Malnutrition remains to be a challenge in the region despite of the decline in the under five mortality rate. The decline of breastfeeding, compounded by inappropriate complementary feeding practices, is a cause for alarm because of the consequent under nutrition and risk for childhood mortality and morbidity.
One of the Global Nutrition Targets for 2025 is a 40% reduction in stunting, thus the Philippines is committed to this target under the Global Scaling-Up Nutrition Movement (SUN), ensuring optimal nutrition in the First 1,000 Days of life from a mother’s pregnancy up to a child’s second year of life.
The Global Strategy for Infant and Young Child Feeding was jointly developed by the World Health Organization and UNICEF is the result of a comprehensive participation process and grounded on the best available scientific and epidemiological evidence.
The Global Strategy is based on the evidence of nutrition’s significance in the early months and years of life, and of the crucial role that appropriate feeding practices play in achieving optimal health outcomes. Lack of breastfeeding especially lack of exclusive breastfeeding during the first half year of life are important risk factors for infant and childhood morbidity and mortality that are only compounded by inappropriate complementary feeding. The life-long impact includes poor school performance, reduced productivity, and impaired intellectual and social development.
The Strategy identifies interventions with proven positive impact, it emphasizes providing mothers and families the support they need to carry out their crucial roles, and it explicitly defines the obligations and responsibilities of the government and other organizations and agencies.
The overall objective is to improve the survival of infants and young children by improving their nutritional status, growth and development through optimal feeding.
- To raise awareness of the main problems affecting infant and young child feeding, identify approaches to their solution, and provide a framework of essential interventions;
- To create an environment that will enable mothers, families and other caregivers in all circumstances to make and implement informed choices about optimal feeding practices for infants and young children.
- To increase commitment of the local chief executives and other partners.
A. Breastfeeding Practices (IYCF)
- Exclusive Breastfeeding for the first six months – Infants shall be exclusively breastfeed for the first six months of life to achieve optimum growth and development. Only breast-milk should be given and no other food or drinks, not even water. Vitamins and medicines are permitted by physicians.
- Extended breastfeeding up to three years – Although volume of breast-milk consumed declines as complementary foods are added, breast-milk contribute significantly as it provides one third to two thirds of average total energy intake towards the end of first year.
B. Complementary Feeding Practices (IYCF)
- Appropriate complementary feeding
Infants shall be given appropriate complementary foods at age six months in order to meet their evolving nutritional requirements. This means that it should be given: timely, adequate, safe, and properly fed.
- Ensure access to appropriate complementary foods – through diversified approaches and use of home-and community based technologies.
- Use of locally available and culturally acceptable foods
- Low-cost complementary foods
C. Micronutrient Supplementation
Based on the updated Guidelines on Micronutrient Supplementation, the following are the priority targets for micronutrient supplementation:
- Universal Vitamin A supplementation shall continue to be provided to infants and children 6-59 months of age. Vitamin A supplementation shall be given to children at risk, particularly those with measles, persistent diarrhoea, severe pneumonia and severely malnourished children to help re-establish body reserves of vitamin A and protect against severity of infections and prevent complications. Postpartum women shall be given vitamin A capsule within one month after delivery to increase vitamin A concentration of her breast-milk as well as vitamin A status of their breastfed children. Children with signs of xeropthalmia shall be treated with vitamin A. Children during emergencies shall be given priority for vitamin A supplementation following schedule for high risk children.
- Iron Supplementation shall be provided to pregnant and lactating women and low birth weight babies and children 6-11 months of age. In addition, anaemic and underweight children 1-5 years of age shall be provided with iron supplements including adolescent girls enrolled in Grades 7-10.
- Iodine supplementation shall be provided to women of reproductive age group, school age children in areas when the Urinary iodine Excretion of less than 50 ug/L in more than 20% of the population. Priority will be given to all pregnant women who do not have access to iodized salt.
- Calcium Supplementation for Pregnant Women shall be provided to reduce the risk of developing gestational hypertensive disorders and associated health problems thereby improving maternal and new born health and nutrition outcomes through provision of daily calcium supplementation.
D. Universal Salt Iodization
Families shall be encourage and educated on the use of iodized salt in the preparation of foods for older infants and young children and even adults to prevent iodine deficiency disorders which is prevalent in Zamboanga Peninsula.
E. Food Fortification
Food fortification of staple foods like oils and flour and salt to include processed foods was undertaken to ensure that older infants and young children receive adequate amounts of micronutrients.
F. Mother Baby Friendly Health Initiative (MBFHI)
To promote and support and protect breastfeeding and Infant and Young Child Feeding Practices in all health facilities, and the need to transform these facilities (government and private-hospitals and Lying-in) rendering maternal and new born care services into Mother Baby Friendly Health Institution.
G. Philippine Integrated Management of Acute Malnutrition (PIMAM)
This aims to support the implementation and expansion of quality treatment for children suffering from the most severe and acute form, of under nutrition which is severe acute malnutrition (SAM). These children with SAM are at most risk of dying as a result of their under nutrition.
Roll-out trainings for the Management of Severe Acute Malnutrition are on-going in the provinces of Zamboanga del Sur and Zamboanga City.
It has four guiding principles:
1. Maximum coverage and access – to achieve the greatest possible coverage by making services accessible and acceptable to the highest possible proportion of a population in need;
2. Timeliness – early case-finding and mobilization so that most of the cases of SAM can be treated before complications develop;
3. Appropriate care – simple and effective Out-patient and In-patient Therapeutic Care;
4. Care when and where it is needed – continuous and appropriate support with other interventions
1. Outpatient Therapeutic Care (OTC)- management of non-complicated cases of SAM using ready to use therapeutic foods (RUTF)at the community level;
2. Inpatient Therapeutic Care (ITC) – management of complicated cases of SAM at the hospital level;
3. Community Mobilization – involves engagement with the community to promote a common understanding of acute malnutrition and promote services offered;
4. Management of Moderated Acute Malnutrition (MAM) – It targets cases of MAM with supplementary food, some basic medicines, monitoring and nutritional education.
1. Zamboanga del Sur and Pagadian City
2. Zamboanga Sibugay
3. Zamboanga City
Infants, 0-11 months
Young Children, 1 year up to 3 years old
Adolescent females (Grades 7-10, ALS, Out of School
AREA OF COVERAGE
Zamboanga Peninsula (3 province and 5 cities)
National Nutrition Council, Other Govt. Agencies, Academe, NGOs, LGUs
POLICIES AND LAWS
- E.O. No. 51 – Adopting a National Code of marketing of Breast milk substitutes, Breast milk supplements and related products, penalizing violations thereof, and for other purposes.
- Resolution No. 2s. 2008 – Adoption of the New Who Child Growth standards for use for children 0-5 years old in the Philippines.
- M.C. No. 2008-0005 (January 23, 2008) – Executive Order No. 685 from the office of the President entitled “Expanding the Preschool Coverage to Include Children Enrolled in Day Care Centres”
- R.A. No. 7600 – An act providing incentives to all government and private health institutions with Rooming-in and Breastfeeding practices and for other purposes.
- R.A. No. 10028 – An act expanding the promotion of Breastfeeding, Amending for the purpose Republic Act No. 7600, otherwise known as “An act providing incentives to all government and private health institutions with Rooming-in and Breastfeeding practices and for other purposes”
- D.C. No. 2009-0228 (August 17, 2009) – Guidelines for the Monitoring of Milk Code Activities.
- D.C. No. 2010-0147 (May 14, 2010) – Guidelines for Physicians on the promotion protection and support of Breastfeeding.
- D.C. No. 2011-0365 (September 16, 2011) – Guidelines for the “Mother-Baby Friendly Workplace Certification”
- D.O. No. 2009-0169-A (May 5, 2010) – Amendment to Department Order No. 2009-0169 dated June 29, 2009 regarding the “Guidelines for Sub-Allotment of Funds to Centres for Health Development. As Grant to the Winning Provinces and Cities for the Garantisadong Pambata Champs.
- D.O. No. 14, s. 2015 (May 20, 2015) – Guidelines governing exemption of establishments from setting up workplace Lactation Stations.
- D.O. No. 2016-0184 (July 11, 2016) – Guidelines on the Utilization of Fund Sub-allotment/ Fund Transfer to Regional Health Offices, ARMM, select DOH Retained Hospitals and other health facilities to support implementation, monitoring and evaluation of related new born care and IYCF programs, activities and plans.
- D.O. No. 80, s. 2012 (October 23, 2012) – Strengthening the integration of Breastfeeding Education in the curriculum, setting up and sustaining the operation of lactation stations in schools and compliance with executive order no. 51.
- A.O. No. 2005-0014 (May 23, 2005) – National Policies on Infant and Young Child Feeding.
- A.O. No. 2006-0012 (May 15, 2006) – Revised Implementing Rules and Regulations of Executive Order No. 51, Otherwise Known as the “Milk Code”, Relevant International Agreements, Penalizing Violations Thereof, and for other purposes.
- A.O. No. 20017-0026 (July 10, 2007) – Revitalization of the Mother-Baby Friendly Hospital Initiative in Health Facilities with Maternity and New born Care Services.
- A.O. No. 2009-0025 (December 01, 2009) – Adopting New Policies and Protocol on Essential New born Care.
- A.O. No. 2010-0010 (April 19, 2010) – Revised Policy on Micronutrient Supplementation to Support Achievement of 2015 MDG Targets to Reduce Under five and Maternal Deaths and Address Micronutrient Needs of other Population Groups.
- A.O. No. 2010-0015 (June 08, 2010) – Revised Policy on Child Growth Standard.
- A.O. No. 2012-0012 – Licensing Requirements for Birthing Homes.
- A.O. No. 2015-0055 (December 19, 2015) – National Guidelines of the Management of Acute Malnutrition for Children under 5 years.
- A.O. No. 2016-0035 (September 19, 2016) – Guidelines on the Provision of Quality Antenatal Care in All Birthing Centres and Health Facilities Providing Maternity Care Services.
STRATEGIES, ACTION POINTS, AND TIMELINE
1. Trainings and Orientations
3. Mentoring and Coaching
5. Technical Assistance
CALENDAR OF ACTIVITIES (2017)
1. Training on Infant and Young Child Feeding (IYCF) 3 batches
2. Basic Training Course for Barangay Nutrition Scholars 5 batches
3. Orientation on First 1,000 Days of Life 6 batches
4. EMNC-Lactation Management Training 2 batches
5. Severe Acute Malnutrition Management Roll-Out Training 6 batches
6. Barangay Nutrition Scholars Congress
7. Nutrition Implementation Review 3 batches
8. Nutrition Promotion and Advocacies
9. Monitoring and assessment of Health Facilities
10. Nutrition Meetings (RNAHC)
11. Food Supplementation for underweight/pregnant women
12. Procurement/Distribution of Nutrition Supplies
1. Anthropometric Nutrition Survey:
(2015 Food and Nutrition Research Institute- National Nutrition Survey (Updated Survey)
- 0-5 year-old children in Zamboanga Peninsula
- 1 in every 4 were underweight (21.2%) Zambo. norte with highest prevalence (26.9%)
- 4 in every 10 were stunted (39.1%) Zambo. Norte with highest prevalence (41.4%)
- 8 in every 100 were wasted (7.1%) Zambo. Sur with highest prevalence (7.6%)
- 3 in every 100 were overweight (2.5%).Zambo. Sur highest prevalence (2.9%)
- 6-10 years old school children in Zamboanga Peninsula
- 35 in every 100 were underweight (33.4%) Zambo Norte with the highest prevalence (36.8%)
- 4 in every 10 were stunted (38.3%) Zambo. Norte with the highest prevalence (41.7%)
- 7 in every 100 were wasted (6.4%) Zambo. Norte with the highest prevalence (7.3%)
- 5 in every 100 are obese (5.4%) Zambo.Sur highest prevalence (7.1%)
- 11-19 years old adolescents in Zamboanga Peninsula
- 4 in every 10 were stunted (39.6%) Zambo. Norte has the highest prevalence of (45.0%)
- 9 in every 100 were wasted (8.8%) Zambo.Sur has the highest prevalence (10.0%)
- 5 in every 100 were overweight (5.0%) Zambo. Sur highest prevalence (5.8%)
- Among adults
- Chronic Energy Deficiency (CED) in Zampen is 10.1%, Zambo. Sur-highest (9.7%),
- Overweight 23.7%, Zambo. Sur highest (27.7%),
- Obesity- 6.0%, Zambo. City highest (7.8%)
- Pregnant women
- Prevalence of Nutritionally-at-risk pregnant – (29.6%)
- Lactating women
- Prevalence of underweight lactating women – (11.8%)
- Prevalence of overweight and obese lactating women – (20.5%)
2. Biochemical Nutrition Survey
(2013 Food Nutrition Research Institute- National Nutrition Survey)
- Anemia Prevalence
- 6 months to 5 years old children - 5.2%
- 6-12 years old children - 4.4%
- 13-19 years old - 7.7%
- Adults 20-less than 60 years old - 7.6%
- Elderly more than 60 years old - 13.4%
- Prevalence of Iodine Deficiency Disorders:
- The median UIE among pregnant women was 68ug/L which corresponds to insufficient iodine intake
- Median UIE among adolescents was 93 ug/L indicating mild IDD
- Median UIE among adults was 89 ug/L indicating mild IDD
- Median UIE among elderly was 65 ug/L indicating mild IDD
- Median UIE among lactating women was 48ug/L indicating moderate IDD
Infant and Young Child Feeding Practices
- Exclusive BF among 0-5 months – 54.1%
- Duration of EBF among children for 6 months – 4.2
- Percentage of children with continued BF at 2 years – 23.8%
- Percentage of children breastfed within 1 hour after delivery – 74.2%
- Percentage of age-appropriate BF among children – 47.1%
- Mean duration of BF- 8.2
Complementary Feeding Practices:
- Percentage of breastfed children 6-8 months old given solid, semi-solid and soft foods – 57.7%
Minimum Dietary Diversity Score (MDDS):
- Percentage of children 6-23 months old meeting the Minimum Acceptable Diet – 16.3%
- Percentage of children 6-23 months meeting the MDDS – 27.5%
- Percentage of children meeting the Minimum Meal Frequency – 92.5%
Micronutrient Supplementation (2015)
- Percent of children, 12-59 months participated in Vitamin A supplementation:
- Zamboanga Peninsula – 76.1%
- Zamboanga del Norte - 76
- Zamboanga del Sur - 76.5%
- Zamboanga Sibugay – 82.0%
- Zamboanga City - 67.6%
Proportion of Children, 6-23 months who tried Micronutrient Powder (MNP):
- Zamboanga Peninsula – 62.7%
- Percent of children, 12-71 months participated In Deworming program:
- Zamboanga Peninsula – 65.2
- Zamboanga Sibugay - 76.5%
- Zamboanga del Norte - 69.9%
- Zamboanga del Sur - 61.2%
- Zamboanga City - 45.7%
PROGRAM MANAGER CONTACT INFORMATION
Ms. Evelyn M. Capistrano,RND
Mobile Nos- 0927 773 3771