Chapter I THE PROBLEM AND ITS SETTING
Introduction:
Hunger and malnutrition is the gravest single threat to the world's public health and malnutrition is by far the biggest contributor to child mortality, present in half of all cases. Underweight births and inter-uterine growth restrictions cause 2.2 million child deaths deaths a year. year. Poor or non-exi non-existe stent nt breast breastfee feedin ding g causes causes anothe anotherr 1.4 millio million. n. Other Other deficiencies, such as lack of vitamin A or zinc, for example, account for 1 million. Malnutrition is estimated to contribute to more than one third of all child deaths, although it is rarely listed as the direct cause. Lack of access to highly nutritious foods, especially in the present context of rising food prices, is a common cause of malnutrition. Poor feeding practices, such as inadequate breastfeeding, offering the wrong foods, and not ensuring that the child gets enough nutritious food, contribute to malnutrition. Infection – partic particula ularly rly freque frequent nt or persis persisten tentt diarrh diarrhea, ea, pneumo pneumonia nia,, measle measless and malari malariaa – also also undermines a child's nutritional status.
Malnutrition is a general term for a medical condition caused by an improper or insufficient diet. diet. It most most ofte often n refe refers rs to und under ernut nutri riti tion on resu result ltin ing g from from inad inadeq equa uate te consumption, poor absorption, or excessive loss of nutrients, but the term can also encompass overnutrition, overnutrition, result resulting ing from from overeat overeating ing or excess excessive ive intake intake of specif specific ic nutrients. An individual will experience malnutrition if the appropriate amount of, or quality of nutrients of nutrients comprising a healthy diet are not consumed for an extended period of time. An extended period of malnutrition can result in starvation, disease, and infection.
Undern Undernutr utriti ition on is the lack lack of suffi sufficie cient nt nutrie nutrients nts to maintai maintain n healthy healthy bodily bodily functions and is typically associated with extreme poverty in economically developing countries. countries. It is a common cause of reduced of reduced intelligence in parts of the world affected affected by famine. Malnutrition is the result of inappropriate dieting, dieting, overeating or the absence of a "balanced diet". (eg. as indicated by increasing levels of obesity of obesity). ).
As of 2008, malnutrition continues to be a worldwide problem, particularly in lesser developed countries. countries. According to the Food and Agriculture Organization of the United Nations, Nations, "850 million people worldwide were undernourished in 1999 to 2005, the most recent years for which figures are available" and the number of malnourished people has recently been increasing. Malnutrition can also be a result of unhealthy bodies not being able to retain the micronutrients and protein included in their diets. An orange awareness ribbon is used to raise awareness of malnutrition in the world. The FAO calculates undernourishment by comparing the amount of food available in a country at national level with how many people p eople live in the country.
The number of undernourished people (million) in 2001-2003, according to Food and Agriculture of the UN are the following arranged from highest to lowest; India with 217 million, China with 150 million, Bangladesh with 43.1 million, Democratic Republic of Congo with 37.0 million, Pakistan with 35.2 million, Ethiopia with 31.5 million, Tanzania with 16.1 million, Philippines with 15.2 million, Brazil with 14.4 million, Indonesia with 13.8 million, Vietnam with 13.8 million, Thailand with 13.4 million, Nigeria with 11.5 million, Kenya with 9.7 million, Sudan with 8.8 million, Mozambique with 8.3 million, North Korea with 7.9 million, Yemen and Madagascar with 7.1 million,
Colombia with 5.9 million, Zimbabwe with 5.7 million, Mexico and Zambia with 5.1 million, and Angola with 5 million. This table measures "undernourishment", as defined by FAO, FAO, and represents the number of people consuming (on average for years 2001 to 2003) less than the minimum amount of food energy (measured in kilocalories per capita per day) necessary for the average person to stay in good health while performing light physical activity.
Some environmentalists claim that the fundamental issue causing malnutrition is that the human population exceeds the Earth's carrying capacity; capacity; however, Food First raises the issue of food sovereignty and claims that every country (with the possible minor exceptions of some city-states) has sufficient agricultural capacity to feed its own people, but that the "free "free trade" trade" economic order associated with such institutions as the International Monetary Fund (IMF) and the World Bank prevent Bank prevent this from happening. At the other end of the spectrum, the World Bank itself claims to be part of the solution to malnutrition, asserting that the best way for countries to succeed in breaking the cycle of povert poverty y and malnut malnutrit rition ion is to build build export export-le -led d econom economies ies that that will will give give them them the financial means to buy foodstuffs on the world market.
One policy adopted in recent decades to alleviate world malnutrition is food aid, aid, i.e. the physical donation of food from rich to poor countries. From the rich donor countries' point of view, this is a suitable way to reduce excess supply created by domestic agricultural subsidies, stabilizi stabilizing ng farm prices prices in rich countries, countries, even if the cost of supplying the food to its final beneficiaries is often disproportionately high. Food aid may be provided for short-term emergencies (natural (natural disasters like earthquakes, tsunamis,
droughts and floods, or human-made like war and war and refugee flows) or in the form of a longterm program for an extended period. From the viewpoint of recipient countries, the value of food-aid depends on the form it takes. Emergency food aid is welcome, though aid in cash may also be welcome because the food may often be purchased locally in zones not affected by the emergency, thus benefiting local farmers. Long-term foreign food aid has been criticized as discouraging local production and distorting markets. markets. Instead, population population control control has been advocated as a much better approach to solve malnutrition/famine than merely providing food.
The World Food Programme (WFP) is the food aid branch of the United Nations, Nations, and the world's largest humanitarian agency. WFP provides food, on average, to 90 million people per year, 58 million of whom are children. From its headquarters in Rome and more than 80 country offices around the world, WFP works to help people who are unable to produce or obtain enough food for themselves and their families. WFP strives to eradicate eradicate hunger and malnutrition, with the ultimate goal in mind of eliminating the need for food aid itself. WFP focuses much of its aid on women and children, with the goal of ending child hunger. In 2005, food assistance was provided to 58.2 million children, 30 percent of whom were under five. In 2006, WFP assisted 58.8 million hungry children. School-feeding and/or take home ration programmes in 71 countries help help student studentss focus focus on their their studie studiess and encoura encourage ge parent parentss to send send their their childr children, en, especially girls, to school.
With 95% of all malnourished peoples living in the relatively stable climate region of the sub-tropics and tropics, climate change is of great importance to food
security in these regions. According to the latest IPCC reports, temperature increases in these regions are "very likely." Even small changes in temperatures can lead to increased frequ frequen ency cy of extr extrem emee weat weather her condi conditi tion ons. s. Many Many of thes thesee have have grea greatt impac impactt on agricultural production and hence nutrition. For example, the 1998-2001 central Asian droughts brought about an 80% livestock loss and 50% reduction in wheat and barley crops in Iran. Simil Similar ar figure figuress were were presen presentt in other other nation nations. s. An increa increase se in extrem extremee weather weather such such as drought drought in region regionss such such as Sub-Sa Sub-Sahar haran an would would have even greate greater r consequences in terms of malnutrition. Even without an increase of extreme weather events, a simple increase in temperature reduces the productiveness of many crop species, also decreasing food security in these regions.
There are several different approaches in combating under-nutrition including nutr nutrit itio iona nall
educ educat atio ion n
and and
medi medica call
nutr nutrit itio ion n
whic which h
cons consis ists ts of micr microo-nu nutr trie ient nt
supplem supplement entati ation, on, immuni immunizat zation ionss and food food forti fortific ficati ations ons.. Nutrit Nutrition ional al educat education ion is a preven preventat tative ive measur measuree used used to decrea decrease se the preval prevalenc encee of malnut malnutrit rition ion by creati creating ng sustainable nutrition within developing communities. Nutritional education attempts to tack tackle le the the probl problem em of maln malnut utri riti tion on befo before re it occur occurss and and prog progre ress sses es into into chro chroni nicc malnutrition which can only be treated medically. It focuses on raising awareness on what foods are necessary for the body to gain the nutrients which their body needs in order to function. It is a means of educating members of a community who then have the ability to empower generations that follow with the knowledge which they have gained in order to change their lifestyles. Nar4 Nar4 (talk ) 02:05, 18 November 2008 (UTC) Nutritional education is especially beneficial for communities which lack a health system that can support medical nutrition.
In 2006, WFP distribute distributed d 4 million million metric tons of food to 87.8 million million people in 78 countries; 63.4 million beneficiares were aided in emergency operations, including victim victimss of confli conflict, ct, natura naturall disast disasters ers and econom economic ic failur failuree in countr countries ies like like Kenya, Kenya, Lebanon, Lebanon, and Sudan. Sudan. Direct Direct expenditures expenditures reached US$2.9 billion, with the most money being spent on Emergency Operations and Immediate Response Account. WFP’s largest country operation in 2006 was Sudan, Sudan, where the Programme reached 6.4 million people. The second and third largest WFP operations were, respectively, Ethiopia and Kenya. In 2007, 2007, WFP's WFP's Sudan Sudan operati operation on will will requir requiree some some US$ 685 millio million n to provid providee food food assistance to 5.5 million people (2.8 million in Darfur alone). Darfur alone).
WFP focuses much of its aid on women and children, with the goal of ending child hunger. In 2005, food assistance was provided to 58.2 million children, 30 percent of whom were under five. In 2006, WFP assisted 58.8 million hungry children. Schoolfeeding and/or take home ration programmes in 71 countries help students focus on their studies and encourage parents to send their children, especially girls, to school.
Not all food aid is international. Sometimes the World Food Program with the help of numerous NGOs organizes food distribution within a country.
Some Some organi organizat zation ionss have begun begun workin working g with with teacher teachers, s, policy policymak makers ers,, and managed foodservice contractors to mandate improved nutritional content and increased nutritional resources in school cafeterias from primary to university level institutions. Health Health and nutri nutritio tion n have been proven proven to have close links links with with overal overalll educati educational onal success.
In the Philippines, the malnutrition situation has not substantially improved in the last 15 years. Child malnutrition rate, for one, has remained at the 30 per cent level for over a decade.
In the first first Nation National al Confere Conference nce of Nutrit Nutrition ion Stakeho Stakeholde lders rs in the Philip Philippin pines es (April 6, 2006), United Nations Children’s Fund (UNICEF) Country Representative Dr. Nicholas K. Alipui disclosed that major, irreversible damages caused by malnutrition occur in the womb and during the first two years of the child’s life. “Molecular biology confirms this finding. We must therefore focus on how to prevent and treat malnutrition among pregnant and lactating women, and children aged zero to two years old,” Dr. Alipui said.
“Damages to children include lower intelligence, reduced physical capacity, and passing passing on malnutriti malnutrition on to the next generation. generation. These result to reduction reduction in productivit productivity y and sluggish economic growth, which perpetuate the cycle of poverty. Most importantly, every child has a right to be free of malnutrition,” he added.
It revealed the alarming data on vitamin and mineral deficiency in the Philippines based on the UNICEF and Micronutrient Initiative damage assessment report. Some of the findings include:
•
Approximately 10,000 infants a year are exposed to the risk of death
immediately before and after birth;
•
Folate deficiency causes 4,000 cases of birth defects every year. The
deficiency deficiency also triggers triggers infantile infantile paralysis paralysis,, and heart diseases diseases and strokes strokes which lead to deaths; •
Around Around 500 you young ng women women die annuall annually y from from severe severe anaemia anaemia during during
pregnancy and childbirth; •
Estimated productivity loss among the workforce attributed to iron and
iodine deficiency is about 0.7 per pe r cent of the country’s Gross Domestic Product (GDP).
Over 100 delegates from international development agencies were addressed, the academe, local government units (LGU), civil society organizations, health and nutrition sector sectorss and profes professio sional nal groups groups.. The delegat delegates es repres represent ented ed the Univer Universit sity y of the Philip Philippin pines; es; LGU of Bukidn Bukidnon, on, Isabel Isabela, a, Metro Metro Manila Manila,, Quezon, Quezon, Tagayt Tagaytay ay City, City, and Aklan; Aklan; Center Center for Health Health Develo Developme pment; nt; Nutrit Nutrition ion Foundat Foundation ion of the Phili Philippi ppines nes;; Koalisyon Para Alagaan at Isalba ang Nutrisyon (KAIN); Helen Keller International; Save the Children Philippines; and the Christian Children’s Fund, to name a few.
The Department of Social Welfare and Development (DSWD) has embarked on an intensive Supplemental Feeding Program, which is an important component of the Acceler Accelerate ated d Hunger Hunger Mitiga Mitigati tion on Progra Program m of the admini administr strati ation on of Presid President ent Glori Gloriaa Macapag Macapagalal-Arr Arroyo oyo.. DSWD DSWD start started ed its its feedin feeding g progra program m in Novemb November er 200 2005, 5, initia initially lly covering covering 11 regions. regions. For 2006, the program program expanded to cover 15 regions, regions, including including the National Capital Region (NCR) and Region IV-A, serving 282,023 Day Care children nationwide. The children were given one kilo of rice for every day they attended day care session.
DSWD Secretary Esperanza Cabral said the program involves the provision of milk and hot meals for children in day care centers in 370 municipalities in 15 regions during summer vacation and regular school days.
The DSWD head said P750 million has also been allocated in the 2007 General Appropriations Act so the program can be continuously implemented for school year 2007-2008. According to Secretary Cabral, the Day Care Students Parents Groups (DCSPGs in the target municipalities in Regions I, IV-A to VIII as well as in the Cordillera Administrative Region, CARAGA and National Capital Region have already received their respective fund allocation and have started implementing the supplemental feeding program. The DSWD has sub-allotted P256 million to these regional offices, which
subsequently
transferred
the
funds
to
the
DCSPGs.
"In Regions I, IV-A, IV-B, V, VI, VIII, X, CAR, CARAGA and NCR, the feeding program started in many areas during the opening of classes on June 4, while some some Local Local Govern Governmen mentt Units Units (LGUs) (LGUs) starte started d their their feedin feeding g progra program m on June June 18," 18," Secretary
Cabral
said.
The children are given milk and hot meals using available indigenous food materi materials als that that will will provid providee at least least one-th one-third ird of the recomm recommend ended ed daily daily energy energy and nutrients
intake
of
children
three
to
five
years
old.
According to Secretary Cabral, at the start of the feeding program, the children
went through a deworming process in nearby health centers and their baseline height and weight were also taken. At the end of the feeding program, the children’s height and weight will be taken again to determine how the feeding program has improved their nutritional
status.
"Children in the program are already manifesting the social benefits of proper feeding. They are friendlier and more interactive and attend day care sessions more regularly. The children also learn the value of sharing food with other kids," Secretary Cabral
enthused.
The parents, on the other hand, became aware of proper nutrition for their children, especially for those aged six months to six years, through their participation in nutrition education sessions provided by the municipal nutritionist. The parents also enhance their parenting skills through sessions in Parent Effectiveness Service (PES).
Likewise, day care parents demonstrate the value of volunteerism by participating in the program, since they are the ones who cook and supervise the feeding for their children.
Background of the Study:
Barangay Centro West lies at the Northwesterly point within the Metro Poblacion District of the Municipality of Santiago. It covers an area of 5.5 hectares, more or less,
apportioned into residential, industrial, commercial, agricultural, and social/recreational areas. Centro West is divided into seven (7) puroks and has a total population of 3068 and 537 households as of year 2008. People who reside here are mostly Ibanag, Gaddang, Ilocano, and Chinese.
Centro West is only one among the barangays who conducts Feeding Program for the children. Because of known malnutrition from the area that they decided to conduct this program. Inadequate food intake and deficiency in the absorbed nutrients are two of the main causes leading to malnutrition. Commonly, economic problems in the family such such as finan financi cial al cris crisis is,, low low budg budget et allo allott tted ed to food, food, and and high high commo commodi dity ty pric prices es contribute to the causes. The primarily affected here are families with greater number of children and those with low income or salary basis jobs or those who are unemployed. And with that the children are mostly the ones who suffer. They are thin in figure and have low weight inappropriate to their height and age.
Malnutrition harms people both physically and mentally. The more malnourished someone is — in other words, the more nutrients they're missing — the more likely it is that person will have physical problems. (People who are only slightly to moderately malnourished may show no outward physical signs at all.)
The signs and symptoms of malnutrition depend on which nutritional deficiencies a person has, although they can include:
•
fatigue and low energy
•
dizziness
•
poor immune function (which can cause the body to have trouble fighting
off infections) •
dry, scaly skin
•
swollen and bleeding gums
•
decaying teeth
•
slowed reaction times and trouble paying attention
•
underweight
•
poor growth
•
muscle weakness
•
bloated stomach
•
bones that break easily
•
problems with organ function
Fort Fortuna unate tely ly,, many many of the the harm harmfu full effe effect ctss of maln malnut utri riti tion on can can be reve revers rsed ed,, especially if a person is only mildly or briefly malnourished. If you or your parents think you aren't getting enough of the right nutrients, you can seek advice from your doctor, who may look for signs of malnutrition in several ways. He or she will ask about how you are feeling, do a physical exam, and probably ask about the types and amounts of food in your diet.
When checking for malnutrition, a doctor may do one of several things:
•
look at a person's height and weight or body mass index (BMI) to get an
idea of whether their weight is in the healthy range for their height and age •
use blood tests to check for abnormalities
take X-rays or other types of images to look for signs of malnutrition in
•
organs and bones check for diseases or conditions that might be the underlying cause of
•
malnutrition
To correct problems related to malnutrition, a doctor or dietitian will recommend specific changes in the types and quantities of foods that a person eats. Sometimes he or she will prescribe dietary supplements, such as vitamins and minerals. Other treatment may be necessary for people who are found to have a specific disease or condition causing their malnutrition.
Conceptual Framework:
This study is based on the basic system framework INPUT - PROCESS – OUTPUT.
The input load includes the profile of the respondents, the status of the Feeding Program and the improvement measures used in the program.
The process load includes the assessment of the Feeding Program through survey, interview, observation, and documentary analysis to extract and collect the necessary information needed in this study.
And the output includes the effective Feeding Program and reliable rendering of services for the children in Centro West, Santiago City.
INPUT
PROCESS
OUTPUT
● Profile of the respondents
Assessment of the Feeding Program at Barangay Centro West, Santiago City through:
Effective
● Status of the feeding program i ● Measures us used for improvement
Feeding ● Survey ● Interview ● Observation ● Documentary Analysis
Program
FEEDBACK
Figure I. The Paradigm of the Study.
Statement of the Problem:
This study is aimed to assess the Feeding Program at a t Barangay Centro West, Santiago City. Specifically, it attempts to answer the following questions:
1. What is the profile of the children ch ildren in terms of the following demographic variables: 1.1 1.1 age age 1.2 1.2 gend gender er 1.3 weight and height 1.4 educational educational attainment attainment of the parents 1.5 parent’s parent’s occupati occupation on 1.6 income income per month 2. What is the status of the Feeding Program in Barangay Centro West, Santiago City as indicated by the following variables: 2.1 objectives 2.2 services 2.3 facilities 2.4 financing and fund 2.5 staff and health workers 3. What are the measures used to improve the Feeding Program?
Significance of the Study:
Our country is facing nowadays several economic and political crises. One of this is the uncontrollable rapid growth of population pop ulation both in the urban and an d rural areas.
And because of this there is an imbalance in our everyday physiologic resources, which is a less food to more people causing the younger generation to suffer.
The effects of this conflict to children are inadequate consumption of nutrients and insufficient amount of diet which causes malnutrition. If this is not given any attention it can progressively complicate into a disease which is why the government in the country acted to launch programs that may minimize or eradicate malnutrition prioritizing the children in specified barangays.
Since the children are important part of the society which is high risk for malnutrition, it is important to see through the effectiveness of the program introduced for this particular problem such as the Feeding Feed ing Program at Barangay Centro West, Santiago City. The success or the failure of the program depends largely on the organization, promotion and the delivery of the services.
It is hoped that the findings in this study will be best valuable to the present health workers of the health institutions themselves. It may help them understand the improvement of nutritional status and to further strengthen the various levels involve in the program.
It will help the children affected by such conditions and the parents realize the importance and the true value of having a sufficient intake of nutrients and the proper foods that will provide sufficient nutrition.
This study is important to us, researchers ourselves because it will help us in identifying the incidence of malnutrition in a specific barangay and the effectiveness of this program in providing the children in their needed services.
And to the readers of this study we hope that we provide the abundant information and be able to enlighten you, our readers to what you want to know.
Scope and Delimitation:
This study focuses on the assessment of the Feeding Program at Barangay Centro West, Santiago City. It aims to analyze and evaluate the actual implementation of the program. The respondents of this study are the health workers, parents and the children. And it is limited to only a specific area, the Barangay Centro West, Santiago City which is why it seeks to assess Feeding Program in presenting a reliable example in the administration of such program.
Definition of Terms:
Malnutrition [màl noo trísh'n] is a lack of healthy foods in the diet, or an excessive intake of unhealthy foods, leading to physical harm.
Hunger [húng gər] is the need or desire for food.
Diet [d ət] consists of the food that a person usually consumes.
Nutrition [noo trísh'n] is the study of how food affects the health and survival of the human body.
Poverty [póvvərtee] is the state of not having enough money to take care c are of basic needs such as food, clothing, and housing.
Nutrients [n tree ənt] is a substance that provides nourishment, no urishment, e.g. the minerals that a plant takes from the soil or the constituents in food that keep a human body healthy and help it to grow.
Program [pr ṓ gràm] is a system of procedures or activities that has a specific purpose.
Supplement [súppləmənt] is a charge payable in addition to the basic charge for a special service or under set conditions.
Assessment [ə séssmənt] is evaluation, a judgment about something based on an understanding of the situation.
Status [stáytəss] is a condition that is subject to change. . Survey [sər váy] is to do a statistical study of a sample pop ulation by asking questions about age, income, opinions, buying preferences, and other aspects of people's lives.
Priority [prī áwrətee] is the state of having most importance or urgency.
Services [súrvəss] is a system or organization that provides people with something that they need.
Threat [thret] is an indication of something unpleasant or d angerous is about to happen.
Deficiency [di físh'nsee] is an inadequate supply of something necessary.
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