Ethnic group inequalities in coverage with reproductive, maternal and child health interventions:cross-sectional analyses of national surveys in 16 Latin American and Caribbean countries

Background Latin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among these groups in population coverage with reproductive, maternal, newborn, and child health interventions. Methods We analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15-49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12-23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), woman's education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression. Findings Ethnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0.82, IQR 0.66-0.92), antenatal care (0.86, 0.75-0.94), and skilled birth attendants (0.75, 0.68-0.92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries. Interpretation The lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level-such as vaccines-show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes.Entidad financiadora: Bill & Melinda Gates Foundation; Wellcome Trus

Long-term nutritional consequences of acute infectious diseases in childhood: cohort study

This study was aimed to assess the relationship between hospital admission for diarrhea and pneumonia in the first three years of life and anthropometry and body composition in 18-year-old men. In 1982, all live births in the city s hospital were identified and followed-up several times. In 2000, males were identified and examined when enrolling in the national Army, were evaluated 2250 individuals of the original members of the cohort. Multiple linear regression models were used in multivariable analyses. When analyses were adjusted, admission for pneumonia in the first two years of life was negatively associated with later height. Boys with two or more admissions, were 2.40 cm shorter (IC95% -4.19;-0.61 cm) at age 18 compared to those without admissions. Admission for diarrhea and pneumonia in infancy did not have an impact on weight, body mass index or body composition, suggesting that later recovery of weight deficit in infancy did not occur at expense of fat mass accumulation.O presente estudo teve por objetivo avaliar a associação entre as hospitalizações por diarréia e pneumonia nos primeiros três anos de vida com a antropometria e a composição corporal em homens com 18 anos de idade. Em 1982, todos os nascimentos ocorridos nas maternidades da cidade foram identificados e acompanhados inúmeras vezes. Em 2000, os homens foram identificados e examinados no momento do alistamento militar, avaliou-se 2250 indivíduos pertencentes à coorte original. Modelos de regressão linear múltipla foram utilizados nas análises multivariadas. Logo após as analises ajustadas, somente as hospitalizações por pneumonia ocorridas nos dois primeiros anos de vida estiveram negativamente associadas à altura aos 18 anos de idade. Os meninos com >2 hospitalizações, tiveram -2,40cm (IC 95% -4,19; -0,61cm) aos 18 anos comparados aos meninos sem antecedentes de hospitalizações. As hospitalizações por diarréia e pneumonia na infância não tiveram impacto sobre o peso, o índice de massa corporal e a composição corporal, sugerindo que a recuperação posterior do déficit de peso na infância não ocorreu às custas de um acúmulo de massa gorda

Ethnic group inequalities in coverage with reproductive, maternal and child health interventions: cross-sectional analyses of national surveys in 16 Latin American and Caribbean countries

Summary: Background: Latin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among these groups in population coverage with reproductive, maternal, newborn, and child health interventions. Methods: We analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15–49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12–23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), woman's education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression. Findings: Ethnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0·82, IQR 0·66–0·92), antenatal care (0·86, 0·75–0·94), and skilled birth attendants (0·75, 0·68–0·92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries. Interpretation: The lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level—such as vaccines—show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes. Funding: The Bill & Melinda Gates Foundation (through the Countdown to 2030 initiative) and the Wellcome Trust