[Differences in infant mortality within Bolivia]. / Diferencias de mortalidad infantil dentro de Bolivia.

There was an overall decrease in infant mortality in Bolivia between the national censuses of 1976 and of 1992. That general pattern, however, in fact conceals differences in trends from one department to another, as well as between urban and rural areas. In order to elucidate this situation, in 1996 the reducible differences in mortality were analyzed. This was done by comparing the infant mortality rate in each department of the country with the lowest rate found in the other departments and calculating the possible reduction if all the departments had had the same level of achievement. Using a similar approach, urban areas were compared with rural ones. The results show that in four departments of Bolivia (Beni, Oruro, Pando, and Potosí) the differences in mortality rates increased in comparison to the other departments. That is, in those four departments infant mortality has not fallen as much as could be expected given the general trends in the country. Similarly, the decline in infant mortality rates in the rural areas has lagged behind the decreases seen in urban areas. Quantifying these differences makes it possible to propose goals for the national policy of sustainable human development.

Local health services: some lessons from their evolution in Bolivia.

For a decade, numerous projects in Bolivia have tried to put in practice the concept of local health systems. But, so far, no significant changes have been made and local health services still are the 'poor relation' of the system. The main components of the projects-expansion of health facilities, training of health personnel and institutional decentralization-were not designed to respond to the complexity of the problems encountered. Decentralization was implemented at the level of health districts but not accompanied by redefinition of functions at the central level, and challenged by civil servants' attempts to save their jobs. While training activities did introduce new methods and subjects, they were too often reduced to short workshops or seminars. Health facilities were built without regard for their significance beyond health care. A strategic approach is needed to adapt the planning process to the degree of liberty allowed by society.

[Congenital Chagas in Bolivia: comparative study of the effectiveness and cost of diagnostic methods]. / Chagas congénito en Bolivia: estudio comparativo de la eficacia y el costo de los métodos de diagnóstico.

Eight hundred and twenty newborn babies with a mean weight of < or = 2500g from the Maternity Hospital P Boland in Santa Cruz- Bolivia were examined in 1988-1989 by different methods to diagnose Chagas disease, (placental pathology, serology, parasitologically and clinically) to determine the efficiency and cost of these methods. The histopathological exam detected 87 cases of placenta infection. Out of this total 43 (49%) newborns were positive on the parasitological exam of the chord blood. This number increased by repeating the blood test during the first month of the baby's life, reaching the same level as the histopathology. With the serology, only 2 cases were detected as positive. The clinical sign with a high specificity in children infected with Chagas disease is the hepatosplenomegaly. The advantages and disadvantages regarding the cost and feasibilty of two strategies to detect congenital Chagas disease are being discussed. The first in based on the histopathology and the other over on parasitology. It is concluded that the control programs for this non vectorial form of Chagas' disease cannot be uniform since the aspects to consider are: prevalence of the disease, existence of the vector and availability to laboratory techniques.

[Infectious complications during treatments with interleukin-2]. / Complications infectieuses au cours des traitements par l'interleukine 2.

Between January 1989 and May 1991, 97 patients were treated with interleukin 2 in the Oncology Department of the Avicenne Hospital (Bobigny, France). IL 2 was given over 5 days by continuous infusion through an implantable port. Ten patients (4 males, 6 females), mean age 46 years (36-67) with various cancers (breast 3, kidney 1, melanoma 1, colorectal 5), developed infection: 4 local infections around the port, 1 phlebitis, 4 septicemias, 1 bacteremia were observed. In 9 cases blood cultures were positive: Staphylococcus aureus 5, Staphylococcus epidermidis 3, Streptococcus G 1. In 5 cases the same pathogen was isolated from the port and from the blood. The mean leucocyte count was 10,627/mm3 at the time of infection. The delay between the beginning of interleukin 2 treatment and the infection was 3 months. The mean dose of IL 2 administered before infection was 456 million IU. In all cases infection was controlled without lethal complication by antibiotics and catheter removal. This high incidence (8 percent) of staphylococcal infection is partly due to the skin toxicity of IL 2 and to depressed neutrophil chemotactic response. Prophylactic antibiotics are warranted during IL 2 intravenous therapy.

[Prospective study of Chagas disease in newborn children with placental infection caused by Trypanosoma cruzi (Santa Cruz-Bolivia)]. / Estudio prospectivo de la enfermedad de Chagas en recién nacidos con infección placentaria por Trypanosoma cruzi (Santa Cruz-Bolivia).

In order to know the significance of placental infection by T. cruzi 820 newborn infants (NB) weighing less than or equal to 2500 grs were examined both clinically and by the Strout method and histopathological sections of the placenta in order to detect congenital infection with Chagas' disease. Thirty five (4.26%) NB presented a placentary infections by T. cruzi, but having a negative direct parasitological examination in the cord blood, these NB were followed up parasitologically (microhematocrit), in order to detect an eventual positive change in the post-partum period. The follow-up was done at 7, 15, 30 and 60 days after birth, and with xenodiagnosis 15 days later. In 27 newborn (3.29%) it was possible to complete their follow-up with detection of T. cruzi in every case. In the control group, constituted by NB which were negative to both methods, there was no positivisation at all during the follow-up period. These observations show a high frequency of congenital T. cruzi infection in Santa Cruz.

Leishmaniasis en Bolivia: presencia de dos casos complejos de leishmania en los llanos orientales del departamento de Santa Cruz-Bolivia / Leishmanias in Bolivia: presence of two leishmania complexes cases coming fron the tropical zone of Santa Cruz-Bolivia

The authors showed by biological, immunological and biochemical studies, the presence of two leishmania complexes L.braziliensis and L.mexicana, isolated from cutaneous lesions in patients, coming from the tropical zone of Santa Cruz_Bolivia

Congenital Chagas' disease in Bolivia: epidemiological aspects and pathological findings.

In 329 newborns examined by the method of Strout and/or histopathological sections of the placenta, Trypanosoma cruzi was observed in 25 cases. The serological prevalence of Chagas' disease in mothers was 51%. A greater risk of congenital transmission was observed in newborns ranging between 1,001 and 2,500 g (21%), compared to 2% in newborns weighing more than 2,500 g. Congenital transmission occurred predominantly in newborns with a gestational age of 26 to 37 weeks. Histopathological examination of placentae disclosed T. cruzi in 6.3%. In areas with a high prevalence of Chagas' disease, congenital transmission is a real hazard.