[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.

Implementación de herramienta tecnológica (TIC) para la vigilancia de factores ambientales y posibles afecciones relacionadas a la exposición por uso de plaguicidas agrícolas en Paraguay / Implementation of a technological tool (TIC) for the monitoring of environmental factors and possible conditions related to exposure due to the use of agricultural pesticides in Paraguay

Introducción: Paraguay, con alto desarrollo de agricultura extensiva, es potencialmente vulnerable a situaciones relacionadas con manejo inadecuado, falta de prevención y riesgos para la salud individual, comunitaria y ambiental, por incumplimiento de buenas prácticas en la selección, manipulación y gestión de plaguicidas. Objetivo: Diseñar e implementar un método de vigilancia con carga de datos del sistema público para detectar, jerarquizar y mapear eventos relacionados al manejo inadecuado de plaguicidas; establecer posibles asociaciones con causas de morbilidad y mortalidad; y seguimiento para evaluar riesgos relativos. Métodos: Con la creación del Sistema de Información Georreferenciado de Evaluación de Casos de afecciones a la Salud (SIGEC), método web que recolecta información del monitoreo comunitario de manejo y posibles efectos de plaguicidas en pequeños productores y empresas agrícolas, y de parcelas de plantaciones en el territorio nacional, se realizó un estudio de vigilancia epidemiológica sobre condiciones de vida, variables ambientales y riesgo de exposición a plaguicidas. Resultados: Al relacionar datos del egreso hospitalario de enfermedades trazadoras (EH) 2011 - 2015, en mapas por Departamentos, Regiones del Estudio Piloto y por Distritos, se observó una concentración de las mismas en 3 a 4 regiones relacionadas al uso de plaguicidas, repitiéndose dicha situación en patologías con concentraciones altas (color rojo) o intermedias (color amarillo), con posible asociación casual o causal. Los demás distritos de estas regiones observadas que se encuentran coloreadas de verde, no implica ausencia de casos registrados, sino que se encuentran en el tercio inferior del total registrado (tabla a la izquierda de los mapas). La poligonización valora el grado de exposición de personas en riesgo y brinda georreferenciamiento de las variables del Monitoreo Comunitario, además permite seguimiento mediante gráficos de puntos, útiles para los tomadores de decisiones en salud. Las herramientas propuestas son amigables y similares a las del Censo Comunitario realizado por estadígrafos regionales en las USF. Conclusiones: La vigilancia epidemiológica basada en el SIGEC complementa la visión parcial de los actuales sistemas de seguimiento del MSP y BS mediante la información en gráficos georreferenciados, visualiza datos del problema de salud planteado, en un territorio específico, utiliza variables ambientales y laborales con posible relación a exposición de plaguicidas, en formato de lectura fácil, convirtiéndola en herramienta útil para el posterior seguimiento a través de investigaciones con diseño pertinente, utilizando modelos estadísticos apropiados, para la posterior aplicación de políticas públicas. Palabras-clave: Exposición a plaguicidas; vigilancia del ambiente del trabajo; monitoreo epidemiológico; programas informáticos

Introduction: Paraguay, with high development of extensive agriculture, is potentially vulnerable to situations related to inadequate management, lack of prevention and risks to individual, community and environmental health, due to non-compliance with good practices in the selection, handling and management of pesticides. Objective: Design and implement a surveillance method with data loading of the public system to detect, prioritize and map events related to the inadequate handling of pesticides; establish possible associations with causes of morbidity and mortality; and monitoring to assess relative risks. Methods: With the creation of the Georeferenced Information System for the Evaluation of Cases of Health Conditions (SIGEC), a web method that collects information on community monitoring of management and possible effects of pesticides on small producers and agricultural companies, and on plantation plots In the national territory, an epidemiological surveillance study was conducted on life conditions, environmental variables and risk of exposure to pesticides. Results: When relating hospital discharge data of tracer diseases (EH) 2011 - 2015, in maps by Departments, Regions of the Pilot Study and by Districts, a concentration of them was observed in 3 to 4 regions related to the use of pesticides, repeating this situation in pathologies with high concentrations (red color) or intermediate (yellow color), with possible causal or casual association. The other districts of these observed regions that are colored green, does not imply absence of registered cases, but they are in the lower third of the total registered (table on the left of the maps). Poligonization assesses the degree of exposure of people at risk and provides georeferencing of the Community Monitoring variables, and also allows monitoring through point charts, useful for health decision-makers. The proposed tools are friendly and similar to those of the Community Census conducted by regional statisticians at the USF. Conclusions: The epidemiological surveillance based on the SIGEC complements the partial vision of the current monitoring systems of the MSP and BS through the information in georeferenced graphs, visualizes data of the health problem raised, in a specific territory, uses environmental and labor variables with possible relation to exposure of pesticides, in easy reading format, making it a useful tool for subsequent monitoring through relevant design investigations, using appropriate statistical models, for the subsequent application of public policies. Key words: Exposure to pesticides; monitoring of the work environment; epidemiological monitoring; Software

Perinatal risk for common mental disorders and suicidal ideation among women in Paraguay.

OBJECTIVE: To examine the association between mental health problems among pregnant women and those in the postpartum period using a nationally representative sample of 6538 women aged 15-49 years from the National Survey of Demography and Sexual and Reproductive Health in Paraguay. METHODS: The predicted probabilities (PP) of common mental disorders (CMD) and suicidal ideation were assessed using the Self-Reporting Questionnaire (SRQ-20) and logistic regression models. RESULTS: No evidence was found of an increased risk for mental health problems associated with being pregnant or in the postpartum period alone. The risk for CMD during pregnancy and the postpartum period and for suicidal ideation during pregnancy was significantly greater when the pregnancy was unintended. In addition, unintentionally pregnant women who had neither been in a union nor had a child were at a significantly higher risk for CMD and suicidal ideation compared with non-pregnant and non-postpartum women (PP: 0.54 versus 0.21 for CMD risk and 0.15 versus 0.02 for suicidal ideation). However, there were no significant differences by marital status among postpartum women. CONCLUSION: The significant effects of pregnancy intention and marital status highlight the importance of psychosocial, rather than physiological, contexts in which women experience pregnancy and childbirth.

Factores relacionados al uso de condón en Paraguay: resumen de investigación en base a una encuesta / Factors related to condom use in Paraguay: summary of research based on a survey

El propósito de la presente investigación es identificar los factores asociados a una mayor probabilidad de uso de condón en la última relación sexual en mujeres de 15 a 44 años de edad en Paraguay.