PREV MED – ADDITIONAL PREV MED INFO (from Lecture)

Hi!
Here’s a compilation of the additional info and figures from the Prev Med lecture
that can’t be found in the handout. Hope this helps J
- LMLobo, JRVerceles, MPValdez

[PRACTICE QUESTIONS] Principles of Epidemiology in PH:

https://stacks.cdc.gov/view/cdc/6914/cdc_6914_DS1.pdf
Medical Certification of Death:
https://www.doh.gov.ph/sites/default/files/publications/MEDICAL_CERTIFICATION_OF_DEATH_0.pdf
4x4 table: https://m.youtube.com/watch?feature=youtu.be&v=lyMvsbiXT1c
Genogram symbols:
https://www.genopro.com/genogram/Genogram-Basic-Symbols.pdf
DOH National Objectives for Health:
https://www.doh.gov.ph/sites/default/files/publications/NOH-2017-2022-030619-1.pdf
Antimicrobial Resistance Surveillance Program:
https://www.philhealth.gov.ph/circulars/2018/circ2018-0009.pdf
Various diseases:
https://drive.google.com/file/d/0B9UCjm6J8keSWElUcVQ1SGsxd00/view

LEVELS OF PREVENTION

Level of Prevention Keywords Stages of Disease

Primordial “General Risk”
Primary “Protection” Predisease Stage
Secondary “Early Detection” – Screening Latent Stage
Tertiary “Complications” Symptomatic Stage

REGISTRIES

Vital Events/Statistics:
1. Births
2. Deaths
3. Marriage
Health Statistics
1. Morbidity (causes and frequency of illness)
2. Hospital, Clinic statistics (number of admission and discharge and length of stay)
3. Service statistics (number of family planning acceptors by method, number of deep wells inspected, number of children
immunized)

SCHEMATIC DIAGRAM OF THE CONCEPTS OF STATISTICAL INFERENCE

 State of Reality
Ho true Ho false
Decision made based on Do not reject Ho Correct decision Error in Decision (Type II
sample data according to error)
rule Reject Ho Error in decision (Type I Correct decision
error)

2. LEVEL OF SIGNIFICANCE

P value:
- It is the probability of obtaining the result as extreme or more extreme than the one observed if the null hypothesis is
true
- The probability that the observed result is due to chance alone

Low P High P
p<a p>a
Value of sample results are far from the population Value of sample results are close to population parameters
parameters Likely events
Unlikely events
Reject Ho Do Not Reject Ho

3. CHOOSE THE TEST STATISTIC

Type of Data Statistical Test

Qualitative à Qualitative Chi square test
e.g. Sex and nutritional status
Qualitative à Quantitative T-test: < 30 population
e.g. Comparing intake of yakult with the number of stool Z test: > 30 population
frequency among gastroenteritis patients (positive intake of ANOVA: 3 ore more groups are being compared
yakult is the qualitative data, while the frequency of stools is
the quantitative data)
Quantitative à Qualitative Regression Analysis
e.g. Breastfeeding frequency compared to absence/presence
of certain disease
Quantitative à Quantitative Linear Regression Analysis
e.g. age and BP Correlation coefficient

QUALITATIVE QUANTITATIVE
QUALITATIVE

Logistic
Chi Square
Regression
QUANTITATIVE

ANOVA
Regression
Means/Medians Tests
PHILIPPINES POPULATION

Year Population
2019 108,106,310
2018 106,512,074
2017 104,918,090
2016 103,320,222

CLASSICAL vs CLINICAL EPIDEMIOLOGY

Classical
- Population oriented
- Studies the community origins of health problems
(infectious agents, nutrition, environment, behavior,
social, economic and spiritual)
- Interested in discovering risk factors that might be
altered in a population to prevent or delay disease,
injury and death
Clinical
- Study patients in health care settings rather than in
community at large
- Goal is to improve the prevention, early detection,
diagnosis, treatment, prognosis, and care of illness
in INDIVIDUAL PATIENTS who are at risk for, or
already affected by, specific disease

DESCRIPTIVE VARIABLES

PLACE
- Endemic: refers to the constant presence or usual prevalence of a disease or infectious agents in a given geographic
area
- Hyperendemic: refers to a constant presence of a very high incidence of disease/infection
- Pandemic: refers to widespread disease throughout a continent or across very large geographic areas or countries
affecting very large numbers of people
- Epidemic: refers to the occurrence of disease/infection within a community clearly in excess of what is to be normally
expected
FAMILY RELATIONSHIP AND INTERACTIONS

Family Social Class Pattern

Upper Class
Much more closely knit; greater
concern to maintain family name and
prestige
Middle Class
Believes in hard work, initiative,
independence, responsibility, economic
security and self-improvement through
education
Lower Class
Sees life as a continual struggle for
survival; resigned to a frustration and
defeat

Family Functions
Biologic Reproduction, child rearing, nutrition, health maintenance, recreation
Economic Provision of adequate financial resources, resources allocation, ensures financial security of
members
Educational Teach skills, attitudes relating to other functions
Psychological Promotes the natural development personalities, promotes ability to form relationship with
people in the family circle
Socio-cultural Socialization of children, promotion of status and legitimacy
SCREEM
Resources Pathology
Social Social interaction is evident among family The family is socially isolated from extra
members. familial groups
Cultural Cultural pride or satisfaction can be identified The family has feelings of cultural-ethnic
inferiority or shame
Religion Religion offers satisfying spiritual experiences Dogma and rituals are so rigid that they limit
the family’s problem solving capacity
Economic Ability to meet the economic demands of Financial problems make it difficult for the
normal life events and illness family to meet monetary demands of crisis of
illness
Education Education of the family members is adequate Limit the ability of family members to
to allow members to solve or comprehend comprehend the problem or recommended
most of the problems solution
Medical Medical care is available through channels that Inaccessible and under utilized
are easily established

FAMILY ACCESS TOOLS

VIII. Family Lifeline

- Used to show significant events among family members over a period of time in a chronological sequence
- For exploration of certain family issues

NEWBORN SCREENING: PROGRAM OBJECTIVE

By 2030, all Filipino newborns are screened; Strengthen Quality of service and intensify monitoring and evaluation of NBS
implementation; Sustainable financial scheme; Strengthen patient management

COLORECTAL CANCER

When to test before age 50?

People with increased or high risk
- Polyps or IBD
- Cancer removed by surgery
- Strong family history of colon CA
o Age 40, or 10 years before the youngest case in the immediate family, whichever is earlier
- Family history of a hereditary colorectal cancer syndrome

HEALTH PROMOTION

“A planned combination of educational, political, regulatory, and organizational supports for actions and conditions of living
conducive to the health of individuals, groups, or communities.”

Approach:
- Medical/Educational/Organizational
- Behavioral
- Empowerment/Economic/Social
- Social Change/Legislative
NEGLECTED TROPICAL DISEASES
Buruli ulcer Leprosy (Hansen’s disease)
Chagas disease Lymphatic filariasis*
Cysticercosis Onchocerciasis*
Dengue fever Rabies
Dracunculiasis (Guinea Worm Disease) Schistosomiasis*
Echinococcosis Soil-transmitted Helminths (STH) (Ascaris, hookworm, and
Fascioliasis whipworm)*
Human African Trypanosomiasis (African Sleeping Sickness) Trachoma*
Leischmaniasis Yaws
* Disease is controllable by mass drug administration (MDA) or effective intervention

TEN LEADING CAUSES OF MORTALITY – PHILIPPINES, 2016

Disease Number of Deaths Rate per 100,000 population

1. Ischemic Heart Disease 74,134 71.8
2. Neoplasms 60,470 58.5
3. Pneumonia 57,809 56.0
4. Cerebrovascular Diseases 56,938 55.2
5. Hypertensive Diseases 33,452 32.4
6. Diabetes Mellitus 33,295 32.3
7. Other Heart Diseases 28,641 27.7
8. Respiratory Tuberculosis 24,462 23.7
9. Chronic Lower Respiratory Tract 24,365 23.6
Infections
10. Remainder of Diseases of the 19,759 19.4
Genitourinary System
Source: Philippine Statistics Authority (PSA), 2018b
EFFECT OF NOISE

Acute Effect Chronic Effect

Acute rupture of tympanic membrane usually caused by
sudden explosive noise resulting to conductive hearing loss
Noise-induced deafness usually manifested with tinnitus
Temporary threshold shift
General physiological and psychological responses to noise:
annoyance, interference with sleep and concentration and
efficiency

SANITATION CODE OF THE PHILIPPINES

PD 856
December 23, 1975
Ultimate objective: Protecting and Promoting Health of the Filipinos

AREAS OF IMPORTANCE
- Ensuring a safe water supply
- Prevention of air pollution
- Prevention of soil pollution
- Safe disposal of wastes
- Control of insects and vermin
- Ensuring the sanitary transport of food
- Sanitation in public places

WATER SANITATION

Examination of Water
1. Bacteriological – most important single test to find out if water is potentially dangerous; detects “indicator organisms”
2. Physical – analysis of physical attributes: turbidity, color, taste and odor
3. Chemical – determine and assess behavior of water in pipes and human body
4. Biological – determines the kind of microscopic life
5. Radiological – done when there is a reason to suspect their presence

Considered as Condemned Water Source if there is a presence of:

- Arsenic
- Barium
- Cadmium
- Hexavalent chromium
- Cyanide
- Selenium
- Silver

Sources of Water Supplies

Surface waters Always contaminated by surface run-off and frequently polluted by uncontrolled disposal
of human excreta and other domestic, industrial and agricultural wastes
Streams, brooks, ponds, lakes, rivers
Ground water Largest source of water; untreated non-saline is normally safe to drink since deep supplies
are biologically pure with regard to bacteria, algae, protozoa and viruses
Wells – deep wells are generally >100ft in depth
Springs – ground water seepages when level of underground water comes inContact with
surface; usually on the side of a hill or mountain
Rain water Good supply of water since it is basically free from impurities but contamination may occur
at the collection and storage points
Recommended Frequency of Infection/Sampling
Type Frequency of inspection/sampling
Bacteriological Chemical and Physical
Public wells, springs, and cisterns (Level Once in every 3 months Upon completion of construction and
I) includes communal facilities whenever noticeable changes occur
Private wells and springs Upon request and at least once a year Upon request or complaint
Community water system (subdivision) At least once in 2 months Upon completion of drilling and when
(Level II) noticeable changes occur
Waterworks system One sample per month for system
Maynilad serving <5000 population
Level III Once sample per month for serving
5000-100,000 population

FOOD SAFETY ACT OF 2013 (RA 10611)

- Act to strengthen the food safety regulatory system in the country to protect consumer health and facilitate market
access of local foods and food products, and for other purposes

Five Keys to Safe Food (Source: WHO)

1. Keep clean
2. Separate raw and cooked foods
3. Cook foods thoroughly
4. Keep food at safe temperatures
5. Use safe water and raw materials
DEPARTMENT OF HEALTH

VISION Statement: Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040
MISSION Statement: To lead the country in the development of a productive, resilient, equitable and people-centered health
system

PHILHEALTH
Coverage that extends to your immediate family
Member Dependents
45 days/calendar year 45 days/calendar year
(exclusive for the member) (to be shared by qualified dependents)

- Legitimate spouse not yet a Philhealth member

- Children 20 years old and beolow, single and
unemployed (legitimate, illegitimate, stepchildren,
adopted, etc)
- Parents 60 years old and above and not a GSIS or
SSS retiree/pensioner (biological parent, step
parent, and adoptive parent)
Table. Reportable pathogens under the National Antimicrobial Resistance Surveillance Program (ARSP)
Enterococcus faecium
Enterococcus faecalis
Staphylococcus aureus
Methicillin-resistant Staphylococcus aureus (MRSA)
Streptococcus pneumoniae
Acinetobacter baumanii
Escherichia coli
Haemophilus influenzae
Kiebsiella pneumoniae
Neisseria gonorrhoeae
Pseudomonas aeruginosa
Salmonella enterica
Non-typhoidal Salmonella
Shigella

Restricted Pharmaceuticals in the Philippine National Formulary

Medicine Dosage Form/Strength
1 Cefepime 500 mg, 1 g and 2 g vial (as hydrochloride)
2 Ertapenem 1 g powder, vial (as sodium salt)
3 Meropenem 500 mg and 1 g powder, vial (as trihydrate)
4 Vancomycin 500 mg and 1 g vial (as hydrochloride)
5 Amphotericin B 50 mg and 100 mg vial (IV infusion) (as cholesteryl complex, colloidal suspension) (lipid
complex)
50 mg lyophilized powder, vial (IV infusion) (as deoxycholate) (non-lipid)
6 Voriconazole 200 mg lyophilized powder for solution for IV infusion, 30 ml vial
7 Colistin 2,000,000 IU lyophilized powder for injection (IV infusion)
8 Micafungin 50 mg lyophilized powder for infusion (IV)
9 Aztreonam 1 g powder for injection
10 Linezolid 600 mg tablet/film-coated tablet
2 mg/ml (600 mg/300 ml), solution for infusion (IV)

Restricted Antimicrobials Monitored Antimicrobials

4th gen Cephalosporins 3rd gen Cephalosporins
Aztreonam All Fluoroquinolones
All Carbapenems All Aminoglycosides
Colistin Clindamycin
Vancomycin
Linezolid (IV and PO)
All IV Antifungals
(except Fluconazole)

UNIVERSAL HEALTH CARE LAW

Republic Act No. 11223

An act instituting universal health care for all Filipinos, prescribing reforms in the health care system, and appropriating funds
therefor

Ano ang Universal Health Care o UHC?

- Isang malakwakang reporma sa sector ng kalusugan na naglalayong bigyan ng access ang lahat ng Filipino sa de-kalidad
at abot-kayang serbisyong pangkalusugan nang walang dapat ipangamba sa gastusin

Kailan magiging epektibo ang UHC?

- Pagkaraan ng 15 araw matapos malathala sa Official Gazette nung Pebrero 21, 2019 naging epektibo ang batas, subalit,
ito ay nangangailangan ng Implementing Rules and Regulations (IRR) para lubos itong maipatupad. Binibigyan ang DOH
at Philhealth ng 180 araw para makumpleto ang IRR. Habang binabalangkas ang IRR, mananatiling ipinatutupad ang
mga umiiral na polisiya ng Philhealth
LIST OF NOTIFIABLE DISEASES/SYNDROMES

Category I (Immediately Notifiable) Category II (Weekly Notifiable)

Acute Flaccid Paralysis Acute Bloody Diarrhea
Adverse Event Following Immunization (AEFI) Acute Meningitis Encephalitis Syndrome
Anthrax Acute Encephalitis Syndrome
Ebola Virus Disease Acute Hemorrhagic Fever Syndrome
Hand, Foot and Mouth Disease Acute Viral Hepatitis
Malaria Bacterial Meningitis
Measles-Rubella Chikungunya
Meningococcal Disease Cholera
MERS-CoV Dengue
Neonatal Tetanus Diphtheria
Paralytic Shellfish Poisoning Influenza-like Illness
Rabies Leptospirosis
Severe Acute Respiratory Infection (SARI) Non-neonatal Tetanus
Zika Virus Disease Pertussis
Outbreaks Rotavirus
* Clusters of diseases Typhoid and Paratyphoid Fever
* Unusual diseases or threats

MENINGOCOCCAL DISEASE

NEONATAL TETANUS
PARALYTIC SHELLFISH POISONING

RABIES

GOVERNMENT PROGRAMS
1. National TB Program
2. National Leprosy Control Program
3. Control of Diarrheal Diseases
4. Expanded Program of Immunization
5. Under Five Clinic
6. Family Planning
7. HIV and STI Prevention
8. Control of Acute Respiratory Infection
9. National Dengue Prevention and Control Program
10. Rabies
11. Herbal Medicinal Plants
12. Public Heath Nutrition
13. Preventive Dentistry

NATIONAL TB PROGRAM

VISION: A Tuberculosis-free Philippines

Zero deaths, disease, and suffering due to tuberculosis

LONG TERM GOAL (2035): Reduce TB burden by decreasing TB mortality by 95% and TB incidence by 90%

Primary Diagnostic Choice: DSSM

- It provides a definitive diagnosis of active TB
- The procedure is simple
- It is economical
- A microscopy center could be put up even in remote areas

See end of handout for added screenshots re the TB program J

NATIONAL DENGUE PREVENTION AND CONTROL PROGRAM

Background
• Dengue is the fastest spreading vector-borne disease in the world endemic in 100 countries
• Dengue virus has four serotypes (DENV1, DENV2, DENV3, and DENV4)
• First infection with one of the four serotypes usually is non-severe or asymptomatic, while second infection with one of
other serotypes may cause severe dengue
• Dengue has no treatment but the disease can be early managed
• The five year average cases of dengue is 185,008; five year average deaths is 732; and five year average Case Fatality
Rate is 0.39 (2012-2016 data)

Program Components

Surveillance
• Case surveillance through Philippine Integrated Disease Surveillance and Response (PIDSR)
• Laboratory-based surveillance/virus surveillance through Research Institute for Tropical Medicine (RITM) Department
of Virology, as national reference laboratory, and sub-national reference laboratories
• Vector Surveillance through DOH Regional Offices and RITM Department of Entomology

Case Management and Diagnosis

• Dengue Clinical Management Guidelines training for hospitals
• Dengue NS1 RDT as forefront diagnosis at the health center/RHU level
• PCR as dengue confirmatory test available at the sub-national and national reference laboratories
• NAAT-LAMP as one of confirmatory tests will be available at district hospitals, provincial hospitals and DOH retained
hospitals

Integrated Vector Management (IVM)

• Training on Vector Management, Training on Basic Entomology for Sanitary Inspector, Training on Integrated Vector
Management (IVM) for health workers
• Insecticide Treated Screens (ITS) as dengue control strategy in schools

Outbreak Response
• Continuous DOH augmentation of insecticides such as adulticides and larvicides to LGUs for outbreak response

Health Promotion and Advocacy

• Celebration of ASEAN Dengue Day every June 15
• Quad media advertisement
• IEC materials

PREVENTIVE DENTISTRY

Objectives and Targets:

1. The prevalence of dental caries is reduced
Annual Target: 5% reduction of the prevalence rate every year
2. The prevalence of periodontal disease is reduced
Annual Target: 5% reduction of the prevalence rate every year
3. Dental caries experience is reduced
Annual Target: 5% reduction of the mean dmft/DMFT for 5/6 year old and 12 year old children every year
4. The proportion of Orally Fit Children (OFC) 12-71 months old is increased
Annual Target: increased by 20% yearly
Added info for TB: