Knowledge, attitudes, and practices regarding dengue, chikungunya, and Zika in Cali, Colombia.

Dengue fever (DENF), chikungunya (CHIK), and Zika are responsible for the majority of the burden caused by vector-borne diseases (VBDs); which are produced by viruses primarily transmitted by the Aedes mosquito. Aedes have become prolific in urban areas due to a combination of climate change, rapid urbanization, increased human mobility, and globalization, causing the three VBDs to emerge in novel regions. Community knowledge can provide detailed insights about the spatial heterogeneity of disease risk and rates within a particular region, improving public health interventions. Knowledge, Attitude, and Practice (KAP) surveys are used to shed light on at-risk communities' understanding of the vector, the pathogen, prevention and treatment strategies. Little is known how KAP varies among diseases, and among neighborhoods within a city. Understanding KAP variation among co-circulating VBDs at a fine-level, especially differences between endemic and emerging diseases, can improve targeted interventions, education programs, and health policy. We administered KAP surveys to 327 individuals in healthcare centers and selected neighborhoods in Cali, Colombia in June 2019. We utilized generalized linear models (GLMs) to identify significant predictors of KAP. Our findings suggest that knowledge is related to community characteristics (e.g. strata), while attitudes and practices are more related to individual-level factors. Access to healthcare also forms significant predictor of residents participating in preventative practices. The results can be leveraged to inform public health officials and communities to motivate at-risk neighborhoods to take an active role in vector surveillance and control, while improving educational and surveillance resources in Cali, Colombia.

A survey of patients with substance use disorders at government treatment facilities in The Bahamas / Estudio de pacientes con trastornos por uso de sustancias en centros gubernamentales de tratamiento en Las Bahamas

OBJECTIVE: To determine the sociodemographic information and characteristics of patients aged 18-60 years diagnosed with substance use disorders presenting to the three government treatment facilities. To determine the prevalence rates of alcohol, cannabis, cocaine and poly-substance use disorders in patients presenting to government treatment facilities. METHODS: The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition, text revision (DSM-IV-TR) Axis 1 disorders was the first instrument used to screen for drug abuse or dependence. Additional questionnaires included a sociodemographic questionnaire and the Survey of Addicted Patients in Treatment Centre Standardized Questionnaire. RESULTS: The number of participants interviewed in the study was 120 people; 89.2% were males and 10.8% were females. The mean age of all participants with substance use disorders was 36.22 (10.74) years and they were predominantly male (8 to 1). Males were mostly single, unemployed or casually employed, of middle school education and were residents of New Providence. Alcohol, cannabis and cocaine were the common drugs that were misused. Of cocaine users, 52 (82.5%) met the DSM-IV-TR criteria for dependence and of cannabis users, 20 (18.9%) met the DSM-IV-TR criteria for abuse. CONCLUSIONS: There is a need to conduct community surveys on school children, other adult populations eg in the wider community and on other island populations to determine the population rates of substance use disorders. Once the needs have been identified through research for the different islands and target groups, informed decisions can be made as to the allocation of financial and human resources.

OBJETIVO: Determinar la información sociodemográfica y las características de los pacientes en edades de 18-60 años diagnosticadas con trastornos por uso de sustancia, que acuden a los tres centros gubernamentales de tratamiento de la drogadicción. Determinar la tasa de prevalencia de los trastornos por uso de alcohol, cannabis, cocaína y polisustancias en los pacientes que acuden a los centros de tratamiento del gobierno. MÉTODOS: La Entrevista clínica estructurada para el diagnóstico y el Manual estadístico de trastornos mentales, cuarta edición, texto revisado (DSM-IV-TR), trastornos del eje 1, fue el primer instrumento utilizado para detectar el abuso o dependencia de drogas. Los cuestionarios adicionales incluyen un cuestionario sociodemográfico así como la llamada Encuesta de pacientes adictos en el cuestionario estandarizado de los centros de tratamiento. RESULTADOS: El número de participantes entrevistados en el estudio fue de 120 personas; 89.2% eran varones y 10,8% eran hembras. La edad promedio de todos los participantes con trastornos por uso de sustancias fue 36.22 (10,74) años y eran predominantemente masculinos (8 a 1). Los varones eran en su mayoría solteros, desempleados, o trabajadores eventuales, de nivel educacional medio, y residentes de Nueva Providencia. Alcohol, cannabis y cocaína fueron las comúnmente las sustancias del uso adictivo. De los consumidores de cocaína, 52 (82,5%) correspondían a los criterios del DSM-IV-TR con respecto a la dependencia, y de los consumidores de cannabis, 20 (18,9%) correspondían a los criterios de DSM-IV-TR en relación con el abuso de sustancias. CONCLUSIONES: Es necesario llevar a cabo encuestas comunitarias con niños en edad escolar, otras poblaciones adultas - por ejemplo en la comunidad en general y en otras poblaciones de la isla - para determinar las tasas poblacionales de trastornos por uso de sustancias. Una vez que las necesidades hayan sido identificadas mediante investigación de las diferentes islas y los grupos seleccionados como objetivos, pueden tomarse decisiones informadas en cuanto a la asignación de las finanzas y recursos humanos.

Measles epidemiology and outbreak response immunization in a rural community in Peru.

Only limited data are available on the impact of measles outbreak response immunization (ORI) in developing countries. We conducted a community survey in Espindola, a rural border community in northern Peru, following a measles outbreak and subsequent ORI to study the epidemiology and impact of the outbreak and to evaluate the costs and benefits of measles ORI. During the outbreak, 150 of the 553 Espindola residents developed clinical cases of measles. Adults accounted for 44.0% of cases, and were frequently identified as primary cases. The attack rate among all susceptible people was 45.5% and was highest (61.2%) for the 16-20 year age group. Among adults, significant risk factors for developing measles included being aged 16-20 years (relative risk [RR] = 3.06, 95% CI = 2.08, 4.49) and being male (RR = 1.73, 95% CI = 1.11, 2.71). Among serologically confirmed cases, 60.7% developed diarrhoea and 32.1% pneumonia. The overall case-fatality rate was 3.3%, but reached 19.1% in the 0-23-month age group. Failure to reach children through either routine immunization or national campaigns made this community vulnerable to the severe and extensive impact of measles virus importation. The ORI campaign targeted non-measles case children aged 6 months to 15 years, regardless of their previous immunization status, and was effective in terminating this measles outbreak and in preventing morbidity, loss of livelihood and death despite the involvement of large numbers of adults in measles transmission. The last measles case occurred within 3 weeks of completing ORI. The ORI campaign, which would have cost approximately US$ 3000 in 1998, saved as many as 1155 person-days of work among 77 adults, prevented an estimated 87 cases of diarrhoea and 46 cases of pneumonia, and averted 5 deaths.

PIP: A community survey of the epidemiology and impact of measles outbreak response immunization (ORI) in Espindola, Peru. Blood specimens from 29 clinical cases having the onset of symptoms within 5 weeks to collection were tested for the anti-measles virus nucleoprotein antibody. Questionnaires were given to the head of the household and the 29 clinical cases to identify clinical symptoms an disease outcomes and to determine vaccination coverage. Attack rates, vaccine effectiveness, and predictive value positive was also calculated. Findings showed that primary cases were frequent among adults, who accounted for 44% of cases. The attack rate among all susceptible people was 45.5% and was highest among adults aged 16-20 (61.2%). For the serologically confirmed cases, 60.7% developed diarrhea and 32.1% pneumonia. Case fatality rate was 19.1% for children aged 0-23 months and 1.5% for adults aged 16-40 years. The lack of national campaigns or access to routine immunization caused the severe impact of measles virus outbreak. The ORI campaign targeted nonmeasles case children aged 6 months to 15 years regardless of immunization status, which was effective in terminating measles outbreak, morbidity, and mortality. This campaign cost approximately US$3000 and in 1998 saved 1155 person-days of work among 77 adults. It also prevented 87 diarrhea and 46 pneumonia cases and averted 5 deaths.

The use of donkeys in the Mexican central highlands: a gender perspective.

PIP: This study analyzes the use of donkeys in San Pablo Tlachichilpan, Mexico from a gender perspective. Information was gathered through survey, participatory rural appraisal methods, and direct observation. The results showed that the donkeys were used exclusively for carrying loads. They usually carry water, laundry, firewood, sand, soil, manure, a plough and maize stover, and the harvest. There were no preferences cited for using either the male or female donkey, as both have their own advantages. The males are stronger while the females are more docile. The main problems associated with donkey use were lack of access to veterinary help and advice; inadequate caring of young; low productivity of females; no adequate hoof care; and shortage of fodder. However, these problems were not considered restrictive to their use. With regard to socioeconomic issues, it was revealed that a majority of the rich (72%) did not have donkeys, while most of the poor (80%) have one donkey. Lastly, the donkey was found to be appropriate to the needs of both men and women. However, it is used almost exclusively for the maintenance activities of the household and is less accepted for productive activities such as cultivation or breeding.^ieng

Gender and social differences in adolescent sexuality and reproduction in Nicaragua.

PURPOSE: The aim of this research was to study gender and social differences in adolescent sexuality and reproduction, as reflected in age at first intercourse and age at first pregnancy, as a basis for future interventions in the municipality of León, Nicaragua. METHODS: In a community-based cross-sectional study including 7789 households, all women aged 15-49 years (n = 10,867) were interviewed about socioeconomic, sexual, and reproductive issues. A random subsample of men (n = 388) and women (n = 413) aged 15-49 years was interviewed in more detail about sexual patterns and reproduction. RESULTS: The median age at first intercourse for women and men was 17.8 and 16.2 years, respectively. Women's average latency period to end of first pregnancy was 22 months. There was a significant tendency to start active sexual life later among today's girls aged 15-20 years, compared to the groups 21-27, 28-35, and 36-49 years old. A similar trend was found in age at first pregnancy. These secular trends were not found among men. Age at first pregnancy for current adolescents was lower among those having less formal education. CONCLUSIONS: The short latency period between first sexual intercourse and end of first pregnancy, probably reflecting lack of access to counseling and contraception, is worrying in light of the growing sexually transmitted disease/human immunodeficiency virus threat. The secular trend of later start of reproduction, however, is a positive sign which partly may be an effect of increasing education in the Nicaraguan society.

PIP: This study sought to uncover gender and social differences in adolescent sexuality and reproduction in Nicaragua through an investigation of age at first coitus and first pregnancy. Data were gathered through a 1993 cross-sectional, community-based survey of a representative sample of 7789 households in the municipality of Leon. Interviews were held with 10,867 women aged 15-49, and more detailed information was elicited from a random subsample of 388 men and 413 women. It was found that median age at first coitus was 17.8 for women and 16.2 for men, with 25% of the population engaging in coitus before age 15. Women delivered their first child at a median age of 19.6 years, whereas men became fathers at 21.2 years. Lack of formal education increased risk of earlier pregnancy for women by 2.5 times, but no increased risk occurred for rural versus urban residence. Earlier pregnancy occurred in women who did not live with their biological fathers during childhood and adolescence (living with a stepfather increased risk of early coitus and delivery even more). Men without a formal education became fathers at an earlier age in both urban and rural areas. The period between first coitus and delivery for women was 21.5 months (20 months for women with primary education or less and 27 months for those who completed ninth-grader or higher). Age groups comparisons (15-20, 21-27, 28-35, and 36-49) showed that the current adolescents were experiencing first coitus and first pregnancy significantly later than the older groups but that the 28-35 age group showed significantly earlier onset of each event. These results point to the need to improve gender equity and women's status and to develop a health care policy that responds to the special needs of adolescents (counseling, access to contraceptives, and availability of safe abortion). Sex education programs must begin at the primary levels in schools because of high drop-out rates.

Wastage of family income on skin disease in Mexico.

PIP: In developing countries skin disease prevalences may affect over 60% of the community and are often poorly managed. The impact of ineffective treatment of skin disease on family life in rural Mexico was investigated. In the community of Cayaco, a house to house questionnaire survey was conducted to study the distribution of skin disease and the use and cost of treatments. The diagnosis of skin lesions was validated by physical examination and in a separate random survey in 120 primary school children. Regression analysis was carried out. 380 households with 1528 people (713 males, 815 women) were surveyed, of whom 207 reported skin disease. 131 attended the outpatient clinic (41 males, 90 females). The commonest skin disease among them was pyoderma (27 patients), followed by scabies (26), pityriasis alba (23), acne (8), dermatophytosis (8), viral warts (8), and pediculosis capitis (8). 66 had other skin conditions ranging from urticaria (2) to scrofuloderma (1). 58 patients had more than one condition, a total of 189 dermatoses. Six conditions accounted for 102 of the dermatoses. 15 patients with scabies and 21 with pyoderma had received ineffective treatment over the previous six months at a mean cost of 66 new pesos and 136 new pesos, respectively. Many of the affected children had missed school: eight days for scabies (12 patients) and 15 days for pyoderma (10 patients). 68 of the 120 primary school children in the random survey had at least one treatable skin condition. In half of the households people had symptoms, and 57% of the children had at least one treatable skin disease. The mean total cost of ineffective treatment for the two commonest conditions over six months was a major financial burden on families where the mean daily wage was 15.2 new pesos. Both diseases are readily curable by eliminating scabies. In the area a new system of community dermatology is implemented with close collaboration between specialists and primary health care workers.^ieng

Significant improvements in children's health.

PIP: The field report from PLAN field offices in Sucre and Altiplano in Bolivia, Santo Domingo in the Dominican Republic, and Amatitlan in Guatemala provides a summary of survey results pertaining to diarrheal disease control, immunizations, and nutrition. The PLAN sites are rural with the exception of the periurban slum surrounding Santo Domingo, which has better access to health services. Interviews were conducted among mothers with children aged 0-23 months in project areas, with the exception of Altiplano and Santo Domingo which included nonproject areas for comparative purposes. The results for diarrhea disease control are that an estimated 90% of episodes can be successfully treated at home. Evaluation is made of the timeliness and coverage of immunizations, the degree of management of diarrhea at home and at the health facility, and the extent of exclusive breast feeding in the first 4 months, and total breast feeding with food supplementation in the first year of life. The conclusion is that the four field offices make a significant and positive impact on children aged 0-23 months.^ieng

The use of rectal tubes for stool collection.

PIP: Besides verifying the absence of wild poliovirus transmission in children with acute flaccid paralysis, the ICCPE also advocates verifying the absence of wild poliovirus transmission in the environment. This can be done either by community stool surveys of normal children or by sampling sewage. In developed countries, the sampling of sewage tends not be a constraint since adequate sewage systems exist. In developing countries where such systems do not always exist, or, if they do, they do not always operate, community stool surveys are preferable, especially in remote rural areas. In April 1991, staff from PAHO and the Ministry of Health of Colombia conducted a community survey of 242 5 year old children living in a high risk area of Cartagena, Colombia to compare the effectiveness of the traditional cup technique of collecting stool samples with the polyethylene rectal tube in screening normal children 5 years old. They chose this area of Cartagena because it has had several confirmed cases of polio. The rectal tube was to be inserted 66-75% of its length into the rectum. More children had their stools collected via the traditional cup technique than the rectal tube technique (67% vs. 36%; p.001). Isolation rates for enterovirus including poliovirus were similar for the 2 techniques. Thus the probability of getting stool samples from children 5 years old was 3 times greater with the traditional cup technique than the rectal tube technique. In fact, the collection rate for the rectal tube was so low, staff could not accurately evaluate the possibility of silent transmission among high risk children. PAHO advises then that health workers not use the rectal tube in the polio eradication program in the Americas until further research has been conducted.^ieng

The epidemiology of breast-feeding in Mexico: rural vs. urban areas.

This article summarizes published and unpublished data on breast-feeding in Mexico collected between 1958 and 1987. These data suggest that Mexican rates of initiation of breast-feeding (78-83%) are among the lowest found in developing countries, that the median duration of breast-feeding in 1987 was virtually the same as it had been in 1976, and that about half of all Mexican infants are not breast-fed beyond six months of age. A finding that the duration of breast-feeding was shortest in urban areas has important policy implications, since 72% of the population lives in urban zones.

PIP: Nutritionists collected published and unpublished data from 1966-1990 on incidence or duration of breast feeding to summarize them and to determine breast feeding trends in Mexico. National surveys between 1976-1987 showed that 78-83% of mothers began breast feeding which was highest in rural areas (89%). 1973-1987 community surveys in urban Mexico revealed that breast feeding initiation rates varied from 54-94%. In addition, women in metropolitan areas (Mexico City, Guadalajara, and Monterrey) had lower rates of breast feeding initiation and shorter average breast feeding duration than in smaller urban areas. 1960-1988 community surveys in rural areas demonstrated that these rates ranged from 73-99%. Medial duration of breast feeding stood at 8.7 months in 1976 and 8.6 months in 1987. Further mean duration ranged from 6-12 months in 1976 and 7-14 months in 1987. Duration was consistently higher in rural areas than urban and metropolitan areas. Only 6 of the 19 studies ever reported on exclusive breast feeding which led the nutritionists to conclude that breast feeding mothers may also have supplemented with breast milk substitutes. Despite indications of some improvement in breast feeding in 10 years, Mexico still has 1 of the worst breast feeding initiation rates in the developing world. Besides about 50% of all infants in Mexico do not receive breast milk after 6 months. Since 72% of the population lives in urban areas including 39% in metropolitan areas and breast feeding rates were lowest in these areas, public health policy makers should address these trends. Studies specifically looking at incidence and duration of breast feeding in Mexico are needed.

Epidemiology and transmission of rotavirus infections and diarrhoea in St. Lucia, West Indies.

To determine the epidemiology and risk factors of rotavirus infections in St. Lucia, 229 children in three valleys with varying levels of sanitation were studied for 2 years. A four-fold rise in complement fixation antibody to rotavirus antigen was used in paired samples as evidence of recent infection. Results showed that forty-eight per cent of infants experienced at least one infection during a two-year period, and 17% of children were reinfected. Infections occurred within the first months of life and peaked between 6 and 23 months of age. The peak infection coincided with the dry season in each age group. Children breast-feeding had fewer infections. Although crowding within the home was significantly associated with repeated infection, the incidence of infection was not affected by the degree of sanitation. Other studies in the region, using recently developed techniques, concur with these findings which advance our understanding of the epidemiological importance of rotavirus in St. Lucia. Although these studies provide insights into the risk factors for rotavirus infections, other studies are required to determine whether investments should be focused on improved sanitation or immunization or both.

PIP: During the 1977-1979 Schistosomiasis control project in St. Lucia, researchers studied the prevalence of rotavirus infection in 229 children 3 years old (10 children later dropped out of the study) in 3 valleys with different levels of sanitation. Nurses from the Ministry of Health collected stool and sera samples which laboratory staff tested for rotavirus and antibodies, 48% (106) had at least 1 rotavirus infection during the 2 years. 18 of them were reinfected once and 1 twice. Prevalence was highest in 1 year olds (18.1% 12-176 months; 18.9% 18-23 months). Rotavirus caused diarrhea in 47% of all diarrhea cases during the dry season (April-June), but only 3% during the rainy season (October-December). Only children 6-23 months old had significantly higher infection rates during the dry season. Breast fed children 0-11 months had a lower infection rate than those bottle fed or other wise fed. Crowding was the only consistent and significant social factor associated with rotavirus infection (p.05). Rotavirus infection prevalence remained similar for the 3 different hygienic areas which demonstrated that improved sanitation only affected diarrhea not caused by rotavirus. The fact that children with rotavirus reinfections lived in crowded dwellings and that crowding was significantly associated with rotavirus infections suggested that air may have been responsible for transmitting rotavirus. Other studies are needed to see whether efforts to reduce diarrheal morbidity should center on improved sanitation or immunizations or both.

Socioeconomic, medical care, and public health contexts affecting infant mortality: a study of community-level differentials in Peru.

Socioeconomic, medical care, and public health contexts are examined in Peruvian communities for their relationship to infant mortality. A deviant case analysis is used to uncover characteristics important in the social structure of Peruvian communities. Results from fieldwork in two "deviant" communities suggest that economic diversity, income disparity, social class fluidity, and women's autonomy, along with refined measures of medical care and public health resources, are important in understanding differentials in mortality. Attention is drawn to the community context and to the interplay of socioeconomic determinants affecting infant mortality.

PIP: Socioeconomic, medical care, and public health contexts are examined in Peruvian communities of Pisco and Ilo for their relationship to infant mortality. A deviant case analysis is used to uncover characteristics important in the social structure of Peruvian communities. Results from fieldwork in 2 "deviant" communities suggest that economic diversity, income disparity, social class fluidity, and women's autonomy, along with refined measures of medical care and public health resources, are important in understanding differentials in mortality. Attention is drawn to the community context and to the interplay of socioeconomic determinants affecting infant mortality. Pisco's economy employs workers in agriculture, fishing and fish processing, manufacturing including textiles and chemicals, and agriculture, notably in cotton, fresh vegetables, legumes, and dairy cows. Ilo, although also a port city, is used almost exclusively for exporting copper because Ilo's economy is dominated by the copper industry. Because of pollutants from the refinery, very little fishing or agriculture exist in the area. Public health services are not as good as in Pisco. The public water supply available to the central part of Ilo is salinized and not potable; it flows at random times throughout the day for approximately 3 hours. Sewage and garbage collection are roughly equivalent. Previous research connecting public health services to infant mortality reports equivocal results. Common sense suggests that the availability of water, sewer, and garbage services should reduce mortality, but such a connection has not been found systematically. This study suggests that infant mortality may not depend solely on the type of public health services available. Rather, the scope of coverage and the proportion of the population with adequate services must be taken into account. Although local data on availability and scope of public health services are typically sketchy in survey data, more detailed information on these indicators may reveal the positive effect on infant mortality postulated for public health services.

Resource allocation decisions in low-income rural households.

PIP: This paper is based on the theory that a society's nutritional well-being is both a cause and a consequence of the developmental process within that society. An approach to the choices made by poor rural households regarding food acquisition and nurturing behavior is emerging from recent research based on the new economic theory of household production. The central thesis of this approach is that household decisions related to the fulfillment of basic needs are strongly determined by decisions on the allocation of time to household production activities. Summarized are the results of the estimation of a model of household production and consumption behavior with data from a cross-sectional survey of 30 rural communities in Veraguas Province, Panama. The struture of the model consists of allocation of resources to nurturing activities and to production activities. The resources to be allocated are time and market goods, and in theory, these are allocated according to relative prices. The empirical results of this study are generally consistent with the predictions of the neoclassical economic model of household resource allocation. The major conclusions that time allocations and market price conditions matter in the determination of well-being in low-income rural households and, importantly, that nurturing decisions significantly affect the product and factor market behavior of these households form the basis for a discussion on implucations for agricultural and rural development. Programs and policies that seek nutritional improvement should be determined with explicit recognition of the value of time and the importance of timing in the decisions of the poor.^ieng