Revised Output 2 Community Medicine 15-B Members: Matel, Maria Carolina Nazareno, Christine Panghulan, Aldee Ray Parao,

Angelo Reyes, Kevin Sampelo, Ma. Carmela A. Tee, Jan Raemon

I. II.

GROUP 15-B, JOSEPHINE M. CARNATE, MD, MPH RESEARCH QUESTION A. Research Question Is the prevalence of malnutrition generally higher in street children compared to institutionalized children in orphanages located in Dasmarinas, Cavite during the year 2011? B. Objectives i. General Objectives To be able to compare the prevalence of malnutrition among street children and institutionalized children in orphanages located in Dasmarinas, Cavite during the year 2011. ii. Specific Objectives 1. To determine the body mass index (BMI) of street children and institutionalized children living in orphanages. 2. To compare the Body Mass Index (BMI) of street children and institutionalized children living in orphanages.
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3. To indicate if the absence or presence of biological parents can act as a disease variable that can affect the frequency of malnutrition among street children and institutionalized children living in orphanages. III. BACKGROUND INFORMATION REGARDING THE RESEARCH QUESTION 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 the result of marginal dietary intake compounded by infection. In turn, marginal dietary intake is caused by 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. While income is not the sum of total of people's lives, health status as reflects by level of malnutrition is. Measures of child nutritional status can help capture 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 show that the relationship between child nutritional status and poverty is strong at the lower end of the income range (2). An IFPRI Study in 2000 drawn from the experience of 63 developing countries over this 25- year period on determinants of child malnutrition across different regions found four strong determinants to child malnutrition. 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 birthweight children and thus there is an intergenerational effect of child malnutrition.

IV. 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.

V. SUMMARY
INTEREST

OF

CURRENT KNOWLEDGE

REGARDING DISEASE AND EXPOSURE OF

A. 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 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 issues the 2008 NNS looked into childrens nutrition. It was found out that the number of Filipino children
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who were underweight and underheight or stunted increased from 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 underheight rate increased from 26.3 percent to 27.9 percent, representing 3.57 million children. There was also a significant increase in the prevalence of underweight children aged 6-10 years from 22.8 percent in 2005 to 25.6 percent in 2008, equivalent to 2.6 million. The number of underheight children in this age group likewise increased from 32 percent to 33.1 percent. 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 percent. Chronic malnutrition affected a very high percentage of preschoolers in the provinces of 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 The World Health Organization reported that 49% of the 10.4 million deaths occurring in children below 5 years of age in developing countries are linked with protein-energy malnutrition. Although this kind of malnutrition occurs more frequently in low-income countries, several children from higher-income
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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. A study of (6) found that the nutritional status of orphans in Sana'a was miserable, especially when it was compared with that of orphans in different countries. Some 75 percent of the children were found to be underweight, and 37 % severely so. The prevalence of wasting, which indicates acute or current malnutrition was 27%. Some 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.

B. Epidemiology of exposure/ factor of interest Filipino Street Children In the Philippines, there are three types of children roaming in the street. Children on the Streets, described as children working on the streets but have homes to return to. Children of the Street, described as children living on the
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street and Completely Abandoned Children who are entirely responsible for their own physical and psychological survival (Pineda, 1998). 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. Institutionalized Filipino Children in orphanages

Proportion of Children who are in orphanages (WALA PAA!!!! Please research!!!)

C. 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 the eradication of hunger, reduction of child mortality and improvement of maternal health.
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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 stages 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. VI. SUMMARY OF RELATED/SIMILAR STUDIES

a. Design, result, conclusion, recommendation

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b. Biases, limitations c. Recommendations

VII. CONCEPTUAL FRAMEWORK

In the study entitled Comparison of Malnutrition among Institutionalized and Street Children, the independent variables are the institutionalized and street children while the dependent variable is the frequency of malnutrition. Thus, being institutionalized and street children may affect the frequency of malnutrition. As categorized, the confounding variables are profile (age, sex, socioeconomic status and presence or absence of parents) of the street children and institutionalized children and lifestyle (physical activity, diet and environment) of the street children and institutionalized children. These confounding variables affect the independent and dependent variables.

BIBLIOGRAPHY 1. ADB Institute. (2011). Malnutrition and Poverty. Retrieved July 1, 2011, from http://www.adbi.org/discussionpaper/2005/01/14/869.malnutrition.poverty.indonesia/malnutrition.and.poverty/ 2. National Health Survey, Manila Philippines, 2010. 3. Fuegel, Robert et.al. Economic Growth Analysis. Millenium Envisage Journal. Jan. 1994 Vol 89 4. World Health Organization. International Health Convention. United Nations, 1999. 5. World Health Organization. International Health Convention. United Nations, 1999. 6. Terwaki, A. A Study of Nutritional Status and Diseases in Al-Aitam Orphanage. Diseases associated with Malnutrition. 1999 7. Terwaki, A. A Study of Nutritional Status and Diseases in Al-Aitam Orphanage. Diseases associated with Malnutrition. 1999

CONCEPTUAL FRAMEWORK

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