BACKGROUND

Social Innovation in Health Initiative Philippines introduced the community engagement self-monitoring strategy in two community-managed social innovations in 2021. Phase 1 demonstrated the strategy's viability by identifying community “local monitors,” selecting indicators, monitoring, and conducting feedback sessions. In 2022, a second phase was implemented to improve the process by integrating capacity-building activities and praxis sessions, and gathering insights on the strategy’s sustainability.

In this paper, we sought to describe the stages of the CE-SM strategy applied within a Philippine local health system in geographically isolated and disadvantaged contexts. Specifically, we: 1) Identified the key competencies of the local CE-SM monitors; 2) facilitated capacity building to strengthen their skills and abilities; 3) explored sustainability mechanisms; and 4) identified integration points of the CE-SM in strengthening local health systems.

Two communities in a rural municipality implementing a social innovation called the “Seal of Health Governance'' were chosen for the expanded community engagement self-monitoring (CE-SM) pilot. Profiling of local monitors and self-assessment of competencies were facilitated. Capacity-building activities were conducted for community engagement, data processing, and data analysis, complemented by praxis sessions guided by people-centered principles.

Local monitors from both communities showed determination in performing their responsibilities but differed in their levels of participation. Their appreciation of their role increased as it broadened from merely collecting data to understanding and using it to advocate for their community’s needs. The minimum resources for communities to implement the strategy include financial mechanisms to ensure the availability of resources. Local monitors have improved their ability to analyze their communities' realities, particularly regarding health leadership and governance.

Community engagement self-monitoring is a feasible and sustainable strategy for monitoring and evaluating health interventions if adequate support is provided and complemented by capacity-building and praxis sessions. It promotes listening to the community and empowering them to participate in decision-making, which are vital in fostering ownership and sustainability of social innovations in health.

BACKGROUND

Traumatic peripheral nerve injury (TPNI) is a debilitating condition that may result in significant disability. There is variability in the epidemiology, clinical profile, and mechanism of injury worldwide, but data for low- and middle-income countries (LMICs) such as the Philippines are sparse.

We aimed to determine the demographic and clinical characteristics, management, and outcomes of patients who sustained TPNI in our center.

We performed a retrospective cohort study of all patients referred for TPNI at our institution from 2013 to 2019. Data on demographics, clinical features, etiology, surgical management, and status on last follow-up were collected.

Forty-four patients with injuries to 62 peripheral nerves were included in the cohort, which had a strong male predilection (98%). The mean age at diagnosis was 35.5 years, with 78% of patients aged between 16-45 years. The most common etiologies were laceration due to sharp objects (39%), stab wound (23%), hacking injury (14%), and vehicular crash (14%). In terms of mechanism of nerve injury, the most common was sharp laceration (80%), followed by stretch injury/nerve injury in continuity (14%). The most commonly injured nerves were the ulnar (36%) and median nerves (32%), more often on the right side (66%). Nerve repair surgery was performed in 80% of cases.

TPNIs in a tertiary center in the Philippines most commonly involved young males in the working age group and were caused by occupational and domestic accidents. Appropriate surgical management of TPNI is feasible in low resource settings.

Background: Social Innovation in Health Initiative Philippines introduced the community engagement self-monitoring strategy in two community-managed social innovations in 2021. Phase 1 demonstrated the strategy's viability by identifying community “local monitors,” selecting indicators, monitoring, and conducting feedback sessions. In 2022, a second phase was implemented to improve the process by integrating capacity-building activities and praxis sessions, and gathering insights on the strategy’s sustainability. Objective: In this paper, we sought to describe the stages of the CE-SM strategy applied within a Philippine local health system in geographically isolated and disadvantaged contexts. Specifically, we: 1) Identified the key competencies of the local CE-SM monitors; 2) facilitated capacity building to strengthen their skills and abilities; 3) explored sustainability mechanisms; and 4) identified integration points of the CE-SM in strengthening local health systems. Methods: Two communities in a rural municipality implementing a social innovation called the “Seal of Health Governance'' were chosen for the expanded community engagement self-monitoring (CE-SM) pilot. Profiling of local monitors and self-assessment of competencies were facilitated. Capacity-building activities were conducted for community engagement, data processing, and data analysis, complemented by praxis sessions guided by people-centered principles. Results: Local monitors from both communities showed determination in performing their responsibilities but differed in their levels of participation. Their appreciation of their role increased as it broadened from merely collecting data to understanding and using it to advocate for their community’s needs. The minimum resources for communities to implement the strategy include financial mechanisms to ensure the availability of resources. Local monitors have improved their ability to analyze their communities' realities, particularly regarding health leadership and governance. Conclusions Community engagement self-monitoring is a feasible and sustainable strategy for monitoring and evaluating health interventions if adequate support is provided and complemented by capacity-building and praxis sessions. It promotes listening to the community and empowering them to participate in decision-making, which are vital in fostering ownership and sustainability of social innovations in health.
Philippines ; Health

Objective: The primary goal of this study was to determine the effect of visual impairment (VI) on the quality of life (QoL) in children aged 3-7 years. Methodology: This was a cross-sectional study involving 138 parents or caregivers of children aged 3-7 years from Pediatric Ophthalmology and General Ophthalmology Clinics of a tertiary government hospital. The Filipino version of the Children’s Visual Function Questionnaire (CVFQ3plus), an instrument that measures the impact of visual impairment on the QoL of children aged 3-7 years and their families, was used. It has 6 subscales: general health, general vision, competence, personality, family impact, and treatment. T-test was used to compare the total index QoL score and subscale scores between children with VI (n=69) and the control group (n=69). The multivariate regression model based on the total index QoL score in children with VI was used to assess the effect of other demographic factors. Results: Children with VI had significantly lower total index QoL score (p=0.02), general vision (p=0.04), competence (p=0.00), and personality (p=0.02) subscale scores than the control group. The visual acuity of children with VI had a significant effect on the total index QoL score (p=0.04). Demographic factors like patient’s age and sex, and parental age, sex and educational attainment had no effect on total index QoL score. Conclusion Visual impairment has a negative effect on the quality of life of Filipino children aged 3-7 years as shown by the use of the CVFQ3plus.
Vision Disorders ; Quality of Life ; Vision, Low

Objectives: The primary goal of this study was to determine the relationship between diabetic peripheral neuropathy and retinal nerve fiber layer (RNFL) thickness among elderly Filipinos with type 2 diabetes mellitus. Methodology: This was a cross-sectional study involving 106 subjects aged 60 years or older with type 2 diabetes mellitus recruited from the General Medicine and Diabetes Clinics of a tertiary government hospital. The diagnosis of peripheral neuropathy was made by performing a 10-gram monofilament test. Peripapillary retinal nerve fiber layer thickness was measured using the optic disc cube 200 x 200 protocol of the Cirrus® HD-OCT. T-test was used to compare RNFL thickness in those with and without peripheral neuropathy. The effects of age, sex, duration of diabetes, presence or absence of peripheral neuropathy, and retinopathy status on global and quadrantal RNFL thickness was assessed using multivariate analysis. Results: Compared to subjects without peripheral neuropathy, significant thinning of the superior (P=0.011), inferior (P=0.004), and global (P=0.008) RNFL thickness were observed in subjects with peripheral neuropathy. There were no significant differences in RNFL thickness in the temporal (P=0.211) and nasal (P=0.263) quadrants between the 2 groups. Multivariate regression analysis revealed that presence of peripheral neuropathy has a significant effect on their superior (P=0.036), inferior (P=0.010), and global (P=0.024) RNFL thickness. Other factors such as age, sex, duration of diabetes, and retinopathy had no effect on global and quadrantal RNFL thickness. Conclusion RNFL thinning in the superior, inferior, and global indices on optical coherence tomography has a significant correlation with diabetic peripheral neuropathy
Tomography, Optical Coherence ; Diabetes Mellitus

Background: Critical illness refers to a wide spectrum of life-threatening medical or surgical conditions usually requiring an intensive care unit level of care. In most of these patients a common pathophysiological process is often present, namely infection, trauma, or major surgery. These factors initiate an inflammatory cascade leading to activation of regulatory mechanisms in order to control the intensity of the inflammatory response. The prognosis of critically ill patients usually depends on illness severity, intensity of the biological inflammatory response and nutritional status. Objective and Methodology: This analytical cross-sectional study of 82 mechanically ventilated critically-ill patients with hypoalbiminemia admitted in the ICU and NCCU of St. Luke’s Medical Center from January 1 to December 31, 2008, aimed at determining the odds ratio between hypoalbuminemia and those with albumin >3mg/dl in terms of failure in weaning. Also it seeks to determine the prevalence of hypoalbuminemia among mechanically ventilated patients in the ICU; characterize the patients involved in the study in terms of age, sex, APACHE II score, and co-morbidities/ underlying illness; and to determine the manner of serum albumin correction. A 2x2 table analysis was computed to measure the odds ratio. Chi-Square for qualitative dichotomous variables and unpaired t-test for continuous variables are the statistical tools employed to interpret the present data. Results: Eighty-two of the 109 of patients had hypoalbuminemia, giving a prevalence of 0.75. Of the 82 hypoalbuminemic patients, 26 subjects failed to be weaned off mechanical ventilator support compared to two subjects of 27 patients with no hypoalbuminemia. An odds ratio of 5.8 was obtained. Patient’s demographics of both groups did not significantly differ except for hypertension. The biochemical parameters prior to weaning (hemoglobin, sodium, potassium, calcium and magnesium) were not significantly different between hypoalbuminemic and non hypoalbuminemic patients. From our results, 22.6% of the patients were started on albumin IV infusion at a level of <2.4g/dL. The rest did their correction through diet. Conclusion: Hypoalbuminemia with a serum albumin level of <3mg/dl is associated with negative outcome of weaning from mechanical ventilation. The odds that a patient will have failure in weaning was 6 times more likely in subjects with serum albumin <3 mg/dl.

Introduction. The Research and Biotechnology Division of St. Luke's Medical Center (SLMC-RBD) acquired a transmission electron microscope (TEM) in 1996. As a joint facility with the Institute of Pathology, the Electron Microscope Facility (EMF) is used for both research and clinical purposes. This paper aims to establish the clinical and research usage, as well as identify the most common referring institutions. Methodology. Data records of the EMF at the SLMC-RBD from January 1997 to December 2004 were reviewed. All submitted samples for TEM were initially categorized according to type of request (clinical or research). Thereafter, the samples under each category were classified according to (1) tissue type or site of biopsy and (2) its referring hospital or institution. Yearly data of these classifications were plotted and reviewed, and from this data, we evaluated the trend of clinical and research TEM usage. Results. This study has shown that the trend of clinical electron microscopy in the local setting is comparable to that of other institutions where renal, muscular, nerve, and skin samples dominate the scene in this particular order. This finding is also the same with other Asian electron microscopy institutions. The rise and steady decline in the requests for both clinical and research TEM has been attributed to the use of newer diagnostic techniques such as immunohistochemistry and molecular pathology. The economic situation and long turnaround time in processing may also be a factor in TEM usage. Conclusion and Recommendations. With the steady decline of electron microscopy use worldwide, strategies have been introduced to enhance its usage. Examples of these strategies include continuous information dissemination to clinicians, research scientists and the layman about the usefulness of TEM and its ever-growing applications for use, monthly newsletters containing "a case for the month" feature, which may be circulated within the physicians practicing within the center and the medical staff organizations in the locality. Such information dissemination has proven to be effective in increasing the knowledge that electron microscopy is useful both as a diagnostic tool and an ancillary procedure. Likewise, since research TEM is seemingly geared towards viral identification, negative staining should be introduced as a diagnostic and screening tool per se, capable of producing results in a matter of minutes; hence a high level of expertise in tracking these problems should be maintained.