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Republic of the Philippines
Department of Health
OFFICE OF THE SECRETARY

3 March 2003

ADMINISTRATIVE ORDER
No. 25 s. 2003

 

SUBJECT: Adoption of International Reference Standards (IRS) in Philippine Growth Table and Chart Materials

 

I. Background/Rationale

In 2000, the National Nutrition Council (NNC) Governing Board with the Department of Health (DOH) as one of its members had agreed to adopt the International Reference Standards (IRS) in determining the nutritional status of Filipino children. This decision however required the revision or changes of existing Philippine Reference Standards (PRS)-based national guidelines or reference tables and and charts presently used at the field level and the retooling of field workers in using the International Reference Standards (IRS) based materilas. UNICEF supported the Food and Nutrition Research Institute (FNRI) in developing the International Reference Standards Growth Tables and Charts for Philippine Use.

The DOH in collaboration with FNRI and UNICEFrevised the widely used Growth Monitoring Charts to an Early Childhood Care and Development (ECCD) Card and ensured an IRS adapted material. FNRI in coordination with DOH, NNC and selected Local Government Units conducted orientation/trainings on IRS on weight and Height Measurements.

In order to fast track the implementation and mainstreaming of IRS in the health and nutritional assessment system of the country, this Order clarifies and outlines the adoption of IRS in the existing growth-monitoring programs and activities.

 

II. Coverage and Scope

The International Reference Standards growth tables and charts shall be used in all public health and hospital facilities in the country. The reference tables and charts include weight for age for boys and girls of 0-72 months; length/height for age for boys and girls 0-72 months; and weight for length for boys and girls (49-103 cm) and weight for height for boys and girls (55-137cm).

 

III. Growth Monitoring Programs and Activities

1. Low Birth Weight Monitoring

The WHO cut-off point for low birth weight for both sexes of 2.5 kilograms still prevails as the national standard. The plotting of the weight value 2.3 kg at 0 month age in the IRS based ECCD card represents the lower limit value for the series of standard of measurement for girls to monitor their growth. The weight at 0 month in the chart does not mean the birth weight value of children.

 

2. Integrated Management of Childhood Illnesses (IMCI)

The IMCI Weight-for-Age Chart adapts teh IRS growth chart. The curve lines in the existing IMCI module growth chart shall be read and interpreted as the very low weight-for-age representing the 3 standard deviations (SD) from the median, the low weight-for-age line representing the 2 SD and the upper line as the median curve. The weights of children falling between the 2 SD and the upper line are considered normal for weight-for-age.

The field health workers use the IMCI chart as a quick reference guide in assessing the present nutritional status of a sick child seeking services at the health centers. The IMCI chart is not a growth-monitoring tool like ECCD card but rather as a rapid nutritional assessment tool for case management of sick children.

 

3. Early Childhood Care and Development (ECCD) Growth Monitoring Card (GMC)

The ECCD card serves as the record of essential services a child should receive from birth up to 6 years of age. The growth chart as indicated in the ECCD card is based from the IRS values. The GMC originally in yellow color is now produced as white card and contain two colored curve lines. These two colors are red representing the curve lines for girls and the blue lines for boys. The weights falling within the upper and lower curves are categorized as normal weight-for-age. While the weights falling above the upper lines are categorized as overweight and the weights falling below the lower lines are categorized as underweight.

The expresse desire of some health workers to include the FNRI IRS Prototype chart instructional procedure for age computation and for weight and height measurement shall be considered as a possible instructional poster material for the different health centers.

Considering the limited supply of the ECCD card for nationwide use, the existing yellow charts in the field could still be used until the one-year transition period of 2003.

 

4. Operation Timbnag (OPT)

The target age group for Operation Timbnag shall be reduced from 0-83 months to 0-71 months for consistency with the national policy and thrust. All children ages 0-71 months old (at least 17.5% of total population) shall be weighed.

The annual conduct of Operation Timbang at the field level shall be continously done using the weight-for-age as indicator. The IRS weight-for-age table shall be used in determining the Weight-for-Age values of children during the mass weighing activities of Operation Timbang. The Local Government Units (LGUs) are encouraged to use the OPT results for their local planning, monitoring and evaluation activities.

 

5. Regular Nutritional Assessment Procedure at the Public Health and Hospital Facilities

The regular anthropometrical assessment activities at the Rural Health Units, Barangay Health Stations, Provincial/District/Municipal Hospitals and Retained Hospitals, for the 0-18 years of age shall be done using the IRS growth tables and charts.

 

IV. General Guidelines

In the development and distribution of growth monitoring materials, the following guidelines shall be adopted:

  1. All existing PRS based materials and references shall be replaced with IRS adopted materials.
  2. The IRS reference tables and charts shall be made available to the public and private practitioners and agencies involved in growth monitoring activities.
  3. Tobacco industries, pharmaceuticals and drug companies engaged in the business or function of manufacturing and/or marketing a product within the scope of the Milk code shall not be allowed to sponsor the production and reproduction of growth monitoring materials.

 

V. Implementing Mechanism

A. Department of Health

The Department of Health shall take the leadership in advocating the adoption of International Reference Standards in growth monitoring activities.

1. Center for Family and Environmental Health (CFEH)

The Center for Family and Environment Health of the National Center for Disease Prevention and Control shall serve as the lead office for growth monitoring and shall perform the following functions:

  • Development of policies, standards and guidelines pertaining to growth monitoring;
  • Provision of technical assistance to Central Office Clusters/Bureaus, CHDs and Retained Hospitals relative to IRS based growth monitoring materials;
  • Development of IRS based tools and materials for growth monitoring;
  • Promotion of the adoption of IRS among concerned agencies and practitioners;
  • Development of training programs to orient and retool field health workers on IRS tables and charts;
  • Monitor and evaluate the field implementation of IRS; and
  • Establish coordination and networking with FNRI, NNC and other stakeholders in planning, implementation, monitoring and evalaution of IRS adoption.

 

2. Center for Health Development (CHD)

The CHDs shall be responsible for the following:

  • Translation of growth monitoring national policies and framework for regional and local applications;
  • Provision of technical assistance to LGUs, NGOs, academes and other stakeholders relative to IRS adoption;
  • Advocacy for the adoption, utilization and reproduction of IRS materials to LGUs, NGOs and other stakeholders;
  • Reproduction of IRS prototype growth monitoring materials;
  • Conduct of orientation and training on IRS adoption; and
  • Monitor the implementation of IRS adoption in the region.

 

3. Retained Hospitals

All retained hospitals shall be responsible for the following:

  • Ensuirng all growth tables and charts in the hospital are IRS based;
  • Conducting orientation and/or training of hospital staff in using the IRS based tables and charts; and
  • Monitoring the implementation of IRS adoption in the hospital.

 

B. Local Government Units (LGUs)

All LGU health facilities including the developed hospitals, Rural Health Units and Barangay Health Stations shall be responsible for the following:

  • Ensuring all growth charts and tables in the LGU health facilities are IRS based;
  • Conducting orientation and training of field health workers including barangay health workers and barangay nutrition scholars in using IRS based tables and charts;
  • Monitoring and evaluating the IRS implementation in their localities; and
  • Establishing coordination and networking among concerned agencies in IRS implementation.

 

VI. Repealing Clause

Any existing provisions or issuances found inconsistent with this Order should be repealed.

 

VII. Effectivity

This Order shall take effect immediately.

 

 

 

(Original signed)
MANUEL M. DAYRIT, MD, MSc.
Secretary of Health

 

 

 

 

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