Background Background. Establishing and integrating Basic Emergency Obstetrics and Newborn Care (BEmONC)-capable facilities into the healthcare delivery system is one of the strategies employed by the Philippine government to address high maternal mortality. Objectives. This study aimed to determine the functionality of BEmONC-capable rural health units (RHUs) in Luzon, the largest island in the country. Methods. The study utilized a researcher-administered facility survey and facility observation using a checklist designed to measure BEmONC functionality. Facilities were selected through a two-stage sampling method. A BEmONC Score Card was used to determine the overall functionality of a facility based on three categories — institutional capacity, service capacity, and personnel capacity. The total scores from the three categories provided the overall functionality score.Results. Of the 245 BEmONC-provider RHUs included in the study, 85 (35%) were adequately functional. The mean functionality score for Luzon (60±25.27) corresponded to adequate functionality. The mean institutional and service capacities were consistently high across all regions on the island. Still, the personnel capacity did not reach the minimum average, pulling down the overall score and leading to low overall functionality. Conclusion. The BEmONC facilities continue to function despite being hampered by factors that can be easily remedied. The provision of BEmONC services remains relevant across all regions in Luzon as they fill in the gaps and serve the needs of mothers and pregnant women. This study should be replicated in the Visayas and Mindanao to obtain a complete representation of the BEmONC program.
Maternal Mortality

Background: One of the strategies adopted by the Department of Health (DOH) to improve maternal outcomes is the systems approach which means understanding extensively how the system operates to determine factors affecting the delivery of services. In 2014, Albay province responded by adapting and implementing the Maternal, Newborn and Child Health, and Nutrition (MNCHN) Service Delivery Network Guidelines. However, no external monitoring and evaluation have been done to assess the compliance of birthing facilities to these guidelines. Objectives: To determine Legazpi city’s obstetric service delivery network functionality and to compare government and private primary level birthing facilities in terms of 1) governance; 2) human resources; 3) protocols; 4) transportation and communication; and 5) emergency drugs and equipment. Materials and Methods: A cross-sectional study using the referral system assessment (RSA) questionnaire translated into a scorecard with a review of secondary data on high-risk pregnancies, referral rates, and maternal mortalities was done on eight facilities in Legazpi City. Results: Overall, none of the health facilities assessed were fully-functional. Privately owned facilities scored highest in emergency drugs and equipment (83.3%) and lowest in human resources (38.9%). Government facilities scored highest in emergency drugs and equipment (88.9%) but lowest in transportation and communication (44.4%). Statistically significant differences were observed for human resources (p-value=0.0180), wherein public facilities garnered higher scores, and in transportation and communication (p-value=0.0294), private facilities showed better scores. Only one maternal death in 418 referrals was reported. Conclusion Overall, the health facilities varied in the level of functionality in terms of SDN guidelines.
Birthing Centers

Introduction: The World Health Organization (WHO) reported that special populations are more susceptible to the COVID-19 virus. There is little information on whether COVID-19 affects women of reproductive age and their fertility, pregnancy status, and offspring give: We aimed to assess the knowledge, practices, and perceptions (KPP) on the risk and susceptibility to COVID-19 of women of reproductive age. Methods: We conducted a qualitative exploratory descriptive study using the triangulation method. The study consisted of in-depth interviews (IDIs) with women of reproductive age and their spouses, focus group discussions (FGDs), and key informant interviews (KIIs) with health care professionals (HCP) in University of the Philippines-Philippine General Hospital. We assessed KPP using structured, open-ended interview guides. Interview responses were recorded and transcribed verbatim, and thematic analysis was performed using NVivo 12. Results: Eighty participants, 20 women of reproductive age, 20 spouses, 20 non-pregnant women, and 20 HCPs in UP-PGH were included in the study. All participants were knowledgeable about COVID-19. Pregnant women would consult their physicians when they felt symptoms related to COVID-19. Spouses of pregnant women and non-pregnant women observed health measures to prevent the spread of the virus. Both pregnant and non-pregnant patients with COVID-19 felt shamed and stigmatized while the husbands worried that the exposure to the infection will pose a burden to their families. HCWs provided services through teleconsultation and found it challenging to refer patients to other facilities. Conclusion The study provided insights on KPP of women with reproductive-age to COVID-19 and views of HCWs in providing care to these patients during the pandemic. The effects of COVID-19 are still detrimental and highly evident from the micro to the macro level.
Qualitative Research ; Knowledge ; Perception ; COVID-19

Introduction: Despite implementing various maternal health care programs and integrating these into Service Delivery Networks, the Philippines continues to have high maternal mortality. Identifying factors that impede the utilization of available maternal care services may help reduce maternal morbidity and mortality and bridge the gap between the need and actual use of such services among mothers in the community. Objectives: This study identified barriers, hindrances, and other factors influencing mothers in availing maternal health services in Luzon, the largest island in the country and the area that accounted for more than half of total maternal mortality. Methods: Eight focus group discussions participated in by a total of 78 pregnant women and mothers were conducted across all of the eight regions of Luzon. In each session, the participants were asked to answer questions based on a semi-structured interview guide. The interviews were recorded, translated and back-translated, transcribed, and compiled before analysis by the deductive-dominant approach using NVivo12. Results: Factors affecting maternal health service utilization center on the capacity of health facilities to provide services like evaluation of the progress of pregnancy, laboratory examinations, free medicines, and immunizations; and on region-bound individual factors. The availability of skilled health personnel and lack of financial resources were the most common subthemes. Conclusion This study identified some key factors that deter patients from availing of existing maternal health services in Luzon. Eliminating these barriers will not only help strengthen local health infrastructure and improve service delivery but also promote the utilization of such services, leading to better maternal outcomes.
Maternal Health

Introduction: Understaffed and underfunded Rural Health Units (RHUs) in Luzon struggle to provide Basic Emergency Obstetric and Newborn Care (BEmONC) services, resulting in high rates of maternal morbidity and mortality. The Cordillera Administrative Region (CAR) is different. Despite limited BEmONC-capable facilities, the region has maintained excellent maternal health outcomes. Objectives: This study describes the status of BEmONC-capable RHUs in CAR and how these relate to the maternal and child health outcomes in the region. Methods: This study uses the BEmONC Survey Toolkit to determine facility functionality based on the three categories of institutional capacity, service capacity, and personnel capacity. Focused Group Discussions were conducted to gather insights from community members, health personnel, and local stakeholders. Results: The study evaluated 31 facilities; only one was adequately functional. The service capacity of BEmONC RHUs in CAR (7.19) was significantly lower than that of Luzon (14.16). The overall functionality score of CAR (58.10) was also slightly lower compared to that of Luzon (60.42). Yet CAR still had some of the best outcomes in terms of maternal and child health. Maternal mortality from 2000 (23 deaths) to 2018 (13 deaths) was consistently low. Conclusion The case of CAR reiterates the importance of having health personnel on the ground, maintaining the trust of the populace for health promotion to increase health awareness, and timely intervention in difficult situations. These directly impact health service delivery and improve health outcomes.
Mortality

Objective: This study aimed to determine the clinical characteristics, management, and outcome of gestational trophoblastic neoplasia (GTN) patients with brain metastasis. Materials and Methods: This was a 10‑year descriptive study that included all patients with brain metastasis from GTN. Patients’ sociodemographic and clinicopathological profiles were described. Using Kaplan–Meier survival curve, the survival time was determined Results: From January 1, 2010, to December 31, 2019, there were 33 GTN patients with brain metastasis. Four were excluded from the study due to incomplete records. Twenty‑nine patients were included in the study. Nineteen (65.51%) patients presented with neurologic symptoms upon diagnosis and one (3.44%) during treatment. All received etoposide, methotrexate, actinomycin, oncovin (EMACO) as first‑line treatment. Five (17.24%) patients were given induction chemotherapy with low‑dose etoposide–cisplatin. Seventeen (58.62%) patients underwent whole‑brain radiation and two (6.89%) were given intrathecal methotrexate. Thirteen patients (44.82%) achieved biochemical remission with EMACO chemotherapy. Four patients (13.79%) had resistance to EMACO and were given Etoposide Cisplatin Etoposide Methotrexate Actinomycin (EP EMA). Four patients (13.79%) underwent an adjunctive hysterectomy. Four patients (13.79%) died during treatment. One patient (3.44%) was unable to continue her chemotherapy because she got pregnant before her first consolidation course. There were eight early deaths (<4 weeks of admission) and hence were excluded in the analysis. Three patients who went into biochemical remission relapsed on the 1st, 2nd, and 3rd months after their last consolidation course, respectively. The median follow‑up time was 27 months. After excluding early deaths, the survival rate between 3 and 7 years after treatment is at 61.9%. The mean survival time was 5.43 years. Six surviving patients were contacted. Five (17.24%) of them had resumed their everyday life, and one is currently undergoing chemotherapy. Conclusion The study was able to document brain metastasis from GTN to be 14.28% (29/203) among metastatic high‑risk admissions. The biochemical remission rate from first‑line treatment was of 61.90% (13/21) and resistance rate was 19.04% (4/21). Lost to follow up after achieving biochemical remission was a challenge encountered
Gestational Trophoblastic Disease

Introduction: Breast cancer is the most common cancer among women in the Philippines and about 3 in every 100 Filipina will be diagnosed with breast cancer in their lifetime. There is a need to discover safe, yet inexpensive herbal extracts with potential cytotoxic properties as potential treatment modalities to treat breast cancer. Objectives: This study seeks to explore the cytotoxic and apoptotic properties of the ethyl acetate fraction of the defatted crude methanol leaf extract of Syzygium samarangense in MCF-7 breast cancer cell lines. Methods: Screening for flavonoids of the extracts was performed using TLC, total flavonoids, total phenols, FTIR and LC-MS spectroscopy. The hydrogen peroxide and ferric reducing anti-oxidant power were used as substrates to assess in vitro anti-oxidative properties of the extracts. The MTT dye viability assay was used to assess the cytotoxic properties of the extracts against MCF-7 cells. Apoptotic properties of the extracts in MCF-7 cells were determined by caspase-3 activation assay, DNA fragmentation patterns and fluorescence microscopy after annexin-V and propidium iodide staining. Results: The abundance of flavonoids in the ethyl acetate fraction of the crude methanol leaf extract was established by TLC, FTIR, LC-MS/MS, total flavonoid and total phenol analyses. The in vitro anti-oxidative properties of this extract was comparable to ascorbic acid. The median inhibitory concentration (IC50) of this extract in MCF-7 breast cancer cell lines was 7.2 mcg/mL while doxorubicin registered an IC50 of 1.2 mcg/mL. At this concentration, the extract was not cytotoxic to normally-dividing breast epithelial cells. Cytotoxicity of the extract was mediated via apoptosis as demonstrated by DNA fragmentation, caspase-3 activation and fluorescence microscopic analyses. Conclusion The study shows that the flavonoid-rich ethyl acetate fraction of the crude methanol leaf extract of S. samarangense possesses potent apoptotic and cytotoxic properties against MCF-7 breast cancer cell lines at low concentrations.
MCF-7 Cells ; Syzygium

Background: Scabies is the second most common cause of disability among skin diseases in the Philippines as of 2019. There is no large nationwide study describing the epidemiologic profile of scabies in the country. Objective. This study aimed to describe the demographic, seasonal, and geographic profile of scabies in the Philippines. Methods: We compared secondary data of two local patient registries (Philippine Dermatological Society, PDS, 2010 to 2021; and Philippine Pediatric Society, PPS, 2009 to 2021) for reported cases of scabies in the Philippines. We reported the frequency and percentage distribution according to age, sex, month, year, and type of diagnosis, and region. Results: The median annual frequency of scabies cases (mostly outpatient) for PDS (from year 2010) was 4087 (range ([QR], 342-6422 [3271.5]), while it was 183 (range [IQR], 64-234 [96.5]) (all inpatient) for PPS (from year 2009). There was a reduction to one-third (PDS) and one-fourth (PPS) of pre-pandemic numbers during the pandemic years (2020- 2021). The peak months for scabies cases were the cooler months: January (median, 12.1% of annual cases; range [IQR], 2.6%-31.4% [3.6%]) to February (median, 10.0% of annual cases; range [IQR], 1.5%-27.8% [2.5%]) based on PDS data, and November (median, 10.0% of annual cases; range [IQR], 0.0%-24.3% [7.0%]) to January (median, 9.0% of annual cases; range [IQR], 0.0%-24.3% [6.6%]) for PPS data. Overall, for PDS, age 1-4 years is the most affected age group (median, PDS, 17.5% of annual cases; range [IQR], 11.9%-25.4% [8.1%]), while it was the less than 1-yearolds (median annual cases, 48.9%; range [IQR], 29.1%-67.3% [13.20%]) among PPS pediatric population aged 0 to 18 years. Males (median, 53.9% of annual cases; range [IQR], 45.0%-67.2% [8.8%]) were more affected than females in PPS. While for PDS during earlier years (prior to 2015), males (median, 51.6% of annual cases from 2010 to 2014; range [IQR], 47.4%-52.9% [0.2%]) were more affected than females. However, males became less affected than females with median, 44.7% of annual cases from 2015 onwards (range [IQR], 43.4%-46.5% [1.2%]). NCR was the region with the highest frequency of cases in PPS (median, 52.6% of annual cases; range [IQR], 22.7%-75.0% [20.4%]). The 2nd most affected regions were Central/Eastern Visayas (34.2%, 2009-2013; range [IQR], 17.9%-54.1% [5.3%]), Bicol region (12%; 2014 to 2018; range [IQR], 17.9%-54.1% [7.4%]), Central Luzon (18%; 2019), Central/Eastern Visayas (29%, 2020), and Northern/Central Mindanao (17%, 2021). Conclusion Scabies was commonly seen in the younger age group, slightly more in females in the PDS, while slightly more among males in the PPS, in the cooler months of the year, and in the urbanized NCR.
Scabies ; Philippines ; Epidemiology ; Database ; Registries

Introduction: Breast cancer is the most common cancer among women in the Philippines and about 3 in every 100 Filipina will be diagnosed with breast cancer in their lifetime. There is a need to discover safe, yet inexpensive herbal extracts with potential cytotoxic properties as potential treatment modalities to treat breast cancer. Objectives: This study seeks to explore the cytotoxic and apoptotic properties of the ethyl acetate fraction of the defatted crude methanol leaf extract of Syzygium samarangense in MCF-7 breast cancer cell lines. Methods: Screening for flavonoids of the extracts was performed using TLC, total flavonoids, total phenols, FTIR and LC-MS spectroscopy. The hydrogen peroxide and ferric reducing anti-oxidant power were used as substrates to assess in vitro anti-oxidative properties of the extracts. The MTT dye viability assay was used to assess the cytotoxic properties of the extracts against MCF-7 cells. Apoptotic properties of the extracts in MCF-7 cells were determined by caspase-3 activation assay, DNA fragmentation patterns and fluorescence microscopy after annexin-V and propidium iodide staining. Results: The abundance of flavonoids in the ethyl acetate fraction of the crude methanol leaf extract was established by TLC, FTIR, LC-MS/MS, total flavonoid and total phenol analyses. The in vitro anti-oxidative properties of this extract was comparable to ascorbic acid. The median inhibitory concentration (IC50) of this extract in MCF-7 breast cancer cell lines was 7.2 mcg/mL while doxorubicin registered an IC50 of 1.2 mcg/mL. At this concentration, the extract was not cytotoxic to normally-dividing breast epithelial cells. Cytotoxicity of the extract was mediated via apoptosis as demonstrated by DNA fragmentation, caspase-3 activation and fluorescence microscopic analyses. Conclusion The study shows that the flavonoid-rich ethyl acetate fraction of the crude methanol leaf extract of S. samarangense possesses potent apoptotic and cytotoxic properties against MCF-7 breast cancer cell lines at low concentrations.
MCF-7 Cells ; Syzygium

Introduction: To address the problem of high maternal death, the Department of Health implemented the Basic Emergency Obstetric and Newborn Care (BEmONC) services at the level of primary care health facilities. These are key life-saving interventions that treat obstetric emergencies. Over a decade later, we need to assess and improve the program’s implementation. Objective: The study aims to select indicators for assessing the functionality of BEmONC facilities. Methods: Electronic Delphi process was used to select the indicators. Results: The two-round Delphi process was accepted by 21 respondents, with a 100% response rate. All 30 proposed indicators were retained following the criteria. Conclusion Thirty indicators to assess the functionality of BEmONC facilities have been selected through the consensus of an expert panel using the Delphi process. These indicators help evaluate BEmONC facilities, formulate policy, and guide new programs that promote maternal health.
Maternal Health