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PubMed1991

Establishment of smoke-free offices worldwide--U.S. Peace Corps.

The Peace Corps (PC) of the United States is a government-sponsored international development agency with more than 6000 volunteers in approximately 70 developing countries. Since July 1988, PC headquarters in the District of Columbia has been a smoke-free workplace. From February through March 1991, all overseas PC full-time staff members were surveyed regarding cigarette smoking and attitudes toward a proposed smoke-free policy (complete ban) for PC offices worldwide. In addition, the directors of all overseas offices were surveyed regarding existing restrictions on smoking in the workplace. This report summarizes results of the survey.

Developing Countries↗

PubMed1989

A nutrition/health training program for Peace Corps volunteers.

Nutrition and health education is a crucial component of the overall mission of the Peace Corps program. Individuals selected to work as Peace Corps volunteers need to be well prepared to perform this complex and challenging job in recipient countries. This article presents a model for a training program for Peace Corps trainees that was conducted over a 5-week period. The program was planned in accordance with some specific training guidelines that were provided by the Peace Corps. The trainees included nine women ranging in age from 22 to 61 years with diverse backgrounds; however, all had a BA/BS in a health-related discipline. Training curriculum included fundamental nutrition and health-related areas: basic nutrition, foods, clinical nutrition, maternal and child health, communicable diseases and sanitation, health strategies, and community development. Fifty percent of the curriculum was devoted to "hands-on" practical and clinical activities. Maternal and child health was emphasized in the training curriculum as this is an area of concern in all developing countries. The trainees were evaluated by weekly quizzes as well as completion of a special project involving applications of all their newly acquired skills. Implications of the training program are discussed.

Adult↗

PubMed1985

Fatalities in the Peace Corps. A retrospective study: 1962 through 1983.

Fatalities among Peace Corps volunteers were analyzed for 1962 through 1983, with individual case histories reviewed for all deaths from 1977 through 1983. Unintentional injuries accounted for 70% of the 185 deaths of Peace Corps volunteers, with motor vehicle crashes the number 1 cause of death. The death rate from unintentional injuries for women was significantly higher than the comparable US rate. Motorcycles caused 12% of all Peace Corps deaths and 33% of all motor vehicle deaths. Suicide has emerged as a leading cause of death among volunteers, accounting for 13% of all deaths from 1981 through 1983. Greater emphasis on injury control measures is needed to reduce this toll.

Accidents↗

PubMed1989

Epidemiological surveillance in Peace Corps Volunteers: a model for monitoring health in temporary residents of developing countries.

In 1985, the US Peace Corps developed a computerized epidemiological surveillance system to monitor health trends in over 5500 Peace Corps Volunteers working in development projects in 62 countries worldwide. Data on 31 health conditions and events are collected monthly from each country; quarterly and annual incidence rates are then calculated, and the analysed data are distributed. In 1987, the most commonly reported health problems were diarrhoea (unclassified), 48 cases per 100 volunteers per year; amoebiasis, 24 per 100 volunteers per year; injuries, 20 per 100 volunteers per year; bacterial skin infections, 19 per 100 volunteers per year; and giardiasis 17 per 100 volunteers per year. Tracking each of these common problems, as well as other selected health conditions, guides design of more specific studies and disease control efforts. Health problems with very low rates (less than 1.0/100 volunteers/year) include hepatitis, schistosomiasis, non-falciparum malaria, and filariasis. The epidemiological surveillance system provides the health data needed to plan, implement, and evaluate health programmes for Peace Corps Volunteers, and provides a model for surveillance in other groups of temporary and permanent residents of developing countries.

Adult↗

PubMed1995

HIV risk behavior among Peace Corps Volunteers.

OBJECTIVE: To describe HIV risk behaviors among Peace Corps Volunteers (PCV) and to examine correlates of sexual risk behaviors. METHOD: Cross-sectional data were collected from 1242 randomly selected PCV serving in 28 countries in 1991. PCV reported the frequency of specific risk behaviors in self-administered questionnaires, which were completed anonymously and returned to the Centers for Disease Control and Prevention. RESULTS: Non-sexual HIV risk behaviors were rarely reported by PCV. Sixty-one per cent of the 1080 PCV who answered questions about sexual behavior during their Peace Corps service reported having at least one sex partner. Sixty per cent of PCV had another PCV partner, 39% had a host-country national partner, and 29% had a non-PCV expatriate partner. Overall, less than one-third (32%) of unmarried PCV used condoms during every episode of sexual intercourse; more frequent use was reported in relationships with non-steady and (for male PCV) host-country national partners. Among male PCV, condom use was positively related to lower alcohol use and the belief that HIV was a problem in the host country. Female PCV reporting more condom use with male partners were younger and had fewer partners than those reporting less use. CONCLUSION: These data indicate that PCV are at risk for acquiring HIV through unprotected vaginal intercourse. All persons who become sexually active with new partners while travelling or living abroad should be encouraged to use condoms consistently.

Adult↗

PubMed2006

Suspension of enrollment in the Federal Employees Health Benefits (FEHB) Program for Peace Corps volunteers. Final rule.

The Office of Personnel Management is issuing a final regulation to allow Peace Corps volunteers who are FEHB Program enrolled annuitants, survivors, and former spouses to suspend their FEHB enrollments and then return to the FEHB Program during the Open Season, or return to FEHB coverage immediately, if they involuntarily lose health benefits coverage under the Peace Corps. The intent of this final rule is to allow these beneficiaries to avoid the expense of continuing to pay FEHB Program premiums while they have other health coverage as Peace Corps volunteers, without endangering their ability to return to the FEHB Program in the future.

Federal Government↗

PubMed1983

Pre-exposure prophylaxis in Peace Corps volunteers with intradermal human diploid cell rabies vaccine.

The Peace Corps has had approximately 60 000 person/years of experience with rabies pre-exposure duck embryo vaccine (DEV) immunizations, which are required in 80% of volunteer assignments. Rabies exposure treatment rate is much higher in these areas than in the United States. One death from rabies has occurred despite pre-exposure injections. One death also occurred from serum hepatitis contracted in local emergency management of an anaphylactic reaction to duck embryo vaccine. A query to the Peace Corps field medical offices obtained reports of 21 serious reactions in approximately 8000 duck embryo immunizations. Two thirds of the reactions occurred with the first injection. Only a third of titres measured after four injections of DEV achieved a protective level of greater than or equal to 1:16. Because of these problems human diploid intracellular vaccine (HDCV) was studied in areas where it was available. Because of the high cost and initial short supply, intradermal injections of 0.1 ml HDCV were given. 567 of 570 persons achieved adequate titres. No systemic reactions were reported with intradermal HDCV.

Developing Countries↗

PubMed2000

A multiyear prospective study of the risk factors for and incidence of diarrheal illness in a cohort of Peace Corps volunteers in Guatemala.

BACKGROUND: Diarrheal illness is the most common medical disorder among travelers from developed to developing countries and is common among expatriate residents in developing countries. OBJECTIVE: To assess the risk factors for and incidence of diarrheal illness among Americans living in a developing country. DESIGN: Prospective longitudinal study. SETTING: Rural Guatemala. PATIENTS: Cohort of 36 Peace Corps volunteers. MEASUREMENTS: Collection of daily dietary and symptom data for more than 2 years; identification by multivariate Poisson regression analyses of risk factors for clinically defined episodes of diarrheal illness. RESULTS: The 36 Peace Corps volunteers in this study had 307 diarrheal episodes (median, 7 per person), which lasted a median of 4 days (range, 1 to 112) and a total of 10.1% of the 23 689 person-days in the study. The incidence density (episodes per person-year) was 4.7 for the study as a whole, 6.1 for the first 6-month period, 5.2 for the second 6-month period, and 3.6 thereafter. Statistically significant risk factors for diarrheal illness included drinking water whose source (for example, the tap) and, therefore, quality, was unknown to the person; eating food prepared by a Guatemalan friend or family; eating food at a small, working-class restaurant; eating fruit peeled by someone other than a Peace Corps volunteer; drinking an iced beverage; and eating ice cream, ice milk, or flavored ices. The relative risks comparing the presence of these exposures during the first 6-month period overseas with their absence during the second year of residence ranged from 1.90 to 2.67, and the summary attributable risk percentage (that is, the percentage of diarrheal episodes that could be ascribed to the exposures) was 75.4%. Exposures generally were riskier if they occurred during travel elsewhere in Guatemala rather than in the person's usual work area. CONCLUSIONS: Diarrheal illness of mild-to-moderate severity continued to occur throughout Peace Corps service but decreased in incidence as length of stay increased. Various dietary behaviors increased the risk for diarrheal illness, which suggests that avoidance of potentially risky foods and beverages is beneficial.

Adult↗

PubMedDate not supplied

Health-related challenges in United States Peace Corps Volunteers serving for two years in Madagascar.

BACKGROUND: The United States Peace Corps has nearly 8000 Volunteers (PCVs) working in more than 70 countries, predominantly in the developing part of the world. The volunteers are challenged by many new and unfamiliar health problems, as a result of change in living conditions during their service. The goal of this study was to assess the health problems of PCVs in Madagascar, and to use this information to evaluate the effectiveness of the current PCV health support program. METHODS: PCVs, finalizing their 2 years of service, were enrolled in the study. Data were retrieved from individual Peace Corps service medical records, the close of service (COS) physical evaluation, and a PCV questionnaire, which elicited additional self-reported health problems and concerns. RESULTS: Sixty-nine PCVs took part in the study. Median age at COS was 24 years (95% CI 23-26 years), and the male/female ratio was 1 : 3.6 (15 males and 54 females). Skin, gastrointestinal and respiratory infections constituted the three most common reported health problems. Among the registered parasitic infections were ova and parasites in the stool (42.0%), confirmed and presumptive malaria (15.9%) and schistosomiasis (11.6%). Female PCVs more frequently reported dermatologic manifestations than male PCVs: postadolescent acne (48.2% vs. 13.3%) and telogen hair loss (33.3% vs. 6.7%). Amenorrhea, as the most commonly reported menstrual alteration during service, was reported by 15 (27.7%) female PCVs. CONCLUSIONS: The PCVs in Madagascar encounter a broad range of health-related problems, most of which are preventable infectious diseases. Reinforcement of the preservice personal health-training curriculum later during service is needed. Reported dermatologic and menstrual disturbances in female subjects may be associated with stress-related estrogen imbalance. More studies are warranted to assess the stress impact of long-term travel on the female physiology.

Adult↗

PubMed1990

Chronic diarrhoeal illness in US Peace Corps volunteers.

Chronic diarrhoea of unknown aetiology is increasingly recognized as a problem in international travellers, and has been reported in US Peace Corps volunteers. In December 1987, we surveyed all Peace Corps medical officers to determine the magnitude of this problem and obtain preliminary data on potential risk factors. A rate of nine cases of chronic diarrhoea per 1000 volunteers per year was reported by medical officers representing 4607 volunteers in 43 countries. The highest rates were reported in Haiti, where one-third of the volunteers reportedly developed chronic diarrhoea during their two-year stay, as well as in Central and West Africa and Nepal. Volunteers were reported to drink unpasteurized milk routinely in eight (42%) of 19 countries with greater than or equal to one case of chronic diarrhoea during the previous two years, but in only two (11%) of 19 countries where none of the volunteers had chronic diarrhoea (odds ratio = 6.2, p = 0.06, Fisher exact test). Intensive prospective studies in areas of high incidence are needed to define this syndrome further.

Africa, Central↗

PubMed1994

Peace Corps service as a turning point.

This is a longitudinal study of twenty-one U.S. Peace Corps Volunteers, first interviewed in the mid-1960s during their tour of service in the Republic of the Philippines and then twenty years later as middle-aged adults. Life events reported after their service and the high degree of response agreement in the two interviews confirm that their Peace Corps experience constituted a turning point in their life courses. The study reviews the literature on turning points, proposes an appropriate definition for the concept, identifies conditions that promote turning points, especially for youth, and indicates directions for future research.

Adaptation, Psychological↗

PubMedDate not supplied

Schistosomiasis and US Peace Corps volunteers in Tanzania.

BACKGROUND: Schistosoma haematobium and Schistosoma mansoni are endemic to East Africa. US Peace Corps volunteers (PCVs) serving in Tanzania were not experiencing symptoms of infection, but in 1998 when comprehensive testing was instituted, more than one-quarter were found to be infected with schistosomiasis at the close of their 27-month tour of service. METHODS: An education campaign was instituted by the in-country Peace Corps Medical Officers. At their close of service, all PCVs had a medical examination and blood, urine, and stool samples were tested for schistosomiasis. PCVs also answered a survey that included questions about their knowledge of the blood fluke and the disease, symptoms, where and how many times they had gone swimming, and what precautionary measures they had taken. RESULTS: PCVs in Tanzania are most susceptible to infection from recreational activities within the Lake Victoria ecosystem. After an education campaign, incident cases dropped quickly. Vigorous toweling after exposure may have decreased the risk of disease for those PCVs who went swimming in freshwater. Although schistosomiasis is common in Tanzania and PCVs are highly susceptible, it is possible for them to spend their entire tour without contracting the disease, even if they live by Lake Victoria. CONCLUSIONS: People should be encouraged not to swim in Lake Victoria. The possibility that vigorous toweling immediately after exposure to infected waters is a useful protective measure warrants further investigation.

Adult↗

PubMed1982

Seroepidemiology of heat-labile enterotoxigenic Escherichia coli and Norwalk virus infections in Panamanians, Canal Zone residents, Apache Indians, and United States Peace Corps volunteers.

Serum antibody titrations against the heat-labile enterotoxin (LT) of Escherichia coli were carried out on Panamanians, U.S. citizens resident in the Panama Canal Zone, Apache Indians living on the reservation in Whiteriver, Arizona, and Peace Corps volunteers before they traveled overseas. Antibody titers to Norwalk virus were also carried out on serum from Panamanian and Canal Zone residents. A high prevalence of low-titer LT antibodies was found in infants and adults from Panama, the Canal Zone, and Whiteriver. Panamanian children aged 1 to 5 years had the highest LT antibody titers. Peace Corps volunteers had a low prevalence and titer of LT antibodies. Prevalence and titer of antibodies to Norwalk virus were generally higher in Panamanians compared with Canal Zone residents of the same age. In the populations we studied, various modes of transmission and mechanisms of immunity likely explain the differences which we observed in antibody prevalence and titer to these two enteric pathogens.

Adolescent↗

PubMed1995

HIV-1 and HIV-2 Infections Among U.S. Peace Corps Volunteers Returning from West Africa.

Background: The risk of acquiring HIV-1 and HIV-2 infections among expatriates in, and travelers to, West Africa is not known. The objective of the study was to examine the risk of human immunodeficiency virus type 1 and type 2 (HIV-1 and HIV-2) infections among Peace Corps volunteers in West Africa. Methods: A cross-sectional serosurvey was carried out in 18 West African countries. Subjects were 2491 returning Peace Corps volunteers. The main outcome measure was seropositivity for HIV-1 and HIV-2 antibodies. Results: From March 1988 through February 1993, of 2491 study participants, no HIV-2 infections were detected, but three HIV-1 infections were. All three HIV-1-infected persons reported having had unprotected sex with host-country national partners. Conclusions: Results suggest that although persons having unprotected sex with partners from countries with a high prevalence of HIV-1 are at risk for acquiring the infection, casual transmission of HIV-1 or HIV-2 is extremely unlikely.

Journal Article↗

PubMed1986

Serodiagnosis of visceral leishmaniasis in an American Peace Corps volunteer.

A case of visceral leishmaniasis in a young American Peace Corps volunteer is reported. Both clinical and epidemiologic evidence strongly supported the diagnosis; however, hepatic and splenic aspirates for the causative organism were negative. The diagnosis was eventually confirmed through serology, employing indirect immunofluorescence and complement fixation testing of serum. The patient clinically responded dramatically to sodium stibogluconate, the drug of choice for the treatment of visceral leishmaniasis. This case is significant because it alerts the physician to an unusual cause of fever of unknown origin in residents of the Western nations and demonstrates the potential usefulness of serology in diagnosing visceral leishmaniasis when the infecting organism cannot be isolated.

Adult↗

PubMed1981

Travelers' diarrhea among American Peace Corps volunteers in rural Thailand.

Diarrheal disease was studied prospectively in 35 Peace Corps volunteers during their first five weeks in rural Thailand. Twenty (57%) developed the syndrome of travelers' diarrhea. Recognized bacterial enteric pathogens were isolated from stools during 47% of 39 episodes of travelers' diarrhea. Enterotoxigenic Escherichia coli was isolated during 26% and Shigella during 13% of the episodes. Of the 20 volunteers, 50% had bacteriologic and/or serologic evidence of infection with enterotoxigenic E. coli. Sixty-one percent of isolates of enterotoxigenic E. coli and 92% of isolates of Shigella were resistant to doxycycline. Other enteric pathogens, including Campylobacter jejuni/coli, Yersinia enterocolitica, Salmonella, rotavirus, Norwalk agent, and Entamoeba histolytica, were associated with episodes of travelers' diarrhea. Aeromonas hydrophila, isolated from 31% of 39 episodes of travelers' diarrhea, was of unknown pathogenic importance. Thus, episodes of travelers' diarrhea in Thailand were associated with a variety of organisms, among which antibiotic-resistant bacterial enteropathogens were common.

Adult↗

PubMed1977

Enterotoxigenic Escherichia coli diarrhea of travelers: a prospective study of American Peace Corps volunteers.

Travelers' diarrhea was studied prospectively in a group of 39 American Peace Corps Volunteers (PCVs) during their first five weeks in Kenya. Twenty-seven developed diarrheal disease and 12 remained well. Multiple episodes were documented in 11 of the symptomatic volunteers. Enterotoxigenic Escherichia coli of many serotypes producing heat-labile and/or heat-stable enterotoxin were isolated from 17 of the 27 volunteers with diarrhea and from 1 of the 12 well volunteers. The enterotoxigenic E. coli were more likely to be antibiotic sensitive than the non-enterotoxigenic E. coli. A serum antibody rise to the heat-labile toxin (LT) was detected in six symptomatic volunteers, five of whom had a positive culture for LT-producing E. coli, and from one asymptomatic, culture negative volunteer. Salmonella cubana was isolated from two volunteers, and three volunteers had serologic evidence of infection with human reovirus-like (rotavirus) agent. This study confirms the role of enterotoxigenic E. coli as a major cause of travelers' diarrhea and suggests that the disease is similar in widely separated geographic areas.

Adult↗

PubMed1994

Infections with intestinal parasites in Peace Corps volunteers in Guatemala.

To assess the role of parasites in causing diarrhea in Peace Corps volunteers in Guatemala, 115 stool specimens from a case-control investigation (48 case [diarrhea] and 26 control episodes) were examined. A potentially pathogenic protozoan that could account for diarrheal illness was found for only 12% of the case episodes.

Adult↗