Implementing a programme to treat severe acute malnutrition in Indonesia: What works?

Abstract

Background and objectives: Indonesia, a middle-income country with a large population of young children, is predicted to have a demographic bonus in 2045. However, to benefit from this bonus, the government must optimally manage the triple burden of malnutrition to prevent long-term effects that can significantly decrease quality of life. National data in 2023 showed an increased prevalence of acute malnutrition com-pared to previous years, a wake-up call for the government to address important contributing factors. This article aims to identify the current position of Indonesian guidelines on acute malnutrition (AM) and to provide recommendations.

Methods and study design: A document analysis was conducted to examine the existing guidelines for the treatment of acute malnutrition in children under 5 years of age in Indonesia and their implementation.

Results: The Ministry of Health published the latest guidelines in 2019 and a technical guide-line for the treatment of moderate acute malnutrition (MAM) in 2024. National guidelines were not uniformly implemented across regions due to several factors, such as funding availability, human resources, and logistics. Of the four main components of the latest severe acute malnutrition (SAM) guideline, hospitalisation management has been adequately implemented. Meanwhile, community mobilisation, the availability of out-patient therapeutic regimens, and treatment for moderate acute malnutrition faced numerous challenges.

Conclusions: The implementation of three of the four components of SAM treatment should be improved, with a focus on screening and early detection of acute malnutrition, strengthening the referral system, providing therapeutic regimens, and developing a sustainable reporting system.