title: The Rivas Cohort Study: design and baseline characteristics of a Nicaraguan cohort.
abstract: A lack of advanced healthcare information systems and validated scientific cohorts in Nicaragua makes it difficult to estimate disease prevalences and other public health statistics. Although there is concern of an "epidemic" of chronic kidney disease (CKD) in this country, statistics regarding its magnitude are derived from only a small number of non-representative studies. Budgetary constraints and the logistical problems of maintaining a study cohort make longitudinal studies difficult. The Rivas Cohort was created to measure disease burden of CKD and other public health priorities in the Department of Rivas, Nicaragua. Using primarily volunteer research students and technologic innovation including GPS, digital photography and point of care biochemical analysis, the ability to establish a longitudinal chronic disease cohort is demonstrated.
  
  
  
  Subjects were recruited from consecutive adjacent households in thirty-two randomly selected communities in the ten municipalities that comprise the Department of Rivas in southern Pacific coastal Nicaragua. The study was conducted in two phases. In the first phase, subjects were enrolled into the cohort and consented for future re-contact. In Phase II, conducted two years later, attempts were made to re-contact 400 of these subjects for additional data collection. Demographic, lifestyle, occupational, exposure and health data was collected for both phases of the study. Blood and urine testing and height, weight and blood pressure measurements were also performed. GPS coordinates of homes were recorded and maps of remote communities created.
  
  
  
  Of 1397 adults living in 533 households approached for participation a total of 1242 (89 %) were enrolled in the cohort. The median age is 41 years and 43 % are male, demographics in agreement with Nicaraguan census data for the Department of Rivas. During Phase II we attempted to re-contact 400 subjects for a follow-up study of CKD. It was possible to re-contact 84 % of these participants and of those re-contacted 95 % agreed to participate in the follow-up study. Of subjects that were not successfully re-contacted the majority had either moved (32) or were not at home (22) at the time of the study team visits.
  
  
  
  The Rivas Cohort Study enrolled a representative sample of 1242 adults living in the Department of Rivas, Nicaragua. The high re-contact and participation rates at two years suggests that the cohort is suitable for long-term studies and presents opportunities for investigations of disease prevalence, incidence, treatment and other public health matters. GPS coordinates and maps are available for future researchers who wish to use the cohort for additional studies.
authors.affiliation: University of Toronto Faculty of Medicine, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
authors.forename: Kailey
authors.initials: K
authors.lastname: Minnings
authors.affiliation: UMass Medical School, 55 N Lake Ave, Chestnut St. Apt 21, Worcester, MA 01604 34, UK.|UMass Medical School, 55 N Lake Ave, Chestnut St. Apt 21, Worcester, MA 01609, UK.
authors.forename: Madeline
authors.initials: M
authors.lastname: Fiore
authors.affiliation: Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.|Beth Israel Deaconess Medical Center, 16 Oak Manor Dr. Barrington, Barrington, RI, 02806, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Mosco
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center Health, 150 South Huntington Avenue, Boston, MA, 02130, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ferguson
authors.affiliation: VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Leatherman
authors.affiliation: Warren Alpert Medical School of Brown University, 593 Eddy Street, APC 9, Providence, RI, 02903, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Kerns
authors.affiliation: VA New York Healthcare System, 423 East 23rd Street, New York, NY, 10010, USA.
authors.forename: James
authors.initials: J
authors.lastname: Kaufman
authors.affiliation: Athena Health, 311 Arsenal Street, Watertown, MA, 02472, USA.|Athena Health, 18 Parker Street, Cambridge, MA, 02138, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Fiore
authors.affiliation: Boston University School of Public Health, 715 Albany Street, T317E, Boston, MA, 02118, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brooks
authors.affiliation: Boston University, 715 Albany St., Talbot 3 East, Boston, MA, 02118, USA.
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Amador
authors.affiliation: Boston Children's Hospital, 401 Park Dr., 6th Floor, Landmark Center, Boston, MA, 02115, USA.|Boston Children's Hospital, 12 Greenway Ct. Apt. 3, Brookline, MA, 02446, USA.
authors.forename: Hillary
authors.initials: H
authors.lastname: Paulsen
authors.affiliation: Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, 46202, USA.|Indiana University School of Medicine, 1547 N. College Ave, Indianapolis, IN, 46202, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Ernstberger
authors.affiliation: Boston University School of Public Health, 801 Massachusetts Avenue 4th Floor, Boston, MA, 02118, USA.|Boston University School of Public Health, 60 Parkway Road, Newton, MA, 02460, USA.
authors.forename: Bricia
authors.initials: B
authors.lastname: Trejo
authors.affiliation: Northeastern University, 350 Huntington Ave, Boston, MA, 02115, USA.|Northeastern University, 255 Newbury Street, Apr1R, Boston, MA, 02116, USA.
authors.forename: Elyse
authors.initials: E
authors.lastname: Sullivan
authors.affiliation: UMass Medical School, 55 N Lake Ave, Worcester, MA, 01604, USA.|UMass Medical School, 60 Parkway Rd., Newton, MA, 02460, USA.
authors.forename: Amos
authors.initials: A
authors.lastname: Lichtman
authors.affiliation: University of Massachusetts Medical School, 55 N. Lake Ave, Worcester, MA, 01605, USA.|University of Massachusetts Medical School, 285 Plantation St Apt 522, Worcester, MA, 01604, USA.
authors.forename: Keriann
authors.initials: K
authors.lastname: Nobil
authors.affiliation: Boston University Schools of Medicine and Public Health, 72 E. Concord Street, Boston, MA, 02118, USA.|Boston University Schools of Medicine and Public Health, 255 Newbury St 1R, Boston, MA, 02116, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lawlor
authors.affiliation: Boston University Schools of Medicine and Public Health, 160 E Berkeley St. Apt 304, Boston, MA, 02118, USA.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Parker
authors.affiliation: Hospital for Sick Children, University Health Network and University of Toronto, 555 University Ave, Toronto, ON, M5G1X8, Canada.
authors.forename: Rulan
authors.initials: R
authors.lastname: Parekh
authors.affiliation: Boston University Schools of Medicine and Public Health, 72 E. Concord Street, Boston, MA, 02118, USA. lfiore@bu.edu.
authors.forename: Louis
authors.initials: L
authors.lastname: Fiore
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D040362:Geographic Information Systems; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D019095:Point-of-Care Systems; D015995:Prevalence; D051437:Renal Insufficiency / Q000175:diagnosis / Q000453:epidemiology*; D016482:Urinalysis
chemical_list: D003404:Creatinine
keywords: Baseline Survey; Central America; Cohort studies; Creatinine; Data collection; Nicaragua; Public health; Public health surveillance; Renal insufficiency