Disease Burden in the National Capital Region

What’s inside? 7 July 2016Disease Burden in the National Capital Region 2 DemographyDengueHIV/AIDS Imfluenza- like Illness LeptospirosisTuberculosis

7 July 2016Disease Burden in the National Capital Region 3 7 July 2016National Capital Region3

7 July 2016Disease Burden in the National Capital Region 4 7,107 islands Land area: ~300,000 km 2 No land boundaries  North: Taiwan  South: Malaysia and Indonesia  West: Vietnam  East: Palau  Northwest: China Coastline: 17,500 – 36,289 kms Capital: Manila Population:  99,374, st largest economy in the world

National Capital Region Situated on an isthmus bound by Laguna de Bay to the southeast and Manila Bay to the west Land area: km 2 Bordered by Bulacan to the north, Rizal to the east, Laguna to the south and Cavite to the southwest 4 districts LGUs  16 Cities  1 Municipality  1,705 Barangays 7 July 2016Disease Burden in the National Capital Region 5

National Capital Region Center of culture, economy, education and politics Highly urbanized and industrial region Vastly mobile population Population: 12,532, Growth rate: 2.12 Population density: ~19,626/km 2 7 July 2016Disease Burden in the National Capital Region 6

Health Facilities (2012) Health Centers: 467  Ratio to population: 1:25,605 Lying-in Clinics: 44 Barangay Health Stations: 22 Hospitals  50 public, 133 private 7 July 2016Disease Burden in the National Capital Region 7

ManpowerNo. Ratio to Population Physician6191:19,317 Dentist4981:24,011 Nurse9041:13,227 Midwife1,1381:10,507 Nutritionist851:140,676 Medical Technologist2001:59,788 Sanitary Engineer21:5,978,750 Sanitary Inspector2801:42,705 Active Barangay Health Workers4,5961:2,602 7 July 2016Disease Burden in the National Capital Region 8 Table 1. Health Manpower Complement National Capital Region, 2012

YearPopulation Crude Birth Rate* Crude Death Rate* Maternal Mortality Rate** Infant Mortality Rate** Under-5 Mortality Rate** ,252, ,403, ,552, ,819, ,957, July 2016Disease Burden in the National Capital Region 9 Table 2. Vital Health Indices National Capital Region, *per 1,000 population ** per 1,000 livebirths

What we want? 7 July 2016Disease Burden in the National Capital Region 10 Healthy and safe Metro Manila!

7 July 2016Disease Burden in the National Capital Region 11 (Dengue Prevention and Control Program)

Dengue-free NCR Goal (2015) 50% decrease in the morbidity and mortality of dengue infection from a 5-year average ( ) 7 July 2016Disease Burden in the National Capital Region 12

Activities Advocacy Communication and Social Mobilization  Search for Dengue-Free Barangay  Brigada Eskwela Campaign; ovi /larvi trap Capability Building  Integrated Vector Management, COMBI and Vector Surveillance; clinical management Provision of logistics, equipment, manpower support  adulticides, larvicides, ULV machines, insecticide treated screens  environmental interventions e.g. spray men, space spraying 7 July 2016Disease Burden in the National Capital Region 13

Activities Surveillance  Sentinel sites reporting  Dengue Rapid Reporting and Response System (DR3S) Monitoring and Evaluation Research (ongoing): Dengue Early Warning System 7 July 2016Disease Burden in the National Capital Region 14

Figure 1. Distribution of Dengue Cases by Morbidity Week National Capital Region, 2012 vs July 2016Disease Burden in the National Capital Region 15 Number of Cases Morbidity Week

Figure 2. Distribution of Dengue Cases by Morbidity Week National Capital Region, Alert and Epidemic Threshold, vs July 2016Disease Burden in the National Capital Region 16 Number of Cases

Table 3. Distribution of Dengue Cases and Deaths by LGU (N=23,437) National Capital Region, 2012 vs (January 1 – December 31) 7 July 2016Disease Burden in the National Capital Region 17 LGU CasesDeaths Change Rate 2013 CFR % Quezon City8,7217, Manila City5,4923, Caloocan City3,6912, Parañaque City2,9521, Pasig City2,5331, Pasay City1,3141, Las Piñas City1, Marikina City Valenzuela City1, LGU CasesDeaths Change Rate 2013 CFR % Taguig City1, Muntinlupa City1, Malabon City1, Makati City1, Mandaluyong City San Juan City Navotas City Pateros T O T A L 35,35623,

Table 4. Attack Rates by LGU per 10,000 Population (N=23,437) National Capital Region, January 1 – December 31, July 2016Disease Burden in the National Capital Region 18 LGU CasesPopulation Attack Rate San Juan City339122, Pasay City1,025405, Quezon City7,2342,977, Parañaque City1,542640, Malabon City753359, Pasig City1,418733, Marikina City819437, Manila City3,0071,670, Las Piñas City971582, LGU CasesPopulation Attack Rate Muntinlupa City759461, Caloocan City2,4401,608, Mandaluyong City477340, Valenzuela City810609, Makati City688548, Taguig City801713, Navotas City285256, Pateros6966, T O T A L23,43712,532,

Figure 3. Distribution of Dengue Cases and Deaths by Age-group (N=23,437) National Capital Region, January 1 – December 31, July 2016Disease Burden in the National Capital Region 19 Number of CasesCase-Fatality Rate Age-group

7 July 2016Disease Burden in the National Capital Region 20 Figure 4. Distribution of Dengue Cases by Age-group and Sex (N=23,437) National Capital Region, January 1 – December 31, 2013 Age-group FemaleMale Number of Cases

7 July Disease Burden in the National Capital Region (National AIDS and STI Prevention and Control Program)

Vision / Goal AIDS Medium Term Plan Vision Zero new infection Zero discrimination Zero AIDS-related deaths NASPCP Goal 1. Reduce new HIV infection 2. Improve the quality of life of PLHIV 7 July 2016Disease Burden in the National Capital Region 22

Activities Advocacy Communication & Social Mobilization  Rapid Assessment Survey  Consultative meetings Capability Building  HIV Proficiency Testing  Hospital HIV/AIDS Core Team  HIV Counselling and Testing  Establishment of Social Hygiene Clinics and Satellite Treatment Hubs 7 July 2016Disease Burden in the National Capital Region 23

Activities Provision of logistics  ARV, HIV Testing Kit, RPR, TPHA, gram stain, condom, lubricant, IEC materials, cefixime, metronidazole, azithromycin Monitoring and Evaluation 7 July 2016Disease Burden in the National Capital Region 24

Figure 5. Distribution of HIV/AIDS Cases by Month and Classification (N=2,218) National Capital Region, July 2016Disease Burden in the National Capital Region 25 Number of Cases Morbidity Month

Table 5. Distribution of HIV/AIDS Cases by Classification and Sex (N=2,218) National Capital Region, July 2016Disease Burden in the National Capital Region 26 Classification Sex December, 2013 January – December, 2013 AIDS Female03 Male11148 Asymptomatic Female49 Male1222,018 T O T A L1372,218

7 July 2016Disease Burden in the National Capital Region 27 Figure 6. Distribution of HIV/AIDS Cases by LGU and Classification (N=2,218) National Capital Region, 2013 Number of Cases Local Government Unit

7 July 2016Disease Burden in the National Capital Region 28 Figure 7. Distribution of HIV/AIDS Cases by Age-group and Sex (N=2,218) National Capital Region, 2013 Age-group FemaleMale Number of Cases

Figure 8. Distribution of HIV/AIDS Cases by Mode of Transmission (N=2,218) National Capital Region, July 2016Disease Burden in the National Capital Region 29 Homosexual 1,211 (55%) Bisexual 732 (33%) Heterosexual 275 (12%)

7 July Disease Burden in the National Capital Region

Figure 9. Distribution of Influenza-like Illness Cases by Morbidity Week National Capital Region, 2012 vs July 2016Disease Burden in the National Capital Region 31 Number of Cases Morbidity Week

Table 6. Distribution of Influenza-like Illness Cases and Deaths by LGU (N=2,099) National Capital Region, 2012 vs (January 1 – December 31) 7 July 2016Disease Burden in the National Capital Region 33 LGU CasesDeaths Change Rate 2013 CFR % Parañaque City Pasig City Manila City1, Muntinlupa City Quezon City Valenzuela City Malabon City3611,9330- Las Piñas City Pasay City LGU CasesDeaths Change Rate 2013 CFR % Caloocan City Makati City San Juan City Marikina City Mandaluyong City Pateros Taguig City Navotas City T O T A L 3,5252,

Table 7. Attack Rates by LGU per 10,000 Population (N=2,099) National Capital Region, January 1 – December 31, July 2016Disease Burden in the National Capital Region 34 LGU CasesPopulation Attack Rate Parañaque City565640, Pasig City411733, Muntinlupa City227461, San Juan City28122, Manila City3401,670, Pateros1366, Malabon City61359, Valenzuela City90609, Las Piñas City53582, LGU CasesPopulation Attack Rate Pasay City36405, Quezon City1672,977, Makati City28548, Marikina City22437, Mandaluyong City17340, Caloocan City291,608, Taguig City12713, Navotas City0256,086- T O T A L2,09912,532,

Figure 11. Distribution of Influenza-like Illness Cases and Deaths by Age-group (N=2,099) National Capital Region, January 1 – December 31, July 2016Disease Burden in the National Capital Region 35 Number of CasesCase-Fatality Rate Age-group

7 July 2016Disease Burden in the National Capital Region 36 Figure 12. Distribution of Influenza-like Illness Cases by Age-group and Sex (N=2,099) National Capital Region, January 1 – December 31, 2013 Age-group FemaleMale Number of Cases

7 July Disease Burden in the National Capital Region

Figure 13. Distribution of Leptospirosis Cases by Morbidity Week National Capital Region, 2012 vs July 2016Disease Burden in the National Capital Region 38 Number of Cases Morbidity Week Habagat August 6, 2012 August 26, 2013

Figure 14. Distribution of Leptospirosis Cases by Morbidity Week National Capital Region, Alert and Epidemic Threshold, vs July 2016 Disease Burden in the National Capital Region 39 Number of Cases Morbidity Week

Table 8. Distribution of Leptospirosis Cases and Deaths by LGU (N=1,076) National Capital Region, 2012 vs (January 1 – December 31) 7 July 2016Disease Burden in the National Capital Region 40 LGU CasesDeaths Change Rate 2013 CFR % Quezon City Manila City Parañaque City Caloocan City Pasay City Malabon City Las Piñas City Taguig City Navotas City LGU CasesDeaths Change Rate 2013 CFR % Valenzuela City Pasig City Makati City Muntinlupa City Marikina City Pateros Mandaluyong City San Juan City T O T A L 2,3491,

Table 9. Attack Rates by LGU per 10,000 Population (N=1,076) National Capital Region, January 1 – December 31, July 2016Disease Burden in the National Capital Region 41 LGU CasesPopulation Attack Rate Parañaque City136640, Pasay City84405, Navotas City51256, Malabon City70359, Manila City1961,670, Las Piñas City68582, Taguig City62713, Quezon City2132,977, Caloocan City1021,608, LGU CasesPopulation Attack Rate Pateros466, Valenzuela City27609, Pasig City23733, Makati City17548, Muntinlupa City14461, Marikina City5437, Mandaluyong City3340, San Juan City1122, T O T A L1,07612,532,

Figure 15. Distribution of Influenza-like Illness Cases and Deaths by Age-group (N=1,076) National Capital Region, January 1 – December 31, July 2016Disease Burden in the National Capital Region 42 Number of CasesCase-Fatality Rate Age-group

7 July 2016Disease Burden in the National Capital Region 43 Figure 16. Distribution of Leptospirosis Cases by Age-group and Sex (N=1,076) National Capital Region, January 1 – December 31, 2013 Age-group FemaleMale Number of Cases

(National Tuberculosis Control Program) 7 July Disease Burden in the National Capital Region

TB-free NCR Impact Target (2016) 50% decrease in TB prevalence compared to 1990 data 50% decrease in TB mortality compared to 1990 data Outcome Target (2016) 90% CDR, TB all forms 90% Treatment Success Rate 7 July 2016Disease Burden in the National Capital Region 45

Activities Advocacy Communication & Social Mobilization  Community TB Task Forces  Manuel L. Quezon Awards Capability Building  Basic DOTS, Basic DSSM, Gene Xpert, EQA, PICT Provision of logistics  Laboratory supplies, anti-TB drugs (FLD & SLD), PMDT Treatment Centers and Satellite TC Monitoring and Evaluation Research (ongoing): Prevalence of Chronic Obstructive Pulmonary Diseases (COPD) Among Patients Previously Treated for Pulmonary Tuberculosis in Metro Manila (Pre COPT Study) 7 July 2016Disease Burden in the National Capital Region 46

IndicatorTarget PhilNCRPhilNCRPhilNCR Success Rate Cure Rate Case Detection Rate, New Smear (+) Case Detection Rate, all forms July 2016Disease Burden in the National Capital Region 47 Table 10. Trends of NTP Indicators Philippines vs. National Capital Region,

7 July 2016Disease Burden in the National Capital Region 48 Figure 17. TB Morbidity and Mortality Rates per 100,000 Population National Capital Region, Rate /100,000 Population Year

7 July 2016Disease Burden in the National Capital Region 49 Figure 18. Distribution of TB Cases Notified (N=33,023) National Capital Region, 2012 New Smear Negative (61%) New Smear Positive 11,312 (34%) Extra-pulmonary 853 (3%)

7 July 2016Disease Burden in the National Capital Region 50 Figure 19. Distribution of Dengue Cases by Age-group and Sex (N=36,994) National Capital Region, 2012 Age-group FemaleMale Number of Cases

7 July 2016Disease Burden in the National Capital Region 51 Figure 20. Distribution of New Smear Positive, Treatment Outcome (N=11,707) National Capital Region, 2012 Success 10,072 ( 86%) Defaulted 543 (5%) Transferred-out 466 (4%) Failed 230 (2%)

Programmatic Management of Drug-resistant TB 5 Treatment Centers  (KASAKA QI, LCP, DJNRMH, PTSI Tayuman, SLH) 5 Satellite Treatment Centers  Caloocan City: 1  Manila City: 3 (1 hospital)  Muntinlupa City: 1 (NBPH)  Pasay City: 1  Parañaque City: 1  Quezon City: 2 (1 jail) 7 July 2016Disease Burden in the National Capital Region 52

Drug-resistant TB cases treated in NCR, as of July, 2013: 1,388  NCR residents: 1,150 (83%)  Other regions: 238 (17%) 7 July 2016Disease Burden in the National Capital Region 53 Programmatic Management of Drug-resistant TB

7 July 2016Disease Burden in the National Capital Region 54 Figure 21. Enrolled Drug-resistant TB Cases by Year Philippines vs. National Capital Region,

7 July 2016Disease Burden in the National Capital Region 55 Age-group Number of Cases Figure 22. Distribution of Cohort Outcome by Year Philippines,

Indicators2016 Target 2012 PhilNCR IMPACT Target 50% decrease in TB prevalence compared to 1990 data 414 / 100,000 population % decrease in TB mortality compared to 1990 data 44 / 100,000 population OUTCOME Target CDR, TB all forms 90%82100% Treatment Success Rate 90%9186% 7 July 2016Disease Burden in the National Capital Region 56 Table 11. NTP Status Philippines vs. National Capital Region, 2012

7 July 2016Disease Burden in the National Capital Region 57 Your lifestyle – how you live, eat, emote, and think – determines your health. To prevent disease, you may have to change how you live.