Effects on household income and earnings from chronic kidney disease of non-traditional origins: PREP project findings from Chichigalpa, Nicaragua.

OBJECTIVE: Our purpose with this study is to examine the socioeconomic outcomes associated with chronic kidney disease not related to well-known risk factors (CKDnt) in four communities in Chichigalpa, Nicaragua that are home to a substantial number of sugarcane workers. METHODS: We employed a cluster-based systematic sampling design to identify differences in outcomes between those households affected directly by CKDnt and those that are not. RESULTS: Overall, we find that approximately one-third of households surveyed had a household member diagnosed with CKDnt. 86% of CKDnt households reported that the head of the household had been without work for the last 6 months or more, compared with 53% of non-CKDnt households. Non-CKDnt households took in more than double the earnings income on average than CKDnt households ($C52 835 and $C3120, respectively). Nonetheless, on average, CKDnt households' total income exceeded that of non-CKDnt households due to Nicaragua's national Instituto Nicaraguense de Seguridad Social Social Security payments to CKDnt households, suggestive of a substantial economic burden on the state resulting from the disease. Households headed by widows or widowers who are widowed as a result of CKDnt demonstrate distinct deficits in total income when compared with either non-widowed households or to households widowed by causes other than CKDnt. CONCLUSIONS: Despite strong similarities in terms of demographic characteristics and despite residing in the same communities with similar access to the available resources, households experiencing CKDnt exhibit distinct and statistically significant differences in important socioeconomic outcomes when compared to non-CKDnt households.

Effectiveness of Home Gardening in Improving Food Security and Health in Chacraseca, Nicaragua: A Pilot Study.

We studied the usefulness of home gardening in improving food security and health. One hundred participants were randomized into the control and intervention group of which the intervention group received training in home gardening. Results showed that the percentage of participants with normal body mass index decreased from 24.4% to 20% in the control group whereas it remained unchanged in the intervention group. The number of participants in the very low food security category decreased from 66% (n=33) to 54% (n=27) in the intervention group whereas it increased from 68.8% (n=33) to 70.8% (n=34) in the control group. Results from the present study may be used to guide policymakers in designing or modifying home gardening interventions.

Stressful life events among women living homeless in Nicaragua, a low-income country.

Nicaragua is one of the lowest income countries in Latin America, where there is a shortage of data on women living homeless. This paper analyses the types, timing and perceived causality of stressful life events (SLE) suffered both during childhood and adolescence and throughout life by women living homeless (n = 30). A structured interview was used to collect the data. Findings showed that women living homeless in Nicaragua suffered a very high number of SLEs, and that these were extremely severe and from very early ages. Most of the SLEs took place before the women became homeless. The SLEs suffered by the women interviewed in Nicaragua were largely similar to those seen in women living homeless in other cultural contexts with higher incomes, although it should be noted that those interviewed in Nicaragua had suffered a higher number of SLE during their childhood and adolescence. The women interviewed mainly attributed finding themselves homeless to having suffered SLEs in the family environment. The suffering of multiple and severe SLEs, largely leading to living in socioeconomically disadvantaged situations, seem to present a significant vulnerability factor both for becoming homeless and remaining homeless over time.

Grisi Siknis: A cultural idiom of gender-based violence and structural inequalities in eastern Nicaragua.

For the Miskitu of Nicaragua, Grisi Siknis is a contagious illness that predominantly affects women. It is characterized by numerous psychosomatic symptoms, including headache, fear, aggressive behavior, loss of consciousness, and periods of rapid frenzy. Although Grisi Siknis has gained academic and public attention due to its unique cultural elements and perceived sexual aspects, little is known how the contextual and gender dimensions of Grisi Siknis are played out in relation to the socio-political context in the region. Based on 16 months of ethnographic work in the Nicaraguan Miskitu Coast, including semi-structured interviews (n = 20) and participant observation, this article documents a semantic shift in the embodied and symbolic language of a cultural idiom of distress. I show how duhindu (Miskitu spirit associated with illness and misfortune) and witchcraft are symbols that share cultural resonance in the Miskitu community, while gender violence discourse is a new language incorporated into the logic of this cultural idiom of distress. I argue that this semantic shift allows the individuals in this study to communicate local experiences of complex forms of structural inequalities (migration status, unemployment, ethnic identity) and gender-based violence that tend to be normalized as a ubiquitous cultural problem while preserving the broader socio-cultural meaning the Grisi Siknis represents. The ethnographic accounts of Grisi Siknis provide empirical data to unpack the unexplored contextual processes and local discourses that transform the meaning and logic of cultural idioms of distress at the individual level of experience.

Effectiveness of Home Gardening in Improving Food Security and Health in Chacraseca, Nicaragua: A Pilot Study.

We studied the usefulness of home gardening in improving food security and health. One hundred participants were randomized into the control and intervention group of which the intervention group received training in home gardening. Results showed that the percentage of participants with normal body mass index decreased from 24.4% to 20% in the control group whereas it remained unchanged in the intervention group. The number of participants in the very low food security category decreased from 66% (n=33) to 54% (n=27) in the intervention group whereas it increased from 68.8% (n=33) to 70.8% (n=34) in the control group. Results from the present study may be used to guide policymakers in designing or modifying home gardening interventions.

Assessment of Plasmodium falciparum anti-malarial drug resistance markers in pfcrt and pfmdr1 genes in isolates from Honduras and Nicaragua, 2018-2021.

BACKGROUND: Central America and the island of Hispaniola have set out to eliminate malaria by 2030. However, since 2014 a notable upturn in the number of cases has been reported in the Mosquitia region shared by Nicaragua and Honduras. In addition, the proportion of Plasmodium falciparum malaria cases has increased significantly relative to vivax malaria. Chloroquine continues to be the first-line drug to treat uncomplicated malaria in the region. The objective of this study was to evaluate the emergence of chloroquine resistant strains of P. falciparum using a genetic approach. Plasmodium vivax populations are not analysed in this study. METHODS: 205 blood samples from patients infected with P. falciparum between 2018 and 2021 were analysed. The pfcrt gene fragment encompassing codons 72-76 was analysed. Likewise, three fragments of the pfmdr1 gene were analysed in 51 samples by nested PCR and sequencing. RESULTS: All samples revealed the CVMNK wild phenotype for the pfcrt gene and the N86, Y184F, S1034C, N1042D, D1246 phenotype for the pfmdr1 gene. CONCLUSIONS: The increase in falciparum malaria cases in Nicaragua and Honduras cannot be attributed to the emergence of chloroquine-resistant mutants. Other possibilities should be investigated further. This is the first study to report the genotype of pfmdr1 for five loci of interest in Central America.

Informe anual 2020. La salud universal y la pandemia. Sistemas de salud resilientes. Nicaragua

Establecida en 1902 como el organismo independiente especializado en salud del sistema interamericano, la Organización Panamericana de la Salud (OPS) ha desarrollado competencias y experiencia ampliamente reconocidas al brindar cooperación técnica a sus Estados Miembros para combatir las enfermedades transmisibles y no transmisibles y sus causas, fortalecer los sistemas de salud y responder a situaciones de emergencia y desastres en toda la Región de las Américas. Asimismo, en su calidad de oficina regional de la Organización Mundial de la Salud, la OPS participa activamente en los equipos de las Naciones Unidas en los países, colaborando con otros organismos, fondos y programas del sistema de las Naciones Unidas para contribuir al logro de los Objetivos de Desarrollo Sostenible (ODS) a nivel de país. En este informe anual se presenta la cooperación técnica de la OPS a nivel de país en el 2020, mediante la aplicación de la estrategia de cooperación con el país, la respuesta a las necesidades y prioridades nacionales, y el desarrollo de las actividades en el marco de los mandatos regionales y mundiales de la Organización y los ODS. En consonancia con el tema general de "la salud universal y la pandemia: sistemas de salud resilientes", se pone de relieve la respuesta de la OPS a la pandemia de COVID-19, así como sus esfuerzos continuos en esferas prioritarias como las enfermedades transmisibles, las enfermedades no transmisibles, la salud mental, la salud a lo largo del curso de vida y las emergencias de salud. También se presenta un resumen financiero del ejercicio examinado.

Out-of-Pocket Expenditure: The Need for a Gender Analysis

The main purpose of this publication is to advocate for the need to understand the gendered nature of vulnerabilities to poor health. Gender equality in health is an integral dimension of sustainable development, and it is critical to apply a “gender lens” to all aspects of the health system, including financing mechanisms in health. The impact of health-related out-of-pocket expenditure (OPE) on household poverty has been a significant factor driving the move toward universal health coverage across much of Latin America and beyond. However, not only do health care users still face a broad range of health-related OPEs that can contribute to the impoverishment of households, but the gender dimensions of OPEs have received very little attention. Drawing primarily on data from Bolivia (Plurinational State of), Guatemala, Nicaragua, and Peru, this report offers an in-depth analysis of the gender dimensions of health-related OPEs in Latin America. It highlights the limitations of survey data in determining levels of household spending on health as well as the potential failure of indicators to capture the impacts of coping strategies that households adopt to pay for OPEs. This publication calls for the application of an intersectional analysis to ensure a more nuanced understanding of the ways in which other social identity markers, such as race and ethnicity, alongside gender shape the ability of individuals and households to respond to the different OPEs they may encounter. Until policymakers consider the issue through a gender lens, OPE will continue to limit the potential of universal health care coverage to effectively address health inequalities.

Gastos directos de bolsillo en salud: la necesidad de un análisis de género

El objetivo principal de esta publicación es defender la necesidad de comprender la naturaleza de género de las vulnerabilidades a la mala salud. La igualdad de género en la salud es una dimensión integral del desarrollo sostenible, por lo que es fundamental aplicar una perspectiva de género a todos los aspectos del sistema de salud, incluidos los mecanismos de financiamiento de la salud. El impacto de los gastos directos de bolsillo relacionados con la salud en la pobreza de los hogares ha sido un factor importante que ha impulsado el avance hacia la cobertura universal de salud en gran parte de América Latina y en otros países. Sin embargo, no solo los usuarios de la atención de salud siguen enfrentándose a una amplia gama de gastos directos de bolsillo relacionados con la salud que pueden contribuir al empobrecimiento de los hogares, sino que las dimensiones de género de estos gastos han recibido muy poca atención. Basándose principalmente en datos de Bolivia (Estado Plurinacional de), Guatemala, Nicaragua y Perú, en este informe se ofrece un análisis en profundidad de las dimensiones de género que tienen los gastos directos de bolsillo relacionados con la salud en América Latina. Se destacan las limitaciones de los datos de las encuestas a la hora de determinar los niveles de gasto de los hogares en salud, así como la posible imposibilidad de que los indicadores capten los efectos de las estrategias de afrontamiento que adoptan los hogares para pagar por los gastos directos de bolsillo. En esta publicación se hace un llamamiento a aplicar un análisis interseccional para comprender con más matices las formas en que otros marcadores de identidad social, como la raza y la etnia, junto con el género, determinan la capacidad de las personas y los hogares para responder a los diferentes gastos directos de bolsillo que puedan encontrar. Hasta que los responsables de las políticas no consideren la cuestión desde una perspectiva de género, los gastos directos de bolsillo seguirán limitando el potencial de la cobertura universal de salud para abordar eficazmente las desigualdades de salud.

Short-term general, gynecologic, orthopedic, and pediatric surgical mission trips in Nicaragua: A cost-effectiveness analysis.

BACKGROUND: Short-term surgical missions facilitated by non-governmental organizations (NGOs) may be a possible platform for cost-effective international global surgical efforts. The objective of this study is to determine if short-term surgical mission trips provided by the non-governmental organization (NGO) Esperança to Nicaragua from 2016 to 2020 are cost-effective. METHODS: Using a provider perspective, the costs of implementing the surgical trips were collected via Esperança's previous trip reports. The reports and patient data were analyzed to determine disability-adjusted life years averted from each surgical procedure provided in Nicaragua from 2016-2020. Average cost-effectiveness ratios for each surgical trip specialty were calculated to determine the average cost of averting one disability-adjusted life year. RESULTS: Esperança's surgical missions' program in Nicaragua from 2016 to 2020 was found to be cost-effective, with pediatric and gynecology surgical specialties being highly cost-effective and general and orthopedic surgical specialties being moderately cost-effective. These results were echoed in both scenarios of the sensitivity analysis, except for the orthopedic specialty which was found to not be cost-effective when testing an increased discount rate. CONCLUSIONS: The cost-effectiveness of short-term surgical missions provided by NGOs can be cost-effective, but limitations include inconsistent data from a societal perspective and lack of an appropriate counterfactual. Future studies should examine the capacity for NGOs to collect adequate data and conduct rigorous economic evaluations.

Taxonomic assessment of the genus Procamallanus (Nematoda) in Middle American cichlids (Osteichthyes) with molecular data, and the description of a new species from Nicaragua and Costa Rica.

Procamallanus is a species-rich genus of parasitic nematodes of marine, brackish, and freshwater fishes, occurring also occasionally in amphibians and reptiles. In the Neotropical region, this genus is highly diverse, with species described from a wide range of fish families. In this study, we reassess the taxonomic status of Procamallanus rebecae with molecular and morphological data and describe a new species endemic to Nicaragua and Costa Rica. We analyzed all Procamallanus isolated from fish from the Nicaraguan lakes and some rivers in Costa Rica after an exhaustive analysis of their freshwater fish endoparasite fauna. Procamallanus rebecae is a host-specific parasite of Middle American cichlids, previously reported in southern Mexico, Nicaragua, and Costa Rica. We therefore compared these Central American specimens with individuals of P. rebecae collected in cichlids from southeastern Mexico using two genomic regions (28S rDNA and mitochondrial cytochrome oxidase subunit 1, COI). We found high levels of sequence divergence between Procamallanus from the two geographical regions, with up to 9.8 and 10.5% for both genetic markers, respectively. We also analyzed their morphology and found conspicuous differences in the shape of the mouth and the structure of the female cauda. We therefore describe the specimens of Procamallanus from Central American cichlids as a new species. Both Procamallanus species occur in different cichlid species and are allopatrically distributed. The host specificity and ancient association patterns between cichlids and Procamallanus and the jointly colonization of both hosts and parasites during their northern dispersal from South America are briefly discussed.

Intimate Partner Violence in Nicaragua: The Role of Possessive Jealousy, Intrasexual Competitiveness, Life History, Mate Value, and Stress.

Using an evolutionary perspective, we examined predictors of intimate partner violence (IPV) in the Department of the Rio San Juan in Nicaragua. Specifically, we focused on possessive jealousy, intrasexual competitiveness, life history strategy, mate value, and stress. The sample consisted of 199 men and 201 women (mean age = 36.48, SD = 10.47) from the general population who were all personally interviewed. For all variables, validated measures were used. The data were analyzed for men and women separately, using regression analyses. In contrast to previous research and our expectations, possessive jealousy was not related to IPV among men or women. Rather, among men, IPV was independently predicted by (a) intrasexual competitiveness, (b) a fast life history strategy, (c) a low mate value, and (d) stress, together explaining 35% of the variance. Among women, violence against one's partner was only predicted by intrasexual competitiveness (3% explained variance). These results suggest that perpetration of IPV in Nicaragua may have qualitative different roots among men than among women, and that for men, more "triggers" are present which may evoke aggression toward their partners. These results are discussed in light of their relevance for theory and practice.

Contaminación atmosférica en América Latina: impacto en la salud Y regulación actual - reporte del grupo del Comité de Aerobiología de la Sociedad Latinoamericana de Asma, Alergia e Inmunología / Atmospheric pollution in Latin America: impact on health and current regulation - report of the Aerobiology Committee of the Latin American Society of Asthma, Allergy and Immunology

La contaminación ambiental, en todas sus vertientes, tiene un efecto de enormes dimensiones no sólo sobre la existencia del planeta, sino también sobre la salud de la humanidad. América Latina es una región privilegiada ambientalmente, debido a su gran acervo de patrimonio natural, biodiversidad y posibilidades de provisión de servicios ambientales. Pero, a su vez, es una de las regiones más urbanizadas del orbe, con las afectaciones y presión al medio ambiente que esto implica, principalmente en la calidad del aire que se respira, derivadas de antiguos patrones productivos y de ocupación territorial, que se han agudizado como consecuencia del modelo de desarrollo predominante. Los efectos sobre la salud humana de diversas sustancias contaminantes están relacionados a procesos inflamatorios sobre mucosas y al aumento de la morbimortalidad en personas con enfermedades preexistentes, principalmente de los sistemas neurológico, cardiaco y respiratorio, en particular las enfermedades alérgicas respiratorias. La región latinoamericana enfrenta importantes problemas ambientales, determinados por los patrones de uso de sus recursos naturales, los sistemas de producción, los hábitos de consumo de las poblaciones humanas y la regulación gubernamental ambiental, que en muchos casos es laxa o pobremente implementada por los gobiernos en turno.

Air quality, in all its dimensions, has a major effect not only on the existence of the planet, but also on human health. Latin America is an environmentally privileged region, due to its great wealth of natural heritage, biodiversity and possibilities of provision of environmental services. But, at the same time, it is one of the most urbanized regions in the world, with the effects and pressure on the environment that this implies, mainly in the air quality, due to patterns of production and of territorial occupation, which they have exacerbated as a result of the predominant development model. The effects of diverse pollutant substances on the human health are related to inflammatory processes on mucous membranes and to increased morbidity and mortality in people with pre-existing diseases, especially of the neurological, cardiac and respiratory systems, in particular respiratory allergic illnesses. The Latin American region faces important environmental problems determined by the patterns of use of its natural resources, systems of production, habits of consumption of the human populations, and environmental governmental regulation, which is often lax or poorly implemented by the local authorities.

Health non-governmental organizations (NGOs) amidst civil unrest: Lessons learned from Nicaragua.

The community-based disaster risk management (CBDRM) framework recognises the crucial role that small- and medium-sized NGOs play during adverse events, particularly in marginalised communities. Despite the global frequency of civil unrest, its effect on NGOs' programmatic, administrative, and operational capabilities is poorly understood. To this end, we completed in-depth semi-structured interviews with eight key informants representing seven health NGOs in Nicaragua several months after widespread and persistent civil unrest erupted in April 2018. Data analysis revealed that all NGOs experienced notable disruptions in community education and health promotion, healthcare provision, fundraising, and strategic planning. Further, NGOs experienced several key challenges in responding to crises, including mobility within and between communities, diminishing financial resources, and safety concerns for staff and volunteers. Several NGOs anticipated long-term adverse impacts. In light of these challenges, we propose that health NGOs create a plan of action to mitigate adverse impacts of civil unrest and promote population health. Specifically, a plan of action should address institutional planning, communication strategies, and partnerships and coalitions. We also propose important ways in which future research could build on this preliminary study.

The Relationships between Economic Scarcity, Concrete Mindset and Risk Behavior: A Study of Nicaraguan Adolescents.

Background: Nicaragua is one of the poorest countries in Latin America, with an extremely low human development index (HDI). Fifty-two percent of the Nicaraguan population are children and adolescents under 18 years of age. Nicaraguan adolescents present several risk behaviors (such as teenage pregnancies, consumption of alcohol, tobacco, cannabis). Our study examines the links between risk behaviors, fatalism, real economic scarcity, and concrete construal level for adolescents with low and middle-low socioeconomic status in Nicaragua. Methods: Nicaraguan adolescents (N = 834) from schools located in especially vulnerable areas (low economic status) or in neighborhoods with middle-low social class completed several scales and questions to evaluate fatalism (SFC-social fatalism scale), construal level (BIF) and their past and future risk behaviors (smoking cigarettes, smoking cannabis, unsafe sex, and alcohol consumption). Results: We identified that the poorest individuals who maintained a concrete style of thinking had the highest rates of past and future risk behaviors. This vulnerable group also reported the highest levels of fatalism, i.e., negative attitudes and feelings of helplessness. Encouragingly, the adolescents who were able to maintain an abstract mindset reported healthier past and future habits and lower fatalism, even when they belonged to the lowest social status. In the middle-low economic group, the construal level was not as relevant to maintaining healthy habits, as adolescents reported similar rates of past and future risk behavior at both construal levels. Conclusions: All these results support the importance of considering construal level when studying vulnerable populations and designing risk prevention programs.

Using Google Trends to assess the impact of global public health days on online health information seeking behaviour in Central and South America.

BACKGROUND: Public health awareness can help prevent illness and result in earlier intervention when it does occur. For this reason, health promotion and disease awareness campaigns have great potential to alleviate the global burden of disease. Global Public Health Days (GPHD) are frequently implemented with this intent, but research evaluating their effectiveness, especially in the developing world setting, is scant. OBJECTIVES: We aimed to evaluate the impact of four GPHDs (World Cancer Day, World Diabetes Day, World Mental Health Day, World AIDS Day) on online health information seeking behaviour (OHISB) in five Central and South American (CSA) countries which differ in their stage of economic development and epidemiological transition (Uruguay, Chile, Brazil, Colombia, Nicaragua). METHODS: Google Trends data was used as a 'surrogate' of OHISB. This was measured on the 28 days leading up to the GPHD, on the date of the GPHD, and on the seven days following it. The Joinpoint regression programme was used to perform a time trend analysis on the Google Trends data. This allowed us to identify statistically significant time points of a change in trend, which reflect significant 'changes' to OHISB. RESULTS: GPHDs were inconsistently effective at influencing internet search query activity in the studied countries. In situations where an effect was significant, this impact was consistently short-term, with Relative Search Volume level returning to precampaign levels within 7 days of the GPHD. CONCLUSIONS: Our findings imply the need to revise GPHDs or create alternative health awareness campaigns, perhaps with a more long-term approach and tailored to the specific health needs of the CSA population. Developing effective preventive strategies is vital in helping combat the rising threat of NCDs in this region.

Breastfeeding practices in Masaya, Nicaragua: a facility based cross-sectional study.

BACKGROUND: The World Health Organization recommends exclusive breastfeeding for 6 months and total breastfeeding for at least 2 years. Despite this and multiple interventions promoting breastfeeding, early breastfeeding cessation remains high with little data as to the ongoing barriers contributing to early cessation. METHODS: Two groups of Nicaraguan mothers in an urban hospital were approached to complete a questionnaire to determine what newborn, maternal, and socioeconomic factors contributed to early cessation of breastfeeding. Group 1 participants were mothers of newborns in the newborn units, while group 2 were mothers of children 5 years or younger in the emergency room and pediatric ward. Descriptive statistics summarized the data. Fisher's exact test evaluated factors associated with early breastfeeding cessation. RESULTS: In group 1, 97 participants were enrolled with 81% of mothers planning to fulfill the guideline for exclusive breastfeeding for 6 months. In group 2, there were 139 mothers of which 58% reported they had exclusively breastfed for 6 months. Only 25 and 27% of mothers in group 1 and 2 respectively planned to breastfeed or breastfed for 2 years. In group 1, mothers reported lack of knowledge regarding breastfeeding techniques and older mothers tended to plan for early cessation of exclusive breastfeeding. In group 2, mothers reported feeling uncomfortable with breastfeeding in public or had difficulty with latching. Cessation of any breastfeeding prior to 12 months was associated with being uncomfortable breastfeeding in public and knowing the WHO guidelines. In both groups, social media represented an expanding platform for receiving breastfeeding information. CONCLUSIONS: Interventions focusing on reaching younger mothers and addressing breastfeeding knowledge and techniques while leveraging the increasing influence of social media platforms may help improve compliance with breastfeeding recommendations.

Assessing multidimensional care coverage for pre-eclampsia in the era of universal health coverage: A pre-post evaluation of the Salud Mesoamérica Initiative.

OBJECTIVE: To compare a multidimensional care package for pre-eclampsia/eclampsia in Central American health facilities, before and after implementation of the Salud Mesoamérica Initiative. METHODS: An evaluation study was conducted at 67 basic- and comprehensive-level health facilities serving the poorest areas in Honduras, Nicaragua, and Belize. Cases of severe pre-eclampsia or eclampsia were randomly sampled and relevant quality of care data extracted from medical records at baseline (n=111) from January 1, 2011, to March 31, 2013, and at second-phase follow-up (n=249) from June 1, 2015, to September 30, 2017. The primary outcome was evidence of the delivery of multidimensional care for the management of pre-eclampsia/eclampsia. RESULTS: The care of 360 women with severe pre-eclampsia or eclampsia was analyzed. Odds of multidimensional care for pre-eclampsia management (P=0.271) increased (although not significantly) in the second-phase follow-up compared to baseline. Multidimensional care was significantly associated with training (P<0.001), basic-level facilities (P<0.001), and higher in Honduras (P=0.001) and Belize (P=0.024) than the reference country of Nicaragua. CONCLUSION: Multidimensional care for pre-eclampsia management increased across all facility types, countries, and severity of disease. The Salud Mesoamérica Initiative is a promising model for achieving such quality of care interventions in the era of universal health coverage.