Curb childhood malnutrition
THE Malaysian Paediatric Association commends Dr Milton Lum on his article, “Malaysia fares worst in Asean for nutrition” (Fit For Life, Dec 23; online at tinyurl. com/star-nutrition). The Malaysian Paediatric Association (MPA) would like to add our thoughts and perspectives to the discussion.
Dr Lum refers to the Global Nutrition Report 2018 which highlighted Malaysia as the only country in Asean exhibiting high prevalence rates of all three states of malnutrition, ie stunting, anaemia and overweight.
We would all do well to react constructively and urgently to our “growing public health emergency”. In this vein, we applaud the Malaysian government for initiating the National Children’s Wellbeing Roadmap (NCWR).
We are encouraged by the NCWR as it appears to meet the six key recommendations in “Time To Deliver: Report Of The WHO Independent High-Level Commission On Non-communicable Diseases,” released on June 1, 2018.
1) “Start at the top”. The NCWR is directed by the Deputy Prime Minister herself. We hope the NCWR will be realised by resolute leadership to tackle the enormous challenges of battling childhood obesity.
2) “Prioritise and scale up”. The NCWR gives childhood growth and nutrition the high priority it deserves within the overall non-communicable disease agenda; preventing obesity in children helps prevent them from becoming obese adults.
3) “Embed and expand”. With the NCWR, we hope childhood obesity prevention and management will receive more emphasis in the health system, as part of universal health coverage.
4) “Collaborate and regulate”. A whole-of-society approach is required to protect our children from obesity. We believe the NCWR can galvanise all stakeholders – not just government ministries and selected NGOs, but also medical and allied health professional bodies, academia, the private sector, civil society, and communities – into a concerted force for change.
5) “Finance”. The fight against childhood obesity calls for greater investment in training for multidisciplinary healthcare professionals, public health promotion, and interventions. We hope the NCWR will be instrumental in increasing the availability of funding for such activities.
6) “Act for accountability”. “Time To Deliver” states that governments should strengthen accountability to their citizens for action. Appropriate tools and transparent reporting under the NCWR is necessary and welcomed.
The MPA embraces its responsibility to help combat childhood malnutrition (stunting and obesity) as a professional body of paediatricians, through the following initiatives, among others:
> Positive Parenting was launched in 2000. Activities today include a magazine, a website (mypositiveparenting.org), and public talks. The MPA collaborates with the Nutrition Society of Malaysia to promote healthy eating and nutrition for children as one of the core pillars of the programme.
> IMFeD For Growth is the MPA’s comprehensive programme on childhood growth, feeding and nutrition. Since 2012, it has conducted over 33 training events for paediatricians and GPs across the country. In 2018, it mobilised 200 private paediatricians in a threemonth, nationwide childhood growth screening and counselling campaign.
About 22% of the 23,000 underfive-year-olds screened exhibited growth risk factors, including poor dietary choices, feeding difficulties, frequent illness and chronic health conditions. In a subset of 10,386 children aged two to five, stunting was found at 15.5%; however, the figure fell to 10.1% after factoring in their parents’ height.
This shows that many Malaysian children are short because their parents are short. It also underscores the need for caution when interpreting growth among children above two years old, as Malaysia does not have its own growth chart.
Currently, the MPA is holding discussions with stakeholders including government ministries, state governments, related expert bodies and potential private sector partners, to develop a new childhood obesity prevention programme.
It will integrate screening, faceto-face counselling and customised online intervention, targeting parents during the preconception, antenatal, newborn and infancy, and two to six years old stages. Impact assessment will be incorporated to enable continuous improvement.
Despite our efforts, the “growing public health emergency” continues to loom large over our children’s future. We believe the whole-of-society approach is ever more crucial to make any impact.
As a key stakeholder, the MPA welcomes the opportunity to collaborate with other like-minded parties in the areas of community-wide healthy lifestyle promotion, parent education, clinical intervention and research.
Together, we will be able to achieve the reach, depth, effectiveness and sustainability required to curb childhood malnutrition (stunting, anaemia and obesity) in Malaysia.