Chapter 1
The Provincial Health Situation
INTRODUCTION
The Province of Cagayan continues to be responsive to the Millenium Development Goals particularly those pertaining to health, namely, the reduction of child mortality, improvement of maternal health and combating of HIV/AIDS, malaria and other diseases.
The Province posted modest gains in the implementation of its health programs and it is continually challenged to achieve the goals spelled out in the Medium Term Philippine Development Plan especially in the areas of health insurance, strengthening of the local health system and hospital reforms.
The Province is still facing the problem of rabies, malaria, and other problems of public health which have reached alarming proportions. Schistosomiasis in Gonzaga is a problem that the Local Government Unit and the Province are fighting together to prevent its spread to neighboring municipalities. Dengue also continues to be a problem not only during the rainy season but all throughout the year.
The Province is also trying very hard to rehabilitate its hospitals which are threatened with the possible downgrading by the Department of Health due to their dilapidated facilities and inadequate equipment and human resource.
These are some of the problems that the Province of Cagayan is valiantly fighting and hopefully through the concerted efforts of all stakeholders, can be surmounted.
As gleaned from the comparative health statistics below, the Province of Cagayan has been performing rather well.
Table 2: Comparative performance between National and Provincial MDG’s (2007)
Millennium Development GoalsMDG/NOH
Goal by 2015 / Goal 4 / Goal 5 / Goal 6 / Goal 7
U5 MR/1,000LB
18.1 / IMR/1,000LB
11.2 / MMR/100,000 LB
52 / CPR
80 / HIV / AIDS Prevalence
<1 / %HH with access to safe water / % HH with access to sanitary toilet
National / 40(NDHS) / 29 (NDHS) / 90 / 80% / <1% / 94% / 91%
Cagayan / 36.72 / 5.88 / 66.61 / 49.48 / 0 / 79.65 / 91.87
Source: CHD R2
VITAL HEALTH INDICATORS
Crude Birth Rate (CBR): The CBR is the simplest and most commonly used index of fertility. From 2002 to 2007, the five-year average CBR was 17.6 per 1,000 live births. However, in 2007 it rose slightly to 18 per 1,000 LB which is still lower than the national rate which is 23 per 1,000 live births.
Figure 1: Province of Cagayan, Crude Birth Rate 2002-2007
Crude Death Rate (CDR): The Provincial Crude Death Rate had been hovering at the 4.0 plus range. The 2007 rate of 4.44 per 100,000 population is slightly lower than the national average of 5 per 100,000 population. Pneumonia has been the leading cause of death in all ages. However, it has been noted that the non-communicable and chronic diseases such as Hypertensive Vascular disease, Coronary Artery disease, Malignancies and Pulmonary Tuberculosis have emerged as the major causes of death. It showed that the province is having the double burden of communicable and non communicable diseases.
Crude death rate is highest in Sanchez Mira with 6.32 per 100,000 population, followed by Aparri with 6.18; Alcala with 5.78; Sta. Praxedes with 5.76; and Iguig with 5.19. Municipalities with the lowest CDR are Rizal with 2.99 per 100,000 population; Allacapan with 3; Baggao with 3.26; Gattaran with 3.99; and Tuao with 3.47.
Figure 2: Province of Cagayan, Crude Death Rate 2002-2007
Infant Mortality Rate (IMR): Infant Mortality Rate is a sensitive indicator of the maternal and child health status of the Province. It indicates the quality of maternal and child health services provided in the Province. A high IMR is highly associated with development factors and can be reflective of poor economic conditions, inadequate medical care facilities and a generally low educational level of the population. From 2002 to 2007 the provincial IMR declined for two years and then steadied for two years and a rapid decline by almost 95% was noted in year 2007. The Infant Mortality Rate (IMR) for 2007 was computed at 5.88 deaths per 1,000 live births. The national IMR stands at 48 deaths per 1,000 livebirths.
Figure 3: Province of Cagayan, Infant Mortality Rate 2002-2007
Table 3: Province of Cagayan, Infant Mortality Rate, 2007 vs. 5 year average (2002-2006)
Number and Rate per 1,000 population
CAUSES / 5 - Year Average (2002 – 2006) / 2007No. / Rate / No. / Rate
1. Pneumonias / 39 / 2.64 / 37 / 2.05
2. Prematurity / 18 / 1.06 / 20 / 1.11
3. Septicemia / 6 / 0.37 / 7 / 0.39
4.Sepsis / 7 / 0.41 / 7 / 0.39
5. Congenital Anomalies / 11 / 0.58 / 6 / 0.33
6. Respiratory Distress Synd. / - / - / 3 / 0.33
7. Asphyxia / 11 / 0.55 / 3 / 0.33
8. Bronchitis / 13 / 0.18 / 3 / 0.33
9. Malnutrition / 3 / 0.14 / 3 / 0.33
10. Coronary Artery Dis. / 1 / 0.06 / 2 / 0.11
Figure 4: Province of Cagayan, Top Ten leading Causes of Infant Mortality, 2007
Maternal Mortality Ratio (MMR): From the year 2002 to 2007, maternal deaths have been steadily increasing. From 6 maternal deaths in 2002, it declined to 3 and has been increasing steadily to 9 maternal deaths in 2006. In year 2007, there were 12 reported maternal deaths in the province as against 18,013 live births or a Maternal Mortality Ratio of 66.61. National figure is 172 deaths per 100,000 (1998) and the MDG Goal is to reduce this to 90 deaths by 2010. Causes of maternal deaths are as follows; post partum hemorrhage (6), RHD (2), Amniotic embolism (1), Placental retention (1), Eclampsia, severe (1) and Dystocia of pregnancy (1) Figure 5. These maternal deaths were noted in seven municipalities of the province.
Figure 5: Province of Cagayan, Leading Causes of Maternal Mortality, 2007
Figure 6: Province of Cagayan, Deliveries Attended by Year: 2007
Out of the 18,013 live births in 2007, almost 74% (13,271) were home delivered. Of all live births, 50% (9,190) were assisted by midwives and 26% (4,605) were assisted by trained hilots, 3,725 or 21% were assisted by doctors, 174 (1%) were assisted by nurses and 186 (1%) were assisted by untrained hilots. Of the type of pregnancy, 36 % (6,447) were noted to be high risk and the rest were normal.
Figure 7: Province of Cagayan, Maternal Mortality Ratio 2002-2007
VITAL HEALTH STATISTICS
Leading Causes of Death: Pneumonia continues to be the leading cause of death in the in the Province. It has held this distinction for many years now. However, more and more people have been dying of lifestyle related and non-communicable diseases. These diseases include hypertension, coronary artery diseases and peptic ulcers. This is due to the change in lifestyle of most people from active to sedentary especially as they grow older. Unhealthy diet also plays a big part in the proliferation of these diseases.
Figure 8: Province of Cagayan, Leading Causes of Mortality, Year 2007
Leading Causes of Morbidity: Seven out of the ten leading causes of morbidity are communicable diseases, particularly acute respiratory infections, influenza, diarrhea, bronchitis and pneumonia which are in the top five. . The prevalence of these illnesses may be attributed to the lack of health service providers, inadequate health service facilities including equipments and drugs and the patients’ lack of awareness regarding health and nutrition concerns. It is also worth noting that hypertension, a lifestyle related disease is on the sixth place.
Figure 9: Province of Cagayan, Leading Causes of Morbidity, Year 2007
Table 4: Province of Cagayan, Leading Causes of Mortality & Morbidity, 2007 vs Five
year average(2002-2006)
Year / 5 - Year Average / 5 - Year Average / 2007 / 2007 / 5 - Year Average / 2007
Mortality / No. / Rate (%) / No. / Rate / Morbidity / No. / Rate / No. / Rate
1. Pneumonia / 735 / 15.1 / 802 / 19.16 / 1. ARI / AURI / 27,686 / 2,803.45 / 29,881 / 2,744.42
2. Hypertensive Vascular Disease / 619 / 12.72 / 597 / 14.26 / 2. Influenza / 9,257 / 943.33 / 6,609 / 607.00
3. Coronary Artery Disease / 285 / 5.85 / 446 / 10.65 / 3. Diarrhea / 6,388 / 652.27 / 5,770 / 529.95
4. Cancer / 372 / 7.64 / 406 / 9.7 / 4. Bronchitis / 6,351 / 347.10 / 4,464 / 410.00
5. Accident/Assaults / 329 / 6.76 / 248 / 5.92 / 5. Pneumonia / 9,036 / 944.33 / 3,454 / 317.23
6. Cardio - Vascular Accidents / 342 / 7.02 / 218 / 5.21 / 6. Hypertension / 3,889 / 396.79 / 3,161 / 290.32
7. C.O.P.D. / 112 / 2.3 / 153 / 3.65 / 7. Skin Diseases / 2,401 / 245.74 / 2,863 / 262.95
8. Peptic Ulcer Disease / 120 / 2.46 / 146 / 3.48 / 8. Systematic Viral Inf. / 775 / 81.02 / 2,355 / 216.30
9. Tuberculosis / 226 / 4.64 / 127 / 3.03 / 9. PUD / Gastritis / 1,008 / 103.99 / 2,108 / 193.61
10. Myocardial Infarction / 65 / 1.33 / 98 / 2.34 / 10. Wounds / 1,156 / 118.42 / 1,693 / 155.49
A. PUBLIC HEALTH PROGRAM DEVELOPMENT
DISEASE FREE ZONE
Schistosomiasis: Schistosomiasis is present in Gonzaga, one of the municipalities of the Province of Cagayan. The first case was diagnosed in 2004 and the patient eventually died. The municipality was alarmed and it sought the help of DOH-CHD 2 and through the College of Public Health of the University of the Philippines. An epidemiologic study (snail searching and identification, mass stool exams using Ethyl ether) was made in the municipality. There were three barangays noted to have the snail host Oncomelania quadrasi and there are 10 positive cases of schistosomiasis .
Table 5: Province of Cagayan, Number of Schisotosomaiasis cases (2004-2007)
YEAR / No. of Cases2004 / 117
2005 / 5
2006 / 6
2007 / 10
Figure 10: Province of Cagayan, Number of Schistosomiasis cases in the Municipality of Gonsaga,
Year 2004-2007
Rabies: Rabies has now become a major problem because of the alarming number of reported cases of dog bites and deaths due to rabies. In 2007, there have been 4,744 reported dog bite cases and 17 deaths due to rabies. As a consequence, the province ranked second as having the most total number of rabies deaths in all provinces nationwide. There is only one Animal Bite Center located at the Provincial Capitol catering to the whole province. Patients from nearby municipalities of Isabela and Apayao also come to the Animal Bite Center for treatment. The Provincial Government of Cagayan can only subsidize one free dose of vaccination to all patients coming from Cagayan because of the prohibitive cost of the vaccine. The cost of the other doses has to be shouldered by the patients.
Table 6: Province of Cagayan, Number of Animal Bites and Rabies deaths, 2004-2007
Year / Animal bites / Rabies death2004 / 2784 / 8
2005 / 2642 / 9
2006 / 3245 / 17
2007 / 4744 / 17
Figure 11: Province of Cagayan, Animal Bites, 2004-2007
Figure 12: Province of Cagayan, Rabies Deaths, 2004-2007
Leprosy: In 2007, the province had 19 leprosy cases with a prevalence rate of .20/100,000 population. This is way below the goal of the Department of Health which is to reduce the prevalence rate of leprosy to less than 1/100,000 population. Looking into a 5-year data, it was also noted that year 2000 has the highest number of cases (26) with a prevalence rate (.25/10,000 population). The low prevalence of leprosy may be attributed to good performance and adequate knowledge and skills of health workers in the diagnosis of leprosy. However, we should not be complacent with the prevalence rate but the Province should work hard for the eradication of leprosy as a public health problem.
Figure 13: Province of Cagayan, Leprosy Prevalence Rate per 1,000 pop, 2004-2007
Malaria: Malaria is endemic in all municipalities of the Province except Tuguegarao City. The Global Fund Malaria Component Project has been assisting the top 15 municipalities of Calayan, Baggao, Gattaran, Sta. Ana, Sto. Niño, Lasam, Gonzaga, Pamplona, Claveria, Sanchez, Aparri, all Allacapan, Rizal, Sta. Teresita, and Lallo. From year 2003 to 2006, there has been a decline in malaria morbidity from 2,193 positive cases to 1139. Suddenly the number of cases increased from 1139 in year 2006 to 1162 in year 2007. Fatality rate was highest in 2007 at .68.
Table 7: Province of Cagayan, Number of Malaria cases, deaths and Fatality Rate (2003-2007)
Year / Cases / Death / Fatality Rate2003 / 2193 / 4 / .18
2004 / 1417 / 6 / .42
2005 / 1412 / 4 / .28
2006 / 1139 / 4 / .35
2007 / 1162 / 8 / .68
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.