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Impacts of Flood on Health: Epidemiologic Evidence from Hagonoy, Bulacan

by Maria Danica C. Rivera Ruby Sunshine B. Balatbat Louise Kyleen L. Borja Sheila Marie C. De Chavez Mary Grace C. Dela Cruz Jade M. De Jesus Mary Lorry Laine C. Dionisio Ma. Jaecelyn S. Junio Abigael F. Santos Karen May C. Zaragosa

A Thesis in Partial Fulfillment of the Requirements for the Degree Bachelor of Science in Nursing

Bulacan State University October 2013

Bulacan State University COLLEGE OF NURSING


Research and Development Office

APPROVAL SHEET This Thesis entitled Impacts of Flood on Health: Epidemiologic Evidence from Hagonoy, Bulacan prepared and submitted by Maria Danica C. Rivera, Ruby Sunshine C. Balatbat, Louise Kyleen L. Borja, Sheila Marie D. De Chavez, Mary Grace C. Dela Cruz, Jade M. De Jesus, Mary Lorry Liane C. Dionisio, Ma. Jaecelyn S. Junio, Abigael F. Santos, Karen May C. Zaragosa has been approved and accepted as partial fulfillment of the requirements for the degree Bachelor of Science in Nursing, MART JUARESA M. CABANTOG, RN, MAN Adviser

PANEL OF EXAMINERS Approved by the College of Nursing Research Committee on Oral Examination with a grade of ____________________ on October ___, 2013. ______________________________ Chairman ________________________ ________________________ Member ________________________ ________________________ Member _____________________________ Dean ii Member Member

Acknowledgements The researchers at this point would like to express their sincere appreciation to those who have contributed and helped to their study: To The Dean, who signed the letter of request for the permission to conduct the study. To The Adviser, who gave advices to the researcher to have a better research presentation. To The Dr. Romel Pajela, The Head of Rural Health Unit of Hagonoy, Bulacan who approved and gave the researcher a chance to conduct a study to their town. To The Panel of examiners who correct and examine the study before its implementation. To The Researchers Family who provide financial and emotional support to the researchers. And above all, to our God Almighty who always guide, protect and enlightening the minds of the researchers. The Researchers

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Abstract.

Hagonoy is one of the most flood prone places in Bulacan. Long and heavy rainfall during September 2011 resulted in devastating flood caused a substantial health impact on residence in municipality. The aim of this study is to ascertain the vulnerability and health impacts of the devastating flood in Hagonoy, Bulacan by identifying the differences in injuries, and morbidity patterns (dermatitis, diarrhea, conjunctivitis, leptospirosis, hypertension, and dengue fever) between flood with most affected and least affected household. A comparative studies and descriptive survey design was carried out involving 198 respondents in 6 selected communes (3 less affected area and 3 heavily affected area). Respondent were interviewed and information collected on the social, economic, and health impacts of the devastation of the flood. The finding showed higher incidence of dermatitis and diarrhea in severely affected by flood as compared to the less affected area. For people in flood prone areas, flood prevention and mitigation strategies need to be seriously thought through and acted upon, as this people are exposed to greater health problem.

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Table of Contents

Approval Sheet............................................................................................................... Acknowledgment ........................................................................................................... Abstract .......................................................................................................................

ii iii iv

List of Tables ................................................................................................................. vii List of Figures ................................................................................................................ viii

Chapter 1. The Problem and Review of Literature................................................................. Introduction ........................................................................................................... Significance of the study....................................................................................... Review of Related Literature ................................................................................ Theoretical Framework ......................................................................................... Conceptual Framework ......................................................................................... Statement of the Problem ...................................................................................... Operational Definition of Terms........................................................................... Scope and Delimitation ......................................................................................... 2. Methodology ......................................................................................................... Research Design ................................................................................................... Population and Sample of the Study ..................................................................... Research Instruments ............................................................................................ Development of the Questionnaire ....................................................................... Data Gathering Procedure ..................................................................................... Data Processing and Statistical Treatment ............................................................

1 1 4 5 28 30 31 32 33 34 34 35 36 36 37 37

3.

Results and Discussions ........................................................................................

38

4.

Summary, Conclusions and Recommendations.................................................... Summary ............................................................................................................... Findings ................................................................................................................ Conclusions........................................................................................................... Recommendations .................................................................................................

45 45 50 53 56 57 59

REFERENCES ............................................................................................................. APPENDIX .................................................................................................................... A. B. C. D.

Letter of Request for the Permission to Conduct the Study (Signed) ................ 59 Letter for Conducting A Survey 60 Instruments ......................................................................................................... 61 Curriculum Vitae ............................................................................................... 65

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LIST OF TABLES

Table 1. 2. 3. 4. 5. Table1. Characteristic of study population .................................................... Table2. Experience with the heavy rainfall/flood .......................................... Table3. Access to health care service ............................................................ Table4. Injuries .............................................................................................. Table5. Health condition within one month after the flood ...........................

Page 38 39 40 41 42

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LIST OF FIGURES

Figure 1. Conceptual Framework of the Study .............................................................

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Chapter 1 The Problem and Review of Related Literature and Studies

Introduction Floods have been causing peoples Life too much disaster or devastating their Livestock for some decades. Flood is an overflow of water that submerges or "drowns" land. The European Union (EU) Floods Directive defines a flood as a covering by water of land not normally covered by water. In the sense of "flowing water", the word may also be applied to the inflow of the tide. Flooding may result from the volume of water within a body of water, such as a river or lake, which overflows or breaks levees, with the result that some of the water escapes its usual boundaries, or may be due to accumulation of rainwater on saturated ground in an aerial flood. While the size of a lake or other body of water will vary with seasonal changes in precipitation and snow melt, it is unlikely to be considered significant unless it floods property or drowns domestic animals. Floods can also occur in rivers when the flow rate exceeds the capacity of the river channel, particularly at bends or meanders in the waterway. Floods often cause damage to homes and businesses if they are in the natural flood plains of rivers. While reverie flood damage can be eliminated by moving away from rivers and other bodies of water, people have traditionally lived and worked by rivers because the land is usually flat and fertile and because rivers provide easy travel and access to commerce and industry. Some floods

2 develop slowly, while others such as flash floods can develop in just a few minutes and without visible signs of rain. Additionally, floods can be local, impacting a neighborhood or community, or very large, affecting entire river basins. During Floods if people in a certain community soaked their foot in the dirty water there is a possibility that they can acquire athletes foot, if they have an open wound and had exposed their foot in the water with rats urine they are possibilities to acquire Leptospirosis, and lastly the people left the environment dirty it may be a site for reproduction of mosquitoes that might be a carrier of dengue virus. Flooding accounts for about 40% of all natural disasters worldwide and causes about half of all deaths. The greatest potential flood hazard is in Asia. For the past two decades more than 400 million people on average have been directly exposed to floods. Between 1987 and 1997, 44% of all flood disasters worldwide affected Asia, claiming 228, 000 lives (roughly 93% of all flood-related deaths worldwide). Last August 7, 2012 Manila Philippines get flooded and this cause the 250, 000 to flee their homes (WHO), and in the following day Emergency workers and troops rushed food, water and clothes to nearly 850,000 people displaced and marooned from deadly floods spawned by 11 straight days of southwest monsoon rains that soaked the Philippine capital and nearby provinces. Due to Flooding some diseases was been arises and affects the peoples health. According to the report of Hagonoy Heath Office last August of 2012, There is 450 residents that been affected by flood at San Agustin. The diseases that been reported are Acute Respiratory Infection that has 67 incident, Athletes Foot that has 47, Hypertension that has 22, Diarrhea that has 7 and Leptospirosis that has 4 incidence. According to the Department

3 of Health in the Philippines, the 32,193 cases of the mosquito-borne disease between January and June 2012 are 3.89 percent higher than the 30,989 cases recorded in the same period last year. The National Capital Region recorded the most number of cases at 7,670, Central Luzon having 5, 552 cases, and CALABAR ZONs 4, 508 cases amid repeated reminders from the department for the public to continuously clean mosquitobreeding areas (GMA News, 2012). For the cases of Leptospirosis the department of health said that it increased by 62.32 %. From January 1 to August 18, 2012, leptospirosis cases reached a total of 2,471 with 129 deaths, the report said. In the same period last year, the DOH recorded only 1,522 cases (J.F. Manongdo, Manila Bulletin 2012). The researchers have chosen this topic as their study for them to have a deeper knowledge and understanding about Floods and its Impact to the health of the people living in Hagonoy, Bulacan. Hagonoy Bulacan is one of the town in Bulacan that has been affected so much last 2011 of the Typhoon Pedring that cause to much flood in the area, in addition to this, High Tide contributes to it that cause long term Flood on the area. Also they have chosen this study for the nurses to learn and formulate disease prevention program and Mitigation strategies that needs to be seriously thought through and acted upon.

4 Significance of the Study This study can be a learning source of the student and the community to gain knowledge about the possible impacts of Flood on their health. This will also serves as a guide to formulate certain action and programs for disease prevention before, during and after the Floods. The study will benefit the Residents Residents who really been affected by floods may learn on how to prevent certain diseases and infection caused by floods. This can also help the residents to be prepared every time floods occur. Community The community can be prepared for the possible impacts of flood to their health. They can also now make the most of the resources available in the oceans and be prepared every time the water level rises. They will also gain more knowledge about the disease brought by floods. And now, the health center must be prepared to treat the disease like diarrhea, leptospirosis, malaria, athletes foot (Tinea Pedis) Nurses Nurse will be able to know the possible disease that can be obtained from floods, like diarrhea, leptospirosis, malaria, athletes foot and Wound Infection. This study will help to have a deeper understanding about the impacts of floods on health, so in the near future the researcher can share their knowledge to the communities about possible programs to prevent diseases that may acquires through the floods. Future researchers For future researches they can use this as their reference or guide in creating their thesis. They can also use this study as a comparison to past studies about Impacts of Flood on the health.

5 Review of Literature and Studies

Principal types and causes Areal (rainfall related). Floods can happen on flat or low-lying areas when the ground is saturated and water either cannot run off or cannot run off quickly enough to stop accumulating. This may be followed by a river flood as water moves away from the floodplain into local rivers and streams. Floods can also occur if water falls on an impermeable surface, such as concrete, paving or frozen ground, and cannot rapidly dissipate into the ground. Localized heavy rain from a series of storms moving over the same area can cause areal flash flooding when the rate of rainfall exceeds the drainage capacity of the area. When this occurs on tilled fields, it can result in a muddy flood where sediments are picked up by runoff and carried as suspended matter or bed load. Riverine. River flows may rise to floods levels at different rates, from a few minutes to several weeks, depending on the type of river and the source of the increased flow. Slow rising floods most commonly occur in large rivers with large catchment areas. The increase in flow may be the result of sustained rainfall, rapid snow melt, monsoons, or tropical cyclones. Localized flooding may be caused or exacerbated by drainage obstructions such as landslides, ice, or debris.

6 Rapid flooding events, including flash floods, more often occur on smaller rivers, rivers with steep valleys or rivers that flow for much of their length over impermeable terrain. The cause may be localized convective precipitation (intense thunderstorms) or sudden release from an upstream impoundment created behind a dam, landslide, or glacier. Dam-building beavers can flood low-lying urban and rural areas, occasionally causing some damage.

Estuarine and coastal. Flooding in estuaries is commonly caused by a combination of sea tidal surges caused by winds and low barometric pressure, and they may be exacerbated by high upstream river flow. Coastal areas may be flooded by storm events at sea, resulting in waves overtopping defenses or in severe cases by tsunami or tropical cyclones. A storm surge, from either a tropical cyclone or an extra tropical cyclone, falls within this category.

Catastrophic.

Catastrophic

flooding

is

usually

associated

with

major

infrastructure failures such as the collapse of a dam, but they may also be caused by damage sustained in an earthquake or volcanic eruption. See outburst flood.

Effects Primary effects. The primary effects of flooding include loss of life, damage to buildings and other structures, including bridges, sewerage systems, roadways, and canals. Infrastructure damage also frequently damages power transmission and

7 sometimes power generation, which then has knock-on effects caused by the loss of power. This includes loss of drinking water treatment and water supply, which may result in loss of drinking water or severe water contamination. It may also cause the loss of sewage disposal facilities. Lack of clean water combined with human sewage in the flood waters raises the risk of waterborne diseases, which can include typhoid, giardia, cryptosporidium, cholera and many other diseases depending upon the location of the flood. Damage to roads and transport infrastructure may make it difficult to mobilize aid to those affected or to provide emergency health treatment. Flood waters typically inundate farm land, making the land unworkable and preventing crops from being planted or harvested, which can lead to shortages of food both for humans and farm animals. Entire harvests for a country can be lost in extreme flood circumstances. Some tree species may not survive prolonged flooding of their root systems.

Secondary and long-term effects. Economic hardship due to a temporary decline in tourism, rebuilding costs, or food shortages leading to price increases is a common after-effect of severe flooding. The impact on those affected may cause psychological damage to those affected, in particular where deaths, serious injuries and loss of property occur.

8 Flood forecasting Anticipating floods before they occur allows for precautions to be taken and people to be warned so that they can be prepared in advance for flooding conditions. For example, farmers can remove animals from low-lying areas and utility services can put in place emergency provisions to re-route services if needed. Emergency services can also make provisions to have enough resources available ahead of time to respond to emergencies as they occur. In order to make the most accurate flood forecasts for waterways, it is best to have a long time-series of historical data that relates stream flows to measure past rainfall events. Coupling this historical information with real-time knowledge about volumetric capacity in catchment areas, such as spare capacity in reservoirs, ground-water levels, and the degree of saturation of area aquifers is also needed in order to make the most accurate flood forecasts. Radar estimates of rainfall and general weather forecasting techniques are also important components of good flood forecasting. In areas where good quality data is available, the intensity and height of a flood can be predicted with fairly good accuracy and plenty of lead time. The output of a flood forecast is typically a maximum expected water level and the likely time of its arrival at key locations along water way and it also may allow for the computation of the likely statistical return period of a flood. In many developed countries, urban areas at risk of flooding are protected against a 100-year flood - that is a flood that has a probability of around 63% of occurring in any 100 year period of time.

9 According to the U.S. National Weather Service (NWS) Northeast River Forecast Center (RFC) in Taunton, Massachusetts, a general rule-of-thumb for flood forecasting in urban areas is that it takes at least 1 inch (25 mm) of rainfall in around an hour's time in order to start significant ponding of water on impermeable surfaces. Many NWS RFCs routinely issue Flash Flood Guidance and Headwater Guidance, which indicate the general amount of rainfall that would need to fall in a short period of time in order to cause flash flooding or flooding on larger water basins.

Control In many countries around the world, waterways prone to floods are often carefully managed. Defenses such as levees, bunds, reservoirs, and weirs are used to prevent waterways from overflowing their banks. When these defenses fail, emergency measures such as sandbags or portable inflatable tubes are often used to try and stem flooding. Coastal flooding has been addressed in portions of Europe and the Americas with coastal defenses, such as sea walls, beach nourishment, and barrier islands. In the riparian zone near rivers and streams, erosion control measures can be taken to try and slow down or reverse the natural forces that cause many waterways to meander over long periods of time. Flood controls, such as dams, can be built and maintained over time to try and reduce the occurrence and severity of floods as well. In the USA, the U.S. Army Corps of Engineers maintains a network of such flood control dams.

10 Benefits Floods (in particular more frequent or smaller floods) can also bring many benefits, such as recharging ground water, making soil more fertile and increasing nutrients in some soils. Flood waters provide much needed water resources in arid and semi-arid regions where precipitation can be very unevenly distributed throughout the year. Freshwater floods particularly play an important role in maintaining ecosystems in river corridors and are a key factor in maintaining floodplain biodiversity. Flooding can spread nutrients to lakes and rivers, which can lead to increased biomass and improved fisheries for a few years. For some fish species, an inundated floodplain may form a highly suitable location for spawning with few predators and enhanced levels of nutrients or food. Fish, such as the weather fish, make use of floods in order to reach new habitats. Bird populations may also profit from the boost in food production caused by flooding. Periodic flooding was essential to the well-being of ancient communities along the Tigris-Euphrates Rivers, the Nile River, the Indus River, the Ganges and the Yellow River among others. The viability of hydropower, a renewable source of energy, is also higher in flood prone regions. Impacts of Flood on Health: Mental health The World Health Organization recognizes that the mental health consequences of floods have not been fully addressed by those in the field of disaster preparedness or service delivery, although it is generally accepted that natural disasters, such as earthquakes,

11 floods, and hurricanes, take a heavy toll on the mental health of the people involved, most of whom live in developing countries, where the capacity to take care of these problems is extremely limited. Here, the main evidence relates to common mental disorder, posttraumatic stress syndrome, and suicide.

Common mental disorder (anxiety, depression) Most studies on the effects of flooding on common mental disorders are from high- or middle-income countries, including Australia, Poland, the United Kingdom, and the United States, but there is also a study from Bangladesh. Bennet's analysis of the 1968 Bristol floods found a significant increase (18 percent vs. 6 percent; p < 0.01) in the number of new psychiatric symptoms (considered to comprise anxiety, depression, irritability, and sleeplessness) reported by women from flooded compared with non flooded areas, although there was no significant difference for men. These results broadly agree with the findings for the 1974 Brisbane floods, except that in Brisbane men were also affected. Those between 35 and 75 years of age suffered the greatest impacts. Other evidence for impacts on common mental disorder comes from a controlled panel study of adults aged 5574 years flooded in 1981 and again in 1984. Flood exposure was associated with significant increases in depression (p < 0.005) and anxiety (p < 0.0008) (and also physical symptoms), especially in those with higher levels of pre-flood depressive symptoms and in those from lower socioeconomic groupsa finding that

12 Phifer et al. suggest supports Logue et al.'s 1981 assertion that low-income people are more vulnerable to the adverse effects of a disaster. In a longitudinal study, Ginexi et al. were able to compare symptoms for depression in both the pre- and postflood periods, and they found that, among respondents with a preflood depression diagnosis, the odds of a postflood diagnosis increased significantly (odds ratio = 8.55, 95 percent CI: 5.54, 13.2). A more recent case-control study from the United Kingdom found a fourfold increase in psychological distress among adults whose homes were flooded compared with those whose homes were not (RR = 4.1, 95 percent CI: 2.6, 6.4). On the other hand, more equivocal evidence comes from two case-control studies of the mental health impacts of Tropical Storm Agnes, which caused extensive flooding in Pennsylvania in 1972. The first study, conducted 3 years post flood, focused on workingclass males aged 2565 years; the second, conducted 5 years after the event, focused on women aged 21 years or more. In both cases, respondents from flooded households reported more mental health symptoms than did non flooded respondents, but differences were not statistically significant. The authors speculate that the failure to find a stronger relationship may, in part, be the result of the length of time which had elapsed since the disaster impact . Comparatively few studies have examined mental health impacts on children, but an exception is the 1993 study by Durkin et al. that found postflood changes in behavior and bedwetting among children aged 29 years. Before the flood, none of the 162 children were reported to be very aggressive; postflood, 16 children were found to be very

13 aggressive toward others. Bedwetting increased from 16.8 percent before the flood to 40.4 percent after it. In the Netherlands, Becht et al. interviewed 64 children and their parents (n = 30) 6 months postflood and found 1520 percent of the children having moderate to severe stress symptoms. Other studies after the 1997 floods in Opole, Poland (81, 93), also suggest long-term negative effects on the well-being of children aged 11 14 years and 1120 years, with increases in posttraumatic stress disorder (PTSD), depression, and dissatisfaction with life. Six months after Hurricane Floyd, similar findings were found by Russionello et al. for children aged 912 years. Posttraumatic stress disorder PTSD arises after a stressful event of an exceptionally threatening or catastrophic nature and is characterised by intrusive memories, avoidance of circumstances associated with the stressor, sleep disturbances, irritability and anger, lack of concentration and excessive vigilance [and the specific diagnosis of PTSD] has been questioned as being culturespecific, and may be overdiagnosed . Nonetheless, studies showing increases in PTSD following floods come from Europe and North America. McMillen et al., who interviewed those affected by the 1993 Midwest floods, found that 60 subjects (38 percent) met the criteria for postflood psychiatric disorder and 35 (22 percent) met the criteria for flood-related PTSD. However, the limitations, recognized by the authors, included retrospective data collection, self-selection of interviewees, selfreporting, and the absence of a control group. Similar limitations applied only to a study of 1997 flood victims in the Central Valley of northern California (99): 19 percent (24) of the 128 participants who completed the acute stress disorder questionnaire met the

14 criteria for the disorder's diagnosis, and of the 73 participants who completed the 1-year follow-up, seven (10 percent) met the criteria for full PTSD. Studies of the 1996 flooding in the Saguenay/Lac St. Jean region of Quebec, Canada, also suggest substantial increases in emotional distress and PTSD among flooded respondents (97). Evidence from Puerto Rico and from work by Norris et al. (95) suggests that PTSD symptoms are influenced by the extent of flooding, culture, and age. The difficulties of interpretation are demonstrated in a study by Verger et al. (100), who examined the mental health impacts 5 years after the 1992 floods in Vaucluse, France. They concluded that the subjects' reports of their disaster-related experiences (significantly worse for women and subjects older than 35 years) are by nature subjective and not entirely reliable.

Leptospirosis Leptospirosis is a disease that is caused by pathogenic spirochetes of the genus Leptospira. It is considered the most common zoonosis in the world. Leptospirosis has recently been recognized as a re-emerging infectious disease among animals and humans and has the potential to become even more prevalent with anticipated global warming. Leptospirosis is distributed worldwide (sparing the polar regions) but is most common in the tropics. Humans and a wide range of animals, including mammals, birds, amphibians, and reptiles can develop Leptospira infection. However, humans are rarely chronic carriers and are therefore considered accidental hosts. Leptospirosis is transmitted via direct

15 contact with the body fluid of an acutely infected animal or by exposure to soil or fresh water contaminated with the urine of an animal that is a chronic carrier. Human leptospirosis is often acquired via contact with fresh water contaminated by bovine, rat, or canine urine as part of occupational contact with these animals. The disease is also acquired during adventure travel or vacations that involve water sports or hiking, or even as a consequence of flooding. The burgeoning exotic-pet trade further increases the likelihood of transmission. In 2005, leptospirosis was transmitted from southern flying squirrels imported from Miami, Florida, to two Japanese animal handlers employed by an importer of exotic pets. Endemic canine leptospirosis is becoming more common in the United States, and California has seen a re-emergence of disease since 2000. Leptospirosis in humans is characterized by an acute febrile illness followed by mild self-limiting sequelae or an even more severe, and often fatal, multiorgan involvement. The disease was first described by Larrey in 1812 of fivre jaune among Napoleon's troops at the siege of Cairo. It was initially believed to be related to the plague but not as contagious. Throughout the remainder of the 19th century, the illness was known in Europe as bilious typhoid. A little over 100 years ago, Adolph Weil published his historic paper describing the most severe form of infection that would be later known as Weil disease. In 1907, special staining techniques were used to confirm that a spirochete was responsible for this illness. A postmortem examination of the kidney of a person with

16 Weil disease contained a spiral organism with hooked ends, which was first named Spirochaeta interrogans.

Dengue
Dengue vaccines are currently in development and policymakers need appropriate economic studies to determine their potential financial and public health impact. We searched five databases (PubMed, EMBASE, LILAC, EconLit, and WHOLIS) to identify health economics studies of dengue. Forty-three manuscripts were identified that provided primary data: 32 report economic burden of dengue and nine are comparative economic analyses assessing various interventions. The remaining two were a willingness-to-pay study and a policymaker survey. An expert panel reviewed the existing dengue economic literature and recommended future research to fill information gaps. Although dengue is an important vector-borne disease, the economic literature is relatively sparse and results have often been conflicting because of use of inconsistent assumptions. Health economic research specific to dengue is urgently needed to ensure informed decision making on the various options for controlling and preventing this disease.

The frequent incident of high tides in Hagonoy have altered the lives of the people and in turn driving the community to cope up with the increasing numbers of diseases. The rise and fall of water level is not only caused by the pull of the moon but also by the changes in climate. The people are now adjusting with these changes. Within the community, the health center is field with problems on how to treat leptospirosis, dengue, malaria, athletes foot, and to reduce the numbers of victims. Now that there are

17 calendars and ways to know when the high tide will occur it is really helpful especially to those who are working near the shores. Like what we said earlier high tide nowadays is also caused by climate change and we cannot prevent it anymore. If you are to compare the incidents of high tides in earlier years the incidents almost doubled. Recent science ndings suggest that the climate system is changing faster and to a greater extent than previously thought in response to human-induced greenhouse gas emissions. These changes suggest that many parts of Australias coastline could face considerable risks from inundation, erosion and changing conditions of coastal waters. The most severe risks will be from coincident events of several hazards. For example, sea-level rise on top of an extreme storm tide and a severe revering ood from the same weather event. In a highly urbanized area th is combined series of events has the potential to cause large economic impacts. The breaching of a key coastal barrier during an extreme event, exposing coastal lakes or estuaries to increased wave and tidal energy could also have severe consequences. Climate change will drive changes in many of the processes associated with inundation or erosion of the coastline and will increase the frequency of individual high water level events. With increasing frequency the likelihood of events occurring simultaneously increases and what were once seen as rare and independent events will increasingly become more common. (Australian government; Department of Climate Change 2009). Climate change will drive changes to both landforms and habitat conditions in a range of coastal environments. Within each of the four broad coastal regions identied in this report, there is the potential for enhanced shoreline erosion, beach loss, saline inundation

18 of wetlands, and modication of tidal systems for land-based areas. Oceanic, shallow seas and embayments are also likely to be affected by higher sea temperatures, acidication, and changing storm patterns. Many environments are inuenced by the impacts of non-climate forces such as urban development and nutrient supplies from agricultural lands. All these factors will interact in complex and to some extent unpredictable ways, requiring careful monitoring and adaptive management strategies to help minimize adverse impacts. Coastal ecosystems likely to be most at risk from climate change include estuaries and associated wetlands, coral reefs, constrained tidal at communities and beaches where there is a lack of sediment replenishment. (Australian government; Department of Climate Change 2009). All of the diseases that have been said are not easy to handle. There are also diseasesNew studies have detected a rising number of reports of diseases in marine organisms such as corals, molluscs, turtles, mammals, and echinoderms over the past three decades. Despite the increasing disease load, microbiological, molecular, and

theoretical tools for managing disease in the worlds oceans are underdeveloped. Review of the new developments in the study of these diseases identifies five major unsolved problems and priorities for future research: (1) detecting origins and reservoirs for marine diseases and tracing the flow of some new pathogens from land to sea; (2) documenting the longevity and host range of infectious stages; (3) evaluating the effect of greater taxonomic diversity of marine relative to terrestrial hosts and pathogens; (4) pinpointing the facilitating role of anthropogenic agents as incubators and conveyors of marine pathogens; (5) adapting epidemiological models to analysis of marine disease. (Drew

19 Harvell, Richard Aronson, Nancy Baron, Joseph Connell, Andrew Dobson, Leah Gerber, Kiho Kim Armand Kuris, Hamish McCallum, Kevin Lafferty, James Porter, Mercedes Pascual, Garriett Smith, Katherine Sutherland, Steve Ellner, Bruce McKay, Jessica Ward,2004) Still even they are warned some of the people did not learn their lessons. Health officials in the Philippines have warned people not to wade in floodwaters this monsoon season after three times the usual number of cases of leptospirosis has been reported. Flash floods are common throughout the Philippine archipelago during the monsoon season, which runs from June to December. They are particularly common in Manila, the countrys sprawling capital and home to 14 million Filipinos. After only minutes of a downpour, streets in low lying areas instantly become filthy rivers clogged with waste. Many Manilenos go out in the floodwaters barefoot, and children often swim in the flooded streets. Leptospirosis is usually transmitted to humans through rats and their urine. However, bacteria in the floodwater can also infect people by entering the body through cuts and skin abrasions. Infection causes influenza-like symptoms, with fever, myalgia, and headache. Most cases, if detected early, can be treated with antibiotics. Severe cases can lead to renal failure and, in some cases, death. The increase in cases this year is unusual in that they occurred before the monsoon. We are attributing this to the El Nio weather pattern. Weve experienced a lot of extra rain and flooding because of this, said Dr Maria Soledad Antonio of the Department of Healths communicable disease control service. (PMC July 1999) Diarrhea

20 Diarrhea is a condition that involves the frequent passing of loose or watery stools. It is the opposite of constipation and can have many causes, which may be infectious or non-infectious. Acute diarrhea, meaning diarrhea that is not long-term, is a very common cause death in developing nations, especially among young children and babies. It usually appears rapidly and may last from between five to ten days. Chronic diarrhea, meaning long-term diarrhea is the second cause of death among children in developing countries. People with diarrhea often have fever and/or stomachache (abdominal cramps). Diarrhea may be caused by inflammatory bowel syndrome (IBS), Crohn's disease, an allergy, or an infection. According to the World Health Organization (WHO) approximately 3.5 million deaths each year are attributable to diarrhea. 80% of those deaths occur in children under the age of 5 years. Children are more susceptible to the complications of diarrhea because a smaller amount of fluid loss leads to dehydration, compared to adults.

Flooding and communicable diseases fact sheet Risk assessment and preventive measures Risk assessment Floods can potentially increase the transmission of the following communicable diseases: Water-borne diseases, such as typhoid fever, cholera, leptospirosis and hepatitis A Vector-borne diseases, such as malaria, dengue and dengue haemorrhagic fever,

yellow fever, and West Nile Fever Water-borne diseases

21 Flooding is associated with an increased risk of infection, however this risk is low unless there is significant population displacement and/or water sources are compromised. Of the 14 major floods which occurred globally between 1970 and 1994, only one led to a major diarrhoeal disease outbreak - in Sudan, 1980. This was probably because the flood was complicated by population displacement. Floods in Mozambique in January-March 2000 led to an increase in the incidence of diarrhoea and in 1998, floods in West Bengal led to a large cholera epidemic (01,El Tor, Ogawa). The major risk factor for outbreaks associated with flooding is the contamination of drinking-water facilities, and even when this happens, as in Iowa and Missouri in 1993, the risk of outbreaks can be minimized if the risk is well recognized and disaster-response addresses the provision of clean water as a priority. In Tajikistan in 1992, the flooding of sewage treatment plants led to the contamination of river water. Despite this risk factor, no significant increase in incidence of diarrhoeal diseases was reported. A typhoon in Truk District, Trust Territories of the Pacific in 1971 disrupted catchment water sources and forced people to use many different sources of groundwater that were heavily contaminated with pig faeces. As a result, there was an outbreak of balantidiasis, an intestinal protozoan. A cyclone and flooding in Mauritius in 1980 led to an outbreak of typhoid fever. There is an increased risk of infection of water-borne diseases contracted through direct contact with polluted waters, such as wound infections, dermatitis, conjunctivitis, and ear, nose and throat infections. However, these diseases are not epidemic-prone.

22 The only epidemic-prone infection which can be transmitted directly from contaminated water is leptospirosis, a zoonotic bacterial disease. Transmission occurs through contact of the skin and mucous membranes with water, damp soil or vegetation (such as sugarcane) or mud contaminated with rodent urine. The occurrence of flooding after heavy rainfall facilitates the spread of the organism due to the proliferation of rodents which shed large amounts of leptospires in their urine. Outbreaks of leptospirosis occurred in Brazil (1983, 1988 and 1996), in Nicaragua (1995), Krasnodar region, Russian Federation (1997), Santa Fe, USA (1998) Orissa, India (1999) and Thailand (2000). It is likely that environmental changes increased the vector (rodent) population which facilitated transmission. Vector-borne diseases Floods may indirectly lead to an increase in vector-borne diseases through the expansion in the number and range of vector habitats. Standing water caused by heavy rainfall or overflow of rivers can act as breeding sites for mosquitoes, and therefore enhance the potential for exposure of the disaster-affected population and emergency workers to infections such as dengue, malaria and West Nile fever. Flooding may initially flush out mosquito breeding, but it comes back when the waters recede. The lag time is usually around 6-8 weeks before the onset of a malaria epidemic. Malaria epidemics in the wake of flooding are a well-known phenomenon in

malaria-endemic areas world-wide. For instance, an earthquake and subsequent flooding in Costa Rica's Atlantic region in 1991 and flooding on the Dominican Republic in 2004 led to malaria outbreaks.

23 Periodic flooding linked to El Nino-Southern Oscillation (ENSO) is associated

with malaria epidemics in the dry coastal region of northern Peru and with the resurgence of dengue in the past 10 years throughout the American continent. West Nile Fever has resurged in Europe subsequent to heavy rains and flooding,

with outbreaks in Romania in 1996-97, in the Czech Republic in 1997 and Italy in 1998. The risk of outbreaks is greatly increased by complicating factors, such as changes in human behaviour (increased exposure to mosquitoes while sleeping outside, a temporary pause in disease control activities, overcrowding), or changes in the habitat which promote mosquito breeding (landslide, deforestation, river damming, and rerouting). Risk posed by corpses Contrary to common belief, there is no evidence that corpses pose a risk of disease "epidemics" after natural disasters. Most agents do not survive long in the human body after death (with the exception of HIV -which can be up to 6 days) and the source of acute infections is more likely to be the survivors. Human remains only pose health risks in a few special cases requiring specific precautions, such as deaths from cholera or haemorrhagic fevers. However, workers who routinely handle corpses may have a risk of contracting tuberculosis, bloodborne viruses (such as Hepatitis B/C and HIV), and gastrointestinal infections (such as rotavirus diarrhoea, salmonellosis, E. coli, typhoid/paratyphoid fevers, hepatitis A, shigellosis and cholera). Tuberculosis can be acquired if the bacillus is aerosolized (residual air in lungs

exhaled, fluid from lungs spurted up through nose/ mouth during handling of the corpse).

24 Exposure to bloodborne viruses occurs due to direct contact with non-intact skin

of blood or body fluid, injury from bone fragments and needles, or exposure to the mucous membranes from splashing of blood or body fluid. Gastrointestinal infections are more common as dead bodies commonly leak

faeces. Transmission occurs via the faeco-oral route through direct contact with the body and soiled clothes or contaminated vehicles or equipment. Dead bodies contaminating the water supply may also cause gastrointestinal infections. The public and emergency workers alike should be duly informed to avoid panic and inappropriate disposal of bodies, and to take adequate precautions in handling the dead (see prevention below). Other health risks posed by flooding These include drowning and injuries or trauma. Tetanus is not common after

injury from flooding, and mass tetanus vaccination programs are not indicated. However, tetanus boosters may be indicated for previously vaccinated people who sustain open wounds or for other injured people depending on their tetanus immunization history. Passive vaccination with tetanus immune globulin (Hypertet) is useful in treating wounded people who have not been actively vaccinated and those whose wounds are highly contaminated, as well as those with tetanus. Hypothermia may also be a problem, particularly in children, if trapped in

floodwaters for lengthy periods. There may also be an increased risk of respiratory tract infections due to exposure (loss of shelter, exposure to flood waters and rain).

25 Power cuts related to floods may disrupt water treatment and supply plants

thereby increasing the risk of water-borne diseases as described above but may also affect proper functioning of health facilities, including cold chain.

Skin diseases during floods in Thailand Abstract BACKGROUND: Floods are natural disasters that occur occasionally in Thailand. The most common form skin diseases due to floods are infectious dermatoses especially superficial fungal infection. However the microbiologic evidences have not been evaluated. OBJECTIVE: To evaluate the most common skin diseases during floods and identify the organism that causes skin maceration at web space(s) of toes (Hong Kong foot). MATERIAL AND METHOD: Patients who complained of skin problems were evaluated at the temporary outpatient clinic during October 2006. Skin specimens from all patients who had itches and skin maceration at web space(s) of toes were cultured. RESULTS: Ninety-six patients were evaluated (38 males and 58 females). Eczema was the most prevalent dermatosis, which accounted for 34.5% of the total skin problems and the great majority of these cases were irritant contact dermatitis. Sixteen cases presented with itch and skin maceration at web space(s) of toes. All of them were colonized with various

26 microorganisms. Gram-negative bacilli were the most prevalent ones and were found in 14 out of 16 specimens. Fungal culture was positive in only two specimens. CONCLUSION: Eczema is the most common dermatosis during floods. Skin maceration at web space(s) of toes, which were thought to be fungal infection, are chronic irritant dermatitis with secondary bacterial colonization. Only a few cases were fungal infection. Microbiologic investigation should be done in these patients. Unfortunately, it is not practical in such a situation. Topical medications that have the combination of anti-inflammatory, antibacterial and antifungal properties are the most suitable medications.

Impacts of flood on health: Epidemiologic evidence from Hanoi, Vietnam Background: Vietnam is one of the most disaster-prone countries in the world. The country suffers from many kinds of natural disasters, of which the most common and serious one is flooding. Long and heavy rainfall during the last days of October and the first week of November 2008 resulted in a devastating flood unseen for over three decades in the capital city of Hanoi. It caused a substantial health impact on residents in and around the city and compromised the capacity of local health services. Objective: The aim of this study is to ascertain the vulnerability and health impacts of the devastating flood in Hanoi by identifying the differences in mortality, injuries, and morbidity patterns (dengue, pink eye, dermatitis, psychological problems, and hypertension) between flood affected and non-affected households.

27 Design: A cross-sectional study was carried out involving 871 households in four selected communes (two heavily flood affected and two comparatively less affected) from two severely flooded districts of Hanoi. Participants were interviewed and information collected on the social, economic, and health impacts of the devastation within 1 month after the flood. Results: The self-reported number of deaths and injuries reported in this study within 1 month after the heavy rainfall were a bit higher in severely affected communes as compared to that of the less affected communes of our study. The findings showed higher incidences of dengue fever, pink eye, dermatitis, and psychological problems in communes severely affected by flood as compared to that of the controlled communes. Conclusions: For people in flood prone areas (at risk for flooding), flood prevention and mitigation strategies need to be seriously thought through and acted upon, as these people are exposed to greater health problems such as psychological issues and communicable diseases such as pink eye or dermatitis

28 Theoretical Framework In this study the researchers had chosen the Neumann systems model by Betty Neumann. Neumann System Model describe as reflects nursings interest in well and ill people as holistic systems and in environmental influences on health. Clients and nurses perception of stressors and resources or emphasizes, clients act in partnership with the nurses to set goals and identify relevant prevention interventions. The individual, family or group, community, or a social issue all are the client systems, which are viewed as composites of interacting physiological, sociocultural, developmental, and spiritual variables (Neumann, 2001). Neumann Systems model is also define as a dynamic, open, systems approach to client care originally developed to provide a unifying focus for nursing problem definition and for best understanding the client in interaction with the environment (Neumann, 2002).

Neumann Systems model identified as wholistic approach, open system (including function, input and output, feedback, negentropy, entropy, and stability), environment, created environment, wellness and illness, client system (including five client variables, basic structure, lines resistance, normal line of defense, and flexible line of defense), stressors, degree reaction, prevention as intervention and reconstitution (Neuman, 2002). Clients are reviewed as wholes whose parts are in dynamic interaction. The model considers all variables simultaneously affecting the client system: physiological, psychological, socio-cultural, developmental, and spiritual. Neumann included the spiritual variable in the second edition (1989). She changed the spelling of

29 the term holistic to wholistic in the second edition to enhance understanding of the term as referring to the whole person (B. Neuman, personal communication, June 20, 1988). Betty Neumann was born in 1924 and grew up on a farm in Ohio. Her rural background helped her develop a compassion for people in need, which has been evident throughout her career. She completed her initial nursing education with double honors at Peoples Hospital School of nursing (now General Hospital), Akron, Ohio, in 1947. And in 1970 Neumann designed a nursing conceptual model for UCLA nursing students; the purpose is to expand understanding of client variables beyond the medical model (Neumann & Young, 1972).

This Theory relates to our study, the System Model of Betty Neumann, helps our study to solve the major problem and a guide to construct a Program to be prepare if theres sudden floods come up and disease Prevention Program to prevent to acquire certain diseases that may arise during floods.. Also concern to the stressor affects our mental health (specially trauma during floods); we all know that mental health also is a big factor to the heath of each individual.

30

Conceptual Framework

This figure shows the modifiable factors like health, Morbidity Pattern, prevention of Mitigation Strategies and Non Modifiable factors like Age, Gender, and Location to come up with a Functional Health Program that will affect or improve the modifiable factors of the people living in Hagonoy, Bulacan.

Figure 1. Conceptual Framework of the Study

People Living in Hagonoy, Bulacan

Modifiable Factors Health Morbidity Pattern Prevention of Mitigation Strategies

Non Modifiable Age Gender Location

Functional Health Education Program

31 Statement of the Problem The aim of this study is to ascertain the vulnerability and health impacts of the devastating flood in Hagonoy, Bulacan by identifying the differences in injuries, and morbidity patterns (dermatitis, diarrhea, conjunctivitis, leptospirosis, hypertension, and dengue fever) between flood with most affected and least affected household.

1. How may the characteristics of the study population be described in terms of: 1.1 Number of households 1.2 Gender of respondents 1.3 Religion 1.4 Income 1.5 Marital status 2. How may the experience of the respondents with the historic flood in 2011 be described? 3. How may the impacts of flood on the health aspect of the respondents be described after the historic flood in 2011 in terms of: 3.1 Access to health care services 3.2 Injuries 3.3 Health conditions

32 Definition of Terms The following are the terms and variables used in the study. They are defined for clarity of meaning to present sufficient information and understanding on the part of the readers of this towards Flood. Access. This term refers to the permission to approach or use of usual health care services or medication. Epidemiologic Evidence. This term is used to determine the evidence and of the presence of problems regarding about the flood. Experience. This term to refer to the act of encountering the time of the heavy rainfalls/ flood. Flood. This term refers to the increase level of water in a specific place or community. Gender. This term refers to the gender of the people living in the Hagonoy Bulacan. Health Condition. This term refers to the health of the people lived in Hagonoy Bulacan that experienced heavy rainfall/flood. Health Impacts. This refers to the effects of flood to the health of the community. To determine the types of disease that can be acquired in the community during flood. Injuries. This term refer to the harm that the people of Hagonoy Bulacan experience during the heavy rainfall. Prevention and irrigation strategies. This term refers to develop a certain techniques and strategies on how to prevent flood to occur in a community.

33

Scope and Limitation The sample population selected for this study will be limited and conducted only to the most affected and least affected area in Hagonoy including Brgy. Palapat (33households), San Juan(43households) ,San Pascual(40households), Sto.

Rosario(35households), Carillo(23households), Sta. Cruz(24households) Hagonoy, Bulacan during our 2nd semester this January 2013. The respondents of the study were the affected households of 6 Barangay in Hagonoy. The instrument used in this study will be a survey form which serves as our guide to identify the common problems that they encounter and a possible solution regarding their problems.

34 Chapter 2 Methodology

This division of the study discusses the design of the study, the research method and the technique to be used in particular. It also describes the subject or respondents of the study, and the data gathering instruments utilized. It also includes the statistical methods employed in analyzing the data.

Research Design Polit & Beck (2004:49) described research design is the overall plan for obtaining answers to the question being studied and for handling some of the difficulties encountered during the research process. Research designs are developed to meet the unique requirements of a study. Polit & Beck (2004:209), and Wood and Harbor (1998:157) indicated that selecting a good research design should be guided by an overarching consideration, namely whether the design does the test possible job providing trustworthy answers to the research questions. This study utilized the descriptive method of research. Descriptive research refers to research studies that have as their main objective the accurate portrayal of the characteristics of a person, situations or group (Polit & Hungler 2004:716). In this study, the researchers considered the most suitable research design to be a Comparative Studies and descriptive survey design. Comparative Studies can be used in comparing the result in the differences in certain characteristics according to variable considered. The term survey can be used to designate any may be defined as a purposive process of gathering, analyzing, classifying and tabulating data about the prevailing conditions, beliefs, press, trends and cause-effect relationship which the investigator gathers data from a portion of a population for the purpose of examining the characteristic, opinion, or intentions of that population (Couchman & Dawson 1995:70; Polit &

35 Beck 2004;234) A descriptive design is selected because of its high degree of representativeness and the ease in which a researcher obtain the participants opinion (Polit & beck 2004:50). In the present study, the researchers obtain and describe the views of the respondents with regard to their knowledge, practice and awareness during occurrence of flood.

Research Locale Hagonoy Bulacan is one of the low areas in Bulacan, you can also found many fish pen and rivers around its place. During the Typhoon Pedring last 2011, Hagonoy is one of most affected area in Bulacan. The researcher conducted a research to Hagonoy to know what was the effect of Flood in their area and diseases which may occur, also to know what was the remedies they may provide if flooding arises.

Population Sampling or Respondents of the Study The subjects of the study were composed of 198 respondents out of 23,891 populations residing at the selected Barangay of Hagonoy, Bulacan which are near the bodies of water and those who are usually affected during floods. The respondents were chosen using non-random sampling in collecting the said population specifically incidental sampling technique in determining the extent of knowledge and attitude regarding high tides and the effects of it to the residents.

36 Research Instrument In gathering the data and information requirements of the study, the researcher used the following instruments/techniques: Questionnaire. A structured questionnaire made by the researcher was utilized in determining the extent of knowledge, attitude and practice of the locals regarding about the Impacts of Flood on Health to the residents of Hagonoy, Bulacan. It elicited information about clients name, address, and status. The second part of the questionnaire elicit the respondents level of knowledge concerning about the high tides schedule, risk factors, how did affect to the community, How did community adapt to this environment, what kind of programs or solution that community think so. Questionnaire that determines the clients risk made use of yes or no.

Interview. The researcher will also made use of interview and observation as a means of gathering additional information from the respondents. Respondents were assured that the information will be treated with high confidentiality. These methods will help the researcher to have a more accurate interpretation of the results of the study and to be able to verify the veracity of the answers that will be obtained through the questionnaire.

Development of the Questionnaire The researchers gather and review different related literature and some advices to some residents of Hagonoy, Bulacan to be able to come up with the concepts on the content of the questionnaire. The established draft of the tool was shown to the advisers and critiques for comments, suggestions and recommendations. All of the recommendations were noted and used for the improvement of the questionnaires.

37 The tool was subjected to content validity and face reliability. 3 persons in authority were consulted regarding the validity of the statements used in the tool: one Municipal Health Officer, Each Nurse assigned to the Six(6) Barangay Health Center and the adviser of the researcher. All comments, suggestions and recommendations were considered in putting the tool into its final form.

Data Gathering The whole process started with the formulation of a letter of request to the chief of the hospital asking permission to conduct the study. After having the topic, the researcher created a request being addressed to Dr. Romel Pajela, Municipal Health Officer at Municipality of Hagonoy, Bulacan so that they can gather information and make interviews on a specific place in Hagonoy, Bulacan. After signing the request, the researcher then finally handed out the questionnaires to the locals. Questionnaire that are carefully handed back are checked. Items that are missed will be noted and the researcher will also find time to interview with the client.

Statistical Treatment of Data The data gathered will tabulate, organize and analyze using the following statistical methods and techniques: 1. For the profile of the respondents, frequency and percentage distribution will be utilized. 2. The Standard Deviation will be utilized to measure the degree of variability of the respondents answers regarding the impacts of flood on health.

38

Chapter 3 Results and Discussion This chapter presents, analyzes and interprets the data gathered from the survey. The discussions were made following the order and sequence of the questions raised in Chapter 1.

Table 1. Characteristics of study population Less Affected Area (San Pascual, Sta. Cruz, Sta. Rosario) n = 99 Number of Population Gender of respondent Male Female Religion Roman Catholic Born Again Christian Muslim Iglesia Ni Cristo Ang Dating Daan Income/month 1,000 5,500 6,000 10,500 11,000 15,500 16,000 20,500 Marital Status Single Married Widowed n = 99 38 61 n = 99 95 1 1 1 0 1 n = 99 60 36 3 0 n = 99 30 64 5 % 38.38 61.62 % 95.96 1.01 1.01 1.01 0 1.01 % 60.6% 36.4% 3% 0 % 30.30 64.65 5.05

Most Affected Area (Palapat, San Juan, Carillo) n =99 n = 99 28 71 n = 99 97 1 0 0 1 0 n = 99 59 31 8 1 n = 99 37 57 5 % 28.28 71.72 % 97.98 1.01 0 0 1.01 0 % 59.6% 31.3% 8% 1% % 37.37 57.58 5.05

A total of 198 respondents participated in the survey. The description of the final sample is presented in Table 1. Among the respondents, the proportions of females were higher than

39 males (61.62% vs. 38.38%). Almost the entire respondent said that their religion is Roman Catholic with 97.98% in most affected area (Palapat, San Juan, Carillo) and other religion formed about 1% in each barangay. The income per month reveals that the highest average income of the affected areas in less affected area were range to 1,000-5, 500 pesos (60.6%) while in the most affected area reveals the same 1,000-5,500 pesos (59.6%). Regarding to marital status, about half of our studied population were married, about 30% were single, and about 5% were widowed.

Table 2. Experience with the heavy rainfall/flood Less Affected Area (San Pascual, Sta. Cruz, Sta. Rosario) n = 99 % Present at the time of flood Yes 99 100 No 0 0 Migrated due to flood Yes No Place to stay after evacuation Relative / friends Temporary shelter from government agencies (Inconvenient) Temporary shelter from government agencies (Convenient) Others(neighbors) School goers before flood Yes No School activities affected by food Yes n = 99 21 78 n = 21 11 3 % 21.21 78.79 % 52.38 14.29

Most Affected Area (Palapat, San Juan, Carillo) n = 99 99 0 n = 99 53 46 n = 53 47 1 % 100 0 % 53.54 46.46 % 88.68 1.89

28.57

9.43

1 n = 99 9 90 n = 99 11

4.76 % 9.09 90.91 % 11.11

0 n = 99 12 87 n = 99 13

0 % 12.12 87.88 % 13.13

40 No Daily routine affected Yes No 88 n = 99 92 7 88.89 % 92.93 7.07 86 n = 99 95 4 86.87 % 95.96 4.04

Results from Table 2 shows that almost all people in the sample were present at the time of the heavy rainfalls/flood during Typhoon Pedring (with 100 % in all six communes). About half of the people in Palapat, San Juan, and Carillo (most affected area) had to migrate due to flood and in San Pascual, Sta. Cruz, and Sto. Rosario (less affected area) the number was about 20%. The majority of people who migrated due to flooding stayed in their relative or friends house. In addition, people living in communes that were affected by flood reported that they stayed in temporary shelters provided by the government such as in schools.

Table 3 Access to health care service Less Affected Area (San Pascual, Sta. Cruz, Sta. Rosario) n = 99 % Most Affected Area (Palapat, San Juan, Carillo) n = 99 %

Access and use of usual health care/ medication compromised Yes No Reasons Road damage Lack of money Others (flood, unavailability of transportation, not informed )

40 59 n = 40 7 5 28

40.4 59.6 % 17.5 12.5 70

40 59 n = 40 5 1 34

40.4 59.6 % 12.5 2.5 85

Table No. 3 shows that 40% of the respondents in both affected area said that access to and use of their usual healthcare or medication were compromised during the heavy rain/flood. With regards to the question about the reasons why the access and usual healthcare/medication

41 were compromised by the heavy rain falls/flood, respondents gave multiple reasons. Among those who said that their access to usual healthcare/medication was compromised, about 70% mentioned that the reason was flood, unavailability of transportation and they were not informed in less affected area, while 85% on the most affected area. 2.5 % of the respondents from most affected area and 12.5% from less affected area said that it was due to lack of money. Lastly, 12.5% and 17.5%, respectively, were due to road damage.

Table 4 Injuries Less Affected Area (San Pascual, Sta. Cruz, Sta. Rosario) n = 99 % 5 5.05 94 94.95 n=5 1 3 1 n=5 2 1 2 % 20 60 20 % 40 20 40 Most Affected Area (Palapat, San Juan, Carillo) n = 99 5 94 n=5 4 0 1 n=5 1 1 3 % 5.05 94.95 % 80 0 20 % 20 20 60

Injured Yes No Type of injury Cuts Bone fracture Laceration/contusion Cause of injury Fall Traffic/ road accident Others (slide)

Ten injuries were reported during heavy rainfall/flood. Types of injuries were reported in Table 4. Five persons suffered cuts, four from Palapat, San Juan and Carillo, one of them from Sto. Rosario. Three people suffered bone fracture, one from Sta. Cruz and two from San Pascual. Two people suffered laceration or contusions. Five injuries occurred in all barangays were due to sliding, three persons were injured due to falls, and one in Sto. Rosario and Palapat were injured in a road accident. Falls and Sliding seem to be the attributing factors of injuries during flood.

42

Table 5 Health Condition within one month after the flood Less Affected Area (San Pascual, Sta. Cruz, Sta. Rosario) n = 99 Any family member ever have psychological problems Yes No Having psychological problems before the heavy rain/ flood Yes No Did psychological problems get worse after the heavy rain/flood Yes No Any family member ever been diagnosed having hypertension Yes No Having hypertension before the heavy rain/ flood Yes No Did hypertension get worse after the heavy rain/flood Yes No Any family member ever been diagnosed having dengue fever Yes No Having dengue fever after the heavy rain/flood Yes Most Affected Area (Palapat, San Juan, Carillo) n = 99 %

60 39

60.61 39.39

45 54

45.45 54.55

32 67

32.32 67.68

28 71

28.28 71.72

21 78

21.21 78.79

24 75

24.24 75.76

44 55

44.44 55.56

38 51

38.38 51.52

33 66

33.33 66.67

28 71

28.28 7.72

14 85

14.14 85.86

28 71

28.28 7.72

9 90

9.09 90.91

3 96

3.03 96.97

9.09

1.01

43 No Any family member ever been diagnosed having conjunctivitis Yes No Having conjunctivitis after the heavy rain/flood Yes No Any family member ever been diagnosed having dermatitis Yes No Having dermatitis after the heavy rain/flood Yes No Any family member ever been diagnosed having diarrhea Yes No Having diarrhea after the heavy rain/flood Yes No Any family member ever been diagnosed having Leptospirosis Yes No Having Leptospirosis after the heavy rain/flood Yes No 90 90.91 98 98.99

7 92

7.07 92.93

5 94

5.05 94.95

11 88

11.11 88.89

5 94

5.05 94.95

78 21

78.79 21.21

86 13

86.87 13.13

73 26

73.74 26.26

86 13

86.87 13.13

17 82

17.17 82.83

20 79

20.2 79.8

12 87

12.12 87.88

10 89

10.1 89.9

0 99

0 100.0

0 99

0 100.0

0 99

0 100.0

0 99

0 100.0

Health condition of respondents was measured through a set of questions providing information for other family members. The results were presented in Table 5. There were significant differences between the respondents from severely affected area and those from the less affected area in terms of the family members suffering from psychological problem. In less

44 affected area about 32% of people who ever had suffered from physiological problems were reported to experienced it before the heavy rains and the flooding while these proportion in most affected area were 28%. Only 21% of those suffering in less affected area said that there psychological problems got worst during and after the flood while the percentage of the respondents in most affected area with worsening psychological problem during and after the flood were 24%. There is no significant difference in the number of respondents reporting that his/her family members had ever been diagnosing with developing hypertensions between the most affected area and less affected area. Although most reported cases of hypertension occurred before the heavy rain/flood, the percentage of people reporting that it got worst after the flood was significantly higher in the most affected area than the less affected area (28% in most affected area and 14% in less affected area). Twelve respondents reported having ever been diagnosed by a doctor for dengue fever, 9 respondents in less affected while there is 3 respondents in most affected area. The majority of all cases in the affected area reported that they were diagnosed with dengue fever after the flood. There is significant difference in the proportion of dengue cases in most affected area and less affected area. With regards to conjunctivitis there is 7% respondent in the less affected area reported to have it while there is 5% respondents in the most affected area. There is higher percentage reported by the respondent in the less affected area to have conjunctivitis after the heavy rain. Regarding dermatitis, about 86% respondents in most affected area reported to have it while 78.79% respondents in less affected area. All most dermatitis cases reported were after the flood. Regarding diarrhea, about 20% respondents reported in most affected area to have it while 17% respondents reported in less affected area having it. Percentage lowered in both areas after the heavy rain/flood (10% in most affected area and 12% in less affected area. There is no reported incident by the respondents regarding Leptospirosis.

45

Chapter 4 Summary, Conclusion and Recommendation

Summary Floods is one of the most devastating disaster in the world, it affects individual, family and community, globally, economically and psychologically. It cannot be prevented so people must always be ready and prepared any time when a flood occurred. Many diseases arise during floods such as conjunctivitis, dermatitis, dengue fever, hypertension and leptospirosis. People must undergo programs related to disaster planning so people know what they should do when they experience flood in their area. Global situation

Flooding accounts for about 40% of all natural disasters worldwide and causes about half of all deaths. The greatest potential flood hazard is in Asia. For the past two decades more than 400 million people on average have been directly exposed to floods. Between 1987 and 1997, 44% of all flood disasters worldwide affected Asia, claiming 228, 000 lives (roughly 93% of all flood-related deaths worldwide). The importance of this study is, it can contribute some information about the impacts of flood in the community in the health of each people experienced it globally. They may use this study as their reference if ever a certain Global or International Health Organization such as DOH and WHO conducted a research or study with the same study. National situation Last August 2013, incessant monsoon rains fuelled by Tropical Storm Trami (local name: Maring) have fallen over the Philippine capital, Manila, and surrounding provinces,

46 bringing widespread flooding that has had devastating effect. By 24 August, the National Disaster Risk Reduction and Management Committee (NDRRMC) reported that 21 lives have been lost, 179,000 families or more than 800,000 people have been displaced. Overall, the flooding has had an impact on the lives and livelihood of 2.5 million people across five regions. The governments weather agency monitors estimate that the heaviest rains occurred in Cavite, part of which recorded an amount that exceeded the average monthly for August in just 24 hours. Of the 800,000 persons displaced, 200,000 have sought refuge in evacuation centers while 600,000 are staying in alternative accommodation, often with friends and family. The National Capital Region recorded the most number of cases at 7,670, Central Luzon having 5, 552 cases, and CALABARZONs 4, 508 cases amid repeated reminders from the department for the public to continuously clean mosquito-breeding areas (GMA News, 2012). For the cases of Leptospirosis the department of health said that it increased by 62.32 %. From January 1 to August 18, 2012, leptospirosis cases reached a total of 2,471 with 129 deaths, the report said. In the same period last year, the DOH recorded only 1,522 cases (J.F. Manongdo, Manila Bulletin 2012). The importance of this study regarding Nationally, just like through globally it may contribute for future research and study by using this study in determining what are the impacts of floods in health and what diseases may arise before, during and after the flood. They can formulate certain programs for Flood Preparation. Regional situation

Last August 2013. The National Disaster Risk Reduction and Management Council said eight persons have died and 28, 000 families displaced as the enhanced southwest monsoon continued to dump heavy rains over Luzon. In its 6:00 p.m. bulletin, NDRRMC said over 125, 000 families in 58 municipalities and 29 cities were affected as floods continue to paralyze areas in Region I, III, IV-A, IV-B, the Cordillera Administrative Region (CAR) and the National Capital Region (NCR). Of the total number of affected 9, 300 families are sheltered in198

47 evacuation centers while 19, 140 displaced families stayed with friends and relatives. Sixty-five roads all over Luzon and one bridge in Mt. Province are still impassable to different types of vehicles due to flooding in 68 municipalities under Regions I, III, IV-A, IV-B, and NCR. As of 3 p.m. two gates of Binga and Ambuklao dams have been opened, while Magat has only one. La Mesa dam has already overflowed as the water breached the critical level of 80.15 meters. The government has so far dispatched P4.5 million worth of aid from the Department of Social Welfare and Development, local government units and non-government organizations delivered to affected areas. So far, most of the damage to agriculture is in the Rizal and Laguna, estimated at P1.7 million. Most of the damaged crops in Rizal are grains while in Laguna are forest and Fruit-bearing. As we all know, Region III is one of the regions in the Philippines that been affected by the heavy rain and floods now a days, this study may contribute to the Regional Government and Regional Health Organization when conducting studies and research about the impacts of Flood in the lives of each people specially with regards in Health. Local situation

Due to Flooding some diseases was been arises and affects the peoples health. According to the report of Hagonoy Heath Office last August of 2012, There is 450 residents that been affected by flood at San Agustin. The diseases that been reported are Acute Respiratory Infection that has 67 incident, Athletes Foot that has 47, Hypertension that has 22, Diarrhea that has 7 and Leptospirosis that has 4 incidence. This study focuses in the impacts of flood on health at Hagonoy Bulacan, this can be use as guide for conducting programs and health teaching for the People in Hagonoy regarding Flood Preparation and Alertness and how to prevent diseases that may arise during Heavy Rain and Flood. The Impacts of Flood in Hanoi, Vietnam is related with the impacts of Flood in Hagonoy, Bulacan, Philippines in term of impacts of Flood in Health, Vietnam and Philippines both

48 acquired same diseases that been arises during the heavy rain and floods such as conjunctivitis, dermatitis and hypertension This study can be a learning source of the student and the community to gain knowledge about the possible impacts of Flood on their health. This will also serves as a guide to formulate certain action and programs for disease prevention before, during and after the Floods. The study will benefit the: Residents who really been affected by floods may learn on how to prevent certain diseases and infection caused by floods. This can also help the residents to be prepared every time floods occur. The community can be prepared for the possible impacts of flood to their health. They can also now make the most of the resources available in the oceans and be prepared every time the water level rises. They will also gain more knowledge about the disease brought by floods. And now, the health center must be prepared to treat the disease like diarrhea, leptospirosis, malaria, athletes foot (Tinea Pedis). Nurse will be able to know the possible disease that can be obtained from floods, like diarrhea, leptospirosis, malaria, athletes foot and Wound Infection. This study will help to have a deeper understanding about the impacts of floods on health, so in the near future the researcher can share their knowledge to the communities about possible programs to prevent diseases that may acquires through the floods. For future researches they can use this as their reference or guide in creating their thesis. They can also use this study as a comparison to past studies about Impacts of Flood on the health. The aim of this study is to ascertain the vulnerability and health impacts of the devastating flood in Hagonoy, Bulacan by identifying the differences in injuries, and morbidity patterns (dermatitis, diarrhea, conjunctivitis, leptospirosis, hypertension, and dengue fever) between flood with most affected and least affected household. Specifically, aims to answer the following question: 1. How may the characteristics of the study population be described in terms of Number of households, Gender of respondents, Religion, Income and Marital status?

49 2. How may the experience of the respondents with the historic flood in 2011 be described? 3. How may the impacts of flood on the health aspect of the respondents be described after the historic flood in 2011 in terms of Access to health care services, Injuries and Health conditions? The hypothesis of the study is that there is a significant impact of flood on health. This study utilized the descriptive method of research. Descriptive research refers to research studies that have as their main objective the accurate portrayal of the characteristics of a person, situations or group (Polit & Hungler 2004:716). In this study, the researchers considered the most suitable research design to be a Comparative Studies and descriptive survey design. Comparative Studies can be used in comparing the result in the differences in certain characteristics according to variable considered. Questionnaire/ survey and Interview have been used as instruments in conducting the study. Questionnaire has 5 parts, Parts I is about Demographic data, Part II is about Experience with the historic flood in 2011 (Typhoon Pedring), Part III is regarding to Access to Health Care Services, Part IV is about Injuries within One month after the flood and Part V is regarding to Health conditions within One month after the historic flood (Typhoon Pedring). The total respondents of this study is 198, 99 respondents for less affected and 99 as well in most affected. The survey and interview were conducted and completed in two weeks. After the data gathered were tabulated, organized, the statistical methods and techniques used were: For the profile of the respondents, frequency and percentage distribution will be utilized. The Standard Deviation will be utilized to measure the degree of variability of the respondents answers regarding the impacts of flood on health

50 Findings: Problem 1. How may the characteristics of the study population be described in terms of Number of households, Gender of respondents, Religion, Income and Marital status? A total of 198 respondents participated in the survey. Among the respondents, the proportions of females were higher than males (61.62% vs. 38.38%). Almost the entire respondent said that their religion is Roman Catholic with 97.98% in most affected area (Palapat, San Juan, Carillo) and other religion formed about 1% in each barangay. The income per month reveals that the highest average income of the affected areas in less affected area were range to 1,000-5, 500 pesos (60.6%) while in the most affected area reveals the same 1,000-5,500 pesos (59.6%). Regarding to marital status, about half of our studied population were married, about 30% were single, and about 5% were widowed.

Problem 2. How may the experience of the respondents with the historic flood in 2011 be described? Results show that almost all people in our sample were present at the time of the heavy rainfalls/flood during Typhoon Pedring (with 100 % in all six communes). About half of the people in Palapat, San Juan, and Carillo (most affected area) had to migrate due to flood and in San Pascual, Sta. Cruz, and Sto. Rosario (less affected area) the number was about 20%. The majority of people who migrated due to flooding stayed in their relative or friends house. In addition, people living in communes that were affected

51 by flood reported that they stayed in temporary shelters provided by the government such as in schools.

Problem 3. How may the impacts of flood on the health aspect of the respondents be described after the historic flood in 2011 in terms of Access to health care services, Injuries and Health conditions?

Result shows that 40% of the respondents in both affected area said that access to and use of their usual healthcare or medication were compromised during the heavy rain/flood. With regards to the question about the reasons why the access and usual healthcare/medication were compromised by the heavy rain falls/flood, respondents gave multiple reasons. Among those who said that their access to usual healthcare/medication was compromised, about 70% mentioned that the reason was flood, unavailability of transportation and they were not informed in less affected area, while 85% on the most affected area. 2.5 % of the respondents from most affected area and 12.5% from less affected area said that it was due to lack of money. Lastly, 12.5% and 17.5%, respectively, were due to road damage.

Ten injuries were reported during heavy rainfall/flood. Types of injuries were reported. Five persons suffered cuts, four from Palapat, San Juan and Carillo, one of them from Sto. Rosario. Three people suffered bone fracture, one from Sta. Cruz and two from San Pascual. Two people suffered laceration or contusions. Five injuries occurred in all barangays were due to sliding, three persons were injured due to falls, and one in Sto. Rosario and Palapat were injured in a road

52 accident. Falls and Sliding seem to be the attributing factors of injuries during flood. Health condition of respondents was measured through a set of questions providing information for other family members. There were significant differences between the respondents from severely affected area and those from the less affected area in terms of the family members suffering from psychological problem. In less affected area about 32% of people who ever had suffered from physiological problems were reported to experienced it before the heavy rains and the flooding while these proportion in most affected area were 28%. Only 21% of those suffering in less affected area said that there psychological problems got worst during and after the flood while the percentage of the respondents in most affected area with worsening psychological problem during and after the flood were 24%. There is no significant difference in the number of respondents reporting that his/her family members had ever been diagnosing with developing hypertensions between the most affected area and less affected area. Although most reported cases of hypertension occurred before the heavy rain/flood, the percentage of people reporting that it got worst after the flood was significantly higher in the most affected area than the less affected area (28% in most affected area and 14% in less affected area). Twelve respondents reported having ever been diagnosed by a doctor for dengue fever, 9 respondents in less affected while there is 3 respondents in most affected area. The majority of all cases in the affected area reported that they were diagnosed with dengue fever after the flood. There is significant difference in the

53 proportion of dengue cases in most affected area and less affected area. With regards to conjunctivitis there is 7% respondent in the less affected area reported to have it while there is 5% respondents in the most affected area. There is higher percentage reported by the respondent in the less affected area to have conjunctivitis after the heavy rain. Regarding dermatitis, about 86% respondents in most affected area reported to have it while 78.79% respondents in less affected area. All most dermatitis cases reported were after the flood. Regarding diarrhea, about 20% respondents reported in most affected area to have it while 17% respondents reported in less affected area having it. Percentage lowered in both areas after the heavy rain/flood (10% in most affected area and 12% in less affected area. There is no reported incident by the respondents regarding Leptospirosis.

Conclusions In the light of the findings stated, state the conclusions were drawn from it: 1. A total of 198 respondents participated in the survey. Among the respondents, the proportions of females were higher than males. Almost the entire respondent said that their religion is Roman Catholic. The income per month reveals that the highest average incomes of the affected areas in less affected area were range to 1,000-5, 500 pesos while in the most affected area reveals the same 1,000-5, 500 pesos. Regarding to marital status, about half of the studied population were married. 2. The study shows that almost all people in the sample were present at the time of the heavy rainfalls/flood and experience the Typhoon Pedring. About half of the people in Palapat, San Juan, and Carillo (most affected area) had to migrate due to

54 flood and in San Pascual, Sta. Cruz, and Sto. Rosario (less affected area). The majority of people who migrated due to flooding stayed in their relative or friends house. In addition, people living in communes that were affected by flood reported that they stayed in temporary shelters provided by the government such as in schools. 3. Study shows about the Impacts of Flood in Health Access is that only 40% of the respondents in both affected area said that access to and use of their usual healthcare or medication were compromised during the heavy rain/flood. With regards to the question about the reasons why the access and usual healthcare/medication were compromised by the heavy rain falls/flood, respondents gave multiple reasons. Among those who said that their access to usual healthcare/medication was compromised, about 70% mentioned that the reason was flood, unavailability of transportation due to flood. Were as in term of Injuries, Ten injuries were reported by the respondents during heavy rainfall/flood. Five persons suffered cuts, four from Palapat, San Juan and Carillo, one of them from Sto. Rosario. Three people suffered bone fracture, one from Sta. Cruz and two from San Pascual. Two people suffered laceration or contusions. Five injuries occurred in all barangays were due to sliding, three persons were injured due to falls, and one in Sto. Rosario and Palapat were injured in a road accident. Falls and Sliding seem to be the attributing factors of injuries during flood. 4. There were significant differences between the respondents from severely affected area and those from the less affected area in terms of the family members suffering from psychological problem. In less affected area about 32% of people who ever had suffered from physiological problems were reported to experienced

55 it before the heavy rains and the flooding while these proportion in most affected area were 28%. Only 21% of those suffering in less affected area said that there psychological problems got worst during and after the flood while the percentage of the respondents in most affected area with worsening psychological problem during and after the flood were 24%. 5. There is no significant difference in the number of respondents reporting that his/her family members had ever been diagnosing with developing hypertensions between the most affected area and less affected area. Although most reported cases of hypertension occurred before the heavy rain/flood, the percentage of people reporting that it got worst after the flood was significantly higher in the most affected area than the less affected area. 6. Twelve respondents reported having ever been diagnosed by a doctor for dengue fever, 9 respondents in less affected while there is 3 respondents in most affected area. The majority of all cases in the affected area reported that they were diagnosed with dengue fever after the flood. There is significant difference in the proportion of dengue cases in most affected area and less affected area. With regards to conjunctivitis there is 7% respondent in the less affected area reported to have it while there is 5% respondents in the most affected area. There is higher percentage reported by the respondent in the less affected area to have conjunctivitis after the heavy rain. Regarding dermatitis, about 86% respondents in most affected area reported to have it while 78.79% respondents in less affected area. All most dermatitis cases reported were after the flood. Regarding diarrhea, about 20% respondents reported in most affected area to have it while 17% respondents reported in less affected area having it. Percentage lowered in both areas after the heavy rain/flood (10% in most affected area and 12% in less

56 affected area). There is no reported incident by the respondents regarding Leptospirosis.

Recommendation In view of the conclusions drawn, discuss recommendations you are to propose; 1. This study suggests that flood prevention and mitigation strategies need to be put in place in flood prone areas. Environmental sanitation activities, particularly cleaning campaigns and de-clogging of blocked drainages, are necessary as are efforts to improve access to sanitation facilities in barangays.

2. It is important that those who provide medical care need to be aware of the increased medical and mental health needs of the people who have experienced flood. Health concerns in the affected areas remain diarrhea, skin diseases, and fungal infections. Local government health units continue the delivery of health services, and have adequate capacities to meet the increasing demand. However, Philippine Red Cross will reinforce health and hygiene education efforts of authorities, focusing on disease prevention.

3. In the future if the flood evens become more common and severe, improving the services available to people the time of a flood event and during the recovery period maybe important to reduce the burden on medical services. It is effective to mobilize community health volunteers in targeted areas and provide necessary services.

4. The researchers experience shows that further research is needed for better health measures and stronger epidemiological design to improve understanding of the risk of flooding and the long term consequences on peoples health.

57

References

Anthony Knap (2002). Indicators of Ocean Health and Human Health: Developing a Research and Monitoring Framework http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240980/pdf/ehp0110-000839.pdf Australian government ; Department of Climate Change (2009). Australias Coast Its Nature And Importance http://www.climatechange.gov.au/publications/coastline/climate-change-risks-to-australiascoasts.aspx Australian government; Department of Climate Change (2009). Climate Change Risks To The Coastal Environment http://www.climatechange.gov.au/publications/coastline/climate-change-risks-to-australiascoasts.aspx Bella Gamotea (2012). Metro Manila binaha sa Habagat http://www.balita.net.ph/2012/08/metro-manila-binaha-sa-habagat/#.UN0-aG_28mA Carl Wunsch, June. 2000. Moon, tides and climate. p. 743-744 Danilo C. Israel, Roehlano M. Briones. 2012. Impacts of Natural Disasters on Agriculture, Food Security, and Natural Resources and Environment in the Philippines, Review of disaster risk management in the Philippines, p.9 Drew Harvell, Richard Aronson, Nancy Baron, Joseph Connell, Andrew Dobson, Leah Gerber, Kiho Kim, Armand Kuris, Hamish McCallum, Kevin Lafferty, James Porter, Mercedes Pascual, Garriett Smith, Katherine Sutherland, Steve Ellner, Bruce McKay, Jessica Ward.2004. The rising tide of ocean diseases: unsolved problems and research priorities.

58 Eric Roston (2012). High-Tide Storm Was a Known Risk for New York http://www.bloomberg.com/news/2012-10-30/high-tide-storm-was-a-known-risk-for-newyork.html Higashi-hiroshima (2009). Communities survival and coping mechanisms in flood-prone KAMANAVA, Metro Manila http://www.mode.org/pdf/Track2C%20-%20998.pdf Jing Vallejos (2012). Floods hit Dagupan due to high tide http://www.abs-cbnnews.com/nation/regions/07/03/12/floods-hit-dagupan-due-high-tide J. Timothy Wootton, Catherine A. Pster and James D. Forester (2008). Dynamic patterns and ecological impacts of declining ocean pH in a high-resolution multi-year dataset http://www.pnas.org/content/105/48/18848.full.pdf+html Mika (2011). Literature Review: Tides & Earthquakes http://www.geomika.com/blog/2011/03/23/review-tides-earthquakes

Sharad Vyas (2009). Mumbai can tide it over, says institute http://articles.timesofindia.indiatimes.com/keyword/high-tide

WHO/Europe and Public Health England (2009-2011). Study on the health effects of flooding http://www.euro.who.int/en/health-topics/environment-and-health/Climatechange/news/news/2013/05/how-flooding-affects-health

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APPENDIX A

Letter of Request for the Permission to Conduct the Study (Signed)

60

APPENDIX B Letter For Conducting A Survey

61

APPENDIX C INSTRUMENT Bulacan State University Malolos City, Bulacan College of Nursing Impacts of Flood on Health: Epidemiologic Evidence from Hagonoy, Bulacan Part I. Demographics Name: Marital Status: Average Number of Persons in the Household:

Gender: Religion: Average Family Income:

Part II. Experience with the historic flood in 2011 (Typhoon Pedring) 1. Are you present at the time of flood? _______ Yes _______ No 2. Migrated due to flood? _______ Yes _______ No 3. Place to stay after displacement/evacuation? _______ Relative/friend _______ Temporary shelter from relief agencies _______ Temporary shelter from government agencies _______ Others If Evacuation, did the places condition satisfied you? _______ Yes ________No 4. School goers before the flood? _______ Yes _______ No 5. School activities affected by flood? _______ Yes _______ No 6. Your daily routine affected by flood? _______ Yes _______ No Part III. Access to Health Care Services 1. Access and use of usual health care/medication compromised? _______ Yes _______ No 2. Reasons? _______ Road damaged _______ Lack of medication _______ Health center destroyed _______ Not enough health care professionals _______ Lack of money _______ Others Part III. Injuries within One month after the flood 1. Injured? _______ Yes _______ No

62 2. If yes, a. Type of injury _______ Bone fracture _______ Laceration/contusion _______ Cuts _______ Multiple trauma _______ Others b. Cause of injury _______ Fall _______ Drowning _______ Traffic accident _______ Others Part IV. Health conditions within One month after the historic flood (Typhoon Pedring) 1. Any family member ever have psychological problems, e.g. stress, nervousness, anxiousness, sleeplessness? 2. Having psychological problems before the heavy rain/flood? 3. Did the psychological problems get worse after the heavy rain/flood? 4. Any family member ever been diagnosed by a doctor as having hypertension? 5. Having hypertension before the heavy rain/flood? 6. Did the hypertension get worse after the heavy rain/flood? 7. Any family member ever been diagnosed by a doctor as having dengue fever? 8. Having dengue fever after the heavy rain/flood? 9. Any family member ever been diagnosed by a doctor as having conjunctivitis? 10. Having conjunctivitis after the heavy rain/flood? 11. Any family member ever been diagnosed by a doctor as having dermatitis? 12. Having dermatitis after the heavy rain/flood? 13. Any family member ever been diagnosed by a doctor as having Diarrhea? 14. Having Diarrhea after the heavy rain/flood? 15. Any family member ever been diagnosed by a doctor as having Leptospirosis? 16. Having Leptospirosis after the heavy rain/flood?

_______ Yes _______ No _______ Yes _______ No _______ Yes _______ No _______ Yes _______ No _______ Yes _______ No _______ Yes _______ No _______ Yes _______ No _______ Yes _______ No _______ Yes _______ No _______ Yes _______ No _______ Yes _______ No _______ Yes _______ No _______ Yes ________ No _______ Yes ________ No _______ Yes ________ No _______ Yes ________ No

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APPENDIX C.1 (TAGALOG SURVEY) Impacts of Flood on Health: Epidemiologic Evidence from Hagonoy, Bulacan Part I. Demographics Pangalan: Kasarian: Kalagayang Sibil : Relihiyon : Bilang ng miyembro ng pamilya : Buwanang kita / Sahod : Part II. Karanasan sa nagdaang baha noong 2011 (Bagyong Pedring) 1. Naroon ka ba noong nangyari ang baha? Oo____ Hindi____ 2. Lumipat ba kayo ng lugar dahil sa baha? Oo____ Hindi____ 3. Lugar kung saan pansamantalang nanuluyan. __________ Kamag anak / kaibigan __________ Pansamantalang tuluyan/ bahay mula sa tulong ng ibat ibang ahensya __________ Pansamantalang tuluyan / bahay mula sa gobyerno __________ Iba pa Maayos ba ang napuntahan ninyong evacuation center? Oo____ Hindi____ Hindi____ Hindi____ Hindi____

4. Pumapasok kaba sa paaralan bago ang baha? Oo____ 5. Naapektuhan ba ng baha ang mga gawaing pampaaralan? Oo____ 6. Naapektuhan ba ng baha ang iyong pang araw araw na Gawain? Oo____

Part III. Serbisyong Pangkalusugan 1. Nasubukan mo bang magpatingin sa doktor o uminom ng gamot noong baha? Oo__ Hindi__ 2. Kapag hindi anung dahilan? ________Sirang daan ________Hindi Sapat ang mga gamot ________Nasira ang mga health center ________Kulang sa doctor ________Kulang sa pera ________ Iba pa Part IV. Mga natamong pinsala/ aksidente makalipas ang isang buwan pagtapos ng baha 1. Nadisgrasya / aksidente? Oo____ Hindi____ 2. Kung oo a. Uri ng natamong pinsala/ aksidente _______ Baling buto _______ Pilas/ Nauntog _______ Hiwa _______ Maraming natamong Pinsala _______ Iba pa b. Dahilan ng pinsala/ aksidente _______ Nahulog

64 _______ Nalunod _______ Aksidente sa daan _______ Iba pa Part V. Pangkalusugang kundisyon sa loob ng isang buwan pagtapos ng baha 1. Meron ba sa pamilya ninyo ang nakaranas ng problemang may kinalaman sa mentalidad (hal.pagod,pagka kaba,pagkabalisa, hindi makatulog)? Oo___ Hindi___ 2. Nakaranas ka ba ng problemang may kinalaman sa pagiisip bago ang bagyo/ baha? Oo__ Hindi__ 3. Ang naranasan mo bang problema na may kinalaman sa mentalidad ay lumala pagkatapos ng bagyo/ baha? Oo____ Hindi____ 4. Meron bang miyembro sa pamilya niyo ang nakaranas ng mataas na presyon? Oo__ Hindi__ 5. Ang pagtaas ba ng presyon ay nangyari bago ang bagyo/ baha? Oo____ Hindi____ 6. Ang pagtaas ba ng presyon ay lumala pagtapos ng bagyo/baha? Oo____ Hindi____ 7. Meron bang miyembro sa pamilya niyo ang nagkaroon ng dengue fever? Oo__ Hindi__ 8. Ang pagkakaroon ba ng dengue ay pagtapos ng bagyo/baha? Oo___ Hindi___ 9. Meron bang miyemro sa pamilya niyo ang nagkaroon ng pamamaga ng mata? Oo__ Hindi__ 10. Ang pamamaga ba ng mata ay pagtapos ng bagyo/baha? Oo___ Hindi___ 11. Meron bang miyemro sa pamilya ang nagkaron ng sakit sa balat? Oo___ Hindi___ 12. Ang pagkakaroon ba ng sakit sa balat ay pagtapos ng bagyo/baha? Oo___ Hindi___ 13. Meron bang miyembro sa pamilya ang nakaranas ng pagtatae? Oo___ Hindi___ 14. Ang pagtatae ba ay pagtapos ng bagyo/baha? Oo___ Hindi___ 15. Meron bang miyemro sa pamilya ang nagkaroon ng leptospirosis? Oo___ Hindi___ 16. Ang pagkakaroon ng leptospirosis ay pagtapos ng bagyo/baha? Oo___ Hindi___

65

APPENDIX D Student Profile

Maria Danica C. Rivera


#357 Palayan St., Cut-cot, Pulilan, Bulacan 0935-251-6777 Nica.rivera2003@yahoo.com.ph
PERSONAL DATA Age: 19 years old Date of Birth: March 20, 1993 Place of Birth: Quezon City Hospital Sex: Female Civil Status: Single Citizenship: Filipino Religion: Roman Catholic EDUCATIONAL BACKGROUND Tertiary: Bachelor of Science in Nursing Bulacan State University Malolos City, Bulacan Third Year Student at Present Secondary: St. Dominic Academy Poblacion, Pulilan, Bulacan Batch 2009-2010 Montessori School of Pulilan Poblacion, Pulilan, Bulacan Batch 2004-2005

Primary:

SEMINARS ATTENDED Alert! Latest Trends and Updates in Nursing


Activity Center, Bulacan State University (August 13, 2010) Buhay na Maganda sa Bayang Walang Droga Bulacan Capitol Gym (March 19, 2011) RN Heals Hostel, Bulacan State of University (August 2011)

66

Mary Grace C. Dela Cruz


Address: #548 Carmen De Luna St., Longos, Malolos City, Bulacan Cellphone No.: 09423648838
PERSONAL DATA Age: 28 years old Date of Birth: June 16, 1985 Place of Birth:Tipas, Taguig, Metro Manila Sex: Female Civil Status: Single Citizenship: Filipino Religion: Iglesia Ni Cristo EDUCATIONAL BACKGROUND Tertiary: Bachelor of Science in Nursing Bulacan State University Malolos City, Bulacan Third Year Student Secondary: San Marcos High School San Marcos, Calumpit, Bulacan Batch 2001 2002 Longos Elementary School Longos, Malolos City, Bulacan Batch 1996-1997

Primary:

SEMINARS ATTENDED Forensic Nursing Bulacan State University ( August 11, 2011 )

67

De Chavez, Sheila Marie D.


Address: 9011 Rufina homes Sta. Isabel Malolos City, Bulacan Cellphone No.: 09065796266
PERSONAL DATA Age: 19 years old Date of Birth: Sept. 9, 1993 Place of Birth: K.S.A Sex: Female Civil Status: Single Citizenship: Filipino Religion: Roman Catholic EDUCATIONAL BACKGROUND Tertiary: Bachelor of Science in Nursing Bulacan State University Malolos City, Bulacan Third Year Student Secondary: Ma. Therese Montessori school Bulihan malolos, Bulacan Batch 2008-2009 Holy Spirit Academy of Malolos Malolos City Batch 2005-2006

Primary:

SEMINARS ATTENDED Forensic Nursing Bulacan State University ( August 11, 2011 )

68

Balatbat, Ruby Sunshine C.


Address: #0386 San Agustin Hulo Street Hagonoy, Bulacan Cellphone No.: 09238181384 Email Address: polinntanshine22@yahoo.com
DETAILS OF EMPLOYMENT / WORK EXPERIENCES: (START FROM PRESENT TO PREVIOUS) JOLLIBEE HAGONOY Sto. Nino Hagonoy, Bulacan Cashier 2006-2007 KENTUCKY FRIED CHICKEN (KFC) Shangri-La Plaza Corporation EDSA corner Shaw Boulevard, Mandaluyong City Restaurant Team Member 2009-2010 PERSONAL DATA Age: Date of Birth: Place of Birth: Sex: Civil Status: Citizenship: Religion:

23 years old November 02, 1989 Batallones Hospital Hagonoy, Bulacan Female Single Filipino Roman Catholic

EDUCATIONAL BACKGROUND Tertiary: Bachelor of Science in Nursing Bulacan State University Malolos City, Bulacan Third Year Student Secondary: Sta. Monica National High School Hagonoy, Bulacan Batch 2005 2006 Hagonoy East Central School Sto. Nino Hagonoy, Bulacan Batch 2001-2002

Primary:

SEMINARS ATTENDED Forensic Nursing Bulacan State University ( August 11, 2011 )

69

Junio, Ma. Jaecelyn S.


Address: #0428 Bantayan 2nd, Bulihan, Malolos, Bulacan Cellphone No.: 09052057774

PERSONAL DATA Age: 20 years old Date of Birth: September 13, 1992 Place of Birth: Bulacan Sex: Female Civil Status: Single Citizenship: Filipino Religion: Roman Catholic EDUCATIONAL BACKGROUND Tertiary: Bachelor of Science in Nursing Bulacan State University Malolos City, Bulacan Third Year Student Secondary: La Consolacion University of the Philippines Catmon, Malolos, Bulacan Batch 2008 - 2009 Bulihan Elementary School Bulihan, Malolos, Bulacan Batch 2004 - 2005

Primary:

SEMINARS ATTENDED Forensic Nursing Bulacan State University ( August 11, 2011 )

70

Santos, Abigael F.
Address: #1514 San Vicente, Sta.Maria, Bulacan Cellphone No.: 09997885472
PERSONAL DATA Age: 19 years old Date of Birth: January 14, 1994 Place of Birth: Sta.Maria, Bulacan Sex: Female Civil Status: Single Citizenship: Filipino Religion: Christian EDUCATIONAL BACKGROUND Tertiary: Bachelor of Science in Nursing Bulacan State University Malolos City, Bulacan Third Year Student Secondary: St. Vincent Learning Academy, Inc. San Vicente, Sta. Maria, Bulacan Batch 2008-2009 San Vicente Hulo Elementary School San Vicente, Sta.Maria, Bulacan Batch 2005-2006

Primary:

SEMINARS ATTENDED Forensic Nursing Bulacan State University ( August 11, 2011 )

71

Zaragosa, Karen May C.


#0337 M.Santos St., Guyong, Sta.Maria, Bulacan 0926-888-7440 Karenzaragosa09@yahoo.com.ph
PERSONAL DATA Age: 18 years old Date of Birth: September 9, 1994 Place of Birth: Quezon City Hospital Sex: Female Civil Status: Single Citizenship: Filipino Religion: Christian Baptist EDUCATIONAL BACKGROUND Tertiary: Bachelor of Science in Nursing Bulacan State University Malolos City, Bulacan Third Year Student at Present Secondary: Jesus Lord &Savior Christian Colleges Foundation Inc. E.Celestino St. Sta.Maria, Bulacan Batch 2009-2010 Jesus Lord &Savior Christian Colleges Foundation Inc. Poblacion, Pulilan, Bulacan Batch 2004-2005

Primary:

SEMINARS ATTENDED Alert! Latest Trends and Updates in Nursing Activity Center, Bulacan State University (August 13, 2010) Buhay na Maganda sa Bayang Walang Droga Bulacan Capitol Gym (March 19, 2011) RN Heals Hostel, Bulacan State of University (August 2011)

72

Jade M. De Jesus
Address: #0731Look 1st, Malolos, Bulacan Cellphone No.: 09068877840

PERSONAL DATA Age: 18 years old Date of Birth: September 6, 1994 Place of Birth: Malolos, Bulacan Sex: Male Civil Status: Single Citizenship: Filipino Religion: Roman Catholic EDUCATIONAL BACKGROUND Tertiary: Bachelor of Science in Nursing Bulacan State University Malolos City, Bulacan Third Year Student Secondary: Holy Trinity Academy of Malolos Batch 2008-2009 Primary: Holy Trinity Academy of Malolos Batch 2005-2006 SEMINARS ATTENDED Forensic Nursing Bulacan State University August 11, 2011

73

Dionisio, Mary Lorry Laine C.


Address: #302 Balite, Malolos, Bulacan Cellphone No.: 09353791403 Email Address: lainedionisio@yahoo.com

DETAILS OF EMPLOYMENT / WORK EXPERIENCES: (START FROM PRESENT TO PREVIOUS) Savemore Market Apalit Pampanga Cashier 2012

PERSONAL DATA Age: Date of Birth: Place of Birth: Sex: Civil Status: Citizenship: Religion:

23 years old May 17, 1990 Malolos Bulacan Female Single Filipino Roman Catholic

EDUCATIONAL BACKGROUND Tertiary: Bachelor of Science in Nursing Bulacan State University Malolos City, Bulacan Fourth Year Student Secondary: Marcelo H. Del Pilar National High School Sta. Isabel, Malolos, Bulacan Batch 2006-2007 Sta. Isabel Elementary School Sta. Isabel, Malolos, Bulacan Batch 2003-2004

Primary:

SEMINARS ATTENDED Basic Life Support September 6-7, 2010

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