João Luiz Pena

A comparative study of the TF-Test®, Kato-Katz, Hoffman-Pons-Janer, Willis and Baermann-Moraes coprologic methods for the detection of human parasitosis.

This study compares the diagnostic accuracy of the TF-Test(®) (TFT) for human parasitosis with results obtained using the traditional Kato-Katz (KK), Hoffman-Pons-Janer (HPJ), Willis and Baermann-Moraes (BM) techniques. Overall, four stool samples were taken from each individual; three alternate-day TFT stool samples and another sample that was collected in a universal container. Stool samples were taken from 331 inhabitants of the community of Quilombola Santa Cruz. The gold standard (GS) for protozoa detection was defined as the combined results for TFT, HPJ and Willis coproscopic techniques; for helminth detection, GS was defined as the combined results for all five coproscopic techniques (TFT, KK, HPJ, Willis and BM). The positivity rate of each method was compared using the McNemar test. While the TFT exhibited similar positivity rates to the GS for Entamoeba histolytica/dispar (82.4%) and Giardia duodenalis (90%), HPJ and Willis techniques exhibited significantly lower positivity rates for these protozoa. All tests exhibited significantly lower positivity rates compared with GS for the diagnosis of helminths. The KK technique had the highest positivity rate for diagnosing Schistosoma mansoni (74.6%), while the TFT had the highest positivity rates for Ascaris lumbricoides (58.1%) and hookworm (75%); HPJ technique had the highest positivity rate for Strongyloides stercoralis (50%). Although a combination of tests is the most accurate method for the diagnosis of enteral parasites, the TFT reliably estimates the prevalence of protozoa and selected helminths, such as A. lumbricoides and hookworm. Further studies are needed to evaluate the detection accuracy of the TFT in samples with varying numbers of parasites.

Prevalência de parasitos intestinais na comunidade indígena Maxakali, Minas Gerais, Brasil, 2009

A prevalence survey using the TF-Test technique to identify intestinal parasites was conducted in the Maxakali indigenous villages in Minas Gerais State, Brazil. Stool samples were collected on three alternating days, in separate tubes, containing 10% formalin, and unified in a laboratory by double filtering centrifugation. Samples of sediment aliquot were prepared in triplicate and examined by microscope (10x and 40x) for eggs, cysts, and larvae. Prevalence of parasites (89.5%) and polyparasitism (46%) were similar by sex and age, but varied by village. Prevalent species were: Entamoeba histolytica/Entamoeba dispar (48.9%), Giardia duodenalis (32%), Entamoeba coli (40.8%), Endolimax nana (10.3%), hookworms (37.9%), Schistosoma mansoni (23.7%), Hymenolepis nana (18.6%), Strongyloides stercoralis (5.4%), Ascaris lumbricoides (4.9%), and Trichuris trichiura (0.5%). The Maxakali population lives in socially vulnerable conditions, and government agencies need to introduce measures to improve sanitation infrastructure and health education.

Reducing occurrence of Giardia duodenalis in children living in semiarid regions: impact of a large scale rainwater harvesting initiative.

Background In Brazil, about two million people living in rural semiarid regions were benefited with the construction of rainwater cement cisterns, as an initiative from the program “One Million Cisterns” (P1MC). Nevertheless, few epidemiological studies have been conducted to assess health risks or protection effects associated with consumption of this water source. The aim of this study was to evaluate whether access to rainwater harvesting cisterns is associated with the decrease in the occurrence of Giardia duodenalis infections in children, compared to other children living in households supplied by other water sources. Methodology/Principal Findings A quasi-experimental study with two concurrent cohorts was developed in two rural municipalities of the semiarid region of Brazil. A sample of 664 children, aged between 4 months and 5 years old, was followed up, of which 332 had access to rainwater cisterns (cistern group) and 332 did not, having water supplied from alternative sources (comparison group). In a period of approximately one year (2010) intestinal parasites were investigated in feces three times. The prevalence of G. duodenalis in children from the cistern group ranged from 4.8 to 10.5%, while the prevalence in the comparison group ranged from 7.6 to 16.7%. Multivariate analysis (GEE) showed a higher risk of G. duodenalis infection in children who did not have access to rainwater cisterns, when compared to children who did (OR 1.72; 95% CI 1.14–2.59). The other variables associated with G. duodenalis infection were: number of rooms per house (OR 0.89; 95% CI 0.80–0.99); family income (OR0.48; 95% CI 0.26–0.88); birth order (OR 1.72; 95% CI 1.17–2.51); preterm children (OR 1.70; 95% CI 1.19–2.43); and improper hand hygiene prior to food preparation (OR 4.78; 95% CI 1.95–11.76). Conclusions/Significance Ownership of a rainwater cistern is associated with a lower prevalence of G. duodenalis infection in children after adjustment for environmental and family-related factors. Nevertheless, the study suggests the necessity to complement physical interventions with actions related to personal and domestic hygiene to enable further reductions in parasite infections affecting mainly the underprivileged populations.

Prevalence of intestinal parasites in the Maxakali indigenous community in Minas Gerais, Brazil, 2009

O objetivo deste estudo foi determinar a prevalencia de parasitos intestinais na etnia Maxakali em Minas Gerais, Brasil. Os exames parasitologico das fezes foram realizados atraves da tecnica TF-Test, sendo as amostras fecais coletadas em tres dias alternados, em tubos independentes, contendo formol a 10%, unificados para dupla filtragem por centrifugacao. Triplicatas de uma aliquota do sedimento foram examinadas em microscopio (10x e 40x) para identificacao de ovos, cistos e larvas. A prevalencia de parasitos (89,5%) e do poliparasitismo (46%) foi semelhante quanto ao sexo e idade, e variou entre as aldeias. As especies prevalentes foram: Entamoeba histolytica/Entamoeba dispar (48,9%), Giardia duodenalis (32%), Entamoeba coli (40,8%), Endolimax nana (10,3%), ancilostomideos (37,9%), Schistosoma mansoni (23,7%), Hymenolepis nana (18,6%), Strongyloides stercoralis (5,4%), Ascaris lumbricoides (4,9%) e Trichuris trichiura (0,5%). Os Maxakali vivem em condicoes de vulnerabilidade social, e medidas de infraestrutura e de educacao em saude necessitam ser implementadas pelas instituicoes governamentais.A prevalence survey using the TF-Test technique to identify intestinal parasites was conducted in the Maxakali indigenous villages in Minas Gerais State, Brazil. Stool samples were collected on three alternating days, in separate tubes, containing 10% formalin, and unified in a laboratory by double filtering centrifugation. Samples of sediment aliquot were prepared in triplicate and examined by microscope (10x and 40x) for eggs, cysts, and larvae. Prevalence of parasites (89.5%) and polyparasitism (46%) were similar by sex and age, but varied by village. Prevalent species were: Entamoeba histolytica/Entamoeba dispar (48.9%), Giardia duodenalis (32%), Entamoeba coli (40.8%), Endolimax nana (10.3%), hookworms (37.9%), Schistosoma mansoni (23.7%), Hymenolepis nana (18.6%), Strongyloides stercoralis (5.4%), Ascaris lumbricoides (4.9%), and Trichuris trichiura (0.5%). The Maxakali population lives in socially vulnerable conditions, and government agencies need to introduce measures to improve sanitation infrastructure and health education.

Prevalência de parasitoses intestinais e estado nutricional, segundo sexo e idade, entre a população indígena Caxixó, Minas Gerais, Brasil

Diversos levantamentos realizados no Brasil têm apontado a existência de aproximadamente 200 povos indígenas no país, que falam cerca de 180 línguas (ORELLANA; BASTA; SANTOS; COIMBRA, 2007; PAGLIARO; AZEVEDO; SANTOS, 2005). Esses povos estão distribuídos por todo o território nacional e se dividem em várias etnias, com características sociais, culturais e econômicas distintas (ORELLANA; BASTA; SANTOS; COIMBRA, 2007). O

Tempo de aleitamento materno entre indígenas Xakriabá aldeados em Minas Gerais, Sudeste do Brasil

OBJECTIVE: To estimate the median duration of breastfeeding in the Xakriaba Indigenous lands and identify the factors related to breastfeeding duration among these people. METHODS: A cross-sectional study was conducted, and data regarding health, breastfeeding, and socio-demographic characteristics of 342 mothers/children living in this Indigenous Land in Minas Gerais in 2007 were collected using a questionnaire. Descriptive data of 317 children who were breastfed for at least one day were obtained, but in order to achieve this study objective, only the questionnaires that were fully completed and referred to children who were breastfed for at least one day were analyzed, i.e., 82.2% (287 children) of the total population of indigenous children under 3 years old (349). Data were analyzed using the Kaplan Meier method and the Cox regression model. RESULTS: The majority of children were male (52.0%), 53.6% were the 1st, 2nd, or 3rd born child, and 94.6% were breastfed as the first form of nutrition. The median duration of exclusive breastfeeding and non-exclusive breastfeeding was 11.73 months and 7.27 days, respectively; the boys and the 4th or further children were weaned earlier. CONCLUSION: In the Xakriaba Indigenous Land, the median duration of exclusive breastfeeding is short and half of the children were weaned at around 12 months of age, and therefore they could no longer reap the nutritional, immunological and functional benefits provided by breast milk. Gender and birth order were associated with the duration of breastfeeding, but further studies are needed to better understand the sociocultural factors related to the duration of breastfeeding in this Indigenous Land.

Nutritional profile of the Xukuru-Kariri indigenous people in the state of Minas Gerais in accordance with different anthropometric and body composition indicators

The scope of this study was to evaluate the nutritional profile of indigenous Xukuru-Kariri villagers in the state of Minas Gerais between seven and seventy-eight years of age in accordance with the different anthropometric and body composition indicator. The measurements were: weight, height, waist circumference (WC) and body fat percentage (BF%). The sensitivity and specificity of anthropometric indices were calculated with a confidence interval of 95% and positive predictive value (PPV) and negative predictive value (NPV). A total of 58 individuals was evaluated, of which 56.9% (n =33) were male and 43.1% (n =25) were female. Specificity was greater than sensitivity in all indices. It was seen that 29% of individuals were classified as having excess body fat as assessed by BMI and hand-to-hand bioimpedance and 50% of subjects had high body fat in relation to BMI and WC. Studies need to be conducted with different ethnic groups in order to construct indicators for specific nutritional guidance of indigenous health services.The scope of this study was to evaluate the nutritional profile of indigenous Xukuru-Kariri villagers in the state of Minas Gerais between seven and seventy-eight years of age in accordance with the different anthropometric and body composition indicator. The measurements were: weight, height, waist circumference (WC) and body fat percentage (BF%). The sensitivity and specificity of anthropometric indices were calculated with a confidence interval of 95% and positive predictive value (PPV) and negative predictive value (NPV). A total of 58 individuals was evaluated, of which 56.9% (n =33) were male and 43.1% (n =25) were female. Specificity was greater than sensitivity in all indices. It was seen that 29% of individuals were classified as having excess body fat as assessed by BMI and hand-to-hand bioimpedance and 50% of subjects had high body fat in relation to BMI and WC. Studies need to be conducted with different ethnic groups in order to construct indicators for specific nutritional guidance of indigenous health services.

Infrastructure is a necessary but insufficient condition to eliminate inequalities in access to water: Research of a rural community intervention in Northeast Brazil

Given the importance of reducing diverse forms of inequality in access to water, highlighted both in the framework of the Human Right to Water (HRW) and in the Sustainable Development Goals (SDG), this work assesses conditions of access to water and related inequalities before and after the construction of a Water Supply System (WSS) in a rural community of Brazils semi-arid region. A quasi-experimental study was performed to assess the conditions of access to water for study and control groups (amounting to 380 households). The methodology encompassed two phases, one prior and another subsequent to the construction of a WSS in the study community. The analytical framework of the HRW was applied, specifically the normative content regarding quality, accessibility and availability. The case studys findings help to evidence the limitations and challenges of merely infrastructure-related measures to improve access to water. The construction of a new WSS in the studied community was an improvement as it provided water of good quality to the beneficiary households, which entailed a decreased or even a no-longer-existing need to collect water for children and adolescents. However, certain problems persisted, such as the continued practice of collecting water and the use, by certain families, of water that was fecally contaminated. In a different perspective, the WSS made it possible to increase the per capita volume of water consumed by families and to reduce inequalities associated with this aspect. Meanwhile, the research reveals the possible limits of the WSS in ensuring that higher volumes of water will be consumed per capita, especially among households without intra-household water distribution infrastructure.

Aranãs do médio Jequitinhonha: aspectos socioeconômicos, demográficos e sanitários de uma população indígena desaldeada

Resumo A deficiencia de dados para subsidiar a analise das condicoes epidemiologicas e ambientais em que vivem os povos indigenas no Brasil constitui desafio para a elaboracao de politicas publicas especificas. O deficit informacional e ainda maior para os grupos “desaldeados”. Diante desse cenario, julgou-se relevante caracterizar uma populacao indigena desaldeada, privilegiando as dimensoes demografica, socioeconomica e sanitaria. Buscou-se identificar diferencas internas ao grupo e analisar os dados levantados para essa populacao comparando-os aos de outras etnias. Informacoes foram obtidas a partir da realizacao de inquerito domiciliar. Os resultados evidenciaram semelhancas com aqueles revelados pelo Censo 2010 para os indigenas brasileiros, sobretudo para os domiciliados fora das terras indigenas. Foram identificadas assimetrias dentro do grupo, principalmente de ordem sanitaria, que sugeriram relacao com a localizacao do domicilio. Aponta-se para a necessidade de intervencoes prioritarias voltadas para os Arana residentes no meio rural, recaindo na antiga discussao sobre as disparidades urbano-rurais, tambem aplicada as populacoes nao indigenas. Em adicao, sugere-se que o IBGE precisa aprimorar a investigacao do contingente populacional indigena desaldeado.

Subsidizing the sustainability of rural water supply: the experience of the Brazilian rural rainwater-harvesting programme

This article addresses the tension between subsidies and the sustainability of rural water supply systems based on research carried out in Minas Gerais, Brazil, on the Brazilian rainwater harvesting Programme for One Million Rural Cisterns (P1MC). The fieldwork included a survey of 623 beneficiary households and 47 in-depth interviews, as well as a workshop with P1MC managers. It is concluded that heavy government subsidies for the construction of the cisterns resulted in some alienation of users. It is highlighted that in the cases studied, strong government participation is critical to expanding access to water.