POVERTY always gets the blame for the rise and fall of malnutrition rate. While it’s true enough, policymakers and concerned government agencies have to face yet another nemesis: weather.
When strong Typhoon Pablo battered Davao Region in December 2012, thousands of properties and lives were lost on its wake, plus many others who went missing were never found until now. The survivors of Sendong in 2011 and Yolanda in 2013 have, for sure, their share of the same sad story.
With homes and means of livelihood destroyed, all those who survived were jammed in evacuation centers and subsisted on relief goods from government and other well-meaning humanitarian groups.
But the post-apocalyptic scenario where survivors are in has its immediate effect on the children who are most vulnerable to some health conditions in the evacuation centers and even at the temporary shelters -- malnutrition included.
Having little to no access to enough and proper feeding, malnutrition, in this case, refers to underweight and severely underweight children.
In Davao Region, the Operation Timbang of the National Nutrition Council (NNC) posted a 6.18 percent prevalence rate in 2013 increased from 5.94 percent recorded in 2012. The increase came after Pablo struck land, in which Department of Social Welfare and Development (DSWD) listed a total of 232,354 affected families, or equivalent to 933,416 individuals.
To compare the regional performance rates between 2013 and 2012, the increase seems to be little which only stood at 0.24 percent, but the result however is only being hushed up by cities that scored low on malnutrition rate.
This means that the slight rise in the regional prevalence rate is not reflective of how every province fared well in easing off malnutrition and is nothing but the tip of the iceberg, as more troubling are the results obtained by the individual areas and provinces that were most affected when Pablo made landfall.
“Nakabawi lang sa ibang areas namababaangkanilang malnutrition rate so hindimasyadong nag-escalate sa region,” Ungson added.
The region has a total of 40,299 population of underweight and severely underweight children; 37,953 in 2012; and 38,825 in 2011.
DavOr is most affected
Among the four provinces of the region, Davao Oriental (Davor) increased by 2.36 percent to 6.56 percent in 2013 from 4.2 percent in 2012, the highest recorded in the province for three years. The drastic spike can speak so much how the province was affected when typhoon wreaked havoc the province.
The data from the DSWD showed Davor has the second highest in terms of affected families numbering a total of 56,352 families.
NNC-Davao Region chief Teresa Ungson said Davor was a performing province when it comes to hitting its malnutrition target, but all of a sudden the rate bloated after Pablo struck the region.
“Prolonged hunger can lead to malnutrition,” she said.
The most number of Pablo victims was recorded in the worst hit Compostela Valley (Comval) province, recording a total of 130,038 affected families.
That Comval’s prevalence rate stood the lowest at 5.14 percent despite having the most number of typhoon victims was something laudable.
“AngComvalna contain nilaang malnutrition problem, so hindi masyadong nagtaas,” she said.
This could well be because efforts have been taken up for the residents, especially for the indigenous people (IP) in the province, to help them get back on their feet.
The prevalence rate in Davao Del Sur (Davsur) is consistently high since 2011, but it soared further to 11.67 percent in 2013 from 9.4 percent in 2012, though the province recorded only 521 affected families, the lowest among the four provinces.
Davao del Norte (Davnor) has the second lowest in terms of prevalence rate which stood at 5.77 percent. DSWD recorded 44,905 families affected at the time Pablo struck.
Meanwhile, the prevalence rate of Davao City, which has the highest population of underweight and severely underweight cases, decreased to 4.8 percent last year from 5.77 percent in 2012. The city only had 538 typhoon affected families.
rUngson said Pablo not only toppled the regional performance but also brought the malnutrition slope up again. They who could have gone a level higher in their efforts by this time have to start from scratch again, at least for the severely affected areas.
Effort done
Ungson said severely underweight children in typhoon-hit areas were placed under Integrated Management of Acute Malnutrition (IMAM) whose beneficiaries were on Ready-To-Use-Therapeutic-Feeding (RUTF) for one to three months to help them regain weight.
“It’s a special food that is like a peanut butter which is calorie-dense and has nutrients enough for feeding children,” she said.
Trainings are also done for mothers on how to feed their children using the RUTF and other things like preparing food that is necessary to help the underweight cases, as some of them develop a gastrointestinal tract problem that hampers nutrient absorption from the regular food.
“After three months of rehabilitation, they improve even the skin. That's why, we have a therapeutic feeding para hindi lumala ang situation nila,” she said.
For a three-month feeding, it will cost around P5,000 for every one child.
Culture-sensitive
Not only do project implementers have to face the sad reality of redoing the efforts destroyed by Pablo but also they have to deal with cultural differences. It’s the same old beliefs in some geographically isolated communities that make it hard to reach out to the people.
Ungson said they have to design a cultural-friendly approach on health and nutrition program that is more fitting for the indigenous people.
“They don't want vaccination. They just don't trust the modern ways, so we cannot force them because they will not cooperate. You really have to design a program that is acceptable for IPs,” she said.
The National Commission on Indigenous Peoples (NCIP) has piloted in five Mindanao areas a program that seeks to “strengthen IP leadership and organizational capacity in developing and sustaining culture-based development initiatives on health, nutrition, livelihood, education, and environment towards building a healthy, peaceful and climate change resilient communities in Mindanao.
In Davao Region, Montevista in Comval has been singled out as a pilot area. Others are Dumingag, Zambonga del Sur; SinudaKitaotao, Bukidnon; Bentangan, Carmen in North Cotabato; and Binicalan, San Luis, Agusan del Sur. The selection was done on areas that have Certificate of Ancestral Domain Title (CADT).
This program is supported by European Union with a funding of 300,000 euros, which started in May 2014 and will end in May 2016.
Under the program, among the expected results that NCIP and other stakeholders are hoping to attain are to be able to create access to early childhood development programs with activities that promote awareness on proper nutrition, sanitation and wellness; improve delivery of basic health and other services that contribute to the well-being of the IP communities; and establish mechanisms on food security and access to various livelihood initiatives.
Ungson pointed out that it’s the health-seeking behavior they hope to improve because there are parents who simply do not have the conscious effort to bring their child to the doctor.
“People do not seek. Maybe they are not aware nadapatipa-check up. Maybe, they do not understand how important it is to seek medical assistance,” she added.
Also, mothers should not deny a child of exclusive breastfeeding for the first six months of life, that being the most effective yet free method to combat malnutrition, according to her.
Form good habits
While the long-term solution to malnutrition also lies on forming good habits, Ungson added intervention like that of DSWD 11’s PantawidPamilyang Pilipino Program (4Ps), also known as Conditional Cash Transfer (CCT) fund, might help in a way by keeping the beneficiaries right on the track, with the positive reinforcements on health care and education.
The 4Ps, an anti-alleviation government program, has been giving family beneficiaries P1,400 financial aid, of which P500 goes for the daily expenses and the P900 for the education of three children aged zero to 14 years old. Eligible beneficiaries can stay in the program for five years, except that they have to do the government some favor – that is to follow the conditions provided for by the program.
“They have to bring their child to the center regularly at dapat pumapasok sa school para masanay sila until such time it becomes a lifestyle,” she added.