Factors associated to infant mortality in Sub-Saharan Africa.

Half of the 10 million children who die annually in the world are from Sub-Saharan Africa (SSA). The reasons are known, but lack of will and resources avoid the development of sustainable policies. Associated factors to the high infant mortality rate (IMR) in SSA have been investigated in this research. An ecological multi-group study was designed comparing rates within SSA. The dependent variable is the IMR and health services, economic and development indicators are the independent variables. Information and data sources were WHO, World Bank, UNICEF and UNDP (1997-2007). IMR mean value is 92.2 (per 1000 live births) and a relationship with several of the factors could be observed. In the bi-variate analysis direct relationship was observed with maternal mortality rate and an inverse relationship was observed with prenatal care coverage, births assisted by skilled health personnel, gross national income per capita, per capita government expenditure on health, social security expenditure, adult literacy rate, net primary school enrolment rate, population with access to safe drinking water (in urban and rural areas) and with population with access to basic sanitation in rural areas. In the multi-variate analysis IMR had an inverse relationship with children under 5 years with diarrhoea who receive oral re-hydration, with social security expenditure as percentage of general government expenditure on health and with per capita government expenditure on health. The situation in SSA would change if their inhabitants received education and information to demand more equitable polices and better investments from their governments.

Factors Associated to Infant Mortality in Sub-Saharan Africa

Half of the 10 million children who die annually in the world are from Sub-Saharan Africa (SSA). The reasons are known; but lack of will and resources avoid the development of sustainable policies. Associated factors to the high infant mortality rate (IMR) in SSA have been investigated in this research. An ecological multi-group study was designed comparing rates within SSA. The dependent variable is the IMR and health services; economic and development indicators are the independent variables. Information and data sources were WHO; World Bank; UNICEF and UNDP (1997-2007). IMR mean value is 92.2 (per 1000 live births) and a relationship with several of the factors could be observed. In the bi-variate analysis direct relationship was observed with maternal mortality rate and an inverse relationship was observed with prenatal care coverage; births assisted by skilled health personnel; gross national income per capita; per capita government expenditure on health; social security expenditure; adult literacy rate; net primary school enrolment rate; population with access to safe drinking water (in urban and rural areas) and with population with access to basic sanitation in rural areas. In the multi-variate analysis IMR had an inverse relationship with children under 5 years with diarrhoea who receive oral re-hydration; with social security expenditure as percentage of general government expenditure on health and with per capita government expenditure on health. The situation in SSA would change if their inhabitants received education and information to demand more equitable polices and better investments from their governments

[Governability of the Spanish national health system: improving the balance between the benefits and costs of decentralization. 2008 SESPAS Report]. / Gobernabilidad del Sistema Nacional de Salud: mejorando el balance entre los beneficios y los costes de la descentralización. Informe SESPAS 2008.

The Spanish National Health System (SNHS) is currently in a complex equilibrium which, even if acceptable in the short term, faces major sustainability and governance challenges; the so far inconclusive outcome of the SNHS decentralization process clearly underlines the importance of seeking new alternatives to effectively bring about the real benefits of decentralization, while taking advantage of the system's economies of scale and achieving its equity objectives. To this end, four lines of action are proposed in this paper: first, redefine the SNHS based on universal public coverage, as a civic right and equal for all; second, reframe the financing system and the role of the Cohesion Fund; third, review the role of central government and its Ministry of Health, and fourth, create of a SNHS Agency headed by a Commissioner, for providing an organizational framework and identity for the SNHS, and serving as the cooperative body of the seventeen Autonomous Communities' Health Services.

Gobernabilidad del Sistema Nacional de Salud: mejorando el balance entre los beneficios y los costes de la descentralización. Informe SESPAS 2008 / Governability of the Spanish national health system: improving the balance between the benefits and costs of decentralization. 2008 SESPAS Report

El Sistema Nacional de Salud (SNS) presenta una complejasituación de equilibrio, que aunque puede ser satisfactorioa corto plazo, plantea grandes problemas de sostenibilidady gobernabilidad; el incierto balance del procesode descentralización sanitaria en España señala claramentela senda de buscar nuevas alternativas organizativas parahacer efectivas las ventajas de la descentralización, a la vezque ser capaces de aprovechar las economías del sistemay conseguir la equidad pretendida. Se proponen cuatro líneasde actuación: redefinición del SNS en torno al aseguramientopúblico y derecho cívico igual para todos; replanteamientodel sistema de financiación y del papel delfondo de cohesión; redefinir el papel del gobierno central yel Ministerio de Sanidad, y crear un nuevo organismo, laAgencia del SNS con un Comisionado que de soporte organizativoe identidad al SNS como ámbito de acción cooperativa(AU)

The Spanish National Health System (SNHS) is currently ina complex equilibrium which, even if acceptable in the shortterm, faces major sustainability and governance challenges;the so far inconclusive outcome of the SNHS decentralizationprocess clearly underlines the importance of seeking new alternativesto effectively bring about the real benefits of decentralization,while taking advantage of the system’s economiesof scale and achieving its equity objectives.To this end, four lines of action are proposed in this paper:first, redefine the SNHS based on universal public coverage,as a civic right and equal for all; second, reframe the financingsystem and the role of the Cohesion Fund; third, reviewthe role of central government and its Ministry of Health, andfourth, create of a SNHS Agency headed by a Commissioner,for providing an organizational framework and identity forthe SNHS, and serving as the cooperative body of the seventeenAutonomous Communities’ Health Services(AU)

Gobernabilidad del Sistema Nacional de Salud: mejorando el balance entre los beneficios y los costes de la descentralización. Informe SESPAS 2008 / Governability of the Spanish national health system: improving the balance between the benefits and costs of decentralization. 2008 SESPAS Report

El Sistema Nacional de Salud (SNS) presenta una compleja situación de equilibrio, que aunque puede ser satisfactorio a corto plazo, plantea grandes problemas de sostenibilidad y gobernabilidad; el incierto balance del proceso de descentralización sanitaria en España señala claramente la senda de buscar nuevas alternativas organizativas para hacer efectivas las ventajas de la descentralización, a la vez que ser capaces de aprovechar las economías del sistema y conseguir la equidad pretendida. Se proponen cuatro líneas de actuación: redefinición del SNS en torno al aseguramiento público y derecho cívico igual para todos; replanteamiento del sistema de financiación y del papel del fondo de cohesión; redefinir el papel del gobierno central y el Ministerio de Sanidad, y crear un nuevo organismo, la Agencia del SNS con un Comisionado que de soporte organizativo e identidad al SNS como ámbito de acción cooperativa

The Spanish National Health System (SNHS) is currently in a complex equilibrium which, even if acceptable in the short term, faces major sustainability and governance challenges; the so far inconclusive outcome of the SNHS decentralization process clearly underlines the importance of seeking new alternatives to effectively bring about the real benefits of decentralization, while taking advantage of the system¿s economies of scale and achieving its equity objectives. To this end, four lines of action are proposed in this paper: first, redefine the SNHS based on universal public coverage, as a civic right and equal for all; second, reframe the financing system and the role of the Cohesion Fund; third, review the role of central government and its Ministry of Health, and fourth, create of a SNHS Agency headed by a Commissioner, for providing an organizational framework and identity for the SNHS, and serving as the cooperative body of the seventeen Autonomous Communities Health Services (AU)

Reflexión a mitad de camino / Reflections half way down the road

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Prevalence of latent autoimmune diabetes of adults (LADA) in Southern Spain.

OBJECTIVE: To study the prevalence of diabetes mellitus and islet autoantibodies in an adult population from Southern Spain. RESEARCH AND METHODS: A cross-sectional study in Southern Spain of 1226 people, age 18-65 years. Clinical data were obtained and a blood sample taken to measure autoantibodies (glutamic acid decarboxylase antibodies (GADAb), tyrosine phosphatase antibodies (IA2Ab), and insulin antibodies (IAA)). An oral glucose tolerance test (OGTT) was also given to 982 of the subjects. RESULTS: The overall prevalence of diabetes mellitus according to the WHO 1979 criteria was 10.9% and according to the ADA 1997 criteria it was 14.7% (8.8% were unaware of their diabetes). The prevalence of impaired fasting glucose (IFG) was 12.4% and of impaired glucose tolerance (IGT) 11.5%. The prevalence of GADAb+ in the general population was 0.9% and in the diabetic population 3.7%. There were no significant differences between groups in the prevalence of IA2Ab or IAA (both were 0.8% in the general population). Of the three autoantibodies studied, only GADAb were significantly different in the diabetic population (P=0.0006). CONCLUSIONS: The prevalence of Type 2 diabetes and LADA are high in the south of Spain.