Kewaspadaan gizi buruk
Transcript of Kewaspadaan gizi buruk
Outlines
Kewaspadaan gizi buruk
Minidian Fasitasari Bagian Ilmu Gizi FK UNISSULA
Konsep dasar penyakitHub. agent-host-environmentHub. dg status giziMalnutritionIndicators of malnutritionMasalah gizi di Indonesia (& dunia)13 pesan dasar gizi seimbang
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Types of malnutrition
Protein-energy malnutritionLow birth weight (LBW)Vitamin A deficiencyIron deficiencyIodine deficiencyGrowing insight that other micronutrientdeficiencies like zinc, folic acid,calcium,selenium are also seriousOverweight & obesity
Indicators PEM in infants &children
Height-for-age (stunting: z score < -2)Weight-for-age (wasting: z score < -2)Weight-for-age (underweight: z score <-2)
Classification of severity of PEM: < -1 mild < -2 moderate < -3 severe
Indicator PEM in adult
Body Mass Index (BMI)
Classification of severity of PEM 18.5normal 17 – 18.4mild 16 – 16.9moderate < 16severe
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PEM = KEP atau PCM = KKP
MarasmusKwashiorkorGabungan
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Extent of malnutrition
+ 848 million people suffer from hunger, of whom +800 million live in developing countries, more than in1996In Sub-Saharan Africa currently 212 million hungrypeople, 40 million more than 1990-1992Per year, 30 million babies are born with an IUGR(82.000 per day)182 million children under 5 years (1 of 3) arestunted50 million children under 5 are wasted150 million are underweight
Gizi Buruk Sebabkan 3,5 Juta Kematian Anak per Tahun
1990 – 1992 : 842 million undernourished2003 – 2005 : 848 million undernourished2007: 923 million undernourished
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Banyak Balita gizi buruk di Bogor
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Present challenges
HIV/AIDS33 million people living with HIV/AIDS (PLWHA)Global % of adults PLWHA leveled off since 2000↑ treatment access over past 10y↓ annualnumber of AIDS deathsWorrisome ↑ in new infectionIndonesia, Russian Federation, & various high-income countries
Present challenges…
Direct effect on nutritional status:
Diarrhea (loss of nutrients), chronic fever (↑energy requirements), oral pharyngeal ulceration(↓ food consumption), opportunistic infections(high demand on immune system)
Indirect effect on nutrition:
Diminish capacity to care for young children orAIDS infected household membersDiminish capacity to ensure food securityDirect effect on nutritional status…
Indirect effect on nutrition…
Present challenges…
Poor urban & rural populationsLandless & ‘female-headed’ householdsAre they net food buyers?
Do they buy mainly internationally traded corps(such as maize, rice, wheat)Do they have possibility to change to cheaper(traditional) foods not incorporated in globalmarket?Could they shift to production of foods that yieldmore?
Malnutrition matters: why?
Malnutrition is ethical unacceptableHuman right to food
In most conventions/declarations referred to as“freedom from hunger” or “right to food”Convention on the rights of the child: nutrition isexplicitly recognized as a human right
Security?Malnutrition has unacceptable functionalconsequences
Unacceptable functionalconsequences
HEALTH (morbidity & mortality)
EDUCATION (enrolment & performance)
ECONOMIC DEVELOPMENT (productivity)
Micronutrients malnutrition:Main health consequences
DeficiencyIodine
Iron
ConsequencesImpaired mental development (not onlycretinism)Impaired mental development; anemia (↓work performance, etc.); ↓ immunity;stunting; fetal growth retardation (LBW);mortalityBlindness, ↑ risk of mortality & morbidityfrom infectious diseases; anemia; stunting↑ risk of mortality & morbidity frominfectious diseases; stunting; ↓ appetite
Vitamin A
Zinc
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Child mortality & morbidity
Infants born (1500-1999 g) & (2000-2499 g)were 8.1 & 2.8 times resp. more likely to dieNon-supplemented population with vit A hada relative risk of 1.47 for diarrhea mortality &1.35 for measles mortalityZinc deficiency: relative risk on morbidity: forpneumonia (1.25), for diarrhea (1.09), formalaria (1.11)
Malnutrition matters:functional consequences
Health: morbidity & mortality
35% of all child deaths are related to malnutrition,only 1 out of 10 deaths due to ‘severe’malnutrition20% of maternal deaths is related with anemiacaused by iron deficiencyIodine deficiency & intelligence
Intelligence ↓ with 13.5 IQ points in iodine deficientpopulations
Education
PEM
Attend school at later ageLower school performanceMore frequent duplication
Productivity
1% reduction in length = 1.4% reduction inproductivity1% reduction in iron status = 1% reduction inproductivityIncome & wealth associated with
Birthweight, IUGRHeight-for-age; weight-for-age
Anemic children
Test scores 0.5 – 1.5 sd lower
Schooling (in years) associated with
Maternal height (weak association)Birthweight, & IUGRHeight-for-age; weight-for-age
Consequences of malnutrition
deficiency
Vitamin A
PEM
Iron
IodineIntelligence
reduces
Survival
Productivity
Sasaran program gizi
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Menurunkan prevalensi gizi kurang pd anak balita menjadi 20%
Menurunkan prevalensi GAKY pd anak menjadi < 5%
Menurunkan anemia gizi besi pada ibu hamil menjadi 40%
Tidak ditemukannya kekurangan vit A (KVA) klinis pd anakbalita & ibu hamil
Meningkatkan jumlah rumah tangga yg mengonsumsi garamberyodium menjadi 90%
Tercapainya konsumsi gizi seimbang dengan rata2 konsumsienergi sebesar 2200 Kal per kapita per hari dan protein 50gram per kapita per hari
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Menurunkan prevalensi gizi kurang pd anakbalita menjadi 20%
Susenas 2003: prevalesi gizi kurang & buruk27,5%SKRT 2001: prevalensi gizi kurang 22,5% & giziburuk 8,5%Susenas: prevalensi gizi kurang 19,8% & giziburuk 6,3%
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Menurunkan prevalensi GAKY pd anak menjadi < 5%
1980 prevalensi GAKY pd anak usia sekolah 30%
1990 turun menjadi 27,9%
1996/1998 menjadi 9,8%
2003 sedikit meningkat 11,1%
Meningkatkan jumlah rumah tangga yg mengonsumsigaram beryodium menjadi 90%
2003 rmh tangga yg mengonsumsi garam beryodiumsecara cukup 73,2%pencapaian sasaran 81,3%
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Menurunkan anemia gizi besi (AGB) pada ibuhamil menjadi 40%
Prevalensi AGB bumil turun dr 50,9% (1995)menjadi 40,1% (2001)pencapaian target99,75%
4.Tidak ditemukannya kekurangan vit A (KVA) klinis pdanak balita & ibu hamil
1992 Indonesia bebas KVA , tp 50% anak balita mempunyaiserum retinol < 20mcg/100 ml+ pola makan tdk seimbang berisikokapsul vit A
WHO 1995 + 250 jt balita di dunia menderita KVA, 3 jtdiantaranya gx kerusakan mata menuju kebutaan.
10% kasus kebutaan di negara berkembang disebabkan KVA
Buta krn KVA, 70% meninggal dlm 1 tahun
Study di Sumatra 1980an: KVA berkaitan dg morbiditas &mortalitas
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Tercapainya konsumsi gizi seimbang denganrata2 konsumsi energi sebesar 2200 Kal perkapita per hari dan protein 50 gram per kapitaper hari
Susenas 2002, konsumsi rata2 penduduk 1.985 Kaldan 54,4 gram proteindistribusi tdk merata, adayg < 70% dr kecukupan gizi yg dianjurkan
13 pesan dasar gizi seimbang
1. Makanlah makanan yang beraneka ragam
2. Makanlah makanan untuk memenuhi kebutuhan energi
3. Makanlah makanan sumber karbohidrat setengah dari kebutuhan energi
4. Batasi konsumsi lemak dan minyak sampai seperempat dari kecukupan energi
5. Gunakan garam beryodium
6. Makanlah makanan sumber zat besi
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… 13 pesan dasar gizi seimbang
7. Berikan ASI saja kepada bayi sampai berumur 6 bulan
8. Biasakan makan pagi
9. Minumlah air bersih, aman, dan cukup jumlahnya
10. Lakukan kegiatan fisik dan olah raga yang teratur
11. Hindari minuman beralkohol
12. Makanlah makanan yang aman bagi kesehatan
13. Bacalah makanan pada label yang dikemas
Referensi
Course of Food & Nutrition Security. WageningenInternational – WUR. Wageningen, the Netherlands.March – June 2009.Khomsan, A. SDM Bangsa dan Gizi Buruk.http://kompas.com/kompas-cetak/0602/18/opini/2445871.htm dikutip 2/5/2008Hartono, A. Asuhan Nutrisi Rumah Sakit. PenerbitEGC, Jakarta, 2000.Supariasa,IDN; Bakri, B; Fajar, I. Penilaian StatusGizi. Penerbit EGC, Jakarta, 2002.
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