Background Air pollution and poor ambient air quality are significantly related to multiple health risks. One associated disease is chronic obstructive pulmonary disease (COPD), a preventable disease with several contributing factors and one of the leading causes of morbidity/mortality locally and globally. A potentially high-risk population are traffic enforcers who are constantly exposed to air pollution. In the Philippines, the MMDA has the widest coverage in traffic management. The study determined the risk of COPD among Metro Manila Development Authority (MMDA) traffic enforcers in relation to ambient air quality level, as well as identified other factors that increase the risk of developing COPD. Methods Fifty-two MMDA traffic enforcers deployed in PM 2.5 air quality sensor areas in Metro Manila from 2016 to 2018 were recruited through stratified sampling. The International Primary Airways Guidelines (IPAG) questionnaire was utilized to measure risk of COPD. Respiratory health and working history were obtained through questionnaires. Department of environment and natural resources provided PM 2.5 ambient air quality data which aided in the construction of the Exposure-Month Index. Ordinal logistic regression was used to examine the association of PM 2.5 together with the relevant factors and the risk of COPD. Results We found statistically significant associations between PM 2.5 and COPD among high risk category [odds risk (OR): 1.24, 95% confidence interval (CI): 1.07–1.44]. Age (Moderate, OR: 1.16, 95% CI: 0.98–1.38 and High, OR: 10.06, 95% CI: 4.02–25.17) and chest pain (Moderate, OR: 68.65, 95% CI: 1.71–2.75 × 10 3 ) were potential risk factors, whereas body mass index (BMI) (OR: 0.05, 95% CI: 0.01–0.53) exhibited protective effect. Conclusions Exposure to PM 2.5 was associated with an increased risk of COPD among high-risk category MMDA traffic enforcers. Age and chest pain were potential risk factors to risk of COPD, whereas BMI exhibited a potential protective effect. Results of this study can be used for clinical management of high-risk populations, such that of MMDA traffic enforcers.

This study presents a comprehensive analysis on policies governing the management of COVID-19 waste in the Philippines, highlighting gaps in pre-existing policies and opportunities for further policy development and adaptation in the context of present and future public health emergencies. A hybrid search strategy and consultative process identified fifty (50) policy documents directly impacting the management of wastes (general domestic, healthcare, and household healthcare waste) released prior to and during the pandemic. Content analysis revealed comprehensive policy coverage on managing general domestic waste and healthcare waste. However, there remains a dearth in policies for managing household healthcare waste, an emerging category for waste generated by patients isolating at home or in isolation facilities. Applicable, pre-existing policies were neither adequate nor specific to this category, and may therefore be subjected to variable interpretation and mismanagement when applied to this novel waste category. Assessment using the modified Cradle-to-End-Of-Life (CTEOL) framework revealed adequate policy coverage across the waste lifecycle stages. However, policies on reducing waste generation were relatively minimal and outdated, and policy gaps in waste segregation led to downstream inefficiencies and introduction of environmental health risks in waste collection, treatment, and disposal. The internal validity of policies was also evaluated against eleven (11) criteria adapted from Rütten et al. and Cheung et al. The criteria analysis revealed strong fulfillment of ensuring policy accessibility, goal clarity, provision of human resources, and strength of policy background, but weak fulfillment of criteria on providing adequate financing, organizational capacity building, monitoring and evaluation, and encouragement of opportunities for public participation. We conclude that existing waste management policies in the Philippines leave much room for improvement to ensure effective management of COVID-19 waste from various settings and circumstances. Hence, these policies are expected to adapt and evolve over time, utilizing the best available technology and environmental practices. Integrated, region-wide waste management systems, involving both government and society, and strengthened by equitable provisional support are needed for effective waste management that is both inclusive and resilient in the face of present and future pandemics.

Arsenic (As) is a highly toxic, carcinogenic trace metal that can potentially contaminate groundwater sources in volcanic regions. This study provides the first comparative documentation of As concentrations in groundwater in a volcano-sedimentary region in the Philippines. Matched, repeated As measurements and physico-chemical analyses were performed in 26 individual wells from 11 municipalities and city in Batangas province from July 2020 to November 2021. Using the electrothermal atomic absorption spectrometric method, analysis of the wells revealed that in 2020, 23 out of 26 (88.46%) had As levels above the WHO limit of >10 ppb while 20 out of 26 wells (76.92%) had persistently high As levels a year later. Using a Wilcoxon signed-rank test, levels of As were found to be statistically elevated compared to the national safe limit of 10 pbb in the 26 matched sampling sites in both 2020 (p-value < 0.001) and 2021 (p-value = 0.013). Additionally, a two-paired Wilcoxon signed-rank test revealed that As levels were statistically higher in 2020 than in 2021 (p-value = 0.003), suggesting that As levels may be higher in years when there is more volcanic activity; however, this remains to be further elucidated with suitable longitudinal data, as this study is still in its preliminary stages. The data was also analyzed using a bivariable regression, which showed no evidence of a significant relationship between As levels and distance from the danger zone (Taal volcano crater); however, results showed an inverse but statistically insignificant relationship between As levels and elevation. Due to the toxic profile and persistence of As in groundwater in Batangas Province, continuous groundwater As monitoring, timely public health risk communication, and the provision of alternative water sources to affected populations are recommended.

Introduction:In the Philippines, medicines are procured at higher rates in government hospitals. The prices of essential medicines have high variability, and a significant portion of out-of-pocket expenditures by Filipinos is for medicines. This study's objective is to determine the factors associated with the variation in drug pricing among public hospitals.Methods:This was a mixed-methods, case-control study of 57 hospitals. Two tools were developed based on: (i) Management Sciences for Health (MSH)’s Rapid Pharmaceutical Management Assessment and (ii) World Health Organization (WHO)’s Good Pharmaceutical Practices. The dependent variable is a drug price reference ratio of a preselected drug basket. Examples of factors studied are: (i) preference for generics, (ii) procurement type, and (iii) time out of stock.Results:Hospitals with proper procurement planning and performance monitoring are expected to decrease the price ratio (R = -0.030). However, interview data showed that forecasting is still not robust enough. Past consumption (91 percent) remained the most frequently used input to procurement planning. Few hospitals took into consideration other factors such as morbidity, mortality, and patient demographics. The expertise of hospital procurement staff increases the hospital's price mark-up. Interview results suggest this is because members and hospital units do not meet eye-to-eye to ensure accountability and coordination across units in planning and implementing the procurement procedures.Conclusions:By having a forward-looking procurement plan, forecasting can be more efficient. Potential improvement lies in finding mechanisms where nearby hospitals could participate in pooled procurement. Pooled procurement could have an impact on reducing prices by capturing economies of scale, provided this is operated efficiently and transparently.