By Che de los Reyes
The number of malnourished children is increasing because of poverty, neglect, and stigma. A new government health program engages community to overcome malnutrition.
The light of the flickering candle illuminates the little boy’s face as he nibbles on a piece of bread. It is lunchtime.
The boy of nearly two years and his two school aged brothers are eating their first and only meal of the day. The older boy reaches for another piece of bread, but the bag is already empty.
The boys’ mother had a nervous breakdown last month and is in a mental institution. Their father Roger, 41, can’t drive his pedicab when no one will take care of the youngest, Emmanuel.
“Kapag hindi ako nakakapagtrabaho katulad ngayon, tinatabihan ko na lang sila ng tinapay. Mamaya, isasama ko sila, iikot na naman kami, hahanap ng mauutangan (When I’m not able to work, like today, I set aside bread for them. Later, I’ll bring them with me, we’ll go around the neighborhood and find someone who can lend us cash),” he says. Roger’s real name is concealed in this story to protect the identities of his minor children.
Roger is feeling the pressure to provide for his family. This morning, Emmanuel was diagnosed with severe acute malnutrition. The boy needs immediate treatment or he will die.
Save the Children estimates that 95 children in the Philippines die each day from causes related to malnutrition.
An invisible emergency
Malnutrition, especially acute malnutrition, is an invisible emergency.
“Most of the time, these children are neglected, especially the under-five year olds,” Dr. Celna Mae Tejare of humanitarian group Action Against Hunger says.
This is rooted, she says, in traditional practices where the families with limited food give priority to feeding those with jobs.
“We tend to neglect that those under five need it more,” she adds.
Such neglect leads to chronic malnutrition. Nearly three out of every 10 Filipino children below two years old are suffering from chronic malnutrition. This is the worst rate in 10 years according to 2015 data from the Food and Nutrition Research Institute.
If not addressed, chronically malnourished children become stunted, or short for their age. This affects a child’s ability to learn, and by age five, becomes irreversible.
Children with chronic malnutrition quickly slip to acute malnutrition when they get sick.
So when Emmanuel caught pneumonia a couple of months ago, his weight quickly dropped. He now weighs just 8.1 kilos, which is very low for his height of 79.9 cm and for his age of nearly two years.
A child with severe acute malnutrition is nine times more likely to die than a well-nourished child.
In the Philippines, 95 children die every day from malnutrition.
“It is a silent emergency that can blow up anytime during an emergency,” Dr. Tejare says.
Poverty cause of hunger
UN Special Rapporteur on the right to food, Hilal Elver’s mission to the Philippines in February 2015 revealed that “access to sufficient and nutritious food is limited by poverty and income levels.”
This is despite the fact that Philippine economy has risen to middle income level, according to the World Bank.
“We are leaving those in the margins. Our progress does not reach the communities that really need it more,” Dr. Tejare says (Listen to podcast: A doctor of the people).
In Roger’s barangay of more than 5,000 in the middle of Manila for instance, many live a hand-to-mouth existence. Roger and his boys live in a room the size of closet in a house with 21 other people from four different households.
As a ‘pedicab,’ driver (a kind of rickshaw), on a good day he takes home P240 (roughly equivalent to US$5) after 12 hours of pedaling up and down Quirino highway—barely enough to feed his family a nutritious meal.
First 1,000 days
“How do you attack the problem on the household level, at the community level, and at the national level? Immediately, at the household level, we need to bring Emmanuel to a health care facility that has the capability to treat him,” Kristine Calleja, program manager of Gem’s Heart Foundation, says.
“There’s still a window of opportunity before he reaches two years of age,” she adds.
Gem’s Heart is part of the Philippine Coalition of Advocates for Nutrition Security (PhilCan), a network of organizations that is pushing for the “First 1,000 Days” bill. It seeks to address malnutrition from the time the child is in the womb up until the child turns two. It proposes to give more resources to the National Nutrition Council and implement other existing nutrition laws more strongly such as the Milk Code and Food Fortification Laws.
Several versions of the bill are pending in both Houses of Congress.
Battling stigma in communities
One of the biggest barriers is the stigma of having a malnourished child.
“It implies that you have been very negligent as a parent,” Dr. Tejare says.
Because of this, many parents would rather not seek medical treatment for their children because they feel they will be blamed for the situation,” she says.
Roger is one of those parents. Upon hearing Emmanuel’s diagnosis, Roger walked out of the barangay hall, sons in tow, without waiting for the older one’s turn at the weighing scale.
“Malakas pong kumain ito. Wala itong problema. (He eats a lot. He does not have any problem),” Roger says of Emmanuel’s brother.
This mindset, Dr. Tejare says, has to change.
The first step is to avoid calling them ‘malnourished children’ because the branding stays with them all their lives.
“We’d rather call them ‘kulang sa timbang‘ (underweight) because it’s a bit positive, meaning that if you get to improve the weight, we could bring back these children into good health.”
One such solution is to give children like Emmanuel ready-to-use therapeutic food (RUTF), more commonly known as Plumpy’Nut. This is what humanitarian aid organizations distribute in Africa and areas where many children are suffering from malnutrition.
The Department of Health (DOH) will begin distributing 50,000 boxes of RUTF, worth P145 million, in March, Dr. Anthony Calibo, head of the agency’s Family Health Office, says.
The recipients are 38,289 children with severe acute malnutrition from six months and before they turn five. The DOH targets 17 provinces this year, and another 21 provinces next year.
These provinces have the highest rates of acute malnutrition, are vulnerable to natural calamities and disasters, and have high rates of poverty, Dr. Calibo says.
This is all part of a program called Philippine Integrated Management of Severe Acute Malnutrition, which relies on strong community involvement. For children with less severe malnutrition, the solution is a feeding program to supplement their food intake at home (watch related video: Feeding 700 students every day).
“We encourage parents, even those neighbors who see these cases, to help these families seek consultation because there is treatment. There is hope,” Dr. Tejare says.
Roger is thankful that Gem’s Heart Foundation is helping him seek treatment for Emmanuel.
Because right now, he has no other option but wait for his wife to get well, come home, and take care of the kids. Only then could he get back on his pedicab and bring food on the table.
Signs and treatment of malnutrition
Parents of children whose weight and height have not yet been assessed by a health care provider should look out for the following:
Lack of appetite
– Health care providers will administer an appetite test, where they give a child RUTF and count the number of mouthfuls that the child takes within an hour.
– A child that has good appetite will be given RUTF as an outpatient treatment
– A child with no appetite warrants in-patient care
Lack of appetite plus any sickness such as diarrhea
The child should be treated in a health facility, such as those for Community-based Management of Acute Malnutrition in 17 priority provinces.
-The child will be given therapeutic milk that is appropriate to the phase of treatment.
For more information about malnutrition, contact PhilCan at (+632) 3747618 local 213 or visit facebook.com/philcan
For more information about treating malnutrition, visit Action Against Hunger’s website at actionagainsthunger.org or contact the Department of Health’s Family Health Office at (+632) 651-7800