Prevalence and Risk Factors of Selected Non-Communicable Diseases among Grade Ten
Students Enrolled in Tublay School of Home Industries, Benguet AY 2018-2019
A Research Proposal
Submitted to the Faculty of the Department of Pharmacy
School of Natural Sciences, Saint Louis University
In Partial Fulfillment of the Requirements for the Degree,
Bachelor of Science in Pharmacy
ABERIN, Althea Asher F.
OBED, Kimberly Ann S.
ROSALES, Jaeniele A.
SORIANO, Vench C.
VERZOLA, Vianca Mariz S.
CANARIA, Maria Victoria P.
December 2018
ENDORSEMENT
In partial fulfillment of the requirements for the degree
Bachelor of Science in Pharmacy,
This research proposal entitled,
“Prevalence and Risk Factors of Selected Non-Communicable Diseases among Grade Ten
Students Enrolled in Tublay School of Home Industries, Benguet AY 2018-2019”
Prepared and submitted by:
S1:ABERIN, ALTHEA ASHER F.
S4:SORIANO, VENCH C.
S2:OBED, KIMBERLY ANN S.
S5:VERZOLA, VIANCA MARIZ S.
S3:ROSALES, JAENIELE A.
Is hereby endorsed for implementation.
This endorsement implies that this research proposal has been thoroughly read and reviews
and have seen to it that it is scientifically and ethically sound.
MS. MARIA VICTORIA CANARIA
Faculty Research Promoter
Date: _________________________
Date: December 15,2018
Prevalence and Risk Factors of Selected Non-Communicable Diseases among Adolescents
Enrolled in Tublay School of Home Industries, Benguet AY 2017-2018
Canaria1, MV; Aberin2, AA; Obed3, KA; Rosales4, J; Soriano5, V; Verzola6, VM.
1
Faculty Research Promoter, Department of Pharmacy, School of Natural Sciences, Saint
Louis University
ABSTRACT
Non communicable diseases are chronic, non-infectious health condition of long duration and
generally slow progression. The four main types of common non-communicable diseases are
cardiovascular diseases, chronic respiratory diseases, cancer and diabetes. Globally, the statistics of death
from non-communicable diseases are increasing. In the Philippines, the World Health Organization
reported that 68% of deaths accounting to 457,000 people in the country are caused by non
communicable diseases. The aim of the study is to determine the prevalence of non-communicable
diseases and their risk factors specifically diabetes among grade 10 students enrolled in Tublay School of
Home Industries within the academic year 2018-2019. A total of 308 students responded on one-time
sampling questionnaire survey. Most of the participants have normal anthropometric (BMI) measure.
Generally, male students had higher BMI than female students. The distribution of age ranges from 13 to
19 years old with most of the students being 16 years old. Familial records of diabetes were less common
among the grade 10 students but there were still some students who are likely to be affected due to their
genetic predisposition. Grade 10 students were aware of the importance of eating fruits and vegetables
with most of the students answering that they consume fruits three or four times a week. They also engage
in physical activities which is very important to improve their lifestyle. Overall, there is a low risk of
developing diabetes among grade 10 students in TSHI AY 2018-2019.
Keywords: Diabetes mellitus, Adolescents, Non-communicable Diseases
Introduction
Great health enhances a person’s ability to learn, acquire skills, and contribute to society, thus
showing it as a necessity of a person. However, many of us have paid no attention to the countless choices
confronting us about the way we live, work, and play that can potentially damage our bodies and our
minds, or even cost our lives. There are four main types of common non-communicable diseases namely
cardiovascular diseases (such as hypertension, heart attacks, and stroke), chronic respiratory diseases
(such as asthma), cancer, and diabetes. Globally, the statistics of death from non-communicable diseases
are increasing; in the Philippines, the World Health Organization reported that 68% of deaths, accounting
to 457,000 people, in the country are caused by non-communicable diseases. Public education and
awareness in the Philippines are fully achieved but there are no concrete policies/strategies or action plans
by the government to address the mortality rate according to the Non-communicable Diseases Progress
Monitor 2017 by the World Health organization. Among the main contributing factors are older age and
unhealthy lifestyle-related behaviors, hence the term “lifestyle-related diseases.” A general improvement
of socio-economic factors within Philippines and the resulting increase in life expectancy, has contributed
to an increase in the prevalence of NCDs. People at risk for or living with NCDs often do not know they
are at risk so they do not seek services. Those risk factors can be classified into two categories:
modifiable behavioral risk factors and metabolic risk factors. Modifiable risk factors include tobacco use,
harmful use of alcohol, physical inactivity, and unhealthy diet; metabolic risk factors contribute to
metabolic changes in the body, like raised blood pressure, high blood glucose level, and high levels of fat
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in the blood, which then increases the risk for NCDs (WHO, 2017). The total numbers of deaths
associated with NCDs are rising in almost all countries due to population aging and other factors.
The rising burden of preventable risks for NCDs among adolescents is a major public health
challenge worldwide (Kuhwaja et al., 2011). According to the Philippine Health Statistics (2003), NCDs
account for more than 40% of the deaths in young Filipinos (10-24 years old). Behaviors established
during adolescence period often have life-long consequences to the onset of NCDs in later life (Gamage
& Jayawardana, 2018).This calls for action to prevent the establishment of risk factors from the early
years of life; by arming adolescents with adequate knowledge about chronic diseases and healthy
preventive practices. Evidence on the current knowledge and lifestyle-related practices of adolescents
would immensely help both the health and education sectors with planning and implementation of much
needed programs for school children. Educating students at the school level is considered to have a
significant impact on the prevention of NCDs (Bartlett EE., 1981).
Diabetes mellitus is the most common chronic and endocrine disease emerging in children and
adolescents. It is highly increased at an alarming rate both in the incidence and prevalence worldwide.
According to the World Health Organization, diabetes is a chronic disease that occurs either when the
pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces
which results to hyperglycemia, or raised blood sugar which can damage certain body systems and may
lead to complications. There are two types diabetes, it includes type 1 diabetes also known as insulin
dependent, juvenile or childhood-onset diabetes wherein it is characterized by low or insufficient
production of insulin and requires daily consumption or supplement to suffice the body’s needs; while in
type 2 diabetes, which is also known as non-insulin dependent or adult-onset diabetes, it results from the
body’s ineffective use of insulin. It comprises the majority of people with diabetes around the world, and
is largely the result of excess body weight and physical inactivity.
In 2014, the global prevalence of diabetes in people 18 years old and above is 8.5%. In 2016,
diabetes was the direct cause of 1.6 million deaths and in 2012, it caused 2.2 million deaths. WHO also
estimated that diabetes was the seventh leading cause of death in 2016. According to the Canadian
Diabetes Association Clinical Practice Guidelines Expert Committee, children from ethnic groups are at
high risk of acquiring diabetes namely, those of Aboriginal, African, Arabic, Hispanic or Asian descent,
are disproportionally affected. Recent data from the United States established an incidence of 8.1 in 100,
000 person in the 10- to 14-year age group and 11.8 in 100 000 person in the15- to 19-year group. The
prevalence of diabetes mellitus has been increased threefold. The chronic complications of diabetes
mellitus include accelerated development of cardiovascular diseases, renal disease, loss of visual acuity,
and limb amputations. All of the complications aforementioned contribute to the increase in morbidity
and mortality in individuals with diabetes. (Reinehr, T. 2013)
Diabetes causes a major impact in third-world countries, particularly in the Philippines. It is said
that Asia will see the greatest increase in the number of people with diabetes by 2025. This increase in the
burden of chronic diseases in Asia will significantly affect nations’ respective health care systems, both
acutely and chronically.
Non-communicable diseases including diabetes in the Philippines account for 6 of the top 10
causes of mortality and are considered a major public health concern. What is alarming is that as deaths
due to preventable diseases have been on a decline, lifestyle-related diseases due to “Westernization” of
the culture have begun to dominate as the leading causes of death, particularly due to cardiovascular
diseases, malignant neoplasms, diabetes, and chronic lower respiratory diseases.
At present, there are no published nationwide prevalence or incidence studies on type 1 diabetes
(T1D). However, 1 survey was done in a municipality of Bulacan in Central Luzon Region that showed a
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very low prevalence of T1D with only 7 cases diagnosed among children aged 0 to 14 years during a 10year period from 1989 to 1998. As a result of the low prevalence of T1D, continuous glucose monitoring
(CGM) devices and continuous subcutaneous insulin infusion (insulin pumps) are not widely used. There
is little research on stem cell therapy or islet cell transplantation for T1D in the Philippines.
Type 2 diabetes is the most common type of diabetes in the Philippines. In the latest survey
published by the Food and Nutrition Research Institute in the Philippines (the Eighth National Nutrition
Survey of 2013), the prevalence of high fasting blood glucose based on the World Health Organization
criteria of >125 mg/dL for individuals >20 years old was 5.4%, an increase of 0.6%, compared with the
same study in 2008. The highest prevalence rate was found among the richest in the wealth index, those
living in urban areas, and those in the 60- to 69-year age group in both sexes. These studies show an
alarming growth rate of T2D in the Philippines similar with an upward trend in worldwide prevalence.
Around 1.7 million people with T2D remain undiagnosed.
In the Philippines, there is a very low physician-to-household ratio. As of 2002, it was estimated
that there were only 12 physicians per 10,000 households, although there were more nurses available, at
61 per 10,000 Filipino households. The Philippine government health care insurance company PhilHealth
provides benefits for diabetes-related admissions. Because of the increasing burden of NCDs such as the
cost of maintenance drugs for these diseases, PhilHealth Primary Care Benefit 2 Package (PCB2) will pay
for outpatient medicines for PhilHealth qualified members or dependents with hypertension, diabetes and
dyslipidemia long before their conditions become worst. Limited medications were included in the
coverage for diabetes, namely only the sulfonylurea glibenclamide and the biguanide metformin, provided
on a monthly basis. These guidelines are obviously superior to no provisions for diabetes medical
outpatient care. However, the guidelines are still not sufficiently comprehensive, as reimbursements for
medications and overall health coverage remain limited for each family household.
Diabetes clinics in several government hospitals offer free consultations and affordable medicines
for the underprivileged. Additionally, most city governments also have city health centers, which are
called barangay health units. It is at barangay health stations (BHS) where health care professionals
(HCPs) are expected to deliver basic diabetes self-management and perform basic measures, such as
blood pressure and body mass index calculations. In the City (or Provincial) Health Offices, diabetes
clubs are established.
The Philippines government has implemented reforms to make diabetes medications readily
available and affordable to all Filipinos. The Philippines Generics Act of 1998 under Republic Act No.
6675 was passed mainly to improve the supply of medicines for HCPs, specifically allowing importation,
manufacturing, and encouragement of generics instead of branded medicines.Likewise, the Philippines
Department of Health established the National Drug Policy Pharmaceutical Management Unit, or Pharma
50, to reduce prices of medicines by 50% through parallel drug importation. Local government units also
have the Botika ng Barangay (Pharmacy of the Village) program that caters to marginalized underserved
communities by providing affordable over-the-counter and selected prescription medications at very low
prices. In 2008, the universally accessible Cheaper and Quality Medicines Act No. 9502 was passed,
which granted the government the power to regulate medicine prices and ensure quality affordable
medicines through the Bureau of Food and Drugs.
Diabetes awareness campaigns have always been at the forefront of activities among diabetes
organization in the Philippines, including the PSEDM. The Institute for Diabetes Foundation (IDSF),
Diabetes Philippines (DP), American Association of Clinical Endocrinologists Philippines (AACE
Philippines), and the Philippine Center for Diabetes Education Foundation (PCDEF).
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Diabetes Awareness month is celebrated every July with concurrent activities nationwide,
including many lay forum events. The Department of Health also reserves every fourth week of July in its
yearly calendar for a Diabetes Awareness campaign. Additionally, general practitioners and internal
medicine specialists regularly attend diabetes workshops by these organizations to optimize care in
underserved regions. Glucose tolerance testing should be used as tests for diagnosing diabetes. However
the CPG recommends A1C measurement for glucose control monitoring. Another problem with A1C is
that it is not readily available in public hospitals and health centers, further limiting the ability to monitor
glycemic status and achieve optimal diabetes care. (Tan, G. 2015)
On March 14, 2017, the Department of Health issued a policy and guidelines regarding the
promotion and development of healthy eating habits among the youth and DepEd employees by making
available healthy, nutritious, and affordable menu choices, and for setting food standards.
Thus, the conduct of surveillance of NCDs and their risk factors among adolescents in Tublay,
Benguet is deemed necessary and timely. Adolescents shall be defined in this study as those students
currently enrolled as Grade 10 secondary school students in Tublay School of Home Industries, which is
the basis for the target population of the study. Generally, this study aims to assess the prevalence and
risk factors that contribute to the occurrence and development of non-communicable diseases among
grade 10 students of Tublay School of Industries. The study could benefit the participating school and
health care providers by gaining information on how to prevent behaviors that underlie NCDs among
adolescents, specifically they can identify behaviors that put the adolescents at risk for NCDs that could
provide early detection and early diagnosis, prompt and adequate access to treatment and management
of NCDs. The families and the community will gain relevant information about the risk factors that
could increase a person's chance to develop a disease, thus promoting healthy lifestyle choices. Finally,
the study may also be beneficial to other researchers that are geared towards NCDs since it may be used
as a source or reference which may help in the development of the study. This could provide information
on how to prevent the risk factors that could increase a person's chance to develop a disease and to
estimate the prevalence of behavioral risk factors on NCDs (Adhikari K, Adak M R, December 2012).
The aim of the present study to determine the prevalence of non-communicable diseases and their
behavioral and biological risk factors among adolescents enrolled in Tublay School of Home Industries
within the academic year 2018-2019.
Specific Objectives:
1. To determine the following data from the target population:
a. Age
b. Gender
c. Body Mass Index
d. Dietary behavior
e. Lifestyle
2. To determine the proportion of the target population that may have higher risk of:
a. Diabetes
b. Hypertension
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Methodology
The study utilized the cross-sectional epidemiological study design, which entailed a one-time
sampling of the target population and data collection via questionnaire survey with interview and physical
measurements. The risk factors and physical measurements were treated as exposures and the history of
diabetes mellitus were treated as disease outcomes, and both exposures and disease outcomes for each
subject were determined simultaneously. Reservations, however, were noted regarding the disease
outcomes because these were purely based on the history as reported by each subject and were not
actually diagnosed by a clinician during the study. The calculations for the prevalence of disease in
exposed compared to non-exposed persons and the prevalence of exposure in diseased compared to non
diseased persons were based on this assumption.
The study was a research program of the Department of Medical Laboratory Science, under the
coordination of Sir Audrey Culiao, which was adapted and broken down by the Department of Pharmacy
into research projects managed by individual Faculty Research Promoters (FRPs) in the department with
their assigned undergraduate research teams. There are 11 FRPs in the department with 27 undergraduate
research teams consisting of 5 to 6 student members. These FRP-led student groups were assigned to
particular grade level/s or section/s in the school to maximize the scope of the study. Ethical review and
approval of the study were sought from the Saint Louis University Research Ethics Committee.
Initial permissions and endorsements with a manifestation of consent for participation in the
study document were signed by the principal or head of TSHI. Preliminary arrangements were made with
appropriate class supervisory personnel such as classroom advisers or health educators in each school for
distribution of parental consents to be brought home by each student for parental agreement for their child
to participate in the study as well as participant’s assent form for their agreement to participate in the
study. In securing parental consent and participant’s assent, the rationale and methodology of the study
were clearly stated in the forms and the researchers’ contact details were provided for contacting should
the parents and/or the participants wished to receive further explanations. No undue pressure were exerted
to both parties for their consent/assent. Again, contact details of the research team were included in the
parental consent form so the parents can freely contact the researchers in cases of questions or concerns
and an invitation for the parents to be actually present during the conduct of the research so that any
questions and clarifications that they may have had can be addressed by the research team. To ensure that
the parents actually signed the informed consent forms, no actual verifiable procedure was proposed
except to request parents to attach a photocopy of any valid identification cards with their signatures on
them if possible. Participant’s assent were secured in the study sites to offer direct explanation by the
researchers together with the information already available in the forms. After parental consent and
participant’s assent were obtained, the questionnaires were then distributed per class following a pre
arranged schedule with physical measurements to follow right after completion of the questionnaires.
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Results and Discussion
10 Students
Family history of
Diabetes
BMI of Grade
eight
4%
13
Has a
2%
Underw
2%
member of
11%
Diabetes
9%
Age of Grade
10 Students
0%
14
2%
32%
0% Normal
79%
the family
Overwei ght who has
diabetes
76% Class 1 Obese No family
13%
21%
history of
Figure 1. BMI of
Grade 10 students
in TSHI
Figure 2. Diabetes
Background of
Grade 10 students of
TSHI
15 16 17 18
19
49%
Students
44%
56%
Figure 3. Grade 10 TSHI
Gender of Grade 10 students classified
according
to age
Male
Female
Figure 4. Grade 10 TSHI students classified according to gender
The data gathered as seen on Figure 1 (BMI of Grade 10 students in TSHI), shows that 76% of
the population of Grade 10 students of TSHI has a normal Body Mass Index. Using BMI or body mass
index may help the researchers in knowing the possible factors for the occurrence of diabetes mellitus in
the students from Grade 10. Body mass index is one of the parameters used in order to know the body fat
present in a person using both height and weight. An increase in body fat is one of the known risk factor
which may lead to the occurrence of diabetes mellitus, hypertension and also dyslipidemia which are also
seen in obese and/or overweight person (H E Bays, R H Chapman, and S Grandy, 2007). Referring to
Figure 2 (Diabetes Background of Grade 10 students of TSHI), presents the data of the majority (79%) of
Grade 10 TSHI students has no family history of diabetes while the rest of 21% have a family history of
diabetes and it is considered as one of the risk factors since it is widely known that gene mutations can be
passed on from one generation to another and this includes genes which are also associated with type 2
diabetes mellitus. It was also revealed in Figure 3 (Grade 10 TSHI students classified according to age),
with a age range of 13-19 years old of Grade 10 students of TSHI most of them are 15 years old. As a
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person gets older the risk for Diabetes will increase. As to gender see Figure 4 (Grade 10 TSHI students
classified according to gender), 171 (56%) of the total population 308 Grade 10 students of TSHI were
females and the remaining 137 (44%) were males. As of today there are no present studies showing any
variations of the risk of diabetes for men and women.
Factors affecting the risk of Grade 10 TSHI students for Diabetes
Identification
Yes
No
Undergone blood sugar testing 47 (15.72%) 252 (84.28%)
Diagnosed with Diabetes 9 (2.922%) 299 (97.07%)
Behavior
Currently taking insulin medication for diabetes 0 (0%) 9 (100%)
Currently taking any herbal or traditional remedy
for your diabetes 0 (0%) 9 (100%)
Seeing any traditional healers 0 (0%) 9 (100%)
Table 1. Identification of Diabetes
Based on table 1, 47 students (15.72%) had undergone blood sugar testing which is one of the
significant test needed in order to know the amount of sugar in blood and for the early diagnosis of
diabetes. 9 students out of the 308 respondents were diagnosed with diabetes by a doctor or health care
practitioner. However, the number of students that are taking any herbal or traditional remedy for
diabetes, taking insulin medication and the number of respondents that are seeing any traditional healers
are none. From this interpretation none of the 9 diagnosed patients aren’t taking any steps to manage their
current disease and this may be due to negligence or lack of general knowledge on diabetes. This may be
accountable due to an inadequate diabetes care in the Philippines with respect to its resources,
government support and economics. This may also due to insufficient or a poor pharmacotherapy
adherence which impairs the prevention of such disease (Tan, G. H. 2015).
Average Days
Serving
Fruits
4 days
3 servings
Vegetables
3 days
2 servings
Table 2. Diet based on the number of servings they consume
Table no. 2 shows the data and results regarding the diet of grade 10 students specifically the
consumption of fruits and vegetables. Based on the data, the consumption or intake of fruits and
vegetables is relatively high among grade 10 students and having a healthy lifestyle helps in reducing and
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maintaining blood glucose levels and maintaining a healthy weight thus reducing the risk of having
diabetes mellitus.
TYPE OF
Yes
No
Average time
Average Days
Vigorous Activity
115 (38.59%)
183 (61.41%)
35 minutes
3 days
Moderate-intens
129 (47.25%)
144 (52.75%)
30 minutes
3 days
Walking/Biking
188 (65.28%)
100 (34.72%)
22 minutes
5 days
Sports/Recreation
157 (56.07%)
123 (43.93%)
N/A
N/A
308 (100%)
0 (0%)
3 hours
N/A
ACTIVITY/ response
ity Activity
al Activity
Sitting
Table 3. Physical Activity among grade 10 students
Table no. 3 shows the data and results regarding the physical activity performed among grade 10
students. Based on the data, grade 10 students do not engaged in vigorous activity with a total of 61.41%.
It is also indicated in the data that grade 10 students do not engaged in moderate-intensity activity with a
total of 52.75%. Being in school, the students are limited and sit most of the time which contributes in
lack or limitations in movement thus increasing the risk of contracting diabetes mellitus.
The data we collected "showed/shows" that only very few of the grade 10 students have been told
that they have high blood glucose or diabetes based on the questions they have answered, but none of
them are taking any medications for it. Many/Most of the grade 10 students are at risk for developing
diabetes due to high BMI, family history, diet, and lifestyle.
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Conclusion and Recommendations
Most of the participants have normal anthropometric (BMI and BP) measures. Generally, male
students had higher BMI than female students. The distribution of age ranges from 13 to 19 years old with
most of the students being 16 years old.
Familial records of diabetes were less common among the grade 10 students but there were still some
students who are likely to be affected due to their genetic predisposition.
Grade 10 students were aware of the importance of eating fruits and vegetables with most of the
students answering that they consume fruits three or four times a week. They also engage in physical
activities which is very important to improve their lifestyle.
Overall, there is a low risk of developing diabetes among grade 10 students in TSHI AY 2018-2019.
Based from the findings gathered by the researchers, the following recommendations for future researches
were made:
i. along with diet, physical activity or exercise and physical measurements, menstruation cycle
among females must be included as one of the parameters of determining the occurrence of
diabetes among adolescents because it is found that irregular menstruation, which is an
endocrine disorder, occurs in one of three diabetic women (Hilson, 2015);
ii. since its is beyond the scope of the study to do inferential statistics on the data gathered, the
researchers also recommend the use of ANOVA or t-test in determining the significant
differences on the parameters used in addition to the descriptive statistics used in this study;
iii. canteen foods, specially sugar content since salt intake is already noted in the questionnaire,
must also be noted in the questionnaire as to know their effects on the overall health of the
students;
iv. majority of the students were not able to completely answer the questionnaire due to time
constraints or inability to fully understand the questions therefore we highly recommend
one-on-one interview to address the comprehensive problems of the students, although it is
time consuming but it will yield more accurate results.
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