Soil-transmitted helminthiases in secondary school students in selected sites in two provinces in the Philippines: policy implications.

The latest World Health Organization (WHO) strategic plan for eliminating soil-transmitted helminthiases (STHs) as a public health problem in children puts the emphasis on school-age children. On the other hand, the Philippine national helminth control program excludes secondary school students in mass deworming for STH. This study determined the prevalence and intensity of STH in a sample of 633 students (14-15 years old) in selected secondary schools in two Philippine provinces. Stool specimens were processed following the Kato-Katz technique and examined for the presence of helminth ova. Overall cumulative prevalence of STH was 31.3%, while prevalence of moderate-heavy-intensity infections was 7.7%, well beyond the WHO target of ≤1% for reducing morbidity in school-age children. Recommendations were made to update the Philippine helminth control program and to re-examine the WHO strategic plan so that helminth prevention and control strategies may also be emphasized for secondary school students especially in high-prevalence areas.

Effects of Desert Dust and Sandstorms on Human Health: A Scoping Review.

Desert dust and sandstorms are recurring environmental phenomena that are reported to produce serious health risks worldwide. This scoping review was conducted to identify the most likely health effects of desert dust and sandstorms and the methods used to characterize desert dust exposure from the existing epidemiological literature. We systematically searched PubMed/MEDLINE, Web of Science, and Scopus to identify studies that reported the effects of desert dust and sandstorms on human health. Search terms referred to desert dust or sandstorm exposure, names of major deserts, and health outcomes. Health effects were cross-tabulated with study design variables (e.g., epidemiological design and methods to quantify dust exposure), desert dust source, health outcomes and conditions. We identified 204 studies that met the inclusion criteria for the scoping review. More than half of the studies (52.9%) used a time-series study design. However, we found a substantial variation in the methods used to identify and quantify desert dust exposure. The binary metric of dust exposure was more frequently used than the continuous metric for all desert dust source locations. Most studies (84.8%) reported significant associations between desert dust and adverse health effects, mainly for respiratory and cardiovascular mortality and morbidity causes. Although there is a large body of evidence on the health effects of desert dust and sandstorms, the existing epidemiological studies have significant limitations related to exposure measurement and statistical analysis that potentially contribute to inconsistencies in determining the effect of desert dust on human health.

Scoping Review of Climate Change and Health Research in the Philippines: A Complementary Tool in Research Agenda-Setting.

The impacts of climate change on human health have been observed and projected in the Philippines as vector-borne and heat-related diseases have and continue to increase. As a response, the Philippine government has given priority to climate change and health as one of the main research funding topics. To guide in identifying more specific research topics, a scoping review was done to complement the agenda-setting process by mapping out the extent of climate change and health research done in the country. Research articles and grey literature published from 1980 to 2017 were searched from online databases and search engines, and a total of 34 quantitative studies were selected. Fifty-three percent of the health topics studied were about mosquito-borne diseases, particularly dengue fever. Seventy-nine percent of the studies reported evidence of positive associations between climate factors and health outcomes. Recommended broad research themes for funding were health vulnerability, health adaptation, and co-benefits. Other notable recommendations were the development of open data and reproducible modeling schemes. In conclusion, the scoping review was useful in providing a background for research agenda-setting; however, additional analyses or consultations should be complementary for added depth.

Parasitological and nutritional status of school-age and preschool-age children in four villages in Southern Leyte, Philippines: Lessons for monitoring the outcome of Community-Led Total Sanitation.

While preventive chemotherapy remains to be a major strategy for the prevention and control of soil-transmitted helminthiases (STH), improvements in water, sanitation, and hygiene (WASH) comprise the long-term strategy to achieve sustained control of STH. This study examined the parasitological and nutritional status of school-age and preschool-age children in four villages in Southern Leyte, Philippines where two of the villages attained Open-Defecation-Free (ODF) status after introduction of Community-Led Total Sanitation (CLTS). A total of 341 children (89.0% of the total eligible population) submitted stool samples which were examined using the Kato-Katz technique. Results showed that 27.9% of the total stool samples examined had at least one type of STH (cumulative prevalence), while 7.9% had moderate-heavy intensity infections. Between the two villages where CLTS was introduced, Buenavista had a significantly higher cumulative prevalence of STH at 67.4% (p<0.001) and prevalence of moderate-heavy intensity STH at 23.5% (p=0.000), while Caubang had a significantly lower cumulative prevalence at 4.9% and prevalence of moderate-heavy intensity at 1.8%. On the other hand, the non-CLTS villages of Bitoon and Saub had similar rates for cumulative prevalence (16.7% and 16.8%, respectively; p=0.984) and prevalence of moderate-heavy intensity STH (2.0% and 3.1%, respectively; p=1.000). The findings may be explained by factors that include possible reversion to open defecation, non-utilization of sanitary facilities, and mass drug administration (MDA) coverage, although further studies that can accurately assess the impact of CLTS are recommended. While this study was descriptive, the data indicate no clear pattern among the parasitological and nutritional parameters, as well as the presence of CLTS in the village, suggesting the need to monitor the ODF status of villages on a regular basis even after the end of CLTS activities to ensure the sustainability of the CLTS approach. In order to achieve effective control of STH, deeper collaboration between the WASH and STH sectors are recommended where partners can work together in the area of monitoring and evaluation that may include improved parasitological and nutritional status in high-risk groups, as well as sustainable behavior change as outcome indicators.

Monitoring the impact of a mebendazole mass drug administration initiative for soil-transmitted helminthiasis (STH) control in the Western Visayas Region of the Philippines from 2007 through 2011.

School-aged children in tropical developing countries carry the highest burden of soil-transmitted helminth (STH) infections in the world. The Western Visayas region of the Philippines continues to struggle with this as a major public health issue in both private and public schools. The War on Worms-Western Visayas approach was launched in 2007 with school-based mass drug administration (MDA) as one of the strategies to control morbidity from STH in support of the Department of Health - Integrated Helminth Control Program. This study aimed to determine trends in prevalence and intensity of STH infections as well as to assess related morbidity and program sustainability through 2011. A cross-sectional parasitologic survey was conducted on three independent samples of Grade 3 students in 2007, 2009, and 2011. Supporting aggregate data were obtained for MDA coverage, National Achievement Test mean percentage scores, and nutritional status. Tests for trend were utilized to detect changes in prevalence over time, with a particular emphasis on trends seen between 2009 and 2011. The initial impact of the program was robust as cumulative prevalence, infection intensities, and parasite densities were all reduced four years following the launch. However, subsequent and significant increases in each were found from 2009 until 2011. These results implicate issues with program sustainability, despite consistent MDA, and existing frameworks for environmental sanitation, hygiene, and education.

Validating the WHO dose pole in the Philippines for school-based mass drug administration of praziquantel for morbidity control of schistosomiasis.

BACKGROUND: Praziquantel typically requires weight-based field administration when used to treat helminthic diseases. Proper dosage adjustment of praziquantel by bodyweight can be difficult to achieve if accurate weighing scales are unavailable. The WHO has recommended for use a dose pole that substitutes height for weight during field administrations of praziquantel. METHODS: This cross-sectional study aims to validate the WHO dose pole for Philippine populations using height and drug administration data collected from 1427 Filipino schoolchildren. This study expands upon prior studies by specifically targeting Filipino schoolchildren and by introducing statistical techniques to increase the rigor of the validation process. RESULTS: The study found an average dose of 42.7 mg per kg (mg/kg) administered among 1427 students with a standard deviation of 3.5 mg/kg. The dose pole estimated a WHO-recommended dose (40-60 mg/kg) in 93.5% of students and a WHO-accepted dose (30-60 mg/kg) in 99.7% of all students. The 95% CIs showed that 99-100% of all tested students fell within the WHO-accepted dose range, while 91-93% of all tested students fell within the WHO-recommended dose range. CONCLUSIONS: The results suggest that the WHO dose pole is valid for mass treatment of Filipino schoolchildren with praziquantel. Further validation studies are recommended.