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Social and Economic Research Project Reports
Filariasis: A Study of Knowledge, Attitudes and
Practices of the People of Sorsogon
Aida G. Lu
Luzviminda B. Valencia
Lilian de las Llagas
University of the Philippines
Leticia Aballa
Bicol State University
Leticia Postrado
De La Salle University
Final report of a project supported by
the TDR Social and Economic Research Component
UNDP/WORLD BANKfWHO Special Programme for Research and Training in Tropical Diseases (TDR)
No. 1
Social and Economic Research Project Reports
Filariasis: A Study of Knowledge, Attitudes and
Practices of the People of Sorsogon
Aida G. Lu
Luzviminda B. Valencia
Lilian de las Llagas
University of the Philippines
Leticia Aballa
Bicol State University
Leticia Postrado
De La Salle University
Final report of a project supported by
the TDR Social and Economic Research Component
UNDPWORLD BANKWHO Special Programme for Research and Training in Tropical Diseases (TDR)
TDWswmsn
No. 1
© World Health Organization 1988
SER Project Reports appear as part ofa series of uneditedfinal reports resultingfrom
projects supported by the UNDP/WORLD BANK/WHO Special Programme for
Research and Training in Tropical Diseases (TDR). These reports are submitted to the
TDR Steering Committee on Social and Economic Researchfor review and evaluation
upon completion of a project. Project reports included in this series have not been
published in their entirety elsewhere.
The designations employed and the presentation of the material in SER Project
Reports do not imply the expression of any opinion whatsoever on the part of the
Secretariat of the World Health Organization concerning the legal status of any
country, territory, city or area or of its authorities, or concerning the delimitation of
its frontiers or boundaries.
Authors alone are responsible for the views expressed in SER Project Reports and
for the presentation of the material contained therein.
f
and
; p
and
* J OOCUM^/’0" ?
ii
Foreword
The UNDP/WORLD BANK/WHO Special Programme for Research and Training in Tropical
Diseases (TDR) is a globally coordinated effort to bring the resources of modem science to bear on the
control of major tropical diseases. The Programme has two interdependent objectives:
• To develop new methods of preventing, diagnosing and treating selected tropical diseases, methods
that would be applicable, acceptable and affordable by developing countries, require minimal skills
or supervision and be readily integrated into the health services of these countries;
• To strengthen - through training in biomedical and social sciences and through support to institutions
- the capability of developing countries to undertake the research required to develop these new
disease control technologies.
Research is conducted on a global basis by multidisciplinary Scientific Working Groups on the six
diseases selected for attack: malaria, schistosomiasis, filariasis (including onchocerciasis), the trypano
somiases (both African sleeping sickness and the American form, Chagas’ disease), the leishmaniases and
leprosy. Scientific Working Groups are also active in the "trans-disease" areas of biological control of
vectors, epidemiology, and social and economic research. The training and institution strengthening
activities are limited to the tropical countries where the diseases are endemic.
The Social and Economic Research Project Reports series represents a new communication venture
undertaken by TDR's Social and Economic Research (SER) Component This series has been launched
to facilitate and increase communication among social scientists and researchers in related disciplines
carrying out research on social and economic aspects of tropical diseases and to disseminate social and
economic research results to disease control personnel and government officials concerned with improv
ing the effectiveness of tropical disease control.
Research reports published in this series are final reports of projects funded by TDR and usually include
more material than ordinarily published in peer review journal articles. TDR considers this material to
be valuable both for investigators involved in the study of social and economic aspects of tropical diseases
and for professionals involved in training programmes in the social sciences, economics and public health.
The series should acquaint those working on similar problems with approaches undertaken by others, in
order to test new approaches in different settings, and should provide useful information to personnel in
disease control programmes and related agencies.
In the interests of rapid dissemination of social and economic research findings, supporting material,
e.g., tabulated data, has not been included in the present report. This material is, however, available upon
request to interested researchers. All requests for such material, citing in full the number, title and author(s)
of the SER Project Report, should be addressed to: Dr C. Vlassoff, Secretary, Steering Committee on
Social and Economic Research, TDR, World Health Organization, 1211 Geneva 27, Switzerland.
Tore Godal, Director
Special Programme for Research
and Training in Tropical Diseases
TDR
Hi
Preface
Since 1979 the Social and Economic Research (SER) Component of the UNDP/WORLD BANK/WHO
Special Programme for Research and Training in Tropical Diseases (TDR) has been supporting research
aimed at improving the effectiveness of disease control programmes through the incorporation of social,
cultural and economic factors into the design and implementation of control programme activities. In
aiming towards this overall final objective, two intermediate objectives guide TDR’s social and economic
research activities:
• To determine the impact of social, cultural, demographic and economic conditions on disease trans
mission and control.
• To promote the design and use of cost-effective and acceptable disease control programmes and
policies.
The report of the late Dr Aida Lu and her team is one of the first completed projects carried out under
the first intermediate objective of the SER Component. In this innovative project. Dr Lu and her team
analysed, from an interdisciplinary perspective, the cultural aspects of filariasis in the Philippines and the
social practices of the population of Sorsogon in relation to transmission, treatment and prevention of the
disease. Data were collected through a variety of techniques: informal interviews, questionnaires and
participant observation. The research team consisted of an epidemiologist, sociologist, anthropologist and
entomologist Data were collected with the assistance of the local filariasis control programme staff and
midwives working in the project area.
Following analysis of the data, the team presented its findings to the community where they had worked
as well as to personnel in the filariasis control programme. At the request of the control programme, a TDRsupported follow-up project is now under way to examine in more detail the problems of compliance with
blood collection and treatment and, ultimately, to develop a definitive health education programme for the
control of filariasis in that area.
Reactions to this report were highly favourable, some reviewers pointing out that it was probably the first
interdisciplinary approach to the study of the social aspects of filariasis. Other reviewers noted that the
report highlighted the need to develop a better understanding of filariasis at the community level and to
improve health education aimed at its control. The results of the project are also being used to formulate
guidelines for the filariasis control programme, particularly for its health education control strategies.
The untimely death of Dr Lu, Principal Investigator of the project, deprived health researchers both in
the Philippines and in the international scientific community of a dedicated and creative investigator. Dr
Lu's concern for the development of a strong, multidisciplinary team has ensured continuation of the work
by her colleagues in the Philippines.
Patricia L. Rosenfield, Former Secretary,
Scientific Working Group and Steering Committee on
Social and Economic Research
Special Programme for Research
and Training in Tropical Diseases
TDR
V
TABLE OF CONTENTS
Page
I.
THE EXECUTIVE SUMMARY
Project Information
1
. Project ID Number and Title
. The Research Team
1
1
2.
Highlights of the Research Findings
2
3.
Some Insights on the Data
Collection Methods
4
1.
I I.
THE SCIENTIFIC REPORT
1.
5
Introducti on
General Characteristics of the
Study Area
5
3.
Health Baseline Data and Facilities
9
4.
Filariasis Problem in the Philippines
10
5.
Objectives of the Study
12
6.
Methodo1ogy
12
. Selection of the Study Population
. Collection of Data
. Data Analysis
12
13
14
Results of the Study
14
2.
7.
Characteristics of the Respondents/
Study Barangays
Socio-Economic Profile of Respondents/Barangay Respondents
Indigenous Knowledge of the Disease
.
.
.
.
.
Local Terminology for Filariasis
Theory of Causation
Mode of Transmission
Symptomatology
Diagnosis, Treatment and
Prevent i on
Respondent’s Overall Level of
Scientific Knowledge of the Disease
vii
14
16
18
18
19
20
20
21
22
Attitudes Towards the Disease
The Community’s Perception
of the Disease
Practices Related to Treatment
and Prevention of Filariasis
The Adult "Bungao" Patient’s
Attitudes and Practices
Correlation Between Knowledge,
Attitudes and Practices
Feedback Sessions at the Provin
cial and Municipal Levels
23
25
26
28
29
31
8.
Analysis and Discussion
31
9.
Some Insights on the Data Gathering
Methods Utilized
35
Guidelines for Future Health
Education Programs on Filariasis
in Sorsogon
37
Suggestions for Further Research
on Fi1 arias i s
39
10.
11.
12.
Append ices
Maps of Sorsogon
Sample Questionnaires
viii
PART £
THE EXECUTIVE SUMMARY
1.
PROJECT INFORMATION
1. 1
Project I.D. 800063:
1.2
The Research Team:
A Study of the Knowledge,
Attitudes, and Practices of the
Pe-ople of Sorsogon on Filariasis
Aida G. Lu, M.D., M.P.H.
Assistant Professor of Community Hea1 th
Institute of Public Health
University of the Philippines
(PRINCIPAL INVESTIGATOR)
Luzviminda B. Valencia, Ph.D.
Associate Professor of Sociology
College of Arts and Sciences
University of the Philippines
Lilian de las Llagas, B.S.P.H.,
M.S. Tropical Medicine
Instructor of Entomology, Institute
of Public Heal th
University of the Philippines
Leticia Abai la, B.S. Sociology,
M.S. Anthropology
Head, Department of Sociology
Bicol State University
Leticia Postrado, M.S. Statistics
Associate Professor of Statistics
De La Salle University
1
2.
Highlighta of the Research Findings
The population of Magallanes has developed, through
many years of exposure to filariasis and the stories of
e1ders,
<a system of beliefs and practices
surrounding
the disease,
Their knowledge about
the
causat i on,
symptomatology,
treatment and prevention
of
the
d i sease,
though not scientifically sound,
foilows a
logical sequence.
Regarding the respondent’ s 1 eve 1
of
sc i ent i f i c knowledge of the disease,
the
respondents
gave correct answers
to only 50% of
the know 1 edge
quest ions.
Genera 11y, the older respondents have more
know 1 edge about the disease than the younger ones
and
those with higher socio-economic t
‘
status
tend to have a
better understanding of the disease.
The community has developed
local
terminologies
1 oca 1
for
the disease.
All
of
the existing
terms are
ex i st ing
indicative of the recognizable symptoms of the disease,
Thus,
various
illness categories
were
deve1 oped
pertaining
to signs of the various phases of
the
di sease.
It is interesting to note that
these
terms
broad 1y describe any sign or symptom
regard less of
cause.
For example, MbungaoM is a term used
for any
en1argement
of the scrotum in males and "buwa" of
the
labia in females.
In this sense, hernia cases are a 1 so
es.
identified by these terms.
The
respondent’s
theory
of
causation
and
transmission <of* the
**
disease are similar, namely!
the
entry of coldness ---into-1 a person’s body through contact
with ordinary
<cold
’ * water after heavy work and
the
carrying of heavy
loads,
- -----These aspects of the disease
are viewed as occupationally related,
Male adults
who
work as loaders or farmers constitute the majority
of
observed
cases.
These occupations
are
c1ose1y
associated with heavy loads and perspiration,
Thus to
attr i bute
filariasis to these factors
is
just i f iab1e
within
their world.
A very
limited
number
of
respondents ]pointed to mosquitos as the direct cause,
Knowledge about the
disease» organism is virtual ly nil.
----------However,
in areas where mosquitos
abound,
more
respondents ascribe the disease to it.
Likewise,
due to the prevailing
theory
of
causation/transmission
of
the disease,
prevent i ve
practices consist of avoidance of
getting wet when
fatigued and of carrying heavy loads,
To them, this is
more
logical
than the use of mosquito nets when
sleeping.
No other measures are undertaken,
For
example,
houses are built within abaca and banana
plantations to facilitate the work done in these areas.
No attempts were made to change the materials
materials and
structure of houses for protection against mosquitos.
2
are
Very few respondents and
key
informants
comfortable
knowledge,
attitudes
in discussing their
and practices regarding "bungao"
’’bungao” or ’’buwa”, the
terms
used
for the male and female versions of the disease.
The disease affects the body part considered "delicate"
and
taboo in open discussion.
Especially in females,
early
detection of
cases
is difficult,
if
not
with
impossible,
since
the disease
is
equated
promiscuity and thus carries a social stigma.
"Bungawons",
the male "bungao" cases are subject
to
ridicule but not ostracized.
ostracized,
The disease
is
not
considered contagious since, according
to
indigenous
perception,
it
is not caused by a disease organism.
Therefore, cases are not segregated and continue living
with the
fami 1y.
family.
Afflicted people are welcome in
community gatherings.
But at times they are laughed at
due
to
the enlarged scrotum.
Different titles are
conferred on them.
In view of this,
"bungao"
cases
felt disturbed upon knowing they had the disease.
Some
endulged
in self-pity and became very embarrassed by
their condition.
Only about half of the respondents know about
the
are
exact symptomatology of the disease.
The symptoms
the clinical or recognizable signs only.
They are not
equally familiar with the various phases of the disease
by
severity,
although in general,
the respondents’
perception of the severity and prognosis of the disease
seemed
to correspond with the size of
the
scrotal
enlargement and the degree of physical incapacitation.
The early symptoms of the disease are v i r tua11y
which
unknown to the majority of respondents.
Fever,
is
one of
the earliest symptoms
is not cons i dered
such
symptomatic
of
the disease.
Occurrence of
symptoms may have been attributed to other diseases or
The disease is equated
not given any attention at all.
labia
exclusively with the enlargement of the scrotum,
and
lower
extremities, which signs characterize
the
latter stages of
the disease.
Consequently,
the
urgency to submit oneself to blood and other types of
Of
examination
for
early detection
is overlooked,
b 1 ood
those very few who are aware of the relevance of
examination, only a very restricted number can give an
of
accurate
reason for
the nocturnal
collection
specimens.
Surgery and medications are considered the best
forms of treatment.
These, however, cannot be availed
of
by most of the cases interviewed due
to financial
constraints.
Some of them resort to economically more
accessible
forms of folk surgery in combination with
Most
other forms of traditional and modern practices.
3
a
of the respondents are not aware of the existence of
they
filariasis control program in Magallanes nor have
consulted the center for filariasis problems.
3.
Some Insights on the Data Collection Methods:
in this
Among
the data collection methods used
yi e1ded
with
key
informants
study, the depth interview
relevant
information.
the most comprehensive and
interview
the
The attitude scale negate some of
the
in
studies
It
was
found
in
other
findings.
is
a
setting
that
this
type
of
data
gathering
Philippine
di sma1 failure.
the
to
appeared
interesting
The
vignettes
terms
.
ar
are
expressed
in
popul
respondents since these
4
THE SCIENTIFIC REPORT
INTRODUCTION
known or
is attributable to some cause,
Di sease
causes
of
Throughout history, the cause or
unknown.
factors,
have been ascribed to a variety of
d i sease
influenced by changing human thought and
these being
the
interpretations of man’s observations on
diverging
of disease.
surrounding the development
ci rcums tances
certain manifestations of
particular
Consequent 1y,
diseases have been correlated to the known causes, while
are directed
to
practices on prevention and control
In some areas, much of the past
avert risk of exposure.
causation and transmission has
thinking on disease
persisted in the public mind in spite of the progressive
modernization of
medical
knowledge and
techniques.
These communities seem to have developed a cu1tural
evo1ve
system which has made it possible for people to
their own definition of the causation, transmission and
symptomatology of certain diseases.
studies conducted in the Philippines
by
Severa1
and sociologists
in
foreign and local anthropologists
past have also discerned a
persistent
the
recent
adherence to the traditional and supernatural beliefs as
to
the causation of the disease (Lieban,
1962;
1966).
Thus, people included in a study of folk medicine in the
Philippine municipality stated (Jocano, 1973):
to
a
(illness)
is due
Sakit
or
elements
in the body
disturbance
of
This disturbance is brought
external to it.
diet,
improper
about by changes in season,
the
accidents
and
sorcery,
witchcraft,
general conduct of life....
g i ven
factors,
has
among other
stubbornness,
This
hea1 th
tradi t i ona1
to indigenous,
continued currency
pract i ces and provided local healers with a s i zeab1e
c1i ente1e.
GENERAL CHARACTERISTICS OF THE STUDY AREA
the
southernmost
region dominates
The
B i co 1
the
to
the island of Luzon and extends
peninsu1 a of
The
provinces of Catanduanes and Masbate.
i s1 and
Sur ,
Camarines
include
the mainland
province
in
Camarines Norte, Albay and Sorsogon. M
*The
Sorsogon.
study
site i s situated in the
5
province
of
This region was formerly known as "I ba 1 on” wh i cb
p 1 ace
lowland,
indicating that this place
is most 1y
means
A 1 bay
of
flat
land.
In
1846,
the
province
of
composed
was created and this included Sorsogon.
Half a century
later, in 1894 Sorsogon assumed the status of a separate
province.
How "ibalon” became known as ’’Bicol” was
not
very clear.
According to Don Mariano Goyena,
a well
cu1ture,
known historian and authority on the Bicol culture,
the
original
name
just faded away and was
replaced by
”Bicol” which he theorized was derived from the name of
the famous river in the region.
The Bicol Peninsula is a conglomeration of several
sub-peninsulas with a very lengthy, rugged and irregular
coastline.
In view of this, there are numerous harbors.
The terrain is hilly with large rivers, many streams and
the
a number of lakes formed by the lava emanated by
majestic Mayon Volcano.
the
among
The Bicolanos are the most congenial
T hey are
various ethnic groups in the Philippines,
character
known for the mildness and docility of the i r
Br ien,
and
the temperance of their customs
(O’Brien,
1968).
Their customs and political ways of life most
closely
approach natural reason.
They are calm and
temperate
people and particularly honest and retired (Caba1quinto,
1965).
this
They are very religious.
Churches abound in
region and it is not rare to see men going to church by
themselves.
The women are always finishing a novena or
starting a new one, cleaning or beautifying the altar.
The
dead are spoken of
as
though alive and with
reverence.
Memories of them are woven into endearing
anecdotes retold many times.
The Bicolanos are fond of social dealings and are
adjusted to live in clustered compact villages (O’Brien,
1968).
As is true for most part of the Philippines, the
important
is
the
first and most
bicolano
fami 1y
va1ues
Transfer
of
customs,
beliefs,
socializing agent,
society
ideals
occur
through
the
family.
Thus,
and
chi 1 dren
the desired and expected behavior of
mandates
The functional aspect of
mostly through their parents,
if
kinship is reflected when relatives are approached
can
is
confronted
with
a
problem.
The
Bicolano
someone
the
count on the help of not only his parents, but also
the
ir
poo
1
circle
of
other
relatives.
They
wide
resources together when in need, acting as a cushi on
against hard times.
one of
the provinces
prov i nces
of
the Bicol
Sorsogon,,
i s1 and
lies
at
the
southeasternmost
tip
of
the
region,
1-- --
6
of Luzon.
It is in the form of a "fish hook" surrounded
by embayments and straits at i ts northeastern border.
The western portion, however is characterized by hilly
mountainous terrain where vegetations abound especially
knows practically no dry
abaca and banana.
The province
]
to
maximum
rainfall
from November
season and gets
heart
Lying at the
January (TypeTil rainfall variety).
often
it
is
typhoon
belt
of
the
Philippines,
of
the
and
November
vis i ted by weather disturbances come
December.
This
province has a total land
lana area of
214,144
hectares with 24,514.5 hectares arable for farms.
It is
composed of 16 municipalities with a total population of
81% of
resides in the
rural
1975) 5 L..-- which
--446,502 (as of 1975);
with
only
19%
in
town
centers
or
poblacions.
Of
area
population,
5
years
and
over,
93.1%
are
living
in
the
where
they
have
resided
since
5
years
the same barangay
ago. Majority are gainfully employed, mostly as farmers,
Its literacy
fishermen and related workers.
loggers,
population,
10
the
rate
is 78.4% and about 70.3% of
of
elementary
year s and over, completed at least a year
educat i on.
sq.
Four hundred sixty-six (466) km. of roads/100
products
.
help
link the barangays for easy flow of
km.
1
so
that
Almost all the municipalities had waterworks
35.6% of
households are supplied with piped water.
However, 32.3% still have open wells as source of water.
in this
Mabulos Magalles
is the dialect spoken
is
however,
province.
Tagalog
(Filipino
language),
understood and spoken by everybody.
the
fourth class coastal town of
a
Magallanes,
Sorsogon,
named
of
the
province
of
part
southwestern
Fernando
sailor and discoverer,
famous
after
the
has a
setting of the study.
It
is
the
Magallanes,
I
sprawling area of 14,435 hectares of agricultural lands,
fishpond sites and green forests crisscrossed by streams
of
Long stretches
and patches of swamps and mud flats,
is
It
beach areas define the shorelines of this town.
town
653 kms. from Manila and 47 kms. from the capital
of Sorsogon.
Thirty-five barangays* compose this municipali ty
of which 8 comprise the poblacion; 5 are s i tuated a 1 ong
the
the municipal road, 11 are in the coastal areas and
The
other 11 make up the interior portion of the town.
total population is 28,336 (as of 1981).
*A barangay is the smallest political
about 100-200 househo Ids.
7
unit
with
Three ooff
the 35 barangays,
namely - Bacolod,
Bacalon
and
Siuton
were
the
scenes o f
the
anthropological portion of this study,
Barangay Bacolod
is
part
of
the
"Poblacion"
and
is
situated
on
a
reclaimed
area
along
the
pier
on
the
northwestern
border.
It has a total land area of 3.3639 hectares
with 70% utilized for residential purposes and the rest
for commercial purposes.
The houses are mostly made of
nipa thatch for roofs and walls, bamboos for posts and
flooring.
Except
for
a
few,
most
houses have no
separate sleeping rooms nor are kitchens walled off from
dining rooms.
As a rule , the family sleeps together in
the living room,
Mosquito nets are not
no t commonly used
because they claim there is no need for one since there
are no mo s q u i t o e s .
The drainage system
s ys tern of the town
proper
empties
right
into
the
entrance
of
the
barangay.
The ’’flow" spreads out in rivulets
r ivule t s into the
yards and under the houses before it finally goes out to
the sea.
The unused pier now serves as a breakwater
blocking the flow of
o f sewage
!
and causing some parts of
the
barangay
to
be
constantly
under
water.
Such
condi tions do not obviously concern the locals for their
response is to construct their houses on stilts some two
feet above the ground.
The pier is left undisturbed,
the mud and the dirt
too .
too.
They have
found
their
solution and that is to buildL higher and higher above
the ground .
The unused pier serves aass the playground
for the children.
One of the nearest barangays to the "poblacion"
BacaIon, 4.5 kms . east of the town proper.
is Bacalon,
It i s
the third biggest barangay of Magallanes in terms o f
land area (6.96 hectares),
Percentage of land use i s
mainly agricultural (85.5%) with some parts planted with
coconut trees or converted to f i shponds by landowners.
The terrain is hilly with few kilometers of valleys
marshy
in character
in
the
northwesten border wi th
springs and swamps cutting across 3.5 k i1ome t e r s of
rough roads .
The BacaIon river, however, is utilized
by the people for trans port ing agricultural product s
like coconut, banan , rice, cassava,, vegetables and other
rootcrops.
This barangay is the least progressive area
in the entire municipality wh i ch could be explained by
its relatively low population density and scarce human
resources.
The third barangay studied
:
is Siuton.
The name
originated
from the word
"siut
nin
tubig",
meaning
wedged by two big rivers which surround the communi t y
proper.
It is an agricultural community with 80% of the
total land area (2.722 hectares) devoted to plant ing
coconuts, rice and corn, abaca, coffee and bananas .
During the pre-war days, abaca plantations dominated the
area but with the slump in the demand for Manila hemp in
the local and world markets, the residents decided t o
replace these with coconut trees.
The soil is fertile
8
so that the land abounds with vegetati on.
B1essed with
su i tab 1e climatic conditions and a good amount of
rainfa 11,
the barangay is thriving,
Like in the
other
barangays the houses are made of
bamboo,
wood,
n i pa
thatch and dried abaca stalks and are mostly
s i tuated
along streets, with some near the bank of the river and
in the up 1ands.
The barangay is
linked with other
surrounding areas by roads and by Gibaldon river,
Two
jeepneys
commute
regularly between the pob1ac i on and
Si uton,
serving
the people’s need to
travel
to
the
center of the town.
HEALTH BASELINE DATA AND FACILITIES
The various health indices computed for 1981
are
comparable to the national values.
The Crude Death Rate
is 9.98/1,000 population with Pneumonia,, Diseases of the
Heart and Pulmonary Tuberculosis as the leading
causes
of mortality.
The age-specific death rate is highest in
the age group 60 years and above followed byF the
the 0
0 to
to 4
(275.1~ and 42.35/10,000 population respectively).
years (275.18
The Infant Mortality Rate iIs 54.45/1000 livebirths and 5
leading causes of infant deaths are Bronchopneumonia,
Diarrhea 1 Diseases, Asphyxia Neonatorum, Meningitis
and
Tetanus Neonatorum,
Majority of the cases consulted
to
the health center and barangay health stations are
diarrheal and respiratory diseases.
To
take care of
the health needs
of
the
municipa1i ty, a rural health team mans the local
hea1 th
center.
A public health nurse, 7 midwives, a sanitary
inspector and a dentist compose the team.
The municipal
health officer’s position had been vacant
for
several
months
now.
From time to time,
one or
two
rural
practice doctors* are assigned to the area for 6 months,
There is a small community hospital in a nearby barangay
which is complemented by a medical team consisting of a
resident physicians and several
nurses,
a
medical
techno 1og i st and nurse-aides, The midwives, except
for
one who stays at
the main health center
in
the
pob1aci on,
are fielded in the various barangay health
stations.
They have been trained as primary health care
providers and administers to the health needs of
the
peop1e
within their catchment areas.
Levels
of
referrals are observed in this unit.
Severe cases
are
referred
to the public health nurse in the main health
center and
if
still
beyond
the
capab i1i t i es
and
faci1i ties
in the health center, these are sent to
the
*Med i ca1
graduates are required to serve
in
the
rural
areas
for 6 months
before acquiring
the i r
1icenses.
9
hospi ta1.
community hospital.
Lay barangay health workers
( 10)
had been trained to augment health care delivery at
the
grassroots.
Likewise,
30 indigenous
healers and 30
traditional
birth attendants had also been
g i ven
training on treatment and prevention of simple ai1ments
and
aseptic attendance at
delivery
respective 1y.
Several
"botikas sa barangay” (village drugstores)
had
been established to provide essential drugs at low
cost
to the people.
The
sanitary
inspector
takes care
of
the
environmental
sanitation of
the whole town and
is
assigned at
the main health center,
He
iiss ;also
incharge of the local Filariasis Control act i v i t i es whi ch
are implemented
in coordination with the Prov incia1
Filariasis Unit.
This unit is based at the provincial
health office
in the capital town and composed of
a
medical
specialist, a research entomologist, 6 med i ca1
technicians and several laboratory aides.
They conduct
screening,
treatment and educational campaigns as well
as
entomological
studies in Magallanes
sporad ica1 1y.
Hence,
there are no regular clinics held at the hea1 th
center
for
filariasis,
neither are
there medicines
avai1ab1e
for
treatment.
Campaigns are held at
the
barangays but people are very reluctant in joining blood
screening and treatment clinics.
Persons diagnosed as
having the disease refuse to take the medicines given as
these make
them more sick.
To avail of
surgery,
the
patients had to
go to the capital
town and
seek
admission to the provincial hospital.
This may entail
severa1 visits and so becomes very expensive.
THE FILARIASIS PROBLEM IN THE PHILIPPINES
Infectious d i seases
sti 1 1
account
for a high
propert i on of deaths and i11nesses in the Phi 1ippines.
some of these are a perpetual menace to some parts
of
the country due to their endemicity.
One
of
these
d isenses
f i1 ar i as i s.
is
filariasis.
Scattered widely
in
many
i s1ands,
the
d isease
disease
occurs
most 1y
in
rural
environments.
In 1977, the national incidence rate
was
.02/100,000 population (DIG Report, MOH, 1977), all
the
cases having come from the endemic areas
such as
Sorsogon,
Pa 1awan,
Negros Oriental,
Leyte del
Norte
(with a rate of 0.2/100,000 population)
and Eastern
Samar
(0.7/100,000 population).
However, unlike other
reportab 1e
diseases,
filariasis
is
grossly
underreported,
The prevalence rate which was
revea1ed
in a survey conducted by the Filariasis Control Unit
of
the Department of Health in 1965, was 3.7%; 29 out of
the 48 provinces were again surveyed of which 37 were
pos i t ive
for
filariasis with infection rates
ranging
10
from 0.02% to 10.08% or an average rate of
4.06%.
Of
the Luzon provinces, Sorsogon has the highest prevalence
ranked
rate of
8.40%,
while in the Visayas,
Samar
had
the
highest with 4.04%.
Sulu archipelago, however,
provinces
prevalence rate among al 1
the
hi ghest
the
rate
being
10.18%
(Cabrera
and Arambu1o,
surveyed,
1973).
Several epidemiologic surveys have been conducted
by the Filariasis Control Unit in the 16 municipalities
In the 9 municipalities studied
of Sorsogon since 1964.
from
Tsee
and
1970,
the
prevalence rates ranged
between 110-15
11.66%.
Succeeding surveys
conducted
5. 54% to
preva1ence
later
showed
a
decreasing
trend;
the
years
surveys
ranging
from
2.47%
to
5.08%.
Results
of
rates
1 ower
1970 in the 6 other municipalities revealed
from
Two surveys
pr eva1ence rates (range of .53% to 4.77%).
were conducted in Magallanes, the first in 1965-66 with
a prevalence rate of 5. /<□% and the second in 1979 with a
rate of 4.58%.
The most common mosquito vectors in this province,
revealed
by entomological surveys conducted by the
as
cu 1 ex
poici11 us,
Control
Unit are Aedes
Fi1 ar ias i s
main
The
quinquefasciatus and mansonia uniformia.
usua
1
whose
vector,
however,
is
i s the aedes poicillus
banana
and
breeding place
is
the axil of the abaca
is
the abaca
Though
in
plants.
Thnueh there was a decrement
plantations in the province and the emergence of such in
banana plants abound.
other
areas
in
the country,
<-- *
s teady
due
to
characteristic
Continuous breeding occurs
ra inf a 11 throughout the year.
the
studies on
there
is a dearth of
made
Attempts
have
been
this disease,
This
annual peso loss from filariasis.
the
s
i
nee
to be in staggering amounts
are
endem
i
c
have been established as
most
persons
productive areas and the
this
Moreover,
to the labor
force,
affected belong
is
and
abaca
areas
disease affects the abaca-producing
country.
the main agricultural exports of
the
one of
the social stigma attached to
the pathologic
However,
sequelae of“ the disease tells more heavily on its victim
than its tangible pecuniary cost (Cabrera and Arambu1o,
1973).
There are no known local studies on the existing
rura I
the
indigenous
perceptions of the disease among
the
population.
their
attitudes
towards
Neither
to
it
have
been
disease nor the practices pertaining to it have
investigated.
The serious neglect coupled with the
realization of the impact
the social dimension of the
disease has on its prevention and control, motivated
this study on the knowledge, attitudes and practices of
Planned and
the people of Sorsogon on filariasis.
technical
assistance
of the
conducted with financial and
To date,
social aspect of
to ca Iculate the
has been found
prov i nces which
11
UNDP/World
Social and Economic Research Component of theTTwa
.nin_
* g»
in
Bank/WHO Special Programme for Research and T
i
Apr
i1
Tropical
Diseases, this project study parted tn research
of
1981
terminated in February 1982.
The r___
1981 and
and terminated
di scip1ines s
team consists
of
specialists
from
several
consists of specialists
an
a physician in
in Community
Community Health,
Health,
a socioJogis ,
physician
a
^toSogl.l.
.nthr=P»>o.l.t,
a
p.r.s.to!o
S
l.t
.nd
an anthropologist, a
statistician.
OBJECTIVES OF THE STUDY
determine the knowledge, attitudes and pract i ces
To
f ilariasis.
the
people
of
Sorsogon
on
of
Specifically, the study seeks
1.
1.1.
1.2.
1.3.
2.
- 1 and
To describe the people’s indigenous
traditional knowledge of’ the causation,
transmission and symptomatology of filari as i s.
To describe the existing local attitudes
and perceptions towards the disease and
to
the current prevention and control
program.
To describe the cultural definition of the
disease and
the
social practices of the
people relating to the transmission, treatment and prevention of filariasis.
for
gui de 1ines
in formulating
To utilize data
and
prevent i on
to
vari ous approaches
p1anning
in educat i ona1
especial
1
y
f ilariasis
of
contro1
programs.
2. 1.
To determine target groups
2.2.
To design the appropriate strategies.
METHODOLOGY
Selection of the Study Population
random
2-stage
A
combination
stratified,
of
comb inat i on or
municipa
1i ty
The
sampling was
utilized in this study,
was
using
the
of
Magil lanes was divided into three strata
Hagai lanes was
center
of
the
poblacion
(Stratum
1)
as
initia
the
center
reference.
the basis of distance from listed.
On
In
point
the barangays in each stratum were
12
Strata I I and III,
into two groups,
barangays.
the barangays were further subdivided
namely,
the coastal
and
interior
each
Random samp 1ing of 50% of the barangays in
done,
thereby u11 imate1y
stratum and sub-group was
including 18 barangays in the study.
1980)
There are a total of 4410 households (as of
were
Ten percent (10%) or 441 of these
in Magallanes,
in
proportionately allocated to the selected barangays
the
Four members of
each household,
each stratum,
f ema 1e
father, the mother, one randomly chosen male and
in
child above 10 years old constitute the respondents
A total
of
1261
respondents from 461
the
study,
households were interviewed.
Collection of Data
adopted to
Two methods of data collection were
the
semi
fulfill the objectives of the study, namely:
pre-tested
structured
interview
utilizing
a
questionnaire and participant-observation techniques.
The
interview schedules contained
the
fol lowing
i terns s
1.
The
respondent’s
understanding
of
the
causat i on, transmission and symptomatology of
f i1 ar ias i s based on their indigenous body
of
facts, experiences and observations.
2.
The belief system and feelings surrounding the
causation,
transmission,
treatment
and
prevention of the disease.
3.
Local
habits and customs of
relation
to
transmi ss i on.
prevention of filariasis.
the people
in
treatment
and
The
interview schedule consisted of three parts,
and
specifically,
a series of
closed
open-ended
questions, statements with a likert scale response and a
set of ’’vignettes’’.
Special questionnaires were also
formulated for adult and child cases
if ever
these
existed
in the sample households.
The likert scale
is
composed of discriminatory statements on popular beliefs
the existing
about
the disease and feelings
toward
Agreement or disagreement to these
control
program,
The ’’vignettes", on the other
statements were elicited.
in nonportrayals of the disease worded
hand,
are
the i r
language.
Respondents were asked
techn i ca1
the status of the disease
in terms of
perception of
13
severity and prognosis.
Six
(6)
field
interviewers administered
the
interviews.
With the permission of
the Provincial
Health Officer and in coordination with the Provincia1
Filariasis Control Unit, six midwives in the Maga1 lanes
Rural
Health Unit were
recruited and
trained
in
interview
techniques and later fielded in the sample
barangays.
The
town mayor furnished the mi dw i ves a
letter enjoining the cooperation of all
the barangay
captains of the involved areas.
Periodic
superv i s i on
and re-training were provided by the research team.
Alongside
these procedures, observat i ons
of
the
domestic,
social
and occupational
act i v i t ies
of
the
people were conducted
in order
to obtain
factua1
information on those practices which are related to
the
exposur e
to the disease agent and transmission of
the
d isease.
Moreover, this aspect of the
study provided
va1i dat ion of and
depth to the
interview resu1ts.
Participant
observation was done
in three
random 1y
chosen barangays
representing each of
the
sampling
stratum.
These were Baco1od
(Stratum
I >f
Banacod
(Stratum
I I)
and Siuton (Stratum
III).
k
doctora1
student
i n Anthropology at
the University of
the
Philippines iiveu
lived in tnese
these areas for a month followed by
two sociology graduates from the Bicol State University
for
two
and a half months.
In
addition,
the
collaborating socio-anthropo1ogists, a faculty member of
the Bicol University, together with 6 senior students in
Sociology,
stayed
in these places
for a week
to
determine the ethnography of the three barangays.
Field
and diary notes were written and compiled to record
the
daily observations.
Depth
interviews were
likewise made with key
informants, and group discussions with community leaders
and members were held to supplement
the
observations,
Key
informants were selected on the basis of a set
of
criter ia, name 1y:
1.
2.
Clinica1 case
Non-case
representing various occupational groups
in the community
chosen on the basis of age, length of stay
in the barangay and degree of credibility
in the barangay.
A
photo-ethnography port i on was
included
to
provide
in-depth dimension to
the
research output.
Furthermore,
the following portions of the
study were
documented.
14
1.
area,
Entry of
the
team
into the
study
the
including the training and supervision of
interv i ewers.
2.
geographical terrain and the
The
the community.
eco1ogy
3.
The many faces of the respondents
home setting, and final 1y,
in
4.
The description of the various occupations
the community.
of
their
in
validate the research findings,
feedback
To
di scuss i ons were arranged and conducted with different
the providers and consumers of
groups representing
A meeting was held at the Provincial
hea1 th services.
Health Office with the rural health personnel of various
Control
Unit was
units
in Sorsogon.
The Filariasis
students
from
however met separately.
Six graduating
community
feedback.
the Bicol University prepared the
of
In spite of the inclement weather, barangay captains
vice
mayor
and
the sample barangay, the municipal mayor,
conference.
A
some community
leaders attended
the
and
the
hea
1
th
member
of
the Filariasis Control Unit
center staff were also present.
Data Analysis
initial 1y
distribution tables were
Frequency
the
variables
to
determine
the
trend
constructed for all
the
prevai
1ing
of
responses and
thereby ascertain
the
respondents,
knowledge,
attitude and practices of
To know the
level of knowledge and attitude on the
transmission,
symptomatology, prevention and
causat i on,
each
treatment of the disease, scores were obtained for
for
of
the respondents which were
later
quantified
overall
results.
Mean scores
for
each
attitude
statement were computed and interpreted according to a
or
qualitative
continuum of
levels
of
agreement
a
assi
gned
The vignette responses were
d i sagreement.
va
1
ues
of
on a pre-set table (Appendix A)
score based
1
then were
The scores
each of the five questions.
for
stratum
and
respondent
type
to determine
ana 1yzed by
composite
community
perception
of
each of" the
profile of
sever i ty).
disease
(in
different
levels
of
portrayed
and
differences
in
knowledge,
attitudes
Likewise,
to
among
the
three
strata
were
assessed
practices
of
the
influence
of
distance
from
the
center
determine
the town.
Cross
tabu 1 at ions
15
of
know ledge,
att i tudes
and
practices with respondent types (father, mother, son and
daughter) were done.
Moreover, correlation analysis was
performed to ascertain
the
relationship of
socio
demographic characteristics with knowledge,
attitudes
and practices.
The associations between knowledge and
attitudes and between practice and attitude were a 1 so
explored.
observat ions
The results of the anthropological
the
were ut i1i zed
in supplementing and explaining
transmi ss ion,
Practices related to
interview findings,
by
prevent i on and control of the disease were derived
observations in the three barangays.
RESULTS OF THE STUDY
Characteristics of the Respondents/Study Barangays
More than 10% of the 4410 households were included
the survey consisting of 1261 respondents
from 461
in
Of these, 21.16% (393) are
fathers while
househoIds.
and
32.91%
(415) were mothers; 17.04% (215) daughters,
(217)
sons, with 1.66%
(21)
other
respondent
17.20%
types
like older sisters, brothers or aunts who are
heads
of
families.
Generally,
the
cons i dered
22.75 years,
respondents are young with a mean age of
The average ages by respondent type are as foilows:
Respondent Type
Mean Age in Years
44.2
41.9
20.7
19.2
45.7
Fathers
Mothers
Daughters
Sons
Others
Socio-Economic Profile of Respondents/
Study Barangays
Most of
the respondents are native to the area
1 i ved
having stayed there since birth or having
lived
there
for over 25 years.
the families, consisting of
husband
and wife living with children (usually, family size is 6
and above),
stay in single houses which are one
room
affairs.
They however, own their houses,
except for
some
families,
especially in the sample barangays
of
Stratum I,
I , who are either renting the house or squatting
16
• ‘’s; land.
Majority of
the houses are
on other people
and nipa or wood and nipa.
Most
constructed of
l_ bamboo
--often the household owners raise chicken and poultry
anima 1s in their backyards for food or to be sold in the
Typically also,
they have dogs and cats as
market.
in
their
familial
surroundings.
Families
fami 1ia1
part
of
carabaos
barangays belonging to Stratum II and III own
cu11 ivate
tilling the rice farms.
These families
for
other
fruit-bearing
plants
in
their
yards as
banana and
well.
very
Since most of the houses have only one room,
common
few have separate sleeping quarters.
It is very
to have the wife and husband sleeping together with the
the
children on a single floor mat with or without
protection of a mosquito net, the latter being reserved
for important visitors.
Such sleeping arrangements pose
health problems especially in the mode of
transmission
of illnesses, such as filariasis, in the area.
fathers
than half (54.5%) of the respondent
More
while
are
farmers,
the
farmers, followed by fishermen (21.4%),
rest (24.2%) are vendors, teachers,
employees and abaca
gatherers.
Majority of
the mothers
(82.4%)
are
housekeepers and some help their husbands in vending and
(63.7%
Daughters and sons are mostly students
farming.,
schoo
1
and 55.8% respectively) with the others out of
fathers
in
helping their mothers at home or their
and
farming and fishing.
is
the predominant
occupation
in the
Farming
* ) second and third strata (represented by
barangays of the
since agricultural
lands abound,
Bacalon and Siuton)
L_
landlords” (about 2% of
the
total
However,
"absentee
1ands.
The
number of families) own almost 80% of these lands.
foilows:
system between farmer-landowner is as
sharing
thatch
for coconut and 75-25 for rice.
For nipa
50-50
The
2 pieces for maker and one for nipa owner.
making:
they
are
Consequent 1y,
farmers work on a tenancy basis.
to
chi 1dren
that they cannot even send their
so poor
I
nstead
,
elementary school, much less to high school,
as
extra
children early
in their lives, are utilized
hands in the field.
the
the barangays of Stratum 1, especial 1y in
fishing
is
the
main
shorelines (represented by Bacolod),
Sometimes, fish is used as a
source of
livelihood,
in
the
barter system practiced by the
medium of exchange
local people.
In
in the barangays rests on the barrio
Leadership
councilmen, council secretary and treasurer,
captain,
the
kabataangj barangay chiarman (youth counterpart of
The midwi fe
and the barangay brigade.
barrio captain)
<
to be an
seems
assi gned to the barangay, however,
17
important figure
in the barangay.
She
spearheads
act i v i t i es both in the political, social and
re 1i gious
domains.
The majority of them sees no relevance in joining
community organizations or clubs except for membership
in the Barangay Brigade (which is almost compulsory in the
present
political
structure).
Only a
few
(22%)
indicated affiliation with Parent-Teachers Association.
Boy Scouts and Girl Scouts and the Samahang Nayon.
The Indigenous Knowledge of the Disease
Two-thirds (64.2%) of those interviewed know
that
there is an illness called filariasis.
Fathers
(87.5%)
are more aware than mothers (76.4%) and
so are sons
(33.2%)
more aware than daughters (29.8%).
Because
of
their actual
exposure to people af f1icted with
the
disease,
most of the respondents (44.6%) get
to
know
about
filariasis.
Others (33.2%) jave heard
stor i es
from e Ider members of the community whil e some
(6.2%)
learned about it from the filariasis clinic.
Local Terminology for Filariasis
of
Fi1 ar ias i s
is associated with several
categor i es
1 oca 1 disease shown in the following tab 1e.
FILAR I A S I S
M a 1 e s
F e m a 1 e s
Both Sexes
Bungao
Tustus
Tagu-api
Bubuwa or Buwa
Tibak
The above diagram indicates that sex
is
an
important
sorter of the disease.
Among males,
n taguapi”
(congenital enlargement of one of the testes)
and
tustus
(lowering of intestines into scrotum)
indicate
early stages of
”
bungao”
(full-blown disease
"bungao
wi th
enlarged scrotum).
Several terminologies are used to
identify the disease in females namely:
” bubuwa”
or
”buwa” and "bubuya” or
"buya”
(enlargement
of
the
vaginal
labia or lowering of the ”matres" or
uterus).
These
terms came from the local words ”bubong nagyaya”
or ”bubong nagwawa” which mean descending or
protruding
tissue in the female external genitalia.
”Tibak” on the
18
other
hand
(enlargement of extremities)
occurs among
males
and females.
The work ’’tibak” was
der i ved
from
the word ”tigbak” which means death.
The natives
te 1 1
stories of afflicted people who hide in
the mountains
until
death
to escape ridicule
from
the community,
Likewise,
the word "bungao"
seemed to have or i gi nated
bungao
from the word "bunao"" (testes).
(testes).
A person afflicted with
the disease
is 1abelied a "bungawon"
(with enlarged
scrotum) or ” tibakon” (with swolien legs and feet).
Theory of Causation*
The
preva i1ing view
on di sease causat i on
is
"nasurip na ugat".
Specif ica11y, it refers to the entry
of
"lamig"
(coldness) into a person’s body by way or
"ugat*” through contact with ordinary cold water
his/her "ugat»"
after heavy work.
A farmer or abaca stripper who allows
his perspiration to dry up on his body without changing
his clothes, may develop "bungao".
Fishermen may a 1 so
acquire
the disease from prolonged exposure
to sea
water.
Thus, the swelling of the scrotum is explai ned
to be due to accumulation of water in these body par ts.
ascri bed to the enlargement of the scrotum
Other reasons ascribed
are fatigue, carrying of heavy loads, washing; after
sexual intercourse,
and too much exposure
intercourse,
to heat .
Some, however,
however, noted that a person with ”tagu-api” i s
prone
to
have
"tustus"
which
later
progresses
to
"bungao”.
On the other hand, in women,
women, carrying heavy
loads, "relapse"
’’relapse” after child birth**, taking baths
and
1
during
washing
menstruation,
or
promiscuity
promi scui ty may be
causes ooff "buwa” or "buya”.
’’Tibak” has also been
attributed to long walks, prolonged standing or squatt
ing (especially among fishermen while mending nets).
Depth
interviews with a lawyer, a school
teacher
and
political
figures
in
the barangays,
however,
revealed a different opinion on the causat i on
of
filariasis.
According to them the disease i s
due
to
mosquito bites.
The polarization of knowledge on the cause of
the
disease between the popular view of
"surip"
(sudden
exposure to heat or cold) and mosquito bites
indicates
the
role
of
education
in
the
acquisition
and
internalization
of
scientific information
on
the
d i sease.
*Ugat may mean vein.
nerves,
* 11
is
be 1i eved
that
recover
completely
after
(relapsed)..
19
or
lymphatic vesse1s.
par tur i ents who do not
de 1i very
"nabi nat"
are
Key informants who attributed "bungao” to mosquito
b i tes
1i ve
in Bacalon and Siuton which are mosquito
infested areas, in contrast to the Bacolod residents who
imputed the disease more to "surip" since mosqui to
density is low in that area.
These inhabitants a 1 1eged
that
if
this were true, then "bungao ” would not be
endemic
in the area.
Seemingly,
the
Maga11 anon’s
d i sease world
is
is
preconditioned by the
ecological
si tuat ion.
Mode of Transmission
Pasma w
(same meaning as ”surip” - i.e.,
sudden
exposure to
heat or cold) and
too much work were
expressed as the mode of transmission of
the
d i sease,
responses which are similar
to their
idea of
the
causat i on of the disease.
The respondent’s concept of
causat i on cannot be distinguished from the concept
of
mode
of transmission.
For them what causes the disease
wou1d
eas i1y
be
believed as
the
mechanism
of
transmission.
rt
Their
theory regarding mode of
transmiss ion
is
derived from their observation of n bungao” and
”tibak n
cases,
while son and daughter respondents learned more
about this from other people in the barangay.
More
than half of the respondents (69%) say that
there
is no possibiity for other members of the
fam i1y
to acquire the disease if the father is afflicted with
it.
Those who think otherwise attributed this
to
inheritance or working in same place.
It
is interesting to note that, g i ven their
own
concept of
etiology and their
observations
of
the
features of the disease, adult males are pointed out as
the most
1i ke1y
group to have
the di sease.
The
occupational groups of "kargadores" (loaders);
farmers,
abaca
strippers and fishermen are said to be
the most
prone
to the disease since these groups are associated
wi th
the carrying of
heavy
load,
fatigue,
heavy
perspiration, mosquito-infested surrounding and a water
envi ronment.
Symptomato1ogy
Only
51%
of
the
respondents
know
the
symptomatology of
the disease,
Daughters,
sons
and
other types of respondents are not aware of the symptoms
of
the disease.
Depth interviews with key
informants,
however, provided more information on this aspect of the
d i sease.
20
describe
the
There
are
thr6e
thr^e
terms
that
n
ft
"sakit”ft
(pain),
symptomatology of
"bungao,
"bungao,"
namely:
Pain
"paglaki" (enlargement) and "bumababa" (1owering).
”
ba
1
akang
”
associated
with
"puson"
(lower
abdomen),
is
At
the
initial
"bayag"
or
"bunao"
(scrotum),
(hips) and
pain ranges
the enlargement of the scrotum,
stage of
As it is increasing in size,
from absent to minimal.
minimal,
sometimes
severe and intolerable
pain becomes recurrent,
the
and accompanied by muscular cramps attributed
to
heaviness of
the enlarged scrotum.
-A sensation
of
tt
"something" descending
into the scrotum may also be
felt.
Among affected females, the "matres” (uterus)
is
pushed downward ("bumababa") and the labia of the vagina
sweIls.
She walks awkwardly and wets
her
dress and
chair upon sitting.
"Tibak"
is a kind of
disease character ized by
the
en1 ar gement
of
the
feet and
legs,
Initially,
legs
disease
is identified as "kolebra” (infection of
and
feet).
Rashes
then spread a 1 1
over
the
legs,
Subsequently,
the
legs
and feet become swo11en and
en1 ar ged
to abnormal proportions,
The "tibak"
patient
runs a
fever and occasionally
suffers
from chi 1 Is
("g i ni g inaw w).
The veins (nugatn) in the legs and
feet
may become bukoi-hui/ni
1-buko1” (nodular swe11i ng).
There are
treatment modalities available
for a
”bungaon
case and once cured,
the
symptoms subside,
iiss a
Recurrences
do not usually happen unless
there
re lapse,
a condition brought about by
resumpt i on of
activities on the part of the person carrying
heavy
not
1oads.
It may also recur when treatment
is
comp 1ete.
Diagnosis, Treatment and Prevention:
know
Two-thirds of the respondents (64.2%) do not
how the disease is detected.
Those
who claim
they
know,
stated
that blood examination is
the procedure
done for this purpose.
However, the majority (88.2%) is
not aware of the reasons why blood samples are obtained
at night.
Some believe that perhaps
it
is because
”blood is normal at night since people are at rest.”
Almost all the respondents (91.4%)
thought that
the disease is curable and the best methods of treatment
are
surgery and medication.
They also mentioned that
prevention is attainable by avoidance of carrying
heavy
loads and preventing exposure to water when fatigued.
To control the disease, 72.8% suggested submitting
oneself to medical examination with very few mentioning
21
control of mosquitoes.
The Respondents* Overall Level of Scientific
Knowledge of the Disease:
A 11
the questions on knowledge
were
given
correspond i ng scientifically accepted answers and each
item was assigned a score of one.
The
total
perfect
score
is
18.
Individual
respondent’s scores
were
obtained depending on the number of correct answers they
have.
Mean scores for each respondent type were
then
computed.
The following tables shows the results:
Respondent Types
Father
Mother
Daughter
Son
Others
Knowledge Mean Score
10.5
9.5
8.5
8. 1
7.7
Results
show that there
is no
cons i derab1e
difference by respondent type.
However,
the chi 1dren
who
are younger got
lower
scores,
11
is
also
interesting
to note that the "others
respondent
category,
which
is composed of older aunts and older
males
and females acting as heads of
parent 1 ess
families,
had the
lowest score.
These may be
the
traditionally more adherent members of the community who
refuse to
internalize newer scientific
facts about
f i1 ar iasi s.
Compared with the perfect score of
18.0 points,
the
respondents obtained right answers for only 50% of
the knowledge items which indicates lack of
sc i ent i f i c
know 1 edge of the respondents on f i1 ar ias i s.
The
relationship between demographic and
soci oeconomic characteristics of the respondents with
the i r
know 1 edge of the disease was explored,
Cons i dered as
socio-economic characteristics of the
respondents
are
household size, housing materials, number of
rooms
in
the
house and
house ownership while
the
socio
demographic characteristics are age.
age, length of stay
in
barangay and membership in organizations.
Male and
female parents in good
socio-economic
tend
to have better understanding of
the
standing
But membership in organizatins was shown to be
d i sease.
22
Male and
inversely related with level of knowledge,
(mostly
female parents who are members of organizations
level
of
Barangay Brigade)
are likely to have
lower
i
nf
ormal
knowledge
of
the disease.
Formal
and
in
discussion on the disease might not have been done
the meetings of these organizations.
Attitudes Towards the Disease:
it
is not considered contagious because
"Bungao"
(disease
organism).
It
is
is not caused by a "mikrobio"
previously
generally held that one can sit on a chair
occupied by a "bungao" case without getting the disease,
parents
Children may not get the disease although their
To separate the bedding and
are afflicted with it.
eating utensils of the case is deemed not necessary to
the
of
prevent the disease spreading to other members
n
cases
Also the majority believe that "bungao
fami1y.
can go to church and attend social functions.
Likewise they say "bungao" patients can marry and
beget
children.
The
parent respondents
think
that
chi 1dren.
having an enlarged scrotum wil1 not be a deterrent
in
sexual
activities.
However,
the
son and
daughter
respondents disagreed with their parents on this.
For
preventab 1e.
The disease is believed to be
them the use of mosquito nets while sleeping provides
protection against the mosquitoes which are regarded as
is
This
causing the enlargement of
the
scrotum.
of
theory
inconsistent,
though, with their prevailing
"ant i ngcausation of
the disease.
The wearing of
anting"
(amulets) is not effective either in warding off
'‘
the disease since it is not due to divine punishment for
sins nor to evil spirits.
Whenever afflicted, it is best to consult a doctor
the
and all
the disease very well
because he knows
are
Most
of
examination
for
diagnosis.
them
requi red
even iwilling to submit to blood examination if need be.
the
fear
getting the disease on account of
they
the scrotum which
is
bothersome,
of
en1 ar gement
being called a "bungawon" carries a social
Moreover,
the
Fami1y members often feel the impact of
stigma.
illness more because they are stigmatized along with the
afflicted father.
For them, it is an embarrassment.
A
daughter of
a "bungao" case overheard a derogatory
"Yes, she is beautiful, but her
remark directed at her:
teased about
father
is
"bungawon." Another case was
He
always carrying his wealth in his enlarged scrotum,
as
recalls how sensitivity to his "bungao" affected him
23
he relates the following:*
"When
I worked in a mining company,
my
co-workers told me I did not have to work
since being a bungawon made me a
rich man.
At first,
1 was very sensitive especially
with the thought that the ailment was not
of
my own doing.
doing,
Later, I learned
to accept
a 11 the notions attributed as a
myself
and all
bungawon. n
An observer recounts a "bungao" friend’s attitude as:
.... so irritable and seldom went out of
the
house...
often the butt of
ridicule from
other barrio folks... branded with names as
"tesurero kan baryo" (barangay treasurer)
or
a "pacific bank" (so named because he had a
big one; having a small "bungao" merits
the
name of "a rural bank")... In the end,
his
interaction with other community
members
returned to normal and the people accepted
his condition.
He even attends the New Year
dance at the municipal park. . . .
Another case had been referred to as "Gundo,
duwa
an payo"
(Gundo, with two heads
- his
head and his
bungao).
He was so much annoyed by this, so that,
when
teased, he resorted to fisticuffs or arming himself with
a bolo to attack those who made fun of him.
Unwholesome attitudes, however,
however, revolve about
the
woman inflicted with "buwa" or "buya.
"buya. n" Contracting this
illness
is frowned upon by the community.
Any "buya"
patient is presumed to be promiscuous.
On
the other hand,
being a
"bungawon"
is
considered as indicative of one’s industry and devotion
to family,
the person developing
the disease
being
hardworking and diligent.
A case utilized his
bungao"
as an identity in business transactions.
His
inf 1uence
in "regaton" (fish dealership) was strengthened by
the
(Beato,
name he assumed as
"Beatong Bungawon"
the
his
of
"bungao" case).
case).
Such name became the basis
fate never
livelihood
so that the acceptance of his
F or
one
compelled him to submit himself to surgery.
*Taken from the anthropological field notes. June 1982
24
thing, he could not overcome his fear of the
For another, a stigma dies a natural death.
operat ion.
For a 11 the attitudes associated with f i1 ar ias i s,
of
health midwife
an observation made by the rural
n
"bungao,
that
Bacolod
is
She claims
i s noteworthy.
the hea1 th
to
"tigbak" or
Mbuyan patients seldom go
defect
The
physical
center because of "supog" (shame),
has
been
is
so demeaning that not a single incidence
however
,
reported to the clinic.
If there were one,
medicine
nothing would be done since the center has no
for these ailments.
st i gma than
lesser
however carries a
"Tustus
a norma 1
cons
i
dered
that it is
It seems
"bungao”•
1 ong as
scrotum
so
an
enlarged
to have
occurrence
is
further
enlargement
to stop
corrective measures
a
Otherwise
the
enlargement
develops
into
resorted to.
te
1
1
can
Those who can afford an operation
"bungao.n
who
Those
of
hernia.
the community that his is a case
the i r
cannot afford an operation become "bungawon” al 1
indicates
a
"bungao"
These facts show that having
life,
low economic status.
the
character
i st i cs
The
socio-economic
characteristics
of
the
respondents were correlated with attitudes towards
but
disease.
Household size was shown to be positively
parents.
weakly related towards the disease among male
bigger
household
Likewise, female parents belonging to a
treatment
tend to have a more positive attitude towards
of the disease.
The Community’s Perception of the Disease:
Anecdotal portrayal of five (5) cases in d i f ferent
to
each
of
the
levels of severity were presented
the
of
respondents
to determine
their perception
disease.
The presented case with pain in the
scrotum and
mild
nodular
swellings
swe11ings at the neck are considered of
1
av ia
the
gravity, so are the cases with enlargement of
fruit)
.
of
vagina and the scrotum (size of a coconut
sack
is
The
case with scrotal enlargement as big as a
however perceived as serious.
According to respondents, all the cases portrayed
have better prognosis except those with scrotal pain and
labial
enlargement who some respondents like daughters
25
the
and others* who were interviewed believe will stay
same
for some time.
In fact, the "older”
respondents
and mothers state that those with coconut-sized scrotal
enlargement can even get worse.
Mar r iage
is perceived possible for all
the
five
cases
except
for
those with the
extreme
scrotal
en1 ar gement.
All of them can continue living with their
fami lies,
They can also work/go to
school
with the
exception of the case with the big scrotal enlargement.
The respondents have seen cases similar to
those
described
in the vignettes except for
the one with
n other"
coconut-sized scrotal enlargement,
older
The
respondents and those in Stratum I I I had not seen cases
with nodular swelling of the neck.
There
is no considerable variation
variat i on
in
the
perception of the disease represented by respondent type
nor by stratum.
They seem to have parallel views of the
disease having stayed in the area for long and having
been
exposed to afflicted persons.
The
"other”
respondents however tend to view the disease in a better
light
since they are older and had lived in Magallanes
longer.
Contrary to this, the respondents of Stratum
I
(poblacion)
are more inclined to perceive the diseases
as becoming serious and worse.
The poblacion
is
the
center of the municipality, thus people are more exposed
to health information.
Practices Related to Treatment
and Prevention of Filariasis
There is a significant blending of traditional and
modern
practices
pract
ices
for
treatment and prevention
of
’’bungao” and n"tibak." The traditional practices come in
herbs
the form of body massage, hot compress, medicinal
to
and barks,
Their meager medical knowledge adopted
the conventional
ones consist
in
the
comp 1ement
vaporub,
app1i cat i on of pulverized antibiotic tablets,
rubbing alcohol and gasoline.
Spec i f i ca11y,
for
"tagu-api" and ”tustus”
hot
testes/scrotum.
compresses are applied to the enlarged
Pum i ce stone is thus heated, then covered with coconut
shell with the three holes directed towards the affected
to allow direct evaporation of
heat.
The hot
area
from the heated stone is expected to stop
the
vapors
*0thers are the aunts, older brothers or
who are considered head of families.
26
sisters
Some of the afflicted
swe11ing of the testes/scrotum.
had
abdominal
massage
with
upward strokes by
ind i v idua1s
healers.
A widespread
their own selves or by folk
(locally
called
motonpractice
is
to utilize herbs
sap
buyo or tuba leaves) which are heated.
boton,
The
the
and
applied
to
the
enlarged
part
is extracted
of
with
scrotum.
A folk healer combines the extracted sap
the
salt and rubbing alcohol which he later massages on
lower abdomen.
a I so
sap of a variety of medicinal leaves i s
The
patients
to
the
enlarged
scrotum
of
"bungao"
app1ied
name 1y kumintang, puli, suragga, tuba, moton-boton and
the
Wrapping the scrotum momentarily with
ta1i gbuhay.
done
bunguran"
(a
species
of
banana)
is
also
leaves of "bunguran"
removed
by some folk healers.
The leaves, however, are
the
right after application, otherwise if you prolong
the
testes
may
disappear
and
cause
applications the
a
Folk
surgery
was
performed
by
death of the patient,
the
in
the
process
of
discovering
patient turned healer
who
the folk healer
Tiyo Dado (
(the
for his ailment.
cure
ti
bak,
bungao
,
cases
of
treated almost all
1 ater
had
tustus in the area) reca11s vividly how he
buya and
so 1ved his own "bungao" problem, thus:
....
When my wife was away to do some
bathed and
the poblacion,
I
in
marketing
boiled
with
thorough 1y
cleaned
imyse1f
dapdap",
concoct i oni of leaves of guava and
1 eaves and fruits with
leaves
some heart-shaped
pods.
A blade was then provided with an
improv i sed handle and placed in the boiling
gently
I
sat on a stone and
concocti on.
it
squeezed
massaged my oversized scrotum,
between two bamboo splits, then put it on a
pounded on my
piece.
I
boxed and
metal
resistance
to pain,
to test
its
scrotum
the pain, I
cou 1 d withstand
could
When I felt I
and
the scrotum with the b 1 ade
i nci sed
put
Then I
extracted a reddish white fluid,
and
in
my testes back .into
its place,
"dapdap
droplets,
applied
the
juice of
app1i ed
leaves.
The
smarting pain almost made me
were
tab lets
The powdered penicillin
cry.
covered
then applied on the wound which was
wore
a
I
"dapdap**
leaves.
wi th heated
"bahag " or supporter to protect the wound,
penicillin tablets
twice a day and
took
same
the
cleaned the wound regularly with
also
infect i on
I
concoction.
To prevent
after
applied heated leaves of "duso1"
hea
1ed.
nine days of treatment, the wound was
weight
I
gained
I
lost my "bungao"
"bungao”
but
my
re 1i eved of
because
by then
1
was
it
embarrassment and anxiety as a "bungawon"-
27
For
the w buwa" or ’’buya” patient, a clean heated
piece of cloth or tuba leaves are applied to the swollen
nbuwan
labia.
No sure cure can be prescribed for
since
this
involves
a
delicate
part.
"Tibak,"
pat i ents,
1 i kewi se, is considered by many as an incurable disease,
"Kapag tinibak, mangadye
ka
a patient remarked:
Thus,
n
(even
at
the
point
of
a
knife,
the
ailment
tabak
na sa
The accumulated fluid,
’’microbes”
wi11 not leave you).
and dirt are sucked by a leech after which a mentholated
or oil is spread on the surface to prevent
ointment*
This is a folk healer’s way of reducing
the
b1eed ing.
"tibak"
leg.
A
patient
also
had
resorted
to
a
enlarged
gasoline and alcohol rub on the affected leg.
w
buya, ” people
"buya,
To prevent ”bungao,” "tustus” or
to refrain from lifting heavy
loads and
are advised
hard
work
or
being
wet
when
fatigued.
indulging
in
all
of
these
measures
are
seemingly
Interesting 1y,
to the known and accepted etiology of
the
d i rected
n
Furthermore,
upon
meeting
a
"buwa"
patient,
di sease.
one must tear the hem of her skirt to avoid contracting
A parturient must also take the
"panurip"
the disease,
(a
mixture
of
Chinese
wine
and
boiled
extract
of
dr ing
"anonag"
and
"manonggal"
bark)
to
prevent
relapse
anonag
(considered a cause of "buwa").
Attempts at preventing or treating any form of the
disease are,
however, futile among
the economically
For them,
not
deprived
group who are mostly affected,
working
to
earn
their
daily
bread
is
to continue
Moreover,
the
fear
of
the
medical
unrea1istic.
the expenses it entails,
creates a
intervention and
to
proper
care.
Henceforth,
any
folk
healer’s
barri er
prescription becomes the rule for the treatment of
the
disease, not only because it is most accessible but more
significantly because the prescribed "cure” is
locally
available and the cost is not prohibitive.
The Adult "Bungao” Patients Attitudes
and Practices:
(22)
adult males with w"bungao" were
Twenty-two
households.
Additional
identified
in the sample
asked
from
them
to
assess
their
feelings
information was
and practices related to the disease including effects
of the disease on himself and his occupation.
50%)
Most of the cases interviewed were farmers (a 1 most
latter
These
while some (23%)were abaca workers.
*Locally known as Vicks Vaporub.
28
workers had to go to work early, walking for about
10
minutes to the abaca plantations,
They strip the abaca
stalks the whole day until early evening with
very
minimal
clothing
(usually shorts
and
t-shirts),
Sometimes
sons or daughters would accompany them to
work.
The said activities therefore, provide possible
exposure to mosquitoes thriving in the abaca plants.
Upon knowing that they have "bungao," almost
ha 1 f
of
the cases said they started having no peace of
mind
due to
the pain felt in the scrotum,
the continuing
scrotal enlargement and the uncertainty of cure (30% of
respondents felt frustrated and lost hope),
Some of the
respondents indulged in self-pity ("nahihirak sa buhay")
and became embarrassed by their condition..
A 1 most 30%
had
lost their work, had to stay home and depend on
their
families.
Others, however, denied any effect
on
work or well-being since they alleged that the
scrota 1
enlargement was not yet noticeable,
Their working hours
were not also affected except for some who said they had
to work 4-6 hours less especially when the scrotum
had
became bigger.
At
the
onset of scrotal enlargement,
the cases
either went
to see a doctor or sought
treatment
from
"herbo1aryos"
(herba1
med i c i ne man)
while some did
nothing.
Treatments
given were surgery,
tab lets
or
herbs.
The majority (77%) said they had not been involved
in the Filariasis Control Programs.
Of those who were,
25% said they were given tablets
or helped
in the
distribution of these.
Correlation Between Knowledge, Attitudes and Practioes
In genera 1,
the correlation analysis
failed
to
reveal
any substantial
relationship between overa11
knowledge and attitudes,
However, these (knowledge and
attitudes)
were
found
to be associated
in terms of
certain
aspects of
the
d i sease,
i.e.
causation,
transmiss ion,
d iagnos is,
symptomatology.
cont ro1,
prevention and treatment,
Variation
in
re 1 at i onshi ps
between
these aspects of
the disease
among
the
respondent types was also noted.
Respondents who had better
know 1 edge of
knowledge
the
treatment of
the disease were shown to have positive
at t i tudes towards the disease.
The parent's
parent’s knowledge
on
treatment
correlates substantially
(p <.01)
with
<P
atti tudes
towards
the
causation,
prevention,
transmiss ion
and
treatment
of
the disease.
This
re 1 at i onshi p however was not found among the male and
29
fema 1e children.
Instead, the female children who had
knowledge of
the causation,
control,
prevention and
transmission of
the disease tended to have negat i ve
attitudes towards the causation of the disease.
It
is
interesting
to
note
that
negative
re 1 at ionships were demonstrated between practices and
know ledge,
Thus
the male parents who submit
to
examination for filariasis are likely to be
those who
are not knowledgeable of the disease,
especia11y
the
contro1
and diagnosis aspect.
The
respondents were
asked whether they will practice control measures if a
family member gets afflicted with the disease.
Those who said they will use separate utensils
and beddings for the afflicted member, are those who do
not know the treatment of the disease.
Considerable differences were shown by the various
categories of respondents in the relationship between
their practice and attitudes related to the d i sease.
The male parents who submit for examination,
will
use
separate utensils and beddings for a sick member of
the
family and those who will segregate the sick member
are
likely to have a negative attitude towards the disease.
On the other hand, female parents and children who wi 1 1
segregate the sick member of the family tend to have a
positive attitude towards the disease.
Feedback Sessions at the Provincial
and Municipal Levels:
Three
feedback sessions were
conducted at
the
provincia1
and at the muncipal level with the aim of
presenting the
research findings to
the providers
and consumers of health services.
Upon hear ing
t he
resu1ts
of
the study, the immediate reaction of
the
field
staff of the Provincial Filariasis
Contro1
Unit
was that of
surprise.
The results
indicated
that
despi te all efforts and creativity exerted by the
field
staff
in the planning and implementation of
screening
and
educational
campaign,
the people of
Magallanes
continued
to demonstrate adherence
to
traditional
beliefs and practices in connection with the disease.
In the course of the discussions,
stories
of
their
difficult but chailenging experiences were related
to
the research team
in an attempt
to explain
their
approaches and strategies in breaking down people’s
reluctance to join the control activities.
The control
act i v i t i es.
unit utilized group singing and musical entertainment to
draw the attention of the people to the control program.
mu ch effort
Despite much
in making people
aware of
the
disease,
it appears that the people had failed
to
internalize the
teachings about
the d i sease.
The
30
t he
expressed
nevertheless
had
control
people
to
strategies
revitalize the existing
wi11ingness
to
They,
make them more responsive to the people’s needs.
so
f indings
in turn requested a copy of the research
p1anning
of
future
for
this
that
they can use
act i v i t i es.
At the municipa1 1 eve 1 , the research team received
study site.
the
choosing Maga11anes as
thanks
for
the
research created
the participants,
According to
to
It was however stressed
awareness about filariasis.
the people of Magallanes that if they persist in their
traditional beliefs and practices regarding the disease,
any attempts to successfully control it may not succeed.
Both the participants present during
the
feedback
session and the respondents share a common belief system
regarding the disease.
Having the same culture,
they
have similar ways of coping with the disease.
to
research team encouraged the participants
The
modify the
their
ir
prevailing
suggestions on how to
offer
d i sease world.
The response of a barangay captain was
hea1 th educat i on and
comment on the quality of
to
of
higher
teaching,
saying that there was an absence
I n other
moti vat ion and interest among the educators,
hea1 th
the
objectives,
words,
to accomplish their
dedication to
educators must be imbued with greater
their work, so that the people may be made more aware of
Furthermore,
the importance of proper health practices.
that meetings
i t was suggested at the barangay I eve 1,
shou 1 d be scheduled so as not to d i srupt occupat i ona1
routines.
ANALYSIS AND DISCUSSION
The findings indicate that indeed the popu1 at i on
of
of Magallanes
developed through many years
Maga11anes has
exposure
to cases of filariasis and to stor ies of
This
elders a cu
cultural
1tura1 system surrounding the disease,
related to
includes knowledge, attitudes and practices
this
diagram summarizes
the disease.
The following
system:
r>i3‘ 3^
-x
31
i f"
V °oCVJ
'Stories of
elders and
cases of the
di sease
Practices
relating to
the disease
■>
KNOWLEDGE OF THE DISEASE
4
CULTURAL SYSTEM ON FILARIASIS
Stories of
elders and
cases of the
disease
Attitudes
towards the >
disease
;
to
soon as the residents of the area start
actua
1
and
interact
with
peers,
the
exposure
to
mingle
cases
and exchange of
information on these
cases
awareness
commence.
These result in the development of
of
the disease.
Continuing observation of afflicted
the
individuals reinforce the initial discoveries about
dai ly
disease which later became incorporated in their
The form of
lives either consciously or unconsciously,
knowledge assimilation that has taken place is more real
and meaningful to them since it comes first hand.
As
1 ed
Continued exposure to cases in the barangays
The need for
to frequent discussions about the disease,
words to identify the disease resulted in the emergence
terminologies.
In the
light
of
their
of
local
"coping
knowledge
as
part of
their
s i tuat i ona1
several disease categories were deve1 oped.
mechani sm"
the
was
coined
to mean any enlargement
of
"Bungao"
of
"buya"
or
”
buwa
u
of
the
labia
and
"tibak
“
scrotum;
naming
leg
(irrespective
of
cause
cause).
).
This
system
of
the
the disease categories was shaped into the experiences
1imi ts
and behavior of the local people and within the
s i gns
their
understanding.
Since
these
three
of
constitute the earliest changes visible to the nat i ves,
the terminologies were adopted to identify the d i sease.
As long as the enlargement is not noticeable, one is not
labelled a Tt"bungawon".
To be called as such
invites
ridicule from the community so that a case in its
early
stages will not be discerned or branded as "bungawon."
This may be construed to indicate an attempt to reduce
the
impact of stigmatization.
Furthermore,
it also
tends to show that the early symptoms of the disease are
virtually unknown to the majority of
respondents.
Fever,
which
is one of the earliest symptoms,
is not
considered symptomatic of the disease.
Occurrence of
32
such symptoms may have been
attributed to other diseases
or not
not
given any attention at all.
On 1y half
of
the
ofSthAdHntS are knowledgeable of the signs
„
J
and
symptoms
the
d
i
sease
.
of
disease.
The disease is c
equated exclusively with
the
enlargement
the
scrotum
en1argement of
the
scrotum,
labia and
and
lower
labia
extremities,
which s’
’
igns
characterize
the
acute
latter
the acute
stages of
the disease.
Consequently, the urgency
urgency to
subm it
oneself to blood and other types of
for early detection
examination
of the disease is overlooked.
partly explains
This
why it is very difficult
to
peop1e
mot
i
vate
for
b 1 ood
screening.
of
the
respondents know how the disease Merely 36%
is diagnosed and
i3
by b1ood exami nat i on.
that
The i r know 1 edge on this
is
also meager, since they
cannot conceive why nocturna1
col lection of blood samples has to be
done.
However, an
equal proportion of
respondents
had
submitted
t hemse1
to blood examination,
Whether previous knowledge of ves
diagnostic procedure
a
necessarily precedes acceptance
this,
was not conclusively
of
shown by
the
Nonetheless,
the
study.
correlation ana 1ys i s
revea1ed
those male parents who wi11
that
submit
themsel
ves
to
b
1 ood
examination are 1ike1y those
who are not
know 1edgeab1e
of
the t'diagnosis of
the disease.
This may be an
indication•l
of
cur i os i ty or wanting
to
d i agnos is
learn
the
of
the disease, On the other
hand,
one
is
construed to <chailenge
*
this
s i nee B i co 1anos
are known to be congenial andcontention,
to be
surrounded by a wide
kinship circle,
Presumab1y, submission of
a few peers,
or
relatives
can maximize
vo1untary submission of
others to the procedure.
There i s a c1 ear c
overlapping of the native
of causation and transmission
theory
-- i of the disease.
To
causation cannot be dissociated
them,
from transmission
both
lead one to develop the disease.'
s i nee
aspects or
these
the disease were viewed as Moreover,
re 1ated.* Male adults
occupationally
as loaders or farmers
cons t i tute the majoritywho ofwork
observed
cases.
occupat ions are closely associated
These
with
heavy
loads and
perspiration,
Thus, itO_ __
__
®ttribute filariasi
--is
to
factors
fis justifiable within
these
thZi
1r wor1d.
The
idai ly
lives of
the
the natives
revo1ve mainly around
their
occupations and
to
say that the d isease
is
due
to
mosquito bites
wi 1 1
run counter to
their
thei
rea
1
1 ife
situations.
in some
areas (Stratum 1 , peop1e w itness
the development of
cases despite
the
1 ow mosquito
density.
This further
strengthens their assumed cause.
*Getting wet during
carrying
heavy
loads are
causation and transmission.
33
or after
heavy work and
the prevai1ing
theory
of
The respondent’s knowledge of the
treatment and
control
of
the disease, however,
conforms
with the
and
current
intervention of
the disease.
Surgery
medication are considered by the respondents as the best
form of management.
Not many, though, can afford to
seek these modalities of treatment for financial reasons
and
fear of the operation.
Some "tustus” and "bungao"
cases who were able to seek surgical
treatment were
relieved of the scrotal enlargement.
People had been
witness
to the successes of this form of treatment and
of
thus they came to learn about this modern management
on
1y
the disease.
It is quite logical to say so, since,
a quarter of the respondents are aware of preventive and
control services in the municipality and of these,
only
a few
(11%) have sought assistance from this
service
have
once.
Furthermore, almost all of the respondents
This
not
read any educational material on filariasis.
may account for the very
low
level
of
scientific
knowledge among the respondents (they obtained correct
answers for only 50% of the questions).
not
ridicule but
"Bungawons" are subject to
ostracized.
They are not segregated and can continue
living with the family.
Afflicted people are we 1 corned
fami 1y.
they are
times
in the community gatherings.
gatherings,
But at
Di f ferent
scrotum.
laughed at due to the enlarged
They are either called a
titles are conferred on them.
"Rural
bank" or a "Pacific bank" according to the size
felt
cases
of
the scrotum.
In view of this, "bungao"
even
Some
disturbed upon knowing they had the disease,
indulged
in self-pity and become embarrassed by their
condition.
In contrast, those belonging to the higher
socio-economic class who can afford surgical and medical
treatment do not worry since they are confident
that
after the intervention they will be back to normal.
In
general, the respondent’s perception of the severity and
the
prognosis of the disease seemed to correspond with
size of scrotal enlargement and the degree of
physical
incapacitation.
Cases with minimal scrotal
enlargement
cases
who can continue daily work are considered mild
with better
prognosis.
For the
less
fortunate who
peop1efs
cannot
afford surgical
intervention,
the
of
their
perception of
the severity and prognosis
affliction, will progress later from mild to serious and
an
the attitude of
from
better to worse.
Thus
a
’bungawon’
always
interviewed
case
is
"once a
of
percept ion
'bungawon’ 41 .
Evidently,
the people’s
social
"bungao" cases contributes to the enhancement of
st i gma.
are
informants
respondents and key
Very few
know
ledge,
attitudes
comfortable
in discussing their
The disease affects the body
and practices on ’’buwa" .
part considered "de 1icate" and taboo in open discussion.
imposs ib1e
Early detection of cases is difficult if not
34
since this disease is equated with promiscuity.
The healing practices
the d i sease
related to
consist of
syncretization of
traditional
and modern
trad
i t iona1
ways.
Based on their prevai
prevailing
1ing knowledge
of
the
symptomatology of the disease and influenced by their
poverty, most cases resorted to folk healing and herbal
medications supplemented by popularized home remed i es.*
Likewise,
due to
the
prevai1ing
theory
of
causation/transmi ss i on
of
the d i sease,
preventive
practices consist of avoidance of
getting wet when
fatigued and carrying heavy loads.
To them this is more
logical than the use of mosquito nets when s1eepi ng.
No
other
measures are undertaken.
Houses are built
r i ght
with in abaca and banana plantations to
faci1i tate
the
work done
in this areas,
areas.
No attempts
were made
to
change the materials and
structure of
houses
for
protection against mosquitoes,
The traditional nipa hut
sti 1 1
predominates in the area,
Farmers,
loggers
and
abaca
strippers
str ipper s often work with minimal
clothing.
Alterations
in these condi tions and activities
to
prevent being afflicted with ” bungao” are meaningless to
them.
However,
ma 1 e parents who are
inclined
to
practice contro1
measures against filariasis at
home
tend
to view the disease with fear.
Presumably,
apprehension of
the filariasis with
i ts
its
gradually
increas ing enlargement of the scrotum, may provide
the
stimulus
for male parents
to seek
knowledge
on
prevent i ve and control measures against the disease.
From al 1
the findings of this research,
it was
c1 ear 1 y
shown that should a control
and preventive
program be planned and implemented,
the
first
step
should be to gain entrance to this disease wor1d.
In so
doing,
the very foundations on which a re 1evant
scheme
is
to
be built must be
thoroughly
understood,
Otherwi se, costly programs and projects will continue to
be ineffective if not total fai1ures.
SOME INSIGHTS ON THE DATA GATHERING METHODS UTILIZED
Several methods of data collections were employed
in this study, namely:
the interview method, the use of
the
attitude
scale,
the
vignettes,
participant
observation and depth interviews of key informants.
Among
al 1
these methods,
the depth interviews
of
*These
include
rubbing
with
alcohol
and
mentholated ointments on painful or swollen body part.
35
yielded
the
most
accurate
and
key
informants
comrehens i ve information on all aspects of the disease.
Due to the repeated interaction, there was a progressive
key
development
of
rapport between interviewer and
The relaxed atmosphere resulted in a more
informant.
issues
about
exhaustive discussion of
the various
four
filariasis.
On the other hand,
interrogating
members of
a household
in a one sitting provided
gathering
superficial question and answer type of data
the
Nonethe less,
few opportunities for probing,
with
the
strengthened
of
these two methods
combination
The depth interview filled in the gaps
research output,
out by the interview and provided explanations to
left
doubtful interview results.
The results of the attitude scale negated some of
is
the
interview findings.
Whether this inconsistency
instrument
real
or due to inherent weaknesses in the
remains a problem to be studied.
However, the
results
of another study (Feliciano, 1982; The Limits of Western
supported
Social Research Methods in Rural Philippines)
this inconsistency.
It was found out that;
...
the use of the attitude scale at the
barrio level was a dismal failure in terms of
the seemingly erratic responses yielded.
Low
literacy levels, value system and possibly a
nebulous understanding of the
interviewer’s
role probably influenced the barrio folk
to
respond
in a manner which did not
reflect
their real attitudes
It was therefore possible that the respondents
in
Magallanes when requested by the
interviewers,
who
happended to be midwives catering to their health needs,
gave favorable answers if only to please them.
on
The vignettes, however, produced more insights
the perception of the disease.
The anecdotal
accounts
of several cases appeared interesting to the respondents
since
these were expressed
in familiar
language.
Moreover,
this afforded relief from the
long question
and answer session immediately preceding the vignettes.
Nevertheless, more careful preparation of the anecdotes
is needed to fully project the disease.
s tage
Thus,
it is essential that at the pre-test
assessment
of the methods of data collection, a careful
be
the effectiveness and strength of these methods
of
undertaken.
36
GUIDELINES FOR FUTURE HEALTH EDUCATION
PROGRAMSON FILARIASIS IN SORSOGON
Based on the results of this study,
guidelines were developed!
A.
the
fo1 I owing
The Target Groups
The study revealed that socio-demographic factors,
like occupation,, education, sex, age, economic status,
membership
in the
in organizations and length of stay
barangay, are associated with knowledge of and attitudes
towards
following
the disease.
In view of these,
the
groups should be given priority in educational
programs
filariasis:
on
B.
1.
The male members of the community since they are
the most prone to the disease due to higher risk of
exposure to mosquitoes.
This group
is made up
mostly of fathers, so that educating them may have
a multiplier effect if
they echo what
they have
learned to their families.
2.
The younger members of the community so that
will acquire knowledge of the disease early.
3.
Fami1ies of
4.
Individuals with low educational attainment.
5.
Peop1e who have 1 i ved in the barangay for a
durat i on.
6.
Individuals who are members of organ i zat i ons.
they
low socio-economic status.
short
Recommended Approaches/Strateg ies J
1.
the
Indigenization of
strategies by making
of
teachings within the level of understanding
di sease
the people and in the context of their
wor1d.
2.
Muitisectoral approach
2. 1 .
in
the
Involvement
of
the schoo1s
agreement
A memo of
education program,
the
should be drafted and signed between
the
Health
Officer
and
Provincia1
to
Superintendent of Schools
Provincia1
in
the
integrate teachings on filariasis
health education course.
37
3.
4.
2. 2.
Coord i nat i on
with
the
Ministry
of
In f o rmat i on
to set up an
information
drive in the dialect of the region.
2.3.
Involvement
of
the
Ministry
of
Agriculture and Natural Resources so that
their community workers will
include
developing awareness
on
filariasis
in
their sessions with farmers,
f i shermen
and abaca workers.
2.4.
The
formation of an intersectoral
group
or
committee at the municipal
level
to
plan and monitor activities on filariasis
educat i on.
2.5.
Invo1vement of private organizations
in
the
community
<especial
• ■ 1y
in
the
dissemination of information
-- 1 during thei
r
meetings.
Community Participation
3. 1 .
Holding
forma 1
and
informa 1
communi ty
assemb1i es
to
d i scuss
aspects
of
f i1 ar iasi s.
3. 2.
Invo1v i ng
the common i ty
educat i ona1 programs.
3. 3.
Tapping volunteers and interested members
the
community
to
serve
as
1e1cturers/teachers.
3.4.
Utilization of indigenous healers.
in
p1ann i ng
To the Health Center Staff
4. 1 .
The
designated
health
educator/hea1 th
center
staff
should be
trained
to
understand the uniqueness of the cognitive
process of
the people,
tneir
their way
of
understanding
the
causation,
and
transmission, the local terminologies used
for the disease and the perceived symptoms
of the disease.
4.2.
Emphas ize on ithe
'
diagnosis of the disease,
the procedures done to detect
----- ’’ the disease
and the importance of early detection.
4. 3.
Conduct
intensive
information
before mass screening programs.
38
campai gns
5.
4. 4.
Develop teaching materials consistent with
the perceived gradient of
the disease,
stressing on the early signs and symptoms.
4.5.
Conduct counseling sessions with cases
they will seek treatment.
4.6.
Deve1 op a workable referral
system wi th
the
provincial
hospital
for
surgical
intervention of cases•
so
To the Filariasis Control Unit
5. 1 .
Shift strategies from mass campaigns which
are done sporadically, to commun i ty-based
survei1 lance of
the d i sease,
utilizing
barangay health workers and hea1 th center
staff.
5. 2.
Coordinate more with local hea1 th center
staff and barangay officials and other key
leaders
in the community,
Involve
these
people in the planning and
imp 1ementat i on
of local programs.
SUGGESTIONS FOR FURTHER RESEARCH ON FILARIASIS
1.
A more detailed study to compare practices
re 1ated
to exposure to the mosquito vectors of known cases
and non-cases of filariasis.
2.
A study on the factors influencing acceptance
non-acceptance
of
diagnostic
procedures
treatment of filariasis.
3.
The economic impact of the disease (by
1 eve Is of
severity) to the individual case and to the family.
4.
A Health Education Intervention mode 1
5.
Community participation in research and preventive/
control programs.
39
and
and
for filariasis.
APPENDICES
. Maps of Sorsogon
. Sample Questionnaires
41
APPENDIX I
MAPS OF
SORSOGON
PHILIPPINES
1975
(0
N
Q'O
0
o
J •
15 ■
43
^ACON
I
6
/
PRIETO DIAZ
(
<
-i
-j
$
\
(
I
/
J®
/
U
x
ZSORSOGON BAY
£
I
I
□
IS.
V
GUBAT
I
BAGATAOl
IS.
I
®/BARCELONA
■1
\
\
o
\
® IROSIK?
\
\
\
)
I
I
THE PROVINCE OF SORSOGOM Vo
BY MUNICIPALITY
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Stratification and Sampling of the Barangays (colored dots show the sample
barangays in Strata II & III)
APPENDIX II
QUESTIONNAIRES
SAMPLE
I. HOUSEHOLD MEMBER INFORMATION
A.
Respondent Information
1. Name of Respondent
2. Respondent No.
'
3. Age
4. Sex
5. Occupation (Describe actual work being done)
1) Farmer
2) Fisherman
3) Abaca plantation worker
4) Vendor
5) Housewife
6) Employee
7) Teacher
8) Others, specify
6. Marital Status
1) Single
2) Married
3) Separated
4) Widow/Widower
5) Others, specify
7. Length of residence in barangay
8. Religion
1) Catholic
2) INK
3) Protestant
4) Aglipayan
5) Others, specify
9. Are you a member of any organization, club, or association?
1) Yes
2) No
If
Yes, specify name of organization
47
KNOWLEDGE
10. Do you know of a disease called Filariasis?
1) Yes
2) No
11. From whom did you learn about it?
1) Heard from the old people
2) Neighbors
3) Friends
4) Person with the disease
5) Filariasis Clinic
6) Read from books and/or magazines
7) Others, specify
12. Have you seen a person with this disease?
1) Yes
2) No
If Yes, how does he look?
1) Enlarged legs and feet
2) Enlarged scrotum
3) Swollen lymph nodes
4) Others, specify
13. What is the possible cause of this disease?
1) Microbes
2) Inherited
3) Infection
4) Inflammation of the veins
5) Always standing
6) Over-fatigue
7) Hernia
8) Mosquitoes
9) Withcraft
10) Malnutrition
11) Donrt know
12) Others, specify
14. How does one contract this disease?
1) Contracted from sick person
2) Always in contact with water
3) Mosquito bite
4) Inherited
48
5) "Pasma”
6) Over-work
7) Others, specify
8) Don't know
15.
What is your reason for answer on the preceding questinn?
1) Observation from sick person
2) Heard from others
3) Learned from Filariasis Control Clinic
4) Read from reading materials
5) Others, specify
16.
If the father has this disease, is it possible for other members of
the family to have this disease?
1) Yes
2) No
3) ,. Does not know
If Yes, what is the reason?
1) Same place of work
2) Sleeping habits
3) Same food eaten
4) Contracted from sick person
5) Inherited from father
6) Others, specify
17.
Who do you think will be more prone to have this disease as to:
Sex:
1) Male
2) Female
3) Both
Age:
1) Children
2) Adults
3) Both
Occupation:
1) Farmer
2) Abaca worker
3) Fisherman
4) Employee
5) Stevedore
6) Others, specify
18.
Can a person who has been treated from this disease have this
disease again?
1) Yes
2) No
3) Does not know
If Yes, why?
_________
49
19.
Do you know the symptoms of this disease?
1) Yes
2) No
(If No, proceed to Q. No. 22)
20.
What are the most common symptoms of this disease?
1) Stomachache
2) Aching of the whole body
3) Pain in the genital area
4) Fever
5) Loss of feeling of the extremities
6) Loss of appetite
7) Dizziness
8) Paleness
9) Others, specify
21.
How long does this symptom persist?
1) Once in a while
2) Few days
3) One week
4) One month
22.
5) One year
6) Until death
7) For a very long time
8) Others, specify
Is there treatment for this disease?
1) Yes
2) No
3) Does not know
(If No, proceed to Q. No. 24)
23.
What is the treatment that you know?
1) Medicine
2) Surgical Operation
3) Herbal medicine
4) Prayer of witch doctor
5) Offering for the ’’Nuno sa
■ Punso”
6) Others, specify
24.
Can this disease be prevented?
1) Yes
2) No
3) Does not know
(If No, proceed to Q. No. 26)
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25.
What preventive practices do you know?
1) Avoid persons with this disease
2) Refrain from carrying too heavy objects
3) Clean the breeding places of mosquitoes
4) Eat the right kind of food
5) Avoid over-exposing one’s self to water specially after work
6) Others, specify
26.
Do you know how this disease is diagnosed?
1) Yes
2) No
(If No, proceed to Q. No. 28)
27.
What is the diagnostic procedure for Filariasis?
1) Stool examination
2) Urinalysis
3) Blood examination
4) Physical examination
5) Others, specify
28.
In the diagnosis of this disease, do you know why blood is taken
at night?
1)
2)
Yes
No
If Yes, why?
1) The parasite is present in the blood at night
2) Blood is normal since person is at rest
3) Does not know
4) Others, specify
29.
Do you know that there is a Filariasis Control Unit?
1) Yes
2) No
If Yes, have you asked for help?
1) Yes
2) No
If Yes, how many times?
30.
Have you read an article on the prevention and control of this disease?
1) Yes
2) No
If Yes, what is the message?
LIBRARY 'X
51
I (
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AND
and
DOCUMENTATION
DOCUMENTATION
UNIT
J1 W,T
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31.
What measures do you know in order to control this disease?
1) Clean the surroundings
2) Separate the sick person
3) Consult a doctor
4) Others, specify
____________________________
32.
Does killing of mosquitoes help in the control of this disease?
1) Yes
2) No
If Yes, why?
ATTITUDES
33.
What do you feel when you see a person with this disease?
1) "Nandidiri"
2) Sorry
3) Fear
4) None
5) Others, specify
34.
Do you think this per son can still marry?
1) Yes
2) No
3) Does not know
35.
Can a man with this disease still father a child?
1) Yes
2) No
3) Does not know
36.
If a mother has this disease, can she still breastfeed her baby?
1) Yes
2) No
3) Does not know
37.
Can a sick person still go to church?
1) Yes
2) No
3) Does not know
38.
I«Jho do you think will you consult if you are sick with this disease?
1) Doctor
4) Midwife
2_)_ Arbularyo
5) Others, specify
3) Nurse
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39.
Why?
40.
Have you been examined for Filariasis?
1) Yes
2) No
If No, proceed to Q. No. 42)
If Yes, what activities were disturbed?
(e.g. eating time, sleeping, praying, etc.)
41.
What do you feel when you were pricked by the health personnel?
1) Fear
2) Annoyance
3) None
4) Others, specify
If Fear, why?
PRACTICES ■
42.
If a member of the family is sick with Filariasis, co you:
1) Separate his eating utensils
2) Separate his beddings
3) Separate from other members of the family
4) None
5) Others, specify
43.
What kind of food will you give a sick person?
44.
What kind of work can a sick person be allowed to do?
45.
What can be done to prevent this disease?
46.
What can be done to control this disease?
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II. ADULT WITH FILARIASIS
(15 years and over)
Ask the following questions if respondent has Filariasis:
47. How did you feel when first afflicted with the disease?
1)
2)
3)
4)
5)
Frustrated
Hopeless
In favor
Insecure
Others, specify
__________
48, What effect does this disease have on your personal life?
1) I shun my family’s company
2) I lost my job
3) I stopped studying
4) I became dependent to my family for moral support
5) I can not get married
6) I learned to feel sorry for myself
7) None
8) Others, specify
4-9• What effect does this disease have on your role as. a
member of your community?
1) Stopped going out
2) Lost friends
3) Lost identity as member of community
4) No effect
5) Others, specify
50. What did you do when you noticed the swelling of your
legs/enlargement of scrotum?
51 .What treatment did you use?
52.What steps have you taken to prevent members of your
family in having the disease? (e.g. used a separate
room, used separate sleeping quarters, eat separately
from the family, etc.)
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53.
What is your occupation before you got sick?
1) Farmer
2) Fisherman
3) Worker in abaca plantation
4) Employee
5) Others, specify
If abaca plantation worker, ask the following:
A. How far is your place of work from your house in
terms of time spent in going there?
B. At what time do you usually go to work?
C. How many times do you go to work?
D. How long do you stay there?
F. What do you usually do during your breaktime?
G. Who among your family do you usually take in your
place of work
H. At what time do you usually go home?
54.
How much do you earn before you got sick?
1) Daily
2) Weekly
3) Monthly
55.
How much do you earn now?
1) Daily
2) Weekly
3) Monthly
56. How many hours do you spend on your work before you got
sick with Filariasis?
57. Is there a difference in time spent in your work now?
1) Yes
2) No
If Yes, How many hons
58. Have you been involved on any program about Filariasis?
1) Yes
2) No
If Yes, what have you done to help in the control of
this disease?
55
HI.
CHILD WITH FILARIASIS
(10-14 years old)
Ask the following questions to children sick with filariasis:
59.
Do you still go to school?
1) Yes
2) No
If No, why?
60.
(Probe: If failure to go to school is due to
sickness)
Do ;you go with your parents when they leave for work/or
to their working place?
1) Yes
2) No
If No, why?
61<
Do you still play with your friends?
1) Yes
2) No
If Mot anynore, why?
62. Do you play different games now?
change in your playing habits?)
(Actually, is there a
1) Yes
2) No
63. What household chores can you not accomplish at the present
due to your sickness? (e.g. laundry, fetch drinking
water, etc.)
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IV.
ATTITUDE STATEMENTS
Please answer the following sincerely,
There is no right or v/rong
answer, your own thinking should be followed,
Answer according to the
following:
SA (strongly agree)
A (agree)
D (disagree)
SD (strongly disagree)
SA
1. My parents have Filariasis, hence it is possible
that I will also have the disease
2. I will wear ’’anting-anting” (amulet) so I will
not be sick of Filariasis
3. I will not sit on the chair previously occupied
by a "Bungao” case.
4. I believe that the cause of the enlargement of
my scrotum is due to mosquitoes.
5. My swollen legs can be cured by a traditional
healer.
6. I believe that blankets, spoon and plates of case
should be separate to prevent spread of the
disease.
7. I refuse to submit myself for blood examination
because I might collapse at the sight of
blood.
8. I prefer to consult the traditional healer for
my swollen leg since his treatment is not
painful.
9. Pallor and anorexia might lead to Filariasis.
10. The enlargement of my scrotum is a curse of
God due to my sins.
11. My enlarged scrotum will be a hindrance to
my work.
12. I will not be bothered by the enlargement of
my legs or scrotum.
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A
D
SD
SA
13. It is better to use mosquito nets while
sleeping to prevent Filariasis.
14. The enlargement of my scrotum and legs will
be cured with the use of herbs.
15. The activities of the health center staff
will help in the prevention of Filariasis
16. I believe that Filariasis is caused by eating
contaminated food.
17. Filariasis can be prevented.
18. I believe that the enlargement of my scrotum
is due to sitting in hot places always.
For adult respondents only:
19. I believe that I can beget children inspite
of the enlargement of my scrotum.
20. I will not be able to have intercourse with
my wife/husband since my scrotum/labia is
enlarged.
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A
D
SD
V.
I.
VIGNETTES
Jose is a fourth grader at a primary school in one barangay
of Magallanes.
He helps his father in his work in the abaca
plantation whenever he doesn’t have a class.
These past few
weeks, he has been complaining of recurrent pain' in his scrotum
which lasts for three days.
II.
Ka Indo is a healthy workers,
with his work,
income.
He is patient and industrious
He often goes to other barangays to earn extra
He has changed this past year,
He stopped working in
his ricefield and is seldom seen out of the house, Once a neighbor
accidentally saw Ka Indo while he’s taking a bath and he dis
covered that Ka Indo’s scrotum have grown as big as a coconut fruit.
III.
Aling Juana’s husband, Ka Juan is a worker at abaca plantation.
She frequently brings her husband’s food in the working place es-
pecially if he works until night.
She used to wear pants but these
past few months, she has been xizearing loose dresses,
She finds it
painful to wear pants since her labia has swollen to a size.
IV.
Roel is a very active boy.
corner of their yard.
He plays and poker at every
He often comes home at night xcith plenty
of insect bites due to his naughty activities.
Her mother noticed
that Roel has nodular swelling at the sides of neck when she
embraced him one time.
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V.
Lolo Kikoy was branded Kikoy Sako by his townmates since
he always carry a "sako” (sack) wherever he goes.
He cannot
work anymore due to his age and he finds it hard to walk and
carry his ’’sako.”
They accidentally discovered that the "sako It
contains his scrotum which have grown as big as the jackfruit
when some naughty boys poked sticks on the "sako" and Lolo Kikoy
screamed in pain.
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ANSWER SHEET FOR VIGNETTES
*
Each vignette is read to each respondent,
Responses are recorded
separately.
I
1. What do you think of this person?
1) Not sick
2) With slight symptom but not sick
3) With mild disease
4) With severe disease
5) Other responses (specify)
2. What will probably happen to this person?
1) Will be better in a few weeks
2) Will be better in 6 months to one year
3) Stay much the same for sometime
4) Get worse quickly
5) 6et worse slowly
6) Other responses (specify)
3. Could such a person stay living with their
family?
1) Yes
2) No
4. Can get married
1) Yes
2) No
5. Continue working or studying
1) Yes
2) No
6. How often have you come across this case?
1) Never
2) Occasionally
3) Frequently
4) Other responses (specify)
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II
III
IV
V
Position: 309 (10 views)