Experiences of Using Child malnutrition Indicator in Indonesia

Here we use Indonesia as a case study to evaluate the practicality of child malnutrion as a poverty indicator in assessing development interventions. The following sections of the paper review the availability of data and the experience of using it in assessing the poverty consequences of development programs.

Indonesia achieved a high annual average rate of poverty reduction from 1970 to 1990 (World Bank, 1994). The number of absolute poor reduced from 70 million people in 1970 to 22.5 million in 1996. In 1997, the economic crisis increased the number of the poor in Indonesia to 37.5 million people(Irawan and Romdiati, 2000). National food consumption surveys from 1995 to 1998 found that many households consumed less than 1500 Kcal and 32.2 grams of protein per capita per day (<70% recommended daily allowance). They showed an increasing prevalence of energy deficit from 48% in 1997 to 51.1% in 1998. In line with the food insecurity problem at household level, the Food and Nutrition Surveillance System (FNSS) from all provinces in Indonesia reported an increasing number of cases of severely the malnourished (Marasmic and Kwashiorkor) among under-five children from 1997 to 1999(Atmarita, 2000a).

Indonesia applies the World Bank methodology to estimate the number of people living below the poverty line. The national socio-economic survey (Susenas-type-surveys), which consists of a consumption module, are used to obtain the poverty line. From assessment of this data set, it was found that there was an increasing number of people living below poverty line from 11.34% in 1996 to 17.86% in 1998, and although this was reduced again to 11.72% in 1999. The trend of people living below the poverty line was similar in pattern with the trend of the severe malnourished (<-3SD) among preschool children. Using the same series of Susenas data sets, it was found that there was an increasing prevalence of the severe underweight among preschool children in the period of 1995-1998, which declined in 1999 (Central Bureau of Statistics, 2000).

Another experience where child malnutrition was used in poverty program management is in measuring the height of school children. In 1994, Indonesia measured the height of the firstgrade schoolchildren for all districts. The objective of this measurement is to evaluate the change of mean-height of those children over time. The assumption is that in poor populations the main factors affecting the physical growth of schoolchildren are environmental factors experienced before puberty. These include poor food consumption patterns, illness, lack of sanitation, and poor health and hygiene practices (Bengoa, 1971). Besides the mean-height, the prevalence of stunting (low height for age <- 2SD) was also obtained to compare all districts in Indonesia. Every five years measurement is scheduled to see the change in mean-height of first-grade schoolchildren. This information has allowed the government to target social interventions for human development at high-risk areas. The assessment of 1994 and 1999 data sets found the prevalence of stunting among first grade schoolchildren in Indonesia was reduced only 3.7%, from 39.8% in 1994 to 36.1% in 1999. It also found that stunting is more prevalent among children who enter school at an older age (Atmarita, 2000b).

See Figure 2 [ PDF 80.6KB | 1 page ]

See Figure 3 [ PDF 88.8KB | 1 page ]

This is evidence that older children have suffered more in early childhood from environmental factors, and boys have a higher risk of stunting than girls. This kind of assessment suggests that height for age is a specific child malnutrition indicator to evaluate long-term human development program.

As explained in the previous section the most sensitive child malnutrition indicator for assessing short-term intervention is the prevalence of wasting (low weight for height). Wasting rates can change rapidly, especially among preschool children in a situation when food is inadequate. Reassessment of 1998/1999 survey data from small-scale study of the impact of the social-safety net in 5 provinces (Central Java, Jogjakarta, East Java, West Nusa Tenggara and South Sulawesi) found that, wasting among preschool children who received supplemental feeding was a more sensitive indicator compared to stunting and underweight (Atmarita, 2000b). Figure 4 [ PDF 106.5KB | 1 page ]³ presented the result of measurements from three different times. It can be seen that the prevalence of underweight (low weight for age – WFA) was not reduced consistently, and also stunting (low height for age - HFA) showed an increasing prevalence over time. However, the prevalence of wasting (low weight for height – WFH) declined consistently over time. It fell from the baseline (Dec98/Jan99) to the end of the project (September 1999), by 5.5%

This assessment suggests that wasting is a sensitive child malnutrition indicator for shortterm program intervention such as providing supplementation food to vulnerable groups, especially for the poor.

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1. 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
2. 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.