Integrated Approaches and Practical Recommendations in Patient Care Identified with 5q Spinal Muscular Atrophy through Newborn Screening.

In recent years, significant progress has been made in 5q Spinal Muscular Atrophy therapeutics, emphasizing the importance of early diagnosis and intervention for better clinical outcomes. Characterized by spinal cord motor neuron degeneration, 5q-SMA leads to muscle weakness, swallowing difficulties, respiratory insufficiency, and skeletal deformities. Recognizing the pre-symptomatic phases supported by screening and confirmatory genetic tests is crucial for early diagnosis. This work addresses key considerations in implementing 5q-SMA screening within the Brazilian National Newborn Screening Program and explores Brazil's unique challenges and opportunities, including genetic tests, time-to-patient referral to specialized centers, program follow-up, and treatment algorithms. We aim to guide healthcare professionals and policymakers, facilitating global discussions, including Latin American countries, and knowledge-sharing on this critical subject to improve the care for newborns identified with 5q SMA.

Consumo de alcohol durante el COVID-19 en Latinoamérica según edad y situación de empleo / Alcohol consumption during COVID-19 in Latin America according to age and employment situation

Esta investigación evaluó el consumo de alcohol en población adulta Latinoamericana y del Caribe latino durante el confinamiento por COVID-19, atendiendo a la edad y situación laboral. Diseño no probabilístico con muestreo por conveniencia, con una muestra de 4975 participantes. Se analizó edad, situación laboral y consumo de alcohol durante el confinamiento y retrospectivamente antes de la pandemia. Los resultados muestran que independientemente del país, los jóvenes de 18-29 años disminuyeron el consumo durante el confinamiento; mientras que el mayor aumento fue en adultos de 45-54 años. Los trabajadores a tiempo completo consumieron más que las personas desempleadas. Empleados a tiempo completo y a tiempo parcial, disminuyeron su consumo durante el confinamiento. Trabajadores por cuenta propia mostraron un consumo de alcohol significativamente superior al de empleados a tiempo completo y a tiempo parcial, durante el confinamiento. Es importante impulsar políticas de prevención del consumo de alcohol en el ámbito laboral. (AU)

This research evaluated alcohol consumption in the Latin American and Latin Caribbean adult population during COVID-19 confinement, taking into account age and employment status. Non-probabilistic design with convenience sampling, with a sample of 4975 participants. Age, employment status and alcohol consumption were analyzed during confinement and retrospectively before the pandemic. The results show that regardless of the country, young people aged 18-29 decreased consumption during confinement; while the largest increase was in adults aged 45-54 years. Full-time workers consumed more than unemployed people. Full-time and part-time employees decreased their consumption during confinement. Self-employed workers showed significantly higher alcohol consumption than full-time and part-time employees during confinement. It is important to promote policies to prevent alcohol consumption in the workplace. (AU)

Infant congenital heart disease prevalence and mortality in French Guiana: a population-based study.

Background: Few studies have assessed the prevalence and mortality of simple or complex congenital heart diseases (CHD) in newborns. In Latin America and Caribbean (LAC), CHD epidemiology seems highly variable, with few population-based assessments and different methodologies between studies. To date, the situation in French Guiana, a French overseas territory located in South America between Brazil and Suriname, has never been described. Methods: We analysed CHD prevalence, characteristics and related infant mortality in French Guiana, with a population-based registry analysis of all fetal and live birth CHD cases in infants under 1 year (January 2012-December 2016). Findings: Overall, 33,796 births (32,975 live births) were registered, with 231 CHD (56 fetuses), including 215 live births. Most frequent CHD categories were anomalies of the ventricular outflow tract and extra-pericardial trunks, and ventricular septal defects. 18.6% (43/231) chromosomal or genetic anomalies, and 6.5% (15/231) terminations of pregnancy were observed. Total CHD prevalence was 68.4 [95% CI: 67.9-68.8] per 10,000, while live birth prevalence was 65.2 [95% CI: 64.7-65.7] per 10,000. Total infant mortality was 9.4/10,000 live births [95% CI 9.1-9.7], with highest rates for functionally univentricular hearts (FUH). Interpretation: A distinct profile for CHD is highlighted in French Guiana with elevated mortality linked to FUH. A potential determinant of the recognized excess mortality risk might be the presence of chromosomal or genetic anomalies in about a fifth of all CHD. This helps us to better understand CHD burden in this part of South America and provides future keys towards reducing CHD-related infant mortality. Funding: The authors received no financial support for the present research, authorship, and/or publication of this article.

Evaluation of Mpox Knowledge, Stigma, and Willingness to Vaccinate for Mpox: Cross-Sectional Web-Based Survey Among Sexual and Gender Minorities.

BACKGROUND: The 2022 multicountry mpox outbreak positioned the condition as a public health emergency of international concern. By May 2023, Brazil ranked second globally in the cumulative number of mpox cases and deaths. The higher incidence of mpox among gay and other men who have sex with men in the current mpox outbreak deepens the stigma and discrimination against sexual and gender minorities (SGM). This might worsen the structural barriers impacting access to health services, which ultimately leads to undertesting and underreporting of cases. There are no data available on mpox knowledge and stigma in Latin America. OBJECTIVE: We aimed to evaluate mpox knowledge, stigma, and willingness to vaccinate for mpox among SGM, and to describe sociodemographic and behavioral characteristics according to self-reported mpox diagnosis. METHODS: A cross-sectional, internet-based survey was conducted in a convenience sample of adults (aged >18 years) living in Brazil recruited through advertisements on dating apps, social media, referral institutions for infectious diseases websites, and mass media (October-November 2022). We compared participants' characteristics according to self-reported mpox diagnosis using chi-square test or Fisher exact test for qualitative variables and Kruskal-Wallis test for quantitative variables. RESULTS: We enrolled 6236 participants: 5685 (91.2%) were cisgender men; 6032 (96.7%) were gay, bisexual, or pansexual; 3877 (62.2%) were White; 4902 (78.7%) had tertiary education; and 4070 (65.2%) reported low or middle income. Most participants (n=5258, 84.4%) agreed or strongly agreed that "LGBTQIA+ individuals are being discriminated and stigmatized due to mpox." Mpox awareness was 96.9% (n=6044), and 5008 (95.1%) were willing to get vaccinated for mpox. Overall, 324 (5.2%) reported an mpox diagnosis. Among these, 318 (98.1%) reported lesions, 178 (56%) local pain, and 316 (99.4%) sought health care. Among participants not reporting a diagnosis, 288 (4.9%) had a suspicious lesion, but only 158 (54.9%) of these had sought health care. Compared to participants with no diagnosis, those reporting an mpox diagnosis were younger (P<.001), reported more sex partners (P<.001), and changes in sexual behavior after mpox onset (P=.002). Moreover, participants diagnosed with mpox reported more frequently being tested for HIV in the prior 3 months (P<.001), living with HIV (P<.001), currently using HIV pre-exposure prophylaxis (P<.001), and previous sexually transmitted infection diagnosis (P<.001). CONCLUSIONS: Our results point to high mpox knowledge and willingness to vaccinate among SGM in Brazil. Participants self-reporting mpox diagnosis more frequently reported to be living with HIV, STI diagnosis, and current pre-exposure prophylaxis use, highlighting the importance of an mpox assessment that includes comprehensive sexual health screenings. Efforts to decrease stigma related to mpox among SGM are necessary to avoid mpox underdiagnosis.

Addressing Health Inequities and Disparities in Children With Kidney Disease in Disadvantaged Areas: the Latin American and Caribbean Experience.

Purpose of Review: Compared with high-income countries, healthcare disparities and inequities are more evident in low, lower-middle, and upper-middle-income countries with poorer housing and nutrition conditions. At least 20% of Latin America and the Caribbean are low and lower-middle-income countries. Despite the majority of the other countries being upper-middle income, the United Nations Children's Fund had classified all the regions as "less developed," with limited access to health care for the most vulnerable, the children. Latin America and the Caribbean regions represent an extensive territory with communication limitations and an unstable socio-political and economic environment. After considering the vast population affected by poverty worldwide and the long-term impact of kidney disease starting in childhood, it is crucial to better understand and analyze the multifactorial limiting conditions in accessing specialized care such as pediatric nephrology in disadvantaged areas. Recent Findings: Constraints in accessing basic healthcare in rural areas make it impossible to receive specialized pediatric nephrology care including dialysis and transplantation. Disturbingly, incidence and prevalence figures of acute kidney injury, chronic and end-stage kidney disease in some Latin American and the Caribbean countries are unknown, and these conditions still represent a death sentence for underprivileged populations. However, the monumental efforts of the dedicated healthcare providers and stakeholders that pioneered the actions in the past 50 years have shown remarkable progress in developing pediatric nephology services across the continent. Summary: In this review, we compile some of the latest evidence about the care of children and adolescents with kidney conditions in Latin America and the Caribbean, along with the experiences from the field in the care of these patients facing adverse conditions. We also highlight recommendations to address inequities and disparities.

How sport changed my life? Description of the perceived effects of the experiences of young Colombians throughout a sport for development and peace program.

Introduction: This study contributes to the advancement of the field of Sport for Development and Peace (SDP) research in Latin America and the Caribbean (LAC). There are still few studies on SDP programs in this region and it is important to document and understand the impacts of these programs on participants. Methods: The present study is the result of a collaborative research that aims to describe the experiences and perceptions of Colombian youth and program managers who participated in an SDP program that took them from a local community sports club to the Olympic Games. Seven semi-structured interviews were conducted with key actors (administrators, coaches, and athletes) who participated in a triple and transversal (local, district and national) Olympic walking training program. Results: The results provided a better understanding of the program dynamics in the local, regional, and national level, as well as of the short- and long-term effects perceived by the actors of the process on their development, education, health, and career. Recommendations are made for SDP organizations in LAC. Discussion: Future studies should continue to investigate the SDP initiative in LAC to understand how sport can help development and peace building in this region.

An analysis of how health systems integrated priority-setting in the pandemic planning in a sample of Latin America and the Caribbean countries.

BACKGROUND: Latin America and the Caribbean (LAC) are among those regions most affected by the COVID-19 pandemic worldwide. The COVID-19 pandemic has strained health systems in the region. In this context of severe healthcare resource constraints, there is a need for systematic priority-setting to support decision-making which ensures the best use of resources while considering the needs of the most vulnerable groups. The aim of this paper was to provide a critical description and analysis of how health systems considered priority-setting in the COVID-19 response and preparedness plans of a sample of 14 LAC countries; and to identify the associated research gaps. METHODS: A documentary analysis of COVID-19 preparedness and response plans was performed in a sample of 14 countries in the LAC region. We assessed the degree to which the documented priority-setting processes adhered to established quality indicators of effective priority-setting included in the Kapiriri and Martin framework. We conducted a descriptive analysis of the degree to which the reports addressed the quality parameters for each individual country, as well as a cross-country comparison to explore whether parameters varied according to independent variables. RESULTS: While all plans were led and supported by the national governments, most included only a limited number of quality indicators for effective priority-setting. There was no systematic pattern between the number of quality indicators and the country's health system and political contexts; however, the countries that had the least number of quality indicators tended to be economically disadvantaged. CONCLUSION: This study adds to the literature by providing the first descriptive analysis of the inclusion of priority-setting during a pandemic, using the case of COVID-19 response and preparedness plans in the LAC region. The analysis found that despite the strong evidence of political will and stakeholder participation, none of the plans presented a clear priority-setting process, or used a formal priority-setting framework, to define interventions, populations, geographical regions, healthcare setting or resources prioritized. There is need for case studies that analyse how priority-setting actually occurred during the COVID-19 pandemic and the degree to which the implementation reflected the plans and the parameters of effective priority-setting, as well as the impact of the prioritization processes on population health, with a focus on the most vulnerable groups.

From the global to the subnational scale: Landing the compositional monitoring of drinking water and sanitation services.

Monitoring of access to water and sanitation services is stipulated in Sustainable Development Goals (SDG) 6.1 and 6.2, respectively. The monitoring is carried out with a global, regional and country vision. However, in most developing countries, decentralization of services in water and sanitation management has tended to the sub-national level or has shared responsibilities between national and sub-national governments. Management at the subnational level becomes more important, since everything that is done there will impact the objectives and goals of the country. However, little or nothing progress has been made in harmonizing global indicators with those at the subnational level. Therefore, in this study we have proposed a way to disaggregate information and form WASH ladders at the subnational level. The results show using disaggregated data to interpolate models at the subnational level requires overcoming three main points: the validation of the data through statistical methods, interpolation techniques that go according to the compositional characteristics of the data and the incorporation of the uncertainty of the data into the model results. It also shows that subnational behavior is heterogeneous, which a general analysis does not capture correctly, i.e., there is a masking effect of subnational trends that the country's trend does not represent. However, these have been exceptional cases in some specific categories. Finally, the applicability of non-linear models is contrasted in a broader context, an issue that is still under discussion for its application to global monitoring. This study also provides a way to disaggregate information from the global to the sub-national level, allowing any sector analyst to replicate the methodology in a broader context.

Impact of the AACC Global Laboratory Quality Initiative in Partnership with Professional Societies and Universities in Latin America and the Caribbean.

The Global Lab Quality Initiative (GLQI), formerly known as the Emerging Countries program, was funded through a generous endowment from the Wallace H. Coulter Foundation. The aims of GLQI are to develop and implement innovative programs to promote education and training in laboratory medicine for low- or lower middle-income countries worldwide. From its inception in 2010, the GLQI was focused solely on the Latin America and Caribbean (LAC) region under the purview of AACC's Latin American Working Group (LAWG), the members of which have strong ties to the region thereby facilitating the partnerships with national societies. The LAWG has provided in-person workshops in the LAC countries, at the AACC Annual Scientific Meeting, and on-demand webinars. The LAWG aims to implement the GLQI aims in the LAC region. In-person workshops are based on best-practice recommendations and sources such as Clinical Laboratory Standard Institute guidelines and supplemented with professional experiences of the LAWG's lecturers and local experts of the countries visited. In 2015, the GLQI expanded to other regions of the world. Here we report the experience of the LAWG workshops, results of participant surveys, in-person visits to laboratories post-workshop, and the lessons learned throughout the years across different geographic areas. We are hopeful this report provides insights into the challenges and successes of the LAWG in LAC to help support the expansion of the GLQI.

Realizing the right to health in Latin America, equitably.

This special issue "Realizing the Right to Health in Latin America and the Caribbean" provides an overview of one of the most challenging objectives of health systems: equity and the realization of the right to health. In particular, it concentrates on the issues associated with such a challenge in countries suffering of deep inequity. The experience in Latin America and the Caribbean demonstrates that the efforts of health systems to achieve Universal Health Coverage are necessary but not sufficient to achieve an equitable realization of the right to health for all. The inequitable realization of all other human rights also determines the realization of the right to health.

Declines in Pneumonia Mortality Following the Introduction of Pneumococcal Conjugate Vaccines in Latin American and Caribbean Countries.

BACKGROUND: Pneumococcal conjugate vaccines (PCVs) are recommended for use in pediatric immunization programs worldwide. Few data are available on their effect against mortality. We present a multicountry evaluation of the population-level impact of PCVs against death due to pneumonia in children < 5 years of age. METHODS: We obtained national-level mortality data between 2000 and 2016 from 10 Latin American and Caribbean countries, using the standardized protocol. Time series models were used to evaluate the decline in all-cause pneumonia deaths during the postvaccination period while controlling for unrelated temporal trends using control causes of death. RESULTS: The estimated declines in pneumonia mortality following the introduction of PCVs ranged from 11% to 35% among children aged 2-59 months in 5 countries: Colombia (24% [95% credible interval {CrI}, 3%-35%]), Ecuador (25% [95% CrI, 4%-41%]), Mexico (11% [95% CrI, 3%-18%]), Nicaragua (19% [95% CrI, 0-34%]), and Peru (35% [95% CrI, 20%-47%]). In Argentina, Brazil, and the Dominican Republic, the declines were not detected in the aggregated age group but were detected in certain age strata. In Guyana and Honduras, the estimates had large uncertainty, and no declines were detected. Across the 10 countries, most of which have low to moderate incidence of pneumonia mortality, PCVs have prevented nearly 4500 all-cause pneumonia deaths in children 2-59 months since introduction. CONCLUSIONS: Although the data quality was variable between countries, and the patterns varied across countries and age groups, the balance of evidence suggests that mortality due to all-cause pneumonia in children declined after PCV introduction. The impact could be greater in populations with a higher prevaccine burden of pneumonia.

Barriers to vaccination in Latin America: A systematic literature review.

Current vaccination coverage rates in Latin America and the Caribbean (LAC) are lower than the region-wide rates set by the Pan American Health Organization. To improve vaccination uptake, it is crucial to identify barriers to vaccination. We conducted a systematic literature review to identify the key barriers to vaccination in the LAC region, and to classify and quantify factors affecting vaccination coverage using the barrier categories outlined by the Strategic Advisory Group of Experts (SAGE) working group. We mapped knowledge gaps in the understanding of region-specific and population-specific vaccine hesitancy. Nine databases (Medline via PubMed, Web of Science, LILACS, MedCarib, SciELO, Scopus, PATH, SAGE Online and Google Scholar) were searched for articles published in English, Spanish and Portuguese up to 15 July 2017. A total of 6867 articles were identified of which 75 were included in the review. Majority of the articles were quantitative in nature and nearly half from Brazil. Many other countries in LAC have limited published evidence on barriers to vaccination. The most commonly investigated target population was parents (of children <8 years of age [yoa] and adolescents 9-10 yoa) but there was a balance in the number of publications that reported on influenza, childhood and human papillomavirus vaccination. There was limited direct evidence which reported insights on the new generation of childhood vaccines (pneumococcal or meningococcal vaccines) or studies targeting adolescents and pregnant women. Among the SAGE barrier categories, 'individual/group influences' were the most frequently reported barrier category (68%) followed by 'contextual influences' (47%). Adverse socioeconomic factors, a low level of education, lack of awareness of diseases and their vaccines, religious and cultural beliefs are commonly cited as obstacles to vaccination acceptance. Additional evidence is needed to fully understand the barriers to vaccination for different target populations, countries in the region and specific vaccine types.

A Bibliometric Analysis of the Latin American Research on Stroke 2003-2017.

BACKGROUND: Stroke is a leading cause of mortality and disability worldwide. Research activity in Latin American countries might be the key to solving, or at least improving, the understanding of stroke-related issues in the region. Our aim was to describe and analyze the research output on stroke in Latin America. METHODS: We performed a bibliometric analysis of studies on stroke in Latin America reported from 2003 to 2017 in Scopus-indexed journals. We extracted the annual research, countries, journals, authors, institutions, citation frequency, and journal metrics. The data were quantitatively analyzed. Publication activity was adjusted to the countries by population size. Also, the results from an author and country co-occurrence analysis are presented as network visualization maps using VOSviewer. RESULTS: A total of 2298 Latin American stroke-related reports were identified, most were original research reports (72%). The number of reported studies had increased from 2003 to 2017 (P < 0.001). Brazil was the country with the greatest production with 1273 reports (55.4%), followed by Argentina and Mexico. No association was found between stroke prevalence and mortality and the scientific production of the country. Six universities and three hospitals were the most prolific institutions. A collaborative relationship was found between the United States and Brazil, Argentina, and Mexico. The intraregional collaboration of research on stroke was low among Latin American countries. CONCLUSIONS: Despite the continuous increase in research output from Latin American countries, more effort is needed to strengthen the research capacity by developing networks and collaborative research projects, ideally among the Latin American countries themselves.

A human rights-based framework to assess gender equality in health systems: the example of Zika virus in the Americas.

BACKGROUND: The right to health was enshrined in the constitution of the World Health Organization (WHO) in 1946 and in the Universal Declaration of Human Rights in 1948. The latter Declaration, which also guaranteed women's rights, was signed by almost all countries in the world. Subsequent international conventions reinforced these rights, requiring that women be able to realize their fundamental freedoms and dignity. Although the value of incorporating gender into health systems has been increasingly acknowledged over the years, gender inequalities in health persist. OBJECTIVE: To introduce a tool to help countries assess their performance in addressing gender inequalities in their health systems, using the example of the Zika virus (ZIKV) in countries of the Americas. METHODS: This paper is based on comprehensive reviews of the literature on the links between gender equality, health systems and human rights, and available scientific evidence about an adequate response to ZIKV. RESULTS: The authors present a simple two-part framework from the human rights perspectives of the health system as duty bearer, incorporating WHO's six health system building blocks, and of its clients as rights holders. The authors apply the framework to ZIKV in the Americas, and identify strengths and weaknesses at every level of the health system. They find that when considering gender, health systems have focused mainly on dichotomous sex differences, failing to consider broader gender relations and processes affecting access to services, quality of care, and health outcomes. CONCLUSIONS: The authors' framework will permit countries to assess progress toward gender equality in health, within the context of their human rights commitments, by examining each health system building block, and the degree to which clients are realizing their rights. By applying the framework to specific health conditions, gender-related achievements and shortcomings can be identified in each health system component, fostering a more comprehensive and gender-sensitive response.

Interventions Using Regular Activities to Engage High-Risk School-Age Youth: a Review of After-School Programs in Latin America and the Caribbean.

In this paper, I review an issue that is an urgent challenge in the development field-the effectiveness of after-school programs for preventing school-age youth violence in vulnerable settings in Latin American and the Caribbean. These programs have proliferated in the region and include sports, recreation, music, tutoring, and other focused activities. Given their popularity and because they target known risk factors for violence (such as drop-out from school, poor academic performance, lack of motivation, too much idle time, low quality and quantity of adult supervision, and social isolation), it is critical to examine empirically whether they can be effective prevention strategies. Unfortunately, most rigorous trials of after-school interventions to prevent youth violence have been conducted in developed countries, with far fewer in Latin America. In this review, a broad range of databases was searched systematically. Only six studies in five Latin American and Caribbean countries were identified. Reported results indicate at least some benefits for youth behavior, although not across all youth. Additional concerns regarding how these programs are implemented and whether specific components can be tied to violence prevention are noted. The need for more rigorous evaluation of these programs is noted.

Impact of WHO recommendations to eliminate industrial trans-fatty acids from the food supply in Latin America and the Caribbean.

BACKGROUND: The World Health Organization (WHO) has deemed that there is enough evidence to recommend the elimination of industrially produced trans-fatty acids (TFA) from the food supply. This article evaluates government-led public health strategies in countries in Latin America and the Caribbean (LAC), and factors perceived to affect following WHO's recommendation to eliminate industrially produced TFA. METHODS: Descriptive, prospective multiple case studies integrated data from open-ended questionnaires to representatives of ministries of health, and systematic review of internal and publicly available documents in 13 LAC countries. FINDINGS: Overall, government efforts to follow WHO recommendations have not been well co-ordinated throughout the region. Evidence for this includes the lack of standardization of TFA definitions. For example, some countries exclude naturally occurring TFA from the definitions, whereas others leave the option open to their inclusion. As a consequence, the criteria for trans-free nutrient claims and labelling requirements are inconsistent across the region. Government-led strategies varied from banning or limiting TFA content in the food supply to voluntary labelling of TFA. The identified challenges to the implementation of policies to reduce TFA include the shortage of information on TFA content of diets and foods, consumer unawareness of TFA and lack of monitoring and surveillance. The identified enabling factors were intersectoral collaboration with industry, mandatory labelling regulation and international and national visibility of the topic, which facilitated reduction of TFA content. INTERPRETATION: A co-ordinated effort is required to achieve virtual elimination of all TFA in the region, as recommended by WHO. Standardization of the definition of TFA across the region would facilitate regulation, consumer education efforts and monitoring and surveillance efforts. Simultaneously, countries need to determine their level of exposure to TFA through the implementation of small surveys to assess blood TFA levels using blood spots, and the evaluation of TFA in fat sources that are commonly used.

Awareness, adoption and implementation of the water safety plan methodology: insights from five Latin American and Caribbean experiences.

Considerable effort has been made worldwide to disseminate information and provide technical assistance to encourage the adoption and implementation of the water safety plan (WSP) methodology. Described since the third edition of the World Health Organization (WHO) Guidelines for Drinking-water Quality, a WSP provides guidance for water utilities to ensure the delivery of safe drinking water and protect health. Attention is now being given to understand the success of efforts to advance adoption of the WSP methodology in the Latin America and Caribbean (LAC) region. More specifically, there is interest in knowing how early adopters developed strategies to implement the WSP methodology and what challenges exist for further implementation. To better understand adoption and implementation trends, key informants from five LAC countries were interviewed and case studies were developed to reveal the diversity of WSP approaches applied in the region. Results indicate that WSP implementation is more widespread than previously reported. Respondents affirmed that the WHO Guidelines for Drinking-water Quality are routinely used as a model for country-level drinking-water regulations, which has led to uptake of the WSP methodology. Interview respondents also revealed innovative national strategic approaches for WSP implementation.

Latin America and the Caribbean: assessment of the advances in public health for the achievement of the Millennium Development Goals.

To improve health and economy of the world population, the United Nations has set up eight international goals, known as Millennium Development Goals (MDGs), that 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. The goals include: (1) eradicating extreme poverty and hunger; (2) achieving universal primary education; (3) promoting gender equality; (4) reducing child mortality; (5) improving maternal health; (6) combating HIV/AIDS, malaria and other diseases; (7) ensuring environmental sustainability; and (8) developing a global partnership for development. Having been in the midway from the 2015 deadline, the UN Secretary-General urges countries to engage constructively to review progress towards the MDGs. This paper aims to evaluate advances in public health, with special reference to gender inequalities in health, health sector reform, global burden of disease, neglected tropical diseases, vaccination, antibiotic use, sanitation and safe water, nutrition, tobacco and alcohol use, indicators of health, and disease prevention in Latin America and the Caribbean region (LAC). The paper also identifies areas of deficits for the achievement of MDGs in LAC.