GAMBLING dens and machines dot this main road in Barangay Ermita, Cebu City, frequented by mothers and children alike.

Beyond these structures in one of the depressed areas in the city lies the most pressing problem the barangay faces today—children suffering from severe malnutrition.

Two-year-old Lindsay Bacera walks barefoot outside her three-square-meter shanty in Sitio Ermita Right Side. With a bad cough and cold, she’s unable to join her neighbors for afternoon play out in the streets.

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At seven kilos and 70 centimeters in height, Lindsay is one of Ermita’s 182 underweight and severely underweight children below six years old.

Her cousin, Clarissa, 4, is severely underweight, weighing only 11.4 kilos, two kilos lighter than the ideal weight for her age.

Farther down the alley, 18-year-old Rosevic Dejacto insists her 18-month-old son is well-nourished. But according to health worker May Parba’s records, Benz Dejacto weighs only 6.9 kilos. For children his age, 7.5 kilos is already considered severely underweight because the normal weight is 8.4 kilos.

“We’ve already done everything to improve the condition of the children,” said Parba in Cebuano. “We constantly undertake feeding, provide vitamins and monitor their weight, but the parents themselves are not interested in cooperating. They do not see their children being malnourished as a problem.”

UN goal

As a signatory to the United Nations Millennium Development Goals (MDG), the Philippines committed to eradicate extreme poverty and hunger by 2015, just five years away.

This involves halving between 1990 and 2015 the proportion of people who suffer from hunger, as indicated, among others, by the prevalence of underweight and malnourished children under five years old.

The MDGs are eight goals signatory countries committed to meet by 2015, including eradicating extreme poverty, achieving universal primary education, promoting gender equality and empowering women, reducing child mortality and improving maternal health.

The 2007 Philippines Midterm Progress Report on the MDGs says Central Visayas had a 40.7 percent prevalence of underweight children five years old and below in 1990, which means this should be reduced to 20.35 percent by 2015. The report said the proportion of underweight children in Central Visayas in 2005 was 27 percent.

Topping the list

Last month, the National Nutrition Council 7 ranked Cebu City fifth in the list of cities in Central Visayas with the highest malnutrition rates.

Cebu City has a malnutrition rate of 5.68 percent, following four Negros Oriental cities: Canlaon, 11.34 percent; Bayawan, 10.62 percent; Bais, 10.2 percent; and Tanjay, 6.42 percent.

Following the release of the ranking, Cebu City Mayor Michael Rama said lowering the incidence of malnutrition in the city would be a key challenge to his administration.

Barangay Ermita topped the list of barangays in Cebu City with malnourished children, with a malnutrition rate of 13.3 percent, as shown in the Operation Timbang conducted on children below six years old by the City Health Department from January to March this year.

In the Bacera household, Lindsay is the youngest of seven children.

Without a job, single mother Carmen admitted she’s unable to provide for her children, making malnutrition inevitable. They eat only two meals a day.

Two of her children go to school on an empty stomach, often passing out in class and ending up going home.

On the few days that she’s lucky, Carmen gets to wait on tables in a nearby eatery or run errands for her neighbors, from which she earns P50 to P80 a day.

“Pero usahay ra gyud na. Mao nang P15 ra gyud akong magahin para sa pagkaon. Tulo ka puso, unya sabwan ug monggos, ako na nang ipaigo sa mga bata,” she told Sun.Star Cebu. (But that rarely happens. That’s why I can allocate only P15 for food. Three pieces of puso, or rice wrapped in coconut leaves, and mung beans soup—I’ll have to divide that among all the children).

Carmen’s story is similar to those of countless other mothers in Ermita.

Of Barangay Ermita’s 1,368 children aged 71 months and below who were weighed, 47 were severely underweight while 135 were underweight.

A total of 130,383 children were weighed in Cebu City, with 4.32 percent or 5,629 of them found underweight and severely underweight.

But the low rate of 4.32 percent provides little comfort, as the 130,383 pre-schoolers weighed comprised just 15.7 percent of the city’s 827,285 children, which means there could be many more underweight children out there.

Many causes

Although poverty is often made an excuse for malnutrition, barangay officials trace the problem to other causes, among them poor parenting, illnesses, vices, including the use of illegal drugs, laziness to prepare meals, big family size, teenage pregnancies, lack of knowledge on the part of the parents and their environment.

Dr. Amor Ruiz, the doctor assigned to the barangay, said some parents don’t perceive malnutrition as a problem, even if it causes their children to fall ill.

Just last week, she referred a two-month-old child who had turned pale to the Cebu City Medical Center for blood transfusion after she suffered from severe anemia, which she linked to malnutrition.

Illness

Malnourished children are prone to diarrhea, cough, fever, pneumonia and other illnesses, she said.

Poor sanitation contributes to the problem, health worker Parba said, with children wading barefoot in waste water and open canals.

“Sometimes the children get sick because they lack proper nutrition, or in some cases, their condition worsens because of malnutrition. Unfortunately, some parents do not understand the problem,” a frustrated Ruiz said.

“It is also hard to make the parents understand because they have varied concerns. Some have so many children that they neglect the feeding of their other children. Other parents spend their time gambling,” she said in Cebuano.

Irony

She finds it ironic that in Ermita, home to the Carbon market where fruits and vegetables are cheapest, mothers would have problems serving their children nutritious food.

In some households, she lamented, it’s also the children who look after their younger siblings, so they are not fed properly and sufficiently.

“In most cases, it’s all about poverty and the size of the family. The parents are aware that their children are malnourished, but they have no money to sustain the needs of the family. That is why the family size should be small, so that even if their income is small, they would still have enough for food,” said Ruiz.

Surprised

Although he was surprised by the Operation Timbang results this year, Ermita Barangay Captain Felicisimo Rupinta, a family planning advocate, assured he will waste no time in addressing the problem.

In 2004, Rupinta, already barangay captain, said if Ermita had not started promoting birth control methods in 1998, its annual population growth rate would have reached four percent.

Rupinta has been trying to stamp out poverty in his barangay since 2000, when he described his constituents as mostly squatters with no fixed income.

From 2000 to 2006, Barangay Ermita maintained a 2.1 percent population growth rate, yet poverty and hunger linger.

Programs

Ermita has earmarked 10 to 15 percent of its P6-million General Fund for 2010 for nutrition programs. Its P3-million Economic Enterprises Development fund was also set aside for programs for children, mainly for projects to address malnutrition.

In the day care centers and in the sitios, children below six years old will be asked to take part in the feeding program of the barangay and the non-government organizations (NGO) assisting them, such as Bidlisiw Foundation.

Children will be served lugaw (porridge) with malunggay (moringa in English, kamunggay in Cebuano) and squash or beans, and parents will be assisted with livelihood activities.

Holistic

Rupinta admitted that supplemental feeding is just a stop-gap measure. That is why starting this year, the barangay will implement a holistic approach to addressing the malnutrition problem.

“Sa atong nakita, kawad-on gyud ang hinungdan sa malnutrition. Ikaduha, irresponsable gyud ang mga ginikanan. Unya apil na sad diha ang environment. Tungod lagi aning mga bisyo sa mga tawo diri,” he said. (As far as we’ve seen, poverty is the cause of malnutrition. Second, the parents are really irresponsible. If you look at the environment, the people here have many vices.)

“So we will not just try to feed these children, we will address the root cause of the problem. We are working with Bidlisiw, which will help the parents with livelihood and educate them on parenting and how to improve their children’s nutrition,” he added.

No laws

Like Rupinta, Cebu City Mayor Rama believes malnutrition is a result of poverty, often aggravated by numerous family members sharing the limited income.

Despite this, Rama is not agreeable to passing laws that will limit the number of children in a family, or imposing family planning methods on his constituents as a way to address poverty and malnutrition.

Conscience

“I am biased for continuing education on parenting. We have to make the parents conscious of the problem and help them develop a conscience. You cannot just keep getting pregnant, but you cannot feed your children. That means you have no conscience. If you develop a conscience, you will feel guilty, so you will avoid having too many children,” the mayor said.

His administration, he said, will invest in educating the parents, rather than imposing the use of contraceptives and other artificial family planning methods.

Support

Cebu City’s assistant nutrition coordinator Emma Gaviola takes a different view. She said as long as the barangays and the City Government are committed to implementing long-term solutions, the city’s children are on their way to recovery.

Gaviola said nutrition programs such as the Pabasa sa Nutrisyon, feeding and monitoring activities are in place and just need continuous support.

If these programs are funded, poverty and the size of the family would not get in the way of solving the problem, she said.

“Poverty will always be there, but it is not an excuse to have malnourished children. What we need is continuous support from the local government and monitoring of these children,” Gaviola said. “The Pabasa sa Nutrisyon in itself is already a big step in addressing the problem.”

Pabasa sa Nutrisyon is an innovative approach in strengthening the implementation of the five impact programs—home, school and community food production; micronutrient supplementation; food fortification; nutrition education and food assistance. The program initiated by the Nutrition Center of the Philippines aims to introduce behavioral change in ensuring nutrition in the family.

Success story

Barangay Sawang Calero officials implemented the program in all sitios in their barangay last year alongside feeding programs, and because of this, their ranking among barangays with malnutrition cases dropped from number one last year to number 12 this year.

These are the same programs Rupinta will implement in his barangay, with the help of NGOs and private donors.

Last Friday, he ordered barangay officials to remove gambling dens, with the hope that mothers will focus their attention, time and money on the right priorities—their children and their health.