COVID-19 breakthrough infections among medical students under the SLICE and CLARO Programs: Ateneo School of Medicine and Public Health experience

Objective@#This study aims to report the incidence and characteristics of breakthrough infections among medical students in the first Philippine private medical school that resumed limited face-to-face classes and clinical rotations from July to December 2021. @*Methods@#This is a descriptive study using secondary worksheet from multiple-source records review of breakthrough infections among medical students from July to December 2021. @*Results@#Among the 837 vaccinated medical students, 23 (2.7%) experienced COVID-19 breakthrough infections. Of these, 9 were male and 14 were female. Four were asymptomatic and 19 were symptomatic. Of the 19 symptomatic, 18 had mild and 1 had severe disease. Mild infections presented with upper respiratory tract symptoms. Duration of symptoms ranged from 4 to 27 days with an average of 10 days. Timing of breakthrough infections ranged from 35 to 212 days after the second dose of COVID-19 vaccine with a mean of 86 days. Contact with confirmed cases was reported in 14 of 23 cases, 13 were from household members and none within the SLICE and CLARO programs. @*Conclusion@#Our study showed that even in the midst of the Delta surge, low breakthrough infection rate with mostly mildly symptomatic cases and no case transmissions within the SLICE and CLARO programs are possible with vaccination, regular health surveillance, and strict adherence to minimum health protocols.

A systematic review of epidemiologic studies on scabies in the Philippines

Background and Objective@#Scabies is the second most common cause of disability due to skin disease in the Philippines. However, there were no cited studies in Global Burden of Disease 2019 and the disability-adjusted life years (DALY) computations were most likely based on statistical modelling. The Philippine Department of Health has embarked on a program to estimate the disease burden of priority diseases in the country, which include scabies. The last nationwide prevalence survey was 23 years ago. This systematic review aimed to estimate the prevalence or incidence of scabies in the Philippines. @*Methods@#We searched PubMed, Scopus, Herdin, and Philippine Health Research Registry (search date October 2022) for studies on prevalence/incidence (including systematic reviews, cross-sectional studies, cohort studies, case series, registry or census studies) of patients diagnosed with scabies in the Philippines. We excluded narrative reviews, commentaries, and conference proceedings or abstracts. Two reviewers independently screened titles and abstracts, assessed full text reports for eligibility, appraised the quality of included studies, and collected data using a pretested data extraction form. We did not pool studies due to clinical heterogeneity but plotted the individual studies in a forest plot with prevalence estimates and confidence intervals. We reported the median and interquartile range for entire group or relevant subgroups (age, setting) of studies. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence.@*Results@#We included nine studies (N=79,065). Most were clinic-based prevalence studies, retrospective chart reviews, conducted in dermatology outpatient clinics, Metro Manila area, and on pediatric populations. Prevalence of scabies was moderate (i.e., between 2 and 10%), ranging from 2.75% (national prevalence survey) to 6.8% (communitybased review), to high (> 10%) among pediatric patients in clinic-based retrospective chart reviews (29 to 36%) and institution-based surveys (39.0% to 45%), and a tertiary government university training hospital dermatology clinic (22.9%). The most affected age group was from 0 to 14 y/o, while males tended to have a higher prevalence than females. The cooler month of January had higher prevalence than the hotter month of June in one study. @*Conclusion@#Scabies is common in the Philippines, especially among children and elderly in institutional settings, and during the month of January. There is a need to do a national prevalence survey to identify high-risk areas and to monitor the prevalence of scabies, especially in crowded settings and vulnerable populations. This information can be used for estimating the burden of disease for scabies and guide appropriate health resource allocation.

Perspectives on the use of telegenetics services in the Philippines

@#The Philippines is a densely populated nation faced with multiple challenges in the healthcare field given its geographic, cultural, and socioeconomic barriers. Due to the geographic limitations of medical services in the country, many patients must travel a great distance to referral centers. This was further exacerbated by the Coronavirus disease 2019 (COVID-19) pandemic, which spread across the world and upended lives. This pandemic triggered a public health crisis that impacted healthcare systems, healthcare workers, and communities worldwide. It compounded current difficulties with the provision and accessibility of medical services, necessitating the employment of alternative methods of providing health coverage. As a result, advanced technological methods for patient diagnosis, monitoring, treatment, and counseling were rapidly implemented.1 Interest in these technological advances began prior to the COVID-19 pandemic, though primarily in developed countries. However, during this global outbreak, telehealth practices – which refer to online health care services provided by all health care professions – have seen a rapid increase in popularity.2,3 Telehealth was brought to the forefront in all countries in order to surmount lockdown constraints, allow continuous provision of health care for patients, and limit exposure to health systems and health providers.4 Traditional medical education and training were likewise disrupted during this time, resulting in the incorporation of telehealth into medical education. To reduce the risks associated with more personnel in the hospital, medical students were withdrawn from clinical environments during the COVID-19 outbreak. This created an environment of uncertainty and limited clinical exposure, with concerns surrounding progression through the medical course and training program.5 Continuing medical education, which has traditionally been based on clinical knowledge and skills, now requires online technical communication skills. Innovative services were rapidly developed with health professionals embracing this new technological competence, enabling general consultation for patients, remote patient monitoring, and self-directed patient care, thereby decreasing the burden on health facilities. Digital learning platforms also provided an effective way to address the learning gaps caused by the pandemic. The restriction of “in-person” delivery of healthcare services due to the global outbreak has prompted physicians, including clinical geneticists and genetic counselors, to investigate alternative methods of providing health care to patients. A telehealth innovation for online delivery of clinical genetic and genetic counseling services is the Philippine General Hospital’s Telegenetics Service. Despite being launched in 2013 to serve genetics patients across the country, this service has since been upgraded and capitalized resulting in patient appreciation for its COVID-19 exposure prevention, increased access, and time and cost efficiency. However, the telegenetics service has its limitations.6,7 Despite the expanding scope of telehealth/telegenetics and its immediate application, issues such as data/patient privacy, organizational readiness, digital maturity, regulatory impediments, access and acceptance of the technology, geographical and digital disparities, and its integration with traditional medical services have emerged.8 Lack of a detailed physical examination is also lost in a virtual visit, with focused questions leading to fragmented, impersonal interactions. Even when restrictions were lifted, telehealth usage nonetheless remained significantly higher than it had been prior to the pandemic. This may indicate a shift in public opinion in favor of this innovative medical practice.9 With the expansion of genetic services in the country, there is now a greater need for telegenetics due to the increased demand for clinical genetic and genetic counseling expertise. Therefore, evidence on the safety and efficacy of this technology in comparison to the traditional healthcare delivery approach is required. If the technology has the potential to improve health care, we must guarantee its availability in all resource-limited areas. Future efforts should thus focus on establishing solutions to address the aforementioned issues and concerns within our healthcare and education systems, thereby ultimately enhancing the standard of medical care.

Clinical characteristics and outcomes of coronavirus disease 2019-infected adult cancer patients in the Philippines from March to December 2020

Background@#Data on the clinical characteristics and outcomes of Filipino cancer patients who acquired the coronavirus disease 2019 (COVID-19) are limited and local information is lacking. Here we characterize the outcomes of patients with cancer and COVID-19.@*Methods@#Medical records of Filipino cancer patients with COVID-19 from the University of the Philippines – Philippine General Hospital (UP-PGH), Southern Philippines Medical Center (SPMC), De La Salle – University Medical Center (DLS- UMC), and St Luke’s Medical Center (SLMC) from March to December 2020 were reviewed.@*Results@#Sixty-nine cancer patients were identified to have COVID-19. The mean age was 53 years (range 19-88) and 45 (65%) patients were female. The most prevalent malignancies were from the gastrointestinal tract (16 [23%]) and the breast (14 [20%]). The majority (34 [49%]) had metastatic disease and had a functional status of Eastern Cooperative Oncology Group (ECOG) 2 or worse (39 [57%]). Forty-two (61%) patients had active oncologic treatment given for the past three months and twenty-four (35%) of these patients were on chemotherapy. The most common symptoms upon presentation were cough (34 [49%]) followed by dyspnea (28 [41%]). COVID-19 severity of this series was as follows: 15 mild (22%), 32 moderate (46%), 7 severe (10%), and 15 critical (22%). The majority received intravenous antibiotics (54 [78%]), investigational treatments (27 [39%]), and steroids (20 [29%]). Common complications were acute respiratory failure (20 [29%]), acute respiratory distress syndrome (17 [25]), and septic shock (15 [22%]). At the end of the collection period, 21 (30%) cancer patients died. The mean length of hospital stay was 22 days.@*Conclusion@#Based on the findings of our case series, ECOG 2 and higher, metastatic stage, higher neutrophil to lymphocyte ratio showed a trend to worse outcomes. Cancer-related treatment within the past months did not appear to affect outcomes.

Reintegration of returning migrant healthcare workers into the Philippine workforce: A qualitative case study

AIM@#This study aims to explore the reintegration experiences of returning migrant healthcare workers in the Philippines.@*BACKGROUND@#Return migration and reintegration of healthcare labor force is a relevant part of the migration process valuable in the improvement of human capital in source countries through transfer of knowledge and skills. However, this research field has received little attention in terms of policy, program, and research development. Hence, there is a paucity of information in the Philippines describing the reintegration experiences of returning migrant healthcare workers despite its maturity in health worker migration.@*METHODS@# A qualitative case study approach was utilized in this study. Initially, an online literature review of electronic databases and grey literature regarding reintegration of migrant workers in the Philippines was performed. This was followed by online in- depth interviews among purposively selected potential, current, or returning nurses, rehabilitation therapists, and caregiver health worker migrants through Zoom web conferencing platform. Government, private, and non-government institutions involved in the migration of health workers were also invited to participate in online focus group discussions and key informant interviews. An inductive content analysis using matrices was utilized to determine relevant descriptive codes, categories, and themes.@*RESULTS@#Return migration and reintegration is perceived as an uncommon phenomenon among healthcare worker migrants. Nonetheless, motivations and grounds of opting to return and reintegrate in the Philippines can mostly be due to personal reasons or entrepreneurial aspirations. Upon return, they successfully held teaching and training positions, engaged in business through specialized clinics, or established professional associations. There was largely a perceived lack of awareness of government efforts on reintegration as it was felt that services and assistance were limited. Further observed restraints to return migration include lower wages in the Philippines, lack of knowledge on financial management, paucity of skills and qualifications recognition acquired overseas in their home country, and absence of professional network support. The COVID-19 pandemic also positively or negatively influenced healthcare worker migration.@*CONCLUSION@#This study highlighted the motivations and restraints of health worker migrants in returning to reintegrate in the Philippines. The availability and deficiency in policies, programs, and services for returning migrant workers were also emphasized. In addition, the aspects and prospects of return migration and reintegration, as well as the challenges posed by the COVID-19 pandemic on healthcare worker reintegration was identified. The Philippine government and other concerned agencies need to ensure a supportive environment that will foster a positively conducive reintegration experience for returning healthcare worker migrants.

A comparative study on health risks, lifestyle behaviors, health perceptions, and health seeking patterns between older and younger Filipinos in the rural areas

BACKGROUND@#Worldwide trends in health risks, lifestyle behaviors, health perceptions, and health-seeking patterns suggest alarming disparities among individuals from low- and middle-income countries. Such international comparisons are particularly troubling for older individuals (≥60 years).@*OBJECTIVES@#This study aims to compare health risks, lifestyle behaviors, health perceptions, and health-seeking patterns between younger (<60) and older (≥60) Filipinos from rural communities in the Philippines.@*METHODS@# A comparative cross-sectional study was employed with 863 younger and 427 older Filipinos. Data were analyzed using frequencies, chi-squares, and T-tests.@*RESULTS@#Older participants were more likely to be single/widowed, ≤ high school education and had higher rates of hypertension, high cholesterol, diabetes, and depression. They reported poorer health status and went to the village health center when sick. Furthermore, they were less likely to drink alcohol and see a physician.@*CONCLUSION@#There were significant differences in modifiable health risks and lifestyle behaviors and differences in health perceptions between younger and older cohorts of Filipinos living in rural areas in the Philippines. Our findings suggest the need to design separate health promotion interventions that target older and younger Filipinos' unique needs from rural communities.

SAKLAY: A Guide to an Assistive Technology Service Delivery Process in the Philippines

@#Occupational Therapy (OT) can help enhance human performance and well-being through assistive technology (AT). This entails guiding clients through the AT selection and acquisition process down to helping them integrate these tools’ use as supports to their day-to-day living. Unfortunately, the AT prescription and acquisition process can be tedious, costly, complicated, and uncoordinated in some countries such as the Philippines. AT service delivery is an undeveloped area of practice among Filipino occupational therapists due to the lack of local evidence-based research, practice models, and practical knowledge of the process. Moreover, access to AT is affected by economic factors and by some Filipinos’ negative attitudes towards assistive devices as being a validation of one’s incapacitation. The SAKLAY is a service delivery framework that was created to offer a practical and systematic guide to Filipino occupational therapists who render AT services for persons with disabilities (PWD) that takes into account the client’s needs, resources, abilities, and contexts.

An economic analysis of selective laser trabeculoplasty versus topical prostaglandin analogues as initial therapy for primary open-angle glaucoma in a tertiary government hospital in the Philippines

Objective@# This study compared the economic viability of initial medical therapy with topical prostaglandin analogues (PGAs) versus selective laser trabeculoplasty (SLT) in the treatment of primary open-angle glaucoma (POAG).@*Method@#This was an economic analysis using actual, current treatment costs of PGA therapy versus SLT applied to theoretical, literature-derived clinical efficacy data projected for a period of 19 years. A socioeconomic and demographic survey conducted among POAG patients at the Department of Health Eye Center of the East Avenue Medical Center from March-April 2022 provided the economic context and setting for the analysis. The treatment regimens were compared in terms of total cost, clinical efficacy, cost-effectiveness and cost-utility in the setting of a tertiary government hospital.@*Results@#Thirty-one (31) patients were included in the study. The total annual cost of topical PGAs was Philippine Pesos (Php) 13,532 versus Php 6,195 for SLT. Cost-effectiveness was Php 1,933 for PGAs/mmHg reduction in intraocular pressure (IOP) versus Php 983 for SLT. Cost-utility was Php 59,793/Quality Adjusted Life Years (QALY) gained for PGAs versus Php 27,373/QALY gained for SLT projected for 19 years. With government insurance coverage, cost-utility ratio was Php 47,831/QALY gained for topical PGAs versus 16,327/QALY gained for SLT.@*Conclusion@#In POAG patients, SLT was more cost-effective versus PGAs with a lower cost per mmHg IOP reduction, and lower cost-utility ratio for every QALY gained. SLT can be recommended as initial therapy for POAG especially for patients being treated at tertiary government hospitals.

Shortening training duration to address the insufficiency of Ophthalmologists: A deeper look at the China experience

@#The availability of ophthalmologists is vital to making eyecare accessible to everyone. Medical education and ophthalmology residency training in China was reduced to address the high demand for ophthalmologists. This is something the Philippines can consider to increase the number of ophthalmologists in the country. However, decreasing the duration, together with insufficient monitoring of medical education and ophthalmology residency training, were not without consequences in eyecare in China.

Pediatrician knowledge, attitude and practices on children’s oral health in a tertiary public hospital in the Philippines: A descriptive study

Background@#Dental caries is a tolerated and overlooked chronic disease in the Philippines. The 2018 National Survey on Oral Health of the Department of Health found that 85.2% of Filipino children aged five years old have dental caries. Prevention and management of this disease can be established early with better collaborations between dental professionals and pediatricians who generally see children promptly in their well-baby check-ups.@*Objective@#The study aimed to evaluate pediatricians' knowledge, attitude, and practices on dental caries prevention among their child patients.@*Method@#A cross-sectional descriptive study was conducted in March 2017 among pediatricians working in a tertiary public hospital in Metro Manila through a self-administered questionnaire. The questionnaire gathered data on knowledge about dental caries prevention, attitude towards the importance of dental screening and oral hygiene instructions, and dental health practices.@*Results@#Among the 122 participants, 67.8% scored high in the oral health knowledge part, 85.0% revealed a positive attitude toward dental caries prevention, and many claimed that they frequently included dental caries risk assessment and preventive oral health education in their clinical practices.@*Conclusion@#Most pediatricians had high knowledge and a positive attitude toward dental caries prevention, although responses varied in the practice component. It will be valuable to continue improving the oral health proficiency of pediatricians to benefit early dental caries prevention in young patients.

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.

Factors affecting voluntary blood donations among adults in Metro Manila, Philippines, as a basis for policy improvement on donor recruitment

Background@#Blood donation practice in the Philippines is low despite numerous efforts to recruit potential donors and increase blood supply.@*Objectives@#This study aimed to explore the sociodemographic profile of potential donors and their perceived level of knowledge, motivators, and hindrances on blood donation practice to recommend improvements in policies and strategies regarding blood donation recruitment.@*Methods@#A descriptive study design was utilized to attain the objectives of the study. A piloted questionnaire was floated through various social media platforms to gather data. Data were analyzed using descriptive statistics and Pearson's product-moment correlation.@*Results@#We included 260 Metro Manila residents, 18 to 65 years old and without conditions that merited permanent deferral in blood donation. Overall, the respondents had an adequate perceived level of knowledge (x̄ = 3.13, SD = 0.70) on blood donation but the lowest level of knowledge on the interval between successive blood donations (x̄ = 2.71, SD = 1.04). Furthermore, respondents were considerably motivated to donate blood (x̄ = 2.67, SD = 0.42) mainly due to relatives and friends requiring blood (x̄ = 3.73, SD = 0.60), and have minimal discernment of being discouraged from blood donation (x̄ = 2.09, SD = 0.48) mainly due to time constraints (x̄ = 3.23, SD = 0.78). Moreover, there is a significant but low inverse correlation (r = -0.151, p = 0.015) between age and motivation, suggesting younger individuals have more motivation to donate blood. Thus, policies and strategies that target young donors are highly suggested.@*Conclusion@#Poor blood donation practices in the Philippines suggest recalibration of policies and strategies by targeting young individuals and showcasing altruism to improve donor recruitment. Moreover, it is recommended to strategically establish blood service facilities in accessible areas with flexible operating hours to accommodate potential donors with hectic schedules.

Mapping the journey of patients with painful diabetic peripheral neuropathy in the Philippines

Objectives@#Knowing the limited epidemiological studies on painful diabetic peripheral neuropathy (pDPN) in the Philippines, the present review aimed to map the prevalence of pDPN and identify the associated healthcare gaps. @*Materials and Methods@#A systematic search of MEDLINE, Embase and BIOSIS was conducted using predefine inclusion criteria, and relevant studies published in English between 2004 and 2021 were identified. An unstructured literature search was also conducted on public and government websites with no date restriction. Data combined from all sources were synthesized and presented as a simple mean.@*Results@#Three studies were considered for final analyses of the 26 articles retrieved from structured and unstructured searches. The sample sizes for the three studies were 103, 172, and 100, respectively. The simple mean prevalence of pDPN was estimated at 26.5%. Awareness of pDPN based on a published study was 89%. According to published studies, screening and diagnosis of pDPN were 65% and 76.7%, respectively. One-third of the patients with pDPN (75%) were treated. No literature is available for adherence and control.@*Conclusion@#Limited data exist on the different management stages of patients with pDPN in the Philippines. The study analysis will help address the knowledge gaps, improve patient care and pain management, and aid decisionmaking.

Clinical profile of cerebrovascular disease population in Sorsogon: A hospital-based study

Objectives@#In the Philippines, an estimated half million are affected annually by stroke. It is the third most common cause of mortality among Filipinos. Locally, there are limited data on the epidemiology of stroke in the country. This study aimed to study cerebrovascular disease in the rural setting in the country, primarily exploring the demographic characteristics, risk factors, clinical profile, and outcomes of patients assessed with cerebrovascular disease in the province of Sorsogon.@*Methods@#This was a retrospective study of all adult patients admitted to two tertiary hospitals in Sorsogon between February 1, 2020, and January 31, 2021, with a stroke diagnosis (International Classification of Diseases, Revision 10). A manual review of the charts and demographics, risk factors, clinical presentation, neuroimaging findings, and outcome were recorded.@*Results@#A total of 721 cases with a mean age of 63.06 ± 13.96 years were involved in the analysis. Of all the stroke cases, 64.7% were ischemic, and 29.7% were hemorrhagic strokes. The most common risk factors for stroke occurrence were hypertension (65%), history of stroke (16.2%), and diabetes (11.4%). Most sought consultation was due to one-sided weakness (41.3%) and slurring speech (14.2%).@*Conclusion@#In a third-class province in the Philippines, the most common type of stroke was an ischemic stroke. Analysis showed that diabetes was more associated with ischemia while hypertension was significantly associated with hemorrhagic stroke. A mortality rate of 26.8% was seen in this cerebrovascular disease population.

Relationship of work engagement with nurse work and patient outcomes among nurses in Central Philippines

Objective@#This study determined the association between work engagement among hospital nurses and their work outcomes (i.e., job satisfaction, stress, burnout, and turnover intention) and patient outcomes (i.e., missed nursing care, adverse events, and quality of care).@*Methods@#A cross-sectional study was employed using secondary data derived from 549 registered nurses working in different hospitals in Central Philippines. Eight self-report questionnaires were adopted to gather data in this study. Multiple linear and logistic regression analyses were used to test the hypotheses.@*Results@#Nurses with lower levels of work engagement reported increased levels of job burnout and turnover intention. Those nurses with higher scores on the dedication subscale reported increased job satisfaction and perceived quality of patient care.@*Conclusion@#Work engagement influences nurse work and patient outcomes in the Philippines. Higher levels of work engagement prevent nursing staff from leaving their workplaces and may help them find their work fulfilling personally and professionally. Nursing management should highly consider promoting work engagement through enhancing job resources to meet the needs of nurses and, eventually, improve professional work outcomes and quality patient care.

A case study on undernutrition among children under five years of age in Barangay Calumpang, Nagcarlan, Laguna

Background@#In 2020, Barangay Calumpang, a 2nd class municipality in Nagcarlan, Laguna recorded the highest prevalence of undernutrition among children under five years of age out of the 52 barangays.@*Objectives@#This study was undertaken to describe the factors possibly causing undernutrition among children under five years of age in Barangay Calumpang and provide key recommendations to improve their nutritional status.@*Methods@#The study used a descriptive research design wherein secondary data from the 2020 Barangay Management Information System (BMIS) and Operation Timbang (OPT) 2021 was merged to extract the children's data. The Statistical Package for the Social Sciences (SPSS) was used for the principal component analysis (PCA) and creation of the wealth index. The children’s nutrition situation and profile were also cross-tabulated.@*Results@#We included 28 children. Undernutrition was more prevalent in boys than girls. Most of the children had improved water sources, sanitation facilities, and waste disposal methods. The wealth index showed that half of the subjects were in the lower quintiles, and all were partially immunized. The most prevalent forms of undernutrition were severe underweight (36%) and severe stunting (39%). Other forms of undernutrition were also present in the barangay, such as underweight (14%) and severe wasting (14%). There was also a prevalence of 11% for both stunting and wasting.@*Conclusion@#Undernutrition was more frequent in boys, lower quintile households (stunting), and partially immunized children. Conducting gender-targeted nutrition programs, developing nutrition-focused livelihood programs, increasing awareness on the advantages of immunization, and promoting proper infant and child feeding practices were some of the recommendations given to improve the nutritional status of children under five.

The correlates of health facility-related stigma and health-seeking behaviors of people living with HIV

Objective@#This study aims to assess the presence of stigma in health facilities and health-seeking behaviors of persons living with HIV (PLHIV).@*Methods@#This study utilized a cross-sectional design employing self-report questionnaires answered online. A total of 100 PLHIV participants were recruited using the respondent-driven sampling method.@*Results@#Results revealed that most participants are young adult men who have been diagnosed with HIV within the last five years. Overall, participants display moderate health-seeking behavior (M = 2.94, SD = 0.54), and moderate experience of health facility-related stigma (M = 2.21, SD = 0.87). Further, there is a negative correlation between age and health-seeking behavior (r = −0.2796, p = 0.049). The type of facility is significantly correlated with HIV stigma (r = 0.4050, p = 0.036).@*Conclusion@#A sustained linkage to care is essential for a PLHIV to remain engaged on his health and well-being. Necessary strategies should be implemented to improve the health-seeking behaviors of PLHIV. Public Rural Health Units are considered to be the most stigmatizing health facility. The presence of health facility-related stigma requires immediate action of the government to reinvigorate these catchment centers as providers of stigma-free and nondiscriminatory primary health care.

Ethnomedicinal survey of valuable plants used by Eskaya Traditional Healers in Bohol Island, Philippines

Objectives@#A recent review on the status of Philippine ethnobotany showed the lack of ethnobotanical studies in the Visayas group of islands. The use of medicinal plants by the Eskaya, an Indigenous ethnic group in the province of Bohol in Visayas, Philippines, has not yet been documented. This study determines the ethnomedicinal knowledge of traditional healers in selected Eskaya communities in Bohol.@*Methods@#Fifteen (15) Eskaya traditional healers were interviewed using a structured questionnaire, and the valuable medicinal plant species were identified through guided field walks. Informal group discussions with the community were also conducted. Moreover, the fidelity level, informant consensus factor (ICF), and use values (UV) were calculated.@*Results@#Our results showed that the majority of the Eskaya healers belong to an older age group (38 – 71 years old). Eighty-five medicinal plants recorded belong to 44 plant families—with Family Lamiaceae having the highest number of species represented. The leaf is the most common plant part used for healing. Blumea balsamifera was an essential plant with a UV of 0.8. Cardiovascular diseases have the highest ICF values of 0.6, and the most common plants used for these diseases include Cymbopogon citratus, Zingiber officinale, and Luffa cylindrica.@*Conclusion@#Our study yielded a record of native and non-native medicinal plants used by the Eskaya healers. This initial listing is also their contribution to promoting medicinal plants that are accessible and abundant in their communities.

Intravitreous chemotherapy as adjuvant rteatment for vitreous seeding in retinoblastoma: A Philippine tertiary hospital experience

Background@#Intravitreal chemotherapy has been an effective addition in treating vitreous seeding in retinoblastoma. However, it was only in 2020 that it was used in the Philippines. There is no literature on its use in multiple Filipino retinoblastoma patients. @*Objectives@#To describe the clinical course of the four patients who are the first to undergo intravitreal chemotherapy for vitreous seeding of retinoblastoma in the Philippine tertiary hospital.@*Methods@#A case series of four eyes of four patients with retinoblastoma who underwent intravitreous injection of melphalan and topotecan for vitreous seeding at the Department of Ophthalmology and Visual Sciences of a Philippine tertiary hospital. @*Results@#Two eyes, with International Intraocular Retinoblastoma Classification (IIRC) Group C with vitreous seeding, responded well to intravitreous melphalan and topotecan. One eye had recurrent vitreous seeding despite 10 intravitreal injections. One eye with IIRC Group E, did not respond to intravitreous chemotherapy and was eventually enucleated. This is the first case series on the local use of intravitreous chemotherapy in the country for vitreous seeding in retinoblastoma. The control of 50% achieved in this case series is lower than in other series due to longer treatment interval from poor follow-up and the presence of advanced disease.@*Conclusion@#The use of intravitreous melphalan and topotecan can be an effective adjuvant for systemic chemotherapy in controlling vitreous seeding in eyes with IIRC Group C. It is not effective in controlling IIRC Group E disease.

Examination of the right to confidentiality

@#With the establishment of the Republic Act No. 11036, more popularly known as the Mental Health Act, improvement in the mental, neurologic, and psychosocial health took a step forward in the Philippines. This law, which was signed on June 2018, gave specific provisions in different aspects of delivery of mental health services to Filipinos. This law proved very useful in the dilemma faced in the following case where a potential problem in confidentiality was encountered.