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
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General Santos City belong to

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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. Pregnancy Uterine Full Term - 2,653

2. Acute Gastroenteritis with
Moderate Dehydration - 657
3. Pneumonia - 632
4. Acute Gastroenteritis - 350
5. Pulmonary Tuberculosis - 265
6. T/C Acute Appendicitis - 238
7. Bronchial Asthma in Acute
Exacerbation - 214
8. Urinary Tract Infection - 199
9. Incomplete Abortion - 187
10.Cerebro Vascular Accident - 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. That’s why it is so important for dogs to be vaccinated regularly. The
problem is people just don’t 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 MD’s 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 Consuelo-
which 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: Others:

Municipal Health Office 1 Municipal Nutrition Action Officer

1
DOH Representative 1 Municipal Nutrition Aide 1
Public Health Nurse 1 Casual Employees 10
Medical Technologist 1 Barangay Nutrition Scholars
10
Rural Health Midwives 10
Rural Sanitary Inspector 1
Barangay Health Workers 98
Traditional Birth Attendants 20

Population/Number of Households:

BARANGAY POPULATION HOUSEHOLDS

San Teodoro 7,574 1,262

Libertad 7,159 1,193
Bunawan Brook 5,197 866
Poblacion 4,453 742
Consuelo 4,182 697
San Andres 3,014 502
Mam Balili 2,892 482
Imelda 1,512 252
Nueva Era 1,435 239
San Marcos 1,339 223

TOTAL 38,757 6,458

ANNUAL SITUATIONAL ANALYSIS FOR YEAR 2008

Name of Organization: RHU-BUNAWAN

External Factors Opportunities Threats

1. Poor health -Availability of -False Traditional
seeking behavior Health Stations Beliefs especially
especially to the -Trained Manpower alleviating illness
marginalized group -Presence of and addressing
of people (IPs) Volunteer Workers
health problems
2. Poverty -Presence of -Increased social
Foreign Assisted problems
Project -Inability to pay
-Presence of NGO for individual cost
projects of health care
enrolled in PHIC
-Increased
expenditure from
LGU to address
health problems
3. Peace and Order -Increased -Displacement of
visibility of people during
police/military times of
personnel conflict/unrest
-Presence of
armed rebellious
groups that
threatens social
stability
4. Migration -Strong support -Unexpected
from private spread/outbreak
mining, both of emerging and
small scale and endemic dieases
big scale,
companies and
other sectors in
the community
5. Geographical -Easy access to -Dilapidated
location health services structure/facilitie
due to presence s
of transportation -Not all midwives
services and are staying-in the
newly built farm- health stations
to-market roads -Flood prone
and highways barangays
-Strategically
located health
centers for easy
access to far
flung areas

ANNUAL SITUATION ANALYSIS FOR YEAR 2008

Name of Organization: RHU BUNAWAN

Leading Causes of Total No. of Cases Contributing
Mortality Factors

1.Chronic 14 Poverty,
Obstructive overcrowding, poor
Pulmonary sanitation,
Disease smoking, poor
health seeking
behavior
2. Pulmonary 9 Poor health seeking
Tuberculosis behavior, lack of
health education,
poverty, relapse,
unhealthy lifestyle
practices,
occupational
hazards, non-
compliance to
treatment protocols
3. Cardio Vascular 8 Unhealthy lifestyle
Diseases practices, poor
health seeking
behaviors, false
tradition beliefs
4. Renal Failure 6 Lack of health
education,
unhealthy lifestyle
practices, poverty
5. Vehicular 6 Poor transportation
Accident safety awareness,
lack of warning
device, drinking
under the influence
of
alcohol/substance
6. Myocardial 6 Unhealthy lifestyle
Infarction practices, poor
health seeking
behaviors, lack of
health education
7. Severe 5 Lack of potable
Dehydration water supply, poor
health seeking
behaviors, doubtful
sources of drinking
water, lack of
proper sanitation
education
8. Severe Anemia
4 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 Total No. of Cases Contributing

Morbidity Factors
1.URTI 2306 Poor
Environmental
Sanitation, Poor
health seeking
behavior
2.Schistosomiasis 770 Improper exrcreta
disposal, poor
environmental
sanitation, lack of
health education,
unsanitary toilet
3. Diarrhea 332 Poor
environmental
sanitation, lack of
potable/safe water
supply, poor
hygiene
4. Wounds 240 Occupational
hazard, poor
environmental
safety awareness,
unhealthy lifestyle
practices
5. Diseases of the 141 Unhealthy lifestyle
heart practices, poor
health seeking
behaviors, family
history
6. Pnuemonia 127 Overcrowding,
Poor
environmental
sanitation,
malnutrition,
overcrowding
7. Hypertension 115 Unhealthy lifestyle
practices, family
history, poor
health seeking
behaviors
8. PTB 38 Overcrowding,
poor
environmental
sanitation, poor
health seeking
behavior,
occupational
hazards,
inadequate health
education

PRIORITIZATION OF HEALTH PROBLEMS

Name of Organization: RHU-BUNAWAN

HEALTH URG MAG AVAILAB IMPLIC C T R

PROBLE ENC NITU ILITY OF ATIONS O O A
M Y DE TECHNO OF S T N
(Can (Ho LOGY INACTI T A K
this w TO ONS L
resul man SOLVE (If not E
t in y THE attend F P
deat peop PROBLE ed to, F O
h or le M (Are can the E I
disa are there proble C N
bility affec availabl m lead T T
?) ted e to I S
by protocol more V
the s/drugs serious E
prob to treat proble
lem? the ms?)
(20) ) problem
?)
(20)
(20) (
(20) ( 1
2 0
0 0
) )
1.PTB 20 20 19 20 2 9 1
0 9 s
t
2. CVD 20 20 18 20 2 9 2
0 8 n
d
3.ARI 20 20 20 17 1 9 4
8 5 r
d
4.Schist 16 20 20 20 1 9 5
osomia 8 4 t
sis h
5. 15 17 20 18 1 8 7
Malnutr 7 7 t
ition h
6. 20 18 18 20 1 9 3
Renal 8 6 r
Failure d
7. 17 18 18 17 1 8 8
Diarrhe 8 6 t
a h
8.Liver 20 17 15 20 1 9 6
Cirrhosi 7 2 t
s h
9. 15 19 18 18 1 8 9
Anemia 9 6 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 respiratory-
related cases.

B. 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

C. 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 BHW’s 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

• Make objective SMART

• How does this relate to the objective above?

STRA ACTIVITIES T TARG RESP

TEGIE I ETS ONSI
S M ITE C S BILIT
E M O O Y
F S U
R T R
A C
M E
E
1.Inte -Advocacy J -TB Re P L Rural
nsify to TB a symp ag 3 G Med
active symptomati n toma en 0 U Tech,
and c patients u tic ts, , , Munic
passi -conduct a minin wa 0 ipal
ve intensive r g x 0 M Healt
case sputum y work su 0 H h
findin collection of - ers ppl O Office
g of TB J >18 ies , r,
TB symptomati u y.o. , Public
symp c patients n both sli P Healt
tomat especially e sexes de H h
ics to mining 2 s, O Nurse
workers 0 TE , ,
-conduct 1 V BHW’
survey on 0 N s,
mining G RHM’
areas per O s
BHW in
identifying g
TB r
symptomati a
c patients n
t
 ,

2. -conduct J - IE P D All
Stren radio a Gene C 1 O Healt
gthen plugging n ral ma 5 H h
IEC -distribution u popul ter , , Perso
of a ation ial 0 nnel-
flyers/leafle r s, 0 L MHO,
ts y TE 0 G PHN,
-school - V U RHM’
symposium D , s,
-intensify e BHW’
household/i c N s
ndividual e G
teaching m O
classes b
e g
r r
2 a
0 n
1 t
0
3. -Prompt J -TB Re P L Rural
Stren referral of a symp fer 5 G Med
gthen TB suspect n toma ral , U Tech,
referr mining u tic For 0 , RHM’
al workers to a minin ms 0 s,
syste RHU for r g , 0 M BHW’
m consultatio y work TE H s,
n and - ers V O Public
sputum D healt
examinatio e h
n c nurse
e
m
b
e
r
2
0
1
0

• 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 Actual Output Comments Recommended

Indicator Action
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.