Impact of COVID-19 on diabetes care: mixed methods study in an Indigenous area of Guatemala.

Introduction: SARS-CoV-2 has impacted globally the care of chronic diseases. However, direct evidence from certain vulnerable communities, such as Indigenous communities in Latin America, is missing. We use observational data from a health district that primarily serves people of Maya K'iche' ethnicity to examine the care of type 2 diabetes in Guatemala during the pandemic.

The role of daughters in relation to their mother's cervical cancer diagnosis and treatment in Guatemala: a descriptive study.

Purpose: There is currently no information on how caregivers for women diagnosed with cervical cancer in Guatemala, particularly daughters, are affected by their supportive role. This study's objective was to describe the support role of caregivers in the country, with a focus on daughters with a mother diagnosed with cervical cancer.

Methods: This analysis utilizes data from a cross-sectional study which aimed to understand pathways to cervical cancer care.

Prevalence of Hypertension, Diabetes, and Other Cardiovascular Disease Risk Factors in Two Indigenous Municipalities in Rural Guatemala: A Population-Representative Survey.

Background: Nearly 50% of Guatemalans are Indigenous Maya, yet few studies have examined the prevalence of modifiable cardiovascular disease (CVD) risk factors in Indigenous Maya populations. Therefore, we sought to estimate the prevalence of modifiable CVD risk factors in two Indigenous Maya areas in Guatemala.

Methods: We conducted, between June 2018 and October 2019, a population-representative survey of adults aged 18 years and older in two rural Indigenous Maya municipalities in Guatemala.

Implementation of a Diabetes Self-Management Education and Support Intervention in Rural Guatemala: A Mixed-Methods Evaluation Using the RE-AIM Framework.

Introduction: To address the global diabetes epidemic, lifestyle counseling on diet, physical activity, and weight loss is essential. This study assessed the implementation of a diabetes self-management education and support (DSMES) intervention using a mixed-methods evaluation framework.

Methods: We implemented a culturally adapted, home-based DSMES intervention in rural Indigenous Maya towns in Guatemala from 2018 through 2020.

Population Estimates of GFR and Risk Factors for CKD in Guatemala.

Introduction: Chronic kidney disease (CKD) is an emerging public health priority in Central America. However, data on the prevalence of CKD in Guatemala, Central America's most populous country, are limited, especially for rural communities.

Methods: We conducted a population-representative survey of 2 rural agricultural municipalities in Guatemala.

Feasibility of satellite image and GIS sampling for population representative surveys: a case study from rural Guatemala.

Background: Population-representative household survey methods require up-to-date sampling frames and sample designs that minimize time and cost of fieldwork especially in low- and middle-income countries. Traditional methods such as multi-stage cluster sampling, random-walk, or spatial sampling can be cumbersome, costly or inaccurate, leading to well-known biases. However, a new tool, Epicentre's Geo-Sampler program, allows simple random sampling of structures, which can eliminate some of these biases.

Perceptions of chronic kidney disease among at-risk adults in rural Guatemala.

This qualitative study explores perceptions of chronic kidney disease (CKD) among adults with abnormal estimated glomerular filtration rate (eGFR) in Guatemala, where the burden of CKD is rising. Qualitative semi-structured interviews were conducted with 39 individuals screened for CKD and found to have abnormal eGFR (defined as <90 mL/min/1.73 m, per Kidney Disease Improving Global Outcomes [KDIGO] guidelines).

Using self-collection HPV testing to increase engagement in cervical cancer screening programs in rural Guatemala: a longitudinal analysis.

Background: Cervical cancer is a leading cause of death in low- and middle-income countries. Self-collection testing for human papillomavirus (HPV) is an alternative form of cervical cancer screening that can be completed privately and at home. Understanding how the use of HPV testing influences follow-up care in low-resourced settings is crucial before broad implementation.

Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals.

Background: Chronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in low- and middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health professionals experience while providing kidney care in LMICs have not been well described.

Barriers to cervical cancer screening in Guatemala: a quantitative analysis using data from the Guatemala Demographic and Health Surveys.

Objectives: Examine the association between commonly reported barriers to health care, including discordant spoken languages between patients and providers, and reported previous cervical cancer screening.

Methods: Data from the nationally representative Guatemala National Maternal and Child Health Survey from the Demographic and Health Surveys Program were used to explore associations between barriers and screening rates nationwide and in high-risk populations, such as rural and indigenous communities. Negative binomial regressions were run accounting for survey sample weights to calculate prevalence ratios.

HPV self-sampling acceptability in rural and indigenous communities in Guatemala: a cross-sectional study.

Introduction: Cervical cancer disproportionately burdens low-income and middle-income countries (LMICs) such as Guatemala. Self-collection testing for human papillomavirus (HPV) has been suggested as a form of cervical cancer screening to facilitate access in LMICs. This study assessed and compared the acceptability of self-collection HPV testing in two rural, indigenous and ethnically distinct communities in Guatemala: Santiago Atitlán, Sololá and Livingston, Izabal.

Acceptability of Human Papillomavirus Self-Sampling for Cervical Cancer Screening in an Indigenous Community in Guatemala.

Purpose: Cervical cancer rates in Latin America are higher than those in developed countries, likely because of the lower prevalence of screening. Specifically, less than 40% of women in Guatemala are regularly screened and even fewer women are screened in indigenous communities. Current screening strategies-Pap smears and visual inspection with acetic acid-might not be the most effective methods for controlling cancer in these settings.

Prevalence of risk factors for noncommunicable diseases in an indigenous community in Santiago Atitlán, Guatemala.

Objective: To describe the prevalence of noncommunicable disease (NCD) risk factors and assess knowledge of those risk factors in the indigenous community of Santiago Atitlán in Guatemala, a lower-middle income country.

Methods: A population-based, cross-sectional study was conducted using a modified version of the World Health Organization's STEPS protocol. Adults aged 20-65 years were surveyed regarding demographics and NCD risk factors, and the survey was followed by anthropometric and biochemical measurements.

An assessment of community health workers' ability to screen for cardiovascular disease risk with a simple, non-invasive risk assessment instrument in Bangladesh, Guatemala, Mexico, and South Africa: an observational study.

Background: Cardiovascular disease contributes substantially to the non-communicable disease (NCD) burden in low-income and middle-income countries, which also often have substantial health personnel shortages. In this observational study we investigated whether community health workers could do community-based screenings to predict cardiovascular disease risk as effectively as could physicians or nurses, with a simple, non-invasive risk prediction indicator in low-income and middle-income countries.

Methods: This observation study was done in Bangladesh, Guatemala, Mexico, and South Africa.

The training and fieldwork experiences of community health workers conducting population-based, noninvasive screening for CVD in LMIC.

Background: Cardiovascular disease (CVD) is on the rise in low- and middle-income countries and is proving difficult to combat due to the emphasis on improving outcomes in maternal and child health and infectious diseases against a backdrop of severe human resource and infrastructure constraints. Effective task-sharing from physicians or nurses to community health workers (CHW) to conduct population-based screening for persons at risk has the potential to mitigate the impact of CVD on vulnerable populations. CHW in Bangladesh, Guatemala, Mexico, and South Africa were trained to conduct noninvasive population-based screening for persons at high risk for CVD.

Training and supervision of community health workers conducting population-based, noninvasive screening for CVD in LMIC: implications for scaling up.

Background: Community health workers (CHW) can screen for cardiovascular disease risk as well as health professionals using a noninvasive screening tool. However, this demonstrated success does not guarantee effective scaling of the intervention to a population level.

Objectives: This study sought to report lessons learned from supervisors' experiences monitoring CHW and perceptions of other stakeholders regarding features for successful scaling of interventions that incorporate task-sharing with CHW.

Evaluation of a pilot hypertension management programme for Guatemalan adults.

Corazón Sano y Feliz is a hypertension management intervention developed to address deficiencies in the management of hypertensive patients in Guatemala. From 2007 to 2009, Corazón Sano y Feliz was pilot-tested in the community of Mixco. Corazón Sano y Feliz comprises a clinical risk assessment and treatment component implemented primarily by nurses, and a health education component implemented by community health workers.

Barriers and facilitating factors for disease self-management: a qualitative analysis of perceptions of patients receiving care for type 2 diabetes and/or hypertension in San José, Costa Rica and Tuxtla Gutiérrez, Mexico.

Background: The burden of cardiovascular disease is growing in the Mesoamerican region. Patients' disease self-management is an important contributor to control of cardiovascular disease. Few studies have explored factors that facilitate and inhibit disease self-management in patients with type 2 diabetes and hypertension in urban settings in the region.

Secondhand smoke exposure in public places in Guatemala: comparison with other Latin American countries.

Objective: To measure secondhand smoke levels in workplaces in Guatemala and to compare exposure to levels in other Latin American cities.

Methods: Exposure was estimated by passive sampling of vapor phase nicotine using a filter badge. Filters were placed in 1 hospital, 1 school, 2 universities, 1 government building, the airport, and 10 restaurants/bars.