| 1. |
- Dahlblom, Kjerstin, 1950-
(författare)
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Home alone : sibling caretakers in León, Nicaragua
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sibling caretaking, although common across time and cultures, has not been well researched from the carer’s point of view. In Nicaragua, ranked as one of the poorest countries in the Americas, sibling caretaking is common. The country’s historical background and its state of chronic poverty, widespread unemployment, loose family structures, and migration and mobility makes of the old practise of shared management child care a necessity. Households headed by sing¬le mothers constitute a particular Nica¬raguan charact¬eristic. Many children are expected to help in their own families and care for their siblings and other children living in their households. In its broadest sense sibling caretaking is a public health concern, and we conducted this study to widen the understanding of the phenomenon as it is represented in a setting undergoing a rapid social transition. The main objectives were to identify, describe and analyse the life situation of sibling caretakers in poor areas in León, Nicaragua, with focus on how they perceived it themselves. A combined qualitative and quantitative methodological design was used, mainly applying an ethnographic approach. A further ambition was to explore involvement of children in a participatory research process in accordance with the ‘Convention on the Rights of the Child’. The overall emotion expressed among the caretakers was pride, even if their situation often was characterized by stress and coping problems. They perceived their work as important for their families and they appreciated to fend for their siblings. Household work and nurturing of siblings were shaping the future lives of the caretakers and constituted part of their socialization. Even if many of these children achieve essential life skills as caretakers, they are at risk of falling behind as they grow older. Their long-term personal development is likely to be hampered by the obligations they have as caretakers. The carers' awareness of missing out on education was the most problematic issue for them. From a societal point of view, caretaking has negative consequences. The individual child is marginalised with limited access to basic education, contributing to overall low educational levels in Nicaragua. While the structuring conditions leading to sibling caretaking may be difficult to change, awareness of how these can affect children might make way for improvements in terms of access to school education and support from the society. The knowledge gained from this study should be further utilised to plan for interventions that take children’s perspectives into consideration.
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| 2. |
- Åsling Monemi, Kajsa, 1960-
(författare)
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The Impact of Violence Against Women on Child Growth, Morbidity and Survival : Studies in Bangladesh and Nicaragua
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to explore the impact of physical, sexual and emotional violence against women of reproductive age and the level of controlling behaviour in marriage on child health and survival in two different cultural settings: Bangladesh and Nicaragua. Data were acquired from four quantitative community-based studies. In two studies, a cohort including a prospective two year follow-up of 3164 mother-infant pairs in rural Bangladesh was investigated. A third study was a case-referent study in Nicaragua including mothers of 110 cases of under-five deaths and 203 referents, and in a forth study an other cohort of 1048 rural Bangladeshi women and their 2691 children was followed until 5 years of age. Maternal exposure to any form of violence, including physical, sexual, emotional, and controlling behaviour was independently associated with lower body size at birth, increased risk of stunting and under-weight at 24 months of age, slower growth velocity during the first two years of life and a higher incidence of diarrhoeal episodes and respiratory tract infections. In the Nicaraguan setting, the children of women who experienced any history of physical violence had a two-fold increase in risk of death before the age of 5 years, and those whose mothers experienced both physical and sexual violence had a six-fold increase in risk of death. In Bangladesh, an association between violence against women and under-five mortality was found among daughters of educated mothers who were exposed to severe physical violence or a high level of controlling behaviour in marriage. In all four studies, lifetime violence experience among participating mothers was high (37-69%), and the timing was less relevant than the exposure to violence per se. In conclusion, this investigation revealed that violence against women severely affects child health and survival. The findings are especially relevant in a context of high level of child under-nutrition, morbidity and under-five mortality. Efforts for protecting women from all forms of violence are needed as part of the interventions for improved child health.
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| 3. |
- Herrera Rodríguez, Andrés, 1966-
(författare)
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Heaven can wait : studies on suicidal behaviour among young people in Nicaragua
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In developed countries, suicidal behaviour is recognised as a significant public health problem among young people, but there are few studies from developing countries on this subject. The present thesis aims at estimating the extent of the problem and at exploring factors related to suicidal behaviour among young people in a developing country, Nicaragua, using a combined quantitative and qualitative approach. Three studies were conducted between 1999 and 2006. In the first study, all hospital admitted suicide attempt cases in the area of León were assessed over a three year period. Secondly, a qualitative study using individual in-depth interviews was conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. Thirdly, a study using the Attitudes Towards Suicides (ATTS) questionnaire was conducted in a community based sample of 278 young people aged 15-24 years to assess own suicidal behaviours, attitudes towards suicide as well as exposure to suicidal behaviour among significant others. The hospital surveillance showed that suicide attempt rates were highest among females in the age group 15-19 years with a female rate three times that of males (302.9 versus 98.9 per 100,000 inhabits per year). Drug intoxication and pesticides were the most commonly used methods for the attempts. A consistent seasonal variation with peaks in May-June and September-October was found in each of the three years, possibly related to exam periods in schools. Findings in the qualitative approach led to a tentative model for pathways to suicidal behaviour based on four main categories: Structuring conditions, triggering events, emotions and action taken. Dysfunctional families, lack of confidential and trustworthy contacts and interpersonal conflicts followed by emotions of shame and anger were some important components in the model. The community studies showed that suicidal expressions (life-weariness, death wishes, suicidal ideation, suicide plans and suicide attempts) were common among young people where more than 44.8% of males and 47.4% of females reported some kind of suicidal expression. Gender differences were small. Exposure to suicidal behaviour among others was associated with higher levels of self-reported suicidal behaviour. The attitude study showed that boys had less pro-preventive attitudes than girls, possibly indicating their higher risk for completed suicide. Exposure to suicidal behaviour and own suicidal behaviour showed an association with specific patterns of attitudes. The findings should be taken into consideration when planning for prevention of suicidal behaviour among young people in a developing country like Nicaragua.
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| 4. |
- Valladares Cardoza, Eliette, 1963-
(författare)
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Partner violence during pregnancy, psychosocial factors and child outcomes in Nicaragua
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The objectives of the thesis was to explore partner violence during pregnancy in Nicaragua – its prevalence and characteristics, how women perceive, understand and cope with it, its association with specific child outcomes such as low birth weight (LBW), small for gestational age (SGA) and preterm birth, and possible pathways. A cross-sectional community-based study was conducted with 478 pregnant women and for a sub-sample of 147 salivary cortisol was measured. A case-referent hospital-based study was organized including 303 mothers immediately after delivery. In-depth interviews were conducted with women survivors to increase understanding of partner violence during pregnancy. The prevalence of emotional, physical and sexual partner abuse during pregnancy was 32.4%, 13.4% and 6.7% respectively. Seventeen percent of the victims suffered all three types of violence and in two thirds the abuse was severe and repeated. Half of the abused women had experienced punches and kicks directed to the abdomen; however, only 14% had sought health care and very few had disclosed the abuse or contacted police or authorities. Adolescent mothers, unwanted pregnancy and late registration for antenatal care or no check-ups were more likely among victims. The access to social resources facilitated the women’s ability to cope with the abuse, but the pregnancy itself was a barrier to receiving support from family, friends or society. The ability to confront abuse was determined by a complex interplay of factors such as economic independence, severity of abuse, access to social resources, implications for important others (i.e. children), socioeconomic group and a personal ability to cope with social norms. Low social resources, high levels of emotional distress and attempted suicide were associated with violence during pregnancy. Abuse during pregnancy was also found as an independent risk factor for LBW. Sixteen percent of LBW was attributed to physical abuse by a partner during pregnancy. A significant association between abuse during the index pregnancy and SGA was found. Partner violence during the pregnancy, low social resources and emotional distress were associated with higher levels of salivary cortisol. Pregnant women with high cortisol values were significantly more likely to give birth to SGA babies. A substantial decrease of birthweight, 142 grams, was estimated to be associated with increases in cortisol due to violence exposure. Partner violence during pregnancy is a serious social problem that impacts the rights, health and wellbeing of both the woman and her unborn child. The studies call for prioritization of intervention programmes for prevention and detection of violence, treatment and rehabilitation of the victims and the perpetrators, and change of the structural causes producing violence in society.
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| 5. |
- Mendoza, Alfredo
(författare)
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Groundwater occurrence and risk of pollution in a mountain watershed of Nicaragua
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hydrogeological and geophysical methods were applied in the Río Artiguas watershed, a mountain basin located in central Nicaragua. This area is under environmental stress from anthropogenic activities like gold mining using mercury and waste disposal into the streams. The aim of this work was to characterise the hydrogeological conditions in the basin with emphasis on understanding the possible connections between streams and groundwater. It was also important to evaluate the vulnerability and risk of groundwater pollution. Hydrogeological mapping, resistivity imaging, hydrological measurements and hydrochemical surveys were combined to meet the aims of the work. The hydrogeological characterisation permitted identification of a) recharge areas, b) geological units that contribute to the formation of the groundwater system and c) a mechanism of discharge through springs and streams. The geophysical surveys allowed mapping the extension of weathering and tectonic features with hydrogeological significance, e.g. faults, dykes and fractures. A total of 99 perennial springs were documented and classified according to their mechanism of formation. Isotopic data indicate that the recharge occurs very close to the sites where the springs are formed. This is also supported by the relatively low ion concentrations found in the water of the springs. The weathering layers together with fractures and dykes form shallow aquifers that commonly discharge in a spring or along the streams. The high precipitation regime is an immediate source of water to the system, and in conjunction with the geology and steep topography it generates a constant and rapid circulation of water from recharge areas to discharge zones. The natural implication of this hydrogeological framework is that the formation of large or regional flows is not evident at the current state of knowledge. The same factors that influence groundwater occurrence are to some extent responsible for the degree of groundwater vulnerability to pollution. The vulnerable areas are situated along the steep valleys of the basin, where the interactions between subsurface and surface water can facilitate the spreading of pollutants. Since the pollution sources are located near the streams the risk of groundwater pollution is concentrated there. The pollutants disposed into the streams are rapidly removed by the river flow, which has a high contribution from precipitation. The pollutants are then transported far away from the sources. The urgent need to end the pollution of Río Artiguas is obvious. The tools to prevent further deterioration are not only to be found in the hydro geosciences and mining technology sphere, but they are also located in the socio?political arena. In this respect, the research presented in this thesis will gain importance as it reaches and informs local decision makers about the vulnerability and risks of pollution that the current anthropogenic activities represent for the groundwater resources.
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| 6. |
- Berg, Linda, 1974-
(författare)
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InterNacionalistas : identifikation och främlingskap i svenska solidaritetsarbetares berättelser från Nicaragua
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to explore what solidarity workers from Sweden narrate about and from activities in Nicaragua. I focus on how identities reflect nationalising, racialising and gendering imaginations, and how these are being handled within the context of an international solidarity movement – with the ambition to strive for global justice. My search for answers takes its point of departure in a wide gender-oriented postcolonial perspective. With an understanding of identities and places as relational and plastic, postcolonial theory attempts to see the inevitable dilemmas of colonialism, to visualise people who have been sacrificed in the name of colonialism and nationalism. It is a theoretical field concerned with the struggle for the word, values and actions categorised by a (post)colonial order. The dissertation is divided into six chapters. After the introductory chapter, chapter 2 contains a discussion of the concept solidarity as a valuable designation for these activities, connected to a national self-image and as a determining factor for the informants' understanding of their identities. One fundamental theme in this study is the tension concerning “white”, “western”, “Swedish” solidarity workers speaking for and working with people in Nicaragua. In Chapter 3, “To make oneself trustworthy”, I take a closer look at this and discusses how the interviewees verbalised strategies to handle possible positions and the paradoxes of their employment. In chapter 4 “Nationalising gender”, I examine the speech of women, men, machismo and gender equality – and how they interrelate with other factors within the stories from the period in Nicaragua. The difficulties to intervene as a Swedish volunteer or coordinator in Nicaragua were well known among the interviewees/narrators and their organisations. How and what activities for change could be in different parts of the world were, and are, repeated questions within (at least this part of) the Swedish international solidarity movement. This is one reason why the solidarity organisations emphasised the importance of creating space for social change via information and moulding of public opinion. In Chapter five, “Describe Nicaragua”, I analyse the written stories by solidarity workers. I take departure in a few of the dominating themes and clarify how Nicaragua was mediated to a Swedish speaking reader. I argue that the stories of the solidarity workers are captured between recognising difference and creating stereotypes and exotic projections. Even though their object is the opposite, they tend to produce representations which demand the Other to stay in the place of difference. In the very last part I discuss some problems with being the “voice of the poor”. The dissertation concludes with a short summary of some of the most central themes. Here I refer to the narrated liminality and inherited boundaries of the employment. I discuss the anti-imperialist and feminist work with a national dead weight and the efforts to create alternative images and translocal subject positions. I end the study by reflecting on the difficulties of an internationalist “we” and with reference to Gayatri Chakravorty Spivak, I call for “unlearning our privileges as our loss”.
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| 7. |
- Téllez Sierra, Aleyda
(författare)
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Giardiasis in Leon, Nicaragua : prevalence and protection
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Giardia intestinalis is endemic in Nicaragua and affects children early in their lives. Infected individuals may be asymptomatic or suffer from acute or chronic diarrhea, malabsorption and weight loss. The prevalence of Giardia intestinalis infection in the population of León-Nicaragua was investigated. The presence of Giardia specific secretory antibodies was correlated with protection against disease. Parasite proteins as powerful immunogens were evaluated. By microscopic examination of stool samples, we found G. intestinalis cysts in 15.9 % of the tested material. Giardia was most prevalent in the youngest age group, close to 30 % in children less than 5 years old. The presence of the parasite could be correlated to poor socioeconomic conditions. In a subsequent study a prevalence of 15.6 % of anti-Giardia antibodies in milk was detected in lactating women. The protective effect of milk anti-Giardia antibodies against G. intestinalis infection was studied in 307 children aged 1 week to 2 years. Giardia cysts were found in stools of 36.1 % of infants. Among infected children, 24 (21.6 %) acquired the infection before the age of 6 months. Sixty-five children (58.8 %) presented multiples episodes of giardiasis during the first two years of life. Of 24 children infected early in life, 23 (96 %) were born to mothers lacking specific antibodies in milk. These children also developed more severe diarrhea. There was a significant difference between children born to mothers with and without antibodies with respect to the age at which the first Giardia infection was acquired (p=0.036). Milk and saliva samples from a group of 100 lactating women living in the same area were tested for the presence of Giardia specific antibodies. Anti-Giardia antibodies were seen in 59 % of milk samples and 52 % of saliva samples. Milk antibodies gave stronger reactions than saliva and most of them reacted with surface and flagella components. Secretory anti-Giardia antibodies recognized up to 16 different proteins in the molecular weight region between 20 and 165 kDa. Differences among samples were mostly quantitative. Selected anti-Giardia positive milk samples were tested with recombinant Giardia proteins alpha-1 giardin, alpha-enolase, arginine deiminase (ADI) ornithine carbamoyl transferase (OCT), and VSP4EX. All tested milk samples reacted with the recombinant antigens. Specific reactivity of milk antibodies with the ventral flagellae of the parasite was observed. Milk antibodies showed a similar reactivity to a reference anti-tubulin antibody previously generated and shown to recognize Giardia ventral flagella. The 50 kDa target tubulin immunogen has also the mobility of Giardia beta tubulin in polyacrylamide gel electrophoresis and isoclectric focusing of cytoskeleton parasite preparations. In conclusion, Giardia intestinalis is frequent among the population of León-Nicaragua and children born to immune mothers are at lower risk of getting giardiasis. Milk and saliva anti-Giardia antibodies found in Nicaragua women recognized Giardia immunogens such as VSPs, alpha-giardins as well as OCT, ADI and enolase. These antigens can be important in the development of immunodiagnostic tools and vaccines. During Giardia infection antitubulin secretory antibodies are also produced recognizing the ventral flagella of the parasite.
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| 8. |
- Bucardo-Rivera, Filemón
(författare)
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Pediatric rotavirus and norovisrus diarrhea in Nicaragua
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Diarrheal diseases are still one of the major health problems in developing countries with rotavirus (RV) being the most important pathogen of severe diarrhea in young children. Norovirus (NoV), a common cause of gastroenteritis is now recognized as an important cause of sporadic diarrhea and hospitalization in children worldwide. Estimates of the disease burden indicate that every year, RV causes approximately 111 million episodes of gastroenteritis, 2 million of hospitalizations and approximately 600,000 deaths in children <5 years of age, with most of the mortality in developing countries. Likewise, recent estimations indicate that NoV cause 900,000 clinical visits among children in industrialized countries, and up to 200,000 deaths of children <5 years of age in developing countries. Thus viral intestinal pathogens are associated with approximately 800.000 deaths in young children every year predominantly in developing countries. In, this thesis the importance, molecular epidemiology and host genetic factors associated with RV and NoV diarrhea in Nicaraguan children have been investigated. Between February and March 2005 a nationwide outbreak of acute gastroenteritis associated with an exaggerated increase in mortality in children <2 years of age was observed in Nicaragua. A total of 108 stool samples from children and adults of 13 towns or major cities of the country were investigated. RV was detected in 72 (67%) of the 108 samples examined. Surprisingly, most (85%) of the RVpositive samples were typed as P[8]G4, a virus not previously observed in Nicaragua. This viral strain was found to have several amino acid mutations that modified antigenic sites and the secondary structure of VP7. The structural changes observed in this virus may have increased virulence and enable this particular virus strain to escape neutralization. Following the nationwide outbreak of rotavirus, a diarrhea surveillance study was conducted in the city of León between March 2005 and February 2006 to investigate the role of NoVs infections in pediatric diarrhea. NoV was detected in 12% (65/542) of the children; of these, 11% (45/409) were in the community and 15% (20/133) among hospitalized children, with most strains (88%) belonging to genogroup (G) II. A significant proportion (18/31) of NoV-positive children with dehydration required intravenous rehydration. Nucleotide sequence analysis (38/65) of the N-terminal and shell region in the capsid gene revealed that at least six genotypes (GI.4, GII.2, GII.4, GII.7, GII.17, and a potentially novel cluster termed GII.18-Nica ) circulated during the study period, with GII.4 virus being predominant (26/38). GII.4 virus infected predominantly young children (<2 years old) and was the most common strain found among hospitalized cases. Molecular epidemiological analysis revealed circulation of NoV genotypes with significant diversity (GII.2, GII.4, GII.17 and GII.18-Nica) in April followed by decreased diversity (GI.4, GII.4 and GII.18-Nica) in May-June and restriction mainly to GII.4 in July. Our findings suggests that NoV is an important etiological agent of acute diarrhea among children of <2 years of age in Nicaragua. Host genetic resistance to NoV has been observed in challenge and outbreak studies in populations from Europe, Asia and USA. This, thesis also include an study to investigate if histoblood group antigens (HBGA) and secretor status (defined by a nonsense G428A mutation in FUT2 gene) are associated with NoV susceptibility in the Nicaraguan population. A subset of 28 NoV-positive patients and 131 healthy population controls were investigated in relation to blood types, Lewis phenotypes (Lea+b-, Lea-b+ and Lea-b-), secretor status and NoV antibody prevalence and titers. Similar to reports from Europe, none of the nonsecretor or Lea+b- individuals was symptomatically infected. Moreover, only 3% of the Nicaraguan population was nonsecretor in contrast to 20% in Europe. The globally dominating GII.4 virus was found to infect all blood groups except AB, nonsecretors and Lea+b- individuals. AB individuals were found to have significantly lower antibody-prevalence than both A and O individuals (P < 0.05) and also significantly lower antibody-titers than blood group A, B and O (P < 0.05) further suggesting that, AB individuals are highly resistant to NoV infection. The Lewis investigation revealed not only that Lewis status (Lea+b-, Lea-b+ and Lea-b-) is not a predictive marker for NoV infection, an observation consistent with a previous report but also that the Lea-b-individuals can be infected with both GI and GII viruses, an observation not previously made. Furthermore, no significant difference in antibody-prevalence was observed between different Lewis phenotypes. Surprisingly, 25% of the Nicaraguan population was Lea-b- as compared with the 5.7% and 10% observed in Sweden and Spain, respectively. This study extended previous knowledge about the role of HBGAs in NoV disease in a population with different genetic background than North America and Europe. The recognition of NoV as an important cause of gastroenteritis is in part due to recent development of sensitive and specific diagnostic methods. In, this thesis I describe a sensitive and specific LUX real-time PCR assay for detection and quantification of NoV. The LUX system uses a fluorophore attached to one primer having a self-quenching hairpin structure, making it cost-effective and specific. The assay simultaneously detected and distinguished between GI and GII NoV by using genogroup specific primers and melting temperature analysis. Quantification limit per real-time PCR reaction was 10 and 20 gene copies for GII and GI, respectively. The assay correctly identified all (n = 11) coded control specimens in a reference panel containing various NoV genogroups and genotypes. Of the clinical specimens from Nicaragua the LUX real-time PCR assay identified NoV in 29/42 samples which correlated with TaqMan assay, but not with a commercial ELISA (24/42) or a conventional PCR (targeting the RdRp) (25/42). One possible reason why the conventional PCR method failed to detect certain NoV-positive specimens might be that viral RNA concentration was too low. Another reason might be that the sites targeted (RdRp) with the conventional PCR primers are less conserved.
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| 9. |
- Leiva, Byron
(författare)
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Amoebiasis : diagnosis and prevalence in León Nicaragua
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- About ten yearly cases of liver abscess are presented in University Hospital, León, Nicaragua. Based on serology most of them have been shown to be amoebiasis cases. This raised the question of Entameoba histolytica prevalence in the population. Based on microscopy of stool specimens and serology, about 20% prevalence was found. With the new realization that pathogenic E. histolytica is morphologically indistinguishable from some common apathogenic species such as E. dispar (cysts detected by microscopy are reported as E. histolytica/ E. dispar), the aim was to determine the true prevalence of E. histolytica using various tests designed to differentiate between pathogenic and apathogenic species. In 480 apparently healthy individuals, the prevalence of E. histolytica/ E. dispar was 12% (58/480) as determined by microscopy. Out of these 58 stool samples an E. histolytica specific PCR was positive in 5%; thus the prevalence E. histolytica was 0.6%. In a group of 134 diarrhea patients, the most common finding was E. histolytica/ E. dispar (24%) at the health center laboratory level. In the Microbiology Department E. histolytica/E. dispar was found only in 4.5%. With the Triage Parasite test, only one case of E. histolytica/ E. dispar was found. By PCR, E. dispar was recognized in 10 (7.5%) and E. histolytica in two cases (1.5%). Over diagnosis was also confirmed in a quality control study where León health centers were examining 10 different stool samples. We found that the health center technicians continue to mix up E. histolytica/ E. dispar with other amoebas. The consequences of the apparent widespread over diagnosis of E. histolytica were studied retrospectively in 100 records of patients with intestinal symptoms. We found that all patients received treatment with metronidazole or related drugs. In 41% these treatments were not based on any laboratory findings at all. In 32 % E. histolytica/E. dispar were found. Other parasites (Entamoeba coli, Giardia intestinalis, Endolimax nana, Enterobius. vermicularis, Iodamoeba bütschlii) were seen in 27%. To explain the high seroprevalence of anti-E.histolytica antibodies in sero-epidemiological surveys we considered two possibilities: cross reactivity due to the common intestinal apathogenic E. dispar and antibodies to ubiquitous freeliving environmental amoebas. A study was undertaken to identify environmental amoebas and to determine cross-reactivity using antibodies from amoebiasis patients. Amoebas isolated from environmental water samples were characterized by morphological and immunohistochemical methods. In fresh water Acanthamoeba spp. were found in 21 %. Fifty three percent of tested wells in the geothermal area contained thermotolerant amoeboflagellates. Naegleria spp. was identified in 24 out of 39 (62 %) of isolated amoeboflagellates. Absorption studies did not support the idea that environmental free- living amoebas induce antibodies cross-reacting with E. histolytica. Antigenic cross reactivity between E. dispar and E. histolytica remains a possible explanation for the high seroprevalence in the population. This is supported by the observation that IF antibody titers in sera from healthy individuals are similar with both antigens. Also the ratio of antibody reactivity was similar when measured by a densitometric method. In contrast, sera from patients with invasive amoebiasis reacted preferentially with E. histolytica. We conclude that amoebiasis is not a major problem in the community. Overdiagnosis and overtreatment of diarrhea patients thought to suffer from amoebiasis are serious problems. Thus there is an urgent need for education and quality assessment.
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| 10. |
- Corriols Molina, Marianela
(författare)
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Acute pesticide poisonings in Nicaragua : underreporting, incidence and determinants
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Acute pesticide poisonings (APP) are a public health problem in Nicaragua. The quality and coverage of APP´s register, the real incidence of APP, the main determinants, the economic cost of treating cases and the effectiveness of educational intervention are not well known. Aim: The overall aim was to investigate the acute health impact of pesticide use and to discuss the possible effectiveness of preventive measures in Nicaragua. The specific aims were to calculate the proportion of APP cases officially registered, to estimate one year cumulative incidence of APP cases among population 15 years and older, to identify the main determinants related to APP among pesticide sprayers and to evaluate the impact of an integrated pest management (IPM) training intervention. Methods: For studies 1, 2, and 3, data concerning pesticide exposure and health effects were assessed in a nationally representative survey of 3169 persons 15 years and older in year 2000. For study 1, to estimate the proportion of underreporting of APP cases, the cases reported at the official surveillance system were cross matched with the cases reported through the survey. In study 2, based on self reported cases we estimated the one year incidence rate and the number of expected cases of APP in the country. In study 3, after regression analysis, the main determinants for APP among agricultural sprayers were identified. Study 4 assessed the impact of a 2 years IPM training to reduce economic costs and acute adverse health effects among 1200 basic grain farmers comparing the group of trained farmers and a group of "control" farmers who did not receive training. Results: Less than 5% of medically treated APP cases were reported to the official register. The one year APP incidence among general population was 2.3% (95%CI 1.7-2.8). The rate was higher among men, rural population and agricultural workers. More than 66,000 cases were estimated to occur yearly. The national incidence rate of APP among sprayers was extremely high, 8.3% (95% CI 5.8-10.8) and more than 34,000 cases were estimated to occur among pesticide sprayers, and representing 52% of all APP s estimated in year 2000. Although most of the cases were minor and moderate, the poisonings caused near 340,000 disability days. The causal agents for APP in 95% of cases were WHO Class I-II pesticides. The main determinants of APP among sprayers were: backpack pump leakage and incomplete or no use of personal protective equipment. Seventy seven percent of cases were caused by pesticides proposed to be banned or restricted in Central America. The IPM training prevented acute health effects and maintained productivity: after two years of training, the trained farmers used fewer pesticides, spent less money on pest control, made higher net returns, and suffered less exposure to cholinesterase-inhibiting pesticides compared to farmers who did not receive IPM training. Conclusion: Underreport figures leads to an erroneous interpretation of acute pesticide health effects. There is a high APP incidence rate in the general population, but it is four times higher among sprayers, causing important loss of or productivity and important economic costs. IPM interventions were successful in prevent the occurrence of APP cases and economic losses. Traditional prevention and control measures are insufficient and structural changes, including pesticides banning and restriction, and change to IPM agriculture models, are needed to transform the underlying determinants.
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