Mansonia dyari, Mansonia flaveola and Aedeomyia squamipennis in the Dominican Republic, three new country records

We report the first collection of 3 mosquito species representing 2 genera in the Dominican Republic. The collections of adults and larvae of Mansonia dyari Belkin, Heinemann, and Page and Mansonia flaveola (Coquillett) from Santo Domingo City represent 2 additional mosquito species to the mosquito fauna of the Dominican Republic. Larvae were collected in the Quitasueno and Puerta de Hierro lagoons (covered with the Pistia stratiotes plants) in Santo Domingo. The associated species Aedeomyia squamipennis Lynch Arribalzaga was also collected for the first time and is the only representative of the genus Aedeomyia Theobald in the Dominican Republic. These collections increase the number of mosquito species belonging to the Genus Mansonia from 1 to 3 and total species from 45 to 48 in the Dominican Republic.     

Tuberculin reactivity in a population of schoolchildren with high BCG vaccination coverage.

OBJECTIVE: To investigate the influence of BCG vaccination or revaccination on tuberculin skin test reactivity, in order to guide the correct interpretation of this test in a setting of high neonatal BCG vaccination coverage and an increasing BCG revaccination coverage at school age. METHODS: We conducted tuberculin skin testing and BCG scar reading in 1 148 children aged 7-14 years old in the city of Salvador, Bahia, Brazil. We measured the positive effect of the presence of one or two BCG scars on the proportion of tuberculin skin test results above different cut-off levels (induration sizes of > or = 5 mm, > or = 10 mm, and > or = 15 mm) and also using several ranges of induration size (0, 1-4, 5-9, 10-14, and > or = 15 mm). We also measured the effects that age, gender, and the school where the child was enrolled had on these proportions. RESULTS: The proportion of tuberculin results > or = 10 mm was 14.2% (95% confidence interval (CI) = 8.0%-20.3%) for children with no BCG scar, 21.3% (95% CI = 18.5%-24.1%) for children with one BCG scar, and 45.0% (95% CI = 32.0%-58.0%) for children with two BCG scars. There was evidence for an increasing positive effect of the presence of one and two BCG scars on the proportion of results > or = 5 mm and > or = 10 mm. Similarly, there was evidence for an increasing positive effect of the presence of one and two scars on the proportion of tuberculin skin test results in the ranges of 5-9 mm and of 10-14 mm. The BCG scar effect on the proportion of results > or = 5 mm and > or = 10 mm did not vary with age. There was no evidence for BCG effect on the results > or = 15 mm. CONCLUSIONS: In Brazilian schoolchildren, BCG-induced tuberculin reactivity is indistinguishable, for results under 15 mm, from reactivity induced by Mycobacterium tuberculosis infection. BCG revaccination at school age increases the degree of BCG-induced tuberculin reactivity found among schoolchildren. This information should be taken into account in tuberculin skin test surveys intended to estimate M. tuberculosis prevalence or to assess transmission patterns as well as in tuberculin skin testing of individuals used as an auxiliary tool in diagnosing tuberculosis. Taking this information into consideration is especially important when there is increasing BCG revaccination coverage.     

Sensitivity and specificity of the BCG scar reading

OBJECTIVE: To validate the BCG scar as a marker of BCG vaccination status. METHODS: A cross-sectional survey was carried out among 53,348 schoolchildren aged 6-14 years who underwent BCG scar examination as part of a large BCG vaccine trial taking place in the city of Manaus, Brazil. Results of BCG scar reading were compared with information on vaccine status of their vaccination cards or provided by parents or guardians. Double-reading was performed in a sub-sample. Data analysis was conducted using Stata 7 and Kappa coefficient. RESULTS: Of 52,348 schoolchildren studied, vaccine status information from parents/guardian letters was available for 29,254 and from vaccination cards for 4,947. There was found a high agreement between the double-readings of the scars (Kappa=0.81). When the agreement between letter and card information was the gold standard, the sensitivity of BCG scar readings was 96.6% (95%CI 96.0-97.1) and the specificity was 71.1% (95%CI 55.7-83.7). The sensitivity was 96.1%, 97.3% and 95.3% for children vaccinated up to one month of age, four months and one year, respectively. CONCLUSIONS: Sensitivity and specificity did not show an association with the child's age at the scar reading. BCG scar was a good marker of BCG vaccination status regardless of age - from the first years of life up to 14 years old.     

Penetration of ultra-low volume applied insecticide into dwellings for dengue vector control.

Determinations on the penetration of ultra-low volume applied insecticide into dwellings was accomplished with a model house in Frederick, MD, USA, and native houses in Santo Domingo, Dominican Republic. Results from the model house tests show that aerosol droplets, with a volume median diameter of 4 microns, penetrated and remained suspended in low recesses of the building during the first 2 min after spraying. Similar results were found with tests in Santo Domingo, where man-made or natural obstructions were determined to be critical factors in aerosol penetration.     

An institutional ethnography of prevention and treatment services for substance use disorders in the Dominican Republic

ABSTRACT

The Dominican Republic is thought to have significant epidemics of illicit drug use but lacks surveillance and formal analyses of the policy context of drug prevention and treatment services. We conducted an institutional ethnography of 15 drug service organisations in Santo Domingo and Boca Chica, Dominican Republic, to explore barriers and resources for drug abuse prevention and treatment. Here, we present a typology of drug service organisations based on their services, methods, and approach. We then draw on interviews with representatives of drug service institutions to describe the primary barriers to drug treatment and prevention services for drug users. We conclude with a focus on the policy priorities that could improve the conditions of health care for marginalised drug users in the Dominican Republic.     

Infant feeding practices in a poor district of Santo Domingo

We conducted a survey of infant feeding practices by interviewing 103 randomly selected primary care givers of children three years of age and under in poor areas of Los Alcarrizos, Santo Domingo, Dominican Republic. We did the survey to identify community specific deficits in infant feeding practices in order to determine target issues for local health education interventions which are presently based on generalized guidelines. This study identified deficits in milk use, weaning, hygiene, and frequency of food consumption. At least some of these deficits are theoretically amenable to change through nutrition education.     

Patterns of helminth infection and relationship to BCG vaccination in Karonga District, northern Malawi

Surveys of enteric and urinary helminth infections were carried out in 1999 among 501 schoolchildren and among 320 adolescents and young adults participating in a study of immune responses to BCG vaccine in Karonga District, northern Malawi. Hookworm, Schistosoma mansoni and S. haematobium infections were detected in 64%, 27% and 20% of schoolchildren and in 55%, 40% and 25% of the immunology study subjects, respectively. Other helminths were appreciably less common. The prevalence of 'at least one' helminth infection was 76% among schoolchildren, ranging from 60% to 92% in the 4 schools, and was 79% in the immunology study participants. There was no evidence for an association between the presence of a BCG scar and presence or intensity of infection with worms in the schoolchildren, nor evidence that BCG vaccination of adolescents and young adults had any effect on the prevalence of helminth infections 1 year later.     

Assessment of schistosomiasis in the Dominican Republic

Active transmission of intestinal schistosomiasis is currently limited to the southeastern part of the Dominican Republic. A population-based stool survey in 1980 detected 4 asymptomatic individuals among 114 selected at random in 2 towns and a rural community in El Seibo Province. The distribution of the transmitting snail, Biomphalaria glabrata, considerably exceeds that of Schistosoma mansoni, extending to the National District and capital city of Santo Domingo and well into certain central valley provinces. There is evidence that transmission sites have shifted during the past three decades because of urban development, molluscicidal activities and, perhaps, introduction of competing mollusks. In spite of intermittent control activities, the combination of domestic and recreational use of streams with consequent fecal contamination, and the extended distribution of B. glabrata indicates that the potential for new transmission foci is as great today as it was 10 years ago. This potential transmission of S. mansoni is a continuing threat to public health in the Dominican Republic.     

Prevention of diarrhoea in a poor District of Santo Domingo, Dominican Republic: practices, knowledge, and barriers

The study, conducted in a poor periurban community of Santo Domingo, Dominican Republic, assessed the practices, knowledge, and barriers relating to prevention of diarrhoea. A total of 582 caregivers of children, aged less than 5 years, were systematically sampled from four barrios. Results of the study showed that 55% of the caregivers did not boil drinking water for children; 38% did not always wash hands of the children prior to meals; 87% of the children did not always wear shoes outside their house; and 54% were breastfed for less than one year. Biomedical knowledge about these practices was high among the caregivers, and was not related to the reported behaviours. However, several barriers were significantly related to practices, including lapse in caregiving, limited resources, erroneous beliefs, and non-compliance by children. Health education, based on a biomedical knowledge-deficit model, may have little impact on improving the diarrhoea-prevention practices in these communities. Greater attention should, therefore, be directed toward the barriers experienced by caregivers of children.     

Determination of the prevalence of infection with Mycobacterium tuberculosis among persons vaccinated against Bacillus Calmette-Guérin in South Korea

The prevalence of tuberculous infection was estimated among 12,032 persons with a Bacillus Calmette-Guérin (BCG) vaccination scar and 7,788 persons without such a scar who participated in a nationwide tuberculin skin test survey conducted in the Republic of Korea in 1975. The analysis was built upon mixture models that captured the heterogeneity of indurations arising from tuberculous infection, cross-reactions due to infection with environmental mycobacteria, and BCG vaccination. The three distributions were allowed to vary by age, sex, and BCG vaccination status in the Bayesian manner, according to the prior opinion of the authors. Estimated prevalences of tuberculous infection were similar among persons with a BCG scar and persons without one: 7.5% (95% credibility interval (CI): 3.1, 12.5) and 5.2% (95% CI: 4.2, 6.3), respectively, at age 0-4 years and 87.3% (95% CI: 84.0, 90.2) and 84.0% (95% CI: 81.9, 85.8), respectively, at age 25-29 years. From this analysis it can be concluded that mixture models allow investigators, for the first time, to estimate the prevalence of tuberculous infection not only in unvaccinated persons but also in the BCG-vaccinated population. Mixture models are a versatile tool for analyzing diagnostic test data and more general classification problems of considerable complexity.     

Indoor Charcoal Smoke and Acute Respiratory Infections in Young Children in the Dominican Republic

The authors investigated the effect of charcoal smoke exposureon risks of acute upper and lower respiratory infection (AURIand ALRI) among children under age 18 months in Santo Domingo,Dominican Republic (1991–1992). Children living in householdsusing charcoal for cooking (exposed, n = 201) were age-matchedto children living in households using propane gas (nonexposed,n = 214) and were followed for 1 year or until 2 years of age.Fuel use and new episodes of AURI and ALRI were ascertainedbiweekly through interviews and medical examinations. Householdindoor-air concentration of respirable particulate matter (RPM)was measured in a sample of follow-up visits. Incidences ofAURI and ALRI were 4.4 and 1.4 episodes/child-year, respectively.After adjustment for other risk factors, exposed children hadno significant increase in risk of AURI but were 1.56 times(95% confidence interval: 1.23, 1.97) more likely to developALRI. RPM concentrations were higher in charcoal-using households(27.9 µg/m³ vs. 17.6 µg/m³), and ALRI risk increasedwith RPM exposure (10-µg/m³ increment: odds ratio = 1.17,95% confidence interval: 1.02, 1.34). Exposure to charcoal smokeincreases the risk of ALRI in young children, an effect thatis probably mediated by RPM. Reducing charcoal smoke exposuremay lower the burden of ALRI among children in this population. air pollution, indoor; biomass; charcoal; Dominican Republic; particulate matter; respiratory tract infections; smoke; wood     

Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic

OBJECTIVES: We assessed the effectiveness of 2 environmental-structural interventions in reducing risks of HIV and sexually transmitted infections (STIs) among female sex workers in the Dominican Republic. METHODS: Two intervention models were implemented over a 1-year period: community solidarity in Santo Domingo and solidarity combined with government policy in Puerto Plata. Both were evaluated via preintervention-postintervention cross-sectional behavioral surveys, STI testing and participant observations, and serial cross-sectional STI screenings. RESULTS: Significant increases in condom use with new clients (75.3%-93.8%; odds ratio [OR]=4.21; 95% confidence interval [CI]=1.55, 11.43) were documented in Santo Domingo. In Puerto Plata, significant increases in condom use with regular partners (13.0%-28.8%; OR=2.97; 95% CI=1.33, 6.66) and reductions in STI prevalence (28.8%-16.3%; OR = 0.50; 95% CI = 0.32, 0.78) were documented, as were significant increases in sex workers' verbal rejections of unsafe sex (50.0%-79.4%; OR=3.86; 95% CI=1.96, 7.58) and participating sex establishments' ability to achieve the goal of no STIs in routine monthly screenings of sex workers (OR=1.17; 95% CI=1.12, 1.22). CONCLUSIONS: Interventions that combine community solidarity and government policy show positive initial effects on HIV and STI risk reduction among female sex workers.     

Nontuberculous mycobacterial infections after cosmetic surgery--Santo Domingo, Dominican Republic, 2003-2004

Rapidly growing mycobacteria have been associated with postoperative infections in patients undergoing cosmetic surgery procedures. In April 2004, CDC received reports of infections caused by rapidly growing mycobacteria in patients who had undergone cosmetic surgery procedures in Santo Domingo, Dominican Republic (DR). CDC, along with state and local health departments, is investigating additional cases identified by passive surveillance (i.e., solicitation of reports from clinicians by using electronic networks) and, in some areas, active surveillance (i.e., review of laboratory reports).     

BCG vaccination scar associated with better childhood survival in Guinea-Bissau

BACKGROUND: Recent studies have suggested that Bacille Calmette-Guerin (BCG) vaccination may have a non-specific beneficial effect on infant survival and that a BCG scar may be associated with lower child mortality. No study has previously examined the influence of BCG vaccination on cause of death. METHODS: Two cohorts (A and B) were used to describe the mortality pattern for children with and without BCG scar and to determine specific causes of death. In cohort A (n = 1813), BCG scar was assessed at 6 months of age and as previously described children with a BCG scar had lower mortality over the next 12 months than children with no BCG scar. In cohort B, 1617 children aged 3 months to 5 years of age had their BCG scar status assessed in a household-based survey and mortality was assessed during a 12-month period. Causes of death were determined by verbal autopsy (VA) and related to BCG scar status in a cause-specific hazard function. RESULTS: Controlling for background factors associated with mortality, there was lower mortality for children with a BCG scar than without in cohort B, the mortality ratio (MR) being 0.45 (95% CI 0.21-0.96). Exclusion of children exposed to TB did not have any impact on the result. In a combined analysis of cohorts A and B, the MR was 0.43 (95% CI 0.28-0.65) controlling for background factors. There were no large differences in distribution of the five major causes of death (malaria, pneumonia, acute diarrhoea, chronic diarrhoea, and meningitis/encephalitis) according to BCG scar status in the two cohorts. Having a BCG scar significantly reduced the risk of death from malaria [MR 0.32 (95% CI 0.13-0.76)]. CONCLUSIONS: A BCG scar is a marker of better survival among children in countries with high child mortality. BCG vaccination may affect the response to several major infections including malaria.     

Scar size and effectiveness of Bacillus Calmette Guerin (BCG) vaccination in the prevention of tuberculosis and leprosy: a case-control study

BACKGROUND: The study was undertaken to estimate the effectiveness of BCG vaccination in relation to scar size in the prevention of tuberculosis and leprosy. METHODS: The present study was designed as hospital-based pair-matched case-control study and was carried out at Government Medical College Hospital, Nagpur, Maharashtra, India. It included 877 cases of tuberculosis and 292 cases of leprosy (diagnosed by WHO criteria), born onwards 1962. Each case was pair-matched with one control for age, sex and socio-economic status. BCG vaccination status was assessed by examination for the presence of BCG scar, immunisation records if available and information from subjects/parents of children. Subjects uncertain about BCG vaccination were not included. The diameter of the BCG scar was measured both across and along the arm in millimeters using a plastic ruler. The average was then calculated. RESULTS: A significant protective association between BCG vaccination and tuberculosis (OR=0.38, 95% CI 0.31-0.47) and leprosy (OR = 0.38, 95% CI 0.26-0.55) was observed. The overall vaccine effectiveness (VE) was 62% (95% CI 53-69) against tuberculosis and 62% (95% CI 45- against leprosy. Vaccine effectiveness against tuberculosis and leprosy was non-significantly greater in the group who had BCG scar size < or =5 mm as compared to subjects who had BCG scar size > 5 mm. Thus there was no clear association between BCG scar size and its effectiveness. CONCLUSION: The current study did not identify any significant association between BCG scar size and its effectiveness against tuberculosis or leprosy.     

Insecticide susceptibility of Aedes aegypti from Santo Domingo, Dominican Republic.

The insecticide susceptibility of Aedes aegypti adults and larvae from Santo Domingo, Dominican Republic, was investigated using World Health Organization standard procedures. A field strain was more resistant to insecticides than a colony strain that originated from the same place. Larvae produced from ovitrap-collected eggs were resistant to temephos (78.2% mortality on exposure to 0.025 mg/liter). Mortality rates after exposure of adults to discriminating concentrations showed that wild populations were resistant to DDT, malathion, propoxur, permethrin and deltamethrin. The problem of resistance was considered serious enough to warrant consideration of control measures other than the use of chemicals.     

Santo Domingo’s LGBT social movement: At the crossroads of HIV and LGBT activism

ABSTRACT

The emergent Dominican LGBT movement in Santo Domingo, Dominican Republic, has been embedded in local and global structures and discourses related to HIV/AIDS, women’s health, and identity. This article explores how ongoing sociocultural changes, increased international HIV funding, and elite support facilitated a surge of collective actions and the institutional reconfiguration of the movement. However, the entry of new cohorts of leaders and the alignment of leaders with global discourses of gender and human rights exposed some rifts within the movement, including over the framing of identity, confrontational tactics, and the role of health issues. While creating political opportunities, international HIV/AIDS funding also consolidated the social movement around HIV at the expense of other issues. The rapid consolidation of the LGBT movement towards HIV issues in the Dominican Republic raises questions about the role of international health funding and health-related NGOs on a movement’s discourses, strategies, and consolidation, and about the recruitment of social movement leaders as public health professionals. I suggest that the trajectories of new movements, when social and political opportunities arise, are ultimately defined by their ability to bridge over generational and ideological rifts, engage in a broader spectrum of strategies, and embrace intersectional collective actions.     

Sensitivity and specificity of BCG scar reading among HIV-infected children

BCG scar has been used as an indicator of vaccination with BCG in the past, but the validity of scar among HIV-positive children is still unknown. The validity of BCG scar reading among such children was estimated, using three different gold standards. The sensitivity ranged from 81.3% (95%-CI: 78.0–84.2) to 91.6% (95%-CI: 88.4–94.0), when the gold standards were, respectively, information from the adult responsible for the child and the vaccination card. The specificity ranged from 90.5% (95% CI: 81.6–95.5) to 94.1% (95% CI: 87.7–97.4), when the gold standards were, respectively, the vaccination card and information from the adult responsible for the child. Reading of BCG scar was shown to be a good indicator for vaccination in the past, among HIV-infected children.     

Relationship between bacille Calmette-Guérin vaccination, Mantoux test positivity, and geohelminth infection

To investigate the potential protective effects of Bacille Calmette-Guerin (BCG) vaccination scar and sensitization to tuberculin against geohelminth infections, we conducted a cross-sectional study among school age children in rural communities in Pichincha Province in Ecuador where BCG vaccination is routinely given at birth. A total of 944 children aged 8-14 years were evaluated for the presence of BCG scars and sensitization to tuberculin, and underwent faecal examination for geohelminth parasites. BCG scars were present in 88.2% of children and positive Mantoux tests were observed in 19.1% of children. Geohelminth prevalence was high with 70.3% infected with any parasite, 52.1% with Ascaris lumbricoides, 52.3% with Trichuris trichiura, 7.6% with Ancylostoma duodenale, and 3.0% with Strongyloides stercoralis. In multivariate analyses, the presence of BCG vaccine scars was not significantly associated with infections with any geohelminth parasite (adjusted odds ratio [AOR] = 0.74, 95% CI 0.43-1.28, P = 0.28), but an inverse association was observed for infections with S. stercoralis that was of borderline statistical significance (AOR = 0.38, 95% CI 0.15-1.00, P = 0.05). There were no associations between sensitization to tuberculin and infection with geohelminth parasites. The data provide little support for an important protective role of neonatal BCG vaccination or current mycobacterial sensitization against geohelminth infections.     

“Men like to Eat More Rice and Beans and Things like That”: The Influence of Childhood Experience and Life Course Events on Dietary Acculturation

ABSTRACT

Life course perspective provides a framework for examining the immigrant experience within the context of globalization and transnationalism. Life course perspective states that individuals develop food choice trajectories based on childhood experiences with food. This study examined the influence of childhood experiences and life events on eating behaviors of Dominican born women in Santo Domingo, Dominican Republic, and New York City. Findings revealed that women developed traditional or non-traditional food choice trajectories. These food choice trajectories remained stable through transition points, such as immigration, marriage, and divorce. Women discussed changes in the amount of food that was eaten, which may explain weight gain after immigration. These findings highlight the limitations of acculturation theory in understanding the eating behaviors of immigrants and provide an alternative explanation for weight gain after immigration.