Plan de fortalecimiento en la gestión operativa y cultural del cantón Morona provincia de Morona Santiago periodo 2012-2017

El presente trabajo investigativo permitió realizar un plan de fortalecimiento en la gestión operativa y cultural del GAD Municipal del Cantón Morona, para beneficio de la Institución municipal, de los actores sociales y culturales del Cantón Morona. En este trabajo hemos utilizado el Método Inductivo y Deductivo, el cual nos ha permitido contar con las herramientas para obtener conocimientos e información de hechos concretos, reales y objetivos; el método analítico nos permitió conceptualizar los instrumentos técnicos como: FODA Institucional, FODA Departamental, diagnostico situacional, POA de la Dirección de Gestión Cultural. Las técnicas utilizadas fueron: observación científica, entrevista y la encuesta dirigida a 350 personas entre distinto rango desde los 15 a 65 años de edad. La presente investigación promoverá el establecimiento de la Dirección Intercultural como nuevo modelo de Gestión en el ámbito cultural, que permita construir la diversidad cultural, la identidad cultural, la pluriculturalidad en el marco del respeto, la solidaridad y la convivencia a plenitud entre culturas; con la finalidad de consolidar un cantón que preserve, revitalice y mantenga su identidad cultural. La Dirección intercultural promoverá el respeto en la diversidad, sobre la dignidad, los derechos de las personas, con prácticas en la interacción cotidiana, dejando a un lado posiciones racistas e inequidades de grupos asentados en 120 nuestro cantón. La interculturalidad será el nexo de participación ciudadana para construir una sociedad justa e igualitaria, en donde el gobierno municipal con liderazgo y gestión satisfaga las necesidades básicas para el desarrollo de la cultura. Necesitamos en el corto y mediano plazo cambiar las actitudes de autoridades y ciudadanos en general que vivimos en el cantón Morona para eliminar los prejuicios y resistencia mutuos entre grupos étnicos y actores sociales. Es necesario que la Dirección Intercultural mediante planes, programas y proyectos logre el desarrollo equitativo sostenible y sustentable para una convivencia armónica entre Mestizos, Macabeos y Shuaras.This investigative work allowed carrying out a plan to strengthen cultural and operational management of the Municipal GAD from the Morona Canton, to benefit the institution and social and cultural actors of the Morona canton. It was used the inductive and deductive method that allowed to get knowledge and information of specific, real and objective facts; the analytical method allowed to conceptualize technical instruments such as: institutional SWOT, departmental SWOT, Diagnostics situational, POA from the Cultural Management Direction. The techniques used were: interview, scientific observation and survey directed to 350 people between 15 and 65 years of age. This research will promote the establishment of the intercultural leadership as a new model of management in the cultural aspect, multiculturalism in the framework of respect, solidarity and peaceful coexistence between cultures in order to consolidate the canton, in this way it will preserve, revitalize and maintain its cultural identity. The Intercultural Direction will promote the respect in the diversity on the dignity, people's rights, with practices in the daily interaction leaving aside racist positions and inequities from the groups of this canton. The interculturality will be the connection of citizen participation to build a just and egalitarian society where the municipal government with leadership and management satisfies the basic needs for the development of the culture. It is necessary to change the authorities' and citizens' attitudes that live in the canton Morona to eliminate prejudices and mutual resistance between ethnic groups and social. Actors. It is necessary that the Direction, through intercultural plans, programs and projects achieve equitable and sustainable development and sustainable for a harmonious coexistence between Mestizos, Maccabees and Shuaras

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030