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COSTA RICA

COSTA RICA. Presented by Dr. José Luis Garcés F. Office of Health Monitoring. Lymphatic Filariasis Elimination in the Americas, 6 th Regional Program Managers’ Meeting (San José, Costa Rica, October 2005). Demographic Indicators at the National Level: Costa Rica.

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COSTA RICA

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  1. COSTA RICA Presented by Dr. José Luis Garcés F.Office of Health Monitoring Lymphatic Filariasis Elimination in the Americas, 6th Regional Program Managers’ Meeting (San José, Costa Rica, October 2005)

  2. LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  3. Demographic Indicators at the National Level: Costa Rica • Total Population (2004) = 4,248,508 • Male Population = 2,160,670 • Female Population = 2,087,838 • % Urban Population = 71.3% • Increase In Population = 2.8% LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  4. Structure of the Population by Age and Sex. Costa Rica (2004) Age groups 75 and older 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 300 250 200 150 100 50 0 0 50 100 150 200 250 Population (in thousands) Men Women Source : CCP-INEC-Health Statistics Unit LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  5. Demographic Indicators 2004 • Life Expectancy at Birth • General = 78.4 • Men = 76.2 • Women = 81.0 LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  6. Demographic Indicators 2004 • General Mortality Rate (per 1,000 inhabitants) = 3.7 • Maternal Mortality Rate (per 10,000 births)= 3.0 • Infant Mortality Rate (per 1,000 births) = 9.2 • Birth Rate (per 1,000 inhabitants) = 17.0 LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  7. Socioeconomic Indicators • Population with Access to Potable Water Service = 95 % • Urban = 99.6 % • Rural = 91.5 % • Population with Access to Sewage Network • Total = 93.5 % • Urban = 88.5 % • Rural = 97.13 % • Average Number of Persons per Household = 4.1 • % Housing with Household Sewage Connection = 89.5% LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  8. Socioeconomic Indicators • Population with Electricity Services = 96.7 % • Population with Sanitation Services = 89.5 % • Unemployment Rate (2001) = 6.1 • Births to Adolescent Mothers = 21.2 % • Hospital Births = 99.3 % LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  9. Education Characteristics • % of population that is literate = 95.2 • % of population that is illiterate = 4.8 • % of population that has attended school = 92.7% • Net rate of secondary school education = 59% LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  10. SISTEMA DE SALUD COSTA RICA • Ministry of Health • Costa Rican Social Security • Water and Sanitation Systems • Private Health-Care System • National Insurance Institute • Universities LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  11. HUETAR NORTE CHOROTEGA CENTRAL NORTE C.OCCIDENTE HUETAR ATLANTICA CENTRAL SUR CENTRAL ESTE PACIFICO CENTRAL BRUNCA Ministry of Health Regions LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  12. FUNCIONES RECTORAS MINISTERIO SALUD • Management and Administration • Health Monitoring • Regulation of Health-Care Development • Research and Technical Development LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  13. System of Health and Social Security Health Regions (CCSS): 7 Health Areas: 93 Primary Health-Care Units (EBAIs) (approx.): 845 Hospitals: 29 LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  14. Network of Health Services in Costa Rica San José3 high-level centers and 6 specialized centers 8 regional hospitals Network of 12 peripheral hospitals Regional Hospital Peripheral Hospital LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  15. Interruption of Transmission of Filariasis bancrofti in the City of Puerto Limón Costa Rica LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  16. Previous Studies on Filaria bancrofti Conducted In Puerto Limón, Costa Rica LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  17. Epidemiological Studies1974–1983 LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  18. Objectives • Determine prevalence of W. bancrofti • Determine vectors and study their characteristics • Determine frequency of microfilaria • Identify and localize clinical cases LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  19. Distribution by Age and Sex of 17 Cases of Elephantiasis Detected in Puerto Limón LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  20. LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  21. Distribution by Area of 6,155 Persons from the City of Puerto Limón (Costa Rica, 1976–1980) LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  22. Distribution by Age of 4,021 Persons Examined, including 78 with Microfilaria from the City of Limón LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  23. 70.0% of the carriers present less than 6 mf per 20 microliters of blood (Dmf 50: 3.5). It has been determined that the frequency of W. bancrofti was strictly nocturnal. LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  24. Results of Entomological Studies LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  25. Persons Examined in 13 Rural Localities • The 3 positives came from the City of Limón LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  26. Treatment of Positive Cases • 100% of cases • Dose:6mg DEC/kg of weight for 12 days • Follow-up and control LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  27. Follow-Up In one study conducted in 1987, 727 persons from Cristóbal Colón were examined by the Knott technique and none presented microfilaria. LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  28. Vector Control Project inCristóbal Colón,1986–1989 LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  29. Environmental Conditions,Cristóbal Colón LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  30. Sanitation Activities LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  31. Municipality Community Mosquito Control Project PAHO/WHO JAPDEVA Ministry of Health University OF CR LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  32. Paving of roads Filling in of swampy areas Installation of recreational areas Initiation of construction of coastal boulevard Achievements LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  33. Mapping of Antigenemia for W. bancroftiin the City of Puerto Limón, Costa Rica, 2002–2003 LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  34. Problem of Filariasis (W. bancrofti) Limited to the City of Puerto Limón LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  35. Selection of schools • Determination of sample size • Workplan • Informed consent, resulting report LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  36. Technical assessment /Training (CENCET) LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  37. Distribution by School of Persons Examined for Antigenemia (W. bancrofti),City of Puerto Limón, 2002–2003 LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  38. Distribution by Residential Area • 9 schools • 47 areas LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  39. LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  40. Persons examined for antigenemia of W. bancrofti by Age and Sex (City of Puerto Limón, 2002–2003) LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  41. LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  42. Persons examined for antigenemia of W. bancrofti by race (City of Puerto Limón, 2002-2003) LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  43. Morbidity Study • Rapid survey among key informants from EBAIs-CCSS. • Interviews with professionals from Urology and Dermatology services at Tony Facio Hospital LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  44. Morbidity Survey Residual morbidity is limited to older adults. LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  45. Structure and Functioningof the National Epidemiological Monitoring System Filariasis present in Group D of the Subsystem for Mandatory Notification LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  46. National Laboratory of Veterinary Health Ministry of Health Social Security System (CCSS) • Private services • Hospitals, clinics, • and laboratories- National Hospitals Specialized Hospitals Regional Hospitals Peripheral Hospitals Clinics 4 4 INCIENSA - National Public Health Laboratories- 96 CCSS laboratories in the network 7 13 182 Network of Laboratories for Public Health Monitoring LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  47. Conclusions LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  48. Samples of 3,044 students from all areas of the City of Puerto Limón were negative for antigenemia. LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  49. Results of epidemiological studies (1974-1983) and of those for antigenemia (2002-2003) indicate a low probability that sufficient sources of infection exist to maintain an active transmission. LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

  50. The program expresses appreciation to • The Limón community and local institutions participating in this study • Health authorities • CENCET, Dominican Republic • Regional Program for the Elimination of Lymphatic Filariasis • PAHO/WHO Representation in Costa Rica LF Elimination in the Americas, 2005 Regional Meeting, San José, Costa Rica

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