Showing papers by "Pan American Health Organization published in 2005"

Safety of the blood supply in Latin America

Abstract: Appropriate selection of donors, use of sensitive screening tests, and the application of a mandatory quality assurance system are essential to maintain the safety of the blood supply. Laws, decrees, norms, and/or regulations covering most of these aspects of blood transfusion exist in 16 of the 17 countries in Latin America that are the subject of this review. In 17 countries, there is an information system that, although still incomplete (there are no official reports on adverse events and incidents), allows us to establish progress made on the status of the blood supply since 1993. Most advances originated in increased screening coverage for infectious diseases and better quality assurance. However, in 2001 to 2002, tainted blood may have caused infections in 12 of the 17 countries; no country reached the number of donors considered adequate, i.e., 5% of the population, to avoid blood shortages, or decreased significantly the number of blood banks, although larger blood banks are more efficient and take advantage of economies of scale. In those years, paid donors still existed in four countries and replacement donors made up >75% of the blood donors in another eight countries. In addition, countries did not report the number of voluntary donors who were repeat donors, i.e., the healthiest category. In spite of progress made, more improvements are needed.

Neglected diseases of neglected populations: Thinking to reshape the determinants of health in Latin America and the Caribbean

Abstract: People living in poverty throughout the developing world are heavily burdened with neglected communicable diseases and often marginalized by the health sector. These diseases are currently referred to as Neglected Diseases of Neglected Populations. The neglected diseases create social and financial burdens to the individual, the family, the community, and the nation. Numerous studies of successful individual interventions to manage communicable disease determinants in various types of communities have been published, but few have applied multiple interventions in an integrated, coordinated manner. We have identified a series of successful interventions and developed three hypothetical scenarios where such interventions could be applied in an integrated, multi-disease, inter-programmatic, and/or inter-sectoral approach for prevention and control of neglected diseases in three different populations: a slum, an indigenous community, and a city with a mix of populations. The objective of this paper is to identify new opportunities to address neglected diseases, improve community health and promote sustainable development in neglected populations by highlighting examples of key risk and protective factors for neglected diseases which can be managed and implemented through multi-disease-based, integrated, inter-programmatic, and/or inter-sectoral approaches. Based on a literature review, analysis and development of scenarios we visualize how multiple interventions could manage multiple disease problems and propose these as possible strategies to be tested. We seek to stimulate intra- and inter-sectoral dialogue which will help in the construction of new strategies for neglected diseases (particularly for the parasitic diseases) which could benefit the poor and marginalized based on the principle of sustainability and understanding of key determinants of health, and lead to the establishment of pilot projects and activities which can contribute to the achievement of the Millennium Development Goals.

Alcohol consumption and burden of disease in the Americas: implications for alcohol policy

Abstract: OBJECTIVES: To describe patterns of alcohol consumption in the Americas, to estimate the burden of disease attributable to alcohol in the year 2000, and to suggest implications for policies to reduce alcohol-related disease burden. METHODS: Two dimensions of alcohol exposure were included in this secondary data analysis: average volume of alcohol consumption and patterns of drinking. There were two main outcome measures: mortality (number of deaths) and disability-adjusted life years (DALYs) lost (number of years of life lost due to premature mortality and disability). Separate estimates were obtained for different sexes, age groups and WHO regions. RESULTS: Despite regional variations, alcohol consumption in the Americas averaged more than 50% higher than worldwide consumption. Patterns of irregular heavy drinking prevailed. Alcohol consumption caused a considerable disease burden: 4.8% of all the deaths and 9.7% of all DALYs lost in the year 2000 were attributable to drinking, with most of the burden occurring outside North America. Intentional and unintentional injuries accounted for 59.8% of all alcohol-related deaths and 38.4% of the alcohol-related disease burden. Of all risk factors compared here, alcohol accounted for the greatest proportion of risk, followed by smoking. CONCLUSIONS: Interventions should be implemented to reduce the high burden of alcohol-related disease in the Americas. Given the epidemiological structure of this burden, injury prevention including, but not restricted to, prevention of traffic injuries, as well as appropriate treatment options, should play an important role in comprehensive plans to reduce the alcohol-related public health burden.

Relation of neonatal iron status to individual variability in neonatal temperament.

Abstract: The relation between indices of neonatal iron status and individual differences in neonatal temperament were investigated in a sample of 148 low- income Peruvian women and their newborn infants. Using cord blood, at birth we obtained measures of neonatal ferritin, serum iron, and hemoglobin. While neonates were still in the hospital, their behavior during a structured anthropometry exami- nation was videotaped and subsequently coded on four temperament dimensions: activity level, negative emotionality, alertness, and soothability. The same dimen- sions were coded using a videotape obtained during a subsequent visit to the neonates' homes. Results indicated that lower levels of neonatal hemoglobin and serum iron were related to higher levels of negative emotionality and to lower levels of alertness and soothability. A similar pattern was found for ferritin, but only for females. For the most part, relations between neonatal iron measures and neonatal temperament were linear, operating across the full range of iron values. Our pattern of iron-temperament results could not be attributed to variation in family demo- graphics, low birth weight, gestational age, maternal dietary intake, or markers of neonatal illness and maternal diabetes. Our findings are consistent with prior research with older infants relating iron deficiency to temperament. These results support the importance of increased research on the early functional-behavioral consequences of individual differences in iron status as well as on the mechanisms that underlie such consequences. 2005 Wiley Periodicals, Inc. Dev Psychobiol 46: 141-153, 2005.

Prevalence, risk factors and aging vulnerability for psychopathology following a natural disaster in a developing country.

Abstract: Objectives This study explored the psychopathological reactions to a natural disaster and their respective risk factors among the elderly in Honduras and their vulnerability as compared to other adults. Study subjects and sample Eight hundred respondents of both genders aged 15 years and above, of which 103 were 60 and over, were selected from high, middle and low residential status areas in Tegucigalpa that had suffered high and low exposure to the devastating effects of Hurricane Mitch. Research instruments CIDI was used to diagnose PTSD and the Impact of Events Scale was administered as a measure of severity of post-traumatic reaction. Depression and alcohol misuse were examined using screening instruments. The SRQ was used as both a measure of emotional distress and dichotomized to screen for probable psychiatric disorder. Results PTSD, depression and SRQ-case were found, respectively in 13.6%, 18.8%, and 21.4% of the elderly. Their reactions did not differ in frequency than of those of younger adults. Among the elderly, pre-hurricane psychological problems and the intensity of exposure were associated with increased risk for all outcomes measured except for alcohol misuse. Conclusion No evidence was found for a differential vulnerability on the part of the elderly as compared with younger adults. Among the elderly increasing age was not a factor. Copyright © 2005 John Wiley & Sons, Ltd.

Scaling up integrated management of childhood illness to the national level: achievements and challenges in Peru.

Abstract: This paper presents the first published report of a national-level effort to implement the Integrated Management of Childhood Illness (IMCI) strategy at scale. IMCI was introduced in Peru in late 1996, the early implementation phase started in 1997, with the expansion phase starting in 1998. Here we report on a retrospective evaluation designed to describe and analyze the process of taking IMCI to scale in Peru, conducted as one of five studies within the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE) coordinated by the World Health Organization. Trained surveyors visited each of Peru's 34 districts, interviewed district health staff and reviewed district records. Findings show that IMCI was not institutionalized in Peru: it was implemented parallel to existing programmes to address acute respiratory infections and diarrhoea, sharing budget lines and management staff. The number of health workers trained in IMCI case management increased until 1999 and then decreased in 2000 and 2001, with overall coverage levels among doctors and nurses calculated to be 10.3%. Efforts to implement the community component of IMCI began with the training of community health workers in 2000, but expected synergies between health facility and community interventions were not realized because districts where clinical training was most intense were not those where community IMCI training was strongest. We summarize the constraints to scaling up IMCI, and examine both the methodological and policy implications of the findings. Few monitoring data were available to document IMCI implementation in Peru, limiting the potential of retrospective evaluations to contribute to programme improvement. Even basic indicators recommended for national monitoring could not be calculated at either district or national levels. The findings document weaknesses in the policy and programme supports for IMCI that would cripple any intervention delivered through the health service delivery system. The Ministry of Health in Peru is now working to address these weaknesses; other countries working to achieve high and equitable coverage with essential child survival interventions can learn from their experience.

Emerging or re-emerging bacterial zoonoses: factors of emergence, surveillance and control

Abstract: Surveillance and control of emerging bacterial zoonoses is essential in order to prevent both human and animal deaths and to avoid potential economic disorders created by trade barriers or a ban on free circulation of human or animal populations. An increased risk of exposition to zoonotic agents, the breakdown of the host's defenses, the emergence of bacterial strains resistant to antibiotics and their widespread distribution as well as conjunctural causes associated with the action or inaction of man have been identified as the main factors leading to the emergence or re-emergence of bacterial zoonoses. After an in-depth review of these various factors, the present manuscript reviews the main components of detection and surveillance of emerging or re-emerging bacterial zoonoses. A description of the systems of control and the main obstacles to their success is also presented. Detection and surveillance of emerging zoonoses have greatly benefited from technical progress in diagnostics. The success of detection and control of emerging bacterial zoonoses is largely based on international solidarity and cooperation between countries.

Maternal Education and Intelligence Predict Offspring Diet and Nutritional Status

Abstract: The traditional assumption that children's nutritional deficiencies are essentially due either to overall food scarcity or to a lack of family resources to purchase available food has been increasingly questioned. Parental characteristics represent 1 type of noneconomic factor that may be related to variability in children's diets and nutritional status. We report evidence on the relation of 2 parental characteristics, maternal education level and maternal intelligence, to infant and toddler diet and nutritional status. Our sample consisted of 241 low-income Peruvian mothers and their infants assessed from 3 to 12 mo, with a further follow-up of 104 of these infants at 18 mo of age. Using a nonexperimental design, we related measures of level of maternal education, maternal intelligence, and family socioeconomic status to infant anthropometry, duration of exclusive breast-feeding, adequacy of dietary intake, and iron status. Results indicated unique positive relations between maternal education level and the extent of exclusive breast-feeding. Significant relations between maternal education and offspring length were partially mediated by maternal height. There also were unique positive relations between maternal intelligence and quality of offspring diet and hemoglobin level. All findings remained significant even after controlling for family socioeconomic characteristics. This pattern of results illustrates the importance of parental characteristics in structuring the adequacy of offspring diet. Maternal education and intelligence appear to have unique influences upon different aspects of the diet and nutritional status of offspring.

Autoinforme de salud general en adultos mayores de América Latina y el Caribe: su utilidad como indicador

Abstract: OBJETIVOS: Evaluar el autoinforme de salud general (ASG) como indicador de salud y analizar sus covariables en personas de 60 anos de edad o mas que residian en hogares privados en siete centros urbanos de America Latina y el Caribe. METODOS: Estudio descriptivo transversal basado en los datos de la encuesta Salud, Bienestar y Envejecimiento (SABE) realizada entre 1999 y 2000 en: Bridgetown, Barbados; Buenos Aires, Argentina; Mexico, D.F., Mexico; Ciudad de La Habana, Cuba; Montevideo, Uruguay; Santiago, Chile; y Sao Paulo, Brasil. Se exploraron las caracteristicas demograficas y socioeconomicas de los participantes, algunos indicadores de salud (autoinforme de enfermedades cronicas, padecimiento de depresion y elementos cognoscitivos), la red social y familiar de apoyo, el uso de los servicios de salud, la funcionalidad informada y observada, los ingresos del encuestado y los bienes de consumo duraderos en su vivienda. En los modelos de regresion (probit) se utilizo una salud regular o mala segun el autoinforme como variable dependiente. Se empleo el efecto marginal de cada variable explicativa categorica para indicar la diferencia entre la probabilidad de informar mala salud de las personas que tenian y de las que no tenian una caracteristica dada. RESULTADOS: En todas las ciudades estudiadas fue muy baja la propension a informar salud "excelente" (6% o menos). Los resultados del analisis con multiples variables de la relacion entre el ASG mala o regular y las covariables mostraron: 1) la importancia relativa de varios indicadores de salud como covariables del ASG; 2) la asociacion entre las caracteristicas sociodemograficas y el ASG; y 3) las diferencias o similitudes encontradas entre los siete centros urbanos con respecto a las relaciones estudiadas. La proporcion de autoinforme de buena salud fue mayor en Buenos Aires y Montevideo (60%), seguidas de Bridgetown y Sao Paulo (alrededor de 50%) y de Ciudad de La Habana, Santiago y Mexico, D.F. (entre 30 y 40%). La evaluacion de la propia memoria fue el factor mas fuertemente asociado con el resultado del ASG, seguido de la satisfaccion con el estado nutricional y con la vida. CONCLUSIONES: El ASG capto multiples facetas de la salud de los adultos mayores, como el padecimiento de enfermedades cronicas, su grado de satisfaccion con el nivel de nutricion y con la vida, su percepcion del estado de la propia memoria y los problemas de funcionalidad que sufrian. Se deben emprender estudios mas detallados que permitan establecer el papel que desempena la salud emocional en la demanda de atencion sanitaria de los adultos mayores en America Latina y el Caribe y determinar si existe alguna asociacion entre el ASG y el uso de los servicios de salud.

Reducing the Global Burden of Congenital Rubella Syndrome: Report of the World Health Organization Steering Committee on Research Related to Measles and Rubella Vaccines and Vaccination, June 2004

Abstract: Rubella and congenital rubella syndrome (CRS) continue to be important health problems in many countries. In June 2004, the World Health Organization Steering Committee on Research Related to Measles and Rubella Vaccines and Vaccination met to evaluate data from research and operational activities and to identify critical scientific issues and gaps in knowledge that need to be addressed to improve the global control of rubella and CRS. Information about surveillance for rubella, natural and vaccine-induced immunity to rubella, laboratory diagnosis, the molecular epidemiological profile of rubella virus, and mathematical modeling to assess the burden of CRS and the impact of rubella vaccination was reviewed. This report summarizes the presentations and recommendations for future research.

Implementation of the Integrated Management of Childhood Illness strategy in Peru and its association with health indicators: an ecological analysis

Abstract: The Multi-Country Evaluation of Integrated Management of Childhood Illness (IMCI) Effectiveness, Cost and Impact (MCE) was launched to assess the global effectiveness of this strategy. Impact evaluations were started in five countries. The objectives of the Peru MCE were: (1) to document trends in IMCI implementation in the 24 departments of Peru from 1996 to 2000; (2) to document trends in indicators of health services coverage and impact (mortality and nutritional status) for the same period; (3) to correlate changes in these two sets of indicators, and (4) to attempt to rule out contextual factors that may affect the observed trends and correlations. An ecological analysis was performed in which the units of study were the 24 departments. By 2000, 10.2% of clinical health workers were trained in IMCI, but some districts showed considerably higher rates. There were no significant associations between clinical IMCI training coverage and indicators of outpatient utilization, vaccine coverage, mortality or malnutrition. The lack of association persisted after adjustment for several contextual factors including socioeconomic and environmental indicators and the presence of other child health projects. Community health workers were also trained in IMCI, and training coverage was not associated with any of the process or impact indicators, except for a significant positive correlation with mean height for age. According to the MCE impact model, IMCI implementation must be sufficiently strong to lead to an impact on health and nutrition. Health systems support for IMCI implementation in Peru was far from adequate. This finding, along with low training coverage level and a relatively low child mortality rate, may explain why the expected impact was not documented. Nevertheless, even districts with high levels of training coverage failed to show an impact. Further national effectiveness studies of IMCI and other child interventions are warranted as these interventions are scaled up.

Psychological and psychopathological reactions in Honduras following Hurricane Mitch: implications for service planning

Abstract: BACKGROUND: Posttraumatic stress disorder (PTSD) and other psychopathological outcomes have not been sufficiently studied in community-based samples in Latin America. This study explored various psychopathological reactions and their respective risk factors two months after Hurricane Mitch struck Honduras in October 1998. METHODS: In the Honduran capital of Tegucigalpa, 800 respondents age 15 and older were selected from residential areas of high, middle, or low socioeconomic status that had suffered either high or low impact from the devastating effects of the hurricane. The Composite International Diagnostic Interview was used to diagnose PTSD. Depression, alcohol misuse, and grief reaction were examined using screening instruments, and the Self-Reporting Questionnaire was used to measure demoralization. The Impact of Event Scale was administered to ascertain the severity of the posttraumatic reaction. RESULTS: PTSD was present in 10.6% of the sample. Respondents from the high-impact residential areas were more distressed, had higher scores on the grief inventory, and showed greater severity in PTSD symptoms. The respondents from the high-impact residential areas also had higher prevalence rates of major depression, alcoholism, and prior emotional problems. The best explanatory model for the risk of developing PTSD included the degree of exposure based on reported traumatic events, and associated increased demoralization. Among the persons with PTSD, its severity was predicted by being female and by the degree of exposure to hurricane-related traumatic events. CONCLUSIONS: Out of a total population of 3.3 million adults (age 15 and older) in Honduras, it is estimated that over 492 000 of them may have developed PTSD due to Hurricane Mitch. Adequate health disaster preparedness and response requires full acknowledgement of the multiple psychological effects that victims experience.

Screening for Glaucoma: Recommendation Statement

Abstract: This statement summarizes the U.S. Preventive Services Task Force(USPSTF) recommendation on screening for glaucoma and the supporting scientific evidence, and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, second edition.[1][1] Explanations of the ratings

A participatory assessment to identify strategies for improved cervical cancer prevention and treatment in Bolivia.

Abstract: En este trabajo se evaluan la organizacion y disponibilidad de servicios de prevencion y tratamiento del cancer cervicouterino en cuatro de los nueve departamentos de Bolivia y se identifican estrategias de intervencion. De 2001 a 2002 un equipo multidisciplinario de 15 personas llevo a cabo en Bolivia una evaluacion que comprendio una revision bibliografica sobre el cancer cervicouterino en el pais, entrevistas semiestructuradas con 583 partes interesadas y 56 observaciones de servicios de salud de diversos niveles. En un taller celebrado despues del trabajo de campo se reunieron 60 lideres de todos los departamentos del pais para revisar los resultados y determinar su prioridad, y para elaborar recomendaciones basadas en las pruebas cientificas recaudadas con miras a fortalecer los servicios de prevencion del cancer cervicouterino. Bolivia tiene una de las tasas mas altas de cancer cervicouterino en el mundo. No obstante, no tiene ningun programa organizado ni tampoco ninguna estrategia destinada a lograr que el tamizaje del cancer cervicouterino alcance una cobertura minima de 80%, que es la meta establecida por el Ministerio de Salud y Prevision Social. Una buena parte de la poblacion carece de informacion sobre los servicios para la prevencion y el tratamiento de lesiones precancerosas, o no puede llegar a estos servicios con facilidad. Los proveedores de atencion sanitaria en el sector publico calculan que de 50 a 80% de las mujeres sometidas al tamizaje no regresan a su seguimiento porque no hay ningun sistema que garantice un seguimiento adecuado con fines de diagnostico o tratamiento. Muchos prestadores de atencion de salud desconocen que los frotis de Papanicolaou se usan para detectar lesiones precancerosas. Bolivia tiene una unidad establecida dentro del Ministerio de Salud y Prevision Social cuya funcion es crear, administrar y supervisar programas nacionales para la prevencion y el tratamiento del cancer cervicouterino. Dicha unidad, en coordinacion con las autoridades sanitarias en cada uno de los departamentos del pais, tambien busca fortalecer la imposicion de normas nacionales, actividades de capacitacion, e iniciativas comunitarias de tipo informativo o educativo. No obstante, los servicios de tamizaje no estan debidamente vinculados con los de diagnostico y tratamiento de lesiones precancerosas. Por anadidura, los servicios de diagnostico y tratamiento no siempre abundan o son accesibles. Si se han de mejorar los servicios y la atencion a la comunidad, es necesario llevar a cabo investigaciones, efectuar cambios programaticos y adoptar cambios de politicas a fin de fortalecer la planificacion y el proceso decisorio en conexion con los aspectos administrativos, tecnologicos, socioculturales y economicos del asunto.

Maternal death due to domestic violence: an unrecognized critical component of maternal mortality

Abstract: En este trabajo subrayamos la necesidad de contar las muertes maternas que ocurren como resultado de episodios de violencia domestica, y tambien exponemos algunas de las principales dificultades que se enfrentan al tratar de hacerlo. Examinamos algunos elementos basicos que deben tenerse presentes al contar las muertes maternas de este tipo y explicamos como una definicion de mortalidad materna que de cabida a la violencia domestica como causa de muerte mejorara la vigilancia epidemiologica y las intervenciones de salud. Lograr un acuerdo general acerca de la definicion de "muerte materna por violencia domestica" y un marco estrategico para responder a ese tipo de muerte constituiria un logro de gran importancia para los sectores de la comunidad internacional que velan por la salud de la mujer y la equidad de genero.

Enhancing regional capacity in chronic disease surveillance in the Americas

Abstract: Existe la necesidad de reforzar la capacidad regional para la vigilancia de las enfermedades cronicas en las Americas. Los objetivos de este articulo son 1) ofrecer nuestro apoyo decidido a favor de la vigilancia de las enfermedades cronicas, 2) presentar una revision descriptiva y un resumen de las actividades de vigilancia y los problemas en torno a las mismas en las Americas, 3) confeccionar una lista de recursos y fuentes de consulta para obtener mas informacion, y 4) ofrecer unas recomendaciones para reforzar la capacidad regional. Este articulo se basa en una revision personal de informes, sitios de Internet y apuntes personales procedentes de diversos proyectos, reuniones y actividades relacionados con la vigilancia de las enfermedades cronicas en las Americas, y en un analisis a profundidad de los materiales recopilados. Se ha determinado que las agencias sanitarias internacionales, los gobiernos de diversos paises, las organizaciones no gubernamentales y los profesionales de la sanidad publica han dedicado grandes esfuerzos a la construccion y al desarrollo de las capacidades de vigilancia de las enfermedades cronicas en la Region. Para seguir apoyando el aumento de dichas capacidades, se hace necesario establecer una red de redes (una metarred) cuya mision deberia ser la vigilancia de la vigilancia. Siete aspectos importantes para el aumento de esta capacidad son la estrategia, la colaboracion, la informacion, la educacion, la novedad, la comunicacion, y la evaluacion.

Meeting Report: Development of Environmental Health Indicators in Brazil and Other Countries in the Americas

Abstract: This report summarizes the Brazilian experience on the design and implementation of environmental health, with contributions from Argentina, Canada, and Cuba, presented at the International Symposium on the Development of Indicators for Environmental Health Integrated Management, held in Recife, Pernambuco, Brazil, on 17–18 June 2004. The methodology for the development of environmental health indicators has been used as a reference in the implementation of environmental health surveillance in Brazil. This methodology has provided tools and processes to facilitate the understanding and to measure the determinants of risks to environmental health, to help decision makers control those risks.

Assessment of Risks Related to Medicine Dispensing by Nonprofessionals in Colombia: Clinical Case Simulations

Abstract: BACKGROUND:Appropriate dispensing is one of the steps for rational drug use, so it is generally advised that the dispenser should have relevant and updated knowledge, skills, and attitudes.OBJECTIVE:To assess pharmacies and nonprofessional employees' (NEs) skills and knowledge, as well as their response to several specific case simulations in Bogota, Colombia.METHODS:A descriptive cross-sectional study was performed on a random sample of 371 pharmacies in Bogota. Information from each pharmacy was obtained using 2 approaches: (1) direct interview to collect data on organizational aspects of the store and characteristics of NEs, and (2) simulation (both by direct interview and by telephone) to assess dispensing responses in 6 simulated clinical cases.RESULTS:More than half of the simulated clinical situations resulted in inappropriate dispensing (direct simulations 57%; telephone simulations 55%). The proportion of correct answers to theoretical questions regarding a specific therapeutic problem during int...