1

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





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



2
APPROVAL SHEET


This research entitled THE EFFECT OF A NUTRITION EDUCATION
MODULE ON THE KNOWLEDGE, ATTITUDE AND PRACTICES OF
MOTHERS WITH UNDERNOURISHED CHILDREN AGED 0 5 YEARS OLD
IN BARANGAY BIAYON, SERGIO OSMEA SR., ZAMBOANGA DEL
NORTE, prepared and submitted by Dulce Amor A. Dagalea, in partial fulfillment of
the 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. Soriano
Member Member




ACCEPTED in partial fulfillment of the requirements for the degree of DOCTOR OF
MEDICINE.



__________________
Dr. Mario R. Arciaga
Associate Dean for Research
Ateneo de Zamboanga University
School of Medicine

i
3
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.





4


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

5

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












6
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.
7
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.
8
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.
10
Conceptual Framework














Figure 1. Conceptual Framework

With poor maternal knowledge, attitude and practices on nutrition, this study seeks
to intervene with a nutrition education and evaluate its effect on the maternal knowledge,
attitude, and practices on nutrition after the intervention.




Poor maternal knowledge, attitude
and practices on nutrition

Nutrition
Education
Effect on maternal knowledge,
attitude & practices on nutrition
No improvement on maternal
knowledge, attitude & practices
on nutrition
Improvement on maternal
knowledge, attitude & practices on
nutrition
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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.
12
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
14
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
15
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.
16
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
18
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,
19
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.

20
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.
21
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.
22
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 Treatment

For 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.



23
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 years

Number

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.

24
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 Comparison

Mean
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


25
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.





26
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-
Intervention
Post-
intervention

p-value
It is important for mothers to know about preparing
a balanced meal.

Strongly Agree = 4 Strongly Disagree = 1

3.29

3.29

1.000
It is best for growing children to eat their meals on
time.

Strongly Agree = 4 Strongly Disagree = 1

3.29

3.29

1.000
A good meal rich in nutrients can come
from ones small garden.

Strongly Agree = 4 Strongly Disagree = 1

3.29

3.29

1.000
I feel that there are limited food choices available in
our community.

Strongly Agree = 4 Strongly Disagree = 1

2.71

2.51

0.292
Nutritious food does not really have to be expensive.

Strongly Agree = 4 Strongly Disagree = 1

2.77

3.06

0.169
*significant at p-value <0.05










27
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 Items
Pre-
intervention
Post-
Intervention

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

Strongly Agree = 4 Strongly Disagree = 1

3.00


3.34

0.123
Preparing a balanced meal which consists of rice,
meat/fish, vegetables and fruits is time consuming.

Strongly Agree = 1 Strongly Disagree = 4

2.83

2.86

0.895
It is practical to grow green leafy vegetables and fruits
in the home garden.

Strongly Agree = 4 Strongly Disagree = 1

3.14

3.20

0.744
If my child doesnt want to eat vegetables, then I
should not persuade him/her to eat it.

Strongly Agree = 1 Strongly Disagree = 4

2.34

2.69

0.116
It is necessary to keep a growth chart of ones children.

Strongly Agree = 4 Strongly Disagree = 1

2.83

3.14

0.086
*significant at p-value <0.05




























28
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.
29
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.













30
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
Agree
Disagree
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 with
nutritious food, you can prevent them
from getting sick.

Strongly Agree = 4; Strongly Disagree = 1
Strongly Agree
Agree
Disagree
Strongly 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 which
consists of rice, meat/fish,
vegetables and fruits is time
consuming.

Strongly Agree= 1; Strongly Disagree = 4
Strongly Agree
Agree
Disagree
Strongly Disagree
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 leafy
vegetables and fruits in the home
garden.

Strongly Agree = 4; Strongly Disagree = 1
Strongly Agree
Agree
Disagree
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 eat
vegetables, then I should not
persuade him/her to eat it.

Strongly Agree = 1; Strongly Disagree = 4
Strongly Agree
Agree
Disagree
Strongly Disagree

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 Agree = 4; Strongly Disagree = 1
Strongly Agree
Agree
Disagree
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 food
choices available in our community.

Strongly Agree = 4; Strongly Disagree = 1
Strongly Agree
Agree
Disagree
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 eat
their meals on time.

Strongly Agree = 4; Strongly Disagree = 1
Strongly Agree
Agree
Disagree
Strongly Disagree
16 (45.7%)
16 (45.7%)
0
3 (8.6%)
14 (40%)
19 (54.3%)
0
2 (5.7%)
9. Nutritious food does not really have
to be expensive.

Strongly Agree = 4; Strongly Disagree = 1
Strongly Agree
Agree
Disagree
Strongly Disagree
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 can
come from ones small garden.

Strongly Agree = 4; Strongly Disagree = 1
Strongly Agree
Agree
Disagree
Strongly Disagree
16 (45.7%)
16 (45.7%)
0
3 (8.6%)
14 (40%)
18 (51.4%)
2 (5.7%)
1 (2.9%)


31
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 Responses
N = 35
Practice Items Frequency Pre-test Post-test 2

P value
1. 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
*significant at p-value <0.05
Before the intervention, 4 (11.4%) of the respondents said that the meals they cook
include fish/meat and the rest, 31(88.6%) answered that they only do this sometimes.
Later, only 2 (5.7%) of the participants always cook meals that include fish/meat, the
others, 32 (91.4%) only do this sometimes; 1 (2.9%) even never cooks a meal with
fish/meat.
Thirty one (88.6%) of the respondents always prepare meals that include
vegetables, 4 (11.4%) prepares vegetable meals only sometimes before the intervention.
32
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%).
33
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
34
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 lugaw alone; 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
35
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
36
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.

37
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
38
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.



















39
BIBLIOGRAPHY

Bligh, D.A. (2000). Whats the Use of Lectures? 1
st
Ed.

Cabatbat, A. M. M. (2000) Knowledge, Attitude and Practices of Mothers on Nutrition
and their Relationship with the Nutritional Status of their Children aged 0
6 years in Barangay Dumalinao, Zamboanga del Sur.

Cataldo, et al. (1998). Understanding Clinical Nutrition. 2
nd
Ed.

Del Mundo, F. et al. (1990).Growth and Development. Textbook of Pediatrics and Child
Health, 3
rd
Ed. JMC Press, Inc.

DOH (1991). Community Based Planning and Management of Nutrition Program.
Rural Health Unit Trainers Guide. Nutrition Service.

Eschleman, M.M. (1991) Introductory Nutrition and Diet Therapy.

Friedrich, J. (1997). The integrated Rural Nutrition Project, Kwambwa, Zambia: Success
of a Nutrition Education Programme. SCN News.

Gupta, M.C., et al. (1991). Relation of Childhood Malnutrition to Parental Education and
Mothers Nutrition related on Knowledge, Attitude, and Practices. New
Delhi: Human Nutrition Unit, India Institute of Medical Sciences.

Horodynski, M.A., et al. (2004). Nutrition Education aimed at toddlers: A pilot program
for rural, low-income families. Edited by Family Community Health.

King, F., and Burgess.A. (1993). Nutrition for developing countries. 2
nd
Ed.

Mancenido, E. (2000). Knowledge, Attitude and Practices on Nutrition of Caretakers of
Undernourished Under-Five Children: An Interventional Study by Trained
Barangay Health Workers in Barangay Militar.

Mcnaughton, E. (2000). Nutrition Intervention Programs: Pitfalls and Potentials. Ceres.

Niciforovic-Surkovic, O. et al (2002). Knowledge on Nutrition and Nutritional Behavior
of School Children and their Parents in Vojvodina. Med Pregl.

Ruel, M.T., et al (1992). The Mediating Effect of Maternal Nutrition Knowledge on the
Association between Maternal Schooling and Child Nutritional Status in
Lesotho. Edited by American Journal Epidemiology.



40
Tada, Y. et al (2002). Nutritional Status of the Preschool Children of the Klong Toey
slum, Bangkok. Edited by Southeast Asian Journal for Tropical Medicine
Public Health.

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

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

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

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
































41
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 yr
1 yr 5 yrs
6 yrs 14 yrs
15 yrs 40 yrs
41 yrs 64 yrs
> 65 yrs

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



KNOWLEDGE

Check the space provided for
T if your answer to the statement is true and
F 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.
42

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. [ ] [ ]

43
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, and
SA if you strongly agree with 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 is
time 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.



44





PRACTICE

Check the space provided for
A if you always do the things in the statement,
S if you sometimes do it and
N if you never do 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.

















45
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 tinood
B 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.
46

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

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 B
10. 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 maayong
paagi 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.
47

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-om
MB makusganon nga balibad
B balibad
U uyon
MU 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 sa
pagkasakit.

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 sa
pagkaon sa utanon.
48

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 gamay
nga tanaman o garden.

GINABUHAT

Tseke ang luna diin ang pulong moha-om
K kanunay gibuhat
T talagsang gibuhat
W 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 pagkaon
nga gibutang.

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

Palihug ug hatag ug sampol sa gipalit nga pagkaon nga may selyong Sangkap
Pinoy.
_______________________________________

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




49
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 for
lecture is one hour and thirty minuted

Target Date: November 12, 2004

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

Lecturer: Barangay Nutrition Scholar






50
TOPIC 1 NUTRITION
KEY MESSAGES
Nutrition is the food we eat and how the body uses this food to keep us healthy
and fit. It also means eating the right kind of food that the body need in proper
amounts.

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

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

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

Proper nutrition is important for:

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

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

helping in fighting infection and diseases by increasing body
resistance

fast recovery from illness

STEPS
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.













51
TOPIC 2 Kinds of Nutrients

KEY MESSAGE

Nutrients are components of food that gives the body heat and energy; it keeps
the 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 these
nutrients 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 the
development of the body and these nutrients aids in bodily
processes. The body needs only a small amount of these
nutrients.
E.g. green leafy vegetables, fruits
STEPS
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 meal
planning 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 for
growth and maintenance, develop body resistance to infections, and
supply additional energy.
Examples: meat, milk and milk products, chicken, legumes, eggs, nuts, fish and
other sea foods.

2. Body-Regulating Foods (Vitamins and Minerals)

These foods are rich in vitamins and minerals. These help our bodies
work properly by regulating body processes such as digestion and
absorption of food, excretion of waste matter, respiration and circulation.
Examples: all kinds of vegetables and fruits

3. Energy-Giving Foods (Carbohydrates and Fats)
52
These foods are rich in carbohydrates and fats. These are the bodys
main 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 as
visual 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 proper
nutrition.

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

The body needs different kinds of nutritious food everyday because no single
food can give all nutrients needed for health. Some foods have more of certain
nutrients than others. Eating a balanced diet from a wide variety of foods
everyday 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 four
years of the childs life.
2. It hastens the growth and development of the body, including the
formation 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 food
groups poster as visual aid. Reconcile their answers with the correct
information from the lecturette.

53
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 households
at 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 is
affordable.

Household food security is important for adequate and regular intake of
nutritious food for good health. To prevent malnutrition and other nutritional
disorders which may occur anytime among the vulnerable members of the
household 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 correct
answers.


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

KEY MESSAGE

The essential foods that must be available and accessible in the household and in
the 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 name
essential food items among the first group of energy-giving foods that must be present
in the home and the community at all times. Do likewise for the body-building and body-
regulating foods.


54
TOPIC 7 Malnutrition

KEY MESSAGE

Malnutrition is a condition that results when the body gets either too much or too
little amount of nutrients due in part of not eating the right kinds of food needed for
proper 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 of
energy.

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, and
especially 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, especially
energy 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 and
bones. This child needs more food especially energy foods.


Face of an old man
Markedly underweight
Wasted 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
55
kwashiorkor. Edema is present in lower legs, hands and face. Although he
make look somewhat fat, he has very little muscle left. He is little more than
skin, bones and water. This child needs more foods rich in protein.

Apathy
Moon face
Edema on hands and feet

Not all severely underweight child will automatically manifest
marasmus and kwashiorkor. These two conditions are the extremes of
severe malnutrition, meaning that malnutrition has been allowed to
go on for a long time. Only 2-3% of severely underweight children
may have marasmus. Only 1% of severely underweight children have
kwashiorkor.

All children with marasmus and kwashiorkor are severely
underweight. Although the edema of kwashiorkor may add to the
patients weight, the child is still severely underweight, or at best
moderately underweight.

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

STEPS
1. 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 and
illness.

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 practicing
breastfeeding, preschoolers without growth charts, 9 12 months infants
not fully immunized, etc.
2. Insufficient health services and unhealthy environment such as lack of
potable water supply, no sanitary toilets, etc.


56
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 immediate
causes.
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 suffering
from 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 of
malnutrition.
2. Pick out the important key words from their answers and provide the correct
answers.


TOPIC 11 PLANNING AND PREPARING NUTRITIOUS FOOD FOR THE
FAMILY


One-dish Meals

KEY MESSAGE

One-dish meals are not only nutritious but are also cheaper in buying or
preparing separate meat and vegetable dishes especially with a limited food
budget.

57
Examples of one-dish meals are nilaga, sinigang, pinakbet, tinola or dinengdeng.
These are called one-dish meals because the recipes include food items from
each 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 its
nutritional 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.







58
TOPIC 12 HOW TO PREVENT MALNUTRITION

KEY MESSAGES

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

Variety

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

Different kinds of vegetables can also be grown in your own small garden
at 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 are
introduced at age 4 6 months. It supplies the baby with the nutrients
for his growing needs.


Micronutrient Supplementation

Avail of Vitamin A, iron and iodine supplements at the health center at
your 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 by
the different agencies (DSWD, Barangay Health Center, etc.) in your
place. Being more knowledgeable about proper nutrition means better
health for your family.

Other Health Services

Visit the Barangay health center for regular check up, consultation,
weighing of children and immunization.