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Sachett A, Strand E, Serrão-Pinto T, da Silva Neto A, Pinto Nascimento T, Rodrigues Jati S, Dos Santos Rocha G, Ambrósio Andrade S, Wen FH, Berto Pucca M, Vissoci J, Gerardo CJ, Sachett J, Seabra de Farias A, Monteiro W. Capacity of community health centers to treat snakebite envenoming in indigenous territories of the Brazilian Amazon. Toxicon 2024; 241:107681. [PMID: 38461896 DOI: 10.1016/j.toxicon.2024.107681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION The deaths from and morbidities associated with snakebites - amputations, loss of function in the limb, visible scarring or tissue damage - have a vast economic, social, and psychological impact on indigenous communities in the Brazilian Amazon, especially children, and represent a real and pressing health crisis in this population. Snakebite clinical and research experts have therefore proposed expanding antivenom access from only hospitals to include the community health centers (CHC) located near and within indigenous communities. However, there are no studies examining the capacity of CHCs to store, administer, and manage antivenom treatment. In response to this gap, the research team calling for antivenom decentralization developed and validated an expert-based checklist outlining the minimum requirements for a CHC to provide antivenom. METHODS The objective of this study was thus to survey a sample of CHCs in indigenous territories and evaluate their capacity to provide antivenom treatment according to this accredited checklist. The checklist was administered to nurses and doctors from 16 CHCs, two per indigenous district in Amazonas/Roraima states. RESULTS Our results can be conceptualized into three central findings: 1) most CHCs have the capacity to provide antivenom treatment, 2) challenges to capacity are human resources and specialized items, and 3) antivenom decentralization is feasible and appropriate in indigenous communities. CONCLUSION Decentralization would provide culturally and contextually appropriate care accessibility to a historically marginalized and underserved population of the Brazilian Amazon. Future studies should examine optimal resource allocation in indigenous territories and develop an implementation strategy in partnership with indigenous leaders. Beyond the indigenous population, the checklist utilized could be applied to community health centers treating the general population and/or adapted to other low-resource settings.
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Affiliation(s)
- André Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Eleanor Strand
- Department of Emergency Medicine, Duke University School of Medicine, Durham, United States
| | - Thiago Serrão-Pinto
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Faculdade de Ciências Farmacêuticas, Universidade Federal do Amazonas, Manaus, Brazil
| | - Alexandre da Silva Neto
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Thais Pinto Nascimento
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Sewbert Rodrigues Jati
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Secretaria de Estado de Educação e Cultura de Roraima, Boa Vista, Brazil
| | - Gisele Dos Santos Rocha
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | | | - Manuela Berto Pucca
- Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas de Araraquara, Universidade Estadual Paulista, Araraquara, Brazil
| | - João Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, United States
| | - Charles J Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, United States
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Altair Seabra de Farias
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Wuelton Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
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Novais JS, Mota MRL, Kffuri CW, Lauer-Leite ID. Discourse of the collective subject of river dwellers in the Brazilian Amazon regarding the transmission of knowledge about medicinal plants. AN ACAD BRAS CIENC 2023; 95:e20220832. [PMID: 37909563 DOI: 10.1590/0001-3765202320220832] [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: 09/28/2022] [Accepted: 07/09/2023] [Indexed: 11/03/2023] Open
Abstract
This paper investigates the perception of river dwellers in the Brazilian Amazon region about factors that influence the transmission of Traditional Ecological Knowledge (TEK) regarding medicinal plants. Semi-structured interviews were conducted with 43 residents of Vila Franca community (Pará, Brazil). The data were analyzed using the methodological strategy of the Discourse of the Collective Subject. The determining factors in the transmission of TEK were found to be: illness, family coexistence, and necessity, which were represented in the discourses as the most important factors for the acquisition of TEK. In the community context, the locally developed Natural Remedies Project, the beneficial effects of natural remedies, and the lack of resources to purchase allopathic medicines were cited as collaborative factors in the maintenance of TEK. Finally, the most significant determining factors in the decrease or loss of transmission of TEK found in the interviews were: lack of commitment, disbelief, and the valorization of allopathic medicines. A complex network of interactions between the villagers and their natural environment affects the transmission of TEK about medicinal plants. However, we found that the perpetuation of TEK is being threatened by various socio-economic and cultural factors.
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Affiliation(s)
- Jaílson S Novais
- Programa de Pós-Graduação em Ciências e Tecnologias Ambientais (UFSB/IFBA), Universidade Federal do Sul da Bahia, Rod. Porto Seguro - Eunápolis, BR 367, Km 10, 45810-000 Porto Seguro, BA, Brazil
- Programa de Pós-Graduação em Sociedade, Ambiente e Qualidade de Vida, Universidade Federal do Oeste do Pará, Rua Vera Paz, s/n, (Unidade Tapajós), Salé, 68035-110 Santarém, PA, Brazil
- Programa de Pós-Graduação em Recursos Naturais da Amazônia, Universidade Federal do Oeste do Pará, Rua Vera Paz, s/n, (Unidade Tapajós), Salé, 68035-110 Santarém, PA, Brazil
| | - Markos Rogério L Mota
- Programa de Pós-Graduação em Recursos Naturais da Amazônia, Universidade Federal do Oeste do Pará, Rua Vera Paz, s/n, (Unidade Tapajós), Salé, 68035-110 Santarém, PA, Brazil
| | - Carolina W Kffuri
- Programa de Pós-Graduação em Ciências e Tecnologias Ambientais (UFSB/IFBA), Universidade Federal do Sul da Bahia, Rod. Porto Seguro - Eunápolis, BR 367, Km 10, 45810-000 Porto Seguro, BA, Brazil
| | - Iani D Lauer-Leite
- Programa de Pós-Graduação em Sociedade, Ambiente e Qualidade de Vida, Universidade Federal do Oeste do Pará, Rua Vera Paz, s/n, (Unidade Tapajós), Salé, 68035-110 Santarém, PA, Brazil
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Lazo-Gonzales AO, Sarmiento-Casavilca T, Espinosa-Henao OE, Ruelas-González MG, Alcalde-Rabanal JE. Looking at maternal health of Asháninka communities from the conceptual framework of the accessibility of care. Int J Equity Health 2023; 22:154. [PMID: 37580769 PMCID: PMC10426136 DOI: 10.1186/s12939-023-01943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/26/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Peru is one of the 20 countries that has significantly reduced maternal mortality before the pandemic due to implementing policies to strengthen maternal health care, mainly in rural areas with greater poverty. However, the implementation of these policies has been different across the territory; such is the case of the indigenous communities of the Peruvian Amazon that are characterized by the inaccessibility of their territory and continue to face severe problems in accessing maternity care in health services. OBJECTIVE Analyze the main dimensions of accessibility for maternal care in public health services for women of the Asháninka community of Peru between 2016 and 2018. METHODS Qualitative research was carried out in the Asháninka community of the Tambo River. Key informants involved in maternal health care were selected, and 60 in-depth interviews were conducted that explored geographical, financial, cultural, and organizational accessibility. The interviews were recorded and transcribed into a word processor; then, a content analysis was performed to classify the texts according to the dimensions of specified accessibility. RESULTS Geographical accessibility: health units in the territory do not have the resolution capacity to attend maternal health problems. Financial accessibility: the programs implemented by the government have not been able to finance the indirect costs of care, such as transportation, which has high costs that a family cannot afford, given their subsistence economy. Cultural: there are efforts for cultural adaptation of maternal care, but its implementation needs to be improved, and the community cannot recognize it due to the lack of continuity of the model and the high personnel turnover. Organizational: health units are characterized by insufficient human resources, supplies, and medicines that fail to offer continuous and quality care. CONCLUSIONS The poor geographical, financial, cultural, and organizational accessibility that women from the Asháninka community face for maternal care in public health services are evident. So, the Peruvian government must review the implementation processes of its models of care and maternal health programs in these communities and propose strategies to improve the coverage, quality and continuity of maternal care.
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Affiliation(s)
| | - Tania Sarmiento-Casavilca
- Universidad Peruana Cayetano Heredia-Perú, Av. Honorio Delgado 430, 15102, San Martín de Porres, , Perú
| | - Olga Elena Espinosa-Henao
- Instituto Nacional de Salud Pública de México, Av Universidad 655. CP 62100. Cuernavaca, Morelos, México
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Ortiz-Prado E, Simbaña-Rivera K, Cevallos G, Gómez-Barreno L, Cevallos D, Lister A, Fernandez-Naranjo R, Ríos-Touma B, Vásconez-González J, Izquierdo-Condoy JS. Waterborne diseases and ethnic-related disparities: A 10 years nationwide mortality and burden of disease analysis from Ecuador. Front Public Health 2022; 10:1029375. [PMID: 36620267 PMCID: PMC9811003 DOI: 10.3389/fpubh.2022.1029375] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background Despite worldwide progress in terms of clean water supply, sanitation, and hygiene knowledge, some middle and most of low-income countries are still experiencing many diseases transmitted using unsafe water and the lack of sanitation. Methods To understand the impact of all waterborne diseases (WBD) registered in Ecuador. We performed a population-based analysis of all cases and deaths due to WBD in Ecuador based on the national public databases of hospital discharges as a proxy of incidence, in-hospital mortality, and countrywide general mortality rates from 2011 to 2020. Results In Ecuador, mestizos (mixed European and Indigenous American ancestry) had the greatest morbidity rate (141/100,000), followed by indigenous (63/100,000) and self-determined white patients (21/100,000). However, in terms of mortality, indigenous population have the greatest risk and rates, having a 790% additional mortality rate (2.6/100,000) than the reference group (self-determined white populations) at 0.29/100,000. The burden of disease analysis demonstrated that indigenous had the highest burden of disease caused by WBD with 964 YLL per every 100,000 people while mestizos have 360 YYL per 100,000 and self-determined white Ecuadorians have 109 YYL per 100,000. Conclusions In Ecuador, waterborne diseases (WBD) are still a major public health problem. We found that indigenous population had higher probability of getting sick and die due to WBD than the rest of the ethnic groups in Ecuador. We also found that younger children and the elderly are more likely to be admitted to the hospital due to a WBD. These epidemiological trends are probably associated with the lower life expectancy found among Indigenous than among the rest of the ethnic groups, who die at least, 39 years earlier than the self-determined white populations, 28 years earlier than Afro-Ecuadorians and 12 years earlier than the mestizos.
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Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
| | - Katherine Simbaña-Rivera
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
| | - Gabriel Cevallos
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
| | - Lenin Gómez-Barreno
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
| | - Domenica Cevallos
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
| | - Alex Lister
- University Hospital Southampton NHS FT, University of Southampton, Southampton, United Kingdom
| | - Raul Fernandez-Naranjo
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
| | - Blanca Ríos-Touma
- Biodiversity, Environment and Health Research Group (BIOMAS), Faculty of Engineering and Applied Sciences, Universidad de Las Américas, Quito, Ecuador
| | - Jorge Vásconez-González
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
- Facultad de Ciencias de la Salud, Universidad Latina de Costa Rica, San Pedro, Costa Rica
| | - Juan S. Izquierdo-Condoy
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
- Health Management and Research Area, Universidad Internacional Iberoamericana, Arecibo, Puerto Rico
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Santos JDM, Fowler S, Jennings D, Brass C, Porter L, Porter R, Sanderson R, Peña-Sánchez JN. Health care utilization differences between First Nations people and the general population with inflammatory bowel disease: a retrospective cohort study from Saskatchewan, Canada. CMAJ Open 2022; 10:E964-E970. [PMID: 36319027 PMCID: PMC9633056 DOI: 10.9778/cmajo.20220118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Indigenous people in Canada often face barriers to access specialized care, with limited data in evaluating health care utilization among Indigenous people with inflammatory bowel disease (IBD). We aimed to compare health care utilization between First Nations patients and those in the general population diagnosed with IBD in Saskatchewan. METHODS We conducted a patient-oriented, population-based, retrospective cohort study by linking administrative health databases of Saskatchewan between fiscal years 1998/99 and 2017/18. We designed and completed this study in partnership with Indigenous patients and family advocates. We applied a validated algorithm to identify IBD incident cases and then used the self-declared First Nations status variable to divide those cases. We applied a 1:5 ratio for age and sex matching and used Cox proportional models to assess associations. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported. RESULTS We created a matched cohort with 696 IBD incident cases: 116 First Nations patients and 580 patients in the general population. We observed differences between the groups for IBD-specific hospital admissions (HR 1.33, 95% CI 1.01-1.75), IBD-related hospital admissions (HR 1.55, 95% CI 1.20-2.01), medication claims for IBD (HR 0.52, 95% CI 0.41-0.65) and 5-aminosalicylic acid claims (HR 0.56, 95% CI 0.45-0.71) adjusting by rural or urban residence and diagnosis type. There were no significant differences in the hazard rate of outpatient gastroenterology visits (HR 1.13, 95% CI 0.90-1.41), colonoscopies (HR 1.14, 95% CI 0.92-1.41) and surgeries for IBD (HR 1.14, 95% CI 0.80-1.64). INTERPRETATION We identified that First Nations patients diagnosed with IBD had a higher rate of hospital admissions owing to IBD than patients in the general population diagnosed with IBD. We also found an inverse association between First Nations status and having prescription medication claims for IBD.
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Affiliation(s)
- José Diego Marques Santos
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Sharyle Fowler
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Derek Jennings
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Colten Brass
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Linda Porter
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Robert Porter
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Rhonda Sanderson
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Juan Nicolás Peña-Sánchez
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask.
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Soto-Cabezas MG, Reyes MF, Soriano AN, Rodríguez JPV, Ibargüen LO, Martel KS, Jaime NF, Munayco CV. COVID-19 among Amazonian indigenous in Peru: mortality, incidence, and clinical characteristics. J Public Health (Oxf) 2022; 44:e359-e365. [PMID: 35640249 PMCID: PMC9213839 DOI: 10.1093/pubmed/fdac058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 02/23/2022] [Indexed: 11/26/2022] Open
Abstract
Background Few studies have described the clinical characteristics of patients with COVID-19 from ethnic minority groups. Our objective was to evaluate the mortality and incidence rates, clinical characteristics and factors associated with mortality in cases with COVID-19 belonging to the Amazonian indigenous ethnic group in Peru. Methods We performed a retrospective cohort study including all cases from COVID-19 among Peruvian people identified as Amazonian indigenous from 07 March to 31 October 2020. We calculated the standardized mortality and incidence ratios using the indirect age-adjusted method to determine the differences between Amazonian Indigenous and the general population. In addition, we used multivariable logistic regression to determine the risk factors for death. Results A total of 19 018 laboratory confirmed COVID-19 cases were analyzed. Indigenous people had 3.18 (95% CI, 3.13–3.23) times the risk of infection and 0.34 (0.31–0.37) times the mortality risk of the general Peruvian population. Males had 1.29 (1.04–1.61) times the odds of death compared with females and for each year of age, the odds of mortality increased 1.03 (1.03–1.04) times. Cases with respiratory distress had 2.47 (1.96–3.10) times more likely to die. Having an immunodeficiency was 18.7 (6.12–57.00) times more likely to die. Discussion The Amazonian indigenous population in Peru was strongly affected by COVID-19 compared with the general Peruvian population.
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Affiliation(s)
- M Gabriela Soto-Cabezas
- Dirección de Vigilancia Epidemiológica, Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud, Calle Daniel Olaechea 199, Jesús María 15072, Lima, Peru
| | - Mary F Reyes
- Dirección de Vigilancia Epidemiológica, Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud, Calle Daniel Olaechea 199, Jesús María 15072, Lima, Peru
| | - Anderson N Soriano
- Dirección de Vigilancia Epidemiológica, Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud, Calle Daniel Olaechea 199, Jesús María 15072, Lima, Peru.,Pulmonary Training Program in Peru, Latin American Centre of Excellence on Climate Change and Health, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres 15102, Lima, Peru
| | - Jean Pierre Velásquez Rodríguez
- Dirección de Vigilancia Epidemiológica, Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud, Calle Daniel Olaechea 199, Jesús María 15072, Lima, Peru
| | - Luis Ordoñez Ibargüen
- Dirección de Vigilancia Epidemiológica, Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud, Calle Daniel Olaechea 199, Jesús María 15072, Lima, Peru
| | - Kevin S Martel
- Dirección de Vigilancia Epidemiológica, Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud, Calle Daniel Olaechea 199, Jesús María 15072, Lima, Peru
| | - Noemi Flores Jaime
- Dirección de Vigilancia Epidemiológica, Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud, Calle Daniel Olaechea 199, Jesús María 15072, Lima, Peru
| | - Cesar V Munayco
- Dirección de Vigilancia Epidemiológica, Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud, Calle Daniel Olaechea 199, Jesús María 15072, Lima, Peru
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Berlowitz I, O'Shaughnessy DM, Heinrich M, Wolf U, Maake C, Martin-Soelch C. Teacher plants - Indigenous Peruvian-Amazonian dietary practices as a method for using psychoactives. JOURNAL OF ETHNOPHARMACOLOGY 2022; 286:114910. [PMID: 34933085 DOI: 10.1016/j.jep.2021.114910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 05/27/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Indigenous groups of the Amazon have developed intricate methods for the application of psychoactives, among which particularly the dieta or diet method of Peruvian-Amazonian traditional medicine stands out. It is a retreat-like intervention involving lengthy periods of social, behavioural, and alimentary restrictions, while ingesting specially prepared plant substances. The interplay of the dietary conditions and plants ingested sensitizes the dieter to receive healing, strength, guidance, and knowledge. From a clinical scientific point of view, the method has remained largely underexplored, but seems more pertinent than ever given the increasing interest in Amazonian psychoactive preparations including ayahuasca (Banisteriopsis caapi) and the burgeoning field of psychedelic-assisted therapies in general. AIM OF THE STUDY This study offers a descriptive account and emic interpretation of the Peruvian-Amazonian dieta. More specifically we document in detail the procedure, its context and purpose of application, effects, modes of action, adverse effects, and risks, from the perspectives of a sample of Peruvian traditional healers. The Peruvian-Amazonian dieta is a multi-purpose method for making use of medicinal plants, many of which (but not all), are psychoactive; the current work especially focuses on its therapeutic applications in conjunction with psychoactives. METHODS We interviewed 16 healers working in the Ucayali, San Martín, and Loreto provinces of Peru using a semi-structured interview approach. Interviews were audio-recorded and transcribed verbatim. The extensive data derived from these interviews were analysed by means of computer-assisted manifest qualitative content analysis using a theory-advancing approach. Over 500 coded text segments were categorized, resulting in 7 main theme clusters and corresponding sub-themes. RESULTS The interviewed healers described a complex intervention with multifaceted applications (treatment, prevention, training) and effects in various domains (body, mind, spirit, energy). The process was portrayed as transformative, with benefits attributed to the effects of the so-called teacher plants in conjunction with the diet's conditions, along with the skill of the healer guiding the intervention. Further, a detailed risk assessment revealed sophisticated safety measures and tools designed to address adverse responses. The importance of adequate training of the healer that administers the diet was particularly highlighted in this context. CONCLUSIONS The dieta is a central therapeutic concept and tool in Peruvian-Amazonian traditional medicine and a unique method for using psychoactive plants. Multidisciplinary health research that includes traditional treatment methods from Indigenous cultures, Amazonian and other, should not be neglected in the current global interest in psychedelic therapies; such research may in the long-term contribute to a more inclusive psychedelic research paradigm as well as healthcare practice in countries where rich traditional healing systems exist, and perhaps beyond. It may also contribute to the recognition of the Indigenous healers as not only historical forerunners, but also current leading experts in psychedelic medicine.
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Affiliation(s)
- Ilana Berlowitz
- Institute of Anatomy, Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Psychology, University of Fribourg, Fribourg, Switzerland.
| | | | | | - Ursula Wolf
- Institute of Complementary and Integrative Medicine, University of Bern, Switzerland
| | - Caroline Maake
- Institute of Anatomy, Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Carrasco-Escobar G, Qquellon J, Villa D, Cava R, Llanos-Cuentas A, Benmarhnia T. Time-Varying Effects of Meteorological Variables on Malaria Epidemiology in the Context of Interrupted Control Efforts in the Amazon Rainforest, 2000-2017. Front Med (Lausanne) 2021; 8:721515. [PMID: 34660633 PMCID: PMC8511324 DOI: 10.3389/fmed.2021.721515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022] Open
Abstract
Successful malaria control interventions, mostly based on the training of health workers, distribution of insecticide-treated nets, and spraying, decrease malaria incidence; however, when these interventions are interrupted, a resurgence may occur. In the Peruvian Amazon, after discontinuing the control activities implemented by the PAMAFRO project (2006–2010)-a Global Fund-sponsored project for the strengthening of malaria control and surveillance in multiple countries in Latin America– malaria cases re-emerged dramatically. In parallel, meteorological factors determine the conditions suitable for the development, reproduction, and survival of mosquito vectors and parasites. This study hypothesized that interruption of malaria interventions may have modified the meteorological-malaria relationships over time (i.e., temporal changes in the dose-response between meteorological variables and malaria incidence). In this panel data analysis, we assessed the extent that relationships between meteorological variables and malaria changed temporally using data of monthly malaria incidence due to Plasmodium vivax or P. falciparum in Loreto, Peru (2000–2017). Generalized additive models were used to explore how the effects of meteorological variables changed in magnitude before, during, and after the PAMAFRO intervention. We found that once the PAMAFRO intervention had been interrupted, the estimated effects (dose-response) of meteorological variables on incidence rates decreased for both malaria parasite species. However, these fitted effect estimates did not reach their baseline levels (before the PAMAFRO period); variations of time-varying slopes between 0.45 and 2.07 times were observed after the PAMAFRO intervention. We also reported significant heterogeneity in the geographical distributions of malaria, parasite species, and meteorological variables. High malaria transmission occurred consistently in the northwestern provinces of Loreto Department. Since the end of the PAMAFRO period, a higher effect of precipitation and actual evapotranspiration was described on P. falciparum compared to P. vivax. The effect of temperature on malaria was greater over a shorter time (1-month lag or less), compared with precipitation and actual evapotranspiration (12-month lag). These findings demonstrate the importance of sustained malaria control efforts since interruption may enhance the links between meteorological factors and malaria. Our results also emphasize the importance of considering the time-varying effect of meteorological factors on malaria incidence to tailor control interventions, especially to better manage the current and future climate change crisis.
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Affiliation(s)
- Gabriel Carrasco-Escobar
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
| | - Jazmin Qquellon
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Diego Villa
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Renato Cava
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alejandro Llanos-Cuentas
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States.,Scripps Institution of Oceanography, University of California, San Diego, San Diego, CA, United States
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Snakebites in Rural Areas of Brazil by Race: Indigenous the Most Exposed Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179365. [PMID: 34501955 PMCID: PMC8431164 DOI: 10.3390/ijerph18179365] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 01/02/2023]
Abstract
Animal stings are environmental hazards that threaten millions annually and cause a significant socioeconomic impact. Snakebite envenoming affects 2.7 million people globally every year, mostly the poorest and rural communities, with approximately 27,000 annual cases in Brazil. This study’s objective is to identify the most exposed racial group for snakebites in rural areas of Brazil and analyze possible differences in the outcome of an accident. A retrospective epidemiological study was conducted using a database of rural snakebite cases from Brazil’s Ministry of Health (2017). Descriptive analysis and a regression model were performed to examine the association of bad outcomes after a snakebite with several covariables. While mixed-race individuals presented the highest number of cases (61.79%), indigenous and white populations were the racial groups with the highest and lowest exposure rates (194.3 and 34.1 per 100,000 population, respectively). The fatality rate was 3.5 times higher in the indigenous population compared to the white population. In the multivariable model, the number of hours between the accident and health care received and the case classification suggested an association with a bad outcome. Snakebite is prominent in Brazil, particularly among indigenous groups. Antivenom is available in the Brazilian Health System; however, efforts need to be made for decentralization.
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Bussalleu A, Pizango P, King N, Ford J, Team IHACCR, Harper SL. Kaniuwatewara (when we get sick): understanding health-seeking behaviours among the Shawi of the Peruvian Amazon. BMC Public Health 2021; 21:1552. [PMID: 34399726 PMCID: PMC8365975 DOI: 10.1186/s12889-021-11574-2] [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: 07/01/2020] [Accepted: 07/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background Detailed qualitative information regarding Indigenous populations’ health-seeking behaviours within Peru’s plural healthcare system is lacking. Such context-specific information is prerequisite to developing evidence-based health policies and programs intended to improve health outcomes for Indigenous populations. To this end, this study aimed to characterize health-seeking behaviours, factors affecting health-seeking behaviours, and barriers to obtaining healthcare in two Indigenous Shawi communities in Peru. Methods Community-based approaches guided this work, and included 40 semi-structured interviews and a series of informal interviews. Data were analysed thematically, using a constant comparative method; result authenticity and validity were ensured via team debriefing, member checking, and community validation. Results Shawi health-seeking behaviours were plural, dynamic, and informed by several factors, including illness type, perceived aetiology, perceived severity, and treatment characteristics. Traditional remedies were preferred over professional biomedical healthcare; however, the two systems were viewed as complementary, and professional biomedical healthcare was sought for illnesses for which no traditional remedies existed. Barriers impeding healthcare use included distance to healthcare facilities, costs, language barriers, and cultural insensitivity amongst professional biomedical practitioners. Nevertheless, these barriers were considered within a complex decision-making process, and could be overridden by certain factors including perceived quality or effectiveness of care. Conclusions These findings emphasize the importance of acknowledging and considering Indigenous culture and beliefs, as well as the existing traditional medical system, within the professional healthcare system. Cultural competency training and formally integrating traditional healthcare into the official healthcare system are promising strategies to increase healthcare service use, and therefore health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11574-2.
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Affiliation(s)
- Alejandra Bussalleu
- Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, Honorio Delgado, 430, Lima, Peru.
| | - Pedro Pizango
- Communidad Nativa Balsapuerto, Alto Amazonas, Communidad Nativa, Loreto, Peru
| | - Nia King
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, Canada.,Department of Medicine, Queen's University, 99 University Avenue, Kingston, Ontario, Canada
| | - James Ford
- Priestly International Centre for Climate, University of Leeds, Leeds, UK.,Indigenous Health Adaptation to Climate Change Research Team: Lea Berrang-Ford, Cesar Carcamo, Patricia Garcia, Shuaib Lwasa, Didacus B. Namanya, Edmonton, Canada
| | - I H A C C Research Team
- Indigenous Health Adaptation to Climate Change Research Team: Lea Berrang-Ford, Cesar Carcamo, Patricia Garcia, Shuaib Lwasa, Didacus B. Namanya, Edmonton, Canada
| | - Sherilee L Harper
- Indigenous Health Adaptation to Climate Change Research Team: Lea Berrang-Ford, Cesar Carcamo, Patricia Garcia, Shuaib Lwasa, Didacus B. Namanya, Edmonton, Canada.,School of Public Health, University of Alberta, 116 St & 85 Ave, Edmonton, Alberta, Canada
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11
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Barrenechea-Pulache A, Portocarrero-Bonifaz A, Hernández-Vásquez A, Portocarrero-Ramos C, Moscoso-Carrasco J. Determinants of Eye Care Service Utilization among Peruvian Adults: Evidence from a Nationwide Household Survey. Ophthalmic Epidemiol 2021; 29:339-348. [PMID: 34251970 DOI: 10.1080/09286586.2021.1948577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This study analyzes the factors associated with eye care service utilization among Peruvians 50 years of age and older, measured as self-reporting of having undergone examination of visual acuity during the last 12 months. METHODS A secondary analysis of the 2019 Demographic and Family Health Survey (ENDES, for its acronym in Spanish) database was carried out. We estimated the weighted proportion of adults 50 years of age and older that reported having undergone a visual acuity examination in the previous 12 months and the frequency according to the variables of interest. Crude (PR) and adjusted prevalence ratios (aPR) of eye care service utilization were constructed using generalized linear models. RESULTS Approximately 28.8% of Peruvians 50 years of age and older underwent a visual acuity examination in the previous 12 months. Having a higher education (aPR = 1.79; 95% CI: 1.33-2.40), health insurance such as EsSalud (aPR = 1.54; 95% CI: 1.28-1.87), a previous diagnosis of cataracts (aPR = 1.86; 95% CI: 1.67-2.09) and being part of the richest wealth quintile (aPR = 2.36; 95% CI: 1.74-3.20) were associated with greater utilization of eye care services, while living in the jungle was associated with a lower likelihood of utilization of these services. CONCLUSION The unequal distribution of health resources within the territory and socioeconomic gaps among the population could explain our findings. Further efforts are needed to fulfill the eye health needs of the Peruvian population.
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Affiliation(s)
| | | | - Akram Hernández-Vásquez
- Universidad San Ignacio De Loyola, Vicerrectorado De Investigación, Centro De Excelencia En Investigaciones Económicas Y Sociales En Salud. Lima, Peru
| | | | - Jenny Moscoso-Carrasco
- Departamento de salud pública y administración, Unidad de epidemiolgia, ETS y VIH, Unidad De Informática Biomédica En Salud Global, Universidad Peruana Cayetano Heredia, Lima, Peru
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Healthcare and Health Problems from the Perspective of Indigenous Population of the Peruvian Amazon: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217728. [PMID: 33105800 PMCID: PMC7672556 DOI: 10.3390/ijerph17217728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 12/22/2022]
Abstract
Indigenous communities usually experience higher levels of mortality and poorer access to healthcare services compared to non-indigenous communities. This study aims to understand the most prevalent health problems and their treatment in the Asháninka indigenous communities of the Peruvian Amazon. We conducted an ethnographic study in order to explore the perceived health problems, the use of traditional medicine and the resources offered by the official Peruvian healthcare system. Field notes and semi-structured interviews were used. A total of 16 indigenous and four non-indigenous people were interviewed, and interpretative analysis was used to identify themes. The Asháninka community is an overlooked population, which, due to distance restrictions, misconceptions and ethnical disparities, is far away from an appropriate healthcare system and is subjected to acute medical conditions such as infections and gastrointestinal problems. This group tends to seek traditional medicine, mostly herbal medications and traditional healers. The use of a health professional is seen as a last resort. Although the official Peruvian health system incorporates community participation strategies to improve the healthcare of indigenous people, the shortage of material, human resources and cultural sensitivity makes this difficult. Healthcare strategies should be devised and implemented in order to minimize health inequality in this population.
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Bussalleu A, Di-Liberto A, Carcamo C, Carrasco-Escobar G, Zavaleta-Cortijo C, King M, Berrang-Ford L, Maurtua D, Llanos-Cuentas A. Cultural Values and the Coliform Bacterial Load of "Masato," an Amazon Indigenous Beverage. ECOHEALTH 2020; 17:370-380. [PMID: 33216234 PMCID: PMC7719114 DOI: 10.1007/s10393-020-01498-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/28/2020] [Accepted: 09/27/2020] [Indexed: 06/11/2023]
Abstract
Access to safe drinking water is limited in many isolated areas, such as the Amazon where Indigenous peoples frequently reside. Identifying safe forms of drinking water accepted by the communities could have positive health benefits for Indigenous peoples. Many Amazon Indigenous peoples traditionally prepare and consume a fermented beverage called masato, which is frequently the only form of water consumption. Despite its widespread consumption and evidence of the health benefits of fermentation, masato remains poorly investigated. We partnered with a Shawi Indigenous community in the Peruvian Amazon to conduct participatory photography to research masato preparation, and to characterize key cultural features and to assess the presence of total and fecal coliform bacteria by using a membrane filter technique. Pictures show that masato preparation is a key part of cultural practices and that there are clear gender roles in the preparation process. We found that 100% of communal water sources (26/26) were contaminated with coliform bacteria; by contrast, fewer, 18% of masato samples (2/11), were positive for coliform. This exploratory study suggests that fermented beverages like masato merit further investigation as they represent an Indigenous method to improve water quality in Amazonian communities where water safety cannot be assured.
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Affiliation(s)
- Alejandra Bussalleu
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
| | - Aldo Di-Liberto
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
| | - Cesar Carcamo
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
| | - Gabriel Carrasco-Escobar
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Carol Zavaleta-Cortijo
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru.
| | - Matthew King
- Geography Department, McGill University, Burnside Hall Building, Room 705, 805 Sherbrooke Street West, Montreal, QC, H3A0B9, Canada
| | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Dora Maurtua
- Laboratorio de Bacteriología de los Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
| | - Alejandro Llanos-Cuentas
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
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Gochenaur L, Peterson S, Vasquez L, Adler D. Knowledge of Cervical Cancer Prevention Among Women in Amazonian Peru. WOMEN'S HEALTH REPORTS 2020; 1:270-278. [PMID: 33786489 PMCID: PMC7784820 DOI: 10.1089/whr.2020.0051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 11/13/2022]
Abstract
Background and Purpose: Survey-based research was conducted in Yantalo, Peru, a rural Amazonian community, to assess the knowledge base among women surrounding cervical cancer, human papilloma virus (HPV), and preventative health practices as well as to gain a better understanding of barriers to accessing care. Methods: A total of 217 women were interviewed out of the 1612 female inhabitants of Yantalo utilizing a structured interview-style questionnaire with both closed and open-ended questions. Results: Our average respondent was 41.6 years old with the equivalent of some high school education. Approximately 75% of respondents reported that they had heard of HPV and/or cervical cancer, with 44.4% reporting they had received a test to check for cervical cancer within their lifetime. When given a 10-question knowledge assessment regarding safe sex practices and cervical cancer, women obtained an average score of 57.3%. When asked about receiving the HPV vaccine, 29% reported "Yes", 59.4% reported "No", and 11.6% reported "I don't know." Although 62.6% of women indicated that they have "easy access to cervical cancer screening," 37.4% of women reported experiencing at least one barrier to accessing care. The highest reported barriers include fear of the test causing them pain and/or lack of knowledge of the necessity cervical cancer testing. Cervical cancer rates in Peru are approximately three times that in developed countries. Conclusions: Gathering data surrounding knowledge and the barriers among the female population in rural communities is essential to developing targeted initiatives that address pertinent obstacles within these and other vulnerable communities.
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Affiliation(s)
- Lauren Gochenaur
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Sara Peterson
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | | | - David Adler
- Emergency Medicine & Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
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Heitzinger K, Hawes SE, Rocha CA, Alvarez C, Evans CA. Assessment of the Feasibility and Acceptability of Using Water Pasteurization Indicators to Increase Access to Safe Drinking Water in the Peruvian Amazon. Am J Trop Med Hyg 2020; 103:455-464. [PMID: 32372750 PMCID: PMC7356428 DOI: 10.4269/ajtmh.18-0963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Approximately two billion people lack access to microbiologically safe drinking water globally. Boiling is the most popular household water treatment method and significantly reduces diarrheal disease, but is often practiced inconsistently or ineffectively. The use of low-cost technologies to improve boiling is one approach with potential for increasing access to safe drinking water. We conducted household trials to evaluate the feasibility and acceptability of water pasteurization indicators (WAPIs) in the Peruvian Amazon in 2015. A total of 28 randomly selected households were enrolled from a rural and a peri-urban community. All households trialed two WAPI designs, each for a 2-week period. Ninety-six percent of participants demonstrated the correct use of the WAPIs at the end of each trial, and 88% expressed satisfaction with both WAPI models. Ease of use, short treatment time, knowledge of the association between WAPI use and improved health, and the taste of treated water were among the key factors that influenced acceptability. Ease of use was the key factor that influenced design preference. Participants in both communities preferred a WAPI with a plastic box that floated on the water's surface compared with a WAPI with a wire that was dipped into the pot of drinking water while it was heating (77% versus 15%, P < 0.001); we selected the box design for a subsequent randomized trial of this intervention. The high feasibility and acceptability of the WAPIs in this study suggest that these interventions have potential to increase access to safe water in resource-limited settings.
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Affiliation(s)
- Kristen Heitzinger
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation for Health and Development, Department of Infectious Disease, Imperial College London, London, United Kingdom
- Address correspondence to Kristen Heitzinger, Asociación Benéfica Prisma, 251 Carlos Gonzales, Lima 15073 Peru. E-mail:
| | - Stephen E. Hawes
- Department of Epidemiology, University of Washington, Seattle, Washington
| | | | - Carlos Alvarez
- Regional Center for Disease Prevention and Control, Loreto Regional Ministry of Health, Iquitos, Peru
| | - Carlton A. Evans
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation for Health and Development, Department of Infectious Disease, Imperial College London, London, United Kingdom
- IFHAD: Innovation for Health and Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
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Barrenechea-Pulache A, Avila-Jove E, Hernández-Vásquez A, Runzer-Colmenares FM. Socio-demographic inequalities in the uptake of Papanicolaou tests in Peru: analysis of the 2015-2017 Demographic and Family Health Survey. Epidemiol Health 2020; 42:e2020043. [PMID: 32580534 PMCID: PMC7644932 DOI: 10.4178/epih.e2020043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study was conducted to analyze the inequalities in Papanicolaou test (also referred to as the Pap smear) uptake according to the socio-demographic characteristics of Peruvian women 30 years to 59 years of age using information from the 2015-2017 Demographic and Family Health Survey (ENDES, acronym in Spanish). METHODS This is an analytical, cross-sectional study based on information acquired from the 2015-2017 ENDES surveys. Socio-demographic characteristics were reported using absolute frequencies and weighted proportions with 95% confidence intervals, considering results with a p-value <0.05 as statistically significant. Concentration curves (CCs) and concentration indices (IndCs) were created based on the interaction of the wealth index and uptake of Pap smears, taking into account the different characteristics of the population studied for the measure of inequalities. RESULTS All the CCs were distributed below the line of equality. Similarly, all the IndCs were higher than zero, indicating inequality in the uptake of Pap smears, favoring those with a higher wealth index. The highest IndC values were obtained from women aged 50-59 (IndC, 0.293), those who lived in the jungle (IndC, 0.230), and those without health insurance (IndC, 0.173). CONCLUSIONS We found socio-demographic inequalities in the uptake of Pap smears in Peru, favoring women with a higher wealth index. More funding is needed to promote cervical cancer screening programs and to create systems that ensure equal access to healthcare in Peru.
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Affiliation(s)
| | | | - Akram Hernández-Vásquez
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud. Lima, Peru
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Ebbs D, Hirschbaum JH, Mika A, Matsushita SC, Lewis JH. Expanding Medical Education for Local Health Promoters Among Remote Communities of the Peruvian Amazon: An Exploratory Study of an Innovative Program Model. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:215-223. [PMID: 32256139 PMCID: PMC7090155 DOI: 10.2147/amep.s245491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/02/2020] [Indexed: 05/29/2023]
Abstract
PURPOSE Community health workers (CHWs) play integral roles in primary health care provision in low- and middle-income countries (LMICs). This is particularly true in underdeveloped areas where there are acute shortages of health workers. In this study, we evaluated the development and community utilization of a CHW training program in the Loreto province of Peru. Additionally, a community-oriented training model was designed to augment access to basic health information in underserved and isolated areas of the Amazon. METHODS Health resource utilization was compared in each community by surveying community members before and after implementation of the CHW training program, which utilized a community participatory program development (CPPD) model. RESULTS All communities demonstrated significantly increased CHW utilization (p = 0.026) as their initial point of contact for immediate health concerns following CHW training implementation. This increase in CHW utilization was accompanied by trends toward decreased preferences for local shamans or traveling to the closest health post as the initial health resource. CONCLUSION The community-focused, technology-oriented model utilized in this study proved an effective way to promote the use of CHWs in the Amazon region of Loreto, and could prove valuable to CHW capacitation efforts within other Peruvian provinces and in other LMICs around the world.
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Affiliation(s)
- Daniel Ebbs
- Resident Physician Valley Children’s Hospital, Madera, CA, USA
| | - Julian H Hirschbaum
- Resident Physician Los Angeles County USC Medical Center, Los Angeles, CA, USA
| | - Amanda Mika
- Resident Physician Saint Joseph Hospital, Denver, CO, USA
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Soriano-Moreno DR, Soriano-Moreno AN, Mejia-Bustamante A, Guerrero-Ramirez CA, Toro-Huamanchumo CJ. Factors associated with highly effective contraceptive use among reproductive-age women in Peru: Evidence from a nationwide survey. Eur J Obstet Gynecol Reprod Biol 2020; 245:114-120. [PMID: 31891894 DOI: 10.1016/j.ejogrb.2019.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/05/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to assess the factors associated with highly effective contraceptive (HEC) use among reproductive-age women in Peru, using evidence from a nationwide survey. STUDY DESIGN We analyzed the data corresponding to a national representative sample of 30,169 Peruvian women aged 15-49 years, surveyed during the Demographic and Family Health Survey, 2017. Usage of HEC methods included pills, IUD, injections, sterilization and implant. We assessed the factors associated with its use using Poisson regression models, reporting the crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95 % confidence intervals (95 % CI). RESULTS The prevalence of HEC use was 29.9 %. Factors related to a more likely use of HEC methods were having one (aPR: 4.03; 95 % CI: 3.19-5.09) or more children (aPR: 5.60; 95 % CI: 4.42-7.09), and having a health insurance children (aPR: 1.14; 95 % CI: 1.05-1.24). Women from the highlands (aPR: 0.74; 95 % CI: 0.67-0.81), aged ≥35 years (aPR: 0.78; 95 % CI: 0.67-0.90), not currently married or cohabiting (aPR: 0.52; 95 % CI: 0.47-0.58), and who considered it really hard to have to take transportation when they need medical help or advice (aPR: 0.92; 95 % CI: 0.86-0.99) were less likely to use highly effective contraception. CONCLUSION Quality and access to reproductive health is still a challenge in Peru. Family planning programs should be better disseminated and integrated. Similarly, promotion of educational campaigns and easy access to HEC methods are needed.
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Affiliation(s)
| | | | | | | | - Carlos J Toro-Huamanchumo
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru; Association for the Study of Medical Education, Edinburgh, UK.
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ELLWANGER JOELHENRIQUE, KULMANN-LEAL BRUNA, KAMINSKI VALÉRIAL, VALVERDE-VILLEGAS JACQUELINEMARÍA, VEIGA ANABEATRIZGDA, SPILKI FERNANDOR, FEARNSIDE PHILIPM, CAESAR LÍLIAN, GIATTI LEANDROLUIZ, WALLAU GABRIELL, ALMEIDA SABRINAE, BORBA MAUROR, HORA VANUSAPDA, CHIES JOSÉARTURB. Beyond diversity loss and climate change: Impacts of Amazon deforestation on infectious diseases and public health. ACTA ACUST UNITED AC 2020; 92:e20191375. [DOI: 10.1590/0001-3765202020191375] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/17/2020] [Indexed: 12/15/2022]
Affiliation(s)
| | | | | | | | | | | | | | - LÍLIAN CAESAR
- Universidade Federal do Rio Grande do Sul/UFRGS, Brazil
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Solano-Villarreal E, Valdivia W, Pearcy M, Linard C, Pasapera-Gonzales J, Moreno-Gutierrez D, Lejeune P, Llanos-Cuentas A, Speybroeck N, Hayette MP, Rosas-Aguirre A. Malaria risk assessment and mapping using satellite imagery and boosted regression trees in the Peruvian Amazon. Sci Rep 2019; 9:15173. [PMID: 31645604 PMCID: PMC6811674 DOI: 10.1038/s41598-019-51564-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/02/2019] [Indexed: 12/02/2022] Open
Abstract
This is the first study to assess the risk of co-endemic Plasmodium vivax and Plasmodium falciparum transmission in the Peruvian Amazon using boosted regression tree (BRT) models based on social and environmental predictors derived from satellite imagery and data. Yearly cross-validated BRT models were created to discriminate high-risk (annual parasite index API > 10 cases/1000 people) and very-high-risk for malaria (API > 50 cases/1000 people) in 2766 georeferenced villages of Loreto department, between 2010-2017 as other parts in the article (graphs, tables, and texts). Predictors were cumulative annual rainfall, forest coverage, annual forest loss, annual mean land surface temperature, normalized difference vegetation index (NDVI), normalized difference water index (NDWI), shortest distance to rivers, time to populated villages, and population density. BRT models built with predictor data of a given year efficiently discriminated the malaria risk for that year in villages (area under the ROC curve (AUC) > 0.80), and most models also effectively predicted malaria risk in the following year. Cumulative rainfall, population density and time to populated villages were consistently the top three predictors for both P. vivax and P. falciparum incidence. Maps created using the BRT models characterize the spatial distribution of the malaria incidence in Loreto and should contribute to malaria-related decision making in the area.
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Affiliation(s)
- Elisa Solano-Villarreal
- Université de Liège, 4000, Liège, Belgium.
- Research Institute of Health and Society (IRSS), Université catholique de Louvain, 1200, Brussels, Belgium.
- Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, 15102, Peru.
| | - Walter Valdivia
- Ministry of Development and Social Inclusion, Lima, 15047, Peru
| | - Morgan Pearcy
- Research Institute of Health and Society (IRSS), Université catholique de Louvain, 1200, Brussels, Belgium
| | - Catherine Linard
- Namur Research Institute for Life Sciences (Narilis), Université de Namur, 5000, Namur, Belgium
- Institute of Life-Earth-Environment (ILEE), 5000, Namur, Belgium
| | | | - Diamantina Moreno-Gutierrez
- Research Institute of Health and Society (IRSS), Université catholique de Louvain, 1200, Brussels, Belgium
- University of Antwerp, 2000, Antwerp, Belgium
- Faculty of Human Medicine, Universidad Nacional de la Amazonía Peruana, Loreto, 160, Peru
| | | | - Alejandro Llanos-Cuentas
- Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, 15102, Peru
| | - Niko Speybroeck
- Research Institute of Health and Society (IRSS), Université catholique de Louvain, 1200, Brussels, Belgium
| | | | - Angel Rosas-Aguirre
- Research Institute of Health and Society (IRSS), Université catholique de Louvain, 1200, Brussels, Belgium
- Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, 15102, Peru
- Fonds de la Recherche Scientifique (FNRS), 1000, Brussels, Belgium
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Westgard CM, Rogers A, Bello G, Rivadeneyra N. Health service utilization, perspectives, and health-seeking behavior for maternal and child health services in the Amazon of Peru, a mixed-methods study. Int J Equity Health 2019; 18:155. [PMID: 31615516 PMCID: PMC6794768 DOI: 10.1186/s12939-019-1056-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 09/23/2019] [Indexed: 11/12/2022] Open
Abstract
Background Various factors influence health service utilization at the community level. Research on the barriers to uptake of local health services is essential to reduce maternal and child mortality and morbidity. The Amazon region of Peru has some of the poorest health indicators in the country. The current study set out to better understand the health-seeking behavior and perspectives of mothers in Amazonian communities, exploring individual- and contextual-level barriers for seeking care at local health facilities for common maternal and child health issues. Methods The study employed a mixed-methods design by conducting 50 structured interviews with mothers of children under the age of 4. The study took place in 5 communities in Loreto, Peru. The quantitative data was analyzed with descriptive statistics to identify participants’ socio-demographic characteristics and reported utilization of health services. The qualitative data was analyzed in three rounds: inductive codebook development, application of the codebook, and thematic synthesis to contextualize the quantitative results and better understand the perspectives of the mothers regarding maternal and child health issues and the local health services. Results Overall, reported health service utilization among study participants was relatively high. However, the mothers identified several individual- and contextual-level factors that may affect their experiences and the health-seeking behaviors of other mothers in their communities: (i) embarrassment, fear, and trust, (ii) insufficient number and poor attitudes of health personnel, (iii) limited supply of basic medicines and materials in the health facility, and (iv) low demand for family planning services and limited awareness of adolescent-specific services. Conclusion Several findings in the current study reflect the reduced conditions of health services, while others display that many mothers maintain a positive outlook on the health services available to them and are proactive in the care of their child. The study provides valuable insight into the use of local health services and the common perspectives that are hindering further uptake at the community level in the Amazon of Peru, with important implications for health policy.
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Affiliation(s)
| | - Ally Rogers
- Department of Research, Elementos, Lima, Peru.,Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Collins JH, Bowie D, Shannon G. A descriptive analysis of health practices, barriers to healthcare and the unmet need for cervical cancer screening in the Lower Napo River region of the Peruvian Amazon. WOMEN'S HEALTH (LONDON, ENGLAND) 2019; 15:1745506519890969. [PMID: 31840562 PMCID: PMC6918491 DOI: 10.1177/1745506519890969] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 08/05/2019] [Accepted: 10/31/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To undertake an descriptive analysis of the health needs, healthcare practices and barriers to accessing healthcare faced by women in Lower Napo River Region, Peru, and to understand health literacy regarding cervical cancer and the need for more effective cervical cancer screening services. METHODS We performed a community-based needs assessment adapting Demographic and Health survey methodology with additional questions determining female health literacy on cervical cancer and assessing the availability and need for cervical cancer screening services. We surveyed women (N = 121) across all households in six communities along the Lower Napo River, Loreto, Peru, in May 2015. Data were collected as part of the larger Amazon Community Based Participation Cervical Cancer Screen-and-Treat Programme. Survey data were compared to national results from ENDES 2014. RESULTS Comparison between our findings and the ENDES 2014 survey highlighted considerable inequality between indigenous or mixed indigenous, rural populations in Loreto, Peru, and national population data averages over level of formal education, literacy, barriers to accessing healthcare and maternal and sexual health. Even though only 5.9% (N = 7/117) of women had no formal health insurance coverage, money was reported as the leading barrier accessing healthcare (N = 88/117, 75.2%). Health literacy regarding cervical and breast cancer was poor. A high proportion of women highlighted fear of screening processes (70.8%, N = 80/113) and lack of available services (53.6%, N = 60/112) as barriers to cervical cancer screening. CONCLUSION Although progress has been made in improving healthcare access in Peru, such gains have not been experienced equitably and women living in remote communities face persistent marginalization regarding their health. There is a significant need for education related to and screening for cervical cancer in this region that is tailored to the reality of women's lives in remote communities in Loreto.
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Affiliation(s)
- Joseph H Collins
- Institute for Global Health, University College London, London, UK
| | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
- DB Peru, Miraflores, Lima, Peru
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Ruiz EF, Torres-Roman JS, Servan SA, Martinez-Herrera JF, Arce-Huamani MA, Carioli G, La Vecchia C. Trends and geographic pattern of stomach cancer mortality in Peru. Cancer Epidemiol 2018; 58:193-198. [PMID: 30522779 DOI: 10.1016/j.canep.2018.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stomach cancer mortality rates in South America are among the highest in the world. In Peru, stomach cancer has the highest absolute number of cancer deaths in both sexes combined. We estimated mortality rates for stomach cancer in Peru by sex and geographical region between 2008 and 2015. METHODS We obtained death data for stomach cancer from the Peruvian Ministry of Health database. We estimated the age-standardized mortality rate (ASMR) per 100,000 persons using the direct method and the world standard population. RESULTS A total of 25,020 deaths from stomach cancer were identified in the study period. At national level, stomach cancer mortality rates (per 100,000 population) for men ranged from 9.8 in 2008 to 8.8 in 2015 with a percent change of -16%, and for women from 8.8 in 2008 to 7.7 in 2015 with a percent change of -16.8%. The highlands had the highest mortality rates overall, mainly in Huancavelica and Huánuco. The rainforest had the lowest rates and the highest decline in stomach cancer ASMRs. The coast displayed intermediate rates overall. CONCLUSIONS Within the study period, mortality rates from stomach cancer in Peru declined by 16%. The highlands had the highest mortality rates as compared to those from the coast or rainforest region. These geographical differences in mortality could reflect a different distribution in stomach cancer risk factors as the prevalence of H. pylori, poor dietary habits, low socioeconomic background of the Andean population and the lack of a decentralized health system.
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Affiliation(s)
- Eloy F Ruiz
- CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Smith Torres-Roman
- Faculty of Medicine, Universidad Nacional San Luis Gonzaga, Ica, Peru; Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru.
| | - Sebastian A Servan
- Facultad de Medicina "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Greta Carioli
- Department of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy
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Health and Demographic Characteristics of Patients Attending a Newly-Opened Medical Facility in a Remote Amazonian Community: A Descriptive Study. Med Sci (Basel) 2018; 6:medsci6040106. [PMID: 30486307 PMCID: PMC6318754 DOI: 10.3390/medsci6040106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/02/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022] Open
Abstract
Peru is a country with wide regional disparities in health. Remote Amazonian communities have high rates of poverty and poor access to health services. There is a lack of data on morbidity and use of health services in the region. We describe a descriptive, cross-sectional study of the demographic characteristics and presenting complaints of attendees to a newly-opened primary care facility in a remote community. This was supplemented by structured interviews of adult attendees to build a picture of sociocultural determinants of health locally, including engagement with traditional forms of medicine. Our study provides novel insights into an under-studied and under-resourced area. We found a young population with a high prevalence of infectious illnesses, particularly dermatological infections - a previously under-recognised source of morbidity in these communities. Poor literacy rates and widespread use of traditional forms of medicine have important implications for the provision of healthcare in this region.
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Bogar S, Szabo A, Woodruff S, Johnson S. Urban Youth Knowledge and Attitudes Regarding Lead Poisoning. J Community Health 2018; 42:1255-1266. [PMID: 28528525 DOI: 10.1007/s10900-017-0378-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Environmental health literacy (EHL) is a promising and evolving field of research that could benefit from youth engagement. Yet studies focused on youths' environmental health awareness and concerns are limited. For example, although lead exposure remains a threat to youth development in urban environments, no published studies have measured urban youth's knowledge of lead poisoning. A CBPR partnership established a youth advisory council (YAC) who helped to design, interpret and disseminate a mixed methods study exploring environmental health perceptions among urban youths ages 10-18. Surveys assessed awareness, attitudes, and knowledge regarding lead poisoning and five environmental health issues determined by the YAC. Focus group questions further contextualized youths' lead knowledge and understanding of youths' environmental health concerns. A majority of youth could identify specific sources of lead exposure but had minimal knowledge of prevention strategies, and focus group data revealed misinformation regarding lead sources and consequences. Survey and focus group respondents' level of awareness and concern regarding YAC-selected EH issues was high in comparison to lead poisoning. In particular, job opportunities and police brutality were endorsed as both neighborhood concerns and priorities. Awareness and knowledge of environmental health issues among urban youth have not been well described. These findings reinforce the importance of addressing problems of local relevance. Moving forward, lead poisoning prevention education for youth and youth EHL partnerships may benefit from incorporating an ecological approach wherein connections to the social and economic context are made explicit.
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Affiliation(s)
- Sandra Bogar
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, P.O. Box 26509, Milwaukee, WI, 53226-0509, USA.
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shane Woodruff
- Running Rebels Community Organization, Milwaukee, WI, USA
| | - Sheri Johnson
- Center for the Advancement of Underserved Children, Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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Sandes LFF, Freitas DA, de Souza MFNS, Leite KBDS. [Primary health care for South-American indigenous peoples: an integrative review of the literatureAtención primaria en salud a indígenas de América del Sur: revisión integrativa de la bibliografía]. Rev Panam Salud Publica 2018; 42:e163. [PMID: 31093191 PMCID: PMC6385845 DOI: 10.26633/rpsp.2018.163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 08/22/2018] [Indexed: 01/15/2023] Open
Abstract
Objective To review the literature regarding the access to primary health care (PHC) by indigenous communities in South America, identifying the main access barriers. Method Integrative review of articles published from 2007 to 2017 in the LILACS, PubMed, and SciELO databases. The search terms "indigenous AND health AND Brazil" and "indigenous AND health NOT Brazil" were used in Portuguese and English. Articles published in English, Portuguese, or Spanish, focusing strictly on PHC and on South-American indigenous populations were included. Results Forty articles describing aspects of PHC for indigenous populations in eight countries - Brazil, Peru, Colombia, Bolivia, Argentina, Chile, Paraguay, and Ecuador - were included. The main barriers to accessing PHC were the difficulty of reaching the health care facilities closest to villages; difficulty in communicating with health care professionals; inadequate transportation to the health care units; lack of epidemiological data on indigenous villages; lack of information regarding local indigenous cultures; and fear of discrimination or humiliation on the part of indigenous patients. Conclusions Studies regarding the health of indigenous populations in South America are scarce. It is evident that national health systems still need to advance towards an intercultural medicine that respects the social, cultural, and economic realities of all communities, with knowledge and consideration for different forms of care.
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Affiliation(s)
| | - Daniel Antunes Freitas
- Departamento de Saúde Mental e Saúde Coletiva, Universidade Estadual de Montes Claros (Unimontes), Montes Claros (MG), Brasil
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Developmental delay in the Amazon: The social determinants and prevalence among rural communities in Peru. PLoS One 2017; 12:e0186263. [PMID: 29023517 PMCID: PMC5638337 DOI: 10.1371/journal.pone.0186263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/28/2017] [Indexed: 11/19/2022] Open
Abstract
The consequences of poor child development are becoming increasingly recognized. Programs are being put in place around the world to improve child development by providing healthy and stimulating environments for children. However, these programs often have limited reach and little is known about the prevalence of developmental delay in under-developed communities. The current study set-out to better understand the prevalence of developmental delay in rural communities in the Amazon region of Peru. Also, it explores social determinants that are associated with any delay. Cross-sectional study by evaluating developmental delay in children under 4 years utilizing Ages and Stages Questionnaire (ASQ-3). Additionally, conducting a social determinants questionnaire answered by caretakers to identify social drivers for developmental delay. The data was analyzed with multi-variant analysis to measure association. The prevalence of developmental delay in the Amazonian communities was 26.7% (19.3% in communication, 11.4% in gross motor skills, 8% in both) (N = 596). The multivariate logistic regression analysis revealed significant associations between developmental delay and; level of education (OR 0.64, p = 0.009), age of mother during child's birth (OR 0.96, p = 0.002), visits by community health agents (OR 0.73, p = 0.013), and river as primary water source (OR 2.39, p = 0.001). The social determinants questionnaire revealed that 39% of the mothers had their first child before the age of 17, nearly half stopped going to school before the age of 12 (52%), 29% gave birth at home, 13% breast fed for less than 7 months, and 50% of the children had diarrhea in the last month. There is still a great need to improve the conditions for child development in the Amazon region of Peru. One-fourth of the children suffer from developmental delay, which will likely impede their potentials for life unless something is done. The impact of education, age of mother at birth of the child, community health agents, and access to clean drinking water were important findings. Improvements can be made in these areas to create a large, cost-effective impact on the well-being of the communities.
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Benzaken AS, Sabidó M, Brito I, Bermúdez XPD, Benzaken NS, Galbán E, Peeling RW, Mabey D. HIV and syphilis in the context of community vulnerability among indigenous people in the Brazilian Amazon. Int J Equity Health 2017; 16:92. [PMID: 28583173 PMCID: PMC5460420 DOI: 10.1186/s12939-017-0589-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 05/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contextual factors shape the risk of acquiring human immunodeficiency virus (HIV) and syphilis. We estimated the prevalence of both infections among indigenous people in nine indigenous health districts of the Brazilian Amazon and examined the context of community vulnerability to acquiring these infections. METHODS We trained 509 health care workers to screen sexually active populations in the community for syphilis and HIV using rapid testing (RT). We then assessed the prevalence of HIV and syphilis using RT. A multivariable analysis was used to identify factors associated with syphilis infection (sociodemographic, condom use, intrusion, population mobility, and violence). RESULTS Of the 45,967 indigenous people tested, the mean age was 22.5 years (standard deviation: 9.2), and 56.5% were female. Overall, for HIV, the prevalence was 0.13% (57/43,221), and for syphilis, the prevalence was 1.82% (745/40,934). The prevalence in men, women, and pregnant women for HIV was 0.16%, 0.11%, and 0.07%, respectively, and for syphilis, it was 2.23%, 1.51%, and 1.52%, respectively. The district Vale do Javari had the highest prevalence of both infections (HIV: 3.38%, syphilis: 1.39%). This district also had the highest population mobility and intrusion and the lowest availability of prenatal services. Syphilis infection was independently associated with age (odds ratio [OR] 1.04, 95% confidence interval [CI]: 1.03-1.05), male sex (OR 1.32, 95% CI: 1.14-1.52), and mobility (moderate: OR: 7.46, 95% CI: 2.69-20.67; high: OR 7.09, 95% CI: 3.79-13.26). CONCLUSIONS The large-scale integration of RT in remote areas increased case detection among pregnant women, especially for syphilis, in districts with higher vulnerability. Mobility is an important risk factor, especially in districts with higher vulnerability. Contextually appropriate approaches that address this factor could contribute to the long-term success of HIV and syphilis control programs.
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Affiliation(s)
- Adele Schwartz Benzaken
- Department of STI, AIDS and Viral Hepatitis, Secretary for Health Surveillance, Ministry of Health Brazil, Brasília, DF, Brazil.,Tropical Medicine Foundation Doctor Heitor Vierira Dourado, Manaus, Brazil
| | - Meritxell Sabidó
- Department of STI, AIDS and Viral Hepatitis, Secretary for Health Surveillance, Ministry of Health Brazil, Brasília, DF, Brazil. .,Pan American Health Organization, Brasília, Brazil. .,TransLab. Department of Medical Sciences, Universitat de Girona, Catalonia, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Ivo Brito
- Department of STI, AIDS and Viral Hepatitis, Secretary for Health Surveillance, Ministry of Health Brazil, Brasília, DF, Brazil
| | - Ximena Pamela Díaz Bermúdez
- Pan American Health Organization, Brasília, Brazil.,Departamento de Saúde Coletiva, Universidade de Brasília, Brasília, Brazil
| | | | | | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - David Mabey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Toda M, Rengifo Salgado EL, Masuda M. Assessing medicinal plants as the linkage between healthcare, livelihood and biodiversity: a case study from native villages surrounding a second-tier city in the central Peruvian Amazon. TROPICS 2016. [DOI: 10.3759/tropics.ms15-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Miki Toda
- Sustainable Environmental Studies, Graduate School of Life and Environmental Sciences, University of Tsukuba
| | | | - Misa Masuda
- Life and Environmental Sciences, University of Tsukuba
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Williamson J, Ramirez R, Wingfield T. Health, healthcare access, and use of traditional versus modern medicine in remote Peruvian Amazon communities: a descriptive study of knowledge, attitudes, and practices. Am J Trop Med Hyg 2015; 92:857-864. [PMID: 25688165 PMCID: PMC4385786 DOI: 10.4269/ajtmh.14-0536] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/09/2014] [Indexed: 11/15/2022] Open
Abstract
There is an urgent need for healthcare research, funding, and infrastructure in the Peruvian Amazon. We performed a descriptive study of health, health knowledge and practice, and healthcare access of 13 remote communities of the Manatí and Amazon Rivers in northeastern Peru. Eighty-five adults attending a medical boat service were interviewed to collect data on socioeconomic position, health, diagnosed illnesses, pain, healthcare access, and traditional versus modern medicine use. In this setting, poverty and gender inequality were prevalent, and healthcare access was limited by long distances to the health post and long waiting times. There was a high burden of reported pain (mainly head and musculoskeletal) and chronic non-communicable diseases, such as hypertension (19%). Nearly all participants felt that they did not completely understand their diagnosed illnesses and wanted to know more. Participants preferred modern over traditional medicine, predominantly because of mistrust or lack of belief in traditional medicine. Our findings provide novel evidence concerning transitional health beliefs, hidden pain, and chronic non-communicable disease prevalence in marginalized communities of the Peruvian Amazon. Healthcare provision was limited by a breach between health education, knowledge, and access. Additional participatory research with similar rural populations is required to inform regional healthcare policy and decision-making.
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Affiliation(s)
| | | | - Tom Wingfield
- *Address correspondence to Tom Wingfield, Infectious Diseases and Immunity, Imperial College London and Wellcome Trust Imperial College Centre for Global Health Research, Hammersmith Campus, Du Cane Road, W12 0NN London, United Kingdom. E-mail:
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