Dr. Zaenal Abidin, S.H,M.H – Health Woking Group – serves as a moderator for the public discussion organised by KPAI and a number of organisations on Friday (18/10). He gives an introduction about how stunting becomes a key issue, but also caution that we should not forget other issues, such as increasing number of overweight children .
Other equally important issue is the old theme – the inclusive health development policy for children with disability. There are many challenges to the theme of fulfilment for children with disability, but this does not mean that the government is silent or passive. It may be that the government is not doing enough to provide information and it lack of the capability, and perhaps a lack of collaboration.
One speaker in the public discussion, a child growth pediatrician, dr. Hari Wahyu Nugroho, Sp.A (K) says that the critical times are the 1,000 first days n the womb and the 700 days after birth. These should not be ignored
Once stunting happens, then intervention is possible for only two years. Monitoring then follows to ensure there is no comorbidity. He emphasises the importance of monitoring in the first 1,000 days of life. At the age of two years, brain of a two-year old child is already 80% of an adult brain. Thus, one can say that prevention of stunting or paths to disability should focus on teenage girls as this is the moment that they can become pregnant.
Risk factors durig pregnancy: infections, premature birth, low birth weight, inadequate nutrition, and non-optimum stimulation. There are also other development problems: slow growth (aged 0-6 years) - motoric, speech and language, personal - social, autism and ADHD. There is also mental retardation/intellectual disability.
The burden of disease or the scientific and systematic way of measuring the health loss from all major diseases for all ages, sex, geographical areas from time to time for children in Indonesia is as follows:
5 million children annually: late speech: 50,000 or 10%, autism with disorder spectrum: 30,100 (1:160), ADHD : 25,000 (5%), cerebral palsy: 10,000 (2:10,000), with mental retardation/intellectual disability totaling 8,250,000 (3% of population).
Comprehensive Development Intervention should be possible to do: family supports, biomedical intervention, home-based education with interaction with family members, semi-structured problem-solving interaction, motoric and sensory activities, visual-spasial, social and other education activities - interaction with teachers and peers in school education. There is also need for specialised therapy – occupational, speech and language, physical, behavioural, and sensory integration.
Challenges – Doctors and Costs
Survey finds that the challenges include: lack of time 80%, lack of funds 65%, lack of human resources, lack of supportive equipment 50%, lack of training 40%, and lack of referral 40%.
With regards to funds, consultation with child-specialist costs between Rp. 200,000 and Rp.1,000,000, while therapy session costs between Rp. 100,000 and Rp.500.000, and medicine costs between Rp. 200,000 and Rp.750,000. Hence, it costs between Rp. 1,200,000 and Rp. 5,000,000 monthly with an average therapy of four years. (Astuti)
