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1.
Sex Reprod Healthc ; 33: 100761, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36037668

RESUMO

OBJECTIVE: The study explores women's experiences and expectations of maternity care in Timor-Leste. METHOD: Qualitative, descriptive research using focused ethnography. Thirty women and seventeen health professionals from three districts in Timor-Leste were interviewed and/or participated in focus groups. RESULTS: Women's expectations of care include the provision of information, advice and clinical assessment from midwives who have the capacity to provide emergency obstetric care if required. Midwives' access to technology (for example: the fetal doppler), increased the women's confidence in services. The women also identified poor experiences, including angry, busy midwives, poor communication, and lack of privacy in antenatal and birthing services. The lack of privacy inhibits women's communication with health professionals. An absence of covers and multiple staff present during labour and birth embarrass the women and their families. Many Timorese women live in poverty and have poor literacy skills. These women want knowledgeable, approachable, and clinically competent midwives who can support them through their pregnancies and childbirth. Poor communication, angry, busy midwives and lack of privacy cause discomfort and embarrassment and may discourage the women and their family's uptake of skilled birth attendant (SBA) services. CONCLUSION: Midwives have a critical primary role in the provision of advice, information and care of Timorese women during the childbirth continuum. Continuing education of midwives with an emphasis on communication and culturally congruent care will improve women's satisfaction and childbirth outcomes. Impoverished women are particularly vulnerable when birthing in health care services. Attention to the women's privacy and her additional needs can include a focus on the birthing space and the number of staff who have access to it.


Assuntos
Serviços de Saúde Materna , Tocologia , Feminino , Humanos , Motivação , Parto , Gravidez , Pesquisa Qualitativa , Timor-Leste
2.
PLoS One ; 17(7): e0269221, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35802640

RESUMO

Timor-Leste is one of the world's most malnourished nations where micronutrient-deficient diets are a contributing factor to the prevalence of child stunting, currently estimated to be 45.6% of children under five. Fish are an important source of nutrients and one that may assist the country's predominantly rural population of agriculturalists to exit poverty and malnutrition. However, a small national fishing fleet producing low catch volumes places fish out of reach of most inland and upland populations where it is needed most. Fish consumption is very low in rural, inland areas compared to coastal, regional, and global averages. This study is a one-year, partially masked, cluster-randomized controlled trial among families living in rural, inland Timor-Leste. We aim to test and compare the effects of two treatments, alone and in combination, on the frequency and volume of household fish consumption in rural, inland areas as a proxy for improved dietary diversity and micronutrient intake. Treatment 1 is the installation of nearshore, moored fish aggregating devices (FADs) to improve catch rates with existing fishing gears. Treatment 2 is a social and behaviour change (SBC) activity to promote fish consumption. Villages in inland communities will be randomized to receive treatment 1, treatment 2, both treatments, or neither treatment. Data will be collected at baseline (prior to the rollout of the treatments) and endline. Our study will determine the impact of an improved supply of fish, along with nutrition-oriented SBC activities, on the fish purchasing and consumption practices of rural, inland households. Findings from this study are urgently needed by Small Island Developing States to guide policy and investment decisions on how best to improve households' diets using locally available, nutrient-dense foods such as fish. Investments such as these are needed to break the cycle of malnutrition. This trial is registered at clinicaltrials.gov (NCT04729829). Trial registration: Trial registered at clinicaltrials.gov Identifier: NCT04729829.


Assuntos
Desnutrição , Estado Nutricional , Animais , Dieta , Transtornos do Crescimento , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Timor-Leste/epidemiologia
3.
Qual Health Res ; 32(10): 1498-1513, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35758872

RESUMO

Understanding and respecting different linguistic and socio-cultural needs of health service users is critical to design, adapt and provide appropriate health services. We explored access to male family planning methods in The Democratic Republic of Timor-Leste, a linguistically and culturally diverse nation, by conducting 14 participatory group discussions (PGDs) with 175 participants across seven municipalities. Participants (84 men and 91 women, aged 18 to 72) spoke 13 different languages. PGDs were audio-recorded and translated to English using a multilingual panel translation approach that enabled rigorous and reflexive discussion and learning between researchers about context and meaning. Planning for language diversity helped us to centre participant voices and to hear perspectives that may have otherwise been excluded or misrepresented. Our study affirms the need for research teams to include diverse members who help ensure meaning and voice is not lost across cultural and linguistic differences. Linguistic respect, inclusion and transparency are required to realise improved health and development outcomes.


Assuntos
Serviços de Planejamento Familiar , Saúde Reprodutiva , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pesquisa Qualitativa , Timor-Leste
4.
Glob Health Res Policy ; 7(1): 16, 2022 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-35590345

RESUMO

BACKGROUND: A national drug resistance survey (DRS) was implemented for the first time in Timor-Leste (TL) in 2019. The primary objective of the survey was to assess the prevalence of drug resistance among new and previously treated pulmonary TB patients in the country. METHODS: This nation-wide cross-sectional survey was conducted in 2019 targeting all new and previously treated sputum smear-positive pulmonary TB patients. Sputum samples were submitted to the National TB Reference Laboratory for confirmation of TB and to determine resistance to rifampicin by Xpert MTB/RIF. Culture was performed on solid media, and culture isolates of confirmed TB cases were shipped to the WHO Supranational TB Reference Laboratory in Chennai, India for whole genome sequencing (WGS). Survey summary statistics, data cross-tabulations and analysis of potential risk factors of rifampicin-resistant TB (RR-TB) were conducted using R statistical software (version 3.5.2). RESULTS: A total of 953 sputum-smear positive patients were enrolled, of which 917 were confirmed as positive for TB by either Xpert MTB/RIF or culture. An electronic web-based system was used for entry and storage of the data. Rifampicin resistance was detected among 0.6% (95% CI 0.2-1.3) of new cases and 2.7% (95% CI 0.5- 8.2) of previously treated cases. WGS was conducted for validation purposes on 65 randomly selected isolates (29% of RR-TB (2/7) and 7% of RS-TB (63/910) by Xpert MTB/RIF or pDST). The original test results agreed with the WGS validation results for 62/64 isolates (97%). CONCLUSION: The prevalence of RR-TB in Timor-Leste is relatively low compared to the estimated proportions of RR-TB in the WHO South-East Asia Region (2.5% [95% CI 1.9-3.3] among new cases and 14% [95% CI 7.7-21] among previously treated cases). The rapid sputum collection and transportation mechanism implemented in the survey demonstrates its feasibility in low resource settings and should be replicated for routinely transporting TB specimens from microscopy labs to GeneXpert sites. Establishment of in-country capacity for rapid molecular diagnostics for both first- and second-line DST is an immediate need for achieving universal drug susceptibility testing (DST) to guide appropriate patient management.


Assuntos
Antibióticos Antituberculose , Mycobacterium tuberculosis , Tuberculose Pulmonar , Antibióticos Antituberculose/farmacologia , Antibióticos Antituberculose/uso terapêutico , Estudos Transversais , Farmacorresistência Bacteriana , Humanos , Índia/epidemiologia , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/genética , Rifampina/farmacologia , Rifampina/uso terapêutico , Sensibilidade e Especificidade , Timor-Leste/epidemiologia , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
5.
Matern Child Nutr ; 18(3): e13363, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35488424

RESUMO

Both child growth and dietary diversity are poor in rural Timor-Leste. The rainy season is associated with food scarcity, yet the association between seasonal scarcity, food diversity, and child growth is underdocumented. This study assesses the relationship between household dietary diversity and children's standardized growth across the 2018 food-scarce (April-May; post-rainy period) and post-harvest (October) seasons in the agricultural community of Natarbora, on the south-coastal plains of Timor-Leste. We conducted household interviews and collected anthropometric data across 98 and 93 households in the post-rainy and post-harvest periods, respectively. Consumed household foods were obtained via 24-h diet recalls and were subsequently categorized into a nine-food-group dietary diversity score (DDS; number of different food groups consumed). The DDS was related to children's standardized short-term growth (z-weight, z-body mass index [BMI] and percent change in weight over the harvest season) via linear mixed models. Across seasons, DDS increased from 3.9 (standard deviation [SD] = 1.0) to 4.3 (SD = 1.4; p < 0.05). In the post-rainy season, children in high DDS households had higher z-weight than those in low DDS households and higher z-BMI than children in medium and low DDS households. In the post-harvest period, household DDS did not predict children's z-weight but predicted z-BMI. Consumption of protein-rich foods, particularly animal-source foods and legumes, in low- and medium-DDS households may be associated with improved child growth. While consuming more animal-source foods in the post-rainy season would be ideal, promoting the consumption of locally grown legumes, such as beans and pulses, may facilitate better nutritional outcomes for more children in rural Timor-Leste.


Assuntos
Dieta , População Rural , Abastecimento de Alimentos , Humanos , Estações do Ano , Timor-Leste , Verduras
6.
Int J Infect Dis ; 119: 80-86, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35358723

RESUMO

Background Serosurveillance can be used to investigate the extent and distribution of immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within a population. Characterisation of humoral immune responses gives insight into whether immunity is infection- or vaccine-derived. Methods A longitudinal study of health care workers (HCWs) in Dili, Timor-Leste, was conducted during vaccine rollout (ChAdOx1) and a concurrent SARS-CoV-2 outbreak. Results A total of 324 HCWs were included at baseline (April-May 2021). Out of those, 32 (9.9%) were seropositive for anti-nucleocapsid protein (anti-N) IgG antibodies, indicating a significant sub-clinical infection among HCWs early in the local outbreak. Follow-up was conducted in 157 (48.5%) participants (July-September 2021), by which time there had been high uptake of vaccination (91.7%), and 86.0% were seropositive for anti-spike protein antibodies. Acquisition of anti-N antibodies was observed in partially vaccinated HCWs (30/76, 39.5%), indicating some post-dose-1 infections. Discussion Serosurveillance of HCWs may provide early warning of SARS-CoV-2 outbreaks and should be considered in non-endemic settings, particularly where there is limited availability/uptake of testing for acute infection. Characterisation of humoral immune responses may be used to assess vaccine impact and coverage. Such studies should be considered in national and international efforts to investigate and mitigate against future emerging pathogens.


Assuntos
COVID-19 , Vacinas , Anticorpos Antivirais , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Surtos de Doenças/prevenção & controle , Pessoal de Saúde , Humanos , Estudos Longitudinais , SARS-CoV-2 , Timor-Leste , Vacinação
7.
Trans R Soc Trop Med Hyg ; 116(6): 531-537, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34850241

RESUMO

BACKGROUND: Acute febrile illnesses (AFIs), including dengue, scrub typhus and leptospirosis, cause significant morbidity and mortality in Southeast Asia. Serological surveillance can be used to investigate the force and distribution of infections. Dried blood spot (DBS) samples are an attractive alternative to serum because they are easier to collect and transport and require less cold storage. We conducted a pilot study to determine the feasibility of integrating serological surveillance for dengue, scrub typhus and leptospirosis into a population-representative lymphatic filariasis seroprevalence survey in Timor-Leste using DBSs. METHODS: A total of 272 DBSs were collected from healthy community participants. DBSs were analysed at the National Health Laboratory using commercially available enzyme-linked immunosorbent assays. To validate assays for DBSs, 20 anonymised serum samples of unknown serostatus were used to create dried serum spots (DSSs). These were analysed with optical densities compared with those of serum. Where low variance was observed (dengue assay) the published kit cut-offs for serum were applied to the analysis of DBSs. For the other assays (scrub typhus and leptospirosis), index values (IVs) were calculated and cut-offs were determined to be at 2 standard deviations (SDs) above the mean. RESULTS: Of the 272 samples analysed, 19 (7.0% [95% confidence interval {CI} 4.3 to 10.7]) were positive for dengue immunoglobulin G (IgG), 11 (4.0% [95% CI 2.1 to 7.1]) were positive for scrub typhus IgG and 16 (5.9% [95% CI 3.4 to 9.4%]) were positive for leptospira IgG. CONCLUSIONS: While dengue seroprevalence was lower than in nearby countries, results represent the first evidence of scrub typhus and leptospirosis transmission in Timor-Leste. Integrated programmes of serological surveillance could greatly improve our understanding of infectious disease epidemiology in remote areas and would incur minimal additional fieldwork costs. However, when planning such studies, the choice of assays, their validation for DBSs and the laboratory infrastructure and technical expertise at the proposed location of analysis must be considered.


Assuntos
Dengue , Filariose Linfática , Leptospirose , Orientia tsutsugamushi , Tifo por Ácaros , Dengue/complicações , Dengue/diagnóstico , Dengue/epidemiologia , Filariose Linfática/diagnóstico , Filariose Linfática/epidemiologia , Febre/etiologia , Humanos , Imunoglobulina G , Leptospirose/complicações , Leptospirose/diagnóstico , Leptospirose/epidemiologia , Projetos Piloto , Tifo por Ácaros/complicações , Tifo por Ácaros/diagnóstico , Tifo por Ácaros/epidemiologia , Estudos Soroepidemiológicos , Timor-Leste
8.
Vet Parasitol Reg Stud Reports ; 26: 100615, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34879927

RESUMO

Enhanced pig productivity on smallholder farms is recognised as a necessary strategy to enhance financial and food security in Timor-Leste where poverty and malnutrition are abundant. While poor pig health is recognised as a main constraint, information on pig herd health and management have not been thoroughly quantified. This study surveyed 120 pig owners (63 were female) and 352 of their pigs in Bacau and Bobonaro municipalities in 2018 to develop baseline information. Our analysis investigated three management systems among surveyed pig owners: confined management, characterised by permanent penning and/or tethering pigs (33.6%), semi-confined management (39.7%) and free-roaming management (27.7%). Free-roaming management was only observed in non-urban villages. Most inputs were limited across all management types with heavy reliance on cooked household scraps to feed pigs (84.7%), limited use of commercial feeds (5.1%), a lack of routine pen cleaning (73.8%), a lack of vaccination against classical swine fever (72.9%), limited use of para-veterinary services when pigs were sick (71.7%), and low treatment rates for pig skin diseases (10.3%) and intestinal parasites (8.7%). A high use of uncontrolled breeding (79.1%) was identified, accompanied by a limited knowledge of oestrus (20.7%) and gestation length (24.1%). Low output was observed with animals mainly sold when money is needed or when they were old. There was poor health with high piglet mortality rate (22.4-24.4%), moderate rates of current illness (22.4%), common occurrence of mites (12.2%), and high faecal presence of A. suum (29.0%), T. suis (10.2%), and S. ransomi (22.7%). To overcome the widespread constraints to productivity affecting all management systems, and to limit the impacts of highly infectious and often fatal African swine fever which was first reported in Timor-Leste pigs in September 2019, improved animal health and veterinary support, and education on pig management and suitable available nutrition sources are needed.


Assuntos
Febre Suína Africana , Peste Suína Clássica , Doenças dos Suínos , Criação de Animais Domésticos , Animais , Peste Suína Clássica/epidemiologia , Fazendas , Feminino , Suínos , Doenças dos Suínos/epidemiologia , Doenças dos Suínos/prevenção & controle , Timor-Leste/epidemiologia
9.
Zootaxa ; 5027(4): 489-514, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34811157

RESUMO

During the first amphibian and reptile survey of Timor-Leste, we discovered a population of groundsnakes, genus Stegonotus, in the last remnant of lowland coastal forest along the countrys southern coast, which represents a new species. This sexually dimorphic species can be differentiated from all other Wallacean Stegonotus by a combination of 17-17-15 dorsals, ventrals (female 206; males 197207), paired subcaudals (female 61; males 7175), the gull wing + condition of the rostral, large squared prefrontals that each are 2.5 times the area of the internasals and two-thirds the size of the frontal, a snout-scale ratio of near 0.4 and a frontal-parietal suture ratio of ≤ 1.0, a labial scale formula of 73+4 | 94, five gulars separating the posterior genial and the anteriormost ventral, and an overall brown body coloration that lightens progressively from the vertebral scale row in a dorsallateral direction and features color gradients of dark brown posterior edges to lighter brown anterior edges on individual scales. The species is most similar in overall morphology to S. modestus from the central Moluccas and to S. lividus, a species known only from tiny Semau Island that lies off the western end of Timor Island, in close proximity to Kupang, the capital of the Indonesian province of East Nusa Tenggara.


Assuntos
Charadriiformes , Colubridae , Animais , Feminino , Florestas , Masculino , Timor-Leste
10.
BMJ Open ; 11(8): e045547, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380718

RESUMO

OBJECTIVE: This study aimed to assess the possible relationship between television viewing and overweight and obesity among Timorese women of reproductive age. METHODS: This cross-sectional study analysed the Timor-Leste Demographic and Health Survey 2016 dataset. A weighted sample of 11 398 Timorese women aged 15-49 years was chosen using a two-stage stratified random sampling technique. Asian criteria-based body mass index (BMI) cut-offs were used to define overweight (BMI 23.0 to <27.5 kg/m2) and obesity (BMI ≥27.5 kg/m2). Frequency of TV viewing was categorised into three groups: (1) not at all, (2) less than once a week and (3) at least once a week. Multilevel ordered logistic regression was performed to identify the correlates of overweight and obesity. Both crude and adjusted odds ratios (AOR) along with a 95% CI were calculated to show the strength of association. RESULTS: Among 11 398 respondents, 19.4% were overweight or obese (overweight: 15.7% and obese: 3.8%). Although about half of the respondents reportedly did not watch TV at all, just over two-thirds watched TV at least once a week. Women who watched TV at least once a week were found to have 1.3 times the odds of being overweight or obese compared with those who never watched TV (AOR: 1.3, 95% CI: 1.1 to 1.5; p<0.001). However, when stratified by settlement type, the statistical significance stood for the rural women only (AOR: 1.5, 95% CI: 1.2 to 1.8; p<0.001), after adjusting for the covariates. CONCLUSION: Watching TV at least once a week was found to be a significant correlate of overweight and obesity in rural Timorese women of reproductive age. Further studies need to be undertaken to assess physical activity, sedentary and dietary patterns to clarify the possible mechanism through which TV viewing may influence BMI in those groups.


Assuntos
Sobrepeso , Televisão , Índice de Massa Corporal , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , Timor-Leste
11.
BMC Public Health ; 21(1): 951, 2021 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016072

RESUMO

BACKGROUND: The heavy and ever rising burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) warrants interventions to reduce their underlying risk factors, which are often linked to lifestyles. To effectively supplement nationwide policies with targeted interventions, it is important to know how these risk factors are distributed across socioeconomic segments of populations in LMICs. This study quantifies the prevalence and socioeconomic inequalities in lifestyle risk factors in LMICs, to identify policy priorities conducive to the Sustainable Development Goal of a one third reduction in deaths from NCDs by 2030. METHODS: Data from 1,278,624 adult respondents to Demographic & Health Surveys across 22 LMICs between 2013 and 2018 are used to estimate crude prevalence rates and socioeconomic inequalities in tobacco use, overweight, harmful alcohol use and the clustering of these three in a household. Inequalities are measured by a concentration index and correlated with the percentage of GDP spent on health. We estimate a multilevel model to examine associations of individual characteristics with the different lifestyle risk factors. RESULTS: The prevalence of tobacco use among men ranges from 59.6% (Armenia) to 6.6% (Nigeria). The highest level of overweight among women is 83.7% (Egypt) while this is less than 12% in Burundi, Chad and Timor-Leste. 82.5% of women in Burundi report that their partner is "often or sometimes drunk" compared to 1.3% in Gambia. Tobacco use is concentrated among the poor, except for the low share of men smoking in Nigeria. Overweight, however, is concentrated among the better off, especially in Tanzania and Zimbabwe (Erreygers Index (EI) 0.227 and 0.232). Harmful alcohol use is more concentrated among the better off in Nigeria (EI 0.127), while Chad, Rwanda and Togo show an unequal pro-poor distribution (EI respectively - 0.147, - 0.210, - 0.266). Cambodia exhibits the largest socioeconomic inequality in unhealthy household behaviour (EI - 0.253). The multilevel analyses confirm that in LMICs, tobacco and alcohol use are largely concentrated among the poor, while overweight is concentrated among the better-off. The associations between the share of GDP spent on health and the socioeconomical distribution of lifestyle factors are multidirectional. CONCLUSIONS: This study emphasizes the importance of lifestyle risk factors in LMICs and the socioeconomic variation therein. Given the different socioeconomic patterns in lifestyle risk factors - overweight patters in LMICs differ considerably from those in high income countries- tailored interventions towards specific high-risk populations are warranted to supplement nationwide policies.


Assuntos
Países em Desenvolvimento , Estilo de Vida , Adulto , Armênia , Burundi , Camboja , Chade , Egito , Feminino , Gâmbia , Humanos , Masculino , Nigéria , Prevalência , Fatores de Risco , Ruanda , Fatores Socioeconômicos , Tanzânia , Timor-Leste , Togo , Zimbábue
12.
Am J Trop Med Hyg ; 104(6): 2202-2209, 2021 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-33901000

RESUMO

Dengue is an ongoing health risk for Peace Corps Volunteers (PCVs) working in the tropics. On May 2019, the Peace Corps Office of Health Services notified the Centers for Disease Control and Prevention (CDC) of a dengue outbreak among PCVs in Timor-Leste. The purpose of this investigation was to identify the clinical, demographic, and epidemiological characteristics of PCVs with dengue and recommend dengue preventive measures. To identify PCVs with dengue and describe disease severity, the medical records of PCVs reporting fever during September 2018-June 2019 were reviewed. To identify factors associated with dengue virus (DENV) infection, we administered a questionnaire on demographics, travel history, and mosquito avoidance behaviors and collected blood specimens to detect the anti-DENV IgM antibody to diagnose recent infection. Of 35 PCVs in-country, 11 (31%) tested positive for dengue (NS1, IgM, PCR), eight requiring hospitalization and medical evacuation. Among 27 (77%) PCVs who participated in the investigation, all reported having been recently bitten by mosquitoes and 56% reported being bitten most often at home; only 16 (59%) reported having screens on bedroom windows. Nearly all (93%) PCVs reported using a bed net every night; fewer (70%) reported using mosquito repellent at least once a day. No behaviors were significantly associated with DENV infection. Raising awareness of dengue risk among PCVs and continuing to encourage mosquito avoidance behavior to prevent dengue is critical. Access to and use of measures to avoid mosquito bites should be improved or implemented. Peace Corps medical officers should continue to receive an annual refresher training on dengue clinical management.


Assuntos
Dengue/epidemiologia , Peace Corps/estatística & dados numéricos , Voluntários/estatística & dados numéricos , Adulto , Idoso , Animais , Culicidae/virologia , Dengue/transmissão , Surtos de Doenças , Feminino , Humanos , Imunoglobulina M/sangue , Mordeduras e Picadas de Insetos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Timor-Leste/epidemiologia , Viagem , Estados Unidos , Adulto Jovem
13.
Int J Parasitol ; 51(9): 729-739, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33798561

RESUMO

Soil-transmitted helminths (STHs) are parasitic intestinal worms that infect almost a fifth of the global population. Sustainable control of STHs requires understanding the complex interaction of factors contributing to transmission. Identifying risk factors has mainly relied on logistic regression models where the underlying assumption of independence between variables is not always satisfied. Previously demonstrated risk factors including water, sanitation and hygiene (WASH) access and behaviours, and socioeconomic status are intrinsically linked. Similarly, environmental factors including climate, soil and land attributes are often strongly correlated. Alternative methods such as recursive partitioning and Bayesian networks can handle correlated variables, but there are no published studies comparing these methods with logistic regression in the context of STH risk factor analysis. Baseline cross-sectional data from school-aged children in the (S)WASH-D for Worms study were used to compare risk factors identified from modelling the same data using three different statistical techniques. Outcomes of interest were infection with Ascaris spp. and any hookworm species (Necator americanus, Ancylostoma duodenale, and Ancylostoma ceylanicum). Mixed-effects logistic regression identified the fewest risk factors. Recursive partitioning identified the most WASH and demographic risk factors, while Bayesian networks identified the most environmental risk factors. Recursive partitioning produced classification trees that visualised potentially at-risk population sub-groups. Bayesian networks helped visualise relationships between variables and enabled interactive modelling of outcomes based on different scenarios for the predictor variables of interest. Model performance was similar across all techniques. Risk factors identified across all techniques were vegetation for Ascaris spp., and cleaning oneself with water after defecating for hookworm. This study adds to the limited body of evidence exploring alternative data modelling approaches in identifying risk factors for STH infections. Our findings suggest these approaches can provide novel insights for more robust interpretation.


Assuntos
Helmintíase , Solo , Animais , Teorema de Bayes , Estudos Transversais , Fezes , Helmintíase/epidemiologia , Necator americanus , Prevalência , Fatores de Risco , Saneamento , Timor-Leste/epidemiologia
14.
J Paediatr Child Health ; 57(9): 1391-1396, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33825269

RESUMO

AIM: To describe the clinical features, treatment and outcomes of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in children admitted to the national referral hospital in Dili, Timor-Leste. METHODS: This prospective study documented cases of ARF and RHD in children aged 14 years and under who were admitted between June 2017 and May 2019. ARF was diagnosed using an adapted version of the 2015 Jones criteria and presumed (rather than proven) exposure to group A Streptococcus. Clinical and echocardiographic findings, comorbidities and discharge outcomes are reported. RESULTS: A total of 63 patients were admitted with ARF or RHD; 54 were diagnosed with RHD for the first time. Median age was 11 years (range 3-14); 48% were female. Of those with echocardiograms, 56/58 had RHD, 55/56 (98%) had mitral regurgitation (37/55 (67%) severe), 11/56 (20%) had mitral stenosis and 43/56 (77%) had aortic regurgitation. Left ventricular dysfunction (55%), pulmonary hypertension (64%) and cardiac failure (78%) were common. Four (6%) patients died in hospital, and 30/59 (51%) of surviving patients were lost to follow up. CONCLUSIONS: Community echocardiography screening has reported a high prevalence of undetected mild to moderate cases of RHD in Timor-Leste, whereas this hospital study documents mostly severe disease among hospitalised patients with a high case fatality rate and loss to follow up. RHD is a significant health problem in Timor-Leste and improved recognition and diagnosis, as well as effective delivery of treatment and follow-up are imperative.


Assuntos
Febre Reumática , Cardiopatia Reumática , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Pacientes Internados , Prevalência , Estudos Prospectivos , Febre Reumática/complicações , Febre Reumática/epidemiologia , Cardiopatia Reumática/complicações , Cardiopatia Reumática/epidemiologia , Timor-Leste/epidemiologia
15.
ANZ J Surg ; 91(5): 795-801, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33870624

RESUMO

BACKGROUND: Papua New Guinea, Pacific Island nations, and Timor-Leste represent a range of island nations with populations ranging from a few thousand to 8 million. They perform on average about 25% of the Lancet Commission of Global Surgery's target 5000 per 100 000 population and their health workforce have significant deficits of trained surgeons and anaesthetists. This study was conducted to determine how the current national health plans of these nations have included surgery and anaesthesia. METHODS: The most recent (as of December 2018) published national health plans of 10 Pacific Island nations (Cook Islands, Fiji, Nauru, Federated States of Micronesia, Kiribati, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu), Papua New Guinea and Timor-Leste were reviewed for content and process, searching for key words and identifying themes related to surgery and anaesthesia. RESULTS: There were 12 national health plans with a combined total of 478 pages. There was limited surgical and/or anaesthesia input within the planning process. Injuries, blindness, cancer and non-communicable diseases were included themes, but the potential role of surgical care in addressing these conditions was not well documented. The need for better information and registries was noted by several nations but possible surgical care delivery or outcome metrics were not included. CONCLUSION: There is limited mention of surgical and anaesthesia care planning within current health plans in the Pacific, PNG and TL. There is a need for greater surgical and anaesthesia engagement in future plans with performance measured against World Health Organization core surgical indicators.


Assuntos
Procedimentos Cirúrgicos Operatórios , Anestesia , Fiji , Humanos , Ilhas do Pacífico , Papua Nova Guiné , Polinésia , Timor-Leste/epidemiologia
17.
Zootaxa ; 4938(1): zootaxa.4938.1.8, 2021 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-33756989

RESUMO

The Anaphothrips genus-group is a complex of 40 genera of Thripinae that share the condition of "no long pronotal setae". In traditional Thysanoptera classifications this absence of long pronotal setae was interpreted as a plesiomorphy by comparison to the condition in Aeolothripidae. Thus Jacot-Guillarmod (1974) catalogued all Thripinae genera with species showing this condition in a sub-tribe Aptinothripina Karny, a long-established arrangement that had been adopted by many authors. However, a study by Buckman et al. (2013) confirmed that taxa in the families Merothripidae and Melanthripidae share an important number of structural plesiomorphies, and these taxa all have long pronotal setae. From this it is concluded that absence of long pronotal setae is a derived condition, and moreover this loss apomorphy has arisen independently within several unrelated genera, such as Dichromothrips, Trichromothrips and Thrips (Mound Palmer 1981; Mound Masumoto 2004, 2005). As a result, it is possible that the Anaphothrips genus-group does not represent a single lineage, and that not all of the included genera are closely related.


Assuntos
Tisanópteros , Animais , Cocos , Timor-Leste
18.
Parasit Vectors ; 14(1): 156, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33722285

RESUMO

BACKGROUND: Scabies and impetigo are endemic in many tropical, low- and middle-income countries. Mass drug administration (MDA) with ivermectin has emerged as a control strategy for these conditions. In 2019, Timor-Leste Ministry of Health planned to implement MDA including ivermectin for the control of lymphatic filariasis, so we undertook a baseline assessment of scabies and impetigo to better understand local epidemiology and contribute to future surveys assessing the impact of MDA. METHODS: A cross-sectional school survey was conducted in April-May 2019 at six primary schools in a semi-urban (Dili) and two rural (Ermera and Manufahi) settings. Children under 19 years of age present at school on survey days were eligible to participate, of whom we enrolled 1183. Trained health workers interviewed and examined 1043 participants to clinically diagnose scabies using the 2020 International Alliance for the Control of Scabies (IACS) diagnostic criteria, as well as impetigo. Prevalence was adjusted for age and sex. Mixed-effects logistic regression models were used to analyse odds of scabies and impetigo infection. All models accounted for clustering at the school level through the use of random effect terms. Population attributable risk of scabies as a cause of impetigo was also estimated. RESULTS: The overall weighted prevalence of scabies was 30.6%. Children in rural Manufahi were more likely to have scabies than those in semi-urban Dili (53.6% vs 28.2%, adjusted odds ratio [AOR] 3.5). Most cases of scabies were mild (3 to 10 lesions), and lesions were usually distributed on more than one body region. Scabies prevalence was lower among 10 to 14 year olds compared to 5 to 9 year olds. Overall weighted prevalence of impetigo was 11.3%. Relative to Dili, children in rural Ermera and Manufahi were twice as likely to have impetigo. Impetigo was twice as common in children with scabies than in those without, corresponding to an attributable risk of scabies as a cause of impetigo of 22.7%. CONCLUSIONS: Scabies and impetigo prevalence in Timor-Leste is among the highest reported globally, particularly in rural areas. Scabies infestation was strongly associated with impetigo. Comprehensive control strategies are urgently needed in Timor-Leste.


Assuntos
Impetigo/epidemiologia , População , Escabiose/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Razão de Chances , Prevalência , Fatores de Risco , População Rural , Timor-Leste/epidemiologia
19.
Artigo em Inglês | MEDLINE | ID: mdl-33498840

RESUMO

Open defecation (OD) is still a significant public health challenge worldwide. In Timor-Leste, where an estimated 20% of the population practiced OD in 2017, increasing access and use of improved sanitation facilities is a government priority. Community-led total sanitation (CLTS) has become a popular strategy to end OD since its inception in 2000, but evidence on the uptake of CLTS and related interventions and the long-term sustainability of OD-free (ODF) communities is limited. This study utilized a mixed-methods approach, encompassing quantitative monitoring and evaluation data from water, sanitation, and hygiene (WASH) agencies, and semi-structured interviews with staff working for these organizations and the government Department of Environmental Health, to examine sanitation interventions in Timor-Leste. Recommendations from WASH practitioners on how sanitation strategies can be optimized to ensure ODF sustainability are presented. Whilst uptake of interventions is generally good in Timor-Leste, lack of consistent monitoring and evaluation following intervention delivery may contribute to the observed slippage back to OD practices. Stakeholder views suggest that long-term support and monitoring after ODF certification are needed to sustain ODF communities.


Assuntos
Higiene , Saneamento , Humanos , Timor-Leste , Água
20.
Health Promot J Austr ; 32(2): 335-343, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32367605

RESUMO

ISSUE ADDRESSED: In response to high rates of gender-based violence and poor sexual and reproductive health indicators in Timor-Leste, a 'Men's Health Project' was implemented in two rural communities in 2013. A peer education model was utilised to engage men in issues regarding health, relationships and well-being. METHODS: Community-based baseline and endline surveys were undertaken to evaluate the project in the two communities. RESULTS: In 2013, 401 men and boys completed a baseline survey, and 400 completed an endline survey in 2016. Significant differences were found in a number of areas, with more men in the endline survey aware of the negative impacts of alcohol, safe pregnancy practices, family planning and sexually transmitted infections. Many men reported making the major decisions in their family in both surveys. CONCLUSIONS: The peer education approach engaged men in health awareness and contributed to increasing knowledge of sexual and reproductive health and other health issues. However, while education and positive attitudes are an important foundation for change, other enabling mechanisms including vital infrastructure, services and health personnel must be in place to facilitate change and increase access to information and healthcare. Findings highlight the importance of engaging both women and men in processes of challenging behaviours and structures that reinforce gender inequalities. SO WHAT?: Peer education appears to be an effective model for engaging community members in gender and health issues in Timor-Leste. The Men's Health Project enabled men to participate in health awareness and issues regarding health, relationships and well-being.


Assuntos
Infecções Sexualmente Transmissíveis , Feminino , Humanos , Masculino , Gravidez , Saúde Reprodutiva , Comportamento Sexual , Infecções Sexualmente Transmissíveis/prevenção & controle , Inquéritos e Questionários , Timor-Leste
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