Data sources on Child Malnutrition in Indonesia

The nutrition program is part of the Indonesian development program, which was included in the first five-year national development plan 1979-1984, and nutritional data on several dimensions of nutritional status are routinely collected. The sources of nutritional information along with their strengths and weaknesses are explained in the following sections.

Starting from 1985, the Nutrition Surveillance System was gradually established and expanded to all provinces by the 1990s. There were three data collections assigned to monitor child malnutrition: a) Nutritional Status Monitoring through Socio-Economic Survey (Susenas); b) Nutritional Status Monitoring for sub-district level; c) Nutritional Status Monitoring for first-grade schoolchildren.

The purpose of this data collection is to provide information related to nutrition that is needed for a variety of purposes such as: targeting populations for short-term and long-term policy and program development, monitoring changes and evaluating the impact of interventions.

10.1 Nutritional Status Monitoring through Socio-Economic Survey (Susenas)

The Susenas-type surveys which are integrated into routine Central Bureau of Statistics (CBS) annual surveys consist of social and economic variables. Every year the survey collectis information from 220,000 households. This sample size is representative for the district level (core survey). In addition to the core survey, every three years a special module, such as health, agriculture or education, is implemented as a part of Susenas. The module has a sample size of 65,000 households, which is only representative for national and for the provincial level. The Anthropometric measurement for preschool children was introduced to the Susenas-type-module for the first time in 1989. Weight for age was the anthropometrix index chosen to identify the prevalence of child malnutrition nationally as well as the regional/provincial figures. So, this anthropometric information is available for the years 1989, 1992, 1995 and 1998. From 1999 to 2001, the Ministry of Health supported a Susenas-typecore for the purpose of evaluating the consumption of iodized salt. The anthropometric measurement for preschool children is also expanded to cover the district level. The Susenas-type-surveys do not classify the areas into poor or non-poor, but into urban-rural and by gender differential.

10.2 Nutritional Status Monitoring System at Sub-District Level

The Ministry of Health has its own Nutritional Status Monitoring System for classifying subdistrict level nutritional status. The purpose of the data collection is to provide an indication of nutritional status in sub-district areas affected by program development. The underweight data is collected under this system to determine the levels and trends of malnourished children at sub-district levels. The monitoring has been implemented yearly and regularly since 1995 to support district government's prioritizing of the highest risk areas within districts. The calculation of sample size was determined based on the previous prevalence of child malnutrition, and preschool children were chosen based on multi-stage/simple random sample. The data is available at the central level as well as district and sub-district level. There is a problem for continuation of data collection because of budget limitations, especially for the year 2001 when the decentralization system has started. Table 2 [ PDF 148.1KB | 1 page ] compares between these two types of child malnutrition data collections.

10.3 Nutritional Status Monitoring for first-grade schoolchildren.

Starting in 1994, the Ministry of Health decided to evaluate the nutritional outcomes as an impact of program development. National surveys have been implemented for measuring all first grade school age children. The Height for Age (HFA) is the anthropometric index used to measure the children. The data has been collected every 5 years to represent the prevalence of stunted children at the district level. Two data sets are available for the years 1994 and 1999 consist of height measurement for children 5 to 8 years old. The data can be assessed to determine the prevalence of stunting for urban and rural areas and also by gender. A simple random sample was assigned to select elementary schools at the village level, and from selected schools, first graders were measured.

10.4 Village Nutritional Program Data

At the village level, the nutrition program is implemented at Posyandu – the Integrated Health post covering 50-100 households. This growth promotional program includes activities such as immunization, basic health services for mother and children, nutrition counseling, family planning, and food supplementation. The activities are implementied once a month by cadres and supervised by health staff from health centers.

Example:

Using the growth card, all three indexes wasting, stunting and underweight are collected for children visiting the Health Post. The monitoring use growth chart and the growth faltering are detected when a child’s growth curve declines at less than the curve from the growth chart. If it could be assumed that all mothers and children of the village make use of the services regularly, then the village health post would be the most complete source of information on children's nutritional status in Indonesia.

10.5 Child Malnutrition Data from Special Surveys/Studies

The anthropometric information is also available from special surveys or studies. Usually these special surveys/studies collecting all three indexes of child malnutrition. For example:

1. The longitudinal survey from Helen Keller International is collecting the information from urban and rural areas within 7 provinces in Indonesia (West Java, Central Java, Lampung, West Sumatra, South Sulawesi, West Nusa Tenggara, and Jakarta).
2. The national vitamin A survey in 1978 and 1992 covered all provinces

   The longitudinal study for evaluating Supplementary Feeding as the impact of the Social Safety Net Project was in 5 provinces in 1998/1999.In addition there are also other surveys, such as a Mother and Child health survey in 1995, the Indonesian Family Life Survey, the Eastern Island Survey and several small-scale studies.

We now consider the advantages and disadvantages of existing data on child malnutrition for the purpose of monitoring and evaluation of the impact of nutrition program development:

1. Data on wasting from growth promotion at Posyandu is best suited to program intervention at the individual level, because it catches growth faltering, an early sign of health and nutrition problems. However, coverage above 80% is desirable to capture all the important differences for comparing the impact of short-term program interventions. Generally, after the infant reaches 24 months, the attendance at the Posyandu declines dramatically.
2. Data on underweight from the Susenas-module data set is good for comparing the impact of program interventions at national or provincial levels. The information on malnutrition prevalence may be not specific for a certain area because of sample size. Anthropometric information from the Susenas-core-data set is good for the district level.
3. Data on underweight from sub-district nutritional status monitoring is feasible for comparing sub-districts to support government at the district level in prioritizing subdistrict high-risk areas.
4. Data on stunting from first-grade schoolchildren is good for evaluating long-term program development (5 years and above).
5. Anthropometric information from special surveys or studies is good for certain areas with limited sample size, and it is not universal.

Download this Discussion Paper [ PDF 243.5KB| 22 pages ].

Comment(s)

There are [3] comment(s) for this entry. Post a comment.

1. Choco
   (posted 01 May 2010 / 02:19:03 AM)
   
   is poverty line:
   -less that $1.25/day per adult, or
   -less than $1.25/day per person in the household (including children), or
   -less than $1.25/day per household?
   
   What a loophole in the definition! Clarity required please!
2. naveen
   (posted 17 December 2008 / 08:35:28 PM)
   
   This information explain clearly about the malnutrition and poverty,
   Most poor people who battle hunger deal with chronic undernourishment and vitamin or mineral deficiencies, which result in stunted growth, weakness and heightened susceptibility to illness.
   
   Poor children are the most prone to this and are often the victims to malnutrition, deficiencies, diseases and ultimately deaths caused by hunger.
   
   Today our world is home to 6.6 billion people. The United States is a part of the high-income group of nations which has a population of around 30 crores
3. ms.gilor araneta -tino
   (posted 02 April 2008 / 05:39:12 AM)
   
   Conditions tagged as underweight or underheight has been a problem for a longtime. If we dig further poverty is one cause. I am glad that the schools here in the Province of Albay are recipients of the Food for the School program. In its simple way, this is a BIG solution, RICE ON THE TABLE of every family. I'mm sure that this will help increase the nutritional status of our schoolchildren.