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1.

A Qualitative Study of Child Nutrition and Oral Health in El Salvador.

Achalu, Priyanka; Zahid, Neha; Sherry, Dominique N; Chang, Andrew; Sokal-Gutierrez, Karen
| Idioma(s): Inglés
The nutrition transition from traditional diets to processed snacks and sugary beverages has contributed to a higher burden of child malnutrition, obesity, and tooth decay. While child health interventions typically promote nutritious eating, they rarely promote oral health. Mothers' motivations for child nutrition and oral health practices need to be better understood. A convenience sample of 102 mothers in eight rural Salvadoran communities participated in focus groups addressing child nutrition and oral health. Focus groups were transcribed and coded using qualitative content analysis. Primary themes included generational changes in health environments; health knowledge, attitudes, and practices; and access and barriers to health services. Mothers noted general improvements in awareness of oral hygiene but poorer child oral health, which they attributed to widespread sales of unhealthy snacks and beverages near schools. Distance and cost limited families' access to dental services. Knowledge gaps included the belief that oral iron supplements cause tooth decay, uncertainty regarding when to start tooth brushing, and until when parents should help children brush. Maternal-child health programs should emphasize the adverse health consequences of feeding young children processed snacks and sugary drinks, and promote dental care access and regulations to ensure health-promoting environments surrounding schools.
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2.

Intervention Reach and Sexual Risk Reduction of a Multi-level, Community-Based HIV Prevention Intervention for Crack Users in San Salvador, El Salvador.

Dickson-Gomez, Julia; Tarima, Sergey; Glasman, Laura R; Lechuga, Julia; Bodnar, Gloria; de Mendoza, Lorena Rivas
| Idioma(s): Inglés
This article examines the effects of a multi-level, community-based HIV prevention intervention for crack users residing in low-income neighborhoods in San Salvador, El Salvador conducted between August 2011 and June 2016. The intervention consisted of three components introduced sequentially: (1) rapid HIV testing in community settings; (2) a social network HIV testing intervention; and (3) small group interventions with crack users who were members of the same social network. The intervention was evaluated with an interrupted time series design in which we used respondent-driven sampling to conduct 7 cross-sectional surveys with crack users along a 3-4 month period for each assessment (total n = 1597). Results revealed a significant increase in exposure to the intervention over time with 50% of the participants reporting exposure to one or more of the three components. Getting an HIV test at the community site was associated with reductions in total times each individual had sex without a condom (p < 0.05) compared to those who had been exposed to no intervention components. Being referred by another crack user through the Social Network HIV intervention was also associated with reductions in total numbers of condomless sex (p < 0.05) The cumulative effect of being exposed to more than one intervention component was associated with reductions in total number of times individuals had condomless sex (p < 0.05). In spite of the high level of intervention reach and that self-reported exposure to intervention components was associated with lower sexual risk, reductions in sexual risk over time were not observed in the full sample, indicating that the penetration of HIV prevention components was not sufficient to produce population level change.
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3.

A social systems analysis of implementation of El Salvador's national HIV combination prevention: a research agenda for evaluating Global Health Initiatives.

Dickson-Gomez, Julia; Glasman, Laura A; Bodnar, Gloria; Murphy, Molly
| Idioma(s): Inglés
BACKGROUND: Global Health Initiatives (GHIs) have been instrumental in the rapid acceleration of HIV prevention, treatment access, and availability of care and support services for people living with HIV (PLH) in low and middle income countries (LMIC). These efforts have increasingly used combination prevention approaches that include biomedical, behavioral, social and structural interventions to reduce HIV incidence. However, little research has evaluated their implementation. We report results of qualitative research to examine the implementation of a national HIV combination prevention strategy in El Salvador funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. METHODS: We conducted in-depth interviews with principal recipients of the funding, members of the Country Coordinating Mechanism (CCM) and front line peer outreach workers and their clients. We analyzed the data using a dynamic systems framework. RESULTS: El Salvador's national HIV combination prevention strategy had three main goals: 1) to decrease the sexual risk behaviors of men who have sex with men (MSM), commercial sex workers (CSW) and transgender women (TW); 2) to increase HIV testing rates among members of these populations and the proportion of PLH who know their status; and 3) to improve linkage to HIV treatment and adherence to antiretroviral therapy (ART). Intervention components to achieve these goals included peer outreach, community prevention centers and specialized STI/HIV clinics, and new adherence and retention protocols for PLH. In each intervention component, we identified several factors which reinforced or diminished intervention efforts. Factors that negatively affected all intervention activities were an increase in violence in El Salvador during implementation of the strategy, resistance to decentralization, and budget constraints. Factors that affected peer outreach and sexual risk reduction were the human resource capacity of grassroots organizations and conflicts of the national HIV strategy with other organizational missions. CONCLUSIONS: Overall, the national strategy improved access to HIV prevention and care through efforts to improve capacity building of grass roots organizations, reduced stigma, and improved coordination among organizations. However, failure to respond to environmental and organizational factors limited the intervention's potential impact.
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4.

Health system strategies to increase HIV screening among pregnant women in Mesoamerica.

El Bcheraoui, Charbel; Zúñiga-Brenes, Paola; Ríos-Zertuche, Diego; Palmisano, Erin B; McNellan, Claire R; Desai, Sima S; Gagnier, Marielle C; Haakenstad, Annie; Johanns, Casey; Schaefer, Alexandra; Hernandez, Bernardo; Iriarte, Emma; Mokdad, Ali H
| Idioma(s): Inglés
BACKGROUND: To propose health system strategies to meeting the World Health Organization (WHO) recommendations on HIV screening through antenatal care (ANC) services, we assessed predictors of HIV screening, and simulated the impact of changes in these predictors on the probability of HIV screening in Guatemala, Honduras, Mexico (State of Chiapas), Nicaragua, Panama, and El Salvador. METHODS: We interviewed a representative sample of women of reproductive age from the poorest Mesoamerican areas on ANC services, including HIV screening. We used a multivariate logistic regression model to examine correlates of HIV screening. First differences in expected probabilities of HIV screening were simulated for health system correlates that were associated with HIV screening. RESULTS: Overall, 40.7% of women were screened for HIV during their last pregnancy through ANC. This rate was highest in El Salvador and lowest in Guatemala. The probability of HIV screening increased with education, household expenditure, the number of ANC visits, and the type of health care attendant of ANC visits. If all women were to be attended by a nurse, or a physician, and were to receive at least four ANC visits, the probability of HIV screening would increase by 12.5% to reach 45.8%. CONCLUSIONS: To meet WHO's recommendations for HIV screening, special attention should be given to the poorest and least educated women to ensure health equity and progress toward an HIV-free generation. In parallel, health systems should be strengthened in terms of testing and human resources to ensure that every pregnant woman gets screened for HIV. A 12.5% increase in HIV screening would require a minimum of four ANC visits and an appropriate professional attendance of these visits.
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5.

The cost and cost-effectiveness of childhood cancer treatment in El Salvador, Central America: A report from the Childhood Cancer 2030 Network.

Fuentes-Alabi, Soad; Bhakta, Nickhill; Vasquez, Roberto Franklin; Gupta, Sumit; Horton, Susan E
| Idioma(s): Inglés
BACKGROUND: Although previous studies have examined the cost of treating individual childhood cancers in low-income and middle-income countries, to the authors' knowledge none has examined the overall cost and cost-effectiveness of operating a childhood cancer treatment center. Herein, the authors examined the cost and sources of financing of a pediatric cancer unit in Hospital Nacional de Ninos Benjamin Bloom in El Salvador, and make estimates of cost-effectiveness. METHODS: Administrative data regarding costs and volumes of inputs were obtained for 2016 for the pediatric cancer unit. Similar cost and volume data were obtained for shared medical services provided centrally (eg, blood bank). Costs of central nonmedical support services (eg, utilities) were obtained from hospital data and attributed by inpatient share. Administrative data also were used for sources of financing. Cost-effectiveness was estimated based on the number of new patients diagnosed annually and survival rates. RESULTS: The pediatric cancer unit cost $5.2 million to operate in 2016 (treating 90 outpatients per day and experiencing 1385 inpatient stays per year). Approximately three-quarters of the cost (74.7%) was attributed to 4 items: personnel (21.6%), pathological diagnosis (11.5%), pharmacy (chemotherapy, supportive care medications, and nutrition; 31.8%), and blood products (9.8%). Funding sources included government (52.5%), charitable foundations (44.2%), and a social security contribution scheme (3.4%). Based on 181 new patients per year and a 5-year survival rate of 48.5%, the cost per disability-adjusted life-year averted was $1624, which is under the threshold considered to be very cost effective. CONCLUSIONS: Treating childhood cancer in a specialized unit in low-income and middle-income countries can be done cost-effectively. Strong support from charitable foundations aids with affordability. Cancer 2018;124:391-7. © 2017 American Cancer Society.
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6.

Resumen Estratégico. Estrategia de Cooperación de País: OPS/OMS – El Salvador 2017 – 2020

Organización Panamericana de la Salud
| Idioma(s): Español
La Estrategia de Cooperación de la Organización Panamericana de la Salud/ Organización Mundial de la Salud (OPS/OMS) con El Salvador, constituye el acuerdo de trabajo entre ambas partes para el período 2017 – 2020; se basa en prioridades definidas a partir de políticas nacionales relacionadas al área de salud, metas convenidas dentro del Plan Quinquenal de Desarrollo 2014-2019, el Plan Estratégico Institucional del Ministerio de Salud y los Objetivos de Desarrollo Sostenible (ODS). La presente ECP da continuidad a procesos previos que permitieron orientar los esfuerzos en el marco de un proceso de reforma de salud, la finalización de los Objetivos de Desarrollo del Milenio (ODM) y la articulación de nuevos compromisos globales como los ODS, con una amplia agenda al 2030 que guiará el camino de los países bajo metas e indicadores para un crecimiento común sin exclusión. La Estrategia de Cooperación de País refuerza la dimensión del área sanitaria en un contexto de trabajo de todo el Sistema de Naciones Unidas (SNU) bajo el Marco de Asistencia para el Desarrollo (MANUD), principal instrumento de armonización de la cooperación del SNU en El Salvador.
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7.

Política nacional de cuidado de enfermería: plan de implementación/ National nursing care policy: implementation plan

El Salvador. Ministerio de Salud. Viceministerio de Políticas de Salud. Dirección de Regulación y Legislación en Salud. Viceministerio de Servicios de Salud. Unidad de Enfermería
;
| Idioma(s): Español
El "Plan de Implementación de la Política Nacional de Cuidado de Enfermería" que se presenta en este documento, tiene el propósito de orientar al gremio de profesionales en esta disciplina, sobre las actividades precisas que se realizarán para el cumplimiento de la política que guiará el accionar hacia el cuidado de enfermería de calidad en El Salvador. Plan que contribuirá en el desarrollo de la política a lograr las competencias técnicas y mayor desarrollo profesional en el gremio para intervenir eficazmente en la gestión institucional y en la mejora de la calidad de los cuidados de enfermería. El Plan acorde a lo planteado en la política, describe los ocho ejes de actuación: administración del cuidado de enfermería, cuidado de enfermería humanizado y de calidad, docencia en enfermería, investigación en enfermería, promoción y educación para la salud, sistema de información en enfermería, condiciones de trabajo y de vida, e imagen de la profesión de enfermería. Para su elaboración requirió del esfuerzo colectivo, intersectorial e institucional de enfermería, realizando un ejercicio de reflexión sobre el ser y el hacer de la profesión, relacionada con la dinámica compleja del desarrollo social y económico, nacional e internacional. El documento integra objetivos, matrices con los ejes temáticos desarrollados, estrategias y líneas de acción; ampliando de éstas últimas y de una manera más específica las actividades, los indicadores que servirán para medir y evaluar los resultados obtenidos, los tiempos respectivos de cumplimiento, así como las entidades responsables de su ejecución. (AU)
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8.

Política Nacional de Salud 2015 - 2019/ National Health Policy 2015 - 2019

El Salvador. Ministerio de Salud
;
| Idioma(s): Español
El Ministerio de Salud (MINSAL), desde el año 2009 inició la más ambiciosa reforma del Sistema Nacional de Salud (SNS) que se haya realizado en la historia de El Salvador; reconoce a la salud como un derecho humano fundamental, promueve su inclusión en las políticas sociales y económicas del país, rechaza las acciones de mercantilización de la misma y la armoniza con la determinación social de la salud que identifica al proceso salud-enfermedad como el resultado de las interacciones que el modelo hegemónico de desarrollo ejerce entre la naturaleza y la forma en que la sociedad se organiza y funciona mediante la interacción contradictoria de componentes sociohistóricos, económicos, políticos, culturales, demográficos, ambientales y biológicos. Esta interacción entre naturaleza y sociedad es la que determina que las personas gocen o no de una vida saludable, plena y productiva, superando y ampliando la visión estática de la ausencia de enfermedad al incorporar a diversos sectores y actores para garantizar este derecho. El segundo gobierno del cambio, liderado por el Presidente Salvador Sánchez Cerén, ha definido en su Plan de Gobierno 2014 ­ 2019 las acciones necesarias para consolidar los avances sociales básicos que garanticen los Derechos Humanos fundamentales, estableciendo el marco para acelerar la profundización de la Reforma de Salud a fin de avanzar la integración del SNS; fortalece la capacidad del MINSAL como ente Ministerio de Salud de El Salvador rector, estableciendo alianzas estratégicas, incrementando el monto y el uso eficiente del gasto público en salud, mejorando la estructura, organización y funcionamiento de las Redes Integrales e Integradas de Salud (RIIS) y otras acciones que confirman la necesidad de actualizar y plasmar a través de un proceso consultivo, las líneas estratégicas de la Política Nacional de Salud 2015-2019 que se concretan en los planes territoriales de las diferentes instituciones del sistema. (AU)
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9.

La demanda de cigarrillos y el aumento de impuestos en El Salvador/ Demand for cigarettes and tax increases in El Salvador

Ramos-Carbajales, Alejandro; González-Rozada, Martín; Vallarino, Hugo
| Idioma(s): Español
Objetivo. Analizar las elasticidades de corto plazo y de largo plazo de la demanda de cigarrillos en El Salvador como instrumento para apoyar recomendaciones sobre aumentos de impuestos para reducir la prevalencia y el consumo vía aumento de precios. Métodos. Se analizó la demanda de cigarrillos en El Salvador mediante un modelo econométrico de series de tiempo con una base de datos proveniente de la Dirección General de Impuestos Internos (DGII) y la Dirección General de Estadística y Censos (DIGESTYC) de El Salvador. El período de análisis fue trimestral: 2000Q1-2012T4. Se realizaron las pruebas habituales para evitar que la estimación econométrica fuera espuria. Se halló que las variables ventas en volumen, los precios reales de venta y el ingreso real per cápita estaban cointegradas de primer orden; este resultado permite utilizar un modelo de corrección de error con estimaciones de las elasticidades en el corto plazo y en el largo plazo. Resultados. Se halló que solo las elasticidades de largo plazo son estadísticamente significativas al 5% de probabilidad. Los resultados señalan una elasticidad precio de largo plazo (cinco trimestres) de -0,9287 e ingreso de 0,9978. Conclusiones. El nivel del valor absoluto de la elasticidad precio es algo elevada, aunque está dentro de los niveles estimados en otros estudios en los países de menores ingresos per cápita. Un aumento del impuesto de un monto base de USD (dólares estadounidenses) 1,04 por cajetilla de 20 cigarrillos a USD 1,66 en un período de tres años reduciría la demanda entre 20% y 31% y aumentaría los ingresos fiscales entre 9% y 22%. Objective. Analyze short- and long-term elasticities of demand for cigarettes in El Salvador as a tool for supporting recommendations on tax increases to reduce prevalence and consumption through price increases. Methods. Demand for cigarettes in El Salvador was analyzed through an econometric time-series model using a database from El Salvador’s General Directorate of Internal Taxes (DGII) and the General Directorate of Statistics and Census (DIGESTYC). The analysis period was quarterly: 2000Q1-2012Q4. The usual tests were done to prevent a spurious econometric estimation. It was found that the variables volume sales, actual sale prices, and actual per capita income exhibited first-order cointegration; this result makes it possible to use an error correction model with short- and long-term elasticity estimates. Results. Only long-term elasticities were found to be statistically significant to 5%. Results show long-term price elasticity (5 quarters) of –0.9287 and income price elasticity of 0.9978. Conclusions. Absolute price elasticity is somewhat high, although it is within the levels estimated in other studies in low per-capita income countries. A tax increase from a base amount of US$1.04 per pack of 20 cigarettes to US$1.66 within three years would reduce demand by 20% to 31% and would increase tax revenues by 9% to 22%.
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10.

U.S. Migrant Networks and Adult Cardiometabolic Health in El Salvador.

Martin, Michelle Y; Francis, Lori A
| Idioma(s): Inglés
Heightened prevalence of cardiometabolic health conditions in areas where infectious disease remains a major public health concern has created an especially challenging situation for developing countries, like El Salvador. Individuals living within migrant households where migrant networks are present may be at a greater risk for the development of cardiometabolic health conditions. Using data from the 2007 El Salvador database of the Latin American Migration Project (LAMP-ESLS4), this study investigates relations between financial remittances, familial U.S. migration history and cardiometabolic health conditions (overweight status, diabetes, hypertension, heart disease and stroke) among 534 individuals within 351 households from four different communities within the departments of La Unión, Cabañas, and San Miguel in El Salvador. Adults living in households that had close primary kin with U.S. migration history were almost two times less likely to be overweight (OR 0.456, p < 0.001) and obese (OR 0.453, p < 0.01) when adjusting for age, sex, education and economic well-being. This study highlights the importance of exploring the potential role of U.S. migrant ties in the epidemiologic transition present within developing countries, like El Salvador.
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