Food-borne trematodes (FBTs) are emerging infections and of substantial public health importance but are among the most ignored of the neglected tropical diseases (NTDs) in terms of attention, research and funding. A review of the status of FBTs in the Philippines based on the best available local and national information may provide a basis for the formulation of appropriate prevention and control measures most suitable for its setting. This review presents a summary of the key features of FBTs and the epidemiologic pattern of FBTs in the Philippines and on the current measures being done for infection control and prevention in other countries. Paragonimiasis, echinostomiasis, and heterophyidiasis are still prevalent in the Philippines with food preparation and hygiene practices and presence of infected intermediate hosts as major determinants of epidemiology and disease burden. Control and prevention of food-borne trematodes may be best achieved with political will, coordinated efforts among responsible public sectors, and involvement of relevant communities.
FOOD HANDLING

BACKGROUND: Several Philippine studies on selected neglected parasitic diseases cite major challenges in laboratory diagnosis that require review of standards, policies and practices.
OBJECTIVES: This review aims to: (1) describe the epidemiology of selected neglected parasitic diseases in the Philippines; (2) describe the current status of laboratory diagnosis of these diseases in terms of standards, policies and practices; and (3) identify challenges and opportunities for improvement of laboratory diagnosis.
METHODS: Epidemiologic data were collected from published scientific papers and monographs. International standards were gathered from journal articles and the World Health Organization (WHO). Philippine policies were obtained from interviews with the Department of Health (DOH) and other agencies. Recommendations for policy and practice were formulated based on evidence and feasibility.
RESULTS: High prevalence of neglected parasitic diseases in the country, coupled with lack of national policies on diagnosis and quality assurance guidelines specific to parasitology, pose significant challenges to accurate diagnosis.
CONCLUSION: Results of this review merit the development of a comprehensive Philippine policy on a quality assurance scheme for parasitology laboratories and stronger licensing standards. This policy should be supported through a network of reference centers that coordinate parasitology training, staff certification, and laboratory accreditation.

Human ; Animal ; Male ; Female ; Parasitic Diseases ; Laboratories ; Diagnosis ; Epidemiology ; Quality Control ; Parasitology

A 41-year-old man from Occidental Mindoro was diagnosed with intestinal capillariasis at the Philippine General Hospital after a year of diarrhea and multiple hospital admissions. The patient was noted to be harboring Capillaria philippinensis, Strongyloides stercoralis, Entamoeba histolytica, Mycobacterium tuberculosis, and Candida albicans in his stool. He was treated with albendazole, metronidazole, diloxanide, fluconazole, and antiiKoch's. This case was reported to the Department of Health to pursue this site as a potential area for epidemiologic investigation.

Human ; Male ; Adult ; Strongyloides Stercoralis ; Capillaria ; Albendazole ; Fluconazole ; Entamoeba Histolytica ; Candida Albicans ; Metronidazole ; Diloxanide Furoate ; Mycobacterium Tuberculosis ; Diarrhea ; Furans

A small scale survey was performed to know the infection status of intestinal parasite in children of the residential institutions and street communities in Metro Manila, Philippines. A total of 284 stool samples from 11 institutions and 3 street communities was examined by the formalin-ether concentration method. The scotch tape anal swab was adapted to 121 children to investigate the infection status of Enterovius vermicularis. It was found out that 62.0% of the children examined were positive for one or more intestinal parasites. Multiple infections were observed in 34.2% of the children. Among 172 children who gave detail information, the prevalence for Ascaris lumbricoides, Trichuris trichiura, and hookworm was 36.0%, 44.8%, and 7.0% respectively. Of the children examined, 47.7% were found to be harboring parasitic protozoans such as Entamoeba histolytica, Giardia lamblia, and Blastocystis hominis. The most prevalent of these protozoans was B. hominis with an infection rate of 40.7%. The prevalence of these infections among children living in institutions was relatively high. More efforts should be made to implement anthelminthic programs including bi-annual follow-up treatments.
Adolescent ; Animals ; Child ; Feces/parasitology ; Female ; Helminthiasis/epidemiology ; Helminths/isolation & purification ; Homeless Youth ; Human ; Intestinal Diseases, Parasitic/epidemiology/*parasitology ; Male ; Philippines/epidemiology ; Prevalence ; Protozoa/isolation & purification ; Protozoan Infections/epidemiology ; Urban Population

OBJECTIVES: This study utilized a cross-sectional study design to determine the prevalence and intensity of STH infections among adolescent females and pregnant women, to describe the nutritional status of the two population groups in selected study sites in the Philippines, and to propose a scheme for classification of endemic sites as basis for conduct of control strategies.

METHODS: Parasitologic assessment was conducted through examination of collected stool samples using the Kato-Katz technique, while nutritional status was assessed through primary height and weight measurements.

RESULTS: Results of the parasitologic assessment in adolescent females showed an overall cumulative prevalence of 30.4% (12.5% - 61.8%) and a prevalence of heavy intensity infection of 7.9% (0.7% - 22.6%). In pregnant women, overall cumulative prevalence was 31.5% (13.2% - 75.8%) and prevalence of heavy intensity infection was 10.2% (0.9%- 39.6%).

CONCLUSION: Significant differences in prevalence in the different sentinel sites suggest the need to consider a modified classification scheme for endemic communities to determine the most cost-effective strategies for morbidity control. The utilization of this classification scheme alongside regular sentinel surveillance will help validate the scheme and contribute towards the development of more appropriate program guidelines for nationwide implementation.

Human ; Animal ; Female ; Adult ; Young Adult ; Adolescent ; Nutritional Status ; Pregnant Women ; Pregnancy ; Helminths

OBJECTIVES:This study aimed to determine the epidemiologic status of schistosomiasis and soil-transmitted helminth (STH) infections in the Lake Mainit area in Northeastern Mindanao.

METHODS: School children from the municipalities of Alegria and Mainit in Surigao del Norte, and Jabonga and Kitcharao in Agusan del Norte were targeted as participants. Stools were collected, processed through Kata Katz method, and examined. Data gathered were double-encoded and processed to derive parasitologic parameters that were used to categorize the municipalities based on the World Health Organization guidelines.

RESULTS:The overall prevalence of schistosomiasis was 10.9%, while the prevalence of heavy intensity infections was 0.1%. Alegria and Mainit were classified as moderate-risk communities, while Jabonga and Kitcharao were classified as low-risk communities. The overall cumulative prevalence of STH infections was 43.9%, while prevalence of heavy intensity infection was 12.7% Jabonga and Kitcharao were classified as Category I communities, while the reset were classified as Category III.

CONCLUSION:There is a need to consider implementation of school-based Mass Drug Administration (MDA) for schistosomiasis control in the same manner as in the implementation of MDA for STH control. Multisectoral involvement is necessary for integration of efforts in addressing the parasitic diseases as public health concerns in the area.

Human ; Animal ; Male ; Female ; Child ; Soil ; Lakes ; Cities ; Public Health ; Helminthiasis ; Schistosomiasis ; Schools ; Helminths

Objectives. This study aimed to describe baseline and follow-up prevalence and intensity of soil-transmitted helminth (STH) infections, nutritional status and school performance of school-age children in Cebu City. By measuring these parameters, it also aimed to monitor the progress of a local government unit-led, school-based, schoolteacher-assisted deworming initiative. Methods. Grade three and grade four pupils from two selected school districts in Cebu City were chosen as participants. Kato-Katz technique was used to assess helminth infections. All positive slides and 10% of all negative slides were re-examined blindly by a reference microscopist for quality control. Secondary anthropometric and school performance data were also obtained from the Department of Education. Results. Baseline results showed cumulative prevalence and prevalence of heavy intensity infection of 73.1% and 44.3%, respectively, which were significantly lower during follow-up at 56.5% (p < 0.0001) and 26.5% (p < 0.0001), respectively. School performance improved in District B, with an 8.8% increase in mean percentage score from baseline to follow-up. There was no marked difference between baseline and follow-up proportions of pupils with below normal weight-for-age and height-for-age. Conclusions. The positive results merit continuation of the school-based STH control initiative in Cebu City. Improvements in water supply and sanitation, promotion of good hygiene and health education are important in minimizing risks of infection and re-infection.
Human ; Male ; Female ; Child ; INTESTINAL HELMINTHIASIS ; ENVIRONMENT AND PUBLIC HEALTH ; PUBLIC HEALTH ; SANITATION ; SANITARY ENGINEERING ; WATER SUPPLY

OBJECTIVE: Elimination eforts for lymphatic flariasis are underway in the Philippines using mass drug administration (MDA) of diethylcarbamazine and albendazole as one of the main strategies. This cost analysis was done to determine the MDA implementation cost and provide useful information to the control programme on how to best utilize limited resources.

METHODS: This cost analysis study was conducted in the province of Sorsogon, Philippines in 2004. The study was done from a program perspective. Cost data for 2003 was obtained retrospectively via key informant interviews and records review using a standardized guide from a multi-country cost analysis study of flariasis elimination programs. Cost fgures were classifed as either economic or fnancial costs and expressed in real terms using 2002 as base year. Sensitivity analysis was likewise performed.

RESULTS: The total economic cost and cost per person treated with MDA were estimated at US$223,549.55 (Php12,116,385.48) and US$0.40, respectively. The fnancial costs were less than half of the economic costs. The main cost driver was drug distribution. The highest economic and fnancial costs were incurred at the national (54.5%) and municipal (74.4%) levels, respectively. High variation in costs of MDA activities was observed.

CONCLUSION: This cost analysis provides reasonable estimates which may be used to assist government and other stakeholders in program planning and resource generation for flariasis elimination programs in endemic areas.

Diethylcarbamazine ; Albendazole ; Philippines ; Mass Drug Administration ; Costs And Cost Analysis ; Health Resources ; Lymphatic Vessel ; Elephantiasis, Filarial

Intestinal helminth infections caused by soil-transmitted helminths and schistosomes bring about the greatest burden of disease in poverty-stricken areas in the developing world. The most vulnerable group and the most significant contributors to disease transmission are the school-age children. While awaiting major improvements on sanitation, the recommended strategy for helminth control is school-based, teacher assisted, mass drug administration (MDA). However, millions of individuals worldwide remain afflicted with these diseases, and the Philippines is no different from many of the developing countries. The overall objective of this paper is to review current Philippine control programs and initiatives and offer evidence based recommendations for improvement. Discrepancies between parasitologic parameters and drug coverage rates pose significant challenges in the control and prevention of helminth infections in the country. School-based MDA may be scaled up after successful local initiatives, where teachers have direct participation in drug administration. There is also a need to involve the social science sector to help address the behavioral aspects of helminth control. Moreover, monitoring and evaluation of interventions through identification of success parameters will contribute to the optimization of school-based helminth control, and to strategies towards effective control of intestinal helminth infections as a public health problem in the country.
Ascaris ; Trichuris ; Schistosomiasis

Objectives: Since the effectiveness of the Zero Open Defecation (ZOD) program as a scaling-up approach in lowering the rates of soil-transmitted helminth (STH) infections has not yet been locally explored, this study aimed to (1) describe the association between environmental determinants and STH cumulative prevalence, and (2) to predict the 2020 STH cumulative prevalence. Methods: A generalized linear regression (GLR) model was used to determine the association of 2014–2015 environmental determinants and observed 2015 STH cumulative prevalence, while a geographically weighted regression (GWR) model was used to produce predicted 2020 STH cumulative prevalence. Results: ArcGIS’ GLR tool with R2 of 63% found that statistically significant environmental determinants include distance near to water bodies, forest land use, access to sanitary toilet, level one water source, and ZOD status, while the ArcGIS’ GWR tool found that barangays, Cabangcalan, Matalangtalang, Talabaan, and Talib in Aroroy hypothetically met the national target below 30% for 2020 STH cumulative prevalence. Conclusion This study showed that barangays with a moderately low percentage of area with freshwater bodies, a moderately high percentage of households with sanitary toilet and level one water source, and a 100% status of ZOD have lower rates of STH cumulative prevalence in preschool-aged children in the selected municipalities in Masbate.
Mass Drug Administration ; Hygiene ; Sanitation ; Geographic Information Systems