Divina Grace O.

Ang 2009-11624 Written Report for the Present Nutritional Status of the Filipinos

EDH 120

To find the current nutritional situation of our country we must first look at the source of the nutritional statistics that may indicate the current situation of our country. The government agency that has the responsibility to gather data and propose project for the nutritional and health development of the our country is the Food and Nutrition Research Institute or the FNRI. The FNRI is mandated to: Undertake research that defines the citizenrys nutritional status, with reference particularly to the malnutrition problem, its causes and effects, and identify alternative solutions to them; Develop and recommend policy options, strategies, programs and projects; and Disseminate research findings and recommendations FNRI is also the one responsible to conduct the National Nutrition Survey every five (5) years, at the national and regional levels, and to disseminate the results one (1) year after the reference year. Below are the list of General and Specific Objectives of this agency. General Objective: To update the official statistics on the Philippine food, nutrition and health situation Specific Objectives: ANTHROPOMETRY To assess the nutritional status of 0-10 year-old children, 11-19 year- olds, pregnant and lactating women, and other adults 20 years and over using anthropometric indicators of growth To compare results from previous surveys BIOCHEMICAL To assess anemia among 6 months and over, pregnant and lactating women using haemoglobin To assess iodine status using UIE among 6-12 years old children, pregnant and lactating women To compare results from previous surveys

CLINICAL AND HEALTH To determine systolic and diastolic blood pressure of adults, 20 years and over To assess prevalence of diabetes and dyslipidemia using fasting blood sugar and lipid profile data among adults 20 years and over To compare results from previous surveys DIETARY Infant Feeding Practices To assess current infant feeding practices of Filipino mothers among their 0-23 months old children SOCIO-ECONOMICS AND FOOD INSECURITY To describe the socio-economic and demographic characteristics of the sample households and individuals To assess the food insecurity situation using the RadimerCornell instrument To identify the coping mechanisms of food insecure households GOVERNMENT PROGRAM PARTICIPATION To determine government program participation among households, children, pregnant women, and lactating mothers To compare results from previous surveys To gather information on food labeling, use of essential drugs, and on the awareness and usage of food products with Sangkap Pinoy Seal and iodized salt The 7th National Nutrition Survey shows that perceived trends in the nutritional status of 0-10 year-old children, 11-19 year- olds, pregnant and lactating women, and other adults 20 years. Below are the summary of the results gathered:

 Undernutrition (base on weight-for-age and height-for-age) remains to be a public health problem, affecting nearly 3 out of 10 children. Between 2005 and 2008, the proportion of undernourished children has significantly increased, particularly more prevalent in selected provinces in MIMAROPA, Bicol, and selected areas in Visayas and Mindanao. About 2 out of 10 children are overweight (base on weight-for-age). However, this remains to be the same from 2005.

 Underweight is nearly 2 out of every 10 adolescents (base on BMI-for-age), with males being more at-risk than Among children, 0 to 10 years old Among adolescents, 11 to 19 years old Between 2005 and 2008, undernutrition among this age group has significantly increased while overnutrition has decreased. Regions found to be most at-risk to undernutrition among adolescents are MIMAROPA, Bicol, and W. Visayas About 1 in every 10 adults are chronic energy deficient, while 3 out of 10 are overweight. The proportion of CED has decreased while overweight and obese has increased between 2003 and 2008. CED is more prevalent among the regions in Ilocos, Cagayan, MIMAROPA, Bicol, Western Visayas, Zamboanga Peninsula, and ARMM. Between 2005 and 2008, the proportion of nutritionally at-risk pregnant women has significantly decreased. The nutritionally at-risk pregnant women are mostly found in Ilocos, MIMAROPA, Bicol, Western Visayas, Zamboanga Peninsula, and ARMM. Undernutrition and overnutrition among lactating mothers have decreased significantly from 2005. Over all, the 2008 NNS showed a decreasing trend in anemia prevalence among Filipinos The iodine status of children, 6 - 12 yrs/13 19 yrs and adults, 20 -59 yrs and 60 yrs & over are optimal as indicated by median UIEs The iodine status of pregnant and lactating women is of public health The proportion of children, pregnant and Lactating women with high UIE levels corresponding to excessive iodine intake has increased The proportion of households using iodized salt has increased The prevalence of hypertension among adults based on a single visit was 25.3%, prevalence peaked at age 40-49 years. The prevalence of high FBS ( > 125 mg/dL) among adults was 4.8 % , peaked at age 50-59 years with a prevalence of 9.0%. Total cholesterol, LDL-c and triglyceride levels increased with age, particularly rose between ages 40-60 years. The prevalence of low HDL-c had remained relatively high from 2003 to 2008. Overall, dyslipidemia based on total, HDL- cholesterol and triglyceride levels had significantly increased from 2003 to 2008 Exclusive breastfeeding of 0-5 month old children was only 35.9%. This is implies that only more than 1/3 of the children met the WHO recommendation of exclusive breastfeeding for the first 6 months. Of the total sample children, the proportion of ever breastfed children was 89.6%. Out of this ever breastfed, 82.8% were exclusively breastfed and 89.4% were given colostrum. The mean duration of exclusive breastfeeding was 2.3 months. Compared with the 2003 which is 3.0 months, a significant decrease was noted.

 Comparing the mean duration of ever breastfeeding, the 2008 was slightly lower at 4.9 months versus 5.6 months in 2008. There was no significant difference between the 2 base year. Only 17.1% of the sample children were breastfed up to 12-23 months. Again, this is far more short of the recommended length of breastfeeding by WHO which is up to 2 years of age.

Written Report for the Medium Term Philippine Plan on Nutrition On 2000 the UN Millennium Development Goals were formed. And one of the goals is to Reduce by half the proportion of people who suffer from hungerby 2015. The subgoals under this is to Reduce the prevalence of underweight children under- five years of age and the proportion of population below minimum level of dietary energy consumption. To meet these goals the country formed the Philippine Plan of Action for Nutrition (PPAN); this is also the Medium-Term Philippine Development Plan for Nutrition 2004-2010. The PPAN is designed to provide a pattern and action plan to improve the nutritional status of the Filipinos. The Guiding principles of the PPAN are as follows: 1. The attainment of nutritional well-being is a main responsibility of claim-holders.

2. The community and its members are partners in addressing nutritional problems and concerns. 3. 4. Good nutrition is an important input to other sectoral objectives and outcomes. Complementation of efforts will be consciously done at all levels.

5. Undernutrition among preschool children is a function not only of poor health status and inadequate food intake, but also of caring practices. To help in the achievement of these goals, the PPAN also includes its directions for 2008- 2010 in their proposal: 1. Reduce disparities by prioritizing population groups and geographic areas a. b. Focus on pregnant women, infants and children 1-2 years Focus on populations and areas highly affected or at-risk to malnutrition

2. Increase investments in interventions that could impact more significantly on undernutrition a. Breastfeeding promotion

b. c. d. 3.

Complementary feeding Supplementation with vitamin A and zinc Appropriate management of severe acute malnutrition.

Revival, identification, and adoption of good practices and models.

4. Going to scale in the implementation of nutrition and related interventions to have wider coverage

Below are the PPAN Targets for 2008-2010: The MTPPAN targets have been retained based on the assessment of the nutrition situation, the level of implementation of policies and programs, and the likelihood of achieving the targets with continued implementation of these policies and projects until 2010. Key performance indicator Baseline (Year) Reduce the proportion of households with intake below 100 percent dietary energy requirement Reduce the prevalence (in percent) of:

Target 2005-2010

56.9 (2003) 70.0 (1993)

44.0

Underweight children, 0-5 years old

24.6 (2005) 34.5 (1989-90)

21.6

Underweight children, 6-10 years old Stunting among children, 0-5 years old CED among pregnant women Anemia among

22.8 (2005) 26.3 (2005) 28.4 (2005)

22.6 25.4 20.9

Infants Children, 1-5 years old Children, 6-12 years old Pregnant women

66.2 25.1 34.0 43.9

41.7 15.1 25.5 42.1

VADD among

Preschool children, 6 mos 5 years old Pregnant women Lactating women Increase median urinary iodine (UIE) among pregnant women to recommended levels

40.1 (2003) 17.5 (2003) 20.1 (2003) Median UIE at 142 mcg/L (2003)

14.9 10.9 14.9 Eliminate IDD among pregnant women with median UIE at 150 mcg/L Eliminate IDD among children 7-12 y/o with median UIE 100 mcg/L; no more than 20 percent of population with UIE <50mcg/L

Maintain median urinary iodine at 100 Median UIE at 201 mcg/L among children 7-12 years old and mcg/L; 11 percent keep the prevalence of IDD below 20 with UIE <50 mcg/L percent Priority actions for 2008-2010

A. Reduction in Protein-Energy Malnutrition 0-5 years old

6-10 years old Prevent malnutrition among young children Deliver appropriate and adequate nutrition and health package for schoolage children Review the guidelines for voluntary food fortification in the context of increasing coverage of snack foods that are recognized as junk food by the public Watch over media to ensure that correct nutrition information is relayed Explore how the nutritional needs of out-of-school children could be addressed

Households Continue implementation of the national Accelerated HungerMitigation Program (AHMP), but with a stronger link with nutrition particularly the Food for School Program Encourage LGU-funded and homeinitiated food production technologies

Promote early and regular prenatal care for pregnant women to prevent early child and maternal malnutrition Include key nutrition services in prenatal care Promote desirable infant and young child feeding Promote positive caring practices Administer zinc supplements as preventive and therapeutic intervention Ensure wide coverage of sanitary toilet facilities and safe drinking water supply and promote personal hygiene and sanitation with emphasis on hand washing Deworming of preschool children Safety nets for poor households and families with undernourished children Protect the nutritional status of women and children in disaster situations Watch over mass media to ensure that concerns on the care of pregnant and lactating women as well as of infant and young children are projected appropriately

B. Reduction in Micronutrient Malnutrition

Vitamin A Deficiency Disorders

Iron Deficiency Anemia Control and manage

Iodine Deficiency Disorders Ensure supply of quality iodized

Increase and sustain the coverage

of Garantisadong Pambata Provide supply of vitamin A supplements for routine supplementation and high-risk cases and in disaster situations Increase supply of fortified flour, cooking oil, and sugar Revisit the prescribed level of vitamin A fortification and adjust as may be needed Promote production and consumption of vitamin A-rich foods C.

infections especially among young children, pregnant and lactating women Provide iron supplements especially for pregnant women and infants Promote delay cord clamping during child birth Ensure the availability of iron fortified rice and flour Promote the production and consumption of iron-rich foods

salt everywhereMonitor levels of salt iodization vis--vis the new standards Enhance capacities of salt producers in implementing quality control schemes Provide incentives for iodized salt producers Disseminate manual on standardized salt iodization technology for small producers Promote the consumption of iodine-rich foods

Contribute to Key Performance Indicators for the Prevention of Risk Factors Associated with Non-Communicable Diseases through promotion of healthy lifestyle through a comprehensive health and nutrition education using tri-media

Key performance indicator (KPI)

Estimated baseline, 2005 49.5

Target by 2010

Reduction in the prevalence rate (%) of current smoking among adult males Reduction in the prevalence rate (%) of current smoking among adolescent females based on the 2003 FNRI Survey Increase in per capita total vegetable intake (g/day) based on 2003 Food Consumption Survey, NNS Reduction in the prevalence rate (%) of adults with high physical inactivity Reduction in the prevalence rate (%) of hypertension among adult males Reduction in the prevalence of adults with high fasting blood sugar Reduction in the prevalence of central obesity or high waist-hip ratio among females Reduction in the prevalence of high total serum cholesterol among

34.7

10.6

7.5

123.2

160.2

44.1

30.9

19.8

13.9

3.0 48.2

2.1 33.8

7.5

5.2

adults Reduction in adult acute myocardial infarction Reduction in adult stroke mortality rate Reduction in adult chronic obstructive pulmonary disease (COPD) mortality rate Decrease Plateau Plateau Decrease Plateau Plateau

Adopted from the targets of the Philippine Coalition on the Prevention and Control of Non-communicable Diseases

Written Report for the Nutritional Problems among Countries On 2010 the UN released the 7th Report on the World Nutrition Situation which highlights key problems in nutrition all over the world. A particular chapter of the report cites the trend estimates for undernutrition namely child underweight and micronutrient deficiencies. This chapter cites problems in Vitamin A Deficiency, Iodine Deficiency Disorders, Anemia, Underweight and Stunting and Low Birth Weight. The reports states that in developing countries 163 million children are Vitamin A deficient with a prevalence of 30%. The report states: South central Asia (which includes India) has the highest prevalence, and along with central and west Africa has a prevalence of more than 40%. South and central America and the Caribbean have the lowest prevalence, near 10%. South central Asia has two thirds of the affected children. In east Asia (China and Mongolia), and much of south and central America and the Caribbean, the rates of reduction of vitamin A deficiency (low serum retinol) are not far off those needed to halve the prevalence from 1990 to 2015. But in most of Africa (except North Africa) and south central Asia progress is lagging far behind that needed. More effective interventions, including expanded fortifycation with vitamin A, will be needed to reduce vitamin A deficiency at an accelerated rate. The next nutritional issue that the report highlights is the Iodine Deficiency Disorders. Looking at the period <1990, we can see that increased coverage of iodized salt was associated with lower total goitre rate. This pattern is repeated for 19901994. As salt iodization expanded to more countries through time, surveys tended to come from countries with higher coverage. By 19952000, the surveys from countries with iodization >75% had a mean total goitre rate of 12.0% (n=17). In the period >2000, the mean rate was 10.5%. The gradient with endemic groups and low (<25%) iodization persisted as would be expected in the first three time bands,

although numbers of surveys in this group become progressively less, as iodization has continued to expand. Another issue is Anemia; the report states: For non-pregnant women, no trend really appears; rather, the levels seem fairly static at around 45% in Africa and Asia, and somewhat lower in the Americas/Caribbean. For pregnant women the results are similar to those for non-pregnant women, with prevalence somewhat higher (although cut-off points defining anaemia are lower). For children, the data availability itself is interesting because it shows how few surveys were done before 1995. Since then, high prevalence in children has been established, reaching over 60% in Africa. Anaemia in women is a particularly persistent problem, and it is not going away, not even at a slow rate like the other nutritional problems. Some 40% of women are affected, especially in Asia and Africa, but even in south America and the Caribbean one quarter of women are anaemic. An estimated 500 million or more women are anaemic, most of them in Asia. Given the implications of anaemia for iron deficiency in children, and its relation to constraining cognitive development, the very high prevalence up to two thirds in east Africa, for example should be of broad concern in terms of education and fostering human capital. What do these estimates suggest about country priorities and programmes? In most regions progress is slow, especially for women as the most numerous affected group. Anaemia among non-pregnant women in south central Asia (mainly India) is nearly 60% and improving little. In African countries the prevalence is around 45% and is not improving or even worsening. The Caribbean situation also gives grounds for concern. The causes of this extensive anaemia are diverse and no doubt vary between countries. Malaria has a substantial effect where endemic, and anaemia is one of many reasons for malaria control. Animal products in the diet are highly correlated with lowering anaemia levels. In general, dietary improvement with enhanced bioavailability of iron and better public health can be expected to gradually decrease anaemia. But we are not seeing this, at least not in women. This contrasts with the slow but fairly steady improvement seen in other nutritional problems in children (as we do as well for anaemia). It is essential to reduce anaemia in adolescence; and supplementation in schools may have a role. But there is no escaping the urgent need to widely increase the intakes of bioavailable iron, and widespread fortification is likely to be part of the solution. The report also covers Underweight and Stunting; the report states: Although underweight and stunting results are similar in Africa and Asia, in south and central America & Caribbean child malnutrition is represented more by stunting. Stunting prevalence in some countries in this region is in the 30-50% range (e.g. Bolivia, Guatemala, Haiti, Honduras, Peru). Overall, stunting prevalences in the region are falling at a rate similar to (or faster than) underweight. However, for the high stunting prevalence countries listed above there is little recent change. For Africa, the rates of improvement are low, with prevalences declining by 0.1 percentage points per year over the region as a whole, and by less than 0.2 percentage points

per year in all subregions. This represents slow improvement, except in the southern Africa subregion which exhibits no change. In North Africa, the prevalence is relatively low and the improvement rate is enough to meet MDG1. In eastern, central and west Africa the trend needs to be accelerated to parallel that envisaged by MDG 1. HIV/AIDS no doubt contributes to this situation, particularly in southern Africa and elsewhere where HIV prevalences are high. Drought and economic stress, in places interacting with HIV/AIDS, are major constraints. In east, south central and south east Asia steady gains are generally in line with the rates required to meet MDG1.Trends in China and India substantially drive those in Asia and indeed in the developing world. In China, the underweight prevalence in children aged 05 years was reported as 6.8% in 2002, compared with 18.7% in 1987 and 17.4% in 1992. Halving the 1990 prevalence of 17% means reaching 8.5%; evidently, the MDG1 for China was achieved some years ago. In India, the underweight prevalence in children aged 03 years decreased from 44.4% in 1998- 1999 to 41.6% in 2005. This represents a decrease of 0.4- 0.5 percentage points per year. The rate required to achieve MDG1 in India is a decrease of approximately 1 percentage point per year, so acceleration is required. South and central America and the Caribbean have low prevalences of underweight, and generally these are moving downwards, in line with or better than MDG1. Child stunting trends are, in general, similar to those for underweight. Except for south and central America and the Caribbean, and west Asia, underweight and stunting prevalences are highly correlated, moving together through time and telling a similar story. However, for south and central America, stunting prevalences remain substantial, and suggest a continuing problem to be addressed. For example, in Africa the prevalence of underweight is 20% and the prevalence of stunting is 39%. In Asia, the prevalence of underweight is 22% and the prevalence of stunting is 31%. But in south and central America & Caribbean, the prevalence of underweight is only 4%, whereas the prevalence of stunting is 15% there is proportionately more stunting. The last issue the report highlighted is Low Birth Weight; on this issue it states: The incidence in south and south east Asia has fallen by approximately 0.3 percentage points per year over the past two decades: in south Asia from 34% to 27%, and in south east Asia from 18% to 12%. East Asia (mainly China) already had low incidence of low birth weight in the 1980s, and the rate has now fallen to about 6%. In this region, only west Asia shows a deteriorating trend in the past two decades. The incidence of low birth weight in Asia has fallen, from 22% in the 1980s to 18% in the 2000s. Despite these improvements, Asia still has the highest percentage of low-birth-weight babies. Overall, low birth weight in Latin America and the Caribbean was already relatively low in the 1980s and has remained fairly static. The region reached 10% in the 2000s from 13% in the 1980s. Nearly half of the countries in this region show improvement, but the overall rate of change for the region is slow (0.1 percentage points per year over 20 years). Central America had the highest incidence of low birth weight in the region in 1980 (15%) and has shown the most change (0.25 percentage points per year). In line with trends in underweight and stunting, sub- Saharan Africa has essentially remained static over the past twenty years, perhaps with east Africa showing some improvement.

Low maternal pre-pregnancy body mass index is a known determinant of low birth weight, and persistence of low body mass index from a mothers own low birth weight is likely to contribute to the intergenerational nature of growth failure. Regional trends in maternal underweight and low birth weight from the 1980s to the 2000s show that low birth weight tends to move with the prevalence of low body mass index in women. This has several implications. First, in Asia particularly, these suggest a virtuous cycle of improved birth size leading to better grown children, thence to better grown mothers, and hence further lowered low-birth-weight rates. Second, improvements in womens nutrition and health, growing up and in adulthood, benefits the next generation. Third, other factors that support intrauterine growth have a beneficial effect on this process

SOURCES: NNC - Philippine Plan of Action for Nutrition. (n.d.). National Nutrition Council (NNC), Republic of the Philippines. Retrieved November 14, 2012, from http://www.nnc.gov.ph/plans-andprograms/ppan/itemlist/tag/PPAN UN 6th Report on the World Nutritional Situation at http://www.unscn.org/files/Publications/RWNS6/report/SCN_report.pdf FNRI 7th National Nutrition Survey at http://www.fnri.dost.gov.ph/index.php?option=content&task=view&id=1770