EASTERN DISSEMINATION FORUM October 1, 2019 Ironwood Hotel, City 2018 Expanded National Nutrition Survey METHODOLOGY Old Survey Design of the NNS Features Description Survey Design One shot (one year) every 5 years Coverage 17 regions, 81 provinces National, Regional, Level of Disaggregation Provincial for some indicators Target Number of Households 60,000 Households and all members of the sampled Target Population households Duration of Data Collection 6.5 Months (one shot) for the reference year Why did we change the design of the NNS?

. Provide Province and HUC Level estimates for local planning of specific and sensitive interventions of our stakeholders

. Provide reliable National Level Estimates annually Why did we change the design of the NNS?

. Adoption of the new Master Sample of the PSA to provide reliable estimations at the Province and HUC Levels Sampling Design of the 2018 ENNS 2013 Master Sample of PSA

Sampling domains: 2-Stage Cluster Sampling Design 81 provinces st 33 HUCs 1 Stage - PSUs 3 other areas PSU size ranges from (Pateros, City, City) 100 to 400 households z 16 sample replicates are drawn from each domain 2nd stage

Households from 16 replicates (1,536)

Icons used were retrieved from http://www.flaticon.com What is the Survey Design of the 2018 NNS?

40 Provinces & ROLLING HUCs for 2018 40 Provinces & for HUCs for 2019 SURVEY 37 Provinces & 3YEARS HUCs for 2020 Target coverage per sampling domain is 1,536 households PSA Board Resolution No. 06 Approving and Adopting the Survey Design of the Expanded National Nutrition Survey How did we select the provinces and HUCs to be included in the 2018 ENNS?

Grouping of provinces and HUCs with similar characteristics into replicates

A replicate has at least 5 Test variables provinces and HUCs Number of persons Number of birth registered Number of OFWs 2010 Census of Number of WRA Population and Housing Number of infants Number of children below 5

Number of disabled members Replicated Sampling Replicated Formation of replicates Provinces and HUCs covered in the 2018 ENNS

Cagayan Valley Isabela City

Isabela Province City De Oro City

Nueva Vizcaya City Olongapo City Mandaue City City of Davao City

Zambales City of Caloocan

Bulacan Eastern Samar City of San Juan

Laguna Tacloban City City of Las Piñas Western Samar City of Makati Baguio City

Sorsogon City of Mandaluyong

Aklan City of Taguig Level Eligible Response Response Rate (%)

Household 52,285 45,957 87.9

Individuals 196,332 159,926 81.5 Households Individual

Eligible Response Response Eligible Response Response Rate (%) Rate (%)

Philippines 52,285 45,957 87.9 196,332 159,926 81.5

Eastern Samar 1,496 1,447 96.7 6,208 5,697 91.8 2018 Expanded National Nutrition Survey

Sociodemographic and Socioeconomic Profiles of Households and Its Individual Members Socioeconomic Status

• refers to the social standing or class of an individual or group. It is often measured as a combination of education, income and occupation.

Adapted from APA’s Socioeconomic Status Office publications Operational Definitions Household

• an aggregate of persons, generally but not necessarily bound by ties of kinship, who sleep in the same housing unit and have a common arrangement for the preparation and consumption of food. Operational Definitions Household head • person who generally provides the chief source of income for the household unit • adult person, male or female, who is responsible for the organization and care of the household or who is regarded as such by the members of the household Operational Definition Highest Educational Attainment* • refers to the highest grade/year of formal schooling completed by each member of the household and not the total years attended • Regrouped into: a) None - no grade completed b) Elementary level - the stage of formal education concerned with providing the first six years of basic education. c) Secondary level - the stage of formal education following the elementary level concerned primarily with continuing basic education and expanding it to include the learning of employable gainful skills, usually corresponding to four years of high school d) College level - the stage of formal education following the secondary level covering non-degree programs that have varying duration for three months to three years, concerned primarily with developing strong and appropriately trained middle-level skilled manpower possessing capabilities supportive of national development. e) Others - Alternative Learning System, SPED , Arabic Schooling * Phil. Standard Classification of Education (PSCEd) Operational Definition Occupation • The occupation of each individual members of the household, 10 years old and above in the past 6 months

• 2012 Philippine Standard Occupational Codes (PSOC) is a statistical classification of the different occupational groups of the working population, including the military work force in the country Sociodemographic Profile • Describes the population groups by: a) age - refers to the exact age of each household member as of his/her last birthday b) sex – categorized the household members of the households as males and females c) civil status – or marital status d) type of residence - urban-rural classification of PSA Operational Definitions Civil status - status of an individual in relation to marriage and classified as: a) Single - a person who has never been married b) Married - a person who has been united in matrimony with another person of opposite sex through a religious or civil rites. To be considered married, the couple should still be living together, or if living apart from each other, the separation must only be temporary (e.g. working elsewhere, attending seminars, etc) c) Separated - a person whose partner has left permanently, with or without legal sanctions. d) Widowed - a person who has been married before, whether formally or consensually but his/her partner has died and has not remarried at the time of visit. e) Common law/live-in – those who live together consensually with another as husband or wife Operational Definition Wealth Index • The wealth index is a composite measure of a household's cumulative living standard. The wealth index is calculated by principal component analysis using data on household’s ownership of selected assets, materials used for housing construction and types of water access and sanitation facilities. Wealth Index • The wealth index categorizes the households into 5 wealth quintiles, allowing us to assess how the common health and nutrition indicators differ between the poor and non-poor households. • For the provincial and HUCs estimates, wealth status is classified as poor for the bottom 30% of the income group and the non-poor for the upper 30%. Eastern Samar Profile of Households Household Size Sex of Household Members

Mean 4.6

5 members and below 69.4%

Male Female More than 5 30.6% members 50.8% 49.2% Population Groups

Age groups n (%) Women of Reproductive Age 0-23 months 214 4.4 n (%)

24-71 months 547 10.5 45 3.7

72-120 months 598 9.8 154 12.8 >10-19 years 1,340 22.7

20-59 years 2,336 42.5 1,020 83.4

60 years and over 671 10.1 Profile of Household Heads Sex Civil Status 100

80

60 54.3

40

20.5 Male Female 20 14.0 7.2 82.5% 17.5% 4.0 0 Separated Single Widowed Common Married Law/Live-in Farmers, Forestry workers, Fishermen 46.9 Laborers and unskilled workers 16.0 Plant and machine operators 9.8 Occupation Service Workers 8.6 Craft and related traders workers 8.1 Officials of the gov't, Corporate executives, managers, supervisors 3.5 Professionals 2.3 Technicians and associate prof 2.1 Clerks 1.7 Not classified elsewhere 0.7 Special Occupations 0.3

0 10 20 30 40 50 60 70

70.0 60.0 48.5 50.0 Educational 40.0 30.6 30.0 Attainment 17.5 20.0 10.0 3.4 0.1 0.0 No education Elementary level Secondary level College level Others

FOOD SECURITY

“exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life”. (World Food Summit, 1996) FOOD INSECURITY

“limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways” (Institute of Nutrition, 1990) When recurrent leads to hunger and hunger when prolonged results to malnutrition METHODOLOGY Questionnaire  Household Food Insecurity Access Scale (HFIAS)

 nine-item questionnaire  based on the respondent’s perception over food situations, resources or supply  self-reported experience in the past month HOUSEHOLD FOOD INSECURITY ACCESS SCALE (HFIAS) Percentage of households by food security status: , 2015 vs. 2018 Percentage of food insecure households : 66.1% vs. 53.9%

100 2015 2018

80

60 46.1 40 33.9 31.9 28.8 21.9

20 12.3 12.3 12.8 Percentage

0 Food Secure Mildly Food Insecure Moderately Food Severely Food Insecure * Insecure *

* Significantly different at 5% level of significance Percentage of households by food insecurity items: Philippines, 2018 Percentage of food insecure households = 53.9%

Worried about food 50.3 49.7 Yes No Unable to eat preferred food 47.5 52.5 Ate just a few kinds of food 43.2 56.8 Ate food they really do not want to eat 37.8 62.2 Ate a smaller meal 33.8 66.2 Ate a fewer meals in a day 19.1 80.9 Had no food of any kind in the household 7.7 92.3 Experienced going to sleep hungry 7.3 92.7 Experienced going a whole day and night without eating 3.3 96.7

0 20 40 60 80 100 % Percentage of households by food security status by wealth status, household size and sex of household head: Philippines, 2018

Food Secure Food Insecure 100 90 82.0 84.1 80 70 62.1 60 53.9 55.7 49.6 50.4 51.8 48.2 50 46.1 44.3 37.9 40 30

Percentage 18.0 20 15.9 10 0 PHILIPPINES Wealth Quintile (Bottom Wealth Quintile (Upper 1-5 members More than 5 members Male Female 20%) 80%) Wealth Status Household Size Sex of Household Head Food Security Status Eastern Samar, 2018 Percentage of households by food security status: Eastern Samar, 2018

100 Philippines 100 Eastern Samar

80 80

60 60 46.1 39.2* % 40 % 40 28.8 28.0* 20.5* 20 12.3 12.8 20 12.2

0 0 Food Secure Mildly Food Moderately Food Severely Food Food Secure Mildly Food Moderately Food Severely Food Insecure Insecure Insecure Insecure Insecure Insecure

90% Confidence Interval 90% Confidence Interval LL 44.1 11.7 27.1 11.2 LL 24.4 10.0 36.9 17.4 UL 48.0 12.9 30.5 14.4 UL 31.7 14.5 41.6 23.5 * p<0.10 Percentage of households by food insecurity items: Eastern Samar Province, 2018 Percentage of food insecure households = 72.0%

Worried about food 66.8 33.2 Yes No Unable to eat preferred food 66.9 33.1 Ate just a few kinds of food 61.2 38.8 Ate food they really do not want to eat 54.6 45.4 Ate a smaller meal 48.1 51.9 Ate a fewer meals in a day 29.3 70.7 Had no food of any kind in the household 11.3 88.7 Experienced going to sleep hungry 10.2 89.8 Experienced going a whole day and night without eating 4.1 95.9

0 20 40 60 80 100 % Percentage of households by food security status by wealth status, household size and sex of household head: Eastern Samar, 2018

Food Secure Food Insecure 100 86.2 90 81.4 80 72.0 72.9 67.6 70 65.9 67.0 60 50 40 34.1 32.4 33.0 28.0 30 27.1

Percentage 18.6 20 13.8 10 0 Eastern Samar Poor* Non-poor 1-5 members * More than 5 members Male Female Wealth Status Household Size Sex of Household Head

* p<0.10 Summary

Eastern Samar

Food insecurity is higher among households: Poorer Households (bottom 30%)

Households with >5 members Nutritional Status of Filipino Preschool-Age Children in Eastern Samar

Prevalence of malnutrition among children under five (0-59 months) in the Philippines and Eastern Samar: ENNS, 2018 Philippines Eastern Samar

40 40 30.3 32.1 30 30 19.1 20 20

13.7 Prevalence Prevalence (%) Prevalence Prevalence (%) 10 5.6 10 4.0 3.3 3.1 0 0 Underweight Stunting Wasting Overweight-for-Height Underweight Stunting Wasting Overweight-for-Height 90% CI Underweight Stunting Wasting Overweight- 90% CI Underweight* Stunting Wasting* Overweight- for-Height for-Height Lower 17.7 28.2 5.2 3.6 Lower 11.1 28.2 2.1 2.0 Limit Limit Upper 20.5 32.4 6.1 4.3 Upper 16.3 36.0 4.6 4.2 Limit Limit

* significantly different at 10% level of significance Prevalence of malnutrition among children under five (0-59 months) by sex and wealth status: Eastern Samar ENNS, 2018

60 Underweight 60 Stunting

50 50 41.6 40 40 32.1 32.2 32.0 30 30 27.3 19.1 20

13.7 13.8 13.6 20 Prevalence Prevalence (%) 10.2 Prevalence (%) 10 10

0 0 All Male Female Poor Non-Poor * All Male Female Poor* Non-Poor

* significantly different at 10% level of significance Prevalence of malnutrition among children under five (0-59 months) by sex and wealth status: Eastern Samar ENNS, 2018

20 Wasting 20 Overweight-for-Height

10 10 Prevalence Prevalence (%) 4.2 4.4 Prevalence (%) 4.0 3.9 3.3 3.1 2.3 2.4 2.3 2.8

0 0 All Male Female Poor Non-Poor All Male Female Poor Non-Poor in preschool-age children Prevalence of anemia among preschool-age children 6 mos to 5 years old (6-71 months) in Eastern Samar: ENNS, 2018

30 25.8

19.6 20 15.6

14.3 Prevalence (%) Prevalence 10

0 Philippines Eastern Samar Male Female 90% CI Philippines Eastern Samar Male Female Lower 12.8 14.4 16.1 6.9 Limit Upper 15.9 24.7 35.6 24.3 Limit PREVALENCE OF IDD AND VAD

• Urinary iodine excretion and the determination of IDD is not covered among preschool-age children.

• Serum retinol and the determination of Vitamin A deficiency (VAD) is in-progress. Infant and Young Child Feeding Practices Breastfeeding Practices Proportion of infants 0-23 months old, by breastfeeding practices

100 Philippines 100 Eastern Samar

80 80 69.2 70.0 68.9 62.5 54.9 60 50.6 60

38.4

40 33.1 40

Proportions(%) Proportions(%) 20 20

0 0 Timely Exclusive Continued Continued breastfeeding breastfeeding breastfeeding at 1 breastfeeding at 2 Timely Exclusive Continued Continued initiation year years breastfeeding breastfeeding breastfeeding at 1 breastfeeding at 2 initiation year years

90% CI 90% CI

Lower Limit 65.2 51.2 45.4 29.3 Lower Limit 55.0 56.6 52.1 24.0 Upper Limit 73.1 58.5 55.9 37.0 Upper Limit 70.0 83.4 85.7 52.9 Complementary Feeding Practices MINIMUM DIETARY DIVERSITY

Proportion of children 6-23 months of age Minimum Dietary who receive foods from 4 or more food Diversity: groups (DDS > 4) of the following 7 food groups:

1. Grains, roots and tubers 3. Legumes and Nuts 6. Vitamin A rich fruits & vegetables

5. Eggs 7. Other fruits & vegetables 2. Dairy Products 4. Flesh Meat Minimum Meal Frequency

Proportion of breastfed and non-breastfed Minimum children 6-23 months who received solid, Meal semi-solid, or soft foods consumed at the Frequency: minimum number of times per day

Defined as: 2x for breastfed infants 6-8 months old 3x for breastfed children 9-23 months old 4x for non-breastfed children 6-23 months old Minimum Acceptable Diet

Proportion of children 6-23 months meeting Minimum both the minimum dietary diversity and the Acceptable minimum meal frequency to ensure both Diet: dietary and nutrient adequacy. Proportion of children 6-23 months, by complementary feeding practices 100 100 89.0 Philippines 88.4 Eastern Samar

80 80

60 60

40 40

Proportions(%) Proportions(%) 23.0 20 13.4 20 13.4 5.9 0 0 Minimum Dietary Minimum Meal Minimum Acceptable Minimum Dietary Minimum Meal Minimum Acceptable Diversity Frequency Diet Diversity * Frequency Diet *

90% CI 90% CI Lower Limit 21.1 87.6 12.4 Lower Limit 8.9 82.6 3.4 Upper Limit 24.9 90.4 14.4 Upper Limit 17.9 94.2 8.4

* significantly different at 10% level of significance Summary • Underweight and wasting prevalence in Eastern Samar is significantly lower, compared to the national results among preschool-age children. • Stunting is higher, while overweight is lower compared to national results but not significant. • Anemia is a “mild to moderate” public health problem among preschool- age children. • Exclusive breastfeeding among infants 0-5 months is higher than the national estimate. • Complementary feeding among children 6-23 months of age is inadequate in energy and nutrient as indicated by minimum dietary diversity (MDD) and minimum acceptable diet (MAD). Nutritional Status of Filipino School-Age Children Eastern Samar Prevalence of malnutrition among school-age children (5 to 10 years old) in the Philippines and Eastern Samar: ENNS 2018

Philippines Eastern Samar 27.7 28.7 30 24.9 24.6 30

20 20 11.6

10 7.6 10 5.4 6.7

Prevalence Prevalence (%) Prevalence (%)

0 0 Underweight Stunting Wasting Overweight & Obese Underweight Stunting Wasting Overweight & Obese 90% Overweight & 90% Overweight & Underweight Stunting Wasting Underweight Stunting Wasting CI Obese CI * Obese* Lower Lower Limit 23.1 22.8 7.2 10.4 Limit 24.7 25.8 3.7 4.7

Upper Upper Limit 26.8 26.5 7.9 12.9 Limit 30.7 31.5 7.1 8.7

* significantly different at 10% level of significance Prevalence of malnutrition among school-age children (5 to 10 years old) by sex and wealth status: Eastern Samar ENNS, 2018

50 Underweight 50 Stunting

38.2 40 36.1 40 31.2 31.7 27.7 28.7 30 30 25.4 23.9 23.1 23.9

20 20

Prevalence Prevalence (%) Prevalence Prevalence (%) 10 10

0 0 All Male Female Poor * Non-Poor All Male Female Poor * Non-Poor

* significantly different at 10% level of significance Prevalence of malnutrition among school-age children (5 to 10 years old) by sex and wealth status: Eastern Samar ENNS, 2018

Overweight & Obese 30 Wasting 30

20 20

9.4

10 10 8.4 Prevalence Prevalence (%) Prevalence Prevalence (%) 6.9 6.7 5.4 5.6 5.2 5.1 5.2 1.7 0 0 All Male Female Poor Non-Poor All Male Female Poor* Non-Poor

* significantly different at 10% level of significance in school-age children Prevalence of anemia among school-age children (6 to 12 years old) in Eastern Samar: ENNS, 2018

30

20

13.5

Prevalence Prevalence (%) 10 7.2 7.4 6.8

0 Philippines Eastern Samar Male Female 90% CI Philippines Eastern Samar* Male Female Lower 11.8 5.4 5.1 2.9 Limit

Upper 15.2 8.9 9.7 10.6 Limit

* significantly different at 10% level of significance Iodine Status among School-age children in Eastern Samar Median UIEº and Percent UIE below 50μg/L among school-age children (6 to 12 years old) in Eastern Samar: ENNS, 2018

300 20

250 16.8 14.0 200 180 168 11.5 11.3 150

10 Median

100 Percentage (%) Percentage

50

0 0 Philippines Eastern Samar Philippines Eastern Samar Male Female 90% CI 90% Eastern Philippines Eastern Samar Philippines Male Female CI Samar Lower 177.6 154.0 Lower Limit Limit 10.3 11.6 13.4 7.8 Upper 183.2 181.8 Upper Limit Limit 12.7 16.3 20.1 14.7

⁰Iodine Intake <100 μg/L – Insufficient 100-199 μg/L – Adequate 200-299 μg/L – More than Adequate 300 μg/L and up - Excessive Summary • Wasting and overweight & obesity prevalence in Eastern Samar is significantly lower, compared to the national results among school-age children. • Underweight and stunting prevalence is higher compared to the national results but not statistically significant. • Anemia prevalence is a public health problem with mild severity. • Iodine intake of school-age children is adequate based on median urinary iodine, however pockets of IDD is present. Nutritional Status of Filipino Adolescents Eastern Samar Nutritional Status of Adolescents, >10 to 19 years old: Philippines and Eastern Samar, 2018 50 PHILIPPINESPHILIPPINES 50 EASTERN SAMAR

40 40 31.1 30 26.3 30

20 20 Prevalence (%) Prevalence Prevalence (%) Prevalence 11.3 11.6 10.0 10 10 6.2

0 0 Stunting Wasting Overweight and Stunting* Wasting Overweight and Obese Obese*

90% LL 24.7 10.5 10.7 90% LL 28.7 8.2 5.1 CI CI UL 28.0 12.1 12.5 UL 33.6 11.7 7.3

* significantly different at 10% level of significance Prevalence of Stunting among Adolescents, >10 to 19 years old by sex and wealth status: Eastern Samar, 2018

50

41.6 40 34.8 31.1 30 26.8 27.5

20 Prevalence (%) Prevalence

10

0 All Male* Female Poor* Non Poor

* significantly different at 10% level of significance Prevalence of Wasting among Adolescents, >10 to 19 years old by sex and wealth status: Eastern Samar, 2018

20

15

10.7 10.0 9.9

10 9.1 9.5 Prevalence (%) Prevalence 5

0 All Male Female Poor Non Poor Prevalence of Overweight and Obese among Adolescents, >10 to 19 years old by sex and wealth status: Eastern Samar, 2018

10

8.3 8.1 8

6.2 6

4.3

4 Prevalence (%) Prevalence 1.9 2

0 All Male* Female Poor* Non Poor

* significantly different at 10% level of significance OPERATIONAL DEFINITION PHYSICAL ACTIVITY

Insufficiently Physically Active

- Doing less than 60 minutes of moderate- to vigorous-intensity physical activity per day

Reference: World Health Organization (2015) Global Reference List of 100 Care Health Indicators. Geneva 27, Switzerland Proportion of insufficiently physically active adolescents >10 to 19 years old: Philippines and Eastern Samar, 2018

100

76.3 80 72.1

60

40 Prevalence (%) Prevalence 20

0 Philippines Eastern Samar*

90% LL 74.8 69.8 CI UL 77.7 74.4

* significantly different at 10% level of significance Proportion of insufficiently physically active adolescents >10 to 19 years old by sex and wealth status: Eastern Samar, 2018

100

79.9 80 72.1 74.1 65.0 68.1

60

40 Proportion (%) Proportion

20

0 All Male* Female Poor Non Poor

* significantly different at 10% level of significance Smoking Status of Filipino Adolescents OPERATIONAL DEFINITION SMOKING

CURRENT SMOKERS

– those who smoked during the survey either on a “daily” basis (at least one cigarette a day) or on a regular/occasional basis

• Occasional smokers are those who do not smoke daily but who smoke at least weekly and

• those who smoke less often than weekly

Reference: World Health Organization Proportion of current smokers among adolescents, >10 to 19 years old: Philippines and Eastern Samar, 2018

10.0

8.0

6.0

4.0

4.0 3.8 Prevalence (%) Prevalence

2.0

0.0 Philippines Eastern Samar

90% LL 3.7 2.7 CI UL 4.4 4.8 Proportion of current smokers among adolescents, >10 to 19 years old by sex and wealth status: Eastern Samar, 2018

10

8 7.0

6 5.1

3.8

4 3.4 Prevalence (%) Prevalence

2

0.2 0 All Male* Female Poor Non Poor

* significantly different at 10% level of significance Drinking Status of Filipino Adolescents OPERATIONAL DEFINITION DRINKING

CURRENT DRINKERS

– those who consumed one or more drinks of any type of alcohol in the year preceding the survey

Reference: World Health Organization Proportion of current drinkers among adolescents, >10 to 19 years old: Philippines and Eastern Samar, 2018

50

40

30 24.7

20 16.8 Prevalence (%) Prevalence

10

0 Philippines Eastern Samar*

90% LL 15.2 22.1 CI UL 18.4 27.2

* significantly different at 10% level of significance Prevalence of anemia among adolescents, >13 to 19 years old: Philippines and Eastern Samar, 2018

10

8.1 7.8 8

6

4 Prevalence (%) Prevalence 2

0 Philippines Eastern Samar

LL 7.4 6.1 90% UL 8.8 9.5 CI Significance Mild Mild Prevalence of anemia among adolescents, >13 to 19 years old by sex: Eastern Samar, 2018

20

15 12.6

10 7.8

Prevalence (%) Prevalence 4.8 5

0 All Male * Female

* significantly different at 10% level of significance Summary • About 3 in every 10 adolescents are stunted; stunting is more prevalent in poor than non-poor households • The prevalence of overweight and obese adolescents are significantly lower than the national prevalence; overweight and obesity is more prevalent in non-poor than poor households • Majority of adolescents are insufficiently physically active; prevalence among females is significantly higher than in males • Adolescent current smokers are more prevalent in males than in females • Anemia prevalence is significantly higher in females than in males Summary

• Majority of adolescents are insufficiently physically active; prevalence among females is significantly higher than in males • Adolescent current smokers are more prevalent in males than in females • Anemia prevalence is significantly higher in females than in males Nutrition Situation of Women of Reproductive Age Eastern Samar

Prevalence of chronic energy deficiency (CED), overweight and obesity among non- pregnant/non-lactating women of reproductive age, 15-49 years old, 2018 PHILIPPINES EASTERN SAMAR

CED Overweight and Obese CED Overweight and Obese 50 50 40 35.3 40 32.4 30 30 20 20 9.4

10 7.8 10

Prevalence (%) Prevalence Prevalence (%) Prevalence 0 0

90% CI CED Overweight and Obese 90% CI CED Overweight and Obese Lower Limit 7.3 33.7 Lower Limit 8.0 30.3 Upper Limit 8.3 36.9 Upper Limit 10.8 34.5

Proportion of nutritionally-at-risk pregnant women: Philippines and Eastern Samar, 2018 50 40 24.3 30 20.1 20 10

0 Proportion (%) Proportion Philippines Eastern Samar

LL 17.5 14.6 90% CI UL 22.8 34.0

Prevalence of chronic energy deficiency (CED), overweight and obesity among lactating mothers, 2018 PHILIPPINES EASTERN SAMAR

CED Overweight and Obese CED Overweight and Obese 50 50 40 40 32.3 28.5 30 30 20 20 11.0

10 10 7.1

Prevalence (%) Prevalence Prevalence (%) Prevalence 0 0

90% CI CED Overweight and Obese 90% CI CED Overweight and Obese Lower Limit 9.5 26.1 Lower Limit 3.6 24.8 Upper Limit 12.5 30.9 Upper Limit 10.6 39.9

Prevalence of anemia among lactating mothers and non- pregnant/non-lactating women of reproductive age, 15-49 years old: Philippines and Eastern Samar, 2018 Non- Preg/Lact Lactating 50 40 30 20 11.6 14.4 10.1 11.3 10

Prevalence (%) Prevalence 0 Philippines Eastern Samar

90% CI NPNL Lactating 90% CI NPNL Lactating Lower Limit 11.0 12.5 Lower Limit 7.8 3.6 Upper Limit 12.3 16.3 Upper Limit 12.3 18.9 ºMedian UIE and Percent UIE below 50ug/L among non- pregnant/non-lactating women of reproductive age, 15-49 years old: Philippines and Eastern Samar, 2018

250 50 200 40 170 163 30 150 20

Median 11.3 11.5

100 10 Percentage (%) Percentage 50 0 Philippines Eastern Samar Philippines Eastern Samar

90% LL 167.9 153.1 90% LL 10.7 9.5 CI UL 172.1 172.6 CI UL 12.0 13.5

ºIodine Intake based on median UIE <100 ug/L – Insufficient 100-199 ug/L – Adequate 200-299 ug/L – More than Adequate 300 ug/L and up - Excessive ºMedian UIE and Percent UIE below 50ug/L among lactating mothers of reproductive age, 15-49 years old: Philippines and Eastern Samar, 2018

250 50 200 40 30 24.7 150 21.2

103 112 20 Median

100 10 Percentage (%) Percentage 50 0 Philippines Eastern Samar Philippines Eastern Samar

90% LL 98.5 88.9 90% LL 19.7 17.2 CI UL 106.5 135.4 CI UL 22.8 32.2

ºIodine Intake based on median UIE <100 ug/L – Insufficient 100-199 ug/L – Adequate 200-299 ug/L – More than Adequate 300 ug/L and up - Excessive SUMMARY

• 1 in every 3 non-pregnant/non-lactating women and lactating mothers are overweight/obese in Eastern Samar. • Proportion of nutritionally-at-risk pregnant women is higher in Eastern Samar compared to the national estimate, though not statistically significant. • Prevalence of anemia is lower among non-pregnant/non-lactating women and lactating mothers in Eastern Samar compared to the national estimate, though not statistically significant. • Non-pregnant/non-lactating women in Eastern Samar have adequate iodine intake however pockets of the population group (11.5%) have UIE level below 50 ug/L. • Lactating mothers in Eastern Samar have adequate iodine intake however pockets of the population group (24.7%) have UIE level below 50 ug/L. Health and Nutritional Status of Filipino Adults Eastern Samar Nutritional Status of Adults, 20 to 59 years old: Philippines and Eastern Samar, 2018

50 PHILIPPINES 50 EASTERN SAMAR

40 40 28.8 30 30 25.5

20 20

9.6 9.3 Prevalence (%) Prevalence Prevalence (%) Prevalence 10 6.9 10 6.8

0 0 Chronic Energy Overweight Obese Chronic Energy Overweight* Obese Deficient Deficient

90% LL 6.6 28.4 9.3 90% LL 6.0 24.0 8.0 CI UL 7.1 29.2 9.9 CI UL 7.5 27.0 10.6

* significantly different at 10% level of significance Chronic Energy Deficiency among Adults, 20-59 years old, by age group, sex, and wealth status: Eastern Samar, 2018

20 20 25

20 15 15

11.3 15 10 10 8.5 10.0 10 6.8 6.3

Prevalence Prevalence (%) 5.3 4.8 5.7 5 3.8 5 5

0 0 0 ALL 20-29 y 30-39 y 40-49 y 50-59 y Male * Female Poor * Non-Poor * significantly different at 10% level of significance Overweight among Adults, 20-59 years old, by age group, sex, and wealth status: Eastern Samar, 2018

50 50 50

40 40 40

30.6 31.2 30.6 29.1 30 30 30 28.6 25.5 22.4 20 20 20

Prevalence Prevalence (%) 16.4 11.8 10 10 10

0 0 0 ALL 20-29 y 30-39 y 40-49 y 50-59 y Male * Female Poor * Non-Poor

* significantly different at 10% level of significance Obesity among Adults, 20-59 years old, by age group, sex, and wealth status: Eastern Samar, 2018

50 50 50

40 40 40

30 30 30

20 20 20 Prevalence Prevalence (%) 13.5 13.7 10.9 10.7 9.3 10 8.8 10 10 4.7 5.6 5.2

0 0 0 ALL 20-29 y 30-39 y 40-49 y 50-59 y Male* Female Poor* Non-Poor

* significantly different at 10% level of significance Prevalence of High Waist Circumference and High Waist-Hip Ratio among Adults, 20 to 59 years old: Philippines and Eastern Samar, 2018

100 PHILIPPINES 100 EASTERN SAMAR

80 80

60 60

40 35.3 40 30.8 Prevalence Prevalence (%)

Prevalence Prevalence (%) 20 13.5 20 12.1

0 0 High Waist Circumference High Waist-Hip Ratio High Waist Circumference* High Waist-Hip Ratio*

90% LL 13.2 34.9 90% LL 11.1 29.7 CI UL 13.8 35.7 CI UL 13.1 32.0

* significantly different at 10% level of significance High Waist Circumference among Adults, 20-59 years old, by age group, sex, and wealth status: Eastern Samar, 2018

40 40 40

35 35 35

30 30 30

25 25 22.3 25 19.8 20 16.8 20 20 15 15 15 13.4

Prevalence Prevalence (%) 12.1 10 9.0 10 10 8.0 4.6 5 5 3.5 5

0 0 0 ALL 20-29 y 30-39 y 40-49 y 50-59 y Male * Female Poor * Non-Poor * significantly different at 10% level of significance Prevalence of Anemia among Adults°, 20-59 years old: Philippines and Eastern Samar, 2018

PHILIPPINES EASTERN SAMAR 20 20

15 15

9.8 10 8.3 10 7.3

5.3 Prevalence Prevalence (%) 5 Prevalence (%) 5

0 0 Anemia Anemia Male Female

90% LL 7.7 90% LL 5.7 ° excluding pregnant or lactating women CI UL 9.0 CI UL 8.9 Prevalence of Elevated Blood Pressure among Adults, 20 to 59 years old: Philippines and Eastern Samar, 2018

20 16.0 14.7 15

10

Prevalence Prevalence (%) 5

0 Philippines Eastern Samar

LL 15.6 13.1 90% CI UL 16.4 16.2 Elevated Blood Pressure among Adults, 20-59 years old, by age group, sex, and wealth status: Eastern Samar, 2018

40 40 40

35 35 35

30 28.4 30 30

25 25 25 19.5 20 20 20 16.1 16.3 14.7 15 15 13.1 15 Prevalence Prevalence (%) 9.9 10.7 10 10 10 5.9 5 5 5

0 0 0 ALL 20-29 y 30-39 y 40-49 y 50-59 y Male Female Poor* Non-poor

* significantly different at 10% level of significance Prevalence of High Fasting Blood Sugar among Adults, 20 to 59 years old: Philippines and Eastern Samar, 2018

20

15

10 6.7 7.4

Prevalence Prevalence (%) 5

0 Philippines Eastern Samar

LL 6.2 5.8 90% CI UL 7.2 8.9 High Fasting Blood Sugar among Adults, 20-59 years old, by age group and sex: Eastern Samar, 2018

30 30

25 25

20 20

15 13.4 15 10.3 10 10 Prevalence Prevalence (%) 7.4 6.5 7.6 7.1 5 5 0.0 0 0 ALL 20-29 y 30-39 y 40-49 y 50-59 y Male Female Proportion of Current Smokers among Adults, 20 to 59 years old: Philippines and Eastern Samar, 2018

30

25 21.5 20 15.5 15

10 Proportion Proportion (%) 5

0 Philippines Eastern Samar*

LL 20.7 14.2 90% CI UL 22.4 16.9

* significantly different at 10% level of significance Current Smoking among Adults, 20-59 years old, by age group, sex, and wealth status: Eastern Samar, 2018

50 50 50

40 40 40

28.9 30 30 30

20 17.7 17.8 20 20 15.5 15.7 15.3 Proportion Proportion (%) 12.2 13.4 10 10 10 2.4 0 0 0 ALL 20-29 y 30-39 y 40-49 y 50-59 y Male * Female Poor Non-Poor * significantly different at 10% level of significance Proportion of Binge Drinkers among currently drinking Adults, 20-59 years old, in the past 30 days: Philippines and Eastern Samar, 2018

80

60 55.7 54.0

40

Proportion Proportion (%) 20

0 Philippines Eastern Samar

LL 53.3 50.8 90% CI UL 58.1 57.1 Proportion of Binge Drinkers among currently drinking Adults, 20-59 years old, in the past 30 days by age group, sex, and wealth status: Eastern Samar, 2018

80 80 80

70 70 70 62.5 56.9 57.2 60 54.0 60 60 54.5 50.2 50.5 50.7 50 50 50

40 40 33.6 40

30 30 30 Prevalence Prevalence (%) 20 20 20

10 10 10

0 0 0 ALL 20-29 y 30-39 y 40-49 y 50-59 y Male Female Poor Non-Poor * significantly* different at 10% level of significance Proportion of Physically Inactive Adults, 20 to 59 years old: Philippines and Eastern Samar, 2018

60

50 40.6 38.6 40

30 Proportion Proportion (%) 20

10

0 Philippines Eastern Samar

LL 38.1 35.5 90% CI UL 43.1 41.7 Physical Inactivity° among Adults, 20-59 years old, by age group, sex and wealth status: Eastern Samar, 2018 80 80 80

70 70 70

60 60 60 51.1 50 50 50 42.9 42.1 38.6 39.7 40 36.2 34.7 40 40 28.7 Proportion Proportion (%) 30 30 25.7 30

20 20 20

10 10 10

0 0 0 ALL 20-29 y 30-39 y 40-49 y 50-59 y Male Female Poor Non-Poor * significantly* different at 10% level of significance* ° A person not meeting any of the following criteria: . 75 mins of vigorous-intensity physical activity per week (≥ 3 days of vigorous-intensity activity of at least 20 mins per day) OR . 150 mins of moderate-intensity physical activity per week (≥ 5 days of moderate-intensity activity or walking of at least 30 mins per day) OR . an equivalent combination of moderate- and vigorous-intensity physical activity achieving at least 600 MET-minutes per week - World Health Organization (2010). Global recommendations on physical activity for health. Summary (Adults) Chronic energy deficiency prevalence is almost similar with the Philippine estimate and is significantly higher among female than male adults. Overweight is significantly lower than the national prevalence and more prevalent among male adults and those belonging to the poor households. Obesity is significantly greater among female adults and those belonging to the non-poor households.  Android obesity (high WC and high WHR) is significantly lower than the national estimate. Anemia is of “mild” public health significance. Summary (Adults) Raised blood pressure is significantly greater among non-poor households. Prevalence of high fasting blood sugar is slightly higher than the national prevalence however, not significant Current smoking in Eastern Samar is significantly lesser than the national proportion and is more prevalent among male adults. Binge drinking is more prevalent among male adults More female adults are physically inactive than males. Health and Nutritional Status of Filipino Elderly Eastern Samar Chronic Energy Deficiency among Elderly, 60 years old and above: Philippines and Eastern Samar, 2018

30

20 13.4 10.5

10 Proportion Proportion (%)

0 Philippines Eastern Samar

LL 12.9 8.1 90% CI UL 14.0 12.9 Prevalence of Overweight and Obesity among Elderly, 60 years old and above: Philippines and Eastern Samar, 2018

50 PHILIPPINES 50 EASTERN SAMAR

40 40

30 24.7 30 27.0

20 20 Prevalence (%) Prevalence Prevalence (%) Prevalence 10 6.3 10 7.0

0 0 Overweight Obese Overweight Obese

90% LL 23.9 5.9 90% LL 24.2 5.5 CI UL 25.5 6.8 CI UL 29.9 8.5 Prevalence of High Waist Circumference and High Waist- Hip Ratio among Elderly, 60 years old and above: Philippines and Eastern Samar, 2018

100 PHILIPPINES 100 EASTERN SAMAR

80 80

60 47.7 60 44.7 40 40

17.8 16.6 Prevalence (%) Prevalence Prevalence (%) Prevalence 20 20

0 0 High Waist Circumference High Waist-Hip Ratio High Waist Circumference High Waist-Hip Ratio

90% LL 17.1 46.7 90% LL 14.6 41.3 CI UL 18.6 48.6 CI UL 18.6 48.1 Anemia among Elderly, 60 years old and above, by sex, place of residence, and wealth status: Philippines, 2013 vs 2018

30 2013 2018 30 2018 25 23.0 23.3 25 20.8 21.7 20.2 19.1 18.3 20 17.8 20

15 15

10 10 Prevalence Prevalence (%)

5 Prevalence (%) 5 2013 2018 0 0 ALL Male Female Rural Urban

30 2018 24.1 25 21.1 21.8 17.4 20 16.8

15

10

Prevalence Prevalence (%) 5

0 Poorest Poor Middle Rich Richest Prevalence of Anemia among Elderly, 60 years old and above: Philippines and Eastern Samar, 2018

40

30 20.2 20 16.7

Proportion Proportion (%) 10

0 Philippines Eastern Samar

LL 17.7 13.7 90% CI UL 22.8 19.8 Median UIE° and Percent UIE below 50 μg/L among Elderly, 60 years old and above: Philippines and Eastern Samar, 2018

60 200

144.0 50 g/L) 150 (%) μ 40 108.0 30 23.3 100 19.1 20 50

Percentage Percentage 10 Median UIE UIE Median( 0 0 Philippines Eastern Samar* Philippines Eastern Samar

LL 105.2 126.2 LL 90% 90% 20.4 13.4 CI CI UL 110.3 160.9 UL 26.3 24.8

* significantly different at 10% level of significance

°Iodine Intake based on median UIE <100 μg/L – Insufficient 100-199 μg/L – Adequate 200-299 μg/L – More than adequate 300 μg/L and up – Excessive Proportion of Current Smokers, Current Alcohol Drinkers, and Physically Inactive Elderly, 60 years old and above: Philippines and Eastern Samar, 2018

80 PHILIPPINES 80 EASTERN SAMAR

60 50.6 60 47.0 49.7 40 28.2 40 16.3

20 20 Proportion (%) Proportion Proportion (%) Proportion 8.2

0 0 Current Smokers Current Alcohol Physically Inactive Current Smokers* Current Alcohol Physically Inactive Drinkers Drinkers*

90% LL 15.5 25.8 48.5 90% LL 6.4 43.2 45.0 CI UL 17.1 30.5 52.7 CI UL 9.9 50.8 54.4

* significantly different at 10% level of significance Summary (Elderly)  Chronic energy deficiency is lower in Eastern Samar compared with the national estimate but not significant.  Overweight and obesity are slightly higher than the Philippine prevalence.  Android obesity (high WC and high WHR) is slightly lower than the national prevalence however, the difference is not statistically significant.  Anemia is of “mild” public health significance.  Iodine intake in Eastern Samar is adequate based on median UIE. Summary (Elderly)  Elevated blood pressure is slightly higher than the Philippine estimate but not significant.  Prevalence of high fasting blood sugar is slightly lower than the national estimate however, this is not significant.  Current smoking is significantly lower in Eastern Samar compared with the national estimate.  Current alcohol drinking is significantly greater than the national proportion.  Nearly half (49.7%) of the elderly in Eastern Samar are physically inactive.