MORBIDITY & MORTALITY RATE OF DENGUE CASES FROM 2015-2019 IN

VALENCIA CITY, BUKIDNON

A Thesis

Presented to the Faculty of the

School of Nursing

Mountain View College

Valencia City, Bukidnon, Philippines

In Partial Fulfillment

of the Requirements for the Course

Nursing Research II

ABARICO, BELLE KELLY R.

BRONOLA, MIRACHELLE L.

PANTOLLANA, CHRISTLEMAR M.

MAY 2021
 ACKNOWLEDGEMENT

In this chapter states the researcher’s gratitude to the people who are behind their study.

We would like to thank God Almighty for helping us in our research by providing us with

good health despite the pandemic. We were able to collect data and traveled safely from MVC to

the Health Office.

To our parents who supported us and provided for our financial needs.

To our adviser Ma'am Irish C. Riano, RN, MN, who helped and guided us throughout our

research, we are heartfelt grateful.

Our supportive dean, Sir. Devaney M. Bayeta, RN, MPH, extended his full efforts to give

us this opportunity to pursue our data gathering to finish our study. We and the whole batch of

Leal are thankful for your efforts.

To our panel, Dr. Opao, Dr. Paulican, Dr. Mansaguiton, Ma'am Mercado, and Ma'am

Navarro for helping us improve our study.

Especially to Ma'am Jocelyn C. Muring, CHO Dengue Coordinator, who helped us gather

our data and accommodated us, offered her time to make sure we have enough data on hand.

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 ABSTRACT

Valencia City belongs to the highest dengue cases reported in Region 10. Second highest

according to the Provincial Health Office as of 2018. Dengue is a mosquito-borne viral disease

primarily transmitted by Aedes aegypti. Secondary data retrieved from the City Health-

Environmental Sanitation Office from 2015-2019 was utilized by the researchers to set the trend

of dengue cases in the city. In terms of morbidity rate, there was an increase in cases from 2015 to

2016, but there was a decrease in the year 2017. After the year 2017, from 2018 to 2019, there was

a drastic increase in cases during the said year. It indicates that the strategies used by the local

government during the year 2017 were very effective that causes decreased cases. On the other

hand, in terms of mortality rate cases, there were increasing reported cases from 2016 to 2019,

which also presents that even though there were efforts from the government, there were still worse

cases that led to death.

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 CHAPTER I

INTRODUCTION

In the trends of Corona Virus, there is still one existing virus until now the community is

combating. It is popularly known as dengue. It is one of the viral diseases existing globally and

has become a serious problem worldwide. It was an unresolved issue since the 19th century.

Still to this day, dengue causes high mortality rates around the globe, especially in tropical

regions.

Many individuals from urban and rural communities worldwide are suffering from vector-

borne diseases each year. Vector-borne diseases are caused by vectors which are organisms that

can transmit infectious diseases in the human population. Most vectors are blood-sucking insects

that ingest disease-producing microorganisms during a blood meal from an infected host and

later inject them into a new host during their next blood meal (World Health Organization,

2014). The mosquito is one of the most common vectors.

Female mosquitoes coming from the Aedes aegypti species cause dengue, a viral disease.

As the most common arthropod-borne virus infection internationally, dengue threatens about 4

million people, covering at least 128 countries. Since the 1950s, dengue cases have annually

grown from less than a thousand cases to more than 3 million in 2015 (WHO). The World Health

Organization claims an abundant number of under-reporting of dengue cases within the health

systems. This indicates underestimating the global incidence rate, estimated to be 50-100 million

symptomatic cases every year.

The number of dengue cases is rising at an alarming rate in some countries across Asia as

the rainy season intensifies. An article from the International Federation of Red Cross- Asia

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Pacific shows that dengue cases have increased dramatically in recent decades, especially in

South East Asia and the Western Pacific. In addition, dengue outbreaks happen cyclically due to

weather changes and virus-related reasons (Heinasmaki, 2017).

In the Philippines nowadays, the Department of Health reported an increase in cases in

the whole periodic year of 2018. However, in the 2019 Department of Health, Northern

Mindanao ranks 4th most reported cases in dengue cases. Bukidnon is the highest reported case

in region ten compared to the five provinces: Camiguin, Misamis Occidental, Misamis Oriental,

and Lanao del Norte.

Provincial Health Office of Bukidnon released data regarding Valencia City as the second

top leading case in Bukidnon during 2017 and 2018. Highly urbanized and populated areas

contributed to many dengue cases, led by the cities of Malaybalay and Valencia (Reyes, 2017).

Deaths caused by suspected dengue cases in Bukidnon tripled in 2018 compared to the previous

year, according to the chief of the Provincial Health Office (PHO) of Bukidnon.

In the comparison among all provinces and Bukidnon being the highest. It is relevant to

study the prevalence of cases in the locality of Valencia City since the researchers have observed

that during the clinical duties of the researchers' dengue cases are the most admitted cases,

especially during monsoon season.

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Statement of the Problem

The study's main objective is to determine the morbidity and mortality rate of dengue cases from

2015-2019 in the City of Valencia, Bukidnon. This study will answer the following questions:

1. What is the morbidity rate of Dengue cases reported in terms of?

1.1 Year

1.2 Barangay

2. What is the mortality rate of Dengue Cases in terms of?

2.1 Year

2.2 Barangay

3. Is there a significant difference of the number of cases in terms of?

3.1 Month

3.2 Year

3.3 Barangay

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Significance of the Study

This further explains the importance of the studies and some specific contribution to the

following field:

Nursing Practice. The study results will help nursing practice spread awareness to

determine the trends of health issues in the community and prevent increasing numbers of

dengue cases.

Public Health Workers. The study's results will set the direction of dengue cases in

Valencia City. This will also provide a basis for case recording, developing, and implementing

new strategies to enhance dengue awareness and prevention in the community.

Community. The study results will be helpful as they will serve as an awareness of the

current statistics of dengue cases and promote health education as an essential step for vector

control to reduce dengue cases in the community

Future Researcher. The study results may aid future researchers in expanding the study

that will be conducting related research. They may be able to use the current findings for more

prospective studies.

Scope and Delimitation of the Study

This study focuses on the dengue case from 2015-2019. This includes only the cases that

were recorded at the Environmental and Sanitation Office, specifically for the Dengue

Coordinator of the City Health Office of Valencia.

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Definition of Terms

1. Dengue- is a mosquito-borne viral disease primarily transmitted by Aedes aegypti.

2. Morbidity- Number of diseased individuals caused by the dengue virus, specifically in

Valencia City.

3. Mortality- Number of confirmed deceased individuals due to dengue virus reported to

the CHO in Valencia City, Bukidnon.

4. City Health Office (CHO) - Refers to the government health office of Valencia City,

where records of dengue cases were reported and documented.

5. Morbidity Rate- Total Morbidity Cases per barangay x 100

Total Morbidity Cases per year

6. Mortality Rate- Total Number of Death

Total Morbidity Cases per year x 100

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 CHAPTER II

REVIEW OF RELATED LITERATURE & RELATED STUDIES

This chapter presents an overview of the relevant literature, and the researchers considered

strengthening the claim and importance of the present studies. The related studies are taken from

published books, eBooks, journals, and articles. It contains topics such as the definition of the

dengue virus, causative agents, clinical manifestations, classifications, mode of transmissions,

diagnostic tests, methods of vector control, and treatment and management. It is clustered to

further discussed the importance of each topic related to the dengue virus.

Global Burden

Dengue poses a health threat in almost all countries located in tropical and subtropical

territorials. The social and economic burden of mosquito-borne viral infection is widely alarming,

as well as the proven global impact of these diseases. The dengue epidemiology observation

highlights the need to strengthen control of the emerging virus and management in an outbreak.

According to the report released by World Health Organization the incidence of dengue

has grown dramatically around the world in recent decades. A vast majority of cases are

asymptomatic or mild and self-managed, and hence the actual numbers of dengue cases are under-

reported. Many cases are also misdiagnosed as other febrile illnesses.

World Health Organization estimate indicates 390 million dengue virus infections per year

(95% credible interval 284–528 million), of which 96 million (67–136 million) manifest clinically

(with any severity of disease). The number of dengue cases reported to WHO increased over

eightfold over the last two decades, from 505,430 cases in 2000 to over 2.4 million in 2010 and

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5.2 million in 2019. This alarming increase in case numbers is partly explained by a change in

national practices to record and report dengue to the WHO. Therefore, although the total global

burden of the disease is uncertain, this observed growth only brings us closer to a more accurate

estimate of the full extent of the responsibility.

Dengue disease is now endemic in more than 100 countries in WHO regions of Africa, the

Americans, the East Mediterranean, South- East Asia, and the Western Pacific. America, South-

East Asia, and Western Pacific regions are the most seriously affected, with Asia representing

approximately 70% of the global burden of the disease.

Dengue Virus has been reported in Southeast Asia since 1944, first in Papua New Guinea

and Indonesia, later in Malaysia and Thailand in the early 1960s, and then in China, India, and

Singapore in the 1970s and Central America in the 1980s (Lugito, 2017). Surveillance in highly

endemic south-east Asian countries by Asia Pacific Journal of Public Health in 2016 reveals the

mortality increased in Indonesia, Malaysia, and the Philippines, but slightly decreased in Thailand

and Vietnam.

National Burden

In the Philippines, dengue is endemic in all regions, with four serotypes circulating, causing

it a significant public health concern. In Southeast Asia, the Philippines ranks among the countries

with the highest number of dengue episodes. In practice, dengue surveillance in the Philippines

relies almost entirely on disease reporting units (DRUs), including sentinel hospitals, private

clinics, rural health units (RHUs), municipal or city health offices, and human quarantine stations

to report all suspected, probable, and confirmed dengue episodes since 2007 to the Philippines

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Integrated Disease Surveillance and Response System. The current surveillance system primarily

focuses on hospitalized cases, particularly those with severe dengue manifestations.

A press released by the Department of Health (DOH) on 2019, declaring dengue as

endemic in the wake of 146,062 cases recorded for that whole year, 98% higher than the same

period in 2018 with 622 deaths. With the total number of deaths, DOH coordinated with other

government agencies, LGU's (Local Government Unit), schools, offices, and communities to

conduct "Sabayang 4-O'clock Habit" and focus on searching and destroying mosquito breeding

sites as a primary intervention to prevent and control dengue.

However, there was a decreasing trend of reported dengue cases last 2017 to the

Epidemiology Bureau. Their statistics show a decrease in cases reported for the whole year from

the month of January.

Regional Burden

According to the article by Philippine News Agency, Northern Mindanao has consistently

registered a high number of dengue cases in the last five years. Northern Mindanao's dengue cases

have exceeded the epidemic threshold. In 2019 there were 62.54 percent higher compared to the

periodic year of 2018. DOH- Region 10 showed that Bukidnon has the highest cases among the

region's five provinces.

Global Mortality Rate

World Health Organization (WHO) reported that deaths between 2000 and 2015 increased

from 960 to 4032. As the global incidence of dengue has drastically upped in the last few years

reported by the WHO. Worldwide, it has been seen a doubling up of cases of dengue from 2015

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to 2016, and it can cause infection in all age groups. A study in developing countries regarding the

epidemiology of dengue viral infection, a systematic review. An increasing trend of dengue virus

infection affecting young adolescents and females. As most cases were reported during the post-

monsoon period, in the absence of a persistent protective vaccine, effective measures must be taken

to control the transmitting vectors to prevent dengue outbreaks. Shortly, it will be challenging to

maintain such an infection. As vaccines or antiviral drugs are not available for dengue viruses, the

only effective way to prevent dengue is to control the mosquito vector Aedes aegypti and avoid its

bite. (Singh et al., 2017).

A study of a ten-year trend of dengue research in Indonesia and South-east Asian countries,

a bibliometric analysis. In the last ten years, dengue publications' growth from Indonesia in

international journals improved significantly, despite fewer publications than other SEA (South-

East Asia) countries. Bibliographic data were collected from PubMed filtered by Indonesia country

affiliation. The annual growth rate of publication was measured and compared with neighborhood

countries in the SEA (South-East Asia) region. Network analysis was used to visualize emerging

research issues. About 1,625 dengue-related documents originated from the SEA region, of which

Indonesia contributed 5.90%. The publication growth rate in Indonesia is the highest in the

ASEAN region (28.87%). Total citations for documents published from Indonesia were 980, with

an average of 14 citations per publication and an h-index of 16. Within the first five years, the

main research topics were related to insect vectors and diagnostic methods. While insect vectors

remained dominant in the last five years, other issues such as disease outbreaks, dengue virus, and

dengue vaccine started emerging. (Maula et al., 2018).

This study refers to dengue epidemiology since dengue is the fastest spreading, mosquito-

borne viral infectious disease worldwide, with remarkable morbidity and mortality. In the past

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decades, profound contributions have been made towards understanding its epidemiology,

including disease burden and distributions, risk factors, and control and prevention practices.

Dengue continues to disseminate to new areas, including high latitude regions, and a new serotype

(dengue virus serotype 5) has been identified. In disease surveillance, because of its operational

simplicity, rapidity, capability, and utility as an indicator of disease severity, dengue virus NS1

antigen detection have great promotion and application value among primary health care

institutions. Vector control progress has driven breakthroughs in biotechnology, including

Wolbachia-infected Aedes and genetically modified Aedes. Both Aedes variants have been used

to block transmission of the dengue virus through population replacement and suppression. (Jing

& Wang, 2019).

A study of trends of dengue disease epidemiology. The distribution of dengue disease is

influenced by local variation, such as geography, rainfall, temperature, and rapid urbanization or

migration. The epidemy of mosquito-borne infection significantly led to an increased number of

cases and hyperendemicity, which induce a more severe form of dengue accompanied by

cocirculation of chikungunya and zika. The rapid global spreading of dengue disease created

public health burdens presently unfulfilled by the absence of specific therapy, a simple diagnostic

tool for the early phase, and an effective and efficient vector control system. This review highlights

the current dengue distribution, epidemiology, and new strategies for early dengue diagnosis and

risk prediction of severity that can be used to improve oversight and alleviate the heavy burden of

the disease (Cucunawangsih & Lugito et., al, 2017).

A trend and geographic analysis of the prevalence of dengue in Taiwan, 2010–2015. This study

assessed the trends in the majority of dengue in Taiwan by population characteristics and

geographical region. The national prevalence rate of dengue decreased gradually from 8 to 4 per

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100 000 population between 2010 and 2013, but it increased substantially in 2014 and 2015 to 67

and 187 per 100 000 population. There was no significant difference in prevalence rate between

males and females. People aged 60–69 years had a significantly higher prevalence rate than those

in the other age groups during 2010–2014, and people aged over 70 years had the highest rate in

2015. The southern region had the highest yearly dengue prevalence rate. (Hsu et al., 2017).

National Mortality Rate

Dengue is a significant public health problem in the Philippines and is endemic in all

country regions. On average, 750 deaths were officially reported to the Philippines Department of

Health (DOH) annually from 2010 to 2014. An incidence of about 178 symptomatic dengue

episodes per 100,000 population and a reported case fatality rate of approximately 0.44% during

2015 (Undurraga et al., 2016)

Dengue is endemic in the Philippines and poses a substantial economic burden in the

country. A study of dengue in the Philippines, model, and analysis of parameters affecting

transmission. In this work, a compartmentalized model which includes the healthcare-seeking class

is developed. The reproduction number is determined to investigate critical parameters influencing

transmission. The partial rank correlation coefficient (PRCC) technique is performed to address

how the model output is affected by changes in a specific parameter disregarding the uncertainty

over the rest of the parameters. Results show that mosquito biting rate, transmission probability

from mosquito to human, respectively, from human to mosquito, and a fraction of individuals who

seek healthcare at the onset of the disease, posted high PRCC values. To obtain the values for the

desired parameters, the reported dengue cases by morbidity week in the Philippines for 2014 and

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2015 are used. The reliability of parameters is then verified via parametric bootstrap. (De Los

Reyes & Escaner, 2018).

Local Mortality Rate

A disease surveillance report released by the Department of Health- Region 10 shows

that during 2014 there were no reported deaths during that year in the province of Bukidnon.

However, in 2018, a report from Bukidnon Provincial Health Office states that tripled cases and

an increased mortality rate for the whole province of Bukidnon.

Definition

Dengue is a disease that causes significant morbidity and mortality throughout the

developing world. Infected mosquitos spread the disease. Mosquitos, amongst other organisms,

rely on vector-borne parasitic diseases of developing countries to complete life cycles and transmit

diseases. An example of an imported vector-borne disease is dengue fever (Brunner & Suddarth's,

2010). It is known as Philippines Hemorrhagic fever in 1953 and was later classified as

hemorrhagic dengue fever (Castro, 2012). World Health Organization defined it last 2016 as a

mosquito-borne flavivirus found in a tropical and subtropical region, mostly in urban and semi-

urban settings. Day-bitting Aedes mosquitos spread disease. It is the fastest vector-borne viral

disease and is now endemic in over a hundred countries, resulting in 40% of the world's population

living in an area at risk for dengue.

Causative Agents

Vector-borne disease caused by a virus spread through Aedes aegypti mosquito. A. aegypti

is the most common species of mosquito known for its ability to carry the dengue virus. It spreads

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through the urban and rural areas of the Philippines. An infective bite of A. aegypti transmits the

dengue virus. Another most common species of mosquito known for its ability to carry the dengue

virus are Aedes albopictus, Culex pipienspipiens, and Culex pipiensquinquefasciatus. Ae. Aegypti

is present and tolerable to the rural and urban areas (Milagros et al., 2017).

Mode of Transmission

Dengue is a vector-borne disease by dengue mosquito bite (Nies & McEwen, 2019). The

adult mosquitos rest in dark places of the house. Dengue is transmitted through a bite of dengue-

infected Aedes aegypti and Aedes albopictus mosquitoes. These mosquitoes can lay eggs in any

space or container containing clear and stagnant water like a bottle cap, dish dryer, plant axil,

gutter, trash can, and an old rubber tire. They usually bite between 2 hours after sunrise and 2 hours

before sunset and can be found inside and outside the house (DOH, 2019).

First dengue virus detection in Aedes albopictus from Delhi, India and was found to be in

ten types of water container: cement tanks, plastic containers/drums for potable water, potted

plants usually kept indoors or around the house, with excess water on the soil surface or in a cement

or ceramic plate below, desert coolers, used to cool the inside of homes and which have a water

tank and a fan, mud pots, traditional earthenware pots for drinking water, discarded tires, ceramic

bird feeders, bamboo bushes, where rainwater collects inside the slits, the natural breeding sites;

and small pits on rock surfaces (Koomari et al., 2014).

A study conducted in Puerto Rico on Global Effects of Climate on Dengue Transmission.

In this study, it was said that Dengue viruses constitute a significant health problem throughout

the tropical and subtropical regions of the world. Because they are transmitted by mosquitoes

sensitive to changes in rainfall and temperature, transmission intensity may be regulated by

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weather and climate. Although studies prove that it is biologically possible, real-life situations of

transmission are still inconclusive. The result of the study showed increased temperature and

rainfall are associated with increased dengue transmission in subsequent months across Puerto

Rico. They also show that differences in local climate within Puerto Rico can explain regional

differences found between the relationship of weather and dengue transmission. Although dengue

viruses have a universal transmission cycle, changes in temperature or rainfall may have diverse

local effects (Johansson et al., 2014).

According to the study conducted in China on the epidemiological characteristics and

dynamic transmission of dengue, there were dengue outbreaks in three Provinces in China in 2013.

Central China had its first dengue outbreak, along with other regions. The dengue epidemics in

China might have been because of repeated introductions of the dengue virus from Southeast Asia

and domestic transmission of dengue from the different areas. The role of the population could

have been critical to the dynamic dengue transmission, which may have been the cause of the

spread of dengue viruses in broad to non-epidemic areas (Shaowei et al., 2013).

A study on weather, location, timing, and intensity of dengue virus transmission between

humans and mosquitoes has empirical on weather-disease connection for dengue provides an

understanding for regulating human-mosquito information, along with the working of temperature

and humidity. Climate change set up the most significant role in the systematic relationship on

revealed weather-disease profile for dengue. They give information about mosquito-borne diseases

and the downsides of global warming (Campbell et al., 2015).

A study was conducted in Singapore regarding statistical modeling of the effect of rainfall

flushing on dengue transmission. Then they estimated the association between the number of

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flushing events per week and dengue outbreaks in the following weeks. The researchers

demonstrate that historical rainfall patterns accurately predict flushing events. A significant

reduction of dengue outbreaks is associated with flushing events that take up to six weeks to

recover. This research suggests that dengue predictive and early warning systems must consider

hydrological conditions and other contributing factors to predict near-term dengue risk accurately

(Benedum et al., 2018).

Another study of the bacterium Wolbachia mel (W. mel) reduces the transmission potential

of dengue-infected Aedes aegypti. The use of the symbiotic bacterium Wolbachia mel has become

a potential biocontrol approach against the dengue virus. In 2011, after field release in Cairns,

Australia, the Wolbachia mel strain had affected almost all individuals due to the invasion of the

wild mosquito population. To test whether limited dengue replication in W. mel mosquitoes

translates to reducing dengue transmission potential, the researchers repeatedly used a non-

destructive assay to quantify the dengue virus in mosquito saliva. They found that W.mel reduced

dengue's frequency caused by the expectoration of mosquitos, delayed the time for mosquito saliva

to be infections significantly, and lowered the mosquitos' saliva titer. The result of the study

showed that W. mel infection suppresses saliva production in mosquitoes that may, in part, explain

the findings. An accurate assessment of the ability of W. mel to limit disease transmission is

through the nature of saliva-based work. It suggests that W. mel may positively impact

transmission by reducing the number of infectious mosquitoes in a population and delaying the

virus's arrival in the saliva (Yixin et al., 2015).

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Geographical

Endemics and epidemics are sure to happen in tropical and subtropical regions (Bravo et

al., 2014). The epidemic reaches its peak during March, where rainfall is abundant. Dengue

epidemics' differences in timing in the wilderness and coastal regions are significantly associated

with the seasonal temperature cycle. Coastal regions are more likely to get dengue where mosquito

breeding sites may occur throughout the entire year (Gerardo, 2018).

Clinical Manifestation

Infection from dengue produces flulike symptoms of fever, chills, eye pain, joint pain, and

sometimes, a hyper-pigmented rash. Waxing and waning of symptoms may occur before going

away. A small population of patients may get a hemorrhagic disease, which in extreme cases, may

be life-threatening (Bruner & Suddarth, 2010).

Dengue hemorrhagic fever is an acute infectious disease manifested initially with fever and

clinical manifestations in three stages (Castro, 2012). First stage is known for having febrile or

invasive stage, it occurs in first four days, it starts abruptly as high fever, abdominal pain and

headache, later flushing which may be accompanied by vomiting, conjuctival infection and

epistaxis. Second stage is toxic or hemorrhagic stage, this begins on 4th to 7th days and there is

lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from

gastrointestinal tract in the form of hematemesis and melena, unstable blood pressure, narrow pulse

pressure, and shock which may be followed by death. Torniquet test which may have been positive

during the third day can become negative due to low or vasomotor collapse. For the last and third

stage, convalescent or recovery stage occurs on the 7th to 10th day, it shows generalized flushing

with intervening areas of blanching, appetite regain and stabilized blood pressure.

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 A study conducted in Malaysia highlights an exciting relationship between viral factors

and the clinical manifestation of dengue disease during an outbreak. The viral factors, including

serotype and genotype of dengue virus, were studied to discover if the clinical presentation in

patients was serotype and genotype-specific. As most clinical symptoms of severe dengue

infection only manifest at a much later stage of dengue infection. Therefore infected patients

commonly manifested musculoskeletal symptoms (Suppiah et al., 2018).

A study conducted in Thailand revealed the occurrence and clinical features of diseases

caused by dengue infection in a 3-year follow-up in school-children aged 3–14 years in Ratchaburi

Province, Thailand, using active surveillance for the episodes of fever. Those who had fever were

tested for evidence of dengue infection and recorded for clinical features. It was found that most

dengue-infected patients had headaches, muscle aches, nausea and vomiting, and anorexia. Almost

half of the patients presented with clinical symptoms closely copying those of other diseases. These

patients' symptoms mainly were an effect of respiratory tract infections, causing wrong diagnoses

by pediatricians. Only 11% of the patients had dengue hemorrhagic fever, a severe condition.

Dengue hemorrhagic fever may be predicted if anorexia, nausea and vomiting, and abdominal pain

are present after the second day of illness (Sirivichayakul et al., 2014).

Another study in South America about the clinical manifestation on dengue virus infection

reveals that infection with dengue virus may cause life-threatening diseases such as dengue

hemorrhagic fever or dengue shock syndrome, but more often causes less severe manifestations

affecting a wide range of organs. Development of cutaneous, gastrointestinal, musculoskeletal,

neurological, and respiratory manifestations. (Halsey et al., 2014).

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Classification

Due to the wide clinical presentations and predictable clinical evolution and outcome, a

new model for classifying dengue has been developed by the WHO expert consensus group. It is

practical to use and aids the clinician in deciding as to where and how intensively the patient should

be observed and treated (Nies and McEWAN, 2019)

Dengue case classification and levels of severity released by WHO 2009 dengue guidelines

for diagnosis, treatment, prevention, and control. Probable dengue, live in or travel to dengue-

endemic area. Fever and 2 of the signs of nausea and vomiting, rash, aches and pains, positive

tourniquet test, leukopenia, any warning signs. Dengue warning signs require strict observation

and medical intervention. Symptoms include abdominal pain or tenderness, persistent vomiting,

clinical fluid accumulation, mucosal bleeding, lethargy, restlessness, liver enlargement >2cm, and

laboratory: increase in hematocrit (HCT) concurrent with a rapid decrease in platelet count. Severe

dengue is divided into Severe plasma leakage, severe bleeding, and severe organ involvement.

Severe plasma leakage leading to shock (Dengue Shock Syndrome) and fluid accumulation with

respiratory distress. Intense organ involvement may assess by checking the liver function with

Aspartate Aminotransferase (AST) or Alanine Transaminase (ALT) > or = to 1000, CNS with

impaired consciousness, or heart and other organs.

Classification of dengue fever according to the severity of its clinical manifestation. They

are classified as mild when an individual is experiencing slight fever, with or without petechial

hemorrhage but epidemiologically related to typical cases usually discovered in the investigation

of specific issues. Moderate when an individual is characterized by high fever but with minor

bleeding, no shock. Severe frank type is an individual experiencing flushing, sudden high fever,

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severe hemorrhage, followed by a drop of temperature and shock, which may terminate in recovery

or death (Castro, 2012).

A study according to the Department of Health, dengue illness is categorized according to

the level of severity as dengue without warning signs, dengue with warning signs, and severe

dengue. Dengue without warnings can be further classified according to signs and symptoms and

laboratory tests as suspect dengue, probable dengue, and confirmed dengue.

Another study by the Department of Health that dengue infection has 3 phases which are

the febrile phase which lasts 2-7 days, the critical phase when a patient can either improve or

deteriorate that occurs between 3-7 days of illness, and the last phase which is recovery phase that

happens in the next 48-72 hours in which the body fluids goes back to normal.

Diagnostic Tests

Tourniquet Test

Tourniquet Test or Rumpel- Leads Test measures the coagulability of the blood by

applying a tourniquet on the client's extremity and observing the number of petechiae produced.

The presumptive sign for dengue is used to assess bleeding tendencies for a patient suspected to

have the disease (Halstead, 2008).

Before doing the test, the public health nurse must explain the procedure and purpose and

assess the individual's arm for any petechiae, ecchymoses, or infection that affected the result. It

is also contraindicated for individuals with fistula, arteriovenous shunt, or undergone mastectomy

(Daniels, 2009).

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 The public health nurse must inform the individual that it may be uncomfortable for a while

but not painful. In performing this test, the nurse will place the sphygmomanometer of the

individual's upper arm and inflate the blood pressure cuff to appoint midway between the systolic

and diastolic pressure for 5 minutes. Then release the cuff, and make an imaginary 1-inch (2.5cm)

square just below the cuff, at the antecubital fossa. Finally, inspect and count the number of

petechiae in a 1-inch (2.5cm) square. A positive result would mean the presence of more than 20

petechiae per 1-inch (2.5cm) square.

A study of Tourniquet Test for Dengue Diagnosis in systematic review and meta-analysis

of diagnostic test accuracy that aims to perform a diagnostic accuracy meta-analysis comparing

the use of the Tourniquet Test (TT) to a laboratory assay standard for making a diagnosis of dengue

infection. A comprehensive literature search was done in this study to map and assess the quality

of the available evidence. The tourniquet test is widely used in resource-poor settings, even though

evidence proved a marginal benefit in diagnosis-making for dengue infection (Grande et al., 2016).

Capillary Refill Test/ Nail Blanch Test

Capillary refill is the rate at which blood refills empty capillaries. It measures dehydration

and decreases peripheral perfusion for patients with dengue. It can be measured by holding a hand

higher than heart level, then press the soft pad of the thumbnail or toenail until it turns white or

blanching occurs. Release the pressure and measure the time needed for the color to return or once

pressure is released. Average refill time is <3 seconds. Hence, >3 seconds is a warning sign.

Platelet Count and Hematocrit Count

To confirm the diagnosis of dengue, laboratory tests such as platelet and hematocrit count

should be performed. A rapid decrease in platelet count (150,000-400,000cu.mm) in platelet with

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a rising hematocrit (female = 36-46%, male = 41-53%) is suggestive for progress to the critical

face of dengue. If no proper laboratory services are available, the minimum standard is the point

of care testing of hematocrit by capillary (finger prick) blood sample using microcentrifuge (WHO,

2009).

Hemagglutination-inhibition (HI) Test

This test is frequently used for patients admitted to the hospital since this test would require

paired sera. The HI test is based on the ability of dengue virus antibodies to inhibit agglutination

(WHO, 2009). The hemagglutination inhibition (HI) test is used to discriminate between primary

and secondary dengue virus infections. However, this serological test cannot provide an early

diagnosis and requires paired serum samples. HI test for the discrimination of primary from

secondary dengue virus infection, whatever the type of dengue antigen used (Matheus et al., 2005).

Dengue NS1 Kit

This test is available in all RHU's in the country for rapid detection of dengue antigen by

dropping blood samples on a cartridge similar to a pregnancy test kit. It is requested in 1-5 days of

illness. NS1 is detectable during the acute phase of dengue virus infection. Ns1 test can be sensitive

as molecular tests during the first 0-7 days of symptoms after day 7 NS1 test is not recommended.

A positive NS1 result is indicative of a dengue infection but does not provide a serotype of

information. Knowing the serotype of infecting virus is not necessary for patient care. However,

if serotype information is needed for surveillance purposes, the sample should be tested. NS1 can

be found in whole blood or plasma. Most NS1 tests had been developing and evaluated in the

serum sample. While combined with NS1 and IgM antibody tests can usually provide diagnostic

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results during the first 1-7 days of illness, a second, convalescent-phase specimen should be

obtained and tested for IgM when both antigen and antibody tests are negative.

Dengue Duo Test

Dengue duo panel rapid Test is a sandwich solid phase immunochromatographic assay.

When the sample is added to the pad, it moves through the conjugate pad and mobilizes gold anti-

NS1 conjugate coated on the conjugate pad. The mixture moves along the membrane by capillary

action and reacts with an anti-NS1 antibody that is coated on the test region. If NS1 is present, the

result is forming a colored band in the test line region. If there is no NS1 in the sample, the area

will remain colorless. The sample continues to move to the control area and forms a pink to purple

color, indicating the test is working, and the result is valid. (DACD INC, 2019).

A study conducted in Cambodia about Rapid Diagnostic Tests for Dengue Virus Infection

in Febrile Cambodian Children: Diagnostic Accuracy and Incorporation into Diagnostic

Algorithms. Researchers assessed the effect of a commercially available DENV rapid test (RDT)

for diagnostic accuracy in children with febrile illness in Cambodian hospitals. The researchers

found that the DENV RDT did not increase the precision we diagnosed DENV infection and did

not help decide which children required acute care admission (Carter et al., 2015).

Methods of Vector Control

Population Reduction

Synthetic insecticides have long been used to suppress mosquito populations. Still, adverse

environmental and health impacts, lack of intrinsic efficacy, and evolution of insecticide-resistant

mosquitoes are challenging current insecticide-reliant strategies. Two significant paths for

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alleviating these problems come from investment in new chemical classes of insecticides and

"molecular insecticides" that use specially engineered nanoparticles to target insecticides at

specific insect tissues and protect the active ingredient from environmental degradation.

Attracting and then killing female mosquitoes as they lay eggs via lethal oviraptor sticky

gravid traps is a targeted, alternative strategy for vector population reduction first recognized in

the 1970s. Early attempts in Brazil and Thailand demonstrated a decrease in Ae. aegypti adult and

larval populations but did not meet the expectations required for elimination. Trap designs are

being developed to make them more efficient. A bacteria formulation was included to attract

ovipositing females Aedes aegypti while still producing volatile compounds. Preliminary results

in Peru came from a recent field trial.

Behavioral Modification

Spatial repellents and other behavior-modifying chemicals that determine blood-seeking

mosquitoes from humans, thus reducing or preventing pathogen transmission, receive increased

research attention. The active ingredients are volatile, unlike the traditional chemicals designed to

kill the following contact of vectors with a treated surface. They are released into space, such as

inside a home, to prevent mosquito entry and stoppage sensory perception needed to find a human

host. Indoor resting behavior may be interfered with due to the disruption of sensory perception.

The effect on adult vector populations may be enhanced caused by mosquitoes being forced to rest

under suboptimal environmental conditions required for survival.

Prevention & Control

One of the preventive measures given by the Department of Health (DOH) is to "Search

and destroy mosquito breeding places." The first step to prevent dengue is within our homes. It is

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essential to remove any space or container like bottle cap, dish dryer, plant axil, gutter, trash can,

and old rubber tires, which may hold excessive stagnant water and become breeding sites of

mosquitoes.

Cover water drums and pails at all times to prevent breeding. Replacing water in flower

vases once a week, cleaning all water containers once a week, and scrubbing the sides well to

remove eggs of mosquitos sticking to the sides. Cleaning gutters of leaves and debris so that

rainwater will not collect as breeding places for mosquitos. Old tires used as roof support should

be punctured or cut to avoid the accumulation of water. They collect and dispose of all unusable

tin cans, jars, bottles, and other items that can collect and hold water (Castro,2012).

Another protective measure by DOH is to Self-protect, such as wearing long pants, long-

sleeved shirts. Clothing minimizes skin exposure during daylight hours when mosquitoes are most

active, affords some protection from dengue vectors' bites, and is encouraged particularly during

outbreaks. Daily use of mosquito repellent may be applied to exposed skin or clothing. The use

of repellent must be in strict accordance with label instructions.

An experimental study conducted in Mountain View College on effectiveness of citronella

extract (Cymbopogonwinterianus Jowit ex Bor) and Garlic Extract (Allium sativum) as Mosquito

(Culicidae) repellant. Showed that a combination of Citronella and Garlic extracts is an effective

mosquito repellant. Therefore, using the extract as a mosquito repellant for prevention and

protection purposes is essential (Dumay et al., 2019).

Fogging is also very important, especially during outbreaks. Support fogging/spraying only

in hospital areas where an increase in cases is registered for two consecutive weeks to prevent

impending attacks. Fogging should be done correctly and within a standard procedure. It should

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be done while wearing protective clothing (long-sleeved shirt, rubber gloves, boots, masks or gas

mask, cap or hard plastic hats) and in the early morning (6:30- 8:30 AM) or late afternoon (4- 6

PM). This should be done when dengue mosquitoes are not active, there is no rain, and the weather

is not too hot.

Another way of preventing dengue is with the use of insecticide-treated mosquito nets. It

affords good protection for those who sleep during the day. Where indoor bitting occurs, household

insecticide aerosol products, mosquito coils, or other insecticide vaporizers may also reduce biting

activity. Household fixtures such as windows and door screens and air-conditioning can also

reduce biting (WHO, 2021).

Increased capacity for informed preventive versus current reliance on reactive would be

required for decreasing dengue, as vector controls using existing and novel interventions with

improved efficient delivery systems. Interventions must be taken to a halt because of the usage in

the past or their political popularity. Many of the current Ae. aegypti control methods continue to

be deployed merely for community visibility without evidence that they prevent disease.

The study stresses that vector control for dengue can be effective, but an implementation

must be done thoroughly, comprehensively, and sustained for it to happen. Through deliberations

of the first three-step process, a framework is developed to guide decision-making on dengue

vector control interventions' practical application and integration. Due to the number of available

vector control tools, new interventions coming up, and the possibility of emerging dengue

vaccines, it is desirable to update the assessment of vector control options (Castro, 2012).

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Treatment and Management

There are different measures and or strategies to treat and manage the dengue virus. These

are categorized according to different phases of manifestations. It may be managed at home, and

not all cases require hospitalization or confining patients in a hospital facility. This is to help

decongest hospitals by giving assurance that not all dengue cases require hospital confinement.

Seek early consultation and immediate treatment. It is essential to seek early consultation

between 1-3 days of fever to immediately recognize the disease, which may require the patient to

increase fluid intake, especially Oral rehydration solution that is proven to be life-saving for

dengue patients (DOH, 2018)

Medication

Encourage oral intake or oral rehydration solution (ORS), fruits juice, and other fluids

containing electrolytes and sugar to replace losses from fever and vomiting. ORS like Oresol can

be given at 75ml/KBW in 4 hours to children or 2-3 liters for adults. If not tolerated, start

intravenous fluid therapy of 0.9% Saline or Ringer's Lactate with or without dextrose at a

maintenance rate.

Bleeding Prevention & Management

Diet should be low fat, low fiber, non-irritating, non-carbonated. Advise patient to avoid

dark-colored foods that can mask bleeding. Ensure strict bed rest and protect patients from trauma

to reduce the risk of bleeding. Do not give IM injection to avoid hematoma. Instruct the caregivers

that the patient should be brought to the hospital immediately if any of the following occurs: no

clinical improvement, deterioration around the time of defervescence, severe abdominal pain,

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persistent vomiting, cold and clammy extremities, lethargy or irritability/ restlessness, bleeding

(e.g., black stools, or coffee-ground vomiting), not passing urine for more than 4-6 hours.

For nose bleeding (epistaxis), maintain an elevated position and apply an ice compress to

promote vasoconstriction. If gums are bleeding, give ice chips and advise the patient to use a soft

bristle toothbrush. For GI bleeding, place the patient on NPO. Blood transfusion should be given

as soon as severe bleeding is suspected or recognize. However, blood transfusion must be given

with care because of the risk of fluid overload. In cases of shock, place a client in dorsal recumbent

to promote circulation. Monitor laboratory results such as platelet and hematocrit count

accordingly. Those with stable laboratory results, without fever or there, is no danger signs for 72

hours can be sent home after being advised to return to the hospital immediately if they develop

any of the warning signs such as abdominal pain or tenderness, persistent vomiting, clinical fluid

accumulation, mucosal bleeding, lethargy, and restlessness (Nies and McEWEN, 2019).

In the study of treatment for dengue fever, focusing on the febrile phase in dengue, liberal

oral fluid administration, and antipyretic therapy with Paracetamol is recommended. But some

non-steroidal anti-inflammatory drugs should be avoided. There is no specific treatment for the

infection, and management is only supportive care with judicious fluid management during this

phase coupled with continuous monitoring (Senaka et al., 2012).

A study in News Medical life sciences 2019 indicated that dengue fever does not have

specific medications as treatment. The time it takes for the infection to die down is one to two

weeks. Bed rest and drinking lots of water are encouraged as management for dengue fever.

Paracetamol may be taken if pain and fever are experienced. On the other hand, internal bleeding

may occur if Ibuprofen and aspirin are taken, so it is best to abstain from taking them. Dengue

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hemorrhagic fever presents with nosebleeds and bleeding from others. Hospitalization is

imperative. In dengue hemorrhagic fever, treatment is aimed at maintaining the patient's

circulating fluid volume. The patient's circulating fluid volume is the aim of treatment for dengue

hemorrhagic fever. Bleeding symptoms may be attributed to lowered blood platelet count. A

platelet transfusion may be the treatment for the signs. Should the patient be weak and may worsen,

causing secondary infections, recovery can take six weeks. This period requires rest, nutrition, and

care (Mandal, 2019).

A study of Determinants of Current dengue pandemic an emphasis on careful fluid

management. Home treatment is encouraged for patients who do not present complications. It may

take oral fluids, with instructions to go back to the hospital, should there be bleeding or other

warning signs, garnering vascular leakage. However, their practice evaluates these patients daily

in a medical clinic with a complete blood count to monitor hematocrit and platelet values. Should

dengue shock syndrome occur, immediate fluid resuscitation must restore plasma volume, then

with fluid therapy afterward, to assure circulation in safeguarding critical organ perfusion. Using

isotonic crystalloid solutions and reserve isotonic colloid solutions for either profound shock or

those who do not respond to the former therapy (Cameron et al., 2003).

A study conducted in University of Sto Tomas (UST) by the Faculty of Pharmacy on the

intent of finding out the truth behind tawa-tawas curative properties. The study concluded that

administering tawa-tawa decoction help improve the healing mechanism, promotes cell reduction,

and prevents platelet destruction. Likewise, the improvement of the cell bleeding time and clotting

time provided evidence that the indigenous plant can preserve and promote the hemostatic function

of platelets. Furthermore, phenolic compounds in tawa-tawa were also discovered, an active

ingredient suspected to be responsible for increased platelet counts (Raynes et al., 2012).

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 CHAPTER III

METHODOLOGY

This chapter further elaborates the research design and how the data will be gathered,

analyzed, and treated statistically. This will also explain how is the population size is collected and

obtained from the proper authorities, research local, and ethical considerations.

RESEARCH DESIGN

This study utilized the descriptive – comparative design that uses the secondary data on

morbidity and mortality rate of dengue cases in Valencia City, Bukidnon, from 2015-2019.

RESEARCH LOCALE

The researchers conducted the study in the City of Valencia, known as the City of Golden

Harvest, located in Bukidnon, Northern Mindanao, in Region 10. The city has 31 barangays,

including Bagontaas, Lilingayon, Poblacion, Banlag, Lourdes, San Carlos, Barobo, Lumbayao,

San Isidro, Batangan, Lumbo, Sinabuagan, Catumbalon, Lurogan, Sinayawan, Colonia, Maapag,

Sugod, Concepcion, Mabuhay, Tongantongan, Dagat-Kidavao, Mailag, Tugaya, Guinoyuran,

Mount Nebo, Vintar, Kahapunan, Nabago, Laligan and Pinatilan. Valencia City is headed by

Honorable Azucena P. Huervas and Honorable Policarpio P. Murillo as the vice-mayor. The

primary income focuses on agricultural lands, where barangays in the city proper are not yet

highly urbanized.

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POPULATION & SAMPLING

This study used the registration-sampling design wherein the data were obtained using

the people's existing records in a specific population. The records will be taken from the dengue

coordinator in Environmental Sanitation of the City Health Office of Valencia City, Bukidnon.

RESEARCH INSTRUMENT

The researchers used the datasheet recorded from the Environmental Sanitation Office of

Valencia City, Bukidnon, and the FHSIS from the Department of Health. These are secondary data

collected and categorized according to the research questions provided.

DATA COLLECTION PROCEDURE

After the study was approved, the researchers submitted a transmittal letter to the City

Health Officer and narrated the objectives, including the ethical consideration of the data, the letter

of approval from the research adviser, and an endorsement letter from the Dean of the School of

Nursing was given to the City Health Officer. After receiving the approval letter from the City

Health Office of Valencia City, the researchers conducted a courtesy visit to the dengue

coordinator of the Environmental Sanitation Office of the CHO. The data was gathered and

clustered from the City Health Environmental Sanitation, specifically the dengue coordinator's

office.

DATA ANALYSIS

The data was analyzed to identify morbidity and mortality of dengue cases reported in

terms of the year, barangay, and significant differences of morbidity rate in terms of month, year,

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and barangay. Descriptive analysis was used to identify frequencies and percentages to answer

questions 1 and 2. However, to answer question 3, ANOVA (Analysis of variance) was used.

ETHICAL CONSIDERATIONS

The anonymity of the data is assured in cases where the patient's name or address was

disclosed, excluding age ranges, as stated in the study's objectives. Consent from the head office

of CHO was requested with a request letter approved by the researchers' institution. The data

gathered was used for study purposes only. Hence, confidentiality was upheld by the conductors

of the study. The accuracy of the data collected will be maintained, as handed over by the CHO.

The data ownership was accredited to the City Health Office of Valencia City, Bukidnon.

Gratitude was expressed verbally.

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 Chapter IV

RESULTS AND DISCUSSION

This chapter presents the morbidity of dengue cases for the last five years (2015-2019) in

Valencia City, Bukidnon. This chapter contains the presentation of data analysis and the results

of this study.

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 Table 1: Morbidity of Dengue cases of Valencia City Bukidnon for the year 2015-2019

YEAR
BARANGAY
2015 2016 2017 2018 2019
Bagontaas 35 (8.55%) 88 (8.65%) 54 (8.73%) 113 (8.4%) 156 (9.1%)
Banlag 3 (0.73%) 26 (2.55%) 8 (1.29%) 30 (2.2%) 42 (2.46%)
Barobo 7 (1.7%) 15 (1.47%) 11 (1.77%) 15 (1.1%) 28 (1.6%)
Batangan 29 (7.0%) 68 (6.68%) 44 (7.1%) 78 (5.8%) 114 (6.86%)
Catumbalon 7 (1.7%) 11 (1.08%) 7 (1.1%) 28 (2.09%) 14 (0.8%)
Colonia 5 (1.2%) 16 (1.57%) 5 (0.8%) 7 (0.5%) 35 (2.05%)
Conception 2 (0.48%) 4 (0.39) 1 (0.16%) 13 (0.97%) 17 (0.99%)
Dagat-ki-davao 5 (1.2%) 19 (1.86%) 10 (1.6%) 23 (1.7%) 48 (2.8%)
Guinoyoran 20 (4.88%) 29 (2.85%) 15 (2.4%) 29 (2.16%) 53 (3.1%)
Kahaponan 23 (5.6%) 14 (1.37%) 41 (6.6%) 31 (2.3%) 33 (1.9%)
Laligan 9 (2.2%) 27 (2.65%) 11 (1.77%) 40 (2.98%) 39 (2.28%)
Lilingayon 11 (2.68%) 20 (1.96%) 12 (1.9%) 34 (2.5%) 27 (1.58%)
Lourdes 6 (1.46%) 7 (0.68%) 1 (0.16%) 2 (0.1%) 11 (0.6%)
Lumbayao 3 (0.7%) 15 (1.47%) 9 (1.45%) 11 (0.8%) 31 (1.8%)
Lumbo 48 (11.7%) 74 (7.27%) 47 (7.6%) 149 (11.1%) 134 (7.85%)
Lurugan 25 (6.1%) 65 (6.39%) 43 (6.95%) 52 (3.88%) 77 (4.5%)
Maapag 3 (0.7%) 9 (0.88%) 7 (1.1%) 25 (1.86%) 36 (2.1%)
Mabuhay 7 (1.7%) 10 (0.98%) 10 (1.6%) 21 (1.56%) 27 (1.58%)
Mailag 11 (2.68%) 60 (5.89% 11 (1.77%) 68 (5.07%) 34 (1.99%)
Mt. Nebo 7 (1.7%) 15 (1.47%) 7 (1.1%) 16 (1.19%) 29 (1.7%)
Nabag-o 0 (0%) 4 (0.39%) 7 (1.1%) 11 (0.8%) 25 (1.46%)
Pinatilan 2 (0.48%) 13 (1.27%) 10 (1.6%) 34 (2.5%) 36 (2.1%)
Poblacion 96 (23.47%) 276 (27.1%) 138 (22.3%) 344 (25.69%) 379 (22.2%)
San Carlos 12 (2.9%) 27 (2.65%) 10 (1.6%) 52 (3.88%) 30 (1.75%)
San Isidro 3 (0.7%) 10 (0.98%) 14 (2.26%) 7 (0.5%) 15 (0.87%)
Sinabuagan 3 (0.7%) 11 (1.08%) 14 (2.26%) 15 (1.1%) 31 (1.8%)
Sinayawan 13 (3.17%) 33 (3.2%) 24 (3.8%) 31 (2.3%) 83 (4.86%)
Sugod 1 (0.2%) 14 (1.37%) 20 (3.2%) 21 (1.56%) 27 (1.58%)
Tongantongan 6 (1.46%) 22 (2.16%) 20 (3.2%) 25 (1.86%) 67 (3.9%)
Tugaya 5 (1.2%) 8 (0.78%) 3 (0.48%) 4 (0.29%) 11 (0.6%)
Vintar 2 (0.48%) 7 (0.68%) 4 (0.6%) 10 (0.7%) 16 (0.9%)
TOTAL 409 (8.03%) 1017 (19.98%) 618 (12.14%) 1339 (26.30%) 1707 (33.53%)

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 Table 1 shows that during the year 2015, the average cases were 13, wherein barangay

Poblacion with 96 reported cases was the highest number of cases, followed by barangay Lumbo

with 48 cases then barangay Bagontaas with 35 reported cases. On the other hand, the top 3

barangay who had low cases were barangay Nabag-o, Sugod, and Vintar, with 0-2 reported cases.

In 2016, the average cases were 33, wherein barangay Poblacion was the highest cases

reported with 276, followed by barangay Bagontaas with 88 total cases and Lumbo with 74 cases.

However, the top 3 barangay with low cases were Nabag-o and Conception with 4 cases reported

then, barangay Lourdes with 7 cases.

The average case for the year 2017 was 20, wherein barangay Poblacion was the highest

reported case with 138 cases, followed by barangay Bagontaas with 54 cases and barangay limbo

with 47 reported cases. However, there were barangays with low cases, barangay Conception and

barangay Lourdes with only one reported case, and barangay Tugaya with 3.

In 2018, the average reported cases were 43, wherein barangay Poblacion was still the

highest reported case with 344, followed by barangay Lumbo with 149 cases and barangay

Bagontaas with 113 cases for the whole year. Low cases reported were barangay Lourdes with 2

cases, barangay Tugaya with 4, and barangay Colonia and San Isidro with 7 reported cases.

In 2019, the average cases reported were 55, barangay Poblacion at the highest said points

with 379, followed by barangay Bagontaas with 156 instances and Lumbo with 134 total cases. At

the same time, there was barangay with low cases, both barangay Lourdes and Tugaya with a total

of 11 cases, and barangay Catumbalon with 14 reported cases for the whole year.

For the last five years, Poblacion was the highest number of reported cases of dengue.

While in the year 2015, the least number of the said case was Sugod, with only 1 case. In 2015,

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barangay Nabag-o was left blank on the data collected on that specific year, which means there

was invalid data amongst collected. In 2016, barangay Conception and Nabag-o were the most

minor reported cases for the whole year. In 2017 and 2018, barangay Lourdes was the least

reported diseased, with only one point during 2017 and two cases in 2018. Lastly, in 2019, both

barangay Lourdes and Tuyaga were the least reported cases with 11.

In the regions of the Philippines, the incidence of dengue disease per 100,000 population

varied, with exceptionally high incidences observed in the areas of the island of Mindanao. The

increasing incidence of dengue disease may be related to a growing population, increasing

urbanization, improvements in surveillance, and the limited success of vector control measures

(Bravo, 2014).

An epidemiology report of Dengue Disease in the Philippines stated that the increasing

incidence of dengue disease might be related to a growing population, increasing urbanization,

improvements in surveillance, and the limited success of vector control measures (Bravo et al.,

2014). The spread of dengue may be partly due to the increase of unplanned urbanization, rapid

increase in population growth, climate change and extreme weather events, and poor socio-

economic status.

A study conducted in Malaysia showed that non-agricultural areas largely determined the

occurrence of dengue cases. Larger shares of human settlement coverage in the neighborhood are

associated with higher numbers of dengue cases. One of the reasons for this may be higher

population density in areas with more human settlements, leading to higher human biting rates.

Increased human biting rates offer opportunities for the mosquitos to acquire dengue by biting an

infected person and then transmit the virus after becoming infected. (Scott and Morrison, 2019).

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In the said study, in Malaysia, the researchers found that shallow clean stagnant water in drains

served as a suitable habitat for Aedes mosquitos (Norafikah et al., 2012).

Table 2: Mortality rate of Dengue Cases in terms of Year (2016-2019) and Barangay.

Year
Barangay
2015 2016 2017 2018 2019
Batangan 0.09%(1) 0.07%(1) 0.58%(1)
Colonia 0.58%(1)
Kahaponan 0.58%(1)
Laligan 0.58%(1)
Lumbayao 0.16%(1) 0.07%(1)
Lumbo 0.07%(1) 0.58%(1)
Lurugan 0.07%(1)
Mailag 0.16%(2)
Poblacion 0.16%(1) 0.15%(2) 0.16%(2)
Sugod 0.07(1) 0.16%(2)
Tugaya 0.07(1)
TOTAL 0.09%(1) 0.32%(2) 0.59%(8) 0.64%(11)

Table 2 presents the frequency of mortality cases on dengue around the city clustered in

different years. For 2015, the Environmental Sanitation Office was not able to input data for that

specific year in terms of mortality. However, in 2016 only one reported that in 2017 were 2

cases, in 2018 were 8 cases, and in 2019 in 11 patients. During the year 2019, there were

increased mortality cases in the city. There might be many factors that can lead to a specific

increase in number.

According to the report released by the Department of Health, there was an increase in

mortality cases from the year 2016 up to 2019. In the year 2016, there was only 1 (0.09%)

reported case in Valencia City for the whole year, while there were 343 cases nationwide. In the

year 2017, there were 2 (0.32%) reported cases in Valencia City, while there were 811 mortality

cases nationwide. In the year 2018, 8 (0.59%) cases were reported in Valencia City, while there

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were 655 reported cases nationwide. Lastly, in the year 2019, 11(0.64%) cases were reported in

Valencia City, while there were 1,107 cases nationwide.

In comparison to the cases reported nationwide, there was an increase in cases from 2015

to 2017. While there were decreased mortality cases during the year 2018 compared to the year

2017, there was a drastic increase in the year 2019 for the entire Philippines. However, compared

to the cases reported in Valencia City, there was an increased mortality rate from 2016 to 2019.

Table 3.1: Significant difference of morbidity in terms of month.

MONTH Mean F- P- Significance

Value Value
January 69.60A
Febuary 47.20A
March 50.20A
April 44.00A
May 68.00A
June 115.60A
2.21 0.03 Significantly Different
July 170.40A
August 171.00A
September 115.40A
October 73.00A
November 63.80A
December 53.00A

In this table, the data for each month has been very significant due to its p-value of 0.03.

However, the letter groupings written in superscript are used to present considerable differences

in each group. August is very substantial with April due to its contrast with the cases reported each

month.

Amongst all of the months, July and August have a significant difference from April, which

holds the lowest mean value. Since July and August are very significant because in this time of the

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year when the rainy season starts. April is significantly different compared to July and August

since the peak of summer here in the Philippines is this time of the year.

The months of July and August are significantly different due to their relatively humid

environment that can be used to predict the second seasonal peak of dengue in the Philippines. In

August, dengue peaks in south Philippines predominantly occurred, with the peak occurring in

September (Scott Sheridan, 2020).

A study conducted in Manila, Philippines on temperature, relative humidity and rainfall on

dengue fever. Found that relative humidity indicates large values during the wet season, with peaks

in August and July. In summer, the temperature rises, rainfall increases with moist air transport

from the ocean to the continent, a monsoon begins, and the atmosphere moistens, increasing

relative humidity. This was followed by a peak in the number of individuals infected with dengue

(SUMI, 2016).

An earlier study addressed the reasons for dengue fever epidemics in terms of rainfall.

Dengue fever epidemics are correlated not only with rainfall but also relative humidity and

temperature. Dengue during a week related to rains over the prior 6–7 weeks. This can be attributed

to the life-cycle duration of mosquitoes and the requirement of an adequate number of cases for

spread, which is affected by population density (Lulu & Bravo, 2014).

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Table 3.2: Significant difference of morbidity in terms of year.

YEAR Mean F- P- Significance

Value Value
2015 13.19B
2016 32.81AB
2017 19.94AB 3.55 0.008 Significant
2018 43.19AB
2019 55.00A

Table 3.2 shows the significant difference due to its p-value of 0.008. This also presents that year

2015 is very significant to 2019 due to its increasing reported cases. While the years 2015 and

2019 are not significant to the years 2016, 2017, and 2018.

In these data presented, the year 2015 is very significant to the year 2019. As in 2015 has a mean

value of 13.19 with 409 reported cases for the whole year, while in 2019, the mean value of

55.00 with total points 1705 for the entire year. These enormous increases of morbidity for

dengue may hold factors. First, there is an increase in population from 2015 to 2019. During the

2015 census, there was a total of 194,993 compared to the year 2019 during the Barangay

Population from the City Nurses Department of Valencia city total number is at 205,943. The

increased population will also contribute to the increased number of the possible individuals

affected by the virus brought by the dengue mosquitos.

In the years 2016 and 2017, the City of Valencia also strengthens its campaign against Dengue

Mosquito. Together with the head of each barangays, the City Health Office spearheaded and

intensified the awareness against dengue outbreaks and let the community involved in the

campaign. As stated by the Department of Health (DOH)-Epidemiology Bureau's 2019 data,

dengue cases have peaked in this year were 402,694 cases have been reported compared to the

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2017 data, where it is only 52% of the totality of cases in the said year. In addition, 1,502

patients have died from dengue to date, up from 1,075 deaths last year. In August 2019, the

Government of the Philippines, through the Department of Health, declared a national dengue

epidemic. There are 16 provinces that have declared a state of calamity due to dengue: Aklan,

Albay, Cavite, Capiz, Catanduanes, Eastern Samar, Guimaras, Iloilo, Leyte, Mountain Province,

North Cotabato, Paranaque, South Cotabato, Southern Leyte, Western Samar, and Zamboanga

Sibugay.This concludes that Mindanao holds the most cases that alarm the public to stay

connected with the DOH for further safety implementations.

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Table 3.3: Significant difference of morbidity in terms of barangay.

BARANGAY Mean F-Value P-Value Significance

Bagontaas 89.20B
Banlag 21.80BC
Barobo 15.20C
Batangan 66.60BC
Catumbalon 13.40C
Colonia 13.60C
Conception 7.40C
Dagat-ki-davao 21.00BC
Guinoyoran 29.20BC
Kahaponan 28.40BC
Laligan 25.20BC
Lilingayon 20.80BC
Lourdes 5.40C
Lumbayao 13.80C
Lumbo 90.40B
Lurugan 52.40BC 0.000 Significant
11.80
Maapag 16.00C
Mabuhay 15.00C
Mailag 36.80BC
Mt. Nebo 14.80C
Nabag-o 11.75C
Pinatilan 19.00BC
Poblacion 246.60A
San Carlos 26.20BC
San Isidro 9.80C
Sinabuagan 14.80C
Sinayawan 36.80BC
Sugod 16.60C
Tongantongan 28.00BC
Tugaya 6.20C
Vintar 7.80C

Table 3.3 shows the significant difference in terms of barangay due to its p-value of 0.00.

In the table, barangay Poblacion is very substantial to the remaining 30 barangays. In comparison,

barangays Lumbo and Bagontaas are significantly different from barangay Poblacion, Sugod,

Maapag, Barobo, Mabuhay, Sinabuangan, Mt. Nebo, Lumbayao, Colonia, Catumbalon, Nabag-o,

San Isidro, Vintar, Conception, Tugaya, and Lourdes.

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 As we can observe in the table, barangay Poblacion is highly significant amongst all

barangay since it has been the highest reported. Poblacion alone has 35,793 during the year 2015

and another total population of 38,148 during 2019. This also means that barangay Poblacion has

the highest population among the barangays in the city. The possible mosquito breeding sites are

present since there are more settlers in this barangay and considered a significant barangay in the

town.

An article released by World Health Organization on states that immediate housing

environment has an impact on health through quality of urban design. Poorly planned or

deteriorated residential areas lacking public services, greenery, and walking areas have been

associated with blood parasites in their vector function for viral diseases such as dengue.

Along with barangay Poblacion, barangays Lumbo and Bagontaas are another highly

significant barangays among surveyed. Barangay Lumbo was the second most populated area

around the city. In 2015, they had a total population of 16,082, then raised their number to 17,140

during 2019. This barangay has vast agricultural land, which may also result in more breeding sites

for dengue mosquitos. Barangay Bagontaas was the fourth most populated barangay in the city

and yet highly significant with the other barangay together with Barangay Lumbo. Location for

Bagontaas is also more on agricultural lands, and households around this area are more congested.

This contributes to the hike of dengue cases across the south were. According to a report from the

Philippine News Agency (PNA), Valencia City topped the number of cases in the region of

Bukidnon in 2019, with a total of 1,365 cases and four deaths had been recorded along with

Misamis Oriental, which also has more than 2800 cases, that is considered to put in a state of

calamity due to the drastic hike.

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 CHAPTER V

SUMMARY OF FINDINGS, CONCLUSIONS, RECOMMENDATIONS

This chapter presents the summary of the findings, conclusions from the data gathered,

and recommendations offered by the researchers.

Summary of Findings

With the researchers gathered secondary data gathered from CHO is proof that the case of

dengue in Valencia City is increasing. In 2015, there have been 409 cases or 8.03%. However, in

the year 2016, there are 1017 dengue cases or 12.14%. On the other hand, there are 618 cases, or

12.14%, in 2017. In the year 2018, 1339 recorded dengue cases have been reported, equivalent to

26.30%. On top of these all, in the year 2019, there are 1707 cases of dengue in Valencia City or

33.53%. In the year 2017, there is a decrease in cases in comparison to the year 2016.

Concerning mortality rate, there were increase cases every year, starting from 2016 to

2019. In regards to the significant difference, July and August are significantly different from

March and April. On the other hand, year high significant difference can be classified from the

year 2019 to the year 2015. Lastly, in terms of barangay, barangay Poblacion is significantly

different among all the remaining barangays.

Conclusions

With the data gathered, it has been found that the highest rate of dengue cases is in

barangay Poblacion for the last five years. Being consistent in the highest per year, Poblacion

does not have a high mortality rate. The dengue deaths in the previous five years in Poblacion are

0, 0, 1, 2, and 2. In regards to the significant difference, July and August are significantly

different from March and April. On the other hand, year high substantial difference can be

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classified in the year 2019 to the year 2015. Lastly, in terms of barangay, barangay Poblacion is

significantly different among all the remaining barangays.

Recommendations

In the light of the findings of the study, the following are recommended:

Public Health Workers. The researchers suggest that public health workers may

strengthen their programs on health education and disease prevention to the community, especially

the barangays who have high cases. The researchers also recommend maintaining their

recordkeeping or documentation for future researchers.

Community. The researchers recommend that the community be involved in the programs

conducted by the public health workers. It is also suggested that it is not only on an awareness that

should be done but also its practice to prevent further spread of dengue.

Future Researchers. The researchers recommend that future researchers know the reasons

for the barangays as to why they have such high or low dengue cases. For the basis of this research

being a quantitative study, focusing on the rate dengue case, the researchers were not able to know

the correlation of geographical places of the people who experienced dengue. Moreover, it is also

suggested that future researchers compare cities in Bukidnon on the cases they have on dengue.

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APPENDIX A CURRICULUM VITAE

BELLE KELLY R. ABARICO

Curriculum Vitae

Personal Information

Date of Birth: December 6, 1998

Place of Birth: PLV Pueblo de Oro, Cagayan de Oro City

Civil Status: Single

Religion: Seventh-Day Adventist

Home Address: Phil-Amlife Village, Pueblo de Oro, Cagayan de Oro City

Educational Attainment

Elementary School: Graduated in 2009

DelMar SDA Elementary School
Julio Pacana Street, Cagayan de Oro City

Secondary: Graduated in 2013

Nanuri International School
Taguanao, Indahag, Cagayan de Oro City

Tertiary: Bachelor of Science in Nursing, 2021

Mountain View College
Valencia City, Bukidnon, Philippines

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 MIRACHELLE L. BROÑOLA
Curriculum Vitae

Personal Information

Date of Birth: May 25, 1998

Place of Birth: Carmen, Cagayan de Oro City

Civil Status: Single

Religion: Seventh-Day Adventist

Home Address: Carmen, Cagayan de Oro City

Educational Attainment

Elementary School: Graduated in 2010

West City Central School
Ilaya, Carmen, Cagayan de Oro City

Secondary: Graduated in 2014

Nanuri International School
Taguanao, Indahag, Cagayan de Oro City

Tertiary: Bachelor of Science in Nursing, 2021

Mountain View College
Valencia City, Bukidnon, Philippines

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 CHRISTLEMAR M. PANTOLLANA
Curriculum Vitae

Personal Information

Date of Birth: October 20, 1998

Place of Birth: Baybay City, Leyte

Civil Status: Single

Religion: SDA

Home Address: Baybay City, Leyte

Educational Attainment

Elementary School: Graduated in 2011

Baybay Adventist Elementary School
Baybay City, Leyte

Secondary: Graduated in 2015

Baybay National High School
Baybay City, Leyte

Tertiary: Bachelor of Science in Nursing, 2021

Mountain View College
Valencia City, Bukidnon, Philippines

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