study on the association between having an effective health emergency response to leptospirosis and...
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Study on the Association between having an Effective
Health Emergency Response to Leptospirosis and the
Presence of a Functionally Prepared Health Emergency
Response System in high risk barangays during
typhoon Ondoy
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TYPHOON ONDOY
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Leptospirosis Cases
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Department of Health Department Memorandun No. 2009 – 0250
• Issued last Oct. 16, 2009• Doxycycline prophylaxis
– Communities that experienced flooding and have a high number of suspected cases
– Volunteers, government workers and soldiers who helped in the rescue operations
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• Risk of infection and doxycycline doseRISK DESCRIPTION DOXYCYCLINE DOSE
Low Risk Single history of wading in flood or contaminated water
Absence of wounds, cuts, open lesions
2 capsules of 100mg single dose within 24 – 72 hours
Moderate Risk Single history of wading in flood or contaminated water
Presence of wounds, cuts, open lesions
Accidental ingestion of contaminated water
2 capsules of 100mg once a day for 3 – 5 days to be
started immediately within 24 – 72 hours from exposure
High Risk Continuous exposure of wading in flood or
contaminated water with or without wounds, cuts, open
lesionsSwimming in flooded water
and ingestion of contaminated water
2 capsules of 100mg once weekly until the end of
exposure
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WHO: Diagnostic Services, Surveillance and Outbreak Management of Leptospirosis
• Screening methods can be used to confirm the diagnosis of Leptospirosis – Screening methods for anti-leptospira antibodies– IgM ELISA– Microscopic Agglutination Tests
• Philippine setting– Proper history taking– Clinical judgment
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• Education to the public– Identification of Leptospirosis– Importance of seeking immediate treatment– How to limit exposure
• Environmental aspect– Recognize contaminated sources of water and
drain them– Control rodent population
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Statement of the ProblemThis study would like to determine the presence
of an association, if any, between having an effective health emergency response to
Leptospirosis and the presence of a functionally prepared health emergency
response system in a barangay at high risk for Leptospirosis after Typhoon Ondoy
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Significance of the Study
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Research Hypothesis
Barangays at high risk of Leptospirosis after Typhoon Ondoy did not have a functionally
prepared health emergency response system (HERS) to mount an effective health
emergency response
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Scope and Limitations
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Research Objectives• General Objective
To determine the presence of an association, if any, between having an effective health emergency response to Leptospirosis and the presence of a
functionally prepared health emergency response system in barangays at high risk for Leptospirosis
after Typhoon Ondoy
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• Specific ObjectivesTo determine if barangays were also able to have an
effective health emergency response to the Leptospirosis outbreak despite not having a
functionally prepared health emergency response system and to see what other factors contributed to
the effectiveness of the response
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Research DesignThis case control study is designed to assess
and/or determine the presence of an association, if any, between having an effective health emergency response to
Leptospirosis and the presence of a functionally prepared health emergency
response system in flood-stricken barangays during Typhoon Ondoy
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Tool for Data Collection: Interview
• Checklist• Pre-testing of the proposed interview
questionnaire will be done before the actual data collection process
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Selection of Study Subjects
• Stratified random sampling– Pasig, Marikina, Cainta and Taytay– P value of 0.05– Pre-testing
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Sampling Methods
Purposive Sampling
Stratified Simple Random Sampling
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Variables and Operational Definitions
• Case– Barangays which were not able to mount an
effective health emergency response to the Leptospirosis outbreak
• Control– Barangays which were able to mount an effective
health emergency response to the outbreak
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• Exposure– Dependent on the barangay having a functionally
prepared health emergency response system
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Independent Variables• Variables that Determine a Functionally
Prepared HERS – Staff– Meetings– Trainings – Policies– Information dissemination– Other factors which the health workers think
made their HERS effective
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• Staff– Two health workers for every 5,000 population in
the barangay
• Meetings– The barangay health office conducts meeting to
coordinate staff regarding treatment guidelines and planning
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• Training– Pertain to the health health workers with a degree
or certification in health care ( e.g. nurse, medical technologist or midwife)
• Policies– Refers to the health center’s standard guidelines on
Leptospirosis prevention and treatment, and/or NDCC guidelines on disaster control during floods and/or Local Government policies on barangay health emergency services
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• Information Dissemination– Availability of resource or teaching materials
(pamphlets, visual aids) about Leptospirosis and adequate prevention measures
• Others– Factors which the health workers think made their
HERS effective (like assistance, etc.)
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Dependent Variables
• Variables that determine an effective Health Emergency Response System – Knowledge on Leptospirosis diagnosis, prophylaxis
and management– Referral System – Patient Education on Leptospirosis prevention
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• Knowledge on Leptospirosis diagnosis, prophylaxis and management– Having adequate knowledge about the clinical
manifestations of Leptospirosis; symptoms to suspect; risk factors; management of suspected cases
• Referral System– Appropriate referrals to secondary and tertiary-
level hospitals to manage severe Leptospirosis cases
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• Patient Education on Leptospirosis prevention– Properly educating or informing residents in high-
risk communities about the identification, management, and prevention of leptospirosis
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Potential Biases
• Recall bias• Response Bias• Hawthorne Effect• Selection Bias
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Data Collection Procedure
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Data Processing
• Two Way tables – Where data collected will be encoded and
tabulated in
• One Way Frequency Tables – for descriptive interpretation
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PLAN FOR ANALYSIS
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Independent Variable
• The functional preparedness of the system will be measured by different factors:– Policies– Staff– Meetings– Information dissemination– Training
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Dependent Variables
• The effective response to Leptospirosis will be quantified by different factors– Knowledge on Leptospirosis diagnosis, prophylaxis
and management– Referral system– Patient education on Leptospirosis prevention
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Statistical / Analytical Tool of Measurement
DISEASE STATUS (Effective Health Emergency Response) Total
EXPOSURE FACTOR (Functional HERS)
Case: Barangays W/O an Effective Health Emergency Response
Control: Barangays W/ an Effective Health Emergency Response
Exposed (Barangays w/c are functionally prepared for a Health Emergency Response)
A B A + B
Unexposed (Barangays w/c are not functionally prepared for a Health Emergency Response)
C D C + D
Total A + C B + D A + B + C + D
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Odds Ratio (AD/BC)
OR will be used to determine if there is an association between a functional HERS and an effective response to Leptospirosis.
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Chi-Square Test• To be used to all nominal (categorical) data to determine if a
significant relationship exists b/w the variables.• Sampling population will be grouped:
– Ex. With staff/No staff With training/No training
• Set CI at 95% and α=0.05• Hypothesis Testing
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Logistic Regression
• Presence of >2 independent variables• To examine the contribution of each variable in order
to mount an effective response to Leptospirosis• To find out possible interactions b/w the different
independent variables
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Statistical Analysis
Will use the SPSS 17 (PASW 18) software.
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Plan for Dissemination of the Results of the Study
• Baseline study:– further research needed
• The results obtained: – Government institutions– Ateneo School of Medicine and Public Health– Respondents of the study
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WorkplanActivity Duration Pre-requisites
Preparation for Pretest 1 week (1st week of March) Determine pre test samples Contact barangays Fill out interview schedule table
Actual Pre Test 2 weeks Preparation for Pretest
Validation of Results 1 week Pre Test
Preparation for Actual Data Collection
1 week (April) Contact barangays Fill out interview schedule table
Actual Data Collection 3 weeks Preparation for Actual Data Collection
Analysis of Data Results 1 week (May) Completed Data Collection
Final Research Paper writing 2 weeks Completed Data Collection and Analysis
Finalization of Research Paper 1 week Completed Research Paper
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BudgetITEM QUANTITY UNIT COST TOTAL COST
A4 bond paper 500 pages 50 cents Php 250.00
Ink cartridge 2 Php 500.00 Php 1,000.00
Photocopy expenses:
Questionnaire
360 pages 50 cents Php 180.00
Travel expenses: Gasoline
120L Php 40.00 Php 4,800.00
Token for barangays ˜30 Php 100 Php 3,000.00
TOTAL Php 9,230.00