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
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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
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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
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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.
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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.
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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.
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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
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Activity
Week 3
(ComPed Week 2)
June 13-17
T
W
Th
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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
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“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
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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
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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
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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
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