No abstract

In developing countries, diagnoses of diseases associated with deaths in children are frequently derived from retrospective maternal interviews. To determine the validity of this methodology, and to define sensitive and specific diagnostic algorithms, we compared symptoms and signs reported by mothers using structured questionnaires, with selected physician diagnoses for 164 deaths among hospitalized children on the Philippine island of Cebu. The 164 decreased children had 256 physician diagnoses of acute lower respiratory infections (ALRI) (100), diarrhoeas (92), measles (48), and neonatal tetanus cases (16). Forty-three per cent of children had multiple illnesses. An algorithm for tetanus (age at death less than or equal to 30 days with convulsion or spasm) was 100% sensitive, but specificity could not be estimated due to the small number of comparison neonatal deaths. An algorithm for measles (age greater than or equal to 120 days, with rash and fever for at least three days) had 98% sensitivity and 90% specificity. Diagnosis of ALRI was more difficult, cough and dyspnoea alone yielding 86% sensitivity but low specificity, whereas prolonged cough and dyspnoea provided 93% specificity but low sensitivity (41%). Diarrhoea diagnoses based on frequent loose or liquid stools had high sensitivity (78-84%) and specificity (79%), irrespective of whether the child died with diarrhoea alone or in combination with other illnesses. However, maternal reports of moderate/severe dehydration had low specificity. We conclude that, in this setting, verbal autopsies can diagnose major illnesses contributing to death in children with acceptable sensitivity and specificity.

We examine current perceptions and constraints surrounding condom use among young adults in the Philippines to garner a deeper contextual understanding of this aspect of HIV prevention within Filipino society. Through thematic analysis of focus group data, we found three broad themes, all of which included societal and individual barriers to using condoms. The findings may provide insight for similar settings that have strong religious influences on society. To strengthen HIV prevention efforts in such settings, we suggest that the development of strategies to address these constraints in the cultural setting and promote sexual health of young adults is essential.

Filipino adolescents who have witnessed parental domestic violence are significantly more likely to report depressive symptoms.

Increasing obesity in low- and middle-income countries is well documented in cross-sectional studies. However, few longitudinal studies identify factors that influence individual weight gain patterns over time in relation to the major social and economic changes that now characterize these settings. This study uses data from adult Filipino women participating in the Cebu Longitudinal Health and Nutrition Survey from 1983 to 2005. A sample of 3005 women contributed 1-8 observations each. Longitudinal mixed effects models identified how age and secular weight trends related to underlying effects of urbanization and changing household socioeconomic status (SES) and to proximate individual effects of reproductive history, diet, and occupational physical activity. The 23-y secular trend in weight amounted to nearly 10 kg. Younger women gained more weight than older women (12.4 kg in those < 20 y old in 1983 vs. 4.9 kg in those > 35 y). Periods of more rapid weight gain corresponded to periods of rapid increase in SES and urbanization. Weight was positively related to energy intake, percentage of calories from protein, and more sedentary occupations, but negatively related to months pregnant and lactating and postmenopausal status. These effects all varied with age and over time. The trends contributed to a 6-fold increase in prevalence of overweight and an increasing number of women who have or are likely to develop obesity-related metabolic diseases. The trends are highly relevant for health policy and preventive health measures in the Philippines and other countries now facing the dual burden of over- and undernutrition.

The diagnosis of childhood illness by maternal health interview surveys is widely used to estimate the prevalence of childhood morbidity in developing countries. To determine the validity of interview-based diagnoses, and to define simple, sensitive and specific diagnostic algorithms, we compared symptoms and signs reported by mothers during structured interviews with physicians' diagnoses for 271 children on the Philippine island of Cebu. The 271 children had 318 physician diagnosed illnesses: 105 acute lower respiratory infections (ALRI), 121 diarrhoeas, 36 measles, 50 upper respiratory infections (URTI), 5 roseola infantums and one milaria rubria. An algorithm for measles (age greater than or equal to 120 days, rash and fever greater than or equal to 3 days and fading of rash) had a sensitivity and specificity of 94%. For ALRI an algorithm of cough, dysponea and fever had a sensitivity of 82%, but specificity was lower in comparison with URTI (58%) than with children who had no respiratory illness (79%). Inclusion of signs of respiratory distress (flaring of nostrils, intercostal retraction) raised the specificity to 83-84%, but reduced sensitivity to 68%. Diagnosis of diarrhoea based on frequent loose or liquid stools had a sensitivity of 95-97% and specificity of 80% in children with or without concomitant non-diarrhoeal illnesses. Addition of questions on numbers of stools (greater than or equal to 6 per day), and no signs of dehydration increased specificity to 95% but reduced the sensitivity to 84-86%. However, specific signs of dehydration were not well reported by the mothers.(ABSTRACT TRUNCATED AT 250 WORDS)

We examine the importance of family background for early childhood development (ECD) using data collected in 2001 from 3,556 children between age 0 and 36 months in three regions of the Philippines. We focus on four main research questions: 1) are associations of family background with ECD, in part, proxying for health and ECD-related programs? 2) are associations of family background with ECD biased due to omission of unobserved community characteristics that may be related to placement of health and ECD-related services? 3) are there important interactions between family background and health and ECD-related programs in their effect on ECD? 4) are there important interactions among the components of family background? Physical assets and human assets have a number of important positive associations with ECD. These include the positive relations between physical assets and the anthropometrics and hemoglobin levels of children, as well as lower occurrence of worms. Each parent's schooling and height also have notable positive effects on these outcomes and the motor and language skills of children. The failure to account for community characteristics is related to often substantial bias in the estimated effect of family background on ECD. We do not find strong evidence that interactions are important.

The Philippines has experienced rapid sociodemographic changes in recent years, with implications for adolescents. This study combines quantitative and qualitative data from Metro Cebu to assess the timing and predictors of adolescent partnerships, as well as the context in which these partnerships are occurring. The majority of adolescents (54%) had premarital sex, though this pattern varied by gender. Wealthier, urban men, and women with less education and lower reported religiosity, were more likely to have premarital sex. Engagement in risk behaviors was predictive of premarital sex for both males and females. The qualitative data contextualize the circumstances under which adolescents engage in sex and form partnerships, and illustrate how sociocultural norms contribute to gender differences in partnership patterns. Given the ‘new’ realities of young Filipinos’ lives, targeted efforts to support adolescents’ transition to adulthood are needed to avert potentially adverse lifeevents.