[Behavior and social inequalities in prioritized indicators of Sustainable Development Goal 3 in Bolivia]. / Comportamiento y desigualdades sociales en indicadores priorizados del Objetivo de Desarrollo Sostenible 3 en Bolivia.

OBJECTIVE: To describe the behavior and social inequalities in prioritized indicators of Sustainable Development Goal 3 (ODS-3) among subpopulations and departments of Bolivia. METHODS: An analysis of the behavior of selected ODS-3 indicators over time was conducted. In addition, a study of social inequalities in these indicators was carried out for selected equity stratifiers. Simple measures (absolute gap and relative gap) and complex measures (slope inequality index and concentration index) were obtained to explore the magnitude of social inequalities. RESULTS: The ODS-3 indicators that have increased significantly at the national and departmental levels are the prevalence of four prenatal controls and the prevalence of births attended by qualified health personnel. Social inequalities in these indicators have decreased significantly over time. The prevalence of adolescent pregnancy and its social inequalities have remained unchanged, although with low inequalities. The prevalence of modern contraceptive methods use has decreased slightly, although social inequality has declined more rapidly. The maternal mortality rate has decreased nationally and in most departments, but social inequality on this indicator still needs to be addressed. CONCLUSIONS: National averages hide differences between subpopulations and departments in Bolivia. The findings show that the behavior and social inequality of some ODS-3 indicators have improved, but regarding other indicators interventions by different stakeholders must be strengthened to reduce social inequalities in health.

Abortion-related morbidity in six Latin American and Caribbean countries: findings of the WHO/HRP multi-country survey on abortion (MCS-A).

INTRODUCTION: Abortion-related complications are a significant cause of morbidity and mortality among women in many Latin American and Caribbean (LAC) countries. The objective of this study was to characterise abortion-related complication severity, describe the management of these complications and report women's experiences with abortion care in selected countries of the Americas region. METHODS: This is a cross-sectional study of 70 health facilities across six countries in the region. We collected data on women's characteristics including socio-demographics, obstetric history, clinical information, management procedures and using Audio Computer-Assisted Self-Interviewing (ACASI) survey the experience of abortion care. Descriptive bivariate analysis was performed for women's characteristics, management of complications and reported experiences of abortion care by severity of complications, organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Generalised linear estimation models were used to assess the association between women's characteristics and severity of complications. RESULTS: We collected data on 7983 women with abortion-related complications. Complications were classified as mild (46.3%), moderate (49.5%), potentially life-threatening (3.1%), near-miss cases (1.1%) and deaths (0.2%). Being single, having a gestational age of ≥13 weeks and having expelled products of conception before arrival at the facility were significantly associated with experiencing severe maternal outcomes compared with mild complications.Management of abortion-related complications included both uterotonics and uterine evacuation for two-thirds of the women while one-third received uterine evacuation only. Surgical uterine evacuation was performed in 93.2% (7437/7983) of women, being vacuum aspiration the most common one (5007/7437, 67.4%).Of the 327 women who completed the ACASI survey, 16.5% reported having an induced abortion, 12.5% of the women stated that they were not given explanations regarding their care nor were able to ask questions during their examination and treatment with percentages increasing with the severity of morbidity. CONCLUSIONS: This is one of the first studies using a standardised methodology to measure severity of abortion-related complications and women's experiences with abortion care in LAC. Results aim to inform policies and programmes addressing sexual and reproductive rights and health in the region.

Mortalidad infantil en población huichol del estado de Jalisco / Infant mortality among the huichol population in the state of Jalisco

Introducción. La mortalidad infantil supone un importante problema de salud en los países desarrollados, especialmente entre los sectores marginados de los mismos, como son los grupos indígenas. Desgraciadamente, el subregistro y el manejo de cifras globales de mortalidad, impiden conocer la dimensión del problema en estos grupos específicos. El objetivo de este estudio fue conocer la magnitud de la mortalidad infantil entre la población huichola del estado de Jalisco. Material y métodos. Se realizó un estudio de tipo observacional descriptivo en población huichola del estado de Jalisco. Material y métodos. Se realizó un estudio de tipo observacional descriptivo en población huichola del estado de Jalisco. La información recabada se refirió al período comprendido entre agosto de 1990 y agosto de 1991 (un año). La información sobre mortalidad infantil se recogió a través de un cuestionario que se aplicó a 349 familias hicholas . Dicho cuestionario incluyó preguntas de identificación, número de nacidos durante el período estudiado, número de nacidos vivos que murieron antes del año de edad en el mismo período, sexo de los niños fallecidos y causa de muerte. Resultados. Los resultados informaron 208 niños nacidos vivos y 27 fallecimientos de niños menores de 1 año: 15 menores de 28 días y 12 de 28 hasta 364 días. La tasa de mortalidad infantil fue de 129.8 por 1000 nacidos vivos; las tasas de mortalidad neonatal y postneonatal fueron de 72.1 y 57.7 por 1000 nacidos vivos respectivamente. Dichas tasas resultaron más elevadas que las correspondientes a México y otros países del área panamericana. Las causas de las muertes fueron, en orden decreciente: infecciones, causa desconocida, síndrome de dificultad respiratoria, nacimiento pretérmino, bajo peso al nacer y deficiencias de la nutrición. Conclusiones. Existe una elevada mortalidad infantil entre la población huichol, lo cual prodría relacionarse con factores sociales, culturales y de servicios presentes en la zona. Asimismo, la elevada mortalidad infantil encontrada señala a la población huichola como una de las más desprotegidas de México y es reflejo de las considerables diferencias que, en materia de salud, persisten en el país