Lots of food - and malnutrition - in the east

A lack of trained health staff, treatments and health promotion make Indonesia’s eastern province of Nusa Tenggara Timur (NTT) one of the country’s most food insecure, despite the general availability of food.



In the drought-prone mostly rural province of 4.5 million people spread out over 50 islands, the average per capita income is US$265 a year.



“Food is not the main problem here,” said UN Food and Agriculture Organization food security officer, Andrey Damaledo, in Kupang, one of 20 in NTT. “We have pumpkin, cassava, banana here. Locals define food as corn or rice. Diversification [of diets] is what is needed.”



Even rice and maize harvests have steadily increased from 2003 to 2007, according to the government’s most recent Food Security and Vulnerability Atlas, leading to surplus production in some districts.



Yet NTT hosted six of the country’s most vulnerable districts, second only to the far eastern province of Papua, which had 11, according to the atlas.



To create a composite food security index, researchers evaluated 14 factors nationwide, including female literacy; access to safe water, sanitation, electricity, 4x4 road access and health facilities; exposure to natural disasters; deforestation and food production.



According to Damaledo, NTT’s “hunger paradox” goes much deeper than food.



The country’s highest rates of under-five children who were diagnosed as chronically malnourished (as measured by height-for-age) or acutely malnourished was in NTT– 46.7 and 20 percent, respectively, as compared to the national average of 36.8 percent and 13.6 percent.



Overall malnutrition is a longstanding problem in NTT that is still being treated with short-term solutions, said Damaledo. “Peanut pastes and rice giveaways do not address underlying problems of feeding practices, low levels of education, and cultural obstacles to good nutrition. There is a tree of causes we are still mapping.”



Challenges



Some 1,300 children were recorded as severely acutely malnourished in 2009 in NTT, which was 2 percent of all children surveyed.



The province only had therapeutic foods available to treat 10 percent, according to the Ministry of Health. Severe wasting can be deadly if untreated as the child loses body fat and muscle tissue, say nutrition experts.









''It is like we are in a jungle with a machete looking for a way out now''

Another problem is insufficient health promotion and lack of trained nutritionists willing to work in remote areas, said Messel Ataupah, who heads the Ministry of Health’s office in NTT district, Kupang.



“For a long time we [Health Ministry] have ignored health promotion. It is like we are in a jungle with a machete looking for a way out now. People still see health promotion as a waste of time. It is hard to get [staff] to come in for training – some even refuse,” said Ataupah.



There are seven trained nutritionists spread over NTT’s 286 community health posts.



Untrained village health staff can gather inaccurate malnutrition data, said an assistant with the World Food Programme (WFP) office in Kupang city, Ha’i Raja Lawa. “Data is still a challenge we are struggling with in NTT.”



The government is expected to release new malnutrition figures in its 2010 national basic health survey on 20 December.



Interventions



The government recently launched a programme in 11 districts in NTT to target energy-deficient children with 100g of fortified biscuits daily for 90 days.



Another programme distributes “sprinkles” boosted with micronutrients to help children under-two fight lifelong chronic malnutrition – one of the leading causes of preventable disability, according to the World Health Organization.



There are two medical feeding centres in NTT that are supposed to provide nutrient-dense foods to treat emaciated children for severe acute malnutrition.



But these interventions have limited impact, said WFP’s Lawa, “Not all parents want to bring their children to a feeding centre. Parents in NTT do not see malnutrition as a problem.”



Even Lawa admitted she fell into the trap of other working parents who neglect their children’s nutrition. She has an under-five child who is on the border between moderate and severe wasting, diagnosed by a child’s too-low weight-for-height or too-small upper arm.



In the district where she lives in Kupang, 23.9 percent of children surveyed for malnutrition in 2009 had signs of wasting.



pt/mw