THE PERCEPTIONS AND PREVALENCE OF PULMONARY TUBERCULOSIS AMONG PUBLIC UTILITY JEEPNEY

DRIVERS ON SELECTED BARANGAYS IN ZAMBOANGA CITY

A THESIS PRESENTED TO THE FACULTY OF THE GRADUATE SCHOOL

ATENEO DE ZAMBOANGA UNIVERSITY ZAMBOANGA CITY

IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF

MASTERS IN PUBLIC HEALTH

BY:

Dr. MICHAEL D. SUAREZ

April 17, 2006

APPROVAL SHEET

This Thesis entitled The Perceptions and Prevalence of Pulmonary Tuberculosis

among Public Utility Jeepney drivers on selected barangays in Zamboanga City prepared

and submitted by Dr. MICHAEL D. SUAREZ, in partial fulfillment of the requirements

for the degree of Masters in Public Health is hereby accepted.

Dr. Fortunato L. Cristobal

Adviser

Approved by the Oral Examination Committee with a grade of Passed.

_______________________ Dr. Rosemarie S. Arciaga

Chairman

___________________ _____________________ Dr. Ricardo N. Angeles Dr. Servando D. Halili Jr. Member Member

_______________________

Dr. Jocelyn D. Partosa

Member

ACCEPTED in partial fulfillment of the requirements for the degree of Masters in Public

Health.

_______________________ Dr. Servando D. Halili Jr.

Dean, Graduate School

Ateneo de Zamboanga University

ACKNOWLEDGEMENTS The researcher would like to express his deep thanks and gratitude to the men and

women who helped make this research into a reality.

First of all, to God Almighty for His strength, guidance and blessings that He has

showered upon us.

The researcher’s adviser, Dr. Fortunato Cristobal, for his valuable advice,

guidance, patience and understanding during the entire process of this research.

The honorable panelists Dr. Rosemarie Arciaga, Dr. Servando Halili Jr., Dr.

Ricardo Angeles and Dr. Jocelyn Partosa for their valuable comments, suggestions and

patience in this research.

To my loving parents for their encouragement and support.

To the drivers of Pasonanca and Sta. Maria for their patience and participation.

To Ms. Noelle Abarquez for patiently reading the sputum samples and to Dr.

Clint Macrohon for helping in the reading of the chest x-rays.

To my friends and classmates for their unfailing help, support and inspiration

during the research process. And to all those who have helped in making this paper into a

reality.

To all of you, thank you so much.

TABLE OF CONTENTS

PAGE APPROVAL SHEET ……………………………………………………….. i ACKNOWLEDGEMENTS ……………………………………………………..….. ii LIST OF TABLES …………………………………………………………………….. iii ABSTRACT ……………………………………………………………………………. iv CHAPTER

I THE PROBLEM AND ITS SETTING

a.) Background of the Study ……………………………… 1 b.) Related Literature ……………………………………... 4 c.) Statement of the Problems …………………………….. 9 d.) Conceptual Framework ………………………………... 10 e.) Significance of the Study ………………………………. 11 f.) Scope and Delimitation of the Study ………………….. 11 f.) Definition of Terms …………………………………… 11

II METHODOLOGY a.) Research Design ……………………………………… 12

b.) Respondents ………………………………………….. 12 c.) Sampling Design ……………………………………... 12 d.) Data Gathering Procedure …………………………… 13 e.) Research Instrument …………………………………. 15 f.) Treatment of Data ………………………………… 15

III PRESENTATION OF RESULTS ………………………... 17 IV DISCUSSION AND IMPLICATION ……………………. 24 V CONCLUSION AND RECOMMENDATIONS ………… 33 APPENDICES

A. Questionnaire …………………………………………………… 35 B. Health Education Pamphlet …………………………………….. 37 C. Computation of Mean Scores ………………………………….. 39 BIBLIOGRAPHY …………………………………………………………. 41 CURRICULUM VITAE ………………………………………………….. 42

LIST OF TABLES

Table Page

1 Demographic Profile of the Respondents ………………………………. 18 2 Percentage frequency of the perceptions of drivers as regard to the

nature and general idea, transmission, cause, signs and symptoms and management / treatment of tuberculosis of tuberculosis ………………... 20

3 Signs and symptoms found in drivers and their corresponding sputum microscopy results …………………………………………….. 22

4 Result of the repeat sputum microscopy of the

salivary sputum samples ……………………………………….. 23

ABSTRACT

A cross-sectional study was done to determine the prevalence of TB among PUJ

drivers in Zamboanga City as well as to determine their perceptions regarding TB

disease. A total of 153 drivers plying along the route of Pasonanca and Sta. Maria were

included in the study. The TB-DOTS program guideline was used to clinically diagnose

the TB symptomatic subjects. Those patients who met the TB DOTS guideline criteria for

TB symptomatics were asked to submit their sputum for microscopic examination for

Acid-fast Bacilli. In addition, their perceptions about TB were assessed using a checklist

questionnaire. The questionnaire contained 5 items that dealt about the general idea,

cause, transmission, signs & symptoms and management/treatment of tuberculosis. The

results of the study showed that 41 of the 153 drivers were TB symptomatics giving a

prevalence rate of 26%. However, sputum microscopy for acid-fast bacilli of these

symptomatic drivers were all negative. Regarding the perceptions of the drivers

regarding PTB, most of the responses of the drivers were misconceptions about the

disease. Because of this, a health education pamphlet intervention was formulated to

educate these drivers on their misconceptions. These pamphlets which was easy to read

were distributed and explained to the drivers.

CHAPTER I

THE PROBLEM AND SETTING

Background of the Study

The Philippines ranks 9th among countries in the world with high burden of TB.

TB is the 6th greatest cause of morbidity and mortality in the country. Around 293 per

100,000 population are infected with the disease and about 133 new cases are found per

100,000 population (Contreras, 2006). Approximately, 78 Filipinos die from TB

everyday (WHO Global TB Report, 2006). In Region IX, TB still remains to be a major

health problem. It ranks as the 3rd and 4th among the top list of Morbidity and Mortality,

respectively (Ahmad, 2004).

Tuberculosis affects people indiscriminately. It affects people regardless of

occupation, social stature (rich or poor), educational attainment, gender nor age. The

most common mode of transmission is through droplet nuclei infection, which are

aerosolized by coughing, sneezing or speaking. Some people, however, are more

susceptible in acquiring this disease due to occupational or environmental risk hazards,

their health condition or degree of TB exposure. Occupational risk hazards for

developing TB includes silica-using industries-quarrying, pottery and related products,

nonmetallic mineral and stone products, ship and boat building and repair, hospitals,

drivers, agriculture, eating and drinking establishments and janitorial/cleaning jobs

(Rosenman, 1990).

Several studies were done to assess whether there is an increased risk of

developing TB among individuals who work in certain industries or occupation. Sir

Thomas Oliver (2006) from Ireland found that 3.06% of the TB infected patients were

coach, car drivers and van men. In another study done by Rosenman and Hall (1990),

they found that truck drivers have elevated risk for TB. Similarly, Gary and Trinh (2000)

found in another study that 62% of taxi drivers were found to be positive for skin test for

TB. Based upon these studies, public utility vehicle drivers are at risk in developing TB.

Furthermore, they in turn, can be agents for the spread of the disease.

In the Philippines, Public Utility Jeepneys (PUJ) are one of the most commonly

used means for transportation among commuters. In Metro Manila, the University of the

Philippines College of Public Health found that COPD was highest among jeepney

drivers (32.5%), bus drivers (16.4%) and commuters (14.8%). The same study also said

that PUJ drivers are at risk of contracting TB, and that 17.5% of them were already

affected. Similarly, the Philippine Environment Air Quality Monitoring Team, with the

support from WHO, derived the same figure. It was found that the TB prevalence among

PUJ drivers was also 17.5%. In addition, the TB prevalence among bus drivers was

11.5% and commuter TB prevalence was only 9%. Based upon the figure presented by

the two environment groups, the prevalence of TB among PUJ drivers was 17.5%, which

was relatively high.

Currently, there are roughly 2,500 PUJ in Zamboanga City, which serves the need

for transportation of the public. There are only 7 barangays that have more than 100 PUJ

operating to serve the residents of these barangays. In this research, two of the seven

barangays were selected. These were barangay Sta. Maria and barangay Pasonanca that

have a total of 210 members of the operator and jeepney association. These barangays

were chosen because the researcher knows several of the drivers of these barangays and

has already established rapport among these drivers enabling the researcher to conduct

the research. Another reason was that, the loading, unloading and parking area of these

jeepneys were located in the same place making it easy for them to be gathered in a

convenient place.

So far, no TB screening has been done among this population as well as their

perceptions regarding pulmonary tuberculosis. It is the researcher’s interest, therefore, to

know the perceptions of PUJ drivers regarding pulmonary tuberculosis and to screen

these drivers to determine the prevalence of TB.

Related Literature

Tuberculosis poses a problem not only among developing countries but also on

well-developed countries. Despite the advancement of science and technology, the fight

against tuberculosis still goes on. People of various race, age, occupation, gender and

social stature can be infected with this disease. Tuberculosis infection does not exempt

anyone. Some people, however, were found to be more at risk in developing the disease

than others.

A study tried to assess whether there is an increased risk of tuberculosis among

individuals who work in certain industries or occupations. This study was a case-referent

study of 149 male tuberculosis patients in New Jersey Health Department from 1985 to

1987 and 290 referents were performed. The result revealed that occupations and

industries associated with elevated risk for TB included: four silica-using industries-

quarrying (OR=3.96, 95% CL 0.36-44.02); pottery and related products (OR=1.99, 95%

CL 0.49-8.06); nonmetallic mineral and stone products (OR=4.00, 95% CL 0.72-22.10);

and ship and boat building and repair (OR=1.84, 95% CL 1.30-4.77); hospitals

(OR=2.10, 95% CL 1.08-4.10); truck drivers (OR=2.49, 95% CL 1.30-4.77); agriculture

(OR=2.31, 95% CL 0.82-6.50); eating and drinking establishments (OR=2.83, 95% CL

1.11-7.20); and janitors/cleaners (OR=2.00, 95% CL 0.63-6.31) (Rosenman, 1990).

The study of Rosenman was included in this review of literature because it

establishes that drivers are at risk for developing tuberculosis. In the Philippines, Public

Utility Jeepney drivers were found to be at risk to this disease. It was found that about

17.5% of the jeepney drivers already have the disease as presented by the UP College of

Public Health. This was also the finding of the Philippine Environment Air Quality

Monitoring Team that was supported by the WHO.

A similar study about public utility drivers at risk for tuberculosis was done. The

study explored an innovative strategy for targeted testing and disease management among

immigrant communities at risk for tuberculosis. The study targeted taxi drivers at an

airport holding lot and was given skin testing (Mantoux). The study had 123 taxi drivers

who participated. Two-thirds of the respondents were found to be at risk for tuberculosis

and 62% of them had positive skin test results. After receiving their test results, drivers

with positive results were referred for evaluation and treatment (Gany, 2000).

Not only is it important to determine that drivers are at risk for developing

tuberculosis; they may also be a part of the spreading process of the disease. A study

similar to this was done between 1994 and 1995 among 3,300 students in 49 schools in

two counties in New York who were potentially exposed to five school bus drivers with

tuberculosis. The investigation was carried out to determine the extent of the transmission

of tuberculosis among students. Collection of demographic information for students

exposed to a driver with tuberculosis, tuberculin skin test, sputum exam, chest

radiography and medical evaluation of individuals with positive skin tests, and DNA

fingerprinting of M. tuberculosis isolates were done. The results revealed that all bus

drivers except driver 4 presented with signs and symptoms of tuberculosis before

diagnosis of their condition. Sputum specimens were Acid-fast Bacilli (AFB) smear

positive of drivers 1, 3 and 5, while negative for drivers 2 and 4. Driver 1 was exposed to

a relative with tuberculosis in 1979 and had received isoniazid prophylaxis for 3 months.

Driver 2 was anergic and died shortly after her tuberculosis diagnosis. Driver 3 and 4

often sat together in the closed bus of driver 3 while waiting for students to be dismissed

from school and enter their buses. The bacilli isolates of driver 3 and 4 were identical by

DNA fingerprinting. Among the 3,300 students screened, it was found that driver 3 has

infected 44% of students while the rest of the drivers infected their passenger students

with a relatively low range of 0.3% to 1.1% (Yusuf, 1997).

Another study that tried to assess the feasibility and yield of diagnostic procedures

after active case finding for TB was done. This was a prospective multi-center study on

the value of symptoms, spontaneous and induced sputum exam and bronchoscopy for the

confirmation of TB in radiological suspect cases. One hundred one subjects were

examined. Spontaneous on-the-spot sputum collection, morning sputum and induced

sputum exam were done. On-the-spot sputum exam yielded 54% smear-positive subjects.

Morning sputum exam yielded 62% smear-positive subjects. Two induced sputa yielded

no additional smear-positive subjects. Bronchoscopy performed among sputum smear-

negative cases yielded 4 additional smear-positive cases. The study recommends that all

suspect cases must be examined with on-the-spot and early morning sputum, irrespective

of symptoms (Schoch, 2006).

A similar study was also done that tried to expand tuberculosis case detection by

screening household contacts. The study tried to assess the feasibility and yield of a

simple active case finding strategy in a high incidence population in northern Lima, Peru.

Health workers visited household contacts of new TB case subjects to identify

symptomatic individuals and collect sputum for screening. Neighboring households were

screened in the same manner. The results showed that TB prevalence detected through

combined active and passive case finding among 1,094 household contacts was 0.91%,

much higher than with passive case finding alone (18%). Among 2,258 neighbors, the

combined strategy detected a TB prevalence of 0.22% in contrast to 0.08% detected

through active case finding alone. In conclusion, the risk of active TB among

symptomatic household contacts of active case subjects in this study was very high.

Results also suggested that contact tracing in such setting may be a very powerful means

of improving case detection rates for active TB disease (Bayona, 2005).

The studies done by Schoch and Bayona were included because the active case

finding process as well as the use of sputum examination is similar to this research.

However, it is not this paper’s interest to establish the effectiveness of case finding for

TB nor use of sputum examination (spot & induced) which were the goals of the cited

studies.

As part of the screening process in the diagnosis of TB, clinical signs and

symptoms need to be present. In a study about the prevalence of tuberculosis infection

and active tuberculosis in old age homes in Hong Kong, 2,243 respondents were screened

with the use of a questionnaire-based interview, medical record review and a two-stage

tuberculin testing, chest X-ray and sputum examination. The result showed that the

estimated prevalence rate of active TB in this population was 669 per 100,000 and the

skin testing positive result was 68.6% (Chan, 2006). Similarly, a study was done to

evaluate the diagnostic accuracy of the integrated Practical Approach to Lung Health in

South Africa (PALSA) guideline in identifying patients requiring bacteriological

screening for TB. A prospective, cross-sectional study in which 1,392 adult patients with

cough and/or difficult breathing, attending a primary care facility in Cape Town, South

Africa were evaluated by a nurse using the guideline. It was concluded in the study that

the PALSA guideline is an effective screening tool for identifying patients requiring

bacteriological screening for pulmonary tuberculosis (English, 2006). These studies were

included because it involved the use of screening process among the respondents in the

diagnosis of tuberculosis.

Lastly, a study was done to develop the new NTP policies based on WHO

recommendations. The study was a pilot project done in Cebu Province, Philippines in

collaboration with the Japan International Cooperation Agency (JICA). This was to test

the feasibility and effectiveness of the new NTP policies. The test showed a high rate of

three sputum collection (90%), high positive rate (10%), and high cure rate (80%). The

implementation of the new NTP guidelines in Cebu province has reached a satisfactory

level, the cure rate and positive rate have increased, and laboratory services have

improved. Due to this successful implementation, the new NTP guidelines are now being

used nationwide (Giangco, 1991).

Statement of the Problem: How prevalent is pulmonary tuberculosis and what are the

perceptions about PTB among public utility jeepney drivers in selected barangays in

Zamboanga city?

Objective:

General Objective: To determine the prevalence of Pulmonary tuberculosis among Public

Utility Jeepney drivers plying along selected barangay route in Zamboanga City and their

perceptions regarding TB disease.

Specifically, this study aims to:

1. Determine the perceptions of public utility jeepney drivers plying along the selected

barangay route in Zamboanga City regarding pulmonary tuberculosis.

2. Identify the TB symptomatic among the public utility jeepney drivers plying along

selected barangay route in Zamboanga City.

3. Determine the prevalence of PTB among PUJ drivers plying along the selected

barangay route in Zamboanga City.

Conceptual Framework:

Clinical signs & symptoms

screening

Referral to TB DOTS for treatment

TB symptomatic sputum exam

Diagnosis

The concept of this study revolves on the idea that public utility jeepney drivers

are one of the health under-served populations in the community. Studies show that

jeepney drivers are found to have high rate of TB infection. While the DOTS program

has already been established to address this need, still TB is high among this population.

This can either be due to the perceptions of the jeepney drivers about PTB or due to

inadequacy of the screening process of the TB DOTS program. This study therefore

would help in identifying the perceptions of drivers and to know what keeps them from

being diagnosed and treated for TB. It also hopes to screen the prevalence of TB among

jeepney drivers in Zamboanga City.

TB DOTS

PROGRAM

Perceptions of drivers about

PTB

PTB 17.5% among Jeepney

drivers

Significance of the Study:

This study will help identify and evaluate the perceptions of the public utility

jeepney drivers regarding pulmonary tuberculosis in the hope that whatever wrong

perceptions they have will be corrected. This study will also screen and diagnose public

utility jeepney drivers with TB among selected barangays. This will, in some way, stop

the chain of infection of tuberculosis by first identifying the symptomatic drivers and

subsequently treating them. Since these people are one of the under-served populations

on health, this study will help to extend the health services to them. And therefore help in

the campaign of the Department of Health in fighting and eradicating tuberculosis.

Lastly, this study may serve as a baseline data on the prevalence of tuberculosis among

public utility drivers as well as a guide to other researches in the future.

Scope and Delimitation:

This study included the public utility drivers of barangay Pasonanca and Sta.

Maria, Zamboanga City. The TB-DOTS clinical signs and symptoms guideline protocol

was used as a screening modality for the identification of TB symptomatics. The

diagnosis of tuberculosis was limited to the use of sputum microscopy for TB bacilli.

Lastly, a questionnaire was used to assess the perceptions of the subjects regarding TB.

Definition of Term:

Perception = the personal knowledge and understanding of pulmonary tuberculosis.

AFB = Acid-fast Bacilli

CHAPTER II

METHODOLOGY

Research Design:

This was a cross-sectional study. The study tried to determine the perceptions and

prevalence of pulmonary tuberculosis among Public Utility Jeepney drivers in selected

barangays of Zamboanga City. All of the respondents were asked about their perceptions

regarding PTB using a checklist questionnaire (Appendix A). The subjects were also

screened for the signs and symptoms of tuberculosis. The TB-DOTS protocol for

symptomatic screening of tuberculosis was used. Those found to be TB symptomatic

underwent sputum microscopy for diagnosis. The National Tuberculosis Control Program

(NTP) case finding guideline was used in this study.

Respondents:

There were a total of 210 members of the public utility jeepney drivers and

operators association among these selected barangays. All of the drivers in the

association were included in the study.

Sampling Design:

Total enumeration was used in this study. This means that all the subjects were

included in the study.

Data Gathering Procedure

1. Perceptions of drivers about Tuberculosis

The drivers were interviewed about their perceptions regarding PTB. A checklist

questionnaire was used to gather their perceptions. The questionnaire contained 5

items that dealt about the drivers’ general idea of PTB, it’s cause, mode of

transmission, signs & symptoms and management/treatment. In addition, it also deals

with the demographic profile of the respondents.

2. Identification of TB symptomatic drivers

The drivers were also interviewed and asked if they have any of the signs and

symptoms of tuberculosis as described in the TB DOTS protocol program of the

government. These symptoms included having cough for two or more weeks duration for

the past 6 months and those with or without one or more of the following:

• Fever for the past 6 months

• yellow sputum expectoration

• significant weight loss for the past 6 months

• hemoptysis or recurrent blood-streaked sputum

• chest and /or back pains not referable to any musculo-skeletal disorders

• other symptoms such as sweat with chills, fatigue, body malaise, shortness of breath

Drivers with cough and one or more of the above signs and symptoms were

considered as TB symptomatic.

2. Sputum Microscopy for TB symptomatic drivers

Drivers found to have any of the TB signs and symptoms were asked to submit

their sputum for microscopic examination. The researcher explained and demonstrated

how to produce good sputum sample by instructing the subjects to follows these steps:

1. Rinse the mouth with water.

2. Breathe deeply two times, holding the breath for a few seconds after each

inhalation and then exhaling slowly.

3. After inhaling deeply in the third time, at the height of inspiration cough

strongly and spit the sputum in the sterile container.

The researcher supervised the subjects during the procedure and advised for any

contamination precautions. Three sputum specimens were collected within two days

according to these procedures:

1. First specimen (spot specimen). This was collected at the time of consultation,

or as soon as the TB symptomatics were identified.

2. Second specimen (early morning specimen). This was the very first sputum

produced early in the morning immediately after waking up, and collected by

the subjects themselves according to the instructions given by the researcher.

3. Third specimen (2nd spot specimen). This was collected at the time the TB

symptomatic subjects comes back to submit the 2nd sputum specimen.

The sputum container were labeled and sealed, packed securely and transported to

the laboratory. The specimens were brought to Zamboanga City Medical Center (ZCMC)

for Acid-Fast Bacilli microscopy examination.

3. Collection & Interpretation of sputum smear results:

The results were collected and interpreted as follows:

1. Specimens were considered positive when all or at least two sputum specimen

smears were positive for Mycobacterium tuberculosis bacilli.

2. Specimens were considered doubtful when only one sputum specimen was

positive out of the three sputum specimens examined. Another three sputum

specimens will be collected from the same subject. If at least one specimen

from the second set of specimen turns out to be positive, then the diagnosis is

positive. But if all three specimens from the second set of specimen turn out to

be negative, then the diagnosis will be negative.

3. Specimens were considered negative when all sputum specimens were found

negative.

Research Instruments:

A checklist questionnaire approved by the research adviser was developed and

used to assess the perceptions of jeepney drivers regarding PTB. The DOTS clinical

assessment screening for the signs and symptoms of tuberculosis was utilized for the

identification of TB symptomatic subjects.

Treatment of Data:

The percentage and the prevalence rate of PTB among jeepney drivers were

derived from the data gathered. Percentage was also used to describe the results of the

perceptions of drivers regarding PTB.

The prevalence rate formula used was (old plus new cases) in a certain period of

time divided by the total number of population within the same period of time multiplied

by 100.

Prevalence Rate = Old cases (certain period of time) + New cases X 100 Total number of population within the same period of time

CHAPTER III

PRESENTATION OF RESULTS

Demographic Profile of the Respondents

The respondents in the study vary differently in terms of their demographic

profile. The profiles of their age, educational attainment and years of driving experience

were presented in the tables below.

Table 1 shows the age distribution as well as the mean age of the respondents.

The table shows that the mean age of the respondents is 40 and the mean year in service

as drivers is 22. The frequency of the age and years in service as drivers can be found in

appendix C.

The frequency percentage of the educational attainment of the respondents is also

presented in this table. Majority of the respondents reached elementary level or graduates

while a small proportion either finished or reached high school.

Table 1. Demographic Profile of the respondents.

Demographic Profile Mean 1. Age 40 2. Years in service as drivers 22 3. Educational attainment Frequency Elementary Level 39 (25%) Elementary Graduate 48 (32%) High School Level 41 (27%) High School Graduate 25 (16%)

Perceptions of drivers about Tuberculosis

One hundred fifty three public utility jeepney drivers were interviewed regarding

the perceptions about pulmonary tuberculosis.

Table 2 shows the percentage frequency of the responses of the drivers regarding

their perceptions about the nature and general information about pulmonary tuberculosis.

Of the 153 respondents, 86 or 56% of them thinks that tuberculosis is an infection of the

lungs, and 14 or 9% associate tuberculosis with vomiting of blood while 53 or 35% do

not have any idea what tuberculosis is.

The table also shows the percentage frequency on the perceptions of the drivers

regarding the transmission of pulmonary tuberculosis. Seventy-eight or 51% of the

respondents said that tuberculosis could be transmitted from using the utensils of infected

individuals. Nineteen or 12% associate transmission of tuberculosis from intake of food,

and 13 or 9% said that it is acquired from unclean environment, while 21 or 14% do not

have any idea how tuberculosis is being transmitted. However, 22 or 14% of the

respondents knows that tuberculosis is transmitted through droplet infection.

The same table also shows the percentage frequency of the perceptions of the

drivers regarding the etiology of pulmonary tuberculosis. From the respondents of 153,

41 or 27% of them thinks that tuberculosis is due to over work and stress, another 27%

said that it is caused by smoking. Nine percent or 13 respondents said that tuberculosis is

the effect of repetitive sweating of the back and then left to dry, and another 9% associate

tuberculosis with previous history of trauma on the back. Drinking of alcoholic beverage

was also thought to be the cause of tuberculosis among 10 or 6% of the respondents while

24 or 15% do not have any idea about the cause of tuberculosis.

Table 2. Percentage frequency of the perceptions of drivers regarding the nature and general idea, transmission cause, signs & symptoms and management/treatment of tuberculosis.

Perceptions n = 153 (%) A. Nature and General information As infection of the lungs 86 (56) I do not know 53 (35) Associated with vomiting of blood 14 (9) B. Transmission From using the utensils of infected individuals 78 (51) Droplet infection 22 (14) I do not know 21 (14) From intake of food 19 (12) From unclean environment 13 (9) C. Etiology Over work and stress 41 (27) Smoking 41 (27) I do not know 24 (15) Inhalation of dust and smoke from vehicles 13 (9) Sweating of back & then left to dry 13 (9) Trauma on back 11 (7) From drinking alcoholic beverages 10 (6)

D. Signs & Symptoms Excessive coughing 95 (62) Weight loss 66 (43) Spitting or vomiting of blood 40 (26) I do not know 37 (24) Shoulders are a little elevated 29 (19) Shortness of breath 22 (14) Weak-looking 21 (14) Pallor 20 (13) Back pains 20 (13) E. Management/Treatment Go to the doctor 87 (57) Self-medicate (antibiotics, symptomatic treatment) 47 (31) Stop smoking/drinking 31 (20) Eat nutritious food 30 (20) Rest 26 (17) Do nothing 18 (12) Improve personal hygiene 16 (10) Use clean utensils 24 (9)

Table 2 shows the percentage frequency of the response of the drivers regarding

the perceptions on the signs and symptoms of pulmonary tuberculosis. Ninety-five or

62% of the respondents said that excessive coughing is a sign of tuberculosis, 66 or 43%

said that tuberculosis manifest with weight loss, and spitting or vomiting of blood was

said by 40 or 26%. Some, about 20 or 13% each, associate tuberculosis with pallor and

back pains. Both signs like weak-looking appearance and shortness of breath were given

by 21 or 14% of the respondents, while 37 or 24% do not have any idea about the signs

and symptoms of tuberculosis.

The table also shows the percentage frequency of the response of the drivers

regarding the management of pulmonary tuberculosis. Eighty-seven or 57% of the

respondents said that a doctor should manage tuberculosis. The others said that patients

with tuberculosis should stop smoking and/or drinking alcoholic beverages (31 or 20%),

eat nutritious foods (30 or 20%), have plenty of rest (26 or 17%), improve personal

hygiene (16 or 10%), and use clean utensils (14 or 9%) as a means to manage

tuberculosis. Forty-seven or 31% said that they will rather choose to self-medicate either

with antibiotics and symptomatic treatment of the signs and symptoms while 18 or 12%

said that they will do nothing. These items are of multiple response thus the total are

more than 153.

Identification and Sputum Microscopy of TB symptomatic Drivers

Of the 153 interviewed drivers, 41 were found to fit in the category of TB

symptomatics. All of them were analyzed for sputum microscopy.

Table 3 shows the signs and symptoms in each of the subjects. This table shows

that majority of the respondents had cough with at least 1, 2 or even 3 associated signs

and symptoms. While only a small fraction (24%) had cough with 4, 5 or 6 associated

signs and symptoms. The table also shows the corresponding sputum microscopy results

of each respondent. All of the TB symptomatics were found to be negative with

tuberculosis.

The table also shows the previously diagnosed respondents with tuberculosis.

Nine out of the 41 symptomatics said that they were diagnosed to have TB. The table also

shows the DOTS treatment courses of these diagnosed subjects. Six out of the 9 subjects

are currently undergoing TB treatment, while the remaining 3 have already completed the

treatment course. Apparently, no repeat sputum examination, chest x-ray or any

reevaluation procedures were done among these treated subjects to verify this.

Table 3. Signs and symptoms found in the drivers and their corresponding sputum microscopy results.

TB Symptomatic Respondents

Signs and Symptoms

(N=41)

Previously Diagnosed Patients

DOTS Treatment

Course

Sputum Microscopy Result

Diagnosis

1 2 3 4 5 6 Result

1 Result

2 Result

3

1 X X 0 0 0 Negative 2 X X X X X X X Ongoing 0 0 0 Negative 3 X X 0 0 0 Negative 4 X X 0 0 0 Negative 5 X X X 0 0 0 Negative 6 X 0 0 0 Negative 7 X X X X X X X Ongoing 0 0 0 Negative 8 X X X X X X X Ongoing 0 0 0 Negative 9 X X 0 0 0 Negative 10 X 0 0 0 Negative 11 X X X 0 0 0 Negative 12 X X 0 0 0 Negative 13 X X 0 0 0 Negative 14 X 0 0 0 Negative 15 X 0 0 0 Negative 16 X 0 0 0 Negative 17 X X 0 0 0 Negative 18 X X 0 0 0 Negative 19 X X Completed 0 0 0 Negative 20 X 0 0 0 Negative 21 X 0 0 0 Negative 22 X 0 0 0 Negative 23 X X X Completed 0 0 0 Negative 24 X X X 0 0 0 Negative 25 X X X 0 0 0 Negative 26 X X X X X Completed 0 0 0 Negative 27 X X 0 0 0 Negative 28 X X X X 0 0 0 Negative 29 X X X 0 0 0 Negative 30 X X X 0 0 0 Negative 31 X 0 0 0 Negative 32 X X X 0 0 0 Negative 33 X X X X 0 0 0 Negative 34 X X 0 0 0 Negative 35 X X X 0 0 0 Negative 36 X X X X X X Ongoing 0 0 0 Negative 37 X X X X X X Ongoing 0 0 0 Negative 38 X X 0 0 0 Negative 39 X X X X X X Ongoing 0 0 0 Negative 40 X X X 0 0 0 Negative 41 X 0 0 0 Negative

Legend/Signs and Symptoms: 1 = sputum expectoration 2 = recurrent fever for the past 6 months 3 = weight loss 4 = back pains 5 = night sweats 6 = hemoptysis

Table 4 shows the result of the review of the specimen samples of the

respondents. There were 24 mucopurulent sputum samples, 3 mucoid samples and 14

salivary samples during the initial sputum collection process. A repeat sputum collection

was done among the respondents with salivary specimens. The table shows that the repeat

sputum samples of the 14 subjects with salivary samples were now mucopurulent but was

still found to be negative with Acid-fast bacilli.

Table 4. Result of the repeat sputum microscopy of the salivary sputum samples.

Repeat sputum Microscopy Respondent Result Sputum review Second Specimen

sample Result 1 Result 2 Result 3

Final diagnosis

1 Negative Salivary Mucopurulent 0 0 0 Negative 2 Negative Mucopurulent 3 Negative Mucopurulent 4 Negative Salivary Mucopurulent 0 0 0 Negative 5 Negative Salivary Mucopurulent 0 0 0 Negative 6 Negative Salivary Mucopurulent 0 0 0 Negative 7 Negative Mucopurulent 8 Negative Mucopurulent 9 Negative Salivary Mucopurulent 0 0 0 Negative 10 Negative Salivary Mucopurulent 0 0 0 Negative 11 Negative Mucopurulent 12 Negative Mucopurulent 13 Negative Mucopurulent 14 Negative Salivary Mucopurulent 0 0 0 Negative 15 Negative Salivary Mucopurulent 0 0 0 Negative 16 Negative Salivary Mucopurulent 0 0 0 Negative 17 Negative Mucopurulent 18 Negative Mucopurulent 19 Negative Mucopurulent 20 Negative Mucopurulent 21 Negative Salivary Mucopurulent 0 0 0 Negative 22 Negative Mucopurulent 23 Negative Salivary Mucopurulent 0 0 0 Negative 24 Negative Mucopurulent 25 Negative Salivary Mucopurulent 0 0 0 Negative 26 Negative Mucoid 27 Negative Mucopurulent 28 Negative Mucopurulent 29 Negative Mucopurulent 30 Negative Mucopurulent 31 Negative Salivary Mucopurulent 0 0 0 Negative 32 Negative Mucopurulent 33 Negative Mucopurulent 34 Negative Mucopurulent 35 Negative Mucoid 36 Negative Mucopurulent 37 Negative Mucopurulent 38 Negative Mucopurulent 39 Negative Mucopurulent 40 Negative Mucoid 41 Negative Salivary Mucopurulent 0 0 0 Negative

CHAPTER IV

DISCUSSION AND IMPLICATION

This study was formulated to determine the prevalence of tuberculosis among

jeepney drivers as well as to assess their perceptions regarding the disease. The number

of drivers totaled to 153, all of which were interviewed and assessed for the signs and

symptoms of tuberculosis. Out of the 153 respondents, 41 drivers were found to fit the

category of TB symptomatics.

Table 3 shows the TB symptomatic respondents having cough as a primary

symptom along with the number of associated signs and symptoms. The data implies that

regardless of the associated signs and symptoms, coughing of 2 weeks was the necessary

criteria for them to be considered as TB symptomatic. This was the guideline set by the

TB-DOTS program. The number of associated signs and symptoms, in this study

however, did not correlate with an increase probability of having tuberculosis because all

of the sputum microscopy examination yielded negative results.

In a study done by Giangco in 1991 where a pilot study was done in Cebu to test

the feasibility and effectiveness of the New Tuberculosis Program policies, the test

showed a high rate of sputum collection (90%) and a high positive rate (10%). In

contrast, our study yielded no positive result even though the same guideline was used.

During the interview, the researcher also asked the drivers if they were previously

diagnosed with the disease or have had any treatment of tuberculosis in the past. Three

drivers were found to be previously diagnosed with tuberculosis and have claimed to be

treated. Six of the symptomatics are currently undergoing treatment with tuberculosis. To

add to this, the 6 respondents mentioned were in fact the 6 respondents having cough

with 5 or 6 associated signs and symptoms in Table 3. However, their sputum microscopy

were negative suggesting perhaps that their current treatment has converted them to

sputum negative.

Kathadia in 2004, where the evaluation of direct microscopy as a screening test in

the diagnosis of tuberculosis, found high sputum false negative results (16% of the 820).

This study could support the possibility that some of the negative results could have been

false negative.

There may be several reasons that may lead to false negative results. One factor

could be in the technical sputum collection process. However, in this study, the NTP

policy guideline was strictly followed. Furthermore, the respondents were properly

instructed and direct observation while collecting specimen was done. No contamination

or error of collection was noted.

Another technical factor that perhaps could lead to false negative could be the

time delay between the acquisition of sample and the delivery of specimen to the

laboratory. In the NTP guideline, it was suggested that the sample be brought

immediately to the laboratory as soon as possible. This guideline was followed in the

study. The samples were brought to the laboratory not more than 2 hours from

acquisition.

Third factor could be due to the proficiency of the medical technologist reading

the samples or the time spent in reading the slides. The medical technologist assigned in

the sputum laboratory of ZCMC has been previously trained for sputum microscopy

reading specifically for their DOTS program.

In a study done by Cambanis in 2007, whether re-examining the slides for 10

minutes translates into higher case detection, found that sputum smear microscopy has

low sensitivity if performed quickly, and 10 minutes re-examination significantly

increases case detection.

In line with this, the ZCMC laboratory has only one trained medical technician

assigned to read the samples. The laboratory averages 30 patients a day. This could be a

very heavy task to do if the 10 minutes re-examination procedure was to be done.

Therefore the possibility of a false negative result, given this scenario, can not be

discounted.

Another factor that could have contributed to the negative sputum exam result

was due to the reason that these 6 people were already undergoing TB treatment already.

Two months of treatment would render a scanty or even zero count of bacilli in a sputum

exam (Rieder, 2006). This could be the most probable reason why the 6 symptomatics,

despite the clear signs and symptoms of tuberculosis, was found to be negative. A

generalization to this finding, therefore, is that the current TB treatment that they are

having is working. Perhaps it is prudent to further test these symptomatic drivers with

further test like X-ray and sputum culture which, unfortunately, is beyond the scope of

this paper.

Reviewing the given sputum samples, the medical technologist classified the

samples as salivary, mucoid or mucopurulent. In this study, 14 out of the 41 samples

were noted to be salivary specimens. Therefore, a repeat sputum examination among

these 14 subjects was done. However, the repeat sputum samples were by now

mucopurulent sputum samples, but the results were still negative for AFB (Table 4).

While it is true that the respondents were found to be negative with tuberculosis

using the sputum microscopy as a diagnostic tool, their perceptions about this disease was

still inappropriate and therefore may put them in a high risk of acquiring it.

The first table shows the demographic profile of the respondents as to age

distribution, years of driving experience and educational attainment. Majority of the

drivers were between 26-45 years of age and mostly with driving experience ranging

from 10 to 20 years. Their educational attainment were mainly elementary level or

elementary graduates. Some were able to reach high school level though while a few

managed to finish high school. None, however, have reached college level.

Several studies linked drivers to a high risk of having tuberculosis. Like the study

done by Oliver (2006) where car drivers were found to be at risk with having TB, the

study of Rosenman (1990) that linked truck drivers with the risk of having TB or the

study of Gary (2000) that linked taxi drivers with TB.

The years of driving experience could have shaped these perceptions because the

findings in this study show that their notion of tuberculosis was related to their line of

work. They claimed that TB came from sweating of back, over work and stress and even

smoking.

As to the nature and general information about tuberculosis as shown in Table 2,

majority of the respondents knew that tuberculosis was an infection of the lungs.

However, the remaining one-third of the respondent did not know anything else about

this disease. These people claimed that they did not have any experience or had any

chance to know patients with tuberculosis hence their inadequate knowledge about it. It

was likewise noted that this group did not care much about the disease and are not

mindful if they will contract TB at all. They were merely contented that they do not have

the disease. Seemingly, any knowledge about the disease did not seem to be of any

importance to them.

This line of thinking perhaps is due to the reason that their time, effort and interest

were all focused on making a living (driving) that any attempt to increase their

knowledge about the disease takes less significance to them. Another reason is perhaps

due to their lack of education since most of them reached only the elementary level. A

few of the respondents associate tuberculosis with vomiting of blood. This perception

might have came from their firsthand observation of people they knew to have

tuberculosis.

As to the perceptions of drivers regarding the transmission of tuberculosis, the

survey showed that half of the respondents believe that by using the utensils of TB

patients they can contract tuberculosis. They also said that TB could be acquired from

failing to eat nutritious foods or eating from sidewalk fast food establishments. They

claimed that the transmission of tuberculosis is by oral route.

A few of the respondents, however, knows that tuberculosis is acquired by saliva

infected droplet while the remaining one-fifth do not seem to know anything about the

transmission of tuberculosis. Some also thinks that TB came from unclean environment

and they said that tuberculosis most likely will not affect them if home cleanliness is

maintained.

Four-fifths of the respondents thought that tuberculosis was due to over work,

stress and smoking. They think that the days work of the drivers could predispose them to

having the disease if they don’t take enough rest during the night. Others claimed that

smokers would eventually develop tuberculosis because the smoke will destroy the lungs

and eventually experience difficulty of breathing, shortness of breath and frequent

recurrent cough. Unfortunately, these are perhaps symptoms of chronic obstructive

pulmonary disease (COPD) and the respondents seem to mistake COPD for TB. The rest

answered that TB came from inhalation of dust and smoke emitted from vehicles.

Perhaps this reasoning comes from their correlation of smoke emissions from the vehicles

as perceived risk for TB.

Some 7% of the respondents also thought that tuberculosis was due to a previous

trauma on the back that has progressed to TB later in life. Another 9% thought that TB is

derived from profuse sweating of the back and was left to dry. Because of this, putting a

towel inside the shirt on the back might help prevent it. A few (6%) also said that

tuberculosis may be contracted from excessive drinking of alcohol while remaining

respondents simply did not have any idea about the cause of TB.

Table 4 shows the drivers’ perceptions on the signs and symptoms of tuberculosis.

Most of the respondents identify excessive coughing as a primary sign of tuberculosis.

Weight loss ranks second as the most common sign of tuberculosis. The respondents also

associated TB with a thin body built. They claimed that if a person is thin and coughing,

that person most likely is having tuberculosis. Spitting or vomiting of blood was

identified third common sign of tuberculosis. They said that if a person coughs out blood,

that person is for sure having tuberculosis.

The other signs and symptoms given by the drivers included shortness of breath,

weak-looking appearance, pallor which they said was due to vomiting of blood, back

pains and an appearance of an elevated shoulders. They claimed that this particular

posture is associated with tuberculosis. One-third of the population, however, do not have

any idea about the signs and symptoms of tuberculosis.

Perceptions regarding the management/treatment of tuberculosis was also

presented in Table 4. Half of the respondents said that, as soon as the person thinks he

has tuberculosis, he should go and see a doctor. The other respondents said that they

would self-medicate their tuberculosis problem immediately using antitussive drugs or

other symptomatic treatment medications while some would even use antibacterial

medications. This latter behavior is greatly discouraged as inappropriate antibacterial

self-medication will not solve the problem simply because the bacteria may not be

susceptible to the drugs they will use, or at worse, it could lead to multi-drug resistant

strains (MDR) of tuberculosis.

Others have mentioned that the key to solving tuberculosis was to simply stop

smoking or drinking alcohol since they claimed that tuberculosis was caused by these

behaviors. In addition to the above mentioned ways to manage tuberculosis, the

respondents also suggested to eat nutritious foods. Having a good rest was also given

since according to some of the respondents TB was due to over work and stress.

Improving personal hygiene and use of clean utensils were also suggested by the

respondents.

One-fifth, however, said that they will do nothing because according to them TB

is just a self-limiting disease. This means that the TB infection will just get well without

doing anything about it. Unfortunately, this kind of behavior will sustain the cycle of TB

infection among the patient’s family members, household contacts or neighbors.

In summary, much of the perceptions of the drivers about tuberculosis were

inappropriate. Many have no knowledge about the nature of TB. Majority of the

respondents has wrong perceptions regarding TB’s mode of transmission. Only a handful

of the respondents knows the true etiology of TB. While several do not know anything of

TB’s signs and symptoms and that their management/treatment procedures are mainly

wrong ones.

This has challenged the researcher to do a health education intervention. Even

though it is not this paper’s objective, a TB information pamphlet was formulated. It was

constructed based on the drivers’ misconceptions gathered in this research. The pamphlet

contained the correct information, written in the local dialect, regarding the wrong

perceptions of the drivers about the disease. This was subsequently distributed to all of

the respondents.

The prevalence of PTB among public utility jeepney drivers was computed based

on the old and new cases of PTB gathered from this research divided by the total number

of population multiplied by 100. Based upon the survey results, the old cases of

tuberculosis was 9 and no new cases of tuberculosis has been found among jeepney

drivers in the selected barangays based upon the sputum microscopy result. But the 3

respondents that have completed the TB treatment course will not be included so

therefore only the 6 that are ongoing treatment will be divided by the total population of

153 multiplied by 100. Therefore, the prevalence rate of TB symptomatics among public

utility jeepney drivers in selected barangays in Zamboanga City is 26% and with the use

of sputum microscopy it was found that 3.92 per 100 population were found to be having

PTB among the jeepney drivers. The TB symptomatic prevalence was found to be higher

compared to the finding found by the UP College of Public Health of 17.5%, however,

the sputum microscopy TB prevalence was lower compared to the findings in Manila.

In the NTP policy about the diagnosis of tuberculosis, cough of 2 weeks duration

would warrant a consideration of PTB suspect diagnosis even without any associated

signs and symptoms of TB. This policy perhaps was designed for the general public. Any

individual, as long as they have 2 weeks duration of cough, would then be considered as a

TB symptomatic. Some cough however may be due to other pulmonary conditions like

COPD, or primarily those exposed to environmental pollutions. Unfortunately, because

of the generality of the coughing criteria, a reported high prevalence of TB symptomatics

may result among PUJ drivers which are generally exposed to car exhaust. Furthermore,

back pains because of the nature of their work may have also tilted them to a higher TB

symptomatic prevalence. Perhaps this will explain the discrepancy between high

prevalence of TB Symptomatics against diagnosed TB in this population.

CHAPTER V

CONCLUSION & RECOMMENDATIONS

The findings reported in this study show that the perceptions of the drivers on

tuberculosis were mostly wrong notions about the disease. Many have no knowledge

about the nature and general idea of TB. Majority has wrong perceptions regarding TB’s

mode of transmission. Only a handful of the respondents knows the true etiology of TB.

While several do not know anything of TB’s signs and symptoms and that their

management/treatment procedures were wrong.

It was also found that almost one-third of the population were found to fit the

category of TB symptomatics. The sputum microscopy revealed that these symptomatics

were negative for Acid-fast Bacilli. However, the survey revealed that 9 old cases of

tuberculosis was found. But based on prevalence rate computation which includes old

and new cases, the prevalence rate of TB symptomatics was found to be 26%. The

sputum microscopy TB prevalence was only 3.92 per 100 population. This prevalence

rate is relatively better compared to the prevalence of TB among PUJ drivers in Manila

(17.5%).

It is therefore recommended that a similar study be done for the entire jeepney

drivers in Zamboanga City. Similar study of active case-finding be done also among

other groups like tricycle drivers, pedicab drivers, taxi drivers or bus drivers in

Zamboanga city. Further in-depth analysis of their perceptions be carried out as well.

Lastly it is encouraged that further review and follow-up of these TB symptomatics in

this study using other TB diagnostic procedures like chest x-ray be done.

APPENDICES

APPENDIX A

Checklist Questionnaire

Name:__________________________________ Age:_________ Educational Attainment:________________________ Driving years :________

Regarding the nature and general idea of Pulmonary Tuberculosis? Infection of the lungs Vomiting of blood Cancer of the lungs I do not know Others Regarding the transmission of Pulmonary Tuberculosis?

From intake of food From using the utensils of infected individuals From unclean environment I do not know Others Regarding the etiology of Pulmonary Tuberculosis?

Over work and stress Smoking Inhalation of dust and smoke from vehicles I do not know Others Regarding the signs and symptoms of Pulmonary Tuberculosis?

Excessive coughing Spitting or vomiting of blood Back pains Weight loss I do not know Others Regarding the management of Pulmonary Tuberculosis?

Go to the doctor Improve personal hygiene practices Use clean utensils Self medicate (antibiotics, symptomatic treatment) Do nothing Others

APPENDIX B

Health Education Pamphlet

APPENDIX C

Mean Score Computation

Demographic Profile:

1. Age

21 X 3 = 63 36 X 6 = 216 51 X 3 = 153

22 X 2 = 44 37 X 10 = 370 52 X 4 = 208

23 X 2 = 46 38 X 5 = 190 53 X 4 = 212

24 X 1 = 24 39 X 3 = 117 54 X 2 = 108

25 X 2 = 50 40 X 4 = 160 55 X 2 = 110

26 X 5 = 130 41 X 7 = 287 56 X 2 = 112

27 X 6 = 162 42 X 4 = 168 57 X 1 = 57

28 X 4 = 112 43 X 6 = 258 58 X 3 = 174

29 X 3 = 87 44 X 3 = 132 59 X 2 = 118

30 X 5 = 150 45 X 2 = 90 60 X 2 = 120

31 X 6 = 186 46 X 2 = 92 61 X 2 = 122

32 X 4 = 128 47 X 3 = 141 62 X 4 = 248

33 X 5 = 165 48 X 5 = 240 63 X 1 = 63

34 X 5 = 170 49 X 4 = 196 65 X 1 = 65

35 X 2 = 70 50 X 2 = 100 Total: 6, 202 / 153 = 40.55

2. Years of Driving Experience

01 X 2 = 2 16 X 6 = 92 31 X 4 = 124

02 X 1 = 2 17 X 5 = 85 32 X 3 = 96

03 X 3 = 9 18 X 8 = 144 33 X 6 = 198

04 X 2 = 8 19 X 7 = 133 34 X 6 = 204

05 X 2 = 10 20 X 3 = 60 35 X 3 = 105

06 X 5 = 30 21 X 2 = 42 36 X 3 = 108

07 X 2 = 14 22 X 3 = 66 37 X 2 = 74

08 X 4 = 32 23 X 4 = 92 38 X 2 = 76

09 X 3 = 27 24 X 2 = 48 39 X 2 = 78

10 X 4 = 40 25 X 2 = 50 40 X 1 = 40

11 X 5 = 55 26 X 5 = 130 41 X 3 = 123

12 X 4 = 48 27 X 2 = 54 42 X 3 = 126

13 X 6 = 78 28 X 3 = 84 44 X 3 = 132

14 X 6 = 84 29 X 4 = 116 45 X 2 = 90

15 X 7 = 105 30 X 3 = 90 Total: 3, 396 / 153 = 22.20

BIBLIOGRAPHY

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TB among the residents of barangay Labuan, Z.C.

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Curriculum Vitae

Personal Information:

Name: Michael Ducusin Suarez

Age: 26

Sex: Male

Civil Status: Single

Date of Birth: April 20, 1981

Address: Triplet St., San Jose Rd. Zamboanga city

Religion: Roman Catholic

Father’s name: Erlando A. Suarez Sr.

Mother’s Name: Aurelia D. Suarez

Educational Background:

Medicine:

School: Ateneo de Zamboanga University School of Medicine

Year: 2002-2006

College:

Degree: Bachelor of Science in Biology

School: Ateneo de Zamboanga University

Year : 2002

High School: Claret High School of Zamboanga city (1998)

Elementary: Claret High School of Zamboanga city (1994)