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Pnaap369.Pdf Vp MATERNAL AND INFANT NUTRITION REVIEWS PHILIPPINES A Guide to the Literature Compiled by Ron Israel - Senior Editor Joanne Nestor Tighe - Editor and Reviewer Steve Wirtz - Principal Reviewer Ellen Blumenstiel Taylor and Janet Tognetti - Reviewers December, 1983 An International Nutrition Communication Service (INCS) Publication Education Development Center, Inc. 55 ChapJl Street, Newton, MA 02160 USA INCS Advisory Board: Roy E.Brown, Derrick B.Jelliffe, E.F. Patrice Jelliffe, Richard K.Manoff, Marian L. Tompson, R.R.N. Tuluhungwa, Joe D.Wray, Marian F. Zeitlin Thisproject has been conducted underContractA.I.D./DSAN.C-0209, ProjectNo. 931-1010. ProjectOfficer: Dr. Tina Sanghvi, Office ofNutrition- Science and Technology Bureau, - Agency forInternationalDevelopment, Washington, D. C edc CONTENTS Introduction . .. i MINR Classification System . iii Map . .. .. iv Table I: Locations Studied . .. v Review Highlights . .. vii Reviewrp . .. 55 Bibliography . .. .. .. .. .. 55 INTRODUCTION MATERNAL AND INFANT NUTRITION REVIEWS: A RESOURCE FOR NUTRITION PLANNERS AND EDUCATORS The MATERNAL AND INFANT NUTRITION REVIEWS (MINR) profile existing data on nutritional status and nutrition-related beliefs and practices of mothers and chIldren in developing countries. MINRs also contain information on current nutrition policies and programs of governments, the United States Agency for International Development, and other bilateral, international agencies and Private Voluntary Organizations (PVO). There are thirty-five MINRs ii.all, profiling forty-four different countries. (See list on next page). Maternal and Infant Nutrition Reviews summarize important information obtained from available literature, government documents, consultant reports, and personal correspondence. The data is presented in bulleted form under six major headings: nutrition and health status, dietary beliefs, dietary practices, nutrition status correlations, nutrition and health policies and programs, and commentaries. A bibliography at the back of each monograph describes the listed documents in terms of type of study, methodology, sample characteristics and location, and a summary. Special thanks are extended to Dr. Richard Lockwood for his assistance in reviewing this report and supplying information. Nutrition planners and policy makers can use MINRs to help identify a given country's data base. For example, the information contained in each review enables the reader to identify key planning factors such as problem areas of malnutrition, prevailing beliefs about breast feeding, the extent of bottle feeding, types of weaning foods, the government's inter-agency five­ year nutrition plan, the amount of donated food being distributed at MCH centers, and major PVOs involved in administering food and nutrition programs. MINRs can be used as background documents for consultants going into the field and for program developers in-country. They can provide a frame of reference for an in-country workshop aimed at developing a national-nutrition strategy. Technical assistance in organizing a workshop of this kind is available through the International Nutrition Communication Service. MINRs can also be used as a resource document in the development of journal articles and textbooks. MINR data is stored on a computerized word processing system that allows for updateb and individualized literature searches on specific topics. Patterns in a particular country or group of countries can be analyzed in accordance with user needs. A nutrition information retrieval service is available free to those working in developing countries and for a small fee to all others. Orders, inquiries, and comments should be addressed to: Ron Israel, Director International Nutrition Communication Service Education Development Center 55 Chapel Street Newton, Massachusetts 02160, USA x MINR Country Reports: AFRICA: NEAR EAST: ASIA: LATIN AMERICA AND CARIBBEAN: Cameroon Egypt Bangladesh Bolivia Gambia and Senegal Jordan Burma Costa Rica Ghana Morocco India Dominican Republic Kenya Tunisia Indonesia Ecuador Lesotho Yemen Nepal Guatemala Liberia Pakistan Haiti Mali Philippines Honduras Sudan South Pacific* Jamaica Tanzania Sri Lanka Panama Zaire Thailand Peru *South Pacific Region includes the nations of Cook Islands, Fiji, Kiribati, Papua New Guinea, Solomon Islands, Tonga, Tuvalu, Vanuatu, and Western Samoa ii MATERNAL AND INFANT NUTRITION REVIEWS CLASSIFICATION SYSTEM 1. Nutrition and Health Status 1.1 General 1.2 Women, Pregnant 1.3 Women, Lactating 1.4 Infants 0-6 Months 1.5 Infants 6-24 Months 2. Dietary Beliefs 2.1 General 2.2 About Pregnancy 2.3 About Lactation 2.4 About Breast Milk Substitutes (including bottle feeding) 2.5 About Weaning 3. Dietary Practices 3.1 General 3.2 Women 3.2.1 During Pregnancy 3.2.2 During Lactation 3.3 Infants 0-24 Months 3.3.1 Breast feeding 3.3.2 Weaning 3.3.3 After Weaning 3.4 Health and Medicine 4. Nutrition Status Correlations 5. Nutrition and Health Policies and Programs 5.1 Policies 5.2 Programs 6. Commentaries Bibliography iii - .. a.-..2"" ~*.. dh Z - Kaohsmunqg P4&r L~gbA~ S -. Twqdi~.tr,' "9Wn Sr~u vipv~wv i low rL 4i~ B"UC~X~a 4 -me- "k s~c LUOq 1awoU ~-3- BARUYAMILamD 0 c~MAP= v i ud.odd e asta aa -SanI'ws ~ tp S n i a ~~~O~onpp" Qu~ mm N 45 A San D~'4. 3iw~.U-ac P~Mw~.dP car~ - : B4E i~ruiimno TABLE I LOCATIONS STUDIED C .0 m 40Moa Mj 0 88w (n .4 .4 in 4 4 4":4 . .hilipp0,e,,0 .4 04~~ 106. .44...4 Luzon Island Urban Manila .. .. L - - - A Metr'o Manila Area Laguna Pr-ovince x x : x x 1 Pasay I IIX I:ai IX Quezon City x x Quezon Area. Krusina Lig_ Villa___ : : : Old Bular& village : Other Provi-nces and to-­ Al.bay Province :: :X Baquio I I : Bicoli Province x:: : O x BU.acan F; - - L: - - - - Capri x Mrmoval~iches vao Ecla Province x 1I Yamqanga Province X I I I 1 Paranague : ; : San Fr:ancisco del .Y-nts San Rafael .X Central Philippines Cehu island a Cebu Ci ron - - : :-i Region x I I Bohol Island Bohol Province X - TagbilaranAgSandlSrafael City _ x Ceta Hilis inental ------- ------­ OtherCebo laa(notgb specified)deNot x southern Philippine Northern indanao Region x Sg-anFlNr" I I , V National SamplesX . I- . HIGHLIGHTS 1. NUTRITION AND HEALTH STATUS: Halnutrition occurs principally in the form of protein calorie malnutrition in young children, anemia, and vitamin A deficiency. The 1978 National Nutrition Survey found that 85% of pregnant women and 63% of lactating women were anemic; rates among other women were 51.1%, and among children age 0 to 6 years, 55.8%. About 25% of the population has deficient or low blood levels of vitamin A. Among children, nutrition status is good until age 6 months, when growth failure begins. The incidence of underweight (less than 85% of the median weight-for-age, based on Philippine standards) is highest among children one year old, and decreases with age; the prevalence of malnutrition has been decreasing for several years. In 1978, only 27.2% of the children had "normal" weights for their ages; 3.6% were overweight and 68.9% were under­ weight. The areas most affected by malnutrition are in the central part of the country; those in the north and around Manila and Manila Bay are the least affected, and the regions in the southern part of the country contain a mix of worst- and least-affected provinces. 2. DIETARY BELIEFS: Almost all women terminate breast feeding as soon as they realize they are pregnant again, because they believe that "the milk belongs to the new baby." Following delivery, the mother enters into a five-month period known as tangad, which means "to take care." Mother and infant are considered especially vulnerable to ills during this period. 70% of mothers consider breast feeding better than bottle feeding for a child 3 to 6 months of age. "Insufficient milk" is a major reason given by both rural and urban mothers for cessation of breast feeding. Mothers express a good deal of worry over the quality of their milk, e.g. whether it tastes too salty or thin, and whether it becomes altered by hot and cold foods and drink. Many urban mothers believe that colostrum should be discarded. In 1980, a survey of health professional attitudes in Pasay City revealed several important needs for change: 49% of health workers interviewed said they would feel embarrassed or disgusted if they saw a friend nursing in public; 60% said they would prefer their newborns to be kept in a nursery for fear of infection. 3. DIETARY PRACTICES: The basic staples are rice (corn in certain areas), plus fish and succulent vegetables or bananas. The estimated per capita calorie and protein supplies in 1977 and intakes, according to the National Nutrition Survey of 1978, were significantly below recommended FAO/WHO requirements. Mothers do not vary their diets before or after giving birth. Their overall dietary intakes are customarily low in protein, thiamin, vitamins A and C, and iron. The prevalence of breast feeding is 90% among 6 month olds, 85% among 12 month olds, and 80% at 18 months. The median age of weaning frcm the breast is over a year for lower income families and less than 2 months among the economically advantaged urban class. Exclusive breast feeding averages about 4 months. 90% of all rural and urban poor babies under 3 months old who receive supplemental foods are given milk or milk-based products by bottle. By the second year only about 50% receive milk or milk­ based supplements. Approximately 24 types of infant formulas and 22 types of other milk-based products, including condensed and evaporated milks, are available. The average expenditure for breast milk substitutes in 1981 was 14% of the average family income per year. While mass media promotion of breast milk substitutes is rare, extensive promotional activities occur through the health care delivery system, including the use of free samples, vii Previous Page Blank posters, calendars, baby care books, and gifts and support for doctors and professional societies.
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