La salud pública y la mujer peruana / Public health and the Peruvian woman

RESUMEN Se detalla el inicio de la salud publica en la historia y el desarrollo que tuvo en el Perú en general y en particular su relación con eventos que impulsaron las mejoras en el ámbito de la salud materno-infantil, la anticoncepción y, posteriormente, en los derechos sexuales y reproductivos de las mujeres peruanas.

ABSTRACT This article details the beginning of public health in history and its development in Peru in general and in particular its relationship with events that drove improvements in the field of maternal and child health, contraception and, later, in the sexual and reproductive rights of Peruvian women.

Resource partitioning between Microlophus occipitalis and Stenocercus puyango (Sauria: Tropiduridae) in Cerros de Amotape National Park, Tumbes, Peru

Activity, microhabitat use, and diet are patterns commonly used to define the saurian community structure, because of differential exploitation allowing coexistence at the same time and place. We analyze resource partitioning between two sympatric saurian species, Stenocercus puyango and Microlophus occipitalis, in the transitional area of the Pacific Tropical Forest and the Dry Forest inside Cerros de Amotape National Park (PNCA) in Tumbes, northwestern of Peru. Microlophus occipitalis and S. puyango both showed a unimodal activity pattern with higher activity around 13:00 h, with a mean body temperature of 34.83 °C and 32.17 °C respectively, observing a significant relationship between body and environmental (air and substrate) temperatures. Rocks and tree trunks were the most frequent microhabitats used by M. occipitalis while S. puyango were registered more frequently over leaf litter. The diets of both tropidurids were composed by arthropods, ants, and insect larvae mainly. Similarities in activity times (temporal niche) and diet (trophic niche) should be related to phylogenetic relationship and environmental characteristics of PNCA (seasonality, vegetal composition) meanwhile differences in space use and microhabitat thermal quality will be related to thermal quality in the area.

Los horarios de actividad, el uso de microhábitat y dieta, son patrones comúnmente utilizados para dilucidar la estructura de una comunidad de saurios, ya que estos hacen un uso diferenciado de los recursos que explotan, lo que les permite coexistir de forma adecuada en el mismo tiempo y lugar. Analizamos la repartición de recursos entre dos especies simpátridas de saurios, Stenocercus puyango y Microlophus occipitalis, en la zona transicional entre el Bosque Tropical del Pacifico y el Bosque Seco en el Parque Nacional Cerros de Amotape (PNCA), departamento de Tumbes, analizando el solapamiento del nicho espacial, temporal y trófico entre ambas especies, incluyendo algunos aspectos de sus ecologías termales. Microlophus occipitalis y S. puyango presentaron un patrón de actividad unimodal con un pico de actividad hacia las 13:00 horas y una temperatura corporal promedio de 34.83 °C y 32.17 °C, respectivamente, registrándose una relación significativa entre la temperatura corporal y las temperaturas ambientales (aire y suelo). Los microhábitats más utilizados por M. occipitalis fueron los troncos caídos y rocas, mientras que S. puyango fue registrado principalmente sobre hojarasca. La dieta de ambos tropidúridos estuvo compuesta por artrópodos, principalmente hormigas y larvas de insectos. Las similitudes encontradas tanto en los horarios de actividad (nicho temporal) como en la dieta (nicho trófico), estarían asociadas a su parentesco filogenético y a características ambientales propias dentro del PNCA (estacionalidad, composición vegetal), mientras que las diferencias en el uso del espacio y temperaturas corporales entre ambas especies estarían relacionada a la calidad térmica de los microhábitats presentes en el área.

Presence of Pathogenic Leptospira spp. in an Urban Slum of the Colombian Caribbean: A One Health Approach

Introducción: La leptospirosis es una zoonosis que tiene alto impacto en la salud de las personas y los animales, especialmente en áreas tropicales y subtropicales. Esta enfermedad es causada por el patógeno Leptospira spp. y es transmitida principalmente por los roedores. Objetivo: Describir la presencia de Leptospira patógena y los posibles factores de riesgo de leptospirosis en un sector marginal de Colombia, con un enfoque One-Health. Métodos: Se llevó acabo un estudio exploratorio en un sector marginal de Soledad, municipio situado en la costa norte de Colombia. Se tomaron muestras de sangre de 83 sujetos. Se analizaron variables sociodemográficas, clínicas y ecológicas relacionadas con la leptospirosis. La presencia de anticuerpos IgM anti-leptospira en el suero humano fue detectado mediante la prueba ELISA. También, se tomaron muestras de tejido renal de 53 roedores sinantrópicos para identificar Leptospira spp. patógenas mediante PCR convencional a través del uso de cebadores específicos. Resultados: Se detectaron anticuerpos IgM-anti-leptospira en el 30,12 por ciento de los sujetos de estudio. La Leptospira spp. patógena fue identificada en el 7,55 por ciento de los roedores analizados. En la muestra seleccionada se encontró asociación de casos seropositivos con ser comerciantes, ama de casa y estar en contacto con cerdos. Las condiciones higiénico-sanitarias subóptimas también fueron evidentes en el área de estudio. Conclusiones: La circulación de Leptospira spp. patógena y la exposición a factores de riesgo humanos y ecológicos es elevada en el sector marginal (área de pobreza) del Caribe colombiano. Se recomienda dirigir las intervenciones en la interfaz hombre-animal-ambiente de acuerdo con el paradigma One-Health; se debe considerar la extrema pobreza como un factor determinante para la ocurrencia de la leptospirosis(AU)

Objective: This study aims to describe the presence of pathogenic Leptospira and potential risk factors for leptospirosis in a marginal sector of the Colombian Caribbean, with a One Health approach. Methods: an exploratory study was carried out in a marginal sector of Soledad, a municipality located in the north coast of Colombia. Blood samples were taken from 83 subjects, who were also questioned about sociodemographic, clinical and ecological variables related to leptospirosis. The presence of IgM Anti-Leptospira antibodies in human serum was performed by ELISA. A total 53 synanthropic rodents were also captured using Sherman traps. Renal tissue samples were taken from rodents to identify pathogen Leptospira spp. by conventional PCR using specific primers. Results: IgM-anti-Leptospira was present in 30.12 percent of study subjects and pathogenic Leptospira spp. was identified in 7.55 percent of captured rodents. In the selected sample we found an association of positive cases with being a merchant, housewife and being in contact with pigs. Suboptimal hygienic-sanitary conditions were also evident in the study area. Conclusions: Our results show the circulation of pathogenic Leptospira spp. and exposure to human and ecological risk factors in a marginal sector (slum) of the Colombian Caribbean. We suggest to direct interventions in the human-animal-environment interface according to the One Health paradigm, considering extreme poverty as a determining factor for Leptospirosis occurrence(AU)

Correction: Monitoring of the Venezuelan exodus through Facebook's advertising platform.

[This corrects the article DOI: 10.1371/journal.pone.0229175.].

Monitoring of the Venezuelan exodus through Facebook's advertising platform.

Venezuela is going through the worst economical, political and social crisis in its modern history. Basic products like food or medicine are scarce and hyperinflation is combined with economic depression. This situation is creating an unprecedented refugee and migrant crisis in the region. Governments and international agencies have not been able to consistently leverage reliable information using traditional methods. Therefore, to organize and deploy any kind of humanitarian response, it is crucial to evaluate new methodologies to measure the number and location of Venezuelan refugees and migrants across Latin America. In this paper, we propose to use Facebook's advertising platform as an additional data source for monitoring the ongoing crisis. We estimate and validate national and sub-national numbers of refugees and migrants and break-down their socio-economic profiles to further understand the complexity of the phenomenon. Although limitations exist, we believe that the presented methodology can be of value for real-time assessment of refugee and migrant crises world-wide.

Hybrid speciation leads to novel male secondary sexual ornamentation of an Amazonian bird.

Hybrid speciation is rare in vertebrates, and reproductive isolation arising from hybridization is infrequently demonstrated. Here, we present evidence supporting a hybrid-speciation event involving the genetic admixture of the snow-capped (Lepidothrix nattereri) and opal-crowned (Lepidothrix iris) manakins of the Amazon basin, leading to the formation of the hybrid species, the golden-crowned manakin (Lepidothrix vilasboasi). We used a genome-wide SNP dataset together with analysis of admixture, population structure, and coalescent modeling to demonstrate that the golden-crowned manakin is genetically an admixture of these species and does not represent a hybrid zone but instead formed through ancient genetic admixture. We used spectrophotometry to quantify the coloration of the species-specific male crown patches. Crown patches are highly reflective white (snow-capped manakin) or iridescent whitish-blue to pink (opal-crowned manakin) in parental species but are a much less reflective yellow in the hybrid species. The brilliant coloration of the parental species results from nanostructural organization of the keratin matrix feather barbs of the crown. However, using electron microscopy, we demonstrate that the structural organization of this matrix is different in the two parental species and that the hybrid species is intermediate. The intermediate nature of the crown barbs, resulting from past admixture appears to have rendered a duller structural coloration. To compensate for reduced brightness, selection apparently resulted in extensive thickening of the carotenoid-laden barb cortex, producing the yellow crown coloration. The evolution of this unique crown-color signal likely culminated in premating isolation of the hybrid species from both parental species.

Evaluación rápida de la situación de los servicios de salud sexual y reproductiva en el marco de la epidemia del zika en el Perú / Rapid assessment of the situation of the sexual and reproductive health services in the framework of Zika virus epidemic in Peru

En América Latina, los primeros meses del 2016 estuvieron marcados por crecientes reportes de microcefalia, que poco después se demostró estaba causado por el virus zika. Inicialmente su transmisión fue caracterizada como metaxénica (a través del mosquito del dengue, Aedes aegypti), para luego encontrarse evidencias de transmisión sexual. Por ello, el Ministerio de Salud (MINSA) del Perú solicitó evaluar la capacidad de respuesta de sus servicios de salud reproductiva en las áreas de mayor riesgo de contagio, el área nororiental del Perú y Lima, a fin de identificar necesidades y nudos críticos y elaborar un plan de mejora de la oferta de servicios. En el caso de Lima, también se incluyeron dos establecimientos de EsSalud. Mediante entrevistas individuales, grupales, listas de chequeo y guías de observación, se analizaron variables claves del sistema de salud. El presupuesto en las regiones fue siempre menor al solicitado, mientras que el de planificación familiar recibía otros usos. Los horarios de atención fueron limitados, en tanto que se requiere actualizar las competencias del personal para usar el dispositivo intrauterino (DIU) y métodos de larga duración. El 83% de establecimientos tenía desabastecimiento del inyectable mensual, mientras que 17% presentó substock. Asimismo, resultó clara la necesidad de capacitar al personal para la prevención del zika durante las relaciones sexuales, así como antes y durante el embarazo. No se reconoció los vínculos con la violencia sexual. Los servicios orientados a usuarias/os adolescentes brindaban atención con horarios restringidos, además de otras limitaciones a su acceso. Solo el 22% de usuarias había recibido información de parte de los proveedores.

In Latin America, the first months of 2016 were marked by the increasing reports of microcephaly, which was shortly afterwards shown to have been caused by the Zika virus. Initially, its transmission was typified as metaxenic (caused by the Dengue mosquito Aedes aegypti); later, evidences of sexual transmission were detected. Thus, the Ministry of Health of Peru required to evaluate the response capacity of the reproductive health services to needs and critical knots and to draft a plan to improve the offer. In the case of Lima, EsSalud facilities were also included. Through individual and group interviews, and check lists and observation lists, key variables of the health system were analyzed. The budget of the regions was always lower than that requested; the family planning budget was expended in other uses. Office hours were limited. The staff skills on both intrauterine device (IUD) and long-acting reversible contraception (LARC) use needed to be updated. 83% of the facilities had shortage of monthly injectable contraception, and 17% were sub-stocked. Likewise, the staff needed to be trained on Zika prevention during sexual activity, and before and during pregnancy. The links with sexual violence were not recognized. The services for adolescent users had restricted office hours, and other access limitations. Only 22% of the users had received information from the suppliers.

Hybridization in headwater regions, and the role of rivers as drivers of speciation in Amazonian birds.

Many understory birds and other groups form genetically differentiated subspecies or closely related species on opposite sides of major rivers of Amazonia, but are proposed to come into geographic contact in headwater regions where narrower river widths may present less of a dispersal barrier. Whether such forms hybridize in headwater regions is generally unknown, but has important implications to our understanding of the role of rivers as drivers of speciation. We used a dataset of several thousand single nucleotide polymorphisms to show that seven taxon pairs that differentiate across a major Amazonian river come into geographic contact and hybridize in headwater regions. All taxon pairs possessed hybrids with low numbers of loci in which alleles were inherited from both parental species, suggesting they are backcrossed with parentals, and indicating gene flow between parental populations. Ongoing gene flow challenges rivers as the sole cause of in situ speciation, but is compatible with the view that the wide river courses in the heart of Amazonia may have driven interfluvial divergence during episodes of wet forest retraction away from headwater regions. Taxa as old as 4 Ma in our Amazonian dataset continue to hybridize at contact zones, suggesting reproductive isolation evolves at a slow pace.

Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in three cities of Colombia.

OBJECTIVE: To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene (HH) approach in Colombia, and analyze predictors of poor HH compliance. METHODS: An observational, prospective, interventional, before-and-after study was conducted from May 2003 through September 2010 in 10 intensive care units (ICUs) of six hospitals in three cities. The study was divided into two periods: a baseline and a follow-up period. Observations for HH compliance were done in each ICU during randomly selected 30-min periods. The multidimensional HH approach included: (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (6) performance feedback. RESULTS: A total of 13 187 opportunities for HH were observed. Overall HH compliance increased from 50% to 77% (relative risk 1.55, 95% confidence interval 1.43-1.68; p=0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor HH compliance: males vs. females (67% vs. 77%; p=0.0001), physicians vs. nurses (59% vs. 78%; p<0.0001), and adult vs. pediatric ICUs (76% vs. 42%; p<0.001), among others. CONCLUSIONS: Adherence to HH was increased by 55% with the INICC approach. Programs targeted at improving HH in variables found to be predictors of poor compliance should be implemented.

Mutaciones puntuales en el gen de la dihidropteroato sintetasa de Plasmodium falciparum en Bolívar, Colombia / Point mutations in the dihydropteroate synthetase gene of Plasmodium falciparum in Bolivar, Colombia

Introducción: la resistencia antimalárica dificulta el control del paludismo en Colombia. La vigilancia molecular de mutaciones puntuales en blancos terapéuticos es fundamental en el estudio de la resistencia a los antimaláricos. Objetivo: identificar mutaciones puntuales en el gen de la dihidropteroato sintetasa de Plasmodium falciparum (pfdhps), asociadas con resistencia in vitro a sulfadoxina. Métodos: la fuente de ADN de Plasmodium falciparum consistió en láminas de gota gruesa de 55 individuos con infección malárica, reportados en el departamento de Bolívar, Colombia. El ADN se extrajo con solución de Chelex-100 al 5 %. Las mutaciones se identificaron mediante PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) y secuenciación. Resultados: 17 muestras (31 %) amplificaron un fragmento de 438 pb de pfdhps. La PCR-RFLP mostró frecuencia del genotipo mutante G-437 en 65 % de los amplificados, el mixto A/G-437 en 29 % y el silvestre A-437 en 6 %. Los alelos mutantes G-437, F-436 y el alelo silvestre K-540 se identificaron en todas las muestras secuenciadas. Conclusiones: este es el primer reporte de mutaciones puntuales en el gen dhps de Plasmodium falciparum en el departamento de Bolívar, Colombia, lo cual contribuye al conocimiento de la resistencia a los antimaláricos en el Caribe colombiano.

Introduction: antimalarial drug resistance hinders the control of malaria in Colombia. The molecular surveillance of point mutations in therapeutic targets is essential in the study of antimalarial drugs. Objective: to identify point mutations at dihydropteroate synthetase gene of Plasmodium falciparum (pfdhps) associated with sulfadoxine resistance. Methods: source of P. falciparum DNA was blood thick smears of 55 individuals with malaria infection, reported in Bolivar, Colombia. The DNA was extracted with 5 %. Chelex-100 solution. The mutations were identified by PCR-RFLP and sequencing. Results: seventeen samples (31 %) amplified a 438 bp fragment of pfdhps. The PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) showed a frequency of mutant genotype (G-437) in 65 % of amplicons, mixed genotype (A/G-437) in 29 % and wild genotype (A/G-437) in 6 %. The mutant alleles G-437, F-436 and the wild allele K-540 were identified in all sequenced samples. Conclusions: this is the first report of point mutations in the P. falciparum dhps gene in Bolivar, Colombia. This result contributes to the knowledge of antimalarial drug resistance in the Colombian Caribbean region.

Integrative taxonomy and preliminary assessment of species limits in the Liolaemus walkeri complex (Squamata, Liolaemidae) with descriptions of three new species from Peru.

Species delimitation studies based on integrative taxonomic approaches have received considerable attention in the last few years, and have provided the strongest hypotheses of species boundaries. We used three lines of evidence (molecular, morphological, and niche envelopes) to test for species boundaries in Peruvian populations of the Liolaemus walkeri complex. Our results show that different lines of evidence and analyses are congruent in different combinations, for unambiguous delimitation of three lineages that were "hidden" within known species, and now deserve species status. Our phylogenetic analysis shows that L. walkeri, L. tacnae and the three new species are strongly separated from other species assigned to the alticolor-bibronii group. Few conventional morphological characters distinguish the new species from closely related taxa and this highlights the need to integrate other sources of data to erect strong hypothesis of species limits. A taxonomic key for known Peruvian species of the subgenus Lioalemus is provided.

ResumenLos estudios sobre delimitación de especies basados en un enfoque integral han recibido considerable atención en los últimos años, y proveen las hipótesis más robustas sobre límites de especies. Usamos tres líneas de evidencia (molecular, morfológica y modelos de nichos) para evaluar los límites de especies entre poblaciones peruanas del complejo Liolaemus walkeri. Nuestros resultados muestran que las diferentes líneas de evidencia y análisis en diferentes combinaciones son congruentes en el descubrimiento no ambiguo de tres linajes que estuvieron confundidos con especies ya conocidas y que ahora merecen reconocimiento específico. Nuestro análisis filogenético muestra que L. walkeri, L. tacnae y las tres nuevas especies están bien distanciadas de las otras especies asignadas al grupo alticolor-bibronii. Pocos caracteres morfológicos convencionales distinguen las nuevas especies de otras estrechamente relacionadas, y esto indica la necesidad de integración de diferentes fuentes de datos para elaborar hipótesis más sólidas sobre límites entre especies. Se proporciona una clave taxonómica para las especies peruanas conocidas del subgénero Liolaemus.

Findings of the International Nosocomial Infection Control Consortium (INICC), Part I: Effectiveness of a multidimensional infection control approach on catheter-associated urinary tract infection rates in pediatric intensive care units of 6 developing countries.

DESIGN: A before-after prospective surveillance study to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) rates. SETTING: Pediatric intensive care units (PICUs) of hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of the following 6 developing countries: Colombia, El Salvador, India, Mexico, Philippines, and Turkey. PATIENTS: PICU inpatients. METHODS: We performed a prospective active surveillance to determine rates of CAUTI among 3,877 patients hospitalized in 10 PICUs for a total of 27,345 bed-days. The study was divided into a baseline period (phase 1) and an intervention period (phase 2). In phase 1, surveillance was performed without the implementation of the multidimensional approach. In phase 2, we implemented a multidimensional infection control approach that included outcome surveillance, process surveillance, feedback on CAUTI rates, feedback on performance, education, and a bundle of preventive measures. The rates of CAUTI obtained in phase 1 were compared with the rates obtained in phase 2, after interventions were implemented. RESULTS: During the study period, we recorded 8,513 urinary catheter (UC) days, including 1,513 UC-days in phase 1 and 7,000 UC-days in phase 2. In phase 1, the CAUTI rate was 5.9 cases per 1,000 UC-days, and in phase 2, after implementing the multidimensional infection control approach for CAUTI prevention, the rate of CAUTI decreased to 2.6 cases per 1,000 UC-days (relative risk, 0.43 [95% confidence interval, 0.21-1.0]), indicating a rate reduction of 57%. CONCLUSIONS: Our findings demonstrated that implementing a multidimensional infection control approach is associated with a significant reduction in the CAUTI rate of PICUs in developing countries.

Speciation in an avian complex endemic to the mountains of Middle America (Ergaticus, Aves: Parulidae).

The implementation of the phylogeographic approach for the study of biodiversity is critical in poorly sampled regions like the montane systems of Middle America, as complex evolutionary histories often result in the presence of independent lineages not properly considered by traditional taxonomy. Herein we sequenced 2370 bp of mtDNA (ND2, cyt b and ATPase) from 81 individuals of Ergaticus, a complex of birds endemic to the montane forests of Middle America. Although current taxonomy recognizes two species, the results reveal considerable genetic structure with the presence of four mtDNA lineages. Two of these lineages within Ergaticus ruber evidence the need of a revaluation of the species limits for this taxon. The general phylogeographic pattern can be explained as a consequence of relative isolation of the populations in different mountain ranges separated by low elevation barriers. Most population groups did not show signals of demographic expansion with the exception of the one corresponding to clade 1. The divergence time estimates point to the Pleistocene as an important time period for the diversification of this complex.

Determinación de la mutación K76T de la proteína transportadora resistente a Cloroquina de Plasmodium falciparum (PFCRT) en individuos con malaria en una zona de transmisión moderada del Caribe colombiano / Determination of K76T mutation in the Plasmodium falciparum Chloroquine resistance transporter (PFCRT) in people with malaria in a zone of moderate transmission of the Colombian Caribbean

Introducción: La resistencia de Plasmodium falciparum a los antimalaricos, está relacionada con mutaciones puntuales en proteínas esenciales en la biología del parásito. La mutación K76T en la proteína transportadora resistente a Cloroquina (CRT) es un marcador molecular de resistencia a este fármaco. En Colombia se ha reportado una frecuencia del 100% a esta mutación. Objetivo: Determinar la frecuencia de la mutación K76T de CRT en Plasmodium falciparum, infectando sangre de individuos con malaria adquirida en una zona del Caribe Colombiano con transmisión moderada. Materiales y métodos: El ADN del parásito se extrajo de láminas diagnósticas usando Chelex-100. Un fragmento de 148 pb de Pfcrt se amplificó por PCR, la mutación K76T fue determinada por análisis de Polimorfismos en Longitud de Fragmentos de Restricción (RFLP) usando la endonucleasa Apo I, los productos fueron separados por electroforesis en geles de poliacrilamida (PAGE). Resultados: Se estudiaron 66 muestras de individuos con malaria adquirida en seis municipios del Magdalena. Se logró amplificación de Pfcrt en 56 y la mutación T76 fue detectada en 55 (98,2%). La presencia de una muestra con el alelo K76 silvestre indicaría la existencia de reversión de la mutación K76T en Colombia, este fenómeno se ha observado en algunos países del continente africano, donde se reportó recuperación de la sensibilidad a Cloroquina. Conclusión: Este estudio es un primer acercamiento hacia el conocimiento de la resistencia a los antimaláricos en zonas de transmisión moderada en Colombia.

Introduction: The antimalarial drugs resistance from Plasmodium falciparum is related to point mutations in the essential proteins to the parasite biology. The K76T mutation in the Plasmodium falciparum Chloroquine resistance transporter (PFCRT) is a molecular marker resistance to Chloroquine. In Colombia the frequency of this mutation is 100%. Objective: To determine the frequency of K76T mutation in the Plasmodium falciparum CRT, infecting blood from people with malaria in the Colombia Caribbean zone with moderate transmission. Materials and methods: The DNA of the parasite was extracted from diagnostic slide using Chelex-100. A fragment of 148 pb of Pfcrt was amplified by PCR, the K76T mutation was evaluated by Restriction Fragment Length Polymorphism (RFLP) using endonuclease Apo I, the products were separated by polyacrylamide gel electrophoresis (PAGE). Results: Sixty six samples from people with malaria of six municipalities of Magdalena were studied. Fifty six DNA samples amplified of Pfcrt gene, T76 mutation was detected in 55 (98.2%). Occurrence of one sample carried the wild allele K76 would indicated the reversion of K76T mutation in Colombia, this phenomenon has been observed in some countries of the African continent, where recovery of sensitivity to Chloroquine was reported. Conclusions: This study is the first approach towards the knowledge of the antimalarials resistance in zones with moderate transmission in Colombia.

Inserción del DIU posparto en el Perú: Experiencia en nueve hospitales / Pospartum IUD insertion. Experience at nine peruvian hospitals

Este trabajo presenta una revisión de las diferentes estrategias de entrega de servicios de planificación familiar y describe en mayor amplitud la anticoncepción posparto, con énfasis en el dispositivo intrauterino (DIU)). Muestra la experiencia mundial y nacional y, dentro de ella, los resultados de la primera investigación operativa realizadas en el país en nueve hospitales del sector público (5 del Instituto Peruano de Seguridad Social - IPSS- y 4 del Ministerio de Salud- MINSA-) comparando los resultados obtenidos a través de encuestas en el prenatal posparto y seguimiento de una muestra aleatoria de pacientes y usuarias. Se demuestra que la estrategia es aceptable, segura y costo efectiva , y que es una forma de aumentar la prevalencia con métodos de larga duración y de alta seguridad anticonceptiva. Sin embargo, pese a la alta demanda insatisfecha para limitar o espaciar los nacimientos, hay aspectos de mitos y temores por parte de las usuarias con respecto a los diferentes métodos anticonceptivos que deberán ser atendidos con una mejor información y consejería en planificación familiar. Palabras clave: Anticoncepción posparto, DIU posparto, consejería anticonceptiva, costo efectiva, prevalencia.

Cumplimiento de cláusula contractual 6.10 y artículo 7.01 (b) y (d) del anexo A del Contrato de préstamo / Es

El programa integrado de sericios básicos de salud y fortalecimiento institucional del sector (PSF) es un programa de la secretaría nacional de salud, por un monto global de 44,050.000.00 de los cuales 33.900.00 son financiados por el Banco Interamericano de Desarrollo. El componente fortalecimiento de los programas de salud comprende: atención materna, atención infantil, mejoramiento nutricional, mujer salud y desarrollo, fortalecimiento institucional.

Salud para todos en el año 2000: estrategias y política nacional / Health for all by the year 2000: national policy and strategies

Se refiere a la salud en Venezuela, a los antecedentes de la salud para todos en el año 2000. La política nacional de salud, su formulación de estrategias. Los problemas de salud que hay que resolver para llegarse a ese objetivo: crisis asistencial, falta de um sistema de información que permita una toma racional e de decisiones, formación de recursos humanos, cambios en los criterios para la planificación de la salud