The effects of establishment practices, knowledge and attitudes on condom use among Filipina sex workers.

The findings for a baseline assessment for a community-based HIV/STD prevention intervention for commercial sex workers (CSWs) and managers of the establishments that employ them in the Philippines is presented in this study. CSW knowledge, attitudes, behaviours and establishment policies concerning HIV prevention were assessed. Baseline assessments are part of an iterative process that will be used to modify the planned intervention. The preliminary findings point to the importance of an intervention that stresses changes in establishment policies and expectations as a means of reducing risk behaviours associated with HIV/STD transmission.

PIP: As of May 1996, 1025 HIV-infected individuals had been identified in the Philippines, 260 of whom had AIDS. However, in the Philippines' total population of 65 million, approximately 18,000 adults are estimated to carry HIV. Unprotected sex and multiple partners place prostitutes at risk of contracting and transmitting HIV and other STDs. There are 65,000 registered prostitutes and 200,000 or more freelance sex workers in the Philippines. 1394 registered prostitutes, of whom 98.6% were female, were recruited from commercial sex work establishments in 4 sites about 400 miles from Manila for participation in a study assessing prostitutes' knowledge, attitudes, behaviors, and establishment policies concerning HIV prevention. The participants were aged 15-54 of mean age 23.5 years. Establishment policies and practices appear to be more important than prostitutes' knowledge of HIV transmission or their attitudes toward condoms. Any intervention to prevent HIV/STD among prostitutes in the Philippines should therefore consider and possibly target sex work establishments' policies.

Prenatal tetanus immunization and other practices associated with neonatal tetanus.

The relationship between neonatal tetanus (NT) on one hand, and maternal tetanus immunization and other prenatal and natal practices on the other hand, was examined in a case-control study done at San Lazaro Hospital (SLH) in Manila from late 1990 to mid 1991. Included as cases were 54 patients diagnosed as NT on the basis of WHO criteria, and 50 controls who were patients 0-4 months of age, hospitalized at SLH during the study period and with no past history of tetanus. The result showed that the following were statistically associated with the risk of NT: home delivery (OR = 30.5); delivered by a traditional birth attendant (OR = 5.2); use of instrument other than scissors to cut the cord (OR = 19.3); traditional birth attendant who dressed the cord (OR = 12.7); and having less than two doses of tetanus toxoid (OR = 15.3). The need to intensify prenatal tetanus immunization, health education of the mothers as well as the training of birth attendants is evident from this study if NT has to be prevented.

Hygiene behaviour and hospitalized severe childhood diarrhoea: a case-control study.

The relationship between personal and domestic hygiene behaviour and hospitalized childhood diarrhoea was examined in a case-control study of 356 cases and 357 controls from low-income families in metropolitan Manila. Indices of hygiene behaviour were defined for overall cleanliness, kitchen hygiene, and living conditions. Only the indices for overall cleanliness and kitchen hygiene were significantly associated with diarrhoea. An increasing excess risk of hospitalization with severe diarrhoea was noted as the ratings for standards of hygiene became lower, and this excess risk persisted even after controlling for confounding variables. The implications of our findings for the control of diarrhoeal disease are discussed.

PIP: Between April and October, 1989, professors from the College of Public Health at the University of the Philippines in Manila compared data on 356 5-year-old children living in Manila, who had been admitted to a government hospital with diarrhea of 7 days duration, with data on 357 age and neighborhood matched controls to study the relationship between personal and domestic hygiene behavior and hospitalized severe childhood diarrhea. To address selection bias, the researchers chose controls who could potentially use the hospital services. All the children were from low-income families. As standards of hygiene for overall cleanliness and kitchen hygiene fell, the risk of severe diarrhea increased. Specifically, children in the group with a middle score in overall cleanliness acquired severe diarrhea at 2 times the rate as those with a low score (i.e. better hygienic conditions). Those in the high score group acquired it at 3.9 times the rate as those in the low score group. For kitchen hygiene, the odds ratios were 2.7 and 5.3, respectively. Living conditions did not influence the rate of diarrhea. Living conditions included inside and outside sanitary conditions, number of rooms, and presence or lack of a dining table. These findings suggested that effective health education programs aimed to change hygiene behavior could prevent severe diarrhea. Therefore, public health programs should develop suitable interventions for the education of mothers and of the general public.

The potential of the case-control method for rapid epidemiological assessment.

Over the past few decades, the case-control method has been mostly applied to risk-factor studies of chronic diseases. Recently, among its new applications is the use of the method to study the health effect of improvements in sanitation and water supply. The methodological considerations, prospects and constraints of the method for rapid assessment are reviewed.

PIP: It has been proposed that case-control studies be used to evaluate the health impact of sanitation and water supply improvement programs upon diarrheal disease. Experimental and still in need of field studies for further substantiation, methodological considerations, prospects, and constraints of this rapid assessment method are reviewed. Drawing from a clinic-based case-control study in Cebu, a peri-urban area of the Philippines, the paper discusses the issues of methodological approach, study site, study period, sample size, potential sources of bias, and comparing findings from field studies. Case-control studies have the advantages of requiring only a single round of data collection over a short period, while yielding better quality information on disease status. This approach also avoids some ethical problems associated with quasi-experimental designs. These studies do not, however, permit examination of the effect of exposure upon more than 1 outcome, and are inappropriate for situations in which exposure is rare. Case-control studies are also highly vulnerable to bias. In closing, the paper concludes that this method could save time and money over prospective designs in rapid assessment without sacrificing a study's integrity. Case-control studies are, nonetheless, complicated with heavy demands for trained manpower and logistical support. Accordingly, they are presently best suited for urban areas. Steps toward procedural and method design simplification are needed, with care taken to safeguard the method's quality and applicability.

The "crowding effect" phenomenon in Ascaris lumbricoides.

Ascaris lumbricoides worm populations were studied from 150 Filipino children (0-14 years) dewormed with pyrantel pamoate (Combantrin) or oxantel-pyrantel pamoate (Quantrel). Populations were classified according to intensity of infection: very light, light, moderate or heavy. A total of 2072 adult worms were sexed (939 males and 1133 females) and weighed. Descriptive statistics on the weights obtained from each sex were derived and one-way ANOVA was performed to compare the mean weights among the 4 intensity classes. Linear regression analysis (individual worm weight versus total worm burden) was also employed to equalize the possible influence of host factors. Statistical analysis revealed that mean weights of both sexes were significantly different and decreased as worm burden increased. This strongly suggests that the "crowding effect" phenomenon may also apply to Ascaris lumbricoides, and not only to tapeworms, as reported in the literature.

Disposal of faeces of children under two years old and diarrhoea incidence: a case-control study.

This is a report on the relationship of disposal of faeces of children under two years old and diarrhoeal incidence from a clinic-based case-control study. Based on data on 275 cases and 381 controls recruited from 16 clinics in Metropolitan Cebu in the Philippines over a five-month period, the results showed that unsanitary disposal of young children's stools was associated with a 34% increase (OR = 1.34) in clinically diagnosed diarrhoeas and a 63% increase (OR = 1.63) in pathogen-positive diarrhoeas relative to those who were following sanitary practices. Despite several methodological limitations, the findings suggest that the exposure variable under investigation might be an important risk factor for diarrhoeas. Further studies are indicated because of the value of identifying specific hygiene behaviours related to the transmission of enteric pathogens for purposes of formulating interventions.

A comparative study of Trichomonas vaginalis prevalence in Filipino women.

A comparative study of Trichomonas vaginalis prevalence among Filipino women is presented herein. A total of 288 women randomly drawn from various sources, including Social Hygiene clinics, Health Centers, and Family Planning Centers in the Metropolitan Manila Area were examined for T. vaginalis. Nineteen or (6.8%) were found positive either by wet mount or stained smear methods. Prevalence was significantly higher among the group of single than married women and five times higher among the waitress/hostess group than in the housewife/other group. Infection was related to parity and is significantly higher among nulliparous women. Likewise, a significant relationship was observed between prevalence of infection and gravidity. Prevalence decreases with increasing gravidity. No relationship in prevalence was observed between the use and non-use of contraceptives, and the method of contraceptive used. There was no significant association between the presence of the parasite and symptoms.

PIP: To study the Trichomonas vaginalis infection rate in the Philippines, 280 women were examined, by either wet mount or stained smear methods, in the greater Manilla area. chi-square with 1 degree of freedom=9.5). Among a waitress/hostess group the prevalence of infection was 5 times higher (15.2%) than in a housewife/other group designation (2.7%). Infection was related to parity and was significantly higher among nulliparous women (5/41 cases or 12.2%); prevalence decreased as parity increased. A similar significant relationship obtained between prevalence of infection and gravidity; here, prevalence decreased with increasing gravidity from 14.3% in nongravid women to 7.7% in gravida 1-2 women to 3.3% in gravida 3 and over women. No relationship was shown between use or nonuse of contraception and T. vaginalis infection prevalence. Although the prevalence was noted to be slightly higher among nonacceptors (7.4%) than acceptors (5.1%), the difference was not statistically significant. There was no relationship revealed between the type of contraceptive method used and presence of infection. Finally, no significant association was found between the presence of the parasite and symptoms.

Epidemiological features of choriocarcinoma.

By means of hospital records and death certificates, 91 cases of choriocarcinoma were identified in the cities of Manila, Quezon, Pasay, and Caloocan in the Philippines during the 5 years 1970-74. The overall incidence was 17.4 per 100 000 live births. The other principal findings in this population-based study concerned maternal age, history of fetal wastage, and number of pregnancies. Very high incidence rates for choriocarcinoma were registered for mothers aged 40 years and over and there was a slightly higher than average risk for women under 20 years of age. Risk increased with the number of fetal losses. The effect of number of pregnancies was evident only for very old and very young mothers. A case-control study was also conducted on 28 patients with choriocarcinoma and on 187 age-matched controls; for all of these women, the disease had been diganosed (cases) or children had been born (controls) between 1970 and 1975. Compared with the control group, a higher proportion of the case group had a history of pulmonary tuberculosis and had previously used contraceptive pills. Because of the low and unequal levels of cooperation among patients and controls, these findings need further confirmation.