ni baby pahalagahan para sa

malusog na kinabukasan!

1
 Objectives
increase awareness on the importance
of proper nutrition and early childhood
care and development during the First
1000 Days of life
promote collaboration among various
stakeholders at national and local levels
for programs serving families with
pregnant women and children less than 2
years old
2
 Objectives
advocate for increased investment in
nutrition to enable the Scaling Up of
Nutrition and related interventions for
the First 1000 Days of life.

3
 Outline

 The
Importance
Journey
Consequences of poor nutrition

 Current nutritional status and infant and young child feeding

practices
 Ways to ensure proper nutrition in the First 1000 Days
 Current efforts and gaps
 Recommendations
4
 Outline

 Ways to ensure proper nutrition in

the First 1000 Days
 Current efforts and gaps
 Recommendations

5
 First 1000 Days
• Period between conception until the child’s
2nd birthday
• rapid growth where nutrient deficiencies can
have long-term consequences

7
 First 1000 Days
• “Golden window of
opportunity”
• period where growth faltering
happens

8
 Stunting
• Irreversible outcome of poor nutrition
and repeated infections
• Diminished cognitive, physical
development
• Reduced productive capacity
• Poor health

9
• normal weight prior to
pregnancy
gain weight of 1-1.5kg in
1st trimester, 0.5kg/week
during rest of pregnancy
• balanced and varied diet
• right amounts of vitamins and
minerals

The First 1000 Days Journey

10
 Consequences of poor
nutrition during pregnancy
Condition Consequence/Risks
Underweight and Maternal death and low birth weight baby
short stature
Iron deficiency Maternal death due to excessive blood loss
anemia and hemorrhage, stillbirths or give birth to
anemic infant
Folate deficiency Neural tube defects (anencephaly, spina bifida)
Iodine deficiency Stillbirth or give birth to infant with deformity
disorder
Overweight and Gestational diabetes, preeclampsia,
obesity overweight babies

11
Birth to 6 months (180 days)
• Give birth in a birthing facility

• Essential Newborn Care Protocol

(Unang Yakap):
Immediate and thorough drying
Early skin-to-skin contact
Properly-timed cord clamping and cutting
Early initiation of breastfeeding

12
Birth to 6 months (180 days)
• Exclusive breastfeeding

Only breastmilk, no other solids

or liquids, except doctor-
prescribed oral rehydration
solution, drops or syrups
(vitamins, mineral supplements
or medicines)

13
 Advantages of breastmilk

Complete food for the baby for first 6

months
Contains essential nutrients for baby
Protects the baby from sickness
Higher IQ –up to 7 points

14
 Consequences of non-
exclusive breastfeeding
1. Non-attainment of full-potential
2. Increases babies’ risk to infections, allergies,
digestive problems, obesity, cancers, diabetes
and heart diseases in childhood or later in life
3. Lower IQs and may experience iron-
deficiency anemia

15
 Consequences of non-
exclusive breastfeeding
3. Mother: increased risk to being
overweight and obese, predisposes
her to having diabetes, certain types
of cancer (breast, ovarian and uterine)
and cardiovascular diseases
4. Mixed feeding can decrease
breastmilk production

16
6 months to 2 years (550 days)

• Complementary feeding
While continuing breastfeeding

• Critical period
Deficiencies may lead to
STUNTING

17
Components of appropriate
complementary feeding

Timing
Adequacy of amount
Safety
Active Feeding

18
 Consequences of poor
complementary feeding
practices
Improper timing

Too early = decreases demand for

milk
Too late = increases risks for
stunting,
underweight and/or wasting
19
 Consequences of poor
complementary feeding
practices
Improper amount, frequency and
quality
Undernutrition, growth and
development retardation

Unsafe preparation
Increases risk for infections and diarrhea

20
 Impaired mental
Higher mortality rate development

Reduced capacity Increased risk of adult

to care for child chronic disease

Untimely/Inadequate
Baby feeding
Low Frequent infections
Older People
birthweight Inadequate
Malnourished food, health,
Inadequate and care
catch-up growth
Inadequate Inadequate
food, health, fetal
and care nutrition Reduced
Child mental
Stunted capacity
Woman
Malnourished
Pregnancy
Low weight gain
Adolescent Inadequate food,
Stunted health, and care

Higher maternal
mortality
Reduced physical
Inadequate food, health, capacity and fat-free mass
and care
Burden of Undernutrition Throughout the Life Cycle
Adapted from: SCN, 2000 21
CURRENT
nutritional status and
infant and young child
feeding practices
 LOW BIRTH WEIGHT
INFANTS
1. Significant indicator of newborn’s
nutritional status, growth, health and
survival
2. Can be result of preterm birth,
restricted fetal growth due to poor
maternal care and under nutrition
3. Increases risk for morbidity and
mortality
23
 LOW BIRTH WEIGHT
INFANTS
2008 2013
Mother’s age
at birth (in Number of % less % less
Number of
years) than 2.5kg than 2.5kg
births births
(LBW) (L BW)
<20 457 22.9 705 25.1
20-34 3,463 18.9 4,021 20.2
35-49 691 21.2 907 24.2
Average - 21.0 - 23.2
Source: 2008, 2013 NDHS. USAID and PSA.

24
 STUNTING
Prevalence of stunting among children,
0-3 years old
42.5

32.5

22.5

12.5
%Prevalence

2.5
0-5 months 6-11 months 1 year old 2 years old 3 years old
2008 11.6 14.3 27.7 40.1 41.2
2011 14.1 16.2 33.6 39.3 41.5
2013 13.1 16.2 31.5 35.7 35.4
2015 12.7 17.3 36.2 38.4 38.6
Source: 2008-2015 NNS. FNRI-DOST.

25
 STUNTING
• Stunting shoots up from 6-11 months to 2
years old, then plateaus
• Prevalence:
– infants 0-5 months: 12.7% (1 of 10)
– 6-11 months: 17.3% (1 of 10)
– 1 year old: 36.2% (1 of 3)
– 2 years old: 38.4% (2 of 5)
– 0-5 years old (Philippines): 33.4% (1 of 3)

26
 Region % prevalence of

Stunting PHILIPPINES
Ilocos Region
stunting
33.4
31.3
Cagayan Valley 29.0
Cordillera Administrative Region 36.7
• 11 of 17 regions have
stunting prevalence Central Luzon 23.1
National Capital Region 24.9
higher than the CALABARZON 27.7
MIMAROPA 40.9
Philippine prevalence
Bicol Region 40.2
(33.4%) Western Visayas 39.8
Central Visayas 37.7
• Regions with highest Eastern Visayas 41.7
prevalence: Zamboanga Peninsula
Northern Mindanao
38.0
36.5
1 – ARMM (45.2%) Davao Region
SOCCSKSARGEN
31.7
40.0
2 – Region 8 (41.7%) Caraga
Autonomous Region in
36.4
45.2
3 – Region 4B (40.9%) Muslim Mindanao

27
 Anemia
Prevalence of anemia among children (6mo-2yo),
pregnant and lactating mothers
65.0
45.0
25.0
5.0
%Prevalence

1998 2003 2008 2013

6-11 months 56.6 66.2 55.7 39.4
1 year old 53.2 53 41 24.6
2 years old 36.9 34.8 26.6 14
Pregnant 50.7 43.9 42.5 25.2
Lactating mothers 45.7 42.2 31.6 16.6

Source: 2013 NNS. FNRI-DOST.

28
 Nutritionally at-risk pregnant women
Prevalence of nutritionally at-risk
pregnant women by age group

40.0
35.0
30.0 Philippines: 24.8%
25.0
20.0 37.2
15.0
10.0 23.0
14.8 17.4
5.0
0.0
<20 years of 20-29 years 30-39 years ≥ 40 years old
age old old
Source: 2013 NNS. FNRI-DOST. 29
 Initial breastfeeding
Characteristic % ever % started % started
breastfed breastfeeding breastfeeding
within 1 hour of within 1 day of
birth birth
Sex
Male 93.8 49.3 81.7
Female 93.7 50.2 82.1
Assistance at
delivery
Health 93.0 48.8 81.0
professional
Other 96.7 53.2 85.5
Place of delivery
Health facility 92.7 49.0 80.6
At home 96.5 51.6 85.1

31
Source: 2013 NDHS. USAID and PSA.
 Breastfeeding status, duration of breastfeeding and minimum
diet diversity and frequency of complementary feeding

% fed with %fed with

% currently % exclusively
minimum diet minimum
Age in breastfeeding breastfed
diversity times or more
months
2008 2013 2008 2008 2008
0-1 91.6 90.4 49.6 - -
2-3 85.2 82.8 34.3 - -
4-5 74.2 83.9 22.6 - -
6-8 62.6 69.4 - 45.8 58.3
9-11 63.7 64.1 - 79.2 62.6
12-17 53.9 57.6 - 85.4 68.1
18-23 38.3 44.0 - 89.6 67.6
Median duration of any breastfeeding in 2008: 15.1 months
in 2013: 16.6 months
32
Trend of exclusive breastfeeding among infants
0-5 months and duration
52.3 2003
46.7
2008
35.9 2011
29.7
2013

3.0 2.3 3.7 4.1

Source: 2013 NNS. FNRI-DOST. 33

Age of introduction of complementary
foods, 2013
92.6 92.6
84.7 86.2
72.8
65.8

2011
2013

6 7 8
Age in months 34
Complementary feeding practices among
children 6-23 months old

15.4

94.1

15.5

0 10 20 30 40 50 60 70 80 90 100
Percentage of children meeting the Minimum Dietary Diversity
Percentage of children meeting the Minimum Meal Frequency
Percentage of children meeting the Minimum Acceptable Diet
Source: 2013 NNS. FNRI-DOST. 35
WAYS
to ensure proper nutrition
in the First 1000 Days
Ways to ensure proper nutrition
1. Eat a variety of foods; increase
amount of food eaten by 2nd to
3rd trimester
2. Prevent anemia; use iron-folic
acid supplements
3. Give birth in a birthing facility
to ensure safe delivery for
mother and child.

37
Ways to ensure proper nutrition

4. Initiate breastfeeding
within the first hour
after birth.

38
 Ways to ensure proper nutrition
5. Appropriate complementary feeding at 6
months; continue breastfeeding.
• Children 6-23 months - consume foods from
at least 4 food groups (staple, meat, and fruit
and vegetables) every day
• Feed breastfed infants 6-8 months old 2x a
day; breastfed children 9-23 months old 3x a
day; non-breastfed infants 6-23 months old 4x
a day

39
 Ways to ensure proper nutrition
6. Monitor children’s growth
• include in coverage of routine services e.g.
immunization or Garantisadong Pambata
(GP) and micronutrient supplementation.
• Monthly weighing and height
measurement (< 2yo); assess and plot in
the child’s early childhood care and
development card with developmental
milestones

40
 Ways to ensure proper nutrition
7. Provide adequate care and feeding of sick
child to prevent acute malnutrition and
stunting
8. Manage acute malnutrition
9. Prevent infection through proper hygiene
and sanitation.
10.Provide psychosocial stimulation of the child

41
CURRENT
efforts and gaps
 CURRENT efforts and gaps
• Philippine Plan of Action for Nutrition
• Infant and Young Child Feeding Strategic
Plan of Action, 2011-2016
• EO 51 or the Milk Code
• Expanded Breastfeeding Promotion Act of
2009 (RA 10028)
• DOH AO 2009-0025 or Essential Newborn
Care
• Global targets and international
commitments
 Philippine Plan of Action for Nutrition

Targets:
• Reduction in prevalence of stunted under-five
children to 20.9%
• Reduction in prevalence of nutritionally at-risk
pregnant women to 22.3%
• No increase in prevalence of LBW infants

44
 Philippine Plan of Action for Nutrition
INTERVENTIONS
• Organization and capacity building of
community-based support groups on IYCF
• Training of health and nutrition workers
on IYCF
• Setting up/maintaining human milk banks
• Nutrition counselling

45
 Philippine Plan of Action for Nutrition
• Iron-folic acid and other micronutrients
supplementation of pregnant women,
consumption of fortified foods
• Prevention and management of infections
and diarrhea
• Multimedia campaign
• Regular growth monitoring of weight and
height

46
 Infant and Young Child Feeding
Strategic Plan of Action, 2011-2016

• Reduce child mortality and morbidity

through optimal feeding of infant and
young children
• Ensure and accelerate the promotion,
protection and support of good infant
and young child feeding practices.

47
 EO 51 or the Milk Code

• Regulates any form of marketing of

breastmilk substitutes, supplements and
related products
• DOH Food and Drug Administration
coordinates implementation of Milk Code

48
 Expanded Breastfeeding Promotion Act
of 2009 (RA 10028)
• Mandates establishment of milk banks,
lactation stations
• 40-minutes of paid lactation breaks in
addition to regular break times
• Amends RA 7600 or the Rooming-In and
Breastfeeding Act of 1992

49
 DOH AO 2009-0025 or Essential
Newborn Care
• Specific policies and principles for health care
providers regarding essential newborn care to
address health risks known to cause neonatal
deaths
Immediate drying
Skin-to-skin contact
Delayed cord cutting
Non-separation of baby
and mother
50
 Programs
• Regular health services
– Preconception care
– Prenatal services
– Supplementation
– Immunization
– Management of maternal and childhood illnesses
– Water, sanitation and hygiene
– Reproductive health

51
 Programs

• Promotion of optimum IYCF practices

• Micronutrient supplementation
• Food fortification
• Early child learning and psychosocial
stimulation

52
 Global targets and international
commitments
Global Nutrition Targets 2025
1. achieve a 40% reduction in number of children under-5
who are stunted;
2. achieve a 50% reduction of anemia in women of
reproductive age;
3. achieve 30% reduction in low birth weights;
4. ensure that there is no increase in childhood
overweight;
5. increase the rate of exclusive breastfeeding in the
first 6 months up to at least 50%; and
6. reduce and maintain childhood wasting to less than 5%.
53
RECOMMENDE
Dactions
 Individuals
For pregnant women
– At least 4 pre-natal check-ups during entire
pregnancy
– Consume iron-folic acid supplements
– Use iodized salt
– Give birth in a birthing facility assisted by
trained health worker

61
 Individuals

• Encourage expectant women and mothers to

breastfeed their babies
• Women of reproductive age should achieve
normal body weight prior to pregnancy
• Exclusively breastfeed newborn infants up to
six months

62
 Individuals

• Give appropriate complementary foods at

6th month but continue breastfeeding
• Regularly monitor the growth of infants
and young children
• Volunteer as peer counsellor/mother
leader; for the mothers experiencing
problems, ask help from the health center
or a peer counsellor.

63
 Families

• Provide nutritious, balanced meals to

pregnant women and lactating mothers
• Help build confidence of mother to
breastfeed
• Help care for the baby, carry load of doing
household chores to enable the mother to
breastfeed
• Prepare safe, nutritious and adequate
amounts of complementary food for baby
64
 Families

• Practice frequent, proper handwashing and

use clean toilet facility
• Establish and sustain home vegetable gardens
• Facilitate social and behavioral development
of young children
• Protect and uphold rights of children

65
 Communities

• Encourage lactating mothers to breastfeed

• Form IYCF support groups
• Do not accept any milk donations during
emergencies
• Report violation of Milk Code to FDA

66
 Communities

• Refer/treat children with severe acute

malnutrition to health facilities
• Provide access and support to health and
nutrition workers to monitor and promote
growth of infants and young children
• Participate in conduct of nutrition counselling
and nutrition education classes
• Develop programs to educate fathers and
grandmothers about breastfeeding and
complementary feeding
67
 Key Messages

1. Good nutrition in the First 1000 Days of life

prepares the child for better quality of life in
his/her lifetime.
2. Multisectoral, evidence-based interventions
that aim to prevent undernutrition,
particularly stunting, and overnutrition and
delay the onset of noncommunicable
diseases should focus on the First 1000 Days
of life.

76
 Key Messages
4. Promote and support good maternal nutrition
before and during pregnancy, and lactation.
5. Promote, support and protect exclusive
breastfeeding for the first 6 months.
6. Give appropriate complementary feeding to
babies starting at 6 months while continuing
breastfeeding up to 2 years and beyond.
7. Scale up nutrition actions both at the national
and local levels. *

77
Thank you!
 Thank you!
For comments, suggestions and more information, contact

NATIONAL NUTRITION COUNCIL

Department of Health RO V Compound
Legazpi City, 4500
Telefax: (052) 483-4358
Mobile No. 0949-412-2372, 0998-865-2162
E-mail Address: nncbicol@yahoo.com.ph
Facebook: http://www.facebook.com/NNCBicol
Website: http://www.nnc.gov.ph
FB Fanpage: National Nutrition Council Region V
 THANK YOU!
For comments, suggestions and more information, contact

National Nutrition Council

Nutrition Building, 2332 Chino Roces Ave. Ext. Taguig City
Tel.: (02) 843.0141
Fax: (02) 818.7398
Email: info@nnc.gov.ph
Website: ww.nnc.gov.ph
Facebook: fb.com/nncofficial
Twitter: @NNC_official

80