Expanding Access: Cost-effectiveness of Cochlear Implantation and Deaf Education in Asia.

OBJECTIVE: To determine the cost-effectiveness of cochlear implantation (CI) with mainstream education and deaf education with sign language for treatment of children with profound sensorineural hearing loss in low- and lower-middle income countries in Asia. STUDY DESIGN: Cost-effectiveness analysis. SETTING: Bangladesh, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, and Sri Lanka participated in the study. SUBJECTS AND METHODS: Costs were obtained from experts in each country with known costs and published data, with estimation when necessary. A disability-adjusted life-years model was applied with 3% discounting and 10-year length of analysis. A sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost-effectiveness was determined with the World Health Organization standard of cost-effectiveness ratio per gross domestic product (CER/GDP) per capita <3. RESULTS: Deaf education was cost-effective in all countries except Nepal (CER/GDP, 3.59). CI was cost-effective in all countries except Nepal (CER/GDP, 6.38) and Pakistan (CER/GDP, 3.14)-the latter of which reached borderline cost-effectiveness in the sensitivity analysis (minimum, maximum: 2.94, 3.39). CONCLUSION: Deaf education and CI are largely cost-effective in participating Asian countries. Variation in CI maintenance and education-related costs may contribute to the range of cost-effectiveness ratios observed in this study.

Food Fortification in Indonesia

The paper highlights the history, policy, programs of food fortification intervention and its impact on reducing micronutrient deficiency, especially iodine deficiency disorders (IDD), iron deficiency anaemia (IDA), and vitamin A deficiency (VAD) in Indonesia. General issues in the management of food fortification, and lessons learned from the Indonesian experience are discussed in this paper.

Taking the Indonesian nutrition history to leap into betterment of the future generation: development of the Indonesian Nutrition Guidelines.

Nutrition history in Indonesia began in 1887, when Christiann Eijkman discovered the relationship between vitamin B-1 deficiency and beri-beri. In the 1950's, the socialization of nutrition messages started with the introduction of "Healthy Four Perfect Five" (Empat Sehat Lima Sempurna-ESLS). For the next 25 years after that, ESLS became a favorite in nutrition education and was nationally known. Although the ESLS was never evaluated, food consumption pattern of Indonesians are never balanced. Undernutrition is rampant and overnutrition emerged. In 1995 the Indonesian food-based dietary guidelines was launched by the Ministry of Health, and formally incorporated into the nutrition policy. The Guide has 13 messages. Again, the guidelines were never evaluated; in 2010 undernutrition persists and the prevalence of degenerative diseases increased. Thus, it is urgent for Indonesia to have concrete Nutrition Guidelines (Gizi Seimbang) covering messages like: (1) consume a variety of foods; (2) keep clean; (3) be active, exercise regularly; and (4) monitor body weight. The guidelines shall be developed for all age groups. The guidelines were tested to over 300 audiences and the responses were promising. Dissemination of the messages widely within the formal channels is compulsory. The new Nutrition Guideline messages are an open concept ready to be revised accordingly. It is evident that nutrition sciences and its application had undergone rapid changes over time and Indonesia need to adopt accordingly and timely. Although, outcomes may not be seen in a short time, longer term output will benefit future generations.

Food and nutrition security and the economic crisis in Indonesia.

Indonesia has been afflicted by an economic crisis since July 1997. The economic crisis was preceded by a long drought associated with El Nino. The result has been a decline in food production, especially rice. In the eastern part of the country, especially in Irian Jaya, there was food insecurity during the early stages of the economic crisis. When the crisis escalated to become an economic, social and political crisis in 1998, food insecurity spread to other provinces, especially to urban areas in Java. The crisis led to increasingly high inflation. unemployment, poverty, food insecurity and malnutrition. The official figures indicate that poverty in Indonesia increased from 22.5 million (11.3%) in 1996 to 36.5 million (17.9%) in 1998. Food production decreased by 20-30% in some parts of the country. Compared with prices in January 1998, food prices had escalated 1.5- to threefold by August/November 1998 when acute food shortages occurred, especially in urban Java. Coupled with a drop in purchasing power, the higher food prices worsened health, nutritional status and education of children of urban poor and unemployed families. Despite social and political uncertainties, the Indonesian Government has taken prompt action to prevent a worsening of the situation by massive imports of rice, instituting food price subsidies for the poor and launching social safety net programmes to cope with food shortages and malnutrition. The present paper attempts to highlight the impact of the economic crisis on food insecurity and malnutrition in Indonesia.

Respecting, protecting and fulfilling the right to food and nutrition during the economic crisis: the Indonesian perspective.

PIP: This article presents perspectives on the availability and stability of food and nutrition during the economic crisis in Indonesia. The Indonesian Food Law defined food security as a condition in which every household has access to adequate and affordable food. However, due to economic crisis and El Nino induced drought, food availability and accessibility declined leading to poverty and malnutrition. In response to this crisis, the Indonesian government launched several food policies and programs such as the Social Safety Net Program (SSN). The objective of this program is to help minimize the risk of malnutrition, loss of educational opportunities and lack of health services. Supplementary feeding of infants and malnourished pregnant mothers was part of the nutrition component of SSN. The authorities decided to apply the SSN program not only in times of crisis but as part of the nutrition program. Furthermore, all UN agencies should monitor and coordinate with the SSN in the growth and development of Indonesians in order to make the SSN program effective.^ieng