Health workers tasked to help correct the incidence of malnutrition in the Philippines now hava a guide jointly prepared by the World Food Programme and the Department of Health. It contains uniform and cohesive guidelines for managing acute malnutrition.

The guidebook, which is five years in the making, not only aims to address malnutrition but reduce child mortality and improve survival rates of children under 5 years old.

“Our ultimate goal is to significantly lower, if not zero out, the rate of acute malnutrition in the Philippines,” said Dr Martin Betelley, Country Director ad interim of World Food Programme Philippines

Acute malnutrition, a kind of undernutrition, comes in two forms -Moderate Acute Malnutrition (MAM) or Severe Acute Malnutrition (SAM), according to the WFP.

The Food and Nutrition Research Institute (FNRI) puts the number of Filipino children stricken with malnutrition to about a million, based on the 2015 National Nutrition Survey.

Malnourishment profile

Progress on stunting and wasting plateaued last year, making it a health crisis.

“This comprises 7.1 percent of our children’s population, and of the 1 million, 73 percent have moderate acute malnutrition while 27 percent have severe malnutrition,” Health Secretary Paulyn Ubial pointed out.

Children who are malnourished have a compromised immune system, making them prone to infection.

Malnutrition could be traced to poverty, illnesses, poor sanitation, disasters, improper child care practices, and lack of health facilities. Children below 5 years are especially vulnerable to acute malnutrition.

Children with moderate wasting are three times at risk of death compared with normal children, while children with severe wasting are at risk up to nine times.

Affected children are usually those coming from poor communities, remote areas,as well as hazard-prone and conflict-ridden areas.

“Acute malnutrition is the end result of any cause,” said Dr Betteley, “if the cause is not properly addressed, acute malnutrition will recur,” and underscored the need to “treat the basic causes.”

DOH to make use of RUSF

One of the strategies to address the problem is making use of Ready to Use Supplementary Feeding or RUSF. This is a soft, peanut butter-like food made of peanut paste, vegetables fats, soy proteins, sugar, and cacao.

According to the guidebook, RUSF is a highly nutritious, ready-to-eat food given to treat children below five years of age suffering from malnutrition.

RUSF or Read-to-Use-Supplementary Feeding is highly nutritious for kids suffering from malnutrition.
RUSF or Read-to-Use-Supplementary Feeding is highly nutritious for kids suffering from malnutrition.

“The DOH has committed to address malnutrition and procured [Php] 390 million worth of RUSF for children with MAM,” said Secretary Ubial.

The department will prioritize provinces with high burden acute malnutrition and will expand implementation until it covers the entire country, and through the help of the “adopt a village’ programme - where a non government organization (NGO) or an international aid group could adopt a village and provide the RUSF for children with MAM.

So far, DOH has identified 37 provinces and five National Capital Region (NCR) cities for the run. The RUSF will be distributed in local health facilities, be integrated with the Integrated Management of Children Illnesses (IMCI) and in growth monitoring promotion programs.

“Children aged 6 to 59 months months will be routinely screened through the mid-arm circumference and weight for height, or by clinical appearance, then they will be provided with RUSF, [which provides] 60 kilocalories per 1 sachet per day for 3 months,” Secretary Ubial explained. Infants below 6 months, meanwhile, should still be breastfed.

The Health chief clarified that the RUSF is not locally produced, although there are distributors for the supplement.

In the absence of the RUSF, however, fortified blended food can be given. Supplementary food for 6 to 59 months can be prepared from local food sources with micronutrients and fats additive.

Preventing acute malnutrition

In determining acute malnutrition, health workers may measure the patient’s weight against hte child’s length or height, or the mid-upper arm circumference (MUAC) or check for bilateral edema.

In general, prevention and treatment of MAM and SAM start with adherence to breastfeeding for at least the first six months,. At the same time, education on proper diet of both children, pregnant and nursing mothers, as well as provision of micronutrient supplements (MNP), access to safe and clean drinking water, immunization, and good child practices are other strategies to prevent malnutrition.

Secretary Ubial also cited handwashing, deworming, good family planning and vaccination - which has a target of 95 percent inclusion this year, as helpful practices.

Road ahead

Following the ceremony launching the guidebook, regional focal persons received technical briefing and trainings.

Initiatives, capacity building for management of SAM are ongoing, and soon, the training for MAM will commence, said Secretary Ubial.

She also clarified that DOH and NNC already had guidelines for SAM and MAM, but the new guidebook is evidence-based, cohesive and updated.

“We are thankful for the opportunity to partner with the Department of Health in making this initiative a reality. Our strategic collaboration was key to producing a manual that comes in handy for both decision-makers and for healthcare providers,” said Dr Bettelley. MIMS

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