Final Research Paper v. 1.0

A CROSS SECTIONAL STUDY ON THE COMPARISON OF COGNITIVE FUNCTION AND
NUTRITIONAL STATUS OF ORPHANS AGED 7-12 YEARS IN GOVERNMENT

AND NON-GOVERNMENT ORPHANAGES OF THE PROVINCE OF CAVITE, 2015
A Research Project presented to the

Department of Family and Community Medicine
De La Salle Health Sciences Institute
College of Medicine
Dasmarias City, Cavite
By:
Batch 2017 Group 18, Section B
Luna, Keith Basil B.
Menil, Mary Joyce S.
Pingol, Gregory Gustav R.
Talens, Mary Erika Maxine A.
Uy, Maria Carmela C.
Vicente, Antonio Jose V.
Vigilla, Vega P.
Villanueva, Princess Jasmine D.
Wong, Chennie M.
Adviser: Josephine M. Carnate, MD, MPH

March 5, 2015
ABSTRACT
General Objective: To compare the cognitive function and nutritional status of orphans aged 712 years in government and non-government orphanages of the province of
Cavite in the year 2015
Research Design:
Analytic observational cross sectional
Research Setting:
Randomly selected government and non-government orphanages of Cavite
Study Participants: The study included 77 orphans selected using a probability type cluster
sampling of government and non-government orphanages in Cavite. The
participants were orphans 7-12 years of age enrolled in the institution for at
least three years. The study excluded institutions and individuals who did
not comply or agree with the terms of the study.
Methodology:
Cognitive function was assessed using standard tests Rey Auditory Verbal
Learning Test (RAVLT) and Moss Attention Rating Scale (MARS).
Nutritional status was assessed using anthropometric measures (height,
weight and skin-fold thickness).
Data Analysis:
Prevalence of undernourishment and poor cognition among the orphans in

government and non-government orphanages were determined.
Prevalence ratio was used to identify the association between the type of
orphanage and the cognitive and nutritional status of the orphans. Mean
cognitive test results and anthropometric measurements were also
compared between the two types of orphanages.
Results:
The computed prevalence ratio for nutritional status was 0.78 (95% CI:
0.5789-1.0496) with a Chi-square value of 2.785 and a p-value of 0.0952.
On the other hand, the computed prevalence ratio for cognitive function
was 1.95 (95% CI: 0.6397-5.936) with a Chi-square value of 1.459 and a pvalue of 0.2276. These results showed that the differences in both cognitive
function and nutritional status were deemed insignificant.
Conclusion:
The nutritional status and cognitive function of orphans aged 7-12 years in
non-government and in government orphanages of the province of Cavite in
the year 2015 do not significantly differ.
KEYWORDS:
Orphans, cognitive function, nutritional assessment, government and nongovernment orphanages
ACKNOWLEDGEMENTS
The researchers have been blessed with the people who took the time in extending
assistance in the course of their research writing. This whole work would be hardly done in the
absence of their invaluable contribution. To these significant individuals, the researchers
sincerely extend their appreciation, gratitude and utmost recognition.
Above all, to their constant Refuge and Giver of wisdom, the Almighty God, for giving
them the strength to accomplish this undertaking;
Dr. Josephine Carnate, their research adviser, for the patience, guidance and knowledge
shared in the progress of the research work and her suggestions towards the improvement of
the study.
The researchers would also like to thank the DLSHSI College of Medicine Ethics
Committee for reviewing the research protocol.
Ms. Elizabeth Tabura, social worker of In Joy Childrens home, Ms.Vicky Cardeno, social
worker of Childrens Joy Foundation, Inc. and Mrs. Brennie Sotto, center head of DSWD- Bahay
Tuluyan ng mga Kabataan for the accommodation and participation in the acquisition of data
needed in the research.
Mr. Michael Anthony Reginaldo, their friend, for the time, effort and expertise shared in
the performance of the study.
Lastly, the researchers would like to thank their families for their financial support, for
being supportive, patient and understanding in all their endeavors.
ii
TABLE OF CONTENTS
ABSTRACT...i
ACKNOWLEDGEMENT.ii
INTRODUCTION ........................................................................................................................1
Research Question ..................................................................................................................1
Research Hypothesis ..............................................................................................................1
Background Information ..........................................................................................................1
Significance of the Study .........................................................................................................2
Research Objectives ...............................................................................................................2
General Objective ................................................................................................................2
Specific Objectives...............................................................................................................2
Conceptual Framework ...........................................................................................................3
LITERATURE REVIEW ...............................................................................................................4
Orphaned and Abandoned Children ........................................................................................4
Global Prevalence and Distribution of Children being Orphaned ..........................................4
Prevalence and Distribution of Children being Orphaned in the Philippines .........................5
Exposure of Interest: Type of Orphanages ..............................................................................5
Statistics on Government and Non-government Orphanages in the Philippines ...................6
Disease of Interest: Cognitive Function and Nutritional Assessment .......................................7
Evaluation of Cognitive Function ..........................................................................................7
Prevalence of Cognitive Impairment.....................................................................................8
Evaluation of Nutritional Status ............................................................................................8
Prevalence and Distribution of Nutritional Status of Filipino Children ...................................9
Factors Affecting Cognitive Function and Nutritional Status ...................................................10
Review of Similar Studies ......................................................................................................11
METHODOLOGY......................................................................................................................15
Research Design ...................................................................................................................15
Schematic Diagram of the Research Design ......................................................................17
Study Population, Sampling and Sample Size .......................................................................18
Source of Subjects .............................................................................................................18
Step-by-Step Selection of Subjects ....................................................................................19
Sample Size Estimation .....................................................................................................20
Operational Definition of Variables ........................................................................................21
Data Collection ......................................................................................................................25
Methods of Data Collection ................................................................................................25
Sources of Data .................................................................................................................26
Data Collection Tools .........................................................................................................26
Plan for Data Analysis ...........................................................................................................32
Descriptive Statistics ..........................................................................................................32
Inferential Statistics ............................................................................................................36
Plan for Hypothesis Testing ...............................................................................................36
ETHICAL CONSIDERATION ....................................................................................................40

Study Procedure and its Recognized Risks ...........................................................................40
Purpose of the Study .............................................................................................................40
Confidentiality ........................................................................................................................41
Study Participation.................................................................................................................41
Intervention............................................................................................................................42
RESULTS .................................................................................................................................43
Study Population ...................................................................................................................43
Nutritional Status ...................................................................................................................44
Cognitive Function .................................................................................................................47
Measures of Association........................................................................................................49
DISCUSSION............................................................................................................................52
CONCLUSIONS AND RECOMMENDATIONS ..........................................................................58
REFERENCES .........................................................................................................................60
APPENDICES ...........................................................................................................................66
APPENDIX A: Data Collection Tool Sample ..........................................................................66
APPENDIX B: Informed Consent ...........................................................................................69
APPENDIX C: Assent Form.73
LIST OF TABLES
Table 1
Summary of Similar Studies
14
Table 2
NIH Toolbox normative data per age group (8, 9, 10, 11, and 12)
22
Table 3
Two by two dummy table for data analysis of cognitive function
34
Table 4
Two by two dummy table for data analysis of nutritional status
34
Table 5
Summary of Descriptive Statistics
35
Table 6
Statement of Null and Alternative Hypothesis
36
Table 7
Frequency Distribution of the profile of the Orphans from Selected

Government and Non-government Orphanages of Cavite, 2015
Table 8
Nutritional Status of Orphans from Selected Orphanages of the Province

of Cavite according to BMI-for-age, Weight-for-age, and Height-for-age, 2015
Table 9
44
Frequency Distribution of Malnourished and Well-nourished Orphans

from Selected Government and Non-government Orphanages of Cavite, 2015
Table 10
43
45
Means and Standard Deviation of the Quantitative Variables Used in the

Assessment of Nutritional Status among Orphans from Selected Orphanages
of Cavite, 2015
45
Table 11
Mean Difference, T-test Results and P-values of Quantitative Variables

Used in the Assessment of Nutritional Status among Orphans from
Selected Orphanages of Cavite, 2015
Table 12
Frequency Distribution of Good and Poor Cognitive Functions among Orphans

Table 13
46
47
Mean and Standard Deviation of the Quantitative Variables Used in the

Assessment of Cognitive Function among Orphans from Selected Orphanages
48
of Cavite, 2015
Table 14
Mean Difference, T-test Results and P-values of Quantitative Variables

Used in the Assessment of Cognitive Function among Orphans from Selected
Orphanages of Cavite, 2015
Table 15
Two by Two Table Analysis of the Nutritional Status of Orphans from

Selected Government and Non-government Orphanages of Cavite, 2015
Table 16
49
Two by Two Table Analysis of the Cognitive Function of Orphans from

Table 18
49
Chi-square test on the Prevalence of Malnutrition among Orphans from

Table 17
48
50
Chi-square test on the Prevalence of Poor Cognitive Function among Orphans

51
LIST OF FIGURES
Figure 1
Conceptual framework showing the independent, dependent & confounding variables
Figure 2
Schematic diagram of the cross-sectional study design showing the first dependent
variable, cognitive function
Figure 3
3
17
Schematic diagram of the cross-sectional study design showing the second dependent
variable, nutritional status
17
INTRODUCTION
Research Question
Is there a difference in the cognitive function and nutritional status of orphans aged 7-12
years in government and non-government orphanages of Cavite in the year 2014?
Research Hypothesis
Cognitive function or nutritional status of orphans in non-government orphanages and in
government orphanages do significantly differ.
Background Information
Childhood, as defined by the United Nations International Childrens Fund (UNICEF) [1],
is not just the time between ones birth up to ones attainment of adulthood, rather, it refers to
the over-all state and condition of the life of a young individual. It is considered the foundation of
hopes for a nations better future. With this said, individuals of this stage in life are considered
the most vulnerable to any form of threats in their physical, emotional, psychological, and
mental well-being [1].
One of the pressing issues that children may face in this early stage in life is the
premature loss of a parent or a caregiver. Daily, thousands of children become orphans and
thousands more are being neglected or abandoned by their parents and are being enrolled in
residential institutions or orphanages. With this growing concern, global, national, and local
leaders are striving to find the necessary resources to protect these children [2]. Unfortunately,
nations with the highest percentage of orphanhood and abandonment are also noted as
impoverished and under-resourced. As a consequence, these countries are incompetently
prepared in attaining health care, education and social needs of these children [3].
Significance of the Study

In the Philippines, government and non-government organizations work hand in hand to
address the growing number of orphans. A cluster of government and non-government
orphanages scattered throughout the Philippines are working to provide homes, programs and
care to these children [4].
In line with this growing concern, this study aims to compare the cognitive function and
nutritional assessment of children living in government orphanages and those who are living in
non-governmental residential institutions as an essential part of these childrens over-all health.
Any information that this study shall acquire is intended to aid in the improvement of the quality
of services that these institutions may provide in the future.
Research Objectives
General Objective
To compare the cognitive function and nutritional status of orphans aged 7-12 years in
government and non-government orphanages of the province of Cavite in the year 2014.
Specific Objectives
1. To assess the cognitive function and nutritional status of orphans aged 7-12 years in
government and non-government orphanages of Cavite as to:
a. Memory and learning capacity, and
b. Attention
2. To assess the nutritional status of orphans aged 7-12 years in government and nongovernment orphanages of Cavite as to:
a. Body Mass Index (BMI),
b. Wasting and stunting, and
c. Total body fat
3. To identify the prevalence of undernourishment and poor cognition among the orphans
4. To compare the cognitive function of orphans in government and non-government
orphanages of Cavite
5. To compare the nutritional status of orphans in government and non-government
orphanages of Cavite
2
Conceptual Framework
Associated Factors also affecting the
Dependent Variables:
Funding/Budget
Health Programs
Educational Programs
Confounding Variables
o
o
o
o
o
o
o
Age
Environment
Exposure to certain stresses
General health of an individual
Illness and diseases
Nutrition
Education
Availability and access to food,

Dietary inadequacies (eating patterns,
eating styles)
Cultural-religious practices
Lifestyle
Environmental factors
Type of Orphanage
(Government vs. Non-government)
Independent Variable
Cognitive Function
as to Memory, Learning, Attention
Dependent Variable
AND
Nutritional Assessment
using Anthropometric Methods
Dependent Variable
Figure 1. Conceptual framework showing the independent, dependent & confounding variables.
LITERATURE REVIEW
Orphaned and Abandoned Children
As stated in the DSWD Administrative Order 11, Series of 2009 [5], the terms orphaned
and abandoned children can be used interchangeably. It is defined as a child without proper
parental care or guardianship, whose parents have passed away, or who has been abandoned
for at least three consecutive months. It also includes children whose facts of birth are unknown
and referred to as foundlings [5].
An orphaned child is defined as individuals below 18 years of age who has lost one or
both parents [2]. It can be further classified into single, double, maternal, and paternal orphaned
children. An abandoned child, on the other hand, is defined as a child whose basic needs are
not provided by the parents, in such a way that the child does not know where his next meal
would be coming from, where he would be spending the night, and does not live with either of
his parents [2].
Global Prevalence and Distribution of Children being Orphaned
Children without parents are among the most vulnerable members of the society. An
estimated number of 143,000,000 children worldwide were identified to have witnessed the
death of a parent, and a million children more who have been abandoned by both parents.
Daily, 5,760 more children become orphans. Globally, Southeast Asia constitutes the largest
number of orphaned children with an estimated number of 72,000,000 [2]. Moreover, the age
distribution of orphans across countries was stable with roughly 12% of orphans being 0-5 years
old, 33% being 6-11 years old and 55% being 12-17 years old [6].
Prevalence and Distribution of Children being Orphaned in the Philippines

According to the National Statistics Office (NSO), the total population of the Philippines
as of 2000 is 76,498,735 with a markedly increase of 7.88 million (11.5%) individuals for the last
five years. The total population comprises of 32 million (43%) children, and 36% of which are
aged 0-5 years. On that account, there are 1.8 million orphaned children in the Philippines as
stated by UNICEF [2]. In a recent report of DSWD for the year 2011, there were already 884
abandoned children out of the 5,691 total cases of child abuse, in which 511 and 373 cases are
males and females respectively [7]. In line with the recent typhoons, Ondoy, Haiyan and the like,
even more children have been displaced with no families to return to. With so many problems in
sight, to care and nurture for these many children becomes an encumbrance for the government
to bear alone.
Exposure of Interest: Type of Orphanages

Article I of Presidential Decree No. 603 known as The Child and Youth Welfare Code of
the Philippines states that The child is one of the most important assets of the nation. Every
effort should be exerted to promote his welfare and enhance his opportunities for a useful and
happy life In line with this, the government assigned the Department of Social Welfare and
Development (DSWD) to attend to the needs of the young population. The department was
tasked to help and ensure that the people of the government meet their needs as stated by the
law [8].
In response to this, different programs were established. One of those is building of
shelter-care institutions that provide temporary protection and care to children requiring
emergency reception. These institutions cater children who are victims of unforeseen traumatic
events, abandonment by parents, dangerous conditions of neglect or cruelty in the home, or a
5
court order holding them as material witnesses. These institutions intend to provide the needs of
detained children, such as adequate diet, clothing, shelter with adequate ventilation, sanitation,
with a safe, clean and spacious playground and religious training [9]. For the purpose of this
study, these shelter-care institutions run by the government would be referred as government
orphanages.
On the other hand, Non-government Organizations (NGO) are non-profit institutions,
built voluntarily by private people, funded by sponsors, whose purpose is to create sustainable
programs that aid their communities such as orphanages, educational or economic facilities.
They are registered and formally organized, in such a manner that they will be adherent to the
laws stated by the government [10]. NGO-funded orphanages are responsible for providing the
basic needs of the children such as food, clothes and adequate space. Education and other
programs, such as sports programs or team building exercises, will depend on the sponsors of
the orphanages. However, some NGO orphanages, especially those who are sponsored by
international organizations, were able to provide basic, secondary and even tertiary education
through scholarships [11].
Statistics on Government and Non-government Orphanages in the Philippines
According to the Philippines Orphanage Foundation, there is an average of about 15
orphans per square mile. A cluster of 239 orphanage centers scattered throughout the
Philippines are working to provide homes, programs and care to these children. Of these 239
centers, 11 are Reception and Study Center for Children (RSCCs), 82 are Non-government
organization orphanages, and 146 are local government unit orphanages [4].
Disease of Interest: Cognitive Function and Nutritional Assessment

Evaluation of Cognitive Function
Cognitive function is a mental parameter inclusive of learning, memory, linguistics,
attention, critical thinking and decision-making [12]. Understanding the abilities and limits of a
child and learning the factors that enhance or are a detriment to the development of this weigh
in at a heavy importance. This study shall assess the cognitive function of the participant as to
learning, memory and attention.
Learning is the process of a relatively permanent behavioral change based on an
individuals interactional experience with its environment. It refers to the acquisition of skills and
knowledge, which can develop into a flexible and not genetically pre-programmed behavior
through ones personal experience [12].
Memory is defined as the persistence of learning or the ability of an individual to recall
certain information over a particular period. Memory has two types: episodic and working
memories. Episodic memory is a cognitive process involving acquisition, storage and retrieval of
new information or knowledge. It can either be acquired verbally, such as recalling past
conversations, or non-verbally, such as visualization of places he has been to. On the other
hand, working memory or short-term memory is the ability to store new information up until
exceeding ones information storage capacity [13].
Attention is the ability to focus cognitive resources and to selectively process certain
information from the environment while ignoring irrelevant input. It is further classified into
switching attention, divided attention, selective attention, and sustained attention [14]. A
switching attention is defined as the task context in which a person alternates the focus of
attention between two different tasks or sources of information, which may look similar to
divided attention. However, divided attention is related, requiring processing of more than one
source of information at a time or performing more than one task at a time. A selective attention
requires an individual to focus on just one source of information for processing while
disregarding extraneous information. A sustained attention requires an individual to maintain his
or her attention to a task over prolonged periods of time [14].
Some studies have shown that under optimal conditions, the attention span of children
ages 2-3 years old will range from 3-4 minutes. At approximately 5 years of age, attention spans
rise to a maximum of 5 to 10 minutes. When children are engaged in a single learning task,
attention spans stretch to 15-20 minutes between ages six and eight while the best estimates of
an adolescents attention span do not exceed to 35 minutes [15].
Prevalence of Cognitive Impairment
Very limited studies concerning the prevalence of cognitive impairment among children
are available especially in the country. Using the keywords cognitive function of children,
memory and learning impairment, and attention disorders, the researchers have not come
into a similar research that will fit the requirement of this part of the study. Although few
available studies have discussed cognitive function and related it to other health conditions such
as parasitism or congenital disorders, these will not be discussed as these may be misleading
and irrelevant to the objectives of the study.
Evaluation of Nutritional Status
Nutrition is defined as the process by which food or nutrients necessary for growth and
development is obtained. Deprivation of these substances results in malnutrition, a state
vulnerable to multiple risk factors. Malnutrition being a serious issue in several countries had
shown to damage physical and mental development of the population [16].
The nutritional assessment of an individual can be absolutely acquired through the

extent of anthropometric, biochemical or physiological features that defines whether the
individual is well nourished or undernourished. It is a process that utilizes real and measurable
criteria that reflect alterations in anthropometric, biochemical or functional characteristics of the
individual. Manifestations of such changes are consequence of insufficient intakes of food, a
result of seasonal fluctuations in food intakes, or poor absorption and utilization of ingested
food. [17]
Prevalence and Distribution of Nutritional Status of Filipino Children
In the Philippines, 3.6 million children were found to be underweight and 4 million were
stunted [16]. Based on the Nutritional Status of Filipino pre-school children aged 0-7 years old,
74 in every 100 pre-school children (74%) have normal weight for their age. Twenty five
percent of which are underweight and 2% are overweight. Seventy-three percent preschool
children have normal height for their age, 26% are short or under height and 1% are tall for
his/her age. Ninety-three out of every 100 children (93%) have normal weight for their height,
5% are underweight for their height and 2% are overweight for their height. Based on the 2005
Projected Population, the estimated count of 0 to 5 year old children who are underweight is 3.7
million, for under height is 3.9 million, 717,643 are thin and for overweight 299,000 [18].
By single age group, 29 in every 100 children (29%) ages one and 5 years old have high
prevalence rates of underweight. On the other hand, 3 to 5 year-old children, have high
proportion of short or under height with 30%, 35% and 36%, respectively. One-year-old children
have the highest prevalence of thinness of 12% [18].
Based on the Nutritional Status of Filipino School-age Children aged 6 to 10 years old,
76 in every 100 (76%) have normal weight-for-age, 23% are underweight and 2% are
overweight. Thirty two percent of Filipino children are stunted, 3% of children aged 6 to 8 years
old are thin or underweight, 94% are normal and 3% are overweight for their height [18]
By single age group, the 6, 7 and 8 year-old children have high prevalence rate of
underweight, which are 25%, 24% and 24% respectively. The prevalence rate of wasted for 9
and 10 years old children is 21%.The prevalence rate of stunted or short relative to their age are
even higher for every single age group with 31 35%. Translating these percentages into actual
counts, there are 2.4 million and 3.4 million underweight and stunted, children aged six -10
years, respectively [18].
Factors Affecting Cognitive Function and Nutritional Status

Research has found that factors affecting the nutritional factors of children and
adolescents were described as socio-economic status: availability and access to food,
psychological factors: dietary inadequacies such as eating patterns, eating styles and culturalreligious practices and lifestyle and environmental factors were all found to have had direct and
indirect impacts in children and adolescent's nutrition [19].
On the other hand, cognitive functions had been found to be affected by the environment
from which an individual was raised. Illnesses, diseases, nutrition and education also weighed
heavily on the development of individuals especially children and adolescents [19].
10
Review of Similar Studies

All around the world, development policy makers and child-care service providers are
committed to improving the educational opportunities of the million orphans worldwide.
However, the relationship between orphanhood and education outcomes is not well understood
and child-care service providers do not know where exactly to intervene.
A study of Wakoli et. al. compared the under nutrition of orphans and vulnerable
children: among cash transfer beneficiaries and non-beneficiaries in Nairobi. The group of
beneficiaries is based on the fact that they are supplied by an outside source of cash or food
supplies to allocate to their respective orphans. The non-beneficiaries on the other hand are a
group of individuals who are not supplied by an outside source of food and stipend and only rely
on their personal income and integrate the children in their household budget. A comparative
descriptive cross-sectional study design in which 336 children were sampled from the two
groups, each consisting 168 children, assessed the prevalence and associated factors for under
nutrition between the two groups. Methodology includes a Food Frequency Questionnaire, 24
Hour Recall of information of the food consumed, and Anthropometric measurements based on
standard procedures [20].
Wasting, underweight and stunting were determined based on a z-score of > or = -2 or
<-2SD. A chi-square test was used to test significance associations of wasting, underweight
and stunting with other variables [20].
Results wise, a majority (89.3%) and (73.8%) of the principal caregivers were females
among the beneficiaries and non-beneficiaries respectively. Among the beneficiaries,
prevalence of wasting was 6%, underweight 6% and stunting 32.7%. Among non-beneficiaries,
under nutrition was higher with wasting 9.5%, underweight 17.9% and stunting 37.5% [20].
11
Based on the said study there is a significant increase of children with said parameters
such as wasting, underweight and stunting in the group of non-beneficiaries compared to the
beneficiary group. However, generalizability of these studies is limited only to the region where
they were done. Although the study suggests that there should have training in beneficiaries in
adequate allocation of funds to increase the efficacy of said stipend in terms of improving
nutritional status of children [20].
A cross-sectional study of Panpanich et al, compared the nutritional status and health
problems among village orphans, non-orphans and orphanage children. This study also
identified factors, which were believed to be associated with under nutrition. The study was
conducted in three orphanages and two villages near Blantyre, Malawi. 76 orphanage children,
137 village orphans and 80 village non-orphans were recruited in this study. Anthropometric
measurements were also done and guardians were interviewed [21].
Wasting, underweight and stunting were determined based on a z-score, the mean zscore of height/age was significantly lower in the orphanage group, -2.75 (1.29) compared with 2.20 (1.51) and -1.61 (1.57) in the village orphan and non-orphan groups (p<0.05) [21].
Based on the results, the prevalence of undernutrition in orphanage children aged <5
years was 54.8% compared with 33.3% and 30% of village orphans and non-orphans,
respectively. Furthermore, 64% of orphanage children aged <5 years were stunted compared
with 50% and 46.4% of village orphans and non-orphans, respectively. Orphanage children
aged >5 years were less stunted and wasted than orphans and non-orphans in villages [21].
Based on the study, there was no significant difference in nutritional status between
village orphans and non-orphans. Thus, more than 3 children in a family being cared for by
guardians were stated to be significantly associated with undernutrition. Orphanage girls were
more likely to be malnourished than orphanage boys. In addition, children who had been
12
residing to an orphanage for more than a year were less malnourished compared to those
residing in the village. As stated in the study, there was no association between undernutrition
and duration of stay in extended families. It was concluded that young orphanage children are
more likely to be undernourished and more stunted than village children. Lastly, older
orphanage children seem to have better nutrition than village orphans [21].
According to the national nutrition survey conducted by the Food and Nutrition Research
Institute (FNRI), the prevalence of underweight preschoolers was 24.6% in 2005. The target
prevalence by 2015 is 17.25%, which warrants an annual decline of 0.74% [22].
13
STUDY TITLE/
AUTHOR
1. Under nutrition of
orphans and
vulnerable children:
a comparison of
cash transfer
beneficiaries and
non beneficiaries in
Korogocho slums,
Nairobi (Wakoli,
et.al., 2012)
2. Are orphans at
increased risk of
malnutrition in
Malawi? (Panpanich,
et. al., 1999)
STUDY POPULATION/
METHODOLOGY
Comparative descriptive crosssectional study involving 336
children from cash transfer
beneficiaries and nonbeneficiaries in Nairobi.
Data collected through a Food
Frequency Questionnaire, 24
Hour Recall of information of
the food consumed and
anthropometric measurements.
Cross-sectional study
comparing the nutritional status
and health problems among
village orphans, non-orphans
and orphanage children.
76 orphanage children, 137
village orphans and 80 village
non-orphans were recruited in
this study.
Anthropometric measurements
were done and guardians were
interviewed.
3. National Nutritional
Survey (FNRI, 2005)
National survey for nutrition.
RESULTS/ DISCUSSION
CONCLUSION
The prevalence of wasting,

underweight, and stunting
among beneficiaries were 6%,
6%, and 32.7%, respectively.
There is a significant increase of children

with said parameters such as wasting,
underweight and stunting in the group of
non-beneficiaries compared to the
beneficiary group.
The prevalence of
undernutrition among nonbeneficiaries were higher with
wasting 9.5%, underweight
17.9% and stunting 37.5%.
The prevalence of
undernutrition in orphanage
children aged <5 years was
54.8% compared with 33.3%
and 30% of village orphans
and non-orphans,
respectively.
64% of orphanage children
aged <5 years were stunted
compared with 50% and
46.4% of village orphans and
non-orphans, respectively.
The prevalence of
underweight preschoolers
was 24.6% in the year 2005.
There was no significant difference in

nutritional status between village orphans
and non-orphans.
More than 3 children in a family being
cared for by guardians were stated to be
significantly associated with
undernutrition.
Orphanage girls were more likely to be
malnourished than orphanage boys.
Children who had been residing to an
orphanage for more than a year were less
malnourished compared to those residing
in the village.
There was no association between
undernutrition and duration of stay in
extended families.
The target prevalence for the year 2015 is
17.25%, needing an annual decline of
0.74%.
Table 1. Summary of Similar Studies
14
METHODOLOGY
Research Design
An analytical cross-sectional type of study was used in the conduct of this research. This
type of study design examines the relationship between disease and other variables of interest
as they exist in a defined population at a single in time or over a short period of time. As
discussed earlier, this study looks into the cognitive function and nutritional status of orphans
among government and non-government orphanages at a given point in time.
As it is impossible to evaluate the dependent variables among the entire population of
interest, a cross-sectional study was used in order to take a snapshot of what is being observed
in a representative sample population group.
The following steps/procedures were used in the conduct of the study:
1.
Definition of the target population

The target population of the study was defined as orphaned or abandoned
children aged 7-12 years of age residing in orphanages in the Philippines.
2.
Choosing of the study population

Sample population, a representative group of the target population, included
orphans aged 7-12 years currently residing in selected orphanages of a Cavite. The
researchers coordinated with the DSWD for the selection of orphanages where the
participants are coming from. Cluster sampling was performed.
3.
Classifying into disease and exposure status

The exposure and outcome variables were identified at the same period.
Orphans were classified into those who are from government orphanages and those
15
who are from non-government orphanages. Cognitive function and nutritional status was
assessed. They were evaluated as to having poor or good cognitive function and as to
being malnourished or adequately nourished.
4.
Computing for measure of association

Computation for the two different outcome variables, cognitive function and
nutritional status, was separated to individually compare it to the exposure variables.
Prevalence ratio for the cognitive function was computed as to the prevalence of
orphans having poor cognitive function from government orphanages divided by the
prevalence of orphans having poor cognitive function among non-government
orphanages. Whereas, the prevalence ratio for the nutritional status was computed as to
the prevalence of malnourished orphans from government orphanages divided by the
prevalence of malnourished orphans from nongovernment orphanages.
5.
Interpreting the measure of association

For the interpretation, a prevalence ratio equal to 1 would mean that there is no
significant difference in the cognitive function or nutritional status of orphans from the
two different types of orphanage; whereas prevalence ratio greater than or less than 1
would mean that there is a significant difference in the dependent variables. In order to
further differentiate the study variables, mean cognitive function test scores and
anthropometric measurements were also compared.
16
Schematic Diagram of the Research Design
Figure 2. Schematic diagram of the cross-sectional study design showing the first dependent
variable, cognitive function.
Figure 3. Schematic diagram of the cross-sectional study design showing the second
dependent variable, nutritional status.
Note: Though the schematic diagram for the two dependent variables were shown separately, this does
not mean that the research will be using different sample population for the two variables. Sample group
will be the same for evaluating both variables. For presentation purposes, the two variables are
separately shown as to clearly identify a positive outcome and a negative outcome variable.
17
Study Population, Sampling and Sample Size

Definition of Study Population
The target population of this study consisted of orphaned or abandoned children aged 712 years of age residing in orphanages in the Philippines. The sampling population, on the other
hand, included orphaned children aged 7-12 years residing in government and non-government
orphanages in Cavite.
The sampling frame for this study was a list of government and non-government
orphanages in Cavite having children 7-12 years of age from DSWD and NGOs. The sampling
unit was government and non-government orphanages in Cavite. Lastly, the elementary unit for
this study consisted of orphans from selected government and non-government orphanages in
Cavite who will be assessed in terms of their cognitive function and nutritional status.
Source of Subjects
Subjects of this study were selected from clusters of government and non-government
orphanages having orphans aged 7-12 years. Inclusion criteria in selecting the clusters of
orphanages included: (1) orphanages should be classifiable as government or non-government,
(2) orphanages should have children 7-12 years of age, and (3) orphanages should be
accredited or registered by DSWD or accrediting NGOs. As an exclusion criterion, orphanages
that did not comply or agree with the terms of the study were excluded.
Furthermore, inclusion criteria in selecting the elementary unit included: (1) orphans
should be 7-12 years and (2) orphans should have stayed in the selected orphanage for at least
three years. Likewise, orphans who did not comply or agree with the terms of the study were
excluded.
18
Sampling
The sample population was selected using a probability sampling specifically cluster
sampling. This type of sampling method is most appropriate for this study since the target
population is somehow limited. In addition, this is the most feasible method of sampling given
the current setup of orphans in the Philippines, in which they are enrolled in groups among
orphanages throughout the country.
In this type of sampling method, the population was first divided into clusters of
homogenous units that serve as the sampling unit. In this study, the clusters would be the
government and nongovernment orphanages having children 7-12 years of age. After which,
every element found in each sampling unit or cluster was drawn as elementary unit. In this case,
all orphans aged 7-12 years of age who will satisfy the inclusion criterion was drawn as
elementary unit and was assessed in terms of their cognitive function and nutritional status.
Step-by-Step Selection of Subjects
1.
A list of all orphanages in Cavite was acquired from DSWD and accrediting NGOs.
2.
The researchers looked into the inclusion criteria set for the sampling frame in order
to identify which among the list of orphanages were included in sampling.
3.
Out of the orphanages listed in the sampling frame, a specific number of orphanages
that was produced the sample size requirement was randomly selected thru generation of
random numbers. Selected orphanages that satisfy the exclusion criteria for sampling unit
were removed from the study.
4.
Orphans aged 7-12 residing in the selected orphanages that satisfy the inclusion
criterion were served as the elementary units and were assessed in terms of cognitive
function and nutritional status. Likewise, selected orphans who satisfy the exclusion criteria
for elementary unit were removed from the study.
19
Sample Size Estimation

Definition of the Variables Used in the Calculations
p1 estimate of the sample proportion of orphans in non-government orphanages

who are undernourished and who are assessed with poor cognitive function
p2 estimate of the sample proportion of orphans in government orphanages who

are undernourished and who are assessed with poor cognitive function
alpha the probability of the study to commit a Type I Error (reject a true null
hypothesis)
beta the probability of the study to commit Type II Error (fail to reject a false null
hypothesis)
Direction of the test the study is a two-tailed test.
Values from Review of Related Literature
p1 54.8 % underweight orphans (percent outcome among unexposed group)
p2 24.6% underweight orphans (percent outcome among exposed group)
alpha 0.05; 1 - : confidence level of 0.95
beta 0.20; 1 - : power of the study of 0.80
Two-tailed (sided) Test: 1.96 (based on T-distribution critical values table)

The value given for p1 was obtained from a previous cross-sectional study by Panpanich
et. al. entitled Are orphans at increased risk of malnutrition in Malawi? [21] while the value
given for p2 was obtained from the study conducted by the Philippines Food and Nutrition
Institute (FNRI) [22] as published in the Philippines Midterm Progress Report on the Millenium
Development Goals.
20
Designated values for alpha and beta were assigned as 0.05 and 0.20 respectively
giving a confidence level of 95% and a power of 80%. 1.96 corresponds to a T-distribution
critical values table for a one-tailed (sided) test.
Using the sample size generator of OpenEpi, at a confidence level of 95% and at the
power of 80%, the study required a total of 77 samples.
Operational Definition of Variables
Dependent Variables
In this research, the cognitive function and nutritional status of the sample population
was measured and served as the studys dependent variables.
Cognitive function is a mental parameter assessed generally through evaluating specific
criteria including learning, memory and attention. In this study, these criteria were measured
with recognized scales including Rey Auditory Verbal Learning Test (RAVLT) and Moss
Attention Rating Scale (MARS).
RAVLT is a word-list multiple-trial test for episodic declarative memory and learning
assessment. It usually consists of five learning trials of the same word list and an interference
list consequently [23]. Participants with higher scores were interpreted as having better episodic
memory and learning. However, there are no available scale scores in this test as stated in
National Institute of Health Toolbox [24]. The scores were interpreted based on measure
raw/computed score statistics presented by NIH Toolbox normative data per age group (8, 9,
10, 11, 12) as shown in the table below (Table 2). Participants having scores higher than the
standard mean represents good episodic memory and learning, whereas scores lower than the
standard mean represents poor episodic memory and learning [24].
21
NIH Toolbox Auditory Learning (Rey) Test

Mean
Standard Deviation
Age groups
Males
18.59
3.07
Age 8
Females
20.66
3.55
Total
19.57
3.36
Males
21.20
3.53
Age 9
Females
21.55
2.48
Total
21.33
3.04
Males
21.24
4.27
Age 10
Females
23.76
2.72
Total
22.25
3.65
Males
23.76
3.14
Age 11
Females
25.80
2.33
Total
24.42
2.88
Males
24.55
3.11
Age 12
Females
25.54
3.40
Total
25.02
3.25
Table 2. NIH Toolbox normative data per age group (8, 9, 10, 11, and 12)
MARS is a tool composed of 22 items that utilizes a 5-point Likert scale that indicates
the degree to which an item describes a patients behavior from definitely true to definitely
false with mid-range ratings of true, for the most part, sometimes true, sometimes false and
false, for the most part. Items include phrases that reflect both good and impaired attention so
that a higher score reflects better attention whereas a low score reflects poor attention [25].
After the assessment of learning, memory and attention, cognitive function was
classified into poor or good cognition. A child was considered as having good cognitive function
if he/she would mean scoring satisfactory on both the tests whereas a child was considered as
having poor cognitive function if he/she has a mean scoring below the standard for at least one
of the tests used.
22
Nutritional status, on the other hand, is a physical parameter, measured through

methods including physical and dietary assessment and anthropometry, which is usually utilized
as a general indicator of physical health. In this study, anthropometric methods was employed in
order to evaluate nutritional assessment and to identify if the participants are malnourished or if
their nutritional status is adequate for their age. Definition of malnourishment and adequate
nourishment will depend on the anthropometric standards for Filipino child of a specific age
group including standards for BMI, weight and height for age, and skinfold test.
Skin Fold thickness had been associated with studies of nutritional status, body
composition and relative subcutaneous fat distribution. Unfortunately, there are no ideal
references for percentiles of skin fold thickness test that would classify a number below or
above the norm. Studies suggest taking the mean as the reference. Numbers below the mean
of the percentile range are under the standard and numbers greater than mean of the percentile
range are classified as above the standard [26].
For the weight and height for age and BMI, a set of standard means was used as
reference. According to the Centers for Disease Control and Prevention, underweight is defined
as less than the fifth percentile of the percentile range. Healthy weight is defined as fifth
percentile to less than the 85th percentile of the percentile range. Overweight is defined as 85th
to less than the 95th percentile of the percentile range and obese is equal to or greater than the
95th percentile of the percentile range. [27]
Finally, for the over-all assessment of the nutritional status of the orphans, participants
were classified as to malnourished or well nourished. Malnourished children were those who
were considered underweight, overweight and obese children based on BMI, weight, and height
for age, and those who were considered above and below standard for the skinfold test.
Orphans having normal anthropometric measurements were considered well nourished.
23
Independent Variable
The type of orphanage where the study population will be coming from was used
primarily as the studys independent variable. The research looked at how the type of
orphanage shall affect the orphans cognitive and nutritional status. The type of orphanage was
classified into two categories including government and non-government orphanages.
Government orphanages are orphanages under the management of DSWD that admits
children that were abandoned, abused, and detained. Non-government orphanages are
orphanages instituted by private individuals based on volunteerism and funding.
Confounding Variables
In this study, confounding variables were identified as 1) the funding or budget
allocation, 2) health programs, and 3) educational programs being offered by the orphanages
under study.
Basically, funding is defined as the financial capital used by the orphanage to fund
their projects and to carry out institutional operations. The kind and quality of their services are
primarily based on the amount of funds collected and allocated for their activities. Majority of the
funding of these orphanages come from fundraisers, tax deductibles, and donations, both in
cash and in-kind.
On the other hand, health programs include basic health care and promotion of a healthy
lifestyle, which aim to ensure the health and overall well-being of the staff and the children living
in the orphanages. This may or may not include the psychological therapy, which addresses the
mental, emotional and psychological needs of the individuals residing in the orphanages.
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Lastly, educational programs aim to teach the children living in the orphanages basic
educational skills and knowledge that will equip them for the challenges and opportunities
available for their perusal. This may include skills to prep them before entering public school
and to be able to land jobs for the future.
Data Collection
Methods of Data Collection
This study has used three types of methods records review, observation and query
methods. Review of records was used to collect the demographic data of the study participants.
Interview method has facilitated successful RAVLT and MARS cognitive test among them.
Lastly, observation method (anthropometric measurements) was used to assess the subjects
nutritional status.
The use of records review to collect demographic data proves to be an efficient way to
collect standard information, offering anonymity for the participant and control for the
interviewer. Records had helped classify the study participants into those who are from
government orphanages and those who are from non-government orphanages and note their
length of stay in the particular orphanage.
Conversely, the use of interview method to facilitate successful RAVLT and MARS
cognitive test data collection was used because, given that our studys population consists of
children ages 7-12, this method has allowed the participants to clarify the questions, help
generate better answers, and provide the interviewer greater control and results with minimal
missing data. Training of the interviewers in conducting the survey properly and limiting the
interviewers to one particular comparison group is essential to maintain the accuracy of the
results.
25
On the other hand, the use of observation method particularly anthropometric tools is the
most convenient and most suitable tool for the assessment of the participants nutritional status.
The advantage of using this method is that height, weight and the other anthropometric
measurements has accurately measured thus, avoiding error in assessment and bias.
Lastly, so as to take note of the confounding variables, an interview was conducted with
the administrators of the orphanages in order to determine the budget allocation, health and
educational programs that they offer.
Sources of Data
Second hand data involving the orphans demographic data and discussing possible
confounders was coming from the orphanages wherein they are enrolled. Other data such as
cognitive function assessment and nutritional status of orphans was collected directly by the
researchers from the study participants.
Data Collection Tools
Cognitive Function Assessment
As discussed earlier, cognitive function of orphans was measured using recognized
scales including RAVLT and MARS.
Rey Auditory Verbal Learning Test
Verbal learning and memory was evaluated using the RAVLT. This tool is commonly
used to measure an individuals ability to encode, process, store, and retrieve information
[28]. It is an efficient neuropsychological tool for episodic declarative memory assessment,
which provides scores for: 1) immediate memory, 2) new verbal learning, 3) susceptibility to
interference (proactive and retroactive), 4) retention of information after a period of time, and
5) memory recognition [29].
26
RAVLT was performed by showing the participants a particular word list and after a
certain period, participants were asked to recall it (Trial 1). After some delay or recognition
task, participants were once again asked to recall the first list (Trial 2) and so forth.
Repeated presentation of word list to its corresponding trials at different time intervals
enables one to evaluate various learning processes: acquisition, retention, retrieval and
interference [23].
In this study, translation to the local language and revision of the RAVLT tool was
deemed important to make the process more applicable to the study participants. However,
the researchers followed the same guidelines from the original tool wherein the choice of
word list to be given has not presented words of more than two syllables. In addition, all of
the words from the list has frequently used in the local language, Filipino, and was
appropriate, thus, common among the population age.
Previous researches had shown limited importance in the statistical aspect of the
normal population. Rather, studies have shown the correlation of Rey AVLT scores to
various demographic variables. Rey AVLT is sensitive to certain demographic variables,
such as age, gender, educational attainment, intelligence level or IQ, psychiatric condition,
brain trauma and influence of ones culture and/or society [23, 28].
Age
Based on a research conducted in Brazil, age has the greatest influence in the
Rey AVLT results among other factors. On that account, age is consideredstrongest
predictor of performance on all the Rey AVLT scores [28]. In a study conducted among
participants aged 19-85 years, aging individuals showed slower rate of learning and
improvement in repeated memory and learning [23]. This result may be attributed to the
27
individuals processing speed and frontal maturation of young individuals and

deterioration in older individuals [23, 30].
Gender
Previous researches have shown that gender has narrow importance in terms of
Rey AVLT results interpretation. However, consistent results were noted with females
outperforming males in Rey AVLT [30]. Moreover, women scored higher than men did
on some RAVLT scores, and some cut-offs could be made more stringent in women,
while five scores had to be made more lenient for men. [31]
Educational Attainment
Individuals with higher educational attainment outperformed those with lower
educational attainment [30]. Previous research states that 61 non-credible patients
scored significantly below 25 controls and 88 credible clinic patients with no motive to
feign on most RAVLT scores, including added indices of implicit and automatic
memory. A combination of true recognition + implicit memory score + automatic
memory score 22 was associated with 75.7% sensitivity with specificity at 91.5% [32].
Moreover, educational attainment appeared to moderate underperformance in noncredible subject. Less educated non-credible subjects appeared to fake more
Psychiatric Condition
Individuals with neurological impairment showed lower performance compared to
individuals without neurological dysfunction in Rey AVLT. Furthermore, Rey AVLT
scores showed to be insensitive to depression and anxiety [28]. Previous study states
that malingering RAVLT effort equation had a sensitivity of 73.8% and specificity of 90%
when using a cutoff of 12 [28].
28
Moss Attention Rating Scale

MARS as discussed earlier is an observational tool used to measure attentionrelated behaviors. It is composed of 22 items that utilizes a 5-point Liker scale that indicates
the degree to which an item describes a patients behavior [23].
Just as the RAVLT, translation was done with MARS so as the study participants
could be able to understand the process being undertaken. Moreover, the use of interview
method, as stated earlier, shall help the researchers clarify the questions to the participants.
Nutritional Assessment
Various anthropometric techniques including BMI, measures of height and weight and
skinfold testing were used in the conduct of the study.
Weight was measured using a weighing scale. For convenience, a regular bathroom
scale was used. However, the researchers ensured that scale was calibrated by aligning the
balance bar at zero. Participants were asked to empty their pockets and to remove their shoes
and heavy outer garments, such as jacket and coat. Participants were asked to stand at the
center of the weighing scale and weight was recorded.
Height was measured using a flexible, non-stretchable measure tape taped vertically to
the hard flat surface wall with the base at the floor level. Participants were asked to remove their
shoes and hair ornaments. The participants were positioned in such a way that the back of the
head, buttocks, calves and heels are touching the wall, the top of the external auditory meatus
is leveled with the inferior margin of the bony orbit, and with both feet together. Participants
were asked to look straight while height is being measured and recorded.
Body mass index (BMI) is a measure of weight in correlation to height. It is calculated as
weight in kilograms divided by the square of height in meters (kg/m2). BMI does not measure
29
body fat directly and is usually used as a measure to evaluate weight status in a population
across time, regions, or other population subgroups. It is a screening tool that identifies potential
weight problems in individuals. BMI levels can be correlated with imminent health risks and an
appropriate measure for screening for obesity in which high BMI implies future morbidity and
death. BMI is a simple, inexpensive, and noninvasive alternate measure of body fat. BMI is
considered as a proper indicator of total body fat, because it measures excess weight rather
than excess fat [33].
Other three commonly used indicators of childrens nutritional status are based on
weight and height measurements. These are weight for age, height for age and weight for
height.
The Food and Agriculture Organization stated that height for age and weight for height
represent two different biological processes. Weight for height index is sensitive to acute
nutritional disturbances; a low weight for height is described as wasting. Wasted children are
extremely thin as compared to their height. It is the result of rapid decrease in weight or failure
to gain weight because of an acute infection or deficient dietary or food intake. According to the
World Health Organization, it is an evidence of acute malnutrition [34].
Meanwhile, height for age index measures linear growth. Stunted children appear short
for their age. They may have normal body proportions but they do not look like their age,
sometimes younger. Inadequate nutrition or repeated infections or both could lead to stunting
over a period. Stunting could also be a result of a growth failure in the past [35].
Weight for age index represents a combination of the two processes. Underweight
children are too light for their age. It has been recommended that the prevalence data be
disaggregated by age whenever possible because of the different distributions of children under
the age of five [35].
Skinfold thickness is an easy method in assessing the percentage of body fat among
children. Body fat percentage is manifested in the subcutaneous layer. Skinfold thickness is
30
strongly dependent on the biological age of the individual because chemical composition of
body fat changes during maturation [36]. It is measured to the nearest 1 to 0.5 millimeters [37].
Measurements can be obtained at the biceps, triceps, subscapular and supra-iliac areas.
Skinfold thickness can be measured either on the right or left side of the body in a standing and
relaxed condition, subsequently there are no significant difference between measurements on
either side of the body. A Harpenden caliper or a Lange calipers are the usual used instruments
in measuring skinfold thickness.
The Harpenden Skinfold Caliper is a precision instrument designed for use in the
performance of Skinfold thickness measurements. It is marked under the Medical Devices
Directive 93/42/EEC for a Class 1 device with measuring function and is calibrated to National
Standards: Dial graduation of 0.20 mm, measuring range of 0 mm to 80 mm, measuring
pressure of 10 gms/mm2 (constant over range), accuracy of 99.00% and repeatability of 0.20
mm.
Lange caliper on the other hand, is the definitive instrument for many professionals
measuring skinfold thickness. This device is sturdy yet lightweight, made out of metal with an
anticorrosive coating. These calipers feature spring-loaded arms providing a constant standard
pressure of 10 gm/sq.mm over the operating range. Another feature of these calipers are
floating (pivoted) tips that can adjust to enable parallel measurement of skinfolds. The face area
is approximately 30 square mm. It is an easy-to-read scale that permits reading up to 60 mm
and accurate to +/- 1 mm. Recent studies exhibited no significant difference in the results
obtained using these two calipers [38].
In this method, the observer pinched the triceps or posterior mid-acromiale-radiale line
skinfold using the thumb and index finger. This area was located by placing the measuring tape
with the zero mark projected to the level of the acromiale in a perpendicular linear distance, not
including the curvature over the deltoid muscle. Then placed a caliper at 90 angle, 1-2 cm
lateral to the thumb and finger at a depth of mid-fingernail and record the measurement [36].
31
Plan for Data Analysis

Descriptive Statistics
Since this study involved a heterogeneous study population of orphans aged 7-12 years,
variables including sex, age, educational level and years of stay in the orphanage were first
analyzed before looking into the dependent and independent variables. Age measured in years
and years of stay was classified as ratio, whereas sex (male or female) and educational level
(primary or secondary) were classified as nominal or categorical variables.
For the independent variable, the type of orphanage where the study participant is
enrolled in was identified. This variable was assessed as to government or non-government
orphanage and was classified as a nominal variable.
The dependent variables studied were cognitive function and nutritional status. Cognitive
function was generally described as to having poor or good cognition and was classified as a
nominal variable. This variable, however, was assessed using standardized tools including
RAVLT and MARS. These tools involved quantitative variables which were classified as ratio.
Nutritional status, on the other hand, will be generally described as to well nourished and
malnourished (includes undernourishment and over-nourishment) and were classified as a
nominal variable. This variable was assessed by anthropometric measurement. Weight in kg,
height, and skin-fold thickness in cm obtained were all classified as ratio. From the
measurements of height and weight, BMI for age, weight for height, height for age, and weight
for age were assessed as to normal or abnormal (wasted, stunted, underweight, overweight)
and were then classified as a nominal variable.
Confounding variables including funding or budget allocation, health programs, and
educational programs were assessed as to adequate or inadequate, classifying them as
nominal variables.
32
Measure of Disease Frequency

Disease in this study was identified as to having poor cognitive function and
malnourishment. Poor cognitive function was described as having a RAVLT or MARS score
which was lower than the mean of the study population by 2 standard deviations (<-2SD),
whereas, malnourishment was described as having assessed as wasted, stunted, underweight
or overweight or having skin-fold test and MUAC of less than or greater than 2SD from the
mean of the study population.
Measure of disease frequency used in this study would then be the prevalence of
orphans having poor cognitive function and malnourishment. Ratio, distribution frequencies and
proportion for nominal variables were also be presented in the study.
Measures of Central Tendency
Since this study involved nominal dependent and independent variables and was
generally categorical in nature, the measure of central tendency most appropriate for the overall data would be mode. However, this study used other measures of central tendency for the
other variables such as mean and median for variable classified as ratio. (Table 5)
Measures of Dispersion
The best measure of dispersion used in the analysis of the over-all data of this study
was variation ratio as it is the most appropriate measure used for nominal variables. This was
simply described the proportion of cases which were not included in the modal category and
were calculated as one minus the proportion of all cases in the modal category. Still, this study
would use other measures of dispersion for the other variables such as standard deviation for
the cognitive function test and anthropometric measurements summarized in Table 5.
33
Measure of Association
Having a cross-sectional type of study, the measure of association undertaken in this
research was Prevalence Ratio. This was computed by dividing the prevalence of orphans
having poor cognitive function and malnourishment among those who are in government
orphanages to that of those who are in non-government orphanages.
Cognitive Function
Type of Orphanage
Poor (+)
Good (-)
Government
(+)
Non-Government
(-)
TOTAL
Table 3. Two by two dummy table for data analysis of cognitive function
Nutritional Status
Malnourished (+)
Well-nourished (-)
Type of Orphanage
Government
(+)
Non-Government
(-)
TOTAL
Table 4. Two by two dummy table for data analysis of nutritional status
TOTAL
264
TOTAL
264
Prevalence of orphans with poor cognition/malnourishment in government orphanages

Prevalence Ratio = -------------------------------------------------------------------------------------------------------------------------------Prevalence of orphans with poor cognition/malnourishment in non-government orphanages
Interpretation:
PR = 1:
Cognitive function or nutritional status of orphans in non-government orphanages and

in government orphanages does not significantly differ; therefore, cognitive function
or nutritional status and type of orphanage are not related/associated.
PR > 1: Cognitive function or nutritional status of orphans in government orphanages is

inferior to those of orphans in non-government orphanages; therefore, cognitive
function or nutritional status and type of orphanage are related/associated.
PR < 1:
Cognitive function or nutritional status of orphans in government orphanages is

superior to those of orphans in non-government orphanages; therefore, cognitive
function or nutritional status and type of orphanage are related/associated.
34
Qualitative or
Quantitative
Scale of
Measurement
Measures of
Frequency
Quantitative
Qualitative
Qualitative
Quantitative
Ratio
Nominal
Nominal
Ratio
Frequency Distribution
Sex Ratio
Identified as government or
non-government
Qualitative
Nominal
Assessed as good or poor
Qualitative
Nominal
Prevalence of poor
cognition
Quantitative
Quantitative
Ratio
Ratio
Qualitative
Nominal
Quantitative
Quantitative
Quantitative
Quantitative
Quantitative
Qualitative
Ratio
Ratio
Ratio
Ratio
Ratio
Ordinal
Qualitative
Qualitative
Nominal
Nominal
Qualitative
Qualitative
Qualitative
Nominal
Nominal
Nominal
Frequency
Frequency
Frequency
Variable
Age
Sex
Educational Level
Years of stay in the
Orphanage
Independent Variable:
Type of Orphanage
Dependent Variables:
Cognitive Function
RAVLT Score
MARS Score
Nutritional Status
Height
Weight
Skinfold Test
MUAC
BMI
BMI-for-age/ weightfor age
Weight for height
Height for weight
Confounding
Variables:
Funding/Budget
Health Programs
Educational Programs
Measurement Process
Measured in years
Identified as male or female
Primary or secondary
Measured in number of years
Measured in number of points

Standardized scale/Logit
scoring
Assessed as
well/malnourished
Measured in cm
Measured in kg
Measured in cm
Measured in cm
Calculated as kg/m2
Assessed as underweight,
normal, or overweight
Assessed as wasted or normal
Assessed as stunted or
normal
Adequate or inadequate
Measures of
Central
Tendency*
Mean
Measures of
Dispersion
Standard Deviation
Mean
Standard Deviation
Range
Mean
Mean
Standard Deviation
Standard Deviation
Mean
Mean
Mean
Mean
Mean
Standard Deviation
Standard Deviation
Standard Deviation
Standard Deviation
Standard Deviation
Prevalence of
malnourished
Table 5. Summary of Descriptive Statistics

*Median will be also noted for ratio variables which will include outlier
35
Inferential Statistics
Plan for Hypothesis Testing
This study, as stated earlier, aims to compare the cognitive function and nutritional
status of orphans in government and in non-government orphanages in Cavite. In order to make
inferences about the population, the following steps in hypothesis testing shall be undertaken:
1.
Statement of the null (Ho) and alternative (Ha) hypothesis

Ho: Cognitive function and nutritional status of orphans in non-government orphanages and
in government orphanages do not significantly differ; or (Xng = Xg).
Ha: Cognitive function or nutritional status of orphans in non-government orphanages and in
government orphanages do significantly differ; or (Xng Xg).
H0 TRUE
STATE OF NATURE
H0 FALSE
Cognitive function and nutritional
status of orphans in non-government
orphanages and in government
orphanages do not significantly differ.
(Correct Assessment)
FAIL TO
REJECT H0

status of orphans in nongovernment orphanages and in
government orphanages do not
significantly differ.
(Correct Assessment)

status of orphans in non-government
orphanages and in government
orphanages do not significantly differ.
(Type II Error Beta)
DECISION
REJECT H0

status of orphans in nongovernment orphanages and in
government orphanages do not
significantly differ.
(Type I Error Alpha)
Table 6. Statement of Null and Alternative Hypothesis
36
2. Setting the level of significance

The level of significance used in acquiring the sample size and in the interpretation of
results of this study is set at 0.05. This value is intended to lessen the probability of committing
a type 1 error specifically, the chance of rejecting a true null hypothesis.
3.
Determination of the most appropriate test statistic

Since this study requires the comparison of two independent groups (government and
nongovernment orphanages) which are assessed in a nominal scale (nutritional status and
cognitive function), an appropriate test statistic to be used is the Chi-square (X2 Test of
Homogeneity).
Moreover, since this study used quantitative variables to assess the cognitive function
and nutritional status of the orphans (RAVLT and MARS scores, anthropometric measurements)
and involved comparison of means, another test statistic that used in hypothesis testing was the
T-test.
4.
Application of statistical test to the data and determination of either critical

value/region or the p-value
Using the 2x2 table of variables shown earlier (Table 2 & 3), Chi-square (X2) value may
be computed using the formula:
Using the Table of Area of X2 Distribution, the researchers obtained the critical value by
looking for the corresponding value for the level of significance (0.05) and degree of freedom
computed by df = (r-1)(c-1), where r is the number of rows and c is the number of column. In this
37
study, df = (2-1)(2-1) = (1)(1) = 1. Thus, at df = 1 and level of significance = 0.05, the critical
value is set at 3.841.
The calculated chi-square value was compared with the critical value, determining if the
null hypothesis will be rejected or will not be rejected. Moreover, every statistical test has its
corresponding p-value which may also aid in the formulation of the statistical decision.
5.
Making a statistical decision

Using the calculated chi-square value and the critical value, the null hypothesis should
be rejected if the computed chi-square value falls in the critical region (3.841), otherwise, it
should not be rejected.
Also, the null hypothesis should be rejected if the statistical p-value was less than the
alpha value (0.05), meaning the test is significant, whereas, the null hypothesis should not be
rejected if the statistical p-value was greater than the alpha value (0.05), meaning the test is not
significant.
6.
Drawing a conclusion
A conclusion on the significance of the test variable drawn based on the statistical
results and interpretation. If the statistical decision was to reject the null hypothesis, then it is
imperative to conclude that: The cognitive function and nutritional status of orphans in nongovernment orphanages and in government orphanages do significantly differ.
Nevertheless, if the statistical decision was not to reject the null hypothesis, the conclusion shall
be, The cognitive function and nutritional status of orphans in non-government orphanages and
in government orphanages do not significantly differ.
38
Plan for the Estimation and Interpretation of Data
Confidence Interval Adjusted Prevalence Ratio

As this study aims to compare the cognitive function and nutritional status of orphans in
government and non-government orphanages in Cavite, the prevalence ratio was obtained.
However, because of random errors including sampling error and error due to chance, this study
was not 100% conclusive, thus, the need for the formulation of confidence interval. In this case,
the adjusted prevalence ratio (confidence level = 95%) was computed as follows:
With this, data was interpreted as, The researchers are 95% confident that the true
prevalence ratio lies between values x and y. Moreover, if the 95% confidence interval did not
include one, then the PR is considered statistically significant.
Difference Between Two Means

Comparing the quantitative variables used in the assessment of cognitive function
and nutritional status of orphans in this study was involved obtaining difference between two
means. Thus, with confidence level set at 95%, the formula used was:
Data was interpreted as follows: eg. With 95% confidence level, the difference between
the mean RAVLT score of orphans from government and non-government orphanages is x
points.
39
ETHICAL CONSIDERATION
Study Procedure and its Recognized Risks
All procedures and methodologies of data collection was evaluated and proceed under
the approval of the Ethical Board. This study was consisted of 1) review of records of the study
participants, 2) interview session with them, and 3) anthropometric assessment among them.
The researchers assessed the cognitive function as using standard tools RAVLT and MARS.
Conversely, nutritional status was assessed using methods of physical anthropometry.
The study population undergone 2 sessions. The first session took about 10-20 minutes
for taking the cognitive function as to memory, learning capacity, and attention span using the
cognitive function tests. The second session took 5- 10 minutes for taking the nutritional status
using physical anthropometry.
The investigator did not observe more than minimal risks from the involvement in this
study. These risks were similar to those experienced when disclosing information to others.
However, the topics in the survey may upset some respondents. Also, the anthropometric
measurement done may not be comfortable to some. In addition, the participants were asked to
empty their pockets, remove their slippers and anything heavy with them. They were not
required to remove their clothes. Anyone may decline to answer any or all questions and may
terminate his/her involvement at any time if he/she opt to.
Purpose of the Study
The institution may use the information obtained from this research in conducting
guidelines and evaluating the services that they provide. It may also give the idea of things that
might be lacking in the institution and things that could serve as opportunities for improvement.
Results and analysis was given to the administration to serve this purpose.
40
Confidentiality
Every effort was made by the researchers to preserve confidentiality and anonymity
including the following: (1) Code names/numbers were assigned for each participant. These
code names/numbers were used on all the researchers notes and documents throughout the
research. (2) Notes, interview transcriptions, and transcribed notes and any other identifying
participant information were kept in a locked file cabinet in the personal possession of the
researchers' group leader. (3) When no longer necessary for research, all of the said materials
were destroyed.
Study Participation
The participation of the children as a research subject in this study was entirely
voluntary. If the institution did not wish to participate in this study or discontinue its participation
at a later time, they may freely do so. Minimal risks may arise during the progress of the study,
and every effort was made to minimize those risks. Participation in this study was free of cost.
There was no monetary compensation, rather there were snacks and drinks provided during the
interview phase.
Lastly, the researchers secured the informed consent1 of the administration of the
selected orphanages where participants taken. This was very essential as the administration
serves as second parents to the orphaned children. But since this study involved children aged
7-12 years, individual participants were given assent forms as to confirm their willingness to
participate in this study and to make them understand what procedures will be done to them.
Sample of Informed Consent is presented at Appendix B and Assent Forms at Appendix C.
41
Intervention
Should there be significant findings of malnutrition and poor cognitive function of the
orphans, the group intended to report these results to the orphanage administration for further
evaluation and supportive action. The group also suggested nutritional intervention that may
help the orphanage.
42
RESULTS
Study Population
A total of 77 orphans (101.31% of the required sample size) from different orphanages of
the province of Cavite were included in the study. Among the respondents, 49.35% were from
non-government orphanages (In Joy Childrens Home and Childrens Joy Foundation, Inc.) and
50.65% were from government orphanage (DSWD- Bahay Tuluyan ng mga Kabataan).
Majority (62.67%) of the orphans were females. Only 37.33% were males (Table 7).
There were only about six male orphans for every ten female orphans in the population group.
The mean age was noted to be 10.53 years (Range:12.24-8.90; SD 1.64) (Table 7).
Half of them were below and half were above 11 years old. Majority of them were 12 years old.
Table 7. Frequency Distribution of the profile of the Orphans from Selected Government
and Non-government Orphanages of Cavite, 2015
Variable
Frequency
Total (N)
77
Type of Orphanage
Government
39
Non-government
38
Sex
Male
28
Female
47
Age (years)
8
18
9
5
10
5
11
15
12
34
%
100
50.65
49.35
37.33
62.67
23.38
6.49
6.49
19.48
44.16
43
Nutritional Status
The nutritional status of the respondents was determined through anthropometric
measurements such as Body Mass Index-for-age (assessed as normal or wasted), weight-forage (assessed as underweight, normal, overweight), height-for-age (assessed as normal or
stunted) and total body fat (skinfold thickness test).
The mean weight in kilograms of the orphans under study was 30.21 (Range:40.4719.96; SD 10.25) (Table 10). According to Weight-for-age, 35.06% of the orphans were
underweight, 63.64% were normal and 1.30% were overweight (Table 8). The mean height was
noted to be 1.33 meters (Range:1.48-1.19; SD 0.15) (Table 10). About 51.95% of the orphans
were stunted and about 48.05% were normal according to height-for-age (Table 8).
The mean BMI was computed as 17.54 kg/m2 (Range: 20.00-13.11; SD 7.00) (Table
10). According to BMI-for-age, 66.23% were normal while 33.77% were wasted (Table 8). The
mean Skinfold Thickness was measured at 21.22 mm (Range: 13.0029.44; SD 8.22) (Table
10). According to the skinfold test, majority (84.42%) were having normal total body fat,
whereas, 15.58% were below normal (Table 8).
Table 8. Nutritional Status of Orphans from Selected Orphanages of the Province of
Cavite according to BMI-for-age, Weight-for-age, and Height-for-age, 2015
Variable
Total (N)
Weight-for-age
Underweight
Normal
Overweight
Obese
BMI-for-age
Normal
Wasted
Height-for-age
Normal
Stunted
Skinfold Test
Normal
Below Normal
Frequency
77
%
100
27
49
1
0
35.06
63.64
1.30
0.00
51
26
66.23
33.77
37
40
48.05
51.95
65
12
84.42
15.58
44
For a respondent to be considered as being well-nourished, he/she must be classified as

normal under all the given criteria. For those who are under non-government orphanages, the
prevalence of well-nourished orphans was 21.05%, while for those under government
orphanages, the prevalence of well-nourished orphans was 38.46%. Thus, the prevalence of
malnutrition among the orphans under non-government orphanages and government
orphanages were 78.95% and 61.54%, respectively (Table 9).
Table 9. Frequency Distribution of Malnourished and Well-nourished Orphans from Selected

Government and Non-government Orphanages of Cavite, 2015
Nutritional Status
Malnourished
Well-Nourished
Study Population
(n = 77)
Frequency
54
23
%
70.13
29.87
Government
Orphanages
(n = 39)
Frequency %
24
61.54
15
38.46
Non-government
Orphanages
(n=38)
Frequency
%
30
78.95
8
21.05
The quantitative variables used in the assessment of nutritional status were compared
by identifying the difference between two means. The appropriate test statistic utilized to identify
the significance of the difference was the t-test. Using computer-generated data, the degree of
freedom (df) was identified as 75 and the critical region was set to t 1.96 or t -1.96.
Moreover, p-value was compared to the alpha value (0.05) to further identify the significance of
the test. Table 10 summarizes the mean values and standard deviation of the quantitative
variables used in the assessment of nutritional status.
Table 10. Means and Standard Deviation of the Quantitative Variables Used in the Assessment
of Nutritional Status among Orphans from Selected Orphanages of Cavite, 2015
Study Population
(n = 77)
Variables
Weight (kg)
Height (m)
Body Mass Index
Skinfold Thickness
Mean
30.21
1.33
17.54
21.22
SD
10.25
0.15
7.00
8.22
Government
Orphanages
(n = 39)
Mean
SD
34.87
11.53
1.37
1.16
18.02
3.68
19.62
5.76
Non-government
Orphanages
(n=38)
Mean
SD
25.43
5.74
1.30
0.12
12.11
3.45
22.87
9.95
45
With 95% confidence level, mean difference between the mean BMI of the orphans from
government and non-government orphanages was 5.91 (LL: 4.29, UL: 7.53). The calculated Ttest was 7.27 which lies within the critical region and the p-value is <0.0000001 which is less
than the alpha value 0.05. Thus, the mean difference between BMI was deemed significant. On
the other hand, the difference between the mean Skinfold thickness, in 95% confidence level,
was -3.25 (LL: -6.93; UL: 0.43). The calculated T-test (-1.76) and p-value (0.08) denotes that the
difference is not significant. Moreover, mean difference between the mean weight of the
orphans from government and non-government orphanages was 9.44 (LL:5.29, UL:13.59). The
calculated T-test was 4.53 which lies within the critical region and the p-value is 0.0000459
which is less than the alpha value 0.05. Thus, the mean difference between weight was deemed
significant while the difference between height, in 95% confidence level, was 0.24 (LL:-0.14;
UL:1.27). The calculated T-test was 1.27 which lies within the critical region and the p-value is
<0.0000001 which is less than the alpha value 0.05 denotes that the difference is
significant.(Table 11).
Table 11. Mean Difference, T-test Results and P-values of Quantitative Variables Used in the
Assessment of Nutritional Status among Orphans from Selected Orphanages of Cavite, 2015
Variables
Weight (kg)
Height (m)
Body Mass Index
Skinfold Thickness
Mean Difference
Lower
Difference
Limit
9.44
5.29
0.24
-0.14
5.91
4.29
-3.25
-6.93
Upper
Limit
13.59
0.62
7.53
0.43
T-test
P-value
Analysis
4.53
1.27
7.27
-1.76
0.0000459
<0.0000001
<0.0000001
0.08
Significant
Significant
Significant
Insignificant
46
Cognitive Function
The presence of cognitive function was determined through the RAVLT and
MARS tests. The RAVLT was used to test the orphans verbal learning and memory while the
MARS test was used to test for attention. For a respondent to be classified as having good
cognitive function, he/she must score fairly on both test. Should the child perform poorly on
either one of the tests, the child is classified as having poor cognition. Among the respondents,
the prevalence of good cognitive function among the government and non-government
orphanages were 79.49% and 89.47%, respectively. The prevalence of poor cognitive function
among the government and non-government orphanages were identified as 20.51% and
10.53%, respectively (Table 12).
Table 12. Frequency Distribution of Good and Poor Cognitive Functions among Orphans
Cognitive Function
Poor
Good
Study Population
(n = 77)
Frequency
12
65
%
15.58
84.42
Government
Orphanages
(n = 39)
Frequency %
8
20.51
31
79.49
Non-government
Orphanages
(n=38)
Frequency
%
4
10.53
34
89.47
The mean RAVLT score obtained from the over-all population was 36.96 (SD 9.50).
Higher by a few points, the mean RAVLT score obtained from orphans from government
orphanages was 38.95 (SD 9.92), whereas, the mean score obtained from orphans from nongovernment orphanages was 34.92 (SD 8.71) (Table 13). On the other hand, the mean MARS
score obtained from the over-all population was 70.13 (SD 7.14). The mean MARS score
obtained from orphans from government orphanages was 70.54 (SD 6.90) and the mean score
obtained from non-government orphanages was 69.71 (SD 7.45) (Table 13).
47
Table 13. Mean and Standard Deviation of the Quantitative Variables Used in the Assessment
of Cognitive Function among Orphans from Selected Orphanages of Cavite, 2015
Study Population
(n = 77)
Variables
RAVLT Score
MARS Score
Mean
36.96
70.13
SD
9.50
7.14
Government
Orphanages
(n = 39)
Mean
SD
38.95
9.92
70.54
6.90
Non-government
Orphanages
(n=38)
Mean
SD
34.92
8.71
69.71
7.45
Given the parameters used in the analysis of nutritional status, the quantitative variables
used in the assessment of cognitive function were compared, as well, by mean difference. With
95% confidence level, the mean difference for the RAVLT scores was 4.03 (LL: -0.21; UL: 8.27).
The T-test value and P-values were 1.89 and 0.06, respectively, denoting insignificance. Lastly,
the mean difference for the MARS scores was 0.83 (LL: -2.43; UL: 4.09) with a T-test value of
0.51 and p-value of 0.61. This implies that the difference of the mean of the MARS scores
among government and non-government orphans was not significant (Table 14).
Table 14. Mean Difference, T-test Results and P-values of Quantitative Variables Used in the
Assessment of Cognitive Function among Orphans from Selected Orphanages of Cavite, 2015
Variables
RAVLT Score
MARS Score
Mean Difference
Lower
Difference
Limit
4.03
-0.21
0.83
-2.43
Upper
Limit
8.27
4.09
T-test
P-value
Analysis
1.89
0.51
0.06
0.61
Insignificant
Insignificant
48
Measures of Association
Prevalence Ratio for Nutritional Status
Table 15. Two by Two Table Analysis of the Nutritional Status of Orphans from
Type of Orphanage
Government (+)
Non-Government (-)
TOTAL
Nutritional Status
Malnourished (+) Well-nourished (-)
24
15
30
8
54
23
Point
Estimate
0.7795
-17.4089
Prevalence Ratio
Percent Difference
Total
39
38
77
95% Confidence Interval

Lower
Upper
0.5789
1.0496 (T)
-37.4381
2.6202 (T)
Prevalence Ratio = 0.78 (95% CI: 0.5789-1.0496)
The computed prevalence ratio was 0.78. The researchers were 95% confident that the
true prevalence ratio lies between the values 0.5789 and 1.0496 (Table 15). Since the
computed range includes 1, then the prevalence ratio is not considered statistically significant. It
is imperative to conclude that the nutritional status of orphans in non-government orphanages
and in government orphanages does not significantly differ; therefore, nutritional status and type
of orphanage are not related/associated.
Table 16. Chi-square test on the Prevalence of Malnutrition among Orphans from
Statistical Tests
Chi-square
1-tailed p
2-tailed p
Chi-square - uncorrected
2.785
0.09520
Chi-square - Mantel-Haenszel
2.748
0.09737
Chi-square - corrected (Yates)
2.016
0.15580
Mid-p exact
0.05214
0.10430
Fisher exact
0.07741
0.15480
49
The computed chi-square value (2.785) does not fall in the critical region (3.841).
Moreover, the computed p-value (0.0952) is greater than the alpha value (0.05) (Table 16). With
this, the null hypothesis shall not be rejected and the test is not significant. Therefore, the
nutritional status of orphans in non-government orphanages and in government orphanages
does not significantly differ.
Prevalence Ratio for Cognitive Function

Table 17. Two by Two Table Analysis of the Cognitive Function of Orphans from
Cognitive Function
Total
Type of Orphanage
Poor (+)
Good (-)
Government (+)
31
39
Non-Government (-)
34
38
12
65
77
TOTAL
Point
95% Confidence Interval
Estimate
Lower
Upper
Prevalence Ratio
1.9490
0.6397
5.936 (T)
Percent Difference
9.987
-6.007
25.98 (T)
Prevalence Ratio = 1.95 (95% CI: 0.6397-5.936)

The computed prevalence ratio was 1.95. The researchers were 95% confident that the
true prevalence ratio lies between the values 0.6397 and 5.936 (Table 17). Since the computed
range includes 1, then the prevalence ratio is not considered statistically significant. It is
imperative to conclude that the cognitive function of orphans in non-government orphanages
and in government orphanages does not significantly differ; therefore, cognitive function and
type of orphanage are not related/associated.
50
Table 18. Chi-square test on the Prevalence of Poor Cognitive Function among Orphans from
Statistical Tests
Chi-square
1-tailed p
2-tailed p
Chi-square - uncorrected
1.459
0.2276
Chi-square - Mantel-Haenszel
1.440
0.2307
Chi-square - corrected (Yates)
0.799
0.3715
Mid-p exact
0.1862
0.2489
Fisher exact
0.1244
0.3724
The computed chi-square value (1.459) does not fall in the critical region (3.841).
Moreover, the computed p-value (0.2276) is greater than the alpha value (0.05) (Table 18). With
this, the null hypothesis shall not be rejected and the test is deemed not significant. Therefore,
the cognitive function of orphans in non-government orphanages and in government
orphanages does not significantly differ.
51
DISCUSSION
Generally, the rate of occurrence of poor cognitive function can be attributed to methods
of teaching among the facilities, level of activity and age of the participants [39]. In the study, the
orphans from selected government and non-government orphanages of the province of Cavite
scored equally on both MARS and RAVLT tests (Table 14). Producing equitably almost the
same number of good and poor cognitive function test results (Table 12), this created no
significant difference between the two facilities. This may be attributed to the same level of
attention and education the children receive; as non-government orphanage children receive
their education from public schools and government orphanage children receive in-house
education. Although education has been received in different settings, the orphans receive
adequate and age-appropriate lessons.
Together with the basic education program, children from both facilities are also required
to take part in specific chores and activities such as singing and dancing to fill their daily
schedules. These activities enhance memory work and cognition as stated in a study by Carlier
et. al. on cognitive benefits of physical activity saying that performed sequential activities
produce the most important benefit in cognitive stimulation improving the mental capacities of
the children [40].
The comparison between the prevalence of cognitive function among orphans within
government and non-government institutions was elaborated by the results of the chi-square
test (Table 18) reporting no significant relationship between poor cognitive functions of the two
institutions. With this, the cognitive function test results are independent of the type of
orphanage the orphan came from. However, there are very limited studies that discuss cognitive
function differences between groups of children specially orphans, thus, the researchers could
not compare this result to that of the general statistics. Furthermore, baseline data for this topic
was also unavailable.
52
Based on the nutritional data of Filipino school-age children, it can be inferred that the
orphans under study are generally more undernourished than the general population. The
prevalence of underweight among the orphans under study was 35.06%, whereas, the
prevalence of underweight among Filipino school age children is only 23% [18]. Moreover,
66.23% of the orphans were stunted while only 32% of the general population is having low
height-for-age [18]. Furthermore, 51.95% of the orphans were wasted while only 21% of the
general population is having low BMI-for-age [18].
This result may be due to the fact that their main source of food solely depends on the
budget allocated by their respected institution and the donations given to them [41].
Furthermore, there were other factors that may affect the nutritional status of an individual, such
as dietary inadequacies (eating patterns and eating styles) )and lifestyle and environmental
factors [19]. In some orphanages, there is no systematic schedule for eating and the type of the
food they eat arent closely monitored. Case and point, weekend meals depended on whatever
food the volunteers bought in, often unhealthy and sugar-filled. Moreover, workers say eating
practices of some children were not fully established since some of them dont eat vegetables
and fish. The quality of facilities, staff training and staff to child ratio may also contribute to the
prevalence of malnutrition of orphans [41]. Assessment of the nutritional status of the orphans
were not monitored regularly, it is usually the housemother who monitors the health of the
orphans, but there were no schedule or system to it.
Aside from the point prevalence, it is also important to take note of the significance of the
differences between the means of the variables. With 95% confidence interval, the study noted
significant differences between the means of height (d= 0.24 m), weight (d= 9.44 kg), and BMI
(d= 5.91 kg/m2) of orphans from government and non-government orphanages. This might be
attributable to the fact that in the study, there were more orphans aged 11 to 12 years old in the
government (n=33) compared to the non-government orphanages (n=17). The researchers
53
believe that since the bulk of the older age group is in the government orphanages, this might
lead to higher means for height, weight and BMI in that orphanage; thus, the significant
difference.
Over all, the results of the study on prevalence ratio and chi-square test (Table 16),
show no relationship between the type of orphanage and nutritional status, as per the
parameters stated by the researchers. Generally, this was congruent with the previously
discussed literature by Panpanich et.al., stating that there was no significant difference in
nutritional status between different types of orphans. However, the prevalence of malnutrition
among the orphans under study (70.13%) is higher than that of the sudy by Panpanich et. al.,
stating only 54.8% malnutrition in orphanage children.
Conversely, the results portray a different situation versus the study conducted by
Wakoli et al. [21], which shows that between two groups of undernourished orphans, it was the
non-beneficiaries, or those that did not receive outside source of cash or food allocation other
than their household budget, who presented with higher wasting, underweight, and stunting.
Although the findings did not match up, the recommendation of Wakoli et al.s study suggests
that there should be increased training in adequate funding allocation should help boost the
nutritional status of children, which may promote greater delineation and or improvement in
showing a stronger relationship between the types of orphanages and nutritional status.
Generally, based on research observations, the similarity in the prevalence of
malnutrition between government and non-government orphanages may stem from various
factors. First in line is transient care. The orphans health care and nutritional status is not fully
maximized because of their impermanence in their living situation in addition to the fact that
many people handle them. Often impersonal, that the child is not closely monitored as they
should be. Next could be, institutional priorities. Working on a budget, may it be fixed from the
government or based on donations, may constraint allocations for proper nutrition, hospital and
54
even emergency care. Lastly, the lack of expertise of orphanage personnel in keeping a
balanced diet, and holistic approach to the childs welfare could also be a factor for both
orphanage types.
Similar to various researches, this study had also its boundaries and limitations. First
recognized limitation is the generalizability of the study. The study is being limited by time,
resources and most importantly of sources of the sample population. Due to these constraints,
the study only encompasses data from a small sample group, which could not fully represent
the actual situation of the humongous target population. It is also important to take note that
even though government and non-government orphanages follow a specific protocol, internal
arrangement on services they provide may also vary from every institution. In order to overcome
this limitation, the researcher carefully selected the institution where the sample population was
collected.
Another limitation of this study is the weak statistical correlation of a cross-sectional
study design. In such type of study design, the cause and effect relationship is weakly
associated. However, it was clearly stated in the objectives that the purpose of this study is to
compare the cognitive function and nutritional status of orphans in a government orphanage and
of those who are in a non-government orphanage. Thus, this study did not meant primarily to
identify a cause and effect relationship rather this would only identify if there is a significant
difference among the independent variables.
Furthermore, this study would not be free of the threats brought about by confounders
and other related factors affecting the variables. As discussed earlier, the dependent variables
may be a product of multi-factors including socio-economic factors and availability of concrete
health and educational programs. In addition, measurable dependent variables was also be
55
affected by other factors including age, environmental factors, etc. In order to overcome this, the
researcher discussed how these confounders affected the over-all results.
Lastly, the study was also exposed to threats of probable biases. The following are
biases that were encountered in the study:
Selection Bias
Unlike studies starting from a series of patients, there is often the need to select a
sample of subjects from a pool (study population) that can be very large in a cross-sectional
study. Obtaining a representative sample is crucial. With this, samples are sometimes picked by
convenience (being handy) and misleadingly reported as being a random sample. Such
samples are not actual representative of the target population and can result in serious bias.
The fact that there is only a limited source of sample population for this study may
already indicate a reduced selection bias. However, selection bias was further avoided by
ensuring that the researchers used random selection technique in selecting the respondents
among the children in the selected government and non-government funded orphanages.
Inclusion and exclusion criteria were also properly observed.
Observer Bias
Observer bias occurs when researchers alter the outcome of a study. This process is not
typically deliberate, and involves extremely subtle changes both in the way researchers interact
with subjects in the study and in what observers choose to see. This is might be because most
researchers know what they are studying and this might affect the overall judgment of the said
researcher.
56
In overcoming this bias, the researchers were grouped into two for the data collection.
One group were assigned for collecting information in government institutions and the other
group with the non-government institutions. Each group is blinded of each others results to
minimize the preconceptions about the study.
Measurement Error
Measurement error or bias in measurement are one of the easiest errors to commit in
research especially researches that need quantitative measurements. Errors in measuring
exposure or disease can be an important source of bias in epidemiological studies. In
conducting studies, therefore, it is important to assess the quality of measurements. An ideal
survey technique is valid. In the case of the study, the use of anthropometric measurements and
scaled questionnaires posed threats of measurement error. Errors involving this may alter
directly the observed dependent variables of the study.
In order to eliminate the measurement bias, days or weeks prior to data collection, the
group who were assigned especially in the anthropometric method were given special and
proper training and knowledge on the particular process. All the tools and scales used were also
in its proper calibration to ensure fair and orderly gathering of information.
Over all, albeit the study was not free of limitations and biases, the researchers tried
their best to limit it from affecting the validity of the research study.
57
CONCLUSIONS AND RECOMMENDATIONS
Having obtained a prevalence ratio of 0.78 (95% CI: 0.5789-1.0496; X2: 2.785, p-value:
0.0952) for nutritional status and a prevalence ratio of 1.95 (95% CI: 0.6397-5.936 ; X2: 1.459,
p-value: 0.2276) for cognitive function, it is imperative to conclude that, Cognitive function
and nutritional status of orphans in non-government orphanages and in government
orphanages do not significantly differ. This conclusion is similar to the previously discussed
literature by Panpanich et.al., stating that there was no significant difference in nutritional status
between different types of orphans.
With 95% confidence interval, the study also noted significant differences between the
means of height, weight, and BMI of orphans from government and non-government
orphanages. The researchers believe that this is attributable to how the orphans were
distributed according to age, wherein there are more orphans aged 11 years on government
orphanages who tend to have more height, weight and conversely, BMI. Moreover, the
differences between mean skinfold thickness, RAVLT, and MARS scores were deemed
insignificant.
As previously stated, the conclusion of this study is intended to aid in the improvement of
the quality of services that these institutions may provide. Thus, the researchers recommend the
use the results obtained from this study as basis for developing programs that could aid in the
improvement of these institutions services to the orphans.
The results of this study should also remind the caregivers the things they might lack in
their services, thus, the high number of malnutrition among orphans in both government and
non-government orphanages. This may also aid them in looking for better source of assistance
from public or private groups.
On the other hand, since, the study was not able to prove correlation between the type
of orphanage and nutritional status and cognitive function, it is recommended for future studies
58
to dwell with other factors that could directly affect the said dependent variables. These factors
may include health-seeking behavior of caregivers, availability of food and water supply or
adequacy of educational programs.
The researchers would also recommend to use other measuring tools to test the validity
of the test results such as the 24-hour food recall for nutrition and IQ tests for cognitive function.
Furthermore, future studies could also take note of the probable cause and effect of malnutrition
and poor cognition among orphans.
59
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65
APPENDICES
APPENDIX A: Data Collection Tool Sample
PERSONAL INFORMATION SHEET

NAME:
_________________________________________ CONTROL NO. ________
AGE:
_________
SEX: Male ____
Female ____
EDUCATIONAL ATTAINMENT: _______________________________
ORPHANAGE:
CLASSIFICATION:
_________________________________________
_________________________________________
YEARS OF STAY?
Less than 3 years (< 3 yrs)
More or Less 3 years ( 3 yrs)
Greater than 3 years (> 3 yrs)
______
______
______
___________________________________________________
NUTRITIONAL ASSESSMENT
CONTROL NO. _________
NAME:
SEX:
_________________________________________________
Male ____
Female ____
HEIGHT:
_______ cm
WEIGHT:
WEIGHT FOR HEIGHT ASSESSMENT:

HEIGHT FOR AGE ASSESSMENT:
WEIGHT FOR AGE ASSESSMENT:
_______ kg
[ ] Normal
[ ] Normal
[ ] Normal
AGE: _______
BMI: _________kg/m2
[ ] Wasted
[ ] Stunted
[ ] Underweight
[ ] Overweight
SKINFOLD THICKNESS: ____________
66
COGNITIVE FUNCTION TEST

Moss Attention Rating Scale
Instructions:
1. Read and explain the following scenarios below.
2. Using the numbers below, ask the participant which best represents the occurrence of the
following scenarios to the participant:
1 Hindi kailanman
2 Madalang
3 Paminsan-minsan
4 Madalas
5 Palagian
1. _______
Ako ay hindi mapakali sa tuwing walang ginagawa.
2. _______
Napapanatili kong tuloy-tuloy ang usapan nang walang iniisip na ibang bagay.
3. _______
Tinatapos ko muna ang isang gawain bago gumawa ng ibang bagay.
4. _______
Tinitigil ko ang kasalukuyang ginagawa para sa ibang mga gawain.
5. _______
Nakakalimutan ko ang mga bagay na kailangan ko kahit abot na sila ng aking paningin.
6. _______
Nagagawa ko ang gawain nang mas maayos tuwing araw at pagkatapos ng pahinga.
7. _______
Ako ang unang nakikipag-usap sa ibang tao.
8. _______
Nakakalimot akong tapusin ang isang gawaing naiwan ko.
9. _______
Napapatingin ako sa mga taong paparating.
10. _______
Nagpapatuloy ako sa isang gawain kahit na sabihan akong itigil ito.
11. _______
Hindi ako nahihirapan na tumigil sa isang gawain para simulan ang iba.
12. _______
Nakakapakinig ako ng ibang usapan kahit pa may kausap o ginagawa ako.
13. _______
Pinipili kong hindi gawin ang isang gawain kahit alam kong kaya kong gawin ito.
14. _______
Ang pagiging epektibo ko sa gawain ay nababawasan sa paglipas ng mailking oras.
15. _______
Ang gana ko sa paggawa ng gawain ay hindi pare-pareho sa bawat araw.
16. _______
Hindi ko napapansin ang mga bagay na nakakaapekto sa aking ginagawa.
17. _______
Pinag-iisipan ko ang mga bagay na lumipas na o mga nagawa ko sa nakaraan.
18. _______
Alam ko sa tuwing may mali sa ginagawa ko.
19. _______
Ako ang nagsisimula sa isang gawain nang walang nag-uutos.
20. _______
Tumutugon ako sa mga bagay na ibinabato sa akin.
21. _______
Mas nagagawa ko ang isang bagay kung ibinibigay nang mas mabagal ang panuto.
22. _______
Kinakalikot ko ang mga bagay na malapit sa akin kahit na wala naman silang kinalaman
sa gawain ko.
MARS COMPUTER GENERATED SCORE: ________
67
Rey Auditory Verbal Learning Test

Instructions:
1. Read the following words aloud.
2. Ask the participant to recall and recite the following words. (Trial 1)
3. Put a mark (/) on the corresponding words that were recalled by the participant.
4. Repeat steps 1-3 twice. (Trial 2-3)
5. Read the sentence below.
6. Ask the participant to recall and recite the following words again (Trial 4)
7. For the last time, read the following words.
8. Wait for 3 minutes before asking the participant to recall and recite the following words again.
(Trial 5)
9. Put a mark (/) on the corresponding words that were recalled by the participant.
TRIAL 1
TRIAL 2
TRIAL 3
TRIAL 4
TRIAL 5
[ ] Aso
[ ] Adobo
[ ] Aso
[ ] Aso
[ ] Aso
[ ] Kama
[ ] Bilog
[ ] Kama
[ ] Kama
[ ] Kama
[ ] Bilog
[ ] Papaya
[ ] Bilog
[ ] Bilog
[ ] Bilog
[ ] Hangin
[ ] Titser
[ ] Hangin
[ ] Hangin
[ ] Hangin
[ ] Paa
[ ] Damit
[ ] Paa
[ ] Paa
[ ] Paa
[ ] Damit
[ ] Unan
[ ] Damit
[ ] Damit
[ ] Damit
[ ] Papaya
[ ] Kama
[ ] Papaya
[ ] Papaya
[ ] Papaya
[ ] Titser
[ ] Hangin
[ ] Titser
[ ] Titser
[ ] Titser
[ ] Adobo
[ ] Aso
[ ] Adobo
[ ] Adobo
[ ] Adobo
[ ] Unan
[ ] Paa
[ ] Unan
[ ] Unan
[ ] Unan
Ako si Totoy/Nene. Mayroon akong alagang pusa. Madalas ko siyang kasama at kalaro. Mahal ko siya at
mahal niya ako. Palagi kaming masaya.
RAVLT TOTAL SCORE: _________
___________________________________________________
COGNITIVE FUNCTION ASSESSMENT
CONTROL NO. _________
NAME:
SEX:
_________________________________________________
Male ____
Female ____
AGE: _______
RAVLT TEST RESULT: _______________

MARS TEST RESULT: _______________
68
APPENDIX B: Informed Consent

INFORMED CONSENT FOR THE ADMINISTRATION
Title of Study:
The comparison of the cognitive function and nutritional status of orphans in government and
non-government orphanages of Cavite for the year 2014.
Background:
Your institution is being invited to take part in a research study conducted by Group 18 Section
B, Second Year Medical Students from De La Salle Health Sciences Institute. Before you
decide to participate in this study, it is important that you understand why the research is being
done and what it will involve. Please take time to read the following information carefully. Please
ask any of the researchers if there is anything that is not clear or if you need more information.
Principal Investigators:
Reginaldo, Michael Anthony B.
Luna, Keith Basil B.
Menil, Mary Joyce S.
Pingol, Gregory Gustav R.
Talens, Mary Erika Maxine A.
Uy, Maria Carmela C.
Vicente, Antonio Jose V.
Vigilla, Vega P.
Villanueva, Princess Jasmine D.
Wong, Chennie M.
0916-3873117
0916-3443897
0917-4924423
0917-3163077
0922-7826363
0917-8244191
0918-9511149
0927-9279847
0915-4889027
0917-8822235
Purpose of the study:

The study primarily aims to compare the cognitive function and nutritional status of orphans in
government and non-government orphanages of Cavite. This study shall contribute to the
researchers' completion of their Research Project as a partial requirement for the course in
Family and Community Medicine II. Any information that this study shall acquire is intended to
aid in the improvement of the quality of services that these institutions may provide in the future.
69
Study Procedure:
The researchers would like to involve orphans aged 7-12 years who currently live in your
institution for at least three years to be participants in this research study. The researchers
would like to review their records in order to check if they are qualified to be study participants.
The researchers would then give them questionnaires to assess their cognitive function as to
memory, learning capacity and attention. They would then assess their nutritional status by
anthropometric measurements including weight, height, and skinfold thickness.
Expected time commitment for this study:
The study participants will undergo 2 sessions: The first session will take 10-20 minutes for
taking the cognitive function tests Rey Auditory Verbal Learning Test (RAVLT) and Moss
Attention Rating Scales (MARS). The second session will take 5- 10 minutes for the
assessment of nutritional status using physical anthropometry.
Risks:
The investigator does not expect more than minimal risks from the involvement of your
constituents in this study. These risks are only similar to those you experience when disclosing
information to others. The topics in the survey may upset some respondents. Participants may
decline to answer any or all questions and you may terminate their involvement at any time if
they choose to.
Benefits:
Any information that this study shall acquire is intended to aid in the improvement of the quality
of services that these institutions may provide in the future.
Confidentiality:
Every effort will be made by the researchers to preserve the confidentiality and anonymity of the
participants including the following:
Code names/numbers will be assigned for each participant. These code names/numbers
will be used on all the researchers notes and documents throughout the research.
70
Notes, interview transcriptions, and transcribed notes and any other identifying
participant information will be kept in a locked file cabinet in the personal possession of
the researchers' group leader. When no longer necessary for research, all of the said
materials will be destroyed.
Voluntary Participation and Withdrawal:
The participation of your constituents in this study is entirely voluntary. If you or the children do
not wish to participate in this study or discontinue to a later time, you or they, may freely do so.
Unforeseeable Risks:
Minimal risks may arise during the progress of the study, and every effort will be made to
minimize those risks.
Costs to Participants:
Participation in this study is free of cost.
Compensation:
There will be no monetary compensation, rather there will be snacks and drinks provided during
the interview phase.
Person to Contact:
If you have any questions regarding the research, please feel free to contact the leader of this
group, Michael Anthony B. Reginaldo at 0916-3873117 or email at michaelreghie@gmail.com.
Institutional Ethics Review Board:
If you have questions regarding your rights as a research subject, or if problems arise which you
do not feel you can discuss with the Investigator, please contact the Institutional Ethics Review
Board Office, ________________________ at _____________.
71
Safety Agreement:
By signing this consent form, I confirm that I have read and understood the information and
have had the opportunity to ask questions. I have been given satisfactory answers to my
questions. I understand that our participation as institution is voluntary and that I am free to
withdraw at any time, without giving a reason and without cost. I understand that I will be given
a copy of this consent form. I voluntarily agree to take part in this study.
______________________________________
Name of Participant (Printed)
______________________________________
___________________
Name of Participant (Signed)
Date (MM/DD/YYYY)
___________________________________________________
Safety Agreement:
By signing this consent form, I confirm that I have read and understood the information and
have had the opportunity to ask questions. I have been given satisfactory answers to my
questions. I understand that our participation as institution is voluntary and that I am free to
withdraw at any time, without giving a reason and without cost. I understand that I will be given
a copy of this consent form. I voluntarily agree to take part in this study.
______________________________________
Name of Participant (Printed)
______________________________________
___________________
Name of Participant (Signed)
Date (MM/DD/YYYY)
72
APPENDIX C: Assent Form

(For orphans that have difficulty in reading, a member of the group shall guide the child to
facilitate complete understanding of the assent form.)
Magandang araw!
Kami po ay mga estudyante ng Medisina galing sa De La Salle Health Science Institute. Kami
ay gumagawa ng isang pag-aaral tungkol sa kalusugan sa katawan at isipan ng mga batang
katulad ninyo na may edad 7-12 na taong gulang, na inaalagaan ng bahay-ampunan.
Ikaw ay isa sa mga napili upang maging bahagi ng pag-aaral na ito. Kung may mga tanong ka,
huwag ka mahiyang lumapit sa mga ate at kuya na miyembro ng grupo na gumawa nito.
Sisiguraduhin namin na lahat ng impormasyong iyong binigay ay hindi malalaman ng iba.
Ano ang gagawin sa akin sa pagsasaliksik na ito?
Ikaw at ang iyong mga kasama ay kakausapin

ng aming grupo at bibigyan ng maikling survey. Ang
survey na ito ay patungkol sa iyong mental na
kakayahan tulad ng memorya at atensyon. May mga
bahagi ang survey kung saan may mga aktibidad
kayong dapat gawin na para lamang naglalaro.
Pagkatapos, ikaw ay kukuhanan ng timbang at ng

taas. Maaari lamang na tanggalin ang mabibigat na
bagay na iyong dala (halimbawa ay jacket, pitaka o
laruan) pati tsinelas o pangyapak bago kuhanan ng
timbang. Ito ay para makuha ang wasto mong timbang at
taas.
73
Gamit naman ang instrumenting kung tawagin

ay caliper, susukatin namin ang balat sa likod ng
iyong braso. Sinisuguro naming hindi kayo
masasaktan sa pagkuha nito.
Gaano karaming oras ang igugugol ko para rito?

Ang inyong partisipasyon ay aabot lamang sa humigit kumulang 30 minuto. Wala po
kayong dapat alalahanin sapagkat kami po ang pupunta sa inyo at di nyo na kailangan pang
maabala ng matagal.
Ako ba ay nakasisigurong ligtas sa paglahok sa pasasaliksik na ito?
Opo. Sa abot po ng aming makakaya ay sisiguraduhin po namin na kayo ay ligtas at
malayo sa anumang kapahamakan sa inyong partisipasyon sa pagsasaliksik na ito..
74
KASUNDUAN
Naintindihan ko ang mga bagay na aking gagawin bilang bahagi ng pag-aaral na ito. Kung
kayat binibigay ko ang aking buong suporta sa gawaing ito at pinahihintulutan kong maging
kaisa sa pagsasaliksik na ito.
_____________________________
Pangalan at Pirma ng bata
_____________________________
Pangalan at Pirma ng Tagapangalaga
_____________________________
Petsa
___________________________________________________
KASUNDUAN
Naintindihan ko ang mga bagay na aking gagawin bilang bahagi ng pag-aaral na ito. Kung
kayat binibigay ko ang aking buong suporta sa gawaing ito at pinahihintulutan kong maging
kaisa sa pagsasaliksik na ito.
_____________________________
Pangalan at Pirma
_____________________________
Petsa
75

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A CROSS SECTIONAL STUDY ON THE COMPARISON OF COGNITIVE FUNCTION AND

NUTRITIONAL STATUS OF ORPHANS AGED 7-12 YEARS IN GOVERNMENT

A Research Project presented to the

Adviser: Josephine M. Carnate, MD, MPH

Analytic observational cross sectional

Randomly selected government and non-government orphanages of Cavite

Prevalence of undernourishment and poor cognition among the orphans in

Orphans, cognitive function, nutritional assessment, government and nongovernment orphanages

ETHICAL CONSIDERATION ....................................................................................................40

Summary of Similar Studies

Two by two dummy table for data analysis of cognitive function

Two by two dummy table for data analysis of nutritional status

Summary of Descriptive Statistics

Statement of Null and Alternative Hypothesis

Frequency Distribution of the profile of the Orphans from Selected

Nutritional Status of Orphans from Selected Orphanages of the Province

Frequency Distribution of Malnourished and Well-nourished Orphans

Means and Standard Deviation of the Quantitative Variables Used in the

Mean Difference, T-test Results and P-values of Quantitative Variables

Frequency Distribution of Good and Poor Cognitive Functions among Orphans

Mean and Standard Deviation of the Quantitative Variables Used in the

Mean Difference, T-test Results and P-values of Quantitative Variables

Two by Two Table Analysis of the Nutritional Status of Orphans from

Two by Two Table Analysis of the Cognitive Function of Orphans from

Chi-square test on the Prevalence of Malnutrition among Orphans from

Chi-square test on the Prevalence of Poor Cognitive Function among Orphans

Conceptual framework showing the independent, dependent & confounding variables

Significance of the Study

Availability and access to food,

Prevalence and Distribution of Children being Orphaned in the Philippines

Exposure of Interest: Type of Orphanages

Disease of Interest: Cognitive Function and Nutritional Assessment

The nutritional assessment of an individual can be absolutely acquired through the

Factors Affecting Cognitive Function and Nutritional Status

Review of Similar Studies

National survey for nutrition.

The prevalence of wasting,

There is a significant increase of children

There was no significant difference in

Table 1. Summary of Similar Studies

Definition of the target population

Choosing of the study population

Classifying into disease and exposure status

Computing for measure of association

Interpreting the measure of association

Schematic Diagram of the Research Design

Study Population, Sampling and Sample Size

Sample Size Estimation

p1 estimate of the sample proportion of orphans in non-government orphanages

p2 estimate of the sample proportion of orphans in government orphanages who

Direction of the test the study is a two-tailed test.

Values from Review of Related Literature

p1 54.8 % underweight orphans (percent outcome among unexposed group)

p2 24.6% underweight orphans (percent outcome among exposed group)

alpha 0.05; 1 - : confidence level of 0.95

beta 0.20; 1 - : power of the study of 0.80

Two-tailed (sided) Test: 1.96 (based on T-distribution critical values table)

Operational Definition of Variables

NIH Toolbox Auditory Learning (Rey) Test

Nutritional status, on the other hand, is a physical parameter, measured through

individuals processing speed and frontal maturation of young individuals and

Moss Attention Rating Scale

Plan for Data Analysis

Measure of Disease Frequency