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01/08/2013

Annoying coughing spells
Q
: My mom has dry cough and it is getting
worse. What medicine should she take
so it will stop?
A
: Normally, guaifenesin is recommended
for the relief of dry cough. It is an overthe-counter medicine that you could buy at
your nearest drugstore. Guaifenesin is an expectorant that would help loosen phlegm and
would help relieve dry cough. It is also advisable for your mom to drink lots of water and
get some bed rest to help alleviate the symptoms.
It is recommended to see a doctor if there is
still no significant
improvement or
the dry cough gets
worse after five
days of taking any
cough medicine.
Also, consult a
doctor if there are
any other alarming symptoms
such as fever, dizziness, sore throat,
head ache, muscle
pain, chills, exhaustion, vomiting, etc.
In Practice
Ask Your Pharmacist is an advocacy by the Young
Pharmacists Group. For questions on health and
medicines, visit askyourpharmacist.com.ph.
Softdrinks for water?
Q
: Is it okay to drink medicines with soft
drinks instead of water?
A
: Generally the absorption and effects of
orally taken medicines such as capsules
and tablets are tested during formulation using water as the liquid medium.
If we would change it to a different liquid,
such as soft drinks for example, there may be
changes in the medicines that we could not account for. These changes may or may not be clinically significant but this would already depend
on specific details regarding the medicines. For
example, if the medicine that you will take is easily affected by changes in pH and knowing that
soft drinks are acidic in nature then absorption
may be affected. But again, this would already
depend on the specific medicine.
Now, there are medicines that may be taken
with other liquids just like oral rehydration salts
(ORS), which one may dissolve in soft drinks instead of water to improve taste. But unless otherwise instructed by the physician or other health
professionals, it is recommended that medicines
taken orally be swallowed using water.
Now if there are difficulties in swallowing
medicines using water, one may opt to change
to a different dosage form such as syrups. If
there is no available liquid dosage form, one
may also opt to change the medication completely. You may consult your physician regarding the options that you could take.

01/08/2013

Chills, aches–and achoo!

When rainy season illnesses drain your health.

By Neslie Buena, M.D.

JULY 2013

There might be actual wisdom to the nursery rhyme about banishing the rain for another day—and its ingrained health advisory covers adults as well.

In a tropical country like ours, the rainy season is one of life’s certainties. Not only does this wet period give us reasons to take out raincoats and umbrellas, but it also brings a deluge of illnesses, ranging from the common, benign cough and colds, to the potentially life-threatening dengue fever and leptospirosis. Knowing about these threats to health can be beneficial in the long run. There’s a corresponding remedy for each of these ailments—even better, there are ways to prevent them from happening in the first place.

Dengue fever

This dreaded disease is caused by any one of four strains of the dengue virus, passed on to humans through the bite of an infected Aedes aegypti mosquito. Like any mosquito, it breeds in stagnant water—so any vessel that can collect rainwater can possibly house its eggs.

In the community or household level, one of the most effective ways to prevent dengue is to eradicate places where mosquitoes can lay their eggs. Simple steps such as putting away containers that can hold rainwater and cleaning vases or gutters that can collect water are good practices. Another way to go is by avoiding the insect bites with the help of mosquito repellents, window screens and mosquito nets.

There are currently no drugs to treat dengue, so prevention is really best for this illness. Typically presenting with high-grade fever, muscle pains, headache, eye pain, rashes and some mild bleeding symptoms such as bruising, dengue fever is a self-limiting condition that needs increased fluid intake, bed rest and some pain relievers.

Dengue hemorrhagic fever (DHF), on the other hand, is a severe form of dengue. This complication warrants immediate medical attention. According to the Centers for Disease Control and Prevention, warning signs that require a visit to the emergency room include intense abdominal pain, persistent vomiting, red skin patches, bleeding symptoms—vomiting blood, gum and nose bleeding, black and tarry stools—difficulty of breathing and signs of dehydration such as cold and clammy extremities. Patients with DHF are at risk of bleeding with their low platelet count, thus, a visit to the emergency room is a must.

The flu

Has someone ever told you not to get rained on to prevent a case of the sniffles? Truth be told, there’s no direct causation between rain and the common cold. The latter is caused by any of the group of influenza viruses—such as H1N1 or H3N2. It’s spread through infected respiratory droplets, whether via direct contact from a sick person who may be sneezing or talking, or through contact with an infected surface, like touching a doorknob. So the key element to getting the flu is an encounter with the virus, which doesn’t necessarily happen when you go out in the rain.

Studies show that one of the reasons the flu is more common during the rainy season is increased household crowding. Since most people stay indoors, there’s increased risk of contact with people who are infected with the virus, allowing a more rapid spread of the disease-causing agent. In addition, research shows that it isn’t specifically the rain that gives us the common cold, but the humidity in this kind of weather that makes for a good environment for viruses to thrive.

For Filipinos who dismiss the flu as trangkaso, they go on to self-medicate with paracetamol, increased fluids and bed rest. And many may be right in doing so, as this presents with the usual combination of cough and colds, sore throat, headaches, body pains and fever. But even a generally benign illness for most of the public is considered potentially life-threatening in certain patient groups. Particularly susceptible to complications are children below 5 years old, adults 65 years old and above, pregnant women, and patients with existing conditions such as asthma, heart disease and diabetes.

This is why it’s a universal recommendation that everyone 6 months or older gets vaccinated for the flu every year. This preventive action doesn’t just decrease the number of people who get sick, but also the risk of spreading the infection to other people.

Leptospirosis

Caused by exposure to body fluids of infected animals—except saliva—either through direct contact with the urine or contact with contaminated water, soil or food, leptospirosis is a form of bacterial infection. Potentially-infected animals include rodents, horses, cows, dogs, pigs and other wild animals. More common during the rainy season, with the increasing frequency of flash floods, wading in floodwaters has become one of the more significant risk factors for developing this illness.

Symptoms can develop between two days up to four weeks from exposure to the bacteria and could occur in two phases. First-phase symptoms are largely similar to that of the flu or dengue fever, presenting with fever, headache, body pains, rashes, abdominal pain, vomiting and diarrhea. Most patients, with prompt treatment, will recover from the first phase. But for those who move on to the second phase, symptoms become more severe, with yellowing of the skin as a prominent symptom. These patients are said to have Weil’s Syndrome, with complications such as meningitis, liver damage and kidney failure. It’s very important for patients to immediately consult a physician for these cases.

Unlike dengue fever or influenza where the illness is usually self-limiting with adequate hydration, nutrition and rest, leptospirosis requires antibiotic therapy given after a thorough medical evaluation. Prevention is still the best bet with leptospirosis. Refrain from swimming or wading in waters potentially contaminated with animal urine; wear protective clothing and footwear when you can’t avoid the floodwaters; and thoroughly wash after possible exposure.

How else can you protect yourself and your loved ones from the season’s illnesses? Find out more in the July issue of HealthToday.

Chills, aches–and achoo!

When rainy season illnesses drain your health.

By Neslie Buena, M.D.

JULY 2013

There might be actual wisdom to the nursery rhyme about banishing the rain for another day—and its ingrained health advisory covers adults as well.

In a tropical country like ours, the rainy season is one of life’s certainties. Not only does this wet period give us reasons to take out raincoats and umbrellas, but it also brings a deluge of illnesses, ranging from the common, benign cough and colds, to the potentially life-threatening dengue fever and leptospirosis. Knowing about these threats to health can be beneficial in the long run. There’s a corresponding remedy for each of these ailments—even better, there are ways to prevent them from happening in the first place.

Dengue fever

This dreaded disease is caused by any one of four strains of the dengue virus, passed on to humans through the bite of an infected Aedes aegypti mosquito. Like any mosquito, it breeds in stagnant water—so any vessel that can collect rainwater can possibly house its eggs.

In the community or household level, one of the most effective ways to prevent dengue is to eradicate places where mosquitoes can lay their eggs. Simple steps such as putting away containers that can hold rainwater and cleaning vases or gutters that can collect water are good practices. Another way to go is by avoiding the insect bites with the help of mosquito repellents, window screens and mosquito nets.

There are currently no drugs to treat dengue, so prevention is really best for this illness. Typically presenting with high-grade fever, muscle pains, headache, eye pain, rashes and some mild bleeding symptoms such as bruising, dengue fever is a self-limiting condition that needs increased fluid intake, bed rest and some pain relievers.

Dengue hemorrhagic fever (DHF), on the other hand, is a severe form of dengue. This complication warrants immediate medical attention. According to the Centers for Disease Control and Prevention, warning signs that require a visit to the emergency room include intense abdominal pain, persistent vomiting, red skin patches, bleeding symptoms—vomiting blood, gum and nose bleeding, black and tarry stools—difficulty of breathing and signs of dehydration such as cold and clammy extremities. Patients with DHF are at risk of bleeding with their low platelet count, thus, a visit to the emergency room is a must.

The flu

Has someone ever told you not to get rained on to prevent a case of the sniffles? Truth be told, there’s no direct causation between rain and the common cold. The latter is caused by any of the group of influenza viruses—such as H1N1 or H3N2. It’s spread through infected respiratory droplets, whether via direct contact from a sick person who may be sneezing or talking, or through contact with an infected surface, like touching a doorknob. So the key element to getting the flu is an encounter with the virus, which doesn’t necessarily happen when you go out in the rain.

Studies show that one of the reasons the flu is more common during the rainy season is increased household crowding. Since most people stay indoors, there’s increased risk of contact with people who are infected with the virus, allowing a more rapid spread of the disease-causing agent. In addition, research shows that it isn’t specifically the rain that gives us the common cold, but the humidity in this kind of weather that makes for a good environment for viruses to thrive.

For Filipinos who dismiss the flu as trangkaso, they go on to self-medicate with paracetamol, increased fluids and bed rest. And many may be right in doing so, as this presents with the usual combination of cough and colds, sore throat, headaches, body pains and fever. But even a generally benign illness for most of the public is considered potentially life-threatening in certain patient groups. Particularly susceptible to complications are children below 5 years old, adults 65 years old and above, pregnant women, and patients with existing conditions such as asthma, heart disease and diabetes.

This is why it’s a universal recommendation that everyone 6 months or older gets vaccinated for the flu every year. This preventive action doesn’t just decrease the number of people who get sick, but also the risk of spreading the infection to other people.

Leptospirosis

Caused by exposure to body fluids of infected animals—except saliva—either through direct contact with the urine or contact with contaminated water, soil or food, leptospirosis is a form of bacterial infection. Potentially-infected animals include rodents, horses, cows, dogs, pigs and other wild animals. More common during the rainy season, with the increasing frequency of flash floods, wading in floodwaters has become one of the more significant risk factors for developing this illness.

Symptoms can develop between two days up to four weeks from exposure to the bacteria and could occur in two phases. First-phase symptoms are largely similar to that of the flu or dengue fever, presenting with fever, headache, body pains, rashes, abdominal pain, vomiting and diarrhea. Most patients, with prompt treatment, will recover from the first phase. But for those who move on to the second phase, symptoms become more severe, with yellowing of the skin as a prominent symptom. These patients are said to have Weil’s Syndrome, with complications such as meningitis, liver damage and kidney failure. It’s very important for patients to immediately consult a physician for these cases.

Unlike dengue fever or influenza where the illness is usually self-limiting with adequate hydration, nutrition and rest, leptospirosis requires antibiotic therapy given after a thorough medical evaluation. Prevention is still the best bet with leptospirosis. Refrain from swimming or wading in waters potentially contaminated with animal urine; wear protective clothing and footwear when you can’t avoid the floodwaters; and thoroughly wash after possible exposure.

How else can you protect yourself and your loved ones from the season’s illnesses? Find out more in the July issue of HealthToday.

01/08/2013

Steroids improve outcome in leptospirosis

Dr. Carol Tan
The use of steroids decreased the mortality rate of patients with leptospirosis presenting with pulmonary symptoms, according to a new study conducted by Dr. Diane Bernardo et al. from the Philippine General Hospital–Section of Infectious Diseases, Department of Medicine.

The authors discussed that pulmonary involvement of patients afflicted with leptospirosis is associated with rapid clinical deterioration and high mortality rate; hence, the role of steroids in ameliorating the pulmonary insult in leptospirosis was explored in this study.

In this meta-analysis, researchers collected all randomized and non-randomized studies conducted on patients aged 15 years and above, diagnosed with leptospirosis that manifested with pulmonary symptoms and treated with steroids. The primary outcome of interest was mortality rate. Studies that had different population groups, no pulmonary involvement, different outcomes, and no control groups were excluded. After screening all studies, a total of three non-randomized prospective cohorts and one randomized controlled trial were included in the meta-analysis.

Results of the study showed that in the non-randomized trials, the administration of methylprednisolone 500-1000 mg/day or dexamethasone 200 mg/day for 3 days, followed either by oral prednisolone at 1 mg/kg/day for 7 days or oral methylprednisolone at 8 mg/day for 5 days decreased the mortality rate among leptospirosis patients with pulmonary involvement (odds ratio of 0.20, 95 percent, CI 0.09-0.45). The mortality benefit was particularly apparent when steroids were given within the first 10 to 12 hours of presentation.

In addition, one of the non-randomized studies showed that the use of steroids decreased the need for mechanical ventilation. Only 18 percent of the patients who received steroids needed ventilator support, while 62 percent of the patients who did not receive steroids necessitated mechanical ventilation.

In contrast, the randomized controlled trial showed that there was no significant change in mortality rate among patients with pulmonary manifestations of leptospirosis who were given dexamethasone 200 mg/day for 3 days followed by prednisolone 1 mg/kg/day for four days compared to those who were given standard antibiotic therapy only. Steroids were also found to have no significant effect on length of hospital stay, duration of bleeding and duration of mechanical ventilation support.

The authors concluded that data from non-randomized studies suggest that steroids have a mortality benefit in leptospirosis with pulmonary involvement. Randomized trials are still needed to provide stronger evidence for the beneficial effects of steroids in decreasing the mortality rate of leptospirosis with pulmonary manifestations, as well as to evaluate other outcomes such as safety and tolerability.

DOH launches ‘healthy lifestyle movement’Dr. Nicolo CabreraThe Department of Health formally launched nationwide ‘health...
01/08/2013

DOH launches ‘healthy lifestyle movement’

Dr. Nicolo Cabrera
The Department of Health formally launched nationwide ‘healthy lifestyle movement’ PilipinasGo4Health on June 6, 2013, to control rates of non-communicable diseases (NCDs) that the department reports to be on the rise due to improper diet, insufficient exercise and excessive drinking and smoking.

PilipinasGo4Health encourages Filipinos to commit to physical activity, proper nutrition and cessation or prevention of to***co and alcohol consumption citing “abundant scientific and social evidence” that habits like these comprise the “path to better health,” articulated health secretary Dr. Enrique Ona.

The worldwide toll of cardiovascular disease, respiratory disease, diabetes and cancer is 36 million lives annually, established the DOH press release on launch day. It further specified that 10 Filipinos die every hour due to cigarette smoking-associated diseases such as lung cancer, emphysema and bronchial disorders.

Ona also called out to drinkers and would-be drinkers, describing the effect of alcohol as “complex,” possibly leading to impairments in judgment and risky behavior that could later on result in road accidents or violence.

The Global Adult To***co Survey (GATS) in 2007 showed that 57.8 percent of youths live with smokers and 67.9 percent are exposed to smokers outside their homes. The 2009 GATS found that 17.3 million Filipinos ages 15 years and older are to***co smokers. The Food and Nutrition Research Institute informed DOH that only seven out of 100 adult Filipinos get “vigorous exercise” at least three or four times a week.

Ona explained, “GATS data show that a number of smokers accessed to***co when they were very [sic] young to make informed choices. By the time they are old enough, they find it very hard to quit and some may already suffer consequences.” He cited “misinformation or lack of information, indifference and careless practices and habits” among Filipinos when it comes to their health.

“We believe that every Filipino has the right to a healthy family, community and country. As lead advocate for the nationwide healthy lifestyle movement, we work hand-in-hand with different sectors to provide options for healthy living and make it accessible to as many people as possible,” pledged the movement’s web page at www.go4health.ph.

The web page provides lifestyle suggestions for various age groups such as kids, youth and adults as well as roles or settings such as parenting, education, health care and the workplace. Web page visitors may also download documents containing information on to***co, alcohol, diet and exercise.

Pilipinas Go4Health is the nationwide healthy lifestyle movement spearheaded by the Department of Health (DOH) and its partners. It aims to inform and encourage Filipinos from all walks of life to practice a healthy lifestyle by making a personal commitment to physical activity, proper nutrition, an...

15/01/2013

Important benefits for women who quit smoking early

Elvira Manzano
Smoking nearly triples the risk of premature death in women and quitting the habit well before middle-age reduces this risk, according to the Million Women Study.

In this prospective study, the largest in the history of studying the dangers of smoking, 12-year mortality rates among women who smoked throughout their adult years were almost three times higher than those of women who never smoked (rate ratio 2.97, 95% CI, 2.88-3.07). Even light smokers (those who smoked fewer than 10 ci******es per day) had twice the mortality rate of never-smokers (rate ratio 1.98, 95% CI, 1.91-2.04). [Lancet 2012.DOI.org/10.1016/S0140-6736(12)61720-6]

What was encouraging, however, was the positive effect that quitting seemed to have on women’s life span. Stopping the habit before age 40 avoided more than 90 percent of excess mortality from ci******es. Quitting before age 30 avoided 97 percent of this added risk.

“Smokers who stop before reaching middle-age will on average gain about an extra 10 years of life,” said study author Professor Sir Richard Peto, of the University of Oxford, Oxford, UK.

“This does not, however, mean that it is safe to smoke until age 40 and then stop,” the authors warned. Decades later throughout life, women who smoked and stopped still have “1 to 2 times the mortality rate of never-smokers.” For those who continued to smoke past age 40, the risk is 10 times greater.

The study enrolled 1.3 million women (age 50-65) in the UK followed for 12 years. At baseline, 20 percent were smokers, 28 percent were former smokers and 52 percent never smoked.

By 2011, 66,000 had died. Compared with non-smokers, smokers lost at least 10 years of life and died from smoking-related diseases such as lung cancer, heart disease and stroke. While the absolute hazards of prolonged smoking are substantial, so are the benefits of quitting.

“Even cessation at about 50 years of age avoids at least two-thirds of the continuing smoker’s excess mortality in later middle age,” the authors said. The benefits are, however, greater in those who quit earlier.

In a linked comment, Dr. Rachel Huxley, from the University of Minnesota, Minneapolis, US, and Dr. Mark Woodward, from the University of Sydney, Australia, welcomed the findings. “Aside from its impressive sample size, the Million Women Study is distinct from previous large cohorts—and superior for assessment among women of the full hazards of prolonged smoking and the full benefits of long-term cessation because the participants were among the first generation of women in the UK in which smoking was widespread in early adult life, and although many continued smoking, many stopped before age 30 or 40 years.”

The results emphasize the need for effective sex-specific and culturally-specific to***co control policies that encourage adult smokers to quit and discourage children and young adults from starting smoking, they concluded.

15/01/2013

DOH Program improves care of breast cancer patients

Dr. James Salisi
The Department of Health-Philippine Cancer Society, Inc. (DOH-PCSI) Breast Cancer Medicines Access Program improved the quality of care among patients with breast cancer in Philppine General Hospital (PGH), according to a study by Dr. Ma. Pamela Patdu, Dr. Willie Liangco, Dr. Corazon Ngelangel and Dr. Virginia Ala, presented during the recent Philippine Society of Medical Oncologists annual convention held in EDSA Shangri-La Hotel.

The investigators reviewed the charts of all nonmetastatic breast cancer patients whose first consult in PGH was from 2011 to June 2012. They compared patients who were enrolled and not enrolled in the program using 18 quality care indicators from diagnosis, treatment, and follow-up such as completeness of prognostic or predictive characterization, appropriate chemotherapy, post-operative radiotherapy, among others.

There was a significant decrease in the rate of patients lost to follow up from 62 percent in 2011 to 18 percent in 20012. Among the 18 quality indicators used in the study, 13 showed significant improvement, the greatest of which was seen in the time to the initiation of treatment (58.7 percent) and neoadjuvant chemotherapy for locally advanced breast cancer and inflammatory cancer (58.3 percent).

“The research highlights how access to medicines in the context of a patient navigation program increased coverage of cancer care for indigent Filipinos,” said Patdu via email.

The DOH-PCSI has started the program in May 2011 to promote early screening and cancer awareness, as well as improve survival rates of breast cancer among Filipinos. The program provides free chemotherapy for patients with early breast cancer Stages I to IIIA at its inception and expanding to include IIIB and IIIC patients in June 2012. Testing for ER/PR and Her2-Neu immunochemistry is free for these patients as well as tamoxifen for those who are recommended to have hormonal treatment.

“The most significant findings of the study are the large percentage of patients with nonmetastatic breast cancer patients that we lose to follow-up in the charity service of the Philippine General Hospital (PGH) and how the Breast Cancer Medicines Access Program has immensely trimmed down the patients lost to follow-up. Mostly these losses before the implementation of the program are accrued before they finish 4 cycles of chemotherapy or even before they ever start chemotherapy,” Patdu added.

Treatment access for Filipinos with breast cancer is a problem especially in patients with limited resources. The program gives them an opportunity to access appropriate treatment, which is available initially in the PGH, Rizal Medical Center, East Avenue Medical Center and Jose Reyes Memorial Medical Center and is set to expand to regional hospitals nationwide.

“I have always believed in the wisdom behind the DOH-PCSI program and I wanted to test the hypothesis that it indeed makes a lot of difference to our cancer patients,” said Patdu.

15/01/2013

Filipino Sign Language module for health workers launched

Dr. James Salisi
Public health workers in the National Capital Region will soon be able to communicate with their deaf patients with the launch of the first Filipino Sign Language (FSL) module. The Center for Health Development National Capital Region director Dr. Eduardo Janairo said that the module will be used by health workers in understanding and communicating with patients with hearing disabilities.

“Health workers will be educated and trained on the proper gestures and body movements illustrated in the module for them to be able to communicate properly with people who use sign language,” Janairo said.

The module introduces the health worker to the basic signs of communicating with deaf patients, like the alphabet, numbers, greetings, time, days, months and common questions asked in the emergency room, and using simple gestures to talk with hearing-impaired patients.

“We need to introduce FSL in our health care system and strengthen its use for the benefit of people who have difficulty hearing or speaking. Health workers will also benefit from using this module as it will enrich their knowledge, skills and awareness on the needs of people using FSL as their communication,” Janairo explained.

The FSL module is designed to address the need to effectively communicate with deaf patients. Proficiency in FSL enables the health workers to give clear instructions about the services that they render to their hearing- and speech-impaired patients. It also allows the patients to disclose critical information about their condition to the health worker, thereby minimizing the risk of errors and inaccuracy in communication.

“With this manual as a guide, we can address the health inequities in our health care system and ensure PWDs the administration of accurate health care treatment. It is with optimism that this FSL module will pave the way for the adaption of FSL as a second medium of communication for the use of our Filipino Deaf community,” Janairo said.

The FSL module was developed with the cooperation and support of the Philippine Deaf Resource Center, University of the Philippines-Philippine General Hospital, CAP College for the Deaf, De La Salle University-College of Saint Benilde and the Department of Education-National Capital Region.

The number of Filipinos with hearing disabilities is pegged at 120,000 in the 2,000 Census on Person with Disability. In 2004, 571 were registered at the National Capital Region Registry on Persons with Disability as with speech and hearing impairment.

28/11/2012

Use tap water for drinking, says DOH

Dr. Yves Saint James Aquino
The Department of Health-Center for Health Development-National Capital Region director Eduardo Janairo encouraged Metro Manila residents to use potable tap water for drinking instead of bottled water.

“Water coming from our two concessionaires namely the Maynilad Water Services, Inc. (MWSI) in West Manila and the Manila Water Company, Inc. (MWCI) in East Manila are providing quality and sanitary safe potable water. The water from these two facilities is undergoing a monthly examination conducted by the Metro Manila Drinking Water Quality Monitoring Committee (MMDWQMC) to ensure its safety for the welfare of metro residents,” said Janairo.

The health department is aiming to restore the people’s trust in the quality of tap water in Metro Manila, essentially decreasing its residents’ dependence on bottled water.

A report released last September 7, 2012 by the Metro Manila Drinking Water Quality Monitoring Committee (MMDWQMC) said that the water supplied by Manila Water and Maynilad at the time of sampling done last August 2012 was in compliance with the 2007 Philippine National Standards for Drinking Water based on the microbiological and physio-chemical examinations.

Drinking water in the MWSS distribution system was Safe and of Sanitary Quality with adequate residual chlorine of 0.3 parts per million, pronounced the committee.

According to DOH, out of the 1,284 water refilling stations monitored in Metro Manila for the month of August 2012, 1,242 passed the potability standards set by PNSDW (42 or 3.3% failed). Janairo advised that consumers should look for the monthly microbiological quality results posted in refilling stations, ensuring that the water is safe and potable.

“The safety of our water is everyone’s responsibility. As the concessionaire’s accountability ends with the meter, so does our responsibility begins. We should periodically check for leaks and illegal connections in our pipelines and take time to report them. Water conservation is the first step in keeping our health safe,” concluded Janairo.

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