A chronic lack of sunshine and resulting vitamin D deficiencies could be to blame for Indonesia’s number one killer of children aged under two, pneumonia, according to an Australian-Indonesian research collaboration.
Indonesian and Australian scientists are currently working together on two new studies to determine whether a lack of vitamin D in infants and breastfeeding women is responsible for the country’s high rates of pneumonia and infant mortality.
Despite Indonesia’s hot climate, the researchers believe that lifestyle, fashion and religious factors influence whether breastfeeding mothers and infants obtain enough vitamin D to fend the deadly respiratory illnesses.
"Indonesia, being close to the equator, is a very sunny country," says co-leader of the collaborative research team, Dr Margie Danchin of the Murdoch Children’s Research Institute and the Royal Children’s Hospital, Melbourne.
"It predominately has a Muslim population where many mothers wear head scarfs [and other coverings for religious reasons].
"Breastfeeding rates are very high but it is also typically done indoors.
"All of these factors can lead to vitamin D deficiencies in mothers and infants."
"As researchers and paediatricians, it is our responsibility to not only focus on the health of children in Australia but throughout the globe."
Dr Vicka Oktaria of Indonesia’s Gadjah Mada University, who is coordinating the collaborative studies, explains that although vitamin D can be sourced from food, Indonesian children typically do not start on solids until at least six months.
"Foods high in vitamin D also don’t tend to be part of the daily diet in Indonesia," says Dr Oktaria.
"And, although the benefits of breast feeding children for the first six months are huge, breast milk is a poor resource for vitamin D."
UNICEF estimates that both pneumonia and diarrhoea kill more than 50,000 Indonesian children every year.
"I think as researchers and paediatricians, it is our responsibility to not only focus on the health of children in Australia but throughout the globe," says Dr Danchin.
"I also believe it’s my responsibility to contribute to research conducted throughout the region and impact on health policy."
Studies show that vitamin D deficiency is extremely common in Indonesian children aged two to five. Dr Danchin adds that the risk of a vitamin D deficiency is also six times higher in breastfed infants.
Despite this, she says, "there is still a clear knowledge gap in understanding the incidence and severity of pneumonia in children aged under two years old in Indonesia".
The Australian-Indonesian research collaboration is currently conducting a new community-based project in Indonesia that follows the respiratory health of newborn babies for the first 12 months of their life and measures vitamin D levels at birth and at six months.
The second new project, a hospital-based study financed by the Australia Indonesia Centre, will collect data on hospitalised infants with acute respiratory conditions and vitamin D deficiencies.
"This work should also help to improve the case management of respiratory disease generally in Indonesia."
Dr Danchin says the scientists will turn their focus towards trialling a vitamin D a supplement from birth, if a casual link between vitamin D and pneumonia in infants is determined over the course of the next 18 months as expected.
The collaboration will also attempt to change health policy and create a vitamin D supplementation program for new mothers and infants.
Although vitamin-taking practices are not common in Indonesia as they are in Australia, there is evidence of mothers and infants taking vitamin A as part of a government supplementation program for infants aged nine months.
"We know mums are happy to give their children a vitamin supplement if they can see a clear benefit to their child’s health."
The researchers hope to release findings from the two studies within two years.