Latin American And Caribbean Region Research Articles

Dengue Epidemiology and Burden of Disease in Latin America and the Caribbean: A Systematic Review of the Literature and Meta-Analysis

IntroductionDengue virus infection is the most common arthropod-borne disease worldwide with approximately 50 to 100 million cases of dengue infection occurring annually. Globally, dengue incidence has increased in the last 40 years, especially in Latin American and Caribbean (LAC) countries where the highest incidence is found. This systematic review aimed to present information on dengue disease burden and use of health resources in the LAC region in the last 15 years. MethodsWe searched the main international and regional databases and generic and academic Internet search engines. Gray literature was retrieved mainly from regional health ministries and Pan American Health Organization. A set of inclusion criteria was defined. ResultsWe identified 2,041 articles of which 25 met these criteria, 13 for incidence and 12 for the use of resources and related costs. The pooled incidence of classic dengue fever was 72.1 cases per 100,000 persons-years in the 44 LAC countries analyzed (95% confidence interval 71.5–72.7), with an upward trend from 1995 up to 2010. Case-fatality ratio was highest in 1997 (0.12 [0.05–0.22]) and lowest in 2009, and the overall mortality was 0.02 per 100,000 people. More than 60% of the cases in the LAC region came from Brazil. The length of hospital stay ranged from 5 to 13 days. ConclusionsActivities to control dengue transmission in the region have been important but insufficient. The surveillance of dengue burden of disease and circulating strains help shape and evaluate the present and future health policies.

Collateral damage: the ‘War on Drugs’, and the Latin America and Caribbean region: policy recommendations for the Obama administration

The Obama administration has an historic opportunity to reform the US ‘War on Drugs’ (WOD) policies in the strategically important Latin American and Caribbean (LAC) region. This paper examines the impact of the WOD policies and concludes they have seriously exacerbated crime and corruption rates in LAC. The result is weakened governance structures and economic capacities in LAC. The WOD has emphasized supply curtailment in source and transit countries, rather than demand reduction in the US This offshoring of attacks on drug organizations has resulted in the acceleration of violence and corruption as drug traffickers develop new strategies to maintain their profits. The LAC region has the highest murder rate in the world, even higher than regions with armed conflict. We recommend that the US abandon drug prohibition. Decriminalization would allow governments to control the trans-shipment, production and distribution of these drugs. This would immediately allow resources devoted to law enforcement activities to be redirected to assist addicts and to provide financial support to strategically important neighboring LAC states. Controlling the marketplace would also provide the US and LAC with new sources of taxes. We also recommend that LAC governments act together to overcome their small sizes or weak institutional capacities by deepening cooperation as between MERCOSUR and CARICOM. This would enable joint initiatives such as policing of territorial water, thus reducing the need for US incursions into the region. Finally, any solution in the region must be supported by the creation of economic opportunities, both intra-regionally and through fairer access to the US markets, particularly for agricultural goods.

Multicity Study of Air Pollution and Health Effects in Latin America

SS1-08 Abstract: The overall goal of this project is to use a common analytic framework to examine the association between exposure to outdoor air pollution and health effects in several Latin American and Caribbean (LAC) cities to obtain comparable and updated information on effects of air pollution on several age/cause groups. This will be achieved through developing a common protocol for the design and analysis of time-series data to be followed by all centers involved in the project. An important focus will be the detailed examination of the impact of such exposures in specific subgroups of the population considered most vulnerable such as infants and young children and the analysis by socioeconomic position. In the first steps, we will collect data and perform quality assurance for air pollution and mortality data from the participating cities from Brazil, Mexico, and Chile. Candidate cities so far are: Mexico City, Guadalajara, Toluca, Monterey, and Juarez City (Mexico); Sao Paulo, Rio de Janeiro, Porto Alegre, and Vitoria (Brazil); and Santiago, Antofogasta, Calama, Copiapo, and Temuco (Chile). Assessment of the availability and completeness of data in other large Latin American cities will also be pursued and those who fit the inclusion criteria will be included. Descriptive data of air pollutants and frequency distribution of mortality by cause and age groups will be carried out. First, single-city analysis will be conducted using a standardized analytical protocol (first-stage analysis). Heterogeneity will be explored and data combined using metaregression models (second-stage analysis). Overall and subgroup analyses will be conducted using generalized additive models (GAMs) in Poisson regression. We also explore the potential effect modification of socioeconomic position (SEP) and other variables on the association of air pollution and mortality using multilevel modeling (second-stage analysis). A common SEP indicator is identified that can equally represent the SEP of populations in the different cities. This project aims to contribute to the international scientific discussion on the conduct and interpretation of time-series studies of the effects of short-term exposure and to provide relevant information to decision-makers in the LAC region to support prevention and control strategies of air pollution.

Improving the mechanisms of global governance? the ideational impact of the World Bank on the national reform agenda in Mexico

Improving the mechanisms of global governance? the ideational impact of the World Bank on the national reform agenda in Mexico

Subject content analysis of aids literature, as produced in Latin America and the Caribbean

The purpose of this paper is to present the preliminary results of a research in progress regarding the subject content analysis of AIDS literature, as produced in or about the Latin American and Caribbean (LAC) region. An AIDSLINE/OVID literature search was conducted to obtain only the Medical Subject Headings (MeSH)-geographic-terms related to the LAC region. The period of study was from 1982 to June, 1998.

A survey of Canadian countertrade practices with Latin American and Caribbean countries

This paper asserts that countertrade may prove to be an increasingly important marketing tool for doing business in the Latin‐American and Caribbean (LAC) region. The authors suggest that in order for LAC countries to sustain ambitious industrial and economic development plans, they will increasingly resort to non‐debt‐creating trade and finance arrangements to ease financial pressures. This paper assesses Canadian corporate perceptions regarding countertrade with LAC countries. The recent Asian and Russian financial crises will most likely aggravate the LAC region's funding and payments problems. This situation is highly favourable for the spread of countertrade activity. The authors conclude that if Canadian companies wish to participate more fully in the LAC region's infrastructure development and its high levels of defence and civil procurements, they will have to adopt a more proactive approach to such non‐debt‐creating financing methods as countertrade.

Breastfeeding in Africa and the Latin American and Caribbean Region: the Potential Role of Urbanization

This paper compares breastfeeding patterns in Africa (AFR) and the Latin American and Caribbean region (LATCAR) based on demographic and health surveys conducted in 23 countries between 1986 and 1990. Results indicate that the proportion of infants who are never breastfed is twice as high in LATCAR than in AFR. The average median breastfeeding duration is 1.64 times higher in AFR (19.3 months) than in LATCAR (11.8 months). The longer breastfeeding duration found in AFR was due to a better lactation performance in both rural and urban areas. In both LATCAR and AFR 71 per cent of the 0-4-month infants were not breastfed exclusively during the first 4 months of life and breastfeeding duration was longer in rural than in urban areas. However, the degree of urbanization had a stronger negative effect on breastfeeding in LATCAR than in AFR. It is concluded that: (a) while LATCAR is in great need of breastfeeding promotion programmes, breastfeeding in AFR should be protected as it becomes more urbanized; (b) the promotion of exclusive breastfeeding remains a priority in both regions; and (c) the magnitude of the inverse association between urbanization and breastfeeding is likely to vary among regions with different socio-economic and cultural backgrounds.