National Autonomous University of Nicaragua

About: National Autonomous University of Nicaragua is a(n) education organization based out in Managua, Nicaragua. It is known for research contribution in the topic(s): Population & Public health. The organization has 775 authors who have published 715 publication(s) receiving 9791 citation(s).

Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America

Abstract: Summary Background Caesarean delivery rates continue to increase worldwide. Our aim was to assess the association between caesarean delivery and pregnancy outcome at the institutional level, adjusting for the pregnant population and institutional characteristics. Methods For the 2005 WHO global survey on maternal and perinatal health, we assessed a multistage stratified sample, comprising 24 geographic regions in eight countries in Latin America. We obtained individual data for all women admitted for delivery over 3 months to 120 institutions randomly selected from of 410 identified institutions. We also obtained institutional-level data. Findings We obtained data for 97 095 of 106 546 deliveries (91% coverage). The median rate of caesarean delivery was 33% (quartile range 24–43), with the highest rates of caesarean delivery noted in private hospitals (51%, 43–57). Institution-specific rates of caesarean delivery were affected by primiparity, previous caesarean delivery, and institutional complexity. Rate of caesarean delivery was positively associated with postpartum antibiotic treatment and severe maternal morbidity and mortality, even after adjustment for risk factors. Increase in the rate of caesarean delivery was associated with an increase in fetal mortality rates and higher numbers of babies admitted to intensive care for 7 days or longer even after adjustment for preterm delivery. Rates of preterm delivery and neonatal mortality both rose at rates of caesarean delivery of between 10% and 20%. Interpretation High rates of caesarean delivery do not necessarily indicate better perinatal care and can be associated with harm.

Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study

Abstract: Summary Background We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities Methods In our cross-sectional study, we included women attending health facilities in Africa, Asia, Latin America, and the Middle East that dealt with at least 1000 childbirths per year and had the capacity to provide caesarean section We obtained data from analysis of hospital records for all women giving birth and all women who had a severe maternal outcome (SMO; ie, maternal death or maternal near miss) We regarded coverage of key maternal health interventions as the proportion of the target population who received an indicated intervention (eg, the proportion of women with eclampsia who received magnesium sulphate) We used areas under the receiver operator characteristic curves (AUROC) with 95% CI to externally validate a previously reported MSI as an indicator of severity We assessed the overall performance of care (ie, the ability to produce a positive effect on health outcomes) through standardised mortality ratios Results From May 1, 2010, to Dec 31, 2011, we included 314 623 women attending 357 health facilities in 29 countries (2538 had a maternal near miss and 486 maternal deaths occurred) The mean period of data collection in each health facility was 89 days (SD 21) 23 015 (7·3%) women had potentially life-threatening disorders and 3024 (1·0%) developed an SMO 808 (26·7%) women with an SMO had post-partum haemorrhage and 784 (25·9%) had pre-eclampsia or eclampsia Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women who had an SMO Reported mortality in countries with a high or very high maternal mortality ratio was two-to-three-times higher than that expected for the assessed severity despite a high coverage of essential interventions The MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC 0·826 [95% CI 0·802–0·851]) Interpretation High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy Funding UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); WHO; USAID; Ministry of Health, Labour and Welfare of Japan; Gynuity Health Projects

Local Participation in Natural Resource Monitoring: a Characterization of Approaches

Abstract: The monitoring of trends in the status of species or habitats is routine in developed countries, where it is funded by the state or large nongovernmental organizations and often involves large numbers of skilled amateur volunteers. Far less monitoring of natural resources takes place in developing countries, where state agencies have small budgets, there are fewer skilled professionals or amateurs, and socioeconomic conditions prevent development of a culture of volunteerism. The resulting lack of knowledge about trends in species and habitats presents a serious challenge for detecting, understanding, and reversing declines in natural resource values. International environmental agreements require signatories undertake systematic monitoring of their natural resources, but no system exists to guide the development and expansion of monitoring schemes. To help develop such a protocol, we suggest a typology of monitoring categories, defined by their degree of local participation, ranging from no local involvement with monitoring undertaken by professional researchers to an entirely local effort with monitoring undertaken by local people. We assessed the strengths and weaknesses of each monitoring category and the potential of each to be sustainable in developed or developing countries. Locally based monitoring is particularly relevant in developing countries, where it can lead to rapid decisions

Efficacy and safety of an oral live attenuated human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in Latin American infants: a randomised, double-blind, placebo-controlled phase III study.

Abstract: Summary Background Peak incidence of rotavirus gastroenteritis is seen in infants between 6 and 24 months of age. We therefore aimed to assess the 2-year efficacy and safety of an oral live attenuated human rotavirus vaccine for prevention of severe gastroenteritis in infants. Methods 15 183 healthy infants aged 6–13 weeks from ten Latin American countries randomly assigned in a 1 to 1 ratio to receive two oral doses of RIX4414 or placebo at about 2 and 4 months of age in a double-blind, placebo-controlled phase III study were followed up until about 2 years of age. Primary endpoint was vaccine efficacy from 2 weeks after dose two until 1 year of age. Treatment allocation was concealed from investigators and parents of participating infants. Efficacy follow-up for gastroenteritis episodes was undertaken from 2 weeks after dose two until about 2 years of age. Analysis was according to protocol. This study is registered with ClinicalTrials.gov, number NCT00140673 (eTrack444563–023). Findings 897 infants were excluded from the according-to-protocol analysis. Fewer cases (p Interpretation Two doses of RIX4414 were effective against severe rotavirus gastroenteritis during the first 2 years of life in a Latin American setting. Inclusion of RIX4414 in routine paediatric immunisations should reduce the burden of rotavirus gastroenteritis worldwide. Funding GlaxoSmithKline.

Decreased Kidney Function Among Agricultural Workers in El Salvador

Abstract: Background An epidemic of chronic kidney disease of unknown cause has emerged along the Pacific coast of Central America, particularly in relatively young male sugarcane workers. In El Salvador, we examined residence and occupations at different altitudes as surrogate risk factors for heat stress. Study Design Cross-sectional population-based survey. Setting & Participants Populations aged 20-60 years of 5 communities in El Salvador, 256 men and 408 women (participation, 73%): 2 coastal communities with current sugarcane and past cotton production and 3 communities above 500 m with sugarcane, coffee, and service-oriented economies. Predictor Participant sex, age, residence, occupation, agricultural history by crop and altitude, and traditional risk factors for CKD. Outcomes Serum creatinine (SCr) level greater than the normal laboratory range for sex, estimated glomerular filtration rate (eGFR) 2 , and proteinuria categorized as low (protein excretion ≥30- Results Of the men in the coastal communities, 30% had elevated SCr levels and 18% had eGFR 2 compared with 4% and 1%, respectively, in the communities above 500 m. For agricultural workers, prevalences of elevated SCr levels and eGFR 2 were highest for coastal sugarcane and cotton plantation workers, but were not increased in sugarcane workers at 500 m or subsistence farmers. Women followed a weaker but similar pattern. Proteinuria was infrequent, of low grade, and not different among communities, occupations, or sexes. The adjusted ORs of decreased kidney function for 10-year increments of coastal sugarcane or cotton plantation work were 3.1 (95% CI, 2.0-5.0) in men and 2.3 (95% CI, 1.4-3.7) in women. Limitations The cross-sectional nature of the study limits etiologic interpretations. Conclusion Agricultural work on lowland sugarcane and cotton plantations was associated with decreased kidney function in men and women, possibly related to strenuous work in hot environments with repeated volume depletion.