BACKGROUND AND OBJECTIVES: In September 2009, Metro Manila was hit by a heavy rainfall typhoon Ketsana inundating several cities of Metro Manila causing an outbreak of leptospirosis. We analyzed the prognostic factors associated with mortality among leptospirosis patients admitted after the typhoon at nine tertiary hospitals from September to November 2009.
METHODS: We reviewed the charts of patients with probable and confirmed leptospirosis. Confirmed leptospirosis was based on any of the following: positive leptospiral culture of blood or urine, single high leptospira microagglutination titer (MAT) of 1:1600 or a fourfold rise in MAT antibody titers or seroconversion. Patients with negative serology or cultures but with history of wading in floodwaters plus any of the following signs and symptons: fever, headache, myalgia, conjunctival suffusion, diarrhea and abdominal pain, jaundice, oliguria and changes in sensorium were considered probable cases.
RESULTS: We analyzed 332 probable and 259 confirmed leptospirosis patients. Mean age was 37.95± 14.09, mostly males (80.2%). Almost all patients (98%) waded in floodwaters. Majority had moderate to severe form of leptospirosis (83%). Acute renal failure was the most common complication (87.1%). Mortality was 11.3% mostly due to pulmonary hemorrhage. On multivariate analysis of confirmed and probable cases, the factors independently associated with mortality were pulmonary hemorrhage (OR 2.75, 95% CI 1.46 to 5.20), severity of the disease (OR 3.85, 95% CI 1.60 to 9.26), thrombocytopenia (OR 3.16, 95% CI 1.22-8.16), duration of illness before admission (OR 0.88, 95% CI 0.78-0.99) and age (OR 1.03, 95% CI 1.00-1.06).
CONCLUSION: Pulmonary hemorrhage remains a poor prognostic factor and strong predictor of mortality among patients with severe leptospirosis. Early consult through heightened awareness of the public and prompt recognition of leptospirosis among clinicians can decrease the risk for progression to complications of leptospirosis and mortality.

 

Human ; Male ; Female ; Adult ; Adolescent ; Hemorrhage ; Mortality ; Serology ; Abdominal Pain ; Acute Kidney Injury ; Cyclonic Storms ; Diarrhea ; Disease Outbreaks ; Fever ; Headache ; Jaundice ; Leptospira ; Leptospirosis ; Multivariate Analysis ; Myalgia ; Oliguria ; Philippines ; Prognosis ; Seroconversion ; Tertiary Care Centers ; Thrombocytopenia

Introduction: Sepsis is an emerging problem that needs to be recognized early and addressed promptly with hydration and appropriate antibiotics. This study aims to assess the adherence to surviving sepsis campaign (SSC) bundle within three hours and six hours, length of hospital stay and mortality among adult patients admitted at ManilaMed–Medical Center Manila diagnosed with sepsis. Methods: A retrospective cohort study was performed in all adult patients admitted at ManilaMed–Medical Center Manila diagnosed with sepsis and septic shock from January to September 2017. Parameters for SSC bundle for three and six hours were used to assess compliance. Outcomes such as length of hospital stay and mortality were determined. Results: This study included a total of 85 subjects and majority are females (56%). Mean age of study subject was 67.5±17.67 years. Adherence to SSC bundle in three and six hours were observed particularly in blood cultures (45%), administering broad-spectrum antibiotics (69%), fluid resuscitation at 30 mL/kg for hypotensive patients (22%) and administering vasopressors (78%) to maintain systemic perfusion. However, adherence to other parameters of the bundle was not observed, namely: measurement and re-measurement of lactate levels and measurement of CVP and SCVO2. In terms of outcome, the average length of hospital stay is 11 days and mortality was 42%. Discussion: Sepsis is a fatal disease if not promptly recognized and addressed. The SSC bundle was formulated to guide clinicians and other healthcare providers in managing sepsis or septic shock patients. Some of the parameters are absent or are not routinely done in some institution, maximizing the resources that are present is ideal. Conclusion The compliance rate is deemed submaximal since eyeing for a 90-100% compliance rate is recommendable in a tertiary hospital. Emphasis on early identification, obtaining blood cultures and timely initiation of antimicrobials should be done.
Sepsis ; Compliance

Five key policy recommendations were generated from the presentations and discussions in the Global Assembly on Everyday Life, Gender, and Sexuality. The rich source of information supporting the recommendations was the exploration of effective methods of promoting social change through education and research from networks and partnerships. The movement created by collective and participatory approaches in policy development counters the limitations of some societies where gender and sexuality are taboo. Enabling laws is essential, but the implementing guidelines should consider the real-world experience and realize that adequate infrastructure, processes, and resources are necessary. Education of the people on gender and sexuality must start early in life to plant a seed to develop values that uphold respect for human rights and civic responsibility.
Gender Identity ; Sexuality

This article describes the partnership between the College of Public Health, University of the Philippines Manila and the province of Laguna in the context of implementation of the field practice course. This partnership paved the way for the development and implementation of projects in seven field practice sites. Projects concentrated mainly on improving quality of data and health information system, development of educational materials, and addressing health problems such as tuberculosis, hypertension and rabies. After the implementation of the various activities, there is a need for both parties (the College of Public Health and the Provincial Health Office of Laguna) to monitor and evaluate if projects have been sustained. Moreover, successful projects must also be fully documented which can serve as models for other areas in the province of Laguna.

Human ; Rabies ; Health Information Systems ; Public Health ; Tuberculosis ; Quality Improvement ; Universities ; Teaching Materials ; Hypertension

BACKGROUND:The incidence of human immunodeficiency virus (HIV) infection in the Philippines is increasing. HIV-related stigma in the health care setting is a known barrier to healthcare access for people living with HIV (PLHIV).

OBJECTIVE: The study aimed to identify stigmatizing attitudes and practices towards PLHIV among healthcare workers in Philippine General Hospital.

METHODS: In this cross-sectional descriptive study, 375 healthcare workers were recruited via convenience sampling. A standardized questionnaire developed by the Health Policy Project was used.

RESULTS: The study demonstrated concerns regarding transmission, particularly during drawing blood (87.1%),assisting in labor and delivery (82%), and dressing wounds (80.4%). Use of special infection-control measures (76.1%),wearing double gloves (72.8%), additional infection-control procedures during labor and delivery (72.2%), and wearing gloves during all aspects of patient care (70.2%) were reported as well. Perceptions such as the belief that pregnant women who are HIV positive must inform their families of their HIV status (82.1%), and that PLHIV engage in irresponsible behaviors (69.1%) and are promiscuous (66.4%) were also detected.

CONCLUSION: The study confirmed the presence of HIV-related stigma among healthcare workers in Philippine General Hospital.This finding could potentially catalyze the development of stigma-reducing measures which could hopefully translate to improved healthcare for PLHIV.

Human ; Male ; Female ; Hiv Infections ; Social Stigma ; Health Services Accessibility ; Social Discrimination ; Health Care Facilities, Manpower, And Services ; Hiv

Background: Antibacterial resistance poses a significant health and economic burden worldwide. Relatedly, plant-based drug discovery remains an important adjunct to modern pharmaceutical research and development. Plants have an extensive record of being used as a form of alternative healthcare. For instance, the leaves of Persea americana Mill. (avocado) were used by traditional medicinal healers in Africa and the Philippines to alleviate common ailments such as skin ulcers and diarrhea. Objectives: To determine their antibacterial activity, leaves of different P. americana variants maintained at the National Plant Genetic Resources Laboratory, University of the Philippines Los Baños were subjected to disk diffusion assay. Methodology: Four P. americana leaf ethanol extracts (Cardinal, Morado, Semil 1, and Semil 2 variants) were tested in a range of concentrations (5 mg to 5 μg) against S. aureus (ATCC 25923) and E. coli (ATCC 25922) using standard disc diffusion. Results: At 5 mg, all four P. americana leaf variants exhibited an inhibitory activity against S. aureus. Furthermore, Semil 2 variant showed the strongest relative antibacterial potential with activity at lower concentrations of 1.25 mg and 0.31 mg. On the other hand, all four variants did not suppress E. coli growth at the concentrations used. Conclusion The results indicate the potential antibacterial activity of P. americana leaf variants against S. aureus which is consistent with their ethnomedicinal use as a skin ulcer treatment since S. aureusis a common etiologic agent of skin ulcers. Furthermore, the findings suggest the four P. americana leaf variants, particularly Semil 2, as possible sources of novel antibacterial compounds against S. aureus.
Anti-Bacterial Agents ; Diarrhea ; Phytochemicals ; Plant Extracts ; Skin Diseases

Background: Vaccination is an effective public health measure. Health workers, who are at risk of acquiring infectious diseases due to their occupation, are important targets of vaccination. However, previous studies have shown varying rates of vaccine uptake among health workers. Objective: This study aimed to determine the knowledge, attitudes, risk perceptions, and intention towards COVID-19 and vaccination of Filipino health workers in the city of Manila, Philippines. Methodology: The study employed a sequential mixed methods design. A self-administered questionnaire was used to collect data on the study variables. Descriptive statistics was used to analyze the level of COVID-related knowledge, attitude, risk perception, and intention to receive the COVID-19 vaccine. Logistic regression was performed to identify the factors that were associated with intention. Results: Majority (89.4%) had a good knowledge of COVID-19 but had little to moderate knowledge of COVID-19 vaccines. Around half reported feeling unsure about the safety and efficacy of the vaccines while the remaining half expressed intent to get the vaccine. Logistic regression analysis showed that the odds of intention to get vaccinated were higher among those with positive perceived self-efficacy, behavioral intention, external cues to action, perceived vaccine efficacy, and good knowledge on COVID-19 infection prevention. Conclusion Health workers play a crucial role in the promotion of public health measures such as vaccination to control the spread of COVID-19. The study confirms the need for strengthening education and communication strategies focusing on the safety and efficacy of COVID-19 vaccines to prevent the spread of false information and promote vaccine uptake among health workers.
COVID-19 ; Knowledge

Objectives: This scoping review aimed to support a landscape analysis to identify lessons learned about intersectoral collaborations (ISCs) by describing their existing models in the context of dengue, malaria and yellow fever. Methods: A scoping review following the methodology of Joanna Briggs Institute was performed using the following inclusion criteria: studies involving humans; studies discussing intersectoral collaborations, malaria/dengue/yellow fever, and prevention or control at any level; and studies in countries endemic for the aforementioned diseases. Studies were screened using Covidence, while data were extracted using NVivo. Results: Of the 7,535 records retrieved, 69 were included in the qualitative analysis. Most ISCs were initiated by multilateral organizations and ministries of health, and none by communities. Strategies included advocacy, health education, research, public health measures, resource mobilization, service delivery and training; mostly employed on a community level. Monitoring and evaluation were mostly formative, ongoing, and participatory. Gaps included administrative and policy barriers, resource shortages, and inadequate research and training. Conclusions Multiple models of ISC exist in the literature. There is a need to develop a comprehensive framework for an effective and sustainable multisectoral approach for the prevention and control of VBDs ensuring adequate resources, active stakeholders, and strategies that span the entire socio-ecological spectrum.
Dengue ; Disease Vectors ; Intersectoral Collaboration ; Malaria ; Vector Borne Diseases