The Potential Role of Traditional Food in Stunting Prevention in Indonesia; An Expert Consensus

: Indonesia has projected to accelerate stunting reduction to 14% by 2024. Multiform interventions and collaboration among institutions or organizations have already been made to tackle the underlying determinants of stunting. This paper review was to explore the traditional food that may potentially help to accelerate progress towards stunting reduction. The results of an expert meeting of the “Declaration of Consensus Nutrition and Hydration based on Traditional Fo ods” suggested developing an innovative strategy to support the Government of Indonesia in National Strategy stunting reduction. The essential of the first 1000 days of a child’s life particularly in feeding practice to infants aged 6 months with a required on rich macro and micronutrients, home-cooked and derived from traditional foods. Traditional foods have relatively acceptable and affordable with complete nutrients. Growing evidence shows the relationship between local foods and child nutrition status.


INTRODUCTION
Indonesia has projected to reduce the prevalence of child stunting to 14% by 2024 with tremendous interventions (Vice President Office, 2019).Despite the pandemic COVID-19, and disruption to the national development of health, social and the economy, the stunting rate has reduced from 31% in 2018 to 24,4 % in 2021.2However, the disparity in stunting prevalence is wide between geographic areas, sex and socioeconomic status.According to the WHO public health problem, six provinces are in the very high prevalence of stunting category (≥ 30%) moreover four provinces that have a large population of stunted children such as West Java, East Java, Banten and North Sumatra should be called to attention (Ministry of Health, 2018) Inadequate food intake is a direct factor of child stunting.A recent study revealed that inadequate of iron, zinc, calcium, vitamin C and folic acid intake among under-five stunted children in 10 stunting-priority districts in Indonesia (Fahmida et all, 2022).Indonesia is known as the archipelago country and holds multi-cultural and diversity.Each ethnicity has its own food patterns and food availability that can affect the adequacy of nutrients from local foods.This paper review was to explore the traditional food that may potentially help to accelerate progress towards stunting reduction.

RESEARCH METHODS
The conclusions of an expert meeting of "Declaration of Consensus Nutrition and Hydration Based on Traditional Foods" attended by eight expert meeting to discuss and present key consensus findings of the development and utilization of safe and traditional nutritious local complementary foods as part of strategy to prevent stunting.The experts were selected from a across a range of relevant disciplines and expertise such as policy maker, private sector, doctor, socio-anthropologist, and media expert.Several panelists (BK, AF, PST, HM, EMR, NMP, LBS, SS) delivered brief presentations that addressed the core issues on stunting.After the discussion, individual panelist wrote summary brief, which were compiled into this publication.

Stunting problem in Indonesia
President of Indonesia has set out ambitious target to reduce stunting on 14% by 2024 By utilizing the potential of traditional foods as an intervention effort to provide protein that can contribute to accelerating a reduction in stunting rates.Traditional food contains 60% of protein that can ensure the children growth and development (Darapheak et all, 2013).

Acceleration Stunting Reduction
Eradicating The current prevalence of stunting in under-five children has declined from 37.2% in 2013 to 24.4% in 2021, the action to boost the First 1000 Days of Life (1000 HPK) still needs improvement and the Indonesia East Region also have an issue in the WASH program.There are still challenges in ensuring the participation and collaboration of all stakeholders to action in reducing stunting.Likewise, sets a comprehensive assessment, starting from planning, implementation, and distribution as well as monitoring and evaluation of its impact.Therefore, we should orchestra the integration and synergy of program priorities from all stakeholders (Ministry of Health, 2021;Vice President Office, 2017).
The expected output from specific and sensitive interventions, as explained as, 1) an increase in nutritious food consumption, 2) an increase in child care or parenting, 3) an increase in access to health services regarding the case of anaemia, low birth weight, diarrhoea, and malnutrition, 4) an increase in improvement of water, sanitation, and hygiene.One sensitive intervention that is closely related to the improvement of quality nutrition is increasing access to safe, nutritious, and adequate food with locally available foods and affordable prices for pregnant mothers and children (Vice President Office, 2017).

Stunting and Indonesia's Tradition
Indonesia holds cultural richness and diversity with more than a thousand tribes, languages and dialects.Each ethnicity has it's their cuisine, different food preparation and technique also the way to eat the food.Some regions also have a variety of nutritious foods, for example, Indonesia in the east region commonly eat corn or jagung bose, sago palm and cassava as staple foods, while in the west region were mainly eat rice.In addition, traditional foods have nutritional values and are relatively acceptable and affordable where the ingredients are obtained from local food sources.It also can prevent stunting such as nuts, soy bean, mung bean as protein source (Wijaya, 2019;Fahmida & Santika, 2016).
As established by culture and traditions, we should use cultural strategy as our approach and effort to prevent stunting in Indonesia.The reinforcement of the cultural strategy in stunting should have law endorsement, hence the action continues to the next generation.A strong generation generates a strong culture.A well-balanced traditional food which contains complete nutrition-to prevent stunting from early childhood Traditional food derived from local food sources that integrate into community and heritage creates the unique taste, textures and eating experience that defines certain group characteristics.
Regardless of tradition exists, traditional food has rich in nutrients that support health and nourish the body.It provides balance nutrition such as fish, eggs, red meat, seafood, beans, milk, cheese, yoghurt, fruits and vegetables (Wijaya, 2019;Marni et all, 2021).Nutrition investment to prevent stunting should start from the adolescents' age, to prepare their well-being and nutrition status for the future.Besides the requirement of adequate intake, adolescents should have knowledge of stunting and healthy life balance (Marni et all, 2021).However, food products have evolved to become instant and processed foods that expose to adolescents.We need innovation in food traditional and technology use to change the way adolescents view traditional food, experience and value it.
The panel provides a gastronomy strategy to develop Consensus Nutrition and Hydration Based on Traditional Foods in a sample menu as explained below:

Role of nutrition and hydration in traditional food for stunting eradication
The government of Indonesia has demonstrated to point of convergence on the first 1000 days of life as an action to tackle stunting.Infants and young children who face impaired growth as a result of failing to reach their optimal growth and development during their second-year life can cause the short (brain, low IQ and immune) and long impairment (low productivity, short stature, risk of metabolic disease) and it is irreversible.The focus target intervention in the first 1000 days of life started from pregnant women, lactation mothers, and infants to children aged two years.In addition, the program also includes adolescent girls to prepare for their health in the future (Vice President Office, 2017;Sanin et all, 2022;Beal et all, 20218).
At the household and individual level, the importance of the first 1000 days of a child's life includes optimal infant and young child feeding practices and improving adolescent nutrition and health.The important messages for stunting prevention such as include exclusive breastfeeding, weekly iron-folic acid supplementation program, immunization, balanced nutrition intake and hydration status for growth and development.Also, regular growth monitoring and nutrition counselling to pregnant and lactation mothers at Posyandu once a month.In addition, pre-conception nutrition counselling for bride and groom should be encouraged (Vice President Office, 2017).
UNICEF has recommendations for infant and young child feeding, complementary foods given children to infants aged 6 months with an emphasis on nutrient-rich, home-prepared and derived from locally available foods.Also, ensure complementary food textures and variation according to the age development stages.Complementary foods should contain carbohydrates, protein, vitamins and minerals and fat (UNICEF, 2019).
stunting demands collaboration where Stranas stunting has been strengthened by Presidential Regulation No. 72, 2021 which covers specific and sensitive nutrition intervention as a reference for all stakeholders.The funds allocated for this project up to 2024 are IDR 187.1 trillion.To reinforce the stunting reduction program, it is necessary to establish an intervention framework of five pillars in Stranas stunting; 1) Political commitment and National leadership, 2) National campaign focusing on improved awareness, behaviour change, political commitment and accountability, 3) Convergent, a coordinated and consolidated national program with the regional government and community members, 4) Nutritional food security policy and 5) Monitoring and evaluation (Vice President Office, 2019; Vice President Office, 2017).The stunting target has been set to reduce to 14% by 2024, has target to decrease 3,5% each year and National Strategy has been developed and agreed upon.The total national budget allocation for 2022 is IDR 34,10 Billion, it has been tagged and tracked by MoF and Bappenas to ensure that priority intervention and location are implemented.The program focuses on nutrition-sensitive interventions compared to specific interventions where strengthening food security, education and parenting are part of the intervention (Vice President Office, 2019; Vice President Office, 2017).According to Presidential Regulation No. 72, 2021, highlighting the importance of adolescent health as a key to tackle stunting, inadequate nutrition and health among adolescents is a determinant of stunting health outcomes in the future.8They are prone to have anemia then cause mortality during delivery and give birth to low birth weight infants.In 2021, the coverage of Iron-Folic Acid (IFA) supplementation in adolescent girls was 56% (and anemia prevalence is high), while the coverage of IFA has reached 80% among pregnant mothers(Ministry of Health, 2018;Ministry of Health, 2021) Hence, one intervention to cut the intergenerational cycle of malnutrition is to enhance better nutrition "The Potential Role of Traditional Food in Stunting Prevention in Indonesia; An Expert Consensus" the regulation to prevent child marriage under the age of 18 and conduct nutritional counselling the First 1000 Days of Life on the prospective brides in preventing anemia.

"The Potential Role of Traditional Food in Stunting Prevention in Indonesia; An Expert Consensus"
. Thus, strengthened efforts are needed to accelerate stunting reduction to 14%.Stunting is multidimensional issue; hence the government of Indonesia has a strong commitment and multiform interventions to tackle stunting since 2017 by launching the National Strategy to Accelerate Stunting Prevention (Stranas Stunting) (Vice President Office, 2017).Strategy Specific nutrition interventions such as providing supplementation and supplementary food plus nutritional interventions including sensitive nutrition interventions, improving the family's economy, access and utilization of clean water, sanitation (especially latrines and safe septic tanks), which are urgently needed to support personal hygiene behavior and the environment (Vice President Office, 2019).

Potential Role of Traditional Food in Stunting Prevention in Indonesia; An Expert Consensus"
(Ministry of Health, 2021)ortant role in child growth and development where Indonesia's exclusive breastfeeding rate has been increasing steadily during the last decade from 33,7% in 2013 to 52,5% in 2018.Early initiation and exclusive breastfeeding are vital for children's immunity and protection against infections such as diarrhoea and acute respiratory disease.Growing evidence shows that breastfed children are less likely to be sick and obese or overweight and also have better intelligence tests.6Despite the rise in breastfeeding rates, anaemia prevalence stands high among pregnant women.The coverage of IFA> 90 tablets among pregnant mothers was only 37.7%.The current intervention to counter anaemia starts at the adolescence age where the coverage of IFA supplementation in adolescent girls only reaches 46.56%(Ministry of Health, 2021).
. About 5-7 million of children in Indonesia has suffered stunting.Stunting is the multi-causal problem such as "The 3 poverty, economy, social, cultural and so on.East Nusa Tenggara is the highest stunting prevalence (43%) in Indonesia.

Table 1 Nutritious Traditional foods.
Source: Indonesia Gastronomy Community