Impacts of Flood on Health:

Epidemiologic Evidence from Hagonoy, Bulacan

by

Maria Danica C. Rivera

Ruby Sunshine B. Balatbat

Louise Kyleen L. Borja

Sheila Marie C. De Chavez

Mary Grace C. Dela Cruz

Jade M. De Jesus

Mary Lorry Laine C. Dionisio

Ma. Jaecelyn S. Junio

Abigael F. Santos

Karen May C. Zaragosa

A Thesis in Partial Fulfillment of the Requirements

for the Degree Bachelor of Science in Nursing

Bulacan State University

October 2013

Bulacan State UniversityCOLLEGE OF NURSINGResearch and Development Office

APPROVAL SHEET

This Thesis entitled

Impacts of Flood on Health: Epidemiologic Evidence from Hagonoy, Bulacan

prepared and submitted by Maria Danica C. Rivera, Ruby Sunshine C. Balatbat, Louise Kyleen L. Borja, Sheila Marie D. De Chavez, Mary Grace C. Dela Cruz, Jade M. De Jesus, Mary Lorry Liane C. Dionisio, Ma. Jaecelyn S. Junio, Abigael F. Santos, Karen May C. Zaragosa has been approved and accepted as partial fulfillment of the requirements for the degree Bachelor of Science in Nursing,

MART JUARESA M. CABANTOG, RN, MAN Adviser

PANEL OF EXAMINERS

Approved by the College of Nursing Research Committee on Oral Examination with a grade of ____________________ on October ___, 2013.

______________________________Chairman

________________________ ________________________

Member Member

________________________ ________________________

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Member Member

_____________________________Dean

Acknowledgements

The researchers at this point would like to express their sincere appreciation to

those who have contributed and helped to their study:

To The Dean, who signed the letter of request for the permission to conduct the

study.

To The Adviser, who gave advices to the researcher to have a better research

presentation.

To The Dr. Romel Pajela, The Head of Rural Health Unit of Hagonoy, Bulacan

who approved and gave the researcher a chance to conduct a study to their town.

To The Panel of examiners who correct and examine the study before its

implementation.

To The Researchers’ Family who provide financial and emotional support to the

researchers.

And above all, to our God Almighty who always guide, protect and enlightening

the minds of the researchers.

The Researchers

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Abstract.

Hagonoy is one of the most flood prone places in Bulacan. Long and heavy

rainfall during September 2011 resulted in devastating flood caused a substantial health

impact on residence in municipality. The aim of this study is to ascertain the vulnerability

and health impacts of the devastating flood in Hagonoy, Bulacan by identifying the

differences in injuries, and morbidity patterns (dermatitis, diarrhea, conjunctivitis,

leptospirosis, hypertension, and dengue fever) between flood with most affected and least

affected household. A comparative studies and descriptive survey design was carried out

involving 198 respondents in 6 selected communes (3 less affected area and 3 heavily

affected area). Respondent were interviewed and information collected on the social,

economic, and health impacts of the devastation of the flood. The finding showed higher

incidence of dermatitis and diarrhea in severely affected by flood as compared to the less

affected area. For people in flood prone areas, flood prevention and mitigation strategies

need to be seriously thought through and acted upon, as this people are exposed to greater

health problem.

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Table of Contents

Approval Sheet............................................................................................................... ii

Acknowledgment............................................................................................................ iii

Abstract ........................................................................................................................ iv

List of Tables.................................................................................................................. vii

List of Figures................................................................................................................. viii

Chapter1. The Problem and Review of Literature................................................................. 1

Introduction........................................................................................................... 1Significance of the study....................................................................................... 4Review of Related Literature................................................................................. 5

Theoretical Framework.......................................................................................... 28Conceptual Framework.......................................................................................... 30Statement of the Problem....................................................................................... 31Operational Definition of Terms........................................................................... 32Scope and Delimitation......................................................................................... 33

2. Methodology.......................................................................................................... 34

Research Design.................................................................................................... 34Population and Sample of the Study...................................................................... 35Research Instruments............................................................................................. 36Development of the Questionnaire........................................................................ 36Data Gathering Procedure..................................................................................... 37Data Processing and Statistical Treatment............................................................ 37

3. Results and Discussions......................................................................................... 38

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4. Summary, Conclusions and Recommendations.................................................... 45Summary................................................................................................................ 45Findings................................................................................................................. 50Conclusions........................................................................................................... 53Recommendations................................................................................................. 56

REFERENCES .............................................................................................................. 57

APPENDIX..................................................................................................................... 59

A. Letter of Request for the Permission to Conduct the Study (Signed)................. 59B. Letter for Conducting A Survey……………………………………………… 60C. Instruments......................................................................................................... 61D. Curriculum Vitae................................................................................................ 65

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LIST OF TABLES

Table Page

1. Table1. Characteristic of study population.................................................... 38

2. Table2. Experience with the heavy rainfall/flood.......................................... 39

3. Table3. Access to health care service............................................................ 40

4. Table4. Injuries.............................................................................................. 41

5. Table5. Health condition within one month after the flood........................... 42

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LIST OF FIGURES

Figure Page

1. Conceptual Framework of the Study............................................................. 30

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1

Chapter 1

The Problem and Review of Related Literature and Studies

Introduction

Floods have been causing people’s Life too much disaster or devastating their

Livestock for some decades. Flood is an overflow of water that submerges or "drowns"

land. The European Union (EU) Floods Directive defines a flood as a covering by water

of land not normally covered by water. In the sense of "flowing water", the word may

also be applied to the inflow of the tide. Flooding may result from the volume of water

within a body of water, such as a river or lake, which overflows or breaks levees, with the

result that some of the water escapes its usual boundaries, or may be due to accumulation

of rainwater on saturated ground in an aerial flood. While the size of a lake or other body

of water will vary with seasonal changes in precipitation and snow melt, it is unlikely to

be considered significant unless it floods property or drowns domestic animals. Floods

can also occur in rivers when the flow rate exceeds the capacity of the river channel,

particularly at bends or meanders in the waterway. Floods often cause damage to homes

and businesses if they are in the natural flood plains of rivers. While reverie flood

damage can be eliminated by moving away from rivers and other bodies of water, people

have traditionally lived and worked by rivers because the land is usually flat and fertile

and because rivers provide easy travel and access to commerce and industry. Some floods

develop slowly, while others such as flash floods can develop in just a few minutes and

without visible signs of rain. Additionally, floods can be local, impacting a neighborhood

or community, or very large, affecting entire river basins. During Floods if people in a

certain community soaked their foot in the dirty water there is a possibility that they can

acquire athlete’s foot, if they have an open wound and had exposed their foot in the water

with rat’s urine they are possibilities to acquire Leptospirosis, and lastly the people left

the environment dirty it may be a site for reproduction of mosquitoes that might be a

carrier of dengue virus.

Flooding accounts for about 40% of all natural disasters worldwide and causes about half

of all deaths. The greatest potential flood hazard is in Asia. For the past two decades

more than 400 million people on average have been directly exposed to floods. Between

1987 and 1997, 44% of all flood disasters worldwide affected Asia, claiming 228, 000

lives (roughly 93% of all flood-related deaths worldwide). Last August 7, 2012 Manila

Philippines get flooded and this cause the 250, 000 to flee their homes (WHO), and in the

following day Emergency workers and troops rushed food, water and clothes to nearly

850,000 people displaced and marooned from deadly floods spawned by 11 straight days

of southwest monsoon rains that soaked the Philippine capital and nearby provinces. Due

to Flooding some diseases was been arises and affects the people’s health. According to

the report of Hagonoy Heath Office last August of 2012, There is 450 residents that been

affected by flood at San Agustin. The diseases that been reported are Acute Respiratory

Infection that has 67 incident, Athletes Foot that has 47, Hypertension that has 22,

Diarrhea that has 7 and Leptospirosis that has 4 incidence. According to the Department

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of Health in the Philippines, the 32,193 cases of the mosquito-borne disease between

January and June 2012 are 3.89 percent higher than the 30,989 cases recorded in the same

period last year. The National Capital Region recorded the most number of cases at

7,670, Central Luzon having 5, 552 cases, and CALABARZON’s 4, 508 cases amid

repeated reminders from the department for the public to continuously clean mosquito-

breeding areas (GMA News, 2012). For the cases of Leptospirosis the department of

health said that it increased by 62.32 %. From January 1 to August 18, 2012, leptospirosis

cases reached a total of 2,471 with 129 deaths, the report said. In the same period last

year, the DOH recorded only 1,522 cases (J.F. Manongdo, Manila Bulletin 2012).

The researchers have chosen this topic as their study for them to have a deeper

knowledge and understanding about Floods and its Impact to the health of the people

living in Hagonoy, Bulacan. Hagonoy Bulacan is one of the town in Bulacan that has

been affected so much last 2011 of the “Typhoon Pedring” that cause to much flood in

the area, in addition to this, High Tide contributes to it that cause long term Flood on the

area. Also they have chosen this study for the nurses to learn and formulate disease

prevention program and Mitigation strategies that needs to be seriously thought through

and acted upon.

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Significance of the Study

This study can be a learning source of the student and the community to gain

knowledge about the possible impacts of Flood on their health. This will also serves as a

guide to formulate certain action and programs for disease prevention before, during and

after the Floods. The study will benefit the

Residents – Residents who really been affected by floods may learn on how to

prevent certain diseases and infection caused by floods. This can also help the residents

to be prepared every time floods occur.

Community – The community can be prepared for the possible impacts of flood to

their health. They can also now make the most of the resources available in the oceans

and be prepared every time the water level rises. They will also gain more knowledge

about the disease brought by floods. And now, the health center must be prepared to treat

the disease like diarrhea, leptospirosis, malaria, athlete’s foot (Tinea Pedis)

Nurses – Nurse will be able to know the possible disease that can be obtained

from floods, like diarrhea, leptospirosis, malaria, athlete’s foot and Wound Infection.

This study will help to have a deeper understanding about the impacts of floods on health,

so in the near future the researcher can share their knowledge to the communities about

possible programs to prevent diseases that may acquires through the floods.

Future researchers – For future researches they can use this as their reference or

guide in creating their thesis. They can also use this study as a comparison to past studies

about Impacts of Flood on the health.

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Review of Literature and Studies

Principal types and causes

Areal (rainfall related). Floods can happen on flat or low-lying areas when the

ground is saturated and water either cannot run off or cannot run off quickly enough to

stop accumulating. This may be followed by a river flood as water moves away from the

floodplain into local rivers and streams.

Floods can also occur if water falls on an impermeable surface, such as concrete,

paving or frozen ground, and cannot rapidly dissipate into the ground. Localized heavy

rain from a series of storms moving over the same area can cause areal flash flooding

when the rate of rainfall exceeds the drainage capacity of the area. When this occurs on

tilled fields, it can result in a muddy flood where sediments are picked up by runoff and

carried as suspended matter or bed load.

Riverine. River flows may rise to floods levels at different rates, from a few

minutes to several weeks, depending on the type of river and the source of the increased

flow.

Slow rising floods most commonly occur in large rivers with large catchment

areas. The increase in flow may be the result of sustained rainfall, rapid snow melt,

monsoons, or tropical cyclones. Localized flooding may be caused or exacerbated by

drainage obstructions such as landslides, ice, or debris.

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Rapid flooding events, including flash floods, more often occur on smaller rivers,

rivers with steep valleys or rivers that flow for much of their length over impermeable

terrain. The cause may be localized convective precipitation (intense thunderstorms) or

sudden release from an upstream impoundment created behind a dam, landslide, or

glacier. Dam-building beavers can flood low-lying urban and rural areas, occasionally

causing some damage.

Estuarine and coastal. Flooding in estuaries is commonly caused by a

combination of sea tidal surges caused by winds and low barometric pressure, and they

may be exacerbated by high upstream river flow.

Coastal areas may be flooded by storm events at sea, resulting in waves over-

topping defenses or in severe cases by tsunami or tropical cyclones. A storm surge, from

either a tropical cyclone or an extra tropical cyclone, falls within this category.

Catastrophic. Catastrophic flooding is usually associated with major

infrastructure failures such as the collapse of a dam, but they may also be caused by

damage sustained in an earthquake or volcanic eruption. See outburst flood.

Effects

Primary effects. The primary effects of flooding include loss of life, damage to

buildings and other structures, including bridges, sewerage systems, roadways, and

canals. Infrastructure damage also frequently damages power transmission and

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sometimes power generation, which then has knock-on effects caused by the loss of

power. This includes loss of drinking water treatment and water supply, which may result

in loss of drinking water or severe water contamination. It may also cause the loss of

sewage disposal facilities. Lack of clean water combined with human sewage in the flood

waters raises the risk of waterborne diseases, which can include typhoid, giardia,

cryptosporidium, cholera and many other diseases depending upon the location of the

flood.

Damage to roads and transport infrastructure may make it difficult to mobilize aid

to those affected or to provide emergency health treatment.

Flood waters typically inundate farm land, making the land unworkable and

preventing crops from being planted or harvested, which can lead to shortages of food

both for humans and farm animals. Entire harvests for a country can be lost in extreme

flood circumstances. Some tree species may not survive prolonged flooding of their root

systems.

Secondary and long-term effects. Economic hardship due to a temporary decline

in tourism, rebuilding costs, or food shortages leading to price increases is a common

after-effect of severe flooding. The impact on those affected may cause psychological

damage to those affected, in particular where deaths, serious injuries and loss of property

occur.

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Flood forecasting

Anticipating floods before they occur allows for precautions to be taken and

people to be warned so that they can be prepared in advance for flooding conditions. For

example, farmers can remove animals from low-lying areas and utility services can put in

place emergency provisions to re-route services if needed. Emergency services can also

make provisions to have enough resources available ahead of time to respond to

emergencies as they occur.

In order to make the most accurate flood forecasts for waterways, it is best to have

a long time-series of historical data that relates stream flows to measure past rainfall

events. Coupling this historical information with real-time knowledge about volumetric

capacity in catchment areas, such as spare capacity in reservoirs, ground-water levels,

and the degree of saturation of area aquifers is also needed in order to make the most

accurate flood forecasts.

Radar estimates of rainfall and general weather forecasting techniques are also

important components of good flood forecasting. In areas where good quality data is

available, the intensity and height of a flood can be predicted with fairly good accuracy

and plenty of lead time. The output of a flood forecast is typically a maximum expected

water level and the likely time of its arrival at key locations along water way and it also

may allow for the computation of the likely statistical return period of a flood. In many

developed countries, urban areas at risk of flooding are protected against a 100-year flood

- that is a flood that has a probability of around 63% of occurring in any 100 year period

of time.

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According to the U.S. National Weather Service (NWS) Northeast River Forecast

Center (RFC) in Taunton, Massachusetts, a general rule-of-thumb for flood forecasting in

urban areas is that it takes at least 1 inch (25 mm) of rainfall in around an hour's time in

order to start significant ponding of water on impermeable surfaces. Many NWS RFCs

routinely issue Flash Flood Guidance and Headwater Guidance, which indicate the

general amount of rainfall that would need to fall in a short period of time in order to

cause flash flooding or flooding on larger water basins.

Control

In many countries around the world, waterways prone to floods are often carefully

managed. Defenses such as levees, bunds, reservoirs, and weirs are used to prevent

waterways from overflowing their banks. When these defenses fail, emergency measures

such as sandbags or portable inflatable tubes are often used to try and stem flooding.

Coastal flooding has been addressed in portions of Europe and the Americas with coastal

defenses, such as sea walls, beach nourishment, and barrier islands.

In the riparian zone near rivers and streams, erosion control measures can be

taken to try and slow down or reverse the natural forces that cause many waterways to

meander over long periods of time. Flood controls, such as dams, can be built and

maintained over time to try and reduce the occurrence and severity of floods as well. In

the USA, the U.S. Army Corps of Engineers maintains a network of such flood control

dams.

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Benefits

Floods (in particular more frequent or smaller floods) can also bring many

benefits, such as recharging ground water, making soil more fertile and increasing

nutrients in some soils. Flood waters provide much needed water resources in arid and

semi-arid regions where precipitation can be very unevenly distributed throughout the

year. Freshwater floods particularly play an important role in maintaining ecosystems in

river corridors and are a key factor in maintaining floodplain biodiversity. Flooding can

spread nutrients to lakes and rivers, which can lead to increased biomass and improved

fisheries for a few years.

For some fish species, an inundated floodplain may form a highly suitable

location for spawning with few predators and enhanced levels of nutrients or food. Fish,

such as the weather fish, make use of floods in order to reach new habitats. Bird

populations may also profit from the boost in food production caused by flooding.

Periodic flooding was essential to the well-being of ancient communities along the

Tigris-Euphrates Rivers, the Nile River, the Indus River, the Ganges and the Yellow

River among others. The viability of hydropower, a renewable source of energy, is also

higher in flood prone regions.

Impacts of Flood on Health:

Mental health

The World Health Organization recognizes that the mental health consequences of floods

“have not been fully addressed by those in the field of disaster preparedness or service

delivery,” although it is generally accepted that natural disasters, such as earthquakes,

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floods, and hurricanes, “take a heavy toll on the mental health of the people involved,

most of whom live in developing countries, where the capacity to take care of these

problems is extremely limited”. Here, the main evidence relates to common mental

disorder, posttraumatic stress syndrome, and suicide.

Common mental disorder (anxiety, depression)

Most studies on the effects of flooding on common mental disorders are from high- or

middle-income countries, including Australia, Poland, the United Kingdom, and the

United States, but there is also a study from Bangladesh.

Bennet's analysis of the 1968 Bristol floods found a significant increase (18 percent vs. 6

percent; p < 0.01) in the number of new psychiatric symptoms (considered to comprise

anxiety, depression, irritability, and sleeplessness) reported by women from flooded

compared with non flooded areas, although there was no significant difference for men.

These results broadly agree with the findings for the 1974 Brisbane floods, except that in

Brisbane men were also affected. Those between 35 and 75 years of age suffered the

greatest impacts.

Other evidence for impacts on common mental disorder comes from a controlled panel

study of adults aged 55–74 years flooded in 1981 and again in 1984. Flood exposure was

associated with significant increases in depression (p < 0.005) and anxiety (p < 0.0008)

(and also physical symptoms), especially in those with higher levels of pre-flood

depressive symptoms and in those from lower socioeconomic groups—a finding that

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Phifer et al. suggest supports Logue et al.'s 1981 assertion that “low-income people are

more vulnerable to the adverse effects of a disaster”.

In a longitudinal study, Ginexi et al. were able to compare symptoms for depression in

both the pre- and postflood periods, and they found that, among respondents with a

preflood depression diagnosis, the odds of a postflood diagnosis increased significantly

(odds ratio = 8.55, 95 percent CI: 5.54, 13.2). A more recent case-control study from the

United Kingdom found a fourfold increase in psychological distress among adults whose

homes were flooded compared with those whose homes were not (RR = 4.1, 95 percent

CI: 2.6, 6.4).

On the other hand, more equivocal evidence comes from two case-control studies of the

mental health impacts of Tropical Storm Agnes, which caused extensive flooding in

Pennsylvania in 1972. The first study, conducted 3 years post flood, focused on working-

class males aged 25–65 years; the second, conducted 5 years after the event, focused on

women aged 21 years or more. In both cases, respondents from flooded households

reported more mental health symptoms than did non flooded respondents, but differences

were not statistically significant. The authors speculate that “the failure to find a stronger

relationship … may, in part, be the result of the length of time which had elapsed since

the disaster impact” .

Comparatively few studies have examined mental health impacts on children, but an

exception is the 1993 study by Durkin et al. that found postflood changes in behavior and

bedwetting among children aged 2–9 years. Before the flood, none of the 162 children

were reported to be very aggressive; postflood, 16 children were found to be very

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aggressive toward others. Bedwetting increased from 16.8 percent before the flood to

40.4 percent after it. In the Netherlands, Becht et al. interviewed 64 children and their

parents (n = 30) 6 months postflood and found 15–20 percent of the children having

moderate to severe stress symptoms. Other studies after the 1997 floods in Opole, Poland

(81, 93), also suggest long-term negative effects on the well-being of children aged 11–

14 years and 11–20 years, with increases in posttraumatic stress disorder (PTSD),

depression, and dissatisfaction with life. Six months after Hurricane Floyd, similar

findings were found by Russionello et al. for children aged 9–12 years.

Posttraumatic stress disorder

PTSD “arises after a stressful event of an exceptionally threatening or catastrophic nature

and is characterised by intrusive memories, avoidance of circumstances associated with

the stressor, sleep disturbances, irritability and anger, lack of concentration and excessive

vigilance [and the specific diagnosis of PTSD] has been questioned as being culture-

specific, and may be overdiagnosed” . Nonetheless, studies showing increases in PTSD

following floods come from Europe and North America.

McMillen et al., who interviewed those affected by the 1993 Midwest floods, found that

60 subjects (38 percent) met the criteria for postflood psychiatric disorder and 35 (22

percent) met the criteria for flood-related PTSD. However, the limitations, recognized by

the authors, included retrospective data collection, self-selection of interviewees, self-

reporting, and the absence of a control group. Similar limitations applied only to a study

of 1997 flood victims in the Central Valley of northern California (99): 19 percent (24) of

the 128 participants who completed the acute stress disorder questionnaire met the

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criteria for the disorder's diagnosis, and of the 73 participants who completed the 1-year

follow-up, seven (10 percent) met the criteria for full PTSD. Studies of the 1996 flooding

in the Saguenay/Lac St. Jean region of Quebec, Canada, also suggest substantial

increases in emotional distress and PTSD among flooded respondents (97). Evidence

from Puerto Rico and from work by Norris et al. (95) suggests that PTSD symptoms are

influenced by the extent of flooding, culture, and age. The difficulties of interpretation

are demonstrated in a study by Verger et al. (100), who examined the mental health

impacts 5 years after the 1992 floods in Vaucluse, France. They concluded that the

subjects' reports of their disaster-related experiences (significantly worse for women and

subjects older than 35 years) “are by nature subjective … and not entirely reliable”.

Leptospirosis

Leptospirosis is a disease that is caused by pathogenic spirochetes of the genus

Leptospira. It is considered the most common zoonosis in the world. Leptospirosis has

recently been recognized as a re-emerging infectious disease among animals and humans

and has the potential to become even more prevalent with anticipated global warming.

Leptospirosis is distributed worldwide (sparing the polar regions) but is most common in

the tropics.

Humans and a wide range of animals, including mammals, birds, amphibians, and

reptiles can develop Leptospira infection. However, humans are rarely chronic carriers

and are therefore considered accidental hosts. Leptospirosis is transmitted via direct

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contact with the body fluid of an acutely infected animal or by exposure to soil or fresh

water contaminated with the urine of an animal that is a chronic carrier.

Human leptospirosis is often acquired via contact with fresh water contaminated

by bovine, rat, or canine urine as part of occupational contact with these animals. The

disease is also acquired during adventure travel or vacations that involve water sports or

hiking, or even as a consequence of flooding.

The burgeoning exotic-pet trade further increases the likelihood of transmission. In 2005,

leptospirosis was transmitted from southern flying squirrels imported from Miami,

Florida, to two Japanese animal handlers employed by an importer of exotic pets.

Endemic canine leptospirosis is becoming more common in the United States, and

California has seen a re-emergence of disease since 2000.

Leptospirosis in humans is characterized by an acute febrile illness followed by

mild self-limiting sequelae or an even more severe, and often fatal, multiorgan

involvement. The disease was first described by Larrey in 1812 of fièvre jaune among

Napoleon's troops at the siege of Cairo. It was initially believed to be related to the

plague but not as contagious. Throughout the remainder of the 19th century, the illness

was known in Europe as bilious typhoid.

A little over 100 years ago, Adolph Weil published his historic paper describing the most

severe form of infection that would be later known as Weil disease.

In 1907, special staining techniques were used to confirm that a spirochete was

responsible for this illness. A postmortem examination of the kidney of a person with

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Weil disease contained a spiral organism with hooked ends, which was first named

Spirochaeta interrogans.

Dengue

Dengue vaccines are currently in development and policymakers need appropriate

economic studies to determine their potential financial and public health impact. We searched

five databases (PubMed, EMBASE, LILAC, EconLit, and WHOLIS) to identify health

economics studies of dengue. Forty-three manuscripts were identified that provided primary

data: 32 report economic burden of dengue and nine are comparative economic analyses

assessing various interventions. The remaining two were a willingness-to-pay study and a

policymaker survey. An expert panel reviewed the existing dengue economic literature and

recommended future research to fill information gaps. Although dengue is an important

vector-borne disease, the economic literature is relatively sparse and results have often been

conflicting because of use of inconsistent assumptions. Health economic research specific to

dengue is urgently needed to ensure informed decision making on the various options for

controlling and preventing this disease.

The frequent incident of high tides in Hagonoy have altered the lives of the people

and in turn driving the community to cope up with the increasing numbers of diseases.

The rise and fall of water level is not only caused by the pull of the moon but also by the

changes in climate. The people are now adjusting with these changes. Within the

community, the health center is field with problems on how to treat leptospirosis, dengue,

malaria, athlete’s foot, and to reduce the numbers of victims. Now that there are

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calendars and ways to know when the high tide will occur it is really helpful especially to

those who are working near the shores.

Like what we said earlier high tide nowadays is also caused by climate change

and we cannot prevent it anymore. If you are to compare the incidents of high tides in

earlier years the incidents almost doubled. “Recent science findings suggest that the

climate system is changing faster and to a greater extent than previously thought in

response to human-induced greenhouse gas emissions. These changes suggest that many

parts of Australia’s coastline could face considerable risks from inundation, erosion and

changing conditions of coastal waters. The most severe risks will be from coincident

events of several hazards. For example, sea-level rise on top of an extreme storm tide and

a severe revering flood from the same weather event. In a highly urbanized area this

combined series of events has the potential to cause large economic impacts. The

breaching of a key coastal barrier during an extreme event, exposing coastal lakes or

estuaries to increased wave and tidal energy could also have severe consequences.

Climate change will drive changes in many of the processes associated with inundation or

erosion of the coastline and will increase the frequency of individual high water level

events. With increasing frequency the likelihood of events occurring simultaneously

increases and what were once seen as rare and independent events will increasingly

become more common.” (Australian government; Department of Climate Change 2009).

“Climate change will drive changes to both landforms and habitat conditions in a range of

coastal environments. Within each of the four broad coastal regions identified in this

report, there is the potential for enhanced shoreline erosion, beach loss, saline inundation

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of wetlands, and modification of tidal systems for land-based areas. Oceanic, shallow

seas and embayments are also likely to be affected by higher sea temperatures,

acidification, and changing storm patterns. Many environments are influenced by the

impacts of non-climate forces such as urban development and nutrient supplies from

agricultural lands. All these factors will interact in complex and to some extent

unpredictable ways, requiring careful monitoring and adaptive management strategies to

help minimize adverse impacts. Coastal ecosystems likely to be most at risk from climate

change include estuaries and associated wetlands, coral reefs, constrained tidal flat

communities and beaches where there is a lack of sediment replenishment.” (Australian

government; Department of Climate Change 2009).

All of the diseases that have been said are not easy to handle. There are also

diseases“New studies have detected a rising number of reports of diseases in marine

organisms such as corals, molluscs, turtles, mammals, and echinoderms over the past

three decades. Despite the increasing disease load, microbiological, molecular, and

theoretical tools for managing disease in the world’s oceans are underdeveloped. Review

of the new developments in the study of these diseases identifies five major unsolved

problems and priorities for future research: (1) detecting origins and reservoirs for marine

diseases and tracing the flow of some new pathogens from land to sea; (2) documenting

the longevity and host range of infectious stages; (3) evaluating the effect of greater

taxonomic diversity of marine relative to terrestrial hosts and pathogens; (4) pinpointing

the facilitating role of anthropogenic agents as incubators and conveyors of marine

pathogens; (5) adapting epidemiological models to analysis of marine disease.” (Drew

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Harvell, Richard Aronson, Nancy Baron, Joseph Connell, Andrew Dobson, Leah Gerber,

Kiho Kim Armand Kuris, Hamish McCallum, Kevin Lafferty, James Porter, Mercedes

Pascual, Garriett Smith, Katherine Sutherland, Steve Ellner, Bruce McKay, Jessica

Ward,2004)

Still even they are warned some of the people did not learn their lessons. “Health

officials in the Philippines have warned people not to wade in floodwaters this monsoon

season after three times the usual number of cases of leptospirosis has been reported.

Flash floods are common throughout the Philippine archipelago during the monsoon

season, which runs from June to December. They are particularly common in Manila, the

country’s sprawling capital and home to 14 million Filipinos. After only minutes of a

downpour, streets in low lying areas instantly become filthy rivers clogged with waste.

Many Manilenos go out in the floodwaters barefoot, and children often swim in the

flooded streets. Leptospirosis is usually transmitted to humans through rats and their

urine. However, bacteria in the floodwater can also infect people by entering the body

through cuts and skin abrasions. Infection causes influenza-like symptoms, with fever,

myalgia, and headache. Most cases, if detected early, can be treated with antibiotics.

Severe cases can lead to renal failure and, in some cases, death. The increase in cases this

year is unusual in that they occurred before the monsoon. “We are attributing this to the

El Niño weather pattern. We’ve experienced a lot of extra rain and flooding because of

this,” said Dr Maria Soledad Antonio of the Department of Health’s communicable

disease control service.” (PMC July 1999)

Diarrhea

19

Diarrhea is a condition that involves the frequent passing of loose or watery

stools. It is the opposite of constipation and can have many causes, which may be

infectious or non-infectious. Acute diarrhea, meaning diarrhea that is not long-term, is a

very common cause death in developing nations, especially among young children and

babies. It usually appears rapidly and may last from between five to ten days. Chronic

diarrhea, meaning long-term diarrhea is the second cause of death among children in

developing countries. People with diarrhea often have fever and/or stomachache

(abdominal cramps). Diarrhea may be caused by inflammatory bowel syndrome

(IBS), Crohn's disease, an allergy, or an infection.

According to the World Health Organization (WHO) approximately 3.5 million deaths

each year are attributable to diarrhea. 80% of those deaths occur in children under the age

of 5 years. Children are more susceptible to the complications of diarrhea because a

smaller amount of fluid loss leads to dehydration, compared to adults.

Flooding and communicable diseases fact sheet

Risk assessment and preventive measures

Risk assessment

Floods can potentially increase the transmission of the following communicable diseases:

• Water-borne diseases, such as typhoid fever, cholera, leptospirosis and hepatitis A

• Vector-borne diseases, such as malaria, dengue and dengue haemorrhagic fever,

yellow fever, and West Nile Fever

Water-borne diseases

20

Flooding is associated with an increased risk of infection, however this risk is low unless

there is significant population displacement and/or water sources are compromised. Of

the 14 major floods which occurred globally between 1970 and 1994, only one led to a

major diarrhoeal disease outbreak - in Sudan, 1980. This was probably because the flood

was complicated by population displacement. Floods in Mozambique in January-March

2000 led to an increase in the incidence of diarrhoea and in 1998, floods in West Bengal

led to a large cholera epidemic (01,El Tor, Ogawa).

The major risk factor for outbreaks associated with flooding is the contamination of

drinking-water facilities, and even when this happens, as in Iowa and Missouri in 1993,

the risk of outbreaks can be minimized if the risk is well recognized and disaster-response

addresses the provision of clean water as a priority. In Tajikistan in 1992, the flooding of

sewage treatment plants led to the contamination of river water. Despite this risk factor,

no significant increase in incidence of diarrhoeal diseases was reported. A typhoon in

Truk District, Trust Territories of the Pacific in 1971 disrupted catchment water sources

and forced people to use many different sources of groundwater that were heavily

contaminated with pig faeces. As a result, there was an outbreak of balantidiasis, an

intestinal protozoan. A cyclone and flooding in Mauritius in 1980 led to an outbreak of

typhoid fever.

There is an increased risk of infection of water-borne diseases contracted through direct

contact with polluted waters, such as wound infections, dermatitis, conjunctivitis, and ear,

nose and throat infections. However, these diseases are not epidemic-prone.

21

The only epidemic-prone infection which can be transmitted directly from contaminated

water is leptospirosis, a zoonotic bacterial disease. Transmission occurs through contact

of the skin and mucous membranes with water, damp soil or vegetation (such as

sugarcane) or mud contaminated with rodent urine. The occurrence of flooding after

heavy rainfall facilitates the spread of the organism due to the proliferation of rodents

which shed large amounts of leptospires in their urine. Outbreaks of leptospirosis

occurred in Brazil (1983, 1988 and 1996), in Nicaragua (1995), Krasnodar region,

Russian Federation (1997), Santa Fe, USA (1998) Orissa, India (1999) and Thailand

(2000). It is likely that environmental changes increased the vector (rodent) population

which facilitated transmission.

Vector-borne diseases

Floods may indirectly lead to an increase in vector-borne diseases through the expansion

in the number and range of vector habitats. Standing water caused by heavy rainfall or

overflow of rivers can act as breeding sites for mosquitoes, and therefore enhance the

potential for exposure of the disaster-affected population and emergency workers to

infections such as dengue, malaria and West Nile fever. Flooding may initially flush out

mosquito breeding, but it comes back when the waters recede. The lag time is usually

around 6-8 weeks before the onset of a malaria epidemic.

• Malaria epidemics in the wake of flooding are a well-known phenomenon in

malaria-endemic areas world-wide. For instance, an earthquake and subsequent flooding

in Costa Rica's Atlantic region in 1991 and flooding on the Dominican Republic in 2004

led to malaria outbreaks.

22

• Periodic flooding linked to El Nino-Southern Oscillation (ENSO) is associated

with malaria epidemics in the dry coastal region of northern Peru and with the resurgence

of dengue in the past 10 years throughout the American continent.

• West Nile Fever has resurged in Europe subsequent to heavy rains and flooding,

with outbreaks in Romania in 1996-97, in the Czech Republic in 1997 and Italy in 1998.

The risk of outbreaks is greatly increased by complicating factors, such as changes in

human behaviour (increased exposure to mosquitoes while sleeping outside, a temporary

pause in disease control activities, overcrowding), or changes in the habitat which

promote mosquito breeding (landslide, deforestation, river damming, and rerouting).

Risk posed by corpses

Contrary to common belief, there is no evidence that corpses pose a risk of disease

"epidemics" after natural disasters. Most agents do not survive long in the human body

after death (with the exception of HIV -which can be up to 6 days) and the source of

acute infections is more likely to be the survivors. Human remains only pose health risks

in a few special cases requiring specific precautions, such as deaths from cholera or

haemorrhagic fevers.

However, workers who routinely handle corpses may have a risk of contracting

tuberculosis, bloodborne viruses (such as Hepatitis B/C and HIV), and gastrointestinal

infections (such as rotavirus diarrhoea, salmonellosis, E. coli, typhoid/paratyphoid fevers,

hepatitis A, shigellosis and cholera).

• Tuberculosis can be acquired if the bacillus is aerosolized (residual air in lungs

exhaled, fluid from lungs spurted up through nose/ mouth during handling of the corpse).

23

• Exposure to bloodborne viruses occurs due to direct contact with non-intact skin

of blood or body fluid, injury from bone fragments and needles, or exposure to the

mucous membranes from splashing of blood or body fluid.

• Gastrointestinal infections are more common as dead bodies commonly leak

faeces. Transmission occurs via the faeco-oral route through direct contact with the body

and soiled clothes or contaminated vehicles or equipment. Dead bodies contaminating the

water supply may also cause gastrointestinal infections.

The public and emergency workers alike should be duly informed to avoid panic and

inappropriate disposal of bodies, and to take adequate precautions in handling the dead

(see prevention below).

Other health risks posed by flooding

• These include drowning and injuries or trauma. Tetanus is not common after

injury from flooding, and mass tetanus vaccination programs are not indicated. However,

tetanus boosters may be indicated for previously vaccinated people who sustain open

wounds or for other injured people depending on their tetanus immunization history.

Passive vaccination with tetanus immune globulin (Hypertet) is useful in treating

wounded people who have not been actively vaccinated and those whose wounds are

highly contaminated, as well as those with tetanus.

• Hypothermia may also be a problem, particularly in children, if trapped in

floodwaters for lengthy periods. There may also be an increased risk of respiratory tract

infections due to exposure (loss of shelter, exposure to flood waters and rain).

24

• Power cuts related to floods may disrupt water treatment and supply plants

thereby increasing the risk of water-borne diseases as described above but may also affect

proper functioning of health facilities, including cold chain.

Skin diseases during floods in Thailand

Abstract

BACKGROUND:

Floods are natural disasters that occur occasionally in Thailand. The most common form

skin diseases due to floods are infectious dermatoses especially superficial fungal

infection. However the microbiologic evidences have not been evaluated.

OBJECTIVE:

To evaluate the most common skin diseases during floods and identify the organism that

causes skin maceration at web space(s) of toes (Hong Kong foot).

MATERIAL AND METHOD:

Patients who complained of skin problems were evaluated at the temporary outpatient

clinic during October 2006. Skin specimens from all patients who had itches and skin

maceration at web space(s) of toes were cultured.

RESULTS:

Ninety-six patients were evaluated (38 males and 58 females). Eczema was the most

prevalent dermatosis, which accounted for 34.5% of the total skin problems and the great

majority of these cases were irritant contact dermatitis. Sixteen cases presented with itch

and skin maceration at web space(s) of toes. All of them were colonized with various

25

microorganisms. Gram-negative bacilli were the most prevalent ones and were found in

14 out of 16 specimens. Fungal culture was positive in only two specimens.

CONCLUSION:

Eczema is the most common dermatosis during floods. Skin maceration at web space(s)

of toes, which were thought to be fungal infection, are chronic irritant dermatitis with

secondary bacterial colonization. Only a few cases were fungal infection. Microbiologic

investigation should be done in these patients. Unfortunately, it is not practical in such a

situation. Topical medications that have the combination of anti-inflammatory,

antibacterial and antifungal properties are the most suitable medications.

Impacts of flood on health: Epidemiologic evidence from Hanoi, Vietnam

Background: Vietnam is one of the most disaster-prone countries in the world. The

country suffers from many kinds of natural disasters, of which the most common and

serious one is flooding. Long and heavy rainfall during the last days of October and the

first week of November 2008 resulted in a devastating flood unseen for over three

decades in the capital city of Hanoi. It caused a substantial health impact on residents in

and around the city and compromised the capacity of local health services.

Objective: The aim of this study is to ascertain the vulnerability and health impacts of the

devastating flood in Hanoi by identifying the differences in mortality, injuries, and

morbidity patterns (dengue, pink eye, dermatitis, psychological problems, and

hypertension) between flood affected and non-affected households.

26

Design: A cross-sectional study was carried out involving 871 households in four

selected communes (two heavily flood affected and two comparatively less affected)

from two severely flooded districts of Hanoi. Participants were interviewed and

information collected on the social, economic, and health impacts of the devastation

within 1 month after the flood.

Results: The self-reported number of deaths and injuries reported in this study within 1

month after the heavy rainfall were a bit higher in severely affected communes as

compared to that of the less affected communes of our study. The findings showed higher

incidences of dengue fever, pink eye, dermatitis, and psychological problems in

communes severely affected by flood as compared to that of the controlled communes.

Conclusions: For people in flood prone areas (at risk for flooding), flood prevention and

mitigation strategies need to be seriously thought through and acted upon, as these people

are exposed to greater health problems such as psychological issues and communicable

diseases such as pink eye or dermatitis

27

Theoretical Framework

In this study the researchers had chosen the Neumann systems model by Betty

Neumann. Neumann System Model describe as reflects nursing’s interest in well and ill

people as holistic systems and in environmental influences on health. Client’s and nurse’s

perception of stressors and resources or emphasizes, clients act in partnership with the

nurses to set goals and identify relevant prevention interventions. The individual, family

or group, community, or a social issue all are the client systems, which are viewed as

composites of interacting physiological, sociocultural, developmental, and spiritual

variables (Neumann, 2001). Neumann Systems model is also define as a dynamic, open,

systems approach to client care originally developed to provide a unifying focus for

nursing problem definition and for best understanding the client in interaction with the

environment (Neumann, 2002).

Neumann Systems model identified as wholistic approach, open system

(including function, input and output, feedback, negentropy, entropy, and stability),

environment, created environment, wellness and illness, client system (including five

client variables, basic structure, lines resistance, normal line of defense, and flexible line

of defense), stressors, degree reaction, prevention as intervention and reconstitution

(Neuman, 2002). Clients are reviewed as wholes whose parts are in dynamic interaction.

The model considers all variables simultaneously affecting the client system:

physiological, psychological, socio-cultural, developmental, and spiritual. Neumann

included the spiritual variable in the second edition (1989). She changed the spelling of

28

the term holistic to wholistic in the second edition to enhance understanding of the term

as referring to the whole person (B. Neuman, personal communication, June 20, 1988).

Betty Neumann was born in 1924 and grew up on a farm in Ohio. Her rural

background helped her develop a compassion for people in need, which has been evident

throughout her career. She completed her initial nursing education with double honors at

Peoples Hospital School of nursing (now General Hospital), Akron, Ohio, in 1947. And

in 1970 Neumann designed a nursing conceptual model for UCLA nursing students; the

purpose is to expand understanding of client variables beyond the medical model

(Neumann & Young, 1972).

This Theory relates to our study, the System Model of Betty Neumann,

helps our study to solve the major problem and a guide to construct a Program to be

prepare if there’s sudden floods come up and disease Prevention Program to prevent to

acquire certain diseases that may arise during floods.. Also concern to the stressor affects

our mental health (specially trauma during floods); we all know that mental health also is

a big factor to the heath of each individual.

29

Conceptual Framework

This figure shows the modifiable factors like health, Morbidity Pattern, prevention of

Mitigation Strategies and Non Modifiable factors like Age, Gender, and Location to

come up with a Functional Health Program that will affect or improve the modifiable

factors of the people living in Hagonoy, Bulacan.

Figure 1. Conceptual Framework of the Study

Non Modifiable

Age Gender Location

Modifiable Factors

Health Morbidity Pattern Prevention of

Mitigation Strategies

Functional Health Education Program

People Living in Hagonoy, Bulacan

30

Statement of the Problem

The aim of this study is to ascertain the vulnerability and health impacts of the

devastating flood in Hagonoy, Bulacan by identifying the differences in injuries, and

morbidity patterns (dermatitis, diarrhea, conjunctivitis, leptospirosis, hypertension, and

dengue fever) between flood with most affected and least affected household.

1. How may the characteristics of the study population be described in terms of:

1.1 Number of households

1.2 Gender of respondents

1.3 Religion

1.4 Income

1.5 Marital status

2. How may the experience of the respondents with the historic flood in 2011 be

described?

3. How may the impacts of flood on the health aspect of the respondents be

described after the historic flood in 2011 in terms of:

3.1 Access to health care services

3.2 Injuries

3.3 Health conditions

31

Definition of Terms

The following are the terms and variables used in the study. They are defined for

clarity of meaning to present sufficient information and understanding on the part of the

readers of this towards Flood.

Access. This term refers to the permission to approach or use of usual health care

services or medication.

Epidemiologic Evidence. This term is used to determine the evidence and of the

presence of problems regarding about the flood.

Experience. This term to refer to the act of encountering the time of the heavy

rainfalls/ flood.

Flood. This term refers to the increase level of water in a specific place or

community.

Gender. This term refers to the gender of the people living in the Hagonoy

Bulacan.

Health Condition. This term refers to the health of the people lived in Hagonoy

Bulacan that experienced heavy rainfall/flood.

Health Impacts. This refers to the effects of flood to the health of the community.

To determine the types of disease that can be acquired in the community during flood.

Injuries. This term refer to the harm that the people of Hagonoy Bulacan

experience during the heavy rainfall.

Prevention and irrigation strategies. This term refers to develop a certain

techniques and strategies on how to prevent flood to occur in a community.

32

Scope and Limitation

The sample population selected for this study will be limited and conducted only

to the most affected and least affected area in Hagonoy including Brgy. Palapat

(33households), San Juan(43households) ,San Pascual(40households), Sto.

Rosario(35households), Carillo(23households), Sta. Cruz(24households) Hagonoy,

Bulacan during our 2nd semester this January 2013. The respondents of the study were

the affected households of 6 Barangay in Hagonoy. The instrument used in this study will

be a survey form which serves as our guide to identify the common problems that they

encounter and a possible solution regarding their problems.

33

Chapter 2

Methodology

This division of the study discusses the design of the study, the research method and the

technique to be used in particular. It also describes the subject or respondents of the study, and

the data gathering instruments utilized. It also includes the statistical methods employed in

analyzing the data.

Research Design

Polit & Beck (2004:49) described research design is the overall plan for obtaining

answers to the question being studied and for handling some of the difficulties encountered

during the research process. Research designs are developed to meet the unique requirements of

a study. Polit & Beck (2004:209), and Wood and Harbor (1998:157) indicated that selecting a

good research design should be guided by an overarching consideration, namely whether the

design does the test possible job providing trustworthy answers to the research questions.

This study utilized the descriptive method of research. Descriptive research refers to

research studies that have as their main objective the accurate portrayal of the characteristics of a

person, situations or group (Polit & Hungler 2004:716). In this study, the researchers considered

the most suitable research design to be a Comparative Studies and descriptive survey design.

Comparative Studies can be used in comparing the result in the differences in certain

characteristics according to variable considered. The term survey can be used to designate any

may be defined as a purposive process of gathering, analyzing, classifying and tabulating data

about the prevailing conditions, beliefs, press, trends and cause-effect relationship which the

investigator gathers data from a portion of a population for the purpose of examining the

characteristic, opinion, or intentions of that population (Couchman & Dawson 1995:70; Polit &

34

Beck 2004;234) A descriptive design is selected because of its high degree of representativeness

and the ease in which a researcher obtain the participants opinion (Polit & beck 2004:50). In the

present study, the researchers obtain and describe the views of the respondents with regard to

their knowledge, practice and awareness during occurrence of flood.

Research Locale

Hagonoy Bulacan is one of the low areas in Bulacan, you can also found many fish pen

and rivers around its place. During the Typhoon Pedring last 2011, Hagonoy is one of most

affected area in Bulacan.

The researcher conducted a research to Hagonoy to know what was the effect of Flood in

their area and diseases which may occur, also to know what was the remedies they may provide

if flooding arises.

Population Sampling or Respondents of the Study

The subjects of the study were composed of 198 respondents out of 23,891 populations

residing at the selected Barangay of Hagonoy, Bulacan which are near the bodies of water and

those who are usually affected during floods.

The respondents were chosen using non-random sampling in collecting the said

population specifically incidental sampling technique in determining the extent of knowledge

and attitude regarding high tides and the effects of it to the residents.

35

Research Instrument

In gathering the data and information requirements of the study, the researcher used the

following instruments/techniques:

Questionnaire. A structured questionnaire made by the researcher was utilized in

determining the extent of knowledge, attitude and practice of the locals regarding about the

Impacts of Flood on Health to the residents of Hagonoy, Bulacan. It elicited information about

clients’ name, address, and status. The second part of the questionnaire elicit the respondent’s

level of knowledge concerning about the high tide’s schedule, risk factors, how did affect to the

community, How did community adapt to this environment, what kind of programs or solution

that community think so.

Questionnaire that determines the client’s risk made use of yes or no.

Interview. The researcher will also made use of interview and observation as a means of

gathering additional information from the respondents. Respondents were assured that the

information will be treated with high confidentiality.

These methods will help the researcher to have a more accurate interpretation of the

results of the study and to be able to verify the veracity of the answers that will be obtained

through the questionnaire.

Development of the Questionnaire

The researchers gather and review different related literature and some advices to some

residents of Hagonoy, Bulacan to be able to come up with the concepts on the content of the

questionnaire. The established draft of the tool was shown to the advisers and critiques for

comments, suggestions and recommendations. All of the recommendations were noted and used

for the improvement of the questionnaires.

36

The tool was subjected to content validity and face reliability. 3 persons in authority were

consulted regarding the validity of the statements used in the tool: one Municipal Health Officer,

Each Nurse assigned to the Six(6) Barangay Health Center and the adviser of the researcher. All

comments, suggestions and recommendations were considered in putting the tool into its final

form.

Data Gathering

The whole process started with the formulation of a letter of request to the chief of the

hospital asking permission to conduct the study. After having the topic, the researcher created a

request being addressed to Dr. Romel Pajela, Municipal Health Officer at Municipality of

Hagonoy, Bulacan so that they can gather information and make interviews on a specific place in

Hagonoy, Bulacan. After signing the request, the researcher then finally handed out the

questionnaires to the locals. Questionnaire that are carefully handed back are checked. Items that

are missed will be noted and the researcher will also find time to interview with the client.

Statistical Treatment of Data

The data gathered will tabulate, organize and analyze using the following statistical methods and

techniques:

1. For the profile of the respondents, frequency and percentage distribution will be utilized.

2. The Standard Deviation will be utilized to measure the degree of variability of the

respondents’ answers regarding the impacts of flood on health.

37

Chapter 3

Results and Discussion

This chapter presents, analyzes and interprets the data gathered from the

survey. The discussions were made following the order and sequence of the questions raised in

Chapter 1.

Table 1. Characteristics of study populationLess Affected Area

(San Pascual, Sta. Cruz, Sta. Rosario)

Most Affected Area(Palapat, San Juan, Carillo)

Number of Population n = 99 n =99

Gender of respondent n = 99 % n = 99 % Male 38 38.38 28 28.28 Female 61 61.62 71 71.72

Religion n = 99 % n = 99 % Roman Catholic 95 95.96 97 97.98 Born Again 1 1.01 1 1.01 Christian 1 1.01 0 0 Muslim 1 1.01 0 0 Iglesia Ni Cristo 0 0 1 1.01 Ang Dating Daan 1 1.01 0 0

Income/month n = 99 % n = 99 % 1,000 – 5,500 60 60.6% 59 59.6% 6,000 – 10,500 36 36.4% 31 31.3% 11,000 – 15,500 3 3% 8 8% 16,000 – 20,500 0 0 1 1%

Marital Status n = 99 % n = 99 % Single 30 30.30 37 37.37 Married 64 64.65 57 57.58 Widowed 5 5.05 5 5.05

A total of 198 respondents participated in the survey. The description of the final sample

is presented in Table 1. Among the respondents, the proportions of females were higher than

38

males (61.62% vs. 38.38%). Almost the entire respondent said that their religion is Roman

Catholic with 97.98% in most affected area (Palapat, San Juan, Carillo) and other religion

formed about 1% in each barangay. The income per month reveals that the highest average

income of the affected areas in less affected area were range to 1,000-5, 500 pesos (60.6%) while

in the most affected area reveals the same 1,000-5,500 pesos (59.6%). Regarding to marital

status, about half of our studied population were married, about 30% were single, and about 5%

were widowed.

Table 2. Experience with the heavy rainfall/floodLess Affected Area

(San Pascual, Sta. Cruz, Sta. Rosario)

Most Affected Area(Palapat, San Juan, Carillo)

Present at the time of flood

n = 99 % n = 99 %

Yes 99 100 99 100 No 0 0 0 0

Migrated due to flood n = 99 % n = 99 % Yes 21 21.21 53 53.54 No 78 78.79 46 46.46Place to stay after evacuation

n = 21 % n = 53 %

Relative / friends 11 52.38 47 88.68 Temporary shelter from government agencies (Inconvenient)

3 14.29 1 1.89

Temporary shelter from government agencies (Convenient)

6 28.57 5 9.43

Others(neighbors) 1 4.76 0 0

School goers before flood n = 99 % n = 99 % Yes 9 9.09 12 12.12 No 90 90.91 87 87.88

School activities affected by food

n = 99 % n = 99 %

Yes 11 11.11 13 13.13

39

No 88 88.89 86 86.87

Daily routine affected n = 99 % n = 99 % Yes 92 92.93 95 95.96 No 7 7.07 4 4.04

Results from Table 2 shows that almost all people in the sample were present at the time of the

heavy rainfalls/flood during Typhoon Pedring (with 100 % in all six communes). About half of

the people in Palapat, San Juan, and Carillo (most affected area) had to migrate due to flood and

in San Pascual, Sta. Cruz, and Sto. Rosario (less affected area) the number was about 20%. The

majority of people who migrated due to flooding stayed in their relative or friend’s house. In

addition, people living in communes that were affected by flood reported that they stayed in

temporary shelters provided by the government such as in schools.

Table 3

Access to health care service

Less Affected Area(San Pascual, Sta. Cruz, Sta.

Rosario)

Most Affected Area(Palapat, San Juan, Carillo)

n = 99 n = 99Access and use of usual health care/ medication compromised

% %

Yes 40 40.4 40 40.4 No 59 59.6 59 59.6Reasons n = 40 % n = 40 % Road damage 7 17.5 5 12.5 Lack of money 5 12.5 1 2.5 Others (flood, unavailability of transportation, not informed )

28 70 34 85

Table No. 3 shows that 40% of the respondents in both affected area said that access to

and use of their usual healthcare or medication were compromised during the heavy rain/flood.

With regards to the question about the reasons why the access and usual healthcare/medication

40

were compromised by the heavy rain falls/flood, respondents gave multiple reasons. Among

those who said that their access to usual healthcare/medication was compromised, about 70%

mentioned that the reason was flood, unavailability of transportation and they were not informed

in less affected area, while 85% on the most affected area. 2.5 % of the respondents from most

affected area and 12.5% from less affected area said that it was due to lack of money. Lastly,

12.5% and 17.5%, respectively, were due to road damage.

Table 4

Injuries

Less Affected Area(San Pascual, Sta. Cruz, Sta.

Rosario)

Most Affected Area(Palapat, San Juan, Carillo)

Injured n = 99 % n = 99 % Yes 5 5.05 5 5.05 No 94 94.95 94 94.95

Type of injury n = 5 % n = 5 % Cuts 1 20 4 80 Bone fracture 3 60 0 0 Laceration/contusion 1 20 1 20

Cause of injury n = 5 % n = 5 % Fall 2 40 1 20 Traffic/ road accident 1 20 1 20 Others (slide) 2 40 3 60

Ten injuries were reported during heavy rainfall/flood. Types of injuries were reported in

Table 4. Five persons suffered cuts, four from Palapat, San Juan and Carillo, one of them from

Sto. Rosario. Three people suffered bone fracture, one from Sta. Cruz and two from San Pascual.

Two people suffered laceration or contusions. Five injuries occurred in all barangays were due to

sliding, three persons were injured due to falls, and one in Sto. Rosario and Palapat were injured

in a road accident. Falls and Sliding seem to be the attributing factors of injuries during flood.

41

Table 5

Health Condition within one month after the flood

Less Affected Area(San Pascual, Sta. Cruz, Sta.

Rosario)

Most Affected Area(Palapat, San Juan, Carillo)

n = 99 n = 99 Any family member ever have psychological problems

%

Yes 60 60.61 45 45.45 No 39 39.39 54 54.55 Having psychological problems before the heavy rain/ flood Yes 32 32.32 28 28.28 No 67 67.68 71 71.72 Did psychological problems get worse after the heavy rain/flood Yes 21 21.21 24 24.24 No 78 78.79 75 75.76 Any family member ever been diagnosed having hypertension Yes 44 44.44 38 38.38 No 55 55.56 51 51.52 Having hypertension before the heavy rain/ flood Yes 33 33.33 28 28.28 No 66 66.67 71 7.72 Did hypertension get worse after the heavy rain/flood Yes 14 14.14 28 28.28 No 85 85.86 71 7.72Any family member ever been diagnosed having dengue fever Yes 9 9.09 3 3.03 No 90 90.91 96 96.97 Having dengue fever after the heavy rain/flood Yes 9 9.09 1 1.01 No 90 90.91 98 98.99

42

Any family member ever been diagnosed having conjunctivitis Yes 7 7.07 5 5.05 No 92 92.93 94 94.95Having conjunctivitis after the heavy rain/flood Yes 11 11.11 5 5.05 No 88 88.89 94 94.95 Any family member ever been diagnosed having dermatitis Yes 78 78.79 86 86.87 No 21 21.21 13 13.13 Having dermatitis after the heavy rain/flood Yes 73 73.74 86 86.87 No 26 26.26 13 13.13 Any family member ever been diagnosed having diarrhea Yes 17 17.17 20 20.2 No 82 82.83 79 79.8Having diarrhea after the heavy rain/flood Yes 12 12.12 10 10.1 No 87 87.88 89 89.9Any family member ever been diagnosed having Leptospirosis Yes 0 0 0 0 No 99 100.0 99 100.0 Having Leptospirosis after the heavy rain/flood Yes 0 0 0 0 No 99 100.0 99 100.0

Health condition of respondents was measured through a set of questions providing

information for other family members. The results were presented in Table 5. There were

significant differences between the respondents from severely affected area and those from the

less affected area in terms of the family members suffering from psychological problem. In less

affected area about 32% of people who ever had suffered from physiological problems were

43

reported to experienced it before the heavy rains and the flooding while these proportion in most

affected area were 28%. Only 21% of those suffering in less affected area said that there

psychological problems got worst during and after the flood while the percentage of the

respondents in most affected area with worsening psychological problem during and after the

flood were 24%.

There is no significant difference in the number of respondents reporting that his/her

family members had ever been diagnosing with developing hypertensions between the most

affected area and less affected area. Although most reported cases of hypertension occurred

before the heavy rain/flood, the percentage of people reporting that it got worst after the flood

was significantly higher in the most affected area than the less affected area (28% in most

affected area and 14% in less affected area).

Twelve respondents reported having ever been diagnosed by a doctor for dengue fever, 9

respondents in less affected while there is 3 respondents in most affected area. The majority of

all cases in the affected area reported that they were diagnosed with dengue fever after the flood.

There is significant difference in the proportion of dengue cases in most affected area and less

affected area. With regards to conjunctivitis there is 7% respondent in the less affected area

reported to have it while there is 5% respondents in the most affected area. There is higher

percentage reported by the respondent in the less affected area to have conjunctivitis after the

heavy rain. Regarding dermatitis, about 86% respondents in most affected area reported to have

it while 78.79% respondents in less affected area. All most dermatitis cases reported were after

the flood. Regarding diarrhea, about 20% respondents reported in most affected area to have it

while 17% respondents reported in less affected area having it. Percentage lowered in both areas

after the heavy rain/flood (10% in most affected area and 12% in less affected area. There is no

reported incident by the respondents regarding Leptospirosis.

44

Chapter 4

Summary, Conclusion and Recommendation

Summary

Floods is one of the most devastating disaster in the world, it affects individual, family

and community, globally, economically and psychologically. It cannot be prevented so people

must always be ready and prepared any time when a flood occurred. Many diseases arise during

floods such as conjunctivitis, dermatitis, dengue fever, hypertension and leptospirosis. People

must undergo programs related to disaster planning so people know what they should do when

they experience flood in their area.

Global situation

Flooding accounts for about 40% of all natural disasters worldwide and causes about half

of all deaths. The greatest potential flood hazard is in Asia. For the past two decades more than

400 million people on average have been directly exposed to floods. Between 1987 and 1997,

44% of all flood disasters worldwide affected Asia, claiming 228, 000 lives (roughly 93% of all

flood-related deaths worldwide). The importance of this study is, it can contribute some

information about the impacts of flood in the community in the health of each people

experienced it globally. They may use this study as their reference if ever a certain Global or

International Health Organization such as DOH and WHO conducted a research or study with

the same study.

National situation

Last August 2013, incessant monsoon rains fuelled by Tropical Storm Trami (local

name: Maring) have fallen over the Philippine capital, Manila, and surrounding provinces,

bringing widespread flooding that has had devastating effect. By 24 August, the National

45

Disaster Risk Reduction and Management Committee (NDRRMC) reported that 21 lives have

been lost, 179,000 families or more than 800,000 people have been displaced. Overall, the

flooding has had an impact on the lives and livelihood of 2.5 million people across five regions.

The government’s weather agency monitors estimate that the heaviest rains occurred in Cavite,

part of which recorded an amount that exceeded the average monthly for August in just 24 hours.

Of the 800,000 persons displaced, 200,000 have sought refuge in evacuation centers while

600,000 are staying in alternative accommodation, often with friends and family. The National

Capital Region recorded the most number of cases at 7,670, Central Luzon having 5, 552 cases,

and CALABARZON’s 4, 508 cases amid repeated reminders from the department for the public

to continuously clean mosquito-breeding areas (GMA News, 2012). For the cases of

Leptospirosis the department of health said that it increased by 62.32 %. From January 1 to

August 18, 2012, leptospirosis cases reached a total of 2,471 with 129 deaths, the report said. In

the same period last year, the DOH recorded only 1,522 cases (J.F. Manongdo, Manila Bulletin

2012). The importance of this study regarding Nationally, just like through globally it may

contribute for future research and study by using this study in determining what are the impacts

of floods in health and what diseases may arise before, during and after the flood. They can

formulate certain programs for Flood Preparation.

Regional situation

Last August 2013. The National Disaster Risk Reduction and Management Council said

eight persons have died and 28, 000 families displaced as the enhanced southwest monsoon

continued to dump heavy rains over Luzon. In its 6:00 p.m. bulletin, NDRRMC said over 125,

000 families in 58 municipalities and 29 cities were affected as floods continue to paralyze areas

in Region I, III, IV-A, IV-B, the Cordillera Administrative Region (CAR) and the National

Capital Region (NCR). Of the total number of affected 9, 300 families are sheltered in198

evacuation centers while 19, 140 displaced families stayed with friends and relatives. Sixty-five

46

roads all over Luzon and one bridge in Mt. Province are still impassable to different types of

vehicles due to flooding in 68 municipalities under Regions I, III, IV-A, IV-B, and NCR. As of 3

p.m. two gates of Binga and Ambuklao dams have been opened, while Magat has only one. La

Mesa dam has already overflowed as the water breached the critical level of 80.15 meters. The

government has so far dispatched P4.5 million worth of aid from the Department of Social

Welfare and Development, local government units and non-government organizations delivered

to affected areas. So far, most of the damage to agriculture is in the Rizal and Laguna, estimated

at P1.7 million. Most of the damaged crops in Rizal are grains while in Laguna are forest and

Fruit-bearing.

As we all know, Region III is one of the regions in the Philippines that been affected by

the heavy rain and floods now a days, this study may contribute to the Regional Government and

Regional Health Organization when conducting studies and research about the impacts of Flood

in the lives of each people specially with regards in Health.

Local situation

Due to Flooding some diseases was been arises and affects the people’s health.

According to the report of Hagonoy Heath Office last August of 2012, There is 450 residents that

been affected by flood at San Agustin. The diseases that been reported are Acute Respiratory

Infection that has 67 incident, Athletes Foot that has 47, Hypertension that has 22, Diarrhea that

has 7 and Leptospirosis that has 4 incidence. This study focuses in the impacts of flood on health

at Hagonoy Bulacan, this can be use as guide for conducting programs and health teaching for

the People in Hagonoy regarding Flood Preparation and Alertness and how to prevent diseases

that may arise during Heavy Rain and Flood.

The Impacts of Flood in Hanoi, Vietnam is related with the impacts of Flood in Hagonoy,

Bulacan, Philippines in term of impacts of Flood in Health, Vietnam and Philippines both

47

acquired same diseases that been arises during the heavy rain and floods such as conjunctivitis,

dermatitis and hypertension

This study can be a learning source of the student and the community to gain knowledge

about the possible impacts of Flood on their health. This will also serves as a guide to formulate

certain action and programs for disease prevention before, during and after the Floods. The study

will benefit the: Residents who really been affected by floods may learn on how to prevent

certain diseases and infection caused by floods. This can also help the residents to be prepared

every time floods occur. The community can be prepared for the possible impacts of flood to

their health. They can also now make the most of the resources available in the oceans and be

prepared every time the water level rises. They will also gain more knowledge about the disease

brought by floods. And now, the health center must be prepared to treat the disease like diarrhea,

leptospirosis, malaria, athlete’s foot (Tinea Pedis). Nurse will be able to know the possible

disease that can be obtained from floods, like diarrhea, leptospirosis, malaria, athlete’s foot and

Wound Infection. This study will help to have a deeper understanding about the impacts of

floods on health, so in the near future the researcher can share their knowledge to the

communities about possible programs to prevent diseases that may acquires through the floods.

For future researches they can use this as their reference or guide in creating their thesis. They

can also use this study as a comparison to past studies about Impacts of Flood on the health.

The aim of this study is to ascertain the vulnerability and health impacts of the

devastating flood in Hagonoy, Bulacan by identifying the differences in injuries, and morbidity

patterns (dermatitis, diarrhea, conjunctivitis, leptospirosis, hypertension, and dengue fever)

between flood with most affected and least affected household.

Specifically, aims to answer the following question:

1. How may the characteristics of the study population be described in terms of Number of

households, Gender of respondents, Religion, Income and Marital status?

48

2. How may the experience of the respondents with the historic flood in 2011 be described?

3. How may the impacts of flood on the health aspect of the respondents be described after

the historic flood in 2011 in terms of Access to health care services, Injuries and Health

conditions?

The hypothesis of the study is that there is a significant impact of flood on health.

This study utilized the descriptive method of research. Descriptive research refers to

research studies that have as their main objective the accurate portrayal of the characteristics of a

person, situations or group (Polit & Hungler 2004:716). In this study, the researchers considered

the most suitable research design to be a Comparative Studies and descriptive survey design.

Comparative Studies can be used in comparing the result in the differences in certain

characteristics according to variable considered. Questionnaire/ survey and Interview have been

used as instruments in conducting the study. Questionnaire has 5 parts, Parts I is about

Demographic data, Part II is about Experience with the historic flood in 2011 (Typhoon

Pedring), Part III is regarding to Access to Health Care Services, Part IV is about Injuries within

One month after the flood and Part V is regarding to Health conditions within One month after

the historic flood (Typhoon Pedring). The total respondents of this study is 198, 99 respondents

for less affected and 99 as well in most affected. The survey and interview were conducted and

completed in two weeks.

After the data gathered were tabulated, organized, the statistical methods and techniques

used were: For the profile of the respondents, frequency and percentage distribution will be

utilized. The Standard Deviation will be utilized to measure the degree of variability of the

respondents’ answers regarding the impacts of flood on health

49

Findings:

Problem 1. How may the characteristics of the study population be described in terms of Number

of households, Gender of respondents, Religion, Income and Marital status?

A total of 198 respondents participated in the survey. Among the respondents, the

proportions of females were higher than males (61.62% vs. 38.38%).

Almost the entire respondent said that their religion is Roman Catholic with

97.98% in most affected area (Palapat, San Juan, Carillo) and other religion

formed about 1% in each barangay.

The income per month reveals that the highest average income of the affected

areas in less affected area were range to 1,000-5, 500 pesos (60.6%) while in the

most affected area reveals the same 1,000-5,500 pesos (59.6%).

Regarding to marital status, about half of our studied population were married,

about 30% were single, and about 5% were widowed.

Problem 2. How may the experience of the respondents with the historic flood in 2011 be

described?

Results show that almost all people in our sample were present at the time of

the heavy rainfalls/flood during Typhoon Pedring (with 100 % in all six

communes).

About half of the people in Palapat, San Juan, and Carillo (most affected area)

had to migrate due to flood and in San Pascual, Sta. Cruz, and Sto. Rosario

(less affected area) the number was about 20%.

The majority of people who migrated due to flooding stayed in their relative

or friend’s house. In addition, people living in communes that were affected

50

by flood reported that they stayed in temporary shelters provided by the

government such as in schools.

Problem 3. How may the impacts of flood on the health aspect of the respondents be described

after the historic flood in 2011 in terms of Access to health care services, Injuries

and Health conditions?

Result shows that 40% of the respondents in both affected area said that access to

and use of their usual healthcare or medication were compromised during the

heavy rain/flood. With regards to the question about the reasons why the access

and usual healthcare/medication were compromised by the heavy rain falls/flood,

respondents gave multiple reasons. Among those who said that their access to

usual healthcare/medication was compromised, about 70% mentioned that the

reason was flood, unavailability of transportation and they were not informed in

less affected area, while 85% on the most affected area. 2.5 % of the respondents

from most affected area and 12.5% from less affected area said that it was due to

lack of money. Lastly, 12.5% and 17.5%, respectively, were due to road damage.

Ten injuries were reported during heavy rainfall/flood. Types of injuries were

reported. Five persons suffered cuts, four from Palapat, San Juan and Carillo, one

of them from Sto. Rosario. Three people suffered bone fracture, one from Sta.

Cruz and two from San Pascual. Two people suffered laceration or contusions.

Five injuries occurred in all barangays were due to sliding, three persons were

injured due to falls, and one in Sto. Rosario and Palapat were injured in a road

51

accident. Falls and Sliding seem to be the attributing factors of injuries during

flood.

Health condition of respondents was measured through a set of questions

providing information for other family members. There were significant

differences between the respondents from severely affected area and those from

the less affected area in terms of the family members suffering from

psychological problem. In less affected area about 32% of people who ever had

suffered from physiological problems were reported to experienced it before the

heavy rains and the flooding while these proportion in most affected area were

28%. Only 21% of those suffering in less affected area said that there

psychological problems got worst during and after the flood while the percentage

of the respondents in most affected area with worsening psychological problem

during and after the flood were 24%.

There is no significant difference in the number of respondents reporting that

his/her family members had ever been diagnosing with developing hypertensions

between the most affected area and less affected area. Although most reported

cases of hypertension occurred before the heavy rain/flood, the percentage of

people reporting that it got worst after the flood was significantly higher in the

most affected area than the less affected area (28% in most affected area and 14%

in less affected area).

Twelve respondents reported having ever been diagnosed by a doctor for dengue

fever, 9 respondents in less affected while there is 3 respondents in most affected

area. The majority of all cases in the affected area reported that they were

diagnosed with dengue fever after the flood. There is significant difference in the

proportion of dengue cases in most affected area and less affected area. With

52

regards to conjunctivitis there is 7% respondent in the less affected area reported

to have it while there is 5% respondents in the most affected area. There is higher

percentage reported by the respondent in the less affected area to have

conjunctivitis after the heavy rain. Regarding dermatitis, about 86% respondents

in most affected area reported to have it while 78.79% respondents in less affected

area. All most dermatitis cases reported were after the flood. Regarding diarrhea,

about 20% respondents reported in most affected area to have it while 17%

respondents reported in less affected area having it. Percentage lowered in both

areas after the heavy rain/flood (10% in most affected area and 12% in less

affected area. There is no reported incident by the respondents regarding

Leptospirosis.

Conclusions

In the light of the findings stated, state the conclusions were drawn from it:

1. A total of 198 respondents participated in the survey. Among the respondents, the

proportions of females were higher than males. Almost the entire respondent said

that their religion is Roman Catholic. The income per month reveals that the

highest average incomes of the affected areas in less affected area were range to

1,000-5, 500 pesos while in the most affected area reveals the same 1,000-5, 500

pesos. Regarding to marital status, about half of the studied population were

married.

2. The study shows that almost all people in the sample were present at the time of

the heavy rainfalls/flood and experience the Typhoon Pedring. About half of the

people in Palapat, San Juan, and Carillo (most affected area) had to migrate due to

flood and in San Pascual, Sta. Cruz, and Sto. Rosario (less affected area). The

53

majority of people who migrated due to flooding stayed in their relative or

friend’s house. In addition, people living in communes that were affected by flood

reported that they stayed in temporary shelters provided by the government such

as in schools.

3. Study shows about the Impacts of Flood in Health Access is that only 40% of the

respondents in both affected area said that access to and use of their usual

healthcare or medication were compromised during the heavy rain/flood. With

regards to the question about the reasons why the access and usual

healthcare/medication were compromised by the heavy rain falls/flood,

respondents gave multiple reasons. Among those who said that their access to

usual healthcare/medication was compromised, about 70% mentioned that the

reason was flood, unavailability of transportation due to flood. Were as in term of

Injuries, Ten injuries were reported by the respondents during heavy

rainfall/flood. Five persons suffered cuts, four from Palapat, San Juan and Carillo,

one of them from Sto. Rosario. Three people suffered bone fracture, one from Sta.

Cruz and two from San Pascual. Two people suffered laceration or contusions.

Five injuries occurred in all barangays were due to sliding, three persons were

injured due to falls, and one in Sto. Rosario and Palapat were injured in a road

accident. Falls and Sliding seem to be the attributing factors of injuries during

flood.

4. There were significant differences between the respondents from severely

affected area and those from the less affected area in terms of the family members

suffering from psychological problem. In less affected area about 32% of people

who ever had suffered from physiological problems were reported to experienced

it before the heavy rains and the flooding while these proportion in most affected

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area were 28%. Only 21% of those suffering in less affected area said that there

psychological problems got worst during and after the flood while the percentage

of the respondents in most affected area with worsening psychological problem

during and after the flood were 24%.

5. There is no significant difference in the number of respondents reporting that

his/her family members had ever been diagnosing with developing hypertensions

between the most affected area and less affected area. Although most reported

cases of hypertension occurred before the heavy rain/flood, the percentage of

people reporting that it got worst after the flood was significantly higher in the

most affected area than the less affected area.

6. Twelve respondents reported having ever been diagnosed by a doctor for dengue

fever, 9 respondents in less affected while there is 3 respondents in most affected

area. The majority of all cases in the affected area reported that they were

diagnosed with dengue fever after the flood. There is significant difference in the

proportion of dengue cases in most affected area and less affected area. With

regards to conjunctivitis there is 7% respondent in the less affected area reported

to have it while there is 5% respondents in the most affected area. There is higher

percentage reported by the respondent in the less affected area to have

conjunctivitis after the heavy rain. Regarding dermatitis, about 86% respondents

in most affected area reported to have it while 78.79% respondents in less affected

area. All most dermatitis cases reported were after the flood. Regarding diarrhea,

about 20% respondents reported in most affected area to have it while 17%

respondents reported in less affected area having it. Percentage lowered in both

areas after the heavy rain/flood (10% in most affected area and 12% in less

55

affected area). There is no reported incident by the respondents regarding

Leptospirosis.

Recommendation

In view of the conclusions drawn, discuss recommendations you are to propose;

1. This study suggests that flood prevention and mitigation strategies need to be put in

place in flood prone areas. Environmental sanitation activities, particularly cleaning

campaigns and de-clogging of blocked drainages, are necessary as are efforts to improve

access to sanitation facilities in barangays.

2. It is important that those who provide medical care need to be aware of the increased

medical and mental health needs of the people who have experienced flood. Health

concerns in the affected areas remain diarrhea, skin diseases, and fungal infections. Local

government health units continue the delivery of health services, and have adequate

capacities to meet the increasing demand. However, Philippine Red Cross will reinforce

health and hygiene education efforts of authorities, focusing on disease prevention.

3. In the future if the flood evens become more common and severe, improving the

services available to people the time of a flood event and during the recovery period

maybe important to reduce the burden on medical services. It is effective to mobilize

community health volunteers in targeted areas and provide necessary services.

4. The researcher’s experience shows that further research is needed for better health

measures and stronger epidemiological design to improve understanding of the risk of

flooding and the long term consequences on people’s health.

56

References

Anthony Knap (2002). Indicators of Ocean Health and Human Health: Developing a Research and Monitoring Framework

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240980/pdf/ehp0110-000839.pdf

Australian government ; Department of Climate Change (2009). Australia’s Coast – ItsNature And Importance

http://www.climatechange.gov.au/publications/coastline/climate-change-risks-to-australias-coasts.aspx

Australian government; Department of Climate Change (2009). Climate Change Risks ToThe Coastal Environment

http://www.climatechange.gov.au/publications/coastline/climate-change-risks-to-australias-coasts.aspx

Bella Gamotea (2012). Metro Manila binaha sa Habagat

http://www.balita.net.ph/2012/08/metro-manila-binaha-sa-habagat/#.UN0-aG_28mA

Carl Wunsch, June. 2000. Moon, tides and climate. p. 743-744

Danilo C. Israel, Roehlano M. Briones. 2012. Impacts of Natural Disasters on Agriculture, Food Security, and Natural Resources and Environment in the Philippines, Review of disaster risk management in the Philippines, p.9

Drew Harvell, Richard Aronson, Nancy Baron, Joseph Connell, Andrew Dobson, Leah Gerber, Kiho Kim, Armand Kuris, Hamish McCallum, Kevin Lafferty, James Porter, Mercedes Pascual, Garriett Smith, Katherine Sutherland, Steve Ellner, Bruce McKay, Jessica Ward.2004. The rising tide of ocean diseases: unsolvedproblems and research priorities.

57

Eric Roston (2012). High-Tide Storm Was a Known Risk for New York http://www.bloomberg.com/news/2012-10-30/high-tide-storm-was-a-known-risk-for-new-york.html

Higashi-hiroshima (2009). Communities survival and coping mechanisms in flood-prone

KAMANAVA, Metro Manila

http://www.mode.org/pdf/Track2C%20-%20998.pdf

Jing Vallejos (2012). Floods hit Dagupan due to high tide

http://www.abs-cbnnews.com/nation/regions/07/03/12/floods-hit-dagupan-due-high-tide

J. Timothy Wootton, Catherine A. Pfister and James D. Forester (2008). Dynamic patterns and

ecological impacts of declining ocean pH in a high-resolution multi-year dataset

http://www.pnas.org/content/105/48/18848.full.pdf+html

Mika (2011). Literature Review: Tides & Earthquakes

http://www.geomika.com/blog/2011/03/23/review-tides-earthquakes

Sharad Vyas (2009). Mumbai can tide it over, says institute

http://articles.timesofindia.indiatimes.com/keyword/high-tide

WHO/Europe and Public Health England (2009-2011). Study on the health effects of flooding

http://www.euro.who.int/en/health-topics/environment-and-health/Climate-change/news/news/

2013/05/how-flooding-affects-health

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APPENDIX A

Letter of Request for the Permission to Conduct the Study (Signed)

59

APPENDIX B

Letter For Conducting A Survey

60

APPENDIX C

INSTRUMENT

Bulacan State UniversityMalolos City, Bulacan

College of Nursing

“Impacts of Flood on Health: Epidemiologic Evidence from Hagonoy, Bulacan”

Part I. DemographicsName: Gender:Marital Status: Religion:Average Number of Persons in the Household: Average Family Income:

Part II. Experience with the historic flood in 2011 (Typhoon Pedring)

1. Are you present at the time of flood? _______ Yes _______ No2. Migrated due to flood? _______ Yes _______ No3. Place to stay after displacement/evacuation?

_______ Relative/friend_______ Temporary shelter from relief agencies_______ Temporary shelter from government agencies_______ Others

If Evacuation, did the place’s condition satisfied you? _______ Yes ________No4. School goers before the flood? _______ Yes _______ No5. School activities affected by flood? _______ Yes _______ No6. Your daily routine affected by flood? _______ Yes _______ No

Part III. Access to Health Care Services

1. Access and use of usual health care/medication compromised? _______ Yes _______ No

2. Reasons?_______ Road damaged_______ Lack of medication_______ Health center destroyed_______ Not enough health care professionals_______ Lack of money_______ Others

Part III. Injuries within One month after the flood

1. Injured? _______ Yes _______ No

61

2. If yes,a. Type of injury

_______ Bone fracture_______ Laceration/contusion_______ Cuts_______ Multiple trauma_______ Others

b. Cause of injury_______ Fall_______ Drowning_______ Traffic accident_______ Others

Part IV. Health conditions within One month after the historic flood (Typhoon Pedring)

1. Any family member ever have psychologicalproblems, e.g. stress, nervousness, anxiousness, sleeplessness? _______ Yes _______ No

2. Having psychological problems before the heavy rain/flood? _______ Yes _______ No

3. Did the psychological problems get worse after the heavy rain/flood? _______ Yes _______ No

4. Any family member ever been diagnosed by a doctor as having hypertension? _______ Yes _______ No

5. Having hypertension before the heavy rain/flood? _______ Yes _______ No6. Did the hypertension get worse after the heavy

rain/flood? _______ Yes _______ No7. Any family member ever been diagnosed by a

doctor as having dengue fever? _______ Yes _______ No8. Having dengue fever after the heavy rain/flood? _______ Yes _______ No9. Any family member ever been diagnosed by a

doctor as having conjunctivitis? _______ Yes _______ No10. Having conjunctivitis after the heavy rain/flood? _______ Yes _______ No11. Any family member ever been diagnosed by a

doctor as having dermatitis? _______ Yes _______ No12. Having dermatitis after the heavy rain/flood? _______ Yes _______ No13. Any family member ever been diagnosed by a _______ Yes ________ No

doctor as having Diarrhea?14. Having Diarrhea after the heavy rain/flood? _______ Yes ________ No15. Any family member ever been diagnosed by a _______ Yes ________ No doctor as having Leptospirosis?16. Having Leptospirosis after the heavy rain/flood? _______ Yes ________ No

62

APPENDIX C.1

(TAGALOG SURVEY)

“Impacts of Flood on Health: Epidemiologic Evidence from Hagonoy, Bulacan”Part I. DemographicsPangalan: Kasarian:Kalagayang Sibil : Relihiyon :Bilang ng miyembro ng pamilya : Buwanang kita / Sahod :Part II. Karanasan sa nagdaang baha noong 2011 (Bagyong Pedring)

1. Naroon ka ba noong nangyari ang baha? Oo____ Hindi____2. Lumipat ba kayo ng lugar dahil sa baha? Oo____ Hindi____3. Lugar kung saan pansamantalang nanuluyan.

__________ Kamag anak / kaibigan__________ Pansamantalang tuluyan/ bahay mula sa tulong ng iba’t ibang ahensya__________ Pansamantalang tuluyan / bahay mula sa gobyerno__________ Iba pa Maayos ba ang napuntahan ninyong evacuation center? Oo____ Hindi____

4. Pumapasok kaba sa paaralan bago ang baha? Oo____ Hindi____5. Naapektuhan ba ng baha ang mga gawaing pampaaralan? Oo____ Hindi____6. Naapektuhan ba ng baha ang iyong pang araw araw na Gawain? Oo____ Hindi____

Part III. Serbisyong Pangkalusugan 1. Nasubukan mo bang magpatingin sa doktor o uminom ng gamot noong baha? Oo__ Hindi__ 2. Kapag hindi anung dahilan? ________Sirang daan ________Hindi Sapat ang mga gamot ________Nasira ang mga health center ________Kulang sa doctor ________Kulang sa pera ________ Iba pa

Part IV. Mga natamong pinsala/ aksidente makalipas ang isang buwan pagtapos ng baha

1. Nadisgrasya / aksidente? Oo____ Hindi____2. Kung oo

a. Uri ng natamong pinsala/ aksidente_______ Baling buto_______ Pilas/ Nauntog_______ Hiwa_______ Maraming natamong Pinsala_______ Iba pa

b. Dahilan ng pinsala/ aksidente_______ Nahulog

63

_______ Nalunod_______ Aksidente sa daan_______ Iba pa

Part V. Pangkalusugang kundisyon sa loob ng isang buwan pagtapos ng baha1. Meron ba sa pamilya ninyo ang nakaranas ng problemang may kinalaman sa mentalidad (hal.pagod,pagka kaba,pagkabalisa, hindi makatulog)? Oo___ Hindi___2. Nakaranas ka ba ng problemang may kinalaman sa pagiisip bago ang bagyo/ baha?

Oo__ Hindi__3. Ang naranasan mo bang problema na may kinalaman sa mentalidad ay lumala

pagkatapos ng bagyo/ baha? Oo____ Hindi____4. Meron bang miyembro sa pamilya niyo ang nakaranas ng mataas na presyon?

Oo__ Hindi__5. Ang pagtaas ba ng presyon ay nangyari bago ang bagyo/ baha? Oo____ Hindi____6. Ang pagtaas ba ng presyon ay lumala pagtapos ng bagyo/baha? Oo____ Hindi____7. Meron bang miyembro sa pamilya niyo ang nagkaroon ng dengue fever?

Oo__ Hindi__8. Ang pagkakaroon ba ng dengue ay pagtapos ng bagyo/baha? Oo___ Hindi___9. Meron bang miyemro sa pamilya niyo ang nagkaroon ng pamamaga ng mata?

Oo__ Hindi__10. Ang pamamaga ba ng mata ay pagtapos ng bagyo/baha? Oo___ Hindi___11. Meron bang miyemro sa pamilya ang nagkaron ng sakit sa balat? Oo___ Hindi___12. Ang pagkakaroon ba ng sakit sa balat ay pagtapos ng bagyo/baha? Oo___ Hindi___13. Meron bang miyembro sa pamilya ang nakaranas ng pagtatae? Oo___ Hindi___14. Ang pagtatae ba ay pagtapos ng bagyo/baha? Oo___ Hindi___15. Meron bang miyemro sa pamilya ang nagkaroon ng leptospirosis? Oo___ Hindi___16. Ang pagkakaroon ng leptospirosis ay pagtapos ng bagyo/baha? Oo___ Hindi___

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APPENDIX D

Student Profile

Maria Danica C. Rivera#357 Palayan St., Cut-cot, Pulilan, Bulacan0935-251-6777Nica.rivera2003@yahoo.com.ph

PERSONAL DATAAge: 19 years oldDate of Birth: March 20, 1993Place of Birth: Quezon City HospitalSex: FemaleCivil Status: SingleCitizenship: FilipinoReligion: Roman Catholic

EDUCATIONAL BACKGROUNDTertiary: Bachelor of Science in Nursing

Bulacan State UniversityMalolos City, BulacanThird Year Student at Present

Secondary: St. Dominic AcademyPoblacion, Pulilan, BulacanBatch 2009-2010

Primary: Montessori School of PulilanPoblacion, Pulilan, BulacanBatch 2004-2005

SEMINARS ATTENDED “Alert! Latest Trends and Updates in Nursing”

Activity Center, Bulacan State University(August 13, 2010)

“Buhay na Maganda sa Bayang Walang Droga”Bulacan Capitol Gym(March 19, 2011)

“RN Heals”Hostel, Bulacan State of University(August 2011)

65

Mary Grace C. Dela CruzAddress: #548 Carmen De Luna St., Longos, Malolos City, BulacanCellphone No.: 09423648838

PERSONAL DATAAge: 28 years oldDate of Birth:June 16, 1985Place of Birth:Tipas, Taguig, Metro ManilaSex: FemaleCivil Status: SingleCitizenship: FilipinoReligion: Iglesia Ni Cristo

EDUCATIONAL BACKGROUNDTertiary: Bachelor of Science in Nursing

Bulacan State UniversityMalolos City, BulacanThird Year Student

Secondary: San Marcos High SchoolSan Marcos, Calumpit, BulacanBatch 2001 – 2002

Primary: Longos Elementary SchoolLongos, Malolos City, BulacanBatch 1996-1997

SEMINARS ATTENDED

“Forensic Nursing” Bulacan State University ( August 11, 2011 )

66

De Chavez, Sheila Marie D. Address: 9011 Rufina homes Sta. Isabel Malolos City, BulacanCellphone No.: 09065796266

PERSONAL DATAAge: 19 years oldDate of Birth:Sept. 9, 1993Place of Birth: K.S.ASex: FemaleCivil Status: SingleCitizenship: FilipinoReligion: Roman Catholic

EDUCATIONAL BACKGROUNDTertiary: Bachelor of Science in Nursing

Bulacan State UniversityMalolos City, BulacanThird Year Student

Secondary: Ma. Therese Montessori schoolBulihan malolos, BulacanBatch 2008-2009

Primary: Holy Spirit Academy of MalolosMalolos CityBatch 2005-2006

SEMINARS ATTENDED

“Forensic Nursing” Bulacan State University ( August 11, 2011 )

67

Balatbat, Ruby Sunshine C.Address: #0386 San Agustin Hulo StreetHagonoy, Bulacan Cellphone No.: 09238181384Email Address: polinntanshine22@yahoo.com

DETAILS OF EMPLOYMENT / WORK EXPERIENCES:(START FROM PRESENT TO PREVIOUS)

JOLLIBEE HAGONOYSto. Nino Hagonoy, BulacanCashier2006-2007

KENTUCKY FRIED CHICKEN (KFC)Shangri-La Plaza Corporation EDSA corner Shaw Boulevard, Mandaluyong CityRestaurant Team Member2009-2010

PERSONAL DATAAge: 23 years oldDate of Birth: November 02, 1989Place of Birth: Batallones Hospital Hagonoy, BulacanSex: FemaleCivil Status: SingleCitizenship: FilipinoReligion: Roman Catholic

EDUCATIONAL BACKGROUNDTertiary: Bachelor of Science in Nursing

Bulacan State UniversityMalolos City, BulacanThird Year Student

Secondary: Sta. Monica National High SchoolHagonoy, BulacanBatch 2005 – 2006

Primary: Hagonoy East Central SchoolSto. Nino Hagonoy, BulacanBatch 2001-2002

SEMINARS ATTENDED

“Forensic Nursing” Bulacan State University ( August 11, 2011 )

68

Junio, Ma. Jaecelyn S.Address: #0428 Bantayan 2nd, Bulihan, Malolos, BulacanCellphone No.: 09052057774

PERSONAL DATAAge: 20 years oldDate of Birth:September 13, 1992Place of Birth: BulacanSex: FemaleCivil Status: Single Citizenship: FilipinoReligion: Roman Catholic

EDUCATIONAL BACKGROUNDTertiary: Bachelor of Science in Nursing

Bulacan State UniversityMalolos City, BulacanThird Year Student

Secondary: La Consolacion University of the Philippines Catmon, Malolos, Bulacan Batch 2008 - 2009

Primary: Bulihan Elementary SchoolBulihan, Malolos, BulacanBatch 2004 - 2005

SEMINARS ATTENDED

“Forensic Nursing” Bulacan State University ( August 11, 2011 )

69

Santos, Abigael F. Address: #1514 San Vicente, Sta.Maria, BulacanCellphone No.: 09997885472

PERSONAL DATAAge: 19 years oldDate of Birth:January 14, 1994Place of Birth: Sta.Maria, BulacanSex: FemaleCivil Status: SingleCitizenship: FilipinoReligion: Christian

EDUCATIONAL BACKGROUNDTertiary: Bachelor of Science in Nursing

Bulacan State UniversityMalolos City, BulacanThird Year Student

Secondary: St. Vincent Learning Academy, Inc. San Vicente, Sta. Maria, Bulacan

Batch 2008-2009

Primary: San Vicente Hulo Elementary SchoolSan Vicente, Sta.Maria, BulacanBatch 2005-2006

SEMINARS ATTENDED

“Forensic Nursing” Bulacan State University ( August 11, 2011 )

70

Zaragosa, Karen May C. #0337 M.Santos St., Guyong, Sta.Maria, Bulacan0926-888-7440 Karenzaragosa09@yahoo.com.ph

PERSONAL DATAAge: 18 years oldDate of Birth:September 9, 1994Place of Birth: Quezon City HospitalSex: FemaleCivil Status: SingleCitizenship: FilipinoReligion: Christian Baptist

EDUCATIONAL BACKGROUNDTertiary: Bachelor of Science in Nursing

Bulacan State UniversityMalolos City, BulacanThird Year Student at Present

Secondary: Jesus Lord &Savior Christian Colleges Foundation Inc.E.Celestino St. Sta.Maria, BulacanBatch 2009-2010

Primary: Jesus Lord &Savior Christian Colleges Foundation Inc.Poblacion, Pulilan, BulacanBatch 2004-2005

SEMINARS ATTENDED

“Alert! Latest Trends and Updates in Nursing”Activity Center, Bulacan State University(August 13, 2010)

“Buhay na Maganda sa Bayang Walang Droga”Bulacan Capitol Gym(March 19, 2011)

“RN Heals”Hostel, Bulacan State of University(August 2011)

71

Jade M. De Jesus Address: #0731Look 1st, Malolos, BulacanCellphone No.: 09068877840

PERSONAL DATAAge: 18 years oldDate of Birth:September 6, 1994Place of Birth: Malolos, BulacanSex: MaleCivil Status: SingleCitizenship: FilipinoReligion: Roman Catholic

EDUCATIONAL BACKGROUNDTertiary: Bachelor of Science in Nursing

Bulacan State UniversityMalolos City, BulacanThird Year Student

Secondary: Holy Trinity Academy of Malolos

Batch 2008-2009

Primary: Holy Trinity Academy of Malolos

Batch 2005-2006

SEMINARS ATTENDED

“Forensic Nursing” Bulacan State University

August 11, 2011

72

Dionisio, Mary Lorry Laine C.Address: #302 Balite, Malolos, BulacanCellphone No.: 09353791403Email Address: lainedionisio@yahoo.com

DETAILS OF EMPLOYMENT / WORK EXPERIENCES:(START FROM PRESENT TO PREVIOUS)

Savemore MarketApalit PampangaCashier2012

PERSONAL DATAAge: 23 years oldDate of Birth: May 17, 1990Place of Birth: Malolos BulacanSex: FemaleCivil Status: SingleCitizenship: FilipinoReligion: Roman Catholic

EDUCATIONAL BACKGROUNDTertiary: Bachelor of Science in Nursing

Bulacan State UniversityMalolos City, BulacanFourth Year Student

Secondary: Marcelo H. Del Pilar National High SchoolSta. Isabel, Malolos, BulacanBatch 2006-2007

Primary: Sta. Isabel Elementary SchoolSta. Isabel, Malolos, BulacanBatch 2003-2004

SEMINARS ATTENDED

Basic Life SupportSeptember 6-7, 2010

73