What explains the large disparity in child stunting in the Philippines? A decomposition analysis

Abstract Objective: About a third of under-five Filipino children are stunted, with significant socio-economic inequality. This study aims to quantify factors that explain the large gap in stunting between poor and non-poor Filipino children. Design: Using the 2015 Philippine National Nutrition Survey (NNS), we conducted a linear probability model to examine the determinants of child stunting then an Oaxaca-Blinder decomposition to explain the factors contributing to the gap in stunting between poor and non-poor children. Setting: Philippines Participants: 1, 881 children aged 6-23 months Results: The overall stunting prevalence was 38.5% with significant gap between poor and non-poor (45.0% vs. 32.0%). Maternal height, education, and maternal nutrition status account for 26%, 18%, and 17% of stunting inequality, respectively. These are followed by quality of prenatal care (12%), dietary diversity (12%), and iron supplementation in children (5%). Conclusions: Maternal factors account for more than 50% of the gap in child stunting in the Philippines. This signifies the critical role of maternal biological and socio-economic circumstances in improving the linear growth of children.

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The Impact of Wealth Status on Food Intake Patterns in Filipino School-Aged Children and Adolescents

Nutrients ◽

10.3390/nu11122910 ◽

2019 ◽

Vol 11 (12) ◽

pp. 2910

Author(s):

Imelda Angeles-Agdeppa ◽

Yvonne M. Lenighan ◽

Emma F. Jacquier ◽

Marvin B. Toledo ◽

Mario V. Capanzana

Keyword(s):

Dietary Diversity ◽

Age Groups ◽

Daily Intake ◽

Primary Source ◽

Food Groups ◽

Nutrition Survey ◽

Wealth Status ◽

School Aged Children ◽

Filipino Children ◽

The Impact

Socio-economic status (SES) has an impact on food consumption in developing countries. However, the impact of SES on dietary patterns in Filipino school-aged children is currently unknown. The aim of this study was to fill this knowledge gap, using data from the 2013 National Nutrition Survey. Dietary intake of 11,691 children (6–18 years) were assessed using a 24-h recall. All food and beverages were assigned to one of 85 food groups. Mean daily intake, percent consuming (prevalence), and contribution to energy intake were determined, and stratified by SES, in 6–9 years old, 10–12 years old, and 13–18 years old. Rice was the most consumed food and the primary source of energy across all three age groups, independent of SES. Children of poor SES presented greater consumption of fish, vegetables, fruit, and table sugar (p < 0.05). In comparison, children of rich and middle SES presented greater consumption of milk, chicken, pork, sausages, and soft-drinks (p < 0.05). In conclusion, SES impacts the type of foods consumed by Filipino children, with children in the poorest households being most at risk of consuming low-variety diets. This analysis could be used to support public health strategies to improve dietary diversity, and potentially nutrient intake, in Filipino children.

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Contribution of Milk Beverages to Nutrient Adequacy of Young Children and Preschool Children in the Philippines

Nutrients ◽

10.3390/nu12020392 ◽

2020 ◽

Vol 12 (2) ◽

pp. 392 ◽

Cited By ~ 2

Author(s):

Tsz-Ning Mak ◽

Imelda Angeles-Agdeppa ◽

Marie Tassy ◽

Mario V. Capanzana ◽

Elizabeth A. Offord

Keyword(s):

Preschool Children ◽

Young Children ◽

Dairy Products ◽

The Philippines ◽

Health Concern ◽

Nutrient Intakes ◽

Nutrition Survey ◽

Powdered Milk ◽

Nutrient Adequacy ◽

Filipino Children

Malnutrition is a major public health concern in the Philippines. Milk and dairy products are important sources of energy, protein, and micronutrients for normal growth and development in children. This study aims to assess the contribution of different types of milk to nutrient intakes and nutrient adequacy among young and preschool children in the Philippines. Filipino children aged one to four years (n = 2992) were analysed while using dietary intake data from the 8th National Nutrition Survey 2013. Children were stratified by age (one to two years and three to four years) and by milk beverage consumption type: young children milk (YCM) and preschool children milk (PCM), other milks (mostly powdered milk with different degrees of fortification of micronutrients), and non-dairy consumers (no milks or dairy products). The mean nutrient intakes and the odds of meeting nutrient adequacy by consumer groups were compared, percentage of children with inadequate intakes were calculated. Half (51%) of Filipino children (all ages) did not consume any dairy on a given day, 15% consumed YCM or PCM, and 34% consumed other milks. Among children one to two years, those who consumed YCM had higher mean intakes of iron, magnesium, potassium, zinc, B vitamins, folate, and vitamins C, D, and E (all p < 0.001) when compared to other milk consumers. Non-dairy consumers had mean intakes of energy, total fat, fibre, calcium, phosphorus, iron, potassium, zinc, folate, and vitamins D and E that were far below the recommendations. Children who consumed YCM or PCM had the highest odds in meeting adequacy of iron, zinc, thiamin, vitamin B6, folate, and vitamins C, D, and E as compared to other milks or non-dairy consumers, after adjusting for covariates. This study supports the hypothesis that dairy consumers had higher intakes of micronutrients and higher nutrient adequacy than children who consumed no milk or dairy products. Secondly, YCM or PCM have demonstrated to be good dairy options to achieve nutrient adequacy in Filipino children.

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The Nutritional Impact of Milk Beverages in Reducing Nutrient Inadequacy among Children Aged One to Five Years in the Philippines: A Dietary Modelling Study

Nutrients ◽

10.3390/nu12113330 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3330

Author(s):

Tsz-Ning Mak ◽

Imelda Angeles-Agdeppa ◽

Marie Tassy ◽

Mario V. Capanzana ◽

Elizabeth A. Offord

Keyword(s):

Vitamin A ◽

The Philippines ◽

Early Years ◽

Nutrient Intakes ◽

Nutrition Survey ◽

Powdered Milk ◽

Dairy Consumption ◽

Increased Risk ◽

Filipino Children ◽

Calcium Iron

Around half of Filipino children are not consuming any dairy products on a given day, which has shown to be associated with increased risk of inadequate nutrient intakes. The current study applies dietary modelling to assess the nutritional impact of meeting dairy recommendations in reducing nutrient inadequacy in children aged one to five years in the Philippines. Dietary intake data of Filipino children aged one to five years (n = 3864) were analyzed from the 8th National Nutrition Survey 2013. Children who did not meet national dairy recommendations were identified. Two scenarios were applied, based on two types of commonly consumed milk products by the survey participants. In scenario one, one serving of powdered milk was added to the diet of these children. In scenario two, one serving of a young children milk (YCM) or preschool children milk (PCM) was added to the diet of children aged one to two years and three to five years, respectively. Mean nutrient intakes and percentages of children with inadequate intakes were estimated before and after applying modelling scenarios. Scenario one demonstrated improvement in calcium, phosphorus, sodium, vitamin A and riboflavin intakes, while in scenario two, further improvement of intakes of a wider range of nutrients including iron, selenium, zinc, magnesium, potassium, vitamins C, D, E, thiamin, niacin, vitamins B6, and B12 was observed. In both scenarios, if all children would meet their dairy recommendations, theoretical reductions in population nutrient inadequacy would be observed for all micronutrients, for example, only 20% of children aged one to two years would be inadequate in vitamin A instead of the current 60%, iron inadequacy would see a 5% reduction, and approximately 10% reduction for calcium and 20% reduction for folate. The present study is the first to apply dietary modelling to assess the theoretical impact of meeting dairy recommendations on nutrient inadequacy in children in the Philippines. Dairy consumption should be encouraged as part of the strategy to reduce nutrient inadequacies. Calcium, iron, vitamins D, E, and folate are of concern in the Philippines as the level of inadequacies are extremely high in early years, YCM and PCM can help increase the intake of these nutrients.

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Diet Diversity and Micronutrient Adequacy among Filipino School-Age Children

Nutrients ◽

10.3390/nu11092197 ◽

2019 ◽

Vol 11 (9) ◽

pp. 2197 ◽

Cited By ~ 7

Author(s):

Tsz-Ning Mak ◽

Imelda Angeles-Agdeppa ◽

Yvonne M. Lenighan ◽

Mario V. Capanzana ◽

Ivan Montoliu

Keyword(s):

Rural Areas ◽

Dietary Diversity ◽

Current Knowledge ◽

Economic Status ◽

School Age Children ◽

Nutrition Survey ◽

Wealth Status ◽

Diet Diversity ◽

Rigorous Research ◽

Filipino Children

Previous studies have shown that the dietary diversity of young Filipino children to be limited and that the prevalence of nutrient inadequacies is high. This study extends the current knowledge to examine the relationship between diet diversity and the probability of adequacy of micronutrients among Filipino schoolchildren (aged 6 to 12 years), by the wealth status and dwelling location. The dietary intake data were collected using a single 24-h recall from 6460 children in the Filipino National Nutrition Survey 2013. The diet diversity score (DDS) and the probability of adequacies (PA) of 11 micronutrients were calculated, and further stratified by socio-economic status (SES) and dwelling location. The diet diversity was generally low (mean DDS = 4 out of 9). Children from the lowest SES, and living in rural areas, tended to have a lower DDS. Children with a DDS of 1 were likely to be inadequate in all 11 micronutrients. The higher DDS (≥6) was associated with higher PAs for the B vitamins but not for calcium, folate, iron, vitamin A and to large extent, vitamin C. This suggests that it was difficult for this population to achieve adequacy in these 5 micronutrients. More rigorous research on the topic is needed. Better access to nutrient-rich or fortified staple foods, in tandem with increased education on the importance of dietary diversity, are potential strategies to support children in achieving adequate micronutrient intakes.

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Vitamin D Status and Usual Nutrient Intake of Filipino Children Aged 6–12 Years in Selected Areas in the Philippines: A 2018 National Nutrition Survey

Journal of Nutrition and Metabolism ◽

10.1155/2021/8515607 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Imelda Angeles-Agdeppa ◽

Keith V. Tanda

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Serum Vitamin ◽

Vitamin D Insufficiency ◽

The Philippines ◽

Food Sources ◽

Nutrition Survey ◽

Serum Vitamin D ◽

National Nutrition Survey ◽

Filipino Children

Background. This study aimed to determine the prevalence of vitamin D deficiency, usual nutrient intake, and food sources of vitamin D of Filipino children aged 6–12 years in selected areas in the Philippines. Methods. The National Nutrition Survey (NNS) collected blood samples of children aged 6–12 years from selected study sites: Manila City and Quezon City in the National Capital Region (NCR); Cagayan Province and Baguio City in Luzon; Northern Samar and Siquijor in Visayas; and Butuan City and Sultan Kudarat in Mindanao. About 789 children aged 6–12 years participated in this study. Serum vitamin D was determined by electrochemiluminescence binding assay (ECLIA). Food intake data were collected using two-day nonconsecutive 24 h food recall. Usual nutrient intakes were estimated using Personal Computer Software for Intake Distribution Estimation (PC-SIDE) program. Results. The mean serum vitamin D of 25 (OH)D was 72.7 ± 0.67 μmol/L. The overall prevalence of combined vitamin D deficiency (<50 μmol/L) and insufficiency (51–74 μmol/L) among children aged 6–12 years was 60.6%. Females had a higher prevalence of vitamin D insufficiency compared to males. NCR (57.9%) had a higher deficiency compared to the other areas. The usual intake of vitamin D (2 μg/day) among children was below the adequate intake of 5 μg/day. The main food sources of vitamin D are coming from fish (53%), pork (19%), and egg/egg dishes (16%). Conclusion. This study revealed that there is a significantly high level of vitamin D insufficiency in children aged 6–12 years. Filipino females had higher prevalence of vitamin D deficiency and insufficiency compared to males. Among the areas, NCR has the highest prevalence of deficiency/insufficiency.

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Sibling Models, Categorical Outcomes, and the Intra-Class Correlation

European Sociological Review ◽

10.1093/esr/jcaa057 ◽

2021 ◽

Author(s):

Richard Breen ◽

John Ermisch

Keyword(s):

Random Effects ◽

Probability Model ◽

Intraclass Correlation ◽

Linear Probability Model ◽

Intra Class Correlation ◽

Sibling Differences ◽

Sibling Models ◽

Alternative Measures ◽

Linear Probability ◽

Parametric Estimate

Abstract In sibling models with categorical outcomes the question arises of how best to calculate the intraclass correlation, ICC. We show that, for this purpose, the random effects linear probability model is preferable to a random effects non-linear probability model, such as a logit or probit. This is because, for a binary outcome, the ICC derived from a random effects linear probability model is a non-parametric estimate of the ICC, equivalent to a statistic called Cohen’s κ. Furthermore, because κ can be calculated when the outcome has more than two categories, we can use the random effects linear probability model to compute a single ICC in cases with more than two outcome categories. Lastly, ICCs are often compared between groups to show the degree to which sibling differences vary between groups: we show that when the outcome is categorical these comparisons are invalid. We suggest alternative measures for this purpose.

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Household Water Insecurity Affects Child Nutrition Through Alternative Pathways to WASH: Evidence From India

Food and Nutrition Bulletin ◽

10.1177/0379572121998122 ◽

2021 ◽

Vol 42 (2) ◽

pp. 170-187

Author(s):

Neetu Choudhary ◽

Roseanne C. Schuster ◽

Alexandra Brewis ◽

Amber Wutich

Keyword(s):

Water Availability ◽

Structural Equation ◽

Child Nutrition ◽

Diarrheal Disease ◽

Dietary Diversity ◽

Water Access ◽

Child Stunting ◽

Increased Risk ◽

Household Water ◽

Regional Water

Background: Household water security matters greatly for child nutrition outcomes in the global South. Water’s role in sanitation/hygiene, via diarrheal disease, is cited as a primary mechanism here. Yet, the relationship between Water along with Sanitation and Hygiene (WASH) and child stunting remains inconclusive. Water-related mechanisms outside of the traditional scope of WASH might assist with explaining this. Objective: We aim to test the mediating role of reduced dietary diversity as an additional potential mechanism in linking worse household water access to increased risk of early childhood stunting, separating its effects from sanitation and diarrhea among children (as a proxy for hygiene) and taking into account regional water availability. Method: We use nationally representative India Demographic and Health Survey (2015-16) data for 58 038 children aged 6 to 23 months, applying generalized structural equation modelling to estimate water’s direct and indirect effects (as mediated through dietary diversity and access to sanitation) on a child’s likelihood of being stunted. Results: Suboptimal water access is significantly associated with elevated likelihood of child stunting. More than 30% of the effect is indirect. In the context of low water access and availability, children’s dietary diversity alone mediates more than 20% of its total effect on child stunting. Conclusion: Beyond the WASH mechanisms, household water access affects child stunting indirectly, mediated through its impacts on children’s dietary diversity. These mediating effects are also moderated by regional water availability. Water interventions in low-water regions should help reduce children’s risk of nutrition-related stunting in households with lowest water access.

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Growth and Weight Status in Chinese Children and Their Association with Family Environments

Children ◽

10.3390/children8050397 ◽

2021 ◽

Vol 8 (5) ◽

pp. 397

Author(s):

Xu Tian ◽

Hui Wang

Keyword(s):

Weight Status ◽

Family Income ◽

Decomposition Analysis ◽

Overweight And Obesity ◽

Chinese Children ◽

Nutrition Survey ◽

Growth Status ◽

Health And Nutrition ◽

The Impact ◽

Over Time

The growth status and weight status of Chinese children have experienced remarkable changes in the past decades. Using China Health and Nutrition Survey (CHNS) data, this paper examines the secular trends and disparity of the growth status and weight status in Chinese children and further investigates the impact of various family environments on children’s growth from 1991 to 2011. We found an increasing trend in standardized growth indicators (height, weight, and BMI), overweight, and obesity from 1991 to 2011. We also observed an increasing disparity in overweight and obesity over time. Family environments had a significant impact on children’s growth status and weight status. In particular, children that live in families with a small size, higher family income, better sanitary conditions, and with well-educated parents or overweight parents tended to be taller and heavier and have a higher BMI, lower risk of being underweight, and higher risk of exhibiting overweight and obesity. Further decomposition analysis showed that more than 70% of the disparity in standardized height, weight, and overweight and around 50% of the disparity in standardized BMI, underweight, and obesity could be attributed to heterogeneity in family environments. Moreover, the disparity associated with family environments tended to increase over time.

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Impact of differential copayment on patient healthcare choice: evidence from South Korean National Cohort Study

BMJ Open ◽

10.1136/bmjopen-2020-044549 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044549

Author(s):

Sangkyun Jo ◽

Duk Bin Jun ◽

Sungho Park

Keyword(s):

South Korea ◽

Low Income ◽

Primary Healthcare ◽

Probability Model ◽

Individual Characteristics ◽

Research Database ◽

Difference In Difference ◽

Mild Disease ◽

Tertiary Healthcare ◽

Linear Probability

ObjectiveWe evaluate the effectiveness of mild disease differential copayment policy aimed at reducing unnecessary patient visits to secondary/tertiary healthcare institutions in South Korea.DesignRetrospective study using difference-in-difference design.SettingSample Research database provided by the Korean National Health Insurance Service, between 2010 and 2013.Participants206 947 patients who visited healthcare institutions to treat mild diseases during the sample period.MethodsA linear probability model with difference-in-difference approach was adopted to estimate the changes in patients’ healthcare choices associated with the differential copayment policy. The dependent variable was a binary variable denoting whether a patient visited primary healthcare or secondary/tertiary healthcare to treat her/his mild disease. Patients’ individual characteristics were controlled with a fixed effect.ResultsWe observed significant decrease in the proportion of patients choosing secondary/tertiary healthcare over primary healthcare by 2.99 per cent point. The decrease associated with the policy was smaller by 14% in the low-income group compared with richer population, greater by 19% among the residents of Seoul metropolitan area than among people living elsewhere, and greater among frequent healthcare visitors by 33% than among people who less frequently visit healthcare.ConclusionThe mild disease differential copayment policy of South Korea was successful in discouraging unnecessary visits to secondary/tertiary healthcare institutions to treat mild diseases that can be treated well in primary healthcare.

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Genotype Effects on β-Carotene Conversion to Vitamin A: Implications on Reducing Vitamin A Deficiency in the Philippines

Food and Nutrition Bulletin ◽

10.1177/03795721211060229 ◽

2021 ◽

pp. 037957212110602

Author(s):

Mark Pretzel P. Zumaraga ◽

Jose Maria Reynaldo Apollo Arquiza ◽

Mae Anne Concepcion ◽

Leah Perlas ◽

Ma. Neda Alcudia-Catalma ◽

...

Keyword(s):

Vitamin A ◽

Children And Adolescents ◽

Vitamin A Deficiency ◽

The Philippines ◽

Fisher Exact Test ◽

National Capital Region ◽

Nutrition Survey ◽

Vitamin A Status ◽

Genotype Frequencies

Background: The study aimed to identify two beta-carotene 15,15′-monooxygenase (BCMO1) mutations, namely R267S and A379V, and determine their association with vitamin A status among Filipinos 6 to 19 years old respondents of the 2013 Philippine National Nutrition Survey living in the National Capital Region. Materials and Methods: This study followed cross-sectional design. Whole blood specimen was collected in the morning and was used as source of genomic DNA and serum for retinol concentration determination. Fisher exact test was performed to determine whether genotype frequencies were associated to retinol concentrations/vitamin A deficiency status. A level of P < .05 was identified as significant. Results: A total of 693 Filipino children and adolescents were included. Of the 693, there were at least 7.6% who bears the combined mutations for R267S + A379V. Association analysis showed that an inverse relationship exists between the A379V TT variant and vitamin A status. Although the exact role of these identified polymorphisms on retinol/carotenoid metabolism need to be confirmed in dedicated functional studies. Conclusion: This study has identified for the first time the presence of 2 nonsynonymous genetic variants/mutations in the coding region of BCMO1 gene. Interestingly, one of these two variants, the A379V T, was found to be associated with vitamin A status. It is, therefore, warranted to investigate the role of BCMO1 variants for the success of supplementation programs and fortification efforts among vulnerable populations in this region. Genetic variability should be considered for future provitamin A supplementation recommendations among children and adolescents in the Philippines.

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