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Roegner A, Orozco MN, Jarquin C, Boegel W, Secaira C, Caballeros ME, Al-Saleh L, Rejmánková E. Childhood parasitic infections and gastrointestinal illness in indigenous communities at Lake Atitlán, Guatemala. PeerJ 2021; 9:e12331. [PMID: 34820168 PMCID: PMC8605761 DOI: 10.7717/peerj.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/27/2021] [Indexed: 12/05/2022] Open
Abstract
Lake Atitlán has experienced a decline in water quality resulting from cultural eutrophication. Indigenous Mayans who already face disproportionate health challenges rely directly on the lake water. Our objectives were to: (1) estimate prevalence of shedding of water-borne fecal parasites among children 5 years of age and younger, (2) assess household-reported incidence of gastrointestinal illness in children, and (3) characterize water sources, treatment, and sanitation conditions in households. We hypothesized that household use of untreated lake water results in increased risk of shedding of parasites and gastrointestinal symptoms. A cross-sectional fecal sampling and physical exam of 401 children were conducted along with WASH surveys in partnership with healthcare providers in seven communities. Fecal samples were screened for Giardia lamblia and Cryptosporidium parvum, using a rapid ELISA, with a portion examined by microscope. The prevalence of parasite shedding was 12.2% (9.7% for Giardia; 2.5% for Cryptosporidium). Risk factors for Giardia shedding included age 3 years or older (3.4 odds ratio, z-stat = 2.781 p = 0.0054), low height-for-age z-score (2.3 odds ratio, z-stat = 2.225, p = 0.0216), lack of any household water treatment (2.5 odds ratio, z-stat = 2.492, p < 0.0012), and open access to household latrine (2.04 odds ratio, z-stat = 1.992, p = 0.0464). The majority (77.3%) of households reported water treatment, boiling and gravity fed filters as the most widespread practices. The vast majority of households (92%) reported usage of a latrine, while 40% reported open and shared access beyond their household. An overwhelming majority of households reported diarrhea and fever several times per year or greater, with approximately half reporting vomiting at that frequency. Lake water use was identified as a risk factor for households reporting frequent gastrointestinal symptoms (odds ratio of 2.5, 4.4, and 2.6; z-stat of 3.10, 3.65, and 3.0; p-values of 0.0021, 0.0003, and 0.0028, for diarrhea, vomiting, and fever, respectively) in children 5 years of age and younger. The frequency of gastrointestinal illness with a strong link to lake drinking water cannot be explained by the prevalence of protozoa, and risk from other enteropathogens must be explored. Improving access to water treatment and sanitation practices could substantially reduce the parasite burden faced by developing children in the region.
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Affiliation(s)
- Amber Roegner
- Center For Global Health, University of Oregon, Eugene, OR, United States of America.,Department of Environmental Science and Policy, University of California, Davis, Davis, CA, United States of America
| | - Mónica N Orozco
- Center for Atitlán Studies, Universidad del Valle de Guatemala, Sololá, Sololá, Guatemala
| | - Claudia Jarquin
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | | | | | - Lujain Al-Saleh
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States of America
| | - Eliška Rejmánková
- Department of Environmental Science and Policy, University of California, Davis, Davis, CA, United States of America
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2
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Gottschlich A, Rivera-Andrade A, Grajeda E, Alvarez C, Mendoza Montano C, Meza R. Acceptability of Human Papillomavirus Self-Sampling for Cervical Cancer Screening in an Indigenous Community in Guatemala. J Glob Oncol 2017; 3:444-454. [PMID: 29094082 PMCID: PMC5646882 DOI: 10.1200/jgo.2016.005629] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Cervical cancer rates in Latin America are higher than those in developed countries, likely because of the lower prevalence of screening. Specifically, less than 40% of women in Guatemala are regularly screened and even fewer women are screened in indigenous communities. Current screening strategies-Pap smears and visual inspection with acetic acid-might not be the most effective methods for controlling cancer in these settings. We thus investigated the potential of self-collection of cervical samples with testing for human papillomavirus (HPV) to help prevent cervical cancer in an indigenous community in Guatemala. PATIENTS AND METHODS A community representative random sample of 202 indigenous women age 18 to 60 years residing in Santiago Atitlan, Guatemala, were surveyed to assess knowledge of and risk factors for HPV and cervical cancer. Women were then invited to self-collect a cervical sample using HerSwab collection kits to assess the prevalence of HPV and the acceptability of self-sampling. RESULTS Of 202 women who completed the survey, 178 (89%) provided a self-sample. In all, 79% of these women found the test comfortable, 91% found the test easy to use, and 100% reported they were willing to perform the test periodically as a screening method. Thirty-one samples (17%) were positive for at least one of 13 high-risk HPV types, and eight (4.5%) were positive for HPV 16/18. CONCLUSION HPV testing by using self-collected samples was well accepted, suggesting that it is a plausible modality for cervical cancer screening in indigenous communities. Further studies are needed to assess rates of follow-up after a positive test and to determine whether these findings extend to other indigenous and nonindigenous communities in Guatemala and Latin America.
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Affiliation(s)
- Anna Gottschlich
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Alvaro Rivera-Andrade
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Edwin Grajeda
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Christian Alvarez
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Carlos Mendoza Montano
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Rafael Meza
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
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3
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Ford ND, Jaacks LM, Martorell R, Mehta NK, Perrine CG, Ramirez-Zea M, Stein AD. Dietary Patterns and Cardio-metabolic Risk in a Population of Guatemalan Young Adults. BMC Nutr 2017; 3. [PMID: 29892467 PMCID: PMC5993443 DOI: 10.1186/s40795-017-0188-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Latin America is facing an increasing burden of nutrition-related non-communicable disease. Little is known about dietary patterns in Guatemalan adults and how dietary patterns are associated with cardio-metabolic disease (CMD) risk. Methods This analysis is based on data from a 2002–04 follow-up study of the INCAP Nutrition Supplementation Trial Longitudinal Cohort. Diet data were collected using a validated, semi-quantitative food frequency questionnaire. We derived dietary patterns using principal components analysis. CMD risk was assessed by anthropometry (body mass index, waist circumference), biochemistry (fasting blood glucose and lipids), and clinical (blood pressure) measures. We used sex-stratified multivariable log binomial models to test associations between dietary pattern tertile and CMD risk factors. The sample included 1428 participants (681 men and 747 women) ages 25–43 years. Results We derived three dietary patterns (traditional, meat-based modern, and starch-based modern), collectively explaining 24.2% of variance in the diet. Dietary patterns were not associated with most CMD risk factors; however, higher starch-based modern tertiles were associated with increased prevalence of low highdensity lipoprotein cholesterol (HDL-c) in men (Prevalence Ratio (PR) 1.17, 95% Confidence Interval (CI) 1.01, 1.20 for tertile 2; PR 1.20, 95% CI 1.00, 1.44 for tertile 3; p trend 0.04). Higher traditional tertiles were associated with increased prevalence of abdominal obesity in women (PR 1.24, 95% CI 1.07, 1.43 for tertile 2; PR 1.19, 95% CI 1.02, 1.39 for tertile 3; p trend 0.02) but marginally significant reduced prevalence of low HDL-c in men (PR 0.88, 95% CI 0.76, 1.00 for tertile 2; PR 0.85, 95% CI 0.72, 1.00 for tertile 3; p trend 0.05). Conclusion Our findings suggest the presence of two ‘modern' dietary patterns in Guatemala – one of which was associated with increased prevalence of low HDL-c in men. The association between the traditional dietary pattern and some CMD risk factors may vary by sex. Electronic supplementary material The online version of this article (doi:10.1186/s40795-017-0188-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicole D Ford
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Neil K Mehta
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Cria G Perrine
- Division of Nutrition, Physical Activity, and Obesity, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Aryeh D Stein
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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McKerracher L, Collard M, Altman R, Richards M, Nepomnaschy P. The ex-pat effect: presence of recent Western immigrants is associated with changes in age at first birth and birth rate in a Maya population from rural Guatemala. Ann Hum Biol 2017. [PMID: 28625087 DOI: 10.1080/03014460.2017.1343385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Economic transitions expose indigenous populations to a variety of ecological and cultural challenges, especially regarding diet and stress. These kinds of challenges are predicted by evolutionary ecological theory to have fitness consequences (differential reproduction) and, indeed, are often associated with changes in fertility dynamics. It is currently unclear whether international immigration might impact the nature of such an economic transition or its consequences for fertility. AIM To examine measures of fertility, diet and stress in two economically transitioning Maya villages in Guatemala that have been differentially exposed to immigration by Westerners. SUBJECTS AND METHODS This study compared Maya women's ages at first birth and birth rates between villages and investigated whether these fertility indicators changed through time. It also explored whether the villages differed in relation to diet and/or a proxy of stress. RESULTS It was found that, in the village directly impacted by immigration, first births occurred earlier, but birth rate was slower. In both villages, over the sampled time window, age at first birth increased, while birth rate decreased. The villages do not differ significantly in dietary indicators, but the immigration-affected village scored higher on the stress proxy. CONCLUSION Immigration can affect fertility in host communities. This relationship between immigration and fertility dynamics may be partly attributable to stress, but this possibility should be evaluated prospectively in future research.
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Affiliation(s)
| | - Mark Collard
- a Department of Archaeology , Simon Fraser University , Burnaby , BC , Canada.,b Department of Archaeology , University of Aberdeen, King's College , Aberdeen , Scotland
| | - Rachel Altman
- c Department of Statistics and Actuarial Science , Simon Fraser University , Burnaby , BC , Canada
| | - Michael Richards
- a Department of Archaeology , Simon Fraser University , Burnaby , BC , Canada
| | - Pablo Nepomnaschy
- d Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
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5
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Hurree N, Pem D, Bhagwant S, Jeewon R. A pilot study to investigate energy intake and food frequency among middle aged and elderly people in Mauritius. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2017. [DOI: 10.3233/mnm-16118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Natasha Hurree
- Department of Health Sciences, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Dhandevi Pem
- Department of Health Sciences, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Suress Bhagwant
- Department of Marine & Ocean Science, Fisheries & Mariculture, University of Mauritius, Réduit, Mauritius
| | - Rajesh Jeewon
- Department of Health Sciences, Faculty of Science, University of Mauritius, Réduit, Mauritius
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Luna M, Chen D, Rivera-Andrade Á, González J, Burt D, Mendoza-Montano C, Patrie J. Prevalence of risk factors for noncommunicable diseases in an indigenous community in Santiago Atitlán, Guatemala. Rev Panam Salud Publica 2017. [PMID: 28444007 PMCID: PMC6660872 DOI: 10.26633/rpsp.2017.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective. To describe the prevalence of noncommunicable disease (NCD) risk factors and assess knowledge of those risk factors in the indigenous community of Santiago Atitlán in Guatemala, a lower-middle income country. Methods. A population-based, cross-sectional study was conducted using a modified version of the World Health Organization’s STEPS protocol. Adults aged 20–65 years were surveyed regarding demographics and NCD risk factors, and the survey was followed by anthropometric and biochemical measurements. Results. Out of 501 screened individuals, 350 respondents were enrolled. The mean age was 36.7 years, and 72.3% were women. Over 90% reported earning less than US$ 65 per month. Almost 80% were stunted. Among women, 37.3% were obese and over three-quarters had central obesity. Over three-quarters of the entire group had dyslipidemia and 18.3% had hypertension, but only 3.0% had diabetes. Overall, 36.0% of participants met criteria for metabolic syndrome. There was no significant association between participants’ education and NCD risk factors except for an inverse association with obesity by percent body fat. Conclusions. Santiago Atitlán is a rural, indigenous Guatemalan community with high rates of poverty and stunting coexisting alongside high rates of obesity, particularly among women. Additionally, high rates of hypertension and dyslipidemia were found, but a low rate of diabetes mellitus. Knowledge of NCDs and their risk factors was low, suggesting that educational interventions may be a high-yield, low-cost approach to combating NCDs in this community.
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Affiliation(s)
- Max Luna
- Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - David Chen
- University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | | | - Jessica González
- University of Virginia–Guatemala Initiative, Quetzaltenango, Guatemala
| | - David Burt
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | | | - James Patrie
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
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7
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Nagata JM, Gippetti J, Wager S, Chavez A, Wise PH. Prevalence and Predictors of Malnutrition among Guatemalan Children at 2 Years of Age. PLoS One 2016; 11:e0164772. [PMID: 27806066 PMCID: PMC5091788 DOI: 10.1371/journal.pone.0164772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/01/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To identify the prevalence and predictors of malnutrition among 2-year old children in the Western Highlands of Guatemala. METHODS Prospective cohort of 852 Guatemalan children in San Lucas Toliman, Guatemala followed from birth to age 2 from May 2008 to December 2013. Socio-demographic, anthropometric, and health data of children was collected at 2 month intervals. RESULTS Among the 402 males and 450 females in the cohort, mean weight-for-age Z-score (WAZ) declined from -0.67 ± 1.01 at 1 year to -1.07 ± 0.87 at 2 years, while mean height-for-age Z-score (HAZ) declined from -1.88 ± 1.19 at 1 year to -2.37 ± 0.99 at 2 years. Using multiple linear regression modeling, number of children <5 years old, vomiting in the past week, fever in the past week, and WAZ at 1 year were significant predictors of WAZ at 2 years. Significant predictors of HAZ at 2 years included household size, number of children <5 years old, diarrhea in the past week, WAZ at 1 year, and HAZ at 1 year. Vomiting in the past week and WAZ at 1 year were significant predictors of weight-for-height z-score (WHZ) at 2 years. CONCLUSIONS Number of children <5 years old, symptoms such as vomiting or diarrhea in the previous week, and prior nutritional status were the most significant predictors of malnutrition in this cohort. Future research may focus on the application of models to develop predictive algorithms for mobile device technology, as well as the identification of other predictors of malnutrition that are not well characterized such as the interaction of environmental exposures with protein consumption and epigenetics.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, Stanford University, Palo Alto, California, United States of America
- * E-mail:
| | - James Gippetti
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, California, United States of America
| | - Stefan Wager
- Graduate School of Business, Stanford University, Palo Alto, California, United States of America
| | - Alejandro Chavez
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, California, United States of America
| | - Paul H. Wise
- Department of Pediatrics, Stanford University, Palo Alto, California, United States of America
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, California, United States of America
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Hurree N, Jeewon R. An Analysis of Contributors to Energy Intake Among Middle Aged and Elderly Adults. CURRENT RESEARCH IN NUTRITION AND FOOD SCIENCE JOURNAL 2016. [DOI: 10.12944/crnfsj.4.special-issue-elderly-november.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Adulthood and middle age is widely recognized as the time of life when unhealthy eating habits may develop. Data from various studies have demonstrated that changes in eating habits may also occur during old age. It is essential to acknowledge that a high consumption of certain food groups such as sweetened beverages, meat and eggs may contribute to an increased energy intake. This obviously results in high body mass index (BMI) and consequently an increased risk of non-communicable diseases (NCDs) and obesity. Energy intake among middle aged and elderly individuals may be influenced by socio demographic factors (for example: age, gender, socio economic status), social factors (for example: marital status), environmental factors like access to food commodities as well as nutrition knowledge and physical activity level. The present review highlights eating habits, contribution of specific food groups to energy intake and the influence of several factors on energy intake among the middle aged and elderly population.
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Affiliation(s)
- Natasha Hurree
- Department of Health Sciences, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Rajesh Jeewon
- Department of Health Sciences, Faculty of Science, University of Mauritius, Réduit, Mauritius
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Nagata JM, Fiorella KJ, Salmen CR, Hickey MD, Mattah B, Magerenge R, Milner E, Weiser SD, Bukusi EA, Cohen CR. Around the Table: Food Insecurity, Socioeconomic Status, and Instrumental Social Support among Women Living in a Rural Kenyan Island Community. Ecol Food Nutr 2015; 54:358-69. [PMID: 25680030 PMCID: PMC4466072 DOI: 10.1080/03670244.2014.995790] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The objective of this study was to investigate the relationship among socioeconomic status, social support, and food insecurity in a rural Kenyan island community. A cross-sectional random sample of 111 female heads of households representing 583 household members were surveyed in Mfangano Island, Kenya from August to October 2010 using adaptations of the Household Food Insecurity Access Scale and the Medical Outcomes Study Social Support Survey. In multiple linear regression models, less instrumental social support, defined as concrete direct ways people help others (B = -0.81; 95% confidence interval [CI] -1.45 to -0.17), and decreased ownership scale based on owning material assets (B = -2.93; 95% CI -4.99 to -0.86) were significantly associated with increased food insecurity, controlling for age, education, marital status, and household size. Social support interventions geared at group capacity and resilience may be crucial adjuncts to improve and maintain the long term food security and health of persons living in low-resource regions.
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Affiliation(s)
- Jason M. Nagata
- Global Health Sciences, University of California, San Francisco, San Francisco, California, USA, 94105
- Department of Research, Organic Health Response, Mbita, Kenya
- Department of Pediatrics, Stanford University, Palo Alto, California, USA, 94304
| | - Kathryn J. Fiorella
- Department of Research, Organic Health Response, Mbita, Kenya
- Department of Environmental Science, Policy & Management, University of California, Berkeley, Berkeley, California, USA, 94720
| | - Charles R. Salmen
- Global Health Sciences, University of California, San Francisco, San Francisco, California, USA, 94105
- Department of Research, Organic Health Response, Mbita, Kenya
| | - Matthew D. Hickey
- Global Health Sciences, University of California, San Francisco, San Francisco, California, USA, 94105
- Department of Research, Organic Health Response, Mbita, Kenya
| | - Brian Mattah
- Department of Research, Organic Health Response, Mbita, Kenya
| | | | - Erin Milner
- School of Public Health, University of California, Berkeley, Berkeley, California, USA, 94720
| | - Sheri D. Weiser
- Division of HIV/AIDS, University of California, San Francisco, San Francisco, California, USA, 94110
| | - Elizabeth A. Bukusi
- Family AIDS Care & Education Services (FACES), Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya, 00202
| | - Craig R. Cohen
- Global Health Sciences, University of California, San Francisco, San Francisco, California, USA, 94105
- Family AIDS Care & Education Services (FACES), Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya, 00202
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA, 94143
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10
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Rivera-Andrade A, Luna MA. Trends and heterogeneity of cardiovascular disease and risk factors across Latin American and Caribbean countries. Prog Cardiovasc Dis 2014; 57:276-85. [PMID: 25218566 DOI: 10.1016/j.pcad.2014.09.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aging, globalization and urbanization in Latina America and the Caribbean (LAC) have made cardiovascular disease (CVD) the number one cause of death and disability, while communicable diseases have decreased. This epidemiological transition has been more heterogeneous than in other areas of the world. While countries like Argentina, Chile, Brazil and Colombia have seen a significant decrease in CVD mortality, the rest of the countries have seen an increase, particularly Central American and Caribbean countries. These latter countries have now coexisting high prevalence of communicable and non-communicable diseases, threatening the socioeconomic development. Recent multinational cross sectional studies have provided a better perspective of the prevalence and distribution of cardiovascular risk factors in the region. While there has been a decrease in prevalence of smoking in the region, obesity, diabetes and physical inactivity continue to increase the CVD disease burden in LAC.
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Affiliation(s)
- Alvaro Rivera-Andrade
- INCAP Comprehensive Center for the Prevention of Chronic Diseases/Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Max A Luna
- Department of Medicine, University of Virginia, Charlottesville, VA.
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Abstract
All over Latin America, indigenous populations are rapidly changing their lifestyle. This work elaborates on the complex experience of indigenous people in transition. Poverty, discrimination, marginalization, and endurance are defining characteristics of their everyday life. Global health programs represent excellent opportunities for addressing these issues. These initiatives, however, are at risk of being short-sighted, ethnocentric, and paradigmcentric. Global health programs would be increasingly more successful if they break disciplinary boundaries and invite actors with different perspectives to a dialogue that does not emphasize biology over culture or academic over community expertise.
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Affiliation(s)
- Claudia Valeggia
- a Department of Anthropology , Yale University , New Haven , Connecticut , USA
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12
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Kondo MC, Bream KDW, Barg FK, Branas CC. A random spatial sampling method in a rural developing nation. BMC Public Health 2014; 14:338. [PMID: 24716473 PMCID: PMC4021077 DOI: 10.1186/1471-2458-14-338] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 04/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background Nonrandom sampling of populations in developing nations has limitations and can inaccurately estimate health phenomena, especially among hard-to-reach populations such as rural residents. However, random sampling of rural populations in developing nations can be challenged by incomplete enumeration of the base population. Methods We describe a stratified random sampling method using geographical information system (GIS) software and global positioning system (GPS) technology for application in a health survey in a rural region of Guatemala, as well as a qualitative study of the enumeration process. Results This method offers an alternative sampling technique that could reduce opportunities for bias in household selection compared to cluster methods. However, its use is subject to issues surrounding survey preparation, technological limitations and in-the-field household selection. Application of this method in remote areas will raise challenges surrounding the boundary delineation process, use and translation of satellite imagery between GIS and GPS, and household selection at each survey point in varying field conditions. This method favors household selection in denser urban areas and in new residential developments. Conclusions Random spatial sampling methodology can be used to survey a random sample of population in a remote region of a developing nation. Although this method should be further validated and compared with more established methods to determine its utility in social survey applications, it shows promise for use in developing nations with resource-challenged environments where detailed geographic and human census data are less available.
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Affiliation(s)
- Michelle C Kondo
- United States Department of Agriculture-Forest Service, Northern Research Station, 100 North 20th St Suite 205, Philadelphia, PA 19103, USA.
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Descriptive characteristics and health outcomes of the food by prescription nutrition supplementation program for adults living with HIV in Nyanza Province, Kenya. PLoS One 2014; 9:e91403. [PMID: 24646586 PMCID: PMC3960130 DOI: 10.1371/journal.pone.0091403] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 02/11/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical effects and potential benefits of nutrition supplementation interventions for persons living with HIV remain largely unreported, despite awareness of the multifaceted relationship between HIV infection and nutrition. We therefore examined descriptive characteristics and nutritional outcomes of the Food by Prescription (FBP) nutrition supplementation program in Nyanza Province, Kenya. METHODS Demographic, health, and anthropometric data were gathered from a retrospective cohort of 1,017 non-pregnant adult patients who enrolled into the FBP program at a Family AIDS Care and Education Services (FACES) site in Nyanza Province between July 2009 and July 2011. Our primary outcome was FBP treatment success defined as attainment of BMI>20, and we used Cox proportional hazards to assess socio-demographic and clinical correlates of FBP treatment success. RESULTS Mean body mass index was 16.4 upon enrollment into the FBP program. On average, FBP clients gained 2.01 kg in weight and 0.73 kg/m2 in BMI over follow-up (mean 100 days), with the greatest gains among the most severely undernourished (BMI <16) clients (p<0.001). Only 13.1% of clients attained a BMI>20, though 44.5% achieved a BMI increase ≥0.5. Greater BMI at baseline, younger age, male gender, and not requiring highly active antiretroviral therapy (HAART) were associated with a higher rate of attainment of BMI>20. CONCLUSION This study reports significant gains in weight and BMI among patients enrolled in the FBP program, though only a minority of patients achieved stated programmatic goals of BMI>20. Future research should include well-designed prospective studies that examine retention, exit reasons, mortality outcomes, and long-term sustainability of nutrition supplementation programs for persons living with HIV.
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Nagata JM, Cassidy LC, Hickey MD, Chuc JM, Bream KDW. Evaluation of a diabetes education video among the Tz'utujil Maya in Guatemala. Diabetes Technol Ther 2013; 15:606-7. [PMID: 23621823 DOI: 10.1089/dia.2013.0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zeng W, Eisenberg DTA, Jovel KR, Undurraga EA, Nyberg C, Tanner S, Reyes-García V, Leonard WR, Castaño J, Huanca T, McDade TW, Godoy R. Adult obesity: panel study from native Amazonians. ECONOMICS AND HUMAN BIOLOGY 2013; 11:227-235. [PMID: 22591954 DOI: 10.1016/j.ehb.2012.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 01/29/2012] [Accepted: 01/30/2012] [Indexed: 05/31/2023]
Abstract
This paper examines three morphological indicators measuring obesity among a native Amazonian population of foragers-farmers in Bolivia (Tsimane') and estimates the associations between them and standard covariates of obesity (e.g., socioeconomic status [SES]). We collected annual data from 350 non-pregnant women and 385 men ≥20 years of age from all 311 households in 13 villages during five consecutive years (2002-2006). We used three indicators to measure obesity: body-mass index (BMI), waist circumference (WC), and body fat using bioelectrical impedance analysis (BF-BIA). We ran separate individual random-effect panel multiple regressions for women and men with wealth, acculturation, health, and household food availability as key covariates, and controlled for village and year fixed effects and village×year interaction effects. Although BMI increases by a statistically significant annual growth rate of 0.64% among women and 0.37% among men over the five years, the increase does not yield significant biological meanings. Neither do we find consistent and biologically meaningful covariates associated with adult obesity.
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Affiliation(s)
- Wu Zeng
- Heller School, Brandeis University, Waltham, MA 02454, USA.
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Gurven M, Jaeggi AV, Kaplan H, Cummings D. Physical activity and modernization among Bolivian Amerindians. PLoS One 2013; 8:e55679. [PMID: 23383262 PMCID: PMC3561330 DOI: 10.1371/journal.pone.0055679] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/03/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physical inactivity is a growing public health problem, and the fourth leading risk factor for global mortality. Conversely, indigenous populations living traditional lifestyles reportedly engage in vigorous daily activity that is protective against non-communicable diseases. Here we analyze physical activity patterns among the Tsimane, forager-horticulturalists of Amazonian Bolivia with minimal heart disease and diabetes. We assess age patterns of adult activity among men and women, test whether modernization affects activity levels, and examine whether nascent obesity is associated with reduced activity. METHODS AND FINDINGS A factorial method based on a large sample of behavioral observations was employed to estimate effects of age, sex, body mass index, and modernization variables on physical activity ratio (PAR), the ratio of total energy expenditure to basal metabolic rate. Accelerometry combined with heart rate monitoring was compared to the factorial method and used for nighttime sampling. Tsimane men and women display 24 hr physical activity level (PAL) of 2.02-2.15 and 1.73-1.85, respectively. Little time was spent "sedentary", whereas most activity was light to moderate, rather than vigorous. Activity peaks by the late twenties in men, and declines thereafter, but remains constant among women after the early teens. Neither BMI, fat free mass or body fat percentage are associated with PAR. There was no negative effect of modernization on physical activity. CONCLUSIONS Tsimane display relatively high PALs typical of other subsistence populations, but of moderate intensity, and not outside the range of developed populations. Despite rapidly increasing socioeconomic change, there is little evidence that total activity has yet been affected. Overweight and obesity are more prevalent among women than men, and Spanish fluency is associated with greater obesity in women. The lack of cardiovascular disease among Tsimane is unlikely caused by activity alone; further study of diet, food intake and infectious disease is needed.
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Affiliation(s)
- Michael Gurven
- Integrative Anthropological Sciences Unit, Department of Anthropology, University of California Santa Barbara, Santa Barbara, California, United States of America.
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Bose SK, Bream KDW, Barg FK, Band RA. Willingness to pay for emergency referral transport in a developing setting: a geographically randomized study. Acad Emerg Med 2012; 19:793-800. [PMID: 22805629 DOI: 10.1111/j.1553-2712.2012.01382.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective was to identify the correlates of willingness to pay for ambulance transports from a rural city to a regional hospital in Guatemala. METHODS An innovative methodology that utilizes a novel randomization technique and satellite imagery was used to select a sample of homes in Santiago Atitlán, Guatemala. The respondents were surveyed at these homes about their willingness to pay for ambulance transport to a regional hospital. A price ladder was used to elicit respondents' willingness to pay for ambulance transport, depending on the level of severity of three types of emergencies: life-threatening emergencies, disability-causing emergencies, and simple emergencies. Simple and multiple linear regression modeling was used to identify the social and economic correlates of respondents' willingness to pay for ambulance transport and to predict demand for ambulance transport at a variety of price levels. Beta coefficients (β) expressed as percentages with 95% confidence intervals (CIs) were estimated. RESULTS The authors surveyed 134 respondents (response rate=3.3%). In the multivariable regression models, three variables correlated with willingness to pay: household income, location of residence (rural district vs. urban district), and respondents' education levels. Correlates for ambulance transport in life-threatening emergencies included greater household daily income (β=1.32%, 95% CI=0.63% to 2.56%), rural location of residence (β=-37.3%, 95% CI=-51.1% to -137.5%), and higher educational levels (β=4.41%, 95% CI=1.00% to 6.36%). Correlates of willingness to pay in disability-causing emergencies included greater household daily income (β=1.59%, 95% CI=0.81% to 3.19%) and rural location of residence (β=-19.4%, 95% CI=-35.7% to -89.4%). Correlates of willingness to pay in simple emergencies included rural location of residence (β=59.4%, 95% CI=37.9% to 133.7%) and higher educational levels (β=7.96%, 95% CI=1.96% to 11.8%). At all price levels, more individuals were willing to pay for transport for a life-threatening emergency than a disability-causing emergency. Respondents' willingness to pay was more responsive to price changes for transport during disability-causing emergencies than for transport during life-threatening emergencies. CONCLUSIONS The primary correlates of willingness to pay for ambulance transport in Santiago Atitlán, Guatemala, are household income, location of residence (rural district vs. urban district), and respondents' education levels. Furthermore, severity of emergency significantly appears to influence how much individuals are willing to pay for ambulance transport. Willingness-to-pay information may help public health planners in resource-poor settings develop price scales for health services and achieve economically efficient allocations of subsidies for referral ambulance transport.
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Affiliation(s)
- Sourav K Bose
- Vagelos Program in Life Sciences and Management, Wharton School of the University of Pennsylvania, Philadelphia, PA, USA.
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Nagata JM, Barg FK, Valeggia CR, Bream KDW. Coca-colonization and hybridization of diets among the Tz'utujil Maya. Ecol Food Nutr 2011; 50:297-318. [PMID: 21888598 DOI: 10.1080/03670244.2011.568911] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Biomedical health professionals express increasing concern that rising consumption of soft drinks and processed foods in Mayan and Latin American eating patterns may lead to detrimental nutritional and health consequences. Scholars debate whether the pervading presence of Coca-Cola and Pepsi in developing countries represents "Coca-Colonization," synonymous with cultural imperialism, or cultural hybridization. Using mixed qualitative and quantitative research methods, including participant observation and semi-structured interviews, this study explores the development of Coca-Colonization and cultural hybridization among the Tz'utujil Maya of Santiago Atitlán, Guatemala. By specifically examining biomedical perspectives, cycles of conquest, the political economy, religion, celebrations, and the physical environment through the lens of soft drinks, this study finds that Coca-Colonization and cultural hybridization are complementary rather than mutually exclusive processes that contribute to dietary transitions, economic development, and differential health beliefs related to soft drink consumption.
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Affiliation(s)
- Jason M Nagata
- Health and Societies Program, Department of History and Sociology of Science , University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Subramanian SV, Perkins JM, Özaltin E, Davey Smith G. Weight of nations: a socioeconomic analysis of women in low- to middle-income countries. Am J Clin Nutr 2011; 93:413-21. [PMID: 21068343 PMCID: PMC3021433 DOI: 10.3945/ajcn.110.004820] [Citation(s) in RCA: 195] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The increasing trend in body mass index (BMI) and overweight in rapidly developing economies is well recognized. OBJECTIVE We assessed the association between socioeconomic status and BMI and overweight in low- to middle-income countries. DESIGN We conducted a cross-sectional analysis of nationally representative samples of 538,140 women aged 15-49 y drawn from 54 Demographic and Health Surveys conducted between 1994 and 2008. BMI, calculated as weight in kilograms divided by height squared in meters, was specified as the outcome, and a BMI (in kg/m(2)) of ≥25 was additionally specified to model the likelihood of being overweight. Household wealth and education were included as markers of individual socioeconomic status, and per capita Gross Domestic Product (pcGDP) was included as a marker of country-level economic development. RESULTS Globally, a one-quartile increase in wealth was associated with a 0.54 increase in BMI (95% CI: 0.50, 0.64) and a 33% increase in overweight (95% CI: 26%, 41%) in adjusted models. Although the strength of this association varied across countries, the association between wealth and BMI and overweight was positive in 96% (52 of 54) of the countries. Similar patterns were observed in urban and rural areas, although SES gradients tended to be greater in urban areas. There was a positive association between pcGDP and BMI or overweight, with only weak evidence of an interaction between pcGDP and wealth. CONCLUSION Higher BMI and overweight remain concentrated in higher socioeconomic groups, even though increasing BMI and overweight prevalence are important global public concerns.
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Affiliation(s)
- S V Subramanian
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA.
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