Impact of long term policies based on social determinants of health: the Costa Rican experience

The consolidation of Democracy and the abolition of the army in Costa Rica at the end of the 1950s, instituted in the Political Constitution, led to the decision to prioritize the investment of public resources in the social sector as a strategy to advance towards the development of the country. The creation of a solid legal framework, the absence of a rigid stratification connected to a hierarchy of power that generates different access to resources, the implementation of democratic elections with high participation, and the development of public infrastructure have been essential factors in assuring access to education, access to water and basic sanitation as well as to access to health, and social security. Between 1950 and 1980, Costa Rica increased public social spending from 8.6% to 23.6% of the GDP, demonstrating the political will to invest in social determinants, in order to universalize access to education, safe water for consumption, basic sanitation, and primary health care. During this period the illiteracy rate was reduced from 21% to 10%, the average number of years of study increased and the level of education of the economically active population improved. Access to drinking water increased from 53% to 86% and coverage of the population’s health services and social security increased from 8 to 75%. Poverty, measured by level home income, declined from 50% in 1960 to 25% at the beginning of the 1980s. The decline in infant mortality during the period 1960-1980 showed that the least the educational level of mothers, the greater the increase in the probability of surviving, showing a positive effect of public policies and access to education in most secluded populations. At the national level, between 1970 and 1980 infant mortality was reduced from 68.4 to 18.1 x 1000 live births achieving a rate of 9.2 in 2010. Fertility declined from 4.8 to 1.8 and life expectancy increased from 65.8 to 79.2 years, reaching a total of 81.9 years in women in 2010. At the end of the 1980s in the middle of a global economic crisis, Costa Rica implemented a Health Sector Reform process that led to the adaptation of a model of care and delivery of services under the Costa Rican Social Security Fund, strengthening the leading role of the Ministry of Health as a guarantorfor the well-being of the population. The key strategy has been to advance toward health promotion by addressing its determinants to reduce the social gaps. The case of Costa Rica demonstrates that sustained public investment in the social sector with a long term vision has generated a redistributive effect of resources through interventions targeted to address the social determinants. The increase in the educational status and participation of women in the work force and in the political area has been a determinant associated with the improvement of the health indicators. Monitoring and evaluating, transparency, accountability and management, are key factors that have facilitated greater social development.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Centro Centroamericano de Población (CCP

Una aproximación a la sexualidad de los hombres y las mujeres desde la adolescencia hasta la adultez mayor

Mediante el empleo de la base de datos de la ENSSR-10, se caracterizaron las prácticas de sexualidad de una muestra representativa de la población de hombres y mujeres, de 15 a 79 años de edad. A lo largo del ciclo de vida, partiendo de la etapa de adolescencia hasta abordar a las personas adultas mayores, se analizó el tipo de pareja con quien las personas tuvieron sus primeras relaciones sexuales, la frecuencia y el tipo de contacto sexual durante el último año de vida y los roles sexuales con respecto a quién toma las decisiones según sexo, edad y diversas variables sociales (como nivel educativo, zona rural-urbana y religión). Además, se estimó la prevalencia de disfunciones sexuales en hombres y mujeres según grupos etarios, así como la frecuencia con la cual las personas alcanzan el orgasmo y el nivel de satisfacción en el desarrollo de su vida sexual.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Centro Centroamericano de Población (CCP

Assessing factors influencing communities' acceptability of mass drug administration for the elimination of lymphatic filariasis in Guyana.

BACKGROUND: Guyana is one of four countries in the Latin American Region where lymphatic filariasis (LF) remains endemic. In preparation for the introduction of a new triple drug therapy regimen (ivermectin, diethylcarbamazine, and albendazole (IDA)) in 2019, an acceptability study was embedded within sentinel site mapping in four regions to assess mass drug administration (MDA) coverage and compliance, acceptability, and perceptions about treatment and disease. The results from this survey would inform the rollout of IDA in Guyana in 2019. METHODS: Data collection for the study occurred in August 2019, using a validated questionnaire administered by trained enumerators. Across all regions, a total of 1,248 participants were sampled by the Filarial Mapping team. Four-hundred and fifty-one participants aged over 18 years were randomly selected for participation in an expanded acceptability questionnaire. All data were captured in Secure Data Kit (SDK). RESULTS: Acceptability was measured using a mean acceptability score. Unadjusted mean scores ranged from 24.6 to 29.3, with 22.5 as the threshold of acceptability. Regional variation occurred across many indicators of interest: self-rated understanding about LF, mechanisms of LF transmission, LF drug safety and history of treatment during MDA. Region IV (Georgetown) recorded higher knowledge about LF, but lower compliance and acceptability. Number of pills was not perceived as a concern. CONCLUSION: Acceptability of MDA was good across all four regions under study. Results from this study set a baseline level for key indicators and acceptability, from which the acceptability of IDA can be measured. Regional variations across indicators suggest that localized approaches should be considered for social mobilization and MDA delivery to capture these contextual differences

Prevalencia de diabetes mellitus auto-reportada en Costa Rica, 1998

Objetivo: Determinar la prevalencia de diabetes mellitus (DM) autoreportada en Costa Rica y su asociación con factores sociodemográficos. Métodos: En la encuesta Nacional de Hogares de Propósitos Múltiples de 1998 se incluyó un módulo sobre DM. La población de estudio fueron los habitantes de todas las viviendas particulares, los dominios lo constituyeron las regiones de planificación definidas por el Ministerio de Planificación y Política Económica. En cada hogar se entrevistó a un informante mayor de 15 años para recolectar información sobre los miembros del hogar con DM, uso de insulina, presencia de complicaciones, tipo de limitación física y utilización de servicios de salud. Se calcularon frecuencias y OR (IC 95%) mediante regresión logística. Resultados: La prevalencia de diabetes fue 2,5% (1,9% en hombres y 3,1% mujeres). El 89% de la muestra eran mayores de 40 años cuya prevalencia fue de 9,4% (7,4% hombres, 11,4% mujeres). La mayoría de diabéticos eran casados, tenían educación primaria y se clasificaron como "no pobres". El 38,2% usaba insulina. En el último semestre, el 82,2% asistió a consultas médicas y el 8,4% requirió hospitalización. La enfermedad causó complicaciones en 36,1%, especialmente en la agudeza visual. Después de ajustar por edad se encontró que tienen mayor probabilidad de ser diabéticos las mujeres y las personas procedentes de áreas urbanas. El acceso a la educación superior es un factor protector. Conclusión: La prevalencia de la enfermedad es menor que en otros países, pero puede estar subestimada por ser auto-reportada. Las características de los pacientes son acordes con lo reportado por la literatura. El elevado porcentaje de pacientes con complicaciones puede reflejar un pobre control metabólico. Factores genéticos explicarían la mayor probabilidad de diabetes en mujeres. La asociación entre procedencia, estado civil y escolaridad con diabetes puede explicarse por estilos de vida, pero su interpretación es limitada por ser un estudio transversal. Sería útil promover la detección temprana de la enfermedad en la población señaladaObjective: To estimate the prevalence of Diabetes Mellitus through self- notification in Costa Rica and its association with socio-demographic factors. Methods: A module about Diabetes Mellitus was included in the National Home Survey of Multiple Purpose (NHSMP). The study population was defined as all private homes and their occupants, the study dominium were the regions defined by the Ministry of Planning and Economical Policy. At every home, information about family members with Diabetes Mellitus, use of insulin, presence of complications, type of physical limitations and use of health services, was given by and informant, of 15 years or older. Results: The prevalence of diabetes was 2,5% (1,9% in men and 3,1% in women). The prevalence was 9,4% for the 89% of people older than 40 years old (7,4% in men and 11,4% in women). Most of the diabetics were married, had elementary education and were classified as "not poor". The use of insulin was 38,2%. In the last semester, 82,2% attended medical services and 8,4% required hospitalization. The disease caused complications to 36,1%, specially visual. After adjusting for age, it was found that women had greater possibility of becoming diabetic as were, people from urban areas. Access to higher education is a protective factor. Conclusion: The prevalence of this disease was lower than in other countries, however it may be underestimated because of the use of self- notification. The characteristics of the patients agreed with the literature. The elevated percentage of patients with complications may reflect poor metabolic control. Genetic factors could explain the higher probability of diabetes in women. The association of place of residency, marital status and education, with diabetes may be explained by the life styles, but its interpretation is limited since this is a transversal study. It would be useful to encourage early detection of the disease in that specific populatio

Varicella prevention in Costa Rica: impact of a one-dose schedule universal vaccination

Introduction: To describe the impact following a 1-dose Varicella vaccination schedule introduced in Costa Rica in September 2007. Areas covered: This is a retrospective review using epidemiologic surveillance national databases of varicella cases and hospitalizations, period 2000–2015. We analyzed age-related varicella incidence cases and hospitalization trends before and after the vaccine introduction. Expert commentary: Varicella vaccine coverage among children 16 months age increased from 76% in 2008 to 95% in 2015. During this period Costa Rica reached a 73.8% reduction of Varicella reported cases and 85.9% reduction of hospitalizations in the general population. Among children under 5 years of age, that reduction was 79.1% and 87%, respectively. Varicella complications in hospitalized patients decreased 98%, from n = 53 in 2008 to n = 1 in 2014. After 8-years post implementation of a 1-dose schedule of universal varicella vaccination, a dramatic overall disease reduction in incidence, hospitalizations and complicated cases has been observed in all age groups

Community Survey of Lymphatic Filariasis Mass Drug Administration Acceptability in Guyana, August 2019

A cross-sectional community survey of public perceptions and attitudes relating to Lymphatic Filariasis (LF) and Mass Drug Administration (MDA) elimination efforts was conducted in four regions of Guyana during August 2019 as a component of ongoing LF remapping efforts. Enumerators collected data on respondents' self-rated knowledge of and perception of LF and MDA, as well as historic coverage and compliance with MDA and a validated metric of LF MDA acceptability. General demographic information was also collected. (2021-07-15