Height, zinc and soil-transmitted helminth infections in schoolchildren: a study in Cuba and Cambodia.

Soil-transmitted helminth (STH) infections and zinc deficiency are often found in low- and middle-income countries and are both known to affect child growth. However, studies combining data on zinc and STH are lacking. In two studies in schoolchildren in Cuba and Cambodia, we collected data on height, STH infection and zinc concentration in either plasma (Cambodia) or hair (Cuba). We analyzed whether STH and/or zinc were associated with height for age z-scores and whether STH and zinc were associated. In Cuba, STH prevalence was 8.4%; these were mainly Ascaris lumbricoides and Trichuris trichiura infections. In Cambodia, STH prevalence was 16.8%, mostly caused by hookworm. In Cuban children, STH infection had a strong association with height for age (aB-0.438, p = 0.001), while hair zinc was significantly associated with height for age only in STH uninfected children. In Cambodian children, plasma zinc was associated with height for age (aB-0.033, p = 0.029), but STH infection was not. Only in Cambodia, STH infection showed an association with zinc concentration (aB-0.233, p = 0.051). Factors influencing child growth differ between populations and may depend on prevalences of STH species and zinc deficiency. Further research is needed to elucidate these relationships and their underlying mechanisms.

Childhood atopic diseases and early life circumstances: an ecological study in Cuba.

BACKGROUND: Children are especially vulnerable during periods of resource shortage such as economic embargoes. They are likely to suffer most from poor nutrition, infectious diseases, and other ensuing short-term threats. Moreover, early life circumstances can have important consequences for long-term health. We examined the relationship between early childhood exposure to the Cuban economic situation in the nineties and the occurrence of atopic diseases later in childhood. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study of 1321 primary schoolchildren aged 4-14 was conducted in two Cuban municipalities. Asthma, allergic rhinoconjunctivitis and atopic dermatitis were diagnosed using the International Study of Asthma and Allergies in Childhood questionnaire. Children were divided into three groups of exposure to the economic situation in the nineties according to birth date: (1) unexposed; (2) exposed during infancy; (3) exposed during infancy and early childhood. Associations were assessed using multiple logistic regression models. Exposure during infancy had a significant inverse association with the occurrence of asthma (OR 0.56, 95%CI 0.33-0.94) and allergic rhinoconjunctivitis (OR 0.46, 95%CI 0.25-0.85). The associations were stronger after longer exposure, i.e. during infancy and early childhood, for asthma (OR 0.40, 95% CI 0.17-0.95) and allergic rhinoconjunctivitis (OR 0.29, 95%CI 0.11-0.77). No significant associations were found for atopic dermatitis. CONCLUSIONS/SIGNIFICANCE: Exposure to the economic situation in the nineties during infancy and early childhood was inversely associated with asthma and allergic rhinoconjunctivitis occurrence later in childhood. We hypothesize that factors related to this period, such as infectious diseases and undernutrition, may have an attenuating effect on atopic disease development. The exact cause and underlying mechanisms need to be further elucidated.

Costos directos del ingreso en el hogar en Cuba / Direct costs of home-based care in Cuba

Introducción El ingreso en el hogar es una alternativa asistencial de la atención primaria cuyos objetivos principales son mejorar la atención del paciente y lograr una utilización más eficiente de los recursos. En Cuba han sido pocos los estudios sobre esta modalidad que aborden diferentes entornos geográficos. Objetivos Estimar y caracterizar el costo directo del ingreso en el hogar para diferentes áreas geográficas en Cuba. Métodos Se desarrolló un estudio parcial, descriptivo, de costos entre 2001 y 2002 en cuatro áreas geográficas del país. Se consideraron aquellos costos asumidos por el Sistema Nacional de Salud y parte de los asumidos por las familias. Las partidas empleadas fueron: recursos humanos, material gastable, medios diagnósticos y tratamiento farmacológico. Se estimó el costo por paciente y por causa de ingreso. EL total de pacientes ingresados fue de 837. Resultados El costo por paciente osciló entre los casi 10,00 y 20,00 pesos. El área rural mostró el mayor costo en este aspecto. Las partidas de mayor aporte fueron el salario y el tratamiento farmacológico. La diferencia entre el costo por paciente del área rural y el resto estuvo determinada por el tratamiento. El ingreso en el hogar representó un gasto de familia promedio, por compra de medicamentos, que osciló entre los 7,00 y los 18,00 pesos por paciente. Conclusiones El ingreso en el hogar generó costos medios similares en las áreas urbanas y rurales. Las enfermedades respiratorias fueron las de mayores costos asociados y el aporte de las diferentes partidas fue similar independientemente del área geográfica y del motivo que causó el ingreso. A medida que la gravedad del paciente aumentó, se observó diferencias en los costos entre las áreas, y los incrementos se produjeron a expensas fundamentalmente de la partida "tratamiento".

Introduction Home-based care is a primary health care option mainly aimed at improving the patient care and at using available economic resources more effectively. There have been few studies on this care modality that included different geographical settings in Cuba. Objectives To estimate and to characterize the direct cost of home care in the various geographical areas of the island. Methods A partial cost study was conducted from 2001 to 2002 in four Cuban geographical areas. Those costs afforded by the national healthcare system and part of those paid by the families were analyzed. The considered items were human resources, waste materials, diagnostic means and drug therapy. Cost per patient and per cause of home care was estimated. The total number of patients cared at home was 837. Results The cost per patient ranged from nearly 10,00 to 20,00 pesos. The rural setting showed the highest cost in this regard. Items that contributed the most were salary and drug therapy. The difference between cost per patient in a rural area and in the other areas was determined by the kind of treatment. Home-based care accounted for an average family cost, in terms of purchase of drugs, from 7,00 to 18,00 pesos per patient. Conclusions Home care generated comparable average costs in both rural and urban areas. Respiratory diseases were the most costly and the contribution by the various items was similar regardless of the geographical area and of the cause of home care. As the condition of the patients became more critical, differences in terms of costs between urban and rural areas were observed, and cost increases mainly occurred at the expense of the item "treatment."

Association of atopy, asthma, allergic rhinoconjunctivitis, atopic dermatitis and intestinal helminth infections in Cuban children.

OBJECTIVE: To examine the relationship of past and current intestinal helminth infections with asthma, allergic rhinoconjunctivitis, atopic dermatitis and atopy. METHODS: Cross-sectional study of 1320 children aged 4-14 years from two Cuban municipalities. Helminth infections were determined by stool examination and parental questionnaire. Asthma, rhinoconjunctivitis and atopic dermatitis were diagnosed by International Study of Asthma and Allergies in Childhood questionnaire, asthma additionally by spirometry, atopy by skin prick testing. RESULTS: Questionnaire-based frequencies were 21% for asthma, 14% for allergic rhinoconjunctivitis and 8% for atopic dermatitis. According to spirometry, 4% had asthma; 20% had a positive skin prick test. A history of infection for Enterobius vermicularis was associated with increased risk of atopic dermatitis (OR 1.88, P = 0.001) and allergic rhinoconjunctivitis (OR 1.34, P = 0.046), and hookworm with increased risk of allergic rhinoconjunctivitis (OR 2.77, P = 0.021). A positive stool examination for Ascaris lumbricoides infection was negatively associated with atopic dermatitis (OR 0.22, P = 0.007). Asthma and atopy were unrelated to helminth infections. CONCLUSION: Current A. lumbricoides infection protects against atopic dermatitis in Cuban children, while past infection with E. vermicularis and hookworm are risk factors for allergic rhinoconjunctivitis and/or atopic dermatitis. Apparently, interactions differ depending on the type of helminth and atopic disease and on the time of helminth infestation.

El ingreso en el hogar y su costo directo en Cuba / The direct costs of home care in Cuba

OBJETIVOS: Analizar el tiempo de estadía en ingreso en el hogar (IH) y su costo diario y por paciente en Cuba, según el diagnóstico al ingreso y la zona donde se brinda el servicio. MÉTODOS: Se analizó la información de los 837 pacientes en IH entre julio de 2001 y junio de 2002 en un área del municipio Playa, en Ciudad de La Habana (zona urbana metropolitana), una del municipio Cruces, en Cienfuegos (zona urbana no metropolitana), otra del Municipio Unión de Reyes, en Matanzas (zona rural) y una de Fomento, en Sancti Spiritus (zona rural montañosa). Se analizó la mediana del tiempo del IH mediante curvas de supervivencia Kaplan Meier y se evaluó el efecto del diagnóstico al ingreso (afecciones respiratorias, gastrointestinales, ginecobstétricas, egreso hospitalario precoz y otras causas), la zona del IH, el sexo y la edad, sobre la posibilidad de egresar del IH. Para cada municipio se calculó el costo directo del servicio, el costo por paciente y el costo por día de estadía. Se ajustaron modelos de regresión lineal múltiple para identificar el efecto que sobre el costo por paciente tienen el tiempo de estadía, el diagnóstico al ingreso y el área donde se presta el servicio de IH. RESULTADOS: La causa más frecuente de IH en los municipios estudiados fueron las afecciones respiratorias (31,4 por ciento), seguidas del egreso hospitalario precoz (15,5 por ciento), las afecciones ginecobstétricas (10,8 por ciento) y los trastornos gastrointestinales (8,1 por ciento). La mediana del tiempo de estadía fue de 6 días (IC95 por ciento: 5,75 a 6,25). En Fomento los pacientes tuvieron 66 por ciento menos probabilidad de egresar que en Cruces y 30 por ciento menos que en Playa y Unión de Reyes. El costo directo del IH en los municipios estudiados medido en pesos cubanos ($) varió entre $3 983,54 y $9 624,87. El costo por día de estadía fue de $2,57 a $6,88, mientras el costo por paciente fue de $23,04 a $42,78. El tiempo de estadía tuvo un efecto...

OBJECTIVE: To analyze home care services in Cuba and determine how length of stay, per-day cost, and per-patient cost vary by diagnosis and by the area of the country in which the services are rendered. METHODS: Patient information was analyzed for 837 individuals who were enrolled in home care services between July 2001 and June 2002 in the following four municipalities: (1) Playa municipality (a metropolitan urban area) in the province of the City of Havana; Cruces municipality (an urban, but not metropolitan, area) in the province of Cienfuegos; Unión de Reyes municipality (a rural area) in the province of Matanzas; and Fomento municipality (a mountainous rural area) in the province of Sancti Spiritus Analysis of the mean length of stay for home care services was conducted using the Kaplan-Meier survival curve method. The impact of the following criteria on the probability and timing of discharge was also assessed: diagnosis at time of enrollment (respiratory, gastrointestinal, obstetrical/gynecological, hospital discharge follow-up, and other causes), area in which services were rendered, and patient gender and age. The total service, per-patient, and per-day costs were determined for each municipality. Adjusted multilinear regression models were used to determine how length of stay, diagnosis upon enrollment, and service area affected cost. RESULTS: The diagnoses most frequently requiring home care were respiratory illness (31.4 percent), hospital follow-up of acute condition (15.5 percent), obstetrical/ gynecological illness (10.8 percent), and gastrointestinal disorder (8.1 percent). The mean length of stay was 6 days (95 percent confidence interval: 5.75 to 6.25). In Fomento, the probability of patients enrolling in home care was 66 percent lower than in Cruces and 30 percent lower than in Playa and Unión de Reyes. The total direct cost of home care in the municipalities studied ranged, in Cuban pesos, from $3 983.54 to $9 624.87. The...

Prevalence and risk factors of intestinal parasites in Cuban children.

OBJECTIVES: To determine the prevalence of intestinal parasite infections and their risk factors in children in urban and rural settings in two Cuban municipalities. METHODS: A total of 1320 Cuban schoolchildren aged 4-14 were tested by stool examination for intestinal parasite infections and evaluated by parental questionnaire for a number of common environmental, sanitary, socioeconomic and behavioural risk factors. Multivariate regression was applied to examine the relationship between the respective parasite infections and the risk factors. RESULTS: Prevalences of intestinal parasite infections were 58% in Fomento and 45% in San Juan y Martínez; for helminth infections, these were 18% and 24% and for protozoa infections, 50% and 29%, respectively. Helminth infections were associated with high parental education (maternal: OR 0.68, CI 0.50-0.93; paternal: OR 0.71, CI 0.52-0.96), absence of toilet (OR 1.57, CI 1.12-2.19), consumption of water from a well or river (OR 0.56, CI 0.41-0.77) and eating unpeeled/unwashed fruit (OR 1.37, CI 1.01-1.87); protozoa infections were only associated with high maternal education (OR 0.72, CI 0.57-0.91). CONCLUSIONS: Paediatric intestinal parasite infections are still prevalent in certain areas in Cuba and associated with a number of common environmental, socioeconomic and sanitary risk factors.

Neuropatía epidémica cubana: algunos factores de riesgo en la población / Cuban epidemic neuropathy: the risk factors in the population

A cross-sectional study was conducted in 1995 in a representative sample of the Cuban population aged 15 years or over with the objective of describing prevalence and characteristics of smoking, alcohol consumption, and physical inactivity in the urban population which could have been affected by epidemic neuropathy from 1991-1993. The sampling was stratified at provincial and municipal levels and then by cluster samplings. 93 of the sample was surveyed (14 300 people). 30 of the population aged 17 years and over smoked; the highest proportion of smokers was located in 40-49 years age group; men smoked more than woman regardless of age. The prevalence of alcohol consumption was 45.2 in which Eastern provinces exceeded the domestic average with males predominating. The prevalence of physical inactivity at national level was 33, 25.7 for males and 39.8 for females. 47.3 of males and 25.4 of females classified as physically active because of their useful extra activity. It was considered that irregular relationships between these 3 risk factors and the incidence of epidemic neuropathy at the ecological level make it think that, although they have a real influence on the determinants of the disease, other factors may also better account for the occurrence of these cases.