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1.
BMC Public Health ; 23(1): 674, 2023 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-37041550

RESUMO

BACKGROUND: The study of the etiology of acute febrile illness (AFI) has historically been designed as a prevalence of pathogens detected from a case series. This strategy has an inherent unrealistic assumption that all pathogen detection allows for causal attribution, despite known asymptomatic carriage of the principal causes of acute febrile illness in most low- and middle-income countries (LMICs). We designed a semi-quantitative PCR in a modular format to detect bloodborne agents of acute febrile illness that encompassed common etiologies of AFI in the region, etiologies of recent epidemics, etiologies that require an immediate public health response and additional pathogens of unknown endemicity. We then designed a study that would delineate background levels of transmission in the community in the absence of symptoms to provide corrected estimates of attribution for the principal determinants of AFI. METHODS: A case-control study of acute febrile illness in patients ten years or older seeking health care in Iquitos, Loreto, Peru, was planned. Upon enrollment, we will obtain blood, saliva, and mid-turbinate nasal swabs at enrollment with a follow-up visit on day 21-28 following enrollment to attain vital status and convalescent saliva and blood samples, as well as a questionnaire including clinical, socio-demographic, occupational, travel, and animal contact information for each participant. Whole blood samples are to be simultaneously tested for 32 pathogens using TaqMan array cards. Mid-turbinate samples will be tested for SARS-CoV-2, Influenza A and Influenza B. Conditional logistic regression models will be fitted treating case/control status as the outcome and with pathogen-specific sample positivity as predictors to attain estimates of attributable pathogen fractions for AFI. DISCUSSION: The modular PCR platforms will allow for reporting of all primary results of respiratory samples within 72 h and blood samples within one week, allowing for results to influence local medical practice and enable timely public health responses. The inclusion of controls will allow for a more accurate estimate of the importance of specific prevalent pathogens as a cause of acute illness. STUDY REGISTRATION: Project 1791, Registro de Proyectos de Investigación en Salud Pública (PRISA), Instituto Nacional de Salud, Perú.


Assuntos
COVID-19 , Influenza Humana , Humanos , Peru , Influenza Humana/epidemiologia , Estudos de Casos e Controles , SARS-CoV-2 , Febre/epidemiologia , Reação em Cadeia da Polimerase , Instalações de Saúde , Teste para COVID-19
2.
Res Sq ; 2023 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-37034707

RESUMO

Background: The study of the etiology of acute febrile illness (AFI) has historically been designed as a prevalence of pathogens detected from a case series. This strategy has an inherent unrealistic assumption that all pathogen detection allows for causal attribution, despite known asymptomatic carriage of the principal causes of acute febrile illness in most low- and middle-income countries (LMICs). We designed a semi-quantitative PCR in a modular format to detect bloodborne agents of acute febrile illness that encompassed common etiologies of AFI in the region, etiologies of recent epidemics, etiologies that require an immediate public health response and additional pathogens of unknown endemicity. We then designed a study that would delineate background levels of transmission in the community in the absence of symptoms to provide corrected estimates of attribution for the principal determinants of AFI. Methods: A case-control study of acute febrile illness in patients ten years or older seeking health care in Iquitos, Loreto, Peru, was planned. Upon enrollment, we will obtain blood, saliva, and mid-turbinate nasal swabs at enrollment with a follow-up visit on day 21-28 following enrollment to attain vital status and convalescent saliva and blood samples, as well as a questionnaire including clinical, socio-demographic, occupational, travel, and animal contact information for each participant. Whole blood samples are to be simultaneously tested for 32 pathogens using TaqMan array cards. Mid-turbinate samples will be tested for SARS-CoV-2, Influenza A and Influenza B. Conditional logistic regression models will be fitted treating case/control status as the outcome and with pathogen-specific sample positivity as predictors to attain estimates of attributable pathogen fractions for AFI. Discussion: The modular PCR platforms will allow for reporting of all primary results of respiratory samples within 72 hours and blood samples within one week, allowing for results to influence local medical practice and enable timely public health responses. The inclusion of controls will allow for a more accurate estimate of the importance of specific, prevalent pathogens as a cause of acute illness. Study Registration: Project 1791, Registro de Proyectos de Investigación en Salud Pública (PRISA), Instituto Nacional de Salud, Perú.

3.
Clin Infect Dis ; 76(3): e1054-e1061, 2023 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-35748864

RESUMO

BACKGROUND: There is a need to evaluate antibiotic use, duration of therapy, and stewardship in low- and middle-income countries to guide the development of appropriate stewardship programs that are global in scope and effectively decrease unnecessary antibiotic use. METHODS: We prospectively collected information on illness occurrence and antibiotic use from a cohort of 303 children. We evaluated the incidence, duration of therapy, and appropriateness of antibiotic prescriptions by 5 main antibiotic prescribers (physicians and nurses, pharmacists, nursing assistants, self-prescriptions, and neighbors or family members). RESULTS: Ninety percent of children received an antibiotic during follow-up, and on average, by the end of follow-up a child had spent 4.3% of their first 5 years of life on antibiotics. The most frequent prescribers were physicians/nurses (79.4%), followed by pharmacists (8.1%), self-prescriptions (6.8%), nursing assistants (3.7%), and family or neighbors (1.9%). Of the 3702 courses of antibiotics prescribed, 30.9% were done so for the occurrence of fever, 25.3% for diarrhea, 2.8% for acute lower respiratory disease, 2.7% for dysentery, and 38.2% for an undetermined illness. Courses exceeding the recommended duration were common for the principal diseases for which treatment was initiated, with 27.3% of courses exceeding the recommended length duration, representing a potential reduction in 13.2% of days on which this cohort spent on antibiotics. CONCLUSIONS: Stewardship programs should target medical personnel for a primary care stewardship program even in a context in which antibiotics are available to the public with little or no restrictions and appropriate duration should be emphasized in this training.


Assuntos
Antibacterianos , Pessoal de Saúde , Humanos , Criança , Antibacterianos/uso terapêutico , Estudos de Coortes , Peru , Prescrições , Padrões de Prática Médica
5.
PLoS Negl Trop Dis ; 15(3): e0009199, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33651824

RESUMO

BACKGROUND: Diagnosis of toxoplasmic encephalitis (TE) is challenging under the best clinical circumstances. The poor clinical sensitivity of quantitative polymerase chain reaction (qPCR) for Toxoplasma in blood and CSF and the limited availability of molecular diagnostics and imaging technology leaves clinicians in resource-limited settings with few options other than empiric treatment. METHOLOGY/PRINCIPLE FINDINGS: Here we describe proof of concept for a novel urine diagnostics for TE using Poly-N-Isopropylacrylamide nanoparticles dyed with Reactive Blue-221 to concentrate antigens, substantially increasing the limit of detection. After nanoparticle-concentration, a standard western blotting technique with a monoclonal antibody was used for antigen detection. Limit of detection was 7.8pg/ml and 31.3pg/ml of T. gondii antigens GRA1 and SAG1, respectively. To characterize this diagnostic approach, 164 hospitalized HIV-infected patients with neurological symptoms compatible with TE were tested for 1) T. gondii serology (121/147, positive samples/total samples tested), 2) qPCR in cerebrospinal fluid (11/41), 3) qPCR in blood (10/112), and 4) urinary GRA1 (30/164) and SAG1 (12/164). GRA1 appears to be superior to SAG1 for detection of TE antigens in urine. Fifty-one HIV-infected, T. gondii seropositive but asymptomatic persons all tested negative by nanoparticle western blot and blood qPCR, suggesting the test has good specificity for TE for both GRA1 and SAG1. In a subgroup of 44 patients, urine samples were assayed with mass spectrometry parallel-reaction-monitoring (PRM) for the presence of T. gondii antigens. PRM identified antigens in 8 samples, 6 of which were concordant with the urine diagnostic. CONCLUSION/SIGNIFICANCES: Our results demonstrate nanoparticle technology's potential for a noninvasive diagnostic test for TE. Moving forward, GRA1 is a promising target for antigen based diagnostics for TE.


Assuntos
Encefalite/diagnóstico , Encefalite/parasitologia , Infecções por HIV/complicações , Hidrogéis , Nanopartículas , Toxoplasmose/complicações , Adulto , Antígenos de Protozoários/líquido cefalorraquidiano , Antígenos de Protozoários/urina , Encefalite/complicações , Encefalite/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Toxoplasma , Toxoplasmose/líquido cefalorraquidiano , Toxoplasmose/diagnóstico , Toxoplasmose/urina
6.
Front Vet Sci ; 7: 556, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33102543

RESUMO

Aims: To assess the prevalence of Chagas disease in pregnant women in Iquitos City, Peru. Material and Methods: Cross-sectional survey in 300 pregnant women in Iquitos (Peru) from 1 May 2019 to 15 June 2019. Women were tested using an ELISA serology test. Results: Serology was positive in one case (prevalence: 0.33%; 95% confidence interval: 7.1-13.9%), of a 25-year-old woman who lived in a wooden house with a leaf roof in a periurban area of Iquitos. She was familiar with kissing bugs and had chronic, asymptomatic Chagas disease. Conclusion: The prevalence of Chagas disease is low in the urban and peri-urban area of the city of Iquitos.

8.
BMC Public Health ; 20(1): 728, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429863

RESUMO

BACKGROUND: HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in the Amazonian region of Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healthcare advice through experiences and perceptions of HIV-positive men who have sex with men and healthcare professionals in Loreto. METHODS: Twenty qualitative interviews with HIV-positive men who have sex with men and one focus group with HIV-specialist healthcare professionals were conducted in Loreto, January-February 2019. Interviews were transcribed per verbatim. Thematic content analysis and deviant case analysis were used. RESULTS: A culture of isolation and discrimination was identified, propagated by poor public knowledge surrounding HIV transmission and treatment. Employment potential was hampered and 7/20 patients had suicidal thoughts post-diagnosis. Barriers to care included: shame, depression, travel cost/times, a preference for traditional plant-based medicine and side-effects of antiretroviral therapy. Facilitators included: education, family and clinic support, disease acceptance and lifestyle changes. CONCLUSION: More effective, focussed community education and workplace discrimination investigations are recommended to reduce stigma and increase adherence to treatment in this population.


Assuntos
Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Minorias Sexuais e de Gênero/psicologia , Estigma Social , Adulto , Antirretrovirais/uso terapêutico , Grupos Focais , HIV , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Pesquisa Qualitativa
9.
PLoS Negl Trop Dis ; 13(2): e0007116, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30753180

RESUMO

BACKGROUND: Transmission of dengue virus (DENV) from humans to mosquitoes represents a critical component of dengue epidemiology. Examinations of this process have generally been hampered by a lack of methods that adequately represent natural acquisition of DENV by mosquitoes from humans. In this study, we assessed artificial and natural blood feeding methods based on rates of DENV infection and dissemination within mosquitoes for use in a field-based epidemiological cohort study in Iquitos, Peru. METHODOLOGY/PRINCIPAL FINDINGS: Our study was implemented, stepwise, between 2011 and 2015. Participants who were 5 years and older with 5 or fewer days of fever were enrolled from ongoing clinic- and neighborhood-based studies on dengue in Iquitos. Wild type, laboratory-reared Aedes aegypti were fed directly on febrile individuals or on blood collected from participants that was either untreated or treated with EDTA. Mosquitoes were tested after approximately 14 days of extrinsic incubation for DENV infection and dissemination. A total of 58 participants, with viremias ranging from 1.3 × 10(2) to 2.9 × 10(6) focus-forming units per mL of serum, participated in one or more feeding methods. DENV infection and dissemination rates were not significantly different following direct and indirect-EDTA feeding; however, they were significantly lower for mosquitoes that fed indirectly on blood with no additive. Relative to direct feeding, infection rates showed greater variation following indirect-EDTA than indirect-no additive feeding. Dissemination rates were similar across all feeding methods. No differences were detected in DENV infection or dissemination rates in mosquitoes fed directly on participants with different dengue illness severity. CONCLUSIONS/SIGNIFICANCE: Our study demonstrates the feasibility of using direct and indirect feeding methods for field-based studies on vector competence. Direct mosquito feeding is preferable in terms of logistical ease, biosecurity, and reliability.


Assuntos
Aedes/virologia , Vírus da Dengue/fisiologia , Dengue/virologia , Mosquitos Vetores/virologia , Adolescente , Adulto , Aedes/fisiologia , Idoso , Animais , Dengue/transmissão , Comportamento Alimentar , Feminino , Humanos , Consentimento Livre e Esclarecido , Mordeduras e Picadas de Insetos , Pessoa de Meia-Idade , Mosquitos Vetores/fisiologia , Adulto Jovem
10.
Am J Trop Med Hyg ; 100(3): 529-531, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30675848

RESUMO

Here we report the first incidence of New Delhi metallo-ß-lactamase (NDM-1)-producing Acinetobacter baumannii in Peru, identified via a strain-based nosocomial surveillance project carried out in Lima and Iquitos. The bla NDM-1 gene was detected by multiplex polymerase chain reaction (PCR) and confirmed by loci sequencing. Acinetobacter baumannii is a nearly ubiquitous and promiscuous nosocomial pathogen, and the acquisition of bla NDM-1 by A. baumannii may facilitate an increase in the prevalence of this important resistance marker in other nosocomial pathogens.


Assuntos
Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/enzimologia , Antibacterianos/farmacologia , Proteínas de Bactérias/metabolismo , beta-Lactamases/metabolismo , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/genética , Farmacorresistência Bacteriana Múltipla , Hospitais , Humanos , Peru/epidemiologia
11.
Pediatr Infect Dis J ; 38(8): e178-e180, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30531312

RESUMO

Probiotics are increasingly used for diarrhea, but studies under the Food and Drug Administration and Investigational New Drug program are few. We conducted a phase-one placebo-controlled study of Lactobacillus reuteri DSM 17938 under Investigational New Drug program in 60 children 2-5 years of age (41 L. reuteri, 19 placebos) in a resource-constrained community in Peru. No differences in objective data on adverse events were noted, although some differences based on subjective parental reports for fever and diarrhea were seen.


Assuntos
Diarreia/terapia , Limosilactobacillus reuteri/fisiologia , Probióticos/administração & dosagem , Probióticos/efeitos adversos , Biomarcadores , Pré-Escolar , Diarreia/diagnóstico , Diarreia/etiologia , Esquema de Medicação , Feminino , Humanos , Masculino , Avaliação de Sintomas , Resultado do Tratamento
12.
BMC Health Serv Res ; 18(1): 149, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29490643

RESUMO

BACKGROUND: Delays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents' limited education and their difficulties in recognizing the severity of the illness. The "three delays" was a model originally proposed to describe the most common determinants of maternal mortality, but has been adapted to describe delays in the health seeking process for caregivers of children under five. This study aims to explore the caregivers' perceived barriers for seeking and receiving health care services in children under five years old admitted to a referral hospital for community-acquired pneumonia in the Peruvian Amazon Region using the three-delays model framework. METHODS: There were two parts to this mixed-method, cross-sectional, hospital-based study. First, medical charts of 61 children (1 to 60 months old) admitted for pneumonia were reviewed, and clinical characteristics were noted. Second, to examine health care-seeking decisions and actions, as well as associated delays in the process of obtaining health care services, we interviewed 10 of the children's caregivers. RESULTS: Half of the children in our study were 9 months old or less. Main reasons for seeking care at the hospital were cough (93%) and fever (92%). Difficulty breathing and fast breathing were also reported in more than 60% of cases. In the interviews, caregivers reported delays of 1 to 14 days to go to the closest health facility. Factors perceived as causes for delays in deciding to seek care were apparent lack of skills to recognize signs and symptoms and of confidence in the health system, and practicing self-medication. No delays in reaching a health facility were reported. Once the caregivers reached a health facility, they perceived lack of competence of medical staff and inadequate treatment provided by the primary care physicians. CONCLUSION: According to caregivers, the main delays to get health care services for pneumonia among young children were identified in the initial decision of caregivers to seek healthcare and in the health system to provide it. Specific interventions targeted to main barriers may be useful for reducing delays in providing appropriate health care for children with pneumonia.


Assuntos
Cuidadores/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia/terapia , Tempo para o Tratamento/estatística & dados numéricos , Cuidadores/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Lactente , Masculino , Peru
13.
Rev Peru Med Exp Salud Publica ; 32(1): 172-8, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-26102121

RESUMO

Dengue has affected Iquitos since 1990 causing outbreaks of major impact on public health and for this reason great efforts have been made for its temporal control. Currently, with the expansion of the chikungunya virus in the Americas and the threat of the emergence of the virus in Iquitos, we reflect on lessons learned by way of the activities undertaken in the area of vector control; epidemiological surveillance, diagnosis and clinical management during periods of outbreaks of dengue, in a way that will allow us to better face the threat of an outbreak of chikungunya virus in the largest city in the Peruvian Amazon.


Assuntos
Aedes , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/prevenção & controle , Dengue/epidemiologia , Dengue/prevenção & controle , Surtos de Doenças , Controle de Mosquitos/métodos , Animais , Humanos , Peru/epidemiologia
14.
Rev. peru. med. exp. salud publica ; 32(1): 172-178, ene.-mar. 2015. ilus, tab
Artigo em Espanhol | LILACS, LIPECS, INS-PERU | ID: lil-745235

RESUMO

El dengue ha afectado a Iquitos desde 1990 causando varios brotes de gran impacto en la salud pública y por el que se desplegaron grandes esfuerzos para su control temporal. Actualmente, ante la expansión del virus chikungunya en las Américas y la amenaza de la emergencia del virus en Iquitos, reflexionamos a modo de lecciones aprendidas las actividades emprendidas en el área del control vectorial; la vigilancia epidemiológica; el diagnóstico y el manejo clínico durante los periodos de brotes de dengue, de modo que nos permita enfrentar mejor la amenaza de un brote del virus chikunguña en la ciudad más grande de la Amazonía peruana.


Dengue has affected Iquitos since 1990 causing outbreaks of major impact on public health and for this reason great efforts have been made for its temporal control. Currently, with the expansion of the chikungunya virus in the Americas and the threat of the emergence of the virus in Iquitos, we reflect on lessons learned by way of the activities undertaken in the area of vector control; epidemiological surveillance, diagnosis and clinical management during periods of outbreaks of dengue, in a way that will allow us to better face the threat of an outbreak of chikungunya virus in the largest city in the Peruvian Amazon.


Assuntos
Humanos , Surtos de Doenças , Dengue , Dengue/prevenção & controle , Vírus Chikungunya , Peru
15.
PLoS Negl Trop Dis ; 8(7): e3003, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25033412

RESUMO

INTRODUCTION: Long-term disease surveillance data provide a basis for studying drivers of pathogen transmission dynamics. Dengue is a mosquito-borne disease caused by four distinct, but related, viruses (DENV-1-4) that potentially affect over half the world's population. Dengue incidence varies seasonally and on longer time scales, presumably driven by the interaction of climate and host susceptibility. Precise understanding of dengue dynamics is constrained, however, by the relative paucity of laboratory-confirmed longitudinal data. METHODS: We studied 10 years (2000-2010) of laboratory-confirmed, clinic-based surveillance data collected in Iquitos, Peru. We characterized inter and intra-annual patterns of dengue dynamics on a weekly time scale using wavelet analysis. We explored the relationships of case counts to climatic variables with cross-correlation maps on annual and trimester bases. FINDINGS: Transmission was dominated by single serotypes, first DENV-3 (2001-2007) then DENV-4 (2008-2010). After 2003, incidence fluctuated inter-annually with outbreaks usually occurring between October and April. We detected a strong positive autocorrelation in case counts at a lag of ∼ 70 weeks, indicating a shift in the timing of peak incidence year-to-year. All climatic variables showed modest seasonality and correlated weakly with the number of reported dengue cases across a range of time lags. Cases were reduced after citywide insecticide fumigation if conducted early in the transmission season. CONCLUSIONS: Dengue case counts peaked seasonally despite limited intra-annual variation in climate conditions. Contrary to expectations for this mosquito-borne disease, no climatic variable considered exhibited a strong relationship with transmission. Vector control operations did, however, appear to have a significant impact on transmission some years. Our results indicate that a complicated interplay of factors underlie DENV transmission in contexts such as Iquitos.


Assuntos
Dengue/epidemiologia , Dengue/transmissão , Dengue/virologia , Animais , Culicidae , Vírus da Dengue , Humanos , Incidência , Peru/epidemiologia , Estações do Ano , Tempo (Meteorologia)
16.
Rev Chilena Infectol ; 30(5): 541-7, 2013 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-24248170

RESUMO

Dengue fever is the world's most important arboviral disease, presenting a wide clinical spectrum. We report for the first time in Peru, a case caused by dengue virus serotype 4 with significant gastrointestinal involvement (acute acalculous cholecystitis and acute hepatitis). In addition we carried out a review of the literature atypical presentation illustrating the importance of the characteristics of abdominal pain (right upper quadrant); presence of Murphy's sign, ultrasound, and liver enzymes levels, for appropriate diagnosis and clinical management.


Assuntos
Colecistite Acalculosa/virologia , Vírus da Dengue/classificação , Dengue/virologia , Hepatite/virologia , Doença Aguda , Dengue/complicações , Feminino , Humanos , Adulto Jovem
17.
Rev. chil. infectol ; 30(5): 541-547, oct. 2013. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-691161

RESUMO

Dengue fever is the world's most important arboviral disease, presenting a wide clinical spectrum. We report for the first time in Peru, a case caused by dengue virus serotype 4 with significant gastrointestinal involvement (acute acalculous cholecystitis and acute hepatitis). In addition we carried out a review of the literature atypical presentation illustrating the importance of the characteristics of abdominal pain (right upper quadrant); presence of Murphy's sign, ultrasound, and liver enzymes levels, for appropriate diagnosis and clinical management.


El dengue es la arbovirosis más importante del mundo y causa un amplio espectro clínico. Presentamos el primer caso de dengue causado por el serotipo 4 (DENV-4) en Perú con compromiso gastrointestinal (colecistitis aguda alitiásica y hepatitis aguda moderada). Se presenta una revisión de la literatura médica sobre este tipo de presentación, enfatizando la importancia y características del dolor abdominal (hipocondrio derecho), el signo de Murphy, los hallazgos ultrasonográficos y la medición de las enzimas hepáticas para establecer el diagnóstico y manejo adecuado.


Assuntos
Feminino , Humanos , Adulto Jovem , Colecistite Acalculosa/virologia , Vírus da Dengue/classificação , Dengue/virologia , Hepatite/virologia , Doença Aguda , Dengue/complicações
18.
Am J Trop Med Hyg ; 88(6): 1109-15, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23530074

RESUMO

Long-lasting insecticidal net (LLIN) use is a proven malaria prevention method. Mass distribution has greatly expanded LLIN access in sub-Saharan Africa, but a gap remains between LLIN ownership and use. Furthermore, LLINs wear out more quickly than anticipated. This paper suggests a participatory research strategy-trials of improved practices (TIPs)-that could identify locally appropriate approaches to prolonging net life and increasing effective use. We used TIPs to overcome barriers to optimal net use in the Peruvian Amazon. Working with 15 families in three villages, we tested home treatment of cotton nets, use of an alternative netting fabric, and alternative washing and care instructions. TIPs helped confirm feasibility of these interventions. Although our findings are time- and context-specific, TIPs could help improve consistency and effectiveness of current LLIN use and prolong net lifespan in sub-Saharan Africa and elsewhere. This would help maximize the value of shrinking donor resources for malaria.


Assuntos
Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Mosquiteiros Tratados com Inseticida/normas , Malária/prevenção & controle , África Subsaariana , Humanos , Controle de Mosquitos/métodos , Inquéritos e Questionários
19.
Rev. peru. cardiol. (Lima) ; 36(1): 14-20, ene.-abr. 2010. tab
Artigo em Espanhol | LILACS, LIPECS | ID: lil-565423

RESUMO

Objetivo: Presentar incidencia aproximada de cardiopatías congénitas en menores de un año de edad en la ciudad de Iquitos durante los años 2006 y 2007. Material y Método: Estudio epidemiológico descriptivo. El diagnóstico de cardiopatía congénita se hizo con ecocardiógrafo, los casos diagnosticados en el Hospital III Iquitos ESSALUD se confirmaron en el INCOR e Instituto Nacional de Salud del Niño de Lima. Los casos pertenecen a niños que gozan de atención en ESSALUD como derivados de los Hospitales del Minsa de Iquitos, Regional y Apoyo Iquitos. Resultados: La incidencia de cardiopatías congénitas encontrada durante el 2006 fue de 3.92 por mil. La incidencia de cardiopatías congénitas acianóticas fue de 3.32 por mil mientras que las cianóticas fueron de 0.6 por mil. La incidencia encontrada durante el 2007 fue de 6.11 por mil. La incidencia de cardiopatías congénitas acianóticas encontrada fue de 4.6 por mil en tanto que las cianóticas fueron de 1.5 por mil. Palabras clave: incidencia, cardiopatía congénita, Iquitos.


Objective: To determine the approximate incidence of congenital heart disease in children under one years of age in the city of Iquitos in the years 2006 and 2007. Methods: A descriptive epidemiological study. The diagnosis of congenital heart disease was made by Echocardiographs, cases diagnosed at the Hospital Iquitos III ESSALUD. Cases were confirmed by INCOR and National Institute of Child Health in Lima. The cases are children who have attention ESSALUD and also derivatives of Hospitals Regional and Iquitos. Results: The incidence of congenital heart disease found during 2006 was 3.92 per thousand. The incidence of acyanotic congenital heart disease was 3.32 per thousand while the cyanotic was 0.6 per thousand. The incidence found in 2007 was 6.11 per thousand. The incidence of acyanotic congenital heart disease found was 4.6 per thousand while the cyanotic was 1.5 per thousand.


Assuntos
Humanos , Masculino , Feminino , Lactente , Cardiopatias Congênitas , Incidência , Epidemiologia Descritiva
20.
Acta méd. peru ; 25(4): 220-223, oct.-dic. 2008. tab
Artigo em Espanhol | LILACS, LIPECS | ID: lil-525686

RESUMO

Introducción:la malaria es una enfermedad parasitemia endémica en el norte del Perú tanto a nivel de la costa como de la selva. El conocimiento sobre la incidencia de malaria en gestantes, de malaria congénita y algunas variables asociadas, es aún escaso. Objetivo: determinar la incidencia acumulada de malaria en gestantes en un periodo de 15 meses en el Hospital Regional de Loreto. Determinar la incidencia de malaria congénita. Material y método: estudio epidemiológico analítico que busca determinar la asociación entre malaria en gestantes con: bajo peso al nacer, prematuridad, caso anterior de malaria, primigesta, edad menor a 21 años y fiebre con malaria utilizando inferencia estadística, Odds Ratio con intervalos de confianza, valor de chi y valor de p. Resultados: la incidencia acumulada de malaria en gestantes seguidas durante 15 meses fue de 15,3 por ciento. No se encontraron casos de malaria congénita. Se encuentra asociación entre malaria en gestantes y bajo peso al nacer (p = 0,0001855), prematuridad (p = 0,0214822), caso anterior de malaria (p = 0,0000281). No se encuentra asociación con condición de primigesta ni gestante menor de 21 años. Fiebre no es predictor clínico de malaria en gestantes. Otros hallazgos importantes son la asociación entre malaria por P. falciparum y óbitos durante gestación (p= 0,0196497) y que los promedios de hematocrito y hemoglobina son menores en gestantes con malaria comparados con gestantes sin malaria. Conclusiones: este estudio de malaria en gestantes encuentra una mayor asociacion con bajo peso al nacer y prematuridad. Los caso de Malaria falciparum se asociaron con óbito fetal, no hubo casos congénitos.


Introduction: Malaria is an endemic parasitic disease in northern Peru, both in the coast and in the jungle. There is still poor knowledge about the incidence of malaria in pregnant women, as well as about congenital malaria and some associated variables. Objective: To determine the cumulative incidence of malaria in pregnant women during a 15-month period in Hospital Regional de Loreto, and to determine the incidence of congenital malaria. Material and Method: An analytical epidemiological study aiming to determine the association between malaria in pregnant women and: low birth weight, prematurity, prior malaria infection, first pregnancy, being less than 21 years old, and the presence of fever with malaria, using statistical inference, odds ratios and confidence intervals, chi squares and p statistics. Results: The cumulative incidence of malaria in pregnant women followed for 15 months was 15,3 per cent. No cases of congenital malaria were found. There is an association between malaria in pregnant women and low birth weight (p= 0,0001855), prematurity (P= 0,0214822), and a prior malaria infection (p= 0,0000281). There was no association between malaria and being a first pregnancy or being less than 21 years old. Other important findings were the association between P. falciparum malaria and fetal deaths during pregnancy (p= 0,0196497), and that average hematocrit and hemoglobin values are smaller in pregnant women with malaria compared to pregnant women without malaria. Conclusions: The study about malaria in pregnant woman found a significant association of this infection with low birth weight and prematurity. Malaria caused by P. falciparum during pregnancy is associated with fetal death there were no cases of congenital malaria.


Assuntos
Humanos , Adolescente , Adulto , Feminino , Malária , Gestantes , Estudos Epidemiológicos
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