Experiencia de Honduras:Creación de una base de datos ...
Transcript of Experiencia de Honduras:Creación de una base de datos ...
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Experiencia de Honduras:Creación de una base
de datos epidemiológicos
Prof. Lazaro Molina
Prof. Marco T Medina
Universidad Nacional Autonoma de Honduras
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PAHO STRATEGY AND PLAN OF ACTION ON
EPILEPSY
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HONDURAS is a Low middle income country (World Bank) of 8 million
people
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National Autonomous University of Honduras
School of Medical Sciences
• Honduras founded the School of Medical Sciences in 1882 at the National Autonomous University of Honduras (UNAH).
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A Joint project of Neurologists in Honduras and the WFN
• The UNAH Universitary Council approved the progam in October 29th, 1998
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Formación de Neurólogos y Epileptólogos WFN
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Honduras World Federation of Neurology Certification
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HONDURAS NEUROLOGY TRAINING PROGRAM AND
ILAE 1. ILAE Honduras Chapter Since 1994
2. Since 1998 new neurologists trained in Honduras currently represent 50% of the Hondurans neurologists . One of the most significant consequences of the Neurology Training Program in Honduras has been this improvement in the neurologist– population ratio by 35% from 1:325,000 to approximately 1:230,000 between 1998 and 2012. Four Epileptologists and nine child neurologists
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Background: Epidemiological Studies in Honduras
• A 1999-2000 National Population based epilepsy prevalence study of 135,035 inhabitants
• Mean National Epilepsy Prevalence of 6.63/1000.Incidence 104 x 100,000
• Range: 1 to 23.3/1000
• Molina L, Medina MT. Prevalencia e Incidencia de la Epilepsia en Honduras. Rev Postgrado UNAH 2003.
• Medina MT, Molina L, Durón R, et al. Prevalence of the Epilepsies in Honduras.A National Population-Based Study. Epilepsia 2003;44(Suppl.8):155. International Epilepsy Conference , Lisbon, 2003
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Basic Research/Genetic Epidemiology on Childhood Absence Epilepsy and Juvenile Myoclonic epilepsy genes (NIH Supported)
• Tanaka M, Olsen RW, Medina MT, et al Am J Hum Genet. 2008
• Suzuki et al Nature Genetics 2004
• Medina et al Neurology 2008
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The Neurology Training Program has collaborated with the WHO and PAHO on Neuroinfections, the ICD-11 and PAHO Strategy and Plan of
Action
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Neuroinfections: Neurocysticercosis is one of the most common neurological problem
worldwide
• WHO 2007
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Salama Study: Active epilepsy prevalence (15.4), incidence (92.7), and Etiologies.
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Etiologies: Neurocysticercosis (36.6%), Perinatal brain damage (7.8%), Idiopathic (7.8%), etc
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Previous Treatment Gap in the Salama Study was 58%
• Meyer et al Bull World Health Org 2010;88:260-68
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Neurology Training Program and Honduras Community Intervention
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Interventions strategies
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Interventions
1) Education on nutrition and sanitation primarily targeting healthcare providers and community leaders as well as the local citizens by means of brochures, posters, public meetings/conferences, and public communication media.
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Intervention (2)
• 2) Ongoing education along with deparasitization and stool analyses
surveillance for Taenia solium in more than 12,000 toddlers and school-aged children over the 8 years in the Salamá municipalities.
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Intervention (3)
• 3) Improving access to potable water primarily by improving contaminated water and waste disposal infrastructure in the highest risk communities based on the initial prevalence studies.
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Intervention (4)
• 4) Construction and equipping of a county maternal-fetal health clinic and obstetric delivery suite supplied with an ambulance for transportation of emergencies to secondary or tertiary hospitals.
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Intervention (5)
• 5) Education on animal husbandry for county farmers, primarily pig farmers, was instituted by the Department of Agriculture and follow-up inspections made by local authorities for compliance to these established animal-related health codes.
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Epidemiological Surveillance
• On site epidemiological surveillance. An epidemiologist living in the area was appointed.
• The Neurology Training Program was founded, and one of its main aim has been to provide the neurological care and supervision ( locally and at the University Hospital in the capital city)
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Incidence
• Medina MT, Aguilar-Estrada RL, Alvarez A, Durón RM, Martínez L, Dubón S, et al Reduction in
rate of epilepsy from neurocysticercosis by community interventions: the Salamá, Honduras study. Epilepsia. 2011 Jun;52(6):1177-85
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Etiologies
• Medina MT, Aguilar-Estrada RL, Alvarez A, Durón RM,Dubon SA et al . Reduction in rate of
epilepsy from neurocysticercosis by community interventions: the Salamá, Honduras study. Epilepsia. 2011 Jun;52(6):1177-85
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Conclusion
• Community Interventions can reduce rate of preventable Epilepsy from Neurocysticercosis
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Promoting patient advocacy groups
• Honduras Epilepsy Foundation (IBE Chapter)
•
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UNAH: New Imaging (i.e.,3 Tesla MRI), Rehabilitation and Research
Center (i.e., molecular biology) at the UNAH (2013)
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Estudios sobre Medicina complementaria y alternativa
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Cohorte sobre status Epilepticus
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Background
• In August 20th to 22nd 2008 a Regional Workshop in Tegucigalpa, suggested a Demonstrative Treatment Gap Study in Honduras
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Epilepsy Treatment Gap Project