Iron Deficiency Anemia - Philippines

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	EPIDEMIOLOGICAL DATA


Anemia
Most Recent Anemia Survey		5^th National Nutrition Survey conducted by the Food and Nutrition Research Institute (FNRI)

Date:

1998

Groups Surveyed:

The IDA survey covered all provinces (except Basilan and Lanao del Sur) of the 15 regions of the country including Cotabato City, including 10 highly urbanized cities (HUC) and 5 cities and 5 cluster areas in the National Capital Region (NCR). The survey was designed to provide provincial level estimates for infants, preschoolers, pregnant and lactating women and national estimates for the other age/physiologic groups (children 6-12 y, adolescents, 13-19 y adults, 20-59 and older persons, 60 years and above)

Sample Size:

36,364

Sampling Method:

The survey followed a two-stage sampling design, with the barangays (villages) as the primary stage units and individuals as the secondary stage units. A total of 763 barangays and 36,364 individuals were covered to represent the entire Philippines. Briefly, barangays were sorted/arranged based on the 1995 population census. From this ordered list of barangays, a sample of 6-10 barangays was selected using systematic sampling. The number of sample barangays obtained from each stratum was dependent on its total population (Pacificador, A.Y., 1999)

Estimated Anemia Prevalence: Indicators

nonpregnant women >15 years of age:	Hb < 120 g/L
pregnant women of any age:	Hb < 110 g/L
men > 15 years of age:	Hb < 130 g/L
children 6 - 60 months of age:	Hb < 110 g/L
children 5 – 11 years of age:	Hb < 115 g/L
children 12 – 14 years of age:	Hb < 120 g/L

Prevalence of anemia in the Philippines by age group and physiological state.

Area/Location	Sample Size	Prevalence of Anemia
Philippines	36,364	30.6
6 months to <1year	2,790	56.6
1-5 y	12,089	29.6
1 y	2,503	31.8
2 y	2,422	34.8
3 y	2,434	36.5
4 y	2,393	26.2
5 y	2,337	33.2
6 months – 5 years	14,879	31.8
6-12 y M	1,542	34.8
F	1,527	36.5
13-19 y M	1,516	26.2
F	1,495	33.2
20-39 y M	1,516	14.5
F	1,495	31.7
40-59 y M	1,509	27.7
F	1,521	33.3
60 y & over M	1,509	49.1
F	1,501	39.2
Pregnant Women	3,103	50.7
Lactating Women	3,260	45.7

Prevalence of anemia in the Philippines by region in children 6 months to 5 years old.
Area/Location:	Sample Size	Prevalence (%)
Philippines	14,879	31.8
NCR	1,627	31.9
Ilocos	636	35.5
Cagayan	708	48.8
CAR	925	25.4
Central Luzon	1,047	30.5
Southern Tagalog	1,810	20.7
Bicol	949	34.3
Western Visayas	1,204	32.1
Central Visayas	1,086	28.8
Eastern Visayas	893	47.3
Western Mindanao	489	42.4
Northern Mindanao	688	19.8
Southern Mindanao	1,253	27.5
Central Mindanao	541	33.8
CARAGA	591	25.6
ARMM	433	50.6

Prevalence of anemia in the Philippines by region among pregnant women.
Area/Location	Sample Size	Prevalence (%)
Philippines	3,103	50.7
NCR	361	40.8
Ilocos	139	56.5
Cagayan	146	61.6
CAR	177	39.8
Central Luzon	229	55.0
Southern Tagalog	363	35.8
Bicol	179	64.4
Western Visayas	240	54.9
Central Visayas	207	58.0
Eastern Visayas	193	61.7
Western Mindanao	103	53.9
Northern Mindanao	154	33.1
Southern Mindanao	264	49.5
Central Mindanao	112	52.1
CARAGA	149	32.1
ARMM	87	60.4

Prevalence of anemia in the Philippines by region among lactating women, based on hemoglobin determination.
Area/Location	Sample Size	Prevalence/Indicator
Philippines	3,260	45.7
NCR	347	41.7
Ilocos	144	41.6
Cagayan	146	68.0
CAR	206	44.4
Central Luzon	256	44.2
Southern Tagalog	366	34.0
Bicol	186	47.8
Western Visayas	258	46.5
Central Visayas	216	41.9
Eastern Visayas	220	59.9
Western Mindanao	103	71.9
Northern Mindanao	169	30.9
Southern Mindanao	276	49.4
Central Mindanao	128	30.9
CARAGA	146	34.0
ARMM	93	46.6




	POLICY AND LEGISLATION

Legislation on IDA


	The Department of Health has an existing policy to address the problem of iron deficiency. The policy and implementing guidelines specify routine iron supplementation for pregnant and lactating mothers, the preparation of iron to be used, including the start and duration of supplementation.
	The government’s IDA policy was first formulated in 1997 and was updated in 2000. The updated policy includes details on targets of supplementation, iron preparation to be used, start and duration of supplementation, dose, and other information required for program implementation.
	Republic Act 8976, "An Act Establishing the Philippine Food Fortification Program and For Other Purposes", also known as the Food Fortification Act of 2000, was enacted into law on 07 November 2000. The law provides for the mandatory fortification of staple foods based on standards set by the Department of Health, and voluntary fortification of all processed foods or food products under the Sangkap Pinoy Seal Program. The Philippine Government has recently approved the Implementing Rules and Regulations (IRR) of the said law.
	The current government policy focuses primarily on supplementation, but activities on fortification and dietary change are also included.

National Policy for Iron Supplementation of Pregnant Women / Children
	The Department ofHealth has issued Administrative 3-A Series 2000, which specifies the Guidelines on Vitamin A and Iron Supplementation, stating specific levels of supplementation for pregnant women for universal and routine supplementation; and during emergencies, disasters and calamities.

National Policy / Legislation for Iron Fortification
	Specifically for IDA, policies include efforts towards enactment of legislation on mandatory iron fortification of hard flour, all rice sold through the National Food Authority, and commonly consumed processed foods.


Government Agency to Address IDD
	In 1993, the Food Fortification Project under Department of Health was established. The DOH has also created the Food Fortification Inter-Agency Committee under the National Micronutrient Action Team which is tasked to coordinate and synchronize activities and provide directions to the food fortification program. Specific policies on micronutrient fortification have been formulated by the Food Fortification Project in its Strategic Plan for 2000-2004. Food fortification policies, in general, include the determination of vehicles for fortification, identification of targets for fortification, strengthening of promotion and advocacy efforts through the “Sangkap Pinoy” seal, efforts towards enactment of laws, development of standards, research, monitoring, and surveillance, training for industry and program implementors, resource generation, enhanced government-private sector collaboration, and enhancement of government infrastructure.



	PROGRAM DATA


Supplementation
Program Description - Pregnant and Post-partum Women
	Universal iron supplementation started in 1993 with the National Immunization Day in April and National Micronutrient Day in October.
	The large scale iron supplementation program started in 2000.


Targeting
	Universal and routine iron supplementation for pregnant and lactating women is done in rural health units and government health facilities nationwide


Capsule Information
	Daily iron-folate tablets (60 mg. elemental iron with 400 mcg folic acid)
	Total capsules distributed unknown.

Implementation

The supplement is distributed in rural health units and government health facilities. However, supply is erratic and is dependent on the availability of funds

Strategies (Women)	Target	Dose
Universal supplementation	All pregnant women	1 tablet (60 mg. elemental iron with 400 mcg folic acid) once a day. A starter pack of ferrous sulfate with folate tablets is given.
Routine supplementation	Pregnant women	1 tablet (60 mg. elemental iron with 400 mcg folic acid) once a day for a period of 6 months upon diagnosis of pregnancy
Routine supplementation	Lactating women	1 tablet (60 mg. elemental iron with 400 mcg folic acid) once a day for a period of 3 months to start immediately after delivery
Supplementation during emergencies, disasters, and calamities	Pregnant women	1 tablet (60 mg. elemental iron with 400 mcg folic acid) once a day for a period of 6 months
	Lactating women	1 tablet (60 mg. elemental iron with 400 mcg folic acid) once a day for a period of 3 months to start immediately after delivery

Strategies (Children)	Target	Dose
Universal supplementation	Low birth weight (LBW) infants	0.3 mg or 2.0 mg/kg. birthweight per day iron drops at 15 mg elemental iron/0.6 ml of 30 ml. bottle to start at 2 months and consume one (1) 30 ml bottle iron drops
	Infants (6-23 months)	0.3 mg or 2.0 mg/kg. birthweight per day iron drops at 15 mg elemental iron/0.6 ml of 30 ml. bottle and consume one (1) 30 ml. Bottle iron drops
Routine supplementation	LBW infants	0.3 mg or 2.0 mg/kg. birthweight per day iron drops at 15 mg elemental iron/0.6 ml of 30 ml bottle to start at 2 months and consume one (1) 30 ml bottle iron drops
	Infants (6-23 months)	0.6 mg or 2.0 mg/kg, birthweight per day iron drops at 15 mg elemental iron/0.6 ml of 30 ml bottle and consume one (1) 30 ml bottle iron drops
	Children 2-5 years	1 tsp (5 ml) once a day at 30 mg elemental iron/15 ml of 120 ml bottle iron syrup and consume two (2) 120 ml bottles of iron syrup
	Children 6-11 years; anemic, moderately and severely underweight	2 tsp (10 ml) once a day at 30 mg elemental iron/15 ml of 120 ml bottle iron syrup
	Children 5-15 yrs in schistosomiasis endemic areas	2 tsp (10 mi) once a day at 30 mg elemental iron/15 ml of 120 ml bottle iron syrup for 2 months
	Children in malaria endemic areas	2 tsp (10 ml) once a day at 30 mg elemental iron/15 ml of 120 ml bottle iron syrup for 2 months
Supplementation during emergencies, disaters and calamities	LBW infants	0.3 mg or 2.0 mg/kg birthweight per day iron drops at 15 ml elemental iron/0.6 ml of 30 ml bottle to start at 2 months and consume one (1) 30 ml bottle iron drops
	Infants (6-23 months)	0.6 mg or 2.0 mg/kg, birthweight per day iron drops at 15 mg elemental iron/0.6 ml of 30 ml bottle and consume one (1) 30 ml bottle iron drops
	Children 2-5 years	1 tsp (5 ml) once a day at 30 mg elemental iron/15 ml of 120 ml bottle iron syrup and consume four (4) 120 ml bottles of iron syrup
	Children 6-11 years; anemic, moderately and severely underweight	2 tsp (10 ml) once a day at 30 mg elemental iron/15 ml of 120 ml bottle of four (4) 120 ml bottles of iron syrup


Fortification
	The Sangkap Pinoy Seal (SPS) Program of the Department of Health is a strategy that encourages food manufacturers to fortify processed foods or food products with essential nutrients at levels approved by the DOH. To date, there are 45 food products fortified under the SPS Program, 13 ofwhich are fortified with iron

Other Programs

Dietary Change

The Nutritional Guidelines for Filipinos issued in 2000 are primary recommendations to promote good health through proper nutrition. These recommendations aim to encourage the consumption of an adequate and well-balanced diet, and promote desirable food and nutrition practices as well as nutrition-related health habits in the general population. The NGF has specific recommendations, which are intended to correct deficiencies in the current dietary pattern of Filipinos.


De-worming Programs
	The Department of Health undertakes periodic deworming programs as part of basic health services.


Malarial Programs
	Malaria is endemic in many regions in the Philippines. The DOH has undertaken malaria control measures through control of the mosquito vector.



	MONITORING

Anemia
Current monitoring activities for iron deficiency anemia:
	Nationwide: through the National Nutrition Surveys conducted by the FNRI every five years. The main indicator used is hemoglobin concentration.
	The surveys described in the EPIDEMIOLOGY section are being repeated. The Food and Nutrition Research Institute undertakes National Nutrition Surveys every 5 years and includes blood sample collection for hemoglobin measurement.
	At the municipal/community level, some health centers are capable of measuring hemoglobin/hematocrit. Hemoglobin measurement can be done in health centers, as well as in community, district, provincial, and regional government hospitals. HemoCue has been used, but only in small scale surveys ad research studies.

Programs
	There is no available data on systematic/large scale monitoring of distribution of iron tablets.
	The content of fortified commodities is monitored to a limited extent by the DOH, through the issuance of the Sangkap Pinoy Seal. There is no available data on monitoring of distribution of iron fortified foods.



	PROGRAM RESOURCES

Donor and Implementing Agencies

	USAID, UNICEF: Support in the form of provision of iron supplements.