Prevalence of soil-transmitted helminth infections, schistosomiasis, and lymphatic filariasis before and after preventive chemotherapy initiation in the Philippines: A systematic review and meta-analysis.

OBJECTIVE: To estimate the impact of preventive chemotherapy on the prevalence and intensity of soil-transmitted helminth (STH) infections, schistosomiasis, and lymphatic filariasis in the Philippines, using systematic review and meta-analysis. METHODS: We included reports reporting prevalence of STH infections, schistosomiasis, or lymphatic filariasis in the Philippines published until 31 March 2021. Peer-reviewed studies were identified in electronic databases. Grey literature reports by the University of the Philippines and the Department of Health were also included. Pooled infection prevalence, before and after the initiation of preventive chemotherapy, stratified by age group, was calculated using the inverse variance heterogeneity model. FINDINGS: A total of 109 reports were included in the review and meta-analysis. Overall prevalence of moderate-heavy intensity Ascaris lumbricoides (6.6%) and Trichuris trichiura (2.7%) infection after initiation of preventive chemotherapy were significantly lower than the prevalence prior to initiation (23.6% for A. lumbricoides and 12.2% for T. trichiura). Prevalence reductions were also found in school and preschool-age children for A. lumbricoides and T. trichiura. Studies conducted after preventive chemotherapy initiation had significantly lower overall prevalence of moderate-heavy intensity schistosomiasis (3.1% vs 0.2%) and of schistosomiasis in school-age children (30.5% vs 1%). Pooled prevalence of lymphatic filariasis prior to preventive chemotherapy initiation was 3.2% across 12 provinces, while currently only two provinces still have prevalence of more than 1%. There were no published studies reporting prevalence of lymphatic filariasis after initiation of preventive chemotherapy. Heterogeneity was high with I2 mostly above 90%. CONCLUSION: The burden of STH infections and schistosomiasis in children were significantly lower in studies conducted following the initiation of preventive chemotherapy. Eliminating morbidity and interrupting transmission, however, may require expanded control initiatives including community-wide treatment, and improved water, sanitation, and hygiene. Lymphatic filariasis burden has decreased since the implementation of preventive chemotherapy, with all but two provinces having reached the elimination of lymphatic filariasis as a public health problem.

High burden of soil-transmitted helminth infections, schistosomiasis, undernutrition, and poor sanitation in two Typhoon Haiyan-stricken provinces in Eastern Philippines.

This study aimed to describe: 1) soil-transmitted helminthiasis (STH) and schistosomiasis prevalence and intensity in preschool-age children (PSAC) and school-age children (SAC), 2) schistosomiasis seroprevalence in SAC, 3) undernutrition prevalence in SAC, 4) sanitary toilet coverage in households, and 5) association between STH, Schistosoma japonicum exposure, nutritional status, and sanitation. PSAC and SAC in two Haiyan-stricken provinces were examined using Kato-Katz technique and ELISA Antibody test. Anthropometric and hemoglobin measurements were also obtained. The reported sanitary toilet coverage was validated in a survey. The prevalence of any STH in PSAC and SAC was 50.2% and 41.3%, respectively. Moderate-heavy intensity (MHI) STH prevalence in PSAC and SAC was 20.8% and 5.9%, respectively. The prevalence of any STH, MHI STH, ascariasis, MHI ascariasis, and MHI trichuriasis was significantly higher in PSAC. Stunting, underweight, wasting, overweight/obesity, and anemia prevalence was 38.4%, 24.5%, 4.8%, 2.7%, and 34.7% in PSAC, while the prevalence was 34.3%, 21.6%, 8.7%, 3.0%, and 19.2% in SAC, respectively. Anemia and wasting prevalence were significantly higher in PSAC and SAC, respectively. There were five schistosomiasis cases found (0.8% prevalence), while schistosomiasis seroprevalence was 60.1%. Validated and reported sanitary toilet coverage was significantly different in eight out of 13 barangays. Stunting and anemia were associated with STH. STH and anemia prevalence were significantly higher in non-ZOD barangays. High STH burden in PSAC and SAC persists. A more coordinated response addressing STH, undernutrition, and WASH in disaster-stricken areas will require strengthening local health systems and promoting intersectoral collaboration.

Establishing Competencies for a Global Health Workforce: Recommendations from the Association of Pacific Rim Universities.

BACKGROUND: The Association of Pacific Rim Universities Global Health Program facilitates exchange of information, knowledge and experiences in global health education and research among its 50 member universities. Despite the proliferation of global health educational programs worldwide, a lack of consensus exists regarding core competencies in global health training and how these are best taught. METHODS: A workshop was convened with 30 faculty, university administrators, students, and NGO workers representing both the Global North and South to gain consensus on core competencies in masters'-level global health training. The co-authors then collaborated to refine the list of competencies, categorize them into domains, and develop a plan for how academic institutions can ensure that these competencies are effectively taught. FINDINGS: Nineteen competencies across five domains were identified: knowledge of trends and determinants of global disease patterns; cultural competency; global health governance, diplomacy and leadership; project management; and ethics and human rights. The plan for how academic institutions can best train students on these competencies outlined five key opportunities: coursework; practicums; research opportunities; mentorship; and evaluation. The plan recommended additional institutional strategies such as maximizing collaborative research opportunities, international partnerships, capacity-building grants, and use of educational technology to support these goals. CONCLUSIONS AND RECOMMENDATIONS: While further research on the implementation of competency-based training is warranted, this work offers a step forward in advancing competency-based global health masters' education as identified by a globally diverse group of expert stakeholders and economies. Given the challenges facing the current global health landscape, comparable competency-based training across institutions is critical to ensure the training of competent global health professionals.