Accessibility of soil-transmitted Helminthiasis control strategies in selected indigenous people communities in the Philippines

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.

Schistosomiasis and soil-transmitted helminthiasis morbidity control in selected communities in Eastern Visayas, Philippines: Post-Haiyan

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.

Geographic information system-based spatial modelling of soil-transmitted Helminth Infections among preschool-aged children in Masbate, 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.

A PCR-based assay for the detection of Schistosoma japonicum from human samples

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.

Optimizing school-based intestinal helminth control interventions in the Philippines

@#Intestinal helminth infections caused by soil-transmitted helminths and schistosomes bring about the greatest burden of disease in poverty-stricken areas in the developing world. The most vulnerable group and the most significant contributors to disease transmission are the school-age children. While awaiting major improvements on sanitation, the recommended strategy for helminth control is school-based, teacher assisted, mass drug administration (MDA). However, millions of individuals worldwide remain afflicted with these diseases, and the Philippines is no different from many of the developing countries. The overall objective of this paper is to review current Philippine control programs and initiatives and offer evidence based recommendations for improvement. Discrepancies between parasitologic parameters and drug coverage rates pose significant challenges in the control and prevention of helminth infections in the country. School-based MDA may be scaled up after successful local initiatives, where teachers have direct participation in drug administration. There is also a need to involve the social science sector to help address the behavioral aspects of helminth control. Moreover, monitoring and evaluation of interventions through identification of success parameters will contribute to the optimization of school-based helminth control, and to strategies towards effective control of intestinal helminth infections as a public health problem in the country.