Family and Community Med III

RURAL AND URBAN POOR

Rosa Marie N. Flores, M.D., MPH, FPAFP, DFM
2nd Shifting /August 29, 2008
Trans group: JaViCi Code

[Classmates, eto yung lec dapat ni Dra. Flores last week, kaya iron drops to LBW and diagnosed anemic infants
lang di ma-open yung file. Ngayong Wed na lang nya nbigay 6-11 months old.
powerpoint. Self-study na l ang. Un lang. =)] (Baseline data is established in 2000)

6. Increase the percentage of severely and

RURAL and URBAN POOR
moderately underweight under 5 –year-old
children registered in feeding programs.
RURAL POOR
7. Increase the percentage of couples provided
Goal
with family planning service.(Baseline data is
 Health and nutrition of rural poor families are
established in 2000)
improved
8. Increase the percentage of households with
NATIONAL OBJECTIVES FOR HEALTH by 2004 sanitary toilets. (Baseline data is established in
2000)
Health National Objectives 9. Increase the percentage of households with
1. Reduce the percentage of newborns with birth access to safe water supply.
weights less than 2.5 kilograms (Baseline data is 10. Develop a package of health services for rural
established in 2000) poor families.
2. Reduce the percentage of severely and
moderately underweight children under five POVERTY
years old. (Baseline data is established in 2000)  “A deprivation in relation to a social standard,
3. Reduce the incidence of diarrhea cases among or a lack of the minimum entitlements of
children below five years old. (Baseline data is households in society, which the government
established in 2000) must seek to provide either directly or
4. Reduce the percentage of death due to indirectly.”
preventable causes (Baseline in 2000)
POVERTY in the context of human development
Risk Reduction Objectives  “The sustained inability of a household to meet
1. Increase the percentage of infants breastfed for its minimal set of basic needs (MBN).”
at least six months  Extending people’s capabilities sufficiently for
(Baseline data is established in 2000) them to meet their MBN makes the alleviation of
2. Increase the percentage of poor families availing poverty a human development approach.
health services
(Baseline is established in 2000) POVERTY THRESHOLD
3. Increase the percentage of families utilizing any  In the Philippines, poverty is measured against
type of sanitary toilet a total poverty threshold.
(Baseline data established in 2000)  This threshold is determined by a “minimum
income requirement needed by a family to
Service and Protection and Objectives purchase a specific set of freely provided basic
1. Increase the percentage of pregnant and goods and services”.
lactating mothers provided with iron and iodine
supplements. POVERTY INCIDENCE
(Baseline data established in 2000)  The proportion of families falling below the
2. Increase the percentage of deliveries attended threshold is called poverty incidence.
by trained personnel  Between 1988 and 1991 the poverty incidence in
3. Increase the percentage of fully immunized the country hardly improved from 40% (1988)
children to 39% (1991).
(Baseline data is established in 2000)  The number of poor families actually increased
4. Increase the percentage of pregnant women by 11%.
given two or more doses of tetanus toxoid .
(Baseline data is established in 2000) The Presidential Commission to Fight Poverty
5. Increase the provision of food supplements broadly categorized MBN indicators into three:
using indigenous / local processed foods to (1) Survival;
underweight infants aged 6-24 months old and (2) Security; and

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY TLE JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC
PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU
RACHE ESTHER JOEL GLENN TONI
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(3) Empowerment (or enabling needs). o Because the nature and intensity of their
needs are diverse and the causes of poverty
Eight Basic Indicators of the Index of Deprivation vary, solutions to their problem differ.
in the country relating to the MBN(set by the o The approach to poverty alleviation needs to
Commission) distinguish between the different poor groups ,
1. Number of families below the official poverty between the poor and the “core poor” ,between
line. the less poor and the “subsistence poor”.
2. Incidence or proportion of poor families below
the poverty line Five Principal Strategies Adopted by the
3. Infant mortality rates Commission:
4. Malnutrition rates (Because the poor has different causes of poverty and
5. Cohort survival rates because their needs are diverse)
6. Adult illiteracy rates 1. Revive economic growth to create employment
7. Proportion of households without access to safe and livelihood
water. 2. Sustain growth based on people friendly
8. Proportion of households without access to approaches
sanitary toilets 3. Expand social services to provide MBN
4. Foster sustainable income generating
The 10 provinces with the lowest MBN index community projects
1. Sulu 5. Build capabilities of the poor to help themselves.
2. Maguindanao 6. Emphasize the importance of local action
3. Masbate
4. Cotabato The MBN approach to poverty alleviation which focuses
5. Ifugao program resources on identified priority poor
6. Zamboanga del Sur municipalities aptly addresses social inequities among
7. Basilan various groups of the poor.
8. Zamboanga del Norte
9. Lanao del Sur Top Five MBN identified in the country
10. Agusan del Sur 1. Family with income below subsistence threshold
level
The Specific Groups of the Poor Predominant in 2. Family without sanitary toilet
Each Area: 3. Family without access to potable water within
(For which the content of the government’s anti-poverty 250 meters
programs in each of these provinces depended on) 4. Children 3 to 5 years old not attending day care
1. Lowland landless agricultural workers or preschool
2. Lowland small farm owners and cultivators. 5. Housing not durable for five years,
3. Upland farmers
4. Subsistence fisherfolks The CIDSS set a 20% target to meet unmet MBN in
5. Industrial wage laborers priority provinces for one year, but achieved a higher
6. Hawkers and macroenterpreneurs average of 52% reduction of the top MBN.
7. Scavengers
o Low productivity and income is the result of MBN Projects for the Rural Poor include:
the low level of literacy and skills among the  Nutrition
poor.  Maternal and child health
o This situation is worsened by the lack of  Dental health
access to basic infrastructure services that  Care for the elderly
can raise production outputs.  Communicable disease prevention, and
o Moreover, an inadequate basic social service control
results in poor health and welfare that limits  Traditional medicine
its prospects of the rural poor for a better
life. These community health projects were provided
o Since the rural poor have the least especially to fifth and sixth class municipalities using
occupational alternative they depend on poverty alleviation funds.
inferior resource bases that yield low
income. ________________________________________
o Migration to urban centers and resource-rich URBAN POOR
areas becomes an option. GOAL
o Mechanisms that deliver basic services to  Health and nutrition of urban poor families
are improved.
the rural poor are often unresponsive to
their fate and needs.

NATIONAL OBJECTIVES FOR HEALTH BY 2000
1. Reduce the infant and child mortality and
morbidity rates in the urban poor areas.
(Baseline data is established in 2000)
2. Reduce the maternal mortality and morbidity
due to direct obstetrical causes.
3. Reduce protein- energy malnutrition (PEM) and
micronutrient deficiencies among children below
5 years old.
(Baseline is established in 2000)
Risk Reduction Objectives
1. Increase the practice of multi-mix daily diet
among under- two- year old children to 90%.
(Baseline data is established in 2000)
2. Increase the practice of multi-mix daily diet
among women to 90 %.
3. Increase the percentage of infants exclusively
breastfed up to six months to 80% (Baseline
58% in 1996, UHNP)
4. Improve personal hygiene and sanitary practices
(Baseline data established in 2000)
5. Increase the percentage of mothers and
children availing of maternal and child health
services to 90%. (Baseline data is established in
2000)
Service and Protection Objectives
1. Increase the percentage of urban poor with
access to quality MCH care, nutrition and other
health services at the local level to 90% .
(Baseline is established in 2000)
2. Increase the percentage of infants fully
immunized to 95%.
(Baseline data is established in 2000)
3. Formulate and concretize the urban poor
development plan at the local level
4. Establish empowered community level health
and social support groups.
MATERNAL HEALTH
(Baseline is established in 2000)
5. Increase the percentage of households with
access to safe water to 80%.
6. Increase the percentage of households with
access to sanitary toilet facilities to 70%.
(Baseline 64.6 % in 1996, UHNP)
7. Develop a package of health services for urban
poor communities.
DOMESTIC ENVIRONMENT – Urban Poor
• Rapid urbanization and migration have brought
about negative consequences such as slums and
Prenatal Visits
squatters , overcrowding , poor sanitation,
• Seven percent of women had three prenatal visits to
environment degradation and pollution.
• Studies and field researches have shown that
the that the urban poor have less access to
educational services. Only about 6% of urban
• Problems related to the quality of prenatal care
poor had no schooling whereas 10% of rural
poor had none.
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• Overall 35.9 % had an income below the poverty
line and 21.3% had an income below the food
line.
• About three-fourths were employed.
• The median monthly income was P933.
• Based on a study of urban poor communities,
72.2 % of households had access to piped water
or tube wells.
• Seventeen % of water samples were heavily
contaminated by fecal organisms at source.
• Two thirds of households tried to protect their
drinking water and more than one-fourth boiled
it.
• Many households lacked sufficient water to wash
utensils properly and their water containers and
water handling practices were inadequate.
• Over 16% of households lacked toilet. The
consequences were that 21.4 % of people
defecated into a waterway and 14 % used the
so-called “wrap and throw” method.
• 28 % of households reported that garbage was
not collected at all.
• Most commonly uncollected garbage was burnt
(17. 6 %) dumped elsewhere (14. 6 % ) or
thrown into waterways (8.1 % ).
• Other environmental problems include the
proliferation of mosquitoes and other insects,
rats, and domestic animals.
• The commonest cooking methods was gas,
followed by kerosene and electricity. The
remainder used biomass fuels such as wood,
coconut shell and charcoal.
• Households were unlikely to store uncooked
food.
• Most households slept in one room.
• The mean number of persons who slept in the
house was 5.5
 The total fertility rate of urban poor women 15-
49 years old (4. 04 births) was lower than rural
women (4.82 births).
 The crude birth rate was 34 per 1000 among the
urban poor much higher than the rural poor
population (30.9 per 1000)
 Maternal death rate in the urban poor
communities under the Urban Health and --
Nutrition Project (UNHP) was at least 3 deaths
per 1000 live births a year
a health facility and 62.2 % made four or more
visits. Only 8% of women failed to have prenatal
visits at all.
include inadequate laboratory examination;
inadequate iron tablet supplementation and poor
referral of high risk group.

Delivery at home
• Reasons for delivering at home were cost,
convenience and presence of a supportive social
network.
• Even after delivery the overall quality of postnatal
care is low.
Weaning Practices
 Most mothers introduced weaning foods between
the fourth and six months of life.
Breastfeeding Practices
 About 86% of mothers had ever breastfed their
babies.
 By age 7 to 9 months about 58 % were still
breastfeeding.
Reasons commonly given for not breastfeeding:
 Insufficient milk
 Illness, or weakness of the mother
 Refusal by the infant
 Problem with the breast or nipple
Advantages of Breastfeeding include:
♥ emotional bonding between the mother and child
and cost.
Child Health
The infant death in the urban poor population is at least
50 per 1000 livebirths based on UHNP reports.
Immunization
• By age 12 months, 92.5 percent of infants had
received BCG vaccine, their third dose of
diphtheria, pertussis and tetanus vaccine (88
percent)
• On the other hand only 38.6% had received
measles vaccine by age 12 months and 67% by
age 15 months.
• Coverage showed little correction with maternal
background factors
Leading Causes of Mortality
 Acute respiratory infections (ARI) are the
leading cause of death in early childhood.
 Unfortunately in the survey made a high % of
mothers failed to see the significance of cough
with fast breathing or chest indrawing.
Leading Causes of Morbidity
 Diarrhea and ARI are leading causes of illness.
 Traditional home treatment is frequently
practiced.
 Problems on late referrals to the hospital
occur because dehydration and pneumonia are
not recognized at once.
 Over 50% of the urban poor children carried
intestinal parasites with the highest prevalence
in children 5-9 years old.
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 Over 7.5 % of the urban poor were stunted as a
sign of chronic malnutrition as against 5.6% of
the general population.
Attitude towards health services
 The women were conscious that health services
were free easily accessible and provided
satisfactory child health services.
 On the other hand they criticized poor
interpersonal relationships with the staff, long
waiting tlmes and the absence of particular
health staff.
 They thought that existing government health
services were providing narrow support for
maternal and child health (MCH) and saw the
need for wider range of services.
End of transcription
Hate That I Love You
That's how much I love you
That's how much I need you
And I can't stand you
Must everything you do make me wanna smile?
And then I like you for a while
But you won't let me
You upset me girl and then you kiss my lips
All of a sudden I forget that I was upset
Can't remember what you did
But I hate it
You know exactly what to do so that I can't stay mad at you
for too long
That's wrong but I hate it
You know exactly how to touch
So that I don't wanna fuss and fight no more
Said I despise that I adore you
And I hate how much I love you boy
I can't stand how much I need you
And I hate how much I love you boy
But I just can't let you go
And I hate that I love you so
And you completely know the power that you have
The only one that makes me laugh
Sad and it's not fair
How you take advantage of the fact that I...
Love you beyond a reason why (whyyy)
And it just ain't right
One of these days maybe your magic won't affect me
And your kiss will make me weak
But no one in this world
Knows me the way you know me
So you'll probably always have a spell on me...
It's how much I love you
It's how nuch I need you
It's how much I love you
It's how much I need you
And I hate that I love you
Sooooo
And I hate how much I love you boy
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I can't stand how much I need you
And I hate how much I love you boy
But I just can't let you go
And I hate that I love you so
(“,)
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