Targeting children to beat anaemia

An NGO in Jakarta is waging a war against the widespread problem of iron-deficiency anaemia in the country, one school and village at a time.



“Iron-deficiency anaemia is a chronic problem. Many people aren’t aware they have anaemia, because the body adjusts. So we have to go out and find the people with anaemia,” said Adi Sasongko, director of health services for the Kusuma Buana Foundation.



In 2000, backed by an international pharmaceutical company, the foundation began visiting schools and public health facilities in small villages. The results were staggering, but hardly surprising.



“In the Thousand Islands District, last year when we started there, we saw an almost 90 percent anaemia prevalence rate among babies,” Adi said, referring to small islands north of the Indonesian capital where poverty rates are high and access to social services poor.



According to the Asian Development Bank, 63.5 percent of the country’s 230 million inhabitants suffer from iron-deficiency anaemia. Among pregnant women, the rate can reach 72 percent, while among children aged 12–23 months, it varies between 65 and 85 percent.



As anaemia impedes physical and mental development, the disease has been linked to levels of poverty as well, say health specialists.



“Even if the government provides the best teachers and the best education facilities, we will not get good results from students,” Adi said.



The ADB says that for about 22 million children in Indonesia, anaemia is associated with a loss of 5-15 IQ points, poor school performance, and a 2.5 percent loss in discounted future earnings.




Photo: Kusuma Buana Foundation
Students being tested for anaemia

Sustainable action required



Kusumu Buana provided a 12-week treatment of iron supplements to each child and adult they found with the disease.



After a year of testing, treatment and awareness campaigns in the Thousand Islands, the overall prevalence rate dropped from almost 80 to 66 percent. Among the 210 primary schools they visited in Jakarta and neighbouring Bekasi from 2006 to 2008, the prevalence rate declined from 23.4 to 15 percent.



Adi is confident their approach will see results. Two decades ago, they started a similar school health programme in Jakarta that aimed to rid children of intestinal parasites. When they began, more than 78 percent of the children tested had worms. After years of testing, providing treatment and awareness campaigns, that figure is now 5 percent.



However, he says it is not enough. “We cannot solve the problem in short programmes. Sustainable action is needed. Next year, new students will come in,” he said.



The Ministry of Health distributes iron tablets to pregnant women. “But if you wait to treat girls with anaemia until they get pregnant, then that’s already 12-15 years’ delay. The girls would have already suffered accumulative impacts,” he said. “I understand that Indonesia is a very big country, it’s hard to address everybody. But I’m advocating an early start to anaemia detection. Do it through schools, where the children are.”



Barbara Lochmann, an ADB senior social sector specialist based in Manila, supports the early detection approach. “The window of opportunity is [up to two] years,” she told IRIN, adding that a previous ADB pilot project that provided, among others, multi-nutrient fortification tablets and targeted children aged six to 54 months, was promising and would be scaled up in Indonesia.



The ADB says the government has an iron fortification programme for wheat flour, but to further help provide a sustainable solution, various government agencies, including the health ministry and the state logistics agency, would soon begin work on a pilot project funded by a US$2.2 million grant from the ADB to fortify the subsidized rice distributed to Indonesia’s poor.



Adi was cautious, however. “Iron fortification is one way to address the problem,” he said. “But if somebody already has anaemia, treatment is needed, not just a good diet.”



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