RESUMO
Previous studies on commensal Escherichia coli from healthy children in the Bolivian Chaco have shown remarkable resistance rates to the old antibiotics since the early 1990s, and the emergence of resistance to newer drugs (fluoroquinolones and expanded-spectrum cephalosporins) in the 2000s. Here we report the results of a new survey conducted in 2011 in the same setting. Rectal swabs were obtained from 482 healthy children (aged 6-72 months) from three urban areas of the Bolivian Chaco. Screening for antibiotic-resistant E. coli was performed by a direct plating method, as in the previous studies. The blaCTX-M genes were investigated by PCR/sequencing, and CTX-M-producing isolates were subjected to genotyping and detection of several plasmid-mediated quinolone resistance mechanisms. Results showed high rates of resistance to nalidixic acid (76%), ciprofloxacin (44%) and expanded-spectrum cephalosporins (12.4%), demonstrating a relentless increase of resistance to those drugs over the past two decades. CTX-M-type extended-spectrum beta-lactamases were found to be widespread (12%, 97% of extended-spectrum beta-lactamase producers). Compared with the previous studies, CTX-M-producing E. coli underwent a dramatic dissemination (120-fold increase since early 2000s) and a radical change of dominant CTX-M groups (CTX-M-1 and CTX-M-9 groups versus CTX-M-2 group). Most CTX-M producers were not susceptible to quinolones (91%), and 55% carried plasmid-mediated quinolone resistance genes (different combinations of aac(6')-Ib-cr, qnrB and qepA). This study shows the rapid and remarkable increasing trend for resistance to fluoroquinolones and expanded-spectrum cephalosporins in one of the poorest regions of Latin America, and underscores the need for urgent control strategies aimed at preserving the efficacy of those drugs in similar settings.
Assuntos
Antibacterianos/farmacologia , Cefalosporinas/farmacologia , Farmacorresistência Bacteriana , Infecções por Escherichia coli/epidemiologia , Escherichia coli/efeitos dos fármacos , Fluoroquinolonas/farmacologia , Bolívia/epidemiologia , Criança , Pré-Escolar , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Feminino , Genótipo , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Plasmídeos/análise , Reação em Cadeia da Polimerase , Reto/microbiologia , Análise de Sequência de DNARESUMO
OBJECTIVE: To describe the health-seeking behaviour and use of antibiotics in the urban community of Yurimaguas in the Amazonian area of Peru. METHOD: Cross-sectional survey of caregivers of 798 children aged 6-72 months by interview using a semi-structured questionnaire. Reported symptoms were classified as illnesses where antibiotics would or would not be recommended based on principles of the integrated management of childhood illnesses algorithm. RESULTS: Forty-one per cent of consultations were with health care professionals; 71% of antibiotics were obtained through the formal public health sector and prescribed mainly by medical doctors. All prescribed antibiotics were on the Peruvian essential drugs list. When prescribing, doctors and nurses hardly discriminated between illnesses where antibiotic treatment was or was not indicated; there was no significant difference in antibiotic prescribing rates between the two (doctors, P = 0.24; nurses, P = 0.32). Not all caregivers sought help for children with severe symptoms. CONCLUSION: Although most of the antibiotics were prescribed by doctors and nurses, they were commonly prescribed for illnesses where they were not indicated. The use of antibiotics needs to be rationalized, and barriers to health care must be overcome.
Assuntos
Antibacterianos/administração & dosagem , Atitude do Pessoal de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Áreas de Pobreza , Padrões de Prática Médica , Criança , Pré-Escolar , Competência Clínica , Tosse/tratamento farmacológico , Estudos Transversais , Diarreia/tratamento farmacológico , Disenteria/tratamento farmacológico , Comportamentos Relacionados com a Saúde , Humanos , Lactente , Peru , Pneumonia/tratamento farmacológico , Saúde da População UrbanaRESUMO
A door-to-door survey was carried out in rural areas of the Cordillera Province, Bolivia, to determine the prevalence of Parkinson's diseases (PD) in a sample of 9955 subjects. We found five cases of PD on prevalence day, November 1, 1994. The crude prevalence was 50.2/100,000 (95% CI 18.5-124.5) and 286/100,000 (95% CI 28-543) in subjects aged 40 years or more. Our prevalence is close to rates found in other in developing countries.
Assuntos
Inquéritos Epidemiológicos , Doença de Parkinson/epidemiologia , Saúde da População Rural/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bolívia/epidemiologia , Intervalos de Confiança , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To assess the relationship between epilepsy and infection with Taenia solium and Toxocara canis with a case-control study, in the rural area of the Cordillera Province, Bolivia. METHODS: A preliminary two-phase door-to-door prevalence survey determined the prevalence of epilepsy and identified cases and control subjects. At least two control subjects per case were selected, matching on sex, age, and community of residence. Cases and control subjects were assessed serologically for antibodies against T. canis by ELISA and against T. solium by enzyme-linked immunoelectrotransfer blot (EITB). RESULTS: The prevalence survey found 130 confirmed cases of epilepsy, of which 113 were eligible for the case-control study (59 partial seizures and 54 generalized seizures). Two hundred thirty-three control subjects were selected. Multivariable analysis for a matched case-control study was carried out. There was an association between EITB positivity for T. solium and epilepsy with an OR of 1.85 (95% CI 0.99 to 3.4) for all cases. A stronger association was found in those with partial epilepsy with a late onset of disease (15 years and older), where the OR was 3.66 (95% CI 1.10 to 12.10). A positive association was also found with T. canis for all cases with an OR of 2.70 (95% CI 1.41 to 5.19). This increased for those with late-onset partial epilepsy to an OR of 18.22 (95% CI 2.10 to 158.10). CONCLUSION: This finding suggests that both neurocysticercosis and toxocariasis may in part explain the higher prevalence of epilepsy, particularly partial epilepsy, in developing countries.
Assuntos
Cisticercose/epidemiologia , Epilepsia/epidemiologia , Toxocaríase/epidemiologia , Adulto , Idade de Início , Animais , Bolívia/epidemiologia , Estudos de Casos e Controles , Cisticercose/diagnóstico , Cisticercose/parasitologia , Dieta , Eletroencefalografia , Ensaio de Imunoadsorção Enzimática , Epilepsias Parciais/epidemiologia , Epilepsias Parciais/etiologia , Epilepsias Parciais/parasitologia , Epilepsia/diagnóstico , Epilepsia/parasitologia , Epilepsia Generalizada/epidemiologia , Epilepsia Generalizada/etiologia , Epilepsia Generalizada/parasitologia , Feminino , Humanos , Imunoeletroforese , Masculino , Programas de Rastreamento , População Rural , Saneamento , Toxocara , Toxocara canis , Toxocaríase/diagnóstico , Toxocaríase/parasitologiaRESUMO
We carried out a door-to-door survey in rural areas of the Cordillera Province, Bolivia, to determine the prevalence of the most common neurological diseases in a sample of about 10,000 inhabitants. A team of non-doctor health workers administered a standard screening instrument for neurological diseases, a slightly modified version of the World Health Organization protocol. All subjects found positive at the screening phase underwent a complete neurological examination. On screening, we found 1,130 positive subjects, of whom 909 were aged 15 years and above. After the neurological examination, we found 52 cases who had experienced Bell's palsy during their life in the population aged 15 years and above. The lifetime prevalence on November 1, 1994 was 11.1/1,000 (95% confidence interval 7.8-14.5) for the population aged 15 years and above. The prevalence was higher in women than in men (13.7 and 8.7/1,000, respectively) and increased with age, reaching a peak in the group aged 65 years or more (31.7/1,000). Only 3 cases (5.8%) had received medical therapy.
Assuntos
Paralisia de Bell/epidemiologia , Adolescente , Adulto , Idade de Início , Idoso , Bolívia/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , População Rural , Fatores SexuaisRESUMO
BACKGROUND AND PURPOSE: We carried out a door-to-door survey in rural areas of the Cordillera Province, Santa Cruz Department, Bolivia. A cluster sample of 10 124 inhabitants was selected, and 9955 subjects were screened. The aim was to determine the prevalence of the most common neurological diseases (epilepsy, stroke, parkinsonism, and peripheral neuropathy) in this population. METHODS: We used a modified version of the World Health Organization screening instrument. On screening we found that 1130 subjects tested positive, and 1027 underwent a complete neurological examination. According to the World Health Organization guidelines, we defined stroke as "rapidly developing clinical signs of focal (or global) disturbance of cerebral functions, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin." We considered only first stroke and excluded a possible stroke. RESULTS: We found 16 subjects (cases) who had experienced 1 complete stroke on prevalent day (November 1, 1994). The crude prevalence of stroke was 174/100 000 (322/100 000 age-adjusted to the world standard population) and 663/100 000 in subjects aged >/=35 years. Prevalence was >2-fold higher in men than in women (247/100 000 and 99/100 000, respectively) and increased rapidly with age. Seven cases were hospitalized and received specific treatment. CONCLUSIONS: Our crude prevalence is lower compared with rates from developed countries, probably because of a high case fatality rate. Our findings are comparable with those reported from other surveys carried out in rural developing countries.
Assuntos
Inquéritos Epidemiológicos , Saúde da População Rural , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Bolívia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Prevalência , Distribuição por Sexo , Acidente Vascular Cerebral/diagnósticoRESUMO
A cross-sectional survey carried out in the Chaco region of Bolivia showed that 26% (77 of 296) and 0.7% (2 of 298) of the rural population of the Camiri and Villa Montes areas, respectively, harbored Mansonella ozzardi microfilariae (mf). No significant differences were observed between sexes. The lowest prevalence (9%) was in the 0-14-year-old age group, with no children <11 months of age infected. The prevalence increased sharply in the 25-34-year-old age group (32%), and continued increasing in the older age classes. Microfilaremia, ranging from 1 to 305 mf/20 microl of blood, was lowest in 0-14-year-old children (geometric mean concentration = 1.1 mf/20 microl), and increased with age (>100 mf/20 microl in people >44 years old). An expected increasing sensitivity with the blood volume examined was observed. No significant association between clinical symptoms (fever, skin rash, pruritus, headache, lymphedema, elephantiasis, and articular pain) and microfilaremia was observed.
Assuntos
Mansonella/isolamento & purificação , Mansonelose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Animais , Bolívia/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Mansonelose/sangue , Pessoa de Meia-Idade , Parasitemia/epidemiologia , Prevalência , População Rural , Distribuição por SexoRESUMO
OBJECTIVE: To carry out a door-to-door survey in rural areas of the Cordillera Province, Santa Cruz Department, Bolivia, to determine the prevalence of neurologic diseases (epilepsy, stroke, parkinsonism, and peripheral neuropathy) in a sample of approximately 10,000 inhabitants. METHODS: A team of nondoctor health workers administered a standard screening instrument for neurologic diseases-a slightly modified version of the World Health Organization protocol. All subjects found positive during the screening underwent a neurologic examination. RESULTS: On screening, the authors found 1,130 positive subjects, of whom 1,027 were then investigated by neurologists. On the basis of the definition proposed by the International League Against Epilepsy, we detected 124 epileptic patients (prevalence, 12.3/1,000), 112 of whom had active epilepsy (prevalence, 11.1/1,000) on the prevalence day (November 1, 1994). Peak age-specific prevalence occurred in the 15 to 24-year age group (20.4/1,000). Sex-specific prevalence was higher in women (13.1/1,000) than men (11.4/1,000). Eighty-nine patients (71.8%) underwent a standard EEG recording. Considering both EEG and clinical data, partial seizures were the most common type (53.2%) based on the classification of the International League Against Epilepsy. The mean age at onset was 20.7 years for partial seizures and 13.6 years for generalized seizures. Only 10.5% of patients had received specific treatment for more than 2 months of their life. CONCLUSION: This report on epilepsy prevalence in Bolivia confirms that epilepsy is a major health problem in rural areas of developing countries.
Assuntos
Países em Desenvolvimento , Epilepsia/epidemiologia , População Rural/estatística & dados numéricos , Adolescente , Adulto , Idoso , Bolívia/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Epilepsias Parciais/epidemiologia , Epilepsia Generalizada/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-IdadeRESUMO
We conducted a cross-sectional study to determine the seroprevalence of antibodies against hepatitis A and hepatitis E viruses (HAV and HEV) in the population of two rural areas, Camiri and Villa Montes, of the Chaco region, south-eastern Bolivia. HAV antibodies were detected in 461 (94.1%) of 490 serum samples tested, not differing significantly between sexes and study areas. The HAV seropositivity rate (64.7%) was high even in the youngest age group (1-5 years). The prevalence of HEV was 7.3%, with no significant differences between sexes. The prevalence of HEV antibodies in the population of the Camiri area (10.4%) was significantly higher than in the Villa Montes area (4.4%), possibly due to the better quality of drinking water in the Villa Montes area. In the population /= 31 year-old group. This is consistent with findings in other countries. This is the first report of the prevalence of HEV infection in Bolivia.
Assuntos
Anticorpos Anti-Hepatite/sangue , Vírus da Hepatite E/imunologia , Hepatovirus/imunologia , Saúde da População Rural/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Bolívia/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por SexoRESUMO
A seroepidemiological study was conducted to determine the prevalence of antibodies to Trichinella spiralis among rural residents of Cordillera province, Santa Cruz Department, Bolivia. Using the enzyme-linked immunosorbent assay (ELISA), 234 serum samples were examined, and antibodies were detected in seven of the samples (3%). The results document for the first time the presence of human infestation with Trichinella in Bolivia and suggest the need to strengthen trichinelosis surveillance in the municipal slaughterhouses, to prevent the clandestine slaughter of animals, and particularly to ensure that residents and meat producers in the area become aware of the dangers of this zoonosis.
Assuntos
Matadouros , Anticorpos Anti-Helmínticos/imunologia , Trichinella spiralis , Triquinelose/epidemiologia , Zoonoses/parasitologia , Animais , Bolívia/epidemiologia , Métodos Epidemiológicos , Humanos , População Rural , Estudos Soroepidemiológicos , Sorotipagem , Triquinelose/imunologia , Triquinelose/parasitologiaRESUMO
A door-to-door survey was carried out in rural areas of the Cordillera province, Santa Cruz Department, Bolivia. A cluster sample of 10,124 inhabitants was selected. The aim was to determine the prevalence of the most common neurological diseases (epilepsy, stroke, parkinsonism and peripheral neuropathy) in this population using a modification of the World Health Organization screening instrument. 1,130 subjects screened positive and were then investigated by neurologists. In this paper we describe the background and methods of the survey and the characteristics of the population.