Artículos FCS INSIS

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Browsing Artículos FCS INSIS by Author "Amarilis Then Paulino"

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    An integrated urban gardens and peer nutritional counseling intervention to address food insecurity among people with HIV in the Dominican Republic
    (2021-05) Amarilis Then Paulino
    Food insecurity negatively affects HIV prevention and care, and sustainable interventions are needed. Here we describe the development of an integrated urban gardens and peer nutritional counseling intervention to address food insecurity and nutrition among people with HIV, which included: (1) peer nutritional counseling, (2) gardening training, and (3) garden-based nutrition and cooking workshops. The intervention was developed using community-based participatory research over multiple years and stages of data gathering and implementation and evaluation. Lessons learned include the importance of cross-sectoral partnerships to achieve multifaceted, integrated, and sustainable interventions and a shared commitment among partners to an ongoing cycle of action-oriented research, and the need for home-based and community-based gardens to enhance food security and social support. The development process successfully combined an evidence-based framework and community engagement to yield a multicomponent yet integrated food security and nutrition intervention appropriate for people with HIV and potentially adaptable for other chronic conditions.
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    Changes in HIV internalized and experienced stigmas and social support after an urban gardens and peer nutritional counseling intervention among people with HIV and food insecurity in the Dominican Republic
    (2024-09-01) Amarilis Then Paulino
    "Background: Food insecurity and HIV-related stigma negatively affect HIV outcomes. Few studies have examined how food security interventions affect HIV-related stigma and social support. Setting: Two HIV clinics in the Dominican Republic. Methods: A pilot cluster randomized controlled trial of an urban gardens and peer nutritional counseling intervention was conducted to examine outcomes of HIV-related stigmas and social support. Adult patients (≥18 years of age) with moderate or severe household food insecurity and evidence of suboptimal ART adherence and/or a detectable viral load were enrolled; standard measures of internalized and experienced stigmas and social support were collected at baseline and at 6 and 12 months. Intervention clinic participants received training and materials from agronomists for a home garden, 3–4 sessions of nutritional counseling from the clinic's peer counselor, and a garden produce cooking workshop facilitated by professional nutritionists. Results: Of 109 study participants (46 intervention and 63 control), 103 (94%) completed 12-month follow-up. Difference-in-differences multivariate longitudinal linear regressions adjusting for sociodemographic factors found that intervention participants had reduced internalized stigma by 3.04 points (scale 0–32) at 12 months (P = 0.002); reduced probability of experiencing HIV-related stigma or discrimination in the past 6 months (20 percentage points at 6 months, P = 0.05 and 25 percentage points at 12 months, P = 0.02); and modestly improved social support at 12 months (1.85 points on 30-pt scale, P = 0.093). Conclusion: A fully powered, larger trial is needed to establish the efficacy of the intervention and assess pathways by which the intervention may improve HIV stigma and social support."
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    Exploring antiretroviral therapy adherence, competing needs, and viral suppression among people living with HIV and food insecurity in the Dominican Republic.
    (2021-09-27) Amarilis Then Paulino
    Understanding factors related to suboptimal adherence to antiretroviral therapy (ART) and detectable viral load (VL), especially among vulnerable populations, is needed to improve HIV outcomes. The Caribbean is highly impacted by HIV and socioeconomic inequalities, but few studies have been conducted there to explore food insecurity among people with HIV and factors associated with viral suppression in this vulnerable population. Using baseline data from a pilot intervention trial among people living with HIV and food insecurity in the Dominican Republic, we examined psychosocial and behavioral factors associated with viral suppression, ART adherence, and competing needs. Among participants (n = 115), 61% had a detectable VL; the strongest factor associated with detectable VL was having missed taking ART in the last six months due to not having food (OR = 2.68, p = 0.02). Greater odds of reporting missed ART doses due to not having food were associated with severe food insecurity (OR = 4.60, p = 0.006), clinical depression (OR = 2.76, p = 0.018), Haitian background (OR = 6.62 p = 0.017), and internalized HIV stigma (OR = 1.09, p = 0.041), while lower odds were associated with social support (OR = 0.89, p = 0.03) and having health insurance (OR = 0.27, p = 0.017). Ensuring that people with HIV and food insecurity have food to take with their ART is essential for viral suppression.
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    Exploring feasibility and acceptability of an integrated urban gardens and peer nutritional couseling intervention for people with HIV in the Dominican Republic
    (2023-10-31) Amarilis Then Paulino
    Objective. Food security interventions with people living with HIV (PLHIV) are needed to improve HIV outcomes. This process evaluation of a pilot intervention involving urban gardening and peer nutritional counselling with PLHIV assesses feasibility, acceptability and implementation challenges to inform scale-up. Design. Mixed methods were used, including quantitative data on intervention participation and feasibility and acceptability among participants (n 45) and qualitative data from a purposive sample of participants (n 21). Audio-recorded interviews were transcribed and coded using a codebook developed iteratively. Setting. An HIV clinic in the northwest-central part of the Dominican Republic. Results. The intervention was feasible for most participants: 84 % attended a garden workshop and 71 % established an urban garden; 91 % received all three core nutritional counselling sessions; and 73 % attended the cooking workshop. The intervention was also highly acceptable: nearly, all participants (93–96 %) rated the gardening as ‘helpful’ or ‘very helpful’ for taking HIV medications, their mental/emotional well-being and staying healthy; similarly, high percentages (89–97 %) rated the nutrition counselling ‘helpful’ or ‘very helpful’ for following a healthy diet, reducing unhealthy foods and increasing fruit/vegetable intake. Garden barriers included lack of space and animals/pests. Transportation barriers impeded nutritional counselling. Harvested veggies were consumed by participants’ households, shared with neighbours and family, and sold in the community. Many emphasised that comradery with other PLHIV helped them cope with HIV-related marginalisation. Conclusion. An urban gardens and peer nutritional counselling intervention with PLHIV was feasible and acceptable; however, addressing issues of transportation, pests and space is necessary for equitable participation and benefit.
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    Exploring feasibility and acceptability of an integrated urban gardens and peer nutritional couseling intervention for people with HIV in the Dominican Republic
    (2023-10-31) Amarilis Then Paulino
    "Objective: Food security interventions with people living with HIV (PLHIV) are needed to improve HIV outcomes. This process evaluation of a pilot intervention involving urban gardening and peer nutritional counselling with PLHIV assesses feasibility, acceptability and implementation challenges to inform scale-up. Design: Mixed methods were used, including quantitative data on intervention participation and feasibility and acceptability among participants (n 45) and qualitative data from a purposive sample of participants (n 21). Audio-recorded interviews were transcribed and coded using a codebook developed iteratively. Setting: An HIV clinic in the northwest-central part of the Dominican Republic. Results: The intervention was feasible for most participants: 84 % attended a garden workshop and 71 % established an urban garden; 91 % received all three core nutritional counselling sessions; and 73 % attended the cooking workshop. The intervention was also highly acceptable: nearly, all participants (93–96 %) rated the gardening as ‘helpful’ or ‘very helpful’ for taking HIV medications, their mental/emotional well-being and staying healthy; similarly, high percentages (89–97 %) rated the nutrition counselling ‘helpful’ or ‘very helpful’ for following a healthy diet, reducing unhealthy foods and increasing fruit/vegetable intake. Garden barriers included lack of space and animals/pests. Transportation barriers impeded nutritional counselling. Harvested veggies were consumed by participants’ households, shared with neighbours and family, and sold in the community. Many emphasised that comradery with other PLHIV helped them cope with HIV-related marginalisation. Conclusion: An urban gardens and peer nutritional counselling intervention with PLHIV was feasible and acceptable; however, addressing issues of transportation, pests and space is necessary for equitable participation and benefit."
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    Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic
    (2023-08-24) Amarilis Then Paulino
    HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men’s experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women’s experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to “move on” and “look ahead.” Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.
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    Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic,
    (2023) Amarilis Then Paulino
    HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men’s experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women’s experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to “move on” and “look ahead.” Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches
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    Perceptions and determinants of healthy eating for people with HIV in theDominicanRepublicwho experience food insecurity.
    (2020-08-24) Amarilis Then Paulino
    Food insecurity is defined as limited or uncertain access to sufficient nutritious food. Food insecurity is associated with various infectious and non-communicable health outcomes and is a major public health issue for people living with HIV (PLHIV. Food insecurity is associated with poor HIV outcomes through psychosocial, behavioural and nutritional pathways. Moreover, nutrition has a direct impact on viral load beyond behavioural pathways (i.e. antiretroviral therapy (ART) adherence and missed clinic appointments. Food insecurity is associated with decreased efficacy of ART and reduced ART adherence, which can lead to the immunologic decline and progression to AIDS, and increased morbidity and mortality for PLHIV. A study among PLHIV experiencing food insecurity in Honduras found that nutritional counselling improved ART adherence, HIV outcomes and reduced food insecurity for participants regardless of nutrition status. Relatedly, self-management behaviours such as consuming a quality diet, with quality defined as how well an individual conforms to dietary recommendations, are positively associated with improved health outcomes for PLHIV. A multinational qualitative study found that among PLHIV in resource-poor settings, chronic stress and structural barriers such as poor food diversity, unemployment and poverty impeded engagement with dietary behaviors. An intervention that targeted food insecurity by providing community-based food assistance found decreased consumption of fats, increased consumption of fresh fruits and vegetables and increased adherence to ART.
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    Preliminary Effects of an urban gardens and peer nutritional counseling intervention on HIV treatment adherence and detectable viral load among people with HIV and food insecurity: Evidence from a pilot cluster randomized controlled trial in the Dominican Republic
    (2022-09-06) Amarilis Then Paulino
    A pilot cluster randomized controlled trial involving two HIV clinics in the Dominican Republic assessed preliminary efficacy of an urban garden and peer nutritional counseling intervention. A total of 115 participants (52 intervention, 63 control) with moderate or severe food insecurity and sub-optimal antiretroviral therapy (ART) adherence and/or detectable viral load were assessed at baseline, 6- and 12-months. Longitudinal multivariate regression analysis controlling for socio-demographics and accounting for serial cluster correlation found that the intervention: reduced the prevalence of detectable viral load by 20 percentage points at 12 months; reduced any missed clinic appointments by 34 and 16 percentage points at 6 and 12 months; increased the probability of “perfect” ART adherence by 24 and 20 percentage points at 6 and 12 months; and decreased food insecurity at 6 and 12 months. Results are promising and warrant a larger controlled trial to establish intervention efficacy for improving HIV clinical outcomes.
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    Preliminary Effects of an Urban Gardens and Peer Nutritional Counseling Intervention on HIV Treatment Adherence and Detectable Viral Load Among People with HIV and Food Insecurity: Evidence from a Pilot Cluster Randomized Controlled Trial in the Dominican Republic
    (2022-09-06) Amarilis Then Paulino
    A pilot cluster randomized controlled trial involving two HIV clinics in the Dominican Republic assessed preliminary efficacy of an urban garden and peer nutritional counseling intervention. A total of 115 participants (52 intervention, 63 control) with moderate or severe food insecurity and sub-optimal antiretroviral therapy (ART) adherence and/or detectable viral load were assessed at baseline, 6- and 12-months. Longitudinal multivariate regression analysis controlling for socio-demographics and accounting for serial cluster correlation found that the intervention: reduced the prevalence of detectable viral load by 20 percentage points at 12 months; reduced any missed clinic appointments by 34 and 16 percentage points at 6 and 12 months; increased the probability of “perfect” ART adherence by 24 and 20 percentage points at 6 and 12 months; and decreased food insecurity at 6 and 12 months. Results are promising and warrant a larger controlled trial to establish intervention efficacy for improving HIV clinical outcomes.
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    (Proyecto) ProMeSA (Proyecto para Mejorar la Seguridad Alimentaria) Huertos urbanos y consejería nutricional para mejorar la atención y la inseguridad alimentaria en las personas que viven con VIH en la República Dominicana, 2023 al 2028.
    (2026) Amarilis Then Paulino; Kathryn Derose
    La inseguridad alimentaria es un problema común para las personas que viven con el VIH, PCH, en muchos de los entornos dende viven tienen recursos limitados en todo el mundo, y por lo tanto, el estudio propuesto tiene el potencial de tener un impacto significativo en la salud pública. El equipo del estudio es muy fuerte y tiene la experiencia para llevarlo a cabo. La principal fortaleza del estudio es que está basado en el trabajo anterior sobre un estudio piloto que demostró que la intervención fue factible, aceptable y eficaz. Sin embargo, la preocupación de los socios del proyecto era que se necesitaba más información detallada sobre la intervención empleada en el piloto, por lo que se propuso este estudio con el objetivo de evaluar la eficacia de una intervención integrada de huertos urbanas y consejería nutricional entre pares que busca de Mejorar la Seguridad Alimentaria (Proyecto para Mejorar la Seguridad Alimentaria ProMeSA) y contribuir a la reducción de la inseguridad alimentaria en personas que viven con el VIH en la República Dominicana, mediante la realización de un ensayo clínico aleatorizado por conglomerados usando 20 clínicas de VIH (25 participantes por clínica) que serán asignadas al azar para recibir la intervención o para ser una clínica de control de atención habitual. Los resultados serán el primario la supresión viral y el secundario será la adherencia al tratamiento antirretroviral, TAR y la retención de la atención del VIH medidos al inicio, a los 6, 12 y 18 meses. Resultados intermedios (seguridad alimentaria, nutrición, apoyo social, estigma y bienestar psicológico) que se cree que contribuyen a los resultados primarios también se evaluarán. Finalmente, los factores de proceso que contribuyan a la adopción e implementación de la intervención serán evaluados. Como resultado de esta preocupación y algunas otras debilidades menores, el entusiasmo general del comité por el impacto potencial del estudio propuesto se limitó a un nivel moderado.
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    (Proyecto) Síndrome metabólico en personas viviendo con VIH en las clínicas de servicios de atención integral de La Vega y Valverde Mao, 2018-2019.
    (2026) Amarilis Then Paulino
    Se trata de una investigación de fuentes secundarias cuyo objetivo es determinar la prevalencia del síndrome metabólico en la población de adultos que viven con VIH, asociado a carga viral y CD4. Dicho estudio se llevará a cabo en dos clínicas del Servicios de Atención Integral (SAI) ubicadas en La Vega y Mao Valverde. Los datos se obtendrán de las evaluaciones que se realizaron entre del junio 2018 a junio del 2020. La supervivencia de las personas que viven con el virus del VIH ha aumentado, y por lo tanto su exposición a factores de riesgo medio ambientales, comportamiento de alimentación y sedentarismo, lo que puede llevar a un incremento del riesgo en enfermedades metabólicas y cardiovasculares. En República Dominicana hay escasos estudios que se dediquen a describir esta problemática, es por ello que se ha considerado que con los datos que se deriven de este análisis se beneficiará tanto la comunidad científica, así como los prestadores de salud. La fuente de datos será un estudio piloto de intervención titulado “Proyecto para Mejorar la Seguridad Alimentaria (ProMeSA)”. La población de estudio correspondió a 110 sujetos (63 en el SAI de la Vega y 47 en el SAI de Mao Valverde). Las características iniciales de los participantes del estudio se compararon con los que asistían a las clínicas. Se estimará la frecuencia del síndrome metabólico en función de niveles de Lípidos, Hemoglobina glucosilada, Tensión arterial, obesidad y circunferencia de cintura.
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    The co-management of HIV and chronic non-communicable diseases in the Dominican Republic: A qualitative study.
    (2023-07-13) Amarilis Then Paulino
    HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men’s experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women’s experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to “move on” and “look ahead.” Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.
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    The co-management of HIV and chronic non-communicable diseases in the Dominican Republic: A qualitative study.
    (2023-07-13) Amarilis Then Paulino
    HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men’s experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women’s experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to “move on” and “look ahead.” Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.
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    Trends and mortality effects of vitamin A deficiency in children in 138 low –income and middle –income countries between 1991 and 2013: a pooled analysis of population –based surveys
    (2015-09) Amarilis Then Paulino
    "Fondo La deficiencia de vitamina A es un factor de riesgo para la ceguera y la mortalidad por sarampión y diarrea en niños de 6 a 59 meses de edad. Nuestro objetivo fue estimar las tendencias en la prevalencia de la deficiencia de vitamina A entre 1991 y 2013 y su carga de mortalidad en países de ingresos bajos y medios. Métodos Se recopilaron 134 fuentes de datos representativas de la población de 83 países con datos de concentración sérica de retinol medidos. Se utilizó un modelo jerárquico bayesiano para estimar la prevalencia de deficiencia de vitamina A, definida como una concentración sérica de retinol inferior a 0•70 μmol/L. Se estimaron los riesgos relativos (RR) para los efectos de la deficiencia de vitamina A sobre la mortalidad por sarampión y diarrea mediante el agrupamiento de los tamaños del efecto de los ensayos aleatorios de la administración de suplementos de vitamina A. Se utilizó información sobre las prevalencias de deficiencia, los RR y el número de muertes infantiles por causas específicas para estimar las muertes atribuibles a la deficiencia de vitamina A. Todos los análisis incluyeron una cuantificación sistemática de la incertidumbre. • Ver contenido relacionado para este artículo Resultados En 1991, el 39% (intervalo creíble del 95% 27-52) de los niños de 6 a 59 meses de edad en países de ingresos bajos y medianos tenían deficiencia de vitamina A. En 2013, la prevalencia de deficiencia fue del 29% (17-42; probabilidad posterior [PP] de ser una verdadera disminución = 0,81). La deficiencia de vitamina A disminuyó significativamente en asia oriental y sudoriental y Oceanía del 42% (19-70) al 6% (1-16; PP>0•99); una disminución en América Latina y el Caribe del 21% (11–33) al 11% (4–23; PP=0•89) también ocurrió. En 2013, la prevalencia de deficiencia fue más alta en África subsahariana (48%; 25-75) y el sur de Asia (44%; 13-79). 94 500 (54 200–146 800) muertes por diarrea y 11 200 (4300–20 500) muertes por sarampión fueron atribuibles a la deficiencia de vitamina A en 2013, que representó el 1,7% (1,0–2,6) de todas las muertes en niños menores de 5 años en países de ingresos bajos y medianos. Más del 95% de estas muertes ocurrieron en áfrica subsahariana y asia meridional. Interpretación La deficiencia de vitamina A sigue siendo frecuente en Asia meridional y África subsahariana. Las muertes atribuibles a esta deficiencia han disminuido con el tiempo en todo el mundo y casi se han eliminado en regiones distintas de Asia meridional y África subsahariana. Esta nueva evidencia tanto de la prevalencia como de la carga absoluta de la deficiencia de vitamina A debe utilizarse para reconsiderar, y posiblemente revisar, la lista de países prioritarios para la administración de suplementos de vitamina A en dosis altas, de modo que el estado prioritario de un país tenga en cuenta tanto la prevalencia de la deficiencia como los beneficios esperados para la mortalidad de la suplementación. "