ABSTRACT

One of the biggest problems in the world today is the increasing number of tuberculosis cases. Rapid increase of TB patients is due to poor socio-economic situations, migration, alcoholism, and lack of public dissemination about tuberculosis etc. In the Philippines, different provinces have different notions or beliefs about tuberculosis. This is due to different environments, traditions, level of education, existing technology, financial problems, access to information etc. With these, the study aims to look at, investigate, and clarify, using multivariate statistical techniques, the rationale behind the perception of Filipinos on the different aspects of tuberculosis. Multivariate statistical techniques such as Cluster and Factor analysis are used in this study. The authors make use of the data from NDHS about the awareness of the Filipino citizens concerning tuberculosis to determine the perceptions of the Filipino people towards the causes of tuberculosis. Results show that there are four factors that Filipinos think is the cause of tuberculosis and these reasons are superstitious factor, health factor, cause factor, and lung factor.

Page | 1

I. Introduction
A. BACKGROUND OF THE STUDY

Tuberculosis (TB) is one of the extremely infectious diseases and one of the serious health problems caused by the TB bacteria (Mycobacterium tuberculosis). According to the Department of Health, it primarily affects the lungs of an infected patient. TB doesnt choose its victim; it affects people of any age. Those people who had a history of having TB can easily get the bacteria and can be infected easily. Tuberculosis has two types, pulmonary and extrapulmonary. Extra-pulmonary diseases affect other parts of the body such asthe brain, lymph nodes, kidneys, bones, joints, larynx, intestines or eyes while pulmonary disease affects the lung of the infected person. TB bacteria are transferred from the infected patient to uninfected person through air. People with weakened immune system or those who have HIV are at risk of being infected. Signs of having tuberculosis last for about 12 weeks after exposure. Having cough for more than 2 weeks, chest and back pains, poor appetite, rapid decreasing of weight, fever and coughing of blood are the symptoms of having tuberculosis. Tuberculosis may be inactive for some time but there is a high probability that the disease will come back

According to Clinical Practice Guidelines for the Diagnosis, Treatment, Prevention and Control of Tuberculosis in Adult Filipinos 2006, an update from the same guidelines made in 2000, tuberculosis is the sixth leading cause of morbidity and death of the Filipino people. The Philippines is considered as one of the 22 high-burdened countries in the world according to World Health Organization and most tuberculosis patients belong to the age group between 1554 years old. About one third of the total population is affected by this kind of disease (Yahav, 2006).

An increase in population, poor socio-economic situations (e.g. large number of unfortunate Filipino, overcrowding, vast number of unemployed, etc.), migration, alcoholism
Page | 2

and lack of public dissemination about tuberculosis are some of the reasons why there are a large number of infected people of tuberculosis in the Philippines. Increasing prevalence of tuberculosis infection is very alarming for the public and for the government since it causes enormous community health and economic catastrophe. According to Legesse et al (2002), poverty and awareness seems to be the primary factors why there is an increase in tuberculosis cases. They also show that lack of information dissemination to the public about the modes of transmission, causes, proper treatment could continue the rapid increasing of TB cases. According to World Health Organization, any communication from an infected person may cause the TB bacteria to transfer to another person through coughing, sneezing, talking or spitting as TB germs propel into the air. As long as there is communication between infected person and the uninfected one, tuberculosis will still spread.

B. SIGNIFICANCE OF THE STUDY

The Philippines, being one of the developing countries, is considered as 9th largest burden tuberculosis in the world. It seems that tuberculosis is one of the leading causes of death among the Filipinos. It is a risk to the health and economic sector of the country. According to DOH, Directly-Observed Treatment Short-course or DOTS is a strategy supported by the World Health Organization and International Union against Tuberculosis and Lung Diseases (IUATLD) to distinguish and treat TB patients. DOTS can make as high as 95% of cure rates even in the poorest countries, it can also cure TB patients, prevent new infections at low cost.

Tuberculosis can be treated. Patients must be knowledgeable on the different aspects of the tuberculosis. Sufficient information on the different aspects of tuberculosis may lessen the TB incidence. Appropriate treatment for this disease must be given to the patients. According to Department of Health, wrong treatment to the patient will worsen the condition

Page | 3

of the infected person (e.g. drugs used for tuberculosis is a combination of 3-4 anti-TB drugs, it should not be prescribe by a single drug).

Understanding on the perceptions of the public on how tuberculosis is spread and their perception on the causes of this disease will benefit the different health organizations, and hospitals as well as the Filipino citizens to work on programs that will promote public dissemination on the facts about the spread, causes, effects, and proper treatment of tuberculosis that will eradicate the number of tuberculosis cases in the Philippines.

C. STATEMENT OF THE PROBLEM

Different provinces in the Philippines have different notions or beliefs about tuberculosis. This is due to different environments, traditions, level of education, existing technology, financial problems, access to information etc. This is the working problem of this study, explicitly, this paper aims to look at, investigate, and clarify, using multivariate statistical techniques, the rationale behind the perception of Filipinos on the different aspects of tuberculosis. Particularly, this study aims to determine the following objective:

1. Determine the perceptions of the Filipino people towards the factors leading to development of tuberculosis. 2. Determine Filipinos basic awareness, traditional consciousness, superstitions, and biomedical knowledge about Tuberculosis. 3. Compare and contrast the perceptions of the Filipinos towards Tuberculosis and medical findings from the different health organizations about the causes of Tuberculosis.

D. SCOPE AND LIMITATIONS

Page | 4

In this study, the authors used data from 2008 Philippines National Demographic and Health Survey (NDHS). This survey was carried out by National Statisitcs Office to give information in monitoring the population and health condition in the Philippines. This national survey is conducting data about the national demographic and health surveys every five years since 1968. Presenting the latest information on fertility, family planning, family health, nutrition, and childhood mortality, awareness of tuberculosis, HIV-related knowledge, and access to HIV testing services is the purpose of the survey. A total of nationally representative sample of 13,594 women in 12,469 households were interviewed. The number of samples presented estimates for the Philippines as a whole.

The authors make use of the data from NDHS about the awareness of the Filipino citizens concerning tuberculosis to determine the perceptions of the Filipino people towards the causes of tuberculosis. Multivariate statistical techniques such as Cluster and Factor analysis are used in this study.

II. Review of Related Literature

Tuberculosis in the country exacts serious economic consequences caused by loss of income due to disability and premature death. Based on the incidence, mortality data, and the 1997 Philippine population by age and gender, assuming a duration of illness at 2.2 years, Peabody and colleagues estimated that 514,000 years of healthy life or disability adjusted life years (DALYs) are lost, due to illness and premature death from TB each year, affecting predominantly males and the most productive age group (Current State of Tuberculosis in the Philippines 2004).

Early detection and prevention has always been the key in preventing tuberculosis and other such diseases. Proper information of the public as well as government intervention
Page | 5

through public health-care centers is vital. However, there are evidences that show that most Filipinos are not properly educated about the causes of tuberculosis. In a study conducted by Navio (2002), surveys taken in Metro Manila show that most people in Metro Manila received low scores in terms of tuberculosis awareness. According to Navia (2002), Knowledge about TB among the general urban population of Metro Manila was low, and was determined by level of education rather than age, sex, income, occupation or place of residency and was higher among people with a college education.

It has also been found out that many Filipinos have many common misconceptions about tuberculosis (Ladia 2008). Many Filipinos are unaware that tuberculosis is caused by bacteria and not by other factors such as smoking, stress etc. In a study conducted in Tarlac in 2009 showed that Out of the 62 respondents, 35 (57%) scored good in their overall knowledge on TB while sixty-one percent of the respondents had acceptable attitudes and practices toward the disease. Ninety-six percent of the respondents knew that TBs was a highly-infectious disease, but was curable. The main source of information about tuberculosis was the mass media (newspapers, television and radio) in 41% of the respondents. As regards the consequences of interrupted treatment, 69% of the respondents believed that complications would ensue, while 13% believed that patients would die from non-adherence to the TB medication. There was no significant difference in the proportion with good knowledge (Bacay-Domingo 2009).

These kinds of misconceptions do not only exist in the Philippines but in other countries as well. In Pakistan, it was found out that (7%) patients thought TB was not an infectious disease and 18 (10.6%) did not consider it a preventable disease (Khan 2003). Contaminated food was considered the source of infection by 81 (47.6%) and 96 (57%) considered emotional trauma/stress the causative agent of TB. No counseling about preventing spread was received by 81 (50%) patients and 97 (57%) considered separating dishes as an important means of preventing spread (Khan 2003). Lack of knowledge has been attributed to the high tuberculosis rate in Pakistan (Khan 2003).
Page | 6

Many Filipino-Americans however are well informed about TB (Yamada 1999).This is perhaps a result of better access to tuberculosis information in the US compared in the Philippines. In a focus group study, participants expressed a belief in the extreme contagiousness of TB. While all agree that biomedical treatment is necessary, many believe in the effectiveness of traditional and popular treatments (Yamada 1999).

Efforts to educate the public exist but an appropriate strategy must be implemented to effectively educate people about tuberculosis. A study conducted on Mexican immigrants in the United States show a lack of understanding about TB among cultural groups (McEwen 2003). The results of the study illuminated several points including the multiple conflicting viewpoints between the Mexican immigrants' popular explanatory model of TB and the diagnosis of TB, lack of folk knowledge and exclusive use of the formal health care system for producing household health during preventive therapy; and the macro-level social, political, economic and historical factors that influenced adherence to preventive therapy in the Mexican immigrant diagnosed with TB (McEwen 2003). McEwen suggested the use of appropriate teaching techniques in educating Mexican Immigrants about the risks of tuberculosis such as the use of Spanish based novellas in explaining tuberculosis.

In a survey about the attitude among family physicians regarding tuberculosis showed that family physicians in general realize the magnitude of the problem of tuberculosis in the Philippines (Manalo 1998). However, many of those physicians considered the National Tuberculosis Program ineffective in combatting tuberculosis in a nationwide level (Manalo 1998). This highlights the need for effective communication between those implementing national tuberculosis programs and the family physicians.

Tuberculosis program in the Philippines can still be further improved by adapting to the countrys current situation. Many who lack the knowledge about tuberculosis are from the impoverish families. The government must not only provide the access to better healthcare facilities but also be able to educate the public about the disease and its nature. This could

Page | 7

greatly reduce the occurrence of tuberculosis in the country. Many programs similar to the programs in the Philippines have already been conducted in countries such as Papua New Guinea and India. People in Papua New Guinea also showed lack of knowledge about TB which led to a widespread outbreak in the early 90s. However, the use of culturally appropriate methods in TB education effectively reduced the occurrence of TB in Papua New Guinea (Ongugo 2011). In India, healthcare infrastructures vastly improve by the combined efforts of the Indian Government and the World Health Organization in hopes of eliminating tuberculosis (Sandhu 2011).

III. Methodology

A. DATA PREPARATION Using the 2008 NDHS data survey the variables regarding the perception of people on the cause and the spread of tuberculosis were selected. Instead of using the data per household, the variables were aggregated to the provincial level. The proportion of respondents who believe that tuberculosis was spread by or caused by a specific variable was computed. The formula used is shown below: roportion of those who believe in variable for province = otal of those who believe in varialbe in province otal respondents in province

where i=1,74 and j = 1, , no. of variables

The computed proportions are used in the different statistical analysis done in the study. Separate analysis was done for the perception of the people on cause of tuberculosis and for the perception of its spread.

B. Variables Variables for the perception of people on the cause of tubercumicrobes are: caused microbes, germs or bacteria (microbes), it is inherited (inherited), because of ones lifestyle

Page | 8

(lifestyle), caused smoking (smoking), alcohol drinking (alcohol), fatigue (fatigue), malnutrition (malnutrition), unhygienic practices (practice), pollution (pollution), letting sweat dry (sweat), problems (problems), sleping in cold floor (floor), changing weather (weather) and by untreated cough (cough).

C. Statistical Techniques

Factor Analysis Factor Analysis is one of the multivariate statistical methods that analyses how fundamental concepts inuence the responses among a large number of variables (Decoster, 1998). It is also considered as an interdependence technique that takes into account all the variables being tested to give details about the common characteristics or component among the variables. Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Bartletts test of sphericity are used for the model adequacy of the factor analysis.

-Kaiser-Meyer-Olkin Measure of Sampling Adequacy

Kaiser-Meyer-Olkin is an index that measures the suitability of the factor analysis for the problem. Values of KMO ranging between 0.5-1.0 means that the factor analysis is appropriate otherwise it is inappropriate.

KMO Measure 0.9 0.8 0.7 0.6 0.5 Recommendation Marvelous Meritorious Middling Mediocre Miserable
Page | 9

< 0.5

Unacceptable

Low values of KMO means that the relationship of the variables cannot be described by the other variables. Measure of Sampling Adequacy is also computed the same as KMO. A sign of a good factor analysis has a large value of MSA. KMO and MSA are measured by:

KMO

r
i j

2 ij d

r
i j

2 ij

2 a ij i j

MSAi

r
i j d d d i j

2 ij d

rij2 aij2
i j

Where rij is the correlation coefficient between the variables and aij is the partial correlation between the the variables.

Bartletts test of sphericity The Bartletts Test of spericity test the hypothesis of having uncorrelated variables. The null hypothesis of uncorrelatedness among the variables e.g. Ho= = and the alternative hypothesis of significant correlation among the variables e.e Ha= .

Varimax rotation is used in this study to rotate the factor for easy explanation since the most interpretable factor has high and low with few intermediate-sized loadings.

Cluster Analysis Cluster Analysis is one of the multivariate statistical method that divides the data into meaningful and useful clusters or groups. This method is also used for data summarization and data reduction. The main purpose of this method is to cluster similar observations on the same group and dissimilar observations in different groups as much as possible. Grouping in cluster
Page | 10

analysis is based on the information that explains the observations and the its relationships between them. Centroid method of Cluster analysis is used in this study. This method

measures the distance of the centroid of the two clusters. Centroid is the mean vector of the cluster i : xi centroid of the two clusters i and j is : d jk P( xi , x ) .
1 ni

ni

ij

and the distance between the

IV. Results and Discussion

Cause of Tuberculosis Factor Analysis The researchers conducted factor analysis on the data regarding the cause of tuberculosis. To check if factor analysis is appropriate for the data the Bartletts test of Sphericity and the Kaiser-Meyer-Olkein Measure of Sampling Adequacy (KMO-MSA) was used.

Table 2: (Using SPSS) Bartletts test for sphericity Bartlett's Test of Sphericity Approx. ChiSquare df Sig. 581.147 91 0.000

From Table 2, factor analysis is appropriate for the data since the p-value of the Bartletts Test for spericity is less than 0.05. That is, there was no sufficient evidence to claim that the variables are not interrelated. The KMO for the whole data and for the individual variables was also checked.

Page | 11

Table 3: (SAS output) KMO-MSA Kaiser's Measure of Sampling Adequacy: Overall MSA = 0.77194553 prop_microbes prop_inherited prop_lifestyle prop_smoking prop_alcohol 0.66864656 0.73638546 0.73748956 0.49048782 0.47680297 prop_fatigue 0.52339322 prop_problems 0.90099848 prop_malnutrition prop_practices prop_pollution 0.66134058 0.63169743 0.61423972 prop_floor 0.79106679 prop_weather 0.89676156 prop_cough 0.9367835 prop_sweat 0.85824253

The result of the KMO-MSA(table 3) supports the Bartletts Test results since the over-all KMO is 0.77. But, two variables have values for MSA that is less than 0.5, this value is considered unacceptable. The researches decided to run the analysis after removing the variales smoking and alcohol.

Bartletts test (table 4) and the KMO-MSA (table 5) after removing alcohol were checked again to varify factor analysis can now be used. The results shows again that the data is appropriate for factor analysis, the p-value of the Bartletts Test is less than 0.05, the over-all KMO is 0.80 and all the individual MSA for the variables are greater than 0.5.

Table 4: (Using SPSS) Bartletts test for sphericity variables smoking and alcohol removed Bartlett's Test of Sphericity Approx. ChiSquare df Sig. 543.376 78 0.000

Table 5: (SAS output) KMO-MSA Kaiser's Measure of Sampling Adequacy: Overall MSA = 0.79630668 prop_ microbes 0.59351 prop_ inherited 0.7276 prop_ lifestyle 0.7585 prop_ fatigue 0.5873 prop_ malnutrition 0.6518 prop_ practices 0.6460 prop_ smoking 0.559

Page | 12

prop_ pollution 0.6114

prop_ sweat 0.8560

prop_p roblems 0.9384

prop_ floor 0.7911

prop_ weather 0.9031

prop_ cough 0.9338

Factor analysis is performed after the tests for adequacy were satisfied. Principal components method was used for extracting the factor loadings. For the rotation method Varimax is chosen since this produce the most interpretable factors for this study.

Table 6: (SAS output) Eigenvalues of the Reduced Correlation Matrix Eigenvalues of the Reduced Correlation Matrix: Total = 6.13486036 Average = 0.51123836 Eigenvalue Cumulative 1 2 3 4 5 6 7 8 9 10 11 12 13 4.44592779 1.34405824 0.79741621 0.59432430 0.19908598 0.10066524 -.00505165 -.01507588 -.02816821 -.10621222 -.14768042 -.20232757 -.29941864 Difference Proportion

3.10186956 0.54664202 0.20309192 0.39523832 0.09842074 0.10571689 0.01002423 0.01309233 0.07804400 0.04146820 0.05464715 0.09709107

0.6658 0.2013 0.1194 0.0890 0.0298 0.0151 -0.0008 -0.0023 -0.0042 -0.0159 -0.0221 -0.0303 -0.0448

0.6658 0.8671 0.9865 1.0755 1.1053 1.1204 1.1196 1.1174 1.1132 1.0973 1.0751 1.0448 1.0000

In choosing the number of factors to retain the Kaiser Criterion, proportion criterion and the scree plot were considered. The eigenvalues explain the total variance accounted by each factor. Kaiser criterion suggests to retain those factors with eigenvalues equal or higher than 1. From the Eigenvalues of the reduced correlation matrix (table 6), two eigenvalues are greater than one, Kaisers criterion suggest that two factors will be analyzed. However, the proportion criterion and the scree plot suggest that four factors will be retained.

Page | 13

Figure 1: (SAS output) Scree Plot of Eigenvalues

5 1 4 3 2 2 1 3 4 ----------elbow 5 6 0 7 8 9 0 1 2 3 -1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Number

E i g e n v a l u e s

The researchers decided to analyze four factors based on the proportion criterion and the scree plot. After Varimax rotation the resulting factors and the variance explained by each factor are shown in table 7 and table 8. The next step is to name the factors based on the rotated factor pattern.

Table 7: (SAS output) Varimax Rotation Rotated Factor Pattern

Factor1 Factor2 Factor3 Factor4 Page | 14

prop_microbes prop_inherited prop_lifestyle prop_smoking prop_fatigue prop_malnutrition prop_practices prop_pollution prop_sweat prop_problems prop_floor prop_weather prop_cough

0.06624 0.23804 0.32782 0.17539 0.04406 0.07879 0.16471 0.08932 0.91388 0.5811 0.93001 0.88551 0.84186

-0.05597 -0.02063 0.64524 0.01796 0.10664 0.60398 0.54788 0.07932 0.2345 -0.03995 0.27647 0.19364 0.14665

0.62614 0.4827 0.34286 -0.03506 -0.30076 -0.06264 -0.29476 0.49088 0.08629 0.08277 0.12326 0.13375 0.09585

0.00105 0.10858 0.1082 0.58437 -0.4358 -0.23253 0.1759 0.44704 0.0392 0.01143 0.06878 0.12612 0.17021

Factor 1, the variables that have high factor loading are sweat, problems, floor, weather and cough. The researchers name this as superstitious belief factor since the variables that load high are not really related to the cause of tuberculosis.

Factor 2, the variables that have high factor loadings are lifestyle, fatigue, malnutrition and practices. These variables are all related on a persons health, so the researchers name it as health care factor.

Factor 3, the variables that have high factor loadings are microbes and inherited. The researches call this the cause factor. This is because the variable microbes include bacteria which is the real cause of tuberculosis, while the variable inherited might be considered a cause, because there was a point in history when tuberculosis was known to be inherited. But, this now, it is known that tuberculosis cannot be inherited

Factor 4, the variables that have high factor loadings are smoking and pollution. The researches decided to name this lungs factor because these factors mainly caused lung diseases.
Page | 15

Cluster Analysis The data is also analyzed using cluster analysis. This is done to determine the groups of provinces that have the same perception on the cause of tuberculosis. Hierarchical clustering technique was performed using the centroid method. To see the clustering of the provinces the dendogram (Figure 2) is shown below. From the dendogram, the provinces are clustered into 6 groups based on the similarities in the variables.

Page | 16

Figure 2: (SAS output) Dendogram

Page | 17

Table 9: Cluster 1 means prop_ prop_ prop_ prop_ prop_ Prop_ Cluster1 microbes inherited lifestyle smoking prop_fatigue malnutrition practices mean 0.158591 0.192858 0.062389 0.528856 0.275816 0.127722 0.087398641 prop_ prop_ Cluster1 pollution prop_sweat problems prop_floor prop_weather prop_cough mean 0.081036 0.004489 0.00649 0.001091 0.00144 0.00251

Cluster 1, has high value for the variable smoking, this means that people living in provinces which belong in this group believe that smoking is the main cause of tuberculosis. This group has generally lower values for the remaining factors.
Table 10: Cluster 2 means Cluster2 prop_ microbes mean 0.19287 prop_ inherited 0.115455 prop_ lifestyle prop_ Prop_ prop_ prop_ malnutriti practice smoking fatigue on s 0.37107 0.13015 0.190565 4 0.234081 0.473176 6504 prop_ floor 0.01081 2 prop_ weather 0.005495 prop_cou gh 0.003049

Cluster2 prop_pollution prop_sweat mean 0.045664 0.002439

prop_ problems 0

Cluster 2, has medium values on the variable smoking, malnutrition and fatigue. This implies that on the average more people that live in the provinces that belong in this group believe that tuberculosis is caused by the health and lung factors.
Table 11: Cluster 3 means prop_ prop_ prop_ prop_ prop_ prop_ Prop_ Cluster3 microbes inherited lifestyle smoking fatigue malnutrition practices mean 0.417356 0.300272 0.074806 0.338874 0.114932 0.071765 0.025255 prop_ Cluster3 prop_pollution prop_sweat problems prop_floor prop_weather prop_cough mean 0.120582 0 0 0 0 0.013995

Page | 18

Cluster 3, has high value for the variable microbes, which is the real cause of tuberculosis and zero values for the variables that belong in the superstitious belief factor. That is, the people that live in provinces that belong in this group have correct perception on the real cause of tuberculosis.
Table 12: Cluster 4 means prop_ prop_ prop_ prop_ prop_ prop_ Prop_ Cluster4 microbes inherited lifestyle smoking fatigue malnutrition practices mean 0.078761 0.270246 0.023179 0.479328 0.563009 0.4114 0.148628 prop_ Cluster4 prop_pollution prop_sweat problems mean 0.007143 0.014286 prop_ prop_floor weather prop_cough 0 0 0 0.003311

Cluster 4, have high values for the variables smoking, fatigue and malnutrition and zero values on the variables problems, floor, and weather. This means that provinces that belong in this group generally believe that tuberculosis is caused by the health factors and least caused by the superstitious belief factors.
Table 13: Cluster 5 means Cluster 5 mean Cluster 5 mean prop_ prop_ prop_ microbes inherited lifestyle 0.136364 0.090909 prop_ prop_ prop_ prop_ malnutriti practic smoking fatigue on es 0 0.090909 0.318182 0 0

prop_polluti prop_swe prop_proble prop_flo prop_weath prop_coug on at ms or er h 0 0 0 0 0 0

Cluster 5, is consists of only by the province of siquijor. This province has medium value on the variable fatigue and zero values for on most of the variables. This implies that people living in provinces that belong in this group generally believes that tuberculosis is due to fatigue and it is least caused by the other factors.

Page | 19

Table 14: Cluster 6 values prop_ prop_ prop_ prop_ prop_ prop_ malnutritio microbes inherited lifestyle smoking fatigue n 0.368317 0.29703 0.182178 0.835644 0.067327 0.079208 prop_ prop_ prop_ prop_floo prop_ prop_coug pollution sweat problems r weather h 0.368317 0 0 0 0 0 prop_ practices 0.065347

Cluster 6 mean

Cluster 6 mean

Cluster 6 is the province of batangas. This province has a high value for the variable smoking and zero value for the variables sweat, problems, floor, weather and cough. This implies that most of the people in batangas believe that smoking is the cause tuberculosis and no one believes that tuberculosis is caused by the superstitious belief factor.
Table 15: Cluster 7 Values prop_micr obes mea n 0.333333 prop_pollu tion mea n 0.230971 prop_inher ited 0.51706 prop_swea t 0.2021 prop_lifest yle 0.393701 prop_probl ems 0.188976 prop_smo king 0.813648 prop_fatig ue 0.272966 prop_malnut rition 0.291339 prop_pract ices 0.230971

prop_wea prop_floor ther 0.19685 0.188976

prop_cough 0.188976

Cluster 6 is consists of only one province which is quezon. Compared to the other clusters this province has high value for the variables that belong in the superstitious belief. Quezon also has high value for smoking and the other variables have also medium values. That is more people living in qezon compared to the other groups of provinces believe that tuberculosis is generally caused by the superstitious belief factor and it is also caused by smoking.

Page | 20

V. Conclusions
Factor Analysis showed that there are four factors that Filipinos think is the cause of tuberculosis. These are the superstitious factor, health factor, cause factor, and lung factor. The first factor is that tuberculosis is caused by letting sweat dry, sleeping in cold floor, changing weather, untreated cough, these factors do not really cause tb. In general, these factors are related to having a cough which is one of the symptoms of tuberculosis. This is why some mistake these as the factors that cause tb. The second factor is related to the health of a person. The third factor is the present known cause of tb and the past known cause of it. And, the fourth factor consists of those variables which are related to having a lung disease, smoking and pollution.

After cluster analysis is performed 7 groups of provinces were identified based on their similarities. The first group, which is the largest group, is consists of the provinces that generally believe smoking cause tb . The second group believes on health and lung factors. Third group is the correct group which believes in the real cause of tb. The fourth group thinks that tb is caused by the health factor and is least caused by the superstitious belief factor. Siquijor thinks that fatigue causes tb while batangas believes that smoking is the cause and Quezon believes in the superstitious factor and in smoking.

From the results, only one group of provinces has the right perception on the cause of tb. The other groups associate it with other diseases and on beliefs. This is alarming because knowing the cause of a disease is one of the ways to prevent it. This also tells something about the information dissemination in the country, with tb as one of the diseases with high incidence in the country, people should be well informed on its true cause to prevent its further spread.

Page | 21

RECOMMENDATIONS For future researchers who want to continue to study the same topic about the perception of the Filipinos about the causes of tuberculosis, they may add variables such as the perception of Filipinos to the different ways on how the TB bacteria spread, they may used different sample frames,, interviewing experts to help interpret the results and used different source of data from. Also, some concerned analysts may use different multivariate statistical method or used Cluster Analysis before Factor Analysis. Researchers may opt to use different multivariate statistical method other than Cluster Analysis or Factor Analysis.

Works Cited
(2004). Current State of Tuberculosis in the Philippines. Pediatric Infectious Disease Society of the Philippines Bacay-Domingo, M. N, and A. Ong-Lim. (2009). A DESCRIPTIVE STUDY OF THE KNOWLEDGE, ATTITUDES AND PRACTICES ON TUBERCULOSIS AMONG TREATMENT PARTNERS OF PEDIATRIC PATIENTS IN TARLAC CITY.Pediatric Infectious Disease Society of the Philippines, 10 Cookson, S. (2000). Misconceptions about tuberculosis among immigrants to the United States. British Medical Journal, Health, Department of. TB Control program, IDO-NCDPC FAQ. Sta Cruz, Manila: DOH, n.d. Ilongo, I. (2004). Tuberculosis health belief gaps of tuberculosis and suspected tuberculosis cases in New York City 1. International Journal of Clinical and Health Psychology, 4 Jasmer RM, Nahid P, Hopewell PC (2002). "Clinical practice. Latent tuberculosis infection".N. Engl. J. Med. 347 (23): 18606. Khan, J. A, and M. Irfan, and M. Zaki, and M. Beg, and S. Hussain, and N. Rizvi. (2003). Knowledge, Attitude and Misconceptions regarding Tuberculosis in Pakistani Patients. Journal of Pakistan Medical Association Konstantinos A (2010). "Testing for tuberculosis". Australian Prescriber 33 (1): 1218. Kumar V, Abbas AK, Fausto N, Mitchell RN (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 516522. Ladia, M. (2008). Globalization and health knowledge in the Philippines: Tuberculosis and the infectious other.. Michigan State University, Department of Anthropology.

Page | 22

Manalo, M, and A. Pineda, and J. Montoya. (1998). Knowledge, Attitudes and Practices for Tuberculosis Among Filipino Family Physicians: A Comparative Analysis by Practice Setting and Location. Pediatric Infectious Disease Society of the Philippines, 27 McBride, M. (2001). Health and Health Care of Filipino American Elders. Stanford Geriatric Education Center. McEwen, M. M. (2003). Mexican Immigrants' Understanding and Experience of Tuberculosis Infection. University of Arizona, College of Nursing. McLeod, R. (2000). The effects of health beliefs, acculturation, and a culturally appropriate teaching intervention on parents' knowledge of and compliance with tuberculosis treatment in a MexicanAmerican population: A preliminary analysis. Widener University School of Nursing. Mengistu Legesse, Gobena Ameni, Gezahegne Mamo, Girmay Medhin, Dawit Shawel, Gunnar Bjune and Fekadu Abeb. "Knowledge and perception of pulmonary tuberculosis in pastoral communities in the middle and Lower Awash Valley of Afar region, Ethiopia." (2010). Moonan, P. (2005). Epidemiologic assessment of a targeted tuberculosis screening and treatment program based on geographic and molecular clustering. UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH. Navio, J. L, and M. Yuste, and M. Pasicatan. (2002). Socio-economic determinants of knowledge and attitudes about tuberculosis among the general population of Metro Manila, Philippines. The International Journal of Tuberculosis and Lung Disease. NSO. "Philippines 2008 National Demographic and Health Survey Key Findings." 2008. Ongugo, K, and J. Hall, and J. Attia. (2011). Implementing Tuberculosis Control in Papua New Guinea: A Clash of Culture and Science? Journal of Community Health, 36. P Yadav1, ML Mathur2 and AK. Dixit3. "KNOWLEDGE AND ATTITUDE TOWARDS TUBERCULOSIS AMONG SANDSTONE QUARRY WORKERS IN DESERT PARTS OF RAJASTHAN." (2006). Regina Berba, Vincent Balanag. "Clinical Practice Guidelines for the Diagnosis, Treatment, Prevention and Control of Tuberculosis in Adult Filipinos 2006." (2006). Sandhu, G. K. (2011). Sandhu: TB: Current situation and control programs in India. Journal of Global Infectious Diseases, 2 (2). Tuberculosis Fact sheet N104". World Health Organization. November 2010. Retrieved 26 July 2011. Yamda, S, and J. Caballero, and D. Matsunaga, and M. Magana. (1999). Attitudes Regarding Tuberculosis in Immigrants From the Philippines to the United States. Clinical Research and Method, 317. Yu, C, and R. Zantua, and L. Sto. Tomas. (2002). Pulmonary Tuberculosis: Knowledge, Attitudes and Practices of Selected Physicians in a Tertiary-Care Hospital. Pediatric Infectious Disease Society of the Philippines, 31

Page | 23