DATA GATHERING INSTRUMENT

Dear Respondent:

This questionnaire is intended to determine the knowledge level of primary caregivers

about nutrition. You are in the best position to supply the needed data.

In this regard, we would to request you to answer the questions as truthfully and
sincerely as possible. Please do not leave any item unanswered. Furthermore, the researchers
will measure the child’s height and weight.

Any information will be treated with utmost confidentiality.

Thank you very much.

I. Personal Information

Name (Initials):__________
Age (Years):__________
Civil Status:__________
Highest Educational Attainment:_______________
Employment Status: Employed_____ Unemployed_____ Self-employed_____
Monthly Household Income: 7000 and below____

II. ANTHROPOMETRIC MEASUREMENT ( 2-5-YEAR OLD CHILDREN)

Age(as of last birthday):______
Height(in centimeters):______
Weight(in kilograms):________

III. TRUE or FALSE.DIRECTION: Please place a check in the column that corresponds to your
answer. Do not leave any item unanswered.

TRUE – if the statement is correct

FALSE – if the statement is incorrect

1st PART Food Classification

TRUE FALSE
1. Children need less protein in their diet than adults.

2. A low percentage of fats are recommended in the diet

of children.

3. Calcium helps in bone strengthening and teeth

formation in children.

4. Increase intake in protein rich food will protect the child

against infection.

5. Fruits and vegetables are rich in vitamins and minerals.

6. Children need less protein in their diet than adults.

7. Rice is an energy-giving food.

8. Grow foods or body-building foods build and repair

body tissues, which enable children to grow and
develop strong muscles and bones.
9. Vegetables do not increase body resistance to infection
and disease.

10. Carbohydrates or energy-giving foods are obtained

primarily from plant foods.

11. Vitamin content is usually highest in fresh foods that are

consumed quickly after minimal exposure to heat, air or
water.
12. Legumes such as black-eyed peas, beans, peanut and
chickpeas are sources of plant protein.

13. Milk, cheese and yogurt are not good sources of

calcium

14. 14. Starchy foods (rice, pasta, root crops, and bread) are
rich in carbohydrates.

15. 15. Green and yellow vegetables, and, deep orange

fruits and vegetables are rich in vitamin B1.
2ND PART Food Handling and Preparation

TRUE FALSE
1. Planning meals that contain all the Essential nutrients
is the first step toward a nutritionally adequate dietary
intake.
2. Cooking can destroy harmful microorganisms in food.

3. Overcooking of food has no effect on its nutrient value.

4. Frozen meat must be kept frozen until ready to use.

5. It is okay not to wash hands during food preparation

because heat from cooking will kill the microorganisms.

6. Tasting of suspected spoiled food is acceptable.

7. The way I handle food does not affect my health

outcome.

8. Perishable foods can be left out of the refrigerator for

more than 2 hours.

9. Attention should be focused on vitamin and mineral

losses during food preparation and services.

10. Cook just enough quantity with some safety allowance

to avoid storing any leftovers

11. A nutritious breakfast is a central feature of a child’s

diet that supports healthy growth and development.

12. Encourage the child to sit when eating – choking is

more likely when children are running or reclining.

13. Always begin food preparation by washing your hands.

Wash your hands with hot soapy water after any
activity in which your hands could have picked up
germs.
14. Milk consumption answers the child’s requirements for
calcium, protein and the B vitamins – nutrients that are
important for a child’s growth.
15. Use clean utensils and keep food away from flies and
insects.
3rd PART Common Deficiencies/Problems Related to Nutrition

TRUE FALSE
1. Insufficient intake of vitamins and minerals can cause
impaired growth and deficiency diseases .

2. Deficiency in iron can cause anemia.

3. Vitamin K deficiency can promote hemorrhage.

4. Vitamin A helps in the prevention of night blindness.

5. 5. Deficiency in Vitamin D cannot cause softening of the

bones.

6. Undernutrition is a pathological state resulting from

the consumption of inadequate quantity of food over
an extended period of time.
7. Marasmus is mainly due to inadequate calorie intake
and improper feeding practices.

8. Kwashiorkor is due to proper intake of good quality

proteins.

9. Anemia occurs because there is deficient protein

intake.

10. Obesity occurs when the energy intake exceeds the

body’s energy requirement for physical activity and
growth resulting to accumulation of fat stored as
adipose tissue.