Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala

Background The promotion of household water treatment and handwashing with soap has led to large reductions in child diarrhoea in randomized efficacy trials. Currently, we know little about the health effectiveness of behaviour-based water and hygiene interventions after the conclusion of intervention activities. Methods We present an extension of previously published design (propensity score matching) and analysis (targeted maximum likelihood estimation) methods to evaluate the behavioural and health impacts of a pre-existing but non-randomized intervention (a 3-year, combined household water treatment and handwashing campaign in rural Guatemala). Six months after the intervention, we conducted a cross-sectional cohort study in 30 villages (15 intervention and 15 control) that included 600 households, and 929 children <5 years of age. Results The study design created a sample of intervention and control villages that were comparable across more than 30 potentially confounding characteristics. The intervention led to modest gains in confirmed water treatment behaviour [risk difference = 0.05, 95% confidence interval (CI) 0.02-0.09]. We found, however, no difference between the intervention and control villages in self-reported handwashing behaviour, spot-check hygiene conditions, or the prevalence of child diarrhoea, clinical acute lower respiratory infections or child growth. Conclusions To our knowledge this is the first post-intervention follow-up study of a combined household water treatment and handwashing behaviour change intervention, and the first post-intervention follow-up of either intervention type to include child health measurement. The lack of child health impacts is consistent with unsustained behaviour adoption. Our findings highlight the difficulty of implementing behaviour-based household water treatment and handwashing outside of intensive efficacy trial

Intervention to Lower Household Wood Smoke Exposure in Guatemala Reduces ST-Segment Depression on Electrocardiograms

Background: A large body of evidence suggests that fine particulate matter (PM) air pollution is a cause of cardiovascular disease, but little is known in particular about the cardiovascular effects of indoor air pollution from household use of solid fuels in developing countries. RESPIRE (Randomized Exposure Study of Pollution Indoors and Respiratory Effects) was a randomized trial of a chimney woodstove that reduces wood smoke exposure. Objectives: We tested the hypotheses that the stove intervention, compared with open fire use, would reduce ST-segment depression and increase heart rate variability (HRV). Methods: We used two complementary study designs: a) between-groups comparisons based on randomized stove assignment, and b) before-and-after comparisons within control subjects who used open fires during the trial and received chimney stoves after the trial. Electrocardiogram sessions that lasted 20 hr were repeated up to three times among 49 intervention and 70 control women 38–84 years of age, and 55 control subjects were also assessed after receiving stoves. HRV and ST-segment values were assessed for each 30-min period. ST-segment depression was defined as an average value below –1.00 mm. Personal fine PM [aerodynamic diameter ≤ 2.5 μm (PM$_{2.5}$)] exposures were measured for 24 hr before each electrocardiogram. Results: PM$_{2.5}$ exposure means were 266 and 102 μg/m$^3$ during the trial period in the control and intervention groups, respectively. During the trial, the stove intervention was associated with an odds ratio of 0.26 (95% confidence interval, 0.08–0.90) for ST-segment depression. We found similar associations with the before-and-after comparison. The intervention was not significantly associated with HRV. Conclusions: The stove intervention was associated with reduced occurrence of nonspecific ST-segment depression, suggesting that household wood smoke exposures affect ventricular repolarization and potentially cardiovascular health

Periodismo ambiental, y los problemas de salud de la comunidad de la parroquia san juan, cantón pueblo viejo de la provincia de los Ríos

El propósito del presente proyecto fue realizar una investigación sobre el PERIODISMO AMBIENTAL, Y LOS PROBLEMAS DE SALUD DE LA COMUNIDAD DE LA PARROQUIA SAN JUAN, CANTÓN PUEBLOVIEJO DE LA PROVINCIA DE LOS RÍOS. Durante este proceso el objetivo es diseñar estrategias por medio del periodismo ambiental que ayuden a disminuir los problemas de salud en los moradores de la parroquia San Juan. La metodología se enmarco en el paradigma cualitativo, es decir es de carácter descriptivo corresponde a los denominados proyectos de desarrollo que presentan una alternativa de solución al problema planteado. Se apoyó en las investigaciones: documental bibliográfica y de campo. La técnica utilizada fue la encuesta y la observación; para lo cual se elaboró el cuestionario considerando las variables indicadas y los objetivos de investigación

Distancia nasopupilar y su incidencia en la alteración de la agudeza visual en pacientes que acuden a Óptica Macías Machala- El Oro octubre-marzo 2020.

The present study has as its principle and purpose to demonstrate the nasopupillary distance and its incidence in the alteration of visual acuity in patients who go to Macias Optics, with discomfort in their lenses, which were performed by a non-professional person or prefabricated purchased or in certain cases performed by professionals in optometry but who did not take a correct nasopupillary distance. Throughout the study in Macias Optics, in the Machala canton, province of El Oro, optometric examinations were performed and in certain cases the reconstruction of the lens as in the progressive ones to determine in this way how the nasopupillary distance affected the visual acuity of the patient. The research project helped us to set ourselves objectives around the problem, demonstrate the problem through optometric procedures and check how the nasopupillary distance affected the visual quality of patients who use either progressive, bifocal, monofocal or have problems such as strabismus, eye prosthesis problems or some facial deformation and in some cases an incorrect nasopupillary distance is due to the incorrect assembly of the moons in the optical workshop. At the end of this investigation we leave as an informative triptych so that people who wear lenses are informed about the importance of nasopupillary distance at the time of prescription of their lens and always perform it with a professional in optometry.The present study has as its principle and purpose to demonstrate the nasopupillary distance and its incidence in the alteration of visual acuity in patients who go to Macias Optics, with discomfort in their lenses, which were performed by a non-professional person or prefabricated purchased or in certain cases performed by professionals in optometry but who did not take a correct nasopupillary distance. Throughout the study in Macias Optics, in the Machala canton, province of El Oro, optometric examinations were performed and in certain cases the reconstruction of the lens as in the progressive ones to determine in this way how the nasopupillary distance affected the visual acuity of the patient. The research project helped us to set ourselves objectives around the problem, demonstrate the problem through optometric procedures and check how the nasopupillary distance affected the visual quality of patients who use either progressive, bifocal, monofocal or have problems such as strabismus, eye prosthesis problems or some facial deformation and in some cases an incorrect nasopupillary distance is due to the incorrect assembly of the moons in the optical workshop. At the end of this investigation we leave as an informative triptych so that people who wear lenses are informed about the importance of nasopupillary distance at the time of prescription of their lens and always perform it with a professional in optometry.El presente estudio tiene como principio y finalidad demostrar la distancia nasopupilar y su incidencia en la alteración de la agudeza visual en pacientes que acuden a Óptica Macias, con molestia en sus lentes, los cuales fueron realizados por una persona no profesional o comprados prefabricados o en ciertos casos realizados por profesionales en optometría pero que no tomaron una correcta distancia nasopupilar. A lo largo del estudio en Óptica Macias, del cantón Machala, provincia de El Oro, se realizaron exámenes optométricos y en ciertos casos la reconstrucción de la lente como en los progresivos para determinar de esta manera como la distancia nasopupilar incidía en la agudeza visual del paciente. El proyecto de investigación, nos ayudó a plantearnos objetivos en torno a la problemática, demostrar la problemática mediante procedimientos optométricos y comprobar de qué manera la distancia nasopupilar incidía en la calidad visual de los pacientes que utilizan ya sean lentes progresivos, bifocales, monofocales o que tengan problemas como estrabismo, problemas de prótesis ocular o alguna deformación facial y en ciertos casos una incorrecta distancia nasopupilar se da por el incorrecto montaje de la lunas en el taller óptico. Al finalizar esta investigación dejamos como aporte un tríptico informativo para que las personas que utilizan lentes se informen sobre lo importante que es la distancia nasopupilar al momento de la prescripción de su lente y siempre realizarla con un profesional en optometría

Visceral Leishmaniasis Clinical Management in Endemic Districts of India, Nepal, and Bangladesh

Background. National VL Elimination Programs in India, Nepal and Bangladesh face challenges as home-based Miltefosine treatment is introduced. Objectives. To study constraints of VL management in endemic districts within context of national elimination programs before and after intervention. Methods. Ninety-two and 41 newly diagnosed VL patients were interviewed for clinical and provider experience in 2009 before and in 2010 after intervention (district training and improved supply of diagnostics and drugs). Providers were assessed for adherence to treatment guidelines. Facilities and doctor-patient consultations were observed to assess quality of care. Results. Miltefosine use increased from 33% to 59% except in Nepal where amphotericin was better available. Incorrect dosage and treatment interruptions were rare. Advice on potential side effects was uncommon but improved significantly in 2010. Physicians did not rule out pregnancy prior to starting Miltefosine. Fever measurement or spleen palpation was infrequently done in Bangladesh but improved after intervention (from 23% to 47%). Physician awareness of renal or liver toxicity as Miltefosine side effects was lower in Bangladesh. Bio-chemical monitoring was uncommon. Patient satisfaction with services remained low for ease of access or time provider spent with patient. Health facilities were better stocked with rK39 kits and Miltefosine in 2010

Route map for the discovery and pre-clinical development of new drugs and treatments for cutaneous leishmaniasis.

Although there have been significant advances in the treatment of visceral leishmaniasis (VL) and several novel compounds are currently in pre-clinical and clinical development for this manifestation of leishmaniasis, there have been limited advances in drug research and development (R & D) for cutaneous leishmaniasis (CL). Here we review the need for new treatments for CL, describe in vitro and in vivo assays, models and approaches taken over the past decade to establish a pathway for the discovery, and pre-clinical development of new drugs for CL. These recent advances include novel mouse models of infection using bioluminescent Leishmania, the introduction of PK/PD approaches to skin infection, and defined pre-clinical candidate profiles

Eye discomfort, headache and back pain among Mayan Guatemalan women taking part in a randomised stove intervention

Background: Indoor air pollution (IAP) from combustion of biomass fuels represents a global health problem, estimated to cause 1.6 million premature deaths annually. Aims: RESPIRE (Randomised Exposure Study of Pollution Indoors and Respiratory Effects) Guatemala is the first randomised controlled trial ever performed on health effects from solid fuel use. Its goal is to assess the effect of improved stoves (planchas) on exposure and health outcomes in a rural population reliant on wood fuel. Methods: Questions about symptoms were asked at baseline and periodically after the intervention, to an initial group of 504 women (259 randomly assigned to planchas (mean (standard deviation) age 27.4 (7.2) years) and 245 using traditional open fires (28.1 (7.1) years)). Levels of carbon monoxide (CO) in exhaled breath, a biomarker of recent exposure to air pollution from biomass combustion, were measured at each visit. In addition to reducing IAP levels, the plancha may also have a positive health effect by changing the working posture to an upright position. Results: A high prevalence of eye discomfort, headache and backache was found. The odds of having sore eyes and headache were substantially reduced in the plancha group relative to the group using open fires for the follow-up period (odds ratio (OR) 0.18, 95% confidence interval (CI) 0.11 to 0.29 and (OR) 0.63, 95% CI 0.42 to 0.94, respectively). Median CO in breath among women in the intervention trial was significantly lower than controls. Conclusion: In addition to reducing discomfort for women, tangible improvements in symptoms experienced by a substantial proportion of women may help to gain acceptance and wider use of planchas

Introducing single dose liposomal amphotericin B for the treatment of visceral leishmaniasis in rural bangladesh: feasibility and acceptance to patients and health staff.

Background. For the treatment of visceral leishmaniasis in Bangladesh, single dose liposomal amphotericin B (ambisome) is supposed to be the safest and most effective treatment. Specific needs for application and storage raise questions about feasibility of its implementation and acceptance by patients and health staff. Methods. The study was carried out in the most endemic district of Bangladesh. Study population includes patients treated with ambisome or miltefosine, hospital staff, and a director of the national visceral leishmaniasis program. Study methods include direct observation (subdistrict hospitals), open interviews (heath staff and program personnel), structured questionnaires, and focus group discussions (patients). Results. Politicalcommitment for ambisome is strong; the general hospital infrastructure favours implementation but further strengthening is required, particularly for drug storage below 25°C (refrigerators), back-up energy (fuel for generators), and supplies for ambisome administration (like 5% dextrose solution). Ambisome created high satisfaction in patients and hospital staff, less adverse events, and less income loss for patients compared to miltefosine. Conclusions. High political commitment, general capacities of subdistrict hospitals, and high acceptability favour the implementation of ambisome treatment in Bangladesh. However, strengthening of the infrastructure and uninterrupted supplies of essential accessories is mandatory before introducing sLAB in Bangladesh

Leishmaniasis, Impact and Therapeutic Needs

This chapter provides a general overview of the current situation of leishmaniasis, including the biology of the parasite, description of the main clinical forms and its geographical distribution and transmission factors. Special emphasis is placed on the recent outbreaks of leishmaniasis, as well as the role of human migration and invasiveness of the environment in influencing the distribution of the disease and its transmission. In this regard, the relevance of HIV–Leishmania coinfection and of asymptomatic carriers is pinpointed. A description of control strategies, including diagnostic methods, biomarkers and, of utmost relevance, treatment options, including drug combinations, are analysed from a geographical and pathological perspective. The importance of and efforts aimed at increasing drug accessibility for the population in highly endemic areas in order to curtail the incidence of leishmaniasis are described. Finally, the foreseeable evolution of the disease and the ways to tackle unfulfilled challenges are examined.</jats:p

Diseño de la red de distribución de agua potable a la aldea Santo Domingo Los Ocotes y diseño de mercado municipal, municipio de San Antonio la Paz, departamento de el Progreso.

El municipio de San Antonio La Paz, departamento de El Progreso, presenta un crecimiento poblacional notable, por el cual en el presente trabajo de investigación se diagnosticaron, analizaron y priorizaron necesidades de servicios básicos y de infraestructura, aportando soluciones de carácter técnico a dos de ellas, las cuales están contenidas en las fases de investigación y de servicio técnico profesional. A través de la investigación monográfica y de diagnóstico de necesidades de servicios básicos y de infraestructura de la población, se determinaron como prioritarias el diseño de la red de distribución de agua potable a la aldea Santo Domingo Los Ocotes y diseño del mercado municipal del municipio de San Antonio La Paz, departamento de El Progreso. Con este trabajo busca disminuir enfermedades intestinales por el estado en que se encuentra el agua que consumen