2018 Expanded National Nutrition Survey Monograph Series
The Food, Health and Nutrition
Situation of Makati City
2018 Expanded National Nutrition Survey
ISSN 2782-8964 ISBN 978-971-8769-74-4
This report provides data and information on the health and nutritional status of Makati City as a result of the different assessments undertaken during the conduct of the Expanded National Nutrition Survey by the Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI). This monograph series will be published every five years, in the next cycle of the Expanded National Nutrition Survey. Additional information about the survey could be obtained from the DOST-FNRI website https:// www.fnri.dost.gov.ph/ or at the DOST-FNRI Office located at the DOST Compound, Gen. Santos Avenue, Bicutan, Taguig City, Metro Manila, Philippines 1631. Tel. Numbers.: (632) 8837-2071 local 2282/ 2296; (632) 8839-1846; (632) 8839-1839 Telefax: (632) 8837-2934; 8839-1843
Website: www.fnri.dost.gov.ph
Recommended Citation: Department of Science and Technology - Food and Nutrition Research Institute (DOST-FNRI). 2020. 2018 Expanded National Nutrition Survey Monograph Series: The food, health and nutrition situation of Makati City. FNRI Bldg., DOST Compound, Gen. Santos Avenue, Bicutan, Taguig City, Metro Manila, Philippines.
The 2018 Expanded National Nutrition Survey Monograph Series is published by the Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI).
2018 Expanded National Nutrition Survey
Table of Contents
Foreword i The Project Team ii Acknowledgments iii List of Tables iv List of Figures vii Executive Summary 1 ENNS Results at a Glance 4 Introduction 17 Background and Rationale of the Expanded National Nutrition Survey (ENNS) 17 Objectives of the ENNS 18 Significance and Uses of ENNS 19 Methodology 20 Sampling Design 20 Data Collection, Processing, and Analysis 21 Ethics Review 30 Study Site 31 Profile of Makati City 31 Household and Individual Response Rates 33 Socio-demographic Profile of Households and Respondents 33 Food Security Status 35 Key Findings by Life Stage 37 Infants and Preschool Children (0 to 59 months old) 37 School-age Children (5 to 10 years old) 42 Adolescents (10 to 19 years old) 45 Women of Reproductive Age (15 to 49 years old) 50 Adults (20 to 59 years old) 54 Elderly (60 years old and above) 62 Conclusion and Recommendations 66 References 67 Annex 1. List of ENNS Booklets and Forms 69 Annex 2. ENNS Survey Team 71 Annex 3. Data Management Team 72 Annex 4. Biochemical Survey Team 73
2018 Expanded National Nutrition Survey
Foreword
Since its birth in 1947, the Department of Science and Technology - Food and Nutrition Research Institute (DOST-FNRI) has consistently strived to fight malnutrition through accurate data, correct information, and innovative technologies. Food and nutrition research is pertinent to the needs of stakeholders like the policy makers, development program officers, program implementers, local executives, government and non-government stakeholders, and other users who are into program planning and development.
Over the years, the NNS has evolved from a focused assessment of the Filipino’s nutritional status to expanding its purpose and use to include tracking progress towards the country’s commitment to “end malnutrition in all its forms” as stipulated in the Sustainable Development Goals (SDGs) and the Scaling-Up Nutrition (SUN) Movement. Since 1978 to 2013, the survey was conducted every 5 years, however due to the importance of having empirical data, policy makers and other users of the data deemed necessary to conduct the survey every year to provide local- and national-level data. To scientifically do this, the DOST-FNRI has resorted to a rolling survey or the Expanded National Nutrition Survey (ENNS) for three years starting in 2018 until 2021 (not including 2020) to cover all the 81 provinces, 33 highly urbanized cities (HUCs) and three other special areas. Detailed description on the coverage of the ENNS is presented in the methodology of this report.
This monograph presents the results of the 2018 ENNS reported by life stages of the seven survey components: Anthropometry, Biochemical, Clinical and Health, Socio-economic, Food Security, Infant and Young Child Feeding (IYCF) Practices, and Maternal Health and Nutrition. The results of the food consumption survey at the household and individual levels will be provided in another report.
This book is developed by the Nutritional Assessment and Monitoring Division of the DOST-FNRI for use by our Local Chief Executives and development planners. We affirm that the use of correct and accurate food and nutrition information is necessary towards ending all forms of malnutrition. May this book generate fresh ideas and perspectives that shall be translated into doable actions for the betterment of the quality of life of Filipinos.
MARIO V. CAPANZANA, Ph.D. Director
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The Project Team
THE EXPANDED NATIONAL NUTRITION SURVEY 2018 MANAGEMENT TEAM
Mario V. Capanzana, Ph.D. Project Director
Imelda Angeles-Agdeppa, Ph.D. Project Leader
SURVEY OPERATIONS DATA MANAGEMENT
Marina B. Vargas, Ph.D. † Charmaine A. Duante, MSc Epid (PH) Head, Nutritional Assessment Team Head, Nutrition Statistics and and Dietary Component Informatics Team
COMPONENT LEADERS
Ma. Lilibeth P. Dasco, MSAN, MDM Glen Melvin P. Gironella Anthropometry Senior Statistician and SES Component Michael E. Serafico, MSc Biochemical Component Ma. Lynell V. Maniego Senior Statistician Chona F. Patalen, MPH Clinical and Health Component Mae Ann S.A. Javier Programmer Cristina G. Malabad, MSPH and Developer of e-DCS Food Security Component Eldridge B. Ferrer, MSAES Mildred O. Guirindola, MPS-FNP Statistician Maternal Health and Nutrition and IYCF Components Apple Joy D. Ducay Statistician Eva A. Goyena, Ph.D. Maternal Health and Nutrition Cheder D. Sumangue and IYCF Components Statistician
Josie P. Desnacido, MSAN Dietary Component
Charina A. Javier, MDE Government Programs Participation Component
FINAL REPORT WRITERS Maylene P. Cajucom, Glen Melvin P. Gironella, and Charmaine A. Duante
EDITORS Mario V. Capanzana, Ph.D. Imelda Angeles-Agdeppa, Ph.D.
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Acknowledgments
Grateful acknowledgment and appreciation are due to the following:
The Department of Health (DOH), Disease Prevention and Control Bureau for the funding support in the implementation of the ENNS; The Philippine Statistics Authority (PSA) Board for approving the adoption of the ENNS survey design and the PSA for approving the tools and questionnaires of the ENNS through the Statistical Survey Review and Clearance System, and for providing the list of sample housing units and sample households; The Section of Cardiology, Department of Medicine of the Philippine General Hospital (PGH), Philippine Heart Association (PHA) Baguio-Benguet Chapter, Western Visayas Medical Center, Southern Philippines Medical Center, and Zamboanga City Health Office for sharing their expertise during the Blood Pressure Certification Training; The Department of Interior and Local Government (DILG), Local Government Units (LGUs), the Governors, Mayors, Barangay Captains, and their constituents for providing direct assistance in the field survey operations; The National Nutrition Council of the Department of Health (NNC-DOH), through its Regional Nutrition Program Coordinators (RNPCs) and Provincial/City and Municipal Nutrition Action Officers (PNAOs/CNAOs and MNAOs), for sharing their untiring guidance and incessant support during field data collection; The Department of Science and Technology Regional Directors (RDs) and Provincial Science and Technology Directors (PSTDs) for their support, especially during field data collection, training, and pre-survey coordination in the regions, provinces and cities; The Centers for Health Development (CHDs) - Department of Health (DOH) through its Regional Directors, Chiefs of Hospitals, and the Provincial/City and Municipal Health Officers (PHOs/ CHOs and MHOs) for their assistance during training and field data collection; Dr. Cecilia Cristina S. Acuin, former Chief SRS of the Nutritional Assessment and Monitoring Division, DOST-FNRI, for the initial development of the new survey design, conduct of stakeholders’ consultations and pilot survey implementation; Dr. Arturo Y. Pacificador, Jr., as statistics consultant, for the technical guidance in sampling design; Ms. Ma. Adela D. Rubio, for preparing the draft, reviewing, revising and final formatting of this monograph; Mr. Chester G. Francisco and Mr. Owen John de Leon, for the layout and formatting of this monograph; The FNRI Finance and Administrative Division (FAD) for their invaluable assistance in the financial aspect of the survey; All 45,957 households and 159,926 individuals for their indispensable participation and utmost cooperation in the survey; and All FNRI technical and non-technical staff, local researchers, local survey aides, and numerous others who have provided their inputs, involvement, and contribution to the fruition of the 2018 ENNS.
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List of Tables
Table No. Title Page
1 WHO Child Growth Standards 2006 for infants and young children (0-60 22 months) and WHO Growth Reference 2007 for school-age children and adolescents (61-228 months) by indicators and age groups
2 Cut-off points used in classifying the nutritional status of children, 0-10 23 years old (0-120 months), based on the WHO CGS (2006) and WHO Growth Reference (2007)
3 Cut-off points used in determining magnitude and severity of underweight 23 and stunting among children, under-five years old (0 to <60 months), as a public health problem (WHO, 1995)
4 Cut-off points used in determining magnitude and severity of wasting 23 among children, under-five years old (0 to <60 months), as a public health problem (WHO, 1995)
5 Cut-off points in classifying the nutritional status of adults and lactating 24 women, 19.0 years and over (≥228 months), based on Body Mass Index (WHO & NCHS, 1978)
6 Cut-off points in classifying the nutritional status of pregnant women 24 based on weight-for-height (Magbitang, et.al., 1988)
7 Cut-off points used in determining magnitude and severity of underweight 24 (BMI <18.5) among adults, 19.0 years old and over (≥228 months), as public health problem (WHO 1995)
8 Cut-off points for waist circumference and waist-hip ratio, by sex (WHO, 25 2011b ; DOST-FNRI, 2010)
9 Hemoglobin concentrations below which anemia is likely to be present in 25 populations at sea level (WHO, 1972)
10 Classification of public health significance of anemia in populations on the 25 basis of prevalence estimated from blood levels of haemoglobin (WHO, 2001)
11 Guidelines used for the interpretation of Serum Vitamin A level (WHO/ 26 USAID, 1976; WHO/UNICEF/HKI/IVACG, 1982)
12 Prevalence cut-offs to define vitamin A deficiency in a population and its 26 level of public health significance (WHO, 1996; WHO, 2011a)
13 Epidemiological criteria for assessing iodine nutrition based on median 27 urinary iodine concentrations in school-age children (WHO/UNICEF/ ICCIDD, 2001)
14 Epidemiological criteria for assessing iodine nutrition based on urinary 27 iodine concentrations of pregnant women (WHO/UNICEF/ICCIDD, 2007)
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Table No. Title Page
15 Blood pressure classification (NIH: JNC VII, 2004) 28
16 Cut-off points for fasting blood sugar 28
17 Target age or physiologic groups for specific variables 30
18 Household and individual eligibility and response rates in Makati City 33
19 Socio-demographic profile of households and household heads in Makati 33 City: ENNS, 2018
20 Percentage of households by food security status in the Philippines and 35 Makati City: ENNS, 2018
21 Prevalence of underweight, stunting, wasting, and overweight-for-height 39 among children, under-five years old (0-59 months), in the Philippines and Makati City: ENNS, 2018
22 Prevalence of anemia among preschool children, 6 months to 5 years old 40 (6-71 months), in the Philippines and Makati City: ENNS, 2018
23 Prevalence of vitamin A deficiency among preschool children, 6 months to 40 5 years old (6 - 71 months), in the Philippines and Makati City: ENNS, 2018
24 Prevalence of underweight, stunting, wasting, and overweight/obesity 42 among children, 5 to 10 years old, in the Philippines and Makati City: ENNS, 2018
25 Prevalence of anemia among school-age children (6 to 12 years old) in 44 the Philippines and Makati City: ENNS, 2018
26 Median UIE and percent urinary iodine (UI) level of <50 µg/L among 44 school-age children (6 to 12 years old) in the Philippines and Makati City: ENNS, 2018
27 Prevalence of stunting, wasting, and overweight/obesity among 45 adolescents (>10 to 19 years old) in the Philippines and Makati City: ENNS, 2018
28 Prevalence of anemia among adolescents (13 to 19 years old) in the 46 Philippines and Makati City by sex: ENNS, 2018
29 Prevalence of chronic energy deficiency (CED) and overweight/obesity 50 among non-pregnant/ non-lactating women of reproductive age (15 - 49 years old) in the Philippines and Makati City: ENNS, 2018
30 Prevalence of anemia among non-pregnant/ non-lactating women of 50 reproductive age (15 - 49 years old) in the Philippines and Makati City: ENNS, 2018
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Table No. Title Page
31 Prevalence of vitamin A deficiency among non-pregnant/ non-lactating 51 women of reproductive age (15 - 49 years old) in the Philippines and Makati City: ENNS, 2018
32 Median UIE and percent urinary iodine (UI) level of <50 µg/L among non- 51 pregnant/non-lactating women of reproductive age (15 - 49 years old) in the Philippines and Makati City: ENNS, 2018
33 Prevalence of chronic energy deficiency (CED) and overweight/obesity 52 among lactating mothers in the Philippines and Makati City: ENNS, 2018
34 Prevalence of anemia among lactating mothers in the Philippines and 52 Makati City: ENNS, 2018
35 Median UIE and percent urinary iodine (UI) level of <50 µg/L among 52 lactating mothers in the Philippines and Makati City: ENNS, 2018
36 Prevalence of chronic energy deficiency (CED), overweight, and obesity 54 among adults, 20 to 59 years old, in the Philippines and Makati City: ENNS, 2018
37 Prevalence of high waist circumference and high waist-hip ratio among 56 adults, 20 to 59 years old, in the Philippines and Makati City: ENNS, 2018
38 Prevalence of anemia among adults, 20 to 59 years old, in the Philippines 57 and Makati City by sex: ENNS, 2018
39 Prevalence of elevated blood pressure and high fasting blood sugar 57 among adults, 20 to 59 years old, in the Philippines and Makati City: ENNS, 2018
40 Prevalence of chronic energy deficiency (CED), overweight, and obesity 62 among elderly, 60 years old and above, in the Philippines and Makati City: ENNS, 2018 41 Prevalence of high waist circumference and high waist-hip ratio among 62 elderly, 60 years old and above, in the Philippines and Makati City: ENNS, 2018
42 Prevalence of anemia among elderly, 60 years old and above, in the 63 Philippines and Makati City by sex: ENNS, 2018
43 Prevalence of vitamin A deficiency among elderly, 60 years old and 64 above, in the Philippines and Makati City: ENNS, 2018
44 Median UIE and percent urinary iodine (UI) level of <50 µg/L among 64 elderly, 60 years old and above, in the Philippines and Makati City: ENNS, 2018
45 Prevalence of elevated blood pressure and high fasting blood sugar 64 among elderly, 60 years old and above, in the Philippines and Makati City: ENNS, 2018
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List of Figures
Figure No. Title Page
1 Philippine Statistics Authority (PSA) 2013 Master Sample 20
2 Methods of Data Collection 21
3 Political Map of Makati City 32
4 Distribution of educational attainment of household head in Makati City: 34 ENNS, 2018
5 Distribution of occupation of household head in Makati City: ENNS, 2018 35
6 Percentage of households by food insecurity items in Makati City: ENNS, 36 2018
7 Percentage of food insecure households by wealth status, household size, 36 and sex of household head in Makati City: ENNS, 2018
8 Proportion of infants, 0-23 months old, by breastfeeding practices in the 37 Philippines and Makati City: ENNS, 2018
9 Proportion of infants, 6-23 months old, by complementary feeding 38 practices in the Philippines and Makati City: ENNS, 2018
10 Prevalence of underweight, stunting, wasting, and overweight-for-height 39 among children, under-five years old (0-59 months), by sex and wealth status in Makati City: ENNS, 2018 11 Prevalence of underweight, stunting, wasting, and overweight/obesity 43 among children, 5 to 10 years old, by sex and wealth status in Makati City: ENNS, 2018 12 Prevalence of stunting, wasting, and overweight/obesity among 46 adolescents (> 10 to 19 years old) by sex and wealth status in Makati City: ENNS, 2018 13 Proportion of current smokers among adolescents (10 to 19 years old) in 47 the Philippines and Makati City: ENNS, 2018
14 Proportion of current smokers among adolescents (10 to 19 years old) by 47 sex and wealth status in Makati City: ENNS, 2018 15 Proportion of current drinkers among adolescents (10 to 19 years old) in 48 the Philippines and Makati City: ENNS, 2018
16 Proportion of insufficiently physically active adolescents (10 to 19 years 48 old) in the Philippines and Makati City: ENNS, 2018
17 Proportion of insufficiently physically active adolescents (10 to 19 years 48 old) by sex and wealth status in Makati City: ENNS, 2018
18 51 Proportion of nutritionally-at-risk pregnant women in the Philippines and Makati City: ENNS, 2018
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Figure No. Title Page
19 Prevalence of chronic energy deficiency (CED) among adults, 20 to 59 55 years old, by age group, sex, and wealth status in Makati City: ENNS, 2018
20 Prevalence of overweight among adults, 20 to 59 years old, by age group, 55 sex, and wealth status in Makati City: ENNS, 2018
21 Prevalence of obesity among adults, 20 to 59 years old, by age group, 56 sex, and wealth status in Makati City: ENNS, 2018
22 Prevalence of high waist circumference among adults, 20 to 59 years old, 56 by age group, sex, and wealth status in Makati City: ENNS, 2018 23 Prevalence of high waist-hip ratio among adults, 20 to 59 years old, by 57 age group, sex, and wealth status in Makati City: ENNS, 2018
24 Prevalence of elevated blood pressure among adults, 20 to 59 years old, 58 by age group, sex, and wealth status in Makati City: ENNS, 2018
25 Prevalence of high fasting blood sugar among adults, 20 to 59 years old, 58 by age group, sex, and wealth status in Makati City: ENNS, 2018
26 Proportion of current smokers among adults, 20 to 59 years old, in the 59 Philippines and Makati City: ENNS, 2018
27 Proportion of current smokers among adults, 20 to 59 years old, by age 59 group, sex, and wealth status in Makati City: ENNS, 2018
28 Proportion of binge drinkers among currently drinking adults, 20 to 59 59 years old, in the past 30 days, in the Philippines and Makati City: ENNS, 2018
29 Proportion of binge drinkers among currently drinking adults, 20 to 59 60 years old, in the past 30 days, by age group, sex, and wealth status in Makati City: ENNS, 2018
30 Proportion of insufficiently physically active adults, 20 to 59 years old, in 60 the Philippines and Makati City: ENNS, 2018
31 Proportion of insufficiently physically active adults, 20 to 59 years old, by 61 age group, sex, and wealth status in Makati City: ENNS, 2018
32 Prevalence of high waist circumference and high waist-hip ratio among 63 elderly, 60 years old and above, by sex and wealth status in Makati City: ENNS, 2018
33 Proportion of current smokers, current alcohol drinkers, and physically 65 inactive elderly, 60 years old and above, in the Philippines and Makati City: ENNS, 2018
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Executive Summary
The National Nutrition Survey (NNS) is Malnutrition, in all its forms, includes the official nationwide survey conducted by the undernutrition (wasting, stunting, and Department of Science and Technology - Food underweight), inadequate vitamins or minerals, and Nutrition Research Institute (DOST-FNRI) and overweight or obesity resulting to diet- since 1978 as part of its mandate to undertake related non-communicable diseases. The aim of research on the population’s nutritional status. A the ENNS is to provide empirical data on the need for the generation of nutrition and health nutritional and health status of Filipinos for data for local government units (LGUs) planning and development programs, and for particularly in the provinces and highly urbanized timely policy decisions at the national and cities (HUCs) prompted the DOST-FNRI to provincial/HUCs levels. At the local level, this change the design of the NNS to the Expanded report could serve as a basis for LGU to do National Nutrition Survey (ENNS). The ENNS is problem-based nutrition programs and actions distinct from the previous NNS as it is a rolling directed on the groups with nutritional problems. survey which extends the period of data This could be more cost-effective and efficient collection for three years starting from 2018 to because the data are area-based specific. 2021 (not including 2020). The Philippines has 81 provinces and 33 highly urbanized cities A total of 894 households and 1750 (HUCs). All the provinces and HUCs, and 3 other individuals participated in Makati City as part of areas or a total of 117 areas will be surveyed for the 2018 ENNS. Majority of the households had ENNS. In order to cover all these areas, the five members or less (81.4%). Households were survey selected 40 areas each year for the first 2 comprised mostly of adults 20-59 years old years (2018 to 2019) and 37 areas for the last (54.9%) and had more female members year (2021). Each year, the DOST-FNRI (58.5%) than males (41.5%). Most of the releases national estimates of the health and household heads were male (71.5 %), had nutritional status of Filipinos as well as reached at least high school level of education provincial/HUCs estimates in the areas covered (46.4%) and 3 out of 10 were working as during the survey period. The City of Makati was service workers (27.4%). among the areas covered in 2018. Food security was experienced by more For this monograph, seven survey than half of the households in Makati City components are presented to summarize the (66.8%) wherein 14.2% of households assessment of the health and nutritional status of experienced mild food insecurity, 13.5% Makati City and are reported by life stages: experienced moderate food insecurity, and Anthropometric Survey, Biochemical Survey, 5.5% experienced severe food insecurity. Clinical and Health Survey, Socio-economic Moreover, food insecurity was higher among Survey, Food Security Survey, Infant and Young poor households, those households with more Child Feeding (IYCF) Practices, and Maternal than five members, and households that were Health and Nutrition. male-headed.
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The practice of exclusive breastfeeding significantly higher among male (9.1%) than among infants 0-5 months was high in the city female (2.3%) adolescents in the city. at 62.4%; however, continued breastfeeding up Overweight/obesity (19.9%) was more common to two years was not common (49.5%). among adolescents belonging to the non-poor Complementary feeding among children 6-23 households (25.3%). Anemia was of “mild” months was markedly inadequate in energy public health concern (7.9%) and was more and nutrients since only 9.6% of the children prevalent among female adolescents (15.8%). met the minimum acceptable diet (MAD) based Current smokers in this age group was 2.8% on the quality of complementary food eaten the and more common among boys (4.0%) than previous day. girls (1.9%). Meanwhile, the proportion of current drinkers among adolescents was Among infants and preschool children 17.4%. Majority of the adolescents (81.3%) (0 to 59 months old), the prevalence of were insufficiently physically active. underweight (11.5%) and stunting (19.6%) were of public health significance with Among women of reproductive age (15 “medium” and “low” severity, respectively. to 49 years old), overweight and obesity were Meanwhile, wasting prevalence was within the common among non-pregnant/non-lactating acceptable level of <5%. Anemia (12.7%) and women (45.9%) and lactating mothers (41.4%). vitamin A deficiency (3.3%) were both Anemia was of “mild” public health significance considered as “mild” public health problems in among non-pregnant/non-lactating women the city. (17.8%) while it was considered as “moderate” public health significance among lactating Among school-age children 5-10 years mothers at 26.5%. The proportion of old, prevalence of underweight (10.5%) and nutritionally-at-risk pregnant women was 3.4%. stunting (7.7%) were considered a public Vitamin A deficiency was not a public health health problem with “medium” and “low” problem among non-pregnant/non-lactating severity, respectively. Wasting was within the women in the city. Based on median UIE, acceptable level of <5%. Overweight/Obesity iodine intake was adequate among non- for this age group is an emerging problem in pregnant/non-lactating women (176 µg/L) and the city (24.5%). Anemia prevalence was a lactating mothers (134 µg/L). However, 13.2% public health problem with “moderate” severity and 30.4%, respectively, had urinary iodine (20.8%). Iodine status among school-age level of <50 µg/L. children was more than adequate based on median urinary iodine excretion (UIE) (255 µg/ Among adults (20 to 59 years old), L) though 5.9% of the age group had urinary prevalence of chronic energy deficiency (CED) iodine level of <50 µg/L. was 4.4%, and this was notable among the younger age group 20-29 years old (5.2%) and Among adolescents (>10 to 19 years adults coming from poor households (5.6%). old), prevalence of stunting was 12.8% and Overweight prevalence was 36.7% while more common among adolescents living in obesity was 13.4%. Android type of obesity poor households (13.7%). Prevalence of based on high waist circumference and high wasting or thinness was 5.6% and was waist-hip ratio was 20.3% and 44.4%,
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respectively, and this was more common will be included in the Philippine Nutrition Facts among women. Anemia among adults (11.5%) and Figures 2018: Food Consumption Survey. was of “mild” public health significance and was more prevalent among women (17.7%). The In summary, there were marked prevalence of elevated blood pressure was nutritional and health problems across all age 15.6% and was noted to be higher among groups in the city: (1) food insecurity among males at 18.8%. High fasting blood sugar was poor households; (2) low variety of foods and 8.7%. These risk factors were more common poor complementary feeding practices among among older adults aged 50-59 years old. infants and very young children; (3) emerging Current smokers in this age group was 20.0%, concern of stunting and underweight among 0 and was more common among men (39.9%) to 59 month old children; (4) high percentage than women (10.3%). The proportion of binge of underweight and anemia among school-age drinkers among those who reported currently children; (5) among adolescents, high rates of drinking alcoholic beverages for the past 30 stunting and overweight/ obesity; anemia days was 47.6%. While the proportion of particularly among females; physical inactivity insufficiently physically active adults in the city and initiation of smoking and alcohol drinking; was 40.3%. (6) high percentage of overweight and obesity and anemia among non-pregnant/non-lactating Among the elderly (60 years old and women and lactating mothers; and (7) among above), the prevalence of CED was 12.8% adults and elderly, high rates of overweight and while overweight was 29.1% and obesity was obesity and android type of obesity, particularly 7.1%. The prevalence of high waist females; and high rates of smoking, alcohol circumference was 31.3% while high waist-hip drinking, and physical inactivity. It is ratio was 61.8%. Both were more common recommended that the implementation of target among females coming from non-poor -focused development programs and policies households. Anemia prevalence of 15.1% was on health and nutrition must be accelerated to of “mild” public health significance. The address the different health and nutrition prevalence of VAD was 0.8% which indicates concerns identified in this survey in order to that VAD was not a public health problem in the contribute to the achievement of the city. Iodine intake based on median UIE (148 Sustainable Development Goals by 2030. µg/L) was adequate, however, 22.3% of the elderly had urinary iodine level of <50 µg/L. Two in every 10 (25.6%) elderly had elevated blood pressure while the prevalence of high fasting blood sugar was 15.2%. The proportion of current smokers among the elderly was 16.6% while current alcohol drinkers was 26.2%. Moreover, the proportion of physically inactive elderly was 61.5%.
The results of the dietary survey component (household and individual levels)
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ENNS Results at a Glance
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Introduction
Background and Rationale of the Expanded National Nutrition Survey
The state of the Philippines’ health and January 1996), as these serve as vital inputs to nutrition are important factors in securing national plans and programs. sustained national development and economic stability. High rates of malnutrition create a Previous NNS results were generated cascade of developmental, social and medical at the national and regional levels. However, problems which places a significant burden on there was a clamor from the local government national economic growth. It is estimated that units (LGUs), the Congress of the Philippines, undernutrition alone can reduce Gross and other stakeholders for local-level data to be Domestic Product (GDP) by 11% (IFPRI, 2016) used for their local development plan. In 2018, while overnutrition as a risk factor for non- the NNS was redesigned as a rolling survey for communicable diseases also increases health three consecutive years, as the Expanded and economic burden in the Philippines. As National Nutrition Survey (ENNS). The ENNS is such, generation of up-to-date and critical data distinct from the previous NNS as it provides on key health and nutrition indicators is needed national estimates of the health and nutritional in the formulation and refinement of policies status of Filipinos as well as local-level and programs. estimates in the areas covered during the survey period, thereby enhancing program The Department of Science and planning and assisting with developing timely Technology-Food and Nutrition Research policies. Institute (DOST-FNRI), being the research arm of the Philippine government in food and The ENNS has eight survey nutrition is mandated to define and update the components, namely: Anthropometric Survey, country’s food and nutrition situation, Biochemical Survey, Clinical and Health particularly that of children and other Survey, Dietary Survey, Socio-economic nutritionally vulnerable groups (E.O. 128 Survey, Food Security Survey, Infant and Section 22, dated January 1987). Fulfilling this Young Child Feeding (IYCF) Practices and mandate, the DOST-FNRI conducts the Maternal Health and Nutrition. National Nutrition Surveys (NNS) every five years and a survey known as the Updating of The anthropometric survey component the Nutritional Status of Filipino Children and assesses the nutritional status of all population Other Population Groups (Updating Survey) groups by determining weight-for-age, height- was implemented starting in 1989 in between for-age, weight-for-height, BMI-for-age, waist NNS, to provide updates on the nutritional circumference and waist-hip ratio. status of the population. The conduct of the NNS and Updating Survey are designated The biochemical survey component statistical activities of DOST-FNRI that will determines the prevalence of anemia, iodine generate critical data for decision-making of the deficiency and vitamin A deficiency (VAD). government and private sector (E.O. 352 dated
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The clinical and health survey household members, the household’s housing component assesses the prevalence of risk materials, ownership of lot, owned household factors like overweight and obesity, elevated assets, toilet facilities and garbage disposal blood pressure, high fasting blood glucose, and system used in the construction of wealth index dyslipidemia. It also includes the evaluation of of households. certain behavioral risk factors such as smoking and exposure to second-hand smoking, alcohol The food security survey component consumption, physical inactivity and unhealthy provides data on household food security diet. status using the Household Food Insecurity Access Scale (HFIAS). The dietary survey component provides data on the quality, quantity and The IYCF component assesses current adequacy of diets that help track food infant and young child feeding practices of consumption trends over time, both at the mothers for their children age 0-23 months old. household and individual levels. The results of the dietary survey component will be provided The maternal health and nutrition in a separate report. survey component describes the nutritional
status of pregnant, lactating, and non-pregnant/ The socio-economic survey component non-lactating women of reproductive age. determines the economic status of households such as education and occupation of
Objectives of the ENNS
General Objective: To provide empirical data on the food, health, and nutritional status in Makati City.
Specific Objectives: To describe the socio-demographic characteristics of the households and individuals; To assess the physical growth and dimensions of children and other population groups using anthropometric indicators; To assess the nutrition biomarkers of children and other population groups (e.g. hemoglobin, serum retinol, and urinary iodine excretion); To determine food, energy and nutrient intakes and adequacy at the household and individual levels; To determine the following: prevalence of NCD risk factors (e.g. physiologic and behavioral risk factors); magnitude of household food insecurity; feeding practices of infants and young children, 0-23 months; and maternal health and nutritional status of mothers with 0-36 months old children, pregnant women, and lactating mothers.
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Significance and Uses of ENNS
The outputs of the survey are Republic Act No. 11148 (Kalusugan at anchored to the goals of the Philippine Nutrisyon ng Mag-Nanay Act), Republic Act No. Development Plan’s “AmBisyon Natin 2040” 8976 (Philippine Food Fortification Act), under the strategies of accelerating human Republic Act No. 10351 (Sin Tax Law) and capital development and the Philippine Plan Republic Act No. 11037 (Masustansiyang of Action for Nutrition (PPAN) 2017-2022. It is Pagkain para sa Batang Pilipino Act). With the also directed at gauging the country’s information synthesized by the survey, policy progress towards the achievement of the makers and administrators can be equipped second and third Sustainable Development with the necessary data and tools needed in Goals (SDG) and 2025 Global Nutrition initiating positive institutional change relevant to Targets. nutrition and health. At the local level, the results of ENNS could serve as a basis for The NNS serves as the backbone of LGUs to address health and nutrition problems current and future nutrition legislations and with evidence-based programs and actions action plans. Some of the prominent directed towards specific groups. programs that utilized the NNS data are
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Methodology
Sampling Design
The ENNS utilized the 2013 Master and three other areas), which is divided into Sample (MS) of the Philippine Statistics exhaustive and non-overlapping area Authority as its sampling design. The 2013 MS segments known as PSUs with about 100 to design for household-based surveys is a two- 400 households (Figure 1). Sixteen stage cluster sampling design with barangays/ independent sample replicates are drawn from Enumeration Areas (EAs) or group of adjacent each domain to generate sufficiently precise small barangays/EAs as the primary sampling estimates at the province or city level. On the units (PSUs), followed by the selection of average, a total of 12 sample housing units/ secondary sampling units composed of households are allotted for each sample PSUs housing units/households (PSA, n.d.). The in an HUC while 16 sample housing units/ 2013 MS has 117 sampling domains (81 households are allotted for every PSUs in provinces, 33 highly urbanized cities (HUCs) provincial domain.
Figure 1. Philippine Statistics Authority (PSA) 2013 Master Sample
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The number of sampled households similar characteristics into “replicates” and has increased fourfold through the expansion assigned to the years 2018, 2019 and 2021. A in numbers of sampling domains and replicates replicate is composed of at least five provinces in the 2013 MS and requires considerable or HUCs. resources for the highly specialized data collection in the ENNS. Since it is not possible An average of 1,536 households were to complete the survey and yield reliable targeted per sampling domain except for the national and local-level estimates within a year, biochemical, blood parameters of the clinical data collection was spread over three years. and health, and dietary survey components. Replicated sampling was employed in the This is due to the high cost of laboratory selection of provinces and HUCs in order to analyses and data collection for the dietary gain efficiency in the generation of national component, hence only 50% of the target level estimates for a given year. This is done households were covered. by grouping the provinces and HUCs with
Data Collection, Processing and Analysis The methods of data collection for the different survey components are presented in Figure 2.
ANTHROPOMETRY
Actual body measurements: weight, height, waist and hip circumferences
BIOCHEMICAL AND CLINICAL AND HEALTH
Collection of blood and Blood Blood pressure urine samples analysis measurement
CLINICAL AND HEALTH, DIETARY, FOOD SECURITY, IYCF, MATERNAL HEALTH AND
Food weighing 24-hr Food Recall Face-to-face interview Figure 2. Methods of Data Collection
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Weight, height or recumbent length (for two measurements was greater than 0.5 cm. children less than 2 years old), and waist and Weight and height measurements hip circumferences were measured by trained (recumbent length for children less than two nutritionist-dietitians (NDs), nurses and allied years) of children, 0-5 years old, were health professionals following standard interpreted using the World Health protocols. Organization’s Child Growth Standard (WHO- CGS). The WHO Growth Reference 2007 was A double digital window scale with a used to assess the nutritional status of children 150-200 kilogram capacity was used to and adolescents from age 5 years and 1 month measure weight of subjects. Assisted weighing to 19 years (61 to 228 months). The cut-off was done for children who were unable to stand points in classifying the nutritional status of in which the caregiver/adult companion carries children and adolescents, 0-19 years old (0-228 the child and were subsequently weighed months) are shown in Tables 1 and 2. together. Values are then computed accordingly by using the weighing scale 2-in-1 Underweight is based on weight-for- or tare function key to record the corresponding age index and presents both the past and weight of the young child. Measurements were present nutritional status of the child. While done twice and recorded to the nearest 0.01 stunting is based on height-for-age index which kilograms. A third reading was done if the reflects chronic undernutrition or past nutritional difference between the two values was greater status caused by prolonged inadequate intake, than 0.3 kilograms. recurrence of illness or improper feeding practices. Wasting is based on weight-for- Standing height of subjects, 2 years old height index which is also considered a and over, were measured using a stadiometer sensitive index of current nutritional status. while recumbent length of children below two Overweight is an indicator where the weight-for- years of age or those unable to stand was height of the child, 0-60 months, is at >+2 SD measured using a medical plastic infant (WHO, 2006). BMI-for-age for school-age measuring board (infantometer). Values were children and adolescents, 61-228 months, is at recorded to the nearest 0.1 cm and a third >+1 SD for overweight and +>2 SD for obesity reading is done if the difference between the (WHO, 2007).
Table 1. WHO Child Growth Standards 2006 for infants and young children (0-60 months) and WHO Growth Reference 2007 for school-age children and adolescents (61-228 months) by indicators and age groups
WHO Child Growth Standards WHO Growth Reference Indicators 2006 2007 0-60 months 61-120 months Weight-for-age (0-5.0 y) (5 y & 1 mo. - 10.0 y) 0-60 months 61-228 months Length/height-for-age (0-5.0 y) (5 y & 1 mo. - 19.0 y) 0-60 months Weight-for-length/height None (0-5.0 y) 0-60 months 61-228 months BMI-for-age (0-5.0 y) (5 y & 1 mo. - 19.0 y)
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Table 2. Cut-off points used in classifying the nutritional status of children, 0-10 years old (0-120 months), based on the WHO CGS (2006) and WHO Growth Reference (2007)
Indicator/ Nutritional Status Cut-off Points Weight-for-Age Underweight <-2SD Normal -2SD to +2SD Above Normal >+2SD
Height-for-Age* Underheight/Stunting <-2SD Normal -2SD to +2SD Above Average/Tall >+2SD
Weight-for-Length/Height** Thin/Wasting <-2SD Normal -2SD to +2SD Overweight >+2SD NEC *** * Use also for children 10 years and 1 month to 19.0 y (121-228 months) ** Use only for children 0-5 years (0-60 months) *** NEC Not Elsewhere Classified – those whose heights are beyond the limits of the weight-for-height tables
The cut-off points used to determine presented in Tables 3 and 4. These cut-offs are the magnitude and severity of underweight, also used as basis to determine magnitude and stunting, and wasting as a public health severity of undernutrition for school-age problem among children under five years are children and adolescents.
Table 3. Cut-off points used in determining magnitude and severity of underweight and stunting among children, under-five years old (0 to <60 months), as a public health problem (WHO, 1995)
Prevalence Category for Prevalence Category for Magnitude and Severity Underweight Stunting Low <10% <20% Medium 10-19% 20-29% High 20-29% 30-39% Very High ≥ 30% ≥ 40%
Table 4. Cut-off points used in determining magnitude and severity of wasting among children, under-five years old (0 to <60 months), as a public health problem (WHO, 1995)
Magnitude and Severity Prevalence Category for Wasting
Acceptable <5% Poor 5-9% Serious 10-14% Critical ≥ 15%
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Body Mass Index (BMI) by the WHO Magbitang, et al in 1988 was used for was used for the assessment of nutritional pregnant women. Tables 5 and 6 show the cut status among adults and lactating women while -off points for adults (including lactating the Philippine reference criteria developed by women) and pregnant women, respectively.
Table 5. Cut-off points in classifying the nutritional status of adults and lactating women, 19.0 years and over (>228 months), based on Body Mass Index (WHO & NCHS, 1978)
Classification Cut-off Points Chronic Energy Deficiency (CED) <18.5 Normal 18.5 to 24.99 Overweight 25.0 to 29.99 Obesity ≥ 30.0
Table 6. Cut-off points in classifying the nutritional status of pregnant women based on weight-for-height (Magbitang, et.al., 1988) Classification Cut-off Points Nutritionally-at-risk < 95th percentile Not nutritionally-at-risk > 95th percentile
The cut-off points in determining the adults and lactating women are presented in magnitude and severity of underweight for Table 7.
Table 7. Cut-off points used in determining magnitude and severity of underweight (BMI <18.5) among adults, 19.0 years old and over (≥228 months), as public health problem (WHO, 1995) Classification Cut-off Points Low 5-9% Medium 10-19% High 20-39% Very High ≥40%
Waist and hip circumferences of times and recorded to the nearest 0.1 cm. subjects 20 years old and above (excluding Another measurement will be done if the pregnant women) were measured using a non- difference between measurements is greater stretchable tape measure. Waist and hip than 0.5 cm. Pregnant women were not circumferences of adults were measured to included because variations in the physical determine abdominal obesity. Waist dimension might overestimate obesity and circumference is a measurement of the adiposity. Waist-hip ratio is a simple method distance around the smallest part of the for describing the distribution of both abdomen, located at the midway between the subcutaneous and intra-abdominal adipose lowest rib and the tip of the hip bone or iliac tissue. It is computed using the waist and hip crest (Averkamp, 2015). Hip circumference measurements. Cut off points of waist refers to the distance around the largest area of circumference (WC) and waist-hip ratio the hips, usually the largest part of the buttocks (WHR) are shown in Table 8. (CDC, 2007). Measurements were done three
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Table 8. Cut-off points for waist circumference and waist-hip ratio, by sex (WHO, 2011b; DOST-FNRI, 2010)
Waist Circumference Waist-Hip Ratio Males < 90 cm Low <0.9 90-101 cm Normal 0.9 to 0.99 ≥ 102 cm High ≥ 1.0 Females <80 cm Low <0.8 80-87 cm Normal 0.8 to 0.84 ≥ 88 cm High ≥ 0.85
The biochemical survey component directly pipetted into a cyanmethemoglobin determines levels of biomarkers such as solution for determination of hemoglobin. A hemoglobin, serum retinol and urinary iodine portable spectrophotometer was used for excretion in blood and urine samples. Blood absorbance measurements and the results of samples were collected by trained registered hemoglobin levels were reported to the survey medical technologists from preschool children participants. Hemoglobin levels were (6 months to 5 years old) via the finger prick measured to determine the prevalence and method using sterile blood lancets. While the magnitude of anemia using the WHO venipuncture method was used for subjects 60 Guidelines (1972, 2001) presented in Tables 9 months and over using sterile syringes and and 10. needles. Twenty (20) microliters of blood was
Table 9. Hemoglobin concentrations below which anemia is likely to be present in populations at sea level (WHO, 1972)
Hemoglobin Concentrations Age/Sex/Physiological State (g/dL) Children 6 months - 6 years old 11.0 Children >6 - 14 years old 12.0 Adult males, ≥ 15 years old 13.0 Adult females, ≥ 15 years old (non-pregnant) 12.0 Adult females (pregnant) 11.0
Table 10. Classification of public health significance of anemia in populations on the basis of prevalence estimated from blood levels of hemoglobin (WHO, 2001)
Category of public health significance Prevalence of anemia (%) Low < 4.9 Mild 5.0 – 19.9 Moderate 20.0 – 39.9 Severe ≥ 40.0
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Serum was separated from the red samples are analysed in DOST-FNRI cells within two hours after blood collection and laboratories with ISO/IEC 17025 accreditation, transferred to a trace element free blue top following international guidelines and quality tube for the determination of vitamin A by High assurance measures. Pressure Liquid Chromatography (HPLC) method (Furr, et al 1992). All blood collections Serum retinol levels were measured to were done inside rooms to avoid exposure of determine the prevalence and magnitude of the collected specimen to direct sunlight. All vitamin A deficiency using the WHO Guidelines biochemical samples are kept frozen in (1976; 1982, 1996; 2011) presented in Tables household freezers or ice chests until they are 11 and 12. shipped to the DOST-FNRI. Biochemical
Table 11. Guidelines used for the interpretation of Serum Vitamin A level (WHO/USAID, 1976; WHO/UNICEF/HKI/VACG, 1982)
Serum Retinol Level µg/dL µmol/L Deficient < 10 < 0.35 Low 10 – 19 0.35 – 0.69 Acceptable 20 – 49 0.70 – 1.74 High ≥ 50 ≥ 1.75
Table 12. Prevalence cut-offs to define vitamin A deficiency in a population and its level of public health significance (WHO, 1996; WHO, 2011a)
Public Health Importance Serum or Plasma Degree of Severity Retinol Prevalence (%) Mild 2 – <10 Moderate 10 – <20
Severe ≥ 20
About 15 mL mid-stream urine sample digestion method of Dunn et al (1993) was was collected from sample household used to determine UIE concentrations. members: from children, 6-12 years, women of reproductive age (15-49 years old), pregnant or Tables 13 and 14 show the severity of lactating women, and the elderly to determine iodine deficiency based on median UIE using urinary iodine excretion (UIE) level and the the epidemiological criteria set by the WHO/ prevalence of iodine deficiency. The acid UNICEF/ICCIDD (2001, 2007).
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Table 13. Epidemiological criteria for assessing iodine nutrition based on median urinary iodine concentrations in school-age children (WHO/UNICEF/ICCIDD, 2001)*
Urinary Iodine Excretion (UIE) Iodine Intake Iodine Nutrition (µg/L) < 20 Insufficient Severe iodine deficiency 20-49 Insufficient Moderate iodine deficiency 50-99 Insufficient Mild iodine deficiency 100-199 Adequate Optimal Risk of iodine-induced hyperthyroidism 200-299 More than adequate within 5-10 years following introduction of iodized salt in susceptible groups Risk of adverse health consequences ≥ 300 Excessive (iodine-induced hyperthyroidism, autoim- mune thyroid disease) * Applies to adults, but not to pregnant women.
Table 14. Epidemiological criteria for assessing iodine nutrition based on urinary iodine concentrations of pregnant women (WHO/UNICEF/ICCIDD, 2007)
Median UIE (ug/L) Iodine Intake < 150 Insufficient 150 – 249 Adequate 250 – 499 Above requirements ≥ 500 Excessive** ** The term “excessive” means in excess of the amount required to prevent and control iodine deficiency.
Blood pressure was measured through advice. The prevalence of elevated blood the auscultatory method by trained NDs, pressure is reported based on the classification nurses and allied health professionals among and cut-off points set by the 7th Joint National adults 20 years old and above, using non- Committee on detection and treatment of high mercurial sphygmomanometer and dual blood pressure (JNC VII) (NIH, 2004) stethoscope following standard procedures. presented in Table 15. Respondents are requested to rest quietly for five minutes in a seated position upon arrival in Moreover, blood samples were the assembly area. They are asked about collected using vacutainer tubes with Lithium eating, drinking any caffeine-containing Heparin for fasting blood sugar (FBS) drawn beverage, smoking, exercising, or intake of anti via venipuncture method among adults 20 -hypertensive medications within 30 minutes years old and above after 10-12 hour overnight before measurement. If they self-reported any fasting. These were stored on ice and later of these activities, measurement will be centrifuged to separate plasma, which was delayed. The maximum inflation level is later packed, labeled and frozen until ready for recorded and then three readings of systolic analysis in DOST-FNRI laboratories. In the and diastolic blood pressure are taken, with analysis of FBS, enzymatic colorimetric method intervals of one to two minutes. An was used using Roche COBAS Integra and accompanying questionnaire is used to collect Hitachi 912. Values for FBS were interpreted information on the history of raised blood using the WHO Guidelines (1998) (Table 16). pressure, diagnosis, medication and lifestyle
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Table 15. Blood pressure classification (NIH: JNC VII, 2004) Systolic Blood Diastolic Blood Classification Pressure (SBP) Pressure (DBP) (mmHg) (mmHg) Normal <120 and <80 Pre-hypertension 120-139 or 80-89 Hypertension Stage 1 140-159 or 90-99 Hypertension Stage 2 ≥ 160 or ≥ 100
Table 16. Cut-off points for fasting blood sugar Cut-off points (mg/dL) Classification WHO and IDFa Philippine CPGb Normal <110 <100 Impaired Fasting Glucose (IFG) 110-125 100-125 Diabetes ≥126 ≥126 a International Diabetes Federation b Clinical Practice Guidelines
For the dietary survey component, food individual’s food intake. All members of the weighing, food inventory, and food recall were sampled households were interviewed to collect the methods employed in the collection of food data for the first day 24-hour food recall. For the consumption data among sample households. second day recall, only 50% of the randomly A digital weighing scale was used to weigh all selected households with one day recall were food items prepared and served in the interviewed to have a second non-consecutive households throughout the day, which included days food recall data. It involved a face-to-face food items eaten from breakfast, lunch, supper, interview where food consumed by an and in-between snacks. Food items were individual for the past 24 hours were recalled weighed before cooking or in their raw form. and recorded starting from the time the subject Plate wastes, given-out food, and leftover food woke up until bedtime, including morning, were also weighed to obtain the actual weight afternoon and late evening snacks. of food consumed. Respondents were asked to remember and report exactly all foods and beverages they Aside from the actual weighing of food actually consumed during the previous 24-hour in the household, a food inventory was also period using measuring tools (tablespoon, cup, conducted. Non-perishable food items that matchbox, ruler and graduated circle sizes). may be used anytime of the day such as coffee, sugar, salt, cooking oil, and other All food items consumed, as well as condiments were weighed at the beginning and their description, including cooking method and end of the food weighing day. If some brand names, were recorded. Weights of actual members of the household ate outside the food consumed based on the two non- home during the food weighing day, a recall of consecutive 24-hour food recalls were entered the foods eaten out was also administered. to a computer library of the Food Composition Tables to estimate for energy and nutrient For the individual food consumption, intakes. These estimates are then compared 24-hour food recall was used to estimate the against the nutritional requirements indicated in
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the Philippine Dietary Reference Intakes. The adverse conditions more severely or more results of the food consumption survey will be frequently. provided in another report. The maternal health and nutrition Health interviews regarding behavioral survey collected the nutritional status of risk factors, such as smoking, excessive alcohol women of reproductive age, particularly the consumption, and physical inactivity were also non-pregnant/ non-lactating women, pregnant conducted using the WHO STEPS instruments women and lactating mothers. or the STEPwise approach to NCD risk factor surveillance version 3.2. By definition, current In the infant and young child feeding smokers were those who smoke during the time survey, the feeding practice for children aged of the survey using conventional products either 0–23 months is reported using 24-hour food on a “daily” basis (at least one tobacco or recall. Breastfeeding indicators include early nicotine product a day) or on a regular or initiation of breastfeeding which is defined as occasional basis. Current drinkers, on the other the proportion of children 0-23 months who hand, are those who have consumed any were put to breast within an hour after alcoholic beverages during the past 12 months delivery, exclusive breastfeeding which is the at the time of the survey. Binge drinking refers to proportion of infants 0-5 months who received excessive consumption of alcoholic beverages, only breastmilk based on the 24-hour food specifically the intake of four or more (for recall, and continued breastfeeding at 1 year females) or five or more (for males) standard or 2 years. Complementary feeding practices drinks in a row (WHO, 2008) among those who among children, 6-23 months, include the reported drinking alcoholic beverages in the past following indicators: minimum dietary diversity 30 days. For physical activity among adults, a (MDD) is the consumption of foods from at person not meeting the WHO recommendation least 4 food groups during the previous day, of three or more days of vigorous-intensity minimum meal frequency (MMF) reflects the activity of at least 20 minutes per day or five or energy intake from foods other than breastmilk more days of moderate intensity activity or consumed the minimum number of times or walking of at least 30 minutes per day, is more per day, and the minimum acceptable considered insufficiently physically active. diet (MAD) refers to the proportion of children Among adolescents, insufficient physical activity who attained both the MDD and MMF the means doing less than 60 minutes of moderate- previous day. to vigorous-intensity physical activity per day. The 2018 ENNS Interview Schedules For the food security survey component, consisted of eleven booklets categorized by life the Household Food Insecurity Access Scale stage or by component. The list of booklets and (HFIAS) (Coates et al, 2007) was adopted in the forms and the actual interview guides used are ENNS to determine the prevalence and compiled in Annex 1. magnitude of food insecurity at the household level. The HFIAS is categorized into four levels: The summary table for the different food secure, mildly, moderately, and severely variables collected in each specific age or food insecure. The households increase their physiologic group is presented in Table 17. level of food insecurity when they experience
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Table 17. Target age or physiologic groups for specific variables Physiologic Groups Women of Reproductive Age Infant and School- Variables Preschool Adoles- Young age Non- Adults Elderly Household Children cents Pregnant Pregnant Lactating Children Children and Non- Women Mothers Lactating Food Security Status ✔
Food Consumption ✔ (Food Weighing) Infant and Young Child Feeding Practices Breastfeeding Practices ✔ Complementary Feeding Practices ✔ Anthropometric Measurements Underweight ✔ ✔ ✔ Wasting ✔ ✔ ✔ ✔ Stunting ✔ ✔ ✔ ✔ Chronic Energy Deficiency ✔ ✔ ✔ ✔ Nutritionally at-risk ✔ Overweight and Obesity ✔ ✔ ✔ ✔ ✔ ✔ ✔ High Waist Circumference ✔ ✔ High Waist-Hip Ratio ✔ ✔ Micronutrient Status Anemia ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Vitamin A 6-71mos 6-71mos ✔ ✔ ✔ ✔ Iodine Status ✔ ✔ ✔ ✔ ✔ Individual Food Consumption ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ (24-Hour Food Recall) Nutrition-Related and Lifestyle Risk Factors Elevated Blood Pressure ✔ ✔ High Fasting Blood Sugar ✔ ✔ Behavioral Risk Factors Current Smokers ✔ ✔ ✔ Current Drinkers ✔ ✔ ✔ Binge Drinkers ✔ Physical Inactivity ✔ ✔ ✔
Ethics Review The project proposal for “THE interview and other measurements. Signed EXPANDED NATIONAL NUTRITION SURVEY Assent Forms were collected from respondents (ENNS)” was submitted to the FNRI aged 7 to < 15 years old. The Informed Institutional Ethics Review Committee (FIERC) Consent Form (ICF) contains the explanation for clearance on July 12, 2017 which was of the background and objectives of the survey, approved on July 31, 2017 with protocol code the data collection procedures involved, risks FIERC-2017-017. (any undesirable effect that may result or invasion of circumstances, e.g., blood The signed consent forms which were collection, expected duration of the interview translated into the different local languages that with respondent) and benefits of participation, are most commonly spoken in the Philippines confidentiality of information, option to withdraw were obtained from respondents prior to without penalty or consequences.
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Study Site
Profile of Makati City
Makati City, officially the City of Makati, pressure on Makati City’s environment, is a first class highly urbanized city in Metro services, and utilities, most noticeably causing Manila, Philippines. Makati City is the financial large traffic volumes along the major road center of the Philippines; it has the highest corridors leading to the city as well as within concentration of multinational and local and at the periphery of the central business corporations in the country. Major banks, district. corporations, department stores as well as foreign embassies are based in Makati City. Makati City is divided into 33 The biggest trading floor of the Philippine Stock barangays (the smallest local government Exchange is situated along the city’s Ayala units) which handles governance in a much Avenue. Makati City is also known for being a smaller area. These barangays are grouped major cultural and entertainment hub in Metro into two congressional districts where each Manila. district is represented by a congressman in the country’s House of Representatives. According to the 2015 census, it has a Congressional District I is composed of the population of 582,602 people making it as the barangays straddling EDSA, the barangays to 17th-largest city in the country and ranked as the north and west of them, while excluding the 41st most densely populated city in the Guadalupe Viejo and Pinagkaisahan, while world with 19,336 inhabitants per square District II are to the south and east of District I, kilometre. Although its population is just half a including the two aforementioned barangays. million, based on the city’s Transport and The districts used to elect the members of the Traffic Improvement Plan 2004-2014, the city’s city council are coextensive with the daytime population is estimated to be 3.7 congressional districts. million during weekdays, owing to the large number of people who come to work, do The city of Makati City remains the business, or shop. Traffic is expected mostly richest local government unit (LGU) in the during rush hour and holiday seasons. Philippines in terms of income from local sources and on a per capita basis. As of end- The daily influx of people into the city 2012, Makati City had registered over 62,000 provides the skilled labor force that allows business enterprises, which are engaged in Makati City to handle the service requirements financial services, wholesale/retail, services, of domestic as well as international real estate, export/import, and manufacturing. transactions; it also serves as the base of a Makati City also boasts of having the highest large consumer market that fuels the retail and number of BPO offices in Metro Manila at service trade in the city. At the same time, 1,159 companies to date, as well as the however, the large tidal population flows exert highest number of PEZA-accredited IT Parks
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and Buildings. The city government of Makati City sub-district of the Makati City CBD, comprising has not increased its tax rates since its new the parcel of land between Ayala Avenue, Revenue Code took effect in 2006. The city has Makati City Avenue and Paseo de Roxas, as been free of deficit for 26 years. well as the buildings on those streets. Many multinational companies, banks and other The city is known for its developed major businesses are located within the business district called the Makati City Central triangle. A few upscale boutiques, restaurants Business District (CBD). It is bounded by EDSA, and a park called Ayala Triangle Gardens are Gil Puyat Avenue, Arnaiz Avenue and Chino also located in the area. Ayala Avenue and Roces Avenue. It mainly encompasses Legazpi Paseo de Roxas also have the distinction of Village, Salcedo Village, the Ayala Center, and being the runways of the former Nielson Field, parts of Bel-Air Village. The Ayala Triangle is a Metro Manila’s main airport in the 1930s.
Figure 3. Political Map of Makati City1
[1] Makati. 2019. Political Map of Makati [Image]. Retrieved from: https://en.wikipedia.org/wiki/Makati.
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Household and Individual Response Rates
A household refers to a person living Household and individual eligibility and alone or a group of persons, who may be response rates together with the total number related or not, sleep in the same dwelling unit of households and individuals covered in the and have common arrangements for the city are presented in Table 18. There were preparation and consumption of food 1,303 eligible households and 3,381 eligible (Barcenas, 2004). individuals who can participate in the survey. Based on the eligibility of households and individual level, response rate was 68.6% and 51.8%, respectively.
Table 18. Household and individual eligibility and response rates in Makati City
Level Eligible Response Response Rate
Household 1,303 894 68.6 Individual 3,381 1,750 51.8
Socio-demographic Profile of Households and Respondents
Socio-demographic profile of There were more female (58.5%) households and respondents were gathered household members than males (41.5%) and using face-to-face interview and actual were comprised mostly of adults 20-59 years old observation. Table 19 shows the socio- (54.9%). demographic profile of the households and household heads in Makati City. Among women of reproductive age, there were only 3.4% pregnant women and Majority of the households comprised 11.3% lactating mothers in Makati City at the of at least 5 members (81.4%). Household time of survey. heads were mostly male (71.5%), and were married (49.3%).
Table 19. Socio-demographic profile of households and household heads in Makati City: ENNS, 2018
Variable n % Household size 5 members and below 721 81.4 More than 5 members 173 18.6 Sex of household members Male 753 41.5 Female 997 58.5 Sex of household head Male 640 71.5 Female 254 28.5
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Table 19. Socio-demographic profile of households and household heads in Makati City: ENNS, 2018
Variable n % Civil status of household head Separated 52 5.8 Single 124 14.0 Common Law/ Live-in 145 16.0 Widowed 139 14.9 Married 434 49.3 Respondents by age group 0 - 23 months 55 3.3 24 - 71 months 145 8.3 72 - 120 months 158 8.2 > 10 - 19 years 294 14.0 20 - 59 years 834 54.9 60 years and over 264 11.4 Women of reproductive age by physiological status Pregnant 15 3.4 Lactating 45 11.3 Non-pregnant/ Non-Lactating 387 85.3
Most of the household heads (46.4%) or other means of livelihood and classified have reached at least high school level of based on the 2012 Philippine Standard education while 42.7% obtained at least college Occupational Code (PSA, n.d.). About three in level of education. A small proportion of every 10 household heads (27.4%) in Makati household heads had reached elementary level City were service workers, 16.4% were plant (10.9%) (Figure 4). and machine operators, 14.9% were laborers and unskilled workers, and 11.1% were craft Occupation of household heads refers and related trades workers (Figure 5). to the present principal employment, business,
* including Post-Secondary Non-Tertiary and Short-Cycle Tertiary ** including Master and Doctoral Level Education or Equivalent Education
Figure 4. Distribution of educational attainment of household head in Makati City: ENNS, 2018
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Figure 5. Distribution of occupation of household head in Makati City: ENNS, 2018
Food Security Status
Food security exists when all people, at Among households who were food all times, have physical and economic access insecure, 14.2% were classified as mildly food to sufficient, safe and nutritious food that meets insecure wherein the household sometimes or their dietary needs and food preferences for an often worried about food and/or was unable to active healthy life (FAO, 1996). In Makati City, eat preferred foods. more than half (66.8%) of the households reported that they were food secure (Table 20). Meanwhile, one in every 10 (13.5%) This means that three in every 10 (33.2%) of of the households were classified as the households in the city still experienced food moderately food insecure wherein they had a insecurity wherein there was limited or hard time acquiring and accessing food, had uncertain availability of nutritionally adequate faced uncertainties about their ability to obtain and safe foods or limited or uncertain ability to food, and had been forced to compromise on acquire acceptable foods in socially acceptable the quality and/or quantity of the food they ways (Anderson, 1990). consume and obtain.
Table 20. Percentage of households by food security status in the Philippines and Makati CIty: ENNS, 2018
Philippines Makati City 90% CI 90% CI Variable Percentage Percentage (%) Lower Upper (%) Lower Upper Limit Limit Limit Limit Food Secure 46.1 44.1 48.0 66.8* 62.4 71.2 Mildly Food Insecure 12.3 11.7 12.9 14.2 10.8 17.6 Moderately Food Insecure 28.8 27.1 30.5 13.5* 11.5 15.5 Severely Food Insecure 12.8 11.2 14.4 5.5* 3.4 7.5 * significant at p<0.10
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Figure 6. Percentage of households by food insecurity items in Makati City: ENNS, 2018
Five in every 100 (5.5%) households in Furthermore, food insecurity was the city were classified as severely food significantly higher among poor households or insecure. A severely food insecure household those households in the bottom 30% of the often cuts back the quantity of foods and income group (Figure 7). Food insecurity was experiences the three most severe conditions also evident among households with more (running out of food, going to sleep hungry and than five members, and significantly higher not eating for the whole day). among households headed by males than their counterparts.
Wealth Status Household Size Sex of Household Head 90% LL 28.8 47.4 18.9 27.3 33.0 31.8 17.2 CI UL 37.6 62.5 28.1 35.8 54.2 48.3 27.3 * significant at p<0.10
Figure 7. Percentage of food insecure households by wealth status, household size, and sex of household head in Makati City: ENNS, 2018
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Key Findings by Life Stage
Infants and Preschool Children (0 to 59 months old)
Childhood malnutrition encompasses Infant and Young Children 0-23 months both undernutrition like micronutrient deficiency, The role of optimal infant and young stunting, underweight and wasting; and children feeding (IYCF) practices is crucial in overnutrition like overweight and obesity. improving child health, growth, and Malnutrition has important health development during the first two years of life. consequences on growth, learning capacity, It is recommended that newborns should be incidence of infectious diseases, and can even initiated early to breastfeeding within one hour last in adult life as manifested by presence of after birth, exclusively breastfed from birth up chronic non-communicable diseases and low to six months, and complementary foods individual work productivity. From a life cycle should be introduced starting at 6 months of perspective, the most crucial time to meet the age, while continue breastfeeding up to two nutritional needs is in the first 1,000 days years and beyond. The quality and quantity of including the period of pregnancy until the complementary foods should be adequate child’s second birthday when nutritional needs emphasizing the importance of variety or is high to support rapid growth and diversity, frequency, and acceptability as development. measured by the following indicators:
This section of the monograph reports minimum dietary diversity (MDD), minimum the prevalence of underweight, stunting, meal frequency (MMF), and minimum wasting, overweight/obesity, anemia and acceptable diet (MAD), which were previously vitamin A deficiency as indicators of nutritional defined in the methodology section. status of children under-five years of age.
90% LL 65.2 51.2 45.4 29.3 90% LL 64.9 35.9 38.3 21.8 CI UL 73.1 58.5 55.9 37.0 CI UL 95.4 89.0 85.9 77.2
Figure 8. Proportion of infants, 0 - 23 months old, by breastfeeding practices in the Philippines and Makati City: ENNS, 2018
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Promotion of IYCF has been one of the Complementary feeding practices of key priority programs of the Department of children, meanwhile, revealed that only 20.6% Health (DOH) and other government agencies of children met the minimum dietary diversity including the local government units (LGUs) to (MDD) from the different food groups (Figure address childhood undernutrition. 9). A high proportion of children (88.7%) met the minimum meal frequency (MMF) per day. In Makati City, majority of mothers However, a very low proportion (9.6%) of (80.2%) reported initiating breastfeeding their children met the minimum acceptable diet infants within one hour after birth (Figure 8). Six (MAD) based on the quality of complementary out of 10 (62.4%) infants 0-5.9 months were food eaten the previous day. This revealed that exclusively breastfed. Meanwhile, the young children, 6-23 months of age, in the city proportion of children who were continued to be fell short for the minimum quality and quantity breastfed at one year was 62.1%. of complementary feeding when combining Breastfeeding practice decreased with age both the diversity (MDD) and frequency (MMF) where only 49.5% of children were still being indicators. breastfed up to two years of age in the city.
90% LL 21.1 87.6 12.4 90% LL 10.3 81.7 3.4 CI UL 24.9 90.4 14.4 CI UL 30.9 95.6 15.9 Figure 9. Proportion of infants, 6 - 23 months old, by complementary feeding practices in the Philippines and Makati City: ENNS, 2018
Preschool Children Under-Five
Results showed that one out of 10 prevalence between boys (12.2%) and girls children (11.5%) below five years were (10.7%) (Figure 10). underweight or had suffered acute form of malnutrition in the city (Table 21). The city Chronic malnutrition is assessed by low estimate in Makati showed that underweight height-for-age index. The prevalence of was considered “medium” in terms of stunting among children under five years was magnitude and severity. Underweight 19.6% and it was also considered as “low” prevalence was significantly higher in poor public health concern in the city (Table 21). The (23.6%) than non-poor (3.1%) households. prevalence was higher in poor (23.3%) than There were no significant difference in the non-poor (12.1%) households (Figure 10). No
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significant difference in the prevalence was the WHO cut-offs (Table 4). There was no noted between boys (21.4%) and girls (19.5%). significant difference in the prevalence of wasting by household wealth status and sex Wasting or thinness is assessed by (Figure 10). weight-for-height index. It is a sensitive indicator of current nutritional status as a result Overweight was observed among 7.8% of recent insufficient food intake, illness or of children under-five years of age in the city situations, like calamities. Four out of 100 (Table 21). No significant difference in the children (4.2%) under-five years old were prevalence of overweight by household wealth wasted/thin (Table 21). The prevalence of status and sex were noted (Figure 10). wasting was classified as acceptable based on
Table 21. Prevalence of underweight, stunting, wasting, and overweight-for-height among children, under-five years old (0-59 months), in the Philippines and Makati City: ENNS, 2018 Philippines Makati City 90% CI 90% CI Variable Prevalence Prevalence (%) Lower Upper (%) Lower Upper Limit Limit Limit Limit Underweight 19.1 17.7 20.5 11.5 7.1 17.9 Stunting 30.3 28.2 32.4 19.6* 13.1 26.1 Wasting 5.6 5.2 6.1 4.2 0.7 7.8 Overweight-for-height 4.0 3.6 4.3 7.8 3.7 11.9 *significant at p <0.10
90% LL 7.1 5.7 5.4 11.9 0.3 90% LL 13.1 14.4 8.3 14.2 6.1 CI UL 17.9 24.3 20.2 35.4 6.0 CI UL 26.1 28.4 30.6 32.4 18.0
90% LL 0.7 0.0 0.2 0.0 0.0 90% LL 3.7 5.6 0.0 0.0 4.7 CI UL 7.8 9.9 5.3 21.1 4.3 CI UL 11.9 20.1 7.0 10.3 15.2 *significant at p <0.10 Figure 10. Prevalence of underweight, stunting, wasting and overweight-for-height among children, under-five years old (0-59 months), by sex and wealth status in Makati City: ENNS, 2018
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Anemia is the most common indicator was anemic (Table 22). Anemia prevalence in used to screen for iron deficiency (WHO, 2001). this age group was of “mild” public health In Makati City, one in every 10 preschool concern. children (12.7%) 6 months to 5 years of age
Table 22. Prevalence of anemia among preschool children, 6 months to 5 years old (6-71 months), in the Philippines and Makati City: ENNS, 2018
Prevalence 90% CI
(%) Lower Limit Upper Limit Philippines 14.3 12.8 15.9 Makati City 12.7 0.5 25.0
Vitamin A deficiency (VAD) is the among preschool children in Makati City was leading cause of preventable blindness in 3.3% which is considered a “mild” public health children and this also increases the risk of problem based on the WHO cut-offs (Table disease and death from severe infections. The 23). prevalence of VAD (deficient and low levels)
Table 23. Prevalence of vitamin A deficiency among preschool children, 6 months to 5 years old (6 - 71 months), in the Philippines and Makati City: ENNS, 2018
Prevalence 90% CI
(%) Lower Limit Upper Limit Philippines 16.9 13.9 20.5 Makati City 3.3* 1.0 10.4
*significant at p <0.10
Highlights:
Underweight and stunting prevalence among children, under five years old, were public health problems with “medium” and “low” severity, respectively. Anemia was a “mild” public health problem. Vitamin A deficiency was considered a “mild” public health problem. Continued breastfeeding at 2 years was low. Dietary diversity of children during the complementary feeding period was suboptimal, with low percentage of children aged 6-23 months meeting the minimum dietary diversity and minimum acceptable diet.
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Call to Action:
To improve the nutritional status of young children under two years of age: Intensify the promotion of optimal breastfeeding practices at the community and facility level to increase the level of exclusive breastfeeding. Install program that will address timely introduction of nutrient-dense semi-solid/solid complementary foods at 6 months of age. Advise parents to give infants variety foods from family’s pot as early as 6 months. Conduct monthly growth monitoring and promotion with appropriate age-specific counselling.
To improve the nutritional status of 2-5 years of age: Promote and demonstrate utilization of diversified foods. Prevent and control anemia and Vitamin A deficiency. Deworm children annually. Prevent micronutrient deficiency through micronutrient supplementation and promoting consumption of micronutrient-rich foods that are locally available. Promote appropriate dietary practices during illness/sickness.
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School-age Children (5 to 10 years old)
School-age children comprise the ages underweight and “low” for stunting at 7.7%. of 5 to 10 years old or the middle childhood. This implies that one in every 10 school-age This is the period where growth is significant children was underweight or stunted in the city but with a slower rate. Adequate nutrition is (Table 24). necessary to ensure growth to full potential, and to sustain active physical activity in Stunting and underweight prevalence general. Undernutrition at this period have were observed to be higher among boys than negative consequences particularly on girls, and those belonging from non-poor cognition and learning capacity and ability to households but rates were not significantly prevent diseases later in life, as nutritional different (Figure 11). problems in the school-age child may carry into adulthood. This section reports the prevalence On the other hand, the prevalence of of underweight, stunting, wasting, overweight/ wasting was 4.6% (Table 24). No significant obesity, anemia, and iodine deficiency as difference in the prevalence of wasting by indicators of nutritional status of children, 5 to household wealth status and sex were noted 10 years old. (Figure 11).
The picture of undernutrition among Overweight/ obesity were emerging school-age children in the Philippines was high concern among school-age children in the city based on the global cut-off points for the at 24.5%, which was significantly higher severity of nutrition situation with underweight compared to the national prevalence of 11.6% prevalence of 24.9% or about a quarter of (Table 24). Overweight/ obesity prevalence school-age children, 5 to 10 years old. was observed to be higher among girls Moreover, the prevalence of stunting was (29.1%) than boys (20.8%) and among non- 24.6%. In Makati City, the prevalence of both poor than poor households, but rates were not underweight and stunting were significantly significantly different (Figure 11). lower than the national levels but the severity was considered “medium” at 10.5% for
Table 24. Prevalence of underweight, stunting, wasting, and overweight/obesity among children, 5 to 10 years old, in the Philippines and Makati City: ENNS, 2018
Philippines Makati City 90% CI 90% CI Variable Prevalence Prevalence Lower Upper Lower Upper (%) (%) Limit Limit Limit Limit Underweight 24.9 23.1 26.8 10.5* 5.8 15.3 Stunting 24.6 22.8 26.5 7.7* 4.3 11.2 Wasting 7.6 7.2 7.9 4.6* 2.5 6.8 Overweight/Obesity 11.6 10.4 12.9 24.5* 17.5 31.5 *significant at p <0.10
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90% LL 5.8 5.7 2.3 2.5 6.4 90% LL 4.3 3.5 2.7 1.6 4.6 CI UL 15.3 21.2 14.6 15.5 20.1 CI UL 11.2 19.2 9.3 12.9 15.4
90% LL 2.5 2.6 0.0 0.2 2.3 90% LL 17.5 12.6 21.0 12.6 17.4 CI UL 6.8 12.6 6.3 5.7 8.9 CI UL 31.5 29.0 37.1 34.6 36.4 Figure 11. Prevalence of underweight, stunting, wasting, and overweight/obesity among children, 5 to 10 years old, by sex and wealth status in Makati City: ENNS, 2018
Following the age group in the The overall prevalence of anemia Philippine Dietary Reference Intakes (PDRI), among school-age children in the Philippines hemoglobin level of school-age children, 6 to 12 in 2018 was 13.5% while the prevalence in years old, were assessed using the global cut- Makati City was 20.8% (Table 25). The anemia off points in determining anemia status. prevalence in Makati City was considered of Children, 6 years old whose hemoglobin level "moderate” public health significance. were less than 11.0 g/dL and children, 6.1 to 12 years old whose hemoglobin level were less than 12.0 g/dL were classified as anemic (WHO, 1972).
Table 25. Prevalence of anemia among school-age children (6 to 12 years old) in the Philippines and Makati City: ENNS, 2018
Prevalence 90% CI
(%) Lower Limit Upper Limit Philippines 13.5 11.8 15.2 Makati City 20.8 11.6 30.1
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Determination of median urinary iodine status of school-age children in Makati City excretion (UIE) were done to assess iodine had “more than adequate” iodine intake with a status of school-age children, 6 to 12 years old. median UIE of 255 µg/L. However, 5.9% of At the national level, the iodine status of school- the age group in the city had urinary iodine age children in 2018 was at “optimum” iodine level of <50 µg/L (Table 26). nutrition or “adequate” iodine intake with a median UIE of 180 µg/L. Meanwhile, iodine
Table 26. Median UIE and percent urinary iodine (UI) level of < 50µg/L among school-age children (6 to 12 years old) in the Philippines and Makati City: ENNS, 2018 90% CI Percent UI 90% CI Median level < 50µg/L (µg/L) Lower Upper Lower Upper Limit Limit (%) Limit Limit Philippines 180 177.6 183.2 11.5 10.3 12.7 Makati City 255* 199.4 311.5 5.9 0.5 11.4 *significant at p <0.10
Highlights:
Stunting and underweight were public health problems with “low” and “medium” severity, respectively. Overweight and obesity were emerging concern. Anemia was of “moderate” public health significance. Iodine intake was more than adequate.
Call to Action:
Educate school-age children on the importance of eating a wide variety of nutritious foods and balanced diet. Promote and serve nutritious and safe meals in school canteens and cafeterias. Intensify supplementary feeding programs in schools by considering the right amount and types of foods served to school-age children complemented with micronutrient supplementation especially for undernourished children. Promote vegetable production and consumption among children through ‘Gulayan sa Paaralan’ Program. Strengthen mass drug administration of deworming tablets in school by educating both the parents and children on its benefits to encourage participation. Integrate hygiene and sanitation program activities with the administration of deworming tablets both in schools and communities. Carefully monitor salt iodization at all channels of distribution and use of iodized salt to avoid emergence of iodine deficiency, as well as to avoid excessive levels. Encourage physical activities in schools and neighborhoods especially among wealthier quintiles.
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Adolescents (10 to 19 years old)
At the onset of adolescence, growth alcohol drinking or the harmful use of alcohol spurt speeds up abruptly. It begins on the and physical inactivity are also reported in this average at the age of 10 to 11 years for girls section. and 12 to 13 years for boys. During the growth spurt, apparent differences in the skeletal In Makati City, one in every 10 system, lean body mass and fat stores can be adolescents (12.8%) was stunted or short for noted. Along these changes, adolescent’s their age. Stunting in the city was significantly energy and nutrient needs are greater than any lower than the national prevalence at 26.3% other time of life, except pregnancy and (Table 27). Stunting was higher among female lactation. The energy needs of adolescents adolescents (16.5%) than male adolescents vary greatly, depending on the current rate of (8.6%). Also, stunting was higher among growth, sex, body composition, and physical adolescents in poor (13.7%) than those in the activity. This section reports the prevalence of non-poor (10.7%) households (Figure 12). stunting, wasting, overweight/obesity, and anemia as indicators of nutritional status of The prevalence of wasting or thinness adolescents 10 to 19 years old. As it is not only among adolescents was 5.6% (Table 27). It the amount of food intake that affects the was significantly higher among male nutrition and health status of a person, but adolescents at 9.1% than female adolescents behaviour and environment also play a crucial (2.3%). In terms of wealth status, no role. Thus, selected non-communicable significant difference was noted (Figure 12). diseases (NCDs) risk factors including smoking,
Table 27. Prevalence of stunting, wasting and overweight/obesity among adolescents (> 10 to 19 years old) in the Philippines and Makati City: ENNS, 2018
Philippines Makati City 90% CI 90% CI Variable Prevalence Prevalence Lower Upper Lower Upper (%) (%) Limit Limit Limit Limit Stunting 26.3 24.7 28.0 12.8* 8.7 16.9 Wasting 11.3 10.5 12.1 5.6* 3.0 8.3 Overweight/Obesity 11.6 10.7 12.5 19.9* 14.5 26.6 * significant at p<0.10
Overweight and obesity among was significantly higher than the national adolescents is an emerging nutrition concern in prevalence (11.6%). There was no significant the Philippines. It increased by 2.4 percentage difference in the prevalence of wasting by points from the last survey conducted by the household wealth status and sex (Figure 12). DOST-FNRI in 2015. In Makati City, the prevalence of overweight and obesity (19.9%)
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90% LL 8.7 4.3 8.9 6.2 6.1 90% LL 3.0 4.9 0.5 2.5 1.9 CI UL 16.9 12.9 24.0 21.1 15.3 CI UL 8.3 13.3 4.2 13.8 6.3
90% LL 14.5 11.7 11.9 4.1 14.8 CI UL 26.6 26.2 32.7 18.9 35.8 * significant at p<0.10
Figure 12. Prevalence of stunting, wasting, and overweight/obesity among adolescents (> 10 to 19 years old) by sex and wealth status in Makati City: ENNS, 2018
Anemia is another nutritional problem considered of “mild” public health significance among adolescents. Due to abrupt growth spurt (Table 28). Anemia prevalence was not during adolescence, both teenage boys and statistically different between boys (1.2%) and girls need additional iron. The prevalence of girls (15.8%). anemia in Makati City was 7.9% and was
Table 28. Prevalence of anemia among adolescents (13 to 19 years old) in the Philippines and Makati City by sex: ENNS, 2018 Disaggregation/ 90% CI Prevalence (%) Variable Lower Limit Upper Limit Philippines 8.1 7.4 8.8 Makati City 7.9 0.9 14.9 Male 1.2 0.0 3.2 Female 15.8 1.5 30.1
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Adolescents who smoke cigarettes, (2.8%) adolescents were current smokers and other tobacco and nicotine products are at- (Figure 13). risk for developing respiratory illnesses, cancer, heart diseases and other diseases. Though its The proportion of adolescent current effect is beyond the scope of nutrition, smoking smokers in the city was higher among males eases the feeling of hunger and affects food (4.0%) than females (1.9%). It was mostly intake. Moreover, Executive Order 26 s. 2017 observed in adolescents belonging to non- prohibits minors to smoke (even lighting up), poor (5.4%) than poor (0.7%) households, sell or buy cigarettes and other tobacco though not statistically significant (Figure 14). products. In Makati City, three in every 100
90% LL 3.7 1.2 CI UL 4.4 4.3
Figure 13. Proportion of current smokers among adolescents (10 to 19 years old) in the Philippines and Makati City: ENNS, 2018
*proportion of current smokers aged 10 to 17.9 years old was 1.4%
90% LL 1.2 1.3 0.1 0.0 1.4 CI UL 4.3 6.7 3.7 2.0 9.4
Figure 14. Proportion of current smokers among adolescents (10 to 19 years old) by sex and wealth status in Makati City: ENNS, 2018
*proportion of current smokers aged 10 to 17.9 years old: male - 2.5%; female - 0.4%
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Another modifiable behavioral risk among younger teens 10-17 years old, 11.9% factor that affects the nutritional status of were current alcohol drinkers (Figure 15). adolescents is alcohol consumption. Alcohol provides energy but no nutrients, it alters Physical inactivity among adolescents nutrient absorption and metabolism. In Makati was also determined during the survey. Eight City, two in every 10 adolescents 10-19 years in every 10 (81.3%) adolescents in Makati City old (17.4%) were current alcohol drinkers and were insufficiently physically active (Figure 16).
90% LL 15.2 12.5 90% LL 74.8 77.5 CI UL 18.4 22.3 CI UL 77.7 85.1
Figure 15. Proportion of current drinkers among Figure 16. Proportion of insufficiently physically adolescents (10 to 19 years old) in the active adolescents (10 to 19 years old) Philippines and Makati City: ENNS, in the Philippines and Makati City: 2018 ENNS, 2018
*proportion of current alcohol drinkers aged 10 to 17.9 years old: 11.9%
Furthermore, proportion of adolescents physically inactive adolescents belonging to who were insufficiently physically active was the poor and non-poor households was not significantly higher among females at 87.0% significantly different (Figure 17). than male adolescents at 74.2%. Proportion of
90% LL 77.5 69.1 82.3 75.3 71.2 CI UL 85.1 79.3 91.8 89.3 84.8 * significant at p<0.10
Figure 17. Proportion of insufficiently physically active adolescents (10 to 19 years old) by sex and wealth status in Makati City: ENNS, 2018
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Highlights:
Stunting among adolescents was of “low” public health significance. Wasting or thinness was classified as “poor” public health problem. Overweight and obesity were emerging concern. Anemia was a “mild” public health problem. Smoking was reported and more common among male adolescents. About two in every 10 adolescents were current alcohol drinkers. Majority of adolescents were insufficiently physically active.
Call to Action:
Strengthen school nutrition programs such as gardening, feeding and nutrition education. Intensify school gardening programs that uses environmental approach to produce various micronutrient-rich vegetables which can be used for school feeding. Promotion of healthy lifestyle habits such as smoking cessation, control use of alcohol and healthy eating through nutrition education. Revitalize and strengthen sports programs and physical fitness tests in schools and communities to address the problem of physical inactivity among this age group.
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Women of Reproductive Age (15 to 49 years old)
The World Health Organization defines Body Mass Index (BMI) was used to women of reproductive age (WRA) as all determine the nutritional status of women aged 15-49 years (WHO, 2006). non-pregnant/non-lactating women and Optimum nutrition of a woman before, during lactating mothers. and after pregnancy is very important as it has an implication on the health and nutritional Non-pregnant/ non-lactating Women status of infants and young children. In Makati City, overnutrition was more In the ENNS, WRA was disaggregated evident than undernutrition among non- into three groups, the non-pregnant/non- pregnant/non-lactating women. The prevalence lactating women, pregnant women and lactating of CED among this group was 3.7%. In mothers. The nutritional status, hemoglobin contrast, the prevalence of overweight and levels, vitamin A status, and urinary iodine obesity (45.9%) was twelve times higher than excretion levels were determined in these the prevalence of CED in the city (Table 29). groups.
Table 29. Prevalence of chronic energy deficiency (CED) and overweight/obesity among non-pregnant/ non-lactating women of reproductive age (15 – 49 years old) in the Philippines and Makati City: ENNS, 2018 Philippines Makati City 90% CI 90% CI Variable Prevalence Prevalence (%) Lower Upper (%) Lower Upper Limit Limit Limit Limit CED 7.8 7.3 8.3 3.7* 1.2 6.2 Overweight/Obesity 35.3 33.7 36.9 45.9* 39.3 52.4 * significant at p<0.10
About two in every 10 non-pregnant/ was considered of “mild” public health non-lactating women (17.8%) in Makati City significance. had anemia (Table 30). Anemia in this group
Table 30. Prevalence of anemia among non-pregnant/ non-lactating women of reproductive age (15 - 49 years old) in the Philippines and Makati City: ENNS, 2018 90% CI Prevalence (%) Lower Limit Upper Limit Philippines 11.6 11.0 12.3 Makati City 17.8 11.5 24.1
Vitamin A is also important for fetal basic physiologic needs in preparation for growth and development during pregnancy. conception. The prevalence of VAD among non Sufficient vitamin A intake among women -pregnant/non-lactating women in Makati City during their reproductive years is crucial to was less than 1.0% indicating that VAD was not prevent depletion of body stores and meet the a public health problem based on WHO cut-offs.
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Table 31. Prevalence of vitamin A deficiency among non-pregnant/ non-lactating women of reproductive age (15 - 49 years old) in the Philippines and Makati City: ENNS, 2018
90% CI Prevalence (%) Lower Limit Upper Limit Philippines 1.3 1.0 1.8 Makati City 0.6 0.1 3.2
Based on median UIE, the iodine status However, 13.2% had urinary iodine level < 50 among non-pregnant/non-lactating women in µg/L (Table 32). Makati City was adequate at 176 µg/L.
Table 32. Median UIE and percent urinary iodine (UI) level of <50µg/L among non-pregnant/ non-lactating women of reproductive age (15 - 49 years old) in the Philippines and Makati City: ENNS, 2018 90% CI 90% CI Median Percent UI level
(µg/L) Lower Upper < 50µg/L (%) Lower Upper Limit Limit Limit Limit Philippines 170 167.9 172.1 11.3 10.7 12.0 Makati City 176 138.2 214.8 13.2 6.6 19.7
Pregnant Women
The nutritional status of a pregnant pregnant women. woman is an important determinant of pregnancy outcomes. Those who are Based on Magbitang cut-off, three out nutritionally at-risk during pregnancy are at of 100 pregnant women (3.4%) in Makati City greater risk of delivering low birth weight infants was nutritionally-at-risk of giving birth to low and developing other pregnancy complications birth weight babies. The prevalence was such as pre-eclampsia and maternal mortality. significantly lower than the national A weight-for-height table by week of pregnancy prevalence of 20.1% (Figure 18). was used in determining the nutritional status of
90% LL 17.5 0.0 CI UL 22.8 8.9 * significant at p<0.10 Figure 18. Proportion of nutritionally-at-risk pregnant women in the Philippines and Makati City: ENNS, 2018
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Lactating Mothers
Overnutrition among lactating mothers health significance in terms of magnitude and in Makati City was more common than severity. Meanwhile, four in every 10 (41.4%) undernutrition. The CED prevalence in the city lactating mothers in Makati City were was 13.8% and considered of “medium” public overweight/obese (Table 33).
Table 33. Prevalence of chronic energy deficiency (CED) and overweight/obesity among lactating mothers in the Philippines and Makati City: ENNS, 2018
Philippines Makati City 90% CI 90% CI Variable Prevalence Prevalence (%) Lower Upper (%) Lower Upper Limit Limit Limit Limit CED 11.0 9.5 12.5 13.8 1.8 25.8 Overweight/Obesity 28.5 26.1 30.9 41.4 23.7 59.1
Anemia prevalence among lactating considered of “moderate” public health mothers in Makati City was 26.5% and was significance (Table 34).
Table 34. Prevalence of anemia among lactating mothers in the Philippines and Makati City: ENNS, 2018
90% CI Prevalence (%) Lower Limit Upper Limit Philippines 14.4 12.5 16.3 Makati City 26.5 6.4 46.6
Based on the median UIE, the iodine was adequate at 134 µg/L. However, 30.4% had status among lactating mothers in Makati City urinary iodine level < 50 µg/L (Table 35).
Table 35. Median UIE and percent urinary iodine (UI) level of <50µg/L among lactating mothers in the Philippines and Makati City: ENNS, 2018
90% CI Percent UI 90% CI Median level (µg/L) Lower Upper Lower Upper Limit Limit <50µg/L (%) Limit Limit Philippines 103 98.5 106.5 21.2 19.7 22.8 Makati City 134 82.4 186.4 30.4 7.7 53.2
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Highlights:
Overweight/obesity was a common problem among non-pregnant/non-lactating women and lactating mothers. Anemia among non-pregnant/non-lactating women and lactating mothers was of “mild” and “moderate” public health significance, respectively. Based on median UIE, iodine intake among of non-pregnant/ non-lactating women and lactating mothers was adequate. However, the proportion of non-pregnant/ non- lactating women and lactating mothers with urinary iodine level less than 50 µg/L were 13.2 % and 30.4%, respectively. Only 3.4% of pregnant women were at-risk of delivering low birth weight babies.
Call to Action:
Promote healthy lifestyle practices. Provide dietary supplementation for the nutritionally-at-risk pregnant women. Promote the use of Pinggang Pinoy as a guide for healthy eating habits. Promote the importance of physical activity in preventing NCDs Strengthen the implementation of ASIN Law from the national to the local level as well as promotion and advocacy on the use of iodized salt and consumption of iodine-rich foods.
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Adults (20 to 59 years old)
Health and nutritional status of Filipino Chronic energy deficiency (CED) is a adults show that the triple burden of malnutrition multi-factorial nutritional problem defined as a – undernutrition, micronutrient deficiencies, and steady-state condition in which the food intake overweight and obesity – has continuously risen of an individual is inadequate for longer periods and is becoming an emerging threat in this age of time and may result to an increased risk for group. Moreover, NCDs are the leading causes illnesses and other health problems. The of death globally and in the Philippines. These prevalence of CED in Makati City was NCDs pose major challenges for sustainable significantly lower at 4.4% compared to the development causing premature deaths and an national prevalence of 6.9%. increased burden on low- and middle-income countries such as the Philippines. This section Meanwhile, the prevalence of reports the prevalence of CED, overweight and overweight and obesity among adults in Makati obesity, and anemia as indicators of nutritional City were significantly higher at 36.7% and status of adults 20 to 59 years old. Selected risk 13.4%, respectively, than the national factors to NCDs such as smoking, alcohol prevalence (Table 36). This indicates that more drinking and binge drinking or the harmful use than a quarter of adults in the city had high BMI of alcohol, and physical inactivity are also (> 25 kg/m2) and may have higher risk of reported in this section to present the severity of developing additional health problems. risks that predispose an individual to lifestyle- related diseases.
Table 36. Prevalence of chronic energy deficiency (CED), overweight, and obesity among adults, 20 to 59 years old, in the Philippines and Makati City: ENNS, 2018
Philippines Makati City 90% CI 90% CI Variable Prevalence Prevalence Lower Upper Lower Upper (%) (%) Limit Limit Limit Limit CED 6.9 6.6 7.1 4.4* 2.7 6.2 Overweight 28.8 28.4 29.2 36.7* 31.3 42.5 Obesity 9.6 9.3 9.9 13.4* 11.2 15.7 * significant at p<0.10
Disaggregating by age, sex and wealth The prevalence of overweight was status, the prevalence of CED was higher almost the same by sex and wealth status. among male adults (6.1%) than female adults Overweight was more common among adults (3.2%). It was also observed to be more in the 50-59 years old age group (43.4%) than prevalent among adults living in poor other age groups (Figure 20). households (5.6%) and more common among younger adults (20-29 years old) (Figure 19).
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90% LL 2.7 2.6 1.5 1.3 1.5 90% LL 3.5 1.1 90% LL 3.1 2.4 CI UL 6.2 7.7 8.0 5.9 4.7 CI UL 8.7 5.3 CI UL 10.1 6.6
Figure 19. Prevalence of chronic energy deficiency (CED) among adults, 20 to 59 years old, by age group, sex, and wealth status in Makati City: ENNS, 2018
90% LL 31.3 16.6 30.4 28.8 36.1 90% LL 31.3 30.2 90% LL 29.4 30.6 CI UL 42.5 35.1 52.2 47.0 50.7 CI UL 42.3 43.9 CI UL 44.2 43.7
Figure 20. Prevalence of overweight among adults, 20 to 59 years old, by age group, sex, and wealth status in Makati City: ENNS, 2018
Meanwhile, the prevalence of obesity excessive buildup of abdominal fat around the (BMI ≥30.0) was higher among female adults stomach and abdomen. This condition has (15.3%) and those belonging to non-poor been strongly linked to cardiovascular households (15.9%). Obesity was more common diseases, diabetes, and some cancers. among adults in the 40-49 years old age group (Figure 21). The prevalence of high waist circumference (WC) and high waist-hip ratio Another indicator to assess obesity is (WHR) among adults in Makati City were the measurement of waist and hip 20.3% and 44.4%, respectively (Table 37). circumferences. Abdominal obesity, also known as central obesity, happens when there is
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90% LL 11.2 7.2 8.3 10.8 10.9 90% LL 7.7 12.2 90% LL 6.5 12.6 CI UL 15.7 12.8 16.3 20.7 19.9 CI UL 13.9 18.4 CI UL 13.8 19.2 Figure 21. Prevalence of obesity among adults, 20 to 59 years old, by age group, sex, and wealth status in Makati City: ENNS, 2018
Table 37. Prevalence of high waist circumference and high waist-hip ratio among adults, 20 to 59 years old, in the Philippines and Makati City: ENNS, 2018 Philippines Makati City 90% CI 90% CI Variable Prevalence Prevalence Lower Upper Lower Upper (%) (%) Limit Limit Limit Limit High Waist Circumference 13.5 13.2 13.8 20.3* 17.1 23.6 High Waist-Hip Ratio 35.3 34.9 35.7 44.4* 40.1 48.8 * significant at p<0.10
Looking closely by age group, the (30.2%) and more common among those living trend of high WC increases with age. High WC in non-poor households (23.2%) than their was significantly higher among female adults counterparts (Figure 22).
90% LL 17.1 7.3 12.0 18.8 21.2 90% LL 3.9 24.9 90% LL 11.9 18.9 CI UL 23.6 13.7 21.2 32.8 35.4 CI UL 9.1 35.6 CI UL 19.5 27.4 * significant at p<0.10 Figure 22. Prevalence of high waist circumference among adults, 20 to 59 years old, by age group, sex, and wealth status in Makati City: ENNS, 2018
On the other hand, high WHR was higher among non-poor households (45.1%) almost seven times higher among female adults than poor households (39.2%). High WHR (69.2%) than among male adults (10.1%) and increased with age (Figure 23).
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90% LL 40.1 16.8 32.1 41.4 55.1 90% LL 4.3 64.4 90% LL 32.3 40.3 CI UL 48.8 27.1 49.2 58.9 66.9 CI UL 15.8 74.0 CI UL 46.2 49.9 * significant at p<0.10 Figure 23. Prevalence of high waist-hip ratio among adults, 20 to 59 years old, by age group, sex, and wealth status in Makati City: ENNS, 2018
Anemia is characterized by a decreased their productivity. number of red blood cells as measured through hemoglobin determination. The most common The prevalence of anemia in Makati symptoms include weakness, irritability, and City was 11.5% and was considered as “mild” fatigue which may result to numerous adverse public health significance. It was significantly health outcomes, including impaired functional higher among female adults (17.7%) than male status and cognitive disorders, which may affect adults (0.8%) (Table 38).
Table 38. Prevalence of anemia among adults, 20 to 59 years old, in the Philippines and Makati City by sex: ENNS, 2018 Disaggregation/ 90% CI Prevalence (%) Variable Lower Limit Upper Limit Philippines 8.3 7.7 9.0 Makati City 11.5 7.5 15.6 Male 0.8* 0.0 1.7 Female 17.7 11.6 23.8 * significant at p<0.10
Non-communicable diseases are obesity. associated with the following modifiable The prevalence of elevated BP based behavioral risk factors namely tobacco use, on a single-visit blood pressure measurement harmful use of alcohol, physical inactivity and among adults in Makati City was 15.6% (Table unhealthy diet, that result to physiologic risk 39). Meanwhile, the prevalence of high fasting factors like elevated blood pressure (BP), high blood sugar (FBS) among adults in Makati City fasting blood sugar (FBS), dyslipidemia, and was 8.7% (Table 39).
Table 39. Prevalence of elevated blood pressure and high fasting blood sugar among adults, 20 to 59 years old, in the Philippines and Makati City: ENNS, 2018 Philippines Makati City 90% CI 90% CI Variable Prevalence Prevalence (%) Lower Upper (%) Lower Upper Limit Limit Limit Limit Elevated Blood Pressure 16.0 15.6 16.4 15.6 12.7 18.4 High Fasting Blood Sugar 6.7 6.2 7.2 8.7 5.9 11.6
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By age group, the trend of elevated BP was observed to be more common among increases with age. It was higher among males adults belonging to non-poor households (18.8%) than females (14.0%) but the (16.4%) (Figure 24). difference was not statistically significant and
90% LL 12.7 0.6 6.0 15.3 19.3 90% LL 14.1 8.3 90% LL 7.0 13.5 CI UL 18.4 5.5 13.6 34.9 35.5 CI UL 23.5 19.6 CI UL 14.7 19.4
Figure 24. Prevalence of elevated blood pressure among adults, 20 to 59 years old, by age group, sex, and wealth status in Makati City: ENNS, 2018
For high FBS, there was no significant households (2.7%). In terms of age group, high difference in the prevalence by sex. The FBS was more common among adults 50-59 prevalence was significantly higher among the years of age (Figure 25). non-poor households (10.2%) than poor
90% LL 5.9 0.0 0.0 2.5 8.2 90% LL 2.3 5.3 90% LL 0.2 5.4 CI UL 11.6 8.8 5.1 27.7 23.2 CI UL 11.8 12.9 CI UL 5.3 15.0 * significant at p<0.10 Figure 25. Prevalence of high fasting blood sugar among adults, 20 to 59 years old, by age group, sex, and wealth status in Makati City: ENNS, 2018
One out of 5 adults (20.0%) in Makati least one tobacco product a day) or on a City were current smokers or those who smoked regular/ occasional basis (Figure 26). during the survey either on a “daily” basis (at
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LL 20.7 17.5 90% CI UL 22.4 22.6 Figure 26. Proportion of current smokers among adults, 20 to 59 years old, in the Philippines and Makati City: ENNS, 2018
The proportion of current smokers in belonging to non-poor households (20.1%). Makati City was significantly higher among There were more current smokers in the 30-39 male adults (39.9%) than female adults years old age group (Figure 27). (10.3%). It was more common among those
90% LL 17.5 11.6 21.5 14.2 9.8 90% LL 31.1 8.2 90% LL 13.6 17.0 CI UL 22.6 21.2 30.1 34.3 22.8 CI UL 48.6 12.4 CI UL 23.1 23.2 * significant at p<0.10 Figure 27. Proportion of current smokers among adults, 20 to 59 years old, by age group, sex, and wealth status in Makati City: ENNS, 2018
Among those who were reported drinking drinkers. Binge drinking is the excessive consumption alcoholic beverages in the past 30 days, nearly half of alcoholic beverages which is considered an (47.6%) of the adult population in the city were binge important risk factor to NCDs (Figure 28).
90% LL 53.3 40.6 CI UL 58.1 54.7 Figure 28. Proportion of binge drinkers among currently drinking adults, 20 to 59 years old, in the past 30 days, in the Philippines and Makati City: ENNS, 2018
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Binge drinking was observed to be Four in every 10 adults (40.3%) in more prevalent among 40-49 years old (50.3%) Makati City were insufficiently physically active. and significantly higher among male adults People who are insufficiently physically active (55.7%) in Makati City. No significant difference have an increased risk for heart disease, in the proportion of binge drinkers by wealth diabetes, and some cancers. Hence, adults are status was noted (Figure 29). encouraged to engage in at least 150 minutes of moderate intensity physical activity per week, or equivalent, as recommended by the WHO.
90% LL 40.6 34.1 33.1 32.8 23.3 90% LL 47.3 21.9 90% LL 49.6 33.6 CI UL 54.7 60.0 58.4 67.8 58.9 CI UL 64.2 39.8 CI UL 70.1 51.9 * significant at p<0.10 Figure 29. Proportion of binge drinkers among currently drinking adults, 20 to 59 years old, in the past 30 days, by age group, sex, and wealth status in Makati City: ENNS, 2018
90% LL 38.1 33.8 CI UL 43.1 46.7 Figure 30. Proportion of insufficiently physically active adults, 20 to 59 years old, in the Philippines and Makati City: ENNS, 2018
There were more insufficiently physically insufficiently physically active in the city. active young adults belonging to the 20-29 years Furthermore, no significant difference in the old age group as compared to other age groups. proportion of physically inactive adults by Moreover, 4 in every 10 (44.1%) female adults wealth status was noted (Figure 31). and 3 in every 10 male adults (33.1%) were
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90% LL 33.8 39.8 31.9 28.6 30.4 90% LL 26.7 37.3 90% LL 29.0 35.2 CI UL 46.7 61.8 46.5 45.1 45.0 CI UL 39.6 51.0 CI UL 47.6 50.3 Figure 31. Proportion of insufficiently physically active adults, 20 to 59 years old, by age group, sex, and wealth status in Makati City: ENNS, 2018
Highlights:
Three in every 10 adults had high BMI (>25 kg/m2) and may have higher risk of developing additional health problems. Android type of obesity was common among females and those living in non-poor households. Anemia was of “mild” public health significance. Elevated blood pressure and high fasting blood sugar increased with age. Current smoking was common among male adults. About half of currently drinking adults were engaged in binge drinking and more common among males.
Four in every 10 adults were insufficiently physically active.
Call to Action:
The LGU to implement home and community food production (backyard vegetable gardening, seed distribution) and livelihood programs to support nutrition improvement among adults. Conduct regular monitoring of weight, blood pressure, fasting blood sugar, and lipid profile in health centers. Health and nutrition education activities must be conducted by professional Nutritionist- Dietitians. Advise for healthy diet and lifestyle change activities. Intensify programs on smoking cessation and reduced alcohol consumption to help adults avoid or stop smoking and binge drinking. Organize ehersisyo sa barangay program.
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Elderly (60 years old and above)
Senior citizens or the elderly are The double burden of malnutrition is characterized by significant decline in physical seen among Filipino older persons, although activity and general metabolism (DOST-FNRI, the trend differs among provinces and cities 2017). They are vulnerable to malnutrition as a compared to the national estimates. result of dietary factors compounded by changes due to aging. Chronic, degenerative The prevalence of CED among diseases such as cardiovascular diseases, elderly in Makati City in 2018 was 12.8% while diabetes and osteoporosis as well as the national prevalence was 13.4%. Both micronutrient deficiencies are common among were considered a “medium” public health older persons. This section reports the problem in terms of severity and magnitude. prevalence of CED, overweight and obesity, anemia, vitamin A status and iodine status as On the other hand, the prevalence of indicators of nutritional status of the elderly 60 overweight and obesity among the elderly in years old and above. Selected risk factors to Makati City were 29.1% and 7.1%, NCDs such as smoking, alcohol drinking and respectively (Table 40). physical inactivity are also reported in this section.
Table 40. Prevalence of chronic energy deficiency (CED), overweight, and obesity among elderly, 60 years old and above, in the Philippines and Makati City: ENNS, 2018
Philippines Makati City 90% CI 90% CI Variable Prevalence Prevalence (%) Lower Upper (%) Lower Upper Limit Limit Limit Limit CED 13.4 12.9 14.0 12.8 5.6 20.1 Overweight 24.7 23.9 25.5 29.1 23.0 35.2 Obesity 6.3 5.9 6.8 7.1 4.1 10.1
For android type of obesity, the the elderly in Makati City were 31.3% and prevalence of high WC and high WHR among 61.8%, respectively (Table 41).
Table 41. Prevalence of high waist circumference and high waist-hip ratio among elderly, 60 years old and above, in the Philippines and Makati City: ENNS, 2018
Philippines Makati City 90% CI 90% CI Variable Prevalence Prevalence (%) Lower Upper (%) Lower Upper Limit Limit Limit Limit High Waist Circumference 17.8 17.1 18.6 31.3* 24.8 37.9 High Waist-Hip Ratio 47.7 46.7 48.6 61.8* 55.0 68.7 * significant at p<0.10
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Moreover, high WC and high WHR were among elderly from non-poor households. No both significantly higher among elderly females significant difference in the proportion of high than elderly males. By wealth status, the WHR by wealth status was observed (Figure prevalence of high WC was significantly higher 32).
90% LL 24.8 4.2 33.3 6.8 28.3 90% LL 55.0 13.8 72.6 35.8 55.5 CI UL 37.9 16.2 48.3 21.5 42.9 CI UL 68.7 38.6 86.1 62.2 73.2 * significant at p<0.10
Figure 32. Prevalence of high waist circumference and high waist-hip ratio among elderly, 60 years old and above, by sex and wealth status in Makati City: ENNS, 2018
The prevalence of anemia among the 42). By sex, anemia rates did not differ elderly in Makati City was 15.1% and was significantly. considered a “mild” public health problem (Table
Table 42. Prevalence of anemia among elderly, 60 years old and above, in the Philippines and Makati City by sex: ENNS, 2018
Disaggregation/ 90% CI Prevalence (%) Variable Lower Limit Upper Limit Philippines 20.2 17.7 22.8 Makati City 15.1 4.4 25.8 Male 17.5 4.9 30.1 Female 13.7 2.7 24.6
Sufficient vitamin A intake among the needed by the elderly. The prevalence of elderly helps prevent age-related mascular VAD among the elderly in Makati City was degeneration (AMD) or the loss of central vision 0.8% indicating that VAD was not a public as people age. Also, it is a potent antioxidant and health problem based on the WHO cut-offs. the most significant free radical scavenger highly
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Table 43. Prevalence of vitamin A deficiency among elderly, 60 years old and above, in the Philippines and Makati City: ENNS, 2018
90% CI Prevalence (%) Lower Limit Upper Limit Philippines 1.1 0.6 1.8 Makati City 0.8 0.1 4.2
Based on median UIE, the iodine status Two in every 10 elderly (25.6%) in of elderly in Makati City was adequate at Makati City had elevated blood pressure. 148 µg/L. However, 22.3% had urinary iodine Meanwhile, one in every 10 elderly (15.2%) level <50 µg/L (Table 44). had high fasting blood sugar (Table 45)
Table 44. Median UIE and percent urinary iodine (UI) level of <50µg/L among elderly, 60 years old and above, in the Philippines and Makati City: ENNS, 2018
90% CI Percent UI 90% CI Median level (µg/L) Lower Upper Lower Upper Limit Limit <50µg/L (%) Limit Limit Philippines 108 105.2 110.3 23.3 20.4 26.3 Makati City 148 92.3 203.4 22.3 14.3 30.2
Table 45. Prevalence of elevated blood pressure and high fasting blood sugar among elderly, 60 years old and above, in the Philippines and Makati City: ENNS, 2018
Philippines Makati City 90% CI 90% CI Variable Prevalence Prevalence (%) Lower Upper (%) Lower Upper Limit Limit Limit Limit Elevated Blood Pressure 35.0 33.7 36.2 25.6* 20.2 31.1 High Fasting Blood Sugar 13.8 12.2 15.5 15.2 5.7 24.8 * significant at p<0.10
Two in every 10 (16.6%) elderly in For physical activity among the Makati City were current smokers. While three elderly, more than half (61.5%) were in every 10 (26.2%) elderly were current alcohol insufficiently physically active in Makati City. drinkers in the city (Figure 33). Smoking and This proportion was significantly higher drinking alcohol can greatly contribute to the compared with the national estimate (50.6%) risks for NCDs. (Figure 33).
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90% LL 15.5 25.8 48.5 90% LL 6.4 16.2 54.0 CI UL 17.1 30.5 52.7 CI UL 26.8 36.1 69.0 * significant at p<0.10
Figure 33. Proportion of current smokers, current alcohol drinkers, and physically inactive elderly, 60 years old and above, in the Philippines and Makati City: ENNS, 2018
Highlights:
The nutritional concerns of senior citizens or elderly in Makati City include CED, overweight and obesity, high waist circumference, high waist-hip ratio, elevated blood pressure, high fasting blood sugar, smoking, alcohol drinking and physical inactivity. CED prevalence in the province was considered of “medium” public health significance. Anemia was of “mild” public health significance. Iodine intake was adequate based on median UIE. However, 22.3% of elderly had urinary iodine level less than 50 µg/L.
Call to Action:
Promote programs that would increase food intake or appetite of the elderly. Promote physical activity such as community wellness for senior citizens. Conduct regular check-up in health centers or primary care units should be advised among the senior citizens to monitor their health and nutritional status (weight monitoring, BP measurement, determination of fasting blood sugar and lipid profile, and other health and nutrition indicators). Intensify campaign on smoking cessation and reduced alcohol consumption. Ensure continuous supply of maintenance medicines or essential drugs at health centers for distribution to elderly especially among poor and marginalized households. Promote the use of iodize salt but ensure avoidance to too much salty foods to increase iodine intake/status while preventing hypertension. Revitalize and strengthen health and nutrition education activities conducted by professional Nutritionist-Dietitians.
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Conclusion and Recommendations
Based on the results, there were children and adolescents. Anemia especially marked nutritional and health problems across among female adolescents remain a public all age groups in Makati City. Continued health concern. The initiation of smoking and breastfeeding up to two years was not common alcohol drinking and high rates of insufficient (49.5%) in the city. Dietary diversity of children physical activity increase the risk for NCDs. during the complementary feeding period was Overnutrition and anemia were concerns suboptimal, with only 20.6% of children 6-23 among non-pregnant/non-lactating women months meeting the minimum dietary diversity and lactating mothers. Among adults and and a very low percentage (9.6%) meeting the elderly, high rates of overweight and obesity minimum acceptable diet, suggesting that the and android type of obesity particularly among children’s complementary food have females, high rates of smoking, alcohol inadequate level of energy and nutrients. drinking and physical inactivity were Undernutrition was evident among 0 to 59 observed. At the household level, food month old children and school-age children with insecurity was experienced by 33.2% of the high rates of underweight as well as anemia households with one in every 100 households and VAD. Stunting, though classified as “low” in experienced severe food insecurity (5.5%) terms of magnitude and severity, was still a which may have contributed to the nutrition public health concern among pre-school, school and health concerns in the city. -age chidren and adolescents. Overnutrition was an emerging problem among school-age
Health Policy Recommendations
It is recommended that the particularly maternal and child health and implementation of target-focused development nutrition, identified in this survey in order to programs and policies on health and nutrition contribute to the achievement of the must be accelerated to address the different Sustainable Development Goals by 2030. health and nutrition concerns in the city,
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References
Anderson S.A. 1990. Core Indicators of Nutritional State for Difficult-to-Sample Populations. The Journal of Nutrition 120:1557S-1600S. Averkamp S. 2015. www.fitnessforweightloss.com. Accessed on September 24, 2015. Barcenas M.L. 2004. The Development of the 2003 Master Sample (MS) for Philippine Household Surveys. 9th National Convention on Statistics. Centers for Disease Control and Prevention. 2007. National Health and Nutrition Examination Survey (NHANES) Anthropometry Procedures Manual, USA. Centers for Disease Control and Prevention. 2015. Defining Childhood Obesity. www.cdc.gov/ obesity/childhood/defining.html. Accessed on September 23, 2015. Coates J., Swindale A., and Bilinsky P. 2007. Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access: Indicator Guide (v.3). Washington DC: FHI 360/ Food and Nutrition Technical Assistance. Department of Science and Technology - Food and Nutrition Research Institute (DOST-FNRI). 2017. PDRI 2015: Philippine Dietary Reference Intakes. Taguig City, Philippines. Department of Science and Technology - Food and Nutrition Research Institute (DOST-FNRI). 2010. Philippine Nutrition Facts and Figures 2008. FNRI Bldg., DOST Compound, Gen. Santos Avenue, Bicutan, Taguig City, Metro Manila, Philippines. Department of Science and Technology - Food and Nutrition Research Institute (DOST-FNRI). 2015. Philippine Nutrition Facts and Figures 2013: 8th National Nutrition Survey Overview. FNRI Bldg., DOST Compound, Bicutan, Taguig City, Metro Manila, Philippines. Department of Science and Technology - Food and Nutrition Research Institute (DOST-FNRI). 2016. Philippine Nutrition Facts and Figures 2015: Updating of Nutritional Status of Filipino Children and Other Population Groups Overview. FNRI Bldg., DOST Compound, Gen. Santos Avenue, Bicutan, Taguig City, Metro Manila, Philippines. Dunn J.T., Crutchfield H.E., Gutekunst R., Dunn A.D. 1993. Methods for measuring iodine in urine. ICCIDD/UNICEF/WHO. Food and Agriculture Association (FAO). 1996. Rome Declaration on World Food Security and World Food Summit Plan of Action. Rome. Furr HC, Tanmihardjo SA and Olson JA. 1992. Training Manual for Assessing vitamin A Status by Use of the Modified Relative Dose Response and the Relative Dose Response Assaya. Iowa, USA: 70 p. International Council for Control of Iodine Deficiency Disorders (ICCIDD). 2007. Iodine requirements in pregnancy and infancy. ICCIDD Newsletter 23(1):94-200. International Committee for Standardization in Hematology (ICSH). 1978. Recommendations for reference method for hemoglobinometry in human blood (ICSH Standard EP 6/2:1977) and specifications for international hemoglobin reference preparation (ICSH Standard EP 6/3:1977). Journal of Clinical Pathology 31:139-43. International Food Policy Research Institute (IFPRI). 2016. Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030. Washington, DC. Magbitang J.A., Tangco J.B.M., dela Cruz E.O., Flores E.G., and Guanlao F.E. 1988. Weight for height as measure of nutritional status in Filipino pregnant women. Asia Pacific Journal of Public Health 2(2):96-104. National Institutes of Health – National Heart, Lung, and Blood Institute. (2004). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Washington: US Department of Health and Human Services. Philippines. 2017. Executive Order No. 26, s. 2017: Providing for the Establishment of Smoke-Free Environments in Public and Enclosed Places. https://www.officialgazette.gov.ph/ downloads/2017/05may/20170516-EO-26-RRD.pdf.
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Philippine Statistics Authority (PSA). n.d. 2012 Philippine Standard Occupational Classification (PSOC) Technical Notes. https://psa.gov.ph/classification/psoc/technical-notes. Accessed on September 24, 2015. Philippine Statistics Authority (PSA). n.d. 2013 Master Sample Design. http://psada.psa.gov.ph/ index.php/2013-master-sample-design Makati. 2019. Political Map of Makati [Image]. Retrieved from: https://en.wikipedia.org/wiki/Makati. Official Website of the City of Makati. 2017. https://www.makati.gov.ph/. Accessed on January 28, 2020. World Health Organization (WHO). 1972. Nutritional Anemia. WHO Technical Report Series No. 503. Geneva, Switzerland: World Health Organization.29p. World Health Organization (WHO). 1995. Physical Status: The use and interpretation of anthropometry. WHO Technical Report Series 854. Geneva, Switzerland: World Health Organization.462p. World Health Organization (WHO). 1996. Indicators for assessing vitamin A deficiency and their application in monitoring and evaluating intervention programmes. Geneva, World Health Organization, (WHO/NUT/96.10). World Health Organization (WHO). 1998. Definition, Diagnosis, and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation. Part I: Diagnosis and Classification of Diabetes Mellitus. Geneva: Author. World Health Organization (WHO). 2001. Iron deficiency anemia: assessment, prevention and control. A guide for programme managers. Geneva: World Health Organization. World Health Organization (WHO). 2006. WHO Child Growth Standards: Length/Height-for-age, Weight-for-age, Weight-for-length, Weight-for-height and Body Mass Index-for age. World Health Organization; 1 edition (April, 2006). World Health Organization (WHO). 2007. The WHO Growth Reference 2007. Geneva: World Health Organization. World Health Organization (WHO). 2008. WHO STEPS Surveillance Manual. Geneva: Author. World Health Organization (WHO). 2011a. Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization (WHO/NMH/NHD/MNM/11.3) retrieved from http:// www.who.int/vmnis/indicators/retinol.pdf. World Health Organization (WHO). 2011b. Waist circumference and waist–hip ratio: report of a WHO expert consultation. Geneva, 8-11 December, 2008. Retrieved from https://apps.who.int/iris/ bitstream/handle/10665/44583/9789241501491_eng.pdf World Health Organization (WHO). 2017. The WHO STEPwise approach surveillance- Instrument v.3.2. Geneva: Author. World Health Organization and National Center for Health Statistics (WHO & NCHS). 1978. WHO and NCHS Growth Reference. Geneva: World Health Organization. WHO/UNICEF/HKI/IVACG Joint Meeting. 1982. Control of Vitamin A Deficiency and Xeropthalmia. WHO Technical Report Series No. 672, Geneva. WHO/UNICEF/ICCIDD. 2001. Assessment of Iodine Deficiency Disorders and Monitoring their Elimination. A guide for programme managers. Geneva. WHO/USAID Joint Meeting. 1976. Vitamin A deficiency and xerophthalmia : report of a Joint WHO/ USAID Meeting [ held in Jakarta from 25 to 29 November 1974] . World Health Organization. https://apps.who.int/iris/handle/10665/41197.
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Annex 1. List of ENNS Booklets and Forms
BOOKLET/ RESPONSIBLE FORM TITLE RESPONDENT COMPONENT FORM NO. RESEARCHER BOOKLET 1 HOUSEHOLD MEMBERSHIP, ANTHROPOMETRIC AND BLOOD PRESSURE MEASUREMENTS Household Membership and Demographic Infor- Socio- ENNS Form 1.1 HH Head AR mation economic Socio- ENNS Form 1.2 Household and Other Demographic Information HH Head AR economic ENNS Form 2.1 Measurements, All Household Members All Members Anthropometry AR Blood Pressure Measurement of 10 Years Old and Members, Clinical and ENNS Form 5.1 AR/CHR Above 10y above Health BOOKLET 2 HOUSEHOLD FORMS Household Food Security (Household Food Insecuri- Mother/ ENNS Form 1.3 Food Security AR ty Access Scale) Meal Planner ENNS Form 1.4 Household Food Frequency HH Head Food Security AR HH Head/ Government ENNS Form 1.6 Household Government Program Participation AR Mother Program HH Head/ Government ENNS Form 1.7 Household Awareness and Usage of Iodized Salt Mother/Meal AR Program Planner BOOKLET 3 MATERNAL HEALTH AND NUTRITION Mother’s Knowledge, Health-seeking Behaviors and ENNS Form 3.1 Mother Maternal AR Practices (For currently pregnant women) Mother’s Knowledge, Health-seeking Behaviors and ENNS Form 3.2 Mother Maternal AR Practices (For all mothers with child ≤ 36 months) BOOKLET 4 CHILDREN, 0 to 23 MONTHS OLD Birthweight and Related Information of Children, 0- ENNS Form 4.1 Mother Anthropometry AR 71 Months Infant and Young Child Feeding Practices, 0-23 Mother/ ENNS Form 4.2 IYCF AR Months Caregiver Government Program Participation of Children, 0-71 Government ENNS Form 4.3 Mother AR Months Program Mother/ Care- Biochemical Information on Infections, Supplements Biochemical/ ENNS Form 8.3 and Medications for Household Members 6 Months giver/ Member, AR Clinical and Above 15y and above BOOKLET 5 CHILDREN, 24-71 MONTHS OLD Birthweight and Related Information of Children, 0- ENNS Form 4.1 Mother Anthropometry AR 71 Months Government Program Participation of Children, 0-71 Government ENNS Form 4.3 Mother AR Months Program Mother/ Care- Biochemical Information on Infections, Supplements Biochemical/ ENNS Form 8.3 and Medications for Household Members 6 Months giver/ Member, AR Clinical and Above 15y and above BOOKLET 6 CHILDREN, 6-12 YEARS OLD Government Program Participation of Children, Government ENNS Form 4.4 Mother AR 6-12 Years Old – with additional questions Program Smoking and Alcohol Consumption of 10 Years Old Members, Clinical and ENNS Form 5.3 AR/CHR and Above 10y and above Health Physical Activity of Adolescents 10-17 Years Old Member, Clinical and ENNS Form 5.4 AR/CHR and Adults 18 Years Old and Above 10y and above Health Mother/ Care- Biochemical Information on Infections, Supplements Biochemical/ ENNS Form 8.3 and Medications for Household Members 6 Months giver/ Member, AR Clinical and Above 15y and above BOOKLET 7 ADOLESCENT, 13-17.99 YEARS OLD Member, 13- Government ENNS Form 4.5 Youth Development Session (YDS), 13-18 Years Old AR 18y Program Knowledge and Practice of Reading Product Labels Member, Government ENNS Form 4.7 of Packaged Foods and Beverages (15 Years Old AR Program and Above) 15y and above
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BOOKLET/ RESPONSIBLE FORM TITLE RESPONDENT COMPONENT FORM NO. RESEARCHER ENNS Form Reproductive History Questionnaire for All Women of Member, Government AR 4.10 Reproductive Age, 15-49 Years Old 15-49y Program Smoking and Alcohol Consumption of 10 Years Old Members, Clinical and ENNS Form 5.3 AR/CHR and Above 10y and above Health
Physical Activity of Adolescents 10.0 to 17.9 Years Old Member, Clinical and ENNS Form 5.4 AR/CHR and Adults 18 Years Old and Above 10y and above Health Biochemical Information on Infections, Supplements Mother/ Care- Biochemical/ ENNS Form 8.3 and Medications for Household Members 6 Months giver/ Member, AR Clinical and Above 15y and above BOOKLET 8 ADULT, 18 YEARS OLD AND ABOVE Member, Government ENNS Form 4.5 Youth Development Session (YDS), 13-18 Years Old AR 13-18y Program Government Program Participation of Senior Citizens, Member, Government ENNS Form 4.6 AR 60 Years Old and Above 60y and above Program Knowledge and Practice of Reading Product Labels of Member, Government ENNS Form 4.7 Packaged Foods and Beverages, (15 Years Old and AR 15y and above Program Above) Member, Government ENNS Form 4.8 PhilHealth Membership, 21 Years Old and Above AR 21y and above Program Female Mem- ENNS Form Reproductive History Questionnaire for All Women of Government ber, AR 4.10 Reproductive Age, 15-49 Years Old Program 15-49y History of Raised Blood Pressure and Diabetes Ques- Member, Clinical & ENNS Form 5.2 AR/CHR tionnaire of 18 Years Old and Above 18y and above Health Smoking and Alcohol Consumption of 10 Years Old Members, Clinical & ENNS Form 5.3 AR/CHR and Above 10y and above Health Physical Activity of Adolescents, 10.0-17.9 Years Old Member, Clinical & ENNS Form 5.4 AR/CHR and Adults, 18 Years Old and Above 10y and above Health Biochemical Information on Infections, Supplements Mother/ Care- Biochemical/ ENNS Form 8.3 and Medications for Household Members 6 Months giver/ Member, AR Clinical and Above 15y and above BOOKLET 9 HOUSEHOLD FOOD CONSUMPTION ENNS Form 6.1 Household Membership (for Dietary) Household Dietary DR ENNS Form 6.2 Household Food Inventory Household Dietary DR ENNS Form 6.3 Household Food Record Household Dietary DR BOOKLET 10A INDIVIDUAL FOOD CONSUMPTION, ALL CHILDREN, 0-36 MONTHS
24-Hour Food Recall, All Children, 0-36 Months (≤ 3.0 Mother/ Care- ENNS Form 7.1 Dietary DR Years Old) giver
Checklist of Food and Liquid Intake of Children 0-36 Mother/ Care- ENNS Form 7.3 Dietary DR Months giver BOOKLET 10B INDIVIDUAL FOOD CONSUMPTION, > 3.0 (37 MONTHS) TO 14.99 YEARS OLD Member, > 3.0 24-Hour Food Recall, All Children, > 3.0 (37 Months) – ENNS Form 7.2 (37 months) – Dietary DR 14.99 Years Old 14.9 years old BOOKLET 10C INDIVIDUAL FOOD CONSUMPTION, 15 YEARS OLD AND OVER Member, ENNS Form 7.2 24-Hour Food Recall, 15 Years and Over Dietary DR 15y and above Member, ENNS Form 7.4 Consumption Practices, 15 Years Old and Above Dietary DR 15y and above BOOKLET 11 BIOCHEMICAL INFORMATION AND INDICES Biochemical/ ENNS Form 8.1 Household Membership and Biochemical Information HH Head BR Clinical Biochemical/ ENNS Form 8.2 Biochemical Indices All Members BR Clinical AR – Anthropometric Researcher; CHR – Clinical and Health Researcher; DR – Dietary Researcher; BR – Biochemical Researcher
ENNS Booklets and Forms could be viewed at http://enutrition.fnri.dost.gov.ph/
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Annex 2. ENNS Survey Team
TEAM I TEAM IV
Team Coordinator Ma. Lilibeth P. Dasco Eva A. Goyena, Ph.D. Alternate Team Coordinator Maylene P. Cajucom Josie P. Desnacido Assistant Coordinator Taharudin B. Rachman Sharon B. Marasigan Field Monitoring Supervisor Kurt Ivan M. Hernandez Robin E. Nejal (Biochemical) Statistician Cheder B. Sumangue Ma. Lynell V. Maniego Information Technologist/ Archie C. Umlas J. Aaron Paul S. De Leon Programmer Special Disbursing Officer Ma. Sheryl C. Velasco Eva A. Goyena, Ph.D. Ma. Lilibeth P. Dasco Josie P. Desnacido Nelisa P. Cortez
Team Leader (Technical) Kathrina N. Almenie Melody H. Lamangen Marites E. Ambayec Diana C. Lodriguito Paula Joy C. Escanilla Mary Jane D. Patnaan Riza B. Esmeralda Carol Fe C. Repil
Team Leader (Operations) Mary Grace E. Adolfo Erwin Ray E. Octavio Cristy T. Agpalo Matthew Raul C. Quidato Jr. Arvin Jay Bayaca Christian Allan L. Sanvictores Rachelle B. Dela Cruz Maelyn R. Tan
Anthropometric Researchers Adrian Jay A. Almario Jasmin S. Dinopol Kathleen Hope S. Asumo Kathleen Ruth Terese P. Dolores April Clarinelle Aztryd Balbesino Rogelio C. Eijansantos Charlene G. Batusin-in Bernie Jhon G. Gentoba Trisha Kaye D. Butlay Aiza S. Getalla Yazshel R. Cabilto John Fred I. Inson Tricia May P. Cuaresma Clara A. Mangusan Ray Mark Dela Riarte Chris Roi A. Marcos
Dietary Researchers Medarcha S. Adjajul Noime M. Loable Zamubec Alomar C. Adlawan Rashina L. Madjales Sitti Nadzra B. Alpha Erica M. Marquez Stephanie C. Barrio Maria Belinda D. Miguel Michelle T. Delima Nikka Marie V. Oliver Dianne B. Delos Reyes Fenina Gloria A. Osorio Cassandra A. Eparwa Jonah Mae J. Padernal Kristine Mae N. Esparas Danisse Nicole G. Quindo Jane M. Fernandez Christine Jane M. Rafales Kathleen Jane K. Gabuya Jan Abigail C. Sablon Raiza B. Jama Noeme N. Taglinao Eugene Joseph M. Javier Dovie Dawn A. Vergara
Biochemical Researchers Judy Mae H. Alfonso Eren Justine D. Largueza Mark Lester Aragon Cielo B. Ujano Jonel A. Bautista Nathalie Mae I. Vega Sofia Ann A. Dotollo Mica Gelline T. Villalon
Clinical and Health Researcher Rahina A. Abdurahman Van Jay B. Degala Krizzle Love J. Bulaga Eroe B. Evangelista Happie C. Capapas Mikhail S. Reyes Eunice Grace A. Dolendo Cerees Joy S. Sanajon
Science Aides Alvin N. Angeles Harold E. Dorado
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Annex 3. Data Management Team
Statisticians Marvin C. Delos Santos Sarah Jane S. Gohilde Jonel G. Patricio Maverick Aaron C. Lising John Michael E. Borigas Rovie Jane B. Caliguiran Clark D. Baylon Leah Mae C. Bonita Claudine G. Gilban Andre King S. Santos
IT Support Staff / Programmers Edward Regis D. Valdez Archie C. Umlas John Carlo Velasquez J. Aaron Paul S. De Leon Yonard A. Abucay Aaron Gregor Lim
Content Validators Ahmed Jaber T. Asadil Rasell R. Manalo Allan R. Colibao Jeeberly U. De Ade Cecil S. Salen Shirlyn Gil S. Tangec Shania Lyn M. Siadto Sheila Mae C. Montaño Milky Jan G. Ortiz Tiffany Bianca B. Abellera Bianca Joy B. Ubac Jenny Rose A. Malaque Kristine Nicole R. Dasco Ann Francis R. Genove Katty T. Parreño Kimberly O. Ybañez
Assistants to the Coordinators/ Remedios S. America Support Staff Nelisa P. Cortez Ma. Sheryl C. Velasco
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Annex 4. Biochemical Survey Team
Biochemical Coordinators Rosemarie J. Dumag Michael E. Serafico Marites V. Alibayan Joselita Rosario C. Ulanday Ma. Karyn B. Vallejo Maribeth S. Castillo Herbert P. Patalen Soledad G. Pepito
Supervising Validators Dave P. Briones Joan M. Castro Carl Vincent D. Cabanilla
Chemists Rujyla Claire P. Cariño Lian C. Cantal Faith Chalice M. Isla Jim Pauline C. Guiyab Marynol Grace M. Ursabia Mikka Aira R. Ocampo Richard Ron A. Rodriguez Maria Josephine A. Lumabas Zeny G. Grama Jerina Marjorie A. Ramos Junnlit Loraine B. Rivera Riatries Y. Saavedra Arianne Gayle P. Vianzon Ruvy Ann O. Rosales Eunice Anne K. Dulatre Ivy E. Refugio
Medical Technologists Neah Fe G. Cañada Paul Stephen B. Ortia (Clinical Analysts) Rendal Sarah Grace P. Garingo Mathew Brando C. Pecadizo Patricia Gilyn V. Sanchez Krizelle Julie Anne P. Berago
Science Aides Monina J. Latigar Lucilo B. Lilis Jr. Lemuel A. Visto Rieth Harry D. Nebrida Disa S. Simon Ramon L. Ignacio Christy C. Muros Marjon S. Sison Suzette H. Malinao
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