Prevalence and predictor stunting, wasting and underweight in Timor Leste children under five years: An analysis of DHS data in 2016

Stunting, wasting, and being underweight are indicators of malnutrition in a country. The high status reflects the poor nutritional and health status of children under five. We analyzed data from the Demographic and Health Survey conducted in Timor Leste from 2009 to 2016 to identify the prevalence and predictor stunting, wasting, and underweight. The variables analyzed were the mother's education, mother's age, mother BMI, mother's height, number of ANC visits, birth weight, sex of a child, sex of head household, type of residence, wealth index, toilet facility, source of drinking water and province. The sample in this study was 3,723 toddlers. Prevalence of stunting (44.4%), underweight (37.5%) and wasting (25.3%). In the bivariate analysis, the variables statistically significantly associated with stunting, underweight, and wasting was mother's education, sex of a child, type of residence, wealth index, and province. Improving the nutritional status of children in Timor Leste requires various nutrition and health interventions

Avaliação da armadilha ovitrampa iscada com atraente natural para o monitoramento de Aedes spp. em Dili, capital do Timor-Leste / Evaluation of the baited ovitrap with natural attractant for monitoring Aedes spp. in Dili, capital of East Timor

Resumo A dengue ocorre no Timor-Leste desde 2005, porém não existe um programa de monitoramento e controle do "Aedes aegypti". O objetivo deste estudo foi de avaliar a armadilha ovitrampa iscada com atraente natural como uma possível ferramenta para monitorar o vetor das arboviroses: Dengue (DENV), Chikungunya (CHIKV) e Zika (ZIKV). O estudo foi realizado na cidade de Dili, capital do Timor-Leste, entre as semanas epidemiológicas 32 (02/08) a 48 (02/12) de 2016. Foram instaladas 70 armadilhas Ovitrampa, em residências de 15 sucos (ruas), de quatro Postos Administrativos (bairros) da cidade. Para as analises dos dados utilizou-se os indicadores entomológicos: Índice de Positividade de Ovitrampa (IPO), Índice de Densidade Vetorial (IDV) e Índice de Densidade de Ovos (IDO). Durante o experimento foram coletados 158.904 ovos de Aedes spp.. O IPO demonstrou que todas as áreas tiveram 98% a 100% de armadilhas contendo ovos de Aedes spp.. Os indicadores IDO e IPO apresentaram correlações positivas e significativa com a temperatura. A defasagem de duas e três semanas para precipitação indicou correlação positiva significativa para IDV e IDO. Portanto, a armadilha ovitrampa é uma ferramenta que pode integrar as ações de um programa de monitoramento e controle de Aedes spp. no Timor-Leste.

Knowledge, Attitudes, and Practices Regarding Tuberculosis in Timor-Leste: Results From the Demographic and Health Survey 2016 / 예방의학회지

OBJECTIVES: The aim of this study was to assess knowledge, attitudes, and practices regarding tuberculosis (TB) in the general population in Timor-Leste. METHODS: In the nationally representative cross-sectional 2016 Timor-Leste Demographic and Health Survey, 4622 men (aged 15-59 years) and 12 607 women (aged 15-49 years) were randomly selected using stratified multistage sampling and interviewed. RESULTS: Overall, 66.9% of men and 62.8% of women were aware of TB, 4.4% of men and 12.6% of women had TB courtesy stigma, and 83.3% of men and 88.6% of women reported intention to receive TB treatment. The mean±standard deviation overall TB knowledge score was 3.9±2.0 (out of 8) among men and 3.0±1.8 among women. In a multivariable linear regression analysis, among both men and women, older age, higher education, rural residence, and sources of TB information (family/friends, school/workplace, health care provider, Internet, television, and newspaper) were associated with higher TB knowledge scores. In addition, among women, higher wealth status and having heard about TB from the radio were associated with higher TB knowledge scores. Negative associations with TB courtesy stigma were found for urban residence and having heard about TB from family or friends among men, and for older age, higher TB knowledge, and TB information sources (family/friends and school/workplace) among women. Among both men and women, higher TB knowledge scores and having heard of TB from a health care provider were associated with intention to receive TB treatment. CONCLUSIONS: This study identified socio-demographic risk factors for deficiences in population-based TB knowledge in Timor-Leste; these findings should be considered when designing TB communication, prevention, and control strategies.

Cardiovascular Disease Epidemiology in Portuguese-Speaking Countries: data from the Global Burden of Disease, 1990 to 2016 / Epidemiologia das Doenças Cardiovasculares em Países de Língua Portuguesa: Dados do "Global Burden of Disease", 1990 a 2016

Abstract Background: Portuguese-speaking countries (PSC) share the influence of the Portuguese culture but have socioeconomic development patterns that differ from that of Portugal. Objective: To describe trends in cardiovascular disease (CVD) morbidity and mortality in the PSC between 1990 and 2016, stratified by sex, and their association with the respective sociodemographic indexes (SDI). Methods: This study used the Global Burden of Disease (GBD) 2016 data and methodology. Data collection followed international standards for death certification, through information systems on vital statistics and mortality surveillance, surveys, and hospital registries. Techniques were used to standardize causes of death by the direct method, as were corrections for underreporting of deaths and garbage codes. To determine the number of deaths due to each cause, the CODEm (Cause of Death Ensemble Model) algorithm was applied. Disability-adjusted life years (DALYs) and SDI (income per capita, educational attainment and total fertility rate) were estimated for each country. A p-value <0.05 was considered significant. Results: There are large differences, mainly related to socioeconomic conditions, in the relative impact of CVD burden in PSC. Among CVD, ischemic heart disease was the leading cause of death in all PSC in 2016, except for Mozambique and Sao Tome and Principe, where cerebrovascular diseases have supplanted it. The most relevant attributable risk factors for CVD among all PSC are hypertension and dietary factors. Conclusion: Collaboration among PSC may allow successful experiences in combating CVD to be shared between those countries.

Resumo Fundamento: Os países de língua portuguesa (PLP) partilham a influência da cultura portuguesa com desenvolvimento socioeconômico diverso de Portugal. Objetivo: Descrever as tendências de morbidade e mortalidade por doenças cardiovasculares (DCV) nos PLP, entre 1990 e 2016, estratificadas por sexo, e sua associação com os respectivos índices sociodemográficos (SDI). Métodos: O estudo utilizou dados e metodologia do Global Burden of Disease (GBD) 2016. As informações seguiram padrões internacionais de certificação de óbito, através de sistemas de informação sobre estatísticas vitais e vigilância da mortalidade, pesquisas e registros hospitalares. Empregaram-se técnicas para padronização das causas de morte pelo método direto, e correções para sub-registro dos óbitos e garbage codes. Para determinar o número de mortes por cada causa, aplicou-se o algoritmo CODEm (Modelagem Agrupada de Causas de Morte). Estimaram-se os anos saudáveis de vida perdidos (DALYs) e o SDI (renda per capita, nível de escolaridade e taxa de fertilidade total) para cada país. Resultados: Existem grandes diferenças na importância relativa da carga de DCV nos PLP relacionadas principalmente às condições socioeconômicas. Entre as DCV, a doença isquêmica do coração foi a principal causa de morte nos PLP em 2016, com exceção de Moçambique e São Tomé e Príncipe, onde as doenças cerebrovasculares a suplantaram. Os fatores de risco atribuíveis mais relevantes para as DCV entre os PLP foram a hipertensão arterial e os fatores dietéticos. Um valor de p < 0,05 foi considerado significativo. Conclusão: A colaboração entre os PLP poderá permitir que experiências exitosas no combate às DCV sejam compartilhadas entre esses países.

Factores de riesgo de la tuberculosis pulmonar en pacientes timorenses / Risk factors of lung tuberculosis in patients from East Timor

Se realizó un estudio observacional y analítico, de casos y controles, pareados por sexo y edad, de 126 pacientes ingresados en la sala de aislamiento del Hospital Nacional Guido Valadares, en Dili, Timor Oriental, durante el año 2015, con vistas a determinar los factores de riesgo asociados a la tuberculosis pulmonar en ellos. El grupo de casos, de 42 integrantes, incluyó a los recién diagnosticados con tuberculosis y a los que presentaron recaída, fallo terapéutico, resistencia a múltiples fármacos, así como padecimiento previo de la afección con secuelas (bronquiectasias concomitantes con infección, hemoptisis); en tanto, el grupo de controles lo conformaron 84 pacientes con entidades respiratorias no tuberculosas. De las variables analizadas, la presencia de alcoholismo, la desnutrición, el contacto íntimo con pacientes cuya baciloscopia dio positiva y el ser recluso o ex-recluso, fueron los factores de riesgo de mayor asociación causal y estadística en el contagio de la enfermedad y constituyeron los resultados más relevantes de esta investigación

An observational, analytic and cases-controls study of 126 patients paired by sex and age, admitted to the isolation room of Guido Valadares National Hospital, in Dili, East Timor, was carried out during 2015, aimed at determining the risk factors associated with lung tuberculosis in them. The cases group with 42 members, included those recently diagnosed with tuberculosis and those that presented relapse, therapeutic failure, resistance to multiple drugs, as well as previous suffering of the disorder with sequelae (concomitant bronchiectasis with infection, hemoptysis); as long as, the control group was conformed by 84 patients with non tuberculous breathing entities. Of the analyzed variables, the presence of alcoholism, malnutrition, intimate contact with patients whose baciloscopia was positive and being prisoner or former-prisoner, were the risk factors of more causal and statistical association in the infection of the disease and constituted the most outstanding results in this investigation

Uso de mucosa prepucial en la estenosis uretral e hipospadia, Hospital Nacional Guido Valadares de Timor Oriental / Uso de mucosa prepucial na estenose e hipospadia da uretra, Hospital Nacional Guido Valadares de Timor Oriental / Using preputial mucosa in urethral stricture and hypospadias, at National Hospital Guido Valadares East-Timor

Se presentó un caso intervenido en el servicio de Urología del Hospital Nacional "Guido Valadares" de Timor Oriental, con diagnóstico de retención completa de orina, insuficiencia renal aguda obstructiva posrrenal, hidronefrosis bilateral y estenosis uretral e hipospadia, con el objetivo de demostrar el uso de la mucosa prepucial para las hipospadias que concomitan con estenosis uretral. La conducta quirúrgica consistió en una uretroplastia con mucosa prepucial. Se logró la reconstrucción total de la uretra afectada, con buenos resultados finales estéticos y funcionales. El uso de la mucosa oral fue de gran utilidad en el manejo del paciente(AU)

A case was presented in the Department of Urology of Guido Valadares National Hospital in East Timor, diagnosed with complete retention of urine, post renal, obstructive and acute renal failure, bilateral hydronephrosis and urethral stricture and hypospadias, in order to demonstrate the use of prepucial mucosa for hypospadias that concomitan with urethral stricture. The surgical treatment consisted urethroplasty with preputial mucosa. Total reconstruction of the affected urethra was done with good aesthetic and functional outcomes. The use of oral mucosa was very useful in patient management(AU)

Foi apresentado um caso no Departamento de Urologia do Hospital Nacional "Guido Valadares" de Timor Oriental, com diagnóstico de retenção urinária completa, insuficiência renal aguda obstrutiva pós-renal, hidronefrose bilateral e estenose e hipospádia uretral, para demonstrar a utilização da mucosa prepucial para hipospádia que coincide com estenose uretral. O procedimento cirúrgico consistiu em uma uretroplastia com mucosa prepucial. A reconstrução total da uretra afetada foi alcançada, com bons resultados estéticos e funcionais finais. O uso da mucosa oral foi muito útil no manejo do paciente(AU)

Imaginar, contar e descrever as populações coloniais portuguesas, 1776-1875: notas de uma pesquisa em curso / Envisioning, counting and describing Portuguese colonial populations, 1776-1875: notes from research in progress / Imaginar, contar y describir las poblaciones coloniales portuguesas, 1776-1875: notas de una investigación en curso

Em finais do século XVIII a Coroa portuguesa implementou um sistema regular de colecta de dados demográficos nos seus domínios ultramarinos. A partir do modelo definido, cada governador deveria enviar anualmente o numeramento da sua jurisdição. O Arquivo Histórico Ultramarino, em Lisboa, conserva mais de um milhar de tabelas estatísticas provenientes desde o Brasil até Macau. Esta documentação abre importantes horizontes para a história demográfica, social e colonial, apesar de relativamente negligenciada por historiadores e demógrafos. A partir destas fontes o projecto estuda a demografia e os processos estatísticos na construção do império português entre 1776 e 1875. Adiante discutimos o contexto desta investigação, com ênfase nas características da informação, variáveis e suas potencialidades, bem como uma agenda de investigação.

By the end of the 18th century, the Portuguese Crown implemented a system for the gathering of demographic data in its overseas domains. In accordance with the model defined, each governor was to send a population count for the area under his jurisdiction annually. At the Arquivo Histórico Ultramarino, in Lisbon, there are over a thousand "population tables" from Brazil to Macao. This documentation significantly broadens horizons for demographic, social and colonial history, despite having been relatively neglected by historians and demographers. These sources allow for the study of demography and statistical processes during the construction of the Portuguese Empire between 1776 and 1875. The context of this research, with an emphasis on the particular characteristics of the

A finales del siglo XVIII la Corona portuguesa puso en marcha un sistema regulado de recolección de datos demográficos en sus territorios ultramarinos. A partir del modelo establecido, cada gobernador debía enviar anualmente la numeración de su jurisdicción. El Archivo Histórico Ultramarino, en Lisboa, conserva más de un millar de tablas estadísticas que provienen de lugares como Brasil o Macao. Esta documentación abre importantes horizontes para la historia demográfica, social y colonial, pese a la escasa atención que han mostrado historiadores y demógrafos por ella. Con base en estas fuentes, el proyecto estudia la demografía y los procesos estadísticos en la construcción del imperio portugués entre 1776 y 1875. Analiza además el contexto de esta investigación, con énfasis en las características de la información, las variables y su potencial, junto con un plan de investigación.

Caracterización clinicoepidemiológica de pacientes con enfermedad hipertensiva gravídica en el subdistrito Venilale de Timor Oriental / Clinical epidemiological characterization of patients with gestational hipertensive disease in the Venilale subdistrict of Timor Oriental

Se realizó un estudio observacional, de corte transversal, de 83 gestantes con enfermedad hipertensiva gravídica, residentes en el subdistrito Venilale, de Timor Oriental, desde mayo de 2012 hasta igual mes de 2013, con vistas a caracterizarles según variables clinicoepidemiológicas de interés. En la serie se halló una prevalencia de la enfermedad de 29,1 por ciento del total de mujeres en edad fértil. Entre los resultados principales predominaron las familias grandes (60,2 por ciento) y ampliadas (68,7 por ciento), según tamaño y ontogénesis, respectivamente. Como factores de riesgo se identificaron: la edad materna menor de 20 años, la nuliparidad, el bajo peso materno y las condiciones socioeconómicas regulares; asimismo, la preeclampsia no agravada resultó ser la más frecuente. La prevalencia de dicha enfermedad estuvo asociada a factores sociales y epidemiológicos bien definidos.

An observational, cross-sectional study, of 83 pregnant women with gestational hipertensive disease, residents in the Venilale subdistrict, in Timor Oriental was carried out, from May, 2012 to the same month in 2013, aimed at characterizing them according to clinical epidemiological variables of interest. In the series a prevalence of 29.1 percent of the disease in the total of women in fertility age was found. Among the main results the numerous (60.2 percent) and enlarged families (68.7 percent) prevailed, according to size and ontogenesis, respectively. As risk factors were identified: the maternal age younger than 20 years, nonparity, maternal low weight and regular socioeconomic conditions; also, the non worsened pre-eclampsia was the most frequent. The prevalence of this disease was associated to very defined social and epidemiological factors.

Cuerpo extraño intraorbitario de gran tamaño en un niño / Intraorbitary foreign body of considerable size in a child

Se describe el caso clínico de un niño de 11 años de edad, procedente de un distrito de Timor Oriental, que recibió un trauma en el ojo derecho al caer de un árbol y enclavársele un fragmento de una rama en la órbita de ese ojo, por lo cual fue trasladado de urgencia al Hospital Nacional "Guido Valadares" de Dili, donde fue ingresado y se decidió operar inmediatamente para extraer el cuerpo extraño intraorbitario -- cuya longitud era de 10,5 cm --. El paciente evolucionó con buen estado general y una agudeza visual de 6/18 en el ojo dañado, de modo que al quinto día se le dio el alta hospitalaria.

The case report of a 11 years child is described, coming from a Timor Oriental district who suffered from a trauma in the right eye when falling from a tree and a fragment of branch was introduced in the orbit of that eye, reason why he was transferred as an emergency to "Guido Valadares" of Dili National Hospital, where he was admitted and it was decided to operate immediately to extract the strange intraorbitary body--which measured 10,5 cm--. The patient had a good general clinical course and a visual acuity of 6/18 in the damaged eye, so by the fifth day he was discharged from the hospital.

Growth rate and ring width variability of teak, Tectona grandis (Verbenaceae) in an unmanaged forest in East Timor

Teak (Tectona grandis) is one of the most valuable timbers in international trade and an important species for tropical forestry. Teak is found on the island of East Timor but no information is available on teak growth from this region. A pure stand planted in 1940-50 in the North of East Timor and left unmanaged was studied. Fifteen trees were sampled in October-November 2003 and stem discs taken at three height levels of its height (1.7m, 9.5m and 18.7m), and cores were collected at DBH. Transverse surfaces of the discs and cores were polished for ring identification. Core cross sections were first digitized and disc cross sections were observed under the microscope. Three randomly selected radii were analyzed in each disc. Ring width measurement and ring counting were done using image analysis software. The distinction between heartwood and sapwood was performed macroscopically by colour difference, and heartwood radius and sapwood width were measured. The relationship between stem and heartwood radius was studied for each disc and heartwood percentage by radius was determined. Radial ring width curves are presented for the different axial positions within the stem, and ring width variability was analyzed. Growth rates were calculated and age-radius relationships were estimated using cumulative growth curves. Growth rings were large and well defined in the juvenile phase, reflecting the specie’s fast-growing character. The year-to-year variation of ring width showed a similar pattern among trees. Mean ring width ranged between 4.3-7.3mm for the first 20 years and 3.3-5.1mm for 30 to 45 years. Pith eccentricity was evident in the lower part of the stem and ring wedging occurred. On average, heartwood represented 84% of the radius and sapwood contained 6 to 11 rings. The age-related variation of ring width and the occurrence in the lower part of the tree stems of eccentricity and wedging rings, highlights the importance of appropriate stand management, particularly regarding basal density distribution over time, whenever optimized timber production is envisaged.

La madera de teca (Tectona grandis L.f.) es una de las más valiosas en el comercio internacional y una especie importante para la silvicultura tropical. La teca se encuentra en la isla de Timor Leste, pero no existe información disponible sobre su crecimiento en esta región. Se estudió una plantación pura no manejada que fue establecida entre 1940 y 1950 en el Norte de Timor Leste. Entre Octubre- Noviembre 2003 se cosecharon 15 árboles y al tronco se les extrajeron discos a tres niveles de altura (1.7m, 9.5m y 18.7 m), y se recolectaron núcleos a la altura del pecho (DAP). El conteo y la medición de los anillos se realizaron mediante el software de análisis de imagen. La distinción entre el duramen y la albura se realizó macroscópicamente por la diferencia de color, y se midieron el radio del duramen y el ancho de la albura. Para cada disco se estudió la relación entre el tallo y radio del duramen y el porcentaje del duramen. Las curvas de variación del ancho de los anillos se presentan para las diferentes posiciones axiales dentro del tronco y se analizó la variabilidad del ancho de los anillos. Las tasas de crecimiento fueron calculadas y las relaciones de radio con la edad se calcularon usando las curvas de crecimiento acumulado. Los anillos de crecimiento eran grandes y bien definidos en la fase juvenil, lo que refleja el carácter de crecimiento rápido de esta especie. La variación en la anchura de los anillos año a año mostró un patrón similar entre los árboles. La anchura media del anillo osciló entre 4.3-7.3mm para los primeros 20 años y 3.3-5.1mm para los de 30 a 45 años. La excentricidad de la médula fue evidente en la parte inferior del tallo y se observó la formación de anillos sobrepuestos. En promedio, el duramen representó el 84% del radio y la albura mostró entre 6 y 11 anillos. La variación del ancho de los anillos con la edad, la presencia de excentricidad en la parte inferior del árbol y los anillos sobrepuestos pone de relieve la importancia del manejo forestal con particular atención a la distribución de densidad basal en el tiempo, cuando se pretende la producción optimizada de la madera.

Formulação de políticas de saúde em situação pós-conflito: o processo de elaboração do primeiro documento propositivo de uma política de saúde para o Timor Leste, 1999 a 2002 / Formulation of health policies in post-conflict situation: the process of preparing the first document of a purposeful policy of Health for East Timor, 1999 to 2002

O processo de reabilitação do setor saúde em condições pós-conflito é complexo, com prazos muito ajustados e envolve diferentes atores, nacionais e internacionais, exigindo mecanismos de coordenação que maximizem o fluxo da cooperação internacional, tanto financeira quanto da assistência técnica. Este trabalho analisa, em perspectiva histórica, o papel dos diferentes atores, nacionais e internacionais, no processo de elaboração do primeiro documento propositivo de uma política de saúde para o Timor Leste, entre 1999 e 2002, período da administração temporária das Nações Unidas (UNTAET) no país. A proposta de uma política de saúde surgiu, primeiro, nas mobilizações de profissionais timorenses da saúde, em 1999, e, posteriormente, foi retomada nos relatórios das missões conjuntas de avaliação (MiCAs), coordenadas pelo Banco Mundial, e incorporada nos projetos de reabilitação e desenvolvimento para o setor, também financiados pelo Banco. Todo esse processo se deu concomitantemente à construção do arcabouço político nacional e da burocracia administrativa do Estado, promovida pelo governo co-participativo da UNTAET. O desafio deste trabalho foi analisar, nessas condições, como se deu a relação entre diferentes atores, a partir de espaços de troca e de transferência, de conhecimentos e idéias e de um conjunto de “modos de fazer” e de práticas, que permearam o processo de formulação de uma proposta de política para o setor saúde timorense. Conclui-se que, no Timor Leste, a situação de conflito e pós-conflito condicionou, de forma importante, a arquitetura da ajuda externa e esta, por sua vez, pautou a relação entre os diferentes atores, nacionais e internacionais. Por um lado, a realização dos anseios de autodeterminação e independência dos timorenses, e a reconstrução do Estado, dependiam, crucialmente, dessa ajuda e da mediação das Nações Unidas; e, por outro, a reabilitação nacional, inclusive do setor saúde, necessitava do apoio técnico externo, possibilitado pela cooperação técnica, também viabilizada e mediada pelas agências internacionais envolvidas no processo, sobretudo o Banco Mundial. A análise do processo de formulação do primeiro documento propositivo de política de saúde para o Timor Leste aponta elementos para a discussão de como a cooperação técnica internacional, a oferta de idéias, as condicionalidades e os mecanismos de controle das agências e doadores se articulam em conjunturas particulares, em que diversas arenas políticas se entrelaçam em diferentes tempos e espaços de negociação.

Seroprevalence of Burkholderia pseudomallei in East Timorese refugees: implications for healthcare in East Timor.

Melioidosis is a disease with protean clinical manifestations caused by the bacterium Burkholderia pseudomallei. It is endemic in countries surrounding the newly independent East Timor, but has yet to be isolated or demonstrated serologically in that country. One illness that can be clinically indistinguishable from melioidosis is pulmonary tuberculosis, a condition with a very high prevalence in East Timor. We used an indirect hemagglutination test (IHA) to measure antibodies to B. pseudomallei in 407 East Timorese evacuated to Darwin, Australia, in September 1999. Assuming a positive IHA titer as > or = 1:40, the overall seroprevalence rate was 17.0%, in keeping with other seroprevalence studies from the region. The IHA titres ranged up to 1:320. After adjusting for age, females were 2.5 times more likely to be seropositive than males (p = 0.0001). There was an inverse relationship between seropositivity and age. This study shows that exposure to B. pseudomallei occurs in East Timor melioidosis is also likely to occur. Due to the lack of laboratory facilities at present, it may be some time before a laboratory-confirmed case proves that melioidosis occurs. In the meantime, clinicians in East Timor should include melioidosis in the differential diagnosis of the many conditions that it may mimic.