A recent survey said more Filipinos are growing hungry, but it was mainly about common hunger, i.e. lack or absence of food on the table. Other studies have found that “hidden hunger,” mainly malnutrition, is an equally troubling problem. And while Davao leads the country in food fortification, the city, as well as the rest of the country, needs to do more to ensure the prevention of illnesses and conditions — such as iron-deficiency anemia — related to lack of nutrition. Contributor Emmanuel C. Roldan reports.
DAVAO CITY Julie (not her real name) is 10 years old. She looks and behaves like all other fourth grader at the Magallanes Elementary School. She loves to dance, enjoys playing outdoor games with friends but there are problems — she tires easily and lags behind in school.
Her mom says Julie has a pretty normal eating habit although she prefers to eat snacks (chichirias) than vegetables. She also studies hard but the lessons seem to be too difficult for her to digest.
Impaired mental and physical development and sluggishness are but some of the symptoms of Iron Deficiency Anemia (IDA). Anemia also increases susceptibility to infections, low endurance and low capacity for work.
According to the recent Unicef Global Progress Report, one out of three Filipino children has IDA. It also reveals that 35 percent of Filipinos aged 15-49 are deficient in iron and, despite the passage of a national food fortification law, iron and folic acid fortification in local flour and other staple foods such as rice is lacking. Preschool children below six years old and women of reproductive age are the hardest hit. There is no wonder that children like Julie may have enough to eat but still suffer from malnutrition.
A recent nationwide nutrition survey by the Food and Nutrition Institute of the Department of Science and Technology shows that IDA is now a serious health problem of Filipinos. It strongly recommended a national policy on iron supplementation for infants and young people.
Sarah Coe, executive director of EventsPlus, a communications company that prepared a nationwide nutrition awareness campaign among public elementary schools with the Department of Education, said that iron is needed by our body to produce healthy blood. Blood supplies oxygen to our brain and to different body parts. IDA primarily affects proper functioning and development of the brain.
Hidden hunger
The Department of Health (DOH) defines hidden hunger as micronutrient malnutrition, particularly the lack of Vitamin A, iron and iodine, a condition that is one of the most prevalent nutritional disorders in the country and the world.
In the Philippines, hidden hunger is generally categorized into three nutritional deficiencies such as IDA, Vitamin A Deficiency Disorder (VADD) and Iodine Deficiency Disorder (IDD). Perhaps later a new category of Zinc Deficiency Disorder may be added to the list.
The 6th National Nutrition Survey (NNS) in 2003 showed that hidden hunger persisted among Filipinos. In terms of IDA, about seven in every 10 infants, three out of 10 pre-schoolers, four of 10 pregnant women and four of 10 lactating mothers were anemic.
The same survey revealed that four in every 10 pre-school children, two of 10 pregnant women and two of 10 lactating mothers had VADD. Fortunately, iodine deficiency went down from 36 percent in 1998 to 11 percent in 2003 among six to 12 years old children and from 28.4 to 18 percent of pregnant women during the same period due largely to the passage of the Asin Law in 1995, which legislate the use of iodized salt. Davao City has reached 100-percent compliance to this law for three consecutive years now.
Hunger and malnutrition
Hunger is defined as the painful sensation due to inadequate food intake that leads to malnutrition when prolonged. The results of the quarterly self-rated hunger survey by the Social Weather Station (SWS) reflect an increasing incidence of hunger in the country.
In the first quarter of 2006, 16.9 percent or about 700,000 Filipino households experienced hunger, with nothing to eat, at least once in the previous three months. Hunger was highest felt in Mindanao at 21.0 percent followed by the National Capital Region at 18.3 percent and Visayas as 16.0 percent.
The NNS 2003 survey revealed that 27 out of 100 children 0-5 years old or 3.2 million children were underweight for their age. The same 27 out of 100 children 6-10 years old or 2.49 million children were underweight for their age, and 36 out of 100 children 6-10 years old or 3.41 million children were short for their age.
Impact of hidden hunger
DOH warns that unchecked micronutrient deficiencies will have serious negative impact on the nation. If left unabated, it would produce a sickly, weak, handicapped, unproductive and sluggish generation that could not be able to withstand the pressures of global competition.
Reports of the DepEd show an alarming students academic deficiency in math, science and even in English which was considered an edge of Filipino workers against other nationalities in the past.
The lack of Vitamin A leads to preventable blindness, increases susceptibility to various childhood illnesses and respiratory infections, and increases child deaths. On the other hand, lack of iodine results in preventable mental retardation, deaf-mutism, low IQ, physical retardation and goiter. Zinc helps bodys absorption to vitamins and other minerals and increases organ metabolism.
Asin Law
Republic Act 8172, An Act Promoting Salt Iodization Nationwide (Asin), was signed into law in December 1995. This law mandates the iodization of all salt sold in the country to help eliminate IDD. Salt, cooking oil, flour, sugar and rice are among the food items most commonly consumed by Filipino households.
According to sources, Davao City was the first city to seriously implement the Asin Law through the help of various groups such as the Kiwanis Club, business sector and non-government organizations. Dr. Josephine Villafuerte, head of the Davao City Health Office said it took about 10 years to fully implement the law. The city is proud to announce a 100% ASIN law compliance as it garners this years nutrition green banner award for the third time, Villafuerte explained in a local forum on food fortification in October.
Food fortification program
People go hungry and become malnourished because of two immediate causes: 1) unavailable or insufficient food to eat, and 2) no money to buy food. Addressing the issues of poverty by putting money in peoples pocket on the demand side and producing more healthy foods or increasing food security and ensuring efficient food delivery on the supply side of the equation is a paramount strategy against hunger.
To supplement the Asin law, the congress passed Republic Act 8976 or the Philippine Food Fortification Act of 2000 on Nov. 7, 2000, as one of its strategies to fight and eliminate hidden hunger in the country.
The law mandates the compulsory fortification of four staple foods such as flour with Vitamin A and iron, edible oil with Vitamin A, sugar with Vitamin A and rice with iron. Voluntary fortification of other food products is enjoined by the same law. It likewise institutionalized the Sangkap Pinoy Seal Program as a strategy of the DOH to gain support from food manufacturers and suppliers of the said law and to regulate the quality of fortified products.
The fortification program of the government aims to increase dietary intake of Vitamin A, iron and iodine equivalent to 50 percent of the Recommended Energy and Nutrient Intake (RENI) contributed by fortified foods. President Gloria Macapagal-Arroyo even issued Executive Order 382 declaring Nov. 7 of each year as Food Fortification Day to magnify the governments determination in addressing malnutrition in the country.
Fortification of rice
The law defines fortification as the addition of nutrients to processed foods or food products at levels above the natural state. It is an addition of a micronutrient deficient in the diet, to a food which is widely consumed by specific at-risk groups.
Of the four staples, only rice has not yet fortified because of gaps in technology and supply even after six years of the enactment of R.A. 8976. Local fortification, although currently available is still at the infancy stage in Mindanao. The government through the National Food Authority (NFA) still procures iron fortified rice (IFR) from Vietnam for its Food for School Program Bigas para sa Mag-aaral at Pamilya and other feeding programs of the government.
Forty nine provinces in the country belonging to Very, very vulnerable (3 provinces), Very Vulnerable (8 provinces), and Vulnerable (38 provinces) to food insecurity and hunger are targeted for this program. The three top most vulnerable provinces are Masbate in Region 5, Tawi-tawi and Sulu in the ARMM.
CLG health foods
The sound partnership between the government and the private sector is a key factor in the success of the governments food fortification program. The government will ensure that the law and its IRR are promoted and implemented, and its implementation is properly regulated and monitored. On the other hand, the private sector will ensure the availability of fortified products in the market place and assist the government in promoting the consumption of fortified products to the public.
One of those who accepted the challenge is Christina L. Go Health Food Products in General Santos City. After years of development and quality examination by the BFAD, DOH and other government agencies, the corporation has finally produced iron fortified rice premix or iron fortificant for commercial purpose. Its P12 million facility is located in a three-hectare lot at the outskirts of the city with a maximum capacity to provide the needed iron fortificant for raw rice of entire Mindanao.
The premix is rice-based produced from local technology that passed the stringent tests and standards set by BFAD and IRR of R.A. 8976. According to the said law, except for glutinous rice, locally called pilit and malagkit and brown rice, all milled rice should be fortified using the minimum standard fortificant ratio of 60 mg iron (Fe) per kilogram (kg) raw rice to a maximum tolerable level of 90 mg Fe/kg raw rice. A sack of 50 kilo raw rice needs approximately 250 gm of iron premix to produce one sack of IFR.
Upon the issuance of the License to Operate to the corporation by BFAD in April 2006, the analysis of the premix samples showed 83.19 mg Fe/kg content level which was far above the minimum standard of 60 mg Fe/kg as set by the law. The color of the premix is light brown in raw rice that turns into tiny orange specks that appear somewhat like garlic rice when cooked. There have been acceptability tests in private and government hospitals and food establishments in Davao City which showed no appreciable difference in color, odor and taste of the product.
Premix dispenser
Consequently, CLG and its marketing arm Second Wind Marketing also produced the first cost-effective mechanical premix rice dispenser aptly called Blending in Exact Level to Enhance Nourishment (BELEN). Unlike the huge and expensive premix mixer models being introduced before, BELEN dispenser uses a 3-phase to 1 HP electrical motor that is responsible for the homogenous blending of rice and iron premix according to the recommended mixing ratio of 1:100 or 1:200 to produce fortified rice.
Above all, rice millers will not anymore borne the P400,000.00 cost of the iron premix mixer introduced by NFA during the Rice Forum at Rembrandt Hotel on September 9, 2005 because BELEN dispenser only costs a fraction of that amount. It can be either manually or digitally calibrated depending on the milling capacity and can be attached easily to all existing types of rice mill in the country.
METAVCO and San Pedro Hospital
Six rice millers in Mindanao have adapted the BELEN technology into their mills barely four months after the operation of CLG Health Foods. These are Solivio Rice Mill in Surallah, North Cotabato, Arandia Rice Mill in Marbel, Lumbayan Rice Mill in Kidapawan City, Jamin Rice Mill in Panabo City, RAPACON Rice Mill in Midsayap, North Cotabato and lately METAVCO Agricultural Development Corporation in Davao City.
Although BELEN dispensers are attached to the rice mills, they do not guarantee instant massive fortified rice production and acceptability without help from government agencies and local government units. Perhaps it is in Davao City that commercial production of fortified rice takes its stronghold when METAVCOs president, Mr. Benito Mesina agreed to take part in a 4-month trial period with Grains Fortificant Marketing, a local fortificant distributor starting September 2006. As of the end of October, METAVCO had milled and commercially distributed more than 1,000 sacks of fortified rice under the Health and Pinoy brands in the Davao market.
Acceptability of iron fortified rice (IFR) to the public has also been addressed by making it available to the market especially at NCCC Mall, Victoria Plaza, Gaisano Malls and selected rice retailers. Among its first users are the San Pedro Hospital, Davao Doctors Hospital, Davao Medical Center and Brokenshire Memorial Hospital all in Davao City. The Davao Medical Center, the biggest public hospital in Mindanao had purchased its first order of 170 sacks of fortified rice for its patients after undergoing a cooking and sensory testing with experienced hospital dietitians and officials.
Restaurants and food establishments are also a good advocate for the use of fortified foods as fortified rice finds its way into the dining table of Iron Horse Buffet Restaurant since September followed by Kuya Eds, Penongs and others food outlets. So far it garnered positive results as people are aware of the nutritional benefits of using fortified rice and to learn that the healthy product is now available in the market.
Local ordinance
Recognizing the need to spearhead the public advocacy on rice fortification, the Department of Health, National Nutrition Council, Council for the Welfare of Children and the local government of Davao City launched a Forum on IFR on October 19, 2006 and a one week feeding program using fortified rice donated by METAVCO in 10 selected barangays in time for the Childrens Month celebration.
DOH Usec. Ethelyn Nieto graced the said forum and congratulated Davao City for taking a giant step towards eliminating hidden hunger in the country by again vying to be the first city in the country to fortify its rice. The government also awarded five IFR pioneers during the forum such as METAVCO, San Pedro Hospital, Iron Horse Buffet Restaurant, NCCC Mall and Art-Agusan Rice Trader to encourage and elicit more support from the private sector to the rice fortification program.
In order to complement the efforts of government and private sectors, a local ordinance dubbed as the Fortified Rice Utilization Ordinance of Davao City is now on second reading. Councilors Gerald Bangoy and Nenita Orcullo, both from the second congressional district of Davao, authored the ordinance. This move will hopefully give more teeth to the poorly implemented Philippine Food Fortification Program and an opportunity for the city to be at the helm against micronutrient malnutrition.
However, Davao City is not the first to propose and to pass such local legislation on food fortification. On January 9, 2006, the City Council of Panabo enacted Ordinance No. 32-05 but again the absence of supply of fortified rice stalls the implementation of said law. In the same vein, the small Municipality of Bansalan, Davao del Sur, some 150 kilometers south of Davao had passed a law calling for mandatory production and sale of iron fortified rice. Bansalan has included fortified rice as its key product for the One-Town-One Product (OTOP) program being spearheaded by the DTI.
Not all white is good
Hidden hunger? Yes it may be real but the problem is not entirely insurmountable. Food fortification especially on rice as the basic staple of common tao is a direction worth exploring. The greatest barrier is changing peoples perception that white rice is not always good. While organically-produced rice is ideal health alternative to chemical-based staple, rice fortification is still the most sustainable and cost-effective strategy to combat hidden hunger in the country.
Now that Davao City has raised the green light on full rice fortification owing to the locally-available and affordable iron fortification supply and technology, it is hoped that other cities and municipalities would join the bandwagon and invest on the better health of children and young Filipinos.
After all, economic studies done by the World Bank show that hidden hunger could waste as much as 5 percent of the Gross Domestic Product (GDP) while addressing the problem comprehensively and sustainably would cost less than 0.3 percent of the GDP. (Emmanuel C. Roldan/davaotoday.com)
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