‘The Philippine Sustainable Sanitation Knowledge Series Guidebook for a Disease Prevention and Control Program for Soil-transmitted Helminth Infections and Diarrheal Diseases Department of Heath(= Guidebook for a Disease Prevention and Control Program for Soil-transmitted Helminth Infections and Diarrheal Diseases Published by the Department of Health (DOH) Philippines ‘San Lazaro Compound, Rizal Avenue, Sta. Cruz Manila 1003 Philippines November 2010 ISBN 978-97 1-0569-23-6 Opinions expressed inthis publication do not necessary represent those of the DOH, with the exception of material/s specifically adopted by an accompanying policy issuance. The mention, if any, of specific companies or of certain manufacturer's products does not imply that they are endorsed or recommended by the DOH in preference over others of 9 similar nature. Some, sources cited may be informal documents. that are not readily available, Articles may be reproduced in full or in part for non-profit purposes without prior permission provided credit is given to the DOH and/or the individual technical writer/s for original pieces. This document was developed through the Sustainable Sanitation in East Asia Program Philippine Component (SuSEA). Water and Sanitation Program Philippines The World Bank Office Manila, 20th Floor, The Taipan Place, F Ortigas Jr.Road, Ortigas Center, Pasig City 1605, Metro Manila Philippines. Telephone: +632-917-3143, ‘The findings, interpretations, and conclusions expressed herein are those of the writers and not of the World Bank, the Swedish International Development Cooperation Agency or the Water and Sanitation Program, Dr. Vicente Y. Belizario, Jr. Dr. Alexander H. Tuliao. Editorial and Technical Support Team Dr. Jaime Galvez Tan, Dr. Marilyn Gorra, Engr. Marieto Perez, Dr. Rolando Metin, Engr. Virgilio Sahagun, Ms. Evelyn Mendoza, Ms. Maureen Agustin, Ms. Vida Zorah Gabe Graphic Design and Page Layouts follslikeus graphs The Philippine Sustainable Sanitation Knowledge Series: + Guidebook for a Sustainable Sanitation Baseline Study + Guidebook for a Local Sustainable Sanitation Strategy + Guidebook fora Local Sustainable Sanitation Promotion Program + Guidebook for Community-Led Total Sanitation + Guidebook for a Zero Open Defecation Program + Guidebook for Onsite Sanitation Technologies + Guidebook for Designating a Water Quality Management Area + Guidebook for Marketing a Septage Treatment Faclty, + Guidebook for Monitoring and Evaluation + Septage Management Program: The General Santos Cty Experience + The SuSEA LGU Experience: Dagupan, Guiuan, Polomolok, General Santos City, Alabel, Bauko = Guidebook for a Disease Prevention and Control Program for Soil-transmitted Helminth Infections and Diarrheal Diseases + Guidebook on Water Supply Protection Program + Water Pollution Prevention and Control Program: yak The Palomolok Experience Foringuiries or comments please contact the email address listed for the National Center for Disease Prevention and Control listed under this page: ‘p//www.doh gouph/contact_us html,‘usibook or soso Prevention and Con! Progam fr Sa-rensmtes Hemi fects and Darhea seasoe ACKNOWLEDGMENTS. We would like to express profound thanks to the following individuals een for their invaluable support ‘es and commitment. Dir. Eduardo Janairo, Dr. Yolanda Oliveros, Dr. Yvonne Lumampao, Dr. Ernesto Villalon Ill, Engr. Joselito Riego De Dios, Engr. Rolando Santiago, Engr. Luis Cruz, Engr. Gerardo Mogol, and Engr. Ma. Sonabel (DOH) Dir. Juan Miguel Cuna, Dir. Julian Amador, Asst. Dir. Jonas Leones; Reg. Dir. Datu Tungko Saikol, Engr. Renato Cruz, and Engr. Marcelino Rivera (DENR/EMB) Ms. Jema Sy, Mr. Edkarl Galing, and Ms. Shiela Dela Torre (wB-WSP) Dr. Leonardo Carbonell of Dagupan City, Dr. Socorro Flores of Guiuan Munici Dr. Samuel Masidong of Bauko ipl Engr. Nael Joseph Cruspero of General Santos City, ‘Mr. Ronnie Muno of Polomaigk Municipality, and Engr. Allan Rivera of Alabel Municipality (LGU Partners) teFOREWORD This Guidebook describes the systematic approaches and strategies for the prevention and control of soil-transmitted helminth (STH) infec- tions and diarrheal diseases in support of the Integrated Helminth Control Program and the Food and Waterborne Diseases Prevention and Control Program of the Department of Health. As a supplement to the Department. of Health Integrated Helminth Control Program: mass treatment guide, conceptual frame- work, 2006-2010 strategic plan, this learning resource is expected to help enable health service providers and other stakeholders to make provisions for early diagnosis, treatment, preven- tion, and control of these diseases consistent with easing. disease control programs. This Guidebook also describes surveillance and mon toring tools for baseline and continu- ing assessment using disease indica- tors at the community level. Results of surveillance and monitoring will be useful in the assessment of the effec- tiveness of control strategies in relation to set targets for control of these diseases. According to 2008 UN data, 26 billion people still do not have ‘access to or have inadequate sanita- tion facilities Every 20 seconds, a child dies as a result of poor sanitation. That's 1.5 million preventable deaths each year. In the Philippines, 23% of Filipinos or roughly 19 million still do not have accéss to sanitary toilets These realities necessitate tangible and concerted efforts that are owned by the people through the local gevernment units (LGUs). The United Nations has already declared access to water and sanitation as a human right in its July 28, 2010 General Assembly. With the synergis- Pte tic efforts of both the public and private sectors, the Philippines is also making significant gains in raising awareness and accelerating progress towards the Millennium - Develop- ment Goal (MDG) on sanitation: to reduce by half the proportion of people without access to basic sanita- tion by 2015, Through this Guidebook, we also emphasize that the National Government needs the support of its partners in order to achieve this goa) le need greater collaboration with our partners in the local government units. Likewise, we need to intensify our partnership with the private sector, Attaining sustainable sanita- tion is a significant challenge. How- ever, we believe that we have commit- ted partners in the LGUs. Sustainable sanitation will happen, because the LGUs are recognizing their roles and equipping themselves with the appropriate knowledge, tools, and skills. This Guidebooks just one in a series of knowledge resource materi- als that we are developing towards ‘one of our shared aspirations: ensur- ing health and wellness for all Filipi- nos through clean, safe, and life-giving water and sanitation facili- ties. This Guidebook is for the LGUs and the Filipino people. Use it well and then share it with other LGUs who may also find it useful in their pursuit of sustainable sanitation. Enrique T. Ona, MD, FPCS, FACS Secretary Of Health‘cusbaok ors sass Provanton and Conte Pog fr Satrensited Hamith faction and area Oaeasee The SuSEA Program The Sustainable Sanitation in East Asia Progra-Philippine Compo- nent (SuSEA) supported by the Water and Sanitation Program (WSP) of the World Bank and the Swedish Interna- tional Development Cooperation Agency (SIDA), and implemented through the leadership of the Depart- ments of Health (DOH) and Environ- ment and Natural Resources (DENA), is geared towards increasing access by poor Filipinos, primarily low-income households, to sustainable sanitation services by addressing key demand and supply constraints. Aside from this, the program hopes to learn from local implementation of sanita- tion programs as basis for national policy and operational guidance. SuSEA Philippines com- menced in July 23, 2007 as a learning program to support the Government of the Philippines (GoP) update its approaches and interventions in sanitation and needs that were not present or not addressed in tradi- tional sanitation programs that focused on two extremes: 1) toilet- bowl distribution and hygiene education and 2) centralized sewer- age systems. The most important of these emerging needs are: + Complementing interventions related to the reduction of risks of sanitation- and poverty-related diseases such as soil transmitted helminthiasis and acute gastroen- teritis + Linking sanitation interventions with environmental objectives, such as the improvement of water quality and water resources + Sanitation in rapidly urbanizing towns and cities, including the occurrence of disease episodes that aggravate impacts of poor sanitation (such as flooding) on the economy and quality of life of city populations + Reaching pockets of communities that comprise the remaining 20% of those without access to basic sanitation, particularly in the rural areas (among whom include indigenous peoples/cultural minorities) and urban slur communities. SUSEAPhilippines was designed using four different models as. the platform for developing specific interven- tions (according to themes below). The learning gained and the tools developed from these models served to assist other local governments units (LGUs), as well as informing national sanitation policy and programs for GoP-led expansion and ‘scaling up. The four models are: Model 1 Disease Prevention and Control — Sanitation interventions for the eradication/ reduction of disease Model 2 Water Quality Management - Sanitation interventions forthe improvement of water quality within a water quality management area Model 3 Liveable Cities - Sanitation interventions for the improvement of quality of life in cities and low-income urban poor communities Model 4 Sustainable Rural Livelihoods ~ Sanitation interventions to support sustained livelihoods in rural areas Six sites participated in the main program sub-component of SUSEA. These are: Bauko Municipality in the Mt. Province, Dagupan City in Pangasinan Province, Guiuan Munici- pality in Eastern Samar Province, General Santos City and Polomolok Hate‘he Phgens Sustainaie Santon Know Sanus Municipality in South Cotabato, and Alabel Municipality in Sarangani Province. The desired outcome in each of the project sites varied according to the model and agree- ments by the Program Steering Com- mittee and the local government. While outcomes varied per # site, each of the projects were addi- tionally intended to provide the LGUs with a fount of information on devel- oping and running their own sanita- @ tion programs based on the on-field experiences of the SUSEA team and their partners. This information has been @ packaged for your use in a Sustain- able Sanitation Knowledge Series, to which this guidebook/report belongs. The reader is encouraged to familiarize himself/herself with all the guidebooks/reports in. this series beginning with the Guidebook for Conducting a Baseline Study and followed by the Guidebook for Devel- oping a Local Sustainable Sanitation Strategy. What —_guidebooks/reports you choose to utilize next will be determined by your community's particular needs and your LGU's proposed sanitation programs. ‘On the succeeding page, you will find an illustration of the various sustainable sanitation programs (SSPs) under the National Sustainable Sanitation Plan (NSSP). For each of these SSPs, SuSEA has also developed materials under the Philippine Sustainable Sanitation Knowledge Series, intended to guide local government units in implementing the various sanitation programs and initiatives in their own area. The infor- mation gathered in the Knowledge Series is, in turn, based on specific SUSEA projects and activities in each of the six project sites. wie se‘usibook or soso Prevention and Con! Progam fr Sa-rensmtes Hemi fects and Darhea seasoe Sustainable Sanitation Programs ‘Sustainable Sanitation ne Study cm Water guaty Disease I ) and contro! Dee ard Beretta Zero Open Beletton Program ars Pe Shs. Monitoring and Erataton sainabe Sanitation‘The Phere SustanableSantodon Kronen Sess sn Se TABLE OF CONTENTS ‘Acknowledgments & Foreword Sire) & The SuSEA Program ® acronyms and Abbrevia Introduction Epidemiology Diagnosis Treatment Prevention and C Surveillance ® diarrneat Dise Epidemiology Diagnosis Treatment Prevention and Contr Surveillance Framework for the Implementation of the Disease Prevention and Control Program for STH Infections and Diarrheal Diseases ‘Approaches Strategies P annexes @ References Prenton fem We a Pte‘cusisaok ors Deans Provanton and Conte Progr or Sotronsaited Hath faction and Dara Deasoe Ginical syndromes and complications of STH infections Categories for community diagnosis and selection of contol measures fr STH infections for the classification of intensity of STH infections in individuals D framework for comprehensive contra of STH infections Target populations and schedules of MDA for STH infections Target populations and drug regimens of MDA for STH infections Core indicators of MDA for STH infections Fluid administration after each loose stool during an episode of darthea UST OF TABLES Table Title 1 2 Thresholds 3 The WASHEL 4 5 6 7 8 9 10 The fourrules of home treatment for diarrhea 11 Preparation, dose and duration of zinc supplementation for patients with diarrhea 12 Amount of ORS tobe given during the first four hous of treatment of dehydration 13 Antimicrobils used to treat specific causes of dianthea 14 Ineffective antimicrobials or treatment of shigellosis 15 The 10°Golden Rules” for safe food preparation ofthe WHO 16 Standard case definitions for epidemic-prone diarheal diseases 17 DPCP and ZODP: summary of activities LIST OF FIGURES Figure Title 1 Cumulative STH prevalence and heavy intensity infections in school-age children in Aklan, ‘Antique and Capiz, 2007 to 2009 2 Lifecycle of Ascaris 3 lifecycle of Trichur 4 Life cycle of hookworm 5 Comparison of cumulative prevalence in SVES (pilot schoo!) and sentinel schools in Bian, Laguna from 1999 to 2010 6 ‘Acute watery diarrhea morbidity rates inthe Philippines, 1995 to 2008 7 Shoo! teachers helping in MDA in elementary students 8 Stepsin the implementation of the DPCP 9 Then DOH Secretary Francisco Duque and Antique Governor Salvacion Pereg administering anthelminthicto students of Pandan Central School in AntgU: during the launching of War on Worms - Wester Visayas 10 Parade of school children and teachers during the launching of War on Worsig-Bian, La LIST OF ANNEXES, Annex Title A Parastologic diagnosis of STH infections and other parasitic diseases B Reporting of rests of paraitologic assessment Reporting for survelance for acute bloody diarrhea Q Reporting for surveillance for cholera D___ Sample program continuing education and asvocaey D1 Sample action plan forthe prevention and contol of STH infections D2 Sample acon plan forthe prevention and contol ef dare dieses Assessment of dehydration inpatients with diarthea Sample program fate rating ofmediatednoogss othe abratory diagnosis of STH infections and dianheal diseases‘The Phere SustanableSantodon Kronen Sess ACRONYMS AND ABBREVIATIONS AE Adverse event ADR Adverse drug reaction AGE Acute gastroenteritis ALS Alternative Learning Systen Ao Administrative Order Bus Barangay Health Station BHW Barangay health worker cESU Gity Epidemiology and Surveillance Unit CHD Center for Health Development ‘cHO Gity Health Office ars ‘Community-led Total Sanitation DALYs Disability-adjusted life years DEC Diethylcarbamazine DepEd Department of Education DFS Direct fecal smear DOH Department of Health pcp Disease Prevention and Control Program DRA Disease Reporting Advocate RU Disease Reporting Unit psc Disease Surveillance Coordinator so Disease Surveillance Officer sw Department of Social Welfare and Dévélopment oP Garantisadong Pambata EHCP Essential Health Care Package EPI Expanded Program on immunization ESU Epidemiology and Surveillance Unit. FECT Formalin ether/ethyl acetate concent FETP Field Epidemiology Training Program FHSIS Field Health Service information System. FWBDPCP Food and Waterborne Diseases Prevention and HEPO Health Education and Promotion Officer HIS Health Intelligence Service IEC Information, education, and communication 1HCP Integrated Helminth Control Program‘usibook or soso Proventon and Conte! Progam fr Sa-rensmated Hemi fons and area iseasee RONYMS AND ABBREVIATIONS » Indigenous Peoples LF Lymphatic filariasis Leu Local government unit Mesu Municipal Epidemiology and Surveillance Unit CHS Maternal and Child Health Service MOA Mass drug administration mo Medical Officer ms Mean percentage score NAT National Achievement Test Nepec National Center for Disease Prevention an Nec National Epidemiology Center Go Non-government organization NSSP National Sustainable Sanitation Plan ‘ons Oral rehydration salts * osy Out-of school youth PESU Provincial Epidemiology and Surveillance Unit PIDSR Philippine integrated Disease Surveillance and Response PHN Public Health Nurse PHO Provincial Health Office PTA Parent Teacher Association RESU Regional Epidemiology and Surveillance Unit RHM Rural Health Midwife RHU Rural Health Unit si Sanitary Inspector SIDA Swedish International Development Cooperation Agency STH Soiltransmitted helminth SuSEA Sustainable Sanitation in East Asia Philippines UNICEF United Nations Children’s Fund UPM-CPH University ofthe Philippines Manila -College of Public Health UPM.NIH University ofthe Philippines Manila - National Institutes of Health WHO World Health Organization wow Waren Worms we-wsP World Bank- Water and Sanitation’ Program zovP Zero Open Detecation Pragitam Fe, Hoge‘The Popa Susana SantodonKaonedps Sees INTRODUCTION Soiltransmitted helminth (STH) infections and diartheal diseases remain as major public health concerns in devel- oping countries like the Philippines, where poverty, poor environmental hygiene, and impoverished health services exist (WHO, 1998). Open defec- tion outside latrines by infected persons contributes significantly to the transmis sion of the diseases via contamination of soil and water supply. Infected feces left in the open are exposed to mechanical vectors such as flies (Getachew et al, 2007; Monzon et al, 1991). The burden brought about by STH infections and diarrheal diseases Contributes to the vicious cycle of poverty and disease (Schaible and Kauffmann, 2007). The disease burden is based on disability-adjusted life years (DALYs) or the years lost to premature mortality and disability. Recent estimates of disease burden of STH infections and diarrheal diseases amounted to 39 million DALYs (Hotez et al, 2009) and 62 million DALYs watery diarrhea amounted to US$ 517 million or 5196 of the total health care cost in 2008 (World Bank, 2008). STH infections are caused by Ascaris lumbricoides, richuris trichiura, and the hookworms Necator americanus and ‘Ancyclostoma duedenale. High tisk groups for STH infections include children, adoles- ‘cent females, pregnant women, and other ‘occupational groups such as farmers, soldiers, and indigenous peoples (DOH, 2006), Helminth infections often result in subtle morbidities such as anemia, impaired physical and cognitive develop- ment, as well as poor school performance in children (Hall et al, 2008; Bethony et al, 2006). High intensity STH infections may ‘also result in clinical complications (Table 1). The World Health Assembly Resolution 54.19 (2001) urges member countries to reduce STH infections through school- based mass drug administration (MDA) among school-age children The Integrated Helminth Control Program (IHCP) of the Department of Table 1. Clinical syndromes and complications of TH infections Intestinal blood loss iron-defidency anemia Protein malnutrition (Source: Bethony etal, 2006) (Mathers et al, 2007), respectively. Furthermore, the World Bank - Water and Sanitation Program (WB-WSP) estimated the economic losses to diarrheal diseases “a g USS 671.8 million. The losses to acute Health (DOH) aims to reduce the preva- lence rates of STH infections among children, adolescent females, pregnant women, and other special occupational groups. The IHCP proposes the school- based strategy for MDA in children agessix to 12 years, and the community-based approach for the MDA in children ages 12 10 71 months old, as well as in individuals two to 65 years of age for lymphatic filariasis (LF) elimination in endemic areas. The IHCP also gives emphasis on improve- ments in the provision of safe water, sanitation, hygiene (WASH), and health ‘education for the prevention and control of intestinal helminthiasis (00H, 2006a) Infectious diarrheal diseases are caused by viruses, bacteria, and protozoa. The mode of transmission is commonly through the fecal-oral route by consump- tion of contaminated food or water (Pruss ‘et.al, 2002). Viruses remain as the cause of, most diartheal diseases. Viral diarrhea is most commonly caused by rotavirus, which is responsible for 15-25% of episodes of watery diarthea in children less than two years of age (WHO, 2005). Diarrhea-causing bacteria include Escherichia coli, Shigella spp, Vierio cholerae, Campylobacter jejuni and Salmonella spp. Pathogenic groups of E. ‘coli cause up to 25% of diartheal diseases in developing countries. Shigella causes 10-15% of acute diarthea in children below five years of age, and is the most ‘common cause of bloody diarrhea in this age group. V. cholerae O1 and 0139 cause severe watery diarrhea among ‘older children and adults. Other bacterial ‘organisms that cause diarthea are C. jejuni, which causes 5-15% of diarrhea in infants, and Salmonella, which causes 1-5% of gastroenteritis in developing ‘countries (WHO, 2005). Diatthea-causing protozoa include Giardia spp, Entamoeba histolytica and Cryptosporidium spp. Infections with Giardia and E. histolytica are usually asymptomatic. Giardiasis rarely causes persistent diarthea, and amoebiasis is an unusual cause of bloody diarrhea Cryptosporidium causes watery diarrhea in immunocompromised patients (WHO, 2005), Acute watery diarrhea is usually self-limited, but the increased loss of water and electrolytes during diarrhea may cause severe dehydration and electrolyte imbalance leading to mortal- ity, especially among young children (Black et al,, 2003). Diarthea could also cause malnutrition, which is an impor- tant cause of mortality in bloody and persistent diarthea (WHO, 2005). According to the World Health Organization (WHO), the _ essential elements in the treatment of children with diarrhea are the provision of oral rehydration therapy, zinc supplement administration, continued feeding, and proper use of antibiotics. Prevention of diarrheal diseases involves safe water, sanitation, hygienic behavior, education, breastfeeding, and measles immunization, (WHO, 2005). The Food and Waterborne Diseases Prevention and Control Program {FWBDPCP) of the DOH aims to reduce the incidence of diarrheal diseases through the implementation of treatment guide- lines for diarrheal diseases at the commu- nity level (DOH, 2007), surveillance and monitoring of epidemic-prone diarrheal diseases such as cholera and acute bloody diarrhea (OOH, 2008), together with health education and information dissemination (DOH, 1997).‘Tre Pipe Sustainable Santa Knot Sven SOIL-TRANSMITTED HELMINTH INFECTIONS. Epidemiology Approximately two _billion people are Infected with soll-transmited elminths. Itis estimated that 807 million individuals are infected with Ascaris, 604 million with Trichuris, and 576 million with hookworms (Bethony et al, 2006). The burden caused by STH infec- tions remains high in. the Philippines according to results of studies supported by, the DOH and) the, United ‘Nations Children’s Fund (UNICEF), Baseline cumu- lative prevalence of STH infections among preschool-age children in sentinel sites 'was 66.0% in 2004 (de Leon and Lumam- p20, 2004). In the follow-up monitoring in the IHCP sentinel sites in 2009, the cumu- Tative prevalence of STH infections among eternal Reahren a cg Veneer Sara 5-6 ated fom he HO feed di eee op cog ol “ soe ana ee a Table 2. Thresholds fr the classification of intensity of STH infections in individuals Parasite A. lumbricoides 1-4,999 T trichiura Hookworm 11,999 (Source: WHO, 1998) pre-school age children 12 to 71 months old was 43.7% and the prevalence of heavy: intensity infections was 22.4% (elizario et al., 2010). In the school-age group, a baseline study done among Public elementary school children in the Sentinel sites of the IHCP in 2007 revealed a cumulative prevalence and prevalence of heavy intensity infections of 54.0% and 23.1%, respectively (Belizario etal, 2009). in the followup parasitologic Survey 447% of school-age children had STH infections, and 19.7% had heavy intensity infections (Belizario et al, 2010). ‘A DOH and ‘WHO-supported parasitologic survey done among Schookage children in indigenous peoples (IP) communities showed a cumulative prevalence of STH infections of 38.6%, and prevalence of heavy inten- sity infection was 7.8% (Belizario et al,, 2010). As part of the Sustainable Sanita tion in East Asia Philippines (SuSEA) Program, a parasitologic survey was done amang school-age children in the SuSEA sites of Dagupan City and the municipa- lity of Guiuan, Samarin 2007. The cumula- {We prevalence rates in Dagupan City and Guiuan were 48.0% and 83.1%, respec- ‘Moderateintensity eggs per gram 5,000-49,999 50,000 11000-9999 (510.0000) 2,000- 3,999 = 4,000 Diagnosis Parasitologie diagnosis of STH infections is: made by afalyzing stool cheggs the Stones the routine method of stool examination for the detection of motile protozoan ophozoites In diarthele stool. the BFS an jethod together bre recommenced for use In youtine Stool examination for STF infections ahd other helminthg. as well 3s for protozoun cysts The Kato Katz method [e'primanly used for surveillance and manitoring of STH infections as well os Dther intestinal helminthtasis, and makes use of egg counts expressed In number of eggs per grain, as shown in able 3 “nhs preferably done with tal {1998)Th the procedure of choice for the screening Sf food handlers (OOH, 20086) Treatment ‘The treatments of choice for STH infections are the benzimidazoles. ther ndvdualsCuidabook «esse Preven and Cato! Pogam fr Slanted Hein econ and Ores Osea Albendazole and mebendazole are broad spectrum, anthelminthics proven to be highly efficacious for treating STH infec- tions (Keiser and Utzinger, 2008), Reduc- tions in worm burden have an important impact on the health of children, includ- ing improvements in food " intake (Stoltzfus et al, 2004), iron stores, and hemoglobin levels (Pandey et al, 2005; Stoltzfus et al, 2004), vitamin A ievels (Tanumihardo ‘et al, '2004; Jalal et al, 1998), growth (Awasthi et al, 2008; Hall et al, 2008). ‘The adverse events (AEs) associ- ated with albendazole and mebendazole are mostly mild and transient. The most commonly reported AEs associated with benzimidazole administration include mild abdominal pain, diarrhea, headaches, dizziness, local hypersensitivity and erratic ‘worm migration. No treatment is neces- sary_in majority of cases with AEs (Montressor et al, 2003; Horton, 2000; Albonico et al, 1995). Antihistamine is indicated for’ local hypersensitivity reactions, and there is no scientific basis for its use together with routine dewor- ming. Oral hydration therapy can be started for diarthea (WHO, 2006), Albendazole or mebendazole ‘can be safely administered with vitamin A (WHO, 2004). Albendazole and diethy carbamazine (DEC) can be safely adminis- tered to children two years of age and above. Praziquantel and benzimidazoles can be safely administered together (WHO, 2006a) The | AEs experienced by individuals co-administered with the albendazole, DEC, and praziquantel have been described as mild and self-limiting events. Data from a large population under study in Zanzibar suggested that co-administration of the three drugs is a safe intervention when carried out in an area where LF, STH, and schistosomiasis are co-endemic, and where several rounds of treatment with one or two drugs have been implemented in the past (Mohammed et al, 2008). Itis necessary to emphasize the need for maintaining passive surveillance measures when administering similar _ interventions. Detection, management, and reporting of potential AEs are key components of any health intervention administering drugs (Dodoo et al, 2007). EER5R993935 Akan Antique apa bin I ightinensity STH infection HL Moderate-beay intensity THinfection bone fin b-baseline 1h itfllon-p 12° dd ellontp Figure 1. Cumulative STH prevalence and heavy intensity, infections in school-age children in Aklan, Antique, ‘and Capiz, 2007 to 2009 fBelizaria etal, 2010) Prevention and Control The objective of a helminth control program is morbidity reduction among endemic populations by reduc- tion of the number of heavily infected individuals (WHO, 2006), Preventive chemotherapy is the main strategy used in a helminth control program. Preventive chemotherapy refers to administration of drugs, either alone ot in combination, to an entire group of people without prior diagnosis of current infection as a public health tool against helminth infections. Preventive chemotherapy through periodic MDA is considered a rapid first-line intervention in morbidity reduction and control of STH infections (WHO, 20062; WHO, 2002). Infective eggs remain viable in the soil for a maximum of two years, thus, MDA for at least three consecutive years should be done (WHO, 2002), MDA among target populations may be _infrastructure-based or community-based. School-based, teacher- assisted MDA is the recommended control apt = = KP target IHC ar‘The Popa Susana SantodonKaonedps Sees strategy for STH infections (WHO, 2002). In the War on Worms (WOW) initiative in the Wester Visayas, the school-based, teacher- assisted MDA has been shown to result in significant reductions in the prevalence and intensities of infection among the public ‘elementary school children after two years of implementation, with two out of the three provinces achieving the targets of the IHHCP after only two years of MDA (Belizario, et al, 2010) (Figure 1). MDA js included among the key interventions for the control and prevention (of STH infections as outlined in the water, sanitation, hygiene, education, and ‘deworming (WASHED) framework (Table 3). Long-term interventions include improve ments in access to safe water, sanitation, and personal hygiene, with emphasis on the prevention of open defecation. Table 3. The WASHED framework for comprehensive control of STH infections ing (Source Evans 2005) An equilibrium state exists between parasites, host populations, and the environment. Soil-transmitted helminths do not multiply inside the human body. Infection and re-infection. always result from exposure to. the infected ‘environment (Figures 2-4). Unless improve- ‘ments in sanitation and behavior take place, prevalence and intensity of STH infections wil tend to return to their pre-treatment or baseline levels (WHO, 2002), as illustrated in Figure. Data regarding prevalence and intensity of parasitic infections are impor tee" indicators of the impact of intervention, ce sage Shy 1), R-drowsicrtse Figure 2. The lifecycle of Ascaris (wwrw.cde gov) oe cm awn (Otnenaegyget a =hfece ge a ATR sig a Figure 4. The ifecycle of hookworm (wwwicde-gov) These parameters determine the classifica- tion of communities and the appropriate treatment strategy as recommended by the WHO (Table 4). For cumulative prevalence above 50%, MDA in target population groups should be done. Ifthe cumulative‘usdeoak ora esos Prevnton and Conte! Program for Saleansmitd Heimat itor and Drea Dsases prevalence becomes less than 50% and ‘there are major improvements in sanitation and hygiene, MDA can be done once a year (WHO, 2006), although reinfection rates can be high as seen in Figure 5. wee ess sss Delayin Cumulative prevalence (%) 30 | procurement 20) tablets? 10 ° MDA from 2x shifted to 1xa year The national program also aims to increase ‘the proportion of households aware of proper STH prevention and control, with 75% ‘of mothers/caregivers practicing appropriate personal and food hygiene (OOH, 2006a). Figure 5. Comparison of cumulative prevalence in SVES (pilot school) and sentinel schools inBinan, Laguna from 1999 0 2010 (Belzaro eta 2006; 8elizara, unpublished) ‘The objectives of the IHCP include reducing the prevalence of STH infections in children one to 12 years of age to less than '50%, and in other high risk population ‘groups, including adolescent females, Pregnant women, farmers, and soldiers (OOH, 2006a). To achieve the goal of the program, the IHCP aims to achieve at least '85% treatment coverage among all popula- tions at risk (OOH, 2006b). For access to safe water and sanitary toilets, the IHCP aims for 194% and 80% coverage rates, respectively. According to the National Sustainable Sanitation Plan (NSP), the prevalence of ‘STH infections should be reduced by 60% in 2016 and be near zero by 2022 (DOH, 2010). Sentinel surveillance data in 2009 for pre-school and school age children may provide baseline data, MDA among children 12 to 71 ‘months old is being done by trained baran- gay health workers (BHWs) and day care ‘workers duting the Garantisadong Pambata (GP) activities, together with provisions of Table 4. Categories for community diagnesis and selection of control measures for STH infections caer “Includes both enrolled and non-enrolled children six 12 years of age eMass treatment can be conducted thrice a year or every four months. “dfSTH prevalence rates are below 20% and there are adequate improvements in sanitation, selective treatment may be considered. (Sources: DOH, 2006a; WHO, 2006)‘he PrppneSuahade Santon Knowle Seri vitamin A supplements and other micronu- trients (OOH, 2006a). Children sixto 12 years of age enrolled in elementary schools may be given anthelminthics by trained school teachers under the supervision of the ‘rained school nurses, while MDA among the non-enrolled school-age children may be done by trained BHWs. MDA with albendazole with diethylcarbamazine is being done for individuals 2 to 65 years of age in filarasissendemic areas (DOH, 2006a). The schedules of MDA among the target population groups are in Table 5. MOA and selective treatment. A second dose should be provided for pregnant women who come from areas with preva- lence rates of hookworm infections above '50% (DOH, 2006a). For persistent or severe AES, there is aneed to refer a physician and inform the IHCP regional or provincial coordinator (OOH, 20068). The administration of albendazole and mebendazoleis contraindicated during the first trimester of pregnancy and in children less than one year old. Benzimida- Table 5. Target populations and schedules of MDA for STH infections Children 12-71 months old” Individuals 2-65 years od in LF endemic areas Community-based mass treatment ‘School-based mass treatment (Source: DOH, 2006a) MDA among adolescent females and other special population groups will be done by the local health unit staff once a year any time members of the above groups Consult the health faciity. MDA among pregnant women will also be done by the local health unit staff during prenatal visits, particulatly during the second or third trimester (DOH, 2006) Table'6 contains the drugs and their respective doses and regimens for DOH/LGU zole administration is also contraindicated in children with severe malnutrition, high- {gtade fever, profuse diarthea, or abdominal pain (DOH, 2006a). Master listing is recommended before an MDA activity. Trained BHWs may be mobilized to complete a master list of pregnant women, female adolescents, and ‘children age one to 12 years who are not enrolled in schools. Pre-elementary and ‘elementary teachers, as well as day care workers, can easily’ prepare a list of all enrollees (DOH, 2006c) that is usually ‘Table 6. Target populations and drug regimens of MDA for STH infections 12-24months ofage Individuals 2-65 years old in LF-endemic areas Pregnant women second and third timester COncea year anytime they consult thehealth facility Containdiatedin the severely pregnant women, and children below two yeas of age (WHO, 2008) tak stecommended that MOA should be conted unl there are major improvement sanitation and hygiene ‘sent Depress ohio nectar srcheatedtnces year “fegrant women fom (Gource:00H 20069available asa class lst. The formula for drug requirements for mass and selective treatment of different target populations is stated below: (Number of tablets for desired coverage in target population’) + (number of tablets for additional wastage in target popula- tion®) = number of deworming drugs required The desied treatment coverage rates for all ‘population groups 85% (DOH, 20060 Computation for chien age one fo 12 years (otal populatin x 30%) «85% (DOH, 2006 Computation for adolescent. females: (otal ‘population x 18%) x85% (DOH 2006) ‘Computation for pregnant wore ftalpopul tionx3.5%)x85% (DOH, 20066) Computation fr wastage 5% xounberoftablets for dested coverage n target population (DOH, 20066) «Since MOA i done wice a year among children ‘one t012 yeas of age, the computed number of abies required is multphed by two. Since ‘bregnant women who come from areas highly fender forhookworms are also reated wie {year the computed number of tbletsrequed for {this population group is multiplied by eno (DOH, 20086) The DOH shall deliver the anthel- minthies for MDA to the regional health offices or Centers for Health Development (CHD). From the CHDs, the drugs will be distributed to respective local government units (LGUs) and Department of Education (DepEd) division offices (OH, 2006¢) Surveillance and Monitoring Indicators are essential for program planning and monitoring of large scale interventions for the control of helminth infections. Among the proposed indicators by the WHO (2002b), parasito- logic indicators and treatment coverage rates in the target populations are the most, important in monitoring and evaluation of helminth control programs (WHO, 2006). Morbidity indicators such as nutritional status data and data on school performance ‘ould also be noted to allow abetter under- standing of the effects of STH infections (WHO, 1998). Parasitologic indicators are most essential in assessing the impact of interventions on morbidity reduc- tion. The overall prevalence rate of STH infections will determine the appropriate interventions for communities (WHO, 2006). The WHO recommends that control programs for STH infections begin with a baseline parasitologic survey (WHO, 1996).A baseline survey provides a basis for estimating the status and the need for intervention in a population, and produce essential data to guide the development of control programs (WHO, 1998). Parasitologic monitoring is done just before a drug administration cycle. This will allow the assessment of maximal re-infection rates and the estimation of the prevalence of heavy intensity infections ‘These parameters will provide information for planning the type and frequency of future interventions (WHO, 2002) Elementary school pupils are the ideal targets for a parasitologic survey because they harbor the greatest worm burden among all age groups. Moreover, the enrolled schoolage children are accessible in schools (WHO, 1998) To evaluate the prevalence and intensity of STH infections in a division or district, a sample size of 250 students or 50 students ftom five schools is considered adequate (WHO, 1994), Grade three students are likely to have received at least ‘wo years of interventions and are ideal for monitoring purposes (WHO, 2002b}. Follow-up surveys monitor the impact of a control program, and are ideally done every ‘two of three years just before a round of MDA (WHO, 1998). Reporting of the parasitologic data in school surveys should be presented according to grade level, school, district, and division (WHO, 1994). Reporting of the parasitologic data of STH infections should include cumulative prevalence and overall prevalence of heavy intensity STH infections, as well as prevalence and propor- tions of ‘heavy intensity. infections per helminth species. The prevalence rates of multiple infections should also be reported (WHO, 2006e). The laboratory technique and proficiency of the laboratory staff are Major determinants of reliable laboratory diagnosis of STH infections and other intestinal helminthiasis. Quality assu- rance of the laboratory techniques should be maintained through proper collection of specimens, availability of fresh reagents, use of appropriate laboratory technique, meticulous examination of processed specimens, and accurate repor- {ing of findings. Quality control involves a 6 *,he Pipe SutnsleSantatonKrowaye Serbs reference microscopist_who will provide assistance in the verification of positive findings and will blindly re-examine 10% of all slides (WHO, 1998). The treatment coverage isthe ‘minimum indicator to assess the performance of large-scale MDA. The treatment coverage refers tothe proportion of peoplein the target popula tion who have actually swallowed the recom- ‘mended drug (WHO, 20069) ‘The treatment coverage for the schooltbased MDA should be reported as summaries according to class, grade level school, and district. The reports should be accomplished by the teachers and public health hnurses (PHN) for submission to the DepEd Division Medical Officer (MO). From the MO, a summary report should be forwarded to the CHD and then to the National Center for Disease Prevention and Control (NCDPC) of the DOH Central Ofice (DOH, 2006¢) ‘The report on treatment coverage in the GP and MDA for LF will be accomplished by BHWs and midwives, and will be submitted to the City Health Office (CHO)Rural Health Unit (RHU), For chartered cities, the report from the CHO will be forwarded to the CHD. For munic= pallies, the report from the RHU should be sent {o Provincial Health Office PHO) and then to the CHD. Reports from the CHD should be submi- ted to the DOH-NCDPC (DOH, 20060. Table 7. Core indicators of MDA for STH infections Indicator Glelation ‘10036) Numerator Population treated Denominator: Total population Treatment coverage Parastlogic evaluation aula prevalence of THinfectons ing Numerator # of individual postive {or anySTHinfecon Denominator #ofndviduals examined infection ate tet tay Numerator finials ith moderate toheary intensity SHinfecon Denominator: of nid examined PrdespS.geces a Numerator final postve foraspeiicSTHinfecion Denominator: of nial examined of infection ast pete epreaeoe Nemec ott th dete toheary intensity Ascaris chu infection Denominatr # of individual postive for Asa Hchurshookworm ‘The accomplishment report on treatment of adolescent females, pregnant women, and special population groups such as farmers, soldiers, food handlers, and individuals belonging to IP groups must be recorded and reported by the responsible health facilities to the CHO/RHU, Treatment of children in health facilities must also be recorded and reported accordingly (DOH, 2006¢) Reports of AES must be submitted together with the accomplishment report for the treatment round. Accomplishment reports must be submitted not later than one week after the ‘treatment round (00H, 20060), Table 7 contains the core indicators and their formulas targets, frequency, as well as. timing. Monitoring of school. performance ‘may be done using the results of the National ‘Achievement Test (NAT). Indicators for school performance may include the proportion of pupils with NAT mean percentage scores (MPS) below 75%, Data on the NAT scores could be requested from the concemed division and district offices ofthe DepEd, ‘Nutritional status indicators among children may include the proportions of below height and weightfor-age, as well as the prevalence of anemia. Data on the height- and Weightforage could be requested from the concemed division and district offices of the Depéd. Target Frequency 25%among len neo yeas never ound afoge sexed females of veatment yeqant women and eament—agminisraten Atoter spec poplton ous Camultveprealence | Beforethestart of Hinectons <50% of MDA and beforeanent Heavyimenstyinfecion —_roundof NDA ratesoSTMinfecton: 0% initeralsoftwo arthre years “Thresholds of heavy intensity infections are in Table 2. (Sources: DOH, 2006a; WHO, 2006)‘cusbaok ors sass Provrton a Cont Progam fr Sltreasmted Heth nace and Oarhea asese DIARRHEAL DISEASES Epidemiology Diartheal diseases are a leading cause of childhood morbidity and morta- ity in developing countries An estimated 1.87 million children below five years of age died from diarrhea in 2003. "On the average, children below three years of age experience three episodes of diarrhea annually (WHO, 200: Although the incidence rates of acute watery diarrhea have been decrea sing since the 1990s (Figure 3), diarrhea stilf remains to be a significant cause of morbidity in the Philippines. In 2008, acute watery diarthea ranked fifth among the ten leading causes of morbidity, with an incidence rate of 485.4 per 100,000, while the incidence rates for cholera'and acute bloody diarrhea were 0.2 per 100,000 and 5.0 per 100,000, respectively (DOH, 2008) ‘occurred in children below five years of age. A cholera outbreak was reported in 2005, (Guiuan LGU, 2010). Diagnosis ‘There are four types of diarrhea: acute watery “diarthea, "acute | bloody diarthea or dysentery, persistent diarrhe and diarthea in the severely malnourished. gr the severely. The types of careal diseases are recognized based on their clinical features. ‘Acute watery diarrhea is the passage of unusually loose or watery stools three times or more in a period of 24 hours with a duration of less than 14days. Cholera should be suspected when a child older than five years or an adult develops severe dehydration from acute watery diarrhea, Usually with vomiting, or when a child older Figure 6. Acute watery diarrhea morbidity rates in the Philippines, 1995 to 2008 (DOH, 2008) In Dagupan City, acute_water dlarthea was the third eading ‘cause of morbidity with an incidence rate of eight cases per 1,000 population, while there ‘were 980 hospital admissions and five cases of mortality (403 per 1,000 population) in 2009. All “diatheavrelated morialities involved children below five years of age ‘There were also two cases of cholera and 39 cases of amoebiasis in Dagupan in 2009 (Cagupan LGU, 2010) In Guiuan, acute watery diarrhea was the second leading cause of morbidity from 2004 to 2009, with a rate of six cases pper 1,000 population in 2009. In the same year, there were 126 hospital admissions and two cases of mortality (0,04 per 1,000 population). All diarthea-related deaths than, two years develops acute watery diarrhea when cholera is known, to be ‘occurring in the area. In younger children, cholera may be difficult to distinguish from ‘acute watery diarrhea of other causes, ‘especially rotavirus (WHO, 2005). ‘Dysentery is considered if blood is present in diarrheic stool. Persistent diarrhea has a duration of at least 14 days, ‘during which periods without diarrhea have ot exceeded two days. Diarrhea in the severly, malnourished i diagnosed when the child with diarthea has below height- or weightfor-age or has edema with muscle wasting and other signs. of marasmus. Diarrhea in the severely ill is caused by serious non-intestinal infections and usualh presents with systemic signs such as that o ifTh Pine Suite Satan Knowledge Seri pneumonia or meningitis (WHO, 2008), ‘The degree of dehydration should always be assessed in cases of acute watery diarthea, The degree of dehydration is classified according to signs and symptoms that reflect the amount of fluid lost, The current, “classifications of dehydration ‘caused by diarthea are“no signs of dehydra- tion’ “some dehydration’ and “severe dehydration’ In the early stages of dehydra- tion, there are no signs and symptoms. AS dehydration progresses, the patient may develop thirst, restlessness, irtabilty, decreased skin turgor, sunken eyes, or sunken fontanel in infants. In ‘severe dehydration, the patient may develop extreme thifst and other signs of hypo- volemic shock such as diminished consciousness, decreased urine output, cool extremities, feeble pulse, peripheral ‘cyanosis, and low or undetectable blood pressure (WHO, 2005), Laboratory’ tests are important especially for the diagnosis of epidemic- prone diarrheal diseases such as cholera and bloody diarrhea, For cholera suspects, stool cultures for V. cholerae OF and 0139, should be done. For patients with acute bloody diarrhea, microscopic stool exami nation by DFS for trophozoites of E. histolytica may be done, Fecal Gram stain and culture, fecal leukocyte examination, serotyping, ‘toxin identification, and viral identification can also be done (WHO, 2005b). Diagnostic tests are also required when treatment other than fluid replace- ment is expected, such as in persistent diarrhea, oF 'darthea. in the” severly malnourished or in the, severely ill (WHO, 2005). DFS may be done to check for trophozoites of Giardia in patients with persistent diarrhea. In the patients with Severe malnutrition or severe non-intestinal illness, laboratory work-up for systemic infections and illness is warranted upon admission ata hospital (WHO, 2005). Treatment The four types of diarthea have different complications, and the manage- ment strategies for each type of diarrhea depend on the treatment and prevention of therr respective complications. Dehyda, tion is the main complication associated with acute watery diarrhea, as well as in cholera, Weight loss may also occurinacute watery diarrhea if feeding is not continued. Dysentery leads to damage ofthe intestinal mucosa, sepsis, and malnutrition, Dehydra- tion may also occur in dysentery. For persis- tent diarrhea, malnutrition and serious Paik nonintestinal infection are the main risks involved. In diarrhea with severe malnutr- tion, severe systemic infection, dehydration, heart falure, and vitamin and mineral deficiency can occur (WHO, 2005). Treatment of acute watery diarrhea The objectives of treatment of acute watery diarthea include the preven- tion of dehydration, treatment of dehydra- tion if present, prevention of nutritional damage, and reductionsin the duration and severity of diarrhea as well as in the occu- rence of future episodes. (WHO, 2005) Table 8 serves as a guide for fluid adminis- tration after each loose stool for the replace- tpent ofthe existing water and electrolyte cit Table 8. Fluid administration after each lose stoo! during n episode of diarhes Children below two years of age ‘Children older than ‘Toyearsand adults, (Source: WHO, 2005) While treatment to replace the existing water and electrolyte deficit is in progress, the normal daily fluid require- ments must also be met, Asageneral ule,a patient i aven as much ful asthe child wants until the diarrhea stops (WHO, 2005). Home fluids should include at least one fluid that normally contains salt. Suitable fluids for diarrhea that normall Contain salt include oral rehydration sal (ORS) solution and salted drinks such as rice water or soups (WHO, 1993). Plain clean water should also be given to children with dehydration. A home-made ORS solution is not recommended because the preparation may notbe sufficient for electrolyte replace- ‘ment (WHO, 2005). The WHO and UNICEF promote the use of reformulated ORS for diarrhea (WHO and UNICEF, 2006). The reformulated ORS solution has lower osmolarity, which prevents the undesirable effects of hyperto- hicty or net fluid absorption (Duggan etal, i; Hahn et al, 2001), The new ORS Solution reduces the need for supplemental ravenous (WV) fluid therapy by 33% after initial rehydration when compared with the previous standard WHO ORS solution. The reformulated ORS solution also reduces the incidence of vomiting by 30% and stool vo-utstook reese Prevention and Cone! Pasa fr Satan Hains econ and Darhea Dscoser lume by 209 (UNICEF and WHO, 2001), ‘Although the use of reformulated (ORS has been associated with increased risk of transient asymptomatic hyponatremia, large scale studies did not demonstrate increased, isk of symptomatic hypora- ‘remia (WHO and UNICEF, 2006). The new reformulated ORS solution has a 3% or less probability of treatment failure, or the persistence of reappearance of signs of dehydration after administration, The usual causes for treatment failure include insuff- Cient intake of ORS solution due to fatigue for lethargy, severe vomiting, and/or Continuing rapid stool losses, such as in cholera (WHO, 2005), ‘The rare contraindications for ORS treatment include abdominal distension with paralyticileus, which may be caused by opiate drugs, and hypokalemia. Another contraindication is glucose malabsorption, which is indicated by marked increase in stool output, lack of improvement in hydra- tion status, and/or the presence of a large amount of glucose in the stool when ORS solution is administered (WHO, 2005), Some fluids should be avoided dluing epgodes of diarrhea, Drinks swe. tened with, sugar such as commercial carbonated beverages and frat juices can ‘ause osmotic diarrhea and hypematremia. Fluids such as coffee or tea should also be avoided because of their diuretic or purga- tive effects (WHO, 2005), For cholera, the initial treatment consists of fluid and electrolyte replace- ment. Rice-based ORS is superior to standard ORS for, cholera (WHO, 1994), Large amounts of ORS solution may be required to replace large continuing losses of watery stool. The amount of stool lost is greatest in the first 24 hours of illness, Usual” requiring WV maintenance therapy with Ringers Lactate solution (WHO, 2005). ‘WHO and UNICEF also endorse the administration of zinc supplements for dlarthea (WHO and UNICEF, 2006) Zinc has critical roles in metallo-enzymes, polyribo- somes, cell membrane and other cellular functions, cellular growth, and functions of the immuine system. Zinc supplementation reduces the duration of acute diarrhea by 25.0%, duration of persistent diarrhea by 29.0%, treatment failure or death in persis- tent diarrhea by 40.0% (The ZINC Group, 2000), and the incidence of diarrhea for two to three months (WHO, 2005). Vomiting isthe only reported AE of any form of zinc supplementation for the treatment of diarrhea. There is currently no substantial evidence of adverse changes in ‘the copper status as a result of short-term Zinc supplementation for the treatment of diarrhea (WHO, 2006; Sazawal etal, 2004) According " tothe FWBDPCP, clinical care of diartheal diseases will focus fon case_management using ORS and Tational use of diagnostic tests (DOH, 1997) The Maternal and Child Health Service (MCHS) provides the guidelines for Management of diarrheal diseases in children below five years of age, with the goals of prevention and tveatment of jehydration, prevention of nutritional damage, reduction of the duration and severity of diarthea and reduction of future episodes. of diarthea (DOH, 2007). The ICHS guidelines for the treatment of diarrheal diseases at the community level include the WHO/UNICEF-tecommended interventions of reformulated ORS and zinc upplement administration among children less than five years of age (DOH, 2007). In patients: with acute watery diarthea, particularly in children less than five years of age, the ist steps of treatment are the assessment of dehydration and selection of appropriate treatment based ‘on degree of dehydration (DOH, 2007) Table $ contains the categories for assess- ment of patients with diarrhea, ‘Treatment Plan A involves home ‘treatment for category A diarrhea, The Table 9. Assessment of dehydration inpatients with drrhea 5 LethargiceJunconscious Sunken’ Drinks poorly / unable to drink leith > 2signsin, there is severe dehydration Child cannot be fly awakened and may appear tobe ding into unconsciousness. isons cen, tgs tay normaly appear ment sake thesis 2 food practice {0 ask the mother ifthe eyes are normal or more sunken than usual «Skin pinch is less useful in obese children or those with marasmus or kwashiorkor. (Soure-DOH 2007)The PhitgeneSuetanate Santon Knowle Serie mother of the patient should be advised on the four rules of home treatment (Table 10). Table 10. The four rules of home treatment for diarrhea Rule, Giveextaflid Rule2,Givezincsupplementation Rule3, Continue feeding Ruled, Advice when to retun tothe heath facity (Source: DOH, 2007) According to Rule 1, a child should be given as much fluid asthe child can tolerate, Mothers should be advised to breastfeed frequently and. for longer periods, Exclusively breastfed children ould be given ‘ORS oF lean, water in ‘addition to breast milk, while children who are not exclusively breastfed could be given ‘ORS, clean water, or food-based fluids (WHO and UNICEF, 2008; DOH, 2007). ‘The mother of the child should be given two packs of ORS for home use and iuld be taught how to prepare ORS. The mother should be advised to ‘give additional fluid to augment the usual fluid Rule 2 states that the mother should be advised on the dose, duration, and administration of zinc supplementa- tion. For children less than six months old, thezine tabletis dissolved ina small amount of expressed breast milk, ORS, or clean ‘water. Children six months to five years of age can be given tablets to be chewed of issolved in a small amount of clean water ‘The mother should be advised to give zinc supplements for 10-14 days (WHO and UNCER 2008, DOH, 200%), Table 1 contains the preparations and dosing of zinc supplements feeding should continue during an episode of diarrhea according to Rule (GOH, 2007). Continued feeding prevents the development of malnutrition and facilitates faster recovery of the intestinal mucosa (WHO, 2005). Mothers are advised to breastfeed more frequently and for long periods. Children should be encouraged to eat as much as they want and should be offered small and frequent meals. Children above six months of age should be given food with the highest amount of nutrients and calories, such as meat, fish, eggs, and dairy products. The addition of oil to these Table 11. Preparation, dose and duration of zinc supplementation fo patents vith diarrhea (Source 00H, 2007) intake, as shown in Table 8 The mother should be taught to give smali and frequent sips from a cup and to continue additional fluid administration, until diarthea stops. If the child vomits, the mother should be instructed to wait for 10 minutes before feeding is resumed. Mothers should be advised against the use of sports drinks because of their low sodium content which ‘can cause hyponatremia and its high carbo- ke osmotic 2008; DOH, 2007). rate content which can. hea (WHO and UNICER, ‘ml once a day for 10-14 days foods makes them energy-rich. Fresh fruit juices and bananas are good sources of otassum (WHO and UNICEF, 2008; DOH, Mothers should be advised to avoid giving high fiber or bulky foods such as coarse fruits, vegetables, and whole grain Cereals because these aré hard to digest. Mothers should also avoid giving foods with lots of sugar and very dilute soups because of the lack of nutrients (WHO and UNICEF, 2008; DOH, 2007).‘uieboo fora issase Prverton and Con! Pram fr Sol-ransites Hart Ifocons end Care Oscesos According to Rule 4, mothers should be instructed to bring the chi to the health center if the, child develops danger signs, which include inability to eat ot dink, exhibiting exreme titst develo, ping a fever, and/or showing no signs of Improvement after thee days (WHO and UNICEF, 2008; DOH, 2007). ‘Treatment Plan’ B involves the ‘treatment of children with some dehydra- tion with ORS at the health center. The recommended amount of ORS will be given, ‘over a four-hour period (Table 12). Addi- reclassified accordingly. The treatment plan appropriate to the current status should be administered, Oral feeding as tolerated by the child should be resumed (WHO and UNICEF, 2008; DOH, 2007). Ifthe patient must leave the clinic before completing treatment, the mother should be advised on the remaini amount of ORS that must be administ ‘within the fourhour period. The mother should be given enough ORS to complete ‘the four-hour treatment, and two additional ORS for home treatment according to Table 12. Amount of ORS to be given during the fist four hours of treatment of dehydration Use the age ifthe weight ofthe child cannot be determined. the amoiint of ORS required could aso be approximated by weight (kg) multiplied by 76 (Source: WHO/UNICEF, 2008) tional ORS could be given if the child wants more. For children who are not breastfed, 100-200 mi. of clean water may be given (WHO and UNICEF, 2008; DOH, 2607). After four hours, the status of dehydration should be reassessed and Treatment Plan A. The mother should be advised on the four rules of home treatment for diarthea (Table 11) (WHO and UNICEF, 2008; DOH, 2007). Treatment Plan C involves the treatment of children with severe dehydra- Table 13. Antimicrobials used to treat specific causes ofdiarrhea hilren: 12.5 maka PO, Atimesa day: ‘Adul Ais 09s All doses shown are for oral administration. drugs ae not availabe in quid form or usein young Children, itmay be ecessary tse tablets and estimate the doses given inthis table. Selection ofan antimicrobial should be based on sensitivity patterns of strains of Vibrio cholerae O1 {9 0139, or Shigella recently isolatedin the area, ‘An antimicrobials recommended for patients older than 2 years with suspected cholera ‘and severe dehydration. Tinidazole can also be given in a single dose (50 mg/kg oral). (Source: WHO, 2005), FoyPegi ‘he Prtppne Sutra Santon Krowodge Series tion, consisting of urgent hospital referral (00H, 2007). ‘Antimicrobial should not be used routinely for acute watery diarrhea. itis not possible to clinically distinguish diarrhea that_might. respond to, treatment with antibiotics, Selecting an effective antimicro- bial requires knowledge of the sensitivity of the causative, agents, which is_usuall Unavailable. The use’ of antimicrobials provides additional costs and risks of adverse events. Additionally, widespread antibiotic administration can contribute to the development of bacterial resistance (WHO, 200: In acute watery diarrhea, antim- crobials may be given to patients with suspected cholera and severe dehydration, or to patients who are severely mung: compromised or severely ill (WHO, 2005) Table 13. contains the drugs for specific causes of diarrhea, Antidiarrheals_ and antiemetics have no practical benefits for patients with diartheal diseases, and their administration during an episode of diarrhea may cause complications (WHO, 1980). Treatment of acute bloody diarrhea Children with bloody diarrhea should be assessed for dehydration and malnutrition, Appropriate fluids should be given for dehydration. Children with severe Malnutrition should be admitted to a hospi- tal WHO, 2008) Table 14. ineffective antimicrobials for treatment of shigellosis Ghloramphenicol Cephalosprins (first and: “eo ce WHO 205) Patients with bloody diarrhea should be treated for three days with Ciprofloxacin or five days with other antibi- tics to which most Shigella in the area are sensitive to, since Shigella causes most episodes of bloody diarthea and almost all episodes of shigellosis are severe. The deve- lopment of antibiotic resistance by Shigella is frequent and the pattern of resistance is Unpredictable, Antibiotics listed in Table 14 should ever, be given for, shigellosis, regardless ofthe senstvty of local strains (WHO, 2005) The mother of a child should be advised to bring the child back in two days for reassessment and/or further manage- ment ifthe child is less than one year of age ‘or has no signs of clinical improvement. Children who were initially dehydrated or had measles during the past six weeks should also follow-up in two days (WHO, 2005). Amoebiasis is considered in patients without clinical improvement in two days or after treatment with two drugs usually effective for Shigella. Appropriaie antibiotics for amoebiasis (Table 13) should be given if microscopic stool examin: derionstrates trophozoites of F. histolytica ontaining. red blood cells (DOH, 1393; WHO, 2008), Treatment of persistent diarrhea The objective of treatment for persistent diarrhea isto correct malnutrition and restore intestinal function. Treatment of persistent diarrhea consists of appropriate Fehydration, nutritious diet, vitamins and mineral. supplementation including zine and appropriate antimicrobials. Patients with persistent diarrhea can be treated at home with careful: follow-up. Mothers should be advised to follow-up within five days or to retum any time the child deve- Tops danger signs (WHO, 2005), ORS” treatment is generally well-tolerated in patients with, persistent diarthea. In a few patients with impaired glucose absorption, ORS treatment may aggravate dehydration, and hospital admi- ssion for IV rehydration may be required, Infants below four months of age and children with a serious systemic infection, severe malnutrition, or with signs of dehydration should be admitted in a hospi- tal for management (WHO, 2005). Routine use of antimicrobial in patients with persistent diarrhea is not effective and should not be. given Diagnosed systemic infections and intest- nal infections should be treated appropri ately. Drugs for giardiasis should only be iven_when, trophozoites have been lemonstrated in the microscopic stool examination of a patient with persistent diarthea (DOH, 1993; WHO, 2005). Table 13 contains the treatment regimen for giardia- sis. Treatment of diarrhea with severe malnutrition ‘Treatment of diarthea in severely malnourished patients must focus on the Management of the malnutrition and ‘other infections, All severely malnourishedchildren should receive broad spectrum antimicrobial weatment for several days Hospital admission is required in the management of severely “malnourished patients (WHO, 2008). Prevention and Control The target of the FWBDPCP for diartheal diseases is to reduce the morbidity rate to 750 cases per 100,000 and the mortality rate tolless than one death per 100,000 by 2010, inallage groups. For outbreaks of food and waterborne diartheal diseases, the FWBD- PCP aims to reduce confirmed outbreaks of cholera to zero (OOH, 2005), According to the NSSP. the incidence of acute gastroen- tertis (AGE) should be reduced by 60% in 2016 and near zero by 2022 00H, 2010), ‘The FWBDPCP promotes health ‘education and information dissemination, ‘especially the 10 Golden Rules for Safe Food Preparation (Table 15), Safe Water Source, and Environmental Sanitation of the WHO. Table 15. The 10“Golden Rules"forsafe food preparation ofthe WHO ‘Choose foods processed for safety. ‘Cookfood thoroughly. Eat cooked foodsimmediately. Store cooked foods careful. Reheat cooked foods thoroughly. ‘Avid contact between raw foods and cooked foods. ‘Wash hands repeatedly. Keep all kitehen surfaces dean, Protect food from insects, rodents, and other animal. Usesafe water. ource: vm who nt The strategies for the control and prevention of diarrheal diseases include the use of safe wate for drinking, safe food reparation, and good personal hygiene. Eontation, hygienic behavior, breastec- ding, proper niatrition, and measles immu- nization are also emphasized (WHO, 2005) Because the organisms that cause diarthea are excreted in the stools of an infected patient, hygienic behavior such as the proper use of latrines and the safe disposal of stools help in the interruption of transmission of diarrheal diseases’ (WHO, 2005). Hand washing with soap is associ- ated with decreased incidence of diarrheal disease and associated severe outcomes significantly (Curtis and Caimeross, 2003), Hand washing should be done after defeca- tion or after disposal of the stool of a child Hand washing should also be performed before preparing food and eating since food can be contaminated by diarrheal agents at all stages of production and preparation (WHO, 2005), Exclusively breastfed infants are less likely to have diarthea or to die from it compared with infants who are partially breastfed or not breastfed at all. Breast milk is clean and. not contaminated with diarthea-causing agents. Additionally, breast milk has immunologic properties that protect the infant from infections, including diarthea. Infants should be exclu sively breastfed until six months of age, and breastfeeding should continue until two ‘years of age (WHO, 2005). Measles immuni- Zation significantly reduces the incidence and severity of diarrheal diseases. Every infant should be immunized against measles at the recommended age (WHO, 2008). Good feeding practices, involve selecting nutritious foods and using hygienic practices when preparing. them. Complementary foods consisting of eggs meat, fish, fruits, and vegetables. should normally be started when a child is six ‘months old (WHO, 2005). ‘Surveillance and Monitoring Epidemicprone ciartheal diseases, suchas cholera and acute bloody diarthea, are among the rorty diseases targeted for survellance inthe county (DOH, 2008) nthe identification of cases of cholera and acute Bioody ‘darhea, the Phippne integrated Disease Surveillance and Response (PIDSR) ses standard case definitions forthe diseases under surveillance, which are consistent with the WHO Recommended Surveilance Standards, Simple case definitions are also available for use by the Disease Report ‘Advocates (DRAs) (DOH, 2008). The standar case definitions will be Used in the recording and reporting of the diarrheal diseases Table 16 contains the standard case definitions of cholera and acute bloody diarrhea, Table 16. Standardcase definitions forepidemic prone damhealdseases ofese ba theneksinofalsestocut het Serene e sepia gt thespechayofeporing forthe managementaf patents asacite tery lanbeaincolerendemic reas cholera shouldbe pected inal patent ‘Bowe bot 2008‘The Pipe Sustainable Santaton Krieg Sros Confirmatory diagnosis of cholera and acute bloody diarrhea during routine surveillance should be performed using standardized laboratory methods. During an outbreak of an epidemic-prone diarrheal disease, specimen collection for laboratory diagnosis should be mandatory for its investigation. Stool specimens may be brought to tertiary laboratories for bacterial culture for suspected cholera cases, and stool culture as well as microscopic exami nation for dysentery (DOH, 2008) In the surveillance of epidemic- prone diartheal diseases, an intensive case- based data collection through facilty- and community-based approach is utlized, wherein cases or events detected in the community and health facilities are reported and gathered every week (DOH, 2008). DRAs are individuals who have attended an orientation on the PIDSR.DRAS may include community leaders, BHWs, and traditional healers. DRAs are expected to report information regarding notifiable diartheal diseases obtained from the community, schools, or media to a Disease Surveillance Coordinator (DSC) in a Baran- {gay Health Station (BHS) (DOH, 2008). Disease Reporting Units (ORUs) include the BHSs, government and private hospitals or clinics, government and private laboratories, as well as ports and airports. DRUs are expected to report cases of notif able diartheal diseases to the DSCs in CHO/RHU or to the Disease Surveillance Officer (050) in the City Epidemiology and Surveillance Unit (CESU) in chartered cites DRUs with local laboratory capacity can help diagnose suspected cases. Standard protocols for the collection, processing, and transport should be followed (DOH, 2008), The DSCs are health facility staff of government and non-government units in the CHOs/RHUs trained on PIDSR. DSCs are expected to consolidate, analyze, and interpret the data from the different DRUs, and to submit a report to the DSO of the Provincial Epidemiology and Surveillance Unit (PESU) every Friday of the week. The DSCs should prepare and disseminate a Weekly Notifiable Disease Report. The DSCs are also expected to the conduct the preliminary investigations on the cases reported by the DRUs (DOH, 2008). ‘The DSOs are trained physicians or nurses who are members ofthe Epidemio- logy and Surveillance Units (ESU) in of yeifvenin offices of chartered cities, provinces, and regions. The DSOs shall be responsible for the collection, analysis, and interpretation of data from DSCs-The DSOs in the CESU in chartered cities and PESU will forward reports to the DSO inthe Regional Epidemiology and Surveillance Unit (RESU), that will then report to the DOH National Epidemiology Center (NEO), DSOs will also coordinate with and give feedback to the CHO/RHU and CHD regarding control strategies for the cases (DOH, 2008), In the interpretation of surve llance data of notifiable diarrheal diseases, the current situation is compared with that of previous months or years to_assess if certain thresholds are reached. The alert threshold refers to the level of incidence that serves as an early waming for epide- mics. Attainment of the alert threshold will tigger investigations, evaluation of epidemic preparedness, and implementa- tion of prevention and control programs. The epidemic threshold refers to the level of occurrence of disease above which an Urgent response is required (DOH, 2008). For acute bloody diarrhea, the alert threshold is the increasing number of cases over a short period, and the epidemic threshold ‘is the confirmation of the suspected cases. For cholera, the alert threshold isa single suspected case and the epidemic threshold is the laboratory confir- mation of one case in an area with no previously reported cases (DOH, 2008). The aggregated report on the incidence of acute bloody diarthea and cholera from the PIDSR will be incorporated into the annual morbidity reportof the Field Health Service information System (FHSIS) of the DOH (DOH, 2008). Monitoring of rnon-epidemicprone communicable diseases, such as acute watery diarthea in areas without cholera epidemic, is part of the routine FHSIS. ‘The main indicators for the community-based control of dianthea are the total number and incidence of diantheal cases among all age groups, as well as the coverage rates of reformulated ORS and_ zinc supplement administration among children less than five years of age The computation for the incidence of diarrheal diseases at the LGU level peer 1,000 population is stated below (DOH, 20072), Number of cases of diartheal diseases X 1,000 Total population‘cssbaok ors Deets Freverton and Cont! Progam fr Sarenmited Hani econ and snhea seas Framework for the Implementation of the Disease Prevention and Control Program for STH Infections and Diarrheal Diseases The Disease Prevention and Control Program (OPCP) for STH infections and diartheal diseases is based on existing guidelines of the DOH and is generally Consistent with guidelines promoted by the WHO. The framework for the implementa- tion of the DPCP includes approaches and strategies that provide effective and efficient means of program implementation at the local level in the pursuit and attain- ment of the targets set by the DOH. The proposed approaches and strategies in this framework include some of the good practices and means o address the continu- Ing challenges of program implementation. Approaches inthe implementation of the DPCP Leuled While the DOH formulates policies and provides technical support by way of provision of training on disease prevention and control including surveillance, the LGU will ead in the implementation of the DPCP at the local level and shall spearhead the various endeavors of the DPCP, including the establishment and support of a local action committee or task force, and forging of partnerships at the local level. The LGU, in collaboration with its partners, will oversee baseline community assessment, imple- mentation of strategies for prevention and control, as well as surveillance and monito- ring, After having been capacited, the LGU will likewise spearhead capacity building, advocacy, social mobilization, and program marketing atthe local level Builds upon social values of solidarity and cooperation The DPCP builds upon the social values of solidarity and cooperation through community involvement and multisectoral collaboration. While the LGU is tasked to deliver the complete package of health services related to disease preven- tion and control as detailed in existing DOH policies and guidelines, other sectors and partners at the community evel are encour- aged to collaborate towards effective disease prevention and control. Examples of such collaborations may include LGU and education sector * Trained health staff and schoo! health staff may provide training opportuni- ties for teachers to get engaged in health education and information dissemination for the prevention and control of STH infections and diarrheal diseases. © Trained teachers may assist in anthel- minthic administration during MDA among_elementary school pupils (Figure 7). © The Parent-Teacher Association (PTA) may be tapped to help increase compliance to MDA through the conduct of PTA advocacy meetings, thereby increasing MDA coverage rates. © Optimization of the link between health and education sectors may be exemplified by the Essential Health Gare Package (EHCP) of the DepEd, Which aims to institutionalize daily supervised hand washing with soap, dally tooth brushing with fluoride toothpaste, and ‘twice a year teacher-assisted MDA among school children. The EHCP utilizes the educa- tion sector as program implementers, with direct involvement of teachers in drug distribution and administration (Monse et al, 2008). Figure 7. Schoolteachers helping in MDA inelementary students (Photo courtesy ‘of Dr. Vicente ¥.Belizario Jk)‘7 Pgens SstanaieSantaton Rowe Sane LGU health and social welfare and develop- ment sectors © Day cate workers may promote hygienic behavior including breast- feeding among mothers and could participate in the surveillance of diarrheal diseases Involvement of the day care workers may help increase MDA coverage in preschool children through informa- tion dissemination to parents and assisting in anthelminthic distribution and administration in day care centers. LGU health and environment sectors © Collaboration of the LGU health and environment sectors. may help improve access to safe water and sanitary facities. Collaboration may help promote the Zero Open Defeca- tion Program (ZODP) (Dalisay, 20102; 2010b) and improve access to safe Water and sanitary facilities LGU and BHWs © LGU may help provide training ‘opportunities for BHWs for early diagnosis, management, referral, and surveillance of STH infections and diarrheal diseases LGU and private sector © Media, socio-civie groups, and other concerned parties from the private sector may help raise awareness for prevention and control of STH infections and diarrheal diseases Partners may provide materials for awareness raising that may include billboards, streamers, posters, and leaflets. ' Opportunities to’ air messages via television and radio may be explored. Capacity building The DPCP aims to enhance the capabilities and competencies of local stakeholders, particularly the local health units, for the ‘overall implementation of strategies for disease prevention and control, including surveillance. In addition, the DepEd health staffmay be targeted for capacity building to help improve health service delivery in the school setting, which may eventually Fr wn in the reduction of the number of ‘consultations in the local health unit. The DOH plays a major role by providing oppor- tunities for capacity building of the LGU and school health staff. The LGU and partner agencies may provide counterpart funding and other support for capacity building at the local level Diagnosis © Training for medical technologists of local health units and hospitals on the laboratory diagnosis of intestinal parasitoses and diartheal diseases may be conducted in collaboration with established academic institu- tions using WHO-recommended techniques and materials. Training should ideally include quality control and quality assurance, as well as proper recording and reporting of results. '* Diagnostic laboratories should be provided with adequate supplies and equipment for the diagnosis of intestinal parasitoses. Management of diarrheal diseases ‘* Physicians and other health workers in the local health units and hospitals may be given continuing education on the diagnosis and management of diarrheal diseases, which includes rational use of diagnostic tests and antibiotics, as well as management of As associated with anthelminthics, the reformulated ORS, and. zine supplementation, ‘© Local health unit and hospital staff may be trained in the assessment and management of dehydration in diartheic patients. © Reformulated ORS and zinc supple ments should readily be available in all treatment facilities Prevention and control of STH infections and diarrheal diseases © Effective delivery of key messages on prevention and control of the target diseases is essential. Seminars on health communications focused on prevention and control measures (to‘cuisbook fra DseseFrevarton and Cot Program fr Saran Hamt Infect ond Dantes sree include proper method of drug administration and approaches on the prevention and management of AEs) may be conducted for local health unit and hospital staff, DepEd personnel, community leaders, local media practitioners, and other partners. Surveillance and monitoring (of STH infections © Local health units may be oriented and trained on WHO-recommended indicators for helminth control program monitoring (parasitologic, coverage of intervention, nutritional indicators, other morbidity indica- tors), including proper reporting of data, © Local health units and hospital staff, Depéd staff, and other partners may be trained on assessment, manage- ment, and reporting of AES. © Medical technologists should receive training on WHO-recommended laboratory techniques and on proper recording and reporting of data, Surveillance and monitoring of diartheal diseases ¢ The ESU may be strengthened through training on the PIDSR. Targeted individuals include LGU and hospital staff as well as members of the community who may serve as DRAs. Community empowerment © Community empowerment will manifest through communities that are able to: * Formulate and implement an action plan that details strategies for the prevention and control as well as surveillance and monitor- ing of STH infections and diarrheal diseases * Provide budget allocation for logistical needs and delivery of services + Ensure regular supply of anthel- minthics for MDA, reformulated ‘ORS, and zine supplements + Provide support for information, ‘education, and communication + Formulate local policies and ‘ordinances for the prevention and control as well as surveillance and monitoring of the diseases in support of national policies ‘+ Formulate an incentive scheme for outstanding communities, schools, and partners + Create the demand for prevention and control of the diseases to facilitate corresponding _ action from the national and local governments * Local organizations such as socio- civic groups could be involved in the various processes of the DPCP especially in awareness raising activi- ties. © Empowered communities have co-ownership of disease prevention and control programs, and make provisions for their sustainability. Public-private partnership ‘© Government agencies, such as DOH- NCDPC and DOH-NEC, provide techni- calassistance to LGUs and their partners. © Intemational agencies, such as the Swedish Intemational Development Cooperation Agency (SIDA). and WB-WSP provide technical assistance as wellas logistical support © Academic institutions provide technical assistance by way of capacity building and research to generate evidence for policy and planning, ‘© Nor-government organizations (NGOs) may provide support fr social mobiliza- tion as wellas research generation © Local media practitioners and other partners could help provide information and contribute to health education and marketing ofthe DPCP. Fah:‘The Phpre Sustainable Saniaton Krieg Ses Figure &. Steps in the implementation of the DPCP step Fermation faleal Action Committee orTaskForee steps: r Development and i Step2: Implementation I © community ofanAation Plan Assesment —_fortheDPCP Steps avecacy Campaign step Monitoring ‘nd vahtion Step 1: Formation of a Local Action Committee or Task Force Since a multi-sectoral approach may be useful in the implementation of disease prevention and control programs, a local action committee or task force may be formed to provide a mechanism for intersectoral coordination and collabora tion among various stakeholders. The committee may consist of representatives from the various stakeholders, including: © DOH-CHD: STH coordinator, DSO, DOH representative/DOH Provincial Health Team Leader * LGUs: Governor, Mayor, Provincial STH Coordinator, ‘Provincial/ City/Municipal Health Officer, PHN, DSOs, Health Education and Promotion Officer (HEPO), Sanitary Inspector (SI), Information Officer (10), President of the Association of Barangay Captains © DepEd: Division Superintendent, Division MO, District Supervisor, PTA Federation President * Concerned community groups: socio-civic groups, religious organi- zations, Barangay Sanitation Volun- teers + Representatives hospitals facilities of government and other treatment ‘Academe The tasks of the local action committee or task force will include the following: * Coordinate program implementation ‘and monitoring * Formulate an action plan * Define the roles and responsibilities of the stakeholders * Facilitate networking and collabora- tion among different sectors and agencies atthe local level * Review baseline and monitoring data, as well as trends of the diseases * Evaluate the implementation of the DPCP and ZODP using established parameters * Identify good practices and propose means to address challenges The Zero. Open _Defecation Program (ZODP) shares similar strategies with the DPCP, including a local action ‘committee or task force for its implementa- tion (Dalisay, 2010a; 2010b). Since a signifi- ‘cant overlap in membership exists between the local action committees for the DPCP and the ZODP. the unification of the two ‘committees is strongly recommended.Cusisaofors Done Provnton and Corel Pog or Saran Hamtn ston ana Osea Osases Step 2: Community Assessment Community assessment of the city or municipality will be done prior to program implementation. The informa- tion that will be gathered from the commu- nity assessment will help in the formulation of the action plan that will indude the delivery of the proposed strategies consis- tent with the DPCP. Data for community assessment shall include the following: Morbidity and mortality due to STH infections and diartheal diseases ‘+ Cumulative prevalence and heavy intensity infection rates of STH infections among children age one to 12 years of age lin sentinel sites) ‘+ NAT mean percentage score of school children + Nutritional status data of children age fone to 12 years of age ‘© Overall morbidity and mortality rates as well as number of hospital admi- ssions due to diarrheal diseases Procurement, quality control, and coverage of interventions (eg, anthelminthie drugs, (ORS, zinc supplements) © Supply © Procurement Delivery * Storage + Distribution © Coverage rates Health promotion and education ‘© Integration of DPCP into school ‘curriculum * Information, education, and commu- nication (IEC) materials Facilities and capability + Number of elementary schools and enrollees ‘* Number of school teachers and school nurses oriented and trained on MDA ‘+ Number of treatment facilities, inclu ding RHUs, government clinics, and hospitals ‘© Number of doctors, nurses and BHWSs trained in the MDAVselective treatment of STH infections and management of diarrheal diseases ‘+ Number of diagnostic facilities + Number of medical technologists trained in the diagnosis of intestinal parasitoses and quality assurance Community empowerment and sustai- ability + Local legislation or ordinances supporting national strategies for the prevention and control as well as surveillance and monitoring of the diseases ‘© Budget allocation for program imple- ‘mentation, capacity building, program marketing, and other activities © Community involvement ‘© Partnerships and collaborations Marketing * Activities that promote prevention and control of the diseases * Involvement of media and other partners Knowledge, attitudes, and practices of the community + Effects of STH infections and diarrheal diseases on the health of community members ‘* Transmission of STH infections and diarrheal diseases ‘* MDA for STH infections ogi‘he Phpeins SustanaieSontaton Knows Saree Step 3: Development and Implementation of an Action Plan for DPCP The action plan to be developed and implemented by the local action committee with the leadership of the LGU should include how targets and expected outputs in the major areas in disease prevention and control such as diagnosis, treatment, prevention and control, survei- liance and monitoring, as well as advocacy and resource mobilization, are going to be met by way of proposed activities, persons responsible, timelines, and resources needed (Appendices 2a and 2b). Because the DPCP is clealy related to the ZOD and other WASHED programs, it may be good to consider integrating plans forthe DPCP and ZODP To attain the goals Table 17, DPCP and ZODP: summary of activities Personnel deployment of the DOH for STH infections and diarrheal diseases, the DPCP advocates the complete package of the WASHED strategy (Evans, 2005), and additional strategies for diarrheal diseases, including treatment regimens, breastfeeding, and measles immunization (WHO, 2005). Surveillance and monitoring of the diseases are also included in the main strategies of the DPCP The objectives, strategies, and approaches of the DPCP are in line with those of the ZODP, which aims for zero open defection through the community-led total sanitation (CLTS) approach that focuses on. behavioral change communication and hygiene promotion (Dalisay, 2010a; 2010b) US brings out issue of other dseasesin the Barangay Sanitation Volunteers for house-to- house mapping and follow-up‘Step 4: Advocacy Campaign Advocacy with LGU and MOs will help heighten awareness and emphasize the importance of: + Trained medical technologists performing WHO-recommended laboratory” techniques for specific situations, including provision of support for baseline and parasitologic surveys ‘+ Mass treatment of other high isk ‘groups, including adolescent females, pregnant women, food handlers, and ‘other occupational groups ‘+ Synchronized MDA schedules for STH infections and LF in endemic areas to increase the efficiency of the program ‘+ Health personnel who have received ‘continuing education on the manage- ment of diarrheal diseases providing the recommended management for dehydration and other related compli- ‘ations of diarrheal diseases ‘* Sis doing periodic monitoring of water potabilty ‘© Sustaining CLTS to achieve zero open defecation ‘© Measles vaccination as part of the Expanded Program on Immunization (EP) in support of the prevention of diarrheal diseases Advocacy with LGU and school officials as well as health staff willlead to: * Integration of DPCP ‘curriculum into school * Education campaigns on key hygienic behaviors * Physical environment in schools that support the DPCP through provision of adequate sanitary and water facilities * High MDA coverage in school children + Treatment of out-of-school youth (OSY) through instructors of the DepEd Alternative Learning Scheme (ats) ‘© DepEd being involved in baseline and follow-up parasitologic surveys ‘Advocacy with LGU and the Social Welfare and Development Office and the Social Welfare Officer will result in: * Treatment of preschool children through day care workers supervised by local health unit staff ‘+ Treatment of OSY, including street children Advocacy with LGUs and collabo- rators, and potential partners at the community level will lead to: * Participation of collaborators and partners in the local action committee or task force performing. specific assigned roles and responsibilties ina¥in the delivery of strategies forthe DPCPStep 5: Marketing Marketing of the DPCP involves information dissemination and increased exposure of the program to the members of the community, collaborators, and potential partners to increase awareness on and encourage participation in the DPCP. Marketing will be done primarily through the initiatives of the LGU in collaboration with its partners through creative and innovative means. Technical support from the DOH and academe may help ensure success of marketing efforts ~ Rwaage Figure 9. Then DOH Secretary Francisco Duque and Antique Governor Salvacion Perez administe- ring anthelminthcs to students of Pandan Central Schoo! in Antique during the launching of War on Worms ~ Western Visayas (The Philippine Star, 2007} Examples of marketing strategies include the following: *Adedlarationyby the local chief execu- tive that DPCP is priortized and supported by provision of enabling ‘means (Figure 8). + TheDPCPis launched through a public event (Figure 9). ‘Tre PipiceSustaabe Sandan Kates Saez * The local chief executive declares the dates for the awareness campaign and actual strategy implementation eg, “Diarrheal Diseases Awareness Day’, “MDA Day" orSanitation Day Celebra tion’ fora whole administrative unit. * Contests on slogan, poster and jingle-making are conducted in collaboration with partners (eg Deped). ‘To promote the complete package of the DPCP, marketing of the prevention and control strategies for STH infections and diartheal diseases may also be integrated in the marketing of other related strategies such as "Sanifairs’ of the ZODP (Dalisay, 20102; 2010b), marketing of GP every April ‘and October (DOH, 2006a), and the market- ing of the Nutrition Program during Nutvition Month in July. Figure 10. Parade of school children and teachers during thelaunching of War on Worms Bihan, Laguna (Photo courtesy ofDr. Vicente ¥. Belizario, J)‘Step 6: Monitoring and Evaluation The local action committee will oversee the conduct of monitoring and evaluation using established parameters described in the section on surveillance and monitoring, The actual conduct of monito- ring and evaluation activities ideally is done in collaboration with the DOH, DepEd, and other partners that may indude’ the academe. Results should be presented and discussed in regular local action committee ANNEXES. meetings where good practices will be recognized and challenges will be tackled to help ensure that these are managed towards more favorable outputs and ‘outcomes. Monitoring and evaluation data may also be shared with other LGUs in regional and national forums such as program implementation reviews (PIRS). Annex A. Parasitologic diagnosis of STH infections and other parasitic diseases Direct Fecal Smear The direct fecal smear (DFS) is primarily used in the detection of motile protozoan trophozoites. A DFS should Contain approximately 2 mg of stool for the detection of helminth eggs. The stool sample is comminuted thoroughly with drop of 0.85% sodium chloride solution and coveted with a cover slip. Because the stool sample is small light infections may not be detected (WHO, 1994). Kato Thick Method The Kato Thick method is useful inthe detection of STH infections. The Kato Thickmethod makes use of 50 to 60mg of, stool placed over a glass slide and covered with cut cellophane paper soaked in a mixture of glycerine and malachite green solution, Usefulness is limited in watery stools and in the detection of protozoan cysts and trophozoites (WHO, 1994). Kato-Katz technique The Kato-Katz technique or the Cellophane Covered Thick Smear enables the quantitative diagnosis of STH infections. In this procedure, the stool sample is sieved through a wire mesh and pressed under a cellophane paper soaked in glycerine- malachite green solution. A uniform amount of stool is examined through the Use of a template with a uniform-sized hole in the middle. All eggs are counted in the whole preparation, and the total egg count is multiplied by a factor depending on the amount of the stool sample (multiply a 50, img template by 20, 41.7 mg template by 24, and a 20 mg template by 50). Kato-Katz is Useful forassessing the intensity of helminth infections (Table 2). Drier stool specimens yield higher egg counts than moist ones ‘The technique can only be done on fresh formed stools (WHO, 1994), Formalin ether/ethyl acetate concentration technique Formalin ether/ethyl acetate concentration technique (FECT) has high sensitivity for the detection of protozoan ‘gysts and helminth eggs. FECT allows microscopic examination of one to 15 grams of feces. The technique makes use of 310% formalin, which serves as an all purpose fixative, and ether, which dissolves neutral fats in the stool (WHO, 1994). HiteAnnex B. Reporting of results of parasitologic assessment Table 1. Reporting of cumulative prevalence and heavy intensity STH infections at the school district level (parasitologic assessment for basoline and follow: up surveys) Woderate-heavy Number Positive for STH intensity Schools examined Infections Number (4) Number (4) School ‘School? ‘School 3 ‘School 4 School 5 TOTAL Table 2. Reporting of prevalence and heavy intensity infection rate per species at the sae vmoar | 2222, | iaminonay | Moseteneer ‘Schools examined | Trichuris or | SPecies infection | «oie infection rent Number (%) Number (%) Number (%) Table 3. Reporting of cumulative prevalence and heavy intensity STH infections at the Number (*%) Number (%) PathTable 4, Reporting of prevalence and heavy intensity infection rate per species at the ‘schoo! division level (parasitologic assessment for baseline and follow-up surveys) Poatve Tor Moderate-neavy umber | ¢2208% | uantintensiy | "°Stensty senosi ois | ume, | lAsca | patos iacton | pales rookworm) Number (%) Number (%) Number (%) Dart Distt TOTAL Table 5. Reporting of MDA coverage rates in school-age children per class For the period: Region: Province: City/Mdunicipality ‘Service outlet: Schoo! Section: Prepared by MDA Accomplishment Report Instruction: To be filed up by school teachers Name of student With parent consent Directly observed drug ‘administration Student A ‘Student B Student C Student D ‘Student E ‘Student F (complete class list) Total Yay’Annex B. Reporting of results of parasitologic assessment Table 6. Reporting of MDA coverage rates in school-age children per section MDA Accomplishment Report For the period Instruction: To be filed up by grade level coordinator Region: Province: City/Municipaliy Service outlet: School Grade: Propared by Section Target population] _ Total number of children treated Treatment coverage (@ of children. treated) Section 1 ‘Section? ‘Section ‘Section 4 ‘Section 5 Total Table 7. Reporting of MDA coverage rates in school-age children per grade MDA Accomplishment Report For the period Instruction: To be filed up by principal or clinic teacher Region: Province: City/Municipaity Service outlet: School Schoo Prepared bj ‘School Target population] Total number of children treated "Treatment coverage (26 of children treated) Grade Grade 2 Grade 3 Grado 4 Grades Grade 6 Total PyeTable 8. Reporting of MDA coverage rates in school-age children per school MDA Accomplishment Report For the period: Instruction: To be filed up by DepEd PHN. Region: Province: Gity/Municipality Service outlet: School District Propared by: ‘School grade Target population] Total number of children treated Treatment coverage (9 of children ‘teated) ‘School t ‘School 2 ‘Schoo! 3 ‘School 4 ‘Schoo! 5 Total Table 9. Reporting of MDA coverage rates in school-age children per district MDA Accomplishment Report For the period: Instruction: To be filed up by DepEd MO/PHN Region: Province: ity/Municipality Service outlet: School Division Propared by: ‘School grade Target population | Total number of children treated Treatment coverage (% of children treated) District District 2 District 3 District 4 District 5 Total KayAnnex B. Reporting of results of parasitologic assessment ‘Table 10. Reporting of MDA coverage rates in Garantisadong Pambata MDA Accomplishment Report For the period: Instruction: To be filed up by CHO/RHU PHN/RHM. Region: Province: City/Municipality Service outlet: Community Prepared by Barangay Target population] Total number af children treated Treatment coverage (6 of children treated) Barangay Barangay Barangay i 2 Barangay 3 4 5 Barangay Total ‘Table 11. Reporting of MDA coverage rates in LF-endemic areas MDA Accomplishment Report For the period Instruction: To be filed up by CHO/RHU PHN/RHM. Region: Province: CityiMunicipalty Service outlet: Community Prepared by Barangay Target population Tolal number of persons treated Treatment coverage (2 of target population treated) Barangay 1 Barangay 2 Barangay 3 Barangay 4 Barangay 5 Total PeakeTable 12. Reporting of treatment coverage rates in target populations in health facilities MDA Accomplishment Report For the period: Instruction: To be filed up by CHO/RHU PHN/RHM Region: Province: CityMunieipaly Service outlet: RHU/Barangay Health Center Prepared by “Target populaiion ] Target population | Tolal number Weated | Trealment coverage (%) ‘Adolescent females Pregnant women. Food handlers ‘Other groups Total Table 13. Reporting adverse events with MDA “Adverse Events Reporting Form For the period: Instruction: To be filed up by CHO/RHU Region: Province: Municipaity Service outlet Prepared by: Name of patient [Age | Complete address | Chiet complaint and date of | Action onset taken Key'sAnnex C1. Reporting for surveillance for acute bloody diarthea Region: Hespial Lbsie Doaponinipor Province Case Report Form Acute Bloody Diarrhea Municipality: ‘Type: LRM Loto Disovr Hespaat Cbrivate Drovate aboratory C1Public Laboratory Note: atorston cutie of ols may 9 ures to corte pase cures of specie darhes. sch as. antaraetype I, bit sna acess fr ease Cae Clasatiton: Not sponse aurea DOW, POORAnnex C2, Reporting for surveillance for cholera Case Report Form Cholera (ICD 10 Code: A00) re RD ‘hype: Lind LBHO Dov Hospital Chrvate nade: iva Laboratory Crab Laboratory Deapor sunpectgcane: vee roti cae Iman monn nao opdome:a ors wth ate wary aaa wth or Laboratory contemation:golaion Vi cholerae 090199 wroteon fromsoale any pation win lea (Source: BOR, ZO08y HiteAnnex D. Sample program for continuing education and advocacy Sustainable Sanitation in East Asia - Philippines. ‘Seminar-Workshop on the Prevention and Control of STH Infections and Diartheal Diseases (Venue) (Date) Objectives 1.To review the current status of STH infections and diarrheal diseases in the Philippines and the SUSEA sites 2.To discuss updates on diagnosis, treatment, prevention, and control of STH infections ‘and diartheal diseases 3.To discuss surveillance and monitoring of STH infections and diarrheal diseases 4.To formulate an action plan for the control, surveillance, and monitoring of STH infections and diarrheal diseases in the SuSEA sites DAY 800-830 Registration 830-900 Welcome Introduction of participants Expectations and rationale of seminar-workshop 9:00-10:00 _SOIL-TRANSMITTED HELMINTH INFECTIONS Status in the Philippines and in the SuSEA sites 1000-1030 Break 1030-11330 Diagnosis and treatment Prevention and control 1130-1230 Models for control Surveillance and monitoring 1230-130 Lunch break 130-230 DIARRHEAL DISEASES ‘Status in the Philippines and in SUSEA sites 230-330 Diagnosis and treatment Prevention and control 330-400 Surveillance and monitoring Working break 4:00-7:00 WORKSHOP: Formulating an Action Plan Cocktails DAY2 7.00 Breakfast 800-830 ‘Management of Leaming 830-10:00 Presentation of Action Plan for Dagupan City Open forum 10:00-1030 Break 10:30-1200 Presentation of Action Plan for Guiuan Open forum 1200-1230 Summary and next steps 1230 Closing Remarks Participants Local Government Unit ity Health Officer Public Health Nurse Rural Health Midwife Rural Sanitary Inspector Department of Education Division Superintendent Medical OfficerAnnex D1 - Sample action plan for prevention and control STH infections ‘SUSTAINABLE SANITATION IN EAST ASIA - PHILIPPINES Seminar-Workshop on the Prevention and Control of STH Infections and Diarrheal Diseases (Venue) (Date) ACTION PLAN FOR PREVENTION AND CONTROL OF STH INFECTIONS. EXPECTED RCTITES ERSONS TE cost ourPuT RESPONSIBLE FRAME —{inPhilippine pesos) DIAGNOSIS Gually assurance 1. Taingfoveshar —_UPYENI August 72 50}000 and conioriy with course for medical 13,2010 WHO and DOH" fachnoogists on OFS, Standards inthe Kato Thek method, Kate agnosis of STH Kate metnod, FECT Proper use of Z.Estabshmont and Dope MO August 15, = tweniques of Strongihening of referal andhoads of 2010, parasio‘gie networe or paresioogic local haath Siagnoss in iagnoss by DopES wih unis festalishing baseline cal health units andmonterng, 3, Stietimplementaon Stand vamwary lamong eed handlers of DOH AO 2006-0001 medical 2011 (FECT or stocl exam of technologists {god handlers TREATMENT —Redustonafthe 1 Regular mvantory at Suppy___Manihiyer > rovaence rate af albendazole’mabendazole Ofcetsol as noaded STHiniectonste interns of quantty and. Des less than 30% and qually (no aflensva”—CHORHU ‘moderate to neavy adr) Intensity intectons to 0% porcont Information campaign CIO, HEPO August 1, 20,000 on be salty and eficacy 2or0 Sustained 85% MOA of albendazole! and ‘overage among mebendazole to heath Coward Proschocland” —_warkers and patents Eenool enldren 3. Coordination of Dep DWsion BY EDO. = Wwitsthe LGUtrough the Supernton- August 2010, CHOU tora possible dent, Mayor ‘memorandum of ‘roorond Undorstanding on MOA, inclu protocols for handling of adverseAnnex D2- Sample action plan for prevention and control STH infections ‘SUSTAINABLE SANITATION IN EAST ASIA - PHILIPPINES ‘Seminar-Workshop on the Prevention and Control of STH Infections and Diarrheal Diseases (Venue) (Date) ACTION PLAN FOR PREVENTION AND CONTROL OF STH INFECTIONS —SSxPECTED —aeTIVITIES PERSONS —__—TimwE_—cosT ourput PREVENTION Reduction of 1, Period and requar AND STH morbty manioring of water CONTROL — by 25% By EO potatity 2010 and 50% byEO2013 2. Song advocacy for (Local Sustai- zero open defecaton in able Sanitation the community ough Pran) cuts Insttutonalize 3, Integration of WASHED appropiate information framework for on pravention and comprehensive contol of inestinal control and helminthasis in schoo prevention curieulum (Serene ‘and Health) withthe ‘emphasis on behavoral ‘change ang proper hygienic practices 4, Supportive physical fevironment or hand washing, use of sanitary tolets, onthuous use of foot 5. Formulation and dissomiation of kay hygiene messages in Iocal cialec rough posters, advisories, tarpaulins, bilboards 6. Implementation of sanitary laws and ordinances trough issuance of sanitary permits to fooa bstablshments and school canteens 7. Rega mass denen age pods crrcnaton ih cswo and Dopo Cisse csv teas AS ene progam or ¥ orostencres PERSONS RESPONSIBLE a core clTS, Teams Depa Doped CHOIHU, CIO CHOMRHU, SI cSWo, Denes, CHOIRHU TNE FRAME Nort andlor needed On-going September 200 onwards September 200 onwards September 2010 onwards August 1, 20%0 onwards August 1 200 onwards cost (ia Phitippine 40,000 20,000 20,000 30,000 100,000Annex D2 - Sample action plan for prevention and control STH infections ‘SUSTAINABLE SANITATION IN EAST ASIA - PHILIPPINES Seminar-Workshop on the Prevention and Control of STH Infections ‘and Diartheal Diseases (Venue) (Date) ACTION PLAN FOR PREVENTION AND CONTROL OF STH INFECTIONS EXPECTED ourpuT ‘SURVEILLANCE Determination AND ot provalonce MONITORING rate of STH infections (one in December 2007) ‘ADVOCACY increasing RESOURCE awareness on MOBILIZATION prevention and onto! of STH Infections with corresponding funding allocation for ‘Source: Dagupan LGU, 2070) ‘RETWTIES 1 Eaabishment of data bank of pro fshooles and shoo ere, Including OS 2. Followup parasiologeal suveys, 3, Form a Technical ‘Commitee to come win a mentoring {and evaluaton checkist *. Kenbfeation oT launching day of local equivalent ot War on Worms 2.16C and advocacy Ceampaigns during meetings ofthe coeal Healt Bosra, Local Schoo! Board ang PTA 2. Timedia ‘campaign (orn, rao, TV) on STH Infections, anc prevention a wo fs contol 4, Lobbying for resources (nancial In kina’ manpower) ‘tom local NGOs 5. Mentiicaton of ‘acai Champion and recommensston fr ‘SP Resolution! ‘Ordinance wth funding allocation rogarding ‘STH eradeaton PERSONS RESPONSIBLE THORAU, Denes MO, Executive ‘Assistant on Heath Concerns of Mayor Donk as oad agency (CHO, Depés cio cu, SuseA wa Leu, suseA wa TE FRAME August 2010 onwards Docombar 2010 Cctobor, 2010 August 2010 onwards August 1 2010 and onwards August, 45,2010 onwards August 15, 2010 Completed by he end ot Dee. 2010 cost in Phitippine 30,000 30,000 20,000 30000 20,000 20,000 KayeAnnex D2- Sample action plan for prevention and control rrheal diseases SUSTAINABLE SANITATION IN EAST ASIA - PHILIPPINES ‘Seminat-Workshop on the Prevention and Control of STH Infections and Diartheal Diseases (Venue) (Date) ACTION PLAN FOR PREVENTION AND CONTROL OF STH INFECTIONS EXPECTED oureur DIAGNOSIS Reduction at morality fom bartoal dioase Undesirable eects thypartonety Reduction of duration of acute and persistont dares Reduction in and death in Perssont Gannon PREVENTION Reduction nt CONTROL —morbcity and moray fom areal diseases yee ACTNITIES 1. Oratation andre centaton of health tare workers onthe fssesement ot donysratonsiagnosis land atonal use of agnosie tests 7 Ofienlaion and orientation of Pealth workers on use of Felormulated ORS fd ine Suppiomentation kn dares case management 2. Procurement et Fetormulatos ORS {and zine supplements ‘wih prritzaton for those who eannot ators 8. Ragular inventory 91 ORS, zine Supplements and fantbotes for food and wator bore regular montoring ot watorpotabity 2, Ofenlation onthe © Golden as 0 sa food preparation 3. rong advoceay for 2ar0 open defection Ine commurty through CLTS, PERSON RESPONSIBLE Diarheal Coordinator COD Coordinator Cty Hoan Otcor ‘Supp Offcer HEPO cLTs core TNE FRAME agua cnwards of August Staring S* quarter of Bow Monthy ands needed Fiat cot August onwards ongoing cost (in 000 10,000EXPECTED ourur RETNTES Siferent preventive niowentons 63. ‘cary an exclusive brenstoeding, ‘Ssoquat clean proved Yoedg fans food nanding practices, moasios Viamin & _supplomeontaion 6. Intograte armoa provertion and ont in school turicuum (Seine “SURVEILLANCE Appropiats ana AND imely response MONITORING — teoutenke, +. Oretaton oT the Barangay ana ‘epering unis on Pips 2 Updated mobi and mally data tom FHSIS on important (cholera pho, ‘ysentary, nepais PERSONS TIME RESPONSIBLE FRAME Taga eves Sestomber, 2010 onwards TEST ‘Sasi Fisis ‘ongaing RESUMEMS November, 2010 cost fn Philipp 20,000 20,000 reporting » 2. Training on pore roparodess, response and ‘ROVOCAGY! —hereased Tred RESOURCE awarenesson campaign MOBILIZATION. iarrhea Brovaton and, Stuatoner or 2 Dept Academic Oiympes on posteogan IEC and advocacy campaigns during \oealSehoo! Board (Sours Dagupan TEU, ZOTOy co Ragas 5, Chom epes ctaber, 2010 oped 30.00 10.000Annex E. Sample program for the training of medical technologists on the laboratory diagnosis of STH infections and diartheal diseases Sustainable Sanitation in East Asia - Philippines Diagnosis of Intestinal Parasitoses for Medical Technologists, (Wenuie) (Date) Objectives 1.To describe the epidemiology and control of intestinal parasitoses in the Philippines 2.To discuss appropriate diagnostic techniques for intestinal parasitoses 3.To perform standard stool examination for diagnosis and surveillance of STH infections 4.To discuss surveillance and monitoring of STH infections in the community DAY! 8:00-830 Registration 8:30-9:00 Pre-test (theoretical and practical) 9:00-10:00 Welcome Introduction of participants Epidemiology and control of intestinal parasitoses in the Philippines 10:00-1030 Break 10330-1200 Diagnosis of intestinal helminth infections, 12:00-1:00 Lunch break 100-230 Diagnosis of intestinal protozoan infections 230-300 Break 3:00-5:00 Laboratory work: intestinal helminths DAY2 8:00-10:00 Laboratory work: intestinal protozoans 10:00-12:00 Surveillance and monitoring of STH infections in the community 12:00-1:00 Lunch break 1:00-3:00 Practice laboratory unknown 3:00-4:30 Post-test (theoretical and practical) 430-5:00 Feedback and closing remarks Awarding of certificates Participants Medical Technologists from: Center for Health Development Provincial Health Office ity Health Office, Rural Health Unit Regional / Provincial / City Hospitals Pye‘cusssnok ors sane Provanton and Conte Pog for So.trensitedHamitnIfacton and Dara Deas REFERENCES Allen Het al. (2002) New policies for using anthelm: inthcs in high risk groups. Trends in Parasitology, 18:38)-382, Belzario V, Amarilo M, Mataverde C (2006) School-based contro! of intestinal helminthiasis: parastologic assessment and monitoring. The Philippine Journal of Microbiology and Infectious Diseases, 35 (5) Belizario V, de Leon W Lumampao ¥, Anastacio M, Tai C " (2009) “Sentinel Surveilance of SoilTransmitted Helminthiasis in Selected Local Govemment Units in the Philippines. Asia Pacific Journal of Public Health, 21(1:26-42. Belizario V, TotanesF Tulio A, et al (2010) Sentinel surveillance of soll-ransmitted helminthasis in preschool-age and school-age children in selected Jocal government unitsin the Philippines: follow-up assessment. Final report submitted to UNICEF Belzario V, Totanes F; de Leon W, et al. (2010) Soiltransmitted helminth and other intestinal parasitic infections among school children in ‘indigenous people communities in Davao. del Norte Philippines Finalreport submitted to WHO, Belzario V, Totanes f, de Leon W, et al (2010) Baseline and follow-up parasitologic and morbidity ‘assessment for the mebendazole donation in ‘Aklan, Antique and Capizin Wester Visayas. Final ‘epot submited to Johnson & Johson/ansen amaceutica Berhe N, Gundersen 5, Abebe f Binie H, Medhin G, Gemetchu T (1999) Praziquantel sie effects and ‘efficacy related to Schistosoma mansoni egg loads ‘and morbidity in primary schoo! children in nort- ‘east Ethiopia. Acta Topica, 72(1)53-63. Bethony J, Brooker $, Albonico M, et al (2006) Soiktransmitted helminth infections: ascariass, trichurasis and hookworm. Lancet. 3067: 1521-32 Black R Moris 5, Bryce J (2003) Where and why are 10 milion children dying every year? Lancet. 361: 2226-2234. ‘Chenghua’,Min-Ho Young MB, Gui Shuhua W, SungeTae H (2007) A case of anaphylactic reactions topraziquantel treatment. Am4 Trop Med Hyg, 76 603 Curtis V, Caimeross $ (2003) Effect of washing hands with soap on diarrhoea risk in the comms nity: a systematic review. The Lancet Infectious Diseases, 3:275-281, Dalisay $ (2010a) Zero Open Defecation Program for Dagupan. Final report to be submitted 0 Department of Health - Environmental and Occupational Health Office and Department of Environment and Natural Resources. Daalisay $ (20106) Zero Open Defecation Program for Guluan. Final report to be submitted to Depart ‘ment of Health Environmental and Occupational Health Office and Department of Environment and ‘Natural Resources. ‘DeLeon W,Lumampao ¥ (2005) Nationwide Survey ‘of Intestinal Parasitosis in Preschool children. Final report submitted to UNICEF. Department of Health (1993) Circular 179s, 1993, Policies and Guidelines for the National Control of Diarrheal Disease Program. Department of Health (1997) Administrative Order 29:4, 1997, Creation of the Food and Waterborne Disease Prevention and Control Program. Department of Health (1998) Guidelines in the implementation of the National Filarisis Blmina- tion Program. Department of Health (1998) Administrative Order 25s, 1998 The National Filariass. Control Program: strategy shift from Flariasis Contr tothe Elimination ofFilarass, Department of Health (2005) National Objectives of Health Philppines 2005-2010, Department of Heath (2006a) integrated Helminth Control Program: mass treatment guide, concep: tual framework, 2006-2010 strategic plan Department of Health (20066) Administrative Order 2006-0001. Operational guidelines for arasitologic screening offood handlers. Department ofHealth (2006c} Administrative Order 2006-0028. Strategic and operational framework for establishing Integrated Helminth Control Program (HCP) Department of Health (2007a) Administrative Onder 2007-0045. Zinc supplementation and reformulated oral rehydration salt in the manage- ‘ment of diarhea among chien. Department of Health (20076) Administrative Order 2007-0036 Guidelines on the Philippine Integrated Surveillance and Response (PIDSR) Framework Department of Health (2008) Manual ofprocedures for the Philippines integrated Diseases Surveilance ‘and Response. 1st edition. Department of Health (2009) Administrative Order 2009-0013, Declaring the month ofJly every year ‘as the mass treatment and awareness month for schistosomiasis in the established endemic areasin the Philppines. Department of Health (2010) Administrative Order eyehe Phpins Sst REFERENCES 2010-0021. Sustainable sanitation as a national poly and a national priority program of the ‘Department of Health (DOH). Dodoo A, Ade Couper M, Hugman B, Edwards R (2007) When rumours derail amass deworming ‘exercise. Lancet, 370: 465-466. Duggan G Fontaine O, Pierce N, et al. (2004) Scientific Rationale for a Change in the Compos: tion of Oral Rehydration Solution, Joumal of the ‘American Medical Associaton, 291:2628-31. Evans 8 (2005) Securing Sanitation: the Compeling Case to Address the Crisis Stockholm International Wiaterintcute in collaboration with World Health Organization. Friedman J, Kanzaria H, McGarvey 5 (2005) Hurman ‘schistosomiasis and anemia: the relationship and potential mechanisms. Trends in Parasitology, 21:385-392, Getachew 5S, Gebre-MichaelT, Eko 8, Balkew M, ‘Medhin G (2007) Nor-biting ‘cyclorbaphan flies (Diptera) as carers ofintestinal hurnan parasites in slum areas of Addis Ababa, Ethiopia. Acta Tropica 103:786-94 Gulani A, Nagpal J, Osmond C Sachdev H (2007) Effect of administration of intestinal anthelmintic ‘drugs on haemoglobin: systematic review of randomised controled tial. Britsh Medical Journal 334: 1095-1095 Hahn 5, Kim ¥, Gamer P (2001) Reduced osmolarity ‘oral rehydration solution for treating dehydration ‘due {0 diarrhoea in children: systematic review. British Medical Journal. 323381-5. Hall A, Hevite G, Tutfey V, de Siva N. (2008) A review and meta-analysis of the impact of intestinal worms on child growth and nutrition. ‘Maternal Child Nutrition 4 Suppl 1:118-236. Hotez P Fenwick A, Savill L, Molynewx D (2009) Rescuing the bottom bilion through the control of neglected tropical diseases. The Lancet 373: 1570-75, Jaoko W, Muchemi G, Oguya F (1996) Praziquantel Side effects during’ treatment of Schistosoma ‘mansoni infected pupils in Kibwez, Kenya. East Afr Med 4.73 (8499-501 Keiser J, Utzinger J (2008) Efficacy of current drugs ‘against soiltransmitted helminth infections Systematic. review and meta-analysis. JAMA 299:1937-1948. Mathes Ezza M, Lopez AD (2007) Measuring the Burden of Neglected ropa Oseases: The Gobal Burden of Disease Framework, PLOS Neg Top Dis 12 e114. re sae 10.137 Yfoumalpnt00001 14 ‘Matsumoto J(2002) Adverse effects of praziquantel treatment of Schistosoma japonicum infection: Involvement of host anaphylactic reactions Induced by parasite antigen release. int J Parasitol. 32/42461-71. ‘Mehta D, Ryan R, HogerzellH, eds. (2004) WHO ‘Model Formulary 2064. Geneva, World Health Organization ‘Mohanimed K, Hal, Gabriel A, Mubila Biswas Geta. (2008) Triple Co-Administration of vermec- tin, Albendazole and Praziquantel in Zanzibar: A Safety Study. PLoS Negl Trop Dis. 2(1): e171 {401:10.1371/journalpnte.0000171. ‘Montressor A, Ramsan M, Chwaya H, et al. (2001) Extending anthelminthic coverage to.non-enrolled school children using a simple and low-cost ‘method. Trop Med int Heath, 6:535-537, ‘Monse B, Naliponguit E, Belizario V, et al. (2008) Essential health care package for children the Fit for Schoo! program nthe Philipines ‘Monzon RB, Sanchez AR, Tadiaman BM, Najos OA, Valencia EG, de Rueda RR. A comparison of the role ‘of Musca domestica (Linnaeus) and Chrysomya ‘megacephala (Fabricius) as mechanical vectors of, helminthic parasites in a@ typical slum area of ‘Metropolitan Manila, Southeast Asian J Trop Med Public Health, 1991,22222.8, Nosenas JS, Santos AR Jt, Blas Bl, et al. (1984) Experiences with Praziquantel against Schistosoma Japonicum infection in the Philppines. Southeast ‘Asian J Trop Med Public Health. 15(4):489-97 [Nash T (1982) Treatment of Schistosoma mekongi with praziquantel. A double blind study. American Journal of Topical Medicine and Hygiene. 31: 977 (Olds G (2003) Administration of praziquantel to pregnant and lactating women. Acta Tropica 86:185-195, russ, Kay D,Fewtrelll, Bartram J(2002) Estimat- ing the burden of dsease from water, sanitation, ‘and hygiene at the global level. Environmental Health Perspectives. 110;$37-542. Sazavral§, Malik Jala, Krebs N, Bhan M, Black R (2004) Zinc supplementation for four months does not affect plasma copper concentration in infants. ‘Acta Paediatrica 93(5}599-602, Taylor, Pillai G KvaksvigJ(1995) Targeted chemo: therapy for parasite infestations. in rural black pre-schoo! children, South African Medical Journal 35:870-874, United Nation’ Children Fund and World Health Organization (2001) Reduced osmolarity oral rebiydration salts (ORS) formulation -A report from‘cussbaok ors Deane Provanton and Contel Pog for Sates Hamitn faction and Dara Oaeasee REFERENCES ‘a meeting of experts jointly organised by UNICEF ‘and WHO- UNICEF House, New York, USA World Bank - Water and Sanitation Program ~ East ‘Asia and the Pacific (2008) Economic Impacts of ‘Sanitation in the Philippines. A five-country study ‘conducted in Cambodia, Indonesia, LAO PDR, the Philippines and Vietnam under the Economics of Sanitation ritiative (5). Wiorld Health Organization (1990) The Rational Use ‘of Drugs in the Management of Acute Diarrhoea in. Children. Geneva, Switzerland, World Health Organization (1993) The Selection of Fluids and Food for Home Therapy to Prevent Dehydration from Diarrhoea: Guidelines for Developing a National Policy. WHO document WHO/cDB/93.44, Wold Health Organization (1994) Bench Aids for the diagnosis of intestinal parasites. World Health Organization, Geneva, World Health Organization (1996) Report of the WHO informal consultation on the use of chemo- therapy for the control of morbidity due to soiktransmitted nematodes in humans, Geneva, ‘Switzerland, World Health Organization (1998) Guidelines for the Evaluation of Soil transmitted Helminthiass ‘ahd Schistosomiasis at Community Level, Geneva, ‘Switzerland, World Health Organization (20020) Report of the WHO informal consultation on the use of praziquantel during pregnancy/lactation and ‘albendazoleymebendazole in children under 24 ‘months. World Health Organization (20026) Helminth

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