Preventing chronic malnutrition in emergencies

MANILA, Philippines – The current chronic malnutrition rate in Yolanda-affected areas exceeds the 30% global threshold, according to the World Health Organization (WHO).

One-third of all children under 5 in Yolanda-hit areas suffer from chronic malnutrition or “stunting,”  according to a survey by the National Nutrition Cluster.    

Chronically undernourished children have stunted growth, determined through measuring standard of height for age. Stunting is a form of undernutrition resulting from prolonged or repeated episodes of undernutrition which begins during pregnancy. 

Chronic undernutrition is not so much the quick effect of a disaster, as an already pre-existing condition of long-term undernutrition. This means that at the onset of Typhoon Yolanda, the rate of stunting in the affected areas could have already been high. 

The 2011 National Nutrition Survey (NNS) placed stunting rate in the Philippines at 33.6%.

Stunting has irreversible effects for the child if left unsolved beyond 2 years of age.  

Studies like those from Lancet, a permiere medical journal, emphasize that stunting is most effectively prevented during the first 1,000 days in the life of a child, aptly dubbed as a “window of opportunity.” 

Feeding practices

The feeding practices for infants and young children recommended by the WHO and the SPHERE handbook for disaster response is what parents and caregivers have done in many generations of rearing, although perhaps inexact and unoptimized. (READ: Breastfeeding at times of disasters)

Optimal feeding practices that maximize survival and reduce morbidity in children under 2 years old include:

• Early initiation of exclusive breastfeeding
• Exclusive breastfeeding for up to 6 months
• Continued breastfeeding for up to 2 years old or beyond
• Appropriate and safe complementary foods at 6 months

And yet, an alarming 14% of children 0-23 months were reported to have never been breastfed in the Yolanda-affected areas, compared to the regional rate of 4%. 

The survey also showed that about 86% of children 0-23 months were breastfed in the affected areas, lower than the average regional rate of 96% as reported in 2011 NNS. 

Only about 42% of infants less than 6 months of age were exclusively breastfed in the Yolanda-affected areas, below the average of the 3 regions at 57%. 

In fact, about 42% of infants less than 6 months of age were given infant formula on the day before the survey interviews.  

It was also reported that more children, aged 0-2 years old, are bottle-fed.

Regional average of bottle-fed children (0-2 years old)
2011	2013
39%	46%

 

‘Women and Young Children Space’

World Vision distributed relief goods right after typhoon Yolanda hit in November, and began assessing areas where countless mothers, infants and young children needed nutrtition assistance. 

Weeks later, Women and Young Children Space (WAYCS) tents were pitched in North Cebu, the Panay islands, Ormoc, Tacloban, and the rest of Leyte, with the help from local government units (LGUs), health workers, and other humanitarian response organizations. 

By December, World Vision had put up 14WAYCS tents, accommodating a daily average of 100 mothers with their babies and young children in tow. 

More than a hundred health partners, including village health workers, were trained primarily on infant and young child nutrition. Psychological first aid was also provided to the communities. 

“The WAYCS primarily promoted Infant and Young Child Feeding in emergencies,” Eureka Fuentes, Health and Nutrition Specialist of World Vision, said.

“We have seen behavioral change in mothers, and surprisingly, even their husbands have become supportive in providing proper nutrition and care for their infants and young children,”  Fuentes added.

A total of 2,091 breastfeeding and pregnant women, including other caregivers, attended a series of sessions on infant and young child feeding at World Vision’s WAYCS tents. 

The lectures were facilitated by local health volunteers and World Vision staff. 

A variety of kits on breastfeeding, hygiene and care for infants and mothers were also provided. High energy biscuits from the World Food Programme (WFP) were likewise given to 158 pregnant and lactating women, and to 182 children aged 2 to 5 years old.

In late February, World Vision started to turn over the operations of the WAYCS to the local governments of North Cebu, followed by other regions where they were established. 

Long-term rehabilitation, nutrtition goals

While transitioning from relief response to rehabilitation of areas damaged by the typhoon, World Vision and its local partners are focused on capacity-building of health workers to continue facilitating infant and young child feeding interventions in the long term.

For the rehabilitation phase, World Vision’s health and nutrition interventions in the affected areas include:

• Repair of damaged health facilities such as Rural Health Units and Barangay Health Centers or Stations
• Rrovide medical supplies and anthropometric equipment
• Capacity-building of health workers 

At the national level, World Vision’s Child Health Now campaign will continue to engage with the Nutrition Coalition of NGOs supported by the government nutrition council and UNICEF in advocating for a no-amendment stand on the Milk Code. 

While the Philippines has apparently one of the best regulatory policies that protect breastfeeding, there are many challenges besetting the Milk Code, such as court battles between the government and multinational milk companies.  

The most recent of these are bills passed in both houses of Congress with amended provisions relaxing the regulatory policy, and the attempt to lift ban on milk donations during the Yolanda relief response at the tail-end of 2013.  There were also reported but undocumented incidences of milk donations and blanket distribution of formula milk during the Yolanda relief response.

The National Nutrition Cluster, led by the Department of Health (DOH), with multisectoral members of organizations responding to Typhoon Yolanda developed the Operational Guidelines for Infant and Young Child Feeding in Emergencies. 

The guideline is still being reviewed before official release, but it intends to provide guidance to health, nutrition, and social service providers, including government partners, organizations and donors involved in the protection, promotion and support of optimal and appropriate feeding practices during emergenies. 

The priority is to protect, promote and support optimal feeding practices among children. 

The guidlines also stressed that “only after all options for breastmilk feeding have been exhausted – including tandem nursing of older children, cross nursing, wet nursing, cup feeding of donor milk, increasing the proportion of the diet from locally available complementary solids – can the provision of infant formula and milk supplements be considered.”  – Rappler.com

Monalinda Cadiz is an advocate of children’s health. She is a development worker and communication specialist for the Child Health Now Campaign, World Vision’s first global campaign on a single issue: decrease child deaths from preventable causes.

Child Health Now is a campaign by World Vision. It promotes good nutrition, proper childcare practices and education among families. If you want to participate, donate, volunteer, or sponsor a child, you may visit World Vision Philippines here.

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