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1.
Geneva; World Health Organization; 2020-03-21.
em Inglês | WHO IRIS | ID: who-331605
2.
PLoS Negl Trop Dis ; 14(1): e0007967, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32004316

RESUMO

Oral cholera vaccine (OCV) has increasingly been used as an outbreak control measure, but vaccine shortages limit its application. A two-dose OCV campaign targeting residents aged over 1 year was launched in three rural Communes of Southern Haiti during an outbreak following Hurricane Matthew in October 2016. Door-to-door and fixed-site strategies were employed and mobile teams delivered vaccines to hard-to-reach communities. This was the first campaign to use the recently pre-qualified OCV, Euvichol. The study objective was to estimate post-campaign vaccination coverage in order to evaluate the campaign and guide future outbreak control strategies. We conducted a cluster survey with sampling based on random GPS points. We identified clusters of five households and included all members eligible for vaccination. Local residents collected data through face-to-face interviews. Coverage was estimated, accounting for the clustered sampling, and 95% confidence intervals calculated. 435 clusters, 2,100 households and 9,086 people were included (99% response rate). Across the three communes respectively, coverage by recall was: 80.7% (95% CI:76.8-84.1), 82.6% (78.1-86.4), and 82.3% (79.0-85.2) for two doses and 94.2% (90.8-96.4), 91.8% (87-94.9), and 93.8% (90.8-95.9) for at least one dose. Coverage varied by less than 9% across age groups and was similar among males and females. Participants obtained vaccines from door-to-door vaccinators (53%) and fixed sites (47%). Most participants heard about the campaign through community 'criers' (58%). Despite hard-to-reach communities, high coverage was achieved in all areas through combining different vaccine delivery strategies and extensive community mobilisation. Emergency OCV campaigns are a viable option for outbreak control and where possible multiple strategies should be used in combination. Euvichol will help alleviate the OCV shortage but effectiveness studies in outbreaks should be done.


Assuntos
Vacinas contra Cólera/administração & dosagem , Cólera/prevenção & controle , Vacinação em Massa/métodos , Cobertura Vacinal , Adolescente , Adulto , Criança , Pré-Escolar , Cólera/epidemiologia , Vacinas contra Cólera/provisão & distribução , Análise por Conglomerados , Coleta de Dados , Surtos de Doenças , Características da Família , Feminino , Haiti/epidemiologia , Humanos , Lactente , Masculino , População Rural
5.
Rev Panam Salud Publica ; 43, December 2019
Artigo em Inglês | PAHO-IRIS | ID: phr-51733

RESUMO

[ABSTRACT]. Objective. To assess the incidence of obstetric complications—eclampsia, dystocia, cesarean section, postpartum hemorrhage, and stillbirths—in hospitals in southern Haiti in 2013 – 2016 and to discuss implications for improvements to the surveillance of birth outcomes. Methods. This was a cross-sectional, retrospective study of data for 32 442 deliveries recorded in 2013 – 2016 by the Integrated Monitoring, Evaluation, and Surveillance System for facilities across three departments and one high-volume hospital in southern Haiti. Annual incidence rates of eclampsia, dystocia, cesarean section, postpartum hemorrhage, and stillbirths (both macerated and fresh) were calculated. Results. The incidence of eclampsia in the study sample was 2% – 3% and of dystocia approximately 5%, comparable to elsewhere in Haiti and other low-income countries. Cesarean delivery rates averaged about 15% annually. Postpartum hemorrhage rates were lower than published data from similar settings. Stillbirth rates ranged from 30 – 62 per 1 000 births at all facilities, higher than previously recorded by the country’s population surveys. The rates of macerated stillbirths were remarkably high, close to 50% of total stillbirths, indicating severe delays in seeking or receiving emergency obstetric care. Conclusions. This study provides important benchmarks for the current burden of preventable labor- and delivery-related complications in Haiti. Surveillance data suggest an urgent need for the management of hypertensive disorders during pregnancy, timely cesarean sections for dystocia, and management and treatment of postpartum hemorrhage in Haiti. Frequent data reviews may help address facility-specific bottlenecks.


[RESUMEN]. Objetivo. Evaluar la incidencia de las complicaciones obstétricas, como la eclampsia, la distocia, las cesáreas, la hemorragia posparto y la mortinatalidad, en los hospitales del sur de Haití en el período comprendido entre los años 2013 y 2016, y analizar las implicaciones para realizar mejoras en la vigilancia de los resultados perinatales. Métodos. Se trata de un estudio transversal y retrospectivo de los datos de 32 442 partos registrados en el período 2013-2016 mediante el sistema integrado de seguimiento, evaluación y vigilancia para establecimientos en tres departamentos y un hospital de gran actividad en el sur de Haití. Se calcularon las tasas de incidencia anuales de eclampsia, distocia, cesáreas y hemorragia posparto, así como de mortinatalidad (mortinatos macerados y frescos). Resultados. La incidencia de eclampsia en la muestra de estudio fue de entre 2% y 3% y de distocia, de aproximadamente 5%, equiparable a cualquier lugar en Haití y otros países de ingresos bajos. Las tasas promedio de parto por cesárea se aproximaron al 15% anual. Las tasas de hemorragia posparto fueron inferiores a los datos publicados sobre entornos similares. Las tasas de mortinatalidad comprendieron entre 30 y 62 por 1 000 nacimientos en la totalidad de establecimientos, un resultado mayor al que registrado con anterioridad en las encuestas de población del país. Las tasas de mortinatos macerados fueron notablemente elevadas, cerca de 50% de la mortinatalidad total, lo que pone de manifiesto retrasos graves a la hora de solicitar u obtener atención obstétrica de urgencia. Conclusiones. Este estudio ofrece puntos de referencia relevantes para la carga actual de complicaciones prevenibles del embarazo y el parto en Haití. Los datos de vigilancia indican que existe una urgente necesidad de tratamiento de los trastornos hipertensivos durante el embarazo, de cesáreas por distocia a tiempo, y de atención y tratamiento de la hemorragia posparto en Haití. Para abordar los obstáculos propios de los establecimientos puede ser útil realizar análisis frecuentes de los datos.


[RESUMO]. Objetivo. Avaliar a incidência de complicações obstétricas – eclâmpsias, distocias, cesarianas, hemorragias pós-parto e natimortos – em hospitais na região Sul do Haiti no período de 2013 a 2016 e discutir as implicações para melhorar a vigilância dos resultados dos partos. Métodos. Este foi um estudo transversal, retrospectivo, com dados de 32 442 partos registrados pelo Sistema Integrado de Monitoramento, Avaliação e Vigilância para estabelecimentos de saúde situados em três divisões político-administrativas (denominadas de departamentos) e um hospital de alto volume, todos situados na região Sul do Haiti, no período de 2013 a 2016. Foram calculadas as taxas anuais de incidência de eclâmpsias, distocias, cesarianas, hemorragias pós-parto e natimortos (macerados e frescos). Resultados. Na amostra do estudo, a taxa de incidência de eclâmpsias foi de 2 a 3%, e a de partos distócicos de aproximadamente 5%, comparáveis com as de outras localidades no Haiti e com outros países de baixa renda; as cesarianas apresentaram média anual de aproximadamente 15%; as taxas de hemorragia pós-parto foram menores que as publicadas sobre estabelecimentos similares. Em todos os estabelecimentos, as taxas de partos de natimortos variaram de 30 a 62 por 1 000 nascimentos, sendo mais altas que as anteriormente registradas pelos levantamentos populacionais do país. As taxas de natimortos macerados foram excepcionalmente altas, aproximadamente 50% do total de partos de natimortos, o que indica que há graves atrasos, seja na procura por atenção obstétrica de emergência ou no recebimento dessa atenção. Conclusões. Esse estudo fornece importantes parâmetros para determinar a atual carga de complicações passíveis de prevenção relacionadas com o trabalho de parto e com o parto propriamente dito no Haiti. Os dados de vigilância sugerem que, no Haiti, há uma necessidade urgente de manejar distúrbios hipertensivos durante a gestação, realizar cesarianas em tempo oportuno nos casos de distocias e manejar e tratar hemorragias pós-parto. Revisões frequentes dos dados podem ajudar a identificar os gargalos específicos de cada estabelecimento.


Assuntos
Eclampsia , Distocia , Cesárea , Hemorragia Pós-Parto , Natimorto , Haiti , Distocia , Cesárea , Hemorragia Pós-Parto , Natimorto , Haiti , Hemorragia Pós-Parto , Natimorto
6.
Forensic Sci Int ; 305: 110013, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31710881

RESUMO

Ancestry estimation of skeletonized remains by forensic anthropologists is conducted through comparative means, and a lack of population-specific data results in possible misclassifications. This is especially germane to individuals of Latin American ancestry. Generally, each country in Latin America can trace their ancestral lineage through three main parental groups: Indigenous, European, and African. However, grouping all Latin American individuals under the broad "Hispanic" category ignores the specific genetic contributions from each parental group, which is variable and dependent on the population histories and sociocultural dynamics of each country. This study analyzes the craniometric ancestry of Hispaniola (the Dominican Republic and Haiti) using 190 cranial Computed Tomography (CT) scans (f=103; m=87), along with the island's history, to explore similarities and differences between the two groups. MANOVA results indicate that 53.6% and 71.4% of the 28 cranial measurements differ between the ancestries and sexes, respectively; and intraobserver error analyses demonstrate that 85.7% of measurements from CT scans are good-excellent in reliability. Further, a total of 12 canonical discriminant function analyses produced cross-validated classification accuracies of 73.7-78.6% for females, 71.8-87.5% for males, and 72.0-77.8% for pooled sex. This study demonstrates that, despite sharing a small island, Dominican and Haitian individuals can be differentiated with a fair amount of statistical certainty, which is possible due to complex socio-cultural, -political, and -demographic factors that have produced and maintained genetic heterogeneity. Moreover, the discriminant functions provided here can be used by the international forensic science community to identify individuals living on Hispaniola.


Assuntos
Cefalometria , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Discriminante , República Dominicana , Feminino , Antropologia Forense , Haiti , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Adulto Jovem
7.
Zootaxa ; 4568(2): zootaxa.4568.2.1, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-31715855

RESUMO

A faunistic survey of the Hispaniolan bugs of the family Coreidae is presented based on the study of over 1000 specimens deposited in several entomological collections. The new species Zicca gloriosa sp. nov. is described from the Dominican Republic. Another 12 species are new records for the island, 11 of them being new records for the Dominican Republic: Althos obscurator (Fabricius, 1803), Anasa acutangula Stål, 1870, Anasa tristis (De Geer, 1773), Eubule spartocerana Brailovsky, 1992, Leptoglossus confusus Alayo Grillo, 1977, Mamurius cubanus Barber Bruner, 1947, Merocoris distinctus Dallas, 1852, Merocoris typhaeus (Fabricius, 1798), Phthia rubropicta (Westwood, 1842), Sethenira ferruginea Stål, 1870, and Zicca rubricator rubricator (Fabricius, 1803). New records for Haiti are Anasa scorbutica (Fabricius, 1798), Catorhintha selector Stål, 1859, Chariesterus gracilicornis Stål, 1870, Rhytidophthia splendida (Valdes, 1910) and Zicca taeniola (Dallas, 1852). The literature citations presented in Perez-Gelabert (2008) of Leptoglossus cinctus (Herrich-Schäffer, 1836) and Leptoglossus stigma (Herbst, 1784) are probably based on erroneous identifications and not counted as part of the Hispaniolan fauna. The total number of species presently known from Hispaniola is raised to 28. Key to subfamilies, tribes, genera and species are included, as well as color dorsal habitus.


Assuntos
Heterópteros , Animais , República Dominicana , Haiti
8.
Zootaxa ; 4624(2): zootaxa.4624.2.8, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31716227

RESUMO

Three new species of the genus Thaloe are described from Antillean region: Thaloe maricao n. sp., from Maricao, Puerto Rico and Virgin Island, Thaloe leboulet n. sp., from Le Boulet and Mariani, Haiti and Thaloe ebano n. sp., from the Dominican Republic. Females of species of this genus are described for the first time.


Assuntos
Aranhas , Distribuição Animal , Animais , República Dominicana , Feminino , Haiti , Porto Rico
9.
BMC Public Health ; 19(1): 1513, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718594

RESUMO

BACKGROUND: Discrimination is a major driver of health disparities among minority groups and can impede the reach of public health programs. In the Dominican Republic, residents of bateyes, or agricultural 'company towns,' often face barriers to health care. This study examined the extent of perceived discrimination among batey populations and places the findings within the context of disease elimination efforts. METHODS: In March-April 2016, a stratified, multi-stage cluster survey that included the 9-item Everyday Discrimination Scale (EDS) was conducted among residents (n = 768) of bateyes across the Dominican Republic. Exploratory factor analysis, differential item functioning, and linear and logistic regression were used to assess associations between EDS scores, ethnic group status, reasons for discrimination, and healthcare-seeking behavior. RESULTS: Three ethnic groups were identified in the population: Haitian-born persons (42.5%), Dominican-born persons with Haitian descent (25.5%), and Dominican-born persons without Haitian descent (32.0%). Mean EDS scores (range 0-45) were highest among persons born in Haiti (18.2, 95% confidence interval [CI] = 16.4-20.1), followed by persons with Haitian descent (16.5, 95% CI = 14.9-18.0), and those without Haitian descent (13.3, 95% CI = 12.1-14.5). Higher EDS scores were significantly associated with Haitian birth (ß = 6.8, 95% CI = 4.2-9.4; p < 0.001) and Haitian descent (ß = 6.1, 95% CI = 3.2-9.0; p < 0.001). Most respondents (71.5%) had scores high enough to elicit reasons for their discrimination. Regardless of ethnic group, poverty was a common reason for discrimination, but Haitian-born and Haitian-descended people also attributed discrimination to their origin, documentation status, or skin color. EDS scores were not significantly associated with differences in reported care-seeking for recent fever (ß = 1.7, 95% CI = - 1.4-4.9; p = 0.278). CONCLUSION: Perceived discrimination is common among batey residents of all backgrounds but highest among Haitian-born people. Discrimination did not appear to be a primary barrier to care-seeking, suggesting other explanations for reduced care-seeking among Haitian populations. Public health community engagement strategies should avoid exacerbating stigma, build active participation in programs, and work towards community ownership of disease control and elimination goals.


Assuntos
Agricultura , Grupos Étnicos , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Pobreza , Discriminação Social , Migrantes , Adolescente , Adulto , Idoso , Erradicação de Doenças , República Dominicana , Feminino , Haiti , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Saúde Pública , Características de Residência , Inquéritos e Questionários , Adulto Jovem
10.
BMJ Case Rep ; 12(10)2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31604717

RESUMO

Hepatocellular carcinoma (HCC) is a terminal, yet preventable, outcome of untreated infection with hepatitis B virus (HBV). HBV is endemic in many areas of Latin America and the Caribbean, including Haiti. Haitians have the highest incidence of liver cancer among Caribbean immigrants. Unfortunately, many of these patients are not screened, despite current guidelines. As HBV is treatable, screening of high-risk populations is crucial to early intervention and prevention of poor outcomes. We highlight the case of a young Haitian male immigrant who presented with unintentional weight loss and epigastric pain and found to have HCC associated with HBV. Despite chemotherapy, the patient died 15 months after diagnosis. Increased awareness of HBV among patients from high-incidence countries may result in early recognition of this disease and reduced morbidity and mortality from devastating complications.


Assuntos
Carcinoma Hepatocelular/virologia , Hepatite B Crônica/complicações , Neoplasias Hepáticas/virologia , Adulto , Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/tratamento farmacológico , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Diagnóstico Diferencial , Evolução Fatal , Haiti , Hepatite B Crônica/diagnóstico , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Masculino , Programas de Rastreamento , Oxaliplatina/uso terapêutico , Guias de Prática Clínica como Assunto , Sorafenibe/uso terapêutico , Tomografia Computadorizada por Raios X
11.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31530717

RESUMO

BACKGROUND: Newborn screening provides early diagnosis for children with sickle cell disease (SCD), reducing disease-related mortality. We hypothesized that rapid point-of-care (POC) Sickle SCAN would be reliable in Haiti and would assist newborn screening. METHODS: Dried blood specimens were obtained from infant heel sticks and analyzed by isoelectric focusing (IEF) at a public hospital in Cap-Haïtien during a 1-year period. A total of 360 Guthrie cards were also analyzed for quality assurance by high-performance liquid chromatography at the Florida Newborn Screening Laboratory. In addition, two-thirds of the infants were also screened by the POC to assess differences with the IEF. The hemoglobinopathy incidence and the specificity and sensitivity of the POC scan were assessed. RESULTS: Overall, 1.48% of the children screened positive for SCD. The specificity and the sensitivity of POC Sickle SCAN were 0.97 (confidence interval 0.95-0.99) and 0.90 (confidence interval 0.55-1.00), respectively, relative to high-performance liquid chromatography gold standard. The confirmatory testing rate was 75% before POC and improved to 87% after POC was added for dual screening. Confirmatory testing revealed that 0.83% of children screened had SCD. Children who screened positive for SCD by POC started penicillin earlier, had their first pediatric follow-up a median of 38 days earlier, and received antipneumococcal vaccination on time when compared with those who screened positive for SCD by IEF alone. CONCLUSIONS: The observational study revealed a high incidence of SCD among Haitian newborns. Sickle SCAN had excellent specificity and sensitivity to detect SCD during newborn screening and shortened health care access for children positive for SCD.


Assuntos
Anemia Falciforme/diagnóstico , Triagem Neonatal/métodos , Testes Imediatos , Pobreza , Anemia Falciforme/sangue , Anemia Falciforme/epidemiologia , Cromatografia Líquida de Alta Pressão/normas , Intervalos de Confiança , Feminino , Florida/epidemiologia , Haiti/etnologia , Humanos , Incidência , Lactente , Recém-Nascido , Focalização Isoelétrica/métodos , Masculino , Testes Imediatos/normas , Sensibilidade e Especificidade , Traço Falciforme/diagnóstico , Traço Falciforme/epidemiologia
12.
Malar J ; 18(1): 263, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370901

RESUMO

BACKGROUND: Most impact prediction of malaria vector control interventions has been based on African vectors. Anopheles albimanus, the main vector in Central America and the Caribbean, has higher intrinsic mortality, is more zoophilic and less likely to rest indoors. Therefore, relative impact among interventions may be different. Prioritizing interventions, in particular for eliminating Plasmodium falciparum from Haiti, should consider local vector characteristics. METHODS: Field bionomics data of An. albimanus from Hispaniola and intervention effect data from southern Mexico were used to parameterize mathematical malaria models. Indoor residual spraying (IRS), insecticide-treated nets (ITNs), and house-screening were analysed by inferring their impact on the vectorial capacity in a difference-equation model. Impact of larval source management (LSM) was assumed linear with coverage. Case management, mass drug administration and vaccination were evaluated by estimating their effects on transmission in a susceptible-infected-susceptible model. Analogous analyses were done for Anopheles gambiae parameterized with data from Tanzania, Benin and Nigeria. RESULTS: While LSM was equally effective against both vectors, impact of ITNs on transmission by An. albimanus was much lower than for An. gambiae. Assuming that people are outside until bedtime, this was similar for the impact of IRS with dichlorodiphenyltrichloroethane (DDT) or bendiocarb, and impact of IRS was less than that of ITNs. However, assuming people go inside when biting starts, IRS had more impact on An. albimanus than ITNs. While house-screening had less impact than ITNs or IRS on An. gambiae, it had more impact on An. albimanus than ITNs or IRS. The impacts of chemoprevention and chemotherapy were comparable in magnitude to those of strategies against An. albimanus. Chemo-prevention impact increased steeply as coverage approached 100%, whilst clinical-case management impact saturated because of remaining asymptomatic infections. CONCLUSIONS: House-screening and repellent IRS are potentially highly effective against An. albimanus if people are indoors during the evening. This is consistent with historical impacts of IRS with DDT, which can be largely attributed to excito-repellency. It also supports the idea that housing improvements have played a critical role in malaria control in North America. For elimination planning, impact estimates need to be combined with feasibility and cost-analysis.


Assuntos
Anopheles , Controle de Doenças Transmissíveis/métodos , Malária/prevenção & controle , Controle de Mosquitos/métodos , Mosquitos Vetores , África , Animais , Anopheles/efeitos dos fármacos , Anopheles/crescimento & desenvolvimento , Administração de Caso/estatística & dados numéricos , Haiti , Humanos , Larva/efeitos dos fármacos , Larva/crescimento & desenvolvimento , Vacinas Antimaláricas/uso terapêutico , Administração Massiva de Medicamentos/estatística & dados numéricos , Modelos Teóricos , Especificidade da Espécie , Vacinação/estatística & dados numéricos
13.
Int J Infect Dis ; 87: 151-153, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31382049

RESUMO

Mayaro virus (MAYV) is a mosquito-transmitted alphavirus that is being recognized with increasing frequency in South America. As part of on-going surveillance of a school cohort in Haiti, we identified MAYV infections in 5 children across a 7-month time span, at two different school campuses. All had a history of fever, and three had headaches; none complained of arthralgias. On analysis of whole genome sequence data, three strains were genotype D, and two were genotype L; phylogenetic and molecular clock analysis was consistent with at least 3 independent introductions of the virus into Haiti, with ongoing transmission of a common genotype D strain in a single school. Our data highlight the clear potential for spread of the virus in the northern Caribbean and North America.


Assuntos
Infecções por Alphavirus/transmissão , Infecções por Alphavirus/virologia , Alphavirus/isolamento & purificação , Alphavirus/genética , Alphavirus/fisiologia , Infecções por Alphavirus/epidemiologia , Animais , Região do Caribe , Criança , Pré-Escolar , Culicidae/virologia , Feminino , Genoma Viral , Genótipo , Haiti , Humanos , Masculino , Filogenia , Viagem
15.
Elife ; 82019 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-31424386

RESUMO

Little is known about enteropathogen seroepidemiology among children in low-resource settings. We measured serological IgG responses to eight enteropathogens (Giardia intestinalis, Cryptosporidium parvum, Entamoeba histolytica, Salmonella enterica, enterotoxigenic Escherichia coli, Vibrio cholerae, Campylobacter jejuni, norovirus) in cohorts from Haiti, Kenya, and Tanzania. We studied antibody dynamics and force of infection across pathogens and cohorts. Enteropathogens shared common seroepidemiologic features that enabled between-pathogen comparisons of transmission. Overall, exposure was intense: for most pathogens the window of primary infection was <3 years old; for highest transmission pathogens primary infection occurred within the first year. Longitudinal profiles demonstrated significant IgG boosting and waning above seropositivity cutoffs, underscoring the value of longitudinal designs to estimate force of infection. Seroprevalence and force of infection were rank-preserving across pathogens, illustrating the measures provide similar information about transmission heterogeneity. Our findings suggest antibody response can be used to measure population-level transmission of diverse enteropathogens in serologic surveillance.


Assuntos
Anticorpos Antibacterianos/sangue , Anticorpos Antiprotozoários/sangue , Anticorpos Antivirais/sangue , Infecções Bacterianas/epidemiologia , Infecções por Caliciviridae/epidemiologia , Imunoglobulina G/sangue , Enteropatias Parasitárias/epidemiologia , Fatores Etários , Criança , Países em Desenvolvimento , Transmissão de Doença Infecciosa , Monitoramento Epidemiológico , Haiti/epidemiologia , Humanos , Quênia/epidemiologia , Estudos Longitudinais , Estudos Soroepidemiológicos , Tanzânia/epidemiologia
16.
J Grad Med Educ ; 11(4 Suppl): 152-157, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31428273

RESUMO

Background: Access to a trained, competent health care workforce remains a challenge globally, particularly in rural settings. To bridge this gap, the World Health Organization calls for innovations in electronic learning and task shifting. Yet, these approaches are underutilized due to cost, challenges associated with implementing technology, and a lack of suitably educated trainees. Objective: We explored the feasibility of the Acute Care Providers Project (ACPP) to remotely train community members to be health care providers in 2 sites: Haiti and India. Methods: The ACP program is an asynchronous curriculum that provides core health content and a structured approach to clinical care through an electronic curriculum. The curriculum is reinforced with case-based practice and hands-on workshops for procedural skills. ACPP was deployed in rural Haiti and India. Evaluation of the program included multiple-choice pretests and posttests, an objective structured clinical examination (OSCE), and direct observation of skills. Results: Four Haitian and 55 Indian trainees completed the course. In Haiti, mean scores were 34.8% (SD 12.4) on the pretest and 78.0% (SD 6.5) on the posttest (P = .004). Trainees scored 100% on the OSCE and passed the skills checklist. In India, mean scores were 16.5% (SD 3.9) on the pretest and 81.7% (SD 9.0) on the posttest (P < .001). Trainees scored a median of 91.8% (SD 3.95) on the OSCE and all passed the skills checklist. Conclusions: The ACPP offers a scalable, replicable asynchronous curriculum to train lay individuals to provide basic health care in rural communities.


Assuntos
Agentes Comunitários de Saúde/educação , Currículo , Assistência à Saúde , Educação a Distância , Adulto , Competência Clínica , Educação Médica , Avaliação Educacional/estatística & dados numéricos , Feminino , Haiti , Humanos , Índia , Masculino , População Rural
18.
J Bone Joint Surg Am ; 101(14): 1286-1293, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31318808

RESUMO

BACKGROUND: The extent of variation in analgesic prescribing following musculoskeletal injury among countries and cultural contexts is poorly understood. Such an understanding can inform both domestic prescribing and future policy. The aim of our survey study was to evaluate how opioid prescribing by orthopaedic residents varies by geographic context. METHODS: Orthopaedic residents in 3 countries in which residents are the primary prescribers of postoperative analgesia in academic medical centers (Haiti, the Netherlands, and the U.S.) responded to surveys utilizing vignette-based musculoskeletal trauma case scenarios. The residents chose which medications they would prescribe for post-discharge analgesia. We standardized opioid prescriptions in the surveys by conversion to morphine milligram equivalents (MMEs). We then constructed multivariable regressions with generalized estimating equations to describe differences in opiate prescription according to country, the resident's sex and training year, and the injury site and age in the test cases. RESULTS: U.S. residents prescribed significantly more total MMEs per case (mean [95% confidence interval] = 383 [331 to 435]) compared with residents from the Netherlands (229 [160 to 297]) and from Haiti (101 [52 to 150]) both overall (p < 0.0001) and for patients treated for injuries of the femur (452 [385 to 520], 315 [216 to 414], and 103 [37 to 169] in the U.S., the Netherlands, and Haiti, respectively), tibial plateau (459 [388 to 531], 280 [196 to 365], and 114 [46 to 183]), tibial shaft (440 [380 to 500], 294 [205 to 383], and 141 [44 to 239]), wrist (239 [194 to 284], 78 [36 to 119], and 63 [30 to 95]), and ankle (331 [270 to 393], 190 [100 to 280], and 85 [42 to 128]) (p = 0.0272). U.S. residents prescribed significantly more MMEs for patients <40 years old (432 [374 to 490]) than for those >70 years old (327 [270 to 384]) (p = 0.0019). CONCLUSIONS: Our results demonstrate greater prescribing of postoperative opioids at discharge in the U.S. compared with 2 other countries, 1 low-income and 1 high-income. Our findings highlight the high U.S. reliance on opioid prescribing for postoperative pain control after orthopaedic trauma. CLINICAL RELEVANCE: Our findings point toward a need for careful reassessment of current opioid prescribing habits in the U.S. and demand reflection on how we can maximize effectiveness in pain management protocols and reduce provider contributions to the ongoing opioid crisis.


Assuntos
Analgésicos Opioides/administração & dosagem , Comparação Transcultural , Prescrições de Medicamentos/estatística & dados numéricos , Procedimentos Ortopédicos , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Feminino , Haiti , Humanos , Masculino , Países Baixos , Manejo da Dor , Alta do Paciente , Estados Unidos
19.
PLoS Negl Trop Dis ; 13(7): e0007094, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31260444

RESUMO

BACKGROUND: Salt fortified with the drug, diethylcarbamazine (DEC), and introduced into a competitive market has the potential to overcome the obstacles associated with tablet-based Lymphatic Filariasis (LF) elimination programs. Questions remain, however, regarding the economic viability, production capacity, and effectiveness of this strategy as a sustainable means to bring about LF elimination in resource poor settings. METHODOLOGY AND PRINCIPAL FINDINGS: We evaluated the performance and effectiveness of a novel social enterprise-based approach developed and tested in Léogâne, Haiti, as a strategy to sustainably and cost-efficiently distribute DEC-medicated salt into a competitive market at quantities sufficient to bring about the elimination of LF. We undertook a cost-revenue analysis to evaluate the production capability and financial feasibility of the developed DEC salt social enterprise, and a modeling study centered on applying a dynamic mathematical model localized to reflect local LF transmission dynamics to evaluate the cost-effectiveness of using this intervention versus standard annual Mass Drug Administration (MDA) for eliminating LF in Léogâne. We show that the salt enterprise because of its mixed product business strategy may have already reached the production capacity for delivering sufficient quantities of edible DEC-medicated salt to bring about LF transmission in the Léogâne study setting. Due to increasing revenues obtained from the sale of DEC salt over time, expansion of its delivery in the population, and greater cumulative impact on the survival of worms leading to shorter timelines to extinction, this strategy could also represent a significantly more cost-effective option than annual DEC tablet-based MDA for accomplishing LF elimination. SIGNIFICANCE: A social enterprise approach can offer an innovative market-based strategy by which edible salt fortified with DEC could be distributed to communities both on a financially sustainable basis and at sufficient quantity to eliminate LF. Deployment of similarly fashioned intervention strategies would improve current efforts to successfully accomplish the goal of LF elimination, particularly in difficult-to-control settings.


Assuntos
Dietilcarbamazina/economia , Erradicação de Doenças/economia , Filariose Linfática/tratamento farmacológico , Filaricidas/economia , Medicina Social/economia , Cloreto de Sódio na Dieta/administração & dosagem , Administração Oral , Análise Custo-Benefício , Dietilcarbamazina/administração & dosagem , Erradicação de Doenças/métodos , Filariose Linfática/prevenção & controle , Filaricidas/administração & dosagem , Haiti , Recursos em Saúde/economia , Humanos , Administração Massiva de Medicamentos , Modelos Teóricos , Doenças Negligenciadas/tratamento farmacológico , Medicina Social/métodos , Cloreto de Sódio na Dieta/economia
20.
Malar J ; 18(1): 245, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315631

RESUMO

BACKGROUND: In light of increasing complexity of identifying and treating malaria cases in low transmission settings, operational solutions are needed to increase effective delivery of interventions. Community engagement (CE) is at the forefront of this conversation given the shift toward creating local and site-specific solutions. Malaria programmes often confuse CE with providing information to the community or implementing community-based interventions. This study seeks to expand on CE approaches for malaria by looking to a variety of health and development programmes for lessons that can be applied to malaria elimination. METHODS: Qualitative data was collected from key informant interviews and community-based focus group discussions. Manual analysis was conducted with a focus on key principles, programme successes and challenges, the operational framework, and any applicable results. RESULTS: Ten programmes were included in the analysis: Ebola, HIV/Hepatitis C, Guinea worm, malaria, nutrition, and water, sanitation and hygiene. Seven focus group discussions (FGDs) with 69 participants, 49 key informant (KI) interviews with programme staff, and 7 KI interviews with thought leaders were conducted between October-April 2018. Participants discussed the critical role that village leaders and community health workers play in CE. Many programmes stated understanding community priorities is key for CE and that CE should be proactive and iterative. A major theme was prioritizing bi-directional interpersonal communication led by local community health workers. Programmes reported that measuring CE is difficult, particularly since CE is ongoing and fluid. CONCLUSIONS: Results overwhelmingly suggest that CE must be an iterative process that relies on early involvement, frequent feedback and active community participation to be successful. Empowering districts and communities in planning and executing community-based interventions is necessary. Communities affected by the disease will ultimately achieve malaria elimination. For this to happen, the community itself must define, believe in, and commit to strategies to interrupt transmission.


Assuntos
Participação da Comunidade/psicologia , Erradicação de Doenças/métodos , Malária/prevenção & controle , África ao Sul do Saara , Ásia , Belize , Agentes Comunitários de Saúde/estatística & dados numéricos , Participação da Comunidade/métodos , Haiti , Humanos , Liderança
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