RESUMO
The risk of malaria infection displays spatial and temporal variability that is likely due to interaction between the physical environment and the human population. In this study, we performed a spatial analysis at three different time points, corresponding to three cross-sectional surveys conducted as part of an insecticide-treated bed nets efficacy study, to reveal patterns of malaria incidence distribution in an area of Northern Guatemala characterized by low malaria endemicity. A thorough understanding of the spatial and temporal patterns of malaria distribution is essential for targeted malaria control programs. Two methods, the local Moran's I and the Getis-Ord G*(d), were used for the analysis, providing two different statistical approaches and allowing for a comparison of results. A distance band of 3.5 km was considered to be the most appropriate distance for the analysis of data based on epidemiological and entomological factors. Incidence rates were higher at the first cross-sectional survey conducted prior to the intervention compared to the following two surveys. Clusters or hot spots of malaria incidence exhibited high spatial and temporal variations. Findings from the two statistics were similar, though the G*(d) detected cold spots using a higher distance band (5.5 km). The high spatial and temporal variability in the distribution of clusters of high malaria incidence seems to be consistent with an area of unstable malaria transmission. In such a context, a strong surveillance system and the use of spatial analysis may be crucial for targeted malaria control activities.
Assuntos
Análise por Conglomerados , Malária/epidemiologia , Malária/transmissão , Análise Espacial , Estudos Transversais , Meio Ambiente , Guatemala/epidemiologia , Humanos , Incidência , Mosquiteiros Tratados com Inseticida , Malária/prevenção & controle , Estações do AnoRESUMO
We investigated the prevalence and correlates of having current healthcare coverage and of having a usual formal source of care among undocumented Central American immigrant women. Participants were recruited using respondent driven sampling. Thirty-five percent of participants had healthcare coverage and 43% had a usual formal source of care. Healthcare coverage was primarily through the local indigent healthcare program and most of those with a usual formal source of care received care at a public healthcare clinic. Having healthcare coverage and having a usual formal source of care were both associated with older age; having a usual formal source of care was also marginally associated with increased time of residence in the US and increased income security. The primary barriers to healthcare use were not having money or insurance, not knowing where to go, and not having transportation. Healthcare interventions may benefit from targeting young and newly arrived immigrants and addressing the structural and belief barriers that impede undocumented immigrant women's use of healthcare services.
Assuntos
Emigrantes e Imigrantes , Cobertura do Seguro/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , América Central/etnologia , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , TexasRESUMO
Undocumented Central American immigrants in the United States are disproportionately affected by HIV infection. However, epidemiological data on sexual behaviors among undocumented women are sparse and the extent to which behaviors vary by duration of residence in the U.S.is largely unknown. In 2010, we used respondent driven sampling to conduct an HIV behavioral survey among Central American immigrant women residing in Houston, Texas without a valid U.S. visa or residency papers. Here we describe the prevalence of sexual risk behaviors and compare recent (5 years or less in the U.S.) and established immigrants (over 5 years in the U.S.) to elucidate changes in sexual risk behaviors over time. Our data suggest that recent immigrants have less stable sexual partnerships than established immigrants, as they are more likely to have multiple and concurrent sexual partnerships, as well as partnerships of shorter duration.
Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Assunção de Riscos , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Adolescente , Adulto , América Central/etnologia , Preservativos/estatística & dados numéricos , Emigrantes e Imigrantes/psicologia , Feminino , Infecções por HIV/etiologia , Infecções por HIV/transmissão , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Comportamento Sexual/etnologia , Comportamento Sexual/psicologia , Fatores Socioeconômicos , Texas/epidemiologia , Migrantes/legislação & jurisprudência , Adulto JovemRESUMO
OBJECTIVE: The present study analysed the impact of using the 2006 WHO Child Growth Standards ('the WHO standards') compared with the 1977 National Center for Health Statistics (NCHS) international growth reference ('the NCHS reference') on the calculated prevalence of chronic malnutrition in children aged 6·0-59·9 months. DESIGN: Anthropometric data were collected as part of a cross-sectional study exploring the association between household environments and nutritional status of children. Z-scores were computed for height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) using each reference/standard. Results were compared using Bland-Altman plots, percentage agreement, kappa statistics, line graphs and proportion of children in Z-score categories. SETTING: The study was conducted in thirteen rural villages within Honduras's department of Intibucá. SUBJECTS: Children aged 6·0-59·9 months were the focus of the analysis, and households with children in this age range served as the sampling unit for the study. RESULTS: The WHO standards yielded lower means for HAZ and higher means for WAZ and WHZ compared with the NCHS reference. The WHO standards and NCHS reference showed good agreement between Z-score categories, except for HAZ among males aged 24·0-35·9 months and WHZ among males aged >24·0 months. Using the WHO standards resulted in higher proportions of stunting (low HAZ) and overweight (high WHZ) and lower proportions of underweight (low WAZ). The degree of difference among these measures varied by age and gender. CONCLUSIONS: The choice of growth reference/standard employed in nutritional surveys may have important methodological and policy implications. While ostensibly comparable, data on nutritional indicators derived with different growth references/standards must be interpreted cautiously.
Assuntos
Estatura , Peso Corporal , Transtornos do Crescimento/epidemiologia , Inquéritos Epidemiológicos/normas , Desnutrição/epidemiologia , Fatores Etários , Pré-Escolar , Estudos Transversais , Meio Ambiente , Feminino , Crescimento , Honduras/epidemiologia , Humanos , Lactente , Masculino , Estado Nutricional , Valores de Referência , População Rural , Fatores Sexuais , Organização Mundial da SaúdeRESUMO
This paper describes HIV testing behaviors among undocumented Central American immigrant women living in Houston, Texas, USA. Respondent driven sampling was used to recruit participants for an HIV behavioral survey. HIV testing items included lifetime history of testing, date and location of the most recent test, and reason for testing. Multivariate logistic regression was used to assess the demographic, behavioral, and structural characteristics associated with testing. The lifetime prevalence of HIV testing was 67%. Half of those who tested did so within the past 2 years and almost 80% received their most recent test in a healthcare setting. The primary reason for testing was pregnancy. Lifetime testing was associated with being from Honduras, having over a sixth grade education, having a regular healthcare provider, and having knowledge of available healthcare resources. Our results suggest that expanding access to healthcare services may increase the prevalence of HIV testing in this population.
Assuntos
Emigrantes e Imigrantes , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Programas de Rastreamento/estatística & dados numéricos , Migrantes/legislação & jurisprudência , Adolescente , Adulto , América Central/etnologia , Coleta de Dados , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Texas , Adulto JovemRESUMO
Research has demonstrated that prolonged duration of breastfeeding promotes child survival. This study examines the impact of unintended--mistimed or unwanted--pregnancy on breastfeeding duration. We use data from the 1990 Paraguay and 1994 Bolivia Demographic and Health Surveys and restrict our analysis to last-born, surviving children younger than 36 months from singleton births. To assess the association, unintended and intended pregnancies are compared by calculating incidence rates and adjusted hazard ratios (aHR) using survival analysis. Most children (approximately 95 percent) were breastfed initially, but the median duration of breastfeeding in Bolivia was five months longer than that in Paraguay (19 versus 14 months). A greater proportion of pregnancies were described as intended in Paraguay than in Bolivia (74 percent versus 45 percent). In adjusted analyses, unwanted and mistimed pregnancies were associated with slightly longer duration of breastfeeding (aHR = 0.9) than were intended pregnancies, but the association was not statistically significant. In this study, therefore, pregnancy intention was not an important factor in duration of breastfeeding in Bolivia or Paraguay.
Assuntos
Aleitamento Materno/estatística & dados numéricos , Gravidez não Planejada , Adolescente , Adulto , Bolívia/epidemiologia , Anticoncepção/estatística & dados numéricos , Feminino , Humanos , Incidência , Idade Materna , Paraguai/epidemiologia , Paridade , Gravidez , Fatores SocioeconômicosRESUMO
BACKGROUND: This study examined the impact of maternally reported pregnancy intention, differentiating unwanted and mistimed pregnancies, on the prevalence of early childhood stunting. Additionally, it examined the influence of paternal pregnancy intention status. METHODS: Data were collected from a nationally representative sample of women and men interviewed in the 1998 Bolivia Demographic and Health Survey. The sample was restricted to lastborn, singleton children younger than 36 months who had complete anthropometric information. Multivariable logistic regression examined the association between pregnancy intention and stunting. RESULTS: Children from unwanted and mistimed pregnancies comprised 33% and 21% of the sample, respectively. Approximately 29% of the maternally unwanted children were stunted as compared to 19% among intended and 19% among mistimed children. Children 12-35 months (toddlers) from mistimed pregnancies (adjusted prevalence risk ratio [PR(adj)] 1.33, 95% confidence interval [CI]: 1.03-1.72) and unwanted pregnancies (PR(adj) 1.28, 95% CI: 1.04-1.56) were at about a 30% greater risk for stunting than children from intended pregnancies. Infants and toddlers with both parents reporting them as unwanted had an increased risk of being stunted as compared with children both of whose parents intended the pregnancy. No association was found for infants less than 12 months. CONCLUSIONS: Reducing unintended pregnancies in Bolivia may decrease the prevalence of childhood growth stunting. Children born to parents reporting mistimed or unwanted pregnancies should be monitored for growth stunting, and appropriate interventions should be developed. Measurement of paternal pregnancy intention status is valuable in pregnancy intention studies.
Assuntos
Pai/psicologia , Transtornos do Crescimento/etiologia , Intenção , Gravidez não Planejada , Gravidez não Desejada , Bolívia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Bem-Estar do Lactente , Modelos Logísticos , Masculino , Comportamento Materno , Gravidez , Risco , Fatores SocioeconômicosRESUMO
En este trabajo se presenta un método simplificado para efecturar una evaluación epidemiológica basada en la comunidad, compatible con las metas de la investigación en el marco de la atención primaria de salud. Para este fin se utilizó el "análisis de las tablas de vida del estado actual" de los datos correspondientes a 1 131 mujeres asistidas por trabajadores de salud de la comunidad en el estado de México, con objeto de determinar las distribuciones de la duración de la lactancia materna, la amenorrea y el uso de anticonceptivos después del parto. En los métodos de campo empleados se incorporaron procedimientos de control de la calidad. Un mes después del parto, 78 por ciento de los lactantes eran aún amamantados; a los cinco meses, el porcentaje se redujo a 50 por ciento y, a los 12 meses, a 25 por ciento. El porcentaje de amenorrea un mes después del parto fue de 85 por ciento, de 50 por ciento a los tres meses y de 25 por ciento a los cinco meses. El uso de anticonceptivos se inició tempranamente: 42 por ciento de las usuarias comenzaron a emplearlos durante el primer mes posterior al parto (AU)
Disponible en inglés en el Bull WHO 68(2), 1990