Developing an integrated framework to address childhood stunting in Sumba, Indonesia

UQ researchers, including Professor Bill Bellotti of the School of Agriculture and Food Sciences, have partnered with the Indonesian Institute of Sciences and the local government of Sumba Barat Daya to develop an integrated framework to address childhood stunting in Sumba. Sumba largely comprises indigenous communities, and 61 per cent of children in Sumba under the age of 5 are stunted.

“Stunting is a persistent and complex problem that requires coordinated efforts to address, which is why a more integrated approach to addressing stunting in this region is needed,” Professor Bellotti said.

Foods currently produced in Sumba include rice, maize, cashew nuts and fruits, which are sold at markets. The reefs and coastal ecosystems surrounding the area bring seafood to markets. Local stores offer cheap, pre-packaged, convenience foods, which offer high calories, but low nutritional value. Food production is largely the domain of women, some as young as 14, who also care for and raise their children. Traditional wooden houses see families living above their kept animals, with cooking occurring in the middle, and some homes have kitchen gardens.

Within the context of Sumba, the problem of stunting has many contributing factors. There are issues prevalent across the nutrition system that can lead to stunting, for instance, although seafood can be sourced nearby, there is no cold storage at the markets; mothers in the community who are not supported can encounter nutrition issues and other problems that make it difficult to provide nutrition to their children; affordable food can lack essential micronutrients; and poor sanitation and water supply can impact nutrient uptake.

Interventions in the past have been either ‘nutrient-specific’ or ‘nutrient-sensitive’,” Professor Bellotti said.

While nutrient-specific interventions focus on increasing nutrient intake through food supplementation and other technologies, nutrient-sensitive interventions consider the underlying determinants of undernutrition – maternal nutrition, health, or access to water, for example.

“There are so many factors influencing the problem of stunting, but to attempt to alleviate stunting with a single project by targeting everything at once, is to set yourself up for failure,” Professor Bellotti said, “It is also wrong to ‘cherry-pick’ contributing factors and only intervene at a single point. We need to be balanced and systematic about our approach.”

Professor Bellotti explained that the first step to this systematic approach is to map any existing activities against the framework and identify interventions that already have the support of the community. This includes interventions levelled at producing food; processing food; the exchange of food; consuming food; primary health care; and WASH. The framework then links these interventions, which would ordinarily occur separately.

“We’ve tried to create an integrated framework of interventions to reduce childhood stunting, which addresses the nutrition system,” Professor Bellotti said, “People are already working in all these areas, but this often isn’t happening in an integrated way. The innovation lies in the integrating and coordinating of these interventions.”

The project also co-ordinates and designs interventions, which are delivered and evaluated under the same framework.

Another innovative aspect of the framework is what Professor Bellotti calls the ‘lenses’. The impact of each intervention is viewed through a different lens: cultural, gender, environmental, and governance and policy lenses. These different lenses aid the design and evaluation of these interventions, by enabling users to consider a multitude of perspectives.

The interventions are then monitored and evaluated, and learnings are shared.

“With the enormous diversity of stakeholders in Sumba, and anywhere childhood stunting is a concern, coordinating a program of this nature takes considerable organisation,” Professor Bellotti said, “But we hope this program can be scaled to other parts of Indonesia, and to other countries in the region.”

While stunting remains an issue in Sumba, Professor Bellotti hopes this new approach will allow interventions to proceed in a more focussed and cohesive manner.

“Integrated, systemic interventions can contribute enormously to local nutrition systems to reduce the unacceptable levels of childhood stunting in Sumba and the wider region.”