Chlamydia trachomatis infections in Nicaragua: preliminary results from a competitive voucher scheme to prevent and treat sexually transmitted infections and HIV/AIDS among sex workers.

A donor-supported competitive voucher scheme in Nicaragua provides prevention and treatment services for sexually transmitted infections (STIs) and HIV/AIDS to high-risk populations such as sex workers and their partners and clients. Beyond detecting and treating STIs, HIV and AIDS, these health services can also raise awareness of risks and promote safer behavior, leading to widespread benefits. This review describes the voucher scheme, summarizes published data on Chlamydia trachomatis infection in Nicaragua and provides preliminary prevalence data on C. trachomatis obtained in 2003 through the voucher scheme.

Hygiene behaviour in rural Nicaragua in relation to diarrhoea.

BACKGROUND: Childhood diarrhoea is a leading cause of morbidity and mortality in Nicaragua. Amongst the risk factors for its transmission are 'poor' hygiene practices. We investigated the effect of a large number of hygiene practices on diarrhoeal disease in children aged <2 years and validated the technique of direct observation of hygiene behaviour. METHODS: A prospective follow-up study was carried out in a rural zone of Nicaragua. From the database of a previously conducted case-control study on water and sanitation 172 families were recruited, half of which had experienced a higher than expected rate of diarrhoea in their children and the other half a lower rate. Hygiene behaviour was observed over two mornings and diarrhoea incidence was recorded with a calendar, filled out by the mother, and collected every week for 5 months. RESULTS: Of 46 'good' practices studied, 39 were associated with a lower risk of diarrhoea, five were unrelated and only for two a higher risk was observed. Washing of hands, domestic cleanliness (kitchen, living room, yard) and the use of a diaper/underclothes by the child had the strongest protective effect. Schooling (>3 years of primary school) and better economic position (possession of a radio) had a positive influence on general hygiene behaviour, education having a slightly stronger effect when a radio was present. Individual hygiene behaviour appeared to be highly variable in contrast with the consistent behaviour of the community as a whole. Feasible and appropriate indicators of hygiene behaviour were found to be domestic cleanliness and the use of a diaper or underclothes by the child. CONCLUSION: A consistent relationship between almost all hygiene practices and diarrhoea was detected, more schooling producing better hygiene behaviour. The high variability of hygiene behaviour at the individual level requires repeated observations (at least two) before and after the hygiene education in the event one wants to measure the impact of the campaign on the individual.

PIP: Poor hygiene practices are among the risk factors for the transmission of childhood diarrhea, a leading cause of morbidity and mortality in Nicaragua. Findings are reported from a prospective follow-up study in rural Nicaragua of the effect of a number of hygiene practices upon diarrheal disease in children under age 2 years old. 172 families, of whom half had experienced a higher than expected rate of diarrhea in their children and the other half a lower rate, participated. Hygiene behavior was observed over 2 mornings and diarrhea incidence was recorded with a calendar over the course of 5 months. Of 46 good practices studied, 39 were associated with a lower risk of diarrhea, 5 were unrelated, and a higher risk was observed for 2. The washing of hands, domestic cleanliness, and the use of a diaper/underclothes by the child had the strongest protective effect against diarrhea. Mothers with more than 3 years of primary school education and in a comparatively better economic position, including having a radio, exhibited comparatively better general hygiene behavior. Education had a slightly stronger effect when a radio was present. However, individual hygiene behavior seems to be highly variable compared to the consistent behavior of the overall community. Appropriate indicators of hygiene behavior were domestic cleanliness and the use of a diaper or underclothes by the child.

[Childhood diarrhea in rural Nicaragua: beliefs and traditional health practices]. / Diarrea infantil en la Nicaragua rural: creencias y prácticas de salud tradicionales.

In Nicaragua, the principal cause of infant mortality is diarrhea, which is responsible for 40% of these deaths annually. This statistic reflects the low usage of health services and oral rehydration therapy (ORT). In an effort to improve the situation, several studies were carried out in Villa Carlos Fonseca municipio. This report describes two of those studies, one ethnographic and the other epidemiologic (conducted in 1989 and 1990, respectively), to find out beliefs and traditional health practices and their influence on the way in which mothers responded to their children's diarrheal illness. The ethnographic study involved interviewing 70 mothers with an average age of 28 years who had children under 2 years of age. The children represented two groups: one at high risk for diarrhea and the other at low risk. The objectives were to learn the traditional names for diarrhea, the perception of risk, and the treatments that were used. The epidemiologic study included 391 mothers over 14 years of age with one or more children under age 5 years, of whom 215 had had diarrhea in the two weeks preceding the survey. The objectives were to describe local beliefs and health practices and to determine the incidence of diarrheas according to the diagnosis made by the mothers. At least 12 types of diarrhea were identified, for which terms such as "empacho" and "sol de vista" were used. In most cases, the mothers had more confidence in folkloric treatments that they themselves or the traditional healers (curanderos) applied than in the services offered at health centers. This attitude limited their use of health services and ORT, although it was observed that in certain cases traditional treatments were used in combination with those of western medicine. There was a direct but nonsignificant correlation between the level of schooling of the mothers and the frequency with which they visited the health center. The authors suggest the effects of massages, herbal baths, and other traditional treatments should be studied to evaluate their effectiveness and adapt them, to the extent possible, to "modern" medicine. Health services providers should become familiar with traditional nomenclature and beliefs in order to be able to communicate better with mothers and steer them away from harmful practices toward improved results in infant diarrheal disease prevention programs.

A randomized trial of the impact of rope-pumps on water quality.

Rope-pumps are now widely promoted as a low cost, easily maintained means to improve water availability in developing countries. However, in some instances their acceptance has been limited by concerns over the microbiological quality of the water. This study looked at the well water quality under a variety of conditions, comparing unimproved bucket and rope wells with wells with a windlass and rope-pump wells with and without a concrete cover. Other factors influencing the water quality were also examined. Results indicate a 62% reduction of the geometric mean of the faecal coliform contamination of the well water as a result of the installation of a rope-pump with or without a concrete cover. Other factors found to influence the level of contamination of water in hand-dug wells were rainfall, number of households using the well, amount of water extracted daily and the distance of the well from the nearest kitchen. The last three factors probably reflect domestic activities with poor hygiene around the well. The installation of a simple rope-pump on family wells improves the water quality and availability at a favourable cost/benefit ratio.

Water supply, sanitation and diarrhoeal disease in Nicaragua: results from a case-control study.

A case-control study of risk factors for child diarrhoeal disease was undertaken in a rural area of Nicaragua. Some 1229 children under the age of five were matched with an equal number of children of the same age presenting with other illnesses unrelated to water and sanitation. The main types of water supply were sampled at monthly intervals and tested for the presence of faecal coliforms in order to characterize their microbiological quality. In spite of marked differences in water quality between the different types of water supply, no relationship was found with diarrhoea morbidity. In contrast, there was a statistically significant association between water availability and diarrhoea morbidity. Children from homes with water supplies over 500 meters from the house had incidence rates of diarrhoea 34% higher than those of children from houses with their own water supply. Owning a latrine was not found to be significantly related to diarrhoea morbidity. A mother's level of schooling was inversely correlated with the frequency of diarrhoea in her children. A significant association was also found between the number of children under the age of five living in the house and the incidence of diarrhoea. These effects remained significant after controlling for confounding variables by conditional logistic regression.

Determinants of domestic water use in rural Nicaragua.

In order to investigate the factors affecting domestic water use in rural areas of developing countries, an analysis was performed of water consumption estimates from 1029 different households in Nicaragua collected between May 1986 and December 1988. Eight of the 22 variables hypothesized to be related to per capita domestic water consumption, were included in the final multiple regression model. These were; household size, site of clothes washing, the type of water source, mother's and father's levels of schooling, distance to the water source, wealth, and ownership of cattle. According to this model, a decrease in the distance to the water source from 1000 to 10 m is associated with an increase in per capita water consumption of 20%. Similarly, families where the mother has 6 years of schooling use 17% more water than families where the mother has had no formal education. The same difference in the father's schooling is associated with 12% greater per capita water consumption. A better understanding of the factors affecting domestic water use is needed to improve the design of interventions aimed at reducing the transmission of water-washed disease in developing countries.

Determinants of drinking water quality in rural Nicaragua.

One hundred and fifty-three water samples from rural Nicaragua were examined for the presence of faecal coliforms during both wet and dry periods. A linear model was fitted by analysis of covariance with the logarithm of the faecal coliform count as the dependent variable. As expected, traditional water sources were grossly contaminated at all times whereas piped water sources were much cleaner. Hand-dug protected wells had significantly higher levels of faecal contamination than unprotected riverside wells and springs during the dry season. The possible reasons for this unexpected finding are discussed. A close association between rainfall and faecal contamination was demonstrated but the effect of rainfall depended on the type of water source. An association between water quality and the size of the community served by the source was also detected. The finding that stored water was usually more contaminated than fresh water samples is consistent with the results from other studies. Since it is unusual for water quality to be inversely correlated with accessibility, this study site would be suitable for investigating the relative importance of water-borne versus water-washed transmission mechanisms in childhood diarrhoea.