Anda di halaman 1dari 43

Curriculum Vitae

Nama Lengkap : Kusnandi Rusmil,


Gelar : DR.dr.,Sp.A(K).,MM.
Tempat/tanggal lahir : Payakumbuh, 14 Mei 1950
Pekerjaan/Jabatan : Kepala Laboratorium Tumbuh Kembang -Pedsos
Departemen Ilmu Kesehatan Anak FK UNPAD/RSHS
: Ketua UKK Tumbuh kembang –Pedsos PP IDAI
: Ketua Lembaga Perlindungan Anak Jawa Barat
: Ketua Pembina YPAC ,Bandung
Email : kusnandi@hotmail.com
Pendidikan :
SD Negri Slamet Riyadi , Jakarta, Lulus Tahun 1961
SMPN 3 Manggarai , Jakarta, Lulus tahun 1964
SMAN 4 Jakarta, Lulus tahun 1968
Fakultas Kedokteran UNPAD Bandung, Lulus Tahun 1977
Dokter Spesialis Anak FK-UNPAD, Lulus Tahun 1989
Spesialis Anak Konsultan Kolegium IDAI, tahun 1999
Magister Manajemen, UNPAD Bandung, Lulus Tahun 2000
Program Doktor , UNPAD Bandung lulus tahun 2008
Kusnandi Rusmil 1, Eddy Fadlyana1, Andri Firdaus1, Arifin
Kashmir1, Awa Purwanti 2, Utus Indrawati2, Susi Susilawati 2

*Department of Child Health, Medical School, Padjadjaran


University,Hasan Sadikin General Hospital1
*Garuda, Puter, Ibrahim Aji Health Centre2 , Bandung
Background
 Developing Country  Growth disorder
 Poverty and nutrition intake
 Health Surveys
 Last 2 decades  a change in prevalence of children nutritional status in
Indonesia
 1989: 31% of children in Indonesia experiencing a nutritional disorder
 RISKESDAS 2010
 17.9% nutritional disorders (4.9% severe malnutrition and 13.0%
underweight)
PREVALENCE OF UNDERNUTRITION
AND MALNUTRITION, 1989 - 2010
35.0
31.0 29.8 Gz Kurang + Buruk
30.0 28.2
Gz Buruk
26.6
25.0 24.5

20.0 22.8
17.9 15.0
18.4
15.0 12.8 11.8
9.7
10.0

8.1 8.9 3.5


5.0 7.2 4.9
5.4
0.0
1989 1992 1995 1998 2001
year2005 2007 2010 Sasaran 2014
Background

 Target of MDG 2015  15,5% nutritional disorder

 Nutrient excess  changes in prevalence of 1.8%


from 12.2% in 2007 to 14% in 2010
Background
 Are the differences purely due to the success or failure of the programs?

Differences in standards

Differences of interpretation

WCGS x NCHS

An impact on the interpretation of the nutritional status of Indonesian


children

The policies of health programs  standard assessment of nutritional


status
Background

 Assessment of child growth

 Growth curve

 Early detection  early intervention

 Monitoring the health of children  quality of


life in children
Using Curve
International /WHO
 < 1977 : Harvard and Tanner curve

 > 1977 : NCHS

 > 2000 : CDC 2000

 > April 2006 : MGRS ( < Under 5 yr )


WHO Child Growth Standard
 WHO Multicentre Growth Reference Study  growth curve reference

 Represents the development of a normal child

 Subjects from six countries (Brazil, Ghana, India, Norway, Oman, and US)

 8500 children

 Longitudinal study from birth - 24 months and cross sectional for


children 18-71 months

 5 yr- 18 yr : Modification CDC 2000


WHO Child Growth Standard

 Percentile curve and z-score for boys & girls 0-60


bulan
 Body length/age, Height/age
 Body weight/age
 Body weight/Body length, Body weight/Height
 BMI /age
 In addition, arm circumference, triceps skin fold
and subscapular (in children aged ≥ 3 months)
Interpretating Growth Indicator
Growth Indicators
Length/height-for- Weight for
Z-score
age Weight-for-age length/height BMI for age
Above 3
See note 1 obese obese
Above 2 overweight overweight

See note 2 Possible risk of Possible risk of


overweight overweight
Above 1 (see note 3) (see note 3)

0 (median)
Below -1
Stunted
Below -2 (see note 4) Underweight Wasted Wasted

Severely stunted
Severely Severely Severely
Below -3 (see note 4)
Underweight Wasted Wasted
Comparison of WHO Child Growth Standards and CDC
2000 for length/age

 WCGS  the estimates of stunted children will be more than by using the CDC 2000
 compared with the CDC 2000, children with WHO curves have a higher standard  stunted >>>
Comparison of WHO Child Growth Standard and CDC
2000 for weight/age

 The average of baby weight at the WHO curve is higher than CDC 2000 in the period 0-6
months
 increasing number of underweight children during the first 6 months
Comparison of WHO Child Growth Standard and NCHS
reference for weight/length
Comparison of WHO Child Growth Standard and CDC
2000 for weight/height
Comparison of WHO Child Growth
Standards and NCHS
 WHO standard growth curve  ideal picture of how
children should grow at their potential height and
weight.

 WHO  evaluation on the growth of all children in


the world regardless of ethnic origin &
socioeconomic status.

 The research  represent normal subjects.


Research Objectives

Compare the interpretation of the nutritional


status of infants and children under 5
years, based on standard growth curves of
WHO and NCHS
Research Methods
 Cross sectional survey

 7514 Baby and children < 5 years from three public health
service in Bandung on August 2009

 Subjects are grouped according to age (0-5, 6-11, 12-


23, 24-35, 36-47 and 48-60 months)

 Interpretation  WHO and NCHS


Research Methods

 NCHS interpretation
 W/A: Poor, less, better or more

 H/A : Stunted,normal

 W/H: Poor, less, normal and overweight

 WHO
 W/A severly underweight, underweight and median

 H/A severely stunted, stunted and median

 BW/H severly wasted, wasted, median, overweight &

obese.
Research Methods
 The results of the two curves compared on the
basis of equality interpretation
 Statistical analysis using the SPSS 17.1.1
 Prevalence of each age group
 Prevalence rates
 Differences in interpretation of each group
according to age
Results

 From 7514 subject, 3258 subyek (43%) was


analyzed of problem of nutritional status
 The largest distribution is group of 12-23
months (22.8 %)
Subject

Health centers n (%)


Kiaracondong 2939 39,2
Padasuka 2889 38,4
Puter 1686 22,4

TOTAL 7514 100%


Jumlah Sampel Menurut Jenis
Kelamin

Sex n (%)
male 3765 49,9
women 3749 50,1
Total 7514 100
Group age

age total (%)


0-5 mth 438 5,8
6-11 mth 920 12,2
12-23 mth 1712 22,8
24-35 mth 1563 20,8
36-47 mth 1446 19,2
48-60 mth 1435 19,1
Total 7514 100
Comparison of underweight between WHO child growth
standard and NCHS
45.0%

40.0%

35.0%

30.0%

25.0%
NCHS
20.0% WHO

15.0%

10.0%

5.0%

0.0%
0-5 bulan 6-11 bulan 12-23 bulan 24-35 bulan 36-47 bulan 48-60 bulan 0-60 bulan
0-5 mo 6-11 mo 12-23 mo 24-35 mo 36-47 mo 48-60 mo 0-60 mo
Comparison of wasted between WHO child growth
standard and NCHS
20.0%

18.0%

16.0%

14.0%

12.0%

10.0% NCHS
WHO
8.0%

6.0%

4.0%

2.0%

0.0%
0-5 bulan 6-11 bulan 12-23 bulan 24-35 bulan 36-47 bulan 48-60 bulan 0-60 bulan
0-5 mo 6-11 mo 12-23 mo 24-35 mo 36-47 mo 48-60 mo 0-60 mo
Comparison of overweight between WHO child growth
standard and NCHS

45.0%

40.0%

35.0%

30.0%

25.0%
NCHS
20.0% WHO

15.0%

10.0%

5.0%

0.0%
0-5 bulan 6-11 bulan 12-23 bulan 24-35 bulan 36-47 bulan 48-60 bulan 0-60 bulan
Comparison of stunted between WHO child growth
standard and NCHS

35.0%

30.0%

25.0%

20.0%

NCHS

15.0% WHO

10.0%

5.0%

0.0%
1
0-5 mo 2 mo
6-11 12-233 mo 12-2324-35
4 5 6
0-5 bulan 6-11 bulan bulanmo24-3536-47
bulanmo36-4748-60
bulanmo 48-60 bulan
Discussion

 WHO curve
 more sensitif

 can be used to detect growth disorders earlier 


performed intervention since the beginning of
period life

 useful to prevent disturbance of growth


Discussion
 initial growth is too fast  long-term effects
of poor health :
 obesity

 dyslipidemia

 hypertension

 Increased insulin resistance


Discussion
 Disturbance of growth of early age  health
problems:
 increased morbidity in children and mortality in
infants and toddlers
 impaired cognitive function
 chool enrollment rates are declining coverage
 mental health in children who are not good
 disruption function is impaired motor development
in pre-school age
 behavior problems
Discussion

 Monitoring growth of children

 Very important

 Influence in the growth and development of a child

 Use the WHO standard curve  early detection of impaired


growth in children  early intervention
Conclusion

 WHO standard growth curve  a standard measurement


that has been commonly used standard in the world

 Currently WHO curves have been applied in child health


programs in Indonesia through Kartu Menuju Sehat (KMS
2010)
Conclusion
WHO standard growth curve has the advantage in
monitoring changes in growth patterns and
nutritional status of infants at an early age

Use of the WHO growth curves are more sensitive


than the other growth curve so it is useful for
detecting growth disorders early, so early
intervention can be done
Conclusion

Growth itself related to the physical condition of a child


that is one aspect in measurement of quality of life of a
child

use of growth curves WHO Child Growth Standards


were expected to improve an earlier one aspect of
quality of life so this one will be able to contribute to
the achievement Millennium Developmental Goals
Height /Age < - 2 SD
40.0%

35.0%

30.0%

25.0%
WHO Male

20.0% WHO Female


NCHS Male
NCHS Female
15.0%

10.0%

5.0%

0.0%
00-05 06-11 12-23 24-35 36-47 48-60

Grafik Perbandingan prevalensi stunted antara WHO Child Growth Standard


dengan kurva NCHS berdasarkan jenis kelamin
Weight/ Age < -2 SD
25.0%

20.0%

15.0%
WHO Male
WHO Female
NCHS Male
10.0% NCHS Female

5.0%

0.0%
00-05 06-11 12-23 24-35 36-47 48-60

Grafik Perbandingan prevalensi underweight antara WHO Child


Growth Standard dengan kurva NCHS berdasarkan umur jenis
kelamin
Weight/Height <-2 SD
16.0%

14.0%

12.0%

10.0%
WHO Male

8.0% WHO Female


NCHS Male

6.0% NCHS Female

4.0%

2.0%

0.0%
00-05 06-11 12-23 24-35 36-47 48-60

Grafik Perbandingan prevalensi wasted antara WHO Child Growth


Standard dengan kurva NCHS berdasarkan jenis kelamin
Weight / Heigt >2 SD
30.0%

25.0%

20.0%

WHO Male

15.0% WHO Female


NCHS Male
NCHS Female
10.0%

5.0%

0.0%
00-05 06-11 12-23 24-35 36-47 48-60

Grafik Perbandingan prevalensi overweight antara WHO Child


Growth Standard dengan kurva NCHS menurut jenis kelamin