This session aimed to collectively put together statements/ recommendations of an important and urgent nutrition and related policy, strategy and/or program recommendation that will contribute to the improvement of the current nutrition situation of Filipinos – particularly of the population groups in most need. Implementation of the PAN Recommends is a partnership by and among government agencies, local government units, nongovernment organizations, business sector, media and all other entities. The PAN Recommends targets policy makers, program planners and managers, field program personnel and local government officials who are in a position to initiate, support, and cause the implementation of urgently needed measures and actions.
In the past years, PAN Recommends focused on identified significant health and/or nutrition issues:
For 2019, PAN Recommends focuses on Nutrition and Physical Activity for Longevity. Initially, PAN Recommends Committee was created. The Committee consisted of Dr. Talavera, Ms. Raval and Ms. Gonzales. The Committee reviewed relevant evidences on the importance of nutrition and physical activity for longevity. These were eventually validated and a set of recommendations were crafted through consensus. The recommendations were subsequently presented/ disseminated in the convention. Collectively put together, PAN Recommends the following actions for different concerned agencies/ groups:
This session aimed to collectively put together recommendations for sustainable home and community food gardens based on the research, evidence, technologies and identified gaps, challenges and opportunities presented in the preceding sessions. Dr. Tuazon facilitated the discussion and a panel of reactors from the LGU (Ms. Sabado), academe (Dr. Belino), NNC (Dr. Dayanghirang) and PAN, Inc. (Dr.
Panlasigui) were invited to provide significant inputs and comments in the set of PAN Recommends.
The identified social, economic, health and nutritional contributions of home and community gardens were as follows:
…. that youth groups be supported as agents of change for adolescent health.
This can be achieved by ….
By ….
Why are we concerned with adolescent health?
The burden of adolescence:
Thus ….
Why are we recommending that the youth be an agent of change?
The youth occupies a major segment of the Philippine population, constituting a powerful, largely untapped, social and intellectual force.
What should we do…?
What can we do…?
What can the PAN do?
Let us mobilize the youth as agents of change for adolescent health!
…. that, elementary school aim to be nutrition-friendly schools.
The PAN recommends that five-point criteria, measured by specified indicators, may be used to identify nutrition-friendly schools. We believe that nutrition-friendly schools are those that:
The evidence is clear:
To this end, we recommend that the government, through Department of Education as the lead agency, initiate public-private partnership to enact policies that would support the goal of achieving nutrition-friendly schools. By achieving this goal, we could have a generation of children who are physically, mentally and socially fit through the practice of healthy lifestyle as they grow to adulthood, free from the double burden of under- and over-nutrition.
| Criteria | Suggested Activities and Messages | Indicators |
| Enhanced Curriculum | Incorporate key nutritional messages into the curriculum (detailed below) | Implementation of TCP Further integration of nutrition and physical activity in the curriculum |
| Comprehensive Health and Nutrition Plan | Division or school-specific health and nutrition priority setting | School-specific plan with set priority activities |
| Regular Physical Activity Program | Incorporation into the curriculumPromotion of regular physical fitness activities | Inclusion of physical fitness activities as part of the school curriculum Regular physical fitness activities being conducted |
| Provision of Health Diet Options in School | Promotion of healthy food choices in the school canteenPromotion of Food Guide Pyramid for Filipinos | Availability of health nutritious choices in school canteenActivities and IEC materials to promote consumption of fruits and vegetables |
| Essential Health Interventions | Targeted Food Supplementation ProgramsIron Supplementation Deworming programs for intestinal worms and schistosomiasisAdvocacy programs promoting the use of insecticide-treated nets in malaria-endemic areasTreatment of MDR-TB+ (multi-drug resistant tuberculosis) teachers | Initiate supplementary feeding programsInitiate school-based iron supplementation programsImplementation of school-based control programs for endemic parasitic diseaseIdentification and completed treatment of MDR-TB + teachers |
Among the key messages to be integrated into the curriculum are:
Together with
LGUs as prime movers for improved nutrition
An appeal to all Barangay Chairmen, City and Municipal Mayors, Provincial Governors, Congressmen and the National Nutrition Council to participate in the urgent need for immediate action for nutritional improvement.
PAN call upon official and national agencies to:
The local government units at the provincial and municipal levels and in particular, at the barangay, are the key to effective strategy to address the needed urgent call for action in nutritional improvement.
LGUs have the authority and responsibility to plan, implement, monitor and evaluate, and most importantly, allocate needed resources for local nutrition programs through a barangay and family- driven approach.
LGUs have the power and accountability as well, to bring about improved nutrition for its constituents and their families by integrating the barangay plan and program of action for nutrition into the local development plan in all levels.
Over the last three decades of nutrition program implementation, nutritional improvement has been slow among Filipino households particularly infants and young children, pregnant and lactating women.
There is a high prevalence of undernutrition among children 0-5 years. Provinces have been identified where prevalence of protein-energy malnutrition is high.
In 2003:
About five to six out of 100 children aged 0-5 years are wasted in body due to severe malnutrition.
From 1988-90 to 2001:
Between 1998 and 2003
People are the country’s key human resource capital. Their quality determines to an immeasurable extent the state of national development.
Nutrition tells heavily on the mental performance, physical endurance and socio-psychological adaptability of men, women, and children.
Global examples show the very close relation between good nutrition and national economic and social development. Poor nutrition holds back economic and social progress.
Achieving good nutrition, adequate food in quality and quantity, for a continually growing population such as the Philippines is a huge challenge.
A barangay plan and program of action for nutrition emanating from the Philippine Plan of Action for Nutrition (PPAN) has been successfully demonstrated by the Nutrition Center of the Philippines.
In 1999-2000, 43 selected barangays in 17 municipalities in Luzon and the Visayas implemented the barangay plan and program of action for nutrition resulting in:
Micronutrient malnutrition trends to reside mostly in families with children suffering from protein-energy malnutrition. Reaching families with underweight preschool children will most likely target children with micronutrient malnutrition as well.
PAN Recommends . . . . . . . . .
The judicious use of modern biotechnology in the search for foods of improved nutritional quality in terms of their nutritional content, nutrient bioavailability, functional properties and acceptability, and in enhancing the efficiency of food production for the growing population, for as long as utmost regard is accorded to their safety to health and environment.
More particularly, PAN urges the continuing development of:
Towards this end, PAN strongly supports increased human resources and financial support for research and development in modern biotechnology, particularly towards the development of foods of improved nutritional quality.
Furthermore, the PAN Recommends that government exert every effort and means to ensure safety of foods derived from modern biotechnology, the provision of adequate regulatory and monitoring system of such foods, and the development of a comprehensive program to educate the public on the benefits of modern biotechnology and on what the government as well as the private sector are doing to ensure safety to health and environment.
On its part, the PAN and all its members throughout the country should contribute to public understanding of the benefits of modern biotechnology together with the measures being implemented in ensuring its safety to health and environment.
Weekly iron supplementation for 1 to 5 year-old children, an economical and effective intervention for anemia prevention.
Philippines, the overall prevalence of iron deficiency anemia (IDA) is 30.6%, with a prevalence of 29.6% among children aged 1-5 years. Iron supplementation and food fortification have been identified as impact programs to address IDA. However, the existing guidelines on iron supplementation contained in the Department of Health Administrative Order 3-A s. 2000 does not include universal iron supplementation of 1-5 year-old children although routine supplementation of 2-5 year old children daily for about 2 months is indicated. Food fortification, on the other hand, is still not fully implemented. In addition, when hookworm infection is one of the underlying causes of IDA, both iron supplementation and food fortification will be less effective. Thus, the strategy for IDA in hookworm-endemic areas should include addressing hookworm infection concurrently.
In 2000, the Early Childhood Development Project of the Department of Social Welfare and Development (ECD-DSWD) called for the conduct of the study on the “Cost-effectiveness of deworming and weekly iron supplementation in the reduction of anemia among preschoolers: a field test”. The Nutrition Center of the Philippines (NCP) responded to this call and was subsequently selected to conduct the study. The project was In the conducted from September 2001 to May 2003. The study showed that weekly iron supplementation for 4 months, with or without deworming, was effective in improving the iron status of 1-5 year-old children. Based on this finding, the Philippine Association of Nutrition recommends weekly iron supplementation for 1-5 year-old children. A summary of the study, taken from the final report by the NCP, is presented below.
Title: Cost-effectiveness of deworming and weekly iron supplementation in the reduction of anemia among preschoolers: a field test
Objective: This study aimed to determine the cost-effectiveness of the combined strategy of deworming and weekly iron supplementation (DIS) versus weekly iron supplementation alone (IS) in reducing the prevalence of anemia among preschoolers.
Methods: This randomized field trial was conducted among 2,082 preschoolers (aged 12-71 months) in
8 rural villages in the municipalities of Barili and Dalaguete in Cebu Province. After the baseline data collection, the children were randomized to DIS group (experimental) or the IS group (control). The children in the DIS group were dewormed before the iron supplements were given. Children aged 1-2 years old were given 200 mg of albendazole while those aged 3-5 years old were given 400 mg of albendazole. All the children were given iron supplements weekly for 4 months as follows: 1.2 ml of ferrous sulfate drops for age 1-2 years; 7.5 ml of ferrous sulfate syrup for age 3-4 years; and, 12.0 ml of ferrous sulfate syrup for age 5 years.
Results: At baseline, the characteristics of the children in the DIS and IS groups did not differ significantly except for Trichuris infection and mixed infection. After the intervention, the hemoglobin, zinc protoporphyrin and serum ferritin levels increased in both groups, with no significant differences observed between groups. Overall, the prevalence of anemia was reduced by 43%, iron deficiency (using serum ferritin) by 65%, iron deficiency (using zinc protoporphyrin) by 50%, IDA (using hemoglobin and serum ferritin) by 73% and IDA (using hemoglobin and zinc protoporphyrin) by 70%. The prevalence of infection for all helminths was similar to baseline levels after 4 months, although the prevalence and intensity of infection was significantly lower in the DIS group. The prevalence of stunting decreased while that of underweight and wasting increased slightly but not significantly. The average cost of administering DIS to a child is PHP 77.57 and PHP 45.52 for IS. The cost of drugs comprised 68.2% of total costs for DIS and 62.5% for IS. Significant additional mild anemia cases prevented were observed for IS while for DIS, significant reductions in hookworm and Ascaris infections were noted. DIS prevented less number of mild anemia cases and is more costly than IS. DIS was effective in reducing hookworm, Ascaris and Trichuris infection. As expected, IS did not have any considerable effect on geohelminthic infections.
Conclusions: The combined intervention of DIS did not significantly impact on IDA among preschoolers possibly due to the low prevalence of IDA and hookworm infection in this study population.
IS alone for 4 months was effective in reducing anemia. IS alone has a potential of cost savings compared to the combined strategy in preventing cases of mild anemia, because of more cases of mild anemia prevented at a lower cost.
Deworming alone is also cheaper than the combined strategy in preventing geohelminthic infections in this population of preschoolers.
Recommendations and Policy Implications: As weekly iron supplementation for 4 months was proven effective in reducing anemia, it is recommended that this be implemented as a national program of the government. However, the duration of the iron supplementation must be for at least 1 year to prevent iron deficiency, improve iron stores and consequently prevent anemia. If the resources of the government are limited, iron supplementation can be targeted only among preschoolers who are anemic. If assessment of anemia is not feasible due to budget constraints, the child’s nutritional status can be used as surrogate indicator for anemia. As this study has shown, it is more likely that underweight, stunted or wasted children are anemic.
It is recommended that weekly iron supplementation for 1-5 year-old children should be considered as a policy. Although this study did not assess the effect of daily iron supplementation, studies conducted elsewhere has proven that daily and weekly iron supplementation produce the same effect on iron status.
While iron supplementation in itself is highly effective in reducing anemia, food-based strategies as food fortification and dietary diversification through nutrition education are still more recommended as long-term interventions to address the malnutrition problem in the country. The evident inadequate energy and nutrient intake of children in this population is expected to be found in other poor communities in the country.
An effectiveness trial in other communities with higher prevalence and intensity of geohelminthiases and/or other areas with multiple parasitic infections (for example, soil-transmitted helminths plus malaria or schistosomiasis) should be conducted. An efficacy trial on a subset of preschool children diagnosed with anemia and helminthiases may also be done. It is important that the frequency, timing and duration of deworming children be studied and instituted as a national program.
Authors:
Florentino S. Solon, M.D., M.P.H.; Liberty Fajutrao, M.D., M.P.H.; Juan Antonio A. Solon, M.D., M.Sc.; Jesus N. Sarol, Jr., Ph.D.; Lorena S. Wambangco-Tengco, R.N.D.; and, Liza S. Fermin, M.Sc., R.N.D.
Funder: Early Childhood Development Project-Department of Social Welfare and Development
Studies on the efficacy of weekly iron supplementation
1. Beaton GH, McCabe GP (1999) Efficacy of intermittent iron supplementation in the control of iron deficiency anemia in developing countries. An analysis of experience: Final report to the Micronutrient Initiative. Canada: Micronutrient Initiative.
2. Monteiro CA, Szarfarc SC, Brunken GS, Gross R, Conde WL (2001) Long-term preventive mass prescription of weekly doses of iron sulfate may be highly effective to reduce endemic child anemia. Food Nutr Bull 1:53-61.
3. Liu X-N, Kang J, Zhao L, Viteri FE (1995) Intermittent iron supplementation in Chinese children is efficient and safe. Food Nutr Bull 16:139-46.
4. Palupi L, Schultink W, Achadi E, Gross R (1997) Effective community intervention to improve hemoglobin status in preschoolers receiving once-weekly iron supplementation Am J Clin Nutr 65:1057-61.
5. Schultink W, Gross R, Gliwitzki M, Karyadi D, Matulessi P (1995) Effect of daily vs. twice weekly iron supplementation in Indonesian preschool children with low iron status. Am J Clin Nutr 61:111-15.
6. Soemantri AG, Pollitt E, Kim I (1985) Iron deficiency anemia and educational achievement Am J Clin Nutr 42:1221-8.
7. Thu BD, Schultink W, Dillon D, Gross R, Leswara ND, Kha HH (1999) Effect of daily and weekly micronutrient supplementation on micronutrient deficiencies and growth in young Vietnamese children. Am J Clin Nutr 69:80-6.
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