DETERMINATION OF FECAL OCCULT BLOOD...

CENTRO ESCOLAR UNIVERSITY – MANILA

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DETERMINATION OF FECAL OCCULT BLOOD AMONG PATIENTS WITH

HELMINTHIC INFECTION IN PATEROS PUBLIC HEALTH DEPARTMENT

An Undergraduate Research Proposal Presented to the

College of Medical Technology

Centro Escolar University

In Partial Fulfillment of the Requirements

of the Degree Bachelor of Science

in Medical Technology

By

Kate Mylene Pacunayen

Abuel, Jasmine

Constantino, Danica

Dris, Nicole

Dela Paz, Katherine

Garcellano, Auwie Gleah

Gruta, Margarette

Lorzano, Josephina

Magtalas, Anna Rose

Medes, Danica Mae

Noveno, Sachiko

March 2015


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TABLE OF CONTENTS

Pages

List of Tables…………………………………………………………………………..IV

List of Figures……………………………………………………………………….…V

Chapter

1. INTRODUCTION AND DEFINITION OF THE PROBLEM..................6

1.1 Introduction…………………………………………………………....….….….6

1.2 Objective of the study.................................................................................7

1.3 Conceptual framework……………………………………….……..… . ..........8

1.4 Background of the study…………………………………….……..…...….......8

1.5 Setting of the study………………………………………………...........…......9

1.6 Statement of the Problem………………………………………....... .............11

1.7 Hypothesis…………………………………………………………… …….......11

1.8 Significance of the study…………………………………………… ……........12

1.9 Scope, Delimitation and Limitation of the Study………...……… .……........12

1.10 Definition of Terms……………………………………………… ……..….....13

2. REVIEW OF RELATED LITERATURE AND STUDIES..…………..14

2.1 Introduction…………………………………………………….... ....................14

2.2 Foreign Literature………………………………………………… ....………...14

2.3 Local literature………………………………………………….......................15

2.4 Foreign Studies……………………………………………………...…..……..16

2.5 Local Studies…………………………………………………………………....18

3. METHODS AND PROCEDURE………………………………………..21

3.1 Introduction………………………………………………………………………21

3.2Methods of Research Used…………………………………………………….21

3.3Sample Collection and Processing………………………………...………….21

3.3.1 Patient Preparation…...……………………………………………..21

3.4 Parasitologic Examination………….…………………………………………..22


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3.4.1 Detection of Diagnostic stage…………………………………………..22

3.4.2 Occult Blood Testing……………………………………………......23

3.4.3 Quality Control……………………………….……………………....23

3.5 Statistical Analysis……………………………………………………………...24

Bibliography………………………………………………..…………………26

Appendices…………………………………………………….…………..…28


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List of Tables

Page

I. Research Time Table…………………………………….....…….45


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List of Figures

Pages

I. Figure 1……………………………………………….........................………10

I.1 Municipality of Pateros as part of Metro Manila, Philippines

II. Figure 2……………………………………………….......................………..25

I.2 Diagram of Research Methodology


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CHAPTER 1

INTRODUCTION AND DEFINITION OF THE PROBLEM

Introduction

Intestinal parasitism involves parasites that can infect the gastrointestinal tract of

humans and other animals. It can be acquired through drinking infected water and

ingestion of undercooked meat. They can live throughout the body but most

preferably in the intestinal walls.

Human intestinal protozoa that include non-pathogenic and pathogenic amoeba,

flagellates, ciliates and human intestinal helmithes such as Ascaris lumbricoides

that causes Ascariasis, Stongyloides steroralis causes Strongyloidiasis,

Enterobiasis by Enterobius vermicularis, hookworm infections, human tapeworm,

and Trichenella worms are harbored in the intestinal area and thus considered

luminal parasites. The infection that causes by these parasites may lead to

ulcerations of the intestines and may result to bleeding which can be attributed to

anemia.

Fecal occult blood (FOB) test determines the presence of hidden or microscopic

blood in the stool specimen. Presence of fecal occult blood can be a sign of a

digestive problem particularly in the obstruction of intestinal walls produced by the

parasites due to its large rate of reproducibility. They tend to look for other locations

to become their habitat. Its early detectability can determine the source of bleeding

that can help the patient in determining the disease so that the problem can be

diagnosed and treated.


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Children from Pateros, as respondents of this study are particularly susceptible

if they are not thoroughly cleaned after coming into contact with infected soil that is

present in the environment, that they may have frequently visited such as

sandboxes, school playgrounds, are well as drinking water from contaminated

sources.

This research study aims to determine if there is correlation between positive

FOB and any of the common intestinal parasitic infection and finding a positive

result can alleviate awareness of the people, the establishments, authorities and

children to be conscious of their day to day exploring activities to maintain

cleanliness of their environment and surrounding.

Objective of the study

The study aims to determine if the cause of positive FOB in patients from

Pateros public health department is indeed due to parasitic infection of

helminths.This study may also prove that fecal occult blood may be used as a

screening examination in detecting intestinal parasitism among infected patients. It

will serve as a preliminary test in detecting human intestinal parasites causing

intestinal ulcerations that lead to gastrointestinal bleeding that may further be

detected in the stool. The presence of fecal occult blood among patients may mean

that the patient is also positive for intestinal parasitism.


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Conceptual Framework

Background of the Study

Many years had passed, a significant amount of scientific data has been

gathered connecting the causal relationship between parasites and diseases in

man, usage of these data helped to make some campaign against parasitic

infection successful. But despite of the medical advances and global initiatives in

eradication programs, infectious parasitic diseases would eventually become a

thing of the past. This parasitic infection becomes the major causes of death in

INPUT Identification of respondents involves informing the patients what the study

is about and its purpose. Researchers are supposed to earn their consent and approval as test subjects.

The subjects are comprised of mid-age adults particularly children that are positive for intestinal worms and they will be subjected for fecal occult blood

testing.

PROCESS Fecal Screening is where the positive patients with intestinal parasitism

are to be identified. It is done by performing direct fecal smear. During fecal occult blood testing, the collected positive samples are

screened with proper instructions and protocols including confidentiality, insurance that the patient followed the doctors’ instructions.

OUTPUT Positive or negative results in fecal occult blood testing will be noted and

will indicate possible diseases in the long term run. Suggested medication and awareness for affected individuals follows.

A health awareness program will follow where possible ways on how to prevent intestinal parasitism will be discussed.


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human and in addition it complicates and contributes to other illnesses. The burden

of these diseases often rests on the communities in the tropics and subtropics.

However, developed countries may also be affected. WHO estimates that one

person in every four harbors parasitic worm (WHO, 2013).

One of the disease that the parasite may cause is occult gastro intestinal

bleeding. By definition, occult Gastro Intestinal bleeding is hidden or unseen. It

may be surprising, but we all lose blood through our GI tract daily. Occult bleeding

is not present or absent but rather occurs along a continuum from normal

physiologic bleeding to abnormal bleeding. This physiologic blood loss averages

less than 2 ml a day. However, levels above a 2 ml a day threshold occur in 5 %

and are considered abnormal. If blood loss chronically exceeds 5 ml a day, iron

deficiency ensues.

Setting of the Study

The performance of the sample and stool collection will be held in Pateros

Public Health Department. Before 1770, Pateros was only a barrio of Pasig until the

Spanish Governor-General in the Philippines issued a decree making Pateros an

independent municipality. The town was then composed of five barangays

(villages), namely, Aguho, San Roque, Sta. Ana, Sto. Rosario and Mamancat (now

a portion of Fort Bonifacio). On March 29, 1900, Pateros became one of the towns

in the newly created province of Rizal. Then on October 12, 1903, Taguig City and

Muntinlupa City into a single municipality under Pateros.


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The municipality was renamed Taguig and on February 29, 1908 separates

Pateros from Taguig. Pateros then regained its independent status as a

municipality on January 1, 1909. Pateros became a part of the new Metropolitan

Manila Area.

Municipality of Pateros is a first-class municipality in Metro Manila, Philippines.

This small town is famous for its duck-raising industry and especially for producing

balut, a Filipino delicacy that is boiled duck egg. Pateros is also known for the

production of red salty eggs and "inutak", a local rice cake. Moreover, the town is

known for manufacturing of "alfombra", a locally-made footwear with a carpet-like

fabric on its top surface. Pateros is bordered by Pasig City to the north, Makati City

to the west, and Taguig City to the south.

Fig. 1 Municipality of Pateros as part of Metro Manila, Philippines


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Pateros is the only municipality and the smallest, both in population and in land

area, in Metro Manila, but it is the second most densely populated at around 29

thousand people per square kilometer after Manila.

Statement of the Problem

The aim of the study is to determine if the cause of positive FOB in patients of

Pateros public health department is indeed due to Parasitic infection of helminths.

Analytically, the study seeks to determine if there is/are significant difference/s

in the levels of fecal occult blood in patients with intestinal parasitism vs patients

without intestinal parasitism.

Specifically, it sought to answer the problem:

1. What is the percentage of patients positive and negative to FOB?

Hypothesis

The presence of fecal occult blood among patients with intestinal parasitism

may be due to gastrointestinal bleeding caused by human intestinal parasites

primarily the helminthes that tend to ulcerate the intestine, because of increased in

number.

Parasites travel towards other parts of the body and escaping from the intestine

by ulceration for the parasite to get out and find another organ that can serve as

habitat. Gastrointestinal bleeding may be produced and it can be shown in the stool

that gives a positive result for fecal occult blood.


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Significance of the study

Intestinal parasitism is a widespread condition here in the Philippines. It may be

caused by a poor hygiene, environment and a lot more instances like food and

water contamination. It must be diagnosed as soon as possible to prevent further

complications.

Presence of fecal occult blood in the sample may serve as a step in detecting

intestinal parasitism. Detection of blood in the stool will show a positive result.

Intestinal parasitism may lead to different effects. The researchers conducted an

experimental observation with the use of a simple and reliable technique that may

help in the diagnosis of intestinal parasitism among individuals.

Scope, Delimitation and Limitation of the Study

This study will determine the fecal occult blood in specimens positive with

parasitic infection among all enrolled patients in Pateros Public Health Department.

Fecal specimen tested negative for parasitic infection will not be considered.

The respondents are children, adolescents, and mid-age adults. Study is limited

to those who are positive in intestinal parasitism, and the team will only be dealing

with helminthes and not protozoans.

As per the exclusion criteria, patients who are found to have carcinoma,

inflammatory, ulcerative and erosive conditions and vascular disorders involving

gastrointestinal tract are excluded from the study. Parents who did not allow their

children to join in the study are also excluded. Stool specimens must not be

contaminated with urine or toilet water otherwise it would be rejected.


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Definition of Terms

a. Fecal occult blood test – A test that determines the presence of hidden blood

in the fecal sample.

b. Fecal specimen – Stool sample used in the test.

c. Gastrointestinal Tract – The tract consists of the stomach and intestines, and

is divided into the upper and lower gastrointestinal tracts.

d. Helminth – A parasitic worm; a fluke, tapeworm, or nematode.

e. Intestinal parasitism – a case where in parasites that cause infections in the

gastrointestinal tract.

f. Occult blood – Hidden blood in the fecal specimen.

g. Parasites – An organism that lives in or on another organism and benefits by

deriving nutrients at the host’s expense.

h. Parasitic infection – Disease or infection caused by parasites.

i. Parasitism – a non-mutual symbiotic relationship between species, where one

species, the parasite, benefits at the expense of the other, the host.

j. Protozoa – A diverse group of mostly motile unicellular eukaryotic organisms.


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CHAPTER 2

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents both foreign and local related literature and studies that

are useful to the present study which contains facts and information on the research

problem at hand. It also provides explanations and logical connections between

previous researcher and the present work on determination of Fecal Occult Blood

among Patients with Intestinal Parasitism.

The researchers were able to review several foreign literatures and studies that

are significant to the present study being conducted.

Foreign Literature

Based on Bustinduy et. al., (2013) the book stated that the severity of intestinal

infection have downstream potential complications of this disease include anemia,

failure to thrive, and chronic multi-organ damage. Point-of-care (POC) tools to

monitor intestinal parasitism in low resource settings are urgently needed to better

quantify the burden of disease in endemic countries. It's important to know the

person's health and condition.

Studies have suggested that the immunochemical fecal occult blood test has

superior specificity for detecting bleeding in the lower gastrointestinal tract even if

bleeding occurs in the upper tract.


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Park et. al.,(2007) Gastrointestinal tract is the primary involvement site of

parasites during their life cycle. Parasitic infection are mostly widespread in

undeveloped or developing countries where sanitation is poor, but now the

diseases are more frequently encountered in developed countries because of

increase immigrations and travelling. Although the incidence of disease include

amebiasis, ascariasis, trichuriasis, hookworm amd tapeworm. Most of these

diseases present with nonspecific radiologic findings making the hygienic

environment and clinical history such as food ingestion important for differential

diagnosis.

Local literature

Cabrera (2004) reported in the book, Philippine Textbook of Medical

Parasitology, about the pathogenesis and clinical manifestations of Hookworm. The

pathology of hookworm infection involves the existence of the adult worms in the

small intestine. The stage of maturation of the worm can be acquired due to

abdominal pain, steatorrhea or sometimes diarrhea with blood and mucus, and

blood eosinophilia of 30 to 60%. The infection is usually chronic, hence, it shows no

acute or terminal manifestation to the patients. Heavy hookworm infection can lead

to a progressive, secondary, microcytic, hypochromic anemia of the iron-deficiency

type, that result to continuous loss of blood. He also stated about Hypoalbuminemia

which is another manifestation of hookworm infection. This infection causes low

level of albumin due to combined loss of blood, lymph, and protein. The diagnosis

of this infection is not pathogonomic to allow differentiation from nutritional


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deficiency anemias and edemas from other helminthic infections. Finding parasite

eggs in the feces is the final diagnosis. The techniques that can be used were

indicated in the book and can be applied to both individual and mass

screening. The first technique was direct fecal smear but this technique is possible

only when the infection is quite heavy. Kato-Katz or Kato technique method may

give a rapid result since more stool is examined while concentration methods like

zinc sulphate (ZnSO4) centrifugal method may increase positive several fold. The

Harada-Mori is an example of a culture method that allows to hatch the larvae from

eggs on strips of filter paper with one end immersed in water.

This literature gives a relevance to the topic for it described one of the parasites

that can be encountered when performing the fecal occult blood test.

Foreign Studies

Majed H. Wakid (2010) stated that Human infections due to intestinal parasites

are most prevalent infections in developing and tropical countries causing a

significant morbidity and mortality. Fecal occult blood (FOB) refers to a nonvisible

blood in the stool. Although the FOB test was developed to specifically screen for

colon cancer there are various causes of positive FOB including infection with some

intestinal parasites. From parasitologic point view, most of the published studies

concerned with determination of FOB in patients infected with Trichuris trichiura,

Hook worm, Schistosoma spp. and Entamoeba histolytica.

Majed H. Wakid (2010) further added that detecting fecal occult blood by a guaiac-

based test is still the most widely used test in medical laboratories in Jeddah. This


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test depends on the peroxidase-like activity of hemoglobin in catalyzing the

oxidation by peroxide of a chromogen.

Dietary and medication restrictions are recommended with this test to decrease

false positive and false negative results guaiac-based test was suitable for our

design during this study to resemble the situations during routine analysis in

medical laboratories in Jeddah,

regardless of dietary and medication restrictions, which is not followed by the

majority of ordinary population in Jeddah and regardless of infection intensity, which

is not performed with routine Fecal Occult Blood testing (Majed H. Wakid 2010).

Sarika, et. al., (2007) stated in their study "Fecal Occult Blood Screening in

Children with Severe Malnutrition" Fecal occult blood test is a rapid test, specific to

human hemoglobin which is based on a one step lateral flow chromatographic

immunoassay. It is a qualitative and sensitive test and highly accurate to detect low

levels of human fecal occult blood. Gastrointestinal tract blood loss in high risk

children is an added source of concern, and under such conditions, FOBT can be

routinely utilized for supportive evidence of the presence of any GIT pathology.

Positive result should be followed up with additional diagnostic procedures to

determine the exact cause and source of the occult blood in the feces. Qualitative

measurement of fecal occult blood can aid in evaluation and timely treatment of

severely malnourished children at highest risk of mortality. However, it

needs a multivariate logistic approach to evaluate the utility of this test as an

additional supplement to age, sex, visible severe wasting, shock, infection, etc.;

responsible for increased morbidity and mortality.


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Betson, et. al., (2012) mentioned that Fecal occult blood (FOB), which refers to

cryptic blood in feces, has been used for a number of years as a marker of

intestinal pathologic changes. They were able to investigate whether FOB could be

used as a marker to assess bowel morbidity associated with intestinal

schistosomiasis over time and after PZQ treatment. The study have found that

there was a tendency for FOB prevalence to increase from baseline to 12 months in

children who become infected with S. mansoni and to decrease in children who

become negative for egg-patent schistosomiasis.

FOB tests would not be appropriate for diagnosis of intestinal schistosomiasis at

an individual or population level, but do have potential for monitoring changes in

intestinal morbidity associated with schistosomiasis at a community level.

Consistent with the specificity of FOB for S. mansoni infection, there was no

association between FOB and hookworm infection. However, it must be

remembered that prevalence level and intensity of this helminth infection were low

in the study cohort. In areas where hookworm prevalence level and intensity are

higher, an association with FOB may be observed and the specificity of FOB for S.

mansoni infection may be lower (Betson, et. al., 2012).

Ugwuoke et. al., (2013) Infections due to intestinal parasites are among the

most prevalent infections in humans in developing countries. These infections

constitute serious health problem among Nigerians especially children. . Symptoms

of infection include abdominal pain, dizziness, fever, nausea, diarrhea, hair loss,

etc. Fecal occult blood refers to blood in the feces that is not visible to the naked


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eye and FOBT, as the name implies, is aimed to detect subtle blood loss in the

gastrointestinal tract from the mouth to the colon.

The prevalence of positive FOBT in some volunteers with parasites of intestinal

tissue invasive capability is of pathological significance. In chronic phase, these

parasites could constitute important risk factor some malignancy in colorectal

region. However, this assertion require further investigation.

Local Studies

Kanzaria, Acosta, Langdon, Manalo, Olveda, McGarvey, Kurtis, Friedman

(2005) conducted a study about the role of occult blood loss in mediating

Schistosoma japonicum which is associated to anemia.

The primary objective of the researchers was to deliberate the function of occult

blood loss in the species after adjusting for age, sex, socioeconomic status and

other helminth infections. The secondary objective was to identify the different

categories of risk for occult blood loss for Trichuris and hookworm.

The purpose of occult blood loss in mediating S. japonicum- associated anemia

was studied cross sectionally in 729 individuals 8-30 years old in Leyte, Philippines.

Stool specimen were examined in duplicate for helminth eggs.

The test was done in order to measure the hemoglobin, fecal occult blood loss

and anemia in determining the presence and intensity of helminths. The

researchers found out that individuals with higher intensities of S. japonicum and T.

trichiura were 3.5 time more likely to be positive in the fecal occult blood test than

the rest of the cohort (P = 0.018) and were more highly anemic. Adjustment was


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done for SESS. japonicum but there was no significant relationship between

hookworm infection and occult blood loss (odds ratio = 1.70, 95% CI= 0.25, 6.58,

P= 0.50) Also, after adjusting for SES, participants with moderate or heavy intensity

of T. trichiura, resulted into fecal occult blood positive by 2.68 times than individuals

who had no Trichuriasis or with low intensity infections. (P = 0.013)

This study was relevant to the present study in that the researchers' limitations

include the lack of performing the fecal occult blood test and that it may help the

present researchers to improve the necessary test.


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CHAPTER 3

METHODS AND PROCEDURE

This chapter presents the method of research used, sample collection and

processing, test procedure and the statistical treatment used in the present study

being undertaken.

Methods of Research Used

This research utilized the correlational method. According to Porter & Carter

(2000) correlational research studies go beyond simply describing what exists and

are concerned with systematically investigating relationships between two or more

variables of interest. Furthermore the correlational method only describes and

attempts to explain the nature of relationships that exist, and do not examine

causality.

Sample Collection and Processing

PATIENT PREAPARATION

Patients should be instructed no avoid eating red meats, horseradish, melons,

raw broccoli, cauliflower, radishes, and turnips for 3 days prior to specimen

collection in such manner presence of dietary pseudo peroxidase activity will be

prevented. Aspirins and nonsteroidal anti-inflammatory drugs other than

acetaminophen should be not taken 7 days prior to specimen collection to prevent

gastrointestinal irritation.


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Vitamin C and Iron should be avoided for 3 days prior to collection because

ascorbic acids is a strong reducing agent that interferes the peroxidase reaction.

Therefore these precautions must be followed in order not to obtain false positive

and false negative results.

This study will be carried out on pediatric and pregnant patients of Pateros

Public Health Hospital. Stool samples were collected from the patients, after

informed and written consent were obtained from them, following the explanation on

the purpose of the investigation and the need for their participation. Three specimen

containers will be collected from each subject for giving stool samples for three

consecutive days and the procedure for introduction of stool specimens into the

containers was carefully explained to them.

Parasitologic Examination

DETECTION OF DIAGNOSTIC STAGES

The direct fecal smears and formal ether concentration techniques will be used

for the detection of diagnostic stages of enteric parasites.

Direct stool smears will be performed by emulsifying 2 mg of stool uniformly in a

drop of saline or iodine on a microscope slide, then covered with cover glasses and

scanned microscopically.

Formal ether concentration technique shall be performed by emulsifying 2 g of

stool in 15 mL of 10% (v/v) formal-saline. In unpreserved specimens, the

suspension is allowed to stand for 30 min, then strained through two layers of gauze

into a 15 mL conical centrifuge tube and centrifuged at 2000 rpm for 5 min. When


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needed, washing step will be repeated until supernatant becomes clear. The

sediment is then resuspended with 10 mL of 10% (v/v) formal-saline, then 3 mL of

diethyl ether is added. The tube will be shaken vigorously for 30 sec and followed

by centrifugation at 2000 rpm for 5 min. The fecal debris layer will be loosened by

wooden applicator stick and the tube rapidly inverted to discard the top three layers

while the sediment remained at the bottom. A drop of iodine is to be mixed with the

sediment, then transferred to a microscope slide, covered with a cover glass, and

scanned microscopically. Wakid (2010)

OCCULT BLOOD TESTING

Each stool sample will be processed to detect occult blood using a guaiac-

based test (Hema-Screen, Stanbio, Texas, USA) by spreading thin smear of stool

according to the manufacturer instructions. Hema-Screen can detect 10 mg of

hemoglobin per gram of feces. A positive reaction is indicated by the appearance of

a blue-green color between 30 seconds to two minutes after addition of two drops

of developer reagent. The occult blood tests is to be achieved by a technologist

blinded to parasitologic results.

QUALITY CONTROL

A. External Quality Control is not available for fecal occult blood testing.

B. Internal Quality Control (positive and negative Performance Monitors) must be

performed and documented for all individual patient tests performed.


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C. Patient results may be reported only when both the Positive and Negative

Performance Standards give the expected results.

D. Corrective action must be performed and documented whenever the Positive or

Negative Performance Standards fail to give expected results.

Statistical Analysis

The Chi square test will be used for determining the significance of association

between intestinal parasitic infection and FOB test finding. A P-value level of

significance was 0.05.


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Fig. 2 Diagram of Research Methodology

PATIENT PEPARATION

Explanation of research purpose

Obtain patient/parent’s consent

SAMPLE COLLECTION

Three fecal samples for 3

consecutive days

PARASITOLOGIC EXAM

+ - Reject

Direct Fecal Smear (DFS) Formal Ether Technique

+ +

- Reject

- Defer -

Fecal Occult Blood Testing

+ -

+ -

Quality Control

STATISTICAL ANALYSIS

Direct Fecal Smear (DFS)


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BIBLIOGRAPHY


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Articles:

Majed H. Wakid., (2010) “Fecal Occult Blood Test and Gastrointestinal Parasitic

Infection,” Journal of Parasitology Research, vol. 2010, Article ID 434801, 4

pages. Retrieved from http://www.hindawi.com/journals/jpr/2010/434801

Kanzaria HK1 et. Al. (2005) International Health Institute. Schistosoma japonicum

and occult blood loss in endemic villages in Leyte, the Philippines. Retrieved

from http://www.ncbi.nlm.nih.gov/pubmed/15741543

Porter, S., Carter, DE (2000) Common terms and concepts in research & In

Cormack, D. (Ed.) The Research Process in Nursing (4th Ed.). Oxford,

Blackwell Science (pp. 17-28) Retrieved from

http://www.researchproposalsforhealthprofessionals.com/correlational_research

Books:

Cabrera, Benjamin. (2004). Philippine Textbook of Medical Parasitology. Taft

Avenue, Manila: The Publications Program.

Strasinger, S. K. & Di Lorenzo, M. S. (2008). Urinalysis and Body Fluids 5th ed.

Philidephia, Pennsylvania: F.A. Davis Company

Online Sources:

http://www.wpro.who.int/philippines/areas/communicable_diseases/mvp/story_ntd/en/i

ndex2.html

http://en.wikipedia.org/wiki/Pateros,_Metro_Manila

http://en.wikipedia.org/wiki/Pateros,_Metro_Manila#Geography

https://www.google.com.ph/maps/place/Pateros,+Metro+Manila/

http://www.webmd.com/colorectal-cancer/guide/fecal-occult-blood-test

http://labtestsonline.org/understanding/analytes/fecal-occult-blood/tab/test/

http://en.wikipedia.org/wiki/Parasitism

http://en.wikipedia.org/wiki/Protozoa

http://www.medicinenet.com/script/main/art.asp?articlekey=4769

http://www.mayoclinic.org/tests-procedures/fecal-occult-blood-

test/basics/definition/prc-20014429

http://en.wikipedia.org/wiki/Human_gastrointestinal_tract

http://www.healthline.com/health/parasitic-infections#Overview1


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APPENDICES


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APPENDIX 1

INFORMED CONSENT

Research Title: Determination of Fecal Occult Blood among Patients with Helminthic

Infection in Pateros Public Health Department.

Purpose/s: To determine if the cause of positive fecal occult blood in stool in patients

from Pateros Public Health Department is indeed due to parasitic infection of

helminthes.

Procedure/s:

Name Discomfort/Risks Recovery Time

Direct Fecal Smear none 10 minutes _

Formal Ether Concentration none 20-30 minutes

Fecal Occult Blood Testing none 30 minutes__

Benefits/Compensation: This study will help the participants know if they have

intestinal parasites or gastrointestinal bleeding by the presence of occult blood in

stool. Confirming the positive result can also alleviate the awareness of participants,

establishments, authorities, and children to be conscious of their day-to-day

exploring activity.

Subject-participant shall: (1) receive adequate and immediate medical treatment

should complication arise; (2) receive full and adequate compensation and

indemnification in case harm or injury arise out of participation; and (3) be free to

withdraw his/her consent to discontinue participation in the research anytime without

prejudice to him/her and no explanation is required.

The researchers shall: (1) answer at anytime, any inquiry of subject-participant

concerning the procedure; (2) preserve anonymity and respect full confidentiality;

and (3) be fully responsible and accountable for all complications, injury,

compensation, and the like to subject-participant as a result of any or all of the

procedures.


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SUBJECT-PARTICIPANT

Name: __________________________________ Date: _________________

Address: __________________________________________________________

Birthday: ___________________________Signature: _______________________

Parents/Guardian’s Name and Signature:_________________________________

RESEARCHERS

Name Participation Signature Date Pacunayen, Kate Mylene __ Leader ____ __________________ ____________________

Abuel, Jasmine Karla __ Member ____ __________________ ____________________

Constantino, Danika Mae __ Member ____ __________________ ____________________

Dris, Nicole Jellie __ Member ____ __________________ ____________________

Dela Paz, Katherine __ Member ____ __________________ ____________________

Garcellano, Auwie Gleah __ Member ____ __________________ ____________________

Gruta, Margerette Victoria __ Member ____ __________________ ____________________

Lorzano, Josephina __ Member ____ __________________ ____________________

Magtalas, Anna Rose __ Member ____ __________________ ____________________

Medes, Danica Mae __ Member ____ __________________ ____________________

Noveno, Sachiko Aivee Mari __ Member ____ __________________ ____________________


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APPENDIX 2

APPROVAL SHEET

CENTRO ESCOLAR UNIVERSITY

Manila * Makati * Malolos Research and Evaluation Office

Approval Sheet For the Conduct of Scientific Procedures Using Human Subjects

Undergraduate Graduate Research Faculty Research

School/College/Department/Program: College of Medical Technology

Research Title: Determination of Fecal Occult blood among Patients with Helminthic

Infections in Pateros Public Health Department

Researchers: Lead Researcher: Kate Mylene Pacunayen Co-researchers: Abuel, Jasmine Gruta, Margarette Constantino, Danica Lorzano, Josephina Dris, Nicole Magtalas, Anna Rose Dela Paz, Katherine Medes, Danica Mae Garcellano, Auwie Gleah Noveno, Sachiko Purposes of the conduct of Scientific Procedures (encircle one or more):

a. Biomedical research, experiment, studies, investigation (including pre-clinical research) b. Teaching and instruction c. Product testing d. Production of antisera or other biologicals I certify that the statements made herein are correct and true.

________________________________ _________________________

Signature of adviser/ Lead Researcher Signature of Dean

Date:__________________________ Date:_____________________

Approved by IERC members: Subject Specialist/s: ______________________ IERC Member ______________________ _____________________ IERC Member Subject Specialist ______________________ IERC Member


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______________________ _____________________ IERC Member Subject Specialist ______________________ IERC Member Recommending approval: ______________________ IERC Chair

Instrument for the Approval of Research Proposal Requiring Human Subjects

(Protocol Review Form)

I. Procedure(s) or Title of Research/ Study:

Determination of fecal occult blood among patients with helminthic infection in Pateros Health Department.

II. Purpose/ Objectives:

The study aims to determine if the cause of positive for fecal occult blood in

patients from Pateros Public Health Department is indeed due to parasitic

infection of helminths.

III. Duration or Time Frame:

Summer Term (March-April 2015) IV. Responsible Person or Principal Investigator:

A. Name:

Kate Mylene Pacunayen

B. Qualification (degree(s) or training experience)

B.S. Medical Technology (Undergraduate) – CEU


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V. Background and Significance of the Procedure or Research:

Intestinal parasitism is a widespread condition here in the Philippines. It may

be caused by a poor hygiene, environment, and a lot more instances like food,

and water contaminations. It must be diagnosed as soon as possible to prevent

further complications. Presence of fecal occult blood in the sample may serve

as a step in detecting intestinal parasitism. Detection of blood in stool will show

a positive result.

VI. Description of Methodologies/ Experimental Design:

This section should establish that the proposed procedures/research is well

designed scientifically and ethically. The following should be indicated or

described:

A. Written informed consent – Attached herewith

B. Human subject participation

The study is comprised by only pediatric (ages 1-18) and pregnant

women (with no particular age) from Pateros Public Health Department who will

be enrolled in the collection of stool samples to be used in the study.

C. Rationale of Selecting Human Subject

Pediatric and pregnant patients are the subjects of the study to their

vulnerability to intestinal parasitism because of many factors. The inclusion

criteria include the pediatric patients with ages 1-18 and pregnant women with

no particular age who are willing to participate and will sign the informed

consent. Study is limited to those who are positive in intestinal parasitism. As

per the exclusion criteria, patients who are found to have carcinoma,

inflammatory, ulcerative and erosive conditions and vascular disorders

involving gastrointestinal tract are excluded from the study. Parents who did not

allow their children to join in the study may also be a cause for exclusion.

Contaminated specimens will also be excluded.


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D. Number of Human Subjects

The researchers’ collaborators will administer questionnaires and will

evaluate approximately 200 to 300 patients from which positive for parasitism

are will be identified and undergo fecal occult blood testing.

E. Pre-treatment Procedure

The study will be conducted after obtaining the ethical approval from the

Centro Escolar University Research and Evaluation Office. Informed consent

will be given to the parents or guardians of participating pediatric patients, and

pregnant women from the Pateros Public Health Department. Participants will

be informed that all personal information is treated strictly confidential. The

researchers will explain to the patients that the procedures that will be used will

pose no risk and that their participation is voluntarily and they could withdraw

from the study at any time without giving any reason. The collaborators will

evaluate the patient’s profile and medical history. Collection procedures will be

instructed by the researchers to the patients for prevention of poorly collected

stool specimens. All participating subjects will be given sterile stool containers

with no preservatives and includes the label for name, age, and sex. The stool

samples, collected by the patients under the supervision of the collaborators,

will be verified and will be processed by the researchers. A data sheet will be

used to record each stool sample’s macroscopic and microscopic

examinations.

F. Safety Information

The researchers will be guided by the staff of Pateros Public Health

Department in doing the collection of data and specimens and in performing the

experiment. The researchers will assure that the following procedures are of no

risks and will not harm the subject-participants who will undergo the

experiment. The methods will follow the WHO protocol that ensure the safety of


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both the researchers and the participants and will produce accurate results for

the participant’s benefit of knowing their health status.

G. General Description

The study will be conducted at Pateros with the cooperation of the local

community which posses the records of the patients that are willing to

participate. This study will identify the prevalence of parasitism among the

pediatric, adolescents, and pregnant women of Pateros public health

department. This study will give the patients considerable awareness on

preventing helminthic infections.

H. Medication and Treatment – Not applicable

I. Monitoring procedure after the experiment – Not applicable

J. Rights and Privileges

The rights of the subject-participants: (1) The researchers has the full

responsibility to the subject participants especially when complication arise

within the study should receive adequate and intermediate treatment (2) The

participants are free to withdraw his/her consent and to discontinue

participation in the research anytime with no explanation required.

Examinations of stool samples are free with no financial obligation.

K. Obligation and Risk

The researchers are obliged to reach out to their patients especially for

the concerns and performing proper examination is essential to obtained

accurate results. Risk may be concerned with the patient’s discomfort in

collection of their specimen and errors may occur if specimens are improperly

collected.


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L. Benefits of the Human Participants

The patients who are in need of medical attention as for the result

obtained from the study will be referred to the physician of the municipality for

consultation and treatment. This study will give patients awareness in parasitic

infection and the need for prevention.

VII. Gantt Chart

(Attached herewith)

VIII. Declaration by the Responsible Person:

I accept responsibility for assuring that the procedures/ study will be conducted in accordance with the approved protocol. I assure that all personnel (adviser, researcher, students, consultant, and project leader have appropriate training and expertise in conducting scientific research that requires human subjects. I also ensure that safety, protect the right and promote the welfare and well-being of the human participants for the benefit of mankind as a whole. I take the full responsibility of the human subjects including the pre-treatment and post-treatment procedure and medication in specified duration. I agree to obtain written approval form from the institutional ethics review committee. And if in cases revisions will be made in the approved protocol, I also agree that IERC have the right to know the update if the study and may suggest termination of the experimentation if it inflict harm/danger to human. Signature of the Responsible Person Researchers Adviser Consultant Date: _____________________ Date:_______________________


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APPENDIX 3

LETTER OF CONSENT

(English)

Informed Consent

Research Title: DETERMINATION OF FECAL OCCULT BLOOD AMONG

PATIENTS WITH HELMINTHIC INFECTION IN PATEROS PUBLIC HEALTH

DEPARTMENT

Researchers: Kate Mylene S. Pacunayen

Jasmine Karla Abuel, Danica Constantino, Katherine Dela Paz, Nicole Jellie Dris,

Auwie Gleah S. Garcellano, Margerette Victoria J. Gruta, Josephina P. Lorzano,

Anna Rose D. Magtalas, Danica Mae P. Medes, Sachiko Aivee Mari S. Noveno,

Before agreeing to participate and comply in this research, we strongly

encourage you to read the following explanation of this study for you to have a

knowledge about the study to be conducted. This statement describes the purpose

and procedures that will be done in the study.

This research is conducted to examine the stools given with positive results of

intestinal parasitism. The researchers are conducting this study to determine if the

presence of fecal occult blood may be due to intestinal ulcerations caused by

intestinal parasites. The research will be undtertaken by Kate Mylene S. Pacunayen

and the group under the supervission of Mr. Mark Mendros, Mrs. Corazon Tan and

Mrs. Nenita Alcantara, Professors of College of Medical Technology in Centro

Escolar University.


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Participation in the study involves complying on basic questions that my be

asked by the researchers and with the instructions that must be undergone prior to

sampling. The researchers will highly appreciate your willingness and cooperation to

obtain information that may give a great contribution to fulfill the needs of this study.

The researchers will conduct a house-to-house visit for those patients that are

positive for intestinal parasitism. They will be asking some questions that can give

additional information in the study. You will also be requested to collect a sample of

your stool with proper guidelines to avoid contamination. Plastic containers and

sticks for collecting samples are provided. The stool samples shall be collected by

the researcher on the same day of collection and will be examined. This procedure

will be done in three consecutive days.

There are no risks or discomforts that are anticipated from your participation in

the study.

The anticipated benefit of participation is to know and have knowledge in your

own condition or the condition of your son/daughter. For you to be aware on the

things that is needed to be done and to know the causes and effect of the infection.

The researchers will provide information and safety measures to prevent further

complications.

The information gathered during this study will remain confidential. The results

and findings will only be relayed to you. Only the researchers, research panelist and

the physician will have access to the study data and information. There will not be

any identification of names on the results and samples,. Codes will be used and

assigned in each patients that will serve as a form of identification. Your names or

your son/daughter’s name and any other identifying details will never be revealed in

any publication of the results of this study.

Results that need medical attention will be referred to the physicians in the

health centers of this municipality for consultation advice and treatment to prevent


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further complications.

Participation in this study is voluntary; if you feel uncomfortable with the study,

refusal to participate will involve no penalty.

You are welcome to ask questions to the researchers for verification and some

concerns. If you have other concerns, you can contact this number 09********.

Thankyou.


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Consent Form

I, _________________________________, resident of Pateros have read and

fully understood all the information and procedures conducted during the research.

All guidelines are clear and reviewed. I have received a copy of this informed

consent form.

_______I voluntarily agree to participate in the study

_______I agree and allow my child to participate in the study

Statement by the researcher/person taking consent

I reviewed the information sheet to the potential respondent and made sure that

the patient understands the research objectives and methodology.

I confirm that the respondent is not forced to comply, they are voluntarily

participating in the study.

Signature of Researcher/person taking the consent: ________________________

Date: ______________________________


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APPENDIX 4

LETTER OF CONSENT

(Tagalog)

Pagpapahayag ng Pahintulot

Research Title: DETERMINATION OF FECAL OCCULT BLOOD AMONG

PATIENTS WITH HELMINTHIC INFECTION IN PATEROS PUBLIC HEALTH

DEPARTMENT

Pangalan ng Researcher: Kate Mylene S. Pacunayen

Jasmine Karla Abuel, Danica Constantino, Katherine Dela Paz, Nicole Jellie Dris,

Auwie Gleah S. Garcellano, Margerette Victoria J. Gruta, Josephina P. Lorzano,

Anna Rose D. Magtalas, Danica Mae P. Medes, Sachiko Aivee Mari S. Noveno,

Bago pumirma sa pahayag na ito ay maaaring basahin lamang mabuti ang mga

nakapaloob sa pagaaral na ito upang magkaroon kayo ng kaalaman sa mga

mungkahi at proseso sa gagawing pagsusuri.

Ang pagaaral na ito nais isagawa upang pagaralan at examinahin ang mga

dumi na makakalap na mayrong positibong resulta mula sa naunang grupo kung ito

ay mayroong parasitic infection. Isinakatuparan ito ng mga mananaliksik upang

makita kung ang fecal occult blood na makikita mula sa duming makakalap ay may

kinalaman sa pagkabutas ng bituka na sanhi ng intestinal parasitism. Ang pagaaral

na ito ay isasagawa ni Kate Mylene S. Pacunayen at ng kanyang mga kagrupo sa

ilalim ng pamumuno ni Mr. Mark Mendros, Mrs. Corazon at Mrs. Nenita Alcantara,

mga Propesor ng College of Medical Technology mula sa Cento Escolar University.


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Ang mga tagapanliksik ay bibisita sa mga bahay bahay ng mga patienteng

nagkaroon ng positibong resulta ng intestinal parasitism. Maaari silang tanungin ng

mga kaunting impormasyon na maaaring makatulong sa kanilang pagaaral. Kayo rin

o ang inyong mga anak ay hihilinging magbigay sa mga tagapanaliksik ng inyong

dumi upang examinahin. Kayo ay tuturuan kung paano ang tamang pagkolekta sa

mga ito at ang tamang lagayan at stick na gagamitin ay manggagaling sa mga

mannaliksik. Ang sample ay kailangaang makalap sa mismong araw na nasabi. Ang

pagkuha ng sample na ito ay gagawin ng tatlong beses.

Ang inyong pagpapartisipa ay hindi magdudulot ng kahit ano mang negtibo sa

inyong parte.

Makakatulong ang pagaral na ito upang kayo ay magkaroon ng kaalaman

tungkol sa kondisyon na maaring mayroon kayo. Importante rin ito upang alam ng

bawat isa ang mga dapat at hindi dapat gawin upang maiwasan pa ang pagkumplika

ng kondisyon. Ang mga tagapanaliksik ay magbibigay impormasyon din upang

maibahagi ang kanilang kaalaman kung paano maaagapan o maiiwasan pa ang

paglala ng kundisyon.

Ang mga impormasyong makakalap ay konpindensyal. Ang mga resulta ay

ilalathala sa iyo lamang. Tanging ang mga taga-panaliksik, Research Panel, at

Physician lamang ang may karapatang makaalam ng nakapaloob sa pagaaral na ito.

Hindi gagamitin ang mg pangalan ng mga responde sa bawat sample at resulta

upang mapantili ng pagiging pribado. Gagamit lamang ng mga palantandaan upang

hindi mapagpalitpalit ang mga ito.

Ang mge resulta na nangangilangan ng lubusang pagaaral ay ilalathala sa

tagasuri ng munisipalidad na ito para sa mga konsultasyon upang maiwaasaan ang

paglubha nito.


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Ang pagsangayon sa pagpartisipa sa pagaral na ito ay hindi sapilitan, maaaari

ang sinuman g tumaanggi kung kayo ay hindi kumportable sa gagawing

pageexamina.

Kayo ay maaaring magtanong kung mayroon kayong hindi nauunawaan sa

nasabing pagaaral. Maari kaayong sumangguni saa numerong ito para sa mga

katanungan, 09********. Salamat.


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Consent Form

Ako si, ________________________________________, residente ng Pateros

nagsasaad na nabasa at naintindihan kong mabuti ang mga nakapaaloob sa

pahayag na ito. Lahat ng impormasyon ay malinaw at napagaaralan. Ito ay

nagpapatunay na nakatanggap ako ng kopya ng pahayag na ito.

______ Ako ay sumasangayon sa pagiging parte ng pagaaral na ito.

______ Ako ay sumasangayon at pumapayag na maging parte ang anak ko ng

pagaaral na ito.

Pirma ng Patiente

______________________ ________________________ ________________

Pangalan Pirma Petsa

Pirma ng Magulang

_____________________ ________________________ ________________

Pangalan Pirma Petsa

Pahayag ng tagapanaliksik/kukuha ng impormasyon

Binasa at inaral ko ang mga impormasyon na nakasulat na inilathala ng

responde at nakakasisigurong naintindihan at napagaralan niya ang mga nakasaad

dito. Ito ay patunay na hindi pinilit at ito’y kusang loob na inaprubahan ng responde.

Pirmaa ng tagapanaliksik/kukuha ng impormasyon: _______________________

Petsa: ______________________________


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APPENDIX 5

RESEARCH TIMETABLE


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APPENDIX 6

THE RESEARCHERS: Curriculum Vitae

CONTACT INFORMATION Name: Kate Mylene S. Pacunayen Address: Blk 7 Lt 11 Amethyst St. Golden City Subdivision, Taytay Rizal Telephone: 368 43 11 Cell Phone: 09058243898 Email: [email protected] PERSONAL INFORMATION

Date of Birth: September 6, 1994 Place of Birth: Davao City Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION Tertiary: Centro Escolar University Mendiola, Manila 2011-present Secondary: Harris Memorial College Taytay, Rizal 2007-2011 Primary: Harris Memorial College Taytay, Rizal 2001-2007 ACCOMPLISHMENTS

PHISMETS Vice President S.Y 2015-2016 President's Lister Second Semester S.Y. 2012 – 2013 President's Lister First Semester


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Curriculum Vitae

CONTACT INFORMATION Name: Auwie Gleah S. Garcellano Address: 25 Chiefmate Lane Regatta Classic Subdivision, Anabu 2B Imus, Cavite Telephone: (046) 515 72 95 Cellphone: 0927328722 Email: [email protected] PERSONAL INFORMATION

Date of Birth: October 29, 1994 Place of Birth: UERM Hospital, Quezon City Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION Tertiary: Centro Escolar University Mendiola, Manila 2011-present Secondary:Vel Maris School Inc. Dasmariñas, Cavite 2007-2011 Primary: Hansel and Gretel School of Cavite Imus, Cavite 2001-2007


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Curriculum Vitae CONTACT INFORMATION

Name: Margerette Victoria J. Gruta Address: 61-A San Perfecto St. San Juan City Cell Phone: 09173780040 Email: [email protected] PERSONAL INFORMATION Date of Birth: August 21, 1995 Place of Birth: San Juan City, Manila Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION Tertiary:Centro Escolar University Mendiola, Manila 2012-present Secondary: University of The East-Secondary Laboratory High School 2009-2012


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Curriculum Vitae

CONTACT INFORMATION Name: Josephina P. Lorzano Address: 1248 Abreu St. San Miguel, Manila Telephone: 4104929 Cell Phone: 09153857524 Email: [email protected] PERSONAL INFORMATION Date of Birth: August 7, 1994 Place of Birth: Sta. Mesa, Manila Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION Tertiary: Centro Escolar University Mendiola, Manila 2011-present Secondary: Canossa Academy Lipa City, Batangas 2005-2011 Primary: De La Salle Lipa Lipa City, Batangas 2001-2005 Pinagtung-ulan Elementary School Pulo Lipa City, Batangas ACCOMPLISHMENTS Medical Technology Student Council Year Level Secretary S.Y. 2011 - 2012 Dean's Lister First Semester S.Y. 2012 – 2013 Dean's Lister First Semester


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Curriculum Vitae

CONTACT INFORMATION Name: Anna Rose D. Magtalas Address: 8 Mendiola St. San Miguel, Manila Cell Phone: 09278786266 Email: [email protected] PERSONAL INFORMATION

Date of Birth: October 30, 1995 Place of Birth: Cebu City Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION

Tertiary: Centro Escolar University Mendiola, Manila 2012-present Secondary: Our Lady of Caysasay Academy Taal, Batangas 2009-2012 Primary: Our Lady of Caysasay Academy Taal, Batangas 2004-2009 ACCOMPLISHMENTS Dean's Lister First-Second Semester S.Y. 2012 – 2013 Dean's Lister First Semester S.Y. 2013 – 2014 President’s Lister Second Semester S.Y. 2013 – 2014

Curriculum Vitae


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CONTACT INFORMATION

Name: Danica Mae P. Medes Address: P-7 Batang, Ligao City, Albay Cellphone: 09174734918 Email: [email protected] PERSONAL INFORMATION Date of Birth: May 23, 1996 Place of Birth: Batang, Ligao City, Albay Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION

Tertiary: Centro Escolar University Mendiola, Manila 2012-present Secondary:Bicol Regional Science High School Tuburan, Ligao City, Albay 2008-2012 Primary: Ligao East Central School Tuburan, Ligao City, Albay 2002-2008 ACCOMPLISHMENTS

Dean's Lister Second Semester S.Y. 2012 – 2013 Dean's Lister First Semester S.Y. 2013 – 2014


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Curriculum Vitae

CONTACT INFORMATION

Name: Sachiko Aivee Mari S. Noveno Address: 821 Nueve de Pebrero St. Mandaluyong City Cell Phone: 09051804296 Email:[email protected] PERSONAL INFORMATION Date of Birth: October 26, 1996 Place of Birth: San Juan City Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION Tertiary: Centro Escolar University Mendiola, Manila 2011-present Secondary: Mataas na Paaralang Neptali A. Gonzales 2007-2011 Primary: Highway Hills Elementary School 2001-2007 ACCOMPLISHMENTS Dean's Lister First Semester S.Y. 2012 – 2013

http://jobsearch.about.com/od/cvadvice/qt/cv-date-of-birth.htm


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APPENDIX 7

BUDGET PROPOSAL

The researchers proposed a budget worth for their research entitled

“Determination of Fecal Occult Blood Among Patients with Helminthic

Infection in Pateros Public Health Department”. The said budget will be used

for the following:

Name of Item Unit Price

(Php)

Quantity Total Price (Php)

A. Materials

Fecal Occult Blood Kit 3,500 300 10,500

Box of slides (frosted) 250 4 1,000

Box of Gloves 150 1 150

Box of Mask 80 1 80

Big Alcohol 160 1 160

Stool Container 17 300 5,100

Tissue Roll 12.50 12 150

Cotton (Big) 150 1 150

Yellow bag 50 1 pack 50

Applicator Sticks 15 2 box 30 B. Others

Transportation 200/person 8 1,600

Patient’s Snack 100 15 1,500

Paper Form 150 1 150

Short Envelopes 5 3 15

Book Bind 350 1 350

English Editor 1,000 1 1,000

Statistician 1,000 1 1,000

Panelist refreshment and souvenir

120 15 1,800

C. Miscellaneous 1000

TOTAL AMOUNT PHP 25,785

BUDGET PHP 26,000

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