and hold a toy
Age 3 - 6 months plus the play '-a-boo', saw the baby and the sitter's face in the mirror, is stimulated to his stomach, back and forth on his back, sit down.
Age 6-9 months plus calling his name, invited shaking hands, clapping, reading fairy tales, stimulate sitting, standing holding onto trained.
Age 9-12 months coupled with repeated mentions mama-papa, brother, inserting toys into containers, drinking from the cup, rolling the ball, trained to stand, walk with holding.
Age 12-18 months coupled with doodling exercises using color pencil, arrange cubes, blocks, pieces of a simple picture (puzzle) insert and remove small objects from the container, playing with dolls, spoons, plates, cups, teapots, broom, rag. Practice walking without holding, walking backward, climb stairs, kick a ball, took off his pants, understand and perform simple commands (where the ball, hold it, put it, grab it), mentioning names or showing objects.
Age 18-24 months plus with asked, mentioning and showing the parts of the body (where the eye? Nose?, Ears?, Mouth? Etc.), ask for a picture or mention the names of animals and objects around the house, talking about daily activities -day (eating, drinking bath, play, ask, etc.), practice drawing the lines, washing hands, wearing pants - clothes, playing throw ball, jump.
Age 2-3 years plus the know and mention the color, use adjectives (big-small, hot-cold, high-low, many-bit, etc.), mentioning the names of friends, counting objects, wear clothes, brush your teeth , playing cards, dolls, cooking, cuisine, drawing lines, circles, people, practice standing on one leg, urinated / large in the toilet.
After 3 years in addition to developing life skills earlier, stimulation is also directed to go to school readiness include: holding a pencil properly, write, recognize letters and numbers, simple arithmetic, understand simple commands (urinating / large in the toilet), and independence (left at school), share with friends etc.. Stimulation can be done at home (by the caregiver and family) but can also be in the Play Group, TK or the like.
The importance of the atmosphere when the stimulation
 Stimulation is carried out every opportunity to interact with the infant-toddler, every day, continuously, variable, adjusted for age development of ability, performed by the family (especially mother or mother substitute).
Stimulation should be done in an atmosphere of fun and excitement between caregiver and infant / balitanya. Do not provide stimulation to the hurry-hurry, obtrude nanny, no interest or desire attention to infant / toddler, or infant-toddler is sleepy, bored or want to play another. Caregivers who are often angry, bored, annoyed, then the caregiver would unwittingly give a negative emotional stimuli. Because in principle all the words, attitudes and actions nanny is a stimulation that were recorded, remembered and will be replicated or even cause fear infant-toddler.
The importance of a democratic parenting (authoritative)Therefore, the interaction between caregiver and infant or toddler should be done in a democratic atmosphere of parenting (authoritative). That nanny should be sensitive to infant cues, it means pay attention to their interests, desires or opinions of children, not to impose the will of caregivers, full of love, and joy, a sense of security and comfort, giving examples without forcing, pushing the courage to try to be creative, give awards or credit for the success or good behavior, giving a correction rather than a threat or punishment if the child can not do something or when making a mistake.
Why early stimulation can stimulate multiple intelligences?Fetal brain cells are formed after 3-4 months in the mother's womb and after birth until the age of 3-4 years the number increased rapidly to reach billions of cells, but there is no relationship between these cells. Starting 6 months of pregnancy, the relationship established between cells, thus forming a series of functions. The quality and complexity of the sequence relationships between brain cells is determined by the stimulation (stimulation) performed by the environment to the infant-toddler.
The more varied stimuli received by infant-toddler, the more complex relationships between brain cells. The more frequent and regular stimulation received, the stronger the relationship between these brain cells. The more complex and powerful relationship between brain cells, the higher and varied intelligence of children in the future, when developed over time, so the child will have many variations in intelligence (multiple intelligences).
How do I stimulate multiple intelligences?
To stimulate verbal language intelligence invite conversation, read the story again and again, stimulated to talk and tell stories, sing songs, etc. children.
Logical-mathematical intelligence Train by classifying, composing, arranging, counting toys, play figures, checkers, congklak, abacus, chess, cards, puzzles, puzzle, monopolies, computer games etc..
Develop visual-spatial intelligence by observing the picture, photos, assemble and disassemble lego, cutting, folding, drawing, checkers, puzzles, houses, computer games etc..
Trained intelligence body motion with one leg standing, squatting, bending, walking on one line, running, jumping, throwing, catching, gymnastics, dancing, sports games etc..
Stimulates musical intelligence by listening to music, singing, playing musical instruments, the rhythm and tone.
Trained inter-personal emotional intelligence by playing along with older children and younger, sharing the cake, give in, toy lending, working to make something, the game control myself, recognize the various tribes, nations, cultures, religions through books, TV etc.
Train the intra-personal emotional intelligence by telling feelings, desires, ideals, experience, imagination, writing stories etc..
Stimulate naturalist intelligence by planting seeds to grow, maintain potted plants, pets, gardening, tourism in the forest, mountains, rivers, beaches, watching the sky, clouds, moon, stars, etc..
If the child has the innate potential of the various intelligence and stimulated continuously since childhood in a fun and varied types so our children will have multiple intelligences.

How do I develop the creativity of children?
Creativity is needed by humans to solve various problems in daily life. Creativity should be developed early on. Many families who do not realize that the attitude of parents who are authoritarian (dictatorship) against children will kill the seeds of creativity of children, so that when the adults have only a very limited creativity.
How does the role of parents to develop the creativity of children?
Creativity of children will develop if parents are always being authoritative (democratic), namely: to listen to talk of children, value the opinions of children, encourage children to dare to express it. Do not interrupt the child when he wants to express his thoughts. Do not force the child that parents are the most correct opinion, or opinion of child abuse
Parents should encourage children to dare to try to express their opinions, ideas, do something or take their own decisions (provided it does not endanger or harm other people or yourself). Do not threaten or punish a child when opinions or actions are considered wrong by the parent. Child is not wrong, they generally do not know, in the learning phase. Therefore the opinion or ask why they do so, given the opportunity to promoted reasons. Give examples, take thought, do not be dictated or forced, let them fix it in its own way. Therefore do not turn off their courage to express thoughts, ideas, opinions or do something.
In addition, parents should encourage independence of the child in doing something, appreciate the efforts he has done, giving praise for the results that have been achieved even though no matter how small. The ways this is one important element of creativity development of children.
Families should encourage children to interested in observing and questioning about various things or events around us, what they hear, see, feel or think in their daily lives. Parents must respond in a way that increasingly provide the means to stimulate children to think more deeply, for example by providing the pictures, books. Do not refuse, prohibit or stop the child's curiosity, as long as it does not endanger himself or others.
Parents should give children the opportunity to develop imagination, contemplate, think and realize the idea of ​​children with each. Let them play, draw, create shapes or colors in a way that is unusual, illogical, unrealistic or has never existed. Let them draw a bicycle with square wheels, the sky is red, blue leaves. Do not many prohibit, dictate, denounced, condemned, or restrict the child. Give freedom, opportunity, encouragement, appreciation or praise to try an idea, provided it does not endanger himself or others.
All these things will stimulate the development of right brain functions that are essential for the creativity of children, namely: divergent thinking (extended), intuitive (based on intuition), abstract, free, simultaneously.
Summary

    If you want a child with multiple intelligence from infant stimulation should be performed every day in all sensory systems (hearing, seeing, touching, pembauan, taste), with invited talk, play to stimulate feelings and thoughts, stimulate the rough and smooth motion of the neck, body, feet, hands and fingers.
    How do the stimulation should be adjusted to the age and stage for growing up children. Stimulation is done every time there is a chance to interact with the infant / toddler, for example when bathing, changing diapers, feeding, feeding, holding, take a walk, play, watch TV, in the vehicle, before bedtime, or anytime and anywhere when you can interact with your toddler. Next can be added through the Play Group, TK and the like.
    Stimulation should be done in a fun atmosphere, that authoritative parenting (democratic). Meaning: caregivers must be sensitive to infant cues, pay attention to their interests, desires or opinions of children, not to impose the will of caregivers, full of love, and joy, a sense of security and comfort, giving examples without forcing, pushing the courage to try to be creative, give awards or credit for the success or good behavior, giving a correction rather than a threat or punishment if the child can not do something or when making a mistake.
    Authoritative parenting is important to develop the creativity of children.
    Listen to the talk of children, encourage children to dare to utter their opinions, respect the opinion of the child, do not interrupt the child, parents do not force an opinion or the opinion of child abuse.
    Rangsanglah child to be attracted to observe and question about various things in their environment, give freedom and encouragement to develop imagination, contemplate, think, try and realize the idea. Give praise for the results that have been achieved even though no matter how small.
    Do not stop the child's curiosity, do much to threaten or punish, give a chance to try, provided it does not endanger himself or others.

author : Arvien 
see also : www.arvienfarrel.blogspot.com

Nutritional Health Analysis

Nutrition Paper: Situation Analysis of Nutrition and Public Health
The success of the national development of a nation is determined by the availability of human resources (HR) berkualtias, namely human resources that have a tough physically, mentally strong and vibrant health in addition to mastery of science and technology. Lack of nutrition can damage the nation. The purpose of the analysis is to identify trends and public health nutrition problems and the determinants that affect this problem.
The analysis uses primary data from SUSENAS 1989 to 2003, and other data that have nutritional and health status information society. The studies were also based on differences between districts, between provinces, as well as differences between urban and rural areas. How to "Bivariate and Multivariate" analysis applied in this paper to explain the changes in nutritional status and health determinants for the community and to provide recommendations on policy programs for improving nutrition and public health in the future.
The results of this study generally indicates that the problem of nutrition and public health is still quite dominant. Of health indicators, despite the marked improvement of health status with increasing life expectancy, and declining infant mortality and under five, but still carrying around 24% of districts with infant mortality rate (IMR)> 50 per 1000 live births.
High Mortality Due to Malnutrition
The cause of death entered in 2000 was still dominated by infectious diseases and increasing circulation and respiratory diseases. The low health status is partly due to environmental factors or environmental contamination of water and air. In addition, behavioral factors are also influential to the occurrence of chronic diseases, such as heart disease, cancer, and others.
The high death rate is also the impact of malnutrition on the population. Starting from birth, the problem has begun to emerge, namely the number of babies born with low weight (LBW <2.5 kg). This problem continues with the height problem of malnutrition in young children, school age children, adolescents, adults up to old age.
Results of other studies that are not less important is the more he explained "the phenomenon of double burden" that struck the Indonesian population, especially in urban areas, marked by the increasing problem of overweight, and the increased proportion of mothers with overweight children who have short or thin. This paper also discusses the assumption of decreasing nutritional problems until 2015, with a variety of alternative interventions.
Increasing human resources for the future needs to be done to repair or reinforce existing intervention become more effective, useful for the target groups especially vulnerable and poor population. Improved quality of health care and nutrition in the population a priority, in addition to improving education and reducing poverty, especially in districts and cities that its severity is very heavy.
Health and nutrition services for the future must also consider the growth of urban population that will bring other problems. By improving the quality of the intervention to the community, assumed to decline in nutrition and public health problems can be achieved.
The success of the national development of a nation is determined by the availability of human resources (HR) quality, namely human resources that have a tough physically, mentally strong and vibrant health in addition to mastery of science and technology. Malnutrition can impair the quality of human resources.
At present, the majority or 50% of Indonesia's population can say no ill will but also unhealthy, generally referred to malnutrition. Incidence of malnutrition is often terluputkan of sight or ordinary observation, but gradually have an impact on maternal mortality, infant mortality, child mortality and low life expectancy.
The period of pregnancy is a period that largely determine the quality of human resources in the future, because the child's growth is largely determined by its condition when the fetus in the womb. However, keep in mind that the state of health and nutritional status of pregnant women is also determined much earlier, namely when the teens or school age. So forth the nutritional status of adolescents and school age is determined also on the health and nutritional conditions at birth and infants.
United Nations (January, 2000) focused efforts to improve nutrition in relation to efforts to increase human resources in all age groups, by following the life cycle. In Figure 1 can be seen groups of people that need attention on efforts to improve nutrition. In Figure 1 is shown also factors that affect the deteriorating nutritional situation, namely the inadequate health care, infectious diseases, parenting, lack of food consumption, and others that ultimately have an impact on mortality.
To more clearly know the factors that cause nutritional problems, chart 2 above (Unicef, 1998) show systematically the determinants that affect the nutritional problems that can occur in society. Thus, nutrient improvement efforts will be more effective by always reviewing these factors.
Nutritional Status Population Projection 2015
If the nutritional status of populations can be improved, the health status can be achieved. Here are just focused on nutrient status projections, based on the latest situation of 2003 in Indonesia and discussed with regard Healthy Indonesia 2010, the World Fit for Children, 2002, and the Millennium Development Goal by 2015. Decline in nutritional status depends on many factors.
Based on previous descriptions and also contained in the chart 1 and chart 2, the underlying causes are:
o Food security at household level is not adequate. Review monitoring of food consumption in 1995 to 1998, concluded (see table 10): 40-50% of households consume less energy than 1500 kcal and 25% of households consume 32 grams of protein per person per day or consume <70% of the adequacy of recommended. (Widyakarya National Food and Nutrition / WKNPG, 2000). Based on the SP 2000, the estimated number of households is 51,513,364, the problem of food security hit 20-25 million households in Indonesia. Although there were improvements in 2003 on household food security, this study still showed the ratio of food expenditure to total expenditure is still high family. Indonesia still faces at least 20% in rural districts where this ratio was> 75%, and 63% of districts with a ratio of spending on food / non food between 65-75%.
o Food security at household level is closely related to poverty, which is based on analysis of SUSENAS 2002, found the proportion of poor people is 18.2% or 38.4 million people (CBS, 2002). Distribution of poor districts vary widely, there are still about 15% percent of the poor districts with> 30%.
o The lack of balance between regions (sub-district, district) as seen from the variation of the severity of the prevalence of nutrition problems, other health problems, and the problem of poverty. As previously disclosed in the description below is 75% of districts in Indonesia bear the burden with a prevalence of underweight> 20%.
o The high rates of infectious diseases associated with sanitation, environment, and inadequate health services, along with immunization coverage is still not universal. Infectious diseases cause malnutrition in children under five include acute respiratory infection and diarrhea. Results of IDHS 1991, 1994 and 1997 did not decrease the prevalence of ARI respectively 10%, 10% and 9%. Even the 2001 Household Health Survey the prevalence of ARI by 17%. While the prevalence of diarrhea IDHS 1991, 1994 and 1997 also did not differ much from year to year are respectively 11%, 12% and 10%, and the results SKRT 2001 amounted to 11%.
o The scope of nutrition improvement programs are generally low, many Posyandu are not working. Growth monitoring is only done in about 30% of the existing five.
o Giving only breast milk in general is still low, and there is a declining trend from 1995 to 2003. Furthermore, breast feeding till 6 months tend to lace, only about 15-17%. After that giving complementary feeding into the problem and resulted in inhibition of growth.
o The high prevalence of short children who show nutrition problems in Indonesia is a chronic problem.
o The high maternal mortality, infant and toddler, low income and low education levels lead to low human resource index.
o lack of financing for good health from the government sector and non-government (2000: USD 147.0/kapita/tahun), as well as financing for nutrition (2003: USD 200/kapita/tahun).
From the magnitude of the problem of nutrition 2003 and causes a multi-factor, then the predictable projection of nutrition trends yad like the following:
1. Projected prevalence of underweight
From the previous description, the decline in prevalence of underweight (weight for age) is studied based on SUSENAS 1989 up to 2003 amounted to 27% or a decrease in prevalence around 2% per year. There have been many interventions to improve the nutritional status of young children, including nutrition services through integrated health. By improving the nutritional status of the service efforts, especially related to enhancing nutrition counseling to the public, is expected to decline in prevalence of at least equal to the previous period or by 30%. In the study SUSENAS 2003, the prevalence of underweight was 19.2% and 8.3% severe malnutrition. Assuming a 30% decline, expected by 2015 prevalence to 13.7% and the prevalence of malnutrition to 5.7%
2. Projected prevalence of malnutrition (stunted) on the new kid in school
Changes in the physical size of the population is one indicator of the success of efforts to improve the quality of human resources. It is well known together that in many countries children grow faster than 20-30 years ago. They are not only mature but also achieved early adult growth faster. Of the few studies conducted in several countries, shows the differences in height between the age group 20 years and 60 years in men and women mature height of approximately 8 cm.
Stated also that in most developing countries' secular trend "of increasing height is 1 cm for every decade since 1850. This change is closely associated with environmental conditions and changes in the quality of human life.
In Indonesia research "secular trend" increase the population's height from one particular time. The information that exists is the result of the survey ansional 1978 and 1992 among children under five from 15 provinces. From the results of both surveys, it was stated that there is a change in the average height of 2.3 cm in boys and 2.4 cm in girls within a period of 14 years.
The analysis of TBABS survey showed a decrease prevalence of underweight (stunted) on the new kid in school in 1994-1999 amounted to 3.7%. Stunting or short is the problem of chronic malnutrition and are generally very slow decline. Experience increases the average height from generation to generation in developing countries in general as high as 1 cm in a period of 10 years. The increase in average height of new child entered school from 1994 to 1999 in 5 years ranged from 0.1-0.3 cm. With the situation in 1999 with only a 3.7% decline over a period of 5 years, and using the same assumptions with a reduced prevalence of underweight, which is 40% then in 2015 the prevalence of stunted the new kid in school is assumed to be 24%.
3. Projection KEK in Infertile Women Aged
Based on the study SUSENAS 1999-2003, the decline in the proportion of KEK risk ranged from 5-8% in the period of 4 years depending on age group. Group of women of childbearing age, up to 2003 has not been a priority for nutrition improvement program. To improve the nutritional status of populations, this age group particularly at WUS aged 15-19 years should be a priority for the future. As shown in Figure 10, the 35-40% WUS KEK-risk aged 15-19 years.
Interventions for this age group may not be too complex compared to the intervention on infants or pregnant women. However, the interventions will be more useful to develop human resources for future generations. By using the assumption of decline from the year 1999 - 2003 for the age group 15-19 years.
By positioning the proportion of the risk of KEK 35% in 2003, in 2015 the assumption will be 20%. Assumption decrease the proportion of KEK on WUS group 15-19 in 2015 is expected to suppress the occurrence of low birth weight, lower prevalence of underweight and also accelerate the increase in height of Indonesian children.
4. Projection problem micronutrients
Micronutrient problem that has come out until 2003 is a matter of VAD, IDD and Nutrition Anemia. There are many other micro-nutrient problems that have not been revealed but the role is very important to the nutritional status of populations, such as the problem of lack of calcium, lack of folic acid, lack of vitamin B1, less zinc.
The majority of interventions that have been made to reduce the problem of VAD, IDD and Nutrition Anemia in Indonesia was still revolves around the capsule supplementation or provision of vitamin A, iodine capsules, and iron tablets. Another strategy is much more effective such as fortification, counseling for the diversification of food is still not implemented.
For projection micro-nutrient problem until 2015 according to the information available up to 2003 can only be done for problems KVA, IDD and anemia. Baseline data for overall micronutrient problem for the future needs to be done, because the information for lack of calcium, zinc, folic acid, vitamin B1 is only available from the food consumption information at the household level which tend defrisit in the daily diet.
In the previous description KVA known problem in infants is known only from the survey results 1992. In the survey stated xeroftalmia issues as the impact of VAD has been declared free from Indonesia, but 50% of infants still suffer from retinal serum <20 mg, where this situation will be able to trigger re-emergence xeroftalmia case. From some reports, the case xeroftalmia was already starting to reappear, especially in NTB.
Giving vitamin A in infants is assumed to have not reached all children under five. Intervention KVA with the distribution of high-dose vitamin A capsules for the next 5 years are still considered necessary, in addition to other strategies (fortification, extension, and diversification of food) began intensified. It is expected that with "multiple strategy" 50% of VAD in infants can be reduced to 25% in 2015, or a decrease of 50%.
Year 2003 has been evaluated to determine the prevalence of IDD prevention of IDD after the last information is 9.8% in 1996/1998. in 1996 assumed the prevalence of IDD will be reduced at least 50% in 2003 after the intensification of IDD prevention project (IP-IDD) 1997-2003.
However, this decline did not occur nationally, there are still many problems are not resolved completely in the response to this, such as iodized salt consumption at household level is still not universal (SUSENAS 2003 show only 73% of households consume iodized salt.)
In addition, monitoring of iodine capsules in endemic areas of heavy and medium is not known to what extent these capsules given to the target group. Given the problem of IDD is very closely related to the content of iodine in the soil, in general, the prevalence of IDD in populations living in endemic areas of heavy and medium can be decreased after the intervention of iodine capsules in a certain period and will be improved if the consumption of iodized salt can be universal.
However, if the capsule is not giving the right target and can not be universal salt beyodium, the prevalence of IDD is likely to rise again. With this condition, there is the possibility of the prevalence of IDD could not overcome a hundred percent within 12 years (until 2015). It is expected that TGR in 2015 could be reduced to less than 5%.
Prevention of anemia up to 2002 is still focused on pregnant women. As disclosed in previous descriptions of the prevalence of anemia among pregnant women declined from 50.9% (1995) to 40% (2001). Reduction of anemia for the future are expected not only to pregnant women, but also to women of childbearing age in order to reduce maternal mortality and increase productivity.
The prevalence of anemia in WUS by SKRT 2001 was 27.1%. This figure is projected to be 20% in 2015. Assumption decline only about 30% until 2015, because until 2002, anemia prevention intervention on WUS still not intensive.
Assumed reduction in the prevalence of nutrition problems need to be enhanced by taking into account the tendency of death rates, disease patterns, levels of consumption, income and education. In addition, up to 2003, there are many nutritional problems that have not been revealed mainly deals with the problem of other micronutrients that have a significant role in overall nutrition improvement. Health And Nutrition Improvement Program Future
Departing from the magnitude of the problem of nutrition and health and varied factors that cause this problem between regions, it requires a comprehensive and integrated programs both at the district, provincial, and national. Obviously the cooperation among relevant sectors is important, in addition to reducing the activity of the overlapping and unfocused.
Here's a thought for future programs, among others:
1. Many things must be strengthened to implement nutrition programs, ranging from the availability of data and information periodically to be used in planning programs that correct and effective. Studies program that efficient strategy for the coming period is absolutely necessary, ranging from national to district level.
2. Conduct prevention programs for improving nutrition and preventive health for the long term, while the curative may be given to groups of people who really need it. Form of effective programs such as improved health and nutrition behavior conducted in a professional level of the family began to think about, and certainly with the provisions of local or specific criteria.
3. Perform specific program strategies to address poverty, both in urban and rural areas in the form of family empowerment strategy and create a good cooperation with the private sector.
4. Gradually make improvements in education, this strategy is a long-term strategy that can be raised Indonesia from various issues of nutrition and health.
By: Arvienfarrel