Professors Inauguration Speech
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MULTIPLE CHARGES AND NUTRITIONAL PROBLEMS implications NATIONAL HEALTH POLICY DEVELOPMENT
Inauguration Speech Professor Position
the Faculty of Medicine
Gadjah Mada University
Spoken in front of the Open Meeting of Council of Professors
Gadjah Mada University
On February 5, 2005
Yogyakarta
By
Prof. dr. Hamam Hadi, M.S., Sc.D.
Assalamu'alaikum Wr. Wb.
Peace for us all.
Dear Chairman, Secretary, and members of the Board of Trustees University of Gadjah Mada.
Dear Chairman, Secretary, and members of the Council of Professors of Gadjah Mada University.
Dear Rector and Vice Rector of the University of Gadjah Mada
Dear Chairman, Secretary, and members of the Academic Senate University of Gadjah Mada.
Of the House of Kyai, my teacher from the elementary school level to university in or outside the pesantren pesantren.
Dear All civitas academica Gadjah Mada University, The Guest Invite, peers and the happy ladies and gentlemen.
First of all let us praise the presence prayed Almighty Alloh have mercy and His grace to us in the morning so that we can be happy together in the honorable Assembly in order to follow the Open Meeting of Council of Professors of Gadjah Mada University.
Thank you profusely to my Professors Council Chairman, Mr Rector, and Academic Senate Chair of Gadjah Mada University who have given honor to me to the inauguration speech related to my appointment as Professor in the Faculty of Medicine Gadjah Mada University under the title:
MULTIPLE CHARGES AND NUTRITIONAL PROBLEMS implications NATIONAL HEALTH POLICY DEVELOPMENT
I respect the audience,
As a developing country and are building, the Indonesian nation still has some major gaps and shortcomings when compared to other countries that have more advanced.
In the health sector, the Indonesian people still have to struggle to fight various infectious diseases and malnutrition that interact with each other to make a public health level are not visiting Indonesia increased significantly. In most areas of Indonesia, infectious diseases such as Acute Respiratory Tract Infection (ARI), diarrhea, and measles is still a major disease and 10 is still a major cause of death. The high morbidity and mortality Maternal and Child Toddler in Indonesia is associated with poor nutritional status. Ironically, several other regions or to a group of Indonesian society, especially in other large cities, major public health issue instead be triggered by an excess of nutrients; explosion of obesity incidence in several regions in Indonesia will bring new problems which have serious consequences for the development Indonesian nation especially in the health field. In short, the still high prevalence of malnutrition in some areas and the prevalence of obesity increased dramatically in several other areas will increase the burden of more complex and expensive to be paid by the Indonesian people in development efforts in health, human and economic resources.
Poor nutrition Health Problems For The Not-ending visit
Ladies who I respect,
The success of the development of a nation depends on the success of the nation itself in preparing the human resources quality, healthy, intelligent, and productive. No matter how rich natural resources that are available to a nation without a human resources are expected to tough it difficult to successfully build the nation itself. One indicator of success that can be used to measure the success of a nation in building the human resource is the Human Development Index (HDI) or the Human Development index. IPM is based on the development of human resources Indonesia has not shown encouraging results. In 2003, Indonesia HDI ranks to 112 and 174 countries (UNDP, 2003). While in 2004, HDI ranked Indonesia 111 out of 177 countries (UNDP, 2004), which is ranked lower than the HDI rank neighboring countries. The low HDI is influenced by the low nutritional status and health of the Indonesian population, which can be shown to the still high infant mortality rate is 35 per thousand live births, and infant mortality by 58 per thousand and maternal mortality of 307 per hundred thousand live births (UNDP , 2001). Please note that more and half of infant mortality, infant and mother is associated with poor nutritional status.
Malnutrition in Early Life
I respect the audience.
Human life begins from the time of the fetus in the womb. Since then, the little man had entered the struggle for life is one of them for a possible lack of nutrients received from the mother who conceived him. If received nutrients from the mother is insufficient then the fetus will be malnourished and were born with low weight that has less favorable consequences in the next life. Classic history of the impact of undernourishment during pregnancy on pregnancy outcomes has been well documented (Stein & süßer 1975). Lean years in the Netherlands "The Dutch Fainine" which took place in the year 1944-1945, has m mbawa serious impact on pregnancy outcomes. The Dutch Famine phenomenon indicates that infants who during pregnancy (especially 2nd and 3rd trimesters) fell on lean times has the average body weight, body length, head circumference, and weight of placenta is lower than the babies of the abortion is not exposed to the lean years and this is due to decreased intake of calories, protein and other essential nutrients (Stein Z and süßer M 1975).
Ekonoini crisis in Indonesia that occurred in 1998-2000 has made the nutrient intake of pregnant women from poor communities, especially decreased significantly and make them experience Chronic Lack of Energy (KEK) which is defined with Upper Arm Circumference (Lila) <23.5 cm (HKI, 2000). Although no specific studies documenting the effects of ekonoini and crisis kehainilan outcomes, but research conducted recently show clearly that infants born to mothers who experienced KEK has an average birth weight 2568 grams, or 390.9 grams lower than average birth weight of infants born to mothers who did not have the KEK. Pregnant women (BUMIL) who experienced KEK risk babies with Low Birth Weight (BBLR) 5 times greater than pregnant women who did not KEK (Mustika 2004). The prevalence of pregnant women increases KEK during the economic crisis that is reaching 24.9%. Despite experiencing a significant decrease with the improvement in post-crisis Indonesia ekonoini, until the current prevalence of KEK BUMIL still high enough that 16.7% (MOH, 2003). Higher rates of malnutrition in pregnant women has contributed to higher rates in Indonesia BBLR estimated 350,000 infants each year (MOH, 2004)
I respect the audience,
Anemia is another health problem most commonly found in BUMIL. Approximately 50% or 1 in 2 pregnant women in Indonesia suffer from anemia, mostly due to iron deficiency. In some specific areas such as East Nusa Tenggara and Papua, anemia prevalence among pregnant women and even exceeded 80%. Anemia of pregnant women at risk of dying during the birth process 3.6 times greater than mothers who did not hainil anemia (Chi et al., 1981) mainly because perdarahari and / or sepsis. From several studies in Asia concluded that anemia contributes at least 23% of the total maternal deaths in Asia (Ross & Thomas, 1996). Contribution of anemia to the mother's death in Indonesia is estimated even higher reaching 50% to 70%. In other words that 50% to 70% of maternal death in Indonesia actually could be prevented if the prevalence of anemia in pregnant women can be reduced to as low (Hadi, 2002). Indonesia is estimated that 20,000 women per year or 60 women die every day Indonesia therefore associated with pregnancy and childbirth. This figure is higher in areas left behind, especially in eastern Indonesia that reached 1000 per 100,000 live births (UNICEF, 1997). Maternal mortality rate (MMR) was 3 s / d 8 times higher than in AKI in ASEAN countries. Thus, Indonesia can be said to be the largest cemetery in ASEAN for the mothers. Another consequence of anemia in pregnant women is a high risk of premature babies and infants BBLR (Gillespie, 1998). In addition to KEK, and iron deficiency anemia, pregnant women are also vulnerable to deficiencies of other nutrients such as vitainin A, iodine, and zinc. Lack of nutrients this together will bring a more serious impact both for his mother who threatened his safety during pregnancy, labor and childbirth as well as for the baby.
Malnutrition in Early Toddler
Dear Ladies,
Babies are born with low birth weight generally will have a future life of the poor. Babies BBLR have a higher risk of dying within the first five years of life. Those who can survive in the first five years will have a higher risk for experiencing difficulties in long-term life.
For infants of non BBLR, in general they have the nutritional status at birth is roughly equal to the nutritional status of infants in the United States. However, along with age, accompanied by the intake of nutrients was lower than kebutuhari and high burden of infectious diseases early in life then most babies Indonesia continues to experience a decline in nutritional status at the age of peak decreased approximately 18-24 months. In this age group the prevalence of thin toddlers (wasting) and toddler short (stunting) reached the highest (Hadi, 2001). After going through 24 months of age, nutrition status generally improved, although not perfect.
Malnourished toddlers who have a higher risk of dying compared to infants who are not undernourished. Each year approximately 11 million and toddlers around the world die due to infectious diseases such as ARI, diarrhea, malaria, measles, etc.. Ironically, 54% and deaths were related to the lack of nutrition (WHO 2002). Nutritional deficiencies in infants include lack of energy and protein and nutrient deficiencies such as vitainin A, iron, iodine and zinc. As with AKI, infant mortality rate in Indonesia is also the highest in ASEAN (BAPPENAS, 2004). Infancy become more important because a critical period in an effort to create quality human resources. Moreover the last 6 months of pregnancy and the first two years after the birth of a golden period in which brain cells are experiencing growth and optimal development.
Failure to thrive is caused by malnutrition during periods of gold will be bad for the next life difficult repaired. Children who suffer from malnutrition (stunted) had weight average IQ 11 points lower on average than children who are not stunted (UNICEF, 1998). Prevalence of malnutrition in infants and less year to year has decreased significantly. In 1989, preva! Ensi infants less nutritious (Z score Weight Loss by Age) reached 37.5%. In the following years the prevalence of infant malnutrition continue to decline so that by 2000 the prevalence of infant malnutrition to be 24.7%. However, starting in Indonesia 200 after multi-dimensional crisis, lack of nutrition prevalence increases again in a row to 26.1%, 27.3% and 27.5% in 2001.2002 and 2003 (MOH, 2004).
Other malnutrition problems faced by children aged under five is the lack of micro nutrients such as vitainin A, iron, iodine and the like. More and 50% of children under five suffered vitainin A subclinical deficiency characterized by serum retinol <20 mcg / dL (Hadi et. Al., 2000), and one of two (48.1%) of them suffer from lack of iron anemia (SKRT, 2001 ). As already known that children who lack even the vitainin A degree is a high risk for impaired pertumbuhari (Hadi et. Al., 2000), suffering from some infectious diseases such as measles, and diarrhea and, more important is that the lack of vitainin A is responsible for 23% of deaths of children under five in the world (Beaton, 1997).
In Malnutrition in School Children
Ladies and Gentlemen,
As a further result of the high number of BBLR and malnutrition in infancy and lack of achievement of improvement pertumbuhari (catch-up growth) is perfect in the next period, it is not surprising that the common school-age children who are malnourished. More than a third (36.1%) of school age children in Indonesia relatively short when entering school age is an indicator of chronic malnutrition. The prevalence of these short children increased with age and this picture is found both in men and women. If the observed changes in prevalence of short children from one year to the prevalence of short children was virtually no change because the change is very little hariya and 39.8% in 1994 to 36.1% in 1999 (MOH, 2004).
Growing inter-Generation Failed
Pregnant women who experience malnutrition have a higher risk for the baby than the mother hainil BBLR who do not suffer from malnutrition. If not died in early life, BBLR baby will grow and develop with pertumbuhari levels and slower growth, even more so when a less exclusive breastfeeding and supplementary food U.S.! is not enough. Therefore BBLR babies tend to be large to the nutritional status of infants with the worse. Malnourished toddlers will usually also hampered the growth of food consumption, especially if it is not enough and parenting is not true. Therefore, malnourished infants tend to grow into teenagers who have growth disorders and have low productivity. If this young teenager growing up then it will be a short adult, and if the women then obviously she will have a risk BBLR baby again, and so on.
Against Malnutrition Impacts of Economic Value
Ladies and Gentlemen,
Poor nutrition has a significant contribution to the economic value lost due to the malnutrition. In calculating the economic value and malnutrition made recently concluded that due to the prevalence of malnutrition in keseluruhari still relatively high, the Indonesian nation in 2003 to lose the economic value of 22.6 trillion rupiah, or 1.43% of GDP values in 2003 (Lingkage profile 2002). Economic value is calculated based on the costs directly or indirectly arising from the 3 major nutritional problem, namely iodine deficiency disorders result (Gaki) give contributions of 4.5 trillion rupiah, KEP contribution of 5.0 trillion rupiah, anemia in adults given contributions of 7.3 trillion rupiah and anemia in children contributes for 5.9 trillion rupiah. If the prevalence and 3 major nutritional problems in Indonesia constant until 2010 Indonesia is predicted that the nation would lose the economic value of a very high reach 186.1 trillion rupiah. Conversely, if 3 major nutritional problems in Indonesia have been addressed with the use of effective intervention strategies so that intervention can bring economic value to 55.8 trillion rupiah in the year 2010 (Lingkage Profile 2002).
Ladies and gentlemen,
With the condition that the health sector budget is still very limited, the economic value lost due to lack of nutrition or economic benefits that can be obtained with appropriate interventions remains a very significant figure. As is known, the health sector budget in Indonesia is still low compared to most health budget neighboring countries; less than half of Malaysia's health sector budget, and approximately only a third of the health budget in Thailand and the Philippines. Economic value lost due to nutritional problems would be much greater when taking into account the economic value lost due to other nutritional problems, especially nutrient masalab more (Indonesia Human Development Report 2001).
More Nutrition and Obesity In the New World syndrome ( 'New World Syndrome)
Ladies and Gentlemen,
If a lot less nutrition associated with infectious diseases (although not entirely true), then the more nutrition and obesity is considered as the first signal of the emergence of the disease groups, non-infectious diseases (Non-communicable Diseases) are now common in developed countries and countries is growing. This phenomenon is often given the name "New World Syndrome" or the New World Syndrome (Gracey, 1995) and this has led to the socio-economic burden and public health is very large in countries including Indonesia are developing. Higher rates of obesity, diabetes mellitus (NIDDM), hypertension, dyslipidemia, and kardiovakuler diseases accompanied by high prevalence of smoking and drug abuse is closely related to the process of modernization / acculturation and increased prosperity for a group of people. New World Syndrome is responsible for high morbidity and mortality disproportionately in countries that had just reached the category of developed countries including the countries of Eastern Europe and among ethnic minorities and disadvantaged groups in developed countries.
Modernization and global market trends that began to be felt in most developing countries have given people some progress in living standards and services available. However, modernization has also brought some negative consequences that directly and indirectly, has directed the deviations diet and physical activity an important role for the emergence of obesity.
The size of Nutrition More Problems
I respect the audience,
Obesity is often defined as an abnormal condition or a serious excess fat in adipose tissue is such that damage the health (Garrow, 1988). We have evidence that the prevalence of overweight (overweight) and obesity increased significantly in the whole world that reaches a dangerous level. Incidence of obesity in developed countries like the European countries, USA, and Australia has reached epidemic levels. However, this is not just happening in developed countries, in some developing countries obesity has become a health problem more serious. For example, 70% and the adult population in Samoa in Polynesia obese category (WHO, 1998).
Prevalence of overweight and obesity increased significantly in the Asia-Pacific region. For example, 20.5% of the population of South Korea classified as overweight and 1.5% classified as obese. In Thailand, 16% of the population experienced 4% overweight and obese individuals experience. In urban areas of China, the prevalence of overweight was 12,% in men and 14.4% in women, while in rural areas the prevalence of overweight in men and women respectively was 5.3% and 9.8% (Inoue , 2000).
Obesity is not only found in the adult population but also in children and adolescents. Research conducted in Malaysia recently showed that the prevalence of obesity reached 6.6% for the age group 7 years and became 13.8% in the age group 10 years (Ismail & Tan, 1998). In China, approximately 10% of school children have obese, while in Japan the prevalence of obesity in children aged 6-14 years ranged from 5% s / d 11% (Ito & Murata, 1999).
Along with increasing obesity, the prevalence of type 2 diabetes also increased significantly and this increase is expected to continue. Current population in the Asia-Pacific region who suffer from type 2 diabetes is estimated to reach 30 million people and an estimated 120 million and the current world population has type 2 diabetes. In the year 2010 estimated 210 million people in the world have type 2 diabetes, including 130 million in the Asia-Pacific (Amos et al., 1997).
Ladies and Gentlemen,
Data on obesity in Indonesia can not describe the prevalence of obesity throughout the population, but the data of obesity in adults living in the Indonesian provincial capital is enough to concern us. National survey conducted in 1996/1997 in all provinces of Indonesia's capital showed that 8.1% of adult males (> = 18 years) had overweight (BMI 25-27) and 6.8% are obese, 10.5 % of adult women experienced 13.5% overweight and obese. In the 40-49 year age group overweight and obesity reached its peak respectively 24.4% and 23% in men and 30.4% and 43% in women (MOH, 2003).
Until now there has been no national data on obesity in school children and adolescents. However, several surveys conducted separately in several major cities that showed the prevalence of obesity in school children and adolescents is quite high. At the elementary school children the prevalence of obesity reached 9.7% in Yogyakarta (Ismail, 1999) and 15.8% in Denpasar (Padmiari & Hadi, 2002). Obesity survey conducted recently in adolescent students in Yogyakarta junior showed that 7.8% adolescents in 2% of urban and rural adolescents are obese (Hadi, 2004). The prevalence of obesity over both in children and adults had a warning for the government and the wider community that obesity and all its implications is a serious threat for the Indonesian people, especially in big cities.
Consequences of Nutrition More
Ladies and Gentlemen,
Obesity increases the risk of death for all causes of death. People who have a 40% weight heavier than the weight average of the population at risk of death 2 times greater than the weight average (Lew & Garfinkel, 1979). The increase in mortality among obese patients is the result of some life-threatening diseases like type 2 diabetes, heart disease, bladder disease, gastrointestinal cancer and cancers that are sensitive to hormonal changes. Obese people also have a greater risk to suffer some health problems such as back pain, arthritis, infertility, and decreased function of psychososial (WHO, 2000).
In children, obesity can lead to several chronic diseases including disorders of glucose metabolism, insulin resistance, type 2 diabetes in adolescents, hypertension, dyslipideinia, hepatic steatosis, gastrointestinal disorders, and respiratory obstruction during sleep. More specifically, obesity in adolescents in the Asia-Pacific region associated with type 2 diabetes at a younger age (Mahoney et al., 1996).
Many studies indicate a tendency for obese children remain obese in adulthood (Guo et al, 1994), which can result in increased risk of diseases and disorders associated with obesity in the next life. Psychososial disorders are also often a problem for obese children with obesity learned by themselves and others as a serious handicap.
Why Obesity Can Exploding In Almost All the World?
Energy imbalance
Ladies and Gentlemen,
In short we can say that obesity is a result of an imbalance between energy intake (energy intake) that exceeds the energy used (energy expenditure).
In normal circumstances, energy balance varies from one food to another food, from day to day, week after week with no lasting changes in reserves or body weight. Several physiological mechanisms play an important role within the individual to balance the overall energy intake with total energy used and to maintain stable body weight over a period long enough. Obesity appears only in the event of a positive energy balance for the period of time long enough (WHO, 2000).
Physiological mechanisms responsible for the occurrence of obesity is not completely known. However, there is now more clear evidence of the existence of several signaling mechanisms in the small intestine, adipose tissue and brain, and possibly other networks that can provide a description of current nutrient intake, distribution and metabolism, and / or storage. The entire mechanism is coordinated in the brain and lead, at perubahari diet, physical activity, and metabolism of the body so the body's energy reserves can be maintained. The discovery of late about the hormone leptin, which is secreted by the adipocyte in proportion to the amount of reserves triglisenda and bond with receptors in the hipothalamus gives menanik of system settings that may signal (regulatoiy possible signal systems) that functions to maintain energy balance . However, still much to learn more about the system.
In traditional societies, where people tend to do physical activity and with a note that food availability is not limited to the few people who have nutritional problems; either malnourished or excess nutrients. It is estimated that the human body has a strong defense to fight malnutrition and weight loss than the defense against excessive consumption and being overweight.
Diet and Physical Activity
I respect the audience,
Dietary factors and physical activity patterns have a strong influence on energy balance and can be considered as the main factors that can be changed (modifiable factors) that through these factors many outside forces that trigger weight gain works. More specifically, a diet high in fat and high in calories and a sedentary lifestyle (sedentary Lifestyles) are two characteristics that are associated with increased prevalence of obesity in the world (WHO, 2000).
Ladies and Gentlemen,
Several cross-sectional data indicate a negative relationship between BMI and physical activity (Rising et al., 1994; Schulz & Schoeler, 1994), which shows that obese or overweight people had less activity than the people who lean. However, these relationships can not describe the cause-effect relationship and it is difficult to determine whether obese people have less physical activity because physical activity obesitasnya or less making them obese. However, some results of studies with different study design showed that the low and declining physical activity is the factor most responsible for the occurrence of obesity. For example, obesity does not occur in active athletes and the athletes who stopped doing exercise more often experience weight gain and obesity (Williamso, 1996; Rissanen et al, 1991). Furthermore, the secular trend (Secular trend) in the prevalence of obesity increased in parallel with a decrease in physical activity and increased sedentary behavior, hereinafter referred SEDENTARIAN (sedentary). One example of the best studies that support this hipothesis is expressed by Prentice & Jebb (Prentice & Jebb, 1995). Using a rough proxy of the lack of aktifan like amount of time spent watching television or the number of cars per family, this study shows that physical activity and decrease or increase sedentarian behavior has an important role in weight gain and obesity. Another prospective study showed that the amount of time spent watching televeisi by children is a predictor of high or low BMI few years later (Dietz & Gortmarker, 1985), and physical activity levels low in adults can serve as an important predictor of weight gain substantial (> 5 kg) in 5 years (Rissanen et al., 1991).
I respect the audience,
In a study conducted in 2003 involving 4747 students and junior Yogyakarta 4602 students in junior high school in Bantul regency that 7.8% adolescents in the city of Yogyakarta, and 2% of adolescents are obese Bantul District (cut-off BMI> = 95th percentile NCHS). The average energy intake of obese children in the city of Yogyakarta is 2818.3 499.4 kcal / day while the average energy intake of non-obese adolescents in the city of Yogyakarta is 2210.4 329.8 kcal / day. In other words that the energy intake of obese adolescents was 607.9 kcal / day higher than non-obese adolescents. What is interesting is that obese teenagers 2-3 times more frequently consume fast foods like Mac Donald, Kentucky Fried Chicken, Pizza, etc.. Obese adolescents in everyday to have time to watch TV longer than non-obese adolescents (1.56 hours 3.14 / hr 2.62 VS 1.67 hours / day). Obese adolescents in their everyday activities have the time to read books such as light, sitting, playing play station, etc. longer (1.94 hours 12.20 / hr 11.36 1.76 VS hours / hr) than non-obese adolescents . Conversely obese adolescents have the time to perform moderate or heavy activities like riding a bike, football, basketball and so much shorter than non-obese adolescents. In further analysis found that adolescents with normal energy intake (<2200 kcal / day) but watching TV> = 3 hours / day had a risk of obesity 2.7 times higher than the energy intake of adolescent normal <2.200 kcal / day and the time to watch TV <3 hours / day. Teenagers are a high energy intake (> = 2.200 kcal / day) and had the time watching TV> = 3 hours / day had a risk of obese individuals suffer 12.3 times higher than the energy intake of adolescents <2200 kcal / day and time watching TV <3 hours / day (Hadi et al, 2004). This study indicates that the interaction is additive, multiplicative between sedentarian lifestyle and high-calorie diet.
Main Disease Pattern Changes in Indonesia
Ladies and Gentlemen,
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Conclusion
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67
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70
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71
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73
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74
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77
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Acceptance
78
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Disclaimer
Information
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DEFINITIONS
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