Estado nutricional y acceso a la salud durante la pandemia en población infantil de Argentina / Nutritional status and access to health during the pandemic in children in Argentina

INTRODUCCIÓN La pandemia de COVID-19 y las medidas de confinamiento han afectado la seguridad alimentaria de los niño/as, especialmente en contextos socioeconómicos de vulnerabilidad, mientras que la atención preventiva de la salud del niño/a se postergó de modo Significativo. OBJETIVOS Analizar el impacto de la pandemia sobre el estado nutricional y el acceso al sistema de salud de la población infantil de 0 a 5 y de 6 a 12 años con cobertura exclusiva del sistema público de salud en Argentina. MÉTODOS A partir de datos antropométricos de controles de salud recopilados por el programa SUMAR (Ministerio de Salud), se estudió la variación en las prevalencias de baja talla y obesidad de la población de interés para un año típico prepandemia (del 21-3-19 al 20-3-20) y para el período de pandemia (del 21-3-20 al 20-3-21). mediante Ecuaciones de Estimación Generalizadas. Para estudiar los factores asociados a cantidad de niños/as que asistieron a los controles de salud en el 2020 se implementaron modelos lineales generalizados mixtos con distribución binomial negativa, ajustando por la estructura poblacional del centro de salud. RESULTADOS comparados con las tendencias esperadas para un año típico, aumentaron las prevalencias de baja talla en la población de 0 a 5 años y de obesidad en la población de 6 a 12 años durante la pandemia. Las zonas con mayores prevalencias de baja talla se concentran en el norte del país, mientras que las de obesidad en el sur. A nivel provincial, se detectó una reducción media en el acceso a los controles de salud del 33.62% en individuos de entre 0 y 5 años, y del 50.07% en individuos de 6 a 12 años. DISCUSIÓN se precisan políticas públicas tendientes a disminuir las prevalencias de malnutrición, diferenciales en función de la edad y del área evaluada. Se requiere acción del estado para reducir las inequidades en el acceso a los controles de salud.

Multiscale environmental determinants of Leishmania vectors in the urban-rural context.

BACKGROUND: In South America, cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL) are emerging diseases, expanding in the border area of Argentina, Brazil and Paraguay. Outbreaks of CL were reported since the 1990s, with Nyssomyia whitmani as the main vector in this region. Regarding VL, urban reports started in 2010 with Lutzomyia longipalpis as the main vector. The aim of this study was to evaluate environmental determinants related to the main vectors of leishmaniasis, to contribute to the prevention and control response to the emergence of VL and CL in the Argentina-Brazil-Paraguay border region. METHODS: The cross-sectional survey includes two cities and two close rural areas in the Argentinean Northeast Region, between November 2014 and January 2015, with a total of 95 sampling sites. REDILA-BL traps were set for three consecutive nights, and a total of 68 meso- and microscale environmental and landscape characteristics were surveyed. The association between vector abundance with different variables was evaluated using a generalized linear model with zero-inflated negative binomial distribution. We analyzed females for detection of Leishmania DNA. RESULTS: The analysis for Lu. longipalpis indicates an excess of absences when the mean NDWI around the sites were higher. The abundance of Lu. longipalpis at mesoscale level was higher when more urban services were present, and when blood sources such as chickens or dogs at the microscale level were present. For Ny. whitmani, no variable was found to be associated with the absences, while its abundance increased in association with the following variables: percentage of tree cover, presence of garbage collection service, hosted people and, at microscale, the presence of poultry. Leshmania infantum DNA was detected in 2/49 (4%) Lu. longipalpis. CONCLUSIONS: The abundance of both species is influenced by variables at different scales, their influence probably has a hierarchy and they are acting on different aspects of the biology of these vectors. The urban spatial segregation of Lu. longipalpis and the peri-urban and rural segregation of N. whitmani increase the risk of VL and CL. The selection of the better variables for each scale will allow the design of appropriate control strategies depending on species.

Performance of light-emitting diode traps for collecting sand flies in entomological surveys in Argentina.

The performance of two light-emitting diode traps with white and black light for capturing phlebotomine sand flies, developed by the Argentinean Leishmaniasis Research Network (REDILA-WL and REDILA-BL traps), were compared with the traditional CDC incandescent light trap. Entomological data were obtained from six sand fly surveys conducted in Argentina in different environments. Data analyses were conducted for the presence and the abundance of Lutzomyia longipalpis, Migonemyia migonei, and Nyssomyia whitmani (106 sites). No differences were found in presence/absence among the three types of traps for all sand fly species (p>0.05). The collection mean of Lu. longipalpis from the REDILA-BL didn´t differ from the CDC trap means, nor were differences seen between the REDILA-WL and the CDC trap collection means (p>0.05), but collections were larger from the REDILA-BL trap compared to the REDILA-WL trap (p<0.05). For Mg. migonei and Ny. whitmani, no differences were found among the three types of traps in the number of individuals captured (p>0.05). These results suggest that both REDILA traps could be used as an alternative capture tool to the original CDC trap for surveillance of these species, and that the REDILA-BL will also allow a comparable estimation of the abundance of these flies to the CDC light trap captures. In addition, the REDILA-BL has better performance than the REDILA-WL, at least for Lu. longipalpis.

Spatial and temporal changes in Lutzomyia longipalpis abundance, a Leishmania infantum vector in an urban area in northeastern Argentina.

This study aimed to analyse changes in the spatial distribution of Lutzomyia longipalpis in Posadas, an urban area located in northeastern Argentina. Data were obtained during the summer of 2007 and 2009 through two entomological surveys of peridomiciles distributed around the city. The abundance distribution pattern for 2009 was computed and compared with the previous pattern obtained in 2007, when the first human visceral leishmaniasis cases were reported in the city. Vector abundance was also examined in relation to micro and macrohabitat characteristics. In 2007 and 2009, Lu. longipalpis was distributed among 41.5% and 31% of the households in the study area, respectively. In both years, the abundance rates at most of the trapping sites were below 30 Lu. longipalpis per trap per night; however, for areas exhibiting 30-60 Lu. longipalpis and more than 60 Lu. longipalpis, the areas increased in both size and number from 2007-2009. Lu. longipalpis was more abundant in areas with a higher tree and bush cover (a macrohabitat characteristic) and in peridomiciles with accumulated unused material (a microhabitat characteristic). These results will help to prioritise and focus control efforts by defining which peridomiciles display a potentially high abundance of Lu. longipalpis.

Spatial and temporal changes in Lutzomyia longipalpis abundance, a Leishmania infantum vector in an urban area in northeastern Argentina

This study aimed to analyse changes in the spatial distribution of Lutzomyia longipalpis in Posadas, an urban area located in northeastern Argentina. Data were obtained during the summer of 2007 and 2009 through two entomological surveys of peridomiciles distributed around the city. The abundance distribution pattern for 2009 was computed and compared with the previous pattern obtained in 2007, when the first human visceral leishmaniasis cases were reported in the city. Vector abundance was also examined in relation to micro and macrohabitat characteristics. In 2007 and 2009, Lu. longipalpis was distributed among 41.5% and 31% of the households in the study area, respectively. In both years, the abundance rates at most of the trapping sites were below 30 Lu. longipalpis per trap per night; however, for areas exhibiting 30-60 Lu. longipalpis and more than 60 Lu. longipalpis, the areas increased in both size and number from 2007-2009. Lu. longipalpis was more abundant in areas with a higher tree and bush cover (a macrohabitat characteristic) and in peridomiciles with accumulated unused material (a microhabitat characteristic). These results will help to prioritise and focus control efforts by defining which peridomiciles display a potentially high abundance of Lu. longipalpis. .

Lutzomyia longipalpis abundance in the city of Posadas, northeastern Argentina: variations at different spatial scales.

The distribution of Lutzomyia longipalpis is heterogeneous with a pattern of high abundance areas (HAAs) embedded in a matrix of low abundance areas (LAAs). The objective of this study was to describe the variability in the abundance of Lu. longipalpis at two different spatial levels and to analyse the relationship between the abundance and multiple environmental variables. Of the environmental variables analysed in each household, the condition that best explained the differences in vector abundance between HAA-LAA was the variable "land_grass", with greater average values in the peridomestic environments within the LAA, and the variables "#sp tree", "#pots" and "dist_water" that were higher in the HAA. Of the environmental variables analysed in the patches, the variable "unpaved_streets" was higher in the LAAs and the variable "prop_inf_dogs" was higher in the HAAs. An understanding of the main environmental variables that influence the vector distribution could contribute to the development of strategies for the prevention and control of visceral leishmaniasis (VL). This is the first work in which environmental variables are analysed at the micro-scale in urban areas at the southern edge of the current range of Lu. longipalpis. Our results represent a significant contribution to the understanding of the abundance of the vector in the peridomestic habitats of the region.

Lutzomyia longipalpis abundance in the city of Posadas, northeastern Argentina: variations at different spatial scales

The distribution of Lutzomyia longipalpis is heterogeneous with a pattern of high abundance areas (HAAs) embedded in a matrix of low abundance areas (LAAs). The objective of this study was to describe the variability in the abundance of Lu. longipalpis at two different spatial levels and to analyse the relationship between the abundance and multiple environmental variables. Of the environmental variables analysed in each household, the condition that best explained the differences in vector abundance between HAA-LAA was the variable "land_grass", with greater average values in the peridomestic environments within the LAA, and the variables "#sp tree", "#pots" and "dist_water" that were higher in the HAA. Of the environmental variables analysed in the patches, the variable "unpaved_streets" was higher in the LAAs and the variable "prop_inf_dogs" was higher in the HAAs. An understanding of the main environmental variables that influence the vector distribution could contribute to the development of strategies for the prevention and control of visceral leishmaniasis (VL). This is the first work in which environmental variables are analysed at the micro-scale in urban areas at the southern edge of the current range of Lu. longipalpis. Our results represent a significant contribution to the understanding of the abundance of the vector in the peridomestic habitats of the region.

Lutzomyia longipalpis spatial distribution and association with environmental variables in an urban focus of visceral leishmaniasis, Misiones, Argentina.

This study describes the spatial distribution pattern of Lu. longipalpis abundance in Posadas-Garupá, Argentina, where four cases of human Visceral Leishmaniasis had been recorded. A total of 2428 Lu. longipalpis were captured in 42% of the 305 sites sampled with CDC light traps, its abundance shows spatial autocorrelation ranging up to 590 m (semivariogram model), with six downtown 'islands' of vector highest abundance (>or=60 individuals). A significant association between Lu. longipalpis and the presence of chickens was observed (odds ratio 3.26). The best stepwise multiple regression using Generalized Linear Models explained 31% of the deviance for Lu. longipalpis abundance, including as explanatory variables: (a) negatively: households with 'lack of building material and with economic deprivation', (b) positively: surface covered by trees and bushes at 50 meters of the house, and households without electrical lighting. In conclusion, Lu. longipalpis in a recent settled focus of visceral leishmaniasis was urbanized with a highly heterogeneous spatial distribution within the cities, with the vectors concentrated in limited 'islands' of high abundance, in the downtown relatively more affluent and dense populated areas, but also more heterogeneous with patches that had higher tree coverage and poor urban services. These results once validated will contribute to the control strategy design through risk maps, in order to prioritize areas for prevention and control, and setting the appropriate scale for intervention.