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ABSTRACT BACKGROUND: In Latin America, liver cancer is one of the top causes of cancer mortality. It is the fifth most common cause of death among malignant tumors in Mexico and is the leading cause in Hidalgo State (43.8% of the population living in poverty). OBJECTIVE: To conduct a correlational analysis on the main risk factors for liver cancer in Hidalgo State, Mexico, including municipal disaggregation and comparison with the national level. DESIGN AND SETTING: Cross-sectional, correlational, descriptive and comparative epidemiological study using Mexican governmental databases covering 1990-2019. METHODS: A comprehensive review of the databases of the General Directorate of Health Information (DGIS) was performed to analyze official death figures, hospital discharges and national and municipal population projections, using specific search criteria defined in the Global Burden of Disease classification, based on the risk factors for liver cancer. RESULTS: Liver cancer rates showed an evident rise in Hidalgo (183%), moving from 21st place in Mexico in 1990 to 9th place in 2019. This increase was correlated with alcoholism. An increasing trend for liver cancer deaths, of 133.89%, is projected for 2030. Females and the population over 60 years of age are more affected. There are some critical regions with liver cancer death rates twice the national rate or more. CONCLUSION: Targeted effective public health strategies should be structured by identifying, characterizing and regionalizing critical marginalized municipalities that are vulnerable to alcoholism and other risk factors for liver cancer. This approach may be helpful for other states in Mexico or similar countries.
ABSTRACT
RESUMEN La estratificación es una estrategia útil para obtener un diagnóstico objetivo de acuerdo con el cual planificar las actividades de prevención y control de las distintas enfermedades. El objetivo fundamental del trabajo fue identificar el comportamiento territorial del riesgo absoluto de enfermedades transmisibles seleccionadas en la provincia. Se realizó la estratificación epidemiológica de 5 enfermedades seleccionadas (EDA, IRA, Tuberculosis, Meningoencefalitis viral y Lepra), utilizando para ello el método de riesgo absoluto, que consistió en la formación de diferentes estratos de riesgo: bajo, mediano y alto. Durante el año 2018 se clasificó como municipio de alto riesgo Bayamo; la distribución por municipios según número de entidades en alto riesgo pudimos constatar lo siguiente: Bayamo (5); Manzanillo (3); Cauto Cristo, Yara, Campechuela, Media Luna, Niquero, Buey Arriba y Guisa (2 cada uno); Jiguaní, Pilón y Bartolomé Masó (1 cada uno); Río Cauto (no se encuentra en alto riesgo para ninguna entidad); según las enfermedades seleccionadas, la distribución de los municipios que se encontraban en alto riesgo fue la siguiente: IRA, Tuberculosis, Meningoencefalitis viral y Lepra (4 municipios en cada una), EDA (3 municipios). La conformación de los estratos de riesgo según la metodología escogida garantiza a los jefes de programa el diseño de estrategias de intervención para cada una de las enfermedades analizadas, según el comportamiento de los factores asociados a las mismas y completar el proceso de diagnóstico-intervención-evaluación.
ABSTRACT Stratification is a useful strategy to obtain an objective diagnosis according to which to plan prevention and control activities for different diseases. The main objective of the work was to identify the territorial behavior of the absolute risk of selected communicable diseases in the province. Epidemiological stratification of 5 selected diseases (EDA, ARI, Tuberculosis, Viral Meningoencephalitis and Leprosy) was carried out, using the absolute risk method, which consisted of the formation of different risk strata: low, medium and high. During 2018 Bayamo was classified as a high risk municipality; the distribution by municipalities according to the number of high risk entities we could verify the following: Bayamo (5); Manzanillo (3); Cauto Cristo, Yara, Campechuela, Media Luna, Niquero, Buey Arriba and Guisa (2 each); Jiguaní, Pilón and Bartolomé Masó (1 each); Río Cauto (it is not at high risk for any entity); According to the selected diseases, the distribution of the municipalities that were at high risk was as follows: ARF, Tuberculosis, Viral Meningoencephalitis and Leprosy (4 municipalities in each), EDA (3 municipalities). The conformation of the risk strata according to the chosen methodology guarantees the program managers the design of intervention strategies for each one of the analyzed diseases, according to the behavior of the factors associated with them and completing the diagnostic-intervention process- evaluation.
RESUMO A estratificação é uma estratégia útil para obter um diagnóstico objetivo de acordó com o qual planejar atividades de prevenção e controle para diferentes doenças. O principal objetivo do trabalho foi identificar o comportamento territorial do risco absoluto de doenças transmissíveis selecionadas na província. Foi realizada estratificação epidemiológica de 5 doenças selecionadas (AED, IRA, Tuberculose, Meningoencefalite Viral e Hanseníase), utilizando o método do risco absoluto, que consistiu na formação de diferentes estratos de risco: baixo, médio e alto. Em 2018, Bayamo foi classificado como um município de alto risco; a distribuição pelos municípios de acordó com o número de entidades de alto risco, pudemos verificar o seguinte: Bayamo (5); Manzanillo (3); Cauto Cristo, Yara, Campechuela, Mídia Luna, Niquero, Buey Arriba e Guisa (2 cada); Jiguaní, Pilón e Bartolomé Masó (1 cada); Rio Cauto (não corre alto risco para nenhuma entidade); De acordó com as doenças selecionadas, a distribuição dos municípios de alto risco foi a seguinte: IRA, Tuberculose, Meningoencefalite Viral e Hanseníase (4 municípios em cada), EDA (3 municípios). A conformação dos estratos de risco de acordó com a metodología escolhida garante aos gestores do programa o desenho de estratégias de intervenção para cada uma das doenças analisadas, de acordó com o comportamento dos fatores a eles associados e a conclusão do processo diagnóstico-intervenção. avaliação.
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The research was carried out to identify the possible constraints and development of strategic policies in expanding and improving cassava production and processing amongst cassava value chain actors in Cross River State, Nigeria. Data generated from the research the 150 cassava producers and processors (cassava value chain actors) through the use of well- define structured interview schedule was collated. The Multistage sampling procedure was adopted in selection of farmer respondents. The multivariate analytical technique was used in analyzing generated data employing the statistical application software of Genstat version 12. The eigen value, percentage variations and loading values contributing to low cassava output were used in achieving the objectives. The results showed that the major constraints to cassava production and processing were agronomic, technical/institutional and financial constraints. The major policy strategies should include a global, national, regional and community strategies all geared towards the evolution of industry analysis for improving cassava productivity in the study area through the development of the traditional farming systems, making good planting material accessible to farmers and on time and at lowest possible prices; the provision of credit facilities to the resource poor cassava –based farmers in the area with no collateral; the establishment of cassava product based cottage industries in the area for cassava value chain development; provision of adequate cassava processing equipment and the formation of cassava farmers’ multipurpose cooperative societies to enhance farmers’ access to benefit from world bank assisted programmes; have free access to basic information and production facilities. The study, therefore, recommended that cassava product based cottage industries be established in the study area in order to encourage both producers and processors in the value addition chain. This will also provide employment and likewise encourage the restive youths in the region to venture into agriculture as a business for economic returns, growth and development of the area. The identified constraints with the higher loading values for each of the principal multivariate should be strengthened using appropriate development strategies/policies to ensure food security and increased farm income for cassava – based farmers in the region.
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By the end of 2010, Latin America and the Caribbean (LAC) achieved 63% antiretroviral treatment (ART) coverage. Measures to control HIV drug resistance (HIVDR) at the countrylevel are recommended to maximize the efficacy and sustainability of ART programs. Since 2006, the Pan American Health Organization has supported implementation of the WorldHealth Organization (WHO) strategy for HIVDR prevention and assessment through regional capacity-building activities and direct technical cooperation in 30 LAC countries. By 2010, 85 sites in 19 countries reported early warning indicators, providing information about the extent of potential drivers of drug resistance at the ART site. In 2009, 41.9% of sites did notachieve the WHO target of 100% appropriate first-line prescriptions; 6.3% still experienced high rates (> 20%) of loss to follow-up, and 16.2% had low retention of patients (< 70%) on first-line prescriptions in the first year of treatment. Stock-outs of antiretroviral drugs occurred at 22.7% of sites. Haiti, Guyana, and the Mesoamerican region are planning and implementing WHO HIVDR monitoring surveys or threshold surveys. New HIVDR surveillance tools for concentrated epidemics would promote further scale-up. Extending the WHO HIVDR lab network in Latin America is key to strengthening regional lab capacity to support quality assuredHIVDR surveillance. The WHO HIVDR control strategy is feasible and can be rolled out in LAC. Integrating HIVDR activities in national HIV care and treatment plans is key to ensuring the sustainability of this strategy.
Hacia fines del 2010, América Latina y el Caribe lograron una cobertura de tratamiento antirretroviral de 63%. Se recomienda la ejecución de medidas para controlar la farmacorresistencia del VIH a nivel de país para potenciar al máximo la eficacia y la sostenibilidad de los programas de tratamiento antirretroviral. Desde el 2006, la Organización Panamericana de la Salud ha apoyado la aplicación de la estrategia de la Organización Mundial de la Salud (OMS) para la prevención y la evaluación de la farmacorresistenciadel VIH mediante actividades regionales de formación de capacidad y de cooperación técnica directa en 30 países de América Latina y el Caribe. En 2010, 85 centros en 19 países notificaron indicadores de alerta temprana y suministraron información acerca del alcance de los posibles impulsores de la farmacorresistencia enlos centros de tratamiento antirretroviral. En el 2009, 41,9% de los centros no lograron la meta de la OMS de 100% de prescripción de medicamentos de primera línea apropiados; 6,3% todavía tenían tasas elevadas (> 20%) de pérdida de seguimiento y 16,2% tenían una baja retención de pacientes (< 70%) en tratamiento con antirretrovirales deprimera línea en el primer año de tratamiento. Se registraron desabastecimientos de medicamentos antirretrovirales en 22,7% de los centros. Haiti, Guyana y la zona mesoamericana están planificando y ejecutando estudios de vigilancia de la farmacorresistencia del VIH o estudios del umbral de la OMS. Las nuevas herramientas para la vigilancia de la farmacorresistencia del VIH en las epidemias concentradas permitiránuna mejor vigilancia. La ampliación de la red de laboratorios de farmacorresistenciadel VIH acreditados por la OMS en América Latina es fundamental para el fortalecimientode la capacidad de los laboratorios regionales, a fin de de efectuar una vigilancia de la farmacorresistencia del VIH de calidad garantizada...