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Socio Cultural Determinants that Affect Nutritional Status (of elderly above sixty years of age and children below five years of age) in Barangay Banga, Talisay, Batangas Introduction The effects of malnutrition on human performance, health and survival have been the subject of extensive research for several decades and studies show that malnutrition affects physical growth, morbidity, mortality, cognitive development, reproduction, and physical work capacity.
Malnutrition is an underlying factor in many diseases in both children and adults, and it contributes greatly to the disability-adjusted life years worldwide. Malnutrition is caused by various factors, which includes an individual’s vulnerability to health disorders due to fragile physical health conditions and different lifestyles. The first category, wherein physical health conditions determine an individual’s vulnerability to malnutrition, is aptly related to infants, children, pregnant women, and the elderly.
Factors that contribute to malnutrition are many and varied. The aim of the present study is to evaluate the level of malnutrition and the impact of some socio cultural factors of households on the nutritional status of children under five years of age and the elderly in Barangay Banga, Talisay, Batangas. The factors included are the demographic profile of the respondents such as age, sex, weight, number of siblings, marital status, income and occupation of the parents, socio-cultural factors such as eating habits, physical activity, religion and educational attainment.
The Reference standard used is the Body Mass Index (BMI) since the study is a cross-sectional descriptive survey using a structured questionnaire and measurements of weight and height. This study examines the relationship between nutritional status, as indicated by BMI, and to determine the socio cultural factors affecting under-nourishment or over-nourishment of the target population. In addition to determine malnutrition among the elderly, Geriatric Depression Scale or GDS, a self-report assessment used to identify depression in the elderly, is used to assess well being.
The simplicity of GDS enables the scale to be used with ill or moderately cognitively impaired individuals. The scale is commonly used as a routine part of a comprehensive geriatric assessment. While objective measurement of well being is commonly performed in research settings, it is not currently part of routine clinical practice that may reflect inaccuracy, unreliability and inapplicability of existing measures of well being in a clinical setting, owing to the lack of a uniform definition of well being.
A documented relationship between BMI and well being would support and emphasize the importance of assessment of nutritional status in older people, facilitate the assessment of well being by using a well known and simple measurement and suggest a potentially modifiable factor for the enhancement of well being. Socio cultural determinants that affects nutritional status in Barangay Banga, Talisay, Batangas Statement of the Problem 1. What is the demographic profile of the respondents with regards to the following personal variables: . 1 Age 1. 2 Sex 1. 3 Weight 1. 3. 1 Present Weight 1. 3. 2 Weight at Birth 1. 4 Height 1. 5 Income 1. 6 Occupation 1. 7 Marital Status 1. 8 Number of Siblings 2. What are the socio cultural factors in the community as the following: 2. 1 Eating Habit 2. 2 Type of Food 2. 2. 1 Protein 2. 2. 2 Carbohydrates 2. 2. 3 Fruits 2. 2. 4 Vegetables 2. 3 Physical Activity 2. 4 Educational Attainment 2. 5 Religion 3. Is there a significant relationship between socio cultural factors and nutritional status? THEORIES (diagram)
This conceptual framework is based on the transcultural nursing theory of Madeleine Leininger which focuses on the comparative study and analysis of different cultures and subcultures in the world with respect to their caring values, perceptions of health and illness, and patterns of behavior, with the aim of developing knowledge to provide culture-specific practice. Madeleine Leininger Madeleine Leininger underlines the meaning and importance of culture in explaining an individual’s health and caring behaviour, and her Culture Care Theory is the only nursing theory that focuses on culture. Rosenbaum 1997. ) Leininger became convinced about the need for a theoretical framework to discover, explain, and predict dimensions of care, and developed the Culture Care Theory as the outcome of studies performed in numerous Western and non-Western cultures. (Leininger 1997. ) In her Culture Care Theory, Leininger states that caring is the essence of nursing and unique to nursing. Leininger actually criticizes the four nursing metaparadigm concepts of person, environment, health and nursing (Fawcett 1989. First, Leininger considers nursing a discipline and a profession, and the term ‘nursing’ thus cannot explain the phenomenon of nursing. Instead, care has the greatest epistemic and ontologic explanatory power to explain nursing. Leininger (1995a) views ‘caring’ as the verb counterpart to the noun ‘care’ and refers it to a feeling of compassion, interest and concern for people (Leininger 1970, Morse??et al. 1990, Reynolds 1995, McCance??et al. 1997). When Leininger’s definition of care is compared to other transcultural scholars’ definitions, it appears that her view of care is wider than, for example, that of Orque??et al. 1983), who describe care as goal-oriented nursing activities, in which the nurses recognise the patients’ ethnic and cultural features and integrate them into the nursing process. Second, the term ‘person’ is too limited and culture-bound to explain nursing, as the concept of ‘person’ does not exist in every culture. Leininger (1997) argues that nurses sometimes use ‘person’ to refer to families, groups, communities and collectivities, although each of the concepts is different in meaning from the term ‘person’.
Third, the concept of ‘health’ is not distinct to nursing as many disciplines use the term. (Leininger 1997. ) Fourth, instead of ‘environment’ Leininger uses the concept ‘environmental context’, which includes events with meanings and interpretations given to them in particular physical, ecological, sociopolitical and/or cultural settings. (Leininger 1991, 1995a,b, 1997. ) Care always occurs in a cultural context. Culture is viewed as a framework people use to solve human problems. (Orque??et al. 1983, Leininger 1991. ) In that sense, culture is universal.
It is also diverse, as Leininger (1991, 1995a, 1995b, 1997) refers culture to the specific pattern of behavior which distinguishes any society from others. Transcultural scholars define culture by stressing behavioral aspects as an explicit form of it. Leininger (1997, 38) states that culture refers to “the life ways of an individual or a group with reference to values, beliefs, norms, patterns, and practices” and agrees that culture is learnt by group members and transmitted to other group members or intergenerationally. distinguishes between emic and etic perspectives of culture.
Emic refers to an insider’s views and knowledge of the culture, while etic means the outsider’s viewpoints of the culture and reflects more on the professional angles of nursing. Apart from culture and environmental context, ethnohistory is also meaningful when examining care from the cultural perspective. (Leininger 1995a. ) The environmental context, which includes physical, ecological, sociopolitical and cultural settings, gives meaning to human expressions of care. Ethnohistory refers to the past events and experiences of individuals or groups, which explain human life ways within particular cultural contexts over short or long periods. pic] Dorothea Orem The??self-care deficit nursing theory??is a??grand nursing theory??that was developed between 1959 and 2001 by??Dorothea Orem. It is also known as the Orem model of nursing. It is particularly used in??rehabilitation??and??primary care??settings where the patient is encouraged to be as??independent??as possible. The??nursing theory??is based upon the philosophy that all “patients wish to care for themselves”. They can recover more quickly and holistically if they are allowed to perform their own self-cares to the best of their ability.
Major assumptions insists that people should be self-reliant and responsible for their own care and others in their family needing care, people are distinct individuals, nursing is a form of action ??? interaction between two or more persons, successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health, a person’s knowledge of potential health problems is necessary for promoting self-care behaviors and self care and dependent care are behaviors learned within a socio-cultural context.
This theory consists of the Theory of Self Care which includes self care??as a practice of activities that individual initiates and perform on their own behalf in maintaining life ,health and well being, self care agency??as a human ability which is “the ability for engaging in self care” -conditioned by age developmental state, life experience socio cultural orientation health and available resources, therapeutic self care demand??as the totality of self care actions to be performed for some duration in order to meet self care requisites by using valid methods and related sets of operations and actions and self care requisites as the actions directed towards provision of self care. 3 categories of self care requisites are universal self-care requisites or those needs that all people have, developmental self-care requisites or progress toward higher level of maturation and situational or prevention of deleterious effects related to development.
Health deviation requisites are those needs that arise as a result of a patient’s condition. When an individual is very unable to meet their own self-care requisites, a “self-care deficit” occurs. It is the job of the??Registered Nurse??to determine these deficits, and define a support modality. Nurses are encouraged to rate their patient’s dependencies or each of the self-care deficits on the following scale of total compensation, partial compensation and educative or supportive. The Universal self-care requisites that all or health are air, water, food, elimination, activity and rest, solitude and social interaction, hazard prevention and promotion of normality. HYPOTHESIS
Ho: The population thinks that their socio cultural factors affect their nutritional status. Ha: The population thinks that their socio cultural factors do not affect their nutritional status. OBJECTIVES OF THE STUDY The objectives of the present study are to evaluate and report on the nutritional status and socio cultural indicators of malnutrition among elderly and children below the age of five years in Barangay Banga, Talisay, Batangas, and analyze some of the factors that previous studies suggest are correlates of malnutrition. The study also aims to describe the possible relationships between nutritional status and health-related quality of life as to well being.
This study also aims to increase the level of knowledge pertaining to nutrition, identify and quantify the relative importance of various socio cultural factors which may have significant role in determining nutritional status of elderly and preschoolers. SIGNIFICACE OF THE STUDY The??World Health Organization??cites malnutrition as the gravest single threat to the world’s public health and improving??nutrition??in every single way is widely regarded as the most effective form of aid. This paper examines how??malnutrition??is a result of improper food diet and unhealthy eating habits and how??malnutrition??is a health disorder not only associated with hunger, but also with overeating.
It looks at how??malnutrition is a prevalent health disorder that can result to death if undetected or no immediate and proper medical intervention is used. Different studies show causes for the phenomenon on malnutrition such as genetics, economy, politics, culture, etc. which are believed to be the greatest influence of nutritional imbalance in different countries. Since there are many factors contributing to nutritional imbalance, researchers look upon the cause that contributed most effectively in the issue by looking at the socio cultural factors as the potential cause of nutritional imbalance and how great its effects are. Scope and Limitations
This study is only limited to the socio cultural determinants that affect nutritional status in Barangay Banga, Talisay, Batangas. CHAPTER 2 REVIEW OF RELATED LITERATURE The Review of Related Literature presents important remarks and records from foreign and local studies significant to the study of socio cultural determinants that affect nutritional status in Barangay Banga, Talisay, Batangas. Prevalence of Malnutrition and 12-month Incidence of Mortality in Two Sydney Teaching Hospitals The objectives of the study were to determine the prevalence of malnutrition in two Sydney teaching hospitals using Subjective Global Assessment (SGA), the effect of malnutrition on 12-month mortality and the proportion of patients previously identified to be at nutritional risk.
A prospective study using SGA to assess nutritional status of eligible inpatients, from April to September 1997, with a 12-month follow-up to assess mortality was made. A total of 819 patients were systematically selected from 2194 eligible patients. Patients were excluded if they were under the age of 18, had dementia or communication difficulties, or were under obstetric or critical care. The main outcome measures were prevalence of malnutrition, 12-month incidence of mortality, proportion of patients identified with malnutrition, and hospital length of stay (LOS). The prevalence rate of malnutrition was 36%. The proportion of malnourished patients was not significantly different between the two hospitals (P??= 0. 4).
The actuarial incidence of mortality at 12 months after assessment was 29. 7% in malnourished subjects compared with 10. 1% in well-nourished subjects (P??< 0. 0005). Malnourished subjects had a significantly longer median LOS (17 days??vs. 11 days,??P??< 0. 0005) and were significantly older (median 71 years??vs??63 years,??P??< 0. 0005) than well-nourished subjects. Only 36% of the malnourished patients had been previously identified as being at nutritional risk. The researchers therefore concluded that malnutrition in Australian hospitals is a continuing health concern and is associated with increased LOS and decreased survival after 12 months.
The present study revealed that malnourished patients were not regularly identified. Further studies are required to determine whether routine identification of malnutrition and subsequent nutritional intervention are effective in improving clinical outcomes in these individuals. (Intern Med J 2001; 31: 455???461) [Retrieved Feb. 11, 2011 http://onlinelibrary. wiley. com/doi/10. 1046/j. 1445-5994. 2001. 00109. x/full] A Look at??Malnutrition??in Developing Countries and Kwashiorkor as One of the Most Prevalent Forms of??Malnutrition. This paper addresses the problem of??malnutrition??in developing countries and lists the primary causes and factors of its occurrence.
The author notes that marasmus and kwashiorkor are the two most prevalent forms of??malnutrition and goes on to describe the characteristics, signs and symptoms of these two forms of??malnutrition??before focusing on kwashiorkor, providing various treatment methods. The researcher stated that agricultural resources have the means to produce ample food to feed everyone on our planet, and that malnutrition and starvation aren’t necessary, made this even more disturbing. Poverty is the primary cause, with factors including, man-made and natural disasters, discrimination, (especially against women) racism, corruption, and the HIV/AIDS epidemic, as contributing issues.
The paper also argues that in this day and age when technology enables one to fly to outer space, finding a way to curb malnutrition??in developing countries should not be an issue. In closing, the author persuades a committed intervention to stop this outrage. An analysis of the risk factors, assessment principles and possible interventions for malnutrition in the elderly. This paper explores the causes and contributing factors linked with malnutrition??in the elderly. It also addresses ways to assess??malnutrition??in the aging population. The paper then focuses on interventions for??malnutrition in the elderly in terms of health promotion principles and strategies.
Additionally, the paper looks at primary, secondary and tertiary interventions. The researchers in the paper concluded that one strategy for teaching and health promotion is to make use of mentors who also are peers of the elderly person. It is essential that, whatever the specific type of health promotion program, the elderly person participate fully. The strategy of using volunteer peer educators is based in social learning theory as defined by the World Health organization, and can be very effective for providing nutrition education for the elderly (Panayota & Amanatidou 2003). Peer mentors mainly act as a support system for providing reliable nutrition information as well as educational materials.
These mentors need to understand and practice healthy nutrition and preferably also be somewhat experienced with teaching. It is preferable that these mentors be experts on nutrition because research indicates that older people prefer that all their information related to health should come from expert sources (Panayota & Amanatidou 2003). Malnutrition and Heart Disease This paper explains that, although some experts contend that heart disease and??malnutrition??is mainly a problem of industrialized nations, populations held back by economic and other factors often lack public education about health, wellness and the nutritional behaviors that could prevent heart disease.
The author stresses the importance of proper infant-stage nutrition, which is needed to avoid developing heart diseases as an adult. The paper recommends that patients with??malnutrition??be normalized nutritionally through an adequate delivery system to decrease heart disease risks determined through a professional assessment program. The article takes up the argument about whether heart disease is more common in industrialized or developing nations, and concludes that the industrialization process does lead to changes in dietary habits that may lead to this state of being. Heart disease, cancer, and other degenerative disorders are most frequent among populations of the industrialized nations.
These diseases have been increasing rapidly over the past few generations, making it easy for the petro-chemical-medical-pharmaceutical-complex to assign blame to bad genes, while ignoring the issues of increased environmental degradation and deteriorating nutrition over the same time frame. ” This is an opinionated article within the literature but it nonetheless supports albeit subjectively the conclusion that heart disease can be linked to malnutrition. [Retrieved Feb. 14, 2011http://www. essaytown. net/db/search? KEYW=Malnutrition] Prevalence of Malnutrition and Determinants of Nutritional Status among Elderly People: A Population-Based Study in Rural Bangladesh
The paper states that both the number and proportion of persons aged 60+ years are growing rapidly in almost all countries of the world. Research shows that elderly people are nutritionally vulnerable and that their nutritional profiles differ with type of disease. Disease, increasing age, being a woman, and social factors such as lack of social support, limited social network or social isolation are all associated with malnutrition among elderly people. In Bangladesh, the malnutrition prevalence is among the highest in the world. Although more than one third of the population are malnourished, figures for elderly people are hard to find because most of the research and public health activities are focused on women in reproductive age, and children and young adults.
The aim of this thesis is to describe the nutritional status of individuals aged 60 years and older, living in a rural community in Bangladesh, with particular focus on the impact of demographic, disease and social factors on nutritional status in old age. This thesis uses data from a multi-disciplinary cross-sectional study of people aged 60+ years. The study was conducted in a rural area in Matlab, Bangladesh during August 2003 to January 2004. Data were obtained through home interviews where information on demographic, socio-economic, social support and self reported health status were collected. The participants in the survey were invited to a nearby medical sub-centre for a complete clinical examination on another day, conducted by physicians and including taking medical history, physical examination and collection of blood samples.
Nutritional status was assessed using the Mini Nutritional Assessment (MNA), that is a simple and rapid tool to screen older persons for malnutrition. A total of 850 elderly individuals were randomly selected from the surveillance database, of which 625 subjects participated in the home interviews, and 473 underwent clinical examination. Information on complete nutritional status was available for 457 individuals. The findings showed that the prevalence of malnutrition among older people living in a rural community in Bangladesh is 26%. In addition, more than half of the participants (62%) were at risk of being malnourished. Only 12% were diagnosed as well-nourished according to MNA. Women were found to have significantly lower MNA scores than men (p