Results: South Sulawesi AL (the social marketing campaign for the

n ofvitamin A-rich foods) in Ujung Pandang

¢>OMNI ~ (JppClrlumlles fOf Micronutrient InterventIons .... 11.·'

HELEN KELLER 'I';"8*;"'IN4

Contents Preface .......................................... .

Introduction _ .................................... _ 1 Map - Project headquarters ......................................................................... 2

Launch report: SUVITAL launched in Gowa 3 Sidebar - SUVlTAL media ............................................................................ 3

Preliminary results of the baseline survey 6 Socio-demographic and socioeconomic characteristics ............................. 6 Graph - Education levels amongparents interviewed ....................................... 6 Pie chart - Socioeconomic status .................................................................... 6 Nutritional status and anemia ................................................................... 7 Graph - Parasitic infestation among women and children ................................. 7 Graph - Anthropometric measurements of the children ..................................... 7

Baseline survey design and implementation 8 P · . . . 8 rOJect actIvItIes ...................................................................................... .

Survey results cont'd 10 Health ....................................................................................................... 10 Distribution of vitamin A capsules and iron pills ...................................... 10 Graph - Anthropometric measurements: BMf index of the mothers ...................... 10 Pie chart and Graph - Children with acute respiratory infections and measles ..... 10 Food production: Homegardening, livestock and fishponds ..................... 11 Breastfeeding, food consumption and nutrient intake ............................... 11 Graph - Household food production in Gowa and Bulukumba ......................... 11 Graph - Proportion of mothersstill breastfeeding child .................................... 11 Knowledge about vitamin A-rich foods and sources of knowledge .......... 12 Media coverage ......................................................................................... 12 Graph - Food consumption among mothers and children .................................. 12 Pie chart - Sources of vitamin A intake ' ........................................................ 12 Pie chart - Television viewing habits: TV channels preferred ........................... 13 Graph -Sources of information andknowledgeon vitaminA among women ..... 13

Conclusion _ ........................ I1111111111 .......... 1IIlIIIIIII 13

COORDINATION Drs. Benny A. Kodyat, Head of the Directorate of Nutrition at the Department of Health Dr. Muhilal, Head of the Nutrition Research and Development Center Dr. Martin W. Bloem, Helen Keller International Indonesia Country Director

The Localvita program group includes, in addition to the coordinators: Alwi, AI-Habsyi, Asmira Sukaton, Dunanty R.K. Sianipar, Ernanti Wahyurini, Elviyanti Martini, Fatimah Muis, Kresnawan, Mayang Sari, Nico Kana, Riza Adirza, Roy Tjiong, Ruflina Rauf, Saskia de Pee, Satoto, Siti Halati and Victor Sartono.

The Localvita program is a collaboration among the Department of Health of Indonesia, Opportunities for Micronutrient Interventions (OMNI), the United States Agency for International Development (USAID) and Helen Keller International.

Indonesia has a long history of implementing successful strategies to combat vitamin A

deficiency. Since 1974, high-dose vitamin A capsules have been distributed to children

younger than 5 years old. By 1992, nutritional blindness caused by vitamin A deficiency was

no longer a public health problem. However, low vitamin A status, which increases mortality

risk, was still highly prevalent.

To further improve the vitamin A status of the population and to reduce the mortality related to

poor vitamin A status, more groups of the population are currently being targeted with different

strategies. This includes giving high-dose vitamin A capsules to women within one month

after delivery as well as the promotion of dietary diversification. Dietary diversification includes

foods naturally rich in vitamin A as well as fortified foods.

For two areas in Indonesia with a relatively low vitamin A status, South Sulawesi and South

Kalimantan, social marketing campaigns are being implemented to increase the

consumption of vitamin A-rich foods. Both the identification of good food sources of vitamin

A as well as the appropriate media for promoting them were done locally.

This document reports the launching of the social marketing campaign in South Sulawesi,

as well as the results of the baseline survey conducted in the province. The baseline survey

was conducted between November '96 and January '97, and the campaign was launched

on 27 February '97.

Comparison of the baseline data with the endline data, from both the intervention and the

control districts, will allow an assessment of the social marketing campaign's impact on

vitamin A intake, vitamin A status, morbidity and mortality.

Frances Davidson

United States Agency for International Development (USAID)

Ian Darnton-Hill

Opportunities for Micronutrient Interventions (OMNI)

Martin Bloem

Helen Keller International (HKi)

Helen Keller fnternational (Indonesia)

prelace

" <~~~ Imp of maternal child survival th rough pro'Ni;tam itlt;A~rI~b".f oods

'C'.."".. :r:-~-,V

in South Sulawesi and Soutl1Kalfmantan

I n February 1997, SUVITAL, a social marketing campaign aimed at improving maternal

health and child survival by promot­ing the consumption of local vitamin A-rich foods, was launched in the Indonesian province of South Sulawesi.

SUVIT AL is the social marketing component of the LOCAL VITA project, a collaboration among the Depart­ment of Health of Indonesia, Oppor­tunities for Micronutrient Interven­tions (OMNI), the United States Agency for International Develop­ment (USAID), and Helen Keller International (HKI).

The goal ~:>f LOCAL VIT A is to improve the health and survival of Indonesian women in their reproduc­tive years and pre-school children by reducing vitamin A deficiency (VAD).

In order to monitor and evaluate the impact of the campaign, data is collected before the start (baseline) and toward the end (endline) of the campaign. In South Sulawesi, the

Helen Keller International (Indonesia)

baseline survey was conducted between November 1996 and un, 'II I,! [i ~ [I] I J January 1997.

South Sulawesi was chosen as a project site for the SUVITAL campaign because the 1992 National Vitamin A Survey identified the province as one among three _ provinces ofIndonesia The goal of loeAlVIIA IS to where xerophthalmia improve the health and was still a public survival of Indonesian health problem. .. women in their reproduc-

Xero~hth~mla IS a tive vears and pre-school progressIve dIsease of _ _ the eye caused by VAD children hv reducmg and can lead to vitamin A deficiencv (VAO]. blindness.

PUBLIC HEALTH PROBLEM With xerophthalmia identified as

a public health problem in South Sulawesi, the population is at great risk from the consequences of VAD, such as increased child mortality, more severe illnesses of longer durations, and to some extent, anemIa.

/JEST AVAILA'tJfJt~PY

INDONESIA:

project interven- : South Kalimantan :

South Sulawesi : al cities of

. -~ ...................... .

.. ,,~ ,.-.....-, , One of the immediate actions

taken in South Sulawesi and the other two provinces was to improve the coverage of mega-dose vitamin A capsule (VAC) distribution through cooperation between the Ministry of Health, local NGOS, and the provincial government.

d- t -b t- 1 -t - LONG TERM . .. IS rl U Ion 0 VI amm But VAC distribu-A capsules is a shon-term tion is a short-term solution to the problem 01 solution to the VAO; a long-term solution problem of VAD; a lies in increasing the long-term solution intake 01 vitamin A Irom lies in increasing the

intake of vitamin A dietarv sources. from dietary sources.

2

Therefore, the SUVITAL campaign has been designed to promote the increased consumption of locally­available vitamin A-rich foods while efforts to improve the cover­age of v AC distribution continue.

The design and planning of SUVITAL was carried out by staff from the local govern.ment and local

NGOS, all of whom were trained by experts on social marketing.

EVALUATION

SUVITAL is being conducted in the Gowa district of South Sulawesi.

In order to evaluate whether changes in food consumption, vitamin A status and health between the start and the end of the cam­paign are related to the campaign, data is also being collected from a non-intervention district, Bulukumba (also in South Sulawesi), as the control district. Bulukumba was chosen as the control district as

. its geological characteristics and living conditions resemble those of Gowa.

The baseline survey collected data from women and their children under five years old on health, nutritional status, food consumption and nutrient intake, as well as on coverage of vitamin A capsule distribution, indicators of socioeco­nomic status, and media coverage. <lID>

Helen Keller International (Indonesia)

.--------ILAUNCH REPORTI----------,

SUIITAl launched in Gowa

messages mixed with popular music (3 versions) - one version

asa minute .. long. radio. spot to be br()adcast dYring: . CiiulgciutTa popular local form of mu-

• ';···.S!c;:):·-:c::: ?'i;V::: C

:~;;f:=;£irtig:..~:nti#!~~.·ic~ , :~~':~'~':

S UVIT AL, the social marketing campaign to promote the con­sumption of local vitamin A-rich foods in South Sulawesi and

South Kalimantan, was officially launched in the two provinces at the end of February and mid-March, respectively.

In South Sulawesi, the launch took place on 27 February at a special ceremony held at the Diklat PLN Mawang compound in the

the Provincial Office of the Ministry of Agriculture (Kanwil eptan) , the Provincial Office of the Ministry of Religion (Kanwil epag) , the Na-

District of Gowa, ~--""""""'~I!!!!Iiiiii;--;;;::::::----

also the intervention district of the IJ '('\1 \IT\ project.

The ceremonv was attended bv various VIPs, includ­ing South Sulawesi Vice-Governor for Welfare Drs. H. Masnawi AS; Gowa District Head H. Svahrul Yasin Limpo, SH; Head of Above: South Sulawesi Vice-Governor for Welfare Drs H. the Provincial Office Masnawi AS (in black) arrives at the launch ceremony in Gowa, of the Ministry of escorted by Gowa District Head H. Syahrul Yasin Limpo, SH (in

r:C2

Health (Kanwil grey); Below: A local children's choir entertains the crowd with epkes) Dr. H. the Mars SUVITAL song

::j Burhanuddin Yusuf, DTM&H; Head tional Family Planning Board

;t~t 1f~ ~~ff!g;~[f~~~;~~~;, ~~w!:.~I;~~i;~~;;;j~~~: :~d q~c;~f~6:eij~~~fft~ i:f~

for ;'.iilder-

91artens (Taman Kanak-kanak

. :'!! d re n' s

" "qs incor­"'lfC'lting

(c(ml'd /1(',1 page)

~ _______________________________________________________________________________ J

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'~i~h:';!~~rh·~~~I'~l~i;( ":" •..•.•..... o.usE! () uS" ,·····particularly':? '.

.••• >th(),sewitb c'.'." ",' .····i:.:i'(W.P:th~;r~~,ri(I' ': !.e.C h ild ren "U nd er

i;·?fiY~::9'~:~f~::·~!'i~;,'· 'i"".",",i", "" \

Vice-Governor for Welfare launches SUVITAl campaign !li'om previous !JaRc)

SUVITAL at the grassroots level, such as vegetable sellers (known locally

wives, village chiefs, cadres from the posyandu, and members ofthe public.

as pagandeng) , kindergartens (Taman Kanak­kanak or TK), food stall (wanmg) and shop (taka) owners, as well as cadres from public healthcare centers (puskesmas) .

"101ul, sayur dan buah bOfWarna sobagai sumbor vitamin A alami

Starting off with a report on SUVIT At.

by the Head of the Dinas Kesehatan, Dr. Abdi, the two-

mombuat balita sohat hour-long cer-

dan cordas, Ibu sohat dan emony which began at lOam was

kuat bokoria" unceremoniously - the SUVITAL message rained upon half an (scc hox. I1(,X{ paRc./or {rails/at ion)

Among the i::8;/.;:/;::1 other guests were heads of puskesmas

'I in the Gowa district, village mid-

hour into the proceedings, much to everyone's dismay.

• t-shirts for house-to­house veg­etable sellers (pagandeng) and public minibus (pete­pete) drivers

" vests for the Safari SUVITAL team, cadres from the posyandu and puskesmas, and other organizations

:::,:,g!

Above. The Vice-Governor for Welfare, Drs. Masnawl 5hakes hands with the Gowa District Head Limpo after ceremonwllv beating the drum to mark the official launch of SUVITAl, Inset,· Drs Masnawi speaks to a TVRI reporter about the SUVITAL

campaign after being shown a c;mall exhibition of local vitamin A-rich foods

Helen Keller International (Indonesia)

But the rain did not last and the event stayed on schedule with musical interludes from a local choir, as well as a children's choir from a local kindergarten. The children's choir sung the Mars SUVIT AL song, which was specially written for the campaIgn.

Following the children's choir were speeches from the Gowa District Chief Limpo and the Head of the Kanwil Depkes, Dr. Y usuf. These were followed by a speech

Cadres from the women's NCO, PKK (Women's Welfare Movement), are presented with SUVITAL vests by the Vice·Governor

Above and left: Locally-available vitamin A-rich foods on display at the launch ceremony which took place at the Diklat PLN Mawang compound; the foods on display included eggs, carrots, bananas, papayas, spinach and various other types of dark-green leafy vegetables

from Vice-Governor for Welfare, Drs. Masnawi, who then proceeded to beat the ceremonial drum, signalling the official launch of SuvrrAL.

Immediately after that was the presentation of the media produced for the campaign to the representa­tives of the various trades and institutions involved. Vice-Gover­nor Masnawi proceeded with the ceremonial presentation of SUVIT AL

vests, t-shirts, shop-blinds, poster calenders and promotional cassettes to members of the organizations, trades and public institutions involved.

After the presentation of the materials, the Vice Governor was shown a small exhibition highlight­ing the various types of locally­available vitamin A-rich foods being promoted by SUVITAL, such as eggs, dark-green leafy vegetables, and red- and orange-coloured fruits.

When the ceremony was over, everyone was treated to a lunch of these foods cooked to a variety of mouth-watering local recipes. (jjfJ)

Helen Keller International (Indonesia) BEST AVA!LABLE COpy

ILAUNCH REPORTI

Also produced was a v!~amin A field manual for training cadres and other vol­unteer health workers, as well as a training manual for trainers. These manuals were prepared by HKI.

Preliminarv results 01 the baseline survev I n total, data was collected from 1,500 households: 750 in

Gowa and 750 from Bulukumba. The data came from mothers and their youngest child under five years of age.

~"'!~(",011"C!')""""':"':'c"""":!oC,,,,,:,,,,,,,1:",",Y'~",C''''':l,'Tl':'''c'''''''''C'''''':'~'l",,,,,,''''i''''"'""""""":_:","" su b j ects was 1 ,490-1 ,500. The

survey results

SOCIOECONOMIC STATUS:

occupations of the main earners in the households involved

industry (4%)

government (12%)

labor (6%)

6

II Mothers

li0B Fathers

As there was almost no differ­ence between the two di~tricts, most of the data was pooled, except for a few indicators. For most analyses, the number of households and

other (4%)

number of children aged 1-5 years old was 1,039.

SOCIO-DEMOGRAPHIC AND SOCIO­

ECONOMIC CHARACTERISTICS

The average number of family members within the households interviewed was 5.4. Among them, on average, were 1.2 children under five years old. The mean age of the mothers was 27.4 years. Approxi­mately 13 per cent of them had less than three years of education (considered illiterate).

Among the households inter­viewed in Gowa, the majority of main earners, in the families, were farmers (37%), with 'businessman' being the second most common occupation (20%). The term 'busi­nessman' includes traders, entrepre­neurs, carpenters and people who make handicrafts.

fisherman (5%) other

(3%) indust (3%)

Gowa share cropper (6%)

businessman (20%)

Bulukumba share cropper (9%)

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Parasitic infestation among women and children in Iowa and lulukumba

MOTHERS 80~--------------------------,

60

40

20

CHILDREN

50rr.~~--------~==~ 40

30

20 10.....__-___

O~---+~--r---~--_+----+---~,----L---~ O~----+-----~----~----~

15-19 20·24 25-29 30-34 35-39 40-44 0-11 12'-23 24-35 36-47 48-59 Age (year) Age (months)

60 L-__ ~ __ -----'

40~ ... BULUK~. .

60 BULUKUMBA ~ 50

20 .. .. . ..

O+-----r---~----_+----_+--~.

15-19 20-24 25-29 30-34 35-39 40-4

Age (year)

-; 40

:E 30 &. 20~ ___ --e 10r:::~~--~----~ c..

O~----~-----r----_+----~

0-11 12'·23 24·35 36-47 48-59 Age (months)

5.tool sample coilection provided information on the prevalence of parasitic infestation in both Gowa and Bulukumba. Ascaris and Trichuris infestation were found in both districts, but there were no cases of Hookworm infestation. This data will be used to answer questions such as whether the prevalence of parasitic infestation affects vitamin A intake and vitamin A status, and is related to vitamin A status and anemia. Deworming half of the control group will also help to determine the effectiveness of a single dose of deworming in improving vitamin A status, compared to community·based social marketing campaigns.

Twelve per cent of the main earners worked for the government, while the rest were mostly employed as daily laborers, drivers, share crop­pers and factory workers. Daily laborers include people who are given work on a daily basis, becak (or trishaw) drivers and boatmen.

There was very little difference among the households in the control district, Bulukumba, as forty-five per cent of the main earners were farIl}.ers, fourteen per cent were businessmen, and nine per cent worked for the government.

NUfRITIONAL STATUS AND ANEMIA'~

The data collection also provided informa­tion on mean height-for-age (HA) and weight­for-height (WH) Z-scores by age of the chiHren. Among children aged 1 to 5 years old, almost half (46.9%) were stunted, with HAz-scores of less than -2SD (Standard Deviation), while 11 per cent were wasted (WHz-scores less than -2SD). Also ofthe children in this age category, 3.9 per cent had a mid-upper-arm circumfer­e!lce (MUAC) of less than 12.Scm.

(cont'd onpJO)

Helen Keifer International (IndoneSIa)

~~~

f ...... M a> '" ...... M

~ .... 6 <D N ~ N M M "d"

':-~-.;:-;;-< ';J!.e .... M a> ":' ---T- -:';;;:"---;orr---;;<T-l .0 ~;~of;f·+. ____ -\~~~co~' -...ect>L' --"gO-_ ...c<D~ ____ ---""'---1O-k·.

i"i'U .

"'i!f {~d;6'~+. -------4------------

~,tj!j-i,-.,:.-. ----..... --....... '----------~ AgE~ Unrnohtl{s)'Y:

H~ighHo[·qge (H,6.»l!~~;~:;lkh~~f;r-h~ight (WH) z· scores 'f1Y~ge .ofihii'i;bildren - - - --~--' - - -

7 * See section on 'Data Collection'. p9./or an explanation afthe measurements used in thiS report

PROJECT ACTIVITIES 199 5

1 9

Development of training manual

by the central team, consisting of Ministry

of Health officials, experts from univer­sities and HKI staff.

The manual, titled Buku Pedoman

Pemasaran Social Sumber Vitamin A

Alami (SUVITAL), which translates as

'Manual for the Social Marketing of Natural Sources of Vitamin A', was finalized in

six months_

December ----

9 6 January----

February-

March----

April---

May

8

SOUTH SUlAWESI BASEliNE SURVEY o B J E C T IV E S----------------------------------------

Main objective: To collect data on the health of mothers and under-five children in the project areas before the start of the social marketing campaign promoting local vitamin A-rich foods in order to evaluate the campaign's lmpact. Specific objectives: To assess • the health and nutritional status of mothers and their under-five children,

including vitamin A status; • their socioeconomic status; • their exposure to media; • the women's knowledge about vitamin A • their food consumption patterns; • their vitamin A intake.

I:ETIOIOIOGY --I /6t, I • X 25 per village

Survey areas: • Gowa (intervention district) • Bulukumba (control district)

The subjects

Total number of blood samples

: collected:

Gowa 133 (mothers) 109 (children)

Bulukumba 144 (mothers) 126 (children)

I From this list, 25 households were I selected by interval sampling,

using a random start. (Total· 25x30=750 households) -Sample size per district was 30 villages, selected by PP5 (probability propor­tional to size) sampling. Each selected village was asked to provide a list of all the households with one or more children under five years old_

x10 per

A subsample of 10 households per village, from 10 villages, was selected randomly for the collection of blood from mothers and under-five children. (Total: lOx 1 0= I 00 households)

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IES~GIIID I PiE ENIATION DATA COllECTION

Conducted by graduates of Akademi Gizi (Academy of Nutrition) , who had under­gone a four-day training session, the following data was collected from the mothers and children between November 1996 and January 1997: General infonnation Using a questionnaire, information was collected on e socioeconomic background o environmental conditions e food consumption, particularly vitamin A intake

o food patterns (the frequency of con­sumption of several different food items)

e exposure to different media e food production (e.g. home gardening, livestock, fish ponds)

e whether the salt they consume contains adequate levels of iodization (deter­mined by the Kimia Farma test kit)

Anthropometric il1leaSUrements €!I The weight of each mother and each child, without shoes and with minimum clothing (for infants, without clothing), was assessed to the nearest O.1kg with a l;NICEF Mother & Child Weighing Scale.

o The height of each mother and each child (two years of age or older), with­out shoes or hats, was measured to the nearest 0.1cm using a microtoise.

Q The length of each child under two years old, without shoes or hats, was measured to the nearest O.1cm using a length board.

e Mid-upper-arm circumference (MUAC)

was measured to the nearest 0.1cm using an insertion tape produced by the Department of Health. For subjects with a MUAC larger than the insertion tape, a measuring tape was used.

F rom these measurements, several indicators were created, including weight­for-height (W/H), height-for-age (B/A), and weight-for-age (wi A), expressed as stan­dard deviation scores (z-scores) from the international reference population (NCI-fS)

• recommended for international use by the , World Health Organization (WHO). • The body mass index (BMI) of the • mothers was calculated by dividing their · weight (kg) by their height (m) squared. • Women with a BMI less than 18.Skgl m2 are • classified as malnourished, while those • with a BM! of 25-30kgl m2 are classified as

overweight. A BM! of over 30kgl m2

reflects obesity, Biochemical parameters e Venous blood (3ml) was collected by staff from the Balai Laboratorium Kesehatan (the Health Laboratory) in South Sulawesi, who had been trained by staff from the N'RDC in Bogor. Hemoglo­bin concentrations were assessed in the field using the HemoCue instrument. The rest of the blood was kept cool and protected from light for the next 4-8 hours, before being transported to a laboratory. In the laboratory, the blood was then centrifuged and the serum separated and frozen at minus 20 degrees Celcius.

e Serum concentrations of retinol, caro­tenoids and ferritin are analysed at the NRDC.

e In addition, between February and March 1997, data was collected on the prevalence and types of parasitic infesta­tions in the women and children in a collaborative effort with Hassanudin University in South Sulawesi. These results will be presented in the next LOCAL VITA report. <lID>

Helen Keffer International '(Indonesia)

.... July' ................ .

Media development, in the form of materi­als, Including a publiC service announce· ment, a song. the LOCALVITA logo. and leaflets. were devel­oped by the teams, based on the formative research results

August

September·

Pretesting of the media was conducted by broadcasting the public service an­nouncement and the song through sound systems on public transportation instead of the radio. The media was then evaluated and revised accordingly.

.... October ... - .......... .

... November

... December

Baseline survey conducted in both South Sulawesi and South Kalimantan. as well as media revisio preparations for the promotional campaign and development of the Plan Of Action (POA)

199) 7 .- January

In January, preparations were being made for the launch of SUVITAL in the following month The launch took place. as planned, in Gowa on 27 February

.... February -- --------;

. March

--April.

9

Stool samples were collected until the end of March and 50% of the sample population in Bulukumba was dew­ormed after stool sample collection Baseline survey results were completed by mld.t\pril

(cont'dfrom p7)

Of the infants (children under 12 months old), 13 per cent were found

80 ~ ______________________ ~ to be stunted and 5 per cent were wasted. ..... 60 +-__ _

il"1 ..... c:1 40 1------­

The body mass index (BMI) distri­bution of the

.~!

~i 20 aI +----01

';:1 0 mothers was <18.5 18.5.25 25.30--,r-""> .... 30--+t calculated by Body mass index (in kg/mIl dividing their

ANTHROPOMETRIC MEASUREMENTS: the 8MI weight, in kilo-(body mass index) distribution of the grams, by their mothers in the study height, in meters,

squared. According to the results of the survey, mean BMI was 21.7kg/m2

and 5.5 per cent of the women had a BMI greater than 27kg/ m2 (the figure that is often used as a cut-off value for obesity in Indonesia).

While 12.1 per cent were under­weight (with BMI less than 18.5kg/ m2), 26.7 per cent had a MUAC mea­

suring less than 23.5cm.

Mean hemo­globin concentra­tion among the (non-pregnant) women measured 13.1 g/ dL (grams/ deci1itre) and 14.3 per cent of them were anemic (with hemoglobin concentrations of less than 12g/ dL).

Mean hemo­globin concentra­tion among the children measured 11.2g/dL and 39.4 per cent of them were anemic (with hemoglobin

"""".---.~'" ~"~-~oflcentrations ~Oess than 11g/dL).

Until the age of 24 months, hemoglo-

bin concentration was lower for older children, while after 24 months, the older the child, the higher the hemoglobin concentration. This reflects the decrease in children's iron needs as they grow older, until adolescence. Results of the analysis of serum retinol concentrations are expected around August, later this year.

Health On the day of the inter view, 4.3

per cent of the children and 0.5 per cent of the mothers were suffering from diarrhea (point prevalence*), whereas 9 per cent of the children and 1.3 per cent of the mothers had suffered from diarrhea in the previ­pus seven days (period prevalence*).

Twenty-four per cent of the children had a runny nose and! or were coughing on the day of the interview. In total, 16 per cent of the mothers reponed that their child had suffered from measles in the previous 12 months. When children suffer from measles, their body vitamin A stores decrease rapidly.

DI5TRIBUI'ION OF VITAMIN A CAPSULFS

AND IRON PILLS

The baseline survey also evaluated the coverage of vitamin A capsule (VAC) and iron pill distribution among the mothers and children in both districts. In the previous six months, 85.2 per cent of the children (aged 1 to 5 years old) had received a vitamin A capsule.

Postpanum VAC distribution to mothers was low; only 1.1 per cent said they had received a capsule after delivery of their YOlll1gest child. In contrast, 84.6 per cent had received iron pills when they were pregnant with their youngest child.

Helen Keller International (Indonesia) . l ;0 particular time (period prevalence) or a stated period (period prevalence)

t1 ., ;/ l--J

FOOD PRODUCTION:

HOMEGARDENING, UVESTOCK AND

FISHPONDS

A large proportion of the house­holds interviewed, both in Gowa and Bulukumba, had access to a homegarden and kept chickens (see chart), while cows were the next most-common livestock kept, and only a few households kept goats. Only a small proportion of the households had access to a fishpond.

The median size of the homegardens was 500m2 and they were located around the house, as well as away from it. Among the households with access to one, 20 per cent sold everything, 30 per cent consumed everything, and the remaining 50 per cent consumed approximately 44 per cent of what they produced in the homegarden.

BREASTFEEDING, FOOD CONSUMPTION

ANDNUlRIENfINfAKE

Most children up to 12 months and 80 per cent of the children,aged 18 to 23 months old, received breastmilk. Fewer than half of the children aged 24

For vegetables, it does not seem to the frequency but the quantity that should be increased. On the question of how much vegetables the women had prepared during the previous three days, it was

! .Buluk urn ba

,oGowa

estimated that the amount used per person per day (children under five accounted for 50%) was 85g. Cor­rected for the loss after cleaning the vegetables, this would mean that daily vegetable consumption was approximately 50g per person. The fruits that are consumed do not seem to be rich sources of vitamin A, as the percentage of vitamin A intake from fruits was found to be only 2

months and .,,120, ________________ ---, to 3 per cent. Vegetables

older received breastmilk as well.

~I

~1100 -, 01 EI 80

I

~I 60 I

0>1 c! 40 nol -, .::1 20 0>1 ul

~: 0

--------- --------------------j

were the

Among both the mothers and children (aged 1 to 5 years old), dark­green leafy vegetables

0..1 0-5 6-11 12- 18- 24- 30- 36- 42- 48- 53-17 23 29 35 41 47 53 59

most important source of vitamin A for both mothers and children.

Age of child (in months)

BREASTFEEDING: Proportion of..mothers still breastfeeding their child, by child's age

were the most frequently con­sumed vitamin A-rich food item, followed by fruits, and then eggs. From this, it can be concluded that the frequency of egg consump­tion can be increased.

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Fortified foods, such as some brands of noodles, instant porridges and sweetened condensed milk, contributed very little Oess than 0.5%) to total vitamin A intake. However, for some women and

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children, it was a substantial source of vitamin A. Almost all the house­holds prepared noodles (mie) one or more times a week and in 30 per cent of the households, the mie­product used was one that is fortified.

Women were also asked how much oil was used in the house­

. hold per week. From this, oil

o Vegetables

iii! Fruits

~,Animal foods

15%

72% 83%

Sources of children's (aged Sources of women's VA

1-5) VA intake (430RE/d)* intake (870RE/d)*

SOURCES OF VITAMIN A INTAKE: As thb graphs ind}catH, vbgbta Ibs contri utb thb most to thb vitamin A intakb of thb mothbrs and childrbn in thb study *(lUid=retinol equivalent/day)

12'

consumption per person per day was estimated at 24ml, which is equivalent to 216kcal, or 912KJ. Assuming an average energy intake of 1S00kcal, this means that at least 12 per cent of energy is from fat. Other important dietary sources of fat are coconut products and meat.

In 16 per cent of the house­holds, the salt used was found to be adequately iodized (greater than 30ppm).

KNOWLEDGE ABour VITAMIN A-RICH

FOODS AND SOURCES OF KNOWLEDGE

In Gowa, 69.5 per cent of the women said they had heard about vitamin A, compared to 54.5 per cent in Bulukumba. Sources of information were varied and in­clude health workers, television broadcasts and radio broadcasts. Some women mentioned more than one source of information. The most important source, how­ever, was the health worker.

When asked what they thought vitamin A was important for, 61.6 per cent did not know, 31.2 per cent replied 'for the eyes', 4.7 per cent replied 'for growth', and 2.1 per cent mentioned resistance against diseases (immunity). They were also asked which foods they thought were good sources of vitamin A. In Gowa, 46.9 per cent of the women correctly mentioned one or more food items containing vitamin A, while in Bulukumba, 39.3 per cent answered similarly.

MEolA COVERAGE

In total, 47.7 per cent of the women reportedly listen to the radio on a regular basis. The most popular time to tune in was in the morning. Forty-one per cent of the households

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TVRI

RCTI 10%

TPI 38%

TELEVISION VIEWING HABITS: (Above) Preferred TV channels in Gowa (Below) Preferred TV channels in Bulukumba

Indosiar TVRI

6%

RCTI 18%

SCTV 6%

worker Information source

TPI 53%

Above: Health workers were found to be the best source of information on vitamin A among the mothers

SCTV 16%

. Below: Dark-green leafy vegetables and fruits appeared to be the most common foods considered by the mothers to be rich in vitamin A, while knowledge of eggs and liver was low

interviewed in Gowa, and 20 per cent of those in Bulukumba, owned a television set. However, 71 per cent of the women were reported to regularly watch television. The most popular times for watching TV were in the afternoon and early evening.

T he social marketing campaign in South Sulawesi will put the most emphasis on eggs and vegetables as foods rich in vitamin A. Regarding egg and vegetable consumption, the baseline survey found that:

e the frequency of egg consumptio~ can be increased e-65 per cent of the households own chickens e women and children eat vegetables almost every day. e average vegetable consumption is approximately 50g per day and can

thus be increased e 65 per cent of the households in Gowa have a homegarden and 80 per

cent consume some or all of their produce

OTHER FINDINGS

The best TV -channels for broadcasting messages about consuming vitamin A-rich foods in Gowa would be TPl and Indosiar.

The coverage of VAC distribution to children under five years old (85%) can be increased, while more efforts must be made to give vitamin A capsules to women after delivery.

The results on vitamin A status, measured by serum retinol concentra­tions, of the morhers and children are expected by August, later this year. <llKI>

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III Gowa

5]Bulukumba

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