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Across the globe, there is increasing interest in implementing circular approaches to urban sanitation and waste management to mitigate environmental challenges and promote sustainable business opportunities. In Latin America where 80% of the population live in urban areas, there is limited investigation into the enabling factors and governance barriers that are critical to implementing circular economy strategies in urban areas. This paper aims at assessing the governance capacity to implement resource recovery from organic waste streams in the municipality of Chía, Colombia, through applying the Governance Capacity Framework in a participatory process with local stakeholders. The findings highlight the importance of local initiatives for resource recovery that allow experimentation, raise awareness and foster collaboration, as well as mechanisms available for public participation in decision-making processes as enabling factors. Meanwhile, the inadequate monitoring and assessment of environmental strategies and policies, inadequate sharing of information among stakeholders and the relative low awareness of potential benefits of recovering resources from organic waste streams, especially among public sector actors, emerge as key barriers. Beyond Chía, the results provide insights on crucial factors for ensuring sufficient governance capacity in other urban areas in low- and middle-income countries which are considering circular approaches to urban sanitation and waste management. The findings also provide an empirical basis to advance the understanding of the governance conditions necessary for implementing resource recovery from organic waste streams, upon which further applications of the governance capacity framework along with participatory aspects in other similar urban contexts could build. Across the globe, there is increasing interest in implementing circular approaches to urban sanitation and waste management to mitigate environmental challenges and promote sustainable business opportunities. In Latin America where 80% of the population live in urban areas, there is limited investigation into the enabling factors and governance barriers that are critical to implementing circular economy strategies in urban areas. This paper aims at assessing the governance capacity to implement resource recovery from organic waste streams in the municipality of Chía, Colombia, through applying the Governance Capacity Framework in a participatory process with local stakeholders. The findings highlight the importance of local initiatives for resource recovery that allow experimentation, raise awareness and foster collaboration, as well as mechanisms available for public participation in decision-making processes as enabling factors. Meanwhile, the inadequate monitoring and assessment of environmental strategies and policies, inadequate sharing of information among stakeholders and the relative low awareness of potential benefits of recovering resources from organic waste streams, especially among public sector actors, emerge as key barriers. Beyond Chía, the results provide insights on crucial factors for ensuring sufficient governance capacity in other urban areas in low- and middle-income countries which are considering circular approaches to urban sanitation and waste management. The findings also provide an empirical basis to advance the understanding of the governance conditions necessary for implementing resource recovery from organic waste streams, upon which further applications of the governance capacity framework along with participatory aspects in other similar urban contexts could build.

Rural children are one of the populations that are most vulnerable to gastrointestinal parasite infections. Such diseases decrease the quality of life and result in growth and cognitive delays in the long term. This cross-sectional study was conducted to determine the frequency of intestinal parasite infections among rural schoolchildren in the municipality of Apulo, Colombia. A total of 97 stool samples from children aged between 5 and 15 years were collected and examined via direct light microscopy. Microscopic examination was repeated with sediments obtained using a fecal parasite concentrator, and the Kato-Katz test was performed. Frequency of intestinal parasite infection was 100%. Endolimax nana (77.35%), Blastocystis sp. (71.1%), Giardia intestinalis (39.1%), Entamoeba coli (25.7%), and the Entamoeba histolytica/dispar/moshkovskii complex (9.2%) were the most prevalent protozoa. Trichuris trichiura was the most prevalent helminth (12.3%), followed by Enterobius vermicularis (6.15%) and Ascaris lumbricoides (5.1%). Among the analyzed associated factors, consumption of untreated water increased the risk of acquiring pathogenic intestinal parasites. Finally, because G. intestinalis was the most prevalent pathogenic protozoan, molecular analysis was conducted to establish genetic assemblages and subassemblages of Giardia through sequence-based genotyping of the glutamate dehydrogenase, triose phosphate isomerase, and beta-giardin genes. A total of 14 G. intestinalis-positive samples were genotyped, which revealed the presence of subassemblages AI (n = 1), AII (n = 7), BIII (n = 2), BIV (n = 2), and BIII/BIV (n = 1) as well as a mixed subassemblage AII + BIII (n = 1). Our results indicate that gastrointestinal parasite infections in the tested population were mainly caused by suboptimal water quality. Moreover, molecular typing of G. intestinalis suggested contamination of water by animal- and human-derived cysts.

Este estudio evaluó la sostenibilidad de un conjunto de intervenciones para la prevención del dengue y la diarrea, en 33 escuelas rurales en los municipios de Anapoima y La Mesa, Colombia, dos años post-proyecto. Se midió la sostenibilidad en dos categorías: mantenimiento de los beneficios e intervenciones, e institucionalización y desarrollo de capacidades de la comunidad. Se comparó la sostenibilidad de las intervenciones que fueron distribuidas en cuatro brazos: intervenciones para prevenir la diarrea, para prevenir el dengue, combinadas para prevenir la diarrea y el dengue, y control. El puntaje final de cada brazo se clasificó en uno de cinco niveles de sostenibilidad: regresivo, no sostenible, moderadamente sostenible, sostenible y altamente sostenible. Se compararon los brazos mediante las pruebas ANOVA y Kruskal-Wallis, con un nivel de significancia de 0,05. A los dos años post-proyecto, se observa que el nivel total de sostenibilidad para la prevención de diarrea fue moderadamente sostenible en los cuatro brazos y para dengue no sostenible en tres de los cuatro brazos, sin encontrar diferencias estadísticamente significativas entre estos. También se observa que los niveles de sostenibilidad varían, en cuanto a los beneficios, intervenciones, desarrollo de capacidades e institucionalización. El mantenimiento de los beneficios y de las intervenciones en ambas enfermedades fue más sostenible que la institucionalización y desarrollo de capacidades. Es importante el análisis de estas variables para identificar los diferentes factores que influyen en la sostenibilidad de los proyectos, relacionados con el diseño y ejecución de estos, con el marco organizacional, y con el contexto social. This study evaluated the sustainability of a set of interventions to prevent dengue and diarrhea in 33 rural schools in the municipalities (counties) of Anapoima and La Mesa, Colombia, two years post-project. The study measured sustainability in two categories: maintenance of the benefits and the interventions, and institutionalization and community capacity-building. The sustainability of the interventions was compared across four arms: interventions to prevent diarrhea, to prevent dengue, combined interventions to prevent diarrhea and dengue, and control. The final score for each arm was classified in five levels of sustainability: regressive, not sustainable, moderately sustainable, sustainable, and highly sustainable. The arms were compared with ANOVA and Kruskal-Wallis test, with significance set at 0.05. At two years post-project, the overall sustainability for the prevention of diarrhea was moderate in the four arms, while dengue prevention was not sustainable in three of the four arms, without statistically significant differences. Sustainability levels also varied in terms of benefits, interventions, capacity-building, and institutionalization. Maintenance of benefits and interventions in both diseases was more sustainable than institutionalization and capacity-building. The analysis of these variables is important for identifying the different factors that influence projects’ sustainability, related to their design and execution, organizational framework, and social context. Este estudo avaliou a sustentabilidade de um conjunto de intervenções para a prevenção de dengue e diarreia, em 33 escolas rurais nos municípios de Anapoima e La Mesa, Colômbia, dois anos pós-projeto. A sustentabilidade foi medida em duas categorias: manutenção dos benefícios e intervenções, e institucionalização e desenvolvimento de capacidades da comunidade. Foi comparada a sustentabilidade das intervenções que foram distribuídas em quatro áreas: intervenções para prevenir a diarreia, e também o dengue, combinadas para prevenir a diarreia e o dengue, e o controle. A pontuação final de cada área foi classificada em um entre cinco níveis de sustentabilidade: regressivo, não sustentável, moderadamente sustentável, sustentável e altamente sustentável. As diferentes áreas foram comparadas através das provas ANOVA e Kruskal-Wallis, com um nível de significância de 0,05. Em dois anos pós-projeto, foi observado que o nível total de sustentabilidade para a prevenção de diarreia foi moderadamente sustentável nas quatro áreas e para dengue não sustentável em três das quatro áreas, sem encontrar diferenças estatisticamente significativas entre elas. Também foi observado que os níveis de sustentabilidade variam, em quanto aos benefícios, intervenções, desenvolvimento de capacidades e institucionalização. A manutenção dos benefícios e das intervenções em ambas as doenças foi mais sustentável do que a institucionalização e desenvolvimento de capacidades. É importante o análise destas variáveis para identificar os diferentes fatores que influem na sustentabilidade dos projetos, em relação com o desenho e execução destes, com o marco organizativo, e com o contexto social.

Dengue and other vector-borne diseases are of great public health importance in Colombia. Vector surveillance and control activities are often focused at the household level. Little is known about the importance of nonhousehold sites, including schools, in maintaining vector-borne disease transmission. The objectives of this paper were to determine the mosquito species composition in rural schools in 2 municipalities in Colombia and to assess the potential risk of vector-borne disease transmission in school settings. Entomological surveys were carried out in rural schools during the dry and rainy seasons of 2011. A total of 12 mosquito species were found: Aedes aegypti, Anopheles pseudopunctipennis, Culex coronator, Cx. quinquefasciatus, and Limatus durhamii in both immature and adult forms; Ae. fluviatilis, Cx. nigripalpus, Cx. corniger, and Psorophora ferox in immature forms only; and Ae. angustivittatus, Haemagogus equinus, and Trichoprosopon lampropus in adult forms only. The most common mosquito species was Cx. quinquefasciatus. Classrooms contained the greatest abundance of adult female Ae. aegypti and Cx. quinquefasciatus. The most common Ae. aegypti breeding sites were containers classified as "others" (e.g., cans), followed by containers used for water storage. A high level of Ae. aegypti infestation was found during the wet season. Our results suggest that rural schools are potentially important foci for the transmission of dengue and other mosquito-borne diseases. We propose that public health programs should be implemented in rural schools to prevent vector-borne diseases.

This study evaluated the sustainability of a set of interventions to prevent dengue and diarrhea in 33 rural schools in the municipalities (counties) of Anapoima and La Mesa, Colombia, two years post-project. The study measured sustainability in two categories: maintenance of the benefits and the interventions, and institutionalization and community capacity-building. The sustainability of the interventions was compared across four arms: interventions to prevent diarrhea, to prevent dengue, combined interventions to prevent diarrhea and dengue, and control. The final score for each arm was classified in five levels of sustainability: regressive, not sustainable, moderately sustainable, sustainable, and highly sustainable. The arms were compared with ANOVA and Kruskal-Wallis test, with significance set at 0.05. At two years post-project, the overall sustainability for the prevention of diarrhea was moderate in the four arms, while dengue prevention was not sustainable in three of the four arms, without statistically significant differences. Sustainability levels also varied in terms of benefits, interventions, capacity-building, and institutionalization. Maintenance of benefits and interventions in both diseases was more sustainable than institutionalization and capacity-building. The analysis of these variables is important for identifying the different factors that influence projects' sustainability, related to their design and execution, organizational framework, and social context.Este estudio evaluó la sostenibilidad de un conjunto de intervenciones para la prevención del dengue y la diarrea, en 33 escuelas rurales en los municipios de Anapoima y La Mesa, Colombia, dos años post-proyecto. Se midió la sostenibilidad en dos categorías: mantenimiento de los beneficios e intervenciones, e institucionalización y desarrollo de capacidades de la comunidad. Se comparó la sostenibilidad de las intervenciones que fueron distribuidas en cuatro brazos: intervenciones para prevenir la diarrea, para prevenir el dengue, combinadas para prevenir la diarrea y el dengue, y control. El puntaje final de cada brazo se clasificó en uno de cinco niveles de sostenibilidad: regresivo, no sostenible, moderadamente sostenible, sostenible y altamente sostenible. Se compararon los brazos mediante las pruebas ANOVA y Kruskal-Wallis, con un nivel de significancia de 0,05. A los dos años post-proyecto, se observa que el nivel total de sostenibilidad para la prevención de diarrea fue moderadamente sostenible en los cuatro brazos y para dengue no sostenible en tres de los cuatro brazos, sin encontrar diferencias estadísticamente significativas entre estos. También se observa que los niveles de sostenibilidad varían, en cuanto a los beneficios, intervenciones, desarrollo de capacidades e institucionalización. El mantenimiento de los beneficios y de las intervenciones en ambas enfermedades fue más sostenible que la institucionalización y desarrollo de capacidades. Es importante el análisis de estas variables para identificar los diferentes factores que influyen en la sostenibilidad de los proyectos, relacionados con el diseño y ejecución de estos, con el marco organizacional, y con el contexto social.Este estudo avaliou a sustentabilidade de um conjunto de intervenções para a prevenção de dengue e diarreia, em 33 escolas rurais nos municípios de Anapoima e La Mesa, Colômbia, dois anos pós-projeto. A sustentabilidade foi medida em duas categorias: manutenção dos benefícios e intervenções, e institucionalização e desenvolvimento de capacidades da comunidade. Foi comparada a sustentabilidade das intervenções que foram distribuídas em quatro áreas: intervenções para prevenir a diarreia, e também o dengue, combinadas para prevenir a diarreia e o dengue, e o controle. A pontuação final de cada área foi classificada em um entre cinco níveis de sustentabilidade: regressivo, não sustentável, moderadamente sustentável, sustentável e altamente sustentável. As diferentes áreas foram comparadas através das provas ANOVA e Kruskal-Wallis, com um nível de significância de 0,05. Em dois anos pós-projeto, foi observado que o nível total de sustentabilidade para a prevenção de diarreia foi moderadamente sustentável nas quatro áreas e para dengue não sustentável em três das quatro áreas, sem encontrar diferenças estatisticamente significativas entre elas. Também foi observado que os níveis de sustentabilidade variam, em quanto aos benefícios, intervenções, desenvolvimento de capacidades e institucionalização. A manutenção dos benefícios e das intervenções em ambas as doenças foi mais sustentável do que a institucionalização e desenvolvimento de capacidades. É importante o análise destas variáveis para identificar os diferentes fatores que influem na sustentabilidade dos projetos, em relação com o desenho e execução destes, com o marco organizativo, e com o contexto social.

Resumen El rabdomioma es un tumor poco frecuente, más aún cuando es diagnosticado en la vida intrauterina; su pronóstico es variable y su etiología permanece desconocida. Se manifiesta clínicamente en la vida fetal de forma asintomática hasta generar un compromiso catastrófico por arritmias severas, hidrops y muerte. Se describe el caso de una paciente primigestante, de 25 años de edad, remitida por masa cardiaca fetal, en cuyo feto y mediante ecografía se le encontraron imágenes ecogénicas en el ventrículo izquierdo, adheridas al septo, sin compromiso hemodinámico. Al nacer, la resonancia evidenció nódulos subependimarios bilaterales. Se decidió tratar con anticonvulsivantes. Discusión: El rabdomioma corresponde al 60% de los tumores cardiacos fetales, y le siguen en frecuencia los teratomas y los fibromas. Los factores de riesgo asociados se desconocen. El diagnóstico se apoya en una visión de 4 cámaras. El pronóstico depende del compromiso. Conclusiones: Las arritmias severas y el hidrops pueden conducir a muerte fetal como consecuencia del rabdomioma cardiaco. Por tanto, se debe llevar a cabo un seguimiento continuo, además de considerar distintos diagnósticos diferenciales. Abstract Rhabdomyomas are rare tumors, even more so when diagnosed in intrauterine life; their prognosis is variable and etiology remains unknown. Their clinical expression in fetal life is asymptomatic until they develop a catastrophic impairment of severe arrhythmias, hydrops and death. We report a case of a 25 year-old primigravid woman, referred for a fetal cardiac mass, in a fetus where an ultrasound revealed left ventricular echogenic focus without hemodynamic impairment. At birth, resonance evidenced bilateral subependymal nodes. Anticonvulsant drugs were the treatment of choice. Discussion: Rhabdomyoma account for 60% of fetal cardiac tumors, followed in frequency by teratomas and fibroids. Associated risk factors are unknown. Diagnosis relies on vision of a 4 D vision camera. Prognosis depends on impairment. Conclusions: Severe arrhythmias and hydrops can lead to fetal death as a consequence of cardiac rhabdomyoma. Thus a constant monitoring must be maintained, as well as considering multiple differential diagnosis.

Resumen Introducción. El retraso del crecimiento o la desnutrición crónica (baja estatura para la edad) indica un fracaso en el logro del potencial genético con el que nacemos. Objetivo. Estimar modelos predictivos de retraso del crecimiento en hogares con menores de cinco años en el departamento de Caldas, inscritos en el Sistema de Identificación de Potenciales Beneficiarios de Programas Sociales (Sisbén). Materiales y métodos. Se hizo un estudio analítico en todos los hogares (N=56.987) incluidos en la base de datos del Sisbén III con presencia de menores de cinco años (N=33.244). Las variables estudiadas fueron las características demográficas y socioeconómicas, el acceso a la salud, la vivienda, la pobreza, la educación, el mercado laboral y el retraso del crecimiento. El análisis multivariado se realizó en dos fases: en la primera, se llevó a cabo un análisis exploratorio en los hogares mediante un análisis de clasificación jerárquica (conglomerado) y, luego, se estimó un modelo no lineal predictivo (probit) con el retraso del crecimiento como variable dependiente. Resultados. La mayor proporción de retraso del crecimiento en los menores de cinco años se encontró en la subregión Centro Sur, en la cabecera municipal y en los hogares con ingresos menores de USD$65 mensuales. Conclusión. La pobreza de los hogares caldenses con jefatura femenina en los que viven los menores de cinco años inscritos en el Sisbén, es el mayor predictor de su retraso en el crecimiento. Abstract Introduction: Growth retardation or chronic malnutrition (low height for age) indicates a failure in the natural genetic potential that allows us to growth. Objective: To estimate predictive models of growth retardation in households with children younger than five years in the department of Caldas and registered in the identification system of potential beneficiaries of social programs ( Sistema de Identificación de Potenciales Beneficiarios de Programas Sociales, Sisbén ). Materials and methods: We conducted an analytical study in all households (N=56,987) included in the Sisbén III database with the presence of children younger than five years (N=33,244). The variables under study were demographic and socioeconomic characteristics, health service access, housing, poverty, education, job market, and growth retardation. The multivariate analysis was done in two phases: first, an exploratory analysis of households using hierarchical classification (cluster), then estimation of a nonlinear predictive model (probit) with growth retardation as the dependent variable. Results. The largest proportion of growth retardation in children younger than five years was found in southcentral Caldas, in urban centers, and households with monthly income lower than USD$ 65. Conclusion. Poverty in Caldas women-headed households with children younger than five years registered in the Sisbén was the main predictor of growth retardation.

The Aedes aegypti vector for dengue virus (DENV) has been reported in urban and periurban areas. The information about DENV circulation in mosquitoes in Colombian rural areas is limited, so we aimed to evaluate the presence of DENV in Ae. aegypti females caught in rural locations of two Colombian municipalities, Anapoima and La Mesa. Mosquitoes from 497 rural households in 44 different rural settlements were collected. Pools of about 20 Ae. aegypti females were processed for DENV serotype detection. DENV in mosquitoes was detected in 74% of the analysed settlements with a pool positivity rate of 62%. The estimated individual mosquito infection rate was 4.12% and the minimum infection rate was 33.3/1,000 mosquitoes. All four serotypes were detected; the most frequent being DENV-2 (50%) and DENV-1 (35%). Two-three serotypes were detected simultaneously in separate pools. This is the first report on the co-occurrence of natural DENV infection of mosquitoes in Colombian rural areas. The findings are important for understanding dengue transmission and planning control strategies. A potential latent virus reservoir in rural areas could spill over to urban areas during population movements. Detecting DENV in wild-caught adult mosquitoes should be included in the development of dengue epidemic forecasting models.

Background As many neglected tropical diseases are co-endemic and have common risk factors, integrated control can efficiently reduce disease burden and relieve resource-strained public health budgets. Diarrheal diseases and dengue fever are major global health problems sharing common risk factors in water storage containers. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Integrating improved water management and educational strategies for both diseases in the school environment can potentially improve the health situation for students and the larger community. The objective of this trial was to investigate whether interventions targeting diarrhea and dengue risk factors would significantly reduce absence due to diarrheal disease and dengue entomological risk factors in schools. Methodology/Principal Findings A factorial cluster randomized controlled trial was carried out in 34 rural primary schools (1,301 pupils) in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Schools were randomized to one of four study arms: diarrhea interventions (DIA), dengue interventions (DEN), combined diarrhea and dengue interventions (DIADEN), and control (CON). Interventions had no apparent effect on pupil school absence due to diarrheal disease (p = 0.45) or on adult female Aedes aegypti density (p = 0.32) (primary outcomes). However, the dengue interventions reduced the Breteau Index on average by 78% (p = 0.029), with Breteau indices of 10.8 and 6.2 in the DEN and DIADEN arms, respectively compared to 37.5 and 46.9 in the DIA and CON arms, respectively. The diarrhea interventions improved water quality as assessed by the amount of Escherichia coli colony forming units (CFU); the ratio of Williams mean E. coli CFU being 0.22, or 78% reduction (p = 0.008). Conclusions/Significance Integrated control of dengue and diarrhea has never been conducted before. This trial presents an example for application of control strategies that may affect both diseases and the first study to apply such an approach in school settings. The interventions were well received and highly appreciated by students and teachers. An apparent absence of effect in primary outcome indicators could be the result of pupils being exposed to risk factors outside the school area and mosquitoes flying in from nearby uncontrolled breeding sites. Integrated interventions targeting these diseases in a school context remain promising because of the reduced mosquito breeding and improved water quality, as well as educational benefits. However, to improve outcomes in future integrated approaches, simultaneous interventions in communities, in addition to schools, should be considered; using appropriate combinations of site-specific, effective, acceptable, and affordable interventions. Trial Registration ClinicalTrials.gov no. ISRCTN40195031, Author Summary Many tropical diseases co-occur in the same areas and have overlapping risk factors and strategies for control and prevention. Therefore, integrating several diseases in control activities can be both effective and cost-efficient. We evaluated sets of diarrhea and dengue interventions in rural primary schools in Colombia to reduce absence due to diarrheal disease among pupils and dengue risk factors. Integrating the control of these two diseases is justified because of the potential joint risk factor of water storage behavior. Stored drinking water may be contaminated with enteric pathogens and such containers also provide breeding opportunities for dengue vectors. Water storage is common in schools in many tropical countries. Although the study did not demonstrate clear evidence of a reduction in pupil absence due to diarrhea or reductions of adult mosquito densities in schools, significant reductions were detected in the number of mosquito breeding sites and drinking water quality was significantly improved. Integrated disease control interventions in school settings should be further explored to prevent diseases with overlapping etiologies amongst pupils and school staff.

Antecedentes.Las enfermedades diarreicas y el dengue son graves problemas de salud pública a nivel global. Cuando el suministro de agua potable es inadecuado, el almacenamiento de agua es crucial. La contaminación fecal del agua almacenada es una fuente común de las enfermedades diarreicas y, al mismo tiempo, el agua almacenada proporciona criaderos para los mosquitos vectores del dengue. Un manejo deficiente del agua doméstica y del saneamiento son, por lo tanto, determinantes potenciales de ambas enfermedades. Poco se sabe de la importancia del agua almacenada para el riesgo combinado de la diarrea y el dengue, sin embargo, una intervención compartida podría ser importante para el desarrollo de esfuerzos en gestión y control integrado. Aun menos conocidos son los efectos de un control integrado de estas enfermedades en los entornos escolares.El objetivo de este estudio fue investigar si las intervenciones contra la diarrea y el dengue reducían significativamente las enfermedades diarreicas y los factores de riesgo entomológico de dengue, en las escuelas primarias rurales de dos municipios de Cundinamarca.Metodología y diseño. Se trata de un ensayo por conglomerados, factorial de 2 x 2, controlado y de asignación aleatoria. Las instituciones elegibles fueron las escuelas rurales de los municipios de La Mesa y Anapoima en el departamento de Cundinamarca. Los estudiantes elegibles fueron los niños de las escuelas de los grados 0 a 5. Las escuelas fueron asignadas aleatoriamente a uno de los cuatro grupos del estudio: intervenciones de diarrea, intervenciones de dengue, las dos intervenciones, diarrea y dengue, y control. Las escuelas fueron estratificadas por municipio y asignadas mediante un acto público al inicio del ensayo. La variable de respuesta primaria para la diarrea fue la tasa de incidencia de diarrea en los niños de las escuelas, y para dengue, la densidad de adultos hembra de Aedes aegypti por escuela. Aproximadamente, 800 estudiantes de 34 escuelas se inscribieron en el ensayo con ocho escuelas en el grupo de diarrea, nueve en el de dengue, ocho en el de diarrea y dengue, y nueve en el grupo control. El ensayo fue financiado por el Consejo de Investigaciones de Noruega, la Universidad El Bosque y la Fundación Lazos de CalandaimaDiscusión. Este es el primer ensayo en que se investiga el efecto de un conjunto de intervenciones integradas para controlar las dos enfermedades, dengue y diarrea. Es también el primer ensayo para estudiar la combinación de intervenciones para el control de dichas enfermedades en entornos escolares.El artículo original fue publicado en inglés como: Diarrhea and dengue control in rural primary schools in Colombia – study protocol for a randomized controlled. Trial. 2012; 13:182. BioMed Central es el editor original del artículo. La información para la traducción de la publicación en español fue actualizada..© 2012 Overgaard HJ, et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Background Diarrheal diseases and dengue fever are major global health problems. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Poor household water management and sanitation are therefore potential determinants of both diseases. Little is known of the role of stored water for the combined risk of diarrhea and dengue, yet a joint role would be important for developing integrated control and management efforts. Even less is known of the effect of integrating control of these diseases in school settings. The objective of this trial was to investigate whether interventions against diarrhea and dengue will significantly reduce diarrheal disease and dengue entomological risk factors in rural primary schools. Methods/design This is a 2×2 factorial cluster randomized controlled trial. Eligible schools were rural primary schools in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Eligible pupils were school children in grades 0 to 5. Schools were randomized to one of four study arms: diarrhea interventions (DIA); dengue interventions (DEN); combined diarrhea and dengue interventions (DIADEN); and control (C). Schools were allocated publicly in each municipality (strata) at the start of the trial, obviating the need for allocation concealment. The primary outcome for diarrhea is incidence rate of diarrhea in school children and for dengue it is density of adult female Aedes aegypti per school. Approximately 800 pupils from 34 schools were enrolled in the trial with eight schools in the DIA arm, nine in the DEN, eight in the DIADEN, and nine in the control arms. The trial status as of June 2012 was: completed baseline data collections; enrollment, randomization, and allocation of schools. The trial was funded by the Research Council of Norway and the Lazos de Calandaima Foundation. Discussion This is the first trial investigating the effect of a set of integrated interventions to control both dengue and diarrhea. This is also the first trial to study the combination of diarrhea-dengue disease control in school settings. Trial registration Current Controlled Trials ISRCTN40195031

RESUMENObjetivo: El objetivo del estudio fue compararla frecuencia de partos operatorios por sospechade compromiso fetal, entre dos grupos de mujeresen trabajo de parto: uno en control cardiotocogra-fico convencional y otro con monitoreo cardiotoco-grafico y oximetria de pulso fetal. Metodos: Elestudio prospectivo, multicentrico, randomizado ycontrolado, de oximetria fetal intraparto (el estudioFOREMOST) fue conducido en 4 maternidadesaustralianas. El resultado primario fue la tasa departo operatorio debido a sospecha de compromi-so fetal. Resultados: Hubo una disminucion signi-ficativa de un 23% en el riesgo relativo de partooperatorio por sospecha de compromiso fetal, enel grupo de oximetria mas cardiotocografia (n= 75/305, 25%), comparado con el grupo cardiotocogra-fia (n= 95/295, 32%) (riesgo relativo 0,77; IC 95%de 0,599 - 0,999; p = 0,048). No hubo diferenciassignificativas en la tasa global de parto operatorio(oximetria fetal + cardiotocografia 73%, cardiotoco-grafia sola 71%, riesgo relativo 1,04; IC 95% de0,94 -1,15; p= 0,478) o en el resultado neonatal.Conclusion: El uso de la oximetria de pulso fetalpara mejorar la evaluacion fetal durante el trabajode parto, resulto en una reduccion significativa enel parto operatorio debido a sospecha de compro-miso fetal, comparado con el uso convencional dela cardiotocografia sola. Esta reduccion se alcan-zo sin diferencias significativas en el resultadoneonatal.ANALISIS DE LA INVESTIGACIONA. Relevancia clinica?Es posible mejorar la eficacia diagnostica dela cardiotocografia intraparto mediante la oximetriade pulso fetal?Escenario clinico: El monitoreo fetal intrapartoes una herramienta diagnostica poco especifica,con una elevada tasa de falsos positivos. Su usose asocia a un aumento significativo en la tasa departos operatorios (principalmente cesareas) porsospecha de compromiso fetal, sin una mejoriasignificativa en el pronostico neonatal (2). Se habuscado metodos que, sumados a la cardiotoco-grafia, provean una mejor acuciosidad diagnostica,evitando intervenciones innecesarias. Se postulaque el registro continuo del porcentaje de satura-cion de la hemoglobina, mediante oximetria depulso fetal, en pacientes con cardiotocografiaintraparto sospechosa, permitiria mejorar la espe-cificidad diagnostica al identificar a los falsos posi-tivos de la cardiotocografia. Se han publicado dosestudios randomizados que analizan este metododiagnostico, uno de ellos sugiere beneficio (3),mientras que el otro lo descarta (4).B. El estudio (1)Diseno: Estudio randomizado, controlado, nociego, realizado en gestantes a termino con unmonitoreo fetal patologico. Pacientes: Embaraza

Background Fourteen African countries are scaling up voluntary medical male circumcision (VMMC) for HIV prevention. Several devices that might offer alternatives to the three WHO-approved surgical VMMC procedures have been evaluated for use in adults. One such device is PrePex, which was prequalified by the WHO in May 2013. We utilized data from one of the PrePex field studies undertaken in Zimbabwe to identify cost considerations for introducing PrePex into the existing surgical circumcision program. Methods and Findings We evaluated the cost drivers and overall unit cost of VMMC at a site providing surgical VMMC as a routine service (“routine surgery site”) and at a site that had added PrePex VMMC procedures to routine surgical VMMC as part of a research study (“mixed study site”). We examined the main cost drivers and modeled hypothetical scenarios with varying ratios of surgical to PrePex circumcisions, different levels of site utilization, and a range of device prices. The unit costs per VMMC for the routine surgery and mixed study sites were $56 and $61, respectively. The two greatest contributors to unit price at both sites were consumables and staff. In the hypothetical scenarios, the unit cost increased as site utilization decreased, as the ratio of PrePex to surgical VMMC increased, and as device price increased. Conclusions VMMC unit costs for routine surgery and mixed study sites were similar. Low service utilization was projected to result in the greatest increases in unit price. Countries that wish to incorporate PrePex into their circumcision programs should plan to maximize staff utilization and ensure that sites function at maximum capacity to achieve the lowest unit cost. Further costing studies will be necessary once routine implementation of PrePex-based circumcision is established.