Malnutrition among Filipino kids up

MANILA, Philippines—As the administration of President Benigno Aquino III settles down and braces for work for the next six years, a review of the latest National Nutrition Survey (NNS) might be imperative to guide it in one of its proclaimed crusades—to reduce poverty.

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. –Janryll Fernandez, Philippine Daily Inquirer

(Janryll Fernandez, a graduate of the UP National College of Public Administration and Governance, is taking up MA media studies at the UP College of Mass Communication. He recently joined Mead Johnson Nutrition Philippines as its corporate affairs manager.)