Integrative Review of Workplace Health Promotion in the Business Process Outsourcing Industry: Focus on the Philippines

Objective

The Business Process Outsourcing (BPO) industry in the Philippines has experienced substantial growth, making a significant contribution to the country's economy. However, concerns about work-related health and safety issues have emerged, necessitating effective workplace health promotion strategies for BPO employees.

Study design

An integrative review of relevant literature was conducted to explore workplace health promotion in the BPO sector.

Methods

The search included quantitative, qualitative, and mixed-method studies, pertinent laws, policies, news articles, and reports published between 2000 and 2022. The scope was intentionally broad to encompass a diverse range of relevant evidence related to workplace health in this field. Articles published both in the English and Filipino languages were considered.

Results

Findings revealed that BPO workers face risks related to physical and psychological stress, sleep disturbances, and occupational diseases owing to the unique challenges inherent to the nature of their jobs. While there are existing occupational health and labor laws, compliance among BPO companies remains a problem, and only a few organizations offer comprehensive wellness programs. Building upon the available evidence, a conceptual framework was developed to provide guidance for enhancing workplace health promotion initiatives specifically designed for BPOs in the country.

Conclusion

Workplace health promotion is vital to warrant the health and safety of BPO workers. This study offers evidence-based recommendations for implementing effective well-being strategies, highlighting the importance of collaboration among employers, employees, and society to prioritize employee health in the workplace.

A multi-framework analysis of stakeholders' perceptions in developing a localized blue carbon ecosystems strategy in Eastern Samar, Philippines

Blue carbon ecosystems (BCEs) are vital for global climate change mitigation and offer diverse local ecosystem co-benefits. Despite existing literatures on integrating national and international BCE agendas at the local level, the development and implementation of localized BCE strategies often lag behind. To provide insights on this knowledge gap, we present a case study conducted in Eastern Samar, Philippines. Employing a multi-framework analysis- encompassing DPSIR (drivers, pressures, state, impact, responses), SOAR (strengths, opportunities, aspirations, results), and PESTLE (political, economic, social, technological, legal, environmental) frameworks, stakeholder perceptions collected from focus group discussions highlight issues and challenges in developing and implementing a BCE strategy. Findings reveal that the aftermath of Typhoon Haiyan in 2013 in the study sites stimulated conservation efforts and raised awareness, but governance structures and policy enforcement influence the success and longevity of management and conservation efforts. Through the integration of multiple frameworks, this study outlined a potential localized BCE strategy, emphasizing both internal priorities such as stakeholder engagement and alternative livelihoods and external priorities related to policy and technological supports. While developed based on a specific case study in the Philippines, the proposed strategy is presented in a general manner, enabling its potential replication in other provinces in the Philippines or in countries with similar geographic settings.

Online sexual abuse and exploitation of children in the Philippines: An exploratory study of outcomes after reintegration into the community

BACKGROUND

This study examined psychosocial outcomes for Filipino survivors of online sexual abuse and exploitation of children (OSAEC).

OBJECTIVE

This study aimed to identify relationships between demographic variables, self-reported and caregiver-reported trauma symptoms, and psychosocial functioning among Filipino youth who have experienced OSAEC.

PARTICIPANTS AND SETTING

This study utilized inclusion criteria of survivors of OSAEC between ages 12 and 18 who received residential care and were reintegrated into the community for at least one year (N = 48). Participants were in care at shelters associated with Project PAVE in the Philippines.

METHODS

As measured by three assessment tools, relationships between demographic variables and psychosocial functioning were explored for risk and protective factors of trauma symptoms and psychosocial functioning to better understand this population's needs post-integration.

RESULTS

Results suggest survivors continue to experience psychosocial symptoms after reintegration. Caregivers reported survivors reintegrated outside the home had significantly higher externalizing symptoms (MR = 6.67; H(3) = 14.85, p = .002, η2 = 0.27) compared to survivors reintegrated within the home and survivors who trafficked themselves to have higher internalizing symptoms (MR = 16.79; H(3) = 11.80; p = .008, η2 = 0.20) than survivors trafficked by a relative. Caregivers reported survivors who resided in the shelter for one month or less to have higher internalizing symptoms (MR = 20.12; H(2) = 11.06; p = .004; η2 = 0.20) than survivors who resided in the shelter for six months or longer.

CONCLUSION

This study highlights the importance of further research to better understand the needs of this vulnerable population in order to guide the most effective intervention, aftercare, and reintegration programs to support survivors and their caregivers.

Draft genome sequence of Pediococcus acidilactici 3G3 isolated from Philippine fermented pork

Pediococcus acidilactici is a well-studied fermentative bacterium reported to have potential probiotic properties. Here, we report the draft genome of P. acidilactici 3G3 previously isolated from burong babi, a Philippine fermented pork dish. The 3G3 draft genome has 1,886,498 bp, a GC content of 42.27%, and a completeness of 99.38%.

Seroprevalence and Shifting Endemicities of Hepatitis A Virus Infection in Two Different Geographical Areas in the Philippines

INTRODUCTION

Infection with hepatitis A virus (HAV) is often asymptomatic in young children, but most adolescents and adults will have symptoms ranging from nausea and tiredness to acute liver failure and even death. The risk of severe disease is higher in older adults and people with pre-existing liver disease. Immunization is recommended in regions with low HAV endemicity levels, i.e., where people get infected later in life. In the Philippines, recent epidemiologic data on HAV infection are lacking. The objective of this study was to assess age-specific seroprevalence and evaluate risk factors associated with HAV seropositivity.

METHODS

People from two geographic areas (urban and rural) were recruited/enrolled and stratified by age group. HAV-specific immunoglobulin G (IgG) antibodies were measured with a chemiluminescent microparticle immunoassay. Sociodemographic parameters, hepatitis medical history, disease knowledge, hygiene measures and sanitation were assessed via a purpose-made questionnaire. Age at midpoint of population immunity (AMPI) was estimated using Kaplan-Meier curves. Logistic regression analyses were carried out to determine factors that were statistically significantly associated (p < 0.05) with HAV seropositivity.

RESULTS

Overall, 1242 participants were included in the analysis; 250/602 (41.5%) participants from urban regions and 283/640 (44.2%) participants from rural regions tested positive for HAV IgG antibodies. AMPI was 35 and 37 years for the rural and urban region, respectively. Higher education was associated with lower HAV seropositivity prevalence ratios, while not living in the same region for the last 5 years, regularly consuming street food and lack of handwashing after defecation were associated with a higher likelihood of HAV seropositivity.

CONCLUSION

Results suggest that HAV endemicity is low in the Philippines. Factors associated with HAV seropositivity were traveling, consuming street food and lack of basic hygienic gestures. Immunization might be an option to protect vulnerable populations against severe hepatitis A disease.

Impact of climate-induced floods and typhoons on geriatric disabling health among older Chinese and Filipinos: a cross-country systematic review

BACKGROUND

Apart from both China and the Philippines continuing to be exposed to and affected by different climate-induced hazards, in particular floods and typhoons, they are also reported to be witnessing rapid ageing populations of 60 years and older. As such, this systematic review synthesized the existing evidence about the impacts aggravated by floods and typhoons on the geriatric disabling health of older Chinese and Filipinos, respectively.

METHODS

Four (4) electronic databases were systematically searched to identify eligible studies published between 2000 and early 2023. This process had to confirm the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), as well as the standard protocol registered with PROSPERO (CRD42023420549).

RESULTS

Out of 317 and 216 initial records retrieved for China and the Philippines, respectively, 27 (China) and 25 (Philippines) studies were eligible for final review. The disabling conditions they reported to affect the health of older adults were grouped into 4 categories: cognitive and intellectual, physical, chronic and terminal illnesses, and mental and psychological, with the latter identified as the most prevalent condition to affect older Chinese and Filipinos. On a sub-category level, posttraumatic stress disorder (PTSD) was the most common condition reported in 27 flood-related studies in China, while injuries and wounds prevailed in the Philippines, according to 25 typhoon-related studies.

CONCLUSION

The increasing occurrence of extreme climate hazards, especially floods and typhoons in China and the Philippines, respectively, impacted the health of their older adults with various disabling effects or conditions. Therefore, this calls for appropriate geriatric-informed interventions in the context of climate change and rapidly ageing settings beyond China and the Philippines to others that are also prone to floods and typhoons.

Association between lead and circulating markers of inflammation among traffic enforcers in Metro Manila, Philippines: the MMDA traffic enforcer's health study

PURPOSE

Several epidemiological studies have linked lead (Pb) exposure to induced oxidative stress and the promotion of inflammatory response. We performed a within-subjects study (repeated measures study) to evaluate the relationship between the concentration of blood lead (B-Pb) and toenail lead (T-Pb) and circulating markers of inflammation.

METHODS

We evaluated the associations between B-Pb concentrations and T-Pb concentrations and circulating markers of inflammation, soluble intracellular adhesion molecule-1 (s-ICAM-1), soluble vascular adhesion molecule-1 (s-VCAM-1), and high-sensitivity C-reactive protein (hs-CRP) on 158 traffic enforcers from the Metropolitan Manila Development Authority (MMDA) traffic enforcer's health study. Linear mixed-effects models with random subject-specific intercepts were fitted to estimate the association between B-Pb and T-Pb exposure and circulating markers of inflammation, adjusting for confounding factors.

RESULTS

Traffic enforcers were middle-aged men (89.4%) with a mean age (± SD) of 37.1 years ± 8.9 years and had a total of 293 valid markers of inflammation measurements. B-Pb concentration was related to increased hs-CRP levels. A 10% increase in B-Pb was associated with a 5.7% increase in hs-CRP level [95% confidence interval (95% CI): 1.3-10.1]. However, B-Pb was not associated with s-ICAM-1 and s-VCAM-1. Furthermore, no associations were observed between T-Pb and all the circulating markers of inflammation.

CONCLUSIONS

Low-level B-Pb may increase hs-CRP among traffic enforcers. Moreover, the study suggests that Pb via the oxidative and inflammation pathways may have an essential role in the development of cardiovascular disease. Furthermore, MMDA and the Department of Labor and Employment can use our study's findings as evidence to conduct routine screening of blood heavy metals, especially Pb, among MMDA and other traffic enforcers as part of their yearly medical examination.

Measuring the unmeasurable multidimensional poverty for economic development: Datasets, algorithms, and models from the poorest region of Luzon, Philippines

Poverty is the oldest social problem that ever existed and is difficult to reverse. It is multidimensional and unmeasurable. Thus, measuring by decomposing rural multidimensional poverty is critical. Most poverty studies are usually generic, exposed to large sampling errors, and intended for macroeconomic decisions. Thus, measuring poverty for a specific locality with various configurations is crucial for economic development. This work presents a processed and analyzed dataset from a huge community-based monitoring system of Goa, Camarines Sur. The local is situated in the poorest district, of the poorest province, in the poorest region of Luzon, Philippines. Research about poverty in this area is limited and measuring poverty at specific locality is scarce. The datasets contain the multidimensional poverty indicators, health, and nutrition, housing and settlement, water and sanitation, basic education from elementary to senior high school, income classifications, employment and livelihood, peace and order, summary of calamity occurrences experienced by residents, disaster risk reduction preparedness, figures of diagnostic analytics, tables of descriptive analytics, poverty analytics, measurement of decomposed poverty, summary of disaggregated configurations, graphs of predictive and prescriptive analytics, and population dynamics. This work is vital in analyzing poverty in rural and multidimensional approaches through poverty incidence, poverty gap, severity statistics, watts index, and classifications. It may also serve as a basis for measuring poverty from nearby regions and nations that use complete enumeration of its households and members. By utilizing the analyzed and processed data, further classifications and regressions can be done. It can be freely used by the government, private organizations, charitable institutions, businesses, academia, and researchers to target policies. An advantage of utilizing the dataset is to address multifaceted poverty that requires different interventions. It will facilitate the creation of programs to alleviate poverty and promote local economic development.

Palliative and Supportive Care in the Philippines: Systems, Barriers, and Steps Forward

Although integral to alleviating serious health-related suffering, global palliative care remains systemically and culturally inaccessible to many patients living in low- and middle-income countries. In the Philippines, a lower-middle income country in Southeast Asia of over 110 million people, up to 75% of patients with cancer suffer from inadequate pain relief. We reviewed factors that preclude access to basic palliative care services in the Philippines. PubMed and Google Scholar were searched thoroughly; search terms included but were not limited to "palliative care," "supportive care," "end-of-life care," and "Philippines." We found that a limited palliative care workforce, high out-of-pocket healthcare costs, and low opioid availability all hinder access to palliative care in the archipelago. Religious fatalism, strong family-orientedness, and physician reluctance to refer to palliative care providers represent contributory sociocultural factors. Efforts to improve palliative care accessibility in the country must address health systems barriers while encouraging clinicians to discuss end-of-life options in a timely manner that integrates patients' unique individual, familial, and spiritual values. Research is needed to elucidate how Filipinos-and other global populations-view end-of-life, and how palliative care strategies can be individualised accordingly.

Treatment gaps in the care of amyotrophic lateral sclerosis in the Philippines: A scoping review

Amyotrophic lateral sclerosis (ALS) is a progressive disease affecting both the upper and lower motor neurons. Much of the management of ALS is supportive with the goal of maximizing patient quality of life. While the Philippines was participative in the "Ice Bucket Challenge" in 2014, it is up for investigation whether substantial changes occurred to improve healthcare for ALS patients. This study aims to evaluate the treatment gaps in the management of ALS in the Philippines through a scoping review. Data on epidemiology, health systems, and pharmacotherapy available regarding ALS in the local setting were synthesized. Nine articles were included. As of July 2023, there were only four indexed studies on ALS from the Philippines. Five of the included articles investigated ALS in Filipino populations but were not authored by Filipinos nor affiliated with Philippine institutions. The available literature showed a distinct lack of local ALS epidemiologic data, as well as limited availability in diagnostic centers, medications, health financing options, and digestible information for Filipinos. The limitations in managing ALS in the country are multifactorial - from political, medical, and social. It is imperative to establish a national database, financing systems, support groups, and accessible diagnostic centers for ALS patients.

Sarcopenia Among Older People in the Philippines: A Scoping Review

Aims: This review aimed to identify and map the evidence about sarcopenia among older Filipinos. Methods: Studies about sarcopenia among Filipinos aged 60 and above were included. All studies regardless of type, setting, language, and timeframe were reviewed. The Cochrane Library, Cumulative Index of Nursing and Allied Health, Embase, PubMed, and Health Research and Development Information Network were searched. The study was conducted per an a priori protocol and utilized the Joanna Briggs Institute guidance for scoping reviews. Results: From the 87 records identified, 20 studies published from 2013 to 2023 were eligible (≥ 5424 participants). The studies were varied; 11 cross-sectional, 2 conference lectures, 2 consensus reports, 1 meta-analysis, cohort study, case series, posthoc analysis, and continuing education. As to setting, 11 studies were conducted in the hospital and 4 in the community. On the level of prevention, 5 studies addressed the primary level, 10 studies secondary, and 2 studies both tertiary and secondary. The studies focused on: sarcopenia in a specific group (13 studies), consensus (4 studies), and education (3 studies). Conclusions: Sarcopenia studies among older Filipinos were limited. Most were hospital-based and involved patients with comorbidities. Some studies used sarcopenia assessment guidelines with Filipino normative references. Sarcopenia impacts the overall well-being of older Filipinos; hence more studies and health promotion programs are necessary.

Incorporating climate-readiness into fisheries management strategies

Tropical oceans are among the first places to exhibit climate change signals, affecting the habitat distribution and abundance of marine fish. These changes to stocks, and subsequent impacts on fisheries production, may have considerable implications for coastal communities dependent on fisheries for food security and livelihoods. Understanding the impacts of climate change on tropical marine fisheries is therefore an important step towards developing sustainable, climate-ready fisheries management measures. We apply an established method of spatial meta-analysis to assess species distribution modelling datasets for key species targeted by the Philippines capture fisheries. We analysed datasets under two global emissions scenarios (RCP4.5 and RCP8.5) and varying degrees of fishing pressure to quantify potential climate vulnerability of the target community. We found widespread responses to climate change in pelagic species in particular, with abundances projected to decline across much of the case study area, highlighting the challenges of maintaining food security in the face of a rapidly changing climate. We argue that sustainable fisheries management in the Philippines in the face of climate change can only be achieved through management strategies that allow for the mitigation of, and adaptation to, pressures already locked into the climate system for the near term. Our analysis may support this, providing fisheries managers with the means to identify potential climate change hotspots, bright spots and refugia, thereby supporting the development of climate-ready management plans.

Gaps and opportunities in addressing the needs of older adults in the Philippines and Vietnam: a qualitative exploration of health and social workers' experiences in urban care settings

Background

Despite numerous government initiatives, concerns and disparities among older adults have continually been growing. Empirical studies focused on older adults in the Philippines and Vietnam appear minimal and mostly regarding perceptions of aging. An effective geriatric care strongly relies on functional service providers requiring their perspectives to be explored toward inclusive service delivery.

Objective

To investigate the perceived gaps and opportunities in geriatric care service delivery among health and social care workers in selected urban areas in the Philippines and Vietnam.

Methods

A qualitative case study approach drawn on social constructivism theory, examined working experiences, observed characteristics of older adults, geriatric services and needs, difficulties on service delivery, and recommended solutions. A total of 12 semi-structured interviews and 29 focus group discussions were conducted in the Philippines, with 174 health and social care workers, while in Vietnam, there were 23 semi-structured interviews and 29 focus group discussions with 124 participants. An inductive thematic analysis was employed.

Results

Interview participants highlighted the increasing unmet needs such as accessibility, availability, and acceptability of geriatric care services. The implementation of interventions on the older population faced multiple challenges, including issues related to older adult conundrums and dilemmas in geriatric care providers and facilities. The participants from the two countries felt that strengthening implementation of collaboration toward an integrated geriatric care structure and expansion of training and capability in handling older adults can be potential in addressing the gaps at both individual and institutional levels. Additionally, a committed leadership was viewed to be the important step to effectively operationalize the strategy.

Conclusion

Health and social workers emphasized that the needs of older adults are exacerbated by various challenges within a fragmented geriatric care system. To address this issue, an establishment of an integrated service delivery mechanism with dedicated leadership is needed. The findings from this study may help develop appropriate solutions for addressing the health and social care needs of older adults in similar settings across Southeast Asia. Further examination of the impact of these challenges and solutions on service delivery and the wellbeing of older adults is essential.

Filling the gaps in ecology of tropical tiger beetles (Coleoptera: Cicindelidae): first quantitative data of sexual dimorphism in semi-arboreal Therates from the Philippine biodiversity hotspot

Background

Sexual dimorphism, driven by sexual selection, leads to varied morphological distinctions in male and female insects, providing insights into selection pressures across species. However, research on the morphometric variability within specific taxa of tiger beetles (Coleoptera: Cicindelidae), particularly arboreal and semi-arboreal species, remains very limited.

Methods

We investigate sexual dimorphism in six semi-arboreal Therates tiger beetle taxa from the Philippines, focusing on morphological traits. We employed morphometric measurements and multivariate analyses to reveal patterns of sexual dimorphism between sexes within the taxa.

Results

Our results indicate significant sexual dimorphism in elytra width, with females consistently displaying broader elytra, potentially enhancing fecundity. Notable sexual size dimorphism was observed in Therates fulvipennis bidentatus and T. coracinus coracinus, suggesting heightened sexual selection pressures on male body size. Ecological factors, mating behavior, and female mate choice might contribute to the observed morphological variation. These findings emphasize the need for further studies to comprehend mating dynamics, mate choice, and ecological influences on morphological variations in semi-arboreal and arboreal tiger beetles.

Changes in Adherence and Viral Load Suppression Among People with HIV in Manila: Outcomes of the Philippines Connect for Life Study

The Philippines HIV epidemic is among the fastest growing globally. Infections among men who have sex with men are rising at an alarming rate, necessitating targeted evidence-based interventions to retain people living with HIV in care, support adherence, and reach viral suppression. We conducted a 48-week prospective cohort study of 462 participants in which we provided a mobile health (mHealth) adherence support intervention using the Connect for Life platform. We observed an improvement in adherence, with the proportion of participants taking more than 95% of their antiretroviral therapy (ART) doses increasing from 78.6% at baseline to 90.3% at 48 weeks. Among treatment experienced participants, adherence improved significantly (McNemar's test = 21.88, P < 0.001). Viral load suppression did not change, with 92.6% suppression at baseline and 92.0% at 48 weeks. Illicit drug use was associated with reduced adherence (aOR = 0.56, 95%CI 0.31-1.00, P = 0.05) and being on second-line therapy was associated with poor viral load suppression (aOR = 0.33, 95%CI 0.14-0.78, P = 0.01). Quality of life improved following ART initiation, from a mean of 84.6 points (of a possible 120) at baseline to 91.01 at 48 weeks. Due to technical issues, fidelity to the intended intervention was low, with 22.1% (102/462) of participants receiving any voice calls and most others receiving a scaled-back SMS intervention. The mHealth intervention did not have any observed effect on adherence or on viral load suppression. While evidence of effectiveness of mHealth adherence interventions is mixed, these platforms should continue to be explored as part of differentiated treatment support services.

Comparing disease specific catastrophic cost estimates using longitudinal and cross-sectional designs: The example of tuberculosis

BACKGROUND

There has been an increasing interest in assessing disease-specific catastrophic costs incurred by affected households as part of economic evaluations and to inform joint social/health policies for vulnerable groups. Although the longitudinal study design is the gold standard for estimating disease-specific household costs, many assessments are implemented with a cross-sectional design for pragmatic reasons. We aimed at identifying the potential biases of a cross-sectional design for estimating household cost, using the example of tuberculosis (TB), and exploring optimal approaches for sampling and interpolating cross-sectional cost data to estimate household costs.

METHODS

Data on patient incurred costs, household income and coping strategies were collected from TB patients in Negros Occidental and Cebu in the Philippines between November 2018 and October 2020. The data collection tools were developed by adapting WHO Tuberculosis Patient Cost Surveys: A Handbook into a longitudinal study design. TB-specific catastrophic cost estimates were compared between longitudinal and simulated cross-sectional designs using different random samples from different times points in treatment (intensive and continuation phases).

RESULTS

A total of 530 adult TB patients were enrolled upon TB diagnosis in this study. Using the longitudinal design, the catastrophic cost estimate for TB-affected households was 69 % using the output approach. The catastrophic cost estimates with the simulated cross-sectional design were affected by the reduction and recovery in household income during the episode of TB care and ranged from 40 to 55 %.

CONCLUSION

Using longitudinally collected costs incurred by TB-affected households, we illustrated the potential limitations and implications of estimating household costs using a cross-sectional design. Not capturing changes in household income at multiple time points during the episode of the disease and estimating from inappropriate samples may result in biases that underestimates catastrophic cost.

Periodicity of Ascaridia galli egg excretion in experimentally infected chicken in the Philippines

The periodicity of parasite egg excretion refers to variations in the number of eggs produced across time, with significant implications in optimizing diagnostic procedures and conducting the Fecal Egg Count Reduction Test (FECRT). Here, we explore whether Ascaridia galli egg excretion varies across time under Philippine conditions, thus informing the best time to collect fecal samples during flock health examination. A time-course analysis was performed in chickens (N = 12) experimentally infected with A. galli, isolated from a naturally infected Philippine native chicken. We examined the fecal egg per gram (EPG) count at 3-h intervals for 3 days, starting from 5:00-6:00 h AM to the following day at 1:00-2:00 h AM. Our results showed a consistent daily egg excretion pattern with a peak EPG count in the morning that abruptly declined in the afternoon and lowest in the evening. The EPG counts correlated with the amount of excreta produced, suggesting that A. galli fecundity corresponds to the timing of host defecation. Our results imply that the best time to collect fecal samples for A. galli diagnosis and FECRT in Philippine conditions should be from sunrise until late morning when parasite EPG count and host excreta production are at their highest.

Embedding viral hepatitis into primary healthcare: results of a strategic landscape analysis in Vietnam and the Philippines

Chronic viral hepatitis is a significant public health concern in the Western Pacific, including in Vietnam and the Philippines. To accelerate progress toward meeting the 2030 elimination goals, the World Health Organization (WHO) encourages countries to adopt an integrated, people-centered health sector response to hepatitis, grounded in Primary Health Care (PHC). A review of the academic and grey literature, along with policy documents, was conducted to describe the national health system and PHC response to hepatitis B and C in Vietnam and the Philippines. Information was analyzed against the four strategic levers of the WHO Operational Framework for PHC to identify challenges and opportunities. The findings suggest that both countries have relatively robust policy frameworks, with some room for improvement. Vietnam may have stronger political commitment and funding than the Philippines, while the Philippines appears to be stronger in community engagement. Both countries share challenges and opportunities for learning to actualize viral hepatitis elimination utilizing a PHC approach.

Source tracking of fecal contamination in Asian green mussels (Perna viridis) harvested in Manila Bay, Philippines by molecular detection and genotyping of Cryptosporidium spp

Manila Bay, a multipurpose body of water located around Metro Manila, Philippines, is progressively deteriorating because of massive pollution. Reports have shown that the bay and its aquatic resources (i.e., seafood) are contaminated with fecal matter and enteric pathogens, posing a threat to public health and industry. This problem raises the need for a microbial source tracking methodology as a part of the rehabilitation efforts in the bay. Bivalve mollusks cultivated in water can serve as sentinel species to detect fecal pollution and can complement water monitoring. With the use of polymerase chain reaction and DNA sequence analysis, this study detected Cryptosporidium spp. in Asian green mussels (Perna viridis) cultivated and harvested in Manila Bay and sold in Bulungan Seafood Market, Parañaque, Philippines, from 2019 to 2021 with an overall occurrence of 8.77% (n = 57). The analysis of the 18S rDNA segment revealed three genotypes from Cryptosporidium-positive samples, namely, Cryptosporidium sp. rat genotype IV (60%), C. galli (20%), and C. meleagridis (20%). These findings suggest fecal pollution in bivalve cultivation sites coming from sewage, nonpoint, and agricultural sources. The presence of C. meleagridis, the third most common cause of human cryptosporidiosis, in mussels poses a threat to human health. Thus, there is a need to establish routine detection and source tracking of Cryptosporidium spp. in Manila Bay and to educate seafood consumers on food safety.

Draft genome sequence of Lactiplantibacillus plantarum BS25 isolated from a local fermented rice-shrimp mixture from the Philippines

The draft genome sequence of Lactiplantibacillus plantarum BS25, previously isolated from a fermented rice-shrimp mixture (balao-balao) in the Philippines, was analyzed. The genome contains 3,264,139 bp (44.62% GC%), and a total of 3,069 predicted coding sequences, 2 rRNAs, and 52 tRNAs.

The Unheard Stories: Experiences of Young People Living with Human Immunodeficiency Virus in Dealing with Discrimination in the Philippines

Purpose

The aim of this study is to gain an in-depth understanding of the experiences of young people living with the human immunodeficiency virus (YPLHIV) in dealing with discrimination and contribute to a more efficient response.

Patients and Methods

We utilised qualitative descriptive research-narrative inquiry. Twenty YPLHIV aged 19 to 24 under treatment from HIV hubs in Metro Manila, Philippines were purposely selected for an in-depth individual interview. Data were transcribed verbatim and manually coded and analysed using narrative thematic analysis.

Results

We found that HIV knowledge and beliefs of YPLHIV plays a huge role in their experience. Second, dealing with HIV stereotypes contributed to how they assume judgments from others (perceived stigma) and may have internalised the stigma which alters their belief toward self and the disease. Third, thoughts of suicide, experiencing emotional dissonance, and having difficulty embracing one's identity indicate declined mental health. Fourth, they continuously seek and may have received support from significant others and the community. Some may have directly received or perceived discrimination, but the YPLHIV reported that support received from others plays positively vital role in their journey. Finally, the disease helped change their behaviour and, in turn, brought them to lifestyle change as they are eager to be undetectable and untransmissible (U=U) and perpetually reflect on the ordeal challenge of adhering to treatment.

Conclusion

Our study concluded that the stigma and discrimination that YPLHIVs endured were caused by misinformation about the disease and stems from both within themselves and from others around them. Support received from friends, family members, and the community helped them deal with their circumstances. We recommend that efforts be made by both the government and non-government to develop programs distinctly for YPLHIV. Future research may explore the mental health aspect as this has been found concerning in the narratives among young population patients.

The COVID-19 pandemic's effects on mental and psychosocial health in the Philippines: A scoping review

Low- and middle-income countries (LMICs) remained at elevated risk for the effects of the COVID-19 pandemic because of persistent stressors to their health systems. Simultaneously facing high infection rates, strict containment measures and natural disasters, the Philippines provides important grounds for health research in LMICs. This review examined how the COVID-19 pandemic affected mental and psychosocial health in the Philippines. This scoping review included literature in English from 2020 to mid-2022 from PubMed, PsycInfo and SCOPUS, and used the PRISMA-ScR and PCC-question model. Two independent reviewers conducted blind article screening and data extraction using COVIDENCE software, followed by consensus building, data charting and analyses. This work identified 405 publications across PubMed (N = 56), PsycInfo (N = 106) and SCOPUS (N = 243), of which 76 articles addressed the Philippines. Article types included 54 research articles, 10 opinion pieces, 4 literature reviews, 6 letters to journals, 1 study protocol and 1 other report. These findings focused primarily on health professionals (N = 23) and educators/learners (N = 22) and reported mostly on moderate-to-severe clinical outcomes such as fear, depression, anxiety or stress. Coping behaviors, like resiliency and other ways of adapting to the pandemic, including religious, spiritual and community-oriented approaches highlighted experiences with stringent infection prevention and control measures to contain COVID-19 in the Philippines. The COVID-19 pandemic brought severe challenges to mental and psychosocial health in the Philippines. The literature focused mostly on healthcare workers and educators/learners, and moderate-to-severe mental health outcomes in these groups. There is a need to expand studies to other sociodemographic groups and communities across the Philippines. Future work stands to benefit from more in-depth qualitative, mixed methods, longitudinal and representative quantitative research in LMICs following this pandemic. Literature reviews remain important to synthesize post-pandemic experiences by providing context for future studies and health practice in the Philippines and other LMICs.

First malaria in pregnancy followed in Philippine real-world setting: proof-of-concept of probabilistic record linkage between disease surveillance and hospital administrative data

BACKGROUND

Although the Philippines targets malaria elimination by 2030, it remains to be a disease that causes considerable morbidity in provinces that report malaria. Pregnant women residing in endemic areas are a vulnerable population, because in addition to the risk of developing severe malaria, their pregnancy is not followed through, and the outcome of their pregnancy is unknown. This study determined the utility of real-world data integrated with disease surveillance data set as real-world evidence of pregnancy and delivery outcomes in areas endemic for malaria in the Philippines.

METHODS

For the period of 2015 to 2019, electronic data sets of malaria surveillance data and Ospital ng Palawan hospital admission log of pregnant women residing in the four selected barangays of Rizal, Palawan were merged using probabilistic linkage. The source data for record linkage were first and last names, birth date, and address as the mutual variable. The data used for characteristics of the pregnant women from the hospital data set were admission date, discharge date, admitting and final diagnosis and body weight on admission. From the malaria surveillance data these were date of consultation, and malaria parasite species. The Levenshtein distance formula was used for a fuzzy string-matching algorithm. Chi-square test, and Mann-Whitney U test were used to compare the means of the two data sets.

RESULTS

The prevalence of pregnant women admitted to the tertiary referral hospital, Ospital ng Palawan, was estimated to be 8.34/100 overall, and 11.64/100 from the four study barangays; that of malaria during pregnancy patients was 3.45/100 and 2.64/100, respectively. There was only one true-positive matched case from 238 women from the hospital and 54 women from the surveillance data sets. The overall Levenshstein score was 97.7; for non-matched cases, the mean overall score was 36.6 (35.6-37.7). The matched case was a minor who was hospitalized for severe malaria. The outcome of her pregnancy was detected from neither data set but from village-based records.

CONCLUSIONS

This proof-of-concept study demonstrated that probabilistic record linkage could match real-world data in the Philippines with further validation required. The study underscored the need for more integrated and comprehensive database to monitor disease intervention impact on pregnancy and its outcome in the Philippines.

"We Need to Go Back Home (to) the Philippines Healthy": An Interpretive Phenomenological Analysis of Migrant Domestic Workers' Experiences of Having Breast Cancer in Hong Kong

Diagnoses of breast cancer are continuing to increase in the Philippines, but little is known about incidence rates among the significant number of Filipino women working abroad as migrant domestic workers (MDWs). These women are often the main income providers for their families, and their ability to work depends upon their physical health and strength. In this article, we use interpretive phenomenological analysis to explore the experiences of 10 MDWs from the Philippines who were diagnosed with breast cancer during a period of employment in Hong Kong. Analysis of these narratives revealed numerous points at which their status as temporary, transnational migrant workers intersected with their experiences of breast cancer detection, diagnosis, and treatment. We argue that these women's experiences of breast cancer were shaped by the structures of migration that link the Philippines with host destinations like Hong Kong. These structures create a unique context in which these women had to constantly renegotiate their identities as migrants, financial providers, and breast cancer patients.

Pampalibog: chemsex, desire and pleasure in the Philippines

This article draws from qualitative interviews to provide the first in-depth exploration of reasons for engaging in chemsex in the Philippines. It articulates the many forms that drugs assume as pampalibog, or enhancers of libido, demonstrating the multidimensional pleasures of chemsex along overlapping sensorial and affective planes. By showing the inextricability of the corporeal to the affective, and of the emotional to the erotic, we contend that chemsex also involves the embodied and performed attainment of pleasure. As such, chemsex is both central to modern sexual scripts yet also a negotiable aspect of any sexual encounter. In constructing this rare account of drug use in settings of pleasure in the Philippines, we situate chemsex within a historical pattern of bodily tinkering and, more significantly, demystify people who use drugs by departing not only from global public health's pathologising approach to chemsex, but also from the scholarly tendency to locate drug use in the country within scenes of hardship and marginalisation.

Clinical profile and outcomes of tetanus patients in a tertiary hospital in the Philippines: a ten-year retrospective study

BACKGROUND

Tetanus is a life-threatening but preventable neurologic disorder characterized by trismus and muscle spasms. Despite its decreasing global incidence, it remains to be endemic in resource-limited settings such as the Philippines. This study aimed to determine the incidence, demographic characteristics, risk factors, clinical presentation, management, complications, and outcomes of non-neonatal tetanus cases in a tertiary hospital in the Philippines. It also aimed to compare the clinical profile and outcomes between the adult and pediatric subgroups.

METHODS

This study used a retrospective cross-sectional design including all adult and pediatric non-neonatal tetanus patients admitted at the University of the Philippines - Philippine General Hospital from January 2012 to June 2023. Data was extracted from department censuses and inpatient charts.

RESULTS

One hundred thirty-eight cases were included. The incidence rate was 0.03%, while mortality rate was 29%. Majority of patients were males presenting with trismus and spasms after sustaining a puncture wound. Chronic hypertension was associated with an increased hazard of death by 4.5 times (p = 0.004), while treatment with magnesium sulfate was associated with a decreased hazard of death by 35 times (p = 0.005). The mode of infection and the medications administered differed between the adult and pediatric subgroups.

CONCLUSIONS

Although the total number of cases has decreased over the past decade, tetanus remains to have a high incidence and mortality rate in the Philippines. Increasing vaccination coverage, improving public awareness, and educating health professionals can help reduce morbidity and mortality from this disease.

Philippine retinoblastoma initiative multi-eye center study 2010-2020

AIM

To provide a comprehensive and more representative national data on the disease, especially on treatment options and outcomes, and to determine access of retinoblastoma patients from Luzon, Visayas and Mindanao to eye care, and determine if access is associated with delay in consultation, staging and outcomes.

METHODS

Cohort study of retinoblastoma patients seen in eleven institutions located in the three major areas of the Philippines namely Luzon, Vizayas and Mindanao from 2010-2020.

RESULTS

Totally 636 patients, involving 821 eyes, were included. Majority (57%) were from Luzon and were seen in institutions in Luzon (72%). Annually, 58±10 new cases were seen with 71% having unilateral disease. Median delay of consultation remained long at 9 (3, 17)mo, longest in patients with unilateral disease (P<0.02) and those from the Visayas (P<0.003). Based on the International Retinoblastoma Staging System, only 35% of patients had Stage 1 while 47% already had extraocular disease. Enucleation was the most common treatment received by 484 patients while intravenous chemotherapy was received by 469. There were 250 (39%) patients alive, 195 (31%) dead, 85 (13%) abandoned, 17 (3%) refused and 89 (14%) with no data.

CONCLUSION

This study presents the largest cohort of retinoblastoma patients in the Philippines in terms of patients' and participating institutions' number and geographical location and type of institution (private and public). It also presents more comprehensive data on the treatments used and outcomes (survival, globe salvage, and vision retention rates). Delay in consultation was still long among patients leading to advanced disease stage and lower survival rate. Despite increasing capacity to diagnose and manage retinoblastoma in the country, the delay of consultation remains long primarily due to accessibility issues to eye care institutions especially in the Visayas and financial concerns. The delay was still significant that overall survival rate remain low.

What explains the high island endemicity of Philippine Rafflesia? A species distribution modeling analysis of three threatened parasitic plant species and their hosts

PREMISE

Rafflesia are rare holoparasitic plants. In the Philippines, all but one species are found only on single islands. This study aimed to better understand the factors contributing to this distributional pattern. Specifically, we sought to determine whether narrow environmental tolerances of host and/or parasite species might explain their island endemicity.

METHODS

We used Maxent species distribution modeling to identify areas with suitable habitat for R. lagascae, R. lobata, and R. speciosa and their Tetrastigma host species. These analyses were carried out for current climate conditions and two future climate change scenarios.

RESULTS

Although species distribution models indicated suitable environmental conditions for the Tetrastigma host species in many parts of the Philippines, considerably fewer areas were inferred to have suitable conditions for the three Rafflesia species. Some of these areas are on islands from which they have not been reported. All three species will face significant threats as a result of climate change.

CONCLUSIONS

Our results suggest that limited inter-island dispersibility and/or specific environmental requirements are likely responsible for the current pattern of island endemicity of the three Rafflesia species, rather than environmental requirements of their Tetrastigma host species.

Evolving academic and research partnerships in global health: a capacity-building partnership to assess primary healthcare in the Philippines

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.

A comparison of the characteristics of adult medicine patients seeking telemedicine consultations versus in-person consultations in a Philippine public hospital

Background

Telemedicine employs the use of technology to increase access to health care. This is especially relevant in developing countries where accessibility is an important issue. In developed countries, studies have shown that despite greater availability and accessibility, there are still disparities in telemedicine use. In the Philippines, however, it is unknown what factors are related to telemedicine use since its underutilization precludes proper characterization of telemedicine patients. We sought to compare the characteristics of telemedicine patients and patients consulting in-person in the internal medicine outpatient department of a Philippine public hospital.

Methods

This is a retrospective descriptive study. Chart reviews were done for patients who consulted from May 2021 to July 2021. They were classified as either having telemedicine consults only or having in-person consults only. Each group was characterized and compared according to demographics, socioeconomic characteristics, health behaviors, and reasons for consultation.

Results

Unadjusted analyses showed that younger, single, or employed individuals were more likely to use telemedicine. However, in adjusted analyses, no demographic factors were associated with telemedicine use. Only the patient type and medical concern were significantly different between patient groups in this public hospital setting. New patients and those consulting for clearance/referral purposes or endocrine-related symptoms were more likely to seek teleconsults.

Conclusions

The findings showed which patients are more likely to use telemedicine in the Philippines. Continued telemedicine use for these patients should be explored to complement in-person medical care.

Prevalence and Covariates of Electronic Cigarette Use among Students Aged 13-15 Years in the Philippines: 2019 Global Youth Tobacco Survey

Electronic cigarette use is growing in popularity and accessibility among youth in the Southeast Asia region. We analyzed data on 6670 students, aged 13-15 years, from the Philippines' 2019 Global Youth Tobacco Survey. Prevalence estimates and 95% confidence intervals (CI) were estimated for current use (i.e., past 30 days), ever use, and awareness of e-cigarettes. Chi-square tests compared prevalence differences between groups. Multiple logistic regression models assessed factors associated with e-cigarette use while controlling for sociodemographic characteristics, current use of other tobacco products, and secondhand smoke exposure. Prevalence of current e-cigarette use was 14.1% (95% CI = 12.4%, 15.8%), ever use was 24.6% (95% CI = 22.4%, 26.9%), and awareness was 75.5% (95% CI = 73.0%, 78.0%). Current use of any other tobacco products and exposure to secondhand smoke at home, school, or other public places were positively associated with current and ever use of e-cigarettes. Boys and youth living in Luzon or Mindanao had higher odds of current e-cigarette use compared to girls and youth in Visayas. Findings indicated that one in four Philippine students aged 13-15 years ever used e-cigarettes and one in seven currently use e-cigarettes. This study highlights the importance of implementing evidence-based strategies, including relevant tobacco control policies.

Genome-wide detection of Wolbachia in natural Aedes aegypti populations using ddRAD-Seq

Background

Wolbachia, an endosymbiotic bacterium, is globally used to control arboviruses because of its ability to block arboviral replication and manipulate the reproduction of Wolbachia host, Aedes aegypti. Polymerase chain reaction (PCR)-based Wolbachia detection has been recently reported from natural Ae. aegypti populations. However, due to the technical limitations of PCR, such as primer incompatibility, PCR-based assays are not sufficiently reliable or accurate. In this study, we examined double digestion restriction site-associated DNA sequencing (ddRAD-Seq) efficiency and limitations in Wolbachia detection and quantification in field-collected Ae. aegypti natural populations in Metro Manila, the Philippines, compared with PCR-based assays.

Methods

A total of 217 individuals Ae. aegypti were collected from Metropolitan Manila, Philippines. We separated it into 14 populations consisting of 7 female and male populations. We constructed a library for pool ddRAD-Seq per population and also screened for Wolbachia by PCR assays using wsp and 16S rRNA. Wolbachia density per population were measured using RPS17 as the housekeeping gene.

Results

From 146,239,637 sequence reads obtained, 26,299 and 43,778 reads were mapped across the entire Wolbachia genome (with the wAlbA and wAlbB strains, respectively), suggesting that ddRAD-Seq complements PCR assays and supports more reliable Wolbachia detection from a genome-wide perspective. The number of reads mapped to the Wolbachia genome per population positively correlated with the number of Wolbachia-infected individuals per population based on PCR assays and the relative density of Wolbachia in the Ae. aegypti populations based on qPCR, suggesting ddRAD-Seq-based semi-quantification of Wolbachia by ddRAD-Seq. Male Ae. aegypti exhibited more reads mapped to the Wolbachia genome than females, suggesting higher Wolbachia prevalence rates in their case. We detected 150 single nucleotide polymorphism loci across the Wolbachia genome, allowing for more accurate the detection of four strains: wPip, wRi, TRS of Brugia malayi, and wMel.

Conclusions

Taken together, our results demonstrate the feasibility of ddRAD-Seq-based Wolbachia detection from field-collected Ae. aegypti mosquitoes.

Reconstructing the phylodynamic history and geographic spread of the CRF01_AE-predominant HIV-1 epidemic in the Philippines from PR/RT sequences sampled from 2008 to 2018

The Philippines has had a rapidly growing human immunodeficiency virus (HIV) epidemic with a shift in the prevalent subtype from B to CRF01_AE. However, the phylodynamic history of CRF01_AE in the Philippines has yet to be reconstructed. We conducted a descriptive retrospective study reconstructing the history of HIV-1 CRF01_AE transmissions in the Philippines through molecular epidemiology. Partial polymerase sequences (n = 1144) collected between 2008 and 2018 from three island groups were collated from the Research Institute for Tropical Medicine drug resistance genotyping database. Estimation of the time to the most recent common ancestor (tMRCA), effective reproductive number (Re), effective viral population size (Ne), relative migration rates, and geographic spread of CRF01_AE was performed with BEAST. Re and Ne were compared between CRF01_AE and B. Most CRF01_AE sequences formed a single clade with a tMRCA of June 1996 [95 per cent highest posterior density (HPD): December 1991, October 1999]. An increasing CRF01_AE Ne was observed from the tMRCA to 2013. The CRF01_AE Re reached peaks of 2.46 [95 per cent HPD: 1.76, 3.27] in 2007 and 2.52 [95 per cent HPD: 1.83, 3.34] in 2015. A decrease of CRF01_AE Re occurred in the intervening years of 2007 to 2011, reaching as low as 1.43 [95 per cent HPD: 1.06, 1.90] in 2011, followed by a rebound. The CRF01_AE epidemic most likely started in Luzon and then spread to the other island groups of the country. Both CRF01_AE and Subtype B exhibited similar patterns of Re fluctuation over time. These results characterize the subtype-specific phylodynamic history of the largest CRF01_AE cluster in the Philippines, which contextualizes and may inform past, present, and future public health measures toward controlling the HIV epidemic in the Philippines.

Caring in crisis: The experiences of local religious leaders meeting community food needs in the Philippines during the COVID-19 pandemic

To respond to the unintended consequences of prevention measures to reduce COVID-19 transmission, individuals and groups, including religious leaders, have collaborated to provide care to those negatively impacted by these measures. Amid these various efforts and interventions, there is a need to deepen our understanding of diverse expressions of care across various geographical and social contexts. To address this need, the objective of this study was to investigate how religious leaders in the Philippines practiced care for their communities by meeting emergency food needs amid the COVID-19 pandemic. Guided by an ethics of care theoretical orientation, we conducted 25 remote semi-structured interviews with Filipino religious leaders who partnered with a Philippines-based non-governmental organization (NGO) to mobilize essential food aid to their local communities. Through defining the efforts and activities of these religious leaders as care work, we found that religious leader experiences revolved around navigating care responsibilities, caring alongside others, and engaging holistically with the care work. Additionally, we observed how contextual factors such as the humanitarian settings where religious leaders worked, the partnership with an NGO, and the positionality of local religious leaders within their communities, fundamentally shaped the care work. This study expands our understanding of how care is practiced and experienced and also brings greater visibility to the experiences and efforts of local religious leaders in responding to humanitarian emergencies.

"Self-care is being attentive to yourself": using assemblages to examine discursive-material practices of self-care among Filipino university students

PURPOSE

Researchers have observed a rise in mental health issues among university students over the course of the pandemic, in part due to the closure of schools and public spaces for wellness. Thus, the purpose of this study is to explore how students creatively reassemble their self-care practices through different objects and spaces within their homes to care for their mental health.

METHODS

Photo-elicitation interviews were conducted with ten (10) female university students from the Philippines. Photographs and interview transcripts were analysed through map-making practices and an iterative process of crafting assemblages and their cofunctionings.

RESULTS

The work-home assemblage was identified as the site of self-care, delineated by boundary-making and place-making practices and the creation of time spaces. The two major cofunctionings of the work-home assemblage were (a) caring for the self as fostering different relationalities with the self, and (b) caring for the self as copresencing with human and nonhuman others.

CONCLUSION

Findings demonstrate the importance of material and spatial relationalities in facilitating caring relational encounters with the self. Theoretical and practical implications include attuning to the existing material and spatial resources in one's environment and integrating them into one's practices of caring for the self.

A comparative analysis of the cost-utility of the Philippine tax on sweetened beverages as proposed and as implemented

Background

In response to increasing overweight and obesity, the Philippine government introduced a tax on sweetened beverages (SBs) in 2018. Evidence suggests that the beverage industry influenced the final tax design, making it more favourable for industry than the initially proposed bill. This study aimed to compare the relative health and economic benefits of the proposed SB tax with the implemented SB tax.

Methods

Philippine dietary consumption data were combined with price elasticity data from Mexico and data from Australia adapted to the Philippine context to estimate reductions in SB purchases and changes in body mass index (BMI) following the implementation of the tax. A multi-state, multiple-cohort Markov model was used to estimate the change in health-adjusted life years (HALYs) due to reduction in the epidemiology of obesity-related diseases, healthcare cost savings and government taxation revenue, resulting from both the proposed and implemented tax policies, over the lifetime of the 2018 Philippine population.

Findings

The proposed and implemented taxes were modelled to be dominant (cost-saving and improving health). Intervention costs were modelled to be PHP305.2 million (M) (approximately US$6M). Compared to the proposed tax, the implemented tax was modelled to result in a 43.0% smaller reduction in targeted beverage intake (51.1 ml/person/day vs. 89.7 ml/person/day), a 43.5% smaller reduction in BMI (0.35 kg/m2 vs. 0.62 kg/m2), 39.7% fewer HALYs gained (2,503,118 vs. 4,149,030), 39.9% fewer healthcare cost savings (PHP16.4 billion (B) vs. PHP27.3B), and 27.7% less government taxation revenue (PHP426.3B vs. PHP589.4B).

Interpretation

While the implemented tax in the Philippines will benefit population health, it is likely to yield less benefit than the proposed tax. The influence of the food and beverage industry on policy processes has the potential to lessen the benefits of population NCD prevention policies.

Funding

OH was supported to conduct this research by an Australian Government Research Training Program Stipend Scholarship. The funding body had no role in data collection and analysis, or manuscript preparation.

A Proposed Pastoral Response to the Increase in the Number of Suicide Cases in the Philippines During the COVID-19 Pandemic

This paper aims to provide a pastoral response to the increase in the number of suicides in the Philippines during the COVID-19 pandemic. This paper will look into the reasons and statistics related to suicide since there was a sudden spike in number during the pandemic. The See-Discern-Act method is used in this study so that the current social issue will be viewed from the teachings of the Church. First, we will discuss the reports on the cases of mental health issues. This issue has alarmed several professionals that focus on protecting one's mental health. Second, we will discuss key concepts from the Catechism of the Catholic Church to present the view on suicide. Also, John Paul II's Evangelium Vitae will be cited to provide a perspective on the value of human life. The Compendium of the Social Doctrine of the Church will also be tackled to explain the Church's view on mental health and well-being. Third, we will attempt to unearth the mental well-being of some Filipinos concerning suicide cases in the Philippines in light of the Church's teachings. Hence, our goal is to provide a perspective on this problem using the teachings of the Church on human life so that we may draw a proposed pastoral theological response. Hence, we propose that the Church must provide plans for prevention, intervention, and postvention when it comes to people involved in any suicide case as these actions are aligned with the goal of the Church to take care of those who suffer from mental illness and emphasize the value of human life.

'I was terrified for my child': understanding the link between the Dengvaxia® controversy and the measles vaccine hesitancy in Pasay City, Philippines

BACKGROUND

The Dengvaxia® (dengue vaccine) controversy has been identified as one of the main reasons for the measles vaccine hesitancy in the Philippines. Our study aimed to identify various issues related to the Dengvaxia® controversy and to link these issues with the social perspective of measles vaccine refusal.

METHODS

Semi-structured interviews and a focus group discussion using ethnography research were conducted with 41 parents and healthcare workers in Pasay City. Using Victor Turner's Social Drama Theory, our study identified existing social issues relating to the different angles of the Dengvaxia® controversy and the measles vaccine hesitancy.

RESULTS

Misinformation on the failed Dengvaxia® rollout implementation has challenged the fundamental understanding of the importance of immunization programs. Our findings on vaccine hesitancy in the community showed a complex problem with compounded factors, including medical populism, moral panics and other social views. We described how Pasay City's clinic waiting room became a significantly important scenario where individuals often discuss information, concerns and experiences on vaccines and vaccine hesitancy.

CONCLUSION

Our study suggests that the Dengvaxia® controversy may reduce the measles vaccination confidence in the Philippines. Lack of transparency played a crucial role in this dilemma, producing a cascading effect on the other vaccines' safety.

Young Filipino breast cancer patients have worse survival outcomes

Background

In the 2020 GLOBOCAN report, breast cancer is the 3rd most common cause of cancer-related mortality in the Philippines. The incidence of breast cancer in the young (≤40 years) was reported to be higher in the Philippines compared to other Asian countries. Several studies have consistently demonstrated poor survival outcomes in this age group due to its aggressiveness and unique tumour biology. However, data on survival outcomes of young Filipino breast cancer patients remains unknown in the Philippines.

Methods

A retrospective study was performed involving patients with stage I-III breast cancer who underwent definitive surgery from January 2010 to December 2015 at a single-tertiary institution. Patients were grouped according to age (≤40 and >40 years old). Their clinicopathological characteristics, treatment profile and 5-year survival outcomes were analyzed.

Results

A total of 524 Filipino patients (15.1% aged ≤40 years) were included. Younger patients were diagnosed at a higher stage and pathologic grade. A negative hormone receptor, high Ki67 status, and triple negative breast cancer (TNBC) subtypes were also more common among younger patients. The overall breast-conserving surgery rate was low at 8.9%. The use of adjuvant chemoradiotherapy was more common and both 5-year overall survival (OS) and disease-free survival (DFS) were lower (61.1% versus 77.1% and 31.1% versus 66.8%, respectively) in the ≤40-year-old group. In the multivariate analysis, age group, tumour size, and nodal status were significant predictors for DFS. However, only tumour size was significant for OS.

Conclusion

Young Filipino breast cancer patients have demonstrated unique pathologic characteristics with associated lower survival outcomes similar to the published literature. Increasing awareness of cancer screening practices among young women, provision of equitable access to healthcare, and prompt management of breast cancer in the young are crucial.

Personal protective equipment (PPE) litter in terrestrial urban areas of Iligan City, Philippines

In recent years, many countries have relied on the massive use of personal protective equipment (PPE) following the recommendation of the World Health Organization (WHO) to combat COVID-19, an infectious disease caused by the SARS-CoV-2 virus. These PPEs include facemasks, face shields, disinfectant wipes, and disposable gloves. While PPE serves as protection, it can also be a source of pollution. This study is the first to establish a baseline monitoring and assessment of the spatial distribution of COVID-19-related PPE litter approaching the post-pandemic from the urban areas in Iligan City, Philippines. A total of 1632 COVID-19 PPE litter were gathered in all surveyed locations, predominantly facemasks (90.7%) and disinfectant wipes (8.8%). Among the surveyed areas, the location that recorded the highest count and density of PPE litter is in a residential zone (52.14%; n = 851; 0.0317 item m-2); the lowest was determined in recreational parks (2.57%; n = 42; 0.0016 item m-2). The significant difference in the total count of PPE items in each location could be traced to the varying land uses and ecosystems as well as the human behavior and activities. FTIR results reveal that all types of facemasks sampled are principally made of polypropylene, a material that threatens environmental sustainability and low recyclability. As the country is embracing the new normal and somewhat returning to pre-pandemic activities, this study calls for the prioritization of the government agendas on ecological solid waste management in the country.

Understanding integrated HPV testing and treatment of pre-cancerous cervical cancer in Burkina Faso, Cote d'Ivoire, Guatemala and Philippines: study protocol

BACKGROUND

Many low- and-middle-income countries are disproportionately burdened by cervical cancer, resulting in high morbidity and mortality. HPV-DNA testing coupled with treatment with thermal ablation is a recommended screening and precancer treatment strategy, but not enough is known about how this can be effectively implemented in the context of integrated services. The (Scale Up Cervical Cancer Elimination by Secondary prevention Strategy, (SUCCESS) project is conducting a study to understand this approach, integrated into existing women's health services in Burkina Faso, Cote d'Ivoire, Guatemala, and the Philippines (2020-2024).

METHODS

A hybrid effectiveness-implementation type III mixed-methods observational study design is used to assess feasibility, acceptability, and costs of integrated service delivery in 10 sites per country, selected considering urban/rural location, facility level, onsite/offsite laboratories, and health services type. In each country, a sample size of 2227 women aged 25-49 years will be enrolled with about 20% being women living with HIV. The primary outcome is proportion of HPV positive women completing precancer treatment, if eligible, within three months of screening. Data collection and analysis includes; facility and client exit surveys, key informant and client interviews, registries and project records extractions, and costing data analysis. Analysis includes descriptive statistics, context description, thematic analysis, and document analysis. Quantitative analyses will be stratified by participant's HIV status.

DISCUSSION

Recruitment of study participants started in April 2022 (Burkina Faso and Côte d'Ivoire) and August 2022 (Guatemala and the Philippines). Enrolment targets for women screened, client exit, in-depth and key informant interviews conducted were reached in Burkina Faso and Cote d'Ivoire in November 2022. Guatemala and Philippines are expected to complete enrolment by June 2023. Follow-up of study Participants 12-months post-treatment is ongoing and is expected to be completed for all countries by August 2024. In LMICs, integrating cervical cancer secondary prevention services into other health services will likely require specific rather than incidental recruitment of women for screening. Reconfiguration of laboratory infrastructure and planning for sample management must be made well in advance to meet induced demand for screening. Trail Registration ClinicalTrials.Gov ID: NCT05133661 (24/11/2021).

Maternity protection policies and the enabling environment for breastfeeding in the Philippines: a qualitative study

BACKGROUND

The Philippines has enacted maternity protection policies, such as the 105-Day Expanded Maternity Leave Law and the Expanded Breastfeeding Promotion Act of 2009, to protect, promote, and support breastfeeding. This study aimed to review the content and implementation of maternity protection policies in the Philippines and assess their role in enabling recommended breastfeeding practices. It also identified bottlenecks to successful implementation from the perspectives of mothers and their partners, employers, and authorities from the government and non-government organizations involved in developing, implementing, monitoring, and enforcing maternity protection policies.

METHODS

This study employed a desk review of policies, guidelines, and related documents on maternity protection, and in-depth interviews. Of the 87 in-depth interviews, there were 12 employed pregnant women, 29 mothers of infants, 15 partners of the mothers, 12 employers and 19 key informants from the government and non-government organizations. Respondents for the in-depth interviews were from the Greater Manila Area and were recruited using purposive snowball sampling. Data were collected from December 2020 to April 2021.

RESULTS

The study shows that maternity protection policies in the Philippines are mostly aligned with the maternity protection standards set by the International Labour Organization. However, their role in improving breastfeeding practices is limited because: (1) not all working women have access to maternity protection entitlements; (2) the duration of maternity leave entitlements is inconsistent with the World Health Organization's recommended duration of exclusive breastfeeding; (3) there are gaps in policy implementation including: a lack of monitoring systems to measure the availability, functionality, and usage of lactation spaces; limited workplace support for breastfeeding; poor communication of maternity and paternity entitlements; and limited breastfeeding advocacy and promotion; and (4) there is limited integration between maternity protection and breastfeeding promotion interventions.

CONCLUSIONS

There is a need to (1) strengthen communication about and promotion of maternity and paternity entitlements for mothers, fathers and employers, (2) improve monitoring and enforcement mechanisms to ensure utilization of entitlements among mothers, (3) develop modalities to extend the coverage of maternity entitlements to the informal sector, (4) fully cover paid leave entitlements from social insurance or public funding sources in line with International Labour Organization recommendations, and (5) revisit the limitations on the coverage of paternity entitlement.

Filipino nurses' experiences and perceptions of the impact of climate change on healthcare delivery and cancer care in the Philippines: a qualitative exploratory survey

Background

Because of its geographical location, the Philippines is vulnerable to the effects of climate change and almost all types of natural hazards such as typhoons, earthquakes, and volcanic eruptions. Cancer is one of the leading causes of death in the Philippines and is one of the major public health concerns. Little is known about how climate change affects cancer services in the Philippines. As the biggest workforce in most institutions, having awareness and knowledge about disaster preparedness and management among nurses can help in reducing the devastating effects of natural disasters on health services. Thus, it is important to understand Filipino nurses' experiences and perception of the impact of climate change on healthcare delivery and cancer care in the Philippines.

Aim

This study explored Filipino nurses' experiences and perception of the impact of climate change on healthcare delivery and cancer care in the Philippines.

Methods

This is a descriptive qualitative exploratory study. Participants were recruited using the snowballing technique and completed an online survey. Forty-six nurses who were working in Luzon, Philippines at the time of the data collection were included in the analysis. Data were analysed using thematic analysis.

Findings

Three themes were identified, namely: (1) effects of climate change causing disruption and delay in provision of patient care, (2) impact of climate change on nurses and a deep sense of duty, and (3) perceived impact on patients with cancer.

Conclusion

Our study findings contribute to the existing literature that focuses on the impact of climate change-related events such as typhoons and floods on healthcare services and nursing staff. Several areas of cancer care are also impacted, particularly delays in treatment such as chemotherapy. Despite the challenges, the nurses in our study demonstrated a deep sense of commitment in carrying out their roles.

Improving the quality of family planning services in the Philippines: Barriers and opportunities

We conducted qualitative research with family planning clients, potential clients, and service providers on barriers and opportunities for improving the quality of family planning services in the Philippines. The family planning service providers included the primary, secondary, and tertiary levels of the health system. Our goal was to aid in developing more effective family planning quality improvement (QI) programs. Our methods included focus groups, key informant interviews and thematic content analysis of the qualitative data. We found four themes: the components of quality of family planning care; factors influencing quality; challenges for improving quality; and provider bias in the types of family planning services offered to clients. We identified five implications for QI, including: reduce provider bias; level off the understanding of QI concepts and roles among the different family planning service providers; involve men more actively; design new digital communication strategies for reaching clients and potential clients; and explore collaborations with private sector pharmacies. The findings from this study can guide the development of a pilot family planning QI programme in the Philippines. The findings provide themes and practical insights for an intervention-focused theory of change on how to improve current programs, design new programs, be more responsive to the needs and concerns of clients and potential clients and be well-accepted and sustained by providers. This can lay the groundwork for improving family planning outcomes and reducing teenage pregnancy rates and the unmet need for family planning throughout the Philippines.

Evaluating the impact of a child sponsorship programme on paediatric health and development in Calauan, Philippines: A retrospective audit

AIM

International child sponsorship programmes comprise a considerable proportion of global aid accessible to the general population. Team Philippines (TP), a health care and welfare initiative run in association with the University of Notre Dame Sydney since 2013, leads a holistic sponsorship programme for 30 children from Calauan, Philippines. To date, empirical research has not been performed into the overall success and impact of the TP child sponsorship programme. As such, this study aims to evaluate its effectiveness in improving paediatric outcomes.

METHODS

Study cohorts comprised 30 sponsored and 29 age- and gender-matched non-sponsored children. Data were extracted from the TP Medical Director database and life-style questionnaires for July-November 2019. Outcome measures included anthropometry, markers of medical health, dental health, exercise, and diet. Statistical analyses were performed in SPSS.

RESULTS

Sponsorship resulted in fewer medical diagnoses and prescription medications, superior dental health, and improved diet. Further, sponsored children may show a clinically significant trend towards improved physical health. Sponsorship did not affect growth and development metrics, or levels of physical activity.

CONCLUSIONS

The TP child sponsorship programme significantly impacts positive paediatric health outcomes in the Calauan community. The strength of the programme lies in its holistic, sustainable, and community-based model, which is enabled by effective international child sponsorship. This study further supports the relationship between supporting early livelihood and improved health in the paediatric population.

Contending with precarity: Digital pathways to sexual and reproductive healthcare among transgender Filipinos during the COVID-19 pandemic

Stringent lockdowns during the COVID-19 pandemic and the cisnormative framing of sexual and reproductive health (SRH) in the Philippines cultivated precarious access to SRH systems among transgender (trans) communities during the public health crisis. With the shift toward digital health initiatives, this study aimed to explore the experiences of the local trans community in using digital health initiatives (DHIs) to access SRH care and gender-affirming services, information, and providers during the COVID-19 pandemic. Online interviews with 13 self-identified trans Filipinos living in the Philippines during the pandemic were conducted and analyzed using interpretative phenomenological analysis. First, the narratives of trans Filipinos illustrate how DHIs can address discontinuities of care that emerged during the COVID-19 pandemic. However, because of long-standing geographic, economic, and social barriers to trans-responsive healthcare in the Philippines, local trans communities navigate alternative pathways to care established within digital spaces (e.g., social media) by trans individuals and groups. These online communities of care not only connect trans Filipinos to culturally competent and affordable care but also foster a sense of belongingness and support. Taken together, this study underscores the need to go beyond technical access to care to ensure that trans-inclusive and trans-responsive sources and providers of care are made available throughout the healthcare system. As the narratives of trans Filipinos illustrate, the narratives, experiences, and practices within their online communities of care may be the key to actualizing such a healthcare system not only in the Philippines but all over the world.