FOOD AND WATERBORNE DISEASES

PREVENTION AND CONTROL PROGRAM

DESCRIPTION

 FWBDs refer to the limited group of illnesses

characterized by diarrhea, nausea, vomiting
with or without fever, abdominal pain,
headache and/or body malaise. These are
spread or acquired through the ingestion of
food or water contaminated by disease-causing
microorganisms (bacterial or its toxins,
parasitic, viral).
 VISION
Zero Mortality from FWBDs

 MISSION
To reduce morbidity and mortality due to FWBDs
OBJECTIVES

 To guarantee universal access to quality FWBD-

PCP intervention and services at all stages of
the life
 To guarantee financial risk protection of clients
availing diagnosis, management and treatment
for FWBDs
 To guarantee a responsive service delivery
network for the prevention and control of
FWBDs
PROGRAM COMPONENTS

 Policy, Plans and Organizational Support. This

component ensures that supportive policies,
directional and annual plans are developed and
updated to govern the design and implementation
of the FWBD-PCP. It shall ensure that
organizational support to the FWBD-PCP is in place
at various levels of operations. This includes
establishment of partnership between DOH and
LGUs and with other partners in the other sectors.
PROGRAM COMPONENTS
 Diagnosis, Management and Treatment. This
component ascertains the proper diagnosis as well as
prompt management and treatment of patients
suffering from FWBDs. Focus will be given to the
development of clinical practice guidelines (CPGs) on
FWBD diagnosis, management and treatment.
Diagnosis will encompass strengthening the laboratory
services and the use of rapid diagnostic test (RDTs). In
the management and treatment, support for the
establishment and sustained operations of ORT corners
in the hospitals and even in outpatient health facilities
will be provided Training of health providers will be
undertaken on the CPGs and overall FWBD-PCP
management.
PROGRAM COMPONENTS

 QualityAssurance System. This

component ensures the quality of
diagnostic services of FWBD cases. This
requires regular test, validation and
follow-up of laboratory capacities and
competencies of medical technologists as
well as provision of the necessary
laboratory supplies and equipment.
PROGRAM COMPONENTS
 Logistic Management. This component guarantees
that essential drugs/medicines, supplies and
equipment are in place and available at the point
of service. While the LGUs are mainly responsible
for placing-in these commodities and other
logistics at their level, the DOH shall design a
system for forecasting the needs nationwide and
design a procurement, allocation and distribution
system to ensure these reach the facilities with
proper tracking and monitoring of their utilization.
PROGRAM COMPONENTS
 Capability Building. This component secures
the quality of services by training the service
providers on the standards and protocols on
the diagnosis, management and treatment of
FWBDs. It shall also develop the managerial
and supervisory capability of FWBD-PCP
managers/coordinators at various levels of
administration to ensure the efficient and
effective implementation of the Program.
PROGRAM COMPONENTS
 Health Promotion and Advocacy. This component
ensures the prevention of FWBDs which hinges on
the promotion of proper practices on water,
sanitation and personal hygiene. It takes off from
the development of an overall Health Promotion
and Communication Plan aimed at effecting
behavior change among community members and
garnering support from key stakeholders through
advocacy. It also encompasses collaboration with
the Environmental Health and Sanitation Unit on
the installation of safe water and sanitation
facilities.
PROGRAM COMPONENTS
 Monitoring and Evaluation, Research, Surveillance and
Response. Under this component, necessary system
and tools will be developed to ensure that quality and
timely data are generated as basis for decision-making,
prioritization of resources and appropriate and
immediate response to any outbreak. A FWBD
Surveillance System that will provide a comprehensive
epidemiologic information, on current situation on
FWBD, in an area will be strengthened. Regular
monitoring of the status of FWBD-PCP implementation
will be carried out including special researches or
studies as needed.
PROGRAM COMPONENTS

 Outbreak Response/Disaster
Management. This component ensures that
any outbreak due to FWBD in any area is
properly monitored and immediately responded
to especially during disaster or emergency
situations where the affected population
became most prone to these infections as in
evacuation centers or flooded areas.
TARGET POPULATION/ CLIENT

 FWBD by Sex
 Based on EB’s data in 2016, there were slightly
more males generally experiencing FWBDs
(cholera, typhoid, Hepa A, rotavirus and
paralytic shellfish poisoning) than females.
However, for acute bloody diarrhea, there were
more females than males reported
experiencing the disease in the same year.
TARGET POPULATION/ CLIENT

 FWBDs by Age Group

 Majority of the reported acute bloody diarrhea in
2016 were among the 1-4 year old children.
Rotavirus as characterized occurs mainly among
the same age group and those below 1 year old.
As for Hepa A, mostly affected are the 15 to 39
year olds and also notable among the younger age
group (5-14 years old). As for typhoid, cholera and
paralytic shellfish poisoning, highest number of
cases reported was among the 5-14 years old.
TARGET POPULATION/ CLIENT

 FWBDs by Geographical Areas

 The Visayas Region particularly Regions 7 and 8
came out as hosts of the highest incidence of
FWBDs in the country. Incidence of acute bloody
diarrhea is highest in Region 7 and also the host
of the highest number of reported Hepa A and
Typhoid cases in 2016. Region 8 on the other
hand had the highest incidence of cholera and
paralytic shellfish poisoning. Region 1 came out
highest in the incidence of rotavirus in the same
year.
AREA OF COVERAGE
 FWBDs are usually manifested as diarrhea. Based on the 2015
Global Health Observatory (GHO) data, diarrhea accounts for 9%
of the total deaths among children below 5 years old. In the
Philippines, a total of 11,876 cases of acute bloody diarrhea
(ABD) were reported from sentinel sites nationwide in the same
year. In addition, 830 Hepatitis A cases and 74 cases of paralytic
shellfish poisoning were also reported. The Philippine Health
Statistics data showed that diarrhea placed 5th as a leading
cause of morbidity among general population in 2010 from
being the top or second leading cause in the 1990s. Morbidity
rate due to diarrhea has gone down from 1,520/100,000
population in 1990 to 347.3/100,000 population in 2010.
Despite this decline however, several notable outbreaks
continue to occur. It is believed that since the occurrence of
FWBDs is essentially related to economic and socio-cultural
factors
 POLICIES AND LAWS

Title Year Issued

Sanitation Code of the Philippines 1975 PD No. 856

Intensifying the Program on Food Handlers and Water Quality

Surveillance to Curb Outbreaks of water and sanitation related 1996 DOH DC No. 110
diseases

Creation of the Food and Water-Borne Disease Prevention and

1997 DOH AO No. 29-A
Control Program

Issuance of the Philippines National Standards for Drinking Water 2007 AO No. 0012

Food Safety Act to strengthen the food safety regulatory system

in the country to protect consumer health and facilitate market 2012. RA 10611
access of local foods and food product
 POLICIES AND LAWS
Title AO/DM/DC No.
Banning Neomycin in Anti-Diarrheal Preparations AO 24-A s. 1982
Policies and Guidelines for the National Control of Diarrheal Diseases
DC No 179 s. 1993
Program
Designation of Ad Hoc Committee for the formulation of plans,
1997.DOH DO No. 99-H
policies and standards for the FWBD-PCP
Revised of List of Notifiable or Reportable Diseases which included
cholera, typhoid, and paratyphoid fever, paralytic shellfish poisoning,
2001. DOH DC No. 176
acute watery diarrhea, acute bloody diarrhea, food poisoning and
chemical poisoning
Alert for Possible Diarrhea Outbreak Particularly Cholera during Rainy
DC No. 191 s. 2004
Season
Guidelines for Foodborne Disease Surveillance of the DOH
AO No. 2005-0012
Philippines with Salmonella as pilot pathogen
Operational Guidelines for Parasitologic Screening of Food Handlers 2006 AO No. 2006-001

Reproduction of Health Advisory on Diarrhea DM No. 2006-0159

 POLICIES AND LAWS
Zinc Supplementation and Reformulated Oral Rehydration Salt in the
2007 AO 2007-0045
Management of Diarrhea among Children

Diagnosis and Treatment Guidelines for Capillariasis Infections 2009 AO 2009-0021

Issuance of Diagnosis and Treatment Guidelines for Paragonimiasis 2010 AO No 2010-0037

Guidelines on verification and certification of Barangay for Zero Open
2015 DM No 2015-0021
Defecation Status
Designation of the RITM as the NRL for Rotavirus and other Enteric
2015 AO No 2015-0050
Viruses
Perform monitoring activities for the Implementation of Harmonized
2016-0230
Schedule and Combined Mass Drug Administration
Conduct monitoring of Food and Waterborne Diseases Outbreak in
2016-1397
Zamboanga City
Dialogue with the Regional Directors of Region 5 & 11 on the Integration
2016-2362
of TB & Paragonimiasis Management
Annual Consultative Meeting for Disease Surveillance Officers and
2016-2704
Coordinators
Provide technical assistance in the Launching and Signing of
2017-0377
Memorandum of Agreement of Regional Food Safety Committee
Orientation on the Guidelines of Integrating the Diagnosis of
2017-3205
Paragonimiasis wiith the NTP-TB Microscopy Services
Creation of Technical Task Force, Expert Panel and Steering Committee
for the Development of Clinical Practice Guidelines (CPGs) on selected 2017-3642
food and waterborne diseases
Consultation on Program and Policy Development for NTD-WASH
2017-3674
Integration
FOOD FORTIFICATION PROGRAM
OBJECTIVES:

 1. To provide the basis for the need for a food

fortification program in the Philippines: The
Micronutrient Malnutrition Problem
 2. To discuss various types of food
fortification strategies
 3. To provide an update on the
current situation of food fortification in
the Philippines
FORTIFICATION AS DEFINED BY CODEX
ALIMENTARIUS

 “the addition of one or more essential nutrients

to food, whether or not it is normally contained
in the food, for the purpose of preventing or
correcting a demonstrated deficiencyof one or
more nutrients in the population or specific
population groups”
VITAMIN A, VITAMIN A DEFICIENCY (VAD) AND
ITS CONSEQUENCES
 › itamin A - an essential nutrient as retinol needed by the
V
body for normal sight, growth, reproduction and immune
competence
 ›Vitamin A deficiency - a condition characterized by depleted
liver stores & low blood levels of vitamin A due to prolonged
insufficient dietary intake of vit. A followed by poor
absorption or utilization of vit. A in the body
 ›VAD affects
children’s proper growth, resistance to infection, and
chances of survival (23 to 35% increased child mortality),
severe deficiency results to blindness, night blindness and
bitot’s spot
IRON AND IRON DEFICIENCY ANEMIA (IDA) AND
ITS CONSEQUENCES

 I› ron - an essential mineral and is part of

hemoglobin, the red protein in red blood cells that
carries oxygen from the lungs to the cells
 ›Iron Deficiency Anemia - condition where there is
lack of iron in the body resulting to low hemoglobin
concentration of the blood
 ›IDA results in premature delivery, increased
maternal mortality, reduce ability to fight infection
and transmittable diseases and low productivity
IODINE AND IODINE DEFICIENCY DISORDERS
(IDD)

 I› odine -a mineral and a component of the thyroid

hormones
 ›Thyroid hormones - needed for the brain and
nervous system to develop & function normally
 ›Iodine Deficiency Disorders refers to a group of
clinical entities caused by inadequacy of dietary
iodine for the thyroid hormone resulting into
various condition e.g. goiter, cretinism, mental
retardation, loss of IQ points
POLICY ON FOOD FORTIFICATION

 ASIN LAW
 Republic Act 8172, “An Act Promoting Salt Iodization
Nationwide and for other purposes”, Signed into law on
Dec. 20, 1995
 Food Fortification Law
 Republic Act 8976, “An Act Establishing the Philippine
Food Fortification Program and for other purposes”
mandating fortification of flour, oil and sugar with
Vitamin A and flour and rice with iron by November 7,
2004 and promoting voluntary fortification through the
SPSP, Signed into law on November 7, 2000