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Item type:Publication, El Niño/Southern Oscillation (ENSO) and stunting in children under 5 years in Peru: a double-difference analysis(Elsevier, 2020-04-01)Background The 1997–98 El Niño/Southern Oscillation (ENSO) was one of the most important natural disasters in 20th century Peru, associated with heavy rainfall and flooding. It affected 502 000 people, ruined 944 km of roads, and damaged 580 health centres and 956 schools. Almost a quarter of all people affected (23%) came from Piura, in the northwest of Peru. In this study, we assessed the association between the 1997–98 ENSO and growth stunting in children younger than 5 years on Peru's north coast. Methods We analysed Peruvian Demographic and Health Survey (DHS) data, from 1996 and 2000, using a double-difference approach. Our primary outcome was childhood growth stunting, and our exposure was the ENSO phenomenon. The exposed group was from Peru's Piura coast, and the unexposed group was from southern coastal regions, which were less affected by the events associated with ENSO 1997–98. First, we conducted a regional comparison. Secondly, we used propensity score matching (PSM) to explore similarities between the exposed and non-exposed groups. We then estimated adjusted prevalence ratios (PR) of childhood growth stunting using generalised linear models. Finally, we conducted a subanalysis by childhood age. Findings We studied 2270 and 1349 children younger than 5 years from 1996 and 2000, respectively. Regression without matching showed a PR of 1·37 (95% CI 0·93–2·01), and a PSM regression 1-to-2 PR of 1·45 (0·66–3·18), obtaining a PR greater than 1 but with a confidence interval that included the null value. Furthermore, we found a possible effect on children aged 0–11 months. In the regressions without PSM, analysis for this age group showed a PR of 2·48 (1·11–5·54); whereas, after PSM 1-to-2, the PR was 2·69 (1·03–7·03); alternative PSM was also consistent with these results. Analysis of the other age groups yielded results that were not statistically significant. Interpretation Our results suggest that the ENSO phenomenon could have increased childhood stunting on the coast of Piura. More specifically, children who were aged 0 to 11 months during the worst and most disruptive period of the El Niño phenomenon were at increased risk of growth stunting. Our results were consistent with and without PSM. Factors that might have contributed to our results include increased childhood morbidity with concurrent reductions in maternal and familial access to health care, and diminished household incomes due to El Niño's devastating effects during the disaster period. Our findings outline a need to prevent harm to people and their health during weather and natural events associated with ENSO. Specifically, there is a need for childhood-focused social protection systems, especially during critical stages of growth and development. Childhood-focused social protection and delivery systems will be instrumental in preventing downstream effects of similar climatic events. Funding Fogarty 2D43 TW007393. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Network Profile: Improving Response to Malaria in the Amazon Through Identification of Inter-Community Networks and Human Mobility in Border Regions of Ecuador, Peru, and Brazil(2023-11-30)Objectives Understanding human mobility’s role on malaria transmission is critical to successful control and elimination. However, common approaches to measuring mobility are ill-equipped for remote regions such as the Amazon. This study develops a network survey to quantify the effect of community connectivity and mobility on malaria transmission. Design A community-level network survey Setting We collect data on community connectivity along three river systems in the Amazon basin: the Pastaza river corridor spanning the Ecuador-Peru border; and the Amazon and Javari river corridors spanning the Brazil-Peru border. Participants We interviewed key informants in Brazil, Ecuador, and Peru, including from indigenous communities: Shuar, Achuar, Shiwiar, Kichwa, Ticuna, and Yagua. Key informants are at least 18 years of age and are considered community leaders. Primary outcome Weekly, community-level malaria incidence during the study period. Methods We measure community connectivity across the study area using a respondent driven sampling design. Forty-five communities were initially selected: 10 in Brazil, 10 in Ecuador, and 25 in Peru. Participants were recruited in each initial node and administered a survey to obtain data on each community’s mobility patterns. Survey responses were ranked and the 2-3 most connected communities were then selected and surveyed. This process was repeated for a third round of data collection. Community network matrices will be linked with eadch country’s malaria surveillance system to test the effects of mobility on disease risk. Findings To date, 586 key informants were surveyed from 126 communities along the Pastaza river corridor. Data collection along the Amazon and Javari river corridors is ongoing. Initial results indicate that network sampling is a superior method to delineate migration flows between communities. Conclusions Our study provides measures of mobility and connectivity in rural settings where traditional approaches are insufficient, and will allow us to understand mobility’s effect on malaria transmission. Strengths and Limitations Strength: Community networks are unmeasured in rural areas of the Amazon, but have been shown to capture human mobility in other regions of the world. Strength: Our design captures social, economic, and human wellbeing connectivity and migration in key indigenous communities along the Peru-Ecuador border as well as in the most important confluence for the Amazon River located in the Brazil-Peru-Colombia tri-country intersection. Strength: Our design quantifies cross-border human mobility between communities, as well as the magnitude, timing, duration, and reason for mobility, which provides actionable information for malaria control and elimination programs in the region Limitation: Migration decisions occur at individual and household levels that are coupled with environmental change and seasonality, meaning that our measures of community mobility may not be stable over time and we may be subject to ecological fallacy by inferring individual risk from community networks. Limitation: Our study relies on passive surveillance to test the community network/human mobility link with malaria. However, there exist cases that are asymptomatic, unreported (i.e., treated with traditional medicines), or that occur in our community network but are reported elsewhere. The extent of these cases can significantly increase uncertainty. Funding This work was supported by the US National Institutes of Health (R01 AI51056; William K. Pan, PI) and by a grant from the Duke Climate and Health Initiative (William Pan, PI). PRC-U was supported by CONCYTEC through the PROCIENCIA program under the call entitled “Science, Technology and Innovation Thesis and Internships” according to the contract PE501081617-2022. AGL, CSC, EJA and PRC-U were sponsored by Emerge, the Emerging Diseases Epidemiology Research Training grant D43 TW007393 awarded by the Fogarty International Center of the US National Institutes of Health. Competing Interests We declare no conflicts