Asia
Pacific Journal of Clinical Nutrition
Volume 11, supplement
4, 2002
Malnutrition and Poverty Alleviation
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Contents
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Abstract |
Paper
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Malnutrition and poverty alleviation
DWI SUSILOWATI, DARWIN KARYADI
Asia
Pac J Clin Nutr. 2002;11(S4):S323-330.
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Malnutrition and poverty alleviation in Vietnam
during the last period 1985-2000
LE THI HOP, NGUYEN CONG KHAN
Asia
Pac J Clin Nutr. 2002;11(S4):S331-334.
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Food
and nutrition security and poverty alleviation in the Philippines
IMELDA ANGELES-AGDEPA
Asia
Pac J Clin Nutr. 2002;11(S4):S335-340.
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Food and nutrition security in poverty alleviation: Concepts,
strategies, and experiences at the German Agency for Technical
Cooperation
RAINER GROSS
Asia
Pac J Clin Nutr. 2002;11(S4):S341-347.
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Sociocultural aspects of the aged:
A case study in Indonesia
NUGROHO ABIKUSNO
Asia
Pac J Clin Nutr. 2002;11(S4):S348-350.
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Trends in dietary habits of the elderly: The Indonesian case
R BOEDHI-DARMOJO
Asia
Pac J Clin Nutr. 2002;11(S4):S351-354.
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Micronutrient supplementation and its relationship
to nutritional status, health and diseases
JULIAWATI UNTORO, SITI MUSLIMATUN, ELVINA KARYADI
Asia
Pac J Clin Nutr. 2002;11(S4):S355-359.
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Policies
in alleviating micronutrient deficiencies: Indonesia's experience
ANI KURNIAWAN
Asia
Pac J Clin Nutr. 2002;11(S4):S360-370.
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Micronutrient deficiency and its alleviation: The Philippine experience
CORAZON VC BARBA, EMERITA A FELICIANO
Asia
Pac J Clin Nutr. 2002;11(S4):S371-376.
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Micronutrient deficiency and its alleviation: The
case of Malaysia
GEOK LIN KHOR
Asia Pac J Clin Nutr. 2002;11(S4):S377-381.
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New perspectives on regional opportunities for community nutrition
NEVIN S SCRIMSHAW
Asia
Pac J Clin Nutr. 2002;11(S4):S382-386.
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Food
safety courses for nutritionists and other health professionals
through intersectorial cooperation
DWI NASTITI ISWARAWANTI, MARIA CATHARINA PHAN JU LAN, JOHN STEPHEN
CROWTHER
Asia
Pac J Clin Nutr. 2002;11(S4):S387-391.
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Malnutrition
and poverty alleviation
DWI
SUSILOWATI, DARWIN KARYADI
The aim of the present paper is to understand the relationship
between malnutrition and poverty, and how to generate ideas and concepts
for developing studies leading to policy and programme implementation
in the context of establishing collaborating networks among South-East
Asian Ministers of Education Organization (SEAMEO) centres. Malnutrition
is found at all stages of life, from the fetus to older people, in
what is considered to be 'nutrition throughout the life cycle'. Low
birthweight could become an important indicator of fetal/intrauterine
nutrition. The consequences of being born undernourished extend into
adulthood. Stunting is an indicator for poverty, it demonstrates early
poor nutrition. Malnourished children face terrifying long-term results
when they grow to adults, deprived of their full mental and intellectual
capacity. The way to break the poverty cycle is to focus on children.
Seventy per cent of the world's poor are women, which is considered
as a feminization of poverty. Women play an important role in giving
birth to the next generation, in food security, and as caregivers
for the family. It is therefore important to increase the physical,
mental, and intellectual well-being of every woman as a good investment
for the well-being of future society and a human right. However, the
gender issues are rarely openly acknowledged in national antipoverty
strategies. Adequate nutrition, healthy ageing, and the ability to
function independently are thus essential components of a good quality
of life. Food security refers to access at all times to sufficient,
nutritionally adequate, and safe food. It is important for healthy
and peaceful development. Nutrition policy must be an integral part
of health policy, from the national to the grass-roots level. The
strategy is to focus government, NGOs and community activities on
the reduction of poverty, hunger, and malnutrition in developing countries;
determine who the poor people are, where they live, why they are poor
and how our research could contribute and reduce both poverty and
malnutrition.
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Malnutrition and poverty alleviation in Vietnam during
the last period 1985-2000
LE THI HOP, NGUYEN CONG KHAN
During the 1980s and early 1990s, Vietnam was classified among the
group of poor countries in the world, having a relatively high rate
of poverty households. Compared to other developing countries, undernutrition
among Vietnamese children is still a serious public health problem.
On 16 September 1995 the Government of Vietnam ratified the National
Plan of Action for Nutrition (NPAN) for the period 19952000. Poverty
reduction is one of the basic social policies given special attention.
In this regard, the Hunger Eradication and Poverty Reduction programme
(HEPR) has been executed by Ministry of Labour, Invalid and Social
Affairs since 1992 with special emphasis on supports for poor communes
and poor households. The present paper will begin by looking at the
trends of undernutrition and the achievements of poverty reduction
in Vietnam over the past decades. For the past few years the HEPR
has achieved great outcomes. Vietnam is evaluated by the international
community as one of the countries with the best performance in poverty
reduction. The gross domestic product per head in 2000 was 1.8-fold
against that in 1990. The percentage of hunger and poor households
declined rapidly, from approximately 40% in 1985 to nearly 30% in
the early 1990s, to 20% in 1995 and 11% in the year 2000. It has been
shown that after 5 years of implementation of the NPAN1 (19952000),
the nutritional status of people in Vietnam has considerably improved
and important nutrition goals (including micronutrient deficiencies,
food supply etc.) were achieved by the year 2000. It could be concluded
that the HEPR and the NPAN in Vietnam during the last
decade have been successfully implemented.
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Food
and nutrition security and poverty alleviation in the Philippines
IMELDA ANGELES-AGDEPA
Poverty, food and nutrition insecurity remain as critical problems
in the Philippines. The average Filipino in 1997 needed an annual
income of at least P7710 to meet food requirements or P11 319 to meet
both food and non-food requirements. Approximately 4 511 000 families
(31.8%) are poor and most of these are in the rural areas. Economic
growth in the country has been characterized as a 'boom and bust'
cycle with growth derailed by a combination of natural calamities,
adverse domestic political factors, energy shortages, and external
shocks such as the Asian currency crisis. In 1988 the gross national
product (GNP) reached a peak of 7.2% and then declined to less than
1% in 1991. The economy started to recover in 1992, and the GNP peaked
at 7.2% in 1996. The Asian financial crisis, compounded by the drought
in 1998, led to a fall in the output of the agricultural sector by
6.6%. A stronger world economy, however, in 1999 helped the Philippine
economy to recover. The Food Balance Sheet 1997 indicates that there
has been a steady increase in the aggregate net food supply in 19921997
with the cereals group contributing approximately 25% of the total
food supply. Translating this into calorie supply, this has provided
approximately 2400 kcal/person per day or approximately 25% more than
2000 kcal/day. The fact that mean per capita intake is low indicates
a gap between supply, distribution and consumption. The 1998 Food
and Nutrition Research Institute survey showed that nutritional deficiencies
still persist. Among 05-year-old children, underweight was approximately
32.0%; stunting 34.0% and wasting 6.0%. Underweight among 610-year-olds
was 30.2% while stunting was 40.8%. Vitamin A deficiency, iron deficiency
anaemia and iodine deficiency disorder continue as public health concerns.
Food security and poverty alleviation are among the top priority programmes.
The Medium-Term Philippine Development Plan (19992004) enunciates
the country's vision of creating a modern and humane society through
improved quality of life characterized by food-secure and poverty-free
Filipinos, in an ecologically healthy state. The different government
programmes are the following: the Agriculture and Fisheries Modernization
Act of 1997 provides the blueprint for developing and modernizing
the agriculture and fisheries sectors; the National Anti-Poverty Alleviation
Commission was created as the coordinating and advisory body for the
implementation of poverty eradication programmes of the different
sectors; the vision of the Medium-Term Philippine Plan of Action for
Nutrition is of a nutritionally improved country whose people are
well nourished, healthy, intelligent, and socially and economically
productive with a strong sense of human dignity.
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Food
and nutrition security in poverty alleviation: Concepts, strategies,
and experiences at the German Agency for Technical Cooperation
RAINER GROSS
Poverty alleviation
and food and nutrition security remain one of the priority areas of
development policies for the German government. Poverty exists when
individuals or groups are not able to satisfy their basic needs adequately.
Poverty consists of at least three dimensions: (i) the availability
of essential resources for basic needs; (ii) financial and other means
of poor individuals and groups; and (iii) the physical, intellectual,
social, and cultural status and position of poor individuals and groups.
Following this model, the severity of poverty is the collective gap
between the availability of the essential resources (i) and the individual
ability to meet basic needs (ii) + (iii). Basic needs are not covered
if individuals or groups are not able to develop themselves physically,
intellectually, and/or socially according to their genetic potentials.
As a result, growth retardation of children ('stunting'), who are
biologically and socially the most vulnerable individuals of the society,
is a valid cultural independent indicator for poverty. One form of
poverty is food and nutrition insecurity. Food security is achieved
if adequate food (quantity, ality, safety, sociocultural acceptability)
is available and accessible for and satisfactorily utilized by all
individuals at all times to live a healthy and happy life. Food and
nutrition programmes have four dimensions: (i) categorical; (ii) socio-organizational;
(iii) managerial; and (iv) situation-related dimensions. As shown
in three examples of IndonesianGerman programmes, despite the complexity
of poverty and food and nutrition security, with adequate targeting
of the most vulnerable population, adequate identification of problems
for a proper selection of interventions and frequent evaluation, reduction
of poverty and food insecurity can be achieved.
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Sociocultural
aspects of the aged: A case study in Indonesia
NUGROHO ABIKUSNO
In the year 2020, the life expectancy in Indonesia will be 71.7 years
and the proportion of older people will be between 10 and 11% or 30
million persons. Presently, older men are mostly married, while older
women are mostly divorced. Older men are the heads of the household,
while older women are spouses or parents in the household. Older women
mostly do not have any formal education, while older men have primary
and intermediate education. Older men are mostly literate, while older
women are illiterate. Monthly income of older women is mostly below
US$5, while that of older men is above US$10. The objective of the
present study was to illustrate intracultural perception of older
people in five ethnic groups in Indonesia: Batak, Java, Pendalungan
(mixed Java and Madurese), Bali, and Buginese. The sociocultural and
operation research technique was used in the study. A total of 300
informants participated in the study. They were divided into groups
that consisted of 10 informants. The groups were differentiated based
on family status, gender, and socioeconomic status. Semi-structure
group discussions (SSGD) were limited to 11.5 h of discussion using
two study instruments: ethnography flow chart and theme guide matrix.
Themes discussed in the SSGD were (i) cultural ideas of ageing; (2)
the needs of older people; and (iii) intracultural perception of themes
such as older person health, communication, and socioeconomics. Perspectives
of cultural perception given by informants showed that their conceptualized
opinions were based mainly on their sociocultural, socioeconomic and
sociogeographical backgrounds.
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Trends
in dietary habits of the elderly: The Indonesian case
R BOEDHI-DARMOJO
Based
on community surveys of the elderly of their nutritional habits in
big cities throughout Indonesia and in urban and rural areas, the
following observations are reported: (i) the elderly tend to reduce
their food intake by themselves, in calories, carbohydrate, fat, protein
content (1530% less); (ii) they even reduce their traditional fatty
food by themselves in spite of their already low fat intake daily
(3040% less); (iii) they very seldom eat snacks between meals (6.725.5%)
of the respondents only; (iv) they tend to eat (very seldom never)
new 'trendy foods' (7895%) such as hamburger, pizza, fried chicken
etc., which are available in big cities; (v) the elderly usually eat
just enough before satiety (84.3%); (vi) the majority of the elderly
usually eat rice or other local staple foods, with mostly vegetables
every day (5080%), especially the traditional témpé
(soybean cake) and tahu (soybean curd) and green vegetables (80%);
fruits are consumed less than vegetables (40%); (vii) milk consumption
still needs to be improved; (viii) fish consumption, the best healthy
animal protein source, still needs to be promoted to the whole country,
especially to the elderly on Java island; and (ix) an urbanrural difference
was noted, the urban elderly having a higher intake of calories, fat
and protein. Gender differences were practically not observed, except
the higher calorie intake in men. The following findings support the
aforementioned observations. The elderly have a lower mean body mass
index (BMI); only 15.9% are overweight and only 4.5% are obese, although
it is admitted that there are many elderly people who are underweight
and malnourished. They also have lower mean cholesterol, triglyceride
and haemoglobin values, but a higher prevalence of glucose intolerance,
hypertension, coronary heart disease etc. is reported in many studies.
In conclusion, the elderly in general have good eating habits, and
they adjust their food intake to the reduced daily physical activities
they perform. However, the consumption of eggs and fish (as low-cost
protein sources) needs to be improved. Hence overeating and obesity
are not a problem for the Indonesian elderly people, although it is
admitted that undernutrition will be a problem unless properly anticipated.
They usually prefer to eat the already healthy traditional food, especially
the still popular vegetable source of protein and anti-oxidants. They
eat the traditional food, témpé and tahu, making them
a stronghold against diet 'westernization', and they should be used
as a good example for the younger generation. Reduced calorie intake
among the elderly is also observed in Japan, but not yet in most European
elderly populations.
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Micronutrient
supplementation and its relationship to nutritional status, health
and diseases
JULIAWATI UNTORO, SITI MUSLIMATUN, ELVINA KARYADI
Micronutrient deficiency is still a major problem in many developing
countries and multiple micronutrient deficiencies often occur concomitantly.
Micronutrient supplementation may be the preferred option because
it is cost-effective. Supplementation with iodized peanut oil was
more efficacious and gave a longer protection period in preventing
iodine deficiency than did iodized poppy seed oil. Inclusion of vitamin
A in the iron supplement improved the vitamin A status of pregnant
women and their infants. Daily or weekly multimicronutrient supplementation
improved growth of stunted young children, whereas weekly multimicronutrient
or ironfolic acid supplementation improved the productivity of female
workers. In addition, vitamin A and zinc supplementation improved
the impact of tuberculosis medication, particularly during the first
2 months. In conclusion, multimicronutrient supplementation has beneficial
effects on the improvement of nutritional status, work productivity,
health and diseases. The challenge is how to translate the efficacy
of supplementation strategies into a large-scale setting. .
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Policies
in alleviating micronutrient deficiencies: Indonesia's experience
ANI KURNIAWAN
see pdf paper
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Micronutrient
deficiency and its alleviation: The Philippine experience
CORAZON VC BARBA, EMERITA A FELICIANO
Results
of the 1998 Fifth National Nutrition Survey (NNS) of the Food and
Nutrition Research Institute of the Department of Science and Technology
(FNRI-DOST) revealed that the country has persisting micronutrient
deficiencies of vitamin A, iron and iodine along with proteinenergy
malnutrition (PEM) and an increasing number of cases of android obesity.
An interplay of various physiological, socioeconomic and political
factors performs a role in the nutrition situation of the country.
The Medium-Term Philippine Plan of Action for Nutrition (MTPPAN) is
a product of multisectoral and multidisciplinary efforts for nutrition
adequacy for all Filipinos. It gives priority attention to persisting
and emerging nutritional problems through timely and focused strategies.
Long-term programmes to address food insecurity through food-based
interventions for alleviating PEM and micronutrient deficiencies will
be strengthened. Thus, the successor MTPPAN 19992004 still implements
similar programmes and strategies proven to be effective but they
must be fully implemented with more vigor and aggressiveness. The
FNRI, as the principal arm of the government as regards food and nutrition,
not only conducts national nutrition surveys but also efforts in food
fortification research and development as an integral component of
the food fortification programme of the MTPPAN. This food-based strategy
aims to develop technologies for fortification of commonly consumed
food items to increase nutrient availability and consequently increase
nutrient intake of the Filipinos.
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Micronutrient
deficiency and its alleviation: The case of Malaysia
GEOK LIN KHOR
Since attaining
independence in 1957, Malaysia has achieved marked socio-economic
development including advances made in the health care delivery system.
Vital statistics over the decades showed much improvement in the health
status of Malaysians in general. For example, the infant, toddler
and maternal mortality rates have declined to levels reflective of
developed countries namely, 9.5, 0.7 and 0.2 per 1,000 live births
respectively in 1997. The nutritional status of Malaysians mirrors
a society that is undergoing nutrition transition. Consequences of
the dual burden of under- and over-nutrition are evident in various
age groups in rural and urban areas. Nutrition problems which persist
include underweight and stunting in children, anaemia in young children,
women and the elderly, iodine deficiency disorders in interior population
groups in Sarawak and Sabah, folic acid deficiency among pregnant
women, and subclinical retinol deficiency in young children. The Ministry
of Health has played a pivotal role in implementing various nutrition
intervention programmes towards the alleviation of these problems.
These programmes will be elaborated.
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New
perspectives on regional opportunities for community nutrition
NEVIN S SCRIMSHAW
This
brief keynote speech provides an annotated check list for topics to
be covered during the meeting. The topics presented include specific
indicators of nutrition, new regional information and communication
technologies, empowerment of communities, effective nutrition and
health interventions, advances in agricultural research, progress
in food technology and the potential of biotechnology and genomics
to benefit the region. Other issues to be considered are land decentralization,
south-south and south-north cooperation, program monitoring and evaluation,
human rights and ethics.
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Food
safety courses for nutritionists and other health professionals through
intersectorial cooperation
DWI NASTITI ISWARAWANTI, MARIA CATHARINA PHAN JU LAN, JOHN STEPHEN
CROWTHER
The present paper describes the development of a food safety course
that was initially given as part of the Master of Science programme
in community nutrition at the South-East Asian Ministers of Education
Organization, Tropical Medicine Regional Centre for Community Nutrition
at the University of Indonesia. This course is an example of intersectorial
collaboration between industry, government and academia. Several years
later the course was rolled out to other countries.
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Updated: September 2004
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