1. By Sunny L. Natividad Donnabel L. Tubera MD MPH DIH Marina Bay Sands September 17, 2014 Web-based Tuberculosis Register for the City of Baguio

2. The world is moving so fast these days that the man who says it can’t be done is generally interrupted by someone doing it- Elbert Hubbard

3. “Baguio is home of diverse and dynamic cultures, center for education, trade and tourism in harmony with nature managed by God-loving steadfast leaders in partnership with responsible and peace-loving citizenry.”

4. BAGUIO CITY Located 5,000 feet ASL Summer Capital of the Philippines; Mean Temperature of 18°C

6. BAGUIO, 1910

7. BAGUIO, 2010

9. Challenges of Urban Health

14. TB Management Framework TB Political commitment Quality assured microscopy Supervised treatment PMDT Sustained Political commitment Rational case finding: accurate & timely diagnosis through quality assured culture and DST Appropriate treatment strategies that utilize 1 st and 2 nd line drugs under proper management conditions P

15. TB Management Framework Regular availability of 1 st line drugs Standardized records & reports Uninterrupted supply of quality assured 1 st and 2 nd line drugs Standardized recording and reporting system designed for DR-TB program TB Register TB MDR-TB

16. MDG: To reduce prevalence and mortality by half by the year 2015 National TB Control Program Case detection rate: > 90% Success rate: > 90% TB in Adult TB in Children PMDT TB/HIV ACSM PPMD TB in Workplace TB in Prison PMDT

17. History of previous treatment? No or UPS* Decision of MD or TBDC? For ages <15 y/o, decide based on the following diagnostic criteria (3/5): Clinical signs and symptoms (3/6) - – Coughing/wheezing of > 2 weeks, esp. if unexplained – Unexplained fever of > 2 weeks after common causes such as malaria or pneumonia have been excluded – Loss of weight/failure to gain weight/weight faltering/loss of appetite – Failure to respond to 2 weeks of appropriate antibiotic therapy for LRTI – Failure to regain previous state of health 2 weeks after a viral infection or exanthema (e.g., measles) – Fatigue, reduced playfulness, or lethargy (child has lost his/her normal energy) Exposure to an active TB case (adult/adolescent) Positive Tuberculin Skin Test Chest X-ray suggestive of TB Other laboratory findings Xpert MTB/Rif result? Yes MTB positive, Rif-sensitive Bacteriologically- confirmed PTB Yes Bacteriologically confirmed PTB, New No Clinically diagnosed TB, New (PTB if CXR+ or with cough) No DSSM positive ? Age <15 y/o? No or not done MTB negative Not TB or investigate further/refer to specialist Chest x- ray findings suggestiv e of TB? No With access to Xpert MTB/Rif? Yes Category I Treatment Clinically diagnosed TB, Retreatment (PTB if CXR+ or with cough) Yes MTB positive, Rif-resistant Refer to PMDT services for evaluation Bacteriologically confirmed PTB, Retreatment Yes Category II Treatment (for Rif-sensitive) Classification Disposition Treatment Diagnosis Xpert Result Question Diagnostic Test COLOR LEGEND Notes: *Unable to produce sputum PRESUMPTIVE TB: Cough of at least 2 weeks in an adult (age >15 y/o) A child (<15 y/o) w/ any 3 out of 6 criteria for TB Signs/Symptoms Chest X-ray suggestive of tuberculosis Cough of any duration in a high risk individual or a close contact of an active TB case (adult/adolescent) Not TB or investigate further/refer to specialist Clinically diagnosed TB (PTB if CXR+ or with cough) History of previous treatment?

19. You just have to take the pills and that’s it? L. Raymond, 2010

20. Default tracing Health education and counseling Provision of enablers Social support network

21. Abstract The integration of Geographic Information Science (GISc) in Health & Medicine is an innovative way for analysis of the spread of communicable diseases. The spatial representation helps strengthen the construction, access, incorporation and the publication of large volumes of geographically related data & facts.

22. Objectives To determine the problems encountered in the current TB Register; To develop the features needed in analyzing and recording patient’s information; and To support the judgments of the health officials on where to focus in preventing the spread of TB.

23. System Features Users can add and modify patient and treatment information to the system as well as schedule an appointment for treatment

24. Calendar view of Scheduler

25. System Features The system is also capable of generating notifications through SMSs and pop-ups in its interface.

26. System Features Use of Geographic Information Science (GISc) to spatially represent the spread of the disease in the City of Baguio.

27. Sample Map of TB Cases in Baguio City

28. System Features In addition, graphs are also added to summarize the tabular form within the system.

29. Sample Graphs

31. Thank you! donnabel_md@yahoo.com sunnynatividad@gmail.com gplus.to/sunnynatividad