Accomplishment and Factors Affecting the Compliance to Immunization Program (2003-2012)

ABSTRACT

An Undergraduate Research Project entitled “Accomplishment and Factors Affecting the Compliance to Immunization Program in Tacloban City (2003-2012)” submitted and prepared by ************************.

This is an analytical study regarding the accomplishment of the immunization program in Tacloban City for the past ten years (2003-2012) and also the factors that affects the compliance to such. The objectives of the study includes: 1) find out the rate of compliance to EPI in the said locale for the past ten years, 2) identify the reasons affecting the compliance to the Expanded Program on Immunization and the current intervention scheme employed to comply it, 3) determine if the seven immunizable diseases are still present as the leading causes of morbidity and mortality.

The data used in this research was gathered from the City Health Office of Tacloban City which provided the information regarding the compliance to immunization program and also the causes of morbidity and mortality. The researchers conducted a survey on ten health centers in the locale regarding the factors that affects the compliance to the said program.

The findings of the study were; 1) that there is a high level of accomplishment to the immunization program in the locale for the past ten years, 2) however a declining trend in regard to the compliance had been seen as the years pass, 3) also a decline in compliance with the third stage of DPT, OPV, and HEPA had been recorded, 4) tuberculosis was the only disease in relation with the EPI was seen among the top ten leading causes of morbidity and mortality, 4) lack of knowledge and wrong perception regarding the immunization program resulted as factors that mostly affect the non-compliance.

From the following result, it is recommended a stricter implementation of the immunization program to achieve a much higher accomplishment regarding the program.

Researchers:

Lledo, Quennie

Logrosa, April Rose

Lorenzo, Emily

Lozada, Jasmine

Madera, Jamaika

Marapao, Gabriel Louis

Mercado, Ann Nicolac

Mondonedo, Joanna

Montezon,Valerie Hearty

Muralla, Princess Ann

Mendiola, Francis Vio

Navilla, Liza Marie

Adviser:

Mr. Agripino LimpiadoDate:

ACKNOWLEDGEMENT

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At the outset, the researchers express their heartfelt gratitude to our all mighty

God. With a fervent prayer we offer every part of this masterpiece to Him. For sharing

with us the knowledge and wisdom, and sound health needed for the compliance of this

research. For providing the necessary materials and opportunities that will all contribute

to Glorify His name.

With profound gratitude we also acknowledge the persons who in every way

contributed to the fulfillment of this research.

To Mr. ***********, our adviser, who with all sincere concern and

immeasurable patience provided guidance and support in this pursuit.

To ************, the City Health Officer, who gave us the data and information

needed in regard with the study.

To *************, who guided us in the gathering of records and shared to us

her experiences and knowledge regarding this field.

To the respondents, who gave us their time in answering the questions provided

and sharing thoughts about the research.

To our dear families who showered us with unwavering support though thick and

thin despite arguments and difficulties who nothing but encouraged us to go on above all

uncertainties, thank you.

To our Teachers, Mentors, Friends, Batchmates, Classmates, and Groupmates

who unselfishly and selflessly offered themselves and shared their resources, all these

will not be forgotten.

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And lastly, whether mentioned, unmentioned and who with their anonymity we

respect, a sincere gratitude we offer, for sharing their lives and provided support to our

destined success.

The Researchers

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TABLE OF CONTENTS

Page

TITLE PAGE . . . . . . . . . . i

ABSTRACT . . . . . . . . . . ii

ACKNOWLEDGMENT . . . . . . . . iii

TABLE OF CONTENTS . . . . . . . . iv

LIST OF TABLES . . . . . . . . . vii

LIST OF FIGURES . . . . . . . . . viii

LIST OF APPENDICES . . . . . . . . x

CHAPTER

I INTRODUCTION . . . . . . . 1

General Objectives . . . . . . 5

Specific Objectives . . . . . . 5

Significance of the Study . . . . . 6

Scope and Delimitations . . . . . 7

Theoretical Framework . . . . . 7

Conceptual Framework . . . . . 8

Definition of Terms . . . . . . 10

II REVIEW OF THE RELATED LITERATURE . . 12

III METHODOLOGY . . . . . . . 20

Data Gathering . . . . . . . 20

Research Locale . . . . . . 21

Instrumentation . . . . . . 22

5

Statistical Analysis . . . . . . 24

IV RESULTS AND DISCUSSIONS . . . . . 25

V SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS . 50

BIBLIOGRAPHY . . . . . . . .

APPENDICES . . . . . . . . .

6

LIST OF TABLES

Table Page

1 Records of Livebirths and Fully Immunized Child . . . . 26

2 Compliance with the BCG Immunization . . . . . 27

3 Compliance to the Measles Immunization . . . . . 28

4 Compliance to the DPT Immunization . . . . . 30

5 Accomplishment in OPV Immunization . . . . . 31

6 Accomplishment in HEPA Immunization . . . . . 33

7 Top Ten Leading Causes of Mortality of Year 2003 and 2004 . . 35





12 Top Ten Leading Causes of Morbidity of Year 2003 and 2004 . . 42





17 Factors Affecting Compliance of Mothers to Child Immunization . . 48

18 Problems Encountered by Health Centers to the Compliance of Child Immunization . . . . . . . . . 49

7

LIST OF FIGURES

Figure Page

1 Schematic Diagram of the conceptual framework in determining the accomplishment and compliance of the immunization program in Tacloban City . . . . . . . . . 9

2 Map of Tacloban City . . . . . . . . 22

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Chapter I

INTRODUCTION

Immunization has been one of the most significant and cost-effective public-

health interventions to decrease childhood morbidity and mortality. It prevents

debilitating illness and disability, and saves millions of lives every year. It is one of the

reasons and key to reduce poverty, and improve human development. The contribution

of immunization is especially critical to achieving the goal to reduce deaths among

children under five years old. In preventive medicine, it is the process of rendering

people immune to an infectious organism by inoculating them with a form of organism

that does not cause severe disease but does provoke formation of antibodies.

Immunization is done through various techniques, most commonly vaccination. Vaccines

against microorganisms that cause diseases can prepare the body's immune system, thus

helping to fight or prevent an infection. (wikipedia.org/immunization) Vaccines are the

most effective protection against most diseases caused by viruses and related organisms

because few antibiotics work against them.

Vaccines have the power not only to save, but also to transform, lives – giving

children a chance to grow up healthy, go to school, and improve their life prospects

(unicef.org). When vaccines are combined with other health interventions – such as

vitamin A supplementation, provision of deworming medicine and bed nets to prevent

malaria – immunization becomes a major force for child survival

(www.ncbi.nlm.nih.gov). According to the 2008 data from United Nations Children

Fund (UNICEF), global effort to immunize children with vaccines against life-

9

http://en.wikipedia.org/wiki/Infection

http://en.wikipedia.org/wiki/Disease

http://en.wikipedia.org/wiki/Microorganism

http://en.wikipedia.org/wiki/Vaccination

threatening disease set a record high, reaching (106 million) and averting more than 2.1

million deaths along with countless episodes of illness and disability annually. However

despite significant gains in recent years, some 23.5 million children (almost 20% of the

children born each year) are not immunized, exposing them disabilities or premature

death (unicef.org). Approximately three million children die each year of vaccine-

preventable diseases. Recent estimates suggest that approximately 34 million children are

not completely immunized, with almost 98% of them residing in developing countries

(unicef.org).

The eradication of small pox by vaccination is one of the greatest achievements of

World Health Organization (WHO). Recognizing the serious problem of infectious

childhood disease, and the benefits of immunization, WHO set up the Expanded Program

on Immunization (EPI) with the goal of making immunization services available to all the

world's children by 1990. It all supports program evaluation and field testing of improved

equipment and methods. More children than ever before are being reached with

immunization: over 100 million children a year in 2005–2007. And the benefits of

immunization are increasingly being extended to adolescents and adults – providing

protection against life-threatening diseases such as influenza, meningitis, and cancers that

occur in adulthood.

In developing countries, more vaccines are available and more lives are being

saved. For the first time in documented history the number of children dying every year

has fallen below 10 million – the result of improved access to clean water and sanitation,

increased immunization coverage, and the integrated delivery of essential health

interventions. In the Philippines, which is one of the developing countries, a key method

10

of reducing morbidity and mortality is childhood immunization however in 2003, only

69% of Filipino children received all suggested vaccinations. Data from the 2003

Philippines Demographic Health Survey were used to identify risk factor for none and

partial-immunization. Results of multinomial logistic regression analyses indicate that the

mothers who have less education and who have not attended the minimally recommended

four antenatal visits are less likely to have fully immunized children.(Bondy, 2009)

The Expanded Program on Immunization (EPI) in the Philippines began in July

1979 and in 1986, made a response to the Universal Child Immunization goal. The four

major strategies include: a) sustaining high routine Full Immunized Child (FIC) coverage

of at least 90% in all provinces and cities, (b) sustaining the polio-free country for global

certification, (c) eliminating measles by 2008, and (d) eliminating neonatal tetanus by

2008 (wikipedia.org/EPI). The country is still fighting in eliminating measles and

neonatal tetanus though a large decline in measles cases has been recorded. Philippines is

one of the countries included in 86% decline measles cases which is bringing closer to its

elimination. (www.measlesrubellainitiative.org) The country was certified polio-free

since October 2000 through high OPV3 (Oral Polio Vaccine) immunization coverage and

good surveillance for polio.

The standard routine immunization schedule for infants in the Philippines is

adopted to provide maximum immunity against seven vaccine preventable disease in the

country before the child's first birthday. The fully immunized child must have completed

BCG1(Bacillus Calmette-Guérin) , DPT1, DPT2, DPT3 (Diphtheria-Pertussis-Tetanus

Vaccine), OPV1, OPV2, OPV3 (Oral Polio Vaccine), HB1, HB2, HB3 (Hepatitis B

Vaccine), and measles vaccine before the child is 12 months of age.

11

http://en.wikipedia.org/wiki/Polio_vaccine#Sabin.27s_.22oral_polio_vaccine.22

http://en.wikipedia.org/wiki/DPT_vaccine

http://en.wikipedia.org/wiki/DPT_vaccine

http://en.wikipedia.org/wiki/Bacillus_Calmette-Gu%C3%A9rin

http://www.measlesrubellainitiative.org/

Every Wednesday is designated as immunization day and is adopted in all parts of

the country. Immunization is done monthly in barangay health stations, quarterly in

remote areas of the country. Because measles kills, every infant needs to be vaccinated

against measles at the age of 9 months or as soon as possible after 9 months as part of the

routine infant vaccination schedule. It is safe to vaccinate a sick child who is suffering

from a minor illness (cough, cold, diarrhea, fever or malnutrition) or who has already

been vaccinated against measles (Measles: Catch up Campaign, 2007). If the vaccination

schedule is interrupted, it is not necessary to restart. Instead, the schedule should be

resumed using minimal intervals between doses to catch up as quickly as possible

(Zimmerman, 2000). Vaccine combinations (few exceptions), antibiotics, low-dose

steroids (less than 20 mg per day), minor infections with low fever (below 38.5º Celsius),

diarrhea, malnutrition, kidney or liver disease, heart or lung disease, non-progressive

encephalopathy, well controlled epilepsy or advanced age, are not contraindications to

vaccination. Contrary to what the majority of doctors may think, vaccines against

hepatitis B and tetanus can be applied in any period of the pregnancy (Management of the

Traveler: Vaccination, 2007).

There are very few true contraindication and precaution conditions. Only two of

these conditions are generally considered to be permanent: severe (anaphylactic) allergic

reaction to a vaccine component or following a prior dose of a vaccine, and

encephalopathy not due to another identifiable cause occurring within 7 days of pertussis

vaccination (Management of the Traveler: Vaccination, 2007). Only the diluents

supplied by the manufacturer should be used to reconstitute a freeze-dried vaccine. A

sterile needle and sterile syringe must be used for each vial for adding the diluents to the

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powder in a single vial or ampoule of freeze-dried vaccine (General Recommendations

on Immunizations, 2007). The only way to be completely safe from exposure to blood-

borne diseases from injections, particularly hepatitis B virus (HBV), hepatitis C virus

(HCV), and human immunodeficiency virus (HIV) is to use one sterile needle, one sterile

syringe for each child (Hoekstra, 2006).

Despite of the efforts of the Department of Health with the help of UNICEF and

WHO, several factors affect the way EPI is implemented on the country which is

sometimes external. Some children does not undergo to the standard process of

immunization and for that reason the community must be aware of the factors that affect

the compliance of the said program.

General Objectives

This particular study aims to determine the accomplishment and the factors

affecting the compliance to immunization program in Tacloban City for the past ten years

(2003-2012).

Specific Objectives

Specifically, it seeks to;

1. Find out the rate of compliance to EPI in the said locale for the past ten years

(2003-2012)

2. Identify the reasons affecting the compliance to the Expanded Program on

Immunization and the current intervention scheme employed to comply

it.

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3. Determine if the seven immunizable diseases are still present as the leading

causes of morbidity and mortality among children.

Significance of the Study

This study tends to benefit the students, professors, medical practitioners, health

providers/ administrators, future researchers.

Students. The knowledge as to their field of specialization through the

determination of strengths, limitations, and their capabilities in understanding critical

concepts.

Professors .The result of this study could provide awareness on the importance of

the adhering to WHO standards by encouraging the students to cognizance of the adverse

effect if there is no compliance to regulation set by policy-making bodies.

Medical practitioners. This study may add insight to motivate them to strictly

adhere to regulations coming from the government as immunization programs are

concerned.

Administrators. The findings of the study may bring into focus the importance of

adhering to the regulations coming from the government regarding immunization

compliance to EPI and how it should be implemented properly in Tacloban City.

Future Researchers. The findings of the study will serve as springboard for other

researchers who may wish to conduct investigations on related fields of concept.

Scope and Limitation of the Study

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This study limits itself to the City of Tacloban, Leyte. It only concerns with the

status of immunization compliance to Expanded Program in Immunization for the past

ten years (2003-2012) in the said locale. It is to be conducted in selected Barangay Health

Centers in Tacloban City during the third quarter of 2012. A quantitative method is to be

used in analyzing and interpreting the data.

Theoretical Framework

The theoretical framework of this study is based in the noble idea of collectively

promoting public health through state-funded programs. Public health includes four

major areas: a.) promotion of positive health and vitality; b.) prevention of infectious and

non-infectious diseases as well as injury; c.) organization and provision of services for

diagnosis and treatment of illness; and d.) rehabilitation of the sick and differently able

people to their highest possible level of function. In the Philippines, it refers to various

health projects of the Department of Health (DOH) such as free immunization to those

who may be prone to illnesses. The EPI could be most equitable of health programs, yet

as shown in this study, reaching the most vulnerable children remains difficult and is

expensive so that an intervention system must be formulated towards full compliance by

means of new underutilized vaccine as well as proper education to he recipient on the

disadvantages of participating in this program.

Conceptual Framework

15

As human beings we are subjected to different types of illnesses once exposed to

an etiologic agent and if circumstances would allow. Due to this fact, vaccines were

developed to serve as protection and prevention against diseases such tuberculosis,

measles, tetanus, pertusis, and Hepatitis B. However, even with the efforts of health

organizations and the government in order to promote strict compliance regarding

immunization, there is still certain part of the population who are unable to follow it.

Here are some of the variables and basis for non-compliance as well the reason for its

compliance to immunization: 1) Interest, 2) Economic Status, 3) Knowledge, 4)

Accessibility, 5) Lifestyle, 6) Location, 7) Past Experience, 8) Culture, and 9) Behavior.

Interest plays a role in a sense that subjects would have enough will to comply

with these vaccinations. Economic status could influence the decision of the subjects to

comply. Lack of resources would most likely result to poor compliance to this program.

Knowledge is the key for the subject’s compliance for the idea regarding its pros and

cons are the basis to formulate a smart decision. Accessibility determines the ability of

the subject to avail the said matter.

If there is a lack of stimuli regarding variables, it would lead to poor compliance

of mothers to secure for their children’s privileges; hereby making them more susceptible

to illness, making them prone to diseases. But if adequate weight is pressed on these

variables the likelihood of diseases prevention and health promotion are well preserved

along favorable circumstances.

In this study, the researchers believe that the factors mentioned above, which are

the basis for compliance and non-compliance, has something to do with the level of

accomplishment and compliance of the immunization program. The independent

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variables are the factors affecting the compliance and non-compliance and the dependent

variable is the result of the accomplishment and level of compliance to the immunization

program in the said locale.

Figure 1. Schematic Diagram of the conceptual framework in determining the accomplishment and compliance of the immunization program in ` Tacloban City.

Definition of Terms

17

FACTORS AFFECTING COMPLIANCE AND NON-

COMPLIANCE

Interest, Economic Status, Knowledge Accessibility Lifestyle Location Past Experience Culture Behavior Others

LEVEL OF ACCOMPLISHMENT AND

COMPLIANCE OF THE IMMUNIZATION

PROGRAM

Independent Variable

Dependent Variable

Department of Health. It is a government agency in the Philippines which focuses

on providing remedies to illnesses and other general health problems of the citizenry,

performing such functions as vaccination programs, free tests of diseases and other form

of medical assistance.

Expanded Program on Immunization. It refers to the routine immunization

program for infants to provide maximum immunity against the seven preventable

diseases in the country before the child’s first birthday. The EPI is a World Health

Organization agenda with the goal to make vaccines available to all children through the

world. The EPI began in the Philippines last 1986 in response to the Universal Child

Immunization Goal.

Fully Immunized Child. It means that a child has received one dose of BCG at

birth or anytime before reaching 12 months. Three doses of DPT and OPV, with at least

four weeks interval for each dose. The first dose given at six weeks after birth or

thereafter, as long as the third dose is given before the child reaches 12 months. One dose

of measles vaccine at the age of nine months or before 12 months. And three doses of

HPV vaccine with at least four weeks interval.

Immunization Compliance. Refers to the level of compliance as mandated by

health agencies with regards to the full implementation of the governments immunization

program among the population. It also denotes as the manner of fulfilling by health

providers and other concerned agencies in implementing the EPI according to the

standards and guidelines set by the WHO.

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Morbidity. It is the incidence of ill health resulting from lack or absence of proper

immunization. It could mean also as the relative frequency of occurrence of a particular

disease in a certain diseases in a certain area.

Mortality. It is an incidence of death in a particular population. Specifically, it is

the number of deaths that occur at a given time, in a given group from a given cause.

United Nations Children’s Fund. United Nations Children's Fund is a United

Nations Programme headquartered in New York City, that provides long-

term humanitarian and developmental assistance to children and mothers in developing

countries. It is one of the members of the United Nations Development Group and its

Executive Committee.

World Health Organization. The trusted authority in directing and coordinating

health issues within the United Nations' structure.

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http://en.wikipedia.org/wiki/United_Nations_Development_Group

http://en.wikipedia.org/wiki/Developing_country

http://en.wikipedia.org/wiki/Developing_country

http://en.wikipedia.org/wiki/Mother

http://en.wikipedia.org/wiki/Child

http://en.wikipedia.org/wiki/Humanitarianism

http://en.wikipedia.org/wiki/New_York_City

Chapter II

REVIEW OF RELATED LITERATURE

History of Immunization and Vaccination

To most people, gasping breath and typical sounds of cough; the iron lungs and

braces designed for children paralyzed by polio; and other devastating effects caused by

incurable diseases, these infectious scourges simultaneously arouse fear and represent

obscure difficulties in the past years. Infectious diseases such as measles, diphtheria,

smallpox, and pertussis topped the list of childhood killers. Fortunately, many of these

devastating diseases have been contained, especially in industrialized nations, because of

the development and widespread distribution of safe, effective, and affordable vaccines.

(Meckel, 2004)

The history of vaccines and immunization started with the story of Edward

Jenner, a country doctor living in Berkeley, England, who in 1796 performed the world’s

first vaccination (Baxby, 2001). Taking secretion from a cowpox lesion on a milkmaid’s

hand, Jenner vaccinated an eight-year-old boy, James Phipps. Six weeks later Jenner gave

a shot to on two sites of Phipps’s arm with smallpox, yet the boy was unaffected by this

as well as subsequent exposures (Barquet, et. al., 1997). Based on twelve experiments

and sixteen additional case histories he had collected since the 1770s, Jenner published at

his own expenses a volume that quickly became a classic book in the history of medicine.

It was entitled "Inquiry into the Causes and Effects of the Variolae Vaccine." His

affirmation “that the cow-pox protects the human constitution from the infection of

smallpox” laid the foundation for modern vaccinology (Jenner, 1798).

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Although Jenner’s milkmaid experiments may now seem like pretty fables, they

provided the scientific basis for vaccinology. This is all the more remarkable especially that

our current conceptions of vaccine development and therapy are now much more

encompassing and firmly rooted in the science of immunology. Until the bright French

chemist Louis Pasteur developed what he called a rabies vaccine in 1885, vaccines referred

only to cowpox injection for treatment of smallpox. Although what Pasteur actually produced

was a rabies antitoxin that functioned as a post-infection antidote only because of the long

incubation period of the rabies germ, he expanded the term beyond its Latin association with

cows and cowpox to include all inoculating agents.(Hansen, 1998) Thus, Pasteur should

largely be thanked for this era's definition of vaccine as a “suspension of live or inactivated

microorganisms, like bacteria or viruses, or fractions thereof administered to induce

immunity and prevent infectious disease or its sequelae”( Advisory Committee on

Immunization Practices and the American Academy of Family Physicians).

Jenner’s initial experiments were done in a pre–germ theory era that lacked

modern methods of quality control and sterilization. Thus, the possibility of

contamination constantly came out over the development of smallpox vaccine, and many

people were wary of catching another dreadful disease from injection. With a method that

often involved extracting lymph from pustules on the arms of those recently vaccinated, it

was not uncommon for existing microorganisms to accompany the vaccine from arm to

arm, spreading diseases such as erysipelas, syphilis, and scrofula (Baxby, 2001).

Vaccines are biologic agents and can be interrupted during development. This

makes it different from most drugs which are basically chemical agents. Whether killed-

virus, whole-cell, bacterial, or live-attenuated, vaccines can be interrupted at different

points down the trip from the laboratory to the vial. Sure enough, quality control,

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sterilization, and monitoring have become consistent for vaccine production. Even with

firm standards, however, the likelihood of contamination persists, although it is extremely

less probable today than several decades ago. In addition, vaccine creation must be

closely managed to guarantee that vaccines bring immunity and do not produce serious

infection. For example, the hopefulness regarding the polio vaccine in spring 1955 was

momentarily restrained following 200 children catching the disease from a vaccine that

had live polio virus that was produced by Cutter Laboratories in California (Smith, 1991,

Baker, 2000, and Johnston, 2004).

Immunization and Vaccination

Understanding immunization requires the knowledge of our own body's immune

system. The human body has two types of immune system, the specific immune system

(also known as adaptive immune system or acquired immunes system) and the

nonspecific immune system or the innate immune system.

The nonspecific immune system and is the primary defense of the body. It

includes the cells and means to protect the host from viruses, bacteria, and other foreign

organisms in a non-specific manner. That is, the cells of the innate system distinguish and

react to pathogens in a basic and standard manner, but unlike the adaptive immune

system, it does not grant a long-term immunity to the host. Nonspecific defense by itself

may not entirely clear an infection, and in some cases parasites can avoid nonspecific

defense (Frank, 2002).

The specific immune system is composed of highly specialized, systemic cells

and processes that eliminate or prevent pathogen growth. It protects us against specific

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non-self organisms and substances. It is an induced response, that is, it must be taught

which things to attack. More technically, pathogen-specific receptors of acquired

immunity are acquired through a somatic expression process during the lifetime of the

organism (Frank, 2002).

Although vaccination and immunization are frequently switched terms, especially

in the nonmedical language, the latter is a more general term because it implies that the

application or injection of an immunologic agent essentially ends in the development of

sufficient immunity (Stern, et. al., 2005).

Immunisation is the process of defending people against dangerous infections

before they make contact with them. It does this by means of the body’s own natural

defence system, the immune response. When you are immunised you are given a vaccine,

usually as an injection, which contains a small dose of either a live but weakened form of

a virus, or killed/inactivated virus or bacteria or parts of these organisms, or a toxin

produced by an infectious organism. Vaccination just means having the injection. When

you are vaccinated, your body produces an immune response, just as you would if you

were exposed to the infection, but without having the symptoms, and this builds up your

resistance to that infection. If you come into contact with that infection in the future, your

immune system will respond fast enough to prevent you from developing the disease.

Immunization is the means of providing specific protection against most common

and damaging pathogens. The means of immunity depends on the site of the pathogen

and also the mechanism of its pathogenesis. Thus, if the mechanism of pathogenesis

involves exotoxins, the only immune mechanism effective against it would be

neutralizing antibodies that would prevent its binding to the appropriate receptor and

23

promoting its clearance and degradation by phagocytes. Alternatively, if the pathogen

produces disease by other means, the antibody will have to react with the organism and

eliminate by complement-mediated lyses or phagocytosis and intracellular killing.

However, if the organism is localized intracellularly, it will not be accessible to

antibodies while it remains inside and the cell harboring it will have to be destroyed and,

only then antibody can have any effect. Most viral infections and intracellular bacteria

and protozoa are examples of such pathogens. In this case, the harboring cells can be

destroyed by elements of cell mediated immunity or, if they cause the infected cell to

express unique antigens recognizable by antibody, antibody-dependent and complement

mediated killing can expose the organism to elements of humoral immunity.

Alternatively, cells harboring intracellular pathogen themselves can be activated to kill

the organism. Such is the case with pathogens that have the capability of surviving within

phagocytic cells (Male, et. al, 2006).

There are two types of immunization, active and passive immunization. Passive

immunity may be acquired naturally or artificially. Naturally acquired passive immunity,

occurs when immunity is transferred from mother to fetus. Artificially acquired passive

immunity is immunity which is often artificially transferred by injection with gamma-

globulins from other individuals or gamma-globulin from an immune animal. Passive

transfer of immunity with immune globulins or gamma-globulins is used in numerous

acute situations of infection (diphtheria, tetanus, measles, rabies, etc.), poisoning (insects,

reptiles, botulism), and as a prophylactic measure (hypogammaglobulinemia). In these

situations, gamma-globulins of human origin are preferable, although specific antibodies

raised in other species are effective and used in some cases (poisoning, diphtheria,

24

tetanus, gas gangrene, botulism). While this form of immunization has the advantage of

providing immediate protection, heterologous gamma-globulins are effective for only a

short duration and often result in pathological complications (serum sickness) and

anaphylaxis. Homologous immunoglobulins also carry the risk of transmitting hepatitis

and HIV (Male, et. al., 2006).

Active immunization refers refers to immunity produced by the body following

exposure to antigens. Vaccination is an active form of immunization. There are also two

types of active immunization, naturally acquired active immunity and artificially acquired

active immunity.

Naturally acquired active immunity is exposure to various pathogens which leads

to sub-clinical or clinical infections then resulting in a protective immune response

against these pathogens (Male, et. al., 2006).

Artificially acquired active immunity, on the other hand, is immunization by

administering live or dead pathogens or their components. Vaccines used for active

immunization consist of live (attenuated) organisms, killed whole organisms, microbial

components or secreted toxins (which have been detoxified) (Male, et. al., 2006).

State of the World’s Vaccines and Immunization

Since the Millennium Summit in 2000, one of the dynamic forces behind attempts

to reach the Millennium Development Goals (MDGs) is immunization, particularly, the

goal to reduce deaths among children under five years old. In addition, increasing number

children are being immunized: over 100 million children a year in 2005–2007. And the

gains of immunization are gradually being expanded to adolescents and adults. This

25

provides protection against life-threatening diseases such as influenza, meningitis, and

cancers that occur in adulthood (WHO, UNICEF, and The World Bank, 2009).

In developing countries, more vaccines are accessible and more lives are being

saved. For the record in known history, the number of children dying every year has

fallen below 10 million. This is due to the improved access to clean water and sanitation,

increased immunization coverage, and the integrated delivery of essential health

interventions (WHO, UNICEF, and The World Bank, 2009).

Creation and improvement of vaccines are being done while some are by now in

the late stages of clinical testing, making this decade the most productive in the history of

vaccine development. More money is available for immunization through innovative

financing mechanisms. And more creative energy, knowledge, and technical know-how

are being put to use through the development of public-private partnerships which were

forged to help advance the immunization-related global goals.(WHO, UNICEF, and The

World Bank, 2009)

Yet despite extraordinary progress in immunizing more children over the past

decade, in 2007, 24 million children – almost 20% of the children born each year – did

not get the complete routine immunizations scheduled for their first year of life. Reaching

these vulnerable children – typically in poorly-served remote rural areas, deprived urban

settings, fragile states, and strife-torn regions – is essential if the MDGs are to be

equitably met (WHO, UNICEF, and The World Bank, 2009).

26

Immunization in the Philippines

The Philippines through the Department of Health has implemented the Expanded

Program on Immunization (EPI) which was established in 1976 to ensure that

infants/children and mothers have access to routinely recommended infant/childhood

vaccines. Six vaccine-preventable diseases were initially included in the EPI:

tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and measles. In 1986, 21.3%

“fully immunized” children less than fourteen months of age based on the EPI

Comprehensive Program review (DOH, www.doh.gov.ph).

Immunization rates in the Philippines have steadily been rising from 1990 until

1999. When the government changed its strategy of procuring vaccines in 2000, the

coverage plummeted because the supplies were not delivered on time and inevitably

resulted in stock shortage. In 2003, the government approved a new set of policies on the

Expanded Program of Immunization (EPI) that included the procurement of vaccines

through UNICEF. Complete immunization coverage for children below 2 years old

reached almost 70 percent in 2003 (UNICEF, www.unicef.org).

The value for Immunization, DPT (% of children ages 12-23 months) in

Philippines was 87.00 as of 2010. Over the past 30 years this indicator reached a

maximum value of 91.00 in 2008 and a minimum value of 47.00 in 1980 (WHO,

www.who.int).

27

Chapter III

METHODOLOGY

In this part of the paper will be on the discussion about the research design, locale

of the study, instrumentation, data gathering procedure, and method of data interpretation

employed in this study.

Research Design

Analytic type of research was utilized in this study. The researchers focus on the

accomplishment of the immunization program in the city with the data given by the

health offices and with the information gathered from health centers in the city. The

concepts of the research is to include the initial use of empirical generalizations and

formal theory, which contains the factor affecting the program, to create questions and

direction during the data collection process as well as the use of such academic

viewpoints during the data analysis phase.

The research also determines the extent of relationship between the given

variables, on how the independent variables affect the success of the immunization

program. The data that will be gathered will be analyzed and be correlated on the top ten

leading causes of mortality and mortality.

Data Gathering

There are two sets of data that will be gathered. The first one will come from the

annual reports from the Tacloban City Health Office which contains the files and

28

documents regarding the Expanded Program on Immunization. The Health Offices in

every town or city is required to keep record and information about the immunization

program as part of the Department of Health’s plan, together with WHO and UNICEF, to

monitor the status of EPI in the different parts in the world including our country. The

facts and figures that will be gathered in this office will be analyzed, be subject to

comparative analysis, and be presented in the later parts of the paper.

The second data is a small scale surveys on the ten existing health centers in

Tacloban City which will answer a self-administered survey question regarding the

factors that affect non-compliance to the immunization program. The data that will be

gathered here are important to point out what affects the immunization program to its full

accomplishment. This data will be correlated with the information gathered in the City

Health Office regarding EPI.

Research Locale

The locale of the study is the City of Tacloban, Leyte which is the capital of the

province. The total population according to the 2010 census is 221,174 inhabitants.

Number of Families counts at 47,014 with an Average Household Size of 5.1. Majority of

the people in the are speaks Waray-Waray. Tacloban is culturally and linguistically

diverse. Today’s population consists of a mix of Spanish and Chinese mestizos, foreign

expatriates and native Leyteños.

The average recorded births every year in the past ten years is 5,936 according to

the gathered in the City Health Office. The EPI had been followed by city since its

implementation and had been rumored that it has high accomplishment regarding the

29

completion of the program. The health centers in which the data from the survey will be

gathered are also present in the locale. In the next page is the map of the City of

Tacloban.

Figure 2. Map of Tacloban City

Instrumentation

The survey questionnaire used was a self-administered one which is to be answered

by the respondents present in the health offices. It is composed of the Factors or Reasons

Affecting the Non-compliance to the Immunization Program in which the researchers

30

asked to mark the factors or reasons that affect the non-compliance to the immunization

program. This ranges from Interest, Economic Status, Knowledge, Accessibility,

Lifestyle, Location, Past Experience, Culture, to Behavior. If the respondents answer is

not included in the choices then he is given the option to specify it.

Statistical Analysis

Statistical tools were used in this research in order to achieved and interpret the

data gathered from different sources. In determining the overall accomplishment of the

immunization program in the locale, the formula in finding the mean was used.

x=∑ x

n

Where: ∑ n = total sum of al data values

n = number of data items in sample

Another significant method used in the research was determining the mortality

and morbidity rate to know the top ten leading causes of mortality and morbidity in the

locale. Rate was determined through the following formula:

x= Nn

(100,000)

Where: N (for mortality) = number of deaths from the specified cause

(for morbidity) = number of people with illness from specified cause

n = total population

31

CHAPTER IV

RESULTS AND DISCUSSIONS

This part of the paper will interpret and discuss the results gathered by the

researchers regarding the level of accomplishment to immunization program in Tacloban

City. In this chapter also the data regarding the level of accomplishment would be

correlated with the ten leading causes of mortality and morbidity. Consequently, the

factors affecting the compliance and non-compliance to the immunization program will

be illustrated.

Accomplishment of the Immunization Program in Tacloban City

The accomplishment to the program will be analyze through the data and records

obtained by the researchers in the City Health Office.

Table 1 shows the total live births in Tacloban City for the past ten years which

has an average of 5885. With this number an average of 5027 or 85 percent was fully

immunized children. This only illustrates that in the past ten years there was a high level

of compliance to the immunization program in Tacloban City. Only 15 percent of the live

births or eligible population in the past ten years had been recorded to have not complied

with the said program.

However a trend was seen regarding the observance of fully immunizing once

child as years pass by. The data recorded in the table shows that as years goes by the

compliance to immunization is declining. As it can be observed, from year 2003 to 2005,

a very high percentage of 96.00 percent was documented which only show that strict

33

implementation the EPI program was being made. On the other hand, in 2009 the

percentage dropped to 60 percent, from the high percentage in 2003 it went down with

almost 30 percent which can be a clear implication that the implementation of the

program had been low. Recently the compliance had been able to rise up in the scales

since in 2012 it had been 86.00 percent.

Table 1. Records of Livebirths and Fully Immunized Child

YearEligible Population

(Livebirths)

Fully Immunized Children

(9-11 months)

Percentage

2003 5469 5270 96.00

2004 5668 5438 96.00

2005 5748 5541 96.39

2006 5829 5183 89.00

2007 6169 5627 91.00

2008 5864 5127 87.00

2009 5765 3515 60.97

2010 5874 4519 79.00

2011 6426 4875 76.00

2012 6041 5175 86.00

Total 58853 50270 857.36

Average 5885 5027 85.73

34

Table 2 illustrates that there is a high compliance regarding the immunization

with BCG. The average percentage shown is over hundred percent. The reason for this is

the fact that once a newborn is delivered, BCG is assured. Since this is routinely given for

every newborn child deliveries in hospitals plus the out-patient department. The only

discrepancy that can be seen is the low percentage on the year 2012 which was only 78%.

Very low compared with the other years (almost always one hundred percent).

Table 2. Compliance with the BCG Immunization


(Live Births)

BCG

(Bacillus Calmette-Guérin)

Percentage

2003 5469 6012 109.92

2004 5668 6193 109.00

2005 5748 6243 109.00

2006 5829 6654 114.00

2007 6169 7013 114.00

2008 5864 6382 109.00

2009 5765 5415 92.48

2010 5874 6500 111.00

2011 6426 6426 97.00

2012 6041 4996 78.00

Total 58853 61834 1043.4

Average 58853 6183 104.34

35



Table 3 shows a high level of compliance with the measles vaccine. Data shows

that it has been consistent with its implementation. The only low point was when in 2009

when it hits a low 70 percent. But overall the compliance regarding measles vaccine has

been high and well.

Table 3. Compliance to the Measles Immunization


(Live Births)MEASLES Percentage

2003 5469 5469 100.00

2004 5668 4919 86.78

2005 5748 5767 100.00

2006 5829 5451 93.51

2007 6169 6045 98.00

2008 5864 5583 95.00

2009 5765 4064 70.44

2010 5874 4652 79.00

2011 6426 5096 79.00

Total 58853 52221 887.73

Average 5885 5222 88.73

36

Table 4 demonstrates compliance to the DPT immunization in the past ten years.

Since there are three processes for the vaccination for DPT the level of compliance will

be discussed separately and be compared. On the first, DPT-1, a high percentage was

recorded. An average of 97.15 percent was recorded. As shown in the table, mostly the

percent for accomplishment in 2003 to 2011 is over ninety. Only last year when hits low,

76 percent. Overall, there was a high compliance to the DPT immunization.

DPT-2 has a 90.26 percent; many of the children from the first process came back

for the second. Only seven percent did not have the second DPT, overall it was a high

level of compliance for the second part in comparison with the first. A 92.27 percent have

been analyzed in comparison with the percentage that came back for the second stage

(5307/5722) which can be seen as high relative to DPT-1.

The record regarding DPT-3 shows a declining rate in compliance. In 2008 the

City Health Office recorded an amazing 98 percent of children who took DPT-3, however

after a year it turned down to 77.06 percent only. Viable reasons for this are. The

development was also show in the following years which also recorded below 80

percentages. 12 percent in overall were the children recorded who have not been fully

immunized wit DPT. Reasons for these decrease will be analyze when the researchers

interprets the data regarding the factors that affect non-compliance to the program.

37

Table 4. Compliance to the DPT Immunization

Year

Eligible Population

(Live Births)

DPT 1 Percentage DPT 2 Percentage DPT 3 Percentage

2003 5469 5147 94.11 5149 94.13 5011 91.62

2004 5668 5470 96.5 5713 100 5328 94

2005 5748 6231 108 5541 96.39 5966 104

2006 5829 6005 103 5653 97 5683 97.49

2007 6169 6351 103 5678 92 5838 95

2008 5864 6266 107 5758 98 5765 98

2009 5765 5245 90.98 4655 80.74 4443 77.06

2010 5874 5781 98 5120 87 5874 79

2011 6426 6114 95 5347 83 4659 73

2012 6041 4610 76 4464 74 4592 76

Total 58853 57220 971.59 53078 902.26 53159 8851.17

Average 5885 5722 97.15 5307 90.26 5315 88.51

38

Table 5 indicates that a high compliance in the OPV immunization was observed

since then. It can be inferred by the high percentages that were recorded. There are

bottom lows like in year 2011 that from 83 percent of OPV-1, it suddenly hit to 69

percent in the 3rd stage. However only in that year where a large discrepancy was seen,

the other years showed stability in the implementation for immunizing the eligible

population. A 12 percent was recorded for not being fully-immunized with OPV.

Table 5. Accomplishment in OPV Immunization

Year

Eligible Population

(Live Births)

OPV-1 Percentage OPV-2 Percentage OPV-3 Percentage

2003 5469 5332 97.49 5311 96.63 5458 99.79

2004 5668 5341 95.81 4814 84.93 5402 95.30

2005 5748 6188 98.00 5634 98.00 5850 102.00

2006 5829 6020 103.00 5645 97.00 5612 96.27

2007 6169 6366 103.00 5766 93.00 5861 95.00

2008 5864 6506 97.15 5804 86.71 5794 86.59

2009 5765 5205 90.28 4719 81.85 4495 77.97

2010 5874 4683 97.00 5196 88.00 4699 80.00

2011 6426 5329 83.00 4798 75.00 4465 69.00

2012 6041 5511 91.00 5204 86.00 4986 83.00

Total 58853 56481 955.73 52891 887.12 52622 884.92

Average 5995 5648 95.57 5289 88.71 5262 88.49

39

Table 6 illustrates the findings regarding the accomplishment of HEPA

immunization. Of all the immunization trends, HEPA was the one which took a different

route. It has the lowest of overall accomplishments and actually started with low

percentages unlike the past four vaccines which have high compliance in year 2003 to

2005. Only 75.99 percent was recorded in 2003 which dropped down to 67.98 percent on

the third stage. Same movement was observed in the following years up to 2005.

Strong compliance was then documented starting 2006 to 2011. From stage 1 to 3

a good turn-in can be seen. Stage one recorded 106 percent at most in these years.

Awareness of the disease HEPA might be the reason for this. In these years, was the

breakthrough in which news about the disease spreading prompt the people to have its

vaccines. The City Health Office took the chance and campaigned for the strong

implementation of the immunization program.

The most remarkable point in the data was in 2012 where it had been able to

record a low compliance in all stages. Starting from 71.01 percent, then 54.00, and

ending with 50.00 percent. The lowest percentage recorded so far in ten years. Almost a

30 percent turn-out was recorded from stage-one to three. Hepatitis is one of the most

difficult infections if not prevented. The very high turn-out recorded in 2012 must be

addressed and give attention to be able to know its cause.

40

Table 6. Accomplishment in HEPA Immunization

Year

Eligible Population

(Live Births)

HEPA-B1

PercentageHEPA-

B2Percentage

HEPA-B3

Percentage

2003 5469 4156 75.99 3829 70.00 3718 67.98

2004 5668 4434 78.22 4037 71.22 4105 72.42

2005 5748 4175 73.00 3630 63.19 3581 62.29

2006 5829 5534 95.00 5078 87.11 5070 87.00

2007 6169 6556 106.00 5481 89.00 5688 92.00

2008 5864 6261 96.00 5737 88.00 5635 86.47

2009 5765 5682 98.56 4790 83.08 4511 78.24

2010 5874 5932 100.68 5209 89.00 4962 84.00

2011 6426 6762 105.23 5560 87.00 5122 80.00

2012 6041 4290 71.01 3242 54.00 3022 50.0o

Total 58853 53782 899.69 46593 781.6 45414 760.4

Average 5885 5378 89.96 4659 78.16 4541 76.04

41

Relationship Between the Accomplishment of the Immunization Program and Top Ten Causes of Mortality and Morbidity in Tacloban City

This part of on the chapter will discuss the relationship between the mortality and

morbidity rate to the accomplishment of the immunization program. The data above will

be compared with the result gathered regarding mortality and morbidity. The researchers

will look for a connection between the two variables.

First the observations made in the results regarding the table. For the past ten

years CP arrest had been the top leading cause of mortality in Tacloban City. Only in the

last three years was CP Arrest reduced and did no appear in the table. Also frequent

diseases that occur in the table are pneumonia, acute MI, diabetes, hypertension, and

tuberculosis.

With the result below following the tables that were analyzed, the only disease

which can be correlated is tuberculosis which appears as one of the leading causes of

deaths in Tacloban City. It is alarming to know that eventhough with the high compliance

recorded regarding immunization with BCG which is over a hundred percent (See Table

2), it is still one of the leading causes of deaths in the locale. It maintains a spot at

number five or six at most. This is the one that taints the immunization program. It must

be discuss and put to notice on health officials so that reasons causing these result will be

look upon to.

On a lighter note, although Hepatitis B and neonatal Tetanus was recorded they

were ranked low enough not to make in the top ten. This result would show that the

implementation of the EPI program is successful and have good results for it prevented

diseases like heap, polio, measles, and Diphtheria to spread. As shown in the table, the

42

seven-preventable diseases are not present in the leading causes of mortality except for

tuberculosis. This only means a high accomplishment to the compliance of immunization

program in Tacloban City in the specified years.

Table 7 to 11. Top Ten Leading Causes of Mortality in Tacloban City for the Each Past Ten Years

Table 7. Top Ten Leading Causes of Mortality of Year 2003 and 2004

Rank

2003Ran

k

2004

Causes/ Diseases

Deaths

Rate Causes/ Diseases

Deaths

Rate

1 CP Arrest 818 456.58

1 CP Arrest 579 322.10

2 Acute Respiratory Failure

51 28.37 2 Acute Respiratory Failure

178 99.02

3 Cardiogenic Shock

18 10.01 3 Pneumonia 84 46.73

4 Central Brain Hernation

15 8.34 4 Acute MI 83 46.17

5 Hypolemic Shock

12 6.67 5 Central Brain Hern.

Multiple Organ Failure

52 28.92

Pneumonia

6 Acute Hemorrhage

11 6.11 6 Vehicular Accident

49 27.25

7 Septis Shock 9 5.00 7 Uremia 46 25.59

Sepsis

8 Multi Organ 7 3.89 8 Diabetis Mellitas 36 20.02

43

Failure

Hepatic Ensephalopathy

9 Metabolic Enseplotitis

6 3.33 9 Hypertensive, Severe

28 15.57

Drowning

10 Asphyxia 5 2.78 10 Acute Renal Failure

27 15.02

44


Rank

2005Ran

k

2006

Causes/ Diseases

Deaths


Deaths

Rate

1 CP Arrest 369 205.27

1 CP Arrest 1001 504.45

2 Multi Organ Failure

147 81.77 2 Pneumonia 127 64.00

3 Pneumonia 116 64.53 3 Hypertension 101 50.90

4 Accidents 98 54.51 4 Vehicular Accidents

78 39.30

5 Tubercolosis 78 43.39 5 Diabetes Millitus

57 28.72

6 Acute Renal Failure

77 42.83 6 PTB 53 26.70

7 Diabetes Mellitus

68 37.82 7 Stab/ Gunshot Wound

53 26.71

8 Cerebro Vascular Diseases

49 27.25 8 Heart Diseases 46 23.18

Kidney Diseases

9 Viral Hepatitis 39 21.69 9 Multi Organ Failure

41 20.66

Uver Cirrhosis

10 Hypertension 38 21.13 10 Cancer 28 14.11

45


Rank

2007Ran

k

2008

Causes/ Diseases

Deaths


Deaths

Rate

1 CP Arrest 798 402.15

1 CP Arrest 853 429.87

2 Pneumonia 54 27.21 2 Neonatal Deaths 55 27.72

3 Neonatal deaths

34 17,13 3 Pneumonia 47 23.68

4 Cerebro Vascular Diseases

26 13.10 4 Acute MI 22 11.08

5 Acute MI 23 11.59 5 Heart Diseases 18 9.07

Hypertension

Pulmonary TB

6 Pulmonary TB 21 10.58 6 Kidney Diseases 15 7.56

7 Fetal Death in Uterus

19 9.57 7 Cerebro Vascular Diseases

14 7.06

8 Stab Wounds 10 5.03 8 Stab Wounds 11 5.54

9 Liver Cirrhosis 9 4.53 9 Septicemia 9 4.53

Vehicular Accidents

10 CA stage IV 8 4.03 10 CA Stage IV 7 3.53

Meningitis

46


Rank

2009Ran

k

2010

Causes/ Diseases

Deaths


Deaths

Rate

1 CP Arrest 385 194.02

1 Pneumonia 357 178.45

2 Hypertension 223 112.38

2 Acute MI 211 105.47


3 Trauma 167 83.48

4 Acute MI 140 70.55 4 Diabetes 142 70.98

5 Vehicular Accident

123 61.98 5 Hypertension 140 69.98

6 Diabetes 120 60.47 6 Pulmonary TB 92 45.99

7 Septecemia 95 47.87 7 CHF 57 28.49

8 Pulmonary TB 89 44.85 8 Asthma 46 22.99

9 Kidney Diseases

69 34.77 9 CP Arrest 44 22.00

10 Liver Cirrhosis 58 29.22 10 Dengue 36 18.00

47


Rank

2011Ran

k

2012

Causes/ Diseases

Deaths


Deaths

Rate

1 Acute MI 473 213.85

1 Acute MI 556 248.50


2 Diarrhea 318 142.00

3 Hypertension 123 55.61 3 Trauma 176 79.60

4 Trauma 96 43.40 4 Hypertension 117 52.20

5 Pulmonary TB 93 42.04 5 Septecemia 124 55.40

6 Diabetes 85 188.00

6 Kidney Diseases 107 47.80

7 CHF 64 28.93 7 CHF 78 34.80

8 G.I. Bleeding 63 28.48 8 G.I. 68 30.30

9 Kidney Disease 55 24.87 9 Liver Cirrhosis 67 29.90

Renal Failure

10 Liver Cirrhosis 45 20.34 10 Anemia 36 16.08

49

The tables below show the top ten leading causes of morbidity in Tacloban City

for the past ten years. As observed from the table URTI is the leading cause of morbidity

in past earlier six years. It was then replaced by ARI in the last four. Reasons for the

disappearance of URTI in the rankings may be for the strict prevention program and

availability of the cure. Frequent diseases that are on the list of top ten are pneumonia,

TB, dengue fever, diarrhea, animal bites, soft skin infections, and wounds. Pneumonia

and diarrhea are also recorded as top ten leading causes of mortality.

In correlation to the compliance to the seven-preventable diseases, only

tuberculosis appears in the top ten leading causes of morbidity. The result is similar with

mortality in which tuberculosis also appeared as one of its leading causes and

consistently appear each year. This is only a clear indication that even with the high

successful rate of compliance to BCG, many still dies with this disease. It can be seen as

one of the leading diseases in the city that causes deaths to many. Cases of Hepatitis B

and tetanus was also seen in the table but very far to be recognize as top leading causes of

morbidity. The result regarding tuberculosis only shows that EPI must still be pursued

intensively.

50

Tables 12 to 16. Top Ten Leading Causes of Morbidity in Tacloban City for the Past Ten Years

Table 12. Top Ten Leading Causes of Morbidity of Year 2003 and 2004

Rank

2003Ran

k

2004

Causes/ Diseases

Deaths


Deaths

Rate

1 URT I 4140 2303.12

1 URT I 4514 2511.18

2 Pneumonia 1915 1065.33

2 Pneumonia 2952 1642.23

3 UTI 1846 1026.95

3 TB 1130 628.63

4 Diarrhea 1034 575.22 4 Dengue Fever 738 410.56

5 Animal Bites 606 337.12 5 Diarrhea 732 407.22

6 Whooping Cough

510 283.72 6 Animal Bites 660 367.16

7 Dengue Fever 501 278.71 7 Skin Trauma 500 278.15

8 Wounds 445 247.56 8 Soft Skin Infection

456 253.68

9 TB 421 234.21 9 Musculoskeletal Pain

422 234.76

10 Bronchitis 411 228.64 10 Bronchial Asthma

374 208.06

51


Rank

2005Ran

k

2006

Causes/ Diseases

Deaths


Deaths

Rate

1 URT I 12370 6881.55

1 URT I 17833 9920.67

2 Musculoskeletal disorder

2133 1186.61

2 ARI 3014 1676.72

3 Diarrhea 1232 685.37 3 Pneumonia 1791 996.35

4 TB 784 436.15 4 Soft Tissue Infection

1064 591.91

5 ARI 719 399.99 5 PTB 803 446.72

6 Bronchial Asthma

564 313.76 6 Wound 648 360.49

7 Soft Tissues Infections

499 277.60 7 Bronchial Asthma

571 317.65

8 Acute Tonsilitis

496 275.93 8 Diarrhea 539 299.85

9 Hypertensive Disorder

475 264.25 9 Bronchitis 536 298.18

10 Animal Bites 474 263.69 10 Animal Bites 527 293.18

52


Rank

2007Ran

k

2008

Causes/ Diseases Deaths


Deaths

Rate

1 URTI 13203 6081.00

1 URT I 4809 2214.91

2 ARI 8820 4062.29

2 ARI 3155 1453.12

3 Soft Tissue Infection

1662 765.48 3 Soft Tissue Infection

608 280.03

4 Muscuskeletal Pain

1257 578.95 4 Pneumonia 461 212.33

5 HPN/HCVD 1041 479.46 5 HCVD 321 147.85

Muscuskeletal Pain

6 Loss of Appetite 945 435.25 6 EENT 258 118.83

7 Pneumonia 889 409.45 7 TB 221 101.79

8 Headache 887 408.53 8 Bronchial Asthma

214 98.56

9 EENT 806 371.22 9 Loss of Appetite

211 97.18

10 Ostee/Rheumatoid Arthritis

693 319.18 10 GIT 193 88.89

53


Rank

2009Ran

k

2010

Causes/ Diseases

Deaths


Deaths

Rate

1 ARI 2158 975.70

1 ARI 1935 874.88

2 Acute Bronchitis

2155 974.35

2 Chronic Bronchitis

1863 842.32

3 Chronic Bronchitis

2016 911.50

3 Acute Bronchitis 759 343.17

4 Rheumatic Arthritis

1311 592.75

4 Soft Tissue Infections

1159 524.02

5 HCVD 894 404.21

5 HCVD 741 335.03

6 Soft Tissue Skin Infection

860 388.83



7 Rheumatic Art 574 259.52

8 Bronchial Asthma

415 187.64

8 Systematic Viral Infections

362 163.67

9 Headache 350 158.25

9 Headache Wound

298 134.74

10 Loss of appetite

349 157.79

10 PTB 223 100.83

54


Rank

2011Ran

k

2012

Causes/ Diseases

Deaths


Deaths

Rate

1 ARI 4260 1962.06

1 Systematic Viral Infectiom

1193 549.47

2 Systematic Viral Infection

1910 879.70 2 ARI 897 413.14

3 Acute Bronchitis

1595 734.62 3 Pneumonia 904 416.36

4 Soft Tissue Skin Infection

1300 598.75 4 Scabies 402 185.15

5 HCVD 589 271.28 5 Essential HPN 264 121.59

6 AURI 519 239.04 6 Wound 178 81.98

7 Pneumonia 451 207.72 7 Bronchial Asthma

173 79.68

8 Bronchial Asthma

371 170.87 8 Impetigo 150 69.09

9 Diarrhea 269 123.90 9 Allergic Rhinitis

117 53.89

10 PTB 250 115.14 10 PTB 109 50.20

55

Factors Affecting the Compliance to the Immunization Program

In this part the researchers will discuss the different factors that affect the

compliance to the immunization program. These are one of the reasons why there is still

percentage left who does not comply with the necessary process in immunizing one’s

child. Ten health care centers where interviewed and surveyed in the research locale

regarding the current study.

Table 17 shows the most common grounds that affects compliance of mothers to

her child’s immunization. These are lack of knowledge, wrong perception, location of

health center, unpleasant experience, economic expense, lack of trust to the healthcare

provider, socio-economic differences, and some other reasons that the respondents have

specified.

Lack of knowledge and wrong perception regarding immunization are the factors

which have the highest frequency. This only inform us that there are still mother who

lack the necessary orientation regarding the importance of her child’s immunization

which may result to more drastic problems. The other one is the misconception of the

mothers regarding immunization, this can be accounted also for the lack of orientation or

beliefs of the mother that having their child undergoes these vaccinations would only

threaten their offspring’s health. Some mother’s affected by our old culture does not rely

on modern medicine and believe that this prevention is harmful to their children. These

beliefs and wrong notions can be cured by proper orientation and advocacies on mothers

regarding the seven-preventable diseases and the goodness immunization can bring.

Other factors although have low frequencies but significant as well came from

unpleasant experience, economic expense and socio-economic differences. These can

also affect the compliance to immunization. Unpleasant experiences in complying are one

56

of the reasons why some mothers do not come back for the second or third stages which

are important especially in DPT, OPV, and HEPA. Turn-outs which were recorded in the

earlier tables can be effect of the following factors especially the last four. When

unpleasant experience happens together with lack of trust to the healthcare provider then

there is a high probability for the mother and child to return for the second process.

Clients and patients should be treated well enough and be assured that everything is

alright for them to trust and come back o fully immunize the child. Other reasons cited

was busy, not-prioritized, they sees it as a burden, and laziness.

Table 17. Factors Affecting Compliance of Mothers to Child Immunization

Factors Affecting Compliance of Mothers to Child Immunization Frequencylack of knowledge 9wrong perception / misconception of mothers regarding Immunization 8Location of the health center 2unpleasant experience 4economic expense 4lack of trust to the healthcare provider 2socio-economic differences 4

Table 18 indicates the problems encountered by health centers to the compliance

of child immunization. The difficulties cited were lack of supply, absent health care

provider, no permanent or fixed schedule, lack of support from the government, and

infrastructural defect. The result of this survey and interview is very important because it

does not only refers to us the health centers as a whole but also as an independent

provider. This reflects also the situations in each health centers.

The table shows that the most common problem health centers faces are the lack

of supply in implementing the program. This is one of the greatest dilemma, many

57

programs have failed because of the lack of supply needed to sustain it. This problem has

to be addressed more by the providers and especially the government who is supporting

this. Saving young ones and health must be on the top of the list on the programs the

government must have its attention to.

Table 18. Problems Encountered by Health Centers to the Compliance of Child Immunization

Problems Encountered by Health Centers to the Compliance of Child Immunization

Frequency

lack of supply 8absent healthcare provider 3no permanent schedule 3lack of support from the government 2infrastructural defect 0

CHAPTER V

SUMMARY AND CONCLUSION

With the acquired data and the analysis done, we can now safely conclude the

study. it has been found out that the total live births in Tacloban City for the past ten

years has an average of 5885. With this number an average of 5027 or 85 percent was

fully immunized children. This only illustrates that in the past ten years there was a high

level of compliance to the immunization program in Tacloban City. Only 15 percent of

the live births or eligible population in the past ten years had been recorded to have not

complied with the said program.

However a trend was seen regarding the observance of fully immunizing once

child as years pass by. The data recorded in the table shows that as years goes by the

compliance to immunization is declining. As it can be observed, from year 2003 to 2005,

a very high percentage of 96.00 percent was documented which only show that strict

implementation the EPI program was being made. On the other hand, in 2009 the

58

percentage dropped to 60 percent, from the high percentage in 2003 it went down with

almost 30 percent which can be a clear implication that the implementation of the

program had been low. Recently the compliance had been able to rise up in the scales

since in 2012 it had been 86.00 percent.

The study has found out that there is a high compliance regarding the

immunization with BCG. The average percentage shown is over hundred percent. The

reason for this is the fact that once a newborn is delivered, BCG is assured. Since this is

routinely given for every newborn child deliveries in hospitals plus the out-patient

department. The only discrepancy that can be seen is the low percentage on the year 2012

which was only 78%. Very low comparing with the other years which was almost always

one hundred percent.

The study has also found out that there is a high level of compliance with the

measles vaccine. Data shows that it has been consistent with its implementation. The only

low point was when in 2009 when it hits a low 70 percent. But overall the compliance

regarding measles vaccine has been high and well.

On the first, DPT-1, a high percentage was recorded. An average of 97.15 percent

compliance was recorded. DPT-2 has a 90.26 percent; many of the children from the first

process came back for the second. Only seven percent did not have the second DPT. A

92.27 percent have been analyzed in comparison with the percentage that came back for

the second stage (5307/5722) which can be seen as high relative to DPT-1.

The record regarding DPT-3 shows a declining rate in compliance. In 2008, the

City Health Office recorded an amazing 98 percent of children who took DPT-3, however

after a year it turned down to 77.06 percent only. Viable reasons for this are. The

59

development was also show in the following years which also recorded below 80

percentages. 12 percent in overall were the children recorded who have not been fully

immunized wit DPT. Reasons for these decrease will be analyze when the researchers

interprets the data regarding the factors that affect non-compliance to the program.

Regarding OPV immunization, it has been found out that there is a high

compliance in the said immunization. There were bottom lows like in year 2011 that from

83 percent of OPV-1, it suddenly hit to 69 percent in the 3rd stage. However only in that

year where a large discrepancy was seen, the other years showed stability in the

implementation for immunizing the eligible population. A 12 percent was recorded for

not being fully-immunized with OPV.

Of all the immunization trends, HEPA was the one which took a different route. It

has the lowest of overall accomplishments and actually started with low percentages

unlike the past four vaccines which have high compliance in year 2003 to 2005. Only

75.99 percent was recorded in 2003 which dropped down to 67.98 percent on the third

stage. Same movement was observed in the following years up to 2005.

Strong compliance was then documented starting 2006 to 2011. Awareness of the

disease HEPA might be the reason for this. In these years, was the breakthrough in which

news about the disease spreading prompt the people to have its vaccines. The City Health

Office took the chance and campaigned for the strong implementation of the

immunization program. The most remarkable point in the data was in 2012 where it had

been able to record a low compliance in all stages.

For the past ten years CP arrest had been the top leading cause of mortality in

Tacloban City. Only in the last three years was CP Arrest reduced. Tuberculosis was

60

found as one of the leading causes of deaths in Tacloban City. It is alarming to know that

even though with the high compliance recorded regarding immunization with BCG which

is over a hundred percent, it is still one of the leading causes of deaths in the locale.. It

must be discussed and put to notice on health officials so that reasons causing these result

will be look upon to.

On a lighter note, although Hepatitis B and neonatal Tetanus was recorded they

were ranked low enough not to make in the top ten. This result would show that the

implementation of the EPI program is successful and have good results for it prevented

diseases like heap, polio, measles, and Diphtheria to spread. This means that a high

accomplishment to the compliance of immunization program in Tacloban City in the

specified years.

It has also been observed that URTI is the leading cause of morbidity in past six

years. It was then replaced by ARI in the last four. Frequent diseases that are on the list of

top ten are pneumonia, TB, dengue fever, diarrhea, animal bites, soft skin infections, and

wounds. Pneumonia and diarrhea are also recorded as top ten leading causes of mortality.

In correlation to the compliance to the seven-preventable diseases, only

tuberculosis appears in the top ten leading causes of morbidity. The result is similar with

mortality in which tuberculosis also appeared as one of its leading causes and

consistently appears each year. This is only a clear indication that even with the high

successful rate of compliance to BCG, many still die with this disease. The result

regarding tuberculosis only shows that EPI must still be pursued intensively.

The most common grounds that affects compliance of mothers to her child’s

immunization are lack of knowledge, wrong perception, location of health center,

61

unpleasant experience, economic expense, lack of trust to the healthcare provider, socio-

economic differences, and some other reasons that the respondents have specified.

Lack of knowledge and wrong perception regarding immunization are the factors

which have the highest frequency. This only inform us that there are still mother who

lack the necessary orientation regarding the importance of her child’s immunization

which may result to more drastic problems. The other one is the misconception of the

mothers regarding immunization, this can be accounted also for the lack of orientation or

beliefs of the mother that having their child undergoes these vaccinations would only

threaten their offspring’s health. Some mother’s affected by our old culture does not rely

on modern medicine and believe that this prevention is harmful to their children. These

beliefs and wrong notions can be cured by proper orientation and advocacies on mothers

regarding the seven-preventable diseases and the goodness immunization can bring.

Other factors although have low frequencies but significant as well came from

unpleasant experience, economic expense and socio-economic differences. Unpleasant

experiences in complying are one of the reasons why some mothers do not come back for

the second or third stages which are important especially in DPT, OPV, and HEPA.

When unpleasant experience happens together with lack of trust to the healthcare

provider then there is a high probability for the mother and child to return for the second

process. Clients and patients should be treated well enough and be assured that

everything is alright for them to trust and come back o fully immunize the child. Other

reasons cited was busy, not-prioritized, they sees it as a burden, and laziness.

The study also found the problems encountered by health centers to the

compliance of child immunization. The difficulties cited were lack of supply, absent

62

health care provider, no permanent or fixed schedule, lack of support from the

government, and infrastructural defect.

The table shows that the most common problem health centers faces are the lack

of supply in implementing the program. This is one of the greatest dilemma, many

programs have failed because of the lack of supply needed to sustain it. This problem has

to be addressed more by the providers and especially the government who is supporting

this. Saving young ones and health must be on the top of the list on the programs the

government must have its attention to.

63

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