Effects of the COVID-19 pandemic on the implementation of NCD Care at the Primary Care Level in the Philippines: A qualitative inquiry

Background and Objective@#The focusing of resources to COVID-19 response hampered and disadvantaged primary care services including that for Non-Communicable Diseases (NCDs), compromising continuity of care and hence, patients’ disease status. However, studies from low- and middle-income countries (LMICs) remain sparse; therefore, evidence generation on how the pandemic impacted the provision of these primary care services in LMICs will help further understand how policies can be reframed, and programs be made more efficient and effective despite similar crises. To bridge this gap, the study investigated how the pandemic affected the implementation of NCD care at the primary care level in the Philippines.@*Methods@#Thirty-one online focus group discussions via Zoom Meetings were conducted among 113 consenting physicians, nurses, midwives, and community health workers from various facilities — community health centers and stations, free-standing clinics, infirmaries, and level 1 hospitals — located within two provinces in the Philippines. All interviews were video-recorded upon participants’ consent and transcribed verbatim. Inductive thematic analysis was employed through NViVo 12® to generate themes, identify categories, and describe codes. @*Results@#The impact of COVID-19 on NCD care at the primary care level revolved around heightened impediments to service delivery, alongside worsening of pre-existing challenges experienced by the healthcare workforce; subsequently compelling the public to resort to unhealthy practices. These detriments to the primary healthcare system involved resource constraints, discontinued programs, referral difficulties, infection, overburden among workers, and interrupted training activities. Citizens were also observed to adopt poor healthcare seeking behavior, thereby discontinuing treatment regimen. @*Conclusion@#Healthcare workers asserted that disadvantages caused by the pandemic in their NCD services at the primary care level possibly threaten patients’ health status. Besides the necessity to address such detriments, this also emphasizes the need for quantitative studies that will aid in drawing inferences and evaluating the effect of health crises like the pandemic on such services to bridge gaps in improving quality of care.

Variations in the clinical management of multibacillary leprosy patients in selected hospitals in Metro Manila

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> This paper documents the variations in the diagnosis and management of multibacillary leprosy patients in three of the biggest case-holding hospitals in Metro Manila. Furthermore, we aimed to discuss the implications of these variations on the country's leprosy control and elimination program.</p><p style="text-align: justify;"><b>METHODS:</b> Focus group discussions (FGD) were conducted with 23 health professionals composed of doctors and nurses with at least a year of experience in managing leprosy patients. The topics included procedures on patient diagnosis and management such as treatment duration, patient follow-up and definitions of treatment completion and default. The FGD participants provided suggestions to improve treatment compliance of patients. Their responses were compared with the World Health Organization (WHO) standards and/or the 2002 DOH Manual of Operating Procedures (MOP) for leprosy. Transcripts of the recordings of the FGDs were prepared and thematic analysis was then performed.</p><p style="text-align: justify;"><b>RESULTS:</b> There were variations in the hospitals' procedures to diagnose leprosy, in treatment duration, and in patient follow-up. Definitions for treatment completion and default differed not just between hospitals but also with the WHO guidelines and the 2002 MOP. Hospitals extended treatment up to 24 or even 36 months, despite the 12 months stipulated in the MOP. Two hospitals required a slit skin smear and skin biopsy in diagnosis, despite the MOP and WHO provisions that these were not mandatory. One hospital defined default as three consecutive months without treatment, which was different from the MOP and WHO standards and from the other hospitals.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Given the variations in patient management, we recommended that the effectiveness of the standard treatment relative to other regimens being practiced by specialists be evaluated.</p>

Health impact of and policy regulations on electronic cigarettes

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> New findings on the detrimental health effects of electronic nicotine delivery system (ENDS)/ electronic non-nicotine delivery system (ENNDS) confounds the "harm reduction" perspective of using it as an alternative to conventional cigarettes. In the Philippines, the pressing debate on its safety and efficacy had initiated actions from policy makers on legislative issues such as draft DOH Administrative Order, House Bill 4325 and House Bill 532.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study aimed to craft an evidence-based policy position on the regulation of ENDS/ENNDS.</p><p style="text-align: justify;"><b>METHODS:</b> Review of literature was conducted, and the proposed scope and measures on electronic cigarette regulation were compared with WHO Framework Convention on Tobacco Control (WHO-FCTC) and existing policies of US FDA regulations on ENDS. Further, UP Manila convened experts of various related fields for evidence-based review and discussion of policy issues to arrive at a consensus policy statement and recommendations. Results. Findings showed that ENDS/ENNDS still need further research to have conclusive results on long term safety and efficacy as smoking cessation methods.</p><p style="text-align: justify;"><strong>CONCLUSION: </strong>Regulations for tobacco control should be clear and supported with strict guidelines in manufacturing, distribution, advertisement, selling, and usage restrictions in public. With the current review, it is recommended that ENDS/ENNDS regulation be under the mandate of the FDA in alignment to WHO-FCTC and to engage different stakeholders from policy makers, implementers, and other involved organizations.</p>

Prevalence of psychosocial distress among flood victims in selected urban barangays in Manila

OBJECTIVES: This study was conducted to estimate the prevalence of psychosocial problems among residents of four flood-prone barangays in Manila located along the Maricaban-Malibay creek in Pasay City and were reported to have experienced 10-15 feet-deep flood waters simultaneously caused by Typhoon Maring and the southwest monsoon in August 2013.METHODOLOGY: A stratified two-stage random cluster sampling method, adapted from the Community Assessment for Public Health Emergency Response (CASPER) Toolkit, was employed in the syudy. The first stage of sampling used street clusters, with more or less of the same size, as the primary sampling unites (PSU) and households as secondary sampling units (SSU) to select the households that will be included in the survey. Since the clusters were more or less of the same size, they ahd equal chances of being selected in the study if the probability of selection is proportionate to size (PPS). Seven houses were then randomly chosen from the 30 selected clusters. All of the househol heads from the 210 selected households were given several copies of the self-administered questionnairescalled the Self-Reporting Questionnaire-20 (SRQ-20), a screening tool developed by WHO, to determine the psychosocial condition of the household members 12-65 years.RESULTS: The prevalence of psychosocial distress in this population was estimated at 17% (95%CI=13.7-20.3%). The residents of the study barangays were in their rehabilitation phase i.e., three months post disaster when data was collected for this study. The study also characterized the households in the sample according to socio-economic status, presence of members with special needs, and presence of children 0-5 years ol. In the aftermath of the disaster, 46.84% of the respondents had positive answer on the group of questions about decreased energy, 49.8% on somatic symptoms,25.89% on depressive thoughts and 40.91% on depressive moods.There was a higher prevalence of these 4 factors among females, those separated, with low socioeconomic status and low educational attainment.CONCLUSION: The estimated prevalence of psychosocial distress was 17% (95%CI=13.7%-20.3%), In the aftermath of the disaster, 46.8% of the respondents had positive answer on the group of questions about decreased energy, 49.8% on somatic symptoms, 25.9% on depressive thoughts and 40.9% on depressive moods.