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Background: We sought to identify resistance patterns and key drivers of recent multidrug-resistant tuberculosis (MDR-TB) transmission in a TB-prevalent area in Peru. Methods: Cross-sectional study including MDR Mycobacterium tuberculosis complex (Mtbc) strains identified in Callao-Peru between April 2017 and February 2019. Mtbc DNA was extracted for whole genome sequencing which was used for phylogenetic inference, clustering, and resistance mutation analyses. Clusters indicative of recent transmission were defined based on a strain-to-strain distance of ≤5 (D5) single nucleotide polymorphisms (SNPs). Epidemiologic factors linked to MDR-TB clustering were analyzed using Poisson regression. Findings: 171 unique MDR-Mtbc strains were included; 22 (13%) had additional fluoroquinolone resistance and were classified as pre-XDR. Six strains (3.5%) harboured bedaquiline (BDQ) resistance mutations and were classified as MDR + BDQ. 158 (92%) Mtbc strains belonged to lineage 4 and 13 (8%) to lineage 2. Using a cluster threshold of ≤5 SNPs, 98 (57%) strains were grouped in one of the 17 D5 clusters indicative of recent transmission, ranging in size from 2 to the largest cluster formed by 53 4.3.3 strains (group_1). Lineage 4.3.3 strains showed the overall highest cluster rate (43%). In multivariate analyses, current or previous imprisonment was independently associated with being part of any MDR-TB transmission clusters (adjusted prevalence ratio [aPR], 1.45; 95% CI, 1.09-1.92). Interpretation: Pre-XDR-TB emerged in more than 10% of the MDR-TB strains investigated. Transmission of 4.3.3 Mtbc strains especially of the dominant group_1 clone is a major driver of the MDR-TB epidemic in Callao. Current or previous imprisonment was linked to recent MDR-TB transmissions, indicating an important role of prisons in driving the MDR-TB epidemic. Funding: This work was supported in part by the ERANet-LAC Network of the European Union, Latin America and the Caribbean Countries on Joint Innovation and Research Activities, and FONDECYT. Additional support was received from Leibniz Science Campus Evolutionary Medicine of the Lung, the Deutsche Forschungsgemeinschaft (German Research Foundation, under Germany's Excellence Strategy-EXC 2167 Precision Medicine in Inflammation), and the Research Training Group 2501 TransEvo.
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Disease surveillance in Neotropical primates (NP) is limited by the difficulties associated with anesthetizing NP for sample collection in remote settings. Our objective was to optimize a noninvasive method of oral sampling from semicaptive NP in Peru. We offered 40 NP at Taricaya Rescue Centre in Madre de Dios, Peru ropes coated in various attractants and measured variables (acceptance of the rope, chewing time, and volume of fluid eluted from ropes) that may affect sample acquisition and quality. We preserved samples by direct freezing in liquid nitrogen or by storing samples in RNA stabilization reagent at room temperature. Sample integrity was measured by testing for mammalian cytochrome b with the use of conventional PCR. The NP successfully chewed on a rope in 82% (125/152) of trials. Overall sample integrity was high, with 96% (44/46) of samples (both directly frozen and stored in stabilization reagent) testing positive for cytochrome b. The number of times that an individual NP was exposed to the rope procedure and NP age were associated with higher acceptance rates and the NP successfully chewing on the rope. We conclude that ropes serve as a feasible noninvasive method of obtaining oral samples from NP at rescue centers and could be used in future studies to evaluate population genetics and for pathogen surveillance for population health monitoring.
Assuntos
Haplorrinos , Saliva , Manejo de Espécimes/veterinária , Envelhecimento , Animais , Comportamento Animal , Feminino , Masculino , BocaRESUMO
OBJECTIVE.: The aim of this study was to determine the percentage of symptomatic respiratory (SR) cases, according to the programmatic definition, among people who attend medical offices at first-level health facilities of the Ministry of Health in Lima under normal circumstances. The study also aims at identifying the percentage of patients with tuberculosis among the RS and among coughers over seven days. MATERIALS AND METHODS.: Cross-sectional study of patients attending consultations at 57 health centers. Patients with cough and phlegm lasting more than seven days and RS were identified and a sputum sample was taken to rule out tuberculosis by smear and culture. RESULTS.: A total of 10,421 people was surveyed. A 2.7% had cough with phlegm for ≥7 days and only 1.1% were SR; 215 patients were screened for tuberculosis. Seven (5.9%) of the RS and eight (4.8%) of the patients with a 7-14-day cough had tuberculosis. CONCLUSIONS.: The percentage of RS in the Ministry of Health's health facilities in Lima was less than the expected 5%, ranging from 0.8% in Callao to 1.5% in Lima City. The percentage of tuberculosis among coughers (lasting 7-14 days) and RS is consistent with the findings of other local studies. Consideration should be given to lowering the RS target to less than 5% and expanding tuberculosis screening to patients with cough ≥7 days at the Health Divisions with high tuberculosis incidence.
OBJETIVO.: El objetivo de este estudio fue determinar el porcentaje de sintomáticos respiratorios (SR), según la definición programática, entre las personas que en condiciones habituales acuden a consulta en los establecimientos de salud de primer nivel del Ministerio de Salud en Lima, e identificar el porcentaje de pacientes con tuberculosis entre los SR y entre tosedores de más de siete días. MATERIALES Y MÉTODOS.: Estudio transversal en pacientes que acudieron a consulta en 57 centros de salud. Se identificó a los pacientes con tos y expectoración de más de siete días y SR, a quienes se les tomó una muestra de esputo para descarte de tuberculosis mediante baciloscopía y cultivos. RESULTADOS.: Se encuestaron 10 421 personas. El 2,7% presentaron tos con expectoración por ≥7 días y solo el 1,1% fueron SR; 215 pacientes fueron examinados para descarte de tuberculosis. Siete (5,9%) de los SR y ocho (4,8%) de los pacientes con tos de 7-14 días tuvieron tuberculosis. CONCLUSIÓN.: El porcentaje de SR en establecimientos de salud del Ministerio de Salud en Lima fue menor al 5% esperado, con un rango de 0,8% en Callao hasta 1,5% en Lima Ciudad. El porcentaje de tuberculosis entre tosedores de 7-14 días y SR concuerda con el hallado en otros estudios locales. Se debe considerar la posibilidad de disminuir la meta de SR a menos del 5% y ampliar el despistaje de tuberculosis a pacientes con tos ≥7 días en las Direcciones de Salud con altas incidencias de tuberculosis.
Assuntos
Tosse/epidemiologia , Programas de Rastreamento/métodos , Escarro/microbiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/epidemiologia , Inquéritos e Questionários , Tuberculose/diagnóstico , Adulto JovemRESUMO
RESUMEN Objetivo. El objetivo de este estudio fue determinar el porcentaje de sintomáticos respiratorios (SR), según la definición programática, entre las personas que en condiciones habituales acuden a consulta en los establecimientos de salud de primer nivel del Ministerio de Salud en Lima, e identificar el porcentaje de pacientes con tuberculosis entre los SR y entre tosedores de más de siete días. Materiales y métodos. Estudio transversal en pacientes que acudieron a consulta en 57 centros de salud. Se identificó a los pacientes con tos y expectoración de más de siete días y SR, a quienes se les tomó una muestra de esputo para descarte de tuberculosis mediante baciloscopía y cultivos. Resultados. Se encuestaron 10 421 personas. El 2,7% presentaron tos con expectoración por ≥7 días y solo el 1,1% fueron SR; 215 pacientes fueron examinados para descarte de tuberculosis. Siete (5,9%) de los SR y ocho (4,8%) de los pacientes con tos de 7-14 días tuvieron tuberculosis. Conclusión. El porcentaje de SR en establecimientos de salud del Ministerio de Salud en Lima fue menor al 5% esperado, con un rango de 0,8% en Callao hasta 1,5% en Lima Ciudad. El porcentaje de tuberculosis entre tosedores de 7-14 días y SR concuerda con el hallado en otros estudios locales. Se debe considerar la posibilidad de disminuir la meta de SR a menos del 5% y ampliar el despistaje de tuberculosis a pacientes con tos ≥7 días en las Direcciones de Salud con altas incidencias de tuberculosis.
ABSTRACT Objective. The aim of this study was to determine the percentage of symptomatic respiratory (SR) cases, according to the programmatic definition, among people who attend medical offices at first-level health facilities of the Ministry of Health in Lima under normal circumstances. The study also aims at identifying the percentage of patients with tuberculosis among the RS and among coughers over seven days. Materials and Methods. Cross-sectional study of patients attending consultations at 57 health centers. Patients with cough and phlegm lasting more than seven days and RS were identified and a sputum sample was taken to rule out tuberculosis by smear and culture. Results. A total of 10,421 people was surveyed. A 2.7% had cough with phlegm for ≥7 days and only 1.1% were SR; 215 patients were screened for tuberculosis. Seven (5.9%) of the RS and eight (4.8%) of the patients with a 7-14-day cough had tuberculosis. Conclusions. The percentage of RS in the Ministry of Health's health facilities in Lima was less than the expected 5%, ranging from 0.8% in Callao to 1.5% in Lima City. The percentage of tuberculosis among coughers (lasting 7-14 days) and RS is consistent with the findings of other local studies. Consideration should be given to lowering the RS target to less than 5% and expanding tuberculosis screening to patients with cough ≥7 days at the Health Divisions with high tuberculosis incidence.
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Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Escarro/microbiologia , Tuberculose/epidemiologia , Programas de Rastreamento/métodos , Tosse/epidemiologia , Peru/epidemiologia , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/epidemiologia , Tuberculose/diagnóstico , Estudos Transversais , Inquéritos e QuestionáriosRESUMO
Este artículo hace breve referencia a los antecedentes del concepto de «Una Salud¼ en el contexto mundial y peruano, y la forma como esta perspectiva holística de salud sirvió de fundamento para la creación del Centro de Investigaciones, Tecnológicas, Biomédicas y Medioambientales (CITBM) en la Universidad Nacional Mayor de San Marcos. Seguidamente, describe el proyecto InterACTION Labs, una de las experiencias que usa el enfoque de «Una Salud¼, liderado por el CITBM, la Universidad de Washington y Traction, esta última una organización no gubernamental enfocada en el diseño e investigación en salud y ecología. InterACTION Labs es un programa de diseño e investigación-acción transdisciplinaria (TDAR, por sus siglas en inglés) que se desarrolla en «Claverito¼, una comunidad flotante en la ciudad de Iquitos en la Amazonía peruana, y que se sustenta en la hipótesis de que el entorno construido es determinante de la salud, tanto del ser humano como de otras especies (aves, reptiles, plantas, etc.). También, discute el concepto de entorno construido en relación a la teoría y práctica de la salud pública, la arquitectura paisajista, la epidemiología y otros campos de la salud y del medio ambiente. Finalmente, reflexiona en los logros y desafíos del proyecto que comenzó en 2015, y describe el plan de trabajo para los próximos años, en los que se propone extender el programa y el uso del enfoque de «Una Salud¼ para promover la salud humana, ecológica y ambiental en el Perú y otras partes del mundo.
This article makes brief reference to the background of the "One Health" concept in the global and Peruvian context, and to the way in which this holistic health perspective served as the foundation for the creation of the Center for Technological, Biomedical, and Environmental Research (CITBM) at Universidad Nacional Mayor de San Marcos. Additionally, it describes the InterACTION Labs project, one of the experiences using the "One Health" approach, led by CITBM, the University of Washington, and Traction, an NGO focused on design and research in health and ecology topics. InterACTION Labs is a design and transdisciplinary action-research (TDAR) program developed in "Claverito," a floating community in the city of Iquitos in the Peruvian Amazon, based on the hypothesis that the built environment is a health determinant for both humans and other species (birds, reptiles, plants, etc.). It also discusses the concept of 'built environment' as related to the theory and practice of public health, landscape architecture, epidemiology, and other health and environmental fields. Finally, it reflects on the achievements and challenges of the project that began in 2015, and describes the work plan for the coming years, with a proposal to extend the program and use the "One Health" approach to promote human, ecological, and environmental health in Peru and other parts of the world.
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Animais , Humanos , Saúde Única , Peru , Epidemiologia , Ecologia , Invenções , Ambiente Construído , Saúde HolísticaRESUMO
A mediados del siglo XIX se empezó a enfocar el concepto de Demencia, como una entidad irreversible asociada a la edad, Esquirol fue uno de los primeros en plantear una aproximación descriptiva del cuadro clínico, y Bayle el primero en proponer Demencia como una enfermedad atribuible a lesiones en el sistema nervioso central. Fue alrededor del año 1900, que Alois Alzheimer precisó las lesiones patológicas de dos entidades clínicas distintas, la primera descrita por él mismo, y la segunda por Arnold Pick (conocidas hoy como enfermedad de Alzheimer y demencia frontotemporal respectivamente). Conforme progresaron las técnicas de imágenes cerebrales y estudios de líquido cefalo-raquídeo fueron mejorando los criterios de diagnóstico para los diversos tipos de demencia, con un enfoque clínico-biológico. Las recomendaciones más recientes, sin embargo proponen un enfoque exclusivamente biológico de la enfermedad de Alzheimer.
By the middle of the 19th Century the concept of Dementia, as an irreversible entity associated with the aging process, came into focus thanks to the work of Esquirol, who was one of the first to propose a descriptive approach to the clinical picture, and Bayle, who was the first to suggest that Dementia was an illness attributable to injuries of the Central Nervous System. Around 1900, Alois Alzheimer described the pathology of the injuries of two distinct entities, the first described by him, and the second by Arnold Pick (known today as Alzheimer´s Disease and Frontotemporal Dementia respectively). The advances in brain-imaging techniques and studies of cerebrospinal fluid led to improvements of the clinical diagnostic criteria for the diverse types of dementia, with a clinical- biological focus. Nevertheless, the most recent recommendations suggest Alzheimer´s disease to be approached from a purely biological focus.
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This article makes brief reference to the background of the "One Health" concept in the global and Peruvian context, and to the way in which this holistic health perspective served as the foundation for the creation of the Center for Technological, Biomedical, and Environmental Research (CITBM) at Universidad Nacional Mayor de San Marcos. Additionally, it describes the InterACTION Labs project, one of the experiences using the "One Health" approach, led by CITBM, the University of Washington, and Traction, an NGO focused on design and research in health and ecology topics. InterACTION Labs is a design and transdisciplinary action-research (TDAR) program developed in "Claverito," a floating community in the city of Iquitos in the Peruvian Amazon, based on the hypothesis that the built environment is a health determinant for both humans and other species (birds, reptiles, plants, etc.). It also discusses the concept of 'built environment' as related to the theory and practice of public health, landscape architecture, epidemiology, and other health and environmental fields. Finally, it reflects on the achievements and challenges of the project that began in 2015, and describes the work plan for the coming years, with a proposal to extend the program and use the "One Health" approach to promote human, ecological, and environmental health in Peru and other parts of the world.
Este artículo hace breve referencia a los antecedentes del concepto de "Una Salud" en el contexto mundial y peruano, y la forma como esta perspectiva holística de salud sirvió de fundamento para la creación del Centro de Investigaciones, Tecnológicas, Biomédicas y Medioambientales (CITBM) en la Universidad Nacional Mayor de San Marcos. Seguidamente, describe el proyecto InterACTION Labs, una de las experiencias que usa el enfoque de "Una Salud", liderado por el CITBM, la Universidad de Washington y Traction, esta última una organización no gubernamental enfocada en el diseño e investigación en salud y ecología. InterACTION Labs es un programa de diseño e investigación-acción transdisciplinaria (TDAR, por sus siglas en inglés) que se desarrolla en "Claverito", una comunidad flotante en la ciudad de Iquitos en la Amazonía peruana, y que se sustenta en la hipótesis de que el entorno construido es determinante de la salud, tanto del ser humano como de otras especies (aves, reptiles, plantas, etc.). También, discute el concepto de entorno construido en relación a la teoría y práctica de la salud pública, la arquitectura paisajista, la epidemiología y otros campos de la salud y del medio ambiente. Finalmente, reflexiona en los logros y desafíos del proyecto que comenzó en 2015, y describe el plan de trabajo para los próximos años, en los que se propone extender el programa y el uso del enfoque de "Una Salud" para promover la salud humana, ecológica y ambiental en el Perú y otras partes del mundo.
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Saúde Única , Animais , Ambiente Construído , Ecologia , Epidemiologia , Saúde Holística , Humanos , Invenções , PeruRESUMO
We estimated the prevalence of human immunodeficiency virus (HIV) disclosure in children from a prospective observational cohort study conducted at clinical sites in Brazil, Mexico, and Peru. Fewer than half of the children in this study knew their HIV status, which highlights the need for better strategies for disclosure that are age and culturally appropriate.
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Infecções por HIV/epidemiologia , Adolescente , Fatores Etários , Brasil/epidemiologia , Criança , Pré-Escolar , Revelação/estatística & dados numéricos , Escolaridade , Feminino , Infecções por HIV/psicologia , Soropositividade para HIV/epidemiologia , Soropositividade para HIV/psicologia , Humanos , Masculino , México/epidemiologia , Peru/epidemiologia , Prevalência , Estudos ProspectivosRESUMO
[English]. Objetivo. Determinar la efectividad de la Estrategia para el Crecimiento y Desarrollo Integral (ECDI) de World Vision Perú sobre la anemia, desnutrición, desarrollo psicomotor y cuidado y protección infantil en niños menores de tres años de edad que residían en tres comunidades rurales de la Región Ayacucho del Perú. Métodos. Se realizó un estudio cuasiexperimental en tres distritos rurales de la región Ayacucho, Perú. La medición de anemia se realizó con sangre capilar y el analizador HemoCue®, con ajuste de los valores de hemoglobina según a la altitud. La desnutrición se midió a través de los indicadores antropométricos de talla y peso; para ello se utilizó la herramienta Anthro de la Organización Mundial de la Salud. El desarrollo psicomotor se midió mediante el Test Abreviado del Ministerio de Salud del Perú. El cuidado y protección de los niños se midió a través de una ficha especialmente elaborada para este fin. Se realizaron tres mediciones, la línea basal en mayo del 2013, la medición intermedia en noviembre del mismo año y la final en mayo del 2014. En total, 283 niños tuvieron dos o más mediciones incluida la medición final y 205 tuvieron las tres mediciones. Resultados. El análisis multivariado para medidas repetidas mostró una efectividad estimada de la ECDI para reducir la anemia de 33,1% (intervalo de confianza del 95%: 1,0%-54,7%) ajustada para la edad, sexo, consumo de alimentos ricos en hierro, consumo de alimentos potenciadores de la absorción de hierro, consumo de alimento inhibidores de la absorción de hierro, haber recibido suplementación de hierro en los últimos seis meses y haber participado del Programa Cuna Más. Conclusiones. La ECDI fue efectiva para mejorar la nutrición de los menores de 36 meses de edad a través de la reducción de la anemia y el incremento del consumo de potenciadores de la absorción de hierro. Las intervenciones que incluyen componentes educativos y de seguimiento comunitarios podrían ser de gran ayuda para combatir la anemia en los niños menores de 36 meses de edad en comunidades rurales.
[Español]. Objective. Determine the effectiveness of the Integrated Growth and Development Strategy (ECDI, Spanish acronym) of World Vision Peru on anemia, malnutrition, psychomotor development, and child care and protection in children aged <3 years living in three rural communities of Ayacucho Region, Peru. Methods. A quasi-experiment was carried out in three rural districts of Ayacucho Region, Peru. Anemia was measured using capillary blood and the HemoCue® analyzer, with hemoglobin values adjusted for altitude. Malnutrition was measured with anthropometric indicators for height and weight, using the World Health Organization’s Anthro software. Psychomotor development was measured with the Abbreviated Test of the Ministry of Health of Peru. Child care and protection was measured using a form specifically designed for this purpose. Three measurements were carried out: baseline in May 2013, midpoint in November 2013, and final in May 2014. In total, 283 children had two or more measurements including the final measurement, and 205 had all three measurements. Results. Multivariate analysis for repeated measures showed that ECDI had an estimated 33.1% effectiveness in reducing anemia (95% CI: 1.0%-54.7%), adjusted for age, sex, consumption of iron-rich foods, consumption of iron-absorption-enhancing foods, consumption of iron-absorption-inhibiting foods, having received iron supplementation in the last six months, and having participated in the Cuna Más Program. Conclusions. ECDI was effective in improving nutrition in children aged <36 months through anemia reduction and increased consumption of iron-absorption enhancers. Interventions that include educational and community monitoring components could be of great assistance to combating anemia in children aged <36 months in rural communities.
[Português]. Objetivo. Determinar a efetividade da Estratégia de Crescimento e Desenvolvimento Integral (ECDI) da World Vision Peru para anemia, desnutrição, desenvolvimento psicomotor e atenção e proteção infantis em crianças menores de 3 anos de idade em três comunidades rurais. Métodos. Foi realizado estudo quase-experimental em três distritos rurais da região de Ayacucho, no Peru. A avaliação da anemia foi realizada em sangue capilar com o uso do analisador HemoCue®, com correção dos valores de hemoglobina Segundo a altitude. A desnutrição foi avaliada segundo indicadores antropométricos de tamanho e peso, com o uso da ferramenta Anthro elaborada pela Organização Mundial da Saúde (OMS). O desenvolvimento psicomotor foi avaliado com o Teste Abreviado do Ministério da Saúde do Peru. A atenção e a proteção infantis foram avaliadas com o uso de uma ficha elaborada para esta finalidade. Foram realizadas três avaliações, com a linha de base em maio de 2013, a avaliação intermediária sendo realizada em novembro deste mesmo ano e a avaliação final, em maio de 2014. Ao todo, 283 crianças passaram por duas ou mais avaliações, incluindo a avaliação final, e 205 passaram por três avaliações. Resultados. Na análise multivariada de medidas repetidas, a efetividade estimada da ECDI de reduzir a anemia foi de 33,1% (intervalo de confiança de 95%: 1,0%-54,7%), corrigida para idade, sexo, consumo de alimentos ricos em ferro, consumo de alimentos potenciadores da absorção de ferro, consumo de alimentos inibidores da absorção de ferro, suplementação de ferro nos últimos seis meses e participação no Programa Cuna Más (programa nacional de desenvolvimento infantil). Conclusões. A ECDI demonstrou efetividade para melhorar a nutrição das crianças menores de 36 meses com a redução da anemia e o aumento do consumo de potenciadores da absorção de ferro. Intervenções com componentes educacionais e acompanhamento comunitário podem contribuir consideravelmente para combater a anemia em crianças menores de 36 meses em comunidades rurais.
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Cuidado da Criança , Cuidado do Lactente , Anemia , Cuidado da Criança , Cuidado do Lactente , Crescimento e Desenvolvimento , Crescimento e DesenvolvimentoRESUMO
BACKGROUND: Adults of the peri-urban Peruvian shantytown of Lomas de Zapallal have a high prevalence of risk factors for developing cardiovascular disease (CVD)-likely due to behavioral choices established during childhood and adolescence. To guide the development of community-based risk reduction programs, we assessed the prevalence of risk factors for developing CVD among adolescents. METHODS: We collected cross sectional data from adolescents of Peruvian peri-urban shantytown to evaluate four domains of CVD risk factors: (1) clinical (blood pressure, fasting blood glucose, and blood lipids), (2) anthropometric (height, weight, and waist circumference), (3) behavioral (physical activity, diet, and substance abuse), and (4) psychosocial (mental health and violence). RESULTS: We enrolled 275 adolescents (56.4% female, mean age 14 years). Prevalence of overweight or obese status was 27.8%. High blood pressure was more common in males (37.4%) than females (20.5%) (p = 0.002). Total cholesterol was elevated (>170 mg/dL) in nearly half (45.5%) of the adolescents, and 71% had impaired fasting blood glucose (>100 mg/dL). Females were less likely to exercise daily (95.4%) than males (84.2%) (p = 0.002) but reported higher rates of depression (66.4%), anhedonia (67.6%), and self-harm behavior (37.9%) (all p < 0.01). CONCLUSIONS: Adolescents living in the peri-urban population of Puente Piedra had high prevalence of risk factors for future development of CVD; preventative efforts focused on improving nutrition, increasing physical inactivity, and addressing mental health conditions could reduce such risk factors.
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Comportamento do Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Doenças Cardiovasculares/etiologia , Dieta/efeitos adversos , Obesidade Infantil/fisiopatologia , Comportamento Sedentário , Saúde Suburbana , Adolescente , Comportamento do Adolescente/etnologia , Fenômenos Fisiológicos da Nutrição do Adolescente/etnologia , Índice de Massa Corporal , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Estudos Transversais , Dieta/etnologia , Feminino , Intolerância à Glucose/epidemiologia , Intolerância à Glucose/etnologia , Intolerância à Glucose/etiologia , Intolerância à Glucose/fisiopatologia , Inquéritos Epidemiológicos , Humanos , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/etnologia , Hipercolesterolemia/etiologia , Hipercolesterolemia/fisiopatologia , Hipertensão/epidemiologia , Hipertensão/etnologia , Hipertensão/etiologia , Hipertensão/fisiopatologia , Masculino , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/etnologia , Obesidade Abdominal/etiologia , Obesidade Abdominal/fisiopatologia , Sobrepeso/epidemiologia , Sobrepeso/etnologia , Sobrepeso/etiologia , Sobrepeso/fisiopatologia , Obesidade Infantil/epidemiologia , Obesidade Infantil/etnologia , Obesidade Infantil/etiologia , Peru/epidemiologia , Áreas de Pobreza , Prevalência , Fatores de Risco , Comportamento Sedentário/etnologia , Fatores Sexuais , Saúde Suburbana/etnologia , Circunferência da CinturaRESUMO
OBJECTIVE: Determine the effectiveness of the Integrated Growth and Development Strategy (ECDI, Spanish acronym) of World Vision Peru on anemia, malnutrition, psychomotor development, and child care and protection in children aged <3 years living in three rural communities of Ayacucho Region, Peru. METHODS: A quasi-experiment was carried out in three rural districts of Ayacucho Region, Peru. Anemia was measured using capillary blood and the HemoCue® analyzer, with hemoglobin values adjusted for altitude. Malnutrition was measured with anthropometric indicators for height and weight, using the World Health Organization's Anthro software. Psychomotor development was measured with the Abbreviated Test of the Ministry of Health of Peru. Child care and protection was measured using a form specifically designed for this purpose. Three measurements were carried out: baseline in May 2013, midpoint in November 2013, and final in May 2014. In total, 283 children had two or more measurements including the final measurement, and 205 had all three measurements. RESULTS: Multivariate analysis for repeated measures showed that ECDI had an estimated 33.1% effectiveness in reducing anemia (95% CI: 1.0%-54.7%), adjusted for age, sex, consumption of iron-rich foods, consumption of iron-absorption-enhancing foods, consumption of iron-absorption-inhibiting foods, having received iron supplementation in the last six months, and having participated in the Cuna Más Program. CONCLUSIONS: ECDI was effective in improving nutrition in children aged <36 months through anemia reduction and increased consumption of iron-absorption enhancers. Interventions that include educational and community monitoring components could be of great assistance to combating anemia in children aged <36 months in rural communities.
OBJETIVO: Determinar a efetividade da Estratégia de Crescimento e Desenvolvimento Integral (ECDI) da World Vision Peru para anemia, desnutrição, desenvolvimento psicomotor e atenção e proteção infantis em crianças menores de 3 anos de idade em três comunidades rurais. MÉTODOS: Foi realizado estudo quase-experimental em três distritos rurais da região de Ayacucho, no Peru. A avaliação da anemia foi realizada em sangue capilar com o uso do analisador HemoCue®, com correção dos valores de hemoglobina segundo a altitude. A desnutrição foi avaliada segundo indicadores antropométricos de tamanho e peso, com o uso da ferramenta Anthro elaborada pela Organização Mundial da Saúde (OMS). O desenvolvimento psicomotor foi avaliado com o Teste Abreviado do Ministério da Saúde do Peru. A atenção e a proteção infantis foram avaliadas com o uso de uma ficha elaborada para esta finalidade. Foram realizadas três avaliações, com a linha de base em maio de 2013, a avaliação intermediária sendo realizada em novembro deste mesmo ano e a avaliação final, em maio de 2014. Ao todo, 283 crianças passaram por duas ou mais avaliações, incluindo a avaliação final, e 205 passaram por três avaliações. RESULTADOS: Na análise multivariada de medidas repetidas, a efetividade estimada da ECDI de reduzir a anemia foi de 33,1% (intervalo de confiança de 95%: 1,0%-54,7%), corrigida para idade, sexo, consumo de alimentos ricos em ferro, consumo de alimentos potenciadores da absorção de ferro, consumo de alimentos inibidores da absorção de ferro, suplementação de ferro nos últimos seis meses e participação no Programa Cuna Más (programa nacional de desenvolvimento infantil). CONCLUSÕES: A ECDI demonstrou efetividade para melhorar a nutrição das crianças menores de 36 meses com a redução da anemia e o aumento do consumo de potenciadores da absorção de ferro. Intervenções com componentes educacionais e acompanhamento comunitário podem contribuir consideravelmente para combater a anemia em crianças menores de 36 meses em comunidades rurais.
RESUMO
RESUMEN Objetivo Determinar la efectividad de la Estrategia para el Crecimiento y Desarrollo Integral (ECDI) de World Vision Perú sobre la anemia, desnutrición, desarrollo psicomotor y cuidado y protección infantil en niños menores de tres años de edad que residían en tres comunidades rurales de la Región Ayacucho del Perú. Métodos Se realizó un estudio cuasiexperimental en tres distritos rurales de la región Ayacucho, Perú. La medición de anemia se realizó con sangre capilar y el analizador HemoCue®, con ajuste de los valores de hemoglobina según a la altitud. La desnutrición se midió a través de los indicadores antropométricos de talla y peso; para ello se utilizó la herramienta Anthro de la Organización Mundial de la Salud. El desarrollo psicomotor se midió mediante el Test Abreviado del Ministerio de Salud del Perú. El cuidado y protección de los niños se midió a través de una ficha especialmente elaborada para este fin. Se realizaron tres mediciones, la línea basal en mayo del 2013, la medición intermedia en noviembre del mismo año y la final en mayo del 2014. En total, 283 niños tuvieron dos o más mediciones incluida la medición final y 205 tuvieron las tres mediciones. Resultados El análisis multivariado para medidas repetidas mostró una efectividad estimada de la ECDI para reducir la anemia de 33,1% (intervalo de confianza del 95%: 1,0%-54,7%) ajustada para la edad, sexo, consumo de alimentos ricos en hierro, consumo de alimentos potenciadores de la absorción de hierro, consumo de alimento inhibidores de la absorción de hierro, haber recibido suplementación de hierro en los últimos seis meses y haber participado del Programa Cuna Más. Conclusiones La ECDI fue efectiva para mejorar la nutrición de los menores de 36 meses de edad a través de la reducción de la anemia y el incremento del consumo de potenciadores de la absorción de hierro. Las intervenciones que incluyen componentes educativos y de seguimiento comunitarios podrían ser de gran ayuda para combatir la anemia en los niños menores de 36 meses de edad en comunidades rurales.
Objective Determine the effectiveness of the Integrated Growth and Development Strategy (ECDI, Spanish acronym) of World Vision Peru on anemia, malnutrition, psychomotor development, and child care and protection in children aged <3 years living in three rural communities of Ayacucho Region, Peru. Methods A quasi-experiment was carried out in three rural districts of Ayacucho Region, Peru. Anemia was measured using capillary blood and the HemoCue® analyzer, with hemoglobin values adjusted for altitude. Malnutrition was measured with anthropometric indicators for height and weight, using the World Health Organization's Anthro software. Psychomotor development was measured with the Abbreviated Test of the Ministry of Health of Peru. Child care and protection was measured using a form specifically designed for this purpose. Three measurements were carried out: baseline in May 2013, midpoint in November 2013, and final in May 2014. In total, 283 children had two or more measurements including the final measurement, and 205 had all three measurements. Results Multivariate analysis for repeated measures showed that ECDI had an estimated 33.1% effectiveness in reducing anemia (95% CI: 1.0%-54.7%), adjusted for age, sex, consumption of iron-rich foods, consumption of iron-absorption-enhancing foods, consumption of iron-absorption-inhibiting foods, having received iron supplementation in the last six months, and having participated in the Cuna Más Program. Conclusions ECDI was effective in improving nutrition in children aged <36 months through anemia reduction and increased consumption of iron-absorption enhancers. Interventions that include educational and community monitoring components could be of great assistance to combating anemia in children aged <36 months in rural communities.
RESUMO Objetivo Determinar a efetividade da Estratégia de Crescimento e Desenvolvimento Integral (ECDI) da World Vision Peru para anemia, desnutrição, desenvolvimento psicomotor e atenção e proteção infantis em crianças menores de 3 anos de idade em três comunidades rurais. Métodos Foi realizado estudo quase-experimental em três distritos rurais da região de Ayacucho, no Peru. A avaliação da anemia foi realizada em sangue capilar com o uso do analisador HemoCue®, com correção dos valores de hemoglobina segundo a altitude. A desnutrição foi avaliada segundo indicadores antropométricos de tamanho e peso, com o uso da ferramenta Anthro elaborada pela Organização Mundial da Saúde (OMS). O desenvolvimento psicomotor foi avaliado com o Teste Abreviado do Ministério da Saúde do Peru. A atenção e a proteção infantis foram avaliadas com o uso de uma ficha elaborada para esta finalidade. Foram realizadas três avaliações, com a linha de base em maio de 2013, a avaliação intermediária sendo realizada em novembro deste mesmo ano e a avaliação final, em maio de 2014. Ao todo, 283 crianças passaram por duas ou mais avaliações, incluindo a avaliação final, e 205 passaram por três avaliações. Resultados Na análise multivariada de medidas repetidas, a efetividade estimada da ECDI de reduzir a anemia foi de 33,1% (intervalo de confiança de 95%: 1,0%-54,7%), corrigida para idade, sexo, consumo de alimentos ricos em ferro, consumo de alimentos potenciadores da absorção de ferro, consumo de alimentos inibidores da absorção de ferro, suplementação de ferro nos últimos seis meses e participação no Programa Cuna Más (programa nacional de desenvolvimento infantil). Conclusões A ECDI demonstrou efetividade para melhorar a nutrição das crianças menores de 36 meses com a redução da anemia e o aumento do consumo de potenciadores da absorção de ferro. Intervenções com componentes educacionais e acompanhamento comunitário podem contribuir consideravelmente para combater a anemia em crianças menores de 36 meses em comunidades rurais.
Assuntos
Humanos , Lactente , Cuidado da Criança , Cuidado do Lactente , Anemia/prevenção & controle , PeruRESUMO
BACKGROUND: An estimated 863 million people-a third of the world's urban population-live in slums, yet there is little information on the disease burden in these settings, particularly regarding chronic preventable diseases. METHODS: From March to May 2012, we conducted a cluster randomized survey to estimate the prevalence of noncommunicable diseases (NCDs) and associated risk factors in a peri-urban shantytown north of Lima, Peru. Field workers administered a questionnaire that included items from the WHO World Health Survey and the WHO STEPS survey of chronic disease risk factors. We used logistic regression to assess the associations of NCDs and related risk factors with age and gender. We accounted for sampling weights and the clustered sampling design using statistical survey methods. RESULTS: A total of 142 adults were surveyed and had a weighted mean age of 36 years (range 18-81). The most prevalent diseases were depression (12%) and chronic respiratory disease (8%), while lifetime prevalence of cancer, arthritis, myocardial infarction, and diabetes were all less than 5%. Fifteen percent of respondents were hypertensive and the majority (67%) was unaware of their condition. Being overweight or obese was common for both genders (53%), but abdominal obesity was more prevalent in women (54% vs. 10% in men, p < 0.001). Thirty-five percent of men binge drank and 34% reported current smoking; these behaviors were less common among women (4% binge drank, p < 0.001; 8% smoked, p = 0.002). Increasing age was associated with an increased risk of abdominal obesity (Odds Ratio (OR) = 1.04, 95% CI = 1.01, 1.07, p = 0.02), hypertension (OR = 1.06, 95% CI = 1.02, 1.10, p = 0.006), arthritis (OR = 1.07, 95% CI = 1.03, 1.11, p < 0.001) and cancer (OR = 1.13, 95% CI = 1.07, 1.20, p < 0.001) in adjusted models. The prevalences of other NCDs and related risk factors were similar when stratified by age or gender. CONCLUSIONS: This study underlines the important burden of noncommunicable disease in informal settlements in Peru and suggests that prevention and treatment interventions could be optimized according to age and gender.
Assuntos
Comportamentos Relacionados com a Saúde , Nível de Saúde , Áreas de Pobreza , População Urbana , Adolescente , Adulto , Idoso , Consumo Excessivo de Bebidas Alcoólicas , Depressão/epidemiologia , Depressão/etiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/etiologia , Peru/epidemiologia , Prevalência , Características de Residência , Fatores de Risco , Fumar , Inquéritos e Questionários , Adulto JovemRESUMO
Objetivos. Estimar la incidencia de VIH en la población adulta del Perú, 2010, y analizar su distribución según comportamientos de riesgo. Materiales y métodos. Se aplicó el modelo de ONUSIDA según modos de transmisión (MoT). Los datos fueron obtenidos de la revisión detallada de 59 documentos (1984 - 2008). También se analizó bases de datos nacionales para obtener datos específicos. La selección final de los datos fue validada por el grupo técnico y un grupo de expertos. Después de la consulta con expertos, se corrigieron los valores y se realizó un análisis de incertidumbre. El modelo fue ajustado a la prevalencia nacional del 2009 (0,45%). Resultados. La incidencia estimada para el 2010 fue de 0,03%, (4346 nuevas infecciones). El 84% de nuevas infecciones se concentra en grupos de mayor riesgo: hombres que tienen sexo con hombres (55%) y personas que tienen sexo casual heterosexual (6,2%). El 16% restante corresponde a la población heterosexual de bajo riesgo. La transmisión heterosexual es el 43% de nuevos casos, y dentro de estos el 18% corresponde a parejas femeninas de sujetos de alto riesgo. Solo 2,2% de casos está relacionado al trabajo sexual femenino y 1,0% a usuarios de drogas inyectables. Conclusiones. El modelo proporciona una estimación de la incidencia y su distribución entre los grupos de riesgo según el modo de transmisión, consistente con los reportes de casos de VIH. El modelo permite crear escenarios para ayudar a la toma de decisiones y formulación de políticas, así como para vigilancia y planificación de la prevención y control.
Objectives. To estimate HIV incidence in the adult population of Peru, 2010, and analyze its distribution based on risk behavior. Materials and methods. The UNAIDS model was applied based on the modes of transmission (MoT). The information was obtained from the review detailed in 59 documents (1984 - 2008). National databases were also analyzed to obtain specific data. Final selection of data was validated by the technical group and a group of experts. After consultation with experts, values were corrected and an uncertainty analysis was conducted. The model was adjusted to 2009 national prevalence (0.45%). Results. Incidence estimated for 2010 was 0.03%, (4346 new infections). 84% of new infections concentrate on higher risk groups: men who have sex with men (55%) and people who have casual sex with heterosexuals (6.2%). The remaining 16% corresponds to low-risk heterosexual population. Heterosexual transmission accounts for 43% of new cases, 18% of which corresponds to female partners of high risk individuals. Only 2.2% of cases is related to female sexual work and 1.0% to injection drug users. Conclusions. The model provides an estimation of the incidence and its distribution among risk groups according to the mode of transmission, consistent with the HIV case reporting. The model creates scenarios to help decision making and policy formulation, as well as surveillance and planning of prevention and control.
Assuntos
Adulto , Feminino , Humanos , Masculino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Modelos Teóricos , Heterossexualidade , Incidência , Peru/epidemiologia , Comportamento SexualRESUMO
OBJECTIVES: To estimate HIV incidence in the adult population of Peru, 2010, and analyze its distribution based on risk behavior. MATERIALS AND METHODS: The UNAIDS model was applied based on the modes of transmission (MoT). The information was obtained from the review detailed in 59 documents (1984 - 2008). National databases were also analyzed to obtain specific data. Final selection of data was validated by the technical group and a group of experts. After consultation with experts, values were corrected and an uncertainty analysis was conducted. The model was adjusted to 2009 national prevalence (0.45%). RESULTS: Incidence estimated for 2010 was 0.03%, (4346 new infections). 84% of new infections concentrate on higher risk groups: men who have sex with men (55%) and people who have casual sex with heterosexuals (6.2%). The remaining 16% corresponds to low-risk heterosexual population. Heterosexual transmission accounts for 43% of new cases, 18% of which corresponds to female partners of high risk individuals. Only 2.2% of cases is related to female sexual work and 1.0% to injection drug users. CONCLUSIONS: The model provides an estimation of the incidence and its distribution among risk groups according to the mode of transmission, consistent with the HIV case reporting. The model creates scenarios to help decision making and policy formulation, as well as surveillance and planning of prevention and control.
Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Modelos Teóricos , Adulto , Feminino , Heterossexualidade , Humanos , Incidência , Masculino , Peru/epidemiologia , Comportamento SexualRESUMO
Human T-cell lymphotropic virus type 1(HTLV-1) is associated with adult T-cell leukemia, tropical spastic paraparesis, and other immune-mediated diseases. There are reports of groups with high prevalences of HTLV-1 infection in Peru, but there is limited knowledge of the epidemiology of infection or which routes of infection are most important. We studied 2,492 women presenting to a large maternity hospital in Lima for prenatal, delivery, or abortion services. HTLV-1 seropositivity was confirmed in 42 women (1.7%; 95% confidence interval, 1.2-2.2). Seroprevalence increased with age but did not vary by region of birth or recency of migration to Lima. Age greater than 30 years and sexual intercourse before 20 years of age were strongly and independently associated with infection. History of abortion and history of transfusion were of borderline significance. Women whose male partner had a characteristic that might be a marker for risk of sexually transmitted infections were also more likely to be infected. HTLV-1 is common among Peruvians throughout the country and is maintained by a low level of neonatally acquired infection that is amplified by sexual transmission. In addition to screening of the blood supply, instituted in 1997, programs designed to reduce neonatal and sexual transmission should be effective.
Assuntos
Doenças Endêmicas , Infecções por HTLV-I/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Aborto Induzido , Adolescente , Adulto , Fatores Etários , Transfusão de Sangue , Estudos Transversais , Feminino , Geografia , Humanos , Análise Multivariada , Peru/epidemiologia , Gravidez , Fatores de Risco , Estudos Soroepidemiológicos , Comportamento Sexual , Parceiros SexuaisRESUMO
OBJECTIVES: To determine age-specific seroprevalence, risk factors, and risk markers for heterosexually-acquired HIV infection among pregnant women. DESIGN: Cross-sectional study of 12436 consecutive pregnant women in Lima, Peru in 1996-1997. METHODS: Standardized interviews, serologic tests for HIV and syphilis, bivariate and multivariate analysis. RESULTS: HIV seropositivity was confirmed in 58 women (0.5%). Only 22.6% were married, and only 12% of HIV infected women reported >or=2 sex partners ever. In multivariate analyses HIV infection was associated with: short duration of current relationship; two risk behaviors of women themselves (early onset of sexual activity and number of past sexual relationships); women's perceptions of two risk behaviors of partners (partner is a 'womanizer,' and partner uses illegal drugs); inadequate prenatal care; and four additional risk factors or markers (history of sexually transmitted disease, tuberculosis, or abortion in the women; and diagnosis of HIV/AIDS in a partner). CONCLUSIONS: HIV infection was related both to women's own risk behaviors and to the perceived risk behaviors of their sexual partners. Underlying societal factors related to heterosexual HIV infection, including deferral of marriage, warrant further study.
Assuntos
Infecções por HIV/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Fatores Etários , Feminino , Soroprevalência de HIV , Humanos , Masculino , Análise Multivariada , Peru/epidemiologia , Gravidez , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/complicações , Abuso de Substâncias por Via IntravenosaRESUMO
Human T cell lymphotropic virus type I (HTLV-I) is sexually transmitted. The purpose of this study was to determine the prevalence and risk factors for cervical shedding of HTLV-I DNA among Peruvian sex workers. HTLV tax DNA was detected in cervical specimens from 43 (68%) of 63 HTLV-I-infected sex workers and in samples obtained during 113 (52%) of 216 clinic visits between 1993 and 1997. Detection of HTLV DNA was associated with the presence of > or =30 polymorphonuclear cells (PMNs) within cervical mucus per 100x microscopic field (odds ratio [OR], 4.3, 95% confidence interval [CI], 1.8-10.1) and with the presence of cervical secretions (OR, 2.0; 95% CI 1.2-3.4). Hormonal contraceptive use (OR 1.7; 95% CI, 0.8-3.6) and concomitant cervical infection by Chlamydia trachomatis (OR, 1.5; 95% CI, 0.3-4.3) or Neisseria gonorrhoeae (OR, 1.1; 95% CI, 0.6-3.7) were not significantly associated with HTLV-I shedding. Our results suggest that cervicitis may increase cervical HTLV-I shedding and the sexual transmission of this virus.