Bad Food Habit influence Nutritional Status of Underfive Indonesia

In one visit to a community health center (Puskesmas)in Kel. Pela Mampang, Mampang Prapatan Sub Distirct, South Jakarta District, Jakarta, Indonesia, I have a chance to meet 8 underweight underfive children with their mothers. They were invited by the nutrition staff at health center to get their entitled ration of food supplements for the underfive. Most of them were underweight or low weight according to her/his age or wasting or low weight according to their height. The children look small, some of them have been 3 years old but their physical appearance look like a one year old child.

The children have received 10 packs of 150 g fortified marie biscuits and 4 packs of 400g milk powder. The intervention program has been running for two months and each of child will receive the food supplement for 3 months consecutively.

When I asked one mother whether her child likes the biscuits, she responded that yes her daughter 3 years old like them very much, and she could finish the 150 g pack in a day. She then continued that her daughter did not want to have any meal. She preferred to have either noodles or ‘meat ball’ soup bought from the food vendor. No wonder why her daughter was wasted and underweight. The other mother mentioned that her daughter has no appetite to eat even she only ate the biscuit ration 2 or 3 pieces. Well, then the leftover ration will be eaten by the other family members.

The outer pack of the biscuits and milk powder have been removed by the health center staff. They explained that this was to prevent the reselling of these items to the market. Since they may use the cash not for the food for their child but for other items for the whole family members.

In conclusion, a continous nutrition education on how to feed the baby and underfive are needed in particularly among low educated women in slum area of urban Jakarta. This preventive action will be more effective than treating the malnourished child. Snacking and eating unhealthy food such as food high in seasoning flavor or monosodium glutamate, or high carbohydrate, sugar and fat e.q noodles, sticky ball, puffing snack, unsafe syrup etc. will result on malnourished child in long term.

Traditional Common Practices to the Newborn Baby in Indonesia

Once the baby was delivered, the baby was bathed by the TBA and then the TBA wrapped the baby with a big napkin. It is common called as ‘dibedong’. At first, the TBA will clean the umbilicus cord with alcohol and wrap it in a cotton. Next, the baby stomach was wrapped with a cloth called ‘gurita’ (see picture) or a cloth having 5 strip as if legs of squid. People belief that by doing this, the umbilical will be in better shape and not push out or ‘udel bodong’. The gurita also keeps the baby’s stomach warm. After that another cloth called ‘popok’ (see picture) or baby’s pant was put on the baby with the small baby’s shirt. The last one to put is ‘bedong’. While ‘bedong’ will keep the baby’s leg and hands warm. Many elderly people also belief that ‘bedong’ (see picture) keep the baby’s legs in good shapes and bone development. The TBA will come everyday to change the cotton and take care the umbilical cords until it cured and dry completely. She also massages the mother and the baby to improve baby and mothers’ fitness. Lately, in some subvillages near the capital of the subdistrict, these practices have been reduced since many deliveries have been assisted by the professional midwife and many old skilled TBAs have passed away.

Improper Child Feeding Practices Among Low Educated Mothers to their Newborn

Based on my visit to some of posyandus in many rural villages in subdistrict Kronjo, District of Tangerang, Banten Province, Indonesia in 2003-2007, I may share my experiences that improper child feeding practices are still common in this area. Most of these improper practices are found in the area where the delivery was assisted by a Traditional Birth Attendance (TBA). A newborn baby is usually given one or two drops of honey in the baby’s lip. It is belief that the baby is hungry and the honey may also clean the baby’s intestines.

Other practices are that some mothers also give a ripe banana to the new born baby while the breastmilk of the mother has not come out yet. The breastmilk was not flowing in enough volume since the baby was not put directly in the mother’s breast in the first hour of delivery. Few mothers also give a steamed fermented cassava which is named as ‘tape/peuyeum’ to the baby

These improper practices may also influence the Infant Mortality Rate (IMR) Indonesia in 2006 which reached 35 per 1.000 live births. Ministry of Health Indonesia has targeted to reduce the IMR to 26 per 1.000 live births in 2009. The higher risk of deliveries which wereassisted by TBA may also account for Maternal Mortality Rate (MMR) 307 per 100.000 live births, while the MoH has targeted to reduce the MMR to 226 per 100.000 live births.

Improper Knowledge among Pregnant Mothers in Indonesia

Indonesia consists of more than 13.000 islands. Based on my experiences in doing nutritional survey in some parts of Indonesia, I found that in many parts of Indonesia a traditional belief is very common among pregnant women. The most common belief is that related with the husband’s behaves. The husband should not kill any animals particularly cutting the chicken’s legs. In case this unwritten rule is neglected then the baby will be crimpled such as what the husband has done to the chicken. Furthermore, a pregnant mother should not say anything bad.

While in terms of food taboos, many elder people in the rural area still belief that pregnant women should not eat these foods such as:

- unripe pineapple which may cause miscarriage in early gestation period

- chicken’s leg will make the child’s handwriting is bad

- drinking ice water which may cause a big baby and it will be difficult during labor process.

Knowledge for Pregnant Mothers

Once a woman realizes that she is becoming a mother to be then she should have a proper perception in her minds that Breastmilk is the best food for the baby. Why? Because of following characteristics of breastmilk:

1. Nutrient content of breastmilk is perfectly suitable for baby’s growth and optimum development.

2. It contains immunity factors which can prevent the baby from many diseases such as diarrhea, coughing, ear infection.

3. It contains factors to influence IQ development

4. A perfect natural food.

5. It doesn’t cause any allergic

6. It create a love bonding between baby and the mother.

Next, what arethe benefits for the mother if she is breastfeeding her baby?

1. To create love bonding with the baby

2. To reduce bleeding during and after the labor

3. To accelerate the health recovery for the mother after labor

4. To postpone another pregnancy

5. To reduce the risk of having breast cancer

6. Breastmilk is ready for the baby any time

7. To give more confident to the mother as well to the baby

Breastfeeding the baby also give many benefits to the whole family:

1. Reduce family expenditure since the family do not need to purchase formula milk, bottles as well as teat, the baby is healthy, and mother may postpone the spending on contraceptive devices

2. Save time since breastmilk is available at any time

3. No dependency on formula milk