The tourist island of Bohol, which was the epicenter of Tuesday's quake, suffered the most with 160 people dead, the civil defence office for the region said. Twelve others were killed on other central islands.
Bohol police commander Senior Superintendent Dennis Agustin said 22 people were missing on the island, including five children who were playing by a waterfall when the quake hit.
It was unlikely many of them would be found alive, he warned. "It looks doubtful. This is the fourth day since the quake. It is an extreme possibility they will be recovered alive," he said.
"Some are believed buried under landslides, some are under fallen structures. We will likely get more reports of deaths," he said. Bohol, an island of about a million people around 600 kilometres (370 miles) from Manila, is known for its beaches, its rolling "Chocolate Hills" and tiny tarsier primates.
It suffered huge landslides, fallen bridges, shattered roads and collapsed structures during the quake.
Government and aid groups have been rushing to deliver assistance to the affected areas, but travel has been hampered by the bridges and roads that have been rendered impassable by the quake.
Many Bohol residents have been living in tents fearing the many aftershocks could cause their homes to collapse.


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