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BackgroundRepeated mass drug administration (MDA) of antihelminthics to at-risk populations is still the main strategy for the control of soil-transmitted helminth (STH) infections. However, MDA, as a stand-alone intervention, does not prevent reinfection. Accordingly, complementary measures to prevent STH reinfection, such as health education and improved sanitation, as part of an integrated control approach, are required to augment the effectiveness of MDA for optimal efficiency and sustainability. ObjectiveThe aim of this study is to determine the impact and generalizability of a school-based health education package entitled The Magic Glasses for STH prevention in the Philippines. MethodsWe conducted a cluster randomized controlled intervention trial, involving 2020 schoolchildren aged 9-10 years, in 40 schools in Laguna Province, Philippines, to evaluate the impact of the school-based health education package for the prevention of STHs. The trial was conducted over the course of 1 year (June 2016 to July 2017). A total of 20 schools were randomly assigned to the intervention arm, in which The Magic Glasses Philippines health education package was delivered with the standard health education activities endorsed by the Philippines Department of Health (DOH) and the Department of Education (DepEd). The other 20 schools comprised the control arm of the study, where the DOH/DepEd’s standard health education activities were done. At baseline, parasitological assessments and a knowledge, attitude, and practice survey were carried out in all schools. In addition, height, weight, and hemoglobin levels were obtained from each child (after parental consent), and their school attendance and academic performance in English and mathematics were accessed from the school records. The baseline and 2 follow-up surveys were completed using the same study measurements and quality-control assessments. ResultsKey results from this cluster randomized intervention trial will shed light on the impact that The Magic Glasses health education package will have against STH infections in schoolchildren in the province of Laguna, located on the Island of Luzon, in the Calabarzon Region of the Philippines. ConclusionsThe results of the trial will be used to assess the generalizability of the impact of The Magic Glasses health education package in different epidemiological and cultural settings, providing evidence for translation of this health education package into public health policy and practice in the Asian region and beyond. Trial RegistrationAustralian New Zealand Clinical Trials Registry number ACTRN12616000508471; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368849 International Registered Report Identifier (IRRID)DERR1-10.2196/18419

Background Recent studies explored which pathogens drive the global burden of pneumonia hospitalizations among young children. However, the etiology of broader acute lower respiratory tract infections (ALRIs) remains unclear. Methods Using a multicountry study (Albania, Jordan, Nicaragua, and the Philippines) of hospitalized infants and non-ill community controls between 2015 and 2017, we assessed the prevalence and severity of viral infections and coinfections. We also estimated the proportion of ALRI hospitalizations caused by 21 respiratory pathogens identified via multiplex real-time reverse transcription polymerase chain reaction with bayesian nested partially latent class models. Results An overall 3632 hospitalized infants and 1068 non-ill community controls participated in the study and had specimens tested. Among hospitalized infants, 1743 (48.0%) met the ALRI case definition for the etiology analysis. After accounting for the prevalence in non-ill controls, respiratory syncytial virus (RSV) was responsible for the largest proportion of ALRI hospitalizations, although the magnitude varied across sites—ranging from 65.2% (95% credible interval, 46.3%–79.6%) in Albania to 34.9% (95% credible interval, 20.0%–49.0%) in the Philippines. While the fraction of ALRI hospitalizations caused by RSV decreased as age increased, it remained the greatest driver. After RSV, rhinovirus/enterovirus (range, 13.4%–27.1%) and human metapneumovirus (range, 6.3%–12.0%) were the next-highest contributors to ALRI hospitalizations. Conclusions We observed substantial numbers of ALRI hospitalizations, with RSV as the largest source, particularly in infants aged <3 months. This underscores the potential for vaccines and long-lasting monoclonal antibodies on the horizon to reduce the burden of ALRI in infants worldwide. [ABSTRACT FROM AUTHOR]

Background Rhinoviruses (RVs) are among the most frequently detected viruses from hospitalized children with severe acute respiratory infections, being classified into RV-A, RV-B, and RV-C (4 clades: C, GAC1, GAC2, and A2). This study aimed to compare the clinical characteristics and respiratory tract illness severity between the RV species and RV-C clades in children in primary care and hospital settings in rural communities in the Philippines. Methods Clinical samples and information of children <5 years old in the Philippines were collected from 2014 to 2016. The samples were tested by reverse-transcription polymerase chain reaction (RT-PCR) targeting the 5′-untranslated region. PCR-positive samples were sequenced, and RV species were identified by phylogenetic analysis. Results Overall, 3680 respiratory tract illness episodes in 1688 cohort children were documented; 713 of those were RV positive and identified as RV-A (n = 271), RV-B (n = 47), and RV-C (n = 395: C [n = 76], GAG1 [n = 172], GAG2 [n = 8], A2 [n = 138], and unidentified [n = 1]). Severe illnesses, low oxygen saturation, cough, and wheezing were more common in patients with RV-C, especially with GAC1, than in those with RV-A or RV-B. Furthermore, severe illness was significantly more common in RV-C (GAC1)–positive cases than in RV-A–positive cases (odds ratio, 2.61 [95% CI, 1.17–4.13]). Conclusions Children infected with RV-C had more severe illnesses than children infected with RV-A and RV-B. Moreover, emerging clades of RV-C were associated with increased severity. [ABSTRACT FROM AUTHOR]

Hookworm infection is associated with poor nutritional outcomes, anemia, and impaired cognitive performance. We examined the association between maternal hookworm infection and birth outcomes in a cohort of women in Leyte, Philippines. We observed poor intrauterine growth characteristics associated with maternal hookworm only among male offspring, with lower birth weight, head circumference, and placental surface area. Male neonates also had higher insulin-like growth factor 2 (IGF-2) and lower adiponectin in cord blood. These data intriguingly suggest nutritional impacts of maternal hookworm infection during pregnancy may be divergent based on sex of the offspring. [ABSTRACT FROM AUTHOR]

Objective In the year 2000, the Philippines&apos; Department of Health adopted mass chemotherapy using praziquantel to eliminate schistosomiasis. Mass treatment was offered to an eligible population of 30 187 residents of 50 villages in Western Samar, the Philippines, in 2004 as part of an ongoing epidemiological study, Schistosomiasis Transmission and Ecology in the Philippines (STEP), aimed at measuring the effect of irrigation on infection with schistosomiasis. This paper descdbes the mass-treatment activities and factors associated with participation. Methods Advocacy, information dissemination and social mobilization activities were conducted before mass chemotherapy. Village leaders were primarily responsible for community mobilization. Mass treatment was offered in village meeting halls and schools. Participation proportions were estimated based on the 2002-2003 census. Community involvement was measured using a participation index; A Bayesian hierarchical logistic regression model was fitted to estimate the association between sociodemographic factors and residents coming to the treatment site. Findings A village-level average of 53.1% of residents (range: 21.1-85.3) came to the treatment site, leading to a mass-treatment coverage with an average of 48.3% (range: 15.8-80.7). At the individual level, participation proportions were higher among males, preschool and school-age children, non-STEP participants and among those who provided a stool sample. At the village-level, better community involvement was associated with increased participation whereas a larger census was associated with decreased participation. Conclusion The conduct of mass treatment in the 50 villages resulted in far lower participation than expected. This raises concern for the ongoing mass-treatment initiatives now taking place in developing countries. Une traduction en francais de ce resume figure a la fin de l&apos;article. Al final del articulo se facilita una traduccion al espanol. Objectif En 2000, le ministere de la sante philippin a adopte la chimiotherapie de masse par le praziquantel pour eliminer la schistosomiase. Le traitement de masse a ete propose a une population justiciable de ce traitement, composee de 30 187 habitants de 50 villages du Samar occidental, aux Philippines, en 2004, dans le cadre d&apos;une etude epidemiologique en cours, le projet STEP sur la transmission et l&apos;ecologie de la schistosomiase aux Philippines. Ce projet STEP vise a mesurer l&apos;impact de l&apos;irrigation sur l&apos;infection par la schistosomiase. Le present article decrit les operations de traitement de masse et ies facteurs lies a la participation a ce traitement. Methodes Des operations de sensibilisation, de diffusion de l&apos;information et de mobilisation sociale ont ete menees avant la chimiotherapie de masse. Ce sont principalement les chefs de village qui ont assure la mobilisation communautaire. Le traitement a ete propose dans les salles de reunion et les ecoles des villages. Les taux de participation ont ete estimes sur la base du recensement de 2002-2003. L&apos;implication de la communaute a ete mesuree par un indice de participation. Un modele de regression logistique hierarchique bayesien a ete applique pour estimer l&apos;association entre des facteurs sociodemographiques et la venue des habitants sur le site de traitement. Resultats En moyenne dans les villages, 53,1% des habitants (plage de variation : 21,1--85,3) se sont rendus sur le site de traitement, ce qui donne un taux de couverture moyen de 48,3 % (plage de variation : 15,8--80,7). Au niveau individuel, le taux de participation etait plus eleve chez les hommes, les enfants d&apos;age prescolaire et scolaire, les personnes ne participant pas au projet STEP et ceux ayant fourni un echantillon de selles. A l&apos;echelle des villages, une plus grande implication de la communaute etait associee a une plus forte participation, tandis qu&apos;un recensement plus large etait associe a une faible participation. Conclusion Le traitement de masse realise dans 50 villages a donne lieu a une participation bien plus reduite que prevu. Cette observation est preoccupante pour les initiatives de traitement de masse en cours actuellement dans les pays en developpement. Objetivo En el ano 2000, el Ministerio de Salud de Filipinas adopto la antibioticoterapia masiva con prazicuantel como medio de eliminacion de la esquistosomiasis. En 2004 se ofrecio tratamiento masivo a una poblacion idonea de 30 187 residentes en 50 aldeas de Samar occidental, Filipinas, como parte de un estudio epidemiologico en curso--Transmision y Ecologia de la Esquistosomiasis en Filipinas (STEP)--concebido para medir el efecto del riego en la infeccion por esquistosoma. En este articulo se describen las actividades de tratamiento masivo y los factores asociados a la participacion. Metodos Antes de la antibioticoterapia masiva se llevaron a cabo actividades de promocion, difusion de informacion y movilizacion social. Los lideres de aldea fueron los principales responsables de la movilizacion comunitaria. Se ofrecio tratamiento masivo en las salas de reunion y las escuelas de las aldeas. Los porcentajes de participacion se estimaron a partir dei censo de 2002-2003, y la implicacion de la comunidad se midio empieando un indice de participacion. Se aplico un modelo jerarquico bayesiano de regresion logistica para estimar la relacion entre los factores sociodemograficos y la visita de los residentes al centro de tratamiento. Resultados A nivel de aldea, acudieron al centro de tratamiento una media dei 53,1% de los residentes (intervalo: 21,1-85,3), lo que se tradujo en una cobertura de tratamiento masivo del 48,3% (intervalo: 15,8-80,7). A nivel individual, los porcentajes de participacion fueron mayores entre los hombres, los ninos en edad preescolar y escolar, los participantes ajenos a STEP y las personas que proporcionaron una muestra de heces. A nivel de aldea, una mayor implicacion de la comunidad se asocio a una mayor participacion; esta disminuia en cambio cuanto mayor era el censo. Conclusion La practica del tratamiento masivo en las 50 aldeas estudiadas se asocio a una participacion muy inferior a la prevista. Esto Suscita preocupacion en relacion con las iniciativas de tratamiento masivo que se estan Ilevando a cabo en los paises en desarrollo., Introduction Schistosomiasis remains a major public health problem in the Philippines. Some 6.7 million people distributed in 1212 villages (barangays), predominantly in the islands of Leyte, Samar and areas of [...]

Background Among the 6.7 million people living in areas of the Philippines where infection with Schistosoma japonicum is considered endemic, even within small geographical areas levels of infection vary considerably. In general, the ecological drivers of this variability are not well described. Unlike other schistosomes, S. japonicum is known to infect several mammalian hosts. However, the relative contribution of different hosts to the transmission cycle is not well understood. Here, we characterize the transmission dynamics of S. japonicum using data from an extensive field study and a mathematical transmission model. Methods and Findings In this study, stool samples were obtained from 5,623 humans and 5,899 potential nonhuman mammalian hosts in 50 villages in the Province of Samar, the Philippines. These data, with variable numbers of samples per individual, were adjusted for known specificities and sensitivities of the measurement techniques before being used to estimate the parameters of a mathematical transmission model, under the assumption that the dynamic transmission processes of infection and recovery were in a steady state in each village. The model was structured to allow variable rates of transmission from different mammals (humans, dogs, cats, pigs, domesticated water buffalo, and rats) to snails and from snails to mammals. First, we held transmission parameters constant for all villages and found that no combination of mammalian population size and prevalence of infectivity could explain the observed variability in prevalence of infection between villages. We then allowed either the underlying rate of transmission (a) from snails to mammals or (b) from mammals to snails to vary by village. Our data provided substantially more support for model structure (a) than for model structure (b). Fitted values for the village-level transmission intensity from snails to mammals appeared to be strongly spatially correlated, which is consistent with results from descriptive hierarchical analyses. Conclusions Our results suggest that the process of acquiring mammalian S. japonicum infection is more important in explaining differences in prevalence of infection between villages than the process of snails becoming infected. Also, the contribution from water buffaloes to human S. japonicum infection in the Philippines is less important than has been recently observed for bovines in China. These findings have implications for the prioritization of mitigating interventions against S. japonicum transmission. The Editors' Summary of this article follows the references., Introduction Modern, inexpensive pharmaceuticals are dramatically reducing the burden of disease caused by schistosomes and other waterborne macroparasites in resource-poor settings [1,2]. Many of the national programs delivering these anthelmintics [...]

Objective To estimate the association between the intensity of animal infection with Schistosoma japonicum and human infection in Western Samar province, the Philippines. Methods We conducted an observational cross-sectional study of 1425 households in 50 villages. Stool samples were collected on each of 1-3 days from 5623 humans, 1275 cats, 1189 dogs, 1899 pigs, 663 rats and 873 water buffalo. Intensity of infection with S. japonicum was measured by the number of eggs per gram (EPG). Egg counts were done using the Kato-Katz method. We used a Bayesian hierarchical cumulative Iogit model, with adjustments for age, sex, occupation and measurement error. Findings The adjusted proportions of humans lightly infected (classified as 1-100 EPG) was 17.7% (95% Bayesian credible interval = 15.3-20.2%); the proportion classified as at least moderately infected (>100 EPG) was 3.2% (2.2-4.6%).The crude parasitological results for animals indicated that 37 cats (2.9%), 228 dogs (19.2%), 39 pigs (2.1%), 199 rats (30.0%) and 28 water buffalo (3.2%) were infected. In univariate analyses the odds ratios corresponding to a unit increase in the mean number of EPG at the village-level in dogs was 1.05 (1.01-1.09), in cats 1.35 (1.02-1.78), in pigs 1.16 (0.24- 5.18) and in rats 1.00 (1.00-1.01). Mean EPG values in cats, dogs, pigs and rats were correlated with one another. This confounding made interpreting the odds ratios difficult, but the odds ratios for dogs and cats were more consistent. Conclusion S. japonicum is endemic in areas of the Philippines despite implementation of control programmes. This may be due to the association of infections in dogs and cats with human infections. Infection control in dogs and cats is challenging, and there is a need to develop new methods to control transmission across all species. Resume Associations transversales entre l&apos;intensite des infestations animale et humaine par Schistosoma japonicum dans la province du Samar occidental, aux Philippines Objectif Evaluer l&apos;association entre l&apos;intensite de l&apos;infestation des animaux par Schistosoma japonicum et l&apos;infestation des etres humains par cette espece dans la province du Samar occidental, aux Philippines. Methodes Une etude transversale d&apos;observation a ete menee aupres de 1425 menages, dans 50 villages. Des echantillons de selles ont ete recueillis quotidiennement sur une periode de 3 jours, aupres de 5623 etres humains, 1275 chats, 1189 chiens, 1899 porcs, 663 rats et 873 buffles d&apos;eau. L&apos;intensite de l&apos;infestation par S. japonicum a ete mesuree par le nombre d&apos;oeufs par gramme (EPG). Le comptage des oeufs a ete effectue par la methode de Kato-Katz. Un modele logit hierarchise cumulatif de type bayesien, avec des ajustements pour tenir compte de l&apos;age, du sexe, de la profession et de l&apos;erreur de mesure, a ete utilise. Resultats La proportion ajustee d&apos;etres humains legerement infestes (categorie correspondant a 1-100 EPG) etait de 17,7 % (intervalle de credibilite bayesien a 95 % = 15,3- 20,2 %) et celle d&apos;humains moderement infestes (> 100 EPG) de 3,2 % (2,2 a 4,6 %). Les resultats parasitologiques bruts pour les animaux ont indique que 37 chats (2,9 %), 228 chiens (49,2 %), 39 porcs (2,1 %), 199 rats (30,0 %) et 28 buffles d&apos;eau (3,2 %) etaient infestes. Dans les analyses monovariees, les odds-ratios correspondant a l&apos;augmentation d&apos;une unite du nombre moyen d&apos;EPG au niveau du village chez les chiens etait de 1,05 (1,01-1,09), chez les chats de 1,35 (1,02-1,78), chez les porcs de 1,16 (0,24-5,18) et chez les rats de 1,00 (1,00-1,01). Les valeurs moyennes de l&apos;EPG chez les chats, les chiens, les porcs et les rats etaient correlees entre elles. Ce facteur de confusion a rendu difficile l&apos;interpretation des odds-ratios, mais on a constate une plus grande stabilite entre les odds-ratios pour les chiens et les chats. Conclusion S. japonicum est endemique dans certaines zones des Philippines en depit de la mise en oeuvre de programmes de lutte. Cette situation peut etre due a l&apos;association d&apos;infestations canines et felines a des infestations humaines. La lutte contre l&apos;infestation des chiens et des chats represente un vrai defi et il est necessaire de mettre au point de nouvelles methodes pour endiguer la transmission entre les especes. Resumen Asociacion transversal entre la intensidad de los casos de infeccion pot Schistosoma japonicum en los animales y en el hombre en la provincia de Samar occidental, Filipinas Objetivo Estimar la relacion entre la intensidad de las infecciones animales por Schistosoma japonicum y la de la infeccion humana correspondiente en la provincia de Samar occidental de Filipinas. Metodos Realizamos un estudio transversal observacional de 1425 hogares en 50 aldeas. Se recogieron muestras de heces de forma diaria durante 1-3 dias en 5623 personas, 1275 gatos, 1189 perros, 1899 cerdos, 663 ratas y 873 bufalos de agua. La intensidad de la infeccion por S. japonicum se midio en funcion del numero de huevos por gramo (HPG). Los recuentos de huevos se hicieron mediante el metodo de Kato-Katz, y utilizamos un modelo logit acumulativo jerarquico de tipo bayesiano, con ajustes para la edad, el sexo, la ocupacion y el error de medicion. Resultados La proporcion ajustada de personas con infeccion ligera (1-100 HPG) fue del 17,7% (intervalo creible bayesiano del 95% = 15,3%-20,2%), y la proporcion clasificada como afectada moderadamente (HPG > 100) fue del 3,2% (2,2%-4,6%). Los resultados parasitologicos brutos para los animales mostraron que estaban infectados 37 gatos (2,9%), 228 perros (19,2%), 39 cerdos (2,1%), 199 ratas (30,0%) y 28 bufalos de agua (3,2%). En los analisis con una variable las razones de posibilidades (OR) correspondientes a un aumento de una unidad del numero medio de HPG a nivel de aldea fueron de 1,05 (1,01-1,09) en los perros, 1,35 (1,02-1,78) en las gatos, 1,16 (0,24-5,18) en los cerdos, y 1,00 (1,00-1,01) en las ratas. Los valores medios de HPG en los gatos, perros, cerdos y ratas estaban correlacionados entre si. Este factor de confusion dificulto la interpretacion de las OR, pero las OR de perros y gatos fueron mas coherentes. Conclusion S. japonicum es endemico en algunas zonas de Filipinas pese a la puesta en practica de los programas de control. Ello puede deberse a la asociacion de la infeccion en perros y gatos a las infecciones humanas. El control de la infeccion en esas dos especies no resulta facil, de ahi la necesidad de desarrollar nuevos metodos para controlar la transmision a traves de todas las especies., [TEXT NOT REPRODUCIBLE IN ASCII] Introduction Schistosomiasis affects 200 million people in 74 countries worldwide; 120 million of these are symptomatic and 20 million have severe disease. (1) Unlike the [...]

There has been much debate recently about several issues related to the migration of physicians from developing to developed countries. However, few studies have been conducted to address these issues in a systematic fashion. In an attempt to begin the process of generating systematic data, we designed and distributed a questionnaire addressing several core issues surrounding physician migration to respondents selected on the basis of their special expertise or experience in India, Nigeria, Pakistan, Colombia, and the Philippines. The issues addressed relate to the reasons physicians migrate to developed countries, how migration is related to the structure of medical education, the effect that migration has on the health care infrastructure of developing countries, and various policy options for dealing with physician migration. Though responses varied somewhat by country, a desire for increased income, greater access to enhanced technology, an atmosphere of general security and stability, and improved prospects for one's children were the primary motivating factors for physician migration. A majority of respondents believed that physicians in developing counties are provided with highly specialized skills that they can better utilize in developed countries, but respondents were ambivalent with respect to the utility of educational reform. Responses varied significantly by country with regard to whether physician migration results in physician shortages, but there was widespread agreement that it exacerbates shortages in rural and public settings. With respect to policy options, increasing physician income, improving working conditions, requiring physicians to work in their home countries for a period following graduation from medical school, and creating increased collaboration between health ministries in developed and developing countries found the most favor with respondents. Keywords: Physician migration; Health policy; Developing countries; India; Pakistan; Nigeria; Columbia; The Philippines

Background: Soil-transmitted helminth (STH) infections are still prevalent among schoolchildren in the Philippines. We evaluated the risk factors associated with STH and the relationship between STH and nutritional indices among schoolchildren aged 9–10 years in Laguna province, the Philippines. Methods: We used the baseline data from 40 schools enrolled in a randomised controlled trial of the Magic Glasses Philippines health education package. Data on demographic and socio-economic variables, and STH related knowledge, attitudes and practices, were obtained through a questionnaire. Stool samples were collected and assessed for STH egg presence using the Kato-Katz technique. Haemoglobin levels and height and weight of study participants were also determined. The generalized estimating equations approach was used to construct logistic regression models to assess STH-associated risk factors, and the association between any STH infection and anaemia, child stunting, wasting and being underweight. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000508471). Findings: Among 1,689 schoolchildren, the prevalence of any STH was 23%. The prevalence of anaemia, stunting, being underweight and wasting was 13%, 20.2%, 19% and 9.5%, respectively. Age, socio-economic status, rural/urban classification of schools and knowledge of STH were significant risk factors for acquiring a STH infection. Moreover, infections with any STH were significantly associated with stunting (P = <0.001) and being underweight (P = <0.003), but not wasting (P = 0.375) or anaemia (P = 0.462) after controlling for confounding covariates. Conclusion: The study findings emphasise the need for sustainable deworming in tandem with other measures such as the provision of health education, improvements in sanitation and hygiene, and nutritional programs in order to control STH infections and improve morbidity outcomes in schoolchildren. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12616000508471). Author summary: Soil-transmitted helminth (STH) infections continue to be high among schoolchildren in the Philippines despite the conduct of semi-annual nationwide school-based mass drug administration (MDA) program more than a decade ago. In this cross-sectional survey, we assess the prevalence of STH, the risk factors associated with infection, and the impact of STH on nutritional indices among schoolchildren in Laguna province, the Philippines. Our results show that STH prevalence (23%) remains above the World Health Organization (WHO) target of < 20% for morbidity control. The prevalences of stunting (20.2%), being underweight (19%) or wasting (9.5%) are high and are still regarded as public health problems according to WHO criteria, but low anaemia prevalence (13%) was observed. Age, socio-economic status, rural/urban classification of schools and knowledge of STH were significant risk factors for STH infections. Moreover, infections with STH were significantly associated with stunting and being underweight but not wasting or anaemia after controlling for key confounders. Sustainable deworming in tandem with other measures such as the provision of health education, improvements in sanitation and hygiene, and nutritional programs, are needed to control intestinal worm infections and improve morbidity outcomes in schoolchildren. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection worldwide, but reports of temporal changes in the risk of transmission among close contacts has been scarce. This study aimed to examine an association between the viral load trajectory and transmission risk to develop a better control strategy for the disease spread. We conducted a household-based prospective cohort study in Biliran Province, the Philippines, and enrolled 451 participants to observe the development of acute respiratory infection. Including the cases found at the health-care facility, we analyzed the data of viral loads with symptom records obtained from 172 followed participants who had household member positive for RSV with a rapid test during an RSV outbreak in 2018–2019. We developed a model estimating a temporal change in the viral shedding from the infection and evaluated transmission dynamics. We found that most transmission events occurred within approximately 7 days of the household exposure, including potential presymptomatic transmissions. The inferred risk of infection among those younger than 5 years was 3.5 times higher than that of those older than 5 years. This finding suggested that the initial week after the household exposure is particularly important for preventing RSV spread. [ABSTRACT FROM AUTHOR]

Abstract Background A large phase III placebo-controlled, randomized efficacy trial of an investigational 11-valent pneumococcal conjugate vaccine against pneumonia in children less than 2 years of age was conducted in the Philippines from July 2000 to December 2004. Clinical data from 12,194 children who were given either study vaccine or placebo was collected from birth up to two years of age for the occurrence of radiologically proven pneumonia as the primary endpoint, and for clinical pneumonia and invasive pneumococcal disease as the secondary endpoints. Several tertiary endpoints were also explored. Along the core trial, several satellite studies on herd immunity, cost-effectiveness of the study vaccine, acute otitis media, and wheezing were conducted. Results We describe here in detail how the relevant clinical records were managed and how quality control procedures were implemented to ensure that valid data were obtained respectively for the core trial and for the satellite studies. We discuss how the task was achieved, what the challenges were and what might have been done differently. Conclusions There were several factors that made the task of data management doable and efficient. First, a pre-trial data management system was available. Secondly, local committed statisticians, programmers and support staff were available and partly familiar to clinical trials. Thirdly, the personnel had undergone training during trial and grew with the task they were supposed to do. Thus the knowledge needed to develop and operate clinical data system was fully transferred to local staff. Trial registration Current Controlled Trials ISRCTN62323832

Abstract Background The goal of this Geographic Information System (GIS) study was to obtain accurate information on the locations of study subjects, road network and services for research purposes so that the clinical outcomes of interest (e.g., vaccine efficacy, burden of disease, nasopharyngeal colonization and its reduction) could be linked and analyzed at a distance from health centers, hospitals, doctors and other important services. The information on locations can be used to investigate more accurate crowdedness, herd immunity and/or transmission patterns. Method A randomized, placebo-controlled, double-blind trial of an 11-valent pneumococcal conjugate vaccine (11PCV) was conducted in Bohol Province in central Philippines, from July 2000 to December 2004. We collected the information on the geographic location of the households (N = 13,208) of study subjects. We also collected a total of 1982 locations of health and other services in the six municipalities and a comprehensive GIS data over the road network in the area. Results We calculated the numbers of other study subjects (vaccine and placebo recipients, respectively) within the neighborhood of each study subject. We calculated distances to different services and identified the subjects sharing the same services (calculated by distance). This article shows how to collect a complete GIS data set for human to human transmitted vaccine study in developing country settings in an efficient and economical way. Conclusions The collection of geographic locations in intervention trials should become a routine task. The results of public health research may highly depend on spatial relationships among the study subjects and between the study subjects and the environment, both natural and infrastructural. Trial registration number ISRCTN: ISRCTN62323832

Abstract Background Verbal autopsy methods are critically important for evaluating the leading causes of death in populations without adequate vital registration systems. With a myriad of analytical and data collection approaches, it is essential to create a high quality validation dataset from different populations to evaluate comparative method performance and make recommendations for future verbal autopsy implementation. This study was undertaken to compile a set of strictly defined gold standard deaths for which verbal autopsies were collected to validate the accuracy of different methods of verbal autopsy cause of death assignment. Methods Data collection was implemented in six sites in four countries: Andhra Pradesh, India; Bohol, Philippines; Dar es Salaam, Tanzania; Mexico City, Mexico; Pemba Island, Tanzania; and Uttar Pradesh, India. The Population Health Metrics Research Consortium (PHMRC) developed stringent diagnostic criteria including laboratory, pathology, and medical imaging findings to identify gold standard deaths in health facilities as well as an enhanced verbal autopsy instrument based on World Health Organization (WHO) standards. A cause list was constructed based on the WHO Global Burden of Disease estimates of the leading causes of death, potential to identify unique signs and symptoms, and the likely existence of sufficient medical technology to ascertain gold standard cases. Blinded verbal autopsies were collected on all gold standard deaths. Results Over 12,000 verbal autopsies on deaths with gold standard diagnoses were collected (7,836 adults, 2,075 children, 1,629 neonates, and 1,002 stillbirths). Difficulties in finding sufficient cases to meet gold standard criteria as well as problems with misclassification for certain causes meant that the target list of causes for analysis was reduced to 34 for adults, 21 for children, and 10 for neonates, excluding stillbirths. To ensure strict independence for the validation of methods and assessment of comparative performance, 500 test-train datasets were created from the universe of cases, covering a range of cause-specific compositions. Conclusions This unique, robust validation dataset will allow scholars to evaluate the performance of different verbal autopsy analytic methods as well as instrument design. This dataset can be used to inform the implementation of verbal autopsies to more reliably ascertain cause of death in national health information systems.

Abstract Background Despite the importance of mortality data for effective planning and monitoring of health services, official reporting systems rarely capture every death. The completeness of death reporting and the subsequent effect on mortality estimates were examined in six municipalities of Bohol province in the Philippines using a system review and capture-recapture analysis. Methods Reports of deaths were collected from records at local civil registration offices, health centers and hospitals, and parish churches. Records were reconciled using a specific set of matching criteria, and both a two-source and a three-source capture-recapture analysis was conducted. For the two-source analysis, civil registry and health data were combined due to dependence between these sources and analyzed against the church data. Results Significant dependence between civil registration and health reporting systems was identified. There were 8,075 unique deaths recorded in the study area between 2002 and 2007. We found 5% to 10% of all deaths were not reported to any source, while government records captured only 77% of all deaths. Life expectancy at birth (averaged for 2002-2007) was estimated at 65.7 years and 73.0 years for males and females, respectively. This was one to two years lower than life expectancy estimated from reconciled reported deaths from all sources, and four to five years lower than life expectancy estimated from civil registration data alone. Reporting patterns varied by age and municipality, with childhood deaths more underreported than adult deaths. Infant mortality was underreported in civil registration data by 62%. Conclusions Deaths are underreported in Bohol, with inconsistent reporting procedures contributing to this situation. Uncorrected mortality measures would subsequently be misleading if used for health planning and evaluation purposes. These findings highlight the importance of ensuring that official mortality estimates from the Philippines are derived from data that have been assessed for underreporting and corrected as necessary.

In areas endemic to schistosomiasis, fetal exposure to schistosome antigens prime the offspring before potential natural infection. Praziquantel (PZQ) treatment for Schistosoma japonicum infection in pregnant women has been demonstrated to be safe and effective. Our objectives were to evaluate whether maternal PZQ treatment modifies the process of in utero sensitization to schistosome antigens potentially impacting later risk of infection, as well as immune response to S. japonicum. We enrolled 295 children at age six, born to mothers with S. japonicum infection who participated in a randomized control trial of PZQ versus placebo given at 12–16 weeks gestation in Leyte, The Philippines. At enrollment, we assessed and treated current S. japonicum infection and measured serum cytokines. During a follow-up visit four weeks later, we assessed peripheral blood mononuclear cell (PBMC) cytokine production in response to soluble worm antigen preparation (SWAP) or soluble egg antigen (SEA). Associations between maternal treatment group and the child's S. japonicum infection status and immunologic responses were determined using multivariate linear regression analysis. PZQ treatment during pregnancy did not impact the prevalence (P = 0.12) or intensity (P = 0.59) of natural S. japonicum infection among children at age six. Among children with infection at enrollment (12.5%) there were no significant serum cytokine concentration differences between maternal treatment groups. Among children with infection at enrollment, IL-1 production by PBMCs stimulated with SEA was higher (P = 0.03) in the maternal PZQ group compared to placebo. Among children without infection, PBMCs stimulated with SEA produced greater IL-12 (P = 0.03) and with SWAP produced less IL-4 (P = 0.01) in the maternal PZQ group compared to placebo. Several cytokines produced by PBMCs in response to SWAP and SEA were significantly higher in children with S. japonicum infection irrespective of maternal treatment: IL-4, IL-5, IL-10, and IL-13. We report that maternal PZQ treatment for S. japonicum shifted the PBMC immune response to a more inflammatory signature but had no impact on their offspring's likelihood of infection or serum cytokines at age six, further supporting the safe use of PZQ in pregnant women. Trial Registration: ClinicalTrials.gov NCT00486863. Author summary: Children living in areas endemic to schistosomiasis typically do not present signs of acute illness during infection. It is believed that fetal exposure from a pregnant mother with infection primes the offspring and influences the child's susceptibility and immune response to infection. Praziquantel treatment for Schistosoma japonicum infection in pregnant women has been demonstrated to be safe and effective, but the long-term impact on the child's immunity is not fully understood. This study enrolled 295 children at age six, who were born to mothers who participated in a randomized controlled trial of praziquantel vs placebo for S. japonicum infection during pregnancy. The children were assessed and treated for S. japonicum infection and blood was collected to measure immune response markers. We found that praziquantel treatment during pregnancy did not impact the prevalence or intensity of naturally acquired S. japonicum infection among children at age six. Among the 37 children with S. japonicum infection, immune response markers did not differ by maternal treatment group. This evidence further supports the safe use of praziquantel for pregnant women. [ABSTRACT FROM AUTHOR]

Background: Studies focusing on the Integrated Management of Childhood Illness (IMCI) program in the Philippines are limited, and perspectives of frontline health care workers (HCWs) are largely absent in relation to the introduction and current implementation of the program. Here, we describe the operational challenges and opportunities described by HCWs implementing IMCI in five regions of the Philippines. These perspectives can provide insights into how IMCI can be strengthened as the program matures, in the Philippines and beyond.Methods: In-depth interviews (IDIs) were conducted with HCWs (n = 46) in five provinces (Ilocos Sur, Quezon, National Capital Region, Bohol and Davao), with full transcription and translation as necessary. In parallel, data collectors observed the status (availability and placement) of IMCI-related materials in facilities. All data were coded using NVivo 12 software and arranged along a Social Ecological Model.Results: HCWs spoke of the benefits of IMCI and discussed how they developed workarounds to ensure that integral components of the program could be delivered in frontline facilities. Five key challenges emerged in relation to IMCI implementation in primary health care (PHC) facilities: 1) insufficient financial resources to fund program activities, 2) inadequate training, mentoring and supervision among and for providers, 3) fragmented leadership and governance, 4) substandard access to IMCI relevant written documents, and 5) professional hierarchies that challenge fidelity to IMCI protocols.Conclusion: Although the IMCI program was viewed by HCWs as holistic and as providing substantial benefits to the community, more viable implementation processes are needed to bolster acceptability in PHC facilities. [ABSTRACT FROM AUTHOR]

Abstract Background Few studies have described heterogeneity in Schistosoma japonicum infection intensity, and none were done in Philippines. The purpose of this report is to describe the village-to-village variation in the prevalence of two levels of infection intensity across 50 villages of Samar Province, the Philippines. Methods This cross-sectional study was conducted in 25 rain-fed and 25 irrigated villages endemic for S. japonicum between August 2003 and November 2004. Villages were selected based on irrigation and farming criteria. A maximum of 35 eligible households were selected per village. Each participant was asked to provide stool samples on three consecutive days. All those who provided at least one stool sample were included in the analysis. A Bayesian three category outcome hierarchical cumulative logit regression model with adjustment for age, sex, occupation and measurement error of the Kato-Katz technique was used for analysis. Results A total of 1427 households and 6917 individuals agreed to participate in the study. A total of 5624 (81.3%) participants provided at least one stool sample. The prevalences of those lightly and at least moderately infected varied from 0% (95% Bayesian credible interval (BCI): 0%–3.1%) to 45.2% (95% BCI: 36.5%–53.9%) and 0% to 23.0% (95% BCI: 16.4%–31.2%) from village-to-village, respectively. Using the 0–7 year old group as a reference category, the highest odds ratio (OR) among males and females were that of being aged 17–40-year old (OR = 8.76; 95% BCI: 6.03–12.47) and 11–16-year old (OR = 8.59; 95% BCI: 4.74–14.28), respectively. People who did not work on a rice farm had a lower prevalence of infection than those working full time on a rice farm. The OR for irrigated villages compared to rain-fed villages was 1.41 (95% BCI: 0.50–3.21). Discussion We found very important village-to-village variation in prevalence of infection intensity. This variation is probably due to village-level variables other than that explained by a crude classification of villages into the irrigated and non-irrigated categories. We are planning to capture this spatial heterogeneity by updating our initial transmission dynamics model with the data reported here combined with 1-year post-treatment follow-up of study participants.

Objectives: Gold standard cause of death data is critically important to improve verbal autopsy (VA) methods in diagnosing cause of death where civil and vital registration systems are inadequate or poor. As part of a three-country research study—Improving Methods to Measure Comparable Mortality by Cause (IMMCMC) study—data were collected on clinicopathological criteria-based gold standard cause of death from hospital record reviews with matched VAs. The purpose of this data note is to make accessible a de-identified format of these gold standard VAs for interested researchers to improve the diagnostic accuracy of VA methods. Data description: The study was conducted between 2011 and 2014 in the Philippines, Bangladesh, and Papua New Guinea. Gold standard diagnoses of underlying causes of death for deaths occurring in hospital were matched to VAs conducted using a standardized VA questionnaire developed by the Population Health Metrics Consortium. 3512 deaths were collected in total, comprised of 2491 adults (12 years and older), 320 children (28 days to 12 years), and 702 neonates (0–27 days). [ABSTRACT FROM AUTHOR]

Background and objectives Despite a substantial reduction in the mortality rate of children under 5 years in the past 25 years, pneumonia remains the single-largest infectious cause of child deaths worldwide. This study explored the chronological order of visited healthcare facilities and practitioners, and the factors affecting mothers’ intention to seek care before the hospitalisation of children with pneumonia. Methods and analysis A qualitative research design was employed using theory of planned behaviour as a framework for the analysis. Using purposive sampling technique, 11 mothers, whose children under 5 years old were hospitalised with severe pneumonia, were recruited for individual semi-structured interviews. Their sociodemographic information was analysed using descriptive statistics. Results Mothers brought their sick children to multiple facilities, and 1 to 19 days had passed before hospitalisation. We identified four major factors determining mothers’ intentions: (1) doing something useful for the sick child, (2) expecting the child to receive the necessary assessment and treatment, (3) accepting advice to visit a healthcare facility and be referred to a hospital and (4) considering issues and benefits associated with hospitalisation. Mothers noticed their children’s unusual symptoms and monitored them while applying home remedies. They also took their children to traditional healers despite knowing that the treatments were not necessarily effective. Mothers expected children to be checked by health professionals and listened to advice from family members regarding the facilities to visit, and from healthcare staff to be referred to a hospital. Financial issues and the double burden of housework and caring for the hospitalised child were mothers’ major concerns about hospitalisation. Conclusion Children were hospitalised after several days because they visited multiple healthcare facilities, including traditional healers. Improving care quality at healthcare facilities and reducing financial and mothers’ burden may reduce the hospitalisation delay for children with pneumonia. [ABSTRACT FROM AUTHOR]

A triage test for tuberculosis: Tuberculosis remains a global health burden. Ahmad et al. used machine learning to develop an algorithm that distinguished active tuberculosis from other diseases with similar symptoms by measuring expression of four proteins in blood samples. The authors validated their triage test's discriminatory power using blood samples from subjects with persistent cough across several continents, showing that performance was improved when detection of antibodies against a mycobacterial antigen was added to the panel. These promising results support further development and field testing using a point-of-care format. Improved tuberculosis (TB) prevention and control depend critically on the development of a simple, readily accessible rapid triage test to stratify TB risk. We hypothesized that a blood protein-based host response signature for active TB (ATB) could distinguish it from other TB-like disease (OTD) in adult patients with persistent cough, thereby providing a foundation for a point-of-care (POC) triage test for ATB. Three adult cohorts consisting of ATB suspects were recruited. A bead-based immunoassay and machine learning algorithms identified a panel of four host blood proteins, interleukin-6 (IL-6), IL-8, IL-18, and vascular endothelial growth factor (VEGF), that distinguished ATB from OTD. An ultrasensitive POC-amenable single-molecule array (Simoa) panel was configured, and the ATB diagnostic algorithm underwent blind validation in an independent, multinational cohort in which ATB was distinguished from OTD with receiver operator characteristic–area under the curve (ROC-AUC) of 0.80 [95% confidence interval (CI), 0.75 to 0.85], 80% sensitivity (95% CI, 73 to 85%), and 65% specificity (95% CI, 57 to 71%). When host antibodies against TB antigen Ag85B were added to the panel, performance improved to 86% sensitivity and 69% specificity. A blood-based host response panel consisting of four proteins and antibodies to one TB antigen can help to differentiate ATB from other causes of persistent cough in patients with and without HIV infection from Africa, Asia, and South America. Performance characteristics approach World Health Organization (WHO) target product profile accuracy requirements and may provide the foundation for an urgently needed blood-based POC TB triage test. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) is one of the main viral causes of lower respiratory tract illness (LRTI), especially in young children. RSV vaccines, including maternal and infant vaccines, are under development; however, more epidemiological studies are needed to develop effective vaccination strategies. Objectives: To estimate detailed age‐specific incidence rates and severity of RSV‐associated LRTI (RSV‐LRTI) using data from a community‐based prospective cohort study in the Philippines. Patients/Methods: Cohort children who visited health facilities due to acute respiratory symptoms were identified, and nasopharyngeal swabs were collected to detect RSV. The severity of RSV‐LRTI was assessed using the severity definition proposed by the World Health Organization. Risk factors for developing RSV‐LRTI and contribution of SpO2 measurement were also evaluated. Results: A total of 395 RSV episodes which occurred in children aged 2‐59 months were categorised as 183 RSV‐LRTI, 72 as severe RSV‐LRTI and 29 as very severe RSV‐LRTI. Children aged 3‐5 months had the highest incidence rate of RSV‐LRTI, at 207.4 per 1000 child‐years (95% CI: 149.0‐279.5). Younger age group, place of living and low educational level of caregivers were associated with developing RSV‐LRTI. Clinical manifestations had low levels of agreement with hypoxaemia as measured by pulse oximeter. Conclusion: The highest burden of RSV was observed in young infants aged 3‐5 months, whereas the burden was also high in those aged 12‐20 months. Future vaccination strategies should consider the protection of older children, especially those aged one year, as well as young infants. [ABSTRACT FROM AUTHOR]

Background: The objectives of this study were to 1) evaluate the influence of treatment with praziquantel on the inflammatory milieu in maternal, placental, and cord blood, 2) assess the extent to which proinflammatory signatures in placental and cord blood impacts birth outcomes, and 3) evaluate the impact of other helminths on the inflammatory micro environment. Methods/Findings: This was a secondary analysis of samples from 369 mother-infant pairs participating in a randomized controlled trial of praziquantel given at 12–16 weeks’ gestation. We performed regression analysis to address our study objectives. In maternal peripheral blood, the concentrations of CXCL8, and TNF receptor I and II decreased from 12 to 32 weeks’ gestation, while IL-13 increased. Praziquantel treatment did not significantly alter the trajectory of the concentration of any of the cytokines examined. Hookworm infection was associated with elevated placental IL-1, CXCL8 and IFN-γ. The risk of small-for-gestational age increased with elevated IL-6, IL-10, and CXCL8 in cord blood. The risk of prematurity was increased when cord blood sTNFRI and placental IL-5 were elevated. Conclusions: Our study suggests that fetal cytokines, which may be related to infectious disease exposures, contribute to poor intrauterine growth. Additionally, hookworm infection influences cytokine concentrations at the maternal-fetal interface. Clinical Trial Registry number and website: ClinicalTrials.gov (). [ABSTRACT FROM AUTHOR]

Objective Pneumonia remains the leading cause of hospitalisations and deaths among children aged <5 years. Diverse respiratory pathogens cause acute respiratory infections, including pneumonia. Here, we analysed viral and bacterial pathogens and risk factors associated with death of hospitalised children. Design A 9-year case series study. Setting Two secondary-care hospitals, one tertiary-care hospital and one research centre in the Philippines. Participants 5054 children aged <5 years hospitalised with severe pneumonia. Methods Nasopharyngeal swabs for virus identification, and venous blood samples for bacterial culture were collected. Demographic, clinical data and laboratory findings were collected at admission time. Logistic regression analyses were performed to identify the factors associated with death. Results Of the enrolled patients, 57% (2876/5054) were males. The case fatality rate was 4.7% (238/5054), showing a decreasing trend during the study period (p<0.001). 55.0% of the patients who died were either moderately or severely underweight. Viruses were detected in 61.0% of the patients, with respiratory syncytial virus (27.0%) and rhinovirus (23.0%) being the most commonly detected viruses. In children aged 2-59 months, the risk factors significantly associated with death included age of 2-5 months, sensorial changes, severe malnutrition, grunting, central cyanosis, decreased breath sounds, tachypnoea, fever (≥38.5°C), saturation of peripheral oxygen <90%, infiltration, consolidation and pleural effusion on chest radiograph. Among the pathogens, adenovirus type 7, seasonal influenza A (H1N1) and positive blood culture for bacteria were significantly associated with death. Similar patterns were observed between the death cases and the aforementioned factors in children aged <2 months. Conclusion Malnutrition was the most common factor associated with death and addressing this issue may decrease the case fatality rate. In addition, chest radiographic examination and oxygen saturation measurement should be promoted in all hospitalised patients with pneumonia as well as bacteria detection to identify patients who are at risk of death. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory infection (ARI) is of great concern in public health. It remains unclear whether viral infections can affect the host's susceptibility to subsequent ARIs.Methods: A prospective cohort study on ARIs of children below 5 years old was conducted in the Philippines from 2014 to 2016. The respiratory symptoms were recorded daily, and nasopharyngeal swabs were collected at both household and health facilities. The specimens were tested for respiratory viruses. We then determined whether viral etiology was associated with the severity of the present ARI and whether previous viral infections was associated with subsequent ARIs.Results: A total of 3851 children and 16337 ARI episodes were enrolled and recorded, respectively. Samples were collected from 24% of all ARI episodes; collection rate at the healthcare facilities was 95%. Enterovirus D68, rhinovirus species C, and respiratory syncytial virus were significantly associated with severe ARIs. The risk for subsequent ARIs was significantly enhanced after infections with adenovirus, influenza A virus, parainfluenza virus type 4, and rhinovirus species C.Conclusions: This study revealed that viral etiology plays a significant role in the severity of the present ARI and that viral infection affects the host's susceptibility to subsequent ARIs. [ABSTRACT FROM AUTHOR]

Objectives Pneumonia remains a primary cause of death for under-five children. It is possible to reduce the mortality impact from childhood pneumonia if caregivers recognise the danger signs of pneumonia and obtain appropriate healthcare. Among caregivers, research on fathers' healthcare-seeking behaviours and perceptions are limited, whereas research on mothers is available. This study aims to reveal fathers' roles and perspectives with respect to the selection of care and treatment for children with pneumonia in a remote island of the Philippines. Design A qualitative research was carried out using semistructured interviews. Setting and participants The interviews were conducted with 12 fathers whose children had pneumonia-like episodes in the 6 months prior to the interview. Data analysis was performed using the concept analysis method to identify codes which were merged into subcategories and categories. Finally, the themes were identified. Results Three themes were identified as part of fathers' roles, and two were identified as fathers' perspectives on various treatment options. Fathers took care of their sick children by not entrusting care only to mothers because they considered this as part of their role. Notably, fathers considered that arranging money for the child's treatment was a matter of prime importance. They selected a particular treatment based on their experiences and beliefs, including herbal medicine, home treatment, and visiting traditional healers and health facilities. Their decision was influenced by not only their perception of the severity of illness but also cultural beliefs on the cause of illness. Visiting health facilities, particularly during hospital admissions, causes significant financial burden for the family which was the main concern of fathers. Conclusion It is crucial to consider the cultural background and also imperative to address issues related to medical cost and the credibility of health facilities to improve fathers' healthcare-seeking behaviour. [ABSTRACT FROM AUTHOR]