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PubMed2002

Determinants of optimal breast-feeding in peri-urban Guatemala City, Guatemala.

OBJECTIVE: This survey was conducted to identify factors affecting early initiation of breast-feeding and exclusive breast-feeding among mothers in peri-urban Guatemala City, Guatemala. MATERIALS AND METHODS: In early November 1999 a census was begun in four communities of peri-urban Guatemala City, Guatemala, to identify all children < 6 months old as well as all pregnant women who were expected to deliver during the two-month data-gathering period. After the census was completed, a survey of breast-feeding practices was administered to all mothers of infants < 6 months of age. RESULTS: The most important determinant of early initiation of breast-feeding was place of delivery. Children born at home (odds ratio (OR) = 4.1, 95% confidence interval (CI): 1.2-13.3) and at Ministry of Health health centers (OR = 4.9, 95% CI: 1.6-15.0) were significantly more likely than children born at private hospitals to initiate breast-feeding early. The most important determinant of exclusive breast-feeding was whether or not the mother worked outside the home. After controlling for infant's age and sex and mother's ethnicity, women who did not work outside the home were 3.2 times as likely (95% CI: 1.6-6.4) to exclusively breast-feed as were women who worked outside the home. Lack of exclusive breast-feeding was often associated with giving a bottle. CONCLUSIONS: Our findings suggest that global efforts must be continued to improve breast-feeding practices in delivery hospitals. In addition, community-based support of breast-feeding is needed well after delivery. Mothers who work outside the home should be provided with options to maintain exclusive breast-feeding when they are physically separated from their infants due to the demands of work.

Adult↗
PubMed2002

The impact of mother-to-mother support on optimal breast-feeding: a controlled community intervention trial in peri-urban Guatemala City, Guatemala.

OBJECTIVE: To assess the impact that a mother-to-mother support program operated by La Leche League Guatemala had on early initiation of breast-feeding and on exclusive breast-feeding in peri-urban Guatemala City, Guatemala. MATERIALS AND METHODS: A population census was conducted to identify all mothers of infants < 6 months of age, and the mothers were then surveyed on their breast-feeding practices, in two program communities and two control communities. Data collection for this follow-up census and survey was carried out between November 2000 and January 2001, one year after a baseline census and survey had been conducted. RESULTS: At follow-up, 31% of mothers in the program communities indicated that counselors had advised them about breast-feeding, 21% said they had received a home visit, and 16% reported attending a support group. Community wide rates of early initiation of breast-feeding were significantly higher in program areas than in the control communities, at both baseline and follow-up. However, the change over time in early initiation in program communities was not significantly different from the change in control communities. Community wide rates of exclusive breast-feeding were similar in program and control sites and did not change significantly from baseline to follow-up. However, of the mothers in the program communities who both received home visits and attended support groups, 45% of them exclusively breast-fed, compared to 14% of women in program communities who did not participate in those two activities. In addition, women who were exposed to mother-to-mother support activities during the year following the baseline census and survey were more likely than mothers exposed before that period to exclusively breast-feed. This suggests that the program interventions became more effective over time. CONCLUSIONS: This study does not provide evidence of population impact of La Leche League's intervention after one year of implementation. In peri-urban Guatemala, long-term community-based interventions, in partnership with existing health care systems, may be needed to improve community wide exclusive breast-feeding rates.

Adult↗
PubMed1995

Guatemala: maternal mortality in Guatemala: assessing the gap, beginning to bridge it.

Developing countries which have somewhat reliable vital statistics but poor or incomplete information about maternal mortality must make the most of the data available. Such data may require modification for maternal mortality analyses. What is important, however, is the decision to use available information and to analyse it properly. The analysis of maternal mortality in Guatemala, using data from 1986 birth and death certificates, identified particular areas, health regions, and particular ethnic groups that had significantly higher maternal mortality ratios than others. Small but disproportionately affected populations that had no available maternal health assistance were identified-a problem found in many developing countries. These groups urgently need the services of traditional birth attendants or other forms of assistance before, during and after delivery. The analysis of vital statistics led to the beginning of operative research and the collection of background information for establishing an epidemiologic surveillance programme for maternal mortality.

Adolescent↗
PubMedDate not supplied

[Leprosy in Guatemala 1982].

Leprosy is an endemic disease in Guatemala. The author presents a brief account of the Leprosy situation, from the year of 1527 to January first, 1982. During the early years of the Guatemala's colonial epoch, Leprosy was also named "Lazarus illness". From the years of 1530 to 1874, the leprosy patients, were successively attended in the following hospitals: 1) "The Mercy Hospital" in 1530; 2) "The Saint Lazarus Hospital" in 1638; 3) "The Piety Asylum" in 1874; and 4) "The Ramiro Galvez Leprosarium" in 1972. In 1973, was founded the "Guatemala Leprosy Patronage" and also, it created the the INSTITUTE OF DERMATOLOGY, also named INDERMA. From January first of 1973 to January first of 1982, INDERMA taked care and and treated, in its Guatemala city hospital and out patients clinics, the following cases: I. Patients with diseases of the skin, 79,241, II. New leprosy patients plus periodical consults (every 3 months) of old and known leprosy patients, during 9 consecutive years, 3,685, III. Clinical controls and consults of suspicious contacts, 6,188, IV. The INDERMA's rural anti leprosy campaign and their mobil units, take care and clinically examined healthy persons, 12,096, Among this group, were discovered 137 new leprosy patients. The total amount of INDERMA's health services, til I/82, 101,206. The rural anti leprosy campaign, has confirmed that the north oriental zone is the endemic area of Guatemala (Photo 7). Until today (I/1982) there are 410 verified cases of Leprosy in Guatemala. Among them, the predominant leprosy type, is the lepromatous one, with 49,04%. 62,43% of the leprosy patients are male. Of the age group, the 30 to 39 year old, predominates with 19,24%. The prevalence and density leprosy index, were verified only in the endemic zone with 24 257 square kilometers and 0,564% and 1 441 290 population = 0,345%. Actually, as the endemic leprosy area is controlled, INDERMA has continued the study and care of the leprosy patients in the rest of the Guatemala republic.

Adolescent↗
PubMed2002

Country response to HIV/AIDS: national health accounts on HIV/AIDS in Brazil, Guatemala, Honduras, Mexico and Uruguay.

National expenditures on HIV/AIDS were estimated as summary indicators to assess the country's response to HIV/AIDS. The methodology is based on a matrix system describing the level and flow of health expenditures on HIV/AIDS: an adaptation of the National Health Accounts methods. The expenditures were classified by source (public, private, international), by the use of funds (prevention, care), by object, and by type of provider institution. The results are reported in US dollars using the official exchange rate for the year of estimation. For international comparisons monetary units were adjusted by the purchasing power parity (US dollars PPP). National HIV/AIDS total expenditures were: Guatemala US dollars PPP29.5 million, Uruguay US dollars PPP 32.5 million, Mexico US dollars PPP 257 million, and Brazil US dollars PPP 587.4 million during 1998, and Honduras US dollars PPP 33.9 million for 1999. The total HIV/AIDS expenditures per capita for 1998 were: Brazil US dollars 2.69, Mexico US dollars 1.25, Guatemala US dollars 1.08, Uruguay US dollars 6.63, and Honduras US dollars 3.6 for 1999. The 1998 distribution of the total HIV/AIDS expenditures in prevention and care were, respectively, Brazil 10 and 80%, Guatemala 15 and 70%, Mexico 29 and 66%, Uruguay 36 and 51%, and Honduras 28 and 65% for 1999. The share of total expenditures on antiretroviral drugs ranged from 52% in Guatemala to 75% in Brazil, even when the estimated coverage of antiretroviral therapy was close to 10% in Guatemala and universal in Brazil. The estimated flow from international sources per capita in 1998 was Uruguay US dollars 0.03, Brazil US dollars 0.24, Guatemala US dollars 0.11, Mexico US dollars 0.01, and Honduras US dollars 1.04 in 1999. The data allow international comparisons and provide critical information to improve equity and efficiency in the allocation of scarce resources. The National HIV/AIDS Accounts also constitute a powerful tool to describe the country's response to HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Geographic distribution and morphometric differentiation of Triatoma nitida usinger 1939 (Hemiptera: Reduviidae: Triatominae) in Guatemala.

Triatoma nitida was found in 14 (0.4%) out of 3,726 houses located in six departments across Guatemala, which were surveyed from 1994 to 1998 by the man-hour collection method. Compared to previous information, the distribution of T. nitida in Guatemala has increased from five to nine departments; the species is present in mild climates at altitudes from 960 to 1,500 m. Fourteen percent of the intradomestic T. nitida were infected with Trypanosoma cruzi. The species was often found in conjunction with other triatomines (T. dimidiata and Rhodnius prolixus). The domestic and peridomestic presence of T. nitida in Guatemala was rare, but occasionally this species was colonizing human-made constructions. T. nitida appears to have a low importance as Chagas disease vector in Guatemala, as indicated by its scarce presence in the domestic habitats and defecation patterns. However, it clearly has potential to become a Chagas vector so we recommend an on-going study of the intradomestic presence of T. nitida following the control programs in Guatemala. Morphometric analysis of 47 T. nitida males from three localities showed quantitative differences between the populations, which indicates that geographic distance is an important factor in the structuring of T. nitida populations.

Animals↗
PubMed2002

A pilot study to assess ground-level ambient air concentrations of fine particles and carbon monoxide in urban Guatemala.

Ambient concentrations and the elemental composition of particles less than 2.5 microm in diameter (PM2.5), as well as carbon monoxide (CO) concentrations, were measured at ground-level in three Guatemalan cities in summer 1997: Guatemala City, Quetzaltenango, and Antigua. This pilot study also included quantitative and qualitative characterizations of microenvironment conditions, e.g., local meteorology, reported elsewhere. The nondestructive X-ray fluorescence elemental analysis (XRF) of Teflon filters was conducted. The highest integrated average PM2.5. concentrations in an area (zona) of Guatemala City and Quetzaltenango were 150 microg m(-3) (zona 12) and 120 microg m(-3) (zona 2), respectively. The reported integrated average PM2.5 concentration for Antigua was 5 microg m(-3). The highest observed half-hour and monitoring period average CO concentrations in Guatemala City were 10.9 ppm (zona 8) and 7.2 ppm (zonas 8 and 10), respectively. The average monitoring period CO concentration in Antigua was 2.6 ppm. Lead and bromine concentrations were negligible, indicative of the transition to unleaded fuel use in cars and motorcycles. The XRF results suggested sources of air pollution in Guatemala, where relative rankings varied by city and by zonas within each city, were fossil fuel combustion emitting hydrocarbons, combustion of sulfurous conventional fuels, soil/roadway dust, farm/agricultural dust, and vehicles (evaportion of gas, parts' wear).

Agriculture↗
PubMed1996

Epidemic cholera in Guatemala, 1993: transmission of a newly introduced epidemic strain by street vendors.

Epidemic cholera reached Guatemala in July 1991. By mid-1993, Guatemala ranked third in the hemisphere in reported cases of cholera. We conducted a case-control study with two age-, sex-, and neighbourhood-matched controls per patient in periurban Guatemala City. Twenty-six patients hospitalized for cholera and 52 controls were enrolled. Seven (47%) of 15 stool cultures obtained after admission yielded toxigenic Vibrio cholerae O1. All seven were resistant to furazolidone, sulfisoxazole, and streptomycin, and differed substantially by pulsed-field gel electrophoresis from the Latin American epidemic strain dominant in the hemisphere since 1991. In univariate analysis, illness was associated with consumption of left-over rice (odds ratio [OR] = 7.0, 95% confidence interval [CI] = 1.4-36), flavored ices (-helados') (OR = 3.6, CI = 1.1 - 12), and street-vended non-carbonated beverages (OR = 3.8, CI = 1.2-12) and food items (OR = 11.0, CI = 2.3-54). Street-vended food items remained significantly associated with illness in multivariate analysis (OR = 6.5, CI = 1.4-31). Illness was not associated with drinking municipal tap water. Maintaining water safety is important, but slowing the epidemic in Guatemala City and elsewhere may also require improvement in street vendor food handling and hygiene.

Adolescent↗
PubMed2002

Occurrence of aflatoxins and fumonisins in Incaparina from Guatemala.

The occurrence of aflatoxins and fumonisins in Incaparina was investigated. Incaparina is a mixture of corn and cottonseed flour with added vitamins, minerals and a preservative. It has been marketed as a high-protein food supplement, particularly for children on protein-deficient diets. According to estimates, 80% of Guatemalan children in their first year are given Incaparina to provide an adequate diet. Eight samples of Incaparina manufactured in Guatemala were collected. Five were from three different geographical locations in the USA and three were from Guatemala. Seven were examined for fungal contamination and analysed for aflatoxins and fumonisins. Aspergillus flavus was the predominant fungus in all samples purchased in the USA and in one sample purchased from Guatemala, whereas Fusarium verticillioides was present in only two samples (one from the USA and one from Guatemala). All samples contained aflatoxins, ranging from 3 to 214 ng g(-1) and <2 to 32ng g(-1) for aflatoxin B(1) and aflatoxin B(2), respectively; and one sample contained aflatoxin G(1) (7 ng g(-1)). Total aflatoxins present ranged from 3 to 244 ng g(1). All samples contained fumonisins, ranging from 0.2 to 1.7 microg g(-1), <0.1 to 0.6 microg g(-1), and <0.1 to 0.2 microg g(-1) for fumonisins B(1), fumonisin B(2), and fumonisin B(2), respectively. Total fumonisins present ranged from 0.2 to 2.2 microg g(-1). The identity of aflatoxin B(2) was confirmed using both the chemical derivatization method and liquid chromatographic (LC)/mass spectrometric (MS) analysis. Appropriate regulatory action was recommended for the import of Incaparina and has been in effect since 22 December 1998.

Aflatoxins↗
PubMed2004

School backpack weights: a survey of students in Ghana, Guatemala and the USA.

Cross-sectional studies were conducted in conveniently selected schools in Ghana, Guatemala, and the USA to quantify and compare the percentage of body weight carried by students in their backpacks as well as assess parental knowledge of the backpack weights and contents. Mean backpack weights varied significantly by country and increased significantly with increasing student grade. In the USA, girls significantly carried heavier backpacks (p <.0001). The backpack loads represented an average of 7.7% (95% CI = 7.4-8.0), 9.7% (95% CI = 9.2-10.2), and 9.4% (95% CI = 9.1-9.8) of student body weights in Ghana, Guatemala, and the USA, respectively. No student in Ghana carried a wheeled backpack in contrast to 6% and 2.8%, respectively, in Guatemala and the USA. In Ghana, 4.1 and 73.6% of parents were reported to be aware of their children's backpack weights and contents, respectively, compared to 21.9 and 57.5% in Guatemala, and 7.7 and 55.3% in the USA. Backpack loads respresent a significant percentage of the body weights of students in all three countries. The vast majority of parents are unaware of their child's backpack weight.

Body Weight↗
PubMed2006

Induced abortion and unintended pregnancy in Guatemala.

CONTEXT: Although Guatemalan law permits induced abortion only to save a woman's life, many women obtain abortions, often under unsafe conditions and in response to an unintended pregnancy. Recent studies indicate that unsafe abortion is a key factor contributing to maternal morbidity and mortality in the country, but no national data on the incidence of abortion exist. METHODS: Surveys of all hospitals that treat women for postabortion complications and of 74 professionals who are knowledgeable about the conditions of abortion provision in Guatemala were conducted in 2003. Indirect estimation techniques were used to calculate the number of induced abortions performed annually. Abortion rates and ratios and the level of unintended pregnancy were calculated for the nation and its eight regions. RESULTS: Nearly 65,000 induced abortions are performed annually in Guatemala, and about 21,600 women are hospitalized for treatment of complications. Abortions occur at a rate of 24 per 1,000 women aged 15-49, and there is one abortion for every six births. The abortion rate is higher than average in the Southwest (less developed, mainly indigenous population) and Metropolitan (more developed, mainly nonindigenous population) regions (29-30 per 1,000 women). Over a quarter of all births are unplanned; combining unplanned births with abortions yields estimates that 32% of pregnancies in Guatemala are unintended, with an unintended pregnancy rate of 66 per 1,000 women. CONCLUSIONS: Unsafe abortion has a significant impact on women's health in Guatemala. Comprehensive government programs are needed to address the issues of unintended pregnancy and unsafe abortion, with attention to regional differences.

Abortion, Induced↗
PubMed1992

Genotype-specific in vitro amplification of sequences of the wild type 3 polioviruses from Mexico and Guatemala.

The extensive nucleotide sequence heterogeneity among independent genotypes of wild polioviruses permits the systematic design of genotype-specific molecular reagents. We have prepared two sets of polymerase chain reaction (PCR) primer pairs specific for the genotype of wild poliovirus type 3 recently endemic to Mexico and Guatemala. Nucleotide sequences of a representative wild type 3 virus isolated in Mexico in 1989 differed from the corresponding Sabin 3 (Leon 12 a1b) sequences at 167 of 900 positions within the VP1 region. From the sequence data, wild virus-specific primer pairs were designed to complement regions of high mismatch (greater than 33%) with Sabin 3 templates. Primer binding sites were spaced along the genome so that the predicted amplification products (142 bp and 163 bp) could be easily resolved electrophoretically from the products generated with our Sabin strain-specific primers (Sabin 1: 97 bp; Sabin 2: 71 bp; Sabin 3: 53 bp). RNAs of all wild type 3 poliovirus isolates from Mexico and Guatemala obtained over a 13-year period (1977-1990) served as efficient templates for amplification of the 142-bp and 163-bp products. Genomic templates derived from vaccine-related polioviruses and most heterologous wild polioviruses were inactive under equivalent reaction conditions. Amplifications generating a 114-bp product with a broadly reacting primer pair, matching highly conserved sequences in the 5'-noncoding region, provided a positive control for the presence in samples of poliovirus (or enterovirus) RNAs. Selective amplification of wild Mexico-Guatemala type 3 poliovirus sequences was obtained with either primer set in reactions containing large stoichiometric excesses (up to 10(6)-fold) of vaccine-related RNAs. We have used wild genotype-specific PCR primer sets to facilitate identification of wild polioviruses present in both clinical and environmental samples.

Amino Acid Sequence↗
PubMed1996

The costs and effectiveness of three vitamin A interventions in Guatemala.

The purpose of the study presented in this paper was to estimate, using secondary sources of data, the cost and effectiveness of three programs to combat vitamin A deficiency in Guatemala-the national sugar fortification program, a targeted capsules distribution program and the promotion of home food production combined with nutrition education and to draw conclusions concerning priorities for Guatemala. Data on the costs and coverage were collected from implementing agencies in Guatemala. Coverage data were converted into a common set of impact indicators. Sensitivity analyses were conducted on variables whose precise value was uncertain. Potential impacts of improvements in program performance operations were also explored. The analysis found the cost per high-risk person achieving adequate vitamin A to be US $0.98 for fortification, US $1.68-1.86 for capsule distribution and US $3.10-4.16 for food production/education. Fortification is the most efficient option if vitamin A levels in sugar are maintained at reasonable levels. Where fortified sugar is not consumed and vitamin A deficiency is highly prevalent, small-scale, targeted, complementary interventions such as capsules and food production education may be appropriate for sustained broader impacts.

Cost-Benefit Analysis↗
PubMed2006

Children at risk of neglect: challenges faced by child protection practitioners in Guatemala City.

OBJECTIVES: The objectives were to (1) delineate the definition, common forms, and perceived risk factors contributing to child neglect in Guatemala from the perspective of different stakeholders and (2) identify the challenges faced by child protection practitioners in identifying children at risk of neglect within the context of Guatemala. METHODS: A range of qualitative methods were used: semi-structured interviews (SSI) with key stakeholders involved in child neglect (n=9); semi-structured interviews with professionals working in the child protection services (n=14); focus group discussions (FGDs) with professionals, voluntary workers and children (n=60), and the group consensus method with key informants (KI, n=10). Data analysis was conducted using the framework approach. RESULTS: Participants described child neglect as a complex social phenomenon combining parental omission of care and an indifferent or negative attitude towards the child compounded by governmental neglect. The main factors which were perceived as contributing to neglect were poverty, societal and cultural norms, and importantly, gender roles and relations. These contextual factors complicate the identification of neglect and raise a number of difficult dilemmas for child protection workers that are exacerbated by limited Guatemalan legislation on neglect and restricted alternative care options. CONCLUSION: Stakeholder perspectives were found to be useful for providing contextual information and highlighting associated challenges related to assessing child neglect in Guatemala.

Child Abuse↗
PubMed2004

A report of a midwifery model for training traditional midwives in Guatemala.

OBJECTIVE: to describe the specific characteristics of one model of training traditional birth attendants (TBAs) in Guatemala. DESIGN: participant observation, unstructured and semi-structured interviews undertaken between 1997 and 2003 to gather the data to report on the characteristics of this training programme as it is evolving in the field. SETTING: the birth centre site of Ixmucane in Antigua, Guatemala, as well as community sites in the Departments of Saquetepequez, Chimaltenango, and Quetzaltenango in the western highlands of Guatemala. PARTICIPANTS: traditional midwives, certified nurse-midwives and certified professional midwives, as well as many allied health professionals and volunteers. INTERVENTION: training philosophy, participant selection, curriculum content, intensity, and planned follow-up are the key components of the training programme described. MEASUREMENT AND FINDINGS: 93 TBAs have received training through the development of a 150 hrs contact course for self-selected TBAs in the Midwives for Midwives Program. Formal evaluation of this training is underway but results are not yet available. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the value of incorporating midwifery philosophy and praxis in TBA training has received scant attention in the TBA literature. This report suggests that TBA training programme characteristics are important considerations in any evaluation of training efficacy of TBAs to improve maternal-child health.

Adult↗
PubMedDate not supplied

The venom of Bothrops asper from Guatemala: toxic activities and neutralization by antivenoms.

Bothrops asper is responsible for approximately half of the snakebite envenomations in Central America. Despite its medical relevance, only the venom of Costa Rican populations of this species has been studied to some detail, and there is very little information on intraspecies variability in venom composition and toxicity. Venom of B. asper from Guatemala was analyzed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and two-dimensional gel electrophoresis, and its basic pharmacological activities were investigated with standard laboratory assays. Venom has lethal, hemorrhagic, myotoxic, edema-forming, coagulant, defibrinating and phospholipase A(2) activities, showing a similar toxicological profile to the one previously described for B. asper from Costa Rica. In addition, polyvalent antivenoms produced in Mexico and Costa Rica, and currently used in Guatemala, were tested for their ability to neutralize venom's toxic activities. Both antivenoms were effective against all effects studied, although the Costa Rican product showed higher potency against most activities tested and higher antibody titer against venom components, as determined by enzyme immunoassay. It is suggested that different dosage regimes should be considered when using these antivenoms in B. asper envenomations in Guatemala.

Animals↗