eary(5%) for haf Annually, Indonesia loses over US$4.3 billion in Malnutrition is responsible LGP to vitamin and mineral deficiencies.' of all deaths in children under five.2 HdI rani12 ouf 186 Children who are undernourished between con- ception and age two are at high risk for impaired KyAtost prxmt cognitive development, which adversely affects Global ra the country's productivity and growth. of Childrhnowh The economic aemi costs ewn include of undernutrition unenuishasaed con direct costs such as the increased burden on the health care system, and indirect costs of lost pro- seri a 0ce ctio anadtaunseing ductivityL Invest invitamin ASupplementation. 1700 Undr-iv mortality rate:rmoeinomain Country Context 2.5% drop in adult wages. Achieve universal salt idization. 3000 HDI rk 121tout of 186 Fortify commonly consumed foods 800 ouomranin with iron. t children under the age of five are stunted, 36% of Ensure an adequate supply of zinc 1370 Life expectancy: 69 years 18% are underweight, and 13% are wasted. 2 supplements tor the treatment of Lifetime risk of maternal death: -9% of infants are born with a low birth weight.2 diarrhea. 2102 Indonesia has achieved high rates of Vitamin supplementation: 76% of children 6-59 months Under-five mortality rate: of age receive the recommended two doses of vi- 32 per 1,000 live births2 Currentrov stunting unde weight tamin A approximately andwasin six months apart. 2 group. A number of countries with less income, Global ranking of stunting such as Togo and Ghana, have lower rates of stunt- out of T18 As shown in Figure 1, the overall prevalence and ingedrowtho andcandards.evies than Indonesia. prevalence: 34 t' highest countries' stunting and underweight has been decreasing over the past decade. Indonesia has Higher Rates of Stunting than its Neighbors and Income Peers Indonesia isOn Track to Meet MG 1 ~~I 45 0 400 Stutig s owhegh fr 3 ge 4 *Cambodia * Indonesia 30 30=* 30 :Uganda *Philippines 25 S Togo :Viennam 20 20 Produceuppemnt 15 i le aaTutFn theor forh of Lanka treamen Sri 0 Thailon S100 China 50 ~ estimate anrn bancd ontemoneet500 0 00 200 30 4000 5000 no00 2000 2007 2010capita (US$2011) forin Stunting Underweight - 2015MOG UnderweightTarget thanin Indonesia.o InoeiMauHge)ae f tnigta Source:Stanting it*eihor rateswere ndIcoePerobtainedfrom UNICEF2013State oftheWorld's UNICEF-WHO-The World Bank: 2012 Joint child malnutrition estimates - m ess I d atrs than 2500g.Leelsandtrends S cf i Nutrition status also varies by region and income level. In some regions, children under five are near- iNote (See Techncal for mor inomai can be found*atK scaling up, ly 3 times as likely to be underweight than those in other regions. Undernutrition affects both the rich and the poor. Although the national prevalence of underweight children under 5 among the poor is As seen in Figure 2, IndonesFa performs worse 30%, 1 in 5 wealthy children under five are still un- than its neighbors in the same region and income derweight.' k,, Poor Infant Feeding Practices High Disease Burden Limited Access to Nutrition Food 29% of all newborns receive breast milk within one InIndonesia, 17% of deaths of children under 5 are 9%of households were food insecure in 2013.11 hour of birth. due to diarrhea." Achieving food security means ensuring quality Less than one-third (32%) of infants under six Undernourished children have an increased risk of and continuity of food access, inaddition to quan- months are exclusively breastfed. falling sick and greater severity of disease. tity, for all household members. During the important transition period to a mix of Undernourished children who fall sick are much Dietary diversity isessential for food security. mix of breast milk and solid food between six and more likely to die from illness than well-nourished Solution: Involve multiple sectors including agri- nine months of age, 15% of infants are not fed ap- children. culture, education, transport, gender, food industry, propriately with both breast milk and other foodS. 2 Parasitic infestation diverts nutrients from the body health and other sectors, to ensure that diverse, nutri- Solution: Support women and their families to practice and can cause blood loss and anemia. tious diets are available and accessible to all house- optimal breastfeeding and ensure timely and adequate Solution: Prevent and treat childhood infection and hold members. complementary feeding. Breast milk fulfills all nutri- other disease. Hand-washing, deworming, zinc sup- tional needs of infants up to six months of age, boosts plements during and after diarrhea, and continued their immunity, and reduces exposures to infections, feeding during illness are important. References during diarrheal episodes can reduce morbidity 1. UNOPR 2013. Human Development Report. by more than 40%."2 2. UNICEF 2013. State of the World's Children. Although they may not be visible to the naked eye, 3. Black Ret al. 2013. Maternal and Child othe vitamin and disease mineral Han-wshng deficiencies dewoming impact zinvin sup-rtinin3 well-being Undereutrition and Overweight inLow- income and Middle-income Countries, in Indonesia, as indicated in Figure 3. Lancet.382: 427-451. The World Bank is supporting nutrition-related in- 4. Horton S.and Ross J.2003. The High Rates of Vitamin Aand Iron Deficiency terventions through multiple projects. For example, Economics of Iron Deficiency. Food Policy. Contribute to Lost Lives and Diminished Productivity the PNPM Generasi Sehat dan Cerdas (National 28:517-50D TrcigPoreso0hl Program for Community Empowerment, Healthy an MaICEF .Tera rioS g 45 and Bright Generation) has set nutrition-sensitive anWod aen20Halv Malutrition in targets including improving the use of maternal and 2015 (Health Policy Note series). Indonesia hy l child health services and consumption of Vitamin A 7. Micronutrient Initiative and UNICEF 2004. 25 for children under five. In 2014, PNPM Generasi is Vitamin and Mineral Deficiency: AGloal expected to extend to three more provinces, and to Progress Report. include a new focus on stunting reduction by pro- 8. World Bank. 2013. World Development viding IYCF (Infant and Young Child Feeding) train- Indicators. 0 Preschool Children Pregnant Weomen ing to service providers and community volunteers 9. WHO. Prevalence of Vitamin A 2009. GloDal f e r Deficiency Populations at Risk 1995-2005.s I s in r- WHO Global Database on Vitamin ADeficieocy. Source: Data from the WHO Global Database onChild Growth and Malnutri- gram Keluarga Harapan, a conditional cash transfer 10. WHO. 2008. Worldwide Prevalence of ion. is being piloted to focus on improving the health Anemia 1993-2005: WHO Global Database and education services utilization including prena- on Anemia. -Vitamin A: About 20% of preschool aged chil- tal and postnatal check-ups, professionally attended 11.Micronutrient Initiative. 2009. investing dren and 17% of pregnant women are deficient birth, growth promotion and monitoring, Vitamin A inthe Future: AUnited Call to Action on in vitamin A.1 supplementation, etc. At the policy level, the World Vitamin and Mineral Deficiencies. Iron: just under half of preschool aged children Bank is supporting the Review of Double Burden 12. Bhandari N., et al. 2008. Effectiveness (4%) and pregnant women (44%) have ane- of Malnutrition (DBM) in Indonesia to discuss the of Zinc Supplementation Plus Oralow- Rehydration Salts Compared With Oral ma'Irnfic cdsupe ntio ofrg- magnitude and causes of this emerging problem, and Rehydration Salts Alone as a Treatment for nant women, deworming, provision of multiple to improve the capacity and governance to address Acute Diarrhea inaPrimary Care Setting: micronutrient supplements to infants and young the DBM in the country. ACluster Randomized Trial.Pediatrics. Vol. children, and fortification of staple foods are ef- 121 No. 5. fective strategies to improve the iron status of 13. Institute for Health Metrics and Evaluation these vulnerable subgroups. (IHME). 2013. Global Burden of Disease Data. -Iodine: Although 62% of households consume 14. FAD. 2013. The State of Food Insecurity 2 inthe World: The multiple dimensions ofioiesat nrl1.mlinnwb nsean food security, unprotected from iodine deficiency 15. Horton S.et al. 2009. Scaling Up Nutrition: Zinc: Nearly 35% of the population is at risk of What will it cost? insufficient zinc intake.9 Zinc supplementation