The current state of nutrition in the Philippines:

Ch ild ren in fo cu s

My task is to present to you The Current State of Nutrition in the Philippines: Children in Focus, culling the data from the recently completed 6th National Nutrition Surveys, as the FN ! cele"rates #ith the nutrition community this year$s month of nutrition and as our contri"ution to the efforts of government and partners of government in improving the nutritional status of our children% The country adopted the Millennium &eclaration in '((( and committed to "uilding a "etter #orld in the ')st century% *mong the strategies to#ards +"uilding a "etter #orld, is "y focusing on children and childhood, and their nutrition situation% -ne of the Millennium &evelopment .oals in the Millennium &eclaration directly concerns us in the nutrition sector% This is: the eradication of poverty and hunger in the ne# millennium% The target is to halve, "et#een )//( and '()0, the proportion of people #ho suffer from hunger, as indicated from the prevalence of under#eight1for1age (10 y old children, and the proportion of the population "elo# the minimum level of dietary energy consumption% The Science 6th NNS results Specialist therefore 2#ill3 help 2us3 chart the challenge 4 Chief Research eradicating hunger 2as #ell as poverty3% FNRI-DOST

Ma. Regina A. Pedro

of

!n '((5, the FN ! carried out the Si6th National Nutrition Surveys to provide the official updates on the Philippine food and nutrition situation, as "asis for policies and programs to achieve national agenda% 7ast year, #e presented the partial results% Today, the rest of the results of the 6yth NNS #ill "e presented% !n this particular session, ! #ill #eave together the results related to the nutrition situation of children and the #indo#s of opportunities #here our efforts should focus on% The presentation #ill hence include 4

From the '((5 NNS, '89 or over 5 million ( : 0 years old children #ere under#eight1for1age, compared to 8'9 #ho had normal nutritional status "ased on #eight for age4 5(9 or close to 5%0 million children 2same age3 #ere short for their age 2likely a result of or resulting from chronic undernutrition3; and 0%09 or over half a million children #ere thin or #asted 2#hich is an indicator of acute or current undernutrition34

*lthough the prevalence of under#eight1for1age among children ( : 0 years of age has "een declining from )//( at a reduction rate of :(%0< percentage point a year 2ppy3, our progress to#ards achieving the Millennium &evelopment .oal target of halving "et#een )//( and '()0 the proportion of under1fives #ho are under#eight1for1 age, so far, has "een "ehind schedule% =e need to accelerate the yearly rate of reduction of under#eight1for1age children to no less than (%<)91point a year% =e should take note that "et#een )//( and '((5 our economic gro#th #as characteri>ed "y short periods of +"oom, then +"ust,, then again short periods of recovery% The first challenge therefore in order to achieve the targeted accelerated reduction of child undernutrition is sustained economic gro#th% That said 4 it is 2nice3 to note that there is no# in fact a colla"oration of efforts "y government, non1government, and private sectors 2including the "usiness community3 to provide nutrition interventions as either palliative or long term measures% *s ! have mentioned, the results of the 6th NNS identifies #indo#s of opportunities for nutrition intervention, intervention areas #here our efforts should focus on 4 !t is important to identify, from the data, #here action points for intervention are urgent%

The 6th NNS results provide us information that could and should guide us in addressing the M&. challenges4 The #indo#s of opportunity to address the malnutrition pro"lem among children4%

These three charts on undernutrition among ( : 0 y old children "y single age groups all agree that the prevalence of undernutrition 2under#eight, underheight and thinness3 more than dou"led from among the less than )1year old children and the ) year1 olds 2and from then relatively tapers off3 1 suggesting that the period "et#een ( to ) year of age is the critical period : this is the period #hen undernutrition and gro#th faltering occurs significantly%

?ven #ith regard to anemia, the critical age group is also the group of young children, especially from 6m to less than ' years of age% T#o out of three infants 6m : less than ) y of age and ) out of ' children from )y to less than ' y of age #ere anemic : and likely #ill suffer from long1term cognitive impairment% The rapid rate of gro#th during this period, plus inade@uate intake of iron, places children in this age group at the highest risk for iron deficiency compared to other age groups% =e also should note that lo# "irth#eight infants are "orn #ith lo#er iron stores and gro# faster during infancy; conse@uently their iron stores "ecome depleted "y ages '1 5 months% Philippine data on lo# "irth #eight from the State of the =orld$s children placed lo# "irth #eight at '(9 for the period from )//<1'((5 2and only /9 from )//(1 )//83% This particular point emphasi>es the urgency of addressing nutrition during pregnancy as #ell as during prepregnancy 2to prepare the #oman for pregnancy, therefore from the period of adolescence3% *lso, it should "e noted that: the prevalence of helminth infections 2nota"ly soil transmitted helminthiasis, and to a lesser degree schistosomiasis3 among 6 : )A y old children ranges from 5' : /89; the prevalence among children )10 y of age is 669 11 these are associated #ith iron as #ell as vit * deficiency; improvements in iron and vit * status has "een sho#n after de#orming

!t is also therefore alarming that the anemia pro"lem among infants had escalated dramatically in the last ten years% 4 and there #as no improvement among the rest of the children%

!nfant feeding practices is an important area of intervention 4 The prevalence of e6clusive "reastfeeding #as found to "e very lo#4 *mong infants less than ' months of age, only A'9 #ere e6clusively "reastfed; among ' : 5 month1old infants, only ) out of 5 #as e6clusively "reastfed; and among A : 0 months old children only ) in )( #as e6clusively "reastfed%

4 the proportion of children under t#o years of age #ho #ere ever1"reastfed B </%69 "ut )(9 of these children did not receive colostrum 4 The mean duration of e6clusive "reastfeeding #as only 5 months; and the mean duration of "reastfeeding #as 0%6 months%

This slide sho#s that close to 6'9 of the 6 : / months old children #ere receiving "reastmilk plus complementary foods 2including the children #ho received "reastmilk and other milk3 at the time of the survey% This "eing the case, the increasing lo# #eight1for1age and lo# #eight1for1height, as #ell as anemia, "et#een ( to less than ' years of age, including this period 6 : / months of age, may "e attri"uted to inade@uate @uantity and @uality of complementary diets%

The vit * deficiency pro"lem among children from 6m10y old also increased and had "een increasing from )//5 to '((54 in spite of the national program of '61yearly vit * supplementation 4

Findings of some studies suggest that the currently recommended supplementation schedule may"e inade@uate to sustain ade@uate 2or improved3 vitamin * status "eyond 6 months of age in high1risk populations4 These include studies "y Perlas et al%, .orstein et al% 4

-ur analysis of the )//< NNS results on vitamin * status revealed that in high C*& areas, the effect of vitamin * supplementation 2as sho#n "y the reduction in the prevalence of lo# and deficient serum retinol3 #as significant up to a"out 51A months after the administration of the vitamin * capsules, after #hich the prevalence of C*& increases%

The NNS data sho#s an improvement in the iodine nutrition situation% The median urinary iodine e6cretion 2D!?3 among 61)' y old children increased to '() microgramsE7 2and less than '(9 have D!? F0( microgramsE73, from 8) microgramsE7 in )//<% This may "e attri"uted to the Salt !odi>ation Program 2*S!N 7a#3% The importance of monitoring compliance to the guidelines for the iodation of salt 2!%e%, keeping #ithin the recommended iodation levels, especially keeping #ithin A(ppm "y the time salt reaches the household level3 needs to "e emphasi>ed, as the data sho# that there may "e some groups in the population found to have high levels of iodine in the urine 2GB 5(( microgramsE73%

The state of maternal nutrition is a significant determinant of "irth#eight and the young child$s nutritional #ell"eing4 !n '((5, '89 of pregnant #omen #ere nutritionally at risk of delivering lo# "irth#eight "a"ies4 and the conse@uences of "eing "orn #ith lo# iron as #ell as vitamin * stores, among others % *mong lactating #omen, )'9 #ere chronically energy deficient : and therefore have compromised caring capacities% 2Nutritional status of pregnant mothers #as "ased on #eight1for1height and estimated #eight gain "y period of pregnancy%3

*nemia and vitamin * deficiency are also nutrition pro"lems of pu"lic health significance among "oth pregnant and lactating #omen : #ith more than A(9 anemic for "oth groups and more than )09 C*& also for "oth groups%

The ne6t slides look at the children$s food intake "eyond "reastfeeding up to 0 years of age4 The children$s usual food intake #as measured from 'A1hour food recall carried out on ' non1consecutive or independent days% Food records #hich #ere edited in the field #ere processed in FN ! using the !ndividual &ietary ?valuation Program of FN !% Foods #ere processed as ra#, edi"le portion; and estimates of nutrient values #ere "ased on ra#, edi"le portion 2as #hat is availa"le from the Philippine FCT%3 The child$s food intake "eyond "reastfeeding is largely composed of, firstly, milk and milk products 25)9 of total food intake, or )8/g mean intake converted as #hole milk3, secondly, cereals and cereal products 25(9 of total food intake, #hich, like the general household diet, is mostly rice3% Meats, fish and eggs, lumped together, contri"ute )89 of total food intake, and fruits and vegeta"les for accounted for )(9%

=ith regard to milk consumption, A/9 of the (10 year1old children had milk in their diet% Hou #ill note that mean milk intake a day decreased dramatically "y one year of age and on#ards% The &iet .uide for children )16y old in the Nutritional .uidelines for Filipinos recommends one glass of milk a day% -n the average, among 5 : 0 years old children, milk consumption #as inade@uate%

=ith regard to vegeta"les and fruits 4 0/9 of the children 2(10y old3 had vegeta"les% *mong ( : 0 years old children, the mean vegeta"le intake a day is '5 grams in ra# #eight #hich corresponds to a"out I serving si>e a day, and #hich is #ithin the suggested num"er of serving si>es per day as stipulated in the &aily Food .uide for ) : 6 y old children% Jy age group, you #ill note that the vegeta"le intake 2as #ell as fruit intake : in fact, like all other food groups e6cept for milk3 increased #ith age, and the intake of the younger children 2less than 5 years of age3 #as less than I serving si>e a day% For fruits, 4 5)9 of the children had fruits 2mostly "anana3 and like vegeta"les, the younger children from 6m : 50m are likely consuming less than the recommended num"er of serving si>es of fruit per day 2#hich is a"out ) medium1si>ed fruit3%

Mean intake of 85g MFP plus legumes 2)'150m old3 is a"out )1) )E5 serving si>e

This slide sho#s the children$s energy and nutrient ade@uacy "y age group% Nutrient intake 2especially calcium and ri"oflavin3 "y age group follo#s the trend o"served #ith regard to milk consumption : i%e%, decreasing #ith age% The contri"ution of milk consumption to the intake of protein, calcium 2A893, the J1vitamins 2especially ri"oflavin : A593, as #ell as vitamin * 25'93 and iron 2#ith fortified milk products3 is significant% The conse@uence of decreasing milk consumption #ith age is hence reflected in the decreasing ade@uacy of nutrient intake particularly "y the )'th month on#ards% 4

The ne6t slides #ill sho# results of the Kousehold Food Consumption Survey in '((5 4

The mean one1day per capita food intake in Philippine households in '((5, in terms of #eight, #as <8/ grams% Jy food groups, this consisted of 56( g cereals 2as +as purchased, ra# #eight3, ))( g vegeta"les 2#hich includes green leafy and yello# vegeta"les and other vegeta"les3, )(5 g of fish and <( g meat 2#hich includes "eef, pork and poultry34%

The total per capita food intake increased to <<6 g after a declining trend from )/<' to )//5%

From the data of the '((5 Kousehold Food Consumption Survey : NNS, 089 of households had per capita energy intake that #as less than )((9 ade@uate% This is the indicator that is officially availa"le, and used to monitor our progress to#ards the specific M&. target of reducing the proportion of people #ho suffer from hunger%

!ncreasing intake for most of the food groups e6cept fruits and vegeta"les, dried "eans, nuts and seeds, and eggs to some e6tent%

-ver the years, the contri"ution of animal foods to the total food intake has increased in '((5%

The calorie density of diets have increased% !n '((5, <<6g food intake contri"uted )/(0 kilocalories compared to )<(A kcal from </8 g food intake in )/8<%

In spite of increased consumption of meat and meat products, iron adequacy has remained low 2in fact no increase in iron intake from )//53 11 The increase in meat intake #as mostly in the form of pork 2#hether as fresh meat or popular processed meat products3, #hich in general has lo#er iron content 2(%< mgE)((g3 than "eef 2'%<mgE)((g3% In spite of increased consumption of milk and milk products, calcium intake has remained low 11 The re@uirement #as increased in the '((' ?N! primarily "ecause of the shift in the paradigm for setting calcium re@uirement, i%e%, from an o"Lective of attaining calcium "alance to the prevention of osteoporosis% Niacin adequacy of 156.4% 2vs% 9 ade@uacy of 659 in)//53 11 the re@uirement 2'(('3, #hich is lo#er than in )/</ &*, did not include correction for "ioavaila"ility% Vitamin adequacy of !1% 11 retinol values in the Phil FCT #as "ased on the factor of 6 instead of )' for the conversion of pro1vitamin * to retinol%

!n terms of dietary population goals, the proportion of the population 2i%e% households3 #ith energy intakes #ithin the dietary goal of )0 : 5( 9 from fats and 00 : 809 from car"ohydrates increased "et#een )//5 and '((5% Ko#ever, the proportion of the population #ith F )(9 energy intake from free sugars and M A((gEday fruits and vegeta"les decreased during the )( year period%

Food insecurity is a threat to childhood4 as malnutrition 2including vitamin * deficiency, Protein1?nergy Malnutrition, 43 is a contri"uting factor to over1half of under1 five deaths in developing countries 2DN '((03%

!n the survey, food security #as defined as 4

In the questionnaire, there were " items that pertained to the e#perience of the mothers$care%i&ers, " items on the child food intake and the remainin% 4 for food intake 'y the hhld in %eneral% ?ach @uestion item #as ans#era"le "y yes to either once or more than once or No% -n a per @uestion item "asis, if the ans#er to the @uestion is yes, then the individual is said to "e food insecure as far as a specific e#perience is concern. (!n evaluating either the motherEcaregiver or individual or household ,the ans#er of the three item per level #ere grouped into a single scale to come up #ith one figure% !f their ans#er in at least one question out of the 5 items under their group is yes% They are classified as food insecure. -n the other hand, for the respondents to "e food secure, the ans#er for all the three @uestions should "e no% These are the @uestions that pertained to e6periences of food security "y a child%

These are the @uestions that pertained to the household$s e6periences on food security%

This slide presents the e6perience of the children% *"out 1)% of children skippedEmissed meals "ecause there #as no food or money to "uy food, ).*% e6perienced not eating for a #hole day "ecause there #as no food or money to "uy food, and 15.1% #ent hungry and did not eat "ec% there #as no food or money to "uy food%

More mothers than children had e6periences of food insecurity, #hich reflects the innate childcaring @uality of Filipino mothersE#omen in general%

More than half of the sampled households e6perienced or felt food insecurity #ith varying scenarios% ) out of 1+ #orried that food #ould run out "efore they got money to "uy more4 2?arlier, ! mentioned that the tool #as adopted from the adimerECornell tool, #hich in fact #as pretested in various communities in the DS and other countries% +=orrying, may "e relative across cultures4 Filipinos may "e innately #orrisome #hen #elfare of the household is concerned and are likas na maaalahanin ??? 3 6 out of 1+ said food "ought did not last and they did not have enough money to get more 0)%<9 or 1 out of * children #ere not eating enough "ec% Kouseholds did not have enough food and they could not afford to "uy more 6 out of 1+ household could not feed the children nutritionally ade@uate meal "ec% There #as not enough food and enough money to "uy food%% 1,hese re&ealed that -ood Insecurity is e#perienced differently at the indi&idual le&el and household le&el

The relation "et#een food insecurity and nutritional status: There #ere more undernourished children among food insecure mothers as #ell as in food insecure households%

-ne of the M&. targets is the reduction of the proportion of people #ho suffer from hunger "y '()0% -ne of the official indicators, from the NNS, is the proportion of households #ith per capita energy intake less than )((9 ade@uacy% From the data of the '((5 Kousehold Food Consumption Survey : NNS, 089 of households had per capita energy intake that #as less than )((9 ade@uate% 7ooking at the trends of the proportion of households #ho are not eating enough and poverty : the association is clear% Kunger is poverty1driven 4 &ecreasing poverty and decreasing proportion of households #ith per capita energy intake less than )((9 ade@uacy%

The relation "et#een household income and nutritional status of (10 y old children: Southern 7u>on here represents C*7*J* N-N 2!f Mimaropa, 50%59 prevalence for undernutrition3 Northern Mindanao, Southern Mindanao 2&avao egion3 and C* prevalence of under#eight had CCG)09, therefore not sho#n in slide; !locos, Cagayan valley, C*7*J* N-N, Jicol, C% Cisayas, and NC in addition have CCs G )(9 Central 7u>on, Cala"ar>on, C* and NC are "etter off than Cagayan Calley and Jicol, among the regions NC #ith the highest per capita income, had lo#er prevalence of undernutrition than most of the regions 2all e6cept Cala"ar>on and Central 7u>on3 #hich had lo#er per capita income; * MM #ith the lo#est per capita income had higher prevalence of undernutrition than NC % The relationship "et#een food insecurity and nutritional status, poverty and hunger, and income and nutrition as sho#n in the slides point and the need to address poverty and lo# income 2livelihood3 to attain improvements in nutritional status%

Dsual food intake of the young child "eyond "reastfeeding is inadequate in energy, iron, calcium, and vitamin A particularly after 12 months of age #hen milk intake has "y then decreased significantly and intake of other foods although increasing #ith age is not sufficient

4 and address lingering poverty%