Kuala Lumpur: Putrajaya is Malaysia’s second richest state by median income, but has the fourth highest stunting rate. Why? When the 2016 National Health and Morbidity Survey (NHMS) revealed that Putrajaya’s stunting rate was 24.3%, many were left puzzled. It was higher than the national prevalence of stunting at the time, which was 20.7%. A higher prevalence of stunting is often associated with rural areas and extreme poverty. The Department of Statistics Malaysia (DOSM) in 2020, however, revealed that Putrajaya had the lowest poverty rate in Malaysia.
Meanwhile, 2016 NHMS statistics show that the states with the highest stunting rates in Malaysia are Kelantan, Terengganu and Pahang, which also had some of the highest absolute poverty rates in the country. DOSM statistics showed that of the 32,700 households in the administrative capital, 79.7% were in paid employment. Why then would Putrajaya have higher stunting rates even in Sabah, the state with the highest incidence of absolute poverty? Zaiton Daud, deputy director of family nutrition in the Department of Health’s Nutrition Division, has similar questions. “We are talking about the degree of development of Putra-jaya and the fact that in terms of income security, there is not really a problem because the majority of them are civil servants. Why then do they have a rate stunting so high?” data showed that the lowest stunting rate is in Kuala Lumpur at 10.5 percent. This is strange. What is the difference between Kuala Lumpur and Putrajaya?” she asked during an online forum titled Isu Kanak-Kanak Bantut: Pencegahan dan Model Solusi, organized by Pertubuhan IKRAM Malaysia. She said the Ministry of Health had recognized that stunting was not just a nutritional issue.Many other factors influenced stunting rates, such as health literacy, environment, and access to health care. Zaiton believed that what happened in Putrajaya was due to young children spending long hours in the care of babysitters, potentially exposing them to poor nutrition. “The majority of families in Putrajaya have both working parents, so their children spend a large part of the day at daycare. “That’s when the child’s diet becomes unregulated. By the time parents pick up their children after work, it’s already late. They’re tired. It’s hard to give the best when we are exhausted.
“Would the parents still have the energy to prepare a nutritious meal, or would they just have takeout?” she asked. The question is important because stunting is the most common measure used to identify chronic malnutrition in children. In addition to being short-lived, chronic malnutrition can cause a child health problems throughout their life. Zaiton pointed out that not all nurseries in Putrajaya are registered and hence it is difficult to monitor and regulate them. Registered nurseries must follow strict rules and regulations to ensure that children receive the best possible care in accordance with the Children’s Act 611 and the Child Care Centers Act 1984. Mandatory basic PERMATA course which includes training in the proper care, balanced diet and safety of infants and young children in the hospitality setting. There are currently 63 registered crèches in Putrajaya, of which 28 are located at the workplace (as of March 8, 2022). However, these numbers are barely sufficient to cater for the population of children under 5 in Putrajaya – which according to DOSM in 2020 is around 13,200. It is therefore not surprising that a number of parents use unlicensed child care. This action, however, can lead to very serious consequences. Although it has not yet been conclusively proven, poor daycare practices may be one of the main reasons why Putrajaya has such a high rate of stunting. This certainly helps explain why Malaysia’s stunting rates are distributed across income groups and ethnicity, and even the urban-rural divide.
However, it cannot be denied that children from low-income households are more likely to be stunted simply because they are more vulnerable to underlying determinants of illness, such as insufficient access to nutrition, health care and even proper sanitation. Although childminders at licensed nurseries and child care centers are regularly trained and educated on proper care and feeding guidelines for infants and young children, those at unlicensed child care centers may not be. The waiting list to enroll at these centers may also be shorter and their fees cheaper, making them the most attractive option for low-income parents. Professor Dr Norhasmah Sulaiman, who heads the Department of Nutrition and Dietetics at Universiti Putra Malaysia, believes this was also the case at Putrajaya. Not all residents of Putrajaya have high incomes. Many can even be classified in group B40. So I think one of the reasons why the prevalence of stunting is so high in Putrajaya is poverty – urban poverty. The income gap in Putrajaya is very wide. The cost of living is also high. I believe the majority of mothers in Putrajaya are working so they send their children to nurseries, where they have little control over feeding practices,” she said. * Follow us on Instagram and join our Telegram and/or WhatsApp channels for the latest news you don’t want to miss.
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