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Mortality trends among refugees in Honduras, 1984-1987.

Mortality data collected from 1984 to 1987 through a routine standardized health information system in the five main refugee populations of Honduras were reviewed. The direct standardized mean annual death rate for all refugees was 5.5 per 1000 population (Honduras population as reference; Honduras mortality rate: 10.1 per 1000). Mortality decreased or remained stable among Salvadoran refugees from 1984 to 1987, but increased among Nicaraguan refugees after 1985. The highest neonatal (56.1 per 1000 livebirths), infant (126.1 per 1000 livebirths) and under-five-year-olds (35.7 per 1000 child less than five years of age) mortality rates were observed in the two Nicaraguan camps. These two camps had the highest rate of newly arriving refugees. Deaths in infants and under-five-year-olds accounted for 42 and 54.1% of all deaths respectively. Of all deaths under five years of age, respiratory infections, diarrhoeal diseases and measles accounted for 21.4%, 22.1% and 4.7%, respectively. Mortality rates, particularly among under-five-year-olds and infants increased when the rate of newly arriving refugees was higher. The importance of adapted health surveillance in refugee settlements is discussed.

Adolescent

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

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

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

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

Field evaluation of four biorational larvicide formulations against Anopheles albimanus in Honduras.

Four biorational larvicide formulations: Teknar (B.t.i.), Arosurf MSF (Monomolecular Surface Film), Arosurf MSF combined with Teknar, and SAN-809-I ([s]-methoprene combined with B.t.i.), were evaluated against naturally occurring populations of the malaria vector mosquito Anopheles albimanus Wiedemann in Honduras. All formulations reduced the mean number of larvae per sample area to 0 within 48 h after treatment, and gave significant (P less than 0.05) control when compared with similar untreated areas for at least 10 days after treatment. It is concluded that each of these four formulations can be used effectively to control the larvae of An. albimanus in Honduras.

Animals

The prevalence of the retrocuspid papilla among three indigenous groups of patients. Study of the subjects in Ecuador, Honduras and Nicaragua.

The retrocuspid papilla (RCP) is a soft well circumscribed nodule located lingually to the mandibular cuspid on the gingival tissue surface. The RCP is observed more frequently in young children and regresses or disappears with age. Little information is available in the literature on this structure. The prevalence of the RCP is discussed as it relates to its distribution among three groups of Latin American patients: those of southern Ecuador, northeastern Honduras and eastern Nicaragua. The distribution by age, sex, symmetry and gingival position is evaluated. Based on the analysis of the results, it was determined that: the RCP is most prevalent in under-five age group at a relative frequency of 25 per cent; its prevalence decreases progressively with age; it is present significantly more often among females in the Honduras group; a unilateral distribution is more frequent than a bilateral distribution, except for the Nicaragua group, where a bilateral distribution prevails; and it is most frequently located on the attached gingiva as compared to free gingiva and mucosa. The clinical significance of the RCP resides in the fact that it may simulate pathological gingival conditions from which it must be differentiated.

Adolescent

Repellency of two deet formulations and Avon Skin-So-Soft against biting midges (Diptera: Ceratopogonidae) in Honduras.

Two U.S. military issue deet repellent formulations (75% deet liquid and 33% deet lotion) and Avon Skin-So-Soft were tested against ceratopogonid midges under field conditions in Honduras. Test subjects were U.S. military personnel deployed to Honduras for training. Culicoides furens accounted for 96.3% of all midges collected. The liquid and lotion formulations of deet and Avon Skin-So-Soft provided 97.9, 95.9 and 71.4% protection, respectively, compared with the untreated control. Both deet formulations provided significantly better protection (P less than 0.05) than Avon Skin-So-Soft. The latter provided protection by trapping the midges in the oily film and not by repelling the insects as did the deet formulations.

Animals

Detection of significant demographic differences between subpopulations of prehispanic Maya from Copan, Honduras, by survival analysis.

Heterogeneity and small sample size are problems that affect many paleodemographic studies. The former can cause the overall distribution of age at death to be an amalgam that does not accurately reflect the distributions of any of the groups composing the heterogeneous population. The latter can make it difficult to separate significant from nonsignificant demographic differences between groups. Survival analysis, a methodology that involves the survival distribution function and various regression models, can be applied to distributions of age at death in order to reveal statistically significant demographic differences and to control for heterogeneity. Survival analysis was used on demographic data from a heterogeneous sample of skeletons of low status Maya who lived in and around Copan, Honduras, between A.D. 400 and 1200. Results contribute to understanding the collapse of Classic Maya civilization.

Age Factors

Gonorrhoea and urogenital chlamydial infection in female prostitutes in Tegucigalpa, Honduras.

The prevalence of gonorrhoea and urogenital chlamydial infection was investigated in female prostitutes in Tegucigalpa, Honduras. Epidemiological data were recorded according to a standardized questionnaire. The median age of the prostitutes was 27 years and the median period of prostitution was 2-4 years. Most of the women (91%) had no occupation other than prostitution and 57% of them had not even completed primary school. In 233 cases when both gonococcal culture and chlamydial antigen detection with a commercial EIA kit were performed the prevalence of gonorrhoea was 25% (59) and that of chlamydial infection 31% (72). Both diseases were recorded in 9%. The women who had been prostitutes for 2 years or longer had gonorrhoea (P less than 0.01) or chlamydial infection (P less than 0.05) less frequently than those who had practised prostitution for a shorter time period. Among 70 different gonococcal isolates from 241 prostitutes, 40 (57%) belonged to serogroup W II/III. Most (83%) of the 30 W I isolates were beta-lactamase producing (PPNG) like 42% of the W II/III isolates. All non-PPNG isolates, except one had decreased susceptibility to benzylpenicillin (MIC greater than or equal to 0.125 mg/l) and all isolates were susceptible to spectinomycin. Four out of five isolates from the throat were PPNG and the fifth had a benzylpenicillin MIC of 0.5-2.0 mg/l.

Adult

The Duffy blood group and resistance to Plasmodium vivax in Honduras.

To test the hypothesis that the Duffy blood group negative genotype is a factor in resistance to Plasmodium vivax, we determined the Duffy blood group, the malaria antibodies, and the slide-demonstrated infection rates with P. vivax and P. falciparum of 420 persons living in Nueva Armenia, Honduras. In all, 247 persons were Duffy negative. Demonstrated infections with P. falciparum were almost equally distributed between Duffy-positive (5,8%) and Duffy-negative (4.9%) persons. Similarly, Duffy-positive (25.6%) and Duffy-negative (28.2%) persons had equal proportions of indirect fluorescent antibody test titers suggestive of past or present P. falciparum infection. In contrast, all 14 P. vivax infections were found in Duffy-negative persons. There was no evidence suggesting that Duffy-positive and Duffy-negative persons had different exposures to malaria. The Duffy negative genotype FyFy appears to be a factor in resistance to P. vivax.

Antibodies

Trypanosomatid isolates from Honduras: differentiation between Trypanosoma cruzi and Trypanosoma rangeli.

With the aim of identifying and differentiating Trypanosoma cruzi from Trypanosoma rangeli, culture epimastigotes from 30 Honduran trypanosomatid isolates were analyzed by susceptibility to complement lysis, reactivity to lectins, reactivity to monoclonal antibodies specific for T. cruzi, and isoenzymatic electrophoretic patterns. Using these four methodologies, 27 of the 30 trypanosomatid isolates, as well as 5 clones, were identified as T. cruzi, whereas the remaining three isolates were classified as T. rangeli. None of the isolates presented mixed trypanosome species. Results indicate that both trypanosomatid species circulate in Honduras and that any of the four methods employed may be used to reliably differentiate T. cruzi from T. rangeli.

Agglutination Tests

One country's story: the PROALMA program in Honduras.

The first phase of the PROALMA project in Honduras resulted in changed hospital breastfeeding practices within as little as 2 years. These changes affected the community, lengthening the duration of exclusive breastfeeding to 1-2 months and the duration of any breastfeeding to 12 months. The second phase of the project sought to extend the program nationwide. One of the original pilot hospitals in San Pedro Sula was well along in breastfeeding promotion but felt there were still problems in breastfeeding education and the integration with family planning services. Following retraining of staff and the opening of a Breastfeeding Clinic and a Temporary Methods Family Planning Clinic, there have been improvements in both areas.

Breast Feeding

[Nursing in the National Health Plan of Honduras].

After summarizing the health situation in Honduras and describing the National Health Plan launched in 1973, the authors explain the changes that have come about in nursing, the difficulties that had to be surmounted to reach a new professional position, and the administrative decisions that had to be taken to devise a health policy. An account is given of the changes made in the training of nursing staff and in the functions that staff must perform in the planning, implementation, and evaluation of the coverage extensive program. The article high-lights the role of the Nursing Division in the Ministry of Public Health and Social Welfare and the levels of coordination established with the other technical divisions and institutions responsible for the health personnel training. In closing, the article points out that the nursing sector represents the keystone of the model for the delivery of services to attain the goal of health for all by the year 2000.

Education, Nursing

Trematode eggs in the peritoneal cavity of man in Honduras.

Surgical repair of an inguinal hernia in a 19-year-old man in Honduras revealed massive numbers of small granulomata containing trematode eggs on the omentum and other peritoneal surfaces. The eggs resembled those of Achillurbainia recondita Travassos, 1942, a species found in the maxillary sinuses of the opossum, Didelphis marsupialis. Species of Achillurbainis (syn. Poikilorchis Fain and Vandepitte, 1957) have been reported in retroauricular cysts or abscesses in residents of West Africa and Southeast Asia.

Adult

Cleft lip and palate surgery in La Ceiba, Honduras.

The volume of experience in the surgical repair of cleft lip and palate deformities is limited in many areas of the United States. This deficit in experience exists not only for those in resident training programs but also for those who practice at universities or are in private practice. Physicians are performing too few operations to maintain their surgical skills in cleft lip and palate surgery. This deficit is also encountered by physicians in the major specialties of plastic surgery, oral surgery, and otolaryngology who perform cleft lip and palate surgery. Physicians from the United States can gain surgical experience in other countries through groups like the Medical Group Mission Christian Medical and Dental Society. Surgical experience is available in Central and South America, India, China, and Africa through similar organizations. The complexity of providing service to under-privileged people through organizations such as the Medical Group Mission Christian Medical and Dental Society is described.

Child

An evaluation of a national breast-feeding promotion programme in Honduras.

A significant increase occurred in the initiation and duration of breast-feeding among Honduran women between 1981 and 1987. Changes in population characteristics (e.g. level of education of women) would be expected to lead to a decrease in breast-feeding at each infant age, but these were offset by behavioural changes that led to an increase in the likelihood of initiation and continuation of breast-feeding. An exploration of relevant factors suggests that the PROALMA breast-feeding promotion programme has had a profound effect on the breast-feeding behaviour of Honduran mothers.

Breast Feeding