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
