RESUMO
BACKGROUND: Despite Colombia's robust well-child visits program, Colombian children and mothers still suffer from anemia, especially in populations of lower socioeconomic status. In this study, we aimed to quantify the prevalence and risk factors among mothers and their children attending their well-child visits in Apartadó, a municipality in the Urabá region of the Colombian Caribbean. METHODS: There were 100 mother-child pairs enrolled in this secondary data-analysis study from a health facility in the municipality of Apartadó, Urabá, Colombia, during well-child visits. Self-reported data included child illnesses in the past two weeks (diarrheal, fever, or respiratory symptoms), child feeding practices (breastfeeding, complementary feeding), child vaccinations, and demographic characteristics (mother's and child's age, mother's education, marital status, race, and child sex) and socioeconomic status. Mother and child anthropometry data were collected via standardized weight and height measurements. Mother or child anemia status was collected via a blood test. Chi-squared tests and multivariable logistic regression were used to assess associations between risk factors and anemia. RESULT: The anemia prevalence in children (74%) and mothers (47%) was higher than the Colombian national prevalence. Reported child comorbidities in the preceding two weeks were not significantly associated with child anemia and included respiratory illnesses (60%), fever (46%), and diarrhea (30%). Stunting (8%) was not significantly associated with anemia. Wasting (0%) was not observed in this study. Reported child breastfeeding and complementary feeding were also not significantly associated with child anemia. In adjusted models, the child's significant risk factors for anemia included the mother's "Mestiza" race (OR: 4.681; 95% CI: 1.258, 17.421) versus the Afro-Colombian race. Older children (25-60 months) were less likely to develop anemia than younger (6-24 months) children (OR: 0.073; 95% CI: 0.015, 0.360). CONCLUSIONS: The finding of high anemia prevalence in this study advances our understanding of child and maternal anemia in populations of low socioeconomic status where health care is regularly accessed through well-child programs.
Assuntos
Anemia , Mães , Lactente , Feminino , Humanos , Criança , Adolescente , Colômbia/epidemiologia , Prevalência , Fatores de Risco , Região do Caribe/epidemiologia , Anemia/epidemiologia , Relações Mãe-Filho , Fatores SocioeconômicosRESUMO
Cantaloupes contaminated with pathogens have led to many high-profile outbreaks and illnesses. Since bacterial virulence genes (VGs) can act in tandem with antibiotic-resistance and mobile genetic elements, there is a need to evaluate these gene reservoirs in fresh produce, such as cantaloupes. The goal of this study was to assess the distribution of antibiotic-resistance, virulence, and mobile genetic elements genes (MGEGs) in cantaloupe farm environments. A total of 200 samples from cantaloupe melons (n = 99), farm workers' hands (n = 66), and production water (n = 35) were collected in México. Each sample was assayed for the presence of 14 antibiotic-resistance genes, 15 VGs, and 5 MGEGs by polymerase chain reaction. Our results indicated that tetracycline (tetA and tetB) (18% of cantaloupe, 45% of hand samples) and sulfonamide (sul1) (30% of cantaloupe, 71% of hand samples) resistance genes were frequently detected. The colistin resistance gene (mcr1) was detected in 10% of cantaloupe and 23% of farm workers' hands. Among VGs, Salmonella genes invA and spiA were the most abundant. There was a significantly higher likelihood of detecting antibiotic-resistance, virulence, and MGEGs on hands compared with water samples. These results demonstrate a diverse pool of antibiotic-resistance and VGs in cantaloupe production.
Assuntos
Resistência Microbiana a Medicamentos , Fazendas , Contaminação de Alimentos/análise , Salmonella/isolamento & purificação , Antibacterianos/farmacologia , Cucumis melo/microbiologia , Farmacorresistência Bacteriana , Microbiologia Ambiental , Manipulação de Alimentos/métodos , Microbiologia de Alimentos , México , Testes de Sensibilidade Microbiana , Salmonella/genética , Salmonella/patogenicidade , VirulênciaRESUMO
Hand hygiene interventions are critical for reducing farmworker hand contamination and preventing the spread of produce-associated illness. Hand hygiene effectiveness may be produce-commodity specific, which could influence implementation strategies. This study's goal was to determine if produce commodity influences the ability of handwashing with soap and water or two-step alcohol-based hand sanitizer (ABHS) interventions to reduce soil and bacteria on farmworker hands. Farmworkers (n = 326) harvested produce (cantaloupe, jalapeño, and tomato) for 30 to 90 minutes before engaging in handwashing, two-step ABHS (jalapeño and cantaloupe), or no hand hygiene. Hands were rinsed to measure amounts of soil (absorbance at 600 nm) and indicator bacteria (coliforms, Enterococcus sp., generic Escherichia coli, and Bacteroidales universal [AllBac] and human-specific [BFD] 16S rRNA gene markers). Without hand hygiene, bacterial concentrations (0.88 to 5.1 log10 CFU/hand) on hands significantly differed by the produce commodity harvested. Moderate significant correlations (ρ = -0.41 to 0.56) between soil load and bacterial concentrations were observed. There were significant produce-commodity-specific differences in the ability of handwashing and two-step ABHS interventions to reduce soil (P < 0.0001), coliforms (P = 0.002), and Enterococcus sp. (P = 0.003), but not the Bacteroidales markers AllBac (P = 0.4) or BFD (P = 0.3). Contamination on hands of farmworkers who harvested cantaloupe was more difficult to remove. Overall, we found that a two-step ABHS intervention was similar to handwashing with soap and water at reducing bacteria on farmworker hands. In summary, produce commodity type should be considered when developing hand hygiene interventions on farms.IMPORTANCE This study demonstrated that the type of produce commodity handled influences the ability of handwashing with soap and water or a two-step alcohol-based hand sanitizer (ABHS) intervention to reduce soil and bacterial hand contamination. Handwashing with soap and water, as recommended by the FDA's Produce Safety Rule, when tested in three agricultural environments, does not always reduce bacterial loads. Consistent with past results, we found that the two-step ABHS method performed similarly to handwashing with soap and water but also does not always reduce bacterial loads in these contexts. Given the ease of use of the two-step ABHS method, which may increase compliance, the two-step ABHS method should be further evaluated and possibly considered for implementation in the agricultural environment. Taken together, these results provide important information on hand hygiene effectiveness in three agricultural contexts.
Assuntos
Carga Bacteriana/efeitos dos fármacos , Produção Agrícola , Produtos Agrícolas/classificação , Desinfecção das Mãos/instrumentação , Higienizadores de Mão/administração & dosagem , Mãos/microbiologia , Solo , Capsicum/crescimento & desenvolvimento , Cucumis melo/crescimento & desenvolvimento , Etanol/química , Fazendeiros , Higienizadores de Mão/química , Humanos , Solanum lycopersicum/crescimento & desenvolvimento , MéxicoRESUMO
Globally, vitamin A deficiency (VAD) affects nearly 200 million children with negative health consequences. VAD can be measured by a retinol-binding protein (RBP) and serum retinol concentrations. Their concentrations are not always present in a 1:1 molar ratio and are affected by inflammation. This study sought to quantify VAD and its impact on infant mortality and infectious morbidity during the first 18 months of life in a cohort of mother-infant dyads in El Alto, Bolivia, while accounting for the previously mentioned measurement issues. Healthy mother-infant dyads (n = 461) were enrolled from two hospitals and followed for 12 to 18 months. Three serum samples were collected (at one to two, six to eight, and 12 to 18 months of infant age) and analyzed for RBP, and a random 10% subsample was analyzed for retinol. Linear regression of RBP on retinol was used to generate RBP cut-offs equivalent to retinol <0.7 µmol/L. All measures of RBP and retinol were adjusted for inflammation, which was measured by a C-reactive protein and alpha (1)-acid glycoprotein serum concentrations using linear regression. Infant mortality and morbidity rates were calculated and compared by early VAD status at two months of age. Retinol and RBP were weakly affected by inflammation. This association varied with infant age. Estimated VAD (RBP < 0.7 µmol/L) decreased from 71.0% to 14.8% to 7.7% at two, six to eight, and 12 to 18 months of age. VAD was almost nonexistent in mothers. Early VAD was not significantly associated with infant mortality or morbidity rates. This study confirmed a relationship between inflammation and vitamin A biomarkers for some subsets of the population and suggested that the vitamin A status in early infancy improves with age and may not have significantly affected morbidity in this population of healthy infants.
Assuntos
Proteína C-Reativa/metabolismo , Inflamação/sangue , Estado Nutricional , Orosomucoide/metabolismo , Proteínas de Ligação ao Retinol/metabolismo , Deficiência de Vitamina A/sangue , Vitamina A/sangue , Fatores Etários , Biomarcadores/sangue , Bolívia , Estudos de Coortes , Humanos , Lactente , Inflamação/complicações , Morbidade , Deficiência de Vitamina A/complicaçõesRESUMO
This study aimed to develop chitosan films incorporating natural antioxidants from peanut skin (EPS) and pink pepper residue (EPP) extracts, as well as to evaluate their effects on lipid oxidation, pH, color, and microbial counts of a restructured chicken product. EPS had higher phenolic content and antioxidant activity compared to EPP. When both extracts were applied to chicken meat and the chitosan films, there were no differences for color, pH and total mesophilic counts compared to control at the end of the storage period. For lipid oxidation (peroxide value and thiobarbituric acid reactive substances), both extracts proved to be as effective as butylated hydroxytoluene to maintain the oxidative stability of the chicken product. The microbial counts of psychrotrophic microorganisms were significantly lower for treatments with active films. Chitosan active films with residue extracts may maintain the quality of chicken products due to their antioxidant and antimicrobial potential.
Assuntos
Antioxidantes/química , Quitosana/química , Embalagem de Alimentos/métodos , Conservação de Alimentos/métodos , Conservantes de Alimentos/química , Resíduos Industriais , Indústria de Embalagem de Carne/métodos , Produtos Avícolas/análise , Anti-Infecciosos/química , Anti-Infecciosos/isolamento & purificação , Antioxidantes/isolamento & purificação , Arachis , Bactérias/efeitos dos fármacos , Bactérias/crescimento & desenvolvimento , Cor , Microbiologia de Alimentos/métodos , Conservantes de Alimentos/isolamento & purificação , Concentração de Íons de Hidrogênio , Peroxidação de Lipídeos , Lipídeos/química , Nozes , Oxirredução , Piper , Produtos Avícolas/microbiologia , Substâncias Reativas com Ácido Tiobarbitúrico/química , Fatores de TempoRESUMO
The objective of this article was to characterize how urbanization and indigenous identity shape nutrition attitudes and practices in El Alto, a rapidly urbanizing and predominantly indigenous (Aymara) community on Bolivia's Andean plateau. We took a qualitative ethnographic approach, interviewing health care providers ( n = 11) and conducting focus groups with mothers of young children ( n = 4 focus groups with 25 mothers total [age = 18-43 years, 60% Aymara]). Participants generally described their urban environment as being problematic for nutrition, a place where unhealthy "junk foods" and "chemicals" have supplanted healthy, "natural," "indigenous" foods from the countryside. Placing nutrition in El Alto within a broader context of cultural identity and a struggle to harmonize different lifestyles and worldviews, we propose how an intercultural framework for nutrition can harmonize Western scientific perspectives with rural and indigenous food culture.
Assuntos
Dieta/etnologia , Abastecimento de Alimentos/estatística & dados numéricos , Indígenas Sul-Americanos/psicologia , População Rural , Urbanização , Adolescente , Adulto , Antropologia Cultural , Bolívia , Pré-Escolar , Características Culturais , Dieta Saudável/etnologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/organização & administração , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Masculino , Adulto JovemRESUMO
BACKGROUND: Iron deficiency (ID) is the most common micronutrient deficiency worldwide, with potentially severe consequences on child neurodevelopment. Though exclusive breastfeeding (EBF) is recommended for 6 months, breast milk has low iron content. This study aimed to estimate the effect of the length of EBF on iron status at 6 - 8 months of age among a cohort of Bolivian infants. METHODS: Mother-infant pairs were recruited from 2 hospitals in El Alto, Bolivia, and followed from one through 6 - 8 months of age. Singleton infants > 34 weeks gestational age, iron-sufficient at baseline, and completing blood draws at 2 and 6 - 8 months of age were eligible for inclusion (N = 270). Ferritin was corrected for the effect of inflammation. ID was defined as inflammation-corrected ferritin < 12 µg/L, and anemia was defined as altitude-corrected hemoglobin < 11 g/dL; IDA was defined as ID plus anemia. The effect of length of EBF (infant received only breast milk with no other liquids or solids, categorized as < 4, 4 - 6, and > 6 months) was assessed for ID, IDA, and anemia (logistic regression) and ferritin (Fer) and hemoglobin (Hb, linear regression). RESULTS: Low iron status was common among infants at 6 - 8 months: 56% of infants were ID, 76% were anemic, and 46% had IDA. EBF of 4 months and above was significantly associated with ID as compared with EBF < 4 months (4 - 6 months: OR 2.0 [1.1 - 3.4]; > 6 months: 3.3 [1.0 - 12.3]), but not with IDA (4 - 6 months: OR 1.4 [0.8 - 2.4]; > 6 months: 2.2 [0.7 - 7.4]), or anemia (4 - 6 months: OR 1.4 [0.7 - 2.5]; > 6 months: 1.5 [0.7 - 7.2]). Fer and Hb concentrations were significantly lower with increasing months of EBF. CONCLUSIONS: Results suggest a relationship between prolonged EBF and ID, but are not sufficient to support changes to current breastfeeding recommendations. More research is needed in diverse populations, including exploration of early interventions to address infant IDA.
Assuntos
Anemia Ferropriva/etiologia , Aleitamento Materno/efeitos adversos , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/epidemiologia , Bolívia/epidemiologia , Aleitamento Materno/métodos , Países em Desenvolvimento , Feminino , Humanos , Lactente , Modelos Lineares , Estudos Longitudinais , Masculino , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Implementing rigorous epidemiologic studies in low-resource settings involves challenges in participant recruitment and follow-up (e.g., mobile populations, distrust), biological sample collection (e.g., cold-chain, laboratory equipment scarcity) and data collection (e.g., literacy, staff training, and infrastructure). This article describes the use of a monitoring and evaluation (M&E) framework to improve study efficiency and quality during participant engagement, and biological sample and data collection in a longitudinal cohort study of Bolivian infants. METHODS: The study occurred between 2013 and 2015 in El Alto, Bolivia, a high-altitude, urban, low-resource community. The study's M&E framework included indicators for participant engagement (e.g., recruitment, retention, safety), biological sample (e.g., stool and blood), and data (e.g., anthropometry, questionnaires) collection and quality. Monitoring indicators were measured regularly throughout the study and used for course correction, communication, and staff retraining. RESULTS: Participant engagement indicators suggested that enrollment objectives were met (461 infants), but 15% loss-to-follow-up resulted in only 364 infants completing the study. Over the course of the study, there were four study-related adverse events (minor swelling and bruising related to a blood draw) and five severe adverse events (infant deaths) not related to study participation. Biological sample indicators demonstrated two blood samples collected from 95% (333 of 350 required) infants and stool collected for 61% of reported infant diarrhea episodes. Anthropometry data quality indicators were extremely high (median SDs for weight-for-length, length-for-age and weight-for-age z-scores 1.01, 0.98, and 1.03, respectively), likely due to extensive training, standardization, and monitoring efforts. CONCLUSIONS: Conducting human subjects research studies in low-resource settings often presents unique logistical difficulties, and collecting high-quality data is often a challenge. Investing in comprehensive M&E is important to improve participant recruitment, retention and safety, and sample and data quality. The M&E framework from this study can be applied to other longitudinal studies.
Assuntos
Vigilância da População , Avaliação de Programas e Projetos de Saúde , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Bolívia/epidemiologia , Diarreia Infantil/epidemiologia , Feminino , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Inflamação/epidemiologia , Masculino , Estudos Prospectivos , Projetos de Pesquisa/normasRESUMO
To improve food safety on farms, it is critical to quantify the impact of environmental microbial contamination sources on fresh produce. However, studies are hampered by difficulties achieving study designs with powered sample sizes to elucidate relationships between environmental and produce contamination. Our goal was to quantify, in the agricultural production environment, the relationship between microbial contamination on hands, soil, and water and contamination on fresh produce. In 11 farms and packing facilities in northern Mexico, we applied a matched study design: composite samples (n = 636, equivalent to 11,046 units) of produce rinses were matched to water, soil, and worker hand rinses during two growing seasons. Microbial indicators (coliforms, Escherichia coli, Enterococcus spp., and somatic coliphage) were quantified from composite samples. Statistical measures of association and correlations were calculated through Spearman's correlation, linear regression, and logistic regression models. The concentrations of all microbial indicators were positively correlated between produce and hands (ρ range, 0.41 to 0.75; P < 0.01). When E. coli was present on hands, the handled produce was nine times more likely to contain E. coli (P < 0.05). Similarly, when coliphage was present on hands, the handled produce was eight times more likely to contain coliphage (P < 0.05). There were relatively low concentrations of indicators in soil and water samples, and a few sporadic significant associations were observed between contamination of soil and water and contamination of produce. This methodology provides a foundation for future field studies, and results highlight the need for interventions surrounding farmworker hygiene and sanitation to reduce microbial contamination of farmworkers' hands.IMPORTANCE This study of the relationships between microbes on produce and in the farm environment can be used to support the design of targeted interventions to prevent or reduce microbial contamination of fresh produce with associated reductions in foodborne illness.
Assuntos
Bactérias/isolamento & purificação , Contaminação de Alimentos/análise , Embalagem de Alimentos/instrumentação , Bactérias/genética , Fazendas , Microbiologia de Alimentos/instrumentação , Mãos/microbiologia , Humanos , México , Recursos HumanosRESUMO
Several produce-associated outbreaks have been linked to the packing facility. Equipment surfaces may be an important source of contamination. The goal was to assess whether the microbial load of packing facility surfaces is associated with the microbial load of produce. From November 2000 to December 2003, 487 matched produce (14 types) and equipment surfaces (six production steps) were sampled from eight packing facilities in the United States near the border with Mexico and enumerated for aerobic plate counts (APC), Escherichia coli , Enterococcus, and coliforms. Bivariate correlations were assessed by Spearman's ρ, and adjusted associations were assessed by multilevel mixed linear regression models. In general, the microbial load both increased and decreased on produce (0.2 to 1.0 log CFU/g) and equipment surfaces (0.5 to 3.0 log CFU/cm2) across production steps. Equipment surface and produce microbial loads were correlated, but correlations varied from none to high depending on the equipment surface. For example, significant correlations (P < 0.01) included APC (ρ = 0.386) and Enterococcus (ρ = 0.562) with the harvest bin, E. coli (ρ = 0.372) and Enterococcus (ρ = 0.355) with the merry-go-round, Enterococcus (ρ = 0.679) with rinse cycle equipment, APC (ρ = 0.542) with the conveyer belt, and for all indicators with the packing box (ρ = 0.310 to 0.657). After controlling for crop type, sample replicate group, and sample location, there were significant positive associations between the log concentration of Enterococcus on produce and the harvest bin (ß = 0.259, P < 0.01) and the rinse cycle (ß = 0.010, P = 0.01), and between the log concentration of all indicators on produce and the packing box (ß = 0.155 to 0.500, all P < 0.01). These statistically significant associations between microbial loads on packing facility surfaces and fresh produce confirm the importance of packing facility sanitation to protect produce quality and safety.