[Health and social inequalities in maternal and child health in Paraguay]. / Desigualdades sanitarias y sociales en la salud materna y del niño en Paraguay.

OBJECTIVE: To describe health and social inequalities in maternal and child health indicators defined in Sustainable Development Goal (SDG) 3.1 and SDG 3.2 targets based on administrative data among the departments of Paraguay in 2017. METHODS: Quantitative descriptive study with ecological design. Simple gap measures and complex gradient measures based on the adjustment of negative binomial and logistic regression models were used. RESULTS: Fifty percent of Paraguay's departments have estimated maternal mortality ratio (MMR) values higher than the national value. The percentage of births attended by a qualified professional in the country is 98.1%, with a range between 82.4% and 99.9%. In 13 of 18 departments, under-five mortality rate (U5MR) is higher than the national average, ranging from 4.2 to 49.2 deaths per 1 000 live births. Neonatal mortality rates (NMR) in the departments vary from 2.6 to 45.1 deaths per 1 000 live births. There are major health and social inequalities in the MMR, U5MR and NMR between the departments. There are no high inequalities in the percentage of births attended by a qualified professional between the departments. CONCLUSIONS: Paraguay needs to make significant efforts to reduce the health and social inequalities that exist in the MMR, U5MR and NMR between departments. Numerical targets must be established to improve national values and reduce inequalities in these indicators, which will allow for accountability on the commitment to "leave no one behind" established in the SDG, and will help generate strategies to improve the health of women and children in Paraguay.

Desigualdades sanitarias y sociales en la salud materna y del niño en Paraguay

[RESUMEN]. Objetivo. Describir las desigualdades sanitarias y sociales en indicadores de salud materna y del niño definidos en las metas del Objetivo de Desarrollo Sostenible (ODS) 3.1 y ODS 3.2 a partir de datos administrativos, entre los departamentos de Paraguay en 2017. Métodos. Diseño ecológico de carácter descriptivo cuantitativo. Se utilizaron medidas simples de brechas y medidas complejas de gradiente basadas en el ajuste de modelos de regresión binomial negativo y logístico. Resultados. Cincuenta por ciento de los departamentos de Paraguay tienen valores estimados de razón de mortalidad materna (RMM) mayores que el valor nacional. El porcentaje de partos atendidos por profesional calificado en el país alcanza 98,1% con valores que fluctúan entre 82,4% y 99,9%. Hay 13 de 18 departamentos con valores de la tasa de mortalidad en menores de 5 años (TMM5) mayores que el promedio nacional, con un rango entre 4,2 y 49,2 muertes por cada 1 000 nacidos vivos. Los valores de la tasa de mortalidad neonatal (TMN) en los departamentos varían entre 2,6 y 45,1 muertes por cada 1 000 nacidos vivos. Existen grandes desigualdades sanitarias y sociales en la RMM, la TMM5 y la TMN entre los departamentos. No se detectan desigualdades elevadas en el porcentaje de partos atendidos por profesional calificado entre los departamentos. Conclusiones. Paraguay debe hacer esfuerzos importantes para disminuir las desigualdades sanitarias y sociales que existen en la RMM, la TMM5 y la TNN entre los departamentos. Se deben establecer metas numéricas de mejoría de los valores nacionales y reducción de las desigualdades en estos indicadores, lo cual permitirá rendir cuentas sobre el compromiso de “no dejar a nadie atrás” establecido en los ODS, y ayudará a generar estrategias que permitan mejorar la salud de la mujer y el niño en Paraguay.

[ABSTRACT]. Objective. To describe health and social inequalities in maternal and child health indicators defined in Sustainable Development Goal (SDG) 3.1 and SDG 3.2 targets based on administrative data among the departments of Paraguay in 2017. Methods. Quantitative descriptive study with ecological design. Simple gap measures and complex gradient measures based on the adjustment of negative binomial and logistic regression models were used. Results. Fifty percent of Paraguay’s departments have estimated maternal mortality ratio (MMR) values higher than the national value. The percentage of births attended by a qualified professional in the country is 98.1%, with a range between 82.4% and 99.9%. In 13 of 18 departments, under-five mortality rate (U5MR) is higher than the national average, ranging from 4.2 to 49.2 deaths per 1 000 live births. Neonatal mortality rates (NMR) in the departments vary from 2.6 to 45.1 deaths per 1 000 live births. There are major health and social inequalities in the MMR, U5MR and NMR between the departments. There are no high inequalities in the percentage of births attended by a qualified professional between the departments. Conclusions. Paraguay needs to make significant efforts to reduce the health and social inequalities that exist in the MMR, U5MR and NMR between departments. Numerical targets must be established to improve national values and reduce inequalities in these indicators, which will allow for accountability on the commitment to “leave no one behind” established in the SDG, and will help generate strategies to improve the health of women and children in Paraguay.

Características de las mujeres asociadas a la pérdida fetal: resumen de investigación en base a cuatro encuestas nacionales / Characteristics of women associated with fetal loss: summary of research on four national surveys

El objetivo de la presente investigación es conocer las características de las mujeres que están asociadas con mayores probabilidades de pérdica fetal.