Autochthonous dengue in two Dutch tourists visiting Département Var, southern France, July 2020.

We report dengue virus (DENV) infection in two Dutch tourists who visited Département Var, southern France, in July and August 2020. As some autochthonous dengue cases have occurred in Europe in recent years, awareness among physicians and public health experts about possible intermittent presence of DENV in southern Europe is important to minimise delay in diagnosis and treatment. Quick diagnosis can lead to timely action to contain the spread of vector-borne diseases and minimise transmission.

Vector-borne transmission of Zika virus in Europe, southern France, August 2019.

On 1 October 2019, a locally-acquired Zika virus disease case was laboratory confirmed in Hyères, Var department. Active case finding identified two additional locally-acquired cases living within 90 m, with symptom onset 8 days before the index case. Extensive patient interviews did not yield information supporting transmission through sexual contact or substances of human origin. Vector-borne transmission by local Aedes albopictus mosquitoes is the most likely mode of transmission. Here we describe the public health response.

Outbreak of diarrhoeal illness in participants in an obstacle adventure race, Alpes-Maritimes, France, June 2015.

An acute gastroenteritis (AG) outbreak occurred among participants in an obstacle race in France in the summer of 2015. An investigation in two phases was conducted to identify the source of infection and document the extent of the outbreak. First, a message on a social media website asked racers to report any symptoms by email to the Regional Health Agency of Provence-Alpes-Côte d'Azur. Second, a retrospective cross-sectional study was conducted through an interactive questionnaire for all participants, followed by an analytical study of potential risks factors. Of 8,229 persons registered, 1,264 adults reported AG resolved within 48 hours. Of adults who reported AG, 866 met the case definition. Age group, departure time and ingestion of mud were associated with AG. Twenty stool specimens tested negative for bacteria. All four stool samples tested for viruses were positive for norovirus genogroup I and genotype 2. No indicator bacteria for faecal contamination were found in drinking water but muddy water of ponds tested positive. The outbreak was possibly caused by human-to-human transmission of a norovirus introduced by one or more persons and transmitted through contaminated mud. Risks related to similar races should be assessed and recommendations be proposed to raise awareness among health authorities and organisers.

Salud Mesoamérica 2015 Initiative: design, implementation, and baseline findings.

BACKGROUND: Health has improved markedly in Mesoamerica, the region consisting of southern Mexico and Central America, over the past decade. Despite this progress, there remain substantial inequalities in health outcomes, access, and quality of medical care between and within countries. Poor, indigenous, and rural populations have considerably worse health indicators than national or regional averages. In an effort to address these health inequalities, the Salud Mesoamérica 2015 Initiative (SM2015), a results-based financing initiative, was established. METHODS: For each of the eight participating countries, health targets were set to measure the progress of improvements in maternal and child health produced by the Initiative. To establish a baseline, we conducted censuses of 90,000 households, completed 20,225 household interviews, and surveyed 479 health facilities in the poorest areas of Mesoamerica. Pairing health facility and household surveys allows us to link barriers to care and health outcomes with health system infrastructure components and quality of health services. RESULTS: Indicators varied significantly within and between countries. Anemia was most prevalent in Panama and least prevalent in Honduras. Anemia varied by age, with the highest levels observed among children aged 0 to 11 months in all settings. Belize had the highest proportion of institutional deliveries (99%), while Guatemala had the lowest (24%). The proportion of women with four antenatal care visits with a skilled attendant was highest in El Salvador (90%) and the lowest in Guatemala (20%). Availability of contraceptives also varied. The availability of condoms ranged from 83% in Nicaragua to 97% in Honduras. Oral contraceptive pills and injectable contraceptives were available in just 75% of facilities in Panama. IUDs were observed in only 21.5% of facilities surveyed in El Salvador. CONCLUSIONS: These data provide a baseline of much-needed information for evidence-based action on health throughout Mesoamerica. Our baseline estimates reflect large disparities in health indicators within and between countries and will facilitate the evaluation of interventions and investments deployed in the region over the next three to five years. SM2015's innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need.

Vector-Borne Transmission of the Zika Virus Asian Genotype in Europe.

Three autochthonous cases of Zika virus occurred in southern France in August 2019. Diagnosis relied on serology and transcription-mediated amplification. Attempts for virus isolation and ZIKV genome RT-PCR detection remained negative. Since the index case was not identified, we addressed the issue of genotyping and geographical origin by performing hemi-nested PCR and sequencing in the Pr gene. Analysis of 16 genotype-specific Single Nucleotides Polymorphisms identified the Asian genotype and suggested a Southeast Asia origin.

[Cost-effectiveness analysis of two strategies for malaria control in the urban area of Buenaventura, Colombia]. / Análisis de costo-efectividad de dos intervenciones para el control de la malaria en el área urbana de Buenaventura, Colombia.

INTRODUCTION: Costs and results of two alternatives for malaria control were compared. One constituted by the activities of the National Programme, the other by the integration of an educational strategy denominated "Integrated Alternative" (IA) into the national program in Buenaventura on the Pacific Coast of Colombia. Objective. To evaluate the cost-effectiveness of two alternatives for malaria control in the urban area of Buenaventura. MATERIALS AND METHODS. A cost-effectiveness analysis was carried out from an institutional and household perspective. Institutional costs were obtained by reviewing records of institutions that implemented each alternative; household costs were obtained from interviews. Effectiveness measurement was the number of averted cases per 10,000 inhabitants. RESULTS: Institutional costs of National Programme and Integrated Alternative were U.S. dollars 3766 and U.S. dollars 24,932.8 respectively. Average household cost in the zone where National Programme was implemented was U.S. dollars 36.2, while in the zone where IA was applied it was U.S. dollars 28.4. The number of averted cases per 10,000 inhabitants was 12.9 (CI 95% -6.0; 31.8) for National Programme and 264.6 (CI 95% 254.1; 275.1) for Integrated Alternative. The institutional cost-effectiveness ratios of National Programme and Integrated Alternative were U.S. dollars 292.4 and U.S. dollars 92.2, respectively. CONCLUSION: Integration of the educational strategy into the National Programme was the most cost-effective alternative. Our data suggest that the educational strategy should be added to the National Programme activities.

[Toward a national plan to control health effects of mercury in Colombia]. / Hacia un plan nacional para el control de los efectos del mercurio en la salud en Colombia.

INTRODUCTION: The problem of mercury effects on humans and the environment is global, and it has different impacts on health. It is necessary, therefore, to address this issue from a broad overview to identify populations at risk of exposure, health effects, the production processes involved and the actions aimed at reducing exposure and mitigating the impact. OBJECTIVE: To design a conceptual and operational framework to develop strategies for prevention, control and mitigation of mercury effects on health and on the environment in Colombia. MATERIALS AND METHODS: We conducted a two-phase study: a literature review following the Cochrane methodology and forums with national and international experts using a comprehensive planning methodology to identify priority actions and establish a national research agenda. RESULTS: The results of the review were structured into four components: mercury effects on health, legal framework in Colombia, emission inventory for the country and health plans and programs. We made recommendations for the design of an intervention plan considering five lines of action: technologies for exposure management, institutional strengthening for exposure prevention and control, strategies for strengthening diagnosis and care, health education on mercury risks, and knowledge generation. CONCLUSION: We detected information gaps, technical weaknesses, and the need of administrative and other resources in this field in Colombia. We proposed priority actions to reduce the economic, social and health impact from exposure to mercury.

HIV sexual risk behaviors in youth 15-24 years of age in Cali, Colombia: Do differences exist among neighborhoods?

INTRODUCTION: HIV/AIDS is a global health priority. About 40% of new infections occur among heterosexual youth by means of sexual contact. In Cali, district 13, 15 and 20 account for 11.5% of the prevalent cases and 18.0% of incident cases. OBJECTIVE: To establish differences in risk behaviors for HIV among young people 15-24 yrs of age from two areas of Cali, Colombia. METHODS: We carried out a cross-sectional study among young people between 15 and 24 yrs of age in these districts. The selection was done with a two-stage probability sampling. We estimated the prevalence of sexual relationships without condom usage, sex with multiple partners, and sex under the effects of alcohol and through logistical regression we identified the related factors. RESULTS: In district 13, 15 and 20, the prevalence of unprotected sexual relationships in the last 12 months and the prevalence of sex with two or more partners was 70%; and 38% of young people had sex under the effects of alcohol. In both areas, the intention was positively related to the risk behaviors. We found socio-demographic factors, intentions, and beliefs that increase the opportunity to display these behaviors. The effect of these factors differs by district. CONCLUSIONS: We observed a high prevalence of risk behaviors for HIV related to socio-demographic factors, intentions and beliefs that warrant interventions appropriate for local realities.

INTRODUCCIÓN: El VIH/SIDA es una prioridad en salud mundial. Alrededor de 40% de las infecciones nuevas se producen por contacto sexual en jóvenes heterosexuales. En Cali, las comunas 13, 15 y 20 agrupan 11,5% de casos prevalentes y 18.0% de los incidentes. OBJETIVO: Establecer diferencias en comportamientos sexuales de riesgo para VIH entre jóvenes de 15 a 24 años de dos áreas de la Ciudad de Cali. Métodos: Se realizó un estudio transversal en jóvenes de 15 a 24 años de las comunas 13 y 15 y de la comuna 20. Se realizó muestreo probabilístico bietápico. Se midieron las prevalencias de relaciones sexuales sin condón, con múltiples compañeros y bajo efectos del licor. Con regresión logística se identificaron los factores relacionados a estos comportamientos. RESULTADOS: La prevalencia de relaciones sin condón en los últimos 12 meses y de relaciones con múltiples compañeros en las comunas 13 y 15 y en la 20 fue 70%. La prevalencia de relaciones sexuales bajo efectos del licor fue 38%. En ambos grupos de comunas, la intención de ejecutar el comportamiento de riesgo se relacionó positivamente con los comportamientos de interés. Además, se encontraron factores sociodemográficos, creencias normativas, creencias de control, motivación para cumplir y de poder percibido relacionados con los comportamientos de riesgo, los cuales tienen efecto diferente para cada grupo de comunas. CONCLUSIONES: Se observaron altas prevalencias de comportamientos de riesgo frente a VIH, relacionadas con factores sociodemográficos, intenciones, creencias y percepciones, que requieren ser intervenidos de acuerdo a las realidades del entorno.

Malaria in selected non-Amazonian countries of Latin America.

Approximately 170 million inhabitants of the American continent live at risk of malaria transmission. Although the continent's contribution to the global malaria burden is small, at least 1-1.2 million malaria cases are reported annually. Sixty percent of the malaria cases occur in Brazil and the other 40% are distributed in 20 other countries of Central and South America. Plasmodium vivax is the predominant species (74.2%) followed by P. falciparum (25.7%) and P. malariae (0.1%), and no less than 10 Anopheles species have been identified as primary or secondary malaria vectors. Rapid deforestation and agricultural practices are directly related to increases in Anopheles species diversity and abundance, as well as in the number of malaria cases. Additionally, climate changes profoundly affect malaria transmission and are responsible for malaria epidemics in some regions of South America. Parasite drug resistance is increasing, but due to bio-geographic barriers there is extraordinary genetic differentiation of parasites with limited dispersion. Although the clinical spectrum ranges from uncomplicated to severe malaria cases, due to the generally low to middle transmission intensity, features such as severe anemia, cerebral malaria and other complications appear to be less frequent than in other endemic regions and asymptomatic infections are a common feature. Although the National Malaria Control Programs (NMCP) of different countries differ in their control activities these are all directed to reduce morbidity and mortality by using strategies like health promotion, vector control and impregnate bed nets among others. Recently, international initiatives such as the Malaria Control Program in Andean-country Border Regions (PAMAFRO) (implemented by the Andean Organism for Health (ORAS) and sponsored by The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)) and The Amazon Network for the Surveillance of Antimalarial Drug Resistance (RAVREDA) (sponsored by the Pan American Health Organization/World Health Organization (PAHO/WHO) and several other partners), have made great investments for malaria control in the region. We describe here the current status of malaria in a non-Amazonian region comprising several countries of South and Central America participating in the Centro Latino Americano de Investigación en Malaria (CLAIM), an International Center of Excellence for Malaria Research (ICEMR) sponsored by the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID).

A factorial randomized controlled trial to evaluate the effect of micronutrients supplementation and regular aerobic exercise on maternal endothelium-dependent vasodilatation and oxidative stress of the newborn.

BACKGROUND: Many studies have suggested a relationship between metabolic abnormalities and impaired fetal growth with the development of non-transmissible chronic diseases in the adulthood. Moreover, it has been proposed that maternal factors such as endothelial function and oxidative stress are key mechanisms of both fetal metabolic alterations and subsequent development of non-transmissible chronic diseases. The objective of this project is to evaluate the effect of micronutrient supplementation and regular aerobic exercise on endothelium-dependent vasodilation maternal and stress oxidative of the newborn. METHODS AND DESIGN: 320 pregnant women attending to usual prenatal care in Cali, Colombia will be included in a factorial randomized controlled trial. Women will be assigned to the following intervention groups: 1. CONTROL GROUP: usual prenatal care (PC) and placebo (maltodextrine). 2. Exercise group: PC, placebo and aerobic physical exercise. 3. Micronutrients group: PC and a micronutrients capsule consisting of zinc (30 mg), selenium (70 µg), vitamin A (400 µg), alphatocopherol (30 mg), vitamin C (200 mg), and niacin (100 mg). 4. Combined interventions Group: PC, supplementation of micronutrients, and aerobic physical exercise. Anthropometric measures will be taken at the start and at the end of the interventions. DISCUSSION: Since in previous studies has been showed that the maternal endothelial function and oxidative stress are related to oxidative stress of the newborn, this study proposes that complementation with micronutrients during pregnancy and/or regular physical exercise can be an early and innovative alternative to strengthen the prevention of chronic diseases in the population. TRIAL REGISTRATION: NCT00872365.

Hacia un plan nacional para el control de los efectos del mercurio en la salud en Colombia / Toward a national plan to control health effects of mercury in Colombia

Introducción. La problemática del uso del mercurio es global y afecta tanto a los humanos como al ambiente. Los efectos del mercurio en la salud son diversos, por eso es necesario abordar el problema desde una perspectiva amplia, identificando las poblaciones en riesgo de exposición, sus efectos en la salud, los procesos productivos involucrados y las acciones para disminuir la exposición y mitigar el impacto. Objetivo. Diseñar un marco conceptual y operativo para desarrollar estrategias de prevención, control y mitigación de los efectos del mercurio sobre la salud y el ambiente en Colombia. Materiales y métodos. Se hizo un estudio en dos fases: una revisión de la literatura científica siguiendo la metodología Cochrane, y foros con expertos nacionales e internacionales orientados a la planificación integral para identificar las acciones prioritarias y construir la agenda de investigación nacional . Resultados. Los resultados de la revisión se estructuraron en cuatro componentes: efectos del mercurio en la salud, marco legal en Colombia, inventario de emisiones en el país, y planes y programas existentes en el sector de la salud. Se presentaron recomendaciones para diseñar un plan de intervenciones considerando cinco líneas de acción: gestión tecnológica para la prevención de la exposición, fortalecimiento institucional para la prevención y el control de la exposición, fortalecimiento de estrategias de diagnóstico y atención, educación en salud sobre los riesgos del mercurio y generación de conocimiento . Conclusiones. Se visibilizaron vacíos de información, así como debilidades técnicas, administrativas y necesidad de recursos en Colombia, y se propusieron acciones prioritarias para disminuir el impacto económico, social y en salud de la exposición al mercurio.

Introduction: The problem of mercury effects on humans and the environment is global, and it has different impacts on health. It is necessary, therefore, to address this issue from a broad overview to identify populations at risk of exposure, health effects, the production processes involved and the actions aimed at reducing exposure and mitigating the impact. Objective: To design a conceptual and operational framework to develop strategies for prevention, control and mitigation of mercury effects on health and on the environment in Colombia. Materials and methods: We conducted a two-phase study: a literature review following the Cochrane methodology and forums with national and international experts using a comprehensive planning methodology to identify priority actions and establish a national research agenda. Results: The results of the review were structured into four components: mercury effects on health, legal framework in Colombia, emission inventory for the country and health plans and programs. We made recommendations for the design of an intervention plan considering five lines of action: technologies for exposure management, institutional strengthening for exposure prevention and control, strategies for strengthening diagnosis and care, health education on mercury risks, and knowledge generation. Conclusion: We detected information gaps, technical weaknesses, and the need of administrative and other resources in this field in Colombia. We proposed priority actions to reduce the economic, social and health impact from exposure to mercury.

[Impact of an open waste disposal site on the occurrence of respiratory symptoms and on health care costs of children]. / Impacto de un botadero a cielo abierto en el desarrollo de síntomas respiratorios y en costos familiares de atención en salud de niños entre 1 y 5 años en Cali, Colombia.

INTRODUCTION: Exposure to contaminants of waste disposal sites potentially has negative health effects on population living in close vicinity. However, the impact to the community in terms of illness and health care costs have not been documented in Colombia. OBJECTIVE: To determine the effects of an open waste disposal site on the occurrence of respiratory symptoms in children 1-5 year old and on associated household care costs in Cali, Colombia. MATERIAL AND METHODS: A cohort of 863 1-5 year old children was assembled-409 exposed to the site and 454 living more distant. Over a 6-month period, measurement of respiratory symptoms and estimates of associated costs were undertaken once a month by interviewing the mother or another adult responsible of child health. A longitudinal logistical analysis was used to determine the independent effect of the disposal site on the occurrence of respiratory symptoms. Differences in average costs between families of exposed and unexposed children were estimated by non-parametric bootstrap techniques. RESULTS: Exposure to the disposal site was associated with a larger probability of respiratory symptoms (odds ratio=1.37, 95%CI 1.17-1.60) and with higher household medical costs due to respiratory symptoms were on the average US$ 10.19 higher (95% US$ 2.63 - 16,82). CONCLUSION: Living in neighborhoods close to garbage disposal sites has negative effects on the respiratory health of children and results in increased family costs related to treatment of associated respiratory symptoms.

HIV sexual risk behaviors in youth 15-24 years of age in Cali, Colombia: Do differences exist among neighborhoods? / Factores relacionados con la prevalencia de comportamientos de riesgo frente a VIH en jóvenes de 15-24 años de tres comunas de Cali

Introduction: HIV/AIDS is a global health priority. About 40% of new infections occur among heterosexual youth by means of sexual contact. In Cali, district 13, 15 and 20 account for 11.5% of the prevalent cases and 18.0% of incident cases. Objective: To establish differences in risk behaviors for HIV among young people 15-24 yrs of age from two areas of Cali, Colombia. Methods: We carried out a cross-sectional study among young people between 15 and 24 yrs of age in these districts. The selection was done with a two-stage probability sampling. We estimated the prevalence of sexual relationships without condom usage, sex with multiple partners, and sex under the effects of alcohol and through logistical regression we identified the related factors. Results: In district 13, 15 and 20, the prevalence of unprotected sexual relationships in the last 12 months and the prevalence of sex with two or more partners was 70%; and 38% of young people had sex under the effects of alcohol. In both areas, the intention was positively related to the risk behaviors. We found socio-demographic factors, intentions, and beliefs that increase the opportunity to display these behaviors. The effect of these factors differs by district. Conclusions: We observed a high prevalence of risk behaviors for HIV related to socio-demographic factors, intentions and beliefs that warrant interventions appropriate for local realities.

Introducción: El VIH/SIDA es una prioridad en salud mundial. Alrededor de 40% de las infecciones nuevas se producen por contacto sexual en jóvenes heterosexuales. En Cali, las comunas 13, 15 y 20 agrupan 11,5% de casos prevalentes y 18.0% de los incidentes. Objetivo: Establecer diferencias en comportamientos sexuales de riesgo para VIH entre jóvenes de 15 a 24 años de dos áreas de la Ciudad de Cali. Métodos: Se realizó un estudio transversal en jóvenes de 15 a 24 años de las comunas 13 y 15 y de la comuna 20. Se realizó muestreo probabilístico bietápico. Se midieron las prevalencias de relaciones sexuales sin condón, con múltiples compañeros y bajo efectos del licor. Con regresión logística se identificaron los factores relacionados a estos comportamientos. Resultados: La prevalencia de relaciones sin condón en los últimos 12 meses y de relaciones con múltiples compañeros en las comunas 13 y 15 y en la 20 fue 70%. La prevalencia de relaciones sexuales bajo efectos del licor fue 38%. En ambos grupos de comunas, la intención de ejecutar el comportamiento de riesgo se relacionó positivamente con los comportamientos de interés. Además, se encontraron factores sociodemográficos, creencias normativas, creencias de control, motivación para cumplir y de poder percibido relacionados con los comportamientos de riesgo, los cuales tienen efecto diferente para cada grupo de comunas. Conclusiones: Se observaron altas prevalencias de comportamientos de riesgo frente a VIH, relacionadas con factores sociodemográficos, intenciones, creencias y percepciones, que requieren ser intervenidos de acuerdo a las realidades del entorno.

Afluencia, permanencia y grado de satisfacción de pacientes adultos de las clínicas de la facultad de odontología de la universidad de el salvador, período 2010-2014 / Affluence, permanence and degree of satisfaction of adult patients in the clinics of the dental school of the University of El Salvador, period 2010-2014

Objetivo: Conocer la afluencia, permanencia y grado de satisfacción de los pacientes adultos que acuden a las clínicas de la Facultad de Odontología de la Universidad de El Salvador (FOUES), en el periodo 2010-2014. METODOLOGÍA: El estudio es observacional descriptivo de corte transversal, realizado en la Facultad de Odontología de la Universidad de El Salvador (FOUES) con 368 pacientes adultos con expediente clínico. Los métodos de recolección de datos fueron: a) una guía de observación que registró información personal de cada paciente; b) cuestionario, aplicado en dos opciones: presencial a pacientes que aceptaron asistir a la Facultad y que aún permanecían recibiendo atención y vía telefónica a los sujetos que al ser contactados no podían asistir. El instrumento permitió conocer las experiencias del paciente, causas de abandono o permanencia, niveles de satisfacción y resolución del motivo de consulta. RESULTADOS: El promedio de la afluencia de pacientes adultos registrados en el área de archivo de la FOUES del 2010 al 2014 fue de 1,836 por año. Permanencia 61.7%. En cuanto a los niveles de satisfacción en la atención brindada por el personal administrativo, docente y estudiante el 51.2% se mostró satisfecho. Con el tratamiento que recibió para resolver el motivo de consulta 36.7% muy satisfecho. CONCLUSIÓN: La afluencia de pacientes en la FOUES fue de 1,836 por año, 60.9% del sexo femenino, la permanencia al plan de tratamiento fue 61.7%, y 51.2% se mostró satisfecho con la atención que recibió de administrativos, docentes y estudiante.

Objective: To know the influx, stay, and level of satisfaction of adult patients coming to clinics of the School of Dentistry of El Salvador (FOUES) during the period 2010-2014. Methodology This is an observational, descriptive, cross-sectional study carried out at the School of Dentistry of the University of El Salvador with 368 adult patients with medical record. The methods for data gathering were: a) an observation guide to record personal information of each patient; b) questionnaire applied in two ways: face-to-face to patients who accepted to come to the School and who still were receiving attention, and by phone to subjects who expressed not being able to attend. The instrument allowed to know the experiences of the patient, causes for abandonment or stay, levels of satisfaction and resolution of the consultation. Results: The average of the influx of adult patients recorded at the FOUES archive area from 2010 to 2014 was 1,836 per year. Stay 61.7%. As to the levels of satisfaction for attention given by the administrative, teaching, and student personnel, 51.2% was satisfied. With respect to the treatment received to resolve the cause for consultation, 36.7% was satisfied. Conclusion: The influx of patients in the FOUES was 1,836 per year, 60.9% females, the stay for the treatment plan was 61.7%, and 51.2% was satisfied with the attention received by administrative, teaching, and student personnel.

Impacto de un botadero a cielo abierto en el desarrollo de síntomas respiratorios y en costos familiares de atención en salud de niños entre 1 y 5 años en Cali, Colombia / Impact of an open waste disposal site on the occurrence of respiratory symptoms and on health care costs of children

Introducción. La exposición a agentes contaminantes provenientes de los sitios de disposición final de residuos sólidos, tiene efectos potencialmente negativos en la salud de la población que vive en su área de influencia. Objetivos. Determinar los efectos del botadero municipal a cielo abierto en Cali, conocido como el botadero de Navarro, en el desarrollo de síntomas respiratorios en niños entre 1 y 5 años de edad y en los costos familiares relacionados con la atención de estos síntomas. Materiales y métodos. Se ensambló una cohorte de niños expuestos y no expuestos al botadero y se les hizo seguimiento durante 6 meses. El desarrollo de síntomas respiratorios y los costos relacionados con la atención en salud se evaluaron mensualmente con entrevistas al adulto responsable del cuidado del niño. Se hizo un análisis logístico longitudinal para determinar el efecto independiente del botadero en el desarrollo de síntomas respiratorios. Mediante técnicas estadísticas no paramétricas de bootstrap, se determinaron las diferencias promedio de costos entre las familias de los niños expuestos y no expuestos. Resultados. La exposición al botadero se asoció a una probabilidad más alta de desarrollar síntomas respiratorios (OR=1,37, IC95% 1,17-1,60) y a mayores costos familiares relacionados con el desarrollo de esos síntomas en niños (diferencia promedio: Col$ 24.038,5; IC95% 6.211,0-39.650,4). Conclusiones. La exposición al botadero tiene efectos negativos sobre la salud respiratoria infantil y sobre los costos familiares relacionados con la atención de los síntomas.

Introduction. Exposure to contaminants of waste disposal sites potentially has negative health effects on population living in close vicinity. However, the impact to the community in terms of illness and health care costs have not been documented in Colombia. Objective. To determine the effects of an open waste disposal site on the occurrence of respiratory symptoms in children 1-5 year old and on associated household care costs in Cali, Colombia. Material and methods. A cohort of 863 1-5 year old children was assembled—409 exposed to the site and 454 living more distant. Over a 6-month period, measurement of respiratory symptoms and estimates of associated costs were undertaken once a month by interviewing the mother or another adult responsible of child health. A longitudinal logistical analysis was used to determine the independent effect of the disposal site on the occurrence of respiratory symptoms. Differences in average costs between families of exposed and unexposed children were estimated by non-parametric bootstrap techniques. Results. Exposure to the disposal site was associated with a larger probability of respiratory symptoms (odds ratio=1.37, 95%CI 1.17-1.60) and with higher household medical costs due to respiratory symptoms were on the average US$ 10.19 higher (95% US$ 2.63 - 16,82). Conclusion. Living in neighborhoods close to garbage disposal sites has negative effects on the respiratory health of children and results in increased family costs related to treatment of associated respiratory symptoms.

Duración de la lactancia exclusiva en Cali, Colombia, 2003 / Duration of exclusive breast feeding in Cali, Colombia, 2003

Introducción: La lactancia exclusiva (LE) es fundamental en la nutrición del niño de 0 a 6 meses de vida y su práctica está recomendada en los planes nacionales vigentes de salud, alimentación y nutrición. Objetivo: Determinar la duración de la práctica de lactancia LE en una cohorte de mujeres lactantes seguida en el año 2003 en Cali, Colombia. Materiales y métodos: Entre las instituciones que respondieron en el año 2002 por más del 80/100 de los partos no complicados de la ciudad, con consentimiento y formularios estructurados, se escogió una muestra de 438 mujeres a quienes se entrevistó en su puerperio y en su domicilio los días 8, 15, 30, 60, 90, 120, 150 y 180 posparto y hasta que se identificara el abandono de la LE. Resultados: De 453 puérperas contactadas, 15 rechazaron ingresar al estudio; la pérdida en el seguimiento fue 8.2/100 (38 mujeres). Al final de cada mes de seguimiento 28/100, 15/100, 9/100, 5/100, 2/100 y 1.6/100 de las mujeres incorporadas al estudio mantuvo la práctica de LE. Conclusiones: La alta participación y representatividad de instituciones, la baja pérdida del seguimiento y la distribución sociodemográfica de participantes, sugieren que lo observado en esta cohorte caracteriza la duración de la práctica de LE en población primigestante de los estratos 1 a 4 de la zona urbana de Cali para el año 2003. La duración de la LE en la cohorte fue muy corta con respecto a las recomendaciones mundiales y nacionales, lo que puede indicar poco o ningún efecto de las acciones, tanto de los planes de beneficios del Sistema General de Seguridad Social en Salud como de las iniciativas globales, nacionales y locales en pro de la lactancia natural feliz