2018 Expanded National Nutrition Survey

2018 Expanded National Nutrition Survey Monograph Series

The Food, Health and Nutrition

Situation of Iloilo Province

2018 Expanded National Nutrition Survey

ISSN 2782-8964 ISBN 978-971-8769-68-3

This report provides data and information on the health and nutritional status of Iloilo Province 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) 8837-20-71 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 Iloilo Province. 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 Iloilo Province 31 Household and Individual Response Rates 32 Socio-demographic Profile of Households and Respondents 32 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) 43 Adolescents (10 to 19 years old) 47 Women of Reproductive Age (15 to 49 years old) 52 Adults (20 to 59 years old) 57 Elderly (60 years old and above) 67 Conclusion and Recommendations 71 Health Policy Recommendations 71 References 72 Annex 1. List of ENNS Booklets and Forms 74 Annex 2. ENNS Survey Team 76 Annex 3. Data Management Team 77 Annex 4. Biochemical Survey Team 78

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

2018 Expanded National Nutrition Survey

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 Ma. Lilibeth P. Dasco, Apple Joy D. Ducay, and Charmaine A. Duante

EDITORS Mario V. Capanzana, Ph.D. Imelda Angeles-Agdeppa, Ph.D.

2018 Expanded National Nutrition Survey

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. Mariele G. Siladan, for preparing the draft of this monograph and Ms. Frances Pola S. Arias for reviewing and revising; Ms. Ma. Cristina A. Musa, for reviewing, revising, and final formatting of this monograph; Mr. Chester G. Francisco and Mr. Aaron Gregor Lim, for the layout and formatting 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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2018 Expanded National Nutrition Survey

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 nutritional status of children 0-10 years 23 (0-120 months) based on 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 and 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 hemoglobin (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)

15 Blood pressure classification (NIH: JNC VII, 2004) 28

2018 Expanded National Nutrition Survey

Table No. Title Page 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 Iloilo Province 32

19 Socio-demographic profile of households and household heads in Iloilo 33 Province: ENNS, 2018

20 Percentage of households by food security status in the Philippines and 35 Iloilo Province: 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 Iloilo Province: ENNS, 2018 22 Prevalence of anemia among preschool children, 6 months to 5 years old 40 (6-71 months), in the Philippines and Iloilo Province: ENNS, 2018

23 Prevalence of vitamin A deficiency among preschool children, 6 months 41 to 5 years old (6 - 71 months), in the Philippines and Iloilo Province: ENNS, 2018 24 Prevalence of underweight, stunting, wasting, and overweight/obesity 43 among children, 5 to 10 years old, in the Philippines and Iloilo Province: ENNS, 2018 25 Prevalence of anemia among school-age children (6 to 12 years old) in 45 the Philippines and Iloilo Province: ENNS, 2018

26 Median UIE and percent urinary iodine (UI) level <50 µg/L among 45 school-age children (6 to 12 years old) in the Philippines and Iloilo Province by sex: ENNS, 2018 27 Prevalence of stunting, wasting, and overweight/obesity among 47 adolescents (>10 to 19 years old) in the Philippines and Province: ENNS, 2018 28 Prevalence of anemia among adolescents (13 to 19 years old) in the 48 Philippines and Iloilo Province by sex: ENNS, 2018

29 Prevalence of chronic energy deficiency (CED) and overweight/obesity 52 among non-pregnant/ non-lactating women of reproductive age (15 - 49 years old) in the Philippines and Iloilo Province: ENNS, 2018

30 Prevalence of anemia among non-pregnant/non-lactating women of 52 reproductive age (15 - 49 years old) in the Philippines and Iloilo Province: ENNS, 2018

31 Prevalence of vitamin A deficiency among non-pregnant/non-lactating 53 women of reproductive age (15 - 49 years old) in the Philippines and Iloilo Province: ENNS, 2018

2018 Expanded National Nutrition Survey

Table No. Title Page 32 Median UIE and percent urinary iodine (UI) level <50 µg/L among 53 non-pregnant/non-lactating women of reproductive age (15 - 49 years old) in the Philippines and Iloilo Province: ENNS, 2018

33 Prevalence of chronic energy deficiency (CED) and overweight/obesity 54 among lactating mothers in the Philippines and Iloilo Province: ENNS, 2018

34 Prevalence of anemia among lactating mothers in the Philippines and 54 Iloilo Province: ENNS, 2018

35 Median UIE and percent urinary iodine (UI) level <50 µg/L among lactating 55 mothers in the Philippines and Iloilo Province: ENNS, 2018

36 Prevalence of chronic energy deficiency (CED), overweight, and obesity 57 among adults, 20 to 59 years old, in the Philippines and Iloilo Province: ENNS, 2018

37 Prevalence of high waist circumference and high waist-hip ratio among 59 adults, 20 to 59 years old, in the Philippines and Iloilo Province: ENNS, 2018

38 Prevalence of anemia among adults, 20 to 59 years old, in the Philippines 61 and Iloilo Province by sex: ENNS, 2018

39 Prevalence of elevated blood pressure and high fasting blood sugar 61 among adults, 20 to 59 years old, in the Philippines and Iloilo Province: ENNS, 2018

40 Prevalence of chronic energy deficiency (CED), overweight, and obesity 67 among elderly, 60 years old and above, in the Philippines and Iloilo Province: ENNS, 2018

41 Prevalence of high waist circumference and high waist-hip ratio among 67 elderly, 60 years old and above, in the Philippines and Iloilo Province: ENNS, 2018 42 Prevalence of anemia among elderly, 60 years old and above, in the 68 Philippines and Iloilo Province by sex: ENNS, 2018

43 Prevalence of vitamin A deficiency among elderly, 60 years old and 68 above, in the Philippines and Iloilo Province: ENNS, 2018

44 Median UIE and percent urinary iodine (UI) level <50 µg/L among elderly, 69 60 years old and above, in the Philippines and Iloilo Province: ENNS, 2018

45 Prevalence of elevated blood pressure and high fasting blood sugar 69 among elderly, 60 years old and above, in the Philippines and Iloilo Province: ENNS, 2018

2018 Expanded National Nutrition Survey

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 Iloilo Province 32

4 Distribution of educational attainment of household head in Iloilo Province: 34 ENNS, 2018 5 Distribution of occupation of household head in Iloilo Province: ENNS, 34 2018

6 Percentage of households by food insecurity items in Iloilo Province: 36 ENNS, 2018

7 Percentage of food insecure households by wealth status, household size, 36 and sex of household head in Iloilo Province: ENNS, 2018

8 Proportion of infants, 0-23 months old, by breastfeeding practices in the 38 Philippines and Iloilo Province: ENNS, 2018

9 Proportion of infants, 6-23 months old, by complementary feeding practic- 38 es in the Philippines and Iloilo Province: ENNS, 2018

10 Prevalence of underweight, stunting, wasting, and overweight-for-height 40 among children, under-five years old (0-59 months), by sex and wealth status in Iloilo Province: ENNS, 2018 11 Prevalence of underweight, stunting, wasting, and overweight/obesity 44 among children, 5 to 10 years old, by sex and wealth status in Iloilo Prov- ince: ENNS, 2018 12 Prevalence of stunting, wasting, and overweight/ obesity among adoles- 48 cents (> 10 to 19 years old) by sex and wealth status in Iloilo Province: ENNS, 2018 13 Proportion of current smokers among adolescents (10 to 19 years old) in 49 the Philippines and Iloilo Province: ENNS, 2018

14 Proportion of current smokers among adolescents (10 to 19 years old) by 49 sex and wealth status in Iloilo Province: ENNS, 2018 15 Proportion of current drinkers among adolescents (10 to 19 years old) in 50 the Philippines and Iloilo Province: ENNS, 2018

16 Proportion of insufficiently physically active adolescents (10 to 19 years 50 old) in the Philippines and Iloilo Province: ENNS, 2018

17 Proportion of insufficiently physically active adolescents (10 to 19 years 50 old) by sex and wealth status in Iloilo Province: ENNS, 2018

18 Prevalence of nutritionally-at-risk pregnant women in the Philippines and 54 Iloilo Province: ENNS, 2018

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2018 Expanded National Nutrition Survey

Figure No. Title Page

19 Prevalence of chronic energy deficiency among, adults, 20 to 59 years 58 old, by age group, sex, and wealth status in Iloilo Province: ENNS, 2018

20 Prevalence of overweight among adults, 20 to 59 years old, by age group, 58 sex, and wealth status in Iloilo Province: ENNS, 2018

21 Prevalence of obesity among adults, 20 to 59 years old, by age group, 59 sex, and wealth status in Iloilo Province: ENNS, 2018

22 Prevalence of high waist circumference among adults, 20 to 59 years old, 60 by age group, sex, and wealth status in Iloilo Province: ENNS, 2018

23 Prevalence of high waist-hip ratio among adults, 20 to 59 years old, by 60 age group, sex, and wealth status in Iloilo Province: ENNS, 2018

24 Prevalence of elevated blood pressure among adults, 20 to 59 years old, 62 by age group, sex, and wealth status in Iloilo Province: ENNS, 2018

25 Prevalence of high fasting blood sugar among adults, 20 to 59 years old, 62 by age group, sex, and wealth status in Iloilo Province: ENNS, 2018

26 Proportion of current smokers among adults, 20 to 59 years old, in the 63 Philippines and Iloilo Province: ENNS, 2018

27 Proportion of current smokers among adults, 20 to 59 years old, by age 63 group, sex, and wealth status in Iloilo Province: ENNS, 2018

28 Proportion of binge drinkers among currently drinking adults, 20 to 59 63 years old, in the past 30 days, in the Philippines and Iloilo Province: ENNS, 2018

29 Proportion of binge drinkers among currently drinking adults, 20 to 59 64 years old, in the past 30 days, by age group, sex, and wealth status in Iloilo Province: ENNS, 2018

30 Proportion of insufficiently physically active adults, 20 to 59 years old, in 64 the Philippines and Iloilo Province: ENNS, 2018

31 Proportion of insufficiently physically active adults, 20 to 59 years old, by 65 age group, sex, and wealth status in Iloilo Province: ENNS, 2018

32 Prevalence of high waist circumference and high waist-hip ratio among 68 elderly, 60 years old and above, by sex and wealth status in Iloilo Province: ENNS, 2018

33 Proportion of current smokers, current alcohol drinkers and physically 69 inactive elderly, 60 years old and above, in the Philippines and Iloilo Province: ENNS, 2018

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2018 Expanded National Nutrition Survey

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-related since 1978 as part of its mandate to undertake non-communicable diseases. The aim of the research on the population‟s nutritional status. ENNS is to provide empirical data on the A need for the generation of nutrition and nutritional and health status of Filipinos for health data for local government units (LGUs) planning and development programs, and for particularly in the provinces and highly timely policy decisions at the national and urbanized cities (HUCs) prompted the DOST- provincial/HUCs levels. At the local level, this FNRI to change the design of the NNS to the report could serve as a basis for LGU to do Expanded National Nutrition Survey (ENNS). problem-based nutrition programs and actions The ENNS is distinct from the previous NNS as directed on the groups with nutritional problems. it is a rolling survey which extends the period of This could be more cost-effective and efficient data collection for three years starting from because the data are area-based specific. 2018 to 2021 (not including 2020). The Philippines has 81 provinces and 33 highly A total of 1,485 households and 5,005 urbanized cities (HUCs). All the provinces and individuals participated in Iloilo Province as part HUCs, and 3 other areas or a total of 117 areas of the 2018 ENNS. Majority of the households will be surveyed for ENNS. In order to cover all had five or less members (76.0%). Households these areas, the survey has selected 40 areas were comprised mostly of adults, 20-59 years old each for the first 2 years (2018 to 2019) and 37 (45.5%), and had almost an equal proportion of areas for the last year (2021). Each year, the males and females. Most of the household heads DOST-FNRI releases national estimates of the were male (76.1%), had reached at least health and nutritional status of Filipinos as well secondary level of education (40.0%) and as provincial/HUCs estimates in the areas majority were involved in agriculture (34.3%). covered during the survey period. The province Food insecurity was high among of Iloilo was among the areas covered in 2018. households in Iloilo Province (60.5%) wherein

38.5% of households experienced moderate food For this monograph, seven survey insecurity, 11.8% had mild food insecurity, and components are presented to summarize the 10.2% experienced severe food insecurity. assessment of the health and nutritional status Moreover, food insecurity was higher among of Iloilo Province and are reported by life poor households, those households with more stages: Anthropometric Survey, Biochemical than five members, and were male-headed. Survey, Clinical and Health Survey, Socio- economic Survey, Food Security Survey, Infant The practice of exclusive breastfeeding and Young Child Feeding (IYCF) Practices, among infants, 0-5 months, was high in the and Maternal Health and Nutrition. province at 69.7%; however, continued breastfeeding up to two years was not common

2018 Expanded National Nutrition Survey

(40.5%). Complementary feeding among common among males (8.0%) than females children, 6-23 months, was markedly (0.4%). Meanwhile, the proportion of current inadequate in energy and nutrients since only drinkers among adolescents was low at 11.0%. 13.1% met the minimum acceptable diet Majority (73.7%) were insufficiently physically (MAD) based on the quality of complementary active. food eaten the previous day. Among women of reproductive age (15 Among infants and preschool children to 49 years old), overweight and obesity were (0 to 59 months old), the prevalence of common among non-pregnant/non-lactating underweight (26.7%) and stunting (38.3%) women (29.5%) and lactating mothers (26.1%). were of public health significance with “high” Anemia was of “mild” and “moderate” public severity. Wasting prevalence was above the health significance among non-pregnant/non- acceptable level of <5%. Anemia (9.2%), on lactating women (11.9%) and lactating mothers the other hand, was considered a “mild” public (21.1%), respectively. Meanwhile, vitamin A health problem. Meanwhile, vitamin A deficiency among non-pregnant/ non-lactating deficiency among 6-71 months was at 9.8% was very low at 1.8%. Median UIE was and also considered as a “mild‟ public health adequate (156µg/L) for non-pregnant/non- problem in the province. lactating women and insufficient (92µg/L) for lactating mothers. Percentage of non-pregnant/ Among school-age children, 5-10 non-lactating women with urinary iodine level years old, prevalence of underweight (33.5%) less than 50µg/L was 13.1%. However, iodine and stunting (31.5%) were considered public deficiency exist among lactating mothers at health problem with “very high” and “high” 23.3%. Based on Magbitang cut-off, one in severity, respectively. Wasting prevalence every ten (11.0%) pregnant women was was also above the acceptable level of <5%. nutritionally-at-risk of delivering low birth weight Overweight for this age group was not much of babies. a problem in the province (8.1%). Anemia prevalence was a public health problem with Among adults (20 to 59 years old), “moderate” severity (24.2%). Iodine status prevalence of chronic energy deficiency (CED) among school-age children was adequate was 8.4%, and this was notable among the based on median urinary excretion (UIE) (183 young adults, 20-29 years old (11.3%), and µg/L) but percentage of children with urinary among poor households (13.2%). Overweight iodine level below 50µg/L in the province was prevalence was 24.5% while obesity was 6.9%. 12.7%. Android type of obesity based on high waist circumference and high waist-hip ratio was Among adolescents (>10 to 19 years 10.7% and 30.2%, respectively, and this was old), prevalence of stunting was high at 30.9% more common among females. Anemia among and was more common among males (35.3%) adults in the province was of “mild” public and those living in poor households (39.3%). health significance (10.0%). Raised blood Anemia was of “mild” public health concern pressure level was 16.4% and high fasting (8.3%) and was more prevalent among blood sugar was 7.8%. These risk factors females (12.5%). Current smoking was more increased with age and there were more males

2018 Expanded National Nutrition Survey

with elevated blood pressure. Current smokers infants and very young children; (3) high in this age group was 22.6%, and smoking percentage of stunting and underweight among was more common among males (43.6%) than 0 to 59 month old children and school-age females (3.9%). The proportion of binge children; (4) among adolescents, high rates of drinkers among those who reported currently stunting and anemia especially among females, drinking alcoholic beverages for the past 30 and initiation of smoking and alcohol drinking; days was 54.0%. While the proportion of (5) high overweight and obesity among non- insufficiently physically active adults in the pregnant/non-lactating women and lactating province was 25.0%. mothers; (6) high iodine deficiency rates among lactating mothers; and high rate of anemia Among the elderly (60 years old and among female adults, and (6) among adults above), the prevalence of CED was 18.6% and elderly, high rates of CED, overweight and while overweight was 20.6% and obesity was obesity and android type of obesity, particularly only 3.2%. Among females, high waist females; and high rates of smoking, alcohol circumference was 22.9% and high waist-hip drinking, and physical inactivity. It is ratio was 71.9%. Anemia prevalence of 26.6% recommended that the implementation of target was of “moderate” public health significance -focused development programs and policies and affecting both sexes in the province. on health and nutrition must be accelerated to Vitamin A deficiency, however, was low at address the different health and nutrition 1.2%. Iodine intake based on median UIE (82 concerns identified in this survey in order to µg/L) was insufficient and the iodine deficiency contribute to the achievement of the prevalence was 33.7%. About one-third Sustainable Development Goals by 2030. (33.7%) of the 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 16.1% while current alcohol drinkers was 18.7%. Moreover, insufficiently physically active elderly was 41.5%.

The results of the dietary survey component (household and individual levels) will be included in the Philippine Nutrition Facts and Figures 2018: Food Consumption Survey.

In summary, there were marked nutritional and health problems across all age groups in the province: (1) high household food insecurity; (2) low variety of foods and poor complementary feeding practices among

2018 Expanded National Nutrition Survey

ENNS Results at a Glance

2018 Expanded National Nutrition Survey

2018 Expanded2018 Expanded National National Nutrition Nutrition Survey Survey

2018 Expanded National Nutrition Survey

Introduction

Background and Rationale of the Expanded National Nutrition Survey

The state of the Philippines‟ health and nutrition January 1996), as these serve as vital inputs to are important factors in securing sustained national plans and programs. national development and economic stability. High rates of malnutrition create a cascade of Previous NNS results were generated developmental, social and medical problems at the national and regional levels. However, which places a significant burden on national there was a clamour from the local government economic growth. It is estimated that units (LGUs), Congress of the Philippines, and undernutrition alone can reduce Gross 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

2018 Expanded National Nutrition Survey

The clinical and health survey materials, ownership of lot, owned household component assesses the prevalence of risk assets, toilet facilities and garbage disposal factors like overweight and obesity, elevated system used in the construction of wealth index blood pressure, high fasting blood glucose, and of households. dyslipidemia. It also includes the evaluation of certain behavioral risk factors such as smoking The food security survey component and exposure to second-hand smoking, alcohol provides data on household food security consumption, physical inactivity and unhealthy status using the Household Food Insecurity diet. Access Scale (HFIAS).

The dietary survey component The IYCF component assesses current provides data on the quality, quantity and infant and young child feeding practices of adequacy of diets that help track food mothers for their children age 0-23 months old. consumption trends over time, both at the household and individual levels. The maternal health and nutrition survey component describes the nutritional The socio-economic survey component status of pregnant, lactating, and non-pregnant/ determines the economic status of households non-lactating women of reproductive age. such as education and occupation of household members, the household‟s housing

Objectives of the ENNS

General Objective: To provide empirical data on the food, health, and nutritional status in Iloilo Province.

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 food insecurity and coping mechanisms among households;  feeding practices of infants and young children, 0-23 months; and  maternal health and nutritional status of mothers with 0-36 month old children, pregnant women, and lactating mothers.

2018 Expanded National Nutrition Survey

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

2018 Expanded National Nutrition Survey

Methodology

Sampling Design

The ENNS utilized the 2013 Master Sample and three other areas), which is divided into (MS) of the Philippine Statistics Authority as its exhaustive and non-overlapping area sampling design. The 2013 MS design for segments known as PSUs with about 100 to household-based surveys is a two-stage 400 households (Figure 1). Sixteen 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 NUTRITION

Food weighing 24-hr Food Recall Face-to-face interview Figure 2. Methods of Data Collection

2018 Expanded National Nutrition Survey

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 2 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 were 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 2 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 was 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) Weight-for-length/ 0-60 months None height (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 nutritional status of children 0-10 years old (0-120 months) based on 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 the magnitude and severity of underweight, were also used as basis to determine stunting, and wasting as a public health magnitude and severity of undernutrition for problem among children under-five years are school-age 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%

2018 Expanded National Nutrition Survey

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 measurement will be done if the difference subjects 20 years old and above (excluding between measurements is greater than 0.5 pregnant women) were measured to determine cm. Pregnant women were not included abdominal obesity using a non-stretchable because variations in the physical dimension tape measure. Waist circumference is a might overestimate obesity and adiposity. measurement of the distance around the Waist-hip ratio is a simple method for smallest part of the abdomen, located at the describing the distribution of both midway between the lowest rib and the tip of subcutaneous and intra-abdominal adipose the hip bone or iliac crest (Averkamp, 2015). tissue. It is computed using the waist and hip Hip circumference refers to the distance measurements. Cut off points of waist around the largest area of the hips, usually the circumference (WC) and waist-hip ratio (WHR) largest part of the buttocks (CDC, 2007). are shown in Table 8. Measurements were done three times and recorded to the nearest 0.1 cm. Another

2018 Expanded National Nutrition Survey

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 were

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 were done inside rooms to avoid exposure of Serum retinol levels were measured to the collected specimen to direct sunlight. All determine the prevalence and magnitude of biochemical samples are kept frozen in vitamin A deficiency using the WHO Guidelines household freezers or ice chests until they are (1976; 1982, 1996; 2011) presented in Tables shipped to the DOST-FNRI. Biochemical 11 and 12.

Table 11. Guidelines used for the interpretation of Serum Vitamin A level (WHO/USAID, 1976; WHO/UNICEF/HKI/IVACG, 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 lactating women, and the elderly to determine Tables 13 and 14 show the severity of urinary iodine excretion (UIE) level and the iodine deficiency based on median UIE using prevalence of iodine deficiency. The acid the epidemiological criteria set by the WHO/ UNICEF/ICCIDD (2001, 2007).

2018 Expanded National Nutrition Survey

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 was reported based on the nurses and allied health professionals among classification and cut-off points set by the 7th adults 20 years old and above, using non- Joint National Committee on detection and mercurial sphygmomanometer and dual treatment of high blood pressure (JNC VII) stethoscope following standard procedures. (NIH, 2004) presented in Table 15. Respondents were requested to rest quietly for five minutes in a seated position upon arrival in Moreover, blood samples were the assembly area. They were 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 before measurement. If they self-reported any overnight fasting. These were stored on ice of these activities, measurement will be and later centrifuged to separate plasma, which delayed. The maximum inflation level was was later packed, labelled and frozen until recorded and then three readings of systolic ready for analysis in DOST-FNRI laboratories. and diastolic blood pressure were taken, with In the analysis of FBS, enzymatic colorimetric intervals of one to two minutes. An method was used using Roche COBAS Integra accompanying questionnaire is used to collect and Hitachi 912. Values for FBS were information on the history of raised blood interpreted using the WHO Guidelines (1998) pressure, diagnosis, medication and lifestyle (Table 16).

2018 Expanded National Nutrition Survey

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 For the individual food consumption, weighing, food inventory, and food recall were 24-hour food recall was used to estimate the the methods employed in the collection of food individual‟s food intake. All members of the consumption data among sample households. sampled households were interviewed to A digital weighing scale was used to weigh all collect data for the first day 24-hour food recall. food items prepared and served in the For the second day recall, only 50% of the households throughout the day, which included randomly selected households with one day food items eaten from breakfast, lunch, supper, recall were interviewed to have a second non- and in-between snacks. Food items were consecutive days food recall data. It involved a weighed before cooking or in their raw form. face-to-face interview where food consumed by Plate wastes, given-out food, and leftover food an individual for the past 24 hours were were also weighed to obtain the actual weight of food consumed. recalled and recorded starting from the time the subject woke up until bedtime, including

morning, afternoon and late evening snacks. Aside from the actual weighing of food Respondents were asked to remember and in the household, a food inventory was also report exactly all foods and beverages they conducted. Non-perishable food items that actually consumed during the previous 24-hour may be used anytime of the day such as period using measuring tools (tablespoon, cup, coffee, sugar, salt, cooking oil, and other matchbox, ruler and graduated circle sizes). condiments were weighed at the beginning and end of the food weighing day. If some All food items consumed, as well as members of the household ate outside the their description, including cooking method and home during the food weighing day, a recall of brand names, were recorded. Weights of actual the foods eaten out was also administered. food consumed based on the two non- consecutive 24-hour food recalls were entered to a computer library of the Food Composition

2018 Expanded National Nutrition Survey

Tables to estimate for energy and nutrient insecure. The households increase their level intakes. These estimates are then compared of food insecurity when they experience against the nutritional requirements indicated in adverse conditions more severely or more the Philippine Dietary Reference Intakes. The frequently. results of the food consumption survey will be The maternal health and nutrition provided in another report. survey collected the nutritional status of Health interviews regarding behavioral women of reproductive age, particularly the risk factors, such as smoking, excessive non-pregnant/ non-lactating women, pregnant alcohol consumption, and physical inactivity women and lactating mothers. were also conducted using the WHO STEPS In the infant and young child feeding instruments or the STEPwise approach to NCD survey, the feeding practice for children aged risk factor surveillance version 3.2. By 0–23 months is reported using 24-hour food definition, current smokers were those who recall. Breastfeeding indicators include early smoke during the time of the survey using initiation of breastfeeding which is defined as conventional products either on a “daily” basis the proportion of children 0-23 months who (at least one tobacco or nicotine product a day) were put to breast within an hour after or on a regular/occasional basis. Current delivery, exclusive breastfeeding which is the drinkers, on the other hand, are those who proportion of infants 0-5 months who received have consumed any alcoholic beverages only breastmilk based on the 24-hour food during the past 12 months at the time of the recall, and continued breastfeeding at 1 year survey. Binge drinking refers to excessive or 2 years. Complementary feeding practices consumption of alcoholic beverages, among children, 6-23 months, include the specifically the intake of four or more (for following indicators: minimum dietary diversity females) or five or more (for males) standard (MDD) is the consumption of foods from at drinks in a row (WHO, 2008) among those who least 4 food groups during the previous day, reported drinking alcoholic beverages in the minimum meal frequency (MMF) reflects the past 30 days. For physical activity among energy intake from foods other than breastmilk adults, a person not meeting the WHO consumed the minimum number of times or recommendation of three or more days of more per day, and the minimum acceptable vigorous-intensity activity of at least 20 minutes diet (MAD) refers to the proportion of children per day or five or more days of moderate who attained both the MDD and MMF the intensity activity or walking of at least 30 previous day. minutes per day, is considered insufficiently physically active. Among adolescents, The 2018 ENNS Interview Schedules insufficient physical activity means doing less consisted of eleven booklets categorized by life than 60 minutes of moderate- to vigorous- stage or by component. The list of booklets and intensity physical activity per day. forms and the actual interview guides used are compiled in Annex 1. For the food security survey component, the Household Food Insecurity The summary table for the different Access Scale (HFIAS) (Coates et al, 2007) variables collected in each specific age or was adopted in the ENNS to determine the physiologic group is presented in Table 17. prevalence and magnitude of food insecurity at the household level. The HFIAS is categorized into four levels: food secure, mildly, moderately, and severely food

2018 Expanded National Nutrition Survey

Table 17. Target age or physiologic groups for specific variables Physiologic Groups Women of Reproductive Age Infant and School- Variables Preschool Young age Adolescents Non- Adults Elderly Household Children 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 Consent Institutional Ethics Review Committee (FIERC) Form (ICF) contains the explanation of the for clearance on July 12, 2017 which was background and objectives of the survey, the approved on July 31, 2017 with protocol code data collection procedures involved, risks (any FIERC-2017-017. undesirable effect that may result or invasion of circumstances, e.g., blood collection, expected The signed consent forms which were duration of the interview with respondent) and translated into the different local languages that benefits of participation, confidentiality of are most commonly spoken in the Philippines information, option to withdraw without penalty were obtained from respondents prior to or consequences.

2018 Expanded National Nutrition Survey

Study Site

Profile of Iloilo Province Iloilo Province is located at the wharves for sea travel and an international southern and north-eastern portion of Panay. It airport for air transportation. Several is surrounded by the Province of Capiz and infrastructures such as roads and bridges are Jintotolo Channel in the north; Panay Gulf and also established in the province for land Iloilo Strait in the south; Visayan Sea and transportation. Guimaras Strait in the east; and the Province of Forestland constitutes 8% of the total Antique in the west. The province has a total land area of the province which is land area of 4,663.42 square kilometers. approximately 38,422.26 hectares. The

Iloilo is a first class province and is province also has 26 watershed areas. There divided into five congressional districts. It has are 42 main health centers, 1 city health office, 42 municipalities and 1 component city. Iloilo‟s and 464 barangay health stations in the capital is Iloilo City, though it is independent province (Iloilo Provincial Planning and and not governed by the provincial Development Office, 2018). government. The total population of the Iloilo Province is known for its old world province based from the 2015 census was at architecture similar to those in Latin America. 1,936,324. By the end of October 2017, the Well-known tourist sites include Spanish employment rate at Iloilo Province was at colonial churches such as Miag-ao Church, 94.4%. Molo Church, and Passi City Church. There are

Citizens from Iloilo Province are called also tourist destinations that are not churches Illonggos. In the province, there are three local such as the Bulabog Putian National Park, languages namely Hiligaynon, Kinaray-a, and Islas de Gigantes, and the Iloilo River Capiznon. Iloilo province is predominated by Esplanade. Catholic people. However, Protestant churches, Evangelical Christians, and non- Christians such as Muslims also exist.

Iloilo Province‟s climate constitute of a dry season from December to June and a wet season from July to November along the southern-northern part of the province and for the portion of the central municipalities. There are no distinct wet and dry seasons for the Iloilo-Capiz border.

Facilities for transportation in the province include several ports, piers, and

2018 Expanded National Nutrition Survey

Figure 3. Political Map of Iloilo Province1 Image Source1 : https://news.mb.com.ph/wp-content/uploads/2018/08/map3-815x1024-copy.jpg

Household and Individual Response Rates

A household refers to a person living of households and individuals covered in the alone or a group of persons, who may be province are presented in Table 18. There related or not, sleep in the same dwelling unit were 1,509 eligible households in Iloilo and have common arrangements for the Province. Response rate at the household level preparation and consumption of food was high at 98.4% and at the individual level, (Barcenas, 2004). this was 86.8% or 5,005 individuals were covered. Household and individual eligibility and response rates together with the total number

Table 18. Household and individual eligibility and response rates in Iloilo Province

Level Eligible Response Response Rate Household 1,509 1,485 98.4 Individual 5,767 5,005 86.8

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Socio-demographic Profile of Households and Respondents

Socio-demographic profile of observation. Table 19 shows the households and respondents were gathered socio-demographic profile of the households using face-to-face interview and actual and household heads in Iloilo Province.

Table 19. Socio-demographic profile of households and household heads in Iloilo Province: ENNS,2018

Variable n % Household size 5 members and below 1,128 76.0 More than 5 members 357 24.0 Sex of household members Male 2,431 48.6 Female 2,574 51.4 Sex of household head Male 1,131 76.1 Female 354 23.9 Civil status of household head Separated 58 3.9 Single 104 7.0 Common Law/ Live-in 108 7.3 Widowed 293 19.8 Married 921 62.0 Respondents by age group 0 - 23 months 159 3.9 24 - 71 months 418 10.0 72 - 120 months 504 9.9 > 10 - 19 years 1,038 19.1 20 - 59 years 2,208 45.5 60 years and over 678 11.6 Women of reproductive age by physiological status Pregnant 31 3.0 Lactating 118 11.6 Non-pregnant/ Non-Lactating 924 85.4

In Iloilo Province, majority of the Among women of reproductive age, households covered were comprised of five there were only 3.0% that were pregnant and members or less (76.0%). Most of household 11.6% were lactating mothers in Iloilo Province. heads were male (76.1%), and were married (62.0%). Most of the household heads (40.0%) had reached at least secondary level of Household members had almost an education while 38.0% had reached at least equal proportion of males and females and elementary level of education. A very small were comprised mostly of adults, 20-59 years proportion of household heads had no grade old (45.5%). completed (1.2%) (Figure 4).

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*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 Iloilo Province: ENNS, 2018

Occupation of household head refers Province were farmers, forestry workers, and to the present principal employment, business, fishermen (34.3%). The three other major or other means of livelihood and classified occupations were laborers and unskilled based on the 2012 Philippine Standard workers (21.0%), plant and machine workers Occupational Code (PSA, n.d). Majority of the (14.0%), and service workers (11.7%). (Figure occupations of the household heads in Iloilo 5).

Figure 5. Distribution of occupation of household head in Iloilo Province: ENNS, 2018

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Food Security Status

Food security exists when all people, at they had a hard time acquiring and accessing all times, have physical and economic access food, had faced uncertainties about their to sufficient, safe and nutritious food that meets ability to obtain food, and had been forced to their dietary needs and food preferences for an compromise on the quality and/or quantity of active healthy life (FAO, 1996). In Iloilo the food they consume and obtain. This Province, four in every ten (39.5%) households percentage was significantly higher than the reported that they were food secure (Table 20). national estimate (28.8%). This means that majority of the households in the province (60.6%) experienced food One in every ten (11.2%) households insecurity wherein there was limited or in the province was classified as severely food uncertain availability of nutritionally adequate insecure. A severely food insecure household and safe foods or limited or uncertain ability to often cuts back the quantity of foods and acquire acceptable foods in socially acceptable experiences the three most severe conditions ways (Anderson, 1990). (running out of food, going to sleep hungry and not eating for the whole day). Among households who were food insecure, 11.8% were classified as mildly food The percentage of households that insecure wherein the household sometimes or experienced severe food insecurity (11.2%) often worried about food and/or was unable to was slightly lower than the national estimate eat preferred foods. (12.8%) but not significant.

Meanwhile, 38.5% of households were classified as moderately food insecure wherein

Table 20. Percentage of households by food security status in the Philippines and Iloilo Province: ENNS, 2018 Philippines Iloilo Province 90% CI 90% CI Variable Percentage Percentage (%) Lower Upper (%) Lower Upper Limit Limit Limit Limit

Food Secure 46.1 44.1 48.0 39.5* 36.7 42.2 Mildly Food Insecure 12.3 11.7 12.9 11.8 10.5 13.1 Moderately Food Insecure 28.8 27.1 30.5 38.5* 34.8 40.4 Severely Food Insecure 12.8 11.2 14.4 10.2 9.2 13.1 * significant at p<0.10

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Figure 6. Percentage of households by food insecurity items in Iloilo Province: ENNS, 2018

Furthermore, food insecurity was group (Figure 7). It was also evident among higher among poor households or those households with more than five members, and households in the bottom 30% of the income households headed by males.

Wealth Status Household Size Sex of Household Head 90% LL 57.8 71.0 50.6 54.7 65.5 59.5 48.3 CI UL 63.3 78.6 58.1 60.4 74.9 65.5 58.8 * significant at p<0.10 Figure 7. Percentage of food insecure households by wealth status, household size, and sex of household head in Iloilo Province: ENNS, 2018

2018 Expanded National Nutrition Survey

Key Findings by Life Stage

Infants and Preschool Children (0 to 59 months old)

Childhood malnutrition encompasses measured by the following indicators: both undernutrition like micronutrient deficiency, minimum dietary diversity (MDD), minimum stunting, underweight and wasting; and meal frequency (MMF), and minimum overnutrition like overweight and obesity. acceptable diet (MAD), which were previously Malnutrition has important health defined in the methodology section. consequences on growth, learning capacity, incidence of infectious diseases, and can even Promotion of IYCF has been one of last in adult life as manifested by presence of the key priority programs of the Department of chronic non-communicable diseases and low Health (DOH) and other government agencies individual work productivity. From a life cycle including the local government units (LGUs) to perspective, the most crucial time to meet the address childhood undernutrition. nutritional needs is in the first 1,000 days including the period of pregnancy until the Majority (89.5%) of newborns were child‟s second birthday when nutritional needs initiated to breastfeeding within one hour after are high to support rapid growth and birth (Figure 8). More than two-thirds (69.7%) development. of infants, 0-5.9 months, were exclusively breastfed. Meanwhile, the proportion of This section of the monograph reports children who were continued to breastfeeding the prevalence of underweight, stunting, at one year was 61.1%. Breastfeeding wasting, overweight/obesity, anemia and practice decreased with age where only vitamin A deficiency as indicators of nutritional 40.5% of children were still being breastfed up status of children under-five years of age. two years of age in the province.

Infant and Young Children 0-23 months

The role of optimal infant and young child feeding (IYCF) practices is crucial in improving child health, growth, and development during the first two years of life. It is recommended that newborns should be initiated early to breastfeeding within one hour after birth, exclusively breastfed from birth up to six months, and complementary foods should be introduced starting at 6 months of age, while continue breastfeeding up to two years and beyond. The quality and quantity of complementary foods should be adequate emphasizing the importance of variety or diversity, frequency, and acceptability as

2018 Expanded National Nutrition Survey

90% LL 65.2 51.2 45.4 29.3 90% LL 85.2 52.0 40.7 24.0 CI UL 73.1 58.5 55.9 37.0 CI UL 93.8 87.5 81.6 56.9 *significant at p <0.10

Figure 8. Proportion of infants, 0 - 23 months old, by breastfeeding practices in the Philippines and Iloilo Province: ENNS, 2018

Complementary feeding practices of on the complementary food eaten the children revealed that only 27.1% met the previous day. This revealed that young minimum dietary diversity (MDD) from the children, 6-23 months of age, in the province different food groups (Figure 9). In contrast, a fell short for the minimum quality and quantity high proportion of children (81.2%) met the of complementary feeding when combining minimum meal frequency (MMF) per day. both the diversity (MDD) and frequency (MFF) However, a low proportion (13.1%) of children indicators. met the minimum acceptable diet (MAD) based

90% LL 21.1 87.6 12.4 90% LL 21.5 74.6 8.4 CI UL 24.9 90.4 14.4 CI UL 32.8 87.9 17.9 Figure 9. Proportion of infants, 6 - 23 months old, by complementary feeding practices in the Philippines and Iloilo Province: ENNS, 2018

2018 Expanded National Nutrition Survey

Preschool. Children Under-Five

In 2018, results showed that three out difference in the prevalence was noted of 10 children (26.7%) below five years were between boys (34.0%) and girls (42.6%). underweight or had suffered acute form of malnutrition in the province (Table 21). The Wasting or thinness is measured by provincial estimate in Iloilo Province showed weight-for-height index. It is a sensitive that underweight was considered high in terms indicator of current nutritional status as a result of magnitude and severity. Underweight of recent insufficient food intake, illness or prevalence was significantly higher in poor situations, like calamities. Six out of 100 (34.2%) than non-poor (21.5%) households. No children (6.0%) under five years were wasted/ significant difference in the prevalence was thin (Table 21). The prevalence of wasting was noted between boys (23.6%) and girls (29.8%) classified as poor based on the WHO cut-offs (Figure 10). (Table 4). No significant difference in the prevalence of wasting by sex was noted Chronic malnutrition is measured by (Figure 10). low height-for-age index. Stunting among children under five years was at 38.3%, Overweight was observed among 4.8% revealing stunting as a high public health of children under five years of age (Table 21). concern in the province (Table 21). It was also The provincial estimate was similar with the significantly higher in the province than the national prevalence of 4.0%. No significant national prevalence (30.3%). Five out of 10 difference in the prevalence of overweight was children (53.0%) or more than half of under-five noted in terms of household wealth status and years from poor households were stunted and sex (Figure 10). this was significantly higher than in non-poor (28.9%) households (Figure 10). No significant

Table 21. Prevalence of underweight, stunting, wasting, and overweight-for-height among children, under-five years old (0-59 months), in the Philippines and Iloilo Province: ENNS, 2018 Philippines Iloilo Province 90% CI 90% CI Variable Prevalence Prevalence Lower Upper Lower Upper (%) (%) Limit Limit Limit Limit Underweight 19.1 17.7 20.5 26.7* 22.6 30.8 Stunting 30.3 28.2 32.4 38.3* 34.8 41.8 Wasting 5.6 5.2 6.1 6.0 3.8 8.2 Overweight-for-height 4.0 3.6 4.3 4.8 3.3 6.3

*significant at p <0.10

2018 Expanded National Nutrition Survey

90% LL 22.6 18.9 24.7 27.7 17.6 90% LL 34.8 29.2 36.5 44.5 24.9 CI UL 30.8 28.2 34.9 40.7 25.5 CI UL 41.8 38.8 48.6 61.5 32.9

90% LL 3.8 2.5 4.0 90% LL 3.3 1.9 3.4 0.5 3.4 CI UL 8.2 7.7 10.1 CI UL 6.3 5.9 8.0 4.0 8.0 *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 Iloilo Province: ENNS, 2018

Anemia is the most common indicator estimate was lower than the national estimate used to screen for iron deficiency (WHO, (14.3%), however, the difference was not 2001). In Iloilo Province, one in 10 preschool statistically significant. children (9.2%), 6 months to 5 years of age, was anemic (Tables 22). This provincial

Table 22. Prevalence of anemia among preschool children, 6 months to 5 years old (6-71 months), in the Philippines and Iloilo Province: ENNS, 2018

Prevalence 90% CI

(%) Lower Limit Upper Limit

Philippines 14.3 12.8 15.9 Iloilo Province 9.2 5.4 12.9

2018 Expanded National Nutrition Survey

Vitamin A deficiency (VAD) is the among preschool children in the province of leading cause of preventable blindness in Iloilo was 9.8% and considered a “mild” public children and this also increases the risk of health problem based on the WHO cut-offs. disease and death from severe infections. The (Table 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 Iloilo Province: ENNS, 2018

Prevalence 90% CI

(%) Lower Limit Upper Limit

Philippines 16.9 13.9 20.5 Iloilo Province 9.8 5.8 16.3

Highlights:

 Malnutrition is pervasive with 38.3% stunted children, under-5 years, 26.7% underweight, 6.0% wasted, 9.2% anemic, and 9.8% vitamin A deficient.  Stunting and underweight were high in magnitude and severity, and were significantly higher among children from poor than non-poor households.  Despite the high rates of early breastfeeding initiation (89.5%) and exclusive breastfeeding (69.7%) during the first six months of life, rates on complementary feeding were suboptimal, as shown by low percentage of 6-23 months old meeting the MDD (27.1%) and MAD (13.1%).

Call to Action:

To improve the nutritional status of young children under two years of age:  Strengthen the health and nutrition education of mothers on the following: Importance of newborn screening, immunization, and deworming; Timely initiation of breastfeeding within one-hour after birth; Importance of exclusive breastfeeding during the first six months of life; Timely introduction of age-appropriate, adequate, and safe complementary foods at six months while breastfeeding continuously until 24-months and beyond; and Feeding a wide variety of nutritious meals for young children.  Monitor the growth and development of infants and young children paying particular attention to low birth weight babies and sick children.

2018 Expanded National Nutrition Survey

 Improve access to age-appropriate nutrient-dense complementary foods particularly among poor and marginalized households.  Advocate use of micronutrient powder to enrich complementary foods.  Advocate regular check-up/visits at health facilities especially for immunization, iron and Vitamin A supplementation, and deworming for one-year and above.  Strengthen the establishment of IYCF support groups in the community, and hospitals and clinics to guide mothers on appropriate infant feeding practices after birth delivery.  Ensure adequate supply of vaccines, deworming tablets, and iron and Vitamin A supplements at health centers.  Conduct continuous training on IYCF among health professionals (particularly those in the private sector), community health workers, and mothers of child-bearing age.

To improve the nutritional status of 2-5 years of age:  Ensure delivery of appropriate child-care and integrated health services especially for children with moderate to severe acute malnutrition: Regular assessment of nutritional status and enrollment in Community Management of Acute Malnutrition programs for moderately and severely undernourished pre- schoolers; Provide sustained vitamin A and iron supplementation, and deworming; Provide sustained supplementary feeding among undernourished day-care students for at least 120 days; and Provide safe drinking water, sanitation facilities, and promote good hygiene practices.  Improve access to food through community vegetable gardens and homestead projects.  Promote and demonstrate utilization of diversified foods.  Promote appropriate dietary practices during illness/sickness.  Conduct livelihood and skills training for parents to increase their ability to access food for the household.  Strengthen the capacity of local health workers in conducting nutrition education classes for mothers and provision of health and nutrition services to preschool children.

2018 Expanded National Nutrition Survey

School-age Children (5 to 10 years old)

School-age children comprise the ages Stunting prevalence was significantly of 5 to 10 years old or the middle childhood. higher among boys than girls. Similarly, This is the period where growth is significant underweight was also higher among boys but with a slower rate. Adequate nutrition is than girls, however, it was not significant necessary to ensure growth to full potential, (Figure 11). These indicate that there were and to sustain active physical activity in more underweight and stunted boys than girls. general. Undernutrition at this period have Also, problems on undernutrition were more negative consequences particularly on common among poor households. cognition and learning capacity and ability to prevent diseases later in life, as nutritional On the other hand, the prevalence of problems in the school-age child may carry into wasting was 8.6% (Table 23). More boys adulthood. This section reports the prevalence (9.5%) were observed to be wasted than girls of underweight, stunting, wasting, overweight/ (7.5%). The poor school-age children had a obesity, anemia, and iodine deficiency as higher rate of wasting compared with the non- indicators of nutritional status of children, 5 to poor school-age children (Figure 11). 10 years old. Overweight and obesity were not yet The picture of undernutrition among serious problems among school-age children school-age children in the Philippines was high in the province at only 8.1%, but this should based on the global cut-off points for the not be taken for granted as they will be at-risk severity of nutrition situation with the to NCDs later in life if not prevented. The prevalence of underweight of 24.9% or about a provincial prevalence was significantly lower quarter of school-age children, 5 to 10 years compared to the national prevalence of 11.6% old. Moreover, the prevalence of stunting was (Table 23). There were more overweight and 24.6%. In Iloilo Province, the situation was even obese children among the non-poor (10.1%) worse with the prevalence for both underweight than the poor households (Figure 11). and stunting at 33.5% and 31.5%, respectively. This implies that three in every 10 school-age children were underweight or stunted in the province (Table 24).

Table 24. Prevalence of underweight, stunting, wasting, and overweight/obesity among children, 5 to 10 years old, in the Philippines and Iloilo Province: ENNS, 2018 Philippines Iloilo Province 90% CI 90% CI Variable Prevalence Prevalence Lower Upper Lower Upper (%) (%) Limit Limit Limit Limit Underweight 24.9 23.1 26.8 33.5* 30.5 36.5 Stunting 24.6 22.8 26.5 31.5* 28.2 34.9 Wasting 7.6 7.2 7.9 8.6 6.4 10.7 Overweight/Obesity 11.6 10.4 12.9 8.1* 6.0 10.2 *significant at p <0.10

2018 Expanded National Nutrition Survey

90% LL 30.5 31.9 25.3 38.0 23.7 90% LL 28.2 31.6 21.8 34.9 21.9 CI UL 36.5 42.2 33.8 50.9 28.9 CI UL 34.9 40.7 31.5 46.4 28.2

90% LL 6.4 6.3 5.2 4.8 5.9 90% LL 6.0 6.4 4.2 2.3 7.0 CI UL 10.7 12.7 9.8 14.6 10.3 CI UL 10.2 12.2 9.3 7.3 13.2 * significant at p<0.10 Figure 11. Prevalence of underweight, stunting, wasting, and overweight/obesity among children, 5 to 10 years old, by sex and wealth status in Iloilo Province: 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 in 2018 was 13.5% while the prevalence in 2017), hemoglobin level of school-age children, Iloilo Province was at 24.2% (Table 24). The 6 to 12 years old, were assessed using the anemia prevalence for the national and global cut-off points in determining anemia provincial levels were considered of "mild” and status. Children, 6 years old whose hemoglobin “moderate” public health significance, level were less than 11.0 g/dL and children, 6.1 respectively. to 12 years old whose hemoglobin level were less than 12.0 g/dL were classified as anemic (WHO, 1972).

2018 Expanded National Nutrition Survey

Table 25. Prevalence of anemia among school-age children (6 to 12 years old) in the Philippines and Iloilo Province: ENNS, 2018

90% CI Prevalence

(%) Lower Limit Upper Limit

Philippines 13.5 11.8 15.2 Iloilo Province 24.2* 20.0 28.5

* significant at p<0.10

Determination of median urinary iodine the median UIE of 180 µg/L. Similarly, school- excretion (UIE) was done to assess the iodine age children of Iloilo Province had “adequate” status of school-age children, 6 to 12 years old. iodine intake with a median UIE of 183 µg/L. The iodine status of school-age children in the However, 12.7% of school-age children had Philippines in 2018 was at “optimum” iodine urinary iodine level of <50 µg/L (Table 26). nutrition or “adequate” iodine intake based on

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 Iloilo Province: 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 Iloilo Province 183 165.5 201.2 12.7 9.6 15.8

Highlights:

 Underweight and stunting were serious nutrition problems in the province.  Wasting among school-age children was poor based on WHO cut-offs.  Overweight was not much of problem in the area but needs attention as children will be at-risk to NCDs in later life if not prevented.  Anemia was a public health problem with “moderate” severity.  Iodine intake was “adequate” based on median UIE, but 12.7% had urinary iodine level of <50 µg/L.

2018 Expanded National Nutrition Survey

Call to Action:

 Promote and serve nutritious and safe meals in school canteens and cafeterias.  Intensify school feeding programs by considering the right amount and types of foods served to school-age children complemented with micronutrient supplementation especially for undernourished children.  Educate school-age children on the importance of eating a wide variety of nutritious foods and a balanced diet.  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.  Improve access to food through homestead projects.  Encourage physical activities in schools and neighborhoods especially among wealthier quintiles/ non-poor households.  Intensify monitoring of salt iodization at all channels of distribution to avoid excessive intake and continue to promote use of iodized salt to ensure adequate intake.

2018 Expanded National Nutrition Survey

Adolescents (10 to 19 years old)

At the onset of adolescence, growth susceptible to non-communicable diseases spurt speeds up abruptly. It begins on the (NCDs) will also be reported in this section. average at the age of 10 to 11 years for girls In Iloilo Province, three in every 10 and 12 to 13 years for boys. During the growth adolescents (30.9%) were stunted or short for spurt, apparent differences in the skeletal their age. The prevalence of stunting was system, lean body mass and fat stores can be significantly higher than the national noted. Along these changes, adolescent‟s prevalence at 26.3%. Likewise, it was also energy and nutrient needs are greater than any noted to be significantly higher among male other time of life, except pregnancy and adolescents (35.3%) and in poor households lactation. The energy needs of adolescents (39.3%) than their counterparts. vary greatly, depending on the current rate of growth, sex, body composition, and physical The prevalence of wasting or thinness activity. This section reports the prevalence of among adolescents was 13.8%. It was more stunting, wasting, overweight/obesity, and observed among male adolescents with anemia as indicators of nutritional status of 17.8% than female adolescents (9.5%). There adolescents 10 to 19 years old. As it is not only was no significant difference in the prevalence the amount of food intake that affects the of wasting among adolescents between poor nutrition and health status of a person, but and non-poor households. Table 27 presents behavior and environment also play a crucial the overall nutritional status of adolescents in role, select risk factors such as smoking, the Philippines and Iloilo Province. alcohol drinking or the harmful use of alcohol and physical inactivity that make an individual

Table 27. Prevalence of stunting, wasting, and overweight/obesity among adolescents (> 10 to 19 years old) in the Philippines and Iloilo Province: ENNS, 2018

Philippines Iloilo Province 90% CI 90% CI Variable Prevalence Prevalence Lower Upper Lower Upper (%) (%) Limit Limit Limit Limit Stunting 26.3 24.7 28.0 30.9* 28.3 33.6 Wasting 11.3 10.5 12.1 13.8 12.1 15.6 Overweight/Obesity 11.6 10.7 12.5 8.7* 7.2 10.1 * significant at p<0.10

Overweight and obesity among adoles- alence of overweight and obesity between cents is an emerging nutrition concern in the adolescent boys and girls. It was more preva- Philippines. It increased by 2.4 percentage lent among adolescents belonging to non- points from the last survey conducted by DOST poor (11.6%) than poor households (3.4%). -FNRI in 2015. In Iloilo Province, the preva- Figure 12 shows the disaggregation of stunt- lence of overweight and obesity was 8.7%. ing, wasting, and overweight and obesity by There was no significant difference in the prev- sex and wealth status.

2018 Expanded National Nutrition Survey

90% LL 28.3 31.6 22.8 34.2 23.8 90% LL 12.1 14.9 7.7 13.9 10.0 CI UL 33.6 38.9 29.6 44.4 31.3 CI UL 15.6 20.7 11.2 21.1 14.4

90% LL 7.2 7.6 5.8 0.7 9.9 CI UL 10.1 11.9 9.3 6.0 13.4

* 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 Iloilo Province: ENNS, 2018

Anemia is also a common nutritional Conversely, anemia was significantly problem among adolescents. Due to abrupt more evident among girls (12.5%) than in growth spurt during adolescence, both teenage boys (4.4%). Table 28 shows the prevalence boys and girls need additional iron. The of anemia among adolescents in the prevalence of anemia in Iloilo Province was Philippines and Iloilo Province. 8.3%. Anemia rates in the Philippines and in Iloilo Province were not significantly different.

Table 28. Prevalence of anemia among adolescents (13 to 19 years old) in the Philippines and Iloilo Province by sex: ENNS, 2018 Disaggregation/ 90% CI Prevalence (%) Variable Lower Limit Upper Limit Philippines 8.1 7.4 8.8 Iloilo Province 8.3 5.4 11.3 Male 4.4* 1.7 7.0 Female 12.5 7.6 17.4 * significant at p<0.10

2018 Expanded National Nutrition Survey

Adolescents who smoke cigarettes, The proportion of current smokers and other tobacco and nicotine products are at- among male adolescents (8.0%) were risk for developing respiratory illnesses, cancer, significantly higher compared to females heart diseases, and other diseases. Though its (0.4%). However, the proportion between the effect is beyond the scope of nutrition, smoking poor (4.0%) and the non-poor (4.4%) eases the feeling of hunger and affects food households were almost similar. Figure 14 intake. Moreover, Executive Order 26 s. 2017 shows the proportion of current smokers prohibits minors to smoke (even lighting up), among adolescents (10 to 19 years old) by sell or buy cigarettes and other tobacco sex and wealth status. products. In Iloilo Province, 4.3% of the adolescents were currently smoking, similar to national prevalence of 4.0% (Figure 13).

90% LL 3.7 3.2 CI UL 4.4 5.3 *proportion of current smokers aged 10 to 17.9 years old was 2.0% Figure 13. Proportion of current smokers among adolescents (10 to 19 years old) in the Philippines and Iloilo Province: ENNS, 2018

90% LL 3.2 5.9 0.0 2.0 3.3 CI UL 5.3 10.2 1.0 6.0 5.5 * significant at p<0.10 Figure 14. Proportion of current smokers among adolescents (10 to 19 years old) by sex and wealth status in Iloilo Province: ENNS, 2018 *proportion of current smokers aged 10 to 17.9 years old: male - 4.0%; female - 0.0%

2018 Expanded National Nutrition Survey

Another modifiable behavioral risk years old, the current drinkers were 7.4%. factor that affects the nutritional status of (Figure 15). adolescents is alcohol consumption. Alcohol provides energy but no nutrients, it alters Physical inactivity among adolescents nutrient absorption and metabolism. In Iloilo was also determined in this survey. Majority of Province, 11.0% of the adolescents were adolescents (73.7%) in Iloilo Province were current drinkers. Among younger teens, 10-17 insufficiently physically active (Figure 16).

90% LL 15.2 8.9 90% LL 74.8 70.0 CI UL 18.4 13.0 CI UL 77.7 77.4 * significant at p<0.10 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 Iloilo Province: ENNS, in the Philippines and Iloilo Province: 2018 ENNS, 2018 proportion of current alcohol drinkers aged 10 to 17.9 years old: 7.4%

Furthermore, proportion of adolescents poor and non-poor households was not who were insufficiently physically active was significantly different (Figure 17). This higher among females (77.4%) as compared to indicates that regardless of sex and wealth males (69.9%). Likewise, proportion of status, adolescents were physically inactive. physically inactive adolescents belonging to the

90% LL 70.0 65.6 72.3 65.4 69.2 CI UL 77.4 74.3 82.5 81.1 77.3

Figure 17. Proportion of insufficiently physically active adolescents (10 to 19 years old) by sex and wealth status in Iloilo Province: ENNS, 2018

2018 Expanded National Nutrition Survey

Highlights:

 Stunting among adolescents was high in the province and common among adolescents belonging to poor households.  Anemia was of “mild” public health concern.  Low proportion of current drinkers among this age group was observed.  Majority of adolescents were insufficiently physically active.

Call to Action:

 Provide micronutrient supplementation among females particularly iron and folic acid.  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.  Encourage social events and skill-building activities that prepare the youth for adulthood while minimizing exposure to risky behaviors.  Promote healthy lifestyle habits such as smoking cessation 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.

2018 Expanded National Nutrition Survey

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 non- women aged 15-49 years (WHO, 2006). pregnant/ non-lactating women and lactating Optimum nutrition of a woman before, during 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 the province of Iloilo, prevalence of

CED among this group was 10.0%, and it was In the ENNS, WRA was disaggregated considered as medium in terms of magnitude into three groups, the non-pregnant/non- and severity. In contrast, the prevalence of lactating women, pregnant women and lactating overweight and obesity (29.5%) was thrice the mothers. The nutritional status, hemoglobin prevalence of CED. Thus, overnutrition was levels, vitamin A status, and urinary iodine more common than undernutrition among non excretion levels were determined in these -pregnant/ non-lactating women (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 Iloilo Province: ENNS, 2018

Philippines Iloilo Province 90% CI 90% CI Variable Prevalence Prevalence (%) Lower Upper (%) Lower Upper Limit Limit Limit Limit CED 7.8 7.3 8.3 10.0* 8.4 11.6 Overweight/Obesity 35.3 33.7 36.9 29.5* 27.3 31.7 * significant at p<0.10

One in every 10 non-pregnant/non- from the national prevalence of 11.6%. Anemia lactating women (11.9%) in Iloilo Province had in this group was considered of “mild” public anemia, which was not significantly different health significance.

Table 30. Prevalence of anemia among non-pregnant/ non-lactating women of reproductive age (15 - 49 years old) in the Philippines and Iloilo Province: ENNS, 2018

90% CI Prevalence (%) Lower Limit Upper Limit Philippines 11.6 11.0 12.3 Iloilo Province 11.9 9.3 14.4

2018 Expanded National Nutrition Survey

Vitamin A is also important for fetal was not a public health problem based on the growth and development during pregnancy. WHO cut-offs. Sufficient vitamin A intake among women during their reproductive years is crucial to The iodine status among non- prevent depletion of body stores and meet the pregnant/non-lactating women in Iloilo basic physiologic needs in preparation for Province based on median UIE was adequate conception. The prevalence of VAD among non at 156µg/L. However, 13.1% had urinary iodine -pregnant/ non-lactating women in Iloilo level of <50 µg/L (Table 32). Province was very low at 1.8% (Table 31) and

Table 31. Prevalence of vitamin A deficiency among non-pregnant/ non-lactating women of reproductive age (15 - 49 years old) in the Philippines and Iloilo Province: ENNS, 2018 90% CI Prevalence (%) Lower Limit Upper Limit Philippines 1.3 1.0 1.8 Iloilo Province 1.8 1.0 3.3

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 Iloilo Province: 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 Iloilo Province 156 141.6 170.6 13.1 10.7 15.4

Pregnant Women

The nutritional status of a pregnant One in every ten (11.0%) pregnant woman is an important determinant of women in Iloilo Province was nutritionally-at- pregnancy outcomes. Those who are risk of delivering low birth weight babies. The nutritionally at-risk during pregnancy are at prevalence, however, was not significantly greater risk of delivering low birth weight infants different from the national prevalence of and developing other pregnancy complications 20.1% (Figure 18). such as pre-eclampsia and maternal mortality. A weight-for-height table by week of pregnancy developed by Magbitang et al. was used in determining the nutritional status of pregnant women.

2018 Expanded National Nutrition Survey

90% LL 17.5 0.0 CI UL 22.8 22.8 Figure 18. Proportion of nutritionally-at-risk pregnant women in the Philippines and Iloilo Province: ENNS, 2018

Lactating Mothers

The CED prevalence in the province common than undernutrition. Overweight and was 10.9% and was considered of “medium” obesity prevalence was almost thrice (26.1%) public health significance in terms of the rate of those with CED. Two in every 10 magnitude and severity. Overnutrition among (26.1%) lactating mothers were overweight/ lactating mothers, however, was more obese.

Table 33. Prevalence of chronic energy deficiency (CED) and overweight/obesity among lactating mothers in the Philippines and Iloilo Province: ENNS, 2018

Philippines Iloilo Province 90% CI 90% CI Variable Prevalence Prevalence Lower Upper Lower Upper (%) (%) Limit Limit Limit Limit CED 11.0 9.5 12.5 10.9 6.9 15.0 Overweight/Obesity 28.5 26.1 30.9 26.1 18.1 34.1

Anemia prevalence among lactating significance. However, the prevalence in the mothers in Iloilo Province was 21.1% and province was not significantly different with the was considered of moderate public health national prevalence of 14.4% (Table 34).

Table 34. Prevalence of anemia among lactating mothers in the Philippines and Iloilo Province: ENNS, 2018

90% CI Prevalence (%) Lower Limit Upper Limit Philippines 14.4 12.5 16.3 Iloilo Province 21.1 10.4 31.7

2018 Expanded National Nutrition Survey

Based on the median UIE, the iodine 23.3% had percent UI level of <50µg/L, indicating status among lactating mothers in Iloilo presence of mild iodine deficiency. Province was insufficient at 92µg/L and

Table 35. Median UIE and percent urinary iodine (UI) level of <50µg/L among lactating mothers in the Philippines and Iloilo Province: 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 Iloilo Province 92 72.9 111.5 23.3 10.9 35.7

Highlights:

 Overweight and obesity were common problems among non-pregnant/ non-lactating women and lactating mothers.  One in every ten pregnant women was nutritionally-at-risk of delivering low birth weight babies.  Anemia was of “mild” and “moderate” public health significance among non-pregnant/ non-lactating women and lactating mothers, respectively.  Iodine status was adequate among non-pregnant/non-lactating women while insufficient among lactating mothers. Percent of UI level <50µg/L among non-pregnant/non- lactating women was 13.1%, and iodine deficiency prevalence among lactating mothers was at 23.3%.

2018 Expanded National Nutrition Survey

Call to Action:

 Intensify nutrition education classes focusing on the first 1000 days which covers the nutritional needs of both the pregnant mother and fetus, and those of the lactating mother and her breastfed child.  Conduct counseling on child spacing for pregnant and lactating mothers and their part- ners, particularly among young couples.  Strengthen health and nutrition services (prenatal and post natal) at health centers for pregnant mothers to prevent pregnancy-related complications and low birth weight babies.  Promote the use of Pinggang Pinoy as a guide for healthy eating habits.  Promote the importance of physical activity in preventing NCDs.  Involve community leaders and other influential people in addressing the need for increased nutritional demands during pregnancy and lactation, and the need for more rest and a decreased workload for pregnant and breastfeeding mothers.  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 to ensure adequate intake.

2018 Expanded National Nutrition Survey

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 multi-factorial nutritional problem defined as a malnutrition – undernutrition, micronutrient steady-state condition in which the food intake deficiencies, and overweight and obesity – has of an individual is inadequate for longer continuously risen and is becoming an periods of time and may result to an increased emerging threat in this age group. Moreover, risk for illnesses and other health problems. NCDs are the leading causes of death globally The prevalence of CED in Iloilo Province was and in the Philippines. These NCDs pose major higher at 8.4% than the national prevalence challenges for sustainable development (6.9%), but considered of low public health causing premature deaths and an increased significance. burden on low- and middle-income countries such as the Philippines. This section reports the Meanwhile, the prevalence of prevalence of CED, overweight and obesity, overweight and obesity among adults in Iloilo and anemia as indicators of nutritional status of Province were 24.5% and 6.9%, respectively adults 20 to 59 years old. Selected risk factors (Table 36). This indicates that one in every 3 to NCDs such as smoking, alcohol drinking, adults in the province had high BMI (>25 kg/ and binge drinking or the harmful use of m2) and may have higher risk of developing alcohol, and physical inactivity are also additional health problems. reported in this section to present the severity of 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 Iloilo Province: ENNS, 2018

Philippines Iloilo Province 90% CI 90% CI Variable Prevalence Prevalence Lower Upper Lower Upper (%) (%) Limit Limit Limit Limit CED 6.9 6.6 7.1 8.4 7.1 9.7 Overweight 28.8 28.4 29.2 24.5* 22.6 26.4 Obesity 9.6 9.3 9.9 6.9* 5.9 7.9 * significant at p<0.10

Disaggregating by age, sex and wealth among male adults (6.8%), and observed to status, the prevalence of CED was more be more prevalent among adults living in poor common among young adults belonging in the households (13.2%) (Figure 19). 20-29 years old age group. It was significantly higher among female adults (10.1%) than

2018 Expanded National Nutrition Survey

90% LL 7.1 9.1 4.0 4.1 7.5 90% LL 5.4 8.6 90% LL 9.9 5.7 CI UL 9.7 13.5 9.1 7.6 12.6 CI UL 8.2 11.6 CI UL 16.5 7.9 * significant at p<0.10 Figure 19. Prevalence of chronic energy deficiency among adults, 20 to 59 years old, by age group, sex, and wealth status in Iloilo Province: ENNS, 2018

Overweight increased with age but was Meanwhile, obesity was more more observed among adults in the age group prevalent among adults in the 30-39 years old of 40-49 and 50-59 years old. The prevalence age group. It was significantly higher among of overweight was not significantly different female adults (9.1%) and those belonging to between female adults (26.1%) and male adults non-poor households (7.9%) (Figure 21). (23.0%). However, those belonging to non-poor households (27.5%) was significantly higher than the poor households. (Figure 20).

90% LL 22.6 13.3 21.8 25.8 24.3 90% LL 20.5 23.6 90% LL 13.2 25.2 CI UL 26.4 21.2 27.8 31.8 30.4 CI UL 25.4 28.7 CI UL 18.7 29.7 * significant at p<0.10 Figure 20. Prevalence of overweight among adults, 20 to 59 years old, by age group, sex, and wealth status in Iloilo Province: ENNS, 2018

2018 Expanded National Nutrition Survey

90% LL 5.9 4.8 6.3 4.0 4.8 90% LL 3.4 7.8 90% LL 2.4 6.8 CI UL 7.9 9.2 9.6 8.6 8.1 CI UL 6.1 10.4 CI UL 5.7 9.0 * significant at p<0.10 Figure 21. Prevalence of obesity among adults, 20 to 59 years old, by age group, sex, and wealth status in Iloilo Province: ENNS, 2018

Another indicator to assess obesity is the measurement of waist and hip The prevalence of high waist circumferences. Abdominal obesity, also circumference (WC) and high waist-hip ratio known as central obesity, happens when there (WHR) among adults in Iloilo Province were is excessive built up of abdominal fat around 10.7% and 30.2%, respectively (Table 37). the stomach and abdomen. This condition has been strongly linked to cardiovascular diseases, diabetes, and some cancers.

Table 37. Prevalence of high waist circumference and high waist-hip ratio among adults, 20 to 59 years old, in the Philippines and Iloilo Province: ENNS, 2018 Philippines Iloilo Province 90% CI 90% CI Variable Prevalence Prevalence Lower Upper Lower Upper (%) (%) Limit Limit Limit Limit

High Waist Circumference 13.5 13.2 13.8 10.7* 9.7 11.7

High Waist-Hip Ratio 35.3 34.9 35.7 30.2* 28.8 31.5

* significant at p<0.10

Looking closely by age group, the (19.3%) and those living in non-poor house- trend of high WC increased with age. High WC holds (12.9%) (Figure 22). was significantly higher among female adults

2018 Expanded National Nutrition Survey

90% LL 9.7 5.9 8.0 8.0 12.9 90% LL 1.8 17.3 90% LL 3.0 11.6 CI UL 11.7 9.5 11.2 12.9 18.4 CI UL 3.3 21.2 CI UL 5.3 14.1 * 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 Iloilo Province: ENNS, 2018

On the other hand, high WHR among male adults (4.6%), and in non-poor increased with age and highest among 50-59 (33.4%) than poor households. (Figure 23). year-old age group. Moreover, this was significantly higher among female (56.8%) than

90% LL 28.8 15.9 24.7 32.2 37.3 90% LL 3.8 54.2 90% LL 18.1 32.1 CI UL 31.5 22.2 30.4 38.7 42.9 CI UL 5.5 59.4 CI UL 23.6 34.8 * 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 Iloilo Province: ENNS, 2018

Anemia is characterized by a result to numerous adverse health outcomes, decreased number of red blood cells as including impaired functional status and measured through hemoglobin determination. cognitive disorders, which may affect their The most common symptoms include productivity. weakness, irritability, and fatigue which may

2018 Expanded National Nutrition Survey

One in every 10 adults (10.0%) had anemia was considered a “mild” public health anemia in Iloilo Province. The prevalence of significance (Table 38).

Table 38. Prevalence of anemia among adults, 20 to 59 years old, in the Philippines and Iloilo Province by sex: ENNS, 2018

Disaggregation/ 90% CI Prevalence (%) Variable Lower Limit Upper Limit Philippines 8.3 7.7 9.0 Iloilo Province 10.0 8.3 11.6 Male 8.7 6.6 10.8 Female 11.4 8.7 14.0

Non-communicable diseases are The prevalence of elevated blood associated with the following modifiable pressure based on a single-visit blood behavioral risk factors namely tobacco use, pressure measurement among adults in Iloilo harmful use of alcohol, physical inactivity and Province was 16.4% while the prevalence of unhealthy diet, that result to physiologic risk high fasting blood sugar (FBS) was 7.8% factors like elevated blood pressure (BP), high (Table 39). fasting blood sugar (FBS), dyslipidemia, and obesity.

Table 39. Prevalence of elevated blood pressure and high fasting blood sugar among adults, 20 to 59 years old, in the Philippines and Iloilo Province: ENNS, 2018

Philippines Iloilo Province

Variable 90% CI 90% CI Prevalence Prevalence Lower Upper Lower (%) (%) Upper Limit Limit Limit Limit Elevated Blood Pressure 16.0 15.6 16.4 16.4 14.6 18.2 High Fasting Blood Sugar 6.7 6.2 7.2 7.8 6.3 9.2

By age group, the trend of elevated between those belonging to non-poor (17.4%) blood pressure increased with age, and it was and poor households (Figure 24), indicating significantly higher among males (21.8%). that regardless of wealth status; all adults There was no observed significant difference were at-risk to hypertension.

2018 Expanded National Nutrition Survey

90% LL 14.6 4.9 8.2 14.2 29.2 90% LL 19.2 9.4 90% LL 10.3 15.5 CI UL 18.2 8.5 14.3 21.6 38.9 CI UL 24.4 13.5 CI UL 16.2 19.3 * significant at p<0.10 Figure 24. Prevalence of elevated blood pressure among adults, 20 to 59 years old, by age group, sex, and wealth status in Iloilo Province: ENNS, 2018

Conversely, the trend of high FBS by wealth status, the prevalence of high FBS age group, increased with age. However, among non-poor households (8.8%) was higher there was no significant difference in the than the poor households (5.7%) (Figure 25). prevalence among male and female adults. By

90% LL 6.2 0.2 1.4 7.2 10.1 90% LL 5.6 5.6 90% LL 2.9 6.7 CI UL 9.1 4.0 8.6 14.5 16.3 CI UL 10.3 9.6 CI UL 8.4 10.9 * 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 Iloilo Province: ENNS, 2018

In Iloilo Province, there were 22.6% basis (at least one tobacco product a day) or on current smokers among adults or those who a regular/ occasional basis (Figure 26). smoked during the survey either on a “daily”

2018 Expanded National Nutrition Survey

90% LL 20.7 21.4 CI UL 22.4 23.9 Figure 26. Proportion of current smokers among adults, 20 to 59 years old, in the Philippines and Iloilo Province: ENNS, 2018

Current smokers were more common households (29.5%) (Figure 27). among males (43.6%) and those living in poor

90% LL 21.4 19.4 22.4 18.1 20.7 90% LL 40.8 2.5 90% LL 26.0 18.4 CI UL 23.9 26.1 26.7 22.9 25.4 CI UL 46.5 5.3 CI UL 33.0 21.8 * 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 Iloilo Province: ENNS, 2018 The proportion of binge drinkers, the among those who reported drinking in the past excessive consumption of alcoholic beverages 30 days, in Iloilo Province was 54.0% (Figure 28).

90% LL 53.3 49.5 CI UL 58.1 58.4 Figure 28. Proportion of binge drinkers among currently drinking adults, 20 to 59 years old, in the past 30 days, in the Philippines and Iloilo Province: ENNS, 2018

2018 Expanded National Nutrition Survey

Binge drinking was more common status was noted. This indicates that binge among the age group, 30-39 years old (60.8%), drinkers were common among male adults, and was significantly higher among male adults those who reported drinking in the past 30 in Iloilo Province. No significant difference in days, regardless of wealth status (Figure 29). the proportion of binge drinkers by wealth

90% LL 49.5 37.0 52.8 52.5 39.1 90% LL 53.2 13.5 90% LL 52.2 46.9 CI UL 58.4 53.5 68.8 63.7 62.3 CI UL 62.9 35.9 CI UL 73.2 55.2 * 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 Iloilo Province: ENNS, 2018

One in every four adults (25.0%) in than the Philippine estimate of 40.6% (Figure Iloilo Province was insufficiently physically 30). active. This proportion was significantly lower

LL 38.1 21.1 90% CI UL 43.1 28.9

* significant at p<0.10 Figure 30. Proportion of insufficiently physically active adults, 20 to 59 years old, in the Philippines and Iloilo Province: ENNS, 2018

2018 Expanded National Nutrition Survey

There were more physically inactive adults coming from non-poor households young adults among the 20-29 years old (26.7%) in Iloilo Province were more compared to other age groups. Female adults physically inactive than poor households (29.9%) were significantly more physically (20.4%), though not significant (Figure 31). inactive than male adults (19.5%). Furthermore,

90% LL 21.1 24.6 18.7 18.2 18.5 90% LL 16.0 24.7 90% LL 15.1 22.7 CI UL 28.9 35.0 28.3 26.3 28.4 CI UL 22.9 35.1 CI UL 25.7 30.7 * significant at p<0.10 Figure 31. Proportion of insufficiently physically active adults, 20 to 59 years old, by age group, sex, and wealth status in Iloilo Province: ENNS, 2018

Highlights:

 One in every three adults had high BMI (>25 kg/m2) and may have higher risk of developing additional health problems.  High waist circumference (WC) and high waist-hip ratio (WHR) among adults were lower than the national estimate.  Anemia was of mild severity in terms of public health significance.  The prevalence of raised blood pressure and high fasting blood sugar increased with age. Male adults were more at-risk to hypertension while non-poor households were more at- risk to diabetes.  Current smokers in the province were more common among men, and adults from poor households.  More than half were engaged in binge drinking among those who reported currently drinking alcoholic beverages in the past 30 days.  Insufficient physical activity was noted among female adults.

2018 Expanded National Nutrition Survey

. Call to Action:

 Promote Pinggang Pinoy for portion control through public and private sector initiatives.  Improve access to healthier food options while making poor diet choices more unattractive through disincentives such as higher taxes and restricted access (limited hours, zoning around schools and workplaces, etc).  Policies such as the sin tax law may have affected smoking rates but not alcohol intake, which needs to be addressed through adult-targeted social interventions.  Intensify programs on smoking cessation and alcohol consumption reduction to help adults avoid or stop smoking and binge drinking.  Revitalize and strengthen home and community production (backyard vegetable gardening, seed distribution and other farming inputs) and livelihood programs to support nutrition improvement among adults.  Conduct and strengthen regular monitoring of weight, blood pressure, fasting blood sugar, and lipid profile in health centers.  Ensure adequate supply of maintenance medicines or essential drugs at the health centers for free distribution to at-risk adults from poor households.  Revitalize and strengthen health and nutrition education activities conducted by a professional Nutritionist-Dietitians.  Organize and strengthen ehersisyo sa barangay program.  Environment interventions which encourage physical activity such as options for walking, active leisure activities and the like should be given in the form of incentives through government support and tax breaks.

2018 Expanded National Nutrition Survey

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 compared 2017). They are vulnerable to malnutrition as a 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 Iloilo Province in 2018 was 18.6% diabetes and osteoporosis as well as which is considered a medium public health problem in terms of severity and magnitude. micronutrient deficiencies are common among This was also similar with the national older persons. This section reports the prevalence of 13.4%. prevalence of CED, overweight and obesity, anemia, vitamin A status, and iodine status as The prevalence of overweight and indicators of nutritional status of the elderly 60 obesity among elderly in Iloilo Province were years old and above. Selected risk factors to 20.6% and 3.2%, respectively. These rates NCDs such as smoking, alcohol drinking and were significantly lower than national levels physical inactivity are also reported in this (Table 40). section.

Table 40. Prevalence of chronic energy deficiency (CED), overweight, and obesity among elderly, 60 years old and above, in the Philippines and Iloilo Province: ENNS, 2018 Philippines IloiloCapiz Province 90% CI 90% CI Variable Prevalence Prevalence Lower Upper Lower Upper (%) (%) (%) Limit Limit (%) Limit Limit CED 13.413.4 12.912.9 14.014.0 22.7*18.6* 18.116.2 27.221.0 Overweight 24.724.7 23.923.9 25.525.5 17.1*20.6* 14.318.1 19.823.0 Obesity 6.36.3 5.95.9 6.86.8 4.0*3.2* 2.71.8 5.34.6 * significant at p<0.10

For android type of obesity, the among the elderly in Iloilo Province were 14.3% prevalence of high WC and high WHR and 45.9%, 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 Iloilo Province: ENNS, 2018 Philippines Iloilo Province 90% CI 90% CI Variable Prevalence Prevalence Lower Upper Lower Upper (%) (%) Limit Limit Limit Limit High Waist Circumference 17.8 17.1 18.6 14.3* 12.1 16.5 High Waist-Hip Ratio 47.7 46.7 48.6 45.9 43.4 48.4 * significant at p<0.10

2018 Expanded National Nutrition Survey

Moreover, high WC and high WHR significant difference was also observed by were both significantly higher among elderly wealth status for both indicators of android females than elderly males. Likewise, obesity (Figure 32).

90% LL 12.1 0.0 19.5 4.6 14.0 90% LL 43.4 7.2 68.1 22.1 47.3 CI UL 16.5 4.9 26.4 12.1 18.4 CI UL 48.4 12.7 75.8 35.4 53.9 * 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 Iloilo Province: ENNS, 2018

The prevalence of anemia among the (Table 42). Anemia among males (44.0%) was elderly in Iloilo Province was 26.6% and significantly higher than females (15.2%). considered a „moderate‟ public health problem

Table 42. Prevalence of anemia among elderly, 60 years old and above, in the Philippines and Iloilo Province by sex: ENNS, 2018 Disaggregation/ 90% CI Prevalence (%) Variable Lower Limit Upper Limit Philippines 20.2 17.7 22.8 Iloilo Province 26.6 21.7 31.5 Male 44.0 33.7 54.4 Female 15.2* 10.2 20.1

* significant at p<0.10

Sufficient vitamin A intake among the and the most significant free radical elderly helps prevent age-related muscular scavenger highly needed by the elderly. The degeneration (AMD) or the loss of central vision prevalence of VAD among the elderly in Iloilo as people age. Also, it is a potent antioxidant Province was low at 1.2% (Table 43).

Table 43. Prevalence of vitamin A deficiency among elderly, 60 years old and above, in the Philippines and Iloilo Province: ENNS, 2018 90% CI Prevalence (%) Lower Limit Upper Limit Philippines 1.1 0.6 1.8 Iloilo Province 1.2 0.2 6.7

2018 Expanded National Nutrition Survey

Iodine intake of elderly in Iloilo Province and 33.7% had percent UI level of <50µg/L, was insufficient based on median UIE of 82µg/L indicating presence of mild iodine deficiency (Table 44) . Table 44. Median UIE and percent urinary iodine (UI) level of <50µg/L among elderly, 60 years old and above, in the Philippines and Iloilo Province: 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 Iloilo Province 82* 70.6 94.3 33.7* 28.4 39.0 * significant at p<0.10

Three in every ten (33.7%) elderly in the prevalence of high fasting blood sugar Iloilo Province had raised blood pressure while was 15.2% (Table 45).

Table 45. Prevalence of elevated blood pressure and high fasting blood sugar among the elderly, 60 years old and above, in the Philippines and Iloilo Province: ENNS, 2018

Philippines Iloilo Province 90% CI 90% CI Variable Prevalence Prevalence (%) Lower Upper (%) Lower Upper Limit Limit Limit Limit Elevated Blood Pressure 35.0 33.7 36.2 33.7 30.8 36.6 High Fasting Blood Sugar 13.8 12.2 15.5 15.2 10.9 19.6

The proportion of current smokers For physical activity among the (16.1%) among the elderly respondents in Iloilo elderly, four in every ten (41.5%) were Province was not significantly different with the insufficiently physically active in Iloilo national estimate (16.3%). On the other hand, Province. This proportion was significantly the proportion of current alcohol drinkers was different compared with the national level significantly lower at 18.7% than the national (50.6%). estimate (28.2%). Smoking and harmful use of alcohol raise the risks for NCDs.

90% LL 15.5 25.8 48.5 90% LL 13.6 16.2 36.9 CI UL 17.1 30.5 52.7 CI UL 18.6 21.2 46.1 * 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 Iloilo Province: ENNS, 2018

2018 Expanded National Nutrition Survey

Highlights:

 The nutritional concerns of senior citizens or elderly in Iloilo Province included CED, overweight, high waist circumference, high waist-hip ratio, elevated blood pressure, high fasting blood sugar, and physical inactivity;  CED prevalence in the province was considered a “medium” public health significance;  Anemia prevalence was of “moderate” public health significance; and  Iodine intake of elderly was insufficient with median UIE of 82µg/L. The prevalence of iodine deficiency was at 33.7%.

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 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).  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.

2018 Expanded National Nutrition Survey

Conclusion and Recommendations

Based on the results, undernutrition evident among 0 to 59 month old children and and micronutrient deficiencies were palpable school-age children. Among adolescents, nutrition concerns in the province of Iloilo. It stunting and anemia were still of public health was pervasive across all age groups and concern. The initiation of smoking and alcohol experienced more by those belonging to poor drinking, and high rates of insufficient physical households. Among 0 to 23 month old children, activity increase the risk for NCDs. despite high undertaking of early breastfeeding Overnutrition was a concern among non- initiation (89.5%) and exclusive breastfeeding pregnant/non-lactating women and lactating (69.7%) during the first six months of life, mothers, as well as the high rates of anemia continued breastfeeding at one year and two and iodine deficiency among lactating years of age was only 61.1% and 40.5%, mothers. Among adults and elderly, high rates respectively. Also, dietary diversity of children of overnutrition, and high rates of smoking, during the complementary feeding period was alcohol drinking, and physical inactivity were suboptimal, with only 27.1% of children, 6-23 observed. At the household level, food months, meeting the minimum dietary diversity, insecurity was experienced by three out of 5 and a very low percentage (13.1%) meeting the households (60.5%), with one in every 10 of minimum acceptable diet, suggesting that the the households had experienced severe food children‟s complementary food have insecurity (10.2%), which may have inadequate level of energy and nutrients. contributed to the nutrition and health Undernutrition with high rates of stunting and problems in the province. underweight, and micronutrient deficiency were

Health Policy Recommendations

It is recommended that the Development programs, identified in this implementation of target-focused development survey, should prioritize maternal and child programs and policies on health and nutrition health and nutrition in order to contribute to must be accelerated to address the different the achievement of the Sustainable health and nutrition concerns in the province. Development Goals by 2030.

2018 Expanded National Nutrition Survey

References

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2018 Expanded National Nutrition Survey

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 Socio- ENNS Form 1.1 HH Head AR Information 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 Mother/ ENNS Form 1.3 Food Security AR Insecurity 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, ENNS Form 4.1 Mother Anthropometry AR 0-71 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 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 5 CHILDREN, 24-71 MONTHS OLD Birthweight and Related Information of Children, ENNS Form 4.1 Mother Anthropometry AR 0-71 Months Government Program Participation of Children, 0-71 Government ENNS Form 4.3 Mother AR Months Program 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 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 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 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 15y and above Program and Above)

2018 Expanded National Nutrition Survey

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 and giver/ Member, AR Clinical 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 Member, Clinical & ENNS Form 5.2 AR/CHR Questionnaire 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 and giver/ Member, AR Clinical 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/

2018 Expanded National Nutrition Survey

Annex 2. ENNS Survey Team TEAM I

Team Coordinator Ma. Lilibeth P. Dasco Alternate Team Coordinator Maylene P. Cajucom Assistant Coordinator Taharudin B. Rachman Field Monitoring Supervisor Fritz Jerald C. Pinlac (Biochemical) Statistician Cheder B. Sumangue Information Technologist/ John Carlo Velasquez and Archie C. Umlas Programmer Special Disbursing Officers Sheryl C. Velasco Ma. Lilibeth P. Dasco

Team Leader (Technical) Kathrina N. Almenie May Jane D. Patnaan Marites E. Ambayec Lorelane C. Ramirez Jannet O. Gutierrez Ma. Cristina Velez

Team Leader (Operations) Mary Grace E. Adolfo Melody O. Lamangen Chriseldy S. America Dianne Leticia A. Lambito Janine Ruth S. Barrozo Diana C. Lodriguito

Anthropometric Researchers Marnellie S. Abanilla Aiza S. Getalla Adrian Jay A. Almario Ben-Nasir J. Jala Richzanne Grace S. Arrojado Joshua Elijah L. Lira Charlene G. Batusin-in Victor Emman D. Monzon Trisha Kaye D. Butlay Matthew Raul C. Quidato Jr. Ma. Leica Grace V. Cabinbin Ginivie Y. Rendon Jasmin S. Dinopol Erwin Y. Salen Kathleen Ruth Terese P. Dolores Janet D. Salomes Bernie Jhon G. Gentoba Christine E. Su

Dietary Researchers Medarcha S. Adjajul Noime M. Loable Cristy T. Agpalo Erwin Ray E. Octavio Stephanie C. Barrio Charlene B. Onas Kimberly M. Basiya Maria Cassandra B. Ortaliz Nylisa Joie D. Bron Jonah Mae J. Padernal Kayla Anne D. Calumpong Eloisa Luz C. Prado Rachelle G. Dela Cruz Danisse Nicole G. Quindo Lailanie M. Entol Carol Fe C. Repil Cassandra A. Eparwa Dianne B. Delos Reyes Kristine Mae N. Esparas Jan Abigail C. Sablon Jane M. Fernandez Noeme N. Taglinao Kathleen Jane K. Gabuya Dovie Dawn A. Vergara Raiza B. Jama

Biochemical Researchers John Vincent B. Canlas John Gideon A. Narvaez Coreen Maurice I. Gianan Cristine Joy F. Sedano Kurt Ivan M. Hernandez Mica Gelline T. Villalon

Clinical and Health Researchers Krizzle Love J. Bulaga Van Jay B. Degala Happie C. Capapas Jeanifer G. Quistadio Hardy John F. Daria Roarke Luigi C. Virtudazo

Science Aides Dustin A. Amigo Harold E. Dorado Alvin N. Angeles Dennis F. San Gabriel Joseph R. Bustos Elmer J. Ramat

2018 Expanded National Nutrition Survey

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

77 2018 Expanded National Nutrition Survey

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

2018 Expanded National Nutrition Survey