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

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.

Mental health and well-being of children in the Philippine setting during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has subjected the mental health and wellbeing of Filipino children under drastic conditions. While children are more vulnerable to these detriments, there remains the absence of unified and comprehensive strategies in mitigating the deterioration of the mental health of Filipino children. Existing interventions focus on more general solutions that fail to acknowledge the circumstances that a Filipino child is subjected under. Moreover, these strategies also fail to address the multilayered issues faced by a lower middle-income country, such as the Philippines. As the mental well-being of Filipino children continues to be neglected, a subsequent and enduring mental health epidemic can only be expected for years to come.

Risk Factors of Persistently Active Disease among Filipino Children with Systemic Juvenile Idiopathic Arthritis: a 10-Year Study in a Tertiary Hospital

Background: Systemic juvenile idiopathic arthritis (SJIA) is one of the most common subtypes of arthritis among children in southeast Asia with higher progression of disease activity. Unsuccessful control of the disease may lead to long-term disability resulting in functional limitations that would affect productivity of the individual. Objective: The study determined the risk factors for persistently active disease among Filipino children aged 2 weeks to 18 years diagnosed with SJIA seen in the Section of Pediatric Rheumatology of the University of Santo Tomas Hospital (USTH) from June 2009 to June 2019. Methodology: A retrospective cohort study was done involving chart review of both clinical division and private division patients. The following parameters were determined: sex, age at diagnosis, time elapsed from symptom onset to diagnosis, joint involvement, inflammatory markers and extra-articular manifestation. Statistical analysis included frequencies, percentages and logistic regression for the risk factors of interest. Results: One hundred twenty-seven patients with SJIA who were appropriately treated for at least three years were included. Among which, 88 (69%) developed persistently active disease. Among them, 36 (41%) were diagnosed at 1-5 years old. Many were diagnosed (n=54, 61%) after five weeks. The most commonly affected joints were the wrists, knees and ankles. The most common contracture noted involved the cervical joint. Only 33 (26%) patients received biologic agents. Risk factors identified for the development of persistent disease activity were low hemoglobin levels at the time of diagnosis and after one month of treatment, elevated platelet count after a month, substantial joint count after three months and increased ESR after 6 months. Conclusion: The change or improvement of the joint count and in hemoglobin, platelet count and ESR levels after appropriate treatment may determine the risk for persistently active disease in Filipino children with SJIA.

Evaluating Interventions With Special Fortified Products and Complementary Feeding Recommendations to Best Achieve the Nutrient Adequacy in Filipino Complementary Diets

Objectives The objective of this study was to predict the intervention scenarios that best fulfil the nutrient adequacy in Filipino complementary diets in rural settings using linear programming (LP) analyses of special fortified foods, alone or in combination with complementary feeding recommendations (CFRs). Methods A cross-sectional survey was conducted in the municipality of Mercedes, Camarines Norte Province. Dietary intakes of breastfed children 6–8, 9–11 and 12–23 months of age (n = 297) were assessed using a multi-pass 24-hour recall method with 7-day food consumption frequency. Optifood, an LP tool was used to formulate age-specific CFRs and determine the extent to which special fortified foods, namely micronutrient powder (MNP), small-quantity lipid-based nutrient supplements (LNS-SQ) and fortified blended food with micronutrient powder (FBF + MNP), can contribute towards nutrient adequacy in complementary diets. Results LP analyses show that for 6–8 and 9–11-month-old infants, requirements for iron will be difficult to meet even with four serves of MNP per week, while for 9–11 and 12–23-month-old young children, calcium adequacy would remain a challenge even with daily serves of LNS-SQ per week. Adequacy for 11 modelled micronutrients could only be achieved if CFRs that modify current dietary patterns were fully adopted along with supplementation of LNS-SQ 5–7 times per week. Conclusions Adoption of food-based CFRs with special fortified products is necessary to best fulfil the gaps of essential micronutrients in the diets of rural Filipino children aged 6–23 months. The findings provide insight into the current program in the Philippines. The MNP supplementation with the usual ration of MNP 3 to 4 times per week would not be sufficient to ensure adequacy for iron in 6–8 and 9–11-month-old infants unless the frequency is increased to 5 times per week. Empirical intervention studies are needed to confirm the LP simulations and feasibility of the CFRs. Funding Sources The authors received no funding for this work.

Risk factors of stunting during the complementary feeding period 6-23 months in the Philippines

Introduction: Stunting persists as a public health problem in the Philippines, affecting 30% of under-five children. This study aimed to identify the drivers of stunting in young Filipino children aged 6-23 months. Methods: Data were extracted from the cross-sectional Updating Survey conducted in 2015 by the Food and Nutrition Research Institute of the Department of Science and Technology (FNRI-DOST). Potential predictors of stunting, which were categorised into childrelated characteristics, feeding practices, maternal socio-demographic status and health practices, and household economic and food security status, were examined using descriptive and regression analyses. Results: Of the 2,275 children aged 6-23 months, 18.7% were stunted and 8.3% were severely stunted. The risk of stunting increased significantly among older children aged 12-23 months (relative risk ratio, RRR 3.04), males within 6-23 months of age (RRR 1.99), and low-birth-weight infants (RRR 2.19). Children born from teenage mothers (RRR 1.90), mothers with short stature (RRR 2.33), and mothers with low education (RRR 1.59) posed higher risks of becoming stunted relative to their counterparts. Mothers with >4 children (RRR 2.44), coming from the poorest households (RRR 4.27), having untimely introduction of complementary foods (RRR 4.44), and not meeting the minimum meal frequency (RRR 2.30) increased the risks of severe stunting. Conclusion: The study illustrated the multi-factorial nature of stunting among Filipino children aged 6-23 months old. Therefore, a multi-sectoral approach is needed to address the underlying factors of stunting among young Filipino children to help achieve the country’s nutrition targets by 2025.

Engaging, Affirming, Nurturing Inclusive Environment: A Grounded Theory Study in the Philippine Context

Implementing the tenets of inclusive education in different countries may be diverse because of varying interpretations, contexts, and ways of application. In the Philippines, studies that delve into the kind of environment involving Filipino children with special needs are scarce. Thus, through a grounded theory approach, this qualitative paper aims at developing a framework as a means of understanding inclusive environments thriving in an inclusive Philippine setting. Thirty-two special education teachers from three private schools were interviewed, the data being triangulated through class observations. The emerging theory encapsulated three major dimensions to understand concepts of inclusive environment: engaging environment, affirming environment, and nurturing environment. An engaging environment points to having high-standard learning outcomes, promoting collaboration and communication among learners, teachers, and parents, and involving them in decision-making. An affirming environment, on the other hand, denotes practicing expressive and receptive languages, imbibing the sacred worth of class members, and celebrating diversity. Finally, a nurturing environment can be achieved through interdependence and care for the needs of everyone. These dimensions are inter-related and are not standalone. This paper advances that success in the diversified Philippine inclusive classroom context can be achieved through the interdependence of school community members. The question of the significance of the inclusive practices and principles should not be the primary concern of a particular context. Rather, involvement and interdependence to achieve an engaging, affirming, and nurturing environment matter. Ramifications to micro and macro integration of inclusion that support inclusive environments are also discussed.