Stunting and malnutrition pose health and economic burden in Bangsamoro

1 in 2 children under 5 years old in the region is stunted

UNICEF Philippines
A mother, wearing a hijab, carrying her child
UNICEF Philippines/2019/Jeoffrey Maitem

14 November 2019

PIAGAPO, Lanao del Sur, Philippines—Isnaira Markakim is carrying her two-year-old son Ansary at the foot of the valley where her family lives. Ansary and his brother, five-year-old Ashary, were diagnosed with severe acute malnutrition (SAM). The family’s remote home is at four hours walking distance from the town’s health center. It’s nearly a full day’s walk back and forth if not riding a horse or a motorcycle, that costs PHP 200 for a single ride, an amount unaffordable for Isnaira.

“I only learned about my children’s condition when I first met the health workers. Back then, I wasn’t worried that they are small. I just thought that they took after me. I am short too,” Isnaira shared. “When they told me that my children are stunted and severely malnourished and explained to me what it means, I felt sad and helpless. I didn’t know how to treat them or how they would survive.” she added.

Link to video on it's hosted site.
UNICEF Philippines/2019

The vicious cycle of chronic malnutrition 

Isnaira, now 25, was married when she was younger than 18. She is not sure of her age. She and her siblings did not have birth registration. She now has five children: Aslimah (7), Ashary (5), Norasia (4), Ansary (2), and Soraya (6 months).

Her children were delivered at home by a traditional birth attendant. She did not have prenatal health check-ups or a healthy diet during her pregnancy. Undernourished pregnant adolescent girls have a higher chance of giving birth to malnourished children.

Due to the inaccessibility of health centers, only one of Isnaira’s five children was partially immunized. “My son Ashary only received the first dose of vaccine when he was two months old. I brought him to the health center hoping he grow up healthy and strong. But we could not afford to continue visiting the health centers and had to stop short of completing his immunization,” she explained.

Medical services in Piagapo is inadequate. Only 26 health care workers serve over 27,000 people – almost 4,000 of whom are children under 5.

Water and sanitation are also a problem in the Markakim household. “Our drinking water comes from the waterfalls. When we have good weather, we get better water, otherwise not,” she said. “We have a toilet but it’s not working now. We don’t have the money to repair it.”

Isnaira started breastfeeding her children but could not continue, likely due to her own malnourished condition. When times get even harder, she resorted to feeding the children watered down infant formula, am or rice water, sugared water, and even diluted coffee, all devoid of nutritional values.

She and her husband, 27-year-old Mahadali are farmers. They plant corn and chilis and grow vegetables. “From sunrise to sundown, my husband and I are in the fields tending to our crops. I leave my eldest daughter, Aslimah, to take care of her younger siblings. That is the only way for us to survive,” said Isnaira.

Aslimah, 7, is responsible for the household chores and care for her siblings, including the infant sister, when their parents are away working in the field. She lets them play and serves them the rice and vegetables prepared by their mother before leaving to the field.

A boy squatting on the ground while playing with a set of wheels
UNICEF Philippines/2019/Jeoffrey Maitem
Ashary Markakim, 5, is short for his age. Without proper nutrition in the first two years of life, children become stunted as they grow up. This affects not only their body, but also their cognitive development, affecting their productivity as adults.

UNICEF and partner Health Organization for Mindanao (HOM) met Aslimah and his siblings at home while conducting a community outreach. The family of four stunted and two children with SAM was immediately noticed. Five-year-old Ashary cannot walk. He moves by crawling and plays sitting on the ground, and can only stand when propped up by his sister.

The health workers waited for the parents to return and inform them of the children’s condition. “I was extremely worried when they told me that my children are sick. I usually give them home remedies with leaves and weeds when they get sick with cough and fever. The health center is very far for us to avail of the free check-up and medicines,” Isnaira said, “But I was told SAM is different. If not addressed, this can cause permanent damage to my children,” she added.

The children were provided with Ready-to-Use-Therapeutic Food (RUTF). After a few months, both children started to recover. Ashary walked for a brief time. But his condition relapsed when the supply of RUTF ran out for a few months.

“I feel very sad seeing him not able to walk and his feet deformed. It will be difficult for him to learn and live a regular life,” said Isnaira.

The high cost of malnutrition

Stunting results from poor nutrition and repeated episodes of infection during the child’s first 1,000 days, or from the beginning of the mother’s pregnancy, when the baby is still in the womb, until two years of age. Poor health-seeking behaviors and sanitation practices also lead to malnutrition and stunting.

Stunting cannot be treated but it can be prevented. Strategies to counter stunting need to reach children during the first 1,000 days of their life. A combination of interventions is needed that includes children, mothers and women of reproductive age.

Care and nutrition in the first 1,000 days from pregnancy to two years of age in a child’s life is the critical foundation for life-long health and well-being of children. Missing this window of opportunity can have irreversible adverse impact to children’s physical and cognitive development.

A recent study supported by UNICEF on the economic consequence of undernutrition indicates that stunting costs the Philippine economy more than USD3.1 billion per year due to losses in individuals and social productivity.

“Prolonged exposure to malnutrition leads to irreversible damage to a child’s long-term physical and cognitive growth and further traps families in a lifelong cycle of poor health and poverty,” said Dr. Sally Bataclan, UNICEF Health and Nutrition Specialist.

A UNICEF staff member, wearing a black t-shirt, carries a baby in front of her family
UNICEF Philippines/2019/Jeoffrey Maitem
A UNICEF staff member carries Soraya, the youngest child of the Markakim family.

Long-term solution for stunting

Even after her children’s nutritional status improved, Isnaira worked out a plan with the health workers in her municipality. She walks for over two hours to meet them halfway and receive the supplies of RUTF. She also asks for advice on more nutritious food choices she can prepare for her children.

Meanwhile, the health workers continuously monitor the situation of all children in their town especially those who live in geographically isolated communities like the Markakim family. But their efforts can only do so much.

According to the National Nutrition Survey, the Bangsamoro region has the highest prevalence of stunting in the Philippines at 45.2%.

This means that an estimated 230,000 children, or at least 1 in every 2 children under 5, are stunted and deprived of achieving their full potential in life.

Despite the monumental efforts of mothers like Isnaira and the health workers of Piagapo in Lanao del Sur, they cannot do it alone. Stunting and acute malnutrition (wasting) requires stronger health and nutrition governance.

Investments at the local government level is critical to quality health and nutrition programmes reaching children and families across Philippines. Adequate investment is also needed to implement these programmes and for health and nutrition front line workers to reach every child, even in remote communities. Poor nutritional status of children is the predictor of loss in the country’s future productivity, national health status and income.

For every child, good health and nutrition.


This is the second in a series of CRC@30 Philippines stories gathered by Shirin Bhandari, Teresa Cerojano, Claro Cortes, Jeoffrey Maitem, Charena Escala, Arby Laraño and Iris Lapid, with fact checks, technical and editorial inputs by a UNICEF Philippines team.