June 18, 2011 Community Pediatrics Rotation Final Paper Submitted by: LEC 5 Abela, Benjamin G. Caro, Lizzette R. Cosalan, Samantha Gail V. Dator, Melissa A. De Castro, Ricardo M. Hernandez, Luisa M. Hernandez, Jay Grace U. Ishimura, Marie P. Pascua, Rodelia C. Que, Agnes Karen B. Ateneo School of Medicine and Public Health Batch 2013 TABLE OF CONTENTS I. BACKGROUND II. GENERAL OBJECTIVES III. PROJECTS A. NUTRIBOOK 2011 i. Rationale ii. Specific Objectives iii. Project Proposal/Mechanics iv. Evaluation Tool v. Project Outcome vi. Recommendations vii. Resources B. ILUGIN CHILDREN’S ACTIVITY BOOK i. Rationale ii. Specific Objectives iii. Project Proposal/Mechanics iv. Evaluation Tool v. Project Outcome vi. Recommendations vii. Resources C. ILUGIN COMMUNITY CENTER-COMMUNITY HEALTH WORKERS’ TEAM BUILDING ACTIVITY i. Rationale ii. Specific Objectives iii. Project Proposal/Mechanics iv. Evaluation Tool v. Project Outcome vi. Recommendations vii. Resources IV. APPENDIX A. GANTT CHARTS PRE PROJECT B. BUDGET MATRIX C. “JING-ILUGIN” ENTRIES D. NUTRITION QUIZ QUESTIONS 3 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 5 5 6 6 7 7 7 7 8 10 11 12 2 I. BACKGROUND Childhood malnutrition remains to be one of the major causes of mortality and morbidity among children in the Philippines. According to the National Nutrition Survey (2008), the prevalence of Filipino children who were underweight and under height or stunted increased from 2005 to 2008 with the percentage of underweight children aged 0-5 years increasing from 24.6 percent to 26.2 percent, about 3.35 million children; whereas the under height rate increased from 26.3 percent to 27.9 percent, representing around 3.57 million children. 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 is also present, which is equivalent to 2.6 million children. The number of under height children in this age group likewise increased from 32 percent to 33.1 percent. Malnutrition is considered a major health problem because of its role in increasing susceptibility to disease. It is a basic health program in most communities that is often poorly addressed. In preparation for The Medical City’s Department of Pediatrics Nutrition Program launch in July 2011, the group has decided to come up with projects and activities that aim to promote the importance of proper child nutrition to members of Barangay Ilugin, with assistance from the community health workers who will serve as front liners in actively promoting the program. The group has tried to design each project to cater to specific segments of the population: the parents, the kids, and the community health workers to ensure their active participation in the project. The group has also taken into consideration the existing nutrition-related programs that have already been established by the department, including the ongoing feeding program for school-age children, to ensure that the project’s goals are also aligned with the goals and principles of the existing projects. II. GENERAL OBJECTIVES 1) To develop a useful tool for evaluating the impact and progress of the feeding program on its participants and at the same time, provide useful and accessible nutrition information to their caregivers. 2) To aid the goals of the Nutrition Month through an educational and creative exercise that instills basic knowledge about key nutrition concepts to young children ages 4-6 years old. 3) To foster camaraderie and self-worth among the Community Health Workers (CHWs) of the Ilugin Community Center (ICC) by promoting the importance of teamwork and unity through an enjoyable and cost-effective team-building activity that also incorporates basic concepts of childhood nutrition. III. PROJECTS A. NutriBook 2011 i. Rationale In preparation for upcoming launch of Nutrition Month in July 2011, it would be helpful to provide a standardized monitoring tool to assess the nutritional status, both baseline and the updated status, of children enrolled in the feeding program. In the Ilugin Community Center, the community health workers are knowledgeable of documentation and identification of malnourished children and are capable of utilizing this booklet. This monitoring tool will aid in providing feedback on the effectiveness of the nutrition program and in tracking the child’s progress in the program in terms of nutritional status. Aside from charts and tables for monitoring the child’s height and weight, the booklet will also include a food diary, a food pyramid, meal plans and a guide to the correct serving size for food portions, recipes for simple nutritious food, and information about how to prevent acute gastroenteritis and dehydration. ii. 1. 2. 3. 4. iii. Specific Objectives To aid primary caregivers and community health workers in monitoring the nutritional status of individual patients enrolled in the Ilugin Community Center feeding program To document daily dietary intake of the patients enrolled in the ICC Nutrition Program To assess and correct the gaps in knowledge regarding standard portions and meal preparation To provide handy information regarding acute gastroenteritis and dehydration that will include homemade oral rehydration salts preparation and preventive measures. Project Proposal/Mechanics The 5x7 inch booklet will consist of the following parts: Part One: 1. Title page 2. Demographics with full length body picture 3. Baseline anthropometric measurements 4. Anthropometrics monitoring table 5. Growth charts (CDC and WHO) Part Two: 6.Food Pyramid 3 7. Food preparation and serving size guide 8. Meal plan 9. Food diary 10. Recipes 11. Acute gastroenteritis and dehydration guidelines 12. References (FNRI, WHO, CDC, DOH) The booklet will be published in Tagalog and will be printed and reproduced on pink/blue paper (depending on the child’s sex). This booklet will have 2 parts, the first part to be kept and filed at the ICC to monitor the child’s nutritional status and the second part to be distributed to all primary caregivers of patients enrolled in the ICC Nutrition Program. The booklet should be brought to every feeding and anthropometric measurement session, as well as for OPD consultations. Prior to the implementation of the project, parents and CHWs will be given a short briefing about how the booklet should be used and filled up with the necessary data. iv. Evaluation Tool After the first month of the Nutrition Program implementation, the following will be measured/surveyed through a focus group discussion (FGD) among community health workers and mothers, to be conducted by clerks or residents. The questions to be asked during the FGD will include the following: Nakatulong po ba ang Nutri-Book sa inyong pag-rerecord ng mga kailangang impormasyon para sa ICC feeding program? Sa paano pong paraan? Madali bang maintindihan ang laman ng Nutri-Book? Kung hindi, ano ang maaaring gawin upang maintindihan (halimbawa: training, demonstration)? Madali bang sundin at gawin ang mga nutrition tips at sample menu ng Nutri-Book? May kailangan bang baguhin sa Nutri-Book? Ano? Iba pang rekomendasyon The issues discussed in the FGD must be recorded and necessary changes should be made for the improvement of the NutriBook project. v. Project Outcome Four sets of Nutri-Book prototypes designed according to age and sex: Boys, 1-3 years old Boys, 4-6 years old Girls, 1-3 years old Girls, 4-6 years old If necessary, all data fields should be filled up. Growth charts should be regularly plotted during each consultation or monitoring session to track the child’s progress. vi. Recommendations Since the group was not able to rotate at Ilugin Community Center during the actual Nutrition Month, it is recommended that the Department of Pediatrics implement this tool instead and make the necessary changes deemed necessary to attain the objectives of the feeding program. The succeeding clerks who will rotate at the ICC may choose to continue the implementation and facilitate the evaluation of the project. vii. Resources The materials required would be those needed for printing and reproduction of the booklets: paper, ink, and photocopying expenses. Manpower will also be needed for booklet production and distribution. B. Ilugin Children’s Activity Book i. Rationale In addressing the problem of childhood malnutrition, there is a need to dig deeper into incorporating changes in attitudes and mindsets of the members of the community. Unfortunately, this appears to be a bigger problem than malnutrition itself. Therefore, there is a need to change the attitudes and perspectives of the community at its most important resource – at the level of the child itself. Generally, dietary habits formed during childhood persist until adult life. As such, it would be better to teach children the basics of proper nutrition at a young age. This project will then focus on children from the ages of 4 to 6 years old, who will be provided with activity books that not only contain information and teaching material about good nutrition but also incorporate 4 writing and reading skills as well. Thus, while the project is mainly aimed at the development of a health-oriented perspective on nutrition at a young age, it also includes the enhancement of the developmental stages of the child. ii. 1. 2. 3. Specific Objectives To create an activity book that will engage children into learning about nutrition as they learn about the basics of reading and language. To empower teachers and parents to teach their children about healthy habits and nutrition. To provide a medium for communication between children and community health workers and doctors about the importance of good nutrition and maintaning a healthy lifestyle. iii. Project Proposal/Mechanics A) Materials The materials required for this project would be paper, folders, fasteners and crayons. B) Mechanics The illustrations from the activity books are to be taken from the internet and modified to suit the Filipino culture. The illustrations will be about healthy food starting with letters of the alphabet (in order to both teach the child his/her first word as well as be able to associate it with healthy eating) as well as about the major food groups. A sample of 50 children will be given the first prototypes of the activity book, in order to gauge their response and have time for evaluation. iv. Evaluation Tool The evaluation tool for this project shall be in the form of a focus group discussion (FGD) with the mothers of the children. The FGDs may be facilitated by the clerks or the CHWs. v. Project Outcome The outcome of this project is a prototype of the activity book containing the first nutrition-based activity. Any other activities that consultants, residents and other clerks rotating in Community Pediatrics may have in mind or may wish to include can be included in it as well. vi. Recommendations The group recommends that this activity book not only include information and education about nutrition, but also about physical activity and safety as well, in order to promote a multifaceted approach to health and prevention. It is possible for other clerkship groups rotating in Community Pediatrics to include their own activities for children with regard to general health and well being. For its sustainability, it is recommended that the recycled scrap papers be used for the pages of the activity book. It is also recommended that the resources needed in this project (folders, crayons) be accumulated through donations of art materials. If a possible sponsor can be encouraged to join the production and distribution of the activity book, it would be very helpful in terms of the funding, as this ensures sustainability of the project. The activity book may also be given to out-of-school youth beyond the age of 6 years old who have not learned basic reading and writing skills. vii. Resources The resources for the activity book, should it be well received by the community, would be first from the ASMPH community, then hopefully from the whole Ateneo community as well. The cost of the materials will be the biggest hurdle in the success of this project, and thus there must be ways in order for this project to be sustainable. One option to maintain the project’s sustainability would be to collect scrap paper from other students of the ASMPH or other Ateneo students in order to both recycle paper and be able to save on costs. This would be a big help since this is a paper-based activity. Another idea would be to ask for crayon donations from Ateneo elementary school, although donations will not be limited to crayons as colored pens and pencils are welcome as well. The folders can also be requested from students and faculty of the Ateneo if they are available. C. Ilugin Community Center-Community Health Workers’ Team Building Activity i. Rationale The strength of any organization lies in its human resource. The community health workers are basically the critical success factors of the Ilugin Community Center, with the major role of being front liners in responding to health queries of members of the community and in ensuring that the community’s health problems are brought to attention. Knowing this, it is very important that they are able to work well and efficiently with each other. Through this team building activity, the CHWs may be able to improve communication among them, to motivate themselves to work in a team, to learn more about each other, and to make the workplace more enjoyable. 5 ii. 1. 2. 3. 4. 5. Specific Objectives To develop a sense of unity and camaraderie among the CHWs of the Ilugin Community Center. To let the CHWs understand the importance of good communication skills and teamwork. To motivate the CHWs into continuing to serve their community. To allow the CHWs to have fun and be given recognition for their efforts. To give the CHWs an idea of what constitutes proper nutrition. iii. Project Proposal/Mechanics “Vidyuhin Ilugin” Background The community health workers work very hard to make sure all the health-related needs of the community are met. They serve as a very important link between the health center, physicians and the general public. Being a CHW requires dedication, compassion and resilience. Over the past few years, there has been a decrease in the number of community health workers in Ilugin due to a number of factors: Being overworked, being underpaid, personal conflicts, etc. The responsibility of maintaining the ICC has been now designated to only a few remaining dedicated CHWs. The purpose of this activity is to motivate them and remind them of how their efforts are much appreciated in the community. Mechanics Video presentation that chronicles the activities of the CHWs, clerks, residents, consultants, and members of the community during the ComPeds rotation. The video also includes thank you messages to the CHWs from the clerks, doctors, and members of the community as well as pictures and videos of CHWs performing their everyday tasks in the community center. Obstacle Course/Relay Each station of the course puts emphasis on a specific skill or trait that the CHWs need to master, either individually or as a group, in order to win the game. Each skill or trait is essential to the CHW’s role in helping promote the importance of proper health care in the community. Parts: 1. Paper Maze – develops teamwork and self-discipline 2. Nutrition Quiz – for basic knowledge or background about nutrition concepts 3. Egg Toss – develops trust among partners 4. Puzzle – develops teamwork The activity is broken down into several stations: 1. Paper Maze – CHWs need to navigate through a web-like maze of crepe paper. They must not allow any body part to come in contact with the crepe paper. 2. Nutrition Quiz – CHWs need to correctly answer 6 out of 10 nutrition-related questions in order to proceed 3. Egg Toss – each CHW pair from the team toss an egg back and forth to one another, moving farther apart with each subsequent toss. They must catch the egg on all occasions without breaking it. 4. Puzzle – CHWs are given pieces of a jigsaw puzzle that spell out a hidden message. They must assemble the puzzle to Jing-Ilugin The launching of Nutrition Month this July needs a nutrition-themed jingle to serve as promotional material for the upcoming activity. The jingle will be actively used during the nutrition month campaign to remind parents and kids about the importance of good health and proper nutrition. Community health workers will be responsible for promoting the nutrition month campaign to the people of Ilugin; as such, they should also actively participate in the process of formulating the jingle so that they may fully understand the concept of good nutrition and promote it to others. This would also give the CHWs a sense of ownership over the jingle, empowering them to be more active in promoting proper nutrition. CHWs must come up with an original, short nutrition-related jingle with accompanying choreography. The jingle may be in English, Tagalog, or a combination of both. If appropriate, the winning jingle will be used as promotional material for the upcoming Nutrition Month activity. 6 read the message, which they should shout out upon completion. iv. Evaluation Tool The success of the project will be evaluated based on feedback obtained from participating CHWs, consultants, and the residents. Topics for feedback will be based on the highlights of the activity, possible areas of improvement, and suggestion s or recommendations for future activities. Feedback obtained immediately after the activity include the following: “First time lang na meron ng ganitong activity para sa CHWs”. “Sana meron pang mga activity na ganito”. “Natutuwa talaga kami.” “Ang galling ng mga clerks ngayon.” v. Project Outcome By the end of the activity, the CHWs are expected to understand the importance of unity and teamwork in accomplishing set goals, have some basic knowledge about what constitutes proper nutrition, and receive recognition for their efforts in serving the community. vi. Recommendations Team building activities should be done at least yearly, to allow new CHWs to interact with and develop a good working relationship with current CHWs. Future team building activities may be done in venues outside of the community center, to allow more space for more activities and to allow CHWs to venture outside of the community as well. vii. Resources Materials used for the activity include the supplies used in the obstacle course: crepe paper, masking tape, eggs, bond paper, plastic bags, polvoron, cardboard puzzle, etc. Lunch was also provided during the activity. Instruments used for making the video for the CHWs only include a camera and laptop. 7 APPENDIX A GANTT CHARTS PER PROJECT NUTRIBOOK 2011 Week 1 Week 2 (ComPeds (MBA week 1) week) May 30– June 6– June 3 June 11 Activity Week 3 ComPeds week 2) June 13-17 M T W Th F Planning Research Project Proposal Prototype creation Nutribook compilation Prototype presentation Revision of prototype Final presentation Reproduction and distribution (before July/ start of the ICC feeding program) ILUGIN CHILDREN’S ACTIVITY BOOK Week 1 Week 2 (ComPed Week 1) (MBA) May 30 – June 3 June 6-10 M 13 Activity Week 3 (ComPed Week 2) June 13-17 T W Th 14 15 16 F 17 Planning Project proposal Research on materials, costing Prototype Creation Submission of Prototype for Evaluation and Revisions Revision of Prototype Presentation of Prototype to the Pediatrics faculty and residents OBSTACLE COURSE Brainstorming and Planning Submission of Proposal Buying Materials Activity Proper Final Presentation May 30 ICC-CHW TEAM BUILDING ACTIVITY COMPEDS WEEK 1 May 31 June 1 June 2 June 3 June 13 COMPEDS WEEK 2 June 14 June 15 June 16 June 17 8 “JING – ILUGIN” Brainstorming and Planning Submission of Proposal Activity Proper Final Presentation “VIDYUHIN – ILUGIN” Brainstorming and Planning Submission of Proposal Gathering of pictures and videos Making the video Activity Proper Final Presentation May 30 COMPEDS WEEK 1 May 31 June 1 June 2 May 30 COMPEDS WEEK 1 May 31 June 1 June 2 June 3 June 3 June 13 COMPEDS WEEK 2 June 14 June 15 June 16 June 17 June 13 COMPEDS WEEK 2 June 14 June 15 June 16 June 17 9 APPENDIX B BUDGET MATRIX Expense Paper Ink Photocopying Expense Folder Photocopying Fastener Crayons *May be free if able to acquire from donations Snacks for kids NUTRIBOOK 2011 Qty Unit Price 100 booklets, 30 pages each 1 cartridge P350 P1.00 TOTAL ILUGIN CHILDREN’S ACTIVITY BOOK Qty Unit Price 25 P2.50 750 P0.50 50 50 boxes of 8 crayons P20 P350 P1500 Total P65 P375 P100 (for box of 50) P1000 P400 PHP 1940 TOTAL Expense Crepe paper Folder Egg Total ICC-CHW TEAM BUILDING ACTIVITY Qty Unit Price 8 P9 2 P8.5 5 P5 Total P72 P17 P25 Snacks Palabok Chicken Juice Cupcake Cube ice Utensils TOTAL 2 7 8 3 2 2 P600 P130 P9.5 P57 P20 P110 TOTAL P1200 P910 P76 P171 P40 P220 P2731 10 APPENDIX C “JING-ILUGIN” ENTRIES ENTRY #1 Verse 1: GO at GROW Leron, leron, sinta Puno ng vitamina Kanin, patatas, mais, at Gatas, pagdating sa dulo Tinapay at butter at nuts Verse 2: GLOW Kangkong, malunggay Kalabasa at talong May kasamang prutas Pampakinis ng balat Verse 3: Kailangan ang tubig Walong baso araw-araw Para tayo ay lagging malakas Healthy food! ENTRY #2 Sabi ni nanay kumain ng gulay Sabi ko naman para saan ang gulay Pampaganda ng kulay pampahabang buhay, Sagot ni nanay. Makulay samaha pa ng itlog Pampasigla ng buhay Karne at manok ay ligaya kong tunay Kasiyahan kong tunay, paksiw at gulay 11 APPENDIX 4 NUTRITION QUIZ QUESTIONS 1. Alin sa sumusunod na gulay ang pinaka-maraming protein? A. Carrots B. Gabi C. Munggo D. Kamatis 2. Anong bitamina ang pwede makuha sa araw? A. Vitamin A B. Vitamin B C. Vitamin C D. Vitamin D 3. Alin ang sumusunod ang hindi miyembro ng mga “GROW” na pagkain? A. Patatas B. Isda C. Itlog D. Gatas 4. Ano ang pinaka-importante na meal sa isang araw? A. Almusal B. Tanghalian C. Hapunan D. Merienda 5. Magbigay ng tatlong halimbawa ng “GO” na pagkain. 6. Magbigay ng tatlong halimbawa ng “GROW” na pagkain. 7. Magbigay ng tatlong halimbawa ng “GLOW” na pagkain. 8. Alin sa sumusunod ang may pinaka-maraming calcium para sa malusog na ngipin at buto? A. Karne B. Kanin C. Gatas D. Saging 9. Alin sa sumusunod ang may pinaka-maraming potassium? A. Saging B. Kangkong C. Kamote D. Mangga 10. Ayon sa guidelines ng DOH, ilang buwan ba dapat mag exclusibong breastfeeding ng sanggol? A. 12 months B. 15 months C. 3 months D. 6 months 12