Gembong Hanung, Jakarta – The recent death of a toddler in West Java has raised concerns over the prevalence of worm infection and its relationship to childhood stunting in Indonesia, with experts calling for more comprehensive health policies to address the underlying causes of stunting.
Raya, a 4-year-old girl who lived in poverty, died on July 22 after nine days of being hospitalized at the Syamsuddin Regional General Hospital in Sukabumi, West Java. She was admitted to the hospital in an unconscious state after showing symptoms such as fever, coughing and difficulty breathing.
While later examinations concluded that she died of sepsis caused by tuberculous meningitis exacerbated by malnutrition and stunting, the case went viral on social media after doctors retrieved live roundworms from her body.
According to a statement issued by the Health Ministry on Monday, the medical team found adult roundworms in her abdomen, although the worms did not cause any medical conditions that immediately contributed to her demise.
At the hospital, the doctors gave Raya worm medicine that led to "a significant number of worms" excreted through her feces.
The Sukabumi case raised public concern over the state of medical intervention for such parasitic worms.
In its ministerial regulation issued in 2017, the Health Ministry mandated a regular deworming treatment for toddlers and school children in integrated health services posts (Posyandu).
But Raya's case showed that such treatment may not be deployed equally, particularly in poor and remote areas in the country, according to epidemiologist Pandu Riono at the University of Indonesia (UI).
"If left untreated, it will lead to chronic stunting and potentially heavily affect children from underprivileged families," Pandu said on Monday.
High stunting
As Indonesia is working to reduce stunting prevalence, eliminating worm infection should be an integral part of stunting policy, which requires improving sanitation and promoting a healthy lifestyle, Pandu said.
Parasitic worms, such as roundworms and threadworms, typically enter one's body through direct contact with contaminated soil, often due to unwashed hands. They can also be transmitted through ingestion of contaminated foods or drinks.
The worms impair an infected human's ability to absorb nutrients, leading to malnutrition and stunted growth.
The World Health Organization (WHO) estimated in 2023 that 1.5 billion people were infected by the disease, also known as soil-transmitted helminth (STH) infections.
The United Nations health body also included the disease in the category of neglected tropical diseases (NTDs), an umbrella term of health conditions mainly prevalent in tropical areas and often ignored in public health policy making.
In Indonesia, the prevalence rate for the disease among children varies between 2.5 to 62 percent, with poor regions more vulnerable to the disease, said epidemiologist Dicky Budiman at Griffith University.
He argued the worm infection is caused by a combination of poor environment, health, social and economic qualities, making measures to tackle such a disease crucial in efforts to reduce stunting.
"Repeated infections, such as diarrhea, parasitic worms and tuberculosis, can contribute to the worsening stunting conditions," Dicky said on Sunday.
According to the latest report from the Health Ministry, the stunting rate among children in Indonesia was 19.8 percent in 2024. While the figure decreased from 21.5 percent in the previous years, it puts Indonesia in the top 15 countries with the highest stunting prevalence rates.
To address the high stunting rate in the country, President Prabowo Subianto has rolled out the free nutritious meal program, with the government earmarking Rp 171 trillion (US$10.5 billion) to provide meal packages for 82 million schoolchildren as well as pregnant and breastfeeding mothers.
But as stunting stems from malnutrition during early ages, some experts say the policy comes too late in addressing the root problems, with them urging the government to focus on pregnant women, breastfeeding mothers and toddlers.
While the free meals program falls short in addressing malnutrition among young children that causes stunting, leaving the worm infection issue unsolved will exacerbate the situation, said epidemiologist Riris Andono Ahmad from Gadjah Mada University (UGM).
"Providing free meals without eliminating [parasitic] worms," Riris said, "will only benefit the worms as they will be the ones absorbing the meals, not the children."
Source: https://asianews.network/worm-infection-case-raises-stunting-concerns-in-indonesia