Nutritional status and human milk intake of exclusively breast-fed infants at high altitude in La Paz, Bolivia.

Breast-feeding habits are related to the nutritional status and the risk of illness and death in children under 2 years of age. For the first 6 months, infants should be exclusively breast-fed. This study aimed to evaluate the relationship between the infant's nutritional status and human milk intake by breast-fed infants at high altitude. A quantitative, descriptive, correlational study was conducted including mother/baby pairs of infants aged 2-6 months. The amount of human milk consumed by the infants was assessed by the deuterium oxide dose-to-mother technique. The lipid content of human milk was measured by creamatocrit, and anthropometric measurements were performed. A total of eighteen mother/baby pairs were assessed. The mean human milk intake was 888 (sd 149) g/d, and the intake of water from other sources was 24·3 (sd 29·8) g/d. The lipid content in human milk was 41 (sd 12) g/l. The infant's nutritional indicators were normal in all cases. A moderate positive correlation was found between milk volume and z scores weight-for-length r 0·58 (P=0·01), BMI-for-age r 0·56 (P=0·01) and weight-for-age r 0·45 (P=0·05). There was no correlation with length-for-age z score. The mean of breast milk intake in this study was similar to that found in other studies in the world. The lipid content is comparable to similar studies and was within the normal range. Children older than 3 months showed signs of stunting despite adequate volume and lipid content of breast milk.

Malnutrition-related early childhood exposures and enamel defects in the permanent dentition: A longitudinal study from the Bolivian Amazon.

OBJECTIVES: We investigated the relationship between early childhood malnutrition-related measures and subsequent enamel defects in the permanent dentition. MATERIALS AND METHODS: This cohort study included 349 Amerindian adolescents (10-17 years, 52% male) from the Bolivian Amazon. Exposures included: stunted growth (height-for-age z-scores), underweight (weight-for-age z-scores), anemia (hemoglobin), acute inflammation (C-reactive protein) and parasitic infection (hookworm). We measured the occurrence (no/yes) and extent (<1/3, 1/3-2/3, >2/3) of enamel defects. We estimated associations between childhood exposures and enamel defect measures using log-binomial and multinomial logistic regression. RESULTS: The prevalence of an enamel defect characterized by an orange peel texture on a large central depression on the labial surface of the central maxillary incisors was 92.3%. During childhood (1-4 years), participants had a high prevalence of stunted growth (75.2%), anemia (56.9%), acute inflammation (39.1%), and hookworm infection (49.6%). We observed associations between childhood height-for-age (OR = 0.65; P = 0.028 for >2/3 extent vs. no EH) and gastrointestinal hookworm infection (OR = 3.43; P = 0.035 for >2/3 extent vs. no defects or <1/3 extent) with enamel defects. DISCUSSION: The study describes a possibly novel form of enamel hypoplasia and provides evidence for associations of malnutrition-related measures in early childhood, including stunted growth and parasitic helminth infection, with the observed enamel defects.

Association of birth and periodontal disease in Bolivia, Chile and Colombia / Asociación de parto prematuro y enfermedad periodontal en Bolivia, Chile y Colombia.

Introducción. El parto prematuro es un problema médico, social y económico importante, causa gran mortalidad y morbilidad neonatal, tiene un impacto importante en el sistema de salud y afecta la calidad de vida de las familias. El peso de los recién nacidos de madres con enfermedad periodontal es significativamente menor en comparación con los de madres no afectadas por esta enfermedad bucal. Este resultado adverso se considera un problema de salud pública global según los datos epidemiológicos. Objetivo. Determinar la asociación entre la prevalencia de parto prematuro y la enfermedad periodontal en Bolivia, Chile y Colombia entre el 2000 y el 2020. Materiales y métodos. Este estudio ecológico consideró las poblaciones de mujeres de Bolivia, Chile y Colombia, y la prevalencia de partos prematuros y enfermedad periodontal, discriminadas por grupos de edad. El estudio abarcó el período entre el 2000 y el 2020. La estrategia de búsqueda con la herramienta de investigación del Institute for Health Metrics and Evaluation incluyó prevalencia, grupos de edad, años entre 2000 y 2020, causas de parto prematuro y enfermedad periodontal, contexto y ubicaciones, mujeres y tasas. El análisis estadístico incluyó una regresión lineal simple entre parto prematuro y enfermedad periodontal para cada grupo de edad dentro de cada país. Resultados. Las tasas de partos prematuros fueron mayores en el grupo de 15 a 19 años (Bolivia: 697.563, Chile: 844.864, Colombia: 804.126). La prevalencia de la enfermedad periodontal aumentó con la edad, particularmente en el grupo de 45 a 49 años (Bolivia: 22'077.854, Chile: 34'297.901, Colombia: 32'032,830). Según los grupos de edad, la regresión lineal fue estadísticamente significativa (p < 0,001) para todos los grupos evaluados de la población boliviana, en los grupos mayores de 30 años para las colombianas y solo en el grupo de 15 a 19 años para las mujeres chilenas. Conclusión. Se encontró asociación entre el parto prematuro y la enfermedad periodontal en todos los grupos de edad en Bolivia, solo en el grupo de 15 a 19 años en Chile, y de 30 años y más en Colombia en el período evaluado de 20 años.

Introducción. El parto prematuro es un problema médico, social y económico importante, causa gran mortalidad y morbilidad neonatal, tiene un impacto importante en el sistema de salud y afecta la calidad de vida de las familias. El peso de los recién nacidos de madres con enfermedad periodontal es significativamente menor en comparación con los de madres no afectadas por esta enfermedad bucal. Este resultado adverso se considera un problema de salud pública global según los datos epidemiológicos. Objetivo. Determinar la asociación entre la prevalencia de parto prematuro y la enfermedad periodontal en Bolivia, Chile y Colombia entre el 2000 y el 2020. Materiales y métodos. Este estudio ecológico consideró las poblaciones de mujeres de Bolivia, Chile y Colombia, y la prevalencia de partos prematuros y enfermedad periodontal, discriminadas por grupos de edad. El estudio abarcó el período entre el 2000 y el 2020. La estrategia de búsqueda con la herramienta de investigación del Institute for Health Metrics and Evaluation incluyó prevalencia, grupos de edad, años entre 2000 y 2020, causas de parto prematuro y enfermedad periodontal, contexto y ubicaciones, mujeres y tasas. El análisis estadístico incluyó una regresión lineal simple entre parto prematuro y enfermedad periodontal para cada grupo de edad dentro de cada país. Resultados. Las tasas de partos prematuros fueron mayores en el grupo de 15 a 19 años (Bolivia: 697.563, Chile: 844.864, Colombia: 804.126). La prevalencia de la enfermedad periodontal aumentó con la edad, particularmente en el grupo de 45 a 49 años (Bolivia: 22'077.854, Chile: 34'297.901, Colombia: 32'032,830). Según los grupos de edad, la regresión lineal fue estadísticamente significativa (p < 0,001) para todos los grupos evaluados de la población boliviana, en los grupos mayores de 30 años para las colombianas y solo en el grupo de 15 a 19 años para las mujeres chilenas. Conclusión. Se encontró asociación entre el parto prematuro y la enfermedad periodontal en todos los grupos de edad en Bolivia, solo en el grupo de 15 a 19 años en Chile, y de 30 años y más en Colombia en el período evaluado de 20 años.

Economic aspects of foot and mouth disease in Bolivia.

The paper presents results from two economic analyses of foot and mouth disease (FMD) in Bolivia. Both recommended a programme to eradicate the disease, but one reported a negative economic return while the later study found a positive and robust return. To investigate the reasons for these differences the paper presents information on cattle movement and how this relates to the epidemiological situation of FMD in Bolivia. This analysis identifies two important trade routes: southern and central cattle trade routes and two FMD endemic areas: the humid tropical areas of the Departments of the Beni and Santa Cruz, and the semi-arid subtropical area to the south east of the country known as the Bolivian Chaco. The farm-level incentives to control FMD in the endemic areas, where cattle are kept in extensive systems, are negative and the main losses caused by the disease occur four to six years after an outbreak. Given this situation it is suggested that resources being used to eradicate the disease in Bolivia should be concentrated in these endemic areas where convincing cattle owners of the need to control FMD is particularly difficult. It is also suggested that the eradication programme should coordinate its activities with neighbouring countries.

Lesiones ocasionadas por mordeduras de perros en niños atendidos en un hospital de tercer nivel de Bolivia / Dog bite injuries in children seen at a tertiary care hospital in Bolivia

Introducción. Este estudio pretende caracterizar las lesiones provocadas por perros en niños de un hospital pediátrico de Bolivia. Población y métodos. Se realizó un estudio observacional, retrospectivo, en pacientes atendidos del 2017 al 2021. Resultados. Se estudiaron 769 pacientes. Las lesiones representaron el 5,6 % de las emergencias y el 0,8 % de las internaciones. Fueron más frecuentes en niños de hasta 5 años (55,1 %), en quienes se observó mayor gravedad de las lesiones (p = 0,008), antecedente de provocación al animal (p = 0,048), un animal agresor conocido (p <0,036), el contexto doméstico del accidente (p = 0,021), mayor frecuencia de profilaxis con suero luego de la exposición (p = 0,005) y regiones afectadas principalmente maxilofaciales (p <0,001). Observamos 3 casos de mortalidad por rabia humana y 1 por shock hipovolémico. Conclusión. Las lesiones producidas por perros son causas frecuentes de visita a emergencia y hospitalización en pediatría, y tienen características particulares en niños de hasta 5 años de edad.

Introduction. The objective of this study is to describe the characteristics of dog bite injuries in children seen at a children's hospital in Bolivia. Population and methods. This was an observational, retrospective study in patients seen between 2017 and 2021. Results. A total of 769 patients were studied. Dog bite injuries accounted for 5.6% of emergency visits and 0.8% of hospitalizations. They were more frequent in children younger than 5 years (55.1%), in whom the following were observed: greater injury severity (p = 0.008), history of animal provocation (p = 0.048), known attacking animal (p < 0.036), domestic accident (p = 0.021), greater frequency of post-exposure prophylaxis with anti-rabies serum (p = 0.005), and maxillofacial area as the main region involved (p < 0.001). There were 3 deaths due to human rabies and 1 due to hypovolemic shock. Conclusion. Dog bite injuries are a frequent cause of visit to the emergency department and hospitalization in pediatrics and have specific characteristics in children younger than 5 years.

Prevalence of measles antibody among children under 15 years of age in Santa Cruz, Bolivia: implications for vaccination strategies.

We conducted a community-based survey in Santa Cruz city, Bolivia, to determine the age-specific prevalence of measles antibodies, determine factors associated with absence of detectable measles antibodies, and to compare results of salivary and serum measles immunoglobulin G (IgG) antibody assays. Serum samples from 1654 children were assayed for measles IgG antibody using the haemagglutination inhibition (HI) assay, and salivary samples were also obtained from 187 children and tested for measles IgG antibody using an antibody capture radioimmunoassay. Reported measles vaccine coverage in children aged 12-35 months was 77% (95% confidence interval [CI], 72-81%). Eighty-seven percent (95% CI 85-89%) had detectable HI antibody, but a high proportion had antibody levels below 200 miu (30-40% of 2-14 years old children). Measles seronegativity was associated with not being vaccinated against measles, a negative history of measles disease, living in the inner city, being a lifetime resident of Santa Cruz, and young age. Of 212 children without detectable measles antibody, 58% had a positive history of vaccination or measles disease, so that historical information was not sufficiently reliable to identify susceptibles. The salivary measles antibody assay was not sufficiently sensitive to be used for population screening; only 54% of 171 salivary samples from children who had detectable serum HI antibody were positive. A mass measles vaccination campaign of all children under 15 years of age is planned in Bolivia in 1994. Although only 7% of school-age children in Santa Cruz were seronegative, the effectiveness of a mass campaign in this age group depends in part on the response to revaccination of children with low, but detectable, antibody levels.

Does hypoxia impair ovarian function in Bolivian women indigenous to high altitude?

Fertility appears to be reduced in at least some high altitude populations relative to their counterparts at lower elevations. Inferring from the difficulties with reproduction of newcomers to high altitude and from animal experiments, it has been hypothesized that this apparent reduction is the result of hypoxia acting to reduce fecundity and/or increase fetal loss. In humans, however, several behavioral as well as biological factors may affect fertility levels. These many factors have been organized by demographers into a framework of seven proximate determinants that includes fecundability (the monthly probability of conception) of which successful ovulation is one component. To test whether ovarian function is impaired in women indigenous to high altitude, we measured salivary progesterone (P) in a sample (n = 20) of Quechua women (aged 19-42 years) residing at 3,100 m. It was found that mean luteal P = 179 pmol/L and mean midluteal P = 243 pmol/L, levels that fall about midway in the range of known values for several populations and are higher than some lower altitude populations. These findings suggest that hypoxia does not appear to significantly impair ovarian function in those with lifelong residence at high altitude. There are, however, several factors common to many high altitude populations that may act to reduce fecundability and fertility including intercourse patterns (affected by marriage and migration practices), prolonged lactation, dietary insufficiency, and hard labor.

Caries experience of some countries and areas expressed by the Significant Caries Index.

OBJECTIVES: To calculate and present the caries prevalence for some countries/states among 12-year-olds, expressed as Significant Caries Index (SiC Index) and to analyse the relationship between the mean DMFT and the SiC Index for these countries. SiC Index is the mean DMFT of the one-third of a population with the highest caries values. METHODS: An Excel(R) application for calculating SiC was developed (http://www.whocollab.od.mah.se/expl/siccalculation.xls) and indices were calculated from the data collected for 14 countries and one state from the Country/Area Profile Programme (http://www.whocollab.od.mah.se/index.html). To investigate the provinces of a country that had already reached the proposed SiC Index goal of 3 DMFT among the 12-year-olds, data for 17 counties and a city from Sweden were collected and the respective mean DMFT and SiC Indices calculated. RESULTS: The mean DMFT varied from 1.0 to 8.5 and the SiC Index varied from 2.8 to 13.7 in the national data. Jamaica, Senegal and Sweden were the only three countries that showed SiC Indices that were less than 3 DMFT. The mean DMFT varied from 0.5 to 1.4 and the SiC Index varied from 1.4 to 3.6 in the Swedish county/city data examined. A strong linear relationship between the mean DMFT and the SiC Index was found for the populations presented in this study. CONCLUSION: The SiC Index is an indicator that reflects the situation among the most caries-exposed individuals and could be included in future population-based oral health surveys together with the mean DMFT.

Disease survey of free-ranging grey brocket deer (Mazama gouazoubira) in the Gran Chaco, Bolivia.

Samples from 17 free-ranging hunter-killed grey brocket deer (Mazama gouazoubira) in the Gran Chaco, Bolivia, were collected during June-August 1999. All 17 deer appeared to be in good condition at the time of death. Gross necropsies were performed, serum was collected for serologic evaluation of selected infectious disease agents, and feces and ectoparasites were collected for evaluation of internal and external parasites. Serologic tests were positive for antibodies against bovine respiratory syncytial virus and four Leptospira interrogans serovars, with questionable results for epizootic hemorrhagic disease virus serotypes 1 and 2. No antibodies were detected to Anaplasma marginale, Babesia bigemina, Babesia bovis, Babesia odocoilei, bluetongue virus (serotypes 2, 10, 11, 13, and 17), bovine viral diarrhea virus, Brucella abortus, foot-and-mouth disease virus, infectious bovine rhinotracheitis virus, Mycobacterium avium subsp. paratuberculosis, and parainfluenza-3 virus. Sixty-four percent (7/11) of the deer had endoparasites. Amblyomma spp. ticks were found on seven deer, flies of the family Hippoboscidae on six deer, and lice on six deer.

[Status of dentition in Bolivia according to altitude, sex and age]. / Estado de la dentición en Bolivia según la altitud, el sexo y la edad.

The author's quantitative evaluation of the condition of teeth among peasants in several rural communities in Bolivia gave the following results: As altitude decreases the health status of human dentition deteriorates. Further study of possible explanations of this phenomenon is proposed, specifically: the effect of diet, the fluorine content of drinking water, the habit of chewing coca leaves, and inadequate oral hygiene. Whatever the ecological conditions, it was found that younger girls have healthier teeth than boys, but that for all other ages male teeth are in better condition. Studies undertaken by other authors show that younger girls' molars exhibit more attrition than boys'; at other periods in life, the opposite is the case. Currently, there is no satisfactory explanation for the differential health status of dentition by age and sex.

Using mixed methods to investigate factors influencing reporting of livestock diseases: a case study among smallholders in Bolivia.

Livestock disease surveillance is particularly challenging in resource-scarce settings, where disease events are often unreported. Surveillance performance is determined as much by the quantifiable biological attributes of the disease, as it is by motivations and barriers perceived by livestock keepers for disease reporting. Mixed methods designs, which integrate the collection, analysis and interpretation of qualitative and quantitative data in a single study, are increasingly used across different disciplines. These designs allow for a deeper exploration of the topic under investigation, than can be achieved by either approach alone. In this study a mixed methods design was used in order to gain a greater understanding of the factors that influence reporting of livestock diseases in Bolivia. There is a need to strengthen passive surveillance in this country, among other reasons as part of an eradication programme for Foot and Mouth Disease (FMD). Findings revealed livestock keepers in the study area were extremely unlikely to report the occurrence of livestock health events to the Official Veterinary Services (OVS). Communication outside the local community occurs more often through alternative routes and this is positively correlated with disease awareness. The main barriers to disease reporting identified were a lack of institutional credibility and the conflicting priorities of the OVS and livestock keepers. As for other animal and human diseases across the developing world, passive surveillance of livestock diseases in Bolivia should be enhanced; this is urgent in view of the current FMD eradication programme. Increasing timeliness and smallholders' participation requires a detailed understanding of their likely actions and perceived barriers towards disease reporting. These insights are most likely to be developed through a holistic mixed methods approach of quantitative and qualitative analyses.

Within herd transmission and evaluation of the performance of clinical and serological diagnosis of foot-and-mouth disease in partially immune cattle herds.

The control of foot-and-mouth disease (FMD) in vaccinated populations relies upon surveillance activities such as clinical inspections (CI) and serological monitoring. New evidence to refine current surveillance guidelines has been provided by evaluating (1) the diagnostic performance of CI and serological tests for detection of FMD virus (FMDV) non-structural proteins (NSP), and (2) the within-herd transmission of the virus in partially immune cattle. Data came from 23 affected herds during an epidemic of FMDV type O in Bolivia, in 2007. All cattle (n=957) in these herds were clinically inspected and serum samples were collected one month after the last animal with clinical signs was detected. Samples were tested for the presence of antibodies against NSP using the PANAFTOSA 3ABC-ELISA test and a subset of samples were tested using the enzyme-linked immunoelectrotransfer blot assay (EITB). Data from clinical and serological diagnoses were analysed using a Bayesian model. The sensitivity Se and specificity Sp of the tests, as well as the prevalence and the within-herd reproduction ratio R of FMDV were estimated. In addition, risk factors for infection were identified. The Se of CI, the 3ABC-ELISA and the EITB tests were estimated to be 0.30, 0.88 and 0.96 respectively. The estimated Sp, in the same order, were 0.88, 0.93 and 0.97. The within-herd prevalence of infected animals ranged from 0.04 to 0.91 and R ranged from 1.02 to 2.68. It was observed that cattle coming from areas with high vaccination coverage had a lower risk of becoming infected than home-bred cattle from the affected herds, where vaccination coverage was thought to be low. Although these estimates come from herds kept under specific conditions, they provide a reference for future surveillance design and can inform simulation models for surveillance and control of FMD in similar cattle populations.

Human antibody response to Aedes aegypti saliva in an urban population in Bolivia: a new biomarker of exposure to Dengue vector bites.

Aedes mosquitoes are important vectors of re-emerging diseases in developing countries, and increasing exposure to Aedes in the developed world is currently a source of concern. Given the limitations of current entomologic methods, there is a need for a new effective way for evaluating Aedes exposure. Our objective was to evaluate specific antibody responses to Aedes aegypti saliva as a biomarker for vector exposure in a dengue-endemic urban area. IgG responses to saliva were strong in young children and steadily waned with age. Specific IgG levels were significantly higher in persons living in sites with higher Ae. aegypti density, as measured by using entomologic parameters. Logistic regression showed a significant correlation between IgG to saliva and exposure level, independently of either age or sex. These results suggest that antibody responses to saliva could be used to monitor human exposure to Aedes bites.

Salivary progesterone levels and rate of ovulation are significantly lower in poorer than in better-off urban-dwelling Bolivian women.

BACKGROUND: Agriculturalists in less-developed countries (LDC) have lower progesterone levels than urban industrialized populations. However, it is unknown if urban LDC populations are also relatively lower. We tested whether urban Bolivia samples-poorer (Bol-p) and better-off (Bol-b)-have lower progesterone than a Chicago (USA) sample, and whether progesterone and rate of ovulation are lower in Bol-p than in Bol-b. METHODS: Serial salivary samples collected from Bolivians, screened according to strict exclusion criteria during two complete menstrual cycles, were radioimmunoassayed for progesterone; anthropometrics were collected at mid-follicular and mid-luteal phases. RESULTS: Progesterone levels are lower in the Bolivia samples, and higher in the Bol-b than Bol-p; ovulation rate is greater in Bol-b than Bol-p. For only ovulatory cycles, mean-follicular-P (pmol/l), mean-luteal-P (pmol/l), and mean-peak-P (pmol/l) are respectively 65, 142 and 208 in Bol-p; 76, 167 and 232 in Bol-b; and 96, 240 and 330 in Chicago. Principal components representing body-size and progesterone level are positively correlated (r = 0.404, P = 0.005). CONCLUSIONS: Progesterone levels appear to be influenced by chronic and acute ecological conditions, evidenced by the association with body-size and the probability of ovulation respectively. These findings have implications for understanding cancer aetiology, developing population-appropriate hormonal contraceptives, and modelling the evolution and functioning of the reproductive system.

Paleogenética de populações pré-colombianas da Bolívia: análises do mtDNA humano, e infecções por Trypanosoma cruzi e vírus linfotrópico das células T humanas (HTLV) / Paleogenetic of pre-Columbian populations of Bolivia: analysis of mtDNA human, and infections for Trypanosoma cruzi and human T-cell lymphotropic virus (HTLV)

Restos humanos de origem arqueológica podem ser fonte de informação relevante para o conhecimento da origem de infecções parasitarias. Tivemos a oportunidade de analisar material de 26 múmias pré-columbianas da Bolívia datadas de 3600-900 anos atrás. Utilizando o sistema comercial de extração de DNA antigo (GeneClean BIO101) e sob condições especiais estabelecidas para a manipulação de aDNA (DNA antigo), ossos, dentes e tecido mole foram processados. O aDNA recuperado por reação de polimerização em cadeia, utilizando iniciadores específicos para os alvos humano e do vírus HTLV (Human T-cell Lymphotropic Virus) e do protozoário Trypanosoma cruzi, foi clonado e seqüenciado. Desta forma, foram identificadas as linhagens genéticas ou haplogrupos de 19 múmias pré-columbianas, assim como o haplogrupo de três múmias hispânicas do museu de Chuquisaca. A freqüência das linhagens genéticas foi: haplogrupo B 58por cento (11/19), haplogrupo A 42por cento (7/19) e haplogrupo D na múmia 1590 de Tiwanaku. A presença de aDNA de T. cruzi foi revelada pela hibridação, com sondas de kDNA do protozoário, em 11/29 múmias (38por cento). Três foram de Chuquisaca, quatro de Tiwanaku em La Paz e quatro de Cochabamba. Também recuperamos aDNA de HTLV e as análises genéticas determinaram a presença de ambos tipos do vírus: HTLV-1 e HTLV-2 nos indivíduos 1710 (Chuquisaca) e 1590 (Tiwanaku, La Paz) respectivamente. A recuperação de aDNA de HTLV-2, da múmia pré-columbiana de Tiwanaku, é a primeira evidencia biológica da presença ancestral deste vírus na América, apoiando a hipótese da sua introdução no continente junto com os primeiros povoadores há 35000-15000 anos atrás.