| 1. |
- Laux, Timothy S, et al.
(författare)
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Nicaragua revisited : evidence of lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village
- 2012
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Ingår i: JN. Journal of Nephrology (Milano. 1992). - : SAGE Publications. - 1121-8428 .- 1724-6059. ; 25:4, s. 533-540
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Chronic kidney disease (CKD) is found at epidemic levels in certain populations of the Pacific Coast in northwestern Nicaragua especially in younger men. There are knowledge gaps concerning CKD's prevalence in regions at higher altitudes.METHODS: A cross-sectional study of adults between the ages of 20 and 60 years in 1 coffee-growing village in Nicaragua located at 1,000 m above sea level (MASL) altitude was performed. Predictors included participant sex, age, occupation, conventional CKD risk factors and other factors associated with CKD suggested by previous surveys in Central America. Outcomes included serum creatinine (SCr) values >1.2 mg/dL for men and >0.9 mg/dL for women, estimated glomerular filtration rate (GFR) <60 ml/min per 1.73 m2, dipstick proteinuria stratified as microalbuminuria (30-300 mg/dL) and macroalbuminuria (>300 mg/dL), hypertension and body mass index.RESULTS: Of 324 eligible participants, 293 were interviewed (90.4%), and 267 of those received the physical exam (82.4% overall). Of the sample, 45% were men. Prevalence rate of estimated GFR <60 ml/min per 1.73 m2 was 0 for men (0%) and 2 for women (1.4%). The prevalence of at least microalbuminuria was significantly higher among men compared with women (27.5% vs. 21.4%, respectively; p=0.02).CONCLUSIONS: The CKD prevalence in this village is comparable to a previously studied Nicaraguan coffee-farming region and much lower than previously screened portions of northwestern Nicaragua. There is heterogeneity in CKD prevalence across Nicaragua. At this time, screenings should target individuals living in previously identified, higher risk regions. More work is needed to understand determinants of CKD in this resource-poor nation.
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| 2. |
- Ziaei, Shirin, et al.
(författare)
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Women´s autonomy and social support and their associations with infant and young child feeding and nutritional status : community-based survey in rural Nicaragua
- 2015
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Ingår i: Public Health Nutrition. - 1368-9800 .- 1475-2727. ; 18:11, s. 1979-1990
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo evaluate the associations of women’s autonomy and social support with infant and young child feeding practices (including consumption of highly processed snacks and sugar-sweetened beverages) and nutritional status in rural Nicaragua.DesignCross-sectional study. Feeding practices and children’s nutritional status were evaluated according to the WHO guidelines complemented with information on highly processed snacks and sugar-sweetened beverages. Women’s autonomy was assessed by a seventeen-item questionnaire covering dimensions of financial independence, household-, child-, reproductive and health-related decision making and freedom of movement. Women’s social support was determined using the Duke-UNC Functional Social Support Questionnaire. The scores attained were categorized into tertiles.SettingLos Cuatro Santos area, rural Nicaragua.Subjects A total of 1371 children 0–35 months of age.ResultsChildren of women with the lowest autonomy were more likely to be exclusively breast-fed and continue to be breast-fed, while children of women with middle level of autonomy had better complementary feeding practices. Children of women with the lowest social support were more likely to consume highly processed snacks and/or sugar-sweetened beverages but also be taller.ConclusionsWhile lower levels of autonomy and social support were independently associated with some favourable feeding and nutrition outcomes, this may not indicate a causal relationship but rather that these factors reflect other matters of importance for child care.
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| 3. |
- Lebbad, Marianne, et al.
(författare)
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Dominance of Giardia assemblage B in León, Nicaragua.
- 2008
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Ingår i: Acta Tropica. - : Elsevier BV. - 0001-706X .- 1873-6254. ; 106:1, s. 44-53
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Tidskriftsartikel (refereegranskat)abstract
- Giardiasis is a major problem in León, Nicaragua, yet despite this no data are available regarding the prevalence of different Giardia genotypes in this area. To address this question, a molecular analysis of Giardia isolates from humans and dogs living in the same area in León, Nicaragua was performed. Giardia isolates from 119 Nicaraguan patients and 8 dogs were successfully genotyped using single and/or nested beta-giardin PCR with subsequent restriction length fragment polymorphism (RFLP) analysis. The analyses of human samples yielded 94 (79%) assemblage B isolates and 25 (21%) assemblage A isolates. Only the non-human-associated assemblages C and D were found in the dog samples. Sixteen isolates with assemblage A pattern, 26 isolates with assemblage B pattern and all dog isolates were further characterized by sequencing the nested beta-giardin PCR product and by molecular analyses of the glutamate dehydrogenase (gdh) gene. Within the study area the assemblage A isolates were highly genetically homogenous, showing only sub-genotypes A2 (n=3) or A3 (n=13) at the beta-giardin locus and AII only at the gdh locus while assemblage B showed a high genetic polymorphism at both loci. Seven different sub-genotypes were identified within 13 of the sequenced assemblage B beta-giardin isolates. The remaining 13 sequenced assemblage B-isolates appeared to contain several different variants of the beta-giardin gene since the chromatograms displayed one to seven double peaks. The gdh sequences showed an even higher polymorphism since only 2 of 26 assemblage B isolates were without double peaks. Two mixed infections between assemblage A and B were found when the gdh gene was analyzed. Polymorphisms were also observed in the dog-associated assemblages C and D, but to a lesser extent than in assemblage B.
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| 4. |
- Bucardo, Filemón, et al.
(författare)
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Association of Genetic Polymorphisms in DC-SIGN, Toll-Like Receptor 3, and Tumor Necrosis Factor a Genes and the Lewis-Negative Phenotype With Chikungunya Infection and Disease in Nicaragua
- 2021
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Ingår i: Journal of Infectious Diseases. - : Oxford University Press. - 0022-1899 .- 1537-6613. ; 223:2, s. 278-286
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundChikungunya infections range from subclinical infection to debilitating arthralgia and to chronic inflammatory rheumatism. Tumor necrosis factor (TNF) α, DC-SIGN (dendritic cell–specific intercellular adhesion molecule 3–grabbing nonintegrin), Toll-like receptor (TLR) 3, and blood groups have been directly or indirectly implicated in the susceptibility and pathogenesis of chikungunya.MethodsTo test the hypothesis that polymorphisms in genes coding for these molecules determine clinical outcomes of chikungunya infection, a retrospective case-control study was performed in León, Nicaragua. The study included 132 case patients and 132 controls, matched for age, sex and neighborhood. Case patients had clinical symptoms of chikungunya, which was diagnosed by means of polymerase chain reaction. Controls were individuals not reporting abrupt presentation of clinical chikungunya-like symptoms. Polymorphisms were identified by TaqMan single-nucleotide polymorphism genotyping assays.ResultsAfter adjustment for sociodemographic risk factors, chikungunya disease was associated with polymorphism in DC-SIGN and TLR3 genes (odds ratios, 5.2 and 3.3, respectively), and TNF-α with reduced persistent joint pain (0.24). Persistent joint pain was also associated with age, female sex and other comorbid conditions. Most interestingly, the Lewis-negative phenotype was strongly associated with both symptomatic chikungunya and immunoglobulin G seropositivity (odds ratios, 2.7, and 3.3, respectively).ConclusionThis study identified polymorphisms in DC-SIGN, TLR3, and TNF-α genes as well as Lewis-negative phenotype as risk factors for chikungunya infection and disease progression.
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| 5. |
- Ugarte, William J., 1979-, et al.
(författare)
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Measuring HIV- and AIDS-related stigma and discrimination in Nicaragua : Results from a community-based study
- 2013
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Ingår i: AIDS Education and Prevention. - : Guilford Publications. - 0899-9546 .- 1943-2755. ; 25:2, s. 164-178
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Tidskriftsartikel (refereegranskat)abstract
- Psychometric properties of external HIV-related stigma and discrimination scales and their predictors were investigated. A cross-sectional community-based study was carried out among 520 participants using an ongoing health and demographic surveillance system in León, Nicaragua. Participants completed an 18-item HIV stigma scale and 19 HIV and AIDS discrimination-related statements. A factor analysis found that 15 of the 18 items in the stigma scale and 18 of the 19 items in the discrimination scale loaded clearly into five- and four-factor structures, respectively. Overall Cronbach’s alpha of .81 for the HIV stigma scale and .91 for the HIV discrimination scale provided evidence of internal consistency. Hierarchical multiple linear regression analysis identified that females, rural residents, people with insufficient HIV-related transmission knowledge, those not tested for HIV, those reporting an elevated self-perception of HIV risk, and those unwilling to disclose their HIV status were associated with higher stigmatizing attitudes and higher discriminatory actions towards HIV-positive people. This is the first community-based study in Nicaragua that demonstrates that overall HIV stigma and discrimination scales were reliable and valid in a community-based sample comprised of men and women of reproductive age. Stigma and discrimination were reported high in the general population, especially among sub-groups. The findings in the current study suggest Community-based strategies, including the monitoring of stigma and discrimination, and designing and implementing stigma reduction interventions, are greatly needed to reduce inequities and increase acceptance of persons with HIV.
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| 6. |
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| 7. |
- Ugarte, William J., et al.
(författare)
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Assessing knowledge, attitudes, and behaviors related to HIV and AIDS in Nicaragua : A community-level perspective
- 2013
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 4:1, s. 37-44
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Tidskriftsartikel (refereegranskat)abstract
- Background:Nicaragua's HIV epidemic is concentrated among men who have sex with men.Nevertheless, the increasing number of HIV cases among heterosexuals, high levels of poverty andmigration rates, and incomplete epidemiological data suggest the need to improve the understanding of the epidemic.Objective:To examine the prevalence of HIV-related knowledge, attitudes, and sexual rsik-taking behaviors, and their predictors among the adult population.Methods: A community-based cross-sectional survey was conducted in 2009 among 520 participants ages 15 to 49 from an ongoing Health and Demographic Surveillance System in Nicaragua. Bivariate analysis and adjusted prevalence ratios were use to examine factors associated with HIV-related knowledge, attitudes, and sexual behavior.Results: Contributing factors for risk-taking behaviors included cognitive, psychosocial, and emotional elements. Insufficient knowledge affecting the accurate assessment of HIV risk were low educational level, poverty, and rural origin, especially among females. Recognizing risk was not sufficient to promote safer sex: 90% of the females and 70% of the males who reported being sexually active in the past year did not use condoms during their last sexual encounter. Inconsistent condom use among men was associated with older age, long-term relationships, and lack of awareness about acquiring HIV infection.Conclusions:Interventions to reduce social-structural contextual factors in Nicaragua are needed so that individuals may adopt and maintain HIV risk reduction strategies. Increased gender-specific HIV education and skills-building programs need to be implemented. Sensitive mass media messages may also increase the knowledge of HIV and AIDS, and serve to encourage protective attitudes and behaviors.
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| 8. |
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| 9. |
- Ugarte Guevara, William J., et al.
(författare)
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Sexuality and Risk Behavior among Men Who have Sex with Men in León, Nicaragua : A Mixed Methods Approach
- 2012
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Ingår i: Journal of Sexual Medicine. - : Oxford University Press (OUP). - 1743-6095 .- 1743-6109. ; 9:6, s. 1634-1648
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Tidskriftsartikel (refereegranskat)abstract
- Introduction.HIV prevalence among men who have sex with men (MSM) is 38 times higher than among the general population in Nicaragua. There are little data about the sexuality and sexual behaviors of MSM. It is essential to gain a better understanding of this understudied population.Aims.The nature of sexual relationships among MSM, their reasons for engaging in risky sexual behaviors, and the sociocultural context in Leon, Nicaragua, were investigated through in-depth interviews. Our findings resulted in a structured overview of sociodemographic characteristics and HIV-related knowledge, attitudes, and risk behaviors.Methods.Fifteen participants recruited by purposive sampling completed an in-depth interview that was then thematically analyzed. An additional 104 participants were surveyed by means of an interviewer-administered questionnaire.Main Outcome Measures.The in-depth interview guide and the survey covered topics related to sociodemographics, childhood, social and sexual relationships, knowledge and attitudes toward HIV and AIDS, identity, and networks.Results.The resulting ecological model explored sexuality and behaviors in four categories. It showed that despite a homophobic and heterosexist society, there is an increasing gay community and greater social acceptance of homosexuality. Nevertheless, interpersonal and intrapersonal factors continue to negatively influence MSM behavior. Quantitative findings demonstrate a satisfactory understanding of HIV transmission among this population, 75% of whom reported concerns of becoming infected with HIV in the future. Approximately one-half claimed that they always used condoms when having sex with men, but only one-third of the time with women, indicating inconsistent condom use. Negative attitudes toward HIV/AIDS were seldom heard.Conclusions.This study is the first mixed methods approach in a Nicaraguan context that shows the interrelations among sex, sexuality, and identity at various levels of MSM life, and how they influence the sexual risk behaviors of individuals. Engaging in unprotected sex and postponing HIV testing are seen as cognitive dissonances.
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| 10. |
- Pérez, Wilton, 1979-, et al.
(författare)
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Comparing progress toward the child mortality Millennium Development Goal in León and Cuatro Santos, Nicaragua, 1990–2008
- 2014
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 14, s. 9-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Social inequality in child survival hampers the achievement of Millennium Development Goal 4 (MDG4). Monitoring under-five mortality in different social strata may contribute to public health policies that strive to reduce social inequalities. This population-based study examines the trends, causes, and social inequality of mortality before the age of five years in rural and urban areas in Nicaragua. Methods: The study was conducted in one rural (Cuatro Santos) and one urban/rural area (Leon) based on data from Health and Demographic Surveillance Systems. We analyzed live births from 1990 to 2005 in the urban/rural area and from 1990 to 2008 in the rural area. The annual average rate reduction (AARR) and social under-five mortality inequality were calculated using the education level of the mother as a proxy for socio-economic position. Causes of child death were based on systematic interviews (verbal autopsy). Results: Under-five mortality in all areas is declining at a rate sufficient to achieve MDG4 by 2015. Urban Leon showed greater reduction (AARR = 8.5%) in mortality and inequality than rural Leon (AARR = 4.5%) or Cuatro Santos (AARR = 5.4%). Social inequality in mortality had increased in rural Leon and no improvement in survival was observed among mothers who had not completed primary school. However, the poor and remote rural area Cuatro Santos was on track to reach MDG4 with equitable child survival. Most of the deaths in both areas were due to neonatal conditions and infectious diseases. Conclusions: All rural and urban areas in Nicaragua included in this study were on track to reach MDG4, but social stratification in child survival showed different patterns; unfavorable patterns with increasing inequity in the peri-urban rural zone and a more equitable development in the urban as well as the poor and remote rural area. An equitable progress in child survival may also be accelerated in very poor settings.
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