Rural Dominican Republic Research Articles

Incorporating hearing screening to an otolaryngology surgical mission in the rural Dominican Republic

IntroductionHearing loss disproportionately affects low- and middle-income countries. Children with undiagnosed hearing loss may have difficulty with learning, language development, and behavior. The aim of this study was to understand the extent of hearing loss and common otologic disorders among school-age children in the rural western region of the Dominican Republic and to chronical the early stages of a limited-resource, locally-sustained hearing screening program in tandem with a bi-annual surgical mission. MethodsHearing screenings were performed for 528 school-age children (1056 ears, age 5–17 years old) over 5 days in a village hospital in Peralta, DR. Testing initially included otoscopy and screening audiometry. Children who referred or could not be conditioned underwent distortion product otoacoustic emissions (OAEs), and tympanometry. Children who referred following both screening audiometry and OAEs were considered to have hearing loss. Those with normal tympanograms were considered potential hearing aid candidates. ResultsAbnormal ear examination/otoscopic results were present in 43 children (8.1%) and included: microtia/atresia, impacted cerumen, ear canal foreign body, serous otitis media, otitis externa, and tympanosclerosis. 55 of 528 school-age children referred following screening audiometry and 7 were unable to condition. Of these 62 children, 56 tolerated OAEs and 20 referred following OAEs (3.8%). Fourteen children had type B or C tympanogram and 6 school-age children who were determined to have chronic otitis media with effusion (COME) underwent myringotomy and pressure equalization tube placement. Ten of 528 children (1.9%) had normal tympanometry and otoscopy, and referred following screening audiometry and OAEs suggesting the patients may be potential hearing aid candidates. ConclusionsThe prevalence of hearing loss in this cohort of children in the rural, western Dominican Republic was high at roughly 4% with roughly 2% of children being potential hearing aid candidates. Nearly 10% of children screened had an abnormal otologic examination; sometimes easily remedied by otolaryngologic intervention. With the support of local leadership, it is feasible to incorporate hearing services into otolaryngology outreach and build locally sustainable programs.

A cross-sectional evaluation of HIV testing practices among women in the rural Dominican Republic

BackgroundThe Dominican Republic (DR) ranks among nations with the highest burden of HIV in the Caribbean. Cultural and gender roles in rural areas of the DR may place women at increased HIV risk. However, little is known about sexual health and HIV testing behaviors among women in the rural DR.MethodsWe conducted a needs assessment among a systematic sample of adult women in a rural DR community in 2016. Demographic and behavioral attributes related to HIV testing, sexual health, and healthcare utilization were evaluated. Poisson regression analysis was used to identify demographics and behaviors associated with having had a previous HIV test. Significance was defined as a p-value < 0.05.ResultsAmong 105 women evaluated, 77% knew someone with HIV and 73% of women reported that they would be very or extremely likely to take an HIV test if offered. Only 68% reported a previous HIV test, including 47% who were tested over 2 years prior. Barriers to HIV testing included low risk perception (23%), distance or requisite travel (13%), and discomfort being tested (11%). Women who had never been tested for HIV were more likely than those who had been tested to be older (p = 0.03), to have a lower level of education (p = 0.04), and to have never been tested for other sexually transmitted infections (STI; p < 0.01). In the Poisson multiple regression model, the only significant predictor of having had an HIV test was having had an STI test (p = 0.03).ConclusionsIn the rural DR, numerous barriers contribute to low prevalence of HIV testing among women. Most women report willingness to have an HIV test and many engage in routine health care, indicating that this population may benefit from incorporating HIV testing and other sexual health promotion activities into routine medical care.

Adapting a water, sanitation, and hygiene picture-based curriculum in the Dominican Republic.

Water, sanitation, and hygiene issues present barriers to health in rural Dominican Republic. Limited access to adequate water, sanitation, and hygiene accompanies a prevalence of water, sanitation, and hygiene-related diseases. To address these issues, an education and behavior change program using community health clubs has been adapted for areas at greatest risk of water, sanitation, and hygiene disease transmission. To support this initiative, a protocol was created to evaluate 147 images from a community health clubs toolkit for Dominican agricultural communities, or bateyes, to determine image comprehension and cultural appropriateness, as well as the demographic variables associated with visual literacy. A total of 112 interviews were completed across seven bateyes located near the city of La Romana; 60 images were determined to require additional adaptation. Further analyses demonstrated that age and education were significantly associated with greater visual literacy. These results reinforce that educational visual aids require testing for cultural appropriateness and that future work should be conducted to investigate factors that contribute to visual literacy.

Evaluation of a program to improve intermediate diabetes outcomes in rural communities in the Dominican Republic

AimsTo describe implementation of diabetes and hypertension program in rural Dominican Republic (DR), and report six years of quality improvement process and health outcomes. MethodsDominican teams at two clinics are supported by Chronic Care International with: supervision and continuing education, electronic database, diabetes and hypertension protocols, medications, self-management education materials, behavior change techniques, and equipment and testing supplies (e.g., HbA1c, lipids, blood pressure, BMI). A monthly dashboard for care processes and health outcomes guides problem solving and goal setting. Results were analyzed for quality improvement reports and by fitting the clinical data to random-effects linear models. Results1191 adults were enrolled in the program at two clinics (44% men, baseline means: 56.4 years, BMI 27.4 kg/m2, HbA1c 8.8% (73 mmol/mol), BP 133/81 mmHg). Data show steady growth in clinic populations reaching capacity. Protocols for comprehensive foot examinations, BP and HbA1c assessments, and proportions reaching quality measures improved over time, especially after clinic goal setting. Modeling of BP, BMI and HbA1c values revealed important differences in outcomes by clinic over time. ConclusionsImprovements in process and health outcomes are attainable in rural DR when medical teams have support and access to data. Scalability and sustainability are continuing goals.

Contextualizing Experiences of Diabetes-Related Stress in Rural Dominican Republic.

Type 2 diabetes (T2D) is changing the burden of disease across Latin America. In this formative, qualitative study, we explored experiences of T2D diagnosis and management among adults in rural Dominican Republic. We conducted 28 in-depth interviews (12 men, 16 women) and used inductive analysis to explore the emotional burden of T2D and identify coping strategies. We found that stress relating to T2D began at diagnosis and persisted throughout management. Stress was produced by concerns about healthy food and medication access, fears about illness-induced injury, and the cyclical process of experiencing stress. Participants identified diabetes care and free medication services as external stress-reducers. Internally, participants' mitigated stress by not thinking about diabetes (" no dar mente"). Our study highlights the importance of a contextualized understanding of diabetes-related stress and the need for individual, clinic, and community-level interventions to reduce stressors and improve health outcomes among adults with T2D.

Tablet-based Hearing Screening in Children Aged 5 to 17 in Rural Dominican Republic.

The principal aim of this study was to examine the feasibility of hearing screening using tablet audiometry among a cohort of school-aged children in rural Dominican Republic. The authors hypothesized that the tablet audiometer would serve as an expeditious means for hearing loss screening in various remote locations. Cross-sectional. Twenty-three remote locations in and around the city of La Romana, Dominican Republic. The quietest location available in each site was used for testing. Inclusion criteria comprised children aged 5 to 17 currently residing in the testing location. Children aged <5 years or >18 years were excluded. Screening. For each subject, air conduction thresholds were obtained bilaterally at 500, 1000, 2000, and 4000 Hz; testing duration was also measured. Hearing loss was suspected if any threshold measured ≥30 dB. In this cohort of 423 subjects, 44 (10.4%) failed the screening protocol. The mean thresholds for 500, 1000, 2000, and 4000 Hz frequencies were 26.05, 22.73, 17.57, and 17.15 dB, respectively. Of the 658 thresholds obtained at ≥30 dB, the majority were at 500 or 1000 Hz. The mean testing duration was 494 seconds. These results suggest that children living in remote communities can be screened quickly for hearing loss using a tablet audiometer. However, significant background noise during testing negatively impacted the low-frequency measurements, thus compromising test reliability. Despite extending the reach of existing audiological services, the value of tablet audiometry is not entirely clear in rural environments with uncontrollable background noise.

Improving Diabetes Outcomes in Rural Dominican Republic

The Dominican Republic (DR) is a Caribbean country of 10 million with estimated diabetes prevalence at ∼11%. While the public health system has a diabetes program, there are few reliable surveillance data to portray diabetes outcomes in the DR. The HbA1c is not a widely available test for metabolic control in the DR. In 2010, a non-profit group, Chronic Care International (CCI), began a diabetes and hypertension program with 2 clinics in poor, rural DR. CCI developed a model of quality improvement for care and self-management with its Dominican medical team, including doctors, nurses and community health workers. We present process and outcome data collected over 6 years utilizing electronic medical records. In addition to quality improvement analyses, we fit a random-effects linear model to the data to assess trends over time. By May 2017, subjects (N=1,031) were adults: mean age 60.1 years, 45% men, 74% with T2DM. Of those with diabetes (n=758), 76% had an HbA1c &amp;lt;9%, with 86% having had an HbA1c test done in the last 4 mos. Of 650 with hypertension, 64% had a BP &amp;lt; 140/90mmHg. In assessing trends over time, we found the modeled HbA1c trajectory for those with diabetes showed an average decline of 0.13 percentage points per year (95% CI 0.10-0.15) over 6 years. The modeled BMI trajectory for all subjects showed an average decline of 0.kg/m2 per year (95% CI 0.04-0.08) over 6 years. For those with a dx of hypertension, the modeled BP trajectories are biphasic, showing decreases over years 1 and 2, followed by increases. Systolic BP averaged a decline of 3.5mmHg (95% CI 3.0-4.0) per year, followed by an average increase of 1.7mmHg (95% CI 1.3-2.1) per year. Diastolic BP averaged a decline of 2.4mmHg (95% CI 2.1-2.7) per year, followed by an increase of 0.27mmHg (95% CI 0.03-0.5) per year. While decline trends in HbA1c and BMI are encouraging for this model of care in rural areas of this developing country, some challenges in managing BP remain, even with access to several antihypertensive medications. Program sustainability and access to healthy food and exercise are DR priorities. Disclosure E.A. Walker: None. H.J. Dethlefs: None. R.A. Dowd: None. C. Schechter: None. C. Filipi: None.

Zika Virus Knowledge, Health Education, and Contraceptive Use Among Rural Dominican Republic Communities [12I

INTRODUCTION: Amidst the Zika virus epidemic, a team from Des Moines University traveled to four rural communities surrounding Monte Cristi, Dominican Republic to provide health services. The team assessed Zika virus knowledge, common contraceptive methods, and current methods of disseminating vital health information over a period of four days. METHODS: Ninety men and women provided informed consent to participate in a 12-question, verbally administered survey. RESULTS: Most participants had heard of Zika virus and had received their information from charlas, a local term for informal health presentations. Few knew that Zika is present in their communities, can be sexually transmitted, and is incurable. The most commonly cited contraceptive method was condoms, and thirty percent of participants did not use contraception. One patient reported long-acting reversible contraceptive (LARC) usage. CONCLUSION: Significant Zika knowledge deficits were present within these communities and accurate knowledge varied. Through identification of specific knowledge gaps, communities can disseminate standardized, unambiguous, and realistic recommendations to prevent infection during similar epidemics. Additionally, the limited usage of LARCs appeared, anecdotally, to be due to lack of access, rather than lack of desire for LARCs. This is particularly concerning in an environment where pregnancy prevention is the primary recommendation to prevent fetal harm. Future research should analyze charlas to identify the most effective methods for disseminating critical information in a timely manner to similar populations. In the context of inevitable future epidemics, results may not only be applicable to Dominican communities, but to rural communities globally.

Using Mixed Methods to Describe a Spatially Dynamic Food Environment in Rural Dominican Republic

Using Mixed Methods to Describe a Spatially Dynamic Food Environment in Rural Dominican Republic

Affordable solar thermal water heating solution for rural Dominican Republic

Energy in rural Dominican Republic is often a limited and expensive commodity. Grid electricity, propane gas, and firewood are among the common energy sources in rural areas, however with limited accessibility and increasingly high cost. Heating water for personal bathing and showering is a low priority and unaffordable for most rural Dominicans. Consequently, people take showers infrequently, personal hygiene is compromised, and risk of illnesses, especially pneumonia, is increased. This work aims to develop a low-cost but effective solar thermal powered water heater with simple construction, low maintenance, and using locally available materials. Two different designs are evaluated, including batch and thermosiphon models. Several system parameters, such as insulation, greenhouse effect, reflective surface, mechanical stirring, and available surface area for heat absorption are varied, and system performance is characterized based on water temperature maximum and stability. The thermosiphon model is found to be most optimal, considering its performance, cost, ease of maintenance, manufacturability, and adaptability. The selected design is then implemented at several community and residential locations in El Cercado, Dominican Republic with performance results meeting and exceeding temperature rise target of at least 12 °C.

Ethnic difference and language ideologies in popular Dominican literature: the case of Haitianized speech

AbstractIn the vast amount of popular and folkloric literature which depicts everyday life in the rural Dominican Republic, Haitian characters are perpetually present. In particular, Juan Antonio Alix's (1833–1918)

Health status and behaviors among adults residing in rural Dominican Republic

The rapidly increasing burden of chronic diseases linked to adequacy of healthcare services and individual health behaviors is a key determinant of global public health. Given demographic aging and the accompanying health transition, chronic diseases in low and middle income communities of the Dominican Republic are likely to increase significantly. The objective of this article was to report on efforts in surveillance of health conditions and behaviors in underserved rural Dominican communities. A modified 30 item, language-sensitive health survey was randomly administered to 117 adult participants (18 years and older) during a health fair held at three rural villages from March to April 2009 in the rural San Cristobál region of the Dominican Republic. Descriptive analyses of select health conditions and behavior variables from all completed surveys were tabulated. Adult participant ages ranged from 18 to 79 years (mean ± standard deviation; 34.0 ± 2.1), height from 1.4 to 2.0 m (1.7 ± 0.1), weight from 41.8 to 100.0 kg (66.2 ± 1.7) and BMI from 15.2 to 46.2 (24.2 ± 0.7). Overall, 69.2% of the sample self-reported their general health status to be fair to poor. The top three chronic diseases included: high blood pressure (35.8%), diabetes (15.0%), and asthma (14.2%). In all, 33.4% reported current smoker status and 61.7% were classified as heavy alcohol drinkers. Considerable variation was found in the self-report of health conditions and behavioral characteristics among those individuals that attended the health fair. Documenting these important health indicators in the rural communities has the potential to inform the development of surveillance activities and prevention efforts for future health education interventions.

A garden‐based nutrition intervention in the rural Dominican Republic – impact on vitamin A rich food consumption

Garden‐based nutrition interventions focus on improving food security and food diversity through the creation and augmentation of homestead food production.ObjectivesThis study assesses the impact of a garden‐based nutrition intervention on the consumption of vitamin A rich foods in rural communities of the Dominican Republic.MethodsA garden‐based nutrition intervention was implemented by the Fundación Salud y Bienestar (NGO) in partnership with the authors. A validated “Vitamin A Food Frequency” questionnaire was conducted by convenience sampling of households containing a pregnant woman or a child under the age of five years in two control and two intervention communities. Interviews were conducted before the intervention (n=71) and two years after its initiation (n=48).ResultsPre‐ and post‐intervention analysis revealed an increase in average weekly intake of vitamin A‐rich foods in both intervention and control communities (p &lt; 0.001). There was a larger, but not statistically significant, increase in vitamin A food intake in the intervention communities compared to control communities.ConclusionsThese results indicate that garden‐based nutrition interventions may be a valuable means to enhance Vitamin A food intake in rural settings in developing countries. Support was provided by the Downs Fellowship/Yale University School of Medicine.

A diabetic hypertension treatment program for the underserved in rural Dominican Republic

Background: Worldwide, diabetes and hypertension are leading causes of preventable end-organ disease. The prevalence of these diseases in the Dominican Republic is high and the end stage complications common. A treatment program utilizing modern protocols often thought too complex for the rural poor was initiated. Methods: With local government permission, a pilot study utilized Dominican physicians and local healthcare advocates (cooperadores) to obtain medical histories and physical exams as well as to determine healthcare needs specifically for type 2 diabetes and hypertension. A glycosylated hemoglobin (A1c) was used to identify and stratify diabetes patients. Blood pressure parameters per established standards were used to identify patients with hypertension. As indicated, pharmacotherapy was initiated (see treatment protocols), multiple forms of education and awareness building utilized, and a protocol-driven follow-up program maintained under weekly review. Results: In fifteen months, 1405 patients were screened, 229 type 2 diabetes patients, 59 pre-diabetes patients, and 98 hypertension patients were identified and enrolled for education, treatment, and follow-up. Normalization of blood pressure in hypertensives at 6 month follow-up was 78% and reduction of A1c values to <7.0 was 79.8%. Conclusion: Utilizing a best practice approach per internationally agreed-upon parameters has been shown here to be not only relevant but capable of improving outcomes in a developing world setting. A model incorporating standard of care, education, and integration of local resources as established suggests that further study is warranted to evaluate the long-term benefits as well as secondary outcomes of this approach to local populations.

Effects of Free Trade on Women and Immigrants: CAFTA and the Rural Dominican Republic

Summary We construct a disaggregated rural economywide model with a focus on gender and immigration as well as on the allocation of time to wage work, household production activities, and housework (reproduction). We use this model to simulate the impacts of the Dominican Republic-Central American Free Trade Agreement (DR-CAFTA) on rural incomes and welfare in the Dominican Republic. We find that elimination of agricultural import tariffs hurts both agricultural and non-agricultural households, via adverse factor-market effects, but impacts vary substantially by workers’ gender and country of origin. Females and Haitian immigrants tend to fare better than Dominican males, and there are ramifications for both market and non-market activities.

Culture Care Meanings, Beliefs, and Practices in Rural Dominican Republic

This ethnonursing study explored the meanings, beliefs, and practices of care for rural Dominicans in the Dominican Republic. Leininger's culture care diversity and universality theory, ethnonursing, and four-phase analysis method guided the study. Interviews were conducted with 19 general and 10 key informants. Analysis of interviews revealed three main themes: (a) family presence is essential for meaningful care experiences and care practices, (b) respect and attention are central to the meaning of care and care practices, and (c) rural Dominicans value and use both generic (folk) and professional care practices. Implications and recommendations for nursing practice, education, and research are described.

Caribbean women: changes in the works

[First paragraph]The women of Azua: work and family in the rural Dominican Republic, by BARBARA FINLAY. New York: Praeger, 1989. xi + 190 pp. (Cloth US$ 35.00)The psychosocial development of Puerto Rican women, edited by CYNTHIA T. GARCIA COLL &amp; MARIA DE LOURDES MATTEI. New York: Praeger, 1989. xiii + 272 pp. (Cloth US$ 45.00)Women and the sexual division oflabour in the Caribbean, edited by KEITH HART. Mona, Jamaica: Consortium Graduate School of Social Sciences, UWI, 1989. 141 pp. (Paper n.p.)The three books under review work have a common theme: the impact of changing gender expectations on Caribbean women. The authors are mainly concerned with recent political and economie changes that might have contributed to either the improvement or deterioration of women's status in these societies. The questions raised by the contributors are strikingly similar: What has been the impact of dependent economie development on women's lives and has this resulted in increased labor participation (a problem explored for rural Dominican women as well as for Jamaican and Barbadian women) or in the migration to metropolitan centers, with its psychosocial consequences (an issue raised for Puerto Rican women living in the United States)? If patriarchal values (often referred to as traditional values) prevail in these societies, then what impact might wage work, migration, or improved education have on those values? Could it be the disintegration of the nuclear family with an increased proportion of female-headed households (Hart), higher rates of mental illness as a result of dysfunctional aceulturation (Garcia Coll and Mattei), or even an improvement of women's status within their families and communities (Finlay)?

The Women of Azua: Work and Family in the Rural Dominican Republic.

The Women of Azua: Work and Family in the Rural Dominican Republic.

The Women of Azua: Work and Family in the Rural Dominican Republic. By Barbara Finlay, New York Praeger, 1989, 143 pp. $35.00

The Women of Azua: Work and Family in the Rural Dominican Republic. By Barbara Finlay, New York Praeger, 1989, 143 pp. $35.00

The Women of Azua: Work and Family in the Rural Dominican Republic.

Preface Introduction Geographical and Historical Setting Procedures: Carrying out the Survey Background Characteristics of Respondents Land, Agriculture, and Employment: Resources for Survival Housing, Housing Tenancy, and Loan Taking Family, Marital Status, and Attitudes Marital Resource Sharing and Decision Making Division of Labor: Women's Work in Agriculture and in the Household Nutrition, Health, and Contraceptive Use Childbearing, Education of Children, Hopes for the Future The Workers Speak Individual Portraits of the Women of Rural Azua Conclusions Appendix A. Interviewer Instructions Appendix B. Questionnaire, English Translation Appendix C. Questionnaire, Spanish Version Index