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Aryal A, Garcia FB, Scheitler AJ, Faraon EJA, Moncatar TJRT, Saniel OP, Lorenzo FME, Rosadia RAF, Shimkhada R, Macinko J, Ponce NA. Evolving academic and research partnerships in global health: a capacity-building partnership to assess primary healthcare in the Philippines. Glob Health Action 2023; 16:2216069. [PMID: 37249029 PMCID: PMC10231040 DOI: 10.1080/16549716.2023.2216069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
Building fair, equitable, and beneficial partnerships between institutions collaborating in research in low- and middle-income countries (LMIC) and high-income countries (HIC) has become an integral part of research capacity building in global health in recent years. In this paper, we offer an example of an academic collaboration between the University of California Los Angeles, Center for Health Policy and Research (UCLA CHPR) and the University of Philippines, Manila, College of Public Health (UPM CPH) that sought to build an equitable partnership between research institutions. The partnership was built on a project to build capacity for research and produce data for policy action for the prevention and care of non-communicable diseases (NCDs) through primary healthcare in the Philippines. The specific objectives of the project were to: (1) locally adapt the Primary Care Assessment Tool for the Philippines and use the adapted tool to measure facility-level primary care delivery, (2) conduct focus group discussions (FGDs) to gather qualitative observations regarding primary care readiness and capacity, and (3) conduct a comprehensive population-based health survey among adults on NCDs and prior healthcare experience. We describe here the progression of the partnership between these institutions to carry out the project and the elements that helped build a stronger connection between the institutions, such as mutual goal setting, cultural bridging, collaborative teams, and capacity building. This example, which can be used as a model depicting new directionality and opportunities for LMIC-HIC academic partnerships, was written based on the review of shared project documents, including study protocols, and written and oral communications with the project team members, including the primary investigators. The innovation of this partnership includes: LMIC-initiated project need identification, LMIC-based funding allocation, a capacity-building role of the HIC institution, and the expansion of scope through jointly offered courses on global health.
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Affiliation(s)
- Anu Aryal
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Fernando B. Garcia
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - A. J. Scheitler
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Emerito Jose A. Faraon
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - T. J. Robinson T. Moncatar
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Ofelia P. Saniel
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Fely Marilyn E. Lorenzo
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Roberto Antonio F. Rosadia
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Riti Shimkhada
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
| | - James Macinko
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Ninez A. Ponce
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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Pepito VCF, Loreche AM, Samontina RED, Abdon SJA, Fuentes DNL, Saniel OP. Factors affecting treatment adherence among leprosy patients: Perceptions of healthcare providers. Heliyon 2023; 9:e17975. [PMID: 37501956 PMCID: PMC10368771 DOI: 10.1016/j.heliyon.2023.e17975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
Background Treatment adherence is a vital aspect in the management of chronic diseases like leprosy; however, most studies on treatment adherence focus on patients. This study aims to examine the perceptions of healthcare providers on factors that can promote or prevent patients from adhering to treatment. Methods We conducted three focus group discussions (FGDs) with healthcare providers who have at least one year experience in managing leprosy in three large leprosy case-holding hospitals in Metro Manila, Philippines. We audio-recorded, transcribed, translated the FGD proceedings, and analyzed the transcripts thematically to identify patient-intrinsic and patient-extrinsic enablers and barriers to treatment adherence of leprosy patients. Results Patient-intrinsic motivators to complete treatment include innate desire to be cured, fear of infecting family and friends, fear of disability, good knowledge about the disease, need for medical clearance to be considered fit to work, and experiencing leprosy reactions. Patient-extrinsic motivators to complete treatment include free treatment, immediate and sufficient counselling, flexibility in treatment, follow-up and motivation of healthcare workers, and presence of Hansen's Club and support groups. Patient-intrinsic barriers to good treatment adherence include distance between residence and hospital, financial and opportunity costs, adverse drug reactions, misconceptions about being cured, disabilities and presence of leprosy reactions, stubbornness and/or laziness, and undergoing clinical depression. Patient-extrinsic barriers to good treatment adherence include poor availability of MDT, transfer to other leprosy treatment facilities without informing current facility, and stigma. Conclusion Healthcare providers perceive that patient-intrinsic and patient-extrinsic factors influence the treatment adherence of leprosy patients through different mechanisms. We highlight the role of healthcare provider attitudes, stigma, and support groups in promoting treatment adherence.
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Affiliation(s)
- Veincent Christian F. Pepito
- College of Public Health, University of the Philippines Manila, Manila, Philippines
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Arianna Maever Loreche
- College of Public Health, University of the Philippines Manila, Manila, Philippines
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- National Clinical Trials and Translation Center, National Institutes of Health, University of the Philippines Manila
| | - Rae Erica D. Samontina
- College of Public Health, University of the Philippines Manila, Manila, Philippines
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Sarah Jane A. Abdon
- College of Public Health, University of the Philippines Manila, Manila, Philippines
- Department of Internal Medicine, Mandaluyong City Medical Center, Mandaluyong City, Philippines
| | - David Norman L. Fuentes
- College of Public Health, University of the Philippines Manila, Manila, Philippines
- Institute for Neurosciences, St. Luke’s Medical Center, Quezon City, Philippines
| | - Ofelia P. Saniel
- College of Public Health, University of the Philippines Manila, Manila, Philippines
- Symmetrix Research Consultancy Company, Manila, Philippines
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Saniel OP, Pepito VCF, Amit AML. Effectiveness of peer counseling and membership in breastfeeding support groups in promoting optimal breastfeeding behaviors in the Philippines. Int Breastfeed J 2021; 16:53. [PMID: 34247624 PMCID: PMC8274007 DOI: 10.1186/s13006-021-00400-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 06/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background The prevalence of early initiation of breastfeeding and exclusive breastfeeding (EBF) at 6 months remain low in the Philippines. To help meet the 90% early initiation of breastfeeding target and to improve infant and young child feeding practices in the Philippines, the Millennium Development Goals - Fund 2030 Joint Programme (JP) on Ensuring Food Security and Nutrition for Children 0–24 months old was implemented. We aimed to determine the effectiveness of visits by peer counselors during pregnancy and after delivery, and membership in breastfeeding support groups in promoting these optimal breastfeeding practices. Methods We used data from the Endline Survey of the JP to study the effects of prenatal and postnatal peer counselor visits, and membership in breastfeeding support groups, and their possible interactions with initiation of breastfeeding within 1 hour of birth among children aged 0 to 24 months and EBF at 6 months among children aged 6 to 24 months, while adjusting for confounding. We used logistic regression methods for survey data to assess these associations. Results Of the 2343 mother-infant pairs, only 1500 (63.1%) practiced early initiation of breastfeeding. Of the 1865 children aged 6 months or older, only 621 (34.7%) were exclusively breastfed at 6 months. After adjusting for confounding variables, there was no strong evidence that peer counselor visits were associated with early initiation or EBF at 6 months. However, members of breastfeeding support groups had 1.49 times higher odds of early initiation of breastfeeding (95% CI [Confidence Interval] 1.12, 1.98) and 1.65 times higher odds of EBF (95% CI 1.20, 2.24) compared to those who were not members of breastfeeding support groups. There was no interaction between the different exposure variables and early initiation and EBF at 6 months. Conclusions Our findings suggest breastfeeding support groups may be institutionalized to promote both early initiation of breastfeeding and EBF in the Philippines, while the role of peer counselors in promoting optimal breastfeeding behaviors should be further reviewed. Our suggestion to integrate non-healthcare professionals to promote early initiation of breastfeeding and EBF could be tested in future intervention studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00400-5.
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Affiliation(s)
- Ofelia P Saniel
- College of Public Health, University of the Philippines Manila, 625 Pedro Gil St., Ermita, Manila, Philippines. .,Symmetrix Research Consultancy Company, Manila, Philippines.
| | - Veincent Christian F Pepito
- College of Public Health, University of the Philippines Manila, 625 Pedro Gil St., Ermita, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Ortigas Ave., Pasig City, Philippines
| | - Arianna Maever L Amit
- College of Public Health, University of the Philippines Manila, 625 Pedro Gil St., Ermita, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Ortigas Ave., Pasig City, Philippines
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Pepito VCF, Amit AML, Samontina RED, Abdon SJA, Fuentes DNL, Saniel OP. Patterns and determinants of treatment completion and default among newly diagnosed multibacillary leprosy patients: A retrospective cohort study. Heliyon 2021; 7:e07279. [PMID: 34222685 PMCID: PMC8243009 DOI: 10.1016/j.heliyon.2021.e07279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/26/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background Poor treatment adherence among leprosy patients contribute to relapse, development of antimicrobial resistance, and the eventual plateauing of the prevalence and incidence of leprosy not just in the Philippines, but also worldwide. For this reason, we aimed to identify the patterns and determinants affecting treatment completion and default among multibacillary leprosy patients. Methods We conducted a retrospective cohort study involving three large hospitals in Metro Manila, Philippines. Patients who started the World Health Organization - Multiple Drug Therapy for multibacillary leprosy between January 1, 2007 and December 31, 2013 were included in the study. Selected socio-demographic and clinical data were abstracted from the patient treatment records. Survival analysis and proportional hazards regression were used to analyze the data. Results Records of 1,034 patients with a total follow-up time of 12,287 person-months were included in the analysis. Most patients were male, younger than 45 years old, had an initial bacterial index between 1 and 4, and were residents of Metro Manila. Less than 20% had their treatment duration extended to more than 12 months. Treatment adherence of the patients was poor with less than 60% completing treatment. Most patients complete their treatment within 12 months, but treatment duration may be extended for up to three years. Patients who default from treatment usually do so a few months after initiating it. After adjusting for other variables, hospital, initial bacterial index, and non-extended treatment duration were associated with treatment completion. These factors, in addition to age, were also found to be associated with treatment default. Conclusion This study provides quantitative evidence that there might be marked variations in how doctors in particular hospitals manage their patients, and these findings underscore the need to revisit and re-evaluate clinical practice guidelines to improve treatment outcomes and adherence.
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Affiliation(s)
- Veincent Christian F Pepito
- College of Public Health, University of the Philippines Manila, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Arianna Maever L Amit
- College of Public Health, University of the Philippines Manila, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Rae Erica D Samontina
- College of Public Health, University of the Philippines Manila, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Sarah Jane A Abdon
- College of Public Health, University of the Philippines Manila, Manila, Philippines.,College of Medicine, San Beda University, Manila, Philippines
| | - David Norman L Fuentes
- College of Public Health, University of the Philippines Manila, Manila, Philippines.,Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Ofelia P Saniel
- College of Public Health, University of the Philippines Manila, Manila, Philippines.,Symmetrix Research Consultancy Company, Manila, Philippines
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Rohner F, Woodruff BA, Aaron GJ, Yakes EA, Lebanan MAO, Rayco-Solon P, Saniel OP. Infant and young child feeding practices in urban Philippines and their associations with stunting, anemia, and deficiencies of iron and vitamin A. Food Nutr Bull 2013; 34:S17-34. [PMID: 24049993 DOI: 10.1177/15648265130342s104] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevalence of stunting, underweight, and micronutrient deficiencies are persistently high in young children in the Philippines, and among other factors, suboptimal infant and young child feeding behavior may contribute to these forms of malnutrition. OBJECTIVE To improve the understanding of contributors associated with the nutritional status of children 6 to 23 months of age living in urban areas of the Philippines. METHODS A cross-sectional survey was conducted covering five urban centers in the Philippines. Data on infant and young child feeding and nutritional status (including wasting, stunting, underweight, anemia, iron deficiency, and vitamin A deficiency) were collected for 1,784 children. RESULTS Among children from urban and predominantly poor and very poor households, 26% were stunted, 18% were underweight, and 5% were wasted. Forty-two percent were anemic, 28% were iron deficient, and 3% were vitamin A deficient. About half of the children were breastfed within an hour after birth, were breastfed at the time of the survey, and had been continuously breastfed up to 1 year of age. Of the factors investigated, low socioeconomic status, use of cheaper cooking fuel, and nonuse of multivitamins were all independently associated with stunting. The prevalence of anemia, iron deficiency, and vitamin A deficiency were independently associated with the same factors and poorer sanitation facilities, lower maternal education, current unemployment, and inflammation. CONCLUSIONS These factors merit attention in future programming and interventions may include promotion of the timely introduction of appropriate fortified complementary foods, the use of affordable multiple micronutrient preparations, and measures to reduce infections.
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Saniel OP, De los Reyes SJ. Prevalence of risky behaviours and determinants of multiple sex partnerships among male Filipino seafarers. Int Marit Health 2010; 62:215-223. [PMID: 21348015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND This study describes the HIV/AIDS knowledge, attitudes, and related practices among male Filipino seafarers assigned to non-passenger vessels. It also identifies some factors associated with the seafarers' practice of having multiple sex partners. MATERIAL AND METHODS An analytical cross-sectional study design, utilizing a standard interview schedule administered to 501 male seafarers from 12 large manning agencies in Metro Manila. RESULTS Multiple logistic regression analysis shows that seafarers who are unmarried and who have a history of alcohol drinking are more likely to report multiple sex partnerships compared to married men and those who do not drink alcohol, respectively. Men who have inadequate knowledge about HIV transmission and prevention and those who are relatively young are also more likely to engage in multiple sex partnerships. CONCLUSIONS/RECOMMENDATIONS HIV prevention messages should target the unmarried and young seafarers. The HIV module during pre-departure needs to be reviewed for the seafarers' knowledge of HIV transmission and prevention to improve. The use of condoms during high-risk sexual encounters should be emphasized.
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Affiliation(s)
- Ofelia P Saniel
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines, Manila, Philippines.
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