Malnutrition woes still loom large, but stakeholders fighting onBy Fat Reyes
MANILA Philippines—The Philippines still has a long way to go in its fight against child malnutrition, and various stakeholders are shaping up with their “intervention strategies” to help in the process.
As part of its commemoration of this year’s Nutrition Month in July, the Infant and Pediatric Association of the Philippines (IPNAP) hosted a roundtable discussion last July 17. The undertaking gathered experts from the government, academe, health, civic organizations, and media to discuss and focus on developing a deep understanding of the country’s state of nutrition and the steps being done to combat child malnutrition and mortality.
“We need to focus on the challenge to meet the Millennium Development Goal (MDG) of two-thirds reduction of child mortality by 2015 and ensure the protection and development of the Philippines’ future human capital,” said Alex Castro, IPNAP Executive Director.
Mario Capanzana, director of the Food and Nutrition Research Institute (FNRI) and representative from the Department of Science and Technology (DOST), gave an assessment of the 2011 National Nutrition Survey among Filipinos, and noted what he described as an “alarming” constant increase in the “stunting rates” among Filipino children.
“From a rate of 16.2 percent for children aged six to 11 months, the proportion of stunting in children doubled at one year old to an increase of 33.6 percent. The prevalence of stunting increases with age thereafter and this needs to be investigated,” Capanzana said.
Capanzana said that stunting, or the deficiency in height for age of children, if not addressed properly, could turn into a chronic or irreversible situation.
Capanzana pointed out that the problem was there were no sufficient support systems or intervention methods designed for children belonging to the six months to 35 months age bracket – a critical stage where children are most vulnerable to malnutrition, infection, and irreversible long-term physical and mental damage.
“The problem for stunting has been shown and this is the point where we need to intervene and not on later age of the child to prevent the onset of malnutrition,” Capanzana said.
Breast feeding practices
Capanzana said that there had been “commendable” increases in exclusive breast feeding rates in Filipino children, saying that comparing rates from the years 2003 to 2011, results showed a significant increase of 6.2 percentage points in the proportion of exclusively breastfed children from 2003 to 2008, and 10.8 percentage points from 2008 to 2011.
“Mean duration of breastfeeding and exclusively breastfeeding in 2011, at 7.7 months and 3.7 months, respectively, significantly improved as compared to that recorded in 2003 and 2008,” Capanzana added.
Capanzana said that for the past years, among children 0-five months, 48.9 percent were exclusively breastfed, which is a significant step for the country in reaching the World Health Organization (WHO) 50-percent goal for 2025.
Dr. Leonora Panlasigui, dean of the School of Nutrition of the Philippine Women’s University (PWU) for her part stressed the importance of the need for pregnant women to be healthy, saying that the amount and composition of the milk depends largely on the nutritional status of the mother.
“However, when exclusive breast feeding practices cannot be provided, mothers should also have an awareness, education, and access to complementary feeding practices and other options so as not to deter the child’s growth,” Panlasigui said.
Meanwhile, Capanzana noted that for the country to achieve the MDG target of reducing to half the proportion of underweight children by 2015 from 1990 to 2011, the prevalence should be reduced by 6.6 percentage points in 2015 with an average annual reduction of 1.65 percent from 2011.
He said that based on the 2011 statistics, two out of 10 Filipino children were underweight, three out of 10 were stunted, and seven out of 100 were wasted.
He said that to meet the target, DOST had put in place measures to provide and campaign for the adoption of “extrusion technology” to create alternatives to complementary food.
Called DOST High Impact Techonology Solutions or DOST HITS, the program, said Capanzana, is aimed to enhance the uses of extrusion cooking in preparing low-cost, ready-to-cook baby foods which are also rich in protein and energy.
“It’s like junk food but without the junk,” Capanzana said in describing some of the products he showed like the Big Mo Rice Mongo-Curls, Big Mo Rice Mongo-Sesame blend, and Big Mo Rice Mongo-Instant Blend.
The DOST Package for the Improvement of Nutrition of Young Children or DOST PINOY, on the other hand, was another intervention program which Capanzana said involved 120 days of feeding program using the complementary foods plus a nutrition and awareness education program for mothers and caregivers using modules.
Capanzana said that the targeted output of the program was for it to serve as a model on how the intervention strategies can be taught from the experts down to the local government units and grass roots or barangay levels.
He said they first implemented the program in Antique, Occidental Mindoro, Leyte, and Iloilo, – four provinces which he said were characterized by high malnutrition rates.
“The strategy was to meet provincial executives, as well as other government officials from up to down the barangay level, and make them agree to implement the package,” Capanzana said.
“We trained the nutrition program implementers on the module, and then we conducted launching and turnover ceremonies so that the community would be efficient in adopting the intervention strategy,” Capanzana said.
Based on the data collected after the time period of 120 days, Capanzana noted that there was a significant decrease in the prevalence of underweight children in the intervention group (or group applied with the package) while there was no decrease in the non-intervention group (group without package).
Capanzana also said that based on mean scores on the data, the nutrition awareness of mothers and caregivers on concepts such as breastfeeding and complementary feeding, safe food handling, meal planning, and vegetable gardening, significantly increased for those in the intervention group compared to the non-intervention group. The mothers and caregivers were given a test on the said concepts, Capanzana said.
Capanzana also noted that since the program yielded positive results, they wanted to expand it but that they needed the support of donors and civic-society organizations for funds and facilities needed.
“The LGUs can support the program by setting up a production facility for complementary foods,” he said.
“The FNRI would provide technical assistance in the production of complementary foods and training of community workers on the program’s implementation,” he added.
Civil society’s part: Bayanihan to curb malnutrition
Vicky Wieneke, president of Kabisig ng Lahi, for her part, stressed the importance of partnerships between public and private sectors, saying the results from team efforts would be a big help in lessening the effects of malnutrition.
Wieneke shared how her non-government organization started in 2001, from quietly implementing nutrition programs to earning the support and funds from the Department of Social Welfare and Development (DSWD), other private organizations like Mead Johnson and Jollibee, and other civic and church organizations.
She said the flagship programs involved targeting malnourished children in far flung areas, using a six-month daily supplemental feeding of a nutritious hot meal from a specially designed 28 days cycle-menu paired with a cup of high grade milk with necessary government clearance.
“It was a public private partnership initiative before the name PPP was even coined,” she said in describing the program.
“It was nation-building at its most basic form, with many people working together for solving a poverty issue now but with a long term investment for the children,” she added.
Wieneke said that they designed the programs because she found out, through visiting operations, that feeding programs, if given at all, were only limited to serving “lugaw” or banana cue or operating a soup kitchen.
“I wanted a program that would not fill a stomach but solve a poverty issue,” Wieneke said.
She said that as their resources were precious, they had to choose the beneficiaries with “the best return of investment, so to speak” – meaning those children who had the most chance to make something of themselves because they had parents who were supportive and would go the extra mile.
She added that when Mead Johnson in 2002 decided to join them and provide milk to be integrated with the hot meal program, they then were able to provide nutrition for children from infancy to six years, choosing malnourished children from the very young who could not breast feed for various reasons.
Wieneke said, however, that a problem came up when a code was enforced, limiting the program to three years and above as stated by government clearance. She said they encountered mothers of malnourished children below three years old begging to include them in the program.
“I battled with the thought of being proactive and fight for the reversal of the regulation,” she said. “Instead, I decided to design a feeding program for children three years and under using a different approach, no milk but a mongorized sesame blend nutri-pack added to the hot meal and vitamins donated by pharmaceutical companies,” she said.
She said the pilot programs, started in 10 communities in Abra, Rizal, and Camarines Sur, proved to be effective with positive results, and was supported by a technology transfer from UP Los Baños in providing the food packs.
“But the new intervention needs levelling up, and we are now in the planning stage with FNRI for work collaboration,” she said.
Wieneke said that so far, most of the organization’s projects for various age groups yielded positive results, with children being “fully rehabilitated,” children gaining substantial weight gains, and lesser children dropping out from schools.
“There are more things that need to be done. We hope the government will maximize resources to find the right solutions and that private sectors will continue to be involved in the fight for a better future for Filipino children,” she said.
Need for vegetables
Joey Montalvo, IPNAP programs administrator, for his part, shared how the Oh My Gulay (OMG!) Project aimed to help fight malnutrition by reinforcing the culture of vegetable gardening.
Montalvo said that the project, started in June 2011, was an advocacy program which intended to create awareness among target families on the nutritive value of common vegetables by encouraging them to plant vegetables and enjoy eating vegetables.
Under the program, 40 schools were adopted under the supervision of DepEd and private sectors, Montalvo said. He added that the initiative was done in partnership with Senator Edgardo Angara, East-West Seeds Corporation, and donors from the private sector.
Montalvo said that the challenge for the initiative was the prevalence of malnutrition among school children, saying that based on statistics, 26 out of 100 preschool children in the country were malnourished.
“In Cadiz and Kabangkalan cities, both in Negros Occidental, out of 49,000 Grade 1-6 students, close to 17,000 are malnourished, or 34 percent,” Montalvo said.
“But in the Ifugao province, a rich source of vegetables, there is only a 4 percent rate of malnourished children,” Montalvo said.
He said that priority schools, or those with the high rates of malnutrition in children, were chosen based on DepEd statistics.
Montalvo said the program involved an orientation for students, teachers, parents, and community officials on the importance of the nutritional value of vegetables and the methods in using bio-intensive gardening.
“Then it becomes a community event, where they plant the vegetables using the gardening implements supplied and the instructional manuals on how to produce organic soil,” Montalvo said.
He cited an example in San Isidro, Pontevedra, where a school had its small land areas and playgrounds converted into flower pots and vegetable gardens.
He said that the planting period was culminated with a community day, where the community members conduct the harvest activities.
“After the harvest, they also conduct cook fests, or contests to produce the most delicious dish from the harvest,” he said.
“It’s a simple community project, but when conducted on a large-scale, it would develop long-term effects for the community and their families,” he added.