Modeling transmission of avian influenza viruses at the human-animal-environment interface in Cuba.

Introduction: The increasing geographical spread of highly pathogenic avian influenza viruses (HPAIVs) is of global concern due to the underlying zoonotic and pandemic potential of the virus and its economic impact. An integrated One Health model was developed to estimate the likelihood of Avian Influenza (AI) introduction and transmission in Cuba, which will help inform and strengthen risk-based surveillance activities. Materials and methods: The spatial resolution used for the model was the smallest administrative district ("Consejo Popular"). The model was parameterised for transmission from wild birds to poultry and pigs (commercial and backyard) and then to humans. The model includes parameters such as risk factors for the introduction and transmission of AI into Cuba, animal and human population densities; contact intensity and a transmission parameter (ß). Results: Areas with a higher risk of AI transmission were identified for each species and type of production system. Some variability was observed in the distribution of areas estimated to have a higher probability of AI introduction and transmission. In particular, the south-western and eastern regions of Cuba were highlighted as areas with the highest risk of transmission. Discussion: These results are potentially useful for refining existing criteria for the selection of farms for active surveillance, which could improve the ability to detect positive cases. The model results could contribute to the design of an integrated One Health risk-based surveillance system for AI in Cuba. In addition, the model identified geographical regions of particular importance where resources could be targeted to strengthen biosecurity and early warning surveillance.

Ethnoracial disparities in childhood growth trajectories in Brazil: a longitudinal nationwide study of four million children.

BACKGROUND: The literature contains scarce data on inequalities in growth trajectories among children born to mothers of diverse ethnoracial background in the first 5 years of life. OBJECTIVE: We aimed to investigate child growth according to maternal ethnoracial group using a nationwide Brazilian database. METHODS: A population-based retrospective cohort study employed linked data from the CIDACS Birth Cohort and the Brazilian Food and Nutrition Surveillance System (SISVAN). Children born at term, aged 5 years or younger who presented two or more measurements of length/height (cm) and weight (kg) were followed up between 2008 and 2017. Prevalence of stunting, underweight, wasting, and thinness were estimated. Nonlinear mixed effect models were used to estimate childhood growth trajectories, among different maternal ethnoracial groups (White, Asian descent, Black, Pardo, and Indigenous), using the raw measures of weight (kg) and height (cm) and the length/height-for-age (L/HAZ) and weight-for-age z-scores (WAZ). The analyses were also adjusted for mother's age, educational level, and marital status. RESULTS: A total of 4,090,271 children were included in the study. Children of Indigenous mothers exhibited higher rates of stunting (26.74%) and underweight (5.90%). Wasting and thinness were more prevalent among children of Pardo, Asian, Black, and Indigenous mothers than those of White mothers. Regarding children's weight (kg) and length/height (cm), those of Indigenous, Pardo, Black, and Asian descent mothers were on average shorter and weighted less than White ones. Regarding WAZ and L/HAZ growth trajectories, a sharp decline in average z-scores was evidenced in the first weeks of life, followed by a period of recovery. Over time, z-scores for most of the subgroups analyzed trended below zero. Children of mother in greater social vulnerability showed less favorable growth. CONCLUSION: We observed racial disparities in nutritional status and childhood growth trajectories, with children of Indigenous mothers presenting less favorable outcomes compared to their White counterparts. The strengthening of policies aimed at protecting Indigenous children should be urgently undertaken to address systematic ethnoracial health inequalities.

A emergência do Zika vírus no Brasil e a resposta federal dos Sistemas Nacionais de Vigilância em Saúde e de Vigilância Sanitária / The Zika virus emergency in Brazil and the federal response of the National Public Health Surveillance and Brazilian Health Regulatory Systems

Resumo O artigo analisa a resposta federal dos Sistemas Nacionais de Vigilância em Saúde e de Vigilância Sanitária frente à epidemia do Zika vírus no Brasil, de 2015 a 2018, com foco nos contextos político-institucionais e no conteúdo das medidas governamentais desenvolvidas no período. O estudo ancorou-se na abordagem institucionalista histórica, compreendendo análise documental e entrevistas com atores-chave. A resposta se caracterizou pela priorização inicial da emergência sanitária na agenda política do governo federal, reduzindo-se ao longo do período, influenciada pelas crises financeira e política. Verificou-se multiplicidade de atores e instâncias voltadas à contingência, com certa articulação entre os dois sistemas, a partir de experiências pré-emergência próprias. O controle vetorial teve centralidade, valorizando ações intersetoriais e comunitárias, induzidas sobretudo pela Secretaria de Vigilância em Saúde do Ministério da Saúde e complementarmente pela Agência Nacional de Vigilância Sanitária. Observaram-se expressivas limitações alocativas de recursos financeiros novos e mudanças no aparato organizativo de resposta, com efeitos para a continuidade das políticas no pós-emergência, incluindo o desenvolvimento de medicamentos, vacinas e testes. A Emergência em Saúde Pública do Zika Vírus no Brasil foi marcada por limitada institucionalização de aprendizados e estratégias estruturantes, reduzindo oportunidades para a (re)organização das vigilâncias no Sistema Único de Saúde.

Abstract The article analyzes the federal response of the National Public Health Surveillance and Brazilian Health Regulatory Systems to the Zika virus epidemic in Brazil, from 2015 to 2018, focusing on the political-institutional contexts and the content of government measures developed during the period. The study was anchored in the historical institutionalist approach, comprising documentary analysis and interviews with key actors. The response was characterized by the initial prioritization of the health emergency on the federal government's political agenda, which was reduced over the period, influenced by the financial and political crises. There was a multiplicity of actors and instances focused on contingency, with a certain articulation between the two systems, based on their own pre-emergency experiences. Vector control had centrality, valuing intersectoral and community actions, induced mainly by the Health Surveillance Secretariat of the Ministry of Health and additionally by the National Health Surveillance Agency. Significant allocation limitations of new financial resources and changes in the organizational response apparatus were observed, with effects on the continuity of post-emergency policies, including the development of medicines, vaccines and tests. The Zika Virus Public Health Emergency in Brazil was marked by limited institutionalization of learning and structuring strategies, reducing opportunities for the (re)organization of surveillance in the Unified Health System.

Avaliação do sistema de vigilância em saúde do trabalhador relacionada aos acidentes de trabalho, antes e após a implantação do software de linkage Sentinela, em Porto Alegre, 2018-2021 / Evaluation of the occupational health surveillance system before and after the implementation of the Sentinela linkage software, in Porto Alegre, 2018-2021 / Evaluación del sistema de vigilancia de la salud del trabajador relacionada con los accidentes de trabajo, antes y después de la implementación del software de enlace Sentinela, en Porto Alegre, 2018-2021

O objetivo deste artigo é avaliar, segundo alguns atributos, o sistema de vigilância dos acidentes de trabalho antes e após a implantação do software Sentinela (2018-2021), com base em uma pesquisa descritiva de dados secundários, e efetuar recomendações. Foram analisadas variáveis da ficha de investigação, de acordo com os atributos qualidade dos dados (completitude e consistência), oportunidade e representatividade. Os resultados mostraram que, após o Sentinela, houve aumento da notificação de acidentes (66,16%), maior completitude das variáveis, com importante alteração na 'atividade econômica' (98,9%) e 'evolução' (96,3%), diminuição dos campos ignorados/em branco, com destaque para o campo 'evolução' (3,7%), e melhora na oportunidade de controle dos acidentes fatais (79 dias). Concluímos que a vigilância dos acidentes de trabalho tem excelente qualidade dos dados, é representativa, mas inoportuna. O Sentinela melhorou o sistema, tornando-o mais sensível na captação dos acidentes e permitindo-lhe ter informações de melhor qualidade. É necessária a avaliação rotineira dos atributos, para aprimoramento constante do sistema, assim como rever as rotinas das equipes de saúde, melhorando a oportunidade de controle por meio de suas ações

This article aims to evaluate the occupational health surveillance system before and after the implementa-tion of the Sentinela software (2018-2021), according to some attributes and based on descriptive research using secondary data, and to make recommendations. Variables of the accident investigation report were analysed, according to the attributes of data quality (completeness and consistency), opportunity and rep-resentativeness. The results have revealed that after Sentinela, there was an increase in the notification of accidents (66.16%), greater completeness of the variables, with an important change in 'economic activity' (98.9%) and 'evolution' (96.3%), a decreased in blank fields/information missing, with emphasis on the 'evolution' field (3.7%), and an improvement in the opportunity to control fatal accidents (79 days). We have concluded that the surveillance of the occupational accidents has excellent data quality, is representative, but inopportune. The Sentinela has improved the system, making it more sensitive in capturing accidents, allowing it to provide better quality of information. An evaluation of the attributes is routinely necessary to constantly improve the system, as well as reviewing the routines of health professionals, improving the opportunity to control by their actions

El objetivo de este artículo es evaluar, según algunos atributos, el sistema de vigilancia de los accidentes de trabajo antes y después de la implementación del software Sentinela (2018-2021), por medio de una investigación descriptiva de datos secundarios, y hacer recomendaciones. Fueron analizadas variables de la ficha de investigación de accidentes, de acuerdo con los atributos de calidad de los datos (completitud y consistencia), oportunidad y representatividad. Los resultados demostraron que, después del Sentinela, ha habido un aumento de la notificación de accidentes (66,16 %), una mayor completitud de las variables, con un cambio importante en 'actividad económica' (98,9 %) y 'evolución' (96,3 %), una disminución de campos ignorados/en blanco, con énfasis en el campo 'evolución' (3,7%), y mejora en la probabilidad de control de los accidentes mortales (79 días). Concluimos que la vigilancia de los accidentes de trabajo tiene excelente calidad de datos, es representativa, pero inoportuna. El Sentinela ha mejorado el sistema, haciéndolo más sensible en la captación de los accidentes y permitiéndole tener informaciones de mejor calidad. La evaluación de los atributos con regularidad es necesaria para el perfeccionamiento constante del sistema, así como la revisión de las rutinas de los equipos de salud, mejorando la oportunidad de control a través de sus acciones

Risk factors associated with suicide attempt as predictors of suicide, Colombia, 2016-2017.

BACKGROUND: Suicidal behaviour is the cause of half of all violent deaths. It is considered to be a public health problem with one million victims a year. Suicide attempt is the most important risk factor. In Colombia, in 2017 the suicide attempt rate was 51.8/100,000 inhabitants, and the fatality rate reached 10.0/100,000. The objective is to identify suicide attempt factors associated with death and determine survival after the attempt for 2 years. MATERIAL AND METHODS: Retrospective cohort study and survival analysis. A total of 42,594 records of the suicide attempt surveillance system databases and 325 records of death by suicide in 2016 and 2017 were analysed. The risk factors were examined and a χ2-test and multivariate analysis and logistic regression were performed. Cumulative survival probability was calculated using the Kaplan-Meier method. A Cox regression model was applied to determine the proportional relationship of the suicide attempt variables that are related to suicide. RESULTS: Men die by suicide 4.5 times more often than women. One in four suicide victims had made at least one prior suicide attempt. The attempt factors related with death by suicide were: male gender (HR = 2.99; 95% CI, 2.27-3.92), adulthood (over 29 years, HR = 2.38; 95% CI, 1.90-2.99), living in a rural area (HR = 2.56; 95% CI, 2.04-3.20), chronic disease history (HR = 2.43; 95% CI, 1.66-3.57) and depression disorder (HR = 1.94; 95% CI, 1.55-2.41). Some 50% of suicide deaths occur up to 560 days after the suicide attempt. CONCLUSIONS: The risk of suicide is highest in male patients, with a history of depression, chronic illness and exposure to heavy workloads.

Factores De Riesgo Relacionados Con Intento de Suicidio Como Predictores De suicidio, Colombia 2016-2017✩

Introducción: La conducta suicida es la causa de la mitad de las muertes violentas. Se considera un problema de salud pública con un millón de víctimas al año. El intento de suicidio es el factor de riesgo más importante. En Colombia, en 2017 la tasa de intento de suicidio fue de 51,8/100.000 hab. y la letalidad alcanzó 10,0/100.000. El objetivo es identificar factores del intento suicida asociados con la muerte y determinar la supervivencia después del intento durante 2 años. Material y métodos: Estudio de cohorte retrospectiva y análisis de supervivencia. Se cruzaron 42.594 registros del sistema de vigilancia de intento de suicidio con 325 muertes por suicidio del registro único de defunciones de 2016 y 2017. Se examinaron factores de riesgo, y se realizó la prueba de la x2, análisis multivariado y regresión logística. Se calculó la probabilidad de supervivencia acumulada con el método de Kaplan-Meier. Se aplicó un modelo de regresión de Cox para determinar la relación proporcional de las variables del intento suicida que se relacionan con suicidio. Resultados: Por cada muerte de mujer por suicidio, mueren 4,5 varones por esta causa; 1 de cada 4 personas fallecidas reportó al menos un intento previo. Los factores del intento relacionados con la muerte por suicidio fueron: ser varón (HR = 2,99; IC95%, 2,27-3,92), la edad adulta (> 29 años, HR = 2,38; IC95%, 1,90-2,99), vivir en área rural (HR = 2,56; IC95%, 2,04-3,20) y padecer enfermedad crónica (HR = 2,43; IC95%, 1,66-3,57) o trastorno depresivo (HR = 1,94; IC95%, 1,55-2,41). El 50% de las muertes por suicidio ocurren hasta en los 560 días posteriores al intento. Conclusiones: Se evidencia mayor riesgo de suicidio en pacientes varones, con historia de expresión, antecedentes de enfermedades crónicas y exposición a carga laboral.

Background: Suicidal behaviour is the cause of half of all violent deaths. It is considered to be a public health problem with one million victims a year. Suicide attempt is the most important risk factor. In Colombia, in 2017 the suicide attempt rate was 51.8/100,000 inhabitants, and he fatality rate reached 10.0/100,000. The objective is to identify suicide attempt factors associated with death and determine survival after the attempt for 2 years. Material and methods: Retrospective cohort study and survival analysis. A total of 42,594 records of the suicide attempt surveillance system databases and 325 records of death by suicide in 2016 and 2017 were analysed. The risk factors were examined and a X2-test and multivariate analysis and logistic regression were performed. Cumulative survival probability was calculated using the Kaplan-Meier method. A Cox regression model was applied to determine the proportional relationship of the suicide attempt variables that are related to suicide. Results: Men die by suicide 4.5 times more often than women. One in four suicide victims had made at least one prior suicide attempt. The attempt factors related with death by suicide were: male gender (HR = 2.99; 95% CI, 2.27-3.92), adulthood (over 29 years, HR = 2.38; 95% CI, 1.90-2.99), living in a rural area (HR = 2.56; 95% CI, 2.04-3.20), chronic disease history (HR = 2.43; 95% CI, 1.66-3.57) and depression disorder (HR = 1.94; 95% CI, 1.55-2.41). Some 50% of suicide deaths occur up to 560 days after the suicide attempt. Conclusions: The risk of suicide is highest in male patients, with a history of depression, chronic illness and exposure to heavy workloads.

Eliminating morbidity caused by neglected tropical diseases by 2030 / Eliminar la morbilidad causada por las enfermedades tropicales desatendidas para el 2030 / Eliminação até 2030 da morbidade causada pelas doenças tropicais negligenciadas

ABSTRACT The objective of this manuscript is to provide selective examples of the work of the Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Centre for Research and Training in Parasite Epidemiology and Control which contribute to the WHO goal of eliminating neglected tropical diseases by 2030. This PAHO/WHO CC specifically aligns its activities with the Sustainable Development Goals and with the goals outlined in the WHO Road Map for Neglected Tropical Diseases 2021-2030. Its role is to contribute to advancing global action on NTDs, primarily through policy development and knowledge translation. Three important projects have recently been completed: 1. Finalizing the Monitoring and Evaluation Framework for the NTD Road Map (published May 2021; this PAHO/WHO CC was a member of the working group); 2. Developing new guidelines for the preventive chemotherapy of Taenia solium taeniasis (published September 2021; this PAHO/WHO CC was co-Chair; and 3. Formulating a policy brief on deworming for adolescent girls and women of reproductive age (published January 2022; this PAHO/WHO CC is co-lead). These projects are the result of the integration of expertise and experience from multiple partners, including from PAHO and WHO (where both organizations provided key leadership), this PAHO/WHO CC, government ministries, civil society organizations and universities, among others. In conclusion, this PAHO/WHO CC contributes timely guidance to country-led evidence-informed public health policy, to cost-effective program implementation and to the identification of priority research topics - all focused, ultimately, on eliminating NTD-attributable morbidity by 2030.

RESUMEN El objetivo de este artículo es proporcionar ejemplos seleccionados de la labor del centro colaborador de investigación y capacitación en epidemiología y control de parásitos de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS), que contribuye al objetivo de la OMS de eliminar las enfermedades tropicales desatendidas para el 2030. Este centro colaborador de la OPS/OMS alinea sus actividades específicamente con los Objetivos de Desarrollo Sostenible y con los objetivos descritos en la Hoja de ruta sobre enfermedades tropicales desatendidas 2021-2030 de la OMS. Su función es contribuir al avance de las medidas mundiales sobre las enfermedades tropicales desatendidas, principalmente mediante la elaboración de políticas y la traducción de conocimiento. Recientemente se han completado tres proyectos importantes: 1) finalización del marco de seguimiento y evaluación de la Hoja de ruta sobre enfermedades tropicales desatendidas (publicado en mayo del 2021; este centro colaborador de la OPS/OMS formó parte del grupo de trabajo); 2) elaboración de nuevas directrices para la quimioterapia preventiva de la teniasis por Taenia solium (publicado en septiembre del 2021; este centro colaborador fue copresidente); y 3) formulación de un informe de políticas sobre la desparasitación de las adolescentes y las mujeres en edad reproductiva (publicado en enero del 2022; este centro colaborador fue coautor). Estos proyectos son el resultado de la integración del conocimiento y la experiencia de múltiples asociados, como la OPS y la OMS (ambas organizaciones ofrecieron un liderazgo clave), este centro colaborador de la OPS/OMS, así como varios ministerios gubernamentales, organizaciones de la sociedad civil y universidades, entre otros. En conclusión, este centro colaborador de la OPS/OMS ofrece orientaciones oportunas para las políticas de salud pública basadas en la evidencia lideradas por los países, la ejecución de programas costo-efectivos y la determinación de los temas de investigación prioritarios, todo ello destinado, en última instancia, a eliminar la morbilidad atribuible a las enfermedades tropicales desatendidas para el 2030.

RESUMO O objetivo deste manuscrito é fornecer exemplos seletivos do trabalho do Centro Colaborador de Pesquisa e Treinamento em Epidemiologia e Controle de Parasitos da Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) que contribuem para a meta da OMS de eliminar até 2030 as doenças tropicais negligenciadas. Este CC da OPAS/OMS alinha especificamente suas atividades com os Objetivos de Desenvolvimento Sustentável e com as metas delineadas no Roteiro da OMS para Doenças Tropicais Negligenciadas 2021-2030. Seu papel é contribuir para o avanço da ação global contra doenças tropicais negligenciadas, principalmente por meio do desenvolvimento de políticas e da tradução de conhecimentos. Três importantes projetos foram concluídos recentemente: 1. Finalização da Estrutura de Monitoramento e Avaliação do Roteiro para as DTN (publicada em maio de 2021 - este CC da OPAS/OMS foi membro do grupo de trabalho); 2. Desenvolvimento de novas diretrizes para a quimioprofilaxia da teníase por Taenia solium (publicado em setembro de 2021 - este CC da OPAS/OMS foi copresidente); e 3. Formulação de orientação para políticas de desparasitação para adolescentes e mulheres em idade reprodutiva (publicado em janeiro de 2022 - este CC da OPAS/OMS foi cogestor). Esses projetos são o resultado da integração de conhecimentos e experiência de múltiplos parceiros, incluindo a OPAS e a OMS (onde ambas as organizações forneceram liderança essencial), este CC da OPAS/OMS, ministérios governamentais, organizações da sociedade civil e universidades, entre outros. Em suma, este CC da OPAS/OMS contribui com orientações oportunas para uma política de saúde pública liderada pelos países e informada com base em evidências, para a implementação de programas com boa relação custo-benefício e para a identificação de tópicos prioritários de pesquisa - todos focados, em última análise, na eliminação da morbidade atribuível às DTN até 2030.

Morbimortalidade materna no Brasil e a urgência de um sistema nacional de vigilância do near miss materno / Maternal morbidity and mortality in Brazil and the urgency of a national surveillance system for maternal near miss / La morbimortalidad materna en Brasil y la urgencia de un sistema nacional de vigilancia del near miss materno

A Organização Mundial da Saúde (OMS) recomenda a análise dos casos de morbidade materna severa/near miss materno como complemento às análises das mortes de mães, dado que a incidência é mais elevada e os fatores preditivos dos dois desfechos são semelhantes. Tendo em vista que as razões de mortalidade materna, no Brasil, têm se mantido constantes apesar do compromisso firmado durante a Assembleia Geral da Organização das Nações Unidas (ONU), em 2015, o objetivo deste artigo é propor um sistema nacional de vigilância de near miss materno. Propõe-se a inclusão dos eventos near miss materno na Lista Nacional de Notificação Compulsória de Doenças, Agravos e Eventos de Saúde Pública, por meio da compatibilização dos critérios diagnósticos de near miss materno, informados pela OMS, com os códigos da Classificação Internacional de Doenças (CID) para identificação dos casos. Tendo em vista que a vigilância em saúde se faz baseada em diversas fontes de informações, a notificação poderia ser feita pelos profissionais dos serviços de saúde tão logo fosse identificado um caso confirmado ou suspeito. A partir do estudo dos fatores associados aos desfechos, espera-se a avaliação mais qualificada dos serviços voltados à assistência obstétrica e consequente implementação de políticas mais eficientes de prevenção não apenas do óbito materno, mas de eventos que podem tanto causar sequelas irreversíveis à saúde da mulher quanto aumento do risco de óbito fetal e neonatal.

The World Health Organization (WHO) recommends the analysis of severe maternal morbidity/maternal near miss cases as complementary to the analysis of maternal deaths since the incidence is higher and the predictive factors of the two outcomes are similar. Considering that the reasons for maternal mortality in Brazil have remained constant despite the commitment made during the General Assembly of the United Nations in 2015, this article aims to propose a nationwide maternal near miss surveillance system. We propose the inclusion of maternal near miss events in the National List of Compulsory Notification of Diseases, Injuries, and Public Health Events, via the compatibility of the diagnostic criteria of maternal near miss, informed by the WHO, with the codes of the International Classification of Diseases for the identification of cases. Considering that health surveillance is based on several sources of information, notification could be made by health service professionals as soon as a confirmed or suspected case is identified. With the study of the factors associated with the outcomes, we expect a qualified evaluation of the services focused on obstetric care and consequent implementation of more efficient policies to prevent not only maternal death but also events that can both cause irreversible sequelae to women's health and increase the risk of fetal and neonatal death.

La Organización Mundial de la Salud (OMS) recomienda el análisis de los casos de morbilidad materna grave/near miss materno como complemento a los análisis de las muertes maternas, dado que la incidencia es más elevada y los factores predictivos de los dos resultados son similares. Teniendo en vista que las razones de mortalidad materna, en Brasil, se han mantenido constantes a pesar del compromiso firmado durante la Asamblea General de la Organización de las Naciones Unidas, en el año 2015, el objetivo de este artículo es proponer un sistema de vigilancia de near miss materno de alcance nacional. Se propone la inclusión de los eventos de near miss materno en la Lista Nacional de Notificación Obligatoria de Enfermedades, Agravios y Eventos de Salud Pública, por medio de la compatibilización de los criterios diagnósticos de near miss materno; informados por la OMS, con los códigos de la Clasificación Internacional de Enfermedades para identificación de los casos. Teniendo en vista que la vigilancia en salud se basa en diversas fuentes de Informaciones, la notificación podría ser hecha por los profesionales de los servicios de salud, tan pronto fuese identificado un caso confirmado o sospechoso. Se espera que el estudio de los factores asociados a los resultados conduzca a una evaluación más calificada de los servicios de atención obstétrica y a la consecuente implementación de políticas más eficientes de prevención no solo de la muerte materna; sino de eventos que pueden tanto causar secuelas irreversibles a la salud de la mujer como aumento del riesgo de muerte fetal y neonatal.

Plataforma de monitoreo y evaluación para HEARTS en las Américas: hacia la mejora de los programas de control de la hipertensión a nivel poblacional en la atención primaria de salud / Monitoring and evaluation platform for HEARTS in the Americas: improving population-based hypertension control programs in primary health care / Plataforma de monitoramento e avaliação do programa HEARTS nas Américas: melhoria dos programas de controle da hipertensão de base populacional na atenção primária à saúde

RESUMEN HEARTS en las Américas es el programa insignia de la Organización Panamericana de la Salud para acelerar la reducción de la carga de enfermedades cardiovasculares (ECV) mediante la mejora del control de la hipertensión y la prevención secundaria de las ECV en la atención primaria de salud. Es necesaria una plataforma de monitoreo y evaluación (M&E) para ejecutar el programa, establecer puntos de referencia y notificar a los responsables de las políticas. En este artículo se describen las bases conceptuales de la plataforma de M&E de HEARTS, como los principios de diseño del software, la contextualización de los módulos de recopilación de datos, la estructura de los datos, la presentación de información y la visualización. Se escogió la plataforma web District Health Information Software 2 (DHIS2) para ejecutar el ingreso de los datos agregados de los indicadores de resultados, procesos y factores de riesgo estructurales de las ECV. Además, se eligió PowerBI para la visualización de datos y la elaboración del panel de control para el análisis del desempeño y las tendencias más allá del nivel de los centros de atención médica. El desarrollo de esta nueva plataforma de información se centró en el ingreso de datos de los centros de atención primaria de salud, la presentación oportuna de datos, las visualizaciones y, en última instancia, el uso activo de los datos para impulsar la toma de decisiones en la ejecución del programa con equidad y la mejora de calidad de la atención. Además, se evaluaron las enseñanzas extraídas y las consideraciones programáticas con la experiencia del desarrollo de software de M&E. Lograr el apoyo y la voluntad política es esencial para desarrollar y poner en marcha una plataforma flexible en múltiples países que sea contextualmente específica según las necesidades de las diversas partes interesadas y los niveles del sistema de atención de la salud. La plataforma de M&E de HEARTS brinda apoyo para la ejecución del programa y muestra las limitaciones estructurales y gerenciales, así como las brechas en la atención. Esta plataforma será fundamental para monitorear e impulsar nuevas mejoras a nivel de la población en lo que respecta a las ECV y otras enfermedades no transmisibles relacionadas.

ABSTRACT HEARTS in the Americas is the Pan American Health Organization flagship program to accelerate the reduction of the cardiovascular disease (CVD) burden by improving hypertension control and CVD secondary prevention in primary health care. A monitoring and evaluation (M&E) platform is needed for program implementation, benchmarking, and informing policy-makers. This paper describes the conceptual bases of the HEARTS M&E platform including software design principles, contextualization of data collection modules, data structure, reporting, and visualization. The District Health Information Software 2 (DHIS2) web-based platform was chosen to implement aggregate data entry of CVD outcome, process, and structural risk factor indicators. In addition, PowerBI was chosen for data visualization and dashboarding for the analysis of performance and trends above the health care facility level. The development of this new information platform was focused on primary health care facility data entry, timely data reporting, visualizations, and ultimately active use of data to drive decision-making for equitable program implementation and improved quality of care. Additionally, lessons learnt and programmatic considerations were assessed through the experience of the M&E software development. Building political will and support is essential to developing and deploying a flexible platform in multiple countries which is contextually specific to the needs of various stakeholders and levels of the health care system. The HEARTS M&E platform supports program implementation and reveals structural and managerial limitations and care gaps. The HEARTS M&E platform will be central to monitoring and driving further population-level improvements in CVD and other noncommunicable disease-related health.

RESUMO A iniciativa HEARTS nas Américas é o principal programa da Organização Pan-Americana da Saúde para acelerar a redução da carga de doenças cardiovasculares (DCV) por meio do melhoramento do controle da hipertensão e da prevenção secundária de DCV na atenção primária à saúde. Uma plataforma de monitoramento e avaliação (M&E, na sigla em inglês) é necessária para a implementação do programa, para fazer a avaliação comparativa e para informar os formuladores de políticas. Este documento descreve as bases conceituais da plataforma de M&E do HEARTS, incluindo princípios de design de software, contextualização dos módulos de coleta de dados, estrutura de dados, relatórios e visualização. A plataforma baseada na web do District Health Information Software 2 (DHIS2) foi escolhida para implementar a inserção de dados agregados de indicadores de fatores de risco estruturais, processos e desfechos de DCV. Além disso, o PowerBI foi escolhido para a visualização de dados e para fazer o dashboard da análise de desempenho e tendências para além do nível da unidade de saúde. O desenvolvimento desta nova plataforma de informações teve como foco a inserção de dados da unidade de atenção primária à saúde, a notificação oportuna de dados, visualizações e o uso ativo dos dados para orientar a tomada de decisões para a implementação equitativa do programa e a melhoria da qualidade do atendimento. Além disso, as lições aprendidas e as considerações programáticas foram avaliadas por meio da experiência do desenvolvimento do software de M&E. Fomentar vontade política e apoio é essencial para desenvolver e implantar uma plataforma flexível em vários países, que seja contextualmente específica para as necessidades das diferentes partes interessadas e níveis do sistema de saúde. A plataforma de M&E do HEARTS ampara a implementação do programa e revela limitações estruturais e gerenciais, bem como lacunas na atenção à saúde. A plataforma de M&E do HEARTS será central para monitorar e impulsionar mais melhorias no nível populacional em DCV e outras doenças não transmissíveis.

Vigilância Sanitária em Debate: 10 anos de contribuição ao conhecimento em saúde / Health Surveillance in Debate: 10 years of contributions to knowledge in healthcare

Este debate, resultado de um breve estudo sobre o periódico Vigilância Sanitária em Debate: Sociedade, Ciência & Tecnologia (Visa em Debate) em sua primeira década, teve como objetivo apresentar uma visão panorâmica das publicações, que foram classificadas em categorias previamente definidas; também foram identificadas as instituições às quais os autores das publicações estavam vinculados. A categoria Objetos sob Controle Sanitário abriga o maior quantitativo de publicações, com 72,0% do total, entre as quais predominam alimentos, medicamentos, e serviços de saúde e de interesse da saúde. As categorias Sistema Nacional de Vigilância Sanitária; Regulação e Vigilância Sanitária; Doenças, Agentes, Epidemiologia; e Tecnologias Analíticas apresentam quantitativos semelhantes, em torno de 7,0%. Entre as instituições de vínculos dos autores, as universidades e outras instituições de ensino superior são aquelas com maior número de vínculos, em todas as regiões. A Região Sudeste concentra o maior número de referências, seguida do Nordeste, Sul, Centro-Oeste e, por último, a Região Norte. Também foram referidos vínculos a universidades de outros países, como Canadá, França, Portugal e Colômbia. Observou-se uma grande diversidade de temáticas em todas as categorias de classificação das publicações, também lacunas e/ou poucos trabalhos em certos temas relevantes para a área. Este estudo denota que o periódico vem se constituindo um relevante veículo de disseminação do conhecimento em saúde em geral e vigilância sanitária em especial. Neste pouco tempo já foi indexada em importantes bases de dados científicos e conta com uma boa classificação Qualis/Capes na área interdisciplinar da saúde, o que contribui para um número crescente de publicações oriundas de renomadas universidades.

This debate is the result of a brief study in the journal Health Surveillance in Debate: Society, Science & Technology (Visa em Debate) in its first decade. The objective is to present a panoramic view of the publications of this journal. The articles were classified into previously defined categories and the institutions to which the authors of the publications were linked were also identified. The category "Objects Under Sanitary Control" contains the largest number of publications, with 72.0% of the total, among which food, medicines and health services predominated. The categories "National Health Surveillance System", "Health Regulation and Surveillance", "Diseases, Agents, Epidemiology", and "Analytical Technologies" presented similar amounts of around 7.0%. Among the authors' affiliation institutions, universities and other higher education institutions are the ones with the highest number, in all regions. The Southeast region possesses the largest number of references, followed by the Northeast, South, Midwest, and finally the North region. In addition, links to universities in other countries, such as Canada, France, Portugal, and Colombia, were mentioned. A great diversity of themes was observed in all categories of classification and there are still gaps and/or few works in certain themes that are relevant to the area. This study shows that the journal has become a relevant vehicle for the dissemination of knowledge in health in general, and sanitary surveillance, in particular. In this short time, this journal has already been indexed in relevant scientific databases and has a good Qualis/Capes classification in the interdisciplinary area of health, which contributes to a growing number of publications from renowned universities.

Provider-Initiated HIV Testing in Puerto Rico from Data of the National HIV Behavioral Surveillance-Heterosexual Cycle (NHBS-HET) 2016: National Cross-sectional Survey.

BACKGROUND: According to the Centers for Disease Control and Prevention and World Health Organization guidelines, all individuals aged 13-64 years should get screened for HIV infection as part of their routine medical examinations. Individuals at high risk should get tested annually. OBJECTIVE: This study aimed to identify the sociodemographic, health care, and sexual behavioral characteristics of provider-initiated HIV testing using data from the Puerto Rico National HIV Behavioral Surveillance 2016 cycle, directed toward heterosexual individuals at increased risk of HIV infection. METHODS: A sample of 358 eligible participants were recruited through respondent-driven sampling, where sociodemographic characteristics, health care use, and HIV test referral were used to assess a description of the study sample. Pearson chi-square and Fisher tests were used to evaluate proportional differences. Multivariate logistic regression models were performed to determine the association between independent variables and HIV test referral. Adjusted prevalence ratios by sex and age with their 95% CIs were determined using a statistical significance level of .05. RESULTS: Despite 67.9% (243/358) of participants showing high-risk sexual behavioral practices and 67.4% (236/350) reporting a low perceived risk of HIV infection among those who visited a health care provider within the last 12 months, 80.7% (289/358) of the study sample did not receive an HIV test referral at a recent medical visit. Multivariate analysis showed that the estimated prevalence of the participants who received an HIV test referral among those who reported being engaged in high-risk sexual behaviors was 41% (adjusted prevalence ratio .59, 95% CI .39-.91; P=.02) lower than the estimated prevalence among those who did not engage in high-risk sexual behavior. CONCLUSIONS: This sample of Puerto Rican adults reported a significantly lower prevalence of receiving an HIV test referral among heterosexual individuals at increased risk of HIV infection who engaged in high-risk behaviors. This study further emphasizes the need for health care providers to follow recommended guidelines for HIV test referrals in health care settings. Promotion practices in the future should include enhancing referral and access to HIV tests and implementing preventive measures to counteract the HIV epidemic in Puerto Rico.

Epidemiological surveillance in COVID- 19 pandemic: EPIVIGILA system. / Epidemiological surveillance in COVID-19 pandemic: EPIVIGILA system.

In March 2020, the first version of EPIVIGILA was deployed in a productive environment a few days after the first local case of COVID- 19. This system is a technological integration plat-form for national epidemiological surveillance of notifiable diseases. Previously, Chile used a manual process that would probably have failed with a peak volume of more than 38 000 daily notifications; in a country with 18 million inhabitants, long and narrow geography, and centralized governance. This work highlights the importance of the national electronic surveillance system EPIVIGILA in managing the pandemic. The systems main strength is its ability to adapt to the needs of reliable, precise, timely, and real- time information. EPIVIGILA was able to include, under the circumstances, different flows, actors, data, and functionalities with high expectations of accuracy. This valuable information allowed the authorities to assess the impact of the measures to manage and control the pandemic. Its versatility positions this platform among the few globally that operates national data with a high level of granularity in a single system through a pandemic. In Chile, EPIVIGILA is the primary source of information for daily reports, epidemiological reports, and data published on government websites about COVID- 19. Thus, electronic systems prove fundamental for public health because the recording and processing of data generate clear, reliable, and timely information, helping authorities make decisions to reduce the spread of infectious diseases, prevent deaths, and improve the populations quality of life.

En marzo 2020 se despliega la primera versión de EPIVIGILA en un ambiente productivo, plataforma de integración tecnológica de vigilancia epidemiológica nacional para enfermedades de notificación obligatoria (a pocos días del caso 1 de COVID- 19 local). Anteriormente, Chile usaba un proceso manual que probablemente hubiese fracasado ante un volumen máximo superior a 38 000 notificaciones diarias, en un país con 18 millones de habitantes, de geografía larga y angosta y gobernanza centralizada. El objetivo del trabajo es relevar la importancia que tiene en el manejo de la pandemia el sistema nacional de vigilancia electrónico EPIVIGILA. La principal fortaleza del sistema es su capacidad de adaptación a las necesidades de información fidedigna, precisa, oportuna y en tiempo real. EPIVIGILA fue capaz de incluir, en el curso de las circunstancias, distintos flujos, actores, datos y funcionalidades con altas expectativas de exactitud. Ello permitió que las autoridades pudieran evaluar el impacto de las medidas implementadas para el manejo y control de la pandemia. Su versatilidad posiciona a esta plataforma entre las pocas en el mundo que opera datos nacionales en una pandemia con un alto nivel de granularidad en un único sistema. En Chile, EPIVIGILA es la principal fuente de información para los reportes diarios, informes epidemiológicos y datos publicados en sitios web gubernamentales sobre COVID- 19. Así, el uso de sistemas electrónicos muestran ser un soporte fundamental para la salud pública, porque el registro y procesamiento de los datos genera información clara, confiable y oportuna, contribuyendo a que las autoridades puedan tomar decisiones orientadas a disminuir la propagación de enfermedades transmisibles, evitar muertes y mejorar la calidad de vida de la población.

Network analysis of pig movements in Ecuador: Strengthening surveillance of classical swine fever.

The analysis of domestic pig movements has become useful to understand the disease spread patterns and epidemiology, which facilitates the development of more effective animal diseases control strategies. The aim of this work was to analyse the static and spatial characteristics of the pig network, to identify its trading communities and to study the contribution of the network to the transmission of classical swine fever. In this regard, we used the pig movement records from the National Veterinary Service of Ecuador (2017-2019), using social network analysis and spatial analysis to construct a network with registered premises as nodes and their movements as edges. Furthermore, we also created a network of parishes as its nodes by aggregating their premises movements as edges. The annual network metrics showed an average diameter of 20.33, a number of neighbours of 2.61, a shortest path length of 4.39 and a clustering coefficient of 0.38 (small-world structure). The most frequent movements were to or from markets (55%). Backyard producers made up 89% of the network premises, and the top 2% of parishes (highest degree) contributed to 50% of the movements. The highest frequencies of movements between parishes were in the centre of the country, while the highest frequency of movements to abattoirs was in the south-west. Finally, the pattern of classical swine fever (CSF) disease outbreaks within the Ecuador network was likely the result of network transmission processes. In conclusion, our results represented the first exploratory analysis of domestic pig movements at premise and parish levels. The surveillance system could consider these results to improve its procedures and update the disease control and management policy, and allow the implementation of targeted or risk-based surveillance.

Vigilancia epidemiológica en pandemia de COVID-19: Sistema EPIVIGILA / Epidemiological surveillance in COVID- 19 pandemic: EPIVIGILA system

En marzo 2020 se despliega la primera versión de EPIVIGILA en un ambiente productivo, plataforma de integración tecnológica de vigilancia epidemiológica nacional para enfermedades de notificación obligatoria (a pocos días del caso 1 de COVID- 19 local). Anteriormente, Chile usaba un proceso manual que probablemente hubiese fracasado ante un volumen máximo superior a 38 000 notificaciones diarias, en un país con 18 millones de habitantes, de geografía larga y angosta y gobernanza centralizada. El objetivo del trabajo es relevar la importancia que tiene en el manejo de la pandemia el sistema nacional de vigilancia electrónico EPIVIGILA. La principal fortaleza del sistema es su capacidad de adaptación a las necesidades de información fidedigna, precisa, oportuna y en tiempo real. EPIVIGILA fue capaz de incluir, en el curso de las circunstancias, distintos flujos, actores, datos y funcionalidades con altas expectativas de exactitud. Ello permitió que las autoridades pudieran evaluar el impacto de las medidas implementadas para el manejo y control de la pandemia. Su versatilidad posiciona a esta plataforma entre las pocas en el mundo que opera datos nacionales en una pandemia con un alto nivel de granularidad en un único sistema. En Chile, EPIVIGILA es la principal fuente de información para los reportes diarios, informes epidemiológicos y datos publicados en sitios web gubernamentales sobre COVID- 19. Así, el uso de sistemas electrónicos muestran ser un soporte fundamental para la salud pública, porque el registro y procesamiento de los datos genera información clara, confiable y oportuna, contribuyendo a que las autoridades puedan tomar decisiones orientadas a disminuir la propagación de enfermedades transmisibles, evitar muertes y mejorar la calidad de vida de la población.

In March 2020, the first version of EPIVIGILA was deployed in a productive environment a few days after the first local case of COVID- 19. This system is a technological integration plat-form for national epidemiological surveillance of notifiable diseases. Previously, Chile used a manual process that would probably have failed with a peak volume of more than 38 000 daily notifications; in a country with 18 million inhabitants, long and narrow geography, and centralized governance. This work highlights the importance of the national electronic surveillance system ­ EPIVIGILA ­ in managing the pandemic. The system's main strength is its ability to adapt to the needs of reliable, precise, timely, and real- time information. EPIVIGILA was able to include, under the circumstances, different flows, actors, data, and functionalities with high expectations of accuracy. This valuable information allowed the authorities to assess the impact of the measures to manage and control the pandemic. Its versatility positions this platform among the few globally that operates national data with a high level of granularity in a single system through a pandemic. In Chile, EPIVIGILA is the primary source of information for daily reports, epidemiological reports, and data published on government websites about COVID- 19. Thus, electronic systems prove fundamental for public health because the recording and processing of data generate clear, reliable, and timely information, helping authorities make decisions to reduce the spread of infectious diseases, prevent deaths, and improve the population's quality of life.

Evaluation of Selective Deltamethrin Application with Household and Community Awareness for the Control of Chagas Disease in Southern Ecuador.

Chagas disease is endemic in ~70% of Ecuador. Rhodnius ecuadoriensis and Triatoma carrioni (Hemiptera: Reduviidae) are the primary vectors of Chagas disease in Southern Ecuador. This study tested the effectiveness of selective deltamethrin application of Domiciliary Units (DUs) infested with triatomines, coupled with community education activities and a community-based surveillance system. Ten communities were selected in Loja Province, 466 DUs were examined, of these, 5.6% were infested with R. ecuadoriensis (Density [D] = 4 triatomines/DUs searched, Crowding [CR] = 71 triatomines/infested house, Colonization Index [CI] = 77% infested DUs with nymphs) and 8% with T. carrioni (D = 0.6, CR = 7, CI = 64%). Infested DUs were sprayed with deltamethrin. Subsequent visits were conducted at 6 and 12 mo after spraying. At each time point, new entomological searches were carried out in all DUs. All entomological indexes dropped significantly for the primary vector species one year after the initial intervention (R. ecuadoriensis: I = 2%, D = 0.1, CR = 7, CI = 100%; T. carrioni: I = 1.6%, D = 0.1, CR = 5.5, CI = 50%). Fifteen min educational talks were conducted in every DUs and workshops for schoolchildren were organized. Community-based surveillance system was established. However, there is a high risk of DUs reinfestation, possibly from sylvatic habitats (especially of R. ecuadoriensis) and reinforcing educational and surveillance activities are necessary.

Factors associated with the severity of road traffic injuries from emergency department based surveillance system in two Mexican cities.

BACKGROUND: Limited data from low- and middle-income countries (LMICs) on the severity of road traffic injuries (RTIs) and their relation to different variables of interest are routinely obtained. Knowledge on this subject relies on evidence from high-income countries, which might not be the same as in LMICs. This information is greatly needed to advance and inform local and regional efforts towards the United Nations' Decade of Action and the Sustainable Development Goals. METHODS: From May 2012 to November 2014, a RTI surveillance system was implemented in two referral hospitals in two Mexican cities, León and Guadalajara, with the objective of exploring the relationship between Injury Severity Score (ISS) and different sociodemographic characteristics of the injured as well as different variables related to the event and the environment. All individuals suffering RTIs who visited the Emergency Rooms (ER) were included after granting informed consent. A Zero-Truncated Negative Binomial Model was employed to explore the statistical association between ISS and variables of interest. RESULTS: 3024 individuals participated in the study: 2185 (72.3%) patients from León and 839 patients (27.7%) from Guadalajara. Being male, in the 20-59 age-group, having less schooling, events occurring in Guadalajara, on Sundays, at night, and arriving at ER via public/private ambulance were all associated with an increased log count of ISS. Found a significant interaction effect (p-value< 0.05) between type of road user and alcohol intake six hours before the accident on severity of the injury (ISS). The use of illicit drugs, cellphones and safety devices during the event showed no association to ISS. CONCLUSIONS: Our study contributes to the statistical analysis of ISS obtained through RTI hospital surveillance systems. Findings might facilitate the development and evaluation of focused interventions to reduce RTIs in vulnerable users, to enhance ER services and prehospital care, and to reduce drink driving.

Evaluation of the collaborative integrated surveillance system (ViCo) in Guatemala: a qualitative study on lessons learned and future perspectives.

BACKGROUND: The collaborative integrated surveillance system known as Vigilancia Integrada Comunitaria (ViCo) was implemented in 2007 to better understand and characterize the burden of diarrheal, respiratory and febrile illnesses in Guatemala. METHODS: To evaluate the usefulness of ViCo and inform a redesign of the system and new surveillance activities in the Central American region, personnel from the United States Centers for Disease Control and Prevention (CDC) conducted thirty-nine in-depth interviews from June-December 2018 with key stakeholders responsible for the design and implementation of ViCo in Guatemala. A semi-structured questionnaire adapted from the Updated CDC Guidelines for Evaluating Public Health Surveillance Systems was used for data collection. We used a grounded theory approach to explore stakeholder perceptions of ViCo and generate recommendations for improvement. Primary qualitative findings were organized based on thematic areas using ATLAS.ti version 8 software. RESULTS: Emergent themes relevant to the usefulness of ViCo were organized across strengths, weaknesses, and recommendations pertaining to the: (1) Size and Complexity of ViCo, (2) Stakeholder Expectations About the Objectives of ViCo, (3) Data Management and Structure of the Information System, (4) Local Control of Data, (5) Integration of ViCo within the Ministry of Health, and, (6) Improvement of the Operational and Design Aspects of ViCo across System, Process, and Output levels. CONCLUSIONS: Stakeholders perceived ViCo to be useful. They recommended measures to improve system performance and quality, including simplifying the surveillance system, routine data analysis and feedback, and channeling efforts towards integrating surveillance data into the national health information system. To create a well-performing surveillance system and achieve the intended objective of surveillance for public health action, ongoing evaluation and assessment of surveillance activities are necessary.

Age and Sex-Related Associations between Marital Status, Physical Activity and TV Time.

Marital status mediates an association between physical activity (PA) and TV time with health outcomes. However, population-based studies have revealed that the health effect of marriage or divorce is age-dependent and differs between women and men. The study aimed to identify the age and sex-related associations between marital status with PA and TV time. We used data from Vigitel, an annual telephone survey started in 2006 in Brazil. We applied a complex sample logistic regression model to estimate the odds for PA and TV time comparing marital statuses according to age and sex subgroups, independent of obesity, hypertension, diabetes, self-assessed poor health, and smoking. Our sample included 561,837 individuals from 18 to 99 years, with a TV time > 3 h/day (prevalence = 25.2%) and PA > 150 min/week (prevalence = 35%). Later, we divided our sample in seven age groups by marital status and sex. Compared to single individuals, married men and women were less likely to watch TV more than 3 h/day in participants >30 years old. When compared to single, married participants were less likely to do more than 150 min of PA/week at younger age groups. Married women older than 40 years were more likely to do more than 150 min of PA/week than the single ones, while there were no differences among married men by age group. In conclusion, our study suggests that the investments in public policies to encourage the practice of PA and reduction of TV time could be based on the marital status, sex, and age, prioritizing less active groups.

Individual and Socioeconomic Contextual Factors Associated with Obesity in Brazilian Adolescents: VigiNUTRI Brasil.

This study investigated the association of socioeconomic contextual factors of the municipality of residence of adolescents, their eating behavior and food consumption with the prevalence of obesity. This was a cross-sectional study, based on individual data regarding anthropometry, eating behavior (eating in front of screens and having at least three main meals a day), and markers of healthy and unhealthy eating of 23,509 adolescents aged 10 to 19 years, participating in the Food and Nutrition Surveillance of the Brazilian Population monitored in Primary Health Care (VigiNUTRI Brasil) assessment in 2018. Based on multilevel Poisson regression, a higher prevalence of obesity was observed among adolescents living in municipalities with per capita income above USD209.68 (PR = 1.22; 95% CI 1.05;1.42) and among those who consumed hamburgers and/or processed meats the previous day (PR = 1.09; 95% CI 1.01;1.17). Adolescents who had the habit of having three main meals a day (PR = 0.81; 95% CI 0.73;0.89 p < 0.05) and who consumed fresh fruit the previous day (PR = 0.91; 95% CI 0.84;0.98 p < 0.001) had lower prevalence of obesity. The results reinforce the influence of the social context and food consumption on obesity rates. The persistence of this situation implies a worsening in the current and future health of adolescents.

Evaluation of Selective Deltamethrin Application with Household and Community Awareness for the Control of Chagas Disease in Southern Ecuador

Chagas disease is endemic in ~70% of Ecuador. Rhodnius ecuadoriensis and Triatoma carrioni (Hemiptera: Reduviidae) are the primary vectors of Chagas disease in Southern Ecuador. This study tested the effectiveness of selective deltamethrin application of Domiciliary Units (DUs) infested with triatomines, coupled with community education activities and a community-based surveillance system. Ten communities were selected in Loja Province, 466 DUs were examined, of these, 5.6% were infested with R. ecuadoriensis (Density [D] = 4 triatomines/DUs searched, Crowding [CR] = 71 triatomines/infested house, Colonization Index [CI] = 77% infested DUs with nymphs) and 8% with T. carrioni (D = 0.6, CR = 7, CI = 64%). Infested DUs were sprayed with deltamethrin. Subsequent visits were conducted at 6 and 12 mo after spraying. At each time point, new entomological searches were carried out in all DUs. All entomological indexes dropped significantly for the primary vector species one year after the initial intervention (R. ecuadoriensis: I = 2%, D = 0.1, CR = 7, CI = 100%; T. carrioni: I = 1.6%, D = 0.1, CR = 5.5, CI = 50%). Fifteen min educational talks were conducted in every DUs and workshops for schoolchildren were organized. Community-based surveillance system was established. However, there is a high risk of DUs reinfestation, possibly from sylvatic habitats (especially of R. ecuadoriensis) and reinforcing educational and surveillance activities are necessary.