Social inequalities in maternal mortality among the provinces of Ecuador.

OBJECTIVE: This study set out to describe the association between the maternal mortality ratio (MMR) estimates and a set of socioeconomic indicators and compute the MMR inequalities among the provinces of Ecuador. METHODS: A cross-sectional ecological study was conducted, using data for 2014 from the country's 24 provinces. The MMR estimate was calculated for each province, as well as the association and its strength between MMR and specific socioeconomic indicators. For the indicators that were found to be significantly associated with MMR, inequality measurements were computed. RESULTS: Despite a relatively low MMR for Ecuador overall, ratios differed substantially among the provinces. Five socioeconomic indicators proved to be statistically significantly associated with MMR: total fertility rate, the percentage of indigenous population, the percentage of households with children who do not attend school, gross domestic product, and the percentage of houses with electrical service. Of these five, only three had MMR inequalities that were significant: total fertility rate, gross domestic product, and the percentage of households with electricity. CONCLUSIONS: This study supports research arguing that national averages can be misleading, as they often hide differences among subgroups at the local level. The findings also suggest that MMR is significantly associated with some socioeconomic indicators, including ones linked with significant health outcome inequalities. In order to reduce health inequities, it is crucial that countries look beyond national averages and identify the subgroups being left behind, explore the particular social determinants that generate these health inequalities, and examine the specific barriers and other factors affecting the subgroups most vulnerable to maternal health inequalities.

Social inequalities in maternal mortality among the provinces of Ecuador / Las desigualdades sociales en cuanto a la mortalidad materna entre las provincias del Ecuador

Objective. This study set out to describe the association between the maternal mortality ratio (MMR) estimates and a set of socioeconomic indicators and compute the MMR inequalities among the provinces of Ecuador. Methods. A cross-sectional ecological study was conducted, using data for 2014 from the country’s 24 provinces. The MMR estimate was calculated for each province, as well as the association and its strength between MMR and specific socioeconomic indicators. For the indicators that were found to be significantly associated with MMR, inequality measurements were computed. Results. Despite a relatively low MMR for Ecuador overall, ratios differed substantially among the provinces. Five socioeconomic indicators proved to be statistically significantly associated with MMR: total fertility rate, the percentage of indigenous population, the percentage of households with children who do not attend school, gross domestic product, and the percentage of houses with electrical service. Of these five, only three had MMR inequalities that were significant: total fertility rate, gross domestic product, and the percentage of households with electricity. Conclusions. This study supports research arguing that national averages can be misleading, as they often hide differences among subgroups at the local level. The findings also suggest that MMR is significantly associated with some socioeconomic indicators, including ones linked with significant health outcome inequalities. In order to reduce health inequities, it is crucial that countries look beyond national averages and identify the subgroups being left behind, explore the particular social determinants that generate these health inequalities, and examine the specific barriers and other factors affecting the subgroups most vulnerable to maternal health inequalities.

Objetivo. El propósito de este estudio fue describir la asociación entre la razón de mortalidad materna y un conjunto de indicadores socioeconómicos, y calcular las desigualdades en la razón de mortalidad maternal entre las distintas provincias del Ecuador. Métodos. Se consideró un estudio ecológico transversal utilizando datos provenientes de las 24 provincias de Ecuador en el 2014, calculándose la razón de mortalidad materna para cada provincia, así como estudiando la asociación y su fuerza entre la razón de mortalidad materna y el conjunto de los indicadores socioeconómicos. Se obtuvieron las medidas de la desigualdades para aquellos indicadores socioeconómicos que mostraron una asociación estadísticamente significativa con la mortalidad materna. Resultados. A pesar de que la razón de mortalidad materna en Ecuador es relativamente baja a nivel mundial, las razones de la mortalidad materna difieren mucho entre las provincias. Hubo cinco indicadores socioeconómicos que resultaron estar asociados siginificativamente con la razón de mortalidad materna: la tasa total de fecundidad, el porcentaje de población indígena, el porcentaje de hogares con niños que no asisten a la escuela, el producto interno bruto y el porcentaje de hogares con servicio eléctrico. De estos cinco, solo tres mostraron desigualdades estadísticamente significativas en la mortalidad materna: la tasa total de fecundidad, el producto interno bruto y el porcentaje de hogares con electricidad. Conclusiones. Este estudio respalda las investigaciones que sostienen que los promedios nacionales pueden ser engañosos, pues a menudo ocultan diferencias entre subgrupos a nivel local. Los resultados también indican que la razón de mortalidad materna esta asociada significativamente con algunos indicadores socioeconómicos, incluyendo algunos que resultaron en desigualdades significativas en salud materna. Para reducir las inequidades en materia de salud, es crucial que los países adopten un enfoque que trascienda a los promedios nacionales y detecten los subgrupos que van quedando rezagados, analicen los determinantes sociales particulares que generan esas desigualdades en materia de salud y examinen los obstáculos específicos y otros factores que afectan a los subgrupos más vulnerables a las desigualdades en salud materna.

Social inequalities in maternal mortality among the provinces of Ecuador / Las desigualdades sociales en cuanto a la mortalidad materna entre las provincias del Ecuador

ABSTRACT Objective This study set out to describe the association between the maternal mortality ratio (MMR) estimates and a set of socioeconomic indicators and compute the MMR inequalities among the provinces of Ecuador. Methods A cross-sectional ecological study was conducted, using data for 2014 from the country’s 24 provinces. The MMR estimate was calculated for each province, as well as the association and its strength between MMR and specific socioeconomic indicators. For the indicators that were found to be significantly associated with MMR, inequality measurements were computed. Results Despite a relatively low MMR for Ecuador overall, ratios differed substantially among the provinces. Five socioeconomic indicators proved to be statistically significantly associated with MMR: total fertility rate, the percentage of indigenous population, the percentage of households with children who do not attend school, gross domestic product, and the percentage of houses with electrical service. Of these five, only three had MMR inequalities that were significant: total fertility rate, gross domestic product, and the percentage of households with electricity. Conclusions This study supports research arguing that national averages can be misleading, as they often hide differences among subgroups at the local level. The findings also suggest that MMR is significantly associated with some socioeconomic indicators, including ones linked with significant health outcome inequalities. In order to reduce health inequities, it is crucial that countries look beyond national averages and identify the subgroups being left behind, explore the particular social determinants that generate these health inequalities, and examine the specific barriers and other factors affecting the subgroups most vulnerable to maternal health inequalities.

RESUMEN Objetivo El propósito de este estudio fue describir la asociación entre la razón de mortalidad materna y un conjunto de indicadores socioeconómicos, y calcular las desigualdades en la razón de mortalidad maternal entre las distintas provincias del Ecuador. Métodos Se consideró un estudio ecológico transversal utilizando datos provenientes de las 24 provincias de Ecuador en el 2014, calculándose la razón de mortalidad materna para cada provincia, así como estudiando la asociación y su fuerza entre la razón de mortalidad materna y el conjunto de los indicadores socioeconómicos. Se obtuvieron las medidas de la desigualdades para aquellos indicadores socioeconómicos que mostraron una asociación estadísticamente significativa con la mortalidad materna. Resultados A pesar de que la razón de mortalidad materna en Ecuador es relativamente baja a nivel mundial, las razones de la mortalidad materna difieren mucho entre las provincias. Hubo cinco indicadores socioeconómicos que resultaron estar asociados siginificativamente con la razón de mortalidad materna: la tasa total de fecundidad, el porcentaje de población indígena, el porcentaje de hogares con niños que no asisten a la escuela, el producto interno bruto y el porcentaje de hogares con servicio eléctrico. De estos cinco, solo tres mostraron desigualdades estadísticamente significativas en la mortalidad materna: la tasa total de fecundidad, el producto interno bruto y el porcentaje de hogares con electricidad. Conclusiones Este estudio respalda las investigaciones que sostienen que los promedios nacionales pueden ser engañosos, pues a menudo ocultan diferencias entre subgrupos a nivel local. Los resultados también indican que la razón de mortalidad materna esta asociada significativamente con algunos indicadores socioeconómicos, incluyendo algunos que resultaron en desigualdades significativas en salud materna. Para reducir las inequidades en materia de salud, es crucial que los países adopten un enfoque que trascienda a los promedios nacionales y detecten los subgrupos que van quedando rezagados, analicen los determinantes sociales particulares que generan esas desigualdades en materia de salud y examinen los obstáculos específicos y otros factores que afectan a los subgrupos más vulnerables a las desigualdades en salud materna.

Integrating oral health into Haiti's National Health Plan: from disaster relief to sustainable development.

In 2010, Haiti suffered three devastating national emergencies: a 7.0 magnitude earthquake that killed over 200 000 and injured 300 000; a cholera outbreak that challenged recovery efforts and caused more deaths; and Hurricane Tomas, which brought additional destruction. In the aftermath, the Pan American Health Organization (PAHO) reoriented its technical cooperation to face the myriad of new challenges and needs. Efforts included support and technical assistance to the Ministry of Health and Population of Haiti and coordination of actions by the United Nations Health Cluster. This Special Report focuses specifically on the PAHO Regional Oral Health Program's call to action in Haiti and the institutional partnerships that were developed to leverage resources for oral health during this critical time and beyond. To date, achievements include working with Haiti's private sector, dental schools, public health associations, and other stakeholders, via the Oral Health of Haiti (OHOH) Coalition. The OHOH aims to meet the immediate needs of the dental community and to rebuild the oral health component of the health system; to provide dental materials and supplies to oral health sites in affected areas; and to ensure that the "Basic Package of Health Services" includes specific interventions for oral health care and services. The experience in Haiti serves as a reminder to the international community of how important linking immediate/short-term disaster-response to mid- and longterm strategies is to building a health system that provides timely access to health services, including oral health. Haiti's humanitarian crisis became an important time to rethink the country's health system and services in terms of the right to health and the concepts of citizenship, solidarity, and sustainable development.