The SPMC Journal of Health Care Services is the official journal of Southern Philippines Medical Center (SPMC). It is a multi-disciplinary, peer reviewed, Open Access journal that showcases the written works of SPMC employees and other submitting authors. The journal is published twice a year. The goal of the publication is to contribute to local and international efforts to broaden the knowledge base of health care services.

SPMC Journal of Health Care Services is owned and published by Southern Philippines Medical Center (SPMC). The owner grants editorial freedom to the editors of this publication.

Information contained in the SPMC Journal of Health Care Services is intended for professionals and students of health care disciplines. Contents made available in this publication are contributions of individuals or organizations. SPMC is not responsible for the accuracy of any data used in coming up with the contents reported in the articles.

The views and opinions expressed by the authors of individual articles in the SPMC Journal of Health Care Services are their own and do not reflect the official position of SPMC. Contents in this publication shall not be used to disregard or replace the advise of a qualified medical professional. SPMC shall not be held liable for any damages resulting from the use or inability to use the contents of the SPMC Journal of Health Care Services.




Editor in Chief
Alvin Concha

Issue editor
Pamela Lacuesta
Mark Anthony Tom

Associate editors
Seurinane Sean Española
Aura Rhea Lanaban
Eugene Lee Barinaga
Alex Ivan Junefourth Bolor

Managing editor
Clarence Xlasi Ladrero

Assitant editors
Jaryll Gerard Ampog
Rodel Roño

Layout editors
Jaryll Gerard Ampog
Rodel Roño
Clarence Xlasi Ladrero

Article editors
Neila Batucan
Jesse Jay Baula
Joanne Kate Martinez
Christine May Astudillo
Janice Natasha Ng
Emily Rose Gavarra Doliente

Ludivina Porticos (Intern)
Michael Casas (Intern)
Jessy Mae Panggoy (Intern)
Jay Lord Canag (Intern)
Amariz Zarate (Intern)
Nestle Arguilla (Intern)

May Kathryn Lazaro (Intern)
Elsa May Baron (Intern)
Jasmen Pasia (Intern)
Aileen Ang (Intern)
Fatima Tesoro (Intern)
Yasmine Avila (Intern)



Fitzgerald Cabahug Arancel
Southern Philippines Medical Center

Vicente Belizario Jr
University of the Philippines College of Public Health

Noel Espallardo
New Marketlink Pharmaceutical Corporation

Noel Juban
University of the Philippines Manila

Lynette Lu Lasala
Southern Philippines Medical Center

Zorayda Leopando
University of the Philippines – Philippine General Hospital

Leopoldo Vega
Southern Philippines Medical Center

Ma. Elinore Alba-Concha
Southern Philippines Medical Center

Jose Florencio Lapeña
World Association of Medical Editors

Anthony Sales
Department of Science and Technology