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MESSAGE
FROM
CHIEF
EDITOR
Dear Readers,
We heartily welcome everyone to be a part of the readership of our Centre’s magazine we call RECFON Awesome! This is our maiden issue and
we hope that you will find all the articles interesting and insightful for you.
In July 2019, the idea of coming up with a regional popular magazine on food and nutrition came about during one of our regular monthly
meetings. We are thankful to our Governing Board members for approving this idea during its 9th annual meeting in September 2019 held in
Bogor, Indonesia. After 10 months of conceptualizing the format, contents, and procedures for calling for articles, selecting the theme, and going
through the editorial and printing processes, we finally produced our first issue!
Our magazine is meant for general readership. We envision it to serve as a platform to enhance awareness on food and nutrition issues and
concerns in the region toward enabling you, our dear readers, to make informed decisions and actions to improve your well-being and ensure a
healthy lifestyle. Our magazine shall disseminate easy to understand information on various food and nutrition topics that would address our
readers’ needs.
For our first issue, we thought of focusing on stunting alleviation in Southeast Asia as the main theme. Stunting is a serious problem confronting
our countries in the region. Many studies have shown that this form of malnutrition affects the overall physical, cognitive and psychological
growth and development of a child. It determines the child’s potentials for life in terms of school performance, ability to earn a living during
adulthood as well as susceptibility to chronic diseases. Fortunately, there have been several research works, programs and policies, trends and
practices from various sectors toward addressing stunting in our region.
We invite you to read and learn from every page of our magazine about stunting alleviation. We hope that you can share your reading experience
to your family and friends. We look forward to hearing your feedback so we can improve on our next issue. We would also love to hear the topics
that you would like to be featured in our magazine.
In the meantime, sit back, relax and enjoy our magazine. Thank you.
Muchtaruddin Mansyur
1
RECFON AWESOME 1 EDITION
Vol 1. No. 1
September 2020
WHAT’S
INSIDE
COVID-19 : Counter Demanding
Our Anti-Stunting Goals | 4
Infographics
What is Stunting? | 23
A Glint of Hopes in Indonesia’s
Integrated Healthcare Center
(Posyandu) for Child Stunting
Prevention during COVID-19 | 7
The End of the Silver Bullet:
A Holistic Approach to Stunting Research | 17
Empowering the Elderly as “Actors”
in Stunting Alleviation | 19
Opportunities and Challenges of Stunting
Prevention in Islamic Boarding Schools
in Indonesia | 20
The Benefits of Breastfeeding | 24
List of Contents | 2
The AWESOME Story | 3
Our Chefs | 3
From the Research Bench
Main Article
The Application of UNICEF’S 2020
Conceptual Framework of Maternal and
Child Nutrition in Indonesia | 9
The Urgency of Tobacco Control in
Stunting Alleviation in Indonesia | 11
Perspective
Investing in Nutrition Literacy to Reduce
Stunting in Indonesia | 14
Opinion
Gastro-Tourism in Southeast Asia as Food
Diplomacy through Asian Cuisine in an
Effort to Prevent Stunting through Tourism-
Based Nutrition and Food Education | 22
Message from Chief Editor | 1
ECCNE and NGTS
Corner | 25
2
RECFON AWESOME 1 EDITION
Laboratory Brochure | 27
ISSN 2745-8709
The AWESOME Story
Our Chefs
Muchtaruddin Mansyur Jesus C. Fernandez Agus Haryanto
Grace Wangge
Production staff
The SEAMEO Regional Centre for Food and
Nutrition (RECFON) believes that Southeast
Asian countries share similar issues and
concerns on food and nutrition. The Centre
further believes that Southeast Asian
countries have a lot to share in terms of
programs, policies, research results, field
experiences, and best practices to address
such food and nutrition issues and concerns.
Some of this information may have been
published in technical publications but may
have not been disseminated in formats that
could be easily understood and utilized by
the general public. The Centre feels that
there is a need to popularize this abundance
of information to benefit a wider range of
stakeholders in the region.
Thus, the Centre conducted a roundtable
discussion during its 9th Governing Board
Meeting held in September 2019 in Bogor,
Indonesia about the plan to come up with a
bi-annual publication of a magazine that
would capture the abovementioned
scenarios. The idea of publishing a popular
magazine was also conceived as a support in
operationalizing the compilation of best
practices and advocacy function of the
working groups that the Centre had
established for its flagship programs on
Nutrition Goes To School (NGTS) and Early
Childhood Care, Nutrition, and Education
(ECCNE).
The Governing Board members approved
and endorsed the publication of the proposed
magazine. They also agreed to name the
magazine as RECFON AWESOME. The
word AWESOME was adopted from the
expected outcome of the NGTS program of
developing Active, Well-nourished and Smart
Of ME school children. The Centre believes
that awareness on proper food and nutrition
must start at an early age and reinforced in
school so that AWESOME school children
could become healthy and productive
citizenry of their nation when they become
adults.
The Magazine shall serve as a platform to
enhance awareness on food and nutrition
related issues and concerns in Southeast Asia
toward enabling its target readers to make
informed decisions and actions to improve their
well-being and lifestyle. It shall disseminate
easy to understand information on various food
and nutrition topics that would address the
needs of its intended readers.
The Magazine shall enhance the knowledge
and inspire its target readers to improve their
well-being and lifestyle through proper food and
nutrition. Thus, it will publish highlights of
research results, opinions on public health
issues, briefs on existing policies and program
initiatives, personalities, and trends and good
practices depicting the richness of Southeast
Asian culture in food and nutrition that could
contribute to developing a healthy lifestyle
among Southeast Asian nationals. (ed).
Procedures for Submission and Acceptance of Articles
The Magazine will announce a call for articles at the start of every year. The submitted articles shall be screened and selected by the Editorial Board
according to certain criteria.
For more information you can contact the Knowledge Management and Policy Support Unit at information@seameo-recfon.org
3
RECFON AWESOME 1 EDITION
Chief Editor Executive Editor Member of Editorial Board
Publishing Manager
Dodi Suswandi Rindrawati Siti Fadhiatun Nasfriyah
If the current trend continues, 127 million
children under 5 years old will be stunted in
2025 but looking upon the pandemic
condition, there is a fear of increase in
numbers. According to the World Bank
estimates, 1% loss in adult height is due to
childhood stunting; also associated with 1.4%
loss in economic productivity. Stunted
children earn 20% less as adults compared
to non-stunted ones. This also becomes the
barrier in our GDP growth draining up to 3%
of it.
4
RECFON AWESOME 1 EDITION
COVID-19: Counter Demanding Our
Anti-Stunting Goals
by Sumedha Pandey, Rama Medical College, Kanpur, Utar Pradesh, India
How is stunting affecting us and the role of COVID-19?
Figure 1. Conceptual Framework of the double burden of malnutrition
The rise in the number of malnutrition victims
seems to be gradually being abated to some
extent as per reports of various governments,
regional organizations and the World Health
Organization (WHO). However, all the plans
went into vain as the pandemic of COVID-19
stormed our shelters. According to WHO, at
the start of the crisis - 25 million children were
wasted, 52 million were stunted, 5 million were
overweight, and 400 million of women
suffering from anemia. The World Bank
estimates that 40-60 million could be pushed
into extreme poverty due to the pandemic.
Stunting is not just a condition that affects the
health of the population but also has a great
impact on our economy. Most of the Southeast
Asian countries are developing nations so
those who have already been fighting stunting
and malnutrition (double burden) are now
suffering major losses due to the pandemic.
Figure 2. The double burden of malnutrition across the life - course
Main Article
Largely irreversible outcome of inadequate
nutritional demands and repeated bouts of
infections lead to stunting, making it a marker
of poor child development. It has started
affecting on an individual level including
diminished cognitive and physical
development, frequently prone to an
infectious disease, increasing the risk of
degenerative diseases such as diabetes,
cardiovascular problems, etc. In fact, children
already suffering from such a non-
communicable disease are more prone to
COVID-19 death.
Stunting has a devastating effect on
household as well as community level. For
example, stunted children have less total
schooling, lower test performances, lower
household per capita expenditure, and the
likelihood of living in poverty.
There have been various interventions by
important organizations:
● Nutrition interventions in Elena
● The 2025 WHO Global Nutrition
Targets policy
● Action plan for prevention and
control of a non-communicable
disease in South-East Asia,
● Asian UN networks on nutrition
(FAO, UNICEF, & WFP) have
developed a joint statement &
technical note on nutrition in
context of COVID-19 in Asia and
the Pacific.
Overview of existing policies:
Figure 4. The outcomes of the action plan are set out in the following theory of change
5
RECFON AWESOME 1 EDITION
COVID-19: Counter Demanding Our Anti-Stunting Goals
Figure 3. Global nutrition and diet - related noncommunicable
disease targets andindicators
Challenges faced in the process of stunting alleviation
A. Before the pandemic:
In general, people were neglecting attitude
towards self-hygiene and lack of higher
education hence kept them unaware about
various provisions regarding nutritional
values. The challenges from mothers' side
include increase rate of maternal depression
that has led to improper infant caring and
unhealthy lifestyle. Mothers also received
improper care nutrition especially during
post-partum. For the children, there were
lack of treatment provided to children who
frequent illness and have weak immunity,
thus made them more prone to stunting.
In terms of health facilities and their access,
there were lack of proper training of local
health care workers and lack of attention
towards already stunted kids especially in
remote areas. These were the results of
malfunctioning of the laws and protocols due
to careless attitude towards nutrition and
food storage sector from the government.
We also faced improper and unfair use of
the funds for the nutritional programs.
Moreover, in poor areas, alleviation efforts of
stunting were also challenged with natural
calamity.
B. After the onset of COVID-19 Pandemic:
(In addition to the above-mentioned
problems)
Increasing the gap between coverage of
beneficiaries, due to global lockdown has
slowed down food production drastically.
Unemployed farmers have caused the crops
stock run up to very high prices. Prolonged
lockdown and shortage of labor have
affected many big and small businesses.
The slowdown of all food sectors in the mid
of crop harvesting and processing has
decreased the production and hence
reversing the changes that have been
brought about the various nutritional
programs. Household food consumption and
nutrition have been significantly affected by
loss of jobs and income and limited access to
food. COVID-19 impact on cash inflow and
financial liquidity of producers, small and
medium agricultural business due to inhibited
financial institution and production capacity.
Restricted travel, access to healthcare
services, and delayed vaccination schedules
may enhance stunting rate.
Food distribution and various other important
nutritional policies that are exchanged across
foreign borders have come to a halt. Strict
quarantine measures have affected various
basic food imports-exports. SEA countries
have major agricultural sectors which are
seriously affected by the pandemic,
destroying the life of the workers, from rich to
poor workers, increasing the stunting and
malnutrition conditions.
The pandemic has led to an increase in the
number of school-dropouts of children,
especially female students, causing serious
impairment in their school nutritional
programs. These hard times have also led to
an increasing number of child marriages, so
very young mothers' health is affected, and
birth of premature or low birth babies causes
increasing rates of stunting further.
Domestic violence is enhanced by this
pandemic and is going to have a major effect
on the health of mothers and children
(especially breastfeeding mothers and their
infants).
Thus, as per the following figures mentioned,
we can see that the SEA countries have been
really determined in decreasing the stunting
and the double burden malnutrition
How can stunting and double
burden of malnutrition be
resolved in this pandemic?
The critical humanitarian food for the risk
prone livelihoods should be preserved.
Therefore, social protection schemes and
community programs should help and ensure
that the most vulnerable groups will be able
to access nutritional foods.
Food production should be declared,
marketing it as an essential service, ensuring
proper training and protection to all the
healthcare workers and food sector workers
(especially delivery men, who go to so many
homes). The poor unemployed small land
farmers should be relieved from taxes, and
their family should be considered as one of
the most important beneficiaries of all the
nutritional schemes. Access to food
resources are not kept only by one and they
should include the vulnerable age groups like
mothers and children, sick and newborns.
A clear message about the importance of a
healthy and safe diet should be
communicated while limiting the consumption
of food that contributes to overweight and
obesity. The most vulnerable groups
especially women who play key roles in the
household and essential service delivery
should be protected.
Food and nutritional assistance should be
gathered by the potential agriculture students,
to come forth and volunteer for better and
smart implementation in their local areas
during this lockdown. Small food non-profit
distributors from various NGOs and other
social workers should be expanded,
recognized, and promoted.
The mental health of mothers and stunted
children should be acknowledged and given
more attention with the understanding that a
healthy body can give rise to wealthy society.
Mass micronutrient campaigns (vitamin and
supplementation and deworming) should be
pre-planned/postponed as per the pandemic
conditions in the target areas. School meal
programs should continue using alternative
transfer modalities including case transfers
and food deliveries. Remote mobile or web-
based surveys to monitor food markets
functionality, coping mechanism in case of
lack of supplements, food consumption
patterns and multidimensional poverty.
All governments have been working and
need some additional improvement to
alleviate stunting, which has become a great
barrier in our economic, social, and
sustainable development. Medical students
also have a great responsibility by spreading
awareness and volunteer work to narrow this
gap of malnutrition that has been widened by
COVID-19 pandemic.
6
RECFON AWESOME 1 EDITION
Fun Facts
COVID-19: Counter Demanding Our Anti-Stunting Goals
If we want to find out where the greatest
expectation of healthcare services during
this pandemic is, then we will talk about
Indonesia’s Integrated Healthcare Center or
better known as posyandu. Especially in
remote areas, Indonesia’s Integrated
Healthcare Center (Posyandu) has a
function as the frontline in child healthcare
service in the community. According to its
purpose, posyandu is established to reduce
the prevalence of the mortality rate of
children and mothers through community
empowerment. Thus, the goal of posyandu
is not only for children but also for their
mothers.
Posyandu's array of health services are
carried out in a Public Health Service Centre
or Puskesmas (Pusat Kesehatan
Masyarakat) of a particular area.
Puskesmas plays a role as the first level
health facility which is at the forefront in
preventing stunting during this pandemic.
There are three important keys: conducting
prevention, detection, and response to
prevent and control the spreading of COVID-
19. Puskesmas must be able to manage and
utilize its resources effectively and efficiently
in breaking the chain of transmission, at
both the individual and community level.
Sebatik Puskesmas has been carrying out
the above mentioned functions through risk
communication activities and counselling
programs, providing information and
education to the public about COVID-19, as
well as community empowerment activities
such as training of housewives to make
ginger drinks to enhance the immunity of
households around the puskesmas and to
mobilize participation across sectors as
volunteers in charge of checking public
compliance in wearing of masks and
providing clean water in every house for
washing hands. The activity proves to be
effective because nowadays Sebatik Island
is included in the green zone and does not
have COVID-19 positive cases among its
residents
The implementation of posyandu's activities
during the COVID-19 pandemic is not going
to be easy since these activities require
physical gathering and personal contacts
among people such as weighing and
measuring toddlers. Therefore, posyandu in
almost all of Indonesia stopped operations
for a few weeks after the onset of the
pandemic. However, as of now, many
posyandu in Indonesia are back in operation
with the 'new normal' condition and follow
the health protocols for COVID-19 regulated
by the World Health Organization (WHO).
Improvement in hygiene and sanitation is
also observed in posyandu as one of the
health protocols for COVID-19. For instance,
Posyandu Lentera Perbatasan in Sebatik
Island has already implemented the 'new
normal' health protocols.
Sebatik Island is one of the islands located in
Nunukan Regency, North Kalimantan in the
border area, or commonly called the 3T area
(Tertinggal, Terdepan, dan Terluar) – frontier,
outermost, and least developed region.
Sebatik belongs to two countries: Indonesia
and Malaysia. As a border island, Sebatik
often becomes a transit point from
neighboring countries, and even many
migrants from South Sulawesi pass here.
This condition makes residents in Sebatik
Island very vulnerable to be impacted by
corona virus. Moreover, the common health
issue here is the lack of hygiene and health
awareness. Fortunately, during the COVID-
19 pandemic, people’s awareness about
hygiene and health has increased.
The following is how Posyandu Lentera
Perbatasan in Sebatik Island during the
COVID-19 pandemic runs: days before the
posyandu reopens, its cadre ensures that the
posyandu is safe, clean, and away from the
crowded area. When the activities in the
posyandu are carried out, mothers and
children enter the room one by one with their
masks on, then the nurse from the
puskesmas checks the body temperature of
the mother and child. The posyandu cadres
and mothers wash their hands using soap
before doing the measurement of infants and
toddlers and keep a distance from one and
another. After weighing their children, the
mothers wait until the posyandu cadre is
done filling in the KMS book, which will be
proceeded by giving the PMT (Pemberian
Makanan Tambahan – additional food) to the
child. Before leaving, the mothers and
children have to wash their hands.
Stunting, or low height for age, is a complex
problem focusing on child malnutrition,
maternal and child under nutrition, and food
security. In Indonesia, the prevalence of child
stunting has increased over the past decade,
approximately 37% at the national level. This
percentage is the highest stunting rate in the
world after India, China, Nigeria, and
Pakistan.
When we talk about “what causes a child to
be stunted in Indonesia?”, the answer will be
complicated due to the multifactorial and
inter-linked causes of stunting, connecting
biological, social, and environmental spheres.
The determinants of child stunting in
Indonesia from biological factors include non-
exclusive breastfeeding, premature birth,
short birth length, and low maternal height.
The most prevalent social factors include the
lack of education, poor access to health care,
and living in a rural area. Furthermore, the
environmental factors consist of water
availability and quality, sanitation, hygiene,
culture, agriculture, and the food system
existing in a particular community.
The national strategy for accelerating
stunting prevention is through specific and
sensitive nutrition interventions and
improving the environments. Specific nutrition
interventions have contributed to reducing
stunting cases by 30%. This intervention was
shown to households in the First 1000 Days
of Life (HPK), carried out by the health
sector, and it is short-term in nature, with
results that can be recorded in a relatively
short time. Meanwhile, sensitive nutrition
interventions contributed to reducing stunting
rates by 70%, held by non-health sectors,
whose target is the public. Also, a supportive
environment is aimed at fundamental factors
related to nutritional status, such as
government, income, and equality.
A Glint of Hopes in Indonesia’s Integrated
Healthcare Center (Posyandu) for Child Stunting
Prevention during COVID-19 era
by Yuga Putri Pramesthi - Nunukan Regency, North Kalimantan, Indonesia
Figure 1. Weighing of children at Posyandu Lentera
Perbatasan in Sebatik Island during the COVID-19
pandemic
Main Article
7
RECFON AWESOME 1 EDITION
The role of posyandu to
countermeasure stunting in
Indonesia is important especially
during infancy. Monitoring the
growth and development of infants
and toddlers is done once in a
month through KMS book. Toddlers
who have growth problems will be
detected earlier, so they do not
suffer from stunting. Children who
potentially experience stunting will
get an evaluation to find the causes
and risks. The analysis of the causal
factors requires a cross-sectoral and
program role, so toddlers who have
the potential of growth disorders will
be given a home visit to assess the
factors affecting them, including
family and environmental factors.
Just as the confirmed COVID-19's
patients rise worldwide including in
Indonesia, threatening to crush life-
saving health services, the survival
of mothers and children is at a great
risk. Regarding the relationship
between stunting and COVID-19,
new evidence reveals that the
potential growth problem in maternal
and child mortality in low-income
and middle-income countries occurs
since essential health services are
disrupted due to COVID-19. One of
the determinants of stunting in
Indonesia is low access to health
care which is worsened by the
anxiety caused by COVID-19.
Furthermore, the negative effects of
COVID-19 for children are worsened
not only by the risk of infection, but
also of losing or being separated
from family members and caregivers.
Mothers and children are restricted
to access healthcare services and
schools, and the lack of child
protection is particularly harmful to
women and children in need of
safety. Also, there is a concern
regarding the economic impact of the
pandemic knock-on effect. The
global financial collapse causes
reduced incomes, increased public
and private debt, and reduced
access to goods, which will impact
many aspects of household health
and nutrition.
The pandemic is certainly a once-in-
a-lifetime story, but it is also a once-
in-a-lifetime chance to take
advantage of this existing moment.
Besides all the negative effects of the
pandemic mentioned above, there is
always a glimpse of hope to improve
the quality of Indonesia's Posyandu.
The World Health Organization's
recommendations to prevent the
spread of the coronavirus include
improving hygiene and sanitation like
washing our hands with the right
steps with soap reinforces the
recommendation of the Ministry of
Health of Indonesia in preventing
stunting in all Posyandu. This is
principally appropriate among
populations where diarrhea and
upper respiratory infections are
frequent in children under the age of
2. This change in behavior has the
potential to significantly reduce the
overall rate of stunting besides
diarrhea and upper respiratory
infections.
Posyandu's position is not only as an
effort to prevent stunting, but also as
the first place in the community to
continue to get used to clean and
healthy living as an effort to avoid the
COVID-19 pandemic. Through the
Posyandu, there is still a hope in
alleviating stunting if we focus on
these several points. Firstly, we must
keep children healthy and well
nourished by providing supplies and
protective equipment. Secondly, we
must urgently prioritize funding and
support for maintaining and
improving water, sanitation, and
hygiene. The collaboration between
the government and the private
sector will be required to increase the
practice of handwashing across the
board, tapping into local innovation
and global partnerships.
References:
Beal, T., Tumilowicz, A., Sutrisna, A., Izwardy, D. and Neufeld, L., 2018. A review of child stunting determinants in Indonesia. Maternal & Child Nutrition, 14(4), p.e12617.
Chang, T., Wu, J. and Chang, L. (2020) ‘Since January 2020 Elsevier has created a COVID-19 resource Centers with free information in English and Mandarin on the novel coronavirus COVID- research
that is available on the COVID-19 resource Centers - including this ScienceDirect Clinical characterise’, Journal of the Formosan Medical Association, (January).
Cumming, O. and Cairn cross, S. (2016) ‘Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications’, Maternal and Child Nutrition, 12, pp. 91–105. doi:
10.1111/mcn.12258.
Fore, H. H. (2020) ‘A wake-up call: COVID-19 and its impact on children’s health and wellbeing’, The Lancet Global Health. The Author(s). Published by Elsevier Ltd. This is an Open Access article under
the CC BY-NC-ND 4.0 license, (20), pp. 19–20. doi: 10.1016/s2214-109x (20)30238-2.
Roberton, T. et al. (2020) ‘Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study’,
The Lancet Global Health. The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license, (20), pp. 1–8. doi: 10.1016/s2214-109x (20)30229-1.
Walden, M. & Souisa, H., 2020. Why are so many Indonesian children dying from coronavirus? ABC News. Available at: https://www.abc.net.au/news/2020-06-18/why-are-so-many-indonesian-children-
dying-from-coronavirus/12356444 [Accessed June 24, 2020].
Zack, P. (2020) Handwashing and improved hygiene a silver lining in the dark cloud of COVID-19 - Opinion - The Jakarta Post, The Jakarta Post. Available at:
https://www.thejakartapost.com/academia/2020/05/30/handwashing-and-improved-hygiene-a-silver-lining-in-the-dark-cloud-of-covid-19.html
Figure 2. Map of Nunukan, Borneo, Indonesia
8
RECFON AWESOME 1 EDITION
A Glint of Hopes in the Indonesia’s Integrated Healthcare Center (Posyandu)
for Child Stunting Prevention during COVID-19
The Application of UNICEF'S 2020 Conceptual Framework
of Maternal and Child Nutrition in Indonesia
For many decades, stunting has been the
most significant nutritional problem in
Indonesia. According to a basic health survey
conducted from 2007 to 2018, the prevalence
of stunting was never lower than 30%,
although it slightly decreased to 30.8% in
2018 (Ministry of Health of the Republic of
Indonesia, 2018). Child malnutrition is a
complex and vicious cycle of low nutrition,
infection, and poverty. Stunting lowers
children's opportunity to achieve optimal
growth; this in turn, limits their opportunity to
get better employment and leads to poverty.
Moreover, poverty lowers a family's ability to
access nutritious food and better health
services (Schaible and Kaufmann, 2007). In
1990, UNICEF developed a framework of
maternal and child malnutrition to provide a
better understanding of the determinants and
ways to overcome the problem. Thirty years
later, UNICEF developed the 2020
Conceptual Framework of Maternal and Child
Nutrition (UNICEF, 2019). The differences
between the 1990 framework and the 2020
framework and the extent to which the 2020
framework has been applied in Indonesian
context are discussed in this article.
Since the 1990s, UNICEF Framework has
been used as a reference for finding the best
formula to overcome the problem of child
malnutrition. By showing the multisectoral
factors behind malnutrition, the framework
helps researchers and policy makers to
analyze the causes of malnutrition and
identify the most suitable actions to address
the issue. It was within this framework that
the Scaling Up Nutrition (SUN) movement
was initiated in 2011. SUN developed
nutrition strategies by using the dual nutrition
intervention approaches: specific and
sensitive (UNICEF, 2015). Then, in 2019,
UNICEF decided to modify the framework to
give more emphasis on what constitutes
good nutrition. The 2020 framework aims not
only to underline the benefit of providing
adequate food and healthy environment for
children and women, but also to promote
social and political commitment to securing
people's right to adequate nutrition. These
changes in terms and narratives reflect great
commitment to improving the nutrition of our
children, young people and women, as well
as providing them with an opportunity to
access nutritious food (UNICEF, 2019).
Figure 1. UNICEF's 1990 Conceptual Framework of Maternal and Child Malnutrition ‘
(UNICEF, 2015)
Unlike UNICEF's 1990 framework, the 2020
framework uses more positive narratives and
different terms. As part of a marketing
strategy, positive narratives correlate with
better brand consumer engagement (Riva,
Graffigna, and Gambetti, 2015). This indicates
that the narratives used in the 2020
framework were deliberately chosen to
increase people's engagement—not only
mothers and children, but also all parties
involved (i.e. the government and nutritional
experts)—in addressing the problem of
malnutrition. By using different terms, the
2020 framework focuses on inviting the
contributors to improve maternal and child
nutrition. The use of the term “determinants”
in the 2020 framework aims to emphasize
their important roles in helping mothers and
children to achieve good nutritional status by
giving proper nutrition intervention. Besides
that, the change from the word “basic” to
“enabling” when explaining the role of social
norms, economic regulations, and
government policies aims to highlight the
importance of maintaining social and political
commitments to supporting actions designed
to provide good food for children and mothers.
The concept of “enabling determinants” refers
to good governance, positive norms, and
sufficient resources. A report on countries'
progress in reducing the prevalence of
stunting show that countries with medium or
high stunting prevalence (≥20%) were more
likely to have a relevant policy environment
(i.e. policies, coordination, capacity, and
actions that support stunting reduction) than
countries with lower prevalence of stunting.
This finding emphasizes the role of
government policy in influencing and
improving the determinants, which are the
foundations of a successful stunting
reduction. Furthermore, the policy review
stresses great opportunity for creating better
public policies on nutrition in certain areas,
such as policy review, inter-sector
coordination, personnel capacity building, all-
stage-life health facility and services, school-
based nutrition program, and specific
programs on micronutrients and healthy diets
for non-communicable diseases prevention .
In conclusion, the first conceptual framework
was modified to serve two main purposes.
The first was to increase and strengthen inter-
sector collaboration in stunting reduction
program, particularly in terms of policy. The
second was to underline the role of
government in the formulation of sustainable
and nutrition-friendly policies, particularly
those designed to promote healthy diets at all
stages of life.
Perspective
by Pramesthi Hapsari - Universitas Jendral Soedirman, Indonesia
9
RECFON AWESOME 1 EDITION
The Application of UNICEF'S 2020 Conceptual Framework
of Maternal and Child Nutrition in Indonesia
The next question now is the extent to which
the modified version of the framework has
been applied in Indonesian context.
As mentioned earlier in the first paragraph,
stunting has been a significant public health
problem in Indonesia for many decades. By
joining the SUN movement, Indonesia has
taken part in an international effort to achieve
global nutrition targets, one of which is a 40%
reduction in the number of children under-five
who are stunted by 2025 worldwide.
However, by 2018 the reduction in the
prevalence of stunting has only reached 18%,
compared to the 40% target. In order to
achieve the target, various other problems
behind the stunting phenomenon should be
tackled in a more effective way. However,
based on a 2018 national survey, the
prevalence of anemia in pregnant women had
increased by around 31.8%, compared to
2013 data. In line with this, the number of low
birth weight babies also increased steadily
from 5.4% in 2007 to 6.2% in 2018. A report
on stunting prevention programs such as iron
folic acid supplementation (IFAS) and
exclusive breastfeeding also shows similar
findings, i.e. only 73.2% of pregnant women
received IFAS (the 2018 target was 95%) and
only 37.3% of under-five children were
exclusively breastfed (the 2018 target was
45%) (Ministry of Health of the Republic of
Indonesia, 2018). The above national survey
results indicate the ineffectiveness of current
stunting prevention programs. Therefore, in
2018, the Indonesian government formulated
a set of strategies to accelerate the 40%-
reduction program, and this target is
projected to be achieved in 2024.
Indonesia has identified four limitations in its
current nutrition program. First, the classic
problem of inter-sector coordination at every
level of the government has always had
negative impacts on the effectiveness of
stunting prevention program. Such problems
occur at each stage of nutrition program
management, from planning to monitoring and
evaluation. In terms of resources, there are
also problems related to budget allocation and
utilization for the purpose of carrying out the
program. Besides that, the limited number of
health workers and their low capacity further
reduce the quality of the program and its
implementation. Lastly, Indonesia also lacks
an effective stunting prevention campaign for
informing the general public about the
magni tu de o f the prob lem and for
disseminating the government's prevention
program. In consideration of these limitations,
Indonesia has formulated five pillars of
st unting preve ntion (Sekre tariat Wakil
Presiden Republik Indonesia, 2018).
The focus of the 2018 stunting reduction
program was pregnant mothers and under-
five children in 1,000 priority villages plagued
with stunting. Then, the program was
gradually expanded to cover all villages in
2020. The five pillars of stunting prevention
address the root causes and optimize the
above limitations on the government's
nutrition program. The first pillar is political
commitment, which is reflected in the national
long-term development program and has
been translated into policies at national and
local levels with the help of private-public
partnership. The second pillar is campaign
program, which is organized in order to
increase public awareness of stunting
prevention program. The third pillar is clear
guidelines on budget allocation in order to
increase the synergy between national and
local governments. In order to secure food
availability at household level, the Ministry of
Health and the Ministry of Agriculture are
charged with food fortification, while
conditional cash transfer also strengthens the
regulation of convenience food claims. Lastly,
regular monitoring and evaluation are also
carried out to ensure the effectiveness of the
program (Sekretariat Wakil Presiden
Republik Indonesia, 2018).
The application of UNICEF'S 2020
framework by Indonesia in the form of many
nutrition programs and initiatives
demonstrates the country's strong
commitment to overcome malnutrition.
However, more rigorous monitoring should be
performed to keep Indonesia on the right
track for stunting reduction. If everything
goes as planned, 2025 will mark the end of
stunting in Indonesia.
Figure 2. UNICEF's 2020 Conceptual Framework of
Maternal and Child Nutrition ''''''(UNICEF, 2019)
References:
Ministry of Health of the Republic of Indonesia (2018) RISKESDAS 2018: Executive Summary.
Riva, G., Graffigna, G. and Gambetti, R. C. (2015) Are positive narratives a possible marketing tool? Preliminary insights from narrative and cognitive psychology, Micro & Macro Marketing, 24(3), pp.
439462. doi: 10.1431/81835.
Schaible, U. E. and Kaufmann, S. H. E. (2007) Malnutrition and infection: Complex mechanisms and global impacts, PLoS Medicine, 4(5), pp. 08060812. doi: 10.1371/journal.pmed.0040115.
Sekretariat Wakil Presiden Republik Indonesia (2018) Strategi Nasional Percepatan Pencegahan Stunting Periode 20182024. Jakarta, Indonesia.
UNICEF (2015) UNICEF's Approach to Scaling Up Nutrition. New York.
UNICEF (2019) The State of the Worlds Children 2019Children, Food, and Nutrition: Growing Well in a Changing World. New York.
WHO (2018) Global Nutrition Policy Review 20162017: Country Progress in Creating Enabling Policy Environments for Promoting Healthy Diets and Nutrition. Geneva. doi:
10.4324/9780203832721.ch30. 10
RECFON AWESOME 1 EDITION
Tobacco consumption is one of the leading
contributors to the proliferation of non-
communicable disease in developing
countries, including Indonesia. Data from
the Indonesia Basic Health Research
(Riskesdas) (2018) show that smoking
prevalence in Indonesia remains high. It
significantly rose from 27% in 1995 to
36.3% in 2013. The recent data of
Riskesdas showed a slight decrease in the
prevalence of tobacco consumption to
33.8% in 2018. However, smoking
prevalence in Indonesia is still the highest
in Southeast Asia, as reported by Southeast
Asia Tobacco Control Alliance or SEATCA
(2017). The report revealed that smoking
prevalence is 19.1% in Thailand, 22.8% in
Malaysia, 12% in Singapore, 26.1% in
Myanmar, 27.9% in Lao PDR, 19.9% in
Brunei Darussalam, 22.5% in Vietnam,
28.3% in The Philippines, and 16.9% in
Cambodia.
Meanwhile, the prevalence of stunting in
Indonesia remains high. In 2018, the
prevalence of stunting in Indonesia was
30.8% among toddlers and 29.9% among
babies under two years old. In addition, the
report shows that the proportion of low birth
weight babies (<2500 gram) increased
slightly from 5.7% in 2013 to 6.2% in 2018,
and the proportion of babies with a birth
length of <48 cm increased from 20.2% in
2013 to 22.7% in 2018.
Smoking behavior among parents is closely
associated with stunting among children
(Dartanto et al., 2018). The authors
explained that the high number of cigarettes
consumed per day is negatively correlated
with the expenditure on nutritious food. The
authors added that stunting among children
is a leading factor that determines those
children’s cognitive skills and abilities (logic
and math), which more or less will affect
their future. Moreover, the Corona Virus
Disease 2019 (COVID-19) pandemic has
led to an increase in poverty, which results
in food and nutrition insecurity, because
people are facing dwindling access to food
and shortages of food products (Kinsey et
al., 2020). Fulfilling the nutritional need of
children in an adequate manner is very
important. If households’ daily expenditure
for cigarettes is still high, it might increase
the difficulty of fulfilling the children’s
nutrition need in a proper way.
Smoking behavior not only affects one’s
health but also one’s socio-economic
condition. Thus, reducing smoking
consumption through tobacco control efforts
is critical to protect all members of the
society, especially the children and youths,
from the harmful effect of smoking.
Furthermore, Indonesia is predicted to
reach its highest demographic dividend
between 2020 and 2030. Therefore,
increasing the quality of life of the current
generation of children should be the
society's priority for a healthy-secure
future.
The Urgency of Tobacco Control in Stunting
Alleviation in Indonesia
Perspective
Correlation between Smoking and Stunting
Stunting is a multi-factor issue where nutrition,
environment, and genetics play a role in
affecting the normal growth of children
(Semba et al., 2016). One of the risk factors
that contribute to stunting is smoking.
Smoking increases children’s chances to
suffer from stunting through nutrition and
environment risks. Figure 1 shows the
transmission factors that cause stunting.
Dartanto et al. (2018) and Dartanto et al.
(2019a) show that parents who smoke
increase the probability of a stunted growth in
their children. One of the transmission factors
is nutritional intake. Smoking tends to crowd-
out other expenditures such as food and
health expenditure, thus, the child will have
lower nutritional intake due to the income
being allocated for smoking. Another
explanation from Dartanto et al. (2019a) is
that smoking also exposes children to
second-hand smoke, which increases their
probability of having chronic diseases and
affects their growth, which will lead to
stunting.
We took a closer look at how smoking may
cause stunting through the experience of
Mrs. X who lives in Bunderan Village,
Demak. Mrs. X is a housewife in a relatively
poor household with three children. Her last
child is considered stunted (Figure 2.). One
of the factors may be due to smoking, which
is a necessity in her household. She said, “If
we have to choose between reducing
essential needs spending and reducing
cigarette spending, it’s better to reduce
essential needs spending. The important
thing is to have one pack per day...” This
shows that the household sacrifices food and
other essential needs to fulfill the smoking
urges of the husband, and considering the
fact that this is a poor household, it puts
more strain on the budget for essential
needs. The child also easily gets sick, which
may be due to complications caused by low
nutritional intake and exposure to cigarette
smoke. The child was said to catch fevers
easily and cough frequently, and even after
recovering, he will be sick again in just one
day. Therefore, there is a strong indication
that parental smoking causes stunting, both
directly and indirectly.
Figure 1. Transmission Factors of Stunting
Source: Dartanto et al. (2019a)
Figure 2. Mrs. X and Her Stunted Child
(left); Respondents’ Average Expenditure
Proportions (right)
Source: Dartanto et al. (2019a)
by Renny Nurhasanah, Suci P Ratih, Faizal R Moeis, Aryana Satrya - School of Strategic and Global
Studies Universitas Indonesia
11
RECFON AWESOME 1 EDITION
Cigarette consumption has become a
dominant feature among low-income
households in Indonesia. Based on the
Indonesia Socio-economic Survey or
Susenas (2018), the monthly expenditure of
the poorest population in rural areas shows
that 15.05% households buy cigarettes,
9.07% buy vegetables, 8.17% buy fish, and
4.68% buy milk and eggs. Data in urban
area also shows something similar. About
9.3% of households buy cigarettes, 7.32%
buy vegetables, 7.32% buy fish, and 6.17%
buy milk and eggs. Therefore, there is an
urgency to control smoking in low-income
families, especially because the smokers are
mostly at productive age. At this stage,
families need to buy nutritious foods to
improve their children’s development.
The government of Indonesia provides social
assistance in order to increase the quality of
its human capital. Additional help can also
be provided to increase their purchasing
power to buy food and household
necessities. However, this is problematic
because the recipients may use the money
to purchase unnecessary things rather than
nutritious food that they really need.
Dartanto et al. (2019b) shows that recipients
of social assistance tend to consume even
more cigarettes. Recipients who smoke also
have lower consumption of calories, protein,
fat, and carbohydrates compared to
recipients who do not smoke. This also has
impacts on their children’s educational
attainment, increasing the dropout rate and
sick period period that hinders them to attend
school classes.
To prove this, let us take a closer look at a
specific case. A qualitative study in Malang
and Kediri area, East Java reveals that low-
income families, who also receive social
assistance from the government, prefer
buying cigarette than food (Nurhasana et al.,
2019). The smokers continue to smoke, while
their families still have to endure economic
burden. Figure 3 shows an example of a low-
income family’s house. This study involved
mostly non-permanent informal workers with
low education level with more than 2 (two)
children. Respondents said that they have
high cigarette consumption, which dominates
the family expenditure (Figure 4). The
cigarette spending is about US$ 0.4 to US$
2.1/family/day. More than half of the
household’s income is spent on cigarettes,
reducing their ability to purchase nutritious
food, which will have an impact on the family
members’ health in the long term.
These households can only afford to buy
protein sources such as tempe (soybean
cakes), tofu, and eggs. They cannot afford to
buy fish, meat, or expensive vegetables, let
alone fruits. A respondent said, “We rarely eat
fruits, maybe once in a month. We eat
vegetable often... if it is possible to eat it for
the next day, we do it (to save money).”
Another respondent said, “Cigarette reduces
our food spending. Cigarettes cost about
US$ 2.1/day, while food only costs about US$
1.4/day. Education expenses are also
affected.” The study stresses the importance
of promoting tobacco control in low-income
households to break the cycle of
intergenerational poverty, improving health,
and investing in human capital for a better
future.
The Urgency of Tobacco Control in Stunting
Alleviation in Indonesia
Choosing Cigarette or Food?
Figure 3. The house of a low income
family (Kediri, East Java) which struggles
from cigarette addiction.
Source: Nurhasana et al. (2019)
Figure 4. Daily expenditure of Social Assistance
Recipients. Source: Nurhasana et al. (2019)
Smoking behavior has become a daily habit
that is considered normal in Indonesia. Most
households are accustomed to not fulfilling
their children's need for nutritious food
because the budget is allocated for
cigarettes. Even during economic crises,
many low-income families still spend money
to buy cigarettes while the rest of the
household members, mostly women and
children, must give way to the smoking habit
of the smokers within their family. Tobacco
expenditure will crowd-out other important
expenditures such as food, education, and
medical services. These expenditures are
important for the development of all
household members, especially the children
who are still in their early life stages.
Smoking behavior affects not only the
smokers' health, but also the health of their
family members, and their socio-economic
conditions. Moreover, it also perpetuates the
violation of women's and children's rights
Smoking increases children's chances of
suffering from stunting due to nutrition and
environmental risks. It also increases the
probability of children's having chronic
diseases caused by exposure to second
hand smoke and affects their growth, which
will lead to stunting.
Conclusion
12
RECFON AWESOME 1 EDITION
Health is a human right which every child
must be entitled to. Failure to fulfill these
rights due to smoking behavior is a form of
human right violation. This requires decisive
action from the government as the party
responsible for ensuring the fulfillment of
their citizens' rights. One of the things that
can be done by the government is to
implement effective tobacco control efforts
such as raising cigarette excise as high as
possible, so that cigarettes become
unaffordable. This effort must be
accompanied by other efforts, such as
educating the public about the dangers of
smoking. The community must be made
aware that smoking is not only bad for the
smokers but also for their family members
and people around them, and that it can
have long-term impacts, such as stunting
and poverty.
However, the idea of raising tobacco excise
is neither widely accepted nor followed by
all policy makers, academics, and experts
yet. The general publich nevertheless agree
that the price of cigarettes should be raised
to protect children from the dangers of
smoking. A study conducted by the Center
for Social Security Studies of Universitas
Indonesia (2018) shows that 88% of the
people and even 80.45% of smokers
support an increase in cigarette prices. It
indicates that most members of the society
want children to be protected from the
dangers of smoking. They want our young
generation to grow into high quality and
productive individuals in the future.
Therefore, the government, together with
the community, should work together to
reduce cigarette consumption, starting from
the smallest social unit, i.e. the family.
Therefore, there is an urgency for effective
tobacco control to help reduce stunting in
Indonesia.
Fun Facts
The Urgency of Tobacco Control in Stunting
Alleviation in Indonesia
13
RECFON AWESOME 1 EDITION
References:
Center for Social Security Studies Universitas Indonesia. 2018. People’s Support for Cigarette Price Increase in Indonesia. PKJS-UI Report.
Dartanto, T., Moeis, F. R., Nurhasana, R., Satrya, A., & Thabrany, H. 2018. Parental Smoking Behavior and Its Impact on Stunting, Cognitive, and Poverty: Empirical Evidence from the IFLS Panel Data. Turkey: The
Conference Proceeding of 14th Annual Conference of the ISPTID.
Dartanto, T., Moeis, F. R., Rahardi, F., Rohman, M. A., Nurhasana, R., & Satrya, A. 2019a. Parental Smoking Behavior and Its Impacts on Stunting and Children Development: A Case Study of Bunderan Village,
Demak. PKJS Report.
Dartanto, T., Moeis, F. R., Nurhasana, R., Satrya, A., & Thabrany, H. 2019b. Social Assistance, Smoking, and Socio-economic Indicator of Households in Indonesia. Jakarta: PKJS-UI.
Kinsey, E. W., Kinsey, D., & Rundle, A. G. 2020. COVID-19 and Food Insecurity: An Uneven Patchwork of Responses. Journal of Urban Health: Bulletin of the New York Academy of Medicine, p. 1.
Nurhasana, R., Ratih, S. P., Satrya, A., Gayatri, R. W., Tama, T. D., & Shellasih, N. M. 2019. Smoking and Its Impact on Social Assistance Recipients’ Quality of Life. Jakarta: PKJS-UI.
Semba, R. D., Trehan, I., Gonzalez-Freire, M., Kraemer, K., Moaddel, R., Ordiz, M. I., & Manary, M. J. 2016. Perspective: The Potential Role of Essential Amino Acids and the Mechanistic Target of Rapamycin
Complex 1 (mTORC1) Pathway in the Pathogenesis of Child Stunting. Advances in Nutrition. https://doi.org/10.3945/an.116.013276.
Literacy is the gateway to the knowledge and
skills necessary for students to build their
character. According to the Comprehensive
Dictionary of the Indonesian Language (KBBI)
and the Cambridge Dictionary, literacy simply
means the ability to read and write. UNESCO
also defines a literate person as a person
who can understand, read, and write short
simple statements in his/her everyday life.
The development of a country cannot be
separated from the literacy level of its
citizens. Unfortunately, studies reported that
literacy rate in Indonesia is still very low.
The 2015 Program for International Student
Assessment (PISA) survey indicated that
Indonesia ranked 64th (or 10th lowest) out of
72 countries in terms of children literacy
(Kementerian Pendidikan dan Kebudayaan,
2019). Even UNESCO stated that only one
out of 1,000 Indonesians is literate
(Ramadhani and Yuwinanto, 2020) This
condition has raised high concern.
Today literacy is no longer only about reading
and writing skills. Its range of meaning
continues to grow, and now it is commonly
associated with the terms 'knowledge' and
'skills' in various fields of life. For example,
financial literacy refers to the set of
knowledge and skills that allows an individual
to manage and make effective decisions
regarding all of their financial issues.
In the context of nutrition, financial literacy at
the household level is very important.
Financial literacy means the ability of a
household to make financial decisions, which
manifests in an ability to budget basic family
expenses (especially those for food) or
manage family incomes for savings purposes.
The research conducted by Carman and
Zamarro (2016) stated that household food
insecurity is not only caused by insufficient
income but also due to a lack of financial
literacy. Households that lack knowledge
about basic financial skills such as income
management are more likely to experience
food insecurity. Conversely, households that
have good financial literacy are more likely to
be able to manage savings that can protect
them from food insecurity (Carman and
Zamarro, 2016).
Perspective
Investing in Nutrition Literacy to in IndonesiaReduce Stunting
The Vicious Circle of Stunting and Low Literacy Rate
Stunting is the consequence of a range of
factors. Based on the UNICEF Conceptual
Framework on Childhood Malnutrition, there
are three underlying causes of stunting
among children: (1) household food
insecurity, (2) inadequate childcare, and (3)
poor access to health care and unhealthy
environment, while the root cause of this
complex interaction of factors is poverty.
Like low literacy rates, a high prevalence of
stunting in Indonesia is a serious problem that
needs to be addressed because they are
connected to each other. Studies showed that
stunting is associated with poor literacy and
numeracy skills. Their impacts are closely
associated with high rates of school dropout,
unemployment, and poverty that indicate low
human development index. Moreover, the
Indeks Aktivitas Literasi Membaca 2019
(Reading Literacy Activity Index 2019) also
confirmed that poverty is associated with low
literacy rate in Indonesia. Students from poor
families have limited access to books, public
libraries, and schools (Kementerian
Pendidikan dan Kebudayaan, 2019).
Stunting is a major public health problem, and
it is a cyclical process, which is shown in
Figure 1. As an illustration, a woman who is
stunted in her childhood tends to have a
stunted child. Then, this stunted child is more
likely to grow as a woman who has a low
cognitive level, suffers from malnutrition, and
has a poor health status. Thus, maternal
nutritional status before, during, and after
pregnancy will influence a child’s early
growth, and these mothers are more likely to
give birth to low birth weight (LBW) babies
that might grow to be stunted children.
Therefore, stunting and low literacy rate is a
vicious circle that has economic
consequences on both sexes at the
individual, household, and national level. One
intervention measure to cut this vicious cycle
is women empowerment, which can be
achieved by improving their literacy,
especially nutrition literacy.
Figure 1: Nutrition throughout an individual’s life cycle
(Ahmed et al., 2012)
by Nurbaya, S.Gz.,M.Gz - Poltekes Kemenkes, Mamuju, Indonesia
14
RECFON AWESOME 1 EDITION
Nutrition literacy is defined as an individual’s
ability to have the capacity to obtain, process,
and understand nutritional information and
acquire nutritional skills needed in order make
proper nutrition decisions in their lives (Gibbs
et al., 2019; Joulaei et al., 2018). Increasing
nutrition literacy is one of the important keys
to increase maternal health and to reduce
stunting.
The above definition of nutrition literacy
emphasizes an individual’s cognitive
capacities which are related to basic literacy
and numeracy skills required to understand
information about nutrition. With nutrition
literacy, people can access, analyze, and
practice their nutrition knowledge (Krause et
al., 2016).
Studies found that there is a strong
relationship between the nutrition knowledge
of the mothers and the nutritional status of
their children (Christian et al., 1988). Maternal
literacy has a significant association with
malnutrition among under-five children. Low
literacy among mothers can lead to poor
understanding of childcare and health
problems. This finding is similar to that of a
study conducted in Indonesia, which found
that households who had stunted children
and an overweight or obese mother had
significantly lower maternal nutrition literacy
(Mahmudiono et al., 2018).
Strengthening nutrition literacy is one of the
nutrition-specific interventions that could work
together with promoting and supporting
pregnant and lactating women, and
promoting optimal infant and young child
feeding. Therefore, strategies to improve and
promote nutrition literacy are urgently needed
in regions with high prevalence of stunting. It
is important to persuade and encourage all
members of communities, especially women,
to increase their nutrition literacy.
Figure 2 describes the effect of increasing
health literacy on the use of health services
and their outcomes, such as increasing the
quality of life. This outcome is in line with
nutrition literacy that will affect people's
knowledge and perspective, which leads to
improved behaviors and attitudes.
Poor nutrition literacy poses an obstacle for
an individual to understand and interpret
nutritional information as well as to
demonstrate good nutrition practices and
healthy lifestyle in his/her daily life.
Meanwhile, good nutrition literacy is
associated with better quality of diet and
disease management. Optimum nutritional
status will help people to achieve high quality
of life. Therefore, we need to invest in
nutrition literacy.
Investing in Nutrition Literacy to in IndonesiaReduce Stunting
Figure 2: Impacts of health literacy on health (Vettori et al., 2019).
Nutrition Literacy and Stunting
15
RECFON AWESOME 1 EDITION
Investing in Nutrition Literacy to in IndonesiaReduce Stunting
Figure 2: Impacts of health literacy on health (Vettori et al., 2019).
The Indonesian society was born based on
oral tradition. Thus, it is quite a challenge for
the country to increase its people’s interest in
reading. Fuad Hasan proposed three
components of a concerted effort to increase
people’s interest in reading, which consist of
reading ability, reading sources availability,
and fostering of reading habits (Kementerian
Pendidikan dan Kebudayaan, 2019) These
three factors have an important and
interrelated role in improving people’s interest
in reading, which will improve nutrition literacy
among the Indonesian people. Nutrition
literacy must be recognized as an essential
life skill.
Today, the Internet is the most popular source
of various pieces of information, including
those related to nutrition and health. Other
studies also mentioned that, besides the
Internet, family members and books also
serve as alternative sources of information
about food and nutrition (Joulaei et al., 2018).
However, the internet provides us with a huge
amount of scientific and non-scientific
information and even presents a lot of hoax
news about health. This is an opportunity for
us as academicians and nutritionists to
deliver reliable information to increase
people’s nutrition literacy. It is also a
challenge for us to provide valid information
to counter hoaxes and misleading news that
spread quickly every day.
In order to address this situation, a group of
Indonesian young people made the initiatives
and efforts to improve the nutritional literacy
of the Indonesian people. The following are a
few examples of initiatives that they have
taken to provide accurate and up-to-date
information about health and nutrition:
Edugizi (hps://www.edugizi.id), Lini
Sehat (hps://linisehat.com), Zywie Lab
(hps://zywielab.com), Dietisien
(hps://diesien.id), Nutricare
(hps://nutricare.id), Ahli Gizi
(hps://ahligizi.id), and many more.
If we examine more deeply the definition of
nutrition literacy as previously explained, it
turns out that nutrition literacy does not only
mean the ability of individuals to access and
process nutrition information. It also means
the degree to which they are able to practice
or carry out what they have known. By
providing good quality reading materials for
people, those young people hope that they
will be able to bring benefits to the people
(see Figure 3).
Figure 3 shows us the framework of nutrition
literacy that could increase diet quality and
healthy eating behaviors. The black and grey
areas are the antecedents of nutrition literacy
such as public health nutrition policy and
intervention, education and literacy, media
use or smartphone apps, source of nutrition
information, and so on.
These young people are working in the black
and grey areas. They provide Internet-based
nutrition information sources that are
accessible and easily disseminated. They
also provide online consultation to encourage
more people to discuss about their daily
health and nutrition problems. In the era of
COVID-19 pandemic, they also provide
reliable information about COVID and
nutrition.
However, this is just one of the antecedents
to reach the white area , which represents
the consequences of nutrition literacy. As
Fuad Hasan said, the fundamental way to
increase people’s literacy is increasing their
basic reading ability (Kementerian
Pendidikan dan Kebudayaan, 2019).
Increasing children’s cognitive skills must be
done by increasing their nutritional status.
Therefore, much work remains to be done
together by all relevant parties to cut the
vicious cycle of stunting.
Investing in Nutrition Literacy: A Youth Movement
References:
Ahmed, T., Hossain, M., Sanin, K.I., 2012. Global burden of maternal and child undernutrition and micronutrient deficiencies. Ann. Nutr. Metab. 61, 8–17.
Carman, K.G., Zamarro, G., 2016. Does financial literacy contribute to food security? Int. J. Food Agric. Econ. 4, 1–19.
Christian, P., Abbi, R., Gujral, S., Gopaldas, T., 1988. The role of maternal literacy and nutrition knowledge in determining children’s nutritional status. Food Nutr. Bull. 10, 35–40.
Gibbs, H.D., Ellerbeck, E.F., Gajewski, B., Zhang, C., Sullivan, D.K., City, K., City, K., City, K., States, U., 2019. The nutritional literacy assessment instrument (NLit) is a valid and reliable measure of nutrition literacy in adults with chronic
disease. J. Nutr. Educ. Behav. 50, 247–257.
Joulaei, H., Keshani, P., Kaveh, M.H., 2018. Nutrition literacy as a determinant for diet quality amongst young adolescents: A cross sectional study. Prog. Nutr. 20, 455–464.
Kementerian Pendidikan dan Kebudayaan, 2019. Indeks Aktivitas Literasi Membaca 34 Provinsi. Jakarta.
Krause, C., Sommerhalder, K., Beer-Borst, S., Abel, T., 2016. Just a subtle difference? Findings from a systematic review on definitions of nutrition literacy and food literacy. Health Promot. Int. 33, 378–389.
Mahmudiono, T., Nindya, T.S., Andrias, D.R., Megatsari, H., Rachmah, Q., Rosenkranz, R.R., 2018. Comparison of maternal nutrition literacy, dietary diversity, and food security among households with and without double burden of
malnutrition in Surabaya, Indonesia. Malays. J. Nutr. 24, 359–370.
Ramadhani, N.S., Yuwinanto, H.P., 2020. The analysis of the implementation of School Literacy Movement (GLS) program in Public Junior High Schools and Private Junior High Schools/Islamic Junior High Schools in Surabaya. Talent Dev.
Excell. 12, 153–160.
Vettori, V., Lorini, C., Milani, C., Bonaccorsi, G., 2019. Towards the implementation of a conceptual framework of food and nutrition literacy: Providing healthy eating for the population. Int. J. Environ. Res. Public Health 16. 16
RECFON AWESOME 1 EDITION
Stunting is a significant worldwide public
health problem. In 2019, over 144 million
children under the age of five were stunted. In
2015, WHO's World Health Assembly set up
the ambitious target of reducing the number
of stunted children by 40% by 2025. This
target was later adopted by the Sustainable
Development Goals that aims to end all forms
of malnutrition by 2030. Against the backdrop
of the current COVID-19 pandemic, it
becomes more and more unlikely that the
2025 goal will be reached. The most recent
WHO report indicates that numbers are on
the rise again.
Over the past three decades, there has been
a one-sided focus on searching for the 'silver
bullet' or the specific driver to solve stunting;
the only key element that, if addressed, could
explain the insoluble problem. This has
weakened praxis. Although there have been
some encouraging results, this approach has
not been fully successful. It has also ignored
the need to merge different disciplinary
advances.
The UKRI GCRF Action against Stunting
Hub is a program that aims to challenge and
redefine the existing paradigm of child
stunting research. The Hub believes that we
need to rethink stunting: child under-nutrition
is a mosaic, where different individual
elements play a role in creating the picture.
What we need to end stunting globally is a
holistic, pan-disciplinary understanding of the
problem. For example, we have to take into
account that children who are stunted often
have an immature gut microbiome, which
enhances the likelihood of catching infectious
agents, ranging from viruses and bacteria to
protozoa and helminths. Food-borne toxins
also have an impact on stunting. On the other
hand, we need to research the elements that
we believe can prevent stunting from
happening, including behavioral elements,
dietary choices such as feeding animal
source foods (ASF), feeding practices, and
improvements to water, sanitation, and
hygiene (WASH).
If we want to stop considering under-nutrition
as 'siloed' and non-relational (Perkins et al.,
2017), we need to grasp the shape and
structure of the mosaic and the synergies
between the components. What is the
cascade of factors driving child stunting?
What are the synergies and inter-
relationships between drivers? What are the
critical points along this cascade where
healthy linear growth diverges to slow or has
no growth?
To answer the questions, the Hub has
developed a new approach that aims to shift
the focus from the single parts to the "whole
child". We call this the Whole Child
Approach. The priority is to understand the
biological, social, environmental, and
behavioral context in which stunting occurs,
and the synergies and inter-relationships
between drivers. In other words, we aim to
understand the 'bio-developmental' niche
governing child growth, focusing on the
interaction between the biological, physical,
and social environment of the child. Once the
primary paradigm is set, we can now argue
that child under-nutrition is an outcome of four
inter-linked 'environments' radiating from the
physical to the immediate/home environment,
to the educational and broader food system.
These domains, however, are linked by the
social values which directly shape a child's
living experience. In applying this paradigm,
the path ahead is clear: we must radically
change our perspective from the related parts
to the Whole Child.
However, working collectively does not mean
that individual elements of the Hub will not be
innovative and groundbreaking. For example,
the Epigenetics work stream will address the
biology of stunting, looking beyond the simple
height-for-age definition to develop better
methods of defining and identifying stunting
type based on epigenetic status. Here, we will
define epigenetic markers that can be used to
identify the children and pregnancies that
have a high risk of stunting. A full
understanding of the epigenetic changes will,
along with the outputs of the other work
streams, help the study to predict the ability of
stunted children to respond to specific
interventions based on the 'type' of stunting
involved.
The End of the Silver Bullet:
A Holistic Approach to Stunting Research
From the research bench
The Whole Child Approach
of UKRI GCRF Action against Stunting Hub
by Alessia Gasco - Communication Manager UKRI GCRF Action Against Stunting Hub
17
RECFON AWESOME 1 EDITION
The Hub will use two epigenetic
methodologies: 1) a targeted hypothesis-
driven analysis of selected regions of the
genome using Next Generation Bisulphite
Amplicon Sequencing (BSAS) and 2) a
genome-wide analysis of epigenetic states
using the Illumina Infinium Methylation EPIC
850k Bead Chip (EPIC array). The EPIC
array measures the epigenetic state of a
large number of genes. This capability makes
the EPIC method useful for drawing
interdisciplinary comparisons with multiple
work streams across the Hub. However, it is
limited in genomic coverage, and it does not
include key regions critical to stunting. The
ability of the BSAS method to target specific
regions within the genome allows The Hub to
focus on specific epigenetic markers of birth
anthropometry, adult stature, metabolic state,
and cognitive ability. All samples will be
analyzed using BSAS in targeted regions of
the genome. The EPIC array will be used for
selected samples from within the core cohort
study.
To test and put the Whole Child Approach into
action, The Hub works in over 50
communities across three countries: India,
Indonesia, and Senegal. We aim to decrease
stunting by up to 10% in these communities.
Throughout the project, we expect to
positively impact the lives of up to 1 million
children. The Hub consists of 17 partner
organizations in six countries coordinated by
London International Development Centre
(LIDC) and London School of Hygiene
Tropical Medicine. Professor Claire Heffernan
(LIDC) is the Principal Investigator (PI), and
Professor Paul Haggarty (Rowett Institute of
Nutrition and Health at the University of
Aberdeen - UK) is the Deputy Principal
Investigator.
For each country, the Hub has identified a
leading institution in Indonesia; SEAMEO
RECFON is the chosen partner. The
Indonesian Hub comprises of interdisciplinary
researchers chaired by Dr. Umi Fahmida as
the Country Lead. The team consists of
senior and early career researchers in
diverse disciplines, i.e. nutrition, medicine,
biomedicine, food safety, agriculture,
psychology, and education. The RECFON's
team is also supported by SEAMEO
CECCEP for the educational component.
As our PI Professor Claire Heffernan noted:
'To change the frame around child stunting
requires our Hub to be a true collaboration
which leverages our collective expertise.
RECFON has been a brilliant partner, and the
whole Hub has gained Umi and her teams'
extensive experience in best practice around
data collection and management.’
The Hub also aims to impact the academic
community. The Whole Child Approach will
change the 'frame' by which our historical
understanding of stunting is based. The new
conceptual understanding of stunting and the
related typology will benefit the academic
community in different ways. First, new
perspectives on stunting will open up to
innovation processes. Second, by embedding
the findings in the programmatic priorities of
multilateral institutions, non-governmental
organizations, and civil society, we will be
serving the wider stakeholder community.
The interdisciplinarity of the project ensures
that the direct beneficiaries of this work
intersect eight disciplines: biology, clinical
medicine, psychology, sociology, veterinary
medicine, nutrition, economics, and
anthropology. On top of this, by leveraging
networks across the UK and internationally,
we will be able to engage with an even bigger
academic community.
Finally, during the lifetime of The Hub, we will
produce an interdisciplinary data set that will
be a unique resource for researchers working
on issues relating to child under-nutrition. The
data will underpin the development of a
decision support tool that will be freely
available to the academic community and
policymakers. In addition to generating
solutions based on the core Hub hypotheses,
this rich and extensive data set will make
possible the second wave of discovery by
allowing cross-disciplinary suggestions
arising in one center to be tested using the
data from another.
Ultimately, all of the activities taking place
across The Hub and all the data generated
are contributing to our ambitious overall goal:
to fundamentally change the landscape of
child stunting for millions of affected children
globally.sed on the 'type' of stunting involved.
References:
https://www.who.int/gho/child-malnutrition/en/
https://www.who.int/publications/m/item/state-of-food-security-and-nutrition-in-the-world-2020
UK Research and Innovation Global Challenges Research Fund (UKRI GCRF) Action against Stunting Hub (https://www.actionagainststunting.org); twitter page @actionstunting 18
RECFON AWESOME 1 EDITION
The End of the Silver Bullet:
A Holistic Approach to Stunting Research
The elderly, senior citizens, the old
generation, whatever you want to call them,
have always been underestimated by the
society, mainly due to the prevailing
stereotype that they need to be assisted and
are incapable of doing many things
independently. Although this may be true for
some of them, there is also a large proportion
of elderly people who are quite active and
independent, and therefore have the potential
for serving as “actors” rather than “objects” in
health programs and interventions.
The good news is that among the current
10% of older people in Indonesia, the majority
of them are categorized as independent,
meaning that they are capable of assisting
themselves and to some extent even
assisting others. These seniors prove that
they too can be productive and active in the
community. This not only brings relief to the
health care system but also demonstrates
that these seniors can serve as a possible
solution to other health and nutrition problems
faced by the community.
Indonesia has also long been facing the
problem of stunting, which is a public health
concern. In 2019, the government reported
that the prevalence of stunting hovers at a
staggering figure of 27.7% among children
under the age of five. Nevertheless, it is
considered quite an achievement for
Indonesia to have the figure reduced by 3.1%
in only one year. Continuous commitment and
determination is apparent from the
government efforts that strive to bring the
figure down to 14% by the end of 2024. Thus,
in order to reach this ambitious number, all-
hands-on-deck participation is required. This
involves multisectoral and cross-ministerial
efforts as well as all those other potential
resources, including the elderly, to contribute
in the reduction of stunting.
Independent and productive senior citizens
are highly potential actors in stunting
prevention. Indonesian statistics show that
38% of the elderly live with their families,
while 24% of them live with their children and
grandchildren (three generations) within the
same household (TNP2K 2017). Moreover, it
is very common that the caring and feeding of
children are highly influenced by what the
grandparents say. Unfortunately, these
hands-me-down feeding recommendations
may not always be in line with the current
health and nutrition recommendations, which
have come to be considered as food taboos.
Food taboos are still an issue in several
regions in Indonesia. Among the most
common food taboos in Indonesia include fish
consumption during pregnancy, which is
wrongly thought to cause babies to smell like
fish after birth, while others apply honey on
the lips of newborn babies to prevent dry lips.
Many insist on giving the babies water after
breastfeeding them to avoid stickiness in the
throat. Early introduction of food, such as
mashed banana (even as early as one week),
is still quite common. In addition, family
members are usually the first to insist on
giving formula milk when the breastmilk is
considered insufficient. In many cases, these
practices are the leading causes of stunting,
and they get worse in some regions when the
babies reach the age of complementary
feeding at 6 months. The common diet for
these babies only includes rice porridge and
soup without any protein and vegetables.
When the origins of these food taboos are
traced back, it turns out that many of them
come from the older generations. Therefore, it
is critical that these senior citizens
understand the correct health and nutrition
practices in the family.
Considering the important roles of the elderly
within their communities and families in
preventing the proliferation of stunting, the
Directorate of Family Health of the Ministry of
Health, Republic of Indonesia, together with
the Department of Community Nutrition,
Faculty of Human Ecology of IPB University,
collaborated to identify the existing programs
and policies whose objectives are to improve
the health and welfare of the elderly in
Indonesia. The study was conducted in five
provinces in Indonesia through focus group
discussions at the district level and by
involving multiple stakeholders. The lessons
learned from the study were then used to
formulate a solution aimed to empower the
elderly to take part in stunting prevention in
their communities.
In this study, we learned that ample efforts
from the health, social, and government
sectors are already in place at the district
level. Community Health Centers are
encouraged to develop innovative programs
for the elderly, which aims to increase their
involvement as health advocates in their
families. Most of those programs were given
intriguing names, which make them easy to
remember by the community. For example, in
Bogor, one of the programs is called
Antariksa (Antar dan Periksa). In Indonesian,
antariksa means ‘outer space’, while antar
dan periksa means ‘bring in and check’.
Hence, the aim of the program is to increase
the elderly participation to bring in and
accompany pregnant mothers to the
Community Health Centers for a regular
health checkup. Bogor also has another
program called Si Dulan (Si Duta Lansia) or
‘Elderly Role Model’. In Banyuwangi, the
social programs for the elderly include
Rantang Kasih or ‘Basket of Care’, which
provides nutritious food for the elderly who
live alone. In Padang, they have a program
called Nekermen (Nenek Kakek Keren) or
‘Cool Grandma and Grandpa’, which is a
program to educate the elderly to help
prevent stunting in the family. In Tomohon
District, one of the programs is called
Martabak Manis (Mari Datang dan Periksa,
Oma Opa Nikmati Usia Senja). In Indonesian,
martabak manis is a sweet pancake-like
delicacy, while the program itself is aimed to
encourage the elderly to come (to health
services) and check their health condition. In
Wajo, they have a program called Ojol (Ojek
Lansia), which seeks to accompany and take
the elderly to integrated health posts when
they cannot come on their own. All of these
programs are administered by the local
Community Health Centers and implemented
together within the community.
Despite the positive progress found in the
field, problems related to funding and priority
remain an issue in several districts. Lack of
coordination between the sectors is also a
problem: some programs overlap each other
and lack synchronization. Furthermore, the
absence of a coordinating body (i.e. the
Elderly Regional Commission) in many
districts is also hampering the effort to
promote elderly-related issues as a priority.
Moreover, in some areas, many elderly
people are reluctant to come to the available
services, thinking that the services are only
for the poor. This is quite common among the
male elderly.
To tackle the lack of synchronization between
related government sectors and to increase
elderly participation, a community college for
the elderly was established and tested in one
of the working areas in Jampang Community
Health Center, Bogor, Indonesia. The
program was aimed to empower the elderly
as health and nutrition advocates through the
concept of lifelong learning. Weekly sharing
sessions were held for six weeks in one of
Integrated Development Posts, which were
attended by 51 elderly participants.
Empowering the Elderly as in Stunting Alleviation“Actors”
From the research bench
by Purnawati Hustina Rachman, Prof Clara M Kusharto - IPB University
19
RECFON AWESOME 1 EDITION
The main curriculum was developed to
include aspects on nutrition and health issues
throughout the life cycle from pregnancy,
children under five years old, school-age
children, adolescents, adults, and elderly.
During these sessions, the elderly would be
divided into small groups based on whom
they live with from the six age categories
mentioned above. Moreover, to make it more
interesting, each session also includes
enrichment activities, such as planting herbs,
cooking healthy snacks for children and the
family, and also doing simple exercises such
as tongue and brain exercises. These
activities were eagerly awaited by the
participants.
Several stakeholders were also involved as
speakers in the sessions, such as the
Yayasan Indonesia Ramah Lansia
(Indonesian Elderly-Friendly Foundation);
Food Security Office of Bogor; Women’s
Empowerment, Child Protection, Family
Planning, and Population Control Office of
Bogor; and Dahlia Posbindu in Depok. At the
end of the program, there was a graduation
ceremony as a token of appreciation for the
strong commitment and active participation of
the elderly.
The concept of “school” was well received by
the elderly group in Jampang, as
demonstrated by a high participation rate of
94% throughout the program. Participants
were eager to learn something new every
week and actively participate in the sessions.
As a follow up of this program, participants of
the Community College for Elderly are now
enthusiast to join an educational program
named online Talk Show Series with Elderly
organized by IPB University which consists of
20 online sessions up until December 2020.
It is proven that age does not limit elderly to
become tough individuals who are willing to
learn to serve and not only to be served.
This gave great hope for program
implementers that the elderly can give many
contributions to the community, including
becoming health advocates in the fight to
reduce stunting in their immediate
neighborhood. This act of empowerment can
also help bolster their confidence that they
too can contribute in this battle to reduce
stunting through the process of lifelong
learning by acquiring and distributing their
knowledge, starting from their very own
families.
Empowering the Elderly as in Stunting Alleviation“Actors”
Reference:
TNP2K. 2017. Basis Data Terpadu 2015 (2015 Integrated Database). Jakarta: TNP2K.
From the research bench
20
RECFON AWESOME 1 EDITION
Opportunities and Challenges of Stunting Prevention
in Islamic Boarding Schools in Indonesia
by Purnawati Hustina Rachman, Reisi Nurdiani - IPB University
Amidst the rebellious, emotional roller coaster
and undecisive traits of adolescents, as
challenging as they can be, they hold an
important role in shaping the nutritional status
of the next generation. During this important
stage of life, adolescents go through rapid
growth where they experience significant
physical and emotional changes called
puberty. Without sufficient nutritional support,
adolescents may not be able to reach their
potential during this window of opportunity.
Adolescent girls have received a lot of
attention over the past few years as more and
more people acknowledge the importance of
investing in optimal nutrition during this stage.
Although the first 1000 days of life remain a
high-priority period, many agree that
nutritional interventions during adolescence
will lead to positive outcomes in future
pregnancy. Unfortunately, many adolescents
underestimate the importance of achieving a
balanced diet. High snacking habit, little
consumption of fruits and vegetables, and
also skipping meals are found in many
adolescents. Many of these are related to
environmental factors, such as peer influence
and limited access to healthy snacks and
meals. In addition, the prevalence of teen
marriage is also quite high in some regions,
thus increasing the risk of stunting and
malnutrition in the next generation.
Adolescents – a window of opportunity
Islamic Boarding Schools in Indonesia – an Overlooked Potential
Indonesia holds the first rank as the largest
Muslim population in the world with 203
million Muslims, representing 86.1% of
Indonesia’s population
(http://en.reingex.com/Muslim-population-
countries.asp). This large number is
supported by several religious institutions,
including the education sector. Pesantren or
Islamic Boarding School (IBS) is an Islamic
education institution in Indonesia which
provides a non-classical method of learning
religion for adolescents and adults starting
from junior high school level. Recent data
from the Ministry of Religious Affairs,
Republic of Indonesia, show that the number
of IBS in Indonesia reached 26,966 in 2019
and is projected to increase. The number of
students reached 2,647,855 with more than
54% of them living in dormitories within the
school ground. These IBS provide religious
education beyond the formal school hours
and often have strict rules for going off-
campus. In turn, the schools provide all the
necessities for the students. This includes
three meals per day, convenient shops, a
sports area, extracurricular clubs, a library,
shared dormitories, and bathrooms. In most
schools, students must stay at IBS for a full
semester. Parents and relatives are only
allowed to visit once a week. In addition,
students are usually not allowed to bring
mobile phones. Although it may seem quite
difficult for these young adolescents to be
away from home with some restrictions, this
method of education is thought to be most
effective in raising strong and independent
children to focus on their religious and
academic studies.
This unique condition allows the schools and
teachers to take full responsibility for the
students’ wellbeing, replacing the roles of
parents during their time at IBS, including
providing the meals for the students.
Unfortunately, not all schools have the
resources and capacity to plan three
nutritionally balanced meals per day, let alone
to provide them. This is commonly found in a
relatively new and small IBS, mostly funded
by donations. In such schools, the common
dish would consist of all-you-can-eat rice, a
portion of tofu or tempeh and vegetables.
Many lack animal protein and fruit in the diet.
Due to limited dorm space and shared
facilities related to poor hygiene and
sanitation, seasonal colds and coughs are
commonly found among the students.
Moreover, IBS is often overlooked in terms of
government heath programs which often
target public schools. Although in conditions
where the environment is strictly supervised
such as at IBS, access towards health and
nutrition programs and information remains a
challenge.
This different environment requires a different
approach to ensure that the health and
nutritional status of adolescents can reach its
maximum potential. Therefore, the
Department of Community Nutrition, Faculty
of Human Ecology, IPB University, supported
by PT Ajinomoto Indonesia, has organized a
School Lunch Program (SLP) in Bogor,
Indonesia since 2018.
Creating supply and demand
SLP was designed to address the health and
nutrition problem of adolescents through a
supply and demand approach. On the supply
side, SLP provided daily nutritious lunch
throughout the period of one year (SLP 2018)
and 6 months (SLP 2019). This was to ensure
that students were provided with sufficient
nutrition that is needed for their growth and
development. Although our program only
provided balanced lunch meals, sufficient
training was given to school’s food handlers
on how to prepare and process food in a safe
way. Training was also provided for
management staff on how to allocate an
appropriate budget for food supplies, prepare
menu cycles, and also regulate the kitchen
flow to ensure the sustainability of the
program. Hence, the school was also
encouraged to restructure its menu cycle in
the morning and also at evening meals to
make it more balanced.
Meanwhile, from the demand side, SLP
provided nutritional education for students on
a weekly and bi-weekly basis throughout the
program. Teachers were highly involved in
the preparation, and the delivery of nutrition
education and training was provided for
teachers early before the program. Teachers
were asked to arrange schedules and create
a team of volunteers who were willing to
deliver an educational program weekly with
the support of IPB University. The nutritional
education topics ranged from health and
nutrition problems in adolescents to balanced
nutrition, food labels, clean and healthy
lifestyle, and also physical activities. What is
unique in the method of deliverin the
nutritional education at IBS is that there are
ample opportunities to hold sessions beyond
academic hours. As they stay in dormitories
and live within the school, the teachers are
more comfortable delivering nutrition
education sessions in the evening.
These were often held in the hallways of the
dorms or sometimes in the mosque. Some
topics related to physical activities were held
in an open hall in small groups. Furthermore,
related health and nutrition posters were also
postedin bedrooms, kitchen, classrooms,
washing sinks, and many other areas
throughout the school to increase exposure.
The results of SLP were positive in several
aspects. After the program, the prevalence of
anemia decreased and nutritional status also
improved. Both overweight and underweight
fell to normal nutritional status. Knowledge,
attitudes, and practices of students’ health
and nutrition also improved significantly even
though the increment in practices was not as
high as those in knowledge and attitudes.
21
RECFON AWESOME 1 EDITION
Challenges and future ways
Despite the positive effects of SLP, we also
found that focusing on one single meal(lunch)
caused more skipping other meals, especially
dinner. Many students felt that a balanced
lunch could compensate for their dinner which
was held either too late (8 pm during SLP
2018) or too early (5 pm during SLP 2019) by
the school. Therefore, a strong commitment is
needed from the schools to schedule dinner
at the right time for students to enjoy the
meal. This may be a challenge as dinner
usually overlaps with prayer times and
religious activities.
The Program also generated a valuable
lesson on the importance of advocacy and
commitment from the top level management
of IBS to implement such a program. In a
relatively smaller and developing IBS, where
the organizational structure is quite simple, it
is sufficient and effective to advocate the
Kiyai, as solely the top leader of the school as
well as the management that is highly
respected and obeyed by all staff members
and students. The advocacy with the Kiyai
was very effective which resulted in the
delegation of staff and resources to support
our program. This resulted in joint
investments by the school such as the
provision of new equipment in the kitchen
and also dinner plates for all students.
Furthermore, the school restructured its
organization and created a special division
for kitchen affairs (including meal planning
and nutritional education). In schools that are
more established in terms of management,
challenges arise in the communication and
commitment as the hierarchy of the schools
and the foundation are separated; hence,
they required multiple levels of approvals and
plans of action during the implementation of
the program.
The two School Lunch Programs reveal that
IBS requires guidance on how to provide
nutritious meals and nutritional education to
ensure the nutritional and healthy wellbeing
of adolescents attending their schools. If
such guidance can be provided in all IBS
throughout Indonesia, we can ensure that 1.4
million adolescents will receive adequate
nutrition for optimum growth and also the
knowledge needed to maintain their health.
However, maintaining positive impacts is an
entirely new challenge, where it takes two to
mingle, meaning the cooperation and
commitment from both the school as well as
the program implementers are needed.
Nevertheless, it is an effort worth striving for
in order to open the window of opportunity of
adolescence and future generations to come.
Reference:
TNP2K. 2017. Basis Data Terpadu 2015 (2015 Integrated Database). Jakarta: TNP2K.
Opportunities and Challenges of Stunting Prevention
in Islamic Boarding Schools in Indonesia
Gastronomy has recently become a
prominent attraction in the tourism business
all over the world. According to the most
famous food philosopher, Brillat Savarin, in
his book The Physiology of Taste first
published in 1825, gastronomy covers eating
habits, the preparation of food ingredients,
food processing, food history and legends,
food culture, food pleasure, the benefits of
food, and everything else related to food.
Thus, the term gastro-tourism has emerged
and been used in promoting a particular
tourism destination. Gastro-tourism is
sometimes interchangeably refered to as
food tourism or culinary tourism by some
people.
Gastro-tourism programs highlight activities
related to enjoying food from a certain
locality that involves all our senses in
interacting with various culinary products.
Unfortunately, the gastronomic aspect of this
toursim concept is often neglected. In most
cases, gastro-tourism is reduced to just
eating the food prepared by local people in a
certain destination without knowing and
appreciating the history and culture behind
the preparations.
An example of gastro-tourism in Indonesia
can be seen in Bogor, West Java, where
tourists can visit local paddy fields and the
surrounding tourist villages to see the
process of preparing the rice that they will
eat. They are also invited to participate in
farmers' activities during the day to try their
hand at farming. Then, after the foods have
been processed, the tourists are actually
creating the food that will be served and
finish their meal without wasting anything, as
they become aware of the contribution of the
agrobiodiversity of gastro-tourism program.
Another term that has recently appeared in
food and tourism as well as in other
development discourses is gastro-diplomacy.
In 2012, Paul Rockower coined the term
gastrodiplomacy referring to the “concerted
and sustained campaigns of public relations
and investment by governments and states,
often in collaboration with non-state actors,
to increase the value and standing of their
nation brand through food.” In short, food is
used to achieve diplomatic goals and
establish a nation's identity or brand. It can
create a good image among tourists about a
particular country they travel to and
eventually provide them with positive
experiences.
As a region, Southeast Asia posseses
abundant natural resources that contribute to
the numerous exquisite dishes from among
the countries within. Each country is known
for its specific dishes. This diversity in dishes
has led to an interaction, “migration” as well
as exchanges of recipes between and
among countries through the years either by
mixing and adapting traditional recipes with
contemporary ones. Thus, if Southeast Asian
countries effectively adopt gastrodiplomacy,
it could promote the region's overall
cultures, particularly from culinary and
gastronomical points of view. Therefore,
when offering a menu whether in a social
occasion or as part of an educational
program on food ingredients or recipes, one
has to encounter a wide selection of culinary
items which are imbued with diverse cultural
values. Having diverse food sources and
dishes could also mean diverse sources of
nutritients that are essential in building a
healthy citizenry.
The United Nations Economics and Social
Council (ECOSOC) in its Tourism Futures in
the 2030 Agenda: Innovation and
Sustainability states that in the new era of
normality, gastro-tourism may play a role in
alleviating various social, health, and even
food-related problems. A Stunting
Prevention Education intervention, when
packaged as a gastro-tourism program,
could greatly affect the public's view on the
importance of preparing healthy food
considering its socio-cultural contexts as well
as being a source of generating income by
the local people involved from tourists
visiting their communities. Poverty is one of
the contributing factors to stunting incidents
in most countries in the region. Further, the
health dimension of gastro-tourism may
need to be strengthened to raise public
awareness of the vulnerability of some
groups of young people, especially in rural
areas, who are experiencing nutritional
problems such as stunting which could be
caused by inadequate intake of nutritious
food.
The implementation of nutrition and health
education programs for stunting prevention
through a gastro-toursim perspective in the
11 countries of Southeast Asia could be a
promising one. Government of these
countries may need to implement clear
gastro-diplomacy policies and programs that
could prove valuable to raise community
awareness on the importance of culinary
perspectives and healthy food consumption
using available natural resources to help
solve stunting at the regional level..
Gastro-Tourism Gastro-Diplomacy and as Potential Approaches
to Prevent Stunting in Southeast Asia
Opinion
Reference:
Jean Anthelme Brillat-Savarin. The Physiology of Taste. 1825. Ed. www.un.org “High Level Political Forum on SDG’s 2020 ECOSOC”– 14 July 2020 11:48 PM
by Repa Kustipia - Center for Study Indonesian Food Anthropology
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RECFON AWESOME 1 EDITION
Infographic
Infographics for free use. Remodification with consent.
For more info contact : information@seameo-recfon.org
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RECFON AWESOME 1 EDITION
Infographics
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RECFON AWESOME 1 EDITION
ECCNE and NGTS Corner
This section of the magazine will feature news tidbits on SEAMEO RECFON’s two flagship programs,
namely: Nutrition Goes to School (NGTS) and Early Childhood Care, Nutrition and Education (ECCNE).
It will include completed and forthcoming activities as well as publications of the two programs).
ECCNE Program Produces a Series of 9 Modules
A series of nine modules on Holistic
Integrative Early Childhood Care Education
can now be accessed at SEAMEO RECFON
website (http://www.seameo-
recfon.org/books/module/eccne-modules/)
These modules are meant to facilitate the
teaching-learning process on ECCNE among
early childhood education teachers in
Indonesia. All written in Indonesian language,
the modules cover the following topics :
1. Introduction of Early Childhood Care,
Nutrition and Education concept
2. Parenting
3. Understanding growth and development
of young children (0-6 years old)
4. Playing session with young childhood
5. Adequate nutrition for young children
6. Personal Hygiene & Food Safety
7. Integrated management for sick
children
8. Child protection, security and safety
9. Implementation and monitoring of
ECCNE program
The publication of the nine modules was made possible through the efforts of the Indonesian
ECCNE Working Group that consists of staff of SEAMEO RECFON, SEAMEO CECCEP,
Indonesian ECE Teacher Association (Himpunan Pendidik dan Tenaga Kependidikan Anak Usia
Dini – HIMPAUDI) and Academic Partners.
The 1st batch of ECCNE Online Training for Indonesian ECE teachers
To support the needs for capacity building of
ECE teachers on early childhood care,
nutrition and education, SEAMEO RECFON
initiated the first batch of ECCNE Online
Training in 2020 in collaboration with The
Ministry of Education and The Ministry of
Religious Affairs of Indonesia. The training
was designed to deliver 9 ECCNE modules
for 10 weeks with total learning hours of 112
hours (2 credit points from Directorate of
ECE Teachers and School Personnel).
The training was aimed to enable the
participants to (1) understand the concept of
holistic and integrative ECE, (2) deliver
messages related to child care, health and
nutrition to parents via parenting session in
ECE centers, (3) develop action plan to
implement ECCNE in their ECE centers.
The first batch of ECCNE online training was
conducted in April 1st – May 15th 2020 and
attended by 808 participants from 50 stunting
prioritized districts in Indonesia. Active
participation and completion rates were 71%
and 65%, respectively. This initiative is also
planned to be be affered to ECE teacher in
Southeast Asia next year.
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RECFON AWESOME 1 EDITION
ECCNE and NGTS Corner
NGTS Compilation Books, Infographics and Microsite
About School-Based Nutrion Promoon in Indonesia to be available soon
Five compilation books and five
infographics on school-based nutrition
promotion (SBNP) programs in Indonesia
and a microsite for sharing the SBNP tools
will soon be available for the general public
before the end of 2020.
The compilation books and infographics are
targetted for academicians, policy makers,
program implementers, school community,
the general public and the media. Written
in both English and Indonesian versions,
these publications will be accessible at the
the SBNP-Indonesia microsite lodged at
SEAMEO RECFON website.
The publications and the microsite were
made possible through the funding support
from the Global Alliance for Improved
Nutrition-Indonesia and through the efforts
of the members of the Indonesian SBNP
Working Group as part of the NGTS
activities.
A two-month online training on Adolescent
Nutrition is now ongoing for nearly 1200
school teachers and principals from 482
high schools/madrasah in 141 districts in
34 provinces in Indonesia since August
2020.
This online training is aimed at increasing
the awareness of the participants on the
importance of nutrition and building the
capacities their to integrate it effectively in
school classroom and extra-curricular
activities. It covers the topics on nutrition
education, healthy school canteen, school
gardening as a nutrition education medium,
and hygiene and sanitation.
The participants are expected to formulate
lesson plans related to the topics as well as
a general plan of action to implement them
in their respective schools/madrasah after
the training.
Information Sharing on School-Based Nutrition Promotion
Implementation through Online
This year, SEAMEO RECFON has lined up
a series of online information sharing
sessions on school-based nutrition
promotion (SBNP) for both Indonesian and
Southeast Asian audiences.
The series of online information sharing
sessions for Indonesian school teachers
called NGTS SOLUTIONS (Strengthening
via Online Lecture Updates and Teachers'
Interaction on Nutrition Series) started in
July 2020.
This series consists of five sessions and will
culminate in November 2020. Each session
features the experiences of selected school
teachers as resource persons in
implementing the different components of
NGTS. The NGTS components include
nutrition education, promotion of variety of
food consumption, healthy school canteen,
school garden, and sanitation and personal
hygiene.
For the Southeast Asian audience, SEAMEO
RECFON will, for the first time, bring
practitioners in school-based health and
nutrition programs from both education and
health sectors in the region and beyond as
resource persons. The webinar series
serves as a forum to share and discuss best
practices and lessons learned in the
implementation of school-based nutrition and
health programs. For this year, the webinar
series will be held in October and November,
featuring four thematic sessions dealing with
Nutrition Promotion at School, School
Feeding Program, School Canteen, and
School Garden and Sanitation.
Detailed information about this webinar
series can be obtained from SEAMEO
RECFON social media accounts.
High School Teachers and Principals
Participate in Online Training on Adolescent Nutrition
For more info visit : http://sbnp.seameo-recfon.org/
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RECFON AWESOME 1 EDITION
- Dietary Assessment
SEAMEO RECFON
LABORATORY
Food Analysis
Borax | Formaldehyde# | Nitrate-Nitrites
Rhodamine | Methanil Yellow |
Clyclamate | Mercury # |
Escherichia Coli | Total Coliform |
Physic
Semi Quantitaive; # Qualitative
Our Services
Assessment Packages
Biochemical Assessment
Zinc* (300uL) | Vitamin A* (40uL) | Vitamin E* (40uL) |
Beta carotene* (40uL) | Vitamin D-25OH* (450uL) |
Vitamin C (300uL) | Ferritin (450uL) | Hematologic profile** (3mL)
Dietary Assessment
Interview and Analysis on Food Frequecy
Questionnaire (FFQ), Semiquantitative
Food Frequency Questionnaire (SQFFQ)
and 24-h Food Recall.
Analysis on standard nutrients, additional
nutrients, additional food intake by food
group/ sub group/ food intake.
Anthropometry and Body
Composition Assessment
- Anthropometric measurements
(Weight, Height, Length, & mid-upper arm circumference)
- Body composition assessment
(Skin folds & Bioelectrical Impedance Analysis (BIA))
Genetic Analysis
SNP Detection |
Gene Expression Analysis
Freeze Dry Services
Primary applications of freeze drying include
biological (e.g. bacteria and yeasts), biomedical
(e.g. surgical transplants) and food processing
(e.g. coffee). The quality of the product is excellent
and nutritional content generally remain
unchanged.
Risk of Metabolic
Syndrome Risk of Anemia Oxidative Stress Vitamin D
Deficiency Healthy Canteen
*Accredited by
- Complete Blood
Count
- Blood Glucose
- Blood Cholesterol
- Blood Uric Acid
- Bioelectrical
Impedance analysis
- Blood pressure
- Complete Blood
Count
- Ferritin
- Zinc
- Dietary Assessment
- HsCRP
- Vitamin A
- Betacaroten
- Vitamin C
- Vitamin E
- Dietary Assessment
- Vitamin D
- Dietary Assessment
Chemical
Contaminantions:
- Boraxs
- Formaldehyde
- Nitrates - Nitrites
The numbers above are the minimum volume of sample needed
for analysis. **) Whole blood, while the others are serum/plasma
ⱡⱡ
group/ sub group/ food intake.
1.
2.
ⱡ ⱡ
ⱡ
ⱡ
- Rodhamine
- Methanyl Yellow
- Ciclamate
Microbiological
Contaminantions:
- Total Coliform
- E - coli
- Staphylococcus
Healthy Canteen
Checklist
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RECFON AWESOME 1 EDITION
Hematology Analyzer
StepOne™ Real-Time
PCR System
Chemiluminescence
immunoassay
(CLIA) Analyzer
Microtoise Food Model Measuring Tape
(Seca 201)
Knee Height
Caliper (Shorr)
Baby Lenght
Board
Skinfold Caliper
(Holtain)
Food Weighing Scale
Freeze Dryer
BIA Analyzer
MaestroNano Pro,
Micro-volume
Spectrophotometer
Other Equipments
Hemocue 201 Shorrboard
(Shorr)
Body Weighing
Scale (Seca 876)
Our Facilities
HPLC Waters
Alliance E2695 AAS GBC 932AA
SEAMEO RECFON Laboratory aims to support research in
food and nutrition by providing biochemical assessment,
dietary assessment, anthropometry assessment, food
analysis, genetic analysis, freeze dry services and panel of
laboratory tests. Accredited by ISO/IEC 17025:2017, the
laboratory committed to assure quality and serve the best
for you.
SEAMEO RECFON Laboratory aims to support research in
food and nutrition by providing biochemical assessment,
dietary assessment, anthropometry assessment, food
analysis, genetic analysis, freeze dry services and panel of
laboratory tests. Accredited by ISO/IEC 17025:2017, the
laboratory committed to assure quality and serve the best
for you.
food and nutrition by providing biochemical assessment,
dietary assessment, anthropometry assessment, food
analysis, genetic analysis, freeze dry services and panel of
laboratory tests. Accredited by ISO/IEC 17025:2017, the
laboratory committed to assure quality and serve the best
http://seameo-recfon.org/laboratory-servicehttp://seameo-recfon.org/laboratory-servicehttp://seameo-recfon.org/laboratory-serviceshttp://seameo-recfon.org/laboratory-services
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Jl. Salemba Raya 6 Jakarta 10430
(021) 319 30205(021) 319 30205(021) 319 30205
(021) 391 3933(021) 391 3933(021) 391 3933
lab@seameo-recfon.orglab@seameo-recfon.orglab@seameo-recfon.org
Contact Us
Laboratory Unit SEAMEO RECFON
SEAMEO RECFON Building
Jl. Salemba Raya 6 Jakarta 10430
(021) 319 30205
(021) 391 3933
lab@seameo-recfon.org
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RECFON AWESOME 1 EDITION
RECFON AWESOME 1 EDITION
VOL. 1 NO. 1 SEPT 2020
