Research Protocol- Group 15

8/3/2019 Research Protocol- Group 15

1/27

1

De La Salle Health Sciences Institute- College of MedicineDepartment of Family and Community Medicine

Comparison of Malnutrition among Institutionalizedand Street Children in Paco, Manila as determined by

Body Mass Index

Research Protocol2nd year, Sec. B, Group 15

Matel, Ma. CarolinaNazareno, Christine

Panghulan, Aldee RayParao, AngeloReyes, Kevin

Sampelo, Ma. CarmelaTee, Jan Raemon

Preceptor:

Josephine M. Carnate M.D., MPHOctober 13, 2011


2/27

2

INTRODUCTION

Research Question

Is the prevalence of malnutrition generally higher in street children compared to

institutionalized children in orphanages located in Paco, Manila during the year 2011?

Research Hypothesis

The prevalence of malnutrition is generally higher in street children compared to

institutionalized children. There is a direct relationship between the childrens

environment (socio-economic and demographic factors such as location and condition of

household, presence or absence of biological parents) and their nutrition status.

Background of the Study

Malnutrition has long been recognized as a consequence of poverty. It is widely

accepted that higher rates of malnutrition will be found in areas with chronic widespread

poverty [1]. Malnutrition is believed to be caused by marginal dietary intake, combined

with infection. In turn, malnutrition is an interplay of household food insecurity, lack of

clean water, lack of knowledge on good sanitation, and lack of alternative sources of

income. It is also compounded by inadequate care, gender inequality, poor health

services, and poor environment. Measures of child nutritional status can help capture

certain aspects of welfare, such as distribution within the household which are not

adequately reflected in other indicators. Child malnutrition standards are applicable

across cultures and ethnicities. Studies have proven that the relationship between child


3/27

3

nutritional status and poverty is more evident at the lower bracket of the income range

[2].

Based on the study of the International Food Policy Research Institute, there are

exactly fours strong determinants to malnutrition in 63 developing countries. The four,

ranked by their strength of impact, are women's education, national food availability,

womens status relative to men's, and health environment quality [3]. Recent studies have

also pointed out those women who were malnourished as children are more likely to give

birth to low birth-weight children and thus there is an intergenerational effect of child

malnutrition.

RESEARCH OBJECTIVES

General Objective

To be able to compare the prevalence of malnutrition among street children and

institutionalized children in orphanages located in Paco, Manila during the year 2011.

Specific Objectives

To determine the body mass index (BMI) of street children and

institutionalized children living in orphanages.

To compare the Body Mass Index (BMI) of street children and

institutionalized children living in orphanages.

To correlate the absence or presence of biological parents to the frequency

of malnutrition among street children and institutionalized children in

orphanages.


4/27

4

REVIEW OF RELATED LITERATURE

Epidemiology of Disease Interest

It was estimated that nearly 30% of infants, children, adolescents, adults and

elderly in the developing world are suffering from one or more of the multiple forms of

malnutrition [4]. About 20 million children under five years old worldwide are severely

malnourished, which leaves them more vulnerable to illness and early death. Nearly 10

million children under the age of five die every year, more than 1,000 every hour[5].

Almost all of these children could survive and thrive with access to simple, affordable

interventions. These children could survive and escape death if they are given access even

to the simplest and most affordable interventions. Our country today is suffering from

poverty, and thus children belonging to the lower class are the ones who are severely

affected.

Malnourished Filipino Children

Underweight and under height are two of the parameters that are considered in

malnutrition. A number of Filipino children who were underweight and under height or

stunted increased from the year 2005 to 2008. The prevalence of underweight children

aged 0-5 years increased from 24.6% to 26.2%, about 3.35 million children. The rate of

children who are under height increased from 26.3% to 27.9%, representing 3.57 million

children. There was also a significant increase in the prevalence of underweight children

aged 6-10 years from 22.8% in 2005 to 25.6% in 2008, which is equivalent to 2.6 million.

The number of under height children in this age group likewise increased from 32% to

33.1%. A very high level of acute malnutrition among preschoolers (aged 0-5) was noted

in six regions, namely Mimaropa, Bicol, Western Visayas, Eastern Visayas, Zamboanga

Peninsula and Soccsksargen where the underweight-for-age prevalence was at least 30%.

Chronic malnutrition affected a very high percentage of preschoolers in the provinces of
http://opinion.inquirer.net/inquireropinion/talkofthetown/view/20100724-282969/Malnutrition-among-Filipino-kids-uphttp://opinion.inquirer.net/inquireropinion/talkofthetown/view/20100724-282969/Malnutrition-among-Filipino-kids-up


5/27

5

Masbate, Biliran, Northern Samar, Western Samar, Zamboanga Sibugay, Sarangani, Abra

and Mountain Province. About 30% of Manila's 50,000-75,000 street children are

estimated to be moderately or severely malnourished. According to international

standards, both male and female were seriously underweight (lowest 8%) and underheight

(lowest 2.5%).

Malnourished Institutionalized Children

49% of the 10.4 million deaths occurring in children below 5 years of age in

developing countries are linked with protein-energy malnutrition[5]. Although this kind

of malnutrition occurs more frequently in low-income countries, several children from

higher-income countries (Children from large urban areas and low socio-economic status,

children with chronic disease, and children who are institutionalized) are also affected.

Orphans represent an important sector in any society, because they are mostly

children in crucial phases of physical and mental growth, so they need special nutritional

and health care with guidance. Another study reported that the nutritional status of

orphans in Sana'a was miserable, especially when it was compared with that of orphans in

different countries[6]. 75% of the children were found to be underweight, and 37 %

severely so. The prevalence of wasting, which indicates acute or current malnutrition was

27%. 12% of children suffered from moderate or severe wasting. Some 74% of children

suffered from stunted growth, and 40% were moderately or severely stunted.

All of these percents were mainly higher in the Al-Aitam orphanage, and boys

were particularly affected. The study also found that 12% of orphans were anemic. The

percentage was higher in boys, at 13%, whereas only 8% of girls were anemic. Also, Al-

Aitam Orphanage had the highest percentage of anemics, at 14%, compared with just 8%

in the Al-Rahmaa Orphanage.
http://opinion.inquirer.net/inquireropinion/talkofthetown/view/20100724-282969/Malnutrition-among-Filipino-kids-uphttp://opinion.inquirer.net/inquireropinion/talkofthetown/view/20100724-282969/Malnutrition-among-Filipino-kids-uphttp://opinion.inquirer.net/inquireropinion/talkofthetown/view/20100724-282969/Malnutrition-among-Filipino-kids-uphttp://opinion.inquirer.net/inquireropinion/talkofthetown/view/20100724-282969/Malnutrition-among-Filipino-kids-up


6/27

6

In another study comparing institutionalized children and children living in a

permanent household, institutionalized children have significantly lower height & weight

percentiles[7]. Institutionalized children have significantly lower weight for age and

height for age measurements (P 0.05). Using the CPC RCMAS and the DAPT, the scores

of institutionalized children were inferior to those of the domiciled children (P 0.05).

Epidemiology of exposure/ factor of interest

Filipino Street Children

In the Philippines, there are three types of children roaming in the streets.

Children on the Streetsdescribed as children working on the streets but have homes to

return to. Children of the Streetsdescribed as children living on the street and

Completely Abandoned Childrenwho are entirely responsible for their own physical

and psychological survival[8]. Children on the Streets make up approximately 75% of the

street children in the Philippines, while Children of the Street and Completely Abandoned

Children make up 25-30% and 5-10%, respectively, of the approximate total of street

children, which was estimated to be 1.5 million as of 1998. Around 70% of these street

children are boys[9].

Risk Factors of the Disease (Possible Confounding Variables)

In the Philippines poverty and pervasive malnutrition are not limited to families

of deprived seasonal workers. Undernourishment is endemic and increasing throughout

most of this archipelago of some 7,107 islands, and is compounded by the prevalence of

intestinal parasites and gastrointestinal diseases which health workers estimate deprive

youngsters of at least 5-10% of the nutritional value in food they do consume. This

problem is particularly prevalent in rural villages and city slums where many people eat

with their fingers. Philippine National Nutrition Survey provides benchmarks to gauge

the countrys progress toward achieving the Millennium Development Goals, including


7/27

7

the eradication of hunger, reduction of child mortality and improvement of maternal

health.

Infectious diseases, especially the intestinal parasites, affect a high rate of

children in orphanages in 3rd world countries. Entamoeba histolytica was the most

common intestinal parasite affecting orphans, especially boys[7]. Such habits facilitate

more infections that lead to nutritional problems. Crowded orphanages facilitate

transmission of those infections. Lack of frequent health assessments and programs that

can discover and track the orphans nutritional and infectious problems in early s tages

make them more exposed to disease. The inability of orphanages to cover the expenses

of proper food and medical treatments also makes children vulnerable.

A survey of street children from Manila, the Philippines, identified two factors

that are strongly correlated with malnutrition in this population: drug use and non-

attendance at school. Children who were in school and did not use drugs showed the

highest mean weight, while those who were out of school and using drugs had the lowest

mean weight; children with one of these risks factors occupied an intermediate position.

About half the street children reported regular drug use, primarily glue sniffing. It is

recommended that programs currently serving Filipino street children assess the barriers

to participation (e.g., policies against drug use) by high-risk children and pilot projects to

train social workers and street educators in substance abuse counseling. The effectiveness

of such interventions would be enhanced by a detailed study of the various gangs and

syndicates of children in Manila.

SUMMARY OF RELATED/SIMILAR STUDIES

Social correlates of malnutrition among Filipino street children

A similar study conducted by the University Of Connecticut School Of Medicine,

researched on social correlates of malnutrition among Filipino street children. The study


8/27

8

was published by Hixon A.L. on year 1993. He sought to identify subgroups of street

children at high risk for nutritional deficiency in metropolitan Manila in the Philippines.

He had a sample of 150 street children ages six through 18 that were weighed, measured,

and interviewed to establish nutritional parameters. The interrelationships of nutritional

status with social conditions were explored. Children using drugs and children not in

school were the two variables listed showing the highest association with low weight for

age. These variables should be seen as indicative of a range of variation among Filipino

street children, in whom those on drugs and not in school represent the sector at greatest

risk and one to which nutritional programs should be targeted.

The following are the results of the survey conducted on street children from

Manila, Philippines by Hixon[10]. He identified two factors that are strongly correlated

with malnutrition in the population: drug use and non-attendance at school. About 30% of

Manila's 50,000-75,000 street children are estimated to be moderately or severely

malnourished. In the study, he recruited a sample of 150 male and female children ages 6-

18 years was recruited, with the help of social workers, from a neighborhood estimated to

have 500 street children. According to international standards, both male and female

respondents were seriously underweight (lowest 8%) and underheight (lowest 2.5%).

Results showed that children who were in school and did not use drugs has the highest

mean weight, while those who were out of school and using drugs had the lowest mean

weight; children with one of these risks factors occupied an intermediate position. About

half the street children reported regular drug use, primarily glue sniffing.

Among his recommendations for the study, were to establish programs currently

serving Filipino street children assess the barriers to participation like policies against

drug use by high-risk children. Another is to pilot projects to train social workers and

street educators in substance abuse counseling. He also pointed out to conduct detailed


9/27

9

studies of the various gangs and syndicates of children in Manila for better understanding

of life of street children and for the effectiveness of such interventions.

On another similar study, a descriptive cross-sectional study was constructed with

all the streets of Lilongwe serving as potential recruitment areas. However, for practical

purposes it was decided that the study should consider recruiting children from high-

density areas such as the streets that are in close proximity to the main market since in the

Lusaka study. Since street children are highly mobile, a purposive sampling method was

used to recruit children who suited characteristics of being street children. The

characteristics included begging, appearing to be seeking social favours such as piece

work, looking generally disadvantaged, scavenging, and without guidance of an older

responsible person The inclusion criteria were: That the subject be identified as a street

child based on the descriptions mentioned above as well as self testimony; That the

subject be adequately briefed about the study and give verbal assent to participate in the

study; and, that the subject was not already interviewed. 3/4 of the children indicated that

most of the times they eat three main meals each day, one fifth (19.4%) eat two main

meals each day, while 5.6% indicated eating only one meal a day. When the children

were asked to state their impression about the adequacy of the food they ate in the 24

hours preceding the survey, 75% perceived it to be adequate.

Notably, foods that were mostly consumed on a daily basis include nsima (100%),

rice (50%), confectionery (44.4%), and mangoes (41.7%). On the other hand, foods that

were consumed three times a week included fish (80.6%), chicken (58.3%), potatoes

(36.1%), cookies (19.4%), pumpkin leaves (19.4%), and bananas (13.9%). For the

majority of the children, vegetables were mostly consumed once a week. Legumes and

nuts were vividly not reported, with only 11% indicating that they consume legumes

(beans only) on a daily basis. Results of nutritional status assessment showed that 8.4% of

the children were wasted (WHZ


10/27

10

One particular bias occurs in the study mentioned and that is in terms of age,

gender and time that the child has been living on the streets. Children living on the streets

longer are more prone to wasting because of the less food and nutritional intake that they

get. Boys are also more prone to wasting because than are more active than the girls their

age. Its is also necessary to control the age group of the subjects because children at

different age groups have different nutritional requirements from one another. No such

study is conducted in the Philippines. This one should be taken into consideration. Much

research that has addressed the nutritional status of street children has only touched on the

kind of food that they are taking in. One of the primary goals of research on street

children should capture the overall health and wellbeing of the children. Future research

should also examine the variation between street children from different regions and

racial/ethnic backgrounds.

Are orphans at increased risk of malnutrition in Malawi?

The nutritional statuses and health problems of village orphans, non-orphans, and

orphanage children were compared by a cross-sectional study conducted in three

orphanages and two villages near Blantyre, Malawi. Seventy-six orphanage children, 137

village orphans and 80 village non-orphans were recruited. It was reported that children

below 5 years of age manifested the prevalence of undernutrition, with 54.8% compated

to village orphans and non-orphans with 33.3% and 30%, respectively. Another

significant finding was that 64% of young orphanage children experienced stunted growth

compared with 50% of village orphans and 46.4% non-orphans. Conversely, older

orphanage children (age equivalent to 5 years old and above) were less stundted and

wasted than orphans and non-orphans in villages. Illness of children in the last month

was reported to be higher in the non-orphan group, especially diarrhoeal disease, which

occurred in 30% compared with 10.8% of village orphans and 6.6% of orphanage

children. More than three children in a family being cared for by guardians was


11/27

11

significantly associated with undernutrition. Children who had been admitted to an

orphanage for more than a year were less malnourished. In village orphans, there was no

association between undernutrition and duration of stay in extended families. Age and

education of guardians were not associated with the nutritional status of children.

Young orphanage children are more likely to be undernourished and more stunted

than village children and older orphanage children seem to have better nutrition than

village orphans [12]. There was no significant difference in nutritional status between

village orphans and non-orphans.

CONCEPTUAL FRAMEWORK


12/27

12

METHODOLOGY

Research Design

Operational definition of variables:

Dependent variable

In this study, the prevalence of malnutrition would be the dependent variable.

This variable would be determined using BMI. Values less than 18.5 is regarded as

underweight while a BMI value greater than 25 is considered overweight and above

30 is considered obese. as set by WHO.

Independent variables

The independent variables in this particular study would be either being an

institutionalized child or being a street child. Institutionalized children for this matter

will be defined as those living in the orphanages for at least 6 months. Street children

are further classified as Children on the Streets described as children working on

the streets but have homes to return to and Children of the Streets described as

children living on the street.

Confounding variables

Confounding variables include age, sex, lifestyle, diet, environment and

physical activity.
http://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Obesity


13/27

13

Research Design:

Type of study to be employed

A cross-sectional type of study will be utilized to identify the relationship

between being in an orphanage and/or being in the street and the prevalence of

malnutrition.

Definition of study population/study groups and source of subjects

Children, both male and female, ages 6 to 10 would be the target subjects of

this study. They will be randomly selected from a study population which will come

from an orphanage in Paco, Manila (for the representatives of the Institutionalized

children). To represent street children, the areas within the vicinity of the orphanage

will be surveyed to build the sample population. This is done to eliminate any factors

and variables which may affect the outcome of the study like the availability of

certain food groups, environmental hazards, degree of pollution et cetera.

Steps to be undertaken/ Procedure to be followed

The samples from the aforementioned locations would be randomly

numbered and selected using a randomizer (table of random numbers or automated

random number generator) to eliminate selection bias. The heights and weights

would be determined using a standard balance and height meter respectively. Survey

questionnaires would also be given out to the parents and care takers of the


14/27

14

orphanages. The data gathered from the questionnaires would be sorted, analyzed and

by statistics association of the risk factors involved in acquiring malnutrition for the

institutionalized and street children would be done.

Schematic Diagram of the Research Design

Biases/Limitations

Much consideration had been given to the selection of the ages from 6 to 10

primarily which is the facilitation of the measuring of the heights and weights to

determine accurate Body-mass indices. This range has also the advantage of being

able to confirm and validate certain information from the survey questionnaires which

in most cases will be answered by the parents or care takers of the orphanage.

Likewise, the degree of cooperation tends to increase from ages 6 and up. Therefore

the study was decided to be limited to this age range. Another limitation to this study

is the inability of the researchers to determine and eliminate confounders like inherent

defects in metabolism which may significantly affect the outcome of the study.

Likewise, the difficulty of defining and determining factors such as crowding limits

the study to some extent. Other quantitative determinants of malnutrition will also not

InstitutionalizedChildren

and Street Children

Randomly selected

children ages 6-10

Street Child (+)malnutrition

Street Child (-)malnutrition

Institutionalized Child (+)malnutrition

Institutionalized Child (-)

malnutrition

Street Child (+)malnutrition

Street Child (-)malnutrition

Institutionalized Child (+)malnutrition

Institutionalized Child (-)malnutrition


15/27

15

be included in this study which will solely rely on BMI data to report malnutrition.

The extent of association between the availability of some food groups, presence of

pollution and other variables would not be discussed intensively but their individual

possible contribution to malnutrition would be thoroughly discussed.

Selection bias may follow the tendency of the researchers to opt for

malnourish-looking individuals in hopes of generating a large sample population with

a very high percentage of positive malnutrition. This will be circumvented by using

random selection of samples from the representative population.

Study Population

The focus of this study is the population of Street children and

Institutionalized children in Paco, Manila.

Sample population

An orphanage is chosen by location as approved by Esperanza C. Gutierrez,

the president of the Associacion de Damas Filipinas, Inc. Settlement Homes in Paco,

Manila. Through simple random sampling 50 children (the sample population) will be

selectedusing the inclusion criteria: (1) is a Filipino citizen; (2) ages between 6-10

years old; (3) has stayed in the orphanage for atleast 6 months. For the sampling of

street children, selection will be based following these criteria: (1) works on the street

with a shelter to go to at the end of the day (Children on the Street) and/or works on

the street without a shelter to go to at the end of the day(Children of the Street); (2)

within 3 km radius of the named orphanage; (3) ages between 6-10 years old.

Exclusion criteria for both samples include; the child has pre-existing and/or an


16/27

16

illness during selection; has no consent from the parents or guardian as well as the

childs consent if he/she is 7-10 years of age.

Sampling frame

A list of all the names of the orphans in Associacion de Damas

Filipinas, Inc. Settlement Homes in Paco, Manila staying, at the least, since March

2011 as certified by the administration of the aforementioned orphanage. For the

street children, whenever applicable (Children on the Street), the names will be

verified through the local barangay unit, otherwise the list of names will be generated

through personal interviews.

Sampling Unit

This will be taken from the study population, Filipino orphans,

ages 6-10, from Associacionde Damas Filipinas, Inc. Settlement Homes, who stayed

for at least 6 months(Institutionalized children). For street children, Filipinos ages 6-

10 living within a 3 km radius from the orphanage will be selected.

Elementary Unit

Filipino orphans, ages 6-10, from Associacion de Damas Filipinas,

Inc. Settlement Homes, who stayed for at least 6 months(Institutionalized children).

For street children, Filipinos ages 6-10 living within a 3 km radius.


17/27

17

Selections

Subjects

The target population of the study is the institutionalized and street

children in Paco, Manila. Since the population is relatively homogenous for the

orphanage, simple random sampling will be used and randomization will be achieved

via computer generated random numbers. This will be done to avoid selection bias

which may arise. For the street children population, which is heterogenous, stratified

random sampling will be conducted.

Sampling Design

The study that will be done is a cross-sectional type. The

population is relatively homogenous for the orphanage therefore, simple random

sampling will be used and randomization will be achieved via computer generated

random numbers. This will be done to avoid selection bias which may arise. For the

street children population, which is heterogenous, stratified random sampling will be

conducted.

Definition of the Variables used in Data Collection

p1

The p1 variable is the estimate of the sample population for street

children located within the vicinity of the subject orphanage who are malnourished.

The value for p1 was taken from International Centre for Diarrhoeal Disease

Research, Bangladesh: Dissemination Seminar on: Health Needs and Health


18/27

18

Seeking Behaviours of Street Dwellers in Dhaka City, wherein 73% of street

children are found to be malnourished.

p2

The p2 variable is the estimate of the sample population for

orphans located within the vicinity of the subject orphanage who are malnourished.

The value that will be used for this study is 54.8% as taken from the literature

reviewed. The value for p2 was obtained from the journal Are Orphans At Increased

Risk of Malnutrition in Malawi? by Annals of Tropical Paediatrics: International

Child Health, Volume 19, Number 3, 1 September 1999, pp. 279-285(7), in which the

statistical value is 54.8% in favour of institutionalized children.

Alpha

Alpha () is the probability of committing Type I error in which

the null hypothesis is rejected when it is true. In this study, is the probability of

rejecting the claim stating that the percentage of malnutrition among the street

children and orphans is the same, when in fact, it is true. A 90% confidence interval

will be used, hence is 0.1.

Beta

Beta () is the probability of committing Type II error or failing to

reject the null hypothesis. In this study, is the probability of failing to reject the

claim that the percentage of malnutrition among street children is the same among

orphans. The power of the study is 80%, therefore is 0.20.


19/27

19

Direction of the test

The study is a two-tailed test. The critical region is split into two

parts. The null hypothesis states that there is no association between being a street

children and malnutrition if the value that will be obtained is greater or lesser than

that of the alternative hypothesis. The alternative hypothesis states that there is an

association between being a street children and malnutrition.

VALUES OF THE VARIABLES FOR CALCULATIONS

Variables Values

p1 73%

p2 54.8%

Alpha 0.10

Beta 0.20

Sample Size Computation


20/27

20

VARIABLES AND DATA TO BE COLLECTED

Weight Values

One(1) Platform type weighing scale will be used to obtain the weight of each

subject. Only one researcher will be allowed to measure the weight of the subject at

the same time of the day for accurate and precise data collection. Each subject will be

asked to remove his or her footwear and make sure there is nothing on his or her

pocket. Have the child or teen remove shoes and heavy clothing, such as

sweaters.Have the subject stand with both feet in the center of the scale. Record the

weight to the nearest decimal fraction. The set of data will be obtained using a will be

recorded with the KILOGRAM unit.

Height Values

Same platform type of weighing scale with height rod will be used. Only one

researcher will be allowed to measure the height of the each subject. The subject will

be asked to remove his footwear, bulky clothing, and hair ornaments, and to unbraid

hair that interferes with the measurement. Have the subject stand with feet flat,

together, and against height rod. Make sure legs are straight, arms are at sides, and

shoulders are level. Make sure the child is looking straight ahead and that the line of

sight is parallel with the floor. Use a flat headpiece to form a right angle with the

height rod and lower the headpiece until it firmly touches the crown of the head.

Lightly mark where the bottom of the headpiece meets the height rod. Accurately

record the height to the nearest 1/8th inch or 0.1 centimeter.


21/27

21

BMI Values

This set of data will be obtained by dividing the weight values obtained (in kg)

over the square of the height values obtained (m2) and will have a final unit of kg/m2.

Values less than 18.5 and greater than 25 will be considered as positive disease cases

(malnutrition).

Method for elimination of confounding variables

The frequency of malnutrition may be influenced by several factors other than

the childrens environment, which pertains to having a proper shelter and guidance

from their biological parents. These other factors, which we call confounding

variables, include the childrens age, sex, and their physical activity. In order to

eliminate these confounding variables, an interview with the help of a standardized

questionnaire will be carried out prior to collection of height and weight. This will

elicit information regarding these variables and will determine if the participant is

qualified to participate in this study. Since the participants are not of the legal age,

their guardian will be the representative or informant for the interview.

There will be separate questionnaires for the institutionalized children and the

street children. The initial questions in the said interview will comprise of the

childrens general data such as their name, age, sex, address or location of the

childrens shelter, name of guardian or family members present in the household and

their salary per day to obtain their socio-economic status. Then, the representative of

the participants will be asked several questions regarding their lifestyle and daily

activities from the time they wake up in the morning until the time they go to bed.


22/27

22

Further on, they will be asked about their daily diet, which pertains to the quality and

quantity of food they usually consume and the frequency of food consumption per

day, if it is once, twice, or thrice a day.

If the children do not qualify the aforementioned criteria, with the age range of

6- 10 years old, residing within the 5 km radius of the chosen orphanage for street

children, duration of stay of 6 or more months inside the orphanage, then the

particular participant will not qualify as one of the participants in the study.

Method for data collection

For the purpose of this study, Observationby making use of equipment and

tools is the preferred method for data collection. Specifically, the use ofstandardized

and calibrated platform type of weighing scale with height rod will be used for

taking weight and height measurements respectively.

This method was chosen over other data collection methods primarily because

the key element in this study is the determination of BODY MASS INDEX to

determine the nutritional status of the subjects. This data is quantifiable and

measurable by using the height and weight measurements of the subjects. While it can

be argued that observing the physical appearance, behaviour and characteristics of the

subject may be used as a method for nutritional status determination, it is very much

prone to subjective bias from the observers and will not give accurate results unlike

the proposed method of data collection. The same reason holds true in justifying

observation using equipment and tools as choice for data collection over Focus Group

Discussion and Questionnaires/interview which will not give appropriate and

quantified results.


23/27

23

Data Collection Tool

1. Letter of Consent for the Participation of Institutionalized Children

DeLaSalle Health Sciences Institute

College of Medicine

Mrs. Esperanza C. Gutierrez

PresidentAssociacion de Damas Filipinas, Inc.

Settlement HomesPaco, Manila

Maam

Good day!

We are second year medical students from De La Salle Health Sciences

Institute, Dasmarinas City, Cavite. As part of our course requirement in

Community Medicine 2, we are conducting a comparative study on thenutritional status among institutionalized and street children. For the former

category, we will specifically be assessing those children living in the

orphanages.

In light of this, we would like to ask permission from your good office to

allow us to conduct our study in your institution. Aside from the assessment of

nutritional status, our study will also include analysis on the factors which affect

the nutrition and health status of street and institutionalized children. We

believe that this study would be able to provide you with valuable input during

your general improvement planning for the institution and we would be very

glad to share the results of our study with you. We also assure you that we willonly use information necessary for the study and any sensitive and other data

concerning the children and the institution will not be published. All informationobtained shall be limited for the purpose of the study ONLY and access to the files

shall be restricted to the research team. Documents will be stored in a concealedenvelope which is only accessible to the research team. Once the research process is

completed all files will be destroyed. Do understand that this is a nonprofit study and

that no monetary compensation would be handed out. Likewise, we are very much

open to discussing these important terms with you if you deem it necessary to do

so.


24/27

24

Should you agree on the terms discussed above, kindly affix your

signature at the bottom of this page.

We are looking forward to meeting and working with you regarding this

study and it is hoped and prayed for that you would grant us permission to do so.

Thank you and may our good Lord bless you more.Thank you for your kind consideration.

Conformed :

___________________________________

Mrs. Esperanza C. Gutierrez

Sincerely yours,

__________________

Angelo Parao

Noted by:

___________________________

Josephine M. Carnate, MD, MPH


25/27

25

2. Consent Form ( for Parents/Guardians of Street Children )

Magandang araw!

Kami ay mga estudyante ng medisina sa De La Salle Health Sciences Institute at

kasalukuyang nagsasagawa ng pag-aaral ukol sa pagkokompara ng malnutrisyon

sa mga batang lansangan at mga nasa ampunan sa Paco, Manila para sa taong

kasalukuyan.

Layunin ng pagaaral na ito na malaman ang body-mass index (relasyon ng

timbang sa taas ng isang indibidwal) ng mga batang lansangan at mga nasa

bahay ampunan. Titingnan din ng pagaaral na ito ang ilang salik sa kadalasan ng

pagkakaroon ng malnutrisyon katulad ng pagkakaroon ng magulang o guardian.

Sa kadahalinanang ito, nais naming hingin ang inyong tulong sa pagsagot ng ilang

mga simpleng katanungan. Bibigyan naming kayo ng 5 hanggang 10 minuto

upang sagutan ang mga tanong na ito. Kung meron kayong hindi maintindihan

maaari lamang na pakilapitan ang mga researchers na nagbihay sa inyo ng papel

na naglalaman ng mga tanong.

Sa pagsagot ng mga tanong dito, inyo pong kinukumpirma na maliwanag at

nauunawaan ninyo na :

- Boluntaryo ang inyong pagsagot sa mga katanungan at sumasangayon

kayo na sumali sa pagaaral na ito ng walang kapalit na tulong pinansyal

- Na nauunawaan nyo na mananatiling lihim ang mga maseselang

impormasyon na hindi naman kailangan sa pagaaral na ito. At ang

anumang ibinahagi nyo ay para lamang sa kaalaman ng mga researchersat para sa pagaaral na ito at hindi isasapubliko

- Sumasang ayon din kayo bilang magulang o guardian ng isa sa mga batang

kukuhanin naming ng timbang na ipagamit ang datos ukol sa timbang,

bigat at iba pang kailangang impormasyon. Kayo din ay nagbibigay

pahintulot sa mga researchers na gawin ang mga kailangang pamamaraan

upang makuha ang sukat ng mga ito .

________________________Lagda

Maraming salamat sa inyong pagtulong at pakikibahagi sa pagaaral na ito!

Sumasainyo,

__________________________________

Angelo E. Parao, Researcher


26/27

26

3. Questionnaire

De La Salle Health Scineces Institute- College of Medicine- Community

Medicine 2

MGA KATANUNGAN

Pangalan ng Anak/ Inaalagaan : _________________

Edad ng bata:_____

Kasarian ng bata : ______________

Pakilagyan ng tsek ang item/mga item na sa tingin nyo ay pinakamahusay na

sumasagot sa katanungan

1. Ano po ang malimit nyong kainin sa pang araw-araw? (Maaaring lagyan

ng tsek ang ISA HANGGANG TATLONG pagpipilian sa baba)

[ ] Manok [ ] Kanin [ ] Tinapay

[ ] Baboy [ ] Noodles [ ] Pampalasa (Asin,toyo, ketchup)

[ ] Isda [ ] Prutas [ ] Sabaw

[ ] Gulay [ ] De Lata [ ] Iba pa : _____________________

(pakisulat)

2. Ano ang nagdedetermina ng pagpili nyo ng ihahanda bilang pagkain ?

( Pumili lamang ng dalawa)

[ ] Kung ano ang kaya ng pera

[ ] Kung ano ang mura pero masustansya para sa bata

[ ] Kahit mahal ang presyo basta masustansya para sa bata

[ ] Kung ano ang malapit bilihin

[ ] Kung ano ang mas nakakabusog (mabigat sa tyan )

[ ] Kung ano ang masarap.

[ ] Iba pa _________________________ (pakisulat)


27/27

4. Consent Form ( for Children seven years old and above )

P A H I N T U L O T

Ako si _________________, ____ taong gulang ay nagbibigay pahintulot na gamitin ang

mga impormasyon ukol sa aking timbang, taas at ilan pang bagay na

kakailanganin sa pag-aaral na ito. Naunawaan ko ang kahalagahan at naisin ng

pag-aaral na ito at ako ay sumasang-ayon na maging kabahagi ng pagsasaliksik

na ito. Ako ay hindi pinilit na maging kalahok nito at ako ay nagbibigay ng

pahintulot na gawin nila ang kinakailangan (katulad ng pagtanggal ng damit

pang-itaas) upang makakuha ng wastong sukat ng timbang at taas. Nauunawaan

ko din na ang pagtanggi ko dito ay hindi makakaapekto sa akin o sa aking

pamilya at wala itong maidudulot na anumang kapahamakan.

________________________

Lagada ng kalahok

5. Body-Mass Index Determination Sheet