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Sagastume D, Peñalvo JL, Ramírez-Zea M, Polman K, Beňová L. Dynamics of the double burden of malnutrition in Guatemala: a secondary data analysis of the demographic and health surveys from 1998-2015. Public Health 2024; 229:135-143. [PMID: 38442595 DOI: 10.1016/j.puhe.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/08/2024] [Accepted: 01/31/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE We estimated the prevalence and time trends of the double burden of malnutrition (DBM) in Guatemala and explored its occurrence based on socio-demographic factors. STUDY DESIGN This was a secondary data analysis using information from four Demographic and Health Surveys covering the period 1998-2015. METHODS The unit of analysis was the household within which information was gathered from women 18-49 years and their children, 6-59 months. The main outcome was the prevalence of any DBM in the household (co-existence of undernutrition and overnutrition in a woman, her children or both). We estimated the prevalence of any DBM by survey and analysed time trends. Stepwise logistic regression was used to explore the occurrence of DBM and socio-demographic factors. RESULTS We analysed 39,749 households across all surveys. The prevalence of any DBM was 25.3% (95%CI: 22.1-28.7) in 1998-99, 23.8% (22.0-25.8) in 2002, 25.9% (24.3-27.5) in 2008-09 and 24.2% (22.9-25.5) in 2014-15, with no significant change over time (P = 0.782). Characteristics associated with lower odds of any DBM were rural residence, female-headed household, wealth and women's secondary education. Higher odds were seen for households with electricity, women >25y, indigenous and with >2 children. CONCLUSION Our findings revealed that a quarter of Guatemala's households suffer from DBM, which has remained unchanged for 17 years. Interventions should prioritise urban areas, households of lower socio-economic status and those less educated. To increase awareness of policymakers of this pressing public health concern, further research on DBM could be strengthened by prospective study designs, integrating all household members and expanding the types of malnutrition.
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Affiliation(s)
- D Sagastume
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Global Health Institute, University of Antwerp, Wilrijk, Belgium.
| | - J L Peñalvo
- Global Health Institute, University of Antwerp, Wilrijk, Belgium; National Center for Epidemiology, Carlos III Institute of Health (ISCIII), Madrid, Spain
| | - M Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - K Polman
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Department of Health Sciences, Vrije Universiteit (VU) Amsterdam, the Netherlands
| | - L Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Shephard M, Matthews S, Kularatne R, Andrewartha K, Blondeel K, Alvarez C, Camey E, Hançali A, Müller E, Haw A, Oumzil H, Golparian D, Ramirez DE, Kiarie J, Kurbonov F, Mirandola M, Peeling RW, Silva R, Thwin SS, Unemo M, Toskin I. Independent clinic-based evaluation of point-of-care testing for the screening of Chlamydia trachomatis, Neisseria gonorrhoea and Trichomonas vaginalis in women-at-risk in Australia, Guatemala, Morocco, and South Africa. BMC Infect Dis 2024; 24:277. [PMID: 38438953 PMCID: PMC10910521 DOI: 10.1186/s12879-024-09018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/11/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND In 2018, the World Health Organization commenced a multi-country validation study of the Cepheid GeneXpert for a range of molecular-based point-of-care (POC) tests in primary care settings. One study arm focused on the evaluation of POC tests for screening 'women at risk' for chlamydia (CT), gonorrhoea (NG) and trichomonas (TV) in four countries - Australia, Guatemala, Morocco and South Africa. METHODS Study participants completed a pre-test questionnaire which included demographics, clinical information and general questions on POC testing (POCT). Two vaginal swab samples (either self-collected or clinician collected) from each patient were tested on the GeneXpert at the POC and at a reference laboratory using quality-assured nucleic acid amplification tests (NAATs). RESULTS One thousand three hundred and eighty-three women were enrolled: 58.6% from South Africa, 29.2% from Morocco, 6.2% from Guatemala, and 6.0% from Australia. 1296 samples for CT/NG and 1380 samples for TV were tested by the GeneXpert and the reference NAAT. The rate of unsuccessful tests on the GeneXpert was 1.9% for CT, 1.5% for NG and 0.96% for TV. The prevalence of CT, NG and TV was 31%, 13% and 23%, respectively. 1.5% of samples were positive for all three infections; 7.8% were positive for CT and NG; 2.4% were positive for NG and TV; and 7.3% were positive for CT and TV. Compared to reference NAATs, pooled estimates of sensitivity for the GeneXpert tests were 83.7% (95% confidence intervals 69.2-92.1) for CT, 90.5% (85.1-94.1) for NG and 64.7% (58.1-70.7) for TV (although estimates varied considerably between countries). Estimates for specificity were ≥96% for all three tests both within- and between-countries. Pooled positive and negative likelihood ratios were: 32.7 ([CI] 21.2-50.5) and 0.17 (0.08-0.33) for CT; 95.3 (36.9-245.7) and 0.10 (0.06-0.15) for NG; and 56.5 (31.6-101.1) and 0.35 (0.27-0.47) for TV. CONCLUSION This multi-country evaluation is the first of its kind world-wide. Positive likelihood ratios, as well as specificity estimates, indicate the GeneXpert POC test results for CT, NG and TV were clinically acceptable for ruling in the presence of disease. However, negative likelihood ratios and variable sensitivity estimates from this study were poorer than expected for ruling out these infections, particularly for TV. TRIAL REGISTRATION Ethics approval to conduct the ProSPeRo study was granted by the WHO Ethics Review Committee, as well as local ethics committees from all participating countries.
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Affiliation(s)
- Mark Shephard
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, South Australia, Australia.
| | - Susan Matthews
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, South Australia, Australia
| | - Ranmini Kularatne
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Kelly Andrewartha
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, South Australia, Australia
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Elsy Camey
- Sida y Sociedad, ONG (SISO), Escuintla, Guatemala
| | | | - Etienne Müller
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Aurelie Haw
- Médecins sans Frontières, Khayelitsha, Cape Town, South Africa
| | | | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Dorian E Ramirez
- Facultad de Ciencias Médicas, Universidad de San Carlos de Guatemala, Guatemala City, Guatemala
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Firdavs Kurbonov
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- School of Sport and Health Sciences, University of Brighton, Brighton, United Kingdom
| | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ronaldo Silva
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soe Soe Thwin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London, London, United Kingdom
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Balsells E, Vicente M, Reyes S, Figueroa M, Sum K, López Lacán MA, Escalante A, Campos D, Montenegro M, Alvarado G, Quezada LF, Jarquin C, Montufar E, Rondy M. Impact of the 'Health on Wheels' (HoW) strategy on COVID-19 vaccination coverage in hard-to-reach communities in Alta Verapaz, Guatemala, 2022. Vaccine 2024; 42:1179-1183. [PMID: 38281901 PMCID: PMC10911077 DOI: 10.1016/j.vaccine.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND In April 2022, after a year of COVID-19 vaccination, there were large differences in coverage between urban and rural areas in Guatemala. To address barriers in rural communities, the "Health on Wheels" (HoW) strategy was implemented. The strategy deployed mobile brigades with a dedicated team of health workers and a culturally sensitive health promotion plan in selected communities in 15 districts in Alta Verapaz, a health area with low COVID-19 vaccination uptake and a high-level of COVID-19 vaccine hesitancy. This study evaluates the impact of the HoW strategy. METHODS We measured the relative increase in COVID-19 doses administered prior and during the HoW implementation period in the 190 intervened communities and compared to 188 communities without the intervention. Communities were grouped by health district and the impact analyses were stratified by number of COVID-19 vaccine dose (1st, 2nd, and 3rd doses) and history of vaccine hesitancy. RESULTS The increase in 1st, 2nd, and 3rd dose-COVID-19 vaccination coverage between before and during HoW implementation was 2.4, 2.2 and 2.6 times higher in intervened communities (20 %, 21 % and 37 % increase in 1st, 2nd and 3rd dose, respectively) than in non-intervened communities (8 %, 10 % and 14 % increase in 1st, 2nd and 3rd dose respectively). For the 1st dose, increase in dose administration was 2.9 times higher in intervened communities (n = 24) with hesitancy (24 % increase) compared to non-intervened communities (n = 188) without hesitancy (8 % increase). CONCLUSION The deployment of mobile brigades with a dedicated team of vaccinators and culturally sensitive health promotion through the HoW strategy successfully accelerated the increase in COVID-19 vaccination coverage in rural communities in Guatemala.
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Affiliation(s)
| | | | | | | | - Keyla Sum
- Pan American Health Organization, Guatemala
| | | | | | | | | | | | | | | | | | - Marc Rondy
- Pan American Health Organization, Guatemala
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Guarchaj M, Tschida S, Milian Chew JP, Aguilar A, Flood D, Fort MP, Morales LC, Mendoza Montano C, Rodríguez Serrano SN, Rohloff P. Impact of COVID-19 on diabetes care: mixed methods study in an Indigenous area of Guatemala. BMJ Open 2024; 14:e079130. [PMID: 38167279 PMCID: PMC10773399 DOI: 10.1136/bmjopen-2023-079130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION SARS-CoV-2 has impacted globally the care of chronic diseases. However, direct evidence from certain vulnerable communities, such as Indigenous communities in Latin America, is missing. We use observational data from a health district that primarily serves people of Maya K'iche' ethnicity to examine the care of type 2 diabetes in Guatemala during the pandemic. METHODS We used a parallel convergent mixed methods design. Quantitative data (n=142 individuals with diabetes) included glycated haemoglobin (HbA1c), blood pressure, body mass index and questionnaires on diabetes knowledge, self-care and diabetes distress. Quantitative data was collected at two points, at baseline and after COVID restrictions were lifted. For quantitative outcomes, we constructed multilevel mixed effects models with multiple imputation for missing data. Qualitative data included interviews with providers, supervisors and individuals living with diabetes (n=20). We conducted thematic framework analysis using an inductive approach. RESULTS Quantitative data was collected between June 2019 and February 2021, with a median of 487 days between data collection points. HbA1c worsened +0.54% (95% CI, 0.14 to 0.94) and knowledge about diabetes decreased -3.54 points (95% CI, -4.56 to -2.51). Qualitatively, the most important impact of the pandemic was interruption of the regular timing of home visits and peer group meetings which were the standard of care. CONCLUSIONS The deterioration of diabetes care was primarily attributed to the loss of regular contact with healthcare workers. The results emphasize the vulnerability of rural and Indigenous populations in Latin America to the suspension of chronic disease care.
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Affiliation(s)
- Magdalena Guarchaj
- Center for Research in Indigenous Health, Maya Health Alliance | Wuqu' Kawoq, Tecpan, Chimaltenango, Guatemala
| | - Scott Tschida
- Center for Research in Indigenous Health, Maya Health Alliance | Wuqu' Kawoq, Tecpan, Chimaltenango, Guatemala
| | | | - Andrea Aguilar
- Center for Research in Indigenous Health, Maya Health Alliance | Wuqu' Kawoq, Tecpan, Chimaltenango, Guatemala
- Colectiva Guatemala Menstruante, Guatemala City, Guatemala
| | - David Flood
- Center for Research in Indigenous Health, Maya Health Alliance | Wuqu' Kawoq, Tecpan, Chimaltenango, Guatemala
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Meredith P Fort
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Carlos Mendoza Montano
- Centro de Investigación para la Prevención de las Enfermedades Crónicas, Instituto deNutrición de Centro América y Panamá, Guatemala City, Guatemala
| | | | - Peter Rohloff
- Center for Research in Indigenous Health, Maya Health Alliance | Wuqu' Kawoq, Tecpan, Chimaltenango, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Hernández-Chea R, Morales-Ramírez P, Hernández M, Hun A, Silva I, Fleury A, Sciutto E. Epidemiology of swine cysticercosis in two rural communities of Zacapa, Guatemala. Vet Parasitol Reg Stud Reports 2024; 47:100951. [PMID: 38199694 DOI: 10.1016/j.vprsr.2023.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 01/12/2024]
Abstract
Taeniasis/cysticercosis complex caused by Taenia solium, is a serious public health problem and causes major economic losses to swine producers in developing countries in Asia, Africa and the Americas. Despite scarce epidemiological data, Guatemala is considered endemic for T. solium. A cross-sectional study was conducted in Azacualpa and Malpais, two villages in the department of Zacapa, to assess the prevalence of swine cysticercosis and associated factors. Between March and October 2019, 149 pigs were examined by tongue palpation and serum samples were then collected to detect antibodies by ab-ELISA, and necropsy was performed on pigs that were positive by tongue palpation and/or ab-ELISA, to assess parasite load. Pig owners were asked to fill out a questionnaire on factors related to pig husbandry and occurrence of swine cysticercosis. Pearson's chi-square test and multivariate analysis were used to measure the association between serological results and other variables (p < 0.05 was considered significant). The seroprevalence of swine cysticercosis was 13.4% (13/97, 95% C.I. 6.6%-20.2%) and 25% (13/52, 95% C.I. 13.2%-36.8%) in Azacualpa and Malpais, respectively, yielding an overall seroprevalence of 17.4% (26/149, 95% C.I. 11.4%-23.5%). Parasite loads ranged from 1 to over 23,000 metacestodes per carcass. No bivariate association was found between exposure variables and seropositivity. A positive diagnosis by tongue palpation increased the odds of finding pigs seropositive for cysticercosis by a factor of 16.1 in the multivariate analysis. Despite the high prevalence and parasite load of T. solium, risk factors associated with cysticercosis were not significant in this study.
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Affiliation(s)
- Roderico Hernández-Chea
- Dirección Departamental de Redes Integradas de Servicios de Salud, Guatemala-área sur, Ministerio de Salud Pública y Asistencia Social, Guatemala, Amatitlán, Guatemala.
| | | | - Marisela Hernández
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandro Hun
- Escuela de Posgrado, Facultad de Medicina Veterinaria y Zootecnia, Universidad de San Carlos de Guatemala, Guatemala, Guatemala
| | - Ilde Silva
- Facultad de Ciencias Jurídicas y Sociales, Universidad de San Carlos de Guatemala, Guatemala, Guatemala
| | - Agnès Fleury
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico; Unidad Periférica del Instituto de Investigaciones Biomédicas, Departamento de Medicina Genómica y Toxicología ambiental, Universidad Nacional Autónoma de México, Mexico City, Mexico; Instituto de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
| | - Edda Sciutto
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico.
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Mundt AP, Delhey S, Martínez P, Irarrázaval M, Grasso L, Rivera-Arroyo G, Capistrano A, Trujillo N, Golcher F, Benavides Salcedo A, Dedik C, Cordero M, Torales J, Malpartida C, Almánzar Á. Types of Psychiatric Beds and Mental Health Services in 16 Latin American Countries, 1990-2020. Psychiatr Serv 2024; 75:48-54. [PMID: 37644830 DOI: 10.1176/appi.ps.20220590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Latin America has undergone major changes in psychiatric services over the past three decades. The authors aimed to assess the availability of service data and changes in psychiatric services in this region during the 1990-2020 period. METHODS The authors formed a research network to collect data on psychiatric service indicators gathered between 1990 and 2020 from national registries in Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama, Paraguay, Peru, and Uruguay. Indicators included psychiatric beds in psychiatric and general hospitals overall, for children and adolescents, and for forensic populations; residential beds for substance use treatment; treatment slots in residential facilities and day hospitals; and outpatient facilities. RESULTS Data availability varied among countries, service indicators, and time points. The median prevalence of psychiatric beds decreased in psychiatric hospitals from 5.1 to 3.0 per 100,000 people (-42%) and in general hospitals from 1.0 to 0.8 (-24%). The median prevalence estimates of specialized psychiatric beds for children and adolescents (0.18) and for forensic populations (0.04) remained unchanged. Increases in prevalence were observed for residential beds for substance use treatment (from 0.40 to 0.57, 43% increase), available treatment slots in residential facilities (0.67 to 0.79, 17%), treatment slots in day hospitals (0.41 to 0.54, 32%), and outpatient facilities (0.39 to 0.93, 138%). CONCLUSIONS The findings indicate that treatment capacity shifted from inpatient to outpatient and community care. Most countries had a bed shortage for acute psychiatric care, especially for children and adolescents and forensic patients. More comprehensive and standardized mental health service registries are needed.
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Affiliation(s)
- Adrian P Mundt
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Sabine Delhey
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Pablo Martínez
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Matías Irarrázaval
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Luciano Grasso
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Guillermo Rivera-Arroyo
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Adelia Capistrano
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Natalia Trujillo
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Francisco Golcher
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Andrés Benavides Salcedo
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Corinne Dedik
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Martha Cordero
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Julio Torales
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - César Malpartida
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
| | - Ángel Almánzar
- School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar)
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7
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Lu W, Jenny A, Romero C, Diaz-Artiga A, Kuster A, Canuz E, Pillarisetti A, McCracken JP, Huang W, Smith KR, Balmes J, Thompson LM. Biomass smoke exposure and somatic growth among children: The RESPIRE and CRECER prospective cohort studies in rural Guatemala. Environ Int 2024; 183:108401. [PMID: 38147790 DOI: 10.1016/j.envint.2023.108401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Cooking-related biomass smoke is a major source of household air pollution (HAP) and an important health hazard. Prior studies identified associations between HAP exposure and childhood stunting; less is known for underweight and wasting. Few studies had personal HAP measurements. METHODS 557 households in rural Guatemala were enrolled in the CRECER study, the follow-up study of the RESPIRE randomized intervention trial. They were assigned to three groups that received chimney stoves at different ages of the study children. Multiple personal carbon monoxide (CO) exposure measurements were used as proxies for HAP exposures. Children's heights and weights were measured from 24 to 60 months of age. Height-for-age z-score (HAZ), weight-for-age z-score (WAZ), and weight-for-height z-score (WHZ) were calculated based on the World Health Organization's Multicentre Growth Reference Study. HAZ, WAZ, and WHZ below -2 were classified as stunting, underweight, and wasting, respectively. Generalized linear models and mixed effects models were applied. RESULTS 541 children had valid anthropometric data, among whom 488 (90.2 %) were stunted, 192 (35.5 %) were underweight, and 2 (0.3 %) were wasted. A 1 ppm higher average CO exposure was associated with a 0.21 lower HAZ (95 % CI: 0.17-0.25), a 0.13 lower WAZ (95 % CI: 0.10-0.17) and a 0.06 lower WHZ (95 % CI: 0.02-0.10).The associations for HAZ were stronger among boys (coefficient = -0.29, 95 % CI: -0.35 - -0.22) than among girls (coefficient = -0.15, 95 % CI: -0.20 - -0.10). A 1 ppm-year higher cumulative CO exposure was associated with a higher risk of moderate stunting among boys (OR = 1.27, 95 % CI: 1.05-1.59), but not among girls. DISCUSSION In this rural Guatemalan population, higher HAP exposure was associated with lower HAZ and WAZ. The associations between HAP and HAZ/stunting were stronger among boys. Reducing HAP might benefit childhood somatic growth in rural populations of low-income countries.
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Affiliation(s)
- Wenxin Lu
- School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA.
| | - Alisa Jenny
- Institute for Global Health Sciences, University of California, San Francisco, 94158 San Francisco, CA, USA.
| | - Carolina Romero
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Anaite Diaz-Artiga
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Andrea Kuster
- School of Nursing, University of California, San Francisco, 94158 San Francisco, CA, USA.
| | - Eduardo Canuz
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Ajay Pillarisetti
- School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA.
| | - John P McCracken
- Epidemiology and Biostatistics Department, University of Georgia, 30606 Athens, GA, USA.
| | - Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Kirk R Smith
- School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA
| | - John Balmes
- School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Lisa M Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, 30322 Atlanta, GA, USA.
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8
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McMinn RJ, Chacon A, Rückert C, Scorza V, Young MC, Worthington D, Lamb MM, Medrano RE, Harris EK, Arias K, Lopez MR, Asturias EJ, Foy BD, Stenglein MD, Olson D, Ebel GD. Evaluation of Vector-Enabled Xenosurveillance in Rural Guatemala. Am J Trop Med Hyg 2023; 109:1303-1310. [PMID: 37972312 DOI: 10.4269/ajtmh.22-0774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/02/2023] [Indexed: 11/19/2023] Open
Abstract
Surveillance methods that permit rapid detection of circulating pathogens in low-resource settings are desperately needed. In this study, we evaluated a mosquito bloodmeal-based surveillance method ("xenosurveillance") in rural Guatemala. Twenty households from two villages (Los Encuentros and Chiquirines) in rural southwest Guatemala were enrolled and underwent weekly prospective surveillance from August 2019 to December 2019 (16 weeks). When febrile illness was reported in a household, recently blood-fed mosquitoes were collected from within dwellings and blood samples taken from each member of the household. Mosquitoes were identified to species and blood sources identified by sequencing. Shotgun metagenomic sequencing was used to identify circulating viruses. Culex pipiens (60.9%) and Aedes aegypti (18.6%) were the most abundant mosquitoes collected. Bloodmeal sources were most commonly human (32.6%) and chicken (31.6%), with various other mammal and avian hosts detected. Several mosquito-specific viruses were detected, including Culex orthophasma virus. Human pathogens were not detected. Therefore, xenosurveillance may require more intensive sampling to detect human pathogens in Guatemala and ecologically similar localities in Central America.
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Affiliation(s)
- Rebekah J McMinn
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Andrea Chacon
- Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Claudia Rückert
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
- Department of Biochemistry and Molecular Biology, University of Nevada, Reno, Nevada
| | - Valeria Scorza
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Michael C Young
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Delaney Worthington
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Molly M Lamb
- Colorado School of Public Health, Aurora, Colorado
| | - Ramon E Medrano
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Emma K Harris
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Kareen Arias
- Center for Human Development, Retalhuleu, Guatemala
| | - Maria Renee Lopez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Edwin J Asturias
- Colorado School of Public Health, Aurora, Colorado
- Center for Human Development, Retalhuleu, Guatemala
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian D Foy
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Mark D Stenglein
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Daniel Olson
- Colorado School of Public Health, Aurora, Colorado
- Center for Human Development, Retalhuleu, Guatemala
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
| | - Gregory D Ebel
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
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9
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Kabue M, Gauvreau CL, Daceney N, Bertram MM, Shissler T, Reis V, Dodo M, Garces A, Llave C, Dao B, Mohan D, Huang L. Understanding integrated HPV testing and treatment of pre-cancerous cervical cancer in Burkina Faso, Cote d'Ivoire, Guatemala and Philippines: study protocol. Reprod Health 2023; 20:167. [PMID: 37957689 PMCID: PMC10644460 DOI: 10.1186/s12978-023-01696-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/09/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Many low- and-middle-income countries are disproportionately burdened by cervical cancer, resulting in high morbidity and mortality. HPV-DNA testing coupled with treatment with thermal ablation is a recommended screening and precancer treatment strategy, but not enough is known about how this can be effectively implemented in the context of integrated services. The (Scale Up Cervical Cancer Elimination by Secondary prevention Strategy, (SUCCESS) project is conducting a study to understand this approach, integrated into existing women's health services in Burkina Faso, Cote d'Ivoire, Guatemala, and the Philippines (2020-2024). METHODS A hybrid effectiveness-implementation type III mixed-methods observational study design is used to assess feasibility, acceptability, and costs of integrated service delivery in 10 sites per country, selected considering urban/rural location, facility level, onsite/offsite laboratories, and health services type. In each country, a sample size of 2227 women aged 25-49 years will be enrolled with about 20% being women living with HIV. The primary outcome is proportion of HPV positive women completing precancer treatment, if eligible, within three months of screening. Data collection and analysis includes; facility and client exit surveys, key informant and client interviews, registries and project records extractions, and costing data analysis. Analysis includes descriptive statistics, context description, thematic analysis, and document analysis. Quantitative analyses will be stratified by participant's HIV status. DISCUSSION Recruitment of study participants started in April 2022 (Burkina Faso and Côte d'Ivoire) and August 2022 (Guatemala and the Philippines). Enrolment targets for women screened, client exit, in-depth and key informant interviews conducted were reached in Burkina Faso and Cote d'Ivoire in November 2022. Guatemala and Philippines are expected to complete enrolment by June 2023. Follow-up of study Participants 12-months post-treatment is ongoing and is expected to be completed for all countries by August 2024. In LMICs, integrating cervical cancer secondary prevention services into other health services will likely require specific rather than incidental recruitment of women for screening. Reconfiguration of laboratory infrastructure and planning for sample management must be made well in advance to meet induced demand for screening. Trail Registration ClinicalTrials.Gov ID: NCT05133661 (24/11/2021).
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Affiliation(s)
| | - Cindy L Gauvreau
- The Hospital for Sick Children, Research Institute, Toronto, Canada
| | | | | | | | | | | | | | | | | | - Diwakar Mohan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa Huang
- Expertise France, Abidjan, Côte d'Ivoire
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10
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Thomas R, Santodomingo A, Parragué-Migone C, Portillo E, Barrios M, Venzal JM, Muñoz-Leal S. A novel Babesia sp. of the "Western Babesia group", detected in opossums from Guatemala. Ticks Tick Borne Dis 2023; 14:102248. [PMID: 37660526 DOI: 10.1016/j.ttbdis.2023.102248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 07/21/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Abstract
Babesia spp. are tick-borne protozoans that involve birds and mammals in their transmission cycles and cause babesiosis, a severe hemolytic malaria-like disease. Opossums of the genus Didelphis are recognized hosts of tick-borne pathogens. Therefore, exploring tick-borne agents in Didelphis species is important to understand the circulation of pathogens in areas where opossums occur. In this study, we targeted Anaplasmataceae, Babesia, Borrelia and Hepatozoon DNA in ticks, blood and organ samples collected from three hunted Didelphis marsupialis specimens in eastern Guatemala. While the samples were negative for Hepatozoon and bacterial DNA, sequences of Babesia 18S rDNA, cox1 and cytb genes were retrieved from two opossums. Ticks collected on the animals included Amblyomma parvum and an undetermined Ornithodoros sp. The Babesia sp. detected in this study (Babesia sp. THB1-2) clusters phylogenetically within the "Western Babesia group", which includes pathogenic species such as Babesia conradae, Babesia duncani, and Babesia negevi. Our results represent the first record of a Babesia sp. in Guatemala and highlight the importance of D. marsupialis as potential spreaders of ticks and pathogens in Central America.
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Affiliation(s)
- Richard Thomas
- Departamento de Ciencia Animal, Facultad de Ciencias Veterinarias, Universidad de Concepción, Chillán, Chile
| | - Adriana Santodomingo
- Departamento de Ciencia Animal, Facultad de Ciencias Veterinarias, Universidad de Concepción, Chillán, Chile
| | - Catalina Parragué-Migone
- Departamento de Ciencia Animal, Facultad de Ciencias Veterinarias, Universidad de Concepción, Chillán, Chile
| | - Emerio Portillo
- Facultad de Ciencias Ambientales y Agrícolas, Universidad Rafael Landívar, Zacapa, Guatemala
| | - Manuel Barrios
- Instituto de Investigaciones, Centro Universitario de Zacapa, Universidad de San Carlos de Guatemala, Zacapa, Guatemala
| | - José M Venzal
- Laboratorio de Vectores y enfermedades transmitidas, CENUR Litoral Norte, Universidad de la República, Salto, Uruguay
| | - Sebastián Muñoz-Leal
- Departamento de Ciencia Animal, Facultad de Ciencias Veterinarias, Universidad de Concepción, Chillán, Chile.
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11
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Pieters MM, Fahsen N, Craig C, Quezada R, Pratt CQ, Gomez A, Brown TW, Kossik A, McDavid K, Vega Ocasio D, Lozier MJ, Cordón-Rosales C. Assessment of Water, Sanitation, and Hygiene Conditions in Public Elementary Schools in Quetzaltenango, Guatemala, in the Context of the COVID-19 Pandemic. Int J Environ Res Public Health 2023; 20:6914. [PMID: 37887652 PMCID: PMC10606716 DOI: 10.3390/ijerph20206914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023]
Abstract
Water, sanitation, and hygiene (WASH) services in schools are essential to reduce infectious disease transmission, including that of COVID-19. This study aimed to establish a baseline of WASH services in six public elementary schools in Guatemala, with a focus on hand hygiene. We used the WHO/UNICEF Joint Monitoring Programme (JMP) report indicators to assess the WASH infrastructure at each school. We collected water samples from easily accessible water points (pilas, or bathroom sinks) at each school to test for the presence of total coliforms and E. coli. In-depth interviews were carried out with teachers to understand hand hygiene practices and systems at school. Results indicate that all schools had water available at the time of the survey. All water samples at four schools tested positive for total coliforms and at one school, positive for E. coli. All schools had sanitation facilities, but services were limited. Only 43% of handwashing stations at schools had soap available. No school had disability-inclusive WASH services. Financial constraints and a lack of appropriate WASH infrastructure were the main barriers reported by teachers to meet hand hygiene needs at school. Appropriate access to WASH infrastructure and supplies could increase hand hygiene practices and improve learning conditions for students.
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Affiliation(s)
- Michelle M. Pieters
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (N.F.); (R.Q.); (A.G.); (C.C.-R.)
| | - Natalie Fahsen
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (N.F.); (R.Q.); (A.G.); (C.C.-R.)
| | - Christina Craig
- National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (C.C.); (T.W.B.); (A.K.); (K.M.); (D.V.O.); or (M.J.L.)
| | - Ramiro Quezada
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (N.F.); (R.Q.); (A.G.); (C.C.-R.)
| | - Caroline Q. Pratt
- National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (C.C.); (T.W.B.); (A.K.); (K.M.); (D.V.O.); or (M.J.L.)
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Andrea Gomez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (N.F.); (R.Q.); (A.G.); (C.C.-R.)
| | - Travis W. Brown
- National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (C.C.); (T.W.B.); (A.K.); (K.M.); (D.V.O.); or (M.J.L.)
| | - Alexandra Kossik
- National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (C.C.); (T.W.B.); (A.K.); (K.M.); (D.V.O.); or (M.J.L.)
| | - Kelsey McDavid
- National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (C.C.); (T.W.B.); (A.K.); (K.M.); (D.V.O.); or (M.J.L.)
| | - Denisse Vega Ocasio
- National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (C.C.); (T.W.B.); (A.K.); (K.M.); (D.V.O.); or (M.J.L.)
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Matthew J. Lozier
- National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (C.C.); (T.W.B.); (A.K.); (K.M.); (D.V.O.); or (M.J.L.)
| | - Celia Cordón-Rosales
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (N.F.); (R.Q.); (A.G.); (C.C.-R.)
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12
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Olson D, Lamb MM, Connery AK, Colbert AM, Calvimontes M, Bauer D, Paniagua-Avila MA, Martínez MA, Arroyave P, Hernandez S, Colborn KL, Roell Y, Waggoner JJ, Natrajan MS, Anderson EJ, Bolaños GA, El Sahly HM, Munoz FM, Asturias EJ. Cumulative Febrile, Respiratory, and Gastrointestinal Illness Among Infants in Rural Guatemala and Association With Neurodevelopmental and Growth Outcomes. Pediatr Infect Dis J 2023; 42:739-744. [PMID: 37343218 PMCID: PMC10527407 DOI: 10.1097/inf.0000000000004006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Infectious disease exposures in early life are increasingly recognized as a risk factor for poor subsequent growth and neurodevelopment. We aimed to evaluate the association between cumulative illness with neurodevelopment and growth outcomes in a birth cohort of Guatemalan infants. METHODS From June 2017 to July 2018, infants 0-3 months of age living in a resource-limited region of rural southwest Guatemala were enrolled and underwent weekly at-home surveillance for caregiver-reported cough, fever, and vomiting/diarrhea. They also underwent anthropometric assessments and neurodevelopmental testing with the Mullen Scales of Early Learning (MSEL) at enrollment, 6 months, and 1 year. RESULTS Of 499 enrolled infants, 430 (86.2%) completed all study procedures and were included in the analysis. At 12-15 months of age, 140 (32.6%) infants had stunting (length-for-age Z [LAZ] score < -2 SD) and 72 (16.7%) had microcephaly (occipital-frontal circumference [OFC] < -2 SD). In multivariable analysis, greater cumulative instances of reported cough illness (beta = -0.08/illness-week, P = 0.06) and febrile illness (beta = -0.36/illness-week, P < 0.001) were marginally or significantly associated with lower MSEL Early Learning Composite (ELC) Score at 12-15 months, respectively; there was no association with any illness (cough, fever, and/or vomiting/diarrhea; P = 0.27) or with cumulative instances of diarrheal/vomiting illness alone ( P = 0.66). No association was shown between cumulative instances of illness and stunting or microcephaly at 12-15 months. CONCLUSIONS These findings highlight the negative cumulative consequences of frequent febrile and respiratory illness on neurodevelopment during infancy. Future studies should explore pathogen-specific illnesses, host response associated with these syndromic illnesses, and their association with neurodevelopment.
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Affiliation(s)
- Daniel Olson
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Center for Global Health, Colorado School of Public Health, 13199 East Montview Blvd, Aurora, CO 80045, USA
- Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Molly M. Lamb
- Center for Global Health, Colorado School of Public Health, 13199 East Montview Blvd, Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Amy K. Connery
- Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO 80045, USA
| | - Alison M. Colbert
- Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO 80045, USA
| | - Mirella Calvimontes
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Desiree Bauer
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - M. Alejandra Paniagua-Avila
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St. New York, NY 10032, USA
| | - María Alejandra Martínez
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Paola Arroyave
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Sara Hernandez
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Kathryn L. Colborn
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave #6117, Aurora, CO 80045, USA
| | - Yannik Roell
- Center for Global Health, Colorado School of Public Health, 13199 East Montview Blvd, Aurora, CO 80045, USA
| | - Jesse J. Waggoner
- Department of Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA
| | - Muktha S. Natrajan
- Department of Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA
| | - Evan J. Anderson
- Department of Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA
| | - Guillermo A. Bolaños
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | | | - Flor M. Munoz
- Department of Pediatrics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Edwin J. Asturias
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Center for Global Health, Colorado School of Public Health, 13199 East Montview Blvd, Aurora, CO 80045, USA
- Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO 80045, USA
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13
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Lopez Y, Arana B, Rizzo N, Duran E, Acosta-Serrano Á, Mendizabal-Cabrera R. A neglected among the neglected: a review of cutaneous leishmaniasis in Guatemala. Trans R Soc Trop Med Hyg 2023; 117:609-616. [PMID: 37103337 PMCID: PMC10472881 DOI: 10.1093/trstmh/trad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/14/2023] [Accepted: 04/10/2023] [Indexed: 04/28/2023] Open
Abstract
Cutaneous leishmaniasis (CL) is a parasitic vector-borne disease affecting mostly low- and middle-income countries. CL is endemic in Guatemala, where an increase in the number of cases and incidence and a changing disease distribution in the past decade have been reported. Important research was conducted in Guatemala in the 1980s and 1990s to understand the epidemiology of CL and two Leishmania species were identified as the aetiologic agents. Several species of sand flies have been reported, five of which are naturally infected with Leishmania. Clinical trials conducted in the country evaluated different treatments against the disease and provided solid evidence for CL control strategies that are applicable worldwide. More recently, in the 2000s and 2010s, qualitative surveys were conducted to understand community perceptions of the disease and to highlight the challenges and enablers for disease control. However, limited recent data have been generated regarding the current CL situation in Guatemala, and key information necessary for effective disease control, such as incrimination of vectors and reservoirs, is still lacking. This review describes the current state of knowledge of CL in Guatemala, including the main parasite and sand fly species, disease reservoirs, diagnosis and control, as well as the perceptions of communities in endemic regions.
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Affiliation(s)
- Yaimie Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11–95, Guatemala City 01015, Guatemala
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Byron Arana
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11–95, Guatemala City 01015, Guatemala
| | - Nidia Rizzo
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11–95, Guatemala City 01015, Guatemala
| | - Erick Duran
- Ministry of Health and Social Assistance, 3-45, 6a Avenida 3, Guatemala City 01011, Guatemala
| | | | - Renata Mendizabal-Cabrera
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11–95, Guatemala City 01015, Guatemala
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14
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Ramay BM, Castillo C, Grajeda L, Santos LF, Romero JC, Lopez MR, Gomez A, Caudell M, Smith RM, Styczynski A, Herzig CTA, Bollinger S, Ning MF, Horton J, Omulo S, Palmer GH, Cordon-Rosales C, Call DR. Colonization With Antibiotic-Resistant Bacteria in a Hospital and Associated Communities in Guatemala: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study. Clin Infect Dis 2023; 77:S82-S88. [PMID: 37406049 PMCID: PMC10321699 DOI: 10.1093/cid/ciad222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND We estimated the prevalence of colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) from a hospital and associated communities in western Guatemala. METHODS Randomly selected infants, children, and adults (<1, 1-17, and ≥18 years, respectively) were enrolled from the hospital (n = 641) during the coronavirus disease 2019 (COVID-19) pandemic, March to September 2021. Community participants were enrolled using a 3-stage cluster design between November 2019 and March 2020 (phase 1, n = 381) and between July 2020 and May 2021 (phase 2, with COVID-19 pandemic restrictions, n = 538). Stool samples were streaked onto selective chromogenic agar, and a Vitek 2 instrument was used to verify ESCrE or CRE classification. Prevalence estimates were weighted to account for sampling design. RESULTS The prevalence of colonization with ESCrE and CRE was higher among hospital patients compared to community participants (ESCrE: 67% vs 46%, P < .01; CRE: 37% vs 1%, P < .01). Hospital ESCrE colonization was higher for adults (72%) compared with children (65%) and infants (60%) (P < .05). Colonization was higher for adults (50%) than children (40%) in the community (P < .05). There was no difference in ESCrE colonization between phase 1 and 2 (45% and 47%, respectively, P > .05), although reported use of antibiotics among households declined (23% and 7%, respectively, P < .001). CONCLUSIONS While hospitals remain foci for ESCrE and CRE colonization, consistent with the need for infection control programs, community prevalence of ESCrE in this study was high, potentially adding to colonization pressure and transmission in healthcare settings. Better understanding of transmission dynamics and age-related factors is needed.
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Affiliation(s)
- Brooke M Ramay
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Carmen Castillo
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Laura Grajeda
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Lucas F Santos
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Juan Carlos Romero
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Maria Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Andrea Gomez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Mark Caudell
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Rachel M Smith
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley Styczynski
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolyn T A Herzig
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan Bollinger
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mariangeli Freitas Ning
- Central America Regional Office, Centers for Disease Control and Prevention, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Jennifer Horton
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Sylvia Omulo
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Washington State University Global Health–Kenya, Nairobi, Nairobi County, Kenya
| | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Celia Cordon-Rosales
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Douglas R Call
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
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15
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Cerón A. Environmental and Social Factors Associated with High Chronic Kidney Disease Mortality Rates in Municipalities of Guatemala: An Ecological Study of Municipal-Level Mortality Data. Int J Environ Res Public Health 2023; 20:ijerph20085532. [PMID: 37107814 DOI: 10.3390/ijerph20085532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/25/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023]
Abstract
The purpose of this study was to determine the association between social and environmental indicators and high mortality rates from chronic kidney disease (CKD) in municipalities of Guatemala. An ecological study of municipal-level factors associated with CKD mortality in Guatemala was conducted. Crude mortality rates were calculated for the 2009-2019 period for each of the country's 340 municipalities, by gender and age groups. Municipal-level social and environmental indicators were used as independent variables. Linear regression was used for bivariate and multivariate analysis. A total of 28,723 deaths from CKD were documented for the 2009-2019 period. Average crude mortality rate for all ages for the country's 340 municipalities was 70.66 per 100,000 [0-502.99]. Very highly positive associations with high mortality rates were found in two agrarian territories where land use is mainly for permanent crops (e.g., sugar cane, coffee, rubber, banana, plantain, African palm) and pastures for cattle, with very low percentages of land covered by forests or protected areas. Social factors related to poverty and environmental factors related to agricultural use of land may play a role in the high CKD mortality rates documented in a cluster of municipalities of Guatemala.
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Affiliation(s)
- Alejandro Cerón
- Department of Anthropology, University of Denver, Denver, CO 80208, USA
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16
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Cheng Q, Glesener H, Montenegro G, Torres O, Miller AC, Krajmalnik-Brown R, Rohloff P, Voth-Gaeddert LE. Assessment of aflatoxin exposure, growth faltering and the gut microbiome among children in rural Guatemala: protocol for an observational prospective cohort and bioreactor simulations. BMJ Paediatr Open 2023; 7:e001960. [PMID: 37080609 PMCID: PMC10124301 DOI: 10.1136/bmjpo-2023-001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Aflatoxin B1 (AFB1) is a carcinogen produced by Aspergillus flavus and Aspergillus parasiticus which grow on maize. Given the high prevalence of child stunting (ie, impaired growth) and other nutritional disorders in low-income and middle-income countries, where maize is consumed, the role of aflatoxin exposure may be significant. Observational reports have demonstrated associations between aflatoxin exposure and impaired child growth; however, most have been cross-sectional and have not assessed seasonal variations in aflatoxin, food preparation and dynamic changes in growth. Biological mechanistic data on how aflatoxin may exert an impact on child growth is missing. This study incorporates a prospective cohort of children from rural Guatemala to assess (1) temporal associations between aflatoxin exposure and child growth and (2) possible mediation of the gut microbiome among aflatoxin exposure, inflammation and child growth. METHODS AND ANALYSIS We will prospectively evaluate aflatoxin exposure and height-for-age difference trajectories for 18 months in a cohort of 185 children aged 6-9 months at enrolment. We will assess aflatoxin exposure levels and biomarkers of gut and systemic inflammation. We will examine the faecal microbiome of each child and identify key species and metabolic pathways for differing AFB1 exposure levels and child growth trajectories. In parallel, we will use bioreactors, inoculated with faeces, to investigate the response of the gut microbiome to varying levels of AFB1 exposure. We will monitor key microbial metabolites and AFB1 biotransformation products to study nutrient metabolism and the impact of the gut microbiome on aflatoxin detoxification/metabolism. Finally, we will use path analysis to summarise the effect of aflatoxin exposure and the gut microbiome on child growth. ETHICS AND DISSEMINATION Ethics approval was obtained from Arizona State University Institutional Review Board (IRB; STUDY00016799) and Wuqu' Kawoq/Maya Health Alliance IRB (WK-2022-003). Findings will be disseminated in scientific presentations and peer-reviewed publications.
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Affiliation(s)
- Qiwen Cheng
- Biodesign Center for Health Through Microbiomes, Arizona State University, Tempe, Arizona, USA
| | - Hannah Glesener
- Biodesign Center for Health Through Microbiomes, Arizona State University, Tempe, Arizona, USA
| | - Gabriela Montenegro
- Center for Indigenous Health Research, Wuqu' Kawoq | Maya Health Alliance, Tecpan, Guatemala
| | - Olga Torres
- Centro de Investigaciones en Nutricion y Salud (CIENSA), Guatemala City, Guatemala
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rosa Krajmalnik-Brown
- Biodesign Center for Health Through Microbiomes, Arizona State University, Tempe, Arizona, USA
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu' Kawoq | Maya Health Alliance, Tecpan, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lee E Voth-Gaeddert
- Biodesign Center for Health Through Microbiomes, Arizona State University, Tempe, Arizona, USA
- Center for Indigenous Health Research, Wuqu' Kawoq | Maya Health Alliance, Tecpan, Guatemala
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Ortiz L, Geiger G, Ferreri L, Moran D, Alvarez D, Gonzalez-Reiche AS, Mendez D, Rajao D, Cordon-Rosales C, Perez DR. Evolution and Introductions of Influenza A Virus H1N1 in a Farrow-to-Finish Farm in Guatemala. Microbiol Spectr 2023; 11:e0287822. [PMID: 36475876 PMCID: PMC9927084 DOI: 10.1128/spectrum.02878-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Commercial swine farms provide unique systems for interspecies transmission of influenza A viruses (FLUAVs) at the animal-human interface. Bidirectional transmission of FLUAVs between pigs and humans plays a significant role in the generation of novel strains that become established in the new host population. Active FLUAV surveillance was conducted for 2 years on a commercial pig farm in Southern Guatemala with no history of FLUAV vaccination. Nasal swabs (n = 2,094) from fattening pigs (6 to 24 weeks old) with respiratory signs were collected weekly from May 2016 to February 2018. Swabs were screened for FLUAV by real-time reverse transcriptase PCR (RRT-PCR), and full virus genomes of FLUAV-positive swabs were sequenced by next-generation sequencing (NGS). FLUAV prevalence was 12.0% (95% confidence interval [CI], 10.6% to 13.4%) with two distinct periods of high infection. All samples were identified as FLUAVs of the H1N1 subtype within the H1 swine clade 1A.3.3.2 and whose ancestors are the human origin 2009 H1N1 influenza pandemic virus (H1N1 pdm09). Compared to the prototypic reference segment sequence, 10 amino acid signatures were observed on relevant antigenic sites on the hemagglutinin. The Guatemalan swine-origin FLUAVs show independent evolution from other H1N1 pdm09 FLUAVs circulating in Central America. The zoonotic risk of these viruses remains unknown but strongly calls for continued FLUAV surveillance in pigs in Guatemala. IMPORTANCE Despite increased surveillance efforts, the epidemiology of FLUAVs circulating in swine in Latin America remains understudied. For instance, the 2009 H1N1 influenza pandemic strain (H1N1 pdm09) emerged in Mexico, but its circulation remained undetected in pigs. In Central America, Guatemala is the country with the largest swine industry. We found a unique group of H1N1 pdm09 sequences that suggests independent evolution from similar viruses circulating in Central America. These viruses may represent the establishment of a novel genetic lineage with the potential to reassort with other cocirculating viruses and whose zoonotic risk remains to be determined.
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Affiliation(s)
- Lucia Ortiz
- Poultry Diagnostic and Research Center, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Ginger Geiger
- Poultry Diagnostic and Research Center, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Lucas Ferreri
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David Moran
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Danilo Alvarez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Ana Silvia Gonzalez-Reiche
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dione Mendez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Daniela Rajao
- Poultry Diagnostic and Research Center, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Celia Cordon-Rosales
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Daniel R. Perez
- Poultry Diagnostic and Research Center, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
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Abstract
OBJECTIVE The burden of diabetes mellitus is increasing in low-income and middle-income countries (LMICs). Few studies have explored pathways to care among individuals with diabetes in LMICs. This study evaluates care trajectories among adults with diabetes in rural Guatemala. DESIGN A qualitative investigation was conducted as part of a population-based study assessing incidence and risk factors for chronic kidney disease in two rural sites in Guatemala. A random sample of 807 individuals had haemoglobin A1c (HbA1c) screening for diabetes in both sites. Based on results from the first 6 months of the population study, semistructured interviews were performed with 29 adults found to have an HbA1c≥6.5% and who reported a previous diagnosis of diabetes. Interviews explored pathways to and experiences of diabetes care. Detailed interview notes were coded using NVivo and used to construct diagrams depicting each participant's pathway to care and use of distinct healthcare sectors. RESULTS Participants experienced fragmented care across multiple health sectors (97%), including government, private and non-governmental sectors. The majority of participants sought care with multiple providers for diabetes (90%), at times simultaneously and at times sequentially, and did not have longitudinal continuity of care with a single provider. Many participants experienced financial burden from out-of-pocket costs associated with diabetes care (66%) despite availability of free government sector care. Participants perceived government diabetes care as low-quality due to resource limitations and poor communication with providers, leading some to seek care in other health sectors. CONCLUSIONS This study highlights the fragmented, discontinuous nature of diabetes care in Guatemala across public, private and non-governmental health sectors. Strategies to improve diabetes care access in Guatemala and other LMICs should be multisectorial and occur through strengthened government primary care and innovative private and non-governmental organisation care models.
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Affiliation(s)
- Anita Nandkumar Chary
- Medicine & Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | - Meghna Nandi
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Family Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - David Flood
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott Tschida
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | - Katharine Wilcox
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Family Medicine, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Sophie Kurschner
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Pablo Garcia
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Peter Rohloff
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Springfield O, Brouwer KC, Avila-Rios S, Morales-Miranda S, Mehta SR. Molecular epidemiology of HIV-1 among adult female sex workers at the Guatemala-Mexico border. Glob Public Health 2023; 18:2278873. [PMID: 37944916 PMCID: PMC10808948 DOI: 10.1080/17441692.2023.2278873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
ABSTRACTSex workers have been demonstrated to have increased vulnerabilities to HIV and a high population prevalence of the disease. Despite their increased risk, sex workers have been underrepresented in molecular epidemiology studies assessing HIV in Mesoamerica. This study aims to describe the sociodemographic characteristics and phylogenetic profile of HIV-1 within a cohort of HIV-positive female sex workers (FSW) situated at the Guatemala-Mexico border. HIV viral sequences were collected from a cohort of FSW ≥18 years of age from San Marcos, Guatemala (n = 6) and compared to viral sequences collected as part of the Mesoamerican Drug Resistance Monitoring Programme to assess HIV viral diversity in Mexico and Guatemala (n = 3956). All of the FSW sampled were determined to have genetically unrelated HIV infections, suggesting multiple introductions of the virus and/or the potential existence of populations not captured by current surveillance efforts. Many reported numerous vulnerabilities that may have heightened their risk of acquiring and transmitting HIV through sex work activities. Our phylogenetic analysis indicated that national surveillance programmes may not fully capture the viral diversity among FSW and their clients within this region. Additional research is needed to fully capture HIV diversity and transmission in Mesoamerica, especially in the Guatemala-Mexico border region.
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Affiliation(s)
- Olivia Springfield
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Kimberly C. Brouwer
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Santiago Avila-Rios
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Sonia Morales-Miranda
- Consorcio de Investigación sobre VIH SIDA TB Consorcio de Investigación en Salud, Cuernavaca, Morelos, México
| | - Sanjay R. Mehta
- University of California San Diego School of Medicine, La Jolla, California, USA
- San Diego Veterans Affairs Medical Center, San Diego, California, USA
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20
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Lamb MM, Paniagua-Avila A, Zacarias A, Rojop N, Chacon A, Natrajan MS, Waggoner JJ, Lopez MR, Cordon-Rosales C, Huleatt JW, Bonaparte MI, Asturias EJ, Olson D. Repeated Rapid Active Sampling Surveys Demonstrated a Rapidly Changing Zika Seroprevalence among Children in a Rural Dengue-endemic Region in Southwest Guatemala during the Zika Epidemic (2015-2016). Am J Trop Med Hyg 2022; 107:1099-1106. [PMID: 36252798 PMCID: PMC9709015 DOI: 10.4269/ajtmh.22-0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/08/2022] [Indexed: 11/07/2022] Open
Abstract
Although Central America is largely dengue virus (DENV)-endemic, the 2015-2016 Zika virus (ZIKV) pandemic brought new urgency to develop surveillance approaches capable of characterizing the rapidly changing disease burden in resource-limited settings. We conducted a pediatric DENV surveillance study in rural Guatemala, including serial cross-sectional surveys from April through September 2015 (Survey 1), in October-November 2015 (Survey 2), and January-February 2016 (Survey 3). Serum underwent DENV IgM MAC ELISA and polymerase chain reaction testing. Using banked specimens from Surveys 2 and 3, we expanded testing to include DENV 1-4 and ZIKV microneutralization (MN50), DENV NS1 IgG ELISA, and ZIKV anti-NS1 antibody Blockage of Binding (BoB) ELISA testing. Demographic risk factors for ZIKV BoB positivity were explored using multivariable generalized linear regression models. Of Survey 2 and 3 samples available (N = 382), DENV seroprevalence slightly increased (+1%-10% depending on the assay) during the surveillance period and increased with age. In contrast, ZIKV seroprevalence consistently increased over the 3-month period, including from 6% to 34% (P < 0.0001) and 10%-37% (P < 0.0001) using the MN50 ≥100 and BoB ELISA assays, respectively. Independent risk factors for ZIKV seropositivity included older age (prevalence ratio (PR)/year = 1.12, 95% confidence interval (CI) = 1.07-1.17) and primary caregiver literacy (PR = 2.80, CI = 1.30-6.06). Rapid active surveillance (RAS) surveys demonstrated a nearly 30% increase in ZIKV prevalence and a slight (≤ 10%) increase in DENV seroprevalence from October to November 2015 to January to February 2016 in rural southwest Guatemala, regardless of serologic assay used. RAS surveys may be a useful "off-the-shelf" tool to characterize arboviruses and other emerging pathogens rapidly in resource-limited settings.
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Affiliation(s)
- Molly M. Lamb
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado
| | - Alejandra Paniagua-Avila
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque, Quetzaltenango, Guatemala
| | - Alma Zacarias
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque, Quetzaltenango, Guatemala
| | - Neudy Rojop
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque, Quetzaltenango, Guatemala
| | - Andrea Chacon
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque, Quetzaltenango, Guatemala
| | - Muktha S. Natrajan
- Emory University Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
| | - Jesse J. Waggoner
- Emory University Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
| | - Maria Renee Lopez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Celia Cordon-Rosales
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | | | - Edwin J. Asturias
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Olson
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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21
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Lu W, Wang LA, Mann J, Jenny A, Romero C, Kuster A, Canuz E, Pillarisetti A, Smith KR, Balmes J, Thompson L. Biomass Smoke Exposure and Atopy among Young Children in the Western Highlands of Guatemala: A Prospective Cohort Study. Int J Environ Res Public Health 2022; 19:14064. [PMID: 36360942 PMCID: PMC9656762 DOI: 10.3390/ijerph192114064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Women and children in rural regions of low-income countries are exposed to high levels of household air pollution (HAP) as they traditionally tend to household chores such as cooking with biomass fuels. Early life exposure to air pollution is associated with aeroallergen sensitization and developing allergic diseases at older ages. This prospective cohort study assigned HAP-reducing chimney stoves to 557 households in rural Guatemala at different ages of the study children. The children's air pollution exposure was measured using personal CO diffusion tubes. Allergic outcomes at 4-5 years old were assessed using skin prick tests and International Study of Asthma and Allergies in Childhood (ISAAC)-based questionnaires. Children assigned to improved stoves before 6 months old had the lowest HAP exposure compared to the other groups. Longer exposure to the unimproved stoves was associated with higher risks of maternal-reported allergic asthma (OR = 2.42, 95% CI: 1.11-5.48) and rhinitis symptoms (OR = 2.01, 95% CI: 1.13-3.58). No significant association was found for sensitization to common allergens such as dust mites and cockroaches based on skin prick tests. Reducing HAP by improving biomass burning conditions might be beneficial in preventing allergic diseases among children in rural low-income populations.
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Affiliation(s)
- Wenxin Lu
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Laura Ann Wang
- Department of Pediatrics, University of Colorado, Aurora, CO 80045, USA
| | - Jennifer Mann
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Alisa Jenny
- Institute for Global Health Sciences, University of California, San Francisco, CA 94158, USA
| | - Carolina Romero
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
| | - Andrea Kuster
- School of Nursing, University of California, San Francisco, CA 94158, USA
| | - Eduardo Canuz
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
| | - Ajay Pillarisetti
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Kirk R. Smith
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - John Balmes
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Lisa Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
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22
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Naber J, Mactaggart I, Dionicio C, Polack S. Anxiety and depression in Guatemala: Sociodemographic characteristics and service access. PLoS One 2022; 17:e0272780. [PMID: 35960764 PMCID: PMC9374225 DOI: 10.1371/journal.pone.0272780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Epidemiological data on depression and anxiety in Guatemala is lacking. Using 2016 National Disability Survey data, we explored the sociodemographics of people with anxiety and/or depression and its heightened burden on access to key services. The survey (n = 13,073) used the Washington Group Extended Set to estimate disability prevalence, including anxiety and/or depression. A nested case-control study was included to explore the impact of disability on key life areas. Cases (indicating ‘A lot of difficulty’ or ‘Cannot do’ in one or more functional domain) and age-/sex-matched controls were administered a structured questionnaire. Multivariable logistic regression and heightened-burden analysis were conducted. Higher odds of anxiety and/or depression were found in participants who were 50+ (aOR 2.3, 1.8–3.1), female (aOR 1.8, 1.4–2.2), urban (aOR 1.5, 1.2–1.9), divorced/separated (aOR 2.0, 1.3–3.0), and widowed (aOR 1.6, 1.0–2.4), as well as those with impaired communication or cognition (aOR 17.6, 13.0–23.8), self-care (aOR 13.2, 8.5–20.5), walking (aOR 13.3, 9.7–18.3), hearing (aOR 8.5, 5.6–13.1), and vision (aOR 8.5, 6.1–11.8). Lower odds of anxiety and/or depression were found in participants with a university education (aOR 0.2, 0.5–0.9), and those living in the southeast (aOR 0.2, 0.1–0.3) or northeast (aOR 0.3, 0.2–0.4). Compared to people with impairments that were not depression and/or anxiety, people with depression and/or anxiety were less likely to receive a retirement pension (aOR 0.4, 0.2–0.8), and more likely to receive medication for depression/anxiety (aOR 4.1, 1.9–9.1), report a serious health problem (aOR 1.8, 1.3–2.5), and seek advice/treatment with a government health worker/health post (aOR 6.3, 1.0–39.2).
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Affiliation(s)
- Jonathan Naber
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Carlos Dionicio
- Consejo Nacional para la Atención de las Personas con Discapacidad (CONADI), Guatemala City, Guatemala
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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23
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Davis DA, Rock A, Santa Luce R, McNaughton-Reyes L, Barrington C. Intimate Partner Violence Victimization and Mental Health Among Men Who Have Sex With Men Living With HIV in Guatemala. J Interpers Violence 2022; 37:NP1637-NP1657. [PMID: 32552467 PMCID: PMC7941092 DOI: 10.1177/0886260520928960] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by poor mental health compared to their heterosexual counterparts. One factor that may increase mental health problems among MSM is intimate partner violence (IPV) victimization. The objectives of this study are to (a) describe the prevalence of different forms of IPV victimization experienced by MSM living with HIV in Guatemala City and (b) examine the relationship between IPV victimization and mental health. We analyzed cross-sectional survey data from a cohort of MSM living with HIV in Guatemala City (n = 374) to describe the burden of IPV, including physical, sexual, and emotional IPV. We then examined relationships between lifetime IPV and each form of recent IPV (past 12 months) with self-reported anxiety and depression using multivariable logistic regression. Over a quarter (27.3%) of the participants screened positive for anxiety and nearly one fifth (17.9%) screened positive for depression. Over a quarter of the participants (28.6%) reported ever having experienced any IPV victimization and 8.8% reported having experienced any form of recent IPV. In multivariable analyses, participants who experienced any form of lifetime IPV had roughly twice the odds of experiencing anxiety (OR: 1.86; 95% CI = [1.03, 3.38]) and depression (OR: 2.02; 95% CI = [1.02, 3.99]) compared to those who had not. Participants who experienced recent emotional IPV had over seven times the odds of experiencing anxiety (OR: 7.23; 95% CI = [1.46, 38.85]) compared to those who had not. MSM living with HIV in Guatemala experience a high burden of anxiety, depression, and IPV victimization. Those participants who had experienced lifetime IPV and recent emotional IPV were significantly more likely to screen for anxiety and depression. To improve their mental health, HIV clinics and other health services should provide support for MSM who have experienced IPV victimization.
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Affiliation(s)
- Dirk A. Davis
- The University of North Carolina at Chapel Hill, USA
| | - Amelia Rock
- The University of North Carolina at Chapel Hill, USA
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Tschida S, Cordon A, Asturias G, Mazariegos M, Kroker-Lobos MF, Jackson B, Rohloff P, Flood D. Projecting the Impact of Nutrition Policy to Improve Child Stunting: A Case Study in Guatemala Using the Lives Saved Tool. Glob Health Sci Pract 2021; 9:752-764. [PMID: 34933973 PMCID: PMC8691882 DOI: 10.9745/ghsp-d-20-00585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 08/10/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Scott Tschida
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala.
| | - Ana Cordon
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
| | - Gabriela Asturias
- Centre for Evidence-Based Development, Fundación Desarrolla Guatemala para la Educación y Salud (FUNDEGUA), Guatemala City, Guatemala
| | - Mónica Mazariegos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Calzada Roosevelt, Guatemala City, Guatemala
| | - María F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Calzada Roosevelt, Guatemala City, Guatemala
| | - Bianca Jackson
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter Rohloff
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - David Flood
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
- Department of Internal Medicine, National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA
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25
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Hernández-Galdamez D, Mansilla K, Peralta AL, Rodríguez-Szaszdi J, Ramírez JM, Roche D, Gulayin P, Ramirez-Zea M, He J, Irazola V, Fort MP. Monitoring Study Participants and Implementation with Phone Calls to Support Hypertension Control During the COVID-19 Pandemic: The Case of a Multicomponent Intervention Trial in Guatemala. Glob Heart 2021; 16:77. [PMID: 34900568 PMCID: PMC8622336 DOI: 10.5334/gh.954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 10/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background The COVID-19 pandemic presents a challenge to health care for patients with chronic diseases, especially hypertension, because of the important association and increased risk of these patients with a severe presentation of COVID-19 disease. The Guatemalan Ministry of Health has been implementing a multi-component program aimed at improving hypertension control in rural communities since 2019 as a part of an intervention research cluster randomized trial. When the first cases of COVID-19 were reported (March 13, 2020) in Guatemala, our study paused all study field activities, and began monitoring participants through phone calls. The objective of this paper is to describe the approach used to monitor study participants during the COVID-19 pandemic and compare data obtained during phone calls for intervention and control group participants. Methods We developed a cross-sectional study within the HyTREC (Hypertension Outcomes for T4 Research within Lower Middle-Income Countries) project 'Multicomponent Intervention to Improve Hypertension Control in Central America: Guatemala' in which phone calls were made to participants from both intervention and control groups to monitor measures important to the study: delivery of antihypertensive medications in both groups, receipt of coaching sessions and use of a home blood pressure monitor by intervention group participants, as well as reasons that they were not implemented. Results Regarding the delivery of antihypertensive drugs by the MoH to participants, those in the intervention group had a higher level of medication delivery (73%) than the control group (51%), p<0.001. Of the total participants in the intervention group, 62% had received at least one health coaching session in the previous three months and 81% used a digital home blood pressure monitor at least twice a week. Intervention activities were lower than expected due to restricted public transportation on top of decreased availability of health providers. Conclusion In Guatemala, specifically in rural settings, access to antihypertensive medications and health services during pandemic times was impaired and less than expected, even after accounting for the program's implementation activities and actions.
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Affiliation(s)
- Diego Hernández-Galdamez
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, GT
| | - Kristyne Mansilla
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, GT
| | - Ana Lucía Peralta
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, GT
| | - Javier Rodríguez-Szaszdi
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, GT
| | - Juan Manuel Ramírez
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, GT
| | - Dina Roche
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, GT
| | - Pablo Gulayin
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, AR
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, GT
| | - Jiang He
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, US
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, AR
| | - Meredith P. Fort
- Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado, US
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Ortíz DW, Roberts-Sano O, Marroquin HE, Larson L, Franco KB, Spec A, Melendez JR, Pinzón R, Samayoa AJ, Mejia-Chew C, O Halloran JA. Factors associated with viremia in people living with HIV on antiretroviral therapy in Guatemala. AIDS Res Ther 2021; 18:79. [PMID: 34706742 PMCID: PMC8554948 DOI: 10.1186/s12981-021-00400-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/06/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Viral suppression prevents HIV transmission and disease progression, but socio-economic and clinical factors can hinder the goal of suppression. We evaluated factors associated with viral non suppression (VNS) and persistent viremia (PV) in people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in Guatemala. METHODS We conducted a cross sectional analysis using data from an ongoing cohort of PLHIV attending the largest HIV clinic in Guatemala. Univariable and multivariable analyses were conducted between PLHIV with viral suppression and detectable viremia. VNS was defined as most recent HIV RNA ≥ 200 copies/ml and PV as two consecutive HIV RNA ≥ 200 copies/ml. RESULTS Of 664 participants, 13.3% had VNS and 7.1% had PV. In univariable analysis disaggregated by gender, low income, poor education, perceived difficulty attending healthcare, and alcohol use were associated with VNS in men while low CD4 at diagnosis, multiple prior ART regimens and treatment interruptions were significant in both genders. Multiple prior ART regimens (adjusted Odds Ratio (aOR) 2.82, [95% confidence interval (CI) 1.59, 4.99], p < 0.01), treatment interruptions (aOR 4.51, [95% CI 2.13, 9.58], p < 0.01), excessive alcohol consumption (aOR 2.56, [95% CI 1.18, 5.54], p < 0.05) perceived difficulty attending healthcare (aOR 2.07, [ 95% CI 1.25, 3.42], p < 0.01) and low CD4 at diagnosis (aOR 2.34, 95% [CI 1.30, 4.20], p < 0.01) were independently associated with VNS on multivariable regression. CONCLUSIONS We conclude that socio-economic and clinical factors influence viral suppression in our cohort and vary between men and women. Gender specific approaches are necessary to achieve the 90% suppression goal.
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Affiliation(s)
- Dean W Ortíz
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala.
| | - Olivia Roberts-Sano
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Hugo E Marroquin
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Lindsey Larson
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Katherine B Franco
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Andrej Spec
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Johanna R Melendez
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Rodolfo Pinzón
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Ana J Samayoa
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Carlos Mejia-Chew
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Jane A O Halloran
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
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Butler-Dawson J, Barnoya J, Brindley S, Krisher L, Fan W, Asensio C, Newman LS. Cross-sectional study examining the accuracy of self-reported smoking status as compared to urinary cotinine levels among workers at risk for chronic kidney disease of unknown origin in Guatemala. BMJ Open 2021; 11:e050374. [PMID: 34697113 PMCID: PMC8547360 DOI: 10.1136/bmjopen-2021-050374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES There is a lack of information on cotinine levels in rural populations in low-income and middle-income countries like Guatemala. Therefore, there is a need to explore smoking status and biomarkers of tobacco use in epidemiological research in rural, low-income populations, in particular those at-risk for chronic kidney disease of unknown origin (CKDu). DESIGN We evaluated self-reported smoking status against urinary cotinine levels, the gold standard biomarker of tobacco smoke exposure, among agricultural workers at four separate cross-sectional time points. SETTING Guatemala. PARTICIPANTS 283 sugarcane workers. PRIMARY OUTCOME MEASURES Compared self-reported smoking status and urinary cotinine levels in two agricultural worker studies. RESULTS Self-reported smoking prevalence was 12% among workers. According to cotinine levels (≥50 ng/mL), the smoking prevalence was 34%. Self-reported smoking status had 28% sensitivity and 96% specificity. Urinary cotinine levels show that smoking prevalence is underestimated in this worker population. CONCLUSIONS According to our findings, smoking status should be objectively measured with biomarkers rather than self-reported in CKDu epidemiological research. Self-reported smoking status is likely an underestimate of the true smoking prevalence among agricultural workers. Research on the CKDu epidemic in Central America and other parts of the world might be underestimating tobacco exposure as a potential contributor to the development of CKDu.
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Affiliation(s)
- Jaime Butler-Dawson
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Joaquin Barnoya
- Integra Cancer Institute, Guatemala City, Guatemala
- Unit for Cardiovascular Surgery, Unidad de Cirugía Cardiovascular de Guatemala, UNICAR, Guatemala City, Guatemala
| | - Stephen Brindley
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Lyndsay Krisher
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Wenyi Fan
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | | | - Lee S Newman
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, and Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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Martinez-Folgar K, Alburez-Gutierrez D, Paniagua-Avila A, Ramirez-Zea M, Bilal U. Excess Mortality During the COVID-19 Pandemic in Guatemala. Am J Public Health 2021; 111:1839-1846. [PMID: 34554821 PMCID: PMC8561179 DOI: 10.2105/ajph.2021.306452] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 01/22/2023]
Abstract
Objectives. To describe excess mortality during the COVID-19 pandemic in Guatemala during 2020 by week, age, sex, and place of death. Methods. We used mortality data from 2015 to 2020, gathered through the vital registration system of Guatemala. We calculated weekly mortality rates, overall and stratified by age, sex, and place of death. We fitted a generalized additive model to calculate excess deaths, adjusting for seasonality and secular trends and compared excess deaths to the official COVID-19 mortality count. Results. We found an initial decline of 26% in mortality rates during the first weeks of the pandemic in 2020, compared with 2015 to 2019. These declines were sustained through October 2020 for the population younger than 20 years and for deaths in public spaces and returned to normal from July onward in the population aged 20 to 39 years. We found a peak of 73% excess mortality in mid-July, especially in the population aged 40 years or older. We estimated a total of 8036 excess deaths (95% confidence interval = 7935, 8137) in 2020, 46% higher than the official COVID-19 mortality count. Conclusions. The extent of this health crisis is underestimated when COVID-19 confirmed death counts are used. (Am J Public Health. 2021;111(10): 1839-1846. https://doi.org/10.2105/AJPH.2021.306452).
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Affiliation(s)
- Kevin Martinez-Folgar
- Kevin Martinez-Folgar and Usama Bilal are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Diego Alburez-Gutierrez is with the Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany. Alejandra Paniagua-Avila is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Manuel Ramirez-Zea is with the INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Diego Alburez-Gutierrez
- Kevin Martinez-Folgar and Usama Bilal are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Diego Alburez-Gutierrez is with the Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany. Alejandra Paniagua-Avila is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Manuel Ramirez-Zea is with the INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Alejandra Paniagua-Avila
- Kevin Martinez-Folgar and Usama Bilal are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Diego Alburez-Gutierrez is with the Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany. Alejandra Paniagua-Avila is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Manuel Ramirez-Zea is with the INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Manuel Ramirez-Zea
- Kevin Martinez-Folgar and Usama Bilal are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Diego Alburez-Gutierrez is with the Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany. Alejandra Paniagua-Avila is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Manuel Ramirez-Zea is with the INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Usama Bilal
- Kevin Martinez-Folgar and Usama Bilal are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Diego Alburez-Gutierrez is with the Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany. Alejandra Paniagua-Avila is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Manuel Ramirez-Zea is with the INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
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Gonzalez Casanova I, DiGirolamo A, Kroker-Lobos MF, Ochaeta L, Ramirez-Zea M, Martorell R, Stein AD. Association between early child development trajectories and adult cognitive function in a 50-year longitudinal study in Guatemala. BMJ Open 2021; 11:e044966. [PMID: 34193485 PMCID: PMC8246364 DOI: 10.1136/bmjopen-2020-044966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Few studies have used longitudinal data to study the development of cognition over the life course in low-income and middle-income countries. The objectives of this study were to assess predictors of cognitive development trajectories from 6 months through 7 years, and if these trajectories predicted adult cognitive function in a birth cohort from Guatemala. DESIGN We analysed data from the INCAP Nutrition Supplementation Trial Longitudinal Study in Guatemala. Cognition was assessed at eight different time points between 6 months and 7 years. We derived childhood development trajectories using latent class growth analysis. We assessed predictors of the trajectories using ordinal logistic regression, and associations between childhood trajectories and adult non-verbal intelligence and literacy at age 18-52 years (mean±SD =42.7±6.4 years) using mixed models. SETTING The study was conducted in four Guatemalan villages. PARTICIPANTS The study included 927 participants from Guatemala with repeated measurements of cognitive function during the first 7 years of life. RESULTS We identified three trajectories of cognitive development (high: n=214, average: n=583, low: n=130). Participants whose mothers were taller (proportional log odds (PO)=0.03, 95% CI=0.01 to 0.06), had more years of schooling (PO=0.15, 95% CI=0.06 to 0.25), or lived in households with higher socioeconomic scores (PO=0.19, 95% CI=0.09 to 0.29) were more likely to follow higher trajectories. Childhood trajectories predicted adult non-verbal intelligence (high=18.4±0.3, average=14.6±0.53, low=11.4±0.9) and literacy (high=63.8±2.0, average=48.6±1.2, low=33.9± 2.6) scores. CONCLUSIONS In this sample from Guatemala, cognitive development trajectories from 6 months through 7 years were associated with adult non-verbal intelligence and literacy. These findings provide evidence of tracking of cognition over time in a transitioning low-income setting.
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Affiliation(s)
- Ines Gonzalez Casanova
- Department of Applied Health Science, Indiana University Bloomington School of Public Health, Bloomington, Indiana, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ann DiGirolamo
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - Maria F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala, Guatemala
| | - Laura Ochaeta
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala, Guatemala
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala, Guatemala
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Meda-Lara RM, Juárez-Rodríguez P, Carrasco-Tapias NE, Barrales-Díaz CR, Palomera-Chávez A, González-Díaz E, Llantá-Abreu MDC, Lorenzana-Montenegro L, Herrero M, Moreno-Jiménez B. Precautionary Behaviors during the Second and Third Phases of the COVID-19 Pandemic: Comparative Study in the Latin American Population. Int J Environ Res Public Health 2021; 18:6882. [PMID: 34206907 PMCID: PMC8297200 DOI: 10.3390/ijerph18136882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 12/23/2022]
Abstract
The population's behavioral responses to containment and precautionary measures during the COVID-19 pandemic have played a fundamental role in controlling the contagion. A comparative analysis of precautionary behaviors in the region was carried out. A total of 1184 people from Mexico, Colombia, Chile, Cuba, and Guatemala participated through an online survey containing a questionnaire on sociodemographic factors, precautionary behaviors, information about COVID-19, concerns, maintenance of confinement, and medical symptoms associated with COVID-19. Cubans reported the highest scores for information about COVID-19. Colombians reported less frequent usage of precautionary measures (e.g., use of masks), but greater adherence to confinement recommendations in general, in contrast to the low levels of these behaviors in Guatemalans. Chileans reported greater pandemic-related concerns and the highest number of medical symptoms associated with COVID-19. These findings allow a partial characterization of the Latin American population's responses during the second and third phases of the COVID-19 pandemic and highlight the importance of designing and managing public health policies according to the circumstances of each population when facing pandemics.
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Affiliation(s)
- Rosa Martha Meda-Lara
- Centro Universitario de Ciencias de la Salud, Departamento de Psicología Básica, Universidad de Guadalajara, Guadalajara 44340, Mexico; (R.M.M.-L.); (A.P.-C.)
| | - Pedro Juárez-Rodríguez
- Centro Universitario de Ciencias de la Salud, Departamento de Biología Molecular y Genómica, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | | | | | - Andrés Palomera-Chávez
- Centro Universitario de Ciencias de la Salud, Departamento de Psicología Básica, Universidad de Guadalajara, Guadalajara 44340, Mexico; (R.M.M.-L.); (A.P.-C.)
| | - Esteban González-Díaz
- Centro Universitario de Ciencias de la Salud, Instituto de Patología Infecciosa y Experimental, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - María del Carmen Llantá-Abreu
- Instituto Nacional de Psicooncología y Radiobiología, Sección Psicooncología y Trabajo Social, La Habana 10400, Cuba;
| | | | - Marta Herrero
- Departamento de Psicología Social y del Desarrollo, Universidad de Deusto, 48007 Bilbao, Spain;
| | - Bernardo Moreno-Jiménez
- Facultad de Psicología, Universidad Autónoma de Madrid, Comunidad de Madrid, 28049 Madrid, Spain;
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Arévalo-Herrera M, Miura K, Cespedes N, Echeverry C, Solano E, Castellanos A, Ramirez JS, Miranda A, Kajava AV, Long C, Corradin G, Herrera S. Immunoreactivity of Sera From Low to Moderate Malaria-Endemic Areas Against Plasmodium vivax r Pvs48/45 Proteins Produced in Escherichia coli and Chinese Hamster Ovary Systems. Front Immunol 2021; 12:634738. [PMID: 34248932 PMCID: PMC8264144 DOI: 10.3389/fimmu.2021.634738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
P48/45 is a conserved gametocyte antigen involved in Plasmodium parasite fertilization. A recombinant Plasmodium vivax P48/45 (Pvs48/45) protein expressed in Escherichia coli (E. coli) was highly antigenic and immunogenic in experimental animals and elicited specific transmission-blocking (TB) antibodies in a previous pilot study. Here, a similar Pvs48/45 gene was expressed in Chinese Hamster Ovary (CHO) cells and we compared its immunoreactivity with the E. coli product. Specific antibody titers were determined using plasma from Colombian individuals (n=227) living in endemic areas where both P. vivax and P. falciparum are prevalent and from Guatemala (n=54) where P. vivax is highly prevalent. In Colombia, plasma seroprevalence to CHO-rPvs48/45 protein was 46.3%, while for E. coli-rPvs48/45 protein was 36.1% (p<0.001). In Guatemala, the sero prevalence was 24.1% and 14.8% (p<0.001), respectively. Reactivity index (RI) against both proteins showed an age-dependent increase. IgG2 was the predominant subclass and the antibody avidity index evaluated by ELISA ranged between 4-6 mol/L. Ex vivo P. vivax mosquito direct membrane feeding assays (DMFA) performed in presence of study plasmas, displayed significant parasite transmission-blocking (TB), however, there was no direct correlation between antibody titers and oocysts transmission reduction activity (%TRA). Nevertheless, DMFA with CHO rPvs48/45 affinity purified IgG showed a dose response; 90.2% TRA at 100 μg/mL and 71.8% inhibition at 10 μg/mL. In conclusion, the CHO-rPvs48/45 protein was more immunoreactive in most of the malaria endemic places studied, and CHO-rPvs48/45 specific IgG showed functional activity, supporting further testing of the protein vaccine potential.
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Affiliation(s)
- Myriam Arévalo-Herrera
- Immunology Department, Malaria Vaccine and Drug Development Center, Cali, Colombia
- Immunology Department, Caucaseco Scientific Research Center, Cali, Colombia
| | - Kazutoyo Miura
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Nora Cespedes
- Immunology Department, Malaria Vaccine and Drug Development Center, Cali, Colombia
| | - Carlos Echeverry
- Immunology Department, Malaria Vaccine and Drug Development Center, Cali, Colombia
| | - Eduardo Solano
- Immunology Department, Caucaseco Scientific Research Center, Cali, Colombia
| | - Angélica Castellanos
- Immunology Department, Malaria Vaccine and Drug Development Center, Cali, Colombia
| | | | - Adolfo Miranda
- Parasitology Department, Centro Nacional de Epidemiología (CNE), Guatemala City, Guatemala
| | - Andrey V. Kajava
- Centre de Recherche en Biologie Cellulaire de Montpellier, Université Montpellier, Montpellier, France
| | - Carole Long
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | | | - Sócrates Herrera
- Immunology Department, Malaria Vaccine and Drug Development Center, Cali, Colombia
- Immunology Department, Caucaseco Scientific Research Center, Cali, Colombia
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Harrison MS, Garces A, Figueroa L, Westcott J, Hambidge M, Krebs NF. How birth outcomes among a cohort of Guatemalan women with a history of prior cesarean vary by mode or birth across different interpregnancy intervals. Reprod Health 2021; 18:99. [PMID: 34020660 PMCID: PMC8147511 DOI: 10.1186/s12978-021-01153-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Our objectives were to analyze how pregnancy outcomes varied by cesarean birth as compared to vaginal birth across varying interpregnancy intervals (IPI) and determine if IPI modified mode of birth. METHODS This secondary analysis used data from a prospective registry of home and hospital births in Chimaltenango, Guatemala from January 2017 through April 2020, through the Global Network for Women's and Children's Health Research. Bivariate comparisons and multivariable logistic regression were used to answer our study question, and the data was analyzed with STATA software v.15.1. RESULTS Of 26,465 Guatemalan women enrolled in the registry, 2794 (10.6%) had a history of prior cesarean. 560 (20.1%) women delivered by vaginal birth after cesarean with the remaining 2,233 (79.9%) delivered by repeat cesarean. Repeat cesarean reduced the risk of needing a dilation and curettage compared to vaginal birth after cesarean, but this association did not vary by IPI, all p-values > p = 0.05. Repeat cesarean delivery, as compared to vaginal birth after cesarean, significantly reduced the likelihood a woman breastfeeding within one hour of birth (AOR ranged from 0.009 to 0.10), but IPI was not associated with the outcome. Regarding stillbirth, repeat cesarean birth reduced the likelihood of stillbirth as compared to vaginal birth (AOR 0.2), but again IPI was not associated with the outcome. CONCLUSION Outcomes by mode of delivery among a Guatemalan cohort of women with a history of prior cesarean birth do not vary by IPI.
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Affiliation(s)
- Margo S Harrison
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- University of Colorado Anschutz Medical Campus, Mail Stop B198-2, Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Aurora, CO, 80045, USA.
| | - Ana Garces
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Lester Figueroa
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Jamie Westcott
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | | | - Nancy F Krebs
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Jolly PE, Mazariegos M, Contreras H, Balas N, Junkins A, Aina IO, Minott S, Wang M, Phillips TD. Aflatoxin Exposure Among Mothers and Their Infants from the Western Highlands of Guatemala. Matern Child Health J 2021; 25:1316-1325. [PMID: 33945085 DOI: 10.1007/s10995-021-03151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We examined breast milk of mothers and urine of infants before and after introduction of supplementary foods for aflatoxin M1 (AFM1) and the association between AFM1 with maternal and infant diet. METHODS A prospective cohort study was conducted among mothers and infants ages 0-6 months and 7-12 months from June-October 2014. Sociodemographic, dietary, birth, and health data were collected. A breast milk sample was collected from each mother and a urine sample from each infant at baseline (time point 1) and monthly for 2 time points thereafter; samples collected at baseline and time point 3 were tested for AFM1. RESULTS Almost 5% of breast milk and 15.7% of urine samples tested AFM1-positive. The median AFM1 in breast milk was 0.020 ng/mL and in urine 0.077 ng/mg creatinine. At time point 3, infants of 5 of the 6 mothers in each group who were AFM1-positive in breast milk were also AFM1-positive in urine. Mothers' consumption of cooked maize/maize dough ≥ 3 days per week (OR 2.96, 95% CI = 1.19-7.34) and mothers' consumption of tamales made from maize ≥ 3 days per week (OR 0.28, 95% CI = 0.10-0.73) were significantly associated with AFM1 in infant urine. CONCLUSION This is the first study in Guatemala documenting aflatoxin exposure in both breast milk of lactating mothers and infants´ urine during the first year of life. This may have important implications in understanding the multicausality of the high rates of stunting among children < 5 years old in Guatemala.
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Affiliation(s)
- Pauline E Jolly
- Department of Epidemiology, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA.
| | - Manolo Mazariegos
- Section of Nutrition and Micronutrients, Institute of Nutrition for Central America and Panamá (INCAP), Guatemala City, Guatemala
| | - Haglaeeh Contreras
- Department of Epidemiology, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Nora Balas
- Department of Epidemiology, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Anna Junkins
- Department of Epidemiology, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Ibironke O Aina
- Department of Epidemiology, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Selina Minott
- Department of Epidemiology, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Meichen Wang
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
| | - Timothy D Phillips
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
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Alam A, Rehman NU, Ansari MN, Palla AH. Effects of Essential Oils of Elettaria cardamomum Grown in India and Guatemala on Gram-Negative Bacteria and Gastrointestinal Disorders. Molecules 2021; 26:molecules26092546. [PMID: 33925478 PMCID: PMC8123808 DOI: 10.3390/molecules26092546] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
The present study examined the chemical composition and antimicrobial and gastrointestinal activity of the essential oils of Elettaria cardamomum (L.) Maton harvested in India (EC-I) and Guatemala (EC-G). Monoterpenes were present in higher concentration in EC-I (83.24%) than in EC-G (73.03%), whereas sesquiterpenes were present in a higher concentration in EC-G (18.35%) than in EC-I (9.27%). Minimum inhibitory concentrations (MICs) of 0.5 and 0.25 mg/mL were demonstrated against Pseudomonas aeruginosa in EC-G and EC-I, respectively, whereas MICs of 1 and 0.5 mg/mL were demonstrated against Escherichia coli in EC-G and EC-I, respectively. The treatment with control had the highest kill-time potential, whereas the treatment with oils had shorter kill-time. EC-I was observed to be more potent in the castor oil-induced diarrhea model than EC-G. At 100 and 200 mg/kg, P.O., EC-I exhibited 40% and 80% protection, respectively, and EC-G exhibited 20% and 60% protection, respectively, in mice, whereas loperamide (10 mg/kg, i.p., positive control) exhibited 100% protection. In the in vitro experiments, EC-I inhibited both carbachol (CCh, 1 µM) and high K+ (80 mM)-induced contractions at significantly lower concentrations than EC-G. Thus, EC-I significantly inhibited P. aeruginosa and E. coli and exhibited more potent antidiarrheal and antispasmodic effects than EC-G.
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Affiliation(s)
- Aftab Alam
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Correspondence: ; Tel.: +966-509790901
| | - Najeeb Ur Rehman
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (N.U.R.); (M.N.A.)
| | - Mohd Nazam Ansari
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (N.U.R.); (M.N.A.)
| | - Amber Hanif Palla
- Department of Basic Medical Sciences (Pharmacology), Salim Habib University, Deh Dih, Korangi Creek, Karachi 74900, Pakistan;
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Nandi M, Kurschner S, Wilcox K, Flood D, Montano CM, Barnoya J, Rohloff P, Chary A. Perceptions of chronic kidney disease among at-risk adults in rural Guatemala. Glob Public Health 2021; 16:623-638. [PMID: 33161879 PMCID: PMC8005433 DOI: 10.1080/17441692.2020.1839529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 09/23/2020] [Indexed: 11/11/2022]
Abstract
This qualitative study explores perceptions of chronic kidney disease (CKD) among adults with abnormal estimated glomerular filtration rate (eGFR) in Guatemala, where the burden of CKD is rising. Qualitative semi-structured interviews were conducted with 39 individuals screened for CKD and found to have abnormal eGFR (defined as <90 mL/min/1.73 m2, per Kidney Disease Improving Global Outcomes [KDIGO] guidelines). Interviews occurred in participants' homes in Spanish or Kaqchikel Mayan. Interview notes were coded for dominant themes through an inductive approach. Interviewees had limited awareness of diabetes and hypertension as CKD risk factors, but appreciated the progressive nature of the disease. While most reported willingness to pursue renal replacement therapies, if necessary, they anticipated economic and geographic barriers. Public health interventions should focus on the association between diabetes, hypertension, and CKD. Improvement of primary care and screening infrastructure is imperative in CKD prevention in low- and middle-income countries (LMICs).
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Affiliation(s)
- Meghna Nandi
- The Warren Alpert Medical School at Brown University, Rhode Island, USA
- Center for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Guatemala
| | - Sophie Kurschner
- Center for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Guatemala
| | - Katharine Wilcox
- Center for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Guatemala
- Weill Cornell School of Medicine, New York, USA
| | - David Flood
- Center for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Guatemala
- National Clinicians Scholars Program, University of Michigan, Ann Arbor, Michigan
| | - Carlos Mendoza Montano
- Institute of Nutrition of Central America and Panama (Instituto de Nutrición de Centroamérica y Panamá, INCAP), Guatemala
| | - Joaquin Barnoya
- Institute of Research and Higher Studies in Health Sciences (El Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, IECIS), Rafael Landívar University
| | - Peter Rohloff
- Center for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Guatemala
- Department of Medicine, Department of Global Health Equity, Brigham and Women’s Hospital, Boston, USA
| | - Anita Chary
- Center for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Guatemala
- Departments of Emergency Medicine, Massachusetts General Hospital, Brigham and Women’s Hospital, Boston, USA
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Abstract
Violence against Women (VaW) has come to be recognized as a serious human rights abuse with important consequences not only for women but for whole societies. Since VaW has several manifestations, it is possible to differentiate among different types of violence. In this article, a broad theoretical framework with different dimensions of gender violence was adapted to a Latin American social and cultural context to measure three out of the five main types of violence: economic violence, emotional psychological violence, and coercive control. The goal of this article is to provide empirical evidence to determine whether access to microfinance services plays a role in reducing VaW. To this end, we designed and performed a cross-sectional study with a treatment and a control group in rural Guatemala. A sample of 883 rural women in the "Altiplano" area of Guatemala (448 women with microfinance services and 435 without) was surveyed from May to November 2012. The results of the bivariate logistic regression showed evidence of association between access to microfinance services and reduction of VaW. After adjusting for covariates, global, economic, and emotional psychological violence maintained a negative and statistically significant association with microfinance, while only coercive control showed no statistical association with microfinance services. Access to microcredits showed a very clear relationship to reducing economic and emotional violence but not coercive control, a factor that may be determined by social and cultural norms. In contrast to Status Inconsistency Theory, which has been tested primarily in Asia, our study of Guatemala showed that increased status and economic independence of women due to their participation in microfinance services reduced VaW.
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Juarez M, Dionicio C, Sacuj N, Lopez W, Miller AC, Rohloff P. Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model. Int J Environ Res Public Health 2021; 18:ijerph18020773. [PMID: 33477580 PMCID: PMC7831302 DOI: 10.3390/ijerph18020773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022]
Abstract
Rural Guatemala has one of the highest rates of chronic child malnutrition (stunting) in the world, with little progress despite considerable efforts to scale up evidence-based nutrition interventions. Recent literature suggests that one factor limiting impact is inadequate supervisory support for frontline workers. Here we describe a community-based quality improvement intervention in a region with a high rate of stunting. The intervention provided audit and feedback support to frontline nutrition workers through electronic worklists, performance dashboards, and one-on-one feedback sessions. We visualized performance indicators and child nutrition outcomes during the improvement intervention using run charts and control charts. In this small community-based sample (125 households at program initiation), over the two-year improvement period, there were marked improvements in the delivery of program components, such as growth monitoring services and micronutrient supplements. The prevalence of child stunting fell from 42.4 to 30.6%, meeting criteria for special cause variation. The mean length/height-for-age Z-score rose from −1.77 to −1.47, also meeting criteria for special cause variation. In conclusion, the addition of structured performance visualization and audit and feedback components to an existing community-based nutrition program improved child health indicators significantly through improving the fidelity of an existing evidence-based nutrition package.
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Affiliation(s)
- Michel Juarez
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
| | - Carlos Dionicio
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
| | - Neftali Sacuj
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
| | - Waleska Lopez
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
| | - Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA;
| | - Peter Rohloff
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
- Correspondence:
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Duffy S, Norton D, Kelly M, Chavez A, Tun R, Ramírez MNDG, Chen G, Wise P, Svenson J. Using Community Health Workers and a Smartphone Application to Improve Diabetes Control in Rural Guatemala. Glob Health Sci Pract 2020; 8:699-720. [PMID: 33361237 PMCID: PMC7784066 DOI: 10.9745/ghsp-d-20-00076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The global prevalence of diabetes has nearly doubled since 1980. Seventy-five percent of patients with diabetes live in low- and middle-income countries, such as Guatemala, where health care systems are often poorly equipped for chronic disease management. Community health workers (CHWs) and mobile health technology have increasingly been applied to the diabetes epidemic in these settings, although mostly in supportive rather than primary roles in diabetes management. We sought to improve diabetes care in rural Guatemala through the development of a CHW-led diabetes program and a smartphone application to provide CHWs with clinical decision support. METHODS We worked with our local partners to develop a program model and the smartphone application (using the CommCare platform) and to train CHWs. We recruited patients with type 2 diabetes living in rural communities. Program evaluation used a single-group, pre-post design. Primary outcomes were hemoglobin A1c and the percentage of patients meeting A1c goals compared with baseline. We also followed a variety of process metrics, including application reliability. RESULTS Eighty-nine patients enrolled during the study period. The hemoglobin A1c percentage decreased significantly at 3 months (-1.0; 95% CI=-1.7, -0.6), 6 months (-1.5; 95% CI=-2.2, -0.8), 9 months (-1.3; 95% CI=-2.0, -0.6), and 12 months (-1.0; 95% CI=-1.7, -0.4). The percentage of patients with A1c ≤ 8% increased significantly at 3 months (23.6% to 44.4%, P=.007), 6 months (22.0% to 44.0%, P=.015), and 9 months (23.9% to 45.7%, P=.03). CHWs and supervising physicians agreed with application medication recommendations >90% of the time. CONCLUSION Our results suggest that CHWs can safely and effectively manage diabetes with the assistance of a smartphone application and remote physician supervision. This model should be evaluated versus other standards of care and could be adapted to other low-resource settings and chronic diseases.
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Affiliation(s)
- Sean Duffy
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA.
| | - Derek Norton
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Mark Kelly
- University of California-Los Angeles David Geffen School of Medicine, Internal Medicine Residency Program, Los Angeles, CA, USA
| | | | - Rafael Tun
- Hospital Obras Sociales Monseñor Gregorio Schaffer, San Lucas Tolimán, Guatemala
| | - Mariana Niño de Guzmán Ramírez
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA
| | - Guanhua Chen
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Paul Wise
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jim Svenson
- University of Wisconsin School of Medicine and Public Health, Department of Emergency Medicine, Madison, WI, USA
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Núñez-Samudio V, Mayorga-Marín F, López Castillo H, Landires I. Epidemiological Characteristics of Road Traffic Injuries Involving Children in Three Central American Countries, 2012-2015. Int J Environ Res Public Health 2020; 18:ijerph18010037. [PMID: 33374643 PMCID: PMC7793503 DOI: 10.3390/ijerph18010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
Although motor vehicle collisions (MVCs) are a worldwide public health concern due to their high injury, mortality, and fatality rates, few studies have addressed the epidemiologic behavior of MVCs in Latin American youth. Thus, this study was aimed at describing and comparing the characteristics of MVCs involving 0 to 14-year-olds in Costa Rica, Guatemala, and Panama. A secondary aim was to estimate the crude MVC-related injury, fatality, and mortality rates and their trends over time. We conducted a descriptive, retrospective study using publicly available data for Costa Rica, Panama, and Guatemala between 2012 and 2015. We examined the reported MVC cases and calculated the crude injury, fatality, and mortality rates and their trends over time (α = 0.05). Publicly available data reported 12,020 MVC-related injuries and 431 MVC-related deaths involving 0 to 14-year-olds. The most frequent mechanisms involved 0 to 14-year-olds as passengers or pedestrians in MVCs (>85% of all cases). The highest crude MVC-related injury and mortality rates were reported for Panama (119.35 and 2.14 per 100,000 population, respectively, in 0 to 14-years-olds), while Guatemala had the highest median MVC-related fatality rate (8.84 per 100,000 events; χ2 [2] = 377.8; p < 0.001) with a statistically significant trend increasing over time (r = 0.947; p = 0.027). Although several factors play a role in the prevention of MVCs among 0 to 14-year-olds, we found that Costa Rica was the only country that implemented a policy on child restraint systems resulting in the lowest rates of MVC-related injury, mortality, and fatality. These results could be used by decision makers from the aforementioned Central American countries to develop adequate policies addressing MVC preventative strategies to protect Central American infants and children.
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Affiliation(s)
- Virginia Núñez-Samudio
- Instituto de Ciencias Médicas, Las Tablas, Los Santos 0701, Panama;
- Sección de Epidemiología, Departamento de Salud Pública, Región de Salud de Herrera, Ministry of Health, Chitré, Herrera 0601, Panama
| | - Francisco Mayorga-Marín
- Centro de Investigaciones y Estudios de la Salud, Universidad Nacional Autónoma, Managua 10000, Nicaragua;
| | - Humberto López Castillo
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida (UCF), Orlando, FL 32816, USA;
- Department of Population Health Sciences, College of Medicine, UCF, Orlando, FL 32827, USA
| | - Iván Landires
- Instituto de Ciencias Médicas, Las Tablas, Los Santos 0701, Panama;
- Centro Regional Universitario de Azuero (CRUA), Universidad de Panamá, Chitré, Herrera 0601, Panama
- Hospital Joaquín Pablo Franco Sayas, Región de Salud de Los Santos, Ministry of Health, Las Tablas, Los Santos 0701, Panama
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Gottschlich A, Mus S, Monzon JC, Thrasher JF, Barnoya J. Cross-sectional study on the awareness, susceptibility and use of heated tobacco products among adolescents in Guatemala City, Guatemala. BMJ Open 2020; 10:e039792. [PMID: 33318112 PMCID: PMC7737060 DOI: 10.1136/bmjopen-2020-039792] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Heated tobacco products (HTPs) are increasingly marketed worldwide, yet limited research on HTPs has been conducted in low and middle-income countries (LMICs) or among adolescents. Guatemala is one of the few LMICs where HTPs are available. This study examined prevalence and correlates of HTP awareness, susceptibility and use among adolescents in Guatemala. DESIGN, SETTING AND PARTICIPANTS A cross-sectional survey on HTP awareness, susceptibility and use was conducted among 2870 students between the ages of 13 and 17 in private schools in Guatemala City, Guatemala. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was susceptibility to future use of HTP among school-aged current and never smokers in Guatemala. We also explored awareness and use of HTPs. Multivariate binomial regression models were used to explore associations between these outcomes and both sociodemographic factors and established smoking correlates. RESULTS Of all students (n=2870), about half were aware of HTPs (52.4%) and susceptible to future or continued use (52.4%). Whereas 8.4% of students had tried HTPs in the lifetime (but not in the last month), only 2.9% used HTPs in the past month. Independent correlates of HTP susceptibility and ever-use included: use of other tobacco products (current smoking: adjusted OR (AOR)=10.53 and 6.63, respectively; current e-cigarette use: AOR=21.87 and 10.40, respectively), moderate alcohol consumption (AOR=1.49 and 1.19, respectively), marijuana use in the past 30 days (AOR=3.49 and 2.29, respectively) and having friends who use HTPs (AOR=1.83 and 7.28, respectively). CONCLUSIONS Among this sample of adolescents in Guatemala City, where tobacco control is weak, the prevalence of HTP use was low but susceptibility to future use was high. Tobacco prevention and intervention strategies for cigarettes and e-cigarettes should now also include HTPs, which tend to be used by similar adolescent populations (ie, those who use other substances or are exposed to tobacco through family and friends).
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Affiliation(s)
- Anna Gottschlich
- Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, Universidad Rafael Landivar, Guatemala, Guatemala
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sophia Mus
- Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, Universidad Rafael Landivar, Guatemala, Guatemala
| | - Jose Carlos Monzon
- Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, Universidad Rafael Landivar, Guatemala, Guatemala
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Joaquin Barnoya
- Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, Universidad Rafael Landivar, Guatemala, Guatemala
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular, Guatemala, Guatemala
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Southwell BG, Kelly BJ, Bann CM, Squiers LB, Ray SE, McCormack LA. Mental Models of Infectious Diseases and Public Understanding of COVID-19 Prevention. Health Commun 2020; 35:1707-1710. [PMID: 33081500 DOI: 10.1080/10410236.2020.1837462] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The emergence of viral diseases such as Ebola virus disease, Zika virus disease, and the coronavirus disease (COVID-19) has posed considerable challenges to health care systems around the world. Public health strategy to address emerging infectious diseases has depended in part on human behavior change and yet the perceptions and knowledge motivating that behavior have been at times inconsistent with the latest consensus of peer-reviewed science. Part of that disjuncture likely involves the existence and persistence of past ideas about other diseases. To forecast and prepare for future epidemic and pandemic response, we need to better understand how people approach emerging infectious diseases as objects of public opinion during the periods when such diseases first become salient at a population level. In this essay, we explore two examples of how existing mental models of past infectious diseases appear to have conditioned and constrained public response to novel viral diseases. We review previously reported experiences related to Zika virus in Central America and discuss public opinion data collected in the early months of the COVID-19 pandemic. In the case of Zika virus disease, we assess how thinking about earlier mosquito-borne disease seems to have affected public consideration of the virus in Guatemala. In the case of COVID-19, we assess how previous vaccination behavior for a different disease is associated with intention to obtain vaccination for COVID-19 in the future.
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Affiliation(s)
| | | | - Carla M Bann
- Division of Statistical and Data Sciences, RTI International
| | | | - Sarah E Ray
- Translational Health Sciences Division, RTI International
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McClure EM, Saleem S, Goudar SS, Garces A, Whitworth R, Esamai F, Patel AB, Tikmani SS, Mwenechanya M, Chomba E, Lokangaka A, Bose CL, Bucher S, Liechty EA, Krebs NF, Yogesh Kumar S, Derman RJ, Hibberd PL, Carlo WA, Moore JL, Nolen TL, Koso-Thomas M, Goldenberg RL. Stillbirth 2010-2018: a prospective, population-based, multi-country study from the Global Network. Reprod Health 2020; 17:146. [PMID: 33256783 PMCID: PMC7706249 DOI: 10.1186/s12978-020-00991-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Stillbirth rates are high and represent a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC). In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented cause of stillbirths or the trends in rate of stillbirth over time. METHODS We undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, Democratic Republic of Congo, India, Pakistan, and Guatemala). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Cause of stillbirth was assigned by algorithm. RESULTS From 2010 through 2018, 573,148 women were enrolled with delivery data obtained. Of the 552,547 births that reached 500 g or 20 weeks gestation, 15,604 were stillbirths; a rate of 28.2 stillbirths per 1000 births. The stillbirth rates were 19.3 in the Guatemala site, 23.8 in the African sites, and 33.3 in the Asian sites. Specifically, stillbirth rates were highest in the Pakistan site, which also documented a substantial decrease in stillbirth rates over the study period, from 56.0 per 1000 (95% CI 51.0, 61.0) in 2010 to 44.4 per 1000 (95% CI 39.1, 49.7) in 2018. The Nagpur, India site also documented a substantial decrease in stillbirths from 32.5 (95% CI 29.0, 36.1) to 16.9 (95% CI 13.9, 19.9) per 1000 in 2018; however, other sites had only small declines in stillbirth over the same period. Women who were less educated and older as well as those with less access to antenatal care and with vaginal assisted delivery were at increased risk of stillbirth. The major fetal causes of stillbirth were birth asphyxia (44.0% of stillbirths) and infectious causes (22.2%). The maternal conditions that were observed among those with stillbirth were obstructed or prolonged labor, antepartum hemorrhage and maternal infections. CONCLUSIONS Over the study period, stillbirth rates have remained relatively high across all sites. With the exceptions of the Pakistan and Nagpur sites, Global Network sites did not observe substantial changes in their stillbirth rates. Women who were less educated and had less access to antenatal and obstetric care remained at the highest burden of stillbirth. STUDY REGISTRATION Clinicaltrials.gov (ID# NCT01073475).
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Affiliation(s)
- Elizabeth M McClure
- Social, Statistical and Environmental Health Sciences, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA.
| | | | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research J N Medical College Belagavi, Belagavi, Karnataka, India
| | - Ana Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Ryan Whitworth
- Social, Statistical and Environmental Health Sciences, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA
| | | | | | | | | | | | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sherri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | - S Yogesh Kumar
- KLE Academy Higher Education and Research J N Medical College Belagavi, Belagavi, Karnataka, India
| | | | | | | | - Janet L Moore
- Social, Statistical and Environmental Health Sciences, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA
| | - Tracy L Nolen
- Social, Statistical and Environmental Health Sciences, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
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Dally M, Butler-Dawson J, Sorensen CJ, Van Dyke M, James KA, Krisher L, Jaramillo D, Newman LS. Wet Bulb Globe Temperature and Recorded Occupational Injury Rates among Sugarcane Harvesters in Southwest Guatemala. Int J Environ Res Public Health 2020; 17:ijerph17218195. [PMID: 33171945 PMCID: PMC7664243 DOI: 10.3390/ijerph17218195] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022]
Abstract
As global temperatures continue to rise it is imperative to understand the adverse effects this will pose to workers laboring outdoors. The purpose of this study was to investigate the relationship between increases in wet bulb globe temperature (WBGT) and risk of occupational injury or dehydration among agricultural workers. We used data collected by an agribusiness in Southwest Guatemala over the course of four harvest seasons and Poisson generalized linear modelling for this analysis. Our analyses suggest a 3% increase in recorded injury risk with each degree increase in daily average WBGT above 30 °C (95% CI: -6%, 14%). Additionally, these data suggest that the relationship between WBGT and injury risk is non-linear with an additional 4% acceleration in risk for every degree increase in WBGT above 30 °C (95% CI: 0%, 8%). No relationship was found between daily average WBGT and risk of dehydration. Our results indicate that agricultural workers are at an increased risk of occupational injury in humid and hot environments and that businesses need to plan and adapt to increasing global temperatures by implementing and evaluating effective occupational safety and health programs to protect the health, safety, and well-being of their workers.
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Affiliation(s)
- Miranda Dally
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
- Correspondence: ; Tel.: +1-303-724-2463
| | - Jaime Butler-Dawson
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
| | - Cecilia J. Sorensen
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
- Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA
| | - Mike Van Dyke
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
| | - Katherine A. James
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
| | - Lyndsay Krisher
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
| | - Diana Jaramillo
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
| | - Lee S. Newman
- Center for Health, Work & Environment, Department of Environmental and Occupational Health, and Colorado Consortium for Climate Change & Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA; (J.B.-D.); (C.J.S.); (M.V.D.); (K.A.J.); (L.K.); (D.J.); (L.S.N.)
- Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO 80045, USA
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Ceballos F, Hernandez MA, Olivet F, Paz C. Assessing the use of cell phones to monitor health and nutrition interventions: Evidence from rural Guatemala. PLoS One 2020; 15:e0240526. [PMID: 33141833 PMCID: PMC7608922 DOI: 10.1371/journal.pone.0240526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/29/2020] [Indexed: 12/31/2022] Open
Abstract
In-person (face-to-face) data collection methods offer many advantages but can also be time-consuming and expensive, particularly in areas of difficult access. We take advantage of the increasing mobile phone penetration rate in rural areas to evaluate the feasibility of using cell phones to monitor the provision of key health and nutrition interventions linked to the first 1,000 days of life, a critical period of growth and development. We examine response rates to calendarized text messages (SMS) and phone calls sent to 1,542 households over a period of four months. These households have children under two years old and pregnant women and are located across randomly selected communities in Quiche, Guatemala. We find that the overall (valid) response rate to phone calls is over 5 times higher than to text messages (75.8% versus 14.4%). We also test whether simple SMS reminders improve the timely reception of health services but do not find any effects in this regard. Language, education, and age appear to be major barriers to respond to text messages as opposed to phone calls, and the rate of response is not correlated with a household’s geographic location (accessibility). Moreover, response veracity is high, with an 84–91% match between household responses and administrative records. The costs per monitored intervention are around 1.12 US dollars using text messages and 85 cents making phone calls, with the costs per effective answer showing a starker contrast, at 7.76 and 1.12 US dollars, respectively. Our findings indicate that mobile phone calls can be an effective, low-cost tool to collect reliable information remotely and in real time. In the current context, where in-person contact with households is not possible due to the COVID-19 crisis, phone calls can be a valuable instrument for collecting information, monitoring development interventions, or implementing brief surveys.
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Affiliation(s)
- Francisco Ceballos
- Markets, Trade and Institutions Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States of America
| | - Manuel Alejandro Hernandez
- Markets, Trade and Institutions Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States of America
- * E-mail:
| | - Francisco Olivet
- Escuela de Ingeniería en Agronomía, Universidad Mariano Galvez, Ciudad de Guatemala, Guatemala City, Guatemala
| | - Cynthia Paz
- Markets, Trade and Institutions Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States of America
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Shukla VV, Eggleston B, Ambalavanan N, McClure EM, Mwenechanya M, Chomba E, Bose C, Bauserman M, Tshefu A, Goudar SS, Derman RJ, Garcés A, Krebs NF, Saleem S, Goldenberg RL, Patel A, Hibberd PL, Esamai F, Bucher S, Liechty EA, Koso-Thomas M, Carlo WA. Predictive Modeling for Perinatal Mortality in Resource-Limited Settings. JAMA Netw Open 2020; 3:e2026750. [PMID: 33206194 PMCID: PMC7675108 DOI: 10.1001/jamanetworkopen.2020.26750] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE The overwhelming majority of fetal and neonatal deaths occur in low- and middle-income countries. Fetal and neonatal risk assessment tools may be useful to predict the risk of death. OBJECTIVE To develop risk prediction models for intrapartum stillbirth and neonatal death. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women's and Children's Health Research population-based vital registry, including clinical sites in South Asia (India and Pakistan), Africa (Democratic Republic of Congo, Zambia, and Kenya), and Latin America (Guatemala). A total of 502 648 pregnancies were prospectively enrolled in the registry. EXPOSURES Risk factors were added sequentially into the data set in 4 scenarios: (1) prenatal, (2) predelivery, (3) delivery and day 1, and (4) postdelivery through day 2. MAIN OUTCOMES AND MEASURES Data sets were randomly divided into 10 groups of 3 analysis data sets including training (60%), test (20%), and validation (20%). Conventional and advanced machine learning modeling techniques were applied to assess predictive abilities using area under the curve (AUC) for intrapartum stillbirth and neonatal mortality. RESULTS All prenatal and predelivery models had predictive accuracy for both intrapartum stillbirth and neonatal mortality with AUC values 0.71 or less. Five of 6 models for neonatal mortality based on delivery/day 1 and postdelivery/day 2 had increased predictive accuracy with AUC values greater than 0.80. Birth weight was the most important predictor for neonatal death in both postdelivery scenarios with independent predictive ability with AUC values of 0.78 and 0.76, respectively. The addition of 4 other top predictors increased AUC to 0.83 and 0.87 for the postdelivery scenarios, respectively. CONCLUSIONS AND RELEVANCE Models based on prenatal or predelivery data had predictive accuracy for intrapartum stillbirths and neonatal mortality of AUC values 0.71 or less. Models that incorporated delivery data had good predictive accuracy for risk of neonatal mortality. Birth weight was the most important predictor for neonatal mortality.
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Affiliation(s)
| | | | | | | | | | | | - Carl Bose
- University of North Carolina School of Medicine, Chapel Hill
| | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | | | | | | | | | | | - Archana Patel
- Lata Medical Research Foundation, Datta Meghe Institute of Medical Sciences, Nagpur, India
| | | | | | | | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Kroker-Lobos MF, Ford ND, Gonzalez-Casanova I, Martorell R, Ramirez-Zea M, Stein AD. Improved nutrition in early life and pulse wave velocity and augmentation index in mid-adulthood: Follow-up of the INCAP Nutrition Supplementation Trial Longitudinal Study. PLoS One 2020; 15:e0239921. [PMID: 33108379 PMCID: PMC7591084 DOI: 10.1371/journal.pone.0239921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022] Open
Abstract
Nutrition in pregnancy and early childhood affects later blood pressure and precursors of atherosclerosis, but its influence on arterial stiffness is unexplored. This study determines whether exposure to improved nutrition during early life influences Augmentation index (AI) and pulse wave velocity (PWV) in mid-adulthood. We included 1221 adults (37-54y) who participated in a cluster-randomized nutritional supplementation trial of a protein-energy beverage (Atole), conducted between 1969–1977 in Guatemala. The comparison group received Fresco, a low-calorie protein-free beverage. In 2015–17, we measured anthropometry (weight, height, and waist-to-height ratio); AI and PWV (using carotid—femoral tonometry); blood pressure; fasting plasma glucose and serum lipids; and sociodemographic characteristics. Based on patterns of exposure, we characterized participants as fully, partially or unexposed to the intervention from conception to their second birthday (the ‘first 1000 days’). We fit pooled and sex-specific models using intention-to-treat, difference-in-difference regression analysis to test whether exposure to the supplement in the first 1000 days was associated with AI and PWV in adulthood adjusting for basal and current sociodemographic variables and current life-style and cardio-metabolic risk factors. Prevalence of obesity in men and women was 39.6% and 19.6%, and prevalence of hypertension was 44.0% and 36.0%, respectively. Women had higher AI (34.4±9.6%) compared to men (23.0± 9.8%), but had similar PWV (7.60±1.13 m/s and 7.60±1.31, respectively). AI did not differ significantly across intervention groups. PWV was lower in individuals with full exposure to the supplement during the first 1000 days (-0.39m/s, 95% CI -0.87, 0.09; p = 0.1) compared to unexposed individuals. This difference was similar after adjusting for cardio-metabolic risk factors (-0.45m/s; 95%C-0.93, 0.01; p = 0.06). Exposure to improved nutrition during the first 1000 days was marginally associated with lower PWV, but not with AI.
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Affiliation(s)
- Maria F. Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Nicole D. Ford
- Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, Georgia, United States of America
| | - Ines Gonzalez-Casanova
- Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, Georgia, United States of America
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, Georgia, United States of America
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Aryeh D. Stein
- Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, Georgia, United States of America
- * E-mail:
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47
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Ford ND, Martorell R, Mehta NK, Perrine CG, Ramirez-Zea M, Stein AD. Lifecourse body mass index trajectories and cardio-metabolic disease risk in Guatemalan adults. PLoS One 2020; 15:e0240904. [PMID: 33091024 PMCID: PMC7580923 DOI: 10.1371/journal.pone.0240904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 10/01/2020] [Indexed: 11/22/2022] Open
Abstract
Little is known about body size over the life-course and non-communicable disease risk in low- and middle-income country populations. Our study explored the role of body mass index (BMI) trajectories from infancy through mid-adulthood on cardio-metabolic disease (CMD) risk factors in a prospective cohort of Guatemalan adults. Study participants were born in Guatemala from 1962-77 and have been followed prospectively since participating in a nutrition supplementation trial as children. Sex-specific BMI latent class trajectories were derived using latent class growth modeling from up to 22 possible BMI values from age 1 month to 42 years measured between 1969 and 2004. CMD risk factors were assessed in 2015-17 (at age 37-54 years) using anthropometry, blood glucose and lipids, and blood pressure. We used logistic regression to assess the role of BMI trajectory on CMD risk factors in 510 women and 346 men (N = 856). We identified two BMI latent classes for women (low [n = 287, 56.3%] and high [n = 223, 43.7%]) and three classes for men (low [n = 141, 40.8%], medium [n = 160, 46.2%], and high [n = 45, 13.0%]). Given the small percentage of men in the high BMI latent class, we collapsed the medium and high BMI latent classes for men (n = 205, 59.1%). Among the most prevalent CMD risk factors at ages 37-54 years were abdominal obesity defined by waist-height ratio (99.6% of women and 87.3% of men), obesity defined by percent body fat (96.6% of women and 75.9% of men), low HDL-c (87.5% of women and 74.5% of men), and elevated triglycerides (78.3% of women and 73.6% of men). Except for obesity defined by BMI, we found no associations between BMI latent class and CMD risk factors in women. Among men, BMI latent class was not associated with CMD risk factors after controlling for current BMI. For the CMD risk factors we analyzed, the role of early life BMI on adult CMD appeared to be mediated by adult BMI among men-highlighting the need to establish and maintain healthy body weight over the life course.
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Affiliation(s)
- Nicole D. Ford
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Neil K. Mehta
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Cria G. Perrine
- Division of Nutrition, Physical Activity, and Obesity, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Aryeh D. Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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48
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Boyce SC, Morales-Miranda S, Ritter J, Triplett DP, Loya-Montiel I, Silverman JG. HIV Infection and Risk Heightened Among Female Sex Workers Who Entered the Sex Trade as Adolescents in Guatemala. AIDS Behav 2020; 24:2906-2917. [PMID: 32277308 DOI: 10.1007/s10461-020-02841-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A dearth of empirical research exists on female sex workers in Central America who begin selling sex under age 18. Data were collected from adult female sex workers (N = 1216) sampled using census and modified time-location sampling in three urban centers of Guatemala. In adjusted analyses, female sex workers who entered the sex trade under age 16 years were more likely to be HIV positive (AOR = 4.6, 95% CI 1.6, 13.2), have not received HIV education in their first year of sex trade (AOR = 2.8, 95% CI 1.5, 5.5), have experienced violence to force commercial sex (AOR = 4.6, 95% CI 2.2, 9.8) and have not used condoms in their first month (AOR = 2.8, 95% CI 1.3, 6.1) , relative to those who entered as adults. An interaction between age at entry and foreign migration at entry was found for HIV risk. Efforts to prevent adolescent sex trade entry are needed and may also help to reduce HIV rates in Guatemala.
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Affiliation(s)
- Sabrina C Boyce
- Center On Gender Equity and Health, School of Medicine, University of California -San Diego, La Jolla, CA, USA.
- Central Services Research Facility, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | | | - Julie Ritter
- Center On Gender Equity and Health, School of Medicine, University of California -San Diego, La Jolla, CA, USA
| | - Daniel P Triplett
- Center On Gender Equity and Health, School of Medicine, University of California -San Diego, La Jolla, CA, USA
| | - Itzel Loya-Montiel
- Consorcio de Investigación Sobre VIH SIDA TB CISIDAT, A.C., Morelos, México
| | - Jay G Silverman
- Center On Gender Equity and Health, School of Medicine, University of California -San Diego, La Jolla, CA, USA
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Castillo Signor LDC, Edwards T, Escobar LE, Mencos Y, Matope A, Castaneda-Guzman M, Adams ER, Cuevas LE. Epidemiology of dengue fever in Guatemala. PLoS Negl Trop Dis 2020; 14:e0008535. [PMID: 32813703 PMCID: PMC7458341 DOI: 10.1371/journal.pntd.0008535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 08/31/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022] Open
Abstract
Dengue fever occurs worldwide and about 1% of cases progress to severe haemorrhage and shock. Dengue is endemic in Guatemala and its surveillance system could document long term trends. We analysed 17 years of country-wide dengue surveillance data in Guatemala to describe epidemiological trends from 2000 to 2016.Data from the national dengue surveillance database were analysed to describe dengue serotype frequency, seasonality, and outbreaks. We used Poisson regression models to compare the number of cases each year with subsequent years and to estimate incidence ratios within serotype adjusted by age and gender. 91,554 samples were tested. Dengue was confirmed by RT-qPCR, culture or NS1-ELISA in 7097 (7.8%) cases and was IgM ELISA-positive in 19,290 (21.1%) cases. DENV1, DENV2, DENV3, and DENV4 were detected in 2218 (39.5%), 2580 (45.9%), 591 (10.5%), and 230 (4.1%) cases. DENV1 and DENV2 were the predominant serotypes, but all serotypes caused epidemics. The largest outbreak occurred in 2010 with 1080 DENV2 cases reported. The incidence was higher among adults during epidemic years, with significant increases in 2005, 2007, and 2013 DENV1 outbreaks, the 2010 DENV2 and 2003 DENV3 outbreaks. Adults had a lower incidence immediately after epidemics, which is likely linked to increased immunity. Dengue is the most common mosquito-borne virus, and a major cause of fever, with an estimated 390 million infections annually. Guatemala, in Central America, has had ongoing dengue transmission since the 1990s. Its national surveillance system monitors outbreaks and seasonal trends of infections to inform public health responses. We have analysed 17 years of surveillance data collected from 2000 to 2016, to describe seasonal trends, outbreak years, and the fluctuating prevalence of the four dengue serotypes. Laboratory data from 91,554 individual serum samples were included, of which 7.8% were positive for dengue. All four dengue serotypes circulate in the country, with dengue 1 and 2 being the predominant serotypes. This is important, as it increases the likelihood of dengue infections being followed by a new infection with a different serotype, which can lead to severe dengue. We also report that adults in Guatemala have a lower likelihood of infection the year after an epidemic, which might be linked to an increased immunity in the population.
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Affiliation(s)
| | - Thomas Edwards
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Luis E. Escobar
- Department of Fish and Wildlife Conservation, Virginia Tech, Blacksburg, VA, United States of America
| | - Yolanda Mencos
- Ministerio de Salud Publica y Asistencia Social de Guatemala, Guatemala City, Guatemala
| | - Agnes Matope
- Tropical Clinical Trials Unit. Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mariana Castaneda-Guzman
- Department of Fish and Wildlife Conservation, Virginia Tech, Blacksburg, VA, United States of America
| | - Emily R. Adams
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Luis E. Cuevas
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Tropical Clinical Trials Unit. Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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50
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Ramay BM, Caudell MA, Cordón-Rosales C, Archila LD, Palmer GH, Jarquin C, Moreno P, McCracken JP, Rosenkrantz L, Amram O, Omulo S, Call DR. Antibiotic use and hygiene interact to influence the distribution of antimicrobial-resistant bacteria in low-income communities in Guatemala. Sci Rep 2020; 10:13767. [PMID: 32792543 PMCID: PMC7426860 DOI: 10.1038/s41598-020-70741-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/30/2020] [Indexed: 11/09/2022] Open
Abstract
To examine the effects of poor sanitation and hygiene on the prevalence of antimicrobial-resistant bacteria, we surveyed households in two rural and two urban communities in Guatemala (N = 196 randomly selected households). One adult (≥ 18-years old) and, when available, one child (≤ 5 years-old) provided a stool sample. Up to 48 presumptive Escherichia coli isolates were collected from each stool sample (n = 21,256 total) and were subjected to breakpoint assays for ten antibiotics. Mixed-effects logistic models were used to identify potential factors influencing the likelihood of harboring antibiotic-resistant bacteria. For nine out of ten antibiotics, the odds of detecting resistant bacteria decreased by ~ 32% (odds ratios, OR 0.53-0.8, P < 0.001) for every unit of improvement of a hygiene scale. Hygiene differences between households had a greater impact on prevalence compared to antibiotic use differences. The likelihood of detecting resistant isolates was lower for five antibiotics among households that boiled raw milk before consumption (OR 0.31-0.69), and higher for nine antibiotics in urban households (OR > 1.89-9.6). Poor hygiene conditions likely obscure effects of individual antibiotic use, presumably due to enhanced microbial transmission. Consequently, efforts to improve antibiotic stewardship should be coupled with improving hygiene conditions.
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Affiliation(s)
- Brooke M Ramay
- Center for Health Studies, Universidad del Valle de Guatemala, 181 Avenida 11-95, Guatemala City, 01015, Guatemala
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
| | - Mark A Caudell
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
- Food and Agriculture Organization of the United Nations, United Nations Complex, UN Avenue, Gigiri, PO Box: 30470, Nairobi, 00100, Kenya
| | - Celia Cordón-Rosales
- Center for Health Studies, Universidad del Valle de Guatemala, 181 Avenida 11-95, Guatemala City, 01015, Guatemala.
| | - L Diego Archila
- Center for Health Studies, Universidad del Valle de Guatemala, 181 Avenida 11-95, Guatemala City, 01015, Guatemala
| | - Guy H Palmer
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
- Nelson Mandela African Institution of Science and Technology, P.O.BOX 447, Arusha, Tanzania
| | - Claudia Jarquin
- Center for Health Studies, Universidad del Valle de Guatemala, 181 Avenida 11-95, Guatemala City, 01015, Guatemala
| | - Purificación Moreno
- Center for Health Studies, Universidad del Valle de Guatemala, 181 Avenida 11-95, Guatemala City, 01015, Guatemala
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, 181 Avenida 11-95, Guatemala City, 01015, Guatemala
| | - Leah Rosenkrantz
- Department of Geography, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Ofer Amram
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, USA
| | - Sylvia Omulo
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
| | - Douglas R Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
- Nelson Mandela African Institution of Science and Technology, P.O.BOX 447, Arusha, Tanzania
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