The rapid assessment of students health and nutrition in Indonesia - Repositori Institusi Kementerian Pendidikan dan Kebudayaan

  The Rapid Assessment of

Student Health and Nutrition in Indonesia

  

The Education Sector Analytical And Capacity Development Partnership

(ACDP)

The Rapid Assessment of Student Health and Nutrition in Indonesia

  Published by: Education Sector Analytical and Capacity Development Partnership (ACDP) Agency for Research and Development (BALITBANG), Ministry of Education and Culture Building E, 19th Floor Jl. Jendral Sudirman, Senayan, Jakarta 10270 Tel.: +62-21 5785 1100, Fax: +62-21 5785 1101 Website: www.acdp-indonesia.org Secretariat email: secretariat@acdp-indonesia.org Printed in April 2017

The Government of Indonesia (represented by the Ministry of Education and Culture, the Ministry of Religious Affairs and

the Ministry of National Development Planning/ BAPPENAS, the Australian Agency for International Development (AusAID),

the European Union (EU) and the Asian Development Bank (ADB) have established the Analytical and Capacity Development

Partnership (ACDP) as a facility to promote policy dialogue and institutional and organizational reform of the education sector

to underpin policy implementation and help reduce disparities in provincial and district education performance. The facility

is an integral part of the Education Sector Support Program (ESSP) which consists of EU sector budget support with agreed

arrangements for results-led grant disbursement, and earmarked policy and program-led AusAID sector development grant

support consisting of a school infrastructure program, a nationwide district and school management development program

and a program to accelerate the GOI’s accreditation of private Islamic schools. This report has been prepared with grant support

provided by AusAID and the EU through ACDP. _{KEMENTERIAN PENDIDIKAN KEMENTERIAN EUROPEAN UNION DAN KEBUDAYAAN AGAMA Bappenas} Kementerian PPN/

The Consultants Who Prepared This Report Are:

  

Atmarita, MPH, Dr. PH

The views expressed in this publication are the sole responsibility of the authors and do not necessarily represent the views of

the Government of Indonesia, the Government of Australia, the European Union or the Asian Development Bank.

  The Rapid Assessment of

Student Health and Nutrition in Indonesia

Acknowledgement

  

I would like to express my special appreciation and thanks to Ibu Nina Sardjunani, Mr. Subandi,

and Mrs. Suharti (Bappenas), Mr. Alan Prouty, and Mr. Basilius Bengoteku (ACDP, Ministry of

Education and Culture) for enabling me to do the rapid assessment of health and nutrition of

school-aged Indonesian children. I would also like to thank to Balitbangkes, Ministry of Health for

allowing me to have the Riskesdas data for this assessment .

Table of Contents

  

The Rapid Assessment of Student Health and Nutrition, Indonesia ................................................ i

Acknowledgement .......................................................................................................................................... iii

Table of Contents ............................................................................................................................................. iv

Acronyms and Abbreviations .................................................................................................................... viii

Executive Summary ......................................................................................................................................... ix

  

1. Introduction ................................................................................................................................................. 1

  

2. Geographic and Demographic Background .................................................................................... 2

  

3. The Child Rights and Education Profile .............................................................................................. 4

  3.1 Birth Certificates .............................................................................................. 4

  3.2 Education Profile ............................................................................................. 4

  

4. Conceptual Framework ........................................................................................................................... 7

  

5. School Aged Children Health and Nutrition .................................................................................... 8

  

6. Discussion: Health and Nutrition Care for Indonesian Children ............................................. 33

  

7. Conclusions and Recommendations ................................................................................................ 35

Appendix ............................................................................................................................................................ 36

References ......................................................................................................................................................... 39

Attachment: Presentation on Rapid Assessment on Student Health and Nutrition .............. 41

List of Figures

  

Figure 1. Short and long term consequences of nutrition-gene-environment conditions in early

life on relevant health and disease outcomes ................................................................................... 7

Figure 2. Proportion of children 0-18 years having diarrhea last month gender, Riskesdas 2007

and 2013 ........................................................................................................................................................ 10

Figure 3. Proportion of children 0-18 years having diarrhea last month by residence, Riskesdas

2013 ................................................................................................................................................................. 10

Figure 4. Proportion of children 0-18 years having diarrhea last month by wealth quintiles,

Riskesdas 2013 ............................................................................................................................................. 11

  

Figure 5. Proportion of children 0-18 years having diarrhea last month by province, Riskesdas

2007 and 2013 ............................................................................................................................................. 11

Figure 6. Proportion of children 0-18 years having ARI last month by gender, Riskesdas 2007 and

2013 ................................................................................................................................................................. 12

Figure 7. Proportion of children 0-18 years having ARI last month by residence, Riskesdas 2013 .. 12

Figure 8. Proportion of children 0-18 years having ARI last month by wealth quintiles, Riskesdas

  2013 ................................................................................................................................................................. 13

Figure 9. Proportion of children 0-18 years having ARI last month by province, Riskesdas 2007 and

2013 ................................................................................................................................................................. 14

• *)

  Figure 10. Proportion of children 0-18 years ‘sick’ last month by province, Riskesdas 2013 .............. 14

Figure 11. Proportion babies with birth weight: 2010 and 2013 ................................................................... 17

Figure 12. Proportion of Low Birth Weight (<2500 gr) babies by province, Riskesdas 2010 and 2013

  ........................................................................................................................................................................... 17

Figure 13. Proportion babies with birth length: Riskesdas 2013 .................................................................... 18

Figure 14. Proportion Babies with birth length <48 cm by province, Riskesdas 2013 ............................ 18

Figure 15. Proportion of babies with birth weight <2500 gram and birth length <48 cm by

province, Riskesdas 2013 .......................................................................................................................... 19

Figure 16. Proportion of children 12-23 months with complete basic immunization status:

Riskesdas 2007-2013 .................................................................................................................................. 20

  

Figure 17. Proportion of children 12-23 months with complete basic immunization by province,

Riskesdas 2007-2013 .................................................................................................................................. 20

  

Figure 18. Nutritional status for children 0-59 months: Riskesdas 2007-2013 .......................................... 21

Figure 19. Nutritional status for boys and girls aged 0-59 months, Riskesdas 2007-2013 .................... 22

Figure 20. Proportion of Indonesian children 0-59 months by nutritional status (composite of

weight and height): Riskesdas 2007-2013 ......................................................................................... 23

Figure 21. Prevalence of underweight (WFA<-2SD) for children 0-59 months by province, Riskesdas

2007-2013 ..................................................................................................................................................... 23

Figure 22. Prevalence of stunted (HFA<-2SD) for children 0-59 months by province, Riskesdas

2007-2013 ..................................................................................................................................................... 24

Figure 23. Prevalence of wasted (WFH<-2SD) for children 0-59 months by province, Riskesdas

2007-2013 ..................................................................................................................................................... 24

  

Figure 24. Prevalence of underweight (WFA<-2SD) for children 0-59 months according to district

variation by province, Riskesdas 2013 ................................................................................................. 25

Figure 25. Prevalence of stunted (HFA<-2SD) for children 0-59 months according to district

variation by province, Riskesdas 2013 ................................................................................................. 25

Figure 26. Prevalence of wasted (WFH<-2SD) for children 0-59 months according to district

variation by province, Riskesdas 2013 ................................................................................................. 26

Figure 27. Proportion of children under-fives years with growth monitoring within the last 6

months, Riskesdas 2007-2013 ................................................................................................................ 26

Figure 28. Proportion of children under-fives years with growth monitoring ≥ 4 times within the

last 6 months by province, Riskesdas 2007-2013 ............................................................................ 27

Figure 29. Prevalence of stunted children 5-18 years by gender, Riskesdas 2013 ................................... 27

Figure 30. Prevalence of stunted children 5-18 years by gender and wealth quintiles, Riskesdas

  2013 ................................................................................................................................................................. 28

Figure 31. Prevalence of wasted and overweight children 5-18 years by gender, Riskesdas 2013 ... 28

Figure 32. The change of mean height for Indonesian children 5-18 years compare to 2007 WHO

standards by gender, Riskesdas 2007-2013 ....................................................................................... 29

Figure 33. The change of mean height for Indonesian children 5-18 years compare to 2007 WHO

standards by gender and residence, Riskesdas 2013 ..................................................................... 29

Figure 34. Continuum of care: Life Cycle Approach ........................................................................................... 34

List of Tables

  

Table 1. Geography of Indonesia by Region, 2012 ................................................................................................ 2

Table 2. Numbers of children 0-19 years by age groups and gender: 2000-2035 ...................................... 3

Table 3. Numbers of pre-school children 0-6 years, 2010-2012 ........................................................................ 3

Table 4. Proportion of children 0-6 years with birth certificate information by gender, Susenas 2012

  ................................................................................................................................................................................. 4

Table 5. Proportion of children attending ECED programs by age groups and gender, Susenas 2012

................................................................................................................................................................................. 5

Table 6. Type of pre-school attended by age groups and gender, Susenas 2012 ...................................... 5

  

Table 7. Proportion of School participation by age and gender, Susenas 2012 .......................................... 6

Table 8. Proportion of pre-school children sick last month and average days of affected by age

groups and gender, Susenas 2012 ............................................................................................................. 8

Table 9. Proportion of school aged children sick last month and average days of affected by age

and gender, Susenas 2012 ............................................................................................................................. 9

• )

  Table 10. Proportion of children 0-18 years ‘sick’ last month by characteristics, Riskesdas 2013 ...... 15

Table 11. Mean Nutrient intake by age and gender, Riskesdas 2010 ............................................................. 31

Table 12. Mean Nutrient intake (% to RDA) by age and gender, Riskesdas 2010 ...................................... 31

Table 13. Proportion smoking among children 10-18 year by gender, Riskesdas 2013 ......................... 32

Acronyms and Abbreviations

  ARI : Acute Respiratory Infection Bappenas : Badan Perencanaan Pembangungan Nasional BCG : Bacillus Calmette–Guérin BKB : Bina Keluarga Balita BP Blood pressure BPS : Badan Pusat Statistik CBS Central Bureau of Statistics CHO : Carbohydrate DPT : Dipththeria, Pertussis, Tetanus ECED : Early Childhood Education and Development HB : Hepatitis B HD Heart Disease HFA : Height for Age KB : Kelompok Bermain LBW : Low Birth Weight Balitbangkes : Badan Penelitian dan Pengembangan Kesehatan MOH : Ministry of Health NTT : Nusa Tenggara Timur PAUD : Pendidikan anak usia dini Polindes : Pondok Bersalin Desa Poskesdes : Pos Kesehatan Desa Puskesmas : Pusat Kesehatan Masyarakat Pustu : Puskesmas Pembantu RDA : Recommended Daily Allowance Riskesdas : Riset Kesehatan Dasar Susenas : Survei Sosial Ekonomi Nasional TK/BA/RA : Taman Kanak-kanak/Bustanul Athfal/Raudhatul Athfal TPA : Tempat Penitipan Anak

UKS : Usaha Kesehatan Sekolah

  

UNESCO : United Nations Educational, Scientific and Cultural Organization

UNICEF : United Nations Children’s Fund WFA : Weight for Age WFH : Weight for Height WHO : World Health Organization

Executive Summary

  

The rapid assessment of student health and nutrition provides an overview of the current situation

of Indonesian children under the age of 19 years. The number of Indonesian children age 0-19

years in 2014 totals about 91.6 million. Of this total 24 million are age 0-4 years, 23.1 million age 5-

9 years, 22.4 million age 10-14 years, and 22.0 million age 15-19 years. The analyses presented in

this report are based on data from Riskesdas 2007, 2010, and 2013, the Population Census 2010,

and also Susenas 2012.

  

On average, 38.5 percent of children aged 0-6 years are sick for 3.9 days each month. Among

school age children 7 to 18 years, the proportion of those who are sick starts with 28 percent for

those of 7 years of age and declines to 17 percent for those who are 18 years of age. The most

common of diseases affecting Indonesian children are diarrhea, acute respiratory infection,

pneumonia, coughing, and pulmonary tuberculosis.

The next concern for Indonesian children is the high incidence of malnutrition, starting with

malnourishment among infants. The prevalence of low birth weight babies varies across provinces

from the lowest rate of 7.2 percent to the highest rate of 16.9 percent. Some 76 percent of

Indonesian babies are born with normal birth length of 48 to 52 cm; however 20.2 percent are

born below the standard (<48 cm). Nationally 4.3 percent babies are born with a combination of

small weight (<2500 grams) and stunting (<48 cm).

  

The problem of malnutrition continues to the next ages, in 2013 only 36.8 percent of children

under 5 were considered normal in physical development. According to Riskesdas 2013, the

highest prevalence of types of malnutrition was stunting which amounted to 37.2 percent while

19.6 percent were classified as underweight, 12.1 percent wasting, and 11.9 percent overweight.

  

Data from Riskesdas 2013 indicates that many Indonesian children chronically fail to grow normally

starting from birth until they reach the age of 18 years. The mean height differences of Indonesian

children compared to the 2007 WHO standards were 12.5 cm for boys and 9.8 cm for girls by the

time they reach the age of 18 years. Stunting reflects chronic malnutrition among children and

could be related to poverty as large differences between the poorest and richest quintiles in terms

of the magnitude of stunting are found. Among the poorest the prevalence of stunting is almost

two times higher than among the richest.

The direct cause of malnutrition is associated with both unbalanced and insufficient food intake. In

addition, infection and malnutrition have been always associated with malnutrition, and the high

incidence of stunting in Indonesia could be because of hunger combined with infectious diseases.

This situtation is worsened when immunization does not cover all children while growth

monitoring is not always carried out.

  

With all the problems facing Indonesian children, school health and nutrition initiatives become

very important investments that can be implemented through the Usaha Kesehatan Sekolah (UKS).

Bettering health and nutrition among school-age children is a strategic element in efforts to

develop the community as a whole. The benefit from improving health and nutrition at s chool

age will solve the intergenerational issue for the future.

  

The rapid assessment of student health and nutrition provides an overview of the current situation

of Indonesian children under the age of 19. The analyses presented in this report are based on

existing data which have been used to identify factors which impact on child development. This

analysis is a pre-requisite for further progress on the sectors involved in the Indonesian

development agenda during the post MDGs period.

Progress in achieving future development goals depends on progress in improving the health and

nutrition of Indonesian children. The current problem of stunting among Indonesian children is

critical and requires serious attention otherwise the risk of morbidity and mortality as well as other

consequences for child development will not be resolved.

  

WHO estimates that malnutrition directly and indirectly contributes to up to 45 percent of all child

deaths, making children more vulnerable to severe diseases (WHO, 2013). In addition to

contributing to child morbidity and mortality, stunting also carries significant adverse

consequences for income poverty. Several studies have estimated that a one percent reduction in

stunting is associated with a 1.4 percent increase in wages (World Bank, 2006). Moreover,

malnutrition is also affecting development in terms of education and productivity. Stunted

children usually are also anaemic which inhibits cognitive development, undermining school

performance and long-term human productivity.

  

The objective of this rapid assessment is to advocate for greater attention to be committed by

policy makers and involved sectors to address these serious health and nutrition issues of

Indonesian children. This article provides an analysis of the magnitude and causes of child health

and nutrition problems as well as recommendations for future interventions.

  

The analyses use existing data sourced from Riskesdas 2007, 2010 and 2013, Population Census

2010, and Susenas 2012.

  

Indonesia is the largest archipelagic nation in the world, consisting of approximately 17,500

islands. There are five major islands: Sumatra, Java, Kalimantan, Sulawesi and Papua and also two

larger groups of islands which are Nusa Tenggara and the Moluccas. Table 1 shows the geography

of the seven major regions in Indonesia. Administratively up to December 2012, Indonesia

consisted of 34 provinces, 410 districts, and 98 municipalities. About 80 percent of Indonesia’s

territory is covered with water and the total land area is 1,910,716 square kilometers (Wikipedia,

2014).

  

Table 1 . Geography of Indonesia by Region, 2012

Number of Area (Square Km) Region

  % Districts Municipalities Min Max Sum

  Sumatera 119

  34 23 18,359 480,732

  25.2 Jawa

  85

  34 10 5,782 129,383

  6.8 Kalimantan

  47

  9 72 42,620 544,130

  28.5 Sulawesi

  65

  11 68 13,041 188,487

  9.9 Papua

  40 2 537 44,071 416,047

  21.8 Nusa Tenggara

  37

  4 26 7,000 73,051

  3.8 Maluku

  17 4 111 8,152 78,886

  4.1 Indonesia 410

  98 10 44,071 1,910,716 100.0

Based on the 2010 census conducted by the Central Bureau of Statistics (CBS), the Indonesian

population was estimated to be 238.518 million people, making Indonesia the world’s fourth most

populous country. Based on population projections, the total population will reach 305.652 million

in 2035. Around 57 per cent of the population live on the island of Java, which is only 6.8 per cent

of the country’s total land area (BPS, 2013).

The number of children 0-19 years of age was almost 90 million in 2010, and this number is

projected to decline to 89 million by 2035. Table 2 presents the trend for boys and girls by age

groups from the year 2000 and the projections to the year 2035 (BPS, 2005; BPS 2013). Population

distribution by age group, gender, and province in 2014 is presented in Appendix - Table A1.

For the purpose of assessing trends in the condition of pre-school children, it is important to know

the distribution by age groups in months as can be seen in Table 3. The trends presented are

based on data from the Population Census 2010, and Susenas 2012.

  

Table 2. Numbers of children 0-19 years by age groups and gender: 2000-2035

Age groups 2000 2005 2010 2015 2020 2025 2030 2035

  Boys 42,660.50 42,251.80 45,825.00 47,044.00 47,595.90 47,596.40 46,772.00 45,390.80 0-4 10,153.40 10,364.40 12,048.70 12,273.40 11,980.20 11,594.60 11,196.90 10,868.70 5-9 11,117.10 10,082.30 11,542.20 11,974.40 12,208.00 11,922.60 11,542.60 11,148.70 10-14 10,780.60 11,077.80 11,333.60 11,507.20 11,942.30 12,177.90 11,894.90 11,516.80 15-19 10,609.40 10,727.30 10,900.50 11,289.00 11,465.40 11,901.30 12,137.60 11,856.60 Girls 41,485.80 40,794.30 43,871.10 44,908.80 45,510.30 45,615.00 44,954.90 43,588.80 0-4 9,798.60 9,985.10 11,405.70 11,792.10 11,495.60 11,116.40 10,729.20 10,411.10 5-9 10,749.30 9,747.80 10,975.80 11,356.00 11,747.60 11,455.90 11,080.30 10,695.80 10-14 10,370.00 10,724.00 10,832.00 10,954.30 11,336.30 11,729.10 11,438.90 11,064.50 15-19 10,567.90 10,337.40 10,657.60 10,806.40 10,930.80 11,313.60 11,706.50 11,417.40

  

Table 3. Numbers of pre-school children 0-6 years, 2010-2012

Age (in months) SP 2010 Susenas 2012 Boys Girls Boys Girls

  0-11 2,242,180 2,118,580 2,192,636 2,110,378 12-23 2,275,080 2,154,980 2,261,339 2,095,526 24-35 2,334,400 2,199,790 2,460,660 2,365,116 36-47 2,368,230 2,244,270 2,554,596 2,362,844 48-59 2,364,920 2,228,740 2,535,846 2,455,395 60-71 2,305,970 2,167,720 2,489,186 2,357,494 72-83 2,378,940 2,223,970 2,429,892 2,238,949

  

Total 16,269,720 15,338,050 16,924,155 15,985,702

Boys + Girls 31,607,770 32,909,857

  3.1 Birth Certificates

Birth registration is an important measure for child protection. In Indonesia, a birth certificate is the

first certificatory identification made in regards to the child’s civil and legal status. Every parent is

required to register and to certify birth of their babies to the authorized Indonesian civil institution

within the first sixty days of the birth of their child. Birth certificates help the government to track

the country’s demographic statistics, health trends and differentials. Birth certificates also support

the availability of information for more accurate planning and implementation of development

policies and programs, particularly in the fields of health, education, and employment. (UNICEF,

2014)

In Indonesia, birth registration is not sufficiently prioritized by the government. From the Susenas

2012 (see Table 4), only approximately 50 percent boys and girls age 0-6 years have birth

certificates, and about 17 percent report they have but are unable to show it. (The proportions of

children 0-6 years with birth certificates by gender and province is presented in Appendix - Table

A2).

  

Table 4. Proportion of children 0-6 years with birth certificate information by gender, Susenas 2012

Boys Girls Age (in Yes, Yes, Yes, able to Don't Don't Yes, able to Don't Don't months) unable to unable to show it have know show it have know show it show it

  0-11

  38.1

  14.1

  47.3

  0.6

  39.0

  13.9

  46.4

  0.7 12-23

  50.1

  15.8

  33.7

  0.4

  48.6

  15.8

  35.1

  0.6 24-35

  48.9

  17.8

  32.6

  0.7

  51.1

  16.5

  31.7

  0.6 36-47

  51.8

  16.6

  31.1

  0.5

  52.0

  17.5

  29.8

  0.7 48-59

  53.0

  17.9

  28.5

  0.5

  52.1

  17.6

  29.7

  0.6 60-71

  54.4

  18.0

  27.0

  0.6

  54.5

  18.0

  27.0

  0.6 72-83

  55.0

  18.7

  25.8

  0.5

  55.3

  18.4

  25.9

  0.4 Total

  50.4

  17.1

  32.0

  

0.5

  50.5

  16.9

  32.0

  0.6

  3.2 Education Profile

Indonesia has implemented the early childhood education and development (ECED) policy since

2007, when it was officially recognized that childhood stimulation is a key to brain development.

The process of brain development starts when the child is born, even the stimulation should start

from very early during pregnancy. ECED becomes very essential for future education in terms of building the child’s capacity for better child development outcomes. (Bappenas, 2006).

According to Susenas 2012, Indonesian children who are enrolled in an ECED program amounted

to only 15.7 percent of boys and 16.5 percent for girls (Table 5), plus 7.3 percent for boys and 7.9

percent for girls who were previously enrolled, but are no longer enrolled. The highest proportion

is among children at the ages of 4 and 5 years both for boys and girls. The provincial distribution of

Indonesian children who are enrolled in an ECED program can be seen in Table A3. The places that are used for ECED for children 0 to 6 years are Playgroups (KB), Day Care (TPA), official kindergarten (TK/BA/RA), Integrated Pos PAUD with BKB and/or Posyandu, Private Pos PAUD (Table 6). From Susenas, the quality of services cannot be evaluated, such as: (i) the setting of child development in Indonesia, (ii) how is an Indonesian child able to do and by what age, (iii) how many children enrolled in these services have better development outcomes (cognitive indicators).

  Table 5. Proportion of children attending ECED programs by age groups and gender, Susenas 2012 Boys Girls Age (in Yes, Yes, Yes, not Yes, not months) currently No currently No anymore anymore enrolled enrolled

  0-11

  0.2

  0.2

  99.6

  0.3

  0.2

  99.5 12-23

  0.3

  0.7

  99.0

  0.3

  0.5

  99.2 24-35

  0.7

  1.9

  97.4

  0.7

  2.6

  96.7 36-47

  2.1

  9.0

  88.8

  2.6

  10.4

  87.0 48-59

  5.3

  24.8

  69.9

  5.4

  27.6

  67.0 60-71

  11.0

  44.7

  44.3

  12.2

  46.4

  41.4 72-83

  30.8

  25.1

  44.1

  33.4

  24.3

  42.3 Total

  7.3

  15.7

  77.0

  7.9

  16.5

  75.6 Table 6. Type of pre-school attended by age groups and gender, Susenas 2012 Boys Girls Age (in Play Other Play Other TK/BA/ Pos TK/BA/R Pos months) Group TPA Type of Group TPA Type of

  

RA PAUD*) A PAUD*)

(KB) PAUD**) (KB) PAUD**)

  0-11

  0.0

  0.0

  7.3

  0.4

  0.3

  0.0

  0.0

  14.0

  0.3

  0.5 12-23

  0.0

  10.5

  8.3

  0.9

  0.9

  0.0

  4.9

  7.5

  0.7

  0.8 24-35

  0.0

  11.6

  10.6

  4.9

  4.6

  0.0

  18.1

  20.9

  6.4

  3.5 36-47

  1.6

  34.6

  10.0

  21.3

  19.3

  2.0

  30.1

  9.8

  21.6

  19.5 48-59

  13.7

  43.3

  15.0

  36.4

  32.1

  14.5

  46.9

  12.5

  35.7

  33.8 60-71

  41.5

  0.0

  25.9

  20.9

  26.0

  41.9

  0.0

  21.6

  22.6

  23.4 72-83

  43.2

  0.0

  22.8

  15.3

  16.8

  41.6

  0.0

  13.7

  12.7

  18.5

• ) Integrated PAUD with BKB and Posyandu **) Private PAUD There is an overlap in the data from Susenas 2012 on children aged 5 and 6 years attending school.

Table 7 presents the proportions of school participation by age and gender. By the age of 18

  years, only 0.9 percent of boys and girls have never attended school; while 60.5 percent of boys and 62 percent of girls no longer attend school. The drop out generally starts at age 12, both for boys and girls and increases as age increases.

  Table 7. Proportion of School participation by age and gender, Susenas 2012 Boys Girls Never/have Never/have Age Currently Not attending Currently Not attending not not (in years) attended school attended school attended attended school anymore school anymore school school

  5

  95.9

  4.1

  0.0

  94.5

  5.5

  0.0

  6

  51.5

  48.5

  0.0

  48.1

  51.9

  0.0

  7

  4.4

  95.3

  0.3

  3.4

  96.4

  0.1

  8

  1.1

  98.7

  0.2

  1.0

  98.8

  0.2

  9

  1.0

  98.7

  0.3

  0.7

  99.0

  0.3

  10

  0.8

  98.8

  0.4

  0.8

  98.9

  0.3

  11

  0.6

  98.4

  1.0

  0.6

  98.7

  0.7

  12

  0.6

  96.8

  2.6

  0.7

  97.2

  2.2

  13

  0.8

  94.2

  5.1

  0.8

  95.6

  3.6

  14

  0.8

  89.2

  10.1

  0.7

  92.0

  7.3

  15

  0.8

  82.2

  17.0

  0.8

  84.5

  14.6

  16

  0.7

  78.0

  21.3

  0.6

  80.7

  18.7

  17

  0.9

  63.2

  35.9

  0.9

  63.3

  35.8

  18

  0.9

  38.6

  60.5

  0.9

  37.0

  62.0 In Indonesia, based on assessment by UNESCO, the youth literacy rate (15—24 years of age) has

  increased from 96.2 percent in 1990 to 99.5 percent in 2010. By gender, the male literacy rate was a little higher than female. For males the rate has increased from 97.4 percent in 1990 to 99.6 percent in 2010; and for females the rate has increased from 95.1 percent in 1990 to 99.4 percent in 2010 (UNESCO, 2012).

  

Optimum fetal and child growth and development is influenced by several factors related to

behavior, diet, and health. The importance of nutrition during pregnancy and early infancy in

defining short-term health and survival has been well known. Barker’s hypothesis provides

evidence that early nutrition has significant effects on later health and well-being. (Barker, 1998).

Barker’s hypothesis provides that….’The fetal origins of adult disease (FOAD) hypothesis is risk factors

from intrauterine environmental exposures affect the fetus’s development during sensitive periods, and

increases the risk of specific diseases in adult life….’

Figure 1 shows the short term and long term consequences of nutrition-gene-environment

conditions in early life on relevant health and disease outcomes. In the short term, malnutrition

has significant health consequences, increasing both mortality and morbidity, particularly due to

infectious diseases such as diarrhea, measles, pneumonia, and malaria. In the long term,

malnutrition has been associated with lower school performance, poorer attention in class, greater

grade repetition, higher drop out of school, and lower graduation rates. Long-term consequences

of malnutrition have been documented in terms of non-communicable diseases, such as obesity,

diabetes, coronary heart disease, etc., lower earnings and family income, which affect men and

women.

  

Figure 1. Short and long term consequences of nutrition-gene-environment conditions in early life

on relevant health and disease outcomes

  Source: Ricardo Uauy, et.al, 2011

  

This paradigm is true for Indonesia where all evidence demonstrates the double burden of

nutrition related diseases, such as acute malnutrition coexisting with obesity and other chronic

diseases (hypertension, diabetes, cancer, etc.).

Based on the above conceptual framework, the following analyses are presenting the profile of

Indonesian children in terms of their health and nutrition situation.

  

Indonesian children are very vulnerable, they are unhealthy and malnourished. Susenas 2012

provides information about whether in the last month complaints about fever, coughing, runny

nose, asthma, diarrhea, recurrent headache, toothache, or others have affected daily life. The

analysis puts those complaints together and labels them as ‘sick’ and also counts the average days

affected per month. The results are presented in Table 8 for pre-school aged children 0-6 years,

and Table 9 for school aged children 7-18 years of age.

  

Table 8. Proportion of pre-school children sick last month and average days of affected by age

groups and gender, Susenas 2012

Health complaints last month Average Age (in months) days sick Boys Girls Boys + girls

  0-11

  38.5

  35.7

  37.1

  4.2 12-23

  49.0

  49.6