Indigenous perceptions and quality of care of family planning services in Haiti. (1/352)

This paper presents a method for evaluating and monitoring the quality of care of family planning services. The method was implemented in Haiti by International Planned Parenthood Federation Western Hemisphere Region (IPPF/WHR), the managerial agency for the Private Sector Family Planning Project (PSFPP), which is sponsored by the USAID Mission. The process consists of direct observations of family planning services and clinic conditions by trained Haitian housewives playing the role of 'mystery clients', who visit clinics on a random basis without prior notice. Observations conducted by mystery clients during one year, from April 1990 to April 1991, are presented and illustrate the use of the method. In addition, measurements for rating the acceptability of the services were developed, providing a quantitative assessment of the services based on mystery clients' terms. Statistical results demonstrate that simulated clients ranked some criteria of acceptability higher than others. These criteria are: the interaction provider/client, information adequacy, and competence of the promoter. Likewise, simulated clients' direct observations of the services permitted the identification of deficiencies regarding the quality of care such as the paternalistic attitudes of the medical staff; the lack of competence of promoters; and the lack of informed choice. Based on its reliability since its implementation in 1990 the method has proven to be a useful tool in programme design and monitoring.  (+info)

Human immunodeficiency virus infection in Haiti. (2/352)

This article reviews human immunodeficiency virus (HIV) infection in Haiti. The evolution of the epidemic in Haiti, its spread from urban to rural areas, its varied clinical manifestations, and the attitudes of Haitian people toward HIV infection provide important lessons on understanding and managing this infection in a developing country. The heterosexual spread of HIV, particularly among the poor, is well-documented as is the role of other sexually transmitted diseases along with tuberculosis. Coinfection of HIV and tuberculosis have led researchers to study the effects of six-month supervised intermittent tuberculosis therapy both in controlling tuberculosis and slowing the progression of HIV. Various surveys and discussion groups about acquired immunodeficiency virus knowledge and beliefs demonstrate a large deficit in HIV education despite campaigns to educate the population. The great impact of HIV disease on morbidity and mortality in Haiti indicates that a great deal of work still needs to be accomplished and demonstrates the frustration in fighting the infection in countries with inadequate resources and infrastructure. Advances in HIV vaccine research seem to be the most promising option for developing countries such as Haiti.  (+info)

Medical surveillance of multinational peacekeepers deployed in support of the United Nations Mission in Haiti, June-October 1995. (3/352)

BACKGROUND: Multinational peacekeepers, both military and civilian, often deploy to areas of the world where significant health threats are endemic and host country public health systems are inadequate. Medical surveillance of deployed personnel enables leaders to better direct health care resources to prevent and treat casualties. Over a 5-month period, June to October 1995, a medical surveillance system (MSS) was implemented in support of the United Nations Mission in Haiti (UNMIH). Information obtained from this system as well as lessons learned from its implementation and management may help decrease casualty rates during future multinational missions. METHODS: Over 90% of UNMIH personnel (80% military from over 11 countries and 20% civilian from over 70 countries) stationed throughout Haiti participated in the MSS. A weekly standardized reporting form included the number of new outpatient visits by disease and non-battle injury (DNBI) category and number of personnel supported by each participating UN medical treatment facility (MTF). Previously, medical reporting consisted of simple counts of patient visits without distinguishing between new and follow-up visits. Weekly incidence rates were determined and trends compared within and among reporting sites. The diagnoses and numbers of inpatient cases per week were only monitored at the 86th Combat Support Hospital, the facility with the most sophisticated level of health care available to UN personnel. RESULTS: The overall outpatient DNBI incidence rate ranged from 9.2% to 13% of supported UN personnel/week. Of the 14 outpatient diagnostic categories, the three categories consistently with the highest rates included orthopaedic/injury (1.6-2.5%), dermatology (1.3-2.2%), and respiratory (0.9-2.2%) of supported UN personnel/week. The most common inpatient discharge diagnoses included suspected dengue fever (22.3%), gastro-enteritis (15%), and other febrile illness (13.5%). Of the 249 patients who presented with a febrile illness, 79 (32%) had serological evidence of recent dengue infection. Surveillance results helped lead to interventions that addressed issues related to field sanitation, potable water, food preparation and vector control. CONCLUSIONS: Despite hurdles associated with distance, language, and communications, the MSS was a practical and effective tool for UNMIH force protection. UN requirements for standardized medical surveillance during deployments should be developed and implemented. Furthermore, planners should recognize that if ongoing medical surveillance and related responses are to be effective, personnel should be trained prior to deployment and resources dedicated to a sustained effort in theatre.  (+info)

Cyclospora cayetanensis infections in Haiti: a common occurrence in the absence of watery diarrhea. (4/352)

Stool samples from a population-based cohort of mothers and children living in Leogane, Haiti were tested for Cyclospora cayetanensis from January 1997 through January 1998. Data on gastrointestinal symptoms were also collected. During the winter months of January to March, the infection was detected in 15-20% of the persons sampled. Most infections did not appear to be causing diarrhea and most infected persons had few oocysts detectable in concentrates of stool. The infection appears to have marked seasonality, with highest rates during the driest and coolest time of the year. It may be that in this tropical setting, high summer temperature is the critical environmental factor that influences the seasonality of infection. This study demonstrates that Cyclospora infections in Haiti are common in the general population.  (+info)

Assessment of combined ivermectin and albendazole for treatment of intestinal helminth and Wuchereria bancrofti infections in Haitian schoolchildren. (5/352)

This randomized, placebo-controlled trial investigated the efficacy and nutritional benefit of combining chemotherapeutic treatment for intestinal helminths (albendazole) and lymphatic filariasis (ivermectin). Children were infected with Ascaris (29.2%), Trichuris (42.2%), and hookworm (6.9%), with 54.7% of children having one or more of these parasites. Wuchereria bancrofti microfilaria were found in 13.3% of the children. Children were randomly assigned to treatment with placebo, albendazole, ivermectin, or combined therapy. Combination treatment reduced the prevalence of Trichuris infections significantly more than either drug alone. Combination therapy also significantly reduced the prevalence and density of W. bancrofti microfilaremia compared with placebo or ivermectin alone. Only combination therapy resulted in significantly greater gains in height (hookworm-infected children) or weight (Trichuris-infected children) compared with the placebo group. Combined albendazole and ivermectin was a more efficacious treatment for intestinal helminth and W. bancrofti infections in children and resulted in nutritional benefits not found with either drug alone.  (+info)

The impact of economic sanctions on health and human rights in Haiti, 1991-1994. (6/352)

OBJECTIVES: This report examines the impact of an economic embargo from 1991 to 1994 on health, well-being, and human rights in Haiti. METHODS: Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were combined with survey data and interviews with affected women, governmental representatives, diplomats, and staff of nongovernmental organizations. RESULTS: Changes included declining income, rising unemployment, poorer nutrition, declining infant mortality, rising mortality among 1- to 4-year-olds, decreased attention to children's well-being and education, and family breakdown. Survival strategies among poor Haitians included changed dietary habits, informal-sector economic activity, moving in with relatives, selling domestic goods, increased informal unions among couples, decreased school attendance, and indentured servitude among children. CONCLUSIONS: The implementation of economic sanctions in Haiti resulted in extensive violations of rights; the impact was greatest on the most disadvantaged Haitians. Many Haitian and international supporters of democracy were unaware of the extensive negative impact that sanctions could have. The impact continues now, 5 years after sanctions ended. Modified policies reduced some of the burden of sanctions, and international assistance prevented what otherwise might have become a humanitarian disaster during sanctions.  (+info)

AIDS in Haiti: a bibliometric analysis. (7/352)

OBJECTIVES: In Haiti, AIDS has become the leading cause of death in sexually active adults. Increasingly, AIDS has become a disease of women and children. Previous bibliometric studies have shown the emergence of Haiti as a leading country in the production of AIDS literature in the Latin American and Caribbean regions. No information exists, however, regarding the type of publications produced, the collaboration patterns used, or the subject content analysis of this production. The purpose of this study was to gain insight into the construction of this literature production. METHODS: A bibliometric analysis regarding Haitian AIDS research was conducted in the AIDSLINE database for the period 1980 to 1998. An attempt was made to identify the patterns of the growth in AIDS literature, as well as the types of documents published, authorship, institutional affiliations of authors, and subject content. RESULTS: Results indicated that most documents were published in periodicals. The International Conference on AIDS obtained the highest frequency. The United States, Haiti, and Canada were the main productive countries. CONCLUSIONS: While nearly 40% of the records corresponded to ethnology-related articles, HIV infections, sex behavior, pregnancy, and substance-related disorders headed the Medical Subject Headings (MeSH) found. Main aspects of AIDS papers focused on epidemiology, complications, and trends issues.  (+info)

Timing the ancestor of the HIV-1 pandemic strains. (8/352)

HIV-1 sequences were analyzed to estimate the timing of the ancestral sequence of the main group of HIV-1, the strains responsible for the AIDS pandemic. Using parallel supercomputers and assuming a constant rate of evolution, we applied maximum-likelihood phylogenetic methods to unprecedented amounts of data for this calculation. We validated our approach by correctly estimating the timing of two historically documented points. Using a comprehensive full-length envelope sequence alignment, we estimated the date of the last common ancestor of the main group of HIV-1 to be 1931 (1915-41). Analysis of a gag gene alignment, subregions of envelope including additional sequences, and a method that relaxed the assumption of a strict molecular clock also supported these results.  (+info)