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PubMed2000

Geographic targeting of nutrition programs can substantially affect the severity of stunting in Honduras.

The effect of nutrition intervention programs in developing countries is likely to vary with the degree to which the program can be successfully targeted at the most vulnerable. In Honduras, the existence of a recent census of the height of first-grade children makes it possible to assess a priori the effect of different targeting strategies, holding constant other features of a hypothetical program. We simulate a nutrition intervention with 20% national coverage and uniform gains of 0.5 Z-scores for all beneficiaries, with a number of different approaches to targeting. The VIIth National Census of First-Graders' Heights provides the baseline scenario and permits identification of priority departments, municipalities, schools and individuals, for a total of six alternative targeting mechanisms. Effect is assessed on the basis of changes in the prevalence of stunting (less than -2 Z-scores) and in two different measures of the severity of stunting adapted from the economics literature (the malnutrition gap and the quadratic malnutrition gap). We find that the simulated program has the potential to substantially improve the severity, but not the prevalence of stunting in Honduras. Household targeting with an imperfect indicator of vulnerability could reduce the malnutrition gap by >20% and the quadratic malnutrition gap by >30%, but would be very expensive to implement. "Broad stroke" geographic targeting could reduce the same measures by 15 and 20%, respectively, and would be much less expensive to implement. We conclude that geographic targeting has the potential to substantially enhance the effect of nutrition programs on the severity of stunting in Honduras.

Body Height↗

PubMed1997

Field evaluation of rapid HIV serologic tests for screening and confirming HIV-1 infection in Honduras.

OBJECTIVE: To determine the ability of simple, rapid tests to identify HIV-1 antibody-positive specimens in field settings using the World Health Organization's (WHO) alternative testing strategies. DESIGN: Three-phase evaluation of simple, rapid assays using banked specimens and prospectively collected serum specimens at regional hospitals and rural clinics. METHODS: Seven test (Retrocell, Genie, HIVCHEK, SUDS HIV-1, Testpack, Serodia HIV-1, and HIV-1/2 RTD) were evaluated and results compared with standard enzyme immunoassay (EIA) and Western blot results (phase 1). Further evaluation consisted of prospective testing of routine specimens at regional (phase 2; n = 900) and rural, peripheral laboratories (phase 3; n = 1266) throughout Honduras with selected assays. RESULTS: Sensitivity and specificity were calculated for each assay and combination of assays for each phase to evaluate the effectiveness of the WHO alternative testing strategies. All tests in all phases were > 99% sensitive after correcting for technical errors, with two exceptions (SUDS, phase 1; HIVCHEK, phase 3). In phase 3, where the testing algorithm was diagnostic, several combinations of assays were 100% sensitive and specific using WHO strategy II or III. For the Honduras Ministry of Health, the combination of Retrocell and Genie was found to be equally sensitive, more specific (no indeterminate results), and less expensive than EIA/Western blot. CONCLUSION: Combinations of rapid, simple HIV antibody assays provide sensitivity and specificity performance comparable to EIA/Western blot. Application of these combinations in the WHO alternative testing strategies provides an inexpensive and effective method of determining HIV status. Assay combinations using these strategies can be easily performed in small, rural laboratories and have been implemented in routine HIV screening in Honduras.

AIDS Serodiagnosis↗

PubMed1988

School dental health in Honduras.

Project HOPE has been working with the Honduran government since 1983 to establish educational programs for health workers and improve the country's health care services. The Ministry of Health in Honduras, under the direction of the president, is planning a new emphasis on preventive dentistry. The feasibility of community water fluoridation is being examined, and dental health programs have been implemented in pilot schools around the country. The Ministry of Health plans to expand these pilot programs to include all elementary schools in Honduras. This article describes the dental health services in Honduras and the government's effort to establish a nationwide school dental health program with emphasis on preventive dentistry.

Central America↗

PubMed2003

Epidemiology of childhood Guillain-Barré syndrome as a cause of acute flaccid paralysis in Honduras: 1989-1999.

The objective of this study was to investigate the incidence of acute flaccid paralysis in the pediatric population of Honduras over an 11-year period, determine what percentage of acute flaccid paralysis was Guillain-Barré syndrome, and identify the epidemiologic features of Guillain-Barré syndrome. There were 546 childhood cases of acute flaccid paralysis seen between January 1989 and December 1999 at the Hospital Escuela Materno-Infantil in Tegucigalpa, Honduras. Of these cases with acute flaccid paralysis, 394 (72.2%) were diagnosed with Guillain-Barré syndrome. Our incidence of Guillain-Barré syndrome in the Honduran pediatric population (1.37/100,000 per year) is higher than that shown in other studies. There was a significantly higher incidence of Guillain-Barré syndrome in younger children (ages 1-4 years), a significant preponderance of cases from rural areas, and a mild predominance in boys but a typical clinical presentation. The Honduran pediatric Guillain-Barré syndrome population had an increased mortality rate. Guillain-Barré syndrome has become the leading cause of childhood paralysis in Honduras. A better understanding of the population at highest risk and opportunities for earlier intervention with more effective therapeutic modalities may permit reducing the mortality among Honduran children who develop Guillain-Barré syndrome.

Acute Disease↗

PubMed1998

Increased prevalence of Plasmodium falciparum malaria in Honduras, Central America.

We report on our investigation of a malaria outbreak in Honduras, Central America, in January 1997. We tested 202 patients with fever and chills using thin and thick blood film microscopy. Sixteen patients lived in the city and the rest lived in rural areas. A total of 95 samples (47%) were positive for malaria parasites. Seventy-nine percent (63/80) of the rural patients were infected with Plasmodium vivax and 21% (17/80) were infected with P. falciparum. In the urban area, all 15 infected patients had P. vivax malaria and none showed evidence of P. falciparum. Since previous reports indicate that falciparum malaria accounts for only 2% of the overall malaria infections in Honduras, the results reported here suggest that there is a dramatic increase in falciparum malaria in the area of Honduras investigated in this study.

Disease Outbreaks↗

PubMed1996

U.S. experts warn of Honduras AIDS risk to women. International.

Honduras, the Central American country hardest hit by AIDS, may suffer from a particularly aggressive strain of HIV that is especially dangerous to women, US experts said. "We are investigating the presence in Honduras of (HIV) sub-type B, which is more aggressive than others and could be the reason why it is worse in this country," Winslow Klaslala, professor at the University of Miami, Florida, said. According to the Health Ministry, 7664 Hondurans have been infected with HIV since 1985, and 995 have died. That is 60% of the total number of HIV sufferers in the six countries of Central America and the incidence in women is unusually high at 36%. A team of experts, including members from Harvard University and the WHO, have been taking blood samples, primarily from HIV infected women, Klaslala said. They will analyze the blood to look for sub-type B, described by Klaslala as highly "aggressive and adaptable." "If it is present," he said, "women are particularly at risk." Honduran health authorities were paying close attention to the investigations. "If they show that the sub-type that attacks in Honduras is more aggressive, we will have to redesign our campaign for combatting the disease," said Enrique Zelaya, a top Health Ministry official.

Americas↗

PubMed2005

Chlamydia trachomatis and genital human papillomavirus infections in female university students in Honduras.

Sexually transmitted infections are a serious health problem in Honduras. Human papillomavirus (HPV) and Chlamydia trachomatis are major causes of sexually transmitted diseases. To determine the prevalence of C. trachomatis and HPV in young women, 100 female university students in Honduras were assayed for the presence of these pathogens. Twenty-eight percent were positive for HPV and 6% were positive for C. trachomatis. These results show that genital HPV and C. trachomatis infections are very common among sexually active young women in Honduras. It is vital to promote extensive public awareness campaigns among sexually active women concerning preventive measures of these diseases.

Adolescent↗

PubMed1991

Humanitarian Civic Action in Honduras, 1988.

This article describes Humanitarian Civic Action (HCA) activities performed by the Medical Element (MED EL) of Joint Task Force-Bravo in Honduras during 1988. The effort was designed to assist Honduras in nation building, to provide a maximal training experience for U.S. personnel, and enhance the image of the U.S. While security episodes occurred during 1988, no warfare in Honduras involved the MED EL. HCA and low-intensity conflict activities will therefore be discussed as one topic, as they were inextricably intertwined.

Altruism↗

PubMedDate not supplied

Contraceptive use and fertility in Honduras, 1981-84.

This paper presents data on contraceptive use and fertility in Honduras obtained from a household survey conducted in 1984, and compares these data with similar information obtained from surveys carried out in 1981 and 1983. About half of the increase that has taken place in contraceptive use in Honduras is accounted for by sterilization. In 1981, 27 percent of women in union aged 15-49 years were practicing contraception; in 1984, the percentage of those 15-44 was 35 percent. The increase in urban areas was smaller (from 47 percent to 51 percent) than in rural areas (from 16 percent to 24 percent). Also, fertility remained almost unchanged in urban areas while declining in rural areas. Information from questions on place of purchase, price, and brand of contraceptive (for orals) was used to determine source of supply. The use of multiple questions to determine source results in a higher percentage of contraceptive use attributed to the Honduran Family Planning Association as compared with answers to a single question. The duration of breastfeeding in Honduras has increased, with the greatest changes occurring among women in urban areas and women with the highest levels of education. Efforts have been made to promote breastfeeding in urban areas and these results suggest that the efforts have been successful.

Adolescent↗

PubMed2004

The conservation status of the herpetofauna of Honduras.

The conservation status of the members of the Honduran herpetofauna is discussed. Based on current and projected future human population growth, it is posited that the entire herpetofauna is endangered. The known herpetofauna of Honduras currently consists of 334 species, including 117 amphibians and 217 reptiles (including six marine reptiles, which are not discussed in this paper). The greatest number of species occur at low and moderate elevations in lowland and/or mesic forest formations, in the Northern and Southern Cordilleras of the Serranía, and the ecophysiographic areas of the Caribbean coastal plain and foothills. Slightly more than one-third of the herpetofauna consists of endemic species or those otherwise restricted to Nuclear Middle America. Honduras is an area severely affected by amphibian population decline, with close to one-half of the amphibian fauna threatened, endangered, or extinct. The principal threats to the survival of members of the herpetofauna are uncontrolled human population growth and its corollaries, habitat alteration and destruction, pollution, pest and predator control, overhunting, and overexploitation. No Honduran amphibians or reptiles are entirely free of human impact. A gauge is used to estimate environmental vulnerability of amphibian species, using measures of extent of geographic range, extent of ecological distribution, and degree of specialization of reproductive mode. A similar gauge is developed for reptiles, using the first two measures for amphibian vulnerability, and a third scale for the degree of human persecution. Based on these gauges, amphibians and reptiles show an actual range of Environmental Vulnerability Scores (EVS) almost as broad as the theoretical range. Based on the actual EVS, both amphibian and reptilian species are divided into three categories of low, medium, and high vulnerability. There are 24 low vulnerability amphibians and 47 reptiles, 43 medium vulnerability amphibians and 111 reptiles, and 50 high vulnerability amphibians and 53 reptiles. Theoretical EVS values are assessed against available information on current population status of endemic and Nuclear Middle American taxa. Almost half (48.8%) of the endemic species of Honduran amphibians are already extinct or have populations that are in decline. Populations of 40.0% of the Nuclear Middle American amphibian species are extirpated or in decline. A little less than a third (27.0%) of the endemic reptiles are thought to have declining populations. Almost six of every ten (54.5%) of the Nuclear Middle American reptilian species are thought to have declining populations. EVS values provide a useful indicator of potential for endangerment, illustrating that the species whose populations are currently in decline or are extinct or extirpated have relatively high EVS. All high EVS species need to be monitored closely for changes in population status. A set of recommendations are offered, assuming that biotic reserves in Honduras can be safeguarded, that it is hoped will lead to a system of robust, healthy, and economically self-sustaining protected areas for the country's herpetofauna. These recommendations will have to be enacted swiftly, however, due to unremitting pressure from human population growth and the resulting deforestation.

Journal Article↗

PubMed1999

Human papillomavirus infection, cervical dysplasia and invasive cervical cancer in Honduras: a case-control study.

A substantial body of evidence has confirmed human papillomavirus (HPV) infection as the central etiological agent in human cervical carcinogenesis. In Honduras, cervical cancer is the most common cancer among women, with a high annual incidence. We conducted a population-based, case-control study of 229 patients with different grades of CIN and invasive cervical cancer and 438 matched controls. A structured questionnaire was used to investigate known and probable risk factors for cervical cancer. Cervical scrapes were tested for the presence of different HPV types using a general primer-mediated PCR followed by PCR-based sequencing. HPV DNA was detected in 87% of all cancer in situ and invasive cancer cases, and 95% of invasive cases could be attributed to high-risk types. In control women, 39% were positive for HPV DNA sequences. HPV 16 prevalence ranked highest in all stages of cervical dysplasias, invasive cancers and controls. A statistically significant association with HPV was observed for CIN II, CIN III and invasive cancer, showing an upward trend to more severe lesions and being more pronounced for HPV 16 and related types. The OR for HPV 16- and 18-related invasive cancer cases was 14.88 (95% CI 5.12-43.25) and 74.66 (95% CI 7.77-717.62), respectively. Our results confirm a central role of HPV as the cause of cervical cancer in Honduras and provide information as to the type distribution of HPVs in the country.

Adolescent↗

PubMed2007

Impact of an education program on late diagnosis of retinoblastoma in Honduras.

BACKGROUND: In developed countries, more than 90% of children with retinoblastoma present with limited-stage disease and are cured; however, in countries with limited resources, like Honduras, most patients present with advanced disease and cure rates are less than 50%. Early diagnosis is necessary to improve the survival of children with retinoblastoma in these countries. PROCEDURE: We describe the preliminary results of a retinoblastoma education program linked to a national vaccination campaign in Honduras. Posters and flyers were designed to be accessible to poorly educated readers, to convey the severity of retinoblastoma, and to provide contact information. Charts and an electronic database were reviewed to determine age at diagnosis, presenting signs and symptoms, date of diagnosis, and outcome. RESULTS: During the eight previous years (July 1995-June 2003), 73% of the 59 diagnosed cases of retinoblastoma were extraocular; in contrast, during the post-campaign period (June 2003-January 2005), only 35% of the 23 diagnosed cases showed extraocular spread (P = 0.002). More than one-third of patients in both time periods either refused therapy or abandoned treatment. CONCLUSION: This inexpensive approach is an effective first step toward improving survival of childhood retinoblastoma. Abandonment and refusal of therapy are continuing obstacles.

Child↗

PubMedDate not supplied

Parasitism and diarrhoea in children from two rural communities and marginal barrio in Honduras.

In Honduras, one of the leading causes of morbidity and mortality among children is diarrhoea, but little is known about its aetiology and risk factors. A prospective longitudinal study of 266 children over a 12 month period in 2 rural villages and a marginal barrio revealed attack rates of 7 episodes per child per year among those less than 36 months of age. The most common parasite was Giardia lamblia, found in 61% of the children and in 29% of 848 episodes of diarrhoea. Chronic diarrhoea was noted in 46.6% of the children and 81% of them were infected with G. lamblia. Multiple infections with 5-10 different species of parasites or commensals were common (47%); no parasites or commensals were found in 17 children (6.4%). No case of acute amoebic dysentery was diagnosed either clinically or parasitologically, although 20% of the children had cysts of E. histolytica in the stools. Other potential parasitic pathogens identified were Cryptosporidium sp. (6.7%), Hymenolepis nana (8%), and Strongyloides stercoralis (2.6%). Dientamoeba fragilis was found in iron haematoxylin smears for the first time in Honduras. Important risk factors recognized included high faecal contamination of the environment, lack of potable water, education and housing in the midst of poverty. The marginal barrio was more affected than the rural villages. Should these factors not be changed or modified, diarrhoea caused by infectious agents will remain an endemic life-threatening problem.

Age Factors↗

PubMedDate not supplied

Taeniasis-cysticercosis in Honduras.

Data on human taeniasis and human and animal cysticercosis from Honduras were gathered from laboratory, medical and slaughterhouse records, proglottid identification and surveys. The infection rate for human taeniasis was 2.7/1000 individuals at the University Hospital, 10/1000 in the southern provinces of Choluteca and Valle, and 0.6/1000 in Cortes and Atlantida in the north. In surveys, the rates found ranged from 14 to 62/1000 in 9 of 15 communities studied. Taenia solium was identified in 135 of 181 individuals (74.5%) who submitted proglottids for speciation, 23 of whom were children 0-5 years old. The male:female ratio of infection rate was 1:2. The rates of infection with cysticercosis in pigs and cattle at one abattoir in 1981-1986 were 5% and 0.05% respectively. Diagnosis of human cysticercosis at the University Hospital increased five-fold with the introduction of computerized tomography and an enzyme-linked immunosorbent assay: 22 cases were diagnosed in 1980-1984 and 107 cases in 1985-1988. Rates at the neurosurgical ward were higher (29/1000 patients) than in the general hospital census (1.6/1000 patients). aeniasis-cysticercosis may be a serious health problem in some areas of Honduras.

Adolescent↗

PubMed1991

Leishmania donovani chagasi: new clinical variant of cutaneous leishmaniasis in Honduras.

During surveillance for endemic visceral leishmaniasis on an island off the Pacific coast of Honduras, an unusual form of cutaneous leishmaniasis was encountered. By clinical and laboratory criteria, 17 cases were identified over 5 months; children aged 4 to 15 years were primarily affected. Lesions were generally few in number, small, always papular, and non-ulcerative, even when present for several years. Patients with skin lesions seemed otherwise healthy and were well nourished. Montenegro skin tests with Leishmania mexicana and L major antigens were positive in 10 of 17 patients tested, and lesions from 9 patients were positive by culture. Since the summer of 1988, cases of atypical cutaneous leishmaniasis continue to occur on the island (8) as well as on the mainland of southern Honduras (23). A total of 9 parasite isolates from skin lesions, 4 from bone marrow of patients with kala-azar, and 2 from sandflies were identified as L donovani chagasi and were indistinguishable from one another by isoenzyme analysis.

Adolescent↗

PubMed2004

Private and public determinants of child nutrition in Nicaragua and Western Honduras.

We present a multivariate regression model of nutritional indicators, including interactions between education levels and overall community development, as well as estimates of community fixed effects, for two data sets: the first one is from a 2001 nationwide household survey in Nicaragua while the second set was collected in the Western regions of Honduras in 2002, as part of an evaluation process for a family entitlement program. Maternal stature, age difference with an older sibling, household size and income are seen as the main determinants of anthropometric development. Within the more homogeneous communities of Western Honduras, woman's education is also related to the child's nutritional status. The importance of individual community variables is much lower and the inclusion of community fixed effects does not alter the other parameters. However, in the Honduran sample, overall community development (assessed through the community fixed effects) has a small but significant and synergistic effect on the impact of child and household variables. The characteristics of this study and the complex design of entitlement programs prevent an adequate evaluation of those interventions within the poverty reduction strategies. The improvement of intra-community targeting seems to be a key orientation for redesign. An improved socio-economic situation, sound population and family policies, and an appropriate preventive public health care still are safe investments towards improvement of child health and nutrition.

Child↗

PubMed2005

Mosquito larvae density and pollutant removal in tropical wetland treatment systems in Honduras.

Constructed wetlands offer a low-cost wastewater treatment option for tropical developing countries. The vast majority of published treatment wetland research has been conducted in temperate regions. Because the function of treatment wetlands is related to the environmental conditions, more research specific to the tropics should be completed. A six-cell free water surface (FWS) wetland mesocosm was constructed in Santa Rosa de Copán, Honduras that received input from an open-sewer/wastewater-impacted stream. Three cells were planted with Typha domingensis Pers., and three cells were left unplanted. Both planted and unplanted wetlands were constructed with three different surface areas to concurrently study different hydraulic retention times (HRTs) and hydraulic loading rates (HLRs). Results from 6 months of operation showed improved water quality and mosquito larvae populations affected by their specific environment. Five-day biochemical oxygen demand (BOD) removal appeared to be proportional to HRT and HLR, and BOD concentration in the effluent was higher in unplanted cells than in planted cells (P<0.05). BOD removal approached 60% for greater than 3.5 days HRT. Total phosphorus (P) removal and coliform bacteria removal were found to be correlated with pollutant load, and P removal was found to be correlated with HRT but not HLR. A second municipal wastewater FWS treatment wetland in Copán Ruinas, Honduras that had been established for 15 years, was also evaluated. BOD removal in the Copán Ruinas system was determined to be 93% with 2.6 day HRT. These pollutant removal rates are higher than would be expected in temperate regions. Mosquito larvae density was correlated with depth of the wetland. Mosquito larvae densities were higher in cells that were operating below design depth of 0.2 m (P<0.005). Results indicate that it is possible to design FWS wetlands in the tropics for effective BOD removal and reduced mosquito larvae development.

Animals↗

PubMed2005

Program note: Using UN process indicators to assess needs in emergency obstetric services: Bolivia, El Salvador and Honduras.

The UN process indicators are used to assess the availability, utilization and quality of emergency obstetric care (EmOC). Needs assessments for EmOC in Bolivia, El Salvador and Honduras show reasonable availability of comprehensive EmOC facilities for their population sizes, but a scarcity of basic facilities. Utilization rates among women with obstetric complications are high in El Salvador and Honduras. Case fatality rates tend to be below 1% in all three countries, but the more rural areas in each have poorer indicators.

Birth Rate↗