You are on page 1of 37

CHAPTER I

A. Background of the study

According to the World Health Organization (WHO), malnutrition is estimated to

contribute to more than one third of all child deaths, although it is rarely listed as the direct

cause. Many factors can contribute to high rates of child malnutrition such as political instability,

slow economic growth, frequency of infectious diseases and the lack of education. These factors

can vary across countries. Malnutrition commonly affects all groups in a community, but infants

and young children are the most vulnerable because of their high nutritional requirements for

growth and development. In the Philippines, malnutrition continues to be one of the most

common diseases that plague most Filipino children. According to Food and Nutrition Research

Institute (FNRI), the country is facing the worst chronic malnutrition rate among children

especially below 2 years old at 26.2% in the last 10 years. According to the FNRI, because of the

rising prices of commodities, there has been a lack of access to highly nutritious foods thus

making it the common cause of malnutrition. Aside from that, poor feeding practices such as

inadequate breastfeeding and offering the wrong types of food also contribute to the poor

nutritional status of the children.

Malnutrition is common in far-fetched communities due to financial, educational, and

socio-cultural insufficiencies that contribute to a childs inability to reach his ideal status in

health. Due to this, school ordinances such as school based feeding programs, health teaching

campaigns and gardening have been used in the pursuit of solving the problem of malnutrition

(DepEd, 2015).

1
Adequate nutrition during infancy and early childhood is fundamental to the

development of each childs full human potential. It is well recognized that the period from birth

to two years of age is a critical window for the promotion of optimal growth, health and

behavioural development (Department of Child and Adolescent Health and Development, 2005).

Infants grow normally during the first six months of life because breastfeeding

adequately meets their nutrient requirement for that age; however, after the sixth month, breast

milk alone is no longer sufficient to sustain the rapidly growing infant unless breast milk is

supplemented with other types of food. If the nutrient requirements are inadequately met, infants

show a decreasing trend in growth beyond six months. This retardation of growth becomes

accentuated especially during the second year of life (WHO, 2005). With these observations,

direct supplementary feeding intervention will be needed to be able to prevent malnutrition. To

be able to do this every mother should know how to prepare and serve right kind of nutritious

food.

In 2016, the Municipality of Sergio Osmea, Sr. had the highest malnutrition rate among

the municipalities in Zamboanga del Norte. Danao and San Jose were among the barangays with

the highest malnutrition status. In the municipality both barangays Barangay are farming

communities and most of the households fall below the poverty line. The commonly prepared

food for the children in these communities are cooked rice, vegetable soup, dried fish and canned

goods which is not sufficient to fulfil the nutritional needs of growing children. During the

survey done on November 2016 by medical students of Ateneo de Zamboanga School of

Medicine, among the 42 children 6-24 months old in Barangay San Jose, 13(40%) were

2
underweight,6(14%) severely underweight, 12 (28.5%) are stunted, 21(50%) severely stunted. In

Barangay Danao among 18 children 7(39%) are underweight, 1 severely underweight, 4(18%).

Indigenous Supplementary Mixture (INSUMIX) production was first introduced at

Barangay Bila Buko, mountain province Philippines in 1994 by UNICEF to address the

malnutrition problem. Bila was its pilot area. Ground rice, monggo, and sesame seeds were used

to make INSUMIX during that time. The INSUMIX is a mixture consisting of a variety of

indigenous products such as rice, monggo or beans, dried anchovy or shrimp , oil and sugar.

(Ministry of Agriculture; Extension notes).

In Region IX, the local government units of Dipolog City, Zamboanga del Norte and the

Municipality of Tungawan, Zamboanga Sibugay province have been producing INSUMIX for

malnourished children below 5 years old. In Dipolog City, the ingredients used are black rice

with monggo and sesame seeds. In Tungawan, the ingredients used are rice and monggo. For this

study, corn flour will be utilized since it is rich in carbohydrates but has a minimal amount of

protein and fats. It is a good source of dietary fiber which aids in digestion. It also has folate,

thiamine, phosphorus, Vitamin C and magnesium. Another ingredient that was used is monggo.

Monggo is a locally available legume that is a good source of protein, folate, iron, magnesium,

phosphorus and copper. Carrot was used since it is a good source of beta-carotene, fibre,

Vitamin K, potassium and antioxidants. Another ingredient that was used squash. Yellow squash

is a rich source of Vitamin A and C, magnesium, fiber, riboflavin, phosphorus, potassium and

Vitamin B6. Since all of the mentioned ingredients are available in the locality, it will be used to

produce the INSUMIX. It is, therefore, the aim of this study to evaluate the effectiveness of the

locally-produced INSUMIX in improving the nutritional status of the children ages 6-24 months.

3
B. Review of Related literature

Continued breastfeeding beyond six months should be accompanied by consumption

of nutritionally adequate, safe and appropriate supplementary foods that help meet

nutritional requirements when breast milk is no longer sufficient. Appropriate supplementary

foods can be readily consumed and digested by the young child from six months onwards

and provides nutrients - energy, protein, fat and vitamins and minerals - to help meet the

growing child's needs in addition to breast milk (UNICEF, 2005).

In 2012, the Department of Science and Technology in coordination with the Food and

Nutrition Research Institute launched the production of a Rice-Monggo-Sesame blend for

complementary feeding. This food blend powder comes in 100-gram ready-to-eat and ready-

to-cook packages. This complementary food is an instant food preparation rich in protein and

energy, processed using the extrusion cooking method. It contains 120 kilocalories and 4

grams of protein per 100 grams and is given to the children daily for 120 days. This

formulation is sufficient to meet the 17 percent recommended energy and nutrient intake for

children aged 6 to 12 months and 29 percent of the recommended protein intake for the

children of the same age.

Dorado (2012) conducted a study to assess the effectiveness of the Rice-Monggo-

Sesame blend for complementary feeding on the nutritional status among children 6-35

months in Antique, Occidental Mindoro, Leyte and Iloilo. The results of the study showed that

of the 719 children enrolled in the 120-day feeding program, the prevalence of underweight

children significantly decreased from 96.7% to 82.1%.

4
Magsadia, et al (2015), as well, evaluated the effect of the Rice-Monggo-Sesame blend

on the nutritional status of the children ages 6-35 months was evaluated in the Municipality of

Jabonga, Agusan del Norte. Of the 252 children ages 6-35 months who were enrolled in the

120-day feeding program, there was a noted significant decrease in the number of

underweight children from 86% to 78%. The number of children who were wasted also

decreased from 25% to 13%.

Subrahhmanyan (2002) conducted a research study to determine the effect of

supplementary processed protein food fortified with essential vitamins and mineral on the

growth and nutritional status of undernourished weaned infant. The infants were given malt,

groundnut flour, Bengal flour and skimmed milk powder since the ingredients were locally

available. The feeding was conducted for 9 months. Of the 44 weaned malnourished infants

ranging from age 9 to 20 months enrolled in the feeding program, 80% of them had an

improvement in their nutritional status in terms of height, weight and haemoglobin level.

A similar study was done by Huybregts, et al (2012) wherein the effect of adding

ready-to-use supplementary food on the nutritional status and morbidity of children ages 6

to 36 months in Abeche, Chad was evaluated for 4 months in children. There were 1,038

children included in this study wherein a lipid-based nutrient supplement was given. Results

of the study showed that there was a significant improvement in the height-for-age z-scores

with an average increase of 0.03 HAZ-score per month. There was also a significant increase

in the weight of the children with an average of 0.02 kilograms per month.

On the other hand, the effectiveness of a government supplementary feeding program

in child weight gain was evaluated in Southeastern Brazil in the year 2003 and 2008. A

5
cohort study including secondary data on 25, 433 low-income children aged between 6 and 24

months were included in the study. The intervention performed was the distribution of

fortified milk. The program had a positive effect on child weight gain with a mean gain z-

score of 0.193 among those with a normal nutritional status before the intervention; 0.566

among those with risk of low weight; and 1.005 among those with low weight. The conclusion

derived from this study was that the program was effective for weight gain in children

younger than two years, with a more pronounced effect on children who start the program

under less favourable weight conditions.

A research done by Lagrone, et al (2010) determined the effectiveness of a locally

produced ready-to-use supplementary food in resolving moderate acute malnutrition among 6

to 59 month-old children in southern Malawi. The intervention composed of dietary

counselling and targeted distribution and feeding of corn/soy-blended flour for up to 8 weeks.

Each child received 65 kcal/kg/d/ of the locally produced soy/peanut supplementary food, a

product that provided about 1 recommended daily allowance of each micronutrient.

Anthropometric measurements were taken every 2 weeks. Of the 2,417 children enrolled in

the study, 80% recovered from malnutrition. Weight, length and mid-upper arm circumference

gain were 2.6 grams/day, 0.2 millimeter/day and 0.1 millimeter/day respectively.

These studies demonstrate the ability of supplementary foods to address the issue of

malnutrition.

6
C. Statement of the problem

This study sought to determine if locally made INSUMIX improves the nutritional

status of children 6 months to 24 months old in Barangays San Jose and Danao.

D. Objectives

a. General Objective

To determine the effect of locally made INSUMIX on the nutritional status of children

aged 6 months to 24 months in Barangay San Jose and Danao, Sergio Osmea, Zamboanga

del Norte.

b. Specific objectives

a. To determine the nutritional status of children 6 months to 2 year before and after the

intervention.

b. To compare the nutritional status of children 6 months to 2 years before and after

intervention.

c. To determine the height and weight of children 6 months to 2 years before intervention.

d. To compare the height and weight of the children 6 months to 2 years after intervention.

E. Hypothesis

Null: Locally made insumix have no effect on the nutritional status of children 6 to 24 months

old regarding their weight and height in Barangay San Jose and Danao, Sr. Osmea,

Zamboanga del Norte.

Alternative: Locally made insumix have an effect on the nutritional status of children 6 to 24

months old regarding increase in their weight and height in Barangay San Jose and Danao, Sr.

Osmea Zamboanga del Norte

7
F. Operational Definition of terms

a. INSUMIX ( indigenous supplementary mixture ): an energy rich powder composed of

corn flour, mongo , sesame seeds, squash and carrot.

b. Nutritional status: defined as condition of the body in those respects influenced by the

diet; in this study underweight, severely underweight, stunted and severely stunted.

G. Conceptual framework

Inadequate nutritional intake

Locally available ingredients,


corn flour, squash, carrot,
Presence of underweight and stunted children
mongo, and sesame seeds
aged 6months to 24 months

Insumix

Improvement of nutritional status No improvement of nutritional status

8
Figure 1: Conceptual framework of the study

The figure above shows the general sequence of the study. Inadequate nutritional intake by

the children which result in underweight and stunting in age group 6 to 24 months. To

address this problem, the INSUMIX was produced by using locally available ingredients. In

order to determine its effectiveness it was distributed to consume daily for 3 months. Weight

and height were monitored throughout the study time.

H. Significance of the study

The findings of this result will benefit the malnourished children. The result of the study

will encourage the local nutritionist , mothers and Local Government Unit to use and make

cost effective INSUMIX to help fight malnutrition.

I. Scope and delimitation of study

This study is only limited to 6 months old to 24 months old children with malnutrition

residing in Barangay San Jose and Barangay Danao. This study only measures the change in

nutritional status of the individual respondents at the end of the study. This study does not

monitor the INSUMIX sharing by the siblings.

9
CHAPTER II

METHODOLOGY

A. Research Design

This study utilized the pre and post interventional experimental study to determine the

effect of locally produced INSUMIX on the nutritional status of children 6 months to 24

months.

B. Research Setting

The study took place in two Barangays in the Municipality of Sergio Osmea,

Zamboanga del Norte. Barangay San Jose, which has a population of 4000 individuals, lies 9

kilometres away from the Municipal Hall . Barangay Danao, which has a population of 1000

individuals lies 5 kilometres away from the municipal hall. Both of the barangays are farming

communities and are known for corn product.

Inclusion criteria

a. Children 6 to 24 months old

b. Resident of Barangay San Jose and Danao

c. Classified as underweight, severely underweight, stunted and severely stunted

according to WHO growth standards.

Exclusion Criteria

Complains of diarrhea, constipation, nausea, vomiting , headache or sudden appearance of

rashes prior to intake of INSUMIX.

10
C. Sample size and sample design

Based on V. Subrahmanyan (2002) study on the effect of supplementary protein food

fortified with essential vitamins and minerals on growth and nutritional status of

undernourished infants, the computed sample size of 60 respondents were needed with 80%

power and 95% confidence interval using STATA Version 10. A purposive sampling method

with intention to recruit the total count of all malnourished children aged 6 months to 2 years

old that was seen on October 2016 was used in this study.

D. Data gathering procedure.

a. Pre-interventional phase

Ms. Sherwayne Joy B. Entrina, the Municipal Nutrition Action Officer of Sergio

Osmea was interviewed to determine the prevalence of malnutrition in the municipality.

Mrs. Trinidad J. Clamohoy, an administrative aid officer from the Municipal Social Welfare

Development (MSWD) who was trained in INSUMIX production by Livelihood, Skills

Development and Enhancement Canter (LSDEC) was interviewed to determine the

procedure for INSUMIX production. Courtesy calls to the respective Barangay Captains and

a short meeting with the Barangay nutrition scholar (BNS), and Barangay Health Worker

(BHW) was done and detail about activity and the study was given. A schedule was fixed to

gather the children ages 6 to 24 months old. On the scheduled date, the height and weight of

the children were measured and they were categorized as underweight (low weight for age

below minus two standard deviation from the median weight for age), severely underweight

( low weight for age below minus three standard deviation from the median weight for age),

stunted (low height for age below minus two standard deviation from the median height for

11
age), severely stunted (low height for age below minus three standard deviations from the

median height for age). Refer to Appendix D for the chart of the WHO Growth Reference

Standard. Non-digital hanging weighing scale was used to measure the weight of the

children while a stadiometer was used to obtain height as recommended and provided for by

the National Nutrition Council. The height and weight monitoring activity was accompanied

by two trained field RHU nurses, BNS and BHW. Protocols for measuring height and

weight were followed (Appendix C).

At the MSWD office, the researcher was taught by Mrs. Clamohoy on how to create the

INSUMIX powder for distribution and on how to prepare the INSUMIX powder for

consumption. A calorie count for 1 kilogram of INSUMIX was done by Ms. Milafaye

Logroo, a registered nutritionist. Based on Food Exchange list for meal planning guide by

FNRI, 1 kilogram of INSUMIX contains 1,516 kilocalories. An estimated amount of

INSUMIX needed per children was done and was calculated that severely underweight and

severely stunted children would need 100 gm per day and underweight and stunted would

need 75 gm per day. The estimation was based on the nutritional needs of the child and the

amount of INSUMIX they can consume in 1 meal.

Six children, with ages ranging from 6 to 24 months were randomly selected from

Barangay San Jose for taste test. Mothers of the children were given 3 packs of 100 grams of

INSUMIX along with instruction on how to prepare the INSUMIX for consumption. All 3

packs of INSUMIX were consumed within 3 days and according to the mothers, all the

children liked the taste. There were also no complaints of diarrhea, constipation, vomiting,

headache, stomach pain or any sudden onset of rashes

12
b. Intervention phase

Production and distribution of INSUMIX

Fresh ingredients for production of INSUMIX (corn flour, carrot, squash) were

purchased from the local farmers and market. For corn flour, the sweet corn (Bisaya Corn)

was used because of its good taste and sweetness. To 1 kilogram of corn flour, 250 grams

of mongo, 150 grams of squash, 150 grams of carrots and 100 grams of sesame seeds was

added.

Carrot and squash were shredded into fine pieces and were sun dried for 1 day. The

dried pieces were crushed to make a powder . Corn flour was toasted for 10 minutes in low

heat then set aside. Then monggo beans along with sesame seeds were toasted for 10

minutes. Toasted mongo beans along with sesame seeds were crushed together to make

powder form. All the toasted ingredients were mixed well to create the INSUMIX powder.

Seventy-five (75) grams and 100 grams of the INSUMIX were packed and sealed by

the researcher with the help of a trained MSWD official. All the packs were transported

and distributed to the respondents. Before the distribution, brief discussion of information

about the INSUMIX content was given. A demonstration on how to prepare INSUMIX

powder for consumption was shown by the researcher to the mothers and primary

caregivers. During the demonstration, 1 pack of INSUMIX was added to 1 cup of boiling

water. Mix for 2 minutes by constantly stirring it. Then it was left to cool for 3-5 minutes.

Every month, the respondents who were underweight or stunted received 30 75-gram packs

(2.25 kilograms) and respondents who were severely underweight or severely stunted

received 30 100-gram packs (3 kilograms) of INSUMIX. Along with the INSUMIX pack,

13
a guide on how to prepare the INSUMIX powder for consumption was provided to the

mothers and primary caregivers, just in case if the mothers and primary caregivers forget

the steps on how to prepare INSUMIX meal or if there is a change in the caregiver of the

respondent. See Appendix A for guide. A consent form was also signed by the mothers

and/or the primary caregivers of the respondents prior to the distribution of the INSUMIX.

A checklist was given to the BNS and BHW to trace the amount of INSUMIX being

consumed by the respondents weekly. It was done by counting the remaining packs of

INSUMIX found in the home every week after the distribution. See Appendix B for

checklist.

c. Post intervention phase

Height and weight of the respondents were monitored every month. Production and

distribution of INSUMIX was done monthly for 3 months. Every month, the respondents

were categorized according to their nutritional status and were given INSUMIX according

to their nutritional need.

After 3 months of distribution and feeding, training for selected mothers from both

barangays by Mrs. Triniad J. Clamohoy on how to produce INSUMIX powder using local

resources was done for the sustainability of the project.

E. Data Analysis

Descriptive statistics was used to analyse the data. Paired T-test was used to compare the

mean weight and height before and after the intervention. A comparison of proportions

was done to compare the number of malnourished children before and after the

intervention.

14
F. Ethical Considerations

The rights and health concern of the children are considered in this study. Children whose

parents refuse to be part of the study due to cultural or religious reasons will be respected of

their decision. Untoward incidents that may occur such as vomiting or diarrhea or constipation

or sudden onset of rashes among the children with the most probable reason due to INSUMIX

during the course of the intervention be held responsible by the researcher and medical expenses

will be shouldered. This study does not require any monetary assistance from the households .

Confidentiality and privacy of the participants is maintained throughout the study.

15
CHAPTER III

PRESENTATION AND INTERPRETATION OF DATA

Respondent characteristic

There were a total of 53 respondents enrolled in 1 group during the course of the study,

among which, 37 were from Barangay San Jose and 16 were from Barangay Danao. The

computed sample size was 60 but the researcher was unable to attain the computed sample

size. The youngest respondent was 6 month and the eldest was 24 months. The weight of the

respondents ranged from 6 kg to 11.5 kg and the height ranged from 60 cm to 85 cm.

Table 1. Demographic profile of the respondents

Age in months Male Female Percentage (N=53)

6-12 5 12 32%

13-18 10 7 32%

19-24 8 11 36%

Since there were no dropouts, the number of respondents remained constant

throughout the study.

16
a. Weight

Table 2. Change in weight for age among respondents within three months of INSUMIX
feeding.
Number of respondents (n=27)

Weight for age


Pre intervention Post intervention

19 (60%)
Normal weight 0 (0%)

7 (26%)
Under weight 19 (70%)

8 (30%) 1 (3%)
Severely underweight

Table 2. shows that, at the end of 3 months, among 19 underweight children, 15 gained

normal weight and 4 remained underweight. Among 8 severely underweight children, 4

children gained normal weight, 3 became underweight and 1 remained severely underweight.

During 1st post intervention, 5 out of 19 underweight and 1 out of 8 severely

underweight improved to normal weight, so in total 6 improved to normal weight making a

total number of 6 children with normal weight. Among those 19 underweight, 14 remained

underweight and out of 8 severely underweight, 1 improved to underweight making a total of

15 underweight and 6 severely underweight at the end of 1st post intervention.

17
During 2nd post intervention 7 out of 15 underweight and 2 out of 6 severely

underweight improved to normal weight so in total, 9 improved to normal weight making a

total count of 15 children who attained normal weight. Among those 15 underweight children,

8 remained underweight and out of 6 severely underweight children, 1 improved to

underweight making a total 9 underweight and 3 severely underweight at the end of the 2nd

post intervention.

During 3rd post intervention, 3 out of 9 children who were underweight and 1 out of 3

who were severely underweight improved to normal weight, so in total, 4 improved to normal

weight making a total count of 19 children with normal weight. Among those 9 underweight

children, 6 remained underweight and out of 3 severely underweight children, 1 improved to

underweight making a total of 7 underweight children and 1 severely underweight child at the

end of 3rd post intervention.

From a mean weight of 7.8 kg prior to the study, there was an increase to 8.9 kg after 3

months with a p-value<0.000. Weight gain ranged from 500 gm to 1.8kg after daily

consuming locally produced INSUMIX for 3 months. There was no noted respondent who had

decrease in weight within 3 months of study. Based on the weight gain of 1.1kg in 3 months ,

mean weight gain of child 1.6 gm/kg/day.

18
b. Height

Table 3. Change in height for age among respondents within three months of insumix feeding.
Number of respondents (n=44)

Height for age Pre intervention Post intervention

Normal 0 24 (55%)

Stunted 16 (36%) 15(34%)

Severely stunted 28 (64%) 5(11%)

Table 3. shows that At the end of 3 months, among 16 stunted children, 11 gained

normal height and 5 remained stunted. Among 28 severely stunted, 13 children gained normal

height, 10 were stunted and 5 remain severely stunted.

During the 1st post intervention, 4 out of 16 stunted and 4 out of 28 severely stunted

children improved to normal height, thus, a total of 8 improved to normal height. Among 16

stunted children, 12 remained stunted. Among 28 severely stunted, 3 improved to stunted thus

making a total number of 15 stunted children and 21 severely stunted children at the end of the

1st post intervention.

During 2nd post intervention, 5 out of 15 stunted and 6 out of 21 severely stunted

improved to normal height, thus a total of 11 children improved to normal height making a

total count of 19 children who attained normal height. Among 15 stunted children, 10

remained stunted. Among 21 severely stunted children, 6 improved to being stunted children

thus making a total number of 16 stunted and 9 severely stunted children at the end of the 2nd

post intervention.
19
During the 3rd post intervention, 2 out of 16 children who were stunted and 3 out of 9

who severely stunted improved to normal height, thus a total of 5 children improved to normal

height making a total count of 24 who attained normal height. Among 16 stunted children, 14

remained stunted. Among 9 severely stunted children, 1 improved to stunted thus making a

total number of 15 stunted and 5 severely stunted at the end of the 3rd post intervention. The

highest height gained was 16 cm and lowest height gained was 2.8 cm The mean score of

height gain was 8.2 cm in 3 month of study.

From an average height of 69.9 cm before the intervention, the average height increased

to 78.1 cm 3 months after the intervention with a p-value<.000. There was a total mean

increase of 8.2 cm in height. The respondents height ranged from 60 cm to 85 cm. The height

gained range from 2.8 cm to 16 cm.

Table 4. Checklist of INSUMIX intake results.


Frequency N= 53

Once a day (consistent) 47 (89%)

Every other day (inconsistent) 6 (11%)

The result above showed that only 89% of the mothers/caregivers were consistent on feeding

every day.

20
CHAPTER IV

DISCUSSION

Infants and young children, particularly aged 6 to 24 months, are most vulnerable for

malnutrition due to their high nutritional requirements for growth and development.

Therefore, this study focused on that age group in high risk of malnutrition. Since the

ingredients for INSUMIX were easily available in the community, the idea of producing

supplementary food to overcome malnutrition problem was created. Once produced, mothers

were given a monthly supply of INSUMIX for 3 consecutive months. As the mothers and

primary caregivers were also taught how to prepare the INSUMIX for feeding, the cost-

effectiveness of production were also discussed. The cost production for 1 kg of INSUMIX

good for 10 days was roughly 50 to 60 pesos, which gives an estimated 5 to 6 pesos per meal.

In this study, the number of children who attained a normal weight-for-age status

increased from 0% to 60%. The number of children who attained a normal length-for-age

status increased from 0% to 55%. One of the factors that resulted to the improvement in the

nutritional status of the children was attributed to the nutritional value of the INSUMIX, not

as a replacement for the main meals but instead only as supplements to feeding. The average

calorie requirement for children ages 6 to 24 months is 1000 kilocalories/day. The average

protein needed for this age group is 15 grams. In the study of Dorado, et al (2012) and

Magsadia, et al (2015), Rice-Monggo-Sesame blend had almost similar characteristics as the

INSUMIX utilized in this study. One hundred (100) grams of the Rice-Monggo-Sesame blend

contains 120 kilocalories and only 4 grams of protein whereas 100 grams of the locally

produced INSUMIX contains 150 kilocalories and 15 grams of protein as computed according

21
to the FNRI-Food Exchange List. Therefore, the locally produced INSUMIX was able to meet

the recommended protein intake of 15 grams per day for the age group. Because of attaining

the recommended protein intake for the age group, improvements in the nutritional status were

already evident in this study.

Another factor that contributed to the positive effect of INSUMIX on improving the

nutritional status of the children was the regularity of mothers or primary caregivers on giving

the INSUMIX daily. Forty-seven (47) out of 53 mothers followed the instructions that it

should be given on daily basis. Since in the study of Dorado (2012) and Magsadia (2015), the

Rice-Monggo-Sesame blend was given daily for 120 days, the INSUMIX feeding in this study

was also given daily for 90 days or 3 months. During the course of the INSUMIX feeding,

there was no reported case of loose bowel movement, constipation and vomiting thus

encouraging the mothers and primary caregivers to continuously give the feeding to their

children. According to mothers and primary caregivers, the steps in preparing the INSUMIX

feeding for feeding were easy and required a short time to prepare thus further encouraging

the mothers and primary caregivers to give the feeding daily. Even as the INSUMIX feeding

was done for 90 days compared to the 120-day feeding in the study of Dorado (2012) and

Magsadia (2015), improvement in the nutritional status were already evident.

According to FNRI-PPS reference standard on weight-for-age table for Filipino

children, a monthly increase of 0.2-0.3 kilogram is expected among these age groups. In this

study, the average weight gain among the children in this study was noted to be 1.10 kilogram

in 3 months or 0.36 kilogram per month, therefore achieving the expected monthly weight

increase as stated by the FNRI. According to Nelson (2011), the average length increase of a

22
child since birth up to 24 months is 1 inch or 2.54 cm per month. In this study, the

recommended height increase was achieved as the average increase during the 3 months of

feeding was 8.2 cm or 3.22 inches.

By the end of the intervention, 14 out of 19 underweight and 5 out of 8 severely

underweight children attained normal weight. Despite the increasing weight of all the

respondents after the study, 2 previously severely underweight became underweight, 5

previously noted underweight remained underweight and 1 previously severely underweight

remained severely underweight. There was no noted decrease in weight throughout the study.

This therefore signifies that the increases in weight were not enough to cause a change in the

z-scores of the children and, as well, cause a change in the category of the nutritional status to

one of lesser severity. When classified according to height-for-age, out of 16 stunted children,

11 gained normal height, while 5 remained stunted. Out of 28 severely stunted children, 13

gained normal height and 10 became stunted while 5 remained severely stunted. This also

signifies that the increases in height were not enough to cause a change in the z-scores of the

children and, as well, cause a change in the category of the nutritional status to one of lesser

severity. This changes in weight and height could have been better assessed and appreciated if

the monitoring was done for a minimum of 6 months (Dewey & Adu-Afarwuah, 2008)

23
CHAPTER V

CONCLUSION AND RECOMMENDATION

After daily consumption of INSUMIX for 3 months there was a significant mean weight

increase by 1.1 kg and height by 8.2 cm. 19 out of 27 respondents attained normal weight and

24 out of 44 respondents gained normal height within the span of 3 months. Given these results it

can be concluded that locally made INSUMIX is effective in improving the nutritional status of

children 6 to 24 months old.

Given this outcome, the researcher suggests that further studies be conducted in the same

settings for a longer period of time using the locally available ingredients. In which mongo can

be replaced by dilis (dried fish or shrimps) and carrot can be replaced or added with malunggay

(Morianga olifera leaves). Researcher also recommends to do an objective taste test of INSUMIX

before the distribution. The outcomes would have been much better if it was monitored whether

INSUMIX was being shared with their well-nourished siblings or not.

24
References

Dewey, K. and Adu-Afarwuah, S. (2008). Systematic review of the efficacy and effectiveness
of complementary feeding interventions in developing countries. Maternal and
Child Nutrition. Retrieved on May 24, 2017 from
http://onlinelibrary.wiley.com/doi/10.1111/j.1740-8709.2007.00124.x/pdf
Dorado, J., et al (2012). Development of model for DOST PINOY (Package for the
improvement of nutrition of young children:A nutrition intervention strategy.
Retrieved on May 23, 2017 from
122.53.86.125/Seminar%20Series/40th/Malnutrition%20Reduction%
20Program.pdf.
Jilcott, S., Ickes, S., Ammerman, A., and Myhre, J. (2009, February 7). Iterative design,
Implementation and Evaluation of a Supplemental Feeding Program for
Underweight Children ages 6-59 months in Western Uganda. Maternal Child
Health Journal, Vol 14. Retrieved august 2, 2016 from
http://www.ncbi.nlm.nih.gov/pubmed/19199014
Lieven Huybregts et al(2012) The Effect of Adding Ready-to-Use Supplementary Food to a
General Food Distribution on Child Nutritional Status and Morbidity: A Cluster-
Randomized Controlled Trial
Lagrone et al (2010) Locally produced ready-to-use supplementary food is an effective
treatment of moderate acute malnutrition in an operational setting.
Magsadia, C. (2015). The effect of the complementary food produced by the Food and
Nutrition Research Institute (FNRI) on the nutritional status of the children ages 6-
35 months. Retrieved on May 22, 2017 from
http://www.fnri.dost.gov.ph/index.php/21-publications?start=4
Soldao (2010) the effect of lecture and meal guide on the knowledge , attitude and practices
of mothers with undernourished children ages 2-5 years old regarding proper
meal preparation and nutritional status of their meal prepration and on their
nutritional status of the undernourished children in fishing village , barangay
Poblacion, Alicia, Zamboanga Sibugay Province
Smith, L. C., & Haddad, L. (2000). Overcoming child malnutrition in developing countries:
Past achievements and future choices. International Food Policy and Research
Institute. Retrieved December 9,2009 from
http://www.ifpri.org/publication/overcoming-child-malnutrition-developing-
countries.
MICS4 manual Anthropometry
https://flbbilanian.wordpress.com/published-articles/insumix-on-the-go-at-bila-bauko-
mountain-province/
Monitoring the achievements of MDGs using CBMS , Proceeding of the @008 National
conference on CBMS pdf
Home-based rehabilitation of severely malnourished children using indigenous
high-density diet by Durre-Samin Akram,et al.
Experts of WHO, WFP, United Nations Standing Committee on Nutrition, UNICEF.
Community based management of severe acutemalnutrition: A joint statement by the
25
World Health Organization,the World Food Program, the United Nations Standing
Committeeon Nutrition and the United Nations Children Fund. WHO. Geneva:
2007..
Department of Science and Technology (2015) DOSTs complementary food helps dip
malnutrition in Agusan del Norte Town, study says. Retrieved on December 1, 2016
from http://www.dost.gov.ph/knowledge-resources/news/44-2015-news/708-dost-s-
complementary-food-helps-dip-malnutrition-in-agusan-del-norte-town-study-says

World health organization nutrition for health and development protection of human
environment Geneva 2005
WHO technical notes :Supplementary foods for the management of moderate acute
malnutrition in infants and children 659 months of age
http://www.fnri.dost.gov.ph/
Food exchange list for meal planning, department of since and technology, food and
nutrition research institute.
Nelsons textbook of paediatrics, 19th edition

26
APPENDIX A

Directions for serving INSUMIX

Step 1

Magpakulo ng isang basong tubig at ihali ang 1 pack INSUMIX.

Step 2

Dagdagan ng asukal at gatas ayon sa gusting timpla.

Step 3

Ihalo ito ng hanggang 3-5 minuto.

Step 4

Ihain ito ng hindi masyadong mainit.

Nutritional facts

Serving size 1 pack (100gm)

Energy 150 kal

Total carbohydrate 78gms

Protein 15gms

Fats 5gms

27
APPENDIX B

Checklist for Insumix intake

Name: Weight:

Age: Height:

Amount of Insumix given (kg/packs):

AMOUNT Frequency No of Did the child Notes

packs have LBM or

left Constipation

100 gm 75gm Once Every Yes No

Date WEEK a day other

day

1st

2nd

3rd

4th

28
Appendix C

Measuring a childs length

29
MEASURING A CHILDS LENGTH: SUMMARY OF PROCEDURES

(1) Measurer or assistant: Place the measuring board on a hard flat surface, such as the

ground, floor or a steady table.

(2) Assistant: Place the questionnaire and pen on the ground, floor or table (Arrow 1). Kneel

with both knees behind the base of the board, if it is on the ground or floor (Arrow 2).

(3) Measurer: Kneel on the right side of the child so that you can hold the footpiece with your

right hand (Arrow 3).

(4) Measurer and assistant: With the mothers help, lay the child on the board by doing the

following:

Assistant: Support the back of the childs head with your hands and gradually lower the

child onto the board.

Measurer: Support the child at the trunk of the body.

(5) Measurer or assistant: If she is not the assistant, ask the mother to kneel on the opposite

side of the board facing the measurer to help keep the child calm.

(6) Assistant: Cup your hands over the childs ears (Arrow 4). With your arms comfortably

straight (Arrow 5), place the childs head against the base of the board so that the child is

looking straight up. The childs line of sight should be perpendicular to the ground (Arrow

6). Your head should be straight over the childs head. Look directly into the childs eyes.

(7) Measurer: Make sure the child is lying flat and in the centre of the board (Arrow 7). Place

your left hand on the childs shins (above the ankles) or on the knees (Arrow 8). Press them

30
firmly against the board. With your right hand, place the footpiece firmly against the childs

heels (Arrow 9).

(8) Measurer and assistant: Check the childs position (Arrows 1-9). Repeat any steps as

necessary.

(9) Measurer: When the childs position is correct, read and call out the measurement to the

nearest 0.1 centimetre. Remove the footpiece, release your left hand from the childs shins or

knees and support the child during the recording.

(10) Assistant: Immediately release the childs head, record the measurement and show it to the

measurer. Alternatively, the assistant could call out the measurement and have the measurer

confirm by repeating back.

NOTE: If the assistant is untrained, the measurer records the length on the questionnaire.

(11) Measurer: Check the recorded measurement on the questionnaire for accuracy and

legibility. Instruct the assistant to cancel and correct any errors.

31
APPENDIX D

32
33
34
35
APPENDIX E

Production of insumix

Materials needed

1. 1 Gas stove

2. 1 Wok

3. 1 Spatula

4. 1 Mixing bowl

5. 1 Weighing scale

6. 1 Shredder

Ingredients

1. 1kg of sweet corn flour

2. 250 gm of mongo

3. 150 gm of squash

4. 100 gm carrot

5. 100 gm sesame seeds

Directions for production

1. Wash and peel the squash ad carrot then shred into fine pieces and let it sun dry ( or it can be

toasted over lower flame for 30 min until it became dry)

2. Toast corn flour for 15 min under lower flame.

3. Toast mongo and sesame for 10 min under lower flame

4. Mix all the ingredients and grind the mixture.

36
Appendix F

Informed consent form


PERMISO SA PAGPARTICIPAR
Sir/Maam
Maayong adlaw!
Importante alang sa maayong panglawas ang insaktong timbang sa mag bata ayha sila mag-edad ug duh ka-
tuig aron malikayan ang epekto sa stunting sama sa dili maayong pag-develop sa huna-huna ug ubos nna
resistensya.
Mahitungod ani, mangayo unta ko ug permiso nga i-apil imong anak sa akong pagtuon nga ginganlan The
effect of Locally Made Insumix on the Malnourished children Aging 6-24 months of barangay San Jose and
Danao, Sergio Osmena, Zamboanga del Norte.
Ang tumong ani nga pagtuon mao ang pagtabang sa mga bata aron maabot nga himsog na estado sa ilang
panglawas. Gamit ani nga pagtuon, makakuha ang mga bata pati ang mga ginikanan ug impormasyon ug
stratehiya aron adunay pagbag-o sa timbang sa bata.
Matag usa sa mga bata makadawat ug insumix powder na mao ang ipakaon sa nanay sa iyang anak ika-tulo
sa is aka-adlaw kutob sa is aka-bulan. Kung adunay simptomas sama sa kalibanga, pagsuka-suka o sakit ka
tiyan, ayaw pagduha-duha ug paabot sa inyong mga kagulo sa hingtundan.
Kung aduna moy pangutana, pwede ko ninyo adtuon sa purok I, Barangay Biayon. Pwede pud ko ninyo
matawagan or ma-text ani nga numero 09165039184. Palihug ug pirmahi ang form sa ubos kung mosugot
kamo na iapil ang inyong anak ani nga pagtuon. Salamat!

Ako, si(pangala(edad). ginikanan o nagabantay ni


...(pangalan sa bata) sa Barangay .., nakasabot sa gisulat sa itaas ug
nahatagan pud ko ug oportunidad na mangutana kibahin sa pagton. Misugot ako ipa-apil akong anak ani nga
pagtuon.
Pinirmahan sa ika...na adlaw sa Disyembre, 2016.
..
Pirma sa Ginikanan
MILAN KHADKA
Ateneo de Zamboanga University
School of Medicine

37