Seroprevalence of Anti-SARS-CoV-2 IgG Antibodies in Healthcare Personnel in El Salvador Prior to Vaccination Campaigns.

COVID-19, caused by the SARS-CoV-2 virus, is a highly pathogenic emerging infectious disease. Healthcare personnel (HCP) are presumably at higher risk of acquiring emerging infections because of occupational exposure. The prevalence of COVID-19 in HCP is unknown, particularly in low- to middle-income countries like El Salvador. The goal of this study was to determine the seroprevalence of anti-SARS-CoV-2 antibodies among HCP in El Salvador just prior to vaccine rollout in March 2021. We evaluated 2176 participants from a nationally representative sample of national healthcare institutions. We found 40.4% (n = 880) of the study participants were seropositive for anti-spike protein antibodies. Significant factors associated with infection included younger age; living within the central, more populated zone of the country; living in a larger household (≥7 members); household members with COVID-19 or compatible symptoms; and those who worked in auxiliary services (i.e., housekeeping and food services). These findings provide insight into opportunities to mitigate SARS-CoV-2 risk and other emerging respiratory pathogens in HCP in El Salvador.

New Psychometric Evidence of the Grief Impairment Scale (GIS) in People Who Have Experienced the Death of a Loved One From a Network Psychometric Approach in Two Latin American Countries.

This study aimed to evaluate the psychometric properties of the Grief Impairment Scale (GIS) using a network psychometric model. A total of 1048 individuals from Peru and El Salvador participated. A network psychometric model was used to determine internal structure, reliability, and cross-country invariance. The results indicate that the GIS items were grouped into a single network structure through Exploratory Graph Analysis. Reliability was estimated by structural consistency, and it was found that when replicating the network structure within an empirical dimension, a single network structure was consistently obtained, and all items remained stable. Furthermore, the network structure was invariant, thus functioning similarly across the different country groups. In conclusion, the GIS presented solid psychometric evidence of validity based on its internal structure, reliability, and cross-country invariance. Therefore, the GIS is a psychometrically sound measure of functional impairment symptoms due to grief for Peruvian and Salvadoran individuals.

Perinatal dengue and Zika virus cross-sectional seroprevalence and maternal-fetal outcomes among El Salvadoran women presenting for labor-and-delivery.

BACKGROUND: Despite maternal flavivirus infections' linkage to severe maternal and fetal outcomes, surveillance during pregnancy remains limited globally. Further complicating maternal screening for these potentially teratogenic pathogens is the overwhelming subclinical nature of acute infection. This study aimed to understand perinatal and neonatal risk for poor health outcomes associated with flaviviral infection during pregnancy in El Salvador. METHODS: Banked serologic samples and clinical results obtained from women presenting for labor and delivery at a national referent hospital in western El Salvador March to September 2022 were used for this study. 198 samples were screened for dengue and Zika virus IgM, and statistical analyses analyzed demographic and clinical outcome associations with IgM positivity. RESULTS: This serosurvey revealed a high rate of maternal flavivirus infection-24.2% of women presenting for labor and delivery were dengue or Zika virus IgM positive, suggesting potential infection within pregnancy. Specifically, 20.2% were Zika virus IgM positive, 1.5% were dengue virus IgM positive, and 2.5% were both dengue and Zika virus IgM positive. Women whose home had received mosquito abatement assistance within the last year by the ministry of health were 70% less likely to test IgM positive (aOR = 0.30, 95%CI: 0.10, 0.83). Further, statistical geospatial clustering revealed transmission foci in six primary municipalities. Pregnancy complications and poor birth outcomes were noted among the dengue and/or Zika virus maternal infection group, although these outcomes were not statistically different than the seronegative group. None of the resulting neonates born during this study were diagnosed with congenital Zika syndrome. CONCLUSIONS: The high rate of Zika virus detected among pregnant women and the lack of Zika-specific neonatal outcomes monitoring during a non-outbreak year highlights the need for continued surveillance in Central America and among immigrant mothers presenting for childbirth from these countries. As changing climatic conditions continue to expand the range of the disease vector, asymptomatic screening programs could be vital to early identification of outbreaks and clinical management of cases.

Riqueza y densidad de equinodermos en los arrecifes rocosos de Punta Amapala, El Salvador / Richness and density of echinoderms in the rocky reefs of Punta Amapala, El Salvador

Resumen Introducción: Los equinodermos son animales estrictamente acuáticos y de los grupos de invertebrados marinos cuya importancia ecológica es crucial para los ambientes en donde habitan. La característica más destacada es su simetría pentarradial. Estos organismos pueden distribuirse en una amplia variedad de ambientes oceánicos, y no ser exclusivamente habitantes de las formaciones arrecifales. Se han registrado el total de 1 539 especies, de las cuales 717 pertenecen a Pacífico y 60 de ellas se han registrado en El Salvador. Objetivo: El objetivo del trabajo fue registrar la riqueza y densidad de especies de equinodermos en arrecifes rocosos de Punta Amapala (La Unión). Métodos: El muestreo fue llevado a cabo en cinco sitios, dos a 3 m de profundidad y tres a 6 m. Para esto, se utilizó snorkeling y buceo autónomo, recorriendo dos transectos de banda de 30 x 1 m. Dentro de los transectos, se realizó la identificación (riqueza) y contabilización (abundancia) de los organismos. Resultados: La especie que presentó mayor densidad en los arrecifes de 3 m fue Echinometra vanbrunti (0.83 indv/m2), seguido por el ofiuroideo Ophiocomella alexandri (0.16 indv/m2) y Ophiocoma aethiops (0.16 indv/m2). Y en los arrecifes a 6 m fueron Ophiothela mirabilis (0.83 indv/m2), Ophionereis annulata (0.21 indv/m2), Ophiothrix rudis (0.08 indv/m2) y Ophiocomella alexandri (0.01 indv/m2). Conclusiones: Estos organismos, cumplen con diversos roles ecológicos, como ser bioindicadores de calidad de agua al tolerar ciertos cambios en las condiciones físico-químicas, así como cumplir el papel de hospederos de macrofauna por las cavidades que forman algunos erizos. Es por ello que los esfuerzos de muestreo deben incrementarse en estas zonas para monitorear la calidad y salud de los arrecifes rocosos, cuyo papel es clave, por ser junto con Los Cóbanos, los de mayor extensión en el país.

Abstract Introduction: Echinoderms are strictly aquatic animals and one of the groups of marine invertebrates whose ecological importance is crucial for the environments where they inhabit. The most outstanding characteristic is their pentaradial symmetry. These organisms can be distributed in a wide variety of oceanic environments, and are not exclusive inhabitants of reef formations. A total of 1 539 species have been registered, of which 717 belong to the Pacific and 60 of them have been registered for El Salvador. Objective: The objective of the work was to record the richness and density of echinoderm species in rocky reefs of Punta Amapala (La Unión). Methods: The sampling was conducted in five sites, two of them at 3 m of depth and three at 6 m. For this, snorkeling and autonomous diving were used, covering two band transects of 30 x 1 m. Within the transects, the identification (richness) and counting (abundance) of the organisms was carried out. Results: The species that presented the highest density at 3 m reefs was Echinometra vanbrunti (0.83 indv/m2), followed by the ophiuroid Ophiocomella alexandri (0.16 indv/m2) and Ophiocoma aethiops (0.16 indv/m2). And at the 6 m reefs were Ophiothela mirabilis (0.83 indv/m2), Ophionereis annulata (0.21 indv/m2), Ophiothrix rudis (0.08 indv/m2) and Ophiocomella alexandri (0.01 indv/m2). Conclusions: These organisms fulfill various ecological roles, such as being bioindicators of water quality by tolerating certain changes in physicochemical conditions and fulfilling the role of macrofauna hosts due to the cavities formed by some sea urchins. That is why sampling efforts must increase in these areas to monitor the quality and health of the rocky reefs, whose role is key, as they are, together with Los Cóbanos, the largest in the country.

The deinstitutionalization of children and adolescents in El Salvador's child protection system.

BACKGROUND: In 2010, El Salvador introduced legislation aimed at reforming the country's Child Protective System (CPS), with a focus on promoting deinstitutionalization. OBJECTIVE: The study aim was to explore the impact of deinstitutionalization on the Salvadoran CPS. PARTICIPANTS AND SETTING: The study was conducted in El Salvador, granting authors unique access to key informants with extensive experience in the country's CPS. Unlike the United States, which is divided into states, El Salvador is divided into departments, and CPS providers were recruited from all 14 departments. Focus groups were facilitated in the East, West, and Central zones to ensure representation from all regions. METHODS: Qualitative semi-structured interviews (n = 26) were conducted in June/July of 2019, which were then followed by focus groups (n = 4) in August 2019. The analysis of the data employed a combination of deductive and inductive thematic coding methods. RESULTS: CPS providers offered valuable insights, categorized into five main themes: (1) Strengths of El Salvador's CPS, (2) Deinstitutionalization policy encompassing socioenvironmental contextual factors, (3) Challenges in the deinstitutionalization process, including insufficient follow-up on deinstitutionalized children, (4) Recommendations from participants, highlighting the importance of enhancing stakeholder coordination/collaboration, and (5) The necessity for a paradigm shift, emphasizing the need to redefine the social contract on protecting children from child maltreatment. CONCLUSIONS: The Salvadoran CPS requires substantial systemic changes. Encouragingly, key informants have demonstrated a commitment to reform not only the deinstitutionalization process but also the broader CPS system in El Salvador including case management and quality of care in institutional settings.

The Prevalence of Urinary Tract Infections and Antibiotic Prescription Treatments Across Three Countries: A Retrospective Study Using an Electronic Medical Record.

Introduction The Clinical Rotation Evaluation and Documentation Organizer (CREDO) is an electronic medical record (EMR) system created by the Edward Via College of Osteopathic Medicine (VCOM). International healthcare providers who partner with VCOM can gain access to CREDO and input their patient data. The objective of this study was to determine the frequency of urinary tract infection (UTI) diagnoses and prescription use over a one-year period in three Latin American countries. Methods Researchers analyzed the frequency of UTI diagnosis with corresponding prescription recommendations over a 12-month period in three Latin American countries (i.e., Dominican Republic, El Salvador, and Honduras) that utilize the CREDO system. For each month between May 2021 and May 2022, the total number of UTI diagnosis codes and prescription codes were summed, graphed, and analyzed. Results In El Salvador, there were 142 UTIs and 126 corresponding prescriptions written for UTIs reported from May 2021 to May 2022 but diagnoses were not consistent each month. Ciprofloxacin was prescribed most frequently at a rate of 43.7% in El Salvador. In Honduras, there were 68 UTIs and 68 corresponding prescriptions written for the UTIs reported from May 2021 until May 2022 with Ciprofloxacin being prescribed most frequently at a rate of 39.7%. Again, diagnosis frequency was not consistent each month. In the Dominican Republic, there were 42 UTIs and 14 corresponding prescriptions written for those UTIs reported, however, data only reflected two months' worth of UTI diagnoses from May 2021 to May 2022. Fosfomycin was prescribed most frequently at a rate of 61.5%.  Conclusion: The findings above suggest that there are inconsistent UTI reports throughout the year with a varied use of antibiotics prescriptions for UTIs. The discovered discrepancies in disease reporting, or lack thereof of reporting, and prescription recommendation suggest inconsistent reporting in CREDO. In the future, focused education or revision on CREDO reporting and uniform coding practices could be implemented to reduce these inconsistencies.

Áreas geográficas con mayor concentración de accidentes de tránsito en San Salvador, El Salvador: un análisis espacial del periodo 2014-2018 / Geographic areas with the highest concentration of traffic accidents in San Salvador, El Salvador: a spatial analysis of the 2014-2018 period

RESUMEN Objetivo. Identificar las áreas de mayor concentración de accidentes de tránsito y lesionados en el Área Metropolitana de San Salvador (AMSS). Materiales y métodos. Los accidentes de tránsito se analizaron espacialmente mediante la ubicación puntual y por la sumatoria de eventos en áreas de 200 m2. La ubicación puntual se analizó mediante «análisis de vecinos más cercanos¼, mientras que las áreas con la sumatoria de accidentes de tránsito se analizaron mediante Gi* de Getis-Ord para obtener los puntos calientes. Los puntos calientes resultantes con mayor concentración de accidentes de tránsito en el AMSS se evaluaron en campo mediante un formulario de observación de las características de infraestructura y seguridad vial. Resultados. Al analizar 8191 accidentes de tránsito reportados entre 2014‒2018, se identificaron cinco áreas con mayor cantidad de accidentes de tránsito y lesionados, principalmente sobre vías primarias. Conclusión. Los sitios de mayor concentración de accidentes de tránsito y lesionados se caracterizan por una infraestructura vial con daños considerables y falta de sistemas de seguridad para conductores y peatones. El análisis espacial de los accidentes de tránsito y lesionados puede contribuir a mejorar la vigilancia y seguridad vial en el AMSS.

ABSTRACT Objective. This study aimed to identify the areas with the highest concentration of traffic accidents and injuries in the San Salvador Metropolitan Area (SSMA). Materials and methods. Traffic accidents were analyzed spatially by point location and by the sum of events in areas of 200 m2. The point location was analyzed by "nearest neighbor analysis", while the areas with the sum of traffic accidents were analyzed by Getis-Ord Gi* to obtain the hot spots. The resulting hot spots with the highest concentration of traffic accidents in the SSMA were evaluated in the field using an observation form to collect data on infrastructure and road safety characteristics. Results. Five areas with the highest number of traffic accidents and injuries, mainly containing primary roads, were identified by analyzing 8191 traffic accidents reported between 2014-2018. Conclusion. The sites with the highest concentration of traffic accidents and injuries were characterized by considerably damaged road infrastructure and the lack of safety systems for drivers and pedestrians. The spatial analysis of traffic accidents and injuries can contribute to improve surveillance and road safety in the SSMA.

Disasters in the Northern Triangle: A Descriptive Analysis Using the EM-DAT Database 1902-2022.

INTRODUCTION: Since 1902, disasters in the Northern Triangle of Central America, which consists of the countries Guatemala, Honduras, and El Salvador, have caused over one-hundred-thousand deaths, affected millions of people, and caused tens of billions of dollars in damages. Understanding the nature and frequency of these events will allow stakeholders to decrease both the acute damages and the long-term deleterious consequences of disasters. STUDY OBJECTIVE: This study provides a descriptive analysis of all disasters recorded in the Emergency Events Database (EM-DAT) affecting Guatemala, Honduras, and El Salvador from 1902-2022. METHODS: Data were collected and analyzed from the EM-DAT, which categorizes disasters by frequency, severity, financial cost, distribution by country, burden of death, number of people affected, financial cost by country, and type of disasters most prevalent in each country. Results are presented as absolute numbers and as a percentage of the overall disaster burden. These trends are then graphed over the time period of the database. RESULTS: The EM-DAT recorded 359 disasters in the Northern Triangle from 1902 through 2022. Meteorologic events (floods and storms) were the most common types of disaster (44%), followed by transport accidents (13%). Meteorologic events and earthquakes were the most severe, as measured by deaths (62%), people affected (60%), and financial cost (86%). Guatemala had the greatest number of disasters (45%), deaths (68%), and affected people (52%). The financial costs of the disasters were evenly distributed between the three countries. CONCLUSION: Meteorologic disasters are the most common and most severe type of disaster in the Northern Triangle. Earthquakes and transport accidents are also common. As climate change causes more severe storms in the region, disasters are likely to increase in severity as well. Governments and aid organizations should develop disaster preparedness and mitigation strategies to lessen the catastrophic effects of future disasters. Missing data limit the conclusions of this study to general trends.

Understanding Body Resistance in El Salvador: A Qualitative Discussion of a Pilot Program for Embodied Empowerment.

This article evaluates a Body Resistance Program in an urban area of El Salvador. The goal of this program is to facilitate women's reclamation of bodily autonomy and recognition of their shared struggle, thereby laying a foundation for solidarity and structural change around gendered body norms. As a pilot project with limited scope, a key objective is to identify meaningful concepts that address the goals, motivations, and worldviews of Salvadoran participants. This article provides insights into their understandings and experiences of trauma, resistance, and embodied empowerment.

Honey Production and Climate Change: Beekeepers' Perceptions, Farm Adaptation Strategies, and Information Needs.

Because climate change has severely impacted global bee populations by depleting their habitats and food sources, beekeepers must implement management practices to adapt to changing climates. However, beekeepers in El Salvador lack information about necessary climate change adaptation strategies. This study explored Salvadoran beekeepers' experiences adapting to climate change. The researchers used a phenomenological case study approach and conducted semi-structured interviews with nine Salvadoran beekeepers who were members of The Cooperative Association for Marketing, Production, Savings, and Credit of Beekeepers of Chalatenango (ACCOPIDECHA). The beekeepers perceived water and food scarcity, as well as extreme weather events (e.g., increasing temperature, rain, winds), as the leading climate change-induced challenges to their production. Such challenges have augmented their honey bees' physiological need for water, limited their movement patterns, decreased apiary safety, and increased the incidence of pests and diseases, all of which have led to honey bee mortality. The beekeepers shared adaptation strategies, including box modification, apiary relocation, and food supplementation. Although most beekeepers accessed climate change information using the internet, they struggled to understand and apply pertinent information unless they received it from trusted ACCOPIDECHA personnel. Salvadoran beekeepers require information and demonstrations to improve their climate change adaptation strategies and implement new ones to address the challenges they experience.

Population analysis of complete mitogenomes for 334 samples from El Salvador.

The use of mitochondrial DNA (mtDNA) in the field of forensic genetics is widely spread mainly due to its advantages when identifying highly degraded samples. In this sense, massive parallel sequencing has made the analysis of the whole mitogenome more accessible, noticeably increasing the informativeness of mtDNA haplotypes. The civil war (1980-1992) in El Salvador caused many deaths and disappearances (including children) all across the country and the economic and social instability after the war forced many people to emigration. For this reason, different organizations have collected DNA samples from relatives with the aim of identifying missing people. Thus, we present a dataset containing 334 complete mitogenomes from the Salvadoran general population. To the best of our knowledge, this is the first publication of a nationwide forensic-quality complete mitogenome database of any Latin American country. We found 293 different haplotypes, with a random match probability of 0.0041 and 26.6 mean pairwise differences, which is similar to other Latin American populations, and which represent a marked improvement from the values obtained with just control region sequences. These haplotypes belong to 54 different haplogroups, being 91% of them of Native American origin. Over a third (35.9%) of the individuals carried at least a heteroplasmic site (excluding length heteroplasmies). Ultimately, the present database aims to represent mtDNA haplotype diversity in the general Salvadoran populations as a basis for the identification of people that disappeared during or after the civil war.

[Information systems and regulatory documentation in El Salvador related to migration and healthSistemas de informação e documentação regulatória de El Salvador referentes a migração e saúde]. / Sistemas de información y documentación regulatoria de El Salvador referido a migración y salud.

Objective: Analyze, from the perspective of international health, data on migration and health contained in El Salvador's information systems and regulatory documentation. Method: The information and documentation systems of the Virtual Center for Regulatory Documentation of the Ministry of Health of El Salvador were reviewed in detail. Regulatory documentation on migration and health from the websites of the Central American Integration System (SICA), the Mesoamerican Initiative, and the Plan of the Alliance for Prosperity in the Northern Triangle was also studied. Results: None of the six information systems of the Ministry of Health of El Salvador captures either immigration status or access to and use of health services. Of the 52 national documents studied, 50 do not specify actions on migration and health. Conclusions: Not all the information systems provide data on access to and use of health services, nor information on pro-health behaviors or early warnings that are useful for decision-making by health authorities. The guidelines contained in the Salvadoran regulatory framework do not address actions related to migration and health.

Objetivo: Analisar os sistemas de informação e a documentação regulatória de El Salvador referentes a migração e saúde sob a perspectiva da saúde internacional. Método: Foi realizada uma análise detalhada dos sistemas de informação e da documentação contida no Centro Virtual de Documentação Regulatória do Ministério da Saúde de El Salvador. Além disso, foi realizada uma análise da documentação regulatória sobre migração e saúde contida nos sites do Sistema de Integração Centro-Americana (SICA), da Iniciativa Mesoamericana e do Plano da Aliança para a Prosperidade do Triângulo Norte. Resultados: Nenhum dos seis sistemas de informação do Ministério da Saúde de El Salvador captura a situação migratória e o acesso e uso dos serviços de saúde. Dos 52 documentos nacionais analisados, 50 não especificam ações relacionadas a migração e saúde. Conclusões: Nem todos os sistemas de informação registram o acesso aos serviços de saúde e seu uso, comportamentos favoráveis à saúde ou alertas precoces, dados que são úteis para a tomada de decisões pelas autoridades de saúde. As diretrizes do marco regulatório salvadorenho não abordam ações relacionadas à migração e à saúde.

A Psychometric Analysis of the Spanish Version of the Grief Impairment Scale: A Screening Tool of Biopsychosocial Grief-Related Functional Impairment in a Salvadoran Sample.

The objective of this study was to translate and psychometrically evaluate a Spanish version of the Grief Impairment Scale (GIS) using a sample of bereaved adults from El Salvador (N = 579). The results confirm the unidimensional structure of the GIS, and solid reliability, item characteristics, and criterion-related validity, where the GIS scale significantly and positively predicts depression. However, this instrument only showed evidence of configural and metric invariance between different sex groups. Overall, these results support the Spanish version of the GIS as a psychometrically sound screening tool for health professionals and researchers to use in their clinical work.

Boletin Epidemiologico Semana 20/2023 (del 14 al 20 de mayo de 2023) / Epidemiological Bulletin Week 20/2023 (from May 14 to 20, 2023)

Resumen de eventos de notificación hasta SE 20/2023. Alertas internacionales. Situación epidemiológica de dengue. Situación epidemiológica de zika y chikungunya. Situación epidemiológica de Infección respiratoria aguda. Situación epidemiológica de Neumonías. Vigilancia centinela de influenza y otros virus respiratorios. Vigilancia centinela de rotavirus. Situación epidemiológica de Enfermedad diarreica aguda

Summary of notification events up to SE 20/2023. International alerts. Epidemiological situation of dengue. Zika and chikungunya epidemiological situation. Epidemiological situation of acute respiratory infection. Epidemiological situation of pneumonias. Sentinel surveillance of influenza and other respiratory viruses. Rotavirus sentinel surveillance. Epidemiological situation of acute diarrheal disease

Chagas Disease Maternal Seroprevalence and Maternal-Fetal Health Outcomes in a Parturition Cohort in Western El Salvador.

Congenital Chagas disease is a growing concern, prioritized by the World Health Organization for public health action. El Salvador is home to some of the highest Chagas disease (Trypanosoma cruzi infection) burdens in the Americas, yet pregnancy screening remains neglected. This pilot investigation performed a maternal T. cruzi surveillance study in Western El Salvador among women presenting for labor and delivery. From 198 consented and enrolled pregnant women, 6% were T. cruzi positive by serology or molecular diagnosis. Half of the infants born to T. cruzi-positive women were admitted to the NICU for neonatal complications. Geospatial statistical clustering of cases was noted in the municipality of Jujutla. Older women and those knowing an infected relative or close friend were significantly more likely to test positive for T. cruzi infection at the time of parturition. In closing, maternal T. cruzi infections were significantly higher than national HIV or syphilis maternal rates, creating an urgent need to add T. cruzi to mandatory pregnancy screening programs.

Explorando el sistema de protección de la niñez en El Salvador

(analítico) Se exploran las prácticas institucionales que facilitan u obstaculizan la protección de los derechos de niños, niñas y adolescentes en el sistema de protección de la niñez en El Salvador. Partiendo de un diseño de etnografía institucional, se realizaron 61 entrevistas a trabajadores pertenecientes al sistema de protección. Como resultado, se identificó la ausencia de manuales que establezcan prácticas concretas en la aplicación de la Ley de Protección Integral de la Niñez y Adolescencia, obstruyendo su óptimo funcionamiento. A través del uso de la teoría del interaccionismo simbólico, se explora cómo la interpretación discrecional o no entendimiento de la ley forma instituciones aisladas del sistema; también se analiza el grado en que las dinámicas socioeconómicas del país ponen en desventaja a los sectores rurales para acceder a estos servicios.

(analytical) This study explores the institutional practices that support or hinder the rights of children and young people in the child protection system in El Salvador. Using an institutional ethnography approach, 61 individuals who worked directly or indirectly in the child protection system were interviewed. The findings highlight a lack of manuals that establish concrete practices in accordance with the application of the Law of Comprehensive Protection for Children and Youth, which reduces the effectiveness of the country's child protection system. Through an analytical approach based on symbolic interactionism, this study explored how the individual interpretations of the law, or lack thereof, combine with socioeconomic disadvantages to create difficulties for rural child protection institutions in terms of accessing operational resources.

(analítico) O presente estudo explora as práticas institucionais que apoiam ou dificultam os direitos de crianças e jovens no sistema de proteção infantil em El Salvador. Utilizando um desenho de etnografia institucional, foram entrevistados 61 indivíduos que trabalhavam ou trabalham no sistema de proteção à criança. Os achados indicam que faltam manuais que estabeleçam práticas concretas em consonância com a aplicação da Lei de Proteção Integral da Infância e Juventude o que dificulta a efetividade do sistema de proteção. Por meio de um entendimento baseado no interacionismo simbólico, este estudo explorou como as interpretações individuais da lei, ou a falta dela, e a desvantagem socio-econômica das instituições colocam os setores rurais em desvantagem no acesso aos recursos.

Sexual and reproductive health of migrant women and girls from the Northern Triangle of Central America.

Objective: To understand the sexual and reproductive health (SRH) experiences of migrant women and girls of reproductive age (15-49 years) from the Northern Triangle of Central America (El Salvador, Guatemala and Honduras) during their journey to the United States. Methods: A descriptive, qualitative research design included 39 in-depth interviews with migrant women and unaccompanied migrant girls from El Salvador, Guatemala and Honduras from January to June 2022. Participants were recruited using purposive sampling. Interviews were transcribed, coded and analyzed using thematic analysis. Results: Migrant women and girls lack information and resources to manage their SRH during migration. The SRH of those traveling with smugglers is compromised due to their limited access to menstrual pads, water and sanitation services; the risks of transactional sex and sexual violence; the high risk of sexually transmitted infections; the inability to report sexual violence; the lack of access to SRH and prenatal services; and limited knowledge about their sexual and reproductive rights. Conclusions: There is a significant need for improved interventions during the predeparture phase of migration to inform migrant women and girls about the SRH risks they may encounter and to provide information and resources to support their SRH throughout their journey. Special attention should be directed towards trying to reach girls and women who will travel with smugglers.

Characterizing the implementation of performance management interventions in a primary health care system: a case study of the Salud Mesoamerica Initiative in El Salvador.

Performance management (PM) reforms have been introduced in health systems worldwide to improve accountability, transparency and learning. However, gaps in evidence exist regarding the ways in which PM contributes to organizational-level outcomes. Between 2015 and 2017, the government of El Salvador and the Salud Mesoamerica Initiative (SMI) introduced team-based PM interventions in the country's primary health care (PHC) system including target setting, performance measurement, provision of feedback and in-kind incentives. The programme's evaluation showed widespread improvements in performance for community outreach and service timeliness, quality and utilization. The current study characterizes how the implementation of team-based PM interventions by SMI implementers contributed to PHC system performance improvements. We used a descriptive, single-case study design informed by a programme theory (PT). Data sources included qualitative in-depth interviews and SMI programme documents. We interviewed the members of four PHC teams (n = 13), Ministry of Health (MOH) decision makers (n = 8) and SMI officials (n = 6). Coded data were summarized, and thematic analysis was employed to identify broader categories and patterns. The outcomes chain in the PT was refined based on empirical findings that revealed the convergence of two processes: (1) increased social interactions and relationships among implementers that enhanced communication and created opportunities for social learning and (2) cyclical performance monitoring that generated novel flows of information. These processes contributed to emergent outcomes including the uptake of performance information, altruistic behaviours in service delivery and organizational learning. Through time, the cyclical nature of PM appears to have led to the spread of these behaviours beyond the teams studied here, thus contributing to system-wide effects. Findings illustrate the social nature of implementation processes and describe plausible pathways through which lower-order implementation programme effects can contribute to higher-order changes in system performance.

Maternal morbidity under an absolute abortion ban: insights from a 6-year case series of fatal fetal malformations in El Salvador.

BACKGROUND: A striking number of national and subnational governments that previously allowed legal abortion in cases of severe fetal anomaly have passed new legislation to explicitly remove these allowances. However, we know little about the maternal health implications of such restrictions. OBJECTIVE: This study aimed to examine the health outcomes of pregnant individuals in El Salvador whose fetuses were diagnosed with a fatal congenital malformation and who were legally required to carry these nonviable pregnancies to term under the nation's absolute abortion ban. STUDY DESIGN: We reviewed the charts of all 239 pregnancies with fetuses classified as having 1 of 18 congenital malformations typically considered to be incompatible with extrauterine life that were evaluated at the National Women's Hospital in El Salvador between January 1, 2013 and December 31, 2018. Because regional healthcare providers who identify pregnancy complications in El Salvador are instructed to refer those patients to the National Women's Hospital, our analysis captured the total population of lethal fetal malformations treated by the national public health system. We documented pregnant patients' socioeconomic characteristics, pregnancy-related complications, and the medical procedures used to mitigate complications. RESULTS: Individuals who were required to carry pregnancies with severe fetal malformations to term (or until preterm labor began naturally) experienced high rates of maternal morbidity. More than half (54.9%) of pregnancies experienced at least 1 serious pregnancy-related health complication, whereas 47.9% underwent a physically-invasive medical procedure to manage complications, including cesarean deliveries, decompression amniocenteses, fetal head decompressions, and, in 1 case, a full hysterectomy. A total of 9% of patients opted to discontinue care after receiving the diagnosis of fatal fetal malformation. We also found striking variation in how physicians managed pregnancies with fatal fetal malformations, suggesting that different interpretations of the law lead to inequities in individual-level patient care. CONCLUSION: Laws prohibiting abortions in cases of severe fetal malformation can increase risks to pregnant patients by requiring clinicians to subject healthy patients to a course of treatment that generates morbidity.

Gangs, violence, and fear: punitive Darwinism in El Salvador.

This article evaluates the factors impacting support for tough on crime policies in El Salvador. Examining theoretical and empirical scholarly work, we look at how fear, together with social and political contexts drive public appetite for punitive policies towards criminals. We show that President Nayib Bukele is responding to public opinion and has implemented tough on crime policies at the expense of human rights violations and democratic institutions. Society favors candidates who are the "toughest" against criminal actors. Political candidates from all sides of the ideological spectrum tap into the fear of the populace to win votes, leading to punitive Darwinism. We provide an empirical assessment of which theoretically relevant factors are statistically associated with punitivism in the Salvadoran context, using multiple regression analysis of high-quality public opinion survey data from LAPOP.