Incarcerated populations are at high-risk to develop tuberculosis (TB), however their impact on the population-level tuberculosis epidemic has been scarcely studied. We aimed to describe the burden and trends of TB among incarcerated populations over time in Paraguay, its clinical and epidemiological differences and the population attributable fraction. This is an observational, descriptive study including all TB cases notified to the National TB control Program in Paraguay during the period 2009–2018. We also used case registries of prisoners diagnosed with tuberculosis from the Minister of Justice. The population attributable fraction of TB in the community due to incarcerated cases was estimated through Levin’s formula. The characteristics of TB cases in and outside of prison were compared as well as the characteristics of TB in prisons were modified over time. During 2009–2018, 2764 (9.7%) of the 28,534 TB reported cases in Paraguay occurred in prisons. The number of prisoners in Paraguay increased from 6258 in 2009 to 14,627 in 2018 (incarceration rate, 101 to 207 per 100,000 persons) while the number of TB cases among prisoners increased by 250% (n = 192 in 2009 versus n = 480 in 2018). The annual TB notification rate among male prisoners was 3218 and 3459 per 100,000 inmates in 2009 and 2018, respectively. The percentage of all TB cases occurring among prisoners increased from 7.1% in 2009 to 14.5% in 2018. The relative risk of TB in prisons compared to community was 70.3 (95% CI, 67.7–73.1); the overall population attributable risk was 9.5%. Among the 16 penitentiary centers in the country, two of them—Tacumbú (39.0%) and Ciudad del Este (23.3%)—represent two thirds of all TB cases in prisons. TB among inmates is predominantly concentrated in those 20–34 years old (77.3% of all), twice the percentage of cases for the same age group outside of prison. Our findings show that the TB epidemic in prisons represents one of the most important challenges for TB control in Paraguay, especially in the country’s largest cities. Appropriate TB control measures among incarcerated populations are needed and may have substantial impact on the overall TB burden in the country.
Recent rises in incident tuberculosis (TB) cases in Paraguay and the increasing concentration of TB within prisons highlight the urgency of targeting strategies to interrupt transmission and prevent new infections. However, whether specific cities or carceral institutions play a disproportionate role in transmission remains unknown. We conducted prospective genomic surveillance, sequencing 471 Mycobacterium tuberculosis complex genomes, from inside and outside prisons in Paraguay’s two largest urban areas, Asunción and Ciudad del Este, from 2016 to 2021. We found genomic evidence of frequent recent transmission within prisons and transmission linkages spanning prisons and surrounding populations. We identified a signal of frequent M. tuberculosis spread between urban areas and marked recent population size expansion of the three largest genomic transmission clusters. Together, our findings highlight the urgency of strengthening TB control programs to reduce transmission risk within prisons in Paraguay, where incidence was 70 times that outside prisons in 2021.
Se realizó un estudio etnobotánico y se calculó el índice de confianza de las especies medicinales empleadas por los usuarios de la Unidad de Salud Familiar (USF) del Departamento de Caaguazú, Paraguay, buscando incorporar esta medicina al sistema nacional de salud. El estudio fue observacional, descriptivo. El método utilizado fue la entrevista, se empleó el cuestionario semiestructurado a usuarios de las USF, quienes proveyeron las muestras de plantas que reportaban como medicinales. Estas entrevistas se realizaron durante seis meses, entre los años 2015 y 2016. Para el análisis de confianza se empleó el método Uso Significativo TRAMIL (UST). Se identificaron 54 familias botánicas, que corresponden a 93 géneros y 116 especies, siendo Asteraceae la mejor representada con 17 Géneros y 21 especies. El órgano vegetal más frecuentemente empleado fue la hoja, seguido de la parte aérea y la planta entera, existiendo algunas especies de las cuales se emplean más de un órgano vegetal. El índice UST demuestra que las especies con mayor índice de consenso son las introducidas como Artemisia absinthium ajenjo, Mentha x piperita menta, Moringa oleifera moringa. La especie nativa con mayor índice de consenso fue Lippia alba salvia-rã. Las afecciones tratadas con estas especies fueron preferentemente los dolores estomacales y las enfermedades no trasmisibles como colesterol alto, ácido úrico, y estados de ansiedad. Se espera que estos datos sirvan para continuar los estudios hasta la validación farmacológica de las especies que permita el uso de plantas medicinales en atención primaria de salud.
Background The objective of this study was to measure the prevalence of syphilis among women of reproductive age from 5 distinct indigenous populations in Paraguay. We also sought to identify the demographic profile and behaviors of women with elevated prevalence of syphilis. Methods We conducted a population-based, cross-sectional survey among women aged 15 to 49 years from 5 distinct language families in Paraguay in 2016. The 5 language families were Guaraní, Maskoy, Mataco, Guaicurú, and Zamuco, sampled through a probability-based, multistage cluster design. Participants completed a questionnaire on demographic characteristics and risk-related behavior. Blood samples were drawn for rapid testing for syphilis with confirmation and titers. Participants provided written informed consent; minors had written parental consent and provided their own assent. Results A total of 1732 indigenous women were enrolled. Overall syphilis prevalence was 6.8% (95% confidence interval [CI], 5.6–8.0). Syphilis prevalence varied by language family/ethnic group (P = 0.010), with Mataco having the highest prevalence (8.2%; 95% CI, 5.3–11.9) and Maskoy having the lowest (2.5%; 95% CI, 1.1–4.7). Women reporting multiple partners (11.3%; 95% CI, 6.9–17.1; P = 0.031) and transactional sex in the last year (18.7%; 95% CI, 7.2–36.4; P = 0.010) had higher prevalence of syphilis. Conclusions Our survey found high prevalence of syphilis in indigenous women in Paraguay, in association with transactional sex and multiple partners. Interventions to reduce sexual behaviors associated with an increased risk of sexually transmitted infections (STI) in indigenous women must be carried out with programs aimed at addressing transactional sex, appropriately framed to respect interculturality and an indigenous worldview.
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