Nutritional anemia: Limitations and consequences of Indonesian intervention policy restricted to iron and folic acid.

BACKGROUND AND

OBJECTIVE

Currently, anemia is a severe public health issue in Indonesia. The aim of this review was to examine policy measures and program implementation to reduce anemia attributed to iron deficiency in Indonesia.

METHODS AND STUDY

DESIGN

A literature search was conducted using Google Search, Sciencedirect.com, and PubMed to retrieve relevant studies in the last three decades. Qualitative data were also obtained from service providers. The search yielded 141 articles, of which 32 were excluded, and further screening was conducted based on the type and scale of the intervention program.

RESULTS

In the iron-folic acid (IFA) supplementation programs studied, antenatal care and health personnel capacity information were limited. Implementation often did not correspond to standard operating procedures. Analysis, follow-up, and feedback on IFA tablet programs were lacking. Moreover, the IFA tablet supply was inadequate, facilities and infrastructure were insufficient, and counseling guidance, relevant material, and information media were lacking. In the national fortification program, wheat flour was used as a vehicle for anemia prevention. However, evidence from the Total Diet Study indicated that wheat noodles have limited value across the Indonesian archipelago.

CONCLUSION

Programs to reduce the likelihood of anemia will be more successful if they are less dependent on nutrient-specific strategies and focus more on the pathogenetic complexity arising from personal behavior, sociocultural factors, dietary and health patterns, local community, and ecology. Partnerships between the community and government reflected in evidence-based policy will always be of value, but continued research is required to examine the factors contributing to the successful outcomes of such programs.