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1.
Zootaxa ; 5026(1): 145-150, 2021 Aug 24.
Artículo en Inglés | MEDLINE | ID: mdl-34810936

RESUMEN

Hesychotypa albofasciata sp. nov. from Mexico (Veracruz) and Honduras, and Tulcus santossilvai sp. nov. from Mexico (Oaxaca) are described and illustrated. Distinguishing characters from closely related species are provided and discussed.


Asunto(s)
Escarabajos , Animales , Honduras , México
2.
Hisp Health Care Int ; 19(4): 230-238, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34664509

RESUMEN

The purpose of the current study was to determine the influence of moral injury and Light Triad (LT) personality traits on anxiety and depression symptoms of health-care personnel during the coronavirus-2019 pandemic. A quantitative, cross-sectional research design was used, the study included a sample of 169 health-care workers from Honduras. Data was gathered through the Moral Injury Symptom Scale for Health Professionals (MISS-HP), Light Triad Scale (LTS), the Generalized Anxiety Disorder-7, and the Patient-Health Questionnaire-9. Results suggest that almost 9 out of 10 respondents experienced at least one potentially morally injurious event, 45.6% were at significant risk of impairment related to moral injury. Working with limited staff and resources, and the implications of it, was the most common potentially morally injurious situation reported by the respondents. Results suggest that MISS-HP Mistrust has significant negative correlations with LT traits. A hierarchical regression model determined that Moral Injury, but not LT traits, significantly affected depression symptoms. On the other hand, anxiety symptoms were significantly predicted by Moral Injury, as did LTS-Humanism. The results were discussed according to their implications for public health policy in Latin America.


Asunto(s)
COVID-19 , Trastornos por Estrés Postraumático , Ansiedad/epidemiología , Ansiedad/etiología , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/etiología , Estudios Transversales , Depresión/epidemiología , Depresión/etiología , Personal de Salud , Honduras/epidemiología , Humanos , Pandemias , Encuestas y Cuestionarios
3.
Tegucigalpa; OPS; 2021-09-16. (OPS/HND/21-0001).
No convencional en Español | PAHO-IRIS | ID: phr2-54846

RESUMEN

Establecida en 1902 como el organismo independiente especializado en salud del sistema interamericano, la Organización Panamericana de la Salud (OPS) ha desarrollado competencias y experiencia ampliamente reconocidas al brindar cooperación técnica a sus Estados Miembros para combatir las enfermedades transmisibles y no transmisibles y sus causas, fortalecer los sistemas de salud y responder a situaciones de emergencia y desastres en toda la Región de las Américas. Asimismo, en su calidad de oficina regional de la Organización Mundial de la Salud, la OPS participa activamente en los equipos de las Naciones Unidas en los países, colaborando con otros organismos, fondos y programas del sistema de las Naciones Unidas para contribuir al logro de los Objetivos de Desarrollo Sostenible (ODS) a nivel de país. En este informe anual se presenta la cooperación técnica de la OPS a nivel de país en el 2020, mediante la aplicación de la estrategia de cooperación con el país, la respuesta a las necesidades y prioridades nacionales, y el desarrollo de las actividades en el marco de los mandatos regionales y mundiales de la Organización y los ODS. En consonancia con el tema general de "la salud universal y la pandemia: sistemas de salud resilientes", se pone de relieve la respuesta de la OPS a la pandemia de COVID-19, así como sus esfuerzos continuos en esferas prioritarias como las enfermedades transmisibles, las enfermedades no transmisibles, la salud mental, la salud a lo largo del curso de vida y las emergencias de salud. También se presenta un resumen financiero del ejercicio examinado.


Asunto(s)
Cooperación Técnica , Sistemas de Salud , Programas Nacionales de Salud , Políticas, Planificación y Administración en Salud , Cobertura de los Servicios de Salud , Cobertura Universal de Salud , Enfermedades no Transmisibles , Enfermedades Transmisibles , Sistemas de Información en Salud , Factores de Riesgo , Factores Socioeconómicos , Salud Mental , Administración Financiera , Administración en Salud Pública , América Central , Honduras
4.
Mar Pollut Bull ; 172: 112865, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34419696

RESUMEN

The Gulf of Honduras includes extensive coral reefs in Belize and Guatemala, classified into four biogeographic zones, which are differentially affected by runoff, hurricanes, and fishing. Runoff mostly impacts the coastal and adjacent channel reefs. The Belize Barrier Reef (BBR) experiences less runoff impact due to the prevailing cyclonic ocean circulation. Hurricane waves powerfully impact the BBR, only occasionally the lee-side of Glover's Reef, and rarely the coastal and channel reefs. Fishing pressure is most intense on the coastal and channel reefs, comparatively modest on the BBR, and low at Glover's Reef. The effects of the three local stressors were evaluated using observations from 24 sites in the Gulf of Honduras. Data were analyzed using the Reef Health Index (RHI), with the highest RHI (4.3) for two Glover's Reef sites, medium RHI (2.6) for 10 sites on the barrier reef, and lowest RHI (2.1) for 8 coastal reef sites.


Asunto(s)
Antozoos , Tormentas Ciclónicas , Animales , Belice , Arrecifes de Coral , Honduras
5.
J Invertebr Pathol ; 184: 107642, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34216626

RESUMEN

The genus Beauveria comprises economically important entomopathogenic fungi, widely used for biological control in agriculture. Interest in these organisms in Costa Rica prompted surveys and establishment of collections in the past two decades. However, there was neither a formal identification nor a characterization of the isolates. With that purpose, the morphology and genetic variation by microsatellites and partial sequencing of Bloc, TEF-1α and RPB2 regions were studied for 32 isolates of Beauveria, which included 26 from Costa Rica, five from Puerto Rico and one from Honduras. The isolates were identified as B. bassiana (29) and B. caledonica (3). Ninety-three percent of B. bassiana isolates belonged to a monophyletic group of African and Neotropical isolates. A total of 105 alleles were recorded with 11 SSR markers, and the results suggested high diversity within the collection. Mantel tests showed low association between geographic origin and the variation among isolates.


Asunto(s)
Beauveria/clasificación , Genes Fúngicos , Variación Genética , Beauveria/citología , Beauveria/genética , Beauveria/aislamiento & purificación , Costa Rica , Honduras , Filogenia , Puerto Rico
8.
J Neurol Sci ; 427: 117551, 2021 08 15.
Artículo en Inglés | MEDLINE | ID: mdl-34171744

RESUMEN

Arbovirus infections have been associated with a wide spectrum of neurological manifestations. Among these, Guillain-Barré syndrome (GBS) is one of the most common. This study describes the characteristics of GBS associated with arbovirus infections during the outbreak which occurred in Honduras from January 2016 to February 2019. This was an observational retrospective study of adult patients who were diagnosed with GBS during that time. The diagnosis of GBS was based upon the criteria first published by Asbury, et al. and subsequently revised as the Brighton Criteria. A total of 91 patients with GBS constituted the study population. RT-PCR tests for ZIKV, CHIKV, and DENV arboviruses were performed in 47 (52%) of the patients. Of the tested population, 8/47 were positive for one of the arboviruses (5/8 for ZIKV, 3/8 for CHIKV; 0/8 for DENV). The clinical profile of the eight cases with GBS and arboviral infection did not differ significantly from the GBS patients who tested negative for ZIKV and CHIKV. In the cases with GBS and ZIKV, a parainfectious onset of the disease was suggested. Although not a strikingly large number of patients with GBS and arbovirus infection were seen, the close temporal relationship in these eight cases suggests an arbovirus (ZIKV and CHIKV) etiology.


Asunto(s)
Dengue , Síndrome de Guillain-Barré , Infección por el Virus Zika , Virus Zika , Adulto , Dengue/epidemiología , Brotes de Enfermedades , Síndrome de Guillain-Barré/epidemiología , Honduras/epidemiología , Humanos , Estudios Retrospectivos , Infección por el Virus Zika/complicaciones , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/epidemiología
9.
Soc Sci Med ; 281: 114040, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34144481

RESUMEN

RATIONALE: Stress process theory considers that actual and perceived isolation, caused by mobility restrictions from attempted containment of the COVID-19 pandemic, deteriorates mental health. OBJECTIVE: We examine the relationship between the COVID-19 lockdowns and mental health-related Google searches in 11 Latin American countries. We include the following countries: Argentina, Bolivia, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Uruguay. We also explore how changes in search patterns relate to income support policies and to COVID-19 death rates. METHOD: Using Google Trends data and an event-study design, as well as a difference-in-differences analysis, we investigate the association between country specific stay-at-home orders and internet searches including the following words: insomnia, stress, anxiety, sadness, depression, and suicide. RESULTS: We find three main patterns. First, searches for insomnia peak but then decline. Second, searches for stress, anxiety, and sadness increase and remain high throughout the lockdown. Third, there is no substantial change in depression-related or suicide-related searches after the lockdown. In terms of potential mechanisms, our results suggest that searches declined for suicide and insomnia following the passage of each country's income support, while in countries with higher COVID-19-related death rates, searches for insomnia, stress, and anxiety increased by more. CONCLUSIONS: Our results suggest that, in Latin America, Google searches for words associated with mild mental health disorders increased during the COVID-19 stay-at-home orders. Nonetheless, these conclusions should not be construed as a general population mental health deterioration, as we cannot verify that search indicators are accurately related to the users' current feelings and behaviors, and as internet users may not be representative of the population in this region.


Asunto(s)
COVID-19 , Salud Mental , Motor de Búsqueda , Argentina , Bolivia , Chile , Colombia , Control de Enfermedades Transmisibles , Ecuador , Guatemala , Honduras , Humanos , América Latina/epidemiología , México , Pandemias , Perú , SARS-CoV-2 , Uruguay
10.
Malar J ; 20(1): 208, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33931091

RESUMEN

BACKGROUND: In malaria elimination settings, available metrics for malaria surveillance have been insufficient to measure the performance of passive case detection adequately. An indicator for malaria suspected cases with malaria test (MSCT) is proposed to measure the rate of testing on persons presenting to health facilities who satisfy the definition of a suspected malaria case. This metric does not rely on prior knowledge of fever prevalence, seasonality, or external denominators, and can be used to compare detection rates in suspected cases within and between countries, including across settings with different levels of transmission. METHODS: To compute the MSCT, an operational definition for suspected malaria cases was established, including clinical and epidemiological criteria. In general, suspected cases included: (1) persons with fever detected in areas with active malaria transmission; (2) persons with fever identified in areas with no active transmission and travel history to, or residence in areas with active transmission (either national or international); and (3) persons presenting with fever, chills and sweating from any area. Data was collected from 9 countries: Belize, Colombia (in areas with active transmission), Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, and Panama (September-March 2020). A sample of eligible medical records for 2018 was selected from a sample of health facilities in each country. An algorithm was constructed to assess if a malaria test was ordered or performed for cases that met the suspected case definition. RESULTS: A sample of 5873 suspected malaria cases was obtained from 239 health facilities. Except for Nicaragua and Colombia, malaria tests were requested in less than 10% of all cases. More cases were tested in areas with active transmission than areas without cases. Travel history was not systematically recorded in any country. CONCLUSIONS: A statistically comparable, replicable, and standardized metric was proposed to measure suspected malaria cases with a test (microscopy or rapid diagnostic test) that enables assessing the performance of passive case detection. Cross-country findings have important implications for malaria and infectious disease surveillance, which should be promptly addressed as countries progress towards malaria elimination. Local and easy-to-implement tools could be implemented to assess and improve passive case detection.


Asunto(s)
Monitoreo Epidemiológico , Malaria/epidemiología , Malaria/transmisión , Vigilancia de la Población/métodos , Belice/epidemiología , Colombia/epidemiología , Costa Rica/epidemiología , República Dominicana/epidemiología , El Salvador/epidemiología , Guatemala/epidemiología , Honduras/epidemiología , Nicaragua/epidemiología , Panamá/epidemiología , Prevalencia
11.
Mycoses ; 64(11): 1396-1401, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33966300

RESUMEN

OBJECTIVES: Histoplasmosis and cryptococcosis are important public health problems in people living with HIV (PLHIV) in Central America. Conventional laboratory assays, based on microscopy and culture, are not optimal for the diagnosis of either disease. However, antigen (Ag) assays are rapid and highly accurate for the diagnosis of these infections. METHODS: Laboratory surveillance of PLHIV was carried out in four hospitals in Panama, Honduras and Nicaragua, between 2015 and 2019. Detection of Histoplasma antigens in urine was performed by enzyme immunoassay (EIA), and Cryptococcus antigen detection in sera and cerebrospinal fluid specimens was performed by lateral flow assay (LFA). RESULTS: A total of 4,453 PLHIV with clinical suspicion of histoplasmosis (n = 1,343) or cryptococcosis (n = 3,110; 2,721 sera and 389 CSF) were tested. Of 1,343 patients suspected of having histoplasmosis, 269 (20%) were Histoplasma Ag positive. Of 3,110 patients tested using the Cryptococcus Ag assay, 329 (11%) were positive. Honduras reported the highest positivity rates (32% for Histoplasma Ag, and 16% for Cryptococcus Ag); Panama reported the largest number of patients testing positive using the Histoplasma Ag assay (n = 201); and Nicaragua reported the largest number of patients testing positive using the Cryptococcus Ag assay (n = 170). CONCLUSION: Here, we show how the implementation of rapid diagnostics assays impacted case detection and was useful for the care of people with advanced HIV. Rapid and accurate diagnosis could reduce mortality associated with histoplasmosis and cryptococcosis in PLHIV.


Asunto(s)
Criptococosis/diagnóstico , Infecciones por VIH/complicaciones , Histoplasmosis/diagnóstico , Adulto , Antígenos Fúngicos/sangre , Antígenos Fúngicos/líquido cefalorraquídeo , Antígenos Fúngicos/orina , Cryptococcus/inmunología , Femenino , Citometría de Flujo , Histoplasma/inmunología , Honduras , Humanos , Técnicas para Inmunoenzimas , Masculino , Nicaragua , Panamá
12.
Glob Health Res Policy ; 6(1): 16, 2021 05 07.
Artículo en Inglés | MEDLINE | ID: mdl-33958000

RESUMEN

BACKGROUND: Postpartum Care is a strategy to improve survival of women and newborns, especially in low- and middle-income countries. Early post-partum care can promote healthy behaviors and the identification of risk factors associated with poorer pregnancy-related outcomes. The objective of this study was to assess the association of perceived social support with attendance to post-partum care in women from three Latin-American and Caribbean countries: Costa Rica, Dominican Republic and Honduras. METHODS: Women aged 18+ who completed a pregnancy in the past 5 years were interviewed in local healthcare and community settings in each country. Perceived social support (PSS) was the primary explanatory variable and the primary outcome was self-reported attendance to post-partum care. Odds Ratios (OR) with 95% confidence intervals derived from logistic regression documented the association between variables. Adjusted Odds Ratios (AOR) were calculated, controlling for social and pregnancy-related confounders. Hosmer- Lemeshow's Goodness-of-Fit statistic was computed to assess model fit. RESULTS: Our cohort of 1199 women across the three Latin-American and Caribbean countries showed relatively high attendance to post-partum care (82.6%, n = 990). However, 51.7% (n = 581) of women reported lower levels of total PSS. Women were more likely to attend postpartum care if they had mean and higher levels of PSS Family subscale (OR: 1.9, 95%CI: 1.4, 2.7), Friends subscale (OR 1.3, 95%CI: 0.9,1.8), Significant Other subscale (OR 1.8, 95%CI: 1.3, 2.4) and the Total PSS (OR 1.8, 95%CI: 1.3, 2.5). All associations were statistically significant at p < 0.05, with exception of the Friends subscale. Women with higher levels of total PSS were more likely to attend to post-partum care (AOR:1.40, 0.97, 1.92) even after controlling for confounders (education, country, and food insecurity). CONCLUSIONS: Women with higher perceived social support levels were more likely to attend to post-partum care. From all countries, women from Dominican Republic had lower perceived social support levels and this may influence attendance at post-partum care for this subgroup. Societal and geographic factors can act as determinants when evaluating perceived social support during pregnancy.


Asunto(s)
Servicios de Salud Materna/estadística & datos numéricos , Atención Posnatal/estadística & datos numéricos , Apoyo Social , Adulto , Estudios de Cohortes , Costa Rica , Estudios Transversales , República Dominicana , Femenino , Honduras , Humanos , Persona de Mediana Edad , Atención Posnatal/psicología , Adulto Joven
13.
Soc Sci Med ; 277: 113933, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33873009

RESUMEN

RATIONALE: The purpose of the current study was to analyze the influence of coronavirus awareness, psychological stress responses, and sociodemographic variables on mental health indicators (somatization, depression, and anxiety) in residents of Honduras, Chile, Costa Rica, Mexico, and Spain. METHODS: The study used a quantitative, cross-sectional approach. Data was collected online using the Brief Symptom Inventory-18 (BSI-18); the Coronavirus Awareness Scale-6 (CAS-6) and a questionnaire that included psychological and sociodemographic questions. The total sample size consisted of 1559 respondents from Honduras (34%), Chile (29%), Costa Rica (17%), Mexico (11%), and Spain (9%). RESULTS: The most common stress domains correspond to family (22.97%), financial (22.53%), academic (16.47%), leisure time constraints (14.23%), health (12.48%), peer group (7.63%), and religious concerns (3.69%). These domains are significantly associated with the respondent's country, sex, employment status, and being or not a health worker. Respondents who reported confinement stress also reported higher scores in anxiety, depression, and somatization. The Global Severity Index was significantly predicted by confinement stress, health, academic, and leisure time-related stress, sex, age, being a health worker, COVID-19 Personal Concern, and Perceived Seriousness. Non-significant predictors were employment status, the number of people at home, presence of older adults and children at home, financial, peer group, family, and religious concerns; the regression model had an R2 of 0.26. Similar analyses were conducted for somatization, depression, and anxiety subscales. CONCLUSIONS: The COVID-19 pandemic has adverse effects on the mental health of the general population, particularly regarding anxiety, depression, and somatization. Specific populations, such as women and healthcare workers, are at particular risk of suffering a deterioration in mental wellbeing. The implications of the study for public policy are discussed.


Asunto(s)
COVID-19 , Salud Mental , Anciano , Ansiedad/epidemiología , Niño , Chile , Costa Rica/epidemiología , Estudios Transversales , Depresión/epidemiología , Femenino , Honduras/epidemiología , Humanos , México/epidemiología , Pandemias , SARS-CoV-2 , España , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios
14.
Zootaxa ; 4965(1): zootaxa.4965.1.9, 2021 Apr 27.
Artículo en Inglés | MEDLINE | ID: mdl-33903501

RESUMEN

A new genus and three new species of the subfamily Lamiinae are described and illustrated: Osckayia oaxacae gen. nov., sp. nov. from Mexico (Oaxaca); Pseudastylopsis albus sp. nov. from Mexico (Oaxaca) and Honduras (Cortés); and Urgleptes albomaculatus sp. nov. from Mexico (Oaxaca). New country record for Acanthoderes (Acanthoderes) giesberti Chemsak Hovore, 2002 is provided.


Asunto(s)
Escarabajos , Animales , Escarabajos/anatomía & histología , Escarabajos/clasificación , Honduras , México , Especificidad de la Especie
15.
Int J Hyg Environ Health ; 234: 113734, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33799075

RESUMEN

BACKGROUND: Occupational exposure to agrochemicals, some of which are known or suspected carcinogens, is a major health hazard for subsistence agricultural workers and their families. These impacts are more prevalent in low-and-middle income countries (LMIC) due to weak regulations, lack of awareness of the risks of contamination, predominant use of handheld backpack style spraying equipment, general lack of personal protective equipment (PPE), and low literacy about proper agrochemical application techniques. Reducing exposure to agrochemicals was identified as a paramount concern by rural Hondurans working with a community-engaged research initiative. Fluorescent tracer dyes have been described as a means of visualizing and quantifying dermal exposure to agricultural chemicals, and exposure models adapted for LMIC have been developed previously. Tracer dyes have also been used in educational simulations to promote pesticide safety. However, studies evaluating the effectiveness of these educational dye interventions in reducing future exposure have been lacking. AIM: To evaluate whether observing one's own chemical contamination after applying agrochemicals changed the amount of occupational dermal exposure during a subsequent chemical application. METHODS: We employed a multi-modal community intervention in a rural village in Honduras that incorporated chemical safety education and use of a fluorescent tracer dye during pesticide application on two consecutive occasions, and compared dermal exposure between the intervention group (previous dye experience and safety education, n = 6) and the control group (safety education only, n = 7). RESULTS: Mean total visual score (TVS) of the tracer dye, which accounts for both extent and intensity of whole-body contamination, was lower among those who had previously experienced the dye intervention (mean TVS = 41.3) than among participants who were dye-naïve (mean TVS = 78.4), with a difference between means of -37.10 (95% CI [-66.26, -7.95], p = 0.02). Stratifying by body part, contamination was significantly lower for the anterior left lower extremity and bilateral feet for the dye-experienced group vs. dye-naïve, with most other segments showing a trend toward decreased contamination as well. CONCLUSION: Participants who had previously experienced the dye intervention were significantly less contaminated than the dye-naïve control group during a subsequent spraying event. The findings of this small pilot study suggest that a multi-modal, community-based approach that utilizes fluorescence-augmented contamination for individualized learning (FACIL) may be effective in reducing dermal exposure to carcinogenic agrochemicals among subsistence farmers in Honduras and other LMIC.


Asunto(s)
Exposición Profesional , Plaguicidas , Agricultura , Agroquímicos , Carcinógenos , Agricultores , Colorantes Fluorescentes , Honduras , Humanos , Exposición Profesional/análisis , Plaguicidas/análisis , Proyectos Piloto
16.
Clin Infect Dis ; 73(7): 1203-1210, 2021 10 05.
Artículo en Inglés | MEDLINE | ID: mdl-33906234

RESUMEN

BACKGROUND: The efficacy of currently available anthelminthics against Trichuris trichiura infections is significatively lower than for other soil-transmitted helminths. The combination of ivermectin (IVM) and albendazole (ALB) has shown significant improvements in efficacy. METHODS: Safety and efficacy randomized controlled clinical trial comparing 3 experimental regimens against ALB monotherapy for the treatment of T. trichiura infections in northern Honduras. Infected children were randomized to 4 treatment arms: arm 1, single-dose ALB (400 mg); arm 2, single-dose ALB (400 mg) plus IVM (600 µg/kg); arm 3, ALB (400 mg) for 3 consecutive days; or arm 4, ALB (400 mg) plus IVM (600 µg/kg) for 3 consecutive days. Efficacy was measured based on the egg reduction and cure rates, both assessed 14-21 days after treatment, using the Kato-Katz method. Safety was evaluated by analyzing the frequency and severity of adverse events. RESULTS: Of 176 children randomized to 1 of the 4 treatment arms, 117 completed treatment and follow-up. The egg reduction rates for arms 1, 2, 3, and 4 were 47.7%, 96.7%, 72.1%, and 100%, respectively; with P values <.001 for comparisons between IVM groups and ALB-only arms. The cure rates were 4.2%, 88.6%, 33.3%, and 100%, respectively. A total of 48 adverse events (85.4% mild) were reported in 36 children. CONCLUSIONS: The combined use of ALB and high-dose IVM is a highly effective and well tolerated treatment for the treatment of T. trichiura infections, offering significantly improved treatment for the control of this infection. CLINICAL TRIALS REGISTRATION: NCT04041453.


Asunto(s)
Antihelmínticos , Trichuris , Albendazol/efectos adversos , Animales , Antihelmínticos/efectos adversos , Niño , Honduras , Humanos , Ivermectina/efectos adversos , Instituciones Académicas
17.
Glob Health Sci Pract ; 9(Suppl 1): S98-S110, 2021 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-33727323

RESUMEN

BACKGROUND: Across the Greater Mekong Subregion (GMS) and Central America, governments commonly employ community health workers (CHWs) to improve access to and uptake of malaria services. Many of these networks are vertical in design, organized to extend malaria-only services to those remaining communities in which malaria persists. METHODS: Between 2019 and 2020, national ministries of health (MOH) and Clinton Health Access Initiative conducted mixed-methods CHW program evaluations across the GMS and Central America. Routine surveillance and programmatic data were analyzed to quantify CHW contributions to malaria elimination objectives and identify gaps and challenges. Semistructured interviews were conducted with governmental and nongovernmental stakeholders from central to community level. This article draws comparisons between the Lao People's Democratic Republic (PDR) and Honduras CHW program evaluation results to distill broader hypotheses about how vertical CHW programs might evolve as their primary mission nears its end. RESULTS: CHWs contribute substantially to malaria case detection and surveillance, diagnosing and treating 27% of malaria cases in Lao PDR and 55% in the department of Gracias a Dios, Honduras in 2019. In the same year, malaria test positivity neared less than 1% in both countries. In 2019, 80% of CHWs in Lao PDR and 74% in Gracias a Dios, Honduras did not report a single malaria case. From inception, both programs were organized as vertical (malaria-only) CHW programs reliant upon Global Fund financing for malaria commodities, training, supervision and, where applicable, remuneration. CONCLUSIONS: Although community case management by CHWs has been highly impactful in reducing malaria cases to near zero, new challenges of acceptability and effectiveness of malaria-only service delivery, feasibility of continued vertical program management, and sustainable financing have emerged. To achieve and sustain reductions in malaria, surveillance and delivery platforms must be redesigned to encourage (and reward) care seeking based on experience of symptoms and not on a patient or caregiver's presumptive diagnosis of disease. By expanding the roles and responsibilities of currently vertical malaria CHWs, malarial interventions can be optimized and sustained. Such a shift will also position existing community-based platforms to be resilient and responsive as epidemiology of disease and community need shift.


Asunto(s)
Agentes Comunitarios de Salud , Malaria , Honduras/epidemiología , Humanos , Laos/epidemiología , Malaria/diagnóstico , Malaria/epidemiología , Malaria/prevención & control , Evaluación de Programas y Proyectos de Salud
18.
J Acquir Immune Defic Syndr ; 87(3): 993-1001, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-33675618

RESUMEN

BACKGROUND: Little is known about the long-term outcomes of children living with HIV in Latin America. Few studies have examined antiretroviral therapy (ART) regimen switches in the years after the introduction of ART in this population. This study aimed to assess clinical outcomes among children who started second-line ART in the Caribbean, Central and South America network for HIV epidemiology. METHODS: Children (<18 years old) with HIV who switched to second-line ART at sites within Caribbean, Central and South America network for HIV epidemiology were included. The cumulative incidence and relative hazards of virologic failure while on second-line ART, loss to follow-up, additional major ART regimen changes, and all-cause mortality were evaluated using competing risks methods and Cox models. RESULTS: A total of 672 children starting second-line ART were included. Three years after starting second-line ART, the cumulative incidence of death was 0.10 [95% confidence interval (CI) 0.08 to 0.13], loss to follow-up was 0.14 (95% CI: 0.11 to 0.17), and major regimen change was 0.19 (95% CI: 0.15 to 0.22). Of those changing regimens, 35% were due to failure and 11% due to toxicities/side effects. Among the 312 children with viral load data, the cumulative incidence of virologic failure at 3 years was 0.62 (95% CI: 0.56 to 0.68); time to virologic failure and regimen change were uncorrelated (rank correlation -0.001; 95% CI -0.18 to 0.17). CONCLUSIONS: Poor outcomes after starting second-line ART in Latin America were common. The high incidence of virologic failure and its poor correlation with changing regimens was particularly worrisome. Additional efforts are needed to ensure children receive optimal ART regimens.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , VIH-1 , Adolescente , Fármacos Anti-VIH/administración & dosificación , Brasil/epidemiología , Niño , Preescolar , Femenino , Haití/epidemiología , Honduras/epidemiología , Humanos , Masculino , Resultado del Tratamiento , Carga Viral
19.
J Public Health (Oxf) ; 43(2): e358-e359, 2021 06 07.
Artículo en Inglés | MEDLINE | ID: mdl-33693878

RESUMEN

A recent correspondence discussed that in trying times, technology can help be applied toward epidemiology to benefit communities by building a basic surveillance system. This suggested development in Honduras can be utilized in the Philippines to improve the State's handling of health emergencies. With this, this paper accentuates the importance of prevention and planning to ensure public health in the Philippines, especially during the COVID-19 pandemic.


Asunto(s)
COVID-19 , Tormentas Ciclónicas , Dengue , Honduras , Humanos , Pandemias/prevención & control , Filipinas/epidemiología , Salud Pública , SARS-CoV-2
20.
BMC Public Health ; 21(1): 575, 2021 03 23.
Artículo en Inglés | MEDLINE | ID: mdl-33757471

RESUMEN

BACKGROUND: Diarrhoea poses serious health problems among under-five children (U5C) in Low-and Medium-Income Countries (LMIC) with a higher prevalence in rural areas. A gap exists in knowledge on factors driving rural-non-rural inequalities in diarrhoea development among U5C in LMIC. This study investigates the magnitude of rural-non-rural inequalities in diarrhoea and the roles of individual-level and neighbourhood-level factors in explaining these inequalities. METHODS: Data of 796,150 U5C, from 63,378 neighbourhoods across 57 LMIC from the most recent Demographic and Health Survey (2010-2018) was analysed. The outcome variable was the recent experience of diarrhoea while independent variables consist of the individual- and neighbourhood-level factors. Data were analysed using multivariable Fairlie decomposition at p < 0.05 in Stata Version 16 while visualization was implemented in R Statistical Package. RESULTS: Two-thirds (68.0%) of the children are from rural areas. The overall prevalence of diarrhoea was 14.2, 14.6% vs 13.4% among rural and non-rural children respectively (p < 0.001). From the analysis, the following 20 countries showed a statistically significant pro-rural inequalities with higher odds of diarrhoea in rural areas than in nonrural areas at 5% alpha level: Albania (OR = 1.769; p = 0.001), Benin (OR = 1.209; p = 0.002), Burundi (OR = 1.399; p < 0.001), Cambodia (OR = 1.201; p < 0.031), Cameroon (OR = 1.377; p < 0.001), Comoros (OR = 1.266; p = 0.029), Egypt (OR = 1.331; p < 0.001), Honduras (OR = 1.127; p = 0.027), India (OR = 1.059; p < 0.001), Indonesia (OR = 1.219; p < 0.001), Liberia (OR = 1.158; p = 0.017), Mali (OR = 1.240; p = 0.001), Myanmar (OR = 1.422; p = 0.004), Namibia (OR = 1.451; p < 0.001), Nigeria (OR = 1.492; p < 0.001), Rwanda (OR = 1.261; p = 0.010), South Africa (OR = 1.420; p = 0.002), Togo (OR = 1.729; p < 0.001), Uganda (OR = 1.214; p < 0.001), and Yemen (OR = 1.249; p < 0.001); and pro-non-rural inequalities in 9 countries. Variations exist in factors associated with pro-rural inequalities across the 20 countries. Overall main contributors to pro-rural inequality were neighbourhood socioeconomic status, household wealth status, media access, toilet types, maternal age and education. CONCLUSIONS: The gaps in the odds of diarrhoea among rural children than nonrural children were explained by individual-level and neighbourhood-level factors. Sustainable intervention measures that are tailored to country-specific needs could offer a better approach to closing rural-non-rural gaps in having diarrhoea among U5C in LMIC.


Asunto(s)
Países en Desarrollo , Diarrea , Burundi , Cambodia , Camerún , Preescolar , Diarrea/epidemiología , Egipto , Femenino , Honduras , Humanos , India , Indonesia , Lactante , Liberia , Masculino , Malí , Mianmar , Namibia , Nigeria , Rwanda , Factores Socioeconómicos , Sudáfrica , Togo , Uganda , Yemen
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