Application of the PRECEDE-PROCEED model in the development of evidence-informed interventions for drowning prevention: a mixed-methods study protocol.

INTRODUCTION: Drowning is a global public health threat, disproportionately impacting low-income and middle-income countries. In the Philippines, it is estimated that more than 5200 people die from drowning per annum. This number is likely to be higher than currently estimated with the inclusion of disaster-related and transportation-related drowning. Drowning is preventable if appropriate preventive interventions are put in place which redress known risk factors. METHODS AND ANALYSIS: This study uses the PRECEDE-PROCEED model (PPM), an eight-step health promotion planning and evaluation model for building and improving intervention programmes. This mixed-methods study, which can be used in any location, will be implemented in Los Banos, Laguna, Philippines, identified as an area of concern for drowning. Using the PPM, data on drowning will be collected from death records, community observation, key informant interviews, focus group discussions and community survey. A range of analytical methods will be used to explore drowning data including univariate and χ2 analyses, analysis of variance, relative risk and calculating rates using population data. The quantitative data and themes drawn from qualitative data will be used to populate the first four phases of the PPM. Following the data collection, the remaining stages of the PPM will be designed and implemented in the barangay (village) with the highest drowning rate. ETHICS AND DISSEMINATION: This study has obtained ethical clearance from the University of the Philippines Manila Research Ethics Board (UPMREB 2017-425-01). Study findings will be disseminated through workshops and presentations to the local community as well as through peer-reviewed literature and conference presentations. The PPM has rarely been applied to drowning prevention and it is the aim that the study described in this protocol is expanded across other areas of the Philippines and to other countries with a high drowning burden to inform prevention efforts.

"I Want to See a Drowning-Free Philippines": A Qualitative Study of the Current Situation, Key Challenges and Future Recommendations for Drowning Prevention in the Philippines.

Drowning is described as a public health challenge by the World Health Organization. This challenge faces the Philippines where drowning claims an average of 3276 lives annually (3.50/100,000 population). However, no research comprehensively documents prevention strategies implemented by government and non-government agencies at a national or local level in the Philippines. This study aimed to qualitatively explore the current situation and key challenges of preventing drowning in the Philippines through key informant interviews and make recommendations to guide prevention efforts. Interviews were conducted among government and non-government agencies involved in drowning prevention using purposive sampling. Qualitative data collected were thematically analyzed. Findings indicate government and non-government agencies implement drowning prevention programs or strategies based on the mandate of their institutions. Most commonly cited were activities related to education or information awareness, emergency and disaster preparedness, and swimming skills. It was revealed that each agency was relatively unaware of the drowning prevention programs of other agencies. A multisector approach is needed to develop coordinated and comprehensive programs and activities aimed at preventing drowning. In this way, duplication will be avoided and the minimal resources available will be used effectively to reduce the burden of drowning in the Philippines.

Preventing Child Drowning in the Philippines: The Need to Address the Determinants of Health.

Drowning is a public health issue in the Philippines, with children at significantly increased risk. Determinants of health (DoH) such as education, socio-economic status, ethnicity, and urbanization are factors that impact drowning risk. As drowning is a multisectoral issue, a national drowning prevention plan can drive collaboration with relevant stakeholders. This study reports trends in unintentional child (0-14 years) drowning in the Philippines (incidence, rates, and trends over time for fatal and non-fatal (years lived with a disability (YLDs) and disability adjusted life years (DALYs) from 2008-2017 and conducts an analysis of the Philippines' Multisector Action Plan (MSAP) on Drowning Prevention. From 2008-2017, 27,928 (95%UI [Uncertainty Interval]: 22,794-33,828) children aged 0-14 years died from drowning (52.7% aged 5-14 years old). Rates of drowning have declined among both age groups, with greater reductions seen among 0-4 year olds (y = -0.3368x + 13.035; R2 = 0.9588). The MSAP has 12 child drowning-specific activities and 20 activities were identified where DoH will need to be considered during development and implementation. The MSAP activities, and work done to prevent drowning more generally, must consider DoH such as education, urbanization, water and sanitation health, and safe water transportation. A national drowning surveillance system and investment in research in the Philippines are recommended.

Child drowning prevention in the Philippines: the beginning of a conversation.

This study describes a process to explore factors which contribute to child-drowning deaths and allows the development of appropriate strategies to prevent similar deaths in a selected site in the Northern Philippines. Data collection techniques used in obtaining baseline data include: review of drowning mortality records; key informant interviews; focus group discussions; and community walk-throughs. Risk factors identified which could or did contribute to drowning events were: proximity to bodies of water; inadequate child supervision; lack of information/awareness of prevention strategies; and lack of drowning prevention programme(s). Measures on how to prevent drowning deaths were explored and initial interventions were implemented through a committee convened by the community. These interventions include: community education sessions; capability building measures; redesigning of community wells; development of playpens; and use of barriers. Community engagement is a crucial element in the development and implementation of any health programme. This study demonstrates that by engaging and working with the community action occurs, however, there is a need to conduct further evaluation activities to determine if the actions by the community continued beyond the project and have resulted in a decrease in drowning. One of the strengths of the process described is that it is culturally appropriate and site-specific and allows the community to find the solutions itself. Exploration and delivery of further projects in larger areas is required to reduce drowning in the Philippines. An imperative is the evaluation which will provide valuable information on whether barriers are a sustainable and acceptable means of prevention to the community in the long term.

The status on non-communicable disease prevention and control in the Philippines: A systematic review

OBJECTIVE: This paper aims to provide concise background information regarding the state of noncommunicable diseases (NCDs) and their risk factors as well as the existing efforts to address them in the Philippines in the last 25 years. METHODS: A desk review of documents and literature review as well as analyses of available statistical data and several consultations with involved government agencies have been made to come up with summary figures and tables.RESULTS: NCDs as well as metabolic conditions that can potentially lead to NCDs are on the rise in the last score of years. The Philippines, through the Department of Health, has been visionary in leading various projects and activities to fight NCDs over the last two decades, and its efforts are slowly paying off: the prevalence of tobacco use and that of hypertension have decreased over the last 5 years. NCD mortality (including premature deaths) and prevalence of behavioral risk factors, however, generally remain high, and the Philippines needs to accelerate whole-of-society and whole-of-government actions to sustain the gains and attain its NCD targets in the next 10 years or so. CONCLUSION: The need to strengthen health system interventions and promote accountability of various sectors in addressing NCDs and its risk factors in the country arises. The development of a multisectoral action plan on NCD prevention and control is needed to halt the rise of NCDs in the country.

Assessment of a public health promotion and education module at the graduate level: A basis for revision of learning resource material for teaching and training health promotion and education

OBJECTIVES: This study assessed the existing Public Health Promotion and Education 210 module (PHPE 210) as basis for the revision of the learning resource material. Specifically, this study determined the stakeholders' perceptions on the module in terms of: (1) its presentation, organization, topics covered, clarity/user-friendliness and its relevance to practice; (2) its strengths and weaknesses; and (3) the topics that need to be integrated in the resource material. METHODS: A qualitative approach was used for this study. Through purposive sampling, 4 focus group discussions and 11 key informant interviews were done. Topic Guide was used as the main data collection instrument. Informed consent was obtained prior to data collection. Data was described verbatim, emerging themes and actual quotations from the participants and informants were extracted in the succeeding analysis. RESULTS: The results of the focus group discussions and key informant interviews, in general, were similar and actually complemented each other. The module was perceived to be relevant, comprehensive and logically organized. The historical foundation needs to be presented in a more concise and updated manner, and examples and practical applications of the PRECEDE-PROCEED model must be used. To update the module and make it more relevant to the present issues, innovative health promotion strategies such as social media, healthy settings, health in all policies, and multi-sectoral approach must be included in the revised version. Practical applications of the theories and health promotion and education strategies also need to be considered in the revision of the module. The module has to be presented in a more reader-friendly manner, easy-to-use and visually appealing to its readers. CONCLUSION: This study demonstrated the importance of incorporating the perceptions of educators, module developers, practitioners, experts, and the learners or students in assessing and redesigning a more relevant learning resource material. With the current trends and emerging issues in health promotion and education, an evidence-based development and improvement of learning resource modules to make them relevant to changes have to be continuously undertaken.

Selected sociodemographic and psychosocial variables related to mothers' preference for childbirth setting in a barangay in Rosario, Cavite

OBJECTIVES: This study aimed to describe selected sociodemographic and psychosocial factors that are related to mothers' preference for childbirth setting in a barangay in Rosario, Cavite. METHODS: This study utilized a descriptive cross-sectional design. An interview guide was developed, pretested, and used in interviewing mothers who had given birth from September 1, 2007 to August 31, 2010. Data collected was encoded and analyzed using Epi-info 3.5.1 to compute for the means and proportions of relevant variables. RESULTS: A total of 271 mothers were interviewed, of whom 53.5% gave birth at health facilities. Mothers who were young adults, had at least graduated from high school, and/or had a family income of greater than Php 10,000 tended to prefer facility-based delivery. Those who had adequate knowledge of child delivery and postpartum complications, as well as those with a positive attitude towards facility-based delivery, gave birth in health facilities. Among the family members, the spouses had greater influence on the decisions of mothers regarding their preference. Whereas doctors appeared to have influenced the decisions of mothers who had facility-based deliveries, midwives influenced those who had home-based deliveries. CONCLUSION: The maternal mortality ratio in Rosario, Cavite and the facility-based delivery rate in the sampled barangay remain higher than the targeted rates. This necessitates more efforts to achieve Millennium Development Goal (MDG) No 5. The findings of this study can serve as a guide in developing health promotion and education intervention focusing on specific age group, significant others, and health providers in order to achieve the desired outcomes.

PCR and culture identification of pathogenic Leptospira spp. from coastal soil in Leyte, Philippines, after a storm surge during Super Typhoon Haiyan (Yolanda).

Leptospirosis is a zoonosis caused by pathogenic Leptospira spp. Most of the outbreaks of leptospirosis occur after floods caused by heavy rain in countries where Leptospira spp. are endemic. It has been believed that the overflow of seawater rarely causes outbreaks of leptospirosis because the leptospires are killed by salt water. On 8 November 2013, a storm surge caused by Super Typhoon Haiyan (Yolanda) inundated the entire coastal areas of Tacloban and Palo in Leyte, Philippines. The present study was carried out in order to determine whether the environmental leptospires in soil were able to survive after the storm surge in the affected areas. We collected 23 wet soil samples along the coastal areas of Tacloban and Palo 2 months after the storm surge. The samples were suspended in HEPES buffer, and the supernatants were cultured in liquid or semisolid Korthof's medium supplemented with five antimicrobial agents to inhibit the growth of contaminants. Leptospires were isolated from primary cultures of 22 out of 23 samples. The DNA of pathogenic Leptospira species was detected in 11 samples (47.8%) by analysis of flaB by nested PCR. Eventually, two pathogenic Leptospira strains were isolated and showed the highest 16S rRNA gene sequence similarity to Leptospira kmetyi. When these isolates were experimentally mixed with soil, they were found to survive in seawater for 4 days. These results show the possibility that leptospires living in soil survived after the storm surge. Our findings may serve as a warning that when seawater inundates the land during a storm surge or a tsunami, an outbreak of leptospirosis could occur in the disaster-stricken area.

Tobacco use among fourth year Bachelor of Science in Public Health (BSPH) students of the College of Public Health: University of the Philippines Manila, academic year 2012-2013.

This study determines the prevalence of tobacco use among graduating Public Health students at the College of Public Health, University of the Philippines Manila. It also describes the exposure to environmental tobacco smoke, attitudes, behaviors and smoking cessation training of students. This study used a descriptive cross-sectional study design, adapting a standard questionnaire, pretested and administered to 52 Bachelor of Science in Public Health (BSPH) students at the College of Public Health, University of the Philippines Manila. Data generated from the survey were encoded using Epi Info version 3.5.4 and analyzed using Stata version 12. The prevalence of smoking among 4th year BSPH students was 5.8 % (current smokers). In the past 7 days, respondents have been exposed to secondhand smoke (44 % where they live; 79 % in places other than where they live). Majority were aware of the official policy on smoking ban in school, however, 80 % said that the policy is not enforced. Majority had favorable attitudes in terms of banning tobacco sales to adolescents, banning advertising of tobacco products, banning smoking in restaurants, discos/bars/pubs and enclosed public places. Majority of the respondents also believed that health professionals should get specific training on cessation techniques, that they do serve as role models, and that they have a role in giving advice about smoking cessation. More than three-quarters (76.9 %) of students said that health professionals who smoke are less likely to advise patients to quit. Most of the graduating students learned about the dangers of smoking, importance of obtaining tobacco use history, and providing educational support materials in their public health education but only a few received formal training about smoking cessation approaches. The implementation of the no-smoking policy of the university must be revisited. Smoking cessation approaches should be incorporated in the public health curriculum and the role of public health students in advocating a smoke-free lifestyle should be emphasized.

Partnership for health development through the field practice

This article describes the partnership between the College of Public Health, University of the Philippines Manila and the province of Laguna in the context of implementation of the field practice course. This partnership paved the way for the development and implementation of projects in seven field practice sites. Projects concentrated mainly on improving quality of data and health information system, development of educational materials, and addressing health problems such as tuberculosis, hypertension and rabies. After the implementation of the various activities, there is a need for both parties (the College of Public Health and the Provincial Health Office of Laguna) to monitor and evaluate if projects have been sustained. Moreover, successful projects must also be fully documented which can serve as models for other areas in the province of Laguna.

Knowledge, attitudes and practices of parents in an urban coastal community on preventing childhood drowning

OBJECTIVE:To describe the knowledge, attitudes and practices of parents in an urban coastal community on drowning prevention.METHODS: A descriptive cross-sectional study design was used in the study. Systematic random sampling was used and 431 parents were included as respondents in the study. A questionnaire that was developed and pre-tested was used to determine the knowledge, attitudes and practices on drowning prevention among parents in households with at least one child. RESULTS: The respondents' knowledge on general aspects of drowning such as its preventability and to whom and where it could happen seems to be sufficient (67-99%). Awareness of drowning prevention programs and activities in the barangay is quite low, and awareness of any legislation is even lower. The respondents seem to have positive attitudes toward supervising children while swimming or playing in high risk areas, in buying and wearing flotation devices, and participating in drowning prevention measures. Although 60 % claimed to have supervised their children while swimming in the sea, river, lake or swimming pools, more respondents (67 % - 88%) had admitted that their children had never worn flotation devices when they swim or play in most bodies of water. More than 93% of the parents have not participated in any program or activity on drowning prevention. CONCLUSIONS: The study seems to show that, in the surveyed coastal community, there is a high level of knowledge in terms of the general aspects of drowning and there are positive attitudes in terms of measures and activities to prevent drowning. However, this has not translated to similarly appropriate levels of drowning prevention practices.