Development of a Low-Cost Electronic Data Collection Tool for a Health Facility Survey: Lessons Learned in the Field

The process of selecting and developing a data collection tool for a health facility survey study is described. Several methodologies were considered, and an Android app development platform was chosen to fulfil the requirements of the study. The platform was adopted for its low resource cost, low capacity requirement, efficient and effective community responsiveness and progressive inclusion of functionalities. Data loss was 3.4%, with proposed contributing factors such as network intermittency, malware leading to disuse (necessitating manual encoding), and asynchrony of system interfaces, though the percentage of loss attributable to each factor is indeterminate. Several considerations need to be taken into account prior to employing ICTs for research, namely, requirements of the study, resources available, and how each option being considered fulfils the requirements and proves sustainable given the resources. Planning, risk assessment, and maintenance are important phases in the development of the data collection tool

Blockchain Technology for Detecting Falsified and Substandard Drugs in Distribution: Pharmaceutical Supply Chain Intervention (Preprint)

BACKGROUND Drug counterfeiting is a global problem with significant risks to consumers and the general public. In the Philippines, 30% of inspected drug stores in 2003 were found with substandard/spurious/falsely-labeled/falsified/counterfeit drugs. The economic burden on the population drug expenditures and on governments is high. The Philippine Food and Drug Administration (FDA) encourages the public to check the certificates of product registration and report any instances of counterfeiting. The National Police of Philippines responds to such reports through a special task force. However, no literature on its impact on the distribution of such drugs were found. Blockchain technology is a cryptographic ledger that is allegedly immutable through repeated sequential hashing and fault-tolerant through a consensus algorithm. This project will develop and test a pharmacosurveillance blockchain system that will support information sharing along the official drug distribution network. OBJECTIVE This study aims to develop a pharmacosurveillance blockchain system and test its functions in a simulated network. METHODS We are developing a Distributed Application (DApp) that will run on smart contracts, employing Swarm as the Distributed File System (DFS). Two instances will be developed: one for Ethereum and another for Hyperledger Fabric. The proof-of-work (PoW) consensus algorithm of Ethereum will be modified into a delegated proof-of-stake (DPoS) or practical Byzantine fault tolerance (PBFT) consensus algorithm as it is scalable and fits the drug supply chain environment. The system will adopt the GS1 pedigree standard and will satisfy the data points in the data standardization guidelines from the US FDA. Simulations will use the following 5 nodes: for FDA, manufacturer, wholesaler, retailer, and the consumer portal. RESULTS Development is underway. The design of the system will place FDA in a supervisory data verification role, with each pedigree type–specific data source serving a primary data verification role. The supply chain process will be initiated by the manufacturer, with recursive verification for every transaction. It will allow consumers to scan a code printed on the receipt of their purchases to review the drug distribution history. CONCLUSIONS Development and testing will be conducted in a simulated network, and thus, results may differ from actual practice. The project being proposed is disruptive; once tested, the team intends to engage the Philippine FDA to discuss implementation plans and formulate policies to facilitate adoption and sustainability. REGISTERED REPORT IDENTIFIER RR1-10.2196/10163 </sec

Discoursing Terminology Standards and Interoperability in relation to the Philippine eHealth Strategy

Background. eHealth is the use of information and communication technologies (ICT) for health. It helps in improving the flow of information, through electronic means, in support of the delivery of health services, and the management of health systems. eHealth is used as the strategic context and tool in achieving population health, improved health system status, and socio-economic development goals.&#x0D; Objectives. This study is aimed at looking at the Philippine National eHealth Strategy, particularly the components of Terminology Standards and Interoperability concerning the eHealth strategy in the Philippines, and to assess the barriers and gaps in the integration of these two components.&#x0D; Methods. This study used secondary literature, internet search, Philippine laws, administrative orders, memorandum circulars, and grey literature to discourse terminology standards and interoperability in the Philippine eHealth system, and issues and gaps related to these components that may impede the delivery of Universal Health Coverage in the country.&#x0D; Results. The current Philippine National eHealth strategy includes the following sector governance, legislation, policy and compliance, eHealth solution (i.e., services and applications), strategy and investment, infrastructure (government), human resources, and standards and interoperability. Philippine Health Information Exchange (PHIE) is a software platform in the country that aims to connect many isolated electronic health systems. The proposed interoperability layer across health systems and services in the Philippines includes Patient’s Primary Healthcare Consultation at the Rural Health Unit, health research, legal information, patient healthcare at tertiary hospital, and health insurance claims. The study results showed that issues and gaps related to the interoperability of eHealth in the Philippines include technical issues such as lack of common semantics, lack of an institutional mechanism to regulate EMR, lack of incentives among eHealth providers and stakeholders to adopt standards for interoperability.&#x0D; Conclusion. The effort of the Philippines to achieve interoperability and standards in eHealth goals can be characterized as a work in progress. The government, private sector, physician, patient, and other stakeholders are deemed to continuously develop a shared vision and interoperate under a standardized guide as eHealth is a complex endeavor that covers many aspects.</jats:p

A system study on the production of the E-Jeepney of the M.D. Juan Enterprises

The E-jeepney production system of MD Enterprises has been in existence since 2008, initially producing two units of e-jeepneys for its first client. This system study on the Production of E-jeepney of M.D Juan Enterprise covered all its production processes from the shearing process until the trimming process for the one-year period of July 2009 to June 2010. The main problem being addressed after a thorough situation appraisal is that The E-jeepney production of MD Juan Enterprise experienced a total of 31 cases of warranty returns which generated an additional expense of Php 174,334.61 for the company. The cause and effect analysis conducted surfaced the following true causes: that 81.90% of the cost returns are due to workers lack of electrical wiring connection and part installation skills, quality control is not fully implemented, 17.63% of the costs from returns are low quality part such as: the battery connector, cable, cut off switch, and transmission which are all coming from the suppliers and parts are not properly stored in the inventory. Recommended solutions were generated to solve these root causes with their corresponding proposed systems: proper screening and monitoring of workers by having a systematic hiring procedure changing the layout of the inventory storage and managing how the materials are handled proposing a training program for the workers and implementing a standardize quality control and pre-delivery inspection for the production. It was shown through the cost-benefit that the solutions are feasible because of the positive net present value of PHP 313,456.64 with a payback period of 7.08 months. The alternative solutions could be implemented within a span of 10 weeks or 2.5 months

Diagnosis and Management of Childhood tuberculosis in Public health Clinics in a rural Area in the Philippines: results from a Community surveillance

Background. Childhood tuberculosis (TB) remains a significant health problem worldwide despite the increase on its emphasis in national health programs.&#x0D; Objective. This study aimed to describe how TB in children is identified and managed in a routine TB program in a rural setting in a high-burden country.&#x0D; Methods. This is a prospective, community-based surveillance study in public rural clinics in the Philippines. Observations on case finding and management of TB in children as well as contact tracing in an existing TB program are described.&#x0D; Results. Out of 266 children with presumptive TB, 41 (15.4%) were cases of TB, 15 (5.6%) had latent TB infection (LTBI), 81 (30.5%) had TB exposure, and 129 (48.5%) had no TB. There were 37 (90%) TB cases who were clinically diagnosed. Ninety-three per cent (93%) of children with TB disease were cured or completed treatment. Among 25 children targeted for isoniazid preventive therapy (IPT) for LTBI and TB exposure, only 12 (52%) completed the recommended 6 months of IPT. Only 40 (43%) children aged 0 to 4 years exposed to smear-positive TB cases were screened.&#x0D; Conclusion. Barriers in the diagnosis, low IPT completion and problems in contact tracing may hinder successful implementation of TB programs for children.</jats:p

Urine Xpert MTB/RIF for the diagnosis of childhood tuberculosis

Introduction: Xpert MTB/RIF is recommended for the simultaneous detection of tuberculosis (TB) and rifampicin resistance directly from sputum specimens. Since young children cannot always expectorate, we assessed urine as a possible specimen source to diagnose TB in children using Xpert MTB/RIF. Methods: During a field study to enhance childhood TB identification, spot urine samples were prospectively collected from consecutive ambulatory children aged 0 to 14 years presenting with presumptive pulmonary TB in community health centers. Urine Xpert MTB/RIF was performed by blinded technicians in 182 samples using 2 ml of unprocessed urine. Results: The mean age of presumptive TB cases was 5.9 years (median 5.4, range 0.1 to 14.7) with more males (113, 62%) compared to females. All urine samples tested negative for Xpert MTB/RIF, regardless of whether concentration was performed or not. Out of these 182 presumptive TB cases, 50 (28%) were clinically diagnosed and 5 (3%) were bacteriologically diagnosed to have TB disease using either sputum or nasopharyngeal aspirate specimens. Conclusions: In this community-based study, urine Xpert MTB/RIF does not appear to contribute to the diagnosis of childhood TB. Keywords: Mycobacterium, Pediatric, Philippines, Diagnostic, GeneXpert TB/RIF, Chil

Formulating the National Policy on Telehealth for the Philippines through Stakeholders’ Involvement and Partnership

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Hepatitis B seroprevalence among 5 to 6 years old children in the Philippines born prior to routine hepatitis B vaccination at birth

To assess the prevalence of hepatitis B in the Philippines, we conducted a cross-sectional study among 5 to 6 year old children born in 2007–2008, when the birth dose started to be implemented in the country. The study was conducted from 25 July to 22 October 2013 in 24 provinces and used a 3-stage cluster design and probability-proportional to size sampling. Blood was obtained and sera were tested for hepatitis B surface antigen (HBsAg). The survey included 2,769 children, of whom 26% received a timely birth dose (within 24 hours of birth) and 89% received 3 doses of the hepatitis B vaccine. Due to problems in the initial testing algorithm, only 2,407 sera were available for HBsAg testing, 20 (weighted%, 0.86%) were HBsAg positive. By immunization card and recall, among HBsAg positive children, 2 (weighted%, 20%) received a timely birth dose while 17 (weighted%, 85%) received 3 doses of the hepatitis B vaccine. The seroprevalence of HBsAg that we detected was lower than expected. However, there were several limitations in the field and in the laboratory that may have affected the representativeness of the results. Follow up studies need to be conducted to validate these results