Education ; Health Education ; Global Health

Higher Education Institutions (HEIs) are acknowledged as key drivers in realizing health-related Sustainable Development Goals (SDGs). The University of the Philippines Manila, College of Public Health (UP CPH) together with the Asia-Pacific Academic Consortium for Public Health (APACPH), hosted the 53rd APACPH International Conference last 21-23 September 2022. The conference discussed current issues relating to the attainment of SDGs and promoted collaboration of leading academic institutions and other stakeholders in addressing various public health challenges. The conference revolved around the challenges and opportunities in attaining health-related SDGs, and the good practices and roles of HEIs in addressing health disparities. The lack of certificati on framework of public health tertiary programs, pedagogy and infrastructure, and ambiguous roles and network of public health professionals were discussed. The conference served as a platform for discussing potential resolutions and ways forward in addressing these challenges. Opportunities for improvement such as updating of policies and curricula, strengthening of internship and community engagement programs, establishment of capacity-building partnerships and programs, and developing multidisciplinary-competent faculty and students were identified. This paper providesthe highlights of the conference focusing on the good practices and roles of HEIs in addressing health disparities, the impact of COVID-19 pandemic, and other issues and challenges in attaining SDGs.

BACKGROUND AND OBJECTIVE

The World Health Organization (WHO) reported that most of the tuberculosis (TB) cases are aged between 15 to 54 years old, the working population. This study described workplace policies on TB in selected low- and middle-income countries (LMIC) in Asia-Pacific.

Among the LMICs, countries wherein TB is a public health concern were included. Six policies written in English were included in this study and were reviewed based on the components of the TB workplace programs that were extracted from the WHO Guidelines for Workplace TB Control Activities.

The Philippine policy had the most number of components while those of Cambodia and Papua New Guinea had the least. Only the component on implementing environmental controls was common among the policies. Components on respecting patient rights and confidentiality, tailoring of workload to TB patient’s state of health, registration of all patients with TB diagnosis, reporting of cases to central NTP office, recording of standard treatment outcome, and inclusion of multidrug-resistant TB (MDR-TB) provisions were missing for the majority of the policy documents.

The workplace TB program policies included in this study can be reviewed and updated accordingly, with the coverage expanding to all workplaces. The policies can also integrate measures on COVID-19 as the pandemic has slowed the progress in TB control. With the similarities in the preventive measures against TB and COVID-19, this can be an avenue to develop integrated policies especially for workplaces.

BACKGROUND

Pneumococcal vaccination has been widely used for the prevention of pneumococcal disease, with two types of vaccines available since 2009. With the World Health Organization (WHO) recommendation of incorporating pneumococcal conjugate vaccines (PCVs) in National Immunization Programs (NIPs) worldwide, a ten-valent PCV (PHiD-CV) was initially introduced in the Philippines in 2012. This, however, transitioned to the use of the 13-valent PCV (Prevnar) subsequent to the recommendation of the Formulary Executive Council in 2014.

This review aimed to present evidence on pneumococcal disease and vaccine inclusion in the Philippine NIP from 2005 - 2021.

This narrative review compiled articles on Pneumococcus from January 2005 to October 2021, sourcing literature from databases such as BIOSIS Preview, CAB Direct, Embase, Google Scholar, and others.

In the Philippines, there was a shift in prevalent serotypes of Streptococcus pneumoniae among children under five following the introduction of PCV13 in the National Immunization Program in 2014, with serotype 14 becoming the most common by 2018, and a significant reduction in isolates reported in 2020, where only serotypes 5, 19A, and 23F were identified among invasive strains. The immunogenicity results of a potential vaccine candidate should be factored into the overall evidence when conducting a reassessment of PCV.

As part of the decision making about the inclusion of the PCVs in the NIP of the Philippines, various factors such as local epidemiology, vaccine supply, cost, and programmatic characteristics must be careful weighed. Enhancing laboratory and surveillance capacity are essential to provide evidencebased decision-making in terms of existing serotype distribution and antimicrobial resistance (AMR) profile in the country. With the introduction of a new affordable formulation of a 10-valent PCV offering a comparable serotype coverage, the reassessment of choice of PCV with the consideration of all three formulations, namely PCV13, PHiD-CV, and SIIPL-PCV, may be warranted.

Background: Indigenous peoples (IPs) remain vulnerable to soil-transmitted helminthiasis (STH) due to limited access to sanitary toilets, clean water, quality health education, and services. The World Health Organization recommends periodic mass drug administration (MDA) of anthelminthics, health education, and improvements in water, sanitation, and hygiene (WASH) as control strategies to reduce morbidities caused by STH in target populations such as schoolage children (SAC). This paper complements the published results of the parasitological survey (prevalence and intensity of STH) conducted in selected Aeta and Ata-Manobo communities. Objectives: This study aimed to describe the accessibility of STH control strategies to respond to the needs of SAC in IP communities in Pampanga and Davao del Norte, the Philippines. It likewise intended to describe access of these IP communities to STH control strategies. Methods: Data on accessibility of and access to STH control strategies were collected using key informant interviews (KIIs) and focus group discussions (FGDs). Eleven officials and workers from the departments of health and education, local government units, and two IP leaders were interviewed on the existing STH burden in SAC, implementation of STH control strategies, particularly of MDA, health education campaigns, and improvements in WASH including good practices and challenges in program implementation. Three FGDs with parents, elementary school teachers of IP schools, and rural health midwives were conducted separately. Guide questions focused on accessibility of and access to STH prevention and control strategies for SAC in IP communities. Informed consent to conduct and record KIIs and FGDs were obtained from participants prior to participation. Analysis of a multi-disciplinary team was based on the accessibility framework for IPs accessing indigenous primary health care services by Davy et al. (2016). Results: The characteristics of the STH control strategies and the target populations are interrelated factors that influence accessibility. Challenges in the availability of the MDA program, particularly, inadequate staffing, drug shortages, and delays in delivery affect accessibility of and access to the free STH control strategies. Perceived harm, adverse events, stigma, beliefs, and practices likewise affect access. Lack of information on the similarity of treatment through community- and schoolbased MDA programs also affected engagement of SAC. IP communities are special settings where geographic isolation, peace and order situation as well as water supply need to be considered to help ensure access to STH control strategies, high MDA coverage, and improvements in WASH leading to desired outcomes. Conclusions Considering the context of IP communities and addressing the challenges in the accessibility of and access to STH control strategies are necessary to ensure successful implementation of an integrated approach in STH prevention and control strategies. Challenges in the accessibility of STH control strategies are inadequate staffing, poor inventory, and delays in the delivery of drugs, as well as poor sanitation and hygiene. Access of SAC is likewise affected by misconceptions on safety and efficacy of anthelminthics, including stigma and cultural practices. The similarity of the MDA programs based in school or community need to be disseminated.
Indigenous Peoples ; Mass Drug Administration

Objective: As part of the evaluation of control programs recommended by WHO, this study describes the local implementation of schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) morbidity control as well as water, sanitation, and hygiene (WASH) interventions post calamity. It likewise determines the challenges, areas for improvement, and good practices in SCH and STH morbidity control strategies in Haiyan-stricken areas in Eastern and Western Samar, the Philippines. Methods: Twenty key informant interviews and eight focus group discussions documented the implementation of SCH and STH control strategies in Eastern Visayas. Data analysis was done manually by a multi-disciplinary team. Results: Mass drug administration (MDA) in schools and communities was conducted for morbidity control. MDA for STH for pre-school-age children was integrated into the Garantisadong Pambata program, while a schoolbased teacher-assisted approach was used for school-age children. WASH facilities, such as sanitary toilets, were constructed through the initiatives of the local government units (LGUs) and other private sectors. Partnerships with Plan International Philippines helped in the implementation of WASH through the conduct of Community-led Total Sanitation. Health advocacies helped instill behavioral change in the community. SCH surveillance was conducted annually while STH surveillance was irregularly implemented. Data on MDA coverage were validated through Rapid Coverage Assessment before final reporting. Discrepancies were observed due to typographical errors and the inclusion of teachers and transient migrants in the reports submitted. Challenges in the implementation of MDA include delays in drug delivery, lack of human resources, non-compliance of participants, and drug unpalatability. Challenges in WASH included the lack of hand washing facilities, inaccessibility to safe water, as well as non-utility of sanitary toilets. Strengthening health advocacy and education may help address these challenges. Conclusion The involvement and partnership of various stakeholders such as LGUs, WASH, and veterinary sectors, together with the academe are needed to strengthen and enhance the implementation of SCH and STH control activities. An integrated approach may contribute to improvements in SCH and STH prevention and control of the communities in selected Haiyanstricken areas.
schistosomiasis ; Philippines

Background: There are limited reports on foodborne trematodiases (FBT) and taeniasis prevalence and distribution in the Philippines. Objective: This study aimed to describe their prevalence and distribution and determine the species causing these infections in selected areas in southern Philippines. Methodology: The study was implemented in selected barangays in Caraga and Davao regions in southern Philippines. School-age children and adults with gastrointestinal manifestations within the last two weeks were examined using the modified Kato thick technique, while adults with cough for more than two weeks underwent sputum examination using NaOH concentration technique. The adult helminths from patients positive for FBT and/or taeniasis were processed, mounted, and stained for species identification. Results: Variable FBT and taeniasis prevalence across geographic areas and population groups was seen with a highly focal distribution. Heterophyidiasis was the most common FBT with a 7.5% (168 out of 2,238) prevalence. Species not known to be endemic in the area were identified including Haplorchis taichui, Opisthorchis felineus, and Echinostoma ilocanum. Variable prevalence of soil-transmitted helminthiasis and schistosomiasis was also seen. Conclusion The study revealed the hidden burden of FBT and taeniasis and identified species not known to be endemic in selected areas in southern Philippines. Addressing this hidden burden will require enhancing service delivery. This may be done by utilizing more accurate diagnosis, updating treatment guidelines, implementing evidence-based control interventions, and improving surveillance. Integrating control programs, for instance, integrating FBT and taeniasis control with STH and schistosomiasis control, and integrating paragonimiasis control with the national TB program, may also help in optimizing resources.
Taeniasis ; Schistosomiasis ; Philippines

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

To provide baseline data on the prevalence and intensity of soil-transmitted helminthiasis egg contamination in the soil among indigenous communities. Methods: A total of 317 soil samples from three barangays of indigenous communities communities in Tigaon, Camarines Sur, Philippines were examined for soil-transmitted helminthiasis egg contamination using optimized sugar flotation method. Results: Of the soil samples examined, 141 (44.48%) were contaminated by Ascaris spp., Toxocara spp., and Trichuris spp. with cumulative prevalence varying across the study sites (P0.01). Ascaris spp. was predominant in all study sites, followed by Toxocara spp. and Trichuris spp. with a prevalence of 41.96%, 7.57%, and 5.36%, respectively. Interestingly, Toxocara pp. has the highest intensity of contamination, followed by Ascaris spp. and Trichuris spp. in term of geometric mean soil-transmitted helminthiasis eggs recovered per one gram soil sample (34.25, 21.45, and 11.85 respectively). Each study site harbors significant amount of soiltransmitted helminthiasis eggs and zoonotic Toxocara eggs, which present high risk of soil-transmitted helminthiasis infection, particularly among children observed to play and cohabitate with animals known to be hosts of these parasites. Conclusions: The alarming rate of soil-transmitted helminthiasis and Toxocara egg contamination reported in this study suggests that additional measures should be undertaken to control soil-transmitted helminthiasis and zoonotic intestinal infections in the country.

Background and Objective: Schistosoma japonicum is the causative agent of schistosomiasis in the Philippines. Current diagnostics suffer from low sensitivity and accuracy, hence an accurate and reliable diagnosis of schistosomiasis is essential for its prevention and control. In this study, a PCR-based assay for the detection of Schistosoma japonicumfor patient stool and serum samples was developed. Methodology: Three candidate primer sets targeting mitochondrial genes COX3, NAD4, and NAD5 were assessed. COX3 primer pair was used for the rest of the study for sensitivity, specificity, and performance testing. Lastly, the assay using COX3 primer pair was compared to Kato-Katz and circumoval precipitin test (COPT). Results: COX3 and NAD5 primers showed suitability for the assay as sequencing analyses gave high similarities of 96-98% for S. japonicum, while NAD4 showed no similarity to any organisms. The PCR-assay was shown to have a detection limit of 4 ng/ul DNA and was specific only to S. japonicum. The assay detected seven out of ten S. japonicum-spiked stool samples and ten out of ten S. japonicum-spiked serum samples. Comparative performance testing with Kato-Katz and COPT showed high specificity of 100% for both samples, but low sensitivity for formalin-fixed stool samples and stored serum samples. Conclusion This study developed a sensitive and specific PCR-based assay to detect S. japonicum from human samples. Results suggest that this PCR assay could be useful for the detection of S. japonicum in fresh clinical samples and can be further improved as a reference to improve other diagnostic assays for schistosomiasis.
Schistosoma japonicum ; Schistosomiasis ; Polymerase Chain Reaction