NUTRITION PROGRAM

 (MICRONUTRIENT SUPPLEMENTATION PROGRAM)

 I. INTRODUCTION TO THE PROGRAM

The micronutrient supplementation program was adopted in response to the micronutrient malnutrition in the country. The overall policy on micronutrient supplementation is contained in the DOH AO No. 2010-0010 entitled, “ Revised Policy on the Micronutrient Supplementation to support Achievement of 2015 MDG Targets to reduce under five and maternal deaths and address micronutrient needs of other population groups”.

The population group being prioritized in the program are the low birth weight infants, 6-59 months old, pregnant and lactating women, female adolescents (10-14 years old) and the non pregnant/ non lactating women of reproductive age (15-49 years old).

The Micronutrient supplements should be in the right dosage, timing and frequency and duration according to the needs of the priority groups.

VISION:                      Empowered healthy and well-nourished Filipino Families

MISSION:       DOH and partners shall align their strategic actions and exert collective and unified efforts to create a supportive environment for a sustainable and improved nutrition development.

GOAL:             To reduce mortality and morbidity due to nutrition-related diseases.

OBJECTIVES:            To reduce the prevalence of underweight, anemia and iodine-deficiency disorder among under five children.

PROGRAM TARGET: To provide micronutrients to 90% of the under-five children.

PROGRAM STRATEGIES:

  • Target the nutritionally at-risk and vulnerable. Priority is given to areas with high prevalence of under-nutrition and micronutrient deficiencies among underfive children.
  • Promote Infant and young child feeding practices in various settings to reduce the prevalence of underweight and stunted under-five children.
  • Integrate and strengthen nutrition services in the maternal continuum of care.
  • Promote universal access to the standard child survival package of interventions.

 II.  PROGRAM SITUATION

 The Nutrition situation of the Cordillera region is based on the data from the National Nutrition Survey conducted by the Food and Nutrition Research Institute of DOST, Annual Operation Timbang by the Local Government Unit and the DepED annual nutrition assessment of the school children. The statistics were categorized according to the three major forms of malnutrition: 1). Protein Energy Malnutrition, 2). Micronutrient Deficiencies and 3). Overweight/Obesity.

Protein Energy Malnutrition (PEM) is one of the leading nutrition concerns in the country as exhibited by poor physical growth. It is manifested by having low weight for age (underweight), low weight for height (wasting/thinnes) and short height for age (stunting) resulting from inadequate intake of energy or protein rich foods, failure to appropriately breastfeed or late introduction of complementary foods to infants.

The common and easiest way in determining the child’s nutritional status is through the measurement of physical growth. This indicator is also used by the WHO to measure the nutritional status and health of a country.

A. Local Data on Nutritional Status, 2014

PROVINCE

Prevalence Rate

UW/SUW WASTING STUNTING OVERWEIGHT
Abra

11.0

7.08 18.95

1.05

Apayao

9.02

0.61

Benguet

1.76

1.02 11.75

0.73

Ifugao

2.36

1.20 15.73

0.37

Kalinga

6.81

3.12 24.35

0.82

Mountain Province

4.18

1.89 23.84

0.87

Baguio City

1.48

1.52 6.59

0.76

Tabuk City

3.02

6.19 18.00

0.07

CAR

4.46

2.57 14.8

0.71

Source: Operation Timbang Plus (OPT Plus) Reports, 2014 – National Nutrition Council-CAR

The table shows in the second column that among the 0-5 years old, the Provinces of Abra and Apayao has the highest prevalence of underweight in the region.

Three in every 100 preschool children are wasted in CAR. Abra has the highest prevalence followed by Tabuk City. No data was submitted by Apayao because the heights were not measured. Few Height boards and steel rule were issued in the province but during that time, there was no training conducted yet for the measuring of height. The inclusion of height taking was fully implemented in 2015.

Stunting also called the shortness or underheight for age is an indicator for chronic malnutrition measured by using height for age of a child and comparing it to a height for age standards under the WHO-CGS. Stunting is highest in the provinces of Kalinga and Mountain Province. Gone is the saying that people from Kalinga are tall.

The prevalence of overweight among preschool children and even across all age groups in the Cordillera increased. This should be a cause of alarm and concern among health and nutrition workers.. Double burden of disease is present in the province of Abra, since it has the highest % of underweight and yet it has the highest % of overweight.

B. National Data on Nutritional Status, 2013

Prevalence Rate

UW/SUW WASTING STUNTING OVERWEIGHT
CAR

16.5

5.9 32.4

6.1

PHILIPPINES

19.9

7.9 30.3

5.0

Source: National, Nutrition Survey, Food and Nutrition Research Institute, DOST, 2013

The table shows the national data from the FNRI-DOST, NNS 2013 wherein underweight and wasting are below the national prevalence rate while national rate on Stunting and Overweight were surpassed by the regional data. The high and increasing prevalence of overweight should be a concern among health and nutrition workers. Overweight and obesity contributes to high prevalence of lifestyle related diseases. There are 32 in every 100 preschool children who are stunted.

C.  Nutritionally Depressed Municipalities, 2014 (weight-for-age)

 

PROVINCE Municipality # of Barangays # of PS weighed # of UW & SUW Prevalence
Abra Lagayan 5 487 171 35.11
Tineg 10 635 150 23.62
Lacub 6 583 123 21.10
San Isidro 9 460 89 19.35
Pilar 19 884 164 18.55
San Quintin 6 479 85 17.75
Tayum 11 1356 240 17.70
Licuan-Baay 6 436 76 17.43
Langiden 6 396 66 16.67
Bucay 21 2064 335 16.23
Bucloc 4 170 25 14.71
Pidigan 15 1178 173 14.69
Malibcong 12 610 78 12.79
Apayao Pudtol 22 1746 207 11.86
Villaviciosa 8 535 63 11.78
La Paz 12 2185 255 11.67
Apayao Kabugao 21 1917 253 11.63
Bangued 8 6548 732 11.18

Source: OPT Plus Results, NNC-CAR, 2014

 

The identification of Nutritionally Depressed Municipalities (NDM) was based on the prevalence of undernutrition with 10% or more. From among the 77 municipalities and 2 cities of CAR, 18 were identified to be NDMs with 89% of these NDMs belonging to the province of Abra while 11% belongs to Apayao.

B. MICRONUTRIENT SUPPLEMENTATION

The high prevalence of malnutrition would now mean that there is a need to strengthen vitamin A supplementation as a preventive intervention.

VITAMIN A SUPPLEMENTATION, FIRST ROUND, 2015

APRIL  2015 PROVINCE POPULATION 6 – 11 Months 12 – 59 Months 6 – 59 Months
    Target No. Given % Target No. Given % Target No. Given %
ABRA 247,464 3366 2652 78.79 25316 23,314 92.09 28,682 25,966 90.5
APAYAO 120,653 1629 1234 75.75 12343 10,696 86.66 13,972 11,930 85.4
BENGUET 447,443 6040 5403 89.45 45773 39245 85.74 51,813 44,648 86.2
IFUGAO 207,961 2807 2549 90.81 21274 18,902 88.85 24,081 21,451 89.1
KALINGA 217,140 2700 2665 98.70 22213 20,037 90.20 24,913 22,702 91.1
MOUNTAIN PROVINCE 161,384 2179 1663 76.32 16510 12,667 76.73 18,689 14,330 76.7
BAGUIO CITY 358,770 4843 3727 76.96 36702 26,399 71.93 41,545 30,126 72.5
TOTAL 1,760,815 23564 19893 84.42 180131 151260 83.97 203,695 171,153 84.0

 

The table shows the results of the first round of vitamin A supplementation. The overall accomplishment is 84% while the regionaL / national objectives for health target for VAS is 90%. There is a need to focus the attention on the City of Baguio and Province of Mt. Province for their low accomplishment on VAS. Furthermore, the province of Abra and Apayao also needs to be prioritized since they have the most number of undernourished preschool children.

D. IRON TREATMENT

 

2-6 mos seen w/LBW 2-6 mos given with Iron % 12-59 mos. Anemic 12-59 mos given Iron %
ABRA 76 73 96 316 297 94
APAYAO 25 21 84 221 188 85
BENGUET 156 53 34 234 215 92
BAGUIO 50 26 52 176 176 100
IFUGAO 25 13 52 88 88 100
KALINGA 97 94 97 219 212 97
MT. PROV 21 15 71 81 65 80
CAR 450 259 66% 1334 1241 93%

Source: 2014 FHSIS Annual Report

 

The percentage of children given with iron among 2-6 months who were LBW is only 66%. The regional office only augments ferrous sulphate of the LGUs. The 93% of 12-59 months given with iron is remarkable.

E.  IRON SUPPLEMENTATION, FIRST ROUND, 2015

    TOTAL
drops syrup  
ABRA 356 1165 1521
APAYAO 224 548 772
BENGUET 226 714 940
IFUGAO 397 715 1112
KALINGA 88 92 180
MOUNTAIN PROVINCE 17 54 71
BAGUIO CITY 128 376 504
TOTAL 1436 3664 5100

 

The table shows that due to lack of iron supplements, the underweight and wasted were prioritized for the supplementation. Not all 6-23 months are given iron supplementation.

 WHAT HAVE BEEN DONE:

  1. Augmentation of iron supplements
  2. Provision of Vitamin A capsules for routine supplementation
  3. Provision of TA during monitoring of micronutrient supplementation program and during MELLPI
  4. Provision of laminated guidelines on micronutrient supplementation for health workers.
  5. Provision of OPT Plus logistics: heightboards, steel rule, salter weighing scales, CGS Tables
  6. Conduct of WHO-CGS Training for untrained health workers in selected Nutritionally Depressed Municipality

 PLANS:

  1.  Provision of Vitamin A supplements
  2. Augmentation of iron drops and syrups for under five children
  3. Augmentation for iodine checker solutions
  4. Conduct of Monitoring and Evaluation of Local Level Plan Implementation (MELLPI)
  5. Advocacy for the creation of ordinances that supports micronutrient supplementation and breastfeeding.
  6. Advocacy to the priority province on strengthening their local nutrition committees

Prepared by:                                                                           Reviewed by:

 

CANDICE S. WILLY, MPH                                       VIRGINIA L. NARCISO, MD, MPH

Nutritionist Dietitian IV                                                 MO IV / Head CAHDC