BACKGROUND AND OBJECTIVE

Oral ivermectin is recommended as an alternative to topical permethrin in Japanese, European, and CDC-STI guidelines for treating classic scabies. The combination of oral ivermectin and topical permethrin is also used in some settings. Partial economic evaluations conducted in India and Egypt have conflicting results, and no cost-effectiveness analysis in the Philippines has compared ivermectin-based regimens to permethrin for scabies treatment. We aimed to determine the cost-effectiveness of oral ivermectin, alone or in combination with permethrin, compared to permethrin, in the treatment of Filipino adult patients with classic scabies.

We used a decision tree model to estimate the cost-effectiveness of two regimens, oral ivermectin alone or in combination with permethrin, compared with permethrin to treat adults and children aged five years and older with classic scabies in the outpatient setting from the household perspective in the Philippines. We estimated total costs and disability-adjusted life years (DALYs) over a one-month follow-up. Input parameters were obtained from secondary data, such as effect estimates for probabilities of clinical outcomes from a network meta-analysis, DALYs from the Global Burden of Disease 2019, and prevailing market cost in the Philippines (DPRI 2022 with recommended markup by DOH, and leading drugstores) as of August 2022. We computed for incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) to determine which of the interventions are cost-effective. Univariate and probabilistic sensitivity analyses, and scenario analyses were conducted to assess the impact of parameter and structural uncertainty.

Ivermectin-based regimens are suggested to be likely cost-saving compared to permethrin in the Philippine outpatient setting. Base case analysis showed that oral ivermectin had higher cost-savings (change in cost, -1,039.31; change in DALYS, 0.00027), while combination oral ivermectin/permethrin had higher DALYs averted (change in cost, PhP -1,019.78; change in DALYs, 0.00045), compared to permethrin. Combination oral ivermectin/permethrin (56%) was the most cost-effective, followed by oral ivermectin (44%) compared to permethrin (0%) through probabilistic sensitivity analysis. Estimates for ivermectin were sensitive to risk of cure for ivermectin vs permethrin using 1-way deterministic sensitivity analysis. Oral ivermectin was favored over combination oral ivermectin/permethrin at all thresholds based on the cost-effectiveness acceptability curve.

Both ivermectin-based regimens seem to be cost-saving compared to permethrin in the treatment of classic scabies in the Philippine outpatient setting. Clinicians may consider oral ivermectin, alone or in combination with permethrin as an alternative first-line or second-line treatment depending on patient preference, adverse event risk profile, availability, and economic capacity. This needs to be confirmed using primary data from Filipino patients to enhance the robustness of the findings and support evidence-based local decision-making in different settings. Less uncertainty in modelled parameters can give greater confidence in the results, which can be adopted for budget impact analysis and allow more rational resource allocation. Value of information analysis can be done to determine whether the expense of future RCTs or surveys in Filipinos to collect primary data is worth it. The cost of reducing uncertainty, if deemed worth the cost of further studies, may facilitate population-level decision-making and budget planning. Findings may further inform practice guideline development, coverage decisions, and national control program planning by providing the most cost-effective scabies intervention.

BACKGROUND AND OBJECTIVES

Mechanical ventilators are essential albeit expensive equipment to support critically ill patients who have gone into respiratory failure. Adequate numbers should always be available to ensure that a hospital provides the optimal care to patients but the number of patients requiring them at any one time is unpredictable. Finding therefore the best balance in providing adequate ventilator numbers while ensuring the financial sustainability of a hospital is important.

A quantitative method using Monte Carlo Simulation was used to identify the optimal strategy for acquiring ventilators in a large private tertiary medical center in Metro Manila. The number of ventilators needed to provide ventilator needs 90% of the days per month (27/30) was determined using historical data on ventilator use over a period of four years. Four acquisition strategies were investigated: three ownership strategies (outright purchase, installment, and staggered purchase) and a rental strategy. Return on Investment (ROI), Internal Rate of Return (IRR), Modified Internal Rate of Return (MIRR), Net Present Value (NPV), and Payback period (or Breakeven Point) for each strategy were determined to help recommend the best strategy. A qualitative survey was also conducted among doctors, nurses, and respiratory therapists who were taking care of patients hooked to ventilators to find out their experiences comparing hospital-owned and rental ventilators.

It was found that a total of 11 respirators were needed by the hospital to ensure that enough respirators were available for its patients at least 90% of the days in any month based on the previous four-year period. This meant acquiring three more ventilators as the hospital already owned eight. Among the strategies studied, projected over a 10-year period, the installment strategy (50% down payment with 0% interest over a 5-year period) proved to be the most financially advantageous with ROI = 9.36 times, IRR = 97% per year, MIRR = 26% per year, NPV = ₱39,324,297.60 and Payback period = 1.03 years). A more realistic installment strategy with 15% (paid quarterly or annually) and 25% annual interest rates were also explored with their financial parameters quite like but not as good as the 0% interest. The outright purchase of three ventilators came in lower (ROI = 4.53 times, IRR = 55% per year, MIRR = 19% per year, NPV = ₱38,064,297.60 and Payback period = 1.81 years) followed last by staggered purchase with ROI = 3.56 times, IRR = 64% per year, MIRR = 28% per year, NPV = ₱29,905,438.08, and payback period of 2.06 years. As there was no investment needed for the rental strategy, the only financial parameter available for it is the NPV which came out as ₱21,234,057.60.

The qualitative part of the study showed that most of the healthcare workers involved in the care of patients attached to the ventilator were aware of the rental ventilators. The rental ventilators were generally described as of lower functionality and can more easily break down. The respondents almost uniformly expressed a preference for the hospital-owned ventilators.

This analysis showed that the best ventilator ownership strategy from a purely financial perspective for this hospital is by installment with a 50% down payment and 0% interest. Moderate rates of 15% and 25% interest per year were also good. These were followed by outright purchase and lastly by staggered purchase. The rental strategy gave the lowest cumulative 10-year income compared to any of the ownership strategies, but may still be considered good income because the hospital did not make any investment. However, it seems that most of the healthcare workers involved in taking care of patients on ventilators thought the rental ventilators were of lower quality and preferred the hospital-owned ventilators.

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

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

The Philippines faces a challenge in addressing the mental health needs of internally displaced persons (IDPs) following disasters. The lack of an integrated mental health triage system within evacuation centers and the shortage of specialists trained in post-traumatic stress triaging have hindered effective emergency response. Existing interventions primarily focus on traditional trauma and psychiatric symptoms, often lacking standardized mental health triage classifications and leading to data gaps, complicating resource allocation decisions.

To develop a culturally relevant mental health triage system, this study proposes the "Unahon Tool" to meet the needs of Filipino IDPs. Integrating with existing medical triage protocols equips frontline responders to identify stress-related concerns, enables informed decision-making for mental health and psychosocial support (MHPSS) allocation, and optimizes resource utilization.

The study involved key informants, including disaster responders, mental health specialists, and government officials, who participated in interviews and focus group discussions. Thematic analysis was used to identify behavioral aspects affecting IDP communities. The Unahon Tool development incorporated disaster response frameworks, mental health interventions, and other existing triage tools. A red-yellow-green categorization system was employed based on the severity and urgency of observed behaviors. Stakeholder consultations and expert reviews guided tool refinement.

The final Unahon Tool includes 17 behaviors categorized into red (urgent), yellow (moderate), and green (low) severity levels. It provides corresponding recommended interventions to aid responders. During direct observations, yellow-category behaviors like shouting and cursing were prevalent. Responders focused on reminders for peace and order in response to these behaviors. The tool's "Notes" section was identified as a potential area for contextual information inclusion.

The Unahon Tool fills a crucial gap in the Philippine disaster response infrastructure by offering a behavior-based mental health triage system. It enables responders to prioritize mental health resources effectively, reducing the burden on specialists and enhancing overall disaster response effectiveness. Future directions   include expanding tool adoption beyond Metro Manila, translating it into regional languages, and developing a version for children and teenagers. Collaboration with other regions and age groups will ensure broader applicability and effectiveness in addressing mental health needs among diverse IDP populations.

Background and Objective: Oral ivermectin is recommended as an alternative to topical permethrin in Japanese, European, and CDC-STI guidelines for treating classic scabies. The combination of oral ivermectin and topical permethrin is also used in some settings. Partial economic evaluations conducted in India and Egypt have conflicting results, and no cost-effectiveness analysis in the Philippines has compared ivermectin-based regimens to permethrin for scabies treatment. We aimed to determine the cost-effectiveness of oral ivermectin, alone or in combination with permethrin, compared to permethrin, in the treatment of Filipino adult patients with classic scabies. Methods: We used a decision tree model to estimate the cost-effectiveness of two regimens, oral ivermectin alone or in combination with permethrin, compared with permethrin to treat adults and children aged five years and older with classic scabies in the outpatient setting from the household perspective in the Philippines. We estimated total costs and disability-adjusted life years (DALYs) over a one-month follow-up. Input parameters were obtained from secondary data, such as effect estimates for probabilities of clinical outcomes from a network meta-analysis, DALYs from the Global Burden of Disease 2019, and prevailing market cost in the Philippines (DPRI 2022 with recommended markup by DOH, and leading drugstores) as of August 2022. We computed for incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) to determine which of the interventions are cost-effective. Univariate and probabilistic sensitivity analyses, and scenario analyses were conducted to assess the impact of parameter and structural uncertainty. Results: Ivermectin-based regimens are suggested to be likely cost-saving compared to permethrin in the Philippine outpatient setting. Base case analysis showed that oral ivermectin had higher cost-savings (change in cost, -1,039.31; change in DALYS, 0.00027), while combination oral ivermectin/permethrin had higher DALYs averted (change in cost, PhP -1,019.78; change in DALYs, 0.00045), compared to permethrin. Combination oral ivermectin/permethrin (56%) was the most cost-effective, followed by oral ivermectin (44%) compared to permethrin (0%) through probabilistic sensitivity analysis. Estimates for ivermectin were sensitive to risk of cure for ivermectin vs permethrin using 1-way deterministic sensitivity analysis. Oral ivermectin was favored over combination oral ivermectin/permethrin at all thresholds based on the cost-effectiveness acceptability curve. Conclusion Both ivermectin-based regimens seem to be cost-saving compared to permethrin in the treatment of classic scabies in the Philippine outpatient setting. Clinicians may consider oral ivermectin, alone or in combination with permethrin as an alternative first-line or second-line treatment depending on patient preference, adverse event risk profile, availability, and economic capacity. This needs to be confirmed using primary data from Filipino patients to enhance the robustness of the findings and support evidence-based local decision-making in different settings. Less uncertainty in modelled parameters can give greater confidence in the results, which can be adopted for budget impact analysis and allow more rational resource allocation. Value of information analysis can be done to determine whether the expense of future RCTs or surveys in Filipinos to collect primary data is worth it. The cost of reducing uncertainty, if deemed worth the cost of further studies, may facilitate population-level decision-making and budget planning. Findings may further inform practice guideline development, coverage decisions, and national control program planning by providing the most cost-effective scabies intervention.
Scabies ; Ivermectin ; Permethrin ; Cost-Benefit Analysis

Background and Objective: The focusing of resources to COVID-19 response hampered and disadvantaged primary care services including that for Non-Communicable Diseases (NCDs), compromising continuity of care and hence, patients’ disease status. However, studies from low- and middle-income countries (LMICs) remain sparse; therefore, evidence generation on how the pandemic impacted the provision of these primary care services in LMICs will help further understand how policies can be reframed, and programs be made more efficient and effective despite similar crises. To bridge this gap, the study investigated how the pandemic affected the implementation of NCD care at the primary care level in the Philippines. Methods: Thirty-one online focus group discussions via Zoom Meetings were conducted among 113 consenting physicians, nurses, midwives, and community health workers from various facilities — community health centers and stations, free-standing clinics, infirmaries, and level 1 hospitals — located within two provinces in the Philippines. All interviews were video-recorded upon participants’ consent and transcribed verbatim. Inductive thematic analysis was employed through NViVo 12® to generate themes, identify categories, and describe codes. Results: The impact of COVID-19 on NCD care at the primary care level revolved around heightened impediments to service delivery, alongside worsening of pre-existing challenges experienced by the healthcare workforce; subsequently compelling the public to resort to unhealthy practices. These detriments to the primary healthcare system involved resource constraints, discontinued programs, referral difficulties, infection, overburden among workers, and interrupted training activities. Citizens were also observed to adopt poor healthcare seeking behavior, thereby discontinuing treatment regimen. Conclusion Healthcare workers asserted that disadvantages caused by the pandemic in their NCD services at the primary care level possibly threaten patients’ health status. Besides the necessity to address such detriments, this also emphasizes the need for quantitative studies that will aid in drawing inferences and evaluating the effect of health crises like the pandemic on such services to bridge gaps in improving quality of care.
COVID-19 ; Noncommunicable Diseases ; Primary Health Care ; Philippines ; Qualitative Research

Background and Objectives: Mechanical ventilators are essential albeit expensive equipment to support critically ill patients who have gone into respiratory failure. Adequate numbers should always be available to ensure that a hospital provides the optimal care to patients but the number of patients requiring them at any one time is unpredictable. Finding therefore the best balance in providing adequate ventilator numbers while ensuring the financial sustainability of a hospital is important. Methods: A quantitative method using Monte Carlo Simulation was used to identify the optimal strategy for acquiring ventilators in a large private tertiary medical center in Metro Manila. The number of ventilators needed to provide ventilator needs 90% of the days per month (27/30) was determined using historical data on ventilator use over a period of four years. Four acquisition strategies were investigated: three ownership strategies (outright purchase, installment, and staggered purchase) and a rental strategy. Return on Investment (ROI), Internal Rate of Return (IRR), Modified Internal Rate of Return (MIRR), Net Present Value (NPV), and Payback period (or Breakeven Point) for each strategy were determined to help recommend the best strategy. A qualitative survey was also conducted among doctors, nurses, and respiratory therapists who were taking care of patients hooked to ventilators to find out their experiences comparing hospital-owned and rental ventilators. Results: It was found that a total of 11 respirators were needed by the hospital to ensure that enough respirators were available for its patients at least 90% of the days in any month based on the previous four-year period. This meant acquiring three more ventilators as the hospital already owned eight. Among the strategies studied, projected over a 10-year period, the installment strategy (50% down payment with 0% interest over a 5-year period) proved to be the most financially advantageous with ROI = 9.36 times, IRR = 97% per year, MIRR = 26% per year, NPV = ₱39,324,297.60 and Payback period = 1.03 years). A more realistic installment strategy with 15% (paid quarterly or annually) and 25% annual interest rates were also explored with their financial parameters quite like but not as good as the 0% interest. The outright purchase of three ventilators came in lower (ROI = 4.53 times, IRR = 55% per year, MIRR = 19% per year, NPV = ₱38,064,297.60 and Payback period = 1.81 years) followed last by staggered purchase with ROI = 3.56 times, IRR = 64% per year, MIRR = 28% per year, NPV = ₱29,905,438.08, and payback period of 2.06 years. As there was no investment needed for the rental strategy, the only financial parameter available for it is the NPV which came out as ₱21,234,057.60. The qualitative part of the study showed that most of the healthcare workers involved in the care of patients attached to the ventilator were aware of the rental ventilators. The rental ventilators were generally described as of lower functionality and can more easily break down. The respondents almost uniformly expressed a preference for the hospital-owned ventilators. Conclusion This analysis showed that the best ventilator ownership strategy from a purely financial perspective for this hospital is by installment with a 50% down payment and 0% interest. Moderate rates of 15% and 25% interest per year were also good. These were followed by outright purchase and lastly by staggered purchase. The rental strategy gave the lowest cumulative 10-year income compared to any of the ownership strategies, but may still be considered good income because the hospital did not make any investment. However, it seems that most of the healthcare workers involved in taking care of patients on ventilators thought the rental ventilators were of lower quality and preferred the hospital-owned ventilators.
Ventilators, Mechanical

BACKGROUND: Microplastics pose a significant environmental and health threat, yet the understanding and response of young adults to this issue remain underexplored. There is an increasing amount of microplastics in our environment and as the numbers grow, the danger that comes with it is still not fully understood. This study aimed to explore the knowledge, attitudes, and practices (KAP) of young adults in Muntinlupa, particularly students of a public university regarding microplastics and their health implications. METHODS: Employing a quantitative cross-sectional design, the research targeted college students aged 18 and older. RESULTS: Findings revealed that while students were knowledgeable about microplastics—particularly their harmful effects on health—attitudes and practices related to plastic disposal and recycling could be improved. Although the majority engaged in proper garbage disposal, only 41.5% consistently separated plastic waste from biodegradable materials. However, a weak positive correlation between knowledge and attitudes was observed, suggesting that increased awareness may enhance positive attitudes toward reducing microplastic pollution. CONCLUSION These results suggest that while students are aware of microplastics and generally responded positively, there remains a gap in the translation of knowledge into practices, highlighting the need for enhanced educational interventions.
Microplastics ; knowledge ; attitudes ; young adult

BACKGROUND AND OBJECTIVE

Oral ivermectin, a broad-spectrum anti-parasitic drug, alone or in combination with permethrin, may be a cheaper and more convenient alternative drug to topical permethrin alone in the treatment of classic scabies. There are no previous studies on the treatment acceptability of the three interventions among individual patients with scabies in the Philippines. The purpose of this study was to understand the experiences and perceptions on treatment acceptability for oral ivermectin, topical permethrin or combination treatment among patients with scabies using the multiple-case study approach.

We conducted a qualitative multiple case study among adult Filipino patients with classic scabies who were prescribed oral ivermectin, topical permethrin or its combination at a government tertiary hospital dermatology outpatient clinic from December 2022 to September 2023. Semi-structured interviews were used as the primary source of data and analyzed together with chart reviews, Dermatology Life Quality Index (DLQI) scores, and clinical images. Interviews were transcribed, coded, and triangulated with other secondary data. A three-person research team employed a reflexive and iterative process of familiarization, coding, and thematic analysis using a modified Theoretical Framework of Acceptability (TFA) to generate case descriptions, within-case analyses, and cross-case syntheses.

The acceptability of scabies treatments (permethrin, ivermectin, and combination therapy) was generally positive. Permethrin, used in three patient cases, was generally perceived as effective but itch relief varied. The burden of whole-body application of permethrin was context-dependent, influenced by living arrangements and family support. Perceived affordability of permethrin was linked to socioeconomic status. Ivermectin, used by one patient case, was perceived as highly effective with no side effects. Its single dose use did not interfere with patient routine. Combination therapy was also considered effective but potential antagonistic effects and the cost of adding permethrin made it less preferred. Reluctance in taking oral pills was noted. All patients valued medical advice and deferred to their physicians for treatment decisions.

All three treatment options were considered effective and safe. Patients generally preferred permethrin over oral ivermectin due to its topical nature and perceived lower side effects. However, affordability and logistical challenges, especially for large households and low-income families, were noted with permethrin. Oral ivermectin elicited hesitation due to its controversial role in COVID-19 and veterinary use. Concerns about added costs and potential antagonism in combination therapy were raised. Despite these considerations, patients ultimately relied on physicians for treatment decisions. This study underscores the importance of understanding patient perspectives, experiences, and the patient-physician relationship in choosing scabies interventions. Addressing patient concerns, providing education, and ensuring ease of use and affordability can enhance treatment acceptability and adherence for better outcomes.