I. Definition of the Problem Tuberculosis is an epidemic disease declared by WHO as a global emergency in 1990.

It is the second leading cause of death worldwide after HIV/AIDS among the communicable diseases. In the Philippines, it is considered a moderate health problem with both morbidity and mortality rates declining since 1978 to 2002. Peak incidence rate was observed in 1988 while the lowest in 2002. On the other hand, peak mortality rate was in 1978 and lowest in 1992 as shown in table 2.2 (refer to manual). killer. Table 2.1 (refer to manual) showed the number of cases of TB in eight selected Asian countries in 1996 to 1997, Philippines ranked second in terms of the number of reported TB cases. Indonesia has the highest number of reported cases while Brunei has the lowest. It is printed on May 4, 1994 in Asia Week that the Philippines had has the highest testified rate of morbidity from TB worldwide. This was lifted from a WHO report in 1992. One year after, Philippines the highest number of deaths due to TB among the Southeast Asian nations. The dread of TB resurgence has been established not only in developing countries but even in industrialized countries as well, so much so that WHO raised the alarm stating TB a Global Emergency in April 1990 cautioning that the disease could claim 30M lives in the next decade. According to Global TB Database and Country Profiles of WHO, tuberculosis has consistently been among the top 10 leading causes of morbidity and mortality in the country from 1962 to 2006. Pulmonary tuberculosis ranked fourth among the leading cause of morbidity and second leading cause of mortality in 1962. In addition, TB (all forms) ranked 5th in both morbidity and mortality in 1992. Pulmonary TB ranked 6th among the leading causes of morbidity in 2006 while TB (all forms) ranked 6th in mortality in the same year. It is in the developing countries where the harm is more apparent. In the Western Pacific Region actual incidence and mortality rates could be higher than officially reported. In 1970 to 1979, the mortality rate of TB had increased worldwide. At present, TB kills about 3 million people each year, making it humanitys greatest

II. Appraisal of Existing Facts i) Facts (a) Etiologic agent of tuberculosis - Mycobacterium tuberculosis (b) Mode of transmission commonly transmitted from a person with infectious pulmonary tuberculosis to others by droplet nuclei, which are aerosolized by coughing, sneezing, or speaking (c) Incubation period 6 to 24 months (d) Duration of illness 0.8 years ii) Characteristics of Disease Occurrence as to: (a) Person male > female (b) Place highest incidence in NCR, lowest incidence in CAR

III. Formulation of Hypothesis A. B. C. D. Tuberculosis is endemic in the Philippines. Tuberculosis can be transmitted anywhere in the Philippines. Control of spread of tuberculosis infection is ineffective in the Philippines. Eradication of tuberculosis is difficult.

IV. Testing of Hypothesis A. The endemic occurrence of tuberculosis in the Philippines is evidenced by its presence in all the regions of the country. B. Tuberculosis is transmitted from person to person by aerosol that can be suspended in the air for long periods of time. C. Tuberculosis can be transmitted by asymptomatic carriers rendering it to be highly infectious. D. Mycobacterium tuberculosis develops resistance against anti-TB drugs.

V. Conclusion During the 50s and the 60s tuberculosis was put under control by countries in Europe and North America but during the period between 1970-1979 it has shown an increase in the mortality worldwide. The disease is showing

resurgence not only in developing countries but even industrialized countries as well. In the Philippines, TB is a moderate health problem because there is a decreasing trend in both incidence and mortality rates. It also showed a decrease in both morbidity and mortality rates for the past decades but the country still has one of the highest numbers of cases among Asian countries. Tuberculosis remains endemic in all of the regions in the country, with males aged 15-49 years old having the most reported no. of cases. This is because tuberculosis is easily transmitted from person to person by aerosol. Also, there is difficulty in the control of spread of the disease since asymptomatic carriers are highly infectious. Problems in the treatment also arise because of the emergence of new multidrug resistant strains. VI. Recommendation 1. Recommendation of chemoprophylaxis against tuberculosis among infected individuals. 2. Comply and continue with the vaccination program included in the EPI to prevent infection. 3. Provision of anti-TB drugs, PPD reagents and syringes and conduction of orientation and training of doctors and health personnels at all levels by the DOH. 4. Ensure uninterrupted supply of first-line anti-TB drugs to regional and peripheral levels. 5. Monitor drug supply and distribution at regional levels. 6. Contract external consultant to conduct evaluation of national monitoring and evaluation and information systems for TB. 7. Devise a program that will ensure the compliance of the patients in taking the right medications and in successfully finishing the treatment regimen. 8. Conduct regular monitoring of laboratory activities for quality-assured bacteriology and build capacity for culture needed for programmatic management of MDR-TB.

9. Enhance services at TB DOTS Centers by providing more same day services for chest x-ray and medical evaluations, and by implementing the use of blood based tests for TB infection such as QuantiFERON-Tb Gold.