Chapter 2

REVIEW OF RELATED LITERATURE

The following related literature cited in this chapter are several sources of

information and ideas that helped enhance the knowledge of the researcher on

how other things or phenomena are associated to the concern of this study.

Thus, these would supplement and complement to the findings of this study.

Conceptual Literature

Foreign

In Global Nutrition Report 2016 of International Food Policy Research

Institute in Washington DC, it states that malnutrition creates a cascade of

individual and societal challenges—and opportunities. Malnutrition and poor diets

constitute the number-one driver of the global burden of disease. We already

know that the annual GDP losses from low weight, poor child growth, and

micronutrient deficiencies average 11 percent in Asia and Africa—greater than

the loss experienced during the 2008–2010 financial crisis. This report presents

new data on the cost of malnutrition to both societies and individuals. In the

United States, for example, when one person in a household is obese, the

household faces additional annual health care costs equivalent to 8 percent of its

annual income. In China, a diagnosis of diabetes results in an annual 16.3

percent loss of income for those with the disease. All of these figures mean that

the burden of malnutrition falls heavily on all of us, whether directly suffering or

not. But these costs also represent large opportunities for human and economy
 12

betterment, and this report provides many examples of countries that have

seized these opportunities to improve the lives of their people and the health of

their societies by addressing malnutrition.

Malnutrition, in every form, presents significant threats to human health.

Today the world faces a double burden of malnutrition that includes both

undernutrition and overweight, especially in developing countries. Hunger and

inadequate nutrition contribute to early deaths for mothers, infants and young

children, and impaired physical and brain development in the young. At the same

time, growing rates of overweight and obesity worldwide are linked to a rise in

chronic diseases such as cancer, cardiovascular disease and diabetes -

conditions that are life-threatening and very difficult to treat in places with limited

resources and already overburdened health systems (World Health Organization,

2016.)

The double burden in malnutrition focuses on the undernutrition and

overnutrition. For undernutrition, about 104 million children worldwide (2010) are

underweight; undernutrition contributes to about one third of all child deaths.

Stunting (an indicator of chronic undernutrition) hinders the development of 171

million children under age 5 according to 2010 figures while 13 million children

are born with low birth weight or prematurely due to maternal undernutrition and

other factors. Furthermore, a lack of essential vitamins and minerals in the diet

affects immunity and healthy development. More than one third of preschool-age

children globally are Vitamin A deficient, maternal undernutrition, common in

many developing countries, leads to poor fetal development and higher risk of
 13

pregnancy complications together, maternal and child undernutrition account for

more than 10 percent of the global burden of disease. For the issue in the

overnutrition, about 1.5 billion people worldwide are overweight, of whom 500

million are obese, in 2008 figures while about 43 million children under age 5

were overweight in 2010. Growing rates of maternal overweight are leading to

higher risks of pregnancy complications, and heavier birth weight and obesity in

children worldwide. Furthermore, at least 2.6 million people die each year as a

result of being overweight or obese (World Health Organization, 2016.)

In Asia, according to UNICEF Statistics (2016), 50 million children under 5

were wasted and 16 million were severely wasted. This translates into a

prevalence of almost 8 percent and just less than 3 percent, respectively.

School feeding contributes to the education and well-being of children. A

hungry child does not grow, cannot learn as well and faces many health risks in

the future. School feeding can bring children into school and out of hunger. It is

far more than food-giving. They are an investment in the world’s poorest children.

They are an investment in our common future and global stability. School feeding

can bring children into school and out of hunger. Strong partnerships can

increase factors that pull children to school. It is a springboard for many positive

outcomes for poor children and their families. School feeding programs engage

parents and communities in the promotion of public health, education and the

creation of an independent future. Few safety-net programs provide so many

multi-sector benefits-education- gender equality, food security, poverty

alleviation, nutrition and health-in one single intervention (WFP, 2016).

A hunger-stricken child is not only unable to enroll in school at the right

age but also cannot attend properly even if enrolled. Besides, such children are

also likely to quit school because they have to deal with their immediate

subsistence needs before they get ready for schooling. Thus, low school

enrollment, low class attendance and high student drop-outs are recurring

problems in child education among poor households especially in areas of high

food insecurity. Due to these reasons the level of education attainment has also

been low in many developing countries although both private and social returns

to education are recognized to be high (Adelman, Gilligan et al. 2011).

It has been argued that school meals increase school participation by

improving child nutrition through two links (Vermeersch and Kremer 2004). First,

school meals improve nutrition by enabling children get more nutrients. Second,

the improved nutrition leads to better educational achievements. The study also

reveals that „since child nutrition, child health and schooling reflect household

preferences in human capital investments in the child; they might be correlated

without any direct causal relationship between them‟ (ibid, p.4). Another study

also shows that School Feeding Programs can improve health by reducing

morbidity and illness and hence attract children to school (He 2009).

Local

In the Philippines, malnutrition remains a significant public health concern

with a staggering 3.4 million children who are stunted (short for their age) and

more than 300,000 children under 5 years who are severely wasted. This
 15

continues to be a serious child health problem, with the Philippines being highly

disaster-prone. The risk of malnutrition increases in the aftermath of emergencies

(UNICEF Philippines, 2015)

A national nutrition survey reveals that, 20 percent of Filipino children

aged 0 to 5 are underweight while 30 percent are stunted or too short for their

age. The Philippines ranked 9th in the world, with the most number of stunted

children according to a UNICEF study.

To address the high burden of Severe Acute Malnutrition (SAM) in the

country, the Philippine Nutrition Cluster prioritized the urgent need to support the

development of national protocols and policy on the management of SAM for

children under five years of age. This was achieved through its community-based

management of acute malnutrition (CMAM) working group led by the Department

of Health (DOH). The broad objective of this prioritization was to improve the

access and availability of life-saving services for children with SAM through the

institutionalization of SAM management within the national and local health

systems, in both emergency and non-emergency settings (UNICEF-Philippines,

2016).

The Department of Education of the Philippines issued DepED Order No.

54, s. 2013-Guidelines on the Implementation of School Feeding Programs. The

DepED Order was issued in support of the Philippine Plan of Action for Nutrition

(PPAN) as approved by the National Nutrition Council Governing Board through

NNC-GB Resolution No. 1, s. 2012, the Department of Education (DepED) has

advocated school feeding programs for the past years to improve the nutritional
 16

status of the undernourished pupils and students. This Order is being issued to

guide the regional, division, and school officials in implementing school-initiated

and/or sponsored feeding programs, thereby ensuring that the objectives of the

program are achieved. The DepED implements the School Feeding Programs

(SFPs) to address the undernutrition problem among the learners in order to

improve school attendance and to reduce dropout in schools. The SFPs may be

school-initiated or sponsored by individuals, non-government organizations

(NGOs) and private companies.

School feeding in the Philippines is a tool which today effectively enables

hundreds of millions of poor children worldwide to attend school—in developed

and developing countries alike. One of the advantages of school feeding is that,

in addition to enabling education, it has positive direct and indirect benefits

relating to a number of other development goals (namely for gender equity,

poverty and hunger reduction, partnerships and cooperation, HIV/AIDS care and

prevention, and improvements in health and other social indicators. (UNEP,

2016).;

Research Literature

Foreign

Studies were conducted on malnutrition focusing on: strategies for control;

effects on the health of individual and its impact on the ability to learn and

perform academically in school of school children and students.

On the effect of malnutrition on health, Rice et. al. (2010) conducted a study on

the malnutrition as an underlying cause of childhood deaths associated with

infectious diseases in developing countries. Findings from cohort studies and

case–control studies were reviewed and summarized. The study found out that

the strongest and most consistent relation between malnutrition and an increased

risk of death was observed for diarrhea and acute respiratory infection.

Other research on learning and development showed that families

understood the concept of intelligence, demonstrated the link between

micronutrients and cognitive development and documented the amount of

wastage or repetition and drop-out that occurs in Guatemalan schools (Food

Nutrition Bulletin,2010).

On the effects of malnutrition and poor nutrition on the academic

performance of students. Chinyoka (2014) conducted a study on the impact of

poor nutrition on the academic performance of grade seven learners in case of

Zimbabwe. Its main objective is to identify mitigation policies and measures

designed to reduce negative effects of poor nutrition on children’s academic

performance.

The effects of malnutrition could not be isolated in the health and in the

ability to learn and academic performance of the individual. However, studies

revealed that malnutrition also affect the social and economic development of a

country (Food Nutrition Bulletin,2010).

Chepkwony et.al (2013) conducted a study on School Feeding Program

and Its Impact on Academic Achievement in ECDE in Roret Division, Bureti

District in Kenya. The purpose of this study is to establish the relationship, if any,

between type of school and success of school feeding program, and to determine
 18

the relationship, if any, between school feeding program and academic

achievement among ECD children.

Local

The Department of Education and Health and Nutrition Unit of the

Department of Education – Tarlac Province conducted a study on the SBFP

implementation. It was revealed that as to its coverage, the implementation was

outstanding while the duration and resources (personnel, financial and facilities)

is very satisfactory and the financial allocation and facilities are adequate.

The study also revealed that SBFP’s complimentary activities such as

“Gulayan sa Paaralan” and the “Essential Health Care Program” were highly

implemented. Furthermore, the strategies used by the feeding program

implementers are generally very satisfactory.

The study also showed that after the 100 to 120 feeding days, there was a

very high attainment of the SBFP goals particularly 78.29% of the severely

wasted and those who were categorized as “wasted” were rehabilitated to normal

nutritional status and attendance improved to at least 98.86%. Attainment of

improving the children’s health and nutrition values and behavior is also generally

high.

The study also revealed that there were problems encountered in the

implementation of the SBFP namely: delayed release of budget for feeding,

inability of parents to attend regularly in the preparation of foods for SBFP,

additional work in buying commodities with receipts, dislike of pupil beneficiaries

of vegetables and indifference of the pupil beneficiaries to the feeding program.