[Economic crisis and infant mortality in Latin America since the 1980's]

The impact of primary healthcare in reducing inequalities in child health outcomes, Bogotá-Colombia: an ecological analysis

BACKGROUND

Colombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC) strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá.

METHODS

An ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI). Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR), under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus) were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation). The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007.

RESULTS

In both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT) vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%), IMR (19%) and acute malnutrition (7%). PHC also contributed approximately 20% to inequality in DPT coverage, favoring the poorer localities.

CONCLUSION

The PHC strategy developed in Bogotá appears to be contributing to reductions of the inequality associated with socioeconomic and living conditions in child health outcomes.

[Firearm mortality in Argentina, 1990-2008]

This is a descriptive epidemiological study of firearm mortality in Argentina, 1990-2008. The study compared the firearm mortality percentages and rates between the country's jurisdictions. The data are from the Office of Health Statistics and Information, Ministry of Health. From 1990 to 2008 there were 358,484 deaths from external causes, of which 16.6% (59,339) were caused by firearms. The Province of Buenos Aires showed the highest percentage and crude and adjusted rates. The jurisdictions in the Pampeana region (including the Province of Buenos Aires) showed a more homogeneous profile, similar to that of the country as a whole, with an increase in the rates from 1999 to 2002 and a decrease from 2003 to 2006. These findings are partially explained by the country's deteriorating socioeconomic conditions in the late 20th century, with a greater impact on Buenos Aires, one of the provinces of Argentina with the greatest development and economic dynamism. The situation in Buenos Aires was aggravated by the fact that the Province has one of the country's most repressive police forces.

Mortalidade infantil e acesso geográfico ao parto nos municípios brasileiros

OBJETIVO: Analisar o acesso geográfico ao parto hospitalar nos municípios brasileiros. MÉTODOS: Foram analisadas informações de óbitos e nascimentos quanto à sua adequação para o cálculo do coeficiente de mortalidade infantil no período de 2005 a 2007 para os 5.564 municípios brasileiros. O acesso geográfico foi expresso por indicadores de deslocamento, oferta e acesso aos serviços de saúde. A associação entre o acesso geográfico ao parto e o coeficiente de mortalidade infantil em municípios com adequação de suas informações vitais foi avaliada por meio de regressão múltipla. RESULTADOS: Dentre os municípios analisados, 56% apresentaram adequação das informações vitais, correspondendo a 72% da população brasileira. O deslocamento geográfico ao parto mostrou-se inversamente associado ao porte populacional, à renda per capita, e à mortalidade infantil, mesmo controlado por fatores demográficos e socioeconômicos. CONCLUSÕES: Embora tenham sido desenvolvidas estratégias importantes para a melhoria da qualidade do atendimento às gestantes no Brasil, as ações para garantir o acesso igualitário à assistência ao parto ainda são insuficientes. O maior deslocamento intermunicipal para o parto se mostrou como um fator de risco para a mortalidade infantil, aliado à desigualdade de oferta de serviços qualificados e à falta de integração com a atenção básica de saúde.

Public health services, an essential determinant of health during crisis. Lessons from Cuba, 1989-2000

During the 1990s, Cuba was able to overcome a severe crisis, almost without negative health impacts. This national retrospective study covering the years 1989-2000 analyses the country's strategy through essential social, demographic, health process and health outcome indicators. Gross domestic product (GDP) diminished by 34.76% between 1989 and 1993. In 1994 slow recuperation started. During the crisis, public health expenses increased. The number of family doctors rose from 9.22 to 27.03 per 104 inhabitants between 1989 and 2000. Infant mortality rate and life expectancy exemplify a series of health indicators that continued to improve during the crisis years, whereas low birth weight and tuberculosis incidence are among the few indicators that suffered deterioration. GDP is inversely related to tuberculosis incidence, whereas the average salary is inversely related to low birth weight. Infant mortality rate has a strong negative correlation with the health expenses per inhabitant, the number of maternal homes, the number of family doctors and the proportion of pregnant women receiving care in maternal homes. Life expectancy has a strong positive correlation with health expenses, the number of nursing personnel and the number of medical contacts per inhabitant. The Cuban strategy effectively resolved health risks during the crisis. In times of serious socio-economic constraints, a well conceptualized public health policy can play an important role in maintaining the overall well-being of a population.

Condições de vida e mortalidade infantil no Estado do Paraná, Brasil, 1997/2001

Com o objetivo de verificar se as condições de vida e de infra-estrutura dos municípios do Estado do Paraná, Brasil, se relacionam com a taxa de mortalidade infantil e seus componentes, foi realizado estudo de agregados, com os 399 municípios do Estado agrupados em cinco clusters de condições de vida. As taxas de mortalidade infantil, neonatal e pós-neonatal foram calculadas para o qüinqüênio 1997/2001. Observaram-se taxas médias de mortalidade infantil, neonatal e pós-neonatal no Estado de 19,3, 12,0 e 7,3 por mil nascidos vivos, respectivamente. A taxa de mortalidade infantil pós-neonatal variou de 8,7 (cluster de piores condições) a 6,3 por mil nascidos vivos (cluster de melhores condições de vida). Com relação ao componente neonatal, os clusters de melhor e pior situação apresentaram as menores taxas, com valores semelhantes: 11,8 e 11,4 por mil nascidos vivos, respectivamente. Conclui-se que o componente pós-neonatal ainda discrimina adequadamente as condições de vida no Estado do Paraná, porém há necessidade de estudos complementares visando esclarecer as causas das taxas semelhantes de mortalidade neonatal dos clusters classificados como de melhores e de piores condições de vida.