A national program for control of acute respiratory tract infections: the Philippine experience.
Maturing programs on child immunization and diarrheal diseases, a community-based research project, and a rational drug-use program facilitated the launching in 1989 of a nationwide Philippine Control of Acute Respiratory Infections program (Phil-CARI). From 1990 to 1991 the Phil-CARI expanded rapidly, training >80% of its middle managers and frontline health care providers on the case-management protocols of the World Health Organization for acute respiratory infection. Multiple donors and good collaboration with various societies and medical schools assisted the program. However, by 1992, there were difficulties in maintaining training quality, follow-up, and supervision. Donor assistance dwindled and the health care delivery system decentralized. Government procurement systems were unable to meet the logistics demands of the program. The monitoring and evaluation system was inadequate to measure impact. The Phil-CARI provides lessons in searching for more sustainable approaches and systems to meet the various demands of a nationwide ARI control program and to create the desired impact. (+info)
Improving primary health care through systematic supervision: a controlled field trial.
Most primary health care services in developing countries are delivered by staff working in peripheral facilities where supervision is problematic. This study examined whether systematic supervision using an objective set of indicators could improve health worker performance. A checklist was developed by the Philippine Department of Health which assigned a score from 0 to 3 on each of 20 indicators which were clearly defined. The checklist was implemented in 4 remote provinces with 6 provinces from the same regions serving as a control area. In all 10 provinces, health facilities were randomly selected and surveyed before implementation of the checklist and again 6 months later. Performance, as measured by the combined scores on the 20 indicators, improved 42% (95% Cl = 29% to 55%) in the experimental group compared to 18% (95% Cl = 9% to 27%) in the control group. In the experimental, but not in the control facilities, there was a correlation between frequency of supervision and improvements in scores. The initial cost of implementing the checklist was US $ 19.92 per health facility and the annual recurrent costs were estimated at $ 1.85. Systematic supervision using clearly defined and quantifiable indicators can improve service delivery considerably, at modest cost. (+info)
Using cost-effectiveness analysis to evaluate targeting strategies: the case of vitamin A supplementation.
Given the demonstrated efficacy of vitamin A supplements in reducing childhood mortality, health officials now have to decide whether it would be efficient to target the supplements to high risk children. Decisions about targeting are complex because they depend on a number of factors; the degree of clustering of preventable deaths, the cost of the intervention, the side-effects of the intervention, the cost of identifying the high risk group, and the accuracy of the 'diagnosis' of risk. A cost-effectiveness analysis was used in the Philippines to examine whether vitamin A supplements should be given universally to all children 6-59 months, targeted broadly to children suffering from mild, moderate, or severe malnutrition, or targeted narrowly to pre-schoolers with moderate and severe malnutrition. The first year average cost of the universal approach was US$67.21 per death averted compared to $144.12 and $257.20 for the broad and narrow targeting approaches respectively. When subjected to sensitivity analysis the conclusion about the most cost-effective strategy was robust to changes in underlying assumptions such as the efficacy of supplements, clustering of deaths, and toxicity. Targeting vitamin A supplements to high risk children is not an efficient use of resources. Based on the results of this cost-effectiveness analysis and a consideration of alternate strategies, it is apparent that vitamin A, like immunization, should be provided to all pre-schoolers in the developing world. Issues about targeting public health interventions can usefully be addressed by cost-effectiveness analysis. (+info)
Atovaquone-proguanil compared with chloroquine and chloroquine-sulfadoxine-pyrimethamine for treatment of acute Plasmodium falciparum malaria in the Philippines.
This randomized, open-label clinical trial compared a fixed-dose combination of atovaquone and proguanil (n=55) with chloroquine (n=23) or a combination of chloroquine, sulfadoxine, and pyrimethamine (n=32) for treatment of acute falciparum malaria in the Philippines. Patients were hospitalized for 28 days to ensure medication compliance and prevent reinfection. Atovaquone-proguanil produced a significantly higher cure rate (100%) compared with that for chloroquine (30.4%; P<.0001) or chloroquine-sulfadoxine-pyrimethamine (87.5%; P<.05). Treatments did not differ significantly with respect to parasite clearance time (mean: 46.7 h for atovaquone-proguanil, 60.0 h for chloroquine, and 42.8 h for chloroquine-sulfadoxine-pyrimethamine) or fever clearance time (mean, 38.8, 46.8, and 34.5 h, respectively). Adverse events were typical of malaria symptoms; the most frequently reported events were vomiting (18% for atovaquone-proguanil, 17% for chloroquine, and 9% for chloroquine-sulfadoxine-pyrimethamine), abdominal pain (15%, 17%, and 3%, respectively), anorexia (11%, 13%, and 0%, respectively), and headache (6%, 17%, and 3%, respectively). Atovaquone-proguanil was well tolerated and more effective than chloroquine or chloroquine-sulfadoxine-pyrimethamine for treatment of multidrug-resistant falciparum malaria in the Philippines. (+info)
Management of non-traumatic subarachnoid hemorrhage in Filipinos.
A retrospective study of a consecutive series of 110 Filipino patients with non-traumatic subarachnoid hemorrhage (SAH) treated by the author in an urban setting is presented as to etiology, sex and age, diagnostic procedures employed, and short- and long-term results of non-surgical and surgical management. Aneurysms were the source of hemorrhage in 48%, arteriovenous malformation in 9%, and "other SAH" (hypertension/undetermined causes) in 43%. Fifty-seven (52%) patients were initially seen by a general practitioner, 44 (40%) by a neurologist, and only nine (8%) were seen directly by the neurosurgeon. A male sex preponderance for aneurysm was seen below the age of 50 years and a female preponderance for other SAH and aneurysm above age 50 years. The great majority of patients were admitted on the same day they had SAH--usually within 8 hours of onset. Delay in hospitalization did not adversely affect the clinical grade. SAH was demonstrated by lumbar puncture (71%) and computed tomography (29%). Of 74 patients who underwent angiography, vasospasm was associated mainly with aneurysms and present in 50% of these cases. Medications most commonly utilized were for control of edema, sedation, and anti-vasospasm. Forty-three of 53 patients with aneurysms underwent surgical procedures of various types. In general, patients admitted with good clinical grade had good outcomes of treatment. For high grade patients the attitude was to wait for an improvement in clinical grade before performing surgery. (+info)
Child health interventions in urban slums: are we neglecting the importance of nutrition?
During the early part of the twentieth century, there were dramatic falls in the mortality rates in many cities in the West. The reasons for this improvement are of considerable relevance today because the conditions which prevailed at that time in cities such as New York are comparable to those prevailing in many slums of the Third World today. Some early studies linked the improvements in health, as measured by mortality rates, to a better level of nutrition. The importance of nutrition is now widely accepted and there are many studies which show the association between nutrient intake and both mortality and morbidity, and in particular between breast feeding and infant mortality rates. It is sometimes assumed that, because nutrition indicators for city populations have improved, there is no longer a major problem of malnutrition in urban areas. However, it is likely that the figures hide disparities through aggregation, and studies in slums rather than cities as a whole give a much less encouraging picture. Poverty is at the root of many of the nutritional and associated health problems, but the children who will be born over the coming decades cannot afford to wait for a new economic order to provide the solution. Through the promotion of breast feeding, education, growth monitoring and food supplementation, necessary help can be targeted at this vulnerable population. (+info)
Bartonella henselae and Bartonella clarridgeiae infection in domestic cats from The Philippines.
One hundred seven domestic cats from The Philippines were serologically tested to establish the prevalence of Bartonella infection. A subset of 31 of these cats also had whole blood collected to tentatively isolate Bartonella strains. Bartonella henselae and B. clarridgeiae were isolated from 19 (61%) of these cats. Bartonella henselae type I was isolated from 17 (89%) of the 19 culture-positive cats. Six cats (31%) were infected with B. clarridgeiae, of which four were coinfected with B. henselae. Sixty-eight percent (73 of 107) and 65% (70 of 107) of the cats had antibodies to B. henselae and B. clarridgeiae, respectively, detected by an immunofluorescence antibody (IFA) test at a titer > or = 1:64. When tested by enzyme immunoassay (EIA), 67 cats (62.6%) had antibodies to B. henselae and 71 cats (66.4%) had antibodies to B. clarridgeiae. Compared with the IFA test, the B. henselae EIA had a sensitivity of 90.4% and a specificity of 97%, with positive and negative predictive values of 98.5% and 82.5%, respectively. Similarly, the B. clarridgeiae EIA had a sensitivity of 97% and a specificity of 92% specificity, with positive and negative predictive values of 95.8% and 94.4%, respectively. The presence of antibodies to Bartonella was strongly associated with flea infestation. Domestic cats represent a large reservoir of Bartonella infection in the Philippines. (+info)
Filipino children exhibit catch-Up growth from age 2 to 12 years.
Potential for catch-up growth among stunted children is thought to be limited after age 2 y, particularly when they remain in poor environments. We explored the extent to which there were improvements in height status from age 2 to 12 y in a cohort of >2, 000 children from the Cebu (The Philippines) Longitudinal Health and Nutrition Survey. At age 2 y, about 63% of sample children were stunted as defined by height-for-age (HAZ) <-2 based on the WHO reference. Of children stunted at age 2, 30% were no longer stunted at 8.5 y, and 32.5% were no longer stunted at 12 y. The mean increase in HAZ among those with such improvements was 1.14 units. The likelihood that children stunted at age 2 y would no longer be stunted at 8.5 y was estimated using logistic regression. Low birth weight, which was associated with more severe stunting in the first 2 y of life, significantly reduced likelihood of catch-up growth in later childhood. In contrast, children with taller mothers, who were first born, longer at birth, less severely stunted in early infancy and those with fewer siblings were more likely to increase HAZ from <-2 to >-2 between ages 2 and 8.5 y. Similar factors predicted the improvement in linear growth from 8.5 to 12 y. These results suggest that there is a large potential for catch-up growth in children into the preadolescent years. (+info)