Malnutrition among Filipino kids up
Through Executive Order No. 128, signed on Jan. 30, 1987 during the time of the President?s mother, the Food and Nutrition Research Institute (FNRI) of the Department of Science and Technology (DOST) is mandated to undertake research to define the nutritional status of the population particularly the malnutrition problem and its causes and effects, and to identify alternative solutions to them.
Undertaken every five years, the survey and its results serve as inputs to national plans and programs. The NNS is also useful in providing benchmarks to gauge the country?s progress toward achieving the Millennium Development Goals, including the eradication of hunger, reduction of child mortality and improvement of maternal health.
Underweight, underheight
One of the issues the 2008 NNS looked into is children?s nutrition. The research found that the number of Filipino children who were underweight and underheight or stunted increased from 2005 to 2008.
The prevalence of underweight children aged 0-5 years increased from 24.6 percent to 26.2 percent, about 3.35 million children.
The underheight rate increased from 26.3 percent to 27.9 percent, representing 3.57 million children.
There was also a significant increase in the prevalence of underweight children aged 6-10 years from 22.8 percent in 2005 to 25.6 percent in 2008, equivalent to 2.6 million. The number of underheight children in this age group likewise increased from 32 percent to 33.1 percent.
A very high level of acute malnutrition among preschoolers (aged 0-5) was noted in six regions, namely
Mimaropa, Bicol, Western Visayas, Eastern Visayas, Zamboanga Peninsula and Soccsksargen where the underweight-for-age prevalence was at least 30 percent.
A high prevalence of underheight-for-age or stunted preschoolers was mostly observed in Mimaropa, Bicol, and all the regions in the Visayas and Mindanao.
Based on their weight relative to their height, the nutritional status of preschoolers was considered poor in most regions except for Central Visayas and Davao regions (based on the classification of worldwide prevalence range among children under 5 years of age).
Chronic malnutrition affected a very high percentage of preschoolers in the provinces of Masbate, Biliran,
Northern Samar, Western Samar, Zamboanga Sibugay, Sarangani, Abra and Mountain Province.
Except for Soccsksargen, the same regions with high malnutrition among preschoolers were most at risk of acute malnutrition among schoolchildren as the prevalence of underweight was at least 30 percent.
Meanwhile, the regions with very high prevalence of stunted schoolchildren were Mimaropa, Eastern Visayas, Zamboanga Peninsula, Northern Mindanao and Soccsksargen.
Long standing or chronic malnutrition affected a very high percentage of schoolchildren in 25 provinces, including Abra, Aurora, Mindoro Occidental, Mindoro Oriental, Marinduque, Catanduanes, Masbate,
Negros Occidental, Northern Samar, Western Samar, Leyte, Bukidnon, Agusan del Sur, Davao del Norte, Davao Oriental, Zamboanga del Norte, Zamboanga Sibugay, Misamis Occidental, Sultan Kudarat, Lanao del Norte, Lanao del Sur and Basilan.
These facts should help the new administration, particularly the agencies involved in health and nutrition, in evaluating the effectiveness of the programs put in place by the previous administration.
Iron-deficiency anemia
Looking at the incidence of iron-deficiency anemia, the study found that from 1998 to 2008 there was a significant decrease in anemia prevalence among different age groups except for the infants aged 6 months to one year, which had the highest prevalence at 55.7 percent followed by the pregnant women at 42.5 percent.
Obviously, children of this age are not getting enough iron nutrients which is only logical since anemia prevalence among pregnant women was high in 52.9 percent of the regions, indicating that it is a significant public health problem. The overall prevalence of anemia from infants (6 months) to elderly (60 years old) is 19.5 percent.
The urinary iodine excretion levels for children indicated adequate iodine intake while that for pregnant and lactating women reflected inadequate iodine intake. The proportion of households using iodized salt increased from 9.7 percent in 1998 to 56 percent in 2003 and 81.1 percent in 2008 though this is still below the goal of 90 percent.
Iodine is one of the vitamins and minerals the body needs particularly for the thyroid to function properly.
Infant feeding
One other important factor in evaluating the nutrition of children is the feeding practices. At the time of the survey, 89.6 percent of infants aged 0-23 months were breastfed. Among 0-5 months old children, 35.9 percent were exclusively breastfed while 36.8 percent were breastfed and at the same time given complementary foods.
Of the 6-11 months old, 40 percent were still breastfed, while of the 12-23 months old, 22.2 percent were still breastfed. Of the 0-23 months old, 89.6 percent were breastfed while 10.4 percent were not breastfed.
The percentage of exclusive breastfeeding among 0-5 months old was significantly higher at 35.9 percent in 2008 compared to 29.7 percent in 2003.
The main reasons mothers stopped breastfeeding were inadequate milk flow (34 percent), working outside home (25.5 percent), another pregnancy (9.1 percent), child refused (7.8 percent), mother was ill (7.6 percent), cracked nipple (5.4 percent), child old enough for weaning (2.8 percent), child abandoned (1.5 percent) and others (3 percent).
Complementary foods given to children included solid/semi-solid foods (75.4 percent), vegetable soup/broth (71.9 percent), fish soup/broth (71.3 percent), meat soup/broth (69.6 percent).
Other liquids (50.3 percent), fresh fruit juice (50.2 percent), powdered/ready-to-drink juice (48.0 percent), Am (36.7 percent), milk other than breast milk (26.6 percent) and water plus sugar (22.6 percent).
Government programs
The government has instituted programs to help address the problem on nutrition but there is low participation in most of them.
A relatively high percentage of children aged 0-5 years participated in ?Operation Timbang? while about 40
percent of children participated in the growth-monitoring program. About 18.6 percent participated in supplementary feeding while around 14.3 percent participated in the Orally Fit Child program.
Private sector
The government has also found allies in efforts to address malnutrition. Nongovernment organizations (NGOs) and the corporate sector have initiated programs such as the ?Feeding Hope? community-based feeding program and the ?Pasiglahin ang Estudyanteng Pinoy? (PEP) school-based feeding program.
Feeding Hope is a national growth-monitoring program which is a partnership between the NGO Kabisig ng Kalahi, the Department of Social Welfare and Development, and Mead Johnson Nutrition (Philippines). PEP, meanwhile, is a joint program of Kabisig, the Department of Education, the National Competitiveness Council, Unilever and Mead Johnson.
A study showed that about 30 percent of children in Grades 1 and 2 eventually drop out of school due to malnutrition. In areas covered by PEP, the average dropout rate among these children was only 0.33 percent.
Assessing these results from the 2008 NNS, it is apparent that the Aquino administration will have some work to do on the nutrition front in addition to the other problems of the country. With the government?s fiscal deficit, it will be wise to continue and replicate the model of working with NGOs and the private sector.
Compostela Valley workers fight malnutrition
Frinston Lim
TAGUM CITY, Philippines—A place known for communist insurgency as much as its rich mineral deposits, Compostela Valley is facing yet another battle, and even lowly employees are drawn to it.
No, they would not be displaying guns and cannons. A coin or two, and a generous heart are enough.
For 120 days, Compostela Valley’s 1,000 capitol employees shelled out whatever spare they had in their pockets to help fight malnutrition. They looked after the famished, sickly children from depressed communities and provided their nutritional needs.
Called the Adopt-A-Malnourished Child program, the project seeks to rehabilitate ill-nourished children from several municipalities in one of Davao region’s provinces which have the largest number of malnutrition cases.
“It’s about saving children’s lives,” says Rey Pajarito, Compostela Valley nutrition action officer. “It’s about stopping the spread of malnutrition and helping families and communities transform.”
The program was conceptualized as a direct intervention to arrest the prevalence of malnutrition in the province’s 11 municipalities. It’s also the employees’ way of showing social responsibility in solving a problem so close to home, according to Pajarito.
Started in December last year, the program saw employees—from janitors to clerks, and even up to Gov. Arturo Uy himself—contribute cash weekly to buy infant formula milk, vitamin supplements, nutritious foodstuffs and other provisions.
‘Bayanihan’
In the typical spirit of “bayanihan” (community collaboration), they bring the goods to the farthest barangays of Montevista, the pilot area, says Analyn Vigilla, nutrition coordinator for District 1 to which the municipality belongs.
The provincial nutrition council chose Montevista because it had the third highest rate of malnutrition prevalence in the province. The town is also accessible to the “adoptees,” who visit it weekly, being just 12 kilometers from their offices in Nabunturan town, according to Nena Mirafuentes, provincial nutrition coordinator.
Barangay nutrition scholars, health workers, dentists, physicians and even psychiatrists help monitor the progress of the adopted children using World Health Organization (WHO) standards for height, weight and body mass (ratio of weight over length or height) to determine improvements in overall growth and nutrition.
Severe cases
“Out of the 300 our validation yielded in Montevista, we picked 26 as they were the most severely malnourished, with some of them showing condition so severe that it could kill them if we had acted much later,” Vigilla says.
Care for the adopted children did not end on feeding and monitoring, she says. The majority (about 70 percent) showed improvement in physical condition, but some did not, so the adopting office or department had to continue providing for the child even beyond the four-month period.
“We tried to deepen our involvement by attempting to address the root cause of the children’s malnutrition, (which in most cases, is poverty),” Vigilla says.
Transformation
The program benefited those being helped and also those who helped. Families and communities are being transformed, with parents who used to disregard the needs of their children in terms of good food and proper sanitation.
They are now becoming responsible, according to Pajarito.
“The immediate impact of the program was really the education of the parents on the value of good parenting. Attitudes of fathers and mothers in these depressed communities have already been changing,” he says.
“There is also a larger effect of this to the whole community. Local officials (in Montevista) are seeing the good of the program, with the village head of Barangay Camansi, for example, pledging to continuously assist the family, even contributing for the building of houses of those we adopted.”
Health-seeking behaviour
For Mirafuentes, the program helped improved the “health-seeking behavior” of the adopted children’s mothers. Mothers are supposed to play the most vital role in ensuring the proper health of the entire household, she says, and therefore should be properly counseled.
“The interpretation of malnutrition does not center only on the child’s diet but also of his or her surrounding or the people around him or her that may affect growth and overall health,” Mirafuentes says.
As an example, she cites a sickly child whose father has tuberculosis. The health workers did not immediately give him his “allotment” but instead had him and his entire family checked up. It turned out that four of the family, including the adopted child, had TB.
Mirafuentes says the improvement shown by most of the children were encouraging. She acknowledged that the 120-day program is not enough, and that the provincial government is studying its replication in other municipalities.
Spiritual language
Through the Adopt-a-Malnourished Child program, Pajarito says the program of the provincial government is being put into perspective. It also taught employees the value of being generous, of giving back to fellowmen, “which has become a spiritual language of the employees.”
He says the program also helped the families of recipients regain their dignity by providing opportunities, thus ensuring that they continue to provide nourishment.
Thirty-two-year-old Ramil Lagutom’s family used to live in a rented house and subsist on his measly P200 weekly income as a banana farmer in Barangay Bangkerohan Sur. His four children were all malnourished, with the youngest, 17-month old Raffy, severely stunted, underweight and wasted.
At the start of the program, Raffy stood a mere 70 centimeters, or just over two feet, and weighed 7.7 kilograms.
“He could barely move and looked like as if he’s a kind of a frog or something. I really pitied him,” says a female employee of the provincial general services office who adopted the now listless, puny 21-month-old.
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