Indonesia - Nutrition at a glance

 77174 Nutrition at a GLANCE Indonesia The Costs of Undernutrition Annually, Indonesia loses over US$2.6 billion • Over one-third of child deaths are due to under- nutrition, mostly from increased severity of dis- in GDP to vitamin and mineral deficiencies.3,4 ease.2 Investing 0.05% of total public spending over the • Children who are undernourished between con- next 5 years would halve Indonesia’s prevalence ception and age two are at high risk for impaired of underweight among young children.7 cognitive development, which adversely affects (See Technical Notes for more information) the country’s productivity and growth. • The economic costs of undernutrition include Approximate direct costs such as the increased burden on the Key Actions to Return on health care system, and indirect costs of lost pro- Address Malnutrition: Investment (%):12 ductivity. Improve infant and young 1400 • Childhood anemia alone is associated with a child feeding through effective 2.5% drop in adult wages.5 education and counseling services. Country Context Invest in vitamin A Supplementation. 1700 HDI ranking: 111th out of 182 Where Does Indonesia Stand? • 37% of children under the age of five are stunted, Achieve universal salt iodization. 3000 countries1 18% are underweight, and 14% are wasted.2 Fortify commonly consumed foods 800 Life expectancy: 71 years2 • 1 in 10 infants are born with a low birth weight.2 with iron. Lifetime risk of maternal death: • Indonesia has achieved high rates of vitamin A Ensure an adequate supply of zinc 1370 1 in 972 supplementation: 86% of children 6–59 months supplements for the treatment of of age receive the recommended two doses of vi- diarrhea. Under-five mortality rate: tamin A approximately six months apart.2 41 per 1,000 live births2 Global ranking of stunting As shown in Figure 1, the overall prevalence of As seen in Figure 2, Indonesia performs worse prevalence: 42nd highest out of underweight has fallen over the past two decades relative to many of its neighbors and income peers. 136 countries2 and Indonesia is on track to meet MDG 1.6 Howev- A number of countries with less income have low- er, since decentralization began in 2001, undernu- er rates of stunting such as Togo and Ghana, in trition rates have stagnated and are even increasing Africa. in a number of provinces.7 Technical Notes Figure 2  Indonesia has Higher Rates of Stunting than Figure 1  Indonesia is On Track to Meet MDG 1 its Neighbors and Income Peers Stunting is low height for age. 45 60 Prevalence of Stunting Among Underweight is low weight for age. Prevalence Among Children 40 35 50 Nepal Children Under 5 (%) Wasting is low weight for height. Myanmar 30 Cambodia Under 5 (%) 40 Indonesia 25 Vietnam Current stunting, underweight, and wasting 20 30 Phillippines Togo Mongolia estimates are based on comparison of the 15 Ghana Sao Tome 20 and Principe most recent survey data with the WHO 10 Sri Lanka China Child Growth Standards, released in 2006. 5 10 They are not directly comparable to the 0 0 1998 2003 2005/06 trend data shown in Figure 1, which are 0 1000 2000 3000 calculated according to the previously-used Stunting Underweight 2015 MDG Underweight Target GNI per capita (US$2008) NCHS/WHO reference population. Source: WHO Global Database on Child Growth and Malnutrition (figures Source: Stunting rates were obtained from the WHO Global Database on Low birth weight is a birth weight less based on the NCHS/WHO reference population) Child Growth and Malnutrition (figures based on WHO child growth stan- dards). GNI data were obtained from the World Bank’s World Development than 2500g. Indicators. The methodology for calculating nationwide Most of the irreversible damage due Nutritional status also varies by region and in- costs of vitamin and mineral deficiencies, to malnutrition in Indonesia happens and interventions included in the cost come level. Children under five in Gorontalo are of scaling up, can be found at: during gestation and in the first 24 almost 3 times as likely to be underweight than 6 www.worldbank.org/nutrition/profiles months of life. those in Yogyakarta.7 Undernutrition affects both  Solutions to Primary Causes of Undernutrition Indonesia Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • 39% of all newborns receive breast milk within • 13% of deaths of children under 5 are due to diar- • Nearly one-fifth of households (16%) are food in- one hour of birth.2 rhea.6 secure.8 • Less than one-third (32%) of infants under six • Undernourished children have an increased risk of • Achieving food security means ensuring quality and months are exclusively breastfed.2 falling sick and greater severity of disease. continuity of food access, in addition to quantity, for • During the important transition period to a mix • Undernourished children who fall sick are much all household members. of breast milk and solid foods between six and more likely to die from illness than well-nourished • Dietary diversity is essential for food security. nine months of age, one-quarter of infants are children. Solution: Involve multiple sectors including agricul- not fed appropriately with both breast milk and • Parasitic infestation diverts nutrients from the body ture, education, transport, gender, the food industry, other foods.2 and can cause blood loss and anemia. health and other sectors, to ensure that diverse, nutri- Solution: Support women and their families to Solution: Prevent and treat childhood infection and tious diets are available and accessible to all house- practice optimal breastfeeding and ensure timely other disease. Hand-washing, deworming, zinc sup- hold members. and adequate complementary feeding. Breast milk plements during and after diarrhea, and continued fulfills all nutritional needs of infants up to six feeding during illness are important. months of age, boosts their immunity, and reduces exposure to infections. References the rich and poor. Although the national prevalence children, and fortification of staple foods are of underweight children under 5 among the poor effective strategies to improve the iron status 1. UNDP. 2009. Human Development Report. 2. UNICEF. 2009. State of the World’s Children. is 30%, 1 in 5 wealthy children under five are still of these vulnerable subgroups. 3. UNICEF and the Micronutrient Initiative. underweight.7 • Iodine: While 62% of households consume io- 2004. Vitamin and Mineral Deficiency: dized salt, nearly 1.6 million infants remain un- A Global Progress Report. Vitamin and Mineral Deficiencies Cause protected from iodine deficiency disorders.6 4. World Bank. 2009. World Development • Zinc: Nearly 35% of the population is at risk of Indicators (Database). Hidden Hunger insufficient zinc intake.12 Zinc supplementation 5. Horton. S. and Ross J. The Economics of Although they may not be visible to the naked eye, during diarrheal episodes can reduce morbidity Iron Deficiency. Food Policy. 2003;28:517–5. vitamin and mineral deficiencies impact well-being 6. UNICEF. 2009. Tracking Progress on Child by more than 40%.13 in Indonesia, as indicated in Figure 3. and Maternal Nutrition. 7. World Bank. 2009. Halving Malnutrition Figure 3  High Rates of Vitamin A and Iron Deficiency World Bank Nutrition-Related Activities in in Indonesia by 2015 (Health Policy Note series). Contribute to Lost Lives and Diminished Productivity Indonesia 8. FAO. 2009. The State of Food Insecurity 50 The World Bank is supporting expansion of In- in the World: Economic Crises – Impacts 45 donesia’s human resources for health through the and Lessons Learned. 40 Health Professional Educational Quality Project 35 Prevalence (%) 9. WHO. 2009. Global Prevalence of Vitamin which includes training for nutritionists, an Early 30 A Deficiency in Populations at Risk 25 Childhood Development project with entry points 1995–2005. WHO Global Database on 20 for nutrition, the National Program for Commu- Vitamin A Deficiency. 15 10. WHO. 2008. Worldwide Prevalence 10 nity Empowerment with conditional cash transfers of Anemia 1993–2005: WHO Global 5 with entry points to nutrition, a feasibility study 0 Database on Anemia. Preschool Children Pregnant Women to strengthen the use of the locally collected child 11. Horton S. et al. 2009 Scaling Up Nutrition: Vitamin A Deficiency Anemia weight gain data and the Water Supply and Sanita- What will it Cost? tion for Low Income Countries project which aims 12. Micronutrient Initiative. 2009. Investing Source: 1995–2005 data from the WHO Global Database on Child Growth and to impact nutritional status through reduction of Malnutrition in the Future: A United Call to Action on diarrheal disease frequency and intensity. Vitamin and Mineral Deficiencies. 13. Bhandari N., et al. 2008. Effectiveness • Vitamin A: About one-fifth of preschool aged of Zinc Supplementation Plus Oral children and pregnant women are deficient in Addressing undernutrition is Rehydration Salts Compared With Oral vitamin A.9 Rehydration Salts Alone as a Treatment. cost effective: Costs of core • Iron: Just under half of preschool aged chil- dren and pregnant women suffer from anemia.10 micronutrient interventions are as Iron-folic acid supplementation of pregnant low as US$0.05–3.60 per person women, deworming, provision of multiple mi- annually. Returns on investment are THE WORLD BANK cronutrient supplements to infants and young as high as 8–30 times the costs.11 Produced with support from the Japan Trust Fund for Scaling Up Nutrition