This lecture was delivered during the Malaysian Dieticians Conference held in Sarawak on 21st July 2011
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1) Malnutrition is never an ending problem. The World Food and Agriculture Organisatiion in 2010 estimates that up to 13% of the world population and 70% are in Asia and the Pacific 1
2) The trouble is that these children are usually in a rather secluded areas, the rural communities, or suburban settings, hence “Invisible and Excluded “from the main glare of attention 2
3) Despite great achievements in our health data, often praised by most world authorities, our Minister of Health in 2010 lamented that nutrition problem especially underweight and stunting is still a major threat to our nation’s well being. Estimates put it at 130000 malnutrition children registered over the past decade. This could well be underestimated. The latest National Health and Morbidity survey of 21000 children in 2006 puts malnutrition at 12.9%. Stunting was estimated to be at 17.2%. T he survey highlighted the same issues of growth faltering after 6 months of age ( reflecting improper complementary feeding )and severe malnutrition among infants in rural and underserved areas. Chronic malnutrition manifested by stunting has virtually unchanged over the preceding decade 3
4) It appears that these seemingly “lack of progress” is seen in the background of the manifest National Action Plan 2006 -2015. More worryingly too, is the concomitant rise in the prevalence of obesity among children
REGIONAL HEALTH INEQUALITIES
5) Working in the state of Kelantan for the past 20 years, convinced me those regional economic disparities has resulted in frightening degrees of problems that stemmed from the basic problem of malnutrition. Kelantan’s GDP per capita stands at RM3761, compared with Malaysia’s figures at RM8962 in 2000 ( EPU data for 9th Malaysia Plan ).Moderate to severe malnutrition has been discovered to even 30% in some of the deprived areas such as Tumpat and some parts of ‘urban’ Kota Bharu. 4, 5
6) The World Bank in 2009 noted that” regional poverty remains a stumbling block in Malaysia’s bid to become a high income nation, despite the country’s progress in bringing down poverty levels nationwide” 6
THE GROWTH MONITOR SOFTWARE
7) Researchers in Universiti Sains Malaysia have developed simple open-access software that is useful to capture anthropometric data of children seen in the vast network of clinics in hthe country. This Growth Monitor software has potential in giving a nationwide picture of the extent of nutrition problem among children .Linking this data to the Geographic Information System (GIS) further gives an in-depth analysis of geographic influence and possibility of developing Risk-Factor analysis and thus carefully-targeted intervention. A recently-completed study in 12 clinics in Kota Bharu also noted that the mean prevalence of malnutrition stands at almost 15% , most of the children reside in the densely-populated areas of the city. Early data also shows that up to 20% of the severely malnourished children are iron-deficient 7
ORANG ASLI AND THE HANDICAPED
8) 2 groups of underserved: The Orang Asli population and the handicapped shows high prevalence of malnutrition with serious co-morbidities. 45.9% of the 130000 children malnourished over the last decade were among the orang asli population (Deputy Minister of Health 2010.The Star )
9) In as much as there is a detailed risk map analysis in some states, more data is needed to decipher malnutrition in other states such as Sabah where 20% of population lives under the poverty line and represents 42% of Malaysia’s total poor , or the urban poor.
10) Our recent and ongoing study on the handicapped in Kelantan communities discovered that up to 80% of them are malnourished, making rehabilitation efforts difficult and potentially disappointing. We also discovered that among over 400 children admitted to a tertiary centre for various physical illnesses, 25 % of them are malnourished. 10% are stunted.
11) The Malaysian authorities has recognized the tenacious problem of malnutrition and its counterpart, the obesity epidemic and are putting active efforts to alleviate this to meet the Millennium Development Goal target by 2015
NEW APPROACHES NEEDED
12) I feel that efforts to alleviate malnutrition ought to move from the culture of ‘giving’ such as the Food Basket, food subsidy etc, to creating the culture of empowering people on their health matters. Psychological approaches ought to be enhanced in the training of our health personnel, and equip them with the knowledge of child development.
13) We have experimented this through the launching of COMEL Carnival recently. In this carnival-type approach, families of malnourished children were invited to participate in health i exhibition and fun-type activities where subtle intervention involving knowledge empowerment of families were emphasized. The outcome of this approach will be closely watched.
1) The State of Food Insecurity in the World. FAO October 2010
2) UNICEF, The State of World Children 2006
3) Khor GL et al. Nutritional Status of Children under 5 years in Malaysia: Anthropometric Analysis from the Third National Heath and Morbidity Survey III (NHMS2006) Mal J Nutr 15(2): 121-126;2009
4) Cheah Whye Lian, Wan Manan Wan Muda , Zabidi-Hussin ZAMH, Chang Kam Hock
A Qualitative Study on Malnutrition in Children from the Perspectives of Health Workers in Tumpat, Kelantan Mal J Nutr 13(1): 19-28, 2007
5) Factors Associated With Undernutrition Among Children in a Rural District of Kelantan, Malaysia.
Whye Lian C, Wan Muda WA, Mohd Hussin ZA, Ching Thon C.
6) World Bank 2009
7) Comput Methods Programs Biomed. 2009 Jan;93(1):83-92. Epub 2008 Sep 11.
Development and implementation of a web-based system to study children with malnutrition.