Effects of the 1997-1998 El Niño episode on community rates of diarrhea.
ABSTRACT To improve our understanding of climate variability and diarrheal disease at the community level and inform predictions for future climate change scenarios, we examined whether the El Niño climate pattern is associated with increased rates of diarrhea among Peruvian children.
We analyzed daily surveillance data for 367 children aged 0 to 12 years from 2 cohorts in a peri-urban shantytown in Lima, Peru, 1995 through 1998. We stratified diarrheal incidence by 6-month age categories, season, and El Niño, and modeled between-subject heterogeneity with random effects Poisson models.
Spring diarrheal incidence increased by 55% during El Niño compared with before El Niño. This increase was most acute among children older than 60 months, for whom the risk of a diarrheal episode during the El Niño spring was nearly 100% greater (relative risk=1.96; 95% confidence interval=1.24, 3.09).
El Niño-associated climate variability affects community rates of diarrhea, particularly during the cooler seasons and among older children. Public health officials should develop preventive strategies for future El Niño episodes to mitigate the increased risk of diarrheal disease in vulnerable communities.
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ABSTRACT: Background In endemic settings, Helicobacter pylori infection can occur shortly after birth and may be associated with a reduction in childhood growth.Materials and Methods This study investigated what factors promote earlier age of first H. pylori infection and evaluated the role of H. pylori infection in infancy (6–11 months) versus early childhood (12–23 months) on height. We included 183 children near birth from a peri-urban shanty town outside of Lima, Peru. Field-workers collected data on socioeconomic status (SES), daily diarrheal and breast-feeding history, antibiotic use, anthropometrics, and H. pylori status via carbon 13-labeled urea breath test up to 24 months after birth. We used a proportional hazards model to assess risk factors for earlier age at first detected infection and linear mixed-effects models to evaluate the association of first detected H. pylori infection during infancy on attained height.ResultsOne hundred and forty (77%) were infected before 12 months of age. Lower SES was associated with earlier age at first detected H. pylori infection (low vs middle-to-high SES Hazard ratio (HR) 1.59, 95% CI 1.16, 2.19; p = .004), and greater exclusive breast-feeding was associated with reduced likelihood (HR 0.63, 95% CI 0.40, 0.98, p = .04). H. pylori infection in infancy was not independently associated with growth deficits (p = .58). However, children who had their first detected H. pylori infection in infancy (6–11 months) versus early childhood (12–23 months) and who had an average number of diarrhea episodes per year (3.4) were significantly shorter at 24 months (−0.37 cm, 95% CI, −0.60, −0.15 cm; p = .001).DiscussionLower SES was associated with a higher risk of first detected H. pylori infection during infancy, which in turn augmented the adverse association of diarrheal disease on linear growth.Helicobacter 04/2014; DOI:10.1111/hel.12130 · 2.99 Impact Factor
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ABSTRACT: Background: El Niño is responsible for natural disasters and infectious disease outbreaks worldwide. During the 1997–1998 El Niño, northern Peru endured extreme rainfall and flooding. Since short stature may occur as a result of undernutrition or repeated infections during childhood, both of which are highly prevalent during natural disasters, we sought to determine if the 1997–1998 El Niño had an adverse effect on stature and body composition a decade later. In 2008–2009, we measured height, weight, and bioimpedance in a random sample of 2,095 children born between 1991 and 2001 in Tumbes, Peru. Results: Height-for-age increased by 0.09 SD/year of birth between 1991 and 1997 (P < 0.001), indicating overall improvements in health over time in the study area; however, this rate fell to 0.04 SD/year of birth during and shortly after El Niño, less than half the rate prior to El Niño (P = 0.046). Height shortfalls were even greater in children residing in households most likely to be flooded after El Niño. Any improvement over time was completely blunted and became negative in children living in households with flood likelihoods of ≥7% (P = 0.001). In the subset of 912 children with bioimpedance measurements, those born after the onset of El Niño had less lean mass (P < 0.001), whereas fat mass was unaffected (P = 0.48). Conclusions: Children born during and after 1997–1998 El Niño were on average shorter and had less lean mass for their age and sex than expected had El Niño not occurred. The effects of El Niño on health are long lasting and, given its cyclical nature, may continue to negatively impact future generations.11/2014; 1(7). DOI:10.1186/s40665-014-0007-z
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ABSTRACT: This article is a review of the pollution of water, air and the effect of climate change on the health of the Peruvian population. A major air pollutant is particulate matter less than 2.5 μ (PM 2.5). In Lima, 2,300 premature deaths annually are attributable to this pollutant. Another problem is household air pollution by using stoves burning biomass fuels, where excessive indoor exposure to PM 2.5 inside the household is responsible for approximately 3,000 annual premature deaths among adults, with another unknown number of deaths among children due to respiratory infections. Water pollution is caused by sewage discharges into rivers, minerals (arsenic) from various sources, and failure of water treatment plants. In Peru, climate change may impact the frequency and severity of El Niño Southern Oscillation (ENSO), which has been associated with an increase in cases of diseases such as cholera, malaria and dengue. Climate change increases the temperature and can extend the areas affected by vector-borne diseases, have impact on the availability of water and contamination of the air. In conclusion, Peru is going through a transition of environmental risk factors, where traditional and modern risks coexist and infectious and chronic problems remain, some of which are associated with problems of pollution of water and air.Revista peruana de medicina experimental y salud publica 09/2014; 31(3):547-56.