Output 1 TITLE Comparison of Malnutrition among Institutionalized and Street Children as determined by Body Mass Index THESIS STATEMENT

The prevalence of malnutrition is generally higher in street children compared to institutionalized children. General Objectives -To be able to compare the prevalence of malnutrition among the street children and institutionalized children Specific Objectives -To be able to measure the body mass index of street children and institutionalized children as determinant in malnutrition -To be able to determine the frequency of malnutrition among street children

-To be able to determine the frequency of malnutrition among institutionalized children -To be able to identify causes of malnutrition among street children and institutionalized children -To be able to determine the interrelationship of nutritional status with social conditions among street children and institutionalized children Research Questions -How does the economic status influence the frequency of Malnutrition? -How does absence and presence of parents influence frequency of Malnutrition among street children and institutionalized children?

Output 2 Review of Related Literature

About 20 million children under five worldwide are severely malnourished, which leaves them more vulnerable to illness and early death. Nearly 10 million children under the age of five die every year , more than 1000 every hour. (WHO, 2007). Almost all of these children could survive and thrive with access to simple, affordable interventions. The loss of a child is a tragedy, families suffer and human potential is wasted. WHO is improving child health by helping countries to deliver integrated, effective care in a continuum, starting with a healthy pregnancy for the mother, through birth and care up to five years of age. Investing in health systems is key to delivering this essential care. A survey of street children from Manila, the Philippines, identified two factors that are strongly correlated with malnutrition in this population: drug use and non-attendance at school. About 30% of Manila's 50,000-75,000 street children are estimated to be moderately or severely malnourished. According to international standards, both male and female were seriously underweight (lowest 8%) and underheight (lowest 2.5%). Children who were in school and did not use drugs showed the highest mean weight, while those who were out of school and using drugs had the lowest mean weight; children with one of these risks factors occupied an intermediate position. About half the street children reported regular drug use, primarily glue sniffing. It is recommended that programs currently serving Filipino street children assess the barriers to participation (e.g., policies against drug use) by high-risk children and pilot projects to train social workers and street educators in substance abuse counseling. The effectiveness of

such interventions would be enhanced by a detailed study of the various gangs and syndicates of children in Manila. Malnutrition and Social Status Malnutrition has long been recognized as a consequence of poverty. It is widely accepted that higher rates of malnutrition will be found in areas with chronic widespread poverty (ADB, 2001). Malnutrition is the result of marginal dietary intake compounded by infection. In turn, marginal dietary intake is caused by household food insecurity, lack of clean water, lack of knowledge on good sanitation, and lack of alternative sources of income. It is also compounded by, inadequate care, gender inequality, poor health services, and poor environment. While income is not the sum of total of people's lives, health status as reflects by level of malnutrition is. Meeting primary health care needs and the nutritional requirements of children are fundamental to the achievement of sustainable development. In the United Kingdom and a number of Western European countries about half their economic growth achieved between 1790 and 1980 has been attributed to better nutrition and improved health and sanitation conditions (Fugel, 1994) Malnutriton in childhood is known to have important long-term effects on the work capacity and intellectual performance of adults. Health consequences of inadequate nutrition are enormous. It was estimated that nearly 30% of infants, children, adolescents, adults and elderly in the developing world are suffering from one or more of the multiple forms of malnutrition, 49% of the 10 million deaths among children less than 5 years old each year in the developing

world are associated with malnutrition, another 51% of them associated with infections and other causes (WHO, 1999). Recent studies have also pointed out that women who were malnourished as children are more likely to give birth to low birth-weight children and thus there is an intergenerational effect of child malnutrition. Measures of child nutritional status can help capture aspects of welfare, such as distribution within the household which are not adequately reflected in other indicators. Child malnutrition standards are applicable across cultures and ethnicities. Studies show that the relationship between child nutritional status and poverty is strong at the lower end of the income range. (U.N. ACC/SCN, 1992). An IFPRI Study in 2000 drawn from the experience of 63 developing countries over this 25- year period on determinants of child malnutrition across different regions found four strong determinants to child malnutrition. The four, ranked by their strength of impact, are women's education, national food availability, womens status relative to men's, and health environment quality (Smith and Haddad, 2000). With all of the above consideration, child malnutrition appears as a highly conceptually relevant candidate for a poverty indicator. The following sections further evaluate other qualifications of child malnutrition as a poverty indicator. Malnutrition among Filipino Children In the Philippines poverty and pervasive malnutrition are not limited to families of deprived seasonal workers. Undernourishment is endemic and increasing throughout most of this archipelago of some 7107 islands, and is compounded by the prevalence of intestinal parasites and gastrointestinal diseases which health workers estimate deprive youngsters of at least 5-10% of the nutritional value in food they do consume. This problem is particularly prevalent in rural

villages and city slums where many people eat with their fingers. Philippine National Nutiriton Survey provides benchmarks to gauge the countrys progress toward achieving the Millennium Development Goals, including the eradication of hunger, reduction of child mortality and improvement of maternal health. Underweight and under height are two of the issues the 2008 NNS looked into childrens nutrition. It was found out that the number of Filipino children who were underweight and underheight or stunted increased from 2005 to 2008. The prevalence of underweight children aged 0-5 years increased from 24.6 percent to 26.2 percent, about 3.35 million children. The underheight rate increased from 26.3 percent to 27.9 percent, representing 3.57 million children. There was also a significant increase in the prevalence of underweight children aged 6-10 years from 22.8 percent in 2005 to 25.6 percent in 2008, equivalent to 2.6 million. The number of underheight children in this age group likewise increased from 32 percent to 33.1 percent. A very high level of acute malnutrition among preschoolers (aged 0-5) was noted in six regions, namely Mimaropa, Bicol, Western Visayas, Eastern Visayas, Zamboanga Peninsula and Soccsksargen where the underweight-for-age prevalence was at least 30 percent. Chronic malnutrition affected a very high percentage of preschoolers in the provinces of Masbate, Biliran, Northern Samar, Western Samar, Zamboanga Sibugay, Sarangani, Abra and Mountain Province. According to the Philippine Ministry of Health (2009), nearly 1/2 of all reported deaths are among infants and children through age 4, and about 1/2 of the accelerated death rate among those age 5 and younger is related to malnutrition, compounded by diarrhea, measles, and malaria which is returning to areas where it once was almost eradicated. 3 factors critically affect

a newborn's survival prospects: the family size he or she is born into; the time or spacing between the mother's pregnancies; and the child's birth order. Malnutrition is not a hidden problem. The government, almost since the proclamation of 1972 martial law, has campaigned against malnutrition. During the 1970s, the government developed a major program of expanded production with the result that rice production expanded substantially. Even this achievement leaves the average Filipino short by 300 calories of food intake per day. It is not jiggering with food aid or government price incentives that will assure that future Filipinos will have enough to eat. Only a productive revolution of rural life that also educates mothers to know what makes for sound family nutrition will be adequate. Street Children Classification In the Philippines, there are three types of children roaming in the street. Children on the Streets, described as children working on the streets but have homes to return to. Children of the Street, described as children living on the street and Completely Abandoned Children who are entirely responsible for their own physical and psychological survival (Pineda, 1998). Children on the Streets make up approximately 75% of the street children in the Philippines, while Children of the Street and Completely Abandoned Children make up 25-30% and 5-10%, respectively, of the approximate total of street children, which was estimated to be 1.5 million as of 1998. Around 70% of these street children are boys. Most of these children roam the streets to beg for money or food, aside from the fact that some of them just do not have a roof over their heads. And this is a significant and pressing problem that the Philippines is facing. In the streets, these children face a lot of challenges that can affect their health, mental, and psychological well-being. In the streets, they are prone to drugs and sexual abuse. They are also exposed to life-

threatening situations, like being hit by speeding vehicles. There are government-funded and privately-owned institutions that help fight against this vital situation, however, some of the children run away from these shelters because there is not enough funding that will support each childs basic needs like food and clothing. And worse, some institutions refuse to accept more children because of lack of beds to sleep on. Government-funded and privately-owned institutions do receive external help from those who care and want to share, but these supports are always never enough to sustain everyone with the growing number of homeless children. Childrens centers are trying their best to keep these children off the streets by providing them with education, teaching them life skills to survive in the real world outside (when the right time comes), and much importantly, values. However, these programs cannot be truly fulfilled if basic necessities of these children are not also met. If only more people would want to share their blessings, it would definitely help these institutions fight against adversities within their walls. Children in the Institution and Malnutrition Orphans represent an important sector in any society, because they are mostly children in crucial phases of physical and mental growth, so they need special nutritional and health care with guidance. A study of (Terwaki, 1999) found that the nutritional status of orphans in Sana'a was miserable, especially when it was compared with that of orphans in different countries. Some 75 percent of the children were found to be underweight, and 37 percent severely so. The prevalence of wasting, which indicates acute or current malnutrition was 27 percent. Some 12 percent of children suffered from moderate or severe wasting. Some 74 percent of children suffered from stunted growth, and 40 percent were moderately or severely stunted.

All of these percents were mainly higher in the Al-Aitam orphanage, and boys were particularly affected. The study also found that 12 percent of orphans were anemic. The percentage was higher in boys, at 13 percent, whereas only 8 percent of girls were anemic. Also, Al-Aitam Orphanage had the highest percentage of anemics, at 14 percent, compared with just 8 percent in the AlRahmaa Orphanage. Infectious diseases, especially the intestinal parasites, affect a high rate of children in both orphanages. Entamoeba histolytica was the most common intestinal parasite affecting orphans, especially boys (Terwaki, 1999). Such habits facilitate more infections that lead to nutritional problems. Crowded orphanages, facilitate transmission of those infections. Lack of frequent health assessments and programs that can discover and track the orphans nutritional and infectious problems in early stages make them more exposed to disease. The inability of orphanages to cover the expenses of proper food and medical treatments also makes children vulnerable.