Browsing by Subject "Peru"
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Item Baseline Assessment of Adolescent Reproductive and Sexual Health in Yantaló, San Martin, Peru(2016-04-01) Murarka, Shivani; Johnson, AndreaBACKGROUND: The term “adolescent fertility rate” refers to the number of births per 1000 in girls ages 15-19. In July 2013, the adolescent fertility rate in rural Yantaló, Peru, was nearly 10%, almost double the national rate of 5.2% in 2012 (World Bank). Adolescent pregnancy remains a major contributor to maternal and child mortality and to the cycle of ill-health and poverty world-wide (WHO). In Yantaló, many young mothers are forced to terminate their schooling in order to care for their children, giving them fewer opportunities for financial independence in a society with a strong machismo culture. OBJECTIVE: To gain a better understanding of the adolescent sexual and reproductive health education and practice in Yantaló and the potential interventions that could be made to decrease the adolescent fertility rate. METHODS: This study involved numerous methods of data collection that were then evaluated and presented to the local community. We started by conducting oral interviews with 19 local authorities, who played different roles in the community, to gain a deeper understanding of the issues surrounding adolescent sexual and reproductive health in the region. We then conducted 218 written surveys with high school students ages 11-19 to investigate their baseline reproductive health knowledge, religious values, family life, and their preferences regarding avenues of receiving sexual health information and sexual health classes. We also evaluated the proposed national curriculum on sexual health. All of this data was then used to create suggestions regarding interventions to improve the adolescent fertility rate in Yantaló, and this information was presented to local authorities. RESULTS: Analysis of the study revealed that there were many components that contributed to the high adolescent fertility rate in Yantaló and many potential areas for intervention were made apparent. Data from oral interviews pointed to a strong machismo culture, rampant misconceptions regarding sexual health and contraceptive methods, insufficient outreach programs, and a general lack of coordination between local entities as reasons for the high number of adolescent pregnancies. The surveys of the adolescents revealed that they lacked basic reproductive health knowledge but were eager to learn more, especially from local clinicians and their mothers and fathers, despite admitting having difficulty communicating openly about sexual health with their parents. Although the proposed national curriculum was analyzed, the school in Yantaló admitted that it only followed the guidelines loosely, which made it an ineffective tool to evaluate sexual health education in the region. CONCLUSION: Yantaló is similar to many other rural communities in South and Central America in that it has a strong traditional, machismo culture that influences much of the adolescent sexual health practices. Like much of Peru, Yantaló also has access to trained healthcare providers and free contraceptive care, but misconceptions and a lack of education regarding sexual health limits access. This research emphasized the importance collaboration within the community to utilize the existing infrastructure of the village to increase education of adolescents and encourage communication between providers, parents, and adolescents to improve adolescent sexual health and reduce the burden of unwanted teenage pregnancy. This practice could be easily translatable to numerous other communities that struggle with the same inefficiencies.Item Characterization of the Infectious Agent Causing Tegumentary Leishmaniasis in Peru(2016-01-19) Tapscott, Michael; Wetzel, Dawn M.Leishmaniasis is a parasitic disease most commonly manifested as cutaneous lesions that occur on exposed areas of skin. The lesions begin as red papules that grow to form a painless ulcer associated with granulomatous tissue at the base, surrounded by raised margins. It is estimated that 12 million people worldwide are infected with the disease, and an additional 2 million are diagnosed each year, with 1/10 of the world population at risk of infection. There are 20 species of Leishmania pathogenic to humans and an estimated 30 species of sandfly that serve as vectors. In the endemic country of Peru the main causative Leishmania species is not certain. We aimed to collect data from patients with tegumentary and mucosal leishmaniasis and perform nested Real-Time PCR to determine the species of the causative agent. We also aimed to collect the vector in the field and identify which sandfly species are carrying the parasite and which species of Leishmania the sandfly is infected with. Individuals who were suspected of having cutaneous or mucocutaneous leishmaniasis were referred to a study site to have a tissue sample taken of their lesion. Three tissue samples were collected: a lancet scraping, a filter paper impression, and a tissue aspiration. Lancet scraping was performed by first disinfecting the lesion, then obtaining tissue secretions from the inside border. Filter paper was performed by disinfecting the lesion and pressing the filter paper on the lesion, thus collecting the fluids. Aspiration was performed by disinfecting the lesion, and a needle containing a sterile saline solution with antibiotics was inserted on the outside border and base, and then rotated. The fluid collected was then placed in a tube with Senekjie's rabbit blood agar. Of the patients with suspected leishmaniasis, the causative agents were L braziliensis, L guyanensis, L laisoni, and some species that could not be identified. L braziliensis was the majority of the species in the positively identified cases, as well as being nearly all of the cases of mucocutaneous leishmaniasis. Patients receiving treatment after testing positive are being followed to determine clinical presentations during treatment and any resistance each specific species may show. In the future, the cultures will then be used to help determine the mechanism of resistance to help better administer treatment. We also propose to develop a sensitive and specific diagnostic test that can be deployed in areas without additional equipment by using a technique called recombinase polymerase amplification (RPA).Item Epidemiological Risk Factors for Severe Plasmodium vivax Malaria in Peru(2016-01-19) Hamilton, Hayley; Stanley, AdriannaRecent investigation has produced a significant shift in the paradigm of Plasmodium vivax. No longer characterized as a mild and clinically benign disease, P. vivax can produce severe and life-threatening symptoms. While most of the recent literature seeks to address the clinical manifestations of severe P. vivax infection, we have chosen to examine the epidemiological risk factors in the progression to severe disease. We conducted an analysis based upon a prospective case-control study that took place between the years of 2012-2015 in the Peruvian Amazon Basin. The study population of 215 total patients with mono-infection of P. vivax consisted of 125 cases and 90 controls - as defined by the WHO guidelines for severe falciparum malaria. Men and women comprised 56% and 44% of the patients, respectively. Ages ranged from 4 to 88 years, including 20 children. Factors we found to be associated with severe malaria include sex, previous infection with malaria, and residence proximity to water. To determine significance, we performed chi-squared and logistic regression analyses and obtained odds ratios, p-values, and 95% confidence intervals using STATA software. Women were three times more likely to present with severe vivax malaria than men (p=0.0001). Patients with previous malaria infection(s) of any species were 4.16 times less likely to develop severe malaria (p=0.0003), suggesting that prior infection may be protective. Finally, we observed that study participants who lived near a source of water are 2.9 times more likely to present with severe infection (p=0.0005. Future studies should focus on identifying the relative contributions of innate host factor (immuno-tolerance and genetics) with differences associated with pathogen exposure (parasite load strain).Item Leptospirosis Risk Perception and Associated Behavior in a Region of High Seroprevalence in Iquitos, Peru(2016-04-01) Gutierrez, Carolina Paola; Higashi, Robin T.; Niwagaba, Lilian; Southern, PaulBACKGROUND: Iquitos has an ideal environment for Leptospira transmission leading up to endemic leptospirosis. Studies in Belen, an urban slum in Iquitos, indicate seroprevalence as high as 28% with rates higher in flooding and non-flooding areas, and pathogenic Leptospira in floodwater. Public health education efforts to date have failed to reduce prevalence and transmission rates. OBJECTIVE: Assess the community environment, residents' beliefs and behaviors, and social networks for information exchange to identify opportunities for enhancing public health strategies. METHODS: The primary researcher collected qualitative data from site observation (approximately 12 hours), 51 interviews, and 4 focus group interviews (n=27). All audio recordings were transcribed verbatim, translated to English, then analyzed and interpreted using NVivo 9.0 (QSR Australia). RESULTS: Roughly half (47%) of participants were familiar with the term "Leptospirosis" or "la enfermedad de la rata" (the rat's disease), but few could report on disease presentation or prevention. Although limited knowledge uptake has hampered prevention efforts, results also demonstrate that high-risk behaviors are closely aligned with environmental conditions, daily living practices, and cultural values, beliefs, and priorities. CONCLUSION: Complex and interconnected social, economical, and cultural conditions make Belen an ideal environment for transmission of leptospirosis. Public health strategies and funding to reduce transmission should target community trash disposal techniques, knowledge of water-borne illness, and modification of education modalities and distribution to leverage community-oriented values and priorities.Item Resource-Poor Resuscitation: Approach to Cardiac Arrest in a Developing Country(2017-03-24) Hoerster, Valerie Ann; Mihalic, Angela; Chang, Mary; Idris, Ahamed H.BACKGROUND: As part of its Advanced Cardiac Life Support (ACLS) guidelines, the American Heart Association (AHA) recommends immediate cardiac monitoring for adults in cardiac arrest and, in cases of Ventricular Fibrillation (VF) or pulseless Ventricular Tachycardia (pVT), early administration of electric shocks with a cardiac defibrillator. In the United States, cardiac monitors and defibrillators are available in all hospitals for use during in-hospital cardiac arrest. Furthermore, the use Automated External Defibrillators (AEDs) is encouraged for out-of-hospital arrests. In geographically remote, resource-limited areas, cardiac defibrillators may not be readily available. OBJECTIVE: This paper aims to evaluate the availability and efficacy of in-hospital cardiac defibrillation and discuss the potential global health goal of improving defibrillator access in Peru. METHODS: An online literature search was performed looking for key words. Retrieved articles, their references, and past literature reviews on the subject were screened for relevance. RESULTS: In the United States, overall survival to discharge for cardiac arrest is low; however, there is well-established evidence that the use of ACLS guidelines improves outcomes for cardiac arrest. Patients who present in shockable rhythms are more likely to survive than those in non-shockable rhythms when a defibrillator is available. Identification of the precipitating acute medical illness is a moderate predictor of both initial rhythm and chance of survival. In Peru, etiologies of in- hospital cardiac arrest is somewhat different. Few scientific data are available for cardiac arrest outcomes or defibrillator availability in Peru. CONCLUSION: Physicians practicing international medicine must recognize and adapt to differences in patient demographics and resource availability. In Peru and similar lesser-developed countries, basic public health need such as potable water and vaccines remain a priority. Efforts to improve outcomes for in-hospital arrest should focus on teaching high-quality CPR. When sufficient infrastructure is in place, improving access to defibrillators would be an appropriate next step.Item Secondary Prevention: A Cost-Effective Yet Underutilized Strategy for Reducing the Stroke Burden in Resource-Limited Settings(2015-03-25) Rimmer, Kathryn; Gebreyohanns, MehariBACKGROUND: Over two-thirds of global stroke occur in low- and middle-income countries (LMIC), where the populations are affected on average 15 years younger. Those who survive potentially lose their livelihood and are financially vulnerable to health care expenses. On a national level, stroke DALYs rob the developing economy of its workforce. Cost-effective prevention strategies and interventions could help reduce the stroke burden in LMIC. Primary prevention is considered the top priority, but it necessitates sufficient infrastructure and human resources for successful campaigns. In resource-limited health systems, the population at greatest risk for stroke are likely not receiving regular health maintenance. OBJECTIVE: Secondary prevention targets the cohort seeking medical attention for an incident stroke. It is hypothesized to be a more feasible strategy of improving stroke rates in LMIC by reducing recurrence in high-risk populations. The objectives of this study are to compare stroke risk and secondary prevention practices across four different countries of varying income level, and to determine which secondary prevention drug regimen would be optimal for resource-limited settings. METHODS: Current economic and health indicator data were collected from the World Bank and the World Health Organization (WHO) on the United States, France, Vietnam, and Peru. Death and disability-adjusted life-years (DALYs) rates along with risk factor prevalences for each country were accessed from the WHO. Literature reviews on secondary prevention of recurrent stroke and healthcare-utilization in the developing world were conducted on MEDLINE and Pubmed databases using the following key words: stroke, epidemiology, risk factors, stroke burden, secondary prevention, secondary prevention drugs, cost-effectiveness, healthcare-utilization, resource-limited settings, developing world, developing countries, and LMIC. Articles that addressed thesis objectives were selected for review. Additionally, the latest country-specific guidelines for secondary prevention of stroke were retrieved online from the relevant national stroke organizations. RESULTS: Vietnam experienced the highest death (109) and DALY (729) rates for both genders despite having a young population. Peru has the next highest incidence of death (45.8) and DALYs (385) from stroke. There was a trend of increasing stroke burden with decreasing country GNI per capita among the four countries. Each country had a signature risk factor profile; the United States with raised total cholesterol and obesity; France with hypertension, raised total cholesterol, and smoking; Vietnam with the greatest risk of hypertension and the highest prevalence of smoking among men; and Peru with risk of high BMI. Regarding clinical practice, both the United States and France have an established national guidelines on secondary prevention of stroke. Vietnam recently established its own quality standards based on the Royal College of Physicians' recommendations. Peru does not have its own clinical guidelines for secondary prevention, and adherence to evidence-based recommendations is likely variable among Peruvian neurologists. CONCLUSION: In the absence of a health system that can adequately screen and monitor common risk factors in its population, most susceptible patients will go untreated until a cerebrovascular event brings them to medical attention. The opportunity to intervene in the high-risk population is at the moment of incident stroke. Secondary prevention is a cost-effective strategy that can be implemented in the interim while sufficient healthcare capacity develops to maximize primary prevention in the future. LMIC must economize according to the constraints of their resources. Therefore, it would be practical to initiate secondary prevention drug therapy according to the top one or two risk factors in the population.