Community Medicine 2 - Output 4 (Sampling Method) Community Medicine15-B Members: Matel, Maria Carolina Nazareno, Christine Panghulan, Aldee

Ray Parao, Angelo Reyes, Kevin Sampelo, Ma. CarmelaA. Tee, Jan Raemon

I. II.

GROUP15-B, JOSEPHINE M. CARNATE,MD, MPH RESEARCH QUESTION AND OBJECTIVES A. Research Question Is the prevalence of malnutrition higher in street children compared to institutionalized children in orphanages located in Paco, Manila during the year 2011? B. Objectives i. General Objectives To be able to compare the prevalence of malnutrition among street children and institutionalized children in orphanages located in Paco, Manila during the year 2011. ii. Specific Objectives 1.To determine the body mass index (BMI) of street children and

institutionalized children living in orphanages. 2.To compare the Body Mass Index (BMI) of street children and institutionalized children living in orphanages. 3.To correlate the absence or presence of biological parents to the frequency of malnutrition among street children and institutionalized children in orphanages.

Research Design:

Type of study to be employed

A cross-sectional type of study will be utilized to identify the relationship between being in an orphanage and/or being in the street and the prevalence of malnutrition.

Definition of study population/study groups and source of subjects

Children, both male and female, ages 6 to 10 would be the target subjects of this study. They will be randomly selected from a study population which will come from an orphanage in Paco, Manila (for the representatives of the Institutionalized children). To represent street children, the areas within the vicinity of the orphanage will be surveyed to build the sample population. This is done to eliminate any factors and variables which may affect the outcome of the study like the availability of certain food groups, environmental hazards, degree of pollution et cetera.

Steps to be undertaken/ Procedure to be followed

The samples from the aforementioned locations would be randomly numbered and selected using a randomizer (table of random numbers or automated random number generator) to eliminate selection bias. The heights and weights would be determined using a standard balance and height meter respectively. Survey questionnaires would also be given out
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to the parents and care takers of the orphanages. The data gathered from the questionnaires would be sorted, analyzed and by statistics association of the risk factors involved in acquiring malnutrition for the institutionalized and street children would be done.

Schematic Diagram of the Research Design

Street Child (+) malnutrition

Institutionalized Children and Street Children

Street Child (-) malnutrition

Randomly selected children ages 6-10

Institutionalized Child (+) malnutrition Institutionalized Child (-) malnutrition

Biases/Limitations

Much consideration had been given to the selection of the ages from 6 to 10 primarily which is the facilitation of the measuring of the heights and weights to determine accurate Body-mass indices. This range has also the advantage of being able to confirm and validate certain information from the survey questionnaires which in most cases will be answered by the parents or care takers of the orphanage. Likewise, the degree of cooperation tends to increase from ages 6 and up. Therefore the study was decided to be limited to this age range. Another limitation to this study is the inability of the researchers to determine and eliminate confounders like inherent defects in metabolism which may significantly affect the outcome of the study. Likewise, the difficulty of defining and determining factors such as crowding limits the study to some extent. Other quantitative determinants of malnutrition will also not be
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included in this study which will solely rely on BMI data to report malnutrition. The extent of association between the availability of some food groups, presence of pollution and other variables would not be discussed intensively but their individual possible contribution to malnutrition would be thoroughly discussed. Selection bias may follow the tendency of the researchers to opt for malnourish-looking individuals in hopes of generating a large sample population with a very high percentage of positive malnutrition. This will be circumvented by using random selection of samples from the representative population. Study Population The focus of this study is the population of Street children and Institutionalized children in Paco, Manila.

Sample population

An orphanage is chosen by location as approved by Esperanza C. Gutierrez, the president of the Associacion de Damas Filipinas, Inc. Settlement Homes in Paco, Manila. Through simple random sampling 50 children (the sample population) will be selectedusing the inclusion criteria: (1) is a Filipino citizen; (2) ages between 6-10 years old; (3) has stayed in the orphanage for atleast 6 months. For the sampling of street children, selection will be based following these criteria: (1) works on the street with a shelter to go to at the end of the day (Children on the Street) and/or works on the street without a shelter to go to at the end of the day(Children of the Street); (2) within 3 km radius of the named orphanage; (3) ages between 6-10 years old. Exclusion criteria for
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both samples include; the child has pre-existing and/or an illness during selection; has no consent from the parents or guardian as well as the childs consent if he/she is 7-10 years of age.

Sampling frame

A list of all the names of the orphans in Associacion de Damas Filipinas, Inc. Settlement Homes in Paco, Manila staying, at the least, since March 2011 as certified by the administration of the aforementioned orphanage. For the street children, whenever applicable (Children on the Street), the names will be verified through the local barangay unit, otherwise the list of names will be generated through personal interviews.

Sampling Unit

This will be taken from the study population, Filipino orphans, ages 6-10, from Associacionde Damas Filipinas, Inc. Settlement Homes, who stayed for at least 6 months(Institutionalized children). For street children, Filipinos ages 6-10 living within a 3 km radius from the orphanage will be selected.

Elementary Unit Filipino orphans, ages 6-10, from Associacion de Damas Filipinas, Inc. Settlement Homes, who stayed for at least 6 months(Institutionalized children). For street children, Filipinos ages 6-10 living within a 3 km radius.
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Selections Subjects The target population of the study is the institutionalized and street children in Paco, Manila. Since the population is relatively homogenous for the orphanage, simple random sampling will be used and randomization will be achieved via computer generated random numbers. This will be done to avoid selection bias which may arise. For the street children population, which is heterogenous, stratified random sampling will be conducted.