Multidimensional poverty and COVID-19 in Latin America and the Caribbean : recent trends and the route ahead

The briefing presents levels of multidimensional poverty in the Latin America and Caribbean (LAC) region according to the Global Multidimensional Poverty Index (MPI, 2020). The MPI reflects deprivations of those unable to reach minimum standards in health, education and income. Results show that the experience of acute poverty in LAC is heterogeneous. In terms of population groups, children and older adults are still most likely to live in poverty. The COVID-19 pandemic will reverse progress in poverty reduction worldwide, with expected setbacks of three to nine years. Haiti, Guatemala, Honduras, and Nicaragua have the largest percentage of populations who are at risk or high risk from the pandemic

Multidimensional poverty and disability: A case control study in India, Cameroon, and Guatemala.

Although the association between disability and multidimensional poverty has been consistently found in several studies in Low- and Middle-Income Countries. None of these studies so far has used an extended and internationally comparable questionnaire (extended Washington Group Questionnaire) and a clinical screening of disability. The purpose of this article is to calculate, compare and analyse the levels of multidimensional poverty of people with and without disabilities in Guatemala (national), in one district of Cameroon (Fundong Health District, North West Cameroon) and in one district in India (Mahbubnagar District, Telangana State). We used a case-control study approach; adults with disabilities identified in a population-based disability survey using the Washington Group Extended Questionnaire were matched to age-sex matched controls without disabilities and interviewed about their levels of access and use of different social services. Following the Alkire-Foster method, the levels of multidimensional poverty between cases and control were computed and compared. Additionally, we analysed how disability and other individual characteristics are associated with being poor in each country. The results showed that people with disabilities in all three-study settings face significantly higher levels of poverty and the intensity of their poverty is higher. In the case of Cameroon, differences in the levels of deprivation between people with and without disabilities were smaller than those observed in India and Guatemala. This might suggest that in countries with higher levels of human, economic and social development people with disabilities are being left behind by public policies aiming to reduce poverty and deprivation in basic indicators. In addition, indicators related to health contributed the most to the levels of multidimensional poverty for people with disabilities. These findings provide important evidence about the association of multidimensional poverty and disability and underline the importance of including indicators capturing individual deprivations to analyse poverty for this group

Entrevista a Elina Scheja

Versión en inglés disponible en la Biblioteca Digital del IDR

Mapping mental health care services for children and youth population in Colombia’s Pacific:potential for boundary spanning between community and formal services

Background: Conflict and violence can impact on the mental health of children and young people, who are in a crucial stage of their personal growth. Not much is known about the provision of mental health care to young people in conflict-affected areas. Community-based care can be essential, as state-led services are often scarce in conflict contexts, like Colombia’s Pacific region where this research was conducted. According to the WHO, such care is ideally provided in the form of a network of interconnected services, offered by different actors beyond the formal health sector. This article describes the relationship between the formal and community mental health systems in Colombia’s Pacific region, and identifies ways of improving their interaction.Methods: Qualitative data were collected through 98 semi-structured interviews with community organisations, schools, international organisations and state institutions. These interviews aimed to identify the strategies used to promote young people’s mental health and the interactions between the different providers. Boundary spanning theory was used to analyse how different actors and forms of mental health care provision could coordinate better.Results: Community organisations and schools use a wide array of strategies to attend to the mental health of children and young people, often of a collective and psychosocial nature. State institutions offer more clinically focused strategies, which are however limited in terms of accessibility and continuity. International organisations aim to strengthen state capacity, but often struggle due to high staff turnover. Although mental health care pathways exist, their effectiveness is limited due to ineffective coordination between actors.Conclusions: To make sure that the variety of strategies to improve young people’s mental health effectively reach their beneficiaries, better coordination is needed between the different actors. Mental health care pathways should therefore integrate community organisations, while community connectors can help to manage the coordination between different actors and forms of clinical and psychosocial support

Special : multidimensional measures during the covid-19 pandemic

These articles are drawn from a high-level online Side Event at the 75th UN General Assembly September (2020) entitled 'Poverty at a Crossroads: Using Leadership and the Multidimensional Poverty Indices to Build Back Better.' Some dimensions of poverty measured by MPI are: resources; choice; power and voice; and human security. This framework embraces complexity, allowing theories of change to be developed in order to break siloed divisions and poverty traps. As the pandemic continues to rage through many parts of the planet, the session evoked powerful messages of reflection, leadership, collaboration and hope

Water Quality for Human Consumption in Rural Supply Systems in Boyacá, Colombia. An Infrastructural Analysis

Objetivo: Analizar la asociación entre la infraestructura de los sistemas de abastecimiento rurales de Boyacá y la calidad del agua de consumo humano distribuida durante el año 2016.Materiales y métodos: Análisis observacional retrospectivo de datos secundarios de variables independientes en infraestructura de 288 sistemas de abastecimiento rurales, empleando estadísticos descriptivos, bivariados y multivariados, en relación con variable dependiente de calidad de agua de consumo humano nombrada CAT.Resultados: no contar con un sistema de tratamiento reduce en 0,2 (IC 95% 0,05 - 0,72) los chances de cumplir con CAT en comparación con tener un tratamiento. Así mismo, si un acueducto controla la eficiencia de los procesos de potabilización se incrementan en 4,2 (IC 95% 1,16 - 15,25) chances de no superar CAT, en comparación con los sistemas que no realizan esta actividad operativa.Conclusión: El abastecimiento de agua no segura en las áreas rurales de Boyacá se asocia con la falta de infraestructura de potabilización y el control de la eficiencia de las unidades de potabilización como actividad rutinaria operativa. Estas variables se relacionan con la presencia de Escherichia coli y coliformes en el agua de consumo de estas comunidades.Objective: To analyze the association between the infrastructure of rural supply systems of Boyacá and the quality of water for human consumption distributed during 2016. Materials and methods: Retrospective descriptive analysis of secondary data of independent variables in infrastructure of 288 rural supply systems, using descriptive, bivariate and multivariate statistics in relation to the dependent variable of water quality for human consumption named CAT. Results: not having a treatment system reduces in 0.2 (95% CI 0.05 - 0.72) the chances of complying with CAT compared to having a treatment. Likewise, if an aqueduct controls the efficiency of the purification processes, they increase in 4.2 (95% CI 1.16 - 15.25) chances of not exceeding CAT, in comparison with systems that do not perform this operational activity. Conclusion: The unsafe water supply in the rural areas of Boyacá is associated with the lack of potable water infrastructure and the control of the efficiency of the purification units as a routine operational activity. These variables are related to the presence of Escherichia coli and coliforms in the drinking water of these communities. Key words: Drinking Water, Water Supply, Rural Population and Risk factors, Escherichia coli y Coliforms

Legislation on Disability and Employment: To What Extent Are Employment Rights Guaranteed for Persons with Disabilities?

Although the Convention on the Rights of Persons with Disabilities guarantees the right to employment and most countries in Latin America have signed and ratified the Convention, a large proportion of the population with disabilities still does not participate in the labour market. (1) Objective: The objective of this research was to understand how legislation in seven Latin American countries (Bolivia, Costa Rica, Chile, Colombia, Ecuador, Mexico, and Peru) has defined and enabled the inclusion of people with disabilities in the labour market. (2) Methods: We conducted a thematic analysis of the content of 34 documents and generated two thematic networks that summarise the results of the thematic analysis and represent the general relationships between the categories of analysis in each country. Using this information, we analysed the differences between countries and the advance in their legislation to fulfil the recommendations made by the Convention. (3) Results: Although all countries have enacted legislation promoting the employment rights of persons with disabilities, six of the seven countries (except Chile) have applied a medical perspective to the definition of disability in their labour legislation, thus imposing a barrier to the labour-market inclusion of this population and perpetuating the association of disability with lack of capacity to work

Tipología de experiencias en la Transferencia-Intercambio-Diálogo (TID) de conocimientos en salud materna y perinatal: un enfoque intercultural

Introducción: En el año 2000, los líderes de 189 países se unieron en las Naciones Unidas para formular los Objetivos del Desarrollo del Milenio (ODM) con el fin de combatir la pobreza en sus múltiples dimensiones.Sin embargo, para el 2017 los avances de dichas metas no fueron los esperados, registrándose una Razón de Mortalidad Materna (RMM) en Colombia de 51 muertes maternas por 100.000 nacidos vivos, siendo esta mayor en mujeres vulnerables y aquellas que viven en áreas dispersas. Objetivo: caracterizar las distintas tipologías de experiencias existentes que describen las formas de relación (el continuo transferencia-intercambio-diálogo) entre saberes tradicionales y saberes institucionales para la atención de la salud materno-perinatal en Chocó, Guajira y Cesar con el fin de marcar un primer momento y ser un insumo primordial para la puesta en marcha de la propuesta piloto de dicho objetivo. Metodología: Análisis descriptivo, de revisión primaria y secundaria de datos con enfoque participativo e interpretativo para la construcción de un marco y propuesta para el intercambio y transferencia de conocimientos y experiencias entre saberes comunitarios y profesionales sobre atención materno-perinatal. Discusión: La medicina occidental/biomedicina al igual que la medicina tradicional tienen como objetivo que sus prácticas y cuidados estén dirigidos a la búsqueda del bienestar de las comunidades. La búsqueda de una disminución en la brecha de ambos mundos, no busca que los médicos occidentales se vuelvan expertos en partería y viceversa; sino que se busca que trabajen en conjunto y se reconozca la importancia de la medicina tradicional y la partería en las zonas rurales de nuestro país. Este proyecto, demostró que existen una variedad de barreras y limitaciones para la posibilidad de que se de una adecuada transferencia-intercambio-diálogo de conocimientos entre ambos mundos, pero también demostró que existen oportunidades para ir abriendo puertas y posibilidadesIntroduction: In 2000, the leaders of 189 countries joined the United Nations to formulate the Millennium Development Goals (MDGs) in order to combat poverty in its multiple dimensions. These goals were not as expected, registering a Maternal Mortality Ratio (MMR) in Colombia of 51 maternal deaths per 100,000 live births, this being higher in vulnerable women and those who live in dispersed areas. Objective: to characterize the different typologies of existing experiences that describe the forms of relationship (the continuous transfer-exchange-dialogue) between traditional knowledge and institutional knowledge for maternal-perinatal health care in Chocó, Guajira and Cesar in order to mark a first moment and be a primary input for the implementation of the pilot proposal of said objective. Methodology: Descriptive analysis, primary and secondary review of data with a participatory and interpretive approach for the construction of a framework and proposal for the exchange and transfer of knowledge and experiences between community knowledge and professionals on maternal-perinatal care. Discusion:Western medicine / biomedicine as well as traditional medicine have the objective that their practices and care are directed to the search for the well-being of the communities. The search for a decrease in the gap of both worlds, does not look for western doctors to become experts in midwifery and vice versa; rather, it is intended that they work together and the importance of traditional medicine and midwifery in rural areas of our country is recognized. This project demonstrated that there are a variety of barriers and limitations for the possibility of an adequate transfer-exchange-dialogue of knowledge between both worlds, but it also demonstrated that there are opportunities to open doors and possibilities.Magíster en EpidemiologíaMaestrí

Economic evaluation of Tacrolimus and Hydrocortisone in acute flare of atopic dermatitis

Introduction: Atopic dermatitis (AD) is a chronic, remitting-relapsing, and inflammatory dermatosis. It occurs in patients of all ages, with a peak in children and young adults. Immunomodulator treatment improves the quality of life by reducing the intensity and frequency of symptomatic periods, number of physician visits, and cost of the treatment for patients and the health system. Methodology: A cost-effectiveness analysis, comparing tacrolimus and hydrocortisone butyrate 1% to treat an acute flare of moderate to severe AD in Colombia for patients aged two years or older. A decision tree model was designed in this analysis, and we used a health system perspective and evaluated only direct costs, during 2019. Results: The treatment of a symptomatic exacerbation episode of moderate to severe AD is cost-effective with tacrolimus compared to hydrocortisone. Discussion: tacrolimus is dominant and can be cost-saving because its use reduces complications and adverse events that increase treatment costs. Conclusion: The use of tacrolimus will benefit both patients and the health care system