East Nusa Tenggara battling malnutrition

Indonesia's East Nusa Tenggara province continues to grapple with malnutrition, with cases of underweight, stunting and wasting among children exceeding thresholds set by the World Health Organization (WHO), the UN and officials say.

East Nusa Tenggara - comprising about 500 islands but dominated by Flores, Sumba and West Timor, the western half of the island of Timor - is one of the poorest provinces in Indonesia, with about 30 percent of the population living below the poverty line, according to the Central Bureau of Statistics.

The Health Ministry's Basic Health Research 2008 (Riskesdas 2008) reveals that the number of underweight children, or low weight for age, in East Nusa Tenggara reached 33.6 percent, exceeding the WHO threshold of 30 percent, which indicates a significant public health problem.

The prevalence of stunting, or low height for age, is 46.7 percent against a WHO threshold of 40 percent, according to Riskesdas, the latest government data available.

Stunting is the chronic restriction of a child's potential growth, reflecting the cumulative effects of inadequate food intake and poor health conditions, according to UNICEF.

The prevalence of wasting is 20 percent, exceeding the WHO threshold of 15 percent.

Wasting, or low weight for height, is a strong predictor of mortality among children under five and is usually the result of acute food shortages and disease, say health experts.

Immunisation factors

The Basic Health Research stated that up to 42 percent of children in the province were not fully immunised partly because of parents' lack of awareness of the importance of immunisation or difficulties in reaching health centres.

The survey also reported that some 10 percent of children in the province had never been vaccinated for any antigen.

"Malnutrition rates in East Nusa Tenggara are very high. Undernourished children are more vulnerable to contracting diseases," Anne Vincent, head of child survival and development at the UN Children's Fund (UNICEF) Indonesia, told IRIN.

"Poor immunisation coverage increases the risk of mortality and morbidity from vaccine preventable diseases," she said.

At the national level, one in every five children in Indonesia suffers from malnutrition and most are younger than two, Riskesdas noted.

The vast majority of severely malnourished children in Indonesia suffer from long-term chronic malnutrition and not from sudden onset, Vincent said. It was difficult to determine the extent of malnutrition-related deaths and UNICEF's field monitoring showed that most children died from multiple infections.

In most hunger-related deaths, the terminal event is an infectious disease, such as pneumonia or diarrhoea, because severe under-nutrition reduces resistance to infections.

"The technical capacity and resources in local government to treat malnutrition are limited. Children come too late to hospitals, making the cases more difficult to treat. In-patient treatment has achieved limited outcomes," she said.

Funding concerns

The head of the provincial health office, Stefanus Bria Seran, said his agency was struggling with a lack of funding and staff. "The extent of the problem is beyond our capacity to handle," he told IRIN.

He said poor sanitation, lack of clean water, and lifestyles were to blame for recent outbreaks of diarrhoea in the provincial capital, Kupang, and South Timor Tengah District. The outbreak killed two people and affected more than 200 within two weeks this month.

UNICEF is working with the Health Ministry, other UN agencies, national and international organisations in East Nusa Tenggara's Sikka and Belu districts to treat and prevent malnutrition by giving children ready-to-use therapeutic foods, promoting infant feeding programmes, such as exclusive breastfeeding in the first six months, and timely introduction of nutrient-rich complementary foods at six months.

Ardhiani Dyah Priamsari, a nutrition expert with Action Contre la Faim, a Paris-based aid group, said in several places in South Timor Tengah District, malnutrition reached more than 50 percent.

"Many factors contribute to malnutrition, including lack of food diversification, lack of clean water, inappropriate feeding practice and local customs," she said.