Apoyando el desarrollo en la primera infancia : de la ciencia a la aplicación a gran escala

Mensajes clave de la serie: Las consecuencias de salud y económicas de no actuar son elevadas. Un alarmante 43% de los niños menores de cinco años que viven en países de ingresos bajos y medianos (en total, unos 250 millones de niños) están en riesgo de tener un desarrollo inadecuado a causa de la pobreza y el retraso del crecimiento.1,4 En realidad, este porcentaje es más elevado porque hay otros factores que representan riesgos para la salud y el bienestar. Un mal comienzo en la vida puede afectar negativamente la salud, la nutrición y el aprendizaje. Estos efectos negativos se extienden a la edad adulta, resultando en bajos ingresos económicos y generando tensiones sociales. Además, estas consecuencias negativas repercuten no solo en la generación actual, sino también en las futuras. Se calcula que los individuos afectados por un mal comienzo en la vida sufren una pérdida de aproximadamente una cuarta parte del promedio anual de ingresos en la edad adulta, mientras que los países pueden perder hasta el doble de su gasto actual del PIB en salud y educación; Los niños pequeños necesitan recibir, desde el principio, un cuidado cariñoso y sensible a sus necesidades. El desarrollo empieza en el momento de la concepción. Los estudios demuestran que la primera infancia no es solamente el período de mayor vulnerabilidad a los factores de riesgo, sino también una etapa crítica en la que los efectos positivos de las intervenciones tempranas son más marcados y en la que se pueden reducir los efectos de los factores que afectan negativamente al desarrollo. La experiencia que influye más en el desarrollo de los niños pequeños es el cuidado cariñoso y sensible que le procuran sus padres, otros familiares, sus cuidadores y los servicios comunitarios. El cuidado cariñoso y sensible a las necesidades del niño se caracteriza por la existencia de un ambiente estable que facilita la buena salud y la nutrición de los niños, que protege al niño de posibles peligros y le ofrece la posibilidad de empezar su aprendizaje a una edad temprana, a través de relaciones e interacciones cariñosas. Los beneficios del cuidado cariñoso y sensible se extienden a toda la vida y se expresan en una mejor salud, mayor bienestar y mayor capacidad de aprender y de ganarse la vida. Las familias necesitan apoyo para proveer el cuidado cariñoso y sensible, incluyendo recursos materiales y económicos, políticas nacionales, como licencias de paternidad remuneradas, y prestación de diversos servicios, incluyendo servicios de salud, nutrición, educación y la protección infantil y social; Debemos de entregar intervenciones multisectoriales comenzando con el sector salud como punto de partida para llegar a los niños más pequeños. El objetivo de estas intervenciones, entre ellas el apoyo a las familias para que puedan proporcionar un cuidado cariñoso y sensible y hagan frente a los problemas que se puedan presentar, es proteger al niño de diversos riesgos que pueden afectar a su desarrollo. Para ello, se pueden integrar las intervenciones en los servicios de salud materno-infantil existentes. Estos servicios deben satisfacer las necesidades tanto del niño como de su cuidador principal. Por tanto, deben apoyar el desarrollo del niño y la salud y el bienestar de la madre y la familia. Este enfoque viable es un punto de partida esencial para establecer colaboraciones multisectoriales de ayuda a las familias que permitan llegar a los niños más pequeños. Estas intervenciones deben satisfacer necesidades básicas como la nutrición, el apoyo al crecimiento y la salud; la protección de los niños; la prevención de la violencia doméstica, la protección social que asegure la estabilidad económica de la familia y la capacidad para acceder a servicios; y la educación que brinde acceso a oportunidades de aprendizaje de calidad a una edad temprana; Debemos reforzar la capacidad de las autoridades gubernamentales para ampliar los servicios que funcionan. Cuatro estudios de casos realizados en países de distintas regiones del mundo demuestran que se pueden llevar a gran escala programas nacionales que son efectivos y sostenibles. Sin embargo, para que esto suceda es un requisito indispensable el contar con liderazgo de las autoridades y dar prioridad a las políticas adecuadas. Los gobiernos disponen de distintas opciones para alcanzar las metas y los objetivos fijados en relación con el desarrollo en la primera infancia, desde iniciativas que promuevan cambios y abarquen a diversos sectores gubernamentales hasta la ampliación progresiva de servicios existentes. Los servicios y las intervenciones en favor del desarrollo de los niños pequeños son fundamentales para que todos ellos alcancen el máximo de su potencial en el transcurso de su vida y para extender estos efectos a la siguiente generación. Este propósito es un elemento central de los Objetivos de Desarrollo Sostenible

Is Swaziland on track with the 2015 millennium development goals?

According to the Millennium Development Goals (MDGs) agreement, each participating country has to periodically provide a report that will show the progress on their achievement towards the goals. This article’s aim is to evaluate Swaziland’s prospects of achieving eight MDGs by 2015. This article is an analysis of the current situation of Swaziland, and the aim of this analysis is to look beyond the statistical values to see if the achievements (including lifetime achievements) are on track and whether what is yet to be achieved can really be achieved. Secondary information was collected from various sources. Several countries and organizations have committed themselves to the following eight development goals: (1) eradicate extreme poverty; (2) achieve universal primary education; (3) promote gender equality and empower women; (4) reduce child mortality; (5) improve maternal health; (6) combat HIV/AIDS, malaria and other diseases; (7) ensure environmental sustainability; and (8) develop a global partnership for development. National development is dependent on many factors; therefore, different countries across the world have adopted the MDGs as means of alleviating many of the social ills hindering progress and development. Based on different sources, Swaziland is on track with its MDGs, and there is no doubt that Swaziland will continue to work hard to these ends. It has been argued that there has been progress made that has resulted in significant changes to people’s lives, but the question that has to be asked is how long these achievements can realistically last. A reduction of the rate of child mortality, maternal mortality and HIV/AIDS in Swaziland are needed

Prevalence and factors associated with non-utilization of healthcare facility for childbirth in rural and urban Nigeria: Analysis of a national population-based survey

Aim: The aim of this study was to assess the rural–urban differences in the prevalence and factors associated with non-utilization of healthcare facility for childbirth (home delivery) in Nigeria. Methods: Dataset from the Nigeria demographic and health survey, 2013, disaggregated by rural–urban residence were analyzed with appropriate adjustment for the cluster sampling design of the survey. Factors associated with home delivery were identified using multivariable logistic regression analysis. Results: In rural and urban residence, the prevalence of home delivery were 78.3% and 38.1%, respectively (p < 0.001). The lowest prevalence of home delivery occurred in the South-East region for rural residence (18.6%) and the South-West region for urban residence (17.9%). The North-West region had the highest prevalence of home delivery, 93.6% and 70.5% in rural and urban residence, respectively. Low maternal as well as paternal education, low antenatal attendance, being less wealthy, the practice of Islam, and living in the North-East, North-West and the South-South regions increased the likelihood of home delivery in both rural and urban residences. Whether in rural or urban residence, birth order of one decreased the likelihood of home delivery. In rural residence only, living in the North-Central region increased the chances of home delivery. In urban residence only, maternal age ⩾ 36 years decreased the likelihood of home delivery, while ‘Traditionalist/other’ religion and maternal age < 20 years increased it. Conclusion: The prevalence of home delivery was much higher in rural than urban Nigeria and the associated factors differ to varying degrees in the two residences. Future intervention efforts would need to prioritize findings in this study

Neonatal tetanus in Turkey; what has changed in the last decade?

dikici, bunyamin/0000-0001-7572-6525WOS: 000259222800001PubMed: 18713452Background: Neonatal tetanus (NT) is still considered as one of the major causes of neonatal death in many developing countries. The aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may contribute (or may have contributed) to the elimination of the disease in Diyarbakir. Methods: The data of sixty-seven infants whose epidemiological and clinical findings were compatible with neonatal tetanus were reviewed. Patients were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Factors having a contribution to the higher rate of tetanus among newborn infants were discussed. Results: A total of 55 cases of NT had been hospitalized between 1991 and 1996 whereas only 12 patients admitted in the last decade. All of the infants had been delivered at home by untrained traditional birth attendants (TBA), and none of the mothers had been immunized with tetanus toxoid during her pregnancy. Twenty-eight (41.8%) of the infants died during their follow-up. Lower birth weight, younger age at onset of symptoms and at the time admission, the presence of opisthotonus, risus sardonicus and were associated with a higher mortality rate. Conclusion: Although the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the last decade efforts including appropriate health education of the masses, ensurement of access to antenatal sevices and increasing the rate of tetanus immunization among mothers still should be made in our region to achieve the goal of neonatal tetanus elimination

The impact of the environment on health by country: a meta-synthesis

<p>Abstract</p> <p>Background</p> <p>Health gains that environmental interventions could achieve are main questions when choosing environmental health action to prevent disease. The World Health Organization has recently released profiles of environmental burden of disease for 192 countries.</p> <p>Methods</p> <p>These country profiles provide an estimate of the health impacts from the three major risk factors 'unsafe water, sanitation & hygiene', 'indoor air pollution from solid fuel use' and 'outdoor air pollution'. The profiles also provide an estimate of preventable health impacts by the environment as a whole. While the estimates for the three risk factors are based on country exposures, the estimates of health gains for total environmental improvements are based on a review of the literature supplemented by expert opinion and combined with country health statistics.</p> <p>Results</p> <p>Between 13% and 37% of the countries' disease burden could be prevented by environmental improvements, resulting globally in about 13 million deaths per year. It is estimated that about four million of these could be prevented by improving water, sanitation and hygiene, and indoor and outdoor air alone. The number of environmental DALYs per 1000 capita per year ranges between 14 and 316 according to the country. An analysis by disease group points to main preventions opportunities for each country.</p> <p>Conclusion</p> <p>Notwithstanding the uncertainties in their calculation, these estimates provide an overview of opportunities for prevention through healthier environments. The estimates show that for similar national incomes, the environmental burden of disease can typically vary by a factor five. This analysis also shows that safer water, sanitation and hygiene, and safer fuels for cooking could significantly reduce child mortality, namely by more than 25% in 20 of the lowest income countries.</p

The burden of child maltreatment in the East Asia and Pacific region

This study estimated the health and economic burden of child maltreatment in the East Asia and Pacific region, addressing a significant gap in the current evidence base. Systematic reviews and meta-analyses were conducted to estimate the prevalence of child physical abuse, sexual abuse, emotional abuse, neglect, and witnessing parental violence. Population Attributable Fractions were calculated and Disability-Adjusted Life Years (DALYs) lost from physical and mental health outcomes and health risk behaviors attributable to child maltreatment were estimated using the most recent comparable Global Burden of Disease data. DALY losses were converted into monetary value by assuming that one DALY is equal to the sub-region’s per capita GDP. The estimated economic value of DALYs lost to violence against children as a percentage of GDP ranged from 1.24% to 3.46% across sub-regions defined by the World Health Organization. The estimated economic value of DALYs (in constant 2000 US$) lost to child maltreatment in the EAP region totaled US$151 billion, accounting for 1.88% of the region’s GDP. Updated to 2012 dollars, the estimated economic burden totaled US $194 billion. In sensitivity analysis, the aggregate costs as a percentage of GDP range from 1.36% to 2.52%. The economic burden of child maltreatment in the East Asia and Pacific region is substantial, indicating the importance of preventing and responding to child maltreatment in this region. More comprehensive research into the impact of multiple types of childhood adversity on a wider range of putative health outcomes is needed to guide policy and programs for child protection in the region, and globally

Resource flows and levels of spending for the response to HIV and AIDS in Belarus

<p>Abstract</p> <p>Background</p> <p>Belarus has a focused HIV epidemic concentrated among injecting drug users, female sex workers and men who have sex with men. However, until 2008, Belarus had no way of evaluating HIV spending priorities. In 2008, Belarus committed to undertaking a comprehensive National AIDS Spending Assessment (NASA) in order to analyze HIV spending priorities. NASA was used to 'follow the money' from the funding sources to agents and providers, and eventually to beneficiary populations.</p> <p>Findings</p> <p>Belarus spent the majority of its funding on prevention, diagnosis and treatment of sexually transmitted infections and on securing the blood supply. International donors and NGOs working within Belarus spent the majority of their funding on preventative activities for high risk groups while Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) solely funded antiretroviral treatment.</p> <p>Conclusions</p> <p>The data and experience obtained through conducting NASA will help build capacity for future resource tracking activities for HIV and other health priorities. This experience established the foundation for enhanced and future consistent quality-reporting of National Health Accounts. Monitoring the flow of resources for Belarus' HIV response provides valuable strategic information that can improve operations and planning as well as mobilize greater resources. NASA offers Belarusian policy makers an overview of HIV activities that merit their priority attention. In addition, the findings from Belarus are particularly relevant for the rest of the Commonwealth of Independent States due to their similar epidemiological profiles and centrally planned systems. The Belarusian government faces future challenges, especially in increasing public investments in HIV prevention for female sex workers and their clients, men who have sex with men, and among intravenous drug users.</p

Human resource management in the Georgian National Immunization Program: a baseline assessment

Background: Georgia's health care system underwent dramatic reform after gaining independence in 1991. The decentralization of the health care system was one of the core elements of health care reform but reports suggest that human resource management issues were overlooked. The Georgian national immunization program was affected by these reforms and is not functioning at optimum levels. This paper describes the state of human resource management practices within the Georgian national immunization program in late 2004. Methods: Thirty districts were selected for the study. Within these districts, 392 providers and thirty immunization managers participated in the study. Survey questionnaires were administered through face-to-face interviews to immunization managers and a mail survey was administered to immunization providers. Qualitative data collection involved four focus groups. Analysis of variance (ANOVA) and Chi-square tests were used to test for differences between groups for continuous and categorical variables. Content analysis identified main themes within the focus groups. Results: Weak administrative links exist between the Centres of Public Health (CPH) and Primary Health Care (PHC) health facilities. There is a lack of clear management guidelines and only 49.6% of all health providers had written job descriptions. A common concern among all respondents was the extremely inadequate salary. Managers cited lack of authority and poor knowledge and skills in human resource management. Lack of resources and infrastructure were identified as major barriers to improving immunization. Conclusion: Our study found that the National Immunization Program in Georgia was characterized by weak organizational structure and processes and a lack of knowledge and skills in management and supervision, especially at peripheral levels. The development of the skills and processes of a well-managed workforce may help improve immunization rates, facilitate successful implementation of remaining health care reforms and is an overall, wise investment. However, reforms at strategic policy levels and across sectors will be necessary to address the systemic financial and health system constraints impeding the performance of the immunization program and the health care system as a whole

Equity in health and healthcare in Malawi: analysis of trends

<p>Abstract</p> <p>Background</p> <p>Growing scientific evidence points to the pervasiveness of inequities in health and health care and the persistence of the <it>inverse care law</it>, that is the availability of good quality healthcare seems to be inversely related to the need for it in developing countries. Achievement of the Millennium Development Goals is likely to be compromised if inequities in health/healthcare are not properly addressed.</p> <p>Objective</p> <p>This study attempts to assess trends in inequities in selected indicators of health status and health service utilization in Malawi using data from the Demographic and Health Surveys of 1992, 2000 and 2004.</p> <p>Methods</p> <p>Data from Demographic and Health Surveys of 1992, 2000 and 2004 are analysed for inequities in health/healthcare using quintile ratios and concentration curves/indices.</p> <p>Results</p> <p>Overall, the findings indicate that in most of the selected indicators there are pro-rich inequities and that they have been widening during the period under consideration. Furthermore, vertical inequities are observed in the use of interventions (treatment of diarrhoea, ARI among under-five children), in that the non-poor who experience less burden from these diseases receive more of the treatment/interventions, whereas the poor who have a greater proportion of the disease burden use less of the interventions. It is also observed that the publicly provided services for some of the selected interventions (e.g. child delivery) benefit the non-poor more than the poor.</p> <p>Conclusion</p> <p>The widening trend in inequities, in particular healthcare utilization for proven cost-effective interventions is likely to jeopardize the achievement of the Millennium Development Goals and other national and regional targets. To counteract the inequities it is recommended that coverage in poor communities be increased through appropriate targeting mechanisms and effective service delivery strategies. There is also a need for studies to identify which service delivery mechanisms are effective in the Malawian context.</p