COVID-19 Response in Latin America

Effective management of a pandemic due to a respiratory virus requires public health capacity for a coordinated response for mandatory restrictions, large-scale testing to identify infected individuals, capacity to isolate infected cases and track and test contacts, and health services for those infected who require hospitalization. Because of contextual and socioeconomic factors, it has been hard for Latin America to confront this epidemic. In this article, we discuss the context and the initial responses of eight selected Latin American countries, including similarities and differences in public health, economic, and fiscal measures, and provide reflections on what worked and what did not work and what to expect moving forward.

Salud Global en las instituciones académicas latinoamericanas: hacia un desarrollo e identidad propia

Salud Global es un campo relativamente nuevo en las instituciones académicas de América Latina y su expansión ha sido lenta en comparación con el explosivo desarrollo que esta disciplina ha experimentado en países de Europa y Norteamérica. Este artículo presenta una visión general de los principales programas de docencia e investigación en Salud Global en universidades e institutos de la Región que han surgido durante los últimos 10 años. Asimismo, se describe la creación de ALASAG, una red de instituciones académicas con programas en Salud Global, a través de la cual se está haciendo sentir la voz de Latinoamérica en los foros mundiales de Salud Global. Los autores plantean que el quehacer de las instituciones académicas debe, necesariamente, inscribirse dentro de una conceptualización e identidad regional propia y distintiva. La perspectiva Latinoamericana de la Salud Global debe partir de una posición crítica frente al fenómeno de globalización económica capitalista manejado desde la ideología neoliberal. Desde dicha perspectiva se propone un listado de aéreas prioritarias en docencia, investigación y abogacía en Salud Global para la Región, entre otras: la equidad en el acceso a la salud; la globalización económica en América Latina y sus efectos en la equidad en salud; y la liberación y protección del comercio internacional en contraposición con la protección de la salud humana y el medio ambiente.

Human resources for health: overcoming the crisis

In this analysis of the global workforce, the Joint Learning Initiative-a consortium of more than 100 health leaders-proposes that mobilisation and strengthening of human resources for health, neglected yet critical, is central to combating health crises in some of the world's poorest countries and for building sustainable health systems in all countries. Nearly all countries are challenged by worker shortage, skill mix imbalance, maldistribution, negative work environment, and weak knowledge base. Especially in the poorest countries, the workforce is under assault by HIV/AIDS, out-migration, and inadequate investment. Effective country strategies should be backed by international reinforcement. Ultimately, the crisis in human resources is a shared problem requiring shared responsibility for cooperative action. Alliances for action are recommended to strengthen the performance of all existing actors while expanding space and energy for fresh actors.

Responding to the global human resources crisis

The global community is in the midst of a growing response to health crises in developing countries, which is focused on mobilising financial resources and increasing access to essential medicines. However, the response has yet to tackle the most important aspect of health-care systems--the people that make them work. Human resources for health--the personnel that deliver public-health, clinical, and environmental services--are in disarray and decline in much of the developing world, particularly in sub-Saharan Africa. The reasons behind this disorder are complex. For decades, efforts have focused on building training institutions. What is becoming increasingly clear, however, is that issues of supply, demand, and mobility (transnational, regional, and local) are central to the human-resource problem. Without substantial improvements in workforces, newly mobilised funds and commodities will not deliver on their promise. The global community needs to engage in four core strategies: raise the profile of the issue of human resources; improve the conceptual base and statistical evidence available to decision makers; collect, share, and learn from country experiences; and begin to formulate and enact policies at the country level that affect all aspects of the crisis.

A follow-up study of the effects of early malnutrition on subsequent development. II. Fine motor skills in adolescence

One hundred nine children, aged 8 through 15 yr, who suffered from malnutrition in the 1st yr of life and 107 well-nourished comparison children were tested for fine motor skills by the Purdue Pegboard test. The performance of index children was impaired on three of the four test measures. IQ measured concurrently showed a reduction in the index group; when the effects of IQ were eliminated, there was no longer any significant difference between index and comparison groups. The data suggest that the effects of early malnutrition on Pegboard performance are largely mediated by deficits in IQ. The presence of soft neurologic signs measured 4 yr earlier in the same children was highly correlated with reduced Pegboard performance, implying that early malnutrition has effects on nervous system function that are evident at least through 15 yr of age.

A follow-up study of the effects of early malnutrition on subsequent development. I. Physical growth and sexual maturation during adolescence

A follow-up study of growth and development was conducted on 216 Barbadian children aged 9 to 15 yr, half of whom had histories of moderate to severe protein-energy malnutrition in their 1st yr of life. Although index girls had significant delays in sexual maturation and were reduced relative to comparison girls on measures of weight for height, arm circumference, and skinfold thickness, their rate of growth when compared with values obtained 4 yr earlier was equal to or better than that of the comparison group. In contrast, boys in the index group were slightly reduced in height compared with their matched comparisons and had similar patterns of growth and sexual maturation. This study suggests a relationship between an episode of infantile malnutrition and impaired endocrine functioning among girls in the adolescent years.

The influence of early malnutrition on subsequent behavioral development. IV. Soft neurologic signs

Soft neurologic signs were evaluated in 101 Barbadian school children, ages 4-11 years, who were malnourished in the first year of life, and 101 comparison children matched for age, sex, and handedness, but who had no history of malnutrition. Previously malnourished children performed significantly slower than comparison children on several timed motor tasks when using the nondominant hand only. Boys were found to perform significantly slower than girls, and younger (4-7 years of age) children performed slower than older (8-11 years of age) children. A model is presented that displays interrelationships among previous malnutrition, soft neurologic signs, classroom behavior, intelligence, and physical growth. In summary, slow motor performance was associated with lower verbal and performance IQ and the presence of attention deficit disorder, as assessed by the child's teacher. The time to perform the motor tests was unrelated to measures of physical growth.

Parental behavior and the availability of foods among undernourished inner-city children

This study was designed to identify differences in parental behaviors and the availability of food between undernourished and well-nourished inner-city children of early school age. Children with a constellation of measurements of height below the 25th percentile, midarm muscle circumference below the 50th percentile, and hemoglobin concentration below 11.5 g/dL were considered undernourished. These children were matched with controls having measurements above these levels. The homes of all children were investigated. Families of undernourished children were found to have significantly less variety of nutritious foods requiring preparation by an adult available in the home (P less than .01), to have greater variety of convenience foods of low nutritional value (P less than .01), and to prefer fewer vegetables (P less than .04) and dairy products (P less than .01). The Polansky Child Level of Living Scale showed that mothers of undernourished children were less likely to prepare meals regularly for their children (P less than .05) and that they were less effective in providing general parental support to their children (P less than .03).

The influence of early malnutrition on subsequent behavioral development III. Learning disabilities as a sequel to malnutrition

The academic performance of 129 Barbadian children (77 boys and 52 girls), who were 5-11-yr-old and suffered moderate to severe protein-energy malnutrition in the first year of life, was compared with the performance of matched comparisons, children who had no history of malnutrition. Children with a history of malnutrition were found to have lower performance on eight out of nine academic subject areas, namely, language arts, mathematics, general science, social science, reading, health, religion, and arts/crafts. Socioeconomic factors in the backgrounds of the children were also examined. A model is presented clarifying the interrelationships of malnutrition, socioeconomic status and school performance. Reduced school performance in the previously malnourished children can be largely accounted for by deficits in classroom behavior, and, to a lesser extent by a reduction in I.Q. Current socioeconomic status is not directly involved in altering academic performance whereas the early history of malnutrition and its accompanying conditions at the time of the illness are leading contributors to altered behavioral outcome and school performance.

Nutrition and national development: the case of Chile

This study is an historical analysis of food consumption and nutrition in Chile emphasizing the influence of political and economic factors on nutritional standards. It attempts to document and explain the persistence of malnutrition as a widespread social problem in Chile even as the country achieved a relatively advanced state of economic development and boasted an unusually progressive record of social legislation. The major findings of the study were: (a) Chile's pattern of development, social reform efforts notwithstanding, consistently discriminated against low-income groups, and (b) this discrimination perpetuated low standards of nutrition and low levels of food consumption among the country's poor and undermined the effectiveness of specific measures to alleviate malnutrition.

Effects of rise in food costs on hemoglobin concentrations of early school-age children, 1972-75

In a hematologic survey conducted in 1972, microcythemia in school children was found to be associated with microcythemia in other family members. The association of cultural characteristics of chronic poverty with reduced red cell volume suggested nutritional iron deficiency. A resurvey of families was made in 1975. For 39 children between the ages of 3 and 10 years at the time of both surveys, mean hemoglobin concentration (HGB) decreased from 21.0 g/dl to 10.8 g/dl. Thirteen infants, 6 months to 3 years of age in 1972, in the resurveyed families had mean HGB of 11.5 g/dl as compared to 10.4 g/dl for 9 similarly aged children newly born into the resurvey families. The rate of somatic growth was unchanged during the interval between survey. During the interval between 1972 and 1975, food costs rose nationally, and the purchase of meat products decreased both nationally and (as found in this study) locally. The data suggest that the high cost of foods rich in micronutrients may increase the prevalence of iron deficiency in an impoverished community.

Protein-calorie malnutrition: effect of deficient diets on enzyme levels of jejunal mucosa of rats

1. The effects of low-protein and protein-free diets on the levels of disaccharidase, peptidase and aldolase activities in the jejunal mucosa of rats were studied.

2. Maltase, palatinase and sucrase activities increased significantly after both types of feeding, although there was an initial fall with the protein-free diet.

3. The rise in lactase levels was, however, not so marked.

4. Glycyl-glycine and glycyl-leucine dipeptidase levels fell consistently with both diets.

5. Aldolase activities were generally unaltered, but tended to fall if the period of low-protein feeding was prolonged.

6. Enzyme levels rapidly returned to normal when the rats were given a normal diet after a period on a protein-deficient one.

7. It is suggested that the rise in disaccharidase and fall in peptidase levels are adaptive changes to the high-carbohydrate, low-protein diet, with diminished enzyme synthesis, due to lack of nitrogen, contributing to the lowered peptidase activities. The relevance of these results to disaccharide intolerance in chronic malnutrition, kwashiorkor and gastro-intestinal infection is discussed.