Use of rapid diagnostic tests (RDTs) for conclusive diagnosis of chronic Chagas disease - field implementation in the Bolivian Chaco region.

Chagas disease, caused by the parasite Trypanosoma cruzi, is the neglected tropical disease with a highest burden in Latin America. Its acute stage is mostly asymptomatic and goes unnoticed. Symptoms appear at the chronic stage, which is when diagnosis is usually made. This is based on the agreement of two conventional serological tests such as Enzyme-Linked Immunosorbent Assays (ELISAs). There are commercial kits with good sensitivity and specificity but their use is impractical in many highly endemic regions with poorly equipped laboratories. Luckily, several rapid diagnostic tests (RDTs) are available for the detection of anti-T. cruzi immunoglobulins. They are easy to operate, require no cold storage, provide fast turnaround of results, and some can work with a tiny volume of whole blood as sample. With the aim to field validate their use we compared an alternative algorithm based on a combination of RDTs with the standard based on ELISAs. In both cases a third test was available in case of discordance. RDTs were implemented by mobile teams in field campaigns to detect chronic T. cruzi-infections in the Chaco region of Bolivia. ELISAs were made in the reference laboratories located in the main hospitals of Yacuiba and Villa Montes, two major cities of the region. We enrolled 685 subjects who voluntarily participated in the study and had not been treated against the disease before. The agreement between the two main RDTs was 93.1% (638/685) (kappa index = 0.86; CI 95% 0.83-0.90). In comparison to the ELISAs algorithm, the combined use of the RDTs provided a sensitivity of 97.7% and a specificity of 96.1%. These results support the use of RDTs for the diagnosis of chronic Chagas disease in the studied region, and encourage their evaluation in other regions of Bolivia and other endemic countries.

Evaluación de la atención de enfermería por gestantes que asisten a un programa de control prenatal de Malambo-Atlántico (Colombia) / Evaluation of nursing care by pregnant women attending a prenatal control program of Malambo ­ Atlantico (Colombia)

INTRODUCCIÓN: Los programas de control prenatal se constituyen en una estrategia de atención primaria que forma parte de un proceso de protección específica destinado a fomentar la salud de la madre, el feto y la familia, en este sentido, el profesional de enfermería cumple un rol fundamental dentro del equipo de salud. Por ello, el objetivo del presente trabajo fue evaluar la atención de enfermería en un Programa de Control Prenatal de una Institución Prestadora de Servicios de Salud de Malambo ­ Atlántico desde la opinión de las gestantes. METODOLOGÍA: Se desarrolló un estudio cuantitativo, de tipo descriptivo y transversal, en el que se encuestaron 20 gestantes pertenecientes al programa de control prenatal, teniendo en cuenta aspectos éticos y metodológicos de rigor. RESULTADOS: Los aspectos mejor valorados por las gestantes en la atención prenatal fueron: la información que la enfermera le proporciona y la vigilancia de los signos vitales. Los aspectos peor valorados fueron: la vigilancia de la dieta y la educación con respecto al cuidado futuro de su hijo. El 45% manifestó que la atención de enfermería durante el control prenatal fue buena. DISCUSIÓN: Las gestantes perciben buena atención de enfermería en el programa de control prenatal, pero requieren mayor educación sobre signos de alarma, cuidado del bebé y hábitos alimenticios. Hallazgo coherente con estudios previos revisados. CONCLUSIONES: La Institución necesita establecer estrategias de mejoramiento de la calidad de la atención para fortalecer las acciones de demanda inducida y protección específica.

INTRODUCTION: Prenatal care programs constitute a primary care strategy that is part of a specific protection process aimed at promoting the health of the mother, the fetus and the family. In this sense, the nursing professional plays a role fundamental within the health team. Therefore, the objective of the present study was to evaluate the nursing care in a Prenatal Control Program of a Health Services Provider Institution of Malambo -Atlántico from the opinion of the pregnant women. METHODOLOGY: A quantitative, descriptive and cross-sectional study was conducted in which 20 pregnant women from the prenatal control program were surveyed, taking ethical and methodological aspects into account. RESULTS: The aspects most valued by pregnant women in prenatal care were: information provided by the nurse and vital signs surveillance. The least valued aspects were: monitoring of diet and education regarding the future care of your child. 45% stated that nursing care during prenatal care was good. DISCUSSION: Pregnant women perceive good nursing care in the prenatal control program, but require more education about signs of alarm, baby care and eating habits. Findings consistent with previous studies reviewed. CONCLUSIONS: The Institution needs to establish strategies to improve the quality of care to strengthen the actions of induced demand and specific protection.