Tags: NGOs and foundations, Poverty
By Alexander Villafania
DATU UDIN SINSUAT, MAGUINDANAO – This province has seen the most brutal and unforgiving armed conflicts. But this only masks a more debilitating problem people here have been suffering from for a long time.
Maguindanao is a virtual minefield that, for decades, has seen the exodus of hundreds of thousands of residents fleeing from crossfire between government forces and Muslim insurgents.
In 2008, the United Nations estimated that over 600,000 people were displaced by fighting – so far the biggest ever recorded worldwide.
It was in late 2009 that Maguindanao once again became the center of a major debacle when over 50 people, at least 30 of whom were members of local media, were brutally massacred allegedly by men loyal to former governor Andal Ampatuan, Sr.
The incident was allegedly carried out by Ampatuan’s son, Andal Ampatuan Jr. The incident drew plenty of attention towards Maguindanao and only cemented its reputation as a war torn province.
Maguindanao is also among the poorest. The National Statistical Coordination Board (NSCB) showed that as of 2009, there were over 72,800 families (or 437,790 Maguindanaoans) who were under the poverty threshold.
The Asian Development Bank also ranks Maguindanao among the top 10 poorest provinces in the Philippines since 2003.
‘Silent emergency’
The armed conflicts, corruption, and poverty in Maguindanao only masked some of the other problems that the province has been facing for years. Underneath the fighting, another threat is befalling the province’s poorest and most vulnerable residents: malnutrition.
The United Nations Children’s Fund (UNICEF) has already identified malnutrition as a “silent emergency.” Many victims claimed by malnutrition are not reported mainly due to the prevalence of poverty.
Children of those born to displaced families are most vulnerable to malnutrition because the parents are unable to find opportunities to earn some income to buy food, or have no land to grow their own food.
Malnutrition generally describes a physical condition resulting from unbalanced diet and lack or excess of certain nutrients. While the common image of a malnourished child is underweight with skin and bones, it can also describe obese children that are already showing some poor health conditions.
Malnutrition could be a purveyor of other diseases for children, such as coronary heart disease, diabetes, high or low blood pressure. Even the Department of Education (DepEd) stressed that malnutrition is also a cause for high number of dropouts among students in public elementary schools.
Statistics from UNICEF revealed that the average malnutrition rate in Maguindanao in 2009 is 9.8 percent out of 717 children. Of this figure, there is a 7.5 percent rate of “moderate acute malnutrition” and another 2.2 percent have “severe acute malnutrition”.
Malnutrition is also an underlying factor in deaths of children under five years old. Between 35 percent and 60 percent of childhood deaths are caused by malnutrition.
Saving malnourished children
In 2009, amid the on-going armed conflict in the province, UNICEF started a program to help curb the malnutrition problem in Maguindanao.
But instead of a massive feeding program, the organization started the Community-based Management of Acute Malnutrition (CMAM), a program that was successfully implemented in Africa where there is also high prevalence of malnutrition.
Dr. Paul Andrew Zambrano, nutrition officer for the Health and Nutrition Division of UNICEF Philippines, said that Maguindanao was chosen for the CMAM program due to the high prevalence of malnutrition among children of poor families that are displaced by armed conflict.
“The high number of malnourished children is tied with other negative factors. These are lack of access to basic necessities such food and clean water, sanitation, inadequate maternal and childcare practices, and of course insufficient food,” Zambrano said.
“You have to remember that these are people who are trying to run away from the conflict so they have no place to go. They have no work and are trying to survive from what little they can get. Children are the most affected because they cannot fend for themselves and the parents are unable to properly care for their children.”
The identification and intervention process begins with the training of health workers at the regional health units and hospitals in Maguindanao. UNICEF tapped non-government organizations Save the Children Fund and Medecins Sans Frontieres for the training, which helped RHU workers to identify signs of malnutrition.
This is followed by training of the parents, particularly the mothers, of the child patients admitted to the CMAM Outpatient Therapeutic Feeding sites.
Zambrano said that caring for malnourished children is a different intervention process that requires proper screening. Treating a malnourished child with the wrong approach could even lead to the child’s death.
“There is an internationally accepted process to help identify a malnourished child and how to care for them. It’s not just about feeding a malnourished child but a whole therapy that involves proper nutritional feeding and patient management,” Zambrano said.
Among the first process is called a MUAC (middle and upper arm circumference) test wherein a tape that measures the circumference of a child’s arm. If the tape hits a certain threshold, marked by red, then the child is considered malnourished.
The patient is then fed only with a ready-to-use therapeutic food (RUTF) paste, which is a cross between actual food, medicine, and mineral supplement. The purpose of the RUTF is to help the child’s body recover.
After therapy, which could last between a week or two, the child is then sent to a “stabilization facility” such as a partner hospital where he or she is treated for other diseases that may have incurred from being malnourished.
So far, the CMAM program has already helped at least 66,000 children between the ages 6 months to 4 years from eight municipalities in Maguindanao. There are now 27 RHU workers trained to screen for malnourished children. Twelve outpatient therapeutic care centers and another two stabilization centers were established.
Zambrano also noted that the cure rate for malnourished children has increased to 80 percent and mortality rate has decreased to just 5.2 percent.
However, the program is set to end by December. Zambrano said that by then, there should already be a national policy on malnutrition intervention not just in Maguindanao but for the entire country. Already, a national task force for CMAM has been established with the help of the Department of Health (DoH), which could pave the way for a nationwide campaign.
“Malnutrition isn’t going away unless there is a concerted effort from all sectors,” Zambrano said.
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