Saving children from malnutrition

By providing ready-to-use therapeutic food, UNICEF, in partnership with the UK government, is helping malnourished children in Maguindanao fight illnesses and early death

Jude Ortega
Namraida Drapal, 16 months old, had gained weight  since she was enlisted as a child with severe acute malnutrition.
UNICEF/Louie Pacardo
27 September 2021

In February this year, when Namraida Drapal was 13 months old, she weighed 6 kilograms only despite having a height of 71 centimeters. Community health workers identified her as a child with severe acute malnutrition (SAM).

Just three weeks later, when Namraida was weighed again, she showed a marked improvement. Her weight had increased to 6.9 kilograms. Although still malnourished, her nutritional status had improved and was reclassified to moderate acute malnutrition (MAM).

Health workers had provided Namraida with ready-to-use therapeutic food (RUTF) from UNICEF. RUTF has been helping children with SAM and MAM in Datu Salibo town, Maguindanao province.

Better health, good appetite

Namraida’s mother, 28-year-old Norsida Kanayo, has noticed that her child has become less sickly. “Namraida used to have colds and cough often,” says Kanayo. “She’s stronger now. I have less worries.”

Kanayo, who was born without arms, also appreciates the convenience of using RUTF, which comes in packs that are small and light enough for children to hold. “I just need to cut the edge of the pack, and Namraida eats the contents on her own,” says Kanayo. The child presses the pack so that its soft and sticky contents ooze out.

Kanayo’s other children, aged 11, 8, and 4, help their mother in taking care of their youngest sibling and in household chores. The family has to keep watch of Namraida because they live in a stilt house in Magaslong village, a part of Liguasan Marsh, and the ground under their house is constantly flooded. Kanayo’s husband, 36-year-old Drapal Ali, is often away because he works as a fisherman.

Aside from Namraida’s improved physical appearance, Kanayo has also observed that the child has developed a healthy appetite. “It’s no longer difficult to make her eat,” says Kanayo. “Her ration is two packs of RUTF per day, and she eats them all. She likes the taste.”

Ready-to-use Therapeutic Food (RUTF) has been helping children with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) in Datu Salibo town, Maguindanao province.

Namraida, a child who experienced sever acute malnutrition, with her family
UNICEF/Louie Pacardo
Namraida Drapal (bottom left), a child who experienced sever acute malnutrition, with mother Norsida Kanayo (top left) and her two sisters sit inside their stilt house in Datu Salibo, Maguindanao.

Constant intervention

Catherine Lozarito, a doctor and a health officer of UNICEF, attributes Namraida’s appetite to the micronutrients in the RUTF. “As evident in Namraida’s case, RUTF is a fast treatment for SAM,” says Lozarito. “With regular food, it may take six months to see the same results.”

After three months and one week of intervention, Namraida is now 72.5 centimeters tall but still weighs 6.9 kilograms. Her weight decreased to as low as 6.6 kilograms in the past weeks because she still gets sick every now and then. “It’s a usual trend for children with SAM and MAM,” explains Lozarito. “Their health may fluctuate even with a steady supply of RUTF or the right food. That’s why the intervention must be consistent for them to recover from malnutrition.”

The Joint Child Malnutrition Estimates 2021 edition states that in 2020, globally, among children under 5 years old around 6.7 per cent or 45.4 million were wasted and 149.2 million (or 22 per cent) were stunted.[1] In the Philippines, based on the 2015 National Nutrition Surveys (NNS), the nutrition situation of children under 5 years of age in ARMM (now BARMM), are among the most challenging in the country: the highest stunting rate at 45.2% and second highest wasting rate at 8.2%. In 2013, ARMM has the second highest anemia rate at 21.9%.Lozarito emphasizes that, in the treatment of SAM and MAM, the community, community health workers and the family must be involved. “The family should understand how malnutrition develops so they can also realize what they need to do to prevent it. It is vital to stress to the families and health workers why the intervention must be constant. Once you stop giving the children RUTF or the right food, their health deteriorates again,” she says.

“The family should understand how malnutrition develops so they can also realize what they need to do to prevent it."

Catherine Lozarito, a doctor and UNICEF health officer
Norsida Kanayo and her family of four children lives in a stilt house in Magaslong village within the Liguasan Marsh in Datu Salibo, Maguindanao.
UNICEF/Louie Pacardo
Norsida Kanayo and her family of four children lives in a stilt house in Magaslong village within the Liguasan Marsh in Datu Salibo, Maguindanao. Her husband Drapal Ali (not in photo) works as a fisherman.

Partners in health

The distribution of RUTF is part of the Department of Health’s Philippine Integrated Management of Acute Malnutrition (PIMAM) program. “This intervention is just an additional support to the program,” says Amina Rafia Zeina Lim, UNICEF’s health and nutrition officer.

“Through a grant of the United Kingdom government, UNICEF procures RUTF from suppliers and distributes it to beneficiaries through the Health Organization for Mindanao (HOM) and local government units,” Lim adds.

From October 2020 to March 2021, UNICEF and HOM, in partnership with UK-FCDO, implemented a program called “Protecting the Most Vulnerable in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) through Strengthening Community-based Health and Nutrition Service Delivery in the Context of COVID-19 Pandemic.”

“We implemented the program in ten municipalities in Maguindanao,” says Sharon Mae Macalawan, a nurse and a nutrition supervisor of HOM. “We conducted different activities, including immunization, lectures on COVID-19, distribution of hygiene kits, lectures and counseling on breastfeeding and on infant and young child feeding, and screening of children for malnutrition.”

She adds that the program had to be extended in six of the municipalities, including Datu Salibo, when an armed conflict erupted in March between government forces and members of the Bangsamoro Islamic Freedom Fighters. “Many people have been displaced and have to stay in evacuation centers,” she says. “We have to continue helping them. We have to make sure that even if their environment has changed, they still continue to practice what we taught them.”

Under the program, UNICEF also provided support to community health workers, such as transportation allowance for community outreach activities, personal protective equipment, and information, education and communication materials.

“Before, we rarely get to reach the geographically isolated and disadvantaged areas,” says Vicky Kunting, a nurse in the Rural Health Unit. “Datu Salibo is a sixth-class municipality, so its funds are limited. Through the help of UNICEF, we can now go to remote areas and serve the people there every two weeks or so.”

“We implemented the program in ten municipalities in Maguindanao. We conducted different activities, including immunization, lectures on COVID-19, distribution of hygiene kits, lectures and counseling on breastfeeding and on infant and young child feeding, and screening of children for malnutrition.”

Sharon Mae Macalawan, a nurse and a nutrition supervisor, Health Organization for Mindanao (HOM)
Namraida Drapal (left), 16 months old, plays with the height-measuring board used to monitor children with severe acute malnutrition.
UNICEF/Louie Pacardo
Namraida Drapal (left), 16 months old, plays with the height-measuring board used to monitor children with severe acute malnutrition. She had also gained weight since she was treated for SAM. She also grew 1.5 centimeters in just 3 months.

Continued service

Badria Bidul, the village midwife of Magaslong, also received a height board from UNICEF. She lays it on the floor or table and then lays Namraida on the board to take her height. Namraida’s mother takes the child to the health center every three weeks or so to have her measured and checked and to claim the RUTF ration. Sometimes, Bidul, along with Datu Salibo nutritionist Irene Umagap, visit Namraida at home.

Umagap notes that only UNICEF and HOM currently provide the municipality with RUTF. “Government agencies and other non-government organizations have feeding programs also, but usually, they give regular food only,” she says.

“Service delivery is affected due to the pandemic,” says Lozarito. “The government’s health workers are focused on COVID-19 response. People are also afraid of going to public places, including health centers. UNICEF aims to help the government continue what was being done for the people, before the pandemic.”

At home, Namraida is not aware of the ongoing global health crisis. She sits contentedly on her mother’s lap as her eldest sister, Jubaina, opens a pack of RUTF for her. When the pack is given to Namraida, she puts her mouth around the edge and starts eating. Her mother or sister doesn’t need to persuade her.

When the upper part of the pack is emptied, Namraida gives it back to her sister. Namraida doesn’t want the pack to be put away. She is only asking for help in squeezing out the contents. She wants more.

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“Before, we rarely get to reach the geographically isolated and disadvantaged areas. Datu Salibo is a sixth-class municipality, so its funds are limited. Through the help of UNICEF, we can now go to remote areas and serve the people there every two weeks or so.”

Vicky Kunting, nurse, HOM Rural Health Unit

[1] UNICEF / WHO / World Bank Group Joint Child Malnutrition Estimates (2021). Levels and trends in child malnutrition. World Health Organization. https://www.who.int/publications/i/item/9789240025257