The Philippines health system review

The Asia Pacific Observatory on Health Systems and Policies (the APO) is a collaborative partnership of interested governments, international agencies, foundations, and researchers that promotes evidence-informed health systems policy regionally and in all countries in the Asia Pacific region. The APO collaboratively identifies priority health system issues across the Asia Pacific region; develops and synthesizes relevant research to support and inform countries' evidence-based policy development; and builds country and regional health systems research and evidence-informed policy capacity.

Epidemiology of Ebola (subtype Reston) virus in the Philippines, 1996.

Ebola (subtype Reston [EBO-R]) virus infection was detected in macaques imported into the United States from the Philippines in March 1996. Studies were initiated in the Philippines to identify the source of the virus among monkey-breeding and export facilities, to establish surveillance and testing, and to assess the risk and significance of EBO-R infections in humans who work in these facilities. Over a 5-month period, acutely infected animals were found at only one facility, as determined using Ebola antigen detection. Three of 1732 monkeys and 1 of 246 animal handlers tested had detectable antibodies; all were from the same facility, which was the source of infected monkeys imported to the United States. Virus transmission, which was facilitated by poor infection-control practices, continued for several months in one facility and was stopped only when the facility was depopulated. None of the 246 employees of the facilities or 4 contacts of previously antibody-positive individuals reported an Ebola-like illness. This investigation suggests that human EBO-R infection is rare.

The reading habits of family practice residents.

BACKGROUND AND OBJECTIVES: Little is known about the reading habits of family practice residents. This study describes the reading practices of family practice residents, including how much time they spend reading and what information sources they use, identifies factors that may be used by educators to stimulate resident reading, and identifies factors that may inhibit or discourage reading. METHODS: A questionnaire about reading habits was mailed to 613 randomly selected resident members of the American Academy of Family Physicians in March 1994. RESULTS: Of 613 questionnaires sent, 314 (51%) were completed and returned. Participants reported reading an average of 3.7 hours per week and were most often motivated to read to obtain information related to clinical cases or to prepare for an upcoming presentation. Pocket manuals were the most frequently read and original scientific research the least frequently read sources of medical information. Fatigue and family responsibilities were the factors most important in preventing reading. Year in residency, moonlighting hours, age, gender, or household size were not associated with reported reading time. CONCLUSIONS: Clinical cases and upcoming presentations may be the best motivators of resident reading. Training programs need to continue to develop strategies to minimize resident fatigue, which may lead to increased reading among trainees. The importance of original scientific research articles during residency training is unclear.

Improving vaccination coverage in urban areas through a health communication campaign: the 1990 Philippine experience.

From March to September 1990 the Philippine Department of Health, with the assistance of the HEALTHCOM Project, carried out a national mass-media communication campaign to support routine vaccination services. The essential elements of the campaign strategy were as follows: focusing on measles as a way to get mothers to bring their children to the health centre; emphasizing logistic knowledge in the mass-media messages, in particular popularizing a single day of the week as "vaccination day" and giving clear information about the age for measles vaccination; and focusing on urban areas, which had lower vaccination rates than rural areas. Evaluation of the effects of the campaign indicates an increase in vaccination coverage and a substantial increase in the timeliness of vaccination that can be attributed to improvement in carers' knowledge about vaccination. Furthermore, most of the observed increase in knowledge was related to exposure to the mass-media campaign. There was no evidence of any programmatic change that could account for the increase in vaccination or evidence that increased health education efforts at health centres could account for the change in knowledge. These results indicate that when countries meet certain conditions--a high level of access to the media, sufficient expertise and funds available to develop and produce high-quality radio and television advertisements, and a routine system that is able to serve the increased demand--a mass communication campaign can significantly improve vaccination coverage.

PIP: The Philippine Department of Health conducted a national mass media communication campaign during the period March-September 1990 to support routine vaccination services. The campaign focused upon measles as a way to get mothers to bring their children to the health center, emphasized logistic knowledge in the mass-media messages, and focused upon urban areas with lower vaccination rates than rural areas. Examples of logistic emphasis include designating one day per week as vaccination day and giving clear information about the age for measles vaccination. An increase in vaccination coverage and a substantial increase in the timeliness of vaccination were observed which may be attributed to the improvement in carers' knowledge about vaccination. Most observed increase in knowledge was related to campaign exposure. There was no evidence of any programmatic change which could account for the increase in vaccination or evidence that increased health education efforts at health centers could account for the change in knowledge. These results indicate that when countries meet certain conditions, a mass communication campaign can significantly improve vaccination coverage. Conditions include access to media, expertise, and funds to produce and air high quality television and radio spots, and a routine system capable of handling the increased demand.

Cholera in metropolitan Manila: foodborne transmission via street vendors.

Reported are the results of an unmatched case-control study to determine the risk factors associated with acquisition of cholera in Manila. Cases were patients admitted to the San Lazaro Hospital between July and September 1989 and whose stools yielded Vibrio cholerae O1 on culture. Controls were patients admitted to the same hospital and who had no history of diarrhoea or of having taken antibiotics during the 3 days prior to admission. Of the 158 cases and 158 controls who had bought food from street vendors, cases were more likely to have bought the following items: pansit (rice noodles with shrimp, meat, and vegetables), mussel soup, spaghetti, fish balls, pig blood coagulated with vinegar, and salty brine shrimp with vegetables. Cases were also more likely to lack piped water at home. An unconditional logistic regression analysis indicated that only pansit (OR = 2.15, 95% CI = 1.32-3.51), mussel soup (OR = 2.29, 95% CI = 1.06-4.95), and the absence of piped water at home (OR = 2.70, 95% CI = 1.63-4.46) remained as risk factors. As control measures we recommend stricter implementation of the food sanitation code and the licensing of street food vendors.

Outbreak of fatal illness among captive macaques in the Philippines caused by an Ebola-related filovirus.

Following the detection of an Ebola-like virus in cynomolgus macaques recently imported into the United States from The Philippines, studies were initiated to document transmission at export facilities located in the latter country. At one export facility, 52.8% of 161 monkeys that died over a 2.5-month period were shown to be infected with this virus using an enzyme-linked immunosorbent assay to detect antigen in liver homogenates. A case fatality rate of 82.4% was documented for the infected monkeys. The initial anti-viral antibody prevalence among the captive macaques at this facility was 25.9% (indirect fluorescent antibody titer greater than or equal to 1:16). Followup documented infection of 24.4% of initially seronegative animals and 8.7% of initially seropositive monkeys. Being held in a gang cage versus a single cage was found to be a significant risk factor for subsequent virus infection, and the presence of IFA antibody was shown to predict protection. This study documents unequivocally for the first time the presence of an Ebola-related filovirus in Asia.

Risk factors for injuries due to the 1990 earthquake in Luzon, Philippines.

On 16 July 1990, an earthquake measuring 7.7 on the Richter scale struck the island of Luzon, Philippines. A case-control study was carried out to identify the risk factors for earthquake-related injuries and at the same time observations were made on the rescue efforts. Being hit by falling objects was the leading cause of injury (34%). Those injured during the tremor were more likely to have been inside buildings constructed of concrete or mixed materials (odds ratio, 2.6; 95% confidence interval (CI), 1.7-4.1) and to have been on the middle floors of multistorey buildings (odds ratio, 3.4; 95% CI, 2.2-5.5). Leaving a building during the earthquake was a protective behaviour (odds ratio, 0.3; 95% CI, 0.2-0.8). Of the 235 survivors who were trapped and rescued alive from the rubble, 99% were rescued within 48 hours of the impact of the tremor. These findings should prove useful in developing seismic safety codes. People should be taught proper evasive actions to take during earthquakes, and training in basic first aid and methods of rescue should be an integral part of community preparedness programmes.

Risk factors for injuries due to the 1990 : Earthquake in Luzon, Philippines

On 16 July 1990, an earthquake measuring 7.7 on the Richter scale struck the island of Luzon, Philippines. A case-control study was carried out to identify the risk factors for earthquake-related injuries and at the same time observations were made on the rescue efforts. Being hit by falling objects was the leading cause of injury (34

). Those injured during the tremor were more likely to have been inside buildings constructed of concrete or mixed materials (odds ratio, 2.6; 95

confidence interval (CI), 1.7-4.1) and to have been on the middle floors of multistorey buildings (odds ratio, 3.4; 95

CI, 2.2-5.5). Leaving a building during the earthquake was a protective behaviour (odds ratio, 0.3; 95

CI, 0.2-0.8). Of the 235 survivors who were trapped and rescued alive from the rubble, 99

were rescued within 48 hours of the impact of the tremor. These findings should prove useful in developing seismic safety codes. People should be taught proper evasive actions to take during earthquakes, and training in basic first aid and methods of rescue should be an integral part pf community preparedness programmes.(AU)