CHAPTER ONE

INTRODUCTION

1.1 Background

Diarrhea is a symptom of an infection in the intestinal tract, caused by a variety of

bacteria, viruses and parasites. Infection can be spread through contaminated food or
drinking-water, or from person-to-person. During a diarrheal episode, water and
electrolytes are loss through liquid stools, vomit, sweat, urine and breathing, making
dehydration as the main cause of death when these losses are not replaced. (World Health
Organization, 2013)

Diarrhea remains the leading cause of morbidity and mortality in children under
five years old worldwide, the majority of deaths related to diarrhea take place in Africa
and South Asia (Mengistie et al, 2013).

Globally, the Centers for Disease Control and Prevention (2012) estimated that
diarrhea kills 2,195 children every day—more than AIDS, malaria, and measles
combined that accounts for 1 in 9 child deaths worldwide, making diarrhea the second
leading cause of death among children under the age of five.

Epidemiologic studies show that factors determining the occurrence of diarrhea in

children are complex and the relative contribution of each factor varies as a function of
interaction between socio-economic, environmental and behavioral variables (Mengistie
et al, 2013).

Diarrheal disease due to unsafe water and lack of sanitation are the biggest cause
of morbidity and mortality in under-five children in the world especially in poor
countries. Where a child dies every 15 seconds from diarrhea caused largely by poor
sanitation and contaminated water supply. Behavioral factors associated with acute
childhood diarrhea include lack of hand-washing, poor infant and young child feeding
practices and lack of child immunizations (Zeleke, 2014).

In spite of the advancement of the health care system in delivering effective and
efficient means of diagnosing and treating different diseases, still, diarrhea is a long way
battle amongst the developing countries that significantly influences the health of the
children.

In the Philippines, United Nations International Children’s Emergency Fund

(2013) stated that almost 90 percent of child deaths from diarrheal diseases are caused by
contaminated water, lack of sanitation or inadequate hygiene. Over 30 million people do
not have access to improved sanitation facilities. Out of this, 7.8 million people, or
roughly 8 percent of the country's population don't have access to sanitation facilities at
all. Every day nearly 10 million or 1 in 10 Filipinos defecate in open places or use a
plastic bag that is then thrown out with the trash (Ebora, 2015).

Coastal barangays namely Fuerte, Pandan, Puro, Pantay Tamurong and Villamar
are amongst the 17 barangays in the Municipality of Caoayan, Ilocos Sur, Philippines
with an estimated total population of 9,277 (Barangay Health Centers, 2016). Garbage
disposal are one of the major concerns of the said barangays, garbage is dumped as one
on an area of the barangays. Another concern is the inadequate source of water, there are
only limited numbers of water pumps that serve as the means of household and drinking
water for coastal barangays, wherein sanitation of the water is uncertain.

According to the health records obtained from the Provincial Health Office of
Ilocos Sur, diarrhea is among the top 10 causes of morbidity in year 2014 and 2015.
Morbidity rate is high among the under-five children with an approximate 2,453 cases
from year 2014 to 2015. In 2015, based on the health records of Rural Health Unit of
Caoayan, Ilocos Sur, the top five leading causes of morbidity and mortality in the coastal
barangays are the following: Acute Respiratory Infection as rank one, followed by
hypertension, musculoskeletal related illnesses, dental problems and lastly diarrhea.
Amongst the five diseases, diarrhea is more common to under-five children. Poor
sanitation practices and lack of protected water sources are considered factors associated
with diarrhea in the said barangays. However, whether these risk factors have contributed
to the diarrhea situation in the study areas is not documented. This research therefore,
intends to establish and explore the factors resulting to diarrhea and improve the health of
the respondents with the collaboration of the mothers, community and rural health unit by
delivering community-based services.
1.2 Statement of the Problem

This study aims to identify the environmental factors associated with the
occurrence of diarrhea among under- five children in coastal barangays of Caoayan,
Ilocos Sur. Specifically, it will seek to answer the following inquiries:
1. What is the profile of the respondents as to
a. Age
b. Sex
2. What are the environmental factors associated with the occurrence of diarrhea
in the respondents in terms of:
a. Type and distance of water source
b. Amount of daily water consumption
c. Availability of latrine
d. Livestock in the house
e. Waste disposal
3. Is there a significant relationship between environmental factors and the
occurrence of diarrhea?

1.3 General Objectives

This study aims to identify the environmental determinants associated with the
occurrence of diarrhea among the under- five children in coastal barangays of Caoayan,
Ilocos Sur

Specific Objectives

a. To determine the under-five prevalence and incidence of diarrhea.

b. To determine the associated environmental factors of diarrhea in
relation with the following:
i. Type and distance of water source
ii. Amount of daily water consumption
iii. Availability of latrine
iv. Livestock in the house
v. Waste disposal
 c. To determine the point and two- week period prevalence and incidence
of diarrhea in under- five children.
d. To determine the association of environmental factors in the
occurrence of diarrhea.

1.4 Significance of the Study

The significance of this study is that it will provides data that can greatly enhance
a better understanding of the social, environmental, economic and behavioral factors
associated with the occurrence of diarrhea among the under-five children in coastal
barangays of Caoayan, Ilocos Sur. Such data is important in making recommendations on
possible focal points for child- health programs that aims to reduce the high rate of
diarrhea in under-five children not only in the coastal barangays of Caoayan Ilocos Sur
but, hopefully, elsewhere in the Philippines. The findings of the study therefore should be
of use to the Rural Health Unit of Caoayan, Provincial Health Office of Ilocos Sur and
other stakeholders such as NGOs in designing and implementing child health
intervention programs and projects.

1.5 Scope and Limitation of the study

This study intends to explore the socioeconomic, environmental and behavioral

factors associated with the occurrence of diarrhea in coastal barangays of Caoayan,
Ilocos Sur.

The independent variables are the socioeconomic status that include family
economic status, household size, and maternal age, educational attainment of the parents/
caregiver, number of children, occupation and marital status. Another, the environmental
sanitation that include the type of water source, distance to the water source, amount of
daily water consumption, availability of latrine, number of rooms, livestock in house and
waste disposal. Lastly, the behavioral factors that include method of water drawing and
storage, feeding practices, action for diarrhea, duration of breast-feeding and time of
introducing supplementary feeding. The dependent variable is the occurrence of any
episode of diarrhea from the given point and two- week period.
 The source and study population are the under- five children of the coastal
barangays of Caoayan, Ilocos Sur. Since the children were too young at under five years
of age to be interviewed, verbal consent will be taken from the mothers or caregivers,
provided that the mothers and the caregivers of the respondents are also willing to
participate in the study by answering the questionnaire and interview.

One of the limitations of this study is that the specific etiologic agent causing the
diarrhea to the respondents will not be identified, because the study will only focus to the
factors associated with diarrhea.

Another limitation is related to the definition of the term “diarrhea”. There may be
difference among mothers in perceiving their child’s health.
 CHAPTER II

REVIEW OF RELATED LITERATURE

This chapter presents the related literature and studies after the thorough and in
depth search done by the researchers that provides an overview of previous research on
knowledge sharing and intranets. It introduces the framework for the case study that
comprises the main focus of the research described in this study.

The review of related literature studied by the researchers is divided in to

following categories:

• Overview of diarrhea

• Role of environment on health

• Coastal environment on health

• Environmental factors of diarrhea among under-five children

2.1 Overview of diarrhea

According to the report of WHO in 2008, diarrhea cases each year results in 1.5
million deaths and mostly contributed by children. Total number of deaths cause by
unsafe water and insufficient hygiene is 860,000 deaths per year in children under the age
of 5. Diarrhea results from an imbalance in the absorption and secretion properties of the
intestinal tract; if absorption decreases or secretion increases beyond normal, diarrhea
will occur. It can range in severity from an acute, self-limited annoyance to a severe, life-
threatening illness.

According to Khalili, B. et al 2009, they defined diarrhea as the passage of three

or more watery stools per day. There are three clinical types of acute, chronic or
persistent and dysentery. Acute diarrhea is defined as the abrupt onset of 3 or more loose
stools per day and lasts no longer than 14 days. Chronic or persistent diarrhea lasts longer
than 14 days; and the last type is dysentery or bloody diarrhea.
2. 2 Role of the Environment in Child’s Health

In a report published by the WHO Statistical Information, more than 3 million

children under five die each year from environment-related causes and conditions.
Among the 10 million child deaths annually in the world, the environment is one of the
most critical contributors to this global toll (WHO, 2017).

Furthermore, the report also stated that polluted indoor and outdoor air,
contaminated water, lack of adequate sanitation, toxic hazards, disease vectors,
ultraviolet radiation, and degraded ecosystems are all important environmental risk
factors for children and also their mothers.

The Department of Health (DOH) reported that in a year approximately 82,000

children die because of pneumonia, diarrhea and respiratory tract infections. In the
Philippines for children under 10 year-olds, these infectious diseases are among the top
three leading causes of mortality. Environmental factors in school and housholds like
overcrowding, lack of access to clean water and sanitation facilities, poor personal
hygiene practices and lack of awareness can cause these serious health problems. These
factors of environment cause a problematic impact on the health status of the child
(Monse, B et, all. 2010).

2.3 Coastal Environment on Health

Living in a coastal area poses many problems especially regarding public health.
In a study conducted by Supinganto et. Al. in 2016, they concluded that due to their
location, the coastal areas have lesser resources that can increase the welfare of the
communities. They further reported that people in their study have low community
awareness to create a clean and healthy environment, this is based on their observation in
the number of people who throw their garbage into the coast, low yard utilization among
others. The result obtained from their study showed that 34.8% of the people still use the
beach as a garbage, 93.5 has a septic tank <10M from wells, and 41.3% people do not
have a yard. Increasing the density, increasing household industry too, that will lead the
environment pollution.
 In a study conducted by Griffin et al. It has been recognized that the observed
decrease in coastal marine water quality occurring in areas impacted by human waste and
refuse is negatively affecting both human and ecosystem health. A majority of pathogens
responsible for outbreaks of human illnesses acquired from marine recreational exposure
have not been identified but are thought to be viruses.

2. 2 Environmental Factors of diarrhea among under-five children

In a study conducted by Mohammed and Zungu (2016), more than 40% of the
global burden of disease can be attributed to environmental factors especially in children
below five years of age.

Types of water source. According to the report of WHO in 2011 type of water
resource is an important aspect of the drinking-water quality. Prevention of water
contamination brought by microorganism and chemicals are challenge to health care
providers. Management for polluted water source and human activity that causes unclean
water will influence water quality. This will have an impact on the treatment steps
required to ensure safe water, and preventive action may be preferable to upgrading
treatment. The effect of drinking water on the incidence of diarrhea among children of
age 6 months to 5 years living in rural communities is proven by the study conducted by
McGuigan et al.

Distance to the water source. Health gains increase from improving service level
in two key stages: the delivery of water within 1 km or 30 minutes of total collection
time; and when supplied to a yard level of service. Further health gains are likely to occur
once water is supplied through multiple taps inside the house, as this will increase water
availability for diverse hygiene practices. Hygiene practices and accessible to improve
water was associated with a lower risk of diarrhea (WHO, 2011).

Amount of daily water consumption. Estimates of the volume of water needed for
health purposes vary widely. In deriving World Health Organization (2011) guideline
values, it is assumed that the daily per capita consumption of drinking-water is
approximately 1 liter for children, although actual consumption varies according to
climate, activity level and diet. Special situations require additional water intake in
diarrheal disease.
Availability of Latrine. Yiman et al, stated that poor practice such as limited
utilization of sanitary facilities contaminates the environment and water sources. Access
to safe water and improved sanitation must come hand in hand to achieve proper
sanitation. Hygienic condition of latrine and educational status of mothers were
significant predictors of satisfactory latrine utilization. The most common reason for not
utilizing latrine by the households was long live habit and considering open defecation
comfortable. Progress in improving sanitation in developing countries has been slow,
studies show that latrines are effective in reducing the disease by about 30% and improve
the child growth. Households with a latrine has lower episodes of diarrhea than
households without a latrine. Latrines should be cleaned daily to prevent disease
transmission through contact with faces and flies and, perhaps more crucially, insanitary
conditions and odor which may deter people from using them. Households which have
hygienic latrines were more likely to utilize latrine compared with latrines not hygienic.
The strong association between hygienic condition of latrine and utilization could be
attributed to fear of contamination, odor and flies that are major problems of unhygienic
latrines.

Livestock in the house. According to the study by Ngure in 2013, in rural

Zimbabwe, fecal bacteria from soil and chicken feces are often contaminated with E. coli.
Infant and young children who are frequently expose with the soil are at high risk to
expose to the bacteria. Accidental ingestion of chicken feces and soil containing chicken
feces will eventually lead to a huge burden of pathogenic bacteria, which later may cause
diarrhea.

Waste disposal. The method for garbage disposal, such as using a pit, sewer, river,
or burying, was found to influence the risk of diarrhea. This may be due to incomplete
treatment of garbage. According to the study by Kafando et.al 2015, stagnation and
infiltration of waste in waters will influence the degradation of components of the
environment (ecosystem degradation). Poorly managed plastic bags will pollute the soil,
attack vegetation, reduce infiltration of rainwater, clogged pipes and drains discharge
storm water and wastewater which will lead to unsafe water source. In another study
conducted by Kafando P. in 2013, disposal of garbage close to homes and rural
communities were significant risk factors for high fly densities. Flies are known to carry
enteric pathogens, and it is thought that some foodborne transmission of enteric
infections may be mediated by flies. The adjusted relative risks of diarrheal episodes and
duration of diarrhea, associated with fly density at the 75th percentile.
 CONCEPTUAL FRAMEWORK

Type and distance of

water source

Availability of latrine

ENVIRONMENTAL
Waste disposal
FACTORS

Livestock in the house

Amount of daily water

consumption

Childhood
Diarrheal
Morbidity
DEFINITION OF TERMS

Place of residence: this refers to place and environment where the respondent lives such
as rural or urban
Monthly family income: this refers to the total monthly earnings of the family derived
from the family members’ salaries and other income generating activities. Behavioral
determinants: This refers to the factors that control or influence on how the under-five
children response to their environment and how it will affect their health status.

Diarrheal disease: This refers to the frequent passage of the loose or watery stool at least
three or more times in a day.

Acute diarrhea: This refers to the diarrheal disease that lasting for less than 14 days.

Chronic diarrhea: This refers to the diarrheal disease that lasting for more than 14 days.
Index child: refers to a child that was included in the study from a household to have
information on the demographic and health characteristics, and also to calculate the
prevalence and incidence of diarrhoea
Environmental sanitation practices: this refers to the type of water source, distance to the
water source, amount of daily water consumption, availability of latrine, number of
rooms, livestock in house and waste disposal.

Cross-sectional: refers to the collection and assessment of data regarding diarrhea within
two-week period.
Barangay: this refers to a unit of society that consists 50-100 families.
 CHAPTER III

METHODOLOGY

A. Research Design

This study will utilize the descriptive cross-sectional method of research. It will
examine the households’ environmental factors associated with diarrhea of under-five
children in the different coastal barangays in Caoayan, Ilocos Sur as the exposure
variables and diarrheal morbidity in under-five children as the outcome variable.

B. Locale of the study

The study will be conducted in the coastal barangays of Caoayan, Ilocos Sur. The
municipality is bounded by the City of Vigan in the north, Municipality of Santa in the
east and the South China Sea in the south and on the west by the southern barangays of
Vigan City. According to the records of Provincial Health Office of Ilocos Sur, the total
population of Caoayan is estimated to be 19,260 as of 2014 census. The municipality is
subdivided into 17 barangays and among them 5 are in the coastal area which are
Barangay Fuerte, Pandan, Pantay-Tamurong, Puro and Villamar.

The aforementioned barangays’ main livelihood is fishing and other related work
like boat-sailing. Some of the residence are also engaged into farming mainly rice and
corn.

C. Unit of the study

The source population will be the households with under- five children of the
selected coastal barangays of Caoayan, Ilocos Sur while the subjects are the mothers or
guardians in the household that had under-five child.
 If the household have more than 1 under-five child, the index child will be the
youngest that will be selected to collect information on the child’s demographic and
health characteristics.

D. Sampling Design

The sample size was calculated using the G*Power 3.1.9.2 Software using the
Power Analysis method while purposive sampling was used to determine the respondents
of the study. The distribution of the respondents is presented in Table 1.

Table 1
Distribution of the Respondents
Barangay N n

Fuerte 323 41

Panday 126 16

Pantay-Tamurong 276 35

Puro 82 10

Villamar 240 31

TOTAL 1047 134

E. Data Collection Technique

The main instrument to gather data for this study will be a structured
questionnaire adopted from the study of Teklu Mulegata entitled “Socio-economic,
Environmental, and Behavioral Factors associated with the occurrence of Diarrhoeal
Disease Among Under-five Children, Meskenena Mareko Woreda, Southern Ethiopia”.
Revisions will be made to adjust to the setting and respondents of this study and the
content will be validated by a pool of experts.

The questionnaire will be divided into two parts. Part I will gather information
regarding Environmental Health Conditions. Part II will ask about the Information of the
Index Child.
 The study instrument will contain a combination of open-ended and closed-ended
questions.

To determine the prevalence of diarrhea, the mothers or guardians will be given

each a card. An identity number and household number will be shown in the card. The
mothers or guardian will be asked if their child has diarrhea at the time of the first
interview which will serve as the point prevalence of the study. Also in the first
interview, the researchers will explain to the mother or guardian a diarrhea is that if ever
their child gets it in the subsequent 2 weeks they will have to mark any sign on the card.
At the second interview, the researchers will collect the cards and recorded diarrhea
cases, if there are any. The recorded diarrhea cases at the second interview will serve as
the period prevalence of the study.

F. Data Gathering Procedure

The researchers will ask permissions to the Mayor of Caoayan, Ilocos Sur and
Barangay Officials of the selected coastal barangays for the conduct of the study.
Likewise, permission will also be requested to the Provincial Health Office and
Municipal Health Office for the review of records and identification of respondents.

After permissions are granted, the questionnaires will be personally administered

in a face to face interview. The questionnaire will be first prepared in English and then
translated to Iloko.

G. Tools of Analysis

The following statistical tools are to be used to treat and analyze data that will be
gathered:

1. Frequency and percentage for the environmental factors and also the
occurrence of diarrhea.

2. Simple linear correlation analysis that will ascertain the relationship between
the variables that will be studied.
BIBLIOGRAPHY
BIBLIOGRAPHY

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(4) Mabgua S., Musikoyo E., Ndungi F., Sang R., Kaumau-Mbuthia E. and Ngotho
D., Determinants of Diarrhea among Young Children under the Age of Five in Kenya,
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(5) Siziya S., Muula AS., Rudatsikira E., Correlates of Diarrhea among Children
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(6) Woldemichael G. Diarrhoeal Morbidity Among Young Children in Eritrea:

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(7) Avisek Gupta, Gautam Sarker, Arup Jyoti Rout, Tanushree Mondal, and Ranabir
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Bankura, West Bengal. 2015
(8) Ogbo F., Page A., Idoko J., Claudio F. and Agho K,. Diarrhoea and Suboptimal
Feeding Practices in Nigeria: Evidence from the National Household Surveys. 2016
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APPENDICES
 APPENDIX A

Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES
Vigan City

COLLEGE OF MEDICINE

HON. JUAN PAOLO ANCHETA

Mayor
Municipality of Caoayan, Ilocos Sur

Sir:

We, the undersigned third year medical students of the University of Northern
Philippines College of Medicine, are required to conduct a study entitled “Environmental
Factors associated with the occurrence of Diarrhea among Under-five Children in the
Coastal Barangays of Caoayan, Ilocos Sur”.

In this connection we would like to request permission to conduct our study from your
municipality. We plan to gather information regarding the different environmental
associated with the occurrence of diarrhea among under-five children in the coastal
barangays of Caoayan, Ilocos Sur namely Barangays Fuerte, Panday, Pantay-Tamurng,
Puro and Villamar.

Thank you very much and we are anticipating a favorable response regarding this matter.

Very truly yours,

AGCAOILI, PHOEBE NICOLE Y. CHRISSANTI, DIANA L.

DAET, RYAN I. RACHO, KIM SZYDNEY L.

TJAKRAPAWIRA, AGNES

Noted by:
PABLO R. QUEDADO, M.D.
Dean, College of Medicine

APPENDIX B

Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES
Vigan City
COLLEGE OF MEDICINE

EDNA RABENA, MD
Municipal Health Officer
Caoayan, Ilocos Sur

Ma’am:

We, the undersigned third year medical students of the University of Northern
Philippines College of Medicine, conducting a study entitled “Environmental Factors
associated with the Occurrence of Diarrhea among Under-five Children in the Coastal
barangays of Caoayan, Ilocos Sur”

In this connection, we would like to ask your good office to lend us data on the following
as a basis of our study:
1. Incidence of diarrheal diseases in Caoayan, Ilocos Sur for the calendar years
2014, 2015, 2016
2. Incidence of diarrheal diseases among 0-5 years old children in Caoayan, Ilocos
Sur for the calendar years 2014, 2015, 2016
3. Incidence of diarrheal diseases in Barangays Fuerte, Panday, Pantay-Tamurng,
Puro and Villamar, Caoayan, Ilocos Sur for the calendar years 2014, 2015, 2016
4. Incidence of diarrheal diseases among 0-5 years old children in Barangays
Fuerte, Panday, Pantay-Tamurng, Puro and Villamar, Caoayan, Ilocos Sur 014,
2015, 2016
5. Total population of the municipality of Caoayan, Ilocos Sur as of the calendar
year 2016
6. Total population of Barangays Fuerte, Panday, Pantay-Tamurng, Puro and
Villamar, Caoayan, Ilocos Sur as of the calendar year 2016
7. Total population of children ages 0-5 years old in Barangays Fuerte, Panday,
Pantay-Tamurng, Puro and Villamar, Caoayan, Ilocos Sur as of the calendar year
2016
 8. Programs of the Municipal Health Office in addressing the different diarrheal
diseases

Rest assured that any information gathered will be treated with utmost confidentiality.
We hope for your favorable response regarding this matter.

Thank you very much and may the good Lord bless you.

Respectfully yours,

AGCAOILI, PHOEBE NICOLE Y. CHRISSANTI, DIANA L.

DAET, RYAN I. RACHO, KIM SZYDNEY L.

TJAKRAPAWIRA, AGNES

Noted by: Approved by:

PABLO R. QUEDADO, M.D. EDNA RABENA, MD

Dean, College of Medicine Municipal Health Officer
 APPENDIX C

Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES
Vigan City

COLLEGE OF MEDICINE

Name of Barangay Chairman

Name of Barangay
Municipality of Caoayan, Ilocos Sur

Sir/Ma’am:

We, the undersigned third year medical students of the University of Northern
Philippines College of Medicine, are required to conduct a study entitled “Environmental
Factors associated with the Occurrence of Diarrhea among Under-five Children in the
Coastal barangays of Caoayan, Ilocos Sur”

In this connection we would like to request permission to conduct our study from your
Barangay. We plan to gather information regarding the different environmental factors
associated with the occurrence of diarrhea among under-five children in the coastal
barangays of Caoayan, Ilocos Sur namely Barangays Fuerte, Panday, Pantay-Tamurng,
Puro and Villamar.

Thank you very much and we are anticipating a favorable response regarding this matter.

Very truly yours,

AGCAOILI, PHOEBE NICOLE Y. CHRISSANTI, DIANA L.

DAET, RYAN I. RACHO, KIM SZYDNEY L.

TJAKRAPAWIRA, AGNES

Noted by:
PABLO R. QUEDADO, M.D.
Dean, College of Medicine

APPENDIX D

Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES
Vigan City

COLLEGE OF MEDICINE

I, ____________________________________________________, of legal age,

single/married/divorce, currently residing at _______________________________,
voluntarily participates in the study entitled “Environmental Factors associated with the
Occurrence of Diarrhea among Under-five Children in the Coastal barangays of
Caoayan, Ilocos Sur” conducted by the group of third year medical students of the
University of Northern Philippines.

The goal of the said study has been clearly presented to me and that the procedures that
need to be done have been properly discussed with me. I have been advised that I may
withdraw my participation anytime I wish, and any information given will be kept
confidential.

Signed this ________day of ________, 2017, Brgy. ____________,Caoayan, Ilocos Sur.

_________________________
Signature Over Printed Name
 APPENDIX E

Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES
Vigan City

COLLEGE OF MEDICINE

Siak ni __________________________________, addaan iti usto a tawen,

naasawaan/divorsiado/baro weno balasang/balo, madama nga agnanaed iti Barangay
_______________________, ket sisipakada nga maki-partisipar iti research dagiti
estudyante iti College of Medicine iti University of Northern Philippines a addaan iti
titulo na a “Environmental Factors associated with the Occurrence of Diarrhea among
Under-five Children in the Coastal barangays of Caoayan, Ilocos Sur”

Naiisplikar kanyak a nasayaat no ana iti pagserbian detoy a reasearch. Naiisplikar pay

kanyak no ana dagiti naduma-duma nga impormasyon nga alaen da kanyak. Nabagaan

nak pay a mabalinak a agbabawi iti pinagpartisipar ko anyaman a oras. Naiisplikar pay

kanyak nga anyaman nga impormasyon a maala da kanyak ket para iti pinagbasa da laeng

ken haan maamwan iti sabali no awan pammalubos ko.

Pinirmaan iti aldaw ti _____, 2017, Brgy. _______________, Caoayan, Ilocos Sur.
_____________________

Pirma ken Nagan

APPENDIX F

Identification Number:

House Number:

NAME OF THE No. of Sex Age Diarrhea at the

INDEX CHILD Diarrheal

(in time of the
Episodes
months) survey**
within 2

weeks

** Check if the child has diarrhoea, and mark “X “if he hasn’t

 APPENDIX G

QUESTIONNAIRE

IDENTIFICATION

001. House number: __________

002. Number of persons in the household___________

003. Number of under-five children in the household_________

List all under-five children present in the household

No NAME OF THE CHILD SEX AGE DIARRHEA AT THE

(In months) TIME OF THE SURVEY**

** Check if the child has diarrhoea, and mark “ X “ if he hasn’t

PART I. ENVIRONMENTAL HEALTH CONDITIONS

NO. QUESTIONS AND FILTERS RESPONSES

Q101 Type of floor material of the living 1. Mud 3. Cement

house
2. Wood 4. Other (specify)

(OBSERVATION)

Q102 Type of roof material of the living 1. Nipa palm leaves

house
2. Corrugated iron sheet

(OBSERVATION)
3. Other (specify)

Q103 Do animals live in the same house 1. Yes

where the members of the family

2. No
live?

(OBSERVATION)

Q104 Number of rooms in the house ________

Q105 Is latrine available? 1. Yes

2. No (If No, skip to Q108)

Q106 Ownership of the latrine 1. Privately owned

 2. Shared with neighbors

Q107 Is feces seen around the pit-hole 1. Yes

(or on the floor)?

2. No

(OBSERVATION)

Q108 Is feces seen around the house (or 1. Yes

in the compound)?
2. No

(OBSERVATION)

Q109 If the family has no latrine, where 1. Open field

do you dispose human waste?

2. Other (specify)

Q110 How do you dispose refuse? 1. Pit 3. Open field

2. Burning 4. Garbage

can

5.Other

Q111 From where do you get water for 1. Pipe

drinking?
2. Protected well/spring

(OBSERVATION)
3. Unprotected well/spring

4. Jetmatic water pump

5. Other (specify)
Q112 Distance from the house to the __________ Minutes

water source

Q113 Type of collection container 1. Pot 4. Jerry

can

2. Plastic bucket 5. Other

3. Iron bucket

Q114 How did you transport the 1. In a covered container

collected drinking water to the

2. In an uncovered container
house yesterday?
3. Other (specify)

Q115 Capacity of the container, which _______ Liters

you used to collect drinking water

yesterday?

Q116 How many times did you collect

water for drinking yesterday?

PART IV. INFORMATION OF THE INDEX CHILD

Ask the mother/caretaker about the child with diarrhea, or if there is no child with

diarrhea, ask about the child who is younger than others.

NO. QUESTIONS AND FILTERS RESPONSES

Q201 Age of the index child ________ Months

Q202 Sex of the index child 1. Male 2.

Female

Q203 Where was your child born? 1. Health institution 2.

Home

Q204 Birth order of the child 1. First 3. Third

2. Second 4. Fourth

&above

Q205 Do you (the mother/caretaker) 1. Yes

have a history of diarrhoea in the

2. No
past two weeks?

Q206 Have you ever breast-fed your 1.Yes 2. No (Skip to

 child? Q408)

Q207 For how long did you breastfed __________Months

your child?

Q208 What is his/her current 1. Exclusive breastfeeding

breastfeeding status?
2. Partial breastfeeding

3. Not breastfeeding

Q209 At what age the child started ________ Months

supplementary /weaning food?

Q210 Did the child receive measles 1. Yes, (by the response of the

vaccination?
respondent)

2. Yes, (by checking the card)

Ask for children of age greater

3. No
than nine months

Q211 Do your child have diarrhea 1. Yes

today?
2. No

Q412 For how long the diarrhea last? 1. Less than 14 days

2. Greater than 14 days

Q213 If the child has diarrhea today, 1. Three times

how many times a day he/she

passes stool?
 2. More than three times

3. Don't know

Q214 The type of diarrhea that the child 1. Watery

had
2. Blood and mucus

Q215 What actions do you take to 1. Take him/her to health

treat/stop the diarrhea?

institution

2. Take him/her to traditional

healer

3. Increase feeding

4. Give him/her ORS

5. Give him/her cereal based

fluids

6. Stop/decrease feeding

7. Homemade treatment

8. Other (specify)

Date of interview-------------------
Name of the interviewer------------------------------ Signature---------------
 APPENDIX G

Numero iti paka-ladawan:

Numero iti Balay:

Nagan iti Anak Naminano Sexo Edad Panagtakki iti

nga tiempo ti
(bulan)
nagtakki iti panagsaludsod**

napalabas

nga duwa a

lawas
**Kitaen no agsuyot ti ubing, markaan ti “x” no saaan

APPENDIX H

KUESTIONARIO

PANANGILADAWAN

001. Nagan ti ina/mangtartaraken: _______________

002. Numero ti balay: __________

003. Bilang ti tao iti sangkaamaan ___________

004. bilang ti ubbing nga agtawen ti nababbaba ngem lima iti sangkaamaan _________

llista amin nga ubbing nga agtawen ti nababbaba ngem lima iti sangkaamaan.

BILANG NAGAN TI UBING SEXO EDAD PANAGTAKKI ITI

TIEMPO TI
(BULAN)
PANAGSALUDSOD**
**Kitaen no agsuyot ti ubing, markaan ti “x” no saaan

PARTE I. KINASAYAAT TI KASASAAD ITI AGLAWLAW

NUMERO SALUDSUD SUNGBAT

S101 Tipo ti material ti suelo ti 1. Pitak

pagnaedan
2.Kayo

(OBSERVASION)
3. Semento

4. Dadduma pay (ispesifikaren)

S102 Tipo ti material ti atep ti 1. Labig

pagnaedan
2. Galva

(OBSERVASION)
3. Dadduma pay (ispesifikaren)

S103 Agnaed kadi dagiti ayup ken 1. Wen

 miembro ti familia iti maymaysa 2. Saan

a balay?

(OBSERVASION)

S104 Bilang ti kuarto iti balay ________

S105 Adda kasilyas? 1. Adda

2. Awan (No “Awan”, lumibtaw

ti S108)

S106 Agtagikkua ti kasilya 1. Bukod a panagtagikkua

2. Pagraramanan ti

sangakarubaan

S107 Adda makita a takki iti 1. Adda

rungarong ti erodoro (wenno

2. Awan
suelo)

(OBSERVASION)

S108 Adda makita iti aglawlaw iti 1. Adda

balay (wenno iti arubayan)

2. Awan

(OBSERVASION)

S109 No awan kasilyas, ayan na 1. Bengkak

 ngarud ti pagtakkian ti familia? 2. Dadduma pay (ispesifikaren)

S110 How do you dispose refuse? 1. Iyabot

Kasano ti pinangibellengyo iti 3. Puuran

rugit?
2. Bengkag

4. Lata a pagibasuraan

5. Dadduma pay

S111 Paggapuan ti mainom a danum? 1. Tubo

(OBSERVASION) 2. Naakkuban a bubon

3. Awan proteksionna a bubon

4. Bomba/poso

5. Dadduma pay (ispesifikaren)

S112 Distansia ti paggappuan ti __________ Minuto

danum manipud ti balay?

S113 Tipo ti pagkargaan ti naummong 1. Banga

a danum
2. Plastik a timba

3. landok a timba

4. Lata
 5. Dadduma pay

S114 Kasanu ti panangilatiwmo ti 1. Naakkuban a pagkargaan

naurnong a mainum a danum iti

2. Awanan akkub a pagkargaan
balay idi kalman?
3. Dadduma pay (ispesifikaren)

S115 Kaadu ti malaun a mainum a _______ Liters

danum ti pagkargaan a naurnong

idi kalman?

S116 Naminanu a daras ti nagurnong

idi kalman ti mainum a danum?

PARTE II- IMPORMASION ITI PAGIBASARAN NGA UBING

Saludsuden iti ina/mangayaywan maipanggep iti ubing nga agtakki, no awan agtakki,

saludsudem ti maipanggep iti kaubingan.

NUMERO SALUDSUD SUNGBAT

S201 Edad ti ubing ________ Bulan

S202 Sexo ti ubing 1. Lalaki

2. Babai

S203 Nakaiyanakan ti ubing? 1. Ospital

2. Balay

S204 Maikamano a naiyanak 1. Umuna 3. Maikatlo

2. Maikadua 4. Maikapat
 ken nangatngato pay

S205 Adda pakasaritaan (ina/ 1. Adda

mangayaywan) ti panagtakki iti 2. Awan

napalabas a dua-lawas?

S206 Napadasmo a pinasuso iti 1.Yes 2. No (Skip to

anakmo? Q208)

S207 Kasano kabayag a pinasusom ti __________ Bulan

anakmo?

S208 Ana ti agdama nga estado ti 1. Puro a gatas ti ina

pinagsuso ti ubing.
2. Ada nayun ti gatas ti ina

3. Haan pulos napadasan a

nagpasuso

S209 Ania nga edad a nangrugi a ________ Bulan

nangan ti ubing?

S210 Nabakunaanen ti ubing para iti 1. Wen, (no isu ti sungbat ti

kontra kamuras? respondente)

2. Wen, (markaan ti tsek)

Saludsod para ti ubing nga 3. Saan

agtawen nangatngato ngem

 siam a bulan?

S211 Agtakki diay ubing ita nga 1. Wen

aldaw?
2. Saan

S212 Kasanu ti kaatiddog ti aldaw ti 1. Nabibiit ngem 14 nga aldaw

panagtakkina?
2. Nabaybayag ngem 14 nga

aldaw

S213 Nu agtakki ti ubing ita nga 1. Mamin tallo

aldaw, mamin-anu a tumakki?

2. Adaddu ngem mamin tallo

3. Diak ammu

S214 Tipo ti takki ti ubing 1. Nabasa

2. Sobra a natangken

S215 Ania dagiti ubraem tapnu 1. ipaospital

maagasam ti panagtakki ti
2. ipan iti mangagas
ubing?
3. Nayunan ti makan

4. Ipakatan ti ORS

5. Ipakatan cereal based fluids

6. Isardeng/kissayan ti maan

7. Agas ti balay
 8. Dadduma pay (ispesifikaren)

APPENDIX I

Distribution of the Respondents

Barangay N n

Fuerte 323 41

Panday 126 16

Pantay-Tamurong 276 35

Puro 82 10

Villamar 240 31

TOTAL 1047 134