title: Needs, acceptability, and value of humanitarian medical assistance in remote Peruvian Amazon riverine communities.
abstract: Much debate exists regarding the need, acceptability, and value of humanitarian medical assistance. We conducted a cross-sectional study on 457 children under 5 years from four remote riverine communities in the Peruvian Amazon and collected anthropometric measures, blood samples (1-4 years), and stool samples. Focus groups and key informant interviews assessed perspectives regarding medical aid delivered by foreigners. The prevalence of stunting, anemia, and intestinal parasites was 20%, 37%, and 62%, respectively. Infection with multiple parasites, usually geohelminths, was detected in 41% of children. The prevalence of intestinal parasites both individual and polyparasitism increased with age. Participants from smaller communities less exposed to foreigners expressed lack of trust and fear of them. However, participants from all communities were positive about foreigners visiting to provide health support. Prevalent health needs such as parasitic infections and anemia may be addressed by short-term medical interventions. There is a perceived openness to and acceptability of medical assistance delivered by foreign personnel.
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Sanchez
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Halsey
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Bayer
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California.
authors.forename: Martin
authors.initials: M
authors.lastname: Beltran
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California.
authors.forename: Hugo R
authors.initials: HR
authors.lastname: Razuri
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Velasquez
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California.
authors.forename: Vitaliano A
authors.initials: VA
authors.lastname: Cama
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California.
authors.forename: Paul C F
authors.initials: PC
authors.lastname: Graf
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California.
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Quispe
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Maves
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Montgomery
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California.
authors.forename: John W
authors.initials: JW
authors.lastname: Sanders
authors.affiliation: U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; David Geffen School of Medicine, University of California, Los Angeles, California; Universidad Peruana Cayetano Heredia, School of Public Health and Management, Lima, Peru; Alto Amazonas Health Network, Peruvian Ministry of Health, Yurimaguas, Peru; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Naval Medical Center, San Diego, California willy.lescano@med.navy.mil wlescano@hotmail.com.
authors.forename: Andres G
authors.initials: AG
authors.lastname: Lescano
mesh_terms: D000367:Age Factors; D015362:Child Nutrition Disorders / Q000453:epidemiology; D002675:Child, Preschool; D060085:Coinfection; D005260:Female; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D007223:Infant; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology; D008297:Male; D008493:Medical Missions; D010272:Parasitic Diseases / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D010568:Peru / Q000453:epidemiology; D045483:Rivers; D012424:Rural Population / Q000706:statistics & numerical data
references.citation: Trop Med Int Health. 2008 Apr;13(4):458-67
references.pmid: 18312476
references.citation: Lancet. 2007 Jan 6;369(9555):60-70
references.pmid: 17208643
references.citation: Mil Med. 2013 May;178(5):537-42
references.pmid: 23756013
references.citation: Rev Peru Med Exp Salud Publica. 2010 Mar;27(1):123-37
references.pmid: 21072458
references.citation: J Vector Borne Dis. 2010 Dec;47(4):228-34
references.pmid: 21178216
references.citation: BMC Health Serv Res. 2008;8:121
references.pmid: 18518997
references.citation: Disaster Med Public Health Prep. 2008 Dec;2(4):237-44
references.pmid: 19050430
references.citation: BMC Public Health. 2010;10:21
references.pmid: 20085635
references.citation: Disasters. 2010 Oct;34(4):1139-70
references.pmid: 20618382
references.citation: Parasitol Int. 2007 Jun;56(2):129-33
references.pmid: 17324610
references.citation: Hastings Cent Rep. 2007 Nov-Dec;37(6):21-3
references.pmid: 18179101
references.citation: Pediatr Int. 2009 Aug;51(4):520-5
references.pmid: 19400813
references.citation: J Infect Dev Ctries. 2011 Apr;5(4):260-9
references.pmid: 21537067
references.citation: J Epidemiol Community Health. 2012 Jul;66(7):e14
references.pmid: 21551179
references.citation: Trans R Soc Trop Med Hyg. 2011 Apr;105(4):204-8
references.pmid: 21349565
references.citation: Cad Saude Publica. 2007 Feb;23(2):427-34
references.pmid: 17221092
references.citation: Prehosp Disaster Med. 2007 Sep-Oct;22(5):390-5
references.pmid: 18087907
references.citation: Mil Med. 2004 Jan;169(1):23-9
references.pmid: 14964497
references.citation: Trop Med Int Health. 2006 Dec;11(12):1813-20
references.pmid: 17176346
references.citation: Public Health. 2008 Dec;122(12):1410-7
references.pmid: 18752815
references.citation: PLoS Negl Trop Dis. 2008;2(9):e300
references.pmid: 18820747
references.citation: PLoS One. 2013;8(3):e57814
references.pmid: 23555564
references.citation: PLoS One. 2011;6(7):e22044
references.pmid: 21789210
references.citation: Emerg Themes Epidemiol. 2004 Oct 07;1(1):3
references.pmid: 15679909
references.citation: Am J Trop Med Hyg. 2011 Dec;85(6):1141-3
references.pmid: 22144459
references.citation: Mil Med. 2003 Dec;168(12):975-80
references.pmid: 14719620
references.citation: Pediatrics. 2010 Mar;125(3):e473-80
references.pmid: 20156903
references.citation: Disaster Med Public Health Prep. 2008 Dec;2(4):230-6
references.pmid: 19050429
references.citation: Cad Saude Publica. 2007 Jun;23(6):1283-93
references.pmid: 17546320
references.citation: J Health Popul Nutr. 2007 Dec;25(4):399-405
references.pmid: 18402182
references.citation: Bull U S Army Med Dep. 1948 Apr;8(4):326
references.pmid: 18911509
references.citation: Rev Panam Salud Publica. 2007 Sep;22(3):169-77
references.pmid: 18062851
references.citation: BMJ. 2005 May 21;330(7501):1199-201
references.pmid: 15905258
references.citation: N Engl J Med. 2007 Sep 6;357(10):1018-27
references.pmid: 17804846
references.citation: J Pediatr (Rio J). 2006 Sep-Oct;82(5):383-8
references.pmid: 17003939