edh 120 written report for letter a

7/28/2019 EDH 120 Written Report for Letter A

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Divina Grace O. Ang EDH 120

2009-11624

Written Report for the Present Nutritional Status of the Filipinos

To find the current nutritional situation of our country we must first look at the source of thenutritional 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 nutritionalstatus, 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 andlactating women, and other adults 20 years and over using anthropometric indicators of

growth

To compare results from previous surveysBIOCHEMICAL

To assess anemia among 6 months and over, pregnant and lactating women usinghaemoglobin

To assess iodine status using UIE among 6-12 years old children, pregnant and lactatingwomen

To compare results from previous surveys


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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 surveysDIETARY Infant Feeding Practices

To assess current infant feeding practices of Filipino mothers among their 0-23 months oldchildren

SOCIO-ECONOMICS AND FOOD INSECURITY

To describe the socio-economic and demographic characteristics of the sample householdsand individuals

To assess the food insecurity situation using the RadimerCornell instrument To identify the coping mechanisms of food insecure householdsGOVERNMENT PROGRAM PARTICIPATION

To determine government program participation among households, children, pregnantwomen, 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:


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Undernutrition (base on weight-for-age and height-for-age) remains to be a public healthproblem, 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 remainsto be the same from 2005.


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Underweight is nearly 2 out of every 10 adolescents (base on BMI-for-age), with males beingmore 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, WesternVisayas, Zamboanga Peninsula, and ARMM.

Between 2005 and 2008, the proportion of nutritionally at-risk pregnant women hassignificantly 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 from2005.

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 levelscorresponding 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%, prevalencepeaked at age 40-49 years.

The prevalence of high FBS ( > 125 mg/dL) among adults was 4.8 % , peaked at age 50-59years with a prevalence of 9.0%.

Total cholesterol, LDL-c and triglyceride levels increased with age, particularly rose betweenages 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 onlymore 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 thisever 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 2003which is 3.0 months, a significant decrease was noted.


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Comparing the mean duration of ever breastfeeding, the 2008 was slightly lower at 4.9months 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 moreshort 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 ageand 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. Good nutrition is an important input to other sectoral objectives and outcomes.

4. 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. Focus on pregnant women, infants and children 1-2 years

b. 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


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b. Complementary feeding

c. Supplementation with vitamin A and zinc

d. Appropriate management of severe acute malnutrition.

3. 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 Target 2005-2010

(Year)

Reduce the proportion of households

with intake below 100 percent dietary

energy requirement

56.9 (2003) 44.0

70.0 (1993)

Reduce the prevalence (in percent) of:

Underweight children, 0-5 years old 24.6 (2005) 21.6

34.5 (1989-90)

Underweight children, 6-10 years old 22.8 (2005) 22.6

Stunting among children, 0-5 years old 26.3 (2005) 25.4

CED among pregnant women 28.4 (2005) 20.9

Anemia among

Infants 66.2 41.7

Children, 1-5 years old 25.1 15.1

Children, 6-12 years old 34.0 25.5

Pregnant women 43.9 42.1


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VADD among

Preschool children, 6 mos 5 years old 40.1 (2003) 14.9

Pregnant women 17.5 (2003) 10.9

Lactating women 20.1 (2003) 14.9

Increase median urinary iodine (UIE)

among pregnant women to

recommended levels

Median UIE at 142

mcg/L (2003)

Eliminate IDD among pregnant

women with median UIE at 150

mcg/L

Maintain median urinary iodine at 100

mcg/L among children 7-12 years old and

keep the prevalence of IDD below 20

percent

Median UIE at 201

mcg/L; 11 percent

with UIE


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A. Reduction in Protein-Energy Malnutrition0-5 years old 6-10 years old Households

Promote early and regular prenatal

care for pregnant women toprevent 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

interventionEnsure 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

Prevent malnutrition among

young childrenDeliver appropriate and

adequate nutrition and

health package for school-

age children

Review the guidelines for

voluntary food fortification in

the context of increasing

coverage of snack foods that

are recognized as junkfood

by the publicWatch over media to ensure

that correct nutrition

information is relayed

Explore how the nutritional

needs of out-of-school

children could be addressed

Continue implementation of the

national Accelerated Hunger-Mitigation Program (AHMP), but

with a stronger link with nutrition

particularly the Food for School

Program

Encourage LGU-funded and home-

initiated food production

technologies

B. Reduction in Micronutrient Malnutrition

Vitamin A Deficiency Disorders Iron Deficiency Anemia Iodine Deficiency Disorders

Increase and sustain the coverage Control and manage Ensure supply of quality iodized


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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

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

C. Contribute to Key Performance Indicators for the Prevention of Risk Factors Associated withNon-Communicable Diseases through promotion of healthy lifestyle through a comprehensive

health and nutrition education using tri-media

Key performance indicator (KPI) Estimated

baseline, 2005

Target by 2010

Reduction in the prevalence rate (%) of current smoking among

adult males

49.5 34.7

Reduction in the prevalence rate (%) of current smoking among

adolescent females based on the 2003 FNRI Survey

10.6 7.5

Increase in per capita total vegetable intake (g/day) based on 2003

Food Consumption Survey, NNS

123.2 160.2

Reduction in the prevalence rate (%) of adults with high physical

inactivity

44.1 30.9

Reduction in the prevalence rate (%) of hypertension among adult

males

19.8 13.9

Reduction in the prevalence of adults with high fasting blood sugar 3.0 2.1

Reduction in the prevalence of central obesity or high waist-hip

ratio among females

48.2 33.8

Reduction in the prevalence of high total serum cholesterol among 7.5 5.2


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adults

Reduction in adult acute myocardial infarction Decrease Decrease

Reduction in adult stroke mortality rate Plateau Plateau

Reduction in adult chronic obstructive pulmonary disease (COPD)

mortality rate

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 forundernutrition 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 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 (


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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 highlycorrelated 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


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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 theCaribbean 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.


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Low maternal pre-pregnancy body mass index is a known determinant of low birth weight, and

persistence of lowbody 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 andhealth, 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-and-

programs/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
http://www.nnc.gov.ph/plans-and-programs/ppan/itemlist/tag/PPANhttp://www.nnc.gov.ph/plans-and-programs/ppan/itemlist/tag/PPANhttp://www.unscn.org/files/Publications/RWNS6/report/SCN_report.pdfhttp://www.unscn.org/files/Publications/RWNS6/report/SCN_report.pdfhttp://www.nnc.gov.ph/plans-and-programs/ppan/itemlist/tag/PPANhttp://www.nnc.gov.ph/plans-and-programs/ppan/itemlist/tag/PPAN

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