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Neyra J, Kambhampati AK, Calderwood LE, Romero C, Soto G, Campbell WR, Tinoco YO, Hall AJ, Ortega-Sanchez IR, Mirza SA. Household economic costs of norovirus gastroenteritis in two community cohorts in Peru, 2012-2019. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002748. [PMID: 38985718 PMCID: PMC11236139 DOI: 10.1371/journal.pgph.0002748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
While costs of norovirus acute gastroenteritis (AGE) to healthcare systems have been estimated, out-of-pocket and indirect costs incurred by households are not well documented in community settings, particularly in developing countries. We conducted active surveillance for AGE in two communities in Peru: Puerto Maldonado (October 2012-August 2015) and San Jeronimo (April 2015-April 2019). Norovirus AGE events with PCR-positive stool specimens were included. Data collected in follow-up interviews included event-related medical resource utilization, associated out-of-pocket costs, and indirect costs. There were 330 norovirus-associated AGE events among 3,438 participants from 685 households. Approximately 49% of norovirus events occurred among children <5 years of age and total cost to the household per episode was highest in this age group. Norovirus events cost a median of US $2.95 (IQR $1.04-7.85) in out-of-pocket costs and $12.58 (IQR $6.39-25.16) in indirect costs. Medication expenses accounted for 53% of out-of-pocket costs, and productivity losses accounted for 59% of the total financial burden on households. The frequency and associated costs of norovirus events to households in Peruvian communities support the need for prevention strategies including vaccines. Norovirus interventions targeting children <5 years of age and their households may have the greatest economic benefit.
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Affiliation(s)
- Joan Neyra
- U.S. Naval Medical Research Unit SOUTH, Lima, Peru
| | - Anita K Kambhampati
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laura E Calderwood
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Cherokee Nation Operational Solutions, Tulsa, Oklahoma, United States of America
| | - Candice Romero
- Vysnova Partners, LLC, Greater Landover, Maryland, United States of America
| | - Giselle Soto
- U.S. Naval Medical Research Unit SOUTH, Lima, Peru
| | - Wesley R Campbell
- Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | | | - Aron J Hall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ismael R Ortega-Sanchez
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sara A Mirza
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Anthropometric proxies for child neurodevelopment in low-resource settings: length- or height-for-age, head circumference or both? J Dev Orig Health Dis 2023; 14:61-69. [PMID: 35844103 PMCID: PMC9845425 DOI: 10.1017/s2040174422000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Stunting (<-2 SD of length- or height-for-age on WHO growth curves) is the most used predictor of child neurodevelopmental (ND) risk. Occipitofrontal head circumference (OFC) may be an equally feasible, but more direct and robust predictor. We explored association of the two measurements with ND outcome, separately and combined, and examined if cutoffs are more efficacious than continuous measures in predicting ND risk. Infants and young children in rural Guatemala (n = 642; age range = 0.1-35.9 months) were enrolled in a prospective natural history study, and their ND was tested using the Mullen Scales of Early Learning (MSEL) longitudinally. Length- or height-for-age and OFC-for-age were calculated. We performed age-adjusted multivariable regression analyses to explore the association between 1) length or height and ND, 2) OFC and ND, and 3) both length or height and OFC combined, with ND; concurrently, predictively, and longitudinally, as continuous variables and using WHO z-score cutoffs. Continuous length- or height-for-age and OFC z-scores were more strongly associated with MSEL than the traditional -2 SD WHO cutoff. The combination of height-for-age z-score and OFC z-score was consistently, strongly associated with the MSEL Early Learning Composite concurrently (p-values 0.0004-0.11), predictively (p-value 0.001-0.07), with the exception of the 18-24 months age group which had very few records, and in the longitudinal model (p-value <0.0001-0.004). The combination of continuous length- or height-for-age and OFC shows additional utility in estimating ND risk in infants and young children. Measurement of OFC may improve precision of prediction of ND risk in infants and young children.
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Lamb MM, Paniagua-Avila A, Zacarias A, Rojop N, Chacon A, Natrajan MS, Waggoner JJ, Lopez MR, Cordon-Rosales C, Huleatt JW, Bonaparte MI, Asturias EJ, Olson D. Repeated Rapid Active Sampling Surveys Demonstrated a Rapidly Changing Zika Seroprevalence among Children in a Rural Dengue-endemic Region in Southwest Guatemala during the Zika Epidemic (2015-2016). Am J Trop Med Hyg 2022; 107:1099-1106. [PMID: 36252798 PMCID: PMC9709015 DOI: 10.4269/ajtmh.22-0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/08/2022] [Indexed: 11/07/2022] Open
Abstract
Although Central America is largely dengue virus (DENV)-endemic, the 2015-2016 Zika virus (ZIKV) pandemic brought new urgency to develop surveillance approaches capable of characterizing the rapidly changing disease burden in resource-limited settings. We conducted a pediatric DENV surveillance study in rural Guatemala, including serial cross-sectional surveys from April through September 2015 (Survey 1), in October-November 2015 (Survey 2), and January-February 2016 (Survey 3). Serum underwent DENV IgM MAC ELISA and polymerase chain reaction testing. Using banked specimens from Surveys 2 and 3, we expanded testing to include DENV 1-4 and ZIKV microneutralization (MN50), DENV NS1 IgG ELISA, and ZIKV anti-NS1 antibody Blockage of Binding (BoB) ELISA testing. Demographic risk factors for ZIKV BoB positivity were explored using multivariable generalized linear regression models. Of Survey 2 and 3 samples available (N = 382), DENV seroprevalence slightly increased (+1%-10% depending on the assay) during the surveillance period and increased with age. In contrast, ZIKV seroprevalence consistently increased over the 3-month period, including from 6% to 34% (P < 0.0001) and 10%-37% (P < 0.0001) using the MN50 ≥100 and BoB ELISA assays, respectively. Independent risk factors for ZIKV seropositivity included older age (prevalence ratio (PR)/year = 1.12, 95% confidence interval (CI) = 1.07-1.17) and primary caregiver literacy (PR = 2.80, CI = 1.30-6.06). Rapid active surveillance (RAS) surveys demonstrated a nearly 30% increase in ZIKV prevalence and a slight (≤ 10%) increase in DENV seroprevalence from October to November 2015 to January to February 2016 in rural southwest Guatemala, regardless of serologic assay used. RAS surveys may be a useful "off-the-shelf" tool to characterize arboviruses and other emerging pathogens rapidly in resource-limited settings.
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Affiliation(s)
- Molly M. Lamb
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado
| | - Alejandra Paniagua-Avila
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque, Quetzaltenango, Guatemala
| | - Alma Zacarias
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque, Quetzaltenango, Guatemala
| | - Neudy Rojop
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque, Quetzaltenango, Guatemala
| | - Andrea Chacon
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque, Quetzaltenango, Guatemala
| | - Muktha S. Natrajan
- Emory University Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
| | - Jesse J. Waggoner
- Emory University Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
| | - Maria Renee Lopez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Celia Cordon-Rosales
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | | | - Edwin J. Asturias
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Olson
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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A prospective cohort study of head circumference and its association with neurodevelopmental outcomes in infants and young children in rural Guatemala. J Dev Orig Health Dis 2022; 13:779-786. [PMID: 35450541 DOI: 10.1017/s204017442200023x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Microcephaly, an anthropometric marker of reduced brain volume and predictor of developmental disability, is rare in high-income countries. Recent reports show the prevalence of microcephaly to be much higher in lower resource settings. We calculated the prevalence of microcephaly in infants and young children (n = 642; age range = 0.1-35.9 months), examined trends in occipitofrontal circumference (OFC) growth in the year after birth and evaluated the relationship between OFC and performance on the Mullen Scales of Early Learning (MSEL) in rural Guatemala. Multivariable regression analyses adjusted for age were performed: (1) a model comparing concurrent MSEL performance and OFC at all visits per child, (2) concurrent OFC and MSEL performance by age group, and (3) OFC at enrollment and MSEL at final visit by age group. Prevalence of microcephaly ranged from 10.1% to 25.0%. OFC z-score decreased for most infants throughout the first year after birth. A significant positive association between continuous OFC measurement and MSEL score suggested that children with smaller OFC may do worse on ND tests conducted both concurrently and ∼1 year later. Results were variable when analyzed by OFC cutoff scores and stratified by 6-month age groups. OFC should be considered for inclusion in developmental screening assessments at the individual and population level, especially when performance-based testing is not feasible.
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Colbert AM, Connery AK, Lamb MM, Bauer D, Olson D, Paniagua-Avila A, Martínez MA, Arroyave P, Hernández S, Mirella Calvimontes D, Bolaños GA, El Sahly HM, Muñoz FM, Asturias EJ. Caregiver rating of early childhood development: Reliability and validity of the ASQ-3 in rural Guatemala. Early Hum Dev 2021; 161:105453. [PMID: 34530320 DOI: 10.1016/j.earlhumdev.2021.105453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/20/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although performance-based assessment of early childhood development is preferred, there are a number of limitations to this methodology in low resource settings (LRSs). Hence, clinicians and researchers often rely on caregiver report screening tools. The Ages and Stages Questionnaire 3 (ASQ) is one of the most widely used caregiver report measures globally. Adequate psychometric properties have been demonstrated in high income settings, especially when used in older children, high- risk children, or those with severe neurodevelopmental delays. However, its utility is more variable within very young children and for use in LRSs. METHODS The reliability and validity of the ASQ was determined for children ages 0-5 years living in rural Guatemala. Internal consistency and test-retest reliability were assessed, as well as concurrent and predictive validity. Sensitivity, specificity, positive and negative predictive values related to performance-based developmental assessment (Mullen Scales of Early Learning; MSEL) and growth status (i.e. stunting) were also calculated. RESULTS Internal consistency reliability for the ASQ was adequate, except when results were limited by small sample size. Test-retest reliability ranged from low to moderate (r = 0.08-0.43; p < 0.05-0.01). However, there was significant variability in mean scores over time across ASQ domain scores. In terms of validity, the ASQ did not discriminate adequately between children who performed within or below age-expectations on performance-based developmental testing or those with and without stunting. CONCLUSIONS The ASQ did not demonstrate adequate psychometric properties in rural Guatemala, consistent with concerns documented in other LRSs. These results indicate that existing caregiver report screening measures of early childhood development should be utilized with caution in LRSs, and alternative methods for assessment or in the development and utilization of caregiver report measures should be considered.
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Affiliation(s)
- Alison M Colbert
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States.
| | - Amy K Connery
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Molly M Lamb
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Desiree Bauer
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Daniel Olson
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Alejandra Paniagua-Avila
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - María Alejandra Martínez
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Paola Arroyave
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Sara Hernández
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - D Mirella Calvimontes
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Guillermo A Bolaños
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Hana M El Sahly
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Flor M Muñoz
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Edwin J Asturias
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
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6
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Muhib FB, Pecenka CJ, Marfin AA. Risk-based Vaccines and the Need for Risk-based Subnational Vaccination Strategies for Introduction. Clin Infect Dis 2021; 71:S165-S171. [PMID: 32725237 PMCID: PMC7388704 DOI: 10.1093/cid/ciaa483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Most vaccines in the Expanded Program on Immunization are universal childhood vaccines (eg, measles and rotavirus vaccines). Other vaccines such as typhoid conjugate (TCV) and Japanese encephalitis vaccines are risk based and only used in countries where populations are at risk of these diseases. However, strategies to introduce risk-based vaccines are becoming complex due to increasing intracountry variability in disease incidence. There is a need to assess whether subnational vaccine strategies are appropriate. Criteria, challenges, and benefits Subnational strategies consider intracountry heterogeneous risk and prioritize vaccination only in those areas that are at risk; there is no intent to introduce the vaccine nationally. The following variables should be considered to determine appropriateness of subnational strategies: disease burden, outbreak potential, treatment availability and costs, cost-effectiveness, and availability of other preventive interventions. We propose criteria for each variable and use a hypothetical country considering TCV introduction to show how criteria are applied to determine if a subnational strategy is appropriate. Challenges include granularity of disease-burden data, political challenges of vaccinating only a portion of a population, and potentially higher costs of introduction. Benefits include targeted reduction of disease burden, increased equity for marginalized populations, and progress on development goals. Conclusions In the absence of perfect information at the national level, adopting a subnational vaccine strategy can provide country decision makers with an alternative to national vaccine introduction. Given the changing nature of communicable disease burden, subnational vaccination may be a tool to effectively avert mortality and morbidity while maximizing the use of available health and financial resources.
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Affiliation(s)
- Farzana B Muhib
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
| | - Clint J Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
| | - Anthony A Marfin
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
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7
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Connery AK, Lamb MM, Colbert AM, Bauer D, Hernández S, Arroyave P, Martínez MA, Barrios EE, El Sahly HM, Paniagua-Avila A, Calvimontes M, Bolaños GA, Olson D, Asturias EJ, Munoz FM. Parent Report of Health Related Quality of Life in Young Children in Rural Guatemala: Implementation, Reliability, and Validity of the PedsQL in Stunting and Wasting. Glob Pediatr Health 2021; 8:2333794X21991028. [PMID: 33614851 PMCID: PMC7868501 DOI: 10.1177/2333794x21991028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/07/2021] [Indexed: 11/16/2022] Open
Abstract
In this study, we review the implementation, reliability, and validity of the Pediatric Quality of Life Inventory (PedsQL), a measure of health-related quality of life, in young children in rural Guatemala. Mothers of 842 children (age range = 1-60 months) completed the PedsQL Generic Core Scales 4.0 serially for 1 year. Low (Pearson’s r = 0.28, P < .0001) to moderate (Pearson’s r = 0.65, P < .0001) consistency in responding over time was shown. The PedsQL did not discriminate reliably between healthy children and those with stunting or wasting. PedsQL scores were not lower during the time of an acute illness. While we found low to moderate evidence for the reliability of the PedsQL in healthy children, it did not discriminate between healthy children and those with stunting, wasting or other acute illness.
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Affiliation(s)
- Amy K Connery
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Molly M Lamb
- Colorado School of Public Health, Aurora, CO, USA
| | - Alison M Colbert
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Sara Hernández
- Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Paola Arroyave
- Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | | | | | - Hana M El Sahly
- Department of Molecular Virology and Microbiology, Baylor College of Medicine
| | | | - Mirella Calvimontes
- Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | | | - Daniel Olson
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA.,Colorado School of Public Health, Aurora, CO, USA
| | - Edwin J Asturias
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA.,Colorado School of Public Health, Aurora, CO, USA
| | - Flor M Munoz
- Department of Molecular Virology and Microbiology, Baylor College of Medicine.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Arenas-Castañeda PE, Aroca Bisquert F, Martinez-Nicolas I, Castillo Espíndola LA, Barahona I, Maya-Hernández C, Lavana Hernández MM, Manrique Mirón PC, Alvarado Barrera DG, Treviño Aguilar E, Barrios Núñez A, De Jesus Carlos G, Vildosola Garcés A, Flores Mercado J, Barrigon ML, Artes A, de Leon S, Molina-Pizarro CA, Rosado Franco A, Perez-Rodriguez M, Courtet P, Martínez-Alés G, Baca-Garcia E. Universal mental health screening with a focus on suicidal behaviour using smartphones in a Mexican rural community: protocol for the SMART-SCREEN population-based survey. BMJ Open 2020; 10:e035041. [PMID: 32690505 PMCID: PMC7371217 DOI: 10.1136/bmjopen-2019-035041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Mental disorders represent the second cause of years lived with disability worldwide. Suicide mortality has been targeted as a key public health concern by the WHO. Smartphone technology provides a huge potential to develop massive and fast surveys. Given the vast cultural diversity of Mexico and its abrupt orography, smartphone-based resources are invaluable in order to adequately manage resources, services and preventive measures in the population. The objective of this study is to conduct a universal suicide risk screening in a rural area of Mexico, measuring also other mental health outcomes such as depression, anxiety and alcohol and substance use disorders. METHODS AND ANALYSIS A population-based cross-sectional study with a temporary sampling space of 9 months will be performed between September 2019 and June 2020. We expect to recruit a large percentage of the target population (at least 70%) in a short-term survey of Milpa Alta Delegation, which accounts for 137 927 inhabitants in a territorial extension of 288 km2.They will be recruited via an institutional call and a massive public campaign to fill in an online questionnaire through mobile-assisted or computer-assisted web app. This questionnaire will include data on general health, validated questionnaires including Well-being Index 5, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale 2, Alcohol Use Disorders Identification Test, selected questions of the Drug Abuse Screening Test and Columbia-Suicide Severity Rating Scales and Diagnostic and statistical manual of mental disorders (DSM-5) questions about self-harm.We will take into account information regarding time to mobile app response and geo-spatial location, and aggregated data on social, demographical and environmental variables. Traditional regression modelling, multilevel mixed methods and data-driven machine learning approaches will be used to test hypotheses regarding suicide risk factors at the individual and the population level. ETHICS AND DISSEMINATION Ethical approval (002/2019) was granted by the Ethics Review Board of the Hospital Psiquiátrico Yucatán, Yucatán (Mexico). This protocol has been registered in ClinicalTrials.gov. The starting date of the study is 3 September 2019. Results will serve for the planning and healthcare of groups with greater mental health needs and will be disseminated via publications in peer-reviewed journal and presented at relevant mental health conferences. TRIAL REGISTRATION NUMBER NCT04067063.
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Affiliation(s)
- Pavel E Arenas-Castañeda
- Secretaría de Salud de la Ciudad de México, Jurisdicción Sanitaria Milpa Alta, Milpa Alta, Mexico
| | - Fuensanta Aroca Bisquert
- Instituto de Matemáticas. Unidad de Cuernavaca. Universidad Nacional Autónoma de México, Cuernavaca, Mexico
- CNRS-UMI 4584 - LaSoL Laboratorio Internacional Solomon Lefschetz, Ciudad de Mexico, Mexico
| | | | | | - Igor Barahona
- Cátedra-Conacyt, Instituto de Matemáticas, Unidad de Cuernavaca, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Cynthya Maya-Hernández
- Center for Evaluation and Surveys Research, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | | | - Paulo César Manrique Mirón
- Cátedra-Conacyt, Instituto de Matemáticas, Unidad de Cuernavaca, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | | | - Erik Treviño Aguilar
- Instituto de Matemáticas. Unidad de Cuernavaca. Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | | | - Giovanna De Jesus Carlos
- Instituto de Matemáticas. Unidad de Cuernavaca. Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | | | | | - Maria Luisa Barrigon
- Psychiatry, Autonomous University of Madrid, Madrid, Spain
- Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain
| | - Antonio Artes
- Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Leganés, Madrid, Spain
- CIBERSAM (Centro de Investigacion en Salud Mental), Carlos III Institute of Health, Madrid, Spain
| | - Santiago de Leon
- Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Madrid, Spain
| | | | | | | | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, University of Montpellier, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Gonzalo Martínez-Alés
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Enrique Baca-Garcia
- Psychiatry, Autonomous University of Madrid, Madrid, Spain
- Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain
- Universidad Catolica del Maule, Talca, Chile
- CIBERSAM, Madrid, Spain
- Department of psychiatry, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
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9
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Colbert AM, Lamb MM, Asturias EJ, Muñoz FM, Bauer D, Arroyave P, Hernández S, Martínez MA, Paniagua-Avila A, Olson D, Calvimontes DM, Bolaños GA, El Sahly HM, Connery AK. Reliability and Validity of an Adapted and Translated Version of the Mullen Scales of Early Learning (AT-MSEL) in Rural Guatemala. Child Care Health Dev 2020; 46:327-335. [PMID: 31978249 DOI: 10.1111/cch.12748] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND A growing literature base supports the use of tests developed in high-income countries to assess children in low resource settings when carefully translated, adapted, and applied. Evaluation of psychometric properties of adapted and translated measures within populations is necessary. The current project sought to evaluate the reliability and validity of an adapted and translated version of the Mullen Scales of Early Learning (AT-MSEL) in rural Guatelama. METHODS The reliability and validity of the AT-MSEL in rural Guatemala were analyzed for children ages 0-5 years. RESULTS Interrater reliability coefficients (ICC = 0.99-1.0) and internal consistency (Cronbach's alpha = 0.91-0.93) were excellent for all subscales. General linear models utilizing paired data showed consistency between standard scores (p < 0.0001). Mean raw scores increased with chronological age, as expected. Across age groups, subscales were significantly, positively correlated with one another (p < 0.05 - < 0.001) with one exception, visual reception and expressive language at the 0-10 month age range (p = 0.43). CONCLUSIONS The AT- MSEL showed strong psychometric properties in a sample of young children in rural Guatemala. Findings demonstrate that the AT-MSEL can be used validly and reliably within this specific population of children. This work supports the concept that tests developed in high-income countries can be used to assess children in low resource settings when carefully translated, adapted and applied.
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Affiliation(s)
- Alison M Colbert
- Children's Hospital Colorado, Aurora, Colorado.,University of Colorado, Aurora, Colorado
| | | | - Edwin J Asturias
- Children's Hospital Colorado, Aurora, Colorado.,University of Colorado, Aurora, Colorado
| | | | | | - Paola Arroyave
- Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Sara Hernández
- Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | | | | | - Daniel Olson
- Children's Hospital Colorado, Aurora, Colorado.,University of Colorado, Aurora, Colorado
| | | | - Guillermo A Bolaños
- Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | | | - Amy K Connery
- Children's Hospital Colorado, Aurora, Colorado.,University of Colorado, Aurora, Colorado
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10
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Effect of Definitions of Acute Gastroenteritis Episodes Using Symptom Diaries in Paediatric Cohorts: A Systematic Review. J Pediatr Gastroenterol Nutr 2020; 70:e54-e58. [PMID: 31834113 DOI: 10.1097/mpg.0000000000002584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Estimates of acute gastroenteritis (AGE) burden are difficult to compare between studies because of inconsistent definitions describing this illness. AGE definitions used in prospective, community-based childhood cohort studies were identified by searching databases for studies that collected daily observations of AGE symptoms. Disease definitions and refractory periods were extracted. Data from the Australian community-based Observational Research in Childhood Infectious Diseases birth cohort were used to calculate AGE incidence and duration using identified AGE definitions, and the World Health Organization definition for diarrhoea. Eight distinct AGE definitions were identified. All included loose stools and 7 included vomiting as symptoms. The refractory period separating episodes ranged from 1 to 21 days. When applied to the Observational Research in Childhood Infectious Diseases dataset, AGE incidence ranged from 0.8 to 2.6 episodes per child-year-at-risk, a 3-fold relative difference. Direct comparisons of rates from different cohorts can only be undertaken if a standard definition for AGE is adopted.
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11
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Bierhoff M, Arvelo W, Estevez A, Bryan J, McCracken JP, López MR, López B, Parashar UD, Lindblade KA, Hall AJ. Incidence and Clinical Profile of Norovirus Disease in Guatemala, 2008-2013. Clin Infect Dis 2019; 67:430-436. [PMID: 29420688 DOI: 10.1093/cid/ciy091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/03/2018] [Indexed: 12/15/2022] Open
Abstract
Background Acute gastroenteritis (AGE) is a leading infectious cause of morbidity worldwide, particularly among children in developing countries. With the decline of rotavirus disease rates following introduction of rotavirus vaccines, the relative importance of norovirus will likely increase. Our objectives in this study were to determine the incidence and clinical profile of norovirus disease in Guatemala. Methods We analyzed data from a population-based surveillance study conducted in Guatemala from 2008 through 2013. Demographic information, clinical data, and stool samples were collected from patients who presented with AGE (≥3 liquid stools within 24 hours that initiated 7 days before presentation). Estimated incidence of hospitalized, outpatient, and total community norovirus disease was calculated using surveillance data and household surveys of healthcare use. Results We included 999 AGE hospitalizations and 3189 AGE outpatient visits at facilities, of which 164 (16%) and 370 (12%), respectively, were positive for norovirus. Severity of norovirus was milder than of rotavirus. Community incidence of norovirus ranged from 2068 to 4954 per 100000 person-years (py) in children aged<5 years. Children aged <5 years also had higher incidence of norovirus-associated hospitalization (51-105 per 100000 py) compared with patients aged ≥5 years (0-1.6 per 100000 py and 49-80 per 100000 py, respectively). Conclusions This study highlights the burden of norovirus disease in Guatemala, especially among young children. These data can help prioritize development of control strategies, including the potential use of vaccines, and provide a baseline to evaluate the impact of such interventions.
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Affiliation(s)
- Marieke Bierhoff
- Centers for Disease Control and Prevention, Atlanta, Georgia.,VU Medical Center, Amsterdam, The Netherlands
| | - Wences Arvelo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Joe Bryan
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Kim A Lindblade
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aron J Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Connery AK, Colbert AM, Lamb MM, Hernández S, Martínez MA, Bauer D, Arroyave P, El Sahly HM, Paniagua-Avila A, Calvimontes M, Bolaños GA, Olson D, Asturias EJ, Munoz FM. Receptive language skills among young children in rural Guatemala: The relationship between the Test de Vocabulario en Imagenes Peabody and a translated and adapted version of the Mullen Scales of Early Learning. Child Care Health Dev 2019; 45:702-708. [PMID: 31270836 DOI: 10.1111/cch.12702] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/24/2019] [Accepted: 06/30/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Children in low- and lower middle income countries (LMICs) often have poorer language skills compared with children from high-income countries. Limited availability of culturally and linguistically appropriate assessment measures in LMICs, especially for young children, can hinder early identification and prevention efforts. Here, we describe receptive language (RL) skills among young children in rural Guatemala and report on the validity of a translated and culturally adapted developmental measure of RL. METHODS Children (n = 157; m = 53.6 months, range = 42-68 months) enrolled in a prospective cohort study of postnatally acquired Zika virus infection were administered the Test de Vocabulario en Imagenes Peabody (TVIP) and the RL scale from a translated and adapted version of the Mullen Scales of Early Learning (MSEL). Performance on the TVIP was compared with the Latin American normative sample. Correlational analysis examined the relationship between performance on the TVIP and the MSEL-RL. RESULTS Mean scores were significantly below the normative sample mean on the TVIP, t(126) = -11.04, p < .001; d = 1.00. Performance on the TVIP among children who passed the practice items (n = 127) was significantly positively associated with performance on the MSEL-RL (r = .50, p < .001), but not significantly associated with age or gender. Older age (p < .0001) and female gender (p = .018) were associated with passing the TVIP practice items. CONCLUSIONS Delays in RL vocabulary were identified among young children in rural Guatemala on the TVIP. The association between scores on the TVIP and the RL scale of the MSEL provides preliminary support for the construct validity of this translated and adapted version of the MSEL.
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Affiliation(s)
- Amy K Connery
- Children's Hospital Colorado, Aurora, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
| | - Alison M Colbert
- Children's Hospital Colorado, Aurora, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
| | - Molly M Lamb
- Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Sara Hernández
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - María Alejandra Martínez
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Desirée Bauer
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Paola Arroyave
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Hana M El Sahly
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Alejandra Paniagua-Avila
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Mirella Calvimontes
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Guillermo Antoñio Bolaños
- Center for Human Development, Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Daniel Olson
- Children's Hospital Colorado, Aurora, Colorado.,Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Edwin J Asturias
- Children's Hospital Colorado, Aurora, Colorado.,Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Flor M Munoz
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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13
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K. Connery A, Berrios-Siervo G, Arroyave P, Bauer D, Hernandez S, Paniagua-Avila A, Bolaños GA, Bunge-Montes S, M. El Sahly H, Calvimontes M, Olson D, M. Munoz F, J. Asturias E. Responding to the Zika Epidemic: Preparation of a Neurodevelopmental Testing Protocol to Evaluate Young Children in Rural Guatemala. Am J Trop Med Hyg 2019; 100:438-444. [PMID: 30594262 PMCID: PMC6367612 DOI: 10.4269/ajtmh.18-0713] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/31/2018] [Indexed: 11/07/2022] Open
Abstract
The ongoing Zika virus (ZIKV) epidemic in Latin America presented a unique opportunity to develop a neurodevelopmental assessment protocol for children in a lower middle-income country. Although studies of neurodevelopment in young children have taken place in many diverse global settings, we are not aware of any study that has provided a high level of detail about how a measure was selected and then specifically translated and adapted in a low-resource setting. Here, we describe considerations in measurement selection and then the process of translation and adaptation to assess neurodevelopmental outcomes of infants and young children with postnatal exposure to ZIKV in rural Guatemala. We provide a framework to other research teams seeking to develop similar assessment models across the globe.
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Affiliation(s)
- Amy K. Connery
- Children's Hospital Colorado, Aurora, Colorado
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
| | - Gretchen Berrios-Siervo
- Children's Hospital Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paola Arroyave
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Desiree Bauer
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Sara Hernandez
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Alejandra Paniagua-Avila
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Guillermo Antonio Bolaños
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Saskia Bunge-Montes
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
- Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Hana M. El Sahly
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Mirella Calvimontes
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Daniel Olson
- Children's Hospital Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Flor M. Munoz
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Edwin J. Asturias
- Children's Hospital Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
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14
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Vaccine Demand and Willingness-to-pay for Arbovirus Vaccines: A Cross-sectional Survey in Rural Guatemala. Pediatr Infect Dis J 2018; 37:1184-1189. [PMID: 30153226 DOI: 10.1097/inf.0000000000002169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Arboviruses including dengue (DENV), chikungunya (CHIKV) and Zika cause significant morbidity in Latin America. With multiple arbovirus vaccines in development, better understanding of community attitudes and acceptability for these vaccines is needed. METHODS In September 2016, a cross-sectional survey assessed arbovirus knowledge, attitudes, vaccine demand and willingness-to-pay (WTP) at the conclusion of a DENV/norovirus surveillance study in rural Guatemala with high arbovirus endemicity. Factors associated with vaccine demand and WTP were assessed with regression analysis. RESULTS Among 564 surveyed households, DENV knowledge was high. There was great concern for arboviruses, particularly CHIKV. Overall vaccine attitudes were positive with <5% identifying significant barriers, hesitancy or refusing previous vaccination. At 50% and 75% efficacy, 75% and 88% of respondents wanted arbovirus vaccines, respectively. DENV vaccine demand at 50% efficacy was associated with increased housing density, nonhealth postvaccination location, older children and medical source for information. For each vaccine, 52-55% of respondents were WTP $0-$3.40, while 16-17% were WTP ≥$6.81. WTP at $3.40 and $6.81 levels for all vaccines was associated positively with parental education but negatively with good DENV knowledge. History of purchasing and identifying barriers to vaccines was associated with WTP ≥$6.81. CONCLUSIONS Demand for potential DENV, CHIKV and Zika vaccines is high at 50% and 75% efficacy in this Guatemalan community. Associated factors could be leveraged to optimize arbovirus vaccine implementation. Overall low WTP given current cost of Dengvaxia (Sanofi Pasteur, Lyon, France) suggests that government subsidization may be necessary in resource-poor regions, though a small private market may be supported.
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15
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Olson D, Krager S, Lamb MM, Rick AM, Asturias EJ. Knowledge of Norovirus and Attitudes toward a Potential Norovirus Vaccine in Rural Guatemala: A Cross-Sectional Exploratory Survey. Am J Trop Med Hyg 2018; 98:1498-1501. [PMID: 29582734 DOI: 10.4269/ajtmh.17-0771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Given limited data on norovirus vaccine acceptance, we performed an exploratory survey in a rural Guatemalan community on knowledge, interest, and willingness to pay (WTP) for a norovirus vaccine. Cluster-randomized households with children aged 6 weeks to 17 years were enrolled into one of two norovirus surveillance studies: 1) a prospective cohort (N = 207 households) and 2) two separate, community-based, cross-sectional surveys (N = 420 households). After completion of the surveillance study, vaccine surveys were completed by 564 (90%) of 627 households. Most households correctly answered questions regarding norovirus symptoms and transmission; 97% indicated interest in a hypothetical norovirus vaccine. Households with higher education had greater WTP for a vaccine (prevalence ratios = 2.2, 95% confidence interval: 1.2-3.1) and households with lower WTP were more likely to use pharmacies, the Ministry of Health, and radios for health care and information. These results suggest that a future norovirus vaccination program could be acceptable and feasible even in rural areas.
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Affiliation(s)
- Daniel Olson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.,Children's Hospital Colorado, Aurora, Colorado.,Center for Global Health, Colorado School of Public Health, Aurora, Colorado
| | - Steven Krager
- Preventive Medicine Residency Program, Colorado School of Public Health, Aurora, Colorado
| | - Molly M Lamb
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.,Center for Global Health, Colorado School of Public Health, Aurora, Colorado
| | - Anne-Marie Rick
- Children's Hospital Colorado, Aurora, Colorado.,Center for Global Health, Colorado School of Public Health, Aurora, Colorado.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Edwin J Asturias
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Center for Global Health, Colorado School of Public Health, Aurora, Colorado.,Children's Hospital Colorado, Aurora, Colorado
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16
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Olson D, Lamb M, Lopez MR, Colborn K, Paniagua-Avila A, Zacarias A, Zambrano-Perilla R, Rodríguez-Castro SR, Cordon-Rosales C, Asturias EJ. Performance of a Mobile Phone App-Based Participatory Syndromic Surveillance System for Acute Febrile Illness and Acute Gastroenteritis in Rural Guatemala. J Med Internet Res 2017; 19:e368. [PMID: 29122738 PMCID: PMC5701088 DOI: 10.2196/jmir.8041] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND With their increasing availability in resource-limited settings, mobile phones may provide an important tool for participatory syndromic surveillance, in which users provide symptom data directly into a centralized database. OBJECTIVE We studied the performance of a mobile phone app-based participatory syndromic surveillance system for collecting syndromic data (acute febrile illness and acute gastroenteritis) to detect dengue virus and norovirus on a cohort of children living in a low-resource and rural area of Guatemala. METHODS Randomized households were provided with a mobile phone and asked to submit weekly reports using a symptom diary app (Vigilant-e). Participants reporting acute febrile illness or acute gastroenteritis answered additional questions using a decision-tree algorithm and were subsequently visited at home by a study nurse who performed a second interview and collected samples for dengue virus if confirmed acute febrile illness and norovirus if acute gastroenteritis. We analyzed risk factors associated with decreased self-reporting of syndromic data using the Vigilant-e app and evaluated strategies to improve self-reporting. We also assessed agreement between self-report and nurse-collected data obtained during home visits. RESULTS From April 2015 to June 2016, 469 children in 207 households provided 471 person-years of observation. Mean weekly symptom reporting rate was 78% (range 58%-89%). Households with a poor (<70%) weekly reporting rate using the Vigilant-e app during the first 25 weeks of observation (n=57) had a greater number of children (mean 2.8, SD 1.5 vs mean 2.5, SD 1.3; risk ratio [RR] 1.2, 95% CI 1.1-1.4), were less likely to have used mobile phones for text messaging at study enrollment (61%, 35/57 vs 76.7%, 115/150; RR 0.6, 95% CI 0.4-0.9), and were less likely to access care at the local public clinic (35%, 20/57 vs 67.3%, 101/150; RR 0.4, 95% CI 0.2-0.6). Parents of female enrolled participants were more likely to have low response rate (57.1%, 84/147 vs 43.8%, 141/322; RR 1.4, 95% CI 1.1-1.9). Several external factors (cellular tower collapse, contentious elections) were associated with periods of decreased reporting. Poor response rate (<70%) was associated with lower case reporting of acute gastroenteritis, norovirus-associated acute gastroenteritis, acute febrile illness, and dengue virus-associated acute febrile illness (P<.001). Parent-reported syndromic data on the Vigilant-e app demonstrated agreement with nurse-collected data for fever (kappa=.57, P<.001), vomiting (kappa=.63, P<.001), and diarrhea (kappa=.61, P<.001), with decreased agreement as the time interval between parental report and nurse home visit increased (<1 day: kappa=.65-.70; ≥2 days: kappa=.08-.29). CONCLUSIONS In a resource-limited area of rural Guatemala, a mobile phone app-based participatory syndromic surveillance system demonstrated a high reporting rate and good agreement between parental reported data and nurse-reported data during home visits. Several household-level and external factors were associated with decreased syndromic reporting. Poor reporting rate was associated with decreased syndromic and pathogen-specific case ascertainment.
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Affiliation(s)
- Daniel Olson
- Section of Pediatric Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States.,Center for Global Health, Colorado School of Public Health, Aurora, CO, United States.,Children's Hospital of Colorado, Aurora, CO, United States.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
| | - Molly Lamb
- Center for Global Health, Colorado School of Public Health, Aurora, CO, United States.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
| | - Maria Renee Lopez
- Centro de Estudios en Salud,, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Kathryn Colborn
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States.,Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO, United States
| | - Alejandra Paniagua-Avila
- Fundacion para la Salud Integral de los Guatemaltecos, Center for Human Development, Coatepeque, Guatemala.,Center for Public Health Initiatives, Perelman School of Medicine, Philadelphia, PA, United States
| | - Alma Zacarias
- Fundacion para la Salud Integral de los Guatemaltecos, Center for Human Development, Coatepeque, Guatemala
| | | | | | - Celia Cordon-Rosales
- Centro de Estudios en Salud,, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Edwin Jose Asturias
- Section of Pediatric Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States.,Center for Global Health, Colorado School of Public Health, Aurora, CO, United States.,Children's Hospital of Colorado, Aurora, CO, United States.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
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17
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Olson D, Lamb MM, Lopez MR, Paniagua-Avila MA, Zacarias A, Samayoa-Reyes G, Cordon-Rosales C, Asturias EJ. Rapid Active Sampling Surveys as a Tool to Evaluate Factors Associated with Acute Gastroenteritis and Norovirus Infection among Children in Rural Guatemala. Am J Trop Med Hyg 2017; 97:944-948. [PMID: 28722580 DOI: 10.4269/ajtmh.16-1003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We examined burden and factors associated with norovirus (NoV) acute gastroenteritis (AGE) among children in rural Guatemala. Children age 6 weeks to 17 years were enrolled into three AGE surveillance groups, using two-stage cluster sampling: a prospective participatory syndromic surveillance (PSS) cohort and two cross-sectional rapid active sampling (RAS) surveys, conducted from April 2015 to February 2016. Epidemiologic and NoV testing data were used to identify factors associated with NoV infection, AGE, and NoV+ AGE. The three cross-sectional surveys (PSS enrollment visit, RAS Survey 1, and RAS Survey 2) enrolled 1,239 children, who reported 134 (11%) AGE cases, with 20% of AGE and 11% of non-AGE samples positive for NoV. Adjusted analyses identified several modifiable factors associated with AGE and NoV infection. The cross-sectional RAS surveys were practical and cost-effective in identifying population-level risk factors for AGE and NoV, supporting their use as a tool to direct limited public health resources toward high-risk populations.
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Affiliation(s)
- Daniel Olson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Center for Global Health, Colorado School of Public Health, Aurora, Colorado.,Children's Hospital Colorado, Aurora, Colorado.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Molly M Lamb
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.,Center for Global Health, Colorado School of Public Health, Aurora, Colorado
| | - Maria R Lopez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Maria A Paniagua-Avila
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Quetzaltenango, Guatemala
| | - Alma Zacarias
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Quetzaltenango, Guatemala
| | - Gabriela Samayoa-Reyes
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado.,Center for Global Health, Colorado School of Public Health, Aurora, Colorado
| | - Celia Cordon-Rosales
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Edwin J Asturias
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Children's Hospital Colorado, Aurora, Colorado.,Center for Global Health, Colorado School of Public Health, Aurora, Colorado.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
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