DISPARITIES IN NUTRITIONAL STATUS OF FILIPINO PRESCHOOL AND SCHOOL-AGE CHILDREN BETWEEN INCOME GROUPS

Ma. Adrienne S. Constantino, Ma. Regina A. Pedro, Ph.D. and Pentalpha C. Cabrera
Food and Nutrition Research Institute, Department of Science and Technology, Philippines

ABSTRACT B

METHODOLOGY
DATA SOURCE

RESULTS
50.0 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 Underweight Underheight
10.6 11.3 6.8 7.1 4.7 5.2 2.8 0.2 0.6 0.8 0.9 4.0 40.7 34.3 26.8 23.0 30.3 21.6 49.9

ackground. Undernutrition and micronutrient deficiencies affect large proportions of children. There are concerns that inequalities in nutritional status in the Philippines, particularly across income groups and regions, are high. Information on the extent of the gap in nutritional status particularly between groups that are least and most socially disadvantaged such as by virtue of income will help policy makers and program implementers fine-tune programs to achieve increased equity in nutrition, consistent with the Philippines 2005-2010 Medium-term Philippine Plan of Action for Nutritions adoption of the human rights perspective for nutrition improvement. Aim. The analysis was carried out to examine disparities in nutritional status among Filipino children across income groups. Method. The Philippines 2003 National Nutrition Surveys (NNS) was conducted using a national Master Sample (MS) based on a stratified multi-stage sampling design covering all regions and 5,522 households, and 4,110 0-5y old and 4,777 6-12y old children, among others. Food intake by households was measured by one-day food weighing, with recall of foods eaten outside the home by household members. Energy and nutrient adequacy were assessed using Philippine Food Composition Tables and Recommended Energy and Nutrient Intakes. Weight and height of children were measured using standard procedures and evaluated using the NCHS standards, blood samples were collected by fingerprick, and analysed for serum retinol using the HPLC and hemoglobin using cyanmethemoglobin method, casual urine samples were analysed for urinary iodine by acid digestion. Information on household income was obtained from the 2003 Family Income and Expenditure Survey which was done in same period and using same MS. All analyses were done using SPSS. Findings. There are about 4X more underweight and stunted preschool- and school-age children in households in the poorest income quintile than in the highest income quintile. The highest income group also has advantage over the poorest group with vitamin A deficiency and anemia, affecting 1-2 less children in every 10 compared to the poorest group. These gaps are reflections of dietary inequities and disparities in energy and nutrient intakes between rich and poor households. There is also wider gap with iodine deficiency affecting 5X more 6-12 y old children in lowest than in highest income group, which had high iodine intake and more than adequate iodine status, based on UIE, and in turn is associated with high consumption of processed foods. Conclusion. With evidence of disparities in nutrition, programs should pay attention to underlying inequities in the population.

1st Quintile 2nd Quintile

38.2

60.0 50.0 41.9 40.0 32.1 30.0 20.0 10.0 0.0 9.5 25.7 21.2

59.2

1st Quintile 2nd Quintile

39.8

3rd Quintile 4th Quintile 5th Quintile

3rd Quintile
36.7 28.3 16.3 5.0

4th Quintile 5th Quintile

Degrees of freedom, F-ratio and p-value of the test for independence of income quintiles by weight-for-age, heightfor-age and weight-for-height among 0-10 year-old children: Philippines, 2003
Indices of Nutritional Status 0-5 years Weight-for-Age Classification Height-for-Age Classification Weight-for-Height Classification 6-10 years Weight-for-Age Classification Height-for-Age Classification DF (7.10,3120.52) (7.48,3330.50) (10.82, 4812.73) (7.05, 3054.55) (7.11, 3078.22) F-ratio 23.47 31.90 9.95 25.01 24.63 P-value 0.00 0.00 0.00 0.00 0.00

0.0 Underweight Underheight

0.1 0.6 0.7 Thin

Thin

Overweight

Percent of malnutrition among 0-5 yr-old children by income quintile, Philippines: 2003

Percent of malnourished among 6-10 yrs old by income quintile, Philippines: 2003

Antropometric Survey

Biochemical Survey

Dietary Survey

Prevalence of malnutrition was highest in the lowest income quintile. As income increased, the percentage of malnutrition decreased.
60.0 50.0 40.0

+
NSO Food Income and Expenditure Survey (FIES)
Household Income

1st Quintile 4th Quintile

38.2

2nd Quintile 5th Quintile

38.8 30.8 40.8

3rd Quintile

60.0 50.0
49.2

1st Quintile 4th Quintile

41.0 40.5

2nd Quintile 5th Quintile

43.6

3rd Quintile

20.0

1st Quintile 4th Quintile

15.2

2nd Quintile 5th Quintile

3rd Quintile

15.0
37.3 35.5 33.1 28.5

35.2

36.2

36.2 35.5

35.9

40.0 30.0 20.0

38.0 29.9

30.0 20.0 10.0 0.0 6 mos - 5 yrs

23.9

10.0

9.7 8.32 5.9 4.7 3.1 4.96 2.58 2.07 1.82

5.0
10.0 0.0

6-12 yrs

6 mos - 5 yrs

6-12 yrs

0.0 Moderate Severe

=
1st Income quintiles 2nd Income quintiles 3rd Income quintiles 4th Income quintiles

Prevalence of anemia by income quintile

Prevalence of VAD by income quintile

Prevalence of IDD by income quintile

Highest prevalence of anemia, VAD, IDD were found in the low income quintiles. Similarly as income increased, prevalence of anemia, VAD, IDD decreased. Prevalence of anemia aong 6 months to 12 year-old children by income quartile: Philippines, 2003
INCOME QUINTILES 6 months 5 years 1st Quintile 2nd Quintile 3rd Quintile 4th Quintile 5th Quintile ALL 6 12 years 1st Quintile 2nd Quintile 3rd Quintile 4th Quintile 5th Quintile ALL Estimate 35.24 38.15 36.17 30.81 23.91 32.83 38.82 40.79 36.21 35.46 35.88 37.39 SE 2.18 2.09 2.14 2.04 2.08 0.99 2.21 2.29 2.06 2.20 2.09 1.09
1170.4 1058.0 971.8

Prevalence of VAD among 6 months to 12 year-old children by income quartile: Philippines, 2003
INCOME QUINTILES 6 months 5 years 1st Quintile 2nd Quintile 3rd Quintile 4th Quintile 5th Quintile 6 12 years 1st Quintile 2nd Quintile 3rd Quintile 4th Quintile 5th Quintile Estimate 49.24 40.99 40.48 37.96 29.91 43.63 37.33 35.52 33.10 28.49 SE 3.16 2.51 2.51 2.51 2.40 2.42 2.27 2.25 2.20 2.01 LL 43.04 36.06 35.54 33.04 25.20 38.88 32.86 31.09 28.77 24.53 UL 55.45 45.92 45.42 42.89 34.61 48.39 41.80 39.95 37.42 32.44 CV 6.41 6.12 6.20 6.60 8.01 5.55 6.09 6.35 6.66 7.06

LL 30.96 34.04 31.97 26.80 19.82 30.89 34.48 36.29 32.16 31.13 31.78 35.25

UL 39.51 42.26 40.37 34.83 28.01 34.78 43.16 45.29 40.26 39.78 39.98 39.54

CV 6.17 5.48 5.91 6.63 8.71 3.01 5.69 5.61 5.70 6.21 5.81 2.91

he Philippines is an archipelago of 7,107 islands located off the southeastern coast of the Asian mainland. Its has a tropical climate with wet and dry seasons. The islands are divided into three main groups: Luzon, in the north; Visayas, a scattered collection of small islands in the centre of the archipelago; and Mindanao, which is in the southern part of the country. Population stands at 87 million. Malnutrition continue to persist in the country. In the 2003 National Nutrition Survey, undernutrition afflicted more than 25% of children aged 0-10 years. Overweight is increasing at an alarming rate although its prevalence is not considered a public health concern. More than 32% of children aged 6 moths to 12 years are suffering from anemia, while 11.4% of six to twelve year-old children are suffering from moderate to severe iodine deficiency disorder (IDD). Vitamin A Deficiency (VAD) is a significant public health problem among preschool children with a prevalence of 40.1%. Energy and protein intake almost reached the recommended levels. Vitamin A was 91.4 % adequate while iron was only 60.1% adequate. Poverty is one of the major contributors to childhood malnutrition. Inequalities in nutritional status across income quintiles will provide planners information that will provide increased equity in nutrition among the disadvantaged group of children.

INTRODUCTION T

Degrees of freedom, F-ratio and p-value of the test for independence of income quintiles by urinary iodine excretion (UIE0 levels among 6 12 year-old children: Philippines, 2003
UIE Levels DF F-ratio P-value

5th Income quintiles

UIE (4 levels: normal, mild, moderate and severe)

Per capita income quintile (10.94,4933.60)

18.47

0.00

STATISTICAL ANALYSIS
Descriptive analysis used frequency and percent distribution to present prevalence of selected variables. Test of Relationship used Pearson Chi-Square and Spearmans Rho to test for independence

1200.0 1000.0 800.0 600.0 400.0 200.0

781.0 908.7

1st Quintile 2nd Quintile 3rd Quintile 4th Quintile 5th Quintile
448.1 369.6 213.1 24.5 28.8 30.2 34.2 39.1 4.2 5.1 5.7 7.1 8.7 245.9 290.3

Spearmans Rho coefficient and p-value of the test for independence of adequacy levels for energy, protein, iron and vitamin A among 6months to 5 year-old children with income: Philippines, 2003
NUTRIENTS Energy Protein
Vitamin A

Spearman's Rho Coefficient 0.34 0.35 0.41 0.30

P-value 0.00 0.00 0.00 0.00

0.0 Ene rgy Prote in Iron

Iron Retinol Equivalent

Mean one day Per Capita intake of Energy, Protein, Iron and Vitamin A of 6 mos 5 yr old children, Philippines: 2003 Adequacy levels of energy, protein, iron and vitamin A were directly proportional with income.

OBJECTIVES continues affect The double burden of malnutrition the country.toThey alsoFilipino preschool- and school-age children in suffer
from micronutrient deficiencies. This study will look into the nutritional inequities among the vulnerable group of preschool and school-aged children across income groups.

CONCLUSIONS
The nutritional status of children were positively related to income The proportion of children who were underweight, underheight and thin are greater among the lower income quintiles, while overweight was directly proportional to income. Similarly, prevalence of IDA, VAD and IDD were inversely proportional to income The childrens nutrient adequacy levels increased as income increased.

RECOMMENDATIONS
Government programs towards poverty alleviation such as entrepreneurial training and livelihood programs need to be intensified Food security strategies and programs of the government geared towards the upliftment of nutritional status of children should be strengthened Physical activities should be encouraged especially among the affluent families as they are most prone to overweight and obesity