The associations between enteric pathogenic parasites and growth in infants in São Tomé were explored using a refined anthropometric approach to recognize early growth faltering. A birth cohort study was conducted with follow-up to 24 months of age. Microscopic examination for protozoa and soil-transmitted helminths was performed. Anthropometric assessments included: z-scores for weight-for-length (WLZ), length-for-age (LAZ), weight (WAVZ) and length velocities (LAVZ), length-for-age difference (LAD), and wasting and stunting risk (≤−1 SD). Generalized additive mixed effects regression models were used to explore the associations between anthropometric parameters and enteric parasitic infections and cofactors. A total of 475 infants were enrolled, and 282 completed the study. The great majority of infants were asymptomatic. Giardia lamblia was detected in 35.1% of infants in at least one stool sample, helminths in 30.4%, and Cryptosporidium spp. in 14.7%. Giardia lamblia and helminth infections were significantly associated with mean decreases of 0.10 in LAZ and 0.32 in LAD, and of 0.16 in LAZ and 0.48 in LAD, respectively. Cryptosporidium spp. infection was significantly associated with a mean decrease of 0.43 in WAVZ and 0.55 in LAVZ. The underestimated association between subclinical parasitic enteric infections and mild growth faltering in infants should be addressed in public health policies.

The cumulative effect of repeated asymptomatic enteric infections on intestinal barrier is not fully understood in infants. We aimed to evaluate the association between previous enteric parasitic infections and intestinal inflammation and permeability at 24-months of age, in asymptomatic infants of São Tomé Island. A subset of infants from a birth cohort, with intestinal parasite evaluations in at least four points of assessment, was eligible. Intestinal inflammatory response and permeability were assessed using fecal S100A12 and alpha-1-antitrypsin (A1AT), respectively. The cutoff <–1SD for weight-for-length and length-for-age was used to define wasting and stunting. Multivariable linear regression analysis explored if cumulative enteric parasitic infections explained variability of fecal biomarkers, after adjusting for potential confounders. Eighty infants were included. Giardia duodenalis and soil-transmitted helminths (STH) were the most frequent parasites. The median (interquartile range) levels were 2.87 μg/g (2.41–3.92) for S100A12 and 165.1 μg/g (66.0–275.6) for A1AT. Weak evidence of association was found between S100A12 levels and G. duodenalis (p = 0.080) and STH infections (p = 0.089), and between A1AT levels and parasitic infection of any etiology (p = 0.089), at 24-months of age. Significant associations between A1AT levels and wasting (p = 0.006) and stunting (p = 0.044) were found. Previous parasitic infections were not associated with fecal biomarkers at 24 months of age. To summarize, previous asymptomatic parasitic infections showed no association with intestinal barrier dysfunction. Notwithstanding, a tendency toward increased levels of the inflammatory biomarker was observed for current G. duodenalis and STH infections, and increased levels of the permeability biomarker were significantly associated with stunting and wasting.

This birth cohort study compared the infant growth curve estimates in São Tomé Island to the WHO growth standards. Despite this island belonging to a lower-middle-income country, there were several factors favorable for growth that were present. Four-hundred and seventy-five full-term singleton appropriate for-gestational-age infants were enrolled and followed-up to 24 months of age. Weight-for-age, length-for-age, weight-for-length, body mass index-for-age, head circumference-for-age, weight velocity, and length velocity curves were estimated and compared to the WHO standards. In the first 6 months of age, the weight gain was adequate in the presence of a high prevalence of exclusive breastfeeding. Thereafter, weight trajectories tracked close to the WHO standards, except for a progressive decline in the infants growing in higher percentiles, especially in girls. Median length at birth was below the median WHO standards, followed by an early postnatal velocity spurt, which probably reflected the transition from an unfavorable to a more favorable postnatal environment. Thereafter, linear growth faltering was observed without relevant deterioration up to 24 months of age, which was probably due to the presence of protective factors. These results may be useful to implement strategies to further approximate infant growth in São Tomé Island to the WHO standards.

In this chapter, Marisol Garzón reconstructs the experience of exile among Guatemalans in the context of worsening political violence in their country in the early 1980s and their experiences as refugees in Chiapas. She examines the vicissitudes of refugees who crossed the border in fear of their lives, the adversities they faced when fleeing Guatemala, the precarious living conditions in the camps, deportations by Mexican authorities, relocation far from the border region, and attacks by the Guatemalan army on Mexican territory.

This book is a collective work developed to present a series of topics related to the history of the cross-border region of Mexico, Guatemala, and Belize from the perspective of new interpretative approaches, developed within the framework of the “Mexico-Guatemala Cross-Border Region: Regional dimensions and bases for its integral development” project. The chapters that comprise this publication describe the history of community life on a triple border, of the ties established and the conflicts that have emerged in a common space, introducing new perspectives on the historical, political, economic, and social dynamics that have shaped both the past and the present of this region.