BackgroundChild health in many low- and middle-income countries lags behind international goals and affects children’s education, well-being, and general development. Large-scale school health programmes can be effective in reducing preventable diseases through cost-effective interventions. This paper outlines the baseline and 1-year results of a longitudinal health study assessing the impact of the Fit for School Programme in the Philippines.MethodsA longitudinal 4-year cohort study was conducted in the province of Camiguin, Mindanao (experimental group); an external concurrent control group was studied in Gingoog, Mindanao. The study has three experimental groups: group 1—daily handwashing with soap, daily brushing with fluoride toothpaste, biannual deworming with 400 mg albendazole (Essential Health Care Program [EHCP]); group 2—EHCP plus twice-a-year access to school-based Oral Urgent Treatment; group 3—EHCP plus weekly toothbrushing with high-fluoride concentration gel. A non-concurrent internal control group was also included. Baseline data on anthropometric indicators to calculate body mass index (BMI), soil-transmitted helminths (STH) infection in stool samples, and dental caries were collected in August 2009 and August 2010. Data were analysed to assess validity of the control group design, baseline, and 1-year results.ResultsIn the cohort study, 412 children were examined at baseline and 341 1 year after intervention. The baseline results were in line with national averages for STH infection, BMI, and dental caries in group 1 and the control groups. Children lost to follow-up had similar baseline characteristics in the experimental and control groups. After 1 year, group 1 showed a significantly higher increase in mean BMI and lower prevalence of moderate to heavy STH infection than the external concurrent control group. The increases in caries and dental infections were reduced but not statistically significant. The results for groups 2 and 3 will be reported separately.ConclusionsDespite the short 1-year observation period, the study found a reduction in the prevalence of moderate to heavy STH infections, a rise in mean BMI, and a (statistically non-significant) reduction in dental caries and infections. The study design proved functional in actual field conditions. Critical aspects affecting the validity of cohort studies are analysed and discussed.Trial registrationDRKS00003431 WHO Universal Trial Number U1111-1126-0718

This study reports the impact of the HiFive program, a 6-week handwashing campaign that targets social and emotional motivators to improve student handwashing in primary schools in the Philippines. We designed a clustered randomized trial to evaluate the impact of HiFive on student handwashing behavior, motivation, and access. Of the sample of 196 primary schools located in two districts, half were randomly assigned to receive the program in the 2017-2018 school year. Survey and observation data were collected 3 months after the conclusion of the campaign. In control schools, only 2.5% of students were observed washing their hands with soap and water, our primary outcome and 14.8% were observed washing their hands with at least water. HiFive led to a 3.7 percentage point (p.p.) increase (P < 0.01) in the rate of handwashing with soap and water and a 5.6 p.p. increase (P = 0.03) in handwashing with at least water after toilet use. HiFive also led to a 10.8 p.p. (P < 0.01) increase in the number of handwashing facilities stocked with soap. The program had limited impact on the motivators targeted by the program, suggesting that the small improvements in handwashing may have been driven by increases in the availability of soap. More research is needed to understand how interventions can effectively trigger social motivators to improve handwashing behavior among schoolchildren, and whether the effectiveness of these programs can be augmented with "nudge"-based interventions from the behavioral sciences.

Objectives Evidence for affordable and pragmatic programmes to address the burden of untreated tooth decay in children in low‐ and middle‐income settings is limited. This study aimed to (1) assess the effect of a government‐run, school‐based daily group toothbrushing programme compared to standard school‐based oral health education on the incidence of dental caries and odontogenic infections in Filipino children over a period of 3 years; and (2) assess the additional preventive effect of on‐demand oral urgent treatment (OUT) and weekly fluoride gel application. Methods A cluster‐randomized trial was conducted in Camiguin, Philippines. Schools in three regions were randomly assigned to one of three intervention groups: The Essential Health Care Programme (EHCP), which includes daily toothbrushing with fluoride toothpaste; EHCP plus twice‐yearly access to on‐demand urgent oral treatment (EHCP + OUT) and EHCP plus weekly application of high‐concentrated fluoride gel (EHCP + Fluoride). Schools in a nearby province with a similar child population were selected as external concurrent control group. Clinical oral examinations were performed by calibrated dentists from a random sample of 682 seven‐year‐old students who were examined at baseline and over the following 3 years. Outcome variables were the number of decayed primary teeth, the number of decayed, missing and filled permanent teeth (DMFT) and surfaces (DMFS), and the number of permanent teeth with pulpal involvement, ulcerations, fistula or abscess (PUFA). Data were analysed using multilevel mixed‐effects negative binomial regression. Results Three years after implementation, increments in dental caries and odontogenic infections in permanent teeth did not significantly differ between the EHCP and control group, yet the incidence of DMFT was lower by 22% in children receiving EHCP. Compared to controls, children receiving EHCP + Fluoride had a significantly lower increment of DMFT, DMFS and PUFA by 40%, 40% and 47%, respectively. Children receiving EHCP + OUT had lower incidence rates of DMFT and DMFS than control children by 23% and 28%, respectively. A lower incidence rate was also found for PUFA, but the effect was not statistically significant. Conclusions Findings suggest that the weekly application of fluoride gel and urgent oral treatment, in addition to daily school‐based toothbrushing with fluoride toothpaste, are realistic and effective strategies to lower the burden of dental caries in Filipino children. Implementation challenges may explain why no substantial caries‐preventive benefits were demonstrated for school‐based toothbrushing only. Intervention compliance should be considered in future programme implementation and evaluation research.

Objectives: The Department of Health (DOH) aims to reduce the prevalence of intestinal parasitism and proportion of heavy intensity of infection in the country by 2022. Among the interventions is school-based mass drug administration (MDA). Regular assessment of MDA gives guidance to the DOH. The aim of this survey was to determine the prevalence of soil transmitted helminthiasis and histosomiasis among public school children ages 5 to 16 years old. Methodology: A cross-sectional, school-based study using multi-stage stratified cluster sampling was conducted from 2013 to 2015, covering the National Capital Region (NCR), and all provinces, except Maguindanao and Sulu. Stool samples were examined using the duplicate Kato Katz (KK). Results: Of the 26,171 school children with stool samples examined, 7,440 (28.4%) were infected with at least one soil-transmitted helminth (STH). Infections among male students were significantly higher than female students (31.0% versus 26.0%). Heavy, moderate, and light intensity of infections were 3.2%, 29.0% and 67.7%, respectively. STH cumulative prevalence per province ranged between 0.5% and 89.5%. Schistosomiasis infections were detected in known non-endemic provinces: Ilocos Norte, Biliran, Tawi-Tawi, Basilan, and Dinagat Islands. Majority (68%) of the infections were with single parasites but as many as five parasites were detected in one child. Infections with heterophyids were also observed. Conclusion: While the national prevalence of schistosomiasis was less than 1.0%, the cumulative prevalence of soil-transmitted helminthiasis among school-aged children was higher than the global figure of 24.0%.