THE EFFECTIVENESS OF HEALTH EDUCATION ON SPUTUM SUBMISSION OF PTB SUSPECT PATIENTS TO UNDERGO DOTS IN BARANGAY GAULAN, DIPLAHAN, ZAMBOANGA

SIBUGAY PROVINCE CHAPTER 1 Introduction

A. Background of the Study In the Philippines, TB is the number six leading cause of death, with 73 Filipinos dying every day of TB. Many of these deaths can be prevented with early detection and treatment. They can be cured and the promotion to combat TB can be achieved. As the treatment takes a long period, patients who are within the barangay feels the pressures of poverty as seeking treatment entails a budget for travel expenses. Treatment for such cases is often interrupted and even when provided with anti-TB medications, the awareness of compliance is overlooked. Therefore, just providing anti-TB medication is not sufficient to ensure that patients are cured. Tuberculosis (TB) is an infection caused by bacteria that usually affect the lungs. These bacteria, called Mycobacterium tuberculosis it is spread from a TB patient to another person through the air when he/she coughs or sneezes. Even the accidental spread of saliva through laughing, singing, and spitting can pass on the TB bacteria. Symptoms include cough of more than two weeks duration, weight loss, fever, chest pain or hemoptysis. A TB patient may infect 10- 15 persons per year. It is usually an illness of adults but it can also affect children. TB is curable and preventable. A definite diagnosis of tuberculosis can be established only by isolation of Mycobacterium tuberculosis in culture. When infection of the lung is suspected, sputum is the initial specimen of choice. Sputum is the mucous or phlegm coughed up from your lungs. It is not saliva or mucous from the back of the throat. Sputum specimens are best if coughed up first thing in the morning, after you have been sleeping at night. You will normally be asked to produce one sputum sample each morning for three mornings in a row. You will have 3 jars/bags, 1 for each day. Before you do the test, gargle with water (not mouthwash) to rinse out your mouth. Do not eat, drink, smoke or brush your teeth before collecting the sputum. About a tablespoon of sputum is the amount that is needed. Specimens should be kept in the refrigerator (not freezer) until they are returned to the clinic/office. (Sputum Collection Instructions, BC Center for Disease Control) This research seeks to determine the effect of health education on the sputum submission of suspected PTB patients in Brgy Gaulan, Diplahan, ZSP.

B. Statement of the Problem

This research seeks to determine the effect of health education on the sputum submission of suspected PTB patients in Brgy Gaulan, Diplahan, ZSP. Specifically, this research seeks to answer whether there is a significant relationship between health education on sputum submission of said patients in Brgy Gaulan, Diplahan, ZSP.

C. Hypothesis

This study assumes that there is no significant relationship between health education on sputum submission of said patients in Brgy Gaulan, Diplahan, ZSP.

D. Conceptual Framework

E. Significance of the Study

The results of the research may be beneficial to the following: Department of Health - this study aims to provide information dissemination and increase awareness which may in return help in increase in sputum submission and thereby accurate diagnosis and cure. Health Providers - to gain increase awareness of PTB and DOTS. Residents of Brgy Gaulan to gain increase awareness of PTB and DOTS.

F. Objective
The objective of this research is to determine the effect health education on PTB Suspects knowledge on PTB and DOTS and increase their awareness in the importance and significance of sputum submission in Brgy Gaulan, Diplahan, ZSP.

G. Scope and Limitation of the Study

This study primarily focuses on health education of suspected PTB patients. The target respondents are adult residents, 18-50 y/o, who are PTB Suspects from different Puroks in Brgy Gaulan, Diplahan, ZSP.

H. Definition of Terms:
For better comprehension of the contents of this research, the terms used are defined operationally as: Health Education Lecture Seminar conducted. Sputum Submission - following the 3 consecutive scheduled days for sputum collection. PTB Suspect - patient presenting with more than 3 weeks duration, sputum production and weight loss which make the health worker, think the patient may have PTB.

CHAPTER 2 Review of Related Literature Tuberculosis profoundly affects human health, with 5.7 million new or recurrent cases reported and >1 million deaths attributed to the infection by the World Health Organization in 2010. Global expansion of the WHOrecommended Stop TB strategy marked significant achievements in tuberculosis (TB) control, with 46 million patients successfully treated and seven million lives saved between 1995 and 2010. (World Health Organization: Global tuberculosis control: WHO report 2011. Geneva: World Health Organization; 2011.) In addition, recent prevalence surveys have shown serious limitations of the current diagnostic approach. According to survey findings, approximately 40%60% of TB patients would be ruled out through initial symptom screening under the routine program setting. Similarly, smear microscopy can detect only a proportion (30% to 69%) of all confirmed cases. Yet, most developing countries still have to rely on sputum smear microscopy for symptomatic patients who present to health facilities. (Target prioritization and strategy selection for active casefinding of pulmonary tuberculosis: a tool to support country-level project planning, Nobuyuki Nishikiori, and Catharina Van Weezenbeek, World Health Organization, Regional Office for the Western Pacific, Manila, Philippines, BMC Public Health 2013, 13:97 ) Active case-finding (ACF) is a special effort of the health care system to detect TB patients among people who do not seek care for TB symptoms. In light of the limitations of the current case-finding approach and the global urgency to improve case detection, ACF has been suggested as an important complementary strategy to accelerate TB control (Target prioritization and strategy selection for active case-finding of pulmonary tuberculosis: a tool to support country-level project planning, Nobuyuki Nishikiori, and Catharina Van Weezenbeek, World Health Organization, Regional Office for the Western Pacific, Manila, Philippines, BMC Public Health 2013, 13:97 )

The planning and implementation of efficient tuberculosis control programs is crucial, and the strategies that compose them must be submitted to constant evaluation and refining. One of the main strategies for the early detection of pulmonary tuberculosis (PTB) is through the screening of individuals with symptoms compatible with PTB, known also as respiratory symptomatic patients (RS). Although this is programmatic strategy for active case finding, its yield is not well known. (Active Case Finding of Pulmonary Tuberculosis through Screening of Respiratory Symptomatics Using Sputum Microscopy: Is It Time to Change the Paradigm? , Tuberculosis Research and Treatment, Volume 2013 (2013)) In the diagnosis of tuberculosis, detection of acid fast bacilli (AFB) on microscopic examination of sputum smears remains the most widely used investigation in clinical practice, especially in developing countries and countries with high prevalence. (Washington JA. Microbiologic diagnosis of Lower Respiratory tract infections. In: Murray JF, Nadel JA, editors. Text book of Respiratory Medicine. 2nd ed. Philadelphia: WH Saunders; 1994. pp. 585600. / Enarson DA, Rieder HL, Arnadottir T, et al. Management of tuberculosis: A guide for law income countries. 5th ed. Paris: IUATLD; 2000.) As this also differentiates the infectious from the noninfectious cases, sputum smear microscopy represents one of the five pillars in the directly observed treatment short course (DOTS) strategy for tuberculosis control. (World Health Organization. Guidelines for national programmes. WHO/TB/97.220. Geneva: WHO; 1997.) Unfortunately, this has its pitfalls because the positivity depends on the number of bacilli, type of lesions, etc. Some studies have shown that the diagnostic yield increases with each specimen that is examined leading to the recommendation that serial sputum smear examination is better than single sample. WHO in its tuberculosis control program strategy recommends spot, morning, spot (SMS) sampling method. This study was undertaken to assess whether this is cost- beneficial or is there any incremental benefit by increasing the number of samples. (Sputum smear microscopy in DOTS: Are three samples necessary? An analysis and its implications in tuberculosis control, Sukhesh Rao, Department of Tuberculosis and Respiratory Diseases, Yenepoya Medical College, Deralakatte, Mangalore 575 018, Karnataka, India)