Malnutrition

problems in
Indonesia
dr. Nadhira Nuraini Afifa, MPH
Outline

Problems Causes Solutions

1 PROBLEMS
What is
malnutrition?

Malnutrition refers to deficiencies,

excesses or imbalances in a person’s intake
of energy and/or nutrients.

1 Undernutrition

2 Specific deficiency

3 Overnutrition

4 Imbalance
 Indonesia is currently facing
triple burden of malnutrition

Micronutrient
Obesity Stunting/wasting
deficiency

Source: UNICEF global databases Infant and Young Child Feeding, UNICEF/WHO/World Bank Group
Have you been familiar with the terms?
Obesity Wasting

Adults >18yo --> BMI > 25 kg/m2 Low weight for height <-2SD

Toddler & teenager 5-18yo --> BMI/Age >3SD Stunting

Low height for age <-2SD

Under-5 --> Weight/Age or Weight/Height >3SD
What is ‘hidden hunger’?
Hidden hunger à or micronutrient deficiency

“a phenomenon caused by lacking in essential

micronutrients in a person’s diet”

Vitamins
• Required in little amounts
• Support physiological
functions
Minerals
Micronutrient deficiency
with the highest prevalence
in Indonesia:
Iron deficiency anaemia

Source: WHO Global Health Observatory

 Children are
suffering too

30.8% 10.2% 8%

Source: UNICEF global databases Infant and Young Child Feeding, UNICEF/WHO/World Bank Group, 2018.
Stunting is an
inter-
generational
problem

The vicious cycle must end

Stunting rates
are shown
stubbornly
high

Source: Ministry of Health, 2020.

Stunting affects all
Stunting rates are high in nearly all provinces of Indonesia,
affecting children from different family backgrounds and
although poor children are worse off, even higher income
quintiles have significant stunting levels.
Stunted children bear short-term and
long-term consequences

Short-term Long-term

Lost productivity &

Impaired brain healthcare costs
development Smaller stature
Lower IQ

Weakened
immune system Premature Greater risk of
death NCDs
2 CAUSES
The unique drivers of malnutrition in Indonesia
1
Poor diet diversity

Over-dependent on single staple food à

white rice (energy-dense, lack of
essential nutrients)

Healthy food (vegetables, fruits and

animal-based foods) are often
considered unaffordable for a large part
of populations
2
Lacking knowledge on growth
measurement
Is this child malnourished?
It’s difficult to tell by naked eye whether a child suffers from
malnutrition.

- Mothers’ lack of knowledge

- Don’t know their children’s nutritional status
- Provide food that has inadequate calories

- Data collection
- Manual measurement is prone to human error
- Manually written on books —> data is scattered and difficult
to track

Unknown children's Inappropriate Increasing

nutritional status nutrition intake malnutrition cases
3
Nutrition in pregnancy: poor
knowledge & cultural beliefs
• Knowledge of a healthy diet during pregnancy is often limited.

• Follow all relatives' suggestions.

• Use of TBA is still dominant.

• Cultural habits encourage mothers not to eat certain foods during

pregnancy.
4
Breastfeeding critical: cultural
beliefs & poor facilitation
• In 2017, still only 42% of Indonesian children up to six
months of age were exclusively breastfed.
• Aggressive marketing of formula to mothers à No clear
regulation.
• Working mothers face additional barriers to breastfeeding
à only 11% provides nursery room
5
Complimentary feeding problems:
poor knowledge

• Only one third of children 6-23 months were

fed according to all IYCF (Infant and Young
Child Feeding) recommendations.
• Consume too few food groups
• Fed far too infrequently once exclusive
breastfeeding ends
 6
High rates of early marriage and
kawin siri
• 17.1% of adolescent girls
aged <18 years are married.
• 8% of adolescent girls are
already mothers or pregnant
with their first child.
7
High tobacco consumption
• Has highest rates of cigarette consumption in the
world (68.1%).
• Household expenditure on tobacco displaced
expenditure on nutritious foods for children (22%).
• Cultural beliefs on smoking tobacco à Kretek pride
3 SOLUTIONS
 Nutrition supplementation; Breastfeeding, PAUD with health and nutrition curriculum;
complementary feeding, fortification; Reproductive health curriculum;
Nutrition education; Balanced-diet Parenting class
promotion; Deworming; UHC
Holistic approach
Food sustainability;
WASH improvement Household garden
program
is needed
Iodized salt; Non-cash food assistance; PKH
General fortification

Food security and standardization; Reproductive health education;

Fortified food monitoring; Labeling Bina Keluarga Balita (BKB),
and advertising Parenting

Course for bride-to-be;

Encouraging role of religious Birth
figure; Training for islamic certification
dormitory school students

Village fund distribution

Region incentive
fund
What are the
simplest things
we can do?
 Make sure to eat all
good sources of
micronutrients

Source: Gizi dan Kesehatan Remaja. 'Buku Pegangan dan Kumpulan Rencana Ajar untuk Guru Sekolah Menengah
Pertama'. 2016. SEAMEO RECFON- Kementerian Pendidikan dan Kebudayaan Republik Indonesia
Thank you!
Any questions?

dr. Nadhira Nuraini Afifa, MPH