NKRA, LIH: Orang Asli/ Pribumi

Improving & Sustaining Nutritional

Status of Interior Orang Asli/

Pribumi Children

COMMUNITY FEEDING

PROGRAMME

NUTRITION DIVISION, MOH

Community Feeding Programme (PCF) is an initiativeunder Government Transformation Programme(GTP) 2.0 (2013-2015) for Low Income Households.

In October 2012, Pilot Project for Community FeedingProgramme was carried out among interior Orang Asliin Hulu Perak and Jerantut.

Community Feeding Programme has been implementedsince 2013 in the interior Perak (Hulu Perak), Pahang(Jerantut, Lipis and Cameron Highland), Kelantan (GuaMusang) and Sarawak (Long Keluan).

Background

Childhood malnutrition amongst Orang Asli

•Several studies had revealed that underweight and stunting Orang Asli children were found in one-third to three quarters of the population groups (Khor, 1985; Ismail, 1988, Zalillah & Tham, 2002, Hesham et al, 2005, Shasikala et al, 2005).

•Thus, prevalence of child malnutrition was higher among interior Orang Asli community in Malaysia.

Based on report, 3 states (Kelantan, Perak, Pahang) had the highest cases of malnourished children in the interior. Cases were higher in hard core poor families (JHEOA, 2006).

Gerik

CameronHighlands Lipis

Gua Musang

Areas identified are Gua Musang, Gerik, Cameron Highlands, Lipis

Contributing factors leading to malnutrition among OA children

poverty

shortage of Food

inadequate dietary intake

infectious diseases

incomplete vaccination

socio-economic

status

cultural poor health care

access to agricultural resourcesaffordability

of foodfood

security

safe water

women status

health services sanitation

environment

caring capacity

education

Conceptual Framework of Childhood Malnutrition

Childhood malnutrition

Inadequate dietary intake

Insufficient access to food

Inadequate maternal and child

care

Poor water/sanitation and

inadequate health services

Quantity and quality of actual resources – human economic and

organizational and the way they are controlled

Potential resources, environment, technology,

people

Disease

Outcomes

Immediate causes

Underlying causes at household/ family levels

Basic causes at societal level

Inadequate and/or inappropriate

knowledge and discriminatory

attitudes limit household access

to actual resources

Political, cultural, religious,

economic and social systems,

including women’s status, limit

the utilisation of potential

resources

Adapted: UNICEF

1. To ensure at least 95% of malnourished Orang Asli/

Pribumi children enrolled in the Community

Feeding Programme.

2. To rehabilitate > 25% of malnourished Orang Asli/

Pribumi children after 6 months in the Community

Feeding Programme.

3. To sustain the normal nutritional status of Orang

Asli/ Pribumi children in the Community Feeding

Programme.

Objectives

7

Distribution of Community Feeding Centres (2013-2015)

Gua Musang = 5 PCF

Perak

Kelantan

Pahang

36 Community Feeding Centres2013 = 26 2014 = 7 2015 = 3

Cameron Highlands = 1 PCF

Kuala Lipis = 2 PCF

Jerantut = 3 PCF

Rompin = 1 PCF

Hulu Perak = 18 PCF

Batang Padang = 2 PCF

Kuala Kangsar = 2 PCF

Long Keluan, Miri = 1 PCF

Long Urun, Kapit = 1 PCF

Sarawak

2013 2014 2015

District PCF District PCF District PCF

Hulu Perak 1. Kg. Banun2. Kg. Bal Ragak3. Kg. Bal Salor4. Kg. Bal Chemelak5. Kg. Bal Chareh6. Kg. Bal Changkes7. Kg. Bal Stol8. Kg. Akei9. Kg. Katong 110. Kg. Katong 211. Kg. Senangit12. Kg. Senangit Dalam13. Kg. Lediau14. Kg. Rantau 1a15. Kg. Rantau 1b16. Kg. Rantau 217. Kg. Lerlar

Kuala Kangsar 27. Kg. Piah28. Kg. Kembok

Hulu Perak 34. Kg. Sg Tiang

Jerantut 18. Kg. Sungai Tiang19. Kg. Sungai Koi20. Kg. Sungai Mai

Batang Padang 29. Kg. Jernang30. Kg. Bersih

Gua Musang 35. Kg. Sugi36. Kg. Ayong

Kuala Lipis 21. Kg. Lenjang22. Kg. Pagar

Rompin 31. Kg. Sawah Batu

Cameron Highland

23. Kg. Lemoi Gua Musang32. Kg Pasik

Gua Musang 24. Kg. Jias25. Kg. Langsat

Kapit 33. Long Urun

Miri 26. Long Keluan

Distribution of Community Feeding Centre (PCF 2013-2015)

COMMUNITY FEEDING CENTRE

PCF IN HULU PERAK

PCF Sg Tiang

PCF Rantau 1b

PCF Lediau

PCF Sg Lerlar

PCF Rantau 2

PCF Rantau 1a

PCF Senangit Dalam

PCF Senangit Baru

PCF Akei

PCF IN HULU PERAK

PCF Katong 1 PCF Katong 2

PCF Bal Chemelak

PCF Bal Ragak

PCF Bal StolPCF Bal Changkes

PCF Pos Jernang, Sungkai

PCF Pos Bersih, Slim River

PCF IN BATANG PADANG

PCF IN KUALA KANGSAR

PCF Kg Kembok

PCF Kg Piah

PCF IN JERANTUT

PCF Sg Koi

PCF Sg Tiang

PCF Sg Mai

PCF IN KUALA LIPIS

PCF Kg Lenjang

PCF Kg Pagar

PCF IN CAMERON HIGHLAND

PCF IN ROMPIN

PCF Kg. Sugi, Pos Pasik

PCF Kg. Ayong,Pos Pasik

PCF Kg. Pasik, Pos Pasik

PCF Kg. Jias,Kuala Betis

Bangunan PascabanjirPCF Kg. Langsat, Kuala

Betis

PCF IN GUA MUSANG

PCF IN SARAWAK

PCF Long Urun

PCF Long Keluan

Two initiatives have been identified to reduce malnutrition amongst interior OA children by 50% in 2015 throughCommunity Feeding Programme

20

Food Basket Community Feeding

Community Feeding Programme

Focused initiatives through Community Feeding Programme

21

Rehabilitation Programme

Food Basket (Option 13)

Community Feeding

Ready to Use Therapeutic Food (RUTF)

Supplementary Feeding Programme

Community EmpowermentProgramme

• Special milk and multivitamin•Given to malnourished OrangAsli/ Pribumi children aged 6 months to 6 years from hardcore poor family until rehabilitated

• To support food basket initiative and avoid sharing of food baskets among family members.•Consists of 3 main programmes ie RUTF, supplementary feeding programme and community empowerment programme•Runs parallel with food basket until identified malnourished children in targeted community is rehabilitated.

•Target group: All malnourished Orang Asli/ Pribumi children aged 6 months to 6 years old in selected community •Made of peanut, sugar, milk powder, oil and etc• RUTF is given until the children get rehabilitated (3times/week)

•Target group: All children aged 6 months to 6 years old in selected community • Local volunteers feed the children with:i. a glass of milkii. fish oil or/and multivitaminiii. carbohydrate food based

(biscuits, cereal, etc) iv. protein food based (fish,

chicken and etc)for 5 times/ week.

•Objective: Sharing of information on nutrition/health care through community activities ie health talk, health screening, cooking classes for mothers, gotong royong•Empower local volunteer/leaders on health issues

Implementing Food Basket (Option 13) to interior OA malnourished children from hard core poor families

• To provide special milk powder and multivitamin for the malnourished

children monthly.

• Only for underweight children from 6 months to 6 years old from poor and

hardcore poor family was selected into the programme.

• Considered as a priority case and need to be monitored closely.

• Food baskets is given until rehabilitated.

• To reduce 50% of malnourished children by year 2015

• Improve health status of targeted children.

• Milk is a nutrient dense food and easily consumed .

• Targeted to children, thus, reducing the possibility of food sharing within

family members and OA communities.

• Targeted children with improved weight gain .

• Procurement of milk and multivitamin.

What is the

initiative?

Why is it

Important?

What is the

deliverable?

Where /How to

obtain resources?

Type of food Opt.1 Opt.2 Opt.3 Opt.4

Opt.5 Opt.6 Opt.7 Opt.8 Opt.9 Opt. 10

Opt. 11

Opt. 12

Opt. 13

Rice (5 kg) √ √ √ √ √ √

Beehon (2.8 - 3 kg ) √ √ √ √ √ √

Full Cream Milk(1.8 - 2 kg)

√ √ √ √ √ √ √ √ √ √ √ √

Breakfast Cereal (0.9-1 kg)

√ √ √ √ √ √ √ √ √ √ √ √

Biscuit (1.8-2 kg) √ √ √ √ √ √ √ √ √ √ √ √

Egg (30s) √ √ √ √

Sardine (7 tin:155g/tin )

√ √ √ √

Anchovies (500 g) √ √ √ √

Margarine (240-250 g) √ √ √ √ √ √

Cooking Oil (1 kg) √ √ √ √ √ √

Malt Choc powder (1 kg) √ √ √ √ √ √ √ √ √ √ √ √

Multivitamin (30/ 60 tablets or 50-120ml)

√ √ √ √ √ √ √ √ √ √ √ √ √

Special milk or formula milk (1.6-2 kg)

√

Food Basket Options

Ready to Use Therapeutic Food (RUTF)

• To give the children RUTF until rehabilated (3times/ week).

• Criteria for selection: i. High prevalence of underweight amongst

children under 6 years ii. Hard core poor families iii. Accessibility to

community feeding centre.

• To reduce malnutrition amongst children by at least 30%.

• To improve and sustain nutritional status of children.

• To assist children attain optimal growth.

• Establishment of feeding centre, elimination of food sharing and

community empowerment to health care.

• OA children from 6 months to 6 years old for fast improved weight

gain.

• OAs are more responsible for their children nutritional status.

• RUTF (specially prepared).

• Local village health volunteer.

• Utensils for preparation/cooking.

What are the

initiatives?

Why is it

Important?

What is the

deliverable?

What are the

resources?

RUTF IN 2013 & 2014

At the beginning of the programme,RUTF was locally prepared andsupplied by the respective districtusing the same basic ingredientsconsisted of peanut, sugar, fullcream milk and oil.

RUTF IN 2015

Since 2015, centralized preparation/formulation and supply of RUTFcoordinated by the Nutrition Division.RUTF is made of peanut butter, butter,glucose syrup, glucose, shredded driedcoconut, cereal, full cream milk powderand ground nut.

Nutritional value

Per 100g Per serving (23g)

Energy 605Kcal 139.15Kcal

Protein 8g 1.84g

Total fat 49.8g 11.45g

Carbohydrate 31.2 7.18g

Moisture 9.2g 2.12g

Ash 1.8g 0.41g

Supplementary Feeding Programme

• To provide a glass (~250 ml) of milk, carbohydrate based food

(biscuits/ breakfast cereals and etc), protein based food

(fish/chicken & etc) and multivitamin or/ and fish oil 5x times/week.

• Milk

• Multivitamin or/and fish oil

• Carbohydrate based food

• Protein based food

What are the

initiatives?

Why is it

Important?

What is the

deliverable?

What are the

resources?

• Direct consumption by the child with strict local village health

volunteer supervision.

• Recommended daily important nutrient intake through

supplemented foods given to the child.

• Improved growth.

• Inculcation of milk drinking habit to meet the

recommendation based on the Malaysian Food

Pyramid.

Menu 1:

1 glass of milk

1 tbsp Scott Emulsion

1 tablet Multivitamin

5 piece of biscuit with cream

Menu 2:

1 glass of milk

1 tbsp Scott Emulsion

Rice + sardine

Mix Vegetables

Menu 3:

1 glass of milk

1 tbs Multivitamin

Nasi lemak/ mee goreng/ nasi

ayam

Menu 4:

1 glass of milk

1 tbsp Scott Emulsion

1 tablet multivitamin

1 bowl of bubur keledek

Menu 5:

1 glass of milk

1 tbsp Scott Emulsion

1 tablet of multivitamin

1 piece of lempeng

pisang

1 hard boiled egg

Examples of Supplementary Feeding Menu

Supplementary Feeding

• Carry out activities to create awareness

and improve their knowledge and practices through:-

- Nutrition & health talks

- Health screening & interventions

- Cooking classes

- Gotong royong

• Conducted at least 3 times/week.

• To empower the community/local leaders in the

implementation of health and nutrition

programmes.

• Empowered/ mobilised community leaders and its

community on health and nutrition.

• Improved knowledge and practices on proper

food preparation, handling and storage as well

as feeding principles.

• Collaboration between MOH, JAKOA and OA

community .

Community Empowerment Programme

What are the

initiatives?

Why is it

Important?

What is the

deliverable?

What are the

resources?

No. District No. of PCF No. of volunteers

1. Hulu Perak 18 56

2. Kuala Kangsar 2 6

3. Batang Padang 2 6

4. Jerantut 3 6

5. Kuala Lipis 2 6

6. Cameron Highland 1 2

7. Rompin 1 2

8. Gua Musang 5 14

9. Miri 1 1

10. Kapit 1 5

Total 36 104

Distribution of Orang Asli/ Pribumi Volunteers

Incentive for local volunteers: RM150/ month

Roles of Orang Asli/ Pribumi Volunteer

1. To prepare and feed supplementary foods 5 times/week to allchildren age 6 months to 6 years.

2. To feed RUTF to malnourished children age 6 months to 6 yearsfor 3 times/week.

3. To record daily attendance of children in the Log Book.

4. To ensure all children attend the Community Feeding Centre to gettheir supplementary feeding.

5. To help the health staff to monitor children’s weight and height bytaking anthropometric measurement every month.

6. To help teach the local community on how to prepare nutritiousfood/meals for their children using their own native language.

7. Help to give health education to the local community using theirown language.

Community Empowerment

COMMUNITY EMPOWERMENT PROGRAMME IN JERANTUT

COMMUNITY EMPOWERMENT PROGRAMME IN ROMPIN

HEALTH COMMUNITY PROGRAMME RPS KEMAR

COMMUNITY EMPOWERMENT PROGRAMME IN GUA MUSANG

Cooking Demonstration

Health and hygiene education

COMMUNITY EMPOWERMENT PROGRAMME IN GUA MUSANG

Supplementary Feeding

39

COMMUNITY EMPOWERMENT PROGRAMME

IN SARAWAK

Roadmap and targets by 2015

40

Reduce 25% from baseline

(in 2012) of malnourished OA

children

Implementation

plan

50% reduction of

malnourished OA

children

• Train local village

health volunteer

• Programme

implementation

2015

2014

2013

2012

Malnourished children enrolled in the Community Feeding Programme (2013- Jan-June 2015)

State

2013 20142015

(Jan-June)

No. of

cases <6

years

No. of malnourished cases

% of malnourished cases

No. of cases

<6years

No. of malnour

ished cases

% of malnourished cases

No. of cases

<6years

No. of malnouri

shed cases

% of malnourished

cases

Perak 644 262 40.6 803 289 36.0 793 209 26.4

Pahang 159 123 77.4 300 101 33.7 269 66 24.5

Kelantan 79 63 79.7 224 65 29.0 204 61 29.9

Sarawak 26 14 53.8 155 43 27.7 90 4 4.4

TOTAL 908 459 50.6 1482 498 33.6 1356 262 19.3

Status of malnourished children rehabilitated in the Community Feeding Programme (2013- Jan-June 2015)

State

2013 20142015

(Jan-June)

No. of malnour-

ishedcases

No. of cases

rehabili-tated

% of cases

rehabili-tated

No. of malnour-

ishedcases

No of cases

rehabili-tated

% of cases

rehabili-tated

No. of malnour-

ished cases

No of cases

rehabilita-ted

% of cases rehabilita-

ted

Perak 262 157 59.9 289 63 21.8 209 54 25.8

Pahang 55 34 61.8 101 36 35.6 60 11 18.3

Kelantan 43 22 51.1 65 14 21.5 61 15 24.6

Sarawak 14 9 64.3 43 34 79.1 4 3 75.0

TOTAL 374 222 59.4 498 147 29.5 334 83 24.9

KPITarget

2013-2015

Achievemen

t 2013

Achievemen

t 2014

Achievement

2015 (Jan-June)

1. % of malnourished children enrolled in the Community Feeding Programme

> 95% 95.5% 99.5% 99.7%

2. % of malnourished children recovered after 6 months in the Community FeedingProgramme

25% 59.4% 29.5% 24.9%

Key Performance Indicators (2013-2015)

93.9

96.9

100 100100.0

97.5

100.0 100.0100

98.5

100 100.0

90

91

92

93

94

95

96

97

98

99

100

101

Perak Pahang Kelantan Sarawak

% o

f m

aln

ou

rish

ed c

hild

ren

en

rolle

d in

th

e p

rogr

am

State

Percentage of malnourished children enrolled in Community Feeding Programme (2013- Jan- June 2015)

2013 2014 2015

0

10

20

30

40

50

60

70

80

Perak Pahang Kelantan Sarawak

59.9 61.8

51.1

64.3

21.8

35.6

21.5

79.1

25.8

18.3

24.6

75.0

% o

f m

aln

ou

rish

ed

ch

ildre

n r

eh

abili

tate

d

State

Percentage of malnourished children rehabilitated in Community Feeding Programme 2013- Jan-June 2015

2013 2014 2015

Initiatives

Budget (RM)

2013 2014 2015

Community Feeding (RUTF, Supplementary Feeding Programme and Community empowerment Programme)

2,256,000 1,817,240 1,151,500

Food Basket (Option 13) 1,200,000 1,213,920 848,500

TOTAL (RM) 3,456,000 3,031,160.00 2,000,000

Budget for PCF Implementation: 2013 - 2015

Grand total: RM 8,987,160.00

Other issues

• Food availability/ food insecurity among Orang Asli .

• Parasitic Infection

• Fostering Good Hygiene Practice

• Nomadic- hard to monitor the children

• Transportation (the availability of 4WD and boats)

• Turnover staff – frequent staff transfer/ exchange

The Challenges• Food taboos/ beliefs, they don’t eat what they rear. (ie livestock's only for the purpose of earning money)• Difficulty in introducing/ altering their taste bud.• Don’t eat certain food, limit the variation of food consumption (picky eater).

•Communication barrier (languages) between health personnel/worker and Orang Asli community.

Way Forward

Short Term

• Community Feeding Programme will continued in 2016•To expand Community Feeding Programme to other Orang Asli/Pribumi settlement.• To ensure the malnourished children in existing Community Feeding Programme rehabilitated and able to sustain their nutritional status.

Long Term

• To enable the Orang Asli/Pribumi Community to inculcate elements emphasized in the community empowerment into their daily life.

To achieve this, multi-pronged strategy by multi agencies to improve economic status, educational level, food security (food availability and food utilization) are warranted.

CADANGAN POLISI PEMBERIAN SUSU FORMULA KEPADA BAYI BERUMUR <6 BULAN YANG MENGALAMI

MASALAH KEKURANGAN ZAT MAKANAN MELALUI

PRESKRIPSI KLINIKAL

Bahagian PemakananKementerian Kesihatan Malaysia

1. Objective

• To prevent and reduce infant morbidity andmortality due to malnutrition.

• To promote optimal infant growth anddevelopment.

2. Prerequisite

• Counseling on infants feeding

• Despite adequate counseling on breastfeeding

2. Suggested Criteria For Formula Milk Supplementation To Children Under 6 Months

1.Infant’s criteria

2.Mother’s criteria

3.Socio economic status – poverty

Must fulfill all the 3 criteria

3. Entry Criteriaa) Infant’s Criteria

• Low weight for age ( below -2SD) OR

• Low weight for length ( below -2SD) OR

• Failure to thrive with weight crossing 2 major percentiles which includes inadequate calories, inadequate caloric absorption or excessive caloric expenditure. OR

• Clinical Kwashiorkor (edema of both feet)

3. Entry Criteriab) Mother’s criteria

• Not breast feeding because of maternal illness(HIV, medications, mental disorder and etc. Refer Listof contraindication for breastfeeding), foster care andadopted child. OR

• Not able to establish or re-establish effectiveexclusive breastfeeding by the mother after adequatecounseling and support. OR

• Inadequate volume of expressed breast milk (EBM)for infants who are not directly feeding at the breast.

3. Entry Criteria: c) Socio economic status

• Hard core poor, poor and easily poor

4. Discharge Criteria

• Discharge from the supplementation programwhen the infant reach 6 months of age.

• If the condition persists (the infant stillmalnourished), continue with the existingrehabilitation programme for malnourishedchildren.

5. Management

• Continuous infant feeding assessment

• Monitoring infant growth

• Counseling to mothers/ caretakers

• AFASS (Acceptable, feasible, affordable, sustainable and safe) component

• Continue breastfeeding while giving milk supplementation for mothers without contraindication

• The supplementation should be started if there is no improvement after 2 weeks of intervention (assessment, counseling and support)

Recommended Type of Infants Formula Milk

• Normal term baby- Prescribe Normal infant formula milk

• Pre term baby- post discharge formula milk

Formula Milk Supplementation by Prescription

• Prescription by Pediatricians

FMS

• In rural clinics with no immediate access to FMS/ Pediatricians

CADANGAN MEKANISME PEMBERIAN SUSU FORMULA KEPADA BAYI BERUMUR <6 BULAN YANG MENGALAMI MASALAH KEKURANGAN ZAT

MAKANAN MELALUI PRESKRIPSI KLINIKAL

ii. Kuantiti Pemberian Susu Formula

• Dikira mengikut cadangan anggaran pemberian susu yang diperlukan oleh bayidalam sehari, Garis Panduan Pemberian Makanan Bayi dan Kanak-kanak Kecil,2009.

Umurbayi

Bil. penyusuan sehari

Amaun susupada setiappenyusuan

Jumlahsusu /Hari

Amaun Susu Dalam

Gram/ Hari

(1scoop=4.4g)

Amaun Susu/

BulanJumlah Tin/ Bulan

(1 tin = 900 g)

Dari lahir - 1 bulan

8 60 ml 480 ml2 scoop x 4.4g x 8 kali

= 70.4 g

70.4 g x 30 hari

= 2,112 g 3

1 - 2 bulan

7 90 ml 630 ml3 scoop x 4.4g x 7 kali

= 92.4 g

92.4 g x 30 hari

= 2,772 g 3

2 - 4 bulan

6 120 ml 720 ml4 scoop x 4.4g x 6 kali

= 105.6 g

105.6 g x 30 hari

= 3,168 g 4

4 - 6 bulan

6 150 ml 900 ml5 scoop x 4.4g x 6 kali

= 132 g

132 g x 30 hari

=3,960 g 4

Terima Kes Bayi <6 Bulan

Saringan Pertama oleh Jururawat

i) Antropometri (berat dan tinggi) ii) Pemeriksaan fizikal dan klinikal

Menentukan status kes:

Normal (-2SD-<+2SD KZM Sederhana (-3SD-<-2SD) dan

Susut (BMI-untuk-umur < -2SD)

KZM Teruk (<-3SD)

Bayi Menyusu Susu Ibu Bayi Tidak Menyusu Susu Ibu Bayi Menyusu Susu Ibu dan Susu

Formula (mix feeding)

Layak Mengikut Kriteria

Ditetapkan (akan ditetapkan)

*Bantuan Susu Formula mengikut kuantiti yang

ditetapkan diberi (Rujuk Pegawai Sains

Pemakanan)

Temujanji Susulan (mengikut TCA) oleh Pakar

Kanak-Kanak/ Pakar Perubatan Keluarga/ Pakar

Perubatan

Rujuk kepada Pakar Kanak-

Kanak/ Pakar Perubatan

Keluarga/ Pakar Perubatan

untuk pemeriksaan lanjut dan

pengesahan kes. (eg: FTT)

Nasihat pemakanan dan

lain-lain berkaitan

CARTA ALIR

PENGESAN

AN DAN

PENDAFTA

RAN KES

KZM BAGI

BAYI

BERUMUR

<6 BULAN

Penilaian dan

Kaunseling

Penyusuan Susu Ibu

-Ada checklist:

Verified by Matron/

PSP

Kawal Pemberian

Susu:

SPESIFIKASI SUSU RUMUSAN BAYI (NORMAL)

Bil Syarikat Nama Kategori Berat Tenaga/ hidangan (kcal)

Protein/100g

(g)

Lemak/ 100g (g)

Karb/ 100g (g)

Harga (RM)

1. Wyeth

S-26 Gold SMA

Rumusan Bayi (0-12 bulan)

900g 513 10.0 28.0 54.0 113.80

S-26 SMARumusan

Bayi (0-12 bulan)

1.2kg 529 11.0 28.0 57.0 88.60

2. Nestle

LactogenRumusan

Bayi (0-12 bulan)

1.8kg 508 10.5 26.0 58.0 57.80

NAN Pro® 1Rumusan

Bayi (0-12 bulan)

1.3kg 519 9.6 27.7 57.8 129.60

3. FonterraAnmum Infacare

Langkah 1

RumusanBayi (0-12 bulan)

900g 507 13.1 25.9 55.2 85.70

4. Abbott Similac 1Rumusan

Bayi (0-12 bulan)

900g 512 10.6 28.1 52.9 112.90

SPESIFIKASI SUSU RUMUSAN BAYI (NORMAL)

Bil Syarikat Nama Kategori Berat Tenaga/ hidangan (kcal)

Protein/100g

(g)

Lemak/ 100g (g)

Karb/ 100g (g)

Harga (RM)

5. Dumex

Dupro 1Rumusan Bayi (0-12 bulan)

900g 487 10.2 23.8 56.3 27.30

Mamex Cherish

Rumusan Bayi (0-12 bulan)

1.5kg 497 10.5 26.1 52.0 158.80

Babelac Langkah 1

Rumusan Bayi (0-12 bulan)

800g 487 10.5 23.9 56.2 47.80

6.Dutch Lady

Frisolac 1 Rumusan Bayi (0-12 bulan)

900g 505 10.8 27.0 53.6 81.50

Dutch Baby Langkah 1

Rumusan Bayi (0-6 bulan)

1.3kg 505 10.6 27.0 54.5 34.95

7.Mead

Johnson

Enfalac A+ Rumusan Bayi (0-12 bulan)

1.3kg 510 10.7 27.0 57.0 154.60

Enfalac Langkah 1

Rumusan Bayi (0-12 bulan)

650g 520 11.0 30.0 53.0 51.60

SPESIFIKASI SUSU RUMUSAN BAYI (PRA-MATANG)

Bil Syarikat Nama Kategori Berat Tenaga/ hidangan (kcal)

Protein/100g

(g)

Lemak/ 100g (g)

Karb/ 100g (g)

Harga(RM)

1. Nestle PreNAN ® Rumusan Khas

400g 498 14.4 25.9 53.2 28.90

2. DumexMamex Premature

Rumusan Khas

400g 477 15.6 22.9 49.8 33.10

3.Mead Johnson

Enfalac A+ Pramatang

Rumusan Khas

400g 480 14.7 25.0 54.0 47.80

SPESIFIKASI SUSU RUMUSAN BAYI (POST-DISCHARGE)

Bil Syarikat Nama Kategori Berat

Tenaga/

hidangan

(kcal)

Protein/100g

(g)

Lemak/ 100g

(g)

Karb/ 100g (g)

Harga(RM)

1. AbbottSimilac

Neosure Rumusan

Khas900g 513 13.3 28.2 52.8 69.90

2.Mead

Johnson

Enfalac A+ Post

Discharge

Rumusan Khas

900g 500 13.5 27.0 52.0123.2

0

PEMATUHAN TERHADAP TATA ETIKA PEMASARAN PEMAKANAN BAYI DAN PRODUK BERKAITAN

• Sebelum preskripsi klinikal dibuat, Pakar Pediatrik/ PakarPerubatan Keluarga/ Pegawai Perubatan harus melakukankaunseling/ penilaian berkenaan penyusuan susu ibuterhadap ibu penerima untuk memastikan jika ibu mengalamimasalah penyusuan.

• Selain itu, tatacara pemberian dan pembelian susu formulamesti mengikut Tata Etika Pemasaran Pemakanan Bayi danProduk Berkaitan. Perlu juga memastikan pendidikan diberikepada ibu tentang Prinsip AFASS (Acceptable, Feasible,Affordable, Sustainable, Safe) kerana golongan penerimakebanyakannya tidak berkemampuan dan dalam kalanganOrang Asli.

Sekian, Terima Kasih