Panamanian Children Research Articles

Micronutrient deficiencies according to sociodemographic factors and nutritional status among Panamanian children aged six to 59 months in 2019: a cross–sectional population–based study

Micronutrient deficiencies have serious lifelong consequences. This study aimed to estimate the prevalence of anaemia, iron deficiency anaemia, iron deficiency, and vitamin A deficiency, according to sociodemographic factors and nutritional status among Panamanian children aged six to 59 months in2019. We used data from the National Health Survey of Panama (ENSPA), a population-based, cross-sectional study, with a nationally representative subsample to evaluate haemoglobin, C-reactive protein (CRP), ferritin, and retinol levels among children aged six to 59 months. The data are shown weighted. A total of 625 children representing a population of 62,100 children (females 45.0%, 27,971/62,100; 95% CI: 37.3-53.1), aged six to 59 months were assessed. Nationally, the prevalence of anaemia was 15.5% (9604/62,100; 95% CI: 11.5-20.6), iron deficiency anaemia was 8.0% (4950/62,100; 95% CI: 5.1-12.2), iron deficiency was 26.2% (16,259/62,100; 95% CI: 20.7-32.5), and vitamin A deficiency was 3.4% (2087/62,100; 95% CI: 2.1-5.3). Children from indigenous areas exhibited a higher prevalence of all micronutrient deficiencies studied, and nationally 40.9% (2316/5656; 95% CI: 22.1-62.9) of the children with overweight/obesity exhibited at least one micronutrient deficiency. Our results highlight important disparities in the prevalence of nutritional deficiencies among children in different living areas. Public health strategies should focus on these vulnerable populations, as the first years of life are crucial for adequate growth and development. This work was supported by an institutional research grant via the Ministry of Economy and Finance of Panama (019910.002). The ENSPA study was funded by the Inter-American Development Bank.

Pertussis vaccine effectiveness following country-wide implementation of a hexavalent acellular pertussis immunization schedule in infants and children in Panama

ABSTRACT Despite high pediatric vaccination coverage rates (VCRs), pertussis incidence has increased worldwide, including in several countries in Latin America in the last two decades. Given the few vaccine effectiveness (VE) studies in Latin American countries, this retrospective, observational, cohort study estimated the effectiveness of hexavalent acellular (aP) primary and booster vaccination (wP) against pertussis in infants (6.5–18.5 months) and children (18.5–48.5 and 48.5–72.5 months) in Panama. Age-specific incidence rates (IRs) were calculated for the vaccine’s pre-initiation (2001–2013), initiation (2014), and post-initiation (2015–2019) periods. VCRs and trends were determined, and VE was analyzed using a case coverage or screening method to compare proportions of vaccinated cases and vaccinated individuals in the population. Between 2001–2019, 868 confirmed pertussis cases were reported in Panama; 712 (82.0%; 54.8 cases/year) during the pre-initiation period, 19 (2.2%; 19 cases/year) during the initiation period, and 137 (15.8%; 27.4 cases/year) during the post-initiation period. Panama underwent cyclical increases in IRs, which varied between age groups. VCRs increased for primary and booster doses. Between 2015 and 2019, third-dose yearly vaccine coverage increased, on average, 3.3%. Specifically, during the post-initiation period, 109/137 (79.6%) of cases were unvaccinated. Relative VE was estimated at 96.2% [95% CI: 86.5%, 98.9%] with three doses; 100% with 4 and 5 booster doses. Absolute VE was estimated at 99.3% with three doses only. These results show that vaccination played an important role in maintaining a low number of pertussis cases in Panama, affirming the need for sustained investment and commitment to vaccination programs.

Oral Health Status of Ngäbe-Buglé Children in Panama: A Cross Sectional Study.

Poor oral health is often more prevalent in rural and resource-limited areas. Evaluating oral health status in these communities is the first step in ensuring adequate future health care for the population. The aim of this study was to assess the oral health status of children aged 6-12 years living in the indigenous Ngäbe-Buglé communities. A cross-sectional study was conducted in two rural indigenous communities of Ngäbe-Buglé on San Cristobal Island in Bocas del Toro, Panama. All children between 6 and 12 years of age and attending local schools were invited to participate, and those whose parents provided oral consent were enrolled. Dental examinations were performed by one trained dentist. To describe oral health, plaque index, DMFT/dmft (decayed, missing, and filled for permanent and primary teeth) index, and developmental defects of enamel index were recorded. Orthodontic characteristics were also evaluated, assessing the prevalence of different molar classes and the prevalence of open bite, lateral crossbite, and scissor bite. A total of 106 children, representing 37.3% of the child population in the age range attending local schools, were included in this study. The mean plaque index of the entire population was 2.8 (SD 0.8). Caries lesions were more common in children living in San Cristobal (80.0%) compared to those living in Valle Escondido (78.3%), p = 0.827. The mean DMFT/dmft for the entire population was 3.3 (SD 2.9). Developmental defects of enamel were recorded in 49 children (46.2%). The majority of the population had a class I molar relationship (80.0%). Anterior open bite, lateral crossbite, and anterior crossbite were found in 10.4%, 4.7%, and 2.8% of the participants, respectively. The oral health of children living in Ngäbe-Buglé communities is generally poor. Oral health education programs for children and adults might play a crucial role in improving the oral health status of the Ngäbe-Buglé population. In addition, the implementation of preventative measures, such as water fluoridation as well as regular toothbrushing with fluoridated toothpaste and more accessible dental care, will be essential in improving future generations' oral health.

Educación alimentaria y nutricional para reducir la obesidad en escolares de Panamá: protocolo de estudio

El sobrepeso en escolares representa un creciente problema de salud pública en Panamá. El objetivo es desarrollar y validar un programa de intervención en educación alimentaria y nutricional (EAN) contra el sobrepeso y la obesidad en escolares de Panamá bajo la perspectiva de una política pública intersectorial de salud y educación. La intervención se basa en el cambio de conducta bajo el modelo socio-ecológico que favorezca la adopción de comportamientos alimentarios y de estilos de vida más saludables. Se trata de un estudio en 768 escolares de diseño cuasi experimental, pre-post intervención, prospectivo y sin grupo control, de tipo observacional explicativo en instituciones de educación básica general del sector público en tres Distritos de Panamá Oeste: La Chorrera, Capira y Chame. Se seleccionaron 5 escuelas, la escuela Victoria DˈSpinay y La Herradura en el Distrito de La Chorrera, la escuela Hernando Bárcenas en el Distrito de Capira y las escuelas El Espavé y Berta Elida Fernández en el Distrito de Chame. El protocolo fue registrado en la plataforma internacional de ensayos Nº ISRCTN28920505. Se obtendrán datos sociodemográficos, antropométricos, nutricionales y alimentarios; de seguridad alimentaria; y de conocimiento, actitud, percepción y comportamiento sobre alimentación y estilos de vida saludables de marzo a diciembre de 2019 durante la implementación del programa intersectorial denominado “Escuelas Saludables” del Ministerio de Salud y del Ministerio de Educación de Panamá. Se describirán y compararán los datos utilizando estadística paramétrica y no paramétrica. El protocolo de estudio fue revisado y aprobado por el Comité de Bioética de la Universidad de Panamá (Ref. CBUP/Nº075/2019), registrado en la Dirección General de Salud (DIGESA) del MINSA (Nº 881). Se solicitará consentimiento informado firmado por parte de los acudientes y asentimiento por cada niño participante. Los resultados del estudio serán difundidos ampliamente en revistas indexadas de revisión de pares y en congresos de salud y nutrición.Número de registro de protocolo: ISRCTN28920505.

Partnering with Panama: Exploring Anthropometrics, Dietary Patterns, and the Built Food Environment of School-aged Children

ABSTRACTChildhood obesity is a global public health concern in developed and developing countries. Approximately 3 in 10 Panamanian children suffer from obesity, and overweight/obesity is responsible for the highest number of premature or avoidable deaths in this country. A formative community assessment and exploration of the built food environment was conducted. Analysis suggests that almost one-third of the children measured were overweight or obese, and the availability of foods recommended for optimal health is limited in this community. Actionable recommendations for intervention and future collaboration were provided, and stakeholders from all groups will continue to explore opportunities.

P194 Validity and Reliability of Knowledge, Attitude, Perception and Behaviors on Healthy Feeding in School-Age Children in Panama

Background Given the growing problem of overweight among school-aged children in Panama, understanding their food related knowledge, attitudes, perceptions and behaviors (KAPB) through valid, reliable and culturally appropriate instruments is critical in addressing in a more comprehensive way the obesity epidemic. Objective To describe the development and validation of an instrument to assess food related KAPB in school children in Panama, which used as a conceptual foundation the recent national Food Based Dietary Guidelines (FBDGs). Study Design, Settings, Participants The instrument development and validation consisted on the following three-stage process: conceptualization and construction of the instrument, primarily based on the Panama FBDGs; expert reviews (n = 6); and phsycometric testing, including internal consistency and confirmatory factor analysis. For the psychometric testing, the sample size included 248 school-age children of 7-13 years old, from five elementary schools in Panama West Province. Measurable Outcome/Analysis A valid, reliable and culturally appropriate instrument to assess healthy eating related KAPB in school-children in Panama. Results The adequacy of the sample was acceptable of 0.8052, determined by The Kaiser-Meyer-Olkin index. The CFA yield four factors related to healthy eating habits and lifestyles, with good internal consistency (Cronbach alpha > 0.5). Conclusion This study provides a tested instrument, with acceptable psychometric properties, which can be potentially used to measure healthy eating habits and lifestyles in school-age children in Panama within the context of multi-sectoral childhood obesity prevention programs.

Efficacy of 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine against acute otitis media and nasopharyngeal carriage in Panamanian children – A randomized controlled trial

ABSTRACT We previously reported 10-valent pneumococcal non-typeable Haemophilus influenzae (NTHi) protein D conjugate vaccine (PHiD-CV) efficacy in a double-blind randomized trial (ClinicalTrials.gov: NCT00466947) against various diseases, including acute otitis media (AOM). Here, we provide further analyses. In the Panamanian subset, 7,359 children were randomized (1:1) to receive PHiD-CV or control vaccine at age 2/4/6 and 15–18 months. Of these, 2,000 had nasopharyngeal swabs collected. AOM cases were captured when parents sought medical attention for children with AOM symptoms; surveillance was enhanced approximately 2 y into the study through regular telephone calls or home visits by study personnel, who advised parents to visit the clinic if their child had AOM symptoms. Mean follow-up was 31.4 months. Clinical AOM (C-AOM) cases were assessed by physicians and confirmed by otorhinolaryngologists. Middle ear fluid samples, taken from children with C-AOM after specific informed consent, and nasopharyngeal samples were cultured for pathogen identification. For 7,359 children, 2,574 suspected AOM cases were assessed by a primary healthcare physician; 649 cases were C-AOM cases as per protocol definition. From the 503 MEF samples collected, 158 resulted in a positive culture. In the intent-to-treat cohort (7,214 children), PHiD-CV showed VE against first C-AOM (24.0% [95% CI: 8.7, 36.7]) and bacterial (B-AOM) episodes (48.0% [20.3, 66.1]) in children <24 months, which declined thereafter with age. Pre-booster VE against C-AOM was 30.7% [12.9, 44.9]; post-booster, −6.7% [−36.4, 16.6]. PHiD-CV VE was 17.7% [−6.1, 36.2] against moderate and 32.7% [−20.5, 62.4] against severe C-AOM. VE against vaccine-serotype pneumococcal NPC was 31.2% [5.3, 50.3] 3 months post-booster, and 25.6% [12.7, 36.7] across all visits. NTHi colonization rates were low and no significant reduction was observed. PHiD-CV showed efficacy against C-AOM and B-AOM in children younger than 24 months, and reduced vaccine-serotype NPC.

The prevalence of functional gastrointestinal disorders in children in Panama: a school-based study.

Functional gastrointestinal disorders (FGIDs) are common in children, but the epidemiology of FGIDs is incompletely understood. Our aim was to perform a population-based study using Rome III criteria to describe the prevalence of FGIDs in children in Panama. We performed a cross-sectional study of children attending three schools in Panama City, Panama. Children with organic medical diseases were excluded. Subjects provided demographic information and completed the Questionnaire on Pediatric Gastrointestinal Symptoms - Rome III Spanish version. A total of 321 subjects (61.1% female, median age 10 years, range 8-14 years) completed our study. A total of 92 subjects (28.7%) met criteria for an FGID. Gender, age and school type did not differ significantly between subjects with and without FGIDs. The most common FGIDs included functional constipation (15.9%), irritable bowel syndrome (5.6%), and functional abdominal pain or functional abdominal pain syndrome (4.0%). Abdominal pain-related FGIDs were present in 12.1%. FGIDs are common in school-aged children in Panama. The prevalence of abdominal pain-related FGIDs in children in Panama is similar to that described in other parts of the world. Further population-based studies utilising Rome III criteria to measure FGID prevalence in children are needed to advance our understanding of the pathogenesis of FGIDs.

Detection of human bocavirus type 1 infection in Panamanian children with respiratory illness.

The human bocavirus (HBoV) was added as a new member of the Parvoviridae family in 2005 upon its discovery in nasopharyngeal aspirates from children with respiratory infection. Recently, there has been increasing evidence of worldwide circulation of HBoV; however, in Latin America few studies have been conducted. In order to detect the circulation of HBoV in Panama, based on the National Flu Surveillance System, we developed this retrospective, cross-sectional study, from January 2011 to January 2012. Children younger than 6 years old who presented with respiratory disease were enrolled in this study. Nasopharyngeal swabs were taken in sentinel surveillance sites. Samples were tested to detect mRNA from HBoV, as well as viral RNA and DNA from others respiratory viruses. A total of 1078 patients were enrolled in this study. Overall, 44 (4.1%) of the patients presented HBoV. The most common symptoms were cough (84.6%), fever (82.1%), rhinorrhea (74.4%), and sore throat (38.5%). Less than half (45.5%) of HBoV infected patients presented with monoinfection while 54.5% of cases presented with coinfection with others respiratory viruses. Both, outpatients and inpatients were included in this study. Outpatients corresponded to 52.3% of the cases and 47.7% were inpatients. Coinfection was observed in the 50% of the inpatient cases. Phylogenetic analyses indicated that the circulating strains belonged to different clades of HBoV genotype 1. Taken together, our results support the pathogenic nature of this viral agent, especially in younger children.

Enteric parasites and enteroaggregative Escherichia coli in children from Cañazas County, Veraguas Province, Panama.

This study was designed to examine the height-for-age z-scores (HAZ), and the prevalence of intestinal inflammation, gastrointestinal infections with parasites, and enteroaggregative Escherichia coli (EAEC) in rural Panamanian children. Stool microscopy and polymerase chain reaction (PCR) testing for EAEC detected Giardia lamblia (32%, 32 of 100) and EAEC (13%, 11 of 87) in the study participants, respectively. Anthropometric analyses showed that those children who were > 12 months of age had lower HAZ scores (mean of -1.449) than the reference population. As a group, the children in the study 1 to 5 years of age did not show recovery from the previously mentioned decline in terms of their HAZ. The HAZ means of the children infected with G. lamblia, EAEC, and Ascaris lumbricoides were -1.49, -1.67, and -2.11, respectively. Furthermore, the study participants with A. lumbricoides and EAEC infections in the presence of lactoferrin showed another decrease of 0.19 and 0.13, respectively, in their HAZ means.

Diarrhea and Novel Dietary Factors Emerge as Predictors of Serum Vitamin B12 in Panamanian Children

The role of gastrointestinal infection as a factor determining vitamin B12 status in populations with low intake of animal-source foods is unclear. To determine dietary adequacy and serum concentrations of vitamin B12 in an extremely impoverished indigenous population of Panamanian children aged 12 to 60 months, and to identify predictors of both dietary and serum vitamin B12. A previous community-based survey provided the usual dietary intake and personal, household, and infection (Ascaris and diarrheal disease) information for 209 weaned children. Serum vitamin B12 was assayed using electrochemiluminescence for 65 of these children. Children with adequate or inadequate dietary vitamin B12 intake were compared, and predictors of dietary and serum vitamin B12 were identified using stepwise regression analyses of one index child per household. Dietary vitamin B12 intake was inadequate in 43% of children; these children were poorer, had less frequent diarrhea, and obtained a higher percentage of their energy from carbohydrate than children with adequate intake. Energy intake positively predicted dietary vitamin B12 intake. In contrast, serum vitamin B12 concentrations were normal in all but 3% of the children. Serum vitamin B12 was positively associated with weekly servings of fruit, corn-based food, and name (a traditional starchy food), but not with animal-source foods. Finally, serum vitamin B12 was not associated with Ascaris intensity but was lowered with increasing frequency of diarrhea. Although inadequate dietary intake of vitamin B12 was common, most serum values were normal. Nevertheless, diarrheal disease emerged as a negative predictor of serum vitamin B12 concentration.

Reduction of Diarrhea-associated Hospitalizations Among Children Aged &lt;5 Years in Panama Following the Introduction of Rotavirus Vaccine

In March 2006, rotavirus vaccine (Rotarix, RV1) was introduced into the Panamanian national immunization program. We assessed the effect of vaccine on diarrhea-associated hospitalizations among young Panamanian children. We obtained monthly numbers of diarrhea-associated hospitalizations among children aged ≤ 5 years during 2003 and 2008 from 5 health regions in Panama, representing 53% of the birth cohort. We compared the number of diarrhea-associated hospitalizations during the postvaccine years of 2007 and 2008 with the prevaccine mean numbers 2003-2005 among children < 1 year and those 1 to 4 years of age. Administrative data were used to estimate national rotavirus vaccine coverage. During prevaccine years, diarrhea-associated hospitalizations among children < 5 years in the 5 regions averaged 4057 annually. After the vaccine introduction, a decrease in diarrhea-associated hospitalizations of 22% (898 fewer) occurred in 2007 and 37% (1502 fewer) in 2008. Greater reductions were observed during January through June, the months presumed to have high rotavirus activity in prevaccine years (33% reduction in 2007 and 58% in 2008, compared with prevaccine mean). Reduction estimates were similar among infants and those aged 1-4 years of age, even though only 25% of the latter group was likely to have received vaccine by early 2008. Estimated coverage with ≥ 1 dose of rotavirus vaccine among infants increased from 63% at the end of 2006 to 94% at the end of 2008. RV1 appears to have had a substantial impact on diarrhea-associated hospitalizations among young children in Panama.

The Impact of High Diastase Malted Barley Flour on Weight and Height of Malnourished Children in Panama

ABSTRACT Enzymatic malted products reduce dietary bulk while maintaining nutrient density of cooked cereals. This study examined whether height/weight changes of malnourished Panamanian children fed oatmeal supplemented with high diastase malted barley flour were greater than for those fed unenhanced oatmeal. A pre-test/post-test control-group design was used, with random assignment to treatment/control groups. Treatment-group subjects gained more weight than did control-group subjects, both per day (t = 2.48, p = 0.016) and overall (t = 2.47, p = 0.016). Findings provide evidence that supplementation of oatmeal with malted barley improves nutritional status of malnourished children, as evidenced by weight gain.

Complications and costs associated with chickenpox in immunocompetent children

Chickenpox is a common infection of childhood in countries that have not included the corresponding vaccination in their immunization schedules. Chickenpox is usually benign in immunocompetent children, and treatment is not needed. The objectives of this study were to investigate the frequency and characteristics of chickenpox complications that require hospital treatment in immunocompetent children and the clinical progression in children of mothers with perinatal chickenpox. In addition, the hospital costs associated with chickenpox in the studied children were calculated. This was a retrospective study using the clinical records of children with chickenpox hospitalized at the Children's Hospital of Panama, from January 1991 through December 2000. We analyzed the types of complications, the clinical progression, and the hospital costs of the chickenpox patients. Of 5 203 children seen in outpatient consultations, 568 of them (11%) were hospitalized. We included 513 children in our study: 381 (74%) with chickenpox acquired in the community, 92 (18%) the children of mothers with chickenpox, and 40 (8%) with nosocomial chickenpox. The most frequent complications were cutaneous and subcutaneous infections (45%), respiratory infections (25%), and neurological changes (7%). The respiratory and cutaneous complications occurred sooner and among younger patients than did the neurological changes. Overall, 13 of the children (2.5%) died. The case fatality rate was 8% for chickenpox with respiratory and neurological complications and 0% for chickenpox with cutaneous complications. Of the 92 children with a mother with chickenpox, 60 of them (65%) did not develop the disease, and none of the 92 died. In contrast, 2 of the 32 neonates (6%) with perinatal chickenpox died. The mean length of hospitalization was 8.9 days (standard deviation, +/- 17.4 days). Parenteral pharmacotherapy was used with the great majority of the children, particularly antibiotics (54%), acyclovir (17%), and intravenous immunoglobulin (14%). The mean per-patient cost of hospitalization was US$ 1 209. Our results show that chickenpox is associated with a sizable number of expensive complications and a not-insignificant case fatality rate in immunocompetent children. Routine vaccination against chickenpox could reduce the impact of this disease on the health of children in Panama

Intestinal helminthiases in relation to the socioeconomic environment of Panamanian children

A cross-sectional investigation was made into ascariasis and nutritional status in Panamanian preschool children from October 1983 to July 1984. Within this framework, an analysis was undertaken of possible relationships between a range of intestinal helminthiases and the socioeconomic status of the participants. Attention was paid to caregiver's education, parental occupation, family earnings, quality of housing and sanitation in the assessment of socioeconomic status. On this basis, strong associations were established between the socioeconomic status of the children and infection with Ascaris lumbricoides, Trichuris trichiura and hookworm. In general, the prevalence of single and multiple helminth infections was significantly higher in children living in housing made of wood or bamboo than in those living in housing made of concrete blocks. The same pattern applied to levels of sanitation. Ascaris lumbricoides occurred more frequently in children of mothers with the least formal education and in children living in relatively crowded conditions. Evidence was also obtained to indicate that the intensity of the intestinal helminth infections was greater in the children from the poorer environment. Since children from poorer socioeconomic conditions might be more exposed to infective stages than those from a better environment, the possible role of socioeconomic factors in contributing to the predisposition of some individuals to harbour large worm burdens of intestinal helminths was briefly discussed.

Age-related immunity to measles, mumps and rubella in Middle American and United States children.

Serum samples from 3000 1 to 15-year-old children residing in the Dominican Republic, Honduras and the Republic of Panama were analyzed for measles, mumps and rubella susceptibility. These data were compared with results obtained on sera drawn from 2221 United States children of similar ages. It was found that children in all areas usually acquired immunity to measles early in life and tended to contract mumps and rubella somewhat later. Immunity data from the urban areas of the United States closely resembled that from the urban areas of the Dominican Republic. Honduran and Panamanian children showed much higher age-related frequencies of rubella, susceptibility. When compared to the other Middle American countries studied, the rural Honduran sample showed significantly higher age-grouped susceptibility rates for measles and simultaneous triple rate revealed a consistent bias, indicating that the attack rates of the three infections are not entirely independent.

A pilot search for environmental factors influencing diarrheal disease in young children in Panama.

A pilot survey of 13 family interviews and 70 record reviews from 3 different health facilities in Panama showed that the nutritional state of the population at risk is a vital epidemiologic factor in acute diarrheal disease. Panamas malnutrition problem is reflected by the fact that majority of the children can be diagnosed as malnourished on the criteria of low weight and low hemoglobin. In addition diarrhea and other illnesses appear as chronic health problems. Type of antibiotics prescribed and method of food preparation were implicated in the spread of th disease. Recommendations for more extensive study of diarrhea includes the following: 1) collection of data on normal newborns and follow up for at least 6 months to 1 year; 2) collection of data relating to nutritional parameters (eg hemoglobin weight height and sugar intolerance) to determine extent of malnutrition as to specific type of diarrhea; 3) collection and analysis of samples of water cereals and milk in the home to see if they serve as reservoirs for pathogens or massive doses of organisms normally not pathogenic; 4) collection and analysis of stools for pathogenic and nonpathogenic organisms; and 6) enlarging personal interviews used in previous Panama study by including additional external environmental information.

Histoplasmosis survey of preschool children in Panama.

SummaryA survey of 631 preschool children in Panama and the Canal Zone revealed an over-all prevalence rate of 6.3 per cent hypersensitivity to histoplasmin and 3.5 per cent hypersensitivity to PPD skin tests.Among forty children with positive histoplasmin skin tests there was evidence of clinical disease in only three. Roentgenographs of the chest revealed infiltration or adenopathy in six, and calcifications in four. Complement-fixation tests were positive in nineteen.

Meningitis on the Isthmus of Panama 1

Summary 1. In 457,701 admissions to Gorgas Hospital from May 1904 to December 31, 1941, there were 524 cases of bacterial meningitis, the incidence being 1.14 per 1,000 admissions. 2. Of the 524 cases, 157 or 29.9 per cent were caused by the tubercle bacillus, 120 or 22.9 per cent by the pneumococcus, 119 or 22.7 per cent by the meningococcus, 38 or 7.2 per cent by the streptococcus, 15 or 2.9 per cent by the staphylococcus, 14 or 2.7 per cent by H. influenzae, and 61 or 11.7 per cent by other or mixed organisms. 3. The relative incidence of pneumococcus meningitis on the Isthmus of Panama is higher than that in series from New York and Chicago, but the same as in New Orleans. The relative incidence of meningococcus meningitis on the Isthmus of Panama is half of that in series reported from New York and New Orleans; the incidence is somewhat less than in Chicago if transients are excluded from the Panama series. 4. The impression is gathered that Panamanians are more susceptible to meningitis than West Indians. The incidence of meningitis in Panamanian children, especially H. influenzae meningitis, is remarkably high. 5. The death rate for all cases of meningitis was 86.8 per cent. All patients with tubercle bacillus, pneumococcus, and staphylococcus meningitis died. Two out of 38 patients (5 per cent) with streptococcus meningitis, and 2- of 13 (15 per cent) with H. influenzae meningitis recovered. Half of the patients with meningococcus meningitis died. The death rate of patients with meningococcus meningitis was about twice as high in West Indians as in whites.

Human Factors in Parasite Ecology

Next article No AccessHuman Factors in Parasite EcologyW. W. CortW. W. Cort Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by The American Naturalist Volume 76, Number 763Mar. - Apr., 1942 Published for The American Society of Naturalists Article DOIhttps://doi.org/10.1086/281025 Views: 4Total views on this site Citations: 3Citations are reported from Crossref PDF download Crossref reports the following articles citing this article:R. K. Kar Ecology of health and health culture: A case study among the tea labourers in Assam, India, International Journal of Anthropology 15, no.1-21-2 (Jan 2000): 171–183.https://doi.org/10.1007/BF02442057Celia V. Holland, Douglas L. Taren, D.W.T. Crompton, M.C. Nesheim, Diva Sanjur, Irma Barbeau, Katharine Tucker, Jean Tiffany, Gloria Rivera Intestinal helminthiases in relation to the socioeconomic environment of Panamanian children, Social Science & Medicine 26, no.22 (Jan 1988): 209–213.https://doi.org/10.1016/0277-9536(88)90241-9G.A. SCHAD, T.A. NAWALINSKI, V. KOCHAR Human Ecology and the Distribution and Abundance of Hookworm Populations, (Jan 1983): 187–223.https://doi.org/10.1016/B978-0-12-196880-9.50013-0