Factors affecting medication adherence of hypertension and diabetes club members in the District Health Centers in the City of Baguio

Background@#Medication adherence is important to mitigate complications of NCDs. Hypertension and diabetes clubs were intended to make essential medications accessible to club members. Despite these efforts, patients avail treatment and management in acute care with noted complications. To address this problem, it is important to identify factors that affect patients’ adherence medication.@*Objectives@#This study aimed to determine the factors affecting adherence to medications of members enrolled in the Hypertension and Diabetes Club in the district health centers in the city of Baguio.@*Methods@#This is a cross-sectional study with a total of 374 respondents from the 16 different district health centers in the City of Baguio, obtained through random sampling. A validated questionnaire was utilized for the collection of data and was presented using percentage and frequency tables. A chi-square test was used to find the association of clinic-demographic data with respondents’ medication adherence.@*Results@#Hypertension and Diabetic Club members overall reported good adherence to medication. Majority of the respondents are female and are older than 61 years old while comorbidities show significant association with level of adherence. On the other hand, lack of finances, feeling that the drug is not effective, multiple medications, taking medications for many years, interference with meal plan, feeling the dose is too high, and complexity of drug regimen are noted to be associated factors for non-adherence.@*Conclusion@#Hypertension and Diabetes Club a community-based management in the City of Baguio shows a good impact on patients’ medication adherence. Comorbidities, chronicity, good family support as well as good physician-patient relationship can positively affect adherence to medications. On the other hand, factors affecting medications non-adherence are: complexity of medications, subjective report that medication is too high, interference to meal, having medications for many years and having multiple medications. Identifying factors affecting adherence and nonadherence are important to decrease further complications of the common NCDs.

Diagnostic accuracy of the neonatal early onset sepsis calculator in screening for early onset sepsis in neonates more than 35 weeks age of gestation

Background@#Early-onset sepsis (EOS) is a leading cause of morbidity and mortality among neonates. Diagnosis of EOS can be difficult as clinical signs are subtle. The use of the Neonatal EOS Calculator (NEOSC) may help screen high-risk neonates for EOS and may result in a significant reduction in unnecessary antibiotic use. @*Objective@#To determine the diagnostic accuracy of the NEOSC in screening for EOS in neonates more than 35 weeks age of gestation. @*Methodology@#This was a retrospective, case-control study where 245 septic (cases) and 245 non-septic (controls) neonatal and maternal medical records were reviewed. The EOS risk classification from the NEOSC was compared with the actual clinical outcome. An online statistical software (medcalc.org) was used to compute for the sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and accuracy of the NEOSC. @*Results@#Based on the NEOSC, only 64 of 245 clinically septic neonates were truly positive for sepsis while 181 were falsely negative for sepsis. Of the 245 non-septic neonates, 3 were falsely positive for sepsis, while 242 were truly negative for sepsis. With a 95% confidence interval, the computed variables showed a Sn 26.12%, Sp 98.78%, PPV 76.12%, NPV 89.95%, PLR 21.33, and NLR 0.75. The accuracy of the NEOSC is 89.33%.@*Conclusion@#The NEOSC had poor sensitivity and is not recommended in screening for EOS in neonates more than 35 weeks age of gestation. It may be used as an adjunct in EOS diagnosis due to its high specificity and accuracy.

Clinical profile and course on follow-up of newborns of SARS-CoV-2 positive mothers

Objective@#This study aims to determine the clinical profile and course on follow-up of newborns delivered to a SARS-CoV-2 positive mother from two private tertiary hospitals. @*Methodology@#This is a retrospective, cross-sectional study. A chart review of all neonates delivered to SARS-CoV-2 positive mothers was conducted. Subsequent interview was done to determine their clinical course and neurologic status at 3-, 6-, 9-, 12-, and 15-month-old. Data collected was presented as frequencies, percentages, or proportions. @*Results@#Out of the 67 newborns born to SARS-CoV-2 positive mothers, three neonates tested positive for SARS-CoV-2. All three were delivered to mothers with mild symptoms, were full term, with good APGAR score and appropriate for gestational age. One was eventually intubated and managed as COVID-19 confirmed critical. Among the SARS-CoV-2 negative newborns, majority had an unremarkable neonatal outcome. Thirty-six neonates were available for follow-up: 1 expired due to aspiration pneumonia at 2 months of age, 4 were readmitted for pneumonia, UTI, acute gastroenteritis, and cow’s milk allergy. Twenty-one had infection at one point prior to this study follow-up but were all mild not requiring admission. Two had abnormal head size, while 2 had developmental delay, these 4 infants with neurological findings on follow-up were all RT-PCR negative at birth. @*Conclusion@#Maternal COVID-19 infection does not necessarily result to a neonatal infection. For those neonate swith mild symptoms, SARS-CoV-2 causality could not be established. On follow-up, there were a few who developed significant problems that have long-term implications in the overall growth and development of the child.

Factors associated with obstetric and perinatal outcomes among pregnant teen/adolescent Filipino 13–19 years old in a tertiary hospital

Background@#The 2013 National Demographic and Health Survey (NDHS) showed that 1 in 10 young Filipino women aged 15–19 years are childbearing. Yet, teenage pregnancy is known to be associated with complications in the mother and the child. @*Objective@#This study aimed to describe the sociodemographic characteristics and obstetric and perinatal outcomes of teenage pregnancy among Filipino women aged 13–19 years at the Philippine General Hospital. @*Methods@#This is a retrospective study consisting of reviewing the hospital records of teenage mothers from years 2014–2016. Descriptive statistics were used to analyze the gathered data. @*Results@#Almost 50% of the cases of adolescent pregnancy yielded obstetric and perinatal complications. The odds of having abnormal obstetric outcome among mothers with obstetric score of g1 is 7.8 times (95% CI: 2.0 to 30.7) higher as compared to other gravida scores and the odds of having at least one perinatal disorder decreases by 19% (95% CI: 6% to 30%) as the mothers regularly visit an obstetric clinic. This study also showed that among the pregnant adolescents, most of their partners were of legal age. Thirty-nine (23.9%) of them were seen by the Adolescent Service while 31(19%) were seen by the Child Protection Unit (CPU). @*Conclusion@#With the noted obstetric and perinatal outcomes, teenage pregnancy is an important issue that needs to be dealt with. To ensure good outcomes, provision of health care services designed particularly to cater to the needs of adolescent mothers should be properly and timely implemented. A referral to the Adolescent Service and CPU will greatly improve policies pertaining to provision of holistic care and protection services to teenage mothers.

Evaluation Of In Vitro Antioxidant And Cytotoxic Effect Of Methanol Extract From Aerial Parts Of Myristica Beddomei King Ssp. Ustulata W.J. De Wilde

Plants are traditionally used for pharmacological activities because of its ability to produce bioactive compounds. Myristica beddomei King ssp. ustulata W.J. de Wilde is an ethnomedicinal plant and it is seen in South Western Ghats of Kerala, India. The present study assessed the phenolic content, flavonoid concentration, in vitro antioxidant and cytotoxic effect of different parts of Myristica beddomei King. The total phenolic contents in the extracts ranged from 96.29 (pericarp) to 314.47 (bark) mg g-1 gallic acid equivalent. The concentration of flavonoids in different plant part extracts ranged from 1.81 to 2.76 mg g-1 equivalent to quercetin. All the parts exhibited potential antioxidant activity with an IC50 value of 2.87 to 9.67 μg ml-1 when compared to the standard ascorbic acid with an IC50 value of 2 μg ml-1 in 1,1-diphenyl-2- picryl-hidrasil (DPPH) method. Bark showed highest activity in terms of DPPH radical scavenging (IC50 value of 2.87 µg ml-1), phosphomolybdenum test (2261.33 ± 1.65 mg g-1 trolox equivalent) and ferric ion reducing antioxidant power (FRAP) (113.1 ± 0.28 µmol Fe2+ µg-1) while pericarp showed low antioxidant activity. The in vitro screening results revealed that the seeds exhibited promising anticancer activity compared to PA1 (Ovarian Cancer) cells (50 % inhibition) were observed at a concentration 100.68 µg ml-1. In cytotoxicity test L929 (Fibroblast) cell line compared to the other parts pericarp, mace and seed needed higher concentration (>240 µg ml-1) for LC50 value. It is a promising plant for further development of antioxidant agent as it got high content of phenolic compounds and potential antioxidant and anticancer activity.

Addressing primary care inequities in underserved areas of the Philippines: A review

@#Background. Inequities in health care exist in the Philippines due to various modifiable and non-modifiable determinants. Through the years, different interventions were undertaken by the government and various stakeholders to address these inequities in primary care. However, inequities still continue to persist. The enactment of the Universal Health Care (UHC) Act aims to ensure that every Filipino will have equitable access to comprehensive and quality health care services by strengthening primary care. As a step towards UHC, the government endeavors to guarantee equity by prioritizing assistance and support to underserved areas in the country. This paper aims to review different interventions to promote equity in the underserved areas that could aid in needs assessment. @*Methods@#A search through PUBMED and Google Scholar was conducted using the keywords, “inequity,” “primary care” and “Philippines.” The search yielded more than 10,000 articles which were further filtered to publication date, relevance to the topic, and credibility of source. A total of 58 full-text records were included in the review. @*Results and Discussion@#In the Philippines, inequities in primary care exist in the context of health programs, facilities, human health resources, finances, and training. These were recognized by various stakeholders, from government and private sector, and nongovernment organizations, taking actions to address inequities, applying different strategies and approaches but with a shared goal of improving primary care. On another end, social accountability must also be instilled among Filipinos to address identified social and behavioral barriers in seeking primary care. With political commitment, improvement in primary care towards health equity can be achieved.@*Conclusion and Recommendation@#To address inequities in primary care, there is a need to ensure adequate human resources for health, facilities, supplies such as medications, vaccination, clean water, and sources of funds. Moreover, regular conduct of training on healthcare services and delivery are needed. These will capacitate health workers and government leaders with continuous advancement in knowledge and skills, to be effective providers of primary care. Institutionalizing advocacy in equity through policies in healthcare provision would help realize the aims of the Universal Health Care Act.

Policy analysis on determining hospital bed capacity in light of Universal Health Care

Background@#Through the years of improving quality health service delivery, hospital bed capacity in the Philippines has remained to be a persistent challenge. In light of the aim of the Universal Health Care Act to protect and promote the right to health of every Filipino, one metric used to identify areas that are in most need or are under served, is the number of public hospital beds vis a vis the catchment population. @*Methods@#The systematic review of literature was utilized to generate a policy brief presented to the invited stakeholders of the policy issue for the roundtable discussion participated by all key stakeholders of the policy issue. Evidence and insights were thematically analyzed to generate consensus policy recommendations. @*Results@#With the current hospital bed availability and maldistribution, the Philippines still faces compounded issues in addressing healthcare demands. Currently, the request for increasing bed capacity is done through legislation. In context, this request is also parallel in expanding service capacity through the allocation of more funds and personnel. The ratio of private and charity beds must ensure to have equity among all patients of varying segments of the population. Enjoining private hospitals to share bed capacity for public service was also explored given appropriate subsidies.@*Conclusion and Recommendation@#To ensure equity in health service delivery, it is imperative to assess, strategize, and conduct prioritization of the needs of government hospitals for increased bed capacity, considering the distribution, socio-demographic profile, and health needs of the catchment population.

A call for an evidence-informed criteria selection to guide equitable health investments in the era of Universal Health Care: Policy analysis

Background@#The passage of the Universal Health Care (UHC) Act in the Philippines in early 2019 intensified the need to ensure equitable health investments by the government. Exploring the different criteria and indicators that are used to determine areas that are most in need of health services can help local and national health authorities determine priorities for health investments given finite resources. @*Methods@#A systematic review of literature on determinants of health equity and other indicators was conducted as pre-work to generate discussion points to the roundtable discussion participated by all major key stakeholders. Shared insights and expertise were thematically analyzed to produce a policy paper with consensus policy recommendations. @*Results@#Based on the review of the literature and the discussion, indicators (mainly physical inaccessibility and socioeconomic factors) for identifying Geographically Isolated and Disadvantaged Areas (GIDA) in DOH Administrative Order 185, s. 2004 is used to prioritize municipalities for health investments. Review of other policies and guidelines to determine the level of health needs and prioritizing investments yielded to four laddered domains: geographic, population characteristics (e.g., social and cultural determinants of access), health system (e.g., health service delivery), and health status. These domains may provide a more equitable set of metrics for health investment. The Local Investment Plan for Health (LIPH) is the current process used for health-related investments at the local level and may be revised to be more responsive to the requirements set by the UHC Act 2018. Hot spotting to concentrate health services by communities may be a more rapid approach to investment planning for health. Bed capacity as a specific metric in the UHC Act 2018 highlights the need for a review of the Hospital Licensure Act 2004. @*Conclusion and Recommendations@#To aid in determining priorities for health investments, a comprehensive integrated analysis of resources, determinants, and indicators should be done to determine the need and the gaps in the available resources. Innovative strategies can also be best implemented such as mathematical models or formulas. Lastly, current strategies in the development, monitoring, and evaluation of investment planning for health at different levels should be strengthened, expanded, and harmonized with other existing development plans.

Does intensified case finding increase tuberculosis case notification among children in resource-poor settings? A report from Nigeria

Objective/Background: Tuberculosis [TB] is a major cause of morbidity and mortality in developing countries. Passive case detection in national TB programmes is associated with low case notification, especially in children. This study was undertaken to improve detection of childhood TB in resource-poor settings through intensified case-finding strategies

Methods: A community-based intervention was carried out in six states in Nigeria. The creation of TB awareness was undertaken, and work aids, guidelines, and diagnostic charts were produced, distributed, and used. Various cadres of health workers and ad hoc project staff were trained. Child contacts with TB patients were screened in their homes, and children presenting at various hospital units were screened for TB. Baseline and intervention data were collected for evaluation populations and control populations

Results: Detection of childhood TB increased in the evaluation population during the intervention, with a mean quarterly increase of 4.0% [new smear positive [NSP], although the increasing trend was not statistically significant [chi[2] = 1.8; p <.179]]. Additionally, there was a mean quarterly increase of 3% for all forms of TB, although the trend was not statistically significant [chi[2] = 1.48; p <.224]. Conversely, there was a decrease in case notification in the control population, with a mean decline of 3% [all forms]. Compared to the baseline, there was an increase of 31% [all forms] and 22% [NSP] in the evaluation population

Conclusion: Intensified case finding combined with capacity building, provision of work aids/guidelines, and TB health education can improve childhood-TB notification

A cross-sectional triangulation analysis of the knowledge, attitudes and practices of patients from the endocrinology clinic of the Philippine General Hospital on the use of herbal dietary supplements

OBJECTIVE: This study aimed to determine the knowledge, attitudes and practices (KAP) of a selected population of patients on herbal dietary supplements (HDS).METHOD: Methodological triangulation was used to generate a conceptual framework on HDS KAP. A survey of 175 patients was performed to measure knowledge and attitudes regarding HDS and SPSS was used for data analysis. Inverviews and focus group discussions (FGDs) were conducted to further explore the attitudes and practices, and constant comparison method was used for analysis of responses.RESULTS: Respondents were generally aware of HDS. Majority of survey respondents believed that HDS are different from conventional drugs (52.0%, pThe attitude toward HDS was generally positive. Majority (64.0%, pAmong the survey respondents, only 22% were HDS users. Family was shown to promote use while cost deterred their use.CONCLUSION: Individual knowledge and attitudes on HDS exert significant influence toward HDS practices. Factors that promote use are poor knowledge and positive attitudes toward HDS. Good knowledge seems to lead to judicious use or non-use.

Gastrointestinal helminth infection in pregnancy: disease incidence and hematological alterations

The incidence and hematological effects of helminth infection during pregnancy were investigated among pregnant women in Isiala, Mbano, Southeast Nigeria. Totally 282 pregnant women were enlisted for the study between October 2011 and September 2012. Stool samples were examined for intestinal helminths using formalin-ether sedimentation technique. Hemoglobin [Hb] and Packed Cell Volume [PCV] levels were evaluated in venous blood samples using Sahli's and microhaematocrit methods respectively. Forty six [16.3%] subjects were infected with at least one helminth parasite; 24 [8.5%] hookworm, 14[5.0%] and 2[0.7%] A. lumbricoides and Trichuris trichiura infections respectively. Intestinal helminthiases in pregnant women was significantly associated with age [P<0.05]. The prevalence of intestinal helminthiases by parity was also significantly different [P<0.05] with primigravidae having the highest infection rate [27.5%]. Hematological assessment showed that the prevalence of anemia among the women was 58.9% [mean +/- SD = 9.3 +/- 1.0]. The differences in hemoglobin levels by age groups was statistically significant [P <0.05]. The contributory effect of gastrointestinal helminths in anemia showed that infected pregnant women had lower mean hemoglobin [8.60 +/- 0.22g/dl] than the uninfected [9.72 +/- 0.07g/dl]. Significant difference [t-value = 5.660, P<0.05] was observed between the Hb of the infected and uninfected pregnant women. In addition, infected pregnant women had mean PCV of 26.09 +/- 0.65% while the uninfected had 34.54 +/- 2.96%. The mean PCV of infected pregnant women was significantly different [t-value= 0.013, P<0.05] from that of the uninfected. Anti-helminthic therapy after the first trimester should be part of the antenatal programme. Intestinal helminth infection showed significant negative correlation with Hb and PCV and contributed moderately to anemia

Hazardous alcohol use in rural southern India: Nature, prevalence and risk factors.

Background. There is a dearth of data on the hazardous use of alcohol in rural India. Methods. We examined the nature, prevalence and factors associated with hazardous use of alcohol among men in a rural community in southern India. We used stratified sampling to select subjects from the Kaniyambadi block and employed ‘AUDIT’, a standard instrument, to assess the use of alcohol. Results. The prevalence of life-time use, use in the past year and hazardous use of alcohol was 46.7%, 34.8% and 14.2%, respectively. Using Indian made foreign liquor (OR 20.51; 95% CI 8.81–47.75) and living in a village which brewed illicit alcohol (OR 2.82; 95% CI 1.39–5.72) were risk factors for hazardous use while education (OR 0.39; 95% CI 0.21–0.72) was protective. These factors remained significantly associated with hazardous use after adjusting for age and education using logistic regression. Conclusion. The relationship between the availability of illicit and commercial alcohol and its hazardous use suggests the need for an alcohol policy which takes into account health and economic issues and also implements the law to prevent the negative impact of problem drinking.