Lesson From Nepal's Experience In Handling Stunting

JAKARTA, July 5 (Antara) - Childhood stunting has become a serious problem in Indonesia, with several millions of children reportedly suffering from the impacts of this "chronic undernutrition" (Cruz et al, 2017). According to University of Gadjah Mada (UGM) nutritionist Hamam Hadi, the total number of stunted children in Indonesia has reached around 8.8 million (2016). This unfortunate condition needs to be handled properly by the government and related stakeholders in the country. Indonesia, however, is not the only country facing this problem in the world because many other developing countries, including Nepal, also undergo the same thing. Luckily, Nepal has been able to overcome this problem. According to World Health Organization, stunting is the impaired growth and development that children experience from poor nutrition, repeated infection and inadequate psychosocial stimulation. Stunted children are defined by their height-for-age is more than two standard deviations below the WHO Child Growth Standards median. The children with chronic undernutrition can be detected in the first 1,000 days from conception until the age of two. Impaired growth has adverse functional consequences on the children, such as poor cognition and educational performance, low adult wages and lost productivity. It is also closely linked with child development in several domains including cognitive, language and sensory-motor capacities. Moreover, when the children grow up to become adult, they run an increased risk of nutrition-related chronic diseases in their adult life. In view of the serious impacts of these stunted children on Indonesia's future, Vice President Jusuf Kalla has underlined the importance of dealing with the problem by taking preventive measures since the early stage of childhood. "If a child born today is not provided with good nutrition, then our generation will be stunted in the next 20 or 30 years. The nation that has a stunted generation will have low productivity," he stated while opening Widyakarya National Food and Nutrition (WNPG) XI in Jakarta on Tuesday. In this regard, it should be the government's concern to promote campaigns to help pregnant women and children receive sufficient nutrition. What Vice President Jusuf Kalla expects has reminded the entire nation of the misery of the native Papuan people in Asmat District, Papua Province, last year. At that time, 72 children reportedly died of measles and malnutrition. The central and provincial governments then responded to this Asmat case by providing the targeted families and children with sustainable family nutrition and health care program. The team of the Indonesian Health Ministry, for instance, also checked the nutrition status of 100 children and toddlers in Kaye Village, Asmat District. The World Bank helps Indonesia deal with this childhood stunting by providing it with US$400 million in grants . Coordinating Minister for Maritime Affairs Luhut Binsar Panjaitan said the World Bank is willing to grant US$400 million but the government will also allocate Rp46 trillion to deal with stunting, because this is a demographic bonus that the government must seriously handle. Nepal: A Lesson Learned Referring to other countries' experience, Nepal can be taken as a good example due to its success in handling the stunting case. Adhikari's research (2018) as published in News Deeply revealed that in the late 1970s, Nepal's first national study on nutrition found that more than 70 percent of its children suffered from the condition of stunting. It increases since the experts said this was the result of few nutrient-limited foods, irregular meals and high infection rates that could be traced to limited access to clean water. By the late 1990s, though, the government had committed to making a scheme like this: malnutrition reduction - particularly stunting ¿ a top priority. "The government gathered that families with well-nourished children will eventually lead to the country's economic prosperity," a member of the National Planning Commission Geeta Bhakta Joshi stated. The government started by adding more coverage for malnutrition onto a rapidly improving healthcare system. It also provides female health volunteers, who had been introduced in 1988. Their responsibilities expand in the mid-2000s to include monitoring for malnutrition. Then, the government had established more than 15,000 primary healthcare outreach clinics to provide treatment for under-nutrition within a continuum of care stretching from pregnancy through early childhood. According to a 2015 paper from the International Food Policy Research Institute (IFPRI), which evaluated Nepal's success between 2001 and 2011. Reductions in stunting rates are strongly associated with the use of prenatal and neonatal care, the researchers noted. At the same time, the Nepalese authorities understood that stunting is not a health sector issue alone. "Children are malnourished because they suffer from diarrhea," the deputy chief of party at Helen Keller International's Suaahara program Pooja Pandey Rana revealed. So, the health ministry must take serious of diarrhea because it needs to be prevented. To prevent diarrhea, it must have cooperation with the ministry of water, sanitation and hygiene. Based on data scale on the website of WHO whose the data are available at www.who.int, Nepal's success to handle malnutrition recorded by WHO that shows Nepal could decrease number of stunting in children to 37.40% in 2014 as the lowest value, while the highest value over the past 39 years was 75.00 in 1975. Indonesia must adopt this Nepal's steps to adress serious malnutrition problem, especially stunting. To this end, besides the government, the people must also have awareness and sensitivity to a healthy environment because everything starts from the smallest thing, such as clean water.