Improving current helminth control strategies: Lessons from a baseline prevalence survey of soil-transmitted helminth infections in adolescent females and pregnant women in selected local government units in the Philippines

OBJECTIVES: This study utilized a cross-sectional study design to determine the prevalence and intensity of STH infections among adolescent females and pregnant women, to describe the nutritional status of the two population groups in selected study sites in the Philippines, and to propose a scheme for classification of endemic sites as basis for conduct of control strategies. METHODS: Parasitologic assessment was conducted through examination of collected stool samples using the Kato-Katz technique, while nutritional status was assessed through primary height and weight measurements.RESULTS: Results of the parasitologic assessment in adolescent females showed an overall cumulative prevalence of 30.4% (12.5% - 61.8%) and a prevalence of heavy intensity infection of 7.9% (0.7% - 22.6%). In pregnant women, overall cumulative prevalence was 31.5% (13.2% - 75.8%) and prevalence of heavy intensity infection was 10.2% (0.9%- 39.6%). CONCLUSION: Significant differences in prevalence in the different sentinel sites suggest the need to consider a modified classification scheme for endemic communities to determine the most cost-effective strategies for morbidity control. The utilization of this classification scheme alongside regular sentinel surveillance will help validate the scheme and contribute towards the development of more appropriate program guidelines for nationwide implementation.

Laboratory diagnosis of selected neglected parasitic diseases in the Philippines: Can we do better?

BACKGROUND: Several Philippine studies on selected neglected parasitic diseases cite major challenges in laboratory diagnosis that require review of standards, policies and practices.OBJECTIVES: This review aims to: (1) describe the epidemiology of selected neglected parasitic diseases in the Philippines; (2) describe the current status of laboratory diagnosis of these diseases in terms of standards, policies and practices; and (3) identify challenges and opportunities for improvement of laboratory diagnosis.METHODS: Epidemiologic data were collected from published scientific papers and monographs. International standards were gathered from journal articles and the World Health Organization (WHO). Philippine policies were obtained from interviews with the Department of Health (DOH) and other agencies. Recommendations for policy and practice were formulated based on evidence and feasibility.RESULTS: High prevalence of neglected parasitic diseases in the country, coupled with lack of national policies on diagnosis and quality assurance guidelines specific to parasitology, pose significant challenges to accurate diagnosis.CONCLUSION: Results of this review merit the development of a comprehensive Philippine policy on a quality assurance scheme for parasitology laboratories and stronger licensing standards. This policy should be supported through a network of reference centers that coordinate parasitology training, staff certification, and laboratory accreditation.

Schistosomiasis and soil-transmitted helminth infections in school children in the Lake Mainit area in Northeastern Mindanao: An opportunity for integrated helminth control in the school setting

OBJECTIVES:This study aimed to determine the epidemiologic status of schistosomiasis and soil-transmitted helminth (STH) infections in the Lake Mainit area in Northeastern Mindanao. METHODS: School children from the municipalities of Alegria and Mainit in Surigao del Norte, and Jabonga and Kitcharao in Agusan del Norte were targeted as participants. Stools were collected, processed through Kata Katz method, and examined. Data gathered were double-encoded and processed to derive parasitologic parameters that were used to categorize the municipalities based on the World Health Organization guidelines. RESULTS:The overall prevalence of schistosomiasis was 10.9%, while the prevalence of heavy intensity infections was 0.1%. Alegria and Mainit were classified as moderate-risk communities, while Jabonga and Kitcharao were classified as low-risk communities. The overall cumulative prevalence of STH infections was 43.9%, while prevalence of heavy intensity infection was 12.7% Jabonga and Kitcharao were classified as Category I communities, while the reset were classified as Category III. CONCLUSION:There is a need to consider implementation of school-based Mass Drug Administration (MDA) for schistosomiasis control in the same manner as in the implementation of MDA for STH control. Multisectoral involvement is necessary for integration of efforts in addressing the parasitic diseases as public health concerns in the area.

A case of chronic diarrhea secondary to Capillaria philippinesis in Occidental Mindoro: Possibly a newly-described endemic area?

A 41-year-old man from Occidental Mindoro was diagnosed with intestinal capillariasis at the Philippine General Hospital after a year of diarrhea and multiple hospital admissions. The patient was noted to be harboring Capillaria philippinensis, Strongyloides stercoralis, Entamoeba histolytica, Mycobacterium tuberculosis, and Candida albicans in his stool. He was treated with albendazole, metronidazole, diloxanide, fluconazole, and antiiKoch's. This case was reported to the Department of Health to pursue this site as a potential area for epidemiologic investigation.

Cost of mass drug administration for filiriasis elimination in the province of Sorsogon, Philippines

OBJECTIVE: Elimination eforts for lymphatic flariasis are underway in the Philippines using mass drug administration (MDA) of diethylcarbamazine and albendazole as one of the main strategies. This cost analysis was done to determine the MDA implementation cost and provide useful information to the control programme on how to best utilize limited resources. METHODS: This cost analysis study was conducted in the province of Sorsogon, Philippines in 2004. The study was done from a program perspective. Cost data for 2003 was obtained retrospectively via key informant interviews and records review using a standardized guide from a multi-country cost analysis study of flariasis elimination programs. Cost fgures were classifed as either economic or fnancial costs and expressed in real terms using 2002 as base year. Sensitivity analysis was likewise performed. RESULTS: The total economic cost and cost per person treated with MDA were estimated at US$223,549.55 (Php12,116,385.48) and US$0.40, respectively. The fnancial costs were less than half of the economic costs. The main cost driver was drug distribution. The highest economic and fnancial costs were incurred at the national (54.5%) and municipal (74.4%) levels, respectively. High variation in costs of MDA activities was observed. CONCLUSION: This cost analysis provides reasonable estimates which may be used to assist government and other stakeholders in program planning and resource generation for flariasis elimination programs in endemic areas.