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Nutrition Programme

The Foundation for Mother and Child Health (FMCH) helps undernourished children by:

• Offering a nutritious meal three times a week, rich in protein, vitamins and minerals
• Conducting regular medical checks and ensuring supplementation of vitamins and minerals.
• Providing nutrition education and demonstration for mothers through meetings and cooking classes to improve the quality of home feeding
• Providing regular counselling and home visits where follow ups are necessary
• A growth chart is used to monitor the children’s progress on a monthly basis. The chart plots the child's weight against age (weight for age) and is a quick and convenient tool that shows growth over time of an individual child. It is useful as an initial assessment to show how underweight a child is. At FMCH the nutritional status of the children is also determined by comparing how wasted (thin) a child is or how short they are for their age (stunted). Medical reasons behind the slow growth are determined and addressed after the initial check up.

Once the children have reached an appropriate weight for their age, they graduate from the feeding programme. They continue to receive supplements and FMCH monitors their progress over a further 3 months. The children are also offered a free place at one of our three early learning education centres.

There is a continual turnover of children as some become mildly undernourished and eventually discharged and new severely undernourished ones are admitted to the programme.

Current Nutrition Activities

1. Focus on Enriched Porridge

Children under age two are the most vulnerable to malnutrition especially during the critical period (i.e., during the first twelve months of life). This period coincides when the need for optimal infant and complementary feeding practices are crucial. For its undernourished children under age one, FMCH has created enriched porridge with local foods namely rice, vegetables, oil and protein sources such as fish, chicken, or liver. Additional roasted peanut sprinkles are offered to those who do not have allergies to nuts.

2. Focus on High Energy Milk (HEM)

In addition to providing nutritious foods and enriched porridge to moderately and severely malnourished children, FMCH also offers High Energy Milk (HEM). The HEM recipe utilized for catch-up growth is the one recognized as the “gold standard” by the World Health Organization to rehabilitate severely undernourished children. FMCH receives milk donations for this purpose. Community Health Workers teach mothers how to prepare the High Energy Milk (with powdered milk, sugar and oil) and to offer it frequently over a 24 hour-period.

3. Low rice Menus

Rice is the staple food for most Indonesians and is eaten more often than not, three times a day, year round. In order to improve food variety and nutrition among malnourished children, FMCH has begun to promote a reduction in the amount of rice eaten in favor of occasional, culturally-appropriate “low rice menus” including sweet potatoes and plantains among other foods.

4. Focus on modified positive deviance project

The positive deviance or Hearth Model approach is based on the premise that within poor communities with the same resources, there are children with good nutritional status and some that are undernourished. An assessment of the families with good nutritional status, involves identification of mothers who are positively feeding their children, care for their children and seek out health care within their community. In assessing these mothers, positive traits that can be used as a model for the rest of the community are identified and used. This approach is considered to be of potential benefit to all underweight children on the programme.

The Positive Deviant Inquiry has helped to identify children and families who were positive deviants (i.e children who have remained healthy since birth). They were identified by their growth charts and subsequently observed and questioned regarding their child care and feeding practices. Positive deviant behaviors were extrapolated and compiled and incorporated into health education sessions for the families of malnourished children to benefit from.

5. Focus on micronutrients

Iodine levels in salt:
Iodine is important for mental development and in the prevention of goitre. A lack of iodine can prevent normal growth in the brain and nervous system and lead to poor school performance, reduced intellectual ability and impaired work capacity.

One of the major sources of iodine is salt. Manufacturers and environmental conditions such as heat, light, storage conditions and moisture determine the iodine content in salt. This may explain why 50% of salt samples brought in by mothers for testing this year did not contain iodine. FMCH continues to check the iodine content of salt used by the families on the programme on a regular basis and provide advice.

Vitamin A:
Vitamin A is essential for a well functioning immune system and the survival, growth and development of children. Mothers are encouraged to partake in the Government of Indonesia and Helen Keller International Vitamin A campaign, which takes place twice yearly at posyandu centres (local health clinics). Children from 6 to 59 months are given a routine dose of Vitamin A capsule.

Iron and Anaemia:
Nutritional causes of anaemia are usually attributed to deficiencies of iron, folic acid vitamin B12 and vitamin A in the diet. Iron deficiency anaemia (the most common) is a major cause of maternal death and of cognitive defects in young children. It can permanently affect motor development later on in a child’s life and school performance.

Anaemia levels were tested for the children attending FMCH and 50% were found to be anaemic. Iron supplements in the form of syrup were provided for those anaemic and borderline cases. The supplementation was effective as there was a reduction in the anaemia level after further checks.

6. Focus on Ramadan

In response to the observed weight loss of FMCH children during the Muslim fasting month of Ramadan, the Foundation consulted with Muslim religious leaders to better address the issue by dispelling myths and the perception that young children should fast. Apparently several children were fasting with their parents by default. Based on research provided by the religious leaders, FMCH teaches mothers during Ramadan that children under the age of seven should not fast. Beginning at age seven, the Islamic religion states that children can start practicing to fast during a shortened day and should be fully capable of fasting by age 12. To enable young undernourished children to maintain their weight or continue weight gain, FMCH developed messages and activities encouraging mothers to cook and feed their children regularly during the day throughout Ramadan.

Jl. Puri Sakti I/25A, Cipete, Jakarta Selatan, Indonesia 12410 Tel. (62-21) 769-9812 / 759-09733   Fax (62-21) 765 8023  fmch@cbn.net.id