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

BACKGROUND

WHAT MORE TO BE DONE

WHAT HAVE WE DONE

01

02

03

CONTENT

3

BACKGROUND LOW BIRTH WEIGHT & STUNTING 01

4

DEFINITION OF LOW BIRTH WEIGHT

5

11.19 11.22 11.07

11.41

11.2

11.53 11.41

10

10.2

10.4

10.6

10.8

11

11.2

11.4

11.6

11.8

12

2010 2011 2012 2013 2014 2015 2016

Pe

rce

nta

ge (

%)

TRENDS OF LOW BIRTH WEIGHT IN MALAYSIA

Source: Department of Statistics Malaysia, DOSM 6

NPANM III Target: < 8% (by 2025)

LOW BIRTH WEIGHT IN MALAYSIA

1 in 10

7

DEFINITION OF UNDERNUTRITION

#anakmalaysiatinggi 8

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 as severely stunted (WHO, 2006).

• A sign of past or chronic undernutrition and cannot measure short-term changes in undernutrition.

Stunted

Severely Stunted

#anakmalaysiatinggi 9

Prevalence of Underweight, Stunting, Wasting & Overweight among Under 5 Children in

Malaysia

National Health and Morbidity Survey 2006 -2016

#anakmalaysiatinggi 10

STUNTING PREVALENCE IN MALAYSIA BY STATES (NHMS 2016)

12

18.1

34

14.1

19.1

25.7

20.3 23.7

20.8 18.5

26.1 23.1 23.5

10.5

24.3

0

5

10

15

20

25

30

35P

erc

en

tage

(%

)

-------------------------------------------------------------------------------------------------------------------------------

Upper Middle Income Countries = 6.9%

#anakmalaysiatinggi 11

STUNTING PREVALENCE IN MALAYSIA BY HOUSEHOLD INCOME (NHMS 2016)

29.8

22.3 25.1

18.4 19.8

17.4

0

5

10

15

20

25

30

35

< RM 1,000 RM 1,000 -RM 1,999

RM 2,000 -RM 2,999

RM 3,000 -RM 3,999

RM 4,000 -4,999

> RM 5,000

Pe

rce

nta

ge (

%)

#anakmalaysiatinggi 12

FACTORS CONTRIBUTING TO

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

Maternal Characteristics

#anakmalaysiatinggi

Factors Contributing to

Stunting

14

Infant and Young Child Feeding and Care Practices

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

#anakmalaysiatinggi

FACTORS CONTRIBUTING TO

STUNTING

15

Socio Demographic Factors

1. Strata (urban/ rural areas)

2. Sex of the children

3. Maternal education

4. Poor households

5. Race

#anakmalaysiatinggi

WHAT HAVE WE DONE TACKLING THE PERSISTANT PROBLEMS 02

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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

WHAT MORE TO BE DONE TACKLING THE PERSISTANT PROBLEMS 03

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Strengthening infant and young child feeding practices with improved counselling and care of breastfeeding mothers.

Increase knowledge and skills of parents using affordable and nutritious complementary foods.

Broadcast of TV & radio spots focusing on early initiation & exclusivity; continuing promotion of infant feeding.

Strengthening growth monitoring system – develop procedure to cater cases at risk of malnourished especially stunting

Collaborative engagements with other agencies – public, private, NGOs.

Use social and behavior change communication to address knowledge, behavior and social culture - beliefs and practices related to infant and young child feeding.

Partnership with global network –UNICEF, WHO, World Bank, ILSI, WABA

Built up alertness and awareness on malnourished issue focusing on stunting – to the community

21

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CONCEPTUAL FRAMEWORK OF DETERMINANTS OF UNDERNUTRITION (UNICEF 2013)

Stunting & low birth weight is everybody’s business

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COLLECTIVE EFFORTS ARE NEEDED FROM VARIOUS PARTNERS

Governments, Private Sectors, NGOs, Others

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Let's walk & work together,

for the Future of Our Children

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