The State of the World's Children 1998: Focus on Nutrition

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Panel 16

Indonesia makes strides against vitamin A deficiency

Photo: A health and nutrition worker in Indonesia explains the benefits of eggs, a good source of vitamin A.

One of the great - and still evolving - nutritional success stories is the progress made by Indonesia towards eliminating vitamin A deficiency. Two decades ago, in this nation of islands with a population of 200 million - the fourth highest in the world - the problem was serious. High levels of vitamin A deficiency, which can cause blindness and damage the immune system, greatly increasing the risk of illness and death, affected more than 2 million Indonesians.

The Government, in cooperation with UNICEF and other international partners, tackled the problem through the distribution of high-dose vitamin A capsules to children ages one to five, reducing deficiency levels dramatically. The rate of severe vitamin A deficiency has declined by more than 75 per cent, according to a national survey in 1993, sparing the eyes, health and lives of millions of children. Blindness among children due to vitamin A deficiency was eliminated in 1994.

Indonesia has not fully solved the vitamin A problem, however. Severe deficiency remains a problem in three provinces, and the survey also found that approximately half of all children under five had inadequate levels of vitamin A. Studies among schoolchildren and breastfeeding women in West Java have shown mild and moderate deficiency to be prevalent.

In response, the Indonesian Gov ernment has set the goal of eliminating vitamin A deficiency by the year 2000, using four strategies. The first is continued distribution of vitamin A capsules to children ages one to five through posyandu (community health posts), an effort which reached 60-70 per cent of children in this age group in 1993-1994. The second strategy is distribution of high-potency vitamin A capsules to mothers after they give birth, which will require special efforts, as only 35 per cent of births occur under medical supervision. The other strategies are food fortification with vitamins and minerals, including vitamin A (which is already under way by noodle manufacturers), and promotion of increased con sumption of foods rich in the vitamin.

In support of this effort, the Gov ernment, with assistance from Helen Keller International, the Micro nu trient Initiative and UNICEF, has launched the Central Java Project to improve vitamin A intake among children in this region in the first two years of life.

The project undertook three major efforts beginning in 1996, with the Indonesian system of posyandu and its cadre of midwives and birth attendants at the centre. First, a supplementation programme was launched to give one high-potency vitamin A capsule to all new mothers during the first month after delivery, along with two doses of deworming pills, to improve their health and nutrition. En suring mothers' adequate intake of vitamin A also ensures that babies receive the amount they need through breastfeeding.

In the first six months of the project, nearly 20 per cent of new mothers in Central Java received vitamin A capsules, almost double the rate in the previous two years. The goal of the project is to reach at least 80 per cent coverage.

A second element of the project is a large-scale social marketing campaign to promote consumption of foods rich in vitamin A, focusing on eggs and dark green leafy vegetables. Research found, for example, that while a number of vitamin A-rich foods - such as eggs, liver, spinach, cassava leaves and papaya - are available year-round, few mothers or community leaders recognized these as good sources of vitamin A. Therefore a series of radio and television spots, posters, banners, advertising and one-on-one counselling methods were developed to publicize the benefits - for pregnant and breastfeeding women and for children between the ages of 6 and 24 months in particular - of eating eggs and vitamin A-rich foods.

Third, a nutritional surveillance system was instituted to provide information on nutritional status, food consumption patterns and updates on the effectiveness of the project.

Thus far, the project clearly has improved the understanding of nutrition and diet patterns in Cen tral Java. Within three months of the start of the social marketing campaign, egg consumption by both children and mothers had increased, correlated with higher vitamin A levels.

Vitamin A capsules will continue to be an important measure because people's diets are still not sufficiently high in the vitamin. But the project has demonstrated that enriching diets through eggs, an available and rich source of vitamin A, is an important and sustainable step towards ensuring that mothers and children receive the vitamin A that they need to help them live and grow.

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