the effect of a nutrition education module

8/11/2019 The Effect of a Nutrition Education Module

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THE EFFECT OF A NUTRITION EDUCATION MODULEON THE KNOWLEDGE, ATTITUDE AND PRACTICES

OF MOTHERS WITH UNDERNOURISHEDCHILDREN AGED 0 5 YEARS OLD

ON NUTRITION IN BARANGAYBIAYON, SERGIO OSMEA SR.,

ZAMBOANGA DEL NORTE

A research Paper Presented

To

The Faculty of

Ateneo de Zamboanga University

School of Medicine

In Partial Fulfillment of the

Requirements for the Degree of

DOCTOR OF MEDICINE

By

DULCE AMOR A. DAGALEA

April 2005


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APPROVAL SHEET

This research entitled THE EFFECT OF A NUTRITION EDUCATIONMODULE ON THE KNOWLEDGE, ATTITUDE AND PRACTICES OF

MOTHERS WITH UNDERNOURISHED CHILDREN AGED 0 5 YEARS OLDIN BARANGAY BIAYON, SERGIO OSMEA SR., ZAMBOANGA DELNORTE,prepared and submitted by Dulce Amor A. Dagalea, in partial fulfillment ofthe requirements for the degree of Doctor of Medicine, is hereby accepted.

____________________Dr. Ricardo N. Angeles

Adviser

Approved by the Oral Examination Committee with a grade of PASSED.

_______________________ ______________________Dr. Bernadette C. Chua Dr. Samuel L. Cristobal

Member Member

________________________ ______________________Dr. Analisa A. Santamaria Dr. Ernesto G. Florendo

Member Member

_______________________ ________________________Dr. Roesmin S. Edding Dr. Hazel Eiza C. SorianoMember Member

ACCEPTED in partial fulfillment of the requirements for the degree of DOCTOR OFMEDICINE.

__________________

Dr. Mario R. ArciagaAssociate Dean for Research

Ateneo de Zamboanga University

School of Medicine

i


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ABSTRACT

This research aims to assess the effect of a nutrition education module on the

knowledge, attitude and practices of mothers with undernourished children aged 0

5 years old on nutrition in Barangay Biayon, Sergio Osmea Sr., Zamboanga del

Norte. Respondents of this study were mothers obtained through convenience

sampling. The research design used is the pre and post interventional design. The

knowledge, attitude and practices of the respondents were evaluated before and after

the nutrition education utilizing a self-administered questionnaire with 25 items on

knowledge, 10 items for attitude and 5 items for practices. Two post-tests were given

for the knowledge items, one immediately after the intervention and the other, two

months after. Data for knowledge items were analyzed using ANOVA for repeated

measures which in summary illustrated a significant increase in the mean scores from

post-test 1 to post-test 2. the respondents attitude on nutrition before the intervention

was under the positive spectrum. Using the paired t-test, the mean attitude scores

increased after the intervention, implying that the attitudes were strengthened but not

significant statistically. Practice items assessed through Wilcoxon Signed Ranks had

no improvement. Though the intervention achieved to increase the knowledge of the

respondents and strengthen their attitude, it was insufficient to affect practices.


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v

TABLE OF CONTENTS

Page

APPROVAL SHEET i

LIST OF TABLES ii

LIST OF FIGURES ii

ACKNOWLEDGEMENT iii

ABSTRACT v

CHAPTER I INTRODUCTION 1

Background of the Study 1

Statement of the Problem 4

Objectives 4

Hypothesis 4

Conceptual Framework 5

Significance of the Study 6

Scope and Delimitation of the Study 6

Definition of Terms 7

CHAPTER II REVIEW OF RELATED LITERATURE 8

CHAPTER III METHODOLOGY 12

Research Design 12


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Respondents 12

Sampling Design 12

Research Setting 13

Data Gathering Procedure 13

Research Instrument 15

Intervention 16

Statistical Instrument and Treatment 17

CHAPTER IV RESULTS 18

CHAPTER V DISCUSSION 28

CHAPTER VI CONCLUSION AND RECOMMENDATIONS 32

BIBLIOGRAPHY 33

APPENDICES

A Questionnaire (English) 35

B Questionnaire (Visayan) 39

C Module 43


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CHAPTER I

INTRODUCTION

Background of the Study

Rapid screening of the nutritional status of children less than five years of age is

done semi-annually in the Operation Timbang (OPT). This is one of the programs

launched by the Department of Health to combat the problem of malnutrition.

For the year 2003, the data on the Operation Timbang of the entire municipality of

Sergio Osmea Sr. showed that for an 83% coverage of the OPT, 26% of the total

children weighed have low weight for age and therefore are considered undernourished.

The top five barangays with the most number of children with low weight for age are San

Isidro (31%), Biayon (25%), San Francisco (32%), San Jose (29%) and Venus (18%). For

the year 2004, the data of the first OPT report show that the top five barangays with the

most number of undernourished children are Biayon, San Isidro, Sinai, San Jose and

Poblacion Bajo. These data reveal that for the last two years, barangay Biayon has been

top 2 in the list of barangays with the most number of underweight children in the

municipality. Thus, action is called for to help decrease the number of underweight

children in the barangay.

Programs on nutrition in the municipality are mainly implemented by the

Department of Social Welfare and Development (DSWD) in cooperation with the

Municipal Health Office. One of these programs is the Operation Timbang carried out by

the Barangay Health Workers (BHW) and the Barangay Nutrition Scholar (BNS) under

the supervision of the DSWD.


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The Barangay Nutrition Scholar Project was created in 1977 to provide an effective

means of disseminating nutrition information and providing nutrition services to the

barangays through a trained community worker. The role of the BNS is to measure and

weigh preschool children to screen for malnutrition, conduct mothers classes which

dispense information on nutrition and health and distribute seeds and supplementary food

packets for preschoolers to target families (Torres, 1979).

Interviews with the department chair of DSWD and the residents disclosed that

although measuring and weighing of preschool children for screening for malnutrition is

done regularly, mothers classes are rarely done and distribution of seeds and

supplementary food packets are dependent on the supply from the city office of the

DSWD.

Rapid growth and development occurs in the first couple of years of life. An

infants birth weight doubles in the first 4 to 6 months. When nutrients are missing in the

critical phases of growth and development, growth slows and may even stop (Whitney, et

al, 2002). Children should be given the proper nutrients needed for optimal development.

And since they are not yet able to look after themselves, they rely completely on people

who are taking care of them, most often the mothers. Their source of nourishment is

limited to what their caregivers provide.

The relationship of mothers knowledge and its effect on the nutritional status of

the child, among other factors, has been investigated in many studies.

Tada, et al (2002) discovered that one of the factors that affect the nutritional

status of the children is the mothers knowledge and perception of nutrition and mothers

food practice.


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Results of a study by Ruel et al (1992) showed that there is a positive association

between the mothers' nutrition knowledge and the children's weight-for-age.

A research by Blaylock et al. revealed that mothers knowledge on nutrition has a

significant positive influence on childrens diet quality and childrens dietary intakes.

Among the numerous factors affecting diet and nutrition intakes, maternal health and

nutrition knowledge is one factor that can be manipulated by health authorities.

These studies illustrate that maternal nutritional knowledge play a crucial role on

the nutritional status of children. It is therefore important that mothers are educated on

proper nutrition so that they could cater to the growing needs and for a better nutritional

status of their children.


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Statement of the Problem

Will the nutrition education using teaching modules have an effect on the

knowledge, attitude and practices of mothers with undernourished children aged 0 5

years old on nutrition in Barangay Biayon, Sergio Osmea, Zamboanga del Norte?

Objectives

Generally, this study aims to determine the effect of a nutrition education using

teaching modules in improving knowledge, attitude and practices of mothers with

undernourished children aged 0 5 years old on nutrition. More specifically it aims to:

a. determine the existing knowledge, attitude and practices of mothers with

undernourished children 0 5 years old on nutrition before the intervention

b. determine maternal knowledge, attitude and practices on nutrition after the

intervention

c. compare the knowledge, attitude and practices of mothers with undernourished

children 0 5 years old on nutrition before and after the intervention.

Hypotheses

Null: The nutrition education using teaching modules has no significant

effect in improving the knowledge, attitude and practices of mothers in

barangay Biayon, Zamboanga del Norte.

Alternative: The nutrition education using teaching modules has a significant

effect in improving the knowledge, attitude and practices of mothers in

barangay Biayon, Zamboanga del Norte.


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Significance of the Study

Lack of education is one of the numerous underlying causes of poor nutrition

(King, 1993). This study serves to equip the mothers of undernourished under-five

children on the proper knowledge regarding nutrition. With the improvement of

knowledge and sound understanding of the importance of nutrition, this study also

intends to influence positive attitude and practices.

The result of this study could be used as a basis on creating a more sustainable

nutrition program in the community. If this intervention proves to be effective, teaching

modules can thus be instituted in the future mothers classes in the barangays. Results

may also provide information on what should be taught in future mothers' classes in order

to better convey the message of nutrition across. If on the other hand, results will show

that teaching modules do not have an effect on the maternal knowledge, attitude and

practices on nutrition, other avenues must be explored in order to better convey the

message of nutrition across.

Scope and Delimitation of the Study

Results in this study are true only for the mothers of undernourished under-five

children residing in Barangay Biayon, Osmea and may or may not be true for the

general population of mothers.

Only the knowledge, attitude and practices of mothers on topics with regard to the

three basic food groups, the importance of a balanced diet, signs and symptoms of

malnutrition, and the prevention of malnutrition are evaluated in this study.


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Practices are evaluated only through the use of questionnaires, thus, are short of

validation in this study since a 24-hour observation has not been done.

Definition of Terms

Undernourished children children aged 0 59 months old who falls under

the category of underweight using the FNRI-PPS reference standard

on weight for age table. Specifically,

if a childs weight is 76 90% of his ideal weight for age, he is

first degree or mildly underweight

if a childs weight is 61 75% of his ideal weight for age, he is

second degree or moderately underweight

if a childs weight is less than 60% of his ideal weight for age, he

is third degree or severely underweight.

Teaching module modified from the Community Based Planning and Management

Nutrition Program authored by the Department of Health for

Barangay Health Workers.


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CHAPTER II

REVIEW OF RELATED LITERATURE

It is imperative that those responsible for the care of the children, the mothers

more often than not, are knowledgeable about the factors affecting malnutrition in order

to provide an ideal condition to enhance the proper growth of their children.

Several studies show that there exists an association between the knowledge,

attitude and practices of mothers and the nutritional status of children.

The following are studies which examined the maternal factors in relation to the

nutritional status of children.

Tada, et al (2002) conducted a cross-sectional study in Bangkok to examine the

nutritional status of the children and to determine the factors related to it. It was

discovered that the factors that affect the nutritional status of the children are: family

characteristics (mothers age, educational background family income), childrens

characteristics (age, gender, birth order, immunization status, and history of illness), and

mothers knowledge and perception of nutrition and mothers food practice.

Results of a study by Ruel et al (1992) in Guatemala that tested whether maternal

nutrition knowledge was a mediating factor in the association between maternal

schooling and child nutritional status showed that there is a positive association between

the mothers nutrition knowledge and the childrens weight-for-age. Furthermore, the

effect of maternal schooling on weight-for-age was mediated by the mothers nutrition

knowledge only among wealthier households. It implies that nutrition education for

mothers could contribute to improving childrens growth, but only in households that


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have access to a minimum level of resources. For poorer households, nutrition education

would not be sufficient.

The relation of childhood malnutrition to parental education and mothers

nutrition on related knowledge, attitude and practices was investigated in a study in India.

Twenty-six severely malnourished children and their mothers were paired equally with

well-nourished children and their mothers. A 37-point questionnaire was administered to

mothers to gather their nutritional knowledge, attitude and practices. Mothers of well-

nourished children scored higher. Result showed that there was a significant relation on

nutritional status of children and the educational level of their mothers but there was no

significant association found between the mothers knowledge, attitude and practices and

educational level. It was concluded that maternal education and knowledge, attitude and

practices are significantly and independently associated with childrens nutritional status

(Gupta et al, 1991).

A study by Horodynski, et al (2004) examined the strategies effective for

promoting healthy eating in toddlers The study investigated rural, low-income caregivers'

knowledge, attitudes, mealtime practices, and dietary intake before and after a nutrition

program. A convenience sample of 38 families participated in the study; 19 attended

classes, and 19 did not. Six months after the lessons, no significant differences were

found between groups. However, caregivers' perceptions about feeding their toddlers

differed from their reported dietary intakes of dairy, fruits, and vegetables.

Yunus, M. et al (1996) also had undertaken a study on increasing the intake of

vegetables rich in beta-carotene by young children through nutrition education of their

caregivers. One hundred fifty-six children aged 6-59 months were selected from


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households of very poor socioeconomic status. Nutrition education intervention was

provided to the caregivers of these children on the importance of feeding vegetables rich

in beta-carotene. This education included verbal communication and cooking

demonstrations. It was provided by trained female community health workers once every

2 months over a period of 12 months. Information on the consumption of green leafy

vegetables by the children for the preceding 3 days was collected at baseline and after the

12-month intervention by interviewing the caregivers. The proportion of children who

consumed vegetables with high content of beta-carotene increased from 28% at the

baseline to 96% after the intervention, showing a highly significant increase with a p-

value of 0.000. The mean frequency of intake of vegetables rose from 0.65 per 3 days at

baseline to 4.33 after the intervention. This increase in intake was also highly significant

(p-value 0.000). The significant increase in the consumption of vegetables was achieved

within a period of one year from the intervention.

Feeding programs have been the common intervention used to raise the level of

nutrition, but generally have demonstrated very small benefits in relation to the cost. A

cost-effective and more commonly used intervention is nutrition education using lectures.

Nutrition education has helped improve nutritional status, particularly in the area of

motivating mothers to change their practices regarding supplementary feeding of older

infants and young children (Mcnaughton, 1983).

According to Bligh (2002), lecture is still the most commonly used tool that is

proven effective to impart information. Lectures may also reinforce the values and

attitudes that are already accepted, it is relatively effective in changing peoples attitudes

and values.


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The following are studies that explored the effect of nutrition education on the

health status of children and on the nutritional behavior.

Findings from an evaluation of the Integrated Rural Nutrition Project in Zambia

indicate that the nutrition education programs had a significant, positive effect on the

nutritional status of children aged under 5. The nutrition education component, which

aimed in improving knowledge, attitudes, and practices, was more successful than the

activities that aimed at increasing food availability (Friedrich, 1997).

Niciforovic-Surkovic, et al (2002) assessed knowledge and behavior regarding

nutrition among schoolchildren and their parents. The study was performed in a random

sample of 210 children in 4 elementary schools and their parents in Vojvodina using a

formulated questionnaire. Results showed that childrens and parents knowledge about

healthy food is satisfactory, but it is not enough for healthy behavior.

The studies above operate on the premise that nutritional knowledge can have an

impact on childrens nutritional status. It is in this light that this study is undertaken.


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CHAPTER III

METHODOLOGY

Research Design

This study utilized the pre and post interventional research design to determine

any improvement of maternal knowledge, attitude and practices on nutrition before and

after the intervention.

Respondents

Inclusion Criteria

mothers ages 15 50 years old

with an undernourished under-five child, as identified in the mass

weighing conducted

Drop-out Criteria

failure to attend the session on health teaching

failure to take the second post intervention test

Sampling Design

All the possible respondents for the study were identified and a convenience

sampling method was used for the selection of the actual respondents for this study.

The participants of this study are mothers from the barangay of Biayon. All the

mothers who met the inclusion criteria after the weighing and rapid assessment of the

childrens nutritional status were classified. There were 71 mothers identified. These


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mothers were invited for the session on nutrition education. Of the 71 prospective

respondents, only 35 have attended the nutrition education session. These 35 mothers

were thus enrolled as the respondents of this study.

Research Setting

This study is conducted in Biayon, the barangay with the most number of

underweight children in the OPT report for the first semi-annual period, with a total of 50

underweight children; and the second top most barangay in the 2003 annual OPT data,

with a total of 63 underweight children.

Biayon is one of the largest barangay of the municipality. The barangay is not

situated along the highway. It is 2 kilometers away from Poblacion Alto where the seat of

government is located and where the public market is situated. It entails an estimated 10

to 15 minutes drive by habal-habal to reach the public market where varieties of food are

available.

Electricity is available in the barangay. Although there are sources of water from the

spring, low water pressure hampers adequate flow in some households.

Data Gathering Procedure

Pre-Interventional Phase

The selection of respondents began with the mass weighing of under-five children

in the barangay performed by the researcher with the help of the barangay midwife,

barangay health workers and barangay nutrition scholar. This event was done in concert

with the Garantisadong Pambata activity. After taking the weight and age of the children,


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rapid screening of their nutritional status was done assessed using the FNRI PPS

reference standard on weight-for-age table according to the following categories: if the

childs weight is 76 90% of his ideal weight for age, he is first degree or mildly

underweight; if the childs weight is 61 75% of his ideal weight for age, he is

second degree or moderately underweight; if a childs weight is less than 60% of his

ideal weight for age, he is third degree or severely underweight.

The underweight children were identified. Their mothers were the prospective

respondents, thus, the mothers were informed and given an invitation to attend the

nutrition education session.

Mothers who attended the event held at the barangay multipurpose hall were

asked to answer the self-administered questionnaire before the lecture started.

Participants who are illiterate or not adept at reading were assisted by BHWs who were

instructed to read the questions and jot down the answers. The importance of no coaching

was emphasized. Thirty minutes was allotted for the test. The result of this exam served

as the baseline knowledge, attitude and practices of mothers on nutrition.

Intervention Proper

The intervention was in a form of lecture with visual aids which was set to last for

one hour and thirty minutes. The lecturer was the Biayon Barangay Nutrition Scholar.

The lecture contained information on general nutrition, the three basic food groups,

malnutrition and its signs and symptoms, and prevention.

At the end of the lecture, queries from the participants were entertained.


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Post-Interventional Phase

The respondents were requested to answer the knowledge questions immediately

after the intervention (post-test 1). Only the knowledge questions were evaluated during

this time. The attitude and the practices items are not evaluated as more time is needed in

order to see a change in attitude or practices.

Reevaluation of knowledge, attitude and practices of mothers was instituted two

months after the intervention (post-test 2). The respondents were visited in their houses

and were asked to once again answer the same self-administered questionnaires that they

have accomplished in the pretest and post-test 1.

The author and five barangay health workers of Biayon, divided into three pairs,

were the ones who went from house to house. When there were a number of respondents

who were neighbors, they were gathered together in a place and were given the

questionnaires. The BHWs were instructed to just supervise. When there were

respondents who were not around during the visit, it was noted so that they would be

visited again.

Research Instrument

A self-administered questionnaire which includes 25 items on knowledge, 10

items on attitude and 5 items on practices of mothers on nutrition is the instrument used

in this research.

In general, knowledge items include questions on weaning, signs and symptoms

of malnutrition, and sources of the three basic food groups. Attitude and practice items

cover the importance of balanced diet and food preparation.


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The questions were reviewed by the chairperson of the Municipal Department of

Social Welfare and Development who happens to also be the chairperson of the nutrition

program in the municipality.

To facilitate better understanding of the questions by the respondents, the

questionnaire was translated into the local dialect, Bisaya. The translation of the

questionnaire was made also by the chairperson of the municipal DSWD. Back

translation was also made to ensure preservation of the idea conveyed.

Pre-testing of questionnaire was conducted on October 21, 2004 at the

municipality of Josefina. Josefina is 25 kilometers away from Sergio Osmea. It shares

the same socio-cultural and geographical setting as that of Osmea with similar food

choices.

Seven mothers with children under five years old were gathered and were

requested to answer the questionnaire. In the end, queries were raised, issues and items

were clarified, suggestions were noted and the necessary changes were made.

Intervention

The teaching module used in the nutrition education is modified from the

Community Based Planning and Management of Nutrition Program (CBPM NP)

nutritional module, which is formulated by the DOH for Barangay Health Workers. Only

those materials applicable to mothers were included in the teaching module. Other

relevant items not included it the CBPM NP were also added, such as the topics on

planning and preparing nutritious food for the family and food preparation.


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The teaching module is composed of 12 topics regarding the three basic food

groups, the importance of a balanced diet, signs and symptoms of malnutrition,

prevention of malnutrition, and planning and preparing nutritious food.

The abovementioned chairperson of the DSWD and of the nutrition program was

also requested to go through the modules for the validation of its contents. Suggestions

were for some of the topics not to be included and presented some topics that are more

valuable in the study. These suggestions were considered and the changes were made.

Statistical Instrument and TreatmentFor the comparison of the means of the pre-intervention, the post-test 1 and the

post-test 2 results of the knowledge items, the statistical tool used is the ANOVA for

repeated measures.

The attitude items are assessed using the paired t-test where the mean scores of

the respondents in the pre-test and post-test 2 were matched to investigate any

improvement.

To measure the alteration in practices, Wilcoxon Rank is utilized.

The frequency and percentage distribution is also applied to complement the tests

used.

All these measurements are accessed in the Statistical Package for the Social

Sciences (SPSS) for windows.


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CHAPTER IV

RESULTS

Demographic Profile

Majority of the mothers who are participants of this study are aged thirty-five

and below. There were 4 (11.4%) between ages 15 20, 10 (28.6%) between 21 25

years old, the age group with the most number of respondents; 9 (25.7%) between 26

30 years old and 7 (20%) between ages 31 35. The rest of the respondents were of

the ages above thirty-five years old. Three (8.6%) were between 36 40 years old,

and 1 (2.9%) each between 41 45 and 45 50 years of age, respectively.

Table 1. Age Distribution

AGE in yearsNumber Percentage

15 20 4 11.4%

21 25 10 28.6%

26 30 9 25.7%

31 35 7 20%

36 40 3 8.6%

41 45 1 2.9%

46 50 1 2.9%

Roman Catholic is the predominant religion with 24 (68.5%) respondents

practicing it. It is followed by the Seventh Day Adventist and Piniling Nasod both

with 4 (11.4%) of the participants. The religions Church of God, Born Again and

Rock Christ each has 1 (2.9%) member.


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Most of the mothers were housewives 32 (91.4%) and they depend on their

husbands to earn to be able to meet the necessity of everyday life. The common

occupation of their husbands is farming 29 (82.9%) and majority 28 (80%) earns less

than P1500 monthly.

Only 2 (5.7%) of the respondents reached tertiary education. Sixteen (45.7%)

and 17 (48.6%) were able to attain secondary and primary education, respectively.

Knowledge

Data obtained for knowledge reveal that there was an increase in the mean score of

the respondents, with the mean difference of 1.086 from pre-test to post-test 1. From the

mean score of 17.89 in the 25-item knowledge questions before the intervention, the

mean score increased to 18.97 in the test given right after the intervention (post-test 1).

The increase was statistically significant with a p-value of 0.002. This suggests that the

health education given to mothers about nutrition was effective in increasing their

knowledge.

Table 2. Test Means Comparisons of Knowledge Items

Test ComparisonMean

Scores

Standard

Deviation

Mean

Difference

Standard

Error p-value

Pre-test

And Post Test 1

17.89

18.97

+/- 1.94

+/- 1.58

1.086 .291 .002*

Post-test 1

And Post-test 2

18.97

18.57

+/- 1.58

+/- 2.00

.400 .381 .902

*significant at p-value < 0.05


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The result of the post-test 2 given two months after the post-test 1 showed a mean

score of 18.57, with a mean difference of 0.400 from post-test 1. The decrease in the

mean score is not statistically significant with p-value of 0.902. This means that there was

no significant decay in the knowledge gained by the mothers from post-test 1 to post-test

2. There has been, therefore, knowledge retention for the time being.

Attitude

At 0.05 level of significance on the paired t-test for the mean scores of attitude items

in the tests conducted before and after the health education on nutrition, not one of the

attitude items had a significant change after the intervention. It purports that the health

education did not bring about significant effect to increase the scores of the responses for

the attitude items.

Each attitude item is assessed using a Likert Scale. Specifically, four choices of

degree of predilection (strongly agree, agree, disagree, strongly disagree) are assigned

with values. The higher the value assigned to the degree of predilection, the better the

attitude.

The questionnaire contained 10 items on attitude, five are purely opinions and the

other five are attitudes that can be translated to actions.


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Among the five which are purely opinions, three (items #s 1, 8 and 10 in the

questionnaire) maintained the same mean score of 3.29 before and after the intervention.

Table 3. Mean Scores Comparison of Attitude Items with regard to opinion

Mean Scores (N = 35)Attitude Items Pre-

InterventionPost-

interventionp-value

It is important for mothers to know about preparinga balanced meal.

Strongly Agree = 4 Strongly Disagree = 1

3.29 3.29 1.000

It is best for growing children to eat their meals ontime.


3.29 3.29 1.000

A good meal rich in nutrients can comefrom ones small garden.


3.29 3.29 1.000

I feel that there are limited food choices available inour community.


2.71 2.51 0.292

Nutritious food does not really have to be expensive.

Strongly Agree = 4 Strongly Disagree = 12.77 3.06 0.169

*significant at p-value


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The attitude items with regard to action earned slight increases after the

intervention, but these changes did not effect a significant change statistically.

Table 4. Mean Scores Comparison of Attitude Items with regard to action

Mean Scores (N = 35)

Attitude ItemsPre-

interventionPost-

Intervention p-valueWhen you feed your children with nutritious food,you can prevent them from getting sick.


3.00 3.34 0.123

Preparing a balanced meal which consists of rice,meat/fish, vegetables and fruits is time consuming.


2.83 2.86 0.895

It is practical to grow green leafy vegetables and fruitsin the home garden.


3.14 3.20 0.744

If my child doesnt want to eat vegetables, then Ishould not persuade him/her to eat it.


2.34 2.69 0.116

It is necessary to keep a growth chart of ones children.

Strongly Agree = 4 Strongly Disagree = 12.83 3.14 0.086



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Looking closer per item, (refer to questionnaire in Appendix) although the mean

scores increased slightly two months after the intervention, these changes are not

sufficient to be statistically significant. For item #1, most of the respondents agree on the

attitude towards the importance of mothers knowing about preparing a balanced meal.

Before the after the intervention, their scores fall between agree and strongly agree. Only

1 (2.9%) disagreed after the intervention. The mean scores remained the same before and

after the intervention at 3.29. This signifies that mothers believe on the importance of

preparing a balanced meal.

Majority of the participants agree on item # 2 regarding the prevention of illness

when children are fed with nutritious food. There was a gain of 8 (22.8%) respondents

who agreed to this item after the nutrition education. An increase of 0.34 was noted in the

mean score from 3.00 in the pre-intervention to 3.34 after the intervention. They remain

true to their stand that when children are fed with nutritious food, they are prevented from

getting sick.

Item #3 had an increase of 0.03 points from 2.83 to 2.86. Out of the 4 (11.4%) who

strongly agreed that preparing a balanced meal is time consuming before the nutrition

education, only 1 (2.9%) strongly agreed after the nutrition education. The mean score for

item #3 had an increase of 0.03 points from 2.83 to 2.86, implying the mothers

disagreement that preparing a balanced meal is time consuming.

An increase of 0.06 from 3.14 to 3.20 is shown for item #4 that states it is practical

to grow green leafy vegetables and fruits in the home garden. From 30 (85.7%)

respondents before to 32 (91.4%) respondents after the intervention agreed and strongly

agreed to this item.


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For item #5 which imparts that if the child does not want to eat vegetables,

therefore he/she should not be persuaded, a change in the mean score of 0.35 from 2.34 to

2.69 is seen; almost disagreeing and implying that children should be persuaded to eat

vegetables.

The mean attitude score for item #6 regarding the importance of keeping a growth

chart, increased from 2.83 to 3.14. Most of the mothers agree that it is necessary to keep

the childrens growth charts.

For the mothers opinion that there seem to be limited food choices in their

community, a change in the mean scores from 2.71 to 2.51 is noted, which is between

agree and disagree. There is a change in attitude for item #9 of 0.29 points from 2.77 to

3.06, agreeing more that nutritious food does not really have to be expensive. Items

number 8 and 10 remained the same with a mean score of 3.29. Illustrating the mothers

agreement that it is best for children to eat their meals on time and a good meal rich in

nutrients can come from ones small garden.


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Table 5. Pre and Post Intervention Mode for Attitude Items

Question Scale Mode

Pre- Intervention

Mode

Post Intervention

1. It is important for mothers to know

about preparing a balanced meal.

Strongly Agree = 4; Strongly Disagree = 1

Strongly Agree

AgreeDisagree

Strongly Disagree

14 (40%)

19 (54.3%)0

2 (5.7%)

11 (31.4%)

23 (65.7%)1 (2.9%)

0

2. When you feed your children withnutritious food, you can prevent themfrom getting sick.


Strongly AgreeAgree

DisagreeStrongly Disagree

14 (40%)11 (31.4%)6 (17.1%)4 (11.4%)

14 (40%)19 (54.3%)

2 (5.7%)0

3. Preparing a balanced meal whichconsists of rice, meat/fish,vegetables and fruits is timeconsuming.

Strongly Agree= 1; Strongly Disagree = 4

Strongly AgreeAgree


13 (37.1%)7 (20%)

11 (31.4%)4 (11.4%)

10 (28.6%)11 (31.4%)

13 (37.1%)1 (2.9%)

4. It is practical to grow green leafyvegetables and fruits in the homegarden.


Strongly AgreeAgreeDisagree

Strongly Disagree

14 (40%)16 (45.7%)

1 (2.9%)4 (11.4%)

12 (34.3%)20 (57.1%)

1 (2.9%)2 (5.7%)

5. If my child doesnt want to eatvegetables, then I should notpersuade him/her to eat it.


Strongly AgreeAgree


6 (17.1%)6 (17.1%)

17 (48.6%)6 (17.1%)

9 (25.7%)9 (25.7%)14 (40%)3 (8.6%)

6. It is necessary to keep a growth

chart of ones children.



Strongly Disagree

6 (17.1%)

21 (60%)4 (11.4%)4 (11.4%)

10 (28.6%)

21 (60%)3 (8.6%)1 (2.9%)

7. I feel that there are limited foodchoices available in our community.



Strongly Disagree

4 (11.4%)22 (62.9%)

4 (11.4%)5 (14.3%)

3 (8.6%)15 (42.9%)

14 (40%)3 (8.6%)

8. It is best for growing children to eattheir meals on time.



Strongly Disagree

16 (45.7%)

16 (45.7%)0

3 (8.6%)

14 (40%)19 (54.3%)

02 (5.7%)

9. Nutritious food does not really haveto be expensive.


Strongly AgreeAgree


5 (14.3%)22 (62.9%)

3 (8.6%)5 (14.3%)

9 (25.7%)20 (57.1%)

5 (14.3%)1 (2.9%)

10. A good meal rich in nutrients cancome from ones small garden.



Strongly Disagree

16 (45.7%)16 (45.7%)

03 (8.6%)

14 (40%)18 (51.4%)

2 (5.7%)1 (2.9%)


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Practices

The general picture of the result illustrated in the post-test 2 is a decline in the

number of subjects who responded always in all the practice items as compared with

the pre-test result.

Table 6. Comparisons of Frequency of Responses of Practice Items

Frequency of ResponsesN = 35

Practice Items Frequency Pre-test Post-test 2 P value1. The meals I cook include

fish/meat.

Always

Sometimes

Never

4 (11.4%)

31 (88.6%)

0

2 (5.7%)

32 (91.4%)

1 (2.9%)

0.180

2. The meals I cook include

vegetables.

Always

Sometimes

Never

31 (88.6%)

4 (11.4%)

0

21 (60%)

14 (40%)

0

0.008*

3. I supervise my children as they

eat, making sure that they finish

the food served to them.

Always

Sometimes

Never

32 (91.4%)

3 (8.6%)

0

21 (60%)

14 (40%)

0

0.001*

4. I buy fortified food products with

the Sangkap Pinoy Seal.

Always

Sometimes

Never

2 (5.7%)

22 (62.9%)

11 (31.4%)

3 (8.6%)

21 (60%)

11 (31.4%)

0.868

5. I allow my children to eat some

junk foods during meal time.

Always

Sometimes

Never

6 (17.1%)

13 (37.1%)

16 (45.7%)

3 (8.6%)

17 (48.6%)

15 (42.9%)

0.669



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After the health education, the rate that the mothers always prepare meals with vegetables

decreased to 21 (60%) and the rate of those who make meals with vegetables sometimes

increased to 14 (40%). As a result, there was a decrease of 10 (28.6%) in those who

responded always from the pre-test result to the post-test result and this decrease is

significant statistically.

The frequency that mothers always supervise their children as they eat to make

sure that they finish the food served to them, decreased from 32 (91.4%) to 21 (60%). For

those who supervise their children sometimes, the number of respondents increased from

3 (8.6%) to 14 (40%). The number of respondents who changed their practice from

always doing it to doing it only sometimes and vice versa was statistically significant

with a p-value 0.001.

When asked how often they buy fortified food products with the Sangkap Pinoy

Seal, 2 (5.7%) answered always and 22 (62.9%) said sometimes and 11 (31.4%) said

never. Two months after the health teaching only 1 changed the practice from sometimes

to always in buying fortified foods. The post-test 2 result shows 3 (8.6%) for those who

always buy fortified foods, 21 (60%) for those buying only sometimes and still 11

(31.4%) continued their old practice of not buying fortified food products.

Before the health education, 6 (17.1%) of the respondents always allow their

children to eat some junk foods during meal time, 13 (37.1%) sometimes allow and 16

(45.7%) never allow their children to eat junk foods during meal time. After the health

education, the number of mothers who allow their children to eat some junk foods during

meal time decreased to 3 (8.6%) those who sometimes allow increased to 17 (48.6%) and

those who never allow decreased to 15 (42.9%).


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CHAPTER V

DISCUSSION

The respondents of this study are mostly housewives with low socioeconomic

status with an educational attainment of a secondary or a primary level in education.

Several studies show that undernourished children usually belong to families with low

socioeconomic status. One of these studies is the study of Tada et al (2002) who

discovered that one of the factors that affect nutritional status is family characteristics

(mothers age, educational background, and family income).

In the 25 questions of the knowledge item, inferring from the scores that the

respondents obtained, their performance on the test was relatively good before the

intervention. With a mean score of 17.89, it can be deduced that the majority of the

participants were able to answer most of the questions correctly. The perfect score is 25,

and the highest and lowest scores obtained were 20 and 13 respectively. Immediately

after the nutrition education, the result of post-test 1 revealed an improvement in the

highest score to 22 and the lowest score to 14. In effect, the mean score of the post-test

immediately after the nutrition education is shown to be statistically significant,

suggesting gain in knowledge. This significance can be attributed to the type of

intervention that this study utilized, a nutrition education through lectures. Studies

conducted by Bligh (2000) demonstrate that lecture is still the most commonly used tool

that is proven effective to impart information.

The items worth noting on the knowledge questions are items number two and

three. These items are about weaning. While correct responses on the rest of the items

also increased, items two and three are with the most number of correct responses after


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the nutrition education. The mothers as a result learned that although breast milk is best

for babies, additional solid foods should be introduced by the age of four months and

onward. Babies cannot depend on breast milk or lugawalone; they need food from other

food groups that would sustain their growing needs.

The decrease in the mean scores from post-test 1 to post-test 2 did not bring about

significance statistically. It implies that the knowledge gained by the mothers after the

nutrition education is retained. The outcome insinuates that the nutrition education was

effective because the mothers learned and had retention of the information acquired.

However, examining the increase of knowledge in post-test 2 at a different angle,

familiarization of the test items can also be considered as a factor for the increase in

scores. It could also mean that more time is needed for decay to be evident.

The findings of the maternal education factor in this study substantiates the study of

Gupta, et al (1991) that there is no strong association between the knowledge, attitude

and practices of mothers on nutrition and their educational level. On the findings of

Gupta, et al (1991) that there is a significant relation on the nutritional status of children

and the educational level of their mothers, the result of this study is not enough to

conform or refute it due to the fact that this study was only conducted to one group of

mothers whose children are all undernourished. Thereby, no comparison on the

educational attainment of mothers was made on another group of mothers with well-

nourished children. In this study the educational attainment of mothers is equally

distributed in the secondary and primary levels of education.

The general picture of the result of the attitude items shows that before the

intervention, the mothers have relatively positive responses for the attitude items on


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nutrition. After the nutrition education, the respondents agreed more to the positive

attitudes. Although their mean scores for each attitude items increased, these changes are

very small to affect significance statistically. This result is consistent with the findings of

Bligh (2000) that lectures may reinforce the values and attitudes that are already

accepted, it is relatively effective in changing peoples attitudes and values. Even before

the nutrition education, the respondents already possessed a positive disposition on

nutrition. The nutrition education just strengthened this disposition.

However, the positive attitude possessed by the respondents of this study are true

only for the topics that the attitude items evaluated on the questionnaire, which are

mainly focused to balanced diet and food preparation. The questionnaire failed to assess

topics such as the willingness of mothers to learn about malnutrition and their opinion

when their children are labeled malnourished.

Examining the practice items, the rate in always performing the positive practice in

the questionnaire decreased for all the five items.

Although the participants have increased their knowledge on nutrition, their gain in

information is not translated to better practices. Moreover, the questionnaire in this study

assessed only few items on practices with regards to nutrition and is therefore inadequate.

It is a fact that transformation entails time, and change in practices is difficult but

not impossible.

Difficulty in changing practice is illustrated in the study of Horodynski, et al.

(2004) who examined the low-income caregivers knowledge, attitude, mealtime

practices, and dietary intake before and after a nutritional program. Six months after the


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lessons, no significant change was found; although the perception about feeding their

toddlers differed, knowledge was insufficient to change the eating habits.

On the contrary, overcoming the difficulties, a study undertaken by Yunus, M. et

al., (1996) to increase the intake of vegetables by young children through nutrition

education of their caregivers showed that changes in the feeding practices of young

children were feasible through education and motivation.

Comparing the above studies to this paper in terms of increasing knowledge and

modifying attitude and practices, the inconsistency of the increase in the knowledge and

the poor practice can be attributed to the intervention used and the time that the study was

implemented. This study only lasted for roughly 2 months, with just one intervention in

the form of a lecture implemented only once. The study of Yunus, M., et al (1996) was

conducted for 12 months. The intervention in a form of health education included a

cooking demonstration and was implemented once every 2 months.

The discrepancy between the increase of the mothers knowledge and their

inconsistent practices can also be accounted to their low socioeconomic status. Even if

they have the right knowledge and attitude, their means and purchasing power are

limited. Thus, these knowledge and attitude are not transformed into ideal practices. Ruel

et al (1992) in his study on the effect of maternal nutrition knowledge on the child

nutrition status, reveal that though there was a positive effect of maternal education

knowledge on the childrens weight-for-age, nutrition education for mothers could

contribute to improving childrens growth in households that have access to a minimum

level of resources; for poorer households, nutrition education would not be sufficient.


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CHAPTER VI

CONCLUSION AND RECOMMENDATION

Conclusion

Having gone though the results of the study, it is concluded that there was an

increase in the knowledge of the respondents after the intervention and the result of the

post-test 2 implies that there has been retention of knowledge gained.

The attitude of the respondents on nutrition before the intervention already falls

within the positive spectrum. Only a small increase in the mean scores was noted and this

increase is not significant statistically. Therefore, the attitude of the respondents is

strengthened and remains in the same positive spectrum.

The overall rate in always performing the positive practice on the items on

practices decreased after the nutrition education, validating that knowledge is insufficient

to affect change.

This study achieved to enhance the knowledge of the respondents; it strengthened

the existing attitude. However, it failed to have an effect on the practices of mothers with

under-five undernourished children.

Recommendation

Further studies has to be undertaken in evaluating the factors that affect maternal

knowledge, attitude and practices, thus, the author recommends the following:

Another study done with a better module to better assess the knowledge,

attitude and practices of mothers


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Another study be conducted for a longer period of time to better determine the

retention of knowledge and the improvement of attitude and practices

A study that uses a more reliable tool to evaluate knowledge, attitude and

practices.


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Tada, Y. et al (2002).Nutritional Status of the Preschool Children of the Klong Toey

slum, Bangkok. Edited by Southeast Asian Journal for Tropical MedicinePublic Health.

Torres, R.T. (1979). The Barangay Nutriton Scholar in Action.Edited by Initiatives

Population.

Wardlaw, G.M. (1999). Perspective in Nutrition, 4th

Ed.

Whitney, E.N., et al. (2002). Understanding Normal and Clinical Nutrition, 6thEd.

Yunus, M. et al. (1996). Feeding green vegetables to young children in ruralBangladesh: an analysis of intake following education to caregivers. Edited

by Glimpse, 1996.


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APPENDIX A

QUESTIONNAIRE

Name: __________________________________

Age: _______Religion: _________________________Occupation: ______________________Husbands Occupation: _____________________Income per month: __________________Number of Children: _________Number of persons in the household by age and sex

Age Male Female< 1 yr1 yr 5 yrs6 yrs 14 yrs15 yrs 40 yrs

41 yrs 64 yrs> 65 yrs

Educational Attainment:[ ] Elementary [ ] High School [ ] Vocational [ ] College

KNOWLEDGE

Check the space provided forT if your answer to the statement istrueandF if your answer is false.

T F

1. By the age of four months, solid foods [ ] [ ]may already be given to the child.

2.An infant can depend on breast milk as a single [ ] [ ]source of nourishment from birth up to one year

of life.

3.

It is okay for the child to eat "lugaw" alone until [ ] [ ]one year of age.

4. Malnutrition may leave a child with [ ] [ ]permanent mental disabilities.


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5. Malnutrition may leave a child with [ ] [ ]permanent physical disabilities.

6.

Easy fatigability may be an early symptom [ ] [ ]of malnutrition.

7. The child can be malnourished if he is not eating [ ] [ ]

enough meat.

8. Malnutrition can be prevented or treated. [ ] [ ]

9. Malnourished children are prone to infections. [ ] [ ]

10. Chronic illness can cause malnutrition. [ ] [ ]

11. The nutrients needed by our body cannot be [ ] [ ]provided by just one kind of food.

12.

Protein-rich foods are needed to build and [ ] [ ]repair body tissues.

13.

Rice, corn, bread and root crops are rich in vitamins. [ ] [ ]

14. Vegetables and fruits are rich in protein. [ ] [ ]

15. Taking note of the changes and development of [ ] [ ]children is a good measure of their health.

16.Slow growth and development is one of the signs [ ] [ ]of a malnourished child.

17.

Munggo seeds are rich in protein. [ ] [ ]

18.Eggs are food that gives energy. [ ] [ ]

19.Carbohydrates and fats are energy-giving foods. [ ] [ ]

20.

Vitamins and minerals are body-regulating foods. [ ] [ ]

21.Fish is a good source of protein. [ ] [ ]

22.

Green leafy vegetables are rich in vitamins and minerals. [ ] [ ]

23.

Corn is an energy-giving food. [ ] [ ]

24.Fruits are needed to build up the tissues of the body. [ ] [ ]


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25.Fruits are rich in vitamins and minerals. [ ] [ ]

ATTITUDE

Check the space provided for:SD if you strongly disagree,D if you disagree,A if you agree, andSA if you strongly agreewith the statement.

SD D A SA

1. It is important for mothers to know about [ ] [ ] [ ] [ ]preparing a balanced meal.

2.

When you feed your children with nutritious [ ] [ ] [ ] [ ]food, you can prevent them from getting sick.

3. Preparing a balanced meal which consists [ ] [ ] [ ] [ ]of rice, meat/fish, vegetables and fruits istime consuming.

4. It is practical to grow green leafy vegetables [ ] [ ] [ ] [ ]and fruits in the home garden.

5.

If my child doesnt want to eat vegetables, [ ] [ ] [ ] [ ]then I should not persuade him/her to eat it.

6. It is necessary to keep a growth chart [ ] [ ] [ ] [ ]of ones children.

7.

I feel that there are limited food choices [ ] [ ] [ ] [ ]available in our community.

8.

It is best for growing children to eat their [ ] [ ] [ ] [ ]meals on time.

9.

Nutritious food does not really have to [ ] [ ] [ ] [ ]be expensive.

10.

A good meal rich in nutrients can come [ ] [ ] [ ] [ ]from ones own small garden.


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PRACTICE

Check the space provided forA if you alwaysdo the things in the statement,S if you sometimesdo it andN if you neverdo it.

A S N

1. The meals I cook include fish/meat. [ ] [ ] [ ]

2.

The meals I cook include vegetables. [ ] [ ] [ ]

3. I supervise my children as they eat, making [ ] [ ] [ ]sure that they finish the food served to them.

4.

I buy food products that are fortified with the [ ] [ ] [ ]Sangkap Pinoy seal.

Please give examples of the products you buy._______________________________________

5.

I allow my children to eat some junkfood during [ ] [ ] [ ]meal time.


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APPENDIX B

MGA PANGUTANA

Ngalan: _________________________________

Edad: _______Relihiyon: _________________________Trabaho: ______________________Trabaho sa Bana: _____________________Kita matagbulan: __________________Pila kabuok ang anak: _________Pila ka tawo sulod sa panimalay:

Ngalan Edad Lalaki Babaye

Mga Nahuman sa pag-eskwela:

[ ] Elementarya [ ] High Skul [ ] Vocational [ ] Kolehiyo

KAHIBALO

Tseke ang luna diin ang pulong moha-om:T kon tinoodB kon bakak o dili tinood

T B

7. Pwede na pakaunun ang bata pag-abot niya [ ] [ ]ug 4 ka bulan.

8.Ang gatas sa inahan ay pwede ra nga saligan sa [ ] [ ]sustansya sa puya gikan sa pagkatawo hangtod siya

mag-edad usa ka tuig.

9.

Ang bata pwede mokaon ug lugaw lang hangtod muabot [ ] [ ]siya sa usa ka tuig.


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10.Ang kakulangan sa sustansya o malnutrisyon pwede [ ] [ ]mobilin ug permanenteng kadaut sa utok sa bata.

11.

Ang kakulangan sa sustansya o malnutrisyon pwede [ ] [ ]mobilin ug permanenteng kadaut sa pisikal o panglawassa bata.

12.

Ang daling kapuyon sa lawas, tingali usa sa sayo nga [ ] [ ]sintoma o tilimad-on sa malnutrisyon o kakulangan sasustansya.

7. Ang bata makulangan ug sustansya kon dili siya [ ][ ]

makakaon ug sakto sa kadagahan nga karne.

9.

Ang kakulangan sa sustansya malikayan ug matambalan. [ ] [ ]

9. Ang bata kulang sa sustansya ay madaling [ ] [ ]mataptan ug sakit.

T B10. Ang dugay nga sakit pwede hinungdan sa malnutrisyon. [ ] [ ]

11. Ang sustansya nga gikinahanglan sa atong lawas dili [ ] [ ]makuha sa usa lang ka klase nga pagkaon.

13.Ang pagkaon nga protina kinahanglan sa pundasyon [ ] [ ]

ug pag-ayo sa unod sa lawas.

14. Taas sa bitamina ang mga pagkaon nga humay, mais, [ ] [ ]pan ug salag-on.

14. Mga utanon ug prutas taas ug protina. [ ] [ ]

26.Ang paghikutar ug lista o timaan sa kausahan ug [ ] [ ]pag-uswag sa panglawas sa bata usa ka maayongpaagi sa ilang panglawas.

27.

Hinay ang pagtubo ug pag-uswag, usa kini sa mga [ ] [ ]sintomas sa usa ka batang kulang ug sustansya.

28.Ang liso sa munggo taas sa protina. [ ] [ ]

29.

Ang itlog ay pagkaon nagahatag ug enerhiya. [ ] [ ]

30.Nagahatag ug enerhiya ang mga pagkaon nga [ ] [ ]carbohydrates ug taba.


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31.Ang bitamina ug mineral ay mga pagkaon nagahatag [ ] [ ]ug kondisyon sa lawas.

32.

Ang isda maoy usa ka maayong pagkaon nga [ ] [ ]kakuha-an ug protina.

33.

Ang mga berdeng dahunan nga utanon ay taas sa [ ] [ ]bitamina ug mineral.

34.Ang pagkaon nga mais taas ug enerhiya. [ ] [ ]

35.

Ang mga prutas ay gikinahanglan sa pundasyon sa [ ] [ ]kaunoran sa atong lawas.

36.Ang mga prutas taas ug bitamina ug mineral. [ ] [ ]

BATASAN O KINAIYA

Tseke ang luna sa mga pulong maha-omMB makusganon nga balibadB balibadU uyonMU makusganon nga uyon

MB B U MU

11.

Importante sa inahan mahibalo sa pag-andam sa [ ] [ ] [ ] [ ]balanseng pagkaon.

MB B U MU

12.Kon nagpakaon ka sa imong anak ning [ ] [ ] [ ] [ ]sustansyang pagkaon, malikay nimo sila sapagkasakit.

13.Makalangan sa oras ang pag-andam sa balanseng [ ] [ ] [ ] [ ]pagkaon sama sa lutong humay, karne/isda

utanon ug prutas.

14.Usa ka praktikal nga buhat ang pagtanom sa [ ] [ ] [ ] [ ]garden sa berdeng dahonan nga utanon ug prutas.

15.

Kon ang bata dili ganahan mokaon ug utanon, [ ] [ ] [ ] [ ]dili na lang nako pugson o alam-alaman sapagkaon sa utanon.


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16.Kinahanglan ang paghipos ug pagbaton ug record [ ] [ ] [ ] [ ]sa pagtubo (growth chart) sa bata.

17.

Akong tanawi nga limitado kaklase nga pagkaon [ ] [ ] [ ] [ ]na makuha sa atong komunidad.

18.

Mas maayo na ang nagtubo nga mga bata [ ] [ ] [ ] [ ]makakaon sa tempranong oras.

19.Ang sustansya nga pagkaon dili kinahanglan [ ] [ ] [ ] [ ]mahalon.

20.

Ang eksakto nga pagkaon taas ug sustansya [ ] [ ] [ ] [ ]mahimong magagikan sa kaugalingong gamaynga tanaman o garden.

GINABUHAT

Tseke ang luna diin ang pulong moha-omK kanunay gibuhatT talagsang gibuhatW wala gibuhat

K T W

6. Ang giandam o giluto nako nga pagkaon naa ang [ ] [ ] [ ]isda o karne.

7.

Ang giandam o giluto nako nga pagkaon naay utanon. [ ] [ ] [ ]

8. Akong gibantayan ang akong anak sa pagkaon [ ] [ ] [ ]aron makasiguro ko nga mahurot nila ang pagkaonnga gibutang.

9. Nagpalit ako sa mga pagkaon nga may selyong [ ] [ ] [ ]Sangkap Pinoy.

Palihug ug hatag ug sampol sa gipalit nga pagkaon nga may selyong SangkapPinoy.

_______________________________________

10.

Gitugotan nako ang akong mga bata sa pagkaon nga [ ] [ ] [ ]mga setserya sa tiempong tingkaon.


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APPENDIX C

Module

Learning Objectives

At the end of the module, participants will learn the following:

Definition of nutrition Definition of malnutrition Kinds of Nutrients

Micronutrients Macronutrients

What composes the three basic food groups Body-Building Foods

Body-Regulating Foods Energy-Giving Foods

The importance of a balanced diet Severe Malnutrition Signs of Malnutrition Protein-Energy Malnutrition

Marasmus Kwashiorkor

Obtaining proper nutrition How to prepare nutritious food Preventing Malnutrition

Venue: Multipurpose Hall, Biayon, Sergio Osmea Sr., Zamboanga del Norte

Time Frame: Activity started at 8 am and ended at 12nn. Time allotted forlecture is one hour and thirty minuted

Target Date: November 12, 2004

Target Audience: All mothers with underweight children aged 0 5 years oldof Barangay Biayon, Sergio Osmea Sr., Zamboanga del Norte

Lecturer: Barangay Nutrition Scholar


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TOPIC 1 NUTRITION

KEY MESSAGES

Nutrition is the food we eat and how the body uses this food to keep us healthyand fit. It also means eating the right kind of food that the body need in properamounts.

A person is well-nourished if he eats the right kinds of food in proper amounteveryday.

All the nutrients needed by the body are present in foods. But there is no onefood that can provide for all the nutrients required by the body, a balanced dietcomposing of the three basic food groups is necessary.

The amount of food and nutrients needed by the body varies from person toperson according to his age, sex, and activities.

Proper nutrition is important for:

the development of the brain, especially during the first four years ofthe childs life.

speeding up the growth and development of the body including theformation of teeth and bone

helping in fighting infection and diseases by increasing bodyresistance

fast recovery from illness

STEPS1.

Ask participants of their own concept of kinds of nutrients.2.

Pick out the important key words from their answers and provide the correctanswers.


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TOPIC 2 Kinds of Nutrients

KEY MESSAGE

Nutrients are components of food that gives the body heat and energy; it keepsthe body strong and healthy and makes us glow with health.

Two Kinds of Nutrients

Macronutrients these are nutrients that are needed for growth.It supplies the body with energy. An ample amount of thesenutrients are needed by the body.

E.g. Meat, fish, eggs, milk, oil, margarine, rice, bread, root crops

Micronutrients these are nutrients that are important fro thedevelopment of the body and these nutrients aids in bodily

processes. The body needs only a small amount of thesenutrients.

E.g. green leafy vegetables, fruitsSTEPS

1. Ask participants of their own concept of kinds of nutrients.2. Pick out the important key words from their answers and provide the correct

answers.

TOPIC 3 What are the Three (3) Kinds of Food Groups?

KEY MESSAGES

Foods which contain similar nutrients are grouped together as guide for mealplanning and good nutrition. The three (3) food groups are the following:

1.

Body-Building Foods (Proteins)

These foods are rich in protein. These build and repair body tissues forgrowth and maintenance, develop body resistance to infections, andsupply additional energy.

Examples: meat, milk and milk products, chicken, legumes, eggs, nuts, fish andother sea foods.

2. Body-Regulating Foods (Vitamins and Minerals)

These foods are rich in vitamins and minerals. These help our bodieswork properly by regulating body processes such as digestion andabsorption of food, excretion of waste matter, respiration and circulation.

Examples: all kinds of vegetables and fruits

3. Energy-Giving Foods (Carbohydrates and Fats)


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These foods are rich in carbohydrates and fats. These are the bodysmain source of energy.

Examples: rice, corn, bread, root crops (camote, gabi), sweet foods, fats and oils

STEPS

1.

Give a lecturette using the reference poster on the 3 Basic Food Groups asvisual aid.

2. Solicit participation by involving participants in the discussion.

TOPIC 4 Balanced Diet and its Importance

KEY MESSAGES

A balanced diet is eating the right combination of foods in proper amounts. It

has all of the nutrients the body needs to function well. It also means propernutrition.

All nutrients needed by the body are available in food. All persons need the samekind of nutrients, but in varying amounts, depending on their age, sex, and typeof activity or work.

The body needs different kinds of nutritious food everyday because no singlefood can give all nutrients needed for health. Some foods have more of certainnutrients than others. Eating a balanced diet from a wide variety of foodseveryday gives you more chance of getting all the nutrients your body needs.

Eating a balanced diet every day is important because:

1. It helps in the development of the brain especially during the first fouryears of the childs life.

2.

It hastens the growth and development of the body, including theformation of teeth and bones.

3. It helps fight off infection and diseases by increasing resistance.4. It speeds up recovery from illness.5. It enables a person to work better.

STEPS

1. Ask participants on their concept of balanced diet and its importance.2.

Write answers on the board.3.

Give a lecturette on what a balanced diet is by using the three (3) basic foodgroups poster as visual aid. Reconcile their answers with the correctinformation from the lecturette.


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TOPIC 5 What is Food Security and Why is it Important?

KEY MESSAGES

Food security means that food is available and can be acquired by all householdsat all times for a healthy life. Food must not only be available but also accessible,meaning the family has enough resources to buy and the price of the food isaffordable.

Household food security is important for adequate and regular intake ofnutritious food for good health. To prevent malnutrition and other nutritionaldisorders which may occur anytime among the vulnerable members of thehousehold especially young children, household food security must be ensured.

STEPS

3.

Ask participants of their own concept of food security and why it is important.4.

Pick out the important key words from their answers and provide the correctanswers.

TOPIC 6 What are the Essential Food Items that must be Available andAccessible at all times?

KEY MESSAGE

The essential foods that must be available and accessible in the household and inthe community to ensure good nutrition are:

1. Energy-Giving Foods- rice or corn, root crops-

edible oil

2.

Body-Building Foods- fish, beans, poultry/eggs or meat

3.

Body-Regulating Foods-

dark green, leafy and/or yellow vegetables-

yellow fruits or other fruits

STEP

Show a poster of the three basic food groups. Ask the participants to nameessential food items among the first group of energy-giving foods that must be presentin the home and the community at all times. Do likewise for the body-building and body-regulating foods.


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TOPIC 7 Malnutrition

KEY MESSAGE

Malnutrition is a condition that results when the body gets either too much or toolittle amount of nutrients due in part of not eating the right kinds of food needed forproper growth and development.

STEPS

1. Ask participants of their own concept of malnutrition.2. Pick out the important key words from their answers and provide the correct

answer.

TOPIC 8 What is Protein-Energy Malnutrition (PEM)?

KEY MESSAGES

It is a nutritional problem that results from a deficiency of protein and/or ofenergy.

Protein-deficiency means that body-building foods such as meat, fish, poultry,eggs, milk and beans are lacking in the diet.

Energy or calorie-deficiency means a lack of calories from the total food intake,that is, the child simply does not have enough protein, carbohydrate, andespecially fats and oils in his food intake.

There are 2 kinds of severe PEM:

1. Marasmus

This child does not get enough amount and the right kind of food, especiallyenergy foods. He is said to have marasmus. In other words, he is starved.His body is small, and muscle wasted. He is a little more than skin andbones. This child needs more food especially energy foods.

Face of an old man

Markedly underweightWasted muscles and fats

2. Kwashiorkor

This child has not been eating enough body-building foods, or proteins,although he may be getting enough energy foods. He is said to have


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kwashiorkor. Edema is present in lower legs, hands and face. Although hemake look somewhat fat, he has very little muscle left. He is little more thanskin, bones and water. This child needs more foods rich in protein.

ApathyMoon faceEdema on hands and feet

Not all severely underweight child will automatically manifestmarasmus and kwashiorkor. These two conditions are the extremes ofsevere malnutrition, meaning that malnutrition has been allowed togo on for a long time. Only 2-3% of severely underweight childrenmay have marasmus. Only 1% of severely underweight children havekwashiorkor.

All children with marasmus and kwashiorkor are severelyunderweight. Although the edema of kwashiorkor may add to the

patients weight, the child is still severely underweight, or at bestmoderately underweight.

Marasmus and kwashiorkor with complications (e.g. diarrhea, measlesor ARI) should b referred to the hospital.

STEPS1.

Ask participants to define Protein-Energy Malnutrition.2. Write down key messages.3. Compare their answers with the definition above and supply missing ideas.4. Show the 2 kinds of severe PEM.

TOPIC 9 What are the causes of PEM?

KEY MESSAGE

There are two immediate causes on malnutrition: inadequate food intake andillness.

The underlying factors in malnutrition are:

1.

Inefficient food security due to lack of home-food production, low food

availability in the community, low purchasing power, and low income.Inadequate maternal and child health care such as mothers not practicingbreastfeeding, preschoolers without growth charts, 9 12 months infantsnot fully immunized, etc.

2.

Insufficient health services and unhealthy environment such as lack ofpotable water supply, no sanitary toilets, etc.


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STEPS

1. Ask participants to name possible causes of malnutrition.2. Write down key phrases.3. After a few have given their answers, give them a short lecture on the

immediate causes of malnutrition.4. Emphasize that these two are the immediate causes of malnutrition. The other

causes they have cited either contribute to or result in these immediatecauses.

5. Ask them to recite the 2 immediate causes of PEM.

TOPIC 10 SIGNS AND SYMPTOMS OF MALNUTRITION

How will you recognize if your child or any member of the family is sufferingfrom malnutrition?

Take note of the following:

Under weight or over weight for his age Decrease appetite Weakness and easy fatigability Is not sleeping well Pale Stomatitis Night blindness

STEPS

1. Ask participants of their own concept of the signs and symptoms ofmalnutrition.

2. Pick out the important key words from their answers and provide the correctanswers.

TOPIC 11 PLANNING AND PREPARING NUTRITIOUS FOOD FOR THEFAMILY

One-dish Meals

KEY MESSAGE

One-dish meals are not only nutritious but are also cheaper in buying orpreparing separate meat and vegetable dishes especially with a limited foodbudget.


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Examples of one-dish meals are nilaga, sinigang, pinakbet, tinola or dinengdeng.These are called one-dish meals because the recipes include food items fromeach of the 3 food groups. Eaten with rice, these recipes make a complete meal.

STEPS

1.

Continue with the lecture by discussing one-dish meals.2. Ask participants to give examples of one-dish meals.

Proper Preparation of Food

The right choice, preparation, cooking, serving and storage of food can affect itsnutritional content.

Processes of preparing food:

Choice Make sure that you only buy fresh fish, meat, fruits and

vegetables. Food that is in season is cheaper. Nutritious food does not really have to be expensive.

Preparation Use running water to wash fruits and vegetables before peeling

and slicing. Wash rice once or twice to wash out dust and dirt. Do not over wash the rice for this will take away its nutrients.

Cooking In cooking vegetable, cover the pot to preserve its nutritional

value. Do not overcook.

Serving Serve the food right after it is cooked. Left-over food which is not yet spoiled should be reheated before

serving.

Storage Cover left-over food so as not to attract housefly, cockroach and

rats.


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TOPIC 12 HOW TO PREVENT MALNUTRITION

KEY MESSAGES

The health and nutrition of your family can be maintained through the followingways:

Variety

Prepare a variety of meals or recipes for your family everyday using thedifferent kinds of food composing the three basic food groups.

Different kinds of vegetables can also be grown in your own small gardenat home.

Breastfeeding and Introduction of Solid Foods

Breast milk is still the most appropriate milk and the best food for babies.It provides nutrients and energy needed by babies. Solid foods areintroduced at age 4 6 months. It supplies the baby with the nutrientsfor his growing needs.

Micronutrient Supplementation

Avail of Vitamin A, iron and iodine supplements at the health center atyour place.

Food Fortification

Buy foods that are enriched and fortified with the Sangkap Pinoy seal.These foods are ensured to contain nutrients at right amount.

Learn More about Nutrition

Learn more about nutrition by attending parents classes conducted bythe different agencies (DSWD, Barangay Health Center, etc.) in yourplace. Being more knowledgeable about proper nutrition means betterhealth for your family.

Other Health Services

Visit the Barangay health center for regular check up consultation

the effect of a nutrition education module

Documents