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PubMed1999

Prevalence of antibodies against hepatitis A and E viruses among rural populations of the Chaco region, south-eastern Bolivia.

We conducted a cross-sectional study to determine the seroprevalence of antibodies against hepatitis A and hepatitis E viruses (HAV and HEV) in the population of two rural areas, Camiri and Villa Montes, of the Chaco region, south-eastern Bolivia. HAV antibodies were detected in 461 (94.1%) of 490 serum samples tested, not differing significantly between sexes and study areas. The HAV seropositivity rate (64.7%) was high even in the youngest age group (1-5 years). The prevalence of HEV was 7.3%, with no significant differences between sexes. The prevalence of HEV antibodies in the population of the Camiri area (10.4%) was significantly higher than in the Villa Montes area (4.4%), possibly due to the better quality of drinking water in the Villa Montes area. In the population </= 30 years of age, the HEV seropositivity rate (4.4%) was significantly lower than in the >/= 31 year-old group. This is consistent with findings in other countries. This is the first report of the prevalence of HEV infection in Bolivia.

Adolescent↗

PubMed2003

Domiciliation process of Rhodnius stali (Hemiptera: Reduviidae) in Alto Beni, La Paz, Bolivia.

We report a systematic collection of Triatominae inside houses and in the peridomestic environment of Alto Beni, department of La Paz, Bolivia. This area is free of Triatoma infestans and although we detected previously seropositivity for Trypanosoma cruzi, the Alto Beni region is not officially considered as endemic for Chagas disease. From 11 houses of five localities, we collected adults, nymphs and eggs of a Rhodnius species, which was confirmed by morphological and morphometric analysis as Rhodnius stali. This little-known species has long been confused with R. pictipes, and was originally described from museum specimens labelled as R. pictipes. Our data show that R. stali is able to establish colonies in domestic and peridomestic habitats in Bolivia, and it is probably the vector responsible for Chagas disease seropositivity observed in the indigenous population of Alto Beni.

Animals↗

PubMed2001

New Pudicinae (Trichostrongylina, Heligmosomoidea) coparasites of Proechimys longicaudatus (Caviomorpha) from Bolivia. I--Description of Pudica ginsburgi n. sp. and Heligmostrongylus chiarae n. sp.

Two new Pudicinae (Trichostrongylina, Heligmosomoidea, Heligmonellidae) coparasites of Proechimys longicaudatus (Caviomorph rodent) from Bolivia are described: Pudica ginsburgi n. sp. is differentiated from all the other species of the genus by the great length of the spicules and of the vestibule and by a different ratio of the length of the spicules on the length of the body. Heligmostrongylus chiarae n. sp. has very developed rays 4, strongly divergent from rays 5 as occurs in three other species, H. almeidai (Durette-Desset & Tcheprakoff, 1969), a parasite of Trichomys apereoides (= Cercomys cunicularius) from Brazil, H. squamastrongylus (Travassos, 1937), a parasite of Proechimys oris from Brazil and H. proechimysi Durette-Desset, 1970, a parasite of Proechimys semispinosus from Columbia. The specimens from Bolivia are differentiated from the three species by the division of the dorsal ray (anterior half versus posterior half) and by a different ratio of the length of the spicules on the length of the body.

Animals↗

PubMed1998

Morphometrics of domestic Panstrongylus rufotuberculatus in Bolivia.

The trend to domesticity in Triatominae may represent a transitionary phase, towards increasing vectorial importance in the transmission of Chagas disease to humans, and requires sustained entomological surveillance. Although generally considered a sylvatic species, Panstrongylus rufotuberculatus has been recently captured inside human dwellings in the provinces of Nor Yungas and Muñecas in the Department of La Paz, Bolivia, providing evidence of this species' ability to colonise domestic habitats. The results of previous research on domestic and sylvatic specimens of other species of Triatominae indicate that morphometrics could be used to monitor this adaptive process. The most likely cause of differences seen in the size and shape of bugs from domestic colonies of P. rufotuberculatus from two neighbouring villages in Bolivia is probably genetic drift rather than environmental influences. Comparison with allopatric sylvatic specimens, including the holotype of P. rufatuberculatus, showed a general reduction in size from sylvatic to domestic specimens.

Animals↗

PubMed2003

Incidence of surgical-site infections and the validity of the National Nosocomial Infections Surveillance System risk index in a general surgical ward in Santa Cruz, Bolivia.

OBJECTIVES: To estimate the frequency of and risk factors for surgical-site infections (SSIs) in Bolivia, and to study the performance of the National Nosocomial Infections Surveillance (NNIS) System risk index in a developing country. DESIGN: A prospective study with patient follow-up until the 30th postoperative day. SETTING: A general surgical ward of a public hospital in Santa Cruz, Bolivia. PATIENTS: Patients admitted to the ward between July 1998 and June 1999 on whom surgical procedures were performed. RESULTS: Follow-up was complete for 91.5% of 376 surgical procedures. The overall SSI rate was 12%. Thirty-four (75.6%) of the 45 SSIs were culture positive. A logistic regression model retained an American Society of Anesthesiologists score of more than 1 (odds ratio [OR], 1.87), a not-clean wound class (OR, 2.28), a procedure duration of more than 1 hour (OR, 1.81), and drain (OR, 1.98) as independent risk factors for SSI. There was no significant association between the NNIS System risk index and SSI rates. However, a "local" risk index constructed with the above cutoff points showed a linear trend with SSI (P < .001) and a relative risk of 3.18 for risk class 3 versus a class of less than 3. CONCLUSIONS: SSIs cause considerable morbidity in Santa Cruz. Appropriate nosocomial infection surveillance and control should be introduced. The NNIS System risk index did not discriminate between patients at low and high risk for SSI in this hospital setting, but a risk score based on local cutoff points performed substantially better.

Adult↗

PubMed2000

Molecular characterization of human immunodeficiency virus type 1-infected individuals from bolivia reveals the presence of two distinct genetic subtypes B and F.

Thirty HIV-1-positive samples from Bolivia were genetically characterized on the basis of HMA and DNA sequencing, revealing the presence of B and F subtypes, in accordance with the molecular epidemiology pattern already described for other South American countries such as Brazil and Argentina. The interpatient divergence of subtype B Bolivian specimens was on average 14.2% (4.3-19.8%) at the nucleotide level, whereas the two unlinked subtype F samples (BO23 and BO29) were only 8.2% divergent, suggesting a more recent introduction of this subtype in the country. In our study group, which represents 13% of the HIV/AIDS cases already described in Bolivia as of May 1996, the transmission occurred more frequently through heterosexual exposures (46.7%), followed by homosexual (23.3%), bisexual (10%), intravenous drug use (3.3%), and vertical (3.3%); in one case the potential exposure category could not be defined (3.3%). No association could be established between exposure categories, gender, or clinical classification and subtype distribution in the Bolivian HIV/AIDS patients.

Adult↗

PubMed1980

Prevalence and cost of illness episodes in rural Bolivia.

As part of a demonstration project to improve the delivery of health services in rural Bolivia, a household survey of 3372 persons (98% participation) was conducted in the Montero region of eastern Bolivia during the last 3 months of 1977. The population surveyed was relatively young, 52% less than 15 years of age. Spells of illness occurring during the 14 days prior to the survey were reported by 42% of the population. Nearly half (46%) of these symptomatic illnesses, here defined as illness episodes, were respiratory or gastrointestinal problems, and medical assistance was sought for 21% of them. Physicians were consulted by 70% of the persons who sought medical assistance. Only 39% of persons disabled 3 or more days by a symptomatic illness obtained medical assistance. The average expenditure for illness episodes during the preceding 2 weeks was $2.13 per person, 76% for medication, 15% for fees, 5% for transportation, and 4% for other expenses. The results of this survey are intended to aid the Bolivian government in planning more effectively for improved rural health services.

Adolescent↗

PubMed2004

Parental pregnancy intention and early childhood stunting: findings from Bolivia.

BACKGROUND: This study examined the impact of maternally reported pregnancy intention, differentiating unwanted and mistimed pregnancies, on the prevalence of early childhood stunting. Additionally, it examined the influence of paternal pregnancy intention status. METHODS: Data were collected from a nationally representative sample of women and men interviewed in the 1998 Bolivia Demographic and Health Survey. The sample was restricted to lastborn, singleton children younger than 36 months who had complete anthropometric information. Multivariable logistic regression examined the association between pregnancy intention and stunting. RESULTS: Children from unwanted and mistimed pregnancies comprised 33% and 21% of the sample, respectively. Approximately 29% of the maternally unwanted children were stunted as compared to 19% among intended and 19% among mistimed children. Children 12-35 months (toddlers) from mistimed pregnancies (adjusted prevalence risk ratio [PR(adj)] 1.33, 95% confidence interval [CI]: 1.03-1.72) and unwanted pregnancies (PR(adj) 1.28, 95% CI: 1.04-1.56) were at about a 30% greater risk for stunting than children from intended pregnancies. Infants and toddlers with both parents reporting them as unwanted had an increased risk of being stunted as compared with children both of whose parents intended the pregnancy. No association was found for infants less than 12 months. CONCLUSIONS: Reducing unintended pregnancies in Bolivia may decrease the prevalence of childhood growth stunting. Children born to parents reporting mistimed or unwanted pregnancies should be monitored for growth stunting, and appropriate interventions should be developed. Measurement of paternal pregnancy intention status is valuable in pregnancy intention studies.

Bolivia↗

PubMed1995

Sylvatic triatomines (Hemiptera: Reduviidae) in Bolivia: trends toward domesticity and possible infection with Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae).

The risk of domestic transmission of Trypanosoma cruzi (Chagas) by sylvatic triatomines was assessed in an isolated area of the subandean region of Bolivia. None of the 390 residents examined had serological evidence of infection. Two sylvatic triatomine species, Eratyrus mucronatus (Stål) and Triatoma sordida (Stål), were found in houses and in peridomestic structures. The collection of nymphal instars of both species from some houses indicated possible domesticity. Microscopic examination of feces from 92 insects showed no parasites, and cultures from the guts of 30 insects were negative. Nevertheless, a polymerase chain reaction (PCR) test performed on the same fecal samples showed the presence of T. cruzi DNA in 19.1 and 12.5% of E. mucronatus and T. sordida, respectively. These 16 PCR-positive samples were hybridized with 2 T. cruzi-specific probes known from the domestic cycle in Bolivia (clones 20 and 39). At least 1 of these clones was identified in 7 bugs (5 E. mucronatus and 2 T. sordida). Moreover, no hybridization was observed with these probes in S E. mucronatus and 1 T. sordida samples that showed an amplified band by PCR. These data indicated that T. cruzi clones, genetically unrelated to clones 20 and 39, also were circulating in this area. Based on these results, the 2 sylvatic triatomine species encountered in Apolo should not be overlooked as possible local vectors of T. cruzi.

Animals↗

PubMed1997

Metric differences between silvatic and domestic Triatoma infestans (Heteroptera: Reduviidae) in Bolivia.

One hundred and fifty-seven specimens of Bolivian Triatoma infestans (Klug 1834), including 44 from the silvatic focus at Cochabamba (Bolivia), were compared using morphometric characters of the head capsule. From these specimens, 10 silvatic and 28 domestic adults were also compared using additional morphometric characters of the membranous part of the hemelytra. Nonparametric univariate comparisons between specimens from silvatic and domestic ecotopes indicated the importance of the postocular region as a possible diagnostic character for nymphs and adults from the different ecotopes, and they detected wing differences in males. Populations became more distinct entities when head or wing characters were considered jointly in canonical variate analysis. Regardless of whether size variation was considered, canonical variate analysis generally showed greater significance for wing than for head features. These morphological differences between silvatic and domestic bugs, particularly unrelated to size differences, are interpreted to indicate incipient separation between silvatic and domestic populations that had not been detected by previous isoenzyme analyses, and suggest a reinterpretation of the epidemiological significance of silvatic populations of T. infestans in Bolivia.

Analysis of Variance↗

PubMed2007

Analysis of the operational costs of using rapid syphilis tests for the detection of maternal syphilis in Bolivia and Mozambique.

OBJECTIVE: The objective of this study was to compare the costs of antenatal syphilis screening with the rapid plasma reagin (RPR) test and the immunochromatographic strip (ICS) test in low-resource settings. GOAL: The goal of this study was to assess the costs of introducing rapid syphilis tests to reduce maternal and congenital syphilis. STUDY DESIGN: Cost data were collected from participating study hospitals and antenatal clinics during 4 field visits to the 2 countries in 2003 and 2004. Health utilization outcome data on the number of women screened and treated routinely during the demonstration projects were used with unit cost data to estimate the incremental costs and average cost per woman screened and treated for maternal syphilis. RESULTS: In Mozambique, the average cost per woman screened was U.S. $0.91 and U.S. $1.05 for the RPR and ICS tests, respectively. In Bolivia, the average cost of screening was U.S. $1.48 and U.S. $1.91 using the RPR and ICS test, respectively. In health centers without laboratories, the cost per woman screened using the ICS test ranged from U.S. $1.02 in Mozambique to U.S. $2.84 in Bolivia. CONCLUSIONS: It is feasible to introduce rapid syphilis testing in settings without laboratory services at a small incremental cost per woman screened. In settings with laboratories, the cost of ICS is similar to that of RPR.

Ambulatory Care Facilities↗

PubMed1995

Major enteropathogenic bacteria isolated from diarrheal patients in Bolivia: A hospital-based study.

A total of 1,234 fecal samples from diarrhea cases were examined for etiological bacterial agents at medical facilities in La Paz and Sucre, Bolivia. Eighty strains of Shigella spp., 39 strains of Salmonella spp., 29 strains of Vibrio cholerae, and 222 strains of enteropathogenic Escherichia coli (139 EPEC, 55 ETEC, 29 EIEC, and 1 EHEC) were isolated. With regard to the serovars of Shigella, S. flexneri 2a, 3a, and 1b were predominant. In the case of Salmonella, S. enteritidis was the most common, followed by S. typhi, S. poona, and S. paratyphi B. Out of 29 cholera strains, 25 belonged to biovar El Tor, serovar Ogawa while the remaining 4 were serovar Inaba. Among 55 strains of ETEC serotypes, 5 showed ST producers but none showed LT producers. Likewise, among 55 strains of enterohemorrhagic serotypes, only one strain (O157:H7) produced verocytotoxin (VT 2). The results of drug sensitivity tests revealed the predominance of Shigella, EPEC, and ETEC strains resistant to aminobenzil-penicillin (ABPC) and trimethoprim. Since diarrheal patients in Bolivia are treated mainly with ABPC or sulfamethoxazole/trimethoprim (SXT) and rarely with gentamicin, kanamycin, or other drugs, it is possible that ABPC- and SXT-resistant strains will increase and persist in the near future.

Adolescent↗

PubMed2005

Collaboration between private pharmacies and national tuberculosis programme: an intervention in Bolivia.

BACKGROUND: Public-private partnerships are felt to be necessary for tuberculosis (TB) control in some developing countries. OBJECTIVES: To evaluate the potential of a collaboration between the National TB Programme (NTP) and private pharmacies in Bolivia, the country with the highest TB incidence in Latin America. METHODS: We contacted the local Pharmacists' Association in the city of Cochabamba, and designed a two phase intervention. The objectives of the first phase were to decrease the availability of TB drugs in private pharmacies on a voluntary basis, and to improve referral of clients seeking TB drugs to the NTP. A survey of all pharmacies allowed for a before-after comparison with a baseline survey. The objectives of the second phase were to obtain referral of pharmacy clients with chronic cough for TB screening in the NTP. This phase was started in 70 pharmacies and evaluated after 2 months using the referral slips issued by the pharmacists. RESULTS: The proportion of pharmacies selling TB drugs decreased (rifampicin: 23-11.5%; isoniazid: 16-3.1%; P<0.001) and the proportion of pharmacies referring to the NTP clients seeking TB drugs increased (22-58%; P<0.0001). In the second phase, 26 of 70 pharmacies (38%) referred a total of 41 clients for screening in the NTP (i.e. an average of 0.29 clients per pharmacy and per month); 11 of 41 (27%) were screened and three of 11 (27%) diagnosed with smear-positive TB. CONCLUSION: The first phase of the intervention proved effective in reducing the availability of the main TB drugs in pharmacies, and in improving referral of clients seeking TB drugs. Key factors in this success were not specific to Bolivia, and collaboration between private pharmacies and public services appears possible in that respect. However, collaboration with pharmacies does not seem an efficient way to increase the number of patients screened for TB, and to shorten delays to TB diagnosis and treatment.

Antitubercular Agents↗

PubMed1997

Serologic survey for antibodies to Borrelia burgdorferi in sheep, goats and dogs in Cordillera Province, Bolivia.

A serosurvey for antibodies to Borrelia burgdorferi using an enzyme-linked immunosorbent assay (ELISA) was conducted on sheep, goat and dog serum samples collected in Cordillera Province, Bolivia, in 1992 Sera from 98 sheep, 218 goats and 43 dogs were tested. The observed seroprevalence in sheep and dogs was 0.0%, whereas the seropositivity rate for goat serum samples was 5.0%. Upon analysing 10 positive sera by Western immunoblotting, five reacted against the specific protein antigens and all of them met the criteria for positivity on the basis of immunoglobulin G (IgG) bands, indicating that goats in Cordillera Province were exposed to B. burgdorferi. These findings, which are further proof of the existence of B. burgdorferi infection in Bolivia, indicate the serologic analysis of goats as a suitable tool for Lyme borreliosis surveillance.

Animals↗

PubMed2004

Detection of CTX-M-type beta-lactamase genes in fecal Escherichia coli isolates from healthy children in Bolivia and Peru.

A survey was carried out from August to November 2002 to evaluate the antimicrobial susceptibilities of fecal Escherichia coli isolates from 3,208 healthy children from four different urban areas of Latin America, two in Bolivia (Camiri and Villa Montes) and two in Peru (Yurimaguas and Moyobamba). Ceftriaxone-resistant E. coli isolates were detected in four children, one from each of the areas sampled. The isolates exhibited a multidrug-resistant phenotype, including resistance to oxyimino-cephalosporins and aztreonam, and the MICs of ceftazidime for the isolates were lower than those of cefotaxime. By PCR and sequencing, the bla(CTX-M-2) determinant was detected in three isolates and the bla(CTX-M-15) determinant was detected in one isolate (from Peru). The CTX-M-2-producing isolates belonged to three different phylogenetic groups (groups A, B2, and D), while the CTX-M-15-producing isolate belonged to phylogenetic group D. The bla(CTX-M-2) determinants were transferable to E. coli by conjugation, while conjugative transfer of the bla(CTX-M-15) determinant was not detectable. Plasmids harboring the bla(CTX-M-2) determinant exhibited similar restriction profiles, and in all of them the gene was located on a 2.2-kb PstI fragment, suggesting a genetic environment similar to that present in In35 and InS21. The findings of the present study confirm the widespread distribution of CTX-M-type beta-lactamases and underscore the role that commensal E. coli isolates could play as a potential reservoir of these clinically relevant resistance determinants. This is the first report of CTX-M-type enzymes in Bolivia and Peru and also the first report of the detection of CTX-M-15 in Latin America.

Bolivia↗

PubMed2004

A comparative analysis of abandoned street children and formerly abandoned street children in La Paz, Bolivia.

AIMS AND METHODS: A comparative study of abandoned street children and formerly abandoned street children was conducted in La Paz, Bolivia, representing the first such comparative assessment. Between August and December 1997, all abandoned street children in La Paz, Bolivia, who were willing to participate (n = 124) were interviewed repeatedly at night using standardised questionnaires to collect information on family history, demographics, socioeconomics, drug use, and physical/sexual abuse. The same questionnaires were administered to all former abandoned street children who chose to enter a local orphanage (n = 35). RESULTS: The persistent street children differed greatly from those who entered the orphanage, most markedly in their higher risk of police abuse (95% versus 38%), absence from school (84% versus 19%), engagement in robbery (26% versus 4%), paint thinner use (88% versus 41%), alcohol use (58% versus 12%), and a serious medical problem (53% versus 20%). The risks for street children increased rapidly with age. CONCLUSIONS: A cascade of adverse outcomes afflicts the vast majority of abandoned street children in La Paz, which cumulate with age and diminish the likelihood of successful rehabilitation through lasting placement in an orphanage or residential home. Informed by these findings, the investigators operate a home for abandoned street children in La Paz.

Absenteeism↗

PubMed2006

Generic sodium stibogluconate is as safe and effective as branded meglumine antimoniate, for the treatment of tegumentary leishmaniasis in Isiboro Secure Park, Bolivia.

Human cutaneous leishmaniasis (CL) and mucous leishmaniasis (ML) are highly endemic in Isiboro Secure Park, which lies in the Bolivian department of Cochabamba--an area where branded meglumine antimoniate (Glucantime) is expensive and poorly distributed. The safety and efficacy of generic sodium stibogluconate (SSG), from Albert David Ltd, was therefore explored, in CL and ML cases from the park, who were treated with 20 mg/kg.day for 20 and 30 days, respectively. A questionnaire recording adverse effects was completed by a physician in each treatment centre. Efficacy of treatment was assessed at the end of treatment and at follow-ups 1 month and 3, 6 and 12 months later. Overall, 146 patients completed treatment with SSG in 2003-2004. No fatalities or severe adverse effects were reported but mild to moderate adverse effects were noted in 41 (28%) of the patients. The incidence of adverse effects was significantly higher among the cases of ML than among the cases of CL. Of the 86 patients with CL who completed 6 months of follow-up, 81 (94.2%) were considered to have been clinically cured; a comparable cohort of 69 CL cases who had been treated with Glucantime in 2001-2002 showed a similar frequency of clinical cure (90%). Generic SSG was shown to be safe and efficacious for the treatment of tegumentary leishmaniasis in Bolivia. Being several times cheaper than Glucantime, it could contribute to improving the access of CL and ML patients to treatment, not only in Bolivia but also in other countries of Latin America.

Adult↗

PubMed1999

Prevalence of epilepsy in rural Bolivia: a door-to-door survey.

OBJECTIVE: To carry out a door-to-door survey in rural areas of the Cordillera Province, Santa Cruz Department, Bolivia, to determine the prevalence of neurologic diseases (epilepsy, stroke, parkinsonism, and peripheral neuropathy) in a sample of approximately 10,000 inhabitants. METHODS: A team of nondoctor health workers administered a standard screening instrument for neurologic diseases-a slightly modified version of the World Health Organization protocol. All subjects found positive during the screening underwent a neurologic examination. RESULTS: On screening, the authors found 1,130 positive subjects, of whom 1,027 were then investigated by neurologists. On the basis of the definition proposed by the International League Against Epilepsy, we detected 124 epileptic patients (prevalence, 12.3/1,000), 112 of whom had active epilepsy (prevalence, 11.1/1,000) on the prevalence day (November 1, 1994). Peak age-specific prevalence occurred in the 15 to 24-year age group (20.4/1,000). Sex-specific prevalence was higher in women (13.1/1,000) than men (11.4/1,000). Eighty-nine patients (71.8%) underwent a standard EEG recording. Considering both EEG and clinical data, partial seizures were the most common type (53.2%) based on the classification of the International League Against Epilepsy. The mean age at onset was 20.7 years for partial seizures and 13.6 years for generalized seizures. Only 10.5% of patients had received specific treatment for more than 2 months of their life. CONCLUSION: This report on epilepsy prevalence in Bolivia confirms that epilepsy is a major health problem in rural areas of developing countries.

Adolescent↗