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1.
Infectio ; 25(4): 256-261, oct.-dic. 2021. tab, graf
Artículo en Español | LILACS, COLNAL | ID: biblio-1286719

RESUMEN

Resumen Objetivo: Determinar los factores de riesgo en adultos con COVID-19 en población rural andina durante 2020. Métodos: En este estudio de cohorte retrospectivo multicéntrico, incluimos a 184 pacientes adultos (≥18 años) con pruebas serológicas y moleculares para CO VID-19 de tres hospitales de la sierra peruana (Ancash y Apurímac) incluidos con sospecha clínica entre abril y junio. Se utilizó análisis descriptivos y regresión logística univariable para explorar los factores de riesgo asociados a los pacientes con COVID-19. Resultados: Del total de pacientes, 14 (7.6%) tuvieron SARS-CoV-2. En los pacientes infectados 12 (85.7%) fueron varones con promedio de edad de 47.3±21 años. Las comorbilidades estuvieron presentes en cerca de la tercera parte de pacientes, siendo la hipertensión y diabetes las más frecuentes (ambas 14.3%), y la sinto matología más frecuentes fueron fiebre y cefalea (57.2%). La regresión univariable mostró mayores probabilidades de infección con SARS-CoV-2 en la población rural andina asociada con la edad avanzada (OR: 1.1 IC95% 0.7-1.8; p=0,019), comorbilidades previas (OR: 1.7, IC95% 0.32-9.39; p=0,006), y sintomatología previa (OR: 49.8, IC95% 5.6-436.9; p=0,0011). Conclusiones: Los posibles factores de riesgo como la edad avanzada, las comorbilidades y sintomatología previas están relacionados con el desarrollo de CO VID-19 en población rural andina de Perú.


Abstract Objective: To determine the risk factors in adults with COVID-19 in the rural Andean population during 2020. Methods: This multicenter retrospective cohort study included 184 adult patients (≥18 years) with COVID-19's serological and molecular tests from three Hospitals in the Peruvian mountains (Ancash and Apurímac) included with clinical suspicion between April and June. Descriptive analysis and univariate logistic regression were used to explore the risk factors associated with patients with COVID-19. Results: Of total of patients, 14 (7.6%) had a SARS-CoV-2. In infected patients 12 (85.7%) were men with an average age of 47.3±21 years. Comorbidities were present in about a third of patients, with hypertension and diabetes being the most frequent (both 14.3%), and the most frequent symptoms were fever and hea dache (57.2%). Univariate regression showed higher probabilities of infection with SARS-CoV-2 in the rural Andean population associated with advanced age (OR: 1.1 95% CI 0.7 - 1.8; p = 0.019), previous comorbidities (OR: 1.7, 95%CI 0.32 - 9.39; p = 0.006), and previous symptoms (OR: 49.8, 95%CI 5.6 - 436.9; p = 0.0011). Conclusions: Possible risk factors such as advanced age, comorbidities and previous symptoms are related to the development of COVID-19 in the rural Andean population of Peru.


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , COVID-19 , Perú , Población Rural , Factores de Riesgo , Estudios de Cohortes , SARS-CoV-2 , Cefalea , Hospitales , Hipertensión , Infecciones
2.
Rev Paul Pediatr ; 40: e2020385, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-34614137

RESUMEN

OBJECTIVE: This study aims to analyze the effects of social isolation on children's and teenagers' development, with emphasis on the possible impacts over their physical and mental health. DATA SOURCE: Review of the literature following the standards of PRISMA using the SciELO, LILACS and PubMed databases. The following key-words were used: "social isolation" and "child development", "quarantine" and "adolescent development" according to the Medical Subject Headings (MESH) and their translation to the Portuguese. Studies in English, Portuguese and Spanish from inception were included. DATA SYNTHESIS: 519 studies were screened and 12 were included in the systematic review. Five of those focused the psychology and social issues, two of them the effects of pandemics on these issues; four studies reported on impacts on general health and two consequences over the hypothalamus- hypophysis - adrenal axis and the cognitive and social development. CONCLUSIONS: The review shows a strong association between social isolation and anxiety and depression in children and adolescents. Social isolation leads to higher levels of cortisol and worse cognitive development. Therefore, the mental and physical health of children and adolescents need a careful follow up by health professionals during and after the COVID-19 pandemic.


Asunto(s)
Conducta del Adolescente/psicología , Desarrollo del Adolescente , COVID-19/psicología , Conducta Infantil/psicología , Desarrollo Infantil , Aislamiento Social/psicología , Adolescente , Niño , Humanos , Salud Mental/estadística & datos numéricos , Cambio Social
3.
BMC Public Health ; 21(1): 1608, 2021 09 02.
Artículo en Inglés | MEDLINE | ID: mdl-34470632

RESUMEN

BACKGROUND AND AIM: According to the United Nations' Sustainable Development Goal (SDG) target 3.4, premature mortality from four non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes mellitus, collectively referred to as NCD4) should achieve a minimum decline of 33% in 2030 relative to 2015. This remains a challenge for China. This study aimed to evaluate the current status and progress towards this target in Liaoning Province, one of the three provinces in northeast China. METHODS: We calculated the premature mortality rates (PMRs) per year and average annual percentage changes (AAPCs) from NCD4 using mortality data between 2004 and 2017. The trend was analyzed in the whole population, as well as in subpopulations of gender (male/female) and inhabiting area (urban/rural). PMRs from NCD4 for 2030 were projected by fitting a linear regression based on the current trend, which was identified by a Joinpoint model. FINDINGS: In the whole population, only chronic respiratory diseases showed a significant decline (AAPC: - 6.5%, p < 0.05), while only cancer showed a significant increase (AAPC: + 1.3%, p < 0.05); taken together, NCD4 showed a significant increase (AAPC: + 0.6%, p < 0.05). In the subpopulations, while males showed a significant increase in NCD4 (AAPC: + 1.5%, p < 0.05), cardiovascular diseases (AAPC: + 1.7%, p < 0.05), cancer (AAPC: + 1.8%, p < 0.05), and diabetes mellitus (AAPC: + 4.2%, p < 0.05), females showed a significant decline in NCD4 (AAPC: - 1.2%, p < 0.05), cardiovascular diseases (AAPC: - 1.8%, p < 0.05), diabetes mellitus (AAPC: - 2.1%, p < 0.05), but showed a mild increase in cancer (AAPC: + 0.5%, p > 0.05). A comparative analysis of the projected PMRs for 2030 with the 2015 levels revealed that only chronic respiratory diseases are expected to achieve the SDG target 3.4, apart from in the urban male subpopulation. CONCLUSION: Except for chronic respiratory diseases, NCD4 cannot be expected to achieve the SDG target 3.4 in the whole population of Liaoning Province. Under these circumstances, special attention should be paid to reducing the risks of cancer and providing preventative interventions for men.


Asunto(s)
Enfermedades no Transmisibles , Desarrollo Sostenible , China/epidemiología , Femenino , Objetivos , Humanos , Masculino , Mortalidad Prematura , Enfermedades no Transmisibles/epidemiología
4.
N Engl J Med ; 385(11): 982-995, 2021 09 09.
Artículo en Inglés | MEDLINE | ID: mdl-34496174

RESUMEN

BACKGROUND: Universal provision of iron supplements (drops or syrup) or multiple micronutrient powders to young children in low-to-middle-income countries where anemia is prevalent is recommended by the World Health Organization and widely implemented. The functional benefits and safety of these interventions are unclear. METHODS: We conducted a three-group, double-blind, double-dummy, individually randomized, placebo-controlled trial to assess the immediate and medium-term benefits and risks of 3 months of daily supplementation with iron syrup or iron-containing multiple micronutrient powders, as compared with placebo, in 8-month-old children in rural Bangladesh. The primary outcome was cognitive development, as assessed by the cognitive composite score on the Bayley Scales of Infant and Toddler Development, third edition, immediately after completion of the assigned 3-month regimen; scores range from 55 to 145, with higher scores indicating better cognitive performance. Secondary outcomes included the cognitive composite score at 9 months after completion of the assigned regimen; behavioral, language, and motor development, as well as growth and hematologic markers, immediately after completion and at 9 months after completion; and safety. RESULTS: We randomly assigned 3300 infants to receive iron syrup (1101 infants), multiple micronutrient powders (1099), or placebo (1100) daily. After completion of the assigned 3-month regimen, no apparent effect on the cognitive composite score was observed with iron syrup as compared with placebo (mean between-group difference in change in score from baseline, -0.30 points; 95% confidence interval [CI], -1.08 to 0.48) or with multiple micronutrient powders as compared with placebo (mean between-group difference in change in score from baseline, 0.23 points; 95% CI, -0.55 to 1.00). No apparent effect on any other developmental or growth outcome was observed immediately after completion of the assigned regimen or at 9 months after completion. At 9 months after completion of the assigned regimen, the prevalences of anemia, iron deficiency, and iron deficiency anemia increased in all three trial groups but remained lower among the children who received iron syrup or multiple micronutrient powders than among those who received placebo. The risk of serious adverse events and incidence of symptoms of infection were similar in the three trial groups. CONCLUSIONS: In this trial involving infants in Bangladesh, 3 months of daily supplementation with iron syrup or multiple micronutrient powders did not appear to have an effect on child development or other functional outcomes as compared with placebo. (Funded by the National Health and Medical Research Council of Australia; BRISC Australian New Zealand Clinical Trials Registry number, ACTRN12617000660381.).


Asunto(s)
Anemia Ferropénica/tratamiento farmacológico , Desarrollo Infantil/efectos de los fármacos , Suplementos Dietéticos , Micronutrientes/uso terapéutico , Anemia Ferropénica/prevención & control , Bangladesh , Cognición/efectos de los fármacos , Método Doble Ciego , Femenino , Hemoglobinas/análisis , Humanos , Lactante , Desarrollo del Lenguaje , Masculino , Población Rural
5.
Rev Sci Tech ; 40(2): 483-495, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34542101

RESUMEN

Animal health services play an essential role in supporting livestock production, with the potential to address the challenges of hunger, poverty, health, social justice and environmental health as part of the path towards the Sustainable Development Goal (SDG) defined in the United Nations, 2030 Agenda. However, the provision of animal health services remains chronically underfunded. Although the aspiration that â€Ëœno one will be left behind' is core to the SDG agenda, animal health service provision still fails to meet the basic needs of many of the poorest livestock owners. This review draws largely on experience from Tanzania and highlights the obstacles to equitable provision of animal health services, as well as identifying opportunities for improvement. Delivery models that rely on owners paying for services, whether through the private sector or public?private partnerships, can be effective for diseases that are of clear economic importance to animal keepers, particularly in more market-orientated production systems, but are currently constrained by issues of access, affordability, availability and quality. Substantial challenges remain when attempting to control diseases that exert a major burden on animal or human health but are less well recognised, as well as in the delivery of veterinary public health or other public good interventions. Here, the authors propose solutions that focus on: improving awareness of the potential for animal health services to address the SDGs, particularly those concerning public and environmental health; linking this more explicitly with advocacy for increased investment; ensuring that the voices of stakeholders are heard, particularly those of the rural poor; and embracing a cross-cutting and expanded vision for animal health services to support more adaptive development of livestock systems.


Asunto(s)
Sector Privado , Salud Pública , Animales , Ganado , Evaluación de Resultado en la Atención de Salud , Desarrollo Sostenible
6.
BMC Health Serv Res ; 21(1): 966, 2021 Sep 14.
Artículo en Inglés | MEDLINE | ID: mdl-34521388

RESUMEN

BACKGROUND: This research analyzed the Sixth Five-Year Economic, Social, and Cultural Development Plan of the Islamic Republic of Iran (6NPD) to shed light on how the plan addresses the Universal Health Coverage (UHC). METHODS: This research was a qualitative study. We systematically analyzed 'Secs. 14 -Health, Insurance, Health & Women, and Family' in the 6NPD. Through a content analysis, we converted this section into meaning units and coded them. Coding was guided through the conceptual framework 'Six Building Blocks of Health System' and the key principles of UHC. RESULTS: Six themes and twenty-one subthemes were identified. The subthemes of financing include a fair and secured process of resource pooling, payment methods, revenue generation for the health sector, and a definition of a basic benefits package. The subthemes of governance and leadership consist of social insurance policies' integration, compliance of providers, a designation of the Ministry of Health and Medical Education (MoHME) as the regulator and the steward of health resources, a payer-provider split, and stakeholders' participation. The subthemes of health workforce emphasizes balancing the quality and quantity of the health workforce with populations' health needs and the health system's requirements. The subthemes of health information systems consist of the electronic health records for Iranians, information systems for organization and delivery functions, and information systems for the financing function. The subthemes of the organization and delivery consider improving effectiveness and efficiency of healthcare delivery, strengthening the family physician program and referral system, and extending the pre-hospital emergency system. Lastly, access to medicine focuses on the design and implementation of an essential drug list and drug systems for approving the coverage and provision of generic medicine. CONCLUSIONS: The 6NPD introduced policies for strengthening the 6 building blocks of the health system. It introduced policies to improve financing particularly resource pooling and the sustainability of financial resources. As mandated by 6NPD, centering the health system's governance/leadership in MoHME may exacerbate the existing conflict of interests and provoke various arguments, which impede the enforcement of rules and regulation. The 6NPD is a step forward in terms of improving financial protection, yet several other policies need to be made to adequately meet the requirement of UHC regarding equity and effective coverage.


Asunto(s)
Atención a la Salud , Cobertura Universal del Seguro de Salud , Femenino , Humanos , Seguro de Salud , Irán , Planificación Social
7.
Artículo en Inglés | MEDLINE | ID: mdl-34574575

RESUMEN

Safe water and sanitation, which give rise to appropriate hygiene, are fundamental determinants of individual and social health and well-being. Thereby, assessing and widening access to sustainable, durable water and sanitation infrastructure remains a global health issue. Rural areas are already at a disadvantage. Poor access to water, sanitation, and hygiene (WASH) can have a major negative effect on students in rural schools. Thus, the paper aims to assess the current condition and the challenge to access WASH in rural Kazakh schools. The study was conducted in three rural schools in Central Kazakhstan. Data were gathered through a survey among pupils, observations of the WASH infrastructure and maintenance, and a face-to-face interview with school administrators. The mean survey response rate was 65% across schools. Results indicated there was no alternative drinking-water source in schools, and 15% of students said they had access to water only occasionally. Half of the students reported that the water was unsafe to drink because of a poor odor, taste, or color. The toilet in school 3 was locked with a key, and a quarter of the students reported there was no access to a key. Moreover, not having gender-separated toilet facilities was a challenge because of the traditional gender norms. Despite the effective regulations and measures of handwashing taken during COVID-19, 27.7% of the students answered that soap was not offered daily in classrooms. Additionally, warm water was only provided in school 2. About 75% of students did not have access to drying materials continuously. The study shows that having the schools' infrastructure is not enough when characteristics, such as availability, accessibility, maintenance, operation, quality of services, education, and practices, are ignored. Cooperation between local education authorities, school administration, and parents should be encouraged to the achievement of the sustainable development goals (SDGs) by 2030.


Asunto(s)
COVID-19 , Agua Potable , Países en Desarrollo , Humanos , Higiene , Kazajstán , SARS-CoV-2 , Saneamiento , Instituciones Académicas , Abastecimiento de Agua
8.
Reprod Health ; 18(1): 186, 2021 Sep 20.
Artículo en Inglés | MEDLINE | ID: mdl-34544444

RESUMEN

BACKGROUND: Reduction in ideal number of children has been suggested as a necessary precursor for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the social contexts of fertility desires by documenting the effects of individual, household as well as contextual characteristics among young men and women in Nigeria. METHODS: Data source was the male and female recode file of 2018 Nigeria Demographic and Health Survey. Analytical sample comprised 2674 males and 9637 females aged 15-24 years. The main outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Analysis involved use of descriptive statistics and random-effect logit models fitted in four stages. RESULTS: DLFS was 71% among young men and 53% in women. Individual-level factors associated with DLFS among men includes Islam religion (OR = 3.95, CI 2.68-5.83), household size (OR = 1.05) and richer (OR = 0.47, CI 0.29-0.75) or richest wealth index (OR = 0.28, CI 0.16-0.75). Geo-political region and high level of negative attitude to family planning (OR = 1.72, CI 1.23-2.40) were the main contextual factors associated with DLFS. For women, individual-level correlates were education, religion, ethnicity, marital status, household size, and wealth index. Contextual factors include geo-political region, community education (OR = 0.68, CI 0.52-0.89), child mortality experience (OR = 1.29, CI 1.11-1.51) and negative attitude to family planning (OR = 1.36, CI 1.13-1.65). The influence of religion, household wealth and attitude to family planning differ between young men and women. CONCLUSION: Active communication and programmatic interventions are needed so that desire for large family size by young men and women do not become a clog for fertility transition in Nigeria.


Asunto(s)
Servicios de Planificación Familiar , Fertilidad , Países en Desarrollo , Composición Familiar , Femenino , Humanos , Masculino , Nigeria , Dinámica Poblacional , Medio Social , Factores Socioeconómicos
9.
BMJ Open ; 11(9): e053871, 2021 09 24.
Artículo en Inglés | MEDLINE | ID: mdl-34561263

RESUMEN

INTRODUCTION: COVID-19 has significantly affected community health workers' (CHWs) performance as they are expected to perform pandemic-related tasks along with routine essential healthcare services. A plausible way to optimise CHWs' functioning during this pandemic is to couple the efforts of CHWs with digital tools. So far, no systematic evidence is available on the use of digital health interventions to support CHWs in low-middle-income countries (LMICs) amid the COVID-19 pandemic. The article describes a protocol for a scoping review of primary research studies that aim to map evidence on the use of unique digital health interventions to support CHWs during COVID-19 in LMICs. METHODS AND ANALYSIS: Our methodology has been adapted from scoping review guidelines provided by Arksey and O'Malley, Levac et al. and the Joanna Briggs Institute. Our search strategy has been developed for the following four main electronic databases: Excerpta Medica Database, Medical Literature Analysis and Retrieval System Online, Cochrane Central Register of Controlled Trials and Cumulated Index to Nursing and Allied Health Literature. Google Scholar and reference tracking will be used for supplementary searches. Each article will be screened against eligibility criteria by two independent researchers at the title and abstract and full-text level. The review will include studies that targeted digital health interventions at CHWs' level to provide support in delivering COVID-19-related and other essential healthcare services. A date limit of 31 December 2019 to the present date will be placed on the search and English language articles will be included. ETHICS AND DISSEMINATION: Formal ethical approval is not required, as primary data will not be collected in this study. The results from our scoping review will provide valuable insight into the use of digital health interventions to optimise CHWs' functioning and will reveal current knowledge gaps in research. The results will be disseminated through journal publications and conference presentations.


Asunto(s)
COVID-19 , Países en Desarrollo , Agentes Comunitarios de Salud , Humanos , Pandemias/prevención & control , Proyectos de Investigación , Literatura de Revisión como Asunto , SARS-CoV-2
10.
Cad Saude Publica ; 37(8): e00247820, 2021.
Artículo en Portugués | MEDLINE | ID: mdl-34495095

RESUMEN

The article aims to analyze the work process for community health agents (ACS in Portuguese) in remote rural municipalities (counties) and identify specificities and contributions to primary healthcare. The qualitative study included 23 interviews with ACS and nurses in the family health teams in five remote rural counties in western Pará State, Brazil. Analysis of the work process for ACS covered two interconnected dimensions: scope of practices and qualification for the work. The scope of practices proved to be comprehensive, involving family follow-up, individual care and preventive measures, collective approach, and administrative activities. Home visits are the main activity by ACS and an important form of contact between health services and the clientele, meeting different objectives of enrollment, care, and information. ACS in remote rural communities, usually the only available health resource, display a broader scope of practices than in the municipal seats, including individual procedures. The qualification of ACS for the work can either enhance or limit the development of their practices and was expressed by the high motivation of the ACS, insufficient supervision and continuing education, and low integration with the larger health team. Policies are needed that acknowledge the specificities and guarantee greater support (materials, transportation, and continuing education) for full development of work by ACS in remote rural communities in the Amazon. The expanded set of practices by ACS suggests that they are relevant actors for providing care, facilitating the population's access to the healthcare network, and as a real link between rural populations and health services in remote rural communities.


Asunto(s)
Servicios de Salud Rural , Población Rural , Brasil , Recursos en Salud , Humanos , Atención Primaria de Salud , Salud Pública
11.
J Med Microbiol ; 70(9)2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34486973

RESUMEN

Introduction. Prototheca species are non-photosynthetic trebouxiophyte algae ubiquitously distributed in nature and can be found in sewage and soil. This microbial eukaryote causes human protothecosis in immunocompromised individuals. Thus, Prototheca presence in the stool of individuals without gastrointestinal symptoms has been reported only rarely.Hypothesis/Gap statement. There is an absence of detailed characterization of human Prototheca isolates.Aim. The aim of this study was to perform morphological and molecular characterization of Prototheca isolates obtained from human stool.Methodology. Prototheca was isolated from faecal samples of four individuals living in a rural area in Thailand. A combination of bioimaging along with molecular and bioinformatics tools was used to characterize the four strains. The growth rate was tested using four media and three temperature conditions. Phylogenetic analysis using the small subunit ribosomal RNA (SSU rRNA) and cytochrome b (cytb) was also performed.Results. Static and live microscopy demonstrated the various life stages of Prototheca and its major defining cellular characteristics. An optimized DNA extraction methodology that improves DNA yield is provided. Partial fragments of the SSU rRNA and cytb genes were obtained. Phylogenetic analysis placed all four strains in the clade with Prototheca bovis. More broadly, Prototheca was not monophyletic but split into at least two distinct clades instead.Conclusion. The results represent the first molecular characterization of Prototheca in Thailand. The study provides insight into transmission dynamics of the organism and potential caveats in estimating the global prevalence of Prototheca. These will spearhead further investigations on Prototheca occurrence in rural areas of both industrialized and developing nations.


Asunto(s)
Heces/microbiología , Microbioma Gastrointestinal , Prototheca , Voluntarios Sanos , Humanos , Prototheca/clasificación , Prototheca/crecimiento & desarrollo , Prototheca/aislamiento & purificación , Población Rural , Tailandia
12.
J Environ Manage ; 300: 113706, 2021 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-34521001

RESUMEN

Rural problems are becoming increasingly prominent in sustainable development in China. Landscape services (LSs) are an emerging concept associated with ecosystem services and play an important role in promoting sustainable development. However, a comprehensive framework of rural LS and empirical research are still lacking. Here, we proposed a rural LSs system based on its multiple functions of "ecological maintenance, agricultural production and human living", including 9 LS types. Combined with the impact of landscape pattern on LSs, we optimized the assessment method of LS, and the LS capabilities were assessed at the village scale in Hangzhou city. Furthermore, we identified the spatial differentiation of rural LSs capabilities and trade-offs/synergies along urban-rural and terrain gradients. The results showed that the LSs capabilities of the rural landscape were greatly affected by the urban radiation and terrain, and we found that the turning point of LSs capabilities was 35 km from the urban fringe and the terrain gradient T5. The LSs in most villages (77%) revealed trade-offs, and the villages with LS synergies largely occurred in the middle and eastern regions of the study area. This study could improve our current understanding of LSs in regard to sustainable rural development, and identifying the trade-offs/synergies of LSs in a spatially explicit way can provide suggestions for the differentiated management of rural landscape sustainability.


Asunto(s)
Ecosistema , Desarrollo Sostenible , Agricultura , Conservación de los Recursos Naturales , Humanos , Planificación Social
13.
Artículo en Inglés | MEDLINE | ID: mdl-34444085

RESUMEN

Based on an analysis of the life trajectories of 2510 conscripts and their families from a Spanish rural area in the period 1835-1977, this paper studies the development of the fertility transition in relation to height using bivariate analyses. The use of heights is an innovative perspective of delving into the fertility transition and social transformation entailed. The results confirm that the men with a low level of biological well-being (related to low socio-economic groups) were those who started to control their fertility, perhaps due to the effect that increased average family size had on their budget. The children of individuals who controlled their fertility were taller than the children of other families. Therefore, the children of parents who controlled their fertility experienced the largest intergenerational increase in height (approximately 50% higher). This increase could be due to the consequence of a greater investment in children (Becker's hypothesis) or a greater availability of resources for the whole family (resource dilution hypothesis).


Asunto(s)
Economía , Fertilidad , Niño , Demografía , Países en Desarrollo , Humanos , Masculino , Dinámica Poblacional , Factores Socioeconómicos , España
14.
Artículo en Inglés | MEDLINE | ID: mdl-34444063

RESUMEN

A systematic review of published literature (2000-2019) evaluating the impact of sanitation interventions on the prevalence of disease, parasite infestation, and/or child growth using randomized controlled trials (RCTs) was done according to the PRISMA checklist. Earlier reviews indicated mixed evidence citing relatively poor quality evidence from mixed designs. Public health policy and practice appear to rely on evidence from RCTs. Records were searched in six electronic databases. The methodological quality of RCTs was assessed using the Cochrane collaboration risk of bias tool. Fifteen records (2.0%) were included for review. Impact trials were done in rural communities of African and Asian countries. The significant effect of sanitation-focus interventions was found in one trial for the prevalence of childhood diarrhea (14.3%), three trials for parasite infestation (37.5%), and two trials (25.0%) for child growth. Results indicate mixed quality evidence from RCT designs. Evidence is limited and suggestive of the impact of sanitation on parasite infestation and child growth. Further rigorous sanitation intervention trials under varying settings are needed to show what really works and under what settings. Future work may explore sanitation behavior change strategies and latrine options to address the challenges of poor latrine use under high sanitation coverage.


Asunto(s)
Población Rural , Saneamiento , Niño , Países en Desarrollo , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Cuartos de Baño
15.
BMJ Open ; 11(8): e047779, 2021 08 19.
Artículo en Inglés | MEDLINE | ID: mdl-34413102

RESUMEN

OBJECTIVES: Latin America and the Caribbean (LAC) countries have made important progress towards achieving the Sustainable Development Goal (SDG) targets related to health (SDG3) at the national level. However, vast within-country health inequalities remain. We present a baseline of health inequalities in the region, against which progress towards the SDGs can be monitored. SETTING: We studied 21 countries in LAC using data from Demographic and Health Surveys and Multiple Indicator Cluster Survey carried out from 2011 to 2016 PARTICIPANTS: The surveys collect nationally representative data on women and children using multistage sampling. In total, 288 207 women and 195 092 children made part of the surveys in the 21 countries. OUTCOME MEASURES: Five health intervention indicators were studied, related to reproductive and maternal health, along with adolescent fertility and neonatal and under-five mortality rates. Inequalities in these indicators were assessed through absolute and relative measures. RESULTS: In most countries, subnational geographical health gradients were observed for nearly all women, child, and adolescent (WCA) indicators. Coverage of key interventions was higher in urban areas and among the richest, compared with rural areas and poorer quintiles. Analyses by woman's age showed that coverage was lower in adolescent girls than older women for family planning indicators. Pro-urban and pro-rich inequalities were also seen for mortality in most countries. CONCLUSIONS: Regional averages hide important health inequalities between countries, but national estimates hide still greater inequalities between subgroups of women, children and adolescents. To achieve the SDG3 targets and leave no one behind, it is essential to close health inequality gaps within as well as between countries.


Asunto(s)
Disparidades en el Estado de Salud , Desarrollo Sostenible , Adolescente , Anciano , Región del Caribe , Niño , Estudios Transversales , Femenino , Disparidades en Atención de Salud , Humanos , Recién Nacido , América Latina/epidemiología , Factores Socioeconómicos
16.
Artículo en Inglés | MEDLINE | ID: mdl-34360185

RESUMEN

Community Health Workers (CHWs) can effectively implement maternal and child health interventions, but there is paucity of evidence on how to integrate child stimulation into these interventions, and their delivery at scale. In rural Bangladesh, CHWs implemented an intervention integrating psychosocial stimulation, nutrition, maternal mental health, water, sanitation, hygiene (WASH) and lead exposure prevention. In each of 16 intervention villages, one CHW worked with 20 households. CHWs bi-weekly held group meetings or alternated group meetings and home visits with pregnant women and lactating mothers. We assessed the intervention through five focus groups, four interviews and one group discussion with CHWs and their supervisors to explore success factors of implementation. CHWs' training, one-on-one supervision and introduction by staff to their own community, and adoption of tablet computers as job aids, enabled successful session delivery to convey behavioral recommendations. CHWs reported difficulties delivering session due to the complexity of behavioral recommendations and struggled with age-specific intervention material. Young children's attendance in group sessions generated distractions that undermined content delivery. We identified ways to minimize the difficulties to strengthen intervention-delivery during implementation, and scale-up. Iterative revisions of similarly integrated interventions based on qualitative evaluation findings could be delivered feasibly by CHWs and allow for implementation at scale.


Asunto(s)
Desarrollo Infantil , Agentes Comunitarios de Salud , Bangladesh , Niño , Preescolar , Femenino , Humanos , Lactancia , Embarazo , Saneamiento
17.
Artículo en Inglés | MEDLINE | ID: mdl-34444264

RESUMEN

BACKGROUND: In low- and middle-income countries (LMICs), household air pollution as a result of using solid biomass for cooking, lighting and heating (HAP) is associated with respiratory infections, accounting for approximately 4 million early deaths each year worldwide. The majority of deaths are among children under five years. This population-based cross-sectional study investigates the association between solid biomass usage and risk of acute respiratory infections (ARI) and acute lower respiratory infections (ALRI) in 37 LMICs within Africa, Americas, Southeast Asia, European, Eastern Mediterranean and Western Pacific regions. MATERIALS AND METHODS: Using population-based data obtained from Demographic and Health surveys (2010-2018), domestic cooking energy sources were classified solid biomass (wood, charcoal/dung, agricultural crop) and cleaner energy sources (e.g., Liquid Petroleum Gas (LPG), electricity, biogas and natural gas). Composite measures of ARI (shortness of breath, cough) and ALRI (shortness of breath, cough and fever) were composed using maternally reported respiratory symptoms over the two-week period prior to the interview. Multivariable logistic regression was used to identify the association between biomass fuel usage with ARI and ALRI, accounting for relevant individual, household and situational confounders, including stratification by context (urban/rural). RESULTS: After adjustment, in the pooled analysis, children residing in solid biomass cooking households had an observed increased adjusted odds ratio of ARI (AOR: 1.17; 95% CI: 1.09-1.25) and ALRI (AOR: 1.16; 95% CI 1.07-1.25) compared to cleaner energy sources. In stratified analyses, a comparable association was observed in urban areas (ARI: 1.16 [1.06-1.28]; ALRI: 1.14 [1.02-1.27]), but only significant for ARI among those living in rural areas (ARI: 1.14 [1.03-1.26]). CONCLUSION: Switching domestic cooking energy sources from solid biomass to cleaner alternatives would achieve a respiratory health benefit in children under five years worldwide. High quality mixed-methods research is required to improve acceptability and sustained uptake of clean cooking energy source interventions in LMIC settings.


Asunto(s)
Contaminación del Aire Interior , Infecciones del Sistema Respiratorio , Contaminación del Aire Interior/efectos adversos , Niño , Preescolar , Culinaria , Estudios Transversales , Demografía , Países en Desarrollo , Humanos , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/etiología
18.
Dev Psychol ; 57(6): 888-899, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34424007

RESUMEN

Fine motor skills enable children to make precise and coordinated movements with their hands and support their ability to engage in everyday activities and learning experiences. In a longitudinal study of 1,058 4-year-old children in rural Pakistan (n = 488 girls), we examined how prior and concurrent levels of home stimulation relate to change in fine motor skills from ages 2 to 4 while controlling for family wealth, maternal education, number of siblings at birth, prior and concurrent measures of children's physical growth and food insecurity, and prior motor skills at age 2. Moreover, we tested whether the association between early home stimulation and subsequent fine motor skills was mediated by physical growth, food insecurity, motor skills at age 2, and concurrent home stimulation. Results revealed that home stimulation at 18 months was positively associated with change in fine motor skills from ages 2 to 4, over and above family socioeconomic resources. This association was mediated by physical growth, food insecurity and motor skills at age 2. In contrast to home stimulation at 18 months, home stimulation at age 4 was positively associated with concurrent motor skills at age 4 when controlling for all antecedent family factors, as well as prior and concurrent measures of physical growth and food insecurity, and prior motor skills at age 2. Findings suggest that the preschool period may be an important window of time when physically and cognitively stimulating experiences at home uniquely relate to variability in fine motor development. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Asunto(s)
Desarrollo Infantil , Destreza Motora , Preescolar , Femenino , Humanos , Recién Nacido , Estudios Longitudinales , Pakistán , Población Rural
20.
BMJ Glob Health ; 6(8)2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34417271

RESUMEN

INTRODUCTION: Inadequate care during early childhood can lead to long-term deficits in skills. Parenting programmes that encourage investment in young children are a promising tool for improving early development outcomes and long-term opportunities in low-income and middle-income regions, such as rural China. METHODS: We conducted a systematic review and a meta-analysis to investigate the prevalence of early developmental delays and stimulating parenting practices as well as the effect of parental training programmes on child development outcomes in rural China. We obtained data in English from EconPapers, PubMed, PsycARTICLES, Cochrane Library, Web of Science and Scopus (Elsevier) and in Chinese from China National Knowledge Infrastructure, Wanfang Data and VIP Information. We conducted frequentist meta-analyses of aggregate data and estimated random-effects meta-regressions. Certainty of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: We identified 19 observational studies on the prevalence of developmental delays and stimulating parenting practices for children under 5 years of age (n=19 762) and ten studies on the impact of parental training programmes on early child development (n=13 766). Children's risk of cognitive, language and social-emotional delays in the rural study sites (covering 14 provinces mostly in Central and Western China) was 45%, 46%, and 36%, respectively. Parental training programmes had a positive impact on child cognition, language and social-emotional development. CONCLUSION: There is evidence to suggest that early developmental delay and the absence of stimulating parenting practices (ie, reading, storytelling and singing with children) may be prevalent across rural, low-income and middle-income regions in Central and Western China. Results support the effectiveness of parental training programmes to improve early development by encouraging parental engagement. TRIAL REGISTRATION NUMBER: This study was registered with PROSPERO (CRD42020218852).


Asunto(s)
Desarrollo Infantil , Responsabilidad Parental , Niño , Preescolar , China/epidemiología , Humanos , Padres , Población Rural
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