MALNUTRITION IN THE

PHILIPPINES
Edgar M. Gerodias, R.N.,ECF,PCM, Hep. B Prec. CAP I, FMD
Joanna Ruth Palermo, R.N., ICF,PBL, AIDS Prec., TB Stage V, FMD

Common Malnutrition Problems
in the Philippines

Protein -Energy Malnutrition (PEM) - A lack of
energy and protein which results in growth
redardation.

Iron Deficiency Anemia (IDA) - A deficiency in iron
wherein hemoglobin concentration is below the
normal level which results in short attention span,
reduced ability to learn and irritability.


Common Malnutrition Problems
in the Philippines

Vitamin A Deficiency (VAD) - Lack of vitamin A that may
result to xeropthalmia (dryness of the eye), nightblindness
(inability to see in dim light) eyes sensitive to bright light,
rough dry skin and membranes of nose and throat , low body
resistance to disease, poor growth, and blindness in severe
cases.
Iodine deficiency Disorders (IDD) - Lack of iodine in the
body which results in goiter, mental retardation, deaf-mutism,
difficulty in standing or walking normally, and stunting of the
limbs.


Common Malnutrition Problems
in the Philippines

Vitamin A Deficiency (VAD) - Lack of vitamin A that may
result to xeropthalmia (dryness of the eye), nightblindness
(inability to see in dim light) eyes sensitive to bright light,
rough dry skin and membranes of nose and throat , low body
resistance to disease, poor growth, and blindness in severe
cases.
Iodine deficiency Disorders (IDD) - Lack of iodine in the
body which results in goiter, mental retardation, deaf-mutism,
difficulty in standing or walking normally, and stunting of the
limbs.

This condition is characterized by an enlargement
of the entire gland, or of one of its two lobes,
caused by a deficiency of iodine in the diet.

Simple Goiter





The Food Fortification Program
RA 8976


Republic Act 8976 or the Food Fortification Act
of 2000 was signed into law on November 7, 2000
for full implementation on November 7, 2004, to
address the problem of micronutrient malnutrition

This law is complimentary to RA 8172 or the
ASIN Law (An Act Promoting Salt Iodization
Nationwide), passed in December 1995, mandating
the iodization of all salt sold in the country.
Sangkap Pinoy
a term used by the DOH for micronutrients added to
food to enhance its nutritional quality
These micronutrients are vitamin A, iron and iodine,
which cannot be synthesized by the human body,
and therefore must be provided through the diet.
The intake of these micronutrients through the
Filipino diet is often inadequate and is responsible
for the micronutrient malnutrition afflicting a majority
of the population.
SANGKAP PINOY SEAL
Sangkap Pinoy Seal (SPS) is a
mark of DOH recognition of a
food product that is properly
fortified with either vitamin A,
iodine or iron or a combination of
these micronutrients and that
complies with regulations of the
Bureau of Food & Drug (BFAD)
of the DOH for quality, labeling
and addition of fortificants.
a campaign to support various health
programs to reduce childhood illnesses and
deaths by promoting positive child care
behaviors
A program of the Department of Health in
partnership with the Local Government Units
and other government and non-government
organizations
GARANTISADONG PAMBATA
GARANTISADONG PAMBATA

GP is done twice a year one week in April
and one week in October.

Second week of October was designated as
"Garantisadong Pambata" week.
GARANTISADONG PAMBATA
SERVICES
Giving VIT A capsules (VAC) supplement to all 12-
59 months old children.

Catch up immmunizations (children who missed the
routine immunizations like BCG, OPV, DPT,
Measles)

Distribution of iron supplements to infants and
pregnant women

GARANTISADONG PAMBATA
SERVICES
Promotion of child positive caregiving behaviors like

exclusive breastfeeding of infants from 0-6months old,
feeding infant micronutrient rich complementary foods
starting 6 months old,
use of iodized salt daily,
Buying and eating fortified foods,
brushing of teeth properly and regularly,
letting children play safe toys
no smoking in front of preschooler

Marasmus speaks:
I am derived from a word meaning withering or
wasting Hence, my physical manifestations
are related to my meaning
Kwashiorkor reacts:
I come from the African language meaning the
sickness of the older child when the next
baby is born. This corresponds to the
weaning time of the older child. Therefore, I
am the result of the misfortune in the family
Etiology:
Marasmus
-due to a diet very low in calories (CHO, fats
and protein)
-BALANCED STARVATION
Kwashiorkor
-a deficiency of PROTEIN with adequate or
even excess of calories.
Age Incidence:
Marasmus
-often the result of unsuccessful BF or
insufficient BM supply with little or no other
food given.
BF may be given on:
a. Scheduled
b. Per Demand
Marasmus
-failure to gain weight leads to loss of weight
which leads to emaciation
-the face becomes shrunken (old mans face),
muscle wasting best seen and felt at the
buttocks, thighs , upper arms and scapular
region (winged scapula)
Kwashiorkor
-usually occurs in a breastfed child until he is
weaned gradually into starchy diet, without
high protein foods
-it is highly probable that deficiencies of other
nutrients such as Vit. A, B complex, other
minerals and etc. are frequent contributing
factors
Clinical Features
1. Diagnostic
Edema-is a cardinal sign (meaning syndrome
should not be diagnosed in its absence)
-1
st
detected at the anklegeneralized
but more marked on the subcutaneous
tissues of the dependent parts such as legs,
forearms, penis, scrotum, the lower back,
and the lower face (moonface)
-protruding abdomen is due to
hypotonia of the abdominal muscles and the
intestine and edema of the abdominal wall
-muscle wasting can be demonstrated
functionally by testing the infants ability to
hold his head when gently pulled from a lying
to a sitting position
Psychomotor changes
-looks miserable and does not smile
-motor development is retarded

Irritability-psychological trauma d/t maternal
withdrawal assoc. with weaning from the
breast plays an impt. role
Mental changes
-1
st
3 years of life is very critical in brain
development
2. Common Signs
-certain signs though not necessary for
diagnosis are common and are usually
present singly or in combination
a. Hair changes-occasionally serve to indicate
the duration of the deficiency: long scanty,
pale,pluckability records a prolonged period
of deprivation
FLAG SIGN-alternate light and dark bands in the hair
indicates alternating periods of protein adequacy and
deprivation
b. Depigmentation of the skin-there is general
lightening of the color of the pigment of the skin due
to interference in melanogenesis
c. Anemia-nutritional anemia
-the hemoglobin content of the blood is lower than the
prescribed value for a given age group as a result of
deficiency of folic acid or B12 like hookworm
infestation
3. Occasional Signs of Kwashiorkor
a. Flaky Paint Rash or Enamel Dermatoses
-seen in advanced cases; if present it is
pathognomonic of the disease
-these are patches of skin turn reddish, then
purplish with macules and vesicleslater
they become dry, peel off, leaving a raw,
weeping areas like burns
-seen mostly in the hidden parts of the
body like buttocks, groins and trunk.

Grave Prognosis:
Hepatomegaly-there is usually enlargement of
the liver which has a smooth surface and
edge
Marasmus and Kwashiorkor are assoc. with Vit.
A deficiency
Difference Between Marasmus and
Kwashiorkor
Marasmus Kwashiorkor
Muscle Wasting Poor appetite
Growth Retardation Diarrhea
Apathetic, Quiet Diffuse depigmentation
Good Appetite Flaky-paint/enamel or
Diarrhea dermatosis
Moonface
Hepatic Enlargement
Kwashiorkor Ching!
Kwashiorkor Triple Treat!
Mr. Marasmus
TREATMENT OF PCM
1. Evaluate the Clinical Condition
- determine the presence of any
medical emergency, make a clinical
diagnosis and treat accordingly.


Ex. Severe dehydration secondary to
Infectious Diarrhea

Dehydration:
REPLACEMENT
Mild 5% weight loss 50 ml/kg BW
Moderate 10% weight loss 100ml/kg BW
Severe 15% weight loss 150ml/kg BW

Treat with antibiotics


TREATMENT OF PCM
2. Assess the Nutritional Status
- make Nutritional diagnosis

3. Rehabilitate the malnourished child
a.) refer to malward if warranted
- institute medical and nutritional
management
b.) home basis
- enroll in teaching programs if necessary

TREATMENT OF PCM
4. Institute follow-up measures such as:
Weighing
Medical and nutritional advice
Immunization, deworming , sanitation advice,
family planning advice
food production information
Income- generating activities