Jenny Bituin

[Jenny Bituin]

Yes, there is a big difference in the access and quality of care between rural and urban setting. In the Philippines, one way to close this gap is through mobile health clinics. A mobile health clinic is a customized vehicle—often a van or bus—equipped with medical supplies and staffed by healthcare professionals. They allow healthcare providers to reach marginalized communities that lack access to traditional healthcare facilities.

Here are some examples of mobile health clinics operating in the Philippines:
Mobile Primary Care Facility (MPCF) Vehicles
– Mobile clinics of the Department of Health that provide essential medical assistance and healthcare services to geographically isolated and disadvantaged areas (GIDAs) or areas with underserved populations. It contains a standard set of equipment such as an x-ray machine, ultrasound, laboratory equipment, telemedicine kit, generator set, vehicle airbags, and an air conditioning unit.

KonsulTayo mobile clinic
– a project of the Department of Health and Philippine Business for Social Progress (PBSP), the largest business-led NGO for social development in the Philippines. These mobile clinics are part of PBSP’s Access TB Project, providing free chest x-ray, specimen collection and transportation, ECG, and other primary care services. Our town is one of the beneficiaries of this project. Several times a year, a KonsulTayo mobile clinic arrive at our municipality to provide free chest x-ray.

TrucKABATAAN
– a combination of the words, truck and “kabataan” which means youth in Filipino. It is a collaboration of several agencies, including the Joint Programme on Accelerating the Reduction of Adolescent Pregnancy (JPARAP) in Southern Leyte and Samar, Korea International Cooperation Agency (KOICA), the Philippine Government, the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO)
– This mobile clinic provides essential health services to adolescents, from sexual and reproductive health to maternal and child health services for adolescent parents.

KliniKalye
– this mobile health clinic is found in an urban area (Metro Manila). It provides free and accessible medical care to street children and their families.

[Jenny Bituin]

In the Philippines, Overseas Filipino Workers (OFWs) are hailed as modern-day heroes because of their contribution to the Philippine economy through their remittances, and because of their resilience and sacrifices to work abroad in order to support their family at home. However, outward migration of health workers, especially nurses, has been a problem for many years. The Philippines lacks an estimated of 127,000 nurses and according to the WHO’s State of World’s Nursing report in 2020, this figure is projected to increase to 249,843 by 2030. Despite the shortage of nurses in the country, outward migration of Filipino nurses continues. In 2021 for example, the Department of Health estimated that of the 316,000 licensed Filipino nurses, 51% are working abroad. This number continues to increase, as reported by the Department of Migrant Workers (DMW). Every year, DMW’s Overseas Employment Statistics list nursing as one of the top 10 skills of Deployed Landbased Overseas Filipino Workers – New Hires. In 2023, 12,630 nurses were newly-hired overseas, and an additional of 10,635 nurses were newly-hired in 2024.

Two of the main reasons why nurses prefer to work abroad are inadequate salary/benefits and poor working conditions (especially high nurse-to-patient ratios). My younger sister is a nurse working at a private hospital, and many of her colleagues had left the hospital to work in another country. She is also thinking of working abroad herself, because of the many job opportunities that offer higher salary and less workload. Last December 2025, a bill was filed by a senator seeking to increase the salary grade of nurses from salary grade 15 to 19. Hopefully, this will help in convincing nurses to stay in the Philippines and persuade other nurses abroad to come back and serve the country. Another solution that I think will be useful is to provide nursing scholarship similar to the Medical Scholarship and Return Service Program of the Commission on Higher Education (CHED). The MSRS scholarship program provides full scholarships to Filipino medical students, requiring mandatory service in underserved areas in return. Since we are experiencing a nursing shortage, a similar scholarship for nurses will help in increasing the nurse workforce.

University of the Philippines Manila, a public university considered as one of the top health sciences university in the Philippines, also has a Return Service Agreement. All graduates of its health science colleges (Nursing, Medicine, Dentistry, Pharmacy, Allied Medical Professions, and Public Health) must serve in the Philippines for at least two years within five years of graduation. I think all state universities and colleges should consider implementing a similar return service agreement for health graduates. Since we are scholars of the people, we have a duty to serve our fellow Filipinos.

Lastly, I would like to share an article from Business Mirror, titled, “Healing the world, bleeding at home: The Philippines’ nurse drain crisis”. I think it is a well-written article about the nursing crisis in our country.
Here is the link of the article:
https://businessmirror.com.ph/2026/02/02/healing-the-world-bleeding-at-home-the-philippines-nurse-drain-crisis/

[Jenny Bituin]

Our healthcare facility uses Wireless Access for Health (WAH) as our EMR. Here are the advantages and disadvantages of using EMR over paper-based medical records based on my observations.

Good
1. Enables centralized management of patient records, all relevant patient information can be stored/found in the EMR
2. Patient records can be accessed anywhere, as long as there is internet and desktop/laptop/tablet with Google Chrome
3. Reports for public health programs such as Maternal and Child Care, Family Planning, and Adolescent Health can be easily generated in the EMR
4. Ensures security and privacy of data (better than paper-based system) through data encryption, role-based access, and automatic account controls
5. Enables our healthcare facility and healthcare workers to receive direct reimbursement from PhilHealth for the services we provided to PhilHealth members. This will not be possible if our facility is only using paper-based medical records since PhilHealth requires a facility to have a functional EMR in order to be an accredited healthcare provider.

Bad
1. EMR is more expensive than paper-based system because we have to invest in the software, hardware, and maintenance cost of the system
2. Needs electricity and internet to function. If any of these became unavailable, we will not be able to access the EMR
3. Requires training and hiring of additional personnel with IT background since we do not have enough personnel who can manage the system
4. Patient records can be exposed to cyberattacks
5. Using EMR can be time-consuming, especially when PhilHealth started to require every member to do liveness check every time they avail a service with their accredited healthcare provider

[Jenny Bituin]

Here are my suggestions on coping with big health data challenges
1. Missing data
Some methods to deal with missing data are the following:
a) complete-case analysis (CCA)
– all persons with missing values on one or more variables are excluded from the analysis. This method has a lot of drawbacks and should be avoided in general because it generates unbiased results only in some situations
b) imputation
– replacement of missing data by real values
– multiple imputation is recommended over single imputation methods (mean imputation, imputation based on linear regression, and last value/observation carried forward) because most single imputation methods lead to an artificial decreased standard deviation in the variables to be analyzed, resulting in too small standard errors
– multiple imputation consists of three phases: imputation, analysis, and pooling

2. Selection bias
In a paper published by Rojas-Saunero et al. (2023), the following solutions can prevent selection bias in health research:
a) Clearly specify the target population
b) Collect primary data in a way that ensures accessibility for participants who are often marginalized. Ideally, all social groups should be recruited from the same source, rather than creating a distinct recruitment pipeline that draws from different populations to achieve diversity.
c) Design retention strategies to prevent differential loss to follow up

3. Data analysis and training
This can be solved by training the clinicians and researchers on informatics and tools for big health data analysis.

4. Interpretation and Translational Applicability of Results
Tools for visualization of big data such as Tableau, Microsoft Power BI, Google Looker Studio, and D3.js can be used to present big data into information that is easy to understand and interpret.

5. Privacy and Ethical Issue
Regulations on the use of data, for example the General Data Protection Regulation (GDPR) in Europe and Data Privacy Act in the Philippines, must be followed to ensure data privacy and confidentiality.

References:
Heymans, M. W., & Twisk, J. W. (2022). Handling missing data in clinical research. Journal of Clinical Epidemiology, 151, 185–188. https://doi.org/10.1016/j.jclinepi.2022.08.016

Rojas-Saunero, L. P., Glymour, M. M., & Mayeda, E. R. (2023). Selection Bias in Health Research: Quantifying, Eliminating, or Exacerbating Health Disparities? Current Epidemiology Reports, 11(1), 63–72. https://doi.org/10.1007/s40471-023-00325-z

Staff, C. (2025, April 11). Big Data Visualization tools: Types, benefits, and how to choose. Coursera. https://www.coursera.org/articles/big-data-visualization-tools-types-benefits-and-how-to-choose

[Jenny Bituin]

Here is my view on the four recommended points that public health professionals can do to fight corruption.
1. Convene key stakeholders in the health system
I agree with the authors that this is such a formidable task, similar to what is happening in the Philippines today, in relation to the investigations on the alleged corruption of flood control projects worth billions of pesos. Some former officials of the department involved (Department of Public Works and Highways) who previously gave statements to the Senate were rumored to have recanted their statements. Another former official who was said to be a key figure in the investigation was found dead, likely of suicide according to reports.

2. Prioritize action
I agree that prioritizing action is important. Aside from addressing the causes of corruptions, people might also be more encouraged to report/expose corruption practices if they can see that actions are being done.

3. Take a holistic view
Although looking at the problem in a holistic view is important, I think looking for the root cause of corruption at the smallest unit of the organization must also be emphasized.

4. Research community sets out what it can offer
Aside for conducting research on health corruption, I think it is also important for the findings of these researches to be disseminated to the general public, policy makers, and legislators, preferably in a language that common/average people will understand.

To add from the points mentioned above, another way of fighting corruption in my opinion is recognizing the efforts of people who dedicate their work fighting corruption, and sharing all about them to others, especially the youth. Like in the Philippines, we have a popular mayor who is a well-known anti-corruption champion. He sets a good example to others, showing how more prosperous and comfortable a city can be without corruption. He is a good role model, especially to youths who will be the future leaders of our country. Because of his popularity, some mayors even copied some of their city’s practices to fight corruption. He also inspires other people to fight against corruption and push for change, because they know that they are not alone in the fight.

[Jenny Bituin]

I would like to share about PhilHealth Check Utility (PCU) Liveness Check, a health system improvement introduced last October 2025 by PhilHealth, the government corporation tasked to administer the National Health Insurance Program of the Philippines. PCU is an online tool accessible via the PhilHealth Member Portal that allows individuals to verify their PhilSys (Philippine identification system) registration and validate their PhilHealth membership status. Using personal details and facial recognition, it confirms identity, performs liveness checks, and automatically tags verified users in the PhilHealth database to support secure and streamlined access to all benefits.

Here are the barriers that we have encountered/will possibly encounter while using the PCU:
1. Accessibility
Using PCU Liveness check requires a stable internet connection and a smartphone with camera, which some patients do not have access to. Some patients were also not very computer/digitally literate, making the process of using the tool difficult for them.

2. Increased consultation and waiting time
A PCU liveness check must be done by the patient during the selection of his/her preferred primary care clinic, First Patient Encounter (FPE) assessment, and every consultation. Using the PCU tool every consultations increased consultation time because many patients need assistance using the tool, especially those who are using it for the first time and those who received errors during the liveness check.

3. Additional burden to patients and healthcare workers
As stated in the PhilHealth circular patients must use the PCU liveness check every time they avail a service with their accredited public or private healthcare providers. For example, a patient who availed medical consultation for three consecutive days must also do the PCU liveness check for those three days. Repetitive liveness check adds a burden to both the healthcare workers and the patients.

4. Data privacy concerns
The PCU tool asks for the patient’s personal details and facial recognition, and some patients may be hesitant to share their personal information in fears of their data being hacked/compromised.

[Jenny Bituin]

page 340, item 1. (Common misinterpretations of single P values)
P values are sometimes misinterpreted as the probability of the test hypothesis being true. For example, a P value equal to 0.40 does not mean that the null hypothesis has a 40% chance of being true. It simply indicates how close the data is to where the statistical model predicted they should be.

[Jenny Bituin]

Hello everyone! I am Jenny Bituin, a nutritionist-dietitian from the Philippines. I currently work as a local nutrition action officer in our town, responsible for managing nutrition programs, supervising volunteer nutrition workers, and providing nutrition and other related services. A part of my work that is related to statistics is collecting and analyzing nutrition data, such as height and weight of preschool age children, to determine the prevalence of undernutrition and overnutrition in our town. I learned a few basics on data and statistical analysis when I was an undergraduate student, but I have not been able to apply it in my work. I hope to learn more about statistics in health science and its application through this course.

[Jenny Bituin]

Our organization is a Rural Health Unit (RHU), a local government-owned health facility that provides basic and comprehensive health services to our municipality. For our organization’s disaster recovery plan, the procedures that should be included are the following:
1. Creation of the Disaster Recovery Committee/Team
2. Identification and Analysis of Disaster Risks/Threats to the Information System
3. Classification of Risks Based on Relative Weights
4. Building the Risk Assessment
5. Determining the Effects of Disasters to the Information System
6. Evaluation of Disaster Recovery Mechanisms

Since we have a limited budget and human resource, the technologies that will be used are:
1. Devices such as radio and phones, and applications such as email, messaging, and other social media apps (whichever is available) for sending notifications as soon as a disruption or emergency has been detected or definitely predicted.
2. Cloud storage, either Google Drive or Microsoft OneDrive, for online data backup and replication.
3. External hard drive for offline data backup and replication.

[Jenny Bituin]

One of the health challenges the Philippines is facing today in terms of health informatics systems is corruption and mismanagement of allocated funds. For example, here are some issues with the information system of PhilHealth, the government corporation tasked to administer the National Health Insurance Program of the Philippines:

1. In 2020, PhilHealth proposed a budget of 2.1 billion pesos for their ICT project, but during a Senate investigation, a certified public accountant who was part of the PhilHealth’s board of directors revealed that the proposed budget was significantly inflated by at least 734 million pesos. According to the board member, multiple items in the budget proposal were either overpriced or were redundant, with several items priced up to quadruple the amount.

2. In 2023, PhilHealth was attacked by the Medusa ransomware group, possibly compromising the data of 42 million people. The attackers were able to compromise the PhilHealth database because the agency’s antivirus software licenses were expired, and they blamed the government’s new procurement rules for the delay of license renewal.

3. A Commission of Audit (COA) report released in 2024 found that PhilHealth is still using fragmented systems for data management, not an integrated one. They also found that PhilHealth compromised application servers due to weak security measures.

4. The Corporate Operating Budget (COB) of PhilHealth for 2024 is 259 billion pesos, but according to their board of directors, only 8% of the COB were used for the purchase of information and communications technology (ICT) and other capital expenditures.

5. The PhilHealth board of directors did not grant a new ICT budget for 2025, they instead extended the validity of the 2024 COB for ICT projects (989 million pesos).

As mentioned above, PhilHealth has hundreds of millions allotted for the improvement of their information system but the budget was not utilized efficiently and properly. Transparency in the utilization of funds is important in order to prevent corruption and misuse of funds. Hiring competent and qualified individuals to lead is also important (the President and CEO of PhilHealth who approved the proposed 2020 budget was a retired army general, and has no medical background). Highly competent and qualified leaders are needed in making informed decisions, efficient resource management, ensuring confidentiality, integrity, and availability of the health information systems, and improving performance and productivity of the organization.

[Jenny Bituin]

A hospital information system (HIS) that implements High Availability will have the following benefits:
Hospital
1. Continuity of service – the HIS will be able to recover quickly from failures, and the hospital can continue serving patients without a noticeable outage
2. Secured data – the hospital’s most important data will always be available, accessible and protected from data breaches
3. Improved reputation – a system with High Availability will improve patient satisfaction and ensures that the reputation of the hospital will not suffer from negative feedback due to outage or unexpected downtime

Patients
1. Improved user experience – patients will be able to use a fast and reliable Hospital Information System
2. Protection of patients’ data – patients’ data will be protected from unplanned outages caused by human error, software problems, hardware failures, and environmental issues

[Jenny Bituin]

The change that I wished to do in my organization was to request for the transfer of the Nutrition Unit from the Social Welfare and Development Office to the Health Office. In our municipality, the Nutrition Unit has been under the Social Welfare and Development Office for a long time. I wanted to transfer to the Health Office because they implement many nutrition-related programs, like the deworming program, micronutrient supplementation, and integrated management of acute malnutrition. I wanted to be involved in these programs and practice my profession as a nutritionist-dietitian, which I was not able to do as much when I was in the social welfare and development office.

At first, I was not sure how to request for the transfer because I fear that my boss at the Social Welfare and Development Office would take it the wrong way/misunderstand me. Then I heard from other people that the head of the health office also want the nutrition unit to be transferred to them because nutrition and health should be working together. Three years ago, while a university was conducting an interview in our municipality, me and the head of the Health Office were left alone in the room. I approached her and expressed my interest to transfer to their office. Thankfully, after a few months, I received a transfer order from our mayor.

[Jenny Bituin]

We have not yet encountered any problem in Confidentiality, Integrity, and Availability in our current EMR. However, we are currently experiencing a problem with confidentiality and availability of a system we are using, the Integrated Tuberculosis Information System (ITIS). ITIS is a web-based application wherein all health facilities in the Philippines are required to record all TB patients registered in their facility for treatment. Recently, they started requiring OTP during login as a form of two-factor authentication. However, we encounter the error “failed to send OTP email” every time we tried to login. Because of this, we are unable to access our TB patients’ data and send reports since the first week of November. Many users across the Philippines are also experiencing difficulty logging into ITIS and we are still waiting for the Knowledge Management and Information Technology Service (KMITS) of the Department of Health to fix the said system. This situation can be prevented by testing system updates and running a trial upgrade before deployment.

[Jenny Bituin]

I work with volunteer workers, known as Barangay Nutrition Scholars, who assist in delivering nutrition and other related services in the community. Here are some of my strategies for open, honest, and respectful communication with them:
1. Communicate clearly and straight to the point. In this way, message can be delivered efficiently, avoid misunderstanding, and to avoid wasting time.
2. Always talk respectfully to everyone, regardless of their position.
3. Be approachable. I want my team members to always feel comfortable communicating with me, not afraid to ask for any help or questions.
4. Encourage them to give feedback/opinions/suggestions. Listen to them and make them feel that their voice matters.

[Jenny Bituin]

Hi Aung, thank you for your great presentation. I would like to suggest adding an alternative method for confirming absence of students,in case parents do not have access to Line app or are not always connected to the internet.

[Jenny Bituin]

Hello Nang Phyoe, thank you for your great presentation. You mentioned by 2026 you plan to develop data sharing policies since there are no existing policies in the target area. How about national policies for data sharing in Myanmar? Is there any national policy or law that you can adopt for your system?

[Jenny Bituin]

Hi Salin, thank you for your great presentation. In your data collection method, data will be automatically extracted from EHRs. May I know what tool/s will you use for the data extraction?

[Jenny Bituin]

I would like to share my memorable leadership experience in 2023, when I was tasked to lead one of the events during our town festival, the Ana Kalang Lanzones Festival. Our town has been annually holding this festival since 1987, but celebrations had been on hold since 2019 due to election ban and the pandemic. Many people were excited and waiting for it to be celebrated again.

During the festival, I was assigned to lead the cooking contest. I have organized cooking contests before, but my events focus on nutrition and public health, with usually a hundred people in the audience. This time, the event will focus on showcasing our town’s harvest and culture. There will be thousands of people watching, since the event will be streamed on Facebook live. In addition, I was informed by our tourism officer that a national TV show will feature our event in one of their episodes. Out of all the events in the festival they chose ours, so I feel very pressured that time.

Since that was my first time leading the event, I decided to do a democratic style of leadership. Although it was my first time, my team members have been helping organize the festival cooking contest for many years. Their inputs/suggestions have been very valuable and contributes greatly to the success of the event.

[Jenny Bituin]

After watching the public communication on COVID-19 of the two leaders, I think the (former) Prime Minister of Singapore is a better communicator than the President of the United States. Here are the reasons why PM Lee Hsien Loong is better in my opinion:

1. Be First
Prime Minister Lee Hsien Loong addressed the nation on February 8, 2020, a day after raising the Disease Outbreak Response System Condition (DORSCON) level from Yellow to Orange and people started panic-buying instant food and toilet paper in Singapore. On the other hand, President Donald Trump’s announcement was made on March 12, 2020, a day after WHO declared COVID-19 as pandemic. During that time, COVID-19 has already reached alarming levels and severity.

2. Be Right
PM Lee Hsien Loong presented accurate and verifiable information about COVID-19 in his speech. For example, he compared the current mortality rate of COVID-19 (0.2%) to SARS (10%) and seasonal influenza (0.1%). On the other hand, President Trump only mentioned in his speech that “the risk is very, very low”, without saying what “very, very low” means and what kind of risk he is pertaining to. People may have different interpretations of what this means, and may lead to misinformation.

3. Be Credible
Because PM Lee Hsien Loong presented facts about the status of COVID-19 in his country, I think he sounded more credible than President Trump. He was also honest about the current possibility of the virus infecting a large number of people, and its possible effect to the healthcare system.

4. Express Empathy
In his speech, PM Lee Hsien Loong acknowledged the fear and anxiety that people were feeling, which he said are “natural human reactions”. He smiles occasionally and was calm during the delivery of his address, which I find reassuring. On the other hand, I found President’s Trump speech as monotonous. I also think that his speech was more focused on addressing the people’s fear of financial hardship caused by COVID-19 restrictions, and the people’s fear on COVID-19 was not emphasized and acknowledged very well.

5. Promote Action
Both leaders mentioned that each citizen has a role in preventing the spread of the virus. However, PM Lee Hsien Loong instructions to practice good personal hygiene were more specific. For example, he told people to take their temperature twice daily, and when not feeling well, avoid crowded places and see a doctor immediately. On the other hand, President Donald Trump mentioned in his speech that if people are sick, they should stay at home. Consulting a doctor was not mentioned.

6. Show Respect
Both leaders were respectful in their speech. However, PM Lee Hsien Loong was the only one to acknowledge the efforts of volunteers, students, healthcare workers, and other frontline workers in keeping their country running amidst the threat of COVID-19. For me this shows that he sees these people with respect and was grateful to them.

[Jenny Bituin]

I think the Philippines still need to improve on all the five themes. However, I think the one that is most relevant today is about Transparency and Trust (Theme 2). The controversy surrounding the alleged corruption on flood control projects worth billions of pesos have been on the headlines for weeks now, with private contractors and government officials under investigation. Although the main agency involved is the Department of Public Health and Highways (DPWH) and not the Department of Health, I think this controversy affects the public’s trust on the government as a whole. We have to put extra effort in getting the public to trust the digital health care tools and systems that we are going to use, and ensure them that their health data are secured and kept private. Transparency is also very important, so people will be assured that their taxes are being used on real digital health projects, not “ghost” projects.

[Jenny Bituin]

A Public Health Emergency of International Concern (PHEIC) have been declared for the following disease outbreaks:
1. Influenza A (H1N1)
Date of Declaration: April 25, 2009
Date of Undeclaration: August 10, 2010
Rationale:
• The widespread presence of the virus
• Virus containment unfeasibility at that stage

2. Poliomyelitis
Date of Declaration: May 5, 2014
Date of Undeclaration: Still remains as a PHEIC
Rationale:
• The risk of international spread of wild virus and the increasing evidence that adult travelers were contributing to the spread
• During the low season in 2014, there were 10 countries that are considered to have active transmission of wild poliovirus, and in contrast with previous years, there has already been a spread from three of these countries internationally
• Considering the large number of polio-free but conflict torn and fragile states which have severely compromised routine immunization services and are particularly at high risk of infection

3. Ebola (West Africa)
Date of Declaration: April 25, 2009
Date of Undeclaration: August 10, 2010
Rationale:
• The Ebola outbreak in West Africa constitutes an ‘extraordinary event’ and a public health risk to other States.
• The possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns and the weak health systems in the currently affected and most at-risk countries.
• A coordinated international response is deemed essential to stop and reverse the international spread of Ebola.

4. Zika
Date of Declaration: February 1, 2016
Date of Undeclaration: November 18, 2016
Rationale:
• The rising international concerns about Zika infections in South America, especially in Brazil.
• The postulated link to rising numbers of babies born with the congenital abnormality known as microcephaly.

5. Ebola (Democratic Republic of Congo)
Date of Declaration: July 17, 2019
Date of Undeclaration: June 26, 2020
Rationale:
• The concern about potential spread from Goma (as the city is a provincial capital with an airport with international flights.)
• The concern of the reinfection and ongoing transmission in Beni, which has been previously associated with seeding of virus into multiple other locations.
• The murder of two healthcare workers demonstrates continued risk for responders owing to the security situation.
• The lack of the global community contribution to sustainable and adequate technical assistance, human or financial resources for outbreak response, despite the previous recommendations for increased resources.

6. COVID-19
Date of Declaration: January 30, 2020
Date of Undeclaration: May 5, 2023
Rationale:
• Significant increases in numbers of cases and additional countries reporting confirmed cases and that there are still many unknowns, and human-to-human transmission has occurred outside Wuhan and outside China.
• WHO believes that it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk.

7. Monkeypox
Date of Declaration: July 2022; August 14, 2024
Date of Undeclaration: May 2023; September 5, 2025
Rationale:
• The disease spread rapidly via sexual contact across a range of countries where the virus had not been seen before
• The emergence of a new clade of monkeypox, its rapid spread in eastern Democratic Republic of Congo (DRC), and the reporting of cases in several neighboring countries are very worrying.
• A coordinated international response is needed to stop outbreaks and save lives.

References:
WHO Director-General declares mpox outbreak a public health emergency of international concern. (2024, August 14). World Health Organization (WHO). Retrieved October 28, 2025, from https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern

Wilder-Smith, A., & Osman, S. (2020). Public health emergencies of international concern: a historic overview. Journal of travel medicine, 27(8), taaa227. https://doi.org/10.1093/jtm/taaa227

In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?

In my opinion, measles is one disease that may potentially lead to PHEIC in the future. In the United States for example, measles has been officially eliminated since 2020 (meaning no measles spreading within the country and new cases are only found when someone contracts measles abroad and returns to the country). However, according to the CDC, a total of 1,618 confirmed measles cases have been reported as of October 21, 2025. There have been 43 outbreaks, and 87% of the confirmed cases (1,401 of 1,618) are outbreak-associated. Two fatalities due to measles have also been reported, the first time since 2015.

According to the WHO, least 95% of people in a community should be vaccinated in order to be protected through community immunity (herd immunity). In the US, however, vaccine coverage among US kindergartners has decreased from 95.2% during the 2019-2020 school year to 92.7% during the 2023-2024 school year. Vaccine hesitancy, fueled by misinformation and fake news, especially on social media, contributes to the continued decline in vaccine coverage.

Reference:
Measles cases and outbreaks. (2025, October 22). Measles (Rubeola). https://www.cdc.gov/measles/data-research/index.html

[Jenny Bituin]

1. Which single design limitation most threatens valid estimates of sensitivity and representativeness? How would you address it within six weeks?
The stability or resilience of the AEFI surveillance system of the Kebbi State most threatens the valid estimates of sensitivity and representativeness. According to the study, 88.7% of respondents reported that lack of resources interrupted the AEFI surveillance system. This may lead to high degree of underreporting of AEFI cases, affecting the sensitivity and representativeness of the system. This can be addressed by increasing the investment to the lacking resources (financial resources, human resources, and logistics such as data tools) in order for the AEFI system to be fully operational.

2. Using the CDC surveillance attributes, propose one low-cost intervention to increase sensitivity. State the expected trade-offs, and list 2–3 indicators to detect impact from the intervention.
Since interviews and FGDs revealed that some health workers lacks positive attitude towards AEFI reporting and the community have low awareness about AEFI and its reporting, a low-cost intervention to increase the sensitivity of the system is by educating the health workers and the community about the importance of AEFI reporting and surveillance. The expected trade-offs are it will take some time to educate and convince everyone to report AEFI cases and will be added workload to the health worker tasked in educating others. Two indicators to detect the impact from the intervention are increased number of AEFI cases reported and increased participation of the community in AEFI reporting.

3.For a newly introduced vaccine, should the AEFI case definition be temporarily broadened to maximize early signal detection?
Because it is a new vaccine, yes, the AEFI case definition should be temporarily broadened to maximize early signal detection. The trigger to revert to the prior definition is when high number of false positive cases were detected.

[Jenny Bituin]

Here are some examples of how information technology was applied to assist in the outbreak investigation process:

1. Verification and Preparation
The Early Warning, Alert and Response System (EWARS) application of WHO can be used to improve disease outbreak detection in emergency settings, such as in countries in conflict or following a natural disaster. The app can be used to collect data from various sources, such as healthcare facilities and the community. Standard alert thresholds for a disease can be programmed into the app, and when the threshold is exceeded, it will send an alert to the surveillance officer.

2. Describe the outbreak
Spreadsheet applications such as Microsoft Excel can be used in making a line list – a table containing basic information on each case (Unique ID number/case identifier, age, type of case, sex, etc.). A line list allows for organization of information and provides an overall picture. This will help in the creation of descriptive statistics and epi curve.

3. Hypothesis and testing
For analytical studies to test hypotheses, OpenEpi can be used. It is a free and open source software that provides statistics for counts and measurements in descriptive and analytic studies, stratified analysis with exact confidence limits, matched pair and person-time analysis, sample size and power calculations, random numbers, sensitivity, specificity and other evaluation statistics, R x C tables, chi-square for dose-response, and links to other useful sites.

4. Response and Action
The UK Health Security Agency (UKHSA) shares public health data (mostly from England and sometimes other UK nations) via the UKHSA Data Dashboard. This dashboard covers a range of topics such as respiratory viruses, healthcare-associated infections and antimicrobial resistance that inform public health decision making in England. It was developed to cater to different users, such as members of the general public, public health professionals, policy makers, and media.

[Jenny Bituin]

The technology from the article that I liked the most is the use of mobility data to evaluate COVID-19 interventions.

How it works
Smartphones were used to collect aggregated location data via GPS, cellular network and Wi-Fi.

Why it is important
Mobility data collected from smartphones was used to:
• Monitor real-time population flows during COVID-19
• Identify potential transmission hotspots
• Give insight into the effectiveness of public-health interventions, such as travel restrictions, on actual human behavior

Examples of how mobility data was used to enhance COVID-19 surveillance and response
• In China, daily aggregated origin-destination data from Baidu are used to evaluate the effect of travel restrictions and quarantine measures on COVID-19 transmission
• In Italy, analysis of location data of smartphone users revealed that in the week after the announcement of lockdown, total trips between Italian provinces was reduced to an estimate of 50%
• Google released publicly downloadable dataset on weekly mobility reports with sub-national granularity, including breakdown by journey type and destination (such as workplaces and parks)
• Apple also released a dataset similar to Google, with daily figures for mobility and assumed method of transport

Disadvantages of using Mobility Data
• Access to data is a major challenge
• Ethical and privacy concerns
• Datasets are limited
• No long-term commitment in place for data-sharing with technology and telecom companies
• No standardization of datasets between providers
• Not all countries or regions are included in datasets

[Jenny Bituin]

1. How can surveillance help to detect and control the disease?
Surveillance can help detect and control dengue by detecting outbreaks in order to initiate timely and effective control measures, monitoring trends of incidence and number of severe cases and deaths, assessing and confirming possibility of outbreaks, and monitoring the impact of control interventions.

2. Should we conduct active or passive surveillance or both for the disease, why?
Both active and passive surveillance should be conducted for dengue because we need data from both health facilities reports and from active surveillance since many dengue cases are asymptomatic or mild and self-managed, leading to underreporting of actual number of dengue cases.

3. Which method should be best to identify cases, why?
1. Cases in medical facilities VS community
To identify cases of severe dengue, using cases in medical facilities is better because most severe cases were treated in medical facilities. For mild and asymptomatic cases, community is better because these cases are usually not underreported.
2. Sentinel VS population-based surveillance
Sentinel surveillance is best to identify cases of dengue because it provides higher quality and more detailed data.
3. Case-based VS aggregated surveillance
For faster identification of potential outbreaks, aggregated surveillance is better because it collects and analyzes data on group of cases for a specific region and time period. If the goal is to understand disease characteristics, case-based is better because it collects information about each case at the individual level.
4. Syndromic VS laboratory-confirmed surveillance
Syndromic surveillance is better for early detection of outbreaks dengue cases and related health events, allowing for rapid response.

4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
I will choose ongoing, real-time dissemination tools such as ProMED because it is free, easily available on the internet, and have a large audience.

[Jenny Bituin]

Thank you for sharing! It is nice to know about the advantages and disadvantages of using EMR on conflict-affected EHOs.

[Jenny Bituin]

In our healthcare facility, I think the things that we need the most for a smooth EMR system are hardware and human resource/manpower. We have not encountered any major problems with our EMR software which is a good thing, but we need more hardware and people that will be used/utilized exclusively for the EMR system.

[Jenny Bituin]

Thank you for sharing the procedures and technology for the disaster recovery plan of your INGO.

[Jenny Bituin]

Thank you for sharing! I agree, maintaining a paper-based system is also important in disaster recovery.

[Jenny Bituin]

Thank you, Nang Phyoe!

[Jenny Bituin]

Thank you, Hteik Htar!

[Jenny Bituin]

Thank you for sharing a comprehensive list of benefits of implementing High Availability technology.

[Jenny Bituin]

Thank you for sharing! High availability of the system is indeed very critical during emergencies.

[Jenny Bituin]

Thank you for sharing your experience. Accidentally deleting the database must be very stressful, thankfully you have backup. Role-based access control might also be useful, so staff can only perform operations on the system (such as reading, writing, and deleting data) based on their roles assigned to them.

[Jenny Bituin]

Thank you for sharing. I agree, every staff member who handle data must be trained on proper data management.

[Jenny Bituin]

Hello Hteik. The system for reporting HFMD cases (Online PIDSR-IS) can only be accessed by Surveillance Officers of hospitals, local, and national health offices. HFMD cases from schools must be reported to their local health office if the students were not hospitalized. If the students with HFMD were hospitalized, the hospital’s surveillance officer will record it on the system, no need to report to the local office.

[Jenny Bituin]

Thank you for sharing. I agree, PM Lee Hsien Loong’s speech was not only well-crafted, he was also able to deliver it well using non-verbal communication skills.

[Jenny Bituin]

Thank you for sharing. I agree, President Trump sounds paternalistic in his speech.

[Jenny Bituin]

Thank you for your insights. I agree, digital health transformation should be seen as a long-term investment in order to be successful.

[Jenny Bituin]

Thank you for sharing, Kevin. The digital health gap between urban and rural areas is also present in the Philippines and needs improvement.

[Jenny Bituin]

Thank you for sharing. I agree, cholera has a potential to be a PHEIC and is a burden to many poor countries/areas.

[Jenny Bituin]

Thank you for sharing. I agree, we should watch out for superbug infections.

[Jenny Bituin]

Thank you for sharing. The use of Internet of Things (IoT) in outbreak investigation seems interesting.

[Jenny Bituin]

I agree, timely outbreak reports with the help of IT can help prevent misinformation in social media.

[Jenny Bituin]

Thank you for sharing. I agree, regular meetings and giving acknowledgment and recognition to health facilities that report AEFI cases in a timely and consistent manner might help in encouraging other healthcare facilities to improve their AEFI case reporting.

[Jenny Bituin]

Thank you for sharing. Your solution to address the parallel reporting systems with no interoperability is very comprehensive.

[Jenny Bituin]

Thank you for sharing. I agree, government websites are important because it provides official and reliable information.

[Jenny Bituin]

Thank you for your detailed explanation on how digital contact tracing apps work. Although as you mentioned, these apps are only effective in contact tracing if a large number of people download and use them.

[Jenny Bituin]

I agree, using dashboards are an effective in relaying key updates and information to the public.

[Jenny Bituin]

Thank you for sharing. I like your idea of sending SMS in local language, since not all people are always connected to the internet.

[Author]

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