Rural Central America Research Articles

Population-based Study of Gastric Cancer Survival and Associations in Rural Western Honduras.

Two-thirds of global cancer occur in low/middle income countries (LMICs). Northern Central America is the largest LMIC region in the western hemisphere, and lack cancer registries to guide cancer control. We conducted a gastric cancer (GC) survival study in rural western Honduras, characterized as having among the highest GC incidence rates in Latin America. The cohort of incident GC diagnosed between 2002-2015 was studied with active follow-up, with household visits. The regional gastric cancer registry was primary for case identification, with completeness examination with hospital data and national death certificates. Cox regression models were used for survival calculations. Survival follow-up was achieved in 741/774 patients (95.7%). Household interviews were conducted in 74.1% (n=549). 65.7% were male, median age at diagnosis was 64 years, 24.5% were <55. 43.9% of tumors had pyloric obstruction. 45.2%, 43.2%, and 7.3% of histology was intestinal, diffuse, and mixed, respectively. 24.7% patients received treatment. 5-year survival rates were 9.9% for both males and females, 7.7% for age <45, and 7.9% for diffuse GC. Median survival time was 4.8 months (95%CI,4.2-5.6). In the final Cox regression model including age, sex, Lauren subtype, and poverty index, only treatment was significantly associated with survival (HR 2.43, 95%CI,1.8-3.2). Markedly low gastric cancer 5-year survival rates are observed in rural Central America. The majority of patients present with advanced disease, and a minority have access to therapy. The findings have implications for cancer control in the Central America LMICs and for U.S. Latino populations.

Volumetric pricing in rural Central America: Drivers of adoption and potential effects on water delivery

In rural and peri‑urban areas of Central America, community water organizations (CWOs) provide water to 60 % of the population, thereby playing a pivotal role in achieving multiple Sustainable Development Goals. However, the underlying environmental, climatic, and institutional factors explaining the adoption of volumetric pricing from these water providers and its effect on service delivery are typically overlooked in the literature. In this paper, we address two issues. First, we test whether volumetric pricing affects the service water delivery in a rural setting, drawing on a random sample of cross-sectional data on 154 CWOs in Costa Rica, Guatemala, and Nicaragua. We find that volumetric pricing is associated with substantially more successful water delivery, even when conditioned on institutional capacity, environmental attributes, climatic conditions, and country-fixed effects. Despite this strong relationship, volumetric pricing has yet to be widely adopted, particularly in Nicaragua and Guatemala. Therefore, as the second goal, we try to identify the institutional and socio-ecological conditions in which volumetric pricing is adopted. We find that volumetric pricing is more likely used when communities (1) experience adverse environmental and climatic conditions associated with water scarcity and (2) have greater institutional capacity. Our results highlight the importance of examining the social-ecological system to assess the performance and adoption of water management institutions

Investigation of Community Energy Business Models from an Institutional Perspective: Intermediaries and Policy Instruments in Selected Cases of Developing and Developed Countries

Community energy development and the empowerment of customers as producers are the main contributors to decentralized market solutions in energy transition policy. Despite the growing literature on community energy projects from the perspectives of various business models, drivers, and barriers, few studies display the impact of institutional factors on the community energy business model configuration. Using insights from Ostrom’s institutional framework, this study develops a conceptual framework comprising policy instruments and the intermediaries that configure the various community energy business models, and it examines this framework in the developed world of northwestern European countries (Germany, Denmark, Belgium, and the UK) and in selected cases in developing countries (Rural Central America, South Africa, Iran, and Indonesia). The findings indicate that ambitious renewable energy consumption targets and national policies in northern EU countries have resulted in political and financial incentives, as well as greater financial security than other investment markets, which encourage citizens to contribute to the proliferation of community energy. On the other hand, in the studied developing countries, top-down energy policies and a centralized energy system are insufficient for participatory energy planning. Due to unsupportive policies, a lack of appropriate regulatory frameworks, and a lack of institutional support in these countries, the initiation of community energy projects requires the presence of intermediaries such as developers who work ‘in-between’ other actors, such as energy providers, users, or regulators.

High-Dose vs. Low-Dose Dexamethasone in Patients With COVID-19: A Cohort Study in Rural Central America.

To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg ( p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension ( p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan-Meier analysis regarding the survival (log-rank p -value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.

Western Honduras Copán Population-Based Cancer Registry: Initial Estimates and a Model for Rural Central America.

PURPOSEPopulation-based cancer registries (PBCRs) are critical for national cancer control planning, yet few low- and middle-income countries (LMICs) have quality PBCRs. The Central America Four region represents the principal LMIC region in the Western hemisphere. We describe the establishment of a PBCR in rural Western Honduras with first estimates for the 2013-2017 period.METHODSThe Western Honduras PBCR was established through a collaboration of academic institutions and the Honduras Ministry of Health for collection of incident cancer data from public and private health services. Data were recorded using the Research Electronic Data Capture (REDCap) web-based platform with data monitoring and quality checks. Crude and age-standardized rates (ASRs) were calculated at the regional level, following WHO methodology.RESULTSThe web-based platform for data collection, available ancillary data services (eg, endoscopy), and technical support from international centers (United States and Colombia) were instrumental for quality control. Crude cancer incidence rates were 112.2, 69.8, and 154.6 per 100,000 habitants overall, males, and females, respectively (excluding nonmelanoma skin cancer). The adjusted ASRs were 84.2, 49.6, and 118.9 per 100,000 overall habitants, males, and females, respectively. The most common sites among men were stomach (ASR 26.0, 52.4%), colorectal (ASR 5.11, 10.15%), and prostate (ASR 2.7, 5.4%). The most common sites in women were cervix (ASR 34.2, 36.7%), breast (ASR 11.2, 12.3%), and stomach (ASR 10.8, 11.7%).CONCLUSIONThe Copán-PBCR represents a successful model to develop cancer monitoring in rural LMICs. Innovations included the use of the REDCap platform and leverage of Health Ministry resources. This provides the first PBCR data for Honduras and the Central America Four and confirms that infection-driven cancers, such as gastric and cervical, should be priority targets for cancer control initiatives.

Effect of Improved Stoves on Wood Consumption, Particulate Matter and Carbon Monoxide Production in Central America

Biomass is the primary source of energy for cooking in rural Central America. The intensity of labour required to collect wood, levels of pollution resulting from incomplete burning, health problems linked to smoke inhalation, and pressure on forests are among the problems commonly associated with cooking with traditional stoves utilized in the region. Since the 1980s, improved stoves programs have been implemented in the region, but exogenous-developed models have had low adoption rates due to a lack of know-how for construction and repairments, expensive materials, and lack of understanding of local culinary traditions and culture. Sustainable Harvest International (SHI), a non-profit organization, has successfully developed two local improved stoves: the Damak model in Panama and the Mani model in Honduras. In both cases, anecdotal evidence of high rates of long-term adoption has been noted by SHI. Nonetheless, before this study, there has been no systematic evaluation of the efficiency of these two models in respect to 1) daily household wood consumption (kg); 2) particulate matter (PM2.5 ug/m3) concentration in the kitchen, and 3) carbon monoxide (CO ppm) concentration in the kitchen when compared to the traditional stoves used in rural households of both countries. The results presented herein were generated from a study using a random representative sample of 174 stoves and a portable Indoor Air Pollutant Meter manufactured by Aprovecho Research Center (ARC). An analysis of variance processed the data under the general and mixed model frameworks. The results showed that there was a statistically significant average decrease in wood consumption per day per stove for the improved models, as well as a statistically significant average decrease in personal exposure to particulate matter and carbon monoxide for the improved models when compared to those self-same measurements generated by traditional stoves.

Narco Robin Hoods: Community support for illicit economies and violence in rural Central America

• Traffickers are more likely to garner community support when they are native to the community. • Traffickers are more likely to garner community support when they operate in rural and marginalized areas. • Community support for illicit economies can limit narco-violence and reduce non-trafficking related crimes. • Narcos invest in spaces the state has abandoned and, in return, locals provide support networks for clandestine operations. Current counter-narcotics policies are counter-productive and have contributed to the ability of narcos to gain local support. While there is a growing literature on criminal governance, to date limited work has focused on rural spaces and transit zones. Drawing on over two years of ethnographic fieldwork in drug trafficking hubs along the Caribbean coast of Costa Rica, Nicaragua, and Honduras, I provide evidence and offer an initial theorization of forms of criminal governance in rural Central America. I show how both structural and individual level factors increase community support for illicit economies. I argue that rural and marginalized communities where there is widespread corruption and limited state capacity are more inclined to be supportive of and form collaborative relationships with traffickers. I argue that traffickers who are native to the community, limit their use of violence in the community, and invest economically in the community are the most likely to win the community’s support or even become viewed as Robin Hood-esque figures. In spaces where community support is low, I find traffickers may still take actions to limit crimes unrelated to their business (e.g. theft) which could draw attention from state actors and result in community frustration. Understanding community-narco dynamics is crucial to formulating effective policies to address violence in the region. Current international counter-narcotics policies are counter-productive; therefore, it should be unsurprising that certain marginalized communities support drug-traffickers who offer tangible benefits instead of counter-narcotics forces who seem to increase conflict and suppress economic activity without providing viable alternatives.

507 The Functional Gastrointestinal Disorders Population-Based Prevalence and Relationship to Dietary Factors in Latino Populations in the Resource Limited Setting of Rural Central America

INTRODUCTION: The prevalence of the Functional Gastrointestinal Disorders (FGIDs) in Latino populations in resource-limited settings such as rural Central America is largely uninvestigated. The relationship of the FGIDs and dietary habits is unknown in this environment. METHODS: With population-based sampling, we administered the Rome IV questionnaire and a validated dietary questionnaire to a cross-section of the general adult population of rural Western Honduras. We estimated the prevalence of specific FGIDs and used logistic regression with Bonferroni adjustment to evaluate the relationship of each FGID diagnosis with particular dietary habits. RESULTS: We interviewed 815 subjects, of whom 151 fulfilled Rome IV criteria for an FGID (18.5% 95% CI 15.9-21.4%). The mean age was 40.6 years, of whom 58.7% were female. Gastroduodenal FGIDs were noted in 10.1%, with epigastric pain syndrome (EPS) more common than post-prandial distress syndrome (PDS), 8.5% versus 1.6%. Among the bowel disorders, functional abdominal bloating (FAB) was most prevalent (6.2%; 95% CI, 4.6-8.1), followed by irritable bowel syndrome (IBS, 3.5%, 95% CI 2.5-5.1; IBS-U 1.6%, IBS-C 1.2%, IBS-D 0.5%), functional diarrhea (FD, 3.4%) and functional constipation (FC, 1.1%). In multivariable logistic regression analysis, the diagnosis of any FGID was inversely associated with consumption of beans (OR 0.41, 95% CI 0.27-0.63, adjusted P = 0.009), driven by negative associations with IBS and FD. Overall vegetable consumption was associated with a lower prevalence of FD (OR 0.12, 95% CI 0.043-0.35, adjusted P = 0.018) and any diarrheal disorder (OR 0.11, 95% CI 0.42-0.31, adjusted P = 0.004). There was a trend toward association with all FGIDs for subjects who consumed greater than the mean daily intake of 4.6 corn tortillas per day, OR 1.74 (95% CI 1.22-2.50, adjusted P-value NS). CONCLUSION: FGIDs are prevalent in the resource-limited setting of rural Central America, with an altered distribution of specific FGIDs (common FAB, versus less common PDS, IBS, FC) compared with other global populations and urban Latin America populations. In this setting, with locally grown foods and limited diet variability, local dietary influences such as vegetable, bean, and tortilla intake may be important factors in specific FGIDs.

Geospatial analyses identify regional hot spots of diffuse gastric cancer in rural Central America

BackgroundGeospatial technology has facilitated the discovery of disease distributions and etiology and helped target prevention programs. Globally, gastric cancer is the leading infection-associated cancer, and third leading cause of cancer mortality worldwide, with marked geographic variation. Central and South America have a significant burden, particularly in the mountainous regions. In the context of an ongoing population-based case-control study in Central America, our aim was to examine the spatial epidemiology of gastric cancer subtypes and H. pylori virulence factors.MethodsPatients diagnosed with gastric cancer from 2002 to 2013 in western Honduras were identified in the prospective gastric cancer registry at the principal district hospital. Diagnosis was based on endoscopy and confirmatory histopathology. Geospatial methods were applied using the ArcGIS v10.3.1 and SaTScan v9.4.2 platforms to examine regional distributions of the gastric cancer histologic subtypes (Lauren classification), and the H. pylori CagA virulence factor. Getis-Ord-Gi hot spot and Discrete Poisson SaTScan statistics, respectively, were used to explore spatial clustering at the village level (30–50 rural households), with standardization by each village’s population. H. pylori and CagA serologic status was determined using the novel H. pylori multiplex assay (DKFZ, Germany).ResultsThree hundred seventy-eight incident cases met the inclusion criteria (mean age 63.7, male 66.3%). Areas of higher gastric cancer incidence were identified. Significant spatial clustering of diffuse histology adenocarcinoma was revealed both by the Getis-Ord-GI* hot spot analysis (P-value < 0.0015; range 0.00003–0.0014; 99%CI), and by the SaTScan statistic (P-value < 0.006; range 0.0026–0.0054). The intestinal subtype was randomly distributed. H. pylori CagA had significant spatial clustering only in association with the diffuse histology cancer hot spot (Getis-Ord-Gi* P value ≤0.001; range 0.0001–0.0010; SaTScan statistic P value 0.0085). In the diffuse gastric cancer hot spot, the lowest age quartile range was 21–46 years, significantly lower than the intestinal cancers (P = 0.024).ConclusionsGeospatial methods have identified a significant cluster of incident diffuse type adenocarcinoma cases in rural Central America, suggest of a germline genetic association. Further genomic and geospatial analyses to identify potential spatial patterns of genetic, bacterial, and environmental risk factors may be informative.

Helicobacter pylori antimicrobial resistance and antibiotic consumption in the low-resource Central America setting.

Antimicrobial resistance is a global public health problem, particularly in low- and middle-income countries (LMICs), where antibiotics are often obtained without a prescription. H. pylori antimicrobial resistance patterns are informative for patient care and gastric cancer prevention programs, have been shown to correlate with general antimicrobial consumption, and may guide antimicrobial stewardship programs in LMICs. We report H.pylori resistance and antimicrobial utilization patterns for western Honduras, representative of rural Central America. In the context of the western Honduras gastric cancer epidemiology initiative, gastric biopsies from 189 patients were studied for culture and resistance patterns. Antimicrobial utilization was investigated for common H. pylori treatment regimens from regional public (7 antimicrobials) and national private (4 antimicrobials) data, analyzed in accordance with WHO anatomical therapeutic chemical defined daily doses (DDD) method and expressed as DDD/1000 inhabitants per day (DID) and per year (DIY). H. pylori was successfully cultured from 116 patients (56% males, mean age: 54), and nearly all strains were cagA+ and vacAs1m1+ positive (99% and 90.4%, respectively). Unexpectedly, high resistance was noted for levofloxacin (20.9%) and amoxicillin (10.7%), while metronidazole (67.9%) and clarithromycin (11.2%) were similar to data from Latin America. Significant associations with age, gender, or histology were not noted, with the exception of levofloxacin (28%, P=0.01) in those with histology limited to non-atrophic gastritis. Total antimicrobial usage in western Honduras of amoxicillin (17.3 DID) and the quinolones had the highest relative utilizations compared with other representative nations. We observed significant H.pylori resistance to amoxicillin and levofloxacin in the context of high community antimicrobial utilization. This has implications in Central America for H. pylori treatment guidelines as well as antimicrobial stewardship programs.

Geospatial analyses identify regional hot spots of diffuse gastric cancer in rural Central America

Geospatial analyses identify regional hot spots of diffuse gastric cancer in rural Central America

The future of Community Renewable Energy for electricity access in rural Central America

When a Renewable Energy (RE) power system is owned, operated or maintained by a community organisation, some of the problems associated with other rural electrification implementation models e.g. private or utility, can potentially be solved; including: lack of utility investment, barriers relating to social integration of RE technologies, lack of local maintenance capabilities, and end-user education. However, a range of challenges for community-based energy initiatives in developing countries are identified in the literature, often compromising the long-term operation of RE technologies and the sustainability of the project as a whole. Hence, questions arise around the set of community capabilities required, appropriate project design, and enabling external environment for sustainable Community RE (CRE) projects. Relatively longstanding CRE rural electrification experiences in Central America can offer useful insights on the challenges, capability requirements, and future perspectives for further deployment and governance of CRE initiatives in the developing world. In this study, a comparative analysis from case studies across Panama, Nicaragua and Costa Rica was undertaken after field investigation conducted over eight months. A cross-disciplinary method combining qualitative social research and techno-economic analysis of RE power systems was then used for data integration and sustainability assessment of selected case studies.

Household dietary diversity indicators in rural Central America

ObjectiveFANTA (2006) and FAO (2012) proposed household dietary diversity scores (HDDS) derived from minimal food consumption data. D'Errico et al (2016) proposed the Shannon‐Wiener and Simpson indices applied to HDDS for food security resilience. WFP (2008) proposed a Food Consumption Score (FCS) weighting HDDS by number of days in a week food was consumed and nutritional importance. This paper proposes new HDDS weighted by utilization coefficients (HDDSU), by nutrient content (HDDSN) and by both (HDDSUN).MethodsThe data on food consumption from 702 households were collected for a seven‐day period in bordering rural communities of El Salvador, Guatemala, Honduras and Nicaragua in 2013, 2014 and 2015. HDDS and new scores HDDSU, HDDSN and HDDSUN for FAO, FANTA and WFP considered 16, 12 and nine food groups respectively and nine for WFP‐FCS with relative nutritional weights only. HDDS and new scores distributions for FAO, FANTA and WFP, and WFP FCS with relative nutritional weights only were estimated as well as correlations between food energy and all scores.ResultsHDDS, HDDSU, HDDSE and HDDSUE distributions based on FAO and FANTA food groupings were similar for small number of food groups consumed, while those based on WFP food groupings behaved differently. Main food groups identified by HDDS were ten in 16 for FAO, ten in 12 for FANTA HDDS, and all nine for WFP; while by FCS, HDDSU, HDDSE and HDDSUE scores identified fewer important food groups for FAO, FANTA and WFP dietary diversity. The correlations between energy intake and dietary diversity scores for FAO, FANTA and WFP were close, ranging from 0.28 to 0.35.ConclusionsIn rural populations of bordering communities in Central America, New scores HDDSU, HDDSE, and HDDSUE provided better results for assessing household dietary diversity than HDDS scores. The new scores weighting by utilization coefficients (HDDSU), nutrient content (HDDSE for example food energy), and both (HDDSUE) identified better the importance of food groups for food and nutrition security. Correlations between dietary energy intake and all household dietary diversity scores analysed were very similar. Policy implications refer to the promotion of main food groups and enhancing potential food groups identified by new scores for improving household dietary diversity in vulnerable populations.

Identifying the potential of governance regimes to aggravate or mitigate local water conflicts in regions threatened by climate change

ABSTRACTThere is a need for specific knowledge of what people can do to mitigate harmful water conflicts. This need is evident in the rural dry tropics of Central America where people face climate change impacts, inefficient water management, and social tension. To address this need, we investigated why some local water conflicts escalated to violence and why other potential conflicts were avoided in Guanacaste Province, Costa Rica. We used interviews, focus groups, and a stakeholder workshop to analyse five cases. We found that violent actions only occurred when rural groups opposed government agencies in settings without mediating leadership. With one exception in a circumstance aggravated over many years, water users did not take violent action against competing water users. Distrust, which has been formed by legacies of ineffective rural stakeholder engagement, diminished the credibility of water-related information used in decision processes and thus prolonged conflicts. Active community-based groups respected by both rural constituencies and government agencies helped some people avoid difficult conflicts. Self-organised groups in other areas struggled to address disputes in settings with contested property rights, high socio-economic inequality, and low human capital. Using insights from Guanacaste, we outline practical conflict mitigation strategies fitted to a range of local water governance contexts found in rural Central America. Results suggest the need for incorporating certain types of peace-building processes in water management and development. The study provides a foundation for policy-makers, water managers, and other stakeholders to more effectively manage water disputes and avoid harmful conflicts in challenging regions.

An alternative framework for analysing and managing conflicts in integrated water resources management (IWRM): linking theory and practice

Research on water resource conflicts needs to be better aligned with practitioner approaches to water resources development, chiefly integrated water resources management (IWRM). This paper bridges the gap between research and practice through a novel application of the social–ecological systems framework to a set of 10 conflict cases from an IWRM initiative in rural Central America. The conflicts in the empirical cases are found to be primarily the result of socio-political variables, particularly low levels of trust and social capital, and peacebuilding is suggested as a promising approach to address this suite of conflicts. The paper concludes with a proposed course of research designed to further both theoretical and applied knowledge of water resource conflicts.

Development of a point‐of‐use, iron fortification technology of nixtamalized corn masa for rural communities in Central America

Iron deficiency anemia (IDA) is major health concern. Fortification of nixtamalized corn (NC) for tortillas at the point of wet grinding could be an effective strategy against IDA in rural Central America. Process of making iron containing extruded pellets (IEP) and their addition to NC is presented. IEPs will be added to NC previous to grinding at local milling facilities. Welly Puffing extruder set at a feed rate of 60 g/min was used to create brown rice:corn grits (1:1, w/w) pellets. Two chelated Fe sources were evaluated, ferric NaEDTA (FeNaEDTA) and ferrous bisglycinate (FeBG). Fe solutions were pumped (2 mL/min) to target levels, 0.4 mg/g or 1 mg/g pellet, respectively. Process stability was evaluated from 0.5 to 19 min from Fe addition. IEPs were added to NC at different amounts,12.5, 25, 50 g pellet/kg NC, resulting in target levels of 8.2, 16.3 and 32.6 (FeBG) and 3.9, 7.8 15.65 (FeNaEDTA) mg Fe/kg of masa. Fe recoveries in IEPs upon processing were 78.3±5% and 65.3±3.8 % for FeNaEDTA and FeBG, respectively; with homogenous distribution for both iron sources after 14 min of processing (Brown and Forsythe P&gt;;0.1). IEPs dimensions (l×ø) from both sources were similar, 16.7±1.1 × 11.4±0.9 mm. Fe source changed color in pellets, but it did not affect masa color. Iron distributed well in NC masa fortified with both EIPs. Our technology shows the feasibility of Fe fortification at the point of NC grinding using extruded materials.Grant Funding Source: ACES SAO Ayre Fellowship, Hatch

Trusting what you're told: how children learn from others

If children were little scientists who learn best through firsthand observations and mini-experiments, as conventional wisdom holds, how would a child discover that the earth is round - never mind conceive of heaven as a place someone might go after death? Overturning both cognitive and commonplace theories about how children learn, Trusting What You're Told begins by reminding us of a basic truth: Most of what we know we learned from others. Children recognize early on that other people are an excellent source of information. And so they ask questions. But youngsters are also remarkably discriminating as they weigh the responses they elicit. And how much they trust what they are told has a lot to do with their assessment of its source. Trusting What You're Told opens a window into the moral reasoning of elementary school vegetarians, the preschooler's ability to distinguish historical narrative from fiction, and the six-year-old's nuanced stance toward magic: skeptical, while still open to miracles. Paul Harris shares striking cross-cultural findings, too, such as that children in religious communities in rural Central America resemble Bostonian children in being more confident about the existence of germs and oxygen than they are about souls and God. We are biologically designed to learn from one another, Harris demonstrates, and this greediness for explanation marks a key difference between human beings and our primate cousins. Even Kanzi, a genius among bonobos, never uses his keyboard to ask for information: he only asks for treats.

Is World Bank “Good Governance” Good for the Poor? Central American Experiences

AbstractThis paper explores the World Bank’s concept of “good governance” as applied in rural Central America. It argues that World Bank good governance seeks to constrain unequal accumulation and privilege in the public sector, but leaves largely unaddressed structural inequalities in the private sector and the conflation of economic and political power in the public sector. This paper suggests that the World Bank analysis does not adequately consider more embedded state/civil society relations linked to national and sub-national political cultures. In contexts in which nation-building projects have promoted forms citizenship linked to more activist “leveling” and paternalistic states, good governance is likely to be ideologically contested. World Bank good governance under these circumstances is unlikely to quell discontent or naturalize the neoliberal state.

Sustainable Ecotourism Development in Central America and the Caribbean: Review of Debates and Conceptual Reformulation

AbstractTourism is one of the world's largest economic sectors. Ecotourism is its fastest growing component (United Nations World Tourism Organization 2007), and a promising strategy for sustainable development. Rural Central America and the Caribbean are in need of sustainable development and contain promising ecotourism sites. Despite their empirical importance and potential, tourism and ecotourism as research topics present several difficulties. This article surveys recent tourism and ecotourism scholarship and pays special attention to other recent literature reviews that contribute to that scholarship. It offers a three‐dimensional view of sustainable ecotourism development based on ecological integrity, economic viability, and social justice. Our common conception of ecotourism needs to broaden. It is typically presented as one of many distinct alternatives to mass tourism such as cultural, historical, and agro‐tourism. It is more fruitful to view alternative tourisms as synergistic components of a sustainable tourism ensemble. The article explores consequences of neglecting any of the three sustainability dimensions. It concludes by summarizing the article's contributions to the practice and analysis of sustainable ecotourism development.

Devil pact narratives in rural Central America: Class, gender and 'resistance'

The Faustian bargain, or 'pact with the devil', made by a person who exchanges human souls in order to obtain unattainable riches and power, is a widespread peasant narrative in Central and South America. The narrative expresses various overlapping meanings, of which a sudden increase in wealth and a concomitant shift in social relationships is a central theme. In the case examined, peasants invoke the devil pact narrative and the realm of the supernatural to explain wealth and poverty in order to avoid tensions that socio-economic accounts would provoke. By not referring to the history of deceit, force, robbery, consent and complicity that has led to an unequal distribution of local resources, peasants make new forms of accumulation ideologically manageable. The Faustian narrative offers an ideologically acceptable explanation, and thus provides them with a way of handling the inequality between villagers created as a result of accumulation. It is therefore best seen as an adaptive mechanism in the face of contradictions generated by a modernizing agrarian capitalism, rather than - as in Taussig's interpretation - as a form of resistance by the gift economy against unfolding capitalism, or - as in Edelman's interpretation - as an everyday form of resistance against sexual domination.