CHAPTER 1.

INTRODUCTION

INTRODUCTION AND BACKGROUND OF THE STUDY

“All for Health and Health for All” (Lahat Para sa

Kalusugan! Tungo sa Kalusugan Para sa Lahat).” President Roa

Duterte’s Philippine Health Agenda 2016-2022: Healthy Philippines

2022 clearly defines the roadmap towards health of the Filipinos.

Under the Philippine Health Agenda, the health system is geared

towards the Filipino’s Financial protection (Filipinos, especially the

poor, marginalized and vulnerable are protected from high cost of

health care), better health outcomes (Filipinos attain the best

possible health outcomes with no disparity) and responsiveness

(Filipinos feel respected, valued, and empowered in all of their

interaction with the health system). Towards realization of the

Health Agenda 2022, the Philippine Health System is equitable and

exclusive to all, transparent and accountable, uses resources

efficiently and provides high quality services.

1
 Aligned with President Duterte’s Health Agenda is Manila

City Mayor Ejercito

Estrada’s 10-point agenda:

CITY OF MANILA 10 POINT AGENDA
1. PEACE AND ORDER: Buhayin ang Manila’s Finest
2. HEALTH: Bigayan ng sapat na gamut at abot-kayang
serbisyong pangkalusugan ang mamamayan ng
Maynila
3. HOUSING / URBAN SETTLEMENT: Bigyan ng
tiyak at desenteng pabahay ang mahihirap sa loob ng
Maynila
4. TRANSPORTATION & TRAFFIC: Ayusin at linisin
ang mga kalsada, tulay at ilog
5. CLEANLINESS: Magpatupad ng mahusay na Sistema
ng pagkolekta at ng wasting pagtapon ng basura
6. EDUCATION: Gawaing ‘Center of Academic
Excellence’ ang Siyudad ng Maynila\

The health programs bid to extend much-needed health

services in remote communities of Manila, Mayor Joseph “Erap”

Estrada and thus increased the capacity and capability of health

workers to implement what he called the “Research Every Purok”

(REP) outreach program.

The DEPARTMENT OF HEALTH (DOH) holds the over-all

technical authority on health as it is a national health policy-maker

and regulatory institution. Basically, the DOH has three major roles

in the health sector: (1) leadership in health; (2) enabler and capacity

2
builder; and (3) administrator of specific services. Its mandate is to

develop national plans, technical standards, and guidelines on health.

Aside from being the regulator of all health services and products, the

DOH is the provider of special tertiary health care services and

technical assistance to health providers and stakeholders.

The MANILA HEALTH DEPARTMENT is responsible for

planning and implementation of the health care programs provided by

the city government. It operated 59 health centers and six city-run

hospitals, which are free of charge for the city’s constituents. The six

public city-run hospitals are the Ospital ng Maynila Medical Center,

Ospital ng Sampaloc, Gat Andres Bonifacio Memorial Medical

Center, Ospital ng Tondo, Sta. Ana Hospital and Justice Jose Abad

Santos General Hospital. Manila is also the site of the Philippine

General Hospital, the tertiary state-owned hospital administered and

operated by the University of the Philippines Manila.

The District Health Office is headed by Dr. Bernadette

Fuggan. Currently, there are 12 health centers in District 4. Barangay

458 is under the Earnshaw Heath Center which is estimately 2 km

away from the vicinity. The health center is supervised by Dr. Rosario

E. Margate with 14 health workers. Three nurses were assigned to

3
cover the 36 barangays consisting of 52,656 who are served by the

health center. The ratio of one health worker to the people served by

the health center is one health worker: 3,762 people. The nurse

assigned to the barangay 458 is Ms. Girlita I. Igtanloc, RN.

4
 M. Earnshaw Health Center Organizational Chart

Dr. Rosario E.
Margate, MD
Physician-In-Charge

Dr. Raymond V.
Reyes, DMD
Dentist

Myrocelle C. Mrs. Girlita I. Mr. Larry Joe

Sabado, RN Ignatoc, RN Magno,Rn
Nurse Nurse-In-Charge
Nurse Deployment Program

Giselle M.
Dungca, RN
Public Health Associate
Miss Marissa C.
Gayrama
Nursing Aide

Miss Lorna C.
Continuado
Utility Worker

Mrs. Artemia D. Ms. Jemaly C.

Sebastian Menpin
BHW Job Order IV

5
 “Community health nursing” is a synthesis of nursing and

public health practice applied to promoting and preserving the health

of people. The practice is general and comprehensive. It is not limited

to a particular age group or diagnosis, and is continuing, not episodic.

The dominant responsibility is to the people as a whole, nursing

directed to individuals, families, or groups contributes to the health of

total population. Health education, promotion, maintenance, and

management, coordination and continuity of health care are utilize in

a holistic approach to the management of health care of the

individuals, families, and groups in a community. The nurses’ actions

acknowledge the need for comprehensive health planning, recognize

the influences of social and ecological issues, give attention to the

population at risk, and utilize dynamic forces which influence

change.

The definition encompasses both direct and indirect services

to individuals, families, groups and communities. Its scope is

concerned with both wellness and illness in providing, as well as

facilitating the delivery of services. Community health nursing

requires the integration of many general areas within nursing, such as

the nursing process, interpersonal skills, and leadership principles. It

6
further necessitates the use of specific content from other practice

areas, such as medical, surgical, pediatric, obstetric, and gynecology,

and psychiatric mental nursing. There is also a specialize body of

knowledge pertaining to such areas as public health science, health

policy and community dynamics.

“Public Health Nursing synthesizes the body knowledge from

public health sciences and professional nursing choice for the

purpose of improving the health of the entire community. This goal

lies at the heart of primary prevention and health promotion, and is

the foundation for public health nursing practice. To accomplish this

goal, public health nurses work with groups, family and individuals,

as well as in multidisciplinary teams and programs. Identifying

subgroups (aggregates) within the population which are at the high

risk of illness, disability or premature death, and directing resources

these groups, is the most effective approach for accomplishing the

goal of public health nursing. Success is reducing the risk and in

improving the health of the community depends on the involvement

of consumes especially group experiencing health risks, and others in

the community health planning and in self-help activities.”

7
 Further, the above definition denotes the public health nursing is a

systematic process/ nursing process, in which the following activities

is practiced.

1. The health and health care needs of a population are assessed

by nurses in collaboration with other disciplines in order to

identify sub-populations (aggregates) families, and

individuals at increased risk of illness, disability or premature

death.

2. A plan for intervention is developed to meet the needs that

include available resources and those activities that contribute

to health and its recovery and to the prevention of illness,

disability and premature death.

3. A health care plan is implemented effectively, efficiently and

equitably.

4. An evaluation is made to determine the extent to which these

activities have an impact on the health status of the

population.

8
Vision and Commitments

Community/public health nurses are concerned with

development of human beings, families, and communities. Nursing

provides us our commitment to assist individuals developmentally,

especially at the time of birth and death. Public health expands our

commitment beyond individuals to consider the development and

healthy functioning of families, groups, and communities.

Public health practice makes its unique contribution to

community/public health nursing by adding to commitments. These

commitments include the following:[ CITATION MAR16 \l 1033 ]

1. Ensuring an equitable distribution of health care

2. Ensuring a basic standard of living that supports the health

and well-being of all persons

3. Ensuring a healthful physical environment

The planning process consists of a series of specific steps,

although each of these is necessary, the steps do not have to occur in

the exact sequence given here. Occasionally, several steps may be

undertaken simultaneously, or they may occur in a slightly different

9
order. Identification of the planning group may occur much earlier in

the sequence. The steps are as follows:

1. Assessment
2. Diagnosis
3. Validation
4. Prioritization of needs
5. Identification of the target population
6. Identification of the planning group
7. Establishment of the program goal
8. Identification of possible solutions
9. Matching solutions which at-risk aggregates
10. Identification of resources
11. Selection of the best intervention strategy
12. Delineation of expected outcomes
13. Delineation of the intervention work plan
14. Planning for program evaluation

DEVELOPMENT DIRECTIONS

The vision of Barangay 458 is to be a unified barangay that is

progressive and is better place to live in. Their mission is to serve its

people by making them the top priority and by providing services that

focuses on Health, Education, Peace and Order, Livelihood, Sport,

and Recreation, to be a responsive and role model in the performance

10
of public services, to extol and encourage participation of each

barangay resident in every barangay undertaking, to ensure every

undertaking to improve the condition of every barangay constituents

in the areas of health sanitation and safety, good governance,

provisions of basic social services, upliftment of economic conditions

and environmental management. The barangay’s objective is to

provide “24/7 Express Public Service” to the barangay community.

The goals of the public servants are to provide the basic needs of

their barangay constituents, to protect our constituents from outside

elements and secure the barangay 24/7, to provide the necessary

medical health and sanitation of community, to inform and educate

the constituents of the directive and trust of the City/ National

Government and to be a role model to its community and neighboring

barangays.

The barangay’s strategies are to trap the readily available

number of professionals and students (especially medical) to

participate in the barangay’s health related and upliftment programs

and project to prevent recurrence of disease, to coordinate with

various government and national agencies on program and activities

providing social services to constituent to eliminate poverty, to be an

11
institute a regular program for nutritional feeding of monitoring of

children, including their health records, to instill awareness by

educating barangay residents regarding government directives,

ordinance and goals and to use the barangay general assembly as a

forum to hear their advice.

STATEMENT OF OBJECTIVES:

Community diagnosis is a comprehensive assessment of

health status of the community in relation to its social, physical and

biological environment. Thus, the purpose of community diagnosis is

to define existing problems, determine available resources and set

priorities for planning, implementing and evaluating health actions,

12
by and for the community. Specifically, the following are the

researcher’s objectives:

a. Collect data which will allow the estimation of demographic

rates
b. Assess attitudes toward community health services and issues
c. Analyze the health status of the community
d. Evaluate the health resources, services, and systems of care

within the community

e. Identify priorities, establish goals, and determine courses of

action to improve the health status of the community

f. Propose health interventions based on identified problems /

issues in the community

METHODOLOGY AND TOOLS USED

Data Collection Tool

This study focusing on deriving community diagnosis is a

non-experimental quantitative type which utilized a survey method

through the use of questionnaires. The researchers utilized a

standardized questionnaire for community diagnosis provided by the

Manila Health Department to generate data for a target community.

Data from the questionnaires was collated and analyzed through the

use of measures of central tendency and illustrated utilizing

13
appropriate data presentation tools. Primary data was obtained from

residents of the community while secondary data was obtained from

the Earnshaw Health Center which covers the health needs of the

community.

The questionnaire has three parts, each one eliciting

information and patterned on the Philippines National Demographic

Health Surveys. The first part collects data on the usual members and

visitors in the selected households. Background information on each

person listed, such as relationship to head of the household, age, sex,

and highest educational attainment. The date also includes the

community’s socio-economic and cultural variables. The social

indicators include Communication network (whether formal or

informal channels) necessary for disseminating health information of

facilitating referral of clients to the health care system, transportation

system including road networks necessary for accessibility of the

people to the health care system, transportation system including road

networks necessary for accessibility of the people to the health care

delivery system, educational level which may indicative of poverty

and may reflect on health perception and utilization pattern of the

community and housing conditions which may suggest health hazards

14
(congestion, fire, exposure to elements). The economic indicators

describe poverty level income, unemployment and underemployment

rate, proportion of salaried and wage earners to total economically

active population and the types of industries and occupations

common and present in the community.

The second part includes environmental factors affecting

health patterns of the community. The physical / geographical /

topographical characteristics of the community, garbage disposal,

water supply / sources data are generated.

The third part elicits data on Health and Illness Patterns of the

community. This may include leading causes of mortality, leading

causes of morbidity, leading causes of infant mortality, leading causes

of maternal mortality and leading causes of hospital admissions.

Sampling Technique and Participants to the Study

The researcher utilized the purposive sampling technique. The

respondents are residents of Barangay 458, Sulucan St., Manila who

either stands as head of the family or a parent. The participants,

having consented for being respondents were interviewed utilizing

15
the standardized and prescribed Community Diagnosis

Questionnaires. The population for study was recommended by the

Physician-in-Charge at the Earnshaw Health Center, Sampaloc,

Manila. The target number of families for this study was given by the

Training Officer at the Manila Health Training Office.

Limitation of the Study

This study was limited primarily by its design, a non-

experimental quantitative type which utilized a survey method

utilizing standard survey questionnaires distributed by the Manila

Health Department Training Office. It basically covers survey of

demographic, household and environmental characteristics of the

family. The number of family respondents for this study sample for

this study generated from the instructions of the MHD Training

Officer and did not make use of prescribed formula in determining

sample size (eg. Sloven’s Formula). The determination of community

16
for this study was given by the Medical Officer-in-Charge of the

Earnshaw Health Center. The study was carried out during the

covered period of training by the researcher. To ensure coverage of

the desired target of respondents, the assistance of the Barangay

Health Worker was tapped who sought help from a leader in the

community.

17
 I. SETTING OF THE COMMUNITY

I.1 Description

Manila, officially referred to as the City of Manila is the

capital of the Philippines was the first chartered City by virtue of the

Philippine Commission Act 183 on July 31, 1901 and gained

autonomy with passage of Republic Act No. 409 or the “Revised

Charter of the City of Manila” on June 18, 1949. Manila is located on

the eastern shores of the Manila Bay in one of the finest harbors in

the country. The Pasig River flows through the middle of the city,

dividing it into the north and south. Manila is made up of 16 districts:

Binondo, Ermita, Intramuros, Malate, Paco, Pandacan, Port Area,

Quiapo, Sampaloc, San Andres, San Miguel, San Nicolas, Santa Ana,

Santa Cruz, Santa Mesa and Tondo. Manila is made up of Six

Congressional Districts that represents the city on the Lower House

of the Philippines Congress.

Sampaloc (District 4) is district of Manila which is primarily a

residential and educational center. Part of Malacanang Palace is

located in Sampaloc. The National University, part of University

Belt, the famous Dangwa flower market at Dimasalang Street and the

former colonial mansion is now called Windsor Inn in Maceda Street

18
named after a famous politician from the Maceda family who comes

from this district, this street used to be known as “Washington Street”

during the American Era named after the Washington Regiments

during the Philippine-American War. Windsor Inn is popular with

backpackers and budget travelers. Nearby is the La Loma area,

famous for its open-air lechon (roast pig) restaurants.

There are 241 barangays in Sampaloc, numbers 351-598. It

has total land area of 5.14 km2. Each barangay has its own

chairperson and councilors. For administrative convenience, all the

barangays in Manila are groups into 100 zones and which are further

grouped into legislative districts. The city further has six

representatives popularly elected to the House of Representatives, the

lower legislative branch of the Philippines. Each representative

represents one of the six Congressional districts of Manila.

One of these Barangays in Sampaloc is Barangay 458.

Barangay 458 is an urban barangay which belongs to the forty fifth

zone and in the fourth district of Sampaloc Manila. The Barangay has

the total land area of approximately 7.89 hectares. As of midyear

2016, according to statistical report of Sampaloc Manila hall, there

are 2588 individuals living in the community. The surveyed total

19
population of the Nursing students conducted a Community Health

Nursing in Barangay 458 as of November 2018 are 130 families

which composed of 400+ households, 250 males and 150 females.

This is caused by the increase in population size. The large numbers

of households are dominantly patriarchal in type. The total voting age

population of the barangay is 1450. For the civil status matter, singles

are in large number than married, widowed, separated, and common

law. Eighty percent (80%) of the community surveyed are Roman

Catholic, some are Iglesia ni Cristo, Christians and Seventh-Day

Adventist. Barangay 458 falls under 1 type of the Philippine Climate

Classification. The two distinct seasons recognized are the dry high-

pressure season, which comes in the months of November until April

and the west season which starts from May up to October. The dry

season corresponds with the northeast monsoon (October to January)

and wet season with the southwest monsoon (June to September).

The public transportation services of Barangay 458 are provided by

jeepney, tricycle, taxi, rail-based services such as LRT are more

significant as the rest. Only few barangay are adjacent to concrete

city streets. Most of the barangays are interior and can be reached

using the concreted interior pathways. However due to some

problems in the road right of way, some portion of this pathway is not

20
completed. Some pathways that are connected to other barangays are

rough and needs to be rehabilitated. Natural drain is directly release

to the bounded canals of the barangay. Drainage system is considered

narrow and limited in length. In fact, consisting drainage needs

further rehabilitation and dredging since some areas are flooded when

heavy rains occur. When Maynilad is not on its operation, the urban

residents have to fill their water jags and container so that they have

stocked water. There are no deep wells which the urban residents can

depend in case of shortage. The water source from Maynilad is

considered not safe for drinking. The barangay has its own Water

Station which is definitely safe for the residents. For the population

who are dependent on Maynilad, proper care must be exercise to

make it safe for drinking. Other susceptibility of water is the

pollution caused by activities of man and animals. The sources of

water are not utilized for domestic, agricultural and industrial

purposes of the populace. Majority of the population enjoy power

connection from MERALCO. The interior and posterior part mostly

in other barangays have also power source. Solid wastes within the

barangay are primarily composed of domestic wastes such as food

waste, litters, biodegradable and non-biodegradable materials like

plastics, can, boxes, etc. The garbage collection of Barangay 458, is

21
roaming every week to collect the garbage. However, in some areas

which is not accessible by the garbage truck collector, the residents

dispose in open pit. There are some households who practice

recycling and composting. Some of the residents are working in the

government and employed in some private institutions. Some are

skilled workers working in construction, machinery, craftsmen, and

similar jobs.

22
 SITUATIONAL ANALYSIS
As Reported by Barangay Developmental Plan 2014-2016
P/B JEFFERSON T. DE GUZMAN

A. ADMINISTRATION. It is presented that there is

harmonious relationship between the elected and appointed

barangay officials. The ability to have a consistent

communication within the community among its residents and

officials is existing. They do have cooperative, responsive and

respectful attitude. Thus, this build a high sense of

camaraderie that would be necessary especially in times of

struggles in the community.

B. SOCIAL SERVICES. There is lack of interest from

constituents in sustaining cleanliness of surroundings.

Malnourished children are everywhere that seems parents

neglect the nutritional requirements of them. The road and

streets are small in terms of its area and width that no four-

wheel vehicle could pass through in case of emergencies. In

23
terms of sanitation, it can be seen that there are plenty of

disposed garbage accumulating on corner streets and alleys. It

is due to undisciplined manner of disposing garbage. Along

the way, there are wastes from dogs and cats that is unpleasant

to see. Families within the community usually quarrel and this

results to physical and psychological abuse. There is great

increase in number of violence against women and children.

The reinforcement of law, authority and ordinances within the

community seem not keen on implementation.

No existing program available in the barangay to

educate parent’s awareness regarding proper care and

management of persons with disabilities. There is no sense of

personal security within the community. There are no

programs for elders either except gift-giving during holiday

season.
Most of the youths are in computer shops and “piso-

net” stations playing games. Programs in terms of sports were

conducted during the past year however it seems that there is

lack of financial support to implement such programs.

Within the barangay, rise in carnapping incidents

involving motorcycles, bikes, vehicles and personal properties

were reported. There is also increase in gang-related violence,

24
 bullying cases from students and out-of-school minors being

involved in petty crimes and vices. Parents are either unaware

or do not bother whether what their children are doing or into.

This kind of practice of parents results to children having an

ill manners and uncooperative behaviors.

Necessary exits on the road are blocked by vehicles

parked along roadsides. There are illegal terminal of tricycles.

There are also proliferation of illegal structures on roadsides

and gutters.
In case of education, there are great number of out-of-

school youths within the barangay. The interest in studying

seems to be very low. The influence of gangs and outside

factors affect their senses of preference. The youths instead

choose to stay in unregistered computer shops without permit

and requirements.

C. ECONOMICS. Uncooperative vendors creating health and

sanitation concern due to garbage accumulation are present in

the barangay. These vendors have no necessary permits and

sell their products to any available spot or area.

In livelihood concerns, there are no programs

available for the improvement of living. With respect to its

25
 residents, they do lack of interest to acquire training or grab

opportunities given by TESDA-sponsored services. They

rather choose to stay at home and do household chores and

gambling as well.
There is no existing business nearby since business

concerns would be affected by the garbage disposal problems,

foul odor from urinated places, dimly-lit places and security

and safety factors.

D. INFRASTRUCTURE. There is a daycare within the

community and it operates in two morning shifts. In terms of

road maintenance, most streets and alleys manholes with

cover needing immediate repair, portion of gutters along

Sulucan Street requires immediate rehabilitation. Sewage

canals are more often clogged due to accumulation plastics.

I.2 Spot Map

26
27
 Illustration 1. Spot Map of Barangay 458, Sampaloc Manila

Barangay 458 Zone 45 is situated in Sampaloc Manila. The barangay

has a total land area of 7.89 hectares with Barangay’s 469-470 at

Northwest, Barangay 432-435 at Northeast, Barangay 401-403 at

South. The Barangay has 420 households, 40% (130) of which have

been surveyed. It is an urban community. There are no terrains,

28
mountains, river or streams that can be found within the

community. Houses are made of mixed materials like concrete and

wood. Most houses of the Barangay are built closely to each other.

The community has a Barangay hall where the people and the

officials gather to discuss pertinent matters concerning their

community. It is located in Sulucan Corner Earnshaw St. Sampaloc

Manila. Other establishments in the barangay are sari-sari stores,

karinderyas, bakeries, junk shop, hardware, water station. There is

also a basketball court.

Boundaries

Street Name (Landmarks) Total length in meters from the

29
 community

North- Earnshaw Medical 250 m

Center 400 m
Florida Bus Terminal 410 m
Espana Boulevard 450 m
Ramon Magsaysay
High School 260 m
400 m
East- National University
Arsenio Lacson Avenue
Metro Oil Gas Station 200 m
250 m
South- Victory Liner 260 m
Sampaloc 300 m
Liana’s Supermarket 350 m
Bustillos Market 380 m
Mercury Drugstore 390 m
Our Lady of Loreto 400 m
St. Anthony Shrine
BPI Family Bank 400 m
LRT 2 Legarda Station 370 m
450 m
West- Barangay 469-470 450 m
Juan Luna High School
UST
Espana Boulevard

30
 II. Population
II.1 Total Population of the Barangay : 2588 [CITATION

EarnshawHealthCenter \l 1033 ]
II.2Total Population Surveyed : 560
II.3Sex Ratio : 99.6
II.4Age and Sex Distribution

Results on Age and Sex Distribution and its implications to health

and health programs.

According to variable age, majority of the population

surveyed are those 25-29 years followed by the 30-34 years which is

belonged to the young adult age group. The programs of the DOH

designed for both males and females are the National Family

Planning Program, Women and Children Protection Program,

Adolescent Youth Health Program, Philippine Cancer Control

Program and Adolescent Health and Development Program.

Common Morbidity Rates Among Male and Female

The same morbid conditions are identified for both sexes,

which only differ in rates and consequently a slight difference in

ranks. Infectious conditions are most common to both sexes.

Respiratory conditions like ARI, ALRTI and Pneumonia, Bronchitis

31
and Tuberculosis were common to both sexes. However, in terms of

the rate of occurrence, females tend to be more ill with these

conditions than males. In summary, seven out of ten leading causes of

morbidity common to both sexes were rate dominated by female.

However, the data were based on reports submitted with sex

disaggregation only.

Analysis:

This shows the distribution of age and sex of the total

population in barangay 458, zone 45 Sampaloc Manila. The total

number of population we surveyed is 560 where In, The age group

(25- 29 years old) both male and female has the highest population.

Therefore, at this age group, reproductive behavior and intentions,

contraceptive knowledge and use and attitudes and beliefs regarding

contraception and abortion should be intensified in the community.

The analysis were stratified based on age: 25-29 years old. The

critical role that the family planning plays in improving maternal and

child health outcomes has become widely recognized among

government. This program provides many benefits to mother,

32
children, father and family. The financial consequences of having

children involves the medical costs of pregnancy and birth and the

high costs associated with actually bringing up children. Since

parents are responsible for providing education, shelter, clothing and

food for their children. Family planning has an important long-term

impact on the financial situation of any family.

Figure 1. Population Pyramid for Barangay 458 zone 45

Sampaloc, Manila November 2018

33
 Formula: SR No. of Males
---------------------------- x 100
No. of Females

280
----------------------------- x 100 TOTAL:
99.6
281

Analysis:

Sex ratio is most frequently calculated as the number of males

in a group divided by the numbers of females. Nature provides that

34
the number of males slightly outnumber females because as they

grow up men at higher risk of dying than women not only due to sex

differentials but also due to higher risk from external causes

(accidents, injuries and violence). Thus, the sex ratio of total

population is expected to equalize. Besides, gender imbalances have

been known in human history to cause serious negative consequences

for the society in the long run. The ratio of males and females in a

community obviously also has a major bearing on the community’s

health needs. Gender distribution has some standard patterns on a

large scale, such as more girls are born than boys and there are more

women than men in the very old age group it is important to know

whether your community fits this pattern, as this will affect the range

of services required. Gender is also important when looking at

specific health issues, such as family planning maternity services or

diseases that are gender specific, such as ovarian cancer.

Sex Ratio and its implications to health and health

programs. There are specific health programs designed specifically

for males and females as target recipients. The programs may also be

based on their natural behaviors in the Philippine society.

35
Prioritization of the programs based on sex may also be based on

official statistics, eg. Are the morbidity and mortality rates based on

Sex (Department of Health, 2014)

Sex Ratio In anthropology and demography, the human sex ratio

is the ratio of males to females in a population. More data is available
for humans than for any other species, and the human sex ratio is
more studied than that of any other species, but interpreting these
statistics can be difficult. The natural factors that affect the human
sex ratio are an active area of scientific research. Human sex ratio,
both at birth and as a population matures, can vary significantly
according to a large number of factors, such as paternal age, maternal
age, plural birth, birth order, gestation weeks, race, parent's health
history, and parent's psychological stress. Remarkably, the trends in
human sex ratio are not consistent across countries at a given time, or
over time for a given country. In economically developed countries,
as well as developing countries, these scientific studies have found
that the human sex ratio at birth. [ CITATION WHJ \l 1033 ]

Table. 1 Percentage Distribution Showing the Civil Status of

Individuals 15 y/o & Above. Barangay 458, Zone 45, District 4,
November, 2018

Civil f %
Status
Single 302 79

36
 Married 49 13
Live-in 22 6
Separated 0 0
Widow 7 2
N= 380 100 %

Analysis:

As of November 2018, out of the 561 residents of Barangay

458, whose ages are 15 y/o and above, 302 or 79% are single and 59

or 13% are married. Others considered as married are couples

bounded by common law. The remainder of the population is either

live in (22 or 6%) or widowed (7 or 2%).

Figure 2. Pie Graph of the Civil Status of Individuals 15 y/o &

Above. Barangay 458, Zone 45, District 4, November, 2018

37
 CIVIL STATUS
Si ngl e
Live-In; 5.79% Widow; 1.84%
Marri ed
Married; Li ve-In
12.89% Sepa rated
Single; 79.47% Wi dow

I. Economic Indices

Situation of the Filipino Elderly

The number of older people is growing. In the Philippines, the

number of older people is increasing rapidly, faster than the growth in

the total population. In 2000, there were 4.6 million citizens (60 years

older), representing about 6% of total population. In one decade, this

grew to 6.6 million older people or about 6.9% of total population.

The National Statistics Office projects that by 2030, older people will

make up around 11.5% of the total population.

Older people need care and support. An ageing population

increases the demand for health services. Older people suffer from

both degenerative and communicable diseases due to the ageing of

38
the body’s immune system. The leading causes of morbidity are

infections, while visual impairment, difficulty in walking, chewing,

hearing, osteoporosis, arthritis and incontinence are other common

health-related problems.

Other problem struggle with poverty. According to the

Department of Social Welfare and Development (DSWD). Nearly, a

third (31.4%) of older people were living in poverty in 2000.

Currently, this number is estimated to be 1.3 million older people.

More than half of all older people (57.1%) were employed in 2000.

More males were employed (63.6%) than women (37.4%). The

majority of those employed (41%) were involved in primary

economic activities such as farming, forestry work and fishing.

Security in old age. One of the issues in security in old age.

Poverty is perceived as an obstacle to a secured old age. As such, the

current pension system in the Philippines requires careful

consideration and evaluation. The government offers welfare services

such as homes for the aged and Senior Citizens Centers to better

address the plight of the Filipino elderly. However, the effectiveness

of such welfare service can only be confirmed by the level of

satisfaction of their intended beneficiaries.

39
Health Programs for Elderly in the Philippines

Free medical and dental services in government facilities.

Medical and dental services, diagnostic and laboratory tests requested

by the physician such as but not limited to X-rays, computerized

tomography scans, and blood tests availed of by senior citizens,

including professional fees of attending doctors in all government

hospitals, medical facilities, outpatient clinics, and home health care

services, shall be provided free of charge. to senior citizens. These

shall be in accordance with the rules and regulations to be issued by

the DOH, in coordination with the PhilHealth.

No. of Pop 0-14y/o + 65y/o. & Above X 100

Formula: DR = Population 15-64y/o.

Dependency Ratio = 145 + 37 X 100

356
=50.84 %
Analysis:

The dependency ratio is a measure showing the ratio of the

number of dependents aged zero to 14 and over the age of 65 to total

40
population aged 15-64. This indicator gives insight into the amount of

people of nonworking age compared to the number of those of

working age. The number of those working age is 37 while the

number of nonworking age is 37. This provides an accounting of

those who have the potential to earn their own income. Therefore, as

of November 2018, 145 dependents had to be supported by every 100

persons in the economically-productive age groups in Barangay 429,

Zone 45 Sampaloc, Manila.

Implications to Health and Health Programs

A higher dependency ratio is likely to reduce productivity

growth. A growth in the non-productive population will diminish

productive capacity and could lead to a lower long-run trend rate of

economic growth. If the government fails to tackle issues relating to a

higher dependency ratio, there could be increased pressures placed on

government finances, leading to higher borrowing or higher taxes

which also reduce economic growth. The retired population will

make up a bigger share of the population. Therefore, they will have a

bigger political voice. It may require different attitudes to how we

care for old people.

41
Table 2. Percentage Distribution showing the Average Income of
Earning Individuals, Barangay 458, Zone 45, District 4,
November 2018
Income/Month f %
< 1,000 5 3
1,000 – 2,999 20 11
3,000 –4,999 20 11
5,000 – 6,999 21 11
7,000 – 8,999 9 5
9,000 – 10,999 19 10
11,000 – 12,999 18 10
13,000- 14,999 5 3
 15,000 67 36
N= 184 100%

Analysis:

Most of the earning individuals or 36% in Barangay 458,

Zone 45 have an average income of above 15,000. The next to the top

are individuals with an average income of 5,000 to 7,000. The ability

of families to meet their most basic needs is important measure of

economic stability and well-being. While poverty threshold is used to

evaluate the extent of serious economic deprivation in our society,

family budgets that is, the income a family needs secure safe and

decent yet modest living standards in the community in which it

resides offer a broader measure of economic welfare.

42
 Monthly Income

10.87%
< 1000
2.72% 1,000 - 2,999
3,000 - 4,999
36.41% 10.87% 5,000 - 6,999
7,000 - 8,999
9,000 - 10,999
11,000 - 12, 999
13, 000 - 14,999
11.41% > 15,000
2.72% 4.89%

9.78% 10.33%
Fig

ure 3. Pie Graph showing the Average Income of Earning

Individuals, Barangay 458, Zone 45, District 4, November 2018

Poverty and its implications to health and health programs

Whether at household, community or national level, poverty

is recognized as a significant determent of ill health. The global

pattern of disease mirrors inequalities in income and wealth

distribution across countries. Research has shown that good health is

central to the survival of poor individuals and households, as it

translates into higher productivity and income, while ill health means

43
less income, frequently unaffordable expenditures and greater

poverty. Evidence is also mounting on the relationship between

higher levels of economic growth and lower burdens of ill health at

the level of countries or societies.

Food threshold is the minimum income required to meet basic

food needs and satisfy the nutritional requirements set by the food

and nutrition research institute (FNRI) to ensure that one remains

economically and socially productive. It is used to measure extreme

or subsistence poverty. Poverty threshold is a similar concept,

expanded to include basic non-food needs such as clothing, housing,

transportation, health, and education expenses (Philippine Statistics

Authority, 2016).

Poverty is closely linked to malnutrition (United Nations,

2011; Manuel Pena, 2012). Thus, the Department of Health family

planning program. Poorer households tend to have larger families and

usually have fewer resources to allocate for the purchase of

contraceptives. This study shows that efforts to identify those women

who needed family planning services and to make services more

accessible can lead to more productive outcomes.

44
Table 3. Percentage Distribution Showing the Type of Occupation
of earning Individuals. Barangay 458, Zone 45, District 4,
November, 2018

Occupation F %
Tricycle Driver 50 50
E.g Laborer, Vendor 74 43
Office worker 23 13
Professional 27 15
N= 174 100%

Analysis:

As of November 2018, majority of the population surveyed in

Barangay 458 are laborers and vendors with 74 or 50% followed by

tricycle drivers with 50 or 34. Aside from ambulant vendor and

tricycle drivers, these labor sector also who would otherwise be

unemployed or without livelihood take refuge in the informal

economy. This due to relative ease of entry and low requirements for

education, skills, technology and capital. Because of their informal

livelihood, workers in this sector are not covered by labor laws and

standards, making them highly vulnerable, since most workers have

low productivity, their income is also not enough to pay for premiums

of social safety net providers such as Social Security System (SSS)

and the Philippines health corporation. Informal sector workers,

45
however, must pay full monthly dues since they has no direct

employees and enrolled as voluntary members.

II. SOCIO-CULTURAL INDICES

4.1 Literacy Rate

Literacy rates implication to health

Choosing a healthy lifestyle, knowing how to seek medical

care, and taking advantage of preventive measures require that people

understand the use of health information. The ability to obtain,

process, and understand health information needed to make informed

health decisions is known as health literacy. Given the complexity of

the healthcare system, it is not surprising that limited health literacy

is associated with poor health. Bennet CL, 2012 cited that according

to research studies, persons with limited health literacy skills are

more likely to skip important preventive measures such as

mammograms, pap smears, and flu shots. When compared to those

with adequate health literacy skills, studies have shown that patients

with limited health literacy skills are associated with an increase in

preventable hospital visits and admissions (Baker DW, 2012). Studies

46
have demonstrated a higher rate of hospitalization and use of

emergency services among patients with limited literacy skills

(Williams MV, 2013).

Health literacy is the degree to which individuals have the

capacity to obtain, process, and understand basic health information

and services needed to make appropriate health decisions. In addition

to basic literacy skills, health literacy requires knowledge of health

topics. People with limited health literacy often lack knowledge or

have misinformation about the body as well as the nature and causes

of disease. Without this knowledge, they may not understand the

relationship between lifestyle factors such as diet and exercise and

various health outcomes.

Health information can overwhelm even persons with

advanced literacy skills. Medical science progresses rapidly. What

people may have learned about health or biology during their school

years often becomes out dated or forgotten, or it is incomplete.

Moreover, health information provided in a stressful or unfamiliar

situation is unlikely to be retained.

The primary responsibility for improving health literacy lies

with public health professionals and the healthcare and public health

47
systems. These health professionals must work together to ensure that

health information and services can be understood and used by

members of the community. They may engage in skill building with

healthcare in reaching out and teaching adults with limited literacy

skills.

Formula: LR = No. of Pop. 8yrs & above who can read

& write X 100
Total No. of Pop. 8y/o. & above

Literacy Rate = __458__ X 100

484
= 94. 63 %

Analysis:

Basic or simple literacy is the ability of a person to read and

write with understanding a simple message in any language or

dialect. As per the survey gathered, among the 560 population of

Barangay 458 Zone 45 ages 8 years old and above, 94.63% are

literate.

Implications to health and health programs

48
 Health literacy has been defined by the Institute of Medicine

(IOM) and National Library of Medicine (NLM) in the United States

as the “degree to which individuals have the capacity to obtain,

process, and understand basic health information and services needed

to make appropriate health decisions. While this definition clearly

suggests that health literacy is a multifaceted concept, reading ability

has implicitly, if not explicitly been viewed as its most fundamental

component. An individual's ability to read, comprehend, and take

action based on health-related material is closely related to the ability

to read, comprehend, and take action based on other types of

materials. However, the context of healthcare is likely to be an

especially challenging environment for many Americans due to its

changing nature and complexity. What an individual - be it a parent

or adolescent -must do to promote, protect, and manage health may

be more difficult or perhaps less familiar than what is typically

required of a person in other settings, with far more serious

consequences associated with inadequate performance.

At the individual level, health literacy involves one's ability to

apply existing functional literacy skills towards learning and

communicating effectively in the context of healthcare. Within a

49
clinical encounter, the physician seeks to elicit information, answer

questions, explain diagnoses, provide anticipatory guidance, and offer

instructions for possible medical or behavioral intervention. The

parent and pediatric patient, in turn, are expected to be able to

provide an accurate account of behaviors or symptoms, and both raise

and answer pertinent questions within a medical and social history

taking process. Beyond the physician visit, the parent must remember

what transpired during the interaction with the physician in order to

make appropriate decisions. In addition to the interpersonal

communication, information about recommended health behaviors,

promotion for self-care, treatment decision making, or even

directions for navigating a particular health system are conveyed

using various health technologies. Families are expected to be able to

use available communication tools, which may range in complexity;

from print forms, brochures, and telephone, to interactive video

programs, electronic health record ‘patient portals’, and the internet.

4.2 Educational Attainment

Table 4. Percentage Distribution Showing the Educational

Attainment of Individuals Surveyed. Barangay 458, Zone 45,
District 4, November, 2018

50
Educational Attainment F %
No Formal Education 5 1
Elementary Level 55 12
Elementary Graduate 16 3
High School Level 101 22
High School Graduate 119 26
College Level 90 20
College Graduate 72 16
N= 458 100%

Note: Consider Educational Attainment of Individuals 8y/o. & above

Analysis:

Based on the populations surveyed in Barangay 458, majority

of the populations surveyed are high school graduates with 119 or

26%. Almost 16% of the population surveyed reached college

graduates only. Some of them only reached elementary level and

some did not have formal education.

Implications to health and health programs

Educational attainment refers to the highest level of

education completed defined here as a high school diploma or

51
equivalency certificate, an associate's degree, a bachelor's degree, or

a master's or higher degree.

This demographic change has several implications for

public health. Life-long health promotion and disease prevention

activities can prevent or delay the onset of non-communicable and

chronic diseases, such as heart disease, stroke and cancer.

The primary health care should not be viewed as a second-

class medical service system for the poor in developing nations, but

rather, the first point of contact between the individual and the health

system within an awareness-building process integral to

development. Such services should be available and accessible to all

members of the community through acceptable means and at a cost

which the community and the country can meet. With respect to

primary health care programs' design and administration, it was

concluded that service should be provided by a team of health care

personnel working together with other disciplines and organizations

involved in overall national socioeconomic development efforts. The

primary health care program requires a substantial share of health

resources and may need a larger share of the total health budget

allocations in many countries, perhaps, at the expense of hospital and

surgical services which do not reach the mass population. This

52
proposition is substantiated by the fact that primary health care is

more cost-effective than hospital-based medicine. Pilot programs so

far have achieved a dramatic decrease in mortality rates, notably

among high risk groups such as preschool age children and mothers.

Adequate program design will also require changes in the traditional

medical education of doctors and nurses who must not only be

technically competent, but also socially and sociologically aware in

order for an adequate respond to popular needs. A greater stress on

community participation was also recommended; the success of

village health committees in the past being cited as exemplary in not

only dealing with health problems, but also in achieving general

community development and solidarity.

This demographic change has several implications for

public health. Good health is key if older people are to remain

independent and to play a part in family and community life. Life-

long health promotion and disease prevention activities can

prevent or delay the onset of non-communicable and chronic

diseases, such as heart disease, stroke and cancer.

But these diseases also need to be detected and treated early to

minimize their consequences, and those who have an advanced

53
disease will need decent long-term care and support. These

services are best delivered through comprehensive primary care.

4.3 Religion

Table 5. Percentage Distribution Showing the Religion of

Families Surveyed Barangay 458 Zone45, District 4, November,
2018

Religion F %
Catholic 117 96
Iglesia ni Cristo 1 1
Muslim 4 3
N= 122 100%

Analysis:

A percentage of 96 of the total population in Barangay 458,

Zone 45 surveyed were Catholics, 3% are Muslims and 1% are

Iglesia ni Cristo.

Implications of the Results to health Programs.

The Philippine constitution guarantees the right to

religion/religious affiliation. Thus, in planning the care for clients,

54
their religious affiliations are respected. Religious teaching and

church regulations or apostolic faith groups fundamentally shape

healthcare-seeking behavior, and hence the differences in healthcare-

seeking behavior among them can be attributed of differences in

religious teaching and church doctrine (regulations) as well as levels

of adherence to their teachings and doctrines. (UNICEF, 2014). One

example is how community residents perceive and accept family

planning services offered by the government. A guiding principles in

family planning program are grounded in voluntary consent and

informed choice. In practice, this means that individuals must have

access to information on a wide range of family planning options,

including details about the benefits and health risks of a particular

method, and that they must be able to choose from a wide range of

methods.

4.4 Place of Origin

Table 6. Percentage Distribution Showing Place of Origin of

Families Surveyed. Barangay 458 Zone 45, District 4, November,
2018

55
 Place of F %
Origin
Luzon 103 81
Visayas 24 19
Mindanao
NCR
N= 127 100
%

Analysis:

Majority of the families surveyed in Barangay 458, Zone 45

were born in Luzon with 103 or 81% while 24 or 19% of the families

surveyed are from Visayas. Luzon area this is the largest and most

populous island in the Philippines. It is ranked 15th largest in the

world. It is economic and political center of the nation, being to the

home to the country’s capital city, the Manila. Visayas is one of the

three principal geographical divisions of the Philippines, along with

Luzon and Mindanao. It is also consists of several islands. They have

6 in western visayas (region VI), 4 in central visayas (region VII),

and 6 in eastern visayas ( region VIII ). And in Mindanao this is the

second largest island in the Philippines.

Implication of the results to health programs

56
 The provision of culturally competent health care is an

important professional issue recognized in primary health care.

Culture is defined as the totality of socially transmitted pattern of

thoughts, values, meanings, and beliefs (Purnell, 2011). It is not

limited to any specific ethic group, geographical area, language,

religious belief, manner of clothing, sexual orientation, and

socioeconomic status.

The relationship of culture and health is important to

understand as it impacts an individual’s worldview and decision-

making process. Like in other fields of medicine, the impact of

cultural beliefs is increasingly being recognized as an essential

component in the genetic counselling process.

4.5 Population Movement

57
 Population movement is a length of stay in the area of the

families surveyed. It is the movement of people (in case of human

population) from one place to another with intentions to settle in the

new location either temporarily or permanently. The movement can

be internal, within the borders of the country or other subject of

political geography, or international.

The subjects of the population movement or migrants can be

also divided into two main categories. The first one is humanitarian

migrants – the people who flee from some unbearable conditions that

threaten their lives: refugees and asylum seekers. Usually they prefer

the short-distance migrations, trying to choose the countries

geographically close to the one they flee from and not having any

preferences. The migrations may seem the chaotic process, because

lots of factors are almost impossible to predict. The different types of

movement intersect, creating an incredibly tangled pattern. Still,

though it is indeed impossible to make precise predictions, the

general directions of population movement can be foreseen.

It is much easier when the major factors like an ecological

disaster or armed conflict are involved, but studying the secondary

factors like worsening health conditions or food quality, also can help

58
to understand the geography of the potential movement. Nowadays

the two most important factors are the ecological conditions and

being in a war zone. [ CITATION 17St \l 2057 ]

Implications to health and health programs

Migration may also affect risk perception and risk behavior

because they are new at the country and the people, place and

environment are new that’s why they can be uncomfortable. Feelings

of loss and psycho-social issues related to lower social positions,

unemployment and being in a minority may lead to a feeling of lack

of connection between current risk behavior and future health effects

(i.e. migrants may be forced to focus on their current feelings rather

than the future health effects of their current health behavior). For

example, a new migrant, separated from friends and family in an

urban environment (feeling more anonymous and less constrained by

social norms). And that’s why people tend to take drugs because of

their feelings because they are separated from their families, friends

and loved ones. It’s their only escape from being lonely, frustration

and social isolation.

59
Implementation of the health center in terms of monitoring

Every country needs to have a strong monitoring and

evaluation system in place as the foundation for national health sector

strategic planning, covering all major disease programs and health

systems activities and so that people can manage the people who are

affected by some diseases and can be treated right away so the

disease wouldn’t spread around the area or place. Existing country

health‐sector review processes are the key entry point to assess

progress and performance. Addressing the need for better data is not

an end in itself but is an intrinsic part of country health sector

program review and planning cycles and is central to ensuring

effective management and public accountability. So that the people

have a better data of the place and people may be guarded on what is

happening to them and in their place.

60
Table 7. Percentage Distribution Showing the Length of
Residency of Families Surveyed. Barangay 458, Zone 45, District
4, November 2018

Length of Residency f %
< 6 months 2 1
6 months – 1 year 1 1
1 year – 5 years 10 8
6 years – 10 years 15 11
10 years & Above 103 79
N= 122 100
%

Analysis:

In Barangay 458, Zone 45, 79% of the population that were

surveyed are residents for more than 10 years; these families were

residents on the said area since birth. While the remaining families

were residents for less than 10 years. Those residents said moved for

various reasons.

Implication to Health providers and health programs.

The study conducted by Keene (2013) shows that residential

length, independent of neighborhood level residential stability,

homeownership and demographic characteristics, is associated with

larger social networks, greater access to social support, and more

61
favorable perceptions of the extent to which neighbors exchange

material and psychosocial support (reciprocal exchange). The study

also indicates that significant positive interaction between residential

length and neighborhood poverty in predicting social cohesion and

social support.

Migration also has an effect on EPI targets. When an infant enrolled

for EPI coverage has been monitored not to receive a particular

vaccine, the Health care personnel (Public Health Nurse) conducts a

follow-up home visit to determine cause of non-completion. Often

times, upon visit to the community, BHWs report that the family has

migrated to another province / community.

4.6 Ownership

Table 8. Percentage Distribution Showing Housing Ownership of

Families Surveyed. Barangay 458, Zone 45, District 4, November,
2018

Ownership f %
Rent- Free 25 20
Owned 68 56
Rented 29 24
N= 122 100%

62
Analysis:

In Barangay 458, Zone 45, 55 % or majority of the residents

own their houses while some of the families pay rent and those

remaining residents live in their house with free of expecting to own

the house.

Ownership

Safe and adequate housing is a basic human right. Like all

human rights, however, housing security for the majority of our

people has been difficult to achieve. While a sweeping history of

urban development in the Philippines has yet to be written, other

observers have pointed to the aftermath of World War II as a key

period in the precipitous worsening of the housing problem in urban

areas. Informal settlers—known for many years simply as

“squatters”—mushroomed in Manila and many other major cities in

search of jobs. By 1946, in the wake of the city’s virtual destruction

during the Liberation, Manila and its suburbs were estimated to have

around 46,000 squatters, a number which rose to 98,000 in 1956 and

63
to 283,000 by 1963. During the Marcos years, those numbers

skyrocketed even further. [ CITATION Lil16 \l 2057 ]

Implications to health and health programs

Explores the relationship between ownership and selected

measures of quality of care and identifies other nursing home

characteristics which more clearly than ownership. Homeownership

has been linked to positive health outcomes there is limited evidence

regarding the conditions under which it may be health

protective. Effects of homeownership may be contingent upon house

values. Homeownership may contribute to persistent racial and

socioeconomic health inequities. However, evidence related to how

these protective effects on health may vary based on the contexts in

which homeownership occurs is limited in homeownership and

health, policies and interventions should implement strategies to

recover and preserve housing values.

There is a large literature that seeks to estimate the causal

effect of increased wealth on health and well-being. We exploit

exogenous variation in housing wealth, the largest asset for the

majority of households. Changes in ownership status were associated

64
with increases in health and well-being. Further models suggest that

the mechanisms through which home ownership affects health may

operate via the labor markets with new job opportunities, extra time

saved travelling and resources available for healthy leisure activities.

There is also strong evidence that housing is critical to health across

the life-course ownership improves physical and psychological health

with an increase in the General Health. We consider a range of

measures of well-being and health. The results from the Barangay

458, and as hypothesized above, we observed no statistical

relationship between ownership and health and well-being outcomes.

The coefficients maintain the expected direction but are much smaller

than for public renters.

65
Table 9. Percentage Distribution Showing the Types of Housing of
Families Surveyed. Barangay 458, Zone 45District 4, November,
2018

Type of Housing F %
Makeshift
Light 33 26
Strong 42 34
Mixed 48 40
N= 122 100
%

Analysis:

Most of the housed in Barangay 458 are made up of

combination of mixed strong and light materials while about 34% are

made up of strong materials. Twenty six percent are composed of

light materials. It is an exciting and challenging experience for many

Filipinos to choose the types of house they want. But with so many

types of homes available in the Philippines, It may be difficult to find

the one that would satisfy your taste, budget, preferences, and

lifestyle. A safe, settled home is the cornerstone on which individuals

and families build a better quality of life, access the services they

need and gain greater independence.

In contrast, homelessness and poor housing multiply

inequalities and have a long-term impact on physical and mental

66
health. The health effects of poor housing disproportionately affect

vulnerable people: older people living isolated lives, the young, those

without a support network and adults with disabilities. Poor energy

efficiency in existing homes and rapidly rising fuel cost make it

unaffordable for low income households to adequately heat their

homes. A cold home is bad for your health and increases the risk of

cardiovascular, respiratory and rheumatoid diseases as well as the

worsening mental health. Over a lifetime, overcrowded homes have

been linked with slow growth in children which correlates with an

increased risk of heart disease as an adult and respiratory problems,

allergies and asthma.

Implications to health and health programs

Poor housing conditions have a long-term impact on health,

increasing the risk of severe ill-health or disability by up to 25

percent during childhood and early adulthood. Homeless children are

three to four times likely to have mental health problems, even one

year after being rehoused. Children living in overcrowded housing

are up to 10 times more likely to contract meningitis, meningitis can

be life threatening. Long-term effects of the disease include deafness,

blindness and behavioural problems and as many as one in three

67
people who grow up in overcrowded housing have respiratory

problems in adulthood. There is a direct link between childhood

tuberculosis (TB) and overcrowding. TB can lead to serious medical

problems and is sometimes fatal. Children living in damp, moldy

homes are between one and a half and three times more prone to

coughing and wheezing - symptoms of asthma and other respiratory

conditions for many children this means losing sleep, restricted

physical activity, and missing school. There may also be a link

between increased mortality and overcrowding. Overcrowded

conditions have been linked to slow growth in childhood, which is

associated with an increased risk of coronary heart disease in later

life. Half of all childhood accidents are associated with physical

conditions in the home. Families living in properties that are in poor

physical condition are more likely to experience a domestic fire.

Lower educational attainment, greater likelihood of unemployment,

and poverty. Homeless children are two to three times more likely to

be absent from school than other children due to the disruption

caused by moving into and between temporary accommodation.

Children in unfit and overcrowded homes miss school more

frequently due to illnesses and infections. Overcrowding is linked to

delayed cognitive development, and homelessness to delayed

68
development in communication skills. Homeless children are more

likely to have behavioral problems such as aggression, hyperactivity

and impulsivity, factors that compromise academic achievement and

relationships with peers and teachers. Long-term health problems and

low educational attainment increase the likelihood of unemployment

or working in low-paid jobs. Opportunities for leisure and recreation

are undermined by low income and health problems. The behavioral

problems associated with bad housing in childhood can manifest

themselves in later offending behavior. In one study, half of young

people who had offended had experienced homelessness.

Homelessness has a significant impact on children’s health, as

well as on the quality of the health care they receive. Homeless

children are more likely to be in poor health than non-homeless

children. Homeless children have four times as many respiratory

infections, five times as many stomach and diarrheal infections, twice

as many emergency hospitalizations, six times as many speech and

stammering problems, and four times the rate of asthma compared to

non-homeless children. However, the extent to which these findings

can be attributed directly to homelessness rather than related risk

factors is unclear. The impact of homelessness on children begins at

69
birth. Children born to mothers who have been in bed and breakfast

accommodation for some time are more likely to be of low birth

weight. They are also more likely to miss out on their immunizations,

which can have serious implications on their future health. On top of

this, living in bed and breakfast accommodation puts children at

greater risk of infection, especially gastroenteritis, skin disorders and

chest infections, and accidents. Living in overcrowded

accommodation or housing with shared facilities puts children at

greater risk of infectious disease, so it is unsurprising that research

demonstrates the link between overcrowded conditions and children’s

ill-health. Several studies have linked respiratory problems in

children to overcrowded housing conditions. Poor respiratory health

in children living in overcrowded homes may be caused by an

increased incidence of infectious disease, but such children are also

more likely to be exposed to tobacco smoke because they are living

in a confined space. Tuberculosis can lead to serious health

complications, including problems with the lungs and kidneys, and

even death. Living in overcrowded housing increases the risk of

children contracting viral or bacterial infections, putting them at

higher risk of life-threatening diseases such as meningitis.

70
Table 10. Percentage Distribution Showing Ventilation of House
of Families Surveyed. Barangay 458, Zone 45, District 4,
November 2018

Ventilation f %
Adequate 68 56
Inadequate 54 44
N= 122 100
%

Analysis:

Ventilation is adequate for majority of the population in

Barangay 458, Zone 45. More than half of the population surveyed,

ventilation is used to remove unpleasant smell and excessive

moisture, introduce outside air, to keep interior building air

circulating and to prevent stagnation of the interior air. The 44% is to

be considered. The almost half percentage of ventilation may

contribute to diseases that are airborne.

Ventilation

Ventilation is the intentional introduction of ambient air into a

space and is mainly used to control indoor air quality by diluting and

displacing indoor pollutants; it can also be used for purposes of

thermal comfort or dehumidification. The correct introduction of

71
ambient air will help to achieve desired indoor comfort levels

although the measure of an ideal comfort level varies from individual

to individual. [ CITATION Mal13 \l 2057 ]

Implications to health and health programs

Poor ventilation can have serious consequences. It can make

our homes “sick”, with condensation and mold damaging the walls

and fabric of our houses. But, more importantly, it can make the

occupants sick.

High levels of relative humidity affects the concentration of

volatile organic compounds in the home and prolonged exposure to

these compound leads to terrible health conditions such as eczema,

nervous system damage and cancer. Therefore, a good ventilation is

needed. Better air quality means a healthier environment.

Disease That Thrive In Poor Ventilation

Poorly ventilated houses affect air quality and can contribute

to the spread of disease. Microorganisms, such as those causing

tuberculosis, influenza, asthma and legionellosis can be transmitted

by air-conditioning systems, particularly when they are poorly

maintained or when the number of air exchanges per hour in a room

72
is insufficient. Viruses can travel through the air, causing and

worsening diseases. They get into the air easily. When someone

sneezes or coughs, tiny water or mucous droplets filled with viruses

or bacteria scatter in the air or end up in the hands where they spread

on surfaces like doorknobs. Inhaling these viruses or bacteria can

spread coughs, colds, influenza, tuberculosis and other infectious

agents. Crowded conditions with poor air circulation can promote this

spread. Some bacteria and viruses thrive and circulate through poorly

maintained building ventilation systems.

Table 11. Percentage Distribution Showing Water Supply of

Families Surveyed. Barangay 458 Zone 45, District 4, November
2018
Level F %
I. Point Source 13 20
II. Communal 109 80
Source
System or Standpost
III. Waterworks
System
N= 122 100%

Analysis:

Majority of the household surveyed in Barangay 458 zone

045 has Level II or Communal Source, a water supply facility

composed of a source, a reservoir, a pipe distribution network

73
adequate treatment facility, and communal faucets. 19% has Level I

or Point Source, they take water supply from a reservoir in an outlet.

Implication of results to health and health programs

Water is generally used for hygiene, cooking and drinking. A

major concern of health program managers is to control water-borne

diseases. Safe drinking water is important for health and sanitation.

Nationally, 96 percent of Filipino households have an improved

source of drinking water (national demographics and health survey

2013, 2013). Twenty-seven percent of households have water piped

into the dwelling, yard, or plot as their main source of drinking water,

while 37 percent drink mostly bottled water. Tube wells or boreholes

are the main source of drinking water into rural areas (24 percent),

while in urban areas the main source is water piped into the premises

(31 percent)

5.2 Excreta disposal:

74
Table 12. Percentage Distribution Showing Excreta Disposal of
Families Surveyed. Barangay 458, Zone 45, District 4, November
2018

Excreta Disposal F %
Level I. Pit Latrines
Level II. Pour-Flush Toilet 90 3
Level III. Flush Toilets 32 97
Balot System/ Wrap &
Throw
Other, Specify:
N= 122 100
%

Analysis:

In Barangay 458, Zone 45, Out of 130 residents 90 families

have Level II Pour Flash Toilet and the remaining 32 families is using

Level III Flush Toilets. Others are Unmaintained and there is no

proper pathway of excreta.

Excreta disposal

Within monitoring and evaluation, sanitation facilities are

often assumed to be safe if, by design, they create a barrier between

humans and human excreta. However, human excreta may be

released into the environment if the waste is not sufficiently

contained on-site, if the waste is “leaked” into the environment

75
through improper disposal or transport, or if the waste is

insufficiently treated. Human waste contains pathogens that are

harmful to health; thus leakage of human excreta into the household,

community, and greater environment is a public health concern.

[ CITATION Ash15 \l 1033 ]

Implications of results to health and health programs.

Most cases of diarrhea worldwide are caused by unsafe water,

inadequate sanitation, or poor hygiene. Safe disposal of children’s

stools is crucial in preventing the spread of diarrheal disease. If stools

are left uncontained, disease may spread by direct contact through or

through animal contact. A child’s using a toilet directly or rinsing a

child’s stools into a toilet or latrine is considered safe disposal

(UNICEF, 2014). The NDHS 2013 gathered information from

mothers on the most recent practices used to dispose of the stools of

the youngest child living with them. The use of proper practices for

the disposal of children’s stools increases with the child’s stools

increases with the child’s age and the mother’s level of education.

Stools of children age 48-59 months are much more likely to be

disposed of safely (88 percent) than younger children. Mothers with

76
college or higher education are more likely to dispose of their

children’s stools safely (49 percent) than mothers with no education

(35 percent). Access to a private toilet facility increases the likelihood

that a child’s stools disposed of safely; 50 percent of children in

households with improved, private toilet facility have their stools

disposed of safely, compared with 32 percent of children in

households with non-improved, public toilet facility (National

Demographics and health survey 2013, 2013). The use of proper

practices for the disposal of children’s stools of children age 48-59

months are much more likely to be disposed of safely (88 percent)

than younger children. Mothers with college or higher education are

more likely to dispose of their children’s stools safely (49 percent)

than mothers with no education (35 percent) (National Demographics

and Health Survey 2013, 2013). Hygiene treatment of human waste

can have a positive impact on reducing disease and mortality. In the

Philippines, seven in ten households use improved toilet facilities that

are not shared with other households, while two in ten households

uses a non-improved facilities that are shared (table 2.2). Almost one

in ten households uses a non-improved facility. The most common

type of toilet is a flush toilet connected to a septic tank. This kind of

toilet is most widely used in both urban and rural areas. The

77
percentage of households having no toilet facility decreased form 10

percent in 2008 to 6 percent in 2013 (National Demographics and

Health Survey 2013, 2013).

5.3 Garbage Disposal

Table 13. Percentage Distribution Showing Garbage Disposal of
Families Surveyed. Barangay 458, Zone 45, District 4, November,
2018

Garbage Disposal F %
DPS (Collected) 120 98
Open Dumping 1 1
Burning 0
Waste Segregation 1 1
N= 122 100%

Analysis:

Out of 130 families surveyed in Barangay 458, 120 families

utilize DPS. None of the families in the Barangay choose burning as

garbage disposal. Although people are knowledgeable on the garbage

schedule, they are not taught to do the proper securing the garbage

away from flies and animals. Others are also dumping their garbage

on the street causing disease like diarrhea. Waste that is not properly

managed, especially excreta and other liquid and solid waste from

78
households and the community, are serious health hazard and lead to

spread of infectious diseases. Unattended waste lying around attracts

flies, rats and other creatures that in turn spread disease. Normally it

is the wet waste that decomposes and release bad odor. This leads to

unhygienic conditions and thereby to rise in the health problems.

The group at risk from the unscientific disposal of solid waste

include the population in areas where there is no proper waste

disposal method, especially the preschool children; waste worker;

and workers in the facilities producing toxic and infectious material.

Other high-risk group includes population living close to waste dump

and those, whose water supply has become contaminated either due

to waste dumping or leakage from any dumping sites. Uncollected

solid waste also increases risk of injury, and infection.

Garbage Disposal

As provided for in RA 9003 and in relation to the Local

Government Code 1991, or RA 7160, the local government units

(LGUs) are given the power to enforce laws on cleanliness and

sanitation, solid waste management, and other environmental matters.

79
Thus, the different LGUs across the country, and in partnership with

several private institutions, are making efforts to efficiently provide a

system for solid waste management. Some of the best practices of

solid waste management need not be from abroad but can be found

locally. [ CITATION ARC17 \l 1033 ]

Implications to health and health programs

Overflowing waste bins are an ideal breeding ground for

bacteria, insects and vermin. The flies that visit the garbage are also

the same flies that roam around your lunch buffet and drop their off

springs on your plate. By doing so, they increase the risk of you

contracting with salmonella, which causes typhoid fever, food

poisoning, enteric fever, gastroenteritis, and other major illnesses.

Besides flies, other animals that thrive from the garbage in and

around the containers include rats, foxes and stray dogs.

80
 Overflowing waste causes air pollution and respiratory

diseases. One of the outcomes of overflowing garbage is air

pollution, which causes various respiratory diseases and other

adverse health effects as contaminants are absorbed from lungs into

other parts of the body. The toxic substances in air contaminated by

waste include carbon dioxide, nitrous oxide and methane. In

everyday life we identify the polluted air especially through bad

odors, which are usually caused by decomposing and liquid waste

items.

Diseases than can be acquired if there is improper garbage

disposal

Vector-borne diseases. Burgeoning heaps of garbage provides a

breeding ground for many kinds of insects. These insects act as a

vector for many deadly diseases such as Malaria and Dengue.

Air-borne diseases. Respiratory infections and allergies are the

common consequences of exposure to waste and garbage. The foul

smell of dead and decaying garbage debris induce nausea and

vomiting and this is one of the direct consequences of exposure to

garbage.

81
Disease due to water contamination

Many life-threatening diseases are the consequence of contaminated

water. Few of the most common diseases

are Hepatitis, Cholera, Dysentery, and Typhoid.

VI. HEALTH INDICES

6.1 Food Storage

Table 14. Percentage Distribution Showing Food Storage Practice

of Families Surveyed. Barangay 458, Zone 45, District 4,
November2018

Food Storage f %
Refrigerated 70 56
Not Refrigerated 52 42
a. Covered 33
b. Exposed 19
N= 122

Analysis:

Large percentage of the families surveyed used refrigerator.

13 families do not have refrigerator and they just cover it with plastic

cover which is an unsure method of food storage. It was conducted to

characterize the effects of storage time temperature and package type.

82
Food storage

All food spoils. Some deterioration occurs through the

spontaneous breakdown of complex organic molecules. Food can also

be consumed by other animals, notably certain insects and rodents.

However, most spoilage of food meant for human consumption is

caused by microorganisms, which effectively compete with humans

for limited and valuable food resources. Given access to unprotected

foodstuffs, bacteria and fungi rapidly colonize, increase in

population, and produce toxic and distasteful chemicals (Janzen

1977, Blackburn 2006, Pitt and Hocking 2009). To help prevent

microbe-caused food spoilage, humans use two main strategies: (1)

obstructing colonization by reducing access to susceptible foodstuffs

and (2) inhibiting population growth and limiting population size by

creating an unfavorable environment. [ CITATION SEA15 \l 1033 ]

6.2 Infant Feeding

Table 15. Percentage Distribution Showing Infant Feeding

Practice of Families Surveyed. Barangay 458, Zone 45, District 4,
November 2018

83
Type of Infant Feeding f %
Breastfeeding 12 98
Bottle-feeding
a. Evaporated
b. Condensed
c. Powdered
Mixed 2 1
a. Evaporated
b. Condensed
c. Powdered 2 1
N= 14 100%

Analysis:

Breastfeeding is defined as any self-reported attempt to feed

the infant at the breast. On feed breast milk or mothers milk by cup or

bottle. In hospital most infant is the milk by the mother through

breastfeeding. But some of them they doing combination feeding

occurs when an infant receives any combination or formula and

breastmilk. In Barangay 458 zone 045, 12 out of 14 infants are

breastfed. The remaining infants are practicing mixed feeding,

usually breastfeeding for the first few months and switching to bottle

feeding until the early toddler year.

Infant feeding practice

Awareness of the health benefits of breastfeeding was noted in

65%, a percentage that may be increased by further breastfeeding

84
education and support. The major barriers to breastfeeding practices

in this study in terms of initiation, exclusivity, and duration are (1)

type of delivery; (2) parity; (3) alcohol consumption; (4) occupation

and education; (5) breast problems, mainly milk insufficiency.

[ CITATION Ash13 \l 1033 ]

Executive Order No. 51 or the Code Of Marketing Of Breastmilk

Substitutes, Breastmilk Supplement And Other Related Products aims to

contribute to the provision of safe and adequate nutrition for infants

by the protection and promotion of breast feeding and by ensuring the

proper use of breastmilk substitutes and breastmilk supplements

when these are necessary, on the basis of adequate information and

through appropriate marketing and distribution.

RA 7600 or The Rooming-In and Breast-feeding Act of 1992

states that State adopts rooming-in as a national policy to encourage,

protect and support the practice of breast-feeding. It shall create an

environment where basic physical, emotional, and psychological

needs of mothers and infants are fulfilled through the practice of

rooming-in and breast-feeding. Breast-feeding has distinct

advantages which benefit the infant and the mother, including the

hospital and the country that adopt its practice. It is the first

85
preventive health measure that can be given to the child at birth. It

also enhances mother-infant relationship. Furthermore, the practice of

breast-feeding could save the country valuable foreign exchange that

may otherwise be used for milk importation. Breastmilk is the best

food since it contains essential nutrients completely suitable for the

infant's needs. It is also nature's first immunization, enabling the

infant to fight potential serious infection. It contains growth factors

that enhance the maturation of an infant's organ systems.

6.3 Immunization Status

Table 16. Percentage Distribution Showing Immunization Status

of Children < 1 year old Among the Families Surveyed. Barangay
458, Zone 45, District 4, November 2018

86
Antigen No. of Targeted F %
Children
BCG/HepB 13
PentaHiB1 12
PentaHiB2 12
PentaHiB3 11
OPV1 11
OPV2 8
OPV3 7
(MCVI) AMV 7

Analysis:

Over 130 families we surveyed from barangay 458, 13

children have been immunized by the important vaccines needed and

7 of them are included as a fully immunized child. Immunization can

save the child’s life because of advances in medical science. The

child can be protected against more diseases than ever before. Some

diseases that once injured or killed thousands of children are no

longer common in the Philippines, primarily due to safe and effective

vaccines. Polio is one example of the great impact that vaccines have

had in the Philippines. Polio was once most feared disease, causing

death and paralysis across the country. A child is considered as “fully

immunized” if the infant received one dose of BCG, three doses each

87
of OPV, DPT and hepatitis B vaccines, and one dose of measles

vaccine before reaching one year of age.

Immunization Status

It is very important that children are immunized against the

vaccine-preventable diseases: tuberculosis, poliomyelitis, diphtheria,

pertussis, tetanus, hepatitis B, and measles.

In addition to the six basic vaccines, the standard immunization

schedule in the Philippines includes three doses of hepatitis B

vaccine. The Mandatory Infants and Child Health Immunization Act

of 2011 requires that all infants be given the first dose of Hepatitis B

vaccine within 24 hours after birth. [ CITATION Bre13 \l 2057 ].

Figure 4: Graphical Representation Vaccination Trends

Source:

88
Figure 5 : Child Immunization Record

89
 The government of the Philippines adopted the EPI in 1976 to

ensure that infants and children age 0 to 5 years have access to

routinely recommended vaccine. The Philippines EPI primarily aims

to reduce the morbidity and mortality among children against seven

vaccine-preventable disease—tuberculosis, poliomyelitis, tetanus,

pertussis, measles, and hepatitis B. The EPI has the following specific

objectives: “(1) to immunize all children aged 0-11 months against

the seven diseases, (2) to maintain the polio-free status of the country.

(3) to eliminate measles infection and neonatal tetanus, (4) to control

90
diphtheria, pertussis, and hepatitis B infections, and (5)to prevent

extra pulmonary tuberculosis among children” (Cabotaje, 2012)

Republic Act No. 10152 provides for all infants to be given the

birth dose of the hepatitis-B Vaccine within 24 hours of birth. The

hepatitis B birth dose was integrated in the Essential Intrapartum and

Newborn Care Package (EINC). The first dose of the hepatitis-B

vaccine may be counted as part of the three-dose primary series.

Subsequent doses are given at least 4 weeks apart, with the third dose

preferably given not earlier than 24 weeks of age. A fourth dose is

needed for the following cases: 1) if the third dose is given at age <24

weeks; 2) for patient using the EPI schedule of birth, 6, and 14

weeks, and, 3) for pre-terms, less than 2 kilograms whose first dose

was given at birth. The pentavalent vaccine (DPT-Hepa-B-HiB) was

initially introduced in Central Visayas and Caraga in 2010 to prevent

the schedule of Hib meningitis and other invasive HiB diseases.

6.4 Health Seeking Behavior

91
Table 17. Percentage Distribution Showing Health Seeking
Behavior of Families Surveyed. Barangay 458, Zone 45 District 4,
November 2018
(Month)

Health Facility F %
Hospital 30 25
Health Center 81 66
Private Clinic 11 9
Others, Specify
N= 122 100%

Analysis:

Barangay 458, Zone 45, District IV most of the residents was

relying on Health Center for Health Problems. They usually go to

Earnshaw Health Center. Earnshaw Health Center Caters to about

31,000 individuals from 26 Barangays in the four Districts in Manila,

and Aside from renovating wellness center, SM Foundation provides

free medicine, Medical consultations and basic laboratory tests

through its Medical Missions. Medical Services such as Urinalysis, x-

ray, electrocardiograph, bone density scan and complete blood

chemistry test (Including FBS, Lipid Profile, RBS and Complete

blood count) are made available through the Foundation’s Mobile

Clinic.

Health Seeking Behavior

92
 The health seeking behavior of a community determines how

they use health services. Utilization of health facilities can be

influenced by the cost of services, distance to health facilities,

cultural beliefs, and level of education and health facility

inadequacies such as stock-out of drugs. The health seeking behavior

of a community determines how health services are used and in turn

the health outcomes of populations1. Factors that determine health

behavior may be physical, socio-economic, cultural or political.

Indeed, the utilization of a health care system may depend on

educational levels, economic factors, cultural beliefs and practices.

Other factors include environmental conditions, socio-demographic

factors, and knowledge about the facilities, gender issues, political

environment, and the health care system itself. Several factors can

determine the choice of health care providers that patients use. These

include factors associated with the potential providers (such as

quality of service and area of expertise) and those that relate to the

patients themselves (such as age, education levels, gender, and

economic status). Such factors can affect access to health care even

when services do exist in a community. Despite the availability of

many service providers in Uganda, the poor, being financially

constrained, normally have limited choice and often use public

93
services many of which are offered free of charge. Indeed, there is a

significant difference in access to various health care providers

between the rich and poor. Although self-care and use of traditional

healers is categorized under health care, these are often discouraged

by health practitioners, with the emphasis on encouraging people to

opt for conventional channels with medically trained personnel.

While 100% of the participants were aware that health center existed

in their community, only 80% had received such services in the past

month. The most significant challenges in utilizing health services

were regular stock-out of drugs, high cost of services and long

distance to health facilities.[ CITATION Dav14 \l 2057 ]

6.5 Source of Health Information

94
Table 18. Percentage Distribution Showing the Source of Health
Information of Families Surveyed. Barangay 458, Zone 45,
District 4, November 2018

Source F %
Hospital 35 29
Health Center 87 71
Media
Others, Specify
N= 122 100%

Analysis:

Majority of the population is getting the source of information

from the health center. To determine if inter-personal versus mass

media sources of health information are associated with meeting

recommendation for health behavior nonsmoking, fruit/vegetables

intake and exercise and cancer screening. The source is mass media,

tv, internet, and inter-personal sources including friends and family

community organization and health providers. It is associated with

self-reported behaviors. And the health center is near at barangay

458.

Source of Health Information

95
 Community Health Center – Health centers are a source of

primary care for millions of insured and medically underserved

patients seeking a quality source of care in every state, is a

welcoming place anyone can turn to for help. Whether you need a

simple check-up or something more serious and give you a wide

range of treatment options. And you don’t need to pay for it. If the

health center is the source of your information you may only get a

small amount of information and sometimes nothing because not

everyone in the health center are professionals, some are volunteers

and barangay workers.[ CITATION Cen18 \l 2057 ].

Reviewing evidence-based and proven indicators recommended by

experts in chronic disease prevention and control is one method to

understanding the overall health of a community.

Identify and select indicators that meet the established focus areas,

themes, issues, and goals. In this step it is important to include key

community groups, partners, and data providers to ensure a

comprehensive process. Determining and developing appropriate

indicators involves a technical process to ensure identification of

valid and reliable measures to assess your community health.

96
Core/Primary Indicators: These indicators are considered the most

important to collect data on in order to see progress with addressing

and improving community health. Core/Primary Indicators have a

“higher priority based on the critical nature of the data, the potential

for comparative value, and the relevance for most

communities.”[ CITATION Nat16 \l 2057 ]

Leading Causes of Morbidity

Many cases of all of the diseases are not reported because the

symptoms are relatively minor, because the ill person does not see a

physician, or because of poor reporting practices within the medical

community. Public health agencies in many poor countries have

difficulty in maintaining databases and even more difficulty in

carrying out investigations of the causes of infection and death. When

epidemics occur, the World Health Organization (WHO) and other

agencies provide support that often results in improved investigation

and record keeping.

97
The BRGY 458 (2018) presented the ten (10) leading causes of

morbidity. The top five diseases reported were URTI with a total of

1691 cases. It was followed by hypertension (1070) and diabetes

mellitus (343), dermatologic diseases (330), tuberculosis (216). The

same top four diseases were recorded last year, and it increase in a

year. And the other (5) leading causes of morbidity are urinary tract

infection (114), PCAP-A (138), acute gastroenteritis (116),

pneumonia (67), and musculoskeletal (52).

ANALYSIS OF TEN LEADING CAUSE OF MORBIDITY

98
Table 19. Ten Leading Causes of Morbidity in Barangay 458,
Zone 45 District 4, November, Manila, Year 2018

2017 2018 %
Diseases Diseases
URTI 1562 URTI 1691 41
cases
Hypertension 286 Hypertension 1070 26
Dermatologic 120 Diabetes 343 8
Diseases Mellitus
Gastrointestina 87 Dermatologic 330 8
l Diseases Diseases
Urinary Tract 57 Tuberculosis 216 5
Infection
Viral Infection 57 Urinary Tract 144 4
Infection
Bronchitis 52 PCAP-A 138 3
Tuberculosis 49 Acute Gastro- 116 3
Enteritis
Pneumonia 44 Pneumonia 67 3
Diabetes 40 Musculoskeleta 52 2
Mellitus l
N= 100%

Formula: %= No. of cases in Present Year – No. of cases in

previous year X 100
No. of cases in previous year

__4167 – 2354_ X 100

2354

= 77.0 %

Analysis:

99
 The Graph Presented shows Top 10 cause of Morbidity in

Barangay 458, Zone 45, District IV. Most of the diseases reported

caused by infection, viral or bacterial to the affected individuals. This

2018 the Leading disease is Upper Respiratory Tract Infection

(URTI) are illness caused by an acute infection which involves the

Upper Respiratory Tract including the nose, sinuses, pharynx and

larynx. The second morbidity is Hypertension also known as High

Blood Pressure (HBP), is a long term medical condition in which the

blood pressure in the arteries is persistently elevated, HBP can lead to

heart disease, stroke and death. Risk factors include obesity, drinking

too much alcohol, smoking and family history. Beta Blockers are

common treatment for Hypertension

The third on the list is Diabetes Mellitus refers to a group of

diseases that affect how your body uses blood sugar (Glucose).

Glucose is vital to your health because it’s important source of energy

for the cells that make up your muscles and tissues, Diabetes

symptoms vary depending on how much your blood sugar is

elevated. Some signs and symptoms are increased thirst, frequent

urination, and extreme hunger, and unexplained weight loss, presence

of ketones, fatigue, irritability, and blurred vision. Frequent infection

100
such as gums or skin infections and vaginal infection. The fourth is

Dermatologic disease. Tuberculosis if fifth in the list Tuberculosis is

a potentially serious infectious disease that mainly affects lungs the

bacteria that cause tuberculosis are spread from one person to another

through tiny droplets released into the air via cough or sneeze

In Summary, the diseases acquired by affected are due to lack

of proper hygiene.

The leading cause of morbidity in barangay 458 which is

Upper respiratory tract infection where there are 1562 cases in 2017

and 1691 cases in 2018. This data is similar to the National Statistic

Office therefore, the barangay health center should have wider

knowledge about this disease for the awareness and safety of the

community.

101
 1800
1600
1400
1200
1000
800
600
400
200
0
TI n e s n n tis is ia s
UR io as ri ti tio tio hi os on e tu
ns is
e te ec ec nc
l ill
rte E n nf nf o rcu um
e cD tro ct
I l I Br b e e s
M
p
og
i
as ra Tu Pn te
Hy ra
Vi e
ol G yT ab
at ar Di
rm in
De Ur

2017 2018

Figure 6. Graphical Representative of the 10 Leading Causes of

Morbidity Barangay 458, Zone45, District 4, Manila 2018

Table 20. Percentage Distribution Showing Choice of Family

Method, of Families Surveyed, Barangay 458, Zone 45, District 4,
Manila as of November, 2018
(Month)

Family Planning F %
Method
Natural 63
Artificial: 59
a. Pills 4
b. Condom 0
c. IUD 0
d. Injectable 5
e. Implant 2
None 169
N=

102
Analysis:

Family planning refers to a program which enables couples

and individuals to decide freely and responsibly the number and

spacing of their children and to have information and means to carry

out their decision. Our survey in Barangay 458 zone 045 the highest

using of family method of families are natural. Overall 90 families in

barangay 458 they are using natural almost 75% and other 25% is an

artificial. Such as pills 4% condom % IUD 1% injectable 5% implant

2% and some of them is none. Which means there are not using

modern family planning method. This is the survey in the Barangay

458 zone 045, cases this November 2018.

7. Summary and Conclusion

The community of Barangay 458, Zone 45 has a total

population 2,588 residents. Out of 561 families that are currently

residing in the area, 561 families were surveyed.

In January to November 2018, the ratio was 99.6 where in,

the age group (25-29 years old) both male and female has the highest

population. Therefore, at this age group, reproductive behavior and

103
intentions, contraceptive knowledge and use and attitudes and beliefs

regarding contraception and abortion should be intensified in the

community.

The population pyramid of Barangay 458, Zone 45 shows that

the middle aged group of the population is greatly dense compared to

the young ones and old ones. Majority of the population is in the

economically-productive age group. As of November 2018, 145

dependents had to be supported by every 100 persons in the

economically-productive age groups in Barangay 458, Zone 45

Sampaloc, and Manila.

As of November 2018, 79% of the population is single while

13% are married, including the residents who are tied by common

law.

The average income of Barangay 458’s residents is greater

than Php 15,000. Most of the people in this barangay belong to level

9 occupational level category.

The Literacy rate of Barangay 458 as per survey gathered,

among the 560 population of Barangay 458 Zone 45 ages 8 years old

and above, 94.63% are literate. Majority of the populations surveyed

104
are high school graduates with 119 or 26%. Almost 16% of the

population surveyed reached college graduates only. Some of them

only reached elementary level and some did not have formal

education.

Most of the members of Barangay 458, Zone 45 surveyed

were Roman Catholic, making up 96% of the total population.

Majority of the families surveyed in Barangay 458, Zone 45

were born in Luzon with 103 or 81% while 24 or 19% of the families

surveyed are from Visayas. Luzon area this is the largest and most

populous island in the Philippine. 79% of the population that were

surveyed are residents for more than 10 years, these families were

residents on the said area since birth. While the remaining families

were residents for less than 10 years. Most of the residents have

various reasons why they moved.

Majority of the households surveyed in barangay 458, Zone 45

District 4 has Level II Waterworks System, a communal faucet

system with stand post which is 80%. 20% has Level I point source

supply, meaning they take water supply from a reservoir with an

outlet.

105
 97% of the families surveyed in Barangay 458, Zone 45

District 4 have Level III flush toilets, and 3 % of the families have

Level II Pour-Flush Toilets.

As for the Garbage disposal majority of the families in

Barangay 458, Zone 45 District 4 practice DPS (collected) and 1 of

the families practice open dumping. Burning of garbage is not

practiced by the residents.

The houses in Barangay 458, Zone 45 District 4, Most of the

house in Barangay 458 are made up of combination of mixed strong

and light materials while about 34% are made up of strong materials.

26% are composed of light materials. 56 % or majority of the

residents own their houses while some of the families pay rent and

those remaining residents live in their house with free of expecting to

own the house. Ventilation is adequate for majority of the population

in Barangay 458, Zone 45. Electricity is constantly supplied by

MERALCO.

Most of the population. 56%, owned a refrigerator while 42%

doesn’t own a refrigerator. Families that do not own a refrigerator just

cover their foods with plastic cover which is an unsure method of

food storage.

106
 In Barangay 458 Zone 45, 12 out of 14 infants are breastfed.

The remaining infants are practicing mixed feeding, usually

breastfeeding for the first few months and switching to bottle feeding

until the early toddler year.

The Top10 causes in Morbidity were mostly diseases or

sickness that caused infection, either viral or bacterial, to the affected

individuals. The leading cause of morbidity for the year 2018 is

Upper Respiratory Tract Infection (URTI) whose pathogenic agent

may be a virus or bacteria. Over 130 families we surveyed from

barangay 458, 13 children have been immunized by the important

vaccines needed and 7 of them are included as a fully immunized

child.

Most of the residents of Barangay 458, Zone 45 District 4 was

relying on Health Center for Health Problems. They usually go to

Earnshaw Health Center. Earnshaw Health Center Caters to about

31,000 individuals from 26 Barangays in the four Districts in Manila,

and Aside from renovating wellness center, SM Foundation provides

free medicine, Medical consultations and basic laboratory tests

through its Medical Missions. Medical Services such as Urinalysis, x-

ray, electrocardiograph, bone density scan and complete blood

107
chemistry test (Including FBS, Lipid Profile, RBS and Complete

blood count) are made available through the Foundation’s Mobile

Clinic.

8. Prioritization of Problems Identified

URTI Hypertensio Diabetes WT

n Mellitus (constant

Value)
Nature of (3/3) x (3/3) x 1 (3/3) x 1 1

the 1 =1.00 = 1.00

Problems = 1.00
Magnitude (3/4) x (2/4) x 3 (2/4) x 3 3

of the 3 =1.5 = 1.5

Problems = 2.25
Modifiabilit (1/3) x (1/3) x 4 (2/3) x 4 4

y of the 4 = 1.33 = 2.67

Problem = 1.33
Preventive (3/3) x (3/3) x 1 (3/3) x 1 1

Potential 1 = 1.33 = 1.00

= 1.00
Social (2/2) x (1/2) x 1 (1/2) x 1 1

Concern 1 =0.5 = 0.5

108
 = 1.00

Total 6.58 5.33 6.67

109
110
111
112
113
Derived from the 3 problems

The 1st problem is about Hypertension as a health deficit in the

barangay 458 Earnshaw St. Sampaloc Manila. In the community

there is a family history of hypertension and unsafe food preparation

114
that is high in sodium they like to eat junk foods since it is cheaper

than the usual average food. And also they lack of knowledge

regarding to the presence of health problem that can cause contribute

to the risk factors of having hypertension.

To Improved Health, they must improve their nutrition to

decrease susceptibility to other diseases. They also need to improve

their hydration to restore the fluids that they’ve lost. they should also

practice exercising regularly, limit amount of alcohol and also quit

smoking.

The 2nd problem is about Upper Respiratory Tract infection as

Health deficit in the barangay 458 Earnshaw St. Sampaloc Manila. In

the area their house has poor ventilation, we see people who are

smoking in the area where the kids are affected by their smoke

causing them to be 2nd hand smoker. Most of them just sneeze without

covering their mouth. With this there is an increased susceptibility to

acquire other diseases and there is an increased infection such as

nasal congestion, runny nose, nasal discharge, sneezing, sore throat,

painful swallowing and cough that can cause Upper Respiratory Tract

Infection.

115
 To Improved Health, they must improve their ventilation and

practice not to smoke. They also need to practice covering their

mouths when they about to sneeze to prevent transportation of

microorganisms to decreased susceptibility of other diseases and to

decrease infection cases as well.

The 3rd problem is about is about Diabetes mellitus as a

Health deficit in the barangay 458 Earnshaw St. Sampaloc Manila.

Where people has history a family history of diabetes mellitus has

been pass through generation. The do not choose the right foods that

they are eating.

To improved Health, they must monitor their blood glucose

level. They can go to the nearest Health Center. They should also

practice exercising and maintain health food intake and quit smoking

to prevent the increase of risk factors of having diabetes mellitus.

116
9. Review of Existing Health Project

PHASES NOV NOV NOV NOV NOV DEC DEC DEC Person
21 22 23 28 29 05 06 07 assigned

PRE-ENTRY
1. Election of committee  Ma’am
Pacis
2. Selection of health  Keith Ugale
need/target
population/community
and suprasystem
3. Seek  Keith Ugale
agency/community
approval to work with
them
4. Community   All of the
assessment: members
a. Identify data participated
needed
5. Determine method(s) of   All of the
data collection members
participated
6. Collect data  All of the
members
participated
7. Analyze data  All of the
members
participated
8. Complete written  All of the
community assessment members
participated

9. Review literature of  All of the

community health members
needs and risk areas for participated
target population
10. Identify additional data  All of the
needed specific to members
selected population participated
11. Determine method of  All of the
data collection members

117
 participated

12. Identify or develop tool  All of the

members
participated
13. Pilot tool and revise  All of the
members
participated
14. 5.Propose nursing  All of the
intervention(s) members
15. Select priorities participated
16. Identify  All of the
goals/objectives members
participated
17. Identify possible  All of the
interventions members
participated
18. Select interventions  All of the
members
participated
19. 6.Develop evaluation All of the
plan members
20. Review literature participated
21. Selection of program All of the
evaluation method members
participated

118
 10. Suggestions and Recommendations

We determined the leading cause of morbidity of Barangay

458 URTI therefore, we suggest a wider knowledge for this

disease. We would implement a health teaching regarding

prevention of URTI. Many factors influence health and well-

being in a community, and many entities and individuals in the

community have a role to play in responding to community health

needs. The committee sees a requirement for a framework within

which a community can take a comprehensive approach to

maintaining and improving health such as assessing its health

needs, determining its resources and assets for promoting health,

developing and implementing a strategy for action, and

establishing where responsibility should lie for specific results.

The chapter also includes a discussion of the capacities needed to

support performance monitoring and health improvement

activities.

119
REFERENCES:

Bibliography
Ashmika Motee, 1. D.-G. (2013). An Assessment of the Breastfeeding
Practices and Infant Feeding Pattern among Mothers in Mauritius.
Journal of Nutrition and Metabolism, 8.

ARCHITECT FELINO A. PALAFOX, J. (2017). Ecological waste management.

The Manila Times.

Overbo, A. R. (2015). Unsafe return of human excreta to the environment:

a literature review. Estimates for the Unsafe Return of
Environment, 1.

SEAN T. HAMMOND, J. H. (2015). Food Spoilage, Storage, and Transport:

Implications for a sustainable future. BioScience, 758-759.

Musoke, D. (2014). Health seeking behaviour and challenges in utilising

health facilities. 8.

Breastfeeding, Immunization, and Child Mortality. (2013). What is the

status of breastfeeding among children aged 6-35 months?, 3.

Immunization: Children falling through the cracks in Manila’s slums. (2017).

A widening gap.

Region with the Highest Number of Poor Households. (2015). Department

of Social Welfare and Development: Cities of the National Capital .

(2017). Study on Population Movement, 7.

Malone, A. (april 2, 2013). "The Windcatcher House".

Centers for Diease Control and Prevention. (2018). Community Health

Center Strengthening, 3.

National prevention strategy health promotion and public health council.

(2016). IDENTIFYING COMMUNITY HEALTH INDICATORS, 5.

James, W. (n.d.).

120
Shahani, L. R. (April 24,2016). Housing informal settlers in the coming
years.

MAGLAYA, M. (2016). CHN IN PH. MANILA: C AND E.

(n.d.). Earnshaw Health Center.

121