The standard of living in Latin America during the twentieth century

New and consistent series for Latin American real incomes, life expectancy and adult literacy over the twentieth century reveal that living standards rose most rapidly between the nineteen-thirties and -seventies, a period characterised by increased state intervention and reduced trade openness. Within the region, Brazil and Mexico advanced most over the century as a whole despite the early start made by Argentina and Chile, although convergence between larger countries was accompanied by divergence from smaller ones. There was no sustained narrowing of the income gap with the US at all between 1900 and 2000 but some convergence in living standards due to improved life expectancy. Our new estimates of regional per capita income also permit a clearer comparison with both Europe and Asia. The major advances in living standards achieved in the middle decades of the century were closely related to early industrialisation, rapid urbanisation and the extension of primary health and education. Subsequent economic volatility and fiscal fragility limited further increases in living standards, undermining social consensus on development strategy

Implementation of cervical cancer screening using visual inspection with acetic acid in rural Mozambique: successes and challenges using HIV care and treatment programme investments in Zambézia Province

Background: In order to maximize the benefits of HIV care and treatment investments in sub-Saharan Africa, programs can broaden to target other diseases amenable to screening and efficient management. We nested cervical cancer screening into family planning clinics at select sites also receiving PEPFAR support for antiretroviral therapy (ART) rollout. This was done using visual inspection with acetic acid (VIA) by maternal child health nurses. We report on achievements and obstacles in the first year of the program in rural Mozambique. Methods: VIA was taught to clinic nurses and hospital physicians, with a regular clinical feedback loop for quality evaluation and retraining. Cryotherapy using carbon dioxide as the refrigerant was provided at clinics; loop electrosurgical excision procedure (LEEP) and surgery were provided at the provincial hospital for serious cases. No pathology services were available. Results: Nurses screened 4651 women using VIA in Zambézia Province in year one of the program, more than double the Ministry of Health service target. VIA was judged positive for squamous intraepithelial lesions in 8% (n=380) of the women (9% if age ≥30 years (n=3154) and 7% if age <30 years (n=1497); p=0.02). Of the 380 VIA-positive women, 4% (n=16) had lesions (0.3% of 4651 total screened) requiring referral to Quelimane Provincial Hospital. Fourteen (88%) of these 16 women were seen at the hospital, but records were inadequate to judge outcomes. Of women screened, 2714 (58%) either had knowledge of their HIV status prior to VIA or were subsequently sent for HIV testing, of which 583 (21%) were HIV positive. Conclusions: Screening and clinical services were successfully provided on a large scale for the first time ever in these rural clinics. However, health manpower shortages, equipment problems, poor paper record systems and a limited ability to follow-up patients inhibited the quality of the cervical cancer screening services. Using prior HIV investments, chronic disease screening and management for cervical cancer is feasible even in severely resource-constrained rural Africa