LA SINDEMIA ASOCIADA A COVID-19 Y LOS DERECHOS DE NIÑAS, NIÑOS Y ADOLESCENTES EN LATINOAMÉRICA: ANÁLISIS A PARTIR DE SEIS PAÍSES DE LA REGIÓN, 2023 / The syndemic associated with Covid-19 and the rights of children and adolescents in Latin America: Analysis from six countries in the region, 2023

El presente trabajo constituye un puntal de evidencia científica que queda disponible a los tomadores de decisiones en políticas nacionales y regionales relativas a la población de niñas, niños y adolescentes, y eso por sí solo es una muy buena contribución a la relevancia que debe tener esta población. Este estudio reconoce que vivimos un momento histórico, una ventana de oportunidad para tomar las decisiones adecuadas. Es prioridad contribuir para lograr que las políticas públicas sean eficaces en la garantía de los derechos humanos, esto requiere avanzar en consolidar Estados Sociales de Derecho y Bienestar con sistemas de salud y protección social universales. Asimismo, es fundamental fortalecer las capacidades de trabajo intersectorial y transdisciplinar, la integración regional y la cooperación internacional para hacer realidad la justicia social y ambiental, así como entender que las niñas, niños y adolescentes no son el futuro, son el presente. De lo que hagamos ahora depende el desarrollo y bienestar de nuestros pueblos. En este sentido el análisis se realiza a partir de un marco conceptual que abarca los siguientes aspectos:: Más allá de la pandemia, una sindemia; desigualdades múltiples: una manera de trascender a las desigualdades de ingreso; Derechos Humanos y su operacionalización en el contexto sindémico; Convención sobre los Derechos del Niño; sindemia COVID-19 y los derechos de niñas, niños y adolescentes; sindemia y políticas públicas, sindemia por COVID-19 y un llamado a la acción.

Rights, justice, and equity: a global agenda for child health and wellbeing.

Worldwide challenges to child health and wellbeing are rapidly becoming existential threats to children and childhood. Inequities, armed conflict and violence, nuclear proliferation, forced migration, globalisation, and climate change are among the global issues violating children's rights to optimal survival and development. Child rights-based approaches will be required to enhance the response to the civil-political, social, economic, and cultural determinants of these global child health issues. In this Viewpoint, we present a global agenda for child health and wellbeing as a blueprint for the practice of paediatrics and child health in the domains of clinical care, systems development, and policy formulation. This global agenda is grounded in the principles of rights, justice, and equity and can address the root-cause determinants of health. The 30th anniversary of the UN Convention on the Rights of the Child is a relevant moment to recommit to shared goals for children's health and wellbeing.

Curitiba Statement on Health Promotion and Equity: voices from people concerned with global inequities.

This Statement represents the voice of participants in the 22nd IUHPE World Conference on Health Promotion, held in Curitiba, Brazil, in May 2016. The Brazilian political context at that time greatly influenced the drafting of the Curitiba Statement, which was considered by many participants as an opportunity to categorically express that Brazilian democracy was threatened, as well as the danger of fiscal austerity implemented by many governments of the world. The conference organizers also perceived the launching of this Statement as an opportunity to influence the WHO Shanghai Declaration, since it very strongly stated the influence of commercial interests and corporate practices of the market that are harmful to health. The Curitiba Statement gathers 120 suggestions made by conference participants and focuses on how strengthening health promotion and equity can improve people's lives. The 21 recommendations were summarized and resulted in appeals to International Organizations, all levels of Governments, Health Sector, Citizens, Health Professionals and Researchers. Unlike a declaration from government summit that are restricted by governments negotiations from different ideological spectrum, the Curitiba Statement was developed in a free environment to foster professional activism. We reaffirm that the objectives of Health Promotion in the Sustainable Development will only be fully achieved by incorporating these four fundamental principles: democracy, social justice, social mobilization and equity. Health Promotion in the twenty-first century needs new narratives and inputs from professional associations, which can be more assertive and to influencing the official declarations of government.

Bases para el desarrollo e implementación de un modelo de información en salud de la mujer y perinatal orientado a la gestión en Latinoamérica

[RESUMEN]. Objetivo. El Sistema Informático Perinatal (SIP) ha marcado un hito en el uso de información sistematizada en la Región de las Américas. Lo que se ha aprendido ha contribuido al desarrollo de un modelo basado en un conjunto mínimo de indicadores (CMI). El objetivo del estudio fue describir el proceso histórico y metodológico de desarrollo, implementación y escalamiento territorial de un CMI para monitorizar y evaluar políticas, programas y servicios de salud de la mujer y perinatal orientado a la gestión (SIP-GESTIÓN). Métodos. El estudio se llevó a cabo en dos etapas: 1) validación en cuatro fases de un CMI en una red de hospitales: a) construcción del modelo teórico de indicadores, b) implementación de la investigación operativa, c) selección final de indicadores, y d) definición de patrones de referencia, y 2) escalamiento territorial. Resultados. Se identificaron 17 modelos de indicadores. El modelo inicial incluyó 177 indicadores agrupados en siete dimensiones (contexto, hábitos, accesibilidad, uso de servicios, calidad de cuidados, impacto materno-fetal, e impacto materno-neonatal) que se redujeron a 21 tras tres rondas Delphi. El modelo final (SIP-GESTIÓN) incluyó 40 indicadores. Se analizaron 240 021 partos (79,1%) de un total de 303 559 atendidos en las 122 maternidades seleccionadas en 24 Jurisdicciones (100%) de Argentina. La información se presenta a nivel nacional y desagregada por región sanitaria, provincia y hospital. Conclusiones. Este modelo permitió alcanzar altos niveles de cobertura y calidad de la información y escalamiento territorial y es útil para la gestión, la investigación y la reorientación de programas y políticas.

[ABSTRACT]. Objective. The Perinatal Information System (SIP) represents a milestone in the use of systematized information in the Region of the Americas. What has been learned from the system has contributed to the development of a model based on a set of core indicators (SCI). The objective of the study was to describe the historical and methodological process involved in the development, implementation, and territorial scaling-up of an SCI to monitor and evaluate women’s and perinatal health policies, programs, and services geared to management (SIP-GESTIÓN). Methods. The study was conducted in two stages: 1) a four-phase validation of an SCI in a hospital network: a) construction of the theoretical indicator model, b) operations research, c) final selection of the indicators, and d) the definition of reference standards; and 2) territorial scaling-up. Results. A total of 17 indicator models were identified. The initial model included 177 indicators divided into seven dimensions (context, habits, accessibility, use of services, quality of care, maternal and fetal impact, and maternal and neonatal impact), with 21 indicators remaining after three Delphi rounds. The final model (SIPGESTIÓN), which included 40 indicators, was then used to study 240,021 (79.1%) of the 303,559 deliveries attended in 122 selected maternity facilities in 24 jurisdictions (100%) in Argentina. The information is presented in national terms and by health region, province, and hospital. Conclusions. This model has made it possible to achieve high levels of information coverage and quality and territorial scaling-up and is useful for management, research, and the reorientation of programs and policies.

[RESUMO]. Objetivo. O Sistema de Informação Perinatal (SIP) é um marco no uso de informação sistematizada na Região das Américas. A experiência obtida contribuiu para o desenvolvimento de um modelo baseado em um conjunto mínimo de indicadores (CMI). O objetivo do estudo foi descrever o processo histórico e metodológico do desenvolvimento, implementação e dimensionamento territorial do CMI para monitorar e avaliar políticas, programas e serviços de saúde materna e perinatal orientado à gestão (SIP-gestão). Métodos. O estudo foi realizado em duas etapas. A primeira etapa consistiu da validação em quatro fases de um CMI em uma rede de hospitais: a) construção do modelo teórico de indicadores, b) implementação da pesquisa operacional, c) seleção final dos indicadores e d) definição dos padrões de referência. A segunda etapa consistiu da determinação da escala territorial. Resultados. Foram identificados 17 modelos de indicadores. O modelo inicial incluiu 177 indicadores agrupados em sete dimensões (contexto, hábitos, acessibilidade, utilização de serviços, qualidade do atendimento, impacto materno-fetal e impacto materno-neonatal) que foram reduzidas a 21 após três rodadas de aplicação da técnica Delphi. O modelo final (SIP-gestão) inclui 40 indicadores. Foram analisados 240.021 partos (79,1%) de um número total de 303.559 casos atendidos nas 122 maternidades selecionadas em 24 jurisdições (100%) da Argentina. Os dados são apresentados ao nível nacional e desagregados por região de saúde, província e hospital. Conclusões. O modelo desenvolvido atingiu altos níveis de cobertura e qualidade da informação e determinação da escala territorial, e pode ser usado na gestão, pesquisa e reorientação de programas e políticas.

[Foundations for the development and implementation of a women's and perinatal health information model for management in Latin AmericaFundamentos do desenvolvimento e implementação de um modelo de informação em saúde da materna e perinatal orientado à gestão na América Latina]. / Bases para el desarrollo e implementación de un modelo de información en salud de la mujer y perinatal orientado a la gestión en Latinoamérica.

OBJECTIVE: The Perinatal Information System (SIP) represents a milestone in the use of systematized information in the Region of the Americas. What has been learned from the system has contributed to the development of a model based on a set of core indicators (SCI). The objective of the study was to describe the historical and methodological process involved in the development, implementation, and territorial scaling-up of an SCI to monitor and evaluate women's and perinatal health policies, programs, and services geared to management (SIP-GESTIÓN). METHODS: The study was conducted in two stages: 1) a four-phase validation of an SCI in a hospital network: a) construction of the theoretical indicator model, b) operations research, c) final selection of the indicators, and d) the definition of reference standards; and 2) territorial scaling-up. RESULTS: A total of 17 indicator models were identified. The initial model included 177 indicators divided into seven dimensions (context, habits, accessibility, use of services, quality of care, maternal and fetal impact, and maternal and neonatal impact), with 21 indicators remaining after three Delphi rounds. The final model (SIP-GESTIÓN), which included 40 indicators, was then used to study 240,021 (79.1%) of the 303,559 deliveries attended in 122 selected maternity facilities in 24 jurisdictions (100%) in Argentina. The information is presented in national terms and by health region, province, and hospital. CONCLUSIONS: This model has made it possible to achieve high levels of information coverage and quality and territorial scaling-up and is useful for management, research, and the reorientation of programs and policies.

OBJETIVO: O Sistema de Informação Perinatal (SIP) é um marco no uso de informação sistematizada na Região das Américas. A experiência obtida contribuiu para o desenvolvimento de um modelo baseado em um conjunto mínimo de indicadores (CMI). O objetivo do estudo foi descrever o processo histórico e metodológico do desenvolvimento, implementação e dimensionamento territorial do CMI para monitorar e avaliar políticas, programas e serviços de saúde materna e perinatal orientado à gestão (SIP-gestão). MÉTODOS: O estudo foi realizado em duas etapas. A primeira etapa consistiu da validação em quatro fases de um CMI em uma rede de hospitais: a) construção do modelo teórico de indicadores, b) implementação da pesquisa operacional, c) seleção final dos indicadores e d) definição dos padrões de referência. A segunda etapa consistiu da determinação da escala territorial. RESULTADOS: Foram identificados 17 modelos de indicadores. O modelo inicial incluiu 177 indicadores agrupados em sete dimensões (contexto, hábitos, acessibilidade, utilização de serviços, qualidade do atendimento, impacto materno-fetal e impacto materno-neonatal) que foram reduzidas a 21 após três rodadas de aplicação da técnica Delphi. O modelo final (SIP-gestão) inclui 40 indicadores. Foram analisados 240.021 partos (79,1%) de um número total de 303.559 casos atendidos nas 122 maternidades selecionadas em 24 jurisdições (100%) da Argentina. Os dados são apresentados ao nível nacional e desagregados por região de saúde, província e hospital. CONCLUSÕES: O modelo desenvolvido atingiu altos níveis de cobertura e qualidade da informação e determinação da escala territorial, e pode ser usado na gestão, pesquisa e reorientação de programas e políticas.

Bases para el desarrollo e implementación de un modelo de información en salud de la mujer y perinatal orientado a la gestión en Latinoamérica / Foundations for the development and implementation of a women's and perinatal health information model for management in Latin America / Fundamentos do desenvolvimento e implementação de um modelo de informação em saúde da materna e perinatal orientado à gestão na América Latina

RESUMEN Objetivo El Sistema Informático Perinatal (SIP) ha marcado un hito en el uso de información sistematizada en la Región de las Américas. Lo que se ha aprendido ha contribuido al desarrollo de un modelo basado en un conjunto mínimo de indicadores (CMI). El objetivo del estudio fue describir el proceso histórico y metodológico de desarrollo, implementación y escalamiento territorial de un CMI para monitorizar y evaluar políticas, programas y servicios de salud de la mujer y perinatal orientado a la gestión (SIP-GESTIÓN). Métodos El estudio se llevó a cabo en dos etapas: 1) validación en cuatro fases de un CMI en una red de hospitales: a) construcción del modelo teórico de indicadores, b) implementación de la investigación operativa, c) selección final de indicadores, y d) definición de patrones de referencia, y 2) escalamiento territorial. Resultados Se identificaron 17 modelos de indicadores. El modelo inicial incluyó 177 indicadores agrupados en siete dimensiones (contexto, hábitos, accesibilidad, uso de servicios, calidad de cuidados, impacto materno-fetal, e impacto materno-neonatal) que se redujeron a 21 tras tres rondas Delphi. El modelo final (SIP-GESTIÓN) incluyó 40 indicadores. Se analizaron 240 021 partos (79,1%) de un total de 303 559 atendidos en las 122 maternidades seleccionadas en 24 Jurisdicciones (100%) de Argentina. La información se presenta a nivel nacional y desagregada por región sanitaria, provincia y hospital. Conclusiones Este modelo permitió alcanzar altos niveles de cobertura y calidad de la información y escalamiento territorial y es útil para la gestión, la investigación y la reorientación de programas y políticas.

ABSTRACT Objective The Perinatal Information System (SIP) represents a milestone in the use of systematized information in the Region of the Americas. What has been learned from the system has contributed to the development of a model based on a set of core indicators (SCI). The objective of the study was to describe the historical and methodological process involved in the development, implementation, and territorial scaling-up of an SCI to monitor and evaluate women's and perinatal health policies, programs, and services geared to management (SIP-GESTIÓN). Methods The study was conducted in two stages: 1) a four-phase validation of an SCI in a hospital network: a) construction of the theoretical indicator model, b) operations research, c) final selection of the indicators, and d) the definition of reference standards; and 2) territorial scaling-up. Results A total of 17 indicator models were identified. The initial model included 177 indicators divided into seven dimensions (context, habits, accessibility, use of services, quality of care, maternal and fetal impact, and maternal and neonatal impact), with 21 indicators remaining after three Delphi rounds. The final model (SIP-GESTIÓN), which included 40 indicators, was then used to study 240,021 (79.1%) of the 303,559 deliveries attended in 122 selected maternity facilities in 24 jurisdictions (100%) in Argentina. The information is presented in national terms and by health region, province, and hospital. Conclusions This model has made it possible to achieve high levels of information coverage and quality and territorial scaling-up and is useful for management, research, and the reorientation of programs and policies.

RESUMO Objetivo O Sistema de Informação Perinatal (SIP) é um marco no uso de informação sistematizada na Região das Américas. A experiência obtida contribuiu para o desenvolvimento de um modelo baseado em um conjunto mínimo de indicadores (CMI). O objetivo do estudo foi descrever o processo histórico e metodológico do desenvolvimento, implementação e dimensionamento territorial do CMI para monitorar e avaliar políticas, programas e serviços de saúde materna e perinatal orientado à gestão (SIP-gestão). Métodos O estudo foi realizado em duas etapas. A primeira etapa consistiu da validação em quatro fases de um CMI em uma rede de hospitais: a) construção do modelo teórico de indicadores, b) implementação da pesquisa operacional, c) seleção final dos indicadores e d) definição dos padrões de referência. A segunda etapa consistiu da determinação da escala territorial. Resultados Foram identificados 17 modelos de indicadores. O modelo inicial incluiu 177 indicadores agrupados em sete dimensões (contexto, hábitos, acessibilidade, utilização de serviços, qualidade do atendimento, impacto materno-fetal e impacto materno-neonatal) que foram reduzidas a 21 após três rodadas de aplicação da técnica Delphi. O modelo final (SIP-gestão) inclui 40 indicadores. Foram analisados 240.021 partos (79,1%) de um número total de 303.559 casos atendidos nas 122 maternidades selecionadas em 24 jurisdições (100%) da Argentina. Os dados são apresentados ao nível nacional e desagregados por região de saúde, província e hospital. Conclusões O modelo desenvolvido atingiu altos níveis de cobertura e qualidade da informação e determinação da escala territorial, e pode ser usado na gestão, pesquisa e reorientação de programas e políticas.

Toward a Child Rights Theory in Pediatric Bioethics.

This article offers a child rights theory in pediatric bioethics, applying the principles, standards, and norms of child rights, health equity, and social justice to medical and ethical decision-making. We argue that a child rights theory in pediatric bioethics will help pediatricians and pediatric bioethicists analyze and address the complex interplay of biomedical and social determinants of child health. These core principles, standards and norms, grounded in the U.N. Convention on the Rights of the Child (CRC), provide the foundational elements for the theory and a means for better understanding the complex determinants of children's health and well-being. Rights-based approaches to medical and ethical decision-making provide strategies for applying and translating these elements into the practice of pediatrics and pediatric bioethics by establishing a coherent, consistent, and contextual theory that is relevant to contemporary practice. The proposed child rights theory extends evolving perspectives on the relationship between human rights and bioethics to both child rights and pediatric bioethics.

[Model for a comprehensive approach to maternal mortality and severe maternal morbidity]. / Modelo para abordar integralmente la mortalidad materna y la morbilidad materna grave.

Maternal mortality is an important public health and human rights problem and reflects the effects of social determinants on women's health. Understanding the extent and causes of maternal death has been insufficient to achieve the Millennium Development Goals. This article proposes a model for a comprehensive approach to maternal mortality, covering seven areas: prioritization and definition of the problem, contextual description, methodological scope, knowledge management, innovation, implementation, and a monitoring and evaluation system. This model helps address problems associated with maternal mortality and severe maternal morbidity through early monitoring of potentially fatal complications in the reproductive process. Knowledge management is important for the reorientation of policies, programs, and health care. Interaction and synergies among people, communities, and actors in the health system should be strengthened in order to improve the results of health programs. More validated scientific information is needed on how actions should be implemented in different environments. It is essential to strengthen communication among research centers, cooperation agencies, and government organizations and to include them in programs and in the definition of a new women's health agenda in the Region of the Americas.

Bases para establecer un sistema de vigilancia activa y respuesta rápida para el manejo de la morbilidad materna severa / Basis for establishing a system of active surveillance and rapid response for the management of severe maternal morbidity

INTRODUCCIÓN: la razón de mortalidad materna (RMM) se ha utilizado como indicador de salud sin considerar los eventos precedentes. La morbilidad materna severa (MMS) incluye a mujeres con morbilidad asociada a un embarazo, que amenaza sus vidas pero que finalmente permite la sobrevida. OBJETIVOS: Investigar la situación de la mortalidad materna (MM) y la MMS en Misiones, Jujuy y LaRioja. Establecer bases para un sistema de vigilancia y manejo de casos.MÉTODOS: Se realizó un estudio multicéntrico de prevalencia con uncomponente de implementación. Mujeres embarazadas, tratadas enel subsector público entre el 1 de octubre de 2013 y el 31 de marzode 2014, fueron tamizadas para detectar condiciones potencialmentefatales (CPF) y notificar MMS y MM. RESULTADOS: Se analizaron 9.921nacimientos. Ingresaron 294 mujeres, y hubo 219 (74,5%) casos de CPF, 67 (22,8%) de MMS y 8 (2,7%) de MM. Criterios de identificación por tamizaje: clínicos 78,1% de CPF, basados en enfermedad 94% de MMS, y 100% de MM presentó algún criterio clínico. Las principales causas de MMS fueron hipertensión (35,8%), hemorragias (29,9%) y complicaciones de abortos (13,4%). La incidencia global deCPF fue 2,21%, la de MMS 0,68% y la de MM 0,08%. El índice demorbimortalidad global fue de 8,4 (4,0-7,4), la tasa de letalidad globalfue del 10,7%, y el uso global de intervenciones beneficiosas para elmanejo de MMS fue del 54,8%. CONCLUSIONES: El estudio permitióconocer la MM y la MMS en las tres provincias y sentar las bases paraimplementar un sistema de vigilancia activa y respuesta rápida para elmanejo de la MMS, consistente con el Plan Operativo Nacional.

INTRODUCTION: maternal mortality ratio (MMR) has been used as an indicator of maternal health regardless of the previous events. Severe maternal morbidity (SMM) refers to women with life-threatening pregnancy-associated morbidity, who ultimately survive. OBJECTIVES: To investigate the status of maternal mortality (MM) and SMM in Misiones, Jujuy and La Rioja. To establish the basis for a system of surveillance and case management. METHODS: Amulticenter prevalence study was conducted, with an implementationcomponent. Pregnant women assisted from October 1, 2013 to March31, 2014 in the public sub-sector were screened for potentially fatalconditions (PFC) and SMM and MM notification. RESULTS: A total of 9921 births were analyzed. From 294 women participating in the study, there were 219 (74.5%) cases of PFC, 67 (22.8%) of SMM and 8 (2.7%) of MM. Clinical screening criteria identified 78.1% of cases of PFC, disease criteria identified SMM 94%, and 100% of MM showedsome clinical criterion. The main causes of SMM were hypertensivedisorders (35.8%), hemorrhagic disorders (29.9%) and abortioncomplications (13.4%). Global incidence of PFC was 2.21%, andfor SMM and MM was 0.68% and 0.08%, respectively. The overallmorbidity index was 8.4 (4.0-7.4), the overall mortality rate was 10.7%,and the overall use of beneficial interventions for the managementof SMM was 54.8%. CONCLUSIONS: The study yielded information on MM and SMM in the three provinces and laid the groundwork for implementing a system of active surveillance and rapid response to handle SMM consistently with the National Operational Plan.

Modelo para abordar integralmente la mortalidad materna y la morbilidad materna grave / Model for a comprehensive approach to maternal mortality and severe maternal morbidity

La mortalidad materna es un importante problema de salud pública y de derechos humanos y refleja los efectos de los determinantes sociales sobre la salud de las mujeres. El conocimiento de la magnitud y las causas de las muertes maternas ha sido insuficiente para intervenir efectivamente en el alcance de los Objetivos de Desarrollo del Milenio. Por ello, se plantea un modelo para abordar integralmente la mortalidad materna, con siete campos: priorización y definición del problema, caracterización contextual, amplitud metodológica, gestión del conocimiento, innovación, implementación, y un sistema de monitoreo y evaluación. Este modelo permite abordar los problemas asociados con la mortalidad materna y la morbilidad materna grave mediante la integración, desde una perspectiva anticipatoria, de las complicaciones potencialmente fatales asociadas con el proceso reproductivo y su vigilancia. Se destaca la importancia de la gestión del conocimiento para la reorientación de políticas, programas y la atención sanitaria. Se debe mejorar la interacción y explotar las sinergias entre las personas, las comunidades y los actores del sistema de salud para potenciar los resultados de los programas sanitarios. Se requiere más información científica validada sobre la forma en que las intervenciones deben aplicarse en diferentes entornos. Para ello, es esencial fortalecer la articulación entre los centros de investigación, las agencias de cooperación y los organismos del Estado y su incorporación a las acciones programáticas y a la definición de una nueva agenda de salud de la mujer para la Región de las Américas.

Maternal mortality is an important public health and human rights problem and reflects the effects of social determinants on women's health. Understanding the extent and causes of maternal death has been insufficient to achieve the Millennium Development Goals. This article proposes a model for a comprehensive approach to maternal mortality, covering seven areas: prioritization and definition of the problem, contextual description, methodological scope, knowledge management, innovation, implementation, and a monitoring and evaluation system. This model helps address problems associated with maternal mortality and severe maternal morbidity through early monitoring of potentially fatal complications in the reproductive process. Knowledge management is important for the reorientation of policies, programs, and health care. Interaction and synergies among people, communities, and actors in the health system should be strengthened in order to improve the results of health programs. More validated scientific information is needed on how actions should be implemented in different environments. It is essential to strengthen communication among research centers, cooperation agencies, and government organizations and to include them in programs and in the definition of a new women's health agenda in the Region of the Americas.

Primer informe nacional de relevamiento epidemiológico SIP-Gestión: desarrollo e implementación a escala nacional de un sistema de información en salud de la mujer y perinatal en Argentina

Presenta los antecedentes, justificación, marco de referencia y desarrollo del SIP-G (Sistema Informático Perinatal); difunde los resultados principales de la implementación y relevamiento epidemiológico del SIP-G a escala nacional; destaca la importancia de la cooperación técnica con OPS/OMS Argentina y CLAP-SMR; y, establece lineamientos sobre el seguimiento de la actual propuesta

Primer informe nacional de relevamiento epidemiológico SIP-Gestión: desarrollo e implementación a escala nacional de un sistema de información en salud de la mujer y perinatal en Argentina

Presenta los antecedentes, justificación, marco de referencia y desarrollo del SIP-G (Sistema Informático Perinatal); difunde los resultados principales de la implementación y relevamiento epidemiológico del SIP-G a escala nacional; destaca la importancia de la cooperación técnica con OPS/OMS Argentina y CLAP-SMR; y, establece lineamientos sobre el seguimiento de la actual propuesta

Políticas en salud pública basadas en la evidencia para mejorar la atención perinatal en el Area Metropolitana de Buenos Aires / Evidence-based public health policies to improve quality of maternal and child care in the Metropolitan Area of Buenos Aires

INTRODUCCION: La mortalidad materna (MM) y la morbilidad materna severa (MMS) constituyen importantes problemas de salud pública en Argentina.OBJETIVO: Estimular la articulación entre investigadores y gestores para reducir la MM y MMS mediante políticas públicas basadas en la evidencia. Abordar la dimensión cualitativa de la MMS.METODOS: Cuantitativo: Estudio no aleatorizado, cuasi-experimental, de tipo serie temporal. Cualitativo: Entrevistas a mujeres (n=16) que padecieron MMS, a profesionales de la salud, gestores (Provincia de Buenos Aires, Ciudad Autónoma de Buenos Aires y Ministerio de Salud de la Nación) e investigadores (n=18). Participaron 8 hospitales del Sur y del Oeste del Area Metropolitana de Buenos Aires. Se usó la base de datos del SIP (Sistema Informático Perinatal) del Centro de Investigación en Salud Poblacional. La unidad de análisis fue el hospital. Las entrevistas fueron procesadas según criterios de categorización predefinidos. Se evaluó la mesa de investigadores-gestores mediante observación no participante. Se tomaron los resguardos éticos correspondientes. RESULTADOS: Se analizaron 43.308 nacimientos (84,1% del total). La tasa mediana de uso de los tres indicadores seleccionados (acompañamiento durante el parto, manejo activo del alumbramiento, corticoides prenatales) fue < 25%, con gradientes interinstitucionales. Existe una diversidad de barreras caracterizadas en la calidad de atención percibida.CONCLUSIONES: El estudio aporta nuevos conocimientos para mejorar la gestión de políticas, programas y servicios de salud tendientes a reducir la MMS y MM en Argentina.

INTRODUCTION: Maternal mortality (MM) and severe maternal morbidity (SMM) represent relevant public health problems in Argentina.OBJECTIVE: To encourage the development of bridges between researchers and policy makers for the formulation of informed puiblic policies and use of effective interventions to reduce MM and SMM; and to understand qualitative dimensions of SMM.METHODS: Quantitative: Non-randomized, quasi-experimental, temporal-series study. Qualitative: Interviews to women (n=16) who experienced SMM, professionals, health managers (Province of Buenos Aires, Buenos Aires City and national levels) and researchers (n=18). 8 hospitals from southwest of the Buenos Aires Metropolitan Area participated in the study. The analysis was based on the SIP (Perinatal Information System) of the CISAP (Population Health Research Center). The unit of analysis was the hospital. Interviews were processed according to predefined categories. The board of researchers and policy-makers was evaluated through non-participatory observation. All ethical safeguards were met.RESULTS: 43.308 births were analyzed (84.1% of the total). The median rate for the 3 selected indicators (support during labor and delivery, active management of third stage of labor, antenatal corticosteroids) was < 25% with significant inter-hospital gaps. There was a diversity of barriers in quality of care perception.CONCLUSIONS: This project contributes with important information oriented to improve the policy making process, program managing and service delivery to reduce SMM and MM in Argentina.

Políticas en salud pública basadas en la evidencia para mejorar la atención perinatal en el Area Metropolitana de Buenos Aires / Evidence-based public health policies to improve quality of maternal and child care in the Metropolitan Area of Buenos Aires

INTRODUCCION: La mortalidad materna (MM) y la morbilidad materna severa (MMS) constituyen importantes problemas de salud pública en Argentina.OBJETIVO: Estimular la articulación entre investigadores y gestores para reducir la MM y MMS mediante políticas públicas basadas en la evidencia. Abordar la dimensión cualitativa de la MMS.METODOS: Cuantitativo: Estudio no aleatorizado, cuasi-experimental, de tipo serie temporal. Cualitativo: Entrevistas a mujeres (n=16) que padecieron MMS, a profesionales de la salud, gestores (Provincia de Buenos Aires, Ciudad Autónoma de Buenos Aires y Ministerio de Salud de la Nación) e investigadores (n=18). Participaron 8 hospitales del Sur y del Oeste del Area Metropolitana de Buenos Aires. Se usó la base de datos del SIP (Sistema Informático Perinatal) del Centro de Investigación en Salud Poblacional. La unidad de análisis fue el hospital. Las entrevistas fueron procesadas según criterios de categorización predefinidos. Se evaluó la mesa de investigadores-gestores mediante observación no participante. Se tomaron los resguardos éticos correspondientes. RESULTADOS: Se analizaron 43.308 nacimientos (84,1% del total). La tasa mediana de uso de los tres indicadores seleccionados (acompañamiento durante el parto, manejo activo del alumbramiento, corticoides prenatales) fue < 25%, con gradientes interinstitucionales. Existe una diversidad de barreras caracterizadas en la calidad de atención percibida.CONCLUSIONES: El estudio aporta nuevos conocimientos para mejorar la gestión de políticas, programas y servicios de salud tendientes a reducir la MMS y MM en Argentina.

INTRODUCTION: Maternal mortality (MM) and severe maternal morbidity (SMM) represent relevant public health problems in Argentina.OBJECTIVE: To encourage the development of bridges between researchers and policy makers for the formulation of informed puiblic policies and use of effective interventions to reduce MM and SMM; and to understand qualitative dimensions of SMM.METHODS: Quantitative: Non-randomized, quasi-experimental, temporal-series study. Qualitative: Interviews to women (n=16) who experienced SMM, professionals, health managers (Province of Buenos Aires, Buenos Aires City and national levels) and researchers (n=18). 8 hospitals from southwest of the Buenos Aires Metropolitan Area participated in the study. The analysis was based on the SIP (Perinatal Information System) of the CISAP (Population Health Research Center). The unit of analysis was the hospital. Interviews were processed according to predefined categories. The board of researchers and policy-makers was evaluated through non-participatory observation. All ethical safeguards were met.RESULTS: 43.308 births were analyzed (84.1% of the total). The median rate for the 3 selected indicators (support during labor and delivery, active management of third stage of labor, antenatal corticosteroids) was < 25% with significant inter-hospital gaps. There was a diversity of barriers in quality of care perception.CONCLUSIONS: This project contributes with important information oriented to improve the policy making process, program managing and service delivery to reduce SMM and MM in Argentina.