Investigation of Dog Bite Rabies cases In General Santos City

In partial requirement of PIME I

Submitted by: Rosalia S. Giralao M.D. MCH-1

GE

General Santos City has a tota the Philippines. The municipalities the municipalities of Polomolok an accessible by land (thru the MacAr catchment for sick people coming f the above mentioned municipalities

General Santos City belong to premier city included in the SOCK population for each barangay is sho
Table 1.

Ten leading causes of Deaths (Mortality) in General Santos City Hospital 1. Pneumonia 103 2. Sepsis 98 3. Pulmonary Tuberculosis 44 4. Cerebro Vascular Disease 32 5. Prematurity 25 6. Malignancy 18 7. Potential Septic 17 8. Hypertensive Bleed 12 9. Hypertension 11 10.AcuteGastro-enteritis with Severe dehydration 8 Ten leading causes of Emergency Cases in the Emergency Room Department of General Santos City Hospital 1. 2. Pregnancy Uterine Full Term Acute Gastroenteritis with Moderate Dehydration 3. Pneumonia 4. Acute Gastroenteritis 5. Pulmonary Tuberculosis 6. T/C Acute Appendicitis 7. Bronchial Asthma in Acute Exacerbation 8. Urinary Tract Infection 9. Incomplete Abortion 10.Cerebro Vascular Accident 632 2,653 657 350 265 238

214 199 187 172

Ten leading causes of consultations at the Out Patient Department of General Santos City Hospital 1.

Background of the Study

While dog bite rabies is extremely rare in the United States and other developed countries. Dog bite rabies is very common in third world countries including the Philippines. In General Santos City, documented animal bite (primarily dog bite) in 2009 is at 402/100,000 population. On the last state of the city address (SOCA February 2009) of the former City Mayor. Honorable Pedro B. Acharon Jr, he mentioned that the city government provided 10,086 anti dog rabies vaccination in 2009. Despite of these program, dog bite cases is still common. One of the primary reason for this is the lack of city government policies and ordinance in the responsible ownership of pet animals like dogs. The city population specially school children and people walking in the streets, people who cycle or jog and people who ride in motorcycles are exposed to danger of dog bites from dogs running loose that are deemed vicious and dangerous. There is no treatment for dog bite rabies. It is always fatal. Thats why it is so important for dogs to be vaccinated regularly. The problem is people just dont care to take care of their pet dogs and to have them vaccinated until one of their family member or other people in the neighborhood is bitten and exposed to contacting rabies and infection. This study is to determine the current programs of the government of General Santos City in Rabies Prevention and Control of New Management of cases. Also, to make recommendations to the city health board and government legislators to achieve the objective of reducing incidence rate of rabies caused by dog bites per million population.

I.

Objective

The objective of the study is to reduce incidence rate of rabies per million population. From actual documented animal bites of 402/100,000 population in 2009 to 301/100,000 population or 25% less in the year 2011.

II.

Situational Analysis

Animal bites documented in 2009 - 402/100,000 population Post-exposure vaccination given to 1,754 clients Pre-exposure vaccination given to 31 clients with direct exposure to patients or rabid dogs Orientation Training conducted among Barangay Health Workers

 There were 2 nurses and 4 MDs attend training on Rabies Prevention and Control on New Management of cases. Conduct Advocacy campaign on Responsible Pet Ownership in coordination with Veterinary Office. The Local Government Unit purchase active vaccines Rabiphur vaccines with 223 vials while DOH provided 110 vials. While Verorab vaccines 175 vials from LGU and 70 vials from DOH LGU purchase passive rabies vaccines like Pavirab of 51 vials while DPH provide 50 vials.

III.

Scope and Limitation

The study is limited to dog bite cases only. Government agencies involved in the study are the City Health Office, City Veterinary Office and Local Government Unit-Barangay Health Centers. Privately owned Veterinary Clinics and Dog Bite Centers are not included in the study.

IV.

Recommendations

Create Animal Bite Center at the City Health Office manned by well trained and qualified personnel. Include Rabies Prevention and Control Program in the barangay health program development. Provide proper education of the barangay health workers in handling dog bite cases such as making investigation report and proper referral to Animal Bite Center in the City Health Office and City Hospital for proper treatment and vaccination of the patient. Also proper reporting to the City Veterinary Office of the pet dog involved for quarantine , observation and disposal if found positive on rabies. Conduct educational and advocacy campaign at the barangay level on Responsible Pet Ownership in coordination with the City Veterinary Office and City Health Office. Through Media involvement and coordination with the City Veterinary Office and City Health Office. Get public attention and involvement in getting city legislators to amend or make animal control ordinances. 1. Ordinance on animal control that require pet owners to be more responsible by requiring them to have their pet registered and vaccinated and even placed with rabies tags. 2. Imposing higher fines of P1,000.00 or more on owners cited for animals (dogs and cats) running loose or deemed vicious and dangerous. To make it a deterrent to people to take care of their pets. 3. To catch, impound and put into adoption stray dogs without owners. 4. Implement anti-hoarding ordinance. Limiting the number of pet dogs owned to two. Giving pet owners three months to sell or give away puppies. This is also to avoid excessive noise pollution and stench from pet animals throughout the neighborhood.

5. A fine of P1,000.00 for a person caught throwing unwanted puppies and kittens in grassy or vacant lots and streets. 6. Proper investigation and reporting of dog bite cases in every barangays for proper documentation. Giving proper and timely health care assistance and vaccination to save the life of the bitten person. To properly quarantine and monitor the animal involved so that it can be euthanized properly when found to develop symptoms of rabies.

The Municipality of Bunawan has an estimated land area of 512.18 sq. kms. It is bounded in the north by the town of Rosario, in the south by the town of Trento, in the east by the province of Surigao del Sur and in the west by the river town municipalities. It has a total population of 38,757 for the CY 2009 with a growth rate of 4.1% per annum. It has 10 barangays with the 5 barangays along the national highway namely Libertad, Bunawan Brook, San Teodoro, San Andres and Consuelowhich is the main Barangay for the mining industry in the Municipality. The remaining 4 of which belong to river barangays which are also flood prone areas, these are Poblacion, Nueva Era, Mam Balili and San Marcos. The last barangay is highly mountainous which is Barangay Imelda. The source of livelihood is namely fishing, farming, and most especially gold panning and mining. According to the 13th Annual Tuberculosis report of the World Health Organization (WHO)- published on World TB Day, March 24, 2009- there were an estimated 9.27 million new cases of TB in 2007 around the world. Last year (2008), deaths due to Pulmonary Tuberculosis ranks 2nd in the top leading causes of mortality for the Municipality with a total number of 9 cases. It clearly shows that even though the availability of technology is present in addressing the problem of Tuberculosis not only in the municipality but throughout the province, TB still is holding its ground as one of the major diseases that contributes to the debilitation and subsequently the fatality of healthy individuals in the community. Much of the morbidity of Tuberculosis is concentrated to those individuals associated to the mining industry, it is then a perilous disposition for the miners to be at high risk for this chronic disease and a delicate situation for the Municipality as well as it depends mainly on the income generated by the mining industry not to mention the scores of individuals whose bread and butter is making a living through this livelihood. In the light of these distresses, a study on the prevalence and positivity rate of PTB among mining workers in Bunawan, Agusan del Sur becomes a necessity. It is then paramount to get a clearer and much precise picture on the impact and burden of Tuberculosis in the area of interest as it is an industry that the Municipality greatly depends on and the health of individuals working in this field is at great risk.

Health Personnel Number: Municipal Health Office 1 DOH Representative 1 Public Health Nurse 1 Medical Technologist 10 Rural Health Midwives Rural Sanitary Inspector Barangay Health Workers Traditional Birth Attendants 1

Others: Municipal Nutrition Action Officer Municipal Nutrition Aide 1 Casual Employees 10 Barangay Nutrition Scholars

1 10 1 98 20

Population/Number of Households: BARANGAY San Teodoro Libertad Bunawan Brook Poblacion Consuelo San Andres Mam Balili Imelda Nueva Era San Marcos TOTAL POPULATION 7,574 7,159 5,197 4,453 4,182 3,014 2,892 1,512 1,435 1,339 38,757 239 223 6,458 1,193 866 742 697 502 482 252 HOUSEHOLDS 1,262

ANNUAL SITUATIONAL ANALYSIS FOR YEAR 2008 Name of Organization: RHU-BUNAWAN External Factors
1. Poor health seeking behavior especially to the marginalized group of people (IPs)

Opportunities
-Availability of Health Stations -Trained Manpower -Presence of Volunteer Workers

Threats -False Traditional Beliefs especially alleviating illness and addressing health problems

2. Poverty

-Presence of Foreign Assisted Project -Presence of NGO projects

3. Peace and Order

-Increased visibility police/military personnel

of

4. Migration

5. Geographical location

-Strong support from private mining, both small scale and big scale, companies and other sectors in the community -Easy access to health services due to presence of transportation services and newly built farmto-market roads and highways -Strategically located health centers for easy access to far flung areas

-Increased social problems -Inability to pay for individual cost of health care enrolled in PHIC -Increased expenditure from LGU to address health problems -Displacement of people during times of conflict/unrest -Presence of armed rebellious groups that threatens social stability -Unexpected spread/outbreak of emerging and endemic dieases

-Dilapidated structure/facilitie s -Not all midwives are staying-in the health stations -Flood prone barangays

ANNUAL SITUATION ANALYSIS FOR YEAR 2008 Name of Organization: RHU BUNAWAN

Leading Causes of Mortality 1.Chronic Obstructive Pulmonary Disease 2. Pulmonary Tuberculosis

Total No. of Cases 14

Contributing Factors Poverty, overcrowding, poor sanitation, smoking, poor health seeking behavior Poor health seeking behavior, lack of health education, poverty, relapse, unhealthy lifestyle practices, occupational hazards, noncompliance to treatment protocols Unhealthy lifestyle practices, poor health seeking behaviors, false tradition beliefs Lack of health education, unhealthy lifestyle practices, poverty Poor transportation safety awareness, lack of warning device, drinking under the influence of alcohol/substance Unhealthy lifestyle practices, poor health seeking behaviors, lack of health education Lack of potable water supply, poor health seeking behaviors, doubtful sources of drinking water, lack of proper sanitation education

3. Cardio Vascular Diseases

4. Renal Failure

5. Vehicular Accident

6. Myocardial Infarction

7. Severe Dehydration

8. Severe Anemia

Poverty, Malnutrition, lack of nutrition education, delayed pre-natal check-ups, belief on food fallacies

ANNUAL SITUATION ANALYSIS FOR YEAR 2008 Name of Organization: RHU-BUNAWAN

Leading Causes of Morbidity

Total No. of Cases 2306

1.URTI

2.Schistosomiasis

770

3. Diarrhea

332

4. Wounds

240

5. Diseases of the heart

141

6. Pnuemonia

127

Contributing Factors Poor Environmental Sanitation, Poor health seeking behavior Improper exrcreta disposal, poor environmental sanitation, lack of health education, unsanitary toilet Poor environmental sanitation, lack of potable/safe water supply, poor hygiene Occupational hazard, poor environmental safety awareness, unhealthy lifestyle practices Unhealthy lifestyle practices, poor health seeking behaviors, family history Overcrowding, Poor environmental sanitation, malnutrition, overcrowding

7. Hypertension

115

8. PTB

38

Unhealthy lifestyle practices, family history, poor health seeking behaviors Overcrowding, poor environmental sanitation, poor health seeking behavior, occupational hazards, inadequate health education

PRIORITIZATION OF HEALTH PROBLEMS Name of Organization: RHU-BUNAWAN

HEALTH PROBLE M URG ENC Y (Can this resul t in deat h or disa bility ?) MAG NITU DE (Ho w man y peop le are affec ted by the prob lem? ) AVAILAB ILITY OF TECHNO LOGY TO SOLVE THE PROBLE M (Are there availabl e protocol s/drugs to treat the problem ?) (20) IMPLIC ATIONS OF INACTI ONS (If not attend ed to, can the proble m lead to more serious proble ms?) (20) ( 2 0 ) ( 1 0 0 ) C O S T E F F E C T I V E T O T A L P O I N T S R A N K

(20)

(20)

1.PTB 2. CVD 3.ARI

20 20 20

20 20 20

19 18 20

20 20 17

2 0 2 0 1 8

9 9 9 8 9 5

1 s t 2 n d 4 r d

4.Schist osomia sis 5. Malnutr ition 6. Renal Failure 7. Diarrhe a 8.Liver Cirrhosi s 9. Anemia

16 15 20 17 20 15

20 17 18 18 17 19

20 20 18 18 15 18

20 18 20 17 20 18

1 8 1 7 1 8 1 8 1 7 1 9

9 4 8 7 9 6 8 6 9 2 8 6

5 t h 7 t h 3 r d 8 t h 6 t h 9 t h

SUMMARY STATEMENT OF PRIORITY PROBLEMS Name of Organization: RHU-BUNAWAN A. Health/Disease Problems High incidence of mortality of infectious diseases like PTB and respiratoryrelated cases. B. C. Operational Problems Limited budget Inadequate drugs and medicines Transportation equipments not in place Lack of monitoring/supervision for programs/projects Low number of enrolled Phil. Health Insurance Corp. Poor structural conditions of health facilities Client-based Problems Poor health seeking behaviors Dole out mentality Non-compliance to treatment protocols Poverty False traditional beliefs Occupational hazards

OBJECTIVES OF THE STUDY

Specifically, the study aims to: 1. To determine the TB case detection rate among mining workers in Bunawan, Agusan del sur; 2. To describe the profile of TB positive mining workers in terms of age, sex, length of employment and exposure to the mining areas; 3. To determine the number of TB relapse cases among mining workers; 4. To describe the perceptions and attitudes of TB positive mining workers regarding treatment protocol using the D.O.T.S. strategy. Make Objectives SMART Are objectives 2-4 covered in the Work Plan? You may limit the Objective(s) since this is not a THESIS. Besides, not all of your objectives can be captured by your Methodology. CDR is your indicator, thus, the objective may be to reduce it.

METHODOLOGY To determine the TB positivity rate among miners in selected Barangays, the Barangay Health Workers (BHWs) of these selected barangays will be first utilized in order to determine the possible candidate for the individuals to be included in the study as because the BHWs responsibilities in delivering health services are designed to specialize per Purok and that they have an in depth knowledge among individuals residing and/or working in the area of assignment and it would prove to be a useful source of information for making a masterlist of individuals to be included in the study. Once identified, a cross-check would be implemented to determine if those individuals included in the masterlist are truly cases of TB symptomatics in order to achieve a much accurate data collection and to maintain standard quality in diagnosing TB symptomatic patients. Once confidence of the list is established, the targeted individuals will be requested for a consent for sputum-specimen collection and clearly inform them that the results will be included in the study and to assure that confidentiality of their identities will be strictly kept under wraps. Calculation of the Positivity Rate will be: number of TB positive (+) sputum specimens divided by the total number of TB symptomatic sputum specimens collected at the specified time frame.

SCOPE AND DELIMITATIONS: The study is limited to mining workers in 3 mining sites in selected Barangays of Bunawan, Agusan del Sur. Only those aged 18 y.o. and above of both sexes and classified as TB symptomatic- having several combination of the following signs and symptoms: cough for more than one month duration, body

malaise/weakness, loss of appetite, weight loss, hemoptysis, experiencing night sweats and afternoon fever are included in this study. The sputum specimens will be collected only to those TB-symptomatic mining workers identified by health personnel during the 1st 2 quarters of CY 2010. Sputum collection will be only up to end of June 2010 but with no limitations as to the number of sputum specimens to be collected. HEALTH PLANNING WORKSHEET Name of Organization: RHU-BUNAWAN GOAL: To reduce prevalence of infectious, communicable, endemic and emerging health problems OBJECTIVES: To determine the case detection rate of TB symptomatic among mining workers in Bunawan, Agusan del Sur
STRA TEGIE S

Make objective SMART How does this relate to the objective above?
ACTIVITIES T I M E F R A M E J a n u a r y J u n e 2 0 1 0 TARG ETS RESP ONSI BILIT Y

ITE M

C O S T

S O U R C E L G U , M H O , P H O , N G O g r a n t

1.Inte nsify active and passi ve case findin g of TB symp tomat ics

-Advocacy to TB symptomati c patients -conduct intensive sputum collection of TB symptomati c patients especially to mining workers -conduct survey on mining areas per BHW in identifying TB symptomati c patients

-TB symp toma tic minin g work ers >18 y.o. both sexes

Re ag en ts, wa x su ppl ies , sli de s, TE V

P 3 0 , 0 0 0

Rural Med Tech, Munic ipal Healt h Office r, Public Healt h Nurse , BHW s, RHM s

2. Stren gthen IEC

-conduct radio plugging -distribution of flyers/leafle ts -school symposium -intensify household/i ndividual teaching classes

3. Stren gthen referr al syste m

-Prompt referral of TB suspect mining workers to RHU for consultatio n and sputum examinatio n

J a n u a r y D e c e m b e r 2 0 1 0 J a n u a r y D e c e m b e r 2 0 1 0

Gene ral popul ation

IE C ma ter ial s, TE V

P 1 5 , 0 0 0

D O H , L G U , N G O g r a n t

All Healt h Perso nnelMHO, PHN, RHM s, BHW s

-TB symp toma tic minin g work ers

Re fer ral For ms , TE V

P 5 , 0 0 0

L G U , M H O

Rural Med Tech, RHM s, BHW s, Public healt h nurse

Time frame is too long What are your indicators? Restate Strategies Activities (begin with action word); Do not confuse your Activities with Indicators! MONITORING WORKSHEET Name of Organization: RHU-BUNAWAN

GOAL: To reduce prevalence of infectious, communicable, endemic and emerging health problems OBJECTIVES: To determine the case detection rate of TB symptomatic among mining workers in Bunawan, Agusan del Sur Output Indicator Objective: TB case detection rate among miners in selected mining sites in Bunawan, ADS, Jan-Jun 2010. Targets: -TB symptomatic miners both sexes 18 y.o. and above. Actual Output Comments Recommended Action