Casamiento infantil y salud perinatal en Ecuador, 2015-2020 / Child marriage and perinatal health in Ecuador, 2015-2020

RESUMEN Este estudio buscó estimar la prevalencia y distribución de nacidos vivos de madres menores de 18 años en Ecuador y la asociación entre indicadores perinatales y estado marital materno. A partir de los registros de nacidos vivos obtenidos del Instituto Nacional de Estadísticas y Censos de Ecuador para el período 2015-2020, se estimó la asociación conjunta entre grupos de edad (10-15, 16-17, 18-19 y 20-24 años) y la situación conyugal materna (casada, unión estable y soltera), con bajo peso al nacer, parto pretérmino e inadecuada atención prenatal. La prevalencia de partos de madres menores de 18 años fue del 9,3% y declinó en el periodo de estudio, drásticamente entre las mujeres casadas. La asociación entre estado marital y las variables explicativas dependió de la edad materna. Los resultados más favorables de salud observados entre las madres casadas de 20-24 años, en comparación con las madres solteras, se debilitan o desaparecen entre las menores de edad. Las madres en uniones de hecho experimentaron resultados intermedios entre las mujeres casadas y las solteras.

ABSTRACT This study sought to estimate the prevalence and distribution of newborns to mothers under age 18 in Ecuador and the association between perinatal indicators and maternal marital status. Newborn records obtained from Ecuador's Instituto Nacional de Estadísticas y Censos (INEC) between 2015 and 2020 were used to assess the joint association between maternal age groups (10-15, 16-17, 18-19, and 20-24 years) and marital status (married, common-law, and single) with low birthweight, preterm birth, and inadequate prenatal care. The prevalence of newborns to mothers under age 18 was 9.3% overall, but declined over the study period, drastically among married mothers. The association between marital status and perinatal indicators depended on maternal age. The more favorable outcomes observed among married mothers aged 20-24 years (compared to their single counterparts) weaken or disappear among mothers under age 18. Mothers in stable unions exhibited outcomes in between those of married and single mothers.

Vinculación de datos administrativos y su utilidad en salud pública: el caso de Ecuador / Administrative data linkage and its usefulness in public health: the case of Ecuador / Vinculação de dados administrativos e sua utilização em saúde pública: o caso do Equador

RESUMEN Los objetivos de este artículo son describir las características del abordaje de vinculación de bases de datos administrativos y sus usos en investigación en salud pública, y discutir las potencialidades y retos para su implementación en Ecuador. La vinculación de bases de datos permite integrar datos de una misma persona dispersos en distintos subsectores como salud, educación, justicia, inmigración y programas sociales, y posibilita investigaciones que informen una gestión más eficiente de programas y políticas sociales y de salud. Las principales ventajas del uso de bases de datos relacionadas son la diversidad de datos, la cobertura poblacional, la estabilidad temporal y el costo menor en comparación con la recolección de datos primarios. A pesar de la disponibilidad de herramientas para procesar, vincular y analizar grandes conjuntos de datos, el uso de este abordaje es mínimo en los países de América Latina. Ecuador tiene un alto potencial para explotar este abordaje, debido a la obligatoriedad del uso de un identificador único en la prestación de servicios de salud, que permite la vinculación con otros sistemas de información nacionales. Sin embargo, enfrenta una serie de retos técnicos, ético-legales, culturales y políticos. Para aprovechar su potencial, Ecuador necesita desarrollar una estrategia de gobernanza de datos que incluya normativas de acceso y uso de los datos, de manera simultánea con mecanismos de control y calidad de los datos, una mayor inversión en formación profesional en el uso de los datos dentro y fuera del sector salud, y colaboraciones entre entidades gubernamentales, universidades y organizaciones de la sociedad civil.

ABSTRACT The objective of this article is to describe the characteristics of addressing the linkage of administrative databases and the uses of such linkages in public health research, and also to discuss the opportunities and challenges for implementation in Ecuador. The linkage of databases makes it possible to integrate a person's data that may be scattered across different subsectors such as health, education, justice, immigration, and social programs. It also facilitates research that can inform more efficient management of social and health programs and policies. The main advantages of using linked databases are: diversity of data, population coverage, stability over time, and lower cost in comparison to primary data collection. Despite the availability of tools to process, link, and analyze large data sets, there has been minimal use of this approach in Latin American countries. Ecuador is well positioned to implement this approach, due to compulsory use of a unique ID in health services delivery, which permits linkages with other national information systems. However, the country faces several cultural, technical, ethical, legal, and political challenges. To take advantage of its potential, Ecuador needs to develop a data governance strategy that includes standards for data access and data use, as well as mechanisms for data control and quality, greater investment in professional training in data use both within and beyond the health sector, and collaborations between government entities, universities, and civil society organizations.

RESUMO Os objetivos deste artigo são descrever as características do método de vinculação de bancos de dados administrativos e sua utilização em pesquisa em saúde pública e examinar o potencial e os desafios para sua implementação no Equador. A vinculação de bancos de dados possibilita integrar dados de uma mesma pessoa dispersos em subsetores diversos como saúde, educação, justiça, imigração e programas sociais e realizar pesquisas para subsidiar a gestão mais eficiente de programas e políticas sociais e de saúde. Entre as principais vantagens de utilizar bancos de dados vinculados estão diversidade dos dados, cobertura populacional, estabilidade temporal e custo menor em comparação à coleta de dados primários. Apesar de existirem ferramentas para processar, vincular e analisar grandes conjuntos de dados, a utilização deste método é mínima nos países da América Latina. O Equador possui um grande potencial para beneficiar-se com este método devido à obrigatoriedade do uso de um identificador único na prestação de serviços de saúde, o que permite a vinculação com outros sistemas de informação nacionais, mas enfrenta uma série de desafios técnicos, éticos-legais, culturais e políticos. Para aproveitá-lo, o país precisa elaborar uma estratégia de governança de dados contendo um conjunto de normas para o acesso e a utilização simultâneos com mecanismos de controle e qualidade dos dados, maior investimento em formação profissional no uso dos dados dentro e fora da área da saúde e colaboração entre entidades governamentais, universidades e organizações da sociedade civil.

Nutrition and physical activity transitions in the Ecuadorian Andes: Differences among urban and rural-dwelling women.

OBJECTIVES: The nutrition and physical activity transitions, characterized by increased consumption of high energy density foods and more sedentary lifestyles, are associated with increased obesity and hypertension in Ecuador. These transitions have been characterized primarily in urban areas, which may neglect variation in specific rural areas of Ecuador. Therefore we examined the extent of the differences in dietary and activity patterns, obesity prevalence, and blood pressure (BP) in urban and rural-dwelling women in the Ecuadorian central highlands. METHODS: Urban-dwelling women (UW, n = 198, mean age = 44 years) from three areas of a city of 250,000 residents and rural women (RW; n = 202, mean age = 47 years) from three remote communities in the same province (Chimborazo) were randomly selected and surveyed for dietary and activity practices, BP, and anthropometrics. RESULTS: Ninety percent of UW reported obtaining their food primarily from markets while 65% of RW women obtained their food primarily from their own cultivation. Cookies, cakes, candies, ice cream, and French fries were consumed more frequently by UW. RW reported lower consumption of beef, poultry, and chicken, as well as fruits, milk, and white rice. UW compared to RW women spent less time walking and in strenuous work activities. Obesity (BMI > 30 kg/m2 ) (UW = 18.7% vs RW = 9.2%) and hypertension (UW = 15.7%, RW= 3.0%) were more common in UW. Average systolic and diastolic BP was significantly higher in UW. CONCLUSIONS: The nutrition and physical activity transitions appear more evident in urban- compared to rural-dwelling women, and are associated with more obesity and higher BP.

Capital social e información para la salud en el contexto del modo de vida de agricultores de pequeña escala / Social capital and health information in the context of small scale farmers' livelihoods

El estudio explora la relación entre el capital social y la información para la salud en agricultores de pequeña escala, en el contexto de su modo de vida. Tener información al respecto promovería la adopción de prácticas agrícolas con menos impacto en su salud debido a la reducción del uso de pesticidas de alta toxicidad. La investigación se desarrolló a través de un diseño longitudinal de medidas repetidas, en julio de 2007 (T1) y febrero de 2010 (T2), en 12 comunidades agrícolas de Ecuador (n=208). La información respecto a las prácticas de producción agrícola, entre ellas, el manejo integrado de plagas, y la toxicidad de los pesticidas constituyeron las variables dependientes. La participación en organizaciones, y la cohesión social, entre otros aspectos del capital social fueron tratados en el análisis como variables independientes. Los hallazgos sugieren que la información para la salud es transmitida por las estructuras del capital social en dependencia de su valor de uso en el marco del modo de producción agrícola.

The study explores the relationship between social capital and health information among small-scale farmers in the context of their livelihoods. Having such information could promote the use of agriculture practices with fewer health impacts by reducing farmers' exposure to highly toxic pesticides. We implemented a longitudinal study design with measurements in July 2007 (T1) and February 2010 (T2), within 12 agricultural communities in Ecuador (n=208 farmers). The dependent variables were based on information regarding agricultural production practices, among them: integrated pest management (IPM) and pesticide toxicity. Independent variables included participation in organizations and social cohesion, among other aspects of social capital. Results suggest that health information is disseminated through structures of social capital, depending on its value of use in the context of the mode of production in which small scale agriculture is developed.

Monitoring adherence to the international code of conduct: highly hazardous pesticides in central Andean agriculture and farmers' rights to health.

The WHO has advocated monitoring adherence to the Food and Agriculture Organization's Code of Conduct to reduce use of highly hazardous pesticides in lower and middle income countries. We re-framed Code articles in terms of farmers' rights and drew on survey data, farmer focus group results, and direct observations of agrochemical stores in Ecuador and Peru to construct indicators reflecting respect for such rights. Use of highly (Ia and Ib) and moderately (II) hazardous pesticides was common. Worse indicators were observed in places with lower education, greater poverty, and more use of indigenous languages. Limited government enforcement capacity, social irresponsibility of the pesticide industry, and lack of farmers' knowledge of the Code were all factors impeding respect for farmers' rights. Addressing the power imbalance among social actors requires informed farmer and farmworker participation in monitoring adherence and active involvement of non-governmental organizations and municipal governments.