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

TYPHOON ONDOY

Leptospirosis Cases

Department of Health Department Memorandun No – 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

Risk of infection and doxycycline dose RISKDESCRIPTIONDOXYCYCLINE DOSE Low RiskSingle 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 RiskSingle 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 RiskContinuous exposure of wading in flood or contaminated water with or without wounds, cuts, open lesions Swimming in flooded water and ingestion of contaminated water 2 capsules of 100mg once weekly until the end of exposure

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

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

Statement of the Problem This 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

Barangay with poor response Functionally prepared Not funtionally prepared Barangay with effective response Functionally prepared Not funtionally prepared

Significance of the Study

Natural disasters Preparedness Health Emergency Response Teams

Preparedness Efficiency Not functioning Functioning Not efficient

Results Knowledg e Better strategies Better functioning Improvement

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

Scope and Limitations

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

Specific Objectives To 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

Research Design This 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

Tool for Data Collection: Interview Checklist Pre-testing of the proposed interview questionnaire will be done before the actual data collection process

Selection of Study Subjects Stratified random sampling – Pasig, Marikina, Cainta and Taytay – P value of 0.05 – Pre-testing

Sampling Methods Target Population Sample Population Number of Health Workers Purposive Sampling Stratified Simple Random Sampling

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

Exposure – Dependent on the barangay having a functionally prepared health emergency response system

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

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

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

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.)

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

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

Patient Education on Leptospirosis prevention – Properly educating or informing residents in high- risk communities about the identification, management, and prevention of leptospirosis

Potential Biases Recall bias Response Bias Hawthorne Effect Selection Bias

Data Collection Procedure Sampling Conduct Pre-test Evaluate Pre-test Actual Data Collection Data Analysis Presentation

Data Processing Two Way tables – Where data collected will be encoded and tabulated in One Way Frequency Tables – for descriptive interpretation

PLAN FOR ANALYSIS

Independent Variable The functional preparedness of the system will be measured by different factors: – Policies – Staff – Meetings – Information dissemination – Training

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

Statistical / Analytical Tool of Measurement

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.

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

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

Statistical Analysis Will use the SPSS 17 (PASW 18) software.

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

Workplan

Budget ITEMQUANTITYUNIT COSTTOTAL COST A4 bond paper500 pages50 centsPhp Ink cartridge2Php Php 1, Photocopy expenses: Questionnaire 360 pages50 centsPhp Travel expenses: Gasoline 120LPhp 40.00Php 4, Token for barangays˜30Php 100Php 3, TOTALPhp 9,230.00