RESUMEN
OBJECTIVE: to report the experience of investigating the outbreak of acute diarrhoea (AD) at the XII Indigenous Games in Cuiabá, Mato Grosso, Brazil, 2013. METHODS: data were collected from the Advanced Medical Post's service records of the AD cases, which were defined as 'individual Games participant referring episode of diarrhoea and/or vomiting'; AD attack rates, relative frequencies and measures of the central tendency of sociodemographic and clinical variables, sanitary inspections and results of bromatological samples were calculated. RESULTS: 384 (37%) cases met the definition of AD; the epidemic peaks of the outbreak occurred on the 4th and 7th day of the event and the disease attack rate was 33.5%; sanitary inspection showed evidence of food contamination by coagulase-negative Staphylococci, Bacillus cereus and heat resistant coliforms. CONCLUSION: there an outbreak of AD caused by food contamination.
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Diarrea/epidemiología , Brotes de Enfermedades , Enfermedades Transmitidas por los Alimentos/epidemiología , Indígenas Sudamericanos/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Diarrea/etnología , Femenino , Enfermedades Transmitidas por los Alimentos/etnología , Humanos , Incidencia , Indígenas Sudamericanos/etnología , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Distribución por Sexo , Adulto JovenRESUMEN
Objectives Diarrheal disease is a significant cause of morbidity among children in Peru. Oral rehydration therapy (ORT) is a cost-effective evidence-based approach to treat diarrhea in young children, yet many Peruvian children in poorer households do not receive this life-saving treatment. This study investigates the social determinants of care-seeking behavior and utilization of appropriate home treatment for diarrheal episodes. Methods We used the nationally-representative 2008 Peru Demographic and Health Survey to: (1) describe the burden of non-bloody diarrheal disease among children <5 years old; and (2) identify socioeconomic correlates of care-seeking behavior and utilization/appropriateness of treatment among mothers of children with recent non-bloody diarrheal episodes (N = 1365). For the former, we reported descriptive statistics; for the latter, we utilized logistic regression to generate odds ratios. Results 2-week period prevalence of diarrheal disease was almost twice as high among poor (17 %) compared with wealthier (10 %) children, higher among children aged 12-23 months old (22 %), and higher among children from households that do not have an improved source of drinking water (16 %) compared with those that have an improved source (12 %). Interestingly, rural residence was a significant predictor of seeking care for diarrhea. Furthermore, although widely available, few mothers (15 %) used appropriate treatment for a recent diarrheal episode. Water source, mother's education, and wealth were significant predictors of appropriate home treatment. Conclusions Mothers in rural areas-typically with less access to care-were more likely to seek care for diarrheal disease in their children, even when adjusting for other variables. However, this increase in care seeking behavior did not extend to appropriate home treatment. Innovative behavior change strategies to reduce barriers to access and appropriate home treatment for diarrheal disease are important, especially given effective and affordable treatment strategies. Future studies should elucidate specific barriers to seeking and utilizing ORT and other appropriate home treatments.
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Diarrea/terapia , Fluidoterapia , Conductas Relacionadas con la Salud , Madres , Aceptación de la Atención de Salud/etnología , Adolescente , Adulto , Niño , Preescolar , Cultura , Diarrea/epidemiología , Diarrea/etnología , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Masculino , Persona de Mediana Edad , Madres/educación , Madres/psicología , Perú/epidemiología , Prevalencia , Población Rural , Factores SocioeconómicosRESUMEN
BACKGROUND: Invasive amebiasis is not frequently seen in the United States. It is associated with considerable morbidity in patients residing in or traveling to endemic areas. We report a case series of patients with amebic colitis in a United States-Mexico border city to alert physicians to the varied clinical manifestations. CASE PRESENTATION: Nine patients were diagnosed with amebic colitis. Mean age was 56 (38-83), 6 were males, and all were Hispanic. Common symptoms were diarrhea (56 %), hematochezia (33 %) and abdominal bloating (11 %). The diagnosis of amebic colitis was established in the following ways: 8 patients by colonoscopy with biopsy, 1 by surgery for colonic obstruction. The diagnosis of amebic colitis was confirmed in 8 patients (89 %) by amebic trophozoites present in histopathologic sections. One patient was diagnosed with amebic colitis based upon clinical symptoms, colitis on colonoscopy and visualization of amebic trophozoites on stool examination. In the 8 patients in whom colonoscopy was done, 6 (75 %) had inflammation with rectosigmoid involvement and 5 (62.5 %) had ulcerations. Infection resolved after treatment with metronidazole in most patients; however, one patient developed a liver abscess and another had a colonic perforation and later developed a liver abscess. CONCLUSION: The occurrence of amebic colitis in this United States-Mexico border city hospital population was low, but in some cases potentially life-threatening. Physicians should be alert to the less common presentations of amebic colitis, such as overt gastrointestinal bleeding, exacerbation of inflammatory bowel disease, and the incidental finding of association with colon cancer, or a surgical abdomen. Rectosigmoid involvement was typically found on colonoscopy.
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Colonoscopía/métodos , Disentería Amebiana/parasitología , Entamoeba histolytica/fisiología , Trofozoítos/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Colitis/diagnóstico , Colitis/etnología , Diagnóstico Diferencial , Diarrea/diagnóstico , Diarrea/etnología , Disentería Amebiana/diagnóstico , Disentería Amebiana/etnología , Entamoeba histolytica/aislamiento & purificación , Femenino , Hispánicos o Latinos , Interacciones Huésped-Parásitos , Humanos , Absceso Hepático Amebiano/diagnóstico , Absceso Hepático Amebiano/etnología , Masculino , México , Persona de Mediana Edad , Estados UnidosRESUMEN
This randomised, double-blind, multicentre study with children nine-23 months old evaluated the immunogenicity of yellow fever (YF) vaccines prepared with substrains 17DD and 17D-213/77. YF antibodies were tittered before and 30 or more days after vaccination. Seropositivity and seroconversion were analysed according to the maternal serological status and the collaborating centre. A total of 1,966 children were randomised in the municipalities of the states of Mato Grosso do Sul, Minas Gerais and São Paulo and blood samples were collected from 1,714 mothers. Seropositivity was observed in 78.6% of mothers and 8.9% of children before vaccination. After vaccination, seropositivity rates of 81.9% and 83.2%, seroconversion rates of 84.8% and 85.8% and rates of a four-fold increase over the pre-vaccination titre of 77.6% and 81.8% were observed in the 17D-213/77 and 17DD subgroups, respectively. There was no association with maternal immunity. Among children aged 12 months or older, the seroconversion rates of 69% were associated with concomitant vaccination against measles, mumps and rubella. The data were not conclusive regarding the interference of maternal immunity in the immune response to the YF vaccine, but they suggest interference from other vaccines. The failures in seroconversion after vaccination support the recommendation of a booster dose in children within 10 years of the first dose.
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Humanos , Masculino , Femenino , Lactante , Anticuerpos Antivirales/aislamiento & purificación , Antivirales/uso terapéutico , Seroconversión , Vacuna contra la Fiebre Amarilla/inmunología , Virus de la Fiebre Amarilla/inmunología , Fiebre Amarilla/prevención & control , Anticuerpos Neutralizantes , Causalidad , Diarrea/etnología , Método Doble Ciego , Fiebre/etnología , Técnica de Placa Hemolítica , Ronquera/etnología , Convulsiones/etnología , Resultado del Tratamiento , Vómitos/etnología , Vacuna contra la Fiebre Amarilla/efectos adversos , Virus de la Fiebre Amarilla/clasificaciónRESUMEN
Norovirus (NoV), sapovirus (SaV) and human astrovirus (HAstV) are viral pathogens that are associated with outbreaks and sporadic cases of gastroenteritis. However, little is known about the occurrence of these pathogens in relatively isolated communities, such as the remnants of African-descendant villages ("Quilombola"). The objective of this study was the frequency determination of these viruses in children under 10 years, with and without gastroenteritis, from a "Quilombola" Community, Northern Brazil. A total of 159 stool samples were obtained from April/2008 to July/2010 and tested by an enzyme immunoassay (EIA) and reverse transcription-polymerase chain reaction (RT-PCR) to detect NoV, SaV and HAstV, and further molecular characterization was performed. These viruses were detected only in the diarrheic group. NoV was the most frequent viral agent detected (19.7%-16/81), followed by SaV (2.5%-2/81) and HAstV (1.2%-1/81). Of the 16 NoV-positive samples, 14 were sequenced with primers targeting the B region of the polymerase (ORF1) and the D region of the capsid (ORF2). The results showed a broad genetic diversity of NoV, with 12 strains being classified as GII-4 (5-41.7%), GII-6 (3-25%), GII-7 (2-16.7%), GII-17 (1-8.3%) and GI-2 (1-8.3%), as based on the polymerase region; 12 samples were classified, based on the capsid region, as GII-4 (6-50%, being 3-2006b variant and 3-2010 variant), GII-6 (3-25%), GII-17 (2-16.7%) and GII-20 (1-8.3%). One NoV-strain showed dual genotype specificity, based on the polymerase and capsid region (GII-7/GII-20). This study provides, for the first time, epidemiological and molecular information on the circulation of NoV, SaV and HAstV in African-descendant communities in Northern Brazil and identifies NoV genotypes that were different from those detected previously in studies conducted in the urban area of Belém. It remains to be determined why a broader NoV diversity was observed in such a semi-isolated community.
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Población Negra/estadística & datos numéricos , Diarrea/etnología , Diarrea/virología , Variación Genética , Norovirus/genética , Norovirus/aislamiento & purificación , Animales , Brasil/etnología , Niño , Diarrea/complicaciones , Perros , Heces/virología , Gastroenteritis/complicaciones , Gastroenteritis/etnología , Gastroenteritis/virología , Humanos , Mamastrovirus/genética , Mamastrovirus/aislamiento & purificación , Mamastrovirus/fisiología , Norovirus/fisiología , Sapovirus/genética , Sapovirus/aislamiento & purificación , Sapovirus/fisiologíaRESUMEN
BACKGROUND: Diarrhea is a major cause of death in children in developing countries. However, in Brazil, diarrhea-related morbidity and mortality have declined over the past decades. OBJECTIVE: To explore community perspectives in Brazil on changes in health related to diarrhea and factors that may have contributed to these changes. METHODS: This qualitative study included 12 focus group sessions held with 50 mothers and 42 grandmothers in the state of Ceará. RESULTS: Most grandmothers reported having lost at least one child to diarrhea, and all participants had witnessed children dying from diarrhea in the past. The participants saw a clear decline in diarrhea over the past 20 years. They felt that this was due to social, economic, and cultural progress. The participants also considered government-supported outreach programs very important for health improvement. CONCLUSIONS: Knowledge of diarrhea and its causes in the community is broad, but many traditional beliefs about the illness still prevail. The Brazilian experience is an example of the critical effect that policies to promote income redistribution and universal access to education, health, water supply, and sanitation services may have on the reduction of undernutrition and diarrhea among children.
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Diarrea Infantil/epidemiología , Diarrea/epidemiología , Transición de la Salud , Salud Rural , Adulto , Anciano , Actitud Frente a la Salud/etnología , Brasil/epidemiología , Preescolar , Servicios de Salud Comunitaria/tendencias , Países en Desarrollo , Diarrea/etnología , Diarrea/mortalidad , Diarrea/prevención & control , Diarrea Infantil/etnología , Diarrea Infantil/mortalidad , Diarrea Infantil/prevención & control , Familia/etnología , Familia/psicología , Femenino , Grupos Focales , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Madres/psicología , Programas Nacionales de Salud/tendencias , Salud Rural/etnologíaRESUMEN
BACKGROUND: Rifaximin has been shown to be effective in treating and preventing travelers' diarrhea (TD) during the summer season. METHODS: The goal of this double-blinded multicenter trial was to assess the efficacy and safety of rifaximin 550 mg administered once daily for 14 days compared with placebo in the prevention of TD during the dry season in Mexico. RESULTS: There were 101 participants randomized. Overall, 25 participants developed TD during the 3 weeks of the study: 22% from the rifaximin group and 29% from the placebo group (p = 0.4). Mild diarrhea (defined as only one or two unformed stools during a 24-h period plus at least one abdominal symptoms) developed in only 3 (6%) participants taking rifaximin compared with 10 (21%) taking placebo during the first week of study (p = 0.03). No clinically significant or serious adverse events were reported. CONCLUSIONS: Antibiotic prophylaxis of TD in Mexico during the dry season needs to be further studied and its benefits weighed against the benefits of self-treatment.
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Diarrea/prevención & control , Rifamicinas/administración & dosificación , Viaje , Administración Oral , Antiinfecciosos/administración & dosificación , Diarrea/etnología , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Humanos , Incidencia , México/epidemiología , Proyectos Piloto , Estudios Retrospectivos , Rifaximina , Estaciones del Año , Estados Unidos/epidemiologíaRESUMEN
This paper takes the theoretical construct of popular nosology of Latino folk illnesses and combines it with Edward Casey's concept of bodily remembering in order to more fully describe the role of memory and place in the illness experiences of the Amuzgos Indians of Oaxaca, Mexico. I ethnographically describe, across time, the interrelated links among social events, physical symptoms, and illness narratives of Latino folk illness popular nosologies as they are contextualized in their unique, social topographies. This enlarged theoretical perspective implies a smallest unit of meaning that is ethnographically defined, but that will often encompass more than the individual sufferer and more than one illness. The research objective of this study was to understand Amuzgan illness experiences through the narratives of detailed case histories and ethnographic observations that were gathered during 18 months of qualitative research. The data show that Amuzgos experience Latino folk illnesses as bodily rememberings of illness events combined with negative interpersonal interactions. Healing these Latino folk illnesses implies curing bodies, households, social relationships, and living environments.
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Indígenas Norteamericanos/etnología , Medicina Tradicional , Memoria , Rol del Enfermo , Trastornos Somatomorfos/etnología , Preescolar , Cristianismo , Diarrea/etnología , Diarrea/psicología , Diarrea/terapia , Emociones , Medicina de Hierbas , Humanos , Indígenas Norteamericanos/psicología , Relaciones Interpersonales , Masculino , Curación Mental , México , Narración , Religión y Psicología , Medio Social , Trastornos Somatomorfos/psicología , Trastornos Somatomorfos/terapia , HechiceríaRESUMEN
In Chiapas, Mexico, diarrheal disease causes the majority of all deaths in children under the age of five. Treatment of childhood diarrhea may be influenced by local beliefs and cultural practices. Few studies have attempted to quantitatively evaluate health seeking behavior (HSB) for diarrheal diseases in indigenous communities, while controlling for potential confounding factors such as parental education or socioeconomic status. A rapid ethnographic survey was conducted in Nabenchauc, Chiapas, to determine hypothetical HSB patterns for each of four major types of childhood diarrhea. Additionally, we examined the actual HSB for the last episode of childhood diarrheal illness within the household. One hundred households participated in the survey; 94 households with children < 5 years old reported a mean of 1.9 diarrheal episodes during the preceding month. Households reported using a mean of 1.3 types of in-home remedies. Oral rehydration therapy (ORT) was used in <2% of the 368 HSB patterns elicited for the four types of diarrhea. HSB patterns utilized an eclectic combination of traditional, allopathic, local and distant health care options. A mean of 2.5 outside-the-home health care options were reported for each diarrheal type; the local grocery store was reported in 245 (67%) of the hypothetical HSB patterns and as a first option in 199 (54%). Maternal and/or paternal education had little impact on hypothetical HSB. Households with lower SES were more likely to report using local grocery stores as a first option and were less likely to use options outside the village. The rapid ethnographic survey approach allows for assessment of changes in the approach to health care option utilization in cultures incorporating new health care paradigms. Public health interventions targeting local stores may lead to increased use of ORT, thereby potentially reducing early morbidity and mortality due to childhood diarrhea.
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Diarrea/terapia , Episodio de Atención , Indígenas Norteamericanos , Aceptación de la Atención de Salud/etnología , Adulto , Niño , Diarrea/etnología , Femenino , Fluidoterapia , Humanos , Masculino , México , Población RuralRESUMEN
This paper discusses research designed to investigate community, clinic, and longitudinal patterns in use of lead as a treatment for empacho, a folk illness manifest by gastrointestinal symptoms. The same questionnaire used in a clinic-based study seven years previously in Guadalajara, Mexico, was used to interview a randomly selected community sample: in addition, the study was repeated at the same clinic sites that had been studied previously. The goals were to investigate: (1) What are community wide prevalences of empacho and use of lead based remedies? (2) To what extent are current patterns of use of lead for treatment of empacho in clinic-based samples similar to those seven years ago. The attributable risk to the population as a whole from use of lead based remedies was found to be 11% of the households of Guadalajara. Essentially this same estimate was seen for the 1987 and 1994 clinic populations. Interestingly, while percentages of lead users have declined since 1987, twice as great a percentage of informants reported treating empacho. Other patterns originally identified in 1987 persisted in 1994; lead use continues to be associated with lower levels of parental education and income.
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Diarrea/tratamiento farmacológico , Conocimientos, Actitudes y Práctica en Salud , Plomo/uso terapéutico , Medicina Tradicional , Vómitos/tratamiento farmacológico , Adulto , Instituciones de Atención Ambulatoria , Niño , Diarrea/etnología , Femenino , Estudios de Seguimiento , Humanos , Masculino , México , Madres/educación , Madres/psicología , Factores Socioeconómicos , Encuestas y Cuestionarios , Vómitos/etnologíaRESUMEN
In Nicaragua, the principal cause of infant mortality is diarrhea, which is responsible for 40% of these deaths annually. This statistic reflects the low usage of health services and oral rehydration therapy (ORT). In an effort to improve the situation, several studies were carried out in Villa Carlos Fonseca municipio. This report describes two of those studies, one ethnographic and the other epidemiologic (conducted in 1989 and 1990, respectively), to find out beliefs and traditional health practices and their influence on the way in which mothers responded to their children's diarrheal illness. The ethnographic study involved interviewing 70 mothers with an average age of 28 years who had children under 2 years of age. The children represented two groups: one at high risk for diarrhea and the other at low risk. The objectives were to learn the traditional names for diarrhea, the perception of risk, and the treatments that were used. The epidemiologic study included 391 mothers over 14 years of age with one or more children under age 5 years, of whom 215 had had diarrhea in the two weeks preceding the survey. The objectives were to describe local beliefs and health practices and to determine the incidence of diarrheas according to the diagnosis made by the mothers. At least 12 types of diarrhea were identified, for which terms such as "empacho" and "sol de vista" were used. In most cases, the mothers had more confidence in folkloric treatments that they themselves or the traditional healers (curanderos) applied than in the services offered at health centers. This attitude limited their use of health services and ORT, although it was observed that in certain cases traditional treatments were used in combination with those of western medicine. There was a direct but nonsignificant correlation between the level of schooling of the mothers and the frequency with which they visited the health center. The authors suggest the effects of massages, herbal baths, and other traditional treatments should be studied to evaluate their effectiveness and adapt them, to the extent possible, to "modern" medicine. Health services providers should become familiar with traditional nomenclature and beliefs in order to be able to communicate better with mothers and steer them away from harmful practices toward improved results in infant diarrheal disease prevention programs.
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Diarrea Infantil/etnología , Diarrea/etnología , Medicina Tradicional , Religión , Población Rural , Adulto , Actitud Frente a la Salud , Preescolar , Diarrea/terapia , Diarrea Infantil/terapia , Femenino , Fluidoterapia , Humanos , Incidencia , Lactante , Recién Nacido , Entrevistas como Asunto/métodos , Nicaragua/epidemiología , Estudios Prospectivos , Población Rural/estadística & datos numéricosRESUMEN
Una investigacion etnografica realizada con grupos focales aymaras en el Altiplano Norte boliviano, Provincia Camacho, sobre creencias y costumbres relacionadas con enfermedades relevantes a la mortalidad evitable: Diarrea en niños y adultos, Neumonia, Tuberculosis, Sepsis puerperal. Comparacion de terminos aymaras con terminos tecnicos castellanos en cuanto a la etiologia, semiologia prevencion y tratamiento de entidades nosologicas percibidas por la poblacion. Recomendaciones concretas de traduccion del castellano al aymara requeridas en la educacion para la salud que concientizan sobre connotaciones especificamente ligadas al contexto cultural
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Humanos , Masculino , Femenino , Salud Rural/tendencias , Atención Primaria de Salud/tendencias , Bolivia/etnología , Características Culturales , Diarrea/etnología , Educación en Salud/tendencias , Conducta Materna/etnología , Medicina Tradicional , Participación de la Comunidad/tendencias , Religión , Enfermedades Respiratorias/etnología , Tuberculosis/etnologíaRESUMEN
Diarrhea is a major cause of infantile morbidity and mortality in developing countries. A community-based, case control study was conducted in a southern Mexican Mayan village for 3 weeks during the peak diarrhea period to prospectively identify the infectious agents associated with childhood diarrheal disease. Several enteropathogens were isolated from stools of 34 of 58 cases, although none was significantly associated with diarrhea. For the 24 cases from which no enteropathogens were isolated, diffuse-adhering Escherichia coli (DAEC) strains were significantly associated with diarrheal disease (P less than .02; odds ratio = 6; 95% confidence limit, 1.08-99.0). DAEC were highly heterogeneous with respect to plasmid content and serotype. Three DNA probes designed to differentiate E. coli exhibiting localized, diffuse, or aggregative adherence were compared with results from a standard HeLa cell binding assay to assess the utility of these probes in the field. This study provides evidence for the potential pathogenic capacity of DAEC and underscores the variety of diarrheal agents operating within a community.