Measuring the Progress and Success of Regional Health Policies: PRARI Toolkit of Indicators for the Union of South American Nations (UNASUR)

PRARI is a social development research project that looks at world-regional social governance, politics, and policy. PRARI brings together an international team of researchers studying the scope for enhancing the effectiveness of the contributions of Southern regional organisations to poverty reduction. It receives funding from the ESRC

Monitoring Pro-Poor Health-Policy Success in UNASUR

Monitoring pro-poor health policies at the regional level is essential for both countries and the regional bodies themselves, by identifying the issues related to the policy guidelines, the approach to health or information flows, as well as understanding implementation mechanisms of health policies at the local level. In order to address poverty and health problems, and strengthen ties between regional organizations and member countries, it is essential to generate mechanisms to track accountability to commitments and exchange of information to support the monitoring and evaluation of activities. Since its creation, UNASUR through the South American Health Council (CSS) has invested political and human resources in the area of health. The Five Year Plan 2010-2015 of the CSS, despite a number of pending activities, is the demonstration of this commitment. Added to this are the new activities the CSS gradually developed, which complement the work of the Council, such as their incursions in global health diplomacy. However, policy directions are still guided by the original values and principles included in the 2010-2015 health work plan. The “Poverty Reduction and Regional Integration” (PRARI) project presents an opportunity to generate a monitoring system that is based on existing needs in the region and supports the link between the countries and UNASUR, as well as UNASUR’s position at the global level. The aim of the PRARI project is to support the development of a monitoring system in collaboration with key stakeholders in the region. The focus will be the actions of the CSS in key policy areas such as primary health care, pharmaceutical policies and surveillance systems. Global processes such as those pertaining to the incoming sustainable development goals (SDGs) wil also be considered. In order for this indicator-based monitoring system to be effective and have an impact, it requires ‘regional ownership’ and the active participation of regional and national experts throughout the process of indicator development, implementation and evaluation. Furthermore, institutional support from UNASUR and its Member States, the main beneficiaries of this process, is critical for the monitoring system to be fully operational

Spatial distribution of tuberculosis in Cochabamba, socioeconomic determinants and catastrophic costs for households

Socioeconomic variables contribute to the burden and the spread of the tuberculosis, especially in developing countries. Likewise, patients with tuberculosis usually incur large costs directly related to their disease. Additional indirect costs also increase the economic burden of households creating barriers of access and adherence that can affect the healing of patients. The objective of our thesis was to determine the distribution of tuberculosis, its relationship to socio-economic determinants and assess the socio-economic consequences for patients and their households affected by the disease in the department of Cochabamba, Bolivia. Therefore, on the one hand we conducted an ecological study to evaluate the spatial distribution of tuberculosis and its relationship with socioeconomic determinants and the other hand we conducted a cross-sectional study with retrospective data collection to determine the socioeconomic impact of TB on patients and their households. We found that each region of the Department showed different values and characteristics regarding not only the incidence of tuberculosis but also regarding geography and socioeconomic variables, reflecting different realities in the five regions. The distribution pattern of the incidence of tuberculosis highlighted a high incidence in the Tropicals Regions, a moderate incidence in the Metropolitans Regions and a low incidence in the Valleys, Southern Cone and Andean Regions. The relationship between the incidence of tuberculosis and socioeconomic variables was also different between Regions. However, the variable "not homeowner" correlated positively with the incidence of tuberculosis in each Region. This variable has a very important link with the economic situation of households, because people who do not have their own home go to rental contracts that are usually associated with precarious conditions and the overcrowding of people, increasing risk of tuberculosis contamination. Likewise, we found that patients with TB treated in the health services network of Cochabamba, Bolivia, face a great financial burden as a result of the disease. Before the beginning of the diagnosis when seeking health care, more medical direct costs are observed, especially by radiography and medicines, these costs decrease during treatment, probably because the coverage of the health system allows avoiding these costs when the patient is already diagnosed. During the treatment, the most important costs were those related to transport and food due to the administration of the DOTS, due to the fact that many people have to travel long distances and even consume food outside the home to receive their treatment in the health center. In addition, there are costs for nutritional supplements and additional foods to the regular diet that patients must incur to improve their general condition. Indirect costs were the highest in the entire TB episode, mainly due to the loss of income due to TB especially in MDR-TB patients. Almost half of patients suffer a catastrophic cost, especially those who came from an urban province, those who were older than 55 years, and those having a low economic income. Regarding the measures to be taken, due to the differences in the distribution of the disease in the different regions, adapted actions must be developed for each one of them. For the disease control, the epidemiological surveillance system must be adapted to each territorial base, using an active detection strategy in regions where the incidence is higher. Our study reports a relationship between the disease and "not homeowner", this finding shows that tuberculosis is associated to the precariousness conditions and in specifically associated to the overcrowding of people. In this sense, many of bad conditions of people can be improved with an intersectoral approach focusing the action on the socio-economic determinants to improve living conditions through primary prevention measures, like the implement social housing programs, improve the educational conditions of the population and improve the nutritional status of the vulnerable population. Regarding costs related to tuberculosis when seeking health care, the public health system should take charge of patients in a timely manner, especially prioritizing the care of patients with suspected tuberculosis. In relation the costs during treatment, since these costs are indirect related to food and transportation, it is necessary to develop food and a transportation subsidy programs. Public policies must also be generated to achieve labor immobility until healing and implement protection programs to population from the economic and health effects of contracting TB, since indirect costs are the highest of the entire TB episode, mainly due to loss of income.(SP - Sciences de la santé publique) -- UCL, 202

Spatial Distribution of Tuberculosis and Socioeconomic Inequalities in Cochabamba, Bolivia

Background: Through their associations with the incidence of tuberculosis, socioeconomic variables contribute to the burden and the spread of the disease, especially in developing countries. Because there is no such data in Bolivia, we conducted an ecological study to evaluate the spatial distribution of tuberculosis and its relationship with socioeconomic determinants in the Department of Cochabamba. Methods: Incidence of tuberculosis was computed from the 2016 data reported from the Tuberculosis Control Program and the socioeconomic indicators were retrieved from the Bolivian Population and Housing Census of the National Institute of Statistics conduced in 2012 at the municipality level. Incidence rates were standardized by age and were mapped to visualize the spatial distribution. Pearson correlation coefficients were used for associations. Results: The spatial distribution of tuberculosis showed a high incidence in the Tropical Region with 163 cases/100,000. The Metropolitan Region showed a lower incidence of 52 cases/100,000 and the Valleys, Southern Cone and Andean Regions showed an ever lower incidence, with 26 cases/100,000. In the Tropical Region where there was a high incidence in all five municipalities, there was a negative correlation with school attendance (r=-0.46) and a positive correlation with population density (r=0.62). In the Metropolitan Region presented with medium incidences, a positive correlation with population density was observed (r=0.52) across de 8 municipalities. In the joint analysis of the 34 municipalities of the Regions Andean, Southern Cone and Valleys having the lowest incidences, a quite low correlation was observed with all socioeconomic variables. In all regions, a moderate to highly positive correlation was observed with the variable “not be owner of its housing”: Tropical Region (r=0.65), Metropolitan Region (r=0.82) and Valleys, Southern Cone and Andean Regions (r=0.51). Conclusions: The pattern of the distribution of the incidence of tuberculosis showed a high incidence in all areas of the Tropical Region. Each of the 3 regions had its own socioeconomic variables associated with tuberculosis incidence but the variable “not be owner of its housing” was however positively associated with TB incidence in all regions

Intestinal Parasitic Infections in Adult Living with HIV in Cochabamba, Bolivia

Background: Thanks to the widespread use of Antiretroviral Therapy (ART), Human Immunodeficiency Virus (HIV) infection is becoming a chronic manageable disease. In low resources settings where ART is available, but not widely, opportunistic infections such as parasites diseases remain common. These conditions represent a public health problem in the world due to the high prevalence in developing countries and particularly for patients with HIV/AIDS. To date there have been no systematic study on the prevalence of intestinal parasites in people living with HIV/AIDS (PLWHIV) in Bolivia. The study aimed to evaluate the occurrence of intestinal parasitic infections in PLWHIV who attended routine controls at the reference center for HIV control and prevention in Cochabamba (CDVIR) between January 2011 and December 2015. Methods: Ethical approval was obtained prior to the commencement of this study from the Ethics Committees of the Department of Cochabamba-Bolivia and the Universidad Mayor de San Simón, Institute of Biomedical Research (IIBISMED/UMSS). Code: CB-2016-015. A Retrospective Analysis was carried out Based on the reports of the reference laboratory in the city of Cochabamba (LABIMED) using direct parasitological methods founded on the macroscopic and microscopic identification of parasitic elements present in the stool. Data was collected in an Excel spreadsheet, based on reports from the parasitology laboratory, which was transferred for statistical analysis to SPSS 24.0 (SPSS Inc., Chicago IL, USA). The characteristics of the study participants are reported as mean, range and percentage, as appropriate. The test of X2 or Fisher’s exact test was used for all categorical variables. Logistic regression analysis was used to test the associations. A given statistical test was reported significant if it resulted in a p-value <0.05. Results: During the 5-years of the study, a number varying between 313 and 620 patients were assessed each year, and 12 parasitic species were identified. The highest prevalence was 33.2% in 2011 and there was 9.9% of polyparasitism. In 2012, the prevalence was 28.6%, with 8.3% of polyparasitism, in 2013 it reached 30.4% with a polyparasitosis of 7.7%, while in 2014 it was 24. 5%, the lowest in the period, with a polyparasitism rate of 8.5%. Finally, in 2015 the prevalence reached 27.1% with a polyparasitism rate of 7.3%. The most prevalent species in order of frequency were Blastocystis Homminis, Entamoeba coli (non-Pathogen), Giardia Lamblia and Entamoeba histolytica/dispar, respectively. Regression analysis showed no significant association with sex or with consistence of stool sample but prevalence was higher in people under 30 years of age. Conclusion: Taking into account the epidemiological and geographical context, the frequency of presentation of these infections reach practically one third of these population and thus remains a high problem in Bolivia. So, further studies are required to clarify the epidemiology of these infectious diseases in this endemic region

Complete genome sequence of the sugarcane nitrogen-fixing endophyte gluconacetobacter diazotrophicus PAL5

17 p. : il.Background: Gluconacetobacter diazotrophicus Pal5 is an endophytic diazotrophic bacterium that lives in association with sugarcane plants. It has important biotechnological features such as nitrogen fixation, plant growth promotion, sugar metabolism pathways, secretion of organic acids, synthesis of auxin and the occurrence of bacteriocins. Results: Gluconacetobacter diazotrophicus Pal5 is the third diazotrophic endophytic bacterium to be completely sequenced. Its genome is composed of a 3.9 Mb chromosome and 2 plasmids of 16.6 and 38.8 kb, respectively. We annotated 3,938 coding sequences which reveal several characteristics related to the endophytic lifestyle such as nitrogen fixation, plant growth promotion, sugar metabolism, transport systems, synthesis of auxin and the occurrence of bacteriocins. Genomic analysis identified a core component of 894 genes shared with phylogenetically related bacteria. Gene clusters for gum-like polysaccharide biosynthesis, tad pilus, quorum sensing, for modulation of plant growth by indole acetic acid and mechanisms involved in tolerance to acidic conditions were identified and may be related to the sugarcane endophytic and plant-growth promoting traits of G. diazotrophicus. An accessory component of at least 851 genes distributed in genome islands was identified, and was most likely acquired by horizontal gene transfer. This portion of the genome has likely contributed to adaptation to the plant habitat. Conclusion: The genome data offer an important resource of information that can be used to manipulate plant/bacterium interactions with the aim of improving sugarcane crop production and other biotechnological applications