Multidrug-resistant tuberculosis patients' views of interventions to reduce treatment loss to follow-up.

SETTING: Patients who initiated treatment for multidrug-resistant tuberculosis (MDR-TB) at 15 Programmatic Management of Drug-resistant Tuberculosis (PMDT) health facilities in the Philippines between July and December 2012. OBJECTIVES: To describe patients' views of current interventions, and suggest changes likely to reduce MDR-TB loss to follow-up. METHODS: In-depth interviews were conducted between April and July 2014 with MDR-TB patients who were undergoing treatment, had finished treatment at the time of the interview (controls), or had been lost to follow-up (LTFU). Responses were thematically analyzed. RESULTS: Interviews were conducted with 182 patients who were undergoing or had completed treatment and 91 LTFU patients. Views and suggestions could be thematically categorized as approaches to facilitate adherence or address barriers to adherence. The top themes were the need for transportation assistance or improvements to the current transportation assistance program, food assistance, and difficulties patients encountered related to their medications. These themes were addressed by respectively 63%, 60%, and 32% of the participants. CONCLUSIONS: A more patient-centered approach is needed to improve MDR-TB treatment adherence. Programs should strive to provide assistance that considers patient preferences, is adequate to cover actual costs or needs, and is delivered in a timely, uninterrupted manner.

Surveillance for tuberculosis in a rural community in The Philippines.

SETTING: Estimates of the tuberculosis (TB) burden in the Philippines are largely dependent on prevalence surveys. OBJECTIVE: To conduct a prospective community-based survey to generate epidemiological data on TB among patients seeking care in public health centres in a rural municipality in the Philippines. DESIGN: Prospective surveillance and follow-up of presumptive TB cases from May 2013 to July 2015. RESULTS: Of 1622 participants with presumptive TB, 468 (28.8%) (95%CI 26.6-31.1) were diagnosed with TB. The annual TB case notification rate in San Juan was 212 (95%CI 184-242) per 100 000 population. There were nine TB-attributable deaths during the study period. Only 8.8% (95%CI 6.2-11.32) of the cases were children aged <15 years; 274 (58.5%) cases were bacteriologically confirmed. Of 210 isolates tested for antimicrobial resistance, 49 (23.3%, 95%CI 17.58-29.02) were resistant. Resistance to isoniazid (INH) was common (n = 33, 15.7%); multidrug-resistant TB was 1.9%. CONCLUSION: TB remains an important health problem in the Philippines. We identified low case detection of TB in children and high INH resistance rates in this rural community.

Multidrug-resistant tuberculosis patients lost to follow-up: self-reported readiness to restart treatment.

SETTING: Multidrug-resistant tuberculosis (MDR-TB) patients lost to follow-up (LTFU) from Programmatic Management of Drug-resistant Tuberculosis facilities in the Philippines. OBJECTIVES: To gain insight into patients' readiness to return to treatment. METHODS: MDR-TB patients who initiated treatment and were categorized as LTFU were identified using TB registers, contacted, and asked to consent to an interview and medical record review. At the conclusion of the interview, patients' readiness to restart treatment was assessed and examined in relation to demographic, clinical, and interview data. Odds ratios were calculated. RESULTS: When asked if they would consider restarting MDR-TB treatment, 3% of the 89 participating patients reported that they had already restarted, 34% indicated that they wanted to restart, 33% had not considered restarting, 28% were undecided, and 2% had decided against restarting. Patients who wanted to restart treatment were more likely to report having borrowed money for TB-related expenses (OR 5.97, 95%CI 1.27-28.18), and were less likely to report being self-employed (OR 0.08, 95%CI 0.01-0.67), or perceive themselves at low or no risk for TB relapse (OR 0.30, 95%CI 0.08-0.96) than patients who did not indicate an interest in restarting treatment. CONCLUSIONS: Efforts to re-engage LTFU patients in care should consider financial barriers, knowledge gaps, and personal adherence challenges in patients.

A study of the environmental determinants of malaria and schistosomiasis in the Philippines using Remote Sensing and Geographic Information Systems.

Malaria and schistosomiasis are two water-related parasitic diseases affecting millions of people worldwide particularly tropical and subtropical countries. In the Philippines, malaria is found in 72 out of 78 provinces while schistosomiasis is endemic in 24 provinces. The Anopheles mosquito and the Oncomelania snail involved in the transmission of these diseases depend on certain environmental determinants that support mosquito and snail populations. This study, done for the first time in the Philippines, successfully showed how Remote Sensing (RS) and Geographical Information Systems (GIS) can be effectively used in showing how these environmental factors affect the spatial distribution of these two diseases. The study sites, i.e. the municipalities of Asuncion and Kapalong, are known endemic sites for both malaria and schistosomiasis. Georeferenced data enabled visualization of prevalence data in relation to physical maps thus facilitating assessment of disease situation in the two municipalities. RS and GIS data proved that other factors aside from climate influence the epidemiology of the diseases in the two sites. Topography and slope as main physical factors influence the vegetation cover, land use and soil type prevailing in particular areas. In addition, water sources especially irrigation networks differed in various places in the study sites in turn affecting the magnitude and distribution of malaria and schistosomiasis. Significant correlations found between the diseases and the environmental variables formed the basis for development of models to predict the disease prevalence in the two municipalities. Proximity to snail breeding sites and irrigation networks and the highly agricultural nature of the barangays were identified as the most common factors that define the high prevalence areas for schistosomiasis confirming the fact that conditions that support the snail populations will in turn favor the presence of the disease. For malaria, the predictive models included temperature, humidity, soil type, predominance of reproduction brush, presence of cultivated areas, distance from deep wells and distance from conventional water source which are in turn influenced by the factor of elevation.

Primary verification: is the TRISS appropriate for Thailand?

The Trauma and Injury Severity Score (TRISS) is a well-accepted model used to evaluate the quality of trauma care in the US. This research aims to study whether TRISS can be applied to evaluate trauma care and classify outcomes of road traffic injury patients in Thailand. A retrospective study was used to review the Thailand's Injury Surveillance System database from the 1st January to the 31st of December 1996. The study subjects were severe road traffic injury patients with blunt injuries. The TRISS model was applied to compute the survival probability for each patient. The chi-square goodness-of-fit was used to compare the survival probability distribution between the American Major Trauma Outcome of Study (MTOS) and the road traffic injuries in Thailand. The accuracy, sensitivity and specificity of the survival prediction by TRISS were evaluated. The distribution of survival probability between American trauma patients and Thai road traffic injury patients was significantly different (p-value < 0.00001). The TRISS model had high accuracy and sensitivity, but low specificity, in predicting the survival of Thai road traffic injuries. The MTOS and Thai road traffic injuries had different distributions for various factors such as the Revised Trauma Score (RTS), Injury Severity Score (ISS), and ages which effect injury survival. Due to these factors the distribution of survival probability between MTOS and Thai road traffic injuries was also significantly different. By applying TRISS, the survival prediction of Thai road traffic injuries resulted in a high number of false positives.

Tuberculosis in the urban poor settlements in the Philippines.

SETTING: Urban poor settlements in the Philippines. OBJECTIVE: To determine the magnitude of the tuberculosis problem in urban poor settlements in comparison with urban areas studied in the Nationwide Tuberculosis Prevalence Survey. STUDY DESIGN AND METHOD: A multistage cluster survey of BCG scar, tuberculin test, chest radiography and sputum examination for bacillary disease, in urban poor areas. RESULTS: The prevalences of culture-positive and smear-positive tuberculosis were 17.5 +/- 2.3 (95% CI 13.3-22.4) and 7.9 +/- 2.3 per thousand (95% CI 2.611.5), respectively. Extrapolated to the total population, the rates in the urban poor settlements were 12.4 +/- 1.7 (95% CI 9.6-16.2) and 5.6 +/- 1.6 per thousand population (95% CI 1.3-8.3), respectively. The prevalence of active pulmonary tuberculosis in subjects aged 10 years or more was 66 +/- 5.6/1000 (95% CI 55-77). The BCG vaccination rate was 72%. The overall prevalence of tuberculosis infection was 66%, and 39% in those aged 5-9 years, corresponding to an annual risk of infection (ARI) of 6.5%. CONCLUSION: The problem of tuberculosis was substantial in the urban poor settlements, and was appreciably worse than that in the general urban population.

Bacillary disease and health seeking behavior among Filipinos with symptoms of tuberculosis: implications for control.

SETTING: Urban and rural communities and urban poor settlements in the Philippines. OBJECTIVE: To determine bacillary disease and action taking among individuals with symptoms of tuberculosis (TB), and to analyze their implications for TB control. STUDY DESIGN AND METHOD: Subjects aged 20 years and older were interviewed in the 1997 nationwide stratified multi-cluster survey. Sputum acid-fast smears and cultures were done in subjects with abnormal screening chest radiographs. RESULTS: Individuals with TB symptoms comprised 18.1% of the population studied. The prevalence of bacillary disease was 39/1000 in symptomatic subjects compared to 13/1000 in asymptomatic subjects. Symptom screening had a 14.3% positive predictive value and a 91.4% negative predictive value for bacillary disease. Significantly more symptomatic than asymptomatic subjects attended chest radiographic screening during the survey. However, in response to their symptoms, the majority (43.0%) took no action or self medicated (31.6%), while 11.8% consulted a private practitioner, 7.5% a public health center, 4.4% a hospital, and 1.7% a traditional healer. CONCLUSION: Sputum smear examination after symptom screening was acceptable for case finding. The health seeking behavior of subjects with TB symptoms was inappropriate. A health education program and public-private collaboration in directly observed therapy, short course (DOTS) are essential for TB control in the Philippines.

in children. Its results were drawn with limited sample size obtained after a short phase of data collection. A further study should be conducted to get more precise and valid results that may be useful for preventing UTI among children.

This hospital-based case-control study was conducted from September 1998 to January 1999 in Metro Manila, Philippines. General objective of the study is to determine the association between selected hygiene behavior and urinary tract infection (UTI) among children aged 6-12 years. Specifically, the study is designed to examine the relationship between UTI and urination, defecation, washing and bathing habits. Twenty-three cases of children with UTI and an equal number of controls were recruited in four tertiary hospitals. The study association was determined by using odds ratio, the chi-square test and the Fisher exact test, where appropriate, in simple analysis. Furthermore, exact logistic regression analysis was applied to overcome the problem of small sample size. The data suggested that bathing habit less than daily, holding of urination during daytime, and washing habit after defecation might have risk effects on UTI. There was not enough evidence of significant association between UTI and other study exposures. Among extraneous variables, age group or school enrollment of children had a borderline significant association with UTI after adjusted simultaneously for selected variables. This study served as a pilot of the Preventive Nephrology Project (Department of Health, Philippines) in determining selected risk factors of

The 1997 Nationwide Tuberculosis Prevalence Survey in the Philippines.

SETTING: The Philippines is a developing country where tuberculosis (TB) remains a significant public health problem. OBJECTIVE: To determine the prevalence of TB as a basis for setting the targets of the National Tuberculosis Control Program. STUDY POPULATION AND METHODS: A multi-stage cluster survey of a random sample of 21960 subjects from 36 clusters nationwide was undertaken from 2 April to 31 July 1997. BCG scar verification and tuberculin testing was performed for subjects aged 2 months and over, and chest radiography screening was done on subjects 10 years and older. Sputum samples were collected from individuals who were initially assessed to have abnormal chest radiographs to determine the prevalence of bacillary tuberculosis. Acid-fast smear by modified Kinyoun's technique and culture on Löwenstein Jensen were done to demonstrate Mycobacterium tuberculosis. RESULTS: The prevalence of active pulmonary TB was 42/1000 population. The prevalence of culture-positive and smear-positive cases was 8.1 and 3.1/1000, respectively. The prevalence was similar in urban and rural areas. CONCLUSION: Morbidity from TB remains high. Allowing for methodological differences from the survey in 1981-1983, the prevalence of active pulmonary TB was unchanged. There was only a minimal decrease, of 37% for smear-positive cases and 25% for culture-positive cases, in the 14-year interval.

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.