Childhood sexual abuse among women in El Salvador, Guatemala, and Honduras: Research brief
"This research brief is one in a series of related publications intended to contribute to understanding the complex dimensions of violence against women in three Central American countries: El Salvador, Guatemala, and Honduras. This brief focuses on the prevalence of child sexual abuse among women, the perpetrators of that abuse, and the associations of child sexual abuse with two health outcomes: (1) having a premarital pregnancy and (2) being in a violent relationship later in life." [The Centers for Disease Control and Prevention/Division of Reproductive Health and the U.S. Agency for International Development, USA, c2005]
Clinical and demographic features of HIV infection in El Salvador
Objective: To understand some of the clinical and demographic features of the epidemic of infection by HIV in El Salvador prior to the availability of antiretroviral therapy in that country. Methods: We conducted a retrospective review of HIV-infected individuals who were admitted to Hospital Rosales, which is a large public teaching hospital in San Salvador, El Salvador, during the 5-year period of 1994 through 1998. Chart abstraction was done of 194 out of the 208 individuals admitted to the Infectious Diseases Unit at Hospital Rosales (14 charts could not be located). We also carried out a sampling of other HIV-infected adults treated in other parts of the hospital. Results: Of the 250 patients whose records we reviewed, 67% were men and 86% were from an urban area. The mean age at HIV diagnosis was 34 years. In terms of occupation, 50% of the men were day laborers; 76% of the women were housewives, and 8% of the women were commercial sex workers. All the women studied listed only heterosexual contact as their risk behavior. Of the men, 9% of them said they had sex only with men, 17% said with both men and women, and 65% said with female commercial sex workers. In terms of drug use, 2% of the patients reported they had used injection drugs at some point. At their initial medical visit to Hospital Rosales, over half of the 250 patients presented with a respiratory complaint or with diarrhea, 6% had pulmonary tuberculosis (TB), and 5% had extrapulmonary TB. Of the 250 patients, 177 of them (71%) had AIDS at the first medical visit. Of the 250, 138 of them (55%) were lost to follow-up. Of the remaining 112 persons, 81 of them (72%) were known to have died. Of those 81, 38 of them (47%) died of unknown causes and 21 (26%) died of TB. Conclusions: The HIV-infected adults treated at the Hospital Rosales during the 1994– 1998 period were usually infected through heterosexual sex, were symptomatic at the time of presentation, and were often lost to follow-up. Utilizing the results of our study and of other research, efforts to expand early intervention, counseling and testing, and targeted prevention activities should be strengthened. [author abstract] [Rev Panam Salud Publica/Pan Am J Public Health 13(5), 327-331, 2003]
Discourses on Violence in Costa Rica, El Salvador, and Nicaragua: Laws and the Construction of Drug- and Gender-Related Violence
In Central America, legislation aiming to reduce violence and crime has become an important topic in the security debate. Focusing on Costa Rica, El Salvador, and Nicaragua, this paper analyzes laws and other legal texts regarding the trade in and consumption of drugs on the one hand, and gender-related violence on the other. It shows how the content and the wording of legal texts contribute to the social construction of stereotyped offenders, such as youth gang members, drug users, or foreign nationals. The legal texts in Costa Rica, El Salvador, and Nicaragua reflect both the hegemonic and the counter-discursive influences on each country's legal discourse. [author abstract] [GIGA Research Programme: Violence, Power and Security, N° 72 March 2008] [Click on One-Click Download to open document in a new page]
Earthquakes in El Salvador: A Descriptive Study of Health Concerns in a Rural Community and the Clinical Implications – Part II
Results reported in Part I of the Earthquakes in El Salvador series (see Disaster Management & Response 2003; 1: 105-9) indicated clinically relevant findings. The findings indicated a need for greater public health action within all five categories reviewed: healthcare, access to healthcare, housing, food, water and sanitation. Significant results between urban and rural communities indicated a need for broader community aid, public health and sanitation services to rural areas. Faster and more efficient disaster management and care services throughout the San Sebastian community were also necessary modifications. [publication abstract] [Disaster Management & Response 2004; 2(1): 10-13]
Health in the Americas 2007: El Salvador - As a health agency, the Pan American Health Organization’s core discipline is epidemiology, which enables the measurement, definition, and comparison of health problems and conditions and their distribution from the perspectives of population, geography, and time. This publication on El Salvador addresses the issue of health as a human right, taking into account both the individual and community contexts, and examines various critical determinants of health, including those of a biological, social, cultural, economic, and political nature. That examination reveals the existence of gaps, disparities, and inequities that persist in El Salvador, especially those related to access to basic services, health, nutrition, housing, and adequate living conditions as well as to the lack of opportunities for human development—all of which contribute to the greater vulnerability to diseases and health risks of some population groups. [Adapted from the preface of Health in the Americas 2007]
Immunization campaigns and political agendas: Retrospective from Ecuador and El Salvador
Since the mid-1980s international donors have promoted vertical, campaign-based strategies to help improve immunization coverage in poor countries. National immunization days (NIDs) are currently in vogue and are prominent in the worldwide polio eradication efforts. In spite of their widespread use, campaigns that include NIDs have not been well evaluated for their effects on coverage, reduction in vaccine-preventable diseases, or effects on the health system. An assessment of the results of two such campaigns implemented in Ecuador and El Salvador shows limited impact on short-term coverage and questionable effects on long-term coverage and disease incidence. Although NIDs may have substantial short-term political benefits, the vertical approach can undermine provision of routine services by ministries of health and may be counterproductive in the long-term. [publication abstract] [International Journal of Health Services, Volume 33, Number 1: 113 – 128, 2003]
Integration of foreign and local medical staff in a disaster area: the Honduras and El Salvador experiences
International medical aid after natural disasters may take various forms, ranging from self-sufficient military forces to single experts or specialists who function primarily as advisers. A model integrating foreign and local medical staff has not previously been reported. In response to the call for international aid by the Honduran and El Salvadorian governments in the wake of Hurricane Mitch in November 1998 and the San Salvador earthquake in January 2001, Israel sent medical supplies and 10 member teams of medical professionals to each country. The aim of the present paper is to describe the unique Israeli approach to providing healthcare in disaster areas by integrating foreign and local medical staff, and to discuss its advantages and disadvantages. The paper focuses on the experience of the two emergency medicine physicians on the team who were assigned to the Atlantida General Hospital in La Ceiba, Honduras. The same team in San Salvador subsequently applied the same approach. [author abstract] [European Journal of Emergency Medicine 10:124–129 (2003)]
On Shaky Ground: The Effects of Earthquakes on Household Income and Poverty
The devastating consequences of large natural disasters on socioeconomic systems are evident to all. Yet, little is really known about the magnitude of such negative effects on human development. For several reasons, El Salvador --the smallest country in Central America—is very susceptible to the effects of repeated and severe natural hazards. We use two strong earthquakes that struck El Salvador in early 2001 together with longitudinal data in a quasi-experimental fashion. Our strategy exploits the exogeneity implicit in the intensity of the geological events which is defined by their seismic parameters, the geographic coordinates of the dwellings and the predominant soil types of the villages. We find that the combined effect of both earthquakes is associated with a reduction in household income per capita of one third of the pre-shock average for households in the upper half of the ground shaking distribution There is also an increase in the depth and severity of poverty, although less significant in statistical sense. The results also highlight that the pervasive effects of natural disasters are likely to persist in the medium- and long-term. Overall, our findings do not appear to be driven by differential trends at pre-shock time, econometric specifications and methods, and sample attrition. Furthermore, we argue that the results are still informative when the empirical design is confronted with the issues of measurement error in the indicator of treatment intensity or aggregated equilibrium effects. [author abstract] [United Nations Development Programme Regional Bureau for Latin America and the Caribbean, Research for Public Policy: RPP LAC – MDGs and Poverty – 02/2008, December, 2008]
Proteinuria and chronic renal failure in the coast of El Salvador
Objectives: El Salvador has high mortality rates from chronic kidney disease (CKD). The actual prevalence and causes remain unknown and local resources are scarce. Previous studies have suggested very high prevalence in specific populations: adult male farmers living in the coastlands, with high frequency of pesticides exposure and alcohol consumption. This population has low incomes and poor healthcare accessibility. Our aim was to detect CKD cases in this population using proteinuria as an inexpensive initial screening, investigating associations with those characteristics and comparing them with another population from the midlands. Methods: We performed a transversal study on volunteer men from both regions, taking into consideration the variables: age, farmer living, pesticides, exposure, alcohol consumption, medical past history, blood pressure level, glycemia and proteinuria in a random urine sample.Coastland men with proteinuria were additionally screened for CKD measuring hemoglobin and serum creatinine levels. Finally, we employed a logistic regression model, and Perason’s Chi2 to investigate associations between those variables and the presence of proteinuria or CKD. Results: We included 291 men from the coastlands and 62 from the midlands: 35 and 16% off the total male population from their respective communities. Proteinuria (table I) was found in 133 (45.7%) and 8 cases (12.9%). CKD was diagnosed in 37 (12.7%) coastland men (table III), with mean creatinine 2.64 ± 2.5 mg/dl, hemoglobin 12.32 ± 1.9 g/dl and 81.1% with proteinuria 15-30 mg/l. Only 14 (37.8%) out of those 37 CKD patients featured diabetes or hypertension, while the remaining (62.2%) did not appear to have a clear-cut cause for CKD. Only one of them was formerly diagnosed with CKD. Farmer living, pesticides exposure and alcohol consumption were found to be very common characteristics in both populations, and were not associated to the presence of proteinuria or CKD (table II and III). Discussion: The prevalence of CKD within the adult male farmers from the Salvadoran coastlands is remarkably high: at least 12.7%. There is a large number of undiagnosed cases, but they can be easily detected with inexpensive methods. This high prevalence is not completely explained by usual CKD causes like diabetes or hypertension. In addition, pesticides exposure and alcohol consumption may not be related, too. The disease is moderate, non symptomatic and has fairly mild proteinuria, possibly from interstitial origin. Further research is required to investigate environmental, occupational and hereditary factors, and to determine the real extent of the problem. [author abstract] [Nefrología, Vol. XXV, No 1, pp.30-37, 2005]
The establishment of injury surveillance systems in Colombia, El Salvador, and Nicaragua (2000–2006)
"An estimated 5.2 million people worldwide died from injuries in 2002 — a mortality rate of 83 per 100 000 population. Injuries accounted for 9% of the world’s deaths in 2002 and 12% of the world’s burden of disease. More than 90% of deaths occurred in low- and middle-income countries. Consequently, injuries are a major public health problem throughout the world and represent a leading cause of mortality and morbidity. Research and surveillance of the frequency, mechanisms, and outcomes of injuries in the developing world remains largely neglected. Injury surveillance is useful for identifying high-risk groups and behaviors and assessing intervention effectiveness. Although some research has been published on injury surveillance systems in developing countries, significant gaps exist concerning the establishment and maintenance of such programs7. Some injury surveillance systems in developing countries have relied on mortuary statistics as their data source. These systems fail to capture the disproportionate number of non-fatal injuries that occur. The aim of this article is to describe key lessons learned in establishing an emergency department (ED)–based injury surveillance system in resource-poor settings." [Rev Panam Salud Publica. 2008; 24(6): 379–389]

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Educational Resources

Association of Caribbean States, Port of Spain, Trinidad and Tobago
CDC - Travel Information : Mexico and Central America
Library of Congress, Country Study: El Salvador

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