Education and the Routine
In front of a thatched house in Rovieng district, Bou Him is holding her one-year-old son tightly so that a health volunteer conduct health checkup for him. Nearby Bou Him is the other three-year-old daughter of her, playing on the ground while her mom is also waiting for the examination result.
Each month, she has to make an appointment with health volunteer for medical checkup. To examine nutritional status of her son, the doctor uses anthropometric measurements asfter learning that her son has been undernourished for months.
“Thus, unless she breastfeeds at least twenty minutes, her son can’t grow well because he receives nutrients deficiently,” says Sith Lot, a health volunteer.
Sith Lot, 27, has been working as a health volunteer in Roveing village for more than ten years. He helps indigenous community to better understand the health care and access to health service.
An exclusive breastfeeding means the baby only breastfeeds with no other food or drink including water. Breast milk provides nutrients and protects children against infection, said Sith Lot.
Asked whether Sith Lot’s comments reflect reality of her breastfeeding routine, Bou Him said nothing. Only her husband, Sor Chheurn, 27, admitted the facts.
“I was wondering why our kid still has gone underweight day-by-day though my wife has regular breastfeeding. There might be matter of her breast milk and habit … and to have breast milk for my son, I tell her to eat much meats and more vegetable. Yet to be frank, our son still not gains weight,” Sor Chheurn said.
At Sor Chheun’s backyard, rice miller seems to have been installed for years. Next to the miller, a small dark-gray truck is ready to load stuff. His livestock including pigs, ducks, and chickens are calling for food.
Amongst other households, their living condition seems to be good enough to afford nutritious food and they are not poor, says Ms. Prak Phally, Health and Nutrition project coordinator of World Vision Cambodia.
To make a living, they both said, that they are quite busy for works and somehow they ignore giving good care of children.
“I don’t stay home often. Only my wife takes care of kids and households,” says Sor Chheurn, adding that, we are poor in knowledge of feeding our children fruitfully once we still follow our old traditions.”
Despite plenty of paired education, Prak Phally said, that some of them are still very careless in feeding practices, and even breastfeeding.
“That’s our concerns – as contributors; we find it so difficult once we use all means to push for change the old habits,” she said.
Working in glove with government on malnutrition issue for decades, World Vision Cambodia is the top NGO which pays close attention on nutrition education.
Malnutrition is the underlying causes that contribute to child mortality. In Cambodia, recent indicators show that malnutrition results in wasting, stunting and underweight.
And up to 32% of children under five are malnourished, says the 2014 Demographic and Health Survey, and with no demonstrable reduction in stunting rates in the kingdom since 2005.
To combat malnutrition, Dr. Ou Ke Vanna, Chief of National Nutrition Department, said that large numbers of educational programs are being actively conducted every year in line with key partners and local authorities.
Despite challenges, he believed, that today nutrition education had reached the local communities.
Asked why malnutrition still remains rampant though child mortality decreased, Dr. Ou Ke Vanna acknowledges the facts.
“We organize training and campaign with commune council and provincial health department for outreaching the information to the villagers,” he said, “We, however, can’t achieve it over a night. We lack of resources such as money, mean, and material.”
Aiming to continue nutrition education and reach wider public, he said, that nutrition team has used mass media: radio and TV to spread out the messages.
In Cambodia, media literacy is still limited. For Dr. Ke Vanna, he plans to revise media campaign’s strategy, seeing a huge failure in changing mothers’ attitude so far toward feeding practices remains remarkable problems.
In remote area, he said, that villagers are die hard to change behavior due to poverty and religious belief.
In 2013, Dr. Ou Ke Vanna said that, at least 20 children across the country died among 1,200 due to malnutrition illness, adding that, the majority of children who are stunted resulted from chronic malnutrition.
The 37-page National Nutrition Strategy reads if the undernutrition and micronutrient deficiencies are not successfully addressed, it will be impossible to reach the other Millennuim Development Goals by 2015.
And the key health challenges prioritized in the strategy are maternal and young child undernutrition, including deficiencies of vitamin A, iron, iodine and zinc.
The 1,000 days is a critical period between a woman’s pregnancy and her child’s 2nd birthday. It offers a unique window of opportunity to shape healthier and more prosperous futures.
For Dr. Ou Ke Vanna, he alarms that all mothers shall pay attention on the first 1,000 days of baby.
“Poor nutrition, particularly during this period, can contribute to lower IQ, lower education performance, weakened immune system, and can trap children and their families in a cycle of poverty,” he said.
In Cambodia, poverty rate fell dramatically between 2004 and 2011 – from more than 50 per cent to roughly 20, according to a recent study by World Bank.
Despite making good progress in poverty deduction, undernutrition is still locked in a vicious cycle of increased mortality, poor health, and poor sanitation in households and the community.
Mr. Chan Sophal, economic analyst, said child malnutrition poses adverse impacts on economic development since it affects children’s health and learning capability at early stage of child development.
In other words, he said that malnutrition also stunts economic growth.
“Metaphorically, children are like seeds. When sown seeds are healthy, it will bring about a fruitful harvest,” he said.
The United Nations in 2011 estimated that Cambodia loses more than US$146 million in GDP every year due to the impacts of vitamin and mineral deficiencies alone.
Also, the impact of the indicators of malnutrition analyzed in the report represent a burden to the national economy of Cambodia estimated at more than $400 million annually – 2.5% of GDP, the 2013 Damage Assessment Report of Malnutrition in Cambodia reads.
Since nutrition is cross-cutting issues, Chan Sophal said, that government must develop economy in all aspects to benefit all families, and increase their income and agriculture.
Cambodia remains one of the poorest countries in South and Southeast Asia and with one of the highest prevalence rates of undernourishment and malnutrition.