Journal Article > ResearchFull Text
Rev Panam Salud Publica. 2021 November 1; Volume 45; e147.; DOI:10.26633/RPSP.2021.147
Schuurmans J, Borgundvaag E, Finaldi P, Senat-Delva R, Desauguste F, et al.
Rev Panam Salud Publica. 2021 November 1; Volume 45; e147.; DOI:10.26633/RPSP.2021.147
OBJECTIVES
To determine the prevalence of maternal death, stillbirth and low birthweight in women with (pre-)eclampsia and complicated pregnancies or deliveries in Centre de Références des Urgences Obstétricales, an obstetric emergency hospital in Port-au-Prince, Haiti, and to identify the main risk factors for these adverse pregnancy outcomes.
METHODS
We conducted a retrospective cohort study of pregnant women admitted to Centre de Référence des Urgences Obstétricales between 2013 and 2018 using hospital records. Risk factors investigated were age group, type of pregnancy (singleton, multiple), type of delivery and use of antenatal care services.
RESULTS
A total of 31 509 women and 24 983 deliveries were included in the analysis. Among these, 204 (0.6%) maternal deaths (648 per 100 000 women giving birth), 1962 (7.9%) stillbirths and 11 008 (44.1%) low birthweight neonates were identified. Of all admissions, 10 991 (34.9%) were women with (pre-)eclampsia. Caesarean section significantly increased the risk of maternal death in the women with a complicated pregnancy and women with (pre-)eclampsia, but reduced the risk of stillbirth in such women. Not attending antenatal care was associated with a significantly higher risk of stillbirth (odds ratio (OR) 4.82; 95% confidence interval (CI) 3.55-6.55) and low birthweight (OR 1.40; 95% CI 1.05-1.86) for women with complicated pregnancies.
CONCLUSION
To prevent and treat pregnancy complications as early as possible, antenatal care attendance is crucial. Improving the quality of and access to antenatal care services and providing it free to all pregnant women in Haiti is recommended.
To determine the prevalence of maternal death, stillbirth and low birthweight in women with (pre-)eclampsia and complicated pregnancies or deliveries in Centre de Références des Urgences Obstétricales, an obstetric emergency hospital in Port-au-Prince, Haiti, and to identify the main risk factors for these adverse pregnancy outcomes.
METHODS
We conducted a retrospective cohort study of pregnant women admitted to Centre de Référence des Urgences Obstétricales between 2013 and 2018 using hospital records. Risk factors investigated were age group, type of pregnancy (singleton, multiple), type of delivery and use of antenatal care services.
RESULTS
A total of 31 509 women and 24 983 deliveries were included in the analysis. Among these, 204 (0.6%) maternal deaths (648 per 100 000 women giving birth), 1962 (7.9%) stillbirths and 11 008 (44.1%) low birthweight neonates were identified. Of all admissions, 10 991 (34.9%) were women with (pre-)eclampsia. Caesarean section significantly increased the risk of maternal death in the women with a complicated pregnancy and women with (pre-)eclampsia, but reduced the risk of stillbirth in such women. Not attending antenatal care was associated with a significantly higher risk of stillbirth (odds ratio (OR) 4.82; 95% confidence interval (CI) 3.55-6.55) and low birthweight (OR 1.40; 95% CI 1.05-1.86) for women with complicated pregnancies.
CONCLUSION
To prevent and treat pregnancy complications as early as possible, antenatal care attendance is crucial. Improving the quality of and access to antenatal care services and providing it free to all pregnant women in Haiti is recommended.
Journal Article > ResearchFull Text
Rev Panam Salud Publica. 2016 January 1
Romero BM, Joya MC, Aviles MAG, Navarro RM, Decroo T, et al.
Rev Panam Salud Publica. 2016 January 1
Objective To assess trends in 1) tuberculosis (TB) case notification by year and 2) cumulative treatment outcomes (stratified by type of TB) in relation to the proportion of indigenous population in municipalities in a countrywide study in Mexico for the period 2009-2013. Methods This ecological operational research study used municipality data for the five-year study period. As no single identifier variable existed for indigenous persons, municipalities were categorized into one of three groups based on the proportion of their indigenous population (< 25% ("low"), ≥ 25% to < 50% ("medium"), and ≥ 50% ("high")). TB case notification rates (CNRs) were standardized to a 100 000 population. Result For the first four years of the study period (2009 through 2012), for all new TB cases reported nationally, the municipalities with a high proportion of indigenous people (≥ 50%) had the highest CNRs (ranging from 20.8 to 17.7 over that period). In 2013, however, the CNR in the high proportion municipalities dropped to 16.7, lower than the CNR for that year in the municipalities with a medium proportion of indigenous people (P < 0.001). In the municipalities with low and medium proportions of indigenous people, the CNR hovered between 15.1 and 17.3 over the study period. For the 96 195 new TB cases reported over the study period, the treatment success rate ranged between 81% and 84% for all three municipality groups. For previously treated TB cases, CNRs ranged between 1.0 and 1.7 for all three groups over the study period. The average proportion of previously treated TB cases (of all TB cases) was 9% for the three groups in 2009 but dropped to 8% by 2013. The cumulative treatment success rate for all previously treated cases (a total of 8 763 for the study period) was 64% in municipalities with a low proportion of indigenous people, 61% in those with a medium proportion, and 69% in those with a high proportion. Conclusions Despite the slightly higher CNR in municipalities with predominantly indigenous populations, there were no stark differences in TB burden across the three municipality groups. The authors were unable to confirm if the relatively low CNRs found in this study were a reflection of good TB program performance or if TB cases were being missed. A survey of TB prevalence in indigenous people, with individualized data, is needed to inform targeted TB control strategies for this group in Mexico.
Journal Article > Research
Rev Panam Salud Publica. 2023 April 19; Volume 47; 1.; DOI:10.26633/RPSP.2023.48
Bastidas-Caldes C, Guerrero-Freire S, Ortuño-Gutiérrez N, Sunyoto T, Gomes-Dias CA, et al.
Rev Panam Salud Publica. 2023 April 19; Volume 47; 1.; DOI:10.26633/RPSP.2023.48
OBJECTIVE
Colistin is an antibiotic of last resort for treating serious Gram-negative bacterial infections. However, the misuse of colistin, especially as an animal growth promoter, has contributed to increasing antimicrobial resistance, mediated mainly through plasmid transfer of the mcr-1 gene. This study assessed the prevalence of phenotypic and molecular colistin resistance in Escherichia coli and Klebsiella pneumoniae in Ecuador in healthy humans and their chickens and pigs.
METHODS
Fecal samples were collected from humans and their chickens and pigs in two rural coastal and Amazon regions between April and August 2020. Gram-negative bacteria were isolated and identified using conventional techniques. Phenotypic resistance was determined using the broth microdilution technique, and the mcr-1 gene was detected using conventional polymerase chain reaction.
RESULTS
A total of 438 fecal samples were obtained from 137 humans, 147 pigs and 154 chickens. The prevalence of E. coli isolates was 86.3% (378/438) and K. pneumoniae, 37.4% (164/438). Overall, the mcr-1 gene was found in 90% (340/378) of E. coli isolates, with higher prevalences found in isolates from coastal regions (96.5%, 191/198), humans (95.6%, 111/116) and chickens (91.8%, 123/134); for K. pneumoniae, the gene was found in 19.5% (32/164) of isolates, with equal distribution between regions and hosts. Only four isolates, two E. coli and two K. pneumoniae, showed phenotypic resistance: mcr-1 was present in both E. coli strains but absent in the K. pneumoniae strains.
CONCLUSIONS
Despite a low prevalence of phenotypic resistance to colistin, the high prevalence of the mcr-1 gene in E. coli is of concern. Ecuador’s ban on using colistin in animal husbandry must be enforced, and continual monitoring of the situation should be implemented.
Colistin is an antibiotic of last resort for treating serious Gram-negative bacterial infections. However, the misuse of colistin, especially as an animal growth promoter, has contributed to increasing antimicrobial resistance, mediated mainly through plasmid transfer of the mcr-1 gene. This study assessed the prevalence of phenotypic and molecular colistin resistance in Escherichia coli and Klebsiella pneumoniae in Ecuador in healthy humans and their chickens and pigs.
METHODS
Fecal samples were collected from humans and their chickens and pigs in two rural coastal and Amazon regions between April and August 2020. Gram-negative bacteria were isolated and identified using conventional techniques. Phenotypic resistance was determined using the broth microdilution technique, and the mcr-1 gene was detected using conventional polymerase chain reaction.
RESULTS
A total of 438 fecal samples were obtained from 137 humans, 147 pigs and 154 chickens. The prevalence of E. coli isolates was 86.3% (378/438) and K. pneumoniae, 37.4% (164/438). Overall, the mcr-1 gene was found in 90% (340/378) of E. coli isolates, with higher prevalences found in isolates from coastal regions (96.5%, 191/198), humans (95.6%, 111/116) and chickens (91.8%, 123/134); for K. pneumoniae, the gene was found in 19.5% (32/164) of isolates, with equal distribution between regions and hosts. Only four isolates, two E. coli and two K. pneumoniae, showed phenotypic resistance: mcr-1 was present in both E. coli strains but absent in the K. pneumoniae strains.
CONCLUSIONS
Despite a low prevalence of phenotypic resistance to colistin, the high prevalence of the mcr-1 gene in E. coli is of concern. Ecuador’s ban on using colistin in animal husbandry must be enforced, and continual monitoring of the situation should be implemented.
Journal Article > Case Report/SeriesFull Text
Rev Panam Salud Publica. 2023 March 10; Volume 47; e41.; DOI:10.26633/RPSP.2023.41
Lam CG, Vasquez L, Loggetto P, Fuentes-Alabi S, Gonzalez Ruiz A, et al.
Rev Panam Salud Publica. 2023 March 10; Volume 47; e41.; DOI:10.26633/RPSP.2023.41
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Working with PAHO/WHO to prioritize childhood cancer in the context of systems strengthening is central to St. Jude Children's Research Hospital (SJCRH)’s role as WHO Collaborating Centre for Childhood Cancer. This manuscript focuses on how SJCRH and PAHO/WHO have partnered to apply C5 (Country Collaboration for Childhood Cancer Control) to define and implement priority actions regionally, strengthening Ministry programs for childhood cancer, while implementing the Global Initiative for Childhood Cancer since 2018. Using C5, a tool developed by SJCRH, PAHO/WHO and SJCRH co-hosted regional/national workshops engaging authorities, clinicians and other stakeholders across 10 countries to map health systems needs and prioritize strategic activities (spanning Central America, Dominican Republic, Haiti, Brazil and Uruguay). SJCRH provided English/Spanish/Portuguese C5 versions/templates for analysis/prioritization exercises, and worked with PAHO/WHO and country teams to implement C5, analyze findings, and develop outputs. In an eight-country regional workshop, countries defined priorities within national/regional initiatives and ranked their value and political will, incorporating country-specific surveys and stakeholder dialogues. Each country prioritized one strategic activity for 2022-2023, exchanged insights via storytelling, and disseminated and applied results to inform country-specific and regional action plans. National workshops analyses have been incorporated into cancer control planning activities and collaborative work regionally. Implementation success factors include engaging actors beyond the clinic, enabling flexibility, and focusing on co-design with stakeholders. Joint implementation of C5 catalyzed prioritization and accelerated strategic activities to improve policies, capacity, and quality of care for children in the Americas, supporting Ministries to integrate childhood cancer interventions as part of systems strengthening.
Journal Article > CommentaryFull Text
Rev Panam Salud Publica. 2023 April 19; Volume 47; e8.; DOI:10.26633/RPSP.2023.8
Calero-Cáceres W, Ortuño-Gutiérrez N, Sunyoto T, Gomes-Dias CA, Bastidas-Caldes C, et al.
Rev Panam Salud Publica. 2023 April 19; Volume 47; e8.; DOI:10.26633/RPSP.2023.8
English
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Português
Whole-genome sequencing is becoming the gold standard for pathogen characterization and offers considerable advantages for understanding the evolution and dissemination of new determinants of antimicrobial resistance. Despite the benefits of whole-genome sequencing for pathogen characterization, implementation costs and lack of expertise may limit its use by public health laboratories. This article reviews the advantages of whole-genome sequencing for pathogen characterization and the current status of the use of whole-genome sequencing for antimicrobial resistance surveillance in Ecuador. A roadmap is suggested for including whole-genome sequencing for pathogen characterization based on the needs of the health reference institutions through alliances with Ecuadorian universities. Establishing a partnership between public health institutions and academia would be valuable for clinicians, policy-makers, and epidemiologists who could then take reasonable measures in those areas and establish a basis for adapting One Health strategies to tackle antimicrobial resistance in Ecuador.
Journal Article > ResearchFull Text
Rev Panam Salud Publica. 2016 January 1
Ayala G, Garay J, Aragon M, Decroo T, Zachariah R
Rev Panam Salud Publica. 2016 January 1
Objective To describe trends in tuberculosis (TB) notification and treatment outcomes in 25 prisons in El Salvador from 2009-2014 and to determine if a set of interventions introduced in 2011 affected TB case finding and management. Methods This was operational research that utilized a retrospective cohort study of program data from 2009-2014. The package of interventions introduced in 2011 provides staff training, engages inmates in TB case finding, and offers diagnosis through mobile X-ray and Xpert® MTB/RIF. Results Case notification rates per 100 000 prisoners tripled, from 532 in 2009 to 1 688 in 2014-about 50 times that of the general population. Individual data were analyzed for 1 177 patients who started TB treatment, among whom 1 056 (89.7%) cases were bacteriologically-confirmed: 966 (92%) were diagnosed through smear microscopy; 42 (4%) with Xpert® MTB/RIF; and 48 (5%) through cultures. Cumulative treatment success and cure rates were over 95% and 90%, respectively. However, among 113 patients with previously-treated TB, drug sensitivity testing results were available for only 53 (47.%). One patient was diagnosed with mono-drug resistant TB. Conclusions These findings show that TB notification increased exponentially since introduction of the intervention package and that excellent treatment outcomes were sustained. Both are of vital relevance to countries striving for TB elimination. Notification might be improved further by providing systematic TB screening upon prison entry and periodically thereafter. Furthermore, previously-treated TB patients should receive prioritized screening for drug resistance.