Latin America And The Caribbean Research Articles

Abstract 4124518: Recent Trends in Cardiovascular Risk Factors in Latin America and the Caribbean: The Rising Threat of a Cardiometabolic Epidemics

Introduction: The sociodemographic context of population growth and ageing, social disparities and the high level of urbanisation in Latin America and the Caribbean (LAC) provide a unique entry point to reflect on the impact of cardiovascular diseases (CVD) on populations. Our objective was to evaluate recent trends in cardiovascular risk factors (CVRF) in LAC to inform the development of potential solutions to address CVD in LAC. Methods: Using data from the “NCD Risk Factor Collaboration (NCD-Risc)” available for public consultation, we evaluated trends in the main CVRFs in LAC from 1990 to 2016-2020, namely: systolic blood pressure (SBP) in mmHg, total cholesterol (TC) in mmol/ml, body mass index (BMI) in average kg/m2 and prevalence of diabetes. NCD Risc compiles and harmonises data from studies representative of populations from various countries around the world. Data on the estimated prevalence of smoking in the region come from the “Global Burden of Diseases” study. Data are presented standardised by age to allow comparison of different periods, given that the age distribution of the population varied. Results: The CVRFs that showed favourable trends in LAC in recent decades were: smoking, mean SBP and TC. The prevalence of smoking fell from 69% to 17% for men and 67.6% to 7.6% for women, reducing the CVD risk attributable to tobacco by 34%. Mean SBP fell from 130 mmHg to 129 mmHg for men and 127 mmHg to 122 mmHg for women. The mean CT reduced from 4.7 mmol/L to 4.6 mmol/L for men and 4.8 mmol/L to 4.7 mmol/L for women. Obesity and diabetes showed unfavourable trends. The average BMI increased from 23.0 kg/m2 to 26.8 kg/m2 for men and from 23.0 kg/m2 to 27.5 kg/m2 for women, with the prevalence of obesity increasing from 3% to 11% in men and from 6% to 15% in women. The prevalence of diabetes followed this pattern and increased from 5.4% to 8.8% for men and from 5.8% to 9.6% for women. Conclusion: CVRF trends are heterogeneous and demonstrate success for policies aimed at CVRF, such as high blood pressure and smoking. However, the trends reveal that the problem in the coming decades will be the rise in obesity and its consequences, which may reverse favourable trends in CVD mortality risk in LAC. Population and individual strategies, considering the social determinants of health, need to be planned, such as taxation of ultra-processed foods and campaigns to encourage physical activity.

Article: Artificial Intelligence and International Trade from a Latin American Perspective

The article explores the impact of Artificial intelligence (AI) on international trade, focusing on challenges and opportunities for developing countries, particularly in Latin America and the Caribbean (LAC). As AI advances, it creates regulatory challenges and ethical concerns, especially regarding human rights and public morals, which may lead to trade frictions not addressed by current international agreements. AI brings important benefits to countries, such as cost reductions and efficiencies, alongside challenges related to data privacy, competition, and security. For developing countries, adopting AI offers both opportunities and obstacles, with infrastructure and human capital constraints being significant hurdles. The article suggests flexible regulatory approaches to attract investment, promote digital services exports, and ease cross-border data flow. While global trade discussions, particularly within the WTO, are addressing AI-related issues, regional agreements have made more progress. These agreements lack however comprehensive coverage and effective dispute resolution. It is important for LAC countries participating in international negotiations to ensure their interests are represented and to help shape global digital governance standards, enabling them to fully benefit from AI.

The Dragon's Overwatch: Chinese Private Security Expansion in Latin America and the Caribbean

This scholarly disquisition furnishes a comprehensive exploration of the burgeoning presence of Chinese private security companies (PSCs) across Latin America and the Caribbean (LAC), delving into the strategic repercussions for regional security architectures and national sovereignty imperatives. Employing a meticulous qualitative methodology encompassing a thorough literature review, policy document analysis, and an examination of Chinese-language sources, the research elucidates the salient drivers catalyzing this phenomenon. These precipitating factors span cultural affinities, economic motivations, geopolitical ambitions, and the exigent security challenges besetting Chinese commercial entities operating within the LAC region. The operational modes of Chinese PSCs are subjected to forensic scrutiny, illuminating their diverse service offerings, geographical permeation across the region, and the obstacles they confront. Furthermore, the inquiry contextualizes the issue within the broader geopolitical milieu, accentuating concerns regarding transparency lacunae, regulatory deficiencies, and potential avenues for Chinese intelligence and military machinations, thereby potentially destabilizing the regional equilibrium. Ultimately, the research culminates in a series of substantive policy prescriptions aimed at mitigating risks, fortifying regional stability, and safeguarding national sovereignty through capacity-building initiatives, constructive engagement with Beijing, enhanced transparency mechanisms, and robust regional cooperation frameworks.

Toward a systemic approach to evaluating evaluation capacity development

AbstractIn this article, we contribute to evaluation capacity development (ECD) research and practice by demonstrating how a systems‐based evaluation approach can be applied to a complex ECD initiative. Since 2013, the German evaluation institute, DEval, has implemented an ECD program focused on Latin America and the Caribbean (LAC). This is a diverse, emergent program developed using a bottom‐up approach. DEval takes a facilitating rather than managerial role, supporting ECD among a range of stakeholders. The article discusses several issues related to evaluating this complex ECD program. The evaluation viewed the program as a system comprising two sub‐systems: one focused on improving the knowledge and skills of evaluators and stakeholders (capacity), and the other focused on fostering an enabling evaluation environment (capability). It drew on an evaluation tradition primarily focused on the consequences of evaluations. A focus on the consequences of evaluations is essentially one step beyond evaluation use (an instrumental orientation) toward usefulness (a value‐based orientation). The evaluation adopted a systemic approach to define the core boundaries of evaluation focus, acknowledging that various stakeholders perceive the evaluation differently based on their interests or stake. By aligning the evaluation with these perspectives, it could focus on what matters most to different stakeholder groups. Four key perspectives or framings were identified: the program itself, the transferability of the LAC lessons to ECD in other parts of the world, collaborations with global agencies undertaking ECD at a global level, and institutional practices within DEval.

Hierarchy and mobility of Latin America and Caribbean container ports

Research on port hierarchies within a maritime region is crucial for comprehending the dynamics of seaborne trade and the broader trends within the maritime sector and related supply chains. This study investigates the evolution of the Latin America and the Caribbean (LAC) container ports and regional sub-systems from 2000 to 2022, analyzing traffic dynamics, shifts in port throughput rankings, and market concentration trends in and among the different coastal regions. Conceptually, this analysis benefits from the notion of evolutionary phases, revealing the stages of a port system's development. Methodologically, 49 LAC ports of international interest are categorized into different coastal regions and tiers based on throughput sizes. Various metrics, including the Gini coefficient, Lorenz curve, Herfindahl-Hirschman Index (HHI), and Kendall Tau (τ), assess port hierarchy and related mobility since 2000. The observed shifts in the hierarchy and market structures, coupled with the fluctuating positions of critical ports, underscore the transition that LAC container ports dynamics experienced in the 21st century. Following a particularly dynamic and volatile evolution observed in the 2000s, the financial crisis of 2008/09 was a critical juncture leading to the transition of the LAC port dynamics from the ‘emerging’ to the ‘maturity’ phase. On the contrary, the pandemic (2019) has not affected the pre-existing hierarchy or the moderate market concentration that was already in progress. The LAC region comprises port sub-systems (coastal ranges) subjected to different tendencies towards (de)concentration, yet mobility in port rankings within each sub-system decreases. The study also reveals the coexistence of this transition with a structural transformation of port governance structures, i.e., granting of concessions of operations to third parties. In 20 of these ports and the above-average mobility of ports are operated by Global Terminal Operators (GTOs), and calls for further research on the (non) causality of these phenomena.

Effects of climate change on migration in Latin America and Caribbean: a scoping review

Climate change-induced natural disasters such as hurricanes, landslides, forest fires, and changes in precipitation directly affect rural sectors that depend on field production and other dimensions of everyday life. This generates the mobilization of people from their homes to safer places within the same country or across borders. There is a lack of information on the impacts of climate change on environmental migrants in Latin America and the Caribbean (LAC). This scoping review aims to describe the scientific evidence of the health effects of climate change on migrant in LAC. The review was conducted using databases from PubMed, Web of Science (WoS), and Google Scholar in English, Spanish and Portuguese. After screening the title, abstract, and full text of identified hits (n = 726), 31 records were finally included. Evidence indicates that climate change relates to health and healthcare, psychosocial and infrastructure dimensions among migrants in LAC. Health effects refer to limited access to healthcare, underdiagnosis, increased susceptibility to diseases and mental health conditions like stress and anxiety. Psychosocial dimensions refer to a heightened risk of sexual and gender-based violence, social marginalization, family separation, and loss of identity and culture. Infrastructure refers to environmental degradation and agricultural and urban infrastructure destruction. Multiple adaptations to these conditions are described among migrant populations in the region. Recommendations for improvements are presented. This scoping review suggests climate change’s significant health, psychosocial, and infrastructural associations with migrants in Latin America.

Prevalence and management of ectopic and molar pregnancies in 17 countries in Africa and Latin America and the Caribbean: a secondary analysis of the WHO multi-country cross-sectional survey on abortion

IntroductionThere are limited global data on ectopic pregnancy (EP) and molar pregnancy (MP), making it important to understand their epidemiology and management across different regions. Our study aimed to describe...

Risk map of human intake of mercury through fish consumption in Latin America and the Caribbean

Mercury (Hg) is a persistent pollutant highly bioaccumulated in the aquatic environment through the food chain reaching high concentration levels in the tissues of predator fishes. Among the relevant sources of anthropogenic mercury emissions in Latin America and the Caribbean (LAC), mining is one of the most important along with soil erosion due to deforestation and agricultural activities where pesticides are intensively used. Several reports have demonstrated an association between a fish-based diet with elevated Hg levels in the blood and neurotoxic effects in humans. In this systematic review with quantitative analysis data from 92 articles were compiled, providing evidence of Hg concentration in fishes that are commonly consumed in LAC. An assessment was conducted using three indices for health risk: the Minamata Initial Assessment (MIA), the Target Hazard Quotient (THQ), and the Meals per Week (MPW) index. Of the 410 fish species studied, 5.4% had concentrations above 0.95 μg g−1 of wet weight (ww), which is the recommended limit for Total Hg (THg) ingestion through fish consumption according to the MIA index, regardless of the water habitat (i.e., marine or freshwater). Additionally, the Target Hazard Quotient (THQ) calculation indicated high-risk values (THQ ≥ 1) in 15 out of the 19 countries studied, and very high-risk values (THQ ≥ 10) were obtained from Hg concentrations measured in 5 fish species inhabiting watersheds in Trinidad and Tobago, Suriname and Peru. Finally, recommendations on fish consumption were made based on the MPW index. This study reveals the need for updated biomonitoring studies of Hg concentrations in fish to perform more accurate human health risk analyses.

Strategic Enhancement and Differential Governance: China’s Partnership Diplomacy in Latin America

This paper studies China’s partnership diplomacy and its practice in Latin America and the Caribbean (LAC). China has constructed an all-round, multi-level, and three-dimensional partnership network in LAC through three stages: strategic exploration, development, and improvement. China has implemented differential governance towards its partners, which enables active shaping and dynamic management of the partnership network. This paper categorizes the 15 partner countries into three types: pivot countries, link countries, and node countries based on their political friendliness with China, geopolitical influence, and potential for economic and trade cooperation. China’s partnerships in LAC are vital support for implementing its diplomatic strategy in the region. However, challenges to this strategy’s development include insufficient mutual support from other diplomatic means, doubts and misinterpretations of the China-Latin America partnership by some Latin American countries, and the political and identity shifts within these countries. To enhance the role of partnerships in maintaining state relations and promoting the implementation of diplomatic strategies, China has introduced new content to its partnership diplomacy in LAC.

Small-scale fisheries in ecologically sensitive areas in Latin America and the Caribbean: Do marine protected areas benefit fisheries governance?

AbstractMany small-scale fisheries (SSFs) in Latin America and the Caribbean (LAC) operate in ecologically sensitive areas, where balancing conservation and resource use is challenging. 'Multiple-use' marine protected areas (MPAs) have been implemented to accommodate SSFs (among other uses) within areas designated for conservation, creating opportunities and challenges for SSF governance. We analyzed eleven case studies from LAC to explore: (1) how different MPA institutional designs affect key aspects of SSF governance and (2) the links between these effects and the type of initiative that promoted MPA establishment (origin). Results indicate that the existence of an MPA benefited SSF governance in many ways, with more pronounced positive effects in MPAs with mixed to bottom-up origin supported by well-organized fishing groups. In addition, the presence of supportive MPA authorities that leveraged local capacities and initiatives and adopted flexible and collaborative governance systems made a difference in several cases. Lessons for integrating MPA and SSF governance are drawn.

Exploring public-private partnerships in Latin America and the Caribbean using topic modeling and sentiment analysis

Collaboration between the public and private sectors is crucial for supporting resource-constrained government budgets globally. Over the past two decades, studies have recorded significant advances in public-private partnerships (PPPs). However, PPPs in agribusiness within Latin America and the Caribbean (LAC) remain underexplored. This study analyzes the primary issues related to PPPs in agribusiness across selected countries and compares sentiments regarding these partnerships within the analyzed countries. Using text mining, topic modeling, and sentiment analysis, the study found that the main issues revolve around infrastructure, impacting trade, flow, and services in regional, national, and continental agribusiness and exports. While PPPs are seen as an innovative approach to improving public services, sentiment analysis reveals that many countries express anger and disgust, primarily due to concerns about corruption and the state’s inability to manage or play an effective role in these public policies. This study highlights that integrating topic and sentiment data offers a comprehensive view that can inform more effective public policies and development strategies for PPPs in agribusiness.

Pesticides in Latin American and Caribbean freshwater: a critical review

Pesticides used in food production contaminate freshwater ecosystems. We present a critical analysis of pesticide use in Latin America and the Caribbean (LAC) from 1990 to 2020 and a systematic review of scientific literature about the presence of pesticides in freshwater, encompassing studies published from 1990 to 2023. Data were collected from FAOStat, PubMed, ScienceDirect, Scopus, and Google Scholar. Brazil was the primary pesticide user, with an annual consumption of 231,621 t, followed by Argentina (132,255 t) and Colombia (52,553 t). In 2020, LAC had the highest rate of pesticide application globally, with Ecuador leading at 13.74 kg/ha. South America dominates the total amount with 90.9% of pesticide use, primarily herbicides (51.5%), while pesticide usage in North and Central America, as well as the Caribbean, varied due to differing agricultural practices. The study examined 221 records for 26 out of 51 countries in the literature, highlighting the significant lack of information from numerous countries. Argentina, Mexico, and Brazil had the highest publication rates. Rivers, streams, and lakes (37%, 20%, and 12%, respectively) were the most commonly studied systems, and research focused mainly on pesticide concentration in water (46%), sediments (27%), and aquatic biota (15%). The imbalance between pesticide usage and monitoring in freshwaters leads to concerns about the awareness of ecological risk. Therefore, there is an urgent need for increased research on environmental monitoring in LAC to better understand pesticide impacts on these vital ecosystems.

One Health Priorities: Advancing Veterinary Public Health in Latin America and the Caribbean.

One Health (OH) is an integrative approach to human, animal, and environmental health and can be used as a comprehensive indicator for comparative purposes. Although an OH index has been proposed for comparing cities, states, and countries, to date, no practical study has compared countries using this approach. Accordingly, this study aimed to assess OH initiatives using a survey with a veterinary public health focus. The questionnaire contained 104 quantitative questions and was sent to representatives of governmental institutions of 32 countries in the Americas. After exclusion criteria were considered, a total of 35 questionnaires from 17 countries were analyzed, with country names remaining undisclosed during the statistical analyses to protect potentially sensitive information. Principal component analysis (PCA) of health parameters in Latin America and the Caribbean (LAC) as a function of country perception (self-vector) showed that food safety was ranked higher than public policies (p = 0.009), and that both (p = 0.003) were ranked higher than institutional routines related to zoonosis programs. National policies in accordance with international standards, regulations, recommendations, and guidelines was considered the standout topic for public policy, with higher-ranking topics including standard. Meanwhile, challenging topics included tools, preparedness, governance, and research. Food safety showed both strengths and challenges in the coordination of its activities with other sectors. Food safety communication was scored as a strength, while foodborne diseases prevention was ranked as a challenge. Institutional routines for zoonosis maintained both strong and challenging topics in the execution and implementation of attributions and daily routine. Thus, the survey showed that topics such as access to and compliance with international guidelines and intercountry integration were ranked higher than in-country articulation, particularly among food safety, zoonoses, and environmental institutions.

Chilean consensus by expert panel using the Delphi technique for primary and secondary prevention of gastric cancer

IntroductionGastric cancer (GC) is the first cause of cancer-related death in Chile and 6th in Latin America and the Caribbean (LAC). Helicobacter pylori (H. pylori) is the main gastric carcinogen, and its treatment reduces GC incidence and mortality. Esophageal-gastro-duodenoscopy (EGD) allows for the detection of premalignant conditions and early-stage GC. Mass screening programs for H. pylori infection and screening for premalignant conditions and early-stage GC are not currently implemented in LAC. The aim of this study is to establish recommendations for primary and secondary prevention of GC in asymptomatic standard-risk populations in Chile. MethodsTwo on-line synchronous workshops and a seminar were conducted with Chilean experts. A Delphi panel consensus was conducted over 2 rounds to achieve >80% agreement on proposed primary and secondary prevention strategies for the population stratified by age groups. Results10, 12, and 12 experts participated in two workshops and a seminar, respectively. In the Delphi panel, 25 out of 37 experts (77.14%) and 28 out of 52 experts (53.85%) responded. For the population aged 16–34, there was no consensus on non-invasive testing and treatment for H. pylori, and the use of EGD was excluded. For the 35–44 age group, non-invasive testing and treatment for H. pylori is recommended, followed by subsequent test-of-cure using non-invasive tests (stool antigen test or urea breath test). In the ≥45 age group, a combined strategy is recommended, involving H. pylori testing and treatment plus non-invasive biomarkers (H. pylori IgG serology and serum pepsinogens I and II); subsequently, a selected group of subjects will undergo EGD with gastric biopsies (Sydney Protocol), which will be used to stratify surveillance according to the OLGA classification (Operative Link for Gastritis Assessment); every 3 years for OLGA III–IV and every 5 years for OLGA I–II. ConclusionA “test-and-treat” strategy for H. pylori infection based on non-invasive studies (primary prevention) is proposed in the 35–44 age group, and a combined strategy (serology and EGD) is recommended for the ≥45 age group (primary and secondary prevention). These strategies are potentially applicable to other countries in LAC.

Economic burden of respiratory syncytial virus disease in Latin America: A systematic review

ABSTRACT This Systematic Review assesses the economic impact of Respiratory Syncytial Virus (RSV) in Latin America and the Caribbean (LAC) in relation to healthcare resource utilization and associated costs. We searched online databases from January 2012 to November 2022 to identify eligible publications. We identified 12 publications that reported direct costs, indirect costs, and resources associated with RSV and its complications. The primary direct medical resources reported were medical services, diagnostics tests and procedures, and length of stay (LOS). Direct total costs per patient ranged widely from $563 to $19,076. Direct costs are, on average, 98% higher than indirect costs. Brazil reported a higher total cost per patient than Colombia, El Salvador, México, Panamá, and Puerto Rico, while for indirect costs per patient, El Salvador and Panamá had higher costs than Brazil, Colombia, and Mexico. The mean LOS in the general ward due to RSV was 6.9 days (range 4 to 20 days) and the mean Intensive Care Unit LOS was 9.1 days (range 4 to 16 days). In many countries of the LAC region, RSV represents a considerable economic burden on health systems, but significant evidence gaps were identified in the region. More rigorous health economic studies are essential to better understand this burden and to promote effective healthcare through an informed decision-making process. Vaccination against RSV plays a critical role in mitigating this burden and should be a priority in public health strategies.

Confronting the challenge: a regional perspective by the Latin American pediatric infectious diseases society (SLIPE) expert group on respiratory syncytial virus-tackling the burden of disease and implementing preventive solutions.

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections in children around the world. The post-pandemic era has resulted in a notable increase in reported cases of RSV infections, co-circulation of other respiratory viruses, shifts in epidemiology, altered respiratory season timing, and increased healthcare demand. Low- and middle-income countries are responsible for the highest burden of RSV disease, contributing significantly to health expenses during respiratory seasons and RSV-associated mortality in children. Until recently, supportive measures were the only intervention to treat or prevent RSV-infection, since preventive strategies like palivizumab are limited for high-risk populations. Advances in new available strategies, such as long-acting monoclonal antibodies during the neonatal period and vaccination of pregnant women, are now a reality. As the Regional Expert Group of the Latin American Pediatric Infectious Diseases Society (SLIPE), we sought to evaluate the burden of RSV infection in Latin America and the Caribbean (LAC) region, analyze current strategies to prevent RSV infection in children, and provide recommendations for implementing new strategies for preventing RSV infection in children in LAC region.

Epidemiology of cardiometabolic health in Latin America and strategies to address disparities.

In Latin America and the Caribbean (LAC), sociodemographic context, socioeconomic disparities and the high level of urbanization provide a unique entry point to reflect on the burden of cardiometabolic disease in the region. Cardiovascular diseases are the main cause of death in LAC, precipitated by population growth and ageing together with a rapid increase in the prevalence of cardiometabolic risk factors, predominantly obesity and diabetes mellitus, over the past four decades. Strategies to address this growing cardiometabolic burden include both population-wide and individual-based initiatives tailored to the specific challenges faced by different LAC countries, which are heterogeneous. The implementation of public policies to reduce smoking and health system approaches to control hypertension are examples of scalable strategies. The challenges faced by LAC are also opportunities to foster innovative approaches to combat the high burden of cardiometabolic diseases such as implementing digital health interventions and team-based initiatives. This Review provides a summary of trends in the epidemiology of cardiometabolic diseases and their risk factors in LAC as well as context-specific disease determinants and potential solutions to improve cardiometabolic health in the region.

Latin American regionalism and integration in the ongoing process of hegemonic transition

When observing the critical balance of Latin America and the Caribbean (LAC) in the 21st century, caught between the withdrawal of the United States and the rise of China in the global and regional political and economic stage, one cannot but wonder on what course the processes of regional integration and regionalism will follow in Latin America and the Caribbean in this context. Our hypothesis is that regionalism and the processes of regional integration cannot be understood as “autonomist” processes—that is, as mere processes of facilitating consensus between different regional political actors—but must rather be perceived as a convergence with extraregional hegemonic powers, even amidst an absolute ideological diversity. Therefore, this work looks into the changes taking place within regionalism and the schemes of regional integration led by the Organization of American States (OAS) and the Community of Latin American and Caribbean States (CELAC) in the face of the ongoing anomalous and interstitial process of hegemonic transition from the United States to China that appears to be taking place; these are, undoubtedly, the extraregional references shaping LAC regionalism in the 21st century.

HPV vaccine acceptance in Latin America and the Caribbean: a systematic review and meta-analysis

Human Papillomavirus (HPV) infection poses a significant health burden in Latin America and the Caribbean (LAC), leading to various conditions from benign to malignant, including cervical, anal, and oropharyngeal cancers. This systematic review encompassed 24 studies with a total of 14,466 participants, exploring HPV vaccine acceptance in the region. It was conducted using the following databases: PubMed, Scopus, Ovid Medline, and Web of Science. The review reveals an 84% prevalence of HPV vaccine acceptance in the LAC. Factors influencing acceptance include education, income levels, and vaccine safety concerns. Peru and Honduras exhibited the highest acceptance rates, while the coronavirus disease 2019 (COVID-19) pandemic contributed to declining acceptance post-2019. The importance of educational campaigns and healthcare recommendations in promoting vaccine acceptance is highlighted, along with the impact of reduced vaccination access during the pandemic. This study underscores the critical role of ongoing educational initiatives and accessible healthcare in maintaining high HPV vaccine acceptance rates in LAC. Addressing the reduced acceptance during the pandemic is pivotal for reinstating effective vaccination programs. Findings emphasize the need of sustained efforts to ensure widespread vaccine acceptance, thereby mitigating the burden of HPV-related diseases in the region.

Fusarium Tropical Race 4 in Latin America and the Caribbean: status and global research advances towards disease management.

Fusarium wilt of banana (FWB), caused by the soil-borne fungus Fusarium oxysporum f. sp. cubense (Foc), poses an undeniable threat to global banana production. This disease has intensified in recent years, with the tropical race 4 (TR4) strain spreading rapidly. Since 2018, the number of affected countries has increased from 16 to 23, presenting a significant challenge to researchers, producers, and National Plant Protection Organizations (NPPOs) worldwide. The potential impact of TR4 in Latin America and the Caribbean (LAC) is particularly concerning. This region boasts seven of the top ten banana-exporting countries, and bananas and plantains are crucial for food security and income generation. In Colombia, where TR4 was detected in 2019, the disease has already spread from La Guajira to Magdalena, and it is currently affecting 20 large commercial export farms. In Peru, the disease was detected in 2021 and although still restricted to the northern region, flood irrigation and heavy rains associated with the Yaku cyclone, boosted pathogen spread, and more than 400 small organic banana farmers are currently affected. In Venezuela, TR4 detection occurred in 2023, with plantations across three states and five municipalities now affected. Worryingly, TR4 has also been confirmed in plantains, a staple food in the region. Current national responses in LAC primarily rely on preventive and reactive measures: preventing initial incursions and containing outbreaks to avoid further spread. However, the disease's relentless progression suggests that its eventual presence in all banana-producing areas is likely. Therefore, exploring alternative management approaches beyond pathogen exclusion becomes crucial, both in affected and disease-free regions. This paper examines the current spread of TR4, focusing on epidemiological aspects and recent research-based management options. Key epidemiological features were highlighted, drawing practical examples from various scales (plots to landscapes) and utilizing experiences from LAC's fight against TR4. The paper also reviews field-tested approaches in biosecurity, biological control, resistant varieties, soil health, and integrated disease management, acknowledging the specific challenges faced by smallholder settings. In each section research initiatives were analyzed, identifying gaps, and proposing directions to minimize TR4 impact and accelerate the development of sustainable solutions for managing this devastating disease.