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 a year. Poor or non-existent breastfeeding causes another 1.4 million. 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 –

particularly frequent or persistent diarrhea, pneumonia, measles and malaria – also

undermines a child's nutritional status.

Malnutrition is a general term for a medical condition caused by an improper or

insufficient diet. It most often refers to undernutrition resulting from inadequate

consumption, poor absorption, or excessive loss of nutrients, but the term can also

encompass overnutrition, resulting from overeating or excessive intake of specific

nutrients. An individual will experience malnutrition if the appropriate amount of, or

quality 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.
 Undernutrition is the lack of sufficient nutrients to maintain healthy bodily

functions and is typically associated with extreme poverty in economically developing

countries. It is a common cause of reduced intelligence in parts of the world affected by

famine. Malnutrition is the result of inappropriate dieting, overeating or the absence of a

"balanced diet". (eg. as indicated by increasing levels of obesity).

As of 2008, malnutrition continues to be a worldwide problem, particularly in

lesser developed countries. According to the Food and Agriculture Organization of the

United 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 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, 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; 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 trade" economic order associated with such institutions as the

International Monetary Fund (IMF) and the World 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

poverty and malnutrition is to build export-led economies that will give them the

financial means to buy foodstuffs on the world market.

One policy adopted in recent decades to alleviate world malnutrition is food 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, stabilizing farm prices in rich 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 disasters like earthquakes, tsunamis,
droughts and floods, or human-made like war and refugee flows) or in the form of a long-

term 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.

Instead, population 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,

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 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 students focus on their studies and encourage parents to send their children,

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

frequency of extreme weather conditions. Many of these have great impact 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. Similar figures were present in other nations. An increase in extreme

weather such as drought in regions such as Sub-Saharan would have even greater

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

nutritional education and medical nutrition which consists of micro-nutrient

supplementation, immunizations and food fortifications. Nutritional education is a

preventative measure used to decrease the prevalence of malnutrition by creating

sustainable nutrition within developing communities. Nutritional education attempts to

tackle the problem of malnutrition before it occurs and progresses into chronic

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 (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 distributed 4 million metric tons of food to 87.8 million people in

78 countries; 63.4 million beneficiares were aided in emergency operations, including

victims of conflict, natural disasters and economic failure in countries like Kenya,

Lebanon, and Sudan. Direct 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, where the Programme reached 6.4 million people.

The second and third largest WFP operations were, respectively, Ethiopia and Kenya. In

2007, WFP's Sudan operation will require some US$ 685 million to provide food

assistance to 5.5 million people (2.8 million in 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. School-

feeding 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 organizations have begun working with teachers, policymakers, and

managed foodservice contractors to mandate improved nutritional content and increased

nutritional resources in school cafeterias from primary to university level institutions.

Health and nutrition have been proven to have close links with overall educational

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 National Conference of Nutrition Stakeholders in the Philippines

(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 on malnutrition to the next generation. These result to reduction in productivity

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 also triggers infantile paralysis, and heart diseases and strokes which lead to

deaths;

• Around 500 young women die annually from severe anaemia during

pregnancy and childbirth;

• Estimated productivity loss among the workforce attributed to iron and

iodine deficiency is about 0.7 per 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

sectors and professional groups. The delegates represented the University of the

Philippines; LGU of Bukidnon, Isabela, Metro Manila, Quezon, Tagaytay City, and

Aklan; Center for Health Development; Nutrition Foundation of the Philippines;

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

Accelerated Hunger Mitigation Program of the administration of President Gloria

Macapagal-Arroyo. DSWD started its feeding program in November 2005, initially

covering 11 regions. For 2006, the program expanded to cover 15 regions, 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 Local Government Units (LGUs) started their feeding program on June 18,"

Secretary Cabral said.

The children are given milk and hot meals using available indigenous food

materials that will provide at least one-third of the recommended daily 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 as financial crisis, low budget allotted to food, and high commodity prices

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

Fortunately, many of the harmful effects of malnutrition can be reversed,

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 Assessment of the Feeding Effective

respondents Program at Barangay Centro
West, Santiago City through:
● Status of the Feeding
i feeding program ● Survey

● Measures used ● Interview Program

for
improvement ● Observation

● Documentary
Analysis
 FEEDBACK

Figure I. The Paradigm of the Study.

Statement of the Problem:

This study is aimed to assess the Feeding Program at Barangay Centro West,

Santiago City.

Specifically, it attempts to answer the following questions:

 1. What is the profile of the children in terms of the following demographic

variables:

1.1 age

1.2 gender

1.3 weight and height

1.4 educational attainment of the parents

1.5 parent’s occupation

1.6 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 both in the urban and 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 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 of basic

needs such as food, clothing, and housing.

Nutrients [ntree ənt] is a substance that provides nourishment, 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 [prṓ 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 population 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 dangerous is about to

happen.

Deficiency [di físh'nsee] is an inadequate supply of something necessary.

(Microsoft® Encarta® 2007. © 1993-2006 Microsoft Corporation.)