Special Report: Absent parents, pregnant teens fuel child hunger (Second of three parts)

OVER 26 years, five presidents failed to adequately address the problem of child malnutrition in the country.

Data from the National Nutrition Survey show that the prevalence of wasting in children under five years old in the Philippines increased from 6.2 percent in 1989 to 7.1 percent in 2015.

Wasting (being too thin for one’s height) indicates acute undernutrition.

In Cebu, in the 2016 reckoning of wasting prevalence based on Operation Timbang (OPT) results for preschool children under six years old, the town or city in Cebu that fared worst was San Fernando.

San Fernando led the 44 municipalities and nine cities in Cebu with wasting prevalence of 9.46 percent after 860 children were found wasted in that town, 305 of them severely.

This was a slight increase from the 854 wasted in 2015, of whom 278 were severely wasted.

Public health nurse Almira Tangente took issue with the town’s number one ranking by the National Nutrition Council (NNC) in wasting prevalence, saying barangay health workers might not have taken the measurements accurately, such as when the weighing scale is not placed on a flat plane.

To be fair, the figures might also not have been completely comparable because the different cities and municipalities did not weigh the same percentage of children in their areas.

“The Operation Timbang is supposed to cover 100 percent of the children in the area. Butsometimes, it is hard for them to reach the far-flung areas like island barangays. And in subdivisions, they don’t allow their children to be weighed,” said Dr. Parolita Mission, nutrition program coordinator of the NNC 7, the repository of nutrition information in the country.

As a result, San Fernando covered 82.61 percent of its estimated number of pre-schoolers in the 2016 Operation Timbang, while the other towns in the top 10 list of Cebu towns with the highest prevalence of wasting covered anywhere from just 65.28 percent (Alcantara) to 89.39 percent (Pinamungajan) of their pre-schooler population.

For the nine cities, the coverage ranged from 54.02 percent (Carcar) to 89.87 percent (Talisay).

The wasting prevalence is computed by dividing the number of wasted children by the number of pre-schoolers measured.

Less value

Nevertheless, Tangente said the town was working hard to get off the number one spot, with the results of this year’s OPT already yielding lower numbers: 671 wasted children, of whom 200 were severely wasted.

“In 2016, OPT was just once a year. Now, we will hold it twice a year,” Tangente said.

Five of the town’s 21 barangays accounted for 75 percent of the severely wasted children below six years old in 2016. Poblacion South had the highest number of severely wasted children at 84; followed by Sangat with 59; Poblacion North, 38; Panadtaran, 25 and Tonggo, 21.

Usually, it is the coastal barangays with big populations that have the greatest concentration of wasted children because of the tendency of parents there to feed their children “buwad (dried fish), ginamos (salted and fermented fish or krill) and instant noodles, which have less nutritional value,” Tangente said.

“In the mountain barangays, they can plant root crops in their gardens and farms, so it’s possible that their nutritional intake is better there, and they spend less. Here, we can’t grow as much fresh food or vegetables because the houses are very close to one another. There is no space to plant,” she said.

She said parents played a primary role in ensuring the health of their children, and that there was a health center in each barangay for parents to bring their children to if they chose to.

But she said some parents neglected their children because they were busy with other things, like earning a living—doing laundry or collecting cans—or gambling.

The result is that they go to the health center only when their child is already very sick.

Big families

Tangente said big families, especially those with five or more children, were the usual places to find wasted children.

Teenage mothers who don’t know how to take care of children, and even themselves, contribute to the problem of child malnutrition, Tangente said.

Some of these teens married early or got pregnant out of wedlock.

“There was even a 13-year-old who got pregnant in Barangay Sangat,” she said.

Last year, there were more than 100 teenage pregnancies in San Fernando. Girls who get pregnant early normally will keep on getting pregnant, she said.

Tangente said this was how some family sizes ballooned to up to 10 children. They included the extended family—typically the children of the eldest child, whose husband may or may not have work, living with the family.

“This contributes to child malnutrition. Menos na ang pagkaon, kay samot man sila kadaghan (They have even less to eat now that there are more mouths to feed),” she said.

A factor in teenage pregnancies is the lack of guidance from parents, especially when the parents split and the mother has children by another man, leaving her children by the first husband unsupervised; or when parents are illiterate or involved in gambling and vice, she said.

Tangente said the problem of teenage pregnancy was not exclusive to San Fernando.

The town has intensified its family planning advocacy, she said.

In Poblacion South, rural health midwife Flor Villarazo said she had barangay health workers go house to house to urge parents with malnourished children to plan their families.

Assistance

To deal with undernutrition, the town’s health officials distribute micronutrient powder with ferrous sulfate, multivitamins, and chewable deworming tablets.

Barangay health workers (BHW) distribute the micronutrients and administer the vitamin A to the malnourished children. They do weekly monitoring.

The Sprinkles micronutrient powder, a fortified vitamin and mineral food supplement for children under five years old, is mixed with the child’s food, like his porridge or vegetables.

“One child should consume 60 packs of this,” Tangente said.

The town, she said, had plenty of supply of this, but they could not do anything if the mother did not mix the micronutrient powder in her child’s food.

She said they had also started distributing the RUTF (ready to use therapeutic food) from the Department of Health, intended for severely wasted children starting this year.

But she said there was a problem of compliance by some mothers, who claimed their children would not eat the RUTF.

Asked what other assistance the malnourished get, Tangente said, “There’s Pantawid and the private sector, like Taiheiyo Cement and Mabuhay Cement, which give supplemental feeding to children in barangays where their factories are located.”

Taiheiyo, which is in Poblacion South, provided three-month feeding to children two to five years old, which includes the malnourished, living near their plant, Villarazo said.

“But then after one month, the children go back to being malnourished because they really lack food,” she said.

According to Villarazo, many of the families that had wasted children in her barangay had fathers engaged in fishing, driving a tricycle, loading cement in the cement firms, or were jobless.

As for the Pantawid Pamilyang Pilipino Program (4Ps), this is the Department of Social Welfare and Development’s (DSWD) anti-poverty program that gives monthly cash grants to families on the condition that they invest in their children’s health and education, and avail themselves of maternal health services. 

Tangente said the local government itself does not feed the children.

Manpower

There are 26 barangay health workers in Poblacion South, Villarazo said.

But since there are more than 2,000 households in the barangay, some BHWs are responsible for 50 households, while others handle more than 100 households each.

The BHW earns P1,500 a month as honorarium from the barangay in Poblacion South. But some six of them are “accredited” and get an additional P1,200 a month from the municipality.

BHWs are usually housewives, whose area of work is their neighborhood.

Site insights

A visit to the barangay’s Sitio Lawis offered insights on why despite the supply of commodities, malnutrition persists.

In the sitio, Babemae Villafuerte’s 10-month-old son, John Peter, is among the beneficiaries of the peanut butter-based RUTF for severely wasted children.

After just two weeks on the Plumpy’Nut RUTF, he no longer looks too thin.

Villafuerte said John Peter is her seventh child. Her husband is a construction worker who earns P200/day, some of which he drinks away on paydays. Her husband used drugs also until President Duterte’s Oplan Tokhang, the police campaign targeted at drug users, scared him into dropping the habit.

She said she doesn’t give her toddler the RUTF regularly because it gives him diarrhea at times.

As for the Sprinkles micronutrients, Villafuerte said she mixed it with John Peter’s rice porridge, but then “lain pud ang lami (the porridge tasted different),” so her child didn’t like it.

Without it, though, her son eats porridge.

“The micronutrients are tasteless if you put only a small amount,” Tangente explained. “It’s high in iron, so it will taste bitter if you put too much of it.”

Nancy Paradero’s two-year-old son is another beneficiary of the Plumpy’Nut RUTF, which Paradero said he eats with rice. Paradero’s husband is a fisherman. Aaron is her sixth child.

Her eldest daughter, Aina Algabre, is a teenage mother who first gave birth at 17. Today, at 19, she is pregnant with her second child. Algabre’s husband is a construction worker.

Paradero said that since Aaron can’t consume all of the RUTF, she gives some of it to Aaron’s older sibling, who is also thin.

On hearing this, Villarazo and the nurses from the Nurse Deployment Program of the DOH advised her to get a separate allocation for her older child.

In the case of Nikki Ivan Lopez, 5, he refused to eat the Plumpy’Nut, preferring apples. So his mother waived the boy’s allocation of the RUTF.

Sharing bounty

Asked how else the severely malnourished could get nourishment, barangay health worker Mary Ann Entero of Sitio Lawis said sometimes, there is extra food when the DSWD conducts its supplementary feeding for pre-schoolers in the day care center for four- to five-year-olds.

When that happens, she takes the extra fortified rice, milk and brown sugar back to her neighborhood and makes champorado (sweet chocolate rice porridge) or arroz caldo (congee), then calls on the neighbors to partake in it.

Typically, more than 30 children aged up to seven years old respond to the call, she said.

Entero does not limit the invitees to the malnourished. Anyone who approaches may join the feast.

The DSWD provides supplementary feeding for 120 days annually in day care centers and neighborhood supervised play areas.

In last year’s day care feeding, which ran from October to March, Entero said they were able to partake of extra food about six times a month.

Top 10 Cebu towns in wasting prevalence of children 0-71 months

9.46% San Fernando
8.12% Oslob
7.81% Sibonga
6.81% Tabogon
6.68% Barili
6.44% Pinamungajan
6.34% Santander
6.06% Catmon
5.98% Aloguinsan
5.69% Alcantara

(Source: National Nutrition Council)

Wasting prevalence of children 0-71 months in Cebu’s 9 cities:

5.20% Cebu
5.00% Talisay
4.68% Carcar
3.86% Danao
3.59% Toledo
2.62% Naga
1.14% Mandaue
1.07% Lapu-Lapu
0.30% Bogo

(Source: National Nutrition Council)
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