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Article ; Online: Seroprevalencia de la enfermedad de Chagas en embarazadas del departamento de Cordillera antes y después de la implementación del control prenatal de Chagas en los periodos 1997 y 2011

Meza, Graciela

Memorias del Instituto de Investigaciones en Ciencias de la Salud, Vol 14, Iss 3, Pp 73-

2016 Volume 80

Abstract: La enfermedad de Chagas es causada por el parásito Trypanosoma cruzi, afecta aproximadamente a 10 millones de individuos se encuentra presente en casi toda América Central y del Sur. En Paraguay se estima que existen aproximadamente 150.000 personas ... ...

Abstract	La enfermedad de Chagas es causada por el parásito Trypanosoma cruzi, afecta aproximadamente a 10 millones de individuos se encuentra presente en casi toda América Central y del Sur. En Paraguay se estima que existen aproximadamente 150.000 personas infectadas, de las cuales 61.000 son mujeres en edad fértil y que estarían naciendo alrededor de 600 niños infectados por transmisión congénita por año. El departamento de Cordillera es una zona endémica de la Región Oriental del país, donde la seroprevalencia en mujeres embarazadas en la década de los noventa era alrededor del 12%. Este estudio descriptivo de corte transverso retrospectivo se planteó con el fin determinar la seroprevalencia de la enfermedad de Chagas en embarazadas del departamento de Cordillera que asistieron a su control prenatal en los años 1997 y 2011. Se realizó el análisis de la base de datos de embarazadas del departamento de Cordillera. Se analizaron los resultados de la serología para T. cruzi de 7.898 embarazadas en 5 laboratorios de diagnóstico correspondiente a 20 distritos del departamento de Cordillera. Se encontró que la prevalencia de infección con T. cruzi en embarazadas en éste departamento en el año 1997 fue del 15% y en el 2011 del 6%, lo que marca un descenso del 9%. La información obtenida contribuye al sistema de control prenatal de la enfermedad en la III Región Sanitaria del departamento de Cordillera, porque demuestra la efectividad del sistema de diagnóstico prenatal y los métodos de prevención implementados por el Ministerio de Salud Pública y Bienestar Social
Keywords	enfermedad de chagas ; seroprevalencia ; embarazadas ; Medicine (General) ; R5-920
Language	Spanish
Publishing date	2016-12-01T00:00:00Z
Publisher	Universidad Nacional de Asunción
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Hear my voice: understanding how community health workers in the Peruvian Amazon expanded their roles to mitigate the impact of the COVID-19 pandemic through community-based participatory research.

Samsamshariat, Tina / Madhivanan, Purnima / Reyes Fernández Prada, Alexandra / Moya, Eva M / Meza, Graciela / Reinders, Stefan / Blas, Magaly M

BMJ global health

2023 Volume 8, Issue 10

Abstract: Introduction: The COVID-19 pandemic led to the collapse of the Peruvian health system, disrupting healthcare access for indigenous communities in the Amazon. Our study analysed how community health workers (CHWs) from indigenous communities in the ... ...

Abstract	Introduction: The COVID-19 pandemic led to the collapse of the Peruvian health system, disrupting healthcare access for indigenous communities in the Amazon. Our study analysed how community health workers (CHWs) from indigenous communities in the Peruvian Amazon expanded their roles to mitigate the effects of the COVID-19 pandemic. Methods: Fourteen CHWs from Loreto, Peru, participated in a community-based participatory research project using Photovoice, a technique encouraging vulnerable groups to take photos and develop stories illustrating their lived experiences. Participants were recruited from Mamás del Río, a local university-based programme, through purposive sampling. CHWs were asked to photograph how the pandemic affected their lives and work. Participants met four times over 5 months to share photos and develop action items. Data were organised into key themes using thematic analysis. CHWs shared photo galleries with policy-makers in Loreto and Lima. Results: CHWs produced 36 photos with 33 texts highlighting their roles during COVID-19. Three core themes emerged: the (1) collapse of health infrastructure, (2) use of medicinal plants versus pharmaceuticals and (3) community adaptations and struggles. The leadership of CHWs emerged as a cross-cutting theme as CHWs supported COVID-19 efforts without government training or resources. CHWs asked policy-makers for formal integration into the health system, standardisation of training and management of community pharmacies. Conclusion: CHWs demonstrated their leadership and expanded their roles during the pandemic with little to no training from the government. Global investment in robust CHW programmes can fortify healthcare delivery.
MeSH term(s)	Humans ; COVID-19 ; Peru/epidemiology ; Pandemics ; Community-Based Participatory Research ; Community Health Workers ; Qualitative Research ; Health Services Accessibility
Language	English
Publishing date	2023-10-13
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2023-012727
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Hear my Voice: Understanding how community health workers in the Peruvian Amazon expanded their roles to mitigate the impact of the COVID-19 pandemic through Community-Based Participatory Action Research

Samsamshariat, Tina / Madhivanan, Purnima / Reyes, Alexandra / Moya, Eva / Meza, Graciela / Reinders, Stefan / Blas, Magaly

medRxiv

Abstract: Introduction: The COVID-19 pandemic led to the collapse of the Peruvian health system, which disrupted healthcare access for indigenous communities in the Amazon. We aimed to understand how the COVID-19 pandemic transformed the responsibilities of ... ...

Abstract	Introduction: The COVID-19 pandemic led to the collapse of the Peruvian health system, which disrupted healthcare access for indigenous communities in the Amazon. We aimed to understand how the COVID-19 pandemic transformed the responsibilities of community health workers (CHWs) from indigenous communities in the Peruvian Amazon so policymakers can support indigenous health efforts. Methods: Fourteen CHWs from Loreto, Peru participated in a community-based Participatory Action Research (CBPR) project using Photovoice, a technique that encourages vulnerable groups to take photos and develop stories illustrating their lived experiences. Participants were recruited from Mamás del Río, a local university-based program, through purposive sampling. CHWs were trained in Photovoice and asked to photograph how the pandemic affected their lives and work. Participants met four times over five months to share photos and develop action items. Data were organized into key themes using a general inductive method. Final photos and action items were shared with policymakers during galleries in Iquitos and Lima. Results: CHWs took a total of 36 photos with 33 accompanying texts highlighting their roles during the pandemic. Four core themes emerged: (1) the collapse of social infrastructure, (2) the use of medicinal plants versus pharmaceuticals, (3) the community adaptations and struggles, and (4) the importance of CHWs. CHWs expanded their responsibilities or leveraged their leadership across these themes to support COVID-19 patients, vaccination, and mandates without training or resources from the government. CHWs asked policymakers for formal integration into the health system, standardization of CHW training, and better management of community pharmacies. Conclusion: CHWs, who work on a voluntary basis, took on additional roles during the pandemic with little to no training from the government. CHWs demonstrated how their roles could be better supported by the government to ameliorate future health catastrophes in the Peruvian Amazon.
Keywords	covid19
Language	English
Publishing date	2023-05-02
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2023.05.01.23289307
Database	COVID19

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Article ; Online: Modalities of GABA and glutamate neurotransmission in the vertebrate inner ear vestibule.

Meza, Graciela

Neurochemical research

2008 Volume 33, Issue 8, Page(s) 1634–1642

Abstract: GABA and glutamate have been postulated as afferent neurotransmitters at the sensory periphery inner ear vestibule in vertebrates. GABA has fulfilled the main criteria to act as afferent neurotransmitter but may also be a putative efferent ... ...

Abstract	GABA and glutamate have been postulated as afferent neurotransmitters at the sensory periphery inner ear vestibule in vertebrates. GABA has fulfilled the main criteria to act as afferent neurotransmitter but may also be a putative efferent neurotransmitter, mainly due to cellular localization of its synthesizing enzyme glutamate decarboxylase derived from biochemical, immunocytochemical, in situ hybridization and molecular biological techniques, whereas glutamate afferent neurotransmission role is supported mainly by pharmacological evidences. GABA and Glu could also act as afferent co-neurotransmitters based upon immunocytochemical techniques. This multiplicity was not considered earlier and postulates a peripheral modulation of afferent information being sent to higher vestibular centers. In order to make a definitive cellular assignation to these putative neurotransmitters it is necessary to have evidences derived from immunocytochemical and pharmacological experiments in which both substances are tested simultaneously.
MeSH term(s)	Animals ; Glutamate Decarboxylase/metabolism ; Glutamic Acid/metabolism ; Molecular Mimicry ; Synaptic Transmission/physiology ; Vestibule, Labyrinth/anatomy & histology ; Vestibule, Labyrinth/physiology ; gamma-Aminobutyric Acid/metabolism
Chemical Substances	Glutamic Acid (3KX376GY7L) ; gamma-Aminobutyric Acid (56-12-2) ; Glutamate Decarboxylase (EC 4.1.1.15)
Language	English
Publishing date	2008-05-31
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	199335-5
ISSN	1573-6903 ; 0364-3190
ISSN (online)	1573-6903
ISSN	0364-3190
DOI	10.1007/s11064-008-9734-5
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Nurses' and teachers' perceived barriers and facilitators to the uptake of the Human Papilloma Virus (HPV) vaccination program in Iquitos, Peru: A qualitative study.

Clavé Llavall, Anna / de Wildt, Gilles / Meza, Graciela / Tattsbridge, Jasmine / Jones, Laura

PloS one

2021 Volume 16, Issue 7, Page(s) e0255218

Abstract: Globally, over 300,000 women die of cervical cancer annually. Given that human papillomavirus vaccines are highly effective in the primary prevention of cervical cancer, it is important to explore the barriers and facilitators to vaccination uptake in ... ...

Abstract	Globally, over 300,000 women die of cervical cancer annually. Given that human papillomavirus vaccines are highly effective in the primary prevention of cervical cancer, it is important to explore the barriers and facilitators to vaccination uptake in areas where the burden of disease remains high. This study, informed by the socio-ecological model, aimed to qualitatively explore vaccination uptake via in-depth interviews with eleven nurses and ten teachers involved in vaccine delivery in Iquitos, Peru. The results highlighted that vaccine uptake was influenced by multiple factors including individuals' knowledge and attitudes, community beliefs, geography, and policy level variables. Findings suggested that professionals were informed and supportive of the HPV vaccination program but perceived that parents were uninformed about the vaccine. There is a need for community education programs, for a revision of the process of obtaining parental consent, for improved communication between professionals and for involvement of grassroots staff in policy making.
MeSH term(s)	Female ; Health Knowledge, Attitudes, Practice ; Humans ; Papillomavirus Infections ; Papillomavirus Vaccines ; Patient Acceptance of Health Care ; Peru ; Vaccination
Chemical Substances	Papillomavirus Vaccines
Language	English
Publishing date	2021-07-29
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0255218
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: How has COVID-19 impacted the civil registration and vital statistics system in Loreto, Perú? Evidence using process mapping and qualitative analysis.

Silva-Valencia, Javier / Adair, Tim / Hart, John / Meza, Graciela / Vargas Herrera, Javier

BMJ open

2021 Volume 11, Issue 11, Page(s) e055024

Abstract: Objectives: Accurate civil registration and vital statistics (CRVS) systems are the primary data source to measure the impact of the COVID-19 pandemic on mortality. This study assesses how the pandemic impacted CRVS system processes in Loreto region of ... ...

Abstract	Objectives: Accurate civil registration and vital statistics (CRVS) systems are the primary data source to measure the impact of the COVID-19 pandemic on mortality. This study assesses how the pandemic impacted CRVS system processes in Loreto region of Peru, one of the worst affected countries globally. Design: Qualitative study. Setting: Loreto, a remote region, which had the highest reported mortality rate in Peru during the pandemic. Participants: Semistructured individual interviews and documentary analysis were conducted between September 2020 and May 2021 with 28 key informants from eight institutions involved in death certification. Key informants were identified using a purposive sampling strategy commencing at the Health Directorate of Loreto, and the snowball method was used where a participant suggested another organisation or person. Information from key informants was used to compare business process maps of the CRVS system before and during the pandemic. Results: During early May 2020, there were seven times more registered deaths than in earlier years, but key informants believed this underestimated mortality by 20%-30%. During the pandemic, families had to interact with more institutions during the death certification process. Several issues disrupted death certification processes, including the burden of increased deaths, the Environmental Health Directorate often removing a body without the family's express agreement, the creation of COVID-19 cemeteries where no death certificate was needed for burial, greater participation of funeral homes that often used outdated paper forms, and closure of civil registry offices. There was increased use of the online National Death System (SINADEF) but many users had problems with access. Conclusions: The pandemic substantially disrupted CRVS processes in Loreto, making death certification more difficult, placing greater burden on the family and leading to more participation from unregulated organisations such as funeral homes or cemeteries. These disruptions were impacted by limitations of the CRVS system's processes before the pandemic.
MeSH term(s)	COVID-19 ; Humans ; Pandemics ; Peru/epidemiology ; SARS-CoV-2 ; Vital Statistics
Language	English
Publishing date	2021-11-19
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-055024
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Patients' perspectives on factors facilitating adherence to tuberculosis treatment in Iquitos, Peru: a qualitative study.

Anthoney, James / De Wildt, Gilles / Meza, Graciela / Skelton, John / Newell, Ian

BMC health services research

2021 Volume 21, Issue 1, Page(s) 345

Abstract: Background: Tuberculosis is a major global health problem and one of the greatest barriers to its control is poor adherence to treatment. Peru has one of the highest burdens of TB in South America, with an incidence rate of 123 per 100,000 populations. ... ...

Abstract	Background: Tuberculosis is a major global health problem and one of the greatest barriers to its control is poor adherence to treatment. Peru has one of the highest burdens of TB in South America, with an incidence rate of 123 per 100,000 populations. There is currently a lack of evidence in South America about factors that facilitate adherence to treatment, with most previous research focusing on factors that negatively influence adherence to TB treatment. Setting: This study was conducted in Iquitos, the capital city of the Loreto region, north-eastern Peru. Loreto has a high incidence of tuberculosis, estimated at 99 per 100,000 population, and a high poverty rate. Methods: Twenty face-to-face, semi-structured interviews were conducted at two healthcare centres. Data collected from the interviews was analysed using thematic content analysis. Results: Three main themes emerged from the data set. Personal Qualities, such as responsibility and determination, were perceived as important factors facilitating adherence. Participants described their Trust in Healthcare Providers positively, particularly focusing on their trust in clinical staff, although knowledge of tuberculosis and its treatment was limited. Social Support, from a variety of sources, was also seen as a driving factor for continued adherence. Conclusions: The results suggest that more emphasis should be placed on educating tuberculosis patients about their disease and its treatment. Additionally, consideration should be given to improving the social support available to patients, for example with tuberculosis support groups involving 'expert' tuberculosis patients.
MeSH term(s)	Health Personnel ; Humans ; Peru/epidemiology ; Qualitative Research ; South America ; Tuberculosis/drug therapy ; Tuberculosis/epidemiology
Language	English
Publishing date	2021-04-14
Publishing country	England
Document type	Journal Article
ISSN	1472-6963
ISSN (online)	1472-6963
DOI	10.1186/s12913-021-06329-z
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Healthcare professionals' perceptions of childhood obesity in Iquitos, Peru: a qualitative study.

Lai, Jo F / Clarke, Joanne / de Wildt, Gilles / Meza, Graciela / Addo, Miriam A / Gardiner, Esme / Khanna, Divya

BMC health services research

2022 Volume 22, Issue 1, Page(s) 175

Abstract: Background: Childhood obesity is an urgent worldwide concern associated with increased morbidity in adulthood. Healthcare professionals (HCPs) are well placed to influence childhood obesity trends and implement interventions. English-language studies ... ...

Abstract	Background: Childhood obesity is an urgent worldwide concern associated with increased morbidity in adulthood. Healthcare professionals (HCPs) are well placed to influence childhood obesity trends and implement interventions. English-language studies regarding HCPs' perceptions of childhood obesity are limited to high-income countries. Peru is an upper-middle-income country with regional disparities in childhood obesity prevalence. This qualitative study aims to explore HCPs' perceptions of childhood obesity in Iquitos, Peru, where prevalence is relatively low. Methods: Twenty-one HCPs with child healthcare experience were purposively recruited from two primary healthcare centres. Semi-structured, individual interviews were conducted with a translator and audio recorded. Transcribed data were analysed using thematic analysis. Results: Eight themes were identified and divided into four categories: (1) HCPs' perceptions and attitudes towards childhood obesity (level of concern regarding childhood obesity, perceived consequences of childhood obesity); (2) Factors which HCPs perceive to be important in the development of childhood obesity (parental factors, contextual factors); (3) HCPs' perceptions of their role in childhood obesity prevention and management (educating parents about childhood obesity, regular monitoring of child growth); and (4) Barriers and facilitators in childhood obesity prevention and management (in healthcare, in schools). Conclusions: HCPs had a low level of concern regarding childhood obesity in Iquitos and prioritised undernutrition. Parental factors were perceived to be the most influential in the development of childhood obesity. HCPs perceived themselves to have minimal influence due to prevailing positive views of excess weight and difficulties engaging parents. Educating parents about childhood obesity was felt to be essential to prevention and management although regular monitoring of child growth and home healthcare visits were viewed as useful additional measures. This study can help to inform the development of targeted public health strategies which are sensitive to local contexts and could prevent the upward childhood obesity trends evident elsewhere in Peru.
MeSH term(s)	Adult ; Child ; Delivery of Health Care ; Health Personnel ; Humans ; Pediatric Obesity/epidemiology ; Pediatric Obesity/prevention & control ; Peru/epidemiology ; Qualitative Research
Language	English
Publishing date	2022-02-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-07519-z
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: A qualitative exploration of women's experiences of antenatal and intrapartum care: The need for a woman-centred approach in the Peruvian Amazon.

Marsland, Harriet / Meza, Graciela / de Wildt, Gilles / Jones, Laura

PloS one

2019 Volume 14, Issue 1, Page(s) e0209736

Abstract: Objective: To explore women's experiences and perceptions of antenatal and intrapartum care in the Peruvian Amazon, including their perceived motivators, enablers and barriers to accessing care.: Design: Interpretive descriptive qualitative study ... ...

Abstract	Objective: To explore women's experiences and perceptions of antenatal and intrapartum care in the Peruvian Amazon, including their perceived motivators, enablers and barriers to accessing care. Design: Interpretive descriptive qualitative study using semi-structured face-to-face interviews. Setting: Primary healthcare centre, Iquitos, Peru. Participants: Women (n = 20) attending the healthcare centre who had given birth in the past 6 months. Measures: Interviews were conducted using a female interpreter, transcribed clean verbatim and thematically analysed. Findings: Four core themes relating to antenatal care were interpreted. (1) Perceived knowledge of antenatal care and its importance: women generally understood the importance of care, mainly for their baby's health rather than their own. (2) Appointments and information received: women wanted more appointments to facilitate greater depth of information relating to their pregnancy. (3) Interaction with healthcare practitioners: women felt they received inadequate attention, care lacked continuity and they were often uncomfortable with male practitioners. (4) Perceived motivators, barriers and enablers to accessing antenatal care: Knowledge of the importance of care acted as the main motivator. Few direct barriers were identified, other than employment. Free care and ease of access enabled attendance. Two core themes were interpreted relating to intrapartum care. (1) Expectations and preferences for labour and delivery: the need for a safe environment for childbirth was acknowledged. (2) Actual experiences of labour and delivery: for most women labour and delivery experiences were not as they had expected. Women objected less to male professionals during labour than antenatal care. Conclusions and implications for practice: Women reported negative experiences of both antenatal and intrapartum care. There is clearly a need for a more woman-centred approach to care and service provision. Ideally, this would involve employing more staff, acknowledging the implications on resources, improving attitudes towards women, facilitating continuity of care, and allowing patient choice to give women greater involvement.
MeSH term(s)	Adult ; Continuity of Patient Care ; Delivery, Obstetric ; Female ; Humans ; Maternal Health ; Peru ; Pregnancy ; Prenatal Care ; Professional-Patient Relations ; Qualitative Research ; Women's Health ; Young Adult
Language	English
Publishing date	2019-01-07
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0209736
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The timing and quality of antenatal care received by women attending a primary care centre in Iquitos, Peru: A facility exit survey.

Wynne, Sara Jabeen / Duarte, Rui / de Wildt, Gilles / Meza, Graciela / Merriel, Abi

PloS one

2020 Volume 15, Issue 3, Page(s) e0229852

Abstract: Background: Maternal mortality is high in Loreto, Peru, but can be reduced by high quality antenatal care. Indicators for the quality of antenatal care received include the timing (with respect to gestational age) and number of antenatal appointments ... ...

Abstract	Background: Maternal mortality is high in Loreto, Peru, but can be reduced by high quality antenatal care. Indicators for the quality of antenatal care received include the timing (with respect to gestational age) and number of antenatal appointments attended, the delivery of antenatal services and health information, and women's perceptions about their care. This study investigated these indicators amongst women receiving antenatal care in predominantly the San Juan Bautista district of Iquitos, Loreto. This was to identify areas for improvement through comparison with antenatal guidelines published by the Ministry of Health, Peru, and the World Health Organization. Methods: A total of 134 women were recruited at the Centro de Salud, San Juan-a primary care centre in Iquitos. Information about the delivery of antenatal services and the number of and gestational ages at appointments attended was collected from 121/134 women's hand-held antenatal cards. The delivery of health information and women's perceptions about their antenatal care were investigated through questionnaires (133/134 completed). Descriptive statistics, such as frequencies and valid percentages, were determined. Results: Hand-held antenatal cards revealed that 52.9% of participants began their antenatal care in the first trimester. Compared to national guidelines, 42.1% attended appointments at recommended gestational ages and no women received all recommended antenatal services. Most women received information about identifying complications in pregnancy and health and lifestyle topics. Over 85% of women reported satisfaction with their antenatal care. Conclusions: Timely antenatal attendance and delivery of services should be encouraged to meet national and global standards. Although all services were not delivered in a combined manner according to national guidelines, individual services were mostly delivered to a high standard and therefore a high proportion of women were satisfied with their antenatal care.
MeSH term(s)	Adult ; Cross-Sectional Studies/statistics & numerical data ; Female ; Humans ; Patient Acceptance of Health Care/statistics & numerical data ; Patient Satisfaction/statistics & numerical data ; Peru ; Pregnancy ; Prenatal Care/statistics & numerical data ; Primary Health Care/statistics & numerical data ; Quality of Health Care/statistics & numerical data ; Young Adult
Language	English
Publishing date	2020-03-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0229852
Database	MEDical Literature Analysis and Retrieval System OnLINE

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