e Leptospirosis is a zoonosis caused by pathogenic Leptospira spp. Most of the outbreaks of leptospirosis occur after floods caused by heavy rain in countries where Leptospira spp. are endemic. It has been believed that the overflow of seawater rarely causes outbreaks of leptospirosis because the leptospires are killed by salt water. On 8 November 2013, a storm surge caused by Super Typhoon Haiyan (Yolanda) inundated the entire coastal areas of Tacloban and Palo in Leyte, Philippines. The present study was carried out in order to determine whether the environmental leptospires in soil were able to survive after the storm surge in the affected areas. We collected 23 wet soil samples along the coastal areas of Tacloban and Palo 2 months after the storm surge. The samples were suspended in HEPES buffer, and the supernatants were cultured in liquid or semisolid Korthof's medium supplemented with five antimicrobial agents to inhibit the growth of contaminants. Leptospires were isolated from primary cultures of 22 out of 23 samples. The DNA of pathogenic Leptospira species was detected in 11 samples (47.8%) by analysis of flaB by nested PCR. Eventually, two pathogenic Leptospira strains were isolated and showed the highest 16S rRNA gene sequence similarity to Leptospira kmetyi. When these isolates were experimentally mixed with soil, they were found to survive in seawater for 4 days. These results show the possibility that leptospires living in soil survived after the storm surge. Our findings may serve as a warning that when seawater inundates the land during a storm surge or a tsunami, an outbreak of leptospirosis could occur in the disaster-stricken area.

This study describes a process to explore factors which contribute to child-drowning deaths and allows the development of appropriate strategies to prevent similar deaths in a selected site in the Northern Philippines. Data collection techniques used in obtaining baseline data include: review of drowning mortality records; key informant interviews; focus group discussions; and community walk-throughs. Risk factors identified which could or did contribute to drowning events were: proximity to bodies of water; inadequate child supervision; lack of information/awareness of prevention strategies; and lack of drowning prevention programme(s). Measures on how to prevent drowning deaths were explored and initial interventions were implemented through a committee convened by the community. These interventions include: community education sessions; capability building measures; redesigning of community wells; development of playpens; and use of barriers. Community engagement is a crucial element in the development and implementation of any health programme. This study demonstrates that by engaging and working with the community action occurs, however, there is a need to conduct further evaluation activities to determine if the actions by the community continued beyond the project and have resulted in a decrease in drowning. One of the strengths of the process described is that it is culturally appropriate and site-specific and allows the community to find the solutions itself. Exploration and delivery of further projects in larger areas is required to reduce drowning in the Philippines. An imperative is the evaluation which will provide valuable information on whether barriers are a sustainable and acceptable means of prevention to the community in the long term.

Drowning kills 372 000 people yearly worldwide and is a serious public health issue in the Philippines. This study aims to determine if the drowning death rates in the Philippine Health Statistics (PHS) reports from 1980 to 2011 were underestimated. A retrospective descriptive study was conducted to describe the trend of deaths caused by drowning in the Philippines from official and unofficial sources in the period 1980 to 2011. Information about deaths related to cataclysmic causes, particularly victims of storms and floods, and maritime accidents in the Philippines during the study period were reviewed and compared with the PHS drowning death data.An average of 2496 deaths per year caused by drowning were recorded in the PHS reports from 1980 to 2011 (range 671–3656). The average death rate was 3.5/100 000 population (range 1.3–4.7). An average of 4196 drowning deaths were recorded from 1980 to 2011 (range 1220 to 8788) when catacylsmic events and maritime accidents were combined with PHS data. The average death rate was 6/100 000 population (range 2.5–14.2).Our results showed that on average there were 1700 more drowning deaths per year when deaths caused by cataclysms and maritime accidents were added to the PHS data. This illustrated that drowning deaths were underestimated in the official surveillance data. Passive surveillance and irregular data management are contributing to underestimation of drowning in the Philippines. Additionally, deaths due to flooding, storms and maritime accidents are not counted as drowning deaths, which further contributes to the underestimation. Surveillance of drowning data can be improved using more precise case definitions and a multisectoral approach.

Drowning is a public health issue in the Philippines, with children at significantly increased risk. Determinants of health (DoH) such as education, socio-economic status, ethnicity, and urbanization are factors that impact drowning risk. As drowning is a multisectoral issue, a national drowning prevention plan can drive collaboration with relevant stakeholders. This study reports trends in unintentional child (0–14 years) drowning in the Philippines (incidence, rates, and trends over time for fatal and non-fatal (years lived with a disability (YLDs) and disability adjusted life years (DALYs) from 2008–2017 and conducts an analysis of the Philippines’ Multisector Action Plan (MSAP) on Drowning Prevention. From 2008–2017, 27,928 (95%UI [Uncertainty Interval]: 22,794–33,828) children aged 0–14 years died from drowning (52.7% aged 5–14 years old). Rates of drowning have declined among both age groups, with greater reductions seen among 0–4 year olds (y = −0.3368x + 13.035; R2 = 0.9588). The MSAP has 12 child drowning-specific activities and 20 activities were identified where DoH will need to be considered during development and implementation. The MSAP activities, and work done to prevent drowning more generally, must consider DoH such as education, urbanization, water and sanitation health, and safe water transportation. A national drowning surveillance system and investment in research in the Philippines are recommended.

This paper was conceptualized to document and evaluate the development and conduct of the training course for physicians on the assessment and management of drug dependence from 2013 to 2017, and provide a model by which other institutions or groups may approach capacity development for drug dependence rehabilitation. Using a case study approach, training-related documents and records for all training activities conducted between 2013 and 2017 were retrieved and reviewed. An iterative process of data abstraction was conducted to describe the a) training process, including the course design, structure and content; and b) the training outputs in terms of coverage (i.e., participants trained) and the first two levels of Kirkpatrick's training evaluation framework (i.e., reaction, and learning). The basic training course implemented in the Philippines is a twoweek locally-developed program consisting of five modules that covers the theoretical and practical aspects of the assessment and management of drug dependence. A total of 208 physicians from across the country were trained and accredited between 2013 and 2017. Paired-samples t-test on the examination scores of 136 participants showed that there was a significant difference in the pre-test (29.71±3.95) and post-test scores (40.31±4.90); t(135)=22.4797, p = <0.0001.