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MANUAL OF OPERATIONS

AND DATA QUALITY

CHECK PROTOCOL

OPERATION TIMBANG PLUS

Operation Timbang Plus

MANUAL OF OPERATIONS
AND DATA QUALITY CHECK
PROTOCOL

Made in partnership with

National Nutrition Council

Department of Health
Republic of the Philippines

United Nations Children’s Fund

Korea International Cooperation Agency

Institute of Human Nutrition and Food

College of Human Ecology
University of the Philippines Los Baños

UPLB Foundation Inc.

This publication was prepared by the OPT Plus National Project Team:

University of the Philippines Los Baños

Prof. Leila S. Africa, Project Leader
Ms. Ma. Charina P. Maneja, Project Manager
Dr. Nancy Tandang, Statistician
Asst. Prof. Reanne Len C. Arlan, Statistician
Asst. Prof. Aiza Kris M. Bernardo, Study Leader
Asst. Prof. Joyce P. Parco, Study Leader
Dr. Raymundo Celestino Habito Jr., Consultant
Ms. Katrina F. Baluyot, Research Assistant
Ms. Danica Mae V. Inoceno, Research Assistant

UNICEF
Ms. Alice Nkoroi
Dr. Rene Gerard Galera
Mr. Frederich Christian Tan

National Nutrition Council

Dr. Azucena M. Dayanghirang, MD, MCH, CESO III, Assistant Secretary & Executive Director IV
Ms. Ellen Ruth F. Abella, RND, MPM
Ms. Maria Cynthia B. Vengco, RND, MPS
Mr. Daniel G. Salunga, RND, MSPH, Project Coordinator
Ms. Christine Jane B. Almira, RND, MAHPS, Asst. Project Coordinator

Copyright © 2023 NNC, UNICEF, and UPLBFI

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in
any form or by any means, including photocopying, recording, or other electronic or mechanical
methods, without prior written permission of the publisher, except in the case of brief
quotations embodied in critical reviews and certain other noncommercial uses permitted by
copyright law.

Published by the National Nutrition Council

Nutrition Building, 2332 Chino Roces Avenue Extension
1630 Taguig City
Telephone No.: +6328843-5824
Email Address: [email protected]

ISBN: 978-621-8323-02-5 (Paperback)

ISBN: 978-621-8323-03-2 (Ebook)
A Message of Support from

Dr. Azucena M. Dayanghirang

The conduct of Operation Timbang (OPT), which started in

the early 70s, is regularly done by local government units (LGUs)
through their local nutrition committees. Every one of us in the
nutrition community put a premium on the quality of data, high
quality data, to be precise. Sound and reliable information is the
foundation of sound decision making. Thus, the quality of data is
of prime importance for accurate, reliable, and valid results. High-
quality data results in better information, which redounds to better
decision-making, and better health of the population.

In this very significant project, we dealt with the quality

of the Operation Timbang Plus results. The quality of the data collected from the OPT has long
been an issue in the past, and at present, and may pose a potential problem in the future if not
addressed. Some of you may be familiar with studies done by Dr. Barba, Dr. Habito, Myra Bondad
and Director Alicia Ramos in the 1990s on the implementation of the OPT which highlighted the
need to improve the capacity of data collectors to ensure quality of OPT results. This was addressed
in part by NNC and other partners by providing the tools, the weight and measuring tools; as well
as in the development of the electronic OPT Plus to minimize the errors in computation of age in
months and determination of the child’s nutritional status. Operations research done by NNC in 2019
showed that there were still gaps that were consistent with the previous study (Salunga et al.), the
research recommendations lead to the development of data quality check protocol and the revision
of the OPT Plus implementing guidelines, which we attained from the output of this project.

The results of the OPT Plus is the only source of information of the nutritional situation
of the barangay, without which, the barangay nutrition committee cannot formulate their nutrition
action plans that will identify appropriate interventions. Without the results of the OPT, there is no
way to measure the effectiveness, efficiency, impact, and sustainability of the nutrition programs
implemented at the local level. A good measure of nutrition progress depends on quality data.
Similarly, without quality data, we cannot measure the contribution of the local level to the PPAN, the
Philippine Development Plan, the Ambisyon Natin 2040, and the Sustainable Development Goals.

We express our gratitude and appreciation to the United Nations Children’s Fund (UNICEF)
and the Korea International Cooperation Agency (KOICA) for the continuous assistance and strong
support in our goal to improve the OPT Plus. We extend our thanks and appreciation too for the hard
work, dedication and professionalism of the team from the University of the Philippines Los Baños
who helped in developing the Manual of Operations, Data Quality Check Protocol and other OPT

Operation Timbang Plus: Manual of Operations 3

Plus information products. The synergy and efforts of the National Project Team of NNC, UNICEF
and UPLB, and all the stakeholders consulted from the barangay up to the national level led to the
success of this project.

Our data quality initiatives do not end with this project. In addition to this project, NNC
has several initiatives lined up to improve data quality: along policy, tools and capacity. In this day
and age, quality data is the new oil. Let us use this to fuel our calibrated and responsive nutrition
policies, plans, projects and activities.

Through this OPT Plus Manual of Operations and Data Quality Check Protocol, we can do
OPT Plus TSEK: Tamang Sukat, Eksaktong Kalidad! Let us all work together to build a structure
to safeguard correct measurements to produce exact quality of data for the OPT Plus, exact
meaning - nothing more, nothing less, walang dagdag bawas.

Together, we can do things better, i-TSEK na natin ang OPT Plus at sama sama nating
itaguyod ang nutrisyong sapat, para sa lahat!

DR. AZUCENA M. DAYANGHIRANG, MD, MCH, CESO III

Assistant Secretary and Executive Director IV
National Nutrition Council, Department of Health

4 Operation Timbang Plus: Manual of Operations

A Message of Support from

Dr. Enrico P. Supangco

Greetings!

This revised and improved Operation Timbang Plus (OPT Plus) publication which includes
manuals and infographics was completed in partnership with UNICEF, the National Nutrition Council
(NNC) and the Institute of Human Nutrition, College of Human Ecology, UPLB through the UPLB
Foundation Incorporated. This publication is the output of two projects namely the “Technical Support
to NNC in the Development of Data Quality Audit Protocol for the Operation Timbang Plus (OPT
Plus)” and the “Updating of Implementing Guidelines”. It incorporates the revised and improved OPT
Plus guidelines and should help ensure the high quality of nutrition data in the country and integrity
of its use as a basis for local and national nutrition program planning.

We would like to congratulate Dr. Leila S. Africa, the project Leader, and all the members of
her research team for their commitment and dedication in the successful implementation of the two
projects and the publication of the Operation Timbang Plus (OPT Plus).

DR. ENRICO P. SUPANGCO, PhD

Executive Director, UPLBFI

Operation Timbang Plus: Manual of Operations 5

A Message of Support from

Dr. Jose V. Camacho, Jr.

On behalf of the University of the Philippines Los Baños

(UPLB), I extend my warmest greetings and congratulations to
the College of Human Ecology’s Institute of Human Nutrition
and Food and to Dr. Leila S. Africa and her team for publishing
a manual for our country’s revised and improved Operation
Timbang (OPT) Plus.

This manual, which is a product of the National Nutrition

Council and United Nation’s Children’s Fund-commissioned
project Development of Data Quality Audit (DQA) Protocol for the
Operation Timbang (OPT) Plus and Updating of Implementing
Guidelines (IG), aims to improve the Philippines’ OPT Plus system, a routine child growth assessment
for all children aged 0 to 59 months. Conducted annually in all barangays nationwide, OPT Plus
serves as a baseline for assessing quality nutrition programs and interventions that are essential
for local nutrition action planning and determining priority areas for nutrition programming. This
manual includes the revised and improved OPT Plus Guidelines designed to better integrate with
the Monitoring and Evaluation of Local Level Plan Implementation (MELLPI) Protocol Tool.

Apart from serving as a valuable reference for local government units in keeping their
communities healthy and thriving, this publication is also a testament to the power of collaboration
and teamwork between the University and its project partners towards achieving its mutual goals for
the communities and people we serve.

I commend Dr. Africa and her team for their work has resulted in a successful project and
the betterment of communities all over our country. You should be incredibly proud of this project’s
impact and the lives it will improve. You have set a shining example of excellence and raised the bar
for future projects. Keep up the excellent work and continue to inspire others with your dedication
and passion for making a difference.

Mabuhay kayong lahat!

DR. JOSE V. CAMACHO, JR.

Chancellor, University of the Philippines Los Baños

Operation Timbang Plus: Manual of Operations 7

A Message of Support from

Oyunsaikhan Dendevnorov

Children have a fundamental right to optimal nutrition and health,

and proper nourishment enables them to grow, learn, play, and develop
resilience, even in difficult circumstances. Tragically, many Filipino
children are currently deprived of the basic needs, essential services,
and nurturing environment they require to reach their full potential.

Accurate data and information are crucial for informed

decision-making, policy development, and effective implementation.
The Operation Timbang (OPT) program provides valuable data on the
nutritional status of children aged 0-59 months, allowing for targeted
service delivery, nutrition program management, and evaluation of
local programs. This tool is essential for local government units to collect and analyze accurate
anthropometric data on malnutrition trends, analyse and report emerging trends and ultimately
improve nutrition programs for children. I believe this new approach will significantly enhance the
quality of data collected from the OPT and OPT Plus.

UNICEF is proud to support the National Nutrition Council (NNC) in its efforts to improve
the existing OPT Plus standards and tools in accordance with global standards. Working with our
institutional partner, University of the Philippines Los Baños Foundation Incoporated, we have
updated the guidelines, training materials, and tools used by local government units to incorporate
data quality checks and automatic functions. These improved standards and tools aim to enhance
the capacities of frontline workers and health professionals to collect and report quality nutrition data
in a timely manner, enabling prompt and appropriate interventions.

Nutrition has always been a central focus of UNICEF’s work for children. We remain
committed to supporting the National Government and our priority local government units in scaling
up nutrition interventions to reach the SDG 2 targets and the national strategic plan. I commend the
NNC for its continued leadership and dedication to improving data quality and systems, with the
ultimate goal of enhancing nutrition for all Filipino children.

OYUNSAIKHAN DENDEVNOROV
Representative, UNICEF Philippine Country Office

Operation Timbang Plus: Manual of Operations 9

TABLE OF CONTENTS
SECTION ONE
OPERATION TIMBANG PLUS (OPT PLUS) OVERVIEW�� 15
LIST OF FIGURES �� 18
LIST OF ACRONYMS��19
DEFINITION OF TERMS�� 21
OPERATION TIMBANG PLUS (OPT PLUS) OVERVIEW �� 24
REFERENCES�� 38
LIST OF ANNEXES �� 39

SECTION TWO
PRE-OPT PLUS PROTOCOL�� 49
LIST OF TABLES �� 52
LIST OF FIGURES �� 53
LIST OF SUPERVISOR’S BOXES �� 54
LIST OF ACRONYMS�� 55
DEFINITION OF TERMS�� 57
ORGANIZING THE OPT PLUS TEAM�� 58
CERTIFICATION OF OPT PLUS MEMBERS�� 61
HOUSEHOLD PROFILING�� 65
SPOT MAPPING �� 73
CALIBRATION AND VERIFICATION OF WEIGHING TOOLS AND EQUIPMENT�� 79
VERIFICATION OF LENGTH/HEIGHT TOOLS AND EQUIPMENT�� 89
STANDARDIZATION EXERCISE�� 97
REFERENCES�� 110
LIST OF ANNEXES �� 111

SECTION THREE
OPT PLUS PROTOCOL ON ANTHROPOMETRIC MEASUREMENT �� 129
LIST OF TABLES�� 133
LIST OF FIGURES �� 134
LIST OF ACRONYMS�� 135
DEFINITION OF TERMS�� 137
ROLES AND RESPONSIBILITIES OF OPT PLUS TEAM AND SUPERVISORS�� 139
OVERVIEW OF THE ANTHROPOMETRIC MEASUREMENTS�� 143
GENERAL REMINDERS IN TAKING ANTHROPOMETRIC MEASUREMENTS�� 145
INSTRUCTIONS ON HOW TO WEIGH THE 0-TO-59-MONTH-OLD CHILDREN �� 149
INSTRUCTIONS ON MEASURING THE LENGTH OF THE 0-TO-23-MONTH-OLD CHILDREN� 155
INSTRUCTIONS ON MEASURING THE HEIGHT OF THE 24-TO-59-MONTH-OLD CHILDREN� 159
INSTRUCTIONS ON HOW TO MEASURE MUAC OF 6-TO-59-MONTH-OLD CHILDREN�� 163
INSTRUCTIONS ON HOW TO CHECK AND CLASSIFY SEVERITY OF BILATERAL PITTING
EDEMA�� 165
REFERRAL OF MALNOURISHED CHILDREN �� 167
WHO CHILD GROWTH STANDARDS (CGS)�� 175
REFERENCES�� 180

SECTION FOUR
OPT PLUS PROTOCOL ON DATA PROCESSING, ENCODING, AND REPORT GENERATION�� 199
LIST OF ACRONYMS�� 203
DEFINITION OF TERMS�� 204
ROLES AND RESPONSIBILITIES OF THE OPT PLUS TEAM AND SUPERVISORS �� 205
THE ELECTRONIC OPT (EOPT) PLUS TOOL VERSION 2 (V2) �� 207
GUIDELINES ON DETERMINATION OF NUTRITIONAL STATUS �� 233

SECTION FIVE
OPT PLUS PROTOCOL ON DATA INTERPRETATION AND ACTION PLANNING�� 241
LIST OF TABLES�� 244
LIST OF FIGURES �� 244
LIST OF ACRONYMS�� 245
DEFINITION OF TERMS�� 247
ROLES AND RESPONSIBILITIES OF THE OPT PLUS TEAM AND SUPERVISORS �� 249
USES OF OPT PLUS RESULTS �� 253
REPORT GENERATION (EOPT PLUS AND FORMS)�� 255
DATA ANALYSIS AND INTERPRETATION�� 257
DATA UTILIZATION AND ACTION PLANNING�� 267
REFERENCES�� 269

SECTION SIX
OPT PLUS PROTOCOL ON FOLLOW THROUGH ACTIVITIES�� 289
LIST OF ACRONYMS�� 293
DEFINITION OF TERMS�� 294
ROLES AND RESPONSIBILITIES OF THE SUPERVISORS AND OPT PLUS TEAM IN THE MONI-
TORING AND EVALUATION�� 295
CHILD GROWTH MONITORING AND ACTIVE SEARCH�� 299
BNAP MONITORING�� 305
REFERENCES�� 306
SECTION SEVEN
DATA QUALITY CHECK (DQC)�� 313
LIST OF ACRONYMS�� 316
DEFINITION OF TERMS �� 318
CONCEPTS, PRINCIPLES, AND DIMENSIONS OF DATA QUALITY��319
GUIDELINES IN ASSURING DATA QUALITY IN KEY AREAS OF OPT PLUS PROTOCOL �� 325
REFERENCES�� 363

SECTION EIGHT
SUPERVISOR’S GUIDE: SUPPORTIVE SUPERVISION�� 365
LIST OF ACRONYMS�� 368
ROLES AND RESPONSIBILITIES OF SUPERVISORS�� 371
PRACTICAL GUIDE IN CONDUCTING SUPPORTIVE SUPERVISION �� 375
REFERENCES�� 386
Section One

OPERATION TIMBANG
PLUS (OPT PLUS)
OVERVIEW

Section 1: OPT Plus Overview 15

OPERATION TIMBANG PLUS
(OPT PLUS) OVERVIEW

OVERVIEW

The general objective of this section is to provide information on the

basic concepts and procedures of the OPT Plus.

After reading this section, one should be able to:

1. Describe the OPT Plus, its purposes, and processes;

2. Identify who are involved in OPT Plus and their roles;
3. Enumerate the forms used in OPT Plus;
4. Identify the common anthropometric measurements used in OPT Plus; and
5. Explain the mechanics in the OPT Plus implementation.

This overview covers the basic definitions and principles of

anthropometry, nutrition assessment, and OPT Plus used throughout
the succeeding sections.

Section 1: OPT Plus Overview 17

LIST OF FIGURES

Figure 1.1 OPT Plus Timeline of Activities

Figure 1.2 Hanging Infant Weighing Scale

Figure 1.3 Hanging Digital Scale

Figure 1.4 Digital Platform Scale

Figure 1.5 Digital Taring Scale

Figure 1.6 Mechanical Column Scale

Figure 1.7 Length/Height Board

Figure 1.8 Stadiometer

Figure 1.9 Microtoise

Figure 1.10 Mobile Measuring Mat

Figure 1.11 Length/Height Boards

Figure 1.12 OPT Plus activities flowchart

Figure 1.13 Flowchart of Operation Timbang Plus Activities and MOP Sections

18 Section 1: OPT Plus Overview

LIST OF ACRONYMS

AIP Annual Investment Plan

BARMM Bangsomoro Autonomous Region of Muslim Mindanao
BHC Barangay Health Center
BHW Barangay Health Worker
BHS Barangay Health Station
BNAP Barangay Nutrition Action Plan
BNC Barangay Nutrition Committee
BNS Barangay Nutrition Scholar
C/MNAO City/Municipal Nutrition Action Officer
C/MNAP City/Municipal Nutrition Action Plan
CHAT Community Health Action Team
cm centimeter
CGS Child Growth Standard
CNAO City Nutrition Action Officer
CNAP City Nutrition Action Plan
CNC City Nutrition Committee
DCW Day Care Worker
DQC Data Quality Check
ECCD Early Child Care and Development
eOPT Electronic Operation Timbang
FANTA Food and Nutrition Technical Assistance
GB Governing Board
LGU Local Government Unit
LNAP Local Nutrition Action Plan
MAM Moderate Acute Malnutrition
MNAO Municipal Nutrition Action Officer
MNAP Municipal Nutrition Action Plan
MNC Municipal Nutrition Committee
MOP Manual of Operation

Section 1: OPT Plus Overview 19

MSt Moderately Stunted
MUAC Mid-Upper Arm Circumference
MUW Moderately Underweight
MW Moderately Wasted
NCP Nutrition Center of the Philippines
NNC National Nutrition Council
Ob Obese
OPT Plus Operation Timbang Plus
Ow Overweight
P/C/M/BNAP Provincial/City/Municipal/Barangay Nutrition Action Plan
PNAO Provincial Nutrition Action Officer
PNC Provincial Nutrition Committee
PPA Programs, projects, and activities
RA Republic Act
RNC Regional Nutrition Council
RHM Rural Health Midwife
RHU Rural Health Unit
RNAP Regional Nutrition Action Plan
RNPC Regional Nutrition Program Coordinator
RSDC Regional Social Development Committee
RTWG Regional Technical Working Group
SAM Severe Acute Malnutrition
SD Standard Deviation
SK Sangguniang Kabataan
SW Severely Wasted
SSt Severely Stunted
St Stunted
SUW Severely Underweight
UNICEF United Nations Children’s Fund
WHO World Health Organization
WHO-CGS World Health Organization Child Growth Standards

20 Section 1: OPT Plus Overview

DEFINITION OF TERMS

Anthropometric Non-invasive and quantitative measurements of the body mass,

Measurements stature, and size [i.e., weight, length, height, and mid-upper arm
circumference (MUAC)].

Certified OPT Plus A member of the OPT Plus team who has completed the
Measurer anthropometry training and has passed both the standardization
exercise and post test.

Early Childhood Care and The card used in regular monitoring of growth and health indicators
Development Card among 0-to-59-month-old children.

Height The stature measurement of 24-to-59-month-old children collected

while standing up.

Length The stature of 0-to-23-month-old children measured while in a

recumbent or lying position.

Length/Height-forAge An indicator used to classify stunting among 0-to-59-month-old

(L/HFA) children.

Local Nutrition Three-year action plan to address prevailing nutritional problems

Action Plan based on administrative level i.e., Provincial, City, Municipal, Barangay
Nutrition Action Plan (P/C/M/BNAP) and is annually updated.

Malnutrition Deficiencies, excesses, or imbalances in a person's intake of protein,

energy (carbohydrates and fats), and/or nutrients covering both
undernutrition which includes suboptimal breastfeeding, stunting,
wasting or thinness, underweight, and micronutrient deficiencies or
insufficiencies, as well as overnutrition, which includes overweight and
obesity (RA 11148 definition).

Mid-Upper Arm Circumference of the left arm taken at the midpoint between the
Circumference elbow and shoulder that is used in determining the presence of acute
malnutrition among 6-to-59-month-old children.

Moderately Stunted (MSt) Nutritional status classification of 0-to-59-month-old children whose

height/length-for-age is below -2 to -3 standard deviations (SD) of
the World Health Organization (WHO) Child Growth Standards (CGS)
median.

Section 1: OPT Plus Overview 21

Moderately Wasted/ Nutritional status classification of 0-to-59-month-old children whose
Moderate Acute weight-for-length/height Z-score is less than –2 SD to –3 SD from
Malnutrition (MW/MAM) the median of the WHO growth standards or a MUAC measurement
of <12.5 cm and ≥11.5 cm.

Nutritional Status Condition of the body resulting from intake, absorption, and use of
nutrients, as well as the influence of disease-related factors.

Operation Timbang Plus Regular growth assessment of all 0-to-59-month-old children in the
barangay, done by the trained team and involves planning, follow-up,
and data quality check.

Overnutrition Includes overweight and obesity.

Obese (Ob) Nutritional status classification of 0-to-59-month-old children whose

weight-for-length/height Z-score is above three (3) SD from the
median of the WHO Child Growth Standards.

Overweight (OW) Nutritional status classification of 0-to-59-month-old children whose

weight-for-length/height Z-score is above 2 to 3 SD from the median
of the WHO Child Growth Standards.

Severely Stunted (SSt) Nutritional status classification of 0-to-59-month-old children whose

length/height-for-age Z-score is less than –3 SD from the median of
the WHO Child Growth Standards.

Severely Wasted/Severe Nutritional status classification of 0-to-59-month-old children whose

Acute Malnutrition weight-for-length/height Z-score is below –3 SD of the median of
(SW/SAM) the WHO Growth Standards; characterized by visible severe
wasting, or by the presence of bilateral pitting edema, or a MUAC
measurement of less than 115 mm or 11.5 cm (RA 11148 definition).

Stunted (St) A form of malnutrition that results from chronic or long-term

undernutrition and can be classified using the length/height-for-age
indicator. It is a general term that refers to both moderate and severe
stunting.

Undernutrition Includes suboptimal breastfeeding, stunting, wasting or thinness,

underweight, and micronutrient deficiencies or insufficiencies.

Underweight A form of malnutrition classified using the weight-for-age indicator.

It is also a general term referring to both moderately and severely
underweight.

22 Section 1: OPT Plus Overview

Wasted A form of malnutrition that results from acute onset of undernutrition
classified using the weight-for-length/height indicator or MUAC. It is
also the term referring to both moderately and severely wasted.

Weight The measurement of body mass or heaviness of a child.

Weight-for-Age (WFA) An indicator used to classify underweight among 0-to-59-month-old

children.

Weight-for-Length (WFL) Indicator used to classify wasting, overweight, and obesity among
0-to-23-month-old children.

Weight-for-Height (WFH) Indicator used to classify wasting, overweight, and obesity among
24-to-59-month-old children.

WHO Child Growth Represents how children should grow through globally accepted
Standards prescriptive measures considered normal growth for all 0-to-59-month-
old children.

Section 1: OPT Plus Overview 23

Section 1.1

OPERATION TIMBANG PLUS

(OPT PLUS) OVERVIEW

What is OPT Plus?

Operation Timbang Plus (OPT Plus) is the regular growth assessment for all 0-to-
59-month-old children in the barangay done by a trained team. It involves planning,
follow-up, and data quality check.

What is the purpose of OPT Plus?

The annual OPT Plus done at the start of the year will serve as the basis for
close and regular follow-up of 0-to-23-month-old children and children at-risk of
malnutrition.

Weight, length, and height are the anthropometric measurements collected during
the OPT Plus to generate data on the nutritional status of children as inputs to
community nutrition assessment, nutrition program planning, and monitoring and
evaluation of the local nutrition action plan (LNAP).

24 Section 1: OPT Plus Overview

GENERAL OBJECTIVES Who are the members of the
The general objectives of the OPT Plus are
OPT Plus Team?
to generate data on the nutritional status of
The OPT Plus Team is composed of at least 7
children in a barangay; locate under- or over-
members. The team is headed by the Rural
nourished children; and guide local government
Health Midwife (RHM), assisted by the Barangay
units (LGU) in nutrition program management.
Nutrition Scholars (BNS) and Barangay Health
Workers (BHWs).
SPECIFIC OBJECTIVES

Other members of the OPT Plus Team can be

Community Level
the Committee Chair on Health and Nutrition,
1. Assess the nutritional status of the 0-to-59- other barangay officials and staff, Sangguniang
month-old children; Kabataan (SK) officials, Day Care Workers
2. Locate families with children who are (DCW), and teachers-in-charge.
underweight, stunted, wasted, overweight,
and obese; The team may be assisted by the purok or
mother leaders, other community leaders, and
3. Determine priority areas and individuals for
representatives from civic organizations. The
program planning;
roles and responsibilities of the OPT Plus Team
4. Serve as the basis for the preparation and and the supervisors are enumerated in Annex
evaluation of the nutrition action plan; 1.1.

5. Monitor the nutrition trend and assess

In the Bangsamoro Autonomous Region of
the effects of nutrition interventions
Muslim Mindanao (BARMM), some of the
implemented.
members of the community health action team
(CHAT) may be tapped to join the OPT Plus
Family Level Team.
1. Provide parents/caregivers information on
the nutritional status of their child/children
to prevent malnutrition;
Who are the target groups of
2. Early detection and immediate referral of
OPT Plus?
undernutrition to prevent severely wasted/
All 0-to-59-month-old children shall have their
severe acute malnutrition (SW/SAM)
MUAC or weight, length/height measured
and moderately wasted/moderate acute
regularly.
malnutrition (MW/MAM) cases;

3. Guide the parents/caregivers on the growth

and development of their children.

Section 1: OPT Plus Overview 25

When is the OPT Plus conducted?
The OPT Plus preparation at the municipal/city level should start every August to prepare for the OPT
Plus activities for the following year. Figure 1.1 describes the schedule of activities for the whole year.

BNC to C/MNAO
(April 16)

C/MNAO to C/MNC
(May 5)
C/MNC to PNAO
(May 15)

Figure 1.1. OPT Plus Timeline of Activities

26 Section 1: OPT Plus Overview

Where is the OPT Plus What anthropometric
conducted? measurements are used for
the OPT Plus?
OPT Plus activities can be conducted in the
health facility, weighing post, barangay hall, day
WEIGHT refers to the measurement of body
care center, house-to-house, or other conducive
mass or heaviness of a child.
areas making sure that all 0-to-59-month-old
children are covered.
LENGTH refers to the stature of a 0-to-23-month-
old child measured while in a recumbent or lying
position.
What are the OPT Plus
follow-up activities? HEIGHT refers to the stature measurement of a
24-to-59-month-old child collected while standing
• Monthly weight and length measurement
up.
of all 0-to-23-month-old children and plotting
them in the growth chart in the Early
MID-UPPER ARM CIRCUMFERENCE (MUAC)
Childhood Care and Development (ECCD)
refers to the circumference of the left arm taken
Card or Mother-baby handbook;
at the midpoint between the elbow and shoulder
• Monthly weight and height measurements that is used in determining the presence of acute
of 24-to-59-month-old children who are malnutrition among 6-to-59-month-old children
malnourished from February to December; (FANTA, 2018). MUAC identifies children at high
and risk for mortality (UNICEF, 2015).

• Semestral weight and height measure-

ments of 24-to-59-month-old children.

NOTE 1.2. MUAC

Why is MUAC not recommended to

assess acute malnutrition in children
<6 months?
NOTE 1.1.
There is insufficient evidence for
For OPT Plus, collection of MUAC recommending MUAC to determine
shall be imposed if the situation does acute malnutrition among <6 months
not allow the collection of weight, old children (FANTA, 2018; WHO,
length, and height such as in case of 2013). The weight-for-length index is
emergencies (NNC, 2020). used instead.

Section 1: OPT Plus Overview 27

What are the recommended tools and equipment for weighing
and measurement of length or height?

WEIGHING SCALES

Several weighing tools can be purchased but only recommended weighing scales can be used in
assessing nutritional status to get accurate data. The National Nutrition Committee (NNC) issued NNC
Governing Board (GB) Resolution No. _____ Approving the Guidelines on the selection of weighing
scales (Annex 1.2).

The following are the recommended weighing scales

that can be used:

1. Hanging Infant Weighing Scale (Figure 1.2) is a

type of mechanical scale designed to be used for
children less than five years old weighing less than
25 kg. The reading scale should only be in grams with
a gradation of 0.1 kg or 100 grams. It comes in a set
composed of the scale and hanging pants where the Figure 1.2. Hanging Infant Weighing Scale
child sits during weighing.

2. Digital Scales

a. Hanging Digital Scale (Figure 1.3) is another

hanging scale for children with a maximum
weight capacity of 25 kg. The parts are similar
to the Mechanical Hanging Infant Weighing
Scale, except that this scale is battery-powered
and features a digital monitor where the weight Figure 1.3. Hanging Digital Scale
can easily be read (NCP, n.d.).

b. Digital Platform Scale (Figure 1.4) is a battery-

powered digital scale with a maximum capacity
load of 150 kg and can be used by all age groups.
It has no buttons and automatically displays the
weight, which makes it easy to use and operate
while maintaining the accuracy and reliability of
weight measurement (Tanita, n.d.). Figure 1.4. Digital Platform Scale

28 Section 1: OPT Plus Overview

c. Digital Taring Scale (Figure 1.5) is a digital
scale specifically designed for mobile use and
for all age groups. It is lightweight but can
measure weight up to a maximum of 200 kg. It
is simple and features a dual screen where both
the measurer and the person being measured
can simultaneously view the reading. It also
simplifies weighing a child with their parent/ Figure 1.5. Digital Taring Scale
caregiver (SECA, n.d.).

3. Mechanical Column Scale (Figure 1.6) is a

mechanical scale that makes use of an eye-level
beam balance to obtain the weight. This type of scale
is usually made from heavy duty steel which makes
it durable but not portable. It can weigh up to 200 kg.

Figure 1.6. Mechanical Column Scale

NOTE 1.3.
Weighing Scales

Why are regular bathroom scales not

recommended for OPT Plus?

Regular bathroom scales, especially the

mechanical or spring-type kind, may not
maintain accurate readings with repeated
use (UW, n.d.). Although cheaper in price,
these types of scales are not meant to last.
Recommended ones, on the other hand,
ensure accurate and precise readings and
are designed to last.

Section 1: OPT Plus Overview 29

LENGTH/HEIGHT MEASUREMENT TOOLS

While there are many available length and height measurement tools in the market, not all are
recommended for nutritional status assessment due to inaccuracies that may result during use. The NNC
issued NNC Governing Board (GB) Resolution No. 3 s.2012 Approving the Guidelines on the Fabrication,
Verification, and Maintenance of Wooden Height Boards (Annex 1.3) and NNC GB Resolution No. 3
s.2018 Approving the Guidelines on the selection of non-wood height and length measuring tool (Annex
1.4).

1. Length/Height Board (Figure 1.7) is a measurement

tool that can be set up horizontally against a flat
surface for measuring the length and vertically
against a wall for children’s height measurement.
Generally, length/height boards can measure up to
130 cm and have a precision of 0.1 cm (FANTA, 2018).
A sliding piece acts as a foot piece when taking
length or a headpiece when taking height. Wooden
length/height board is a commonly used type in the
country as recommended by the WHO (NNC, 2012).
Metal, although durable, is not recommended as it
can become too hot in areas with high temperatures
Figure 1.7. Length/Height Board
and might cause burns (FANTA, 2018).

2. Stadiometer (Figure 1.8) is a height measurement

tool which consists of a vertical ruler and a sliding
paddle which rests on top of the head when height
is being taken. It is lightweight, convenient, and
portable. It features a level which assures that the tool
is completely perpendicular to the floor. It is similar to
a length/height board in form with its graduated body
and sliding piece. However, a stadiometer can only
be used vertically to measure the height of children.

Figure 1.8. Stadiometer

30 Section 1: OPT Plus Overview

3. Microtoise (Figure 1.9) is a height measurement tool
that is mounted to a flat wall. The bottom part of the
tool can be slid down to the top of the child’s head
and the height measurement can be seen through
a window. It is practical to use, lightweight, and
portable.

Figure 1.9. Microtoise

NOTE 1.3.
Mobile Measuring Mat

Mobile measuring mat (Figure 1.10) is a light-

weight and portable length measurement tool
composed of a fixed headpiece and a sliding
foot positioner. This tool is recommended only
during emergencies and if the length board is not
available due to its gradation. Figure 1.10. Mobile Measuring Mat

NOTE 1.4.
Length/Height Board

Wooden length/height boards have been widely

used in the country since the adoption of the WHO
recommendation for its use. But more recently,
use of non-wood materials in fabricating length/
height measurement tools has been approved
as a response to the total log ban policy. See
Annex 1.4 NNC GB Resolution No. 3, Series 2018
Approving the Guidelines on the Selection of Non-
Wood Height and Length Measuring Tool. Figure 1.11. Length/Height Boards

Section 1: OPT Plus Overview 31

What are the forms to be used What are the uses of OPT Plus?
in OPT Plus?
• Identify and quantify the 0-to-59-month-old
children who are malnourished.
The OPT Plus uses different forms to record the
• Locate families with 0-to-59-month-old
gathered data. Below are the list of forms to be
children who are malnourished.
used at the Barangay Level:
• Prevent growth faltering among 0-to-23-
month-old children.
1. OPT Plus Form 1A: List of 0-to-59-month-
• Determine priority areas and individuals for
old children measured which will be used for
nutrition interventions.
recording of weight and length/height in the
• Provide a basis for assessing local nutrition
next OPT Plus
programs, projects, and activities.
2. List of 0-23 mos: List of 0-to-23-month-old
children
3. List_MUAC Status: List of 6-to-59-month- What are the units used in
old children by MUAC status
OPT Plus?
4. List_MW (MAM): List of 0-to-59-month-
old children who are moderately wasted/
1. Weight-for-Age: An indicator used to
moderate acute malnutrition
classify underweight among 0-to-59-month-
5. List_SW (SAM): List of 0-to-59-month-old
old children.
children who are severely wasted/severe
acute malnutrition 2. Length/Height-for-Age: An indicator used
6. List_MSt&SSt: List of 0-to-59-month-old to classify stunting among 0-to-59-month-
children who are moderately stunted or old children.
severely stunted 3. Weight-for-Length/Height: An indicator
7. List_OW&Ob: List of 0-to-59-month-old used to classify wasting, overweight, and
children who are overweight and obese obesity among 0-to-59-month-old children.
8. List_MUW, SUW,MSt&SSt: List of 0-to-
59-month-old children who are both stunted
and underweight. The supervisor’s role is How is OPT Plus implemented?
to ensure that the OPT Plus protocols are
The OPT Plus protocol comprises five (5) major
followed (Section 8)
activities. As a protocol, the OPT Plus Team
9. List_MSt,SSt,MW&SW: List of 0-to-59-
should strictly follow the different activities to
month-old children who are both stunted
generate timely, reliable, accurate, and precise
and wasted
OPT Plus data. The barangays will be clustered
10. List_MSt,SSt,OW&Ob: List of 0-to-59-
and assigned a supervisor. Figure 1.12 presents
month-old children who are both stunted
OPT’s five major activities. Figure 1.13 indicates
and overweight/obese
which sections of the Manual of Operations
(MOP) the OPT Plus activities are discussed in
detail.

32 Section 1: OPT Plus Overview

Activity 1
Activity 2
Pre-OPT Plus Protocol
OPT Plus Protocol on Anthropometric
Measurement
• Organization and Training of the OPT
Plus team
• Anthropometric Measurements and
• Certification of OPT Plus members
Checking for Edema
• Household Profiling and Spot
• Feedbacking to parents the
Mapping
nutritional status of their children
• Preparation and Verification of Tools
• Referral of Malnourished Children
and Equipment

Activity 3
Activity 4 OPT Plus Protocol on Data Processing,
OPT Plus Protocol on Data Encoding, and Report Generation
Interpretation and Action Planning
• OPT Plus Processing
• Report Generation (e-OPT Plus and • Using the Electronic Operation
Forms) Timbang Plus Tool (eOPT Plus Tool)
• OPT Plus Data Interpretation • Data Quality Check
• Data Analysis and Action Planning

Activity 5
OPT Plus Protocol on on Follow Through Activities

• OPT Plus Monitoring and Evaluation and Active Search

• Monthly monitoring of 0-to-23-month-old children and those older children
identified as malnourished
• Semestral monitoring of 24-to-59-month-old children
• BNAP Monitoring

Figure 1.12. OPT Plus activities flowchart

Section 1: OPT Plus Overview 33

Activity 1 Activity 2
Pre-OPT Plus Protocol OPT Plus Protocol on Anthropometric
Measurement
Section 2.1. Organizing the OPT Plus team
Section 2.2. Certification of OPT Plus Section 3.1. Roles and Responsibilities of
members OPT Plus Team and Supervisors
Section 2.3. Household Profiling Section 3.2. General Reminders for Taking
Section 2.4. Spot Mapping Anthropometric Measurements
Section 2.5. Calibration and Verification of Section 3.3. Instruction on How to Weigh
Weighing Tools and Equipment the 0-to -59-month-old Children
Section 2.6. Verification of Length/Height Section 3.4. Instructions on Measuring the
Tools and Equipment Length of the 0-to-23-month-old Children
Section 2.7. Standardization Exercise Section 3.5. Instructions on Measuring the
Height of the 24-to-59-month-old Children
Section 3.6. Instruction on How to Measure
MUAC of 6-to-59-month-old Children
Section 3.7. Instructions on How to Check
Activity 3 and Classify Severity of Bilateral Pitting
OPT Plus Protocol on Data Processing, Edema
Encoding, and Report Generation Section 3.8. OPT Plus Referral
Section 3.9. WHO Child Growth Standards
Section 4.1. Roles of the OPT Plus Team
(CGS)
and Supervisors
Section 4.2. Electronic Operation Timbang
Plus Tool (e-OPT Plus Tool)
Section 4.3. Guidelines on Determination of
Nutritional Status

Activity 5
OPT Plus Protocol on on Follow Through
Activities
Activity 4 Section 6.1. Roles and Responsibilities of
OPT Plus Protocol on Data Interpretation the Supervisors and OPT Plus Team in the
& Action Planning Follow Through Activities
Section 5.1. Roles and Responsibilities of Section 6.2. Child Growth Monitoring and
OPT Plus Team and Supervisors Active Search
Section 5.2. Uses of OPT Plus Results Section 6.3. BNAP Monitoring
Section 5.3. Report Generation (eOPT Plus
and Forms)
Figure 1.13. Flowchart of Operation Timbang Plus
Section 5.4. Data Analysis and
Activities and MOP Sections
Interpretation
Section 5.5. Data Utilization and Action
Planning

34 Section 1: OPT Plus Overview

Activity 1. Pre-OPT Plus Protocol
• OPT Plus Team should be organized and trained accordingly (Section 2.1). The pre-OPT
Plus planning phase should start by August, allowing enough time to prepare for the
conduct of OPT Plus. Measurement of OPT Plus will start in the first quarter of the
succeeding year.

• The measurer needs to be a Certified OPT Plus Measurer (Sections 2.2 and 2.7).

• The master listing of 0-to-59-month-old children (Section 2.3) and spot-mapping (Section
2.4) should be conducted.

• Tools and equipment for weighing and measuring should also be calibrated and verified
(Sections 2.5 and 2.6).

Activity 2. OPT Plus Protocol on Anthropometric

Measurement
• This activity involves measuring the length or height, weight, and checking for edema
of 0-to-59-month-old children using calibrated and verified equipment and tools and the
correct OPT Plus data collection protocol (Sections 3.1 to 3.6).

• The weight and length/height of children are recorded in OPT Plus Form 1A with one
decimal place (0.0). This is also an opportune time to actively search for malnourished
children with apparent manifestations of malnutrition to immediately refer them to
appropriate offices for proper intervention (i.e., health center, social welfare office,
agriculture office, etc.) (Section 3.7).

• The parents or caregivers should be given immediate feedback on the child’s nutritional
status using the weight-for-length/height indicator (Section 3.7). This can easily be
done by using the Child Growth Standards (CGS) weight-for-length/height Growth Chart
in the Early Childhood Care and Development (ECCD) Card (Section 3.8) or through the
National Nutrition Information System (NNIS) mobile application.

Section 1: OPT Plus Overview 35

Activity 3. OPT Plus Protocol on Nutritional
Status Assessment
• The main activity is processing the OPT Plus data using the eOPT Plus Tool. This
tool was developed by the National Nutrition Council (NNC) to make data collection,
calculation, and reporting of OPT Plus data more efficient and accurate (Section 4.2).

• Data Quality Checks (DQC) are included in the eOPT Plus Tool to generate reliable,
accurate, and precise OPT Plus data (Section 7).

• In case there is no access to a computer, a smartphone may be used by downloading

the National Nutrition Information System (NNIS) mobile application to automatically
determine the nutritional status, and fill out the required OPT Plus Forms (Section 4.3).

Activity 4. OPT Plus Protocol on Data

Interpretation and Action Planning
• After generating reliable, accurate, and precise OPT Plus data, its utility should be
promoted at the barangay (Section 5.1). The OPT Plus Team’s efforts will be useless
if the Barangay Nutrition Committee (BNC) will not use the OPT Plus results for the
identification of nutrition actions.

• The data should be presented, analyzed, and interpreted (Sections 5.2 and 5.3). The
data presented should be simple and easy to understand. Then, the BNC will review
the results if there are inconsistencies and will interpret the trends or changes in the
prevalence of malnutrition in the community. What does the data mean? What story is
the data telling?

• After data interpretation, the OPT Plus Team should be ready to plan and/or update the
Barangay Nutrition Action Plan (BNAP) (Section 5.4).

36 Section 1: OPT Plus Overview

Activity 5. OPT Plus Protocol on Follow Through Activities

• Monitoring and evaluation are important components of the OPT Plus process. These aim
to enhance the continuity and implementation of nutrition programs, projects, and activities
(PPA). The main activity is the OPT Plus monitoring of the nutritional status of children
(Section 6.3).

• Monthly monitoring of 0-to-23-month-old and those older children identified as malnourished

(i.e., underweight, stunted, wasted, overweight, and with obesity), and semestral monitoring
of 24-to-59-month-old children (Section 6.2). The eOPT Plus Tool can generate these lists
(Section 6.3).

• The spot map should also be updated (Section 2.4). Lastly, the OPT Plus follow through
activities provide a chance to monitor and evaluate the accomplishments in the BNAP and
assess its contribution to the improvement of malnutrition in the community (Section 6.4).

What resources are needed in the OPT Plus

Implementation?
The OPT Plus Team, appropriate weighing scale, length/height board, MUAC tape, CGS tables,
growth chart for male and female, computer with Excel application, OPT Plus forms, pens/
pencils, clipboard and calibration tools such as:

• Calibrated test weights

• Calibrated steel rule

• L-shaped ruler

Thus, the OPT Plus activities should have a budget appropriation in the City/Municipal Nutrition
Action Plan (C/MNAP), Barangay Nutrition Action Plan (BNAP), and Annual Investment Program
(AIP).

Section 1: OPT Plus Overview 37

REFERENCES

FANTA. (2018). Guide to Anthropometry: A Practical Tool for Program Planners, Managers, and
Implementers.

Inter-agency Technical Working Group on Child Growth Standards. (2012). Implementing Guidelines on
Operation Timbang Plus (OPT+). Retrieved from https://www.nnc.gov.ph/phocadownloadpap/
userupload/elavapie/OPT%20Plus%20Guidelines.pdf.

NNC Governing Board Resolution, No. 2, S. 2008. Retrieved from https://www.nnc.gov.ph/downloads/

category/23-board-resolution?download=640:nnc-governing-board-resolution-no-2-series-
of-2008.

Talavera, M.T.M., Gordoncillo, N.P., Tandang, N.A., and Domningo, D.G.C. (2021). Acceptability of Height
Measuring Equipment of Different Materials among Community Nutrition and Health Workers
and Parents in Laguna Province, Philippines. Acta Medica Philippina. https://doi.org/10.47895/
amp.vi0.3100.

UNICEF (2015). National Guidelines on the Management of Severe Acute Malnutrition for Children under
Five Years: Manual of Operations. 1st Ed.

USAID. (2017). Nutrition in Emergencies: Technical Guidance Brief.

World Health Organization (WHO). (2008a). Training Course on Child Growth Assessment: Introduction.
Geneva, WHO, 2008.

WHO. (2008b). Training Course on Child Growth Assessment: Interpreting Growth Indicators. Geneva,
WHO, 2008.

WHO. (2013). Guideline: Updates on the management of severe acute malnutrition in infants and
children. Geneva: World Health Organization; 2013.

38 Section 1: OPT Plus Overview

LIST OF ANNEXES

ANNEX 1.1 Roles and responsibilities of the OPT Plus Team and supervisors

ANNEX 1.2 NNC Governing Board Resolution ________________ Approving the Guidelines on
the Selection of Weighing Scales

ANNEX 1.3 NNC Governing Board Resolution No. 3, Series 2012 Approving the Guidelines on
the Fabrication, Verification, and Maintenance of Wooden Height Boards

NNC Governing Board Resolution No. 3, Series 2018 Approving the Guidelines on
ANNEX 1.4 the Selection of Non-Wood Height and Length Measuring Tool

Section 1: OPT Plus Overview 39

ANNEX 1.1 Roles and responsibilities of the OPT Plus Team and supervisors

40
Activity National National Provincial Supervisors: City/Municipal OPT Plus Team Barangay
Nutrition Council Nutrition Nutrition Office/ City/Municipal Nutrition Action members Nutrition
Central Office Council Regional Provincial Nutrition Action Officer Committee
Office/ Regional Nutrition Action Officers, District/ (C/MNAO)
Nutrition Officer (PNAO) City/Municipal
Program Coordinators,
Coordinator Midwives,
(RNPC) Barangay
Nutrition Action
Officers among
others as
applicable
Activity 1. 1. Issue national 1. Issue letter on 1. Disseminate 1. Assist in 1. Organize 1. Attend the 1. Provide
Pre-OPT Plus guidance and the conduct of memorandum on organizing the the OPT Plus Training and resources to
Protocol updates as OPT Plus starting the conduct of OPT Plus training, Training and Standardization the OPT Plus
necessary on the August with OPT Plus issued standardization Standardization and Refresher Team members
conduct of OPT reminders on the by the RNPC. and refreshers. and Refresher Training on the to attend the
Plus. following: Training. OPT Plus. Training and
2. Assist in 2. Facilitate the Standardization or
2. Issue updated • Calibration/ the calibration/ organization of the 2. Remind the 2. Assist the Refresher Training
electronic OPT Verification verification OPT Plus Team in barangay OPT supervisor in on the OPT Plus.
Plus tool. of tools and assigned cluster/ Plus Team of facilitating the
• Household/ equipment. area. the scheduled organization of the 2. Organize the
3. Provide Family Profiling conduct of the OPT Plus Team. OPT Plus Team.
technical 3. Provide 3. Check if the OPT Plus every
assistance • OPT Plus team technical support weighing scales 3. Check if the 3. Assist the
Certification January to March
as needed to during the training are calibrated of the current weighing scales OPT Plus Team
stakeholders. • Refresher of the OPT Plus and if length/ year. are calibrated and members in
Training team. height boards are verify the length/ calibrating/
verified. If not, 3. Oversee the height board. verifying the
2. Provide 4. Allocate funds initiate or lead conduct of family weighing scales
technical support for OPT Plus. the calibration profiling and spot- 4. Conduct and verifying the
during the training or verification mapping. household length/height
of the OPT Plus of the tools and profiling and spot- board.
team. equipment. 4. Allocate funds mapping of target
for the purchase households. 4. Assist in
of OPT Plus. conducting
household
profiling and spot-
mapping of target
households.
5. Allocate funds
needed for the
OPT Plus.

Section 1: OPT Plus Overview

Activity National National Provincial Supervisors: City/Municipal OPT Plus Team Barangay
Nutrition Council Nutrition Nutrition Office/ City/Municipal Nutrition Action members Nutrition
Central Office Council Regional Provincial Nutrition Action Officer Committee
Office/ Regional Nutrition Action Officers, District/ (C/MNAO)
Nutrition Officer (PNAO) City/Municipal
Program Coordinators,
Coordinator Midwives,
(RNPC) Barangay
Nutrition Action
Officers among
others as
applicable

Section 1: OPT Plus Overview

4. For highly
urbanized cities,
the City/Municipal
Health Officer
(C/MHO) will
prepare a letter of
communication
to be signed by
the Local Chief
Executive (LCE)
to allow the
conduct of OPT
Plus in exclusive
subdivisions and
villages.

Activity 2. Monitor the status 1. Monitor the 1. Monitor the 1. Check the Monitor the status 1. Conduct 1. Assist in the
OPT Plus of the OPT Plus status of the OPT status of the OPT master list of of the conduct of monthly OPT preparation of
Anthropometric activity at the Plus activity Plus activity 0-to-59-month-old the OPT in each Plus monitoring the master list of
Measurement national level children Barangay Health of MW/MAM, 0- to 59-month-old
2. Provide 2. Provide Station (BHS) SW/SAM, children.
mentoring and mentoring and 2. Oversee the underweight, and
supportive supportive actual collection 0-to-23-month- 2. Mobilize the
supervision supervision visits of length/height old children, under-five children
visits to LGUs/ to barangays measurement and and quarterly to the weighing
barangays needing needing weighing monitoring of post.
assistance assistance 24-to-59-month
3. Review the 3. Provide logistic
recording of the old children. support, i.e.,
sex, date of birth, transportation and
date of weighing, food allowance
length/height, and to the OPT Plus
weight Team.

41
42
4. Refer to the 2. Participate 4. Provide
Barangay Health in the bi-annual transportation and
Centers (BHC)/ review of the other services to
Rural Health Unit BNAP and the family with
(RHU) the children present BNAP malnourished
with edema accomplishments children to visit
and obviously during the the BHC/RHU.
manifesting Barangay General
malnutrition (i.e. Assembly/BNC 5. Assist
extreme thinness, meetings. coordination with
hollow cheeks, the DCW for the
edematous feet, 3. Prepare the children who
and hands, etc.) master list of have not been
0-to-59-month-old measured at
5. Feedback children. home or center-
the child’s based.
nutritional status 4. Conduct the
immediately after actual collection
measurement of length/height
using the weight- measurement and
for-length/height weighing with
index the supervisor, if
feasible.
5. Record the
sex, date of birth,
date of weighing,
length/height, and
weight.
6. Refer to the
BHC/ RHU the
children with
edema and
obviously manifest
malnutrition if
the supervisor is
unavailable.
7. Feedback
the child’s
nutritional status
immediately after
measuring using
the weight-for-
length/height CGS
Growth Chart in
the ECCD Card,
if the

Section 1: OPT Plus Overview

supervisor is
unavailable.
8. Coordinate
with the DCW
to measure the
children who
were not covered
during the center-
based OPT Plus or
home visit.

Activity 3. 1. Provide 1. Provide Provide capacity 1. Assist in Conduct a data 1. If the team Review the
OPT Plus Data technical technical building in using encoding the quality check of has access to submitted OPT
Processing, assistance at the assistance at the the eOPT Plus anthropometric the eOPT Plus a computer or Plus reports and
Encoding national level in regional level in Tool measurements Tool. laptop, use the endorse them to
and Report using the eOPT using the eOPT in the eOPT Plus eOPT Plus Tool the C/MNAO.
Generation Plus Tool Plus Tool Tool. to compute
children’s age
2. Document 2. Submit reports 2. Review the in months and
issues and to the NNC outputs of the nutritional status
concerns CO on issues BNS for possible automatically.
encountered in and concerns errors in data Make sure to get
the tool for future encountered in recording such a soft copy of the
improvements the tool for future as duplicate eOPT Plus Tool.
improvements children, too
big or too small
measurements,
etc.
3. Endorse the
OPT Plus reports
to the barangay.

43
44
2. In case there
is no access
to a computer,
a smartphone
may be used
by downloading
the NNIS mobile
application to
automatically
determine the
nutritional status.
3. Submit the OPT
Plus reports to
the C/MNAO and
Midwife.

Activity 4. 1. Presentation 1. Presentation 1. Presentation Participate in the 1. Organize the 1. Organize the 1. Participate in
OPT Plus Data of the OPT Plus of the OPT Plus of the OPT Plus preparation of the presentation of presentation of the presentation
Interpretation trend during trend during BNS trend to the LNAP OPT Plus results OPT Plus results of OPT Plus.
and Action National BNS Conference and Provincial Nutrition to Municipal to BNC.
Planning Conference and to to the Regional Committee Nutrition 2. Participate in
the NNC Technical Nutrition Council (PNC) and Committee (C/ 2. Facilitate the preparing and
Committee, (RNC), Regional Provincial Board MNC) preparation and updating the
Technical Working Technical Working (Sangguniang updating of the BNAP.
Group, and other Group (RTWG), Panlalawigan) 2. Review and BNAP to the BNC.
consolidate the 3. Allocate funds
meetings Regional Social 3. Present the to implement
Development 2. Consolidate the updated BNAP
2. Consolidate the Committee OPT Plus results results of the the programs/
OPT Plus results 3. Facilitate the OPT Plus to the projects/ activities
(RSDC) among 3. Include OPT preparation of the Sangguniang of the BNAP.
3. Include OPT other fora. Plus results in the C/MNAP Barangay for
Plus results in PNAP to address the budget 4. Review
2. Consolidate the 4. Present the and approve
the Philippine OPT Plus results nutrition problems appropriation of
Plan of Action results of the the BNAP. resolutions
for Nutrition 3. Include OPT 4. Provision OPT Plus to the concerning OPT
specifically areas Plus results in the of technical Sangguniang 4. Facilitate Plus activities.
not covered by Regional Nutrition assistance in Panlungsod/Bayan approval of
National Nutrition Action Plan data analysis and for the budget resolutions at the
Survey to (RNAP) to address interpretation appropriation of barangay level
address nutrition nutrition problems the C/MNAP concerning OPT
problems Plus activities.
5. Facilitate
approval of
resolutions at
the barangay,
municipal, city
levels concerning

Section 1: OPT Plus Overview

OPT Plus activities
Activity National National Provincial Supervisors: City/Municipal OPT Plus Team Barangay
Nutrition Council Nutrition Nutrition Office/ City/Municipal Nutrition Action members Nutrition
Central Office Council Regional Provincial Nutrition Action Officer Committee
Office/ Regional Nutrition Action Officers, District/ (C/MNAO)
Nutrition Officer (PNAO) City/Municipal
Program Coordinators,
Coordinator Midwives,
(RNPC) Barangay
Nutrition Action
Officers among
others as
applicable

Section 1: OPT Plus Overview

Activity 5. OPT 1. Conduct mid- 1. Conduct end- 1. Conduct mid- 1. Assist in 1. Remind the 1. Remind the 1. Assists in
Plus Protocol on year and end-year year meetings year meetings reviewing the BNC of the BNC of the conducting
Follow Through meetings within with P/C/MNAOs with C/MNAOs monthly and schedules of the schedules of the monthly OPT
Activities the Nutrition to discuss the to discuss the quarterly OPT monthly OPT monthly OPT Plus monitoring
Surveillance implemented implemented Plus monitoring Plus monitoring Plus monitoring of SW/MAM
Division staff programs and programs and coverage if all the of SW/MAM of SW/MAM and MW/MAM,
regarding the projects and projects and children weighed and MW/MAM, and MW/MAM, underweight and
conduct of OPT updates on the updates on the and measured in underweight and underweight and 0-to23-month-
Plus nutritional status nutritional status the first quarter 0-to-23-month- 0-to-23-month- old, and quarterly
of children of children were followed up old, and quarterly old, and quarterly monitoring of
2. Conduct monitoring of monitoring of 24-to-59-month-
national activities 2. Conduct 2. Conduct 2. Participate 24-to-59-month 24-to-59-month old children.
related to data regional activities provincial in the bi- old children old children
quality check related to data activities related annual review 2. Participate
quality check to data quality of the BNAP 2. Review the 2. Review the in the bi-annual
check and assist in monthly and monthly and review of the
presenting BNAP quarterly OPT quarterly OPT BNAP and
accomplishments Plus monitoring Plus monitoring present BNAP
during the coverage if all the coverage if all the accomplishments
Barangay General children weighed children weighed during the
Assembly. and measured in in the first quarter Barangay General
the first quarter were all weighed. Assembly.
were all followed
up OR Assist in 3. Organize a 3. Conduct
reviewing the bi-annual review barangay activities
monthly and of the BNAP related to data
quarterly OPT and assist in quality check
Plus monitoring presenting BNAP
coverage if all accomplishments
the children during the
measured were Barangay General
covered during Assembly.
child growth
monitoring.

45
46
3. Conduct a
bi-annual review
of the BNAP and
present BNAP
accomplishments
during the
Barangay General
Assembly.
4. Follow-up to the
BNS on the status
of the referred
malnourished
children.
5. Conduct
city/municipal
activities related
to data quality
check

Section 1: OPT Plus Overview

Section Two

PRE-OPT PLUS
PROTOCOL

Section 2: Pre-OPT Plus Protocol 49

PRE-OPT PLUS PROTOCOL

OVERVIEW

This section aims to cover an in-depth discussion of the pre-OPT

Plus protocol to instill integrity in conducting the OPT Plus.
After reading this section, one should be able to:

1. Describe how to organize the OPT Plus team;

2. Explain the process of OPT Plus members;
3. Collect household profiles;
4. Prepare and update spot maps;
5. Calibrate and verifiy weighing tools and equipment;
6. Verify length and height tools and equipment; and
7. Accurately and precisely measure the weight, length, height, and MUAC.

The general objective of the pre-OPT Plus protocol is to help prepare

all the resources needed for the conduct of the OPT Plus. Specifically,
the pre-OPT Plus protocol aims to provide knowledge and skills in the
following subtopics:

Section 2.1 Organizing the OPT Plus Team

Section 2.2 Certification of OPT Plus Members
Section 2.3 Household Profiling
Section 2.4 Spot Mapping
Section 2.5 Calibration and Verification of Weighing Tools and Equipment
Section 2.6 Verification of Length/Height Tools and Equipment
Section 2.7 Standardization Exercise

Section 2: Pre-OPT Plus Protocol 51

LIST OF TABLES

Table 2.1 Roles and Functions of the different persons involved in the OPT Plus during the
Pre-OPT Plus Protocol.

Table 2.2 Level of Classification of OPT Plus Team after completing the standardization
exercise.

Table 2.3 Definition of terms used in the household profile.

Table 2.4 Color/Legend for the preparation of the barangay spot-map.

Table 2.5 Number of children needed per age group, nutrition assessment type, and coding
procedure.

Table 2.6 Components of standardization test report.

Table 2.7 Suggested cut-off points for acceptability of measurements using TEM.

Table 2.8a Standardization Test of weight measurement using digital flat scale.

Table 2.8b Initial standardization test of weight measurement using Hanging Weighing Scale.

52 Section 2: Pre-OPT Plus Protocol

LIST OF FIGURES

Figure 2.1 Sample coded house.

Figure 2.2 Aerial map downloaded from Open Street Map.

Figure 2.3 Sample GIS barangay map from C/MPDO.

Figure 2.4 Calibrated Standard Weights.

Figure 2.5 Pre-loading.

Figure 2.6 Testing if the scale goes back to zero.

Figure 2.7 Sample calibration certificate with CMV.

Figure 2.8 Hanging of 5 kg, 10 kg, 15 kg, 20 kg and 25kg weights for Departure from Nominal
Value Test

Figure 2.9 Sample Calibration sticker.

Figure 2.10 Calibration sticker attached at the back of the weighing scale.

Figure 2.11 Sample Verification sticker.

Figure 2.12 Verification sticker attached at the back of the weighing scale.

Figure 2.13 A calibrated steel ruler.

Figure 2.14 An L-square angle ruler

Figure 2.15 A magnifying glass.

Figure 2.16 Visual inspection of length/height board.

Figure 2.17 Checking the squareness of headboard and footboard using L-square angle ruler

Figure 2.18 Conducting check calibration of the 10 verification points.

Figure 2.19 Using magnifying glass and flashlight while reading measurements.

Figure 2.20 Verification sticker attached at the back of the height board.

Figure 2.21 Initial set–up and flow of the standardization activity.

Figure 2.22 Color-coded forms are used to record the measurements of children.

Figure 2.23 Screenshots of Training Screen.

Section 2: Pre-OPT Plus Protocol 53

LIST OF SUPERVISOR’S BOXES

Supervisor’s Box 2.1 Data Quality Check

Supervisor’s Box 2.2 Training, Standardization, and Certification

54 Section 2: Pre-OPT Plus Protocol

LIST OF ACRONYMS

AIP Annual Investment Plan

BGA Barangay General Assembly
BHW Barangay Health Worker
BNAO Barangay Nutrition Action Officer
BNC Barangay Nutrition Committee
BNS Barangay Nutrition Scholar
C/MHO City/Municipal Health Officer
C/MPDO City/Municipal Planning Development Office
cm centimeter
CMV Conventional Mass Value
D/C/MNPC District/City/Municipal Nutrition Program Coordinator
DCW Day Care Worker
DOST Department of Science and Technology
g gram
HRH Human Resource for Health
kg kilogram
LCE Local Chief Executive
LGU Local Government Unit
mm millimeter
MSt Moderately Stunted
MUW Moderately Underweight
NDDP Nutritionist-Dietitian Deployment Program
NHTS National Housing Targeting System
NNC National Nutrition Council
OPT Plus Operation Timbang Plus
P/C/MNAO Provincial/City/Municipal Nutrition Action Officer
PNAO Provincial Nutrition Action Officer
R Coefficient of Reliability
RHM Rural Health Midwife

Section 2: Pre-OPT Plus Protocol 55

RNPC Regional Nutrition Program Coordinator
SK Sangguniang Kabataan
SSt Severely Stunted
St Stunted
SUW Severely Underweight
TEM Technical Error of Measurement
UW Underweight

56 Section 2: Pre-OPT Plus Protocol

DEFINITION OF TERMS

Anthropometry Training Training sessions that strengthen the measurers’ knowledge and
skills on the use, maintenance, calibration, and verification of tools
and equipment; procedures and precautions when taking the weight,
length/height, and MUAC measurement; and roles of measurers and
assistants.

Calibration Process of checking and adjusting of the weighing scale within the
possible and allowable error.

Household Profile Summary of demographic, health, and nutrition information of

households living in the barangay.

Spot Map Visual representation of the barangay, where information such as

the geographic and demographic characteristics of the barangay are
indicated.

Standardization Exercise An activity usually conducted after the general training that enables
the trainers/facilitators to directly observe the trainee’s measurement
techniques and correct any error that may lead to an inaccurate
measurement.

Verification Process of checking if the length/height board and weighing scale

calibration results have not changed significantly since it had its last
calibration.

Section 2: Pre-OPT Plus Protocol 57

Section 2.1

ORGANIZING THE OPT PLUS

TEAM

Through the help of the City/Municipal Nutrition Chair on Health and Nutrition, Barangay Nutrition
Action Officer (C/MNAO), two (2) sets of Scholar (BNS), Sangguniang Kabataan (SK)
Operation Timbang (OPT) Plus Teams will be officials, other Barangay Health Workers (BHW),
organized: one at the city/municipal and another Day Care Worker (DCW), and teacher-in-charge,
at the barangay level. At the municipal level, the and other barangay officials and staff.
OPT Plus Supervisors are composed of the C/
MNAO, Rural Health Midwife (RHM), nurses, The roles of the different persons at the different
District/City/Municipal Nutrition Program Coor- Local Government Units (LGU) levels are defined
dinator (D/C/MNPC), and Human Resource in Annex 1.1 while Table 2.1 shows the roles
for Health (HRH), i.e., Nutritionist-Dietitian and functions of the different persons involved
Deployment Program (NDDP). during the Pre-OPT Plus activities. Meetings
should be done to discuss the organization of
Meanwhile, the members of the Barangay the OPT Plus Team with the Barangay Nutrition
OPT Plus Team can include the RHM, Barangay Committee (BNC).
Nutrition Action Officer (BNAO), Committee

58 Section 2: Pre-OPT Plus Protocol

Table 2.1. Roles and Functions of the different persons involved in the OPT Plus during the Pre-OPT
Plus Protocol.

ORGANIZATION/
FUNCTION
PERSON INVOLVED

National Nutrition 1. Issue national guidance and updates as necessary on the conduct of OPT
Council Central Office Plus.
(NNC CO) 2. Issue updated electronic OPT Plus tool.
3. Provide technical assistance to stakeholders as needed.

Regional Nutrition 1. Issue letter on the conduct of OPT Plus starting August with reminders on
Program Coordinator the following:
(RNPC) i. Calibration/Verification
ii. Household Profiling
iii. OPT Plus Certification
iv. Refresher Training
2. Provide technical support during the training of the OPT Plus team.

Provincial Nutrition 1. Disseminate memorandum on the conduct of OPT Plus issued by the
Action Officer (PNAO) RNPC.
2. Assist in the calibration/verification of tools and equipment.
3. Provide technical support during the training of the OPT Plus team.
4. Allocate funds for OPT Plus.

Supervisors 1. Assist in organizing the OPT Plus Training and Standardization and
Refresher Training.
2. Facilitate the organization of the OPT Plus Team in the assigned cluster.
3. Check if the weighing scales are calibrated and if length/height boards are
verified. If not, initiate or lead the calibration or verification of the tools and
equipment.
4. For highly urbanized cities, the City/Municipal Health Officer (C/MHO)
will prepare a letter of communication to be signed by the Local Chief
Executive (LCE) to allow the conduct of OPT Plus in exclusive subdivisions
and villages.

City/Municipal 1. Organize the OPT Plus Training and Standardization and Refresher Training.
Nutrition Action Officer 2. Remind the barangay OPT Plus Team of the scheduled conduct of the OPT
(C/MNAO) Plus every January to March of the current year.
3. Oversee the conduct of family profiling and spot-mapping.
4. Allocate funds for the purchase of tools and equipment.

Section 2: Pre-OPT Plus Protocol 59

ORGANIZATION/
FUNCTION
PERSON INVOLVED

OPT Plus Team 1. Attend the OPT Plus Training and Standardization and Refresher Training.
members 2. Assist the supervisor in facilitating the organization of the OPT Plus Team.
3. Check if the weighing scales are calibrated and verify the length/height
board.
4. Conduct household profiling and spot-mapping of target households.

Barangay Nutrition 1. Provide resources to the BNS to attend the OPT Plus Training and
Committee (BNC) Standardization and Refresher Training.
2. Organize the OPT Plus Team.
3. Assist the BNS in calibrating the weighing scales and verifying the length/
height board.
4. Assist in conducting household profiling and spot-mapping of target
households.
5. Allocate funds needed for the OPT Plus.

SUPERVISOR’S BOX 2.1.

Data Quality Check

The details of the data quality check per activity are discussed in Section 7.
Data Quality Check.

60 Section 2: Pre-OPT Plus Protocol

Section 2.2

CERTIFICATION OF OPT PLUS

MEMBERS

Certifying the OPT Plus members after the component of the standardization exercise. A
Anthropometry Training is vital to OPT Plus Level 2 certification is given to those who passed
activities. The certification will ensure that the one (1) out of the three (3) standardization tests.
OPT Plus Team has the knowledge, skills, and A Level 3 Certification will be given to those who
confidence in generating quality data. The details passed the MUAC component and either weight
of the Anthropometry Training can be found in or height component of the standardization test.
the OPT Plus Training Manual. If the OPT Plus team member passed both
weight and height, they will be given a Level 4
The basis for the level of certification includes certification. If they pass all the components of
the completion of the training, results of the the standardization exercise, they will be given
standardization exercise, and post-test scores a Level 5 certification. A Level 5 certification
of the participating OPT Plus member. The makes an OPT Plus team member eligible to
certification is classified into five: Level 1, 2, be a resource person in the succeeding OPT
3, 4, and 5. Table 2.2 details the criteria and Plus training that will be conducted. Lastly,
implication of each level. participants who completed the training,
but failed the post-test and all components
The minimum requirement for an OPT Plus of standardization exercises will be given a
team member to get a certification of any level certificate of attendance.
includes completing the Anthropometry Training
and passing the post-test by obtaining at least All certified OPT Plus measurers will be recorded
60% of the total score. Level 1 certification is in the Capacity Map database.
given to those who were not able to pass any

Section 2: Pre-OPT Plus Protocol 61

Table 2.2. Level of Classification of OPT Plus Team after completing the standardization exercise.

LEVELS
CRITERIA
CERTIFICATE OF
LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 LEVEL 5*
ATTENDANCE

Training** Completed Completed Completed Completed Completed Completed the

the training the training the training the training the training training but did not
and passed and passed and passed and passed and passed pass the post-test
the post- the post- the post- the post- the post-
test (60%) test (60%) test (60%) test (60%) test (60%)

Standardization*** Did not Passed 1 Passed Passed both Passed Did not pass any
pass the out of 3 MUAC weight and MUAC, standardization
standardiza- standardiza- plus either height stan- weight and test
tion tion test weight or dardization height stan-
height stan- test dardization
dardization test
test

Implication Eligibility to measure depends on the passed measurement (both precision and accuracy).
Those who failed could still help in assisting and recording the measurement.

*Can be tapped as resource persons for the succeeding OPT Plus training.
** Participants who failed the post-test can take the removal test.
***If ≥20% failed, those who failed will undergo restandardization. If <20% failed, re-standardization will not be necessary.

The Regional Nutrition Program Coordinator On the other hand, failing the standardization
(RNPC) shall issue the certification upon test requires the measurer to repeat the
endorsement of the PNAO. The certified OPT anthropometry training and standardization
Plus Team member is eligible for weighing and exercise. If during the standardization test,
measurement of 0-59-month-old children in the ≥20% failed, those who failed may participate in
barangay while those who passed the Level the re-standardization.
5 can be tapped as resource persons for the
succeeding OPT Plus training. In case no OPT Plus member was certified, the
trained team can conduct the OPT Plus with
If an OPT Plus member did not pass the post- close supervision of the trained supervisors or
test, they are allowed to take a removal test and certified OPT Plus member from other LGUs or
they should get 60% and above to pass. villages.

62 Section 2: Pre-OPT Plus Protocol

What are Anthropometry Training and Standardization
Exercises?

ANTHROPOMETRY TRAINING is an activity that aims to strengthen the OPT Plus Team’s
knowledge and skills on the use, maintenance, and calibration of tools and equipment;
procedures and precautions when taking weight and length/height measurements; and roles
of measurers and assistants. The technical staff from the regional office, P/C/MNAOs, and
D/C/MNPCs will support and coordinate the conduct of the Anthropometry Training provided
by duly recognized training institutions.

The STANDARDIZATION EXERCISE is one of the components of the Anthropometry Training

which will enable the trainers/facilitators to directly observe the trained OPT Plus Team
members’ measurement techniques and correct any error that may lead to an inaccurate
measurement. The recorded measurements of the OPT Plus members will be subjected
to accuracy, precision, and reliability analysis which will be used as one of the bases for the
certification of participants.

SUPERVISOR’S BOX 2.2.

Training, Standardization, and Certification

As supervisors, here are 1. In the second semester of the year, do an inventory

some reminders regarding of OPT Plus team members that do not have a
training, standardization, certification. Make sure that the OPT team has
and certification of the OPT a certification before the conduct of the OPT
Plus Team: Plus. If all members have already received their
certification, conduct a refresher training on
measuring the weight, length, height, and MUAC.

2. Allot budget for regular training and standardization

in the Annual Investment Plan (AIP).

3. The certification is valid for five (5) years with

regular refresher course for updating as necessary.

Section 2: Pre-OPT Plus Protocol 63

Section 2.3

HOUSEHOLD PROFILING

Household Profile
A household profile records the health and nutrition information of families in the
barangay and is similar to the Household Profile which can be accessed through the
City/Municipal Health Office (C/MHO). Household profiling is routinely conducted
before or during the OPT Plus Anthropometric Measurement.

To accomplish the household profile, the nutrition worker should use the Household
Profile form (Annex 2.1). The nutrition worker may use the Household Profile as a
reference for completing this form. Table 2.3 shows the definition of terms used
in the household profile.

Section 2: Pre-OPT Plus Protocol 65

Table 2.3. Definition of terms used in the household profile.

TERM DEFINITION

Adolescent Household member ages 10-19 years old.

Caregiver Household member who functions as a head or guardian of children living in the
household in the absence of the mother and/or father.

Family A group of persons usually living together and composed of the head and other
persons related to the head by blood, marriage, or adoption. It includes both the
nuclear and extended family (PSA, n.d.).

Father Male head of the family with biological or adoptive relationship to the children.

Household A social unit consisting of a person living alone or a group of persons who sleep
in the same housing unit and have a common arrangement in the preparation
and consumption of food (PSA).

Indigenous People A group of people or homogenous societies identified by self-ascription and

(IP) ascription by others, who have continuously lived as organized community on
communally bounded and defined territory, and who have, under claims of
ownership since time immemorial, occupied, possessed customs, tradition and
other distinctive cultural traits, or who have, through resistance to political, social
and cultural inroads of colonization, non-indigenous religions and culture, become
historically differentiated from the majority of Filipinos (PSA).

Infant Children ages 29 days to 11 months old.

Mother Female head of the family with biological or adoptive relationship to the children.

Newborn Children ages 0-28 months old.

National Housing An information management system that identifies who and where the poor
Targeting System households in the Philippines.
(NHTS)

Pantawid Pamilyang Poverty alleviation program that aims to provide social assistance through cash
Pilipino Program grants and social development through investing in the health, nutrition, and
(4Ps) education of children from poor families (Official Gazette, n.d.).

Postpartum (PP) A woman who is in the postpartum period or the period not exceeding 6 weeks
or 90 days after giving birth.

Person with Children affected by developmental, neurologic, and genetic conditions, which
Disability may affect growth patterns and overall growth potential.

Senior Citizen Household member 60 years old and above.

Under-five Children 0-59 months old.

66 Section 2: Pre-OPT Plus Protocol

The household profile form has 34 columns that will be filled out based on the number
of household members based on age group, father and mother’s name, occupation, and
educational attainment. It also identifies pregnant mothers, couples practicing family
planning, feeding status of <6-month-old children, toilet type, water source, food production
activities, and utilization of iodized salt, iron-fortified rice, and micronutrient powder. and
should be filled out completely.

C1 - HH No. Write the control number of each household that will be

interviewed. A household is defined as an individual or
group of people living under one housing unit.

C2 - No. of families living Write the number of families living within a household.
in the house A family is a group of people living together and are
related by blood, marriage, or adoption. A family can be
nuclear composed of the father, mother, and children
living together or extended with the inclusion of kin in the
direct or indirect line of one member or members of the
nuclear family.

C3 - No. of HH member Write the total number of household members.

C4 - NHTS Household Write the code that corresponds to the household’s

inclusion in the NHTS list using the following criteria:

CODE CRITERIA DEFINITION

1 NHTS 4Ps Household listed in the NHTS

and a member of 4Ps

2 NHTS Non-4Ps Household listed in the NHTS

but not a member of 4Ps

3 Non-NHTS Not listed in the NHTS

C5 - Indigenous Group Write the code that corresponds to the household’s

membership to an IP group using the following criteria:

CODE TERM DEFINITION

1 IP Household belonging to an IP group

2 Non-IP Household not belonging to an IP

group

Section 2: Pre-OPT Plus Protocol 67

C6-C7 - Newborn (0-28 Write the total number of male (C6) and female (C7)
days) newborn babies 0-28 days old within a family.

C8-C9 - Infant Write the total number of male (C8) and female (C9)
(29 days-11 months) infants 29 days to 11 months old within a family.

C10-C11 - Under-five (1-4 Write the total number of male (C10) and female (C11)
y.o.) children 1-4 years old within a family.

C12-C13 - Children Write the total number of male (C12) and female (C13)
(5-9 y.o.) children 5-9 years old within a family.

C14-C15 - Adolescence Write the total number of male (C14) and female (C15)
(10-19 y.o.) adolescents 10-19 years old within a family.

C16 - Pregnant Write the total number of pregnant women in the family.

C17 - Adolescent Pregnant Write the number of pregnant women 10-19 years old in
the family.
C18 - Postpartum (PP)
Write the number of women in the family who are in the
postpartum period or the period not exceeding 6 weeks
after giving birth.
C19 - 15-49 y.o. not
pregnant & non-PP Write the number of women in the family who are 15-49
years old and are not pregnant nor in postpartum period.
C20-C21 - Adult
(20-59 y.o.) Write the number of male (C20) and female (C21) adults
20-59 years old in the family.
C22-C23 - Senior Citizen
Write the number of male (C22) and female (C23) senior
C24-C25 - Person with citizens 20-59 years old in the family.
Disability
Write the number of male (C24) and female (C25)
C26 - Name of Father individuals in the family who has a disability.
(Fa) and Mother (Mo);
Caregiver (Ca) Write the name of the mother, father, and/or caregiver in
the family.

68 Section 2: Pre-OPT Plus Protocol

C27 - Occupation Write the code of the type of occupation that the mother,
father, and/or caregiver has using the following:

CODE CRITERIA DEFINITION

1 Manager Workers in this group plan, direct, coordinate and evaluate the overall
activities of enterprises, governments and other organizations, or
of organizational units within them, and formulate and review their
policies, laws, rules and regulations.

2 Professional Workers in this group increase the existing stock of knowledge, apply
scientisfic or artistic concepts and theories, teach about the foregoing
in a systematic manner, or engage in any combination of these
activities.

3 Technician Workers in this group perform mostly technical and related tasks
& associate connected with research and the application of scientific or artistic
professionals concepts and operational methods, and government or business
regulations.

4 Clerical support Workers in this group record, organize, store, compute and retrieve
workers information related, and perform a number of clerical duties in
connection with money-handling operations, travel arrangements,
requests for information, and appointments.

5 Service and Workers in this group provide personal and protective services related
Sales Worker to travel, housekeeping, catering, personal care, or protection against
fire and unlawful acts, or demonstrate and sell goods in wholesale
or retail shops and similar establishments, as well as at stalls and on
markets.

6 Skilled Workers in this group grow and harvest field or tree and shrub crops,
Agricultural, gather wild fruits and plants, breed, tend or hunt animals, produce a
forestry, and variety of animal husbandry products, cultivate, conserve and exploit
fishery workers forests, breed or catch fish and cultivate or gather other forms of
aquatic life in order to provide food, shelter and income for themselves
and their households.

7 Craft and related Workers in this group apply specific knowledge and skills in the
trade workers fields to construct and maintain buildings, form metal, erect metal
structures, set machine tools, or make, fit, maintain and repair
machinery, equipment or tools, carry out printing work, produce or
process foodstuffs, textiles, or wooden, metal and other articles,
including handicraft goods.

Section 2: Pre-OPT Plus Protocol 69

CODE CRITERIA DEFINITION

8 Plant and Workers in this group operate and monitor industrial and agricultural
machine machinery equipment on the spot or by remote control, drive and
operators and operate trains, motor vehicles and mobile machinery and equipment,
assemblers or assemble products from component parts according to strict
specifications and procedures.

9 Elementary Occupations in this group involve the performance of simple and

occupations routine tasks which may require the use of handheld tools and
considerable physical effort.

10 Armed forces This major group includes all jobs held by members of the armed
occupations forces. Members of the armed forces are those personnel who are
currently serving in the armed forces, including auxiliary services,
whether on a voluntary or compulsory basis, and who are not free
to accept civilian employment and are subject to military discipline.
Included are members of the army, navy, air force and other military
services, as well as conscripts enrolled for military training or other
service for a specified period.

11 None

C28 - Educational Attainment

CODE CRITERIA DEFINITION

N None Have not attended school

EU Elementary undergraduate Did not graduate from elementary level

EG Elementary graduate Graduated from elementary level

HU High School Undergraduate Did not graduate from high school level

HG Highschool graduate Graduated from high school level

CU College undergraduate Did not graduate from college

CG College graduate Graduated from college

V Vocational Graduated from vocational

PG Post-Graduate Studies College graduate and undertook further study

70 Section 2: Pre-OPT Plus Protocol

C29 - Couple Practicing Put a check mark to answer “Yes” or “No”.
Family Planning

C30 - Toilet Type Write the code that corresponds to the type of toilet the
household has.

CODE CRITERIA DEFINITION

1 Improved Sanitation Flush/pour flush to a piped sewer system

Flush/pour flush to septic tank
Flush/pour flush to a pit latrine
Ventilated improved pit (VIP) latrine
Pit latrine with slab
Composting toilet

2 Shared Facility Flush/pour flush to a piped sewer system

Flush/pour flush to septic tank
Flush/pour flush to a pit latrine
Ventilated improved pit (VIP) latrine
Pit latrine with slab
Composting toilet
Public toilet

3 Unimproved Facility Flush/pour flush not to sewer/septic tank/pit latrine

Pit latrine without slab/open pit
Bucket
Hanging toilet/hanging latrine
Other

4 Open Defecation No facility

Bush
Field

Section 2: Pre-OPT Plus Protocol 71

C31 - Water Source (P, W, S) Write the code that corresponds to the water source the
household has.

CODE CRITERIA DEFINITION

1 Improved Source • Piped into dwelling/yard/plot

• Piped to neighbor
• Public tap/standpipe
• Tube well/borehole
• Protected dug well
• Protected spring
• Rainwater
• Bottled water/refilling station, improved source for
cooking/handwashing (with certification)

2 Unimproved Source • Unprotected dug well

• Unprotected spring
• Tanker truck/cart with small tank
• Surface water
• Bottled water/refilling station, unimproved source for
cooking/handwashing

C32 - Food Production Write the code of the applicable means of food production
Activity (VG/PL/FP) of the family. Multiple answers may be selected.

Put a check mark to answer “Yes” or “No” depending on

C33 - HH using Iodized Salt the use of iodized salt.

C34 - HH using Iron-Fortified Put a check mark to answer “Yes” or “No” depending on
Rice the use of iron-fortified rice.

72 Section 2: Pre-OPT Plus Protocol

Section 2.4

SPOT MAPPING

Spot Map
A spot map is a visual presentation of (Google Maps), or asking for the Geographic
the barangay, where information such as Information System (GIS) barangay map from
the geographic, demographic, health, and the City/Municipal Planning Development Office
nutrition characteristics of the barangay are (C/MPDO). The spot map can be used during
indicated. Ideally, the updating of the spot presentations with the Barangay Nutrition
map is conducted during the anthropometric Committee (BNC) and Barangay General
measurement, however, this can also be done Assembly (BGA).
after the anthropometric measurement. It helps
the nutrition worker to locate target households As mentioned, there are several ways to create
with 0-59 month old children for OPT Plus. a spot map – sketch the barangay, download the
A spot map is created through sketching the map through Google Maps, or ask for the GIS.
barangay, downloading the map on the internet

Section 2: Pre-OPT Plus Protocol 73

A. SKETCH THE SPOT MAP

Here are the steps in sketching a spot map:

1. Draw the streets, pathway, and the creek/canal/drainage of the barangay by purok.

2. Estimate and draw the location of the houses, schools, churches, health center, barangay
hall, daycare centers, water pumps, water tanks, public toilets, water system, basketball
court, business establishments, fishpond, poultry, piggery, rest house, resort, small
market, and other infrastructure in the barangay.

3. Merge the maps by purok, then draw the whole barangay on clean paper.

4. After generating the map, you need to put the codes or legends on the needs and problems
of the families in the houses on the spot map similar to what is indicated in Figure 2.1.
Use the color/legend prescribed by NNC in Memorandum No. 2016-015 Dissemination
and Application of Revised Color Coding/Legend in the Preparation of Spot Maps Among
Local Government Units (Table 3). The details of the memo are shown in Annex 2.3.

Figure 2.1. Sample coded house.

74 Section 2: Pre-OPT Plus Protocol

Table 2.4. Color/Legend for the preparation of the barangay spot-map.

COLOR INTERPRETATION

Green Children with ‘normal weight/length/height’

Yellow Children with ‘underweight/stunted/wasted’

Mark with “UW” for underweight, “St” for stunted, “W” for
wasted

Red Children with “severely underweight/stunted/wasted”

Mark with “SUW” for severely underweight, “SSt” for severely
stunted, “SW” for severely wasted

Orange Children with “overweight/obese”

Mark with “OW” for overweight, “Ob” for obese

Pink With pregnant women

Violet With lactating women

Maroon Infants who were exclusively breastfed for 6 months

Purple Infants who were given complimentary food in addition to

breastmilk (starting at 6 months old)

Brown With infants 0-11 months

Blue With large family size (households with greater than 5 family
members)

Black Without potable water source

Gray Without sanitary toilets

Section 2: Pre-OPT Plus Protocol 75

B. DOWNLOAD THE MAP FROM GOOGLE MAPS

Here are the steps in creating a spot map 8. Some structures are shown on the map.
through downloading a map of the barangay Identify the structures like schools, churches,
from Google Maps: health center, barangay hall, daycare centers,
water pumps, water tanks, public toilets,
1. On your computer, sign in to My Maps or
water system, basketball court, business
https://maps.google.com/.
establishments, fishpond, poultry, piggery,
2. Open or create a map. rest house, resort, small market, and other
3. In the search bar, type the name or address infrastructure in the barangay.
of a place. 9. Identify the households on the map and add
the houses not included on the map.

10. Merge the maps by purok, then draw the

whole barangay on clean paper.

11. After generating the map, you need to put

the codes or legends on the needs and
problems of the families in the houses on
the spot map similar to what is indicated in
Figure 2.1. Use the color/legend prescribed
by NNC in Memorandum No. 2016-015
4. Click one of the results on the map. Dissemination and Application of Revised
Color Coding/Legend in the Preparation of
5. Screenshot or use the snipping tool Spot Maps Among Local Government Units
to copy the map. Then (Table 2.4).
paste (ctrl +v) and save (ctrl+s) it in the word
file. The downloaded file already shows the
roads and bodies of water like rivers and
creeks.

6. Identify the boundaries of each purok.

7. On the map, draw the pathway and other

roads not captured by the downloaded map.

76 Section 2: Pre-OPT Plus Protocol

Figure 2.2. Aerial map downloaded from Open Street Map.

Section 2: Pre-OPT Plus Protocol 77

C. GEOGRAPHIC INFORMATION SYSTEM (GIS)

Here are the steps in creating a spot map of appending geographic coordinates to
through the GIS barangay map: media based on the location of a mobile
device. It can be done through the GPS or
1. Ask the C/MPDO if they have an available
by downloading it on a smartphone.
GIS barangay map. Secure a copy if they
have it on file. The maps in the municipality 3. Merge the coordinates with the barangay
are usually used for disaster risk mapping. shape file and encode the household and
children’s profiles in the table attributes.
2. To locate the houses, get the coordinates
of the houses (latitude and longitude) called 4. Generate the map per indicator as prescribed
geotagging. Geotagging is the process in Table 1.

Figure 2.3. Sample GIS barangay map from C/MPDO.

78 Section 2: Pre-OPT Plus Protocol

Section 2.5

CALIBRATION AND
VERIFICATION OF WEIGHING
TOOLS AND EQUIPMENT

What is Calibration?
Calibration is the comparison of two instruments or measuring devices, one of which
is a standard of known accuracy traceable to national standards, to detect, correlate,
or eliminate by adjustment any discrepancy in accuracy of the instrument or
measuring device being compared with the standard (NIST, USA). A weighing scale’s
performance eventually degrades as it ages and undergoes mechanical stress. Once
this happens, the weight measurement that can be obtained may be inaccurate. For
OPT Plus, calibration is recommended every three years to ensure that the weighing
scale remains functional and reliable.

Section 2: Pre-OPT Plus Protocol 79

MATERIALS NEEDED FOR WEIGHING SCALE
CALIBRATION OR VERIFICATION

1. One (1) 5 kg and two (2) 10 kg calibrated

standard weights

2. Weighing Scale Calibration and Verification

worksheet (Annex 2.8)
Figure 2.4. Calibrated Standard Weights.

How to calibrate weighing scales?

TESTS FOR THE CALIBRATION OF WEIGHING SCALES

1. Departure from Nominal Value Test. Tests whether the weighing scale reading is consistent and
accurate at different points (i.e., 5, 10, 15, 20, and 25 kg).

2. Repeatability Test. Ensures that the weighing scale provides consistent and accurate readings after
repeated measurements.

3. Effect Off-Center Loading/Eccentric Test. Determines if the weighing scale reading is consistent and
accurate if test weight is placed on different points in the weighing scale. This test is applicable with
platform scales only.

STEPS IN CALIBRATING WEIGHING SCALES

Step 1. Fill out the information part of the calibration/verification form for documentation.

Using the Weighing Scale Calibration and Verification Form Record (Annex 2.8), record all the pertinent
information about the weighing scale to be verified or calibrated located at the upper section of the
form. Once filled out, proceed to the next step.

80 Section 2: Pre-OPT Plus Protocol

Step 2. Conduct Pre-loading

Before starting the calibration, pre-load the weighing scale by placing or hanging a 20-kg standard
weight for three (3) minutes. This procedure “warms up” the instrument before the actual calibration.
After removing the test weight, check if the dial has returned to zero. Otherwise, the weighing scale is
suggested to be repaired or replaced.

Figure 2.5. Pre-loading. Figure 2.6. Testing if the scale

goes back to zero.

Step 3. Conduct Departure from Nominal Value Test

1. Tare the weighing scale to 0.0 kg.

2. Prepare 5, 10, 15, 20, and 25 kg standard weights

3. Get the Conventional Mass Value (CMV) found in the Calibration Certificate of the standard weights.
The CMV in the sample shown in Figure 2.7 is 120 mg.

Figure 2.7. Sample calibration certificate with CMV.

Section 2: Pre-OPT Plus Protocol 81

4. Start weighing the 5 kg standard weight, followed by 10 kg until 25 kg. This is Trial 1.

5. Repeat weighing until Trial 3.

Figure 2.8. Hanging of 5 kg, 10 kg, 15 kg, 20 kg and 25kg

weights for Departure from Nominal Value Test.

82 Section 2: Pre-OPT Plus Protocol

Step 4. Conduct Repeatability Test.

1. Tare the weighing scale to 0.0 kg.

For hanging weighing scale, ensure that the rope

that will be used to hang the 20 kg standard weight
is attached to the hook. Tie the rope securely
around the handle of the standard weight.

2. Load the 20 kg standard weight and record the

weight measurement in the verification form. This
is Trial 1.

3. Tare the scale to 0.0 kg before proceeding to Trial 2.

4. Load then unload the standard weight until Trial 10.

For platform scales, follow steps 1 to 5.

Step 5. Conduct Effect Off-Center Loading/Eccentric Test.

1. Tare the weighing scale to 0.0 kg.

2. Apply the 10 kg test weight starting at position 1 and record in the verification sheet.

3. Proceed to position 2 until position 5.

4. Repeat weight measurement at position 1.

Section 2: Pre-OPT Plus Protocol 83

Step 6. Encode the collected data in the Weighing Scale Verification Tool and
interpret results.

The Weighing Scale Verification Tool will automatically generate the calibration results.
To determine if the weighing scale can be considered “Calibrated” or fit for use, check
the Correction column found in the Departure from Nominal Value Test. If any of the
rows appear in red, the weighing scale should be replaced or repaired. Otherwise, the
weighing scale is fit for use.

Fit for use:

For replacement or repair:

Step 7. Attach Calibration Sticker.

Fill out the calibration sticker (Figure 2.9) and attach it at the back of the weighing scale
(Figure 2.10). Calibration is valid for three (3) years.

Figure 2.9. Sample Calibration sticker. Figure 2.10. Calibration sticker attached at the
back of the weighing scale.

84 Section 2: Pre-OPT Plus Protocol

What is Verification?
Verification or intermediate check is done in between regular calibration and is done more
frequently. For OPT Plus, verification of weighing scales is recommended every year before
the next calibration. This process ensures that operational stability and calibration status is
maintained at tolerable limits. To perform verification, calibration records and information
of the weighing scale should be available. If none is available, an initial calibration should
first be conducted. The verification process follows the Scale Value Check Procedure
(Source: NATA Technical Note 13: User Checks and Maintenance of Laboratory Balances).

VERIFICATION PROCESS

1. Tare the weighing scale to 0.0 kg (z1)

2. Load the 20 kg standard weight onto the

scale (M) and record the weight reading
(m1).

3. Remove the standard weight. Do not tare

the weighing scale to 0.0 kg.

4. Load the standard weight again and record

the weight reading (m2).

5. Unload the standard weight and record the

weight reading (z2).

6. Encode the weight measurements in the

Weighing Scale Calibration and Verification
Tool and interpret the results.

The Weighing Scale Verification Tool will automatically generate the verification results.
To determine if the weighing scale can be considered as functional or fit for use, check
the Decision found in the Verification column which could state “fit for use” or “not fit for
use.”

Section 2: Pre-OPT Plus Protocol 85

Fit for use: Not fit for use:

7. Attach the Verification Sticker. Fill the sticker with pertinent information. Verification
should be done annually.

Figure 2.11. Sample Verification sticker. Figure 2.12. Verification sticker attached at the
back of the weighing scale.

86 Section 2: Pre-OPT Plus Protocol

NOTE: Weighing Scale Calibration and Verification Form/Tool

The Weighing Scale Calibration and Verification Form/Tool should be used when
performing calibration and verification. Sample of the form/tool can be seen Annex 2.8.
It can also be accessed at the NNC website (https://nnc.gov.ph/).

NOTE: Standard Weights

The OPT Plus Team may request the purchase of standard weights. If this is not
possible, the OPT Plus Team may request the use of standard weights from the City/
Municipal Treasurer’s Office.

Section 2: Pre-OPT Plus Protocol 87

Section 2.6

VERIFICATION OF LENGTH/
HEIGHT TOOLS AND
EQUIPMENT

VERIFICATION OF LENGTH AND HEIGHT BOARDS

The purpose of this section is to provide maintenance and verification guidelines that
can be used to ensure the reliability and long-term use of height/length measuring
equipment. Before a length or height board can be used, verification should be done
by trained personnel (passed the Competency Training on Verification). The points to
be checked should include:

1. Correct placement and attachment of the steel rule;

2. Zero placement of the steel rule at the base;
3. Dimension of the board and parts;
4. Quality of materials used;
5. Perpendicularity of base/footboard and headpiece against the beam;
6. Functionality and integrity of the unit; and
7. Correction factor, if any.

Section 2: Pre-OPT Plus Protocol 89

The height board should be verified upon installation and yearly thereafter in a well-lit and
controlled temperature room. A verified length/height board is one with a sticker of verification
issued and posted at the upper right corner of the board. The certificate shall contain the
verification date, name, and signature of the person who verified and agency/institution, steel
rule serial number (which will serve as unit number), and correction factor, if any.

Materials needed for height board verification

1. 1.5M calibrated steel ruler

2. Paper
3. L-square angle ruler
4. Leveling tool
5. Magnifying glass
6. Length/Height Board Verification Sheet (Annex 2.7)

Figure 2.13. A calibrated Figure 2.14. An L-square Figure 2.15. A magnifying

steel ruler. angle ruler. glass.

NOTE: Calibration

Before verification, the length/height board should already be calibrated by the

Department of Science and Technology (DOST) and has a visible calibration sticker
on its back or side.

90 Section 2: Pre-OPT Plus Protocol

Care for measuring equipment

1. Practice hand hygiene whenever conducting measurement activities.

2. Clean and disinfect measuring equipment before and after use/transporting.
3. Store equipment at normal indoor temperature protected from extreme temperatures
and humidity.

STEPS IN LENGTH AND HEIGHT BOARD VERIFICATIONS

Step 1. Fill out the information part of the verification sheet for documentation (Annex
2.7).

a. Date and place of verification

b. Name of the verifier
c. Type of height/length board, model, date of acquisition, serial/code number

Step 2. Start with a visual inspection of the equipment.

a. Check that the joints are tight and straight. If not, tighten or straighten them.
b. Check that the board can stand on its own and stay straight when rested on the wall or
laid on a flat surface. You may also use a leveling tool to check if the board is flat.
c. Check that the lines of the steel ruler can still be read. Replace it if it is too worn out to
be read.
d. Check for other damages–chipped parts, needs repainting, immovable or loose head
board, etc. If it has any, it must be repaired or replaced immediately.

Figure 2.16. Visual inspection of length/height board.

Section 2: Pre-OPT Plus Protocol 91

Step 3. Measure in three trials the width and thickness of the different parts of the
length/height board using the calibrated steel ruler.

a. Headboard – left corner, right corner, center

b. Foot board – left corner, right corner, center
c. Body – top, center, bottom

Step 4. Check the squareness of the headboard and footboard.

Using the L-square angle ruler, measure the space using a calibrated steel ruler. In assessing
the squareness, the space should not be >0.2 cm.

Figure 2.17. Checking the squareness of headboard and

footboard using L-square angle ruler.

92 Section 2: Pre-OPT Plus Protocol

Step 5. Check calibration of the 10 verification points.

Check calibration of the 10 verification points (every 10 cm) of the measuring steel rod of the
board, do this for three trials. The 10 verification points of Trial 1 should be done first before
Trial 2, and so on.

a. Lay the length/height board on a stable and flat table. Place the calibrated steel ruler in
line with the measuring steel rod of the board resting firmly on the foot board and should
not be moved until the next trial.

b. Looking at the measuring steel rod of the board, read the measurement that aligns with
the verification point in the calibrated steel ruler, select the nearest 0.1 cm. Record the
measurement in the worksheet under Trial 1.

Figure 2.18. Conducting check calibration of the 10 verification

points.

Section 2: Pre-OPT Plus Protocol 93

c. Use magnifying glass and flashlight to aid in reading the measurements.

Figure 2.19. Using magnifying glass and flashlight while

reading measurements.

d. Remove the calibrated steel ruler only after the 10th verification point of Trial 1 and repeat
the steps until the third trial.

e. Get the difference between the verification point and the average of the three readings.
The allowable error is +/- 2mm or +/- 0.2 cm.

f. If the height/length board reads outside the acceptable allowable error, adjust
measurements accordingly when using the board until fixed or replaced.

Step 6. Encode the collected measurements in the Length/Height Board Verification

Tool and interpret results.

Once all the measurements have been encoded, the Length/Height Board Verification Tool will
automatically display the results. If at least one of the rows under the Error column displays
“Not Acceptable,” then the length/height board is recommended for repair or replacement.
Otherwise, it is fit for use.

94 Section 2: Pre-OPT Plus Protocol

Fit for use:

Not fit for use:

Section 2: Pre-OPT Plus Protocol 95

Step 7. Attach a Verification sticker to the length/height board.

Write down the information needed on the verification sticker and attach it at the back of the
board. Verification should be repeated annually.

Figure 2.20. Verification sticker attached at the back of the height board.

NOTE: Calibration and Verification

Use instructional video available at NNC website (https://nnc.gov.ph/). Only trained

personnel are allowed to conduct calibration and verification of measuring tools and
equipment.

96 Section 2: Pre-OPT Plus Protocol

Section 2.7

STANDARDIZATION EXERCISE

To assure that all OPT Plus Teams are accurate, ACCURACY is the degree to which the
precise, and reliable in measuring weight, length, measurement is close to the “true” value. The
height, and MUAC standardization test will be measurements made by the supervisors can be
conducted. The purpose of the standardization considered as the true value.
test is to evaluate the accuracy, precision, and
reliability of the measurements taken by each PRECISION refers to how close the different
pair of measurers. weight measurements are to each other when
weighing a subject. The size of the variation
between repeated measurements is calculated
to assess precision.

RELIABILITY is the consistency or the ability to

repeat measurement under the same condition.

Section 2: Pre-OPT Plus Protocol 97

PREPARATION OF EQUIPMENT, SUPPLIES AND FORMS

Equipment needed: Supplies needed:

• 5 verified hanging weighing scale • 1 scissor

• 5 verified length/height board • 1 permanent marker
• 5 MUAC tape • 10 pencils
• 1 computer/laptop with ENA SMART • 10 small clipboard
software or application (can be downloaded
from this site: https://smartmethodology.
org/survey-planning-tools/smart-emergen
cy-nutrition-assessment/?doing_wp_cron=1
657333343.8602769374847412109375)

Forms needed:

• Sheets of sticker paper cut into four (4) for the tags of the 15 children

Child Assigned
number measurement

1MC 2MC 3MC 4MC 5MC

1LH 2LH 3LH 4LH 5LH
1W 2W 3W 4W 5W
MC - MUAC LH - Length/Height W - Weight

98 Section 2: Pre-OPT Plus Protocol

• Sheets of sticker paper cut into 4 for the tags of participants (depending on the number
of participants)

SRM SRA 1M 1A 2M 2A
3M 3A 4M 4A 5M 5A
SRM - Supervisor Measurer M - Measurer
SRA - Supervisor Assistant A - Assistant Number of Classification of
pair trainer trainer (measurer
or assistant)

• 5 pieces of Pink Form 1 for all Measurers • 5 pieces of Blue Form 1 for all Measurers
(i.e., 1M, 2M, 3M, etc.) and 5 pieces of Pink (i.e., 1M, 2M, 3M, etc.) and 5 pieces of Blue
Form 2 for all Assistants (i.e., 1A, 2A, 3A, Form 2 for all Assistants (i.e., 1A, 2A, 3A,
etc.) etc.)

• 5 pieces of Yellow Form 2 for all Assistants • 5 pieces of White Form 1 for all Measurers
(i.e., 1A, 2A, 3A, etc.) and 5 pieces of Yellow (i.e., 1M, 2M, 3M, etc.) and 5 pieces of
Form 2 for all Assistants (i.e., 1A, 2A, 3A, White Form 2 for all Assistants (i.e., 1A, 2A,
etc.) 3A, etc.)

Section 2: Pre-OPT Plus Protocol 99

• In case there is no available colored paper, use forms with different shapes to avoid
confusion.

• 15 pieces informed consent form (Attachment 6)

METHODOLOGY

1. Invite children to participate in the standardization exercise.

The total number of children needed for the standardization exercise is 15. There should
be six (6) 6-23-month-old and nine (9) 24-59-month-old children as shown in Table 1. Do not
forget to inform the parents that their child will be measured at least 20 times (weight, length/
height, or MUAC).

100 Section 2: Pre-OPT Plus Protocol

Table 2.5. Number of children needed per age group, nutrition assessment type, and
coding procedure.

AGE GROUP WEIGHT LENGTH/HEIGHT MUAC TOTAL

2 2 2
6-23 months 6
Code: 1W, 2W 1LH, 2LH 1MC, 2MC

3 3 3
24-59 months 9
Code: 3W, 4W, 5W 3LH, 4LH, 5LH 3MC, 4MC, 5MC

TOTAL 5 5 5 15

2. Setting up the training venue 5. Ensuring set-up for the standardization

activity (as presented in Figure 2.21).
Conduct the standardization test in a covered
multi-purpose hall/covered court to ensure social There will be three stations and two tables:
distancing. • Station 1 for hanging weighing scale (weight-
HS);
3. Obtaining of informed consent • Station 2 for length board/infantometer (0-23
months) or height board (24-59 months)
Following the principles of informed consent, • Station 3 for MUAC and edema
each guardian will be briefed on the purpose, • Table 1 for registration of children with their
benefits, risk, and confidentiality of the exercise parents/caregivers
prior to obtaining their consent to participate • Table 2 for the computer/laptop where the
(Annex 2.2). encoder will be stationed.

4. Ensuring the househould profile of each

guardian is available.

The household profile, which summarizes the

demographic, health, and nutrition information of
the household, will be confidential as stipulated
in the Data Privacy Act of 2012.

Section 2: Pre-OPT Plus Protocol 101

Figure 2.21. Initial set–up and flow of the standardization activity.

5. Coding of trainees and children

Trainee

• Participants will be paired, and each pair will be coded as SR, 1, 2, 3, 4, 5, and so on,
depending on the number of trainees.
• The code on the sticker will be used to identify the pair of measurers. A document with
their names and corresponding code should be set aside.

Children

• The parent/caregiver of the children will sign the attendance sheet with the assigned code.
The children’s code is indicated in Table 2.5.
• The stickers with written codes should be attached to the children’s clothes at the back.
Make sure that the code on the sticker is the same on the attendance sheet.

102 Section 2: Pre-OPT Plus Protocol

6. Actual measurements

• Each pair will carry out the measurements in turn. In the first round, one will be assigned
as measurer (Measurer M) while the other will be assigned as a recorder or assistant
measurer (Measurer A).

• The supervisor and each pair of measurers will be assigned first to a station in the initial
set-up (Figure 2.21). Likewise, each of the five (5) children will be assigned to station 1.

• The supervisor and each pair of measurers will be given color-coded form based on their
assigned stations to record the measurers’ code, child’s code, and measurement (weight-
HS; length/height-LH; and MUAC-MC). Since two (2) measurements per child will be
needed for the activity, each piece of form was numbered 1 or 2. Form 1 is for the
measurements of Measurer M while form 2 is for the measurements of Measurer A.
Each measurer will need five (5) pieces of colored-coded form 1, while the assistants will
need five (5) pieces color-coded form 2 (Figure 2.22).

Figure 2.22. Color-coded forms are used to record the

measurements of children.

Section 2: Pre-OPT Plus Protocol 103

• The activity will commence when the supervisor pair, measurer pair 1, measurer pair
2, and measurer pair 3 measured the child on their assigned station and recorded the
measurement in the assigned form.

• The recorder will submit all the accomplished forms to the encoder.

• All the measurers will then transfer to the next station assigned to them until they
complete the first measurement of each of the five (5) children’s weight, length or
height, and MUAC.

Note: These procedures will be repeated to get the second measurements of these 15
children. For this round, the recorder or assistant measurer (Measurer A) will become
the measurer, while the original measurer (Measurer M) will become the recorder or
assistant measurer.

Data Entry and Analysis

The data for each measurement will be encoded in the Training Screen of the SMART ENA
software version 2020. The data will be analyzed in this software following the methods
defined by Ulijaszek and Kerr (1999) and used in the training of the anthropometrists for
the WHO Multicentre Growth Reference Study (MGRS) for Child Growth Standards.

The analyses are more rigorous compared with the older procedures which used
acceptable measures based on two thresholds:

1. PRECISION: <2 times the precision value of the supervisor.

2. ACCURACY: <3 times the precision value of the supervisor. This older procedure is
not the standard method used by anthropometrists and the results are not presented
in recognizable units. In addition, the interpretation of the standardization test results
is compromised if the supervisor is not a competent anthropometrist. The results
of the standardization test were carried out on survey enumerators to assess their
capacity to take accurate and precise measurements.

104 Section 2: Pre-OPT Plus Protocol

Figure 2.23. Screenshots of Training Screen.

As shown in Figure 2.23 (number 1), both numeric continuous data (i.e., weight, height, and
MUAC) and categorical data (e.g., yes/no, green/yellow/red for MUAC, etc.) can be entered
and analyzed. Different analyses are performed and different types of reports are generated
depending on the type of data.

Data collected during the standardization should be entered in the ENA training tab. The
measurement values of 100 subjects from 20 enumerators and 1 supervisor can be entered at
a time.

The height and weight data are entered in 0.1 cm and 0.1 kg respectively, While MUAC data
must always be entered in millimeters (mm). Make sure you entered the right values and unit
of measurement to avoid generating wrong data.

Section 2: Pre-OPT Plus Protocol 105

The standardization test report consists of 1) descriptive results; 2) precision report; and 3) accuracy
report (Table 2.6). The descriptive results consist of: a) mean value of all measurements of 10 children
measured twice; b) standard deviation of each pair of measurer; and c) the largest difference between
two measurements (i.e., Max). There are three (3) indicators for precision including: a) Technical Error
of Measurement (TEM); b) % TEM; and c) R or Coefficient of Reliability. Lastly, the two (2) outputs of
accuracy include bias from supervisor and bias from median.

Table 2.6. Components of standardization test report.

REPORT OUTPUT

• Mean
1. Descriptive • Standard Deviation
• Max

• Technical Error of Measurement (TEM)

2. Precision • % TEM
• R or Coefficient of Reliability.

• Bias from supervisor

3. Accuracy
• Bias from median

ANALYSIS OF PRECISION

a. Technical Error of Measurement (TEM). This reflects the mistakes that the pairs
made between their 1st and 2nd measurements. It is computed using the following
formula:

where D is the difference between the 1st and 2nd measurements.

The analysis will be done at each pair and on the team level and the following cut-off
points were used for the acceptability of measurements (Table 2.7).

Table 2.7. Suggested cut-off points for acceptability of measurements using TEM.

PARAMETER CATEGORIES WEIGHT, KG PARAMETER CATEGORIES WEIGHT, KG

Pair good <0.04 good <0.10

Team TEM
TEM acceptable <0.10 acceptable <0.21
(intra+inter)
poor <0.21 poor <0.24
and Total
(intra)
reject >0.21 reject >0.24

106 Section 2: Pre-OPT Plus Protocol

In the results of the standardization c. Coefficient of Reliability (R). This
test, enumerator (ENUM) as used in the indicator shows the % of natural variation
standardization test is also called a pair. There between measured children (of different
were five (5) results using TEM; 1) pair inter 1st; sizes) in recognition that not all variation
2) pair inter 2nd; 3) inter pair + sup; 4) TOTAL in measurements is due to enumerator
intra+inter; and 5) TOTAL + sup. mistakes. This is the most widely used
measure of precision in population studies.
In pair inter 1st, the measurements between To interpret: using the scale of 0-1, where
enumerators in their 1st round of measurements 1=perfect, if R=0.70, then this means that
were compared while in pair inter 2nd the 70% of variance in measurement is due
comparison between enumerators was on to actual differences in size of children, but
their 2nd round of measurements. In inter pair 30% of variance in measurement is due to
+ sup, the measurements between everyone enumerator measurement error. The cut-off
who measured including the supervisor (pair points used for acceptable measurements
+ supervisor) were compared. In TOTAL are as follow:
intra+inter, the comparison was between each
enumerator/pair to themself, plus comparison
CATEGORIES %
between enumerators or pairs. Lastly, in TOTAL
+ sup, this is similar with TOTAL intra+inter Good >99
but this time the supervisor was included. Acceptable >95
Individual TEM (pair inter 1st or pair inter 2nd)
is the most important measure of precision but Poor >90

the team TEM analysis (inter pair + sup, TOTAL Reject <90
+ sup, or TOTAL intra+inter) gives an indication
of consistency of measurements within and
between all the enumerators/pairs.

b. % TEM. This is a unit-less measurement

which shows the relative mistake as a
percent of the whole measurement size
and appropriate for comparing error across
populations. This is computed by using the
following formula:

(TEM/mean measurement) x 100%

Section 2: Pre-OPT Plus Protocol 107

ANALYSIS OF ACCURACY

As previously mentioned, the first output of Tables 2.8a and 2.8b show two examples of
accuracy is the bias from supervisor or the the results of standardization test for weight
difference between the mean of supervisor and measurement. Using the digital flat scale, all
the mean of enumerator/pair. On the other hand, measurers passed the test in terms of accuracy
bias from median is the difference from median and precision. However, using the hanging
of all measurers and mean of enumerator/pair or weighing scale, the supervisor’s TEM was poor
supervisor. hence the outcome from median should be
used for the analysis of accuracy. The results
If the supervisor has good or acceptable showed that all measurers were precise based
precision as measured by TEM, then bias from on coefficient of reliability but measurers pair 1
supervisor is used. This means that individual/ and pair 6 were precise but not accurate.
pair results are compared to the supervisor.
However, if the supervisor’s TEM is poor, then
the bias from median should be used. When this
is used, the individual/pair results are compared
to the median of the group. The cut-off points for
acceptable measurements are as follows:

CATEGORIES WEIGHT, KG
What do we want?
Good <0.04 The aim of the standardization exercises is to
produce skilled OPT Plus measurers capable
Acceptable <0.10
of obtaining and recording accurate, precise,
Poor <0.21 and reliable anthropometric measurements of
Reject >0.21 children.

108 Section 2: Pre-OPT Plus Protocol

Table 2.8a. Standardization Test of weight measurement using digital flat scale.

Section 2: Pre-OPT Plus Protocol

Table 2.8b. Initial standardization test of weight measurement using Hanging Weighing Scale.

Reference:
Standardization Test: Interpretation of Results under SMART Capacity Building Toolbox downloaded from https://smartmethodology.org/
survey-planning-tools/smart-capacity-building-toolbox/ on 12 January 2022

109
REFERENCES

Cashin, K. and Oot, L. (2018). Guide to Anthropometry: A Practical Tool for Program Planners, Managers,
and Implementers. Washington, DC: Food and Nutrition Technical Assistance III Project (FANTA)/
FHI 360

SMART Methodology. 2023. ENA (Emergency Nutrition Assessment) software. https://

smartmethodology.org/survey-planning-tools/smart-emergency-nutrition-assessment/

NATA Technical Note 13:2010 – User Checks and Maintenance of Laboratory Balances

NNC, UPLB, IHNF. 2011. Trainer’s Manual on Basic Course for the Barangay Nutrition Scholars.

Official Gazette. (n.d.). Pantawid Pamilyang Pilipino Program. Official Gazette Website. Retrieved from
https://www.officialgazette.gov.ph/programs/conditional-cash-transfer/.

Philippine Statistics Authority. (n.d.) Official Concepts and Definitions. Retrieved from https://psa.gov.ph/
ISSiP/concepts-and-definitions.

USAID. (2019). Best Practices for Quality Anthropometry Data Collection at the DHS Program. US: ICF.

World Health Organization. 2019. Recommendations for data collection, analysis, and reporting on
anthropometric indicators in children under 5 years old. Geneva: World Health Organization and
the United Nations Children’s Fund (UNICEF). License: CC BY-NC-SA 3.0 IGO.

110 Section 2: Pre-OPT Plus Protocol

LIST OF ANNEXES

ANNEX 2.1 Household Profile Format

ANNEX 2.2 Standardization Exercise Informed Consent

ANNEX 2.3 NNC Memorandum No. 2016-015, Series 2016 Revised Color Coding/Legend for
the Preparation of Spot Map

ANNEX 2.4 NNC GB Resolution No. ______ Approving the Guidelines on the selection of
weighing scales

ANNEX 2.5 NNC GB Resolution No. 3 s.2012 Approving the Guidelines on the Fabrication,
Verification, and Maintenance of Wooden Height Boards

ANNEX 2.6 NNC GB Resolution No. 3 s.2018 Approving the Guidelines on the selection of non-
wood height and length measuring tool

ANNEX 2.7 Length/Height Board Verification Form

ANNEX 2.8 Weighing Scale Calibration and Verification Form

Section 2: Pre-OPT Plus Protocol 111

ANNEX 2.1. Household Profile Format

112 Section 2: Pre-OPT Plus Protocol

ANNEX 2.2. Standardization Exercise Informed Consent

Standardization Exercise Informed Consent Form

for Children and Parent/Caregiver

This informed consent form is for the Standardization Exercises which is a prerequisite for
the certification of the OPT Plus Team.

PART I: INFORMATION SHEET

1. Introduction
I am ___________, a member of the OPT Plus Team. As part of the training, members of the
OPT Plus Team including the supervisors, BNS, BHW etc. are expected to participate in the
standardization exercise as measurers and assistants in the measurement of the weight,
length, height, MUAC, and checking of the severity of the bilateral pitting edema. The data
gathered through this activity will be used to check the proper techniques, correct errors
that may lead to inaccurate measurement, and ensure that the data collected during the
OPT Plus are accurate, precise, and reliable. We would like to invite you to participate in
this activity. I will accommodate and answer all your questions or clarifications anytime as I
introduce you to the activity. There may be some words that you do not understand. Please
ask me to stop as we go through the information, and I will take time to explain.

2. Purpose
This activity aims to: 1) standardize the skills of the OPT team, including the BNSs, BHWs,
SK members, and Barangay Kagawad; and 2) ensure that the data collected by the OPT
team are accurate, precise, and reliable.

3. Selection of Participants
Participants of the standardization exercise are 6-59-month-old children living in the
barangay or nearby barangay who will be joined by, at least, a parent/caregiver. They shall
be selected and invited based on the organizers of the training. A total of 15 pairs of
parents and children - six (6) pairs of parents and 6–23-month-old children, and nine (9) pairs
of parents and 24–59-month-old children were selected for this sampling.

4. Voluntary Participation
Participation is entirely voluntary. Willingness and approval to participate in the activity is
expressed by signing this Informed Consent Form. You may ask any question regarding the
activity. Should you opt not to participate for any reason, we assure you that you will not
be affected in any way.

Section 2: Pre-OPT Plus Protocol 113

5. Procedure
You will be requested to attend the standardization exercise according to schedule indicated
by the organizers. The activity will start by a registration and a brief interview. You and your
child will be assigned a code and a station (e.g. weight, length/height, or MUAC station).
Your child will be measured multiple times depending on the number of participants. The
activity will be supervised by the training organizers and facilitators.

6. Duration
The whole activity may take up to four (4) hours.

7. Risks and Discomforts

The activity may cause the child to feel irritated or discomfort due to repeated collection
of anthropometric measurement. Although the participants were briefed on safety
protocols, injuries due to accidents may also happen. Should you find some of the activities
uncomfortable for you or your child, you may inform the organizers and facilitators.

8. Benefits
Your participation in this study will be treated as a considerable contribution to the scant
body of knowledge on child growth monitoring and nutrition assessment in the country.

9. Confidentiality
In compliance with the Data Privacy Act of 2012 (R.A. 10173), any personal information and
responses obtained from the activity that can be identified with you will remain strictly
confidential.

10. Right to Refuse of Withdraw

You may decline or withdraw participation at any given time without any obligation or
penalty. In this case, please do inform the training facilitator before leaving the venue.

11. Contact Person

If you have further clarifications regarding the procedure, you may contact the following:

Name: ___________________________________________
Address: _________________________________________
Contact Information: _______________________________

114 Section 2: Pre-OPT Plus Protocol

PART II: CERTIFICATE OF CONSENT

Certificate of Consent

I have read and understood the procedure and implications of participating in the
standardization exercise. The questions and clarification that I have raised were answered
adequately. I hereby declare consent to participate in this activity.

__________________________________________
Signature over Printed Name of Participant

__________________________
Date

Statement of the researcher:

I have read and discussed all the details of the research and procedures to the participant. I
have also adequately answered any questions that were raised to the best of my knowledge.
I confirm that the participants were given the opportunity to ask and clarify any questions
and that the participant was not forced to participate. Participation is entirely voluntary. A
copy of the Informed Consent Form was provided to the participant.

__________________________________________
Signature over Printed Name of Facilitator

__________________________
Date

Section 2: Pre-OPT Plus Protocol 115

ANNEX 2.3. NNC Memorandum No. 2016-015, Series 2016 Revised Color Coding/Legend
for the Preparation of Spot Map

116 Section 2: Pre-OPT Plus Protocol

ANNEX 2.4. NNC GB Resolution No. ______ Approving the Guidelines on the selection of
weighing scales

Section 2: Pre-OPT Plus Protocol 117

ANNEX 2.5. NNC GB Resolution No. 3 s.2012 Approving the Guidelines on the Fabrication,
Verification, and Maintenance of Wooden Height Boards

118 Section 2: Pre-OPT Plus Protocol

Section 2: Pre-OPT Plus Protocol 119
120 Section 2: Pre-OPT Plus Protocol
Section 2: Pre-OPT Plus Protocol 121
122 Section 2: Pre-OPT Plus Protocol
Section 2: Pre-OPT Plus Protocol 123
124 Section 2: Pre-OPT Plus Protocol
Section 2: Pre-OPT Plus Protocol 125
126 Section 2: Pre-OPT Plus Protocol
ANNEX 2.6. NNC GB Resolution No. 3 s.2018 Approving the Guidelines on the selection of
non-wood height and length measuring tool

Section 2: Pre-OPT Plus Protocol 127

128 Section 2: Pre-OPT Plus Protocol
Section 2: Pre-OPT Plus Protocol 129
ANNEX 2.7. Length/Height Board Verification Form

130 Section 2: Pre-OPT Plus Protocol

ANNEX 2.8. Weighing Scale Calibration and Verification Form

Section 2: Pre-OPT Plus Protocol 131

Section Three

OPT PLUS PROTOCOL

ON ANTHROPOMETRIC
MEASUREMENT
OPT PLUS PROTOCOL
ON ANTHROPOMETRIC
MEASUREMENT
OVERVIEW

The general objective of this section is to provide information on

the proper measurement of weight, length, height, and MUAC.
After reading this section, one should be able to:

1. Properly measure the weight of 0-to-59-month-old children using the appropriate

weighing scale;
2. Properly measure the recumbent length of the 0-to-23-month-old children;
3. Properly measure the height of 24-to-59-month-old children;
4. Properly measure the MUAC of 6-to-59-month-old children;
5. Properly check for and classify severity of bilateral pitting edema;
6. Properly record the weight, length, height, and MUAC measurements; and
7. Provide immediate feedback to parents/caregivers and refer malnourished children to
relevant rural health offices for appropriate interventions.

Section 3 covers how to get the weight and height using the
recommended anthropometric tools. This section includes the following:
Section 3.1 Roles and Responsibilities of OPT Plus Team and Supervisors
Section 3.2 General Reminders in Taking Anthropometric Measurements
Section 3.3 Instruction on How to Weigh the 0-to-59-month-old Children
Section 3.4 Instructions on Measuring the Length of the 0-to-23-month-old Children
Section 3.5 Instructions on Measuring the Height of the 24-to-59-month-old Children
Section 3.6 Instruction on How to Measure MUAC of 6-to-59-month-old Children
Section 3.7 Instructions on How to Check and Classify Severity of Bilateral Pitting Edema
Section 3.8 OPT Plus Referral
Section 3.9 WHO Child Growth Standards (CGS)

Section 3: OPT Plus Protocol on Anthropometric Measurement 135

LIST OF TABLES

Table 3.1 Roles and Functions of the different persons involved in the OPT Plus during the
OPT Plus Anthropometric Measurement.

Table 3.2 Grades of bilateral pitting edema.

Table 3.3 Z-score cutoff points for classifying nutritional status using L/HFA, WFA, and WFL/H
indicators (FANTA, 2018; WHO, 2008b).

Table 3.4 MUAC cut-off points and classification.

Section 3: OPT Plus Protocol on Anthropometric Measurement 137

LIST OF FIGURES

Figure 3.1 Correct and incorrect ways of writing numbers.

Figure 3.2 Illustration on proper positioning of the child in the hanging weighing scale.

Figure 3.3 Illustration on how to read the weight using hanging

weighing scale.

Figure 3.4 Illustration on getting the weight of the child using digital platform.

Figure 3.5 Illustration on how to position the child in the length board.

Figure 3.6 Illustration on how to position the child in the height board.

Figure 3.7 Illustration on how to get the midpoint between the shoulder and elbow.

Figure 3.8 Images of Bilateral Pitting Edema.

Figure 3.9 OPT Plus Referral Form.

Figure 3.10 Triangle chart as an aid in identifying possible causes of malnutrition per child.

Figure 3.11 Illustrations of different forms of malnutrition.

138 Section 3: OPT Plus Protocol on Anthropometric Measurement

LIST OF ACRONYMS

AO Administrative Order
BHC Barangay Health Center
BHS Barangay Health Station
BNAP Barangay Nutrition Action Plan
BNC Barangay Nutrition Committee
C/MNAO City/Municipal Nutrition Action Officer
C/MSWD City/Municipal Social Welfare and Development
cm centimeter
CRPD Convention on the Rights of Persons with Disabilities
DOH Department of Health
eOPT Plus Electronic Operation Timbang Plus
FANTA Food and Nutrition Technical Assistance III
FAO Food and Agriculture Organization of the United Nations
GMP Growth Monitoring and Promotion
HB Height Board
kg kilogram
L/HFA Length/Height-for-Age
LFA Length-for-Age
LGU Local Government Unit
HFA Height-for-Age
MW/MAM Moderately Wasted/Moderate Acute Malnutrition
MUAC Mid-Upper Arm Circumference
MUW Moderately Underweight
MW Moderately Wasted
NNC National Nutrition Council
NNC CO National Nutrition Council Central Office
PNAO Provincial Nutrition Action Officer
RHU Rural Health Unit
RNPC Regional Nutrition Program Coordinator

Section 3: OPT Plus Protocol on Anthropometric Measurement 139

SW/SAM Severely Wasted/Severe Acute Malnutrition
SUW Severely Underweight
SW Severely Wasted
TWG-CGS Technical Working Group on Child Growth Standards
WFA Weight-for-Age
WFH Weight-for-Height
WFL Weight-for-Length
WHO World Health Organization
WHO-CGS World Health Organization Child Growth Standards

140 Section 3: OPT Plus Protocol on Anthropometric Measurement

DEFINITION OF TERMS

Disability (Children with Children affected by developmental, neurologic, and genetic

Special Conditions/ conditions, which may affect growth patterns and overall growth
Needs) potential.

Bilateral Pitting Edema A clinical sign of severe malnutrition that makes feet, legs, arms,
hands, and/or face appear swollen or puffed up due to severe muscle
wasting.

eOPT Plus Tool An excel-based tool used by nutrition workers in the community to
help them consolidate and summarize the results of OPT Plus
among 0-to-59-month-old children.

Length/Height- An indicator used to classify stunting among children 0-59 months old.
for-Age (LFA)

OPT Plus Regular growth assessment of all 0-to-59-month-old children in the

barangay, done by the trained team and involves planning, follow-up,
and data quality check.

Tare Adjusting/resetting the equipment’s display to zero.

Triangle Chart It is a simplified and comprehensive pictorial flow chart to identify the
root causes of malnutrition in each child.

Weight-for-Age (WFA) An indicator used to classify underweight among 0-to-59-monthold

children.

Weight-for-Length/ An indicator used to classify wasting and overweight and obesity

Height (WFL/H) among 0-to-59-month-old children.

WHO Child Growth Represents how children should grow through globally accepted
Standards (WHO-CGS) prescriptive measures considered normal growth for all 0-to-59-
month-old children.

Section 3: OPT Plus Protocol on Anthropometric Measurement 141

Section 3.1

ROLES AND RESPONSIBILITIES

OF OPT PLUS TEAM AND
SUPERVISORS

One of the main activities in the OPT Plus is the collection of the anthropometric
measurements of 0-to-59-month-old children. Anthropometric measurement is a non-
invasive quantitative measurement of the body useful in assessing the nutritional status
of both adults and children. Several activities are conducted during this activity including
the actual measurements of weight, length, height, and MUAC, checking the severity
of bilateral pitting edema, and referral for the identified malnourished children. Table 3.1
shows the roles and functions of the different persons involved during the OPT Plus
Anthropometric Measurement.

Section 3: OPT Plus Protocol on Anthropometric Measurement 143

Table 3.1. Roles and Functions of the different persons involved in the OPT Plus during the OPT Plus
Anthropometric Measurement.

ORGANIZATION/
FUNCTION
PERSON INVOLVED

National Nutrition 1. Monitor the status of the OPT Plus activity at the national level.
Council Central Office
(NNC CO)

National Nutrition 1. Monitor the status of the OPT Plus activity.

Council Regional Office/
2. Provide mentoring and supportive supervision visits to LGUs/
Regional Nutrition
barangays needing assistance.
Program Coordinator
(RNPC)

Provincial Nutrition 1. Monitor the status of the OPT Plus activity.

Office/Provincial
2. Provide mentoring and supportive supervision visits to barangays
Nutrition Action Officer
needing assistance.
(PNAO)

Supervisors: City/ 1. Check the master list of 0-to-59-month-old children.

Municipal Nutrition
2. Oversee the actual collection of length/height measurement and
Action Officers,
weighing.
District/City/Municipal
Coordinators, Midwives, 3. Review the recording of the sex, date of birth, date of weighing,
Barangay Nutrition length/height, and weight.
Action Officers among 4. Refer to the Barangay Health Centers (BHC)/Rural Health Unit (RHU)
others as applicable the children with bilateral pitting edema and obviously manifesting
malnutrition (i.e., extreme thinness, hollow cheeks, edematous feet,
and hands, etc.).

5. Feedback the child’s nutritional status immediately after

measurement using the weight-for-length/height index.

City/Municipal Nutrition 1. Monitor the status of the conduct of the OPT in each Barangay
Action Officer (C/ Health Station (BHS).
MNAO)

OPT Plus Team Members 1. Conduct monthly OPT Plus monitoring of MW/MAM, SW/SAM,
underweight, and 0-to-23-month-old children, and quarterly
monitoring of 24-to-59-month-old children.

2. Participate in the bi-annual review of the Barangay Nutrition Action

Plan (BNAP) and present BNAP accomplishments during the
Barangay General Assembly/Barangay Nutrition Committee (BNC)
meetings.

144 Section 3: OPT Plus Protocol on Anthropometric Measurement

ORGANIZATION/
FUNCTION
PERSON INVOLVED

OPT Plus Team Members 3. Prepare the master list of 0-to-59-month-old children.

4. Conduct the actual collection of length/height measurement and

weighing with the supervisor, if feasible.

5. Record the sex, date of birth, date of weighing, length/height, and

weight.

6. Refer to the BHC/ RHU the children with bilateral pitting edema and
obviously manifest malnutrition if the supervisor is unavailable.

7. Provide feedback regarding the child’s nutritional status immediately

after measuring using the weight-for-length/height index through
the Growth Chart in the ECCD Card or NNIS mobile app, if the
supervisor is unavailable.

8. Coordinate with the DCW to measure the children who were not
covered during the center-based OPT Plus or home visit.

Barangay Nutrition 1. Assist in the preparation of the master list of 0-to-59-month-old

Committee (BNC) children.

2. Mobilize the under-five children to the weighing post.

3. Provide logistic support, i.e., transportation and food allowance to

the OPT Plus Team.

4. Provide transportation and other services to the families with

malnourished children to visit the BHC/RHU.

5. Assist coordination with the DCW for the children who have not
been measured at home or center-based.

Section 3: OPT Plus Protocol on Anthropometric Measurement 145

Section 3.2

OVERVIEW OF THE
ANTHROPOMETRIC
MEASUREMENTS

During this activity, the following measurements are taken to assess the nutritional
status of 0-to-59-month-old children:

WEIGHT The measurement of body mass or heaviness of a child.

LENGTH The stature measurement of a child 0-to-23-month-old

while in a recumbent or lying position.

HEIGHT The stature measurement of a child 24-to-59-month-old

collected while standing up.

MID-UPPER ARM The circumference of the left arm taken between the
CIRCUMFERENCE elbow and shoulder at the midpoint.
(MUAC)

EDEMA The presence of excess fluid in muscle tissues caused by

severe muscle wasting.

Section 3: OPT Plus Protocol on Anthropometric Measurement 147

Section 3.3

GENERAL REMINDERS IN
TAKING ANTHROPOMETRIC
MEASUREMENTS

Some Considerations When Planning to Take

Anthropometric Measurements (FAO, 2021)
Before taking the child’s weight and length or height measurements, a few things should be
considered to ensure the collection of high-quality anthropometric data and the child’s safety.
Here are some reminders:

1. PLACEMENT OF TOOLS AND EQUIPMENT

a. Observe and select an appropriate spot in the household where the equipment may be
set up.

b. Length boards and platform scales should be placed on a flat surface while hanging scales
should be securely hung on a sturdy post, beam, or tree.

c. If possible, conduct the measurement outdoors during daylight hours.

d. Opt to measure indoors in case of bad weather or if there are too many people outdoors.

Section 3: OPT Plus Protocol on Anthropometric Measurement 149

2. SAFETY AND PRECAUTION 4. CHILDREN WITH SPECIAL CONDITIONS/
NEEDS
a. Since children’s bones are still developing,
only apply gentle pressure on their limbs or This will include suffering from chronic diseases,
legs when getting their measurements. deformities, disfigurement and disabilities.

b. Do not leave the child alone with any a. Children with special conditions may have to
measuring tools or equipment. be weighed and measured differently.

c. Make sure that the measurer’s fingernails b. If the child’s height cannot be measured, get
are trimmed, and accessories such as rings, the length instead, and subtract 0.7 cm from
bracelets, or watches are removed before the measurement.
handling a child to avoid accidentally hurting
c. If a child cannot form a vertical plane where
the child.
the head, shoulders, buttocks, and heels are
d. Do not hold a pencil or pen while weighing aligned, a minimum of two contact points
or measuring. (i.e., back of the head and buttocks or heels
and buttocks) should touch the surface of
e. When using hanging scales, make sure
the measuring tool. This may occur due to
they are hung on a sturdy pole, beam, or
obesity.
tree. Check the pants, straps, and hooks
and make sure they are not broken or nearly d. If a child has leg length asymmetry, have
broken. the child stand on the longer leg and place a
block or wedge on the shorter leg to align the
f. When taking height measurements, use a
hips before taking the height measurement.
leveling tool to make sure that the board is
To get the length, hold the legs together
on level ground. For measuring recumbent
and get the measurement to the heel of the
length, place the board on top of a flat and
longer leg.
sturdy platform or table.
e. In case weight and length/height cannot be
g. Since children tend to be irritated or
measured, note the child’s information (i.e.,
uncomfortable while taking their weight and
name of the child, name of parent/caregiver,
height, make sure to be attentive and alert
address) in the recording form and note that
to avoid accidents.
the measurements cannot be taken due to
the child’s special condition.
3. DEALING WITH DISTRESSED CHILD

a. If the child is uncooperative or distressed, Note: These guidelines were adapted from
let the parent/caregiver calm the child first Alberta Health Services (2015)
before proceeding with the measurement.

b. If measuring more than one child, measure

another different child first and let the
distressed child watch the process.

150 Section 3: OPT Plus Protocol on Anthropometric Measurement

5. TAKING CARE OF ANTHROPOMETRIC
TOOLS

a. Clean and check the anthropometric tools NOTE 3.1.

regularly. If there are signs of damage that Reminders on Recording
may affect the performance of the tool,
report them immediately for a replacement.
Data
b. Make sure that tools and equipment are
1. Use OPT Plus Form 1A Recording
regularly calibrated and verified.
Sheet in recording the sex,
c. Follow specific guidelines for taking care of weight, length/height, date of
the measurement tools. birth, and date of measure (Annex
d. When using digital scales, make sure that 3.2).
batteries are replaced and that extras are 2. Get all the measurements on the
available. same day. The weight and length/
height taken at different days will
6. RECORDING MEASUREMENTS result in inaccurate data.

a. Use pencils instead of pens in recording to

easily correct errors.

b. Make sure to record all relevant information

for one child before moving on with the next
to avoid confusion or mismatch of records.

c. Record weight in the nearest 0.1 kg

d. Record length, height, and MUAC in the

nearest 0.1 cm.

e. Always validate and confirm the recorded

weight, length, height, and MUAC after the
assistant writes them down.

f. Record anthropometric data legibly in the

OPT Plus Form 1A Recording Sheet.

Section 3: OPT Plus Protocol on Anthropometric Measurement 151

Writing numbers the correct way when recording
anthropometric measurements
In recording anthropometric measurements, the following guidelines are to be
followed to minimize errors:

1 Draw the number 1 as a single vertical line.

2, 3 Write the numbers 2 and 3 without extra loops.
4 Leave the number 4 open. A closed 4 can look like a 9.
5 Don’t close the 5. A closed 5 can look like a 6.
6 Be careful that the circle on the 6 does not look like a 0.
7 Make a small horizontal line to cross the 7. This will
distinguish it from a 1.
8 Make two circles to draw the number 8 so that it does
not look like a 0. Don’t separate the two circles.
9 Close the circle on the number 9 so that it does not look
like a 4.
0 Put a diagonal line through the 0 so that it is easy to
identify and does not look like a 6.
Figure 3.1. Correct and incorrect
ways of writing numbers.

Getting ready to measure weight, length, height, and MUAC

Before you proceed to measure the child, make sure to do the following:

1. Introduce yourself and briefly explain the purpose of your visit to the parent/
caregiver. Mention that OPT Plus is the annual weighing and measurement of 0-to-59-
month-old children and that it aims to determine the nutritional status of their child for
referral to other local programs if needed.

2. Provide the parent/caregiver with an overview of what will be done to the child
during weighing and length/height measurement. Also mention that the parent’s/
caregiver’s help will be needed during the activity.

3. After explaining, get the consent of the parent/caregiver by using Annex 3.2. Once
the parent/caregiver agrees, request her to sign the OPT Plus Form 1A, then you may
proceed. A sample consent form can be seen in Annex 3.3. Sample Data Privacy Notice
and Informed Consent Form.

152 Section 3: OPT Plus Protocol on Anthropometric Measurement

Section 3.4

INSTRUCTIONS ON HOW TO
WEIGH THE 0-TO-59-MONTH-
OLD CHILDREN

Using mechanical/digital hanging weighing scale

(Cashin and Oot, 2018):

1. Set up the hanging scale.

a. Hang the scale using the hooks and a rope looped at a sturdy post, beam, or
tree.

For mechanical scales: Make sure that the scale’s dial is at the measurer’s
eye level.
For digital scales: Press the power button to turn the device on.

b. Tare the scale to “0.”

For mechanical scales: Tare the scale to zero with the empty hanging pants
attached to the scale. Adjustments can be made through taring knobs.
For digital scales: Press the tare button with the empty hanging pants
attached to the scale.

c. Ensure that the set-up is not too low such that the foot of the child reaches the
floor and not too high to avoid injuries in case the child falls.

Section 3: OPT Plus Protocol on Anthropometric Measurement 153

2. Prepare the child for weighing.

a. Explain the reason for getting the child’s weight to the parent/caregiver. Mention that it
will be used to assess the child’s growth and nutritional status.

b. To ensure that accurate weight measurement is obtained, ask the parent/caregiver to

remove any heavy clothing from the child. If possible, the child should be weighed only
in his/her underpants.

3. Weigh the child.

a. Remove the weighing pants from the scale

and carefully direct the child’s legs through
the pants using the measurer’s hand inserted
through the leg holes from the lower part
of the weighing pants. Make sure that the
strap of the pants is in front of the child with
his/her hands placed on the sides.

b. Once the weighing pants are securely

in place, lift the child with the help of the
trained assistant or parent/ caregiver and
hang the straps onto the scale’s hook.
Ensure that straps are securely attached to
the hook before carefully letting go of the
child. DO NOT CARRY THE CHILD BY THE
STRAP ONLY.

c. Before taking the measurement, make sure

that the child’s position is correct, that they
are not holding anything, and that the child
is hanging freely where their feet do not
touch the ground. If the child is agitated,
calm them down first to avoid inaccurate
weight measurements.

Figure 3.2. Illustration on proper positioning of the

child in the hanging weighing scale.

154 Section 3: OPT Plus Protocol on Anthropometric Measurement

4. Get the measurement.

For mechanical scales: The measurer should

stand at eye level in front of the scale to ensure
that the child is still, and the dial is not moving
or fluctuating.

For digital scales: Weight will register on the

digital display of the device or scale.

a. The measurer should read aloud the child’s

weight (in the nearest 0.1 kg), and the
assistant should record it in the OPT Plus
Form 1A Recording Sheet.

b. Lift the child by carrying their body and

removing the pants with the help of the
assistant or parent/caregiver.
Figure 3.3. Illustration on how to
c. Validate and confirm recorded weight. read the weight using hanging
weighing scale.

Using digital platform scales for children who can stand

alone (Cashin and Oot, 2018):
1. Set up the scale.

a. Place the scale on a flat and even surface, preferably the floor.

b. Turn on the scale according to the instructions.

c. Tare the scale to “0.0.” Note that some digital scales are automatically tared when turned
on.

2. Prepare the child for weighing.

a. Explain the reason for getting the child’s weight to the parent/caregiver. Mention that it
will be used to assess the child’s growth and nutritional status.

b. To ensure that accurate weight measurement is obtained, ask the parent/caregiver to

remove any heavy clothing from the child and to make sure the diapers are empty.

Section 3: OPT Plus Protocol on Anthropometric Measurement 155

3. Weigh the child.

a. Ask the child to stand in the middle of the

scale.

b. Wait until the displayed weight remains fixed.

c. Read aloud the measurement and let the

assistant record it in the OPT Plus Form 1A
Recording Sheet.

d. Validate and confirm recorded weight.

Using digital platform scales

to weigh children who cannot
stand alone (Cashin and Oot,
2018):
Most recommended platform scales have a taring Figure 3.4. Illustration on getting the weight of
function which resets the scale to “0.0” while a the child using digital platform.
person is standing on the scale. This function is
useful when weighing infants and children who
are unable to stand on their own with the help
of their parents/caregivers. If your scale has no
taring function, see Note 3.2. Manual Taring.

Here are the steps on using digital platform

scales to weigh children who cannot stand alone:

1. Set up the scale.

a. Place the scale on a flat and even surface,

preferably the floor.

b. Turn on the scale according to the

instructions.

c. Tare the scale to “0.” Note that some digital

scales are automatically tared when turned
on.

156 Section 3: OPT Plus Protocol on Anthropometric Measurement

2. Prepare the child for weighing. Using a beam balance:
a. Explain the reason for getting the child’s
weight to the parent/caregiver. Mention that 1. Set up the scale. Make sure that the scale
it will be used to assess the child’s growth is at 0.0 kg by placing all the weights on the
and nutritional status. left side.

b. To ensure that accurate weight measure-

ment is obtained, ask the parent/caregiver 2. Prepare the child for weighing.
to remove any heavy clothing from the child a. Explain the reason for getting the child’s
and to make sure the diapers are empty. If weight to the parent/caregiver. Mention that
possible, the child should be weighed only in it will be used to assess the child’s growth
his/her underpants or wrapped in a blanket. and nutritional status.

b. To ensure that accurate weight measurement

3. Weigh the parent/caregiver. is obtained, ask the parent/caregiver to
a. Instruct the parent/caregiver to stand on the remove any heavy clothing from the child
scale. and to make sure the diapers are empty.

b. Once the weight registers, tare the digital

scale to “0.” 3. Weigh the child.

a. Ask the child to stand in the middle of the

4. Get the child’s weight. scale.

a. Have the child placed in the parent/ b. Wait until the displayed weight remains
caregiver’s arms. fixed.

b. Read the weight out loud to the nearest 0.1 c. Read aloud the measurement and let the
kg and let the assistant record it in the OPT assistant record it in the OPT Plus Form 1A
Plus Form 1A Recording Sheet. Recording Sheet.

5. Record and verify the weight.

Section 3: OPT Plus Protocol on Anthropometric Measurement 157

NOTE 3.2. Manual Taring

If the digital scale has no taring function, you may follow these steps:

1. Make sure that the scale is tared or in “0.0.”

2. Have the parent/caregiver stand on the scale, then write down the weight.
3. Place the child on the parent’s/caregiver’s arms, then write down the
combined weight.
4. Subtract the parent’s/caregiver’s weight from the combined weight to get the
child’s weight:
Child’s Weight = Combined Weight - Parent’s/Caregiver’s Weight
5. Verify and record.

NOTE:

Access the instructional video on anthropometric measurement at the NNC

website: www.nnc.gov.ph.

158 Section 3: OPT Plus Protocol on Anthropometric Measurement

Section 3.5

INSTRUCTIONS ON MEASURING
THE LENGTH OF THE 0-TO-23-
MONTH-OLD CHILDREN

There are different recommended length and 3, Series 2018 Approving the Guidelines on
height measuring tools (i.e., wooden height the Selection of Non-Wood Height and Length
board (HB), aluminum-acrylic height board, Measurement Tool (Annex 3.3) and Guidelines
stadiometer, microtoise, infantometer, and on the Fabrication, Verification, and Maintenance
measuring mat) and each one has its own of Wooden Height Boards (Annex 3.4) before
unique features. If available, one may refer fabricating it. Below are the protocols you need
to the User’s Manual for the proper use and to understand for getting the length or height of
maintenance of the tool. If there is a need to a child to get reliable, accurate, and precise OPT
fabricate the height boards, one should refer Plus data.
to the NNC’s Governing Board Resolution No.

Section 3: OPT Plus Protocol on Anthropometric Measurement 159

Using length board (Cashin and Oot, 2018):
1. Prepare the set-up for measuring length. c. Stand at the side of the board, and check if
the child is lying straight with the shoulders
a. Place the board horizontally on a hard, flat,
touching the board.
and durable surface such as the ground
or sturdy table. If placed on a table or any d. Gently hold down the child’s legs with one
elevated surface, make sure that it is sturdy hand and use the other hand to slide the
to avoid accidents. footboard.

b. Explain to the parent/caregiver that the child e. Apply pressure on the knees to straighten
will be measured using the board. In the the legs as possible to get the child’s length.
absence of an assistant, mention that you Be careful not to exert too much force and
will need their assistance to keep the 0-to- cause injury to the child.
23-month-old baby while measuring. Also
f. Check the child’s position and make
mention that two (2) or three (3) people will
adjustments as needed.
be measuring the length/height of the child.
g. Once the position is correct, slide the
c. Clean and sanitize the board before placing
footboard firmly on the child’s heels.
the child.
h. Read aloud the measurement (in the nearest
0.1 cm), and the assistant should record it in
2. Prepare the child for measuring
the OPT Plus Form 1A Recording Sheet.
recumbent length.
i. Validate and confirm the recorded length.
a. Ask the parent/caregiver to remove any
footwear or head/hair accessories that could
interfere with the measurement.

3. Measure the length.

a. Ask the parent/caregiver to carefully place

the child on the board.

b. Instruct the parent/caregiver to position the

child’s head such that the child is looking
straight up while the top of the head is
situated firmly on the headboard. The head
of the assistant or parent/caregiver should
be directly above the child’s head while
holding the correct position by gently placing
their hands over the child’s ears.

160 Section 3: OPT Plus Protocol on Anthropometric Measurement

Figure 3.5. Illustration on how to position the child in the length board.

Section 3: OPT Plus Protocol on Anthropometric Measurement 161

Section 3.6

INSTRUCTIONS ON MEASURING
THE HEIGHT OF THE 24-TO-59-
MONTH-OLD CHILDREN

Using height board or stadiometer (Cashin and Oot, 2018):

1. Prepare the set-up for measuring height.

a. Place the board vertically on a hard and flat surface against a wall or pillar.

b. A leveling tool may be used to ensure that the board stands at a 90° angle
against the floor.

If using a stadiometer: Adjust the spacer found at the topmost part until
the built-in leveling tool shows that the stadiometer is completely level
or perpendicular to the floor.
c. Clean and sanitize the board before measuring.

Section 3: OPT Plus Protocol on Anthropometric Measurement 163

Figure 3.6. Illustration on how to position the child in the height board.

2. Prepare the child for measurement. c. Ask the assistant or parent/caregiver to hold
the child’s knees and legs in place.
Remove any footwear and head/hair accessories
that may interfere with the measurement. c. Before getting the measurement, check the
child’s position and adjust as necessary. You
may help a child who cannot stand straight
3. Measure the child.
by gently pushing on their stomach.
a. Kneel at the right side of the child and help
d. Slide the moveable headpiece down
them stand on the baseboard of the board
carefully while cupping the child’s chin.
with feet slightly apart and back against the
Ensure that the line of sight is parallel to the
board.
ground. Make sure that the hair is pushed
b. To help ensure that the child’s position is down before taking the measurement.
correct, check if the tip of the shoulders
e. Read aloud the measurement (in the nearest
is aligned to the position of the heel. It
0.1 cm) and let the assistant record it in the
may help to check if the back of the head,
OPT Plus Recording Sheet.
shoulder blades, buttocks, calves, and heels
touch the board. f. Validate and confirm recorded height.

164 Section 3: OPT Plus Protocol on Anthropometric Measurement

Using microtoise:
1. Prepare the set-up. 2. Take the child’s height.

a. Attach a plumb line on the wall by taping a. Ensure that the child is not wearing any
a long string with a rock at the end of the footwear and has no hair ornaments that may
string. Make sure that the rock is hanging interfere with the accurate measurement of
freely. height.

b. Place the microtoise on the floor and pull the b. Have the child stand directly below the
measuring tape until the “0” mark is on the body of the tool while making sure that the
red line of the read-off area. back of the head, shoulder blades, buttocks,
calves, and heels touch the wall.
c. Make sure that the measuring tape is
against the wall. Mark the end of the tape to c. Slide the body of the tool down until it
indicate where to mount the microtoise. reaches the child’s head. Make sure that
the hair is compressed when taking the
d. Drill a hole exactly where the end of the
measurement.
measuring tape is and mount the tool using
a screw. d. Read the measurement in the read-off area.

e. Pick up the body of the tool from the floor e. Read aloud the measurement (in the nearest
and join it together with the end of the 0.1 cm) and let the assistant record in the
measuring tape OPT Plus Recording Sheet.

f. Validate and confirm recorded height.

NOTE 3.3.
Reminder on Length and Height Measurement
Generally, 0-to-23-month-old children are measured lying down to get their
recumbent length, while 24-to-59-month-old children are measured standing up.
However, there are times this is not followed due to the child’s inability to stand or
refusal to lie down. In this case, the measurer will have to adjust the measurement
accordingly:

• If a 0-to-23-month-old child was measured standing up, add 0.7 cm to the

obtained measurement.
• If a 24-to-59-month-old child was measured lying down, subtract 0.7 cm to the
obtained measurement.

Section 3: OPT Plus Protocol on Anthropometric Measurement 165

166 Section 3: OPT Plus Protocol on Anthropometric Measurement
Section 3.7

INSTRUCTIONS ON HOW TO
MEASURE MUAC OF 6-TO-59-
MONTH-OLD CHILDREN

The use of mid-upper arm circumference (MUAC) tape detects the possible problem
of malnutrition among children immediately, especially during emergencies (See
Annex 3.5. NNC Memorandum 2020-010 Interim Guidelines in the Conduct of OPT
Plus, Nutrition Screening, Growth Monitoring and Promotion (GMP) Activities in the
Context of the COVID-19 and other Disasters). Below are the instructions on how
you are going to use the MUAC.

Section 3: OPT Plus Protocol on Anthropometric Measurement 167

Using MUAC Tape:
1. Position the child so that the measurer can work at
eye level.

2. Locate the midpoint of the child’s upper left arm. It

is the area between the tip of the shoulder and the
tip of the elbow.

a. Locate the shoulder and elbow tip and adjust the arm
to make a right angle.

b. Place one end of the MUAC tape on the tips of the

shoulder and measure the length until the elbow tip.

c. Ask the assistant to mark the midpoint with a pen. The

midpoint is half of the length between shoulder and
elbow tips.

3. Straighten the arm and wrap the MUAC tape around

the midpoint. Do not pull the end of the tape too
tight.

4. Read the measurement through the window at the

end of the tape and record. Figure 3.7. Illustration on how to get
the midpoint between the shoulder and

5. Explain the result to the mother. elbow.

Note 3.4. Under the PIMAM Program, it is very

important to note that MUAC is and
Use of MUAC continues to be used as a criteria for
identifying, admission, and discharge
of children with acute malnutrition or
In the OPT Plus Protocol, MUAC can be wasting. This is applicable for both regular
used only during emergencies. If one and emergency contexts (see National
barangay uses MUAC, all the barangays Guidelines for the Management of Acute
should use MUAC during OPT plus and Malnutrition for Children under 5 years,
follow-up activities. DOH AO 2015-0055).

168 Section 3: OPT Plus Protocol on Anthropometric Measurement

Section 3.8

INSTRUCTIONS ON HOW TO
CHECK AND CLASSIFY SEVERITY
OF BILATERAL PITTING EDEMA

Bilateral pitting edema is the presence of excess fluid in muscle tissues caused
by severe muscle wasting. This condition is characterized by the puffiness
or swelling of feet, hands, and/or face. A child with bilateral pitting edema is
considered severely wasted or SW/SAM, at higher risk of mortality, and in need
of urgent medical attention. Below are the steps for checking for presence of
bilateral pitting edema.

Section 3: OPT Plus Protocol on Anthropometric Measurement 169

Figure 3.8. Images of Bilateral Pitting Edema.

1. Prepare the child. Table 3.2. Grades of bilateral pitting edema.

a. Explain to the parent/caregiver that the child will be

BILATERAL PITTING
checked for bilateral pitting edema and that their SEVERITY
EDEMA
assistance may be needed during the procedure.
+1 Both feet
b. Ask the parent/caregiver to remove any footwear.
Both feet, legs, and may
+2 include hands, lower
2. Check for bilateral pitting edema. arms

a. Hold the child’s feet with your thumb on top of the Both feet, legs, hands,
foot. +3 lower arms, upper arms,
face
b. Gently press your thumbs down and slowly count to
three before lifting your thumb.

c. Check if there are indentations left by your thumbs.

d. Record the results based on severity. You may refer

to Table 3.2 for the grades of bilateral pitting edema.

170 Section 3: OPT Plus Protocol on Anthropometric Measurement

Section 3.9

REFERRAL OF
MALNOURISHED CHILDREN

What is Referral?
Referral is the process of linking identified The information collected should be interpreted
malnourished children to appropriate inter- to identify which of the children are malnourished.
ventions and services in the community and is Referral is an important process to utilize
one of the main objectives of the OPT Plus at nutrition data and improve the nutritional status
the individual level. It is important to understand of children. The health and/or nutrition worker
that OPT Plus is not just the annual weight and should fill out the OPT Plus Referral Form (Figure
length/height measurement of 0-to-59-month- 3.9) if there is a child in need of referral..
old children.

Section 3: OPT Plus Protocol on Anthropometric Measurement 171

Region
Province
City/Municipality
OPT Plus Referral Form

Nameof Child:_______________________________

Age:______ Sex: _ Municipality:____________________

Date of Referral: ____________________________ Severity of Bilateral Pi�ng Edema:

Weight: Height: __ None

MUAC: _____________ If yes: Grade +1 +2 +3

WFH: ☐ SW/SAM: ☐ Normal: ☐ OW/Obese: ☐

WFA: ☐ MUW: ☐ SUW: ☐
HFA: ☐ MSt: ☐ SSt: ☐

Received by: Referred by:

_______________________________ ________________________________
Name Name
_______________________________ ________________________________
Designation Designation

Return Slip
REMARKS
Name of Child:___________________________________________

Date Referred:___________________________________________

Nutritional Status:_______________________________________

____________________________________________

Received by: Name/Signature

Figure 3.9. OPT Plus Referral Form.

172 Section 3: OPT Plus Protocol on Anthropometric Measurement

NOTE:
The list of nutrition interventions can serve as guide for the OPT Plus Team where to refer the
malnourished children.

Nutrition Interventions
Nutritional Status
0 to 5 months 6 to 23 months 24 to 59 months

Moderately wasted
(MAM)/Severely wasted Refer to PIMAM
(SAM)

Dietary supplementation
in Child Development
Counseling of mothers Dietary supplementation Centers and Supervised
Underweight
on the First 1000 Days for children 6-23 months Neighborhood Plays

School-Based Feeding
Program

Promotion of Healthy
Overweight/Obese Counseling of mothers on the First 1000 Days
Lifestyle

For Child Who is Growing Well

A normal nutritional status suggests that the child is growing well. Parents/caregivers of these
children should be commended by the OPT Plus Team during counseling. Moreover, normal
growth should be sustained. This may be achieved by educating the parents/caregivers on
the importance of proper nutrition and by giving feeding advice appropriate for the age of the
child. It will also be helpful to remind the parents/caregivers that there are other interventions
like immunization, deworming, dental check-ups, and other possible interventions that are
accessible in the local health office.

Section 3: OPT Plus Protocol on Anthropometric Measurement 173

For Malnourished Children
If there is a growth problem, the parent/caregiver should be interviewed and counseled
to identify possible causes of the problem and to provide nutritional advice to improve the
nutritional status of the child. It is very important to keep the discussion positive and to
avoid accusing or judging the parent/caregiver. The parent’s/caregiver’s trust should be built
to clearly communicate that he/she can help the child. Use clear, non-medical language as
much as possible. If unfamiliar words such as “Obese” will be used, explain it to the mother.
For example, being obese means being very heavy for one’s height. The triangle chart can
be used in determining the causes of the child’s condition.

NOTE 3.5. Triangle Chart

The triangle chart was developed by the UPLB BIDANI Network Program
(Jequinto et al., 1998).

The Triangle Chart is a simple and comprehensive pictorial flow chart used to identify the root
causes of malnutrition of each child. It can also be used to plan possible interventions and
monitor children and planned activities.

How to Use the Triangle Chart?

1. Identify the family situation of the child. This can be done by interviewing the parent/
caregiver. Questions may include the child’s past and present medical condition, feeding/
caring practices, deworming, supplementation, immunization, etc. You may also directly
observe the living condition of the household.

2. Together with the parent/caregiver, identify the problems that may have led or caused the
child to be malnourished. Write each problem in big triangles.

3. Once the problems are identified, check the list of root causes and get the codes of
causes that are applicable to the child’s situation. Write it down in smaller triangles.

174 Section 3: OPT Plus Protocol on Anthropometric Measurement

Figure 3.10. Triangle chart as an aid in identifying possible
causes of malnutrition per child.

EXAMPLE 1:

A child’s weight-for-age is between the -1 and -2 z-score lines, as it has been for the last three
visits. The health worker shows the parent/caregiver the measurements and says, “Your child is
lighter than most children of his age, but he is growing consistently. Notice how his growth line
has stayed between these two lines. His weight has increased with his age, and this is good.”

Section 3: OPT Plus Protocol on Anthropometric Measurement 175

EXAMPLE 2:

The health worker shows the parent/caregiver the table and says, “You may have noticed that
your child has become very thin. We will talk about what to do to help her gain weight. Do not
worry; there are ways to help her grow.”

However, if the health worker observed any of the following severe undernutrition problems,
refer them immediately for urgent care:
1. Moderately wasted (MW/MAM)
2. Severely wasted (SW/SAM)

Whenever there is a need to refer a child, explain to the parent/caregiver the reasons for the
referral and stress its importance.

Steps on how to explain the reasons for the referral:

1. Explain to the parent/caregiver the child’s nutritional status is MAM or SAM.

2. Tell them the consequences if their child will not be referred immediately to the health
center.

3. Inform them about the possible interventions that will be given to the child.

NOTE 3.6.
Assistance for Families of Malnourished
Children
Sometimes the parents or caregivers refuse to bring their child to the health
center because it is far or they lack the financial resources. The barangay
can give a certification of indigency and ask financial support from the City/
Municipal Social Welfare and Development (C/MSWD) while the barangay can
help facilitate or arrange for transportation. Also, help arrange for care of other
kids or family members.

176 Section 3: OPT Plus Protocol on Anthropometric Measurement

For Children with Disability (Chronic conditions)
The Convention on the Rights of Persons with Disabilities (CRPD) defines people with
disability as “those who have long-term physical, mental, intellectual or sensory impairments
which in interaction with various barriers may hinder their full and effective participation in
society on an equal basis with others.” In case a child has a physical disability that makes him/
her difficult or impossible to weigh and measure, the OPT Plus Team should still record the
child’s information whether the weight and length/height measurements were collected or
not. Regardless of the type of disability, the OPT Plus Team should refer the child to the local
health office and other specialized services.

Section 3: OPT Plus Protocol on Anthropometric Measurement 177

Section 3.10

WHO CHILD GROWTH

STANDARDS (CGS)

What is the WHO Child Growth Standards (CGS)?

The WHO Child Growth Standards (WHO-CGS) represents how children should grow. It
provides a range of globally accepted prescriptive measures considered as normal growth for
children less than five (5) years old. The standards were based on the WHO Multicentre Growth
Reference Study (MGRS) where children from six (6) countries are receiving recommended
feeding and care were included (WHO, 2008a).

NOTE 3.7.
Adoption of WHO-CGS in the Philipines

The country adopted the use of WHO-CGS in 2008. Since then, it has been used
in determining the nutritional status of Filipino children. These standards are
also being used in conducting OPT Plus and as the basis for the development
of the eOPT Plus Tool. See Annex 3. NNC Governing Board Resolution No. 2,
Series of 2008 Adoption of the New WHO Child Growth Standards for Use for
Children 0-to-59-month-old in the Philippines.

Section 3: OPT Plus Protocol on Anthropometric Measurement 179

The WHO-CGS currently has 12 indices used to determine the child’s nutritional status. OPT
Plus uses three of these indicators: length/height-for-age, weight-for-age, and weight-for-
length/height.

1. Length/Height-for-Age (L/HFA) measures linear growth among children compared

to their age. Children who are considered short for their age are classified as stunted.
Stunting is a condition that manifests long-term or chronic malnutrition.

2. Weight-for-Age (WFA) measures the child’s weight compared to their age. Unlike the
HFA/LFA and WFH/WFL, this indicator does not distinguish between chronic or acute
malnutrition. Children who are too light for their age are classified as underweight.
Children can be underweight for their age because they are stunted, wasted, or both.

3. Weight-for-Length/Height (WFL/H) measures the child’s weight compared to their

length or height. Children who are too thin and of low stature can be classified as wasted.
Wasting is a condition that reflects the acute or relatively recent onset of malnutrition.
Overweight and Obese are defined as abnormal or excessive fat accumulation that may
impair health (WHO, 2021).

UNDERWEIGHT STUNTING WASTING OVERWEIGHT

Figure 3.11. Illustrations of different forms of malnutrition.

180 Section 3: OPT Plus Protocol on Anthropometric Measurement

How to determine the nutritional status of a child using
the WHO-CGS?
The WHO-CGS uses anthropometric z-scores in determining the nutritional status of a child.
A Z-SCORE compares the growth of a child through anthropometric measurements to the
median value of the reference population having the same sex or age (FANTA, 2018). A
child’s z-score that falls below or beyond the normal range suggests a nutritional problem
and the farther it is from the normal range, the more severe the problem is. A z-score can be
determined using tables, charts, and/or computed with electronic tools or software.

Moreover, cutoffs are used to better make sense of a child’s z-score. CUTOFFS are thresholds
or ranges of values that correspond to classify the nutritional status of the child. WHO-CGS
cutoffs for WFA, L/HFA, and WFL/H are presented in Table 3.3.

Table 3.3. Z-score cutoff points for classifying nutritional status using L/HFA, WFA, and
WFL/H indicators (FANTA, 2018; WHO, 2008b).

Z-SCORE CUT-OFF POINTS

INDICATOR
<-3 SD ≥-3 TO <-2 SD ≥-2 TO ≤+2 SD >+2 TO ≤+3 SD >+3 SD

Length/Height-for- Severely Moderately

Normal Tall
Age (L/HFA) Stunted Stunted

Weight-for-Age Severely Moderately

Normal Overweight Obesity
(WFA) Underweight Underweight

Weight-for-Length/ Severely Moderately

Normal Overweight Obesity
Height (WFL/H) Wasted/SAM Wasted/MAM

In determining the nutritional status of a child through the z-scores, age is a crucial data. Studies have
shown that the mere estimation of age leads to inaccurate determination of nutritional status. During
the previous years, tools such as the old eOPT Plus (v1) and the WHO-CGS Tables use the age in months
to identify nutritional status. As part of the 2019 recommendations of WHO and UNICEF, age must be
calculated by days for more precise values. Hence, age in days will be used in computing for nutritional
status through length/height-for-age and weight-for-age.

Section 3: OPT Plus Protocol on Anthropometric Measurement 181

By using any of these three tools that computes through age in days, nutritional
status can be determined easily:

If with immediate access to a computer: Electronic Operation Timbang (eOPT) Plus tool
Version 2 (v2)
If with immediate access to a smartphone: National Nutrition Information System (NNIS)
mobile application
If without immediate access to a computer or Growth Chart in the Early Childhood Care and
mobile phone: Development (ECCD) Card

Section 4 will discuss the guidelines on the use of these tools. Due to the required precision when
computing for age in days, digital tools must be used for efficiency and accuracy. The eOPT Plus Version
2 or the NNIS may be used for this.

MID-UPPER ARM CIRCUMFERENCE

MUAC is one of the common anthropometric measurements used in assessing the

nutritional status of a child. It is a simple and fast way to determine whether the child is
acutely malnourished.

SUPERVISOR’S BOX 3.1.

For more information on WHO-CGS, please visit this website: https://www.who.int/tools/
child-growth-standards

For more information of WHO Multicentre Growth Reference Study (MGRS), please visit
https://www.who.int/tools/child-growth-standards/who-multicentre-growth-reference-
study

Table 3.4. MUAC cut-off points and classification.

WASTED
AGE MODERATELY WASTED SEVERELY WASTED (SW)/
NORMAL
GROUP (MW)/MODERATE ACUTE SEVERE ACUTE MALNUTRITION
MALNUTRITION (MAM) (SAM)

6-59
≥ 12.5 cm ≥11.5 cm to <12.5 cm <11.5 cm
months

Source: DOH-AO 2015-005

182 Section 3: OPT Plus Protocol on Anthropometric Measurement

NOTE 3.8.
MUAC vs WFL/H in Assessing Wasting in
6-to-59-month-old Children
MUAC and WFL/H can both be used to identify wasted or acute malnutrition
in children 6-to-59-month-old. A child that was initially classified as SW/SAM
using MUAC should be monitored using MUAC after referring for treatment
until discharge from the PIMAM Program.

BILATERAL PITTING EDEMA

Bilateral Pitting Edema also shows manifestations of malnutrition. When a child is severely
wasted, signs of bilateral pitting edema or simply edema manifest physically. Edema is
the presence of excess fluid in the child’s tissues due to severe muscle wasting. It is
characterized by a swollen and puffed-up appearance usually found at the child’s feet that
leaves a dimpled mark when pressed down. Children with edema are always classified as
SAM. They are at higher risk of mortality, and in need of urgent medical attention. Edema
may also be observed in other parts of the child’s body such as the face and hands. The
severity of edema can be classified into three (3) grades, as shown in Table 3.2.

Section 3: OPT Plus Protocol on Anthropometric Measurement 183

REFERENCES

Alberta Health Services (2015). Childhood Growth Measurement – Public Health and Clinical
Settings. Retrieved from https://www.albertahealthservices.ca/assets/info/hp/cgm/if-hp-cgm-
measurement-protocol.pdf.

Casadei, K., & Kiel, J. (2022). Anthropometric Measurement. In StatPearls. StatPearls Publishing.

FAO (2021). Food Security and Nutritional Assessment in Fishing Communities in the Philippines Training
Manual.

Jequinto, R.A., Kusin, J.A., Lalap, B.A., Tandang, M.B., Burgoz, J.M.C., and Eusebio, J.S. (1998). Training
Manual on Participative Domiciliary Nutrition Rehabilitation, BIDANI, IHNF, CHE, UPLB in
cooperation with DGIS. ISBN # 971-547-141-2, 1998.

World Health Organization (WHO). (2008a). Training Course on Child Growth Assessment: Introduction.
Geneva, WHO, 2008.

WHO. (2008b). Training Course on Child Growth Assessment: Interpreting Growth Indicators. Geneva,
WHO, 2008.

WHO. (2013). Guideline: Updates on the management of severe acute malnutrition in infants and
children. Geneva: World Health Organization; 2013.

184 Section 3: OPT Plus Protocol on Anthropometric Measurement

ANNEX 3.1. OPT Plus Form 1A Recording Form

Section 3: OPT Plus Protocol on Anthropometric Measurement 185

ANNEX 3.2. Sample Data Privacy Notice and Informed Consent Form

SAMPLE DATA PRIVACY NOTICE AND CONSENT FORM

Privacy Notice

Information Collected
Collected information through the OPT Plus including name of child, name of parent/
caregiver, address, birthdate, weight, height, and MUAC will be processed and stored
for use of nutrition and health workers and Barangay Nutrition Committee.

Use of Information
Information collected will be stored and used by nutrition and health workers from
government, non-government sectors, or any individual or organization. Collected
information will primarily be used as baseline information on the nutritional status
of children 0-to-59 months old in barangays. Information will also be used in local
nutrition planning and prioritization of areas for nutrition interventions.

Information Sharing
Data collected will be collated and submitted from the barangay to the national level.
This means that personnel at different government levels will have access to the data
collected from you and your child. Other government agencies, the non-government
sector, or any individual or organization may also be granted access upon approval of
the National Nutrition Council (NNC).

Your Rights
You have the right to ask questions regarding the collection and use of information
through the assigned health or nutrition worker who will be collecting the above
mentioned information from you and your child.

Privacy Consent
I have understood the purpose of OPT Plus and the implication of agreeing with the
process of collecting information from me and my child. The questions I have raised
were also answered adequately. Hence, I hereby authorize collection and use of
personal and anthropometric data from me and my child.

Signature over Printed Name Date

186 Section 3: OPT Plus Protocol on Anthropometric Measurement

ANNEX 3.3. NNC Governing Board Resolution No. 3, Series 2018 Approving the Guidelines
on the Selection of Non-Wood Height and Length Measurement Tool

Section 3: OPT Plus Protocol on Anthropometric Measurement 187

188 Section 3: OPT Plus Protocol on Anthropometric Measurement
Section 3: OPT Plus Protocol on Anthropometric Measurement 189
ANNEX 3.4. NNC Governing Board Resolution No. 3, Series 2018 Approving the Guidelines
on the Selection of Non-Wood Height and Length Measurement Tool

190 Section 3: OPT Plus Protocol on Anthropometric Measurement

Section 3: OPT Plus Protocol on Anthropometric Measurement 191
192 Section 3: OPT Plus Protocol on Anthropometric Measurement
Section 3: OPT Plus Protocol on Anthropometric Measurement 193
194 Section 3: OPT Plus Protocol on Anthropometric Measurement
Section 3: OPT Plus Protocol on Anthropometric Measurement 195
ANNEX 3.5. NNC Memorandum No. 2020-010. INTERIM GUIDELINES IN THE CONDUCT OF
OPT, GMP, AND NUTRITION SCREENING

196 Section 3: OPT Plus Protocol on Anthropometric Measurement

Section 3: OPT Plus Protocol on Anthropometric Measurement 197
198 Section 3: OPT Plus Protocol on Anthropometric Measurement
Section 3: OPT Plus Protocol on Anthropometric Measurement 199
200 Section 3: OPT Plus Protocol on Anthropometric Measurement
Section 3: OPT Plus Protocol on Anthropometric Measurement 201
202 Section 3: OPT Plus Protocol on Anthropometric Measurement
Section Four

OPT PLUS PROTOCOL

ON DATA PROCESSING,
ENCODING, AND
REPORT GENERATION
OPT PLUS PROTOCOL ON
DATA PROCESSING, ENCODING,
AND REPORT GENERATION
OVERVIEW

The general objective of Section 4 is to offer information on

how to process the OPT Plus data. It also provides knowledge
in determining the nutritional status of the children using the
Electronic Operation Timbang Plus Tool (eOPT Plus Tool), using the
National Nutrition Information System (NNIS) and using the World
Health Organization Child Growth Standards (WHO-CGS) Growth
Chart for rapid assessment.
After reading this section, one should be able to:

1. Enumerate the roles and responsibilities of each person involved in the OPT Plus;
2. Be familiar with the basic eOPT Plus Tool functions including encoding and
generating reports; and
3. Determine the nutritional status using the eOPT, NNIS, and WHO-CGS Growth Chart.

This section covers the post-processing of anthropometric

measurements, electronic and manual methods. Sections include
the following:

Section 4.1 Roles of the OPT Plus Team and Supervisors

Section 4.2 The Electronic Operation Timbang Plus Tool (eOPT Plus Tool)
Section 4.3 Guidelines on Determination of Nutritional Status

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 205
206 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
LIST OF ACRONYMS
BNC Barangay Nutrition Committee
C/MNAO City/Municipal Nutrition Action Officer
eOPT Plus Electronic Operation Timbang Plus
FAO Food and Agriculture Organization of the United Nations
L/HFA Length/Height-for-Age
LGU Local Government Unit
M/C Mother/caregiver
MAM Moderate Acute Malnutrition
MSt Moderately Stunted
MUAC Mid-Upper Arm Circumference
MUW Moderately Underweight
MW Moderately Wasted
N Normal
NNC National Nutrition Council
NNC CO National Nutrition Council Central Office
Ob Obese
OW Overweight
PNAO Provincial Nutrition Action Officer
RNPC Regional Nutrition Program Coordinator
SAM Severe Acute Malnutrition
SSt Severely Stunted
SUW Severely Underweight
SW Severely Wasted
UNICEF United Nations Children’s Fund
UPLB University of the Philippines Los Baños
WFA Weight-for-Age
WFL/H Weight-for-Length/Height
WHO-CGS World Health Organization Child Growth Standards
yyyy-mm-dd Year-month-day

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 207
DEFINITION OF TERMS

eOPT Plus Tool An Excel-based tool used by nutrition workers in the community to
help them consolidate and summarize the results of OPT Plus among
0-to-59-months-old children.

Length/Height- Indicator used to classify stunting among 0-to-59-months-old children.

for-Age (L/HFA)

Weight-for-Age (WFA) Indicator used to classify underweight among 0-to-59-months-old

children.

Weight-for-Length/ Indicator used to classify wasting, overweight, and obesity among

Height (WFL/H) 0-to-59-months-old children.

Child Growth Standards Represents how children should grow through globally accepted
Table prescriptive measures considered as normal growth of all 0-to-5-year-
old children.

208 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
Section 4.1

ROLES AND RESPONSIBILITIES

OF THE OPT PLUS TEAM AND
SUPERVISORS

It is important to understand the roles and responsibilities of each person involved in

implementing the OPT Plus encoding and report generation. Table 1 presents the roles and
responsibilities of the persons involved in the activity.

Table 4.1. Roles and responsibilities of persons involved in the OPT Plus encoding and report
generation.

ORGANIZATION/PERSON
FUNCTION
INVOLVED

National Nutrition 1. Provide technical assistance at the national level in using the eOPT
Council Central Office Plus Tool.
(NNC CO)
2. Document issues and concerns encountered in the tool for future
improvements.

National Nutrition 1. Provide technical assistance at the regional level in using the eOPT
Council Regional Office/ Plus Tool.
Regional Nutrition
2. Submit reports to the NNC CO on issues and concerns encountered
Program Coordinator
in the tool for future improvements.
(RNPC)

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 209
ORGANIZATION/PERSON
FUNCTION
INVOLVED

Provincial Nutrition 1. Provide capacity building in using the eOPT Plus Tool.
Office/Provincial
Nutrition Action Officer
(PNAO)

Supervisors 1. Assist in encoding the anthropometric measurements in the eOPT

Plus Tool.

2. Review the outputs of the BNS using the eOPT Plus.

3. Endorse the OPT Plus reports to the barangay.

4. Consolidate all barangay eOPT Plus into the municipal level eOPT
Plus tool.

City/Municipal Nutrition 1. Conduct a data quality check of the eOPT Plus Tool.
Action Officer (C/
MNAO)

OPT Plus Team Members 1. If the team has access to a computer or laptop, use the eOPT Plus
Tool to automatically compute children’s age in days and nutritional
status. If not possible, guide the encoder and review the encoded
data. Make sure to get a soft copy of the eOPT Plus Tool from the
official NNC website www.nnc.gov.ph.

2. Submit the OPT Plus reports to the C/MNAO and Midwife.

Barangay Nurition 1. Review the submitted OPT Plus reports and endorse them to the
Committee (BNC) C/MNAO.

210 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
Section 4.2

THE ELECTRONIC OPT

(EOPT) PLUS TOOL
VERSION 2 (V2)

THE ELECTRONIC OPT TOOL (eOPT TOOL)

The eOPT Tool calculates the nutritional status of 0-to-59-month-old children using reference
tables based on the WHO Child Growth Standards. It is an excel-based program created to
improve efficiency and accuracy in determining nutritional status and reporting the OPT Plus
data. With the use of the tool, barangays and cities/municipalities can better manage their
data while ensuring accuracy, timeliness, and utilization of OPT Plus data in the communities.
Some key features of the eOPT Tool include the following:

• Automated age calculation

• Automated classification of nutritional status
• Flagging of children with age >59 months
• Flagging of too low or too high encoded values for weight, length or height
• Error-checking features (i.e., duplicate entries, same birthdate)
• Simplifies data consolidation through data export
• Simplifies tabulation of results and report generation
• Print-ready forms

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 211
Overview of the Electronic OPT Plus Tool (eOPT Plus Tool) v2
The eOPT Plus Tool is used by nutrition workers Aside from the automation features of the tool,
in the community to help them record and it also lessens the chance of measurement
summarize the results of OPT Plus among errors which should be avoided to achieve
0-59-month-old children. The eOPT Plus Tool reliable nutritional assessment results. The
runs on MS Excel version 2007 or later. Full eOPT PlusTool was developed specifically for
functionality of the tool requires a licensed barangay, city/municipal, provincial, and regional
version of MS Excel. levels. It can be downloaded from the National
Nutrition Council’s (NNC) Website. The tables
The eOPT Plus tool is a spreadsheet used to and reports that this tool provides are discussed
automatically generate the nutritional status in Section 5.
of children. The validity of the nutritional
assessment depends on the accuracy and The previous version (v1) of the eOPT Plus tool
reliability of the encoded child’s weight, length, was developed by the NNC together with the
height, mid-uppar arm circumference (MUAC), Food and Agriculture Organization of the United
sex, date of birth, and measurement date. The Nations (FAO). It was updated by the national
nutritional status is determined using three project team composed of experts from the
indices: weight-for-age (WFA), height-for-age NNC, University of the Philippines Los Baños
(HFA), and weight-for-length/height (WFL/H), or (UPLB), and United Nations Children’s Fund
in the case where the city/municipality decided (UNICEF) Philippines. The updating of the tool
not to use the weight, length, and height, MUAC into the eOPT Plus v2 resulted to the use of age
and edema can be used. The nutritional status in days and the nearest 0.1 cm when computing
is classified using the World Health Organization the nutritional status for a more accurate and
(WHO) Child Growth Standards (CGS) z-scores precise results, especially among those with
cut-off. borderline measurements and age in eOPT v1.

Change in Nutritional Status Computation

Unlike the previous versions of the eOPT Plus (v1) which computes for the nutritional status using age in
months for weight-for-age and length/height-for-age; and using the nearest 0.5 cm for weight-for-length/
height, the eOPT Plus v2 used a more accurate approach as stated in the comparison below:

212 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
How to encode the OPT Plus data in the eOPT Plus Tool?
1. Fill the necessary information in the ‘Nut_Statustool’ headings such as the year, region,
province, municipality, and barangay. The entry worksheet will not appear if the information
is blank.

• Type in the YEAR (cell C1). Choose first the PROVINCE/LGU, then the CITY/
MUNICIPALITY, and lastly the name of the BARANGAY from the dropdown lists in
each corresponding cell. Please fill these out in sequence.

• If the message “Note: Large Barangay” appears in Cell L3, you should use this file
for a Purok or smaller part of the barangay. Please type in the name of the Purok or
sub-part of the barangay in Cell N6.

2. Choose from the dropdown list in Cell KV6 which Nutritional Assessment Method
(Weight+Length/Height or MUAC) will be used during the OPT Plus. If Weight+Length/
Height was chosen as a method, the ‘MUAC’ and ‘MUAC Status’ columns will be
automatically blocked, and vice versa.

3. Refer to the paper forms (i.e., NNC Form 1A) that you used to record details of preschool
children from your last OPT Plus activity. Type in all the required data for each child into the
‘Nut_StatusTool’ worksheet one at a time. One child, one row. Enter all the information
for each child in the table. Do not skip rows - it will cause your OPT Plus Form 1A to not
work properly.

• You can then begin entering information for each child in the main table -- one child
at a time -- starting from the first blank row (Row # 10). Do not skip rows or leave
any rows blank - this will cause your OPT Plus Form 1A recording sheet to not work
properly.

4. For the ‘Address or Location’: make sure to specify the house street, purok/sitio or
landmarks

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 213
5. For the ‘Name of Mother or Caregiver’: 13. For the ‘Disability’: from the dropdown list,
make sure to follow the format: SURNAME, choose ‘NO’ if the child has no disability;
FIRST NAME SUFFIX (e.g., DELA CRUZ, otherwise, choose ‘YES’.
JUAN or DELA CRUZ, JUAN JR.)
14. For the ‘MUAC’: make sure that it is in
6. For the ‘Full Name of Child’: make sure to centimeters (cm) and the value is up to one
follow the format: SURNAME, FIRST NAME decimal place only.
SUFFIX (e.g., DELA CRUZ, JUANITO or
DELA CRUZ, JUANITO JR.)

7. For the ‘Belongs to the IP Group?’: from

the dropdown list, choose YES if the child
NOTE 4.1. Date Format
belongs to an indigenous group; otherwise,
Important:
choose NO.

8. For the ‘Sex’: from the dropdown list, choose The way you type in the date format into
M if the child is a male; otherwise, choose F. the tool for the child’s date of birth and
the date of measurement must be the
9. For the ‘Date of Birth’ AND ‘Date Measured’: same as the way the date format in your
first determine the date format settings on computer’s operating system appears
your computer at the bottom right corner (e.g., MM/DD/YYYY or DD/MM/YYYY).
of your screen on your taskbar (or you can Always type in any date using the
look at the date format in cell G7 in ‘Nut_ format consistent with your computer’s
StatusTool’). For example, if your computer’s settings. When you type in the numeric
date format is MM-DD-YYYY, “January 21, date, make sure that the month and the
2021” would appear as “01/21/2021”; if it date are not interchanged.
is set as DD-MM-YYYY, it would appear as
“21-01-2021”. Otherwise, this will lead to incorrect
10. For the ‘Weight’: make sure that it is in calculation of the child’s age in days.
kilograms (kg) and the value is up to one After you have typed in the numeric
decimal place only. date, it will appear in the cell as MM-
DD-YYYY (for example, Jan-21-2021),
11. For the ‘Height’: make sure that it is in regardless of your computer’s date
centimeters (cm) and the value is up to one format settings. This is to help users
decimal place only. read the correct dates after the date has
12. For the ‘Bilateral Pitting Edema’: from the been typed in. Please check that your
dropdown list, choose ‘NONE’ if there was computer’s date and time settings are
no bilateral pitting edema identified in the always correct.
child, and if yes, indicate its severity (+1, +2
or +3)

214 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
NOTE 4.2. Data Entry

ENSURE ALL CELLS OR INFORMATION ARE FILLED OUT FOR EACH

CHILD.

To auto-generate each child’s If the child is missing any essential

nutritional status for all three indices information (e.g., name of mother/
as well as for the MUAC status, caregiver), type in “TBD,” and make
the following information must be sure to obtain the needed information
complete: address, the name of the during the next house visit. Otherwise,
mother/caregiver, the child’s name, IP if any details are left blank in the tool,
status (whether the child belongs to an one or all nutritional status indices for
indigenous group), child’s sex, date of that child might not appear. To help
birth, date measured, weight (in kg), users of the tool quickly see if a child has
height (in cm), presence or absence any missing information/measurement
of bilateral pitting edema, presence in the Nut_StatusTool, the cell for the
or absence of disability, and MUAC (if corresponding missing information/
MUAC is the nutritional assessment measurement will be highlighted in
method to be used). It is important yellow. Moreover, the cell opposite
that the address, or the location in the the child’s name in Column A will be
barangay where the child lives should highlighted with a gray color.
be entered to facilitate follow-up visits
by nutrition workers. This can be the
name of the purok, block, or part of the
barangay.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 215
How to update the eOPT Plus Tool in the next OPT Plus?
If there is already an encoded worksheet with eOPT data from previous use of the tool, batch
copy the list of multiple children’s names and details into the blank Nut_StatusTool using the
“Copy>>Paste>>Values” function of MS Excel. Doing this avoids errors that might happen
as underlying formulas and formats in cells from the source will also be copied if just “Paste”
is used. Please just note that the children’s names and other information from the source
worksheet should be arranged in exactly the same way the columns in the tool are set up.
Also make sure that the source data are pasted into the blank tool starting from Row #10
downwards.

What are the tables and reports generated in the eOPT

Plus Tool?
1. ‘Instructions’ tab guides the users on how to encode the OPT data and key features of
the tool

216 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
2. ‘Nut_Status Tool’ is the main data entry worksheet. The encoder can enter information
of a child one at a time into each row, or through can do a batch entry for many children.

3. ‘OPT Plus Form 1A’ serves as the pre-printed list of preschool children in the barangay,
which can be used to find age-eligible children on the next rounds in the community.
Names of preschoolers are alphabetically arranged to help match children and names.
Make sure that the names of new or previously unlisted children are written down at the
end of this list.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 217
4. ‘OPT Plus Form 1B’ is the consolidation of the results of the nutrition assessment.

• 0-to-59-month-old children who are • Number of M/Cs of 0-59 months

Wasted and/or Stunted old children who are overweight/
obese
• 24-to-59-month-old children who
are Wasted and/or Stunted • Total number of M/Cs of children
0-23 months old
• Number of children 0-59 months
old who are overweight/obese • Number of M/Cs of 0-23 months
old children affected by Wasting
• Total number of children 0-23
and/or Stunting
months old
• Number of Children with names
• Number of children 0-23 months
and birthdate repeated
old who are Wasted and/or Stunted
• Number of Children with missing
• Total number of children 0-29
information
months old
• Number of Children with no name
• Total number of children 30-59
of parents/address
months old
• Number of Children with no sex
• Total number of children 24-49
data
months old
• Number of Children with no date of
• Number of children 0-59 months
birth data
old with Edema
• Number of children older than 59
• Number of children 0-59 months
months
old with disability
• Number of children with length/
• Total Number of mothers/
height but no weight
caregivers (M/Cs) of children 0-59
months old • Number of children with weight but
no length/height
• Number of M/Cs of 0-59 months
old children affected by wasting • Number of children with no MUAC
and/or stunting

218 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 219
5. ‘OPT Plus Form 1C‘ contains the list of Affected/At-risk 0-to-59-month-old preschool
children.

220 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
6. ‘NutStatusBrgy’ presents sex-aggregated summary tables of the nutritional status of
0-to-23-month and 0-to-59-month-old children which can be used for presentations.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 221
7. ‘Graphs’ shows a graphical representation of the following prevalences in the community:

• Prevalence and Number of Wasted 0-to-59-Month-Old Children

• Prevalence and Number of Stunted 0-to-59-Month-Old Children

222 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
• Prevalence and Number of Obese/Overweight 0-to-59-month-old Children

• Prevalence and Number of Underweight and/or Stunted 0-to-59-Month-Old Children

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 223
• Prevalence and Number of Stunted and/or Obese/Overweight 0-to-59-month-old
Children

• Prevalence and Number of Underweight 0-to-59-month-old Children

224 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
• Distribution of the MUAC Status of 0-to-59-month-old Children

8. ‘DQC Summary‘ summarizes the needed information to be copied and pasted in the
OPT Plus DQC Tool.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 225
226
9. ‘List of 0-23 mos‘ is the list of all 0-to-23-month-old children in the community.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
10. ‘List_MW (MAM)‘ is the list of moderately wasted/MAM children 0-to-59-months old.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
227
‘List_SW(SAM)‘ is the list of severely wasted/SAM children 0-to-59-months old.
11.

228 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
12. ‘List_MSt&SSt‘ is the list of moderately stunted and severely stunted children 0-to-59-months old.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
229
13. ‘List_OW&Ob‘ is the list of overweight and obese 0-to-59-month-old children.

230 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
14. ‘List_MUW,SUW,MSt&SSt‘ is the list of underweight (moderately underweight or severely underweight) and stunted
(moderately stunted or severely stunted) 0-to-59-month-old children.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
231
232
15. ‘List_MSt,SSt,MW&SW‘ is the list of stunted (moderately stunted or severely stunted) and wasted (moderately
wasted and severely wasted) children 0-to-59-months old.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
16. ‘List_MSt,SSt,OW&Ob‘ is the list of stunted (moderately stunted or severely stunted), overweight, and obese 0-to-
59-month-old children.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
233
‘List_MUAC Status‘ is the list of the MUAC status of 6-to-59-month-old children.
17.

234 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
18. ‘Data Export‘ contains all the data that are meant to be exported for consolidation to either a large barangay (in areas
where the barangay preschool population exceeds 500 children) or to the municipal or city-level data.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
235
Section 4.3

GUIDELINES ON
DETERMINATION OF
NUTRITIONAL STATUS

By using any of these three tools that computes through

age in days, nutritional status can be determined:

• Electronic Operation Timbang Plus tool (eOPT) v2

• National Nutrition Information System mobile application
• Early Childhood Care and Development (ECCD) Card

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 237
Electronic Operation Timbang Plus tool (eOPT) v2

As discussed in the previous section, the eOPT, when complete with all the required
information of a child, can automatically compute nutritional status through the
Child Growth Standards (CGS) z-scores.

Step 1. Open the eOPT

Step 2. At the ‘Nut_StatusTool’ worksheet, choose from the dropdown list in Cell
KV6 which nutritional assessment method (Weight+Length/Height or MUAC) was
used. If Weight+Length Height was chosen as a method, the ‘MUAC’ and ‘MUAC
Status’ columns will be automatically blocked, and vice versa.

Step 3. Input all the required data of the child on the first row, ensure complete
information. Refer to NOTE 4.1 for important information about the date format.

Step 4. See columns M-O for the nutritional status. Provide feedback to caregiver.

238 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
National Nutrition Information System
mobile application

The National Nutrition Information System (NNIS) collects data for the OPT
Plus. It was developed by the National Nutrition Council according to the
section 6 of the Republic Act No. 11037 “Masustansyang Pagkain para
sa Batang Pilipino Act” which states that the system shall harmonize
all existing national and local nutrition databases from the national
government agencies (NGAs), local government units (LGUs), and other
relevant agencies of the government to identify individual groups, and
localities that have the highest magnitude of hunger and undernutrition.

Upon completion of input of a child’s anthropometric measurements and other

relevant information needed in the OPT Plus, the NNIS mobile application
automatically computes for the nutritional status of the child in real-time.

Refer to the NNIS User’s Manual for step-by-step information in using the
application.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 239
Early Childhood Care and Development (ECCD) Card
Unlike the two other tools, the ECCD Card does not specifically
compute nutritional status, but instead plots the position of the
measured indicators on the standard growth charts based on the Child
Growth Standards (CGS) z-scores. In the table below is the matrix of
growth indicators and applicable growth charts with the corresponding
step-by-step procedures to identify nutritional status when used for
immediate feedbacking to caregivers. Section 5.4 elaborates on the
more detailed use of the ECCD Card.
Growth
Applicable CGS Charts Steps to identify nutritional status of child
Indicator

1. Select the applicable growth chart.

• Weight-for-age, birth 2. Identify the exact vertical line
to 6 months corresponding to the age then identify the
Weight- • Weight-for-age, 6 to horizontal line corresponding to the weight.
for-age 24 months 3. Mark the point where these lines intersect.
• Weight-for-age, 24 to 4. Looking at the right side of the plotted
71 months point, refer to the label of the bracket to
identify the nutritional status.

1. Select the applicable growth chart.

2. Identify the exact vertical line
• Length-for-age, birth
corresponding to the age then identify the
to 6 months
Length/ horizontal line corresponding to the length
• Length-for-age, 6 to
height- or height
24 months
for-age 3. Mark the point where these lines intersect.
• Height-for-age, 24 to
4. Looking at the right side of the plotted
71 months
point, refer to the label of the bracket to
identify the nutritional status.
1. Select the applicable growth chart.
2. Identify the exact vertical line
corresponding to the length or height (e.g.,
75 cm, 78.5 cm), then identify the horizontal
line corresponding to the weight.
Note: Due to the limited graphical
Weight- • Weight-for-length, representation, it is necessary to round
for- birth to 24 months the measurement to the nearest 0.5
length/ • Weight-for-height, 24 centimeter (i.e., round down if 0.1 to
height to 60 months 0.2 or 0.6 to 0.7 and round up if 0.3 to
0.4 or 0.8 to 0.9).
3. Mark the point where these lines intersect,
as precisely as possible.
4. Looking at the right side of the plotted
point, refer to the label of the bracket to
identify the nutritional status.
240 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
Weight-for-Age (WFA)

1. Select the applicable growth chart.

2. Identify the exact vertical line corresponding to the age then identify the
horizontal line corresponding to the weight.
3. Mark the point where these lines intersect.
4. Looking at the right side of the plotted point, refer to the label of the bracket to
identify the nutritional status.

Example: Maria is a 4-month old baby girl who weighs 5.6kg.

Using the ECCD Card’s WFA Growth Chart for birth to 6 months for girls, we first identify the
exact vertical line corresponding to the age then identify the horizontal line where her
weight falls. Maria’s age in months is 4, and since her weight falls between the two orange
lines which is within the Normal bracket on the right, MARIA is classified as NORMAL.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 241
Length/Height-for-Age (LFA/HFA)

1. Select the applicable growth chart.

2. Identify the exact vertical line corresponding to the age then identify the
horizontal line corresponding to the length or height
3. Mark the point where these lines intersect.
4. Looking at the right side of the plotted point, refer to the label of the bracket to
identify the nutritional status.

Example: Juan is a 9-month old boy whose measured length is 77.8cm.

Using the ECCD Card’s LFA Growth Chart for 6 to 24 months for boys, we first identify the
exact vertical line corresponding to the age then identify the horizontal line where his
length falls. Juan’s age in months is 9, and since his length falls between the green and blue
lines which is within the Stunted bracket on the right, JUAN is classified as MODERATELY
STUNTED.

242 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
Weight-for-Length/Height (WFL/WFH)

1. Select the applicable growth chart.

2. Identify the exact vertical line corresponding to the length or height (e.g., 75 cm, 78.5
cm), then identify the horizontal line corresponding to the weight.
Note: Due to the limited graphical representation, it is necessary to round the
measurement to the nearest 0.5 centimeter (i.e., round down if 0.1 to 0.2 or 0.6 to
0.7 and round up if 0.3 to 0.4 or 0.8 to 0.9).
3. Mark the point where these lines intersect, as precisely as possible.
4. Looking at the right side of the plotted point, refer to the label of the bracket to
identify the nutritional status.

Example: Pedro is a 33-month old boy who weighs 6.5kg and height is 72.2cm.

First, round off Pedro’s weight to the nearest 0.5cm, making the height 72.0cm. Using the ECCD
Card’s WFH Growth Chart for 24 to 60 months for boys, identify the exact vertical line corresponding
to the rounded off height then identify the horizontal line where his weight falls. Since Pedro’s
rounded off height is 72.0 cm and his weight falls below the blue line which is within the Severely
Wasted bracket on the right, Pedro is classified as SEVERELY WASTED/SAM.

Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation 243
244 Section 4: OPT Plus Protocol on Data Processing, Encoding, and Report Generation
Section Five

OPT PLUS
PROTOCOL ON DATA
INTERPRETATION AND
ACTION PLANNING
246 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
OPT PLUS PROTOCOL ON DATA
INTERPRETATION AND ACTION
PLANNING
OVERVIEW

Data is the backbone of a strong action plan. Are all the available
data utilized to make the right decisions? Section 5 discusses
analyzing and interpreting the OPT Plus data in action planning.
After reading this section, one should be able to:

1. Enumerate the roles and responsibilities of the supervisors and OPT Plus Team;
2. Enumerate the uses of the OPT Plus results;
3. Describe the process of report generation via eOPT Plus;
4. Analyze and interpret the plotted points in the growth chart, and identify normal growth
and growth problems; and
5. Understand how to utilize the OPT Plus results in action planning.

This section covers the interpretation of the OPT Plus results and
guidance on how these data can be used for local action planning.
Specific sections include the following:
Section 5.1 Roles and Responsibilities of OPT Plus Team and Supervisors
Section 5.2 Uses of OPT Plus Results
Section 5.3 Report Generation (eOPT Plus and Forms)
Section 5.4 Data Analysis and Interpretation
Section 5.5 Data Utilization and Action Planning

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 247
LIST OF TABLES

Table 5.1 Roles and Functions of the different persons involved in the OPT Plus during the
OPT Plus Data Interpretation and Action Planning.

Table 5.2 Growth indicators according to Z-score.

Table 5.3 Template for recording yearly results of nutritional status.

Table 5.4 Prevalence thresholds for wasting, overweight, and stunting in children under five
years (de Onis et al., 2019).

LIST OF FIGURES

Figure 5.1 Summary Sheet generated from the eOPT Plus (OPT Plus Form 1B).

Figure 5.2 Sample ECCD Growth Chart for plotting points.

Figure 5.3 Summary sheet generated from the eOPT Plus.

Figure 5.4 Sample spot-map showing the location of malnourished children.

Figure 5.5 Graph on the prevalence of stunted 0-to-59-month-old children generated from the
eOPT Plus.

Figure 5.6 Graph on the prevalence of wasted 0-59-month-old children generated from the
eOPT Plus.

248 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
LIST OF ACRONYMS

BNAP Barangay Nutrition Action Plan

BNC Barangay Nutrition Committee
BNS Barangay Nutrition Scholar
C/MNAO City/Municipal Nutrition Action Officer
C/MNAP City/Municipal Nutrition Action Plan
C/MNC City/Municipal Nutrition Committee
ECCD Early Child Care and Development
eOPT Plus Electronic Operation Timbang Plus
GB Governinig Board
LNAP Local Nutrition Action Plan
MW/MAM Moderately Wasted/Moderate Acute Malnutrition
MUw Moderately Underweight
MSt Moderately Stunted
NNC National Nutrition Council
NNC CO National Nutrition Council Central Office
Ob Obese
OW Overweight
PNAO Provincial Nutrition Action Officer
PNAP Provincial Nutrition Action Plan
PNC Provincial Nutrition Committee
PPAN Philippine Plan of Action for Nutrition
RNAP Regional Nutrition Action Plan
RNC Regional Nutrition Committee
RNPC Regional Nutrition Program Coordinator
RPAN Regional Plan of Action for Nutrition
RSDC Regional Social Development Committee
RTWG Regional Technical Working Group
SD Standard Deviation

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 249
SSt Severely Stunted
SSt Severely Stunted
St Stunted
SUW Severely underweight
SW/SAM Severely Wasted/Severe Acute Malnutrition
UW Underweight

250 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
DEFINITION OF TERMS

Barangay Nutrition Barangay-level version of the Philippine Plan of Action for Nutrition (PPAN),
Action Plan the country's directional framework for nutrition improvement.

eOPT Plus Tool An Excel-based tool used by nutrition workers in the community to help
them consolidate and summarize the results of OPT Plus among 0-to-59-
month-old children.

OPT Plus Regular growth assessment of all 0-to-59-month-old children in the

barangays done by a trained team including planning, follow-up, and
quality check activities.

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 251
Section 5.1

ROLES AND RESPONSIBILITIES

OF THE OPT PLUS TEAM AND
SUPERVISORS

The OPT Plus or mass measurement of children at the start of every year can help:

• Identify children's normal growth patterns and any growth problems from plotted
points using appropriate growth charts or Early Child Care and Development (ECCD)
card.

• Locate and identify preschoolers who are wasted, stunted, underweight, or overweight
to be referred to appropriate nutrition and nutrition-related programs and interventions.

• Allows the community to determine the magnitude and prevalence of malnutrition

and observe its trends that may be used to assess the effectiveness of local nutrition
programs.

• Serve as a guide in setting prioritiesand targets, nutrition objectives, and preparing

nutrition action plans for funding at the local level.

Table 5.1 presents the roles and responsibilities of the persons involved in the activity.

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 253
Table 5.1 Roles and Functions of the different persons involved in the OPT Plus during the OPT Plus Data
Interpretation and Action Planning.

ORGANIZATION/PERSON
FUNCTION
INVOLVED

National Nutrition 1. Present the OPT Plus trend during National Barangay Nutrition
Council Central Office Scholar (BNS) Conference and to the NNC Technical Committee,
(NNC CO) Technical Working Group, and other meetings.

2. Consolidate the OPT Plus results.

3. Include OPT Plus results in the Philippine Plan of Action for Nutrition
specifically areas not covered by National Nutrition Survey to
address nutrition problems.

Regional Nutrition 1. Present the OPT Plus trend during BNS Conference and to the
Program Coordinator Regional Nutrition Council (RNC), Regional Technical Working Group
(RNPC) (RTWG), and Regional Social Development Committee (RSDC)
among other fora.

2. Consolidate the OPT Plus results.

3. Include OPT Plus results in the Regional Nutrition Action Plan

(RNAP) to address nutrition problems.

Provincial Nutrition 1. Present the OPT Plus trend to the Provincial Nutrition Committee
Action Officer (PNAO) (PNC) and Provincial Board (Sangguniang Panlalawigan).

2. Consolidate the OPT Plus results.

3. Include OPT Plus results in the Provincial Nutrition Action Plan

(PNAP) to address nutrition problems.

4. Provide technical assistance in data analysis and interpretation.

Supervisor 1. Participate in the preparation of the Local Nutrition Action Plan

(LNAP).

254 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
ORGANIZATION/PERSON
FUNCTION
INVOLVED

City/Municipal Nutrition 1. Organize the presentation of OPT PLUS results to City/Municipal

Action Officer (C/ Nutrition Committee (C/MNC).
MNAO)
2. Review and consolidate the updated Barangay Nutrition Action Plan
(BNAP).

3. Facilitate the preparation of the City/Municipal Nutrition Action Plan

(C/MNAP).

4. Present the results of the OPT Plus to the Sangguniang Panlungsod/

Bayan for the budget appropriation of the C/MNAP.

5. Facilitate approval of resolutions at the barangay, municipal, and city

levels concerning OPT Plus activities.

OPT Plus Team members 1. Organize the presentation of OPT Plus results to BNC.

2. Facilitate the preparation and updating of the BNAP to the BNC.

3. Present the results of the OPT Plus to the Sangguniang Barangay

for the budget appropriation of the BNAP.

4. Facilitate approval of resolutions at the barangay level concerning

OPT Plus activities.

Barangay Nurition 1. Participate in the presentation of OPT Plus.

Committee (BNC)
2. Participate in preparing and updating the BNAP.

3. Allocate funds to implement the programs/projects/ activities of the

BNAP.

4. Review and approve resolutions concerning OPT Plus activities.

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 255
Section 5.2

USES OF OPT PLUS

RESULTS

The OPT Plus or mass measurement of children at the start of every year can help:

• Identify children's growth problems from plotted points using a single indicator growth
chart or ECCD card.

• Locate and identify preschoolers who are wasted, stunted, underweight, or overweight
to be referred to appropriate nutrition and nutrition-related programs and interventions.

• Allows the community to determine the magnitude and prevalence of malnutrition

and observe its trends that may be used to assess the effectiveness of local nutrition
programs.

• Serve as a guide in setting priorities and targets, nutrition objectives, and preparing
nutrition action plans for funding at the local level.

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 257
Section 5.3

REPORT GENERATION
(EOPT PLUS AND FORMS)

The results of the nutritional assessment will be more useful if the data will be
consolidated. The summary table can be generated automatically in the eOPT
Plus Summary worksheet. If without access to a computer, tally the child’s
nutritional status using OPT Plus Form 1B.

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 259
Figure 5.1. Summary Sheet generated from the eOPT Plus (OPT Plus Form 1B).

260 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Section 5.4

DATA ANALYSIS AND

INTERPRETATION

Data needs to be organized and visualized so that the reader can understand the
information for its purpose. Organization also allows proper data analysis and
interpretation and thus derives meaning. Data analysis and interpretation can be
made on individual and community levels.

Individual Level
Using obtained information and accurate measurements, these are then plotted
as points using appropriate growth charts which can also be found in the Early
Childhood Care and Development Card. The following growth indicators are
plotted to create line graphs that indicate the rank of the child’s measurement.
The charts can be seen in Annexes 5.1a and 5.1b.

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 261
Plotting length/height-for-age
PURPOSE PLOTTING POINTS

• Monitor growth in length or height of the 1. Select the growth chart for a girl or boy.
child’s age at a given visit.
2. Identify the age then plot on the
• Identify children who are stunted (short) corresponding vertical line (not between
due to prolonged undernutrition or repeated vertical lines).
illness.
3. Plot on or between the horizontal lines as
• Identify children who are tall for their age. precisely as possible.

4. When points are plotted for two or more

visits, connect adjacent points with a straight
line to better observe the trend.

Plotting weight-for-age
PURPOSE PLOTTING POINTS

• Monitor weight relative to the child’s age at 1. Select the growth chart for a girl or boy.
the time of visit.
2. Identify the age then plot on the
• Assess whether a child is moderately or corresponding vertical line (not between
severely underweight. vertical lines).

3. Plot on or between the horizontal lines to

show weight measurement to 0.1 kg, e.g.,
Note: The WFA indicator is NOT USED to classify
7.8 kg.
a child as overweight or obese. THIS CAN NOT
BE RELIED UPON situations where the child’s 4. When points are plotted for two or more
age cannot be accurately determined visits, connect adjacent points with a straight
line to better observe trends.

262 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Plotting length/height-for-age
PURPOSE PLOTTING POINTS

• Monitor weight in proportion to attained 1. Select the growth chart for a girl or boy.
growth in length or height.
2. Identify the height and plot the length or
• Identify children with low weight-for-height height on the corresponding vertical line
who may be moderately wasted or severely (e.g., 75 cm, 78 cm).
wasted, especially when the children’s ages
Note: It is necessary to round the
are unknown.
measurement to the nearest whole
• Identify wasting caused by a recent illness or centimeter (i.e., round down if 0.1 to 0.4 and
food shortage that causes acute and severe round up if 0.5 to 0.9).
weight loss, although chronic undernutrition
3. Plot weight on the corresponding horizontal
or illness can also cause this condition.
line as precisely as possible.
• Identify children with high weight-for-length/
4. When points are plotted for two or more
height who may be at risk of becoming
visits, connect adjacent points with a
overweight or obese.
straight line to observe the trend better.

Figure 5.2. Sample ECCD Growth Chart for plotting points.

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 263
Interpreting plotted points for growth indicators

Table 5.2. Growth indicators according to Z-score.

GROWTH INDICATOR
Z-SCORE
LENGTH/HEIGHT WEIGHT FOR WEIGHT FOR WEIGHT FOR
FOR AGE AGE LENGTH HEIGHT
>+3SD Obese Obese

+3SD Tall Overweight

Overweight Overweight
>+2SD

+2SD
Normal Normal Normal Normal
-2SD

<-2SD Moderately Moderately Moderately Moderately

-3SD Stunted Underweight Wasted Wasted

Severely Severely Severely Severely

<-3SD
Stunted Underweight Wasted Wasted

264 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Community Level
1. PRESENT. Select, organize, and group ideas and evidence in a logical way. Below are
some ways to present the OPT Plus results.

The BNS may present the overall prevalence of underweight, wasted, and stunted in the
barangay by sex, age group, and purok using the OPT Plus Form 1B table (Figure 5.3)
and graphs from the eOPT tool and with the aid of a spot map.

Figure 5.3. Summary sheet generated from the eOPT Plus.

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 265
2. ANALYZE. Examine the data for patterns and initial observations and then explore any
data limitations. Before beginning data analysis, it is important to discuss any limitations
in the data. Make sure not only the correct measurements are done but as well as
the correct encoding and identification of nutritional status. There are also data quality
checks that can be used in Section 7.

Different Ways to Analyze the OPT Plus results:

a. Present the previous OPT results and compare them with the current year with
the MNAO/OPT Team. Table 5.2 is the sample matrix. Discuss the data if there is
a decrease or increase in the prevalence in the different indices. Take note of the
questions raised by the BNC.

Table 5.3. Template for recording yearly results of nutritional status.

NUTRITIONAL YEAR/PREVALENCE
INDICES
STATUS

Normal

Weight-for-Age MUW

SUW

Normal

Tall
Heigh-for-Age
MSt

SSt

Normal

OW
Weight-for-
Ob
Length/Height
MW

266 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
b. Use prevalence thresholds for wasted, overweight, and stunted (Table 5.3) in
0-59-month-old children.
• Thresholds are cut-off values used for interpreting measurements of individual
children.
• The different labels used for the Interpretation of Anthropometry are ‘low,’
‘medium,’ ‘high,’ and ‘very high.’ A category labeled ‘very low’ has no public
health concern.
• The labels can be used for descriptive purposes to map communities according
to severity levels, identify priority communities for action, and by governments
to trigger action and target programs to achieve ‘low’ or ‘very low’ levels.

Table 5.4. Prevalence thresholds for wasting, overweight, and stunting in children
under five years (de Onis et al., 2019).

WASTING OVERWEIGHT STUNTING

PREVALENCE PREVALENCE PREVALENCE
LABELS LABELS LABELS
THRESHOLDS THRESHOLDS THRESHOLDS
(%) (%) (%)

<2.5 Very Low <2.5 Very Low <2.5 Very Low

2.5 - <5 Low 2.5 - <5 Low 2.5 - <10 Low

5 - <10 Medium 5 - <10 Medium 10 - <20 Medium

10 - <15 High 10 - <15 High 20 - <30 High

≥15 Very High ≥15 Very High ≥30 Very High

c. Use the spot map (Figure 5.4) to visualize which purok/s have the highest
malnourished children.

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 267
Figure 5.4. Sample spot-map showing the location of malnourished children.

3. INTERPRET. Understanding the findings and why they are occurring can help address
them and focus on the action plan.

• A high prevalence of stunting in a community indicates the presence of a more

severe and chronic form of undernutrition, which may be due to long-term food
deprivation and overall poor health. Use the graphs (Figures 5.5 and 5.6) generated
from the eOPT Plus tool to present the OPT Plus results.

268 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Figure 5.5. Graph on the prevalence of stunted 0-to-59-month-old children
generated from the eOPT Plus.

• A high prevalence of wasting in a community may indicate a short-term/ acute food

shortage as in the cases of calamities and/or widespread infections in the immediate
past. If not addressed immediately, wasting may increase stunting in the community
in the long term.

• Several data points for wasting can allow analysis of seasonality patterns and trends
of food shortages and certain illnesses. It will enable more sensitive forecasting
and targeting of children selected for supplemental feeding to prevent further
undernutrition.

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 269
Figure 5.6. Graph on the prevalence of wasted 0-to-59-month-old children
generated from the eOPT Plus.

270 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Section 5.5

DATA UTILIZATION AND

ACTION PLANNING

The activity does not end with submitting and presenting results. The BNC should use
the data generated from OPT Plus for action planning. The National Nutrition Council
(NNC) issued Governing Board (GB) Resolution No. 3, S. 2014 Approving and Adopting
the Guidelines on Local Nutrition Planning. Using the OPT Plus results, household profile,
and other data available in the barangay, the following guide questions will guide you in
ensuring that nutrition problems in your community are properly addressed:

1. What forms of malnutrition were identified in the OPT Plus?

2. How many are malnourished children?

3. Where are they located?

4. What are the causes of malnutrition in the area? Or the child?

5. What nutrition interventions should be implemented?

6. What is the cost of implementing the nutrition interventions?

7. Where can we get the resource?

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 271
NOTE 5.1.
Use the OPT Plus data in the targeting of the number of children in the
BNAP. The OPT Plus Form 1B already has the number of 0-to-59-month-old
children, 0-to-23-months, and children UW, SUW, MW/MAM, SW/SAM, St,
OW, and Ob summarized. Use this data in the Annual Target number in the
different nutrition activities.

Make a table on where data will be utilized Similarly, the consolidated results of the OPT
(from OPT Plus to other sectors and how they Plus must be used at the municipal/city and
can utilize data) in the preparation of the BNAP. provincial level in the targeting of the number of
The BNAP is a local version of the Philippine children in the municipal/city/provincial nutrition
Plan of Action for Nutrition (PPAN), the country's action plan. The OPT Plus results may also be
directional framework for nutrition improvement. used at the regional level for targeting of the
Below is the BNAP Outline which can be found Regional Plan of Action for Nutrition (RPAN).
in the Barangay Nutrition Program Management
Handbook.

272 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
REFERENCES

de Onis, M., Borghi, E., Arimond, M., Webb, P., Croft, T., Saha, K., De-Regil, L. M., Thuita, F., Heidkamp,
R., Krasevec, J., Hayashi, C., & Flores-Ayala, R. (2019). Prevalence thresholds for wasting,
overweight and stunting in children under 5 years. Public health nutrition, 22(1), 175–179. https://
doi.org/10.1017/S1368980018002434

Lalap, B.A, Maneja, M.C.P., Gonzales, P.G., Abuyog, A.T., Castaneda, A.B., Garma, G.F., Felix, A. dR.
BIDANI Network Program. Participative Nutrition Enhancement Approach Manual. Unpublished.
2021

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 273
LIST OF ANNEXES

ANNEX 5.1a Growth chart for girls by age group

Weight-for-age, 0-6 months

Length-for-age, 0-6 months

Weight-for-length, 0-24 months

Weight-for-age, 6-24 months

Length/height-for-age, 6-24 months

Weight-for-height, 24-60 months

Weight-for-age, 24-71 months

Height-for-age, 24-71 months

ANNEX 5.1b Growth chart for boys by age group

Weight-for-age, 0-6 months

Length-for-age, 0-6 months

Weight-for-length, 0-24 months

Weight-for-age, 6-24 months

Length/height-for-age, 6-24 months

Weight-for-height, 24-60 months

Weight-for-age, 24-71 months

Height-for-age, 24-71 months

ANNEX 5.2 BNAP Template

Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 275
ANNEX 5.1a. Growth chart for girls by age group

276 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 277
278 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 279
280 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 281
282 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 283
ANNEX 5.1b. Growth chart for boys by age group

284 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 285
286 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 287
288 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 289
290 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Section 5: OPT Plus Protocol on Data Interpretation and Action Planning 291
ANNEX 5.2. BNAP Template

Barangay Nutrition Action Plan

(Year)
Barangay, Municipality, or City

A. Introduction (Panimula)
B. Nutrition Situation (Ang Kalagayang pang-nutrisyon sa Barangay)
• What forms of malnutrition were identified in the OPT Plus? (Anu-anong uri
ng malnutrisyon?)
• How many are malnourished children? (Ilan ang bilang ng malnutrisyon?)
• Who are malnourished? (Sinu-sino ang mga mayroong malnutrisyon?)
• Where are the malnourished located? (Saan nakatira ang mga mayroong
malnutrisyon?)
• What are the causes of malnutrition in the area? Or the child? (Anu-ano ang
mga sanhi ng malnutrisyon?)
• What are the steps to address malnutrition (Anu-ano ang mga hakbang na
ginawa para matugunan ang malnutrisyon?)
• How effective are the interventions? (Gaano ito ka-epektibo?)
• What are the resources available to address malnutrition? (Anu-anong
resources ang mayroon para sapag tugon sa malnutrisyon?)
• What are the possible hindrances that will affect the implementation of the
nutrition programs? (Anu-ano ang mga balakid na maaaring makaapekto sa
implementasyon ng mga programang pang-nutrisyon?)
C. Objectives
D. Work / Operational Plan
E. Monitoring and Evaluation (Pagsubaybay at Pagsusuri)
F. Budget / Financial Strategy (Badyet /Stratehiyang Pinansyal)
G. Attachment: Nutrition in Emergency Work Plan (Response and Recovery)

NOTE:
Refer to the NNC Barangay Nutrition Program Management Handbook.

292 Section 5: OPT Plus Protocol on Data Interpretation and Action Planning
Section Six

OPT PLUS PROTOCOL

ON FOLLOW THROUGH
ACTIVITIES

Section 6: OPT Plus Protocol on Follow Through Activities 293

OPT PLUS PROTOCOL
ON FOLLOW THROUGH
ACTIVITIES
OVERVIEW

The follow through activities is an important component of the OPT

Plus monitoring and evaluation process which aims to enhance
continuity and implementation. Section 6 covers practical guidelines
for monitoring and evaluating the OPT Plus activities.
After reading this section, one should be able to:

1. Enumerate the roles and responsibilities of the nutrition offices, supervisors, and OPT
Plus team members;
2. Define the importance of conducting follow through activities;
3. Identify the steps in conducting child growth monitoring and active search; and
4. Be familiar with the form used for BNAP monitoring.

This section covers the process of conducting OPT Plus follow through
activities. Specific sections include the following:

Section 6.1 Roles and Responsibilities of the Supervisors and OPT Plus Team in
the Monitoring and Evaluation
Section 6.2 Child Growth Monitoring and Active Search
Section 6.3 BNAP Monitoring

Section 6: OPT Plus Protocol on Follow Through Activities 295

LIST OF ACRONYMS

BNAP Barangay Nutrition Action Plan

BNC Barangay Nutrition Committee
BNS Barangay Nutrition Scholar
C/MNAO City/Municipal Nutrition Action Officer
CMAM Community Management of Acute Malnutrition
eOPT Plus Electronic Operation Timbang Plus
IDA Iron Deficiency Anemia
IGP Income Generating Project
IYCF Infant and Young Child Feeding
MAM Moderate Acute Malnutrition
MNP Micronutrient Powder
MSt Moderately Stunted
MUW Moderately Underweight
MW Moderately Wasted
MW/MAM Moderately Wasted/Moderate Acute Malnutrition
NAP Nutrition Action Plan
NNC CO National Nutrition Council Central Office
Ob Obese
OW Overweight
P/C/MNAO Provincial/City/Municipal Nutrition Action Officer
PPAN Philippine Plan of Action for Nutrition
RNPC Regional Nutrition Program Coordinator
SAM Severe Acute Malnutrition
SPS Sangkap Pinoy Seal
SSt Severely Stunted
St Stunted
SUW Severely Underweight
SW Severely Wasted
SW/SAM Severely Wasted/Severe Acute Malnutrition

Section 6: OPT Plus Protocol on Follow Through Activities 297

DEFINITION OF TERMS

Active Search A more aggressive approach in locating the target children than passive
search, which relies on when the child is brought to the health center.

Barangay Nutrition Barangay-level version of the Philippine Plan of Action for Nutrition (PPAN);
Action Plan plan of a village to address its malnutrition problems and their causes, it
includes the nutrition situation, list of nutrition interventions, monitoring
and evaluation process, and budget for BNAP implementation.

Barangay Nutrition Serves as the advisory committee to the Sangguniang Barangay in the
Committee planning and implementation of health and nutrition programs in the
barangay.

Interventions Actions taken to improve the nutritional status of children.

Monitoring and Ensures that implementation of OPT Plus continues after the
evaluation measurement of children and that the information collected is being
utilized in the area.

Stunting A form of malnutrition that results from chronic or long-term undernutrition

and can be classified using the length/height-for-age indicator. It is a
general term that refers to both moderate and severe stunting.

Underweight A form of malnutrition classified using the weight-for-age indicator.

It is also a general term referring to both moderately and severely
underweight.

Wasting A form of malnutrition that results from acute onset of undernutrition

classified using the weight-for-length/height indicator or MUAC. It is also
the term referring to both moderately and severely wasted.

298 Section 6: OPT Plus Protocol on Follow Through Activities

Section 6.1

ROLES AND RESPONSIBILITIES

OF THE SUPERVISORS AND OPT
PLUS TEAM IN THE MONITORING
AND EVALUATION

The OPT Plus Monitoring and Evaluation is a two-pronged approach that aims to monitor
the growth of children and the Nutrition Action Plans (NAP) of the barangay and city/
municipality. Monitoring and evaluation is an important part to:

• Ensure that implementation of OPT Plus continues after the initial measurement of
the children, and

• The information collected is being utilized in the community.

Table 6.1 enumerates the roles and responsibilities of the nutrition offices, supervisors,
and OPT Plus members.

Section 6: OPT Plus Protocol on Follow Through Activities 299

Table 6.1. Roles and Functions of the different persons involved in the OPT Plus during the OPT Plus
Protocol on Follow Through Activities.

ORGANIZATION/PERSON
FUNCTION
INVOLVED

National Nutrition 1. Conduct mid-year and end-year meetings within the Nutrition
Council Central Office Surveillance Division staff regarding the conduct of OPT Plus.
(NNC CO)
2. Conduct national activities related to data quality check.

Regional Nutrition 1. Conduct end-year meetings with P/C/MNAOs to discuss the

Program Coordinator implemented programs and projects and updates on the nutritional
(RNPC) status of children.

2. Conduct regional activities related to data quality check.

Provincial Nutrition 1. Conduct mid-year meetings with C/MNAOs to discuss the

Action Officer (PNAO) implemented programs and projects and updates on the nutritional
status of children.

2. Conduct provincial activities related to data quality check.

Supervisor 1. Assist in reviewing the monthly and quarterly OPT Plus monitoring
coverage if all the children weighed and measured in the first
quarter were followed up.

2. Participate in the bi-annual review of the BNAP and assist in

presenting BNAP accomplishments during the Barangay General
Assembly.

City/Municipal Nutrition 1. Remind the BNC of the schedules of the monthly OPT Plus
Action Officer (C/ monitoring of SW/MAM and MW/MAM, underweight and 0-to-23-
MNAO) month-old, and quarterly monitoring of 24-to-59-month-old children.

2. Review the monthly and quarterly OPT Plus monitoring coverage if

all the children weighed and measured in the first quarter were all
followed up OR Assist in reviewing the monthly and quarterly OPT
Plus monitoring coverage if all the children measured were covered
during child growth monitoring.

3. Conduct a bi-annual review of the BNAP and present BNAP

accomplishments during the Barangay General Assembly.

4. Follow-up to the Barangay Nutrition Scholar (BNS) on the status of

the referred malnourished children.

5. Conduct city/municipal activities related to data quality check.

300 Section 6: OPT Plus Protocol on Follow Through Activities

ORGANIZATION/PERSON
FUNCTION
INVOLVED

OPT Plus Team members 1. Remind the BNC of the schedules of the monthly OPT Plus
monitoring of SW/MAM and MW/MAM, underweight and 0-to-23-
month-old, and quarterly monitoring of 24-to-59-month-old children.

2. Review the monthly and quarterly OPT Plus monitoring coverage if

all the children weighed in the first quarter were all weighed.

3. Organize a bi-annual review of the BNAP and assist in presenting

BNAP accomplishments during the Barangay General Assembly.

Barangay Nurition 1. Assist in conducting monthly OPT Plus monitoring of SW/MAM

Committee (BNC) and MW/MAM, underweight and 0-to-23-month-old, and quarterly
monitoring of 24-to-59-month-old children.

2. Participate in the bi-annual review of the BNAP and present BNAP

accomplishments during the Barangay General Assembly.

3. Conduct barangay activities related to data quality check.

Section 6: OPT Plus Protocol on Follow Through Activities 301

Section 6.2

CHILD GROWTH MONITORING

AND ACTIVE SEARCH

After weighing and measuring, the nutritional and ensure that they are referred to appropriate
status of 0-to-59-month-old children will be services and interventions. Instead of the center-
determined. While some will be classified as or facility-based search mode, the child growth
normal, a percentage of these children could be monitoring will employ active cases search.
identified with at least one form of undernutrition. Active Search is a more aggressive approach to
The target of OPT Plus child growth monitoring locating the target children than passive search,
and conducting an active search is 0-to-59- which relies on instances when the child is
month-old children classified as underweight brought to the health center. Use the forms for
and/or wasted (MW/MAM and SW/SAM) along OPT Plus Monitoring, which can be generated
with all 0-to-23-month-old infants. These children from the eOPT Plus.
will be weighed monthly to monitor their growth

Instructions
The OPT Plus Monitoring Forms 1 to 8 (eOPT Plus Tool Worksheets) have a similar format for all, varying
only on the identified nutritional status of the children. The columns on the left provide the information
of the child which includes the address, name of the child, name of mother or caregiver, sex, birth date,
and the initial length/height (cm), and weight (kg). This is automatically generated when information is
encoded in the OPT Plus Form 1A. Moreover, the columns after the personal information are allotted for
recording the weight and length/height during the follow-up visits.

Section 6: OPT Plus Protocol on Follow Through Activities 303

304
eOPT Plus v2 Worksheet: List of 0-23 mos is the list of 0-23-month-old children

Section 6: OPT Plus Protocol on Follow Through Activities

eOPT Plus v2 Worksheet: List_MW(MAM) is the list of 0-59-month-old children who are moderately wasted/
moderate acute malnutrition

Section 6: OPT Plus Protocol on Follow Through Activities

eOPT Plus v2 Worksheet: List_SW(SAM) is the list of 0-59-month-old children who are severely wasted/severe
acute malnutrition

305
306
eOPT Plus v2 Worksheet List_MSt&SSt is the list of 0-59-month-old children who are moderately stunted/
severely stunted

eOPT Plus v2 Worksheet: List_OW&Ob is the list of 0-59-month-old children who are overweight
and obese

Section 6: OPT Plus Protocol on Follow Through Activities

eOPT Plus v2 Worksheet: List_MUW, SUW,MSt&SSt is the list of 0-59-month-old children who are both stunted
and underweight

eOPT Plus v2 Worksheet: List_MSt,SSt,MW&SW is the list of 0-59-month-old children who are both stunted and
wasted

Section 6: OPT Plus Protocol on Follow Through Activities

307
eOPT Plus v2 Worksheet: List_MSt,SSt,OW&Ob is the list of 0-59-month-old children who are both stunted and

308
overweight/obese

eOPT Plus v2 Worksheet: List_MUAC Status is the list of 6-59-month-old children by MUAC status

Section 6: OPT Plus Protocol on Follow Through Activities

Section 6.3

BNAP MONITORING
During the BNC Meeting every quarter, report the updates on the nutritional status of the target
groups for monthly weighing using the OPT Plus Monitoring Form 1A to 1G. Monitor the BNC
Action Plan implementation status by answering the BNC Quarterly Accomplishment Report
(Annex 6.1). Worksheet 1 is the sample template and instructions.

Worksheet 1. BNC Quarterly Accomplishment Report.

QUARTERLY OUTREACH (COLUMN 4)

TARGET TARGET
ACTIVITY
GROUP NUMBER 1ST 2ND 3RD 4TH
(COLUMN 1)
(COLUMN 2) (COLUMN 3) QUARTER QUARTER QUARTER QUARTER
NO. % NO. % NO. % NO. %

A. ACTIVITY 1

Instructions

• First Column (Activity): identify the interventions listed in the BNAP,

• Second Column (Target group): list the target groups (i.e. 0-59-month-old children,
0-23-month-old children, stunted, wasted, underweight, etc.).

• Third Column (Target number): write down the target number per age group or nutritional
status classification based on the OPT Plus results.

• Fourth Column (Quarterly Outreach): update the number of children that were involved or
referred to the listed activities in the first column. This should be done every quarter of the
year (March, June, September, and December).

Section 6: OPT Plus Protocol on Follow Through Activities 309

REFERENCES

Department of Health (DOH). (2010). Manual of Operation on Growth Monitoring and Promotion of
Children in the Philippines using the WHO Child Growth Standards.

310 Section 6: OPT Plus Protocol on Follow Through Activities

ANNEX 6.1 BNC Quarterly Accomplishment Report

Quarterly Outreach
Target 1st 2nd 3rd 4th
Activity Target Group
Number Quarter Quarter Quarter Quarter
No. % No. % No. % No. %
A. Weighing Activities
1. Full Weighing (OPT+) All 0-59-month old children
2. OPT Plus Monitoring 0-23-months
Underweight (UW)
Severely UW (SUW)
Moderately Wasted (MW/
MAM)
Severely Wasted (SW/SAM)
Stunted (St)
Overweight (OW)
Obese (Ob)
24-59-month-old
B. Nutrition Specific Programs
1. Infant and Young Child Feeding
a. Referrals for breastfeeding Pregnant
counseling
Lactating
b. Conduct breastfeeding/ Pregnant
complementary feeding
Lactating
counseling
Mothers with MW/MAM or SW/
SAM children
c. Other activities
2. Integrated Management of Acute Malnutrition
a. Referral of MW/MAM and SW (SAM) 6- to 59- months
SW/SAM children
MW (MAM) 6- to 59- months
b. Referrals for ITC and OTC SW (SAM) 6- to 59- months
MW (MAM) 6- to 59- months
c. Assistance in OTC
3. National Dietary Supplemental Feeding
a. Referrals to/for: Dietary MUW and SUW 6- to 23-
Supplementation months
MUW and SUW 24-to
59-months
Nutritionally At-risk Pregnant
Mothers
Infants 6- to 23- months
Pregnant
Lactating

Section 6: OPT Plus Protocol on Follow Through Activities 311

Quarterly Outreach
Target 1st 2nd 3rd 4th
Activity Target Group
Number Quarter Quarter Quarter Quarter
No. % No. % No. % No. %
a. Assistance for Moderate Families of MW (MAM)
Acute Malnutrition (MW/
MAM) Supplementary
Feeding
4. National Promotion for Behavior Change
a. Conduct of Nutrition Mothers of MUW (children)
Education, Education
Mothers of SUW children
Classes (Pabasa sa
Nutrisyon, Idol ko si Mothers of MW (MAM)
Nanay, etc) children
Mothers of SW (SAM) children
Mothers of Stunted children
Mothers of OW children
Pregnant
Lactating
Mothers with infants 0- to 23-
months
Mothers with infants 24- to
59-months
b. Home visits/follow up/ Mothers/ caregivers of 0- to
counseling 23- months
Mothers of MUW
Mothers of SUW
Mothers of MW (MAM)
Mothers of SW (SAM)
Mothers of St
Mothers of OW
Fathers or other male family
members of 0- to 23- months
c. Distribution of Information, Mothers of MUW
Education and
Mothers of SUW
Communication materials
(IECM) Mothers of MW (MAM)
Mothers of SW (SAM)
Pregnant
Lactating
Mothers with infants 0- to 23-
months
Mothers with infants 24- to
59-months

312 Section 6: OPT Plus Protocol on Follow Through Activities

Quarterly Outreach
Target 1st 2nd 3rd 4th
Activity Target Group
Number Quarter Quarter Quarter Quarter
No. % No. % No. % No. %
5. Micronutrient Supplementation
a. Vitamin A All 6- to 11-month old
Supplementation
All 12- to 59- month old
Pregnant
Post-partum women
b. Iron-folic acid Pregnant
supplementation
Lactating
All 6- to 11-month old
All 12- to 59- month old
5-9 years old with IDA
13-18 years old adolescent
girls
c. Zinc Supplementation 0-59 years old with diarrhea
d. Provision of MNP 6- to 23-months
e. Provision of iodized oil Pregnant and lactating
capsules mothers in endemic areas
f. Provision of calcium Pregnant
supplements
6. Mandatory Food Fortification
Assist on: Families of MUW
a. Promotion of Sangkap
Families of SUW
Pinoy Seal (SPS)
Families of MW (MAM)
Families of Severely SW
(SAM)
Families of St
Others
b. Promoting the use of All families
iodized salt
c. Promotion of the use of All Families
fortified rice/flour/cooking
oil
7. Nutrition-in-emergencies
Referral on 0- to 59- months
a. Assessment
b. IYCF Counselling 0- to 59- months
c. Distribution of Vitamin A 0- to 59- months
capsules
d. Community management 0- to 59- months
of Acute Malnutrition
(CMAM) e.g. referral of
cases

Section 6: OPT Plus Protocol on Follow Through Activities 313

Quarterly Outreach
Target 1st 2nd 3rd 4th
Activity Target Group
Number Quarter Quarter Quarter Quarter
No. % No. % No. % No. %
8. Overweight and Obesity Management and Prevention Program
Assist on OW and Ob children
a. Conduct weight
management referral for
overweight and obese
individual
b. Conduct of weight OW and Ob children
management intervention
for overweight and obese
individual
C. Nutrition-Sensitive Programs
1. Home, school, and community food production
Assist on: Families of MUW
a. Seeds/seedlings
Families of SUW
distribution home
gardening Families of MW (MAM)
Families of Severely SW
(SAM)
Families of Pregnant
Families with 0 to 59 months
Other families
b. Establishment of Families of MUW
b1. home yard gardens
Families of SUW
Families of MW (MAM)
Families of Severely SW
(SAM)
Families with 0-23 months old
b2. community gardens Barangays
b3. school gardens Schools
c. small animal dispersal Families of MUW
Families of SUW
Families of MW (MAM)
Families of Severely SW
(SAM)
Other families
2. Livelihood Assistance
Referral on Families of MUW
a. Credit or lending
Families of SUW
institutions for credit
assistance Families of MW (MAM)
Families of Severely SW
(SAM)
Other families

314 Section 6: OPT Plus Protocol on Follow Through Activities

Quarterly Outreach
Target 1st 2nd 3rd 4th
Activity Target Group
Number Quarter Quarter Quarter Quarter
No. % No. % No. % No. %
a. Agencies providing Families of MUW
material support for IGP
Families of SUW
Families of MW (MAM)
Families of Severely SW
(SAM)
Other families
c. IGP training supports IGP Families of MUW
Families of SUW
Families of MW (MAM)
Families of Severely SW
(SAM)
Other families

Section 6: OPT Plus Protocol on Follow Through Activities 315

316 Section 6: OPT Plus Protocol on Follow Through Activities
Section Seven

DATA QUALITY CHECK

(DQC)

Section 7: Data Quality Check 317

318 Section 7: Data Quality Check
DATA QUALITY CHECK (DQC)

OVERVIEW

The goal of OPT Plus is not just to produce the nutritional status
data in the community but also to ensure that the data are produced
through quality procedures. Section 7 discusses the basic principles
of data quality and the OPT Plus Data Quality Check (DQC).
After reading this section, one should be able to:

1. Enumerate the basic concepts and principles of data quality;

2. Describe the data quality dimensions of OPT Plus; and
3. List the Data Quality Check Protocol at different levels.

Section 7 covers the data quality assessment components of OPT Plus.

Specific sections include the following:
Section 7.1 Concepts, Principles, and Dimensions of Data Quality
Section 7.2 Guidelines in Assuring Data Quality in Key Areas of OPT Plus Protocol

Section 7: Data Quality Check 319

LIST OF ACRONYMS

AIP Annual Investment Plan

BNAO Barangay Nutrition Action Officer
BNAP Barangay Nutrition Action Plan
BNC Barangay Nutrition Committee
BNS Barangay Nutrition Scholar
BNSAP Barangay Nutrition Scholar Action Plan
C/MNAO City/Municipal Nutrition Action Officer
C/MNC City/Municipal Nutrition Committee
DQC Data Quality Check
eOPT Electronic Operation Timbang
L/HFA Length/Height-for-Age
LGU Local Government Unit
MAM Moderate Acute Malnutrition
MSt Moderately Stunted
MUW Moderately Underweight
MW/MAM Moderately Wasted/Moderate Acute Malnutrition
NNC CO National Nutrition Council Central Office
NNC RO National Nutrition Council Regional Office
NSD Nutrition Surveillance Division
Ob Obese
OPT Plus Operation Timbang Plus
OW Overweight
PIR Program Implementation Review
PNAO Provincial Nutrition Action Officer
PNC Provincial Nutrition Committee
RNPC Regional Nutrition Program Coordinator
SAM Severe Acute Malnutrition

320 Section 7: Data Quality Check

SSt Severely Stunted
SUW Severely Underweight
SW/SAM Severely Wasted/Severe Acute Malnutrition
UNICEF United Nations Children’s Fund
WFA Weight-for-Age
WFL/H Weight-for-Length/Height
WHO World Health Organization

Section 7: Data Quality Check 321

DEFINITION OF TERMS

Accuracy Aims to determine the quality of measurements and the quality of the
tools used for measurement.

Completeness Refers to the extent to which the data collection covers the target
population.

Integrity Refers to when the system used to generate them is protected from
deliberate bias or manipulation for political or personal reasons.

Reliability Concerned with producing data using standard protocols or procedures

that can be consistently repeated regardless of user or frequency of
the conduct.

Timeliness Refers to the review of OPT Plus data and reports submitted to key
personnel during the period specified in the protocol.

Usefulness Refers to the provision of nutrition services to at-risk 0-59-month-old

children.

Z-score Indicates how much a given value differs from the standard deviation.
The child’s z-score determines his/her nutritional status.

322 Section 7: Data Quality Check

Section 7.1

CONCEPTS, PRINCIPLES,
AND DIMENSIONS OF
DATA QUALITY

Quality data is a prerequisite for better Anthropometry data quality poses implications
information needed in decision-making and policy in understanding the prevalence and burden of
making. In nutrition, quality anthropometric data malnutrition. Threats to data quality can arise
and quality socio-demographic information such at various stages of program implementation,
as sex and age are vital in order to have accurate from initial development, training, and actual
and reliable nutritional status assessment. fieldwork to data recording, cleaning, and
This information will be the primary basis of analysis (Corsi et al., 2017).
policymakers, program managers, researchers,
and advocates of nutrition in devising their
nutrition programs and interventions.

Section 7: Data Quality Check 323

Factors affecting anthropometry
Inaccuracies and deficiencies in anthropometry age calculation in days, as part of the 2019
data quality frequently exist especially in large- recommendations of WHO and UNICEF. In their
scale survey implementation, thus posing report, WHO and UNICEF (2019) noted that if
implications in understanding the prevalence and only the month and year of birth are provided,
burden of malnutrition. Threats to data quality can it must be imputed as missing day of birth. For
arise at the various stages of program standard analysis, however, the 15th day of the
implementation, from initial development, month is recommended to be used.
training, and actual fieldwork to data recording,
cleaning, and analysis (Corsi et al., 2017). Below is Imprecise anthropometry measurements
a descriptive summary of the various factors that
adversely affect anthropometry data quality as Ensuring the accuracy and precision of
identified by the studies and literature reviewed anthropometry measurements are of great
for this desk research. importance in generating a reliable base of
information for growth monitoring and nutrition
Improper age reporting and calculation interventions. This can be owed to the fact that
anthropometry data quality is directly related to
Age is considered to be a crucial data in processing the evaluation of nutrition prevalence and status
and interpreting anthropometry measurements (Leidman et al., 2018). Adversely, imprecise and
since it is primarily used in determining the inaccurate anthropometry measurements pose
presence of stunting and underweight. Studies a significant threat to overall data quality. As
(Grellety & Golden, 2018; Finaret & Hutchinson, emphasized by Leidman et al. (2018), imprecise
2018; Figueroa & Kurdi, 2019) report that data measures of weight and height can result in
errors are usually found in age estimation wider values of standard deviation, suggesting
and misreporting. Due to poor date of birth an overestimated value for the prevalence
information, discontinuities in the estimates nutrition indicators.
of mean height-for-age (HAZ) by month of birth
(MOB) may occur (Perumal et al., 2020). Likewise, Imprecise measures can also lead to statistically
data errors introduced by merely estimating the and biologically implausible values, which in
age, rather than computing it, may overestimate some cases are flagged and corrected to fit
the prevalence of nutrition indicators (Leidman, the accepted range of growth standards. Such
Mwirigi, Maina-Gathigi, Wamae, Imbwaga, & practice may generate data that are within the
Bilukha, 2018). acceptable range but are of poor quality (Corsi
et al., 2017). Few studies (Finaret & Hutchinson,
Tools such as the eOPT Plus, SMART ENA, and 2018; Manzoni et al., 2019), on the other hand,
WHO AnthroPlus allow for the calculation of age reported that implausible values are rather
in months. For more precise values, the WHO tagged as missing data than having them
Anthro Survey Analyser, on the other hand uses flagged or corrected.

324 Section 7: Data Quality Check

Furthermore, inaccurate and imprecise Bilukha, Couture, McCain, and Leidman (2020)
anthropometry measurements can be attributed highlighted in their methodology that missing
to some factors including inconsistencies in and incomplete data has the potential to bias
measuring techniques and protocols (Phan et nutritional indicators, thus the completeness
al., 2020), use of uncalibrated and nonstandard of weight, height, age, and sex variables must
measuring equipment, as well as human error be initially evaluated.Incomplete data are easily
itself or the competence of measurers. The detected and imputed with the use of DQA tools
latter factor is further elaborated in a succeeding similar to the ones previously mentioned. WHO
subsection. and UNICEF’s recommendations, in particular,
foregrounds data completeness as one of the
The use of automated tools, such as the ones primary measures of data quality.
mentioned in the previous section are deemed
useful in preventing entry of data that are Incompetence of measurers
inaccurate and precise. This is possible through
the inclusion of plausibility check and range check Ramirez, Viajar, and Azaña (2019) suggested
features. However, it must be noted that data are that human error can affect the accuracy of
susceptible to manipulation or correction in order data measurements, calculation of age, data
to fit the standard plausible range or limits (Corsi encoding, and validation. All of which are
et al., 2017). considered to be significant in maintaining the
accuracy of OPT Plus’s database. Moreover,
Incomplete anthropometry data data error may occur with the incorrect use of
the eOPT Plus Tool especially with untrained
Missing anthropometry data was reported to BNS or health workers as end users. This is
be another hindrance in ensuring data quality. comparable with the study of Grellety and
Completeness of data from the child and Golden (2018) in which they excluded from their
mother’s basic information down to the actual analysis the surveys that were administered by
anthropometry measurements must be reviewed inexperienced persons who lack performance
in order to generate reliable results. testing and adequate supervision, since such
surveys are indicative of data with questionable
For instance, the evaluation report published by quality. Given such, anthropometry training
the Innovations for Poverty Action(2019) showed and standardization tests are among the
that there was a significant percentage of children recommended activities to be implemented
with missing data in the 2017 and 2018 OPT, prior to actual anthropometry measurements in
suggesting that despite being eligible, a number order to ensure that measurers are capable of
of children were not measured. Similarly, an collecting and reporting data of high quality.
international study conducted by Grijalva-Eternod
et al. (2017) revealed problematic anthropometry
data quality among infants due to the large
proportion of missing anthropometry data.

Section 7: Data Quality Check 325

Data manipulation Contextual factors

Studies also reported instances of data fabrication Other factors that may directly or indirectly
and manipulation which can adversely affect data affect data quality were mentioned in a few
integrity. In their analysis of malnutrition surveys literature. For instance, Perumal et al. (2020)
administered across 55 countries, Grellety and emphasized that variations in the quality of
Golden (2018) excluded the data that had been anthropometry survey may be attributed to
fabricated and replicated from one survey to contextual factors that may hinder successful
another in order to maintain quality within the program implementation such as conflict,
level of their analysis. political instability, and geographical barriers.

In a local setting, the Innovations for Poverty Furthermore, WHO and UNICEF (2020) listed
Action (2019) suggested in their exploratory inadequate research infrastructure, low
analysis that OPT is susceptible to data investment, lack of data collection, and data
manipulation. In their evaluation, the HAZ processing technology as limiting factors in the
and weight-for-age (WAZ) distribution in the conduct of nutrition surveys, especially in the
specified study areas did not resemble a normal context of low-income countries.
curve. This was found to be indicative of data
manipulation deliberately done to underreport
stunting and underweight. The manipulation
was presumably executed by increasing the
actual height and weight measurements by
a small margin to fit the normal weight and
height criteria. The discontinuities found in the
analysis may also be due to the assumption that
undernourished children were taken of their best
measurements outside of the OPT period or right
after the LGU’s implementation of micronutrient
supplementation and feeding program.

Reviewed literature on DQA tools, however,

were silent on the likelihood and mitigation of
data manipulation. Hence, the strengthening of
monitoring and supervision on the part of field
officials and data collectors.

326 Section 7: Data Quality Check

Considerations to address anthropometry problems
The use of a well-established method or tool in child anthropometry and data quality
assessment is evidently a good practice in data management. Tools that have the ability to
clean criteria and feedback through plausibility checks (Grellety & Golden, 2018) can mark
some improvements in data quality. The tools developed by SMART, WHO, and UNICEF are
considered to be especially useful in ensuring data quality given the fact that these references
are based on international standards and valid research.

Dimensions of Data Quality

As for the Operation Timbang Data Quality Check (OPT DQC), the following dimensions were
identified for evaluation:

1. ACCURACY is concerned with the correctness of data such that it measures what
it intends to measure (WHO, 2008). This dimension aims to determine the quality of
measurements and the tools used for measurement. Indicators to be included directly
affect the quality of data collected (weight and length/height measurement) and the
generated child's nutritional status through OPT Plus.

2. RELIABILITY is concerned with producing data using standard protocols or procedures

that can be consistently repeated regardless of user or frequency of the conduct.
Indicators that will be used to measure reliability include training, standardization, and
the ability of the OPT Plus team to follow standard protocols and procedures to produce
consistent results. The reliability of the data on weight, height/length, date of birth, and
sex are also essential in this dimension.

3. COMPLETENESS refers to the extent to which the data collection covers the target
population.

4. TIMELINESS refers to the review of OPT Plus data and reports submitted to key personnel
during the period specified in the protocol.

5. USEFULNESS refers to providing nutrition services to at-risk 0-59-month-old children

The aforementioned dimensions can be completely achieved if done with Integrity - protected
from deliberate bias or manipulation for political or personal reasons.

Section 7: Data Quality Check 327

Section 7.2

GUIDELINES IN ASSURING
DATA QUALITY IN KEY AREAS
OF OPT PLUS PROTOCOL

A. DQC Tools
The data quality assessment of the OPT will be instituted at the different LGU levels. There
are four DQC tools in excel worksheet including 1) barangay, 2) large barangay, 3) city/
municipality, and 4) province. The details per level are described as follows.

1. BARANGAY LEVEL

The barangay DQC tool has eight worksheets including the form for: 1) Welcome; 2) DQC
Guide; 3) Basic Information (Form 1.1); 4) Supportive Supervision (Form 1.2A); 5) Action Plan
resulting from Supportive Supervision (Form 1.2B); 6) DQC dimension; 7) DQC Radial diagram;
and 8) OPT Plus Action Plan. The following are the step-by-step instructions:

Section 7: Data Quality Check 329

a. Welcome

b. OPT DQC Form 1.1: Barangay OPT Plus Data Quality Check Basic Information

Instructions:

Form 1.1. A. 1. Write all the names of the OPT Plus Team members.
2. Encode the latest OPT training information.

Form 1.1. B. 1. Encode the type of weighing scale and the length/height equipment used
and assess its condition.
2. Encode the availability of mid-upper arm circumference (MUAC) tape
and Child Growth Standards (CGS) charts, and record the OPT budgetary
allocation.

330 Section 7: Data Quality Check

Form 1.1. C. 1. Encode the availability of computer/s for eOPT and write its condition.
2. Specify the eOPT version used.
3. Indicate if there is an available barangay data encoder and write how
many encoders are available.
4. Encode the date when data was completed and encoded and write how
many days it was finished.
5. Encode the date when the data was checked and signed by the Brgy.
Captain.
6. Indicate the date when the data was presented to the Barangay Nutrition
Committee (BNC)/BDC, Brgy. Assembly.
7. Indicate the date when the data was submitted to the municipality.

Form 1.1. D. 1. Refer to the eOPT Plus tool and encode the number of children measured
based on their sex and age and the total number of children measured.
2. Encode the total number of children based on the latest population
projection used in the eOPT Plus tool.
3. Encode the total number of children based on the actual Population based
on household profile.
4. Refer to the printed Brgy. eOPT - OPT Plus Form 1A used and encode the
total NS feedbacked to the parents.

Form 1.1. E. 1. Encode the number of children identified as underweight/stunted/

overweight/ obese.
2. Encode the number of identified Moderate Acute Malnutrition (MAM) &
Severe Acute Malnutrition (SAM).
3. Encode the number and percentage of MAM & SAM referred.
4. Encode the number and percentage of MAM & SAM that was rehabilitated.
5. Encode the date when nutrition planning was conducted.
6. Encode the percentage and number of children targeted for nutrition
programs.
7. Encode the percentage and number of nutrition programs with budget
based according to the AIP.
8. Encode the interventions provided to the identified malnourished children.
9. Encode the interventions provided for the first 1000 days.

Section 7: Data Quality Check 331

332 Section 7: Data Quality Check
Section 7: Data Quality Check 333
c. OPT DQC Form 1.2A: Barangay OPT Plus Data Quality Check: Supervisor's Supportive
Supervision

Instructions:
1. Encode the date, venue where OPT Plus was conducted, and name of the OPT Plus Team
member monitored.
2. Check the anthropometric equipment of the OPT Plus Team. Record 1 if the statement/
practice is observed otherwise record 0.
3. Check whether the proper practice in taking anthropometric measurements were followed by
the OPT Plus team. Record 1 if the statement/practice is observed otherwise record 0.

Note that if it was indicated in OPT DQC FORM 1.1: BARANGAY OPT PLUS DATA QUALITY CHECK
BASIC INFORMATION that there were no available equipment or the equipment used were not
calibrated/verified or damaged, the checklist for the said equipment will be blocked.

334 Section 7: Data Quality Check

Section 7: Data Quality Check 335
336 Section 7: Data Quality Check
d. OPT DQC Form 1.2B: Barangay OPT Plus Data Quality Check: Supervisor's Supportive
Supervision (Practices that Needs Action)

This sheet will automatically reflect all actions that needs to be improved based on the
OPT DQC FORM 1.2A: BARANGAY OPT PLUS DATA QUALITY CHECK: SUPERVISOR'S
SUPPORTIVE SUPERVISION

Section 7: Data Quality Check 337

e. OPT DQC Form 1.3: Barangay OPT Plus Data Quality Check by Dimension

Instructions:

COMPLETENESS 1. Refer to eOPT ‘DQC Summary' sheet and copy column I, Rows 8-15
and paste (paste special -> values) to Brgy OPT DQC FORM 1.3
column L, rows 21-28.

ACCURACY 2. Refer to eOPT ‘DQC Summary' sheet and copy column I, Rows 17-
21 and paste (paste special -> values) to Brgy OPT DQC FORM 1.3
column L, rows 35-39.

RELIABILITY 3. Refer to eOPT ‘DQC Summary' sheet and copy column I, row 24 and
paste (paste special -> values) to Brgy OPT DQC FORM 1.3 column
L, row 46.
4. Refer to Brgy OPT DQC Form 1.1 and encode the actual performance
scores on rows 48-53 in column L based on the performance level.

TIMELINESS 5. Refer to eOPT Plus submission forms and check whether the OPT
Plus data was completed on or before March 31. Encode the actual
performance score in column L, row 59 based on the performance
level.
6. Refer to receiving copy of eOPT Plus report and check when the report
was submitted. Encode the actual performance score in column L,
row 60 based on the performance level.
7. Refer to Brgy OPT DQC Form 1.1 (Columns I-J, Row 66) & Brgy OPT
DQC Form 1.2A (Column L, Row 119)2 and check the percentage
of children's NS feedbacked to parents and encode the actual
performance score in column L, row 61 based on the performance
level.
8. Refer to Brgy OPT DQC Form 1.1 (Column G, Rows 78-80) & Brgy
OPT DQC Form 1.2A (Column L, Row 120) and encode the actual
performance score in column L, row 62 based on the performance
level.

338 Section 7: Data Quality Check

USEFULNESS 9. Refer to Brgy_OPT_DQC Form 1.1 (Column G, Rows 78-80) & receiving
copy of the eOPT plus report and encode the actual performance
score in column L, row 68 based on the performance level.
10. Refer to Brgy_OPT_DQC Form 1.1 (Columns C-D and F-G, Rows 56-
58) and check the date OPT data was presented to BNC. Encode
the actual performance score in column L, row 69 based on the
performance level.
11. Refer to Barangay Nutrition Action Plan (BNAP) and Barangay
Nutrition Scholar Action Plan (BNSAP) targeting and encode the actual
performance score in column L, row 70 based on the performance
level
12. Refer to the Program Implementation Review (PIR) and checked
whether the OPT Plus results were discussed during the PIR.
Encode the actual performance score in column L, row 71 based on
the performance level.

Section 7: Data Quality Check 339

I. COMPLETENESS

340 Section 7: Data Quality Check

II. ACCURACY

Section 7: Data Quality Check 341

III. RELIABILITY

342 Section 7: Data Quality Check

IV.A. TIMELINESS

Section 7: Data Quality Check 343

IV.A. USEFULNESS

344 Section 7: Data Quality Check

f. OPT DQC Form 1.4: Barangay OPT Plus DQC Radial Diagram

All results in this sheet including the radial diagram will automatically be encoded based
on the data provided in the BRGY OPT DQC FORM 1.3.

Section 7: Data Quality Check 345

g. OPT DQC Form 1.4: Barangay OPT Plus DQC Action Sheet to Improve Quality

Answer all questions based on experience of the OPT Plus Team from the recent conduct
of OPT Plus including action points to address the gaps identified in the DQC.

346 Section 7: Data Quality Check

2. CITY/MUNICIPAL LEVEL

The city/municipal DQC tool has six worksheets including the form for: 1) Welcome; 2)
Capacity Mapping of Human Resources (Form A); 3) Capacity Mapping of Anthropometric
Equipments and Tools (Form B); 4) Data Quality Check Encoding (Form 2.1); 5) Data Quality
Check Summary (Form 2.2); and 6) OPT Plus Action Plan. The following are the step-by-step
instructions:

a. Welcome

Section 7: Data Quality Check 347

b. OPT DQC Form A. City/Municipality OPT Plus Capacity Mapping of Human
Resources

Instructions:

1. Print or copy this form in a city/municipal OPT logbook.

2. Indicate the municipality, province, and region and number of barangays in the municipality.
3. Write the dates when the supportive supervision was conducted.

Capacity Mapping of Human Resources

First Column List down the barangays in the first column.

Second Column List down all members of the OPT Plus team per barangay. Add rows if
necessary.

Third Column Write the designation of the members of the OPT Plus team.

Fourth Column Write their contact information for each OPT Plus team member.

Fifth Column Indicate if the OPT Plus team member was 1) trained only; 2) oriented
only; 3. trained and passed the standardization test; or 0) not trained
yet.

Sixth Column If the OPT Plus team member was trained, indicate the classification (i.e.,
Level 1, 2, 3, 4 or 5).

Seventh Column Indicate remarks such as newly appointed, resigned, with illness, and
other problematic situations.

348 Section 7: Data Quality Check

Section 7: Data Quality Check 349
c. OPT DQC Form B. City/Municipality OPT Plus Capacity Mapping of Anthropometric
Equipment and Tools

Instructions:

1. Print or copy this form in a city/municipal OPT logbook.

2. Indicate the municipality, province, and region and number of barangays in the municipality.
3. Write the dates when the supportive supervision was conducted.

Capacity Mapping of Anthropometric Equipment and Tools

First Column Indicate the barangay.

Second Column Indicate the type and the number of weighing scale available in the
barangay.

Third Column Indicate the type and number of measuring equipment for length available
in the barangay.

Fourth Column Indicate the type and number of measuring equipment for height available
in the barangay.

Fifth Column Indicate the number of available non-stretchable MUAC tape in the
barangay.

Sixth Column Indicate if the CGS tables for weight-for-age (WFA); length/height-for-age
(L/HFA) and weight-for-length/height (WFL/H) for male and female are all
available in the barangay.

Seventh Column Indicate remarks such wrong unit of measurement in the equipment, bad
condition, and other problematic conditions of the equipment and tools.

350 Section 7: Data Quality Check

Section 7: Data Quality Check 351
d. OPT DQC Form 2.1: City/Municipality OPT Plus Capacity Mapping of
Anthropometric Equipment and Tools

Instructions:

1. Indicate the municipality, province, and region and number of barangays in the municipality.
2. Indicate the total number of children, total number of male children, total number of female
children, total number of 0-to-29-month-old children, and total number of 30-to-59-month old
children measured during the latest OPT Plus.
3. Indicate when the OPT Plus data were submitted to the province.
4. If the eOPT Plus data was used in LNAP and was presented in the MNC, choose YES. If not,
choose NO.

Data Quality Dimensions per barangay

First Column List down all barangays in the municipality.

Second to Sixth Refer to BRGY OPT DQC Form 1.4. Copy the performance rating in
Column column F, row 19-22 and paste on the corresponding columns.

Seventh Column Refer to BRGY OPT DQC Form 1.4. Copy the average performance rating
in column F, row 24 and paste on the corresponding column.

Eighth Column This will be auto-filled once the barangay’s data quality dimensions are
input.

352 Section 7: Data Quality Check

Section 7: Data Quality Check 353
e. OPT DQC Form 2.2: City/Municipal OPT Plus Data Quality Audit Summary

All results in this sheet including the radial diagram will automatically be encoded based
on the data provided in the OPT DQC FORM 2.1: MUNICIPAL/CITY OPT PLUS DATA
QUALITY CHECK ENCODING.

354 Section 7: Data Quality Check

f. OPT DQC Form 2.3: City/Municipal OPT DQC Action Sheet to Improve Quality

Answer all questions based on experience of the OPT Plus Team from the recent conduct
of OPT Plus.

Section 7: Data Quality Check 355

3. PROVINCIAL LEVEL

The province DQC tool has four worksheets including the form for: 1) Welcome; 2) Data
Quality Check Encoding (Form 4.1); 5) Data Quality Check Summary (Form 4.2); and 6)
OPT Plus Action Plan (Form 4.3). The following are the step-by-step instructions:

a. Welcome

356 Section 7: Data Quality Check

b. Provincial OPT DQC Form 4.1. Provincial OPT Plus Data Quality Check Encoding

Instructions:

1. Indicate the period of the conduct of DQC.

2. Indicate the province, region, and number of cities/municipalities in the province.
3. Encode the total number of children measured, total number of 0-to-29-month-old and 30-to-
59-month-old children.
4. Encode the total number of male and female children measured.

Data Quality Dimension per City/Municipality

First Column List down the city/municipality in the first column.

Second to Fifth Refer to city/municipality DQC form 2.2 and encode the performance
Column ratings per functions.

Sixth to Seventh The average rating and remarks will automatically be computed per city/
Column municipality.

Section 7: Data Quality Check 357

358 Section 7: Data Quality Check
c. Provincial OPT DQC Form 4.2: Provincial OPT Plus Data Quality Check Summary

All results in this sheet including the radial diagram will automatically be encoded based
on the data provided in the OPT DQC FORM 4.1: PROVINCIAL OPT PLUS DATA QUALITY
CHECK ENCODING.

Section 7: Data Quality Check 359

d. Provincial OPT DQC Form 4.3: Provincial OPT DQC Action Sheet to Improve
Quality

Answer all questions based on experience of the OPT Plus Team from the recent conduct
of OPT Plus.

360 Section 7: Data Quality Check

B. DQC Activity Cycle
The Data Quality Check (DQC) protocol for OPT conducting OPT Plus at the start of 2024 and
Plus was installed to ensure that the five data data processing. These activities would like to
quality dimensions are met. Four major DQC check the accuracy, reliability, completeness,
activities are 1) OPT Plus Measurement and and timeliness of the OPT Plus data at this
Processing; 2) OPT Plus Monitoring; 3) Resource stage. The next DQC activity is OPT Plus
Evaluation; and 4) Capacity Development. Figure monitoring to check the usefulness of the OPT
1 illustrates the DQC activity cycle. data. It will document the intervention provided
to the at-risk children and the improvement in
The initial implementation of the DQC starts their nutritional status. The next cycle will start
with the Resources Evaluation on Human again in August while the OPT Plus monitoring
Resources and Equipment and Tools in August continues until December.
of 2023. The supervisors will use Municipal
OPT DQC Form A - Capacity Mapping of Human Figure 7.1 shows that the DQC Activity Cycle
Resources and Form B - Capacity Mapping of aligns with the OPT Plus activities enumerated
Anthropometric Equipment and Tools to plan for in Table 7.1. The table also listed the forms to be
Capacity Development, including OPT Training, used for the DQC Activities. These forms are
Planning for procurement, and Calibration and discussed under the DQC tools topic.
Verification of Equipment and Tools. It is done
to prepare the OPT Plus Team members for

Section 7: Data Quality Check 361

Figure 7.1. The DQC Activity Cycle.

362 Section 7: Data Quality Check

FUNCTION DQC ACTIVITY CYCLE
MONTH
Forms and Submission of Forms and Submission of
Activities 2023 2024
Source OPT Plus Source OPT TPlus DQC

January 1. Conduct OPT 1. OPT Plus Form 1. Barangay Brgy OPT DQC
Plus 1A Documentation
1. OPT DQC Form
of OPT Plus
2. Data 1.1: Barangay
activities
Processing OPT Plus
2. Supervisor Documentation

Section 7: Data Quality Check

Supportive
2. OPT DQC Form
Supervision
1.2: Barangay
OPT Plus Data
Quality Check:
Supervisor's
Supportive
Supervision
(Checklist)

February 1. Conduct OPT OPT Plus:

Plus
2. List of 0-23
2. Data mos;
Processing
3. List_MW(MAM)
3. Monthly
4. List_SW(SAM)
monitoring of
0-to-23-month-old 5. List_MSt&SSt
and malnourished
children 6. List_OW&Ob
7. List_MUW,
SUW,MSt&SSt
8. List_MSt,SSt,
MW&SW
9. List_MSt,SSt,
OW&Ob
10. List_MSt,SSt,
OW&Ob

363
364
FUNCTION DQC ACTIVITY CYCLE
MONTH
Forms and Submission of Forms and Submission of
Activities 2023 2024
Source OPT Plus Source OPT TPlus DQC

March 1. Presentation to OPT Plus: March 25:

BNC Barangay Nutrition
Forms 2 to 10
Scholar (BNS) to
2. Preparation and
11. NutStatusBrgy Midwife/Barangay
updating of BNAP
Nutrition Action
12. Graphs Officer(BNAO)
3. Monthly
monitoring of
March 31:
0-to-23-month-old
Midwife/BNAO to
and malnourished
Barangay Nutrition
children
Committee (BNC)

April Monthly Forms 2 to 10 April 16: BNC to 1. Barangay OPT DQC Form
monitoring of City/Municipal Documentation 1.1: Barangay OPT
0-to-23-month-old Nutrition Action of OPT Plus Plus Data Quality
and malnourished Officer (C/MNAO) activities Check Basic
children Information
2. Monitoring of
interventions
(April to
December)

May Monthly Forms 2 to 10 May 5: C/MNAO

monitoring of to City/Municipal
2-23-month-old Nutrition
and malnourished Committee (C/
children (MNC)
May 15: C/MNC
to Provincial
Nutrition Action
Officer (PNAO)

Section 7: Data Quality Check

FUNCTION DQC ACTIVITY CYCLE
MONTH
Forms and Submission of Forms and Submission of
Activities 2023 2024
Source OPT Plus Source OPT TPlus DQC

June Monthly OPT Plus: June 5: PNAO to

monitoring of Provincial Nutrition
Forms 2 to 10
0-to-23-month-old Committee (PNC)
and malnourished 11. NutStatusBrgy
June 15: PNC
children
12. Graphs to Regional

Section 7: Data Quality Check

Nutrition Program
Coordinator - NNC
Regional Office

July Monthly Forms 2 to 10 July 5: RNPC-

monitoring of NNC Regional
0-to-23-month-old Office to NNC
and malnourished Central Office
children - Nutrition
Surveillance
Division

August 1. Semestral OPT Plus Form 1A Resource Resource Municipal OPT August 31: BNC
monitoring of Evaluation Evaluation DQC to C/MNC
0-to-59-month-old
children 6. Form A.
Capacity Mapping
2. Inventory of of Human
resources Resources
3. Organization of 7. Form B.
OPT Plus Team Capacity Mapping
4. Preparation of of Anthropometric
equipment and Equipment and
materials Tools

5. Calibration/
verification of
equipment/tools

365
366
FUNCTION DQC ACTIVITY CYCLE
MONTH
Forms and Submission of Forms and Submission of
Activities 2023 2024
Source OPT Plus Source OPT TPlus DQC

September 1. Monthly Forms 2 to 10 September 30/ September 30: C/

monitoring of 3rd Quarter MNC to PNC
Household Profile
0-to-23-month-old NNC Technical
and malnourished Committee
children Meeting: NNC
CO-NSD to submit
2. BNAP
and present to
Preparation
the NNC Technical
3. Community Committee
Mobilization

October 1. Monthly Forms 2 to 10 1. OPT Training 1. OPT Training October 30: PNC
monitoring of to RNPC/NNC-RO
2. Planning for 2. Planning for
0-to-23-month-old
procurement procurement
and malnourished
children 3. Calibration and 3. Calibration and
Verification of Verification of
2. Community
Equipment and Equipment and
Mobilization
Tools Tools
November 1. Monthly Forms 2 to 10 November 29:
monitoring of RNPC/NNC-RO to
0-to-23-month-old NNC CO
and malnourished
children
2. Community
Mobilization

December 1. Monthly
monitoring of
0-to-23-month-old
and malnourished
children
2. Community
Mobilization

Section 7: Data Quality Check

REFERENCES

Corsi, D. J., Perkins, J. M., & Subramanian, S. V. (2017). Child anthropometry data quality from
Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and National Nutrition
Surveys in the West Central Africa region: are we comparing apples and oranges? Global Health
Action, 10(1). 10.1080/16549716.2017.1328185

Grellety, E., & Golden, M. H. (2018). Change in quality of malnutrition surveys between 1986 and 2015.
Emerging Themes in Epidemiology, 15(8). https://doi.org/10.1186/s12982-018-0075-9.

Hossain, M., Ferdous, T. E., Islam, Z., Billah, S. M., Islam Bulbul, M. M., Rahman, M. M., & Ahmed, T.
(2019). Protocol for a quasiexperimental study testing the effectiveness of strengthening growth
monitoring and promotion in community clinics for improving the nutritional status of under-two
children in rural Bangladesh. BMJ Open, 9, e032458. (http://dx.doi.org/10.1136/bmjopen-2019-
032458.

Leidman, E., Mwirigi, L. M., Maina-Gathigi, L., Wamae, A., Imbwaga, A. A., & Bilukha, O. O. (2018).
Assessment of Anthropometric Data Following Investments to Ensure Quality: Kenya
Demographic Health Surveys Case Study, 2008 to 2009 and 2014. Food and Nutrition Bulletin,
39(3), 406-419. https://doi.org/10.1177/037957 2118783181

Perumal, N., Namaste, S., Qamar, H., Aimone, A., & Bassani, D. G. (2020). Anthropometric data quality
assessment in multisurvey studies of child growth. American Society for Nutrition, 112(Suppl),
806S-815S. https://doi.org/10.1093/ajcn/ nqaa162

Phan, H. T.T., Borca, F., Cable, D., Batchelor, J., Davies, J. H., & Ennis, S. (2020). Automated data
cleaning of pediatric anthropometric data from longitudinal electronic health records: protocol
and application to a large patient cohort. Scientific Reports, 10, 10164. https://doi.org/10.1038/
s41598-020-66925-7

Ramirez, M. A. R. M., Viajar, R. V., & Azaña, G. P. (2019). Operationalizing local children nutrition surveillance
system: The Philippines' Operation Timbang revisited, the case of Abra de Ilog. World Nutrition,
10, 86-98. DOI: 10.26596/wn.201910486-98

Scaling Up Nutrition (SUN) Movement. (n.d.). Information Systems for Nutrition. Scaling Up Nutrition In
Practice.

United Nations Children’s Fund. (2020). LRPS-2020-916437 Technical Support to NNC in the Development
of Data Quality Audit Protocol for the Operation Timbang Plus (OPT Plus) and Updating of
Implementation Guidelines.

Section 7: Data Quality Check 367

World Health Organization (WHO) & United Nations Fund for Children (UNICEF). (2019). Recommendations
for data collection, analysis and reporting on anthropometric indicators in children under 5 years
old. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF).

World Health Organization (WHO). (2009). WHO AnthroPlus for Personal Computers Manual: Software
for assessing growth of the world's children and adolescents. Geneva: WHO, 2009

World Health Organization (WHO). (2019). WHO Anthro Survey Analyser Quick Guide.

Zimowski, M., Moye, J., Dugoni, B., Viox, M. H., Cohen, H., & Winfrey, K. (2016). Home-based
anthropometric, blood pressure and pulse measurements in young children by trained data
collectors in the National Children’s Study. Public Health Nutrition, 20(2), 200-209. doi:10.1017/
S1368980016002378

368 Section 7: Data Quality Check

Section Eight

SUPERVISOR’S
GUIDE:
SUPPORTIVE
SUPERVISION
SUPERVISOR’S GUIDE:
SUPPORTIVE SUPERVISION

OVERVIEW

OPT Plus Supportive Supervision is the process of helping the

OPT Plus Team to continuously improve their work performance
and maintain quality data. Section 8 will discuss the importance of
supportive supervision in implementing OPT Plus.
After reading this section, one should be able to:

1. Define supportive supervision;

2. Enumerate the roles and responsibilities of supervisors; and
3. Be familiar with the data quality check supportive supervision checklist.

This section covers guidelines specifically for OPT Plus supervisors.

Specific sections include the following:
Section 8.1 Roles and Responsibilities of Supervisors
Section 8.2 Practical Guide in Conducting Supportive Supervision

Section 8: Supervisor’s Guide: Supportive Supervision 371

LIST OF ACRONYMS

BGA Barangay General Assembly

BHC Barangay Health Center
BHS Barangay Health Station
BNAP Barangay Nutrition Action Plan
BNC Barangay Nutrition Committee
BNS Barangay Nutrition Scholar
C/MNAP City/Municipal Nutrition Action Plan
CNAO City Nutrition Action Officer
CGS Child Growth Standards
CHO City Health Office
CNC City Nutrition Committee
D/CNPC District/City Nutrition Program Coordinator
DQC Data Quality Check
ECCD Early Child Care and Development
eOPT Plus Electronic Operation Timbang Plus
KAP Knowledge, Attitudes and Practices
L/HFA Length/Height-for-Age
LCE Local Chief Executive
MAM Moderate Acute Malnutrition
MHO Municipal Health Office
MNAO Municipal Nutrition Action Officer
MNC Municipal Nutrition Committee
MNPC Municipal Nutrition Program Coordinator
MUAC Mid-upper Arm Circumference
MW/MAM Moderately Wasted/Moderate Acute Malnutrition
OPT Plus Operation Timbang Plus
RHM Rural Health Midwife
RHU Rural Health Unit
SAM Severe Acute Malnutrition

372 Section 8: Supervisor’s Guide: Supportive Supervision

SW/SAM Severely Wasted/Severe Acute Malnutrition
WFA Weight-for-Age
WFH Weight-for-Height
WFL Weight-for-Length
WFL/H Weight-for-Length/Height
WHO World Health Organization
WHO-CGS World Health Organization Child Growth Standards

Section 8: Supervisor’s Guide: Supportive Supervision 373

Section 8.1

ROLES AND RESPONSIBILITIES

OF SUPERVISORS

What is supportive supervision?

Supportive Supervision can be defined as a process of guiding, monitoring,
and coaching workers to promote compliance with standards of practice and to
ensure the delivery of quality health services. This process permits supervisors
and supervisees the opportunity to work as a team to meet common goals and
objectives (UNICEF, 2019).

Who are the supervisors?

At the city level, City Nutrition Action Officer (CNAO), the District/City Nutrition
Program Coordinator (D/CNPC), or the Rural Health Midwives (RHM) will supervise
and monitor the conduct of OPT Plus in the barangays.

At the municipal level, the Municipal Nutrition Action Officer (MNAO), Municipal
Nutrition Program Coordinator (MNPC), nutritionist-in-charge, or midwife will
supervise and monitor the conduct of Operation Timbang (OPT) Plus in the
barangays.

Section 8: Supervisor’s Guide: Supportive Supervision 375

What are the roles of the supervisors?
Supervisors are guides and trainers of the OPT and coordination. Likewise, during supportive
Plus Team to ensure the proper and successful supervision, the supervisor helps the members
conduct of the OPT Plus. These can be achieved of the OPT Plus team make things work, identify
by developing the skills of the OPT Plus Team in mistakes/shortcomings, and correct them at
communication, accurate, precise, and reliable the same time by demonstrating the correct
anthropometric measurements, presentation, procedure and developing the skills of the team
advocacy, documentation, reporting and members. The roles of supervisors and the C/
recording, organizing, time management, MNAO are enumerated in Table 8.1.

Table 8.1. Roles and responsibilities of the supervisors and C/MNAO according to OPT Plus activities.

CITY/MUNICIPAL NUTRITION
ACTIVITY SUPERVISORS
ACTION OFFICER (C/MNAO)

Activity 1: 1. Assist in organizing the Training 1. Organize the OPT Plus Training
Pre-OPT Plus and Standardization and and Standardization Exercise and
Protocol Refresher Training on the OPT Refresher Training.
Plus.
2. Remind the barangay OPT Plus
2. Facilitate the organization of the Team of the scheduled conduct
OPT Plus Team in the assigned of the OPT Plus every January to
cluster. March of the current year.

3. Check whether the weighing 3. Oversee the conduct of family

scales are calibrated and if profiling and spot mapping.
length/height boards are verified.
4. Allocate funds for the purchase
If not, initiate or lead the
of OPT Plus.
calibration or verification of the
tools and equipment.

4. For highly urbanized cities,

the City Health Officer
(CHO) will prepare a letter of
communication to be signed by
the Local Chief Executive (LCE)
to allow the conduct of OPT Plus
in exclusive subdivisions and
villages.

376 Section 8: Supervisor’s Guide: Supportive Supervision

CITY/MUNICIPAL NUTRITION
ACTIVITY SUPERVISORS
ACTION OFFICER (C/MNAO)

Activity 2: 1. Check the master list of under- Monitor the status of the conduct
OPT Plus five children. of the OPT Plus in each Barangay
Anthropometric Health Stations (BHS).
2. Oversee the actual collection of
Measurement
length/height measurement and
weighing.

3. Review the recording of the sex,

date of birth, date of weighing,
length/height, and weight.

4. Refer to the Barangay Health

Centers (BHC)/Rural Health Unit
(RHU) the children with bilateral
pitting edema and/or obvious
manifestation of malnutrition (i.e.,
extreme thinness, hollow cheeks,
edematous feet and hands, etc.).

5. Provide feedback on the child’s

nutritional status immediately
after measuring using the weight-
for-length/height index.

Activity 3: 1. If possible, assist in encoding the Conduct data quality check of the
OPT Plus Nutritional anthropometric measurements in OPT Plus.
Status Assessment the Electronic Operation Timbang
Tool (eOPT Plus Tool).

2. Review the outputs of the

Barangay Nutrition Scholars
(BNS) using the WHO Child
Growth Standards (WHO-CGS)
Table.

3. Endorse the OPT Plus reports to

the barangay.

4. Consolidate all barangay eOPT

Plus into the municipal level
eOPT Plus tool.

Section 8: Supervisor’s Guide: Supportive Supervision 377

CITY/MUNICIPAL NUTRITION ACTION
ACTIVITY SUPERVISORS
OFFICER (C/MNAO)

Activity 4: Participate in the 1. Organize the presentation of OPT PLUS

OPT Plus Data preparation of the LNAP. results to the City/Municipal Nutrition
Interpretation and Committee (C/MNC).
Action Planning
2. Review and consolidate the updated
Barangay Nutrition Action Plan (BNAP).

3. Facilitate the preparation of the C/MNAP.

4. Present the results of the OPT Plus to the

Sangguniang Panlungsod/ Bayan for the
budget appropriation of the C/MNAP.

5. Facilitate approval of resolutions at

the barangay and municipal/city levels
concerning OPT Plus activities.

Activity 5: 1. Assist in reviewing the 1. Remind the Barangay Nutrition

OPT Plus monthly and quarterly Committee (BNC) of the schedules of
Monitoring and OPT Plus monitoring the monthly OPT Plus monitoring of SW/
Evaluation coverage if all the children MAM and MW/MAM, underweight
weighed and measured and 0-to-23-month-old, and quarterly
in the first quarter were monitoring of 24-to-59-month-old children.
followed up.
2. Review the monthly and quarterly OPT
2. Participate in the bi-annual Plus monitoring coverage if all the children
review of the BNAP and weighed and measured in the first
assist in presenting BNAP quarter were all followed up OR Assist
accomplishments during in reviewing the monthly and quarterly
the Barangay General OPT Plus monitoring coverage to verify if
Assembly (BGA). all the children measured were covered
during child growth monitoring.

3. Conduct a bi-annual review of the BNAP

and present BNAP accomplishments
during the BGA.

4. Follow-up the BNS on the status of the

referred malnourished children.

5. Conduct city/municipal activities related

to data quality check.

378 Section 8: Supervisor’s Guide: Supportive Supervision

Section 8.2

PRACTICAL GUIDE IN
CONDUCTING SUPPORTIVE
SUPERVISION

Activity 1. Pre-OPT Plus Protocol

During this activity, the supervisor should and tools provides information on the availability
determine the availability of trained OPT Plus and condition of anthropometric tools, other
measurers (OPT DQC Mun Form A and B) as supplies, and forms (Worksheet 2).
well as calibrated/verified measuring equipment,
tools, and forms. This documentation of the OPT The capacity mapping will determine how much
Plus human resources, equipment, and supplies equipment should be calibrated, verified, or
serves as an input to the Capacity Mapping purchased and which barangays need OPT Plus
Tool for Human Resources and Supplies training and certified measures. It is why pre-
Worksheets, which should be updated every OPT Plus activities should start in August to give
year. The capacity mapping of human resources ample time to prepare the equipment and the
(Worksheet 1) provides information on trained OPT Plus members.
or untrained OPT Plus Team Members while the
capacity mapping of anthropometric equipment

Section 8: Supervisor’s Guide: Supportive Supervision 379

Worksheet 1. Capacity mapping of human resources.

Instructions:

1. Print or copy this form in a city/municipal OPT Plus logbook.

2. Indicate the municipality, province, and region and number of barangays in the municipality.
3. Write the dates when the supportive supervision was conducted.

Capacity Mapping of Human Resources

First Column List down the barangays in the first column.

Second Column List down all members of the OPT Plus team per barangay. Add rows if
necessary.

Third Column Write the designation of the members of the OPT Plus team.

Fourth Column For each OPT Plus team member, write their contact information.

380 Section 8: Supervisor’s Guide: Supportive Supervision

Fifth Column Indicate if the OPT Plus team member was 1.) trained only; 2.) oriented
only; 3.) trained and passed the standardization test; or 0) not trained
yet.

Sixth Column If the OPT Plus team member was trained, indicate the classification
(Level 1, 2, 3, 4 or 5).

Seventh Column Indicate remarks such as newly appointed, resigned, with illness, and
other problematic situations.

Worksheet 2. Capacity mapping of anthropometric equipment and tools.

*Weighing Equipment: 1) Hanging weighing scale; 2) Digital Hanging scale; 3) Digital Platform Scale;
4) Others, specify

Section 8: Supervisor’s Guide: Supportive Supervision 381

Instructions:

1. Print or copy this form in a city/municipal OPT Plus logbook.

2. Indicate the municipality, province, and region and number of barangays in the municipality.
3. Write the dates when the supportive supervision was conducted.

Capacity Mapping of Anthropometric Equipment and Tools

First Column Indicate the barangay.

Second Column Indicate the type and the number of weighing scale available in the
barangay.

Third Column Indicate the type and number of measuring equipment for length
available in the barangay.

Fourth Column Indicate the type and number of measuring equipment for height
available in the barangay.

Fifth Column Indicate the number of available non-stretchable MUAC tape in the
barangay.

Sixth Column Indicate if the CGS tables for weight-for-age (WFA); length/height-for-age
(L/HFA) and Weight-for-length/height (WFL/H) for male and female are all
available in the barangay.

Seventh Column Indicate remarks such wrong unit of measurement in the equipment,
bad condition and other problematic conditions of the equipment and
tools.

382 Section 8: Supervisor’s Guide: Supportive Supervision

Activity 2. OPT Plus Anthropometric Measurement
The supervisors in this activity are expected to oversee the actual measurement of the
0-to-59-month-old children. The following are some guidelines on how to initiate supportive
supervision and mentoring:

1. Schedule a date and time for a visit with the OPT Plus Team in advance.

2. Use the OPT DQC Form 1.2a: Barangay OPT Plus Data Quality Check: Supervisor’s
Supportive Supervision. The checklist will help the supervisors identify what
knowledge and skills of the OPT Plus team need to be strengthened to generate
accurate and reliable OPT data.

3. Make sure that the nutritional status of the children is immediately provided to parents/
caregivers and let them plot the weight and length/height of the child in the growth
chart. It is usually included in the baby book or Early Child Care and Development
(ECCD) card. Annexes 5.1a and 5.1b provides the growth chart for the three indices if
it is not available. Please take note the growth charts for girls and boys are different.

4. Take photos if possible to help provide feedback in proper/improper measurement

techniques.

5. As supervisors, children with bilateral pitting edema, obvious manifestations of

undernutrition [moderately wasted or moderate acute malnutrition (MW/MAM) or
severely wasted or severe acute malnutrition (SW/SAM)] should be immediately
referred to the health center.

6. At the end of the supervisor’s visit, discuss the observations with the OPT Plus team
and decide on a doable action the team can do to improve the conduct of OPT Plus
before the next mentoring visit.

Section 8: Supervisor’s Guide: Supportive Supervision 383

Activity 3. OPT Plus Nutritional Status Assessment
As supervisors, make sure that the OPT Plus team, especially the BNS, is trained on using
the eOPT Plus and having access to computers. Train them to use the computers to slowly
shift them from the manual to automatic computation of nutritional status.

If the OPT Plus team has no access To lessen the burden in encoding,
to computers and C/MNAO or the follow the instructions in the eOPT Tool
supervisors will encode the data, please on how to update it and use the BNS
do not instruct the BNS to compute the printout form for recording the weight
nutritional status manually. It will be and length/height.
an additional time and workload that
might delay the submission of the OPT
Plus data. The weight-for-length/height
feedback to the parents/caregivers is
enough. If they need to be practiced
on manual computation, it can be done
during refresher training or small-
dosage training.

384 Section 8: Supervisor’s Guide: Supportive Supervision

Activity 4. OPT Plus Data Interpretation and Action
Planning
The supportive supervision of the OPT Plus team on communicating and presenting the
results of the OPT Plus to the local chief executives, and advocating to fund nutrition
programs, projects, and activities should be done. Successful communication is one that
brings the desired changes in actions (NNC and UPLB, 2011). The following are supervisors’
responsibilities during OPT Plus data interpretation and action planning:

1. Assist the BNC in preparing the nutrition situation by answering the following guide
questions:

a) What forms of malnutrition?

b) How many are malnourished?
c) Who is malnourished?
d) Where are the malnourished?
e) What are the causes of malnutrition?
f) What has been done to address malnutrition?
g) What are the resources available to address malnutrition?
h) What constraints could affect the effective implementation of interventions?

2. Practice the OPT Plus team by showing and explaining the OPT Plus results.

3. Guide the BNC in preparing the Barangay Nutrition Action Plan (BNAP) and make sure
that the nutritionally at-risk families and children are targeted in the plan.

Section 8: Supervisor’s Guide: Supportive Supervision 385

Activity 5. OPT Plus Monitoring and Evaluation
The expected supportive supervision in the activity involves monitoring monthly OPT plus
follow-up and BNAP monitoring. A simple recording of activities is shown in Worksheet 3 for
the supervisors. The supervisors should also record the actions done to share or correct any
knowledge, attitudes, and practices (KAP) of the BNS and OPT Plus team. Worksheet 4 is
the DQC checklist is the evaluation tool to determine the efficiency and effectiveness of the
OPT Plus team in maintaining the data quality of the OPT.

Worksheet 3. Sample Logbook for monitoring.

Supervisor/Mentor: _________________________

Names of OPT Plus Team:

1. __________________________________ 4. __________________________________

2. ___________________________________ 5. ___________________________________

3. ___________________________________ 6. __________________________________

Nutrition worker: _____________________________________________________

Follow up
Date Activity observed Actions to be taken (next visit
schedule)

386 Section 8: Supervisor’s Guide: Supportive Supervision

Worksheet 4. Sample Supportive Supervision Checklist.

Section 8: Supervisor’s Guide: Supportive Supervision 387

388 Section 8: Supervisor’s Guide: Supportive Supervision
Section 8: Supervisor’s Guide: Supportive Supervision 389
REFERENCES

United Nations Children’s Fund. 2013. Supportive Supervision/Mentoring and Monitoring for
Community. New York: United Nations Children’s Fund. https://www.unicef.org/media/108436/
file/Supervision%20Mentoring%20Monitoring%20Module.pdf

United Nations Children’s Fund. 2019. Supportive Supervision: A Manual for Supervisors of Frontline
Workers in Immunization. https://ipc.unicef.org/sites/ipcfi/files/2019-06/UNICEF_Supportive_
Supervision_FINAL.pdf

Training for mid-level managers (MLM). Module 4: supportive supervision. Geneva: World Health
Organization. 2008. https://apps.who.int/iris/bitstream/handle/10665/337056/9789240015692-
eng.pdf?sequence=1&isAllowed=y

National Nutrition Council and University of the Philippines Los Baños. 2011. Trainer’s Manual on Basic
Course for Barangay Nutrition Scholars. Manila: Philippines.

390 Section 8: Supervisor’s Guide: Supportive Supervision

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