PUBLIC HEALTH

PROBLEM & PUBLIC

HEALTH INDICATORS
Agustiana Dwi I V, M.BIOMED

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Berdasarkan Keputusan Menteri Kesehatan RI No.

374/MENKES/SK/III/2007 tentang Standar Profesi Gizi

Salah satu peran :

:Pengelola layanan gizi
di masyarakat

NCP

assesment

Memahami masalah gizi di masyarakat

DATA COLECTION

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Hellen Young & Susanne Jaspar, 2006. The meaning and mearurement of acute malnutrition in
emergency. A primer for decision maker. http://se1.isn.ch/serviceengine.../en/networkpaper056-print

Siti Muslimatun, Widya Karya Nasional Pangan dan Gizi, 2012

GAIN, FFI, MI, Unicef, 2009. Global Report 2009, Investingthe future, a united call to action on
vitamin & mineral deficiency. www.unitedcalltoacyion.org

MAGNITUDE MACRO &

MICRONUTRIENT

www.themegallery.com

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Prevalensi StUnting & Overweight GLOBAL

WHO 2013, World Health statistics 2013. http://apps.who.int

iris/bitstream/10665/81965/1/9789241564588_eng.pdf

Masalah Kesehatan Global

Kematian
Ibu, Bayi &
Balita
Penyakit infeksi
(Diare, ISPA (balita)
HIV, TB, malaria

Kekurangan gizi
mikro: Fe, vit A,
Iod, Zn
Kekurangan gizi
makro: wasting,
stunting,
underweight

Overweight,
obesitas
Penyakit degeneratif:
hipertensi, jantung,
stroke, dislipidemia, DM,

PENYEBAB UTAMA KEMATIAN

BALITA

WHO 2013, World Health statistics 2013. http://apps.who.int

iris/bitstream/10665/81965/1/9789241564588_eng.pdf

MASALAH GIZI MIKRO Indonesia?

Pre-school children
with anemia
(Hb<110g/L) =
44,5%
Pregnant women
with anemia
(Hb<110g/L) =
44,3 %
Non pregnant
women with
anemia
(Hb<120g/L) =
33,1%
Population at risk
of inadequate of
intake of zinc =
34,4 %

School children
with iodine
deficiency (EIU=
Ekskresi Iodium
dalam Urin<100
pg/L) = 16,3%
Pre school children
vit A def (serum
retinol
<0,70mol/L) =
19,6 %
Pregant women
with night
blindness = 1,7%
Vitamin A
supplementation
coverage = 87%

Household
consuming
adequate iodine
salt = 73%

GAIN, FFI, MI, Unicef, 2009.

Global Report 2009,
Investingthe future, a united call
to action on vitamin & mineral
deficiency.
14
www.unitedcalltoacyion.org

Consequences of Malnutrition

deficiency

reduces

Vitamin A

survival

PEM
Iron
Iodine

productivity
intelligence

Soekirman, 2007. Indonesia Health Profile. Food and Micronutrient Intervention

Course, SEAMEO-TROPMED RCCN-UI.

Problem Health Indicators

(PHI)
Suatu indikator yang menunjukkan suatu
masalah kesehatan termasuk kategori
masalah kesehatan masyarakat.

PHI - Undernutrition

INDICATOR
LOW
WASTING
UNDERWEIGHT
STUNTING

<5
<10
<20

% PREVALENCE
MEDIUM
HIGH
5-9.9
10-19.9
20-29.9

10-14.9
20-29.9
30-39.9

VERY
HIGH
15
30
40

-nutrition is defined as < -2 Z scores of the median of the reference popu

ein et al., Bulletin of the WHO 72: 273-283, 1994 in Gibson 2005 p. 348

Trigger Level of Over nutrition

> 10% : health problem

PHI - IODINE DEFICIENCY

DISORDER
Outcome indicators for IDD and criteria for classifying the
severity of
IDD
as
a
public
health
problem
(WHO/UNICEF/ICCIDD, 1994)
Indicators
Goiter (%)
Thyroid volume
Median urinary
iodine (g/L)
TSH >5mU/L
whole blood (%)

Target
Classification of IDD severity
population None Low Intermedi Hig
ate
h
School<5
5-19.9
20-29.9
30
aged
children
School<5
5-19.9
20-29.9
30
aged
children
School100 50-99
20-49
<20
aged
children
Neonates
<3
3-19.9
20-39.9
40

 Dampak Defisiensi Iodium

Retardasi mental , kurangnya
perkembangan otak, kretinisme ,
stillbirth, mengalami penurunan fungsi
mental yang ditunjukkan dengan
gangguan kemampuan mengambil
inisiatif dan keputusan sehingga secara
umum akan menghambat perkembangan
Pembesaran kelenjar gondok

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PHI - IRON DEFICIENCY ANEMIA

Estimated From Blood Levels Of Hemoglobin Or Hematocrit

CATEGORY OF PUBLIC
HEALTH SIGNIFICANCE
Severe
Moderate
Mild

PREVALENCE OF
ANEMIA
> or = 40
20.0 39.9
5.0 19.9
< or = 4.9

UNICEF, UNU and WHO, 2001 pp. 17

PHI - IRON DEFICIENCY ANEMIA

Hemoglobin and Hematocrit Anemia Present in a Population
Age or Gender Group
Children 6-59 months
Children 5-11 years
Children 12-14 years
Non pregnant women
(above 15 years of age)
Pregnant women
Men (above 15 years of
age)

Hemoglobin
g/l
mmol/l
110
6.83
115
7.13
120
7.45
120
7.45
110
130

UNICEF, UNU and WHO, 2001 pp. 33

6.83
8.07

Hematocrit
l/l
0.33
0.34
0.36
0.36
0.33
0.39

 Jumlah zat besi yang diserap oleh tubuh

dipengaruhi oleh tiga faktor yaitu jumlah
zat besi dalam makanan, bioavailabilitas
besi dalam makanan, dan penyerapan
oleh mukosa usus

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PHI - VITAMIN A
Biological Indicators of Sub clinical Vitamin A Deficiency in Children 671 Mo of Age and Their Use in Detecting a Public Health Problem
(WHO 1996)
Indicator (cut-off)
Mild Moderat Sever
e
e
Functional
>01-<5%
5%
Night blindness (present at 24-71 mo <1%
of age)
Biochemical
21020%
<10%
<20%
Serum retinol (0.70 mol/L)
Breast milk retinol (1.05 mol/L or 8 <10%
1025%
g/g milk fat)
<25%
<20%
RDR (20%)
2030%
<30%
MRDR
(ratio 0.06)
30%
The
prevalence
in a population of at <20%
least two 20of the above
indicators of vitamin A status, at levels below
the cut-off,
<30%
indicates
a public health problem
Histological
RDR : Relative dose response
CIC/ICT: Modified
(abnormal
atresponse
24-71 mo of <20%
2040%
MRDR
dose
age)
CIC
: Conjunctiva impression cytology
<40%

PHI - VITAMIN A
IVACG 2001 Prevalence Criteria Indicating Significant Vitamin A
Deficiency

Criteria

Clinical
Children 2-5 y
Night blindness
Bitots spot
Corneal xerosis
Corneal ulcers
Corneal scars
Women childbearing age
Night blindness during recent pregnancy
Biochemical
Serum retinol <0.7 mol/dl

Prevalence
(%)
>0.1
>0.5
>0.01
>0.01
>0.05
>5.0
>15

From Sommer and Davidson, Journal of Nutrition 132: 2845S 2850S in

Gibson 2005 p. 497

Riskesdas, 2013

References
1. Corazon VC Barba.2007. Malnutrition: ProteinEnergy Malnutrition. Food and Micronutrient
Intervention Course, SEAMEO-TROPMED RCCNUI.
2. Corazon VC Barba. 2007. Obesity. Food and
Micronutrient Intervention Course, SEAMEOTROPMED RCCN-UI.
3. Soekirman. 2007. Indonesia Health Profile. Food
and Micronutrient Intervention Course, SEAMEOTROPMED RCCN-UI.
4. Micronutrient Initiative, 2007. Vitamin Mineral
Deficiency: a damage assessment report for
INDONESIA

Thanks for authors in citation and widya

rahmawati for slide contribution

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