Maternal and Child Health

and Nutrition Profile

in Indonesia

1

Dr. Rimbawan

Department of Community NutritionInstitut Pertanian Bogor (IPB) University

Bogor, Indonesia

Presidential Palace Botanical Garden INSTITUT PERTANIAN BOGOR(IPB)

60 km from Jakarta

OUTLINE

PROFILEOF

NATIONS

HEALTH AND NUTRITIONPROBLEMS

MAINCAUSES

CONCLUDING REMARKS

PROFILEOF NATIONS

PROFILE OF INDONESIA

• Indonesia is the world’s 4th most populous country after China, India, and USA

• Lower-middle-income country & continue to achieve steady economic growth despite global turbulences

• Although poverty has been greatly reduced, it still affects a large number of people

Socio Demographic Context of Indonesia

• Number of population =

• 260+millions

HEALTH AND NUTRITION PROBLEMSEPIDEMIOLOGICAL TRANSITION OF DISEASES

INFECTIOUS DISEASES NON COMMUNICABLE DISEASES

44.2%

31.2%

28.1%

TREND OF

INFECTIOUS DISEASES

1995 2001 2007

Source : MOH RI, 2012

TREND OF

NON INFECTIOUS DISEASES

1995 2001 2007

41.7%

49.9%

59.5%

Source : MOH RI, 2012

What causes the most deaths in Indonesia?

Top 10 causes of death in 2017 and percent change, 2007-2017, all ages, number

Source : IHME (www.healthdata.org/indonesia)

What risk factors drive the most death and disability combined in Indonesia?

• Top 10 risks contributing to DALYs in 2017 and percent change, 2007-2017, all ages, number

Source : IHME (www.healthdata.org/indonesia)

The changes in food pattern which tends to be shifting to

processed food and beverages high in carbohydrate, fat, sugar

and/or sodium may contribute to the increase of NCDs

FOOD EXPENDITURE PATTERN 2016

HEALTH & NUTRITIONAL

PROBLEMS

19

PROPORTION OF CHRONIC ENERGY DEFICIENCY

(CED) IN WOMEN AT REPRODUCTIVE AGE (WRA),

2018

Indikator KEK: lingkar lengan atas wanita usia subur 15-49 tahun < 23.5 cm

1,717,3 36,8

14,4

14,5

32,5

0

10

20

30

40

50

60

70

80

Kal

iman

tan

Uta

ra

Ace

h

Ben

gku

lu

Kal

iman

tan

Tim

ur

Ria

u

DK

I Jak

arta

Ban

gka

Bel

itu

ng

Go

ron

talo

Bal

i

Sum

ater

a U

tara

Sula

wes

i Uta

ra

Lam

pu

ng

Jaw

a B

arat

Jam

bi

Kal

iman

tan

Bar

at

Sum

ater

a Se

lata

n

Ban

ten

Sum

ater

a B

arat

Kep

ula

uan

Ria

u

IND

ON

ESIA

Sula

wes

i Bar

at

Jaw

a Ti

mu

r

Kal

iman

tan

Sel

atan

Kal

iman

tan

Ten

gah

Sula

wes

i Sel

atan

Jaw

a Te

nga

h

Sula

wes

i Te

nga

h

Nu

sa T

engg

ara

Bar

at

DI Y

ogy

akar

ta

Pap

ua

Pap

ua

Bar

at

Sula

wes

i Ten

ggar

a

Mal

uku

Uta

ra

Mal

uku

Nu

sa T

engg

ara

Tim

ur

Wanita Tidak Hamil Wanita Hamil

20

CED IN WRA:

2013: Pregnant WRA 24.2%, Non Pregnant WRA 20.8%

2018: Pregnant WRA 17.3%, Non Pregnant WRA14.5%

PROPORTION OF PREGNANT WOMEN WITH

ANEMIA, 2018

21

37,1

48,9

0

10

20

30

40

50

60

2013 2018

84,6

33,7

33,6

24

15-24 tahun 25-34 tahun 35-44 tahun 45-54 tahun

Anemia in pregnancy women based on age

PROPORTION OF LOW BIRTH WEIGHT <2500 GRAM BY PROVINCE,

2018

22

Berdasarkan 56,6% yang memiliki catatan berat lahir

Sirkesnas 2016 = 6,9%

23

PROPORTION OF <48 CM LENGTH AT BIRTH BY PROVINCE, 2013-2018

Berdasarkan 47,9% yang memiliki catatan panjang lahir

24

Berdasarkan 19,0% balita yang memiliki catatan lingkar kepala

PROPORTION OF HEAD CIRCUMFERENCE OF NEWBORN

BABIES BY PROVINCE, 2018

STUNTING Stunting is a largely ireversible outcome of

inadequate nutrition & repeated infection during the

first 1000 days of a child’s life

Stunted children have an increased risk

of becoming overweight or obese later in life

DISTRIBUTION OF STUNTING AMONG

UNDER FIVE YEARS OLD CHILDREN BY PROVINCE, 2013-2018

28

27,5

37,2

51,7

17,7

30,8

42,6

0

10

20

30

40

50

60

DK

I Ja

ka

rta

DI Y

ogya

kart

a

Bali

Kepula

ua

n R

iau

Bangka B

elit

ung

Sula

wesi U

tara

Ban

ten

Ka

limanta

n U

tara

Lam

pung

Ria

u

Papua B

ara

t

Bengkulu

Sula

wesi T

eng

gara

Ka

limanta

n T

imur

Sum

ate

ra B

ara

t

Jam

bi

IND

ON

ES

IA

Jaw

a B

ara

t

Jaw

a T

engah

Malu

ku U

tara

Sum

ate

ra S

ela

tan

Sum

ate

ra U

tara

Sula

wesi T

eng

ah

Goro

nta

lo

Ja

wa T

imur

Papua

Kalim

anta

n S

ela

tan

Kalim

anta

n B

ara

t

Nusa T

engga

ra B

ara

t

Malu

ku

Kalim

anta

n T

eng

ah

Sula

wesi S

ela

tan

Aceh

Sula

wesi B

ara

t

Nusa T

engga

ra T

imur

2013 2018Indikator tinggi badan menurut umur (TB/U):

⋆ Sangat pendek : TB/U<-3SD ⋆ Pendek: TB/U ≥-3SD s/d <-2SD

DISTRIBUTION OF STUNTING AMONG UNDER TWO

YEARS OLD CHILDREN BY PROVINCE, 2018

Indikator tinggi badan menurut umur (TB/U):•Sangat pendek : TB/U<-3SD•Pendek : TB/U ≥-3SD s/d <-2SD

• INDONESIA: sangat pendek dan pendek 29.9%

• 18 provinsi dengan prevalensi tinggi (30% - <40%)

18 12,8 18,9

9,2

17,1

19

0

5

10

15

20

25

30

35

40

DK

I Jakart

a

DI

Yogya

kart

a

Ban

ten

Ban

gka

Be

litun

g

Bali

Ria

u

Nu

sa T

eng

gara

…

Sula

we

si T

eng

gara

Sula

we

si U

tara

La

mpun

g

Sula

we

si T

eng

ah

Goro

nta

lo

Sum

ate

ra B

ara

t

Ben

gku

lu

Jaw

a B

ara

t

Sum

ate

ra S

ela

tan

IND

ON

ES

IA

Kalim

an

tan T

imur

Kep

ula

ua

n R

iau

Pap

ua

Ba

rat

Jam

bi

Kalim

an

tan U

tara

Kalim

an

tan B

ara

t

Kalim

an

tan S

ela

tan

Malu

ku

Malu

ku U

tara

Sum

ate

ra U

tara

Jaw

a T

eng

ah

Jaw

a T

imur

Sula

we

si S

ela

tan

Pap

ua

Kalim

an

tan T

eng

ah

Nu

sa T

eng

gara

…

Sula

we

si B

ara

t

Aceh

Pendek Sangat pendek

29

29.9

DISTRIBUTION OF WASTING AMONG UNDER FIVE YEARS OLD

CHILDREN BY PROVINCE, 2013-2018

30

12,1

11,9

4,6

10,2

14,4

02468

101214161820

Kalim

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Kalim

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ah

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DK

I Jakart

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IND

ON

ES

IA

Pap

ua

Ban

ten

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we

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ara

t

La

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g

Kep

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ua

n R

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Sum

ate

ra B

ara

t

Sum

ate

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ku U

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Sum

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Ria

u

Pap

ua

Ba

rat

Nu

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Tim

ur

Sula

we

si T

eng

ah

Kalim

an

tan S

ela

tan

Malu

ku

Kalim

an

tan T

eng

ah

Kalim

an

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ara

t

Goro

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lo

Nu

sa T

eng

gara

Ba

rat

2013 2018

Indikator berat badan menurut tinggi badan (BB/TB):

⋆ Sangat kurus: BB/TB<-3SD ⋆ Kurus: BB/TB ≥ -3SD s/d <-2SD

8,5

11,8

15

3,3

8

13,2

0

5

10

15

20

25

Nu

sa T

eng

gara

Ba

rat

Sula

we

si T

eng

ah

Nu

sa T

eng

gara

Tim

ur

DI

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kart

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ku

Sum

ate

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Goro

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Sula

we

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t

Malu

ku U

tara

Sula

we

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eng

gara

Kalim

an

tan S

ela

tan

Sula

we

si S

ela

tan

La

mpun

g

Jaw

a T

eng

ah

Kalim

an

tan U

tara

Sula

we

si U

tara

Ria

u

Pap

ua

Ba

rat

DK

I Jakart

a

Bali

Ban

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Be

litun

g

Kalim

an

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ara

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IND

ON

ES

IA

Ban

ten

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ara

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Aceh

Sum

ate

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Kep

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n R

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Kalim

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Kalim

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ah

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lu

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tan

Pap

ua

2013 2018

31

• INDONESIA: gemuk 8%

• 13 provinsi dengan prevalensi gemuk di atas prevalensi

nasional

Indikator berat badan menurut tinggi badan

(BB/TB):

•Gemuk BB/TB >2SD

DISTRIBUTION OF OVERWEIGHT AMONG UNDER FIVE

YEARS OLD CHILDREN BY PROVINCE, 2013-2018

MAIN CAUSES

32

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

NA

D

Sum

ut

Sum

Bar

Ria

u

Jam

bi

Sum

Sel

Ben

gku

lu

Lam

pu

ng

BaB

el

Kep

Ri

Jaka

rta

Jab

ar

Jate

ng

DI Y

ogy

a

Jati

m

Ban

ten

Bal

i

NTB

NTT

Kal

Bar

Kal

Tim

Kal

Sel

Kal

Tim

SulU

t

SulT

eng

SulS

el

SulT

era

Go

ron

talo

SulB

ar

Mal

uku

Mal

Ut

Pap

Bar

Pap

ua

IND

ON

ESIA

Stunting %Gakin

Source : Stunting Data (Riskesdas 2010)% Poor Family (Gakin): SUSENAS 2010

Distribution of stunting and poor households by province 2010

• Purchasing power is not an indicator of household nutrient intake

• Nutrition problem does not only occur in poor households

• Purchasing power needs to be accompanied by a family

member who is knowledgeable about nutrient requirements

35

Nutrition and Consumption Pattern

10,2

18,221,2

11,9

27,6

42,3

0

5

10

15

20

25

30

35

40

45

6-11 Mo 12-17 Mo 18-24 Mo

Underweight Stunting

Stunting Gap according to Age (SEANUTS, 2013)

Food consumptionCharacterized by late introduction of animal protein, legumes and fruits and vegetables

Type of food consumed

6-11 mo 12-17 mo 18-23 mo 6-23 mo

Breastmilk Yes No

38.7%61.3%

30.3%69.7%

20.3%79.7%

30.3%69.7%

Animal protein Frequent Rarely

18.3%81.7%

49.3%50.7%

63.6%36.4%

42.6%57.4%

Legumes Frequent Rarely

15.8%84.2%

21.5%78.5%

25.9%74.1%

20.8%79.2%

Processed food Frequent Rarely

13.5%86.5%

26.2%73.8%

29.0%71.0%

22.5%77.5%

Vegetables & Fruits

Frequent Rarely

0.4%99.6%

2.0%98.0%

5.3%94.7%

2.4%97.6%

Bottle milk Frequent Rarely

31.7%68.3%

34.0%66.0%

36.6%63.4%

34.0%66.0%

Source: SEANUTS, 2013

INDICATORS20 %

POOREST20 %

RICHEST National SOURCE

ANUTRITION STATUS OF INFANT, CHILDREN, AND PREGNANT WOMEN

Low birthweight <2500 gram 13.4 8.2 10.2 Riskesdas, 2013

Prevalence of Stunting (TB/U <-2 SD)) 48.4 29.0 37.2 Riskesdas, 2013

Prevalence of Wasting (BB/TB <-2SD) 14.0 10.6 12.1 Riskesdas, 2013

B Nutrient Intake

Average energy intake/capita (Kcal) 1,586 2,498 2,037 SUSENAS, 2016

Average protein intake/capita (gr) 40.4 76.8 56.7 SUSENAS, 2016

Proportion of population <70% Energy adequacy 55.0 39.4 45.7 SKMI, 2014

Proportion of pregnant women <70% Energy adequacy 67.9 48.9 52.2 SKMI, 2014

STUNTING GAP AND THEIR RISK FACTORS BETWEEN 20 % POOREST AND 20 % RICHEST FAMILIES IN INDONESIA (1)

STUNTING gap and their Risk Factors Between 20 % POOREST AND 20 % RICHEST FAMILIES IN INDONESIA (2)

INDICATORS20 %

POOREST 20 % RICHEST NaTional SOURCE

C CARING PRACTICESInfants fulfilling minimum standard of CompLementary Feeding Training 23.2 51.7 36.6 SDKI, 2012

D PROGRAM COVERAGE

Complete Basic Immunization 39.5 67.8 59.2 Riskesdas 2013

Complete ANC 47.7 80.5 70.4 Riskesdas 2013

IFA > 90 Tablet 23.4 32.3 33.4 Riskesdas 2013

E ENVIRONMENT (% HH)

Access to good sanitation (improved) 1.5 93.6 59.8 Riskesdas 2013

Early marriage <20 tahun

-Boys 4.1 2.9 3.5 Riskesdas 2013

-Girls 17.6 4.1 11.2 Riskesdas 2013

Study on Nutritional Status and Food Pattern

of Pre-Pregnant, Pregnant and Lactating

Mothers in Bogor, West Java

Southeast Asian Food & Agricultural Science & Technology

(SEAFAST) Center, Bogor Agricultural UniversityJl. Puspa No. 1 Kampus IPB Dramaga – Bogor 16680

Telp/Fax. +62 251 8629903

Http://www.seafast.ipb.ac.id

Nutritional Status

Nutrition status CBA (n=200) Lactating (n=220)

Underweight (< 18.5) 28 (14%) 20 (9.1%)

Normal (18.5 – 24.9) 110 (55%) 113 (51.4%)

Overweight (25.0 – 29.9) 45 (22.5%) 69 (31.4%)

Obese (≥ 30.0) 17 (8.5%) 16 (8.2%)

Mean ± SD 23.2 ± 4.7 22.5 ± 3.2

A. BMI based

B.MUAC based

Nutrition status CBA (n=200) Pregnant (n=203) Lactating (n=220)

CEM (< 23.5 cm) 25 (12.5%) 38 (18.7%) 32 (14.5%)

Normal (≥ 23.5 cm) 175 (87.5) 165 (81.3%) 188 (85.5%)

Mean ± SD 27.4 ± 3.8 26.1 ± 3.7 26.7 ± 3.3

Average %ID-RDA and

percentage of nutrient deficiencies

NutrientsCBA Pregnant Lactating

%ID-RDA % def %ID-RDA % def %ID-RDA % def

Energy 77.4 45.0 75.7 39.7 73.8 45.9

Protein 93.3 27.0 72.1 57.6 86.4 34.1

Iron 94.7 63.0 59.7 84.7 94.5 68.2

Calcium 69.7 68.0 79.8 55.7 75.5 60.5

Vitamin A 89.1 62.5 72.1 66.5 73.2 65.9

Vitamin C 37.1 88.0 45.5 84.7 49.5 76.8

Folate 40.7 90.0 33.8 98.0 45.5 90.9

Zinc 127.6 30.0 89.6 53.7 91.8 50.0

Percentage of micronutrient deficiencies

DeficiencyCBA (n=200) Pregnant (n=203) Lactating (n=220)

n (%) n (%) n (%)

5 micronutrients 34 (17) 62 (30.5) 50 (22.7)

4 micronutrients 66 (33) 77 (37.9) 72 (32.7)

3 micronutrients 64 (32) 46 (22.6) 58 (26.4)

2 micronutrients 30 (15) 13 (6.4) 25 (11.4)

1 micronutrient 5 (2.5) 5 (2.5) 12 (5.5)

TOTAL 199 (99.5) 203 (100) 217 (98.6)

Micronutrients include Iron, Vitamin A, Vitamin C, Folate, Zinc

Deficiencies can be derived from any combinations of those five micronutrients

Percentage of respondents who are

deficient in blood biomarker

0

10

20

30

40

50

60

Haemoglobin Ferritin Vitamin A Selenium Zinc

11,1

23,08

6,74,4

42,2

22,2

41,2

13,3

8,9

55,6

17,8

27,9

11,1

28,924,4

CBA Pregnant Lactating

Food taboos (prohibition against consuming certain

foods ) in CBA, pregnant, and lactating mothersCBA

No Type of food %

1 Sour food 6.0

2 Spicy food 6.0

3 Shrimp 5.5

4 Instant noodle 4.5

5 Salted fish 3.5

6 Pineapple 2.5

7 Tuna fish 2.5

8 Water spinach 2.5

9 Offal 2.5

10 Cucumber 2.0

Pregnant

No Type of food %

1 Pineapple 18.2

2 Tape (fermented

cassava)

9.4

3 Durian 9.4

4 Salak 6.9

5 Spicy food 4.4

6 Softdrink 3.9

7 Sticky rice 3.4

8 Jengkol/petai” 3.0

9 Sour food 2.5

10 Shrimp 2.5

Lactating

No Type of food %

1 Taro 10.0

2 Spicy food 10.0

3 Banana 6.8

4 Sour food 6.4

5 Shrimp 6.4

6 Salted fish 4.5

7 Fish 4.5

8 Offal 4.1

9 Pumpkin, squash 3.6

10 Kangkong leaves 3.6

Reason

Scare of suffering from:

1. Allergy (8%)

2. Gastritis (7.5%)

3. Hypertension (4.5%)

4. Womb’s health (3%)

5. Leucorrhea (1.5%)

Reason:

Scare of suffering from

1. Abortion (8.4%)

2. Heartburn sensation (3.4%)

3. Gastritis (1.5%)

4. Hypertension (1.0%)

Reason:

Scare of suffering from

1. Baby’s health (9.5%)

2. Allergy (7.7%)

3. Parental believe (6.4%)

4. Disease (5.0%)

5. Fishy odor breast milk (4.5%)

CONCLUDING REMARKS

47

A systematic and planned action undertaken jointly by

all components of the nation with awareness,

willingness, and ability to behave healthy to improve the

quality of life

OBJECTIVE OF GERMAS

INDONESIA’S PRESIDENT INSTRUCTION No.1, 2017

Health maintained Productive Clean

environment

Reduce medical

costs48

Integrated Nutrition Intervention (Spesific & Sensitive)• Specific Nutrition Intervention (MOH)

• Provision of IFA Tablets• Promotion of Exclusive Breastmilk,

complementary feeding, fortified foods• Campaigns of balanced nutrition and

behavior change• Micronutrient supplements (taburia)• Macronutrient supplement (PMT)• Class of pregnant women• Provision of worm medicine• Management of under nutrition• Vitamin A supplementation• National health insurance

Enabling Factors

• Ministry of Home Affairs i (to facilitate

nutrition program and activity using local

budgetary system)• Ministry of Village, Underdevoloped Areas and

Transmigration (allocation of budget for nutrition activity)

• Mnistry of Finance (Local Incentive Budget)

Sensitive Nutrition Education

Ministry of General

Works and Public

Housing

Ministry of Education

and Culture

Ministry of

Industry

Ministry of Agriculture

National Agency

for Food and Drug Control

Health and Nutrition Education for bride and bridegroom, islamic schools and role f religious leaders

Ministry of Social Affairs

National Board of

Population and Family Planning

Education of health reproduction and

Family with Underfive Children

Ministry of Religious

Affairs

Monitoring of food safety

Providing clean water and sanitation facilities

Food Security, Home Gardening Program

Nutrition Education in Early Childhood. Education of Nutrition and Health Reproduction at School

Controlling salt iodization program

Non cash transfer aid for food (protein souce), family social security improvement and use of nutrition education facilitator

50

BACKGROUND

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