Impacto de las remesas sobre el consumo de los hogares y la inversión público-privada en Ecuador: Aplicación de un Modelo Vectorial Autorregresivo y función impulso-respuesta

El objetivo de la presente investigación fue medir el impacto de los componentes de la demanda agregada, consumo e inversión, generado por cambios en los flujos de remesas que ingresaron al Ecuador en el periodo 2000-2020 empleando un modelo de Vectores Autorregresivos, a través de la función impulso-respuesta. Los resultados demostraron que las remesas disminuyeron el consumo de los hogares y la inversión público-privada en el corto plazo. No obstante, el impulso del flujo de remesas que ingresaron al país en el periodo analizado, incrementó ambas variables, tanto en el mediano como en el largo plazo. Concluyendo así que, los hogares receptores de remesas, una vez que reciben este ingreso de sus familiares, tardan en tomar una decisión sobre el destino que le darán, por lo que su consumo no se adapta ni se modifica en los primeros trimestres, sino con el paso del tiempo, cuando pasa a ser utilizado para el gasto final de los hogares. Palabras clave: VAR, remesas, demanda agregada, consumo de los hogares, inversión. AbstractThe objective of this research was to measure the impact of the components of aggregate demand, consumption, and investment, generated by changes in the remittance flows that entered Ecuador in the period 2000-2020, using an Autoregressive Vector model, through the impulse-response function. The results showed that remittances decreased household consumption and public-private investment in the short term. However, the impulse of the flow of remittances that entered the country in the period analyzed increased both variables, in the medium 7and long term. Thus, it concludes that households receiving remittances, once they receive this income from their relatives, take time to decide about the destination they will give it, so their consumption does not  adapt or change in the first quarters, but with time when it becomes used for the final expenditure of households. Keywords: VAR, remittances, aggregate demand, household consumption, investment

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