Double Burden of Excess Weight and Anemia in Latin American Children up to 2019.

The double burden of malnutrition is the coexistence of two different conditions, mainly reflected as excess or deficit in weight. Anemia is a specific nutritional deficit not always included in the double burden assessment. We reviewed overweight and/or obesity (OW/OB) and anemia studies from Latin-American Children over the last ten years up to 2019. Two authors evaluated the MEDLINE, SCOPUS, and LILACS databases. A scale of ten questions was used to assess the risk of bias in prevalence studies. Fourteen studies were selected. The population studies' size ranged from 147 to 20,342 children with different socio-economic backgrounds, such as urban, peri-urban and rural settings, socio-economic status, schooling, population (ethnic minorities and indigenous), and environmental differences (sea level or high altitude). The prevalence of OW/OB ranged from 4.9% to 42%. The prevalence of anemia was from 3.4% to 67%. The double burden, including OW/OB and anemia, ranged from 0.7% to 67%. A higher prevalence of excess weight and anemia was found in rural and high altitude above sea level environments, extreme poverty, low education level, and indigenous communities. These heterogeneous data, before the 2020 (COVID-19 pandemic), reflect the vast inequities between countries and within each country. Food insecurity linked to poverty and the induced change in eating habits and lifestyles threaten optimal child nutrition in ongoing and future scenarios. The existence of OW/OB and anemia and their simultaneous coexistence in the community, home, and individual levels, indicates that interventions should be comprehensive to face the double burden of malnutrition.

Non-clinical performance and acceptability of a small portable respiratory stimulator device for basic neonatal resuscitation, tested by health personnel / Desempeño no clínico y aceptabilidad de un estimulador respiratorio portátil para reanimación neonatal básica, evaluado en personal de salud

Introducción: La reanimación neonatal demanda dispositivos para apoyo respiratorio que no siempre se encuentran en áreas rurales. Se requieren dispositivos innovadores y el prototipado rápido permite generarlos usando diseños e impresoras tridimensionales (3D). Objetivo: Evaluar el desempeño no clínico y la aceptabilidad por el personal de salud de un dispositivo respiratorio neonatal producido mediante prototipado rápido. Métodos: Estudio observacional, descriptivo, de prueba de concepto desarrollado en dos etapas. Etapa 1: Fabricación del dispositivo con prototipado rápido en impresoras y escáneres tridimensionales (3D). Etapa 2: Demostración del dispositivo durante programas de capacitación en reanimación neonatal para personal de salud en tres regiones del Perú (Tarapoto, Huánuco y Ayacucho). En ambas etapas se evaluó el desempeño del dispositivo conectado a un analizador de flujo de gases. Se administró una encuesta a los trabajadores de salud de Tarapoto y Ayacucho para conocer su aceptabilidad. Resultados: El prototipo desarrollado tiene forma de T con dos fuelles laterales que al presionarse con una sola mano, proyectan aire por el centro hacia un adaptador facial. El uso del prototipo en laboratorio generó un flujo de aire promedio de 4,8 Lt/min (DE ± 1,7) y una presión promedio de 5,9 cm H2O (DE ± 1,4). Este dispositivo fue considerado como "de uso muy simple" en una encuesta de aceptabilidad donde participaron 39 enfermeras y 11 médicos en zonas alejadas de la capital del Perú. Conclusiones: El prototipo evaluado fue aceptado por el personal y tuvo un desempeño capaz de generar un estímulo de la respiración espontánea al nacer.

Introduction: Neonatal resuscitation demands equipment for respiratory support not always available in rural areas. Innovative devices are required, and rapid prototyping allows to generate them using three-dimensional (3D) designs and printers. Objective: To evaluate the non-clinical performance and the acceptability by health personnel of a neonatal respiratory device produced by rapid prototyping. Methods: Observational study, descriptive, of proof of concept developed in two steps. Step 1: Manufacture of the device with rapid prototyping in three-dimensional (3D) scanners and printers. Step 2: Demonstration of the invention during training programs in neonatal resuscitation for health personnel in three regions of Peru (Tarapoto, Huánuco and Ayacucho). In both steps, we evaluated the performance of the device connected to a gas flow analyser. A survey was administered to the health workers of Tarapoto and Ayacucho to know their acceptability. Results: The developed prototype is T-shaped with two side bellows that, when pressed with one hand, project air through the centre towards a facial adapter. The use of the prototype in the laboratory generated an average air flow of 4.8 Lt /min (SD ± 1.7) and an average pressure of 5.9 cm H2O (SD ± 1.4). This device was considered to be "very simple to use" in an acceptability survey involving 39 nurses and 11 doctors in remote areas of the capital of Peru. Conclusions: The evaluated prototype is acceptable by the staff and has a performance capable of generating spontaneous breathing at birth.