Sterilization and union instability in Brazil

Brazilian women rely on sterilization as the main source of birth control. Sterilization has been one of the causes of the steep decline in fertility in Brazil, at least since the second half of 1970. It is hypothesized that understanding couples' relationships might be key to explaining this high rate of female sterilizations. Possible reasons for the higher level of fertility among women in unstable unions than among women in stable ones could be the less effective use of contraceptive methods, or that women in unstable unions tend to use less effective or reversible contraceptive methods. In this paper discrete time modelling of the timing of sterilization according to union histories is presented. The analysis uses the calendar data of the 1996 Brazilian DHS. It is shown that women in second or higher order unions have a lower risk of sterilization. This result should be taken into account in the analysis of the determinants of female sterilization in Brazil.     

Policy Development for Environmental Licensing and Biodiversity Offsets in Latin America

Attempts to meet biodiversity goals through application of the mitigation hierarchy have gained wide traction globally with increased development of public policy, lending standards, and corporate practices. With interest in biodiversity offsets increasing in Latin America, we seek to strengthen the basis for policy development through a review of major environmental licensing policy frameworks in Argentina, Brazil, Chile, Colombia, Mexico, Peru and Venezuela. Here we focused our review on an examination of national level policies to evaluate to which degree current provisions promote positive environmental outcomes. All the surveyed countries have national-level Environmental Impact Assessment laws or regulations that cover the habitats present in their territories. Although most countries enable the use of offsets only Brazil, Colombia, Mexico and Peru explicitly require their implementation. Our review has shown that while advancing quite detailed offset policies, most countries do not seem to have strong requirements regarding impact avoidance. Despite this deficiency most countries have a strong foundation from which to develop policy for biodiversity offsets, but several issues require further guidance, including how best to: (1) ensure conformance with the mitigation hierarchy; (2) identify the most environmentally preferable offsets within a landscape context; (3) determine appropriate mitigation replacement ratios; and (4) ensure appropriate time and effort is given to monitor offset performance.     

The anthropometric history of Argentina, Brazil and Peru during the 19th and early 20th century

This anthropometric study focuses on the histories of three important Latin American countries - Brazil, Peru, and Argentina - during the 19th century, and tests hypotheses concerning their welfare trends. While non-farm Brazil and Lima, Peru, started at relatively low height levels, Brazil made substantial progress in nutritional levels from the 1860s to the 1880s. In contrast, Lima remained at low levels. Argentinean men were tall to begin with, but heights stagnated until 1910. The only exception were farmers and landowners, who benefited from the export boom.     

Cultivation of red seaweeds: a Latin American perspective

The Latin American seaweed industry plays an important role at a global scale as 17 % of all seaweeds and 37 % of red seaweeds for the phycocolloid industry comes from this region. Increased market demand for algal raw materials has stimulated research and development into new cultivation technologies, particularly in those countries with economically important seaweed industries such as Argentina, Brazil, Chile, México, and Peru. The marine area of Latin America includes almost 59,591 km² of coastline ranging in latitude from 30ºN to 55ºS and encompasses four different oceanic domains: Temperate Northern Pacific, Tropical Eastern Pacific, Temperate South America, and Tropical Atlantic. Commercial cultivation of red seaweed in Latin America has been basically centered in the production of Gracilaria chilensis in Chile. Attempts have been made to establish seaweed commercial cultivation in other countries, going from experimental research-oriented studies to pilot community/enterprise based cultivation trials. Some genera such as Kappaphycus and Eucheuma have been studied in Brazil and Mexico, Gracilaria species in Argentina and Brazil, Gracilariopsis in Peru and Venezuela, and Chondracanthus chamissoi in Peru and Chile. In this short review, we address the Latin America perspective on the status and future progress for the cultivation of red seaweeds and their sustainable commercial development, and discuss on the main common problems. Particular emphasis is given to the needs for comprehensive knowledge necessary for the management and cultivation of some of the most valuable red seaweed resources in Latin America.     

Estimation of births averted due to breast-feeding and increases in levels of contraception needed to substitute for breast-feeding

After contraceptive use, breast-feeding duration is the major determinant of the birth interval length. Three methods of estimating births averted by breast-feeding, and the increase in contraceptive use needed to substitute for breast-feeding, are presented. Method 1 simply utilizes Bongaarts' Ci, and the other two are based on mean birth intervals with and without breast-feeding. Estimates for each method are derived for six countries with DHS surveys from the mid-1990s: Burkina Faso, Uganda, India, Indonesia, Brazil and Peru. The estimated percentage of additional births that would occur if there were no breast-feeding ranged from 1-4%, in Brazil to about 50% in Burkina Faso and Uganda, reflecting very low breast-feeding in Brazil and very high levels in the sub-Saharan African nations. Strengths and limitations of the three methods are considered.     

Demography of the human sex ratio in some Latin American countries, 1967-1986.

A sample based on hospital births recorded for the Latin American Collaborative Study on Congenital Malformations (ECLAMC) program was used in the present study to determine sex ratios for live births and for stillbirths. Sixty-four cities and 147 hospitals in 11 countries (Uruguay, Chile, Argentina, Brazil, Bolivia, Peru, Paraguay, Ecuador, Venezuela, Colombia, and Costa Rica) were included in the present analyses. The number of live births was 1,886,653 in the period 1967-1986, and the number of stillbirths was 24,818 in the period 1978-1986. The sex ratio for the total sample was 0.5112 for live births and 0.5477 for stillbirths. The sex ratio as a whole is decreasing with time in a parabolic fashion. Each country in our study behaved differently. Except for Peru and Uruguay, the countries experienced a significant decrease in the sex ratio after 1978 for live births; only Brazil did not show a temporal trend for the sex ratio for stillbirths.     

Differences in the Access to Sterilization between Women Living and Not Living with HIV: Results from the GENIH Study,Brazil

BackgroundIn many countries, young women of reproductive age have been especially affected by the HIV epidemic, which have fostered research to better understand how HIV infection influences and shapes women´s fertility and reproductive and sexual decisions. In Brazil, few studies have focused on the impact of the HIV epidemic on contraceptive choices among women living with HIV (WLHIV).ObjectiveThis study evaluates the impact HIV infection may have in the access to female sterilization in Brazil, using a time-to-event analysis.MethodsA cross-sectional quantitative study (GENIH study) was conducted between February 2013 and April 2014 in the city of São Paulo, comparing two probabilistic samples of 975 WLHIV and 1,003 women not living with HIV (WNLHIV) aged 18 to 49. Sexual and reproductive data was collected retrospectively in order to reconstruct women''s reproductive trajectories. Given the objectives of this study, the analysis was restricted to women with parity one or more and, in case of WLHIV, to those sterilized after HIV diagnosis and not infected through vertical transmission. The final sample analysis included 683 WNLHIV and 690 WLHIV. A series of multivariable-adjusted Cox models estimated the probability of being sterilized after HIV diagnosis, compared with WNLHIV. Models were adjusted for schooling, race/color, and stratified by parity at last delivery (1–2, 3+). Hazard ratios were calculated for female sterilization, and separately for interval and postpartum procedures (performed in conjunction with caesarean section or immediately after vaginal delivery). Additionally, information regarding unmet demand for female sterilization was also explored.FindingsNo statistical difference in the overall risk of sterilization between WLHIV and WNLHIV in the two parity-related groups is observed: HR = 0.88 (0.54–1.43) and 0.94 (0.69–1.29), respectively, among women with 1–2 children and those with three and more. However, significant differences regarding the impact of HIV infection at sterilization are observed depending on the timing and the type of sterilization procedure. The probability of obtaining an interval sterilization is significantly lower for WLHIV compared to those not living with HIV. The reverse occurs regarding postpartum sterilization. Although sterilization is mainly performed in conjunction with caesarean section in Brazil, it is evident that caesarean sections are not the sole factor increasing the risk of sterilization among WLHIV.ConclusionThe results indicate barriers in the access to services offering interval sterilization for WLHIV and certain facilitation in obtaining the procedure in conjunction with caesarean section. Health policy makers at local and national levels should promote institutional changes in order to facilitate access to interval sterilization and to confront the sensitive discussion of WLHIV’s eligibility for postpartum sterilization. It is also urgent to increase access to a wider range of contraceptive methods for WLHIV and promote dual method protection strategies. Moreover, since condom use may decrease in the future in the context of the preventive effect of antiretroviral therapy, promoting dual methods will expand the choices regarding the reproductive rights of women living with HIV.     

Abortion as a backup method for contraceptive failure in China

Contraceptive failure rates for modern methods including sterilization are reported to be high in China, but little is known about the consequence of contraceptive failure and characteristics of women who decide to have an abortion if a contraceptive failure occurs. Using 6225 contraceptive failures from the 1988 Chinese Two-per-Thousand Fertility Survey, this study examines the resolution of contraceptive failure and assesses the impact of some women's sociodemographic characteristics on the decision to terminate contraceptive failure in abortion. This study has three important findings: (1) The abortion rate was 50.1%, 75.3% and 80.2% for IUD, condom and pill failures, respectively; (2) The abortion rates differed by contraceptive method and women's social and demographic characteristics. In particular, a woman with just one child was most likely to have the contraceptive failure aborted; (3) Some women experienced repeated abortions because of contraceptive failure. The results suggest that abortion was a backup method if contraception failed in China and the correlates of aborting an unwanted pregnancy reflect the strong impact of the Chinese family planning programme.     

Skewed contraceptive method mix: why it happens, why it matters

Contraceptive prevalence has been central to family planning research over the past few decades, but researchers have given surprisingly little consideration to method mix, a proxy for method availability or choice. There is no 'ideal' method mix recognized by the international community; however, there may be reason for concern when one or two methods predominate in a given country. In this article method skew is operationally defined as a single method constituting 50% or more of contraceptive use in a given country. Of 96 countries examined in this analysis, 34 have this type of skewed method mix. These 34 countries cluster in three groups: (1) sixteen countries in which traditional methods dominate, most of which are in sub-Saharan Africa; (2) four countries in which female sterilization predominates (India, Brazil, Dominican Republic and Panama); and (3) fourteen countries that rely on a single reversible method (the pill in Algeria, Kuwait, Liberia, Morocco, Sudan and Zimbabwe; the IUD in Cuba, Egypt, Kazakhstan, Kyrgyz Republic, Moldova, Turkmenistan and Uzbekistan; and the injectable in Malawi). A review of available literature on method choice in these countries provides substantial insight into the different patterns of method skew. Method skew in some countries reflects cultural preferences or social norms. Yet it becomes problematic if it stems from restrictive population policies, lack of access to a broad range of methods, or provider bias.     

Contraceptive sterilization: A comparison of Mexican‐Americans and Anglos living in U.S. counties bordering Mexico

Abstract

Prior to the U.S.‐Mexico Border Survey of Maternal and Child Health and Family Planning conducted by the Centers for Disease Control in 1979, little information was available about the extent to which Mexican‐Americans in the U.S., relative to Anglos, were using male and female sterilization for contraceptive reasons. This paper compares Mexican‐Americans and Anglos for (a) prevalence of contraceptive sterilization; (b) social and demographic characteristics of users of contraceptive sterlization; and (c) tuning during the reproductive life cycle when contraceptive sterilization occurs. For both Mexican‐Americans and Anglos, contraceptive sterilization (male and female) was the second most prevalent method used. Anglos were more likely to use male than female sterilization (22.4 per cent and 19.5 per cent), while Mexican‐Americans were much more likely to use female than male sterilization (23.2 per cent and 5.8 per cent). Having an unwanted last live birth and/or high parity were important factors related to the use of female sterilization for both Mexican‐Americans and Anglos.     

The current status of ethnobiological research in Latin America: gaps and perspectives

Background

Recent reviews have demonstrated an increase in the number of papers on ethnobiology in Latin America. Among factors that have influenced this increase are the biological and cultural diversity of these countries and the general scientific situation in some countries. This study aims to assess the panorama of ethnobiological research in Latin America by analyzing its evolution, trends, and future prospects.

Methods

To conduct this study, we searched for papers in the Scopus (http://www.scopus.com) and Web of Science (http://www.isiknowledge.com) databases. The search was performed using combinations of keywords and the name of each Latin American country. The following countries were included in this study: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, Guatemala, Haiti, Honduras, Mexico, Panama, Paraguay, Peru, Venezuela, and Uruguay.

Results and conclusions

According to our inclusion criteria, 679 ethnobiological studies conducted in Latin America were found for the period between 1963 and 2012. Of these studies, 289 (41%) were conducted in Brazil, 153 in Mexico (22%), 61 in Peru (9%), 58 in Argentina (8%), 45 in Bolivia (6%), and 97 (14%) in other Latin American countries. The increased number of publications related to this area of knowledge in recent years demonstrates the remarkable growth of ethnobiology as a science. Ethnobiological research may be stimulated by an increase in the number of scientific events and journals for study dissemination and by the creation of undergraduate courses and graduate programs to train ethnoscientists who will produce high-quality studies, especially in certain countries.

     

Education as policy: the impact of education on marriage, contraception, and fertility in Colombia, Peru, and Bolivia

Using data from the World Fertility and Demographic and Health Surveys of Colombia, Peru, and Bolivia, we model the effects of education on three demographic outcomes: the timing of first sexual union, contraceptive use, and fertility. These effects are examined over time and across geographic areas using a multivariate framework. We find substantial improvements in female educational attainment over the last fifty years and a strong relationship between education and the demographic outcomes. Each successive increment in education is associated with declines in the marriage rate, increased contraceptive use, and lower fertility. Education accounts for some of the changes over time in the demographic outcomes, but the pattern varies by outcome, time period, and geographic area. In support of the social diffusion hypothesis, our results indicate that educational differences in reproductive behavior are reduced as the level of development increases and societies pass through their demographic transition.     

A survey of family planning in the Philippines

A multicenter survey of 400 married Filipino women 15-40 years of age conducted in 1986 by Family Health International and the International Health Foundation provided valuable information on contraceptive use in the Philippines, as well as factors influencing such practices. The respondents, who were drawn from 10 urban communities in Metro Manila and 10 rural communities in Nueva Ecija Province, averaged 31.5 years of age and had a mean number of 2.9 children. 32% of respondents indicated they desired another child. 225 women (56%) reported they were using no method of contraception. 59 (14%) were protected from pregnancy by tubal sterilization or vasectomy. 77 women (19%) were oral contraceptive (OC) users, and 8 (2%) were IUD users. Only 1 respondent was using a long-acting contraceptive. 3 women used spermicides, 21 (5%) used condoms, 25 (6%) practiced rhythm, and 30 (3%) of the women's husbands practiced withdrawal. Overall, 27% of contraceptive users in this sample used more than 1 method. 26% had been using a contraceptive method for 1-3 years and another 46% for more than 3 years, indicating consistent acceptance of family planning. A sequential trend of nonuse, OC use, and finally sterilization was observed. OC use was highest among women in their late 20s with 2-3 children. Urban-rural residence and socioeconomic factors had little impact on OC use. An encouraging finding was that only 25% of respondents believed that the pill poses important health risks and 61% were aware that pregnancy and childbirth involve greater health risks than OC use. This finding is in opposition to the extremely high levels of misinformation about the dangers of OC use identified in other surveys in developing countries and probably reflects the fact that 77% of women in the present study reported receiving advice on contraception from family planning professionals.     

Recent trends in contraceptive sterilization in Flanders

Elective sterilization started to spread rather late in Flanders. Despite the sharp increase of this contraceptive method since the end of the 1970s, its frequency is still lower than in many neighbouring countries and much lower than in the US and Canada, mainly due to the lag in male sterilization. Further increase in contraceptive sterilization and a greater participation of men is expected in the near future.     

Detection of Oseltamivir-Resistant Pandemic Influenza A(H1N1)pdm2009 in Brazil: Can Community Transmission Be Ruled Out?

Although surveillance efforts that monitor the emergence of drug-resistant strains of influenza are critical, systematic analysis is overlooked in most developing countries. We report on the occurrence of strains of pandemic influenza A(H1N1)pdm09 with resistance and decreased susceptibility to oseltamivir (OST) in Brazil in 2009, 2011 and 2012. We found 7 mutant viruses, 2 with the mutation S247N and other 5 with the mutation H275Y. Most of these viruses were from samples concentrated in the southern region of Brazil. Some of these resistant viruses were detected prior to the initiation of OST treatment, suggesting that community transmission of mutant viruses may exist. Moreover, we show that one of these OST-resistant (H275Y) strains of A(H1N1)pdm09 was discovered in the tri-border region between Brazil, Argentina and Paraguay, highlighting that this strain could also be found in other Latin American countries. Our findings reinforce the importance of enhanced antiviral resistance surveillance in Brazil and in other Latin American countries to confirm or rule out the community transmission of OST-resistant strains of A(H1N1)pdm09.     

Dominance of Sterilization and Alternative Choices of Contraception in India: An Appraisal of the Socioeconomic Impact

Background

The recent decline in fertility in India has been unprecedented especially in southern India, where fertility is almost exclusively controlled by means of permanent contraceptive methods, mainly female sterilization, which constitutes about two-thirds of overall contraceptive use. Many Indian women undergo sterilization at relatively young ages as a consequence of early marriage and childbearing in short birth intervals. This research aims to investigate the socioeconomic factors determining the choices for alternative contraceptive choices against the dominant preference for sterilization among married women in India.

Methods

Data for this study are drawn from the 2005–06 National Family Health Surveys focusing on a sample of married women who reported having used a method of contraception in the five years preceding the survey. A multilevel multinomial logit regression is used to estimate the impact of socioeconomic factors on contraceptive choices, differentiating temporary modern or traditional methods versus sterilization.

Findings

Religious affiliation, women''s education and occupation had overarching influence on method choices amongst recent users. Muslim women were at higher odds of choosing a traditional or modern temporary method than sterilization. Higher level of women''s education increased the odds of modern temporary method choices but the education effect on traditional method choices was only marginally significant. Recent users belonging to wealthier households had higher odds of choosing modern methods over sterilization. Exposure to family planning messages through radio had a positive effect on modern and traditional method choices. Community variations in method choices were highly significant.

Conclusion

The persistent dominance of sterilization in the Indian family planning programme is largely determined by socioeconomic conditions. Reproductive health programmes should address the socioeconomic barriers and consider multiple cost-effective strategies such as mass media to promote awareness of modern temporary methods.     

Contraceptive knowledge,attitudes and use among women attending health clinics in St. Petersburg,Russian Federation

This study describes women's knowledge, attitudes, and use of contraception in Russia. Data were obtained from a sample of 917 women attending 44 women's consulting centers in St. Petersburg during January 15-30, 1995. Findings indicate that 68% were married; 21% were single. 56.1% worked full-time, 7.2% worked part-time, and 9.4% were students. 50.9% reported having received sex education, of whom 73.8% learned about birth control methods and 70.7% learned about abortion. Over 90% of the entire sample knew about condoms, IUDs, and oral contraceptives. About 60-70% knew about rhythm, withdrawal, and female sterilization. 49-56% were aware of vaginal suppositories and vasectomy. Under 23% were aware of the diaphragm, sponge, jelly, and foam. People talked about family planning with doctors and partners. 58.7% preferred joint responsibility for family planning. 909 women responded to the question about the current method being used: 41% reported using condoms; 33.8%, IUDs; 32.8%, pills; 23.7%, the rhythm method; and 17.2%, withdrawal. Many women used multiple methods, but the questions did not clearly distinguish single from concurrent multiple method use or switching between a few methods. 20.6% report nonuse. 115 of 187 were pregnant or desiring a pregnancy. Nonusers were concerned about side effects. Method choice was based on effectiveness and ease of use. Few were dissatisfied with their method choice. About 75% reported method switching over time. Most of the 452 oral contraceptive users knew 2-3 side effects. 25.1% of the 319 condom users were usual users.     

Colombia,an unknown genetic diversity in the era of Big Data

Background

Latin America harbors some of the most biodiverse countries in the world, including Colombia. Despite the increasing use of cutting-edge technologies in genomics and bioinformatics in several biological science fields around the world, the region has fallen behind in the inclusion of these approaches in biodiversity studies. In this study, we used data mining methods to search in four main public databases of genetic sequences such as: NCBI Nucleotide and BioProject, Pathosystems Resource Integration Center, and Barcode of Life Data Systems databases. We aimed to determine how much of the Colombian biodiversity is contained in genetic data stored in these public databases and how much of this information has been generated by national institutions. Additionally, we compared this data for Colombia with other countries of high biodiversity in Latin America, such as Brazil, Argentina, Costa Rica, Mexico, and Peru.

Results

In Nucleotide, we found that 66.84% of total records for Colombia have been published at the national level, and this data represents less than 5% of the total number of species reported for the country. In BioProject, 70.46% of records were generated by national institutions and the great majority of them is represented by microorganisms. In BOLD Systems, 26% of records have been submitted by national institutions, representing 258 species for Colombia. This number of species reported for Colombia span approximately 0.46% of the total biodiversity reported for the country (56,343 species). Finally, in PATRIC database, 13.25% of the reported sequences were contributed by national institutions. Colombia has a better biodiversity representation in public databases in comparison to other Latin American countries, like Costa Rica and Peru. Mexico and Argentina have the highest representation of species at the national level, despite Brazil and Colombia, which actually hold the first and second places in biodiversity worldwide.

Conclusions

Our findings show gaps in the representation of the Colombian biodiversity at the molecular and genetic levels in widely consulted public databases. National funding for high-throughput molecular research, NGS technologies costs, and access to genetic resources are limiting factors. This fact should be taken as an opportunity to foster the development of collaborative projects between research groups in the Latin American region to study the vast biodiversity of these countries using ‘omics’ technologies.

     

Voluntary sterilization in Flanders

From 1966 to 1990 there was a marked rise in the use of voluntary sterilization in Flanders, followed by a fall in women under the age of 40. In the last three decades a remarkable change has occurred in the choice between male and female sterilization. Compared with many other European countries, sterilization of men and women is widely practised in Flanders. In 1996 40% of 40- to 44-year-old women underwent voluntarily sterilization or had voluntarily sterilized partners. Additionally, another 9% of these women were sterilized for medical reasons. Voluntarily sterilized couples are on average older than non-sterilized couples, and, obviously, consider their families to be complete. For couples with a complete family, parity is the most important predictor in the choice between sterilization and non-sterilization. Regularly practising Catholics undergo sterilization least. Also, highly educated couples are less likely to have a sterilization. Couples who ever experienced a contraceptive failure choose sterilization more. Voluntary sterilization has no substantial effect on the fertility of the population since the effect on the prevented numbers of both wanted and unwanted births appears to be small. However, if voluntary sterilization did not occur, differences in fertility within the population would probably increase. It is presumed that the popularity of voluntary sterilization in Flanders has passed its peak and that its use will decline in the near future.     

Transformation of traditional knowledge of medicinal plants: the case of Tyroleans (Austria) who migrated to Australia,Brazil and Peru

Background

In ethnobotanical research, the investigation into traditional knowledge of medicinal plants in the context of migration has been of increasing interest in recent decades since it is influenced and changed by new environmental and social conditions. It most likely undergoes transformation processes to match the different living circumstances in the new location. This study compares the traditional knowledge of medicinal plants held by Tyroleans – and their descendants – who emigrated to Australia, Brazil and Peru at different time scales. The study’s findings allow a discussion of the complexities and dynamics that influence this knowledge within the context of long-distance migration.

Methods

Information was obtained from 65 informants by free-listing, semi-structured interviews and non-participatory observation in Tyrol (Austria) and the migrants’ countries: Australia, Brazil and Peru. The collected data was analysed using different quantitative approaches, including statistical tests, and compared between the countries of investigation.

Results

All respondents in all four investigation areas claimed that they had knowledge and made use of medicinal plants to treat basic ailments in their day-to-day lives. Informants made 1,139 citations of medicinal plants in total in free lists, which correspond to 164 botanical taxa (genus or species level) in Tyrol, 87 in Australia, 84 in Brazil and 134 in Peru. Of all the botanical taxa listed, only five (1.1%) were listed in all four countries under investigation. Agreement among informants within free lists was highest in Tyrol (17%), followed by Peru (12.2%), Australia (11.9%) and Brazil (11.2%). The proportion of agreement differs significantly between informants in Australia and Tyrol (p?=?0.001), Brazil and Tyrol (p?=?0.001) and Peru and Tyrol (p?=?0.001) and is similar between informants in the migrant countries, as indicated by statistical tests. We recorded 1,286 use citations according to 744 different uses (Tyrol: 552, Australia: 200, Brazil: 180, Peru: 357) belonging to 22 different categories of use. Use values are significantly different between Tyrol and Australia (p?<?0.001) but not between Tyrol and Brazil (p?=?0.127) and Tyrol and Peru (p?=?0.853). The average informant agreement ratio (IAR) in Tyrol is significantly higher than in Australia (p?=?0.089) and Brazil (p?=?0.238), but not Peru (p?=?0.019).

Conclusions

Changing ecological and social conditions have transformed and shaped traditional knowledge of medicinal plants through adaptation processes to match the new circumstances in the country of arrival. Continuation, substitution and replacement are strategies that have taken place at different rates depending on local circumstances in the research areas. Traditional knowledge of medicinal plants acquired in the home country is continuously diminishing, with its composition influenced by urbanisation and ongoing globalisation processes and challenged by shifts from traditional healing practices to modern healthcare facilities.