Parasitological and nutritional status of school-age and preschool-age children in four villages in Southern Leyte, Philippines: Lessons for monitoring the outcome of Community-Led Total Sanitation.

While preventive chemotherapy remains to be a major strategy for the prevention and control of soil-transmitted helminthiases (STH), improvements in water, sanitation, and hygiene (WASH) comprise the long-term strategy to achieve sustained control of STH. This study examined the parasitological and nutritional status of school-age and preschool-age children in four villages in Southern Leyte, Philippines where two of the villages attained Open-Defecation-Free (ODF) status after introduction of Community-Led Total Sanitation (CLTS). A total of 341 children (89.0% of the total eligible population) submitted stool samples which were examined using the Kato-Katz technique. Results showed that 27.9% of the total stool samples examined had at least one type of STH (cumulative prevalence), while 7.9% had moderate-heavy intensity infections. Between the two villages where CLTS was introduced, Buenavista had a significantly higher cumulative prevalence of STH at 67.4% (p<0.001) and prevalence of moderate-heavy intensity STH at 23.5% (p=0.000), while Caubang had a significantly lower cumulative prevalence at 4.9% and prevalence of moderate-heavy intensity at 1.8%. On the other hand, the non-CLTS villages of Bitoon and Saub had similar rates for cumulative prevalence (16.7% and 16.8%, respectively; p=0.984) and prevalence of moderate-heavy intensity STH (2.0% and 3.1%, respectively; p=1.000). The findings may be explained by factors that include possible reversion to open defecation, non-utilization of sanitary facilities, and mass drug administration (MDA) coverage, although further studies that can accurately assess the impact of CLTS are recommended. While this study was descriptive, the data indicate no clear pattern among the parasitological and nutritional parameters, as well as the presence of CLTS in the village, suggesting the need to monitor the ODF status of villages on a regular basis even after the end of CLTS activities to ensure the sustainability of the CLTS approach. In order to achieve effective control of STH, deeper collaboration between the WASH and STH sectors are recommended where partners can work together in the area of monitoring and evaluation that may include improved parasitological and nutritional status in high-risk groups, as well as sustainable behavior change as outcome indicators.

Improving current helminth control strategies: Lessons from a baseline prevalence survey of soil-transmitted helminth infections in adolescent females and pregnant women in selected local government units in the Philippines

OBJECTIVES: This study utilized a cross-sectional study design to determine the prevalence and intensity of STH infections among adolescent females and pregnant women, to describe the nutritional status of the two population groups in selected study sites in the Philippines, and to propose a scheme for classification of endemic sites as basis for conduct of control strategies. METHODS: Parasitologic assessment was conducted through examination of collected stool samples using the Kato-Katz technique, while nutritional status was assessed through primary height and weight measurements.RESULTS: Results of the parasitologic assessment in adolescent females showed an overall cumulative prevalence of 30.4% (12.5% - 61.8%) and a prevalence of heavy intensity infection of 7.9% (0.7% - 22.6%). In pregnant women, overall cumulative prevalence was 31.5% (13.2% - 75.8%) and prevalence of heavy intensity infection was 10.2% (0.9%- 39.6%). CONCLUSION: Significant differences in prevalence in the different sentinel sites suggest the need to consider a modified classification scheme for endemic communities to determine the most cost-effective strategies for morbidity control. The utilization of this classification scheme alongside regular sentinel surveillance will help validate the scheme and contribute towards the development of more appropriate program guidelines for nationwide implementation.

Soil-transmitted helminthiases in secondary school students in selected sites in two provinces in the Philippines: policy implications.

The latest World Health Organization (WHO) strategic plan for eliminating soil-transmitted helminthiases (STHs) as a public health problem in children puts the emphasis on school-age children. On the other hand, the Philippine national helminth control program excludes secondary school students in mass deworming for STH. This study determined the prevalence and intensity of STH in a sample of 633 students (14-15 years old) in selected secondary schools in two Philippine provinces. Stool specimens were processed following the Kato-Katz technique and examined for the presence of helminth ova. Overall cumulative prevalence of STH was 31.3%, while prevalence of moderate-heavy-intensity infections was 7.7%, well beyond the WHO target of ≤1% for reducing morbidity in school-age children. Recommendations were made to update the Philippine helminth control program and to re-examine the WHO strategic plan so that helminth prevention and control strategies may also be emphasized for secondary school students especially in high-prevalence areas.

Integrated surveillance of pulmonary tuberculosis and paragonimiasis in Zamboanga del Norte, the Philippines.

BACKGROUND: Pulmonary tuberculosis (PTB) and paragonimiasis remain as health problems in certain areas in the Philippines. Both share similar clinical manifestations, which include chronic productive cough, hemoptysis, dyspnea, fever, weight loss, and night sweats. This study aimed to determine the prevalence of PTB, paragonimiasis, and co-infections in Zamboanga del Norte, Philippines. METHODS: This study was conducted in selected villages in two municipalities in Zamboanga del Norte. Patients with chronic cough were interviewed, examined, and requested to submit two sputum samples which were processed using Ziehl-Neelsen method to detect acid-fast bacilli (AFB), and NaOH concentration technique for the detection of Paragonimus ova. RESULTS: A total of 836 patients submitted sputum samples for examination. Prevalence was 6·7% (2·5-12·7%) for paragonimiasis and 1·9% (0·9-6·3%) for PTB. Co-infection rate was 0·3%, with two identified cases. Positivity rates for males and females were 9·6 and 5·8% for paragonimiasis and 3·4 and 1·2% for PTB. CONCLUSION: Pulmonary tuberculosis and paragonimiasis are co-endemic in Zamboanga del Norte, suggesting the need to integrate surveillance and control efforts. Strengthening local health systems through collaboration between different sectors is recommended for effective disease control. Development of more sensitive diagnostic tests is important for more accurate disease surveillance.

Validating the WHO dose pole in the Philippines for school-based mass drug administration of praziquantel for morbidity control of schistosomiasis.

BACKGROUND: Praziquantel typically requires weight-based field administration when used to treat helminthic diseases. Proper dosage adjustment of praziquantel by bodyweight can be difficult to achieve if accurate weighing scales are unavailable. The WHO has recommended for use a dose pole that substitutes height for weight during field administrations of praziquantel. METHODS: This cross-sectional study aims to validate the WHO dose pole for Philippine populations using height and drug administration data collected from 1427 Filipino schoolchildren. This study expands upon prior studies by specifically targeting Filipino schoolchildren and by introducing statistical techniques to increase the rigor of the validation process. RESULTS: The study found an average dose of 42.7 mg per kg (mg/kg) administered among 1427 students with a standard deviation of 3.5 mg/kg. The dose pole estimated a WHO-recommended dose (40-60 mg/kg) in 93.5% of students and a WHO-accepted dose (30-60 mg/kg) in 99.7% of all students. The 95% CIs showed that 99-100% of all tested students fell within the WHO-accepted dose range, while 91-93% of all tested students fell within the WHO-recommended dose range. CONCLUSIONS: The results suggest that the WHO dose pole is valid for mass treatment of Filipino schoolchildren with praziquantel. Further validation studies are recommended.