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Article: Clinician perspectives of drug-resistant tuberculosis care services in the Philippines.

Jaramillo, Jahn / Endo, Yutaka / Yadav, Rajendra-Prasad

2022 Volume 70, Issue 1, Page(s) 107–114

Abstract: Background/objectives: In the Philippines, treatment success rates for drug-resistant tuberculosis (DR-TB) remains low and little is known about the quality of DR-TB services. This study aimed to explore clinician's perspectives of DR-TB care services.!# ...

Abstract	Background/objectives: In the Philippines, treatment success rates for drug-resistant tuberculosis (DR-TB) remains low and little is known about the quality of DR-TB services. This study aimed to explore clinician's perspectives of DR-TB care services. Methods: We conducted semi-structured in-depth interviews from January-March 2018 with 11 providers selected purposively to explore the barriers associated with DR-TB care service delivery, best practices, and recommendations for enhancing patient care. Emerging themes were organized according to the socio-ecological framework. Results: Five major themes were identified: (1) nurses do not feel empowered; (2) particular patients are left behind and more vulnerable than others; (3) infection control practices, fear, and limited capacity in rural health centers; (4) financial insecurity due to program reimbursement mechanisms; and (5) local government support is limited and requires more involvement in support of DR-TB elimination activities. Best practices focused on tailored approaches that eliminated structural, economic, and motivational barriers for patients. Participants recommended financial support from local government units, nutritional assistance for patients, and refresher training for healthcare workers. Conclusion: The findings provide additional understanding regarding the barriers that limit successful DR-TB care delivery and provide critical information to improve clinical practice and develop public health interventions for frontline staff including nurses in the Philippines. These strategies could ultimately reduce disparities associated with access to care and treatment adherence, if implemented.
MeSH term(s)	Humans ; Philippines ; Tuberculosis, Multidrug-Resistant/drug therapy ; Tuberculosis, Multidrug-Resistant/prevention & control ; Delivery of Health Care ; Health Personnel ; Treatment Outcome
Language	English
Publishing date	2022-04-01
Publishing country	India
Document type	Journal Article
ZDB-ID	603129-8
ISSN	0019-5707 ; 0019-5705
ISSN	0019-5707 ; 0019-5705
DOI	10.1016/j.ijtb.2022.03.022
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Article: Patient- and Health-System-Related Barriers to Treatment Adherence for Patients with Drug-Resistant Tuberculosis in the Philippines: A Mixed-Methods Study.

Endo, Yutaka / Jaramillo, Jahn / Yadav, Rajendra Prasad Hubraj

Tuberculosis research and treatment

2022 Volume 2022, Page(s) 6466960

Abstract: Purpose: In the Philippines, drug-resistant tuberculosis (DRTB) is a growing concern. Healthcare workers face challenges in retaining patients with DRTB in care. This study intends to understand their perspectives on the factors that influence patient ... ...

Abstract	Purpose: In the Philippines, drug-resistant tuberculosis (DRTB) is a growing concern. Healthcare workers face challenges in retaining patients with DRTB in care. This study intends to understand their perspectives on the factors that influence patient treatment outcomes and to propose potential programmatic solutions for strengthening care services for the patients. Methods: A mixed-methods study was conducted in the Philippines between December 2017 and March 2018 to understand the major barriers for healthcare workers to provide quality care to DRTB patients across the care continuum. In the quantitative phase, healthcare workers participated in an online survey; in the qualitative phase, in-depth interviews were conducted with a select number of the survey respondents to better understand their survey responses. Results: 272 healthcare workers participated in the survey, and of those, 11 were interviewed. Survey results identified economic constraints, patient perceptions of care, family-related concerns, and limited accessibility to healthcare services as the major patient-related barriers across the care continuum. Major health-system-related barriers were insufficient human resources, lack of financial and political support, and limited knowledge about DRTB by healthcare providers. Interviews revealed more elaborate, contextualized, and nuanced aspects of each of the major challenges. The elaborated patient-related barriers included expenses needed during treatment (e.g., transportation); fear of being stigmatized by family, community, or healthcare staff; worries about adverse drug reactions from medication; a lack of family support; and the location of patients' homes. The health-system-related barriers revealed through interviews included the limited capacities of facility staff to provide DRTB care due to insufficient human resources; the shortage of funds to support treatment completion (e.g., transportation allowance and food package for patients, service vehicles and mobile phone costs for outreach actions at the facility level); and discrimination by healthcare staff against patients with DRTB attributed to the staff's limited knowledge and experiences of treating the patients. Conclusion: This study identified the main barriers for DRTB facility staff in the Philippines from the perspectives of providers. Further exploration of the barriers and best practices in facilities may be useful for improving DRTB care in the Philippines.
Language	English
Publishing date	2022-11-19
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2628178-8
ISSN	2090-1518 ; 2090-150X
ISSN (online)	2090-1518
ISSN	2090-150X
DOI	10.1155/2022/6466960
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Article ; Online: Perceptions of the Private Sector for Creating Effective Public-Private Partnerships against Tuberculosis in Metro Manila, Philippines.

Sherpa, James / Yadav, Rajendra-Prasad

The American journal of tropical medicine and hygiene

2019 Volume 101, Issue 3, Page(s) 498–501

Abstract: This article's goal is to assess the perspectives of private providers on current and future public-private engagement in Metro Manila, a city of 13 million using semistructured interviews with a convenience sample of 18 private physicians. Our study ... ...

Abstract	This article's goal is to assess the perspectives of private providers on current and future public-private engagement in Metro Manila, a city of 13 million using semistructured interviews with a convenience sample of 18 private physicians. Our study found that private providers perceived their clientele as loyal and their services as distinct from public services, with unique attractions of convenience and quality of service. They saw value in engaging with the public sector for knowledge exchange, access to public-sector commodities, and access to public sector assistance with public health tasks related to tuberculosis (TB). However, their proposed ways of engaging were more centered on the private sector role, in ways that are not currently being pursued by the public sector. It is of the utmost importance to recognize that private provider perspectives are essential to build effective engagement models and, thus, to reach all clients with quality TB care.
MeSH term(s)	Adult ; Delivery of Health Care ; Female ; Health Personnel/psychology ; Humans ; Male ; Middle Aged ; Philippines ; Physicians/psychology ; Private Sector ; Public Health ; Public-Private Sector Partnerships ; Quality of Health Care ; Tuberculosis/drug therapy ; Tuberculosis/prevention & control
Language	English
Publishing date	2019-07-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.18-0692
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Article ; Online: A systematic review: effectiveness of mass media campaigns for reducing alcohol-impaired driving and alcohol-related crashes.

Yadav, Rajendra-Prasad / Kobayashi, Miwako

BMC public health

2015 Volume 15, Page(s) 857

Abstract: Background: Mass media campaigns have long been used as a tool for promoting public health. In the past decade, the growth of social media has allowed more diverse options for mass media campaigns. This systematic review was conducted to assess newer ... ...

Abstract	Background: Mass media campaigns have long been used as a tool for promoting public health. In the past decade, the growth of social media has allowed more diverse options for mass media campaigns. This systematic review was conducted to assess newer evidence from quantitative studies on the effectiveness of mass media campaigns for reducing alcohol-impaired driving (AID) and alcohol-related crashes, particularly after the paper that Elder et al. published in 2004. Methods: This review focused on English language studies that evaluated the effect of mass media campaigns for reducing AID and alcohol-related crashes, with or without enforcement efforts. A systematic search was conducted for studies published between January 1, 2002 and December 31, 2013. Studies from the review by Elder et al. were added as well. Results: A total of 19 studies met the inclusion criteria for the systematic review, including three studies from the review by Elder et al. Nine of them had concomitant enforcement measures and did not evaluate the impact of media campaigns independently. Studies that evaluated the impact of mass media independently showed reduction more consistently (median -15.1%, range -28.8 to 0%), whereas results of studies that had concomitant enforcement activities were more variable (median -8.6%, range -36.4 to +14.6%). Summary effects calculated from seven studies showed no evidence of media campaigns reducing the risk of alcohol-related injuries or fatalities (RR 1.00, 95% CI = 0.94 to 1.06). Conclusions: Despite additional decade of evidence, reviewed studies were heterogeneous in their approaches; therefore, we could not conclude that media campaigns reduced the risk of alcohol-related injuries or crashes. More studies are needed, including studies evaluating newly emerging media and cost-effectiveness of media campaigns.
MeSH term(s)	Accidents, Traffic/statistics & numerical data ; Alcoholic Intoxication/epidemiology ; Health Promotion/organization & administration ; Health Promotion/statistics & numerical data ; Humans ; Mass Media/statistics & numerical data
Language	English
Publishing date	2015-09-04
Publishing country	England
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-015-2088-4
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Article ; Online: Expansion of social protection is necessary towards zero catastrophic costs due to TB: The first national TB patient cost survey in the Philippines.

Florentino, Jhiedon L / Arao, Rosa Mia L / Garfin, Anna Marie Celina / Gaviola, Donna Mae G / Tan, Carlos R / Yadav, Rajendra Prasad / Hiatt, Tom / Morishita, Fukushi / Siroka, Andrew / Yamanaka, Takuya / Nishikiori, Nobuyuki

PloS one

2022 Volume 17, Issue 2, Page(s) e0264689

Abstract: Background: Tuberculosis (TB) is a disease associated with poverty. Moreover, a significant proportion of TB patients face a substantial financial burden before and during TB care. One of the top targets in the End TB strategy was to achieve zero ... ...

Abstract	Background: Tuberculosis (TB) is a disease associated with poverty. Moreover, a significant proportion of TB patients face a substantial financial burden before and during TB care. One of the top targets in the End TB strategy was to achieve zero catastrophic costs due to TB by 2020. To assess patient costs related to TB care and the proportion of TB-affected households that faced catastrophic costs, the Philippines National TB Programme (NTP) conducted a national TB patient cost survey in 2016-2017. Methods: A cross-sectional survey of 1,912 TB patients taking treatment in health facilities engaged with the NTP. The sample consists of 786 drug-sensitive TB (DS-TB) patients in urban facilities, 806 DS-TB patients in rural facilities, and 320 drug-resistant TB (DR-TB) patients. Catastrophic cost due to TB is defined as total costs, consisting of direct medical and non-medical costs and indirect costs net of social assistance, exceeding 20% of annual household income. Results: The overall mean total cost including pre- and post-diagnostic costs was US$601. The mean total cost was five times higher among DR-TB patients than DS-TB patients. Direct non-medical costs and income loss accounted for 42.7% and 40.4% of the total cost of TB, respectively. More than 40% of households had to rely on dissaving, taking loans, or selling their assets to cope with the costs. Overall, 42.4% (95% confidence interval (95% CI): 40.2-44.6) of TB-affected households faced catastrophic costs due to TB, and it was significantly higher among DR-TB patients (89.7%, 95%CI: 86.3-93.0). A TB enabler package, which 70% of DR-TB patients received, reduced catastrophic costs by 13.1 percentage points (89.7% to 76.6%) among DR-TB patients, but only by 0.4 percentage points (42.4% to 42.0%), overall. Conclusions: TB patients in the Philippines face a substantial financial burden due to TB despite free TB services provided by the National TB Programme. The TB enabler package mitigated catastrophic costs to some extent, but only for DR-TB patients. Enhancing the current social and welfare support through multisectoral collaboration is urgently required to achieve zero catastrophic costs due to TB.
MeSH term(s)	Philippines ; Tuberculosis
Language	English
Publishing date	2022-02-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0264689
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Book ; Online: A systematic review

Kobayashi, Miwako / Yadav, Rajendra-Prasad

effectiveness of mass media campaigns for reducing alcohol-impaired driving and alcohol-related crashes

2015

Abstract: Review ... Journal Article ... Mass media campaigns have long been used as a tool for promoting public health. In the past decade, the growth of social media has allowed more diverse options for mass media campaigns. This systematic review was conducted to ... ...

Abstract	Review Journal Article Mass media campaigns have long been used as a tool for promoting public health. In the past decade, the growth of social media has allowed more diverse options for mass media campaigns. This systematic review was conducted to assess newer evidence from quantitative studies on the effectiveness of mass media campaigns for reducing alcohol-impaired driving (AID) and alcohol-related crashes, particularly after the paper that Elder et al. published in 2004.This review focused on English language studies that evaluated the effect of mass media campaigns for reducing AID and alcohol-related crashes, with or without enforcement efforts. A systematic search was conducted for studies published between January 1, 2002 and December 31, 2013. Studies from the review by Elder et al. were added as well.A total of 19 studies met the inclusion criteria for the systematic review, including three studies from the review by Elder et al. Nine of them had concomitant enforcement measures and did not evaluate the impact of media campaigns independently. Studies that evaluated the impact of mass media independently showed reduction more consistently (median -15.1%, range -28.8 to 0%), whereas results of studies that had concomitant enforcement activities were more variable (median -8.6%, range -36.4 to +14.6%). Summary effects calculated from seven studies showed no evidence of media campaigns reducing the risk of alcohol-related injuries or fatalities (RR 1.00, 95% CI = 0.94 to 1.06).Despite additional decade of evidence, reviewed studies were heterogeneous in their approaches; therefore, we could not conclude that media campaigns reduced the risk of alcohol-related injuries or crashes. More studies are needed, including studies evaluating newly emerging media and cost-effectiveness of media campaigns.
Language	English
Publishing date	2015-09-04
Document type	Book ; Online
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Article ; Online: Increased Case Notification through Active Case Finding of Tuberculosis among Household and Neighbourhood Contacts in Cambodia.

Morishita, Fukushi / Eang, Mao Tan / Nishikiori, Nobuyuki / Yadav, Rajendra-Prasad

PloS one

2016 Volume 11, Issue 3, Page(s) e0150405

Abstract: Background: Globally, there has been growing evidence that suggests the effectiveness of active case finding (ACF) for tuberculosis (TB) in high-risk populations. However, the evidence is still insufficient as to whether ACF increases case notification ... ...

Abstract	Background: Globally, there has been growing evidence that suggests the effectiveness of active case finding (ACF) for tuberculosis (TB) in high-risk populations. However, the evidence is still insufficient as to whether ACF increases case notification beyond what is reported in the routine passive case finding (PCF). In Cambodia, National TB Control Programme has conducted nationwide ACF with Xpert MTB/RIF that retrospectively targeted household and neighbourhood contacts alongside routine PCF. This study aims to investigate the impact of ACF on case notifications during and after the intervention period. Methods: Using a quasi-experimental cluster randomized design with intervention and control arms, we compared TB case notification during the one-year intervention period with historical baseline cases and trend-adjusted expected cases, and estimated additional cases notified during the intervention period (separately for Year 1 and Year 2 implementation). The proportion of change in case notification was compared between intervention and control districts for Year 1. The quarterly case notification data from all intervention districts were consolidated, aligning different implementation quarters, and separately analysed to explore the additionality. The effect of the intervention on the subsequent case notification during the post-intervention period was also assessed. Results: In Year 1, as compared to expected cases, 1467 cases of all forms (18.5%) and 330 bacteriologically-confirmed cases (9.6%) were additionally notified in intervention districts, whereas case notification in control districts decreased by 2.4% and 2.3%, respectively. In Year 2, 2737 cases of all forms (44.3%) and 793 bacteriologically-confirmed cases (38%) were additionally notified as compared to expected cases. The proportions of increase in case notifications from baseline cases and expected cases to intervention period cases were consistently higher in intervention group than in control group. The consolidated quarterly data showed sharp rises in all forms and bacteriologically-confirmed cases notified during the intervention quarter, with 64.6% and 68.4% increases (compared to baseline cases), and 46% and 52.9% increases (compared to expected cases), respectively. A cumulative reduction of case notification for five quarters after ACF reached more than -200% of additional cases. Conclusions: The Cambodia's ACF with Xpert MTB/RIF that retrospectively targeted household and neighbourhood contacts resulted in the substantial increase in case notification during the intervention period and reduced subsequent case notification during the post-intervention period. The applicability of retrospective contact investigation in other high-burden settings should be explored.
MeSH term(s)	Cambodia/epidemiology ; Family Characteristics ; Humans ; Residence Characteristics ; Retrospective Studies ; Tuberculosis/epidemiology
Language	English
Publishing date	2016-03-01
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0150405
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Article: Variation in Grain Zinc and Iron Concentrations, Grain Yield and Associated Traits of Biofortified Bread Wheat Genotypes in Nepal.

Thapa, Dhruba Bahadur / Subedi, Mahesh / Yadav, Rajendra Prasad / Joshi, Bishnu Prasad / Adhikari, Bhim Nath / Shrestha, Keshav Prasad / Magar, Prem Bahadur / Pant, Khem Raj / Gurung, Suk Bahadur / Ghimire, Sapana / Gautam, Nutan Raj / Acharya, Nav Raj / Sapkota, Manoj / Mishra, Vinod Kumar / Joshi, Arun Kumar / Singh, Ravi Prakash / Govindan, Velu

Frontiers in plant science

2022 Volume 13, Page(s) 881965

Abstract: Wheat ( ...

Abstract	Wheat (
Language	English
Publishing date	2022-06-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2613694-6
ISSN	1664-462X
ISSN	1664-462X
DOI	10.3389/fpls.2022.881965
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Article ; Online: Epidemiology of dengue reported in the World Health Organization's Western Pacific Region, 2013-2019.

Togami, Eri / Chiew, May / Lowbridge, Christopher / Biaukula, Viema / Bell, Leila / Yajima, Aya / Eshofonie, Anthony / Saulo, Dina / Hien, Do Thi Hong / Otsu, Satoko / Dai, Tran Cong / Ngon, Mya Sapal / Lee, Chin-Kei / Tsuyuoka, Reiko / Tuseo, Luciano / Khalakdina, Asheena / Kab, Vannda / Abeyasinghe, Rabindra Romauld / Yadav, Rajendra Prasad /

Esguerra, Princess / Casey, Sean / Soo, Chun Paul / Fukusumi, Munehisa / Matsui, Tamano / Olowokure, Babatunde

Western Pacific surveillance and response journal : WPSAR

2023 Volume 14, Issue 1, Page(s) 1–16

Abstract: The global burden of dengue, an emerging and re-emerging mosquito-borne disease, increased during the 20-year period ending in 2019, with approximately 70% of cases estimated to have been in Asia. This report describes the epidemiology of dengue in the ... ...

Abstract	The global burden of dengue, an emerging and re-emerging mosquito-borne disease, increased during the 20-year period ending in 2019, with approximately 70% of cases estimated to have been in Asia. This report describes the epidemiology of dengue in the World Health Organization's Western Pacific Region during 2013-2019 using regional surveillance data reported from indicator-based surveillance systems from countries and areas in the Region, supplemented by publicly available dengue outbreak situation reports. The total reported annual number of dengue cases in the Region increased from 430 023 in 2013 to 1 050 285 in 2019, surpassing 1 million cases for the first time in 2019. The reported case-fatality ratio ranged from 0.19% (724/376 972 in 2014 and 2030/1 050 285 in 2019) to 0.30% (1380/458 843 in 2016). The introduction or reintroduction of serotypes to specific areas caused several outbreaks and rare occurrences of local transmission in places where dengue was not previously reported. This report reinforces the increased importance of dengue surveillance systems in monitoring dengue across the Region.
MeSH term(s)	Animals ; Humans ; Asia/epidemiology ; Disease Outbreaks ; Global Health ; Serogroup ; World Health Organization ; Dengue/epidemiology
Language	English
Publishing date	2023-03-22
Publishing country	Philippines
Document type	Journal Article
ZDB-ID	2592503-9
ISSN	2094-7313 ; 2094-7313
ISSN (online)	2094-7313
ISSN	2094-7313
DOI	10.5365/wpsar.2023.14.1.973
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Article ; Online: Examining the quality of childhood tuberculosis diagnosis in Cambodia: a cross-sectional study.

Frieze, Julia B / Yadav, Rajendra-Prasad / Sokhan, Khann / Ngak, Song / Khim, Team Bak

BMC public health

2017 Volume 17, Issue 1, Page(s) 232

Abstract: Background: Cambodia is one of the 22 countries with the highest TB burden. While childhood TB is estimated to make up 10-20% of total TB cases in high-burden settings, this proportion ranges from 1.3 to 39.4% throughout Cambodia's provinces, suggesting ...

Abstract	Background: Cambodia is one of the 22 countries with the highest TB burden. While childhood TB is estimated to make up 10-20% of total TB cases in high-burden settings, this proportion ranges from 1.3 to 39.4% throughout Cambodia's provinces, suggesting potential under- and over-diagnosis of childhood TB, subnationally. The proportion of case notifications classified as extrapulmonary TB out of total TB case notifications in children is 87%, greatly exceeding the expected global range of 20-30%. There is a gap in the literature on how childhood TB is diagnosed in resource-poor settings, and the quality of diagnoses. The study's aim is to quantitatively assess the quality of clinician performance and availability of diagnostic tools, for diagnosing childhood TB in high-burden Operational Districts in Cambodia. Methods: Between August and September of 2015, a cross-sectional study was conducted at referral hospitals and villages in 24 high-burden Operational Districts. 40 clinicians, and 104 parents whose child was recently diagnosed with TB were interviewed. Questionnaires assessed availability of diagnostic tools, and clinician knowledge and practice during a clinical examination. Descriptive statistics were calculated to provide cross-sectional data. Results: Availability of advanced diagnostic tools was low. Only 27.5% of clinicians had Xpert machines available at their facility, and 5% had equipment to perform gastric aspiration. 77.5% of clinicians reported that they had a chest X-ray at their facility, but only 34.6% of parents reported that the clinician conducted a chest X-ray. 72.5% of clinicians could name 5 out of 7 main TB screening criteria; however, parent data suggests that clinicians may not be applying knowledge to practice. The mean number of examinations/tests the clinician conducted during the clinical assessment of the child was 1.64. Of the parents whose child had an enlarged lymph node, 60.22% described lymph node characteristics that were not suggestive of TB. Conclusion: Limited availability of diagnostic tools and suboptimal clinician performance highlight where resources should be allocated to improve quality of diagnoses. Further research needs to be done in low burden Operational Districts to determine the capacity of clinicians and health facilities for diagnosing childhood TB, where cases are likely being missed.
MeSH term(s)	Adolescent ; Adult ; Cambodia ; Child ; Child Health Services/standards ; Child, Preschool ; Cross-Sectional Studies ; Female ; Humans ; Infant ; Male ; Mass Screening/standards ; Middle Aged ; Outcome Assessment, Health Care ; Radiography, Thoracic ; Surveys and Questionnaires ; Tuberculosis, Pulmonary/diagnostic imaging ; Tuberculosis, Pulmonary/prevention & control
Language	English
Publishing date	2017-03-06
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-017-4084-3
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