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Background We aimed to identify the 2001–2013 incidence trend, and characteristics associated with adolescent pregnancies reported by 20–24-year-old women. Methods A retrospective analysis of the Cuatro Santos Northern Nicaragua Health and Demographic Surveillance 2004–2014 data on women aged 15–19 and 20–24. To calculate adolescent birth and pregnancy rates, we used the first live birth at ages 10–14 and 15–19 years reported by women aged 15–19 and 20–24 years, respectively, along with estimates of annual incidence rates reported by women aged 20–24 years. We conducted conditional inference tree analyses using 52 variables to identify characteristics associated with adolescent pregnancies. Results The number of first live births reported by women aged 20–24 years was 361 during the study period. Adolescent pregnancies and live births decreased from 2004 to 2009 and thereafter increased up to 2014. The adolescent pregnancy incidence (persons-years) trend dropped from 2001 (75.1 per 1000) to 2007 (27.2 per 1000), followed by a steep upward trend from 2007 to 2008 (19.1 per 1000) that increased in 2013 (26.5 per 1000). Associated factors with adolescent pregnancy were living in low-education households, where most adults in the household were working, and high proportion of adolescent pregnancies in the local community. Wealth was not linked to teenage pregnancies. Conclusions Interventions to prevent adolescent pregnancy are imperative and must bear into account the context that influences the culture of early motherhood and lead to socioeconomic and health gains in resource-poor settings.

We identified clusters of multiple dimensions of poverty according to the capability approach theory by applying data mining approaches to the Cuatro Santos Health and Demographic Surveillance database, Nicaragua. Four municipalities in northern Nicaragua constitute the Cuatro Santos area, with 25,893 inhabitants in 5,966 households (2014). A local process analyzing poverty-related problems, prioritizing suggested actions, was initiated in 1997 and generated a community action plan 2002-2015. Interventions were school breakfasts, environmental protection, water and sanitation, preventive healthcare, home gardening, microcredit, technical training, university education stipends, and use of the Internet. In 2004, a survey of basic health and demographic information was performed in the whole population, followed by surveillance updates in 2007, 2009, and 2014 linking households and individuals. Information included the house material (floor, walls) and services (water, sanitation, electricity) as well as demographic data (birth, deaths, migration). Data on participation in interventions, food security, household assets, and womens self-rated health were collected in 2014. A K-means algorithm was used to cluster the household data (56 variables) in six clusters. The poverty ranking of household clusters using the unsatisfied basic needs index variables changed when including variables describing basic capabilities. The households in the fairly rich cluster with assets such as motorbikes and computers were described as modern. Those in the fairly poor cluster, having different degrees of food insecurity, were labeled vulnerable. Poor and poorest clusters of households were traditional, e.g., in using horses for transport. Results displayed a society transforming from traditional to modern, where the forerunners were not the richest but educated, had more working members in household, had fewer children, and were food secure. Those lagging were the poor, traditional, and food insecure. The approach may be useful for an improved understanding of poverty and to direct local policy and interventions. Funding Agencies|Uppsala University, Sweden; Centro de Investigacion en Demografia y Salud (CIDS), Universidad Nacional Autonoma de Nicaragua (UNAN)-Leon; Asociacion para el Desarrollo Economico y Sostenible de El Espino (APRODESE); Fundacion Coordinacion de Hermanamientos e Iniciativas de Cooperacion; Swedish Research CouncilSwedish Research Council

Background: Nicaragua was the first developing nation to implement routine immunization with the pentavalent rotavirus vaccine (RV5). In this RV5-immunized population, understanding infectious etiologies of childhood diarrhea is necessary to direct diarrhea treatment and prevention efforts. Methods: We followed a population-based sample of children less than5 years in Leon, Nicaragua for diarrhea episodes through household visits. Information was obtained on RV5 history and sociodemographics. Stool samples collected during diarrhea episodes and among healthy children underwent laboratory analysis for viral, bacterial and parasitic enteropathogens. Detection frequency and incidence of each enteropathogen was calculated. Results: The 826 children in the cohort experienced 677 diarrhea episodes during 607.5 child-years of exposure time (1.1 episodes per child-year). At least 1 enteropathogen was detected among 61.1% of the 337 diarrheal stools collected. The most common enteropathogens among diarrheal stools were: norovirus (20.4%), sapovirus (16.6%), enteropathogenic Escherichia coli (11.3%), Entamoeba histolytica/dispar (8.3%), Giardia lamblia (8.0%) and enterotoxigenic E. coli (7.7%), with rotavirus detected among 5.3% of diarrheal stools. Enteropathogenic Escherichia coli and enterotoxigenic E. coli were frequently detected among stools from healthy children. Among children with diarrhea, norovirus was more commonly detected among younger children (less than2 years) and G. lamblia was more commonly detected among older children (2-4 years). The mean age of rotavirus detection was 34.6 months. Conclusions: In this Central American community after RV5 introduction, rotavirus was not commonly detected among children with diarrhea. Prevention and appropriate management of norovirus and sapovirus should be considered to further reduce the burden of diarrheal disease.

Postinfectious IBS is defined in the industrialized world as IBS onset following a sentinel gastrointestinal infection. In developing nations, where repeated bacterial and parasitic gastrointestinal infections are common, the IBS pathophysiology may be altered. Our aim was to investigate the relationship between intestinal parasite infection and IBS in the “nonsterile” developing world environment. IBS subjects were identified from a population-based sample of 1624 participants using the Rome II Modular Questionnaire. Stool samples from cases and randomly selected controls were examined for ova and parasites. Logistic regression models explored the relationship between IBS and parasite infection. The overall IBS prevalence among participants was 13.2% (9.3% males, 15.9% females). There was no difference in parasite carriage between IBS cases and controls, 16.6% versus 15.4% (P=0.78), nor among IBS subtypes. The pathophysiology of post-infectious IBS may be altered in the developing world as compared to industrialized nations and warrants investigation.

Summary Background Evidence from Europe, Asia, and North America suggests that standard three-drug regimens of a proton-pump inhibitor plus amoxicillin and clarithromycin are significantly less effective for eradication of Helicobacter pylori infection than are 5-day concomitant and 10-day sequential four-drug regimens that include a nitroimidazole. These four-drug regimens also entail fewer antibiotic doses than do three-drug regimens and thus could be suitable for eradication programmes in low-resource settings. Few studies in Latin America have been done, where the burden of H pylori -associated diseases is high. We therefore did a randomised trial in Latin America comparing the effectiveness of four-drug regimens given concomitantly or sequentially with that of a standard 14-day regimen of triple therapy. Methods Between September, 2009, and June, 2010, we did a randomised trial of empiric 14-day triple, 5-day concomitant, and 10-day sequential therapies for H pylori in seven Latin American sites: Chile, Colombia, Costa Rica, Honduras, Nicaragua, and Mexico (two sites). Participants aged 21–65 years who tested positive for H pylori by a urea breath test were randomly assigned by a central computer using a dynamic balancing procedure to: 14 days of lansoprazole, amoxicillin, and clarithromycin (standard therapy); 5 days of lansoprazole, amoxicillin, clarithromycin, and metronidazole (concomitant therapy); or 5 days of lansoprazole and amoxicillin followed by 5 days of lansoprazole, clarithromycin, and metronidazole (sequential therapy). Eradication was assessed by urea breath test 6–8 weeks after randomisation. The trial was not masked. Our primary outcome was probablity of H pylori eradication. Our analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, registration number NCT01061437. Findings 1463 participants aged 21–65 years were randomly allocated a treatment: 488 were treated with 14-day standard therapy, 489 with 5-day concomitant therapy, and 486 with 10-day sequential therapy. The probability of eradication with standard therapy was 82·2% (401 of 488), which was 8·6% higher (95% adjusted CI 2·6–14·5) than with concomitant therapy (73·6% [360 of 489]) and 5·6% higher (–0·04% to 11·6) than with sequential therapy (76·5% [372 of 486]). Neither four-drug regimen was significantly better than standard triple therapy in any of the seven sites. Interpretation Standard 14-day triple-drug therapy is preferable to 5-day concomitant or 10-day sequential four-drug regimens as empiric therapy for H pylori infection in diverse Latin American populations. Funding Bill & Melinda Gates Foundation, US National Institutes of Health.

Objective. To study the neuroendocrine release of cortisol in response to perceived stress among pregnant women exposed to partner violence and how this affects the duration of pregnancy and the intrauterine growth of the infant. Design. Cross-sectional community-based study. Setting. Health and Demographic Surveillance System of Leon, Nicaragua. Population. One-hundred and forty-seven pregnant women. Methods. Standardized scales to measure intimate partner violence, social resources, perceived stress, and socio-economic conditions were applied. Two salivary samples for cortisol were collected in the morning and afternoon on the same day. Linear regression and path analysis were used. Main outcome measures. Cortisol levels, gestational age, and weight at delivery. Results. Partner violence during the pregnancy, low social resources, and perceived maternal stress were associated with high level of salivary cortisol. Pregnant women with high cortisol levels were significantly more likely to give birth to small-for-gestational age babies, but not to deliver preterm. A substantial decrease of birthweight, 121-186 g, was associated with an increase in cortisol in association with violence exposure. Conclusion. Partner violence during pregnancy is a stressor that provokes high levels of cortisol, which is associated with reduction of birthweight.

OBJECTIVE: This study aims to estimate the prevalence and characteristics of partner abuse during pregnancy as well as to investigate associated social factors in Leon, Nicaragua. DESIGN: Cross-sec ...

BACKGROUND: Social inequality in child survival hampers the achievement of Millennium Development Goal 4 (MDG4). Monitoring under-five mortality in different social strata may contribute to public health policies that strive to reduce social inequalities. This population-based study examines the trends, causes, and social inequality of mortality before the age of five years in rural and urban areas in Nicaragua. METHODS: The study was conducted in one rural (Cuatro Santos) and one urban/rural area (León) based on data from Health and Demographic Surveillance Systems. We analyzed live births from 1990 to 2005 in the urban/rural area and from 1990 to 2008 in the rural area. The annual average rate reduction (AARR) and social under-five mortality inequality were calculated using the education level of the mother as a proxy for socio-economic position. Causes of child death were based on systematic interviews (verbal autopsy). RESULTS: Under-five mortality in all areas is declining at a rate sufficient to achieve MDG4 by 2015. Urban León showed greater reduction (AARR = 8.5%) in mortality and inequality than rural León (AARR = 4.5%) or Cuatro Santos (AARR = 5.4%). Social inequality in mortality had increased in rural León and no improvement in survival was observed among mothers who had not completed primary school. However, the poor and remote rural area Cuatro Santos was on track to reach MDG4 with equitable child survival. Most of the deaths in both areas were due to neonatal conditions and infectious diseases. CONCLUSIONS: All rural and urban areas in Nicaragua included in this study were on track to reach MDG4, but social stratification in child survival showed different patterns; unfavorable patterns with increasing inequity in the peri-urban rural zone and a more equitable development in the urban as well as the poor and remote rural area. An equitable progress in child survival may also be accelerated in very poor settings.

We estimated the incidence of watery diarrhea in the community before and after introduction of the pentavalent rotavirus vaccine in León, Nicaragua. A random sample of households was selected before and after rotavirus vaccine introduction. All children < 5 years of age in selected households were eligible for inclusion. Children were followed every 2 weeks for watery diarrhea episodes. The incidence rate was estimated as numbers of episodes per 100 child-years of exposure time. A mixed effects Poisson regression model was fit to compare incidence rates in the pre-vaccine and vaccine periods. The pre-vaccine cohort (N = 726) experienced 36 episodes per 100 child-years, and the vaccine cohort (N = 826) experienced 25 episodes per 100 child-years. The adjusted incidence rate ratio was 0.60 (95% confidence interval [CI] 0.40, 0.91) during the vaccine period versus the pre-vaccine period, indicating a lower incidence of watery diarrhea in the community during the vaccine period.

The long-term effectiveness of Helicobacter pylori eradication programs for preventing gastric cancer will depend on recurrence risk and individual and community factors.To estimate risk of H. pylori recurrence and assess factors associated with successful eradication 1 year after treatment.Cohort analysis of 1463 randomized trial participants aged 21 to 65 years from 7 Latin American communities, who were treated for H. pylori and observed between September 2009 and July 2011.Randomization to 1 of 3 treatment groups: 14-day lansoprazole, amoxicillin, and clarithromycin (triple therapy); 5-day lansoprazole and amoxicillin followed by 5-day lansoprazole, clarithromycin, and metronidazole (sequential); or 5-day lansoprazole, amoxicillin, clarithromycin, and metronidazole (concomitant). Participants with a positive (13)C-urea breath test (UBT) 6 to 8 weeks posttreatment were offered voluntary re-treatment with 14-day bismuth-based quadruple therapy.Recurrent infection after a negative posttreatment UBT and factors associated with successful eradication at 1-year follow-up.Among participants with UBT-negative results who had a 1-year follow-up UBT (n=1091), 125 tested UBT positive, a recurrence risk of 11.5% (95% CI, 9.6%-13.5%). Recurrence was significantly associated with study site (P = .03), nonadherence to initial therapy (adjusted odds ratio [AOR], 2.94; 95% CI, 1.31-6.13; P = .01), and children in the household (AOR, 1.17; 95% CI, 1.01-1.35 per child; P = .03). Of the 281 with positive posttreatment UBT results, 138 completed re-treatment, of whom 93 tested UBT negative at 1 year. Among the 1340 who had a 1-year UBT, 80.4% (95% CI, 76.4%-83.9%), 79.8% (95% CI, 75.8%-83.5%), and 77.8% (95% CI, 73.6%-81.6%) had UBT-negative results in the triple, sequential, and concomitant groups, respectively (P = .61), with 79.3% overall effectiveness (95% CI, 77.1%-81.5%). In a single-treatment course analysis that ignored the effects of re-treatment, the percentage of UBT-negative results at 1 year was 72.4% (95% CI, 69.9%-74.8%) and was significantly associated with study site (P.001), adherence to initial therapy (AOR, 0.26; 95% CI, 0.15-0.42; P.001), male sex (AOR, 1.63; 95% CI, 1.25-2.13; P.001), and age (AOR, 1.14; 95% CI, 1.02-1.27 per decade; P = .02). One-year effectiveness among all 1463 enrolled participants, considering all missing UBT results as positive, was 72.7% (95% CI, 70.3%-74.9%).One year after treatment for H. pylori infection, recurrence occurred in 11.5% of participants who had negative posttreatment UBT results. Recurrence determinants (ie, nonadherence and demographics) may be as important as specific antibiotic regimen in determining the long-term success of H. pylori eradication interventions. Study findings are relevant to the feasibility of programs for the primary prevention of gastric cancer in high-incidence regions of Latin America.clinicaltrials.gov Identifier: NCT01061437.

The present study describes the use of a home-based antenatal card in a sample of 120 consecutive women who were giving birth at a large teaching hospital in the city of León, Nicaragua. Information was obtained by interviews with the women before leaving hospital and all data on their antenatal cards and regarding delivery outcome were analysed. Antenatal care attendance by the 120 women was 93 per cent, and 86 per cent had received an antenatal card. However, only in 33 per cent of the cases had the card been adequately used: inappropriate handling in hospital was the commonest cause of non-use. Suggestions for a revision of the card are presented in the companion article, in which we also stress the importance of continuous training of the health personnel.

Background The isolated northern region of Nicaragua has one of the highest rates of diarrheal disease in Central America. Political and environmental hardships faced by inhabitants of this region are contributing factors to this health inequity. The aim of this study was to assess the relationship between water and latrine infrastructure and the prevalence of diarrhea in this region. Methods A population-based, cross-sectional survey of women of reproductive age was conducted in the Sahsa region of northern Nicaragua in July, 2009. Households were selected by two stage cluster sampling methodology. A questionnaire was administered in Spanish and Miskito with assessment of household and socioeconomic conditions, sanitation practices, and health care access. Diarrhea prevalence differences at the household level over a two week reporting period were estimated with a standardized instrument which included assessment of water treatment and latrine use and maintenance. Results There were 189 women enrolled in the current study. The use of water purification methods, such as chlorine and filters, and latrine ownership were not associated with reduced prevalence of household diarrhea in the two week reporting period. Latrine overflow, however, was associated with an increased prevalence of diarrhea during the same two week period [adjusted prevalence difference and 95% CI: 0.19 (0.03, 0.36)]. Conclusions Simple, low cost interventions that improve water and latrine infrastructure may reduce the prevalence of diarrheal disease in the isolated regions of Nicaragua and Central America.

Irritable bowel syndrome (IBS) is a disabling functional gastrointestinal disorder, which serves as a model for abdominal pain syndromes. An association between intimate partner violence and IBS has been shown among White women in the industrialized world. To determine whether this relationship transcends cultural boundaries, we conducted a population-based, cross-sectional survey in Nicaragua using the innovative Health and Demographic Surveillance System in the León province. Women who had experienced physical intimate partner violence had significantly increased risk of IBS (odds ratio [OR] = 2.08; 95% confidence interval [CI] = 1.35, 3.21), as did those who had experienced sexual intimate partner violence (OR = 2.85; 95% CI = 1.45, 5.59). These findings argue for intimate partner violence screening among Latina women with IBS.

Rheumatic heart disease (RHD) results in morbidity and mortality that is disproportionate among individuals in developing countries compared to those living in economically developed countries. The global burden of disease is uncertain because most previous studies to determine the prevalence of RHD in children relied on clinical screening criteria that lacked the sensitivity to detect most cases. The present study was performed to determine the prevalence of RHD in children and young adults in Leon, Nicaragua, an area previously thought to have a high prevalence of RHD. This was an observational study of 3,150 children aged 5 to 15 years and 489 adults aged 20 to 35 years randomly selected from urban and rural areas of Leon. Cardiopulmonary examinations and Doppler echocardiographic studies were performed on all subjects. Doppler echocardiographic diagnosis of RHD was based on predefined consensus criteria that were developed by a working group of the World Health Organization and the National Institutes of Health. The overall prevalence of RHD in children was 48 in 1,000 (95% confidence interval 35 in 1,000 to 60 in 1,000). The prevalence in urban children was 34 in 1,000, and in rural children it was 80 in 1,000. Using more stringent Doppler echocardiographic criteria designed to diagnose definite RHD in adults, the prevalence was 22 in 1,000 (95% confidence interval 8 in 1,000 to 37 in 1,000). In conclusion, the prevalence of RHD among children and adults in this economically disadvantaged population far exceeds previously predicted rates. The findings underscore the potential health and economic burden of acute rheumatic fever and RHD and support the need for more effective measures of prevention, which may include safe, effective, and affordable vaccines to prevent the streptococcal infections that trigger the disease.

Aim: To describe the Health and Demographic Surveillance System (HDSS) in León, Nicaragua and to present results from the 2002—2003 baseline. Design and methods: A 22% sample of the total population in León, both urban and rural, was selected in 1993. This sample was updated in 2002 and will be followed up on a biannual basis with regard to births, deaths, in-migration, and out-migration. A group of 18 female fieldworkers perform 10 household interviews per day, 20 days per month. They use a map that is produced by a Geographical Information System. It shows all the households, and is the main means of the interviewers finding the households. An extensive data quality control system is used. Results: In total, 54,647 persons lived in the area of the surveillance system, and they resided in 10,994 households. The mean age was 26 years; the sex ratio was 0.93. The infant and neonatal mortality rates were 25.4 and 20.5 per 1,000 live births, respectively. In total, 2,034 people out-migrated from the study area and 3,377 in-migrated. Of the households, 53% were classified as non-poor, 41% as poor, and 6% as extremely poor. Six per cent of the population did not have a toilet or a latrine, and only 16% in the rural area had indoor running water. The surveillance system revealed that 10% were illiterate. Conclusions: The HDSS in León has shown that it can serve as a platform for further intervention studies as well as for research training.

There are few peer-reviewed studies of HIV/AIDS-related knowledge, attitudes, beliefs and practices among adolescents in Central America. A population-based cross-sectional survey was conducted among 246 adolescents in Leon, Nicaragua, where there is reason for concern about a rise in HIV infections. In many respects, Leon adolescents were typical of those in other Latin American countries, with a mixture of correct and incorrect knowledge about transmission of HIV and sexually transmitted infections, a higher proportion of males than females reporting having had sex or using condoms, and inconsistent condom use. While some sexual attitudes conformed to the ideology of machismo, others did not, providing an opening for prevention interventions. Some dimensions of HIV/AIDS stigma were high, and most adolescents disapproved of same-sex sexual behaviour. Intervention against homosexuality-related stigma is particularly urgent because a concentrated HIV epidemic may be emerging in Nicaragua among men who have sex with men. Personal religious beliefs did not appear to pose a barrier to condom use. In a multivariate model, being out of school was a significant correlate of having had sex and of insufficient HIV/AIDS-related knowledge. Accordingly, HIV prevention interventions must reach adolescents both in and out of school. A multi-component approach to prevention is needed, including programmes based in schools, communities, the mass media and health facilities.

Introduccion. La disfagia neurogena es una secuela del ictus que en ocasiones pone en riesgo la vida del paciente. La magnitud del dano cerebral generado por el ictus comunmente ocasiona la aparicion de otros trastornos que acompanan a la disfagia y agravan la salud del paciente. Objetivo. Analizar posibles asociaciones entre trastornos de la comunicacion, factores propios de la enfermedad, demograficos y comorbidos con disfagia en pacientes que sufrieron un ictus durante el ingreso hospitalario entre los anos 2009 y 2011. Pacientes y metodos. Se estudiaron 1.519 historias clinicas de pacientes que presentaron ictus entre los anos 2009 y 2011. Resultados. De los registros analizados, 206 presentaron disfagia (13,6%). El 80,1% de los casos de disfagia se concentro en pacientes de 60-89 anos. El 66% de ellos permanecio hospitalizado durante mas de 11 dias. La edad (odds ratio = 2,36; p < 0,001), afasia (odds ratio = 4,47; p < 0,001), disartria (odds ratio = 4,95; p < 0,001), tiempo de hospitalizacion (odds ratio = 3,65; p < 0,001) e hipertension arterial (odds ratio = 1,64; p = 0,023) se asociaron estadisticamente con disfagia. Finalmente, en el 73,3% de los casos con disfagia, se presento disfagia mas afasia o disartria o apraxia del habla, mientras que solo el 26,7% tuvo exclusivamente disfagia. Conclusiones. La disfagia neurogena parece concomitar con trastornos de la comunicacion, aumentar el tiempo de hospitalizacion y asociarse a hipertension arterial. Sin embargo, se requieren estudios prospectivos que consideren un gran periodo de tiempo para confirmar estos hallazgos.

To assess whether being physically abused during pregnancy increases the risk of a low birth weight (LBW) infant.We conducted a hospital-based case-control study in León, Nicaragua. Cases consisted of 101 newborns with a birth weight under 2500 g, and for each case two controls with a birth weight over 2500 g were selected randomly from infants born the same day. Anthropometry of newborns was done immediately after birth, and background information and data on experiences of violence and potential confounders were obtained through private interviews with mothers. Crude and adjusted odds ratios (ORs) and population-attributable proportion were calculated for exposure to partner abuse in relation to LBW. Multivariate logistic regression analysis was used to control for potential confounding.Seventy-five percent of LBW newborns (cases) were small for gestational age and 40% were preterm. Twenty-two percent of the mothers of LBW infants had experienced physical abuse during pregnancy by their intimate partners compared with 5% of controls. Low birth weight was associated with physical partner abuse even after adjustment for age, parity, smoking, and socioeconomic status (OR 3.9; 95% confidence interval 1.7, 9.3). Given a causal interpretation of the association, about 16% of the LBW in the infant population could be attributed to physical abuse by a partner in pregnancy.Physical abuse by a partner during pregnancy is an independent risk factor for LBW.

STUDY OBJECTIVE—To describe the responses of women in León, Nicaragua to partner abuse and identify contextual factors associated with the use of certain coping mechanisms and the likelihood of permanent separation. DESIGN—Cross sectional population-based survey. SETTING—León, Nicaragua. PARTICIPANTS—188 women 15-49 years of age who had experienced physical partner abuse, out of 488 women interviewed. MAIN RESULTS—66% of women defended themselves effectively from abuse either physically or verbally. Forty one per cent of women had left home temporarily because of violence and 20% had sought help outside the home. Women experiencing severe abuse were more likely to leave or seek help, whereas women with less severe abuse were more able to defend themselves effectively. Seventy per cent of women eventually left abusive relationships. Help seeking and temporary separations increased the likelihood of a permanent separation, whereas women who defended themselves and were able to stop the violence, at least temporarily, were more likely to remain in abusive relationships. CONCLUSIONS—Women in Nicaragua use a variety of methods in order to overcome physical partner abuse. Temporary leaving and help seeking are critical steps in the process of leaving a violent relationship. However, many women indicated that they did not receive support for their situation. More interventions are needed to help women recognise and deal with violence, as well as strengthening the community support networks available to abused women. Keywords: partner abuse; violence; women

Aims: The objective was to describe experiences of sexual abuse occurring before 19 years of age among men and women in Leon, Nicaragua and to explore the possible association to later sexual risk behavior. Method: A sub-sample of literate urban men and women 25–44 years of age was selected from a representative sample of households in Leon. After an invitation to a public health event, 154 men (53% of the invited) and 213 women (66% of those invited) participated in giving written answers to an anonymous questionnaire. Results: Twenty percent of men and 26% of women reported that they had experienced sexual abuse. Women had been victims of attempted or completed rape twice as often as men, 15% as compared to 7%. Thirty-three percent of the abuse towards boys and 66% of the abuse towards girls was committed by family members. Women who had experienced attempted or completed rape were more likely to later have had a higher number of sexual partners compared to non-abused or moderately abused women. Conclusions: Sexual abuse of children and adolescents of both sexes is common in Nicaragua. The results underscore the urgent need to address this serious problem more openly, and to make more resources available for the prevention of sexual abuse and for support to victims.

The aim of this study was to describe the characteristics of domestic violence against women in Leon, Nicaragua. A survey was carried out among a representative sample of 488 women between the ages of 15-49. The physical aggression sub-scale of the Conflict Tactics Scale was used to identify women suffering abuse. In-depth interviews with formerly battered women were performed and narratives from these interviews were analysed and compared with the survey data. Among ever-married women 52% reported having experienced physical partner abuse at some point in their lives. Median duration of abuse was 5 years. A considerable overlap was found between physical, emotional and sexual violence, with 21% of ever-married women reporting all three kinds of abuse. Thirty-one percent of abused women suffered physical violence during pregnancy. The latency period between the initiation of marriage or cohabitation and violence was short, with over 50% of the battered women reporting that the first act of violence act took place within the first 2 years of marriage. Significant, positive associations were found between partner abuse and problems among children, including physical abuse. Both the survey data and the narrative analysis pointed to extreme jealousy and control as constant features of the abusive relationship. Further, the data indicate that battered women frequently experience feelings of shame, isolation and entrapment which, together with a lack of family and community support, often contribute to women's difficulty in recognizing and disengaging from a violent relationship. These findings are consistent with theoretical conceptualisations of domestic violence developed in other countries, suggesting that, to a large degree, women's experiences of violence transcend specific cultural contexts.

The aim was to study the contraceptive patterns among men and women in Leon, Nicaragua. A questionnaire about sexual, contraceptive, reproductive and socioeconomic issues was directed to 7,789 households including 22% of all women of the municipality aged 15–49 years (n = 10,867). A subsample of 388 men and 413 women aged 15–49 years was drawn at random. Refusals were less than 2%. Private interviews revealed that among fertile women who had been sexually active within the last three months, non-pregnant and wishing to avoid pregnancy, 77% were contracepting. Female sterilization was the most common contraceptive method (39%), followed by intrauterine device (16%). Even though around 60% of women at some time had tried oral contraceptives, only 13% of contraceptors used them currently. The rhythm and interruption methods together constituted only 4%. Condom use was low and mainly occasional. Contraceptive use in sexually active women aged 15–44 years was lower among those having lower education, living in rural areas, and living under poverty conditions. The predominance of female sterilization and the occasional condom use—mainly reported by men—reflects a situation of relative male control over contraception and reproduction. This probably originates from “machista” values where men having many children with different women are considered strong. There was also a significantly higher use of contraceptives among the better-off women and men compared with the extremely poor. The situation of many poor women, in a country with limited contraceptive services, is worrving considering that abortion is illegal and the threat of HIV epidemic is growing. The situation for adolescents is particularly problematic with low experience in contraceptive use.

An antenatal card should be designed to facilitate the early detection of important and clearly defined conditions, which in turn can result in well-defined and beneficial actions. The home-based antenatal card is a good instrument for having relevant information accessible at various antenatal visits, and also for transmitting the information to the delivery staff. If properly designed, it could also serve as an important means to assess epidemiological characteristics of the pregnant population, necessary for deciding priorities in a public health perspective. A cross-sectional study of women giving birth in Leon, Nicaragua, showed that the majority of the women could be classified as high-risk pregnancies. The present paper discusses the design of the Nicaraguan antenatal card, as well as its risk factors. A revision of the antenatal card and the accompanying manual is suggested, particularly with regard to the definitions of the high-risk criteria and the proposed action.

The first steps of a community involvement health project using the principles of community diagnosis and popular participation were carried out in a small Nicaraguan mining village during the second half of the 1980s. Using existing archives and obtaining new information aided by local organizations, priorities could be established for health and safety surveillance within the mining company, as well as for further investigations concerning what seemed to be dominant health problems in the community: serious accidents among the economically active population and diarrhoea and respiratory tract infections among children, as well as infections, and other health indicators of malnutrition. Workers also presented chronic simple bronchitis, ventilatory obstructive disturbance and hearing loss that were strongly associated with working conditions. These results helped to direct health priorities and educational activities at the local level with both the general and working population. The wide experience gained from this study has encouraged us to strengthen the link between research and action and in performing studies in close cooperation with local organizations.

Since 1983, a broad research and development programme has been carried out with the support of Sweden through the Swedish Agency for Research Cooperation in Developing Countries (SAREC). One of the medical research and development projects deals with the environment and state of health of the population of an entire village, and is referred to as the Abdon Vega project. It is pursued by the Department of Social and Preventive Medicine of the University of León, Nicaragua, with the support of the Department of Social Medicine at the Karolinska Institute in Stockholm. The project comprises two stages. The first one centres on the state of health of the workers and the mining environment. This article reports on the objectives of the project and the study area. It presents experience from the development work up to now and the difficulties encountered.

Background: Gastric cancer is the fourth most common cancer and the second cause of cancer death worldwide. In several Latin American countries, it is the most common cancer and the most common cause of cancer death in men and women combined. Infection with H. pylori (Hp) is associated with the development of gastric carcinoma in many parts of the world including Latin America and is thought to be one of the causative agents. We conducted a clinical trial designed to test the effectiveness of three antibiotic regimens for Hp eradication in seven sites in Latin America while assessing feasibility, and the possibility of identifying a direction for future chemoprevention trials of gastric cancer. Methods: Under a locally IRB approved clinical protocol and signed informed consent requirement, 1852 adults (ages 21-65 years) from the general populations of Chile (Santiago), Colombia (Túquerres), Costa Rica (Guanacaste), Honduras (Copán), México (Obregon and Tapachula), and Nicaragua (León) were screened for the presence of Hp infection with the urea breath test (UBT). 79.4% were positive. 1463 participants consented to be randomized to one of three regimens administered twice a day: 14 days of lansoprazole 30mg, amoxicillin 1,000mg, and clarithromycin 500mg (triple 14d); 5 days of lansoprazole 30mg and amoxicillin 1,000mg followed by 5 days of lansoprazole 30mg, clarithromycin 500mg, and metronidazole 500mg (sequential 10d) or 5 days of lansoprazole 30mg, amoxicillin 1,000mg, and clarithromycin 500mg, and metronidazole 500mg (concomitant 5d). Response was assessed at 6-8 weeks after treatment by UBT. Recurrence at one year was also assessed by UBT. Results are presented by UBT testing and by all participants enrolled (intention-to-treat (ITT)) analysis. 123 (30.8%) patients who did not return for UBT testing were presumed failures at one year. Studies of HP virulence, pepsinogens I and II, as well as inflammatory cytokines, are in progress. Results: Participant characteristics were similar in the three treatment groups. At 6-8 weeks after treatment, UBT was negative in 1133/1414 (80.1%) patients who underwent follow-up UBT and in 1133/1463 (77.4%) of all participants enrolled. The triple 14d regimen was the superior (p 0.008) regimen among all who had repeat UBT and in the ITT group (p 0.005). The estimated fraction remaining free of infection at one year was 79.3% among participants followed by UBT, and 72.7% for all participants enrolled in the study (Table 1). At one year, in those patients with a negative UBT at 6-8 weeks, Hp recurrence was observed in 11.5%. The risk of infection was greater by site - worse in Chile and Colombia- (p Conclusions: This is the largest, prospective, randomized clinical trial ever conducted to treat Hp. The trial was successful in recruiting participants, as well as conducting and monitoring trial treatments and outcomes in 6 Latin American countries. We demonstrated greater treatment efficacy of the triple 14d antibiotic regimen at 6-8 weeks, but a one year 11.5% recrudescence rate regardless of antibiotic regimen. Study site, younger age and crowded households are important factors associated with Hp recurrence at one year. The recurrence rate at one year is concerning, and points to the necessity of conducting additional studies of the molecular biology and pathogenesis of Hp before launching definitive chemoprevention trials of gastric cancer. Given the unique prevalence of gastric cancer and other infection-related cancers in Latin America, we propose that Latin America investigators consider the formation of an independent Cancer Cooperative Group to facilitate research involving cancer. Just as the United States wisely invested in the development of cancer cooperative groups in Europe (European Organization for Research and Treatment of Cancer - EORTC) and in Canada (National Cancer Institute of Canada Clinical Trials Group - NCIC-CTG), we believe that the time has come for consideration of the creation of a cancer cooperative group in Latin America with financial support from the National Cancer Institute. Support: The Bill & Melinda Gates Foundation grant #43930 and National Cancer Institute grant # CA037429. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr SY26-02. doi:1538-7445.AM2012-SY26-02