OPT Plus Guidelines

IMPLEMENTING GUIDELINES ON
OPERATION TIMBANG Plus (OPT +)
Developed by the Inter-agency

Technical Working Group on Child Growth Standards
Approved for nationwide implementation by the NNC Governing Board

pursuant to NNC Governing Board Resolution No. 2, Series 2012
12 January 2012
Table of Contents
Page
I. Rationale 1
II. Programmatic Developments 4
III. Objectives of Operation Timbang Plus (OPT Plus) 6
IV. Uses of OPT Plus Results 6
V. Mechanics of OPT Plus Implementation 7

1. Organization and Composition of the OPT Plus Team 10
2. Roles and Responsibilities of the OPT Plus Team 10
3. Other activities during and after the OPT Plus 14
a. Preparation and updating of Spot Map 14
b. Scheduling the Assessment of Preschoolers 14
c. Role of different member during growth assessment 15
d. Steps in taking weight and height measurement 15
e. Computing the Age of Preschoolers in Months 21
f. Determination of Nutritional Status 22
g. Interpretation of OPT Plus Results 26
h. Recording, Reporting and Disseminating OPT Plus Results 29
VI. Post OPT Activities of the BNS/BHW 36
VII References 37
VIII Attachments 38
1 NNC Governing Board Resolution No. 2 Series 2008, Adoption of the 39
New WHO Child Growth Standards for Use for Children 0-5 years old
in the Philippines
2 DOH Administrative Order 0015, Series 2010 Policy on Child Growth 42
Standards
3 Checklist for the OPT Plus Team 47
4 Steps on calibration of weighing scales 49
5 Care and Maintenance of Weighing Scale and Height Boards 51
6a Age in Months Table, 2011 52
6b Age in Months Table, 2012 58
7a Weight-for-Age Table for Boys, 0-71 Months 64
i
Implementing Guidelines on Operation Timbang Plus, Revised January 2010
7b Weight-for-Age Table for Girls, 0-71 Months 65

8a Length/Height-for-Age for Boys 0-71 Months 66
8b Length/Height-for-Age for Girls 0-71 Months 67
9a Weight-for-Length Table for Boys, 0-23 Months 68
9b Weight-for- Length Table for Girls, 0-23 Months 69
10a Weight-for- Height Table for Boys, 24-60 Months 70
10b Weight-for- Height Table for Girls, 24-60 Months 71
11 How to make a Spot Map 72
12 Proven Interventions for Preventing and Managing Wasting and 73

Stunting
13 Operation Timbang Plus Forms 74
1 List of Preschoolers with Weight and Height Measurement and 75

Identified Nutritional Status
1a Barangay Tally and Summary Sheet of Preschoolers with Weight
and Height Measurement by Age Group, Sex and Nutritional
Status
1b List of Affected/At-risk Preschoolers 0-71 Months old
2 City/Municipal Consolidation Sheet of Operation Timbang Plus
Results
2a City/Municipality Summary Report on Operation Timbang Plus
3 Provincial Consolidation Sheet of Operation Timbang Plus
Results
3a Provincial Summary Report on Operation Timbang Plus
4 Regional Consolidation Sheet of Operation Timbang Plus Results
4a Regional Summary Report on Operation Timbang Plus
4b Report on Regional Coverage of Operation Timbang Plus
5 National Consolidation Sheet of Operation Timbang Plus Results
5a National Summary Report on Operation Timbang Plus
Figures
Figure 1 Mechanics of OPT Plus in the barangay 8
Figure 2 Schematic flow of OPT Plus results 9
Figure 3 Flow of OPT Plus Report Forms and dissemination of results 31
Figure 5.3 Child Weight 16

Figure 5.2 Child length measurement length for Infants and children 0-23 18
months
Figure 5.1 Child Height Measurement Height for Children 24 Months and Older 20
ii
Implementing Guidelines on Operation Timbang Plus, Revised January 2010
Tables
Table 1 Comparison of Anthropometric Activities in the Philippines 1
Table 2 Guide in Accomplishing and Submitting OPT Plus Forms 32
iii
Implementing Guidelines on Operation Timbang Plus
IMPLEMENTING GUIDELINES ON
Operation Timbang Plus
As of 12 January 2012
I. Rationale
Growth is the increase in the size as a result of the childs intake of food and
maintenance of a childs overall health and well-being. Increments in weight and
height or length at rates considered acceptable based on growth standards thus
indicate good nutrition and health well-being.
In the Philippines, there are three major activities where growth assessment of
children ages 0-71 months is done. These include the: a) National Nutrition Survey of
the Department of Science and Technology (DOST), b) the health center- or facility-
based growth monitoring and promotion services provided by health workers, and c)
Operation Timbang Plus or OPT Plus done every first quarter of the year in
communities nationwide. While differing in many respects including objectives, they
provide important information on the nutrition situation of the population useful for
nutrition program planning and policy formulation and important nutrition
information about a child for prevention or management of malnutrition.
Table 1. Comparison of Anthropometric Activities in the Philippines

Item National Nutrition Survey Growth Monitoring and Operation Timbang Plus
(NNS) anthropometric Promotion (GMP) (OPT Plus)
component
Description A population-based survey Serial monitoring of a Annual mass weighing
to assess the nutritional childs weight in the of all preschoolers 0-
status of nutritionally at-risk Barangay Health 71 months old in a
groups including 0-5 and 6- Center (BHC) or Rural community to identify
10 years old children using Health Unit (RHU) and locate the
sample children selected aided by the ECCD malnourished children
through a multi-stage card
stratified sampling design
and updated every three
years
General To update the official To detect early any To generate data on
Objective statistics on the Philippine deterioration in the the nutritional status of
food, nutrition and health nutritional status of a children in a barangay,
situation to guide child for immediate municipality or city
formulation of food and counseling and To locate underweight
nutrition policies as well as intervention children and
intervention and related Guide nutrition
development programs. program planning at
the local level
management and
evaluation of local
nutrition programs
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(NNS) anthropometric Promotion (GMP) (OPT Plus)
component
Specific Provide national and sub- Provide immediate Locate families with
Objective national prevalence of action or intervention preschoolers who are
malnutrition among to prevent worsening underweight, severely
children, 0-5 and 6-10 years of childs nutritional underweight and
old status overweight
Identify and quantify
Monitor changes in the PSC who are
nutrition situation underweight, severely
underweight,
overweight, stunted,
severely stunted, tall,
wasted, severely
wasted and obese
needing immediate
assistance
Determine priority
areas and individuals
for program planning
purposes
Provide basis for the
assessment of local
nutrition programs
Encourage parents or
guardians or caregivers
to have their children
measured for weight
and height regularly
Period/ Every 5 years Every month for 0-23 1st quarter of every
Schedule Updating every 2 years in months old year
between the NNS schedule preschoolers and
malnourished 0-71
mos.old children
Quarterly for 24-71
months old
Sampling Stratified two-stage all children Complete enumeration
Design sampling design, barangay participating in health
as primary sampling unit center activities, i.e.
and individual as secondary well child, IMCI,
sampling unit Garantisadong
Pambata
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(NNS) anthropometric Promotion (GMP) (OPT)
component
Sampling Nationwide All 0-71 months old All households with 0-
coverage Randomly sampled HH per preschool children in 71 months old preschool
area the barangay children in the barangay
Data Data collectors/ Midwife or nurse OPT Plus Team
collector enumerators assisted by the trained members (Midwife,
BNS and/or BHW Barangay Nutrition
Scholar, Barangay
Health Worker, etc.)
Indices Weight-for-age Weight-for-age Weight-for-age
Height-for-age Height-for-age Height-for-age
Weight-for-height Weight-for-height Weight-for-height
Uses For setting objectives, To detect For planning at the
reduction targets deterioration in the barangay, city/municipal
(MTPPAN, NOH) health and nutritional levels
For monitoring the MDGs status of the child For prioritization of
For policy formulation Basis for counseling assistance by provinces,
of parents regions, national-based
Help identify NGOs and other partners
intervention needed
by the child
Users National government Midwife National government
agencies BNSs agencies
Researchers BHWs Development partners
Academe Parents Researchers
NGOs & private institutions Academe
Policy Makers NGOs & private
Local government units institutions
(LGUs) Policy Makers
Local nutrition
committees
Administrati National Individual child Barangay
ve data level Regional Municipal
Provincial* City
Provincial *
*Depends on funding
* assuming at least 80% OPT
coverage of population
This guideline, herein referred to as Operation Timbang Plus, aims to provide specific
guideposts on what, why, when, who and how the new Operation Timbang Plus shall be
conducted, processed, analyzed and shared by the Nutrition Committees to help generate
timely, accurate and important nutrition information about children 0-71 months old in aid of
local planning and policy formulation of and in support of the local Plan of Action for
Nutrition.
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The revised OPT Plus has new features different from the previous OPT Guidelines of 2004
such as:
1. Inclusion of length and height measurement because using weight and length or
height in combination with the childs age, allows a more comprehensive assessment
of a childs nutritional status;
2. Improved efforts of the OPT Plus Team to come up, through a group coordinated
effort, with only one set of OPT Plus data, to be used by all functionaries of the LGU;
3. Increased efforts of local nutrition committees to jointly discuss and analyze the OPT
Plus results to plan possible course of action that will prevent/address the malnutrition
problem in the locality; and
4. Based on the CGS, the single international standard that represents the best
physiological growth for all children from birth to five years of age and establish the
breastfed infant as the normative model for growth and development as adopted by
the Philippines through NNC Governing Board Resolution No. 2, S 2008, Adoption
of the New WHO Child Growth Standards for use for Children 0-5 years old in the
Philippines.
II. Programmatic Developments
The conduct of OPT starting from the early 70s was regularly done by local
government units through the local nutrition committees. It is an integral part of the
nutrition committees annual nutrition planning activity, and monitoring and
evaluation of the effectiveness of nutrition programs.
Several growth standards had been used over the years. They are namely: a) the
Gomez standard which classified children as normal if weight is 90% and above of
the standard, 1st degree malnourished if weight is 75-90% of standard, 2 nd degree
malnourished if weight is 60-75% of standard and or 3rd degree if the weight is 60%
and below of standard; b) the Philippine Reference Standards (PRS) developed by the
FNRI-DOST, in coordination with the Philippine Pediatrics Society (PPS) adopted in
1992; and c) the International Reference Standards adopted in 2003.
The IRS was the first reference used in the country which allowed Filipino children to
be compared with children from different parts of the world. The use of the IRS as a
tool to determine nutritional status of Filipino children was approved with the
adoption of NNC Governing Board Resolution No. 5 Series 2002, Adaptation of the
International Reference Standards (IRS) in Determining the Nutritional Status of
Filipino Children in March 2002. The approval was made for the following reasons:
a) the IRS reflects the maximum growth potential of children, thus, it challenges any
child to compete globally rather than nationally; b) the IRS provides a more realistic
and accurate estimate of the prevalence of undernutrition, thus, providing greater
impetus for policy level action; and c) the IRS focuses on preventive and promotive
programs rather than rehabilitative.
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A Task Force on OPT was formed in 2003 to revise the Operation Timbang (OPT)
guidelines and to act on issues arising from the shift in the use of standards. The Task
Force was composed of representatives from the DOH-National Center for Disease
Prevention & Control (NCDPC), FNRI-DOST, and Council for the Welfare of
Children (CWC)Office of the President, Makati Health Department Nutrition Office
(local government unit), and the National Nutrition Council (NNC) Secretariat at
Central Office, the NCR and Region IV.
Simultaneous with the countrys adoption of the IRS, a multi-growth reference study
was initiated by the WHO to review the use of existing standards and current
scientific evidence. Results of this study prompted the World Health Organization
(WHO) to advocate the use of the new Child Growth Standards including its
launching in the East-Asia Region held in the Philippines in 2006. Upon
recommendation of the delegation who attended the launch, the NNC Technical
Committee created the Technical Working Group (TWG) on Child Growth Standards
to do further study and eventually, facilitate its nationwide implementation. Said
TWG is composed of members from the Department of Health (DOH)-Nutrition
Center for Disease Prevention and Control, Department of Social Welfare and
Development (DSWD), Department of the Interior and Local Government (DILG),
Department of Education (DepED), FNRI-DOST, PPS, Council of Deans and Heads
in Nutrition and Dietetics (CODHEND)/ UPLB, Koalisyon para Alagaan at Isalba
and Nutrisyon (KAIN), Integrated Midwife Association of the Philippines, Inc.
(IMAP), representatives from the local governments of Makati City and Province of
Laguna and NNC.
Upon recommendation of the TWG and endorsement by the NNC Technical

Committee based on the following provisions, the NNC Governing Board
approved Resolution No. 2, Series 2008 Adoption of the New Child Growth
Standards for Use for Children 0-5 years old in the Philippines was adopted.
1. The new WHO Child Growth Standards show how every child in the world
should grow.
2. Every child in every part of the world has the potential to grow and develop as
described in these Standards as long as his and her basic needs are met.
3. The new standard is a technically robust tool to measure, monitor and evaluate the
growth of all children worldwide, regardless of ethnicity, socio-economic status or
type of feeding.
4. The Standards are based on the breastfed infant as the normative growth model.
5. The Standards is an effective tool for detecting obesity as it allows for earlier
diagnosis of excessive weight gain.
6. The Standards informs people of what constitutes good nutrition, health, and
development.
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III. Objectives of the Operation Timbang Plus
General:
To generate data on the nutrition situation of children as input to community nutrition

assessment, nutrition program planning, and monitoring and evaluation of local
nutrition programs.
Specific:
1. to identify and quantify preschoolers who are malnourished

2. to locate families with preschoolers who are malnourished
3. to determine priority areas and individuals for nutrition interventions
4. to provide basis for the planning and assessment of local nutrition programs
IV. Uses of OPT Plus Results
At the barangay level, the mass weighing of children at the start of every year can
help locate and identify preschoolers who are wasted, stunted, underweight or
overweight. Through the mass weighing, the families of underweight children can be
identified and summarized to make the masterlist of priority beneficiaries for nutrition
and nutrition-related services. This allows the community to determine the magnitude
and prevalence of malnutrition.
The childrens nutritional status data, a barangay map and the results of the annual
family survey of the Barangay Nutrition Scholar (BNS), health and nutrition workers
can develop a barangay spot map identifying the specific location of underweight
children and problem tree of malnutrition can be developed by the Barangay Nutrition
Committee (BNC). These are tools which help BNCs set priorities and targets,
nutrition objectives, and select and design appropriate nutrition projects for funding
by the barangay and its partners.
Measuring the length of children below 24 months and height among children 24
months and above allows the community to determine the degree of stunting
(shortness) and wasting (thinness) in a population. These provide important insights
as to the nature of malnutrition in the area. A high prevalence of stunting in a
community indicates the presence of more severe and chronic form of undernutrition,
which may be due to long-term deprivation of food and overall poor health. A high
prevalence of wasting in a community may indicate short-term/ acute shortage of food
as in the cases of calamities and widespread infections in the immediate past. If not
addressed immediately, wasting may contribute to increased underweight and stunting
in the community, in the long-term. Areas which have data on length and height of
children are thus, in a better position to assess childrens growth and select more
appropriate interventions.
Nutrition program management also become more guided with the use of several
nutrition indices. Data on wasting is an indicator of and allows trending of the
seasonality of food shortages and certain illnesses. It allows more sensitive targeting
of children who may be selected for supplemental feeding to prevent further
undernutrition. Evaluative studies of nutrition interventions also become more
Page 6 of 81
informative with the use of several nutrition indices. Areas with sustained
implementation of effective nutrition programs will have reduced stunting prevalence
in the long-term.
The results of the OPT Plus from the cities and municipalities is used by the NNC in
the identification of the nutritionally depressed municipalities and cities (NDM/Cs).
The cities/municipalities (C/M) are ranked using a composite index of: 1) prevalence
of underweight using OPT Plus results, and 2) audited per capita income of the C/M
provided by the Commission on Audit (COA). The list of top NDM/Cs is used as a
tool by various partners as basis for selecting priority areas for projects.
V. Mechanics of Implementation of the OPT Plus
The OPT Plus will be done every first quarter of the year, from January until June.
Measurement of weight, length/height of children 0-71 mos. old children shall be
done, house-to-house, in the weighing post, or by clustering the children within the
community. The growth assessment should cover at least 16.2% of the total
population as projected by NSO.
However, for older children enrolled in the day care, DepED supervised schools or
private day care schools, measurement shall be done by the OPT Team in
coordination with the head of the institution and/or teacher-in-charge, also within the
same quarter.
Figure 1 summarizes the various activities relevant to the conduct of OPT Plus in the
barangay.
The BNS in tandem with the BHWs and Day Care Worker and School Teacher will
consolidate the data collected. The consolidated data written in OPT Forms 1 and 1a
will be reviewed and validated by the Rural Health Midwife (RHM) before returning
the copy to the BNS who will keep the complete set of the records and ensure that
results are shared to the Barangay Nutrition Committee during the 1st quarter meeting.
During the meeting, the BNC should identify the priority children and families for
nutrition interventions and make sure that they are considered in the budgeting and
preparation of the barangay nutrition action plan and eventually, the barangay annual
investment plan. The BNC through the BNS should also be able to disseminate the
list of priority children and families to other groups implementing nutrition programs
in their area.
After concurrence of the BNC to the results, the Barangay Captain should within five
(5) working days submit a copy to the City/Municipal Mayor. The Barangay Captain,
as BNC Chairperson will sign the OPT Plus Form 1A for submission.
Similar action of review and consolidating barangay submissions shall be done by the
C/M Nutrition Action Officer and then presentation of city/municipal OPT Plus
results to the C/M Nutrition Committee. The consolidated C/M OPT Plus Report shall
be furnished to the Provincial Nutrition Committee through the PNAO where it will
again be consolidated together with other municipal OPT Plus reports and submitted
to the NNC Regional Office.
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Figure 1. Mechanics of OPT Plus in the barangay
Preparation for OPT Plus Conduct of OPT Plus
Post the schedule (time, date and venue of the OPT Home visit and measurement and recording of
Plus) weight, length/height of the child
Prepare supplies and materials to be used Record the childs name, age, date of birth and
Prepare the masterlist of PS in the barangay, listed by measurements
purok/sitio If time allows, compute the age-in-months and
Prepare a copy of the spot map for updating determine the nutritional status of the child
Refer the mother/caregiver to the Barangay Health
Station (BHS) if the child is obviously underweight,
stunted, wasted or overweight
Feedback to BNC and C/MNC Record and update database Processing of OPT Report
Present the barangay nutrition situation to Prepare/update the masterlist Compute the age in months
the BNC, i.e. overall OPT Plus result, spot of underweight, wasted, and nutritional status of the
map, masterlist of families with affected stunted and overweight child (manual/automated)
children, results of family survey children Print the results for review
Develop/update the problem tree w/ the Prepare/update the spot map by the Rural Health Midwife
BNC Approve the results for
Identify the priority families presentation to the BNC
Identify the possible interventions to be
included in the Nutrition Action Plan and
funded by the barangay
Furnish the C/MNC copy of the OPT Plus
results and planned actions
Page 8
Figure 2. Schematic flow of OPT Plus results

Level Components
Purok 1 Purok 2 Purok 3 Purok 4 Purok n
BNS/BHW
RHM
Barangay
Chairperson, BNC
Bgy 1 Bgy 2 Bgy 3 Bgy 4 Bgy n
MNAO Consolidated Mun

OPT Plus Data Result
Municipality
Chairperson, MNC
Mun/Bgy 1 Mun/Bgy 2 Mun/Bgy 3 Mun/Bgy 4 Mun/Bgy n
P/CNAO Consolidated
Prov/City OPT
Plus Result
Province/City
Chairperson, P/CNC
Prov/City 1 Prov/City 2 Prov/City 3 Prov/City 4 Prov/City n
NPC Consolidated
Regional OPT
Plus Result
Region Chairperson, RNC
Reg 1 Reg 2 Reg 3 Reg 4 Reg n
NNC Consolidated
Regional OPT
Plus Result
National Partners
Page 9 of 81
1. Organization and Composition of the OPT Plus Team
The BNC will create an OPT Plus Team composed of 7-9 members. The team will
be headed by the Rural Health Midwife, assisted by the BNS and BHWs. The
suggested members of the OPT Plus Team can be the Committee Chair on Health
and Nutrition, Sangguniang Kabataan Chairperson, other BHWs, Day Care
Worker (DCW) and Teacher-in-Charge. In ARMM, some of the members of the
community health action team (CHAT) may be tapped to join the OPT Plus Team.
The team may be assisted by the purok or mother leaders, other community
leaders, representative/s from civic organizations.
At the city/municipal level, the City/Municipal Health Officer (C/MHO) together

with the nutritionist-in-charge/C/MNAO will supervise and monitor the conduct
of OPT Plus in the barangays, i.e. availability and use of calibrated measuring
equipment, availability of CGS-based weight-for-age, height/length-for-age and
weight-for-height/length tables and OPT plus forms and use of correct
anthropometric measurement procedure. For highly urbanized cities, the C/MHO
will prepare a letter of communication to be signed by the LCE to allow the
conduct of OPT Plus in exclusive subdivisions and villages.
2. Roles and Responsibilities of the OPT Plus Team

OPT Plus Function/Activity
Team Member
Rural Health 1. Organize and convene the OPT Plus Team

Midwife (RHM) as
Team Leader 2. Ensure that the weighing scales are calibrated and the height
boards are verified.
Alternately, if there
is no assigned RHM 3. Inform and coordinate with the Barangay Nutrition Committee
in the area for some (BNC) the scheduled conduct of the OPT Plus by purok or
reasons, the Bgy. sitios for logistic assistance.
Captain may assign
the BNS or BHW in 4. Request assistance from the Barangay Captain, president of
the area to lead the homeowners association to allow entry/cover exclusive areas
team. for the activity
5. Arrange schedule for nutrition counseling especially among

identified malnourished children
6. Measure length of 0-23 months and height of 24-71 months old

preschoolers during the conduct of OPT Plus and/or supervise
the trained personnel taking the height/length.
7. Validate the OPT Plus results written in OPT Form 1 and 1A

before presentation to the BNC
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Team Member
8. Sign the validated OPT Plus Forms 1 and 1A after review.
9. Assist the BNS/BHW in the presentation of the OPT Plus

results to the BNC during the 1 st quarter meeting.
10. Ensure the submission of the OPT Plus Form 1A to the

City/Municipal Nutrition Committee (C/MNC) within the
prescribed schedule.
Barangay Nutrition 1. Coordinate the conduct of the activity.

Scholar (BNS) as
coordinator of the 2. Coordinate with RHM the barangay schedule for calibration of
OPT Plus Team weighing scale and verification of height board before the
(if no BNS in the activity.
barangay, the BHW
will be the OPT 3. Prepare the supplies and materials needed during the OPT Plus.
Plus coordinator)
4. Inform the community on the schedule of OPT Plus.
5. Encode the list of the 0-71 months old preschoolers based on

the latest re-weighing data in the barangay. The masterlist of
the 0-71 months old preschooler should be checked against the
updated Family Profile using OPT Plus Form 1. The masterlist
of preschoolers should reflect the childs family name, his/her
first name, name of father, name of mother, date of birth of
child, childs length/height and weight and date of
measurement. Arrange the family names of the children in
alphabetical order.
6. Prepare the name tag of all 0-71 months old preschooler based
on the masterlist/family profile. The name tag will contain the
following information: name of child, date of birth, sex, age-in-
months, date of measurement, weight and height measurement
and name of purok/sitio. The name tags will be arranged
according to purok/sitio which will be distributed among the
BHWs (per their catchment area or household areas)
7. Measure the preschoolers weight and assist the RHM in taking

the length/height of the child and have someone record the
measurements.
Page 11 of 81

Team Member
8. Calculate the age & determine nutritional status (NS) of

preschoolers using the standard tables on Weight-for-Age,
Length/Height-for-Age and Weight-for-Length/Height by
writing the information temporarily in the childs name tag and
then, in the appropriate OPT Form.
9. Alternately, if the team has access to a computer, laptop or

notebook, use the automated OPT Plus tool which can be used
to compute for age-in-months, nutritional status after providing
the name of the child, birthday, date of weighing and sex. The
automated OPT tool may be downloaded at www.nnc.gov.ph.
10. Prepare the summary of OPT Plus results using OPT Plus Form
1A. Barangay Tally and Summary Sheet of Preschoolers
Measured by Age Group, Sex and Nutritional Status; and OPT
Plus Form 1B. List of Priority Preschoolers 0-71 Months old.
11. Have the OPT Plus results validated for accuracy of the result
by the RHM/nutritionist-in-charge/nurse using OPT Plus
Forms 1 and 1A.
12. Present the counter-checked OPT Plus result during the 1 st BNC
meeting for inclusion of the priority families in the
programs/activities in the barangay.
13. Ask the Barangay Captain, as BNC Chair, to sign the OPT Plus
Form 1A to be submitted to the City/Municipal Nutrition
Committee (C/MNC).
14. Provide the day care worker and teacher in Kinder from DepED
supervised elementary school a copy of the measurements
(weight and height) and nutritional status of children
Other team 1. Disseminate information regarding the purpose & schedule of

members (DCW, OPT Plus to ensure maximum community participation.
mother leaders,
barangay officials) 2. Arrange facilities for the measurement session i.e. site,
weighing scale/s, height board, 2 tables for writing and chairs.
In case, there is no
BNS in the 3. Gather preschoolers at the site of OPT Plus.
barangay, other
members may 4. Assist the RHM in measuring the height of the preschoolers.
perform the duties
of the BNS. 5. Assist in calculating age of preschoolers (may be done by
Training is trained BHWs and DCW)
necessary for all.
Page 12 of 81
Team Member
. 6. Assist in weighing the preschoolers
7. Refer the mother/caregiver of the preschool children to the

BHC
8. Prepare and update the spot map after the validation of the
OPT Plus result. (Attachment 12)
Teacher-in-charge Coordinate with the BNS/BHW for the measurement of the

children every 1st quarter of the year.
Organize children who have not been measured in the school or

Day Care Center wherein they will be measured at home
Maintain a copy of the nutritional status of children ages 5 and

below.
Municipal Health i. Prepare communications for

Officer (MHO)/ conduct of OPT Plus in
Nutritionist in- private and public schools and
charge/C/MNAO/ Day Care Centers for
C/DNPC preschool children aged 36-71
months enrolled in private and
Day Care Center schools.
ii. Supervise conduct of the OPT

Plus in the barangays
iii. Assist the BNS/BHW in the

scheduled nutrition counseling
sessions for the identified
under- or overweight PS. For
identified cases of moderately
and severely acute
malnutrition (M/SAM),
ensure that the children are
referred immediately to the
hospital for medical
assessment and management.
iv. Collect and validate all

submitted barangay OPT
Plus results and consolidate
for the City/Municipal OPT
Plus result.
v. Present the consolidated OPT

Plus results, including ranking
Page 13 of 81
of barangays according to
prevalence of
underweight/stunting/
wasting; preferably presented
with other data in the updated
C/M profile.
3. Other activities during and after the OPT Plus
a. Preparation/Updating of Spot Map. Update the previous spot map showing

the houses, roadways and other geographic features of the barangay. This
would entail the conduct of:
- an ocular survey of the barangay, noting down new houses, new roadways,
or landmarks; and
- updating/preparing a list of families in the barangay. New families will
have to be assigned their respective household numbers.
For barangays without a spot map, selected members of the BNC or volunteers
from the barangay, i.e. SK, Barangay Secretary, women groups, may assist the
OPT Plus Team in preparing one. On the spot map, the team gives each house
a household number. If more than one family lives in one house, the families
are given the same household number, but the letters A, B and C are assigned
to differentiate each family.
After consolidation of OPT Plus results, houses and families with

underweight, severely underweight, wasted, stunted, overweight and obese
preschoolers should be indicated on the updated spot map using color-coded
markers, i.e. green for normal weight/height, orange for underweight/short, red
for severely underweight/stunted, and blue/purple for overweight.
b. Scheduling the Assessment of Preschoolers
b1. A schedule of OPT Plus, which includes the time, date of weighing and
height measurement should be posted in the health center and other
strategic places (waiting sheds, chapel, health and nutrition post, sari-sari
store, etc). If the barangay has its own public address system, the schedule
must be announced every day at least one week before the actual
weighing. The proposed venues for the conduct of OPT Plus are in DCC
and elementary school especially for enrolled preschool children. It is
highly recommended to do a house-to-house visit to ensure that all
preschool children are measured especially those who are not enrolled,
however the team may still gather the children in a specific place
convenient for the families.
Members of the OPT Plus team should ensure that parents and/or
caregivers are informed of the exact time and place of weighing.
Page 14 of 81
b2. On the scheduled day of measurement, the OPT Plus Team goes to the
designated place taking along the old spot map (if existing), calibrated
salter scale and verified height board, OPT Plus Form No. 1 (names of the
families and children are already encoded), age-in-months table, and
Weight for Length/Height table for boys and girls, 0-71 months old, rope
for hanging of the weighing scale, pencils and paper.
c. Roles of different members during growth assessment
Each member of the OPT Plus Team should have clear and specific
assignments during the conduct of OPT Plus:
For example:
1. Member 1 will organize the children in the designated venue (i.e. DCC,
elementary school for the children enrolled in kinder).
2. Member 2 will look for the name of the child in the masterlist (OPT Plus
Form 1) by noting his/her name, name of mother/father, address, date of
birth and ensuring the same information written in the childs name tag.
3. Member 3 will compute for the age in months (AIM) of the child and
record it.
4. Members 4 will weigh the preschooler and member 5 will record;
5. Member 6 preferably the RHM assisted by the trained BNS/BHW will

measure the length/height.
6. Member 7 who may be the BNS or BHW will assist the RHM in taking
and recording the height/length.
d. Steps in taking weight and height measurement
In weighing the preschoolers, the procedures in proper weighing should be

observed.
(i) Hang the weighing scale from a tree branch, ceiling beam or pole held by
two people. Keep the bar or the dial at eye level of the person who will read
the weight so that the weight can be read easily and correctly. Ask the
mother to remove unnecessary clothing from the child, including shoes and
slippers also ensure that the diaper is empty or new. (Attachment 4. Steps
on calibration)
(ii) Attach the empty weighing pants or crib to the hook of the scale and adjust
the pointer to zero. Most scales have a knob or screw to make this
adjustment.
(iii)Place the child in the weighing pants or crib with the help of the mother.
When using the salter scale, let the mother hold the child. Put your arms
Page 15 of 81
through the leg holes of the weighing pants or crib (Arrow 1). Hold the
childs feet and gently pull his/her legs through the leg holes (Arrow 2).
(iv) Attach the strap of the weighing pants or crib to the hook of the scale. DO
NOT CARRY THE CHILD BY THE STRAP ONLY. Gently lower the
child and allow the child to hang freely (Arrow 3). The childs feet should
not touch the ground.
(v) Hold the salter scale dial which is at eye level and read the weight to the
nearest 0.1kg. WAIT FOR THE NEEDLE TO STOP MOVING BEFORE
READING THE WEIGHT (Arrow 5). Relay the childs weight to the
recorder/assistant who records the weight in the childs name tag (Arrow 4).
(vi) Gently lift the child from the weighing pants or crib by his/her body. DO
NOT LIFT THE CHILD BY THE STRAP OF THE WEIGHING PANTS
OR CRIB.
Source: Excerpt from Bruce Cogill. Anthropometric Indicators Measurement

Guide. Food and Nutrition Technical Assistance Project, Series Title 2
Indicator Guides. June 2001
Page 16 of 81
In measuring the length/height of the preschoolers, proper procedures in

measurement should likewise be observed. (Procedure adopted from Bruce
Cogill. Anthropometric Indicators Measurement Guide. Food and Nutrition
Technical Assistance Project, Series Title 2 Indicator Guides. June 2001)
Using the length board:
i. The measurer or assistant will place the measuring board on a hard flat
surface, i.e., even ground, floor, or steady table.
ii. The assistant will place the OPT Plus Form 1 and pencil on the ground,
floor, or table (Arrow 1); kneel with both knees behind the headboard if
it is on the ground or floor (Arrow 2).
iii. The measurer will kneel on the right side of the child so that he/she can
hold the foot piece with his/her right hand (Arrow 3).
iv. The measurer and assistant with the mothers help, lay the child on the
board by supporting the back of the childs head with one hand and the
trunk of the body with the other hand; gradually lower the child onto the
board.
v. The measurer and assistant will ask the mother to kneel close on the
opposite side of the board facing the measurer as this will help to keep
the child calm.
vi. The assistant will cup his/her hands over the childs ears (Arrow 4) with
his/her arms comfortably straight (Arrow 5). Place the childs head
against the headpiece so that the child is looking straight up. The childs
line of sight should be perpendicular to the ground (Arrow 6). The
assistants head should be straight over the childs head looking directly
into the childs eyes.
vii. The measurer will make sure the child is lying flat and in the center of
the board (Arrow 7). He/She will place his/her left hand on the childs
shins (above the ankles) or on the knees (Arrow 8) pressing them firmly
against the board. With his/her right hand, place the foot piece firmly
against the childs heels (Arrow 9).
viii. The measurer and assistant will check the childs position (Arrows 1-9).
Repeat any steps as necessary.
ix. The measurer will check if the childs position is correct, read and call
out the measurement to the nearest 0.1 cm. Remove the foot piece and
release his/her left hand from the childs shins or knees.
x. The assistant immediately release the childs head, record the

measurement, and show it to the measurer.
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xi. The measurer will check the recorded measurement on the OPT Plus
Form 1 for accuracy and legibility and instruct the assistant to erase and
correct any errors.

Page 18 of 81
Using the height board:
i. The measurer or assistant will place the measuring board on a hard flat
surface against a wall, table, tree, staircase, etc. making sure the board is
not moving.
ii. The measurer or assistant will ask the mother to remove the childs shoes
and unbraid any hair that would interfere with the height measurement.
Ask her to walk the child to the board and to kneel in front of the child.
iii. The assistant will place the OPT Plus Form 1 and pencil on the ground
(Arrow 1) and kneel with both knees on the right side of the child
(Arrow 2).
iv. The measurer will kneel on his/her right knee on the childs left side
(Arrow 3). This will give him/her maximum mobility.
v. The assistant will place the childs feet flat and together in the center of
and against the back and base of the board/wall. Place his/her right
hand just above the childs ankles on the shins (Arrow 4), his/her left
hand on the childs knees (Arrow 5) and push against the board/wall.
Make sure the childs legs are straight and the heels and calves are
against the board/wall (Arrows 6 and 7) and tell the measurer when
he/she have completed positioning the feet and legs.
vi. The measurer will tell the child to look straight ahead at the mother who
should stand in front of the child and make sure the childs line of sight
is level with the ground (Arrow 8). He/She will place his/her open left
hand under the childs chin and gradually close his/her hand (Arrow 9).
Do not cover the childs mouth or ears. Make sure the shoulders are level
(Arrow 10), the hands are at the childs side (Arrow 11), and the head,
shoulder blades and buttocks are against the board/wall (Arrows 12, 13
and 14). With the measurer right hand, lower the headpiece on top of the
childs head and make sure he/she will push through the childs hair
(Arrow 15).
vii. The measurer and assistant will check the childs position (Arrows 1-
15)and repeat any steps as necessary.
viii. The measurer will check if the childs position is correct, then read and
call out the measurement to the nearest 0.1 cm. He/She will remove the
headpiece from the childs head and his/her left hand from the childs
chin.
ix. The assistant immediately records the measurement and show it to the
measurer.
x. The measurer will check the OPT Plus Form 1 for accuracy and
legibility and instruct the assistant to erase and correct any errors.
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In worst scenarios and the length/height should be measured and no

length/height board is available, the team can use a steel ruler placed securely
against a flat surface, i.e. wood board or wall. A carpenters
triangle/triangular ruler may be used as head piece.

Page 20 of 81
e. Computing the Age of Preschoolers in Months
For quick calculation of age in months, use the Age in Months Table
(Attachment 6a and 6b). If said table is not available, use the long hand
method below:
e1. See to it that the date of birth of the child is correct. To ensure that the
birth date is correct, counterchecked the birth date of the child in the
newborn infants record book of the RHM or with the records of local
nutrition and health workers, e.g. midwife, BNS or BHW.
e2. Compute the age of the child to the nearest month as of the child's last
birth date using this formula:
Age = (number of years/month/days from date when

weight measurement was taken) - (date of birth)
e3. Convert age in years into months by dividing by 12. Add the age in
months to the product and the total gives the age in months. After
computation of the age-in-months, disregard the number of days.
To illustrate:
Example 1
Date of birth : November 10, 2009

Date of weighing : November 29, 2009
To compute:
Year Month Day

2009 11 29 - Date of weighing
- 2009 11 10 - Date of birth
0 0 19
Since the age of child is only 19 days, compute the age in months as zero
(0).
Example 2
Date of birth : January 30, 2009

Date of weighing : July 16, 2009
Page 21 of 81
To compute:
Year Month Day

2009 07 6 16 46 - Date of weighing
- 2009 01 30 - Date of birth
0 5 16
The childs age is 5 months and 16 days. Disregard the number of days.
The childs age in months is 5.
Example 3
Date of birth : October 1, 2006

Date of weighing : August 31, 2009
To compute:
Year Month Day

2009 2008 8 20 31 - Date of weighing
- 2006 10 01 - Date of birth
2 10 30
The childs age is 2 years, 10 months and 30 days or converting the years
to months, e.g. (2 years x 12 months is 24) + 10 months, the child is 34
months.
f. Determination of Nutritional Status
The growth tables developed by the TWG-Child Growth based on WHO-

CGS shall be used by all field nutrition and health workers in determining the
nutritional status of children during the OPT Plus. The tables are
downloadable from www.nnc.gov.ph.
The weight-for-age reflects body weight relative to the childs age. This
indicator is used to assess whether a child is underweight or severely
underweight for his/her age.
A child who has oedema of both feet, fluid retention has increased weight,
masking what may actually be very low weight. This child is automatically
considered severely undernourished or severely acute malnutrition (SAM) and
should refer to the Philippines Protocol on Integrated Management of Acute
Malnutrition (PIMAM).
f1. How to use the weight-for-age table:
f1.1 In the weight-for-age table, look for the point where the childs age in
months intersects with the actual weight of the child, use the
appropriate table that is for boy or girl.
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f1.2 Assess the nutritional status of the child using the suggested cut-off
points for normality.
f2. How to interpret results using the weight-for-age table:
Each age under the first column of the weight-for-age table has a
corresponding 2SD (plus or minus 2 standard deviation) values in the
succeeding columns for both sexes. The 2SD values represent the
minimum and maximum boundaries for the measurement of the child to
be classified as within the acceptable limits of normality. Thus, if the
weight of the child is less than the -2SD value, the child is considered
underweight for his/her age. However, if the weight of the child falls
above the +2SD value, the child is overweight for his/her age.
The nutritional status of preschoolers using the weight-for-age indicator is

classified into:
a. Normal has a 2SD (plus or minus 2 standard deviation) value,

meaning the childs weight is within the normal limits.
b. Underweight has a <-2SD (less than minus 2 standard deviation)

value, meaning the childs weight is lower or below the normal weight
for his/her age.
c. Severely Underweight has a <-3SD (less than minus 3 standard

deviation) value, meaning the childs weight is very much lower than
normal for his/her age.
d. Overweight has a >+2SD (more than plus 2 standard deviation) value,

meaning the childs weight is higher or above the normal weight for
his/her age. Note: Obesity is more appropriately determined using
weight-for-length/height data.
Look for the column in the weight-for-age table (Attachment 7a and 7b)
that corresponds to the weight of the child, i.e. determine if the childs
weight is normal, underweight, severely underweight or overweight; use
the appropriate table that is for boy or girl.
Example:
1) A 5-month old girl weighing 5.5 kg - Normal
2) A 17-month old girl weighing 7.5 kg - Underweight
3) A 71-month old boy weighing 11.2 kg - Severely Underweight
4) A 54-month old boy weighing 25.5 kg - Overweight
The length/height-for-age reflects attained growth in length or height at the

childs age at a given time. This indicator can help identify children who are
stunted (short) due to prolonged undernutrition or repeated illness. Children
who are tall for their age can also be identified.
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f3. How to use the length/height-for-age table:
f3.1 In the length/height-for-age table, look for the point where the childs
age in months intersects with the actual length/weight of the child, use
the appropriate table that is for boy or girl.
f4. How to interpret results using the length/height-for-age table:
Each age under the first column of the length/height-for-age table has a
corresponding 2SD (plus or minus 2 standard deviation) values in the
succeeding columns for both sexes. The 2SD values represent the
minimum and maximum boundaries for the measurement of the child to
be classified as within the acceptable limits of normality. Thus, if the
length/height of the child is below the -2SD value, the child is
short/stunted for his/her age. If the length/weight of the child falls above
the +2SD value, the child is tall for his/her age.
The nutritional status of preschoolers using the length/height-for-age

indicator is classified into:
a. Normal has a 2SD (Plus or minus 2 standard deviation) value,

meaning the childs height is within the normal limits.
b. Short/stunted has a <-2SD (less than minus 2 standard deviation)

value, meaning the childs height is lower or below the normal height
for his/her age.
c. Severely stunted/short has a <-3SD (less than minus 3 standard

deviation) value, meaning the childs weight is very much lower the
normal height for his/her age.
d. Tall has a >+2SD (more than plus 2 standard deviation) value,

meaning the childs weight is higher than the normal height for his/her
age.
Look for the column in the length/height-for-age table (Attachment 8a and

8b) that corresponds to the length/weight of the child, i.e. determine if the
childs length/height is normal, stunted, severely stunted or tall.
Example:
1) A 5-month old girl with length of 65.0 cm - Normal

2) A 18-month old girl with length of 72.8 cm - Stunted
3) A 71-month old boy with height of 100.7 cm - Severely Stunted
4) A 54-month old boy with height 120 cm - Tall
Page 24 of 81
The weight-for-length/height reflects body weight in proportion to attained

growth in length or height. Weight-for-length/height help identify children
with low weight-for-height who may be wasted/thin or severely wasted/thin.
Wasting/thinness is usually caused by a recent illness or food shortage that
causes acute and severe weight loss, although chronic undernutrition or illness
can also cause this condition.
f5. How to use the weight-for-length/height table:
f5.1 In the weight-for- length/height table, look for the point where the
childs actual length/height intersects with the actual weight of the
child, use the appropriate table that is for boy or girl.
f6. How to interpret the weight-for-length/height table:
Each length/height under the first column of the weight-for-length/height

table has a corresponding 2SD (plus or minus 2 standard deviation)
values in the succeeding columns for both sexes. The 2SD values
represent the minimum and maximum boundaries for the measurement
of the child to be classified as within the acceptable limits of normality.
Thus, if the weight-for-length/height of the child is less than the -2SD
value, the child is wasted/thin for his/her age. However, if the weight-for-
length/height of the child falls above the +2SD value, the child is
overweight for his/her age.
The nutritional status of preschoolers using the length/height-for-age

indicator is classified into:
a. Normal has a 2SD (plus or minus 2 standard deviation) value,

meaning the childs body weight in proportion to length/height or
thinness is within the normal limits compared to the standard for
children his/her weight-for-length/height.
b. Wasted/Thin has a < -2SD (less than minus 2 standard deviation)

value, meaning the childs body weight in proportion to length/height
or thinness is low relative to the standard weight-for-length/height.
c. Severely wasted/thin has a <-3SD (less than minus 3 standard

deviation) value, meaning the childs body weight in proportion to
length/height or thinness is very low relative to his/her weight-for-
length/height.
d. Overweight has a > +2SD (more than plus 2 standard deviation) value,
fatness is high relative to the standard weight for his/her weight-for-
length/height.
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e. Obese has a > +3SD (more than plus 3 standard deviation) value,
fatness is very high relative to the normal weight-for-length/height for
his/her weight-for-length/height. Note: Obesity is more appropriately
determined using weight-for-length/height data.
Look for the column where the weight intersects with the length/height
(Attachment 9a and 9b) of the child to determine if the child is normal,
wasted/thin, severely wasted/thin, overweight or obese.
Example:
1) A 5-month old girl: length 65.0 cm weight 6.2 kg - Normal

2) A 18-month old girl: length 72.8 cm weight 7.3 kg - Thin/Wasted
3) A 36-month old girl: height 92.5 cm weight 18.5 kg- Obese
4) A 60-month old boy: height 100.9 cm weight 20.0 kg- Overweight
5) A 60-month old boy: height 110.4 cm weight 13.8 kg - Sev Wasted
g. Interpretation of OPT Plus Results
As suggested in this guidelines, the BNC as the primary user of the barangay
OPT Plus data should be encouraged to discuss the OPT Plus results, within or
immediately after the first quarter. The BNS or BHW may present the overall
prevalence of underweight, wasting and stunting in the barangay, by sex, by
age group, by purok/sitio using the following table and with the aid of the spot
map.
Prevalence of Underweight, January-March 20__ OPT Plus, By Sex, By Purok

Areas Girls Boys
No. of Prevalence of No. of Prevalence of
Underweight Underweight Underweight Underweight
Children Children 0-71mos
0-71mos
Barangay X
Purok 1
Purok 2
Purok 3
Purok 4
Prevalence of Wasting, January-March 20__ OPT Plus, By Sex, By Purok

Areas Girls Boys
No. of Wasted Prevalence of No. of Wasted Prevalence of
Children Wasting Children 0-71mos Wasting
0-71mos
Barangay X
Purok 1
Purok 2
Purok 3
Purok 4
Page 26 of 81
Prevalence of Stunting, January-March 20__ OPT, By Sex, By Purok

Areas Girls Boys
No. of Stunted Prevalence of No. of Prevalence of
Children 0- Stunting Stunted Children Stunting
71mos 0-71mos
Barangay X
Purok 1
Purok 2
Purok 3
Purok 4
The table above can indicate which of the puroks in a barangay have higher
prevalence of underweight/wasted/stunted children. The same may be
prepared by the C/MNAO for its barangays, and the PNAO for its component
municipalities and/or cities.
Below is another way of analyzing results, to identify who among the different
age groups and from which area are the most affected by undernutrition. The
same may be used by cities/municipalities and provinces. Instead of puroks,
they may compare the different municipalities according to the prevalence of
underweight/wasting/stunting among the different age groups.
Prevalence of Underweight/Stunting/Wasting, January-March 20__ OPT, By

Age Group, By Purok
Prevalence, by age group
Area 0-5 6-11 12-23 24-35 36-47 48-59 60-71
mos mos mos mos mos mos mos
Barangay X
Purok 1
Purok 2
Purok 3
Purok 4
Note: This is similar to OPT Plus Form 1b
For cities/municipalities, the current year prevalence may be compared with

that of the previous years to determine whether the nutrition situation in the
barangay has improved or deteriorated. The process will help in identifying
areas which are more at-risk to malnutrition.
Prevalence of Underweight/Wasting/Stunting, CYs 2010-2012, by Barangay

Area 2010 2011 2012
No. of 0-71 Prevalence No. of 0-71 Prevalence No. of 0-71 Prevalence
mos. children mos. children mos. children
affected affected affected
Barangay 1
Barangay 2
Barangay 3
Barangay 4
Barangay 5
Page 27 of 81
Aside from determining the prevalence of the nutritional problems, and

comparing the change across years, Provincial/City/Municipal/Barangay
Nutrition Committees (P/C/M/BNC) may also compare the prevalence of
undernutrition of the area with that of other cities/municipalities/barangays
and by comparing their prevalence to the World Health Organizations cut-
offs for problems of public health significance.
Prevalence cut-off values of underweight and underheight for public health

significance (WHO, 1995)
Level In percent
Underweight Underheight
Low < 10 < 20
Medium 10 19 20-29
High 20 29 30-39
Very High >=30 >=40
Prevalence cut-off values of thinness for public health significance

(WHO, 1995)
Level Thinness
(in percent)
Acceptable <5
Poor 59
Serious 10 14
Critical >=15
For the assessment of the situation, BNCs should be encouraged to update the
existing spot map posted in the nutrition office and/or barangay hall. Doing
so will help the BNCs appreciate more visually where most of the
malnourished children are located and possibly the external factors
contributing to higher undernutrition in one area, e.g. poor access to services
due to distance, peace and order problem, natural hazards, and poor sanitation
among others.
Wasting vs Stunting vs. Underweight
Wasting is used often as an indicator of the current or recent situation.

Wasting results from an acute shortage of food or from acute infections which
affect food intake or utilization. Wasting is associated with higher mortality
rate and poses more severe health risks than chronic malnutrition, primarily
through impairment of bodily functions, among them, resistance to disease.
Increased levels of acute malnutrition in a population result in increased
illness and death. Wasting is reversible with re-feeding and should be
therefore be prioritized.
In severe acute malnutrition (SAM), normal physiological mechanisms

continue to adapt. The body reserves its energy and nutrient reserves,
decrease energy and nutrient demands which initially are beneficial.
However, as severity increases, these adaptations prevent the bodys ability to
Page 28 of 81
respond to stresses, e.g. infections. Management of these cases should be

reserved to medical practitioners who are knowledgeable on the Protocol for
IMAM developed by the World Health Organization.
Increased prevalence of wasting in communities or individuals are associated

with displacements of people due to natural calamities and armed conflict,
and/or infections.
Stunted/short (bansot) children are those considered too short for their age
which is an indicator of the long-term cumulative effects of nutrition
deficiency. Children <5 years are particularly affected. Short term
implications of stunting include growth faltering and weight loss with
associated micronutrient deficiencies. Documented longer term effects
include impaired physical and mental development of the child. At the
community level, consequences of stunting include increased demands on
medical, public health services and food assistance especially in crisis and
emergency situations. High prevalence of stunting in communities is an
indicator of poverty, food insecurity and possibly continuous exposure to
infections.
Interventions for stunting should commence on or around 6-12 months to help

avert developmental consequences on children. About 36% reduction can be
achieved when nutrition interventions at 99% coverage is introduced before
36 months (Maternal and Child Undernutrition, Lancet Series). Introducing
nutrition interventions beyond 3 years old have reduced efficiency and may
even contribute to development of obesity and diet-related degenerative
diseases in later life.
Recommended interventions to avert and manage stunting and undernutrition

are found in Attachment 12.
h. Recording, Reporting and Disseminating OPT Plus Results
The activity does not stop with the measurement of children. After the
conduct of OPT Plus, the OPT Plus Team will process the results and record
them in the OPT Plus forms.
h1. The OPT Plus Forms (Attachment 13)
To facilitate the recording and reporting process, the OPT Plus results will
be recorded at different geo-administrative levels using different OPT Plus
forms. A summary of the OPT Plus forms by level, is shown in Table 2.
OPT Plus Form 1B should also be filled up to come up with the masterlist
of preschoolers whose weights are underweight and severely underweight,
and or stunted, wasted.
The list will be presented to the Barangay Nutrition Committee (BNC) for
inclusion as beneficiaries of programs and projects implemented in the
barangay, among others: micronutrient supplementation (vitamin A, iron
& iodine), nutrition education, food production (backyard gardening),
Page 29 of 81
small animal dispersal/raising (poultry, swine, goat), supplementary

feeding, and income-generating projects (handicraft, food vending), among
others.
All workers in the barangay, i.e. RHM, agriculture technician, teacher-in-

charge of nutrition, day care worker, barangay officials should receive a
copy of the masterlist of underweight children from the BNS as soon as
the OPT Plus results has been consolidated. This should guide the workers
when choosing beneficiaries for programs and projects.
h2. Submission and dissemination of OPT Plus Results
Figure 3 shows the flow of report submission and dissemination of OPT

Plus results.
h2.1. Upon completion of OPT Plus and recording in OPT Plus forms by
the BNS, the RHM will check the entries in the OPT Plus Forms for
correctness and accuracy.
h2.2. The BNS as the coordinator of the OPT Plus Team presents the
results of the OPT Plus to the Barangay Nutrition Committee (BNC)
for guidance and to input in the nutrition assessment.
h2.3. Signed by the Barangay Captain as chair of the BNC, the BNC
submits the validated OPT Plus result to the Chairperson of the
City/Municipal Nutrition Committee (C/MNC) thru the Office of the
Nutrition Action Officer (C/MNAO) for consolidation.
h2.4. The C/MNAO presents the consolidated OPT Plus results to the
C/MNC for information and targeting.
The MNC through the mayor will submit the consolidated and signed
municipal OPT Plus results to the Provincial Nutrition Action Officer
(PNAO). The CNC through the mayor will submit the consolidated
OPT Plus results directly to the NNC Regional Office for
consolidation.
h2.5. The PNAO presents the OPT Plus results to the PNC for information
and targeting. The consolidated OPT Plus results is submitted by the
governor to the NNC Regional Office for consolidation.
h2.6. The consolidated City and Provincial OPT Plus result is presented by
the NNC- Nutrition Program Coordinator to the Regional Nutrition
Committee (RNC) for information, targeting and monitoring.
h2.7. The regional OPT Plus results are then submitted to NNC-CO for
consolidation.
h2.8. NNC- central office consolidates the data for presentation to the
NNC Technical Committee, preparation of NDMs and dissemination
to nutrition program partners.
Page 30 of 81
Figure 3. Validation and Flow of OPT Plus Report Forms
Level OPT Prepared by Checked/Validated by Approved/ Submission to:

Plus Noted by:
forms
Barangay 1 BNS/BHW Midwife/Nurse/D/CNPC

1A BNS/BHW Midwife/Nurse/D/CNPC BNC Chair C/MNC Chair
1B BNS/BHW Midwife/Nurse/D/CNPC BNC Chair C/MNC Chair
Component 2 DCNPC/ND/ C/MHO C/MNC Chair Component

City/Municipal C/MNAO City/Mun:
2A DCNPC/ND/ C/MHO C/MNC Chair PNC Chair
C/MNAO
Highly
Urbanized or 2 DCNPC/ND/ C/MHO C/MNC Chair HUC/ICC:
Independent C/MNAO RNC Chair
Component 2A DCNPC/ND/ C/MHO C/MNC Chair
City (HUC or C/MNAO
ICC)
Province 3 DCNPC/ND PHO PNC Chair RNC Chair
3A DCNPC/ND PHO PNC Chair
Region 4 NO III NPC RNC Chair NNC-CO

4A NO III NPC RNC Chair
4B NO III NPC RNC Chair
National 5 NSD Staff NSD Division Chief NNC ED Partners

5A NSD Staff NSD Division Chief NNC ED Partners
Page 31 of 81
Table 2. Guide in Accomplishing and Submitting OPT Plus Forms

Level OPT Plus Title/Description Accomplished Number Submitted to When to submit
Form by of copies
Barangay 1 List of Preschoolers with weight and height BNS/BHW 1 - file (Retained in the 1-2 weeks after last
(1 page) measurement and identified Nutritional copy barangay) day of OPT Plus
Status. The form includes information on the conducted or at the
preschooler measured, specifically: household latest 25 March of
number, name of household every year
head/mother/caregiver; name of preschooler, sex,
date of birth, date of measurement (weight and
length/height), age in months, weight,
length/height and nutritional status. Other
pertinent information in the form are names of
the barangay, city/municipality, province, year,
and date of OPT Plus.
Checked by midwife/nurse/D/CNPC with date.

1A Barangay Tally and Summary Sheet of BNS/BHW 1 - file a. C/MNC 1 week after
(3 pages) Preschoolers with Weight & Height copy Chairperson completion of
Measurement by Age Group, Sex and consolidation of
Nutritional Status. This form will serve as the 1 - for OPT Plus results
tally sheet to determine the actual number of RHU or every 15 April
preschoolers measured aggregated by age, sex, of every year
and nutritional status. Other pertinent information 1 - for
in the form are names of the barangay, BNC
city/municipality, province, estimated number &
actual number of preschoolers aged 0-59 months 1 for
and 0-71 months old measured, percent OPT Plus C/MNC
coverage of 0-59 and 0-71 months old PS,
number indigenous PS measured aged 0-59 and
0-71 months old, indigenous group/s, year/period
of measurement and previous year prevalence
rate.
Checked by RHM/nurse/DCNPC & approved by

BNC Chairperson with specific date
Page 30 of 81

Form By of copies
Barangay 1B List of Affected/At-risk Preschoolers 0-71 BNS 1- file a. Rural Health One (1) week after
(1 page) months old. This form is the summary of the copy Midwife (for completion of OPT
identified preschoolers with underweight, validation) Plus consolidated
severely underweight, stunted, severely stunted, 1- for report within the
wasted, severely wasted, overweight and obese. RHM b. Barangay period Jan-March
Other pertinent information in the form are name Nutrition every year
of barangay, city/municipality, province, 1- for Committee
measurement period & year, name of household BNC (for
head/mother/caregiver, name of preschoolers, approval)
sex, indigenous group, age in months and
nutritional status.
Checked by RHM/nurse/D/CNPC
Approved by BNC Chairperson
City/ 2 City/Municipal Consolidation Sheet of Nutritionist/ 1- file C/MNC One (1) week after
Municipality (4 pages) Operation Timbang Plus Results. This form C/MNAO/ copy consolidation of
summarizes the OPT Plus results of all barangays D/CNPC results of
aggregated by age group, sex and nutritional 1- for city/municipal OPT
status. Pertinent information included are C/MNC Plus or 5 May of
city/municipality, province, total number of every year
barangays, barangays with OPT Plus results, 1-for PNC
year/period of measurement, indigenous group
and number of indigenous PS measured 0-59 and
0-71 months old . Each page of the form
corresponds to the nutritional status of the three
(3) indices, take note of the specific buttons to
check which will inform reader of the specific
information
Approved by City/Mun Health Officer

Noted by Mayor, C/MNC Chaiperson
Page 31 of 81

Form By of copies
2A City/Municipal Summary Report on C/MNAO/ 1- file a. Provincial One (1) week after
(3 pages) Operation Timbang Plus. This form is the nutritionist/ copy Nutrition city/ municipal
consolidation, of all preschoolers measured in the D/CNPC Committee consolidation of
city/municipality aggregated by age, sex and 1-for PNC (PNC) OPT Plus results
nutritional status. Other pertinent information Chairperson or 15 May of
include: name of city/municipality, province, 1- for every year
region, total number of barangays, total number NNC-RO b. NNC-RO
of barangays with OPT Plus results, year/period (for city (for city data)
of measurement, estimated number of data)
preschoolers 0-59 and 0-71 months old, actual
number of preschoolers 0-59 and 0-71 months
old measured, percent OPT Plus coverage 0-59
and 0-71 months old, indigenous group/s, number
of indigenous PS measured 0-59 and 0-71 months
old and the previous year prevalence rate.
Checked by City/Municipal Health Officer

Approved by Mayor, C/MNC Chairperson
Province 3 Provincial Consolidation Sheet of Operation D/CNPC/ 1- file NNC-RO One (1) week after
(4 pages) Timbang Plus Results. This form summarizes nutritionist copy consolidation of
the OPT Plus results of all municipalities provincial OPT
aggregated by age group, sex and nutritional 1- for NPC Plus results
status. Pertinent information include: province, consolidation or 5
total number of municipalities, total number of June of every year
municipalities with OPT Plus results, year/period
of measurement, indigenous group and number of
indigenous preschool measured 0-59 and 0-71
months old. Each page of the form corresponds
to the nutritional status of the three (3) indices,
take note of the specific buttons to check which
will inform reader of the specific information
Approved by Provincial Health Officer
Noted by Governor, PNC Chairperson
Page 32 of 81

Form By of copies
3A Provincial Summary Report on Operation D/CNPC/ 1- file Nutrition One (1) week after
(3 pages) Timbang Plus. This form is the consolidation of Nutritionist copy Program consolidation of
all preschoolers measured in the province, Coordinator city/ municipal
aggregated by age, sex and nutritional status. 1- for NPC (NPC) OPT Plus results
Other pertinent information include: province, or 15 June of
total number of municipalities, total number of every year
municipalities with OPT Plus results, percent
OPT Plus coverage (Mun level); total number of
barangays, total number of barangays with OPT
Plus results, percent OPT Plus coverage (Bgy
level); year/period of measurement, estimated
number of preschoolers 0-59 and 0-71 months
old, actual number of preschoolers aged 0-59 and
0-71 months measured, indigenous group and
number of indigenous preschool 0-59 and 0-71
months old, and the previous year prevalence
rate.
Validated by Provincial Health Officer

Approved by Governor, PNC Chairperson
4 Regional Consolidation Sheet of Operation NO III/NNC 1- file NNC-CO One (1) week after
(4 pages) Timbang Plus Results. This form includes OPT copy completion of
Plus results within the region, specifically the consolidation of
listing of all provinces and cities. Other 1 for provincial OPT
information include: region, total number of RNC Plus results or 5
provinces/cities, total number of provinces and July of every year
cities with OPT Plus Results, year/period of 1- for
measurement, indigenous group and number of NNC-CO
indigenous preschool measured 0-59 and 0-71
months old
Approved by Nutrition Program Coordinator

Noted by Regional Director, RNC Chairperson
Page 33 of 81

Form By of copies
4A Regional Summary Report on Operation NO III 1- file NNC-CO One (1) week after
(3 pages) Timbang Plus. This form is the consolidation copy completion of
of all preschoolers measured in the region, consolidation of
aggregated by age, sex and nutritional status. 1- for provincial OPT
Other pertinent information include: region, total RNC Plus results or 5
number of province/city, total number of July of every year
municipalities/barangays, total number of 1 for
provinces/cities with OPT Plus results, total NNC-CO
number of municipalities/barangays with OPT
Plus results, percent OPT Plus coverage
Province/City/Mun/Barangay, percent OPT Plus
coverage 0-59 and 0-71 months old, year/period
of measurement, estimated number of
preschoolers 0-59 and 0-71 months old, actual
number of preschoolers aged 0-59 and 0-71
months measured, indigenous group and number
of indigenous preschool 0-59 and 0-71 months
old, and the previous year prevalence rate.
Validated by NPC
Approved by RNC Chairperson
Region 4B Report on Regional Coverage of Operation NO III 1- file NNC-CO One (1) week after
(1 page) Timbang Plus. This form is the matrix copy Note: completion of
coverage of OPT Plus results in the region, by Presented to consolidation of
province/city, municipalities, barangay, 1 for RNC regional OPT
estimated and actual number of preschooler RNC Plus results or 15
measured and actual number of indigenous July of every year
preschoolers measured. Other pertinent 1- for
information include: region and period of OPT NNC-CO
Validated by NPC
Page 34 of 81

Forms By of copies
National 5 National Consolidation Sheet of Operation NO II 1- file n/a Should be

(4 pages) Timbang Plus Results. This form summarizes copy completed by end
all OPT Plus results in the country by Note: Presented of September every
city/municipality aggregated by age group, sex to NNC year
and nutritional status. Pertinent information TechCom
includes region, province, total number of
province/city, total number province/citywith
OPT results, year/period of measurement,
indigenous group and number of indigenous PS
measured 0-59 and 0-71 months old.
Approved by NSD Division Chief

Noted by NNC Executive Director
5A National Summary Report on Operation NO II 1- file Should be
(3 pages) Timbang Plus Results. This form consolidates copy completed by end
the OPT Plus results gathered from all barangays of September every
of the country aggregated by age group, sex and year
nutritional status. Pertinent information include
region; total number of province, city,
municipalities, barangays; total number of
province, city, municipalities, barangays with
OPT Plus results; percent OPT Plus coverage of
province, city, municipalities, barangays;
estimated number of 0-59 months and 0-71
months old, actual number of 0-59 months and 0-
71 months old measured; number of indigenous
PS measured 0-59 and 0-71 months old, percent
OPT Plus coverage of 0-59 and 0-71 months old
preschool children; year/period of measurement
and previous year prevalence rate.
Validated by NSD Division Chief

Approved by NNC TechComm Chairperson
Page 35 of 81
i. Post OPT Plus Activities of the BNS/BHW
Action Officers and D/CNPCs should encourage BNSs/BHWs to do the following post-
OPT activities.
2) Ensure that the family/child/children are referred to proper institutions to help them
improve their way of life and nutritional status
3) Ensure active participation of the families/child/children in the programs and projects

they should be involved in (nutrition education classes, supplementary feeding,
immunization, de-worming and others)
4) Ensure that the growth of children, especially the 0-23 months old and underweight
24-71 months old children are monitored every month at the health center, or through
supervised home visit.
5) Maintain active networking among civic groups, Non-government organizations for

referrals and funding source
6) Monitor the planning and implementation of the programs and projects for the
identified families of the malnourished children
7) Ensure that the Barangay Nutrition Committee meets regularly to discuss updates on
the programs and projects being implemented for the families of the malnourished
children during BNC meetings
Page 36 of 81
ii. References
A. Books and Publications
Cogill, Bruce. Anthropometric Indicators Measurement Guide. June 2001.
National Nutrition Council. Revised Operation Timbang Guidelines. 1994.

_____________. Glossary of Terms for the Philippine Plan of Action for Nutrition.
Developed by the Technical Working Group on Nutrition Research and Surveillance.
September 1996.
_____________. The Philippine Nutrition Program: Implementing Guidelines. June
1981.
_____________. Operation Timbang Workbook. (1975)
Food and Nutrition Research Institute. DOST. A Handbook on International Reference

Standards (IRS) Growth Tables and Charts Adopted for Use in the Philippines. 2003.
_____________. Users Manual The International Reference Standards (IRS) Growth
Tables and Charts adopted for Field Use in the Philippines. 2003.
Food and Nutrition Research Institute and Philippine Pediatric Society. Anthropometric
Tables and Charts for Filipino Children. 1992.
Department of Health. Procedural Guidelines for Growth Monitoring of Preschool
Children. 1986.
World Health Organization. Training Course on Child Growth Assessment. Module C.
Interpreting Growth Indicators. Geneva, WHO, 2008.
B. Circulars/Orders
Department of Health Administrative Order No. 0015 Series 2010. Policy on Child
Growth Standards. 8 June 2010.
_________________. Executive Order No. ___, Series 2003 estimating target

population
National Nutrition Council Governing Board Resolution No. 2 Series 2008. Adaptation
of the New WHO Child Growth Standards for Use for 0-5 years old the Philippines
C. Website
www.who.int/childgrowth/en/
www.doh.gov.ph
www. Nnc.gov.ph
Page 37 of 81
ATTACHMENTS
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Attachment 2
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Attachment 3
Checklist for the OPT Plus Team
The checklist ensures that all preparations before, during and after the conduct of OPT Plus are
done. Indicate with a check if activity has been done.
Activities Done Remarks
Prior to conduct of OPT Plus
Rural Health Midwife, Barangay Nutrition Scholar and

Barangay Health Workers coordinate with the Barangay
Nutrition Committee on the schedule, place and time of
OPT Plus
Identify task of OPT Plus Team members

- who will post/inform the community on the OPT
Plus schedule
- who will update previous years spot map
- who will do what during conduct of OPT Plus
- who will process OPT Plus data
Prepare tools/equipment to bring:

- Calibrated weighing scale with strap, 2 hooks and 3
weighing pants (small, medium and large)
- Rope (for hanging of weighing scale)
- Verified Length/Height board
- Weight-for-Age Table of Boys and Girls 0-71
Months
- Length/Height-for-Age Table of Boys and Girls 0-71
Months
- Weight-for-Length Table of Boys and Girls 0-23
Months
- Weight-for-Height Table of Boys and Girls 0-71
Months
- Age in Months Table
- Masterlist of preschoolers
- Family profile (optional)
- OPT Plus Form 1
- Old spot map (previous year) and updated spot map
- Pencils (at least 2)
- Extra sheets of paper
Page 47 of 81
Activities Done Remarks
During conduct of OPT Plus
Setting-up
- Hang the calibrated weighing scale securely
- Organize preschoolers and mothers/caregivers
- List down names/check name and other information
from Masterlist
Actual measurement day

- Compute for the age in months
- Measure preschoolers (weight and height)
- Refer mother or caregiver to the Barangay Health
Center/Rural Health unit/clinic if the child is
obviously underweight, overweight and ill for
counseling and/or treatment
After conduct of OPT Plus

BNS and BHW
- Validate (double check or 48ecomputed) the age in
months and nutritional status
- fill up OPT Plus Forms 1A and 1B
- Update spot map and Masterlist
- Visit the mother/caregiver of children who were
identified as underweight or overweight and refer the
health center/clinic. Advise them to bring the child
every month to the health center/clinic for growth
monitoring
Submit the OPT Plus results to the midwife for

checking of results
Upon approval of the midwife, present the OPT Plus
results to BNC preferably during the 1 st quarter
meeting. Request for a special BNC meeting if
necessary where the updated spot map can also be
discussed and updated barangay profile could be
presented. The BNC can then proceed with
reviewing/formulating the barangay problem tree and
planning the interventions
Submit filled up OPT Plus Form 1A to C/MNAO who
will then consolidate the results of barangay OPT Plus
and present the results to the C/MNC, preferably during
the 1st quarter meeting of the C/MNC
Page 48 of 81
Attachment 4
Steps on Calibration and Verification of Weighing Scales
Definition
Calibration is the checking and adjusting of the weighing scale within the possible and
allowable error. It is important to calibrate to make sure that scale is within the tolerable limits of
accuracy and to detect deterioration beyond the permissible levels.
Procedures in calibrating:
1. Clear and free the scale from any foreign objects or attachments that could hamper its
operation.
2. Make sure that there are no loose parts such as screw of the platform.
3. Make sure that the adjusting screw is functioning properly.
4. Check whether the dial pointer rotates smoothly with no noticeable or visible obstruction.
5. For hanging type scale with dual face, make sure that the readings on both sides are the
same.
6. For table type scale, place the scale on evenly leveled surface
7. Perform the following steps in calibration:
a. Calibrate using standard test weights, available usually in 2, 5 and 10kg.
Perform the increasing load test and the decreasing load test at the 10%,
25%, 50% and nearly 100% of the capacity of the weighing scale.
Take 3 readings for each of the standard weight indicated.
Get the average reading and the difference between the applied weight
and the average reading.
For the applied weight with more than the permissible error, move
adjustment screw and return to 0 balance
Repeat taking 3 readings, get the average and permissible error
If still more than the permissible error, have the scale repaired or
condemned.
Note: Some DOST regional offices and PAO-accredited laboratories offer calibration
services at reasonable cost. Ideally, weighing scales should be submitted to the laboratory
for calibration at least once a year.
Page 49 of 81
Verification is done to check if the weighing scales calibration results have not
changed significantly since it had its last calibration.
Procedures in verifying:
1. Clear and free the scale from any foreign objects or attachments that could hamper its
operation.
2. Make sure that there are no loose parts such as screw of the platform.
3. Make sure that the adjusting screw is functioning properly.
4. Check whether the dial pointer rotates smoothly with no noticeable or visible obstruction.
5. For hanging type scale with dual face, make sure that the readings on both sides are the
same.
6. For table type scale, place the scale on evenly leveled surface
7. Perform the following steps in calibration:
Verify using just one (1) standard test weight, usually close o the full
capacity (not less than 80%) of the weighing scale being checked.
Perform the weighing at the center of the weighing scales pan.
Take 3 readings using the standard test weight.
Get the average reading and the difference between the applied weight
and the average reading.
If the computed difference in the verification has not significantly
changed as compared to the computed difference from the weighing
scales last calibration results, then the weighing scale is fit for use.
Otherwise, the weighing scale needs to be recalibrated.
Note: It is recommended that verification of weighing scales is performed more often

between the calibration interval. Ideally, if the calibration interval of the weighing
scale is one (1) year, the verification is done every month or every quarter depending
on the usage of the weighing scale.
Page 50 of 81
Attachment 5
Care and Maintenance of Weighing Scale and Height Board
Maintenance is the process of always keeping the weighing scale/height board in good
operating condition. It includes:
1. Simple housekeeping measures

2. Lubrication
3. Corrosion control
4. Servicing
5. Repair/Replacement of worn out parts
6. Storage and handling
7. Record keeping
A. Weighing Scales:
To prolong the useful life of the weighing scale, check for the following factors:
1. Normal wear and tear. Normal usage causes wear especially of the moving parts. Through
time, weighing scale in use or in storage undergoes normal wear and tear.
2. Vibration from handling and movements causes misalignment of moving parts
3. Contamination from dust and other particles. The presence of dust/other foreign particles
causes friction and corrosion.
4. Exposure to the elements such as dampness and humidity which cause corrosion.
Regular Preventive Work
1. Always keep the weighing scale clean. Wipe with wet cloth, then with dry cloth daily and
after each use.
2. Apply oil to the moving parts every week. This can be done by an oil dispenser.
3. Wash the crib twice a month.
4. Store and keep weighing scale only in a dry place. Do not expose scale to moisture.
5. Wrap or cover weighing scale with plastic when storing.
6. Apply anti-rust products if available.
7. Maintain a regular maintenance record. Use the maintenance and calibration form.
B. Height Board
1. Use the height board properly according to its specific purpose.

2. Conduct regular tightness checks of all screws and bolts for safety.
3. Conduct regular visual inspection of the height board to check the board quality and avoid
potential risk to children while in-service.
4. Transport or transfer the board from one place to another properly. Do not drag.
5. Replace parts when necessary following the standard specifications in the fabrication of
the height board.
6. Re-apply finishing when the height board in service needs supplemental finishes to retain
its appearance. Excessive used can cause damage to both the finish and wood itself.
7. Let the kids stand on the board barefooted not only to obtain accurate measurements but
also to avoid damage on the surface of the foot board.
8. Regularly clean with a soft, clean and dry cloth to keep the height board looking good.
9. Keep and store the height board in adequately dry area. Do not expose to water, excessive
heat and direct sunlight.
Page 51 of 81
OPT Plus Guidelines Attachment 6a

Republic of the Philippines
Department of Health
NATIONAL NUTRITION COUNCIL
Age in Months Table, 2011
Month of Weighing: JANUARY

Year of Birth
Month of Birth Present
Year 2010 2009 2008 2007 2006 2005
1 January 0 12 24 36 48 60
2 February 11 23 35 47 59 71
3 March 10 22 34 46 58 70
4 April 9 21 33 45 57 69
5 May 8 20 32 44 56 68
6 June 7 19 31 43 55 67
7 July 6 18 30 42 54 66
8 August 5 17 29 41 53 65
9 September 4 16 28 40 52 64
10 October 3 15 27 39 51 63
11 November 2 14 26 38 50 62
12 December 1 13 25 37 49 61
Month of Weighing: FEBRUARY

Year of Birth
Year 2010 2009 2008 2007 2006 2005
1 January 1 13 25 37 49 61
2 February 0 12 24 36 48 60
3 March 11 23 35 47 59 71
4 April 10 22 34 46 58 70
5 May 9 21 33 45 57 69
6 June 8 20 32 44 56 68
7 July 7 19 31 43 55 67
8 August 6 18 30 42 54 66
9 September 5 17 29 41 53 65
10 October 4 16 28 40 52 64
11 November 3 15 27 39 51 63
12 December 2 14 26 38 50 62
Note: This age-in-months table may be updated for succeeding years. Updating may be done by
assigning the number 0 on the month of weighing of the present year and then numbering
the previous month as 1, then 2, 3, 4 for the prior months until 71 months is reached.
Page 52 of 81
Month of Weighing: MARCH

Year of Birth
Year 2010 2009 2008 2007 2006 2005
1 January 2 14 26 38 50 62
2 February 1 13 25 37 49 61
3 March 0 12 24 36 48 60
4 April 11 23 35 47 59 71
5 May 10 22 34 46 58 70
6 June 9 21 33 45 57 69
7 July 8 20 32 44 56 68
8 August 7 19 31 43 55 67
9 September 6 18 30 42 54 66
10 October 5 17 29 41 53 65
11 November 4 16 28 40 52 64
12 December 3 15 27 39 51 63
Month of Weighing: APRIL

Year of Birth
Year 2010 2009 2008 2007 2006 2005
1 January 3 15 27 39 51 63
2 February 2 14 26 38 50 62
3 March 1 13 25 37 49 61
4 April 0 12 24 36 48 60
5 May 11 23 35 47 59 71
6 June 10 22 34 46 58 70
7 July 9 21 33 45 57 69
8 August 8 20 32 44 56 68
9 September 7 19 31 43 55 67
10 October 6 18 30 42 54 66
11 November 5 17 29 41 53 65
12 December 4 16 28 40 52 64
Page 53 of 81
Month of Weighing: MAY

Year of Birth
Year 2010 2009 2008 2007 2006 2005
1 January 4 16 28 40 52 64
2 February 3 15 27 39 51 63
3 March 2 14 26 38 50 62
4 April 1 13 25 37 49 61
5 May 0 12 24 36 48 60
6 June 11 23 35 47 59 71
7 July 10 22 34 46 58 70
8 August 9 21 33 45 57 69
9 September 8 20 32 44 56 68
10 October 7 19 31 43 55 67
11 November 6 18 30 42 54 66
12 December 5 17 29 41 53 65
Month of Weighing: JUNE

Year of Birth
Year 2010 2009 2008 2007 2006 2005
1 January 5 17 29 41 53 65
2 February 4 16 28 40 52 64
3 March 3 15 27 39 51 63
4 April 2 14 26 38 50 62
5 May 1 13 25 37 49 61
6 June 0 12 24 36 48 60
7 July 11 23 35 47 59 71
8 August 10 22 34 46 58 70
9 September 9 21 33 45 57 69
10 October 8 20 32 44 56 68
11 November 7 19 31 43 55 67
12 December 6 18 30 42 54 66
Page 54 of 81
Month of Weighing: JULY

Year of Birth
Year 2010 2009 2008 2007 2006 2005
1 January 6 18 30 42 54 66
2 February 5 17 29 41 53 65
3 March 4 16 28 40 52 64
4 April 3 15 27 39 51 63
5 May 2 14 26 38 50 62
6 June 1 13 25 37 49 61
7 July 0 12 24 36 48 60
8 August 11 23 35 47 59 71
9 September 10 22 34 46 58 70
10 October 9 21 33 45 57 69
11 November 8 20 32 44 56 68
12 December 7 19 31 43 55 67
Month of Weighing: AUGUST

Year of Birth
Year 2010 2009 2008 2007 2006 2005
1 January 7 19 31 43 55 67
2 February 6 18 30 42 54 66
3 March 5 17 29 41 53 65
4 April 4 16 28 40 52 64
5 May 3 15 27 39 51 63
6 June 2 14 26 38 50 62
7 July 1 13 25 37 49 61
8 August 0 12 24 36 48 60
9 September 11 23 35 47 59 71
10 October 10 22 34 46 58 70
11 November 9 21 33 45 57 69
12 December 8 20 32 44 56 68
Page 55 of 81
Month of Weighing: SEPTEMBER

Year of Birth
Year 2010 2009 2008 2007 2006 2005
1 January 8 20 32 44 56 68
2 February 7 19 31 43 55 67
3 March 6 18 30 42 54 66
4 April 5 17 29 41 53 65
5 May 4 16 28 40 52 64
6 June 3 15 27 39 51 63
7 July 2 14 26 38 50 62
8 August 1 13 25 37 49 61
9 September 0 12 24 36 48 60
10 October 11 23 35 47 59 71
11 November 10 22 34 46 58 70
12 December 9 21 33 45 57 69
Month of Weighing: OCTOBER

Year of Birth
Year 2010 2009 2008 2007 2006 2005
1 January 9 21 33 45 57 69
2 February 8 20 32 44 56 68
3 March 7 19 31 43 55 67
4 April 6 18 30 42 54 66
5 May 5 17 29 41 53 65
6 June 4 16 28 40 52 64
7 July 3 15 27 39 51 63
8 August 2 14 26 38 50 62
9 September 1 13 25 37 49 61
10 October 0 12 24 36 48 60
11 November 11 23 35 47 59 71
12 December 10 22 34 46 58 70
Page 56 of 81
Month of Weighing: NOVEMBER

Year of Birth
Year 2010 2009 2008 2007 2006 2005
1 January 10 22 34 46 58 70
2 February 9 21 33 45 57 69
3 March 8 20 32 44 56 68
4 April 7 19 31 43 55 67
5 May 6 18 30 42 54 66
6 June 5 17 29 41 53 65
7 July 4 16 28 40 52 64
8 August 3 15 27 39 51 63
9 September 2 14 26 38 50 62
10 October 1 13 25 37 49 61
11 November 0 12 24 36 48 60
12 December 11 23 35 47 59 71
Month of Weighing: DECEMBER

Year of Birth
Year 2010 2009 2008 2007 2006 2005
1 January 11 23 35 47 59 71
2 February 10 22 34 46 58 70
3 March 9 21 33 45 57 69
4 April 8 20 32 44 56 68
5 May 7 19 31 43 55 67
6 June 6 18 30 42 54 66
7 July 5 17 29 41 53 65
8 August 4 16 28 40 52 64
9 September 3 15 27 39 51 63
10 October 2 14 26 38 50 62
11 November 1 13 25 37 49 61
12 December 0 12 24 36 48 60
Page 57 of 81
OPT Plus Guidelines Attachment 6b
Republic of the Philippines

Department of Health
NATIONAL NUTRITION COUNCIL
Month of Weighing: JANUARY

Year of Birth
Year 2011 2010 2009 2008 2007 2006
1 January 0 12 24 36 48 60
2 February 11 23 35 47 59 71
3 March 10 22 34 46 58 70
4 April 9 21 33 45 57 69
5 May 8 20 32 44 56 68
6 June 7 19 31 43 55 67
7 July 6 18 30 42 54 66
8 August 5 17 29 41 53 65
9 September 4 16 28 40 52 64
10 October 3 15 27 39 51 63
11 November 2 14 26 38 50 62
12 December 1 13 25 37 49 61
Month of Weighing: FEBRUARY

Year of Birth
Year 2011 2010 2009 2008 2007 2006
1 January 1 13 25 37 49 61
2 February 0 12 24 36 48 60
3 March 11 23 35 47 59 71
4 April 10 22 34 46 58 70
5 May 9 21 33 45 57 69
6 June 8 20 32 44 56 68
7 July 7 19 31 43 55 67
8 August 6 18 30 42 54 66
9 September 5 17 29 41 53 65
10 October 4 16 28 40 52 64
11 November 3 15 27 39 51 63
12 December 2 14 26 38 50 62
Note: This age-in-months table may be updated for succeeding years. Updating may be done by
assigning the number 0 on the month of weighing of the present year and then numbering
the previous month as 1, then 2, 3, 4 for the prior months until 71 months is reached.
Page 58 of 81
Month of Weighing: MARCH

Year of Birth
Year 2011 2010 2009 2008 2007 2006
1 January 2 14 26 38 50 62
2 February 1 13 25 37 49 61
3 March 0 12 24 36 48 60
4 April 11 23 35 47 59 71
5 May 10 22 34 46 58 70
6 June 9 21 33 45 57 69
7 July 8 20 32 44 56 68
8 August 7 19 31 43 55 67
9 September 6 18 30 42 54 66
10 October 5 17 29 41 53 65
11 November 4 16 28 40 52 64
12 December 3 15 27 39 51 63
Month of Weighing: APRIL

Year of Birth
Year 2011 2010 2009 2008 2007 2006
1 January 3 15 27 39 51 63
2 February 2 14 26 38 50 62
3 March 1 13 25 37 49 61
4 April 0 12 24 36 48 60
5 May 11 23 35 47 59 71
6 June 10 22 34 46 58 70
7 July 9 21 33 45 57 69
8 August 8 20 32 44 56 68
9 September 7 19 31 43 55 67
10 October 6 18 30 42 54 66
11 November 5 17 29 41 53 65
12 December 4 16 28 40 52 64
Page 59 of 81
Month of Weighing: MAY

Year of Birth
Year 2011 2010 2009 2008 2007 2006
1 January 4 16 28 40 52 64
2 February 3 15 27 39 51 63
3 March 2 14 26 38 50 62
4 April 1 13 25 37 49 61
5 May 0 12 24 36 48 60
6 June 11 23 35 47 59 71
7 July 10 22 34 46 58 70
8 August 9 21 33 45 57 69
9 September 8 20 32 44 56 68
10 October 7 19 31 43 55 67
11 November 6 18 30 42 54 66
12 December 5 17 29 41 53 65
Month of Weighing: JUNE

Year of Birth
Year 2011 2010 2009 2008 2007 2006
1 January 5 17 29 41 53 65
2 February 4 16 28 40 52 64
3 March 3 15 27 39 51 63
4 April 2 14 26 38 50 62
5 May 1 13 25 37 49 61
6 June 0 12 24 36 48 60
7 July 11 23 35 47 59 71
8 August 10 22 34 46 58 70
9 September 9 21 33 45 57 69
10 October 8 20 32 44 56 68
11 November 7 19 31 43 55 67
12 December 6 18 30 42 54 66
Page 60 of 81
Month of Weighing: JULY

Year of Birth
Year 2011 2010 2009 2008 2007 2006
1 January 6 18 30 42 54 66
2 February 5 17 29 41 53 65
3 March 4 16 28 40 52 64
4 April 3 15 27 39 51 63
5 May 2 14 26 38 50 62
6 June 1 13 25 37 49 61
7 July 0 12 24 36 48 60
8 August 11 23 35 47 59 71
9 September 10 22 34 46 58 70
10 October 9 21 33 45 57 69
11 November 8 20 32 44 56 68
12 December 7 19 31 43 55 67
Month of Weighing: AUGUST

Year of Birth
Year 2011 2010 2009 2008 2007 2006
1 January 7 19 31 43 55 67
2 February 6 18 30 42 54 66
3 March 5 17 29 41 53 65
4 April 4 16 28 40 52 64
5 May 3 15 27 39 51 63
6 June 2 14 26 38 50 62
7 July 1 13 25 37 49 61
8 August 0 12 24 36 48 60
9 September 11 23 35 47 59 71
10 October 10 22 34 46 58 70
11 November 9 21 33 45 57 69
12 December 8 20 32 44 56 68
Page 61 of 81
Month of Weighing: SEPTEMBER

Year of Birth
Year 2011 2010 2009 2008 2007 2006
1 January 8 20 32 44 56 68
2 February 7 19 31 43 55 67
3 March 6 18 30 42 54 66
4 April 5 17 29 41 53 65
5 May 4 16 28 40 52 64
6 June 3 15 27 39 51 63
7 July 2 14 26 38 50 62
8 August 1 13 25 37 49 61
9 September 0 12 24 36 48 60
10 October 11 23 35 47 59 71
11 November 10 22 34 46 58 70
12 December 9 21 33 45 57 69
Month of Weighing: OCTOBER

Year of Birth
Year 2011 2010 2009 2008 2007 2006
1 January 9 21 33 45 57 69
2 February 8 20 32 44 56 68
3 March 7 19 31 43 55 67
4 April 6 18 30 42 54 66
5 May 5 17 29 41 53 65
6 June 4 16 28 40 52 64
7 July 3 15 27 39 51 63
8 August 2 14 26 38 50 62
9 September 1 13 25 37 49 61
10 October 0 12 24 36 48 60
11 November 11 23 35 47 59 71
12 December 10 22 34 46 58 70
Page 62 of 81
Month of Weighing: NOVEMBER

Year of Birth
Year 2011 2010 2009 2008 2007 2006
1 January 10 22 34 46 58 70
2 February 9 21 33 45 57 69
3 March 8 20 32 44 56 68
4 April 7 19 31 43 55 67
5 May 6 18 30 42 54 66
6 June 5 17 29 41 53 65
7 July 4 16 28 40 52 64
8 August 3 15 27 39 51 63
9 September 2 14 26 38 50 62
10 October 1 13 25 37 49 61
11 November 0 12 24 36 48 60
12 December 11 23 35 47 59 71
Month of Weighing: DECEMBER

Year of Birth
Year 2011 2010 2009 2008 2007 2006
1 January 11 23 35 47 59 71
2 February 10 22 34 46 58 70
3 March 9 21 33 45 57 69
4 April 8 20 32 44 56 68
5 May 7 19 31 43 55 67
6 June 6 18 30 42 54 66
7 July 5 17 29 41 53 65
8 August 4 16 28 40 52 64
9 September 3 15 27 39 51 63
10 October 2 14 26 38 50 62
11 November 1 13 25 37 49 61
12 December 0 12 24 36 48 60
Page 63 of 81
Attachment 7a
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Attachment 7b
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Attachment 8a
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Attachment 8b
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Attachment 9a
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Attachment 9b
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Attachment 10a
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Attachment 10b
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Attachment 11
How to Make a Spot Map
Step 1. Start the activity by explaining that the spot map is an important tool in program
planning, monitoring, evaluation and assessment
Step2. Continue by defining that a spot map is
a. An aerial view of the barangay, where the important characteristics of the

barangay are indicated
b. A graphical presentation of the current nutrition situation of a barangay
Step 3. Enumerate and discuss the steps in preparing a spot map, as follows:
a. Use the available map of the barangay
b. Make sure of that materials are available including illustration board or

plywood, paint, cartolina, permanent markers, map pins, plastic cover, paste or
tape, scissors, paint brush and ruler.
c. Write the names of neighboring barangays.
d. Draw on the map the existing structures such as school, church, health center,
barangay hall, day care center/s, water pump, water tank, houses, toilets, water
system, basketball court, creek/canal/drainage, water line, electric line,
pathway, cemented/rough road, business establishments, fishpond, poultry,
piggery, rest house, resort, small market and other markers.
e. For the houses drawn on the map, show/mark the following information by
using color codes/legends.
Yellow - with underweight/stunted/wasted children

Red - with severely underweight/severely stunted/severely wasted
children
Green - with normal weight/length/height children
Orange - with overweight children
Pink - with pregnant woman
Violet - with lactating woman
Brown - with infants
Blue - have large family size (households with greater than 5
members)
Gray - without sanitary toilets
Step 4. Once completed, present the spot map to the BNC when presenting the OPT Plus
data to help the BNC visualize the location and characteristics of families with
underweight children
Page 72 of 81
Step 5. Once completed, post the spot map at the barangay center, barangay hall, or any
place commonly frequented by the community.
9 Spot Map of Brgy. Dalisay LEGEND:

8
House
7 1
1 2 3 4 5 6 1 1 1 1 1 1 1 School
Health Center
1 2 3 4 5 6 7 1 2 3 4 1
1
8 1 Barangay
5 Hall
1
1 Church
1 1 1 1 1 9 6
7 1 DaycareCenter
1 2 3 8 1
8 1 Piggery
4 9 1
5 9 1
6 7 w/ UW PS
1 w/ SUW PS
1
1
1
Source : IHNF-CHE-UPLB. Adopted from the Trainers Manual on Basic Course for Barangay Nutrition
Scholar. 2011
Page 73 of 81
Attachment 12
Proven Interventions for Preventing and Managing Wasting and Stunting
Immediate management of acute malnutrition (wasting) should be done to reduce risks to

infections and prevent further deterioration of the nutritional status of the child. The WHO
has existing protocols on the management of moderate and severe acute malnutrition which
the Philippines are adapting which may be done home-based or moderate cases and hospital-
based for severe cases, which may use ready-to-use therapeutic food formulations. Wasted
children in communities should be immediately assisted for immediate nutrition and health
interventions. The adoption of the WHO SAM Protocol reduce deaths due to malnutrition
and complications by 55%.
Proven interventions to reduce stunting include improving complementary feeding support

through nutrition counseling, food supplements or conditional cash transfer-type for food-
insecure areas and without supplementation for food-secure populations. Diarrhea also
increases the risk of stunting among children by 1.04 per episode and therefore deserve
actions along hygiene promotion.
Effect of nutrition-related interventions on mortality and stunting in 36 countries

Proportional reduction in Relative reduction in prevalence
deaths before of stunting at
12 mos 24 mos 36 mos 12 mos 24 mos 36 mos
99% coverage with balanced 3.6 % 3.1% 2.9% 1.9% 0.5% 0.3%
energy protein supplementation
99% coverage with intermittent 2.4% 2.1% 1.9% 1.4% 0.3% 0.1%
preventive treatment
99% coverage with multiple 2.0% 1.7% 1.6% 0.9% 0.3% 0.1%
micronutrient supplementation
in pregnancy
99% coverage with 11.6% 9.9% 9.1% 0% 0% 0%
breastfeeding promotion and
support
99% coverage with feeding 0% 1.1% 1.5% 19.8% 17.2% 15.0%
intervention (promotion of
complementary feeding and
other supportive strategies)
99% coverage with Vitamin A 6.9% 7.1% 7.2% 0% 0% 0%
(including neonatal in Asia)
99% coverage with zinc 1.3% 2.8% 3.6% 9.1% 15.5% 17.0%
supplementation
99% coverage with hygiene 0% 0.1% 0.2% 1.9% 2.4% 2.4%
intervention
Source: Lancet Series on Maternal and Child Undernutrition 3
Attachment 13
Page 74 of 81
OPERATION TIMBANG PLUS

FORMS
Page 75 of 81

OPT Plus Guidelines

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IMPLEMENTING GUIDELINES ON

OPERATION TIMBANG Plus (OPT +)

Developed by the Inter-agency

Approved for nationwide implementation by the NNC Governing Board

II. Programmatic Developments 4

III. Objectives of Operation Timbang Plus (OPT Plus) 6

IV. Uses of OPT Plus Results 6

V. Mechanics of OPT Plus Implementation 7

7b Weight-for-Age Table for Girls, 0-71 Months 65

11 How to make a Spot Map 72

12 Proven Interventions for Preventing and Managing Wasting and 73

1 List of Preschoolers with Weight and Height Measurement and 75

Figure 5.3 Child Weight 16

Table 1. Comparison of Anthropometric Activities in the Philippines

II. Programmatic Developments

Upon recommendation of the TWG and endorsement by the NNC Technical

III. Objectives of the Operation Timbang Plus

To generate data on the nutrition situation of children as input to community nutrition

1. to identify and quantify preschoolers who are malnourished

IV. Uses of OPT Plus Results

V. Mechanics of Implementation of the OPT Plus

Figure 1. Mechanics of OPT Plus in the barangay

Preparation for OPT Plus Conduct of OPT Plus

Figure 2. Schematic flow of OPT Plus results

Purok 1 Purok 2 Purok 3 Purok 4 Purok n

Bgy 1 Bgy 2 Bgy 3 Bgy 4 Bgy n

MNAO Consolidated Mun

Mun/Bgy 1 Mun/Bgy 2 Mun/Bgy 3 Mun/Bgy 4 Mun/Bgy n

Prov/City 1 Prov/City 2 Prov/City 3 Prov/City 4 Prov/City n

Reg 1 Reg 2 Reg 3 Reg 4 Reg n

1. Organization and Composition of the OPT Plus Team

At the city/municipal level, the City/Municipal Health Officer (C/MHO) together

2. Roles and Responsibilities of the OPT Plus Team

Rural Health 1. Organize and convene the OPT Plus Team

5. Arrange schedule for nutrition counseling especially among

6. Measure length of 0-23 months and height of 24-71 months old

7. Validate the OPT Plus results written in OPT Form 1 and 1A

OPT Plus Function/Activity

8. Sign the validated OPT Plus Forms 1 and 1A after review.

9. Assist the BNS/BHW in the presentation of the OPT Plus

10. Ensure the submission of the OPT Plus Form 1A to the

Barangay Nutrition 1. Coordinate the conduct of the activity.

5. Encode the list of the 0-71 months old preschoolers based on

7. Measure the preschoolers weight and assist the RHM in taking

OPT Plus Function/Activity

8. Calculate the age & determine nutritional status (NS) of

9. Alternately, if the team has access to a computer, laptop or

Other team 1. Disseminate information regarding the purpose & schedule of

. 6. Assist in weighing the preschoolers

7. Refer the mother/caregiver of the preschool children to the

Teacher-in-charge Coordinate with the BNS/BHW for the measurement of the

Organize children who have not been measured in the school or

Maintain a copy of the nutritional status of children ages 5 and

Municipal Health i. Prepare communications for

ii. Supervise conduct of the OPT

iii. Assist the BNS/BHW in the

iv. Collect and validate all

v. Present the consolidated OPT

3. Other activities during and after the OPT Plus