ABSTRACT
El estudio explora la relación entre el capital social y la información para la salud en agricultores de pequeña escala, en el contexto de su modo de vida. Tener información al respecto promovería la adopción de prácticas agrícolas con menos impacto en su salud debido a la reducción del uso de pesticidas de alta toxicidad. La investigación se desarrolló a través de un diseño longitudinal de medidas repetidas, en julio de 2007 (T1) y febrero de 2010 (T2), en 12 comunidades agrícolas de Ecuador (n=208). La información respecto a las prácticas de producción agrícola, entre ellas, el manejo integrado de plagas, y la toxicidad de los pesticidas constituyeron las variables dependientes. La participación en organizaciones, y la cohesión social, entre otros aspectos del capital social fueron tratados en el análisis como variables independientes. Los hallazgos sugieren que la información para la salud es transmitida por las estructuras del capital social en dependencia de su valor de uso en el marco del modo de producción agrícola.
The study explores the relationship between social capital and health information among small-scale farmers in the context of their livelihoods. Having such information could promote the use of agriculture practices with fewer health impacts by reducing farmers' exposure to highly toxic pesticides. We implemented a longitudinal study design with measurements in July 2007 (T1) and February 2010 (T2), within 12 agricultural communities in Ecuador (n=208 farmers). The dependent variables were based on information regarding agricultural production practices, among them: integrated pest management (IPM) and pesticide toxicity. Independent variables included participation in organizations and social cohesion, among other aspects of social capital. Results suggest that health information is disseminated through structures of social capital, depending on its value of use in the context of the mode of production in which small scale agriculture is developed.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Pesticides/toxicity , Pest Control/methods , Health Knowledge, Attitudes, Practice , Occupational Exposure/prevention & control , Consumer Health Information , Farmers , Rural Health , Longitudinal Studies , Agriculture/methods , Ecuador , Social CapitalABSTRACT
Objectives: The 2013 Lancet Maternal and Child Nutrition series identified rigorous evaluations of nutrition-sensitive agricultural interventions as a research priority. The Mama SASHA study in Western Kenya links delivery of vitamin A (VA) rich orange-flesh sweet potato (OFSP) vines to antenatal care to improve VA and nutritional status of pregnant and lactating women and their children. Methods: In addition to cross-sectional surveys in intervention and control communities at baseline and endline, the evaluation strategy includes a nested longitudinal study that follows women and their infants from pregnancy through 9 months postpartum. VA status of mothers and their infants is assessed during four visits using infection-adjusted plasma retinol binding protein and breast milk retinol (postpartum). Maternal and child iron and anemia status, anthropometry, dietary intakes, agricultural practices, health services uptake, household food security and program uptake are also measured Results: 505 eligible pregnant women, attending ANC at 4 control and 4 intervention facilities, were consented and enrolled. At enrollment overall prevalence of infection adjusted vitamin A deficiency was 21.8%. Women in control and intervention communities did not differ with respect to VA, iron, anemia or anthropometric status; household food security or dietary diversity scores; demographic characteristics; awareness of vitamin A; or consumption of vitamin A rich foods in the past 7 days. Only 10 women had consumed OFSP in the previous 7 days; all in intervention communities. Conclusions: The longitudinal study will contribute to rigorous impact evaluation of the OFSP intervention on maternal and child VA status and allow assessment of program impact pathways.
ABSTRACT
Objectives: Antenatal clinics (ANCs) are critical for improving maternal nutrition and health knowledge. The Mama SASHA project in western Kenya delivers an orange flesh sweet potato intervention (OFSP) through ANC to improve the vitamin A status of women and children less than 2 years. A nested cohort study following women from pregnancy to 9 months postpartum was designed as an evaluation strategy for the Mama SASHA project to assess the impact of the OFSP on the nutritional status and health of the pregnant mothers and their newborns. Methods: A survey was conducted at enrollment among 505 women, 10-24 weeks gestation attending first ANC clinic visit. Results: Of the 505 enrolled women 72% reported they had not yet received counseling from the nurse on exclusive breastfeeding for the first 6 months during the current pregnancy; over 90% reported not yet receiving counseling on when to initiate breast feeding, the importance of colostrum, when to initiate complementary feeding or how long to breast feed. 70 % of participants were multiparas (N=352) of whom 91% attended ANC during their previous pregnancy. Of these only 39% reported receiving information from the health facility on breast feeding during their previous pregnancy, 35% on how to eat during pregnancy, and 44% on how to feed young children. Conclusions: These findings highlight that ANC is lost opportunity in providing nutrition education and counseling. There is significant need to strengthen nutritional counseling both at the ANC as well as through community-based platforms such as pregnant and/or lactating clubs.
ABSTRACT
Objectives: Mothers' vitamin A (VA) status during pregnancy and lactation determine infants' VA levels. We estimated VA status during pregnancy and assessed its determinants using data on 505 pregnant women attending first antenatal care visit in Western Kenya. Methods: VA and iron status were assessed using plasma retinol binding protein (RBP), and ferritin and transferrin receptor, respectively, corrected for inflammation as measured by C-reactive protein (CRP>5 mg/L) and alpha-1-acid glycoprotein (>1 g/L)]. Anemia was assessed with Hemocue hemoglobinometer. Results: Only 34% of women had heard of VA, and 26% of them could not specify its importance. School was the most common source of VA information (68%), followed by health facility (19%). Mean (±SD) RBP was 1.44 (±0.35) μmol/l and the prevalence of VA deficiency (VAD) was 21.8%. Prevalence of inflammation (by CRP) was 24%. Anemia, but not iron deficiency, was the only factor associated with VAD (OR (CI): 1.68 (1.05, 2.71). Other potentially modifiable factors, including food insecurity, dietary diversity, awareness of VA, household or maternal consumption of VA rich foods, maternal MUAC and gestational age were not associated with VAD. Conclusions: The prevalence of VAD is high among pregnant women in Western Kenya and associated with anemia but not iron deficiency. Additional research is needed to understand the etiology of VAD in this population.
ABSTRACT
Objectives: Vitamin A (VA) deficiency (VAD) is a significant burden among children under-5- years-old and pregnant and lactating women in sub-Saharan Africa. We assessed the levels of VA and prevalence of VAD among children age 6-23 mo in 2 counties in western Kenya. Methods: Dry-Blood-Spot (DBS) samples were obtained from 1838 infants in a community-based cross-sectional survey. Laboratory analysis of retinol-binding protein (RBP) and C-reactive protein (CRP) was carried out using a rapid EIA to estimate VA and subclinical inflammation statuses, respectively. A validation of DBS as a matrix using 60 matching serum-DBS samples was carried out. Values were adjusted for influence of inflammation using CRP (CRP, >5 mg/L) and population prevalence of VAD (RBP<0.825 μmol/L, biologically equivalent to 0.70 μmol/L retinol) estimated. Results: Mean (geometric±SD) concentration of RBP was adequate (1.56±0.79 μmol/L) with inflammation-adjusted mean (±SE) prevalence of VAD being high (18.3±1.1%). The level of CRP was within normal range (1.06±4.95 mg/L) whilst 18.4±0.9% had subclinical inflammation (CRP>5 mg/L). VAD was not associated with child sex (Chi-squared, Χ2=0.42, P=0.51), child nutritional status (wasting (P=0.68) and stunting (P=0.91), reported child intake of VA capsule within the past 1 year (P=0.84), maternal VA nutritional knowledge (Χ2=0.10, P=0.80), or reported maternal intake of VA capsule within 2 months of delivery (P=0.27). Older children had a 10% increased risk of VAD. Conclusions: Prevalence of VAD in this sample of infants was high irrespective of intake of VA capsule or maternal VA nutrition knowledge. A sustainable food-based intervention in this area of western Kenya to combat VAD especially in pregnant women and infants is warranted.
ABSTRACT
Desde la segunda mitad de la década de los 80, el tiempo para quedar en embarazo se está utilizando en epidemiología ambiental para explorar efectos adversos sobre la fecundidad. En este artículo se revisa la racionalidad de los estudios de tiempo para quedar en embarazo y los principales elementos que se deben considerar en el diseño de un estudio de este tipo: tipo de estudio, poblaciones, tamaño de muestra, medición del evento, análisis estadístico y sesgos. Se sugieren algunas pautas por tener en cuenta para la realización de este tipo de estudios
Subject(s)
Female , Pregnancy , Fertility , Pregnancy Rate/trends , Survival Analysis , Epidemiologic Measurements , Epidemiologic Research DesignABSTRACT
Active surveillance of acute pesticide poisonings in a potato-growing region of highland Ecuador during 1991-1992 uncovered a rate of 171/100.000, due predominantly to occupational exposures to organophosphate and carbamate pesticides. Occupational exposure among agricultural workers was the most common reason for poisoning (32 male workers and 1 female worker, out of a total of 50 cases). Of these 33 cases, 28 of them reported pesticide application as the work task just prior to poisoning, with over 80 por cent citing the use of World Health Organization Hazard Category I pesticides. The suicide rate of 17.1/100.000 and the overall mortality rate of 20.5/100.000 that we found are among the highest reported anywhere in the world. At the exchange rates prevailing at that time, median costs associated with these poisonings were estimated as follows: public and social security health care direct costs of US$ 9.85/case; private health costs of US$ 8.33/case; and lost-time indirect costs of US$ 8.33/agricultural worker. Each one of those costs was over five times the daily agricultural wage, which was then about US$ 1.50. Further costing of pesticide poisonings should be carried out in other settings to provide appropriate information for decisions about pesticide use. In addition, integrated pest management should be further evaluated as an appropriate technology to reduce the economic burden of illness from pesticide poisonings in developing countries
Subject(s)
Humans , Male , Female , Adult , Pesticides , Poisoning , Economics , EcuadorABSTRACT
In 1984, work designed to expanded cholinesterase screening activities and improve the reporting of pesticide poisonings was initiated in Nicaragua's León-Chinandega region as a pilot project. Using a field tintometric method, 1,960 workers were screened for whole blood cholinesterase. The percentage with low cholinesterase activity levels (50 per cent or less) increased sharply during the peak spraying season. Airfield workers were most affected, though a noteworthy share of certain agricultural workers were also found to have low levels. Workers who used certain kinds of personal protective equipment were significantly less affected (p .05). In addition to these survey findings, six deaths and 396 pesticide-related poisonings were reported in the León-Chinandega region in 1984. This indicated a relatively high rate of 74.6 poisoning cases per 100,000 inhabitants, 84 per cent of them occurring in October-December. Ninety-four percent of the cases reported via questionnaires were occupationally related, small farms being the most affected. Menthyl parathion was implicated in roughly half of these cases , two-thirds of which were due to dermal exposure. Policy recommendations derived from the initial results reported here include reduction of methyl parathion use, installation of closed systems for safer aircraft loading, provisión and use of clothing that protects the skin against exposure