A re p o rt o n th e p o p u la tio n h e a lth im p a c t o f tu b e rc u lo s is in th e P h ilip p in e s

E r r o l C ia n o

A b s tra c t

T u b e r c u lo s is

(T B )

is

m a jo r by

p u b l ic

h e a lt h

p r o b le m

in

th e

P h il ip p in e s .

A n

in d iv id u a l b e c o m e s in t o th e a ir is by an

in f e c t e d

in h a l in g

M y c o b a c t e r iu m D e v e lo p m e n t fa c to rs of

t u b e r c u lo s is TB to in f e c t io n th e

e x p e lle d and TB

in f e c t io u s by

p a t ie n t . r is k

d is e a s e

in c r e a s e d

c e r t a in

r e la t in g

e n v ir o n m e n t,

in f e c t io u s in d iv id u a l a n d

s u s c e p t ib le

c o n ta c t. T B

has been

c o n s is t e n t ly r a n k e d 2 0 0 0 -2 0 0 4 a m o n g th e ca se s o ccur is b e st

a s t h e s ix t h le a d in g c a u s e o f P h ilip p in e m o r b id it y a n d m o r t a lit y f r o m and 1 9 9 9 - 2 0 0 3 , r e s p e c t iv e ly . I t is d is p r o p o r t io n a t e ly m o r e am o n g com m o n

p o o r , a m o n g m a le s , a n d am ong th e e c o n o m ic a lly

t h e e ld e r ly . M o r e t h a n h a lf o f T B 3 0 -5 0 and y e a r - o ld

p r o d u c t iv e

g r o u p . P r e v e n t io n

a c h ie v e d

th ro u g h

p r o m p t d e t e c t io n B a c i lle

t r e a t m e n t o f in f e c t io u s c a s e s . P r im a r y ( B C G ) v a c c in a t io n under and m e a s u re s

p r e v e n t io n a g a in s t P ro g ra m (D O T S ) th e

in c lu d e s r is k

C a lm e t t e - G u r in

fa c tors . C u rre n t T B B C G

c o n t r o l s t r a t e g ie s O b s e rv e d (P P M D ). case of

th e

N a t io n a l T B

in c lu d e and

v a c c in a t io n , D ir e c t ly M ix D O TS

T re a tm e n t S h o rt-c o u rs e and rate P P M D and 85% w e re c ure

P u b lic - P r iv a t e s u r p a s s in g t h is

D O TS

s u c c e s s f u l in ra te . To

th e ta rg e ts o f 7 0 % engagem ent

d e t e c t io n

s u s t a in

s u c c e s s,

o th e r

s t a k e h o ld e r s ,

in c r e a s e d s id e are

g o v e r n m e n t f u n d in g

o f T B p ro g ra m s a n d

im p r o v e m e n t o f t h e d e m a n d

r e c o m m e n d e d . T B c a u s e s g r e a t b u r d e n , b o t h in t e r m s o f d is e a s e a n d e c o n o m ic c o s t . It c a u s e s s ig n if ic a n t p r e m a t u r e m o r t a lit y w h ic h t r a n s la t e s in t o h u g e a n n u a l lo s s e s in fo re g o n e in c o m e . L ik e w is e , it causes s ig n if ic a n t annual lo s s e s of

d is a b i lit y a d ju s t e d lif e y e a r s a n d w a g e s . F o r t h e s e r e a s o n s , T B is c o n s id e r e d t o h a v e s ig n if ic a n t p o p u la t io n h e a lt h im p a c t in t h e P h ilip p in e s .

L is t o f a c ro n y m s u s e d in th is re p o rt

B C G C D R D A LY s D O H D O TS E P I F H S IS H IV N TP N TP S N E C P h ilC A T P h ilH e a lth P P M D P hP P TB P Y LL S S + TB W H O

B a c ille C a lm e t t e - G u r in C a s e D e t e c t io n R a t e D is a b ilit y A d ju s t e d L if e Y e a r s D e p a r t m e n t o f H e a lt h D ir e c t ly O b s e r v e d T r e a t m e n t S h o r t - c o u r s e E x p a n d e d P r o g r a m o n I m m u n iz a t io n F ie ld H e a lt h S e r v ic e I n f o r m a t io n S y s t e m H u m a n I m m u n o d e f ic ie n c y V ir u s N a t io n a l T u b e r c u lo s is P r o g r a m N a t io n a l T u b e r c u lo s is P r e v a le n c e S u r v e y N a t io n a l E p id e m io lo g y C e n t r e P h ilip p in e P h ilip p in e C o a lit io n A g a in s t T u b e r c u lo s is

H e a lt h I n s u r a n c e C o r p o r a t io n

P u b lic - P r iv a t e M ix D O T S P h ilip p in e P eso

P u lm o n a r y T u b e r c u lo s is P e r s o n - y e a r s o f L if e L o s t o r P o t e n t ia l Y e a r s o f L i f e L o s t S p u t u m s m e a r - p o s it iv e T u b e r c u lo s is W o r ld H e a lt h O r g a n iz a t io n

T a b le o f C o n te n ts

A b s tra c t

L is t o f a c r o n y m s

I n t r o d u c t io n

E p id e m io lo g y

C a u s a t iv e a g e n t a n d m o d e o f t r a n s m is s io n R is k f a c t o r s D is t r ib u t io n o f t u b e r c u lo s is in t h e P h ilip p in e s

5 6 7

P r e v e n t io n

C u r r e n t T B c o n t r o l s t r a t e g ie s in t h e P h ilip p in e s

B a c ille C a lm e t t e - G u r in ( B C G ) v a c c in a t io n D ir e c t ly O b s e r v e d T r e a t m e n t S h o r t - c o u r s e ( D O T S ) P u b lic - P r iv a t e M ix D O T S ( P P M D )

9 9 9

R e c o m m e n d a t io n s

10

E n g a g e m e n t o f o t h e r s t a k e h o ld e r s S u s t a in e d p o lit ic a l c o m m it m e n t I m p r o v in g t h e d e m a n d s id e

10 10 10

C o n c lu s io n

11

R e f e r e n c e lis t

12

E r r o l C ia n o

A s s ig n m e n t 2 - P H C M 9 0 4 1 , d u e 1 6 A p r il 2 0 0 7

P age 3 of 12

A re p o rt o n th e p o p u la tio n h e a lth im p a c t o f tu b e rc u lo s is in th e P h ilip p in e s

E r r o l C ia n o

In tro d u c tio n

T u b e r c u lo s is ( T B ) is a m a jo r h e a lt h p r o b le m o f H e a lt h (D O H ) a d d re s s e s TB th ro u g h it s

in t h e P h ilip p in e s . T h e D e p a r t m e n t N a t io n a l T B P ro g ra m (N T P ) (D O H

2 0 0 7 a ) . T h is r e p o r t e x a m in e s t h e im p a c t o f T B F ir s t , th e e p id e m io lo g y s t r a t e g ie s fo r of and p r e v e n t iv e th e TB N TP

o n p u b lic h e a lt h in s a id c o u n t r y . fo r TB , and c u rre n t TB

m e a s u re s a re

c o n tro l

under

d is c u s s e d . th e as N T P one

S u b s e q u e n t ly , a re a p ro p o s e d . s ig n if ic a n t

r e c o m m e n d a t io n s F in a l ly , th e

im p r o v in g fo r

c o n tro l t h is

under

r a t io n a le

c o n s id e r in g

c o n d it io n

w it h

p o p u la t io n h e a lt h im p a c t is p r e s e n t e d .

E p id e m io lo g y

C a u s a tiv e a g e n t a n d m o d e o f tra n s m is s io n

TB

is a c o m m u n ic a b le

d is e a s e

caused

by a

b a c t e r iu m . T h e

c a u s a t iv e

b a c illu s ,

M y c o b a c t e r iu m & O B r ie n

t u b e r c u lo s is , a ff e c t s t h e lu n g s in t w o - t h ir d s o f c a s e s ( R a v ig lio n e in p u lm o n a r y TB (P T B ). T B d is e a s e of o th e r b o d y

2 0 0 5 ) r e s u lt in g

o r g a n s is c a lle d e x t r a - p u lm o n a r y t u b e r c u lo s is ( D O H 2 0 0 7 a ) .

T B is s p r e a d t h r o u g h d ir e c t p e r s o n - t o - p e r s o n t r a n s m is s io n . A m o n g T B p a t ie n t s , s p u tu m s m e a r - p o s it iv e a re th e (S S + ) cases or th o s e w hose p h le g m & c o n t a in M .

t u b e r c u lo s is C lo s e w hen (D O H

m o s t in f e c t io u s TB in f e c t io n coughs,

(D O H

2 0 0 3 ; R a v ig lio n e in

O B r ie n in t o

2005). th e or a ir

c o n ta c ts an

a c q u ir e

b y b r e a t h in g sneezes, & th e O B r ie n

b a c ill i e x p e lle d s p e a k s,

in f e c t io u s

p a t ie n t

s h o uts ,

s in g s

s p it s n ot TB

2003; D O H by th e

2 0 0 7 a ; R a v ig l io n e im m u n e s ig n s s y ste m , and

2 0 0 5 ) . If th e c o n ta c t (D O H

b a c t e r ia

a re

c o n t a in e d d is e a s e ,

in f e c t e d of TB

w o u ld

d e v e lo p The

e x h ib it in g

s y m p to m s

2 0 0 3 ). to

lit e r a t u r e o n w a rd

in d ic a t e s t h a t t h e

p r o b a b ilit y o f p r o g r e s s io n

fro m

e x p o s u re

in f e c t io n

t o T B d is e a s e is d e t e r m in e d b y r is k f a c t o r s .

E r r o l C ia n o

A s s ig n m e n t 2 - P H C M 9 0 4 1 , d u e 1 6 A p r il 2 0 0 7

P age 4 of 12

R is k fa c to rs

T h e r is k f a c t o r s c a n b e c la s s if ie d in v a r io u s w a y s . F o r e x a m p le , R a v ig lio n e a n d O B r ie n ( 2 0 0 5 ) g r o u p e d t h e m in t o t h o s e w h ic h in c r e a s e t h e r is k o f T B i n f e c t io n

a n d t h o s e w h ic h in c r e a s e t h e r is k o f T B ( 2 0 0 5 ) c la s s if ie d th e s e f a c t o r s r e la t iv e

d is e a s e . F u r t h e r m o r e , G r e e n b e r g e t a l e n v ir o n m e n t , in f e c t io u s in d iv id u a l

to th e

a n d in f e c t e d c o n t a c t . S o m e r is k f a c t o r s a r e lis t e d in T a b le 1 .

T a b le 1 . S u m m a r y o f r is k f a c t o r s f o r T B In c re a s e ris k o f T B in fe c tio n fo llo w in g e x p o s u re to in fe c tio u s in d iv id u a ls E n v ir o n m e n t a l f a c t o r s w h ic h in c r e a s e b a c t e r ia l c o n c e n t r a t io n in t h e a ir p r o m o t e c lo s e c o n t a c t b e t w e e n in f e c t io u s a n d s u s c e p t ib le in d iv id u a ls F e a t u r e s o f in f e c t io u s in d iv id u a l s in c r e a s e t h e a m o u n t o f b a c t e r ia r e le a s e d in t o t h e a ir

2 2 1

C r o w d e d , e n c lo s e d f a c ilit ie s P o o r v e n t ila t io n
1

and

th a t

S S + ; c a v it a r y P T B o r r e s p ir a t o r y tra c t T B
3

A c t iv it ie s w h ic h p r o p e l t h e b a c t e r ia in t o t h e a ir , e s p e c ia lly w it h m o u t h n o t c o v e re d
2 3

In c re a s e ris k o f d e v e lo p in g T B

d is e a s e fo llo w in g in fe c tio n

D is e a s e c o n d it io n s a n d o t h e r f a c t o r s w h ic h w e a k e n t h e im m u n it y o f t h e in f e c t e d c o n ta c t
4

O t h e r d is e a s e s a n d t r e a t m e n t p ro c e d u re s

H u m a n I m m u n o d e f ic ie n c y V ir u s ( H I V ) , m a ln u t r it io n ; c a n c e r ; s ilic o s is , d ia b e t e s m e llit u s , c h r o n ic r e n a l f a ilu r e ; im m u n o s u p p r e s s iv e t h e r a p y

6 1 4 5

B e h a v io u r a l f a c t o r s

U s e o f in je c t a b le d r u g s , d r u g a b u s e a lc o h o l a b u s e
2

A d v a n c in g a g e
S o u rc e s :
1

G r e e n b e r g e t a l 2 0 0 5 ; R a v ig lio n e & O B r ie n 2 0 0 5 G re e n b e rg e t a l 2 0 0 5 D O H 2003; D O H 2005 2 0 0 7 a ; G r e e n b e r g e t a l 2 0 0 5 ; R a v ig lio n e & O B r ie n

D O H D O H D O H

2 0 0 3 ; G r e e n b e r g e t a l 2 0 0 5 ; R a v ig lio n e & O B r ie n 2 0 0 5 2 0 0 3 ; G re e n b e rg e t a l 2 0 0 5 2 0 0 3 ; R a v ig lio n e & O B r ie n 2 0 0 5

A s s ig n m e n t 2 - P H C M 9 0 4 1 , d u e 1 6 A p r il 2 0 0 7 P age 5 of 12

E r r o l C ia n o

D is trib u tio n o f T B in th e P h ilip p in e s

A s o f t h is w r it in g , o n ly t w o

N a t io n a l T B

P r e v a le n c e

S u rv e y s (N T P S ) h a d

been

c o n d u c t e d in t h e P h ilip p in e s . A c o m p a r is o n o f t h e r e s u lt s o f t h e 1997 s u rv e y s ( T a b le 2) d e m o n s trate s an in s ig n if ic a n t

1 9 8 1 -1 9 8 3 a n d of th e P TB

d e c lin e

p r o b le m p . 1 7 3 ).

w it h in t h e in t e r v e n in g 1 5 - y e a r p e r io d ( T u p a s i e t a l 1 9 9 9 ; M a n t a la 2 0 0 3 ,

T a b le 2 . C o m p a r is o n b e t w e e n 1 9 8 1 - 1 9 8 3 a n d 1 9 9 7 N T P S

P r e v a le n c e r a t e s ( / 1 0 0 0 ) 1 9 8 1 -1 9 8 3 S S + P TB S p u t u m c u lt u r e - p o s it iv e P T B C h e s t X - r a y - p o s it iv e P T B
S o u rc e : T u p a s i e t a l 1 9 9 9 ; M a n ta la 2 0 0 3 , p . 1 7 3 .

1997 3 .1 8 .1 42

6 .6 8 .6 42

TB

c o n t r ib u t e s TB

s ig n if ic a n t ly has

to

P h ili p p in e ra n k e d

m o r b id it y s ix t h

and

m o r t a lit y . T o caus es

illu s t r a t e , o f illn e s s

r e s p ir a t o r y fro m

c o n s is t e n t ly

am ong

le a d in g

2 0 0 0 to 2 0 0 4 (D O H

2007b; N E C

2 0 0 4 , p . 2 ) . S im ila r ly , T B

( a ll f o r m s ) w a s

s ix t h a m o n g le a d in g c a u s e s o f d e a t h s a m o n g F il ip in o s f r o m

1 9 9 9 to 2 0 0 3 (D O H

2 0 0 7 c ) . T h e N a t io n a l E p id e m io lo g y C e n t r e ( N E C ) e s t im a t e s t h e 2 0 0 4 m o r b id it y r a t e s o f r e s p ir a t o r y T B a n d a ll T B c a s e s a t 1 2 9 . 1 / 1 0 0 , 0 0 0 ( N E C 1 5 2 .1 /1 0 0 ,0 0 0 (N E C 2 0 0 4 , p . 1 3 9 ) , r e s p e c t iv e ly . O n t h e 2 0 0 4 , p. 2 ) a n d D O H

o th e r h a n d , th e

( 2 0 0 7 c ) c it e s t h a t T B ( a ll f o r m s ) a c c o u n t e d f o r 6 . 8 % 2 0 0 3 , w it h a m o r t a lit y r a t e o f 3 3 / 1 0 0 , 0 0 0 .

o f d e ath s from

a ll c a u s e s in

The

2007

G lo b a l T B of a ll and

C o n tro l R e p o rt (W H O S S + TB cases in fo r th e

2 0 0 7 , p . 1 2 9 ) e s t im a t e s P h ilip p in e s it at

th e

2005 and T B

in c id e n c e

2 9 1 /1 0 0 ,0 0 0 th e P h ilip p in e

1 3 1 /1 0 0 ,0 0 0 ,

r e s p e c t iv e ly .

L ik e w is e ,

2005,

e s t im a t e s

p r e v a le n c e a n d m o r t a lit y r a t e s a t 4 5 0 / 1 0 0 , 0 0 0 a n d 4 7 / 1 0 0 , 0 0 0 , r e s p e c t iv e ly .

P r e v a le n c e

s u rv e y s

and

o th e r

s o u rc e s

suggest

g re a ter

TB

b u rd e n

am ong

c e r t a in g r o u p s . F o r e x a m p le , t h e t w o N T P S in d ic a t e t h a t m o r e t h a n h a lf o f P T B
E r r o l C ia n o A s s ig n m e n t 2 - P H C M 9 0 4 1 , d u e 1 6 A p r il 2 0 0 7 P age 6 of 12

c a s e s a f f e c t t h e 3 0 - 5 9 - y e a r - o ld g r o u p ( T u p a s i e t a l 1 9 9 9 , p . 4 7 4 ) , c o n s id e r e d t o b e t h e e c o n o m ic a lly p r o d u c t iv e a g e b r a c k e t in t h e P h il ip p in e s ( D O H 2 0 0 5 , p . 1 ) . M o re o v e r, th e 1997 N TP S and F ie ld H e a lt h S e r v ic e s I n f o r m a t io n S y s te m

( F H S I S ) A n n u a l R e p o r t 2 0 0 4 b o t h s h o w t h a t T B is m o r e c o m m o n in m a le s t h a n f e m a le s (2 0 0 3 , (T u p a s i e t p. 16) al 1999, th a t th e p. 475 ; N E C t h e 2 0 0 4 ). of A d d it io n a l ly , d is e a s e of th e fro m p o o r, P eabody et al

s ta te s a ffe c ts

b u rd e n

t u b e r c u lo s is e ld e r ly and

d is p r o p o r t io n a t e ly

s e le c t e d

p o p u la t io n s

m a le . F in a lly , M a n t a la ( 2 0 0 3 , p . 1 7 3 ) r e p o r t s a t r ip lin g o f T B u r b a n p o o r v is - - v is t h e r e s t o f t h e p o p u la t io n .

b u rd e n a m o n g th e

P re v e n tio n

R e le v a n t lit e r a t u r e s u g g e s t s m e a s u r e s t h a t a r e e s s e n t ia l f o r T B p r e v e n t io n . T h e m e a s u re s d is c u s s e d h e r e r e la t e t o p r im a r y a n d s e c o n d a r y le v e ls o f p r e v e n t io n

( L a w s o n a n d B a u m a n 2 0 0 1 ; L in e t a l 2 0 0 7 , p . 1 0 2 ) . E a r ly d ia g n o s is o f t h e m o s t in f e c t io u s a c h ie v e cases c u re & is f o llo w e d h ig h ly by i n s t it u t io n o f a p p r o p r ia t e (D O H 2003; a n ti-T B d ru g et th e ra p y to al 2005;

re c o m m e n d e d

G re e n b e rg a im s t o

R a v ig lio n e

O B r ie n

2 0 0 5 ) . T h is s e c o n d a r y p r e v e n t io n from

r a p id ly r e n d e r

t h e s e c a s e s n o n - c o n t a g io u s , p r e v e n t in g t h e m D O H it is 2 0 0 7 a ) . T h u s , w h ile s u c h p r e v e n t io n p r im a r y p r e v e n t io n for th e

in f e c t in g o t h e r s ( D O H 2 0 0 3 ;

is s e c o n d a r y f o r t h e in f e c t io u s c a s e , c o n t a c t. (B C G ) F u rt h e r m o r e , m ay (D O H p r im a r y p ro te ct 2003; fa c tors

s u s c e p t ib le

p r e v e n t io n in f a n t s and

th ro u g h young &

B a c ille c h ild r e n

C a lm e t t e - G u r in fro m m o re

v a c c in a t io n TB d is e a s e

d a n g e ro u s m e a s u re s

R a v ig lio n e

O B r ie n

2 0 0 5 ) . L ik e w is e ,

d ir e c t e d

a g a in s t r is k

a ls o f a ll u n d e r p r im a r y p r e v e n t io n ( L a w s o n & 1 0 1 ) . B a s in g f r o m w it h in f e c t io u s

B a u m a n 2 0 0 1 , p . 5 6 ; L in e t a l, p .

T a b le 1 , t h e s e m a y in c lu d e a v o id in g p r o lo n g e d c lo s e c o n t a c t and o t h e r b e h a v io u r a l r is k s , in f e c t io u s p a t ie n t s c o v e r in g

cases

t h e ir m o u t h s w h e n c o u g h in g a n d b e t t e r n u t r it io n .

C u rre n t T B c o n tro l s tra te g ie s in th e P h ilip p in e s

A s

p r e v io u s ly

m e n t io n e d ,

th e

P h il ip p in e N TP S S + 9 ).

g o v e rn m e n t

re s p o n d s case ra te on

to

th e

TB rate such

p r o b le m (C D R )

th ro u g h th e N T P . T h e am ong cases e s t im a t e d (D O H new

h a s tw o ta rg ets : cases The and 85%

70% c u re

d e t e c t io n am o n g

d e te c te d
E r r o l C ia n o

2005, p.

E xpanded

P ro g ra m

I m m u n iz a t io n
P age 7 of 12

A s s ig n m e n t 2 - P H C M 9 0 4 1 , d u e 1 6 A p r il 2 0 0 7

( E P I ) , e s t a b lis h e d in 1 9 7 6 ( D O H am ong in f a n t s th ro u g h B C G

2 0 0 5 , p . 3 ) , im p le m e n t s p r im a r y T B p r e v e n t io n v a c c in a tio n . Tw o m o re re c e n t TB c o n tro l

in it ia t iv e s o f t h e N T P

a r e d e s c r ib e d b e lo w .

D ire c tly O b s e rv e d T re a tm e n t S h o rt -c o u rs e (D O T S )

T h e D O T S s t r a t e g y is o n e o f t h e s u c c e s s f u l c o n t r o l m e a s u r e s b e in g p u r s u e d b y th e N TP . It w as a d o p te d in 1996 ( M a n t a la 2003, p. 173) and has a c h ie v e d & P h il C A T d ru gof

a lm o s t f u ll p u b lic s e c t o r p a r t ic ip a t io n 2004 t a k in g

in 2 0 0 3 ( D O H s p u tu m and

200 5 p. 6 ; D O H

p . 1 ) . It in c lu d e s d ia g n o s is t h r o u g h to e n s u re and t r e a tm e n t

m ic r o s c o p y , s u p e r v is e d sta n d a rd th e s e

c o m p le t io n

d o c u m e n t a t io n a re

d ia g n o s t ic

tre a tm e n t

r e s u lt s .

U n d e r p in n in g

a c t iv it ie s

lo g is t ic s

m a n a g e m e n t t o e n s u r e t h a t a n t i - T B d r u g s a n d o t h e r D O T S s u p p lie s a r e a lw a y s a v a ila b le w h e r e a n d w h e n n e e d e d , a n d s u s t a in e d g o v e r n m e n t s u p p o r t in t e r m s o f p o lic y a n d f u n d in g (D O H 2005; D O H and P h i lC A T 2 0 0 4 ) . W it h D O T S , c u re

r a t e s r e m a in e d a b o v e - t a r g e t s in c e 1 9 9 9 ; h o w e v e r , C D R at 68% in 2 0 0 3 ( W H O 2 0 0 7 , p . 1 2 9 ) .

r e m a in e d b e lo w - t a r g e t

P u b lic -P riv a te M ix D O T S (P P M D )

A d o p t e d in 2 0 0 3 , t h is s t r a t e g y e x t e n d s t h e s c o p e o f D O T S t o t h e p r iv a t e s e c t o r . I t a im s (D O H to im p r o v e C D R and to h a r m o n iz e m anagem ent am ong a ll p r o v id e r s

a n d P h ilC A T 2 0 0 4 , p . 2 ) . T h e p r e v io u s ly d e s c r ib e d r e s u lt s o f in it ia l D O T S

im p le m e n t a t io n a n d t h e f in d in g s o f lo c a l s t u d ie s o n p r iv a t e d o c t o r s u n d e r s c o r e d th e need fo r P P M D . These f in d in g s in c lu d e s ig n if ic a n t TB c a s e lo a d , non-

n o t if ic a t io n o f c a s e s , D O T S - in c o n s is t e n t m a n a g e m e n t p r a c t ic e s a n d p o o r o r n o k n o w le d g e 2 0 0 3 ). The about D O TS s u p p o rt of (T u p a s i e t a l 2 0 0 0 ; A u e r e t a l 2 0 0 0 ; P o rte ro th e has u m b r e lla f a c ilit a t e d o r g a n iz a t io n p r iv a t e C D R P h i lip p in e C o a l it io n & R u b io

A g a in s t 2005, th e

T u b e r c u lo s is p. 7 ). W it h

( P h il C A T ) P P M D

s e c to r e n g a g e m e n t (D O H and c u re rate s

im p le m e n t a t io n ,

b o th

s u rp a s s e d

t a r g e t s in 2 0 0 4 ( W H O 2 0 0 7 , p . 1 2 9 ) .

E r r o l C ia n o

A s s ig n m e n t 2 - P H C M 9 0 4 1 , d u e 1 6 A p r il 2 0 0 7

P age 8 of 12

R e c o m m e n d a tio n s

The

success of D O TS th e scope

and o f th e

P P M D

s t r a t e g ie s

n e e d s to a re

be

s u s t a in e d

b y fu rth e r to a c h ie v e

e x p a n d in g

N TP . The

f o llo w in g

re c o m m e n d e d

a n d m a in t a in s u c h e x p a n s io n :

E n g a g e m e n t o f o th e r s ta k e h o ld e rs

W h ile need c a re

m a in t a in in g to be

and

e x p a n d in g as w e ll.

p r iv a t e

s e c to r th e

in v o lv e m e n t , academ e o f th e and N TP

o th e r p u b lic

s e c tors h e a lt h 2007,

m o b iliz e d

These

in c lu d e th e

p r o v id e r s in c lu d in g

h o s p it a ls

o u t s id e

d o m a in

(W H O

p . 1 3 1 ) a n d p r o f e s s io n a l m e d ic a l o r g a n iz a t io n s ( Y u & D a n t e s 2 0 0 6 ) .

S u s ta in e d p o litic a l c o m m itm e n t

O ne

of

th e

key

D O TS

e le m e n t s ,

t h is

r e q u ir e s

m in im iz in g

r e lia n c e

on

in t e r n a t io n a l s o u r c e s b y i n c r e a s in g d o m e s t ic f u n d in g ( W H O p . 1 3 2 ) r e p o rt s t h a t t h e N TP b u d g e ts fo r 2 0 0 2 -2 0 0 7 had

2 0 0 6 ). W H O e it h e r b e e n

(2 0 0 7 ,

n o t f u lly

f u n d e d o r h a d r e lie d o n lo a n s a n d g r a n t s t o f ill t h e g a p s . T o s u s t a in D O T S , t h e n a t io n a l and lo c a l g o v e rn m e n ts s h o u ld a f f ir m t h e ir c o m m itm e n t th ro u g h

in c r e a s e d f u n d a llo c a t io n t o T B c o n t r o l .

I m p r o v i n g t h e d e m a n d s i d e ( M a n t a la 2 0 0 3 , p . 1 7 5 )

P u b lic - p r iv a t e c o l la b o r a t io n c a n l ik e w is e b e a p p l ie d t o a w a r e n e s s a n d e d u c a t io n c a m p a ig n s p u b lic r e la t iv e to TB . S uch in it ia t iv e s b oth s h o u ld p re and e m p h a s iz e on in f o r m in g to th e

about

p r e v e n t iv e

m e a s u re s ,

p o s t- e x p o s u r e

in f e c t io u s

c a s e s , a n d o n a p p r o p r ia t e a c t io n t o b e t a k e n o n c e e x p o s e d in d iv id u a ls b e c o m e s y m p t o m a t ic of TB . These a re n e c e s s a ry to im p r o v e TB u t iliz a t io n case of D O TS o n ly

s e r v ic e s . F u r t h e r m o r e , t h e

D O TS

s t r a t e g y e m p h a s iz e s

d e t e c t io n

a m o n g s y m p t o m a t ic p a t ie n t s w h o s e lf - p r e s e n t a t D O T S f a c ilit ie s ( D O H x ). H o w e v e r, in t h is to s h o u ld not p r e c lu d e on t r a c in g of c lo s e to ta k e c o n ta c ts s h o u ld of th e y

2 0 0 5 , p. in f e c t io u s becom e c o u ld

cases

o rd e r

e d u c a te

th e m

w hat

s te p s and

s y m p t o m a t ic

t h e m s e lv e s .

P a t ie n t s r e la t iv e s

c o m m u n it y

v o lu n t e e r s

p la y a r o le h e r e .
E r r o l C ia n o A s s ig n m e n t 2 - P H C M 9 0 4 1 , d u e 1 6 A p r il 2 0 0 7 P age 9 of 12

C o n c lu s io n

T h e re

a re tw o

p r im a r y r e a s o n s f o r t h e

c h o ic e

o f T B a s a s ig n if ic a n t p o p u la t io n

h e a lt h p r o b le m h in t e d b u rd e n a t in t h e is

in t h e P h ilip p in e s . F ir s t is t h e la r g e b u r d e n o f T B w h ic h h a s b e e n E p id e m io lo g y in s e c t io n of of o f t h is r e p o r t . M o r e m e a n in g f u lly , t h e a d ju s t e d (P Y L L ). lif e y e a rs is (D A L Y s ) TB and of

m e a su re d or

te rm s y e a rs

d is a b ilit y lif e lo s t

p e rs o n -y e a rs

p o t e n t ia l

D A LY

t h e

num ber

d is a b i lit y - f r e e y e a r s o f lif e t h a t m ig h t b e lo s t a s a r e s u lt o f p r e m a t u r e d e a t h a n d d is a b i lit y d u e to a d is e a s e in a p a r t ic u la r y e a r ( L in e t a l 2 0 0 7 , p . 6 6 ). O n th e

o t h e r h a n d , P Y L L is t h e n u m b e r o f y e a r s o f lif e lo s t d u e t o p r e m a t u r e m o r t a lit y ( L a w s o n & B a u m a n 2 0 0 1 , p . 2 1 ) . P e a b o d y e t a l ( 2 0 0 3 , p . 8 ) , u s in g 1 9 9 7 N T P S d a t a , e s t im a t e s t h e s ig n if ic a n t a n n u a l lo s s o f a t le a s t 5 1 4 , 3 0 0 D A L Y s d u e t o T B , 6 9 .0 0 % TB o f w h ic h b e in g d u e t o p r e m a t u r e m o r t a lit y . M o r e o v e r , t h e P Y L L of to ta l P Y L L These tw o am ong F ilip in o s 1 0 c le a r ly y e a rs a n d th e d u e to o ld e r g re a t

a c c o u n t s f o r a t le a s t 9 % et a l (2 0 0 3 , p. 2 ).

P eabody

m e a s u re s

il lu s t r a t e

im p a c t o f T B o n t h e P h ilip p in e

p o p u la t io n .

A ls o

n o t a b le

is

th e

g re a t

e c o n o m ic

cost

of

TB age

d is e a s e . b ra c k e t

The has

g re a te r been

TB

p r e v a le n c e

am ong

th e

e c o n o m ic a l ly

p r o d u c t iv e

n o te d y e a r ly in lo s t

e a r lie r . F u r t h e r m o r e , P e a b o d y e c o n o m ic w ages These am ount lo s s due to TB : b il lio n w ay

e t a l (2 0 0 3 , p . 1 3 ) n o te s th e 7 .9 b illi o n P h i lip p in e due to

a s t o u n d in g (P h P )

a ro u n d in

pesos

and

P h P 2 6 .4 a re

fo re g o n e h ig h e r fo r

in c o m e th a n th e th e

p re m a tu re

m o r t a lit y . annual of a ll

a m o u n ts of

m uch

m a x im u m and

e s t im a t e d tre a tm e n t

P hP 500

m illio n

ne eded

d ia g n o s is

u n tre a te d T B c a s e s (P e a b o d y e t a l 2 0 0 3 , p . 4 ).

H e n c e , it c a n b e d e d u c e d t h a t s u c c e s s f u l T B p r e v e n t io n a n d c u r e t h r o u g h in it ia t iv e s w o u ld t r a n s la t e in t o s ig n if ic a n t s a v in g s in hum an liv e s and

N TP

m o n e y.

T h e h e a lt h a n d e c o n o m ic b e n e f it s o f e f f e c t iv e T B c o n t r o l o n t h e d e p e n d e n t s o f e c o n o m ic a l ly p r o d u c t iv e in d iv id u a ls a r e lik e w is e w o r t h m e n t io n in g . I n t h e lig h t o f t h e f o r e g o in g , it is c o n c lu d e d t h a t in d e e d im p a c t in t h e P h ilip p in e s . TB h a s a s ig n if ic a n t p o p u la t io n h e a lt h

E r r o l C ia n o

A s s ig n m e n t 2 - P H C M 9 0 4 1 , d u e 1 6 A p r il 2 0 0 7

P age 10 of 12

R E FE R E N C E

L IS T

A u e r , C , S a r o l, J

J r,

T a n n e r, M

&

W e is s , M

2000 ,

H e a lth

s e e k in g

an d

p e r c e iv e d

c a u s e s o f tu b e r c u lo s is a m o n g p a tie n ts in M a n ila , P h ilip p in e s , T r o p i c a l M e d ic in e a n d In te r n a tio n a l H e a lth , v o l. 5 , n o . 9 , p p . 6 4 8 - 6 5 6 . D O H 2 003, C om m on illn e s s e s : v ie w e d T u b e r c u lo s is , 24 D e p a rtm e n t of H e a lt h P h ili p p in e s , 2007,

M a n ila ,

M arch

< h ttp ://w w w .d o h .g o v .p h /c o m m o n _ d is e a s e /tu b e r c u lo s i s .h tm > . D O H 2 0 0 5 , M a n u a l o f p ro c e d u re s fo r th e N a tio n a l T u b e r c u lo s i s C o n tr o l P r o g r a m , 4 th

e d n , D e p a r tm e n t o f H e a lth P h ilip p in e s , M a n ila . D O H 2 0 0 7 a , T B v s . N T P - D .O . T .S . , D e p a r tm e n t o f H e a lth P h ilip p i n e s , M a n i la , v ie w e d 2 4 M a rc h 2 0 0 7 , < h ttp ://w w w .d o h .g o v .p h /tb n e tw o rk /T B v s N T P .h tm > . D O H 2 0 0 7 b , H e a l th s ta ti s tic s : M o r b id ity , D e p a r tm e n t o f H e a lth P h ilip p in e s , M a n ila ,

v ie w e d 2 4 M a r c h 2 0 0 7 , < h ttp ://w w w .d o h .g o v .p h /d a ta _ s ta t/h tm l/m o r b id .h t m > . D O H 2 0 0 7 c , H e a lth s ta tis tic s : M o r t a lity , D e p a r tm e n t o f H e a lth P h ilip p in e s , M a n ila ,

v ie w e d 2 4 M a r c h 2 0 0 7 , < h ttp ://w w w .d o h .g o v .p h /d a ta _ s ta t/h tm l/m o r ta lity .h tm > . D O H & P h ilC A T 2004, O p e r a tio n a l g u id e li n e s fo r P r iv a te - P u b lic & P h ilip p in e M ix D O TS in th e

P h ilip p in e s , D e p a r t m e n t o f H e a lth T u b e r c u lo s is , M a n ila . G re e n b e r g , R S , D a n ie ls , S of R , F la n d e r s in

P h ilip p in e s

C o a liti o n

A g a in s t

D ,

E le y , J

&

B o r in g 4 th edn 8

III, J

2005, The 2007,

P a tte r n s

o c c u rre n c e C o m p a n ie s ,

M e d ic a l In c .,

E p id e m io lo g y , ch. 3,

( o n lin e ) , A p r il

M c G r a w - H ill

U S A ,

v ie w e d

< h ttp ://w w w . a c c e s s m e d ic i n e .c o m .w w w p r o x y 0 . n u n .u n s w .e d u .a u /c o n te n t.a s p x ? a ID = 5 4 5 2 1 4 > . Law son, J S & B a um an, A E 2 0 0 1 , P u b lic h e a lth A u s tr a lia : A n i n tr o d u c tio n , 2 n d e d n ,

M c G r a w - H ill B o o k C o m p a n y A u s tr a lia P ty L im ite d , R o s e v ille , N S W . L in , V , S m ith , J & F a w k e s , S 2 0 0 7 , P u b lic h e a lth p r a c tic e i n A u s tr a lia : e ffo r t , A lle n & U n w in , C r o w s N e s t, N S W . M a n ta la , M J 2 0 0 3 , P u b lic - p r iv a te m i x D O T S in th e P h ilip p in e s , T u b e r c u lo s is , v o l. 8 3 , T h e o r g a n iz e d

2 0 0 3 , p p . 1 7 3 -1 7 6 . N E C 2 0 0 4 , F i e ld h e a lth s e r v ic e s in f o r m a tio n s y s te m H e a lth P h ilip p in e s , M a n il a , pp. a n n u a l re p o rt 2 0 0 4 , D e p a rtm e n t o f v ie w e d 24 M a rc h 2007,

1 -6 4 ,

< w w w .d o h .g o v .p h /N E C /fh s is / c o m fh s is .p d f> . P eabody, J, T an, C and A R J r , L u c k J & L e y c o , E A 2 0 0 3 , M e a s u r in g th e b u r d e n o f d is e a s e conse quence s o f t u b e r c u lo s is fo r in th e th e P h ilip p in e s : F in a l r e p o r t ,

e c o n o m ic

P h ilip p in e

T u b e r c u lo s is

I n itia tiv e s

P r iv a te

S e c t o r /C h e m o n ic s

In te r n a tio n a l In c . , P a s ig C ity , P h ilip p in e s . P o rte ro , J L & R u b io , M 2 0 0 3 , P r i v a te w hen th e y p r a c titio n e r s and tu b e r c u lo s i s and c o n tr o l in th e

P h ilip p in e s :

s tra n g e r s

m e e t? , T r o p ic a l M e d ic in e

In te r n a tio n a l

H e a lth , v o l. 8 , n o . 4 , p p . 3 2 9 - 3 3 5 . R a v ig lio n e , M C & O B r ie n , R edn J 2 0 0 5 , T u b e r c u lo s is in H a r r is o n s P r in c i p le s o f I n te r n a l D L K a s p e r, E & K 150, J B r a u n w a ld , A The S F a u c i, S L

M e d ic in e , 1 6 th H a u s e r, D L

( o n lin e ) , e d s J L

Longo, In c .,

Jam eson ch.

Is s e l b a c h e r , v ie w e d 7

M c G r a w - H ill A p r il 2007,

C o m p a n ie s ,

U S A ,

< h ttp ://in fo .li b r a r y .u n s w .e d u .a u /c g i b in /lo c a l/ a c c e s s / a c c e s s . c g i? u r l= h ttp :// w w w .a c c e s s m e d ic in e . c o m /r e s o u r c e T O C . a s p x ? re s o u rc e ID = 4 > . T u p a s i, T E , R a d h a k r is h n a , S , R iv e r a , A B , P a s c u a l, M V illa , M C , L G , Q u e l a p io , M V , S a r o l, J N M th e J I D , C o, V M , J r., R e y e s , A T h e 1997 The

L A , B e ltr a n G , L e g a s p i, J D , M a n g u b a t, N A , S o lo n M , S o lo n , F S &

S a rm i e n to

M a n ta la , in

1999 ,

N a tio n w id e

T u b e r c u l o s is

P re v a le n c e

S u rv e y

P h ili p p in e s ,

In te r n a tio n a l J o u r n a l o f T u b e r c u lo s is a n d L u n g D is e a s e , v o l. 3 , n o . 6 , p p . 4 7 1 477. T u p a s i, T E , R a d h a k r is h n a , S , C o , V S a r o l, J S o lo n ,
E r r o l C ia n o

M , V illa , M L M

L A , Q u e l a p io , M

I D , M a n g u b a t, N

V ,

N , R iv e r a , A F S , B u rto n

B , P a s c u a l, M L & M a n t a la ,

G , R ey es, A J 2000,

C , S a r m ie n to d is e a s e

A , S o lo n M , and h e a lth

B a c ill a r y

A s s ig n m e n t 2 - P H C M 9 0 4 1 , d u e 1 6 A p r il 2 0 0 7

P age 11 of 12

s e e k in g b e h a v io r a m o n g F il ip in o s w i th s y m p to m s o f tu b e r c u l o s is :

im p li c a tio n s

fo r c o n tr o l, T h e In te r n a tio n a l J o u r n a l o f T u b e r c u lo s i s a n d L u n g D is e a s e , v o l. 4 , n o . 1 2 , p p . 1 1 2 6 -1 1 3 2 . W H O 2 0 0 6 , T h e fiv e e le m e n ts o f D O T S , W o r l d H e a lth O r g a n i z a tio n , G e n e v a , v ie w e d

1 3 A p r il 2 0 0 7 , < h ttp ://w w w .w h o .in t/tb /d o ts /w h a tis d o ts / e n /p r in t.h tm l> . W H O 2 0 0 7 , C o u n tr y p r o file : P h i li p p in e s , in W H O R e p o rt 2 0 0 7 : G lo b a l tu b e r c u lo s is

c o n tr o l s u r v e i lla n c e , p la n n in g , fi n a n c in g , W o r l d H e a lth O r g a n iz a t io n , G e n e v a , pp. 129-132, v ie w e d 23 M a rc h 2007,

< h ttp ://w w w .w h o .in t/e n tity /tb /p u b lic a tio n s /g lo b a l_ r e p o r t/2 0 0 7 /p d f/p h l.p d f > . Y u, C & D a n te s R B 2 0 0 6 , H e lp i n g a c h i e v e T B c o n tr o l w ith in o u r life ti m e , P h i lip p in e

J o u r n a l o f In te r n a l M e d ic in e , v o l. 4 4 , M a r c h - A p r il 2 0 0 6 , p p . III - V I.

W o rd c o u n t:

1 9 9 5 w o r d s ( e x c lu d in g A b s t r a c t , T a b le o f C o n t e n t s a n d R e f e r e n c e L is t )

E r r o l C ia n o

A s s ig n m e n t 2 - P H C M 9 0 4 1 , d u e 1 6 A p r il 2 0 0 7

P age 12 of 12