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Archive for the ‘Latin America and the Caribbean’ Category

Heart Failure Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

September 1, 2014 Comments off

Heart Failure Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
Source: PLoS Medicine

Background
Heart failure places a significant burden on patients and health systems in high-income countries. However, information about its burden in low- and middle-income countries (LMICs) is scant. We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs.

Methods and Findings
Medline, Embase, Global Health Database, and World Health Organization regional databases were searched for studies from LMICs published between 1 January 1995 and 30 March 2014. Additional unpublished data were requested from investigators and international heart failure experts. We identified 42 studies that provided relevant information on acute hospital care (25 LMICs; 232,550 patients) and 11 studies on the management of chronic heart failure in primary care or outpatient settings (14 LMICs; 5,358 patients). The mean age of patients studied ranged from 42 y in Cameroon and Ghana to 75 y in Argentina, and mean age in studies largely correlated with the human development index of the country in which they were conducted (r = 0.71, p<0.001). Overall, ischaemic heart disease was the main reported cause of heart failure in all regions except Africa and the Americas, where hypertension was predominant. Taking both those managed acutely in hospital and those in non-acute outpatient or community settings together, 57% (95% confidence interval [CI]: 49%–64%) of patients were treated with angiotensin-converting enzyme inhibitors, 34% (95% CI: 28%–41%) with beta-blockers, and 32% (95% CI: 25%–39%) with mineralocorticoid receptor antagonists. Mean inpatient stay was 10 d, ranging from 3 d in India to 23 d in China. Acute heart failure accounted for 2.2% (range: 0.3%–7.7%) of total hospital admissions, and mean in-hospital mortality was 8% (95% CI: 6%–10%). There was substantial variation between studies (p<0.001 across all variables), and most data were from urban tertiary referral centres. Only one population-based study assessing incidence and/or prevalence of heart failure was identified.

Conclusions
The presentation, underlying causes, management, and outcomes of heart failure vary substantially across LMICs. On average, the use of evidence-based medications tends to be suboptimal. Better strategies for heart failure surveillance and management in LMICs are needed.

See: Heart failure is a substantial health burden in low- and middle-income countries (EurekAlert!)

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CRS — Guatemala: Political, Security, and Socio-Economic Conditions and U.S. Relations (August 7, 2014)

August 22, 2014 Comments off

Guatemala: Political, Security, and Socio-Economic Conditions and U.S. Relations (PDF)
Source: Congressional Research Service (via U.S. State Department Foreign Press Center)

Since the 1980s, Guatemala, the most populous country in Central America with a population of 15.5 million, has continued its transition from centuries of mostly autocratic rule toward representative government. A democratic constitution was adopted in 1985, and a democratically elected government was inaugurated in 1986. A violent 36-year civil war ended in 1996.

This report provides an overview of Guatemala’s current political and economic conditions, relations with the United States, and several issues likely to figure in future decisions by Congress and the Administration regarding Guatemala. With respect to continued cooperation and foreign assistance, these issues include security and governance; protection of human rights and human rights conditions on some U.S. military aid to Guatemala; support for the International Commission against Impunity in Guatemala; combating narcotics trafficking and organized crime; trade relations; intercountry adoption; and unaccompanied children at the U.S. border.

Notes from the Field: Hospitalizations for Respiratory Disease Among Unaccompanied Children from Central America — Multiple States, June–July 2014

August 18, 2014 Comments off

Notes from the Field: Hospitalizations for Respiratory Disease Among Unaccompanied Children from Central America — Multiple States, June–July 2014
Source: Morbidity and Mortality Weekly Report (CDC)

During October 2013–June 2014, approximately 54,000 unaccompanied children, mostly from the Central American countries of El Salvador, Guatemala, and Honduras, were identified attempting entry into the United States from Mexico, exceeding numbers reported in previous years (1). Once identified in the United States, U.S. Customs and Border Protection, an agency of the U.S. Department of Homeland Security, processes the unaccompanied children and transfers them to the Office of Refugee Resettlement (ORR), an office of the Administration for Children and Families, U.S. Department of Health and Human Services. ORR cares for the children in shelters until they can be released to a sponsor, typically a parent or relative, who can care for the child while their immigration case is processed. In June 2014, in response to the increased number of unaccompanied children, U.S. Customs and Border Protection expanded operations to accommodate children at a processing center in Nogales, Arizona. ORR, together with the U.S. Department of Defense, opened additional large temporary shelters for the children at Lackland Air Force Base, Texas; U.S. Army Garrison Ft. Sill, Oklahoma; and Naval Base Ventura County, California.

On July 10, 2014, CDC was informed by the California Department of Public Health and ORR about four unaccompanied male children aged 14–16 years with respiratory illnesses at Naval Base Ventura County, three of whom were hospitalized with pneumonia. Among the three patients with pneumonia, two were bacteremic with Streptococcus pneumoniae, ultimately determined to be serotype 5, one of whom also had laboratory-confirmed influenza B virus by polymerase chain reaction (PCR). The fourth patient, without pneumonia, had PCR-confirmed influenza A(H1N1)pdm09. Pneumococcal bacteremia is uncommon among U.S. adolescents, particularly serotype 5, with only three such cases identified in the past 10 years by CDC (2). In addition, influenza activity in the United States is typically lowest in the middle of summer, and Ventura County had no reports of an unusual increase in influenza activity in the community at the time. ORR asked CDC to investigate the scope of this apparent outbreak and implement measures to interrupt transmission.

During July 6–19, 2014, CDC was informed of other clusters of hospitalized children with respiratory disease, increasing the total to 16 cases. The cases were from Naval Base Ventura County (eight cases), Ft. Sill (three), Lackland Air Force Base (two), a standard ORR shelter near Houston, Texas (two), and the Nogales processing center (one). Cases were in persons aged 14–17 years. Diagnoses included laboratory-confirmed pneumococcal pneumonia with laboratory-confirmed influenza (three cases) and without laboratory-confirmed influenza (four cases), influenza pneumonia (one case), and pneumonia with no identified etiology (eight cases). Five patients experienced septic shock requiring intensive care. No case was fatal. All six cases for which pneumococcal isolates were available were identified as serotype 5, a serotype included in 13-valent pneumococcal conjugate vaccine (PCV13) (Prevnar-13, Pfizer). Of the 16 patients identified in this cluster, 11 were tested for influenza viruses; four (36%) were positive (two for influenza A[H1N1]pdm09, one for influenza B, and one for influenza A by rapid test).

Because of the concern that unaccompanied children were at increased risk for influenza and pneumococcal pneumonia in this outbreak setting and the clinically important interaction between influenza and pneumococcal infections (3), CDC recommended that all children residing in temporary or standard ORR shelters receive influenza vaccine and PCV13 in addition to routinely recommended vaccines. Approximately 2,000 children in four affected shelters were vaccinated during July 18–30 with PCV13 and with Food and Drug Administration–approved extended expiration date–specific lots of 2013–14 seasonal influenza vaccine, which includes influenza A(H1N1)pdm09 and influenza B viruses. The shelters reported no serious adverse events.

CRS — Cuba: U.S. Policy and Issues for the 113th Congress (July 31, 2014)

August 14, 2014 Comments off

Cuba: U.S. Policy and Issues for the 113th Congress (PDF)
Source: Congressional Research Service (via U.S. State Department Foreign Press Center)

Cuba remains a one-party communist state with a poor record on human rights. The country’s political succession in 2006 from the long-ruling Fidel Castro to his brother Raúl was characterized by a remarkable degree of stability. In February 2013, Castro was reappointed to a second five-year term as president (until 2018, when he would be 86 years old), and selected 52- year old former Education Minister Miguel Díaz-Canel as his First Vice President, making him the official successor in the event that Castro cannot serve out his term. Raúl Castro has implemented a number of gradual economic policy changes over the past several years, including an expansion of self-employment. A party congress held in April 2011 laid out numerous economic goals that, if implemented, could significantly alter Cuba’s state-dominated economic model. Few observers, however, expect the government to ease its tight control over the political system. While the government reduced the number of political prisoners in 2010-2011, the number increased in 2012; moreover, short-term detentions and harassment have increased significantly over the past several years.

Debt, Growth and Natural Disasters: A Caribbean Trilogy

August 4, 2014 Comments off

Debt, Growth and Natural Disasters: A Caribbean Trilogy
Source: International Monetary Fund

This paper seeks to determine the effects that natural disasters have on per capita GDP and on the debt to GDP ratio in the Caribbean. Two types of natural disasters are studied –storms and floods– given their prevalence in the region, while considering the effects of both moderate and severe disasters. I use a vector autoregressive model with exogenous natural disasters shocks, in a panel of 12 Caribbean countries over a period of 40 years. The results show that both storms and floods have a negative effect on growth, and that debt increases with floods but not with storms. However, in a subsample I find that storms significantly increase debt in the short and long run. I also find weak evidence that debt relief contributes to ease the negative effects of storms on debt.

Why Children are Fleeing Central America

July 31, 2014 Comments off

Why Children are Fleeing Central America (PDF)
Source: Bread for the World Institute

Since last October, more than 52,000 unaccompanied children have fled unspeakable conditions and crossed into the United States. Most have come from Honduras, Guatemala, and El Salvador. By year’s end, that number is expected to grow to between 70,000 and 90,000. The Department of Homeland Security is preparing for more than 100,000 children to arrive in 2015. The United States is witnessing a humanitarian crisis in this situation.

Many members of Congress are focusing on detention centers and how fast the United States can send these children back to their home countries. Few are asking this question: What are we sending these children back to? Without addressing the root causes of this crisis, such as poverty and violence, this situation will continue. More and more children will be driven to flee their home countries in search of greater educational and economic opportunities, safer and more stable communities, and a path out of hunger.

This crisis is not just about the surge of new arrivals in the United States. It is also about the conditions of poverty, hunger, and violence that force children to leave their homes on a very dangerous and uncertain journey:

• 75 percent of these children are coming from three countries: Guatemala, El Salvador, and Honduras.
• More than half of the citizens of Honduras and Guatemala live on less than $4 a day.
• About half of all Guatemalans suffer from moderately or severely stunted growth.
• Honduras has the highest murder rate per capita in the world. It is almost five times that of Mexico and twice that of Detroit.
• Residents of all ages, including children, in these countries are getting caught in gang-related violence.

Select Diaspora Populations in the United States

July 24, 2014 Comments off

Select Diaspora Populations in the United States
Source: Migration Policy Institute

Diaspora populations often perform essential functions in the economic and human capital development of their countries of origin, and can continue playing a strong role in shaping these countries long after they or their forebears departed.The Rockefeller Foundation and the Aspen Institute have launched the Rockefeller-Aspen Diaspora Program (RAD), a joint venture to better understand diaspora members’ financial and human capital investments and to design an approach to foster further growth in these areas. The Migration Policy Institute has partnered with RAD to produce profiles of 15 diaspora communities in the United States, which is home to nearly 60 million first- or second-generation immigrants.

These profiles address 15 different diaspora populations in the United States, gathering in one place key data and analysis on diasporas from Bangladesh, Colombia, El Salvador, Egypt, Ethiopia, Ghana, Haiti, India, Kenya, Mexico, Morocco, Nigeria, Pakistan, the Philippines, and Vietnam. Each profile explores the demographic characteristics of first- and second-generation immigrants in a particular diaspora, their educational attainment, household income, employment patterns, geographic distribution, and remittance volume.

Five longer profiles, focusing on Colombia, Egypt, India, Kenya, and the Philippines, also detail historical immigration pathways and contemporary entry trends, poverty status, active diaspora organizations, and country-of-origin policies and institutions related to interaction with emigrants and their descendants abroad.

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