Ministry of Public Health and Social Assistance

Dengue is endemic throughout the tropical areas of the Americas, but little is known about its regional dynamics. We examined seasonal and multiannual dengue trends across the Americas and possible underlying mechanisms using monthly dengue surveillance data from 14 countries. We collected monthly dengue case data from 241 subnational locations in 14 countries, ranging from 1985 to 2018 (6 to 22 years), and used wavelet analysis to isolate seasonal (8 to 16 months) and multiannual (17+ months) patterns. For each location, we assessed seasonal and multiannual dynamics as well as coherence and differences in timing of dengue cycles between 22,578 location pairs. We assessed patterns in coherence over time and space and compared these patterns to variations in temperature, rainfall, and El Niño Southern Oscillation patterns. Strong synchrony in dengue dynamics was identified across the region at the seasonal and multiannual scales. Seasonal dengue dynamics were associated with local climate patterns and dengue dynamics in nearby locations. High synchrony at multiannual scales indicated that large dengue epidemics were shared across the region, with an average temporal lag of only 6 months at distances of up to 10,000 kilometers. Synchrony of these epidemics likely reflects both regional climate variability and human movement. Observed dengue dynamics were not unique to individual countries in the Americas but rather extended across the region reflecting climatic and nonclimatic drivers. These findings can support the development of better early warning tools to support epidemic preparedness and response and underscore the importance of working collaboratively across borders.

BackgroundTo demonstrate the application and utility of geostatistical modelling to provide comprehensive high‐resolution understanding of the population's protective immunity during a pandemic and identify pockets with sub‐optimal protection.MethodsUsing data from a national cross‐sectional household survey of 6620 individuals in the Dominican Republic (DR) from June to October 2021, we developed and applied geostatistical regression models to estimate and predict Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) spike (anti‐S) antibodies (Ab) seroprevalence at high resolution (1 km) across heterogeneous areas.ResultsSpatial patterns in population immunity to SARS‐CoV‐2 varied across the DR. In urban areas, a one‐unit increase in the number of primary healthcare units per population and 1% increase in the proportion of the population aged under 20 years were associated with higher odds ratios of being anti‐S Ab positive of 1.38 (95% confidence interval [CI]: 1.35–1.39) and 1.35 (95% CI: 1.32–1.33), respectively. In rural areas, higher odds of anti‐S Ab positivity, 1.45 (95% CI: 1.39–1.51), were observed with increasing temperature in the hottest month (per°C), and 1.51 (95% CI: 1.43–1.60) with increasing precipitation in the wettest month (per mm).ConclusionsA geostatistical model that integrates contextually important socioeconomic and environmental factors can be used to create robust and reliable predictive maps of immune protection during a pandemic at high spatial resolution and will assist in the identification of highly vulnerable areas.

The World Health Organization HEARTS Technical Package is a widely implemented global initiative to improve the primary care management of cardiovascular disease risk factors. The study's objective is to report outcomes from a pilot implementation trial of integrated hypertension and diabetes management based on the HEARTS model in Guatemala. We conducted a single-arm pilot implementation trial over 6 months from October 2023 to May 2024 in 11 Guatemalan Ministry of Health primary care facilities in two districts. The pilot evaluated a package of five HEARTS-aligned implementation strategies to improve the pharmacological treatment of hypertension and diabetes. The primary outcomes were feasibility and acceptability, measured through 20 structured interviews with Ministry of Health employees and by examining enrollment and retention. Secondary outcomes included a suite of implementation and clinical outcomes, including treatment rate. The study enrolled 964 patients, of whom 58.8% had hypertension only, 30.4% had diabetes only, and 10.8% had both conditions. Surveys on feasibility and acceptability among Ministry of Health staff had a median score of 5.0 (IQR: 5.0 to 5.0) and 5.0 (IQR range: 4.8 to 5.0), respectively, exceeding the prespecified benchmark of ≥3.5. Both districts achieved the prespecified benchmark of enrolling ≥25 hypertension patients and ≥25 diabetes patients. Only 36% of patients attended a follow-up visit within three months, lower than the prespecified benchmark of ≥75%. M treatment rates during the pilot increased by 22.3 (95% CI: 16.2 to 28.4; P<0.001) and 3.5 (95% CI: -1.6 to 8.7; P=0.17) patients per month for hypertension and diabetes, respectively. Implementation of an integrated hypertension and diabetes model based on HEARTS was generally feasible and acceptable in the Ministry of Health in Guatemala. Findings can refine national scale-up in Guatemala and inform HEARTS implementation projects in other settings.

Background: More than 75% of deaths from cardiovascular diseases (CVD) occur in low- and middle-income countries, yet there is limited adoption of evidence-based interventions to prevent CVD in these settings. The HEARTS Technical Package in Primary Care is the model recommended by the WHO to address this implementation gap. A key barrier of HEARTS is that many health systems lack sufficient resources to provide free access to medications for CVD and lack a system for patient monitoring and follow-up. Methods: We evaluated the implementation of the first official HEARTS project in the Ministry of Health (MoH) of Guatemala. The project was carried out in 6 primary healthcare facilities across 3 rural municipalities over 8 months. The population were predominantly of Indigenous Maya ethnicity, an ethnic group historically underserved by the MoH. HEARTS consists of six evidence-based, cost-effective components. These were complemented by 3 patient-centered strategies to enhance sustainability: (1) community-based social accountability intervention; (2) revolving-fund pharmacy operated by municipal governments to provide low-cost generic medications; and (3) facility-based digital monitoring tool (DHIS2). Results: We observed a 4-fold increase in treatment rate and a 14% absolute increase in the proportion of patients achieving blood pressure control. The availability of free antihypertensive medications was enhanced through the MoH and the revolving-fund pharmacy, improving adherence in 37%. Additional process outcomes include: 28 health personnel received training on hypertension clinical management; 16 self-help groups for hypertensive patients were supported; 178 patient visits were tracked in the DHIS2 monitoring system. Conclusions: The results demonstrated significant improvements in hypertension control. The implementation of patient-centered strategies, coupled with intersectoral collaboration, contributed to the program's success. Challenges in the sustainability of the model were identified due to financial limitations. Overall, the project set an important precedent for addressing hypertension in rural communities. This pilot HEARTS project serves as a model for scaling-up hypertension management in the MoH primary care system.

Community engagement strategies provide tools for sustainable vector-borne disease control. A previous cluster randomized control trial engaged nine intervention communities in seven participatory activities to promote management of the domestic and peri-domestic environment to reduce risk factors for vector-borne Chagas disease. This study aims to assess the adoption of this innovative community-based strategy, which included chickens’ management, indoor cleaning practices, and domestic rodent infestation control, using concepts from the Diffusion of Innovations Theory. We used questionnaires and semi-structured interviews to understand perceptions of knowledge gained, intervention adoption level, innovation attributes, and limiting or facilitating factors for adoption. The analysis process focused on five innovation attributes proposed by the Diffusion of Innovations Theory: relative advantage, compatibility, complexity, trialability, and observability. Rodent management was highly adopted by participants, as it had a relative advantage regarding the use of poison and was compatible with local practices. The higher complexity was reduced by offering several types of trapping systems and having practical workshops allowed trialability. Observability was limited because the traps were indoors, but information and traps were shared with neighbors. Chicken management was not as widely adopted due to the higher complexity of the method, and lower compatibility with local practices. Using the concepts proposed by the Diffusion of Innovations Theory helped us to identify the enablers and constraints in the implementation of the Chagas vector control strategy. Based on this experience, community engagement and intersectoral collaboration improve the acceptance and adoption of novel and integrated strategies to improve the prevention and control of neglected diseases.

Cutaneous leishmaniasis (CL) is a parasitic vector-borne disease affecting mostly low- and middle-income countries. CL is endemic in Guatemala, where an increase in the number of cases and incidence and a changing disease distribution in the past decade have been reported. Important research was conducted in Guatemala in the 1980s and 1990s to understand the epidemiology of CL and two Leishmania species were identified as the aetiologic agents. Several species of sand flies have been reported, five of which are naturally infected with Leishmania. Clinical trials conducted in the country evaluated different treatments against the disease and provided solid evidence for CL control strategies that are applicable worldwide. More recently, in the 2000s and 2010s, qualitative surveys were conducted to understand community perceptions of the disease and to highlight the challenges and enablers for disease control. However, limited recent data have been generated regarding the current CL situation in Guatemala, and key information necessary for effective disease control, such as incrimination of vectors and reservoirs, is still lacking. This review describes the current state of knowledge of CL in Guatemala, including the main parasite and sand fly species, disease reservoirs, diagnosis and control, as well as the perceptions of communities in endemic regions.

Guatemala has held dog rabies mass vaccination campaigns countrywide since 1984, yet the virus remains endemic. To eliminate dog-mediated human rabies, dog vaccination coverage must reach at least 70%. The Guatemala rabies program uses a 5:1 human:dog ratio (HDR) to estimate the vaccination coverage; however, this method may not accurately reflect the heterogeneity of dog ownership practices in Guatemalan communities. We conducted 16 field-based dog population estimates in urban, semi-urban and rural areas of Guatemala to determine HDR and evaluate the standard 5:1. Our study-derived HDR estimates varied from 1.7–11.4:1 (average 4.0:1), being higher in densely populated sites and lowest in rural communities. The community-to-community heterogeneity observed in dog populations could explain the persistence of rabies in certain communities. To date, this is the most extensive dog-population evaluation conducted in Guatemala, and can be used to inform future rabies vaccination campaigns needed to meet the global 2030 rabies elimination targets.