Populations In Panama Research Articles

Reasons and approaches to under-diagnosed obstructive sleep apnea in the adult population of Panama

Obstructive sleep apnea is intimately related to chronic conditions that have significant burden for patients and healthcare systems. It has negative implications for cardiovascular, metabolic, and neuro-psychiatric systems. It is underdiagnosed worldwide; definitive diagnosis, as well as treatment for moderate to severe forms of the disease, are considerably expensive. There is scarce evidence of the burden the condition represents for Panama and other American countries. Sedentary lifestyle, obesity and obstructive sleep apnea are expected to increase in prevalence, making it of the utmost importance to address its underdiagnosis and to establish healthcare networks that can efficiently deal with it. The application of affordable strategies, such as questionnaires and simple biometrics, could help in efficient resource allocation to develop public health networks that would eventually be capable of accurately estimating disease burden and to offer adequate therapeutic options. Panama has a complex health system that shares similarities with other American countries; developing a sleep apnea program in this public health system requires wise scientific driven resource allocation that minimizes underserved areas and maximizes efficiency.

Vaccination and mortality from COVID-19: a comparative study between hemodialysis, peritoneal dialysis, and non-dialysis adult population in Panama

PurposeDialysis patients have a different response than the non-dialysis population to infection with COVID-19. This study evaluates the prevalence of infection and lethality in patients receiving hemodialysis or peritoneal dialysis in Panama, compared to non-dialysis adult population, and reports of adverse events of vaccination.MethodsThis is a prospective, multi-center cohort study of spatients aged 18 years or older and receiving in-center hemodialysis or ambulatory peritoneal dialysis in 13 centers in Panama from March 2021 to 2022. For comparison with general population, the study used an extended period of two years.ResultsA total of 1531 patients receiving dialysis treatment accepted to participate. PD patients represented an 18% of study patients. Lethality was higher in peritoneal dialysis patients with COVID-19 infection than in hemodialysis in the study group (p 0.02). Total deaths in dialysis patients for 2020 were 156 patients, before vaccination; 79 in 2021; and 25 for the first trimester of 2022. Lethality for the period of 2020–2022 was 9.3% for dialysis patients and 0.2% for non-dialysis population. There was no difference in symptoms in first dose, but with second dose, hemodialysis patients reported fewer symptoms than peritoneal dialysis patients (p < 0.0001).ConclusionNinety one percent of people in the country received BNT162b2 Pfizer BionTech vaccine. Lethality decreased from 30 to 5% once vaccination was available. There were no severe adverse effects and symptoms reported were less frequent than in general population, probably due to low reactogenicity in dialysis patients, or better tolerance to pain.

Estimating the Size, Sociodemographic Characteristics, and STI Status of Three Key Populations at Risk for HIV Infection in Panama Using Capture–Recapture Methods: The PEMAR Study

This study aims to estimate the size, sociodemographic characteristics, and rates of sexually transmitted infections (STIs) in three key populations in Panama in 2018. Key populations included persons who self-identified as men who have sex (MSM), sex workers, and transgender women. Nationwide, trained peers conducted capture and recapture during the last quarter of 2018 at key population social gathering sites. Participants completed a self-administered questionnaire and, optionally, could opt-in for a blood sample to be tested for four STIs (HIV, syphilis, and hepatitides B and C). Population estimates were calculated using the Sightability Model R package. Among the 1,886 consenting participants, 1,715 completed the study procedures (1,278 MSM, 250 sex workers, and 187 transgender women). The median age was 28 (interquartile range 23–36 years) and most participants were single, Latinx, completed at least high school, worked, and earned less than twice the minimum wage per month. The national estimates were 49,966 MSM (3.81% of adult men), 8,326 sex workers (0.63% of adult women), and 3,100 transgender women (118.4 per 100,000 population). Most (77.4%) participants consented for STI testing, which allowed estimation of positivity rates for HIV (10.0%), syphilis (2.0%), and hepatitides B (1.0%) and C (0.1%). Incorporating capture-recapture methods allowed more precise estimates of key population sizes and to characterize their sociodemographic and STI profiles, to be used in programmatic efforts for resource allocation and prevention programs. As an indirect result, we anticipate increased representation and visibility of key populations in population and public health programs.

Prevalence of central obesity according to different definitions in normal weight adults of two cross-sectional studies in Panama

Central Obesity (CO) might arise among individuals with normal body mass index (BMI). We aim to estimate the prevalence of Normal Weight CO (NWCO), using different definitions, and to compare its association with cardiometabolic risk factors in the adult population of Panama. Data from two population-based studies conducted in Panama in 2010 and 2019 were used. Using standard definitions, normal weight was defined as a BMI between 18·5 and 24·9 while CO was defined as a Waist-to-Height Ratio (WHtR) ≥ 0·5 in both sexes or a Waist Circumference (WC) ≥ 90, ≥94, or ≥102 cm for men, and 80 or 88 cm for women. Unconditional logistic regression models were used to estimate the association between each CO definition and dyslipidemia, high blood pressure (HBP), diabetes, and clusters of cardiovascular risk factors. Recent CO prevalence ranged between 3·9% (WC ≥ 102 cm for men and WC ≥ 88 cm for women) and 43·9% (WHtR ≥ 0·5) among individuals classify as normal weigh according to the BMI. Different cardiovascular risk factors were present in this normal weight population but among men the threshold of WC ≥ 102 cm screened less than 1·0%. NWCO was associated with cardiovascular risk factors, particularly with elevated concentration of triglycerides. CO evaluation at the primary health care level may be a useful technique to identify normal weight people with metabolically obese characteristics. Gorgas Memorial Institute for Health studies via Ministry of Economy and Finance of Panama and Inter-American Development Bank.

Prevalence of food insecurity and association with mental health in an indigenous population in Panamá.

Understanding food insecurity and its health consequences is important for identifying strategies to best target support for individuals and communities. Given the limited information that exists for indigenous groups in Latin America, this study aimed to understand the association between food insecurity and mental health in an indigenous population in Panama. Cross-sectional data were collected using a survey conducted with Kuna Indians residing off the coast of Panama. Data sources included measures from the Panamanian prevalence of risk factors associated with CVD survey, and validated measures for psychosocial factors and standardised health outcome measures. Regression models with each of the mental health outcomes (depression, serious psychological distress, perceived stress) were used to examine the association between food insecurity and mental health outcomes. Indigenous Kuna community residing on the San Blas Islands of Panama. Two-hundred nine adults. Food insecurity was reported by 83 % of the participants. Across demographic categories, the only significant difference was by age with higher prevalence in younger ages. After adjusting for demographics, higher food insecurity was significantly associated with higher number of depressive symptoms and more serious psychological distress, but not with levels of perceived stress. Based on these findings, treatment for mental health in the Kuna community may need to account for social determinants of health and be tailored to meet the needs of younger age groups in this population. In addition, interventions designed to decrease food insecurity should be considered as a possible means for improving mental health.

Population genomics of Plasmodium vivax in Panama to assess the risk of case importation on malaria elimination.

Malaria incidence in Panama has plateaued in recent years in spite of elimination efforts, with almost all cases caused by Plasmodium vivax. Notwithstanding, overall malaria prevalence remains low (fewer than 1 case per 1000 persons). We used selective whole genome amplification to sequence 59 P. vivax samples from Panama. The P. vivax samples were collected from two periods (2007-2009 and 2017-2019) to study the population structure and transmission dynamics of the parasite. Imported cases resulting from increased levels of human migration could threaten malaria elimination prospects, and four of the samples evaluated came from individuals with travel history. We explored patterns of recent common ancestry among the samples and observed that a highly genetically related lineage (termed CL1) was dominant among the samples (47 out of 59 samples with good sequencing coverage), spanning the entire period of the collection (2007-2019) and all regions of the country. We also found a second, smaller clonal lineage (termed CL2) of four parasites collected between 2017 and 2019. To explore the regional context of Panamanian P. vivax we conducted principal components analysis and constructed a neighbor-joining tree using these samples and samples collected worldwide from a previous study. Three of the four samples with travel history clustered with samples collected from their suspected country of origin (consistent with importation), while one appears to have been a result of local transmission. The small number of Panamanian P. vivax samples not belonging to either CL1 or CL2 clustered with samples collected from Colombia, suggesting they represent the genetically similar ancestral P. vivax population in Panama or were recently imported from Colombia. The low diversity we observe in Panama indicates that this parasite population has been previously subject to a severe bottleneck and may be eligible for elimination. Additionally, while we confirmed that P. vivax is imported to Panama from diverse geographic locations, the lack of impact from imported cases on the overall parasite population genomic profile suggests that onward transmission from such cases is limited and that imported cases may not presently pose a major barrier to elimination.

Elective report: Floating Doctors, Bocas del Toro, Panama

The Floating Doctors is an non-government organization that was set up and initiated by an man from America who recognized the health adversities experienced by the Ngabe population in Panama. The definition of ‘Floating Doctor’ is a doctor who provides temporary medical coverage when normal services are otherwise unavavilable. The idea of The Floating Doctors is to deploy medical teams to remote underserved areas, where ongoing health services and community projects can occur. During my time with The Floating Doctors I was able to play a role in providing medical care to four different remote communities. The isolation of these villages mean’t that their medical care was sub par- the people living there experienced absence of sanitation, electricity, clean water and other infrastructure. This has lead to poverty as well as poor health knowledge. Getting to these communities was a challenge in itself- it could involve up to an 8 hour boat ride, or a bus ride and then a 3 hour treck. We had to take all the equiptment, paper work/notes and medications with us which was proven difficult especially in the extreme heat. The main health issues I was lucky enough to see in these areas was worms as well as many other parasitic infections including scabies, machete wounds, malnutrition, dehydration, STDs, pregnancies, HIV, poor pre-natal health, infected wounds and fungal infections. Everyday on the Floating Doctors held new challenges and experiences for me, and I never knew what I was going to see next. This was a huge contrast to the first part of my elective in Miami.

Bioacoustic Classification of Antillean Manatee Vocalization Spectrograms Using Deep Convolutional Neural Networks

We evaluated the potential of using convolutional neural networks in classifying spectrograms of Antillean manatee (Trichechus manatus manatus) vocalizations. Spectrograms using binary, linear and logarithmic amplitude formats were considered. Two deep convolutional neural networks (DCNN) architectures were tested: linear (fixed filter size) and pyramidal (incremental filter size). Six experiments were devised for testing the accuracy obtained for each spectrogram representation and architecture combination. Results show that binary spectrograms with both linear and pyramidal architectures with dropout provide a classification rate of 94–99% on the training and 92–98% on the testing set, respectively. The pyramidal network presents a shorter training and inference time. Results from the convolutional neural networks (CNN) are substantially better when compared with a signal processing fast Fourier transform (FFT)-based harmonic search approach in terms of accuracy and F1 Score. Taken together, these results prove the validity of using spectrograms and using DCNNs for manatee vocalization classification. These results can be used to improve future software and hardware implementations for the estimation of the manatee population in Panama.

Regional biogeography of microbiota composition in the Chagas disease vector Rhodnius pallescens

BackgroundTriatomine bugs are vectors of the protozoan parasite Trypanosoma cruzi, which causes Chagas disease. Rhodnius pallescens is a major vector of Chagas disease in Panama. Understanding the microbial ecology of disease vectors is important in the development of vector management strategies that target vector survival and fitness. In this study we examined the whole-body microbial composition of R. pallescens from three locations in Panama.MethodsWe collected 89 R. pallescens specimens using Noireau traps in Attalea butyracea palms. We then extracted total DNA from whole-bodies of specimens and amplified bacterial microbiota using 16S rRNA metabarcoding PCR. The 16S libraries were sequenced on an Illumina MiSeq and analyzed using QIIME2 software.ResultsWe found Proteobacteria, Actinobacteria, Bacteroidetes and Firmicutes to be the most abundant bacterial phyla across all samples. Geographical location showed the largest difference in microbial composition with northern Veraguas Province having the most diversity and Panama Oeste Province localities being most similar to each other. Wolbachia was detected in high abundance (48–72%) at Panama Oeste area localities with a complete absence of detection in Veraguas Province. No significant differences in microbial composition were detected between triatomine age class, primary blood meal source, or T. cruzi infection status.ConclusionsWe found biogeographical regions differ in microbial composition among R. pallescens populations in Panama. While overall the microbiota has bacterial taxa consistent with previous studies in triatomine microbial ecology, locality differences are an important observation for future studies. Geographical heterogeneity in microbiomes of vectors is an important consideration for future developments that leverage microbiomes for disease control.

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.

Trends in Prenatal Care Among the Ngöbe Population of Panama [34M

INTRODUCTION: Maternal and infant mortality rates in Panama are reported as being within the best in Latin America, however there is a sharp contrast between rates reported in urban and rural populations. Maternal death rates among indigenous populations, such as the Ngöbe, reach as high as 658 per 100,000 live births. This study assesses the impact of poverty and geographic isolation on women's decisions to deliver at home versus a healthcare facility in this understudied population. Additionally, the use of prenatal vitamins and contraception are evaluated. METHODS: Given high rates of illiteracy, an oral questionnaire was administered, consisting of: 1. Preferences in delivery location 2. Use of prenatal vitamins 3. Experience with prenatal healthcare and family planning. Surveys were administered in Spanish to participants receiving services through the non-profit organization Floating Doctors. RESULTS: 101 pregnant Ngöbe women participated. The majority of women preferred to deliver in a healthcare facility if possible (61%) and wished to use contraception (59%). Age was not a significant factor in the interest in using contraceptives (p=0.74), but the number of living children in the household was (p=0.02). The use of prenatal vitamins during pregnancy did not correlate with age (p=0.27) and was as low as 45%. CONCLUSION: This data further demonstrate the need for improved access to transportation to hospitals in order to reduce maternal and fetal morbidity and mortality among the Ngöbe population. Prenatal education and family planning could positively contribute to maternal and fetal health outcomes.

Analysis of mortality trends due to cardiovascular diseases in Panama, 2001–2014

ObjectiveCardiovascular diseases (CVDs) are still the leading cause of death worldwide despite the recent decline in mortality rates attributable to CVD in Western Europe and the Americas. The aim of...

Low Predictability of Colour Polymorphism in Introduced Guppy (Poecilia reticulata) Populations in Panama.

Colour polymorphism is a recurrent feature of natural populations, and its maintenance has been studied in a range of taxa in their native ranges. However, less is known about whether (and how) colour polymorphism is maintained when populations are removed from their native environments, as in the case of introduced species. We here address this issue by analyzing variation in colour patterns in recently-discovered introduced populations of the guppy (Poecilia reticulata) in Panama. Specifically, we use classic colour analysis to estimate variation in the number and the relative area of different colour spots across low predation sites in the introduced Panamanian range of the species. We then compare this variation to that found in the native range of the species under low- and high predation regimes. We found aspects of the colour pattern that were both consistent and inconsistent with the classical paradigm of colour evolution in guppies. On one hand, the same colours that dominated in native populations (orange, iridescent and black) were also the most dominant in the introduced populations in Panama. On the other, there were no clear differences between either introduced-low and native low- and high predation populations. Our results are therefore only partially consistent with the traditional role of female preference in the absence of predators, and suggest that additional factors could influence colour patterns when populations are removed from their native environments. Future research on the interaction between female preference and environmental variability (e.g. multifarious selection), could help understand adaptive variation in this widely-introduced species, and the contexts under which variation in adaptive traits parallels (or not) variation in the native range.

Gonad development stages and reproductive traits of Diadema mexicanum (Echinodermata: Echinoidea) from Oaxaca, Mexico

Diadema mexicanum is a common inhabitant of the Mexican Pacific coast and a key species for coral reefs dynamics. Several reproductive traits of D. mexicanum throughout one year at La Entrega Bay, Oaxaca (15°44′N), in the Mexican tropical Pacific, were analyzed. Maturity index or microscopic maturity index “MI” was calculated. Annual ratio of males to females (1:1) was not significantly different. Five gonad development stages “GDS” (i.e. development, mature, spawning, post-spawning, nutritive) were recognized. The nutritive stage was noticeably later to post-spawning. High values of gonadosomatic index “GSI” in December 2008 and February/March 2009 did not correspond to maturity but to the nutritive stage. MI values ratified the periodicity of each GDS and spawning preparedness. MI was a better descriptor than GSI for reproductive season of D. mexicanum, and probably for all sea urchins exhibiting the nutritive stage. D. mexicanum has a single annual reproductive season (maturity/spawning) from April to October, similar to the population of Panama (9°00′N), without a second season, as proposed previously for the population of Colima, Mexico (19°10′N). Previous disparities in its reproductive season reflect differences of the environments it inhabits, rather than an effect of the latitudinal gradient in the tropical region.

Reducing child labour in Panama: an impact evaluation

This article examines the impact of two specifically designed educational programmes aimed at reducing child labour among the indigenous population in Panama: a tutoring course (CEC) and an accelerated primary school/course (EPA). Based on a sample of 427 children belonging to 185 households, and using a post-intervention treatment and comparison group design, we find that the CEC programme decreased the probability of working (child labour) by 10.7 per cent and increased the probability of participating in an extracurricular activity by 23.5 per cent. Thus, the programme limited the possibility of CEC participants becoming involved in agricultural-related or other forms of child labour. Because results from the EPA programme are statistically insignificant, we are uncertain about the direct impact of EPAs on the overall goal of child labour reduction.

Participatory Processes Applied to Developing Culturally Appropriate Educational Material Among the Ngäbe-Buglé Women of Panama for Domestic Violence Prevention

The Ngäbe-Buglé is the largest underserved indigenous population in Panama facing extreme health disparities compounded by structural, social, and cultural factors. Contributing factors to the poor health outcomes in this region include extreme poverty, low education, high maternal and infant mortality, alcohol use, and an increasing trend of domestic violence. The present intervention used community participatory processes to develop tailored material within the Ngäbe-Buglé community and training health promoters to deliver health education to the most rural areas. There were 78 health promoters who were trained using the training-of-trainers approach. Promoters distributed the health messages to their communities using the tailored material, the main topic discussed being domestic violence. Almost 7,000 community members received health education, demonstrating increased knowledge and intent to act on information received. Future directions include further funding, research, and education of indigenous groups in Panama on domestic violence.

Effects of Water, Sodium Hypochlorite, Peroxyacetic Acid, and Acidified Sodium Chlorite on In‐Shell Hazelnuts Inoculated with Salmonella Enterica Serovar Panama

Recent foodborne disease outbreaks involving minimally processed tree nuts have generated a need for improved sanitation procedures. Chemical sprays and dips have shown promise for reducing pathogens on fresh produce, but little research has been conducted for in-shell hazelnuts. This study analyzed the effectiveness of 3 chemical sanitizers for reducing Salmonella on in-shell hazelnuts. Treatments of water, sodium hypochlorite (NaOCl; 25 and 50 ppm), peroxyacetic acid (PAA; 80 and 120 ppm), and acidified sodium chlorite (ASC; 450, 830, and 1013 ppm) were sprayed onto hazelnut samples inoculated with Salmonella enterica serovar Panama. Hazelnut samples were immersed in liquid cultures of S. Panama for 24 h, air-dried, and then sprayed with water and chemical treatments. Inoculation achieved S. Panama populations of approximately 8.04 log CFU/hazelnut. Surviving S. panama populations were evaluated using a nonselective medium (tryptic soy agar), incubated 3 h, and then overlaid with selective media (xylose lysine deoxycholate agar). All of the chemical treatments significantly reduced S. Panama populations (P ≤ 0.0001). The most effective concentrations of ASC, PAA, and NaOCl treatments reduced populations by 2.65, 1.46, and 0.66 log units, respectively. ASC showed the greatest potential for use as a postharvest sanitation treatment.

Chocolate and Cardiovascular Health: The Kuna Case Reconsidered

Among numerous studies of the health benefits of chocolate, special attention has focused on the island Kuna, an indigenous population of Panama, who are said to drink home-grown chocolate exclusively and thus to enjoy excellent cardiovascular health. Anthropological research among the Kuna calls these claims into question. The Kuna consume a wide variety of homemade and commercial drinks, including store-bought cocoa. They do make heavy use of cacao beans, especially in curing and other ritual, but little comes from their own farms. Low blood-pressure levels and a low incidence of cardiovascular disease, also characteristic of other traditional populations, are likely due more to a low-fat diet and heavy physical labor than to consumption of chocolate. The erroneous results from the Kuna illustrate the dangers inherent in the search for miracle dietary cures.

Origins and close relatives of a semi‐domesticated neotropical fruit tree: Chrysophyllum cainito (Sapotaceae)

Understanding patterns and processes associated with domestication has implications for crop development and agricultural biodiversity conservation. Semi-domesticated crops provide excellent opportunities to examine the interplay of natural and anthropogenic influences on plant evolution. The domestication process has not been thoroughly examined in many tropical perennial crop species. Chrysophyllum cainito (Sapotaceae), the star apple or caimito, is a semi-domesticated species widely cultivated for its edible fruits. It is known to be native to the neotropics, but the precise geographic origins of wild and cultivated forms are unresolved. We used nuclear ribosomal ITS sequences to infer phylogenetic relationships among C. cainito and close relatives (section Chrysophyllum). We employed phylogeographic approaches using ITS and plastid sequence data to determine geographic origins and center(s) of domestication of caimito. ITS data suggest a close relationship between C. cainito and C. argenteum. Plastid haplotype networks reveal several haplotypes unique to individual taxa but fail to resolve distinct lineages for either C. cainito or C. argenteum. Caimito populations from northern Mesoamerica and the Antilles exhibit a subset of the genetic diversity found in southern Mesoamerica. In Panama, cultivated caimito retains high levels of the diversity seen in wild populations. Chrysophyllum cainito is most closely related to a clade containing Central and South American C. argenteum, including subsp. panamense. We hypothesize that caimito is native to southern Mesoamerica and was domesticated from multiple wild populations in Panama. Subsequent migration into northern Mesoamerica and the Antilles was mediated by human cultivation.

HIV transmitted drug resistance in adult and pediatric populations in Panama

To investigate the prevalence of transmitted drug-resistant HIV among adults in Panama by using a modified World Health Organization Threshold Survey (WHO-TS) and to investigate rates of initial resistance among HIV-positive infants in Panama. At the Gorgas Memorial Institute, 47 HIV-positive adults were genotyped for mutations associated with transmitted drug resistance (TDR) in the reverse transcriptase and protease genes of HIV-1, according to WHO-TS guidelines, modified to include patients ≤ 26 years old. Prevalence rates for drug-resistance mutations against three classes of antiretroviral drugs-nucleoside analog reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors-were calculated as low (< 5.0%), moderate (5.0%-15.0%), and high (> 15.0%). Twenty-five infant patients were also geno-typed and prevalence rates for drug-resistance mutations were calculated. TDR among Panamanian adults was moderate: 6 of 47 HIV-positive adults showed one or more mutations associated with TDR. Horizontal TDR mutations were moderate for NRTIs and NNRTIs and low for protease inhibitors. Vertical transmission of HIV in Panama has decreased for 2002-2007, but vertical HIV TDR prevalence is moderate (12.0%) and is emerging as a problem due to incomplete antiretroviral coverage in pregnancy. The prevalence of HIV TDR indicated by this study, combined with known rates of HIV infection in Panama, suggests more extensive surveys are needed to identify risk factors associated with transmission of HIV drug resistance. Specific WHO-TS guidelines for monitoring vertical transmission of drug-resistant HIV should be established.