Ethical considerations for genetic research in low-income countries: perceptions of informed consent, data sharing, and expectations in Nicaragua.

Genetic research presents numerous ethical, legal, and social implications (ELSI), particularly when the research involves collaborations between investigators in high and low-income countries. Some ELSI issues are universal, and others are specific to context and culture. This study investigates perceptions of genetic research in Nicaragua, Central America, where local and U.S. based researchers have collaborated for over a decade. A total of 43 residents from northwestern Nicaragua, a region with high mortality rates attributed to chronic kidney disease of non-traditional causes (CKDnt), were interviewed, including research participants in ongoing studies (n = 36), health professionals (n = 3), labor leaders (n = 2), and family members of research participants (n = 2). Questions focused on informed consent, data-sharing, and post-study expectations. Audio recordings of interviews conducted in Spanish were transcribed and translated into English. English transcripts were coded and analyzed using NVivo 12 software. The lack of familiarity with terms in the consent form presented a barrier to participant comprehension of key elements of the genetic research study, raising concerns about the validity of informed consent. Research participants often viewed their participation as access to health care. Health professionals emphasized the importance of long-term partnerships between foreign-based researchers and local health institutions. Leaders and family members recommended that they be informed of research studies and allowed the opportunity to consent, as they felt the benefits and risks of research also apply to them. Our findings identified genetic research practices to be improved upon in order to be more responsive to the contextual realities of collaborators living in low-resource settings.

Heat stress and heat strain among outdoor workers in El Salvador and Nicaragua.

BACKGROUND: There is growing attention on occupational heat stress in Central America, as workers in this region are affected by a unique form of chronic kidney disease. Previous studies have examined wet bulb globe temperatures and estimated metabolic rates to assess heat stress, but there are limited data characterizing heat strain among these workers. OBJECTIVE: The aims were to characterize heat stress and heat strain and examine whether job task, break duration, hydration practices, and kidney function were associated with heat strain. METHODS: We used data from the MesoAmerican Nephropathy Occupational Study, a cohort of 569 outdoor workers in El Salvador and Nicaragua who underwent workplace exposure monitoring, including continuous measurement of core body temperature (Tc), heart rate (HR), physical activity, and wet bulb globe temperature (WBGT), over the course of three days in January 2018 - May 2018. Participants represented five industries: sugarcane, corn, plantain, brickmaking, and construction. RESULTS: Median WBGTs were relatively high (>27 °C) at most sites, particularly when work shifts spanned the afternoon hours (e.g., 29.2 °C among plantain workers). Sugarcane workers, especially cane cutters in both countries and Nicaraguan agrichemical applicators, had the highest estimated metabolic rates (medians: 299-318 kcal/hr). Most workers spent little time on break (<10% of the shift), as determined by physical activity data. Overall, sugarcane workers-particularly those in Nicaragua-experienced the highest Tc and HR values. However, a few workers in other industries reached high Tc (>39 °C) as well. Impaired kidney function (estimated glomerular filtration rate <90 mL/min/1.73 m2) was associated with higher Tc and HR values, even after adjustment. SIGNIFICANCE: This is the largest study to-date examining heat stress and strain among outdoor workers in Central America. Workers at sugar companies regularly experienced Tc > 38°C (76.9% of monitored person-days at Nicaraguan companies; 46.5% at Salvadoran companies). Workers with impaired kidney function had higher measures of Tc and HR. IMPACT STATEMENT: This study examined levels of occupational heat stress and heat strain experienced among outdoor workers in five industries in El Salvador and Nicaragua. We characterized heat stress using wet bulb globe temperatures and estimated metabolic rate and heat strain using core body temperature and heart rate. Sugarcane workers, particularly cane cutters and Nicaraguan agrichemical applicators, performed more strenuous work and experienced greater levels of heat strain. Impaired kidney function was associated with higher heart rates and core body temperatures.

High prevalence of chronic kidney disease of unknown etiology among workers in the Mesoamerican Nephropathy Occupational Study.

BACKGROUND: Mortality from chronic kidney disease of unknown etiology (CKDu) is extremely high along the Pacific coast of Central America, particularly among sugarcane workers. The Mesoamerican Nephropathy Occupational Study (MANOS) is a prospective cohort study of CKDu among agricultural and non-agricultural workers in El Salvador and Nicaragua. The objective of this manuscript is to describe the MANOS cohort recruitment, baseline data collection, and CKDu prevalence after two rounds. METHODS: Workers with no known diabetes, hypertension, or CKD were recruited from sugarcane, corn, plantain, brickmaking, and road construction industries (n = 569). Investigators administered questionnaires, collected biological samples, and observed workers for three consecutive workdays at the worksite. Serum specimens were analyzed for kidney function parameters, and used to calculate estimated glomerular filtration rate (eGFR). At six months, serum was collected again prior to the work shift. CKD at baseline is defined as eGFR ≤ 60 ml/min/1.73m2 at both timepoints. Age-standardized prevalence was calculated by industry, country, and demographic measures. Kidney function parameters were compared by CKD status. RESULTS: Prevalence of CKD at baseline was 7.4% (n = 42). Age-standardized prevalence was highest in Salvadoran sugarcane (14.1%), followed by Salvadoran corn (11.6%), and Nicaraguan brickmaking (8.1%). Nicaraguan sugarcane had the lowest prevalence, likely due to kidney function screenings prior to employment. CONCLUSION: Despite efforts to enroll participants without CKD, our identification of prevalent CKD among agricultural and non-agricultural workers in the MANOS cohort indicates notable kidney disease in the region, particularly among sugarcane workers.

Dirección general salud ambiental y epidemiología / General address environmental health and epidemilogy

El documento es el informe de los diferentes programas de la Dirección General Salud Ambiental y Epidemiología del Ministerio de Salud de Nicaragua. Aborda los logros, avances, fortalezas, los proyectos de capacitación de los recursos humanos en epidemiología. También incluye la mision y objetivos de la Dirección de Enfermedades Transmisibles; la Dirección de salud ambiental; Dirección de Inmunizaciones; Dirección de Emergencia en Desastres. Al final incluye algunos logros de la dirección correspondiente al año 1997-2001

Malaria y movimientos de población en la Region IV / Malaria and people dislocation in IV Region

La IV Región del país presenta una evolución epidemiológica favorable, aproximándose rápidamente a un estadio de consolidación del Programa A.C.E.M. Sin embargo el Movimiento Poblacional ha incrementado los casos de origen importados. El presente estudio permite conocer el peso relativo que dicho fenómeno tiene en la Epidemiología de la Malaria en la Región, después de practicarse una revisión a todas las Historias Epidemiológicas registradas en el 1er. Semestre del año 1984 en la Oficina de Estadística Regional del Programa A.C.E.M., se encontró que el peso fundamental como origen del Movimiento Poblacional está determinado por las necesidades de la Defesa Nacional ante la Agresión externa. Se describen los casoso según origen autóctonos e importados y según variables de edad, sexo, residencia y el lugar del país en que se adquirió la infección. Se recomienda finalmente fortalecer las actividades de vigilancia epidemiológica, controles de foco y la coordinación estrecha con los Servicios Médicos del Ejército Popular Sandinista para impedir la introducción a la Región de Malaria por los combatientes

Epidemiología de la rabia en Nicaragua

Estudio descriptivo de la epidemiología de la rabia, a fin de contribuir en la restructuración de estrategias y toma de decisiones para el control de la rabia en el país; durante el período 1967-1983 se obtuvo información de fuentes secundarias. Se encontró que anualmente se registraron un promedio de 160 animales rabiosos de los que 140 son perros, 7 gatos, 6 bovinos y algunos de vida salvaje. Los animales mordedores predominantes son el perro y el vampiro. La mortalidad humana más frecuente fue en niños y en el sexo masculino. Las actividades de control de la rabia canina se han realizado hasta porcentajes de cobertura muy inferior a lo recomendado por los expertos de la OMS, y lo referido en las normas; los años 1980 y 1983 han sido los que registran los mejores porcentajes de vacunación con el apoyo de organizaciones de masas. En 5 de 16 muertes del período 1979-1983 se conoció que acudieron a los Centros de Salud, después de haber sido mordidos por perros rabiosos y en el 100 porciento se dió mal manejo a los mismos, los restantes 11 de 16 se registraron; conociéndose el problema hasta que apareció el cuadro clínico de la enfermedad.