Costs incurred by people with co-morbid tuberculosis and diabetes and their households in the Philippines.

OBJECTIVE: Diabetes is a risk factor for TB mortality and relapse. The Philippines has a high TB incidence with co-morbid diabetes. This study assessed the pre- and post-TB diagnosis costs incurred by people with TB and diabetes (TB-DM) and their households in the Philippines. METHODS: Longitudinal data was collected for costs, income, and coping mechanisms of TB-affected households in Negros Occidental and Cebu, the Philippines. Data collection was conducted four times during TB treatment. The data collection tools were developed by adapting WHO's cross-sectional questionnaire in the Tuberculosis Patient Cost Surveys: A Handbook into a longitudinal study design. Demographic and clinical characteristics, self-reported household income, number of facility visits, patient costs, the proportion of TB-affected households facing catastrophic costs due to TB (>20% of annual household income before TB), coping mechanisms, and social support received were compared by diabetes status at the time of TB diagnosis. RESULTS: 530 people with TB were enrolled in this study, and 144 (27.2%) had TB-DM based on diabetes testing at the time of TB diagnosis. 75.4% of people with TB-DM were more than 45 years old compared to 50.3% of people with TB-only (p<0.001). People with TB-DM had more frequent visits for TB treatment (120 vs 87 visits, p = 0.054) as well as for total visits for TB-DM treatment (129 vs 88 visits, p = 0.010) compared to those with TB-only. There was no significant difference in the proportion of TB-affected households facing catastrophic costs between those with TB-DM (76.3%) and those with TB-only (68.7%, p = 0.691). CONCLUSION: People with TB-DM in the Philippines face extensive health service use. However, this does not translate into substantial differences in the incidence of catastrophic cost. Further study is required to understand the incidence of catastrophic costs due to diabetes-only in the Philippines

Mucosal immunity in severely malnourished gambian children

Severe malnutrition continues to be a serious public health problem. Case fatality rates in resource-poor settings are high. The median case fatality rate for the 1990s is 23% (range 4%-49%). Several studies have shown that the mortality rate associated with those who have been rehabilitated and have gone back to the community can range from 8% to as high as 41%. There may be a combination of socioeconomic and biologic reasons for these high rates, but our work focuses on the biologic aspects of severe malnutrition. We suspect that enteropathy plays an important role in the pathogenesis of severe malnutrition and its sequelae. Studies in The Gambia have been instrumental in shaping our views on mucosal immunity in severe malnutrition. In rural areas, growth faltering is universal (reaching about -2 Z-scores for weight-for-age) and commences at around 3 months of age and has been associated with various intestinal infections, increased intestinal permeability and Helicobacter sp infection. There is an intense lymphocytic infiltration of the lamina propria and the epithelial layer of duodenal biopsy specimens of malnourished children. There also appears to be a bias toward production of T helper 1 cytokines in the gut, suggesting an imbalance. To further characterize immune responses in the most severely affected children, we describe a study that is designed to compare mucosal immunity in severely malnourished children and well-nourished hospital control subjects with cytometry, enzyme-linked immunospot (ELISPOT) assays, and quantitative polymerase chain reaction. Preliminary results suggest that interferon-gamma production in severely malnourished children is relatively unimpaired and that immune responses are modified by infection

Geographical information systems in health research and services delivery in the Philippines

Accessible public data emanating from remote sensing from earth-observing satellites, as well as geographical information systems in general, are playing an increasing role in the public health sector in the Philippines. This paper reviews currently available systems in the country in this area, emphasizing the utility in complementing field studies with the development of disease models. The goal is to map out important biological threats by characterizing the niches infectious agents, and their vectors or intermediate hosts, occupy temporally and spatially

Effect of a multiple-micronutrient-fortified fruit powder beverage on the nutrition status, physical fitness, and cognitive performance of schoolchildren in the Philippines

This study aimed to determine the effect of a multiple-micronutrient-fortified beverage on the micronutrient status, physical fitness, and cognitive performance of schoolchildren. The study was a randomized, double-blind, placebo-controlled trial of schoolchildren assigned to receive either the fortified or nonfortified beverage with or without anthelmintic therapy. Data on hemoglobin level, urinary iodine excretion (UIE) level, physical fitness, and cognitive performance were collected at baseline and at 16 weeks post-intervention. The fortified beverage significantly improved iron status among the subjects that had hemoglobin levels /dl at baseline. The proportion of children who remained moderately to severely anemic was significantly lower among those given the fortified beverage. In the groups that received the fortified product, the median UIE level increased, whereas among those who received the placebo beverage, the median UIE level was reduced significantly. Iron- and/or iodine-deficient subjects who received the fortified beverage showed significant improvements in fitness (post-exercise reduction of heart rate) and cognitive performance (nonverbal mental ability score). The study showed that consumption of a multiple-micronutrient-fortified beverage for 16 weeks had significant effects on iron status, iodine status, physical fitness, and cognitive performance among iron- and/or iodine-deficient Filipino schoolchildren. Anthelmintic therapy improved iron status of anemic children and iodine status of the iron-adequate children at baseline but it had no effect on physical fitness and cognitive performance. The results from the clinical study showed that a multiple-micronutrient-fortified beverage could play an important role in preventing and controlling micronutrient deficiencies

Slaving and release in co-infection control

Background: Animal and human infection with multiple parasite species is the norm rather than the exception, and empirical studies and animal models have provided evidence for a diverse range of interactions among parasites. We demonstrate how an optimal control strategy should be tailored to the pathogen community and tempered by species-level knowledge of drug sensitivity with use of a simple epidemiological model of gastro-intestinal nematodes. Methods. We construct a fully mechanistic model of macroparasite co-infection and use it to explore a range of control scenarios involving chemotherapy as well as improvements to sanitation. Results: Scenarios are presented whereby control not only releases a more resistant parasite from antagonistic interactions, but risks increasing co-infection rates, exacerbating the burden of disease. In contrast, synergisms between species result in their becoming epidemiologically slaved within hosts, presenting a novel opportunity for controlling drug resistant parasites by targeting co-circulating species. Conclusions: Understanding the effects on control of multi-parasite species interactions, and vice versa, is of increasing urgency in the advent of integrated mass intervention programmes