Measuring universal health coverage in reproductive, maternal, newborn and child health: An update of the composite coverage index.

BACKGROUND: Monitoring universal health coverage in reproductive, maternal and child health requires appropriate indicators for assessing coverage and equity. In 2008, the composite coverage index (CCI)-a weighted average of eight indicators reflecting family planning, antenatal and delivery care, immunizations and management of childhood illnesses-was proposed. In 2017, the CCI formula was revised to update the family planning and diarrhea management indicators. We explored the implications of adding new indicators to the CCI. METHODS: We analysed nationally representative surveys to investigate how addition of early breastfeeding initiation (EIBF), tetanus toxoid during pregnancy and post-natal care for babies affected CCI levels and the magnitude of wealth-related inequalities. We used Pearson's correlation coefficient to compare different formulations, and the slope index of inequalities [SII] and concentration index [CIX] to assess absolute and relative inequalities, respectively. RESULTS: 47 national surveys since 2010 had data on the eight variables needed for the original and revised formulations, and on EIBF, tetanus vaccine and postnatal care, related to newborn care. The original CCI showed the highest average value (65.5%), which fell to 56.9% when all 11 indicators were included. Correlation coefficients between pairs of all formulations ranged from 0.93 to 0.99. When analysed separately, 10 indicators showed higher coverage with increasing wealth; the exception was EIBF (SII = -2.1; CIX = -0.5). Inequalities decreased when other indicators were added, especially EIBF-the SII fell from 24.8 pp. to 19.2 pp.; CIX from 7.6 to 6.1. The number of countries with data from two or more surveys since 2010 was 30 for the original and revised formulations and 15 when all the 11 indicators were included. CONCLUSIONS: Given the growing importance of newborn mortality, it would be desirable to include relevant coverage indicators in the CCI, but this would lead a reduction in data availability, and an underestimation of coverage inequalities. We propose that the 2017 version of the revised CCI should continue to be used.

Análisis del gasto de bolsillo ante la enfermedad de menores de 5 años según su condición de pobreza en Paraguay / Analysis of out-of-pocket expenses in the face of the disease of children under 5 according to their poverty status in Paraguay

Introducción: Reducir la pobreza, reducir la mortalidad de menores de 5 años (< 5 años) y lograr cobertura universal de salud son parte de los Objetivos de Desarrollo Sostenible (ODS). Objetivo: determinar el gasto de bolsillo de salud (GBS) ante la enfermedad de < 5 años y su inci-dencia económica en los hogares según su condición de pobreza en Paraguay. Material y Método: se analizó la Encuesta Permanente de Hogares del 2014, considerando la defi-nición oficial de pobreza y la referencia de enfermedad o accidente en un trimestre. Se calculó el promedio de GBS por hogar, la incidencia sobre el ingreso monetario trimestral (IM), sobre los sub-sidios estatales por pobreza (IS) y el equivalente de subsistencia o alimentación (EA). Resultados: Entre los hogares no pobres: 41,1% (IC 37,3 a 45,0) tuvo al menos 1 enfermo < 5 años, de los cuales 76,6% (IC 71,5 a 81,0) tuvo GBS, siendo en promedio 223.455 Gs. (DE 37.445). Los medicamentos fueron 68,9% (IC 61,7 a 76,1) del total. La IM fue 1,7% (IC 1,1 a 2,3). Entre los ho-gares pobres: 50,0% (IC 44,7 a 52,2) tuvo al menos 1 enfermo < 5 años, de los cuales 71,2% (IC 64,7 a 76,9) tuvo GBS, siendo en promedio 125.545 Gs. (DE 14.749). Los medicamentos fueron 77,5% (IC 69,2 a 85,7) del total. La IM fue 4,0% (IC 2,3 a 5,8). La IS fue 54,6% (IC 13,0 a 96,2) y el EA fue el equivalente a 7 días de alimentación en promedio (DE 1,5). Conclusión: Ante los retos de los ODS, Paraguay requiere de mayor protección financiera en salud para niñas y niños < 5 años, mediante sinergias de las políticas de reducción de pobreza y de salud. Palabras Clave: gasto de bolsillo de salud, cobertura universal de salud, derecho a la salud, pobreza, menores de 5 años.

Introduction: Reducing poverty, reducing the mortality of children under 5 years (<5 years) and achieving universal health coverage are part of the Sustainable Development Goals (SDGs). Objective: to determine the out-of-pocket health expenditure (GBS) for the disease of <5 years and its economic impact on households according to their poverty status in Para-guay. Material and Method: the 2014 Permanent Household Survey was analyzed, considering the official definition of poverty and the reference of illness or accident in a quarter. The average of GBS per household, the incidence on quarterly monetary income (IM), on state subsidies for poverty (IS) and the equivalent of feeding (EA) were calculated. Results: Among non-poor households: 41.1% (CI 37.3 to 45.0) had at least 1 <5 years ill or injured, of which 76.6% (CI 71.5 to 81.0) had GBS , being on average 223,455 Gs. (DE 37,445). The medications were 68.9% (CI 61.7 to 76.1) of the total. The IM was 1.7% (CI 1.1 to 2.3). Among poor households: 50.0% (CI 44.7 to 52.2) had at least 1 <5 years ill or injured, of which 71.2% (CI 64.7 to 76.9) had GBS, being in average 125,545 Gs. (DE 14,749). The medications were 77.5% (CI 69.2 to 85.7) of the total. The IM was 4.0% (CI 2.3 to 5.8). The IS was 54,6% (IC 13,0 a 96,2) and the EA was the equivalent of 7 days of feeding on av-erage (SD 1.5). Conclusion: Given the challenges of the SDGs, Paraguay requires greater financial protection in health for children under 5 years, through synergies of poverty reduction and health policies. Keywords: out-of-pocket health expenditure, universal health coverage, right to health, pov-erty, children under 5 years.

Strong effect of Ecuador's conditional cash transfer program on childhood mortality from poverty-related diseases: a nationwide analysis.

BACKGROUND: The mortality rate in children under 5 years old (U5MR) has decreased considerably in Ecuador in the last decade; however, thousands of children continue to die from causes related to poverty. A social program known as Bono de Desarrollo Humano (BDH) was created to guarantee a minimum level of consumption for families and to reduce chronic malnutrition and preventable childhood diseases. We sought to evaluate the effect of the BDH program on mortality of children younger than 5 years, particularly from malnutrition, diarrheal diseases, and lower respiratory tract infections. METHODS: Mortality rates and BDH coverage from 2009 to 2014 were evaluated from the 144 (of 222) Ecuadorian counties with intermediate and high quality of vital information. A multivariable regression analyses for panel data was conducted by using a negative binomial regression model with fixed effects, adjusted for all relevant demographic and socioeconomic covariates. RESULTS: Our research shows that for each 1% increase in BDH county coverage there would be a decrease in U5MR from malnutrition of 3% (RR 0.971, 95% CI 0.953-0.989). An effect of BDH county coverage on mortality resulting from respiratory infections was also observed (RR 0.992, 95% CI 0.984-0.999). The BDH also reduced hospitalization rates in children younger than 5 years, overall and for diarrhea. CONCLUSIONS: A conditional cash transfer program such as BDH could contribute to the reduction of mortality due to causes related to poverty, such as malnutrition and respiratory infections. The coverage should be maintained -or increased in a period of economic crisis- and its implementation strengthened.

Enabling reproductive, maternal, neonatal and child health interventions: Time trends and driving factors of health expenditure in the successful story of Peru.

We compared expenditure trends for reproductive, maternal, neonatal and child health (RMNCH) with trends in RMNCH service coverage in Peru. We used National Health Accounts data to report on total health expenditure by source; the Countdown database for trends in external funding to RMNCH, and Ministry of Finance data for trends in domestic funding to RMNCH. We undertook over 170 interviews and group discussions to explore factors explaining expenditure trends. We describe trends in total health expenditure and RMNCH expenditure in constant 2012 US$ between 1995 and 2012. We estimated expenditure to coverage ratios. There was a substantial increase in domestic health expenditure over the period. However, domestic health expenditure as share of total government spending and GDP remained stable. Out-of-pocket health spending (OOPS) as a share of total health expenditure remained above 35%, and increased in real terms. Expenditure on reproductive health per woman of reproductive age varied from US$ 1.0 in 2002 to US$ 6.3 in 2012. Expenditure on maternal and neonatal health per pregnant woman increased from US$ 34 in 2000 to US$ 512 in 2012, and per capita expenditure on under-five children increased from US$ 5.6 in 2000 to US$ 148.6 in 2012. Increased expenditure on RMNCH reflects a greater political support for RMNCH, along with greater emphasis on social assistance, family planning, and health reforms targeting poor areas, and a recent emphasis on antipoverty and crosscutting equitable policies and programmes focused on nutrition and maternal and neonatal mortality. Increasing domestic RMNCH expenditure likely enabled Peru to achieve substantial health gains. Peru can provide useful lessons to other countries struggling to achieve sustained gains in RMNCH by relying on their own health financing.

Understanding drivers of domestic public expenditure on reproductive, maternal, neonatal and child health in Peru at district level: an ecological study.

BACKGROUND: Peru has increased substantially its domestic public expenditure in maternal and child health. Peruvian departments are heterogeneous in contextual and geographic factors, underlining the importance of disaggregated expenditure analysis up to the district level. We aimed to assess possible district level factors influencing public expenditure on reproductive, maternal, neonatal and child health (RMNCH) in Peru. METHODS: We performed an ecological study in 24 departments, with specific RMNCH expenditure indicators as outcomes, and covariates of different hierarchical dimensions as predictors. To account for the influence of variables included in the different dimensions over time and across departments, we chose a stepwise multilevel mixed-effects regression model, with department-year as the unit of analysis. RESULTS: Public expenditure increased in all departments, particularly for maternal-neonatal and child health activities, with a different pace across departments. The multilevel analysis did not reveal consistently influential factors, except for previous year expenditure on reproductive and maternal-neonatal health. Our findings may be explained by a combination of inertial expenditure, a results-based budgeting approach to increase expenditure efficiency and effectiveness, and by a mixed-effects decentralization process. Sample size, interactions and collinearity cannot be ruled out completely. CONCLUSIONS: Public district-level RMNCH expenditure has increased remarkably in Peru. Evidence on underlying factors influencing such trends warrants further research, most likely through a combination of quantitative and qualitative approaches.

The impact of early life shocks on human capital formation: evidence from El Niño floods in Ecuador.

This paper investigates the persistent effects of negative shocks in utero and in infancy on low-income children's health and cognitive outcomes and examines whether timing of exposure matters differentially by skill type. Specifically, I exploit the geographic intensity of extreme floods in Ecuador during the 1997-1998 El Niño phenomenon, which provides exogenous variation in exposure at different periods of early development. I show that children exposed to severe floods in utero, especially during the third trimester, are shorter in stature five and seven years later. Also, children affected by the floods in the first trimester of pregnancy score lower on cognitive tests. Additionally, I explore potential mechanisms by studying health at birth and family inputs (income, consumption, and breastfeeding). I find that children exposed to El Niño floods, especially during the third trimester in utero, were more likely to be born with low birth weight. Furthermore, households affected by El Niño suffered a decline in income, total consumption, and food consumption in the aftermath of the shock. Falsification exercises and robustness checks suggest that selection concerns such as selective fertility, mobility, and infant mortality do not drive these results.

Parental preferences and allocations of investments in children's learning and health within families.

Empirical evidence suggests that parental preferences may be important in determining investment allocations among their children. However, there is mixed or no evidence on a number of important related questions. Do parents invest more in better-endowed children, thus reinforcing differentials among their children? Or do they invest more in less-endowed children to compensate for their smaller endowments and reduce inequalities among their children? Does higher maternal education affect the preferences underlying parental decisions in investing among their children? What difference might such intrafamilial investments among children make? And what is the nature of these considerations in the very different context of developing countries? This paper gives new empirical evidence related to these questions. We examine how parental investments affecting child education and health respond to initial endowment differences between twins within families, as represented by birth weight differences, and how parental preference tradeoffs and therefore parental investment strategies vary between families with different maternal education. Using the separable earnings-transfers model (Behrman et al., 1982), we first illustrate that preference differences may make a considerable difference in the ratios of health and learning differentials between siblings - up to 30% in the simulations that we provide. Using a sample of 2000 twins, collected in the 2012 wave of the Early Childhood Longitudinal Survey for Chile, we find that preferences are not at the extreme of pure compensatory investments to offset endowment inequalities among siblings nor at the extreme of pure reinforcement to favor the better-endowed child with no concern about inequality. Instead, they are neutral, so that parental investments do not change the inequality among children due to endowment differentials. We also find that there are not significant preference differences between families with low- and high-educated mothers. Our estimates are consistent with previous empirical evidence that finds that parents do not invest differentially within twins.

Health effects of 'Juntos', a conditional cash transfer programme in Peru.

In some countries, conditional cash transfer (CCT) programmes show an impact on maternal and child health. Juntos, the CCT programme in Peru, has been evaluated several times operationally, but seldom for maternal and child health outcomes. The objective of this study is to evaluate the impact of Juntos on children under 6 years, pregnant women and mothers of children under 17 years. Outcomes evaluated included (1) anaemia in women and children; (2) acute malnutrition in children; (3) post-partum complications in mothers; and (4) underweight and overweight in mothers. We identified Juntos eligible respondents from the Demographic and Health Surveys of Peru for years 2007 to 2013. Propensity score matching was used to identify comparable treatment and control groups, including eligible respondents enrolled in Juntos vs. those not enrolled in Juntos (individual-level analysis), as well as eligible respondents living in Juntos districts vs. those not residing in Juntos districts (district-level analysis). We then used generalized linear models to estimate prevalence ratios. Individual level analysis showed that Juntos reduced underweight in women (PR:0.39, 95%CI:0.18 - 0.85) and anaemia in children (PR:0.93, 95%CI:0.86 - 1.00). In the district level analysis, the programme was associated with a reduction of overweight in women (PR:0.94, 95%CI:0.90 - 0.98) and acute malnutrition in children (PR:0.49, 95%CI:0.32 - 0.73), but an increase in the prevalence of anaemia in children (PR:1.09, 95%CI:1.01 - 1.17). We found that Juntos had an effect on maternal and child health indicators, but further studies are required to overcome some limitations encountered here.

[Child health environment in the context of relocating of camp site families to social housing]. / Salud ambiental infantil en el contexto de la reubicación de familias de campamentos a viviendas sociales.

INTRODUCTION: Housing interventions aimed at overcoming poverty can lead to changes in the health status of children by modifying risk factors in their physical and social environment OBJECTIVE: the aim was to identify children's environmental health factors to change with the relocation of families from slums to public housing. SUBJECTS AND METHOD: A cross-sectional study was conducted in children ages 2-8 years old of families relocated to public housing (n=115) who were compared to children residing in slums (n=88) in Santiago, Chile. Family socioeconomic characteristics, indoor environment and neighborhoods were collected. It was included respiratory symptoms, accidents and maternal-child care of children. χ2, Fisher and Mann-Whitney test were used to compare groups. RESULTS: There were differences in households related to pets keeping, presence of humidity/molds in homes, types of fuels, and perceived safety problems in neighborhoods (p<0.05). The families from slums reported higher tenancy of pets (73.8% v/s 32.2%%), humidity/molds in homes (43.,2% v/s 18.3%), use of wood for heating (39.8% v/s 0.0%), compared with families of public housing. Residents of public housing perceived more safety problems in neighborhood, and children have more asthma related symptoms and have lower diversity of accidents in home. CONCLUSION: Among the factors studied, indoor air quality and safety in neighborhoods could be linked to changes from the relocation of families. This reinforces the need to deepen the positive and negative influences of residential mobility of these groups focused on child welfare perspective.

Salud ambiental infantil en el contexto de la reubicación de familias de campamentos a viviendas sociales / Child health environment in the context of relocating of camp site families to social housing

Introducción: Intervenciones habitacionales destinadas a superar la pobreza pueden generar cambios en la situación de salud de la población infantil, modificando factores de riesgo en el entorno físico y social de niños y niñas. El objetivo fue identificar indicadores de salud ambiental infantil susceptibles de ser modificados con la reubicación de familias desde campamentos a vivienda social. Sujetos y método: Estudio transversal en niños de 2-8 años. Se comparó dos grupos de familias provenientes de campamentos. Un grupo fueron familias reubicadas en viviendas sociales entre 2001 y 2002 (n = 115). El otro grupo corresponde a niños cuyas familias permanecieron en campamentos (n = 88) de la zona poniente de Santiago. Se recolectó información sobre: características socioeconómicas, ambiente intradomiciliario y de barrios, y eventos en salud: síntomas respiratorios, accidentabilidad y cuidado materno infantil. Se emplearon pruebas de x², Fisher y Mann-Whitney para la comparación de los grupos. Resultados: Se identifican diferencias entre los grupos comparados en relación a la tenencia de mascotas, presencia de hongos/humedad en el hogar, tipo de combustibles utilizados y problemas de seguridad percibidos en los barrios (p<0,05). Las familias de campamentos reportan una mayor tenencia de mascotas (73,8% v/s 32,2%%), presencia de huellas de humedad/hongos en el hogar (43,2% v/s 18,3%), uso de leña (39,8% v/s 0,0%), en comparación con familias de viviendas sociales. Residentes de viviendas sociales perciben mayores problemas de seguridad en el barrio, mientras que los niños presentan mayor frecuencia de síntomas relacionados con asma y menor diversidad de accidentes en el hogar comparado con el grupo residente en campamentos. Conclusiones: Entre los factores estudiados, aquellos susceptibles de ser modificados con la reubicación de familias desde campamentos a vivienda social se vinculan a indicadores de calidad del aire interior y seguridad en los barrios. Lo anterior refuerza la necesidad de profundizar en las influencias positivas y negativas de la movilidad residencial de estos grupos, desde una perspectiva centrada en el bienestar infantil.

Introduction: Housing interventions aimed at overcoming poverty can lead to changes in the health status of children by modifying risk factors in their physical and social environment Objective: the aim was to identify children's environmental health factors to change with the relocation of families from slums to public housing. Subjects and method: A cross-sectional study was conducted in children ages 2-8 years old of families relocated to public housing (n=115) who were compared to children residing in slums (n=88) in Santiago, Chile. Family socioeconomic characteristics, indoor environment and neighborhoods were collected. It was included respiratory symptoms, accidents and maternal-child care of children. x², Fisher and Mann-Whitney test were used to compare groups. Results: There were differences in households related to pets keeping, presence of humidity/molds in homes, types of fuels, and perceived safety problems in neighborhoods (p<0.05). The families from slums reported higher tenancy of pets (73.8% v/s 32.2%%), humidity/molds in homes (43.,2% v/s 18.3%), use of wood for heating (39.8% v/s 0.0%), compared with families of public housing. Residents of public housing perceived more safety problems in neighborhood, and children have more asthma related symptoms and have lower diversity of accidents in home. Conclusion: Among the factors studied, indoor air quality and safety in neighborhoods could be linked to changes from the relocation of families. This reinforces the need to deepen the positive and negative influences of residential mobility of these groups focused on child welfare perspective.

Factores de riesgo asociados a déficit del desarrollo psicomotor en preescolares de nivel socioeconómico bajo: comuna urbano rural: Región Metropolitana, 2003 / Risk factors associated with developmental delay in pre-school children from a low income urban/rural community of Santiago, Chile

Introducción: La ciencia ha demostrado la importancia del desarrollo infantil temprano. En nuestro país se realizan evaluaciones seriadas y estandarizadas del desarrollo psicomotor (DSM) en lactantes y preescolares, con el propósito de pesquisar e intervenir precozmente trastornos del desarrollo. Objetivo: Identificar factores de riesgo (FR) para déficit DSM en preescolares de bajo nivel socioeconómico, pertenecientes a un centro de salud familiar (CESFAM), comuna urbano rural, área norte, Región Metropolitana. Metodología: Revisión retrospectiva de 159 fichas individuales y familiares de preescolares sanos, con TEPSI correspondiente a los 4 años, realizado, según programa, el 2003. Grupo estudio (GE): todos los niños con déficit del DSM. Grupo comparación (GC): selección secuencial de fichas con test normal realizado durante el último trimestre. Resultados: El 2003 se realizó TEPSI a 541/610 niños en control en el CESFAM. GE 76 niños con déficit, GC 83 preescolares con DSM normal. 23 por ciento GC tenía algún subtest alterado, generalmente lenguaje. FR déficit DSM: varones (p 0,0006), familias de mayor pobreza (p 0,0018), captación en CESFAM posterior a 12 meses de edad (p 0,0075), no asistencia a educación preescolar (p 0,0075), sospecha de déficit DSM en evaluaciones previas (p 0,0013) y madres analfabetas (p 0,018). Conclusiones: Se identifican los factores de riesgo de déficit del desarrollo psicomotor en la infancia, destacando el bajo nivel socioeconómico y las acciones de prevención y educación. La importancia de conocer los FR es identificar aquellos niños que requieren de una intervención más dirigida, para favorecer la expresión de su potencial.

Gasto federal com crianças e adolescentes: 1994 a 1997 / Federal expenditures with children and adolescents: 1994 to 1997

Síntese de estudo que objetivou levantar e analisar o gasto federal com crianças e adolescentes (0 a 18 anos), no período de 1994 a 1997, e que analisa o gasto federal por meio de informação orçamentária considerando os valores executados no perído. Considera os Ministérios da Educação, Saúde, Bem-Estar Social, Justiça e Previdência e Assistência Social. Estima o gasto total e 'per capita'com crianças e adolescentes. Detalha os programas mais relevantes em cada área. Identifica mudanças importantes nos montantes e na composição dos recursos destinados ao atendimento de crianças e adolescentes ao longo do período. Verifica que a área Saúde respondeu pela fatia maior dos gastos e sua proporção, no conjunto dos ministérios analisados, foi crescente ao longo do período compreendido por este estudo. Constata que a área Educação sofreu redução contínua, e que a área Assistência Social oscilou, apresentando tendência ascendente. Percebe que, em relação aos valores globais do gasto público federal e ao gasto social federal, o gasto com crianças e adolescentes teve importante redução de sua participação nesses agregados. Conclui que apesar, de as informações apontarem redução no aporte de recursos federais nas ações destinadas a crianças e adolescentes, estas não indicam necessariamente que houve redução no grau de cobertura dessas ações, existindo a possibilidade de ter ocorrido compensação, pelos estados e municípios, pela diminuição do gasto federal, ou, ainda, uma melhora na alocação dos recursos, resultando em maior eficácia do gasto.

A análise de projetos e o conceito de canal: sobre a política da criança e do adolescente / The analysis of projects and the concept of channel: on the policy for children and youth in Brazil

Nova perspectiva na teoria política com relaçäo ao entendimento de participaçäo política em sociedades do Terceiro Mundo e formulaçäo de demandas através de projetos e utilizaçäo do conceito de "canais". Apresenta o estabelecimento de canais pelas ligaçöes estabelecidas entre diferentes grupos sociais e a instituiçäo federal responsável pela política de bem-estar para crianças e jovens no Brasil

Estado nutricional de niños escolares de la parroquia Quimiag (Provincia de Chimborazo)

Se evaluó el estado nutricional de 438 niños escolares pertenecientes a 5 comunidades de la Parroquia Quimiag (Provincia de Chimborazo), utilizando los parámetros peso para la edad, talla para la edad e índice de masa corporal (BMI) o índice de Quetelet (IQ = pesokg/talla2 (m2)). La muestra estuvo contituída por 438 alumnos de los cuales 231 (52,7 por ciento) eran varones y 207 (47.3 por ciento) eran mujeres, con un promedio de edad de 8,2 años. En el análisis se encontró en relación a peso para la edad un porcentaje de niños de peso bajo del 32,4 por ciento; en ralación a talla para la edad un 70.8 por ciento de talla baja y en relación al IQ al 12.55 por ciento eras desnutridos y además aparece un 7.99 por ciento de niños obesos. Los índices de desnutrición en relación al sexo mostraron un comportamiento similar al de la población total: Mujeres peso bajo 30.91 por ciento talla baja 67.63 por ciento, IQ desnutridos 12,07 por ciento obesos 12.56 por ciento; varones Pb 33,76 por ciento Tb 73,59 por ciento, IQ desn 12,98 por ciento obesos 3,89 por ciento. Al analizar el estado nutricinal en relacióna las comunidades y la distancia de estas a la cabecera parroquial, se encontró igualmente un comportamiento similar al de la población total, pero aumenta el índice de desnutrición mientras más distante se encuentra la cabecera parroquial y por ende a los servicios de salud. Se discute sobre la influencia de los factores ambientales y socio-económicos sobre los indicadores de desnutrición, especialmente la talla que indica una desnutrición crónica que puede influir mayormente que los factores genéticos y hereditarios. Además se discute sobre el fenómeno de hemorresis que sufren estos niños al ser víctimas de una desnutrición crónica, ya que su peso se adapta a la talla baja con lo cual dejan de ser desnutridos, lo mismo que se demuestra al valorar el índice de masa corporal, que s un dicador de desnutrición actual. Se recomienda promover la autogestión comunitaria en colaboración para la prestación de servicios de salud en comunidades distantes...

Poverty among female-headed households in Brazil

It Documents the extent to which female-headed households (FHHs) are in fact over-represented among the poor. Investigates the proximate determinants of the relative greater poverty among FHHs and the consequences of living in FHHs upon children's labor force participation and school attendance. Study three Brazilian metropolitan areas using the 1984 version of the Brazilian annual household survey called PNAD (Pesquisa Nacional por Amostra de Domicílios).