Nutritional status of children under 5 years of age in three hurricane-affected areas of Honduras

Hurricanes and other natural disasters can produce crop destruction, population displacement, infrastructure damage, and long-term public health consequences that include increased malnitrition among the affected populations. This paper presents the results of anthropometric measurements taken of 295 children under 5 years of age from three regions of Honduras that were affected by Hurricane Mitch, a major storm that struck Central America in the fall of 1998. The children in our study were sampled in three shelters in the capital city of Tegucigalpa; in the resettlement zone of Nueva Choluteca, Choluteca; and in the small urban area of Catacamas, Olancho. Our data indicated that, in comparison to the period before the hurricane, there was an elevated prevalence of wasting in all three of the study areas, and that there were also high levels of underweight in the Tegucigalpa and Nueva Choluteca study areas. There were statistically significant differences between the mean values of malnutrition indicators for Catacamas and those for the Tegucigalpa and Nueva Choluteca settlements. These differences suggest that resettled families were confronting a nutritional crisis in July and August of 1999, some 9 months after the hurricane struck (AU)

Transmission thresholds for dengue in terms of Aedes aegypti pupae per person with discussion of their utility in source reduction efforts

The expense and ineffectiveness of drift-based insecticide aerosols to control dengue epidemics has led to suppression strategies based on eliminating larval breeding sites. The present work attempts to estimate transmission thresholds for dengue based on an easily-derived statistic, the standing crop of Aedes aegypti pupae per person in the environment. We have developed these thresholds for use in the assessment of risk of transmission and to provide targets for the actual degree of suppression required to prevent or eliminate transmission in source reduction programs. The notion of thresholds is based on 2 concepts: the mass action principal- the course of an epidemic is dependent on the rate of contact between susceptible hosts and infectious vectors, and threshold theory - the introduction of a few infectious individuals into a community of susceptible individuals will not give rise to an outbreak unless the density of the vectors exceeds a certain critical level. We use validated transmission models to estimate thresholds as a function of levels of pre-existing antibody levels in human populations, ambient air temperatures, and the size and frequency of viral introduction. Threshold levels were estimated to range between about 0.5 and 1.5 Ae. aegypti pupae per person for ambient air temperatures of 28 degrees C and initial seroprevalences ranging between 0 percent to 67 percent. Suprisingly, the size of the viral introduction used in these studies, ranging between 1 and 12 infectious individuals per year was not seen to significantly influence the magnitude of the threshold. From a control perspective, these results are not particularly encouraging. The ratio of Ae. aegypti pupae to human density has been observed in limited field studies to range between 0.3 and >60 in 25 sites in dengue-epidemic of dengue-susceptible areas in the Caribbean, Central America, and South East Asia. If, for purposes of illustration, we assume an initial seroprevalence of 33 percent, the degree of suppression required to essentially eliminate the possibility of summertime transmission in Puerto Rico, Honduras, and Bangkok, Thailand was estimated to range between 10 percent and 83 percent; however in Mexico and Trinidad, reductions of >90 percent would be required.(AU)

Transmission thresholds for dengue in terms of Aedes aegypti pupae per person with discussion of their utility in source reduction efforts

The expense and ineffectiveness of drift-based insecticide aerosols to control dengue epidemics has led to suppression strategies based on eliminating larval breeding sites. With the notable but short-lived exceptions of Cuba and Singapore, these source reduction efforts have met with little documented success; failure has chiefly been attributed to inadequate participation of the communities involved. The present work attempts to estimate transmission thresholds for dengue based on an easily-derived statistic, the standing crop of Aedes aegypti pupae per person in the environment. We have developed these thresholds for use in the assessment of risk of transmission and to provide targets for the actual degree of suppression required to prevent or eliminate transmission in source reduction programs. The notion of thresholds is based on 2 concepts: the mass action principal-the course of an epidemic is dependent on the rate of contact between susceptible hosts and infectious vectors, and threshold theory-the introduction of a few infectious individuals into a community of susceptible individuals will not give rise to an outbreak unless the density of vectors exceeds a certain critical level. We use validated transmission models to estimate thresholds as a function of levels of pre-existing antibody levels in human populations, ambient air temperatures, and size and frequency of viral introduction. Threshold levels were estimated to range between about 0.5 and 1.5 Ae. aegypti pupae per person for ambient air temperatures of 28 degrees C and initial seroprevalences ranging between 0% to 67%. Surprisingly, the size of the viral introduction used in these studies, ranging between 1 and 12 infectious individuals per year, was not seen to significantly influence the magnitude of the threshold. From a control perspective, these results are not particularly encouraging. The ratio of Ae. aegypti pupae to human density has been observed in limited field studies to range between 0.3 and >60 in 25 sites in dengue-endemic or dengue-susceptible areas in the Caribbean, Central America, and Southeast Asia. If, for purposes of illustration, we assume an initial seroprevalence of 33%, the degree of suppression required to essentially eliminate the possibility of summertime transmission in Puerto Rico, Honduras, and Bangkok, Thailand was estimated to range between 10% and 83%; however in Mexico and Trinidad, reductions of >90% would be required. A clearer picture of the actual magnitude of the reductions required to eliminate the threat of transmission is provided by the ratio of the observed standing crop of Ae. aegypti pupae per person and the threshold. For example, in a site in Mayaguez, Puerto Rico, the ratio of observed and threshold was 1.7, meaning roughly that about 7 of every 17 breeding containers would have to be eliminated. For Reynosa, Mexico, with a ratio of approximately 10, 9 of every 10 containers would have to be eliminated. For sites in Trinidad with ratios averaging approximately 25, the elimination of 24 of every 25 would be required. With the exceptions of Cuba and Singapore, no published reports of sustained source reduction efforts have achieved anything near these levels of reductions in breeding containers. Practical advice on the use of thresholds is provided for operational control projects.

Insecticidal paint and fumigant canisters for Chagas' disease control: community acceptance in Honduras

This study assessed public acceptance for two new vectorial control techniques for Chagas' disease: insecticidal paint and fumigant canisters. The study compared the two with traditional fenitrothion insecticide spraying. An experimental field study was performed in an endemic area of central Honduras from August to November 1992, a year after the initial application of the treatments. The objectives of the study were to determine the acceptability of the tools on the part of the population whose homes were treated, and on the part of the personnel applying the treatments. The sample size was drawn up according to a uniform protocol applied in six Latin American countries. For this study a total of 651 persons were surveyed in 15 rural communities. Along with the surveys, focus groups were used to collect information to learn the reasons for accepting or rejecting particular treatments. The survey was done with heads of households. Focus groups were done with heads of households and also with the field operators who applied the treatments. The research showed that insecticidal paint had a low level of community acceptance (28.8 percent). Field operators strongly disliked the paint because of problems with its transport, application, unpleasant smell, and very low effectiveness against triatomines and pest insects. The results showed that in order to increase the public acceptance for insecticidal paint, it would be necessary to make the paint easier to transport and apply and to increase its effectiveness. Because of their very low effectiveness, fumigant canisters did not represent an acceptable alternative for triatomine vector control. A public educational effort should be a component of any new control method developed (AU)

Undernutrition among Honduran children 12-71 months old

In 1996, the Ministry of Health of Honduras conducted a national micronutrient survey that included anthropometric measurements to determine the nutrition status of children 12-71 months old. Among the 1 744 children who participated, 38 percent of them were stunted, including 14 percent who were severely stunted; 24 percent were underweight, of which 4 percent were severely underweight; and 1 percent were wasted, of which 0.1 percent were severely wasted. The country can be divided into three groupings based on the level of stunting and underweight: 1) lowest prevalence: Tegucigalpa, San Pedro Sula, and medium cities; 2) medium prevalence: other urban areas, the rural north, and the rural south; and 3) highest prevalence: the rural west. Using logistic regression analysis, the important determinants of stunting were found to be: mother/caretaker's and father's schooling, source of water, the dominion (geographic location and strata) in which the child lived, and the "possession score" for ownership of such items as a radio, television, refrigerator, stereo system, and electric iron. The predictors for underweight were micronutrient status, diarrhea, maternal/caretaker's schooling, type of toilet, and possession score. Historical data include that the national prevalence of chronic undernutrition has changed little over the last 10 years despite the number of national food and nutrition plans implemented and the significant improvements in health services. It is possible that these positive interventions have been offset by the slow progress in economic development. Future nutrition interventions should take into account household-level perceived needs and priorities in order to set realistic nutrition targets (AU) (AU)

Vitamin A deficiency and anemia among children 12-71 months old in Honduras

Vitamin A deficiency (VAD) and iron deficiency anemia (IDA) have been recognised as public health problems in Honduras for over 30 years. This paper, based on the 1996 National Micronutrient Survey on 1 678 children 12-71 months of age, presents the results for vitamin A status and anemia prevalence, as well as the level of vitamin A in sugar at the household level. The results showed that 14 percent of the children were subclinically vitamin A deficient (plasma retinol < 20 ug/dL) and 32 percent were at risk of VAD (plasma retinol 20-30 ug/dL). These data indicate that VAD is a moderate public health problem in Honduras. Logistic regression analysis showed that children 12-23 months old living in areas other than the rural south of the country were at greatest risk of subclinical VAD. Infection, indicated by an elevated alpha-1-acid-glycoprotein level, increased the risk of subclinical VAD more than three-fold. Children from households that obtained water from a river, stream, or lake were at twice the risk of subclinical VAD compared to other children. That same double risk was found for children from a household with an outside toilet. VAD can be controlled by fortifying sugar. Retinol levels in sugar at the household level were about 50 percent of those mandated by Honduran law. There appears to be a significant leakage of unfortified sugar into the market. This is particularly true in the rural north, where 33 percent of samples contained no retinol. Overall 30 percent of children were anemic (Hb < 11g/dL). Logistic regression analysis showed that children whose fathers lived with them but who had not attended at least grade 4 of primary school were at 33 percent greater risk of being anemic. Infection and being underweight increased the risk of being anemic by 51 percent and 21 percent respectively. Many of the anemic children had not been given iron supplements, suggesting health care providers may not be aware that anemia is widespread among young children and/or know how to diagnose it (AU)

Nutrition of Honduran mothers/caretakers

In 1966, the Honduran Ministry of Health conducted a national micronutrient survey of children 12-71 months old, which also included an assessment of the nutrition status of their mothers/caretakers. THe 1 126 mothers/caretakers who participated in the survey tended to be short and plump. About 15 percent of them were at obstetric risk by virtue of their short stature and/or low body weight. About 9 percent had chronic energy deficiency (CED), but 27 percent were at least 20 percent overweight. CED was associated with socioeconomic indicators of poverty. Risk factors for being at higher than grade 4, 5, or 6 of primary school, coming from a wealthier household, and living in San Pedro Sula or medium-sized cities. Among the women surveyed, 26 percent of nonpregnant and 32 percent of pregnant mothers/caretakers were anemic. The likely principal cause of anemia was the low intake of bioavailable iron from food and, in some cases, excessive iron loss associated with intestinal parasities, especially hookworm. Only 50 percent of the mothers/caretakers participating in this study had received iron during their last pregnancy, and just 13 percent had received postpartum vitamin A. The results highlighted the need to develop and implement an effective program to control iron deficiency anemia in women of reproductive age, including by fortifying such widely consumed foods as processed wheat and maize flour and by routinely administering iron supplements to high-risk groups. Postpartum vitamin A supplementation should be encouraged to protect both the mother and newborn infant against vitamin A deficiency (AU)

Intestinal parasites in human immunodeficiency virus infected patients

Treatment of concurrent opportunistic and non-opportunistic infections is a priority in improving quality of life in HIV infected patients in developing countries. The objective of the study was to determine the prevalence of opportunistic intestinal parasites in persons with and without HIV infection in Honduras. It was based on study of 52 HIV-positive and 48 HIV-negative persons at the Social Security Hospital in San Pedro Sula. Data sheets recording age, sex, stool parasitology, HIV serology and clinical state of HIV infection were completed for each study participant. Cryptosporidium parvum and Strongyloides stercoralis, which are intracellular or live in the mucosa, were found exclusively in persons infected with HIV. In contrast, the prevalence of the extracellular parasites Giardia lamblia, Ascaris lumbricoides and Trichuris trichiura was significantly higher in persons who were HIV-negative. It appears that infection with HIV may selectively deter the establishment of some intestinal parasites. This may be due to HIV induced enteropathy which does not favor the establishment of extracellular parasites. However, intracellular and mucosal dwelling organisms may benefit from pathological changes and reduced local immune responses which are induced by the virus which, in turn, lead to higher prevalence among HIV-infected individuals. We further postulate that the switch from a Th-1 to a predominantly Th-2 response as HIV infection progresses to AIDS may lead to an environment which is unsuitable for parasite survival (AU)

Occurence of Cryptosporidium oocysts and Giardia cysts in water supplies of San Pedro Sula, Honduras

During June 1996, water supplies of the city of San Pedro Sula, Honduras, were sampled to obtain an assessment of Cryptosporidium oocyst and Guardia cyst concentrations. Each sample was concentrated and stained with an indirect immunofluorescent antibody, and parasites were counted through microscopic analysis. In three surface water supplies, Crytosporidium oocyst concentrations ranged from 58 to 260 oocysts per 100 L, and Giardia cysts were present in concentrations ranging 380 to 2100 cysts per 100 L. Unlike the surface water samples, groundwater acquifer protects the water supply more effectively from larger Giardia cysts. Cryptosporidium oocyst concentrations are within the typical range for surface water supplies in North America whereas Giardia cyst concentrations are elevated. Efforts should be made to protect raw water from sources of contamination (AU)

Increased prevalence of Plasmodium falciparum malaria in Honduras, Central America

We report on our investigation of a malaria outbreak in Honduras, Central America, in January 1997. We tested 202 patients with fever and chills using thin and thick blood film microscopy. Sixteen patients lived in the city and the rest lived in the rural areas. A total of 95 samples (47 percent) were positive for malaria parasites. Seventy-nine percent (63/80) of the rural patients were infected with Plasmodium vivax and 21 percent (17/80) were infected with P. falciparum. In the urban area, all 15 infected patients had P. vivax malaria and none showed evidence of P. falciparum. Since previous reports inidicate that falciparum malaria accounts for only 2 percent of the overall malaria infections in Honduras, the results reported here suggest that there is a dramatic increase in flaciparum malaria in the area of Honduras investigated in this study (AU)

Prevalence of paediatric skin diseases in rural Honduras

Although review of medical literature suggests that skin disease is a common cause of morbidity in developing countries, there have been few prospective primary care studies to document the prevalence of dermatologic conditions. The goal of this study was to determine the prevalence of paediatric skin diseases in rural Honduras. The study was conducted in October 1992, during a medical mission sponsored by the University of Cincinnati, Children's Hospital Medical Center (Cincinnati) and the Honduran Ministry of Health (AU)

Promotion of breast-feeding in the media

A summary is provided of a recent report reviewing worldwide program experience with mass media promotion of breast feeding, which is available free of charge to developing countries from the Academy for Educational Development in Washington, D.C. The current situation has seen a decline in promotion of breast feeding and a decline in breast feeding. The objective of the report is to provide information on how to effectively address in the media negative public attitudes toward breast feeding, lack of knowledge on breast feeding, and social norms related to breast feeding. Successful campaigns are cited for Brazil, the Dominican Republic, Egypt, Honduras, and Jamaica. In Brazil, for instance, there was a 50-60 percent increase in breast feeding following a high profile campaign. In Egypt, continuance of breast feeding during bouts of diarrhea was found to increase over a 2-year period by 68-86 percent. Jamaica's breast feeding increased from 10 to 13 months over 2 years after mass media promotion. Success has been attributed to having 1) a plan for long term sustainability, 2) sound administrative and financial management, 3) adequate staff and funding specifically devoted to breast feeding promotion, 4) research to identify impediments to breast feeding and to develop and test a communication strategy, and 5) a well-designed mass media appropriate to its target audience. Design should be accomplished locally and pretested with the targeted audience

Studies of Patois group arboviruses in Mexico, Guatemala, Honduras, and British Honduras

Patois, Zegla, and Shark River-like arboviruses in the Patois group were isolaed in Mexico, Guatemala, Honduras, and British Honduras during 1963 to 1968. Twenty-three Patois viruses came from mosquitoes, sentinel hamsters, and suckling mice, 21 Zegla viruses from sentinel hamsters and mice and from a wild cotton rat, and two Shark River-like viruses from sentinel hamsters. Hemagglutination-inhibition(HI) and neutralizing antibody tests with Patois virus were positive with human sera from each country, and HI antibody tests were positive with sera from pigs in Mexico, Guatemala, and British Honduras and from small wild mammals, wild birds, and cattle in Mexico.(AU)

Dermal leishmaniasis in British Honduras - the parasite

This disease is largely restricted to forest workers and is manifested by localised sores which often causes considerable disfigurement. The causative organism, Leishmania braziliensis mexiccura, is readily demonstrable in stained smears of early lesions, but this becomes increasingly difficult as the infection becomes chronic. Culture in NNN medium supplements microscopic examination. The ear is most commonly involved and lesions there tend to become chronic. Active infection may protect against re-infection but the possibility of long-term immunity is not yet classified. Infected Phlebotomine sand flies and infected rodents were found to co-exist in a selected area of forest where numerous human cases of proven leishmaniasis were found. It is suggested that the disease in British Honduras is a zoonosis. The parasites is maintained in certain rodent populations which act as intermediaries for the Phlebotomes which prey on these rodents and on man. The infected rodents found to date include the Tree-rat (Ototylomus Sp.) White-footed rat (Peromyscus Sp.) and the Spiny-ocket mouse (Heteromys Sp.) (AU)