RESUMO
ABSTRACT: Promoting adherence to HIV care among persons with HIV (PWH) is a key component to addressing the rising HIV epidemic in the Philippines. HIV care adherence is a complex process that may change throughout an individual's life course or "journey" living with HIV. This qualitative study aimed to explore the HIV care adherence journey of PWH. Maximum variation sampling was used to select 12 PWH and 3 health care providers for in-depth online interviews, which were analyzed using thematic analysis. The four themes that emerged to describe the HIV care adherence journey are integration, relation, navigation, and manifestation. Each theme corresponds to a unique set of activities and goals related to PWH's lived experiences as they initiate, practice, and maintain care adherence. This study provides a preliminary framework to characterize the HIV care adherence journey as a dynamic, complex, and multifaceted phenomenon, which can help to inform holistic interventions to support PWH.
Assuntos
Infecções por HIV , Pesquisa Qualitativa , Humanos , Infecções por HIV/psicologia , Infecções por HIV/tratamento farmacológico , Filipinas , Masculino , Feminino , Adulto , Entrevistas como Assunto , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Adesão à Medicação/psicologia , Pessoal de Saúde/psicologiaRESUMO
Six new dimeric 2-(2-phenylethyl)chromones (1-6) were successfully isolated from the ethanol extract of agarwood of Aquilaria filaria from Philippines under HPLC-MS guidance. Compounds 1-6 are all dimers formed by linking 5,6,7,8-tetrahydro-2-(2-phenylethyl)chromone and flindersia 2-(2-phenylethyl)chromone via a single ether bond, and the linkage site (C5-O-C8'') of compound 2 is extremely rare. A variety of spectroscopic methods were used to ascertain their structures, including extensive 1D and 2D NMR spectroscopic analysis, HRESIMS, and comparison with literature. The in vitro tyrosinase inhibitory and anti-inflammatory activities of each isolate were assessed. Among these compounds, compound 2 had a tyrosinase inhibition effect with an IC50 value of 27.71 ± 2.60 µM, and compound 4 exhibited moderate inhibition of nitric oxide production in lipopolysaccharide-stimulated RAW264.7 cells with an IC50 value of 35.40 ± 1.04 µM.
Assuntos
Anti-Inflamatórios , Monofenol Mono-Oxigenase , Óxido Nítrico , Thymelaeaceae , Madeira , Células RAW 264.7 , Animais , Thymelaeaceae/química , Camundongos , Estrutura Molecular , Madeira/química , Óxido Nítrico/metabolismo , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/isolamento & purificação , Anti-Inflamatórios/química , Monofenol Mono-Oxigenase/antagonistas & inibidores , Filipinas , Cromonas/isolamento & purificação , Cromonas/farmacologia , Cromonas/química , Compostos Fitoquímicos/farmacologia , Compostos Fitoquímicos/isolamento & purificação , FlavonoidesRESUMO
The COVID-19 pandemic is impacting individuals and society's physical and mental health. Despite the lack of any definite and effective therapeutic regimen, public health measures such as quarantine and isolation have been instituted to contain this pandemic. However, these mitigating measures have also raised issues regarding isolated patients' mental and psychological well-being. Several stakeholders were engaged in this approach, including the university, the local health office, the tertiary hospital, and the local communities. This intervention addresses concerns regarding the health status of isolated individuals due to COVID-19 infection, making the program available to anyone who agrees to participate. This was done through telehealth services delivered via phone calls and SMS. The university provided technical support and telehealth manpower through medical students. The local health unit manages the isolation facilities, while the referral hospital offers specialty care for isolated patients through teleconsultation. Finally, the local community is the one that reintegrates discharged patients into their communities. Three hundred forty-four (344) participants were provided seven sessions on telehealth education and tracking of their COVID-19 prescribed practices and mental health. The mean age of the patients was 37 years; half were females, and 15% had comorbidities. Regarding their mental health status, the level of depression dropped from 6% to 1% (p<0.0001), the level of anxiety dropped from 12% to 2% (p<0.0001), and the level of stress dropped from 3% to 0% (p<0.0001) from the first day of admission to 2 weeks after discharge. Moreover, a general trend of statistically significant increase in various practices was noted: wearing face masks, physical distancing, disinfecting frequently held objects, hand hygiene, and self-monitoring for COVID-19 symptoms. Those with progressing symptoms of COVID-19 were referred immediately to the referral hospital. There were also no reports of complications of co-morbidities during their stay in the isolation facilities or social isolation upon community reintegration. The study concludes that telehealth services have the potential to address many challenges in providing continuous healthcare services to isolated patients until they are reintegrated into their community. Furthermore, a whole-of-society approach is necessary to provide holistic care to patients affected by the pandemic.
Assuntos
COVID-19 , Telemedicina , Feminino , Humanos , Adulto , Masculino , Pandemias/prevenção & controle , SARS-CoV-2 , Filipinas , Monitorização FisiológicaRESUMO
BACKGROUND: In 2019, the Philippines enacted a universal health coverage law that aimed to establish an integrated health system centered around robust primary care as a core strategy of its health system reform agenda. Although the COVID-19 pandemic disrupted initial progress in the reform process, it also presented an opportunity to pilot interventions to demonstrate integration in various ways. METHODS: We conducted a participatory implementation research study to integrate selected public health interventions into the implementation of the primary care benefit package funded by public health insurance. The study was conducted from October 2022 to April 2023 in the Province of Iloilo, Philippines. Entry points within the primary care service delivery process were identified, and interventions related to COVID-19 vaccination and family planning were implemented and monitored. We used the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to organize the results and present the analysis. RESULTS: The intervention showed substantial improvement across the 5 dimensions of the RE-AIM framework, including enhanced access to health care services, as indicated by improvements in primary care patient registration, family planning services, and COVID-19 vaccination processes, as well as an increase in registrations and first patient encounters. These improvements corresponded to sustained primary care facility participation throughout the study period. Additionally, emergent factors that either impeded or facilitated the integration process were identified, providing insights for effectively integrating COVID-19 vaccination within the primary care health system. CONCLUSION: Our study provides evidence of the feasibility of integrating public health interventions into primary care settings. It highlights the potential of using existing primary care service delivery and financing mechanisms as entry points for integration. However, further iteration of the model is required to identify specific conditions for success that can be applied in other contexts and settings.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , Filipinas/epidemiologia , Pandemias/prevenção & controle , COVID-19/epidemiologia , COVID-19/prevenção & controle , Atenção Primária à SaúdeRESUMO
We conducted an analysis to identify factors influencing the use of traditional complementary and alternative medicine (TCAM), with a particular emphasis on ethnic variations. Using the 2015 Asian American Quality of Life survey (N = 2,609), logistic regression analyses were performed, considering acculturation, health status, healthcare accessibility/utilization, and socio-demographic factors. Ethnicity, specifically being Chinese or Korean Americans, having chronic medical conditions, experiencing unmet healthcare needs, and having regular check-ups were significant predictors of TCAM use among Asian Americans as a whole. However, when we delved into sub-ethnic groups, different patterns were found. Among Vietnamese and Filipino Americans, having unmet healthcare needs emerged as the most prominent predictor of TCAM use. Furthermore, acculturation level and English proficiency were significant in predicting Vietnamese and Filipino Americans' TCAM use, with the direction varying by sub-ethnicity. Being old emerged as a predictor of TCAM use for Chinese, Indian, Korean, and 'other' Americans. Our findings underscore the importance of adopting an ethnically sensitive approach when addressing the healthcare needs of diverse Asian American populations.
Assuntos
Aculturação , Asiático , Terapias Complementares , Humanos , Asiático/estatística & dados numéricos , Feminino , Masculino , Terapias Complementares/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto , Idoso , Estados Unidos , Fatores Socioeconômicos , Nível de Saúde , Acessibilidade aos Serviços de Saúde , Fatores Etários , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Fatores Sociodemográficos , Adulto Jovem , Vietnã/etnologia , Filipinas/etnologia , Qualidade de Vida , Etnicidade/estatística & dados numéricosRESUMO
The COVID-19 pandemic has highlighted the persistent fragmentation of health systems and has amplified the necessity for integration. This issue is particularly pronounced in decentralise settings, where fragmentation is evident with poor coordination that impedes timely information sharing, efficient resource allocation and effective response to health threats. It is within this context that the Philippine Universal Health Care law introduced reforms focusing on equitable access and resilient health systems through intermunicipal cooperation, enhancing primary care networks and harnessing digital health technologies-efforts that underline the demand for a comprehensively integrated healthcare system. The WHO and the global community have long called for integration as a strategy to optimise healthcare delivery. The authors contend that at the core of health system integration lies the need to synchronise public health and primary care interventions to enhance individual and population health. Drawing lessons from the implementation of a pilot project in the Philippines which demonstrates an integrated approach to delivering COVID-19 vaccination, family planning and primary care services, this paper examines the crucial role of local health officers in the process, offering insights and practical lessons for engaging these key actors to advance health system integration. These lessons may hold relevance for other low-ncome and middle-income economies pursuing similar reforms, providing a path forward towards achieving universal health coverage.
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Vacinas contra COVID-19 , Pandemias , Humanos , Filipinas , Projetos Piloto , Saúde Pública , Cobertura Universal do Seguro de Saúde , Atenção Primária à SaúdeRESUMO
In Southeast Asia, the increasing availability of commercially produced complementary foods (CPCF), including dry or instant cereals (CPCF cereals), has been noted, however, concerns exist around their nutrient profile and labelling practices. This 2021 study assessed the nutrient composition, labelling practices, and micronutrient content of CPCF cereals sold in the capital cities of seven Southeast Asian countries: Phnom Penh (Cambodia), Jakarta (Indonesia), Manila (Philippines), Bangkok (Thailand), Vientiane (Lao PDR), Hanoi (Vietnam), and Kuala Lumpur (Malaysia). The study adapted a nutrient profiling model from the WHO Regional Office for Europe to determine the proportion of products suitable for promotion for older infants and young children. Micronutrient content of fortified CPCF cereals was assessed against fortification levels specified in the Codex Alimentarius guideline for formulated complementary foods. Of the 484 products assessed, 184 (38.0%) met all nutrient composition requirements. Around one-third of CPCF cereals contained added sugars and/or sweeteners (37.2%) and high levels of sodium (28.9%). None of the CPCF cereals met all labelling requirements, primarily due to the presence of inappropriate claims on the labels. Most fortified CPCF cereals contained adequate amounts of critical micronutrients, such as calcium, iron, zinc, vitamin A, and vitamin D. However, rates of fortification varied across the seven countries, and almost a third (30.8%) of CPCF cereals were not fortified with any micronutrients. To support the appropriate promotion of CPCF in the region, Southeast Asian countries need to strengthen and enforce national binding legal measures, including national standards for the composition, labelling, and fortification of CPCF cereals.
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Grão Comestível , Rotulagem de Alimentos , Alimentos Fortificados , Oligoelementos , Pré-Escolar , Humanos , Lactente , Benchmarking , Micronutrientes , Filipinas , Tailândia , Necessidades NutricionaisRESUMO
BACKGROUND: Seafarers, confronted with unique health challenges, occasionally necessitate medical repatriation. This study examines the trends in medical repatriation cases among Filipino seafarers employed by OSM Maritime shipping company over a 10-year period from 2013 to 2022. MATERIALS AND METHODS: Medical records of OSM Maritime seafarers were reviewed, obtaining causes for and dates of medical repatriation. International Classification of Diseases (ICD-11) was utilised to classify repatriation cases. Proportion of repatriation cases were calculated and their annual trends were analysed. RESULTS: Our findings reveal that the majority of repatriation cases are attributed to injury/trauma (19.91%), musculoskeletal (18.40%), gastrointestinal (16.56%), cardiovascular (8.77%), infectious (6.82%), and genitourinary conditions (5.30%). Significantly, the study identifies a declining trend in the proportion of cardiovascular, gastrointestinal, and genitourinary conditions in annual repatriation cases, particularly in ischaemic heart conditions, cholelithiasis, cholecystitis, and urinary calculus. CONCLUSIONS: These results emphasize the critical need for multisectoral collaboration to enhance seafarers' health and well-being. Prioritizing comprehensive care programmes, ensuring safe working conditions, and exploring holistic healthcare initiatives are essential steps to enhance seafarers' occupational health.
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Medicina Naval , Saúde Ocupacional , Humanos , Filipinas , Navios , Oncostatina MRESUMO
BACKGROUND: People with diabetes mellitus (DM) have an estimated two- to three-times greater risk of adverse tuberculosis (TB) treatment outcomes compared to those without DM. Blood glucose control is a primary aim of managing DM during TB treatment, yet TB programmes are not generally adapted to provide DM services. The purpose of this study was to understand perceptions and the lived experiences of diabetic patients in TB treatment in the Philippines, with a view to informing the development of disease co-management strategies. METHODS: This mixed methods study was conducted within a prospective cohort of adults newly-starting treatment for drug-sensitive and drug-resistant TB at 13 public TB clinics in three regions of the Philippines. Within the subset of 189 diabetic persons who self-reported a prior DM diagnosis, or were diagnosed by screenings conducted through the TB clinic, longitudinal blood glucose data were used to ascertain individuals' glycaemic control (controlled or uncontrolled). Univariable logistic regression analyses exploring associations between uncontrolled glycaemia and demographic and clinical factors informed purposive sampling of 31 people to participate in semi-structured interviews. All audio-recorded data were transcribed and thematic analysis performed. RESULTS: Participants - both with controlled and uncontrolled blood glucose - were knowledgeable about diabetes and its management. However, a minority of participants were aware of the impact of DM on TB treatment and outcomes. Many participants newly-diagnosed with DM at enrolment in TB treatment had not perceived any diabetic symptoms prior and would have likely not sought clinical consult otherwise. Access to free glucose-lowering medications through TB clinics was a key enabling resource. However, participants expressed fear of side effects and interrupted access to glucose-lowering medications, and a preference for phytotherapy. Many participants felt that physical and financial impacts of TB and its treatment were challenges to DM management. CONCLUSIONS AND RECOMMENDATIONS: Results of this study indicate that public TB clinics can provide diabetic patients with additional health care resources and education to address co-morbidity. TB programmes might consider identifying patients with complicated DM, and offering diabetic monitoring and management, as DM and diabetic complications may compound the burden of TB and its treatment.
Assuntos
Diabetes Mellitus , Tuberculose , Adulto , Humanos , Filipinas/epidemiologia , Glicemia , Estudos Prospectivos , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Glucose , MorbidadeRESUMO
AIM: International child sponsorship programmes comprise a considerable proportion of global aid accessible to the general population. Team Philippines (TP), a health care and welfare initiative run in association with the University of Notre Dame Sydney since 2013, leads a holistic sponsorship programme for 30 children from Calauan, Philippines. To date, empirical research has not been performed into the overall success and impact of the TP child sponsorship programme. As such, this study aims to evaluate its effectiveness in improving paediatric outcomes. METHODS: Study cohorts comprised 30 sponsored and 29 age- and gender-matched non-sponsored children. Data were extracted from the TP Medical Director database and life-style questionnaires for July-November 2019. Outcome measures included anthropometry, markers of medical health, dental health, exercise, and diet. Statistical analyses were performed in SPSS. RESULTS: Sponsorship resulted in fewer medical diagnoses and prescription medications, superior dental health, and improved diet. Further, sponsored children may show a clinically significant trend towards improved physical health. Sponsorship did not affect growth and development metrics, or levels of physical activity. CONCLUSIONS: The TP child sponsorship programme significantly impacts positive paediatric health outcomes in the Calauan community. The strength of the programme lies in its holistic, sustainable, and community-based model, which is enabled by effective international child sponsorship. This study further supports the relationship between supporting early livelihood and improved health in the paediatric population.
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Dieta , Exercício Físico , Criança , Humanos , Filipinas , Estudos Retrospectivos , Avaliação de Resultados em Cuidados de SaúdeRESUMO
This study investigated 216 individual transcripts of faith healing experiences drawn from the healing ministries of 2 Catholic priests in the Philippines. The accounts of these healing narratives were generously provided to the researcher in hard copies for analysis by the 2 Catholic priests. The narratives were individual stories of healing experiences and written voluntarily by the healees themselves. Five themes were extracted from the narratives, namely, sensation of warmth, feeling of lightness, electrifying sensation, feeling of heaviness, and a weeping episode. Further, the study was able to unfold four themes on spiritual coping, namely, empowering faith, letting God be in control, acceptance leading to renewal, and connectedness with God. Faith healing experience begins with multisensory-physiological changes (e.g., sensation of warmth, electrifying sensation, feeling of heaviness) leading to affective/emotional, changes (e.g., weeping moment and feeling of lightness) that occur simultaneously, or in succession as antecedent conditions that awaken or activate inner adaptive spiritual coping responses with illness such as empowering faith, God being in control, acceptance leading to renewal, and connectedness with God.
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Cura pela Fé , Espiritualidade , Humanos , Catolicismo , Emoções , FilipinasRESUMO
Objective: To analyze the implementation of the Principles of Care (PoC) in primary immunodeficiencies (PID) in Southeast Asia (SEA) countries - six years after its call of action. Methodology: Using the newly developed PID Life Index software, the index of implementation of principles of care in the management of PIDs patients involving the six participating SEA countries (Cambodia, Indonesia, Malaysia, Vietnam, Thailand, and Philippines) were extracted. For each of the six separate principles, the index from the six countries will be compared and presented based on the calculated index. Results: Comparative analysis of the six principles of care of PID in the SEA countries showed low diagnostic rate with minimal availability of diagnostic tests options. Generally, almost all SEA countries provide curative treatments, vaccines, and anti-infectious therapies although the reimbursement scheme varied in relieving patients' financial burden. We also highlighted the active involvement of patient organizations in SEA, with main areas of work focused on advocacy and increasing awareness among public and healthcare professionals. Discussion and conclusion: It is applaudable that the SEA continent is gradually strengthening its work in management of PID, especially in Thailand and Vietnam. However, more emphasis must be placed among stakeholders in SEA countries towards successful implementation of the PoC for a holistic management of PID patients.
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Doenças da Imunodeficiência Primária , Humanos , Sudeste Asiático/epidemiologia , Indonésia , Malásia , Filipinas , Tailândia , Doenças da Imunodeficiência Primária/epidemiologia , Doenças da Imunodeficiência Primária/terapiaRESUMO
Information on fortifiable food consumption is essential to design, monitor and evaluate fortification programmes, yet detailed methods like 24-h recalls (24HRs) that provide such data are rarely conducted. Simplified questionnaire-based methods exist but their validity compared with 24HRs has not been shown. We compared two simplified methods (i.e., a household food acquisition and purchase questionnaire [FAPQ] and a 7-day semiquantitative food frequency questionnaire [SQ-FFQ]) against 24HRs for estimating fortifiable food consumption. We assessed the consumption of fortifiable wheat flour and oil using a FAPQ and, for wheat flour only, a 7-day SQ-FFQ and compared the results against 24HRs. The participants included children 12-18 months (n = 123) and their mothers 18-49 years selected for a study assessing child vitamin A intake and status in Mandaluyong City, Philippines. For fortifiable wheat flour, the FAPQ estimated considerably lower mean intakes compared to 24HRs for children and mothers (2.2 vs. 14.1 g/day and 5.1 vs. 42.3 g/day, respectively), while the SQ-FFQ estimated slightly higher mean intakes (15.7 vs. 14.1 g/day and 51.5 vs. 42.3 g/day, respectively). For fortifiable oil, the FAPQ estimated considerably higher mean intakes compared to 24HRs for children and mothers (4.6 vs. 1.8 g/day and 12.5 vs. 6.1 g/day, respectively). The SQ-FFQ, but not the FAPQ, generated useful information on fortifiable food consumption that can inform fortification programme design and monitoring decisions in the absence of more detailed individual-level data. Potential adaptations to improve the FAPQ, such as additional questions on foods prepared away from home and usage patterns, merit further research.
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Farinha , Alimentos Fortificados , Criança , Humanos , Filipinas , Triticum , Inquéritos e Questionários , DietaRESUMO
Background: To augment traditional sources of health information at a time of reduced accessibility, a free online telepharmacy service was developed during the COVID-19 pandemic. Objectives: This study details the process of developing and operating an online telepharmacy service, analyzes its usage, and assesses users' health information-seeking patterns. Methods: The service utilized various platforms for receiving and processing queries, communication, and promotion. Submissions received from March 20 to May 31, 2020 were processed for analysis. Parameters analyzed were time patterns of query submission, response time, service feedback, user and patient demographics, and subjects of inquiry. Results: A total of 271 queries were analyzed. Query frequency decreased over time, consistent with relaxation of quarantine restrictions and increasing availability of information. Peak hours of query influx were outside typical business hours. The majority of users were from the general public (93.8%) and preferred to receive responses through text (61.2%). The majority of users from the general public belonged to the 15- to 25-year-old age group (41.1%) and sought information for oneself. Most submissions mentioned COVID-related topics. From the general public, there was greatest interest in drug indications and vitamins, supplements, and herbal products, and from healthcare professionals, in drug procurement. Users who provided feedback (n = 12) all expressed satisfaction with the service and the information they received. Conclusion: Transition to the "new normal" entails adopting alternative platforms to augment traditional sources of health information. An online telepharmacy service may be utilized to provide and clarify medication information as part of primary care.
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COVID-19 , Humanos , Adolescente , Adulto Jovem , Adulto , COVID-19/epidemiologia , Pandemias , Filipinas , Comunicação , Inquéritos e QuestionáriosRESUMO
Schistosomiasis japonica remains a public health concern in many areas of the Philippines. Periodic Mass Drug Administration (MDA) to at-risk populations is the main strategy for morbidity control of schistosomiasis. Attaining MDA coverage targets is important for the reduction of morbidity and prevention of complications due to the disease, and towards achieving Universal Health Care. The study employed a qualitative case study design. Key informant interviews and focus group discussions were conducted to provide in-depth and situated descriptions of the contexts surrounding the implementation of MDA in two selected villages in known schistosomiasis-endemic provinces in Mindanao in the Philippines. Data analysis was done using the Critical Ecology for Medical Anthropology (CEMA) model coupled with the intersectionality approach. It was found that within various areas in the CEMA model, enabling as well as constraining factors have been encountered in MDA in the study settings. The interplay of income class, geographical location, gender norms and faith-based beliefs may have led to key populations being missed during the conduct of MDA in the study sites. The constraints faced by the target beneficiaries of MDA, as well as programme implementers, must be addressed to enhance service delivery and to control morbidity due to schistosomiasis. Improving compliance with MDA also requires a holistic, integrated approach to addressing barriers to participation, which are shaped by wider socio-political and power structures.
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Enquadramento Interseccional , Esquistossomose , Humanos , Filipinas/epidemiologia , Esquistossomose/epidemiologia , Esquistossomose/prevenção & controle , Esquistossomose/tratamento farmacológico , Administração Massiva de Medicamentos , Saúde PúblicaRESUMO
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.
Assuntos
Etnobotânica , Etnofarmacologia , Medicina Herbária , Filipinas , Medicina TradicionalRESUMO
BACKGROUND: Traditional, complementary and alternative medicine (TCAM) is used to treat a broad range of conditions. In low- and middle-income countries (LMICs), TCAM use is particularly common among those with low socio-economic status. To better understand the patterns and impact of TCAM use on the management of non-communicable diseases in these populations, this study examines the prevalence and characteristics of TCAM use for hypertension, its determinants, and its association with hypertension management outcomes and wellbeing among low-income adults in two Southeast Asian countries at different levels of economic and health system development, Malaysia and the Philippines. METHODS: We analysed cross-sectional data from 946 randomly selected adults diagnosed with hypertension from low-income rural and urban communities in Malaysia (n = 495) and the Philippines (n = 451). We compared the prevalence, characteristics and household expenditure on TCAM use between countries and used multi-level, mixed-effects regression to estimate associations between TCAM use and its determinants, and five hypertension management outcomes and wellbeing. RESULTS: The prevalence of TCAM use to manage hypertension was higher in the Philippines than in Malaysia (18.8% vs 8.8%, p < 0.001). Biologically-based modalities, e.g. herbal remedies, were the most common type of TCAM used in both countries, mainly as a complement, rather than an alternative to conventional treatment. Households allocated around 10% of health spending to TCAM in both countries. Belief that TCAM is effective for hypertension was a positive predictor of TCAM use, while belief in conventional medicine was a negative predictor. TCAM use was not strongly associated with current use of medications for hypertension, self-reported medication adherence, blood pressure level and control, or wellbeing in either country. CONCLUSIONS: A small, but significant, proportion of individuals living in low-income communities in Malaysia and the Philippines use TCAM to manage their hypertension, despite a general lack of evidence on efficacy and safety of commonly used TCAM modalities. Recognising that their patients may be using TCAM to manage hypertension will enable health care providers to deliver safer, more patient-centred care.
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Terapias Complementares , Hipertensão , Adulto , Estudos Transversais , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Malásia/epidemiologia , Filipinas/epidemiologia , PrevalênciaRESUMO
In this Commentary, we discuss disparities in resources for and access to cancer trials from the perspective of the Philippines, a lower-middle-income country in Southeast Asia, where cancer is the fourth leading cause of death. Geographic disparities play out such that academic institutions and clinical trials are centralized in the island of Luzon, particularly in the capital, Manila. These disparities are compounded by the lack of comprehensive cancer patient and clinical trial registries in the Philippines. Additionally, sociocultural considerations influence clinical trial implementation. Providers must consider the role of a patient's family in the decision to participate in clinical trials; a patient's degree of health literacy; and the economic burden of cancer care, with attention to both the direct and indirect financial toxicities associated with cancer care. Our call to action is threefold. (1) Bolster locally led trials and encourage international collaboration to improve diversity in trial participation and trials' generalizability. (2) Strengthen national trial registries to improve awareness of trials for which patients are eligible. (3) Integrate cultural competency frameworks that move beyond parachutism and parasitism in research and instead promote trust, reciprocity, and collaboration. These challenges may yet evolve, but in emphasizing these barriers, we hope to kindle further dialogue, new insights, and innovative action towards solving these disparities in cancer research, not just in the Philippines, but also in other low- and middle-income countries.
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Renda , Neoplasias , Sudeste Asiático , Ensaios Clínicos como Assunto , Países em Desenvolvimento , Humanos , Neoplasias/terapia , Filipinas/epidemiologiaRESUMO
Background: Maternal, infant and young child health and nutrition are affected during the COVID-19 pandemic. Aim: This study aimed to present the snapshot situation of maternal health practices of pregnant women including infant and young child feeding (IYCF) practices of children under two during the COVID-19 pandemic. Methods: A rapid nutrition assessment survey (RNAS) was conducted through phone interview in nine selected areas from November 3 to December 3, 2020. A multi-stage sampling design was employed in the selection of areas with low, medium, and high risk categories across the islands of Luzon, Visayas, and Mindanao in the Philippines. A total of 792 mother-child pairs, and 148 pregnant women were covered. Results: Majority (84.5%) of pregnant women availed pre-natal check-ups, 82.4% of them had micronutrient supplements, of which 20.5% took IFA tablets. Almost 60.0% of children under two were currently breastfed during the pandemic, with 60.8% of infants less than 6 months receiving breastmilk exclusively. Appropriate complementary feeding practices based on this study were not drastically affected by the COVID-19 pandemic. However, access to pregnancy-related information, along with breastfeeding and complementary feeding messages and advice were disrupted during the community lockdown. Conclusion: Although maternal and child feeding practices were unchanged, innovative delivery of community health and nutrition services such as tele-visits by midwives, and community health workers are some of the ways to move forward in improving the health and nutrition of women and children in the wake of the pandemic and during subsequent waves.