Background: The COVID-19 pandemic prompted extensive vaccination efforts globally, yet in the Philippines, many families remained unvaccinated. Caregivers are key decision-makers for family vaccination, but evidence on factors influencing their own vaccine uptake is limited. Methods: A cross-sectional survey of primary caregivers was conducted in low COVID-19 vaccine uptake regions in the Philippines from July to October 2023 using a validated questionnaire. Multivariable logistic regression identified enablers and barriers to vaccine uptake. Results: Among 775 respondents, 72.3% completed primary vaccination, 3.3% had incomplete vaccination, and 24.4% were unvaccinated. Key factors for vaccination included self, family, and community protection, and the influence of government regulations. Distrust in vaccine safety was the main barrier. Positive associations with vaccine uptake were found for age [30–45 years (aOR = 2.23) and 46–59 years (aOR = 2.84)], education [secondary (aOR = 2.25) and tertiary (aOR = 4.93)], and employment (aOR = 1.99). Confidence in vaccine safety (aOR = 1.92), vaccine effectiveness (aOR = 2.23), and satisfaction with vaccination efforts (aOR = 2.39) were additional enablers. Disagreement with restrictions on the unvaccinated was a barrier (aOR = 0.31). Conclusions: This study identified multiple factors influencing COVID-19 vaccination among primary caregivers in low uptake areas of the Philippines. Interventions addressing perceptions about vaccine safety and effectiveness, particularly among younger and less educated caregivers, may improve public trust and satisfaction with vaccination efforts.

COVID-19 vaccines were recommended for the pediatric population in the Philippines in February 2022, after adults, due to both the direct and indirect effects of COVID-19. Despite ongoing vaccination efforts in the Philippines, pediatric COVID-19 vaccination uptake remains low. As such, this study aimed to determine the enablers and barriers of pediatric COVID-19 vaccination uptake amongst children 5–11 years in the Philippines. A cross-sectional survey among 546 caregivers of children aged 5–11 years was conducted onsite in three selected regions in the Philippines with low COVID-19 vaccine coverage between July and October 2023. Multivariable logistic regression was performed to identify factors associated with pediatric COVID-19 vaccination uptake. Of the respondents, 143 caregivers had at least one child vaccinated against COVID-19, while 395 had none. The most common reasons for vaccination were protection against COVID-19 (93.7

INTRODUCTION:Like many countries globally, childhood immunisation coverage is below government targets in the Philippines and has worsened during the COVID-19 pandemic, leading to outbreaks of vaccine-preventable diseases. This study aimed to identify the social and behavioural drivers of routine childhood immunisation and preferred caregiver information sources to improve uptake in the Philippines. METHODS:A quantitative, cross-sectional study, as part of a larger mixed-methods study, was undertaken in three regions in the Philippines with low immunisation coverage in 2023. Data on Behavioural and Social Drivers (BeSD) of immunisation, preferred information sources and vaccination status of children under 5 years were collected, analysed and reported according to the WHO BeSD framework. RESULTS:The study included 653 caregivers and 950 children, with 65% of children fully immunised, 31.8% partially immunised and 2.5% being zero-dose or having received no vaccines. Key reasons for complete vaccination included the protection vaccines offer, healthcare worker recommendations and vaccines being free of charge. For partial vaccination, top reasons were intercurrent illness, inaccessible vaccination sites and parental belief that the child was too young to receive vaccines. The most common reason for non-vaccination was also intercurrent illness. The predictors of complete vaccination were older age of caregivers (46-59 years) (prevalence ratio (PR)=1.29; 95% CI 1.12 to 1.48) and low concerns about vaccine safety (PR=1.13; 95% CI 1.03 to 1.25). Other Christian denominations, compared with Catholics, were less likely to have fully immunised children (PR 0.82; 95% CI 0.69 to 0.97). Preferred vaccine information sources included the Department of Health, healthcare workers and mass media. CONCLUSIONS:We found that only 65% of children were fully immunised in 2023, with both access and acceptance factors impacting uptake of routine childhood vaccines. Improving service accessibility and education of healthcare workers on vaccine safety and effectiveness and more targeted messaging from health authorities and mass media about the benefits of vaccination could increase uptake in the Philippines, with learnings from this study applicable globally.

Routine childhood vaccination coverage under the National Immunization Program of the Philippines is well below the target of 95

Background Routine childhood vaccination coverage under the National Immunization Program of the Philippines is well below the target of 95% with a high number of zero-dose children. Declining immunization rates led to outbreaks of vaccine preventable diseases such as measles, polio, and pertussis. This study aimed to identify the factors affecting childhood vaccine uptake by exploring the perspectives of community members, program managers, and coordinators. Methodology: Three regions with low vaccine coverage in the Philippines were selected as study sites. We conducted focus groups with adult caregivers of vaccinated and unvaccinated children aged 0–11 years recruited by barangay (community) health workers. Key informant interviews were also conducted with immunization program managers and coordinators from different administrative levels. Focus group and interview guides were informed by the World Health Organization’s Behavioural and Social Drivers (BeSD) of Vaccination framework, which include the following domains influencing vaccine uptake: “Thinking and feeling”, “Social processes'', “Motivation”, and “Practical issues''. Transcripts were analyzed by themes and deductive axial coding was used to categorize themes into BeSD domains and socioecological levels. Results Twelve focus groups (n = 143) and 57 key informant interviews were done. Under the ‘Thinking and feeling’ domain of the BeSD, at the intrapersonal level, the perception of benefits and negative side effects of routine vaccines were clear drivers of vaccination. In the ‘Social processes’ domain, factors at multiple socioecological levels such as influence of family, barangay health workers, and community leaders were identified. Incentives such as candies and hygiene kits were also a driver to vaccination. Practical issues such as the availability of vaccines and accessibility of vaccination sites remain a barrier to vaccination despite implementation of strategies such as outreach vaccination activities and house-to-house visits by health center personnel. Conclusions Availability of routine vaccines and accessibility to vaccination sites are major challenges in the Philippines. Acceptability of routine vaccines continue to be affected by previous controversies around the Dengue vaccine and the recent COVID-19 pandemic. Enhancing training for health care workers on health promotion education regarding vaccination may contribute to increased vaccine uptake. Integration of immunization with other population-based health programs could be explored.

Antimicrobial resistance (AMR) is a global public health threat that affects humans, animals, and the environment across the One Health spectrum. Singapore launched its own National Strategic Action Plan (NSAP) on AMR in 2017 with the aim of tackling the growing threat of AMR in Singapore through coordinated approaches. However, little is known about the implementation of the NSAP. In this study, we analysed the implementation of the NSAP with guidance from an AMR governance framework. We conducted in-depth interviews with 20 participants across the One Health spectrum. The interviews were transcribed verbatim and analysed thematically. Overall, the implementation of activities against AMR was more advanced with respect to human health compared to other sectors such as (1) AMR and antimicrobial use (AMU) surveillance systems in hospitals; (2) the hospital antimicrobial stewardship (AMS) service and legislation to optimise AMU; (3) the national children and adults vaccination programme for IPC; (4) multiple avenues for education and awareness for both professionals and public; and (5) extensive research and collaboration networks with many sources of funding. Areas that were lacking presented problems including (1) an incomplete surveillance system for AMR and AMU across all sectors; (2) the need for better AMS and legislation in some sectors; (3) insufficient innovation in education for sustained behavioural modification; and (4) the need for more open research collaborations and the translation of research into policy outcomes. Improvements in these areas will enhance the overall implementation of the NSAP through a more holistic One Health approach.

Tuberculosis (TB) is a chronic infectious disease that remains to be a primary health concern globally. The Philippines is among the top TB-burdened countries. Workplace TB prevention and control programs are essential to ensure the health and safety of workers and economic security. There remains a knowledge gap regarding the Philippine workplace TB prevention and control program implementation. This qualitative study involving key informant interviews reviewed the implementation of the workplace TB program in selected companies in a high TB burden region in Eastern Philippines. Results were presented under four themes in accordance with the components of the workplace TB policy: preventive strategies, medical management, data recording and reporting, and social policy. Various good practices, opportunities, and challenges in the implementation of the workplace TB program were identified. There is a need to strengthen the enforcement of policy across different components. Compliance with guidelines on preventive strategies and recording and reporting schemes needs to be intensified. Coordination across different levels and agencies may also be enhanced to allow more efficient implementation. Increased awareness of corporate decision-makers may improve company ownership of the program leading to improved implementation while increased awareness of employees on their rights and entitlements may likewise enhance compliance.

This paper aimed to determine the facilitating and hindering factors in the implementation of local tuberculosis (TB) control programs in two purposively selected localities in the Province of Laguna, Philippines. Transcripts of semi-structured interviews with six policymakers and program implementers at the regional, provincial, and city/municipal levels were qualitatively analyzed in accordance with the method of Miles and co-authors and validated through triangulation and informant/stakeholder feedback. Identified facilitating factors include 1) allocation and mobilization of human, material, and financial resources to support the implementation of program activities; 2) supervision and monitoring of program implementation; 3) formation and mobilization of partnerships with the other government agencies and the private sector; and 4) streamlining and improvement of existing processes and technologies. Hindering factors were: 1) mismatch in demand and supply for program-related resources; 2) variation in the diagnostic and treatment strategies employed by providers; 3) focus on service provision and reduced attention to activities focused on more upstream factors; and 4) external program drivers. In a decentralized healthcare setting such as the Philippines, local governments play an important role in implementing health programs designed to achieve national and even global health goals. Program managers and implementers will need to design strategies to leverage the identified facilitating factors and mitigate the effects, if not totally prevent the emergence, of hindering factors to implementation of the local TB prevention and control program.

AbstractBackgroundIntersectoral collaboration in the context of the prevention and control of vector-borne diseases has been broadly described in both the literature and the current global strategy by the World Health Organization. Our aim was to develop a framework that will distill the currently known multiple models of collaboration.MethodsQualitative content analysis and logic modeling of data abstracted from 69 studies included in a scoping review done by the authors were used to develop 9 recommendation statements that summarized the composition and attributes of multisectoral approaches, which were then subjected to a modified Delphi process with 6 experts in the fields of health policy and infectious diseases.ResultsConsensus for all statements was achieved during the first round. The recommendation statements were on (1–3) sectoral engagement to supplement government efforts and augment public financing; (4) development of interventions for most systems levels; (5–6) investment in human resource, including training; (7–8) intersectoral action to implement strategies and ensure sustainability of initiatives; and (9) research to support prevention and control efforts.ConclusionsThe core of intersectoral action to prevent vector-borne diseases is collaboration among multiple stakeholders to develop, implement, and evaluate initiatives at multiple levels of intervention.

Objectives. This scoping review aimed to support a landscape analysis to identify lessons learned about intersectoral collaborations (ISCs) by describing their existing models in the context of dengue, malaria and yellow fever. Methods. A scoping review following the methodology of Joanna Briggs Institute was performed using the following inclusion criteria: studies involving humans; studies discussing intersectoral collaborations, malaria/dengue/yellow fever, and prevention or control at any level; and studies in countries endemic for the aforementioned diseases. Studies were screened using Covidence, while data were extracted using NVivo. Results. Of the 7,535 records retrieved, 69 were included in the qualitative analysis. Most ISCs were initiated by multilateral organizations and ministries of health, and none by communities. Strategies included advocacy, health education, research, public health measures, resource mobilization, service delivery and training; mostly employed on a community level. Monitoring and evaluation were mostly formative, ongoing, and participatory. Gaps included administrative and policy barriers, resource shortages, and inadequate research and training. Conclusions. Multiple models of ISC exist in the literature. There is a need to develop a comprehensive framework for an effective and sustainable multisectoral approach for the prevention and control of VBDs ensuring adequate resources, active stakeholders, and strategies that span the entire socio-ecological spectrum.

Background. The incidence of human immunodeficiency virus (HIV) infection in the Philippines is increasing. HIV-related stigma in the health care setting is a known barrier to healthcare access for people living with HIV (PLHIV). Objective. The study aimed to identify stigmatizing attitudes and practices towards PLHIV among healthcare workers in Philippine General Hospital. Methods. In this cross-sectional descriptive study, 375 healthcare workers were recruited via convenience sampling. A standardized questionnaire developed by the Health Policy Project was used. Results. The study demonstrated concerns regarding transmission, particularly during drawing blood (87.1%), assisting in labor and delivery (82%), and dressing wounds (80.4%). Use of special infection-control measures (76.1%), wearing double gloves (72.8%), additional infection-control procedures during labor and delivery (72.2%), and wearing gloves during all aspects of patient care (70.2%) were reported as well. Perceptions such as the belief that pregnant women who are HIV positive must inform their families of their HIV status (82.1%), and that PLHIV engage in irresponsible behaviors (69.1%) and are promiscuous (66.4%) were also detected. Conclusion. The study confirmed the presence of HIV-related stigma among healthcare workers in Philippine General Hospital. This finding could potentially catalyze the development of stigma-reducing measures which could hopefully translate to improved healthcare for PLHIV.

Presented at the 12th Western Pacific Conference on Chemotherapy and Infectious Diseases, December 2010, Singapore (Oral Presentation) and the Infectious Diseases Society of America Convention, October 2010, Canada (Poster Presentation). It has won 2nd place at the Philippine Society for Microbiology and Infectious Diseases Research Forum, November 2010, Crowne Plaza, and 2nd place at the Department of Medicine-UP-PGH Research Forum, October 2010, UP-PGH.

Invasive Trichosporon infection is a rare, life-threatening infection in immunocompromised patients. It has been reported as an emerging opportunistic infection in those with acquired immune deficiency syndrome (AIDS). Only 12 cases of invasive trichosporonosis in patients with HIV have been documented, none in Southeast Asia. We report a case of fatal, disseminated trichosporonosis in a Filipino AIDS patient with severe cutaneous and pulmonary involvement. Invasive trichosporonosis should be considered in HIV-positive patients with disseminated fungal infection since this may be refractory to conventional antifungal treatment.

This study described the clinical features and complications of leptospirosis among patients seen at nine tertiary hospitals from September 28 to November 30, 2009 after a heavy rainfall typhoon. The clinical findings of the confirmed cases were compared with the previous clinical studies on seasonal leptospirosis in the Philippines. Risk factors for complicated disease were also identified. Confirmed cases were based on any of the following: positive leptospiral cultures of blood or urine, single high leptospira microscopic agglutination test (MAT) titer of 1:1,600, a fourfold rise in MAT, and/or seroconversion. Of 670 patients with possible leptospirosis, 591 were probable by the WHO criteria, 259 (44%) were confirmed. Diagnosis was confirmed by MAT 176 (68%), by culture 57 (22%), and by MAT and culture 26 (10%). The mean age of the confirmed cases was 38.9 years (SD 14.3). The majority were males (82%) and had a history of wading in floodwaters (98%). The majority of the patients presented with nonspecific signs, with fever as the most common (98.5%). Other findings were myalgia (78.1%), malaise (74.9%), conjunctival suffusion (59.3%), oliguria (56.6%), diarrhea (39%), and jaundice (38%). Most of the patients presented with a moderate-to-severe form of leptospirosis (83%). Complications identified were renal failure (82%), pulmonary hemorrhage (8%), meningitis (5%), and myocarditis (4%). Mortality rate was 5%, mostly due to pulmonary hemorrhage. This study emphasizes the importance of public awareness and high index of suspicion among clinicians of leptospirosis during the monsoon months when flooding is common. Early recognition and detection of the disease should decrease morbidity and mortality.