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1.
Artigo em Inglês | PAHO-IRIS | ID: phr-60079

RESUMO

[ABSTRACT]. Objective. To assess changes in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Haiti from August 2018 to September 2021, before and during the COVID-19 pandemic. Methods. A retrospective study using surveillance data from the Haitian Unique Health Information System, examining two periods: pre- and peri-COVID-19 pandemic. Health indicators at the national level in the two periods were compared using two-sample t-tests for proportions, and average absolute monthly changes were calculated using variance-weighted regression. Results. There was a statistically significant decline in the proportion of most of the indicators assessed from the pre- to the peri-COVID-19 pandemic period. However, the most affected indicators were the proportions of pregnant women with four antenatal care visits, with five antenatal care visits or more, and those who received a second dose of tetanus vaccine, which decreased by over 4 percentage points during the two periods. Likewise, the proportions of children who received diphtheria, tetanus, and pertussis (DTaP), BCG, polio, pentavalent, and rotavirus vaccines also all declined by over 8 percentage points. In contrast, pneu- mococcal conjugate vaccine increased by over 4 percentage points. A statistically significant decrease was also observed in the average absolute monthly changes of several reproductive and child health indicators assessed. Conclusions. The COVID-19 pandemic may have contributed to the decline observed in several RMNCAH indicators in Haiti. However, the role played by the sociopolitical crisis and control exercised by armed groups over the population in the last three years cannot be ruled out.


[RESUMEN]. Objetivo. Evaluar los cambios en materia de salud reproductiva, materna, neonatal, infantil y adolescente que se produjeron en Haití desde agosto del 2018 hasta septiembre del 2021, antes de la pandemia de COVID-19 y durante ella. Metodología. Estudio retrospectivo basado en datos de vigilancia del sistema único de información de salud de Haití para estudiar los periodos pre y peripandémico. La comparación de los indicadores de salud a nivel nacional de estos dos periodos se realizó mediante pruebas de t de dos muestras para comparar proporciones, y se calculó el promedio de la variación mensual absoluta mediante una regresión ponderada por la varianza. Resultados. Al comparar el periodo prepandémico con el peripandémico, se observó un descenso estadísticamente significativo de la mayoría de los indicadores porcentuales evaluados. Sin embargo, los indicadores porcentuales más afectados fueron los de mujeres embarazadas con cuatro visitas de atención prenatal, con cinco visitas de atención prenatal o más, o que recibieron una segunda dosis de la vacuna contra el tétanos; estos indicadores disminuyeron en más de cuatro puntos porcentuales en el segundo periodo en comparación con el primero. Asimismo, las proporciones de niños y niñas que recibieron las vacunas contra la difteria, el tétanos y la tosferina (DTPa), contra la poliomielitis, antirrotavírica, BCG, y pentavalente también disminuyeron en más de ocho puntos porcentuales. En cambio, la proporción de niños y niñas que recibieron la vacuna antineumocócica conjugada aumentó en más de cuatro puntos porcentuales. También se observó un descenso estadísticamente significativo en el promedio de la variación mensual absoluta de varios indicadores de salud reproductiva e infantil. Conclusiones. La pandemia de COVID-19 puede haber contribuido al descenso observado en varios indica- dores relacionados con la salud reproductiva, materna, neonatal, infantil y adolescente en Haití. Sin embargo, no se puede descartar el papel que ha desempeñado en dicho descenso la crisis sociopolítica y el control ejercido por los grupos armados sobre la población en los últimos tres años.


[RESUMO]. Objetivo. Avaliar mudanças na saúde reprodutiva, materna, neonatal, da criança e do adolescente no Haiti entre agosto de 2018 e setembro de 2021, antes e durante a pandemia de COVID-19. Métodos. Estudo retrospectivo usando dados de vigilância do Sistema Único de Informações de Saúde do Haiti, examinando dois períodos, antes e durante a pandemia de COVID-19. Os indicadores de saúde do país nos dois períodos foram comparados por meio de testes t de duas amostras para proporções, e as variações mensais absolutas médias foram calculadas por meio de regressão linear ponderada. Resultados. Entre o período anterior e o período durante a pandemia de COVID-19, houve uma queda estatisticamente significante na proporção da maioria dos indicadores avaliados. Os indicadores mais afetados, porém, foram as proporções de gestantes com quatro consultas de pré-natal, gestantes com cinco ou mais consultas de pré-natal e gestantes que receberam uma segunda dose de vacina antitetânica, que sofreram uma diminuição de mais de 4 pontos percentuais na comparação entre os dois períodos. Similarmente, as proporções de crianças que receberam vacinas contra difteria, tétano e pertússis (DTPa), BCG, poliomielite, pentavalente e rotavírus também diminuíram em mais de 8 pontos percentuais. Por outro lado, no caso da vacina pneumocócica conjugada houve um aumento de mais de 4 pontos percentuais. Além disso, foi observada uma redução estatisticamente significante nas variações mensais absolutas médias de vários indicadores de saúde reprodutiva e infantil avaliados. Conclusões. A pandemia de COVID-19 pode ter contribuído para a piora observada em vários indicadores de saúde reprodutiva, materna, neonatal, da criança e do adolescente no Haiti. No entanto, não se pode descartar o papel desempenhado pela crise sociopolítica e pelo controle exercido por grupos armados sobre a população nos últimos três anos.


Assuntos
Saúde da Criança , Serviços de Planejamento Familiar , Saúde Materna , Saúde Reprodutiva , Serviços de Saúde da Mulher , COVID-19 , Haiti , Saúde da Criança , Serviços de Planejamento Familiar , Saúde Materna , Saúde Reprodutiva , Serviços de Saúde da Mulher , Haiti , Saúde da Criança , Serviços de Planejamento Familiar , Saúde Materna , Saúde Reprodutiva , Serviços de Saúde da Mulher
2.
HIV Res Clin Pract ; 25(1): 2363129, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38907537

RESUMO

BACKGROUND: COVID-19 profoundly and uniquely impacted people with HIV. People with HIV experienced significant psychosocial and socioeconomic impacts, yet a limited amount of research has explored potential differences across gender and racial/ethnic groups of people with HIV. OBJECTIVE: The objective of this study was to examine psychosocial and socioeconomic stressors related to the COVID-19 pandemic among a diverse sample of people with HIV in South Florida and to determine if the types of stressors varied across gender and racial/ethnic groups. METHODS: We analyzed data from a cross-sectional survey with Miami-Dade County, Ryan White Program recipients. Outcomes included mental health, socioeconomic, drug/alcohol, and care responsibility/social support changes. Weighted descriptive analyses provided an overview of stressors by gender and racial/ethnic group and logistic regressions estimated associations between demographics and stressors. RESULTS: Among 291 participants, 39% were Non-Hispanic Black, 18% were Haitian, and 43% were Hispanic. Adjusting for age, sex, language, and foreign-born status, Hispanics were more likely to report several worsened mental health (i.e. increased loneliness, anxiety) and socioeconomic stressors (i.e. decreased income). Spanish speakers were more likely to report not getting the social support they needed. Women were more likely to report spending more time caring for children. CONCLUSIONS: Findings highlight ways in which cultural and gender expectations impacted experiences across people with HIV and suggest strategies to inform interventions and resources during lingering and future public health emergencies. Results suggest that public health emergencies have different impacts on different communities. Without acknowledging and responding to differences, we risk losing strides towards progress in health equity.


Assuntos
COVID-19 , Infecções por HIV , Pobreza , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Negro ou Afro-Americano/estatística & dados numéricos , Negro ou Afro-Americano/psicologia , COVID-19/psicologia , COVID-19/epidemiologia , Estudos Transversais , Etnicidade/psicologia , Etnicidade/estatística & dados numéricos , Florida/epidemiologia , Haiti/etnologia , Hispânico ou Latino/estatística & dados numéricos , Hispânico ou Latino/psicologia , Infecções por HIV/psicologia , Infecções por HIV/etnologia , Infecções por HIV/epidemiologia , Saúde Mental/estatística & dados numéricos , Pandemias , Pobreza/psicologia , Pobreza/estatística & dados numéricos , Fatores Sexuais , Apoio Social , Fatores Socioeconômicos , Estresse Psicológico/psicologia , Estresse Psicológico/etnologia
3.
Rev Panam Salud Publica ; 48: e57, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38859812

RESUMO

Objective: To assess changes in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Haiti from August 2018 to September 2021, before and during the COVID-19 pandemic. Methods: A retrospective study using surveillance data from the Haitian Unique Health Information System, examining two periods: pre- and peri-COVID-19 pandemic. Health indicators at the national level in the two periods were compared using two-sample t-tests for proportions, and average absolute monthly changes were calculated using variance-weighted regression. Results: There was a statistically significant decline in the proportion of most of the indicators assessed from the pre- to the peri-COVID-19 pandemic period. However, the most affected indicators were the proportions of pregnant women with four antenatal care visits, with five antenatal care visits or more, and those who received a second dose of tetanus vaccine, which decreased by over 4 percentage points during the two periods. Likewise, the proportions of children who received diphtheria, tetanus, and pertussis (DTaP), BCG, polio, pentavalent, and rotavirus vaccines also all declined by over 8 percentage points. In contrast, pneumococcal conjugate vaccine increased by over 4 percentage points. A statistically significant decrease was also observed in the average absolute monthly changes of several reproductive and child health indicators assessed. Conclusions: The COVID-19 pandemic may have contributed to the decline observed in several RMNCAH indicators in Haiti. However, the role played by the sociopolitical crisis and control exercised by armed groups over the population in the last three years cannot be ruled out.

4.
BMC Public Health ; 24(1): 1732, 2024 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-38943127

RESUMO

BACKGROUND: In Haiti, reported incidence and mortality rates for COVID-19 were lower than expected. We aimed to analyze factors at communal and individual level that might lead to an underestimation of the true burden of the COVID-19 epidemic in Haiti during its first two years. METHODS: We analyzed national COVID-19 surveillance data from March 2020 to December 2021, to describe the epidemic using cluster detection, time series, and cartographic approach. We performed multivariate Quasi-Poisson regression models to determine socioeconomic factors associated with incidence and mortality. We performed a mixed-effect logistic regression model to determine individual factors associated with the infection. RESULTS: Among the 140 communes of Haiti, 57 (40.7%) had a COVID-19 screening center, and the incidence was six times higher in these than in those without. Only 22 (15.7%) communes had a COVID-19 care center, and the mortality was five times higher in these than in those without. All the richest communes had a COVID-19 screening center while only 30.8% of the poorest had one. And 75% of the richest communes had a COVID-19 care center while only 15.4% of the poorest had one. Having more than three healthcare workers per 1000 population in the commune was positively associated with the incidence (SIR: 3.31; IC95%: 2.50, 3.93) and the mortality (SMR: 2.73; IC95%: 2.03, 3.66). At the individual level, male gender (adjusted OR: 1.11; IC95%: 1.01, 1.22), age with a progressive increase of the risk compared to youngers, and having Haitian nationality only (adjusted OR:2.07; IC95%: 1.53, 2.82) were associated with the infection. CONCLUSIONS: This study highlights the weakness of SARS-CoV-2 screening and care system in Haiti, particularly in the poorest communes, suggesting that the number of COVID-19 cases and deaths were probably greatly underestimated.


Assuntos
COVID-19 , Programas de Rastreamento , Humanos , Haiti/epidemiologia , COVID-19/epidemiologia , COVID-19/mortalidade , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Incidência , Programas de Rastreamento/estatística & dados numéricos , Adulto Jovem , SARS-CoV-2 , Adolescente , Idoso , Fatores Socioeconômicos , Teste para COVID-19/estatística & dados numéricos
5.
Ethics Hum Res ; 46(3): 16-25, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38629226

RESUMO

Migration research poses several unique challenges and opportunities. Conducting ethical global health practice, especially when studying migrant mental health, is of particular concern. This article explores seven challenges and lessons learned in our mixed-methods study conducted to assess the impact of the migration experience on Haitian migrants' mental health in Santiago, Chile. The primary challenges were recruiting in a highly mobile population, building trust and community participation, overcoming language barriers, safety considerations during the Covid-19 pandemic, mitigating potential negative impacts of research on the community, providing psychological support, and finding meaningful ways to benefit the community. We propose moving toward a better and more ethical migrant research practice by ensuring language accessibility, hiring community members for the study team, working with local institutions and nongovernmental organizations, and maintaining sustainable connections.


Assuntos
Saúde Mental , Migrantes , Humanos , Chile , Haiti , Pandemias
6.
Glob Ment Health (Camb) ; 11: e19, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38414724

RESUMO

Mental health is a significant public health challenge globally, and one anticipated to increase following the COVID-19 pandemic. In many rural regions of developing nations, little is known about the prevalence of mental health conditions and factors that may help mitigate poor outcomes. This study assessed the impact of the COVID-19 pandemic on mental health and social support for residents of rural Haiti. Data were collected from March to May 2020. The Patient Health Questionnaire subscales for anxiety and depression, and the Perceived Stress Scale were utilized in addition to tailored questions specific to COVID-19 knowledge. Half (51.8%) of the 500 survey respondents reported COVID-19-related anxiety and worrying either daily or across a few days. Half (50.2%) also reported experiencing depression daily or across several days. Most (70.4%) did not have any social support, and 28.0% experienced some stress, with 13.4% indicating high perceived stress. Furthermore, 4.6% had suitable plumbing systems in their homes. The results were immediately actionable, informing the implementation of a mental health counseling program for youth following a loss of social support through school closures. Long-term investments must be made as part of public health responses in rural communities in developing nations, which remain under-studied.

7.
Disaster Med Public Health Prep ; 18: e23, 2024 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-38351541

RESUMO

OBJECTIVE: This study explored the barriers and facilitators of mask-wearing behaviors during the pandemic in Taiwan, the United States, the Netherlands, and Haiti. METHODS: Face-to-face interviews were conducted in Taiwan and online interviews were conducted with participants in the United States, the Netherlands, and Haiti. RESULTS: In general, the habit of wearing a mask before coronavirus disease 2019 (COVID-19) was reported by Taiwanese participants. Additionally, Taiwanese participants perceived that wearing a mask was a social responsibility during the pandemic, suggesting that the collectivistic context might influence mask-wearing behavior. Unlike the Taiwanese population, some people in the United States and the Netherlands were reluctant to wear masks due to perceived restrictions on their freedom. Participants from Haiti mentioned that people who wore masks encountered violence, bullying, and discrimination. The results of this study suggest that political leadership and mask mandates have a strong impact on people's mask-wearing behavior. CONCLUSIONS: These findings have valuable implications for the design of diverse behavioral interventions to enhance mask-wearing as part of infectious disease preparedness. Additionally, the findings from these countries offer valuable insights for the development of effective public health interventions to enhance society's resilience during the current pandemic and future infectious disease outbreaks.


Assuntos
COVID-19 , Pandemias , Estados Unidos/epidemiologia , Humanos , Países Baixos , Taiwan/epidemiologia , Pandemias/prevenção & controle , Haiti/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Máscaras
8.
J Virol ; 98(3): e0198223, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38411106

RESUMO

Continuously emerging highly pathogenic coronaviruses remain a major threat to human and animal health. Porcine deltacoronavirus (PDCoV) is a newly emerging enterotropic swine coronavirus that causes large-scale outbreaks of severe diarrhea disease in piglets. Unlike other porcine coronaviruses, PDCoV has a wide range of species tissue tropism, including primary human cells, which poses a significant risk of cross-species transmission. Nucleotide-binding oligomerization domain-like receptor (NLR) family pyrin domain-containing 1 (NLRP1) has a key role in linking host innate immunity to microbes and the regulation of inflammatory pathways. We now report a role for NLRP1 in the control of PDCoV infection. Overexpression of NLRP1 remarkably suppressed PDCoV infection, whereas knockout of NLRP1 led to a significant increase in PDCoV replication. A mechanistic study revealed that NLRP1 suppressed PDCoV replication in cells by upregulating IL-11 expression, which in turn inhibited the phosphorylation of the ERK signaling pathway. Furthermore, the ERK phosphorylation inhibitor U0126 effectively hindered PDCoV replication in pigs. Together, our results demonstrated that NLRP1 exerted an anti-PDCoV effect by IL-11-mediated inhibition of the phosphorylation of the ERK signaling pathway, providing a novel antiviral signal axis of NLRP1-IL-11-ERK. This study expands our understanding of the regulatory network of NLRP1 in the host defense against virus infection and provides a new insight into the treatment of coronaviruses and the development of corresponding drugs.IMPORTANCECoronavirus, which mainly infects gastrointestinal and respiratory epithelial cells in vivo, poses a huge threat to both humans and animals. Although porcine deltacoronavirus (PDCoV) is known to primarily cause fatal diarrhea in piglets, reports detected in plasma samples from Haitian children emphasize the potential risk of animal-to-human spillover. Finding effective therapeutics against coronaviruses is crucial for controlling viral infection. Nucleotide-binding oligomerization-like receptor (NLR) family pyrin domain-containing 1 (NLRP1), a key regulatory factor in the innate immune system, is highly expressed in epithelial cells and associated with the pathogenesis of viruses. We demonstrate here that NLRP1 inhibits the infection of the intestinal coronavirus PDCoV through IL-11-mediated phosphorylation inhibition of the ERK signaling pathway. Furthermore, the ERK phosphorylation inhibitor can control the infection of PDCoV in pigs. Our study emphasizes the importance of NLRP1 as an immune regulatory factor and may open up new avenues for the treatment of coronavirus infection.


Assuntos
Infecções por Coronavirus , Deltacoronavirus , Doenças dos Suínos , Animais , Criança , Humanos , Diarreia , Haiti , Interleucina-11/metabolismo , Proteínas NLR/metabolismo , Nucleotídeos/metabolismo , Fosforilação , Transdução de Sinais , Suínos , Zoonoses/metabolismo
9.
J Acquir Immune Defic Syndr ; 95(4): 329-341, 2024 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-38133577

RESUMO

BACKGROUND: Racial/ethnic minority groups with HIV in the United States are particularly vulnerable to COVID-19 consequences and can significantly benefit from increased uptake of COVID-19 vaccines. This study identified factors associated with full COVID-19 vaccination among people with HIV. SETTING: Ryan White HIV/AIDS Program in Miami-Dade County, FL. METHODS: Data were collected from 299 Ryan White HIV/AIDS Program adult clients during January-March 2022 using a cross-sectional phone survey. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). All analyses were weighted to be representative of the race/ethnicity and sex distribution of clients in the Ryan White HIV/AIDS Program. RESULTS: Eighty-four percent of participants were fully vaccinated with a primary vaccine series; stratified by race/ethnicity, the percentages were 88.9% of Hispanic, 72.0% of black/African American, and 67.5% of Haitian participants. Fully vaccinated participants were less likely to be black/African American than Hispanic (aOR = 0.18; 95% CI: 0.05 to 0.67) and more likely to not endorse any misconceptions about COVID-19 vaccines (aOR = 8.26; 95% CI: 1.38 to 49.64), to report encouragement to get vaccinated from sources of information (aOR = 20.82; 95% CI: 5.84 to 74.14), and to perceive that more than 50% of their social network was vaccinated (aOR = 3.35; 95% CI: 1.04 to 10.71). Experiences of health care discrimination, structural barriers to access vaccines, and recommendations from HIV providers were not associated with full vaccination. CONCLUSIONS: These findings highlight the importance of delivering accurate and positive messages about vaccines and engaging social networks to promote COVID-19 vaccination among people with HIV. This information can be leveraged to promote uptake of subsequent boosters and other recommended vaccines.


Assuntos
Síndrome da Imunodeficiência Adquirida , COVID-19 , Infecções por HIV , Adulto , Humanos , Estados Unidos , Etnicidade , Florida/epidemiologia , Vacinas contra COVID-19 , Minorias Étnicas e Raciais , Estudos Transversais , Haiti , COVID-19/epidemiologia , COVID-19/prevenção & controle , Grupos Minoritários , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Vacinação , Brancos
10.
PLOS Glob Public Health ; 3(9): e0002356, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37698996

RESUMO

Globally, treatment outcomes for people with multi-drug/rifampin-resistant tuberculosis (MDR/RR-TB) are sub-optimal, with MDR/RR-TB programs further weakened due to the COVID-19 pandemic, and in Haiti, by severe civil unrest. We assessed the impact of these disruptions on treatment outcomes at GHESKIO, in Port-au-Prince, Haiti. We conducted a retrospective analysis including all adults (age ≥18 years) who initiated MDR/RR-TB treatment at GHESKIO from 2010 to 2020. We assessed predictors of poor treatment outcome using multivariable logistic regression, adjusting for baseline characteristics and year of treatment. 453 patients initiated treatment for MDR/RR-TB at GHESKIO. Median age was 31 (IQR: 25, 40), 233 (51.4%) were male, and 100 (22.1%) were living with HIV. Three hundred sixty-nine patients (81.5%) achieved cure, 42 (9.3%) died, 40 (8.8%) were lost to follow-up and 2 (<1%) failed treatment. HIV status was associated with poor treatment outcome (aRR: 1.65 (95% CI: 1.09, 2.48)) but there was no difference by year of treatment initiation. Outcomes for patients with MDR/RR-TB remained outstanding, even during the COVID-19 pandemic and severe civil unrest in Haiti. We attribute this resilience in care to the adaptability of program staff and provision of economic and psychosocial support.

11.
Soc Sci Med ; 331: 116076, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37441975

RESUMO

Public experiences of COVID-19 pandemic lockdown differed dramatically between countries and socio-economic groups. Low-income countries raise unique empirical and ethical concerns about (1) the balance between benefits and social harms and (2) how explanatory disease models and everyday life realities influenced the experience and interpretation of lockdown itself. In this paper, we present qualitative data on community perceptions and experiences of the pandemic from a remote area of Haiti, with a focus on the 2020 lockdown. We conducted in-depth interviews with 30 community leaders in Grand'Anse Department, southwest Haiti, at two time periods: May 2020 and October-December 2021. We divide our results into five sections. First, our analysis showed that lockdown was widely considered ineffective at controlling COVID-19. Despite the lack of testing, community leaders believed most of the local population had caught COVID-19 in the first half of 2020, with limited reported mortality. Public concern about the pandemic largely ended at this time, overtaken by other socio-economic and political crises. Second, we found that popular explanations for the low fatality rate were related to various coping strategies: the strength of people's immune systems, use of natural prophylactic folk teas, beliefs about the virus, spiritual protections and the tropical weather. Third, we found that lockdown was widely seen to have not been appropriate for the Haitian context due to various challenges with compliance in the face of socio-economic vulnerability. Fourth, we found strong negative feelings about the social consequences of lockdown measures, which lasted from March-August 2020, including adverse effects on: food security, household income, education, health, and psychosocial well-being. Finally, these perceptions and experiences reinforced popular ideas that lockdown had been imposed by elites for financial and/or political gain, something that was also reflected in the discourse about the low vaccine acceptance rate. Our study showed that pandemic respiratory virus response in Haiti should better balance restrictive non-pharmaceutical interventions (NPIs) with existing socio-economic vulnerability. Local socio-behavioral dynamics and risk perceptions decrease the overall effectiveness of NPIs in fragile states and alternatives to lockdown, such as shielding the most vulnerable, are likely to be a more appropriate strategy.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Haiti/epidemiologia , Pandemias/prevenção & controle , Adaptação Psicológica
12.
Am J Trop Med Hyg ; 108(6): 1140-1144, 2023 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-37127264

RESUMO

In 2018, a mass drug administration (MDA) campaign for malaria elimination was piloted in Haiti. The pilot treated 36,338 people with sulfadoxine-pyrimethamine (SP) and primaquine; no severe adverse events were detected. In 2020, another MDA campaign using the same medications was implemented to mitigate an upsurge in malaria cases during the COVID-19 pandemic. Four cases of Stevens-Johnson syndrome (SJS) were identified among the 42,249 people who took the medications. Three of these individuals required hospitalization; all survived. In addition to SP ingestion, an investigation of potential causes for increased SJS cases identified that all four cases had human leukocyte antigens A*29 and/or B*44:03, another known risk factor for SJS. Additionally, three of the four case individuals had antibodies to SARS-CoV-2, and the fourth may have been exposed around the same time. These findings raise the possibility that recent SARS-CoV-2 infection may have contributed to the increased risk for SJS associated with SP exposure during the 2020 campaign.


Assuntos
Antimaláricos , COVID-19 , Malária , Síndrome de Stevens-Johnson , Humanos , Primaquina/efeitos adversos , Antimaláricos/efeitos adversos , Síndrome de Stevens-Johnson/etiologia , Síndrome de Stevens-Johnson/tratamento farmacológico , Síndrome de Stevens-Johnson/epidemiologia , Haiti/epidemiologia , Administração Massiva de Medicamentos , Pandemias , SARS-CoV-2 , Pirimetamina/efeitos adversos , Sulfadoxina/efeitos adversos , Combinação de Medicamentos , Malária/tratamento farmacológico , Malária/epidemiologia , Malária/prevenção & controle
13.
Popul Health Metr ; 21(1): 7, 2023 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-37210556

RESUMO

BACKGROUND: During the COVID-19 pandemic, governments and researchers have used routine health data to estimate potential declines in the delivery and uptake of essential health services. This research relies on the data being high quality and, crucially, on the data quality not changing because of the pandemic. In this paper, we investigated those assumptions and assessed data quality before and during COVID-19. METHODS: We obtained routine health data from the DHIS2 platforms in Ethiopia, Haiti, Lao People's Democratic Republic, Nepal, and South Africa (KwaZulu-Natal province) for a range of 40 indicators on essential health services and institutional deaths. We extracted data over 24 months (January 2019-December 2020) including pre-pandemic data and the first 9 months of the pandemic. We assessed four dimensions of data quality: reporting completeness, presence of outliers, internal consistency, and external consistency. RESULTS: We found high reporting completeness across countries and services and few declines in reporting at the onset of the pandemic. Positive outliers represented fewer than 1% of facility-month observations across services. Assessment of internal consistency across vaccine indicators found similar reporting of vaccines in all countries. Comparing cesarean section rates in the HMIS to those from population-representative surveys, we found high external consistency in all countries analyzed. CONCLUSIONS: While efforts remain to improve the quality of these data, our results show that several indicators in the HMIS can be reliably used to monitor service provision over time in these five countries.


Assuntos
COVID-19 , Gravidez , Humanos , Feminino , COVID-19/epidemiologia , Pandemias , Laos/epidemiologia , Nepal/epidemiologia , Etiópia , África do Sul/epidemiologia , Haiti/epidemiologia , Cesárea
14.
Hum Vaccin Immunother ; 19(1): 2204048, 2023 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-37157153

RESUMO

Vaccines are the most effective mechanism for ending the COVID-19 pandemic. However, reluctance to accept vaccines has hindered the efforts of health authorities to combat the virus. In Haiti, as of July 2021, less than 1% of the country's population has been fully vaccinated in part due to vaccine hesitancy. Our goal was to assess Haitian attitudes toward COVID-19 vaccination and investigate the primary reasons for Moderna vaccine hesitancy. We conducted a cross-sectional survey across three rural Haitian communities, in September 2021. The research team used electronic tablets to collect quantitative data from 1,071 respondents, selected randomly across the communities. We report descriptive statistics and identify variables associated with vaccine acceptance using logistic regression built using a backward stepwise approach. Among 1,071 respondents, the overall acceptance rate was 27.0% (n = 285). The most common reason for vaccine hesitancy was "concern about side effects" (n = 484, 67.1%) followed by "concern about contracting COVID-19 from the vaccine" (n = 472, 65.4%). Three-quarters of respondents (n = 817) identified their healthcare workers as their most trustworthy source for information related to the vaccine. In the bivariate analysis, male gender (p = .06) and no history of drinking alcohol (p < .001) were significantly associated with being more likely to take the vaccine. In the final reduced model, only those with a history of drinking alcohol were significantly more likely to take the vaccine (aOR = 1.47 (1.23, 1.87) p < .001). The acceptance rate for the COVID-19 vaccine is low, and public health experts should design and strengthen vaccination campaigns to combat misinformation and public distrust.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Masculino , Humanos , Estudos Transversais , Haiti , COVID-19/prevenção & controle , Pandemias , Etanol , Vacinação
15.
Washington, D.C.; PAHO; 2023-05-03. (PAHO/PHE/EMO/COVID-19/23-0011).
em Inglês | PAHO-IRIS | ID: phr-57427

RESUMO

This document outlines PAHO’s regional priorities for the year 2023 to sustain and scale up health emergency and humanitarian assistance in the Americas, with a focus on five priority countries currently facing a prolonged humanitarian crisis and recovering from recent acute emergencies: Colombia, El Salvador, Guatemala, Haiti, and Venezuela (Bolivarian Republic of). These goals align with and build on the World Health Organization’s Global Health Emergency Appeal for 2023, its principles, priorities, and strategies.


Assuntos
COVID-19 , Emergências , Doenças Preveníveis por Vacina , Colômbia , El Salvador , Guatemala , Haiti , Venezuela
16.
Interdisciplinaria ; 40(1): 363-377, abr. 2023.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1430605

RESUMO

Resumen El presente trabajo se inscribe en los estudios sobre las migraciones contemporáneas a Chile, campo iniciado en los años noventa al momento de una transición democrática y una economía presentada como exitosa. Expone breves referencias a la migración hacia Chile proveniente de Haití y algunos elementos de la historia de Haití que conforman una situación migratoria particular. El objetivo es identificar el racismo presente en las interacciones entre profesionales de los centros de la red pública de salud y pacientes haitianos/as que acuden a ellos en Santiago de Chile. Este trabajo proviene de un proyecto mayor que analizó la sociabilidad y las competencias culturales de estos profesionales al interactuar con migrantes. Desde una metodología cualitativa se realizaron entrevistas semiestructuradas a profesionales de la red pública de salud y grupos focales a pacientes haitianos. El marco de referencia se centra en el racismo como sistema y como relación social, en la discriminación racial y sus efectos en las personas. Se analizan las palabras de los/as pacientes y los/as profesionales, se presentan algunas conclusiones sobre el racismo y la violencia registradas como forma de sociabilidad, entendiéndola como el modo en que se da el trato entre dos actores, uno de ellos en una posición superior. Estos procesos precisan ser reflexionados para dar cuenta del sufrimiento producido en hombres, mujeres y niños/as haitianos que buscan atención en la red de salud pública. Por último, se avanzan algunas orientaciones tendientes a superarlos.


Abstract The present work is inscribed within the field of contemporary migration studies in Chile, a line of investigation initiated during the nineties. At the time, various people from South America and the Caribbean arrived to the country, which was undergoing a democratic transition and presented itself as a successful economic model. Twenty-five years later, migrants from Haiti began arriving. Despite not constituting the largest group of migrants, they have become one of the most targeted by Chilean society, the media, the political class and government authorities. Since the election of Sebastián Piñera in 2018, certain measures were taken that signaled a policy aimed towards reducing Haitian presence in the country: namely, a "humanitarian" return plan exclusively for Haitians and the creation of a consular visa as the main permit in order to enter the country. During the COVID-19 pandemic, they were singled out as disobedient to the measures imposed by the state of emergency and the sanitary restrictions put in place. Chilean society agrees with restrictive norms and policies and looks with suspicion at a migrant group that it perceives as different. Chile, a country colonized in the name of humanist and republican values, which upholds cultural homogeneity, does not look favorably on the arrival of migrants from elsewhere in the region, and even less so on a migrant group whose skin color has been negatively evaluated, to the point of linking it to physical, cultural and psychological characteristics. This work makes brief references of the context of migrating to Chile, of doing so from Haiti, and of some elements of Haiti's history that make up this particular migratory situation. The proposed objective is to identify racism present within the interactions between public health workers and Haitian patients who approach them for help or treatment in the city of Santiago. This work stems from a larger project that analyzed the sociability and cultural skills of different public health professionals interacting with migrants. Employing a qualitative methodology, semi-structured interviews were conducted with professionals from the public health service and focus groups were organized with Haitian patients. The frame of reference focuses on racism as a system and as a social relationship, on racial discrimination and its effects on people. The words of patients and professionals are analyzed and conclusions are drawn in regards to racism and registered violence as forms of sociability, the latter understood as the way in which two actors interact when one of them is in a position of superiority. These processes need to be reflected upon in order to account for the damages caused to Haitian men, women and children seeking care in the public health network. Considering the importance of the right to migrate in current times and the multiple obstacles that impede it, Haitian life in Chile emerges as a "problem" when it comes to being attended, cared for or assisted to by health professionals, an issue that is linked to the fact that contemporary migrations have been repeatedly characterized as a "problem" and not as a social phenomenon that needs to be seriously analyzed with academic accuracy. Racist criticism emerges violently, offending and harming Haitian migrants who, in order to avoid it, sometimes prefer not to go public health centers, to look for alternatives when dealing with the ailments that afflict them, or straightforwardly abandon the possibility of being attended at all. Finally, some guidelines are advanced which may help to overcome these situations by training professionals in order to improve communications between them and Haitian migrants.

17.
J Radiol Nurs ; 42(1): 77-84, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36742420

RESUMO

Introduction: Point-of-care ultrasound (POCUS) has enhanced patient care and safety around the world. Clinicians can now use a small diagnostic ultrasound imaging device to answer some binary clinical questions and manage patients more effectively. Since the COVID-19 pandemic, there has been a significant adoption of POCUS by clinicians worldwide. Materials and Methods: A basic cardiac POCUS training was conducted in Haiti with focus on physics, instrumentation, and basic echocardiography. Results: The Mission POCUS team trained 15 Haitian physicians interested in better serving their patients with the implementation of POCUS cardiac in their patient assessment. Conclusion: POCUS skills will empower clinicians from around the world to make rapid and accurate diagnosis and help save lives by diagnosing life threatening conditions and manage patient appropriately. Our experience in Haiti showed that a short POCUS training course can help improve the knowledge of physicians.

18.
BMC Public Health ; 23(1): 350, 2023 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-36797724

RESUMO

BACKGROUND: Vaccines are a strong public health tool to protect against severe disease, hospitalization, and death from COVID-19. Still, inequities in COVID-19 vaccination rates and health outcomes continue to exist among Black and Latino populations. Boston Medical Center (BMC) has played a significant role in vaccinating medically underserved populations, and organized a series of community-engaged conversations to better understand community concerns regarding the COVID-19 vaccine. This paper describes the themes which resulted from these community-engaged conversations and proposes next steps for healthcare leaders. METHODS: We accessed nine publicly available recordings of the community-engaged conversations which were held between March 2021 and September 2021 and ranged from 8 to 122 attendees. Six conversations prioritized specific groups: the Haitian-Creole community, the Cape Verdean community, the Latino community, the Black Christian Faith community, guardians who care for children living with disabilities, and individuals affected by systemic lupus erythematosus. Remaining conversations targeted the general public of the Greater Boston Area. We employed a Consolidated Framework for Implementation Research-driven codebook to code our data. Our analysis utilized a modified version of qualitative rapid analysis methods. RESULTS: Five main themes emerged from these community-engaged conversations: (1) Structural factors are important barriers to COVID-19 vaccination; (2) Mistrust exists due to the negative impact of systemic oppression and perceived motivation of the government; (3) There is a desire to learn more about biological and clinical characteristics of the COVID-19 vaccine as well as the practical implications of being vaccinated; (4) Community leaders emphasize community engagement for delivering COVID-19 information and education and; (5) Community leaders believe that the COVID-19 vaccine is a solution to address the pandemic. CONCLUSION: This study illustrates a need for community-engaged COVID-19 vaccine messaging which reflects the nuances of the COVID-19 vaccine and pandemic without oversimplifying information. In highlighting common concerns of the Greater Boston Area which contribute to a lack of confidence in the COVID-19 vaccine, we underscore important considerations for public health and healthcare leadership in the development of initiatives which work to advance health equity.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Criança , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Haiti , Aprendizagem , Motivação , Vacinação
19.
BMJ Open Qual ; 12(1)2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36593071

RESUMO

BACKGROUND: Following the first COVID-19 peak in 2020, came the seasonal childbirth peak at Hôpital Universitaire de Mirebalais (HUM). This peak is associated with overcrowding on the labour and delivery (L&D) ward. Lack of sufficient bed-space for sick neonates in the neonatal ICU at HUM, has led to overcrowding and lengthy stays of sick newborns on L&D. These conditions contribute to the subsequent lack of bed-space for newly postpartum mothers and potentially decreases quality of care for both new mothers and neonates. METHODS: A Maternity Task Force was created by hospital leadership to address these urgent needs. The team's objective was to eliminate mothers and newborns laying on the floor in L&D. The Six-Sigma/DMAIC quality improvement methodology was used as the problem was urgent, demanded rapid results and centred around the process of patient flow in the institution. Process flow chart and Ishikawa diagrams were used to identify the root causes of the issues. RESULTS: An average of 22% of postpartum women did not have a bed preintervention and 0% of postpartum women were laying on the floor post intervention. An average of 33% of newborns received paediatric care on the maternity ward pre-intervention compared with an average of 17% postintervention. The team did not achieve its objective for this second indicator, which was to have less than 10% of sick newborns on the maternity ward receiving paediatric care. CONCLUSION: HUM hospital leadership took the vital decision to form the Maternity Task Force to make changes, which consequently led to a sustainable positive and lasting impact on the lives of new mothers and their babies at the institution. The objective of 0 postpartum mothers and newborns on the ground was achieved and fewer newborns receive intensive paediatric care on the maternity ward as a result of our interventions.


Assuntos
COVID-19 , Melhoria de Qualidade , Gravidez , Feminino , Humanos , Haiti , Mães , Hospitais Universitários
20.
Fam Process ; 62(1): 216-229, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-35272392

RESUMO

We examine how juvenile justice-involved youth of Haitian descent in Miami-Dade County cope with structural racism and its impact on their mental health. Drawing on longitudinal ethnography, psychosocial assessment data, and a family-based clinical intervention funded by the National Institute on Drug Abuse, this article explores youth narratives of discrimination prior to and during the COVID-19 pandemic. We use critical race theory and theory of practice to understand youths' perceptions as racialized bodies and stigmatized selves, highlighting the experiences and perspectives of a particular black immigrant group, ethnic beings caught up in the everyday practices of racialization, sociocultural marginalization, and racism. We frame these experiences as a variation of the complex continuum of structural racism and racial domination in the US. These experiences have caused anger, fear, anxiety, chronic anticipatory distress, and hopelessness among youth of Haitian descent. We conclude with some recommendations for therapeutic support that encourages youth to process their experiences, promotes their development of a positive self-concept, and provides them with mind-body techniques to attenuate the physical impacts of discriminatory events. The clinical trial registration number for this study intervention is NCT03876171.


Assuntos
COVID-19 , Racismo , Humanos , Adolescente , Estados Unidos , Racismo/psicologia , Haiti , Pandemias , Saúde Mental
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