Trachoma Rapid Assessments in Venezuela, an Example of the Integration of Data Gathering with Service Delivery in Hard-to-reach Populations.

A) PURPOSE: The objective of the study was to assess the presence of trachoma in high priority districts in the Amazon state of Venezuela (the Bolivarian Republic of), and use trachoma data gathering platform to offer integrated primary health care services to underserved hard-to-reach populations living in the border with Colombia. B) METHODS: Trachoma Rapid Assessments (TRA) were conducted in indigenous communities of three municipalities of the Amazonas State of Venezuela from June 2018 to April 2019 using the World Health Organization (WHO) guidelines. Integrated health services were delivered based on the identified needs of the population of the assessed communities. C) RESULTS: 1,185 children aged 1-9 years were examined for trachoma in the three municipalities, of which 6.92% had active trachoma; 994 people 15 years and above were examined for trachomatous trichiasis (TT) finding two cases (0.2%). 1,635 people were examined for other health-related problems and the most common diagnoses were intestinal parasites (54.74%), eye diseases (16.81%), cavities (7.34%), scabies (5.56%), headache (4.40%), and malaria (2.81%); additionally, 2,233 vaccine doses were provided to children and adults to complete vaccination series. D) CONCLUSION: The results of the TRA in the Amazon state of Venezuela suggest that trachoma could be a public health problem and standardized population-based surveys to establish the prevalence and determine the interventions to implement are needed.

Kelch13 mutations in Plasmodium falciparum and risk of spreading in Amazon basin countries.

BACKGROUND: The first potential focus for artemisinin resistance in South America was recently confirmed with the presence of the C580Y mutation in the Plasmodium falciparum kelch 13 gene (pfk13) in Guyana. OBJECTIVES: This study aimed to strengthen pfk13 monitoring in the Amazon basin countries, to compile the available data and to evaluate the risk of spreading of mutations. METHODS: Sanger sequencing was done on 862 samples collected between 1998 and 2019, and a global map of pfk13 genotypes available for this region was constructed. Then, the risk of spreading of mutations based on P. falciparum case importation between 2015 and 2018 within countries of the Amazon basin was evaluated. RESULTS: No additional pfk13 C580Y foci were identified. Few mutations (0.5%, 95% CI = 0.3%-0.8%) in the propeller domain were observed in the general parasite population of this region despite a high proportion of K189T mutations (49.1%, 95% CI = 46.2%-52.0%) in the non-propeller domain. Case information revealed two patterns of intense human migration: Venezuela, Guyana and the Roraima State in Brazil; and French Guiana, Suriname and the Amapá State in Brazil. CONCLUSIONS: There are few pfk13 mutant foci, but a high risk of dispersion in the Amazon basin, mainly from the Guiana Shield, proportionate to mining activities. Therefore, access to prompt diagnosis and treatment, and continuous molecular monitoring is essential in these geographical areas.

[Translation into practice of empowerment strategies for dengue prevention: facilitators and barriers]. / Traslación a la práctica de estrategias de empoderamiento en la prevención del dengue: facilitadores y barreras.

Objective To identify facilitators and barriers to the process of translating community empowerment strategies into the practice of the national Aedes aegypti control program in Cuba. Methods A case study of the process was conducted from 2005 to 2009 at national and provincial levels of the control program. Data from participant observation, in-depth interviews, and document analysis were triangulated and analyzed inductively and deductively. Results The main facilitators identified included a proposal for an empowerment strategy effective in reducing Aedes aegypti infestation, which was explained in such a way that it could be implemented by program staff; and a control program with national coverage capable of implementing the proposal. The principal barriers were the complexity of the strategy and the absence of organizational changes needed to facilitate its insertion into the control program. Each barrier or facilitator identified was either static or dynamic in nature. Dynamic factors are those that offer signals for action. Conclusions Multiple barriers and facilitators influence the process of translating community empowerment strategies into the practice of the Cuban Aedes aegypti control program. The analysis of these factors as either static or dynamic makes it possible to design more appropriate and effective strategies that can promote the process and increase the likelihood of success.

Traslación a la práctica de estrategias de empoderamiento en la prevención del dengue: facilitadores y barreras / Translation into practice of empowerment strategies for dengue prevention: facilitators and barriers

RESUMEN Objetivo Identificar facilitadores y barreras del proceso de traslación de estrategias de empoderamiento comunitario a la práctica del programa nacional de control de Aedes aegypti en Cuba. Métodos Se realizó un estudio de caso del proceso en el período 2005–2009 en los niveles nacional y provincial del programa de control. Se triangularon datos procedentes de la observación participante, la entrevista en profundidad y el análisis de documentos, que se analizaron inductiva y deductivamente. Resultados Entre los facilitadores destacan la existencia, por un lado, de una propuesta de estrategia de empoderamiento efectiva en la reducción de la infestación por Aedes aegypti, que estaba descrita de manera que pudiera ser implementada por el personal del programa y, por otro lado, de un programa de control con cobertura nacional dispuesto a ponerla en práctica. Las principales barreras fueron la complejidad propia de la estrategia y la ausencia de cambios organizacionales que facilitaran su inserción dentro del programa. Tanto las barreras como los facilitadores fueron de naturaleza estática o dinámica. Los factores dinámicos son aquellos que ofrecen señales para la acción. Conclusiones Son múltiples las barreras y facilitadores del proceso de traslación a la práctica de las estrategias de empoderamiento comunitario en el programa nacional de control de Aedes aegypti en Cuba. Su análisis como factores de naturaleza estática y dinámica permitiría diseñar estrategias más adecuadas y eficaces para impulsar el proceso e incrementaría sus probabilidades de éxito.

ABSTRACT Objective To identify facilitators and barriers to the process of translating community empowerment strategies into the practice of the national Aedes aegypti control program in Cuba. Methods A case study of the process was conducted from 2005 to 2009 at national and provincial levels of the control program. Data from participant observation, in-depth interviews, and document analysis were triangulated and analyzed inductively and deductively. Results The main facilitators identified included a proposal for an empowerment strategy effective in reducing Aedes aegypti infestation, which was explained in such a way that it could be implemented by program staff; and a control program with national coverage capable of implementing the proposal. The principal barriers were the complexity of the strategy and the absence of organizational changes needed to facilitate its insertion into the control program. Each barrier or facilitator identified was either static or dynamic in nature. Dynamic factors are those that offer signals for action. Conclusions Multiple barriers and facilitators influence the process of translating community empowerment strategies into the practice of the Cuban Aedes aegypti control program. The analysis of these factors as either static or dynamic makes it possible to design more appropriate and effective strategies that can promote the process and increase the likelihood of success.