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1.
Washington, D.C.; OPS; 2021-02-25.
in Spanish | PAHO-IRIS | ID: phr-53308

ABSTRACT

La tuberculosis sigue representando un problema grave de salud pública en la Región de las Américas, y más aún en el caso de los pueblos indígenas, en los que registra una incidencia muy superior a la de la población general. Para el control de la tuberculosis en estos pueblos es necesario responder a sus necesidades diversas desde una perspectiva intercultural, que permita la aplicación de un abordaje holístico —desde un plano de igualdad y respeto mutuo— y considere el valor de sus prácticas culturales. En la Región de las Américas se ha avanzado en el reconocimiento de la necesidad de integrar la interculturalidad en los servicios de salud, pero persisten obstáculos basados en la discriminación, el racismo y la exclusión que se ejercen sobre las poblaciones indígenas y otros grupos étnicos. Para responder a esta situación, la Organización Panamericana de la Salud (OPS) ha elaborado estos lineamientos que, a partir de un enfoque intercultural que está en consonancia con las líneas prioritarias de la actual Política sobre etnicidad y salud de la OPS y su desarrollo práctico en los pueblos indígenas de la Región, constituyen un instrumento de ayuda para implementar la Estrategia Fin de la TB. Esta publicación integra la experiencia acumulada de la OPS y las buenas prácticas desarrolladas por sus Estados Miembros en los últimos años, incluidas las discusiones y experiencias compartidas en las reuniones regionales celebradas sobre el tema, y pone el acento en la innovación y la inclusión social. Esto requiere cambiar con urgencia los paradigmas tradicionales, partiendo de las acciones específicas que reducen gradualmente la incidencia de la TB para dirigirnos hacia acciones multisectoriales de eficacia demostrada en la contención rápida de la epidemia.


Subject(s)
Tuberculosis , Indigenous Peoples , Health of Indigenous Peoples , Social Discrimination , Racism , Ethnic Groups , Public Health , Americas , Caribbean Region
2.
Article in English | PAHO-IRIS | ID: phr-53281

ABSTRACT

[ABSTRACT]. Objective. Construct and evaluate the care cascade for pulmonary tuberculosis in the indigenous population of the department of Cauca (Colombia) and identify existing gaps. Methods. Mixed-methods sequential explanatory design. In the first phase, the pulmonary tuberculosis care cascade for the indigenous population of Cauca was evaluated. Data were obtained from secondary sources and all cases diagnosed from 1 January 2016 to 31 December 2017 were included. In the second phase, semi-structured interviews were done with nine program coordinators and 11 nursing auxiliaries to explain identified gaps. Absolute and percentage values were estimated for each of the steps and gaps in the care cascade. Quantitative and qualitative results were triangulated. Results. In 2016 and 2017, an estimated 202 patients with respiratory symptoms were expected to be positive and 106 cases of pulmonary tuberculosis were reported among the indigenous population of the department of Cauca. A gap of 47.5% was found for diagnosis, since only 52.5% of subjects were diagnosed in health services. This gap was explained by poor quality of samples and flawed smear techniques; flaws in correct identification of patients with respiratory symptoms; limited access to diagnostic methods, such as culture and molecular tests; and limited training and high turnover of personnel in health service provider institutions. Conclusions. The tuberculosis control program should focus actions on bridging the gap in case detection in the indigenous population.


[RESUMEN]. Objetivo. Construir y evaluar la cascada de atención de la tuberculosis pulmonar en la población indígena del departamento del Cauca (Colombia) e identificar las brechas existentes. Métodos. Metodología mixta con diseño secuencial explicativo. En la primera fase se evaluó la cascada de atención de la tuberculosis pulmonar para la población indígena del Cauca. Se obtuvieron datos de fuentes secundarias y se incluyeron todos los casos diagnosticados entre el 1 de enero del 2016 y el 31 de diciembre de 2017. En la segunda fase, se aplicaron entrevistas semiestructuradas a nueve coordinadores de programa y 11 auxiliares de enfermería para explicar las brechas identificadas. Se estimaron los valores absolutos y porcentuales en cada uno de los pasos y las brechas de la cascada de atención. Se triangularon los resultados cuantitativos y cualitativos. Resultados. Durante 2016 y 2017 se estimaron 202 sintomáticos respiratorios esperados positivos y se notificaron 106 casos de tuberculosis pulmonar en la población indígena del departamento del Cauca. Se encontró una brecha de 47,5% para el diagnóstico, ya que solo 52,5% de los sujetos recibieron el diagnóstico en los servicios de salud. Las explicaciones a esta brecha fueron la mala calidad de muestras y fallas en la técnica del extendido, fallas en la correcta identificación del sintomático respiratorio, acceso limitado a métodos diagnósticos como cultivo y pruebas moleculares, así como capacitación escasa y rotación alta de personal al interior de las instituciones prestadoras de servicios de salud. Conclusiones. Las acciones del programa de control de tuberculosis deben enfocarse en reducir la brecha de detección de casos en la población indígena.


[RESUMO]. Objetivo. Elaborar e avaliar a cascata de atenção da tuberculose pulmonar na população indígena do Departamento de Cauca (Colômbia) e identificar as lacunas existentes. Métodos. Metodologia mista com desenho sequencial explicativo. Na primeira fase, avaliamos a cascata de atenção da tuberculose pulmonar para a população indígena de Cauca. Os dados foram obtidos de fontes secundárias, incluindo todos os casos diagnosticados entre 1 de janeiro de 2016 e 31 de dezembro de 2017. Na segunda fase, realizamos entrevistas semiestruturadas com nove coordenadores do programa e 11 auxiliares de enfermagem para explicar as lacunas identificadas. Estimamos os valores absolutos e percentuais em cada uma das etapas e as lacunas na cascata de atenção. Os resultados quantitativos e qualitativos foram triangulados. Resultados. Nos anos de 2016 e 2017, foi estimada a ocorrência de 202 casos com sintomas respiratórios com diagnóstico esperado positivo; no entanto, os serviços de saúde só diagnosticaram e notificaram 106 casos de tuberculose pulmonar na população indígena do Departamento de Cauca. Portanto, identificamos uma lacuna diagnóstica de 47,5%, já que apenas 52,5% dos casos receberam um diagnóstico nos serviços de saúde. As explicações para esta lacuna foram a má qualidade das amostras e falhas na técnica de esfregaço, falhas na identificação correta dos sintomas respiratórios, acesso limitado aos métodos de diagnóstico, tais como cultura e testes moleculares, bem como capacitação deficiente e alta rotatividade de pessoal nas instituições de saúde. Conclusões. As ações do programa de controle da tuberculose devem se concentrar em reduzir a lacuna na detecção de casos na população indígena.


Subject(s)
Tuberculosis , Population Groups , Health Services, Indigenous , Health Care Quality, Access, and Evaluation , Colombia , Population Groups , Health Services, Indigenous , Health Care Quality, Access, and Evaluation , Tuberculosis , Population Groups , Health Services, Indigenous , Health Care Quality, Access, and Evaluation , Colombia
3.
Glob Public Health ; 16(4): 639-649, 2021 04.
Article in English | MEDLINE | ID: mdl-33491559

ABSTRACT

COVID-19 is a challenge for indigenous communities in Mexico. Social inequalities and limited access to services combine with historical patterns of discrimination to amplify its negative impacts. Nevertheless, there are important ways in which indigenous communities organise and respond. Our paper, organised in three parts, summarises these challenges as well as the response. In the first section, we introduce indigenous Oaxaca and the challenges facing indigenous communities. In the second section, we note the ways in which indigenous communities rely on their traditions in response to the pandemic and limitations they face. In the third and concluding section, we argue that the social inequalities that define indigenous life in Oaxaca must be acknowledged in order to create an effective public health response to COVID-19.


Subject(s)
/epidemiology , Communicable Disease Control/organization & administration , Health Services Accessibility , Indigenous Peoples , Pneumonia, Viral/epidemiology , Socioeconomic Factors , Humans , Mexico , Pandemics , Pneumonia, Viral/virology , Poverty
4.
Aust N Z J Obstet Gynaecol ; 61(1): 135-141, 2021 02.
Article in English | MEDLINE | ID: mdl-33350455

ABSTRACT

BACKGROUND: Indigenous women in the high-income countries of Canada, Australia, New Zealand and USA, have a higher incidence and mortality from cervical cancer than non-Indigenous women. Increasing cervical screening coverage could ultimately decrease cervical cancer disparities. AIMS: To increase cervical screening for under-screened/never-screened Maori women. MATERIALS AND METHODS: This study was a cluster randomised controlled trial. Inclusion criteria were women aged 25-69, last screened ≥4 years ago, in Northland, New Zealand. The intervention arm was the offer of a human papilloma virus (HPV) self-test and the control arm was the usual offer of standard care - a cervical smear. The primary outcome was rate of cervical screening in the intervention group compared to control in Maori, the Indigenous peoples of New Zealand. Six primary care clinics were randomly allocated to intervention or control. RESULTS: Of 500 eligible Maori women in the intervention arm, 295 (59.0%) were screened. Of 431 eligible Maori women in the control arm, 94 (21.8%) were screened. Adjusting for age, time since last screen, deprivation index, Maori women in the intervention arm were 2.8 times more likely to be screened than women in the control arm (95% CI: 2.4-3.1, P-value <0.0001). CONCLUSIONS: Offer of HPV self-testing could potentially halve the number of under-screened/never-screened Maori women and decrease cervical morbidity and mortality. These results may be generalisable to benefit Indigenous peoples facing similar barriers in other high-income countries.


Subject(s)
Alphapapillomavirus , Papillomavirus Infections , Uterine Cervical Neoplasms , Adult , Aged , Australia , Early Detection of Cancer , Female , Humans , Indigenous Peoples , Middle Aged , New Zealand , Papillomavirus Infections/complications , Papillomavirus Infections/diagnosis , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/etiology
5.
BMJ Open ; 10(12): e044197, 2020 12 29.
Article in English | MEDLINE | ID: mdl-33376182

ABSTRACT

AIM: To explore indigenous communities' responses to the COVID-19 pandemic and its consequences for maternal and neonatal health (MNH) care in the Peruvian Amazon. METHODS: Mamás del Río is a community-based, MNH programme with comprehensive supervision covering monthly meetings with community health workers (CHW), community leaders and health facilities. With the onset of the lockdown, supervisors made telephone calls to discuss measures against COVID-19, governmental support, CHW activities in communities and provision of MNH care and COVID-19 preparedness at facilities. As part of the programme's ongoing mixed methods evaluation, we analysed written summaries of supervisor calls collected during the first 2 months of Peru's lockdown. RESULTS: Between March and May 2020, supervisors held two rounds of calls with CHWs and leaders of 68 communities and staff from 17 facilities. Most communities banned entry of foreigners, but about half tolerated residents travelling to regional towns for trade and social support. While social events were forbidden, strict home isolation was only practised in a third of communities as conflicting with daily routine. By the end of April, first clusters of suspected cases were reported in communities. COVID-19 test kits, training and medical face masks were not available in most rural facilities. Six out of seven facilities suspended routine antenatal and postnatal consultations while two-thirds of CHWs resumed home visits to pregnant women and newborns. CONCLUSIONS: Home isolation was hardly feasible in the rural Amazon context and community isolation was undermined by lack of external supplies and social support. With sustained community transmission, promotion of basic hygiene and mask use becomes essential. To avoid devastating effects on MNH, routine services at facilities need to be urgently re-established alongside COVID-19 preparedness plans. Community-based MNH programmes could offset detrimental indirect effects of the pandemic and provide an opportunity for local COVID-19 prevention and containment.


Subject(s)
Communicable Disease Control , Community Health Services , Infant Health , Maternal Health , Adult , /prevention & control , Communicable Disease Control/organization & administration , Communicable Disease Control/standards , Community Health Services/methods , Community Health Services/organization & administration , Community Health Services/standards , Disease Transmission, Infectious/prevention & control , Female , Health Knowledge, Attitudes, Practice , Health Services Needs and Demand , Health Services, Indigenous/trends , Humans , Infant Health/statistics & numerical data , Infant Health/trends , Infant, Newborn , Male , Maternal Health/statistics & numerical data , Maternal Health/trends , Peru/epidemiology , Pregnancy , Preventive Health Services/methods
6.
PLoS One ; 15(12): e0243988, 2020.
Article in English | MEDLINE | ID: mdl-33326453

ABSTRACT

BACKGROUND: The Guarani-Kaiowá are Brazil's second-largest indigenous group. Average annual tuberculosis (TB) incidence rates among the Guarani-Kaiowá are nearly 400/100,000 in Mato Grosso do Sul state, ten times the national average. Although stigma is considered crucial for TB control in indigenous communities, few studies have investigated TB stigma among indigenous populations. This study sought to understand the role of TB-related stigma and perceptions of TB in maintaining hyperendemic TB transmission in the Guarani-Kaiowá communities. METHODS: Various forms of stigma were explored through semi-structured interviews with 19 patients, 11 relatives, and 23 community members. Patients were identified from the registry of the healthcare service. Community members, selected by snowball sampling, were matched by gender and village of residence. Interviews were conducted in Guarani and Portuguese and later translated into English. Framework analysis was performed using NVivo. RESULTS: Traditional beliefs of a weakening of the body allowing the disease to enter were common, but the exact mechanism of transmission was unknown. Strong community/public stigma associated TB with uncleanliness, abuse, and irresponsibility. Anticipated stigma led to significant treatment delays for fear of exclusion and losing employment. While most patients felt supported by their families, nearly all patients related experienced/enacted stigma in the community such as gossip, avoidance, and social exclusion, leading to long-lasting internalized/self-stigma. Secondary stigmatization of relatives was widespread, and blanket latent TB infection (LTBI) treatment of patients' households was a contributing factor in treatment delay. The healthcare service unnecessarily added to stigmatization by enforcing separate utensils and sleeping arrangements for patients. CONCLUSIONS: Our findings suggest that stigma is a driver for treatment delay and continued transmission of TB in the community. The stigmatization of TB was rooted in a poor understanding of TB transmission, partly because of incorrect orientation by the healthcare service. Interventions to reduce TB-associated stigma are urgently needed.


Subject(s)
Indigenous Peoples/psychology , Social Stigma , Tuberculosis/psychology , Adult , Brazil , Female , Humans , Male , Patient Isolation/psychology , Social Isolation , Tuberculosis/prevention & control , Tuberculosis/therapy
7.
Article in Spanish | PAHO-IRIS | ID: phr-53137

ABSTRACT

[RESUMEN]. Objetivo. Construir y evaluar la cascada de atención de la tuberculosis pulmonar en la población indígena del departamento del Cauca (Colombia) e identificar las brechas existentes. Métodos. Metodología mixta con diseño secuencial explicativo. En la primera fase se evaluó la cascada de atención de la tuberculosis pulmonar para la población indígena del Cauca. Se obtuvieron datos de fuentes secundarias y se incluyeron todos los casos diagnosticados entre el 1 de enero del 2016 y el 31 de diciembre de 2017. En la segunda fase, se aplicaron entrevistas semiestructuradas a nueve coordinadores de programa y 11 auxiliares de enfermería para explicar las brechas identificadas. Se estimaron los valores absolutos y porcentuales en cada uno de los pasos y las brechas de la cascada de atención. Se triangularon los resultados cuantitativos y cualitativos. Resultados. Durante 2016 y 2017 se estimaron 202 sintomáticos respiratorios esperados positivos y se notificaron 106 casos de tuberculosis pulmonar en la población indígena del departamento del Cauca. Se encontró una brecha de 47,5% para el diagnóstico, ya que solo 52,5% de los sujetos recibieron el diagnóstico en los servicios de salud. Las explicaciones a esta brecha fueron la mala calidad de muestras y fallas en la técnica del extendido, fallas en la correcta identificación del sintomático respiratorio, acceso limitado a métodos diagnósticos como cultivo y pruebas moleculares, así como capacitación escasa y rotación alta de personal al interior de las instituciones prestadoras de servicios de salud. Conclusiones. Las acciones del programa de control de tuberculosis deben enfocarse en reducir la brecha de detección de casos en la población indígena.


[ABSTRACT]. Objective. Construct and evaluate the care cascade for pulmonary tuberculosis in the indigenous population of the department of Cauca (Colombia) and identify existing gaps. Methods. Mixed-methods sequential explanatory design. In the first phase, the pulmonary tuberculosis care cascade for the indigenous population of Cauca was evaluated. Data were obtained from secondary sources and all cases diagnosed from 1 January 2016 to 31 December 2017 were included. In the second phase, semi-structured interviews were done with nine program coordinators and 11 nursing auxiliaries to explain identified gaps. Absolute and percentage values were estimated for each of the steps and gaps in the care cascade. Quantitative and qualitative results were triangulated. Results. In 2016 and 2017, an estimated 202 patients with respiratory symptoms were expected to be positive and 106 cases of pulmonary tuberculosis were reported among the indigenous population of the department of Cauca. A gap of 47.5% was found for diagnosis, since only 52.5% of subjects were diagnosed in health services. This gap was explained by poor quality of samples and flawed smear techniques; flaws in correct identification of patients with respiratory symptoms; limited access to diagnostic methods, such as culture and molecular tests; and limited training and high turnover of personnel in health service provider institutions. Conclusions. The tuberculosis control program should focus actions on bridging the gap in case detection in the indigenous population.


[RESUMO]. Objetivo. Elaborar e avaliar a cascata de atenção da tuberculose pulmonar na população indígena do Departamento de Cauca (Colômbia) e identificar as lacunas existentes. Métodos. Metodologia mista com desenho sequencial explicativo. Na primeira fase, avaliamos a cascata de atenção da tuberculose pulmonar para a população indígena de Cauca. Os dados foram obtidos de fontes secundárias, incluindo todos os casos diagnosticados entre 1 de janeiro de 2016 e 31 de dezembro de 2017. Na segunda fase, realizamos entrevistas semiestruturadas com nove coordenadores do programa e 11 auxiliares de enfermagem para explicar as lacunas identificadas. Estimamos os valores absolutos e percentuais em cada uma das etapas e as lacunas na cascata de atenção. Os resultados quantitativos e qualitativos foram triangulados. Resultados. Nos anos de 2016 e 2017, foi estimada a ocorrência de 202 casos com sintomas respiratórios com diagnóstico esperado positivo; no entanto, os serviços de saúde só diagnosticaram e notificaram 106 casos de tuberculose pulmonar na população indígena do Departamento de Cauca. Portanto, identificamos uma lacuna diagnóstica de 47,5%, já que apenas 52,5% dos casos receberam um diagnóstico nos serviços de saúde. As explicações para esta lacuna foram a má qualidade das amostras e falhas na técnica de esfregaço, falhas na identificação correta dos sintomas respiratórios, acesso limitado aos métodos de diagnóstico, tais como cultura e testes moleculares, bem como capacitação deficiente e alta rotatividade de pessoal nas instituições de saúde. Conclusões. As ações do programa de controle da tuberculose devem se concentrar em reduzir a lacuna na detecção de casos na população indígena.


Subject(s)
Tuberculosis , Health of Indigenous Peoples , Population Groups , Health Services, Indigenous , Health Care Quality, Access, and Evaluation , Colombia , Population Groups , Health of Indigenous Peoples , Health Services, Indigenous , Health Care Quality, Access, and Evaluation , Tuberculosis , Health of Indigenous Peoples , Population Groups , Health Services, Indigenous , Health Care Quality, Access, and Evaluation , Colombia
8.
N Z Med J ; 133(1524): 50-63, 2020 10 30.
Article in English | MEDLINE | ID: mdl-33119570

ABSTRACT

BACKGROUND: Most cervical cancers are associated with human papillomavirus (HPV) types 16 and 18. In 2008, New Zealand commenced a quadrivalent HPV (virus-like particles of types 6, 11, 16 and 18) vaccination programme. AIM: Document trends in number of colposcopy referrals and number and grade of cervical abnormalities diagnosed in women (20-24 years) referred to three large colposcopy clinics over time. METHOD: Retrospective analysis of colposcopy clinic data. RESULTS: The dataset included 5,012 episodes from 4,682 women. In Auckland (2013-2017), there was a 38% decrease in colposcopy referrals and 55% decrease in cervical intraepithelial neoplasia grade 2 (CIN2) or worse diagnoses. In Waikato (2011-2017), there was an 8% decrease in referrals and 22% reduction in CIN2 or worse diagnoses. In Canterbury (2011-2017), there was a 24% decrease in referrals and 49% reduction in CIN2 or worse diagnoses. Across all centres, the decrease in cervical intraepithelial neoplasia grade 3 (CIN3) or worse diagnoses was marked and more consistent than in CIN2 diagnoses. However, while the proportion of biopsies reported as CIN3 or worse decreased in non-Maori (24% in 2013 vs 16% in 2017, nptrend z=-4.24, p>|z| <.001), there was no change in Maori women (31% in 2013 vs 29% in 2017, nptrend z=-0.12, p>|z| =.90). CONCLUSIONS: We observed a decreased number of CIN diagnoses in young women over time, with a particularly large drop in the number of CIN3/AIS/CGIN diagnoses. However, compared to non-Maori, Maori women having biopsies are more likely to have CIN3 or worse and there was a smaller reduction in the total number of Maori women diagnosed with CIN2 or worse.


Subject(s)
Cervical Intraepithelial Neoplasia/epidemiology , Papillomavirus Vaccines , Uterine Cervical Neoplasms/epidemiology , Biopsy , Cervical Intraepithelial Neoplasia/diagnosis , Colposcopy/trends , Female , Humans , Indigenous Peoples , Neoplasm Grading , New Zealand/epidemiology , Oceanic Ancestry Group , Papillomavirus Infections/prevention & control , Retrospective Studies , Uterine Cervical Neoplasms/diagnosis , Young Adult
9.
Ciênc. Saúde Colet ; 25(10): 3745-3752, Out. 2020. tab, graf
Article in Portuguese | LILACS-Express | LILACS, Coleciona SUS, Sec. Est. Saúde SP | ID: biblio-1132990

ABSTRACT

Resumo O objetivo deste artigo é analisar a tendência da tuberculose (TB) em indígenas no Brasil no período de 2011-2017. Trata-se de um estudo ecológico realizado com todos os casos novos de TB em indígenas notificados no Sistema de Informação de Agravos de Notificação, durante o período 2011 a 2017. Foram confeccionados mapas temáticos para acompanhamento da evolução espaço-temporal da TB na população indígena em cada ano. Para o estudo da tendência utilizou-se o modelo de regressão linear generalizada de Prais-Winsten. No período em estudo, foram notificados 6.520 casos de TB em indígenas. A incidência geral de TB em indígenas no Brasil foi de 109/100.000 habitantes. Na análise por regiões do país, as maiores incidências ocorreram nas regiões Centro-Oeste, Norte e Sudeste. Na análise por UF, as maiores incidências foram encontradas no Mato Grosso, São Paulo, Rondônia, Mato Grosso do Sul, Acre, Maranhão, Pará e Rio de Janeiro. A tendência da doença nos indígenas foi estável tanto no país quanto na maioria das suas regiões e UF. A TB afeta desproporcionalmente os indígenas brasileiros e o presente estudo ao identificar regiões e UF prioritárias pode contribuir para a elaboração e fortalecimento de ações de controle mais específicas.


Abstract This paper aims to analyze the trend of tuberculosis (TB) in Brazilian indigenous people from 2011 to 2017. This ecological study was carried out with all new TB cases in indigenous people reported in the Notifiable Diseases Information System during the 2011-2017 period. Thematic maps were prepared to monitor the spatial-temporal evolution of TB in the indigenous population each year, and the Prais-Winsten generalized linear regression model was used to analyze the trend. A total of 6,520 TB cases were reported in indigenous people during the study period. The overall incidence of TB in Brazilian indigenous people for the period was 109/100,000 inhabitants. In the analysis by region of the country, the highest incidence occurred in the Midwest, North, and Southeast regions. In the UF analysis, the highest incidence was found in Mato Grosso, São Paulo, Rondônia, Mato Grosso do Sul, Acre, Maranhão, Pará, and Rio de Janeiro. The trend of the disease in the indigenous was stable both in the country and in most of its regions and UFs. TB disproportionately affects Brazilian indigenous people, and this study can contribute to the elaboration and strengthening of more specific control actions by identifying priority regions and UFs.

10.
Cien Saude Colet ; 25(10): 3745-3752, 2020 Oct.
Article in Portuguese, English | MEDLINE | ID: mdl-32997008

ABSTRACT

This paper aims to analyze the trend of tuberculosis (TB) in Brazilian indigenous people from 2011 to 2017. This ecological study was carried out with all new TB cases in indigenous people reported in the Notifiable Diseases Information System during the 2011-2017 period. Thematic maps were prepared to monitor the spatial-temporal evolution of TB in the indigenous population each year, and the Prais-Winsten generalized linear regression model was used to analyze the trend. A total of 6,520 TB cases were reported in indigenous people during the study period. The overall incidence of TB in Brazilian indigenous people for the period was 109/100,000 inhabitants. In the analysis by region of the country, the highest incidence occurred in the Midwest, North, and Southeast regions. In the UF analysis, the highest incidence was found in Mato Grosso, São Paulo, Rondônia, Mato Grosso do Sul, Acre, Maranhão, Pará, and Rio de Janeiro. The trend of the disease in the indigenous was stable both in the country and in most of its regions and UFs. TB disproportionately affects Brazilian indigenous people, and this study can contribute to the elaboration and strengthening of more specific control actions by identifying priority regions and UFs.

11.
Parasitol Res ; 119(10): 3181-3201, 2020 Oct.
Article in English | MEDLINE | ID: mdl-32803334

ABSTRACT

Giardia is a parasite distributed worldwide and one of the most prevalent intestinal protozoa in Argentina. We analysed all the national information regarding the prevalence of Giardia infections in humans, animals and environmental surveys over the last 40 years. In this work, we used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and the period between 1980 and 2019 was defined as time lapse for inclusion of the studies. The analysis was conducted using the LILACS, PubMed, Scopus and Argentina SciELO databases employing as keywords 'Giardia' AND 'Argentina'. We also carried out a manual review of papers. Of 304 articles, 92 fitted the eligibility criteria. Giardia was reported in 15 of the 23 Argentine provinces; human prevalence was between 3.4 and 64.8%. Indigenous children and residents in peri-urban areas had the higher infection rates. In animals, Giardia was identified mainly in dogs with a prevalence of 8.9 ± 7.0%, and studies of wild animals and cattle were notably scarce. Environmental studies showed that Giardia was detected in the soil and water which may act as reservoirs for this parasite revealing the need to modify the national water treatment legislation. The identification of Giardia genetic assemblages in the studies analysed was limited and showed that genotypes AII and B were found in humans while assemblage B was mainly detected in animals. This report provides useful information on epidemiological aspects of giardiasis in Argentina that may help to define future research priorities and provides useful tools for professionals regarding actual information on the prevalence of this infection.


Subject(s)
Drinking Water/parasitology , Giardia lamblia/genetics , Giardia lamblia/isolation & purification , Giardiasis/epidemiology , Soil/parasitology , Adolescent , Animals , Animals, Wild/parasitology , Argentina/epidemiology , Cattle , Child , Child, Preschool , Dogs , Feces/parasitology , Female , Genotype , Humans , Indigenous Peoples/statistics & numerical data , Prevalence , Risk Factors , Surveys and Questionnaires , Water Purification
12.
Article in English | MEDLINE | ID: mdl-32824314

ABSTRACT

Many studies document the relationship between housing quality and health status. Poor housing in Aboriginal communities continues to be linked to the compromised health status of Aboriginal Australians. The New South Wales (NSW) Housing for Health (HfH) program has been assessing and repairing Aboriginal community housing across the state for 20 years using a standardised intervention methodology that aims to improve the health of Aboriginal people in NSW by improving their living environments. Items are tested and repairs are prioritised to maximise safety and health benefits and measured against 11 Critical Healthy Living Priorities (e.g., safety, facilities for washing people and clothes, removing waste and preparing food). Descriptive analysis of data collected pre- and post-intervention from 3670 houses was conducted to determine the effectiveness of the program. Analysis demonstrated statistically significant improvements in the ability of the houses to support safe and healthy living for all critical healthy living priorities post-interventions. Trend analysis demonstrated the magnitude of these improvements increased over 20 years. In 24 communities (n = 802 houses) where projects were repeated (5-17 years later), results indicate sustainability of improvements for 9 of 11 priorities. However, the overall condition of health-related hardware in Aboriginal community housing across NSW pre-intervention has not significantly changed during the program's 20 years. Results suggest a systematic lack of routine maintenance and quality control continues to be the overwhelming cause for this lack of improvement pre-intervention. Our evaluation of the HfH program demonstrated that fidelity to a standardised housing testing and repair methodology to improve residents' safety and health can have sustainable effects on housing infrastructure and associated health benefits, such as a 40% reduction in infectious disease hospital separations. Housing and health agencies should collaborate more closely on social housing programs and ensure programs are adequately resourced to address safety and health issues.


Subject(s)
Health Status , Housing , Oceanic Ancestry Group , Australia , Humans , Infection Control , New South Wales , Safety
15.
Washington; Organización Panamericana de la Salud; ago 25, 2020. 11 p. ilus.
Non-conventional in Spanish | LILACS | ID: biblio-1117907

ABSTRACT

El Programa Subregional para América del Sur (SAM) representa la visión estratégica de la OPS/OMS a mediano plazo para la subregión sudamericana. El Programa apoya las prioridades subregionales en materia de salud y busca armonizar el trabajo de OPS/OMS con los mecanismos de integración, particularmente con el Mercado Común del Sur (MERCOSUR), el Organismo Andino de Salud - Convenio Hipólito Unanue (ORAS-CONHU), la Organización del Tratado de Cooperación Amazónica (OTCA), PROSUR, Alianza del Pacífico y otros socios.


Subject(s)
Humans , Personnel Management , Health Systems/organization & administration , Communicable Disease Control , Health of Indigenous Peoples , Pandemics/prevention & control , Noncommunicable Diseases/prevention & control , Pan American Health Organization , Pneumonia, Viral/epidemiology , Border Areas , Climate Change , Coronavirus Infections/epidemiology , Mercosur , Betacoronavirus , Latin America
16.
Lima; Perú. Ministerio de Salud; 20200700. 20 p. tab.
Monography in Spanish | LILACS, MINSAPERÚ | ID: biblio-1102563

ABSTRACT

El documento contiene los lineamientos de prevención, reducción y contención de infecciones respiratorias y COVID-19 en los ámbitos geográficos identificados con presencia de PIA y PICI, con un enfoque intercultural y de derechos humanos.


Subject(s)
Preventive Medicine , Communicable Diseases , Coronavirus Infections , Indigenous Peoples
17.
Aust N Z J Public Health ; 44(4): 279-283, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32583522

ABSTRACT

OBJECTIVES: Determine major barriers to, and facilitators of, influenza vaccination of Aboriginal adults, in order to improve coverage from the current level of 30%. METHODS: i) A focus group with 13 Aboriginal Immunisation Healthcare Workers; and ii) a cross-sectional survey of Aboriginal people aged ≥18 years at the 2017 New South Wales Koori Knockout (29 September-2 October). RESULTS: The focus group nominated poor identification of Aboriginality in general practice. Of 273 survey respondents, a substantial minority (30%) were unaware of their eligibility for free influenza vaccination. More than half (52%) believed the vaccine could cause influenza, 40% reported there were better ways than vaccination for avoiding infection and 30% said they would not have the vaccine if it was offered to them. Regarding health service access, few reported experiencing difficulty (17%), feeling uncomfortable (15%) or being discriminated against (8%), but 53% reported not receiving a reminder from a health professional. CONCLUSIONS: Misconceptions about influenza disease and vaccine among Aboriginal people and inadequate identification of Aboriginality in general practice appear to be the greatest barriers to vaccination, rather than health service access in general. Implications for public health: More active communication to and targeting of Aboriginal adults is required; this is even more urgent following the arrival of COVID-19.


Subject(s)
Health Knowledge, Attitudes, Practice , Health Services Accessibility , Influenza Vaccines/administration & dosage , Influenza, Human/prevention & control , Oceanic Ancestry Group/statistics & numerical data , Vaccination/statistics & numerical data , Adolescent , Adult , Cross-Sectional Studies , Female , General Practice , Health Personnel , Health Services, Indigenous/organization & administration , Humans , Immunization Programs , Male , Middle Aged , Oceanic Ancestry Group/psychology , Vaccination Coverage
18.
Lancet Child Adolesc Health ; 4(6): 425-434, 2020 06.
Article in English | MEDLINE | ID: mdl-32450122

ABSTRACT

BACKGROUND: The burden of acute lower respiratory infection (ALRI) in Indigenous children of Australia's Northern Territory is among the highest globally. No published data exists on the effect of pneumococcal conjugate vaccine (PCV) introduction on ALRIs in this population beyond 2005. The aim of this study was to describe the rates of ALRI admissions to hospital in Indigenous infants in the Northern Territory from 2006 to 2015, across three periods of different PCV use. We hypothesised that broader valency PCVs would be more effective against hospitalisations for pneumonia. METHODS: We did a retrospective population-based cohort study of Indigenous infants born in the Northern Territory followed up until age 12 months. Data were from administrative hospital and perinatal datasets. International classification of diseases codes (tenth revision, Australian modification; ICD-10AM) were used to identify respiratory hospitalisations of interest: all-cause ALRI, all-cause pneumonia, bacterial pneumonia, viral pneumonia, influenza-like illness (ILI), respiratory syncytial virus ALRI (RSV-ALRI), and pneumococcal ALRI. Incidence rates were compared between PCV eras (7-valent PCV [PCV7], 2006-09; 10-valent PCV [PCV10], 2009-11; and 13-valent PCV [PCV13], 2011-15) using interrupted time trend analysis and negative binomial regression. FINDINGS: For children born between Jan 1, 2006, and Dec 31, 2015, 4138 ALRI episodes (31% of all hospitalisations) occurred among 2888 (20%) of the 14 594 infants. The overall ALRI hospitalisation rate was 29·7 episodes per 100 child-years. Prominent risk factors associated with ALRI hospitalisation were living in a remote community or the Central desert region, being born preterm or with low birthweight. ALRI rates were lowest in the PCV13 era, in association with a significant reduction in bacterial pneumonia hospitalisations in the PCV13 era compared with the PCV10 (incidence rate ratio 0·68, 95% CI 0·57-0·81) and PCV7 (0·70, 0·60-0·81) eras. In contrast, RSV-ALRI rates were 4·9 episodes per 100 child-years in each era. INTERPRETATION: A 30% reduction in bacterial-coded pneumonia hospitalisations in the Northern Territory during the era of PCV13 immunisation supports its ongoing use in the region. Despite the reduction, one in five Indigenous infants born in the region continue to be hospitalised with an ALRI in their first year of life. Future gains require multifaceted environmental and biomedical approaches. FUNDING: National Health and Medical Research Council of Australia.


Subject(s)
Hospitalization/statistics & numerical data , Pneumococcal Vaccines/administration & dosage , Pneumonia, Pneumococcal/prevention & control , Respiratory Tract Infections/epidemiology , Acute Disease , Cohort Studies , Databases, Factual , Female , Humans , Incidence , Indigenous Peoples/statistics & numerical data , Infant , Infant, Newborn , Male , Northern Territory/epidemiology , Pneumonia, Pneumococcal/epidemiology , Respiratory Tract Infections/prevention & control , Retrospective Studies , Vaccination/statistics & numerical data
19.
Ir J Psychol Med ; 37(3): 237-242, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32406358

ABSTRACT

Since COVID-19 first emerged internationally, Australia has applied a number of public health measures to counter the disease' epidemiology. The public heath response has been effective in virus testing, diagnosing and treating patients with COVID-19. The imposed strict border restrictions and social distancing played a vital role in reducing positive cases via community transmission resulting in 'flattening of the curve'. Now is too soon to assess the impact of COVID-19 on people's mental health, as it will be determined by both short- and long-term consequences of exposure to stress, uncertainty, loss of control, loneliness and isolation. The authors explored cultural and societal influences on mental health during the current pandemic utilising Geert Hofstede's multidimensional construct of culture and determined psychological and cultural factors that foster resilience. We also reflected on the psychological impact of the pandemic on the individual and the group at large by utilising Michel Foucault' and Jacques Lacan' psychoanalytic theories. Remote Aboriginal Australian communities have been identified as a high-risk subpopulation in view of their unique vulnerabilities owing to their compromised health status, in addition to historical, systemic and cultural factors. Historically, Australia has prided itself in its multiculturalism; however, there has been evidence of an increase in racial microaggressions and xenophobia during this pandemic. Australia's model of cultural awareness will need to evolve, from reactionary to more reflective, post COVID-19 pandemic to best serve our multicultural, inclusive and integrated society.


Subject(s)
Betacoronavirus , Coronavirus Infections/psychology , Culture , Mental Disorders/psychology , Pneumonia, Viral/psychology , Quarantine/psychology , Australia , Disease Outbreaks , Humans , Indigenous Peoples/psychology , Pandemics
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