Knowledge, attitudes and practices of the community residents concerning the prevention and control of leptospirosis in the National Capital Region (NCR), Philippines

OBJECTIVE: This study assessed the knowledge, attitudes and practices of the community residents on the prevention and control of Leptospirosis in the National Capital Region, Philippines.METHODS: In this cross-sectional study, four-stage random cluster sampling proportional to size was used to select the 413 respondents from 30 villages in the National Capital Region. The mother or any responsible adult served as the respondent for the community survey which yielded data on the knowledge, attitudes, domestic practices, and sources of information for the prevention and control of Leptospirosis. Encoding was done using Epi Info Version 6. Descriptive statistics was generated through Microsoft Excel.RESULTS: Majority of the respondents were able to correctly identify that the causative agent of leptospirosis is bacteria (91%), that the disease is transmitted by the urine of infected of rats (89%) through skin abrasions (71%) and mucous membranes (57%). Most commonly identified signs and symptoms of the disease include acute febrile illness with myalgia (87%), difficulty of breathing and decreased urine output (72%). Majority identified the prevention and control measures correctly. Wearing of boots, maintaining a clean and orderly house and maintaining good sanitation were the top answers of the respondents. In terms of attitudes, respondents had positive attitudes towards the preventive practices of wearing boots or following health advisories of authorities (99%). Majority also believed that leptospirosis is curable if detected early (99%) and that it is a serious disease (98%). Similarly, more than 90% had positive attitude when it comes to health care. Wading in flood waters (93%), walking barefoot (85%) and conducting clearing activities after flood (63%) were the commonly believed forms of exposure to the disease. In terms of domestic practices, respondents usually clean their surroundings (40%), avoid wading in floodwaters (25%), wear boots (21%) to protect themselves from acquiring leptospirosis. Primary sources of information on leptospirosis were the mass media (46%), health workers (17%) and the health facilities (14%). The most common educational materials read by the respondents were flyers (9%), posters (8%), and leaflets (7%).CONCLUSION: In general, majority of the respondents were knowledgeable on the causes, signs and symptoms, and modes of transmission of leptospirosis, and had favorable attitudes towards the prevention and control measures against leptospirosis. However, when it comes to domestic practices, less than 40% actually implement measures for the prevention and control of leptospirosis. Respondents' main source of information was the mass media and very few have read educational materials containing information about the prevention and control of leptospirosis. 

Epidemiologic Study of Blastocystis Infection in an Urban Community in the Philippines.

Blastocystis has been considered as the most common intestinal parasite in humans and has an augmented impact on public health. However, the prevalence of this parasite in the Philippines has not been determined. To contribute to a better understanding of the epidemiology of this infection, a cross-sectional study aimed at providing the first documented data on the prevalence and correlates, sociodemographic factors, hygiene practices, source of water supply, and dog ownership, associated with Blastocystis infection was carried out in randomly selected communities at Pateros, Metro Manila. Fecal samples from respondents were collected and cultured in diphasic agar medium for 3-7 days and examined using light microscopy. Of the 1,271 respondents, 12.98% (95% CI: 11.13-14.83) were detected positive for Blastocystis. Among the correlates of Blastocystis infection, dog ownership was found significantly associated as confirmed by multivariate analysis. Therefore, this factor should be considered in information to create awareness about Blastocystis and to prevent and control Blastocystis infection in particular and diarrheal diseases in general. Further studies using molecular approaches to distinguish subtype and to determine genetic characteristics of isolates from humans and dogs are recommended to analyze their relationship and provide more conclusive evidence of cross-transmission.

Using discrete choice modeling to evaluate the preferences and willingness to pay for leptospirosis vaccine.

Leptospirosis is highly endemic in the Philippines and a serious concern to public health. Local research on candidate vaccine is moving through the development pipeline. The availability of vaccines alone does not guarantee acceptance because individuals' vaccination choice decision is influenced by several factors. This study assessed how vaccine attributes and socio-demographic factors affect the acceptability of leptospirosis vaccine; and estimated individuals' willingness to pay for leptospirosis vaccine. A discrete choice experiment was conducted among leptospirosis and non-leptospirosis case respondents (n = 342) living in Metro Manila. Random Parameters Logit model was used to estimate the relative importance of vaccine attributes and socio-demographic variables on respondents' leptospirosis vaccination choice decision. The estimated model coefficients were used to derive implicit prices and willingness to pay for leptospirosis vaccine. Both case respondents preferred leptospirosis vaccine with 70-100% efficacy, mild to moderate risk of side-effects, given in a single shot, and at a lower price. Non-leptospirosis case respondents preferred a vaccine with 7 to 10 y of protection, while leptospirosis case respondents preferred a vaccine with 10 y protection. The probability of leptospirosis vaccination acceptance was affected by respondents' age, education, family size and income, proximity of home to rivers and sewers, and leptospirosis awareness level. Respondents' willingness to pay for leptospirosis vaccine (US$ 31.14-US$ 65.89) was higher than the Japanese retail price (US$ 21.60-US$ 24.00). Our findings indicated significant potential for introducing leptospirosis vaccine in the Philippine vaccine market. Delivery strategies to ensure equitable access to future leptospirosis vaccine are recommended.

Smoking-attributable burden of lung cancer in the Philippines.

BACKGROUND: In the Philippines, smoking is highly prevalent and tobacco control policies fail to fully implement the WHO Framework Convention on Tobacco Control provisions. To aid in policy change, intervention implementation, monitoring and evaluation, this study aimed to provide the first internally consistent and latest Philippine estimates of the following: disability-adjusted life-years (DALYs) lost due to lung cancer; population-attributable fractions (PAFs) of smoking; and smoking-attributable lung cancer DALYs. METHODS: This study applied the Global Burden of Disease and Comparative Risk Assessment frameworks to secondary data, supplemented by expert opinion. A comprehensive internally consistent assessment of disease epidemiology was conducted using DISMOD II and disease impact was quantified as DALYs. PAFs were calculated using the smoking impact ratio and Monte Carlo uncertainty analyses were conducted. RESULTS: For 2008, lung cancer incidence and mortality estimates were 10 871 cases and 9871 deaths respectively. Lung cancer accounted for an estimated 267 787 DALYs lost, 99% of which were due to years of life lost. Overall, the PAF of smoking was 65% and a total of 173 103 DALYs were smoking-attributable. There were increasing trends in incidence, mortality and DALY rates with age. The majority of incidence (72%), mortality (71%) and disease burden (72%) occurred among men, who also had higher PAF estimates. CONCLUSIONS: Considerable health gains could be achieved if smoking exposure were reduced in the Philippines. Strong enforcement of measures like increasing taxation to the WHO-endorsed rate, expanding smoke-free environments, and requiring large graphic warnings within a comprehensive tobacco control programme is recommended.

Partnership for health development through the field practice

This article describes the partnership between the College of Public Health, University of the Philippines Manila and the province of Laguna in the context of implementation of the field practice course. This partnership paved the way for the development and implementation of projects in seven field practice sites. Projects concentrated mainly on improving quality of data and health information system, development of educational materials, and addressing health problems such as tuberculosis, hypertension and rabies. After the implementation of the various activities, there is a need for both parties (the College of Public Health and the Provincial Health Office of Laguna) to monitor and evaluate if projects have been sustained. Moreover, successful projects must also be fully documented which can serve as models for other areas in the province of Laguna.

Valuing human leptospirosis prevention using the opportunity cost of labor.

Leptospirosis is a serious public health concern in the Philippines, not only because of its increasing incidence rate, but also because of its significant health and economic impacts. Despite its relatively high seroprevalence, knowledge on the economic burden of disease, particularly on the value that the society places on disease prevention remains limited. Obtaining such information is important within the context of public health policy. This study was conducted in Metro Manila to determine the economic burden of leptospirosis, by asking respondents about their willingness to contribute to labor (WTCL) for the prevention of leptospirosis. The respondents pledged an average labor contribution of 10.66 h/month. The average WTCL corresponded to a monetary value of US$4.01 per month when valued using the opportunity cost of labor (leisure rate of time). From the monetized labor contribution, the total economic value of preventing leptospirosis was estimated at US$124.97 million per annum, which represents 1.13% of Metro Manila's gross domestic product (GDP). Estimates from a Tobit regression model identified the respondents' knowledge regarding leptospirosis, the susceptibility of their homes to flooding, and the proximity of their homes to sewers as significant factors to consider when developing resource contribution programs for leptospirosis prevention. More efforts need to be made in developing community level preventive programs, and in improving public's knowledge and awareness about leptospirosis.

Association between pregnancy intention and optimal breastfeeding practices in the Philippines: a cross-sectional study.

BACKGROUND: The effect of pregnancy intention on post-natal practices like breastfeeding is still poorly understood in the Philippines. In this light, this study aims to determine the association between pregnancy intention and optimal breastfeeding practices in the Philippines. METHODS: This is a cross-sectional study design using the 2003 Philippine National Demographic and Health Survey. Logistic regression analysis was used to determine the independent association of pregnancy intention and optimal breastfeeding practices. The study includes 3,044 last-born children aged 6-36 months at the time of survey. Dead children were also included as long as their age of death satisfies the age criterion. RESULTS: Children born from mistimed pregnancies are more likely to have late breastfeeding initiation compared to children born from wanted pregnancies (OR = 1.44; 90%CI: 1.17-1.78). However, this occurs only among children belonging to households with low socio-economic status. Among children belonging to households with high socio-economic status, no significant effect of pregnancy intention on breastfeeding initiation was observed. Children born from unwanted pregnancies are less likely to have short breastfeeding duration (OR = 0.60; 90%CI: 0.48-0.76). However, this occurs only among children belonging to households with high socioeconomic status. No significant effect of pregnancy intention on breastfeeding duration was observed among children belonging to households with low socio-economic status. CONCLUSION: The findings of this study suggest that there are different effects of pregnancy intention on the two types of optimal breastfeeding practices examined. With regards to breastfeeding duration, it was found that among infants belonging to high SES, the odds of having short breastfeeding duration is lower among children born from unwanted pregnancies compared to children born from wanted one. Conversely, children belonging to low SES household, the odds of having late breastfeeding initiation among children born from mistimed pregnancies are higher compared to children born from wanted pregnancies.

Single-dose epidural anesthesia for labor and delivery

This paper is a continuation of the preliminary report where we used a gauged 25, 3 and 1/2 inch apinal needle to deposit bupivacaine in the lumbar epidural space.