Chapter 1 The Provincial Health Situation introduction




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Figure 14: Province of Cagayan, Malaria cases, 2003-2007



Figure 15: Province of Cagayan, Malaria Deaths, 2003-2007



INTENSIFIED DISEASE PREVENTION AND CONTROL

Tuberculosis: TB is not among the ten leading causes of morbidity. However, it ranked 9th in the ten leading causes of mortality and therefore it remains a public health threat. All municipalities in the province are implementing the National TB control through the internationally endorsed strategy known as DOTS (Directly observed treatment short course). Under this strategic package are case detection through quality sputum microscopy and patient treatment through “Tutok Gamutan” are strictly observed.

Despite the implementation of DOTS, the Province has only attained a 65% case detection rate which is below the benchmark of 70%. The cure rate of 87% however, is slightly above the national benchmark of 85%.



There are municipalities that are considered priorities for TB control because of low Case Detection Rate and low cure rate, these are: Baggao, Gattaran and Lasam. However, there are also municipalities that have high CDR but very low cure rate: Sta. Praxedes, Amulung, and Solana.

Figure 16: Province of Cagayan, TB Case Detection Rate and Cure Rate (2005-2007)

STI-HIV/AIDS: The efforts of the Province in the control of STI-HIV/AIDS are concentrated in two localities, the municipality of Aparri in northern Cagayan and in Tuguegarao City. These two localities are commercial centers and as such they have a very active night life. Night spots and videoke bars have been attracting men and women of all ages either as customers or workers. Potentially this can be a breeding ground for all kinds of sexually transmitted diseases. Efforts in these two localities include the regulation and close monitoring of the operations of entertainment houses. All Entertainment Establishment Workers (EEWs) are required to subject themselves to routine physical and diagnostic examinations. At least four times a month, the MHO examines them for gonorrhea and other types of STDs. IEC activities are also regularly conducted. Target audience is students, gays and lesbians and other vulnerable groups. When the aforementioned interventions were introduced, the number of gonorrhea and cervicitis cases has since been steadily dropping. There are two social hygiene clinics in Cagayan: one in Aparri and another one in Tuguegarao City. The AIDS Council has been organized in the provincial as well as in the municipal level.

Dengue: From 2002 to 2007, there was an decreasing trend in the dengue morbidity while number of deaths was increasing. In the year 2007 alone, there were 921 reported dengue cases and 12 deaths or a fatality rate of 1.30%. Majority of cases are school children from urbanized areas of the province such as Tuguegarao, Solana, Tuao and Peñablanca. Despite efforts of all sectors in advocating environmental manipulation to prevent dengue, increase in number of cases is still to be expected in the future.

Table 8: Province of Cagayan, Number of Dengue Cases, Deaths and Case Fatality Rate (2003-2007)

Year

Cases

Death

Case Fatality Rate

2003

1644

5

0.30

2004

333

1

0.30

2005

562

9

1.60

2006

854

12

1.40

2007

921

12

1.30

Figure 17: Province of Cagayan, Dengue Cases, 2003-2007


Figure 18: Province of Cagayan, Dengue Deaths, 2003-2007



CHILD HEALTH

Fully Immunized Children: There were no cases of measles for the last three years. For the year 2007, the FIC coverage of the whole province was 86% using projected targets. This is below the DOH benchmark which is 95%. Issues were noted by health workers regarding the use of 3% in computing projected target clients in FIC. There is a big discrepancy between projected target clients and actual target population during Vaccination activities and “Knock out Tigdas” campaign.
Figure 19: Province of Cagayan, Fully Immunized Children, 2005-2007


Table 9: Province of Cagayan, Fully Immunized Children (FIC), 2007

MUNICIPALITY

ELIG. POP. 0.027

FIC

NO.

%

ABULUG

609

798

100

ALCALA

1077

929

86

ALLACAPAN

796

741

93

AMULUNG

1228

853

69

APARRI I

1078

998

92

APARRI II

580

849

100

BAGGAO

2033

2017

99

BALLESTEROS

787

946

100

BUGUEY

789

683

86

CALAYAN

422

393

93

CAMALANIUGAN

624

422

67

CLAVERIA

740

521

70

ENRILE

905

587

64

GATTARAN

1411

1225

86

GONZAGA

936

755

80

IGUIG

592

452

76

LALLO

1034

701

67

LASAM

1019

758

74

PAMPLONA

591

524

88

PEÑABLANCA

1138

821

72

PIAT

462

316

68

RIZAL

434

249

57

SANCHEZ MIRA

563

421

74

STA. ANA

674

557

82

STA. PRAXEDES

87

68

78

STA. TERESITA

730

589

80

STO. NIÑO

2127

1586

74

SOLANA

397

352

88

TUAO I

962

852

80

TUAO II

728

404

55

CVMC




653




CAGAYAN

25553

22020

86.11

Figure 20: Province of Cagayan, Fully Immunized Children (FIC) per Municipality, Year 2007



Micronutrient Supplementation/Protein Energy Malnutrition: As of 2007, there has been a decreasing trend in the prevalence rate of malnutrition among pre-schoolers from 8.79% in 2006 to 5.88%. There is also a decreasing trend in the prevalence of above normal children.

Micronutrient supplementation especially Vitamin A among 6-71 months old showed an accomplishment of 78% in 2007 which is far below the national benchmark of 95%.



Figure 21: Province of Cagayan, Nutritional Status, Pre-School Children, Year 2006-2007



Breast feeding program: The breast feeding coverage of postpartum women who initiated breastfeeding was 63% which is perceived to be too low. Infants exclusively breastfed up to six months was 88%, and so the DOH benchmark of 100% was not achieved.

Integrated Management of Childhood Illnesses: From 2004 to 2007, pneumonia had been the top leading cause of death among 0-5 years old. Children with various health conditions are difficult to manage. Some diseases have the same symptoms that need further assessment before classification of treatment takes place. To address the problem of under-5 mortality, a training for nurses and midwives on IMCI was conducted in 2007. However, out of 233 midwives, only 22 or 9% were trained. Only 3 out of 50 nurses or 6% were trained.

Table 10: Province of Cagayan, Under Five Mortality Rate, 2007 vs 5 year average (2000-2006)

Number and Rate per 1,000 Population


CAUSES

5 - Year Average(2002 - 2006)

2007

No.

Rate

No.

Rate

1. Pneumonias

64

38.04

50

36.72

2. Prematurity

18

10.88

20

14.69

3. Accident / Assaults

13




11

8.08

4. Sepsis

8

5.82

9

6.61

5. Septicemia

7

4.32

9

6.61

6. Congenital Anomalies

12

7.20

6

4.41

7. Asphyxia

9

5.71

5

3.67

8. Respiratory Distress Synd.

-

-

4

2.94

9. Asthma

3

2.40

4

2.94

10. Rheumatic Heart Disease

1

0.80

4

2.94


Figure 22: Province of Cagayan, Under Five Leading Causes of Mortaltity, 2007


Newborn Care / Screening- A law has already been passed requiring health facilities to conduct newborn screening. Newborn screening is also part of the licensing requirements of hospitals and RHUs. Data shows that only fifteen (15) government hospitals, eight (8) private hospitals and one (1) RHU provide newborn screening services for a percentage accomplishment of 19%.

MATERNAL HEALTH
Prenatal CareIn the province, 36% (6,447) of pregnant women seen in health facilities were high risk pregnancies. Only 58% of all pregnant women have had at least 3 or more prenatal visits to a health facility. This is way below the DOH benchmark which is 80%.

Table 11: Cagayan Pre- and Post Natal Care, 2007


Municipality

Pre - Natal w/ 3 or more PN visits

Post - Natal w/ at least 1 visits

Target

Acc

%

Target

Acc

%

Abulug

790

452

57

677

792

117

Alcala

1397

607

43

1197

505

42

Allacapan

1032

785

76

885

597

67

Amulung

1592

641

40

1365

740

54

Aparri I

1398

1,251

89

1199

768

64

Aparri II

753

559

74

645

463

72

Baggao

2636

1,070

41

2260

1,416

63

Ballesteros

1021

973

95

875

635

73

Buguey

1024

567

55

878

559

64

Calayan

548

632

115

469

248

53

Camalaniugan

810

367

45

694

369

53

Claveria

960

469

49

823

449

55

Enrile

1174

222

19

1006

576

57

Gattaran

1830

1,602

88

1568

1,149

73

Gonzaga

1215

792

65

1041

541

52

Iguig

768

492

64

659

443

67

Lallo

1341

669

50

1150

688

60

Lasam

1321

493

37

1133

516

46

Pamplona

767

400

52

658

544

83

Peñablanca

1476

669

45

1265

868

69

Piat

600

443

74

514

290

56

Rizal

563

204

36

483

164

34

Sanchez Mira

731

426

58

627

421

67

Sta. Ana

875

765

87

750

600

80

Sta. Praxedes

113

34

30

97

55

57

Sta. Teresita

516

450

87

442

347

79

Sto. Niño

947

587

62

811

626

77

Solana

2758

1,249

45

2364

1,331

56

Tuao I

1249

842

67

1069

767

72

Tuao II

944

525

56

809

524

65

CAGAYAN

33149

19,237

58

28413

17,991

63

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