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. 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

• 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

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 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

Significance of the Study

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 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

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

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

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

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

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

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

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

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