LEARNING GUIDE 1 FOOD SECURITY AND FOOD PRODUCTION
LESSON 1.5 THE PHASES OF HUNGER
Subject Code: Biology 4
Learning Guide Code: LG 1 (Food Security and Food Production)
Lesson Code: Lesson No. 1.5 (The Phases of Hunger)
Time Frame: 30 minutes
MATERIALS NEEDED
To complete this module, you need the following:
1. pen;
2. paper;
3. phone/tablet/laptop;
4. Adobe scanner mobile app;
5. Moodle Learning Management System account; and
6. stable internet connection.
TARGET
After completing this learning guide, you are expected to:
1. identify the four stages of food insecurity;
2. describe the nature of starvation;
3. distinguish undernutrition from malnutrition;
4. discuss the consequences of being overweight or obese;
5. contrast kwashiorkor from marasmus;
6. discuss the consequences of micronutrient deficiencies; and
7. describe when nutrient-depletion occurs.
HOOK Time Allotment: 5 minutes
• Take a look at this picture. What condition does it show?
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Figure 1. Extreme poverty and hunger by Sophiabasa, retrieved from
https://commons.wikimedia.org/wiki/File:Extreme-poverty-and-hunger.jpg uploaded last June 2,
2014. This file is licensed under the Creative Commons Attribution-Share Alike 4.0 International
license.
IGNITE Time Allotment: 10 minutes
• Recall what is food insecurity.
THINK IT OVER
Food insecurity exists when people do not have adequate physical, social or economic access
to food. As such, a person does not have sufficient, safe, and nutritious food that meets their
food preferences and dietary needs for an active and healthy life.
• Recall the “scales” or “phases” used to grade food security. Of these scales, which one has a
continuum for the phases of food insecurity of individuals or of households? Moreover, are all
food insecure individuals hungry?
THINK IT OVER
The Food Insecurity Experience Scale (FIES) is a measure of access to food at the level of
individuals and households. It measures severity of food insecurity based on people’s
responses to questions about constraints on their ability to obtain adequate food.
All hungry people are certainly food insecure; they are undernourished. However, not all food
insecure people are hungry. It must be emphasized that a lack of food is not the only cause for
food insecurity; there are those who have poor intake of micronutrients while others consume
too much of certain macronutrients. This condition is called malnutrition.
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• Are you aware that there are four stages of hunger in relation to food insecurity? What are these
four stages?
THINK IT OVER
Concept 1
The four stages of hunger in terms of food insecurity are hidden hunger, chronic hunger, acute
hunger, and starvation.
At first, households find ways of cutting food consumption by reducing variety, adding
ingredients to “stretch” meals, using cheaper ingredients, switching to cheaper foods, using
fewer processed foods, and consuming energy-dense foods. Such strategies may compromise
the nutritional value of the food and slip households and individuals further into food
insecurity. These may lead to “hidden hunger” as a result of micronutrient deficiencies that are
not easily identifiable other than by biochemical analysis.
When food shortages continue or worsen, households will continue cutting portion sizes and
skipping meals. They will even sell off non-productive assets to buy food and go further in the
direction of chronic hunger or food insecurity. Continual inadequate intake leads to stunted
growth in children, significant productivity losses for all household members, and
susceptibility to illness. In contrast to hidden hunger, clinical signs of undernourishment are
evident among the chronically food insecure.
Acute food insecurity is characterized by acute hunger. People who are in this stage experience
hunger daily. Households may sell off productive assets to buy food or resort to reducing
household size by sending members to live with relatives who are better off. Here, severe
forms of undernutrition are common, including stunting, wasting, and kwashiorkor.
Starvation is the extreme experience of food insecurity. When severe hunger is widespread, a
famine is declared, and extreme manifestations of undernutrition may appear (e.g. severe
• Of these stages, intervention is prioritized for starvation because of how fatal it can be. What
manifestations are apparent in starvation?
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THINK IT OVER
Concept 2
Starvation is a severe deficiency in caloric energy intake needed to maintain human life. Its
basic cause is an imbalance between energy intake and energy expenditure. As the most
extreme form of malnutrition, it is gradual in its manifestations so that it has four phases.
During the first phase, blood glucose levels are maintained through the production of glucose
from proteins, glycogen, and fats. In the second phase which might last for several weeks, fats
are used as the main energy source; the brain uses ketone bodies after about a week.
The third phase starts when a person's fat reserves are depleted and the body switches to
proteins as the major source of energy; muscles are rapidly depleted. At the end of this phase,
cell function degenerates and loss of weight is now apparent. Other symptoms appear such as
apathy, withdrawal, listlessness, and increased susceptibility to disease. This susceptibility to
disease makes it possible for opportunistic infections to cause death.
Additional signs of starvation may include dehydration, flaky skin, changes in hair color and
massive edema in the lower limbs and abdomen. This edema makes the abdomen seem bloated
yet it is noted that the body’s ability to consume volumes of food decreases.
The last phase makes a person weak, the body runs out of options. Fats, glucose, muscle mass,
and tissue are eventually spent and the person will die. The end-stage of starvation usually
brings with it one of two different diseases - kwashiorkor and marasmus.
Marasmus happens due to extreme energy deficiency, often from inadequate amounts of
calories and protein. The person's body weight reaches dangerously low levels and infections
are common. Kwashiorkor is a related disease that affects children who are protein-energy
deficient and might result in edema and an enlarged and fatty liver, resulting in the distending
of the children's bellies, providing the illusion that children who are starving are well-fed.
When the person dies, the most immediate cause is cardiac arrhythmia or a myocardial
infarction brought on by either extreme tissue degradation due to autophagy or severe
electrolyte imbalances. People can die of starvation in as little as three-weeks, or as long as
• It has been clarified that food insecurity and hunger are different from each other. Moreover,
food insecurity does not mean only persons who lack food are undernourished. Does this mean
that undernutrition is the same as malnutrition?
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THINK IT OVER
Concept
A 3
No, undernutrition and malnutrition are not one and the same.
Undernutrition is part of malnutrition. It has four broad sub-forms namely wasting, stunting,
underweight, and deficiencies in vitamins and minerals. Undernutrition makes children
particularly more vulnerable to disease and death.
Low weight-for-height is known as wasting. It usually indicates recent and severe weight loss
because a person did not have enough food to eat and/or they have had an infectious disease
such as diarrhea. A young child who is moderately or severely wasted has an increased risk of
death, but treatment is possible.
THINK IT OVER
Low height-for-age is known as stunting. It is the result of chronic or recurrent undernutrition,
A
usually associated with poor socioeconomic conditions, poor maternal health and nutrition,
frequent illness, and/or inappropriate infant and young child feeding and care. Stunting holds
children back from reaching their physical and cognitive potential.
Children with low weight-for-age are known as underweight. A child who is underweight may
be stunted, wasted, or both.
Deficiencies in vitamins and minerals indicate a lack of micronutrients due to a poor diet.
On the other hand, malnutrition refers to deficiencies, excesses, or imbalances in a person’s
intake of energy and/or nutrients. The term malnutrition addresses three broad groups of
conditions:
• undernutrition, which includes wasting (low weight-for-height), stunting (low height-
for-age) and underweight (low weight-for-age);
• micronutrient-related malnutrition which includes micronutrient deficiencies (a lack
of important vitamins and minerals) or micronutrient excess; and
• overweight, obesity and diet-related non-communicable diseases (such as heart
• When it comes to food insecurity, being overweight and having obesity and diet-related non-
communicable diseases take a backseat in terms of interventions. Why?
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THINK IT OVER
The idea that poverty is closely associated with food insecurity has been emphasized over the
years. As such, the marginalized poor and low-income individuals have been prioritized in
various interventions such as targeted direct feeding programmes, food-for-work programmes,
and income-transfer programmes.
However, last year, WHO reported that an estimated 38.2 million children under the age of 5
years were overweight or obese. Once considered a high-income country problem, overweight
and obesity are now on the rise in low- and middle-income countries, particularly in urban
settings. In Africa, the number of overweight children under 5 has increased by nearly 24%
percent since 2000. Almost half of the children under 5 who were overweight or obese in 2019
lived in Asia.
Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
The prevalence of overweight and obesity among children and adolescents aged 5-19 has risen
dramatically from just 4% in 1975 to just over 18% in 2016. The rise has occurred similarly
among both boys and girls: in 2016 18% of girls and 19% of boys were overweight.
To clarify, overweight and obesity is when a person is too heavy for his or her height.
Abnormal or excessive fat accumulation can impair health.
THINK IT OVER
The Body Mass Index or BMI is an index of weight-for-height commonly used to classify
overweight and obesity. It is defined as a person’s weight in kilograms divided by the square
of his/her height in meters (kg/m²). In adults, overweight is defined as a BMI of 25 or more,
whereas obesity is a BMI of 30 or more.
Overweight and obesity result from an imbalance between energy consumed (too much) and
energy expended (too little). Globally, people are consuming foods and drinks that are more
energy-dense (high in sugars and fats) but engage in less physical activity (due to the sedentary
nature of many forms of work, changing modes of transportation, and increasing urbanization).
Changes in dietary and physical activity patterns are often the result of environmental and
societal changes associated with development and lack of supportive policies in sectors such
as health, agriculture, transport, urban planning, environment, food processing, distribution,
marketing, and education.
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• When unaddressed, what consequences do people who are overweight or obese encounter?
THINK IT OVER
Concept 4
A raised BMI is a major risk factor for non-communicable diseases such as:
• cardiovascular diseases (mainly hypertension, heart disease, and stroke), which were
the leading cause of death in 2012;
• type 2 diabetes mellitus which leads to problems such as heart disease, stroke, kidney
disease, eye problems, and nerve damage among others;
• musculoskeletal disorders (especially osteoarthritis – a highly disabling degenerative
disease of the joints);
• non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)
which may lead to severe liver damage, cirrhosis, or even liver failure;
• gallbladder diseases such as gallstones and cholecystitis; and
• some cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder,
kidney, and colon).
Other disorders are also associated with being overweight or obese. These include:
• sleep apnea and
• metabolic syndrome.
Pregnant women who are overweight or obese may have a greater chance of the following:
• developing gestational diabetes;
• having preeclampsia—high blood pressure during pregnancy, which can cause severe
health problems for mother and baby if left untreated; and
• needing a caesarean section and as a result, taking longer to recover after giving birth.
THINK IT OVER
Childhood obesity is associated with a higher chance of obesity, premature death, and
disability in adulthood. But in addition to increased future risks, obese children experience
breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular
disease, insulin resistance, and psychological effects.
Finally, overweight and obesity are associated with mental health problems such as depression.
Being subjected to weight bias and stigma from others can lead to feelings of rejection, shame,
or guilt; these aggravate self-esteem issues.
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• So, based on the data from WHO, many low-income and middle-income countries are
experiencing a double burden in malnutrition. What does this mean?
THINK IT OVER
The low-income and middle-income countries are dealing with the problems of infectious
diseases and undernutrition, and they are also experiencing a rapid upsurge in non-
communicable disease risk factors such as obesity and overweight, particularly in urban settings.
Moreover, it is not uncommon to find undernutrition and obesity co-existing within the same
country, the same community, and the same household.
Children in low-income and middle-income countries are more vulnerable to inadequate pre-
natal, infant, and young child nutrition. At the same time, these children are exposed to high-
fat, high-sugar, high-salt, energy-dense, and micronutrient-poor foods, which tend to be lower
in cost but also lower in nutrient quality. These dietary patterns, in conjunction with lower levels
of physical activity, result in sharp increases in childhood obesity while undernutrition issues
remain unsolved.
• Of the macronutrients, it is observed that proteins are the ones that have severe impacts on
food insecure individuals. There are two diseases that have been identified as signs of
starvation: kwashiorkor and marasmus. How are they different from each other?
THINK IT OVER
Concept 5
Deficiency of protein is kwashiorkor also known as “edematous malnutrition” because of its
association with edema (fluid retention). People typically have an extremely emaciated
appearance in all body parts except their ankles, feet, and belly. Even with treatment, children
who had kwashiorkor may never reach their full growth and height potential, and may have
permanent physical and mental disabilities. If left untreated, the condition can lead to coma,
shock, or death.
THINK IT OVER
In contrast, marasmus is not exclusive to deficiency of protein. In fact, marasmus is primarily
caused by a deficiency in calories and energy in all forms. It can occur in anyone with severe
malnutrition but usually occurs in children. Muscular wasting and loss of subcutaneous fat are
the main clinical signs of marasmus. Complications include infections, dehydration, and
circulation disorders; absence of treatment is lethal and leads to mortality.
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• On the other hand, what consequences do people who micronutrient deficiencies encounter?
THINK IT OVER
Concept 6
In contrast to macronutrients, micronutrients are consumed in small quantities but are
nonetheless essential for physical and mental development. Essential micronutrients include (but
are not limited to): iron, zinc, calcium, iodine, vitamin A, B-vitamins, and vitamin C.
Micronutrient deficiencies are an important global health issue, with malnutrition affecting key
development outcomes including poor physical and mental development in children,
vulnerability to or exacerbation of disease, mental retardation, blindness and general losses in
productivity and potential. Unlike energy-protein undernourishment, the health impacts of
micronutrient deficiency are not always acutely visible; it is therefore sometimes termed ‘hidden
hunger’ (the two terms can be used interchangeably). The World Health Organization (WHO)
estimates that more than two billion people suffer from micronutrient deficiency globally.
Although any individual can experience micronutrient deficiency, pregnant women and children
are at greatest risk of developing them. This is not only as a result of low dietary intake, but also
from higher physiological requirements. Pregnancy and childhood development often increases
the demand for specific vitamins and minerals for normal growth and development.
• Are there situations when nutrients are depleted by illnesses?
THINK IT OVER
Concept 7
Illnesses do not typically deplete nutrients; however, medications that may be taken by patients
as part of their treatment may deplete the body of specific nutrients. These form part of what
are known as adverse reactions or side effects.
Using most medications for a short amount of time will not lead to nutrient deficiency, but
long-term use will. In some cases, a drug may interfere with the body's ability to absorb a
nutrient from dietary sources. For instance, in the case of proton-pump inhibitors (PPIs) used
to reduce acid reflux and heartburn, absorption of vitamin B12, is prevented. Consequently,
low B12 levels in the blood can lead to confusion, muscle weakness, and falls. They can also
cause low calcium and magnesium levels.
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THINK IT OVER
Other medications may cause deficiencies of several nutrients at a time. Some diuretics that lower
blood pressure can deplete magnesium, potassium, and calcium. Anticonvulsants and
corticosteroids may reduce levels of calcium and vitamin D. The diabetes drug metformin
(Glucophage, Riomet), may reduce levels of folic acid and vitamin B12; and the Parkinson's drugs
levodopa and carbidopa (Sinemet) may reduce levels of vitamin B6, vitamin B12, and folic acid.
Addressing nutrient deficiency is complicated because even though some drugs can cause the
depletion, taking supplements does not always make it better. Some physicians try fixing the
depletion by recommending a switch to another medication. Others suggest considering the diet
as it may be part of the problem. As a result, a dietitian’s help is sought so that food sources of
important nutrients may be increased and gaps that may be leading to nutrient deficiency
provided.
NAVIGATE Time Allotment: 10 minutes
This is a GRADED Assessment.
1. The Philippines is likely to have overweight and obese adults and children. Thus, there is a need
to come up with strategies that will reduce this form of malnutrition. What are recommended
for overweight or obese people? Give five (5) recommendations. (10 points; 1 point per
recommendation and 1 point per discussion each)
2. In comparison to proteins, deficiency in carbohydrates and in fats and oils is rare. Yet there are
people who do encounter these problems. What conditions are possibly experienced by people
who do have such deficiencies? Give three (3) conditions. (6 points; 1 point per condition and
1 point per discussion each)
3. On the other hand, what problems are associated with deficiencies of micronutrients? Give
seven (7) conditions. (14 points; 1 point per condition and 1 point per discussion each)
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KNOT Time Allotment: 5 minutes
In summary, there are four stages of hunger in terms of food insecurity. These are hidden hunger,
chronic hunger, acute hunger, and starvation.
Households cut food consumption, add ingredients to “stretch” meals, use cheaper ingredients, switch
to cheaper foods, use fewer processed foods, and consume energy-dense foods when they are
undergoing “hidden hunger.”
When food shortages continue or worsen, households continue cutting portion sizes and skipping meals.
They will even sell off non-productive assets to buy food and go further in the direction of chronic
hunger or food insecurity. Continual inadequate intake leads to stunted growth in children, significant
productivity losses for all household members, and susceptibility to illness.
Acute food insecurity is characterized by acute hunger. People who are in this stage experience hunger
daily, and households may sell off productive assets to buy food or resort to reducing household size
by sending members to live with relatives who are better off.
Starvation is the extreme experience of food insecurity. When severe hunger is widespread, a famine is
declared, and extreme manifestations of undernutrition may appear (e.g. severe wasting and marasmus).
At its worst, starvation leads to death of young children.
Starvation has four phases. During the first phase, blood glucose levels are maintained through the
production of glucose from proteins, glycogen, and fats. In the second phase which might last for several
weeks, fats are used as the main energy source; the brain uses ketone bodies after about a week. The
third phase starts when a person's fat reserves are depleted and the body switches to proteins as the
major source of energy; muscles are rapidly depleted. At the end of this phase, cell function degenerates
and loss of weight is now apparent. Other symptoms appear such as apathy, withdrawal, listlessness,
and increased susceptibility to disease. This susceptibility to disease makes it possible for opportunistic
infections to cause death.
Undernutrition is part of malnutrition. It has four broad sub-forms namely wasting, stunting,
underweight, and deficiencies in vitamins and minerals. On the other hand, malnutrition refers to
deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. Aside from
undernutrition, micronutrient-related malnutrition which includes micronutrient deficiencies (a lack of
important vitamins and minerals) or micronutrient excess; and overweight, obesity and diet-related non-
communicable diseases (such as heart disease, stroke, diabetes and some cancers) form part of
malnutrition.
Being overweight or obese boils down to a raised BMI which serves as a major risk factor for non-
communicable diseases such as cardiovascular diseases, type 2 diabetes mellitus, musculoskeletal
disorders, liver diseases, gallbladder diseases and some cancers. Pregnant women who are overweight
or obese may have a greater chance of developing gestational diabetes, having preeclampsia, and
needing a caesarean section. Finally, overweight and obesity are associated with mental health problems
such as depression. Being subjected to weight bias and stigma from others can lead to feelings of
rejection, shame, or guilt; these aggravate self-esteem issues.
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not subject to update notification.
Deficiency of protein is kwashiorkor also known as “edematous malnutrition” because of its association
with edema (fluid retention). People typically have an extremely emaciated appearance in all body
parts except their ankles, feet, and belly. If left untreated, the condition can lead to coma, shock, or
death. In contrast, marasmus is not exclusive to deficiency of protein. In fact, marasmus is primarily
caused by a deficiency in calories and energy in all forms. It can occur in anyone with severe
malnutrition but usually occurs in children. Muscular wasting and loss of subcutaneous fat are the main
clinical signs of marasmus. Complications include infections, dehydration, and circulation disorders;
absence of treatment is lethal and leads to mortality.
Micronutrient deficiencies affect key development outcomes including poor physical and mental
development in children, vulnerability to or exacerbation of disease, mental retardation, blindness and
general losses in productivity and potential. Unlike energy-protein undernourishment, the health
impacts of micronutrient deficiency are not always acutely visible and is sometimes termed ‘hidden
hunger’.
Illnesses do not typically deplete nutrients; however, medications that may be taken by patients as part
of their treatment may deplete the body of specific nutrients. These form part of what are known as
adverse reactions or side effects.
Using most medications for a short amount of time will not lead to nutrient deficiency, but long-term
use will. In some cases, a drug may interfere with the body's ability to absorb a nutrient from dietary
sources. In other cases, medications may interfere with natural processes needed to produce nutrients,
while other medications may cause deficiencies of several nutrients at a time.
References
1. Harvard Health Publishing Harvard Medical School. (2016). Are your medications causing nutrient
deficiency?. Retrieved from https://www.health.harvard.edu/staying-healthy/are-your-medications-
causing-nutrient-deficiency
2. Hendriks, S.L. (2015). The food security continuum: a novel tool for understanding food insecurity
as a range of experiences. Food Security, 7(609-619).
3. Johnson, L.E. (2019). Folate Deficiency (Folic Acid). Retrieved from
https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-
and-toxicity/folate-deficiency
4. Mogensen, K. M. (2017). Essential Fatty Acid Deficiency. Practical Gastroenterology, 164 (37-44).
Retrieved from https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/Parrish-
June-17.pdf
5. National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Understanding Adult
Overweight and Obesity: Treatment for Overweight and Obesity. Retrieved from
https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-
obesity/treatment
6. National Institute of Health Office of Dietary Supplements. (2020). Iodine. Retrieved from
https://ods.od.nih.gov/factsheets/Iodine-Consumer/
Biology 4 Page 12 of 14
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released to third parties with approval of management. Document is uncontrolled unless otherwise marked; uncontrolled documents are
not subject to update notification.
7. National Institute of Health Office of Dietary Supplements. (2020). Vitamin A. Retrieved from
https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/
8. National Institute of Health Office of Dietary Supplements. (2020). Vitamin B12. Retrieved from
https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
9. National Institute of Health Office of Dietary Supplements. (2020). Vitamin D. Retrieved from
https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
10. National Institute of Health Office of Dietary Supplements. (2020). Zinc. Retrieved from
https://ods.od.nih.gov/factsheets/Zinc-
HealthProfessional/#:~:text=Zinc%20deficiency%20is%20characterized%20by,8%2C27%2C28%5D.
11. Physicians Committee for Responsible Medicine. (2020). Macronutrients in Health and Disease.
Retrieved from
https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342092/all/Mac
ronutrients_in_Health_and_Disease#1
12. Ritchie, H. and Roser, M. (2017). Micronutrient Deficiency. Retrieved from
https://ourworldindata.org/micronutrient-
deficiency#:~:text=Micronutrient%20deficiencies%20form%20an%20important,losses%20in%20pro
ductivity%20and%20potential.
13. Weiss, T.C. (2016). What Happens When We Starve? Phases of Starvation. Retrieved from
https://www.disabled-world.com/fitness/starving.php
14. WIC Works Resource System US Department of Agriculture. (2004). AppendixC_Nutrient Chart,
Retrieved from https://wicworks.fns.usda.gov/wicworks/Topics/FG/AppendixC_NutrientChart.pdf
15. World Health Organization. (2020). Malnutrition. Retrieved from https://www.who.int/news-
room/fact-sheets/detail/malnutrition
16. World Health Organization. (2020). Obesity and overweight. Retrieved from
https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Prepared by:
MA. THERESA O. TENCHAVEZ
Special Science Teacher V
PSHS-Southern Mindanao Campus
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Reviewed by:
JENEFER G. CENAS
Special Science Teacher V
PSHS-Central Mindanao Campus
MICHELLE B. DUCUSIN
Special Science Teacher V/Team Lead (Biology)
PSHS-ILOCOS REGION CAMPUS
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