'Desculturización,' urbanization, and nutrition transition among urban Kichwas Indigenous communities residing in the Andes highlands of Ecuador.

BACKGROUND: The nutrition transition continues to affect populations throughout the world. The added impact of market integration and urbanization exacerbates the impact of the nutrition transition upon Indigenous populations worldwide. OBJECTIVES: This study aims to explore the nutritional concerns of the urban Kichwas community residing in the Andes highlands of Ecuador. STUDY DESIGN: This is a qualitative study. METHODS: Eight focus groups were conducted with Kichwas men and women in November 2015 in the Imbabura province of the Andes in Ecuador. DATA ANALYSIS: Applied thematic analysis was used to analyze findings regarding nutrition. RESULTS: The participants shared concerns regarding increased intake of fast food, poor meal timing, and a shift in the child's food preferences that rejects traditional foods. They attributed these concerns to urbanization resulting from an increase in dual-income households and a loss of cultural identity. CONCLUSIONS: Synergistic cultural factors are related to nutritional concerns voiced by the urban Kichwas community. PUBLIC HEALTH IMPLICATIONS: Syndemic theory is a useful interpretive lens regarding nutritional trends within the Kichwas communities as they relate to the increased risk of chronic disease.

Risk and resiliency: the syndemic nature of HIV/AIDS in the indigenous highland communities of Ecuador.

OBJECTIVES: This community-based study explores the syndemic nature of HIV/AIDS risk and resilience among Indigenous Kichwa communities in the province of Imbabura, Ecuador. This study elucidates individual and community-level factors that serve to exacerbate HIV/AIDS risk, as they relate to underlying macrolevel, structural forces. Critically, this study also elicited opportunities for community-based opportunities for resiliency from HIV/AIDS. STUDY DESIGN: Exploratory qualitative study. METHODS: Guided by syndemic theory, a qualitative study was conducted to explore HIV risk and resilience among Indigenous Kichwa communities in the Northern Andean highlands of Ecuador. Eight focus groups (n = 59) with men and women from two communities were conducted. The data were analyzed using applied thematic analysis techniques. RESULTS: Identified risk factors for HIV/AIDS centered around the following themes: (1) parents leaving the community for work, (2) alcohol and drug consumption, (3) unprotected sex, and (4) barriers to health care. Identified HIV/AIDS resiliency factors included the preservation of Indigenous culture and family-focused interventions. CONCLUSIONS: The identified risk factors for HIV/AIDS are interrelated within a complex syndemic relationship. The mutually reinforcing individual-level risk factors of substance abuse and risky sexual behavior coalesce with violence to exacerbate the risk for HIV/AIDS acquisition among Ecuadorian Highland Indigenous communities. Moreover, HIV/AIDS risk prevails in the macrolevel context of disproportionate unemployment among Indigenous peoples and a systematically fragmented healthcare system. It is critical that public health professionals work to revolutionize the systematic discrimination that underpins indigenous health disparities at-large.

Cholera in ecuador: current relevance of past lessons learnt.

This report analyses the trends in the cholera epidemic that hit Ecuador in 1991. The study is based on personal experiences and analysis of epidemiological databases from the Ministry of Public Health of Ecuador. The number of cases and initial attack rates in an immunologically naive population are described by province. An analysis of the Andean and coastal cholera patterns of transmission are described along with its associated risk factors. The logistical, environmental, and socio-cultural risk factors prevalent during the epidemic and the control measures implemented are also reviewed. Also, the role of the epidemic in the development of the public health and healthcare resources in Ecuador is discussed here. Current data indicate favorable conditions for another outbreak of cholera in Ecuador. In view of the existing risk factors, new strategies are proposed to prevent such an epidemic in the future.

The beneficial effects of weekly low-dose vitamin A supplementation on acute lower respiratory infections and diarrhea in Ecuadorian children.

BACKGROUND: Previous studies of large-dose vitamin A supplementation on respiratory morbidity have produced conflicting results in a variety of populations. The influence of malnutrition has not been examined in the majority of these trials. We hypothesized that weekly low-dose vitamin A supplementation would prevent respiratory and diarrheal disease morbidity and that malnutrition might influence the efficacy of vitamin A supplementation. METHODS: In a randomized, double-blind, placebo-controlled field trial of 400 children, 6 to 36 months of age in a high Andean urban slum, half of the children received 10 000 IU of vitamin A weekly and half received placebo for 40 weeks. Children were visited weekly at home by physicians and assessed for acute diarrheal disease and acute respiratory infections. RESULTS: Acute diarrheal disease and acute respiratory infection did not differ globally or by severity between supplement-treated and placebo groups. However, the incidence of acute lower respiratory infection (ALRI) was significantly lower in underweight (weight-for-age z score [WAZ] <-2 SD) supplement-treated children than in underweight children on placebo (8.5 vs 22.3 per 10(3) child-weeks; rate ratio: 0.38 [95% CI: 0.17-0.85]). ALRI incidence was significantly higher in normal-weight (WAZ >-2 SD) supplement-treated children than in normal-weight children on placebo (9.8 vs 4.4 per 10(3) child-weeks; rate ratio: 2.21 [95% CI: 1.24-3.93]). By logistic regression analysis the risk of ALRI was lower in underweight supplement-treated children than in underweight children on placebo (point estimate 0.148 [95% CI: 0.034-0.634]). In contrast, risk of ALRI was higher in normal-weight supplement-treated children (WAZ >-1 SD to mean) than in normal-weight children on placebo in the same WAZ stratum (point estimate: 2.51 [95% CI: 1.24-5.05]). The risk of severe diarrhea was lower in supplement-treated children 18 to 23 months of age than in children on placebo in this age group (point estimate: 0.26 [95% CI: 0.06-1.00]). CONCLUSIONS: Weekly low-dose (10 000 IU) vitamin A supplementation in a region of subclinical deficiency protected underweight children from ALRI and paradoxically increased ALRI in normal children with body weight over -1 SD. Protection from severe diarrhea was consistent with previous trials. Additional research is warranted to delineate potential beneficial and detrimental interactions between nutritional status and vitamin A supplementation regarding ALRI.

The epidemiology of cutaneous leishmaniasis in subtropical Ecuador.

An epidemiologic survey (n = 466) was conducted in an area of subtropical rainforest in north-west Ecuador with the following objectives: (1) to determine the prevalence of cutaneous leishmaniasis (CL), (2) to identify the Leishmania species causing human disease, (3) to investigate the major clinical manifestations of leishmaniasis, (4) to study cellular and humoral immune response indicators associated with disease status and (5) to identify risk factors for CL. Fourteen percent of subjects had parasitologically confirmed CL; 33% had evidence of prior disease. However, 17.2% of subjects with a negative CL clinical history presented with a positive Montenegro skin test (MST), indicating the possibility of subclinical infection. The species isolated from subject lesions were L. guyanensis (63%), L. panamensis (33%), and L. brazilensis (4%). Mean specific anti-Leishmania IgG and IgM OD serum levels were highest in subjects diagnosed with current CL, followed by those with prior CL, and were lowest in healthy subjects, respectively (0.56 +/- 0.27 vs 0.33 +/- 0.2 vs 0.22 +/- 0.14; F-ratio = 74; P < 0.00001) and (665 +/- 270 vs 481 +/- 220 vs 301 +/- 128.5; F-ratio = 37; P < 0.00001). Likewise, subjects with present CL had measurably higher MST reactions (13 +/- 6.7 mm) than those with prior CL (10.9 +/- 7.8 mm) or healthy individuals (2.4 +/- 2.5 mm; F-ratio = 106; P < 0.00001). Serum concentrations of IgG were predicted by lesion number (t = 2.5; P = 0.018), size (t = 3.7; P = 0.0006), and duration (t = 3.5; P = 0.0013). Furthermore, the MST induration size increased as a function of lesion number (t = 3.0; P = 0.005) and size (t = 3.4; P = 0.022). Subject age and sex did not predict serum IgG or IgM concentrations or MST reactions in the 3 disease groups. Although no sex differences were found with respect to clinical characteristics, children < or = 12 years of age were almost 3 times more likely to have CL lesions or scars located on the face and head area compared to adults (OR = 2.75; 95% CI = 1.4-5.6, P = 0.004). The risk factors associated with disease included age under 5 years (AOR = 1.5; 95% CI = 0.48-2.35), male gender in adults (AOR = 2.8; 95% CI = 1.1-7.8), and wood and/or cane exterior house walls (AOR = 1.8; 95% CI = 1.4-2.5). In contrast, electric home lighting was associated with decreased risk (AOR = 0.7; 95% CI = 0.4-2.3). The results suggest that it may be possible to modify a portion of the risk of CL by making changes in the housing environment which may help to reduce the amount of human-vector contact.

La leishmaniasis cutánea en la región subtropical del Ecuador: percepciones, conocimientos y tratamientos populares / Cutaneous leishmaniasis in subtropical Ecuador: popular perceptions, knowledge, and treatment

En una zona endémica de la región subtropical del coroeste del Ecuador se investigaron las creencias y conocimientos populares acerca de la leishmaniasis cutánea y su tratamiento. Aunque la mayoría de las personas adultas entrevistadas estaban familiarizadas con la enfermedad, el vector y los tratamientos tradicionales, muchas no tenían conocimientos sobre la transmisión de la enfermedad, la curación de las úlceras y el tratamiento médico convencional. Se encontro que el riesgo de contraer la enfermedad y las creencias y conocimientos sobre la misma variaban mucho según el género. Entre los varones, el riesgo de sufrir leishmaniasis cutanea fue casi el triple del observado en mujeres. Asimismo, los varones opinaron con más frecuencia que la enfermedad reducía de manera importante, la capacidad de trabajo del paciente. Por otra parte, las mujeres se mostraron más proclives a considerar a la leishmaniasis cutánea un trastorno grave capaz de menoscabar considerablemente la autoestima de quien la padece. Aunque el 80 por ciento de las personas entrevistadas conocían por lo menos uno de los métodos de tratamiento de la enfermedad, las mujeres en general conocían más métodos que los hombres. La mayoría de los 150 regímenes terapéuticos que se mencionaron se basaban en el uso de plantas autóctonas, sustancias químicas, ácidos, antibióticos, tratamientos térmicos o productos derivados del petróleo. Algunos de esos tratamientos podrían tener eficacia clínica. Sin embargo, solo el 7 por ciento de las personas entrevistadas conocían los compuestos antimoniales pentavalentes. Casi 70 por ciento de los que notificaron infección previa o activa fueron tratados únicamente con métodos tradicionales. Solo 12 por ciento recibieron el tratamiento completo con Glucantine, mientras que 7,5 por ciento recibieron un tratamiento incompleto. Los resultados indican que al planificar futuros programas de lucha contra la leishmaniasis cutánea será importante tener en cuenta aquellas áreas en las que se han detectado un deficit de conocimientos y creencias sobre la enfermedad y su tratamiento que varían según el género

Cutaneous leishmaniasis in subtropical Ecuador: popular perceptions, knowledge, and treatment.

Popular perceptions and knowledge about cutaneous leishmaniasis and its treatment were studied in an endemic area of subtropical Northwest Ecuador. Although most of the adults surveyed were familiar with the disease, the vector, and traditional treatments, many showed a lack of knowledge about transmission of the disease, ulcer healing, and conventional treatment. Gender was found to have a significant impact on disease risk, perceptions, and treatment knowledge. Males experienced a risk of contracting cutaneous leishmaniasis that was almost triple that of women. Men were also more likely to perceive that the disease seriously diminished the victim's capacity to work. Women, on the other hand, were more prone to perceive that cutaneous leishmaniasis was a serious disease that significantly decreased self-esteem. Although 80% of the subjects knew at least one method of treating the disease, women tended to know more methods than men. Most of 150 different therapies reported involved the use of indigenous plants, chemicals, acids, antibiotics, heat treatments, or petroleum by-products. Some of these treatments could have clinical value. However, only 7% of the subjects knew about pentavalent antimonials. Almost 70% of the subjects with a past or present infection history were treated solely by traditional methods; only 12% received a full course of Glucantime, while 7.5% got an incomplete course. The findings indicate that it will be important to consider the identified gaps in knowledge and gender perceptions regarding the disease and its treatment when planning future control programs.

PIP: In 1989-1991, a study of 466 children and adults (i.e., = or 18 years) living in 26 small agricultural villages in the remote subtropical forest of Northwest Pichincha Province on the western slope of the Andes Mountains in Ecuador examined perceptions and knowledge of cutaneous leishmaniasis and local methods used to treat it. 13% of all adult subjects had active cutaneous leishmaniasis. Men were 2.83 times more likely to have cutaneous leishmaniasis than women (p = .037), perhaps due to increased occupational exposure (i.e., agricultural work in the rain forest) and social exposure (i.e., outside during times of maximum vector activity). They were more likely to consider it to have a negative effect on the affected person's capacity to work (77.3% vs. 61.2%; p = .025). Women were more likely than men to perceive it as a severe disease (85.2% vs. 68%; p = .015) that reduced the victim's self- esteem (89.9% vs.75.7%; p = .017). 97.3% of subjects were familiar with the sandfly vector, yet less than 10% knew it was responsible for cutaneous leishmaniasis. 80% of adults knew at least 1 treatment option. Women could name more treatment methods than men (1.6 vs. 1.2; p .05). The adults named more than 150 treatment options, most of which were traditional methods involving the application of topical preparations or objects to the ulcers (e.g., herbs, trees, or other plants and homemade rum, wood alcohol, iodine, menthol, methiolate, and sulfur). Just 7% were familiar with antimonial drugs. Most adults and children who had either active cutaneous leishmaniasis or a history of past infection (68%) had been treated with traditional methods. 8.5% received both traditional treatments and Glucantime. Just 12% received the full course of Glucantime therapy. 7.5% received an incomplete course of glucantime therapy. These results show that public health officials need to consider the gaps in knowledge and gender perceptions of cutaneous leishmaniasis and in its treatment when they plan control programs.

Cutaneous leishmaniasis in subtropical Ecuador: popular perceptions, knowledge, and treatment

Popular perceptions and knowledge about cutaneous leishmaniasis and its treatment were studied in an endemic area of subtropical Northwest Ecuador. Although most of the adults surveyed were familiar with the disease, the vector, and traditional treatments, many showed a lack knowledge about transmission of the disease, ulcer healing, and conventional treatment. Gender was found to have a significant impact on disease risk, perceptions, and treatment knowledge. Males experienced a risk of contracting cutaneous leishmaniasis that was almost triple that of women. Men were also more likely to perceive that the disease seriously diminished the victim's capacity to work. Women, on the other hand were more prone to perceive that cutaneous leishmaniasis was a serious disease that significantly decreased self esteem. Although 80 percent of the subjects knew at least one method of treating the disease, women tended to know more methods than men. Most of 150 different therapies reported involved the use of indigenous plants, chemical, acids, antibiotics, heat treatments, or petroleum by products. Some of these treatments could have clinical value. However, only 7 percent of the subjects knew about pentavalent antimonials. Almost 70 percent of the subjects with a past or present infection history were treated solely by traditional methods; only 12 per cent received a full course of Glucantine, while 7.5 percent got an incomplete course. The findings indicate that it will be important to consider the identified gaps in knowledge and gender perceptions regarding the disease and its treatment when planning future control programms

La leishmaniasis cutánea en la región subtropical del Ecuador: percepciones, conocimientos y tratamientos populares / Cutaneous leishmaniasis in subtropical Ecuador: popular perceptions, knowledge, and treatment

En una zona endémica de la región subtropical del coroeste del Ecuador se investigaron las creencias y conocimientos populares acerca de la leishmaniasis cutánea y su tratamiento. Aunque la mayoría de las personas adultas entrevistadas estaban familiarizadas con la enfermedad, el vector y los tratamientos tradicionales, muchas no tenían conocimientos sobre la transmisión de la enfermedad, la curación de las úlceras y el tratamiento médico convencional. Se encontro que el riesgo de contraer la enfermedad y las creencias y conocimientos sobre la misma variaban mucho según el género. Entre los varones, el riesgo de sufrir leishmaniasis cutanea fue casi el triple del observado en mujeres. Asimismo, los varones opinaron con más frecuencia que la enfermedad reducía de manera importante, la capacidad de trabajo del paciente. Por otra parte, las mujeres se mostraron más proclives a considerar a la leishmaniasis cutánea un trastorno grave capaz de menoscabar considerablemente la autoestima de quien la padece. Aunque el 80 por ciento de las personas entrevistadas conocían por lo menos uno de los métodos de tratamiento de la enfermedad, las mujeres en general conocían más métodos que los hombres. La mayoría de los 150 regímenes terapéuticos que se mencionaron se basaban en el uso de plantas autóctonas, sustancias químicas, ácidos, antibióticos, tratamientos térmicos o productos derivados del petróleo. Algunos de esos tratamientos podrían tener eficacia clínica. Sin embargo, solo el 7 por ciento de las personas entrevistadas conocían los compuestos antimoniales pentavalentes. Casi 70 por ciento de los que notificaron infección previa o activa fueron tratados únicamente con métodos tradicionales. Solo 12 por ciento recibieron el tratamiento completo con Glucantine, mientras que 7,5 por ciento recibieron un tratamiento incompleto. Los resultados indican que al planificar futuros programas de lucha contra la leishmaniasis cutánea será importante tener en cuenta aquellas áreas en las que se han detectado un deficit de conocimientos y creencias sobre la enfermedad y su tratamiento que varían según el género

Se publica en inglés en el Bull. PAHO. Vol. 28(2), 1994

Cutaneous leishmaniasis in subtropical Ecuador: popular perceptions, knowledge, and treatment

Popular perceptions and knowledge about cutaneous leishmaniasis and its treatment were studied in an endemic area of subtropical Northwest Ecuador. Although most of the adults surveyed were familiar with the disease, the vector, and traditional treatments, many showed a lack knowledge about transmission of the disease, ulcer healing, and conventional treatment. Gender was found to have a significant impact on disease risk, perceptions, and treatment knowledge. Males experienced a risk of contracting cutaneous leishmaniasis that was almost triple that of women. Men were also more likely to perceive that the disease seriously diminished the victim's capacity to work. Women, on the other hand were more prone to perceive that cutaneous leishmaniasis was a serious disease that significantly decreased self esteem. Although 80 percent of the subjects knew at least one method of treating the disease, women tended to know more methods than men. Most of 150 different therapies reported involved the use of indigenous plants, chemical, acids, antibiotics, heat treatments, or petroleum by products. Some of these treatments could have clinical value. However, only 7 percent of the subjects knew about pentavalent antimonials. Almost 70 percent of the subjects with a past or present infection history were treated solely by traditional methods; only 12 per cent received a full course of Glucantine, while 7.5 percent got an incomplete course. The findings indicate that it will be important to consider the identified gaps in knowledge and gender perceptions regarding the disease and its treatment when planning future control programms

This article will also be published in Spanish in the BOSP. Vol. 117, 1994

Evaluación de la sensibilidad de 5 métodos diagnósticos de la leishmaniasis cutánea

En el presente trabajo se compara cinco diferentes métodos diagnósticos y la efectividad del tratamiento, en un estudio con 49 pacientes, a los que luego del diagnóstico clínico de la (s) lesión (es), se realizó Raspado y/o Frotis, Prueba Cutánea de Montenegro (PCM), Cultivo, Biopsia e inmunofluorescencia Indirecta (IFA). La sensibilidad de las pruebas, son confrontadas con el diagnóstico clínico y la remisión de las lesiones en un 100 por ciento posterior al tratamiento empleado (Glucantin y Pentostan), a dosis convencionales. Los resultados en cuanto a porcentajes de positividad son para el Raspado y/o Frotis 42,86 por ciento, cultivo 67,35 por ciento, Prueba Cutánea de Montenegro 97,96 por ciento, biopsia 55,10 por ciento e IFA 67,35 por ciento lo que estadisticamente nos demuestra una alta sensibilidad para la Prueba Cutánea de Montenegro.

Nuevo indicador de la carencia de hierro: relación hemoglobina y protoporfirina eritrocitaria

La protoporfirna es metabolismo indispensable en al síntesis del HEM, pues su presencia hace posible que el hierro en estado ferroso se incorpore en su interior mediante la acción catalítica de una enzima mitrocondrial denominada ferroquetalasa o hem sintetasa y finalmente formarse el Hem. Este hecho puede alterarse ya sea, por un estado deficitário en hierro en forma crónica o por acumulación anormal de plomo. El estudio se realiza en 199 personas de la zona rural de Sto. Domingo de los Colorados, integrado por 87 hombres (43.72%) y 112 mujeres (56.28%). Los resultados nos permiten inferir la existencia de un estado deficitario de este mineral son: niños en crecimiento rápido (lactantes, preescolares y escolares), mujeres en edad fértil y mujeres embarazadas (no consideradas en este trabajo). En este presente estudio aproximadamente el 90% de las personas pertencientes a estos grupos señalados presentan algún trastorno relacionado con el metabolismo del hierro, definido por una disminución en la concentración sanguínea de hemoglobina y un aumento en la concentración de protoporfirina eritrocitaria. Con el presente estudio pretendemos insistir en el uso de indicadores adecuados y técnicas de laboratório fáciles y fiables para determinar el estado de hierro en el organismo