Association of rule of law and health outcomes : An ecological study

Objectives: To explore whether the rule of law is a foundational determinant of health that underlies other socioeconomic, political and cultural factors that have been associated with health outcomes. Setting: Global project. Participants: Data set of 96 countries, comprising 91% of the global population. Primary and secondary outcome measures: The following health indicators, infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, were included to explore their association with the rule of law. We used a novel Rule of Law Index, gathered from survey sources, in a cross-sectional and ecological design. The Index is based on eight subindices: (1) Constraints on Government Powers; (2) Absence of Corruption; (3) Order and Security; (4) Fundamental Rights; (5) Open Government; (6) Regulatory Enforcement, (7) Civil Justice; and (8) Criminal Justice. Results: The rule of law showed an independent association with infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, after adjusting for the countries' level of per capita income, their expenditures in health, their level of political and civil freedom, their Gini measure of inequality and women's status (p<0.05). Rule of law remained significant in all the multivariate models, and the following adjustment for potential confounders remained robust for at least one or more of the health outcomes across all eight subindices of the rule of law. Findings show that the higher the country's level of adherence to the rule of law, the better the health of the population. Conclusions: It is necessary to start considering the country's adherence to the rule of law as a foundational determinant of health. Health advocates should consider the improvement of rule of law as a tool to improve population health. Conversely, lack of progress in rule of law may constitute a structural barrier to health improvement

Child labor in a marketplace in Bogotá

Objetivos El trabajo infantil en plazas de mercado es un fenómeno poco estudiado que se presenta incluso en países desarrollados y se asocia con trastornos en el desarrollo físico, psíquico, emocional y social de los niños. El presente trabajo pretende determinar el número de niños que se encuentran trabajando en la plaza de mercados más grande del país y los factores de riesgo a los que están expuestos. Métodos Se realizó un conteo de los niños que trabajan en la plaza y se determinó su genero y ocupación. Posteriormente se realizó un análisis de puesto de trabajo utilizando el panorama de riesgos profesionales de Fine. Resultados Se encontraron 376 menores, 318 niños y 58 niñas. El 30 % cargando bultos, el 42 % vendiendo y el 28 % acompañando o realizando tareas menores. Los factores de riesgo relacionados con seguridad son los que presentan un grado de peligrosidad más alto. Los siguen los ergonómicos, los psicosociales y los biológicos. Conclusión Los factores de riesgo que a corto plazo afectan más la salud de los niños en la plaza son los relacionados con la seguridad por el tránsito de vehículos, el apilamiento inapropiado de materiales potencialmente peligrosos y la carga física a que están sometidos. De acuerdo con el panorama de riesgos profesionales presentado, este es un trabajo peligroso para los niños. El trabajo de los niños en plazas de mercado debe ser regulado y el transporte de mercancías por parte de los mismos debe ser abolido.OBJECTIVE: Child labor in marketplaces has not been sufficiently studied. It is present even in developed countries and it has been associated with problems in the physical, psychological, emotional and social development of children. This paper aims at determining the number of children working in the largest marketplace in the country and the risk factors to which they are exposed. METHODOLOGY: Children working in the marketplace were counted and classified by gender and occupation. Working places were analyzed under Fine's professional risk plan. RESULTS: 376 children were found, 318 boys and 58 girls. 30% were carrying loads, 42% were selling merchandise, and 28% were doing minor jobs or accompanying relatives. The risk factors related with their personal security have the greatest danger level. They are followed by the ergonomic, psychosocial and biological factors. CONCLUSIONS: The risk factors affecting children's health the most in the short term are those related to personal security. They include vehicle traffic, inadequate materials storage that can be dangerous, and the physical burden that they have to suffer. According to the professional risk factors plan, this is a dangerous job for children. Child labor in marketplaces shall be regulated and the carrying of heavy loads prohibited

Association of nutritional support programs with zinc deficiency in Colombian children: a cross-sectional study

Background: Zinc is an essential trace element that plays a key role in the immune, gastrointestinal, respiratory and nervous systems. In Colombia, a vast percentage of children live in low-income households with food insecurity and nutritional deficiencies, including zinc. In an effort to improve children's well-being, public health measures such as nutritional support programs that provide meals have targeted the poorest populations. The aim of the present study was to assess the role of nutritional support programs on zinc deficiency in Colombian children, while considering their wealth and food security.Methods: Cross-sectional study using data from the 2010 Colombian National Nutrition Survey, a population-based study representative of Colombia. A total of 4275 children between 12 and 59months of age were included in the study. Stepwise logistic regressions were modelled with SPSS, first for zinc deficiency on wealth and food security, then adding enrolment in a nutritional support program, and finally, adjusting for socio-demographic variables.Results: A zinc deficiency prevalence of 49% was found. The adjusted models showed an association of wealth quintiles: very poor (OR=1.48) and poor (OR=1.39), food security (OR=0.75) and enrolment in a nutritional support program (OR=0.76) with zinc deficiency. Enrolment in nutritional programs did not modify the relationship of wealth and food security to zinc deficiency.Conclusion: Zinc deficiency is associated with wealth, food security and enrolment in nutritional support programs. Nutritional programs may be a good alternative against zinc deficiency, if they focus appropriately on the needs of children according to their wealth and food security

Wealth, Social Protection Programs, and Child Labor in Colombia: A Cross-sectional Study

This article has 3 main objectives: (1) to assess the prevalence of child labor in Colombia, (2) to identify factors associated with child labor, and (3) to determine whether social protection programs have an association with the prevalence of child labor in the country. Using a cross-sectional study with data from the Colombian Demographic and Health Survey 2010, a working child was defined as a child who worked during the week prior to the survey in an activity other than household chores. Through descriptive statistics, bivariate analysis, and multivariate regressions, it was found that child labor was associated with gender (boys were more likely to work), older age, ethnicity (children from indigenous communities were more likely to be workers), school dropout, disability (children with disabilities were less likely to be working), subsidized health social security system membership, and lower number of years of mother’s schooling. Furthermore, the results of this study suggest that children beneficiaries of the subsidy Familias en Acción were less likely to be working and that social protection programs were more effective to reduce child labor when targeting the lowest wealth quintiles of the Colombian population. © The Author(s) 2018

Work-related injuries among child street-laborers in Latin America: Prevalence and predictors

Objectives. To determine the prevalence and nature of occupational injuries among children working in the streets of four major cities in Latin America, as well as to identify factors that predict these work-related injuries. Methods. This cross-sectional study interviewed 584 children from 5-17 years of age working on the streets of Bogota, Colombia; Lima, Peru; Quito, Ecuador; and São Paulo, Brazil. Descriptive analyses and multivariate logistic regressions were conducted, with incidence and serious injuries regressed on occupational and sociodemographic variables. Results. Approximately 39.6% of the child street-laborers surveyed reported an injury sustained while working in the streets: scratches (19.5%), cuts/lacerations (16.4%), bums (8.6%), car accidents (8.9%), sprains (4.6%), and amputations (0.3%). Working a high number of daytime hours and performing on the street predicted the greatest risk of injury, even after controlling for sociodemographic factors; specifically, each additional hour of daytime work increased the risk of injury by 1.4%. Child performers had three times the injury rate of children primarily selling products. Boys, older children, and children in Quito were more likely to experience moderate-to-severe injuries, than girls, younger children, and street children in the other study cities. Conclusions. Interventions are needed to address the substantial risk of injury experienced by children working on the city streets of Latin America

Correlación de las condiciones de iluminación, ángulo visual, agudeza visual y contraste con y síntomas visuales en trabajadores de un call center en Bogotá, Colombia

Objetivo: Establecer la correlación entre condiciones de iluminación, ángulo visual, discriminación de contrastes y agudeza visual en la aparición de síntomas visuales en operarios de computador. Materiales y métodos: Estudio de corte transversal y correlación en muestra de 136 trabajadores administrativos de un “call center” perteneciente a una entidad de salud en la ciudad de Bogotá, utilizando un cuestionario con el que se evaluaron las variables sociodemográficas y ocupacionales; aplicando la escala de síntomas visión – computador (CVSS17), realizando evaluación médica y midiendo iluminación y distancia operario pantalla de computador y con los datos recolectados se realizó un análisis estadístico bivariado y se estableció la correlación entre las condiciones de iluminación, ángulo visual, discriminación de contrataste y agudeza visual; frente a la aparición de síntomas visuales asociados con el uso del computador. El análisis se llevó a cabo con medidas de tendencia central y dispersión y con el coeficiente de correlación paramétrico de Pearson o no-paramétrico de Spearman, previamente se evaluó la normalidad con la prueba de Shapiro-Wilk. Las pruebas estadísticas se evaluarán a un nivel de significancia del 5% (p<0.05). Resultados: El promedio de edad de los participantes en el estudio fue de 36,3 años con un rango entre los 22 y 57 años y en donde el género predominante fue el femenino con el 79,4%. Se encontraron síntomas visuales asociados al uso de pantalla de computador del 59,6%, siendo los más frecuentes la epifora (70,6%), fotofobia (67,6%) y ardor ocular (54,4%). Se reportó una correlación inversa significativa entre niveles de iluminación y manifestación de fotofobia (p=0.02; r= 0,262). Por otra parte no se encontró correlación significativa entre los síntomas referidos con ángulo de visión y agudeza visual y discriminación de contrastes. Conclusión: Las condiciones laborales de iluminación del grupo de estudio están relacionadas con la manifestación de fotofobia, Se encontró asociación entre síntomas visuales y variables sociodemográficas, específicamente con el género, fotofobia a pantalla, fatiga visual y fotofobiaObjective: To establish the association between light conditions and visual angle to the visual appearance of symptoms in computer operators. Materials and methods: Cross-sectional study and correlation sample of 136 administrative workers of a call center belonging to a health institution in the city of Bogotá, using a questionnaire that socio demographic and occupational variables were evaluated; simultaneously symptom scale vision - computer (CVSS17), performing medical evaluation and measurement distance operator lighting and computer screen, the data collected and bivariate statistical analysis was performed and the correlation between lighting conditions, viewing angle, discrimination and visual acuity hired was established; against the appearance of visual symptoms associated with computer use, with a significance level of 5% (p &lt; 0. 05). Results: The average age of study participants was 36. 3 years with a range between 22 and 57 years and where the female gender was predominant with 79. 4%. Visual symptoms associated with the use of computer screen of 59. 6% was found, the most frequent being the epífora (70. 6%), photophobia (67. 6%) and ocular (54. 4%), showing found a significant inverse correlation with lighting levels and manifestation of photophobia (p=0. 02; r= 0. 262). Moreover no significant correlation was found between the symptoms reported with viewing angle and visual acuity and contrast discrimination. Conclusion: Lighting working conditions of the study group are related to the manifestation of photophobia, finding significance; however visual association between symptoms and other sociodemographic variables, specifically with gender-screen photophobia, visual fatigue and photophobia found. and which will be presented in detail the results

Prevalencia de parásitos intestinales en niños preescolares de barrios vulnerables de Bogotá

Introducción: Infecciones parasitarias intestinales (IPI) son enfermedades tropicales desatendidas, a pesar de que su prevalencia es alta en muchos países en desarrollo. El impacto en la salud pública de los IPI es importante, especialmente para los niños debido al efecto negativo sobre el crecimiento y el desarrollo. Objectivos: Este estudio examina la prevalencia y factores de riesgo de IPI en niños preescolares de barrios en riesgo, incluidos los de las familias desplazadas. Materiales y Métodos: estudio transversal entre 239 niños preescolares de dos barrios vulnerables de Bogotá. Se recogieron muestras fecales y se examinaron microscópicamente utilizando dos técnicas (directa y Ritchie). Se aplicó cuestionario para indagar factores relacionados con el parasitismo intestinal. Resultados: Se encontró una prevalencia de 26,4% de parásitos intestinales patógenos (Giardia duodenalis, Blastocystis spp, Trichuris trichiura, Ascaris lumbricoides y Hymenolepis nana). La regresión logística resultó en cuatro factores de riesgo: hermanos ?5 años (OR 2.33 [1.077-5.021]), los perros callejeros (OR 2.91 [0.867-9.767]), los ocupantes de la casa (OR 2.57 [1.155-5.706]) y el sexo del niño/a (OR 2.17 [1.022-4.615]). Discusión: La presencia del IPI en los niños preescolar es un problema de salud importante en Bogotá y que debe abordarse. Una alta prevalencia de protozoos se encontró comparado con helmintos. La implementación de políticas que aborden los factores de riesgo podría ser un primer paso en la disminución de la prevalencia del IPI. El antecedente de desplazamiento no cambio ni el tipo de parásito ni la prevalencia de parasitismo.Introduction: Intestinal parasitic infections (IPIs) are neglected tropical diseases, even though their prevalence is high in many developing countries. The public health impact of IPIs is substantial, in particular for children due to the negative effect on growth and development. Objectives: This study examines the prevalence and risk factors of IPIs in preschool-children from at-risk neighborhoods, including those from internally displaced families. Materials and Methods: A cross-sectional study among 239 preschool-children from two vulnerable neighborhoods in Bogotá. Fecal samples were collected and microscopically examined (direct and Ritchie technique) and data regarding related factors was obtained through a questionnaire. Results: A prevalence of 26.4% for pathogenic parasites (Giardia duodenalis, Blastocystis spp, Trichuris trichiura, Ascaris lumbricoides, and Hymenolepis nana) was found. Logistic regression resulted in four risk factors: siblings ?5 years (OR 2.33 [1.077-5.021]), stray dogs (OR 2.91 [0.867-9.767]), household members (OR 2.57 [1.155-5.706]) and child's sex (OR 2.17 [1.022-4.615]). Discussion: IPI presence in preschool children is an important health issue in Bogotá which should be addressed. A high protozoan prevalence was found compared to helminthes. Implementing policies addressing risk factors could be a first step in decreasing IPI prevalenc

Reduction of malnutrition prevalences through health promotion in groups of school-aged children in a locality of Bogota

La desnutrición es una condición prevalente en la etapa escolar, que conlleva consecuencias en la salud y en el rendimiento escolar de los niños, a corto y a largo plazo. El objetivo del trabajo fue identificar los cambios en las prevalencias de desnutrición en grupos de niños, quienes fueron intervenidos con una estrategia que combinó actividades educativas, evaluación y acciones de intervención directa a casos problemáticos, por parte de estudiantes de medicina, en el periodo 2001-2005. Este estudio corresponde a la evaluación del programa de salud pública “Salud Escolar Integral”, instituido por la Facultad de Medicina y Ciencias de la Salud de la Universidad del Rosario. Para dicha evaluación, se realizó un estudio ecológico con mediciones antes y después a una intervención en grupos seleccionados de estudiantes, entre 5 y 8 años de edad. Cada año, se determinó la prevalencia de desnutrición aguda, crónica y global. En los cinco años de seguimiento, se evidenció una disminución estadísticamente significativa de las prevalencias de desnutrición aguda, de 4,5 a 0,6%; de desnutrición global, de 11,8 a 5,8% y de desnutrición crónica, de 16,4 a 8,3%. Este estudio presenta evidencia sobre la efectividad que puede tener un programa de intervención integral, desarrollado por estudiantes de medicina, sobre el estado nutricional de los niños.Malnutrition is prevalent in school aged children. It impairs the health and school performance of those affected in the short and in the long run. The objective of this study was to identify the changes in the prevalence of malnutrition in groups of school-aged children that were intervened by medical students with a strategy that combined educational activities, health evaluation, and actions directed to children with particular problems. This article presents the evaluation of the program “Salud Escolar Integral” [Comprehensive School Health]. This program was conducted by medical students from Universidad del Rosario School of Medicine and Health Sciences. An ecological study was done with measures before and after intervention. Population: Elementary school students from 5 to 8 years of age. Acute, chronic, and global undernourishment were calculated. During the five years of monitoring an statistically significant decrease was found in the prevalence of acute malnutrition from 4.5 to 0.6%, global malnutrition from 11.8 to 5.8%, and chronic malnutrition from 16.4 to 8.3%. This study presents evidence on the effectiveness of a comprehensive interventional program developed by medical students to decrease undernourishment on school age children.Incluye referencias bibliográfica

Low birth weight and prenatal care in Colombia: A cross-sectional study

Background: Low birth weight (LBW) is one of the most important factors affecting child morbidity and mortality worldwide; approximately one third of neonatal deaths are attributable to it. Most research and public health policy on LBW arise from developed nations, despite that most cases (96.5%) take place in developing countries. The specific features of prenatal care that prevent LBW in developing countries are unclear. This study aims to identify the characteristics of prenatal care associated with LBW in a developing country as Colombia. Methods: Observational cross-sectional study using data from the Colombian Demographic and Health Survey 2010. A total of 10,692 children were included. Descriptive statistics were calculated, followed by bivariate regressions of LBW with all other study variables. Finally, stepwise logistic binomial regression analyses were done. Results: A LBW prevalence of 8.7% was found. Quality of prenatal care (95%CI: 0.33, 0.92; OR=0.55), number of prenatal visits (95%CI: 0.92, 0.93; OR=0.92), and first prenatal visits during pregnancy (95%CI: 1.02, 1.07; OR=1.08) were associated with LBW even after controlling for all the studied variables. The health care provider conducting prenatal checkup, and insurance coverage, were not associated with LBW. Conclusion: This research provides information on the characteristics of prenatal care (quality, number of visits, and gestational age at first prenatal visit) which may strengthen LBW prevention in Colombia and possibly in countries with similar socioeconomic characteristics. © 2015 Pinzón-Rondón et al

Care coordination in two of Bogota’s public healthcare networks: A cross-sectional study among doctors

Introduction: Care coordination is a priority concern for healthcare systems. In Colombia, there is a lack of information on the topic. This study analysed how doctors of two Bogotá’s public healthcare networks perceived coordination between healthcare levels and what factors are associated with their perception. Methods: A cross-sectional study using the COORDENA-CO questionnaire to a sample of 363 doctors (network-1 = 181; network-2 = 182) in 2015. The questionnaire asks about types and dimensions of care coordination: information and clinical management, with items in a Likert scale, as well as conditions regarding health system, organisational and doctors’ conditions. Descriptive statistics and logistic regression analysis were performed. Results: The doctors’ perception of a high level of coordination did not exceed 25.4%. On coordination of information, limited transfer of clinical information was found. Concerning clinical management, there were limited care coherence, deficits in patient follow-up and lengthy waiting times for specialised care. A high perception of coordination were associated with being female, being over 50 years old, being a specialist, having less than one year’s working experience, working less than 20 h per week at the centre, forming part of network-1, having time available for performing coordination tasks, having job satisfaction and not identifying limitations imposed by healthcare insurers. Discussion: There was limited perception of coordination, in its different dimensions and types with some differences between networks. The results support the importance of guaranteeing job satisfaction, ensuring sufficient time to coordination-related activities and intervening in the restrictions imposed by healthcare insurers to improve care coordination. © The Author(s) 2019