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International Nutrition
Module Convenor: Dr Soma Mitra
Coursework Title: Philippines Country
Report
Due Date: 4/12/2015
Abstract
Philippine is a developing country in Southeast Asia. It has rapid economic
growth but 25.2% of Filipinos living under poverty in 2012. Agriculture sector in
Philippine is associated with poverty hence its employment share is decreasing,
absorbed by service sectors. Abandoning the agriculture sector, the poor rural
population migrates to urban area causes the proportion of the poor is higher in
urban area. The traditional diet of Filipinos are influenced by other cultures,
emphasising on combinations of bold flavours. Following income inequality,
undernutrition is a manifestation of the poor not eating well. The national rate of
stunting is 30.3% whereas the rate of wasting is 7.9%. Stunting and wasting is
more prevalent in rural areas and among the poor. They are challenged with high
food cost, rendering their food insecurity. Nutritional promotion and food
subsidies are carried out to provide adequate nutrients and to improve food
security of the needy. In general, the micronutrients status of Filipinos have
been improved over the years. The prevalence of vitamin A deficiency among
infants 6 months to 1 year old is 15.2% in 2008, highest across all age groups in
Philippine. This prevalence decreases along with age. Next, iodine status has
been improved greatly since the universal salt iodisation program, but there is
recent drop in iodine urinary excretion. Mild iodine deficiency occurs in some
pregnant and lactating women. On the other hand, about 11.1% of Filipinos
suffered from anaemia in 2013. Infant has the highest prevalence of anaemia
across age groups, whereby 39.4% is anaemic. Iron deficiency is the primary
cause of anaemia. Some food fortification is made mandatory by law to improve
the micronutrient status of Filipinos. Rice, sugar and oil are the major vehicles to
deliver micronutrients as these are the top three most frequently consumed
products among Filipinos. Besides undernutrition, 31.1% of adult Filipinos are
overweight
or
obese.
In
short,
Philippine
faces
the
double
burden
of
malnutrition.
1. Introduction
Philippine is a lower middle-income country located in Southeast Asia which
composed of 7107 islands occupying 298,171km 2 (United Nation Development
Programme, 2013; Philippine Statistics Authority & ICF International, 2014).
Philippine is divided into 17 administrative regions. There are differences
between income, education and health status among these three regions, most
probably due to the geographical nature of the country whereby the exchange of
resources between islands is difficult. Philippine is prone to natural disaster such
as earthquakes and typhoons. Typhoon Haiyan in 2013 was disastrous to the
country, inevitably leads to poor health among the victims.
few decades, following the trend that when a country becomes more developed,
birth rate decreases.
Economic inequality is a problem in Philippine whereby poverty is high in
some regions of Philippine. Despite high economic growth, about 25.2% of
Filipinos live below the national poverty line in 2012 (The World Bank, 2015).
However, efforts have been made by the government to enable the poor to enjoy
the economic growth by creating better job, reducing the underemployment
while aiming to improve the income of bottom 20% of the population greatly
(The World Bank, 2015). Majority of the poor people worked in agriculture sector
and has low education level (Asian Development Bank, 2009).
Table 1: Distribution of poor people in urban and rural area.
Percentage of population
In Urban Area
In Rural Area
Total
Poor
73.06
26.94
100.00
Non-poor
42.69
57.31
100.00
National Nutrition Survey showed that underweight, stunting and wasting are
dominant among those rural populations and populations in the poorest quintile.
Several regions which are particularly associated with poverty also showed high
prevalence of under-nutrition.
Table 2: Differences in prevalence of under-nutrition across regions among
children under 5 years old.
Form of Under-
Lowest
prevalence
nutrition
(percentage prevalence)
regions
(percentage
prevalence)
MIMAPORA (27.5%)
NCR (12.9%)
Western Visayas (25.9%)
CAR (16.5%)
Bicol (24.6%)
Central Luzon (17.7%)
Stunting
Bicol (39.8%)
NCR (22.4%)
ARMM (39.0%)
Central Luzon (23.1%)
Zamboanga Peninsula (38.7%) CALABARZON (25.3%)
Wasting
MIMAROPA (9.8%)
CAR (5.9%)
Ilocos Region (9.8%)
NCR (6.5%)
Western Visayas (8.9%)
SOCCSKSARGEN (6.6%)
(Food and Nutrition Research Institute Department of Science and Technology,
Underweight
2013)
Male adolescents have greater prevalence in underweight and stunting,
possibly owing to their need to contribute to familys income in poor family.
When children growing up from the under-nutrition environment, they develop
chronic energy deficiency at adult stage.
According to the World Food Summit of 1996, food security is defined as
when all people at all times have access to sufficient, safe, nutritious food to
maintain a healthy and active life (World Health Organisation, 2015).
Zamboanga Peninsula, Northern Mindanao, SOCCSKSARGEN, Bicol and ARMM
are top 5 regions of food insecurity. Within these regions, urban areas have
greater food security than rural areas except ARMM, where there is little
difference. Food insecurity in Philippine is generally attributed to high food cost
and poor infrastructure and facilities (Roel & Casandra, 2012). Although
Philippine attained self-sufficiency in rice, the cultivation is costly as modern
technology is not adopted. As a result, food costed more than 40% of household
budget among Filipinos in 2009 (Roel & Casandra, 2012). Philippine is
susceptible to natural disaster which leads to rising of food price due to harvest
lost. CARAGA, ARMM, Bicol and Zamboanga Peninsula score the highest rates of
poverty among all regions (Carleneth & Juanito, 2012). They have low income
hence many households spent more than 50% of their household income on
food (Carleneth & Juanito, 2012). Volatility in food price affects economical
access of food to these families. Rural populations have greater access to empty
land as compared to urban populations however, rural populations consume
insufficient fruits and protein-rich food as they usually plant tubers and
vegetables in their backyard (Roel & Casandra, 2012).
There are few strategies to tackle the problem of food insecurity and
under-nutrition in Philippine. The government recognises the importance of
childrens nutritional status in their healthy development hence more strategies
are targeted on children. The government categorises the strategies into
nutritional promotion and food subsidies (Roel & Casandra, 2012). These
strategies
are
carried
out
by
local
and
international
non-government
Nutrient
Fortification,
Information,
Education,
and
Nutrition
Percentage (%)
45
40
35.3
35
30
25
20
16.4
15
10
5
0
1993
40.1
38
22.2
20.1
17.5
16.5
15.2
9.5
6.4
1998
2003
2008
Year of survey
6 months to 5 years old
Pregnant
Lactating
Percentage (%)
45
40
35.3
35
30
25
20
16.4
15
10
5
0
1993
40.1
38
22.2
20.1
17.5
16.5
15.2
9.5
6.4
1998
2003
2008
Year of survey
6 months to 5 years old
Pregnant
Lactating
iodine excretion is the cut-off value for having optimum iodine intake for normal
and lactating individuals, whereas 150 g/L is considered ideal for pregnant
women. Philippine attains optimum iodine status among children 6 to 12 years
at the year 2008 in the 7th National Nutrition Survey. However, iodine intake at
year 2008 is lower than 2003, as a result of lowered level of salt iodization.
Hence, mild iodine deficiency is still a problem among pregnant and lactating
women. Iodine is crucial for the brain development of the foetus, thus it is a
serious concern which should be undertaken to produce next intelligent
generation. It is important to recognise that the drop in average iodine intake
will result in more Filipinos fell into the range of moderate iodine deficiency for
those who were at marginal line of sufficiency. At national level, only 41.9% of
households used iodised salt during Philippines 7th National Nutritional Survey.
200
142
150
111
132
105
82
100
71
50
0
1998
2003
2008
Year of survey
Children 6 to 12 years
Lactating women
Pregnant women
200
142
150
111
132
105
82
100
71
50
0
1998
2003
2008
Year of survey
Children 6 to 12 years
Lactating women
Pregnant women
health
significance.
Premenopausal
women
generally
has
higher
prevalence of anaemia than men due to menstrual loss of iron. More women
become anaemic when they become pregnant and lactating and possesses
crucial impact on the infants iron status. The result is consistent with the fact
that only 13.5% of the household achieved Philippines Recommended Energy
and Nutrient Intake (RENI) of iron. Interestingly, household income and
urbanisation is more associated with greater difference in anaemia among
infants between 6 months to 1 year old than other age groups or physiologic
states.
30.6
25
19.5
20
Prevalence (%)
15
11.1
10
5
0
1993
1998
2008
2013
Year
Prevalence (%)
15
10
5
0
1993
1998
2008
2013
Year
Figure 4: The reduction in the rate of anaemia among Filipinos across years.
(Food and Nutrition Research Institute Department of Science and Technology,
2013)
The Philippine Act Promoting Salt Iodisation Nationwide makes all foodgrade salt available for human consumption to be fortified with iodine (Lindsay et
al., 2006). Similarly, many food is fortified with Vitamin A in Philippines,
including sugar and cooking oil, which are the top commodities consumed after
rice (Justin & Geoffry, 2015). These Vitamin A fortified food are fed to children as
part of the nutritional program showed improvement in retinol concentration or
greater liver stores (Lindsay et al., 2006). Iron is fortified mandatorily in rice
which can provide 1 to 2mg iron per 100g of rice when cooked (San Juan et al.,
2011).
Supplementation
program
which
provides
tablets
contained
micronutrients also proved to be useful (Pedro et al., 2002; Risonar et al., 2008).
4.3 The double-burden of malnutrition
Along with other middle income countries, Philippine also faces the
double-burden
of
malnutrition.
While
the
prevalence
of
undernourished
Changes in the prevalnce of overweight/obese and chronic energy deficiency among Filipino's adults
35
30
25
20
16.6
Prevalence(%) 13.9
15
26.6
24
28.4
31.1
20.2
13.2
12.3
11.6
2003
2008
10
10
10
2011
2013
5
0
1993
1998
Year
Overweight/Obese
Column1
Changes in the prevalnce of overweight/obese and chronic energy deficiency among Filipino's adults
35
30
25
20
16.6
Prevalence(%) 13.9
15
26.6
24
28.4
31.1
20.2
13.2
12.3
11.6
2003
2008
10
10
10
2011
2013
5
0
1993
1998
Year
Overweight/Obese
Column1
2013
when
compared
to
1993. (Food
and
Nutrition
Research
Institute
yea
Figure 8: Comparison of the amount and the caloric value of food consumed by
Filipinos across the years. (Food and Nutrition Research Institute Department of
Science and Technology, 2008)
found that those who have greater self-sufficiency in staple food consume less
diverse food products, as compared to those who are less self-sufficient, living in
urban areas. Therefore, encouraging backyard farming may not seem to
promote a diverse diet, also not a strategy to eradicate poverty.
Feeding program was reported to have leakage in the distribution system,
whereby the food supplied did not reach the target group (Roel & Casandra,
2012). Therefore, monitoring and evaluation of the program is necessary to
oversee the effectiveness of an intervention.
5.3 Micronutrient Status
The government report has many limitations for research use because its
primary sources are not available. Important statistical indicators such as
standard error, confidence interval and p-value are missing, therefore, the trends
of micronutrients status cannot be interpreted as significant. Other than that,
data gap is present for vitamin A and iodine status in the year 2013. The iodine
intake fell from the year 2003 to 2008, therefore it is important for the
government to continue monitoring the iodine status to prevent the relapse of
iodine deficiency among Filipinos especially pregnant and lactating women.
A trial carried out by Mason et al. (2010) showed the effectiveness of
vitamin A oil fortification over vitamin A capsule. Oil fortification of vitamin A is
able to sustain the raised of serum retinol level over time. In the study 12 out of
14 branded cooking oil was found to be fortified with vitamin A ranging between
172-2349 g/100 g.
40ppm is the standard iodine level of salt at retail site according to Act for
Salt Iodisation Nationwide (ASIN) Law in 1995. However, a quantitative
assessment showed that the iodine level of salt was below the standard,
whereas only 19.5% of Filipino households consumed adequately iodised salt
due to the low initial salt iodisation by the manufacturer because iodide is
chemically stable (Perlas & Capanzana, 2011). Some households claimed to use
iodised salt but tested negative for iodine, suggesting that Filipinos may not
aware of the non-iodised salt, which is not intended for food use (Perlas &
Capanzana, 2011). At 2007, ASIN Law lowered the standard of iodine level in
salt to 20ppm at retail site, in line with international standard (Perlas &
Capanzana, 2011). This may partly explain the falling in urinary iodine excretion
in 2008. Awareness also does not translate into true usage of iodised salt.
Table 3: The low median urinary iodine excretion of children is associates with
low mean iodine level in salt. Children in Eastern Visayas, Zamboanga, Northern
Mindanao, Davao and Caraga are at risk of iodine deficiency.
Awareness and Usage of Iodised Salt Among Philippine's Households Across Years
90
80
67.3
70
60
50
Percentage 40
24.8
30
20
10
0
1998
83.4
75.4
79.5
56.4
49.2
38.1
2003
2005
83.2
78.5
41.9
2008
Year
Awareness of Iodised Salt
Claimed Usage
6. Conclusion
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