Costs of Digital Adherence Technologies for Tuberculosis Treatment Support, 2018-2021.

Digital adherence technologies are increasingly used to support tuberculosis (TB) treatment adherence. Using microcosting, we estimated healthcare system costs (in 2022 US dollars) of 2 digital adherence technologies, 99DOTS medication sleeves and video-observed therapy (VOT), implemented in demonstration projects during 2018-2021. We also obtained cost estimates for standard directly observed therapy (DOT). Estimated per-person costs of 99DOTS for drug-sensitive TB were $98 in Bangladesh (n = 719), $119 in the Philippines (n = 396), and $174 in Tanzania (n = 976). Estimated per-person costs of VOT were $1,154 in Haiti (87 drug-sensitive), $304 in Moldova (173 drug-sensitive), $452 in Moldova (135 drug-resistant), and $661 in the Philippines (110 drug-resistant). 99DOTS costs may be similar to or less expensive than standard DOT. VOT is more expensive, although in some settings, labor cost offsets or economies of scale may yield savings. 99DOTS and VOT may yield savings to local programs if donors cover infrastructure costs.

Regulatory landscape and public perception for gene-edited bananas in the Southeast Asian region.

Banana is a premier fruit crop in many parts of the world especially Southeast Asia. The demand for banana has contributed to significant national income to primary banana producers in the SEA region such as the Philippines, Indonesia, Thailand, Vietnam, and Malaysia. However, the widely traded banana industry is plagued by numerous threats including pests and diseases, post-harvest issues and extreme climate vulnerability. To address these challenges, new breeding techniques such as gene editing have been explored for breeding programs to develop improved banana varieties. The first gene-edited non-browning banana has been deregulated in the Philippines recently, and more regulatory applications are expected to submit for approvals soon. Hence, it is timely to review the policy options for gene editing that have been adopted and discussed in the Southeast Asian countries and highlight the implications of differing regulatory approaches to gene editing for trading activities. Positive stakeholders' perceptions and public acceptance are key factors in allowing the benefits of gene editing and thus appropriate outreach strategies are important to gain acceptance and avoid the "GMO stigma" that may be associated with gene-edited products.

Plasmodium knowlesi Infection in Traveler Returning to Canada from the Philippines, 2023.

A 55-year-old man sought treatment for an uncomplicated febrile illness after returning to Canada from the Philippines. A suspected diagnosis of Plasmodium knowlesi infection was confirmed by PCR, and treatment with atovaquone/proguanil brought successful recovery. We review the evolving epidemiology of P. knowlesi malaria in the Philippines, specifically within Palawan Island.

Evaluation of lateral flow devices for postmortem rabies diagnosis in animals in the Philippines: a multicenter study.

Expansion of the use of lateral flow devices (LFD) for animal rabies diagnosis can help mitigate the widespread underreporting of rabies. However, this has been hindered by the limited number and small sample size of previous studies. To overcome this limitation, we conducted a multicenter study with a larger sample size to assess the diagnostic accuracy of the ADTEC LFD for postmortem rabies diagnosis in animals. Thirteen governmental animal diagnostic laboratories in the Philippines were involved in this study, and 791 animals suspected of having rabies were tested using both the direct fluorescence antibody test (DFAT) and ADTEC LFD between August 2021 and October 2022. The LFD demonstrated a sensitivity of 96.3% [95% confidence interval (CI): 94.1%-97.9%] and a specificity of 99.7% (95% CI: 98.4%-100%). Notably, false-negative results were more likely to occur in laboratories with lower annual processing volumes of rabies samples in the previous years (adjusted odds ratio 4.97, 95% CI: 1.49-16.53). In this multicenter study, the high sensitivity and specificity of the LFD for the diagnosis of animal rabies, compared to that of the DFAT, was demonstrated, yet concerns regarding false-negative results remain. In areas with limited experience in processing rabies samples, it is essential to provide comprehensive training and careful attention during implementation.

Now is no longer the time for poets.

A reflection piece-on rethinking the return of a Martial Law dictator in the form of his namesake, the newly elected president of the Philippines; the gamut of conversations on (un)covered facts, post-truth, appearances, interpolations, populism, revisionism and transformations, as well as the power of (trans)national media and images entangled with participatory publics; and how might a younger generation and/or transgender poet, such as myself, who did not experience first-hand the atrocities of military rule and learned them only through dominant narratives, might create and/or open capacious spaces for empathic opacity, new understandings, and possible coalitions and resistances within a historical moment concurrent with a present and/or imagined dystopia-expressed as a suit of three poems: To write another eye; Now is no longer the time for poets; Requisite condemnation.

Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men.

BACKGROUND: The Philippines is experiencing an HIV crisis and is considering implementing pre-exposure prophylaxis (PrEP) as a national public health strategy for HIV prevention for cisgender men who have sex with men (cis-MSM). However, critical information on the awareness of PrEP among cis-MSM is needed to roll out this public health initiative. OBJECTIVE: This study aims to assess PrEP awareness and related correlates (ie, sociodemographic variables, social factors, and health care access and use) among Filipino cis-MSM. METHODS: We conducted a web-based survey with Filipino cis-MSM (n=179) residing in the cities of Manila and Cebu, Philippines. Multivariable analysis procedures were performed to examine the factors associated with PrEP awareness. RESULTS: Our sample demonstrated high awareness (134/179, 74.9%) and interest (159/179, 88.8%) in taking PrEP. The adjusted model showed that greater odds of PrEP awareness were associated with having a college education or higher versus a high school education or lower (adjusted odds ratio [aOR] 7.30, 95% CI 1.01-52.47), earning between PHP 10,000 (US $198.6) and PHP 20,000 (US $397.2) versus

Health Information Systems for Older Persons in Select Government Tertiary Hospitals and Health Centers in the Philippines: Cross-sectional Study.

BACKGROUND: The rapid aging of the world's population requires systems that support health facilities' provision of integrated care at multiple levels of the health care system. The use of health information systems (HISs) at the point of care has shown positive effects on clinical processes and patient health in several settings of care. OBJECTIVE: We sought to describe HISs for older persons (OPs) in select government tertiary hospitals and health centers in the Philippines. Specifically, we aimed to review the existing policies and guidelines related to HISs for OPs in the country, determine the proportion of select government hospitals and health centers with existing health information specific for OPs, and describe the challenges related to HISs in select health facilities. METHODS: We utilized the data derived from the findings of the Focused Interventions for Frail Older Adults Research and Development Project (FITforFrail), a cross-sectional and ethics committee-approved study. A facility-based listing of services and human resources specific to geriatric patients was conducted in purposively sampled 27 tertiary government hospitals identified as geriatric centers and 16 health centers across all regions in the Philippines. We also reviewed the existing policies and guidelines related to HISs for OPs in the country. RESULTS: Based on the existing guidelines, multiple agencies were involved in the provision of services for OPs, with several records containing health information of OPs. However, there is no existing HIS specific for OPs in the country. Only 14 (52%) of the 27 hospitals and 4 (25%) of the 16 health centers conduct comprehensive geriatric assessment (CGA). All tertiary hospitals and health centers are able to maintain medical records of their patients, and almost all (26/27, 96%) hospitals and all (16/16, 100%) health centers have data on top causes of morbidity and mortality. Meanwhile, the presence of specific disease registries varied per hospitals and health centers. Challenges to HISs include the inability to update databases due to inadequately trained personnel, use of an offline facility-based HIS, an unstable internet connection, and technical issues and nonuniform reporting of categories for age group classification. CONCLUSIONS: Current HISs for OPs are characterized by fragmentation, multiple sources, and inaccessibility. Barriers to achieving appropriate HISs for OPs include the inability to update HISs in hospitals and health centers and a lack of standardization by age group and disease classification. Thus, we recommend a 1-person, 1-record electronic medical record system for OPs and the disaggregation and analysis across demographic and socioeconomic parameters to inform policies and programs that address the complex needs of OPs. CGA as a required routine procedure for all OPs and its integration with the existing HISs in the country are also recommended.

Displaced by climate and disaster-induced relocations: experiences of cascading displacement in Fiji and the Philippines.

Disasters and climate-related risks displace millions of people each year. Planned relocation is one strategy used to address displacement. However, little attention has been paid to the secondary impacts of planned relocations, and how they influence the risk, vulnerability, and well-being of other groups, particularly people who live on the land selected for relocation sites, or in neighbouring areas. This paper explores how current and potential planned relocations in Fiji and the Philippines redistribute vulnerabilities to non-target communities that previously lived on, or alongside, relocation site land. The notion of cascading displacement is introduced to illustrate a serious consequence of planned relocations in which insecurity and displacement are recreated and perpetuated due to a failure to consider the needs of non-target groups that are directly disadvantaged by relocation processes. Insights from this paper may be used to inform future relocation policy and practice to achieve more equitable and sustainable outcomes for all involved.

Diphtheria in Metro Manila, the Philippines 2006-2017: A Clinical, Molecular, and Spatial Characterization.

BACKGROUND: Diphtheria is a vaccine-preventable disease that persists as a global health problem. An understanding of the pattern of disease is lacking in low- and middle-income countries such as the Philippines. METHODS: We conducted a retrospective review of the clinical, microbiological, and epidemiological features of patients admitted with a clinical diagnosis of diphtheria to an infectious disease referral hospital in Metro Manila, the Philippines, between 2006 and 2017. Cases were mapped and the distribution was compared with population density. Corynebacterium diphtheriae isolates from between 2015 and 2017 were examined by multilocus sequence typing (MLST). RESULTS: We studied 267 patients (range:12-54 cases/year) admitted between 2006 and 2017. The case fatality rate (CFR) was 43.8% (95% confidence interval, 37.8-50.0%). A higher number of cases and CFR was observed among children <10 years. Mortality was associated with a delayed admission to hospital and a lack of diphtheria antitoxin. Between 2015 and 2017 there were 42 laboratory-confirmed cases. We identified 6 multilocus sequence types (STs). ST-302 was the most common (17/34, 48.6%), followed by ST67 (7/34, 20%) and ST458 (5/34, 14%). Case mapping showed a wide distribution of diphtheria patients in Metro Manila. Higher case numbers were found in densely populated areas but with no apparent clustering of ST types. CONCLUSIONS: Our analysis indicates that diphtheria remains endemic in Metro Manila and that the infection is frequently fatal in young children. Improved vaccine coverage and a sustainable supply of diphtheria antitoxin should be prioritized.

Detection of Norovirus Variant GII.4 Hong Kong in Asia and Europe, 2017-2019.

We report a new norovirus GII.4 variant, GII.4 Hong Kong, with low-level circulation in 4 Eurasia countries since mid-2017. Amino acid substitutions in key residues on the virus capsid associated with the emergence of pandemic noroviruses suggest that GII.4 Hong Kong has the potential to become the next pandemic variant.

Relationship between nurse practice environment and work outcomes: A survey study in the Philippines.

AIMS: Challenges in the nurse practice environment greatly affect nurse work outcomes. This study investigated the relationship between nurse practice environment and work outcomes in the Philippines. METHODS: This cross-sectional survey involved 549 hospital nurses in the Philippines in 2018. The nurse practice environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Four self-report scales were used to measure work outcomes: job satisfaction, job burnout, job stress and nurse-assessed quality of care. Multiple linear regression analysis was used to analyse the data. RESULTS: Significant relationships were found between nurse and organizational characteristics and nurse practice environment. Further, multivariate regression analysis revealed that the nurse practice environment had a significant and positive relationship with perceived quality of care and a significant and negative relationship with job burnout and job stress. CONCLUSION: A favourable work environment significantly reduced job burnout and job stress and improved the quality of patient care. With considerable migration abroad, a favourable nurse practice environment may engage a better nurse workforce in the country and subsequently reduce migration. Managers must focus on developing good nurse practice environments that will improve professional work outcomes and quality patient care.

Distribution of Japanese Encephalitis Virus, Japan and Southeast Asia, 2016-2018.

During 2016-2018, we conducted surveillance for Japanese encephalitis virus (JEV) in mosquitoes and pigs in Japan, Thailand, the Philippines, and Indonesia. Phylogenetic analyses demonstrated that our isolates (genotypes Ia, Ib, III, IV) were related to JEV isolates obtained from the same regions many years ago. Indigenous JEV strains persist in Asia.

Environmental Presence and Genetic Characteristics of Carbapenemase-Producing Enterobacteriaceae from Hospital Sewage and River Water in the Philippines.

This study aimed to evaluate the prevalence and genetic characteristics of carbapenemase-producing Enterobacteriaceae (CPE) in hospital sewage and river water in the Philippines, which has a typical tropical maritime climate. We collected 83 water samples from 7 hospital sewage and 10 river water sites. CPE were identified using CHROMagar mSuperCARBA, and Gram-negative strains were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) or 16S rRNA gene sequencing. Resistance genes in Enterobacteriaceae strains were identified using PCR and DNA sequencing, and transferability of carbapenemase genes from the CPE was investigated with conjugation experiments. Genotyping was performed using multilocus sequence typing (MLST) for Escherichia coli and Klebsiella pneumoniae Out of 124 Enterobacteriaceae isolates, we identified 51 strains as CPE and divided these into 7 species, 11 E. coli, 14 Klebsiella spp., 15 Enterobacter spp., and 11 others, including 4 additional species. Conjugation experiments via broth mating and using E. coli J53 revealed that 24 isolates can transfer carbapenemase-encoding plasmids. MLST analysis showed that 6 of 11 E. coli isolates belonged to clonal complex 10 (CC10). Of 11 K. pneumoniae strains, 9 unique sequence types (STs) were identified, including ST147. Five types of carbapenemase genes were identified, with the most prevalent being NDM (n = 39), which is epidemic in clinical settings in the Philippines. E. coli CC10 and K. pneumoniae ST147, which are often detected in clinical settings, were the dominant strains. In summary, our results indicate that hospital sewage and river water are contaminated by CPE strains belonging to clinically important clonal groups.IMPORTANCE Carbapenemase-producing Enterobacteriaceae (CPE) cause severe health care-associated infections, and their increasing prevalence is a serious concern. Recently, natural ecosystems have been recognized as important reservoirs of antibiotic resistance genes. We investigated the prevalence and genetic characteristics of CPE isolated from the environment (hospital sewage and river water) in the Philippines and found several CPE, including Escherichia coli and other species, with different carbapenemases. The most prevalent carbapenemase gene type was NDM, which is endemic in clinical settings. This study revealed that isolates belonging to carbapenemase-producing E. coli CC10 and K. pneumoniae sequence type 147 (ST147), which are often detected in clinical settings, were dominant in the natural environment. Our work here provides a report on the presence and characteristics of CPE in the environment in the Philippines and demonstrates that both hospital sewage and river water are contaminated by CPE strains belonging to clinically important clonal groups.

Parents' characteristics, the home environment, and children's numeracy skills: How are they related in low- to middle-income families in the Philippines?

The home numeracy environment is often assumed to play a role in early numeracy development. This study aimed to provide a comprehensive picture of the home numeracy environment of children living in low- to middle-income communities in the Philippines. Moreover, it examined the relations among various parents' characteristics, the home numeracy environment parents created, and their young children's numeracy skills. Data were collected from 290 families through parental questionnaires, numeracy tests for children, and numeracy tests for parents. Results of structural equation modeling showed that parents' education level, calculation fluency, own reported math activities, home numeracy resources and home numeracy activities all had direct associations with children's numeracy skills. Parents' calculation fluency and own math activities also had indirect links with children's numeracy skills through home numeracy resources and home numeracy activities. These findings provide insights into the question of which children are at risk for poor numeracy development and how to support children's early numeracy learning.

Factors Influencing Measure-based Adaptation of Rice Farmers for Slow-Onset Hazard: the Case of Saltwater Inundation in the Philippines and Vietnam.

This study sought to determine the factors influencing rice farmers' adaptation to a slow-onset hazard such as saltwater inundation. The research is based on a survey conducted through personal interviews using Kobotool App consisting of 326 coastal rice farmers in Northern Mindanao, the Philippines and 258 rice farmers in two provinces in the Mekong Delta in Vietnam. There were four levels of analyses for the assessment of the feasibility of the adaptation measures implemented by the farmers. First, it classified adaptation measures into specific categories: technology based, farm-based crop management, ecosystem-based adaptation, off-farm income diversification, and other measures. Second, it developed a multi-criteria assessment tool on adaptation measures based on stakeholder analysis and expert judgment based on four major feasibility criteria. Third, it determined the level of adaptation based on the combination of measures and the feasibility of the chosen measures by constructing a measure-based adaptation index (MAI). Finally, it came up with a model showing the factors influencing the MAI of the farmers. The results revealed that adaptation takes place at different levels in the two countries based on the diversity of measures, the feasibility of the various measures, and the varying conditions of saltwater inundation. The empirical evidence provides systematic support for the hypothesis that adaptation measures are influenced by a confluence of social, institutional, and economic factors.

Establishing rates of carbon sequestration in mangroves from an earthquake uplift event.

We assessed the carbon stocks (CS) in mangroves that developed after a magnitude 7.1 earthquake in Silonay, Oriental Mindoro, south Luzon, The Philippines in November 1994. The earthquake resulted in a 50 cm uplift of sediment that provided new habitat within the upper intertidal zone which mangroves colonized (from less than 2 ha pre-earthquake to the current 45 ha, 23 years post-earthquake). The site provided an opportunity for a novel assessment of the rate of carbon sequestration in recently established mangroves. The carbon stock was measured in above-ground, below-ground and sediment compartments over a seaward to landward transect. Results showed a mean carbon stock of 549 ± 30 Mg C ha-1 (of which 13% was from the above-ground biomass, 5% from the below-ground biomass and 82% from the sediments). There was high carbon sequestration at a 40 cm depth that can be inferred attributable to the developed mangroves. The calculated rate of C sequestration (over 23 years post-earthquake) was 10.2 ± 0.7 Mg C ha-1 yr-1 and is comparable to rates reported from mangroves recovering from forest clearing. The rates we present here from newly developed mangroves contributes to calibrating estimates of total CS from restored mangroves (of different developmental stages) and in mangroves that are affected by disturbances.

Food sources, energy and nutrient intakes of adults: 2013 Philippines National Nutrition Survey.

BACKGROUND: Comprehensive assessment of dietary intakes of foods and nutrients in Filipino adults are lacking. This study evaluated energy and nutrient intakes and food sources of key nutrients consumed by Filipino adults. METHODS: The participants were from the 2013 National Nutrition Survey wherein food intake of young adults aged 19-49 years (n = 12,896) and older adults aged 50 years and above (n = 7853) were collected using 24-h recalls. Usual nutrient intakes were estimated using PC-SIDE program. The Philippines Dietary Reference Intakes were used to calculate proportions of inadequate intake using Estimated Average Requirement (EAR) and Acceptable Macronutrient Distribution Ranges (AMDR). Energy adequacy was evaluated using the Institute of Medicine (IOM) equation for Estimated Energy Requirements (EER). RESULTS: The nutrient intakes with the highest prevalence of inadequacy (> 50%) were: iron (97-99%), vitamin C (96-98%), calcium (95-98%), riboflavin (86-91%), folate (89-90%), thiamine (73-89%), energy (67-70%), total fat (55-67%), and vitamin A (54-56%). Refined rice, pork and breads contributed most to daily intakes of energy, protein, carbohydrates, thiamine, riboflavin, and iron. Low intake of vegetables, fruits and dairy was common in both age groups. CONCLUSIONS: This study demonstrated that intakes of many nutrients were markedly inadequate among adults in the Philippines, due to the rice-dominant dietary pattern with few nutrient-dense foods. These results can be used to support the development of specific interventions to improve the shortfalls in nutrient intakes.

Reemergence of Reston ebolavirus in Cynomolgus Monkeys, the Philippines, 2015.

In August 2015, a nonhuman primate facility south of Manila, the Philippines, noted unusual deaths of 6 cynomolgus monkeys (Macaca fascicularis), characterized by generalized rashes, inappetence, or sudden death. We identified Reston ebolavirus (RESTV) infection in monkeys by using serologic and molecular assays. We isolated viruses in tissues from infected monkeys and determined viral genome sequences. RESTV found in the 2015 outbreak is genetically closer to 1 of the 4 RESTVs that caused the 2008 outbreak among swine. Eight macaques, including 2 also infected with RESTV, tested positive for measles. Concurrently, the measles virus was circulating throughout the Philippines, indicating that the infection of the macaques may be a reverse zoonosis. Improved biosecurity measures will minimize the public health risk, as well as limit the introduction of disease and vectors.

A qualitative study on the stigma experienced by people with mental health problems and epilepsy in the Philippines.

BACKGROUND: Stigma towards people with mental health problems (PMHP) is known to have substantial negative impacts on their lives. More in-depth exploration of the stigma and discrimination experienced by PMHP in low- and middle-income countries is needed. Previous research suggests that negative attitudes towards PMHP are widespread among the Filipino general public. However, no study has investigated PMHP's own experiences of being stigmatised in the Philippines. METHODS: A qualitative study was conducted on the stigma experienced by PMHP (including people with epilepsy) and its related factors in the Philippines, employing the constructivist grounded theory approach. We analysed data on 39 PMHP collected through interviews with PMHP, their carers, and community health volunteers who know them well. RESULTS: The findings highlight the culturally and socio-economically specific contexts, consequences, and impact modifiers of experiences of stigma. Participants emphasised that PMHP face stigma because of the cultural traits such as the perception of mental health problem as a disease of the family and the tendency to be overly optimistic about the severity of the mental health problem and its impact on their life. Further, stigma was experienced under conditions where mental health care was not readily available and people in the local community could not resolve the PMHP's mental health crisis. Stigma experiences reduced social networks and opportunities for PMHP, threatened the economic survival of their entire family, and exacerbated their mental health problems. An individual's reaction to negative experiences can be fatalistic in nature (e.g. believing in it is God's will). This fatalism can help PMHP to remain hopeful. In addition, traditional communal unity alleviated some of the social exclusion associated with stigma. CONCLUSIONS: The study indicates that existing stigma-reduction strategies might have limitations in their effectiveness across cultural settings. Therefore, we propose context-specific practical implications (e.g. emphasis on environmental factors as a cause of mental health problems, messages to increase understanding not only of the possibility of recovery but also of challenges PMHP face) for the Philippines.

Divided disasters: examining the impacts of the conflict-disaster nexus for distanced crises in the Philippines.

'Divided disasters' are conflicts and natural hazard-induced disasters that occur simultaneously, but in different locations within the same national boundaries. They will place pressure on the same national governance structures, will draw on the same international and national humanitarian resources, and therefore can mutually reinforce the challenges and risks faced by affected populations. Yet, as this paper argues, the impacts do not originate in the direct interaction of these two variables. Rather, they derive, in part, from the management of humanitarian responses to them-namely, through the reprioritisation of attention and the redeployment of resources as driven by the imperatives of 'the good project'. Using a case study of the Philippines, and the parallel emergencies of Typhoon Haiyan (one of the strongest tropical cyclones on record) and the spike in violence in Mindanao in 2013, this paper explores the organisational motivators of humanitarian responses to divided disasters, and assesses their implications for affected populations.