Central American Countries Research Articles

The impact of protected area governance and management capacity on ecosystem function in Central America.

Protected areas (PAs) are a prominent approach to maintaining and enhancing biodiversity and ecosystem services. A critical question for safeguarding these resources is how PA governance processes and management structures influence their effectiveness. We conduct an impact evaluation of 12 PAs in three Central American countries to assess how processes in management restrictions, management capacity, and decentralization affect the annual change in the satellite-derived Normalized Difference Vegetation Index (NDVI). NDVI varies with greenness that relates to plant production, biomass, and important ecosystem functions related to biodiversity and ecosystem services such as water quality and carbon storage. Any loss of vegetation cover in the form of deforestation or degradation would show up as a decrease in NDVI values over time and gains in vegetation cover and regeneration as an increase in NDVI values. Management restriction categories are based on international classifications of strict versus multiple-use PAs, and capacity and decentralization categories are based on key informant interviews of PA managers. We use matching to create a counterfactual of non-protected observations and a matching estimator and regression to estimate treatment effects of each sub-sample. On average, strict and multiple-use PAs have a significant and positive effect on NDVI compared to non-protected land uses. Both high and low decentralized PAs also positively affect NDVI. High capacity PAs have a positive and significant effect on NDVI, while low capacity PAs have a negative effect on NDVI. Our findings advance knowledge on how governance and management influence PA effectiveness and suggest that capacity may be more important than governance type or management restrictions in maintaining and enhancing NDVI. This paper also provides a guide for future studies to incorporate measures of PA governance and management into impact evaluations.

Detection and quantification of Hepatobacter penaei bacteria (NHPB) by new PCR and quantitative PCR assays.

Necrotizing hepatopancreatitis (NHP) is a bacterial disease caused by a Gram-negative bacterium classified as Hepatobacter penaei. H. penaei affects cultured penaeid shrimp in several countries from the western hemisphere, including the USA, and most Central and South American countries that farm shrimp. The current PCR and quantitative PCR (qPCR) assays based on the amplification of the 16S rRNA gene developed at the University of Arizona Aquaculture Pathology Laboratory (UAZ-APL) are the only techniques recommended in the World Organisation for Animal Health (OIE) manual for H. penaei detection. Although these techniques are quite sensitive and specific to H. penaei detection in shrimp, in recent years, rare non-specific amplifications have been observed in the end-point PCR when screening for H. penaei in Artemia cyst samples submitted to the UAZ-APL. To avoid these non-specific amplifications, new end-point PCR and qPCR assays were developed based on the H. penaei flagella gene, flgE. Unlike the current OIE methods, the new H. penaei PCR assay did not provide any non-specific amplification, and the qPCR assay had a detection limit of 100 copies and a log-linear range up to 108 copies. Because the previous PCR-based assay using the 16S rRNA was showing non-specific amplification, the new non-specific product of around 400 bp was sequenced to determine its identity. A phylogenetic analysis revealed 2 clusters of H. penaei: Ecuador and Central-North America. This information will enable us to determine the genetic diversity and possible origin of H. penaei and emphasizes the need to evaluate H. penaei PCR detection methods to avoid inaccurate detection of H. penaei.

Conserved epitopes in variants of amastin protein of Trypanosoma cruzi for vaccine design: A bioinformatics approach

Chagas disease caused by protozoan parasite Trypanosoma cruzi is endemic disease in South and Central American countries but due to migrating human populations it has shown emergence in Europe, North America and Australia. With only two drugs, benznidazole and nifurtimox for its treatment there is need for newer therapies. In the current study, we have tried to analyse the potential of amastin, a major surface protein as a vaccine target using bioinformatics tools. Using 282 variants of this protein available in NCBI protein database we have found out five conserved potential Tc cell and two TH cell epitopes. These epitopes are conserved in more than 90% of the cohort of sequences used in the study. The epitopes showed binding to the peptide binding cleft of HLA-A02 and HLA-DR molecules. With coverage of pan world populations and being non-toxic and non-allergic these epitopes could be used for future vaccine applications.

Intercultural Orientation and Support When Living as a Hispanic-American Expatriate in Jakarta

The population of Hispanic-Americans living in Asia is growing, but there is still a lack of knowledge about their nationalities or cultural background. Past studies and academic research are often too broad as they consider all expatriates as virtually the same. This article will fill this gap by focusing specifically on people originating from Central and South American countries and examining the challenges and adjustment difficulties they face during their assignments overseas. The research was conducted by using a qualitative methodology, hence, in-depth interviews as well as informal conversational interviews were jointly used as methods of data collection, along with theories such as U-curve theory and push-pull theory. The findings indicate that companies need to have a design strategy and full involvement both prior and during the expatriation process, as well as upon repatriation. In addition, it was found that better mechanisms in relation to cross cultural training, good orientation and improved organizational communication for expatriates and their families will enhance their adaptability to and familiarization with the host country environment, which will, in turn, ensure a successful overseas assignment.

Evolutionary history and spatiotemporal dynamics of the HIV-1 subtype B epidemic in Guatemala.

Different explanations exist on how HIV-1 subtype B spread in Central America, but the role of Guatemala, the Central American country with the highest number of people living with the virus, in this scenario is unknown. We investigated the evolutionary history and spatiotemporal dynamics of HIV-1 subtype B in Guatemala. A total of 1,047 HIV-1 subtype B pol sequences, from newly diagnosed ART-naïve, HIV-infected Guatemalan subjects enrolled between 2011 and 2013 were combined with published subtype B sequences from other Central American countries (n = 2,101) and with reference sequences representative of the BPANDEMIC and BCAR lineages from the United States (n = 465), France (n = 344) and the Caribbean (n = 238). Estimates of evolutionary, demographic, and phylogeographic parameters were obtained from sequence data using maximum likelihood and Bayesian coalescent-based methods. The majority of Guatemalan sequences (98.9%) belonged to the BPANDEMIC clade, and 75.2% of these sequences branched within 10 monophyletic clades: four also included sequences from other Central American countries (BCAM-I to BCAM-IV) and six were mostly (>99%) composed by Guatemalan sequences (BGU clades). Most clades mainly comprised sequences from heterosexual individuals. Bayesian coalescent-based analyses suggested that BGU clades originated during the 1990s and 2000s, whereas BCAM clades originated between the late 1970s and mid 1980s. The major hub of dissemination of all BGU, and of BCAM-II, and BCAM-IV clades was traced to the Department of Guatemala, while the root location of BCAM-I and BCAM-III was traced to Honduras. Most Guatemalan clades experienced initial phases of exponential growth (0.23 and 3.6 year-1), followed by recent growth declines. Our observations suggest that the Guatemalan HIV-1 subtype B epidemic is driven by dissemination of multiple BPANDEMIC founder viral strains, some restricted to Guatemala and others widely disseminated in the Central American region, with Guatemala City identified as a major hub of viral dissemination. Our results also suggest the existence of different sub-epidemics within Guatemala for which different targeted prevention efforts might be needed.

Onchodermatitis: Where Are We Now?

Onchocerciasis causes debilitating pruritus and rashes as well as visual impairment and blindness. Prior to control measures, eye disease was particularly prominent in savanna areas of sub-Saharan Africa whilst skin disease was more common across rainforest regions of tropical Africa. Mass drug distribution with ivermectin is changing the global scene of onchocerciasis. There has been successful progressive elimination in Central and Southern American countries and the World Health Organization has set a target for elimination in Africa of 2025. This literature review was conducted to examine progress regarding onchocercal skin disease. PubMed searches were performed using keywords ‘onchocerciasis’, ‘onchodermatitis’ and ‘onchocercal skin disease’ over the past eight years. Articles in English, or with an English abstract, were assessed for relevance, including any pertinent references within the articles. Recent progress in awareness of, understanding and treatment of onchocercal skin disease is reviewed with particular emphasis on publications within the past five years. The global burden of onchodermatitis is progressively reducing and is no longer seen in children in many formerly endemic foci.

Deletions of pfhrp2 and pfhrp3 genes of Plasmodium falciparum from Honduras, Guatemala and Nicaragua

BackgroundMalaria remains a public health problem in some countries of Central America. Rapid diagnostic tests (RDTs) are one of the most useful tools to assist in the diagnosis of malaria in remote areas. Since its introduction, a wide variety of RDTs have been developed for the detection of different parasite antigens. PfHRP2 is the most targeted antigen for the detection of Plasmodium falciparum infections. Genetic mutations and gene deletions are important factors influencing or affecting the performance of rapid diagnostic tests.MethodsIn order to demonstrate the presence or absence of the pfhrp2 and pfhrp3 genes and their flanking regions, a total of 128 blood samples from patients with P. falciparum infection from three Central American countries were analysed through nested or semi-nested PCR approaches.ResultsIn total, 25.8 and 91.4% of the isolates lacked the region located between exon 1 and exon 2 of pfhrp2 and pfhrp3 genes, respectively. Parasites from the three countries showed deletions of one or both genes. The highest proportion of pfhrp2 deletions was found in Nicaragua while the isolates from Guatemala revealed the lowest number of pfhrp2 deletions. Parasites collected from Honduras showed the highest proportion of phfrp3 absence (96.2%). Twenty-one percent of isolates were double negative mutants for the exon 1–2 segment of both genes, and 6.3% of isolates lacked the full-length coding region of both genes.ConclusionsThis study provides molecular evidence of the existence of P. falciparum isolates lacking the pfhrp2 and pfhrp3 genes, and their flanking regions, in Honduras, Guatemala and Nicaragua. This finding could hinder progress in the control and elimination of malaria in Central America. Continuous evaluation of RDTs and molecular surveillance would be recommended.

Integration Processes in Latin America

After describing, within the framework of “Open Regionalism”, the tortuous process that the Central American countries have experienced to achieve their integration as a Common Market, this article analyses the relationship between these countries and Mexico, through the Free Trade Agreement signed among them. Once it is shown that the integration process of the Central American countries is on an impasse, the article explores the possibilities to advance on the economic integration between Mexico and the region. Using quantitative measurement and qualitative elements, this article identifies favorable conditions for such integration to be initiated by Mexico and Costa Rica, whether or not US trade policy changes towards the region.

La Responsabilidad Social Corporativa como factor determinante en la Inversión Extranjera Directa en Panamá.

En esta investigación se analizará la Responsabilidad Social Corporativa (RSC) como factor determinante en la Inversión Extranjera Directa (IED) en Panamá y el rol de las empresas multinacionales en la misma. El pequeño país Centroamericano atrae el 45% de la IED regional, la cual supone un 9,6% del PIB panameño. Eso, sin duda, contribuye a la excelente ratio de crecimiento económico de la economía panameña, que se proyecta será del 5,6% para el año 2018, así como al incremento de la competitividad y productividad de sus empresas. Se intuye que los modelos empresariales que consideran la RSC como parte de su estrategia competitiva, están en mejores condiciones para conseguir una mejor posición en las licitaciones públicas y privadas, lo cual repercute en una mayor facilidad para invertir a largo plazo en el país. La RSC supone un hecho diferencial esencial entre los modelos de negocio europeos y los asiáticos, contribuyendo los primeros al desarrollo global de las economías en las que invierten, mientras que los segundos no lo hacen al no contar con la RSC entre sus políticas.
 
 

Monetary union in Latin America: an assessment in the context of optimum currency area

ABSTRACT The article applies the optimum currency area (OCA) theory to Latin America to assess the potential of a monetary union in Latin America and in its major existing regional trade agreements (RTAs). According to OCA criteria we find that Latin America is far from being an optimum currency area, as its countries’ exposure to asymmetric shocks is high and their capacities to adjust in response to macroeconomic disturbances are limited. Using a panel of 20 Latin American countries from 1990 to 2014, we apply the dynamic OLS estimation techniques to estimate the costs and benefits of a potential monetary union in Latin America and in its various RTAs. to estimate the costs and benefits of a potential monetary union in Latin America and in its various RTAs. We find that the costs are high, because Latin America’s economies are vulnerable to severe macroeconomic disturbances and its RTAs differ significantly in their response to negative demand shocks. Most of the monetary efficiency gains are shown to be the result of a common restrictive monetary policy which would result in higher FDI inflows and, to a more limited extent, increased GDP, both overall and per capita. Although Central American countries are shown to be most suitable for further monetary integration, we conclude that Latin American countries should head first towards greater economic and political integration.

The Lizards, Crocodiles, and Turtles of Honduras. Systematics, Distribution, and Conservation

I discuss the taxonomy, distribution, and conservation of the lizards, crocodiles, and turtles occurring in the Central American country of Honduras. This is the fourth and final work in this series documenting the amphibians and reptiles of that country. I propose three new species: one of Laemanctus and two of the Sceloporus malachiticus species complex of the S. formosus group. I also suggest several other taxonomic changes, including elevating Laemanctus waltersi, Leiocephalus varius, Sceloporus schmidti, and Kinosternon albogulare to valid species. I also place Ctenosaura praeocularis in the synonymy of C. quinquecarinata and Laemanctus serratus mccoyi in the synonymy of L. serratus. All of those decisions are documented with specimens examined (with the exception of L. s. mccoyi) and data and were reviewed by experts on those groups. Several geographically wide-ranging species appear to represent more than one species (i.e., Phyllodactylus tuberculosus, Sphaerodactylus continentalis, Basiliscus vittatus). Also discussed is the uncontested, illegal forest destruction occurring throughout the country, including in areas designated as national parks and other types of reserves. The reader is urged to refer to the materials and methods section for an explanation of the procedures used in this work. In total, 107 species of lizards, 2 species of crocodiles, and 17 species of turtles are discussed. Full species accounts of 86 nominal forms are included herein, since a recent review of the anoles had included full species accounts for 39 of those species (one anole species recently added not included in a species account).

Metodología para la clasificación y caracterización de unidades territoriales homogéneas. El caso de los países de Centroamérica

The aim of this research is to classify and to portray the administrative units of the Central American countries applying the cluster analysis technique of K-means. The methodology used is supported by the application of a multiple-variations technique which is based on a series of socioeconomic variables that allows analysis of the existence of territorial disparities and to identify the most disadvantaged zones of the study area. The results obtained through statistical analysis and GIS tools identify 3 blocks of countries, whose localities share similar dynamics and similar socioeconomic characteristics.

Assessment of Nature Tourism Potential, in Rural Development in West Wollega Zone in The Case of Sayo Nole and Nole Kaba Districts, Ethiopia

<p>Tourism is not just the temporary movement of people to destinations outside their normal places. Tourism includes many geographic, economic, environmental, social, cultural and political dimensions. A tourism industry has a strong relationship with those dimensions because of its dependency and impact on it, and the interests of its stakeholders (Kauffmann 2008).</p><p>As stated by Sinha (2007) the study of tourism is the study of people away from their usual habitat of the establishments which responds to the requirement of travelers and the impact of that they have on the economic physical and social well-being of their hosts. Tourism is an attractive tool for economic development, specifically in the developing world. Viewed as an export industry of three Gs -- "get them in, get their Money, and get them out" – tourism has assisted many developing countries to move away from a dependency on agriculture and manufacturing (Tooman, 1997. </p><p>Chosen forits ability to bring in needed foreign exchange earnings, income and employment, tourism has become a popular addition to economic development policies in many African, Asian, South and Central American countries. Although tourism seems to beading substantially to the economic growth of many of these regions, many developing countries are not reaping full benefits from tourism (Vaugeois, 1990).</p><p>Tourism in Ethiopia dates back to the pre-Axumite period when the first illustrated travel guides to Ethiopia can be found in the friezes of the pyramids and ancient sites of Egypt. These depicted travels to the land of Punt, which the Egyptians knew was the source of the Nile, and where they traded for gold, incense, ivory and slaves. The fourth century Persian historian Mani described the Kingdom of Axum as being one of the four great empires of the world, ranking it alongside China, Persia and Rome (World Bank, 2006). Modern tourism in Ethiopia can be said to have started with the formation of a government body to develop and control it in 1961: The Ethiopian Tourist Organization (Y.Mulualem, 2010).</p>

Suicide trends in Panama: Results from the national mortality registry

Background According to the World Health Organization (WHO), suicide is the second leading cause of death among 15–29-year-olds globally. Consequently, it represents a major public health concern. In Central-American countries, population-based studies on the epidemiology of suicide are scarce. The aim of this study is to investigate mortality trends due to suicide in Panama at a national and regional level from 2001 to 2016, and to characterize the suicide rates by sex and age groups. Material and methods Data was derived from the National Mortality Registry (NMR) from the National Institute of Statistics and Census. Death was recorded according to the International Classification of Disease - 10th Revision (X60.0-X84.0). Crude mortality rates (MR) were calculated as the number of deaths per 100,000, using the mortality data and the estimates and projections of the total population of Panama to July 1st for each year, according to sex and age, based on the last census. MR were then standardised for 5-year age groups using the direct method and the world standard population of the WHO as a reference. Joinpoint regression analyses were performed to estimate and evaluate trends over time in women and men, expressed as annual percentage change (APC) with 95% confidence intervals (CI). Age-specific suicide trends were also evaluated and categorised according to the age groups 14–24, 25–44, 45–64 and ≥ 65 years. Results During the study period (2001–2016), a total of 2526 deaths due to suicide were recorded in Panama (2174 men and 352 women), representing 1.01% of all causes of death; 68.9% of the deaths were due to intentional self-harm by hanging, strangulation and suffocation, followed by intentional self-poisoning by exposure to pesticides (17.5%). National MR per 100,000 decreased from 9.7 and 1.6 in 2001 to 5.4 and 0.8 in 2016, in men and women, respectively. Joinpoint analyses revealed that suicide rates changed differently across sex, age groups and provinces. Overall, the national MR trends due to suicide decline in women with an APC of −4.8, 95% CI −7.8, −1.7, whereas the trend began to decline from 2006 in men; APC −6.9, 95% CI −8.9, −4.9. A sustained decrease in the trend of mortality rates due to suicide was observed across all age categories, except for the group of younger men ( Conclusions Mortality rates due to suicide have declined at a national level. However, sex, age and geographical disparities were observed. New studies at the individual level are warranted to investigate main suicidal risk factors, in particular across Provinces such as Los Santos and Darien, which are affected by the highest suicide rates in the country. Moreover, it seems crucial to evaluate future trends in adolescents and young adults, and particularly in men, whose mortality rate was approximately six times higher than women. Our findings highlight the need of elaborating suicide prevention programs tailored at a national context, as claimed by WHO.

Hurricane Strikes and Migration: Evidence from Storms in Central America and the Caribbean

Abstract This study estimates the impact of hurricanes on migration from 30 Central American and Caribbean countries to the United States from 1989 to 2005. In contrast to previous studies, hurricane destruction indices are employed to study the relationship of hurricanes and migration. These indices measure geographical destruction, which gives a more comprehensive and accurate view of the damage and impact that hurricanes have on the movement of people to international destinations. Controlling for the host country’s migrant stock and the home country’s income, country fixed-effects estimation shows that hurricanes have a positive impact on the ratio of the number of migrants to the home country’s population. On average, hurricanes increase migration by roughly 6%, but the impact is greater for more damaging storms. Estimating the geographical effects reveals that the size of this impact varies across countries. The most damaging storms are related to an increase up to 540% in the ratio of migrants to the home country’s population.

Nineteenth Century Navies Role in Developing an understanding of the Pacific Coast of Central America

Navies, apart from their traditional use by nations as instruments for the projection of power, for the protection of maritime interests and for exercising peacekeeping and war activities, have also had an important role in developing scientific and technical knowledge. The survey work undertaken by various navies since the 18th century, has in particular been of great benefit in improving and making navigation safer on high seas and coasts, through the provision of maritime charts and sailing directions, to all mariners. The technical efforts and geopolitical interests behind those efforts in the 19th century and how they affected the maritime trade and foreign affairs of the Central American countries located on the Pacific Coast are the subject of this study.

Guatemala: repensando el vínculo entre juventud y violencia en la posguerra

Irónicamente, el tema de la violencia criminal es relevante en los países de Centroamérica tras el final de brutales episodios de violencia política. Desde distintos enfoques, la atención al problema se ha centrado en cierto tipo de individuos como protagonistas del fenómeno: hombres jóvenes de áreas urbanas y sectores populares. Aunque estas perspectivas se basan en la evidencia disponible, es necesario examinar críticamente sus premisas e implicaciones. En este artículo se exponen reflexiones derivadas de diversas experiencias de investigación sobre el tema, y se propone una serie de aportes para repensar el vínculo entre juventud y violencia en Guatemala.

Rasgos de una Política de Defensa de Costa Rica: entre la paz y la inseguridad

Históricamente, Costa Rica se ha caracteriza por realmente no poseer una política de defensa definida dentro de sus estamentos estatales. Esto se debe a que se ha convivido dentro de la narrativa militar del país centroamericano en una disyuntiva que radica entre la paz y la seguridad del Estado. Lo anterior se puede explicar, en gran medida, porque tradicionalmente el gobierno costarricense no ha podido consolidar amenazas verdaderamente considerables en la región que comprometan su seguridad y defensa nacionales. Entren los factores que ayudan a entender esta condición se encuentran el carácter de excepcionalidad de sus fuerzas armadas, la preeminencia del derecho internacional como instrumento de defensa nacional y el principio de neutralidad en conflictos armados, además de la presencia y el acompañamiento que desempeñan los Estados Unidos. Las amenazas transnacionales tradicionales han sufrido una transformación que, en la actualidad, pueden verse relativamente reducidas a la lucha contra el narcotráfico y el crimen interno en la nación tica.

MicroRNA and cellular targets profiling reveal miR-217 and miR-576-3p as proviral factors during Oropouche infection.

Oropouche Virus is the etiological agent of an arbovirus febrile disease that affects thousands of people and is widespread throughout Central and South American countries. Although isolated in 1950’s, still there is scarce information regarding the virus biology and its prevalence is likely underestimated. In order to identify and elucidate interactions with host cells factors and increase the understanding about the Oropouche Virus biology, we performed microRNA (miRNA) and target genes screening in human hepatocarcinoma cell line HuH-7. Cellular miRNAs are short non-coding RNAs that regulates gene expression post-transcriptionally and play key roles in several steps of viral infections. The large scale RT-qPCR based screening found 13 differentially expressed miRNAs in Oropouche infected cells. Further validation confirmed that miR-217 and miR-576-3p were 5.5 fold up-regulated at early stages of virus infection (6 hours post-infection). Using bioinformatics and pathway enrichment analysis, we predicted the cellular targets genes for miR-217 and miR-576-3p. Differential expression analysis of RNA from 95 selected targets revealed genes involved in innate immunity modulation, viral release and neurological disorder outcomes. Further analysis revealed the gene of decapping protein 2 (DCP2), a previous known restriction factor for bunyaviruses transcription, as a miR-217 candidate target that is progressively down-regulated during Oropouche infection. Our analysis also showed that activators genes involved in innate immune response through IFN-β pathway, as STING (Stimulator of Interferon Genes) and TRAF3 (TNF-Receptor Associated Factor 3), were down-regulated as the infection progress. Inhibition of miR-217 or miR-576-3p restricts OROV replication, decreasing viral RNA (up to 8.3 fold) and virus titer (3 fold). Finally, we showed that virus escape IFN-β mediated immune response increasing the levels of cellular miR-576-3p resulting in a decreasing of its partners STING and TRAF3. We concluded stating that the present study, the first for a Peribunyaviridae member, gives insights in its prospective pathways that could help to understand virus biology, interactions with host cells and pathogenesis, suggesting that the virus escapes the antiviral cellular pathways increasing the expression of cognates miRNAs.

Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

Aims/hypothesisIn the context of increasing prevalence of diabetes in elderly people with multimorbidity, intensive glucose control may increase the risk of severe hypoglycaemia, potentially leading to death. While rising trends of severe hypoglycaemia rates have been reported in some European, North American and Asian countries, the global burden of hypoglycaemia-related mortality is unknown. We aimed to investigate global differences and trends of hypoglycaemia-related mortality.MethodsWe used the WHO mortality database to extract information on death certificates reporting hypoglycaemia or diabetes as the underlying cause of death, and the United Nations demographic database to obtain data on mid-year population estimates from 2000 to 2014. We calculated crude and age-standardised proportions (defined as number of hypoglycaemia-related deaths divided by total number of deaths from diabetes [i.e. the sum of hypoglycaemia- and diabetes-related deaths]) and rates (hypoglycaemia-related deaths divided by mid-year population) of hypoglycaemia-related mortality and compared estimates across countries and over time.ResultsData for proportions were extracted from 109 countries (31 had data from all years analysed [2000–2014] available). Combining all countries, the age-standardised proportion of hypoglycaemia-related deaths was 4.49 (95% CI 4.44, 4.55) per 1000 total diabetes deaths. Compared with the overall mean, most Central American, South American and (mainly) Caribbean countries reported higher proportions (five more age-standardised hypoglycaemia-related deaths per 1000 total diabetes deaths in Chile, six in Uruguay, 11 in Belize and 22 in Aruba), as well as Japan (11 more age-standardised hypoglycaemia-related deaths per 1000 total diabetes deaths). In comparison, lower proportions were noted in most European countries, the USA, Canada, New Zealand and Australia. For countries with data available for all years analysed, trend analysis showed a 60% increase in hypoglycaemia-related deaths until 2010 and stable trends onwards. Rising trends were most evident for Argentina, Brazil, Chile, the USA and Japan. Data for rates were available for 105 countries (30 had data for all years analysed [2000–2014] available). Combining all countries, the age-standardised hypoglycaemia-related death rate was 0.79 (95% CI 0.77, 0.80) per 1 million person-years. Most Central American, South American and Caribbean countries similarly reported higher rates of hypoglycaemia-related death, whilst virtually all European countries, the USA, Canada, Japan, New Zealand and Australia reported lower rates compared with the overall mean. Age-standardised rates were very low for most countries (lower than five per 1 million person-years in 89.5% of countries), resulting in small absolute differences among countries. As noted with the proportions analysis, trend analysis showed an overall 60% increase in hypoglycaemia-related deaths until 2010 and stable rate trends onwards; rising rates were particularly evident for Brazil, Chile and the USA.Conclusions/interpretationMost countries in South America, Central America and the Caribbean showed the highest proportions of diabetes-related deaths attributable to hypoglycaemia and the highest rates of hypoglycaemia-related deaths. Between 2000 and 2014, rising trends were observed in Brazil, Chile and the USA for both rates and proportions of hypoglycaemia-related death, and in Argentina and Japan for proportions only. Further studies are required to unravel the contribution of clinical and socioeconomic factors, difference in diabetes prevalence and heterogeneity of death certification in determining lower rates and proportions of hypoglycaemia-related deaths in high-income countries in Europe, North America and Asia.Data availabilityData used for these analyses are available at https://doi.org/10.17632/ndp52fbz8r.1