APJCN

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.

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.

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.

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.

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.

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.

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 Indonesian German 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.

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.

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.

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.

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.