Symposium 1 Maternal, Infant and Young Child Nutrition July 3 - 4, 2019 Hotel Istana, Kuala Lumpur, Malaysia 1
Low Birth Weight and Stunting in Malaysia – tackling the persistent problems Zalma Abdul Razak Nutrition Division Ministry of Health Malaysia 2
CONTENT 01 BACKGROUND 02 WHAT HAVE WE DONE 03 WHAT MORE TO BE DONE 3
01 BACKGROUND LOW BIRTH WEIGHT & STUNTING 4
DEFINITION OF LOW BIRTH WEIGHT 5
TRENDS OF LOW BIRTH WEIGHT IN MALAYSIA 12 11.8 11.53 11.6 11.41 11.41 11.4 11.22 Percentage (%) 11.2 11.19 11.07 11.2 11 10.8 NPANM III Target: < 8% 10.6 (by 2025) 10.4 10.2 10 2010 2011 2012 2013 2014 2015 2016 Source: Department of Statistics Malaysia, DOSM 6
LOW BIRTH WEIGHT IN MALAYSIA 1 in 10 7
DEFINITION OF UNDERNUTRITION 8 #anakmalaysiatinggi
STUNTING • Children are stunted if their height or length- for-age is below -2 SDs of the WHO Child Growth Standards median, and those below -3 SDs are considered Stunted as severely stunted (WHO, 2006). • A sign of past or chronic Severely Stunted undernutrition and cannot measure short- term changes in undernutrition. 9 #anakmalaysiatinggi
Prevalence of Underweight, Stunting, Wasting National Health and Morbidity & Overweight among Under 5 Children in Survey 2006 -2016 Malaysia 10 #anakmalaysiatinggi
STUNTING PREVALENCE IN MALAYSIA BY STATES (NHMS 2016) 34 35 30 26.1 25.7 Percentage (%) 24.3 23.7 23.1 23.5 25 20.8 18.5 20.3 19.1 18.1 20 14.1 15 12 10.5 Upper Middle 10 Income ------------------------------------------------------------------------------------------------------------------------------- 5 Countries = 6.9% 0 #anakmalaysiatinggi 11
STUNTING PREVALENCE IN MALAYSIA BY HOUSEHOLD INCOME (NHMS 2016) 35 29.8 30 25.1 Percentage (%) 25 22.3 19.8 18.4 20 17.4 15 10 5 0 < RM 1,000 RM 1,000 - RM 2,000 - RM 3,000 - RM 4,000 - > RM 5,000 RM 1,999 RM 2,999 RM 3,999 4,999 #anakmalaysiatinggi 12
FACTORS Maternal CONTRIBUTING TO Characteristics STUNTING 1. Maternal stature 2. Mothers nutritional status (underweight or obese) 3. Maternal age at birth 4. Low birth weight 5. Women who did not receive any interventions 13 #anakmalaysiatinggi
Factors Infant and Young Contributing to Child Feeding and Care Practices Stunting 1. Infants who received poor breastfeeding practices 2. Children who did not receive early initiation of breast feeding 3. Children who were not exclusive or predominantly breastfed 4. Children with illness, such as fever and diarrhoea 14 #anakmalaysiatinggi
FACTORS Socio Demographic CONTRIBUTING TO Factors STUNTING 1. Strata (urban/ rural areas) 2. Sex of the children 3. Maternal education 4. Poor households 5. Race 15 #anakmalaysiatinggi
02 WHAT HAVE WE DONE TACKLING THE PERSISTANT PROBLEMS 16
Nutrition Intervention Programs/ Activities for Pregnant Women 1. Iron Folate supplementation 2. Full Cream Milk Powder Supplementation Programme 3. Nutrition education and counselling for pregnant women. 4. Cooking demonstration at clinics and communities 17
Nutrition Intervention Programs/ Activities for Children Under 5 Years 1. Breastfeeding Promotion 2. Baby-Friendly Hospital Initiative (BFHI) 3. Baby-Friendly Clinic Initiative (KRB) 4. Code Of Ethics For The Marketing Of Infant Foods And Related Products 5. Promotion Of Infant And Young Child Feeding/ Complementary feeding 6. Training on Child Growth Monitoring and IYCF Counselling (adapted from the Combined Course on Growth Assessment and IYCF Counselling, WHO, 2012) 7. Rehabilitation Program for Undernourished Children (Food Basket) 8. Community Feeding Program (targeted at aborigines) 18
Nutrition Intervention Programs/ Activities for Community & others 1. Cooking demo at clinics and community 2. Healthy menu at nurseries/preschools 3. Dissemination of nutritional knowledge in accordance to target groups such as children, parents, teachers and caregivers of nurseries 4. Improving skills on healthy food preparation amongst parents, teachers and caregivers of nurseries through training/ courses 19
03 WHAT MORE TO BE DONE TACKLING THE PERSISTANT PROBLEMS 20
Built up alertness and awareness on malnourished issue focusing on Partnership with global network – stunting – to the community UNICEF, WHO, World Bank, ILSI, WABA Use social and behavior change communication to address knowledge, behavior and social Strengthening infant and young culture - beliefs and practices child feeding practices with related to infant and young child improved counselling and care of feeding. breastfeeding mothers. Increase knowledge and skills of Collaborative engagements parents using affordable and with other agencies – public, nutritious complementary foods. private, NGOs. Strengthening growth monitoring Broadcast of TV & radio spots system – develop procedure to cater focusing on early initiation & cases at risk of malnourished exclusivity; continuing promotion of especially stunting infant feeding. 21
CONCEPTUAL FRAMEWORK OF DETERMINANTS OF UNDERNUTRITION (UNICEF 2013) 22
Stunting & low birth weight is everybody’s business 23
COLLECTIVE EFFORTS ARE NEEDED FROM VARIOUS PARTNERS Governments, Private Sectors, NGOs, Others 24
Let's walk & work together, for the Future of Our Children 25
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