Food insecurity, socio-environmental determinants, and child and adolescent malnutrition and dehydration in Manila, Philippines: A cross-sectional study

Abstract

BACKGROUND AND AIM: Urban poor children suffer from health disparities due to food insecurity and socio-environmental determinants, specifically poverty and inadequate water, sanitation, and hygiene (WaSH). Our study aimed to measure associations between these determinants and children’s malnutrition and dehydration to identify risk factors of disease. METHODS: We conducted a cross-sectional survey of 15 public schools in three cities of Metro Manila, Philippines: the city of Manila, Navotas, and Quezon City. We measured children’s demographic information, food insecurity, and environmental exposures, including inadequate home WaSH and secondhand smoke, via questionnaire. We used anthropometry to measure stunting, severe thinness, thinness, overweight, and obesity according to the World Health Organization’s Child Growth Standards. We measured dehydration, defined as a urine specific gravity (USG) of 1.020 or greater, via urine test strips. We measured the adequacy of school WaSH via inspection checklists. RESULTS:We surveyed 828 children in grades 5, 6, 7, and 10. While 11% were stunted, over 32% did not have a “normal” weight. For example, 2.8% of children were severely thin, 5% were thin, 16% were overweight, and ~10% were obese. Almost 90% were dehydrated. Over 25% of children had low socioeconomic status. About 37% said that their parent’s highest level of education was high school. About 17% reported having at least one under-age family member who was a child laborer. Almost 4% had no toilet, 8% had no faucet with running water, and ~27% had no refrigerator. Less than 4% said that food was often “unaffordable”; yet almost 25% have asked/begged for food. CONCLUSIONS:Data analysis is in progress. Preliminary findings indicate severe socioeconomic deprivation in households and exposure to inadequate WaSH in schools and homes. During our presentation we will report logistic regression results describing associations between food insecurity, socio-environmental determinants, school and home WaSH, and children’s malnutrition and dehydration. KEYWORDS: Exposures, children's environmental health, socio-economic factors, environmental disparities.